FORM 1023-EZ for MEDI-STAT INC
| Field | Data |
|---|---|
| EIN | 85-1011357 |
| Case Number | EO-2021064-000671 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | MEDI-STAT INC |
| Organization’s Mailing Address | 412 CAPRICORN ST |
| City | CEDAR HILL |
| State | TX |
| ZIP | 75104 |
| Accounting period End | 5 |
| Primary contact name | CAROL PENA |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
CAROL PENA
OWNER
412 CAPRICORN ST
CEDAR HILL TX 75104
Officer/Director/Trustee Two
KATHY GOODMAN
SECRETARY
5 ATLANTIC AVE
MIDLOTHIAN TX 76065
Officer/Director/Trustee Three
IVA EDWARDS
TREASURY
4599 W DAVIS ST APT 613
DALLAS TX 75211
| Organization’s website | MEDISTATMEDICAL.ORG |
|---|---|
| Organization’s email | MEDISTATSTAFF1@YAHOO.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 4/12/2019 |
| Organization Incorporation State | TX |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E32 - Ambulatory Health Center, Community Clinic |
| Organization’s purpose | Charitable: Yes Religious: No Educational: No Scientific: No Literary: No Public Safety: Yes Amateur Sports: No Cruelty Prevention: No |
| Qualify For Exemption | No |
| Legislation influence | No |
| Compensation of Officer director trustee | No |
| Donation of funds | No |
| Conducting Activities Outside of United States | No |
| Financial transactions with officers | No |
| Unrelated Gross Income $1,000 or More | No |
| Gaming Activity | No |
| Disaster relief assistance | No |
| One Third Support Public | No |
| One Third Support Gifts | Yes |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | CAROL PENA |
| Signature Title | OWNER |
| Signature Date | 1/5/2021 |
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