FORM 1023-EZ for HESTIA RX-ASSIST INC

Field Data
EIN 83-3628680
Case Number EO-2019056-000609
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HESTIA RX-ASSIST INC
Organization’s Mailing Address 5401 N PORTLAND AVENUE SUITE 206
City OKLAHOMA CITY
State OK
ZIP 73112
Accounting period End 12
Primary contact name T HERD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TAMMY HERD
EXECUTIVE DIRECTOR/PRES
2107 THREE STARS RD
EDMOND OK 73034

Officer/Director/Trustee Two

LINDA STAMPS
OUTREACH DIRECTOR/VP
1016 HARRISON NW
PIEDMONT OK 73078

Officer/Director/Trustee Three

KRISTY WARD
INSURANCE DIREC/TREASURER
14108NW 124TH ST
YUKON OK 73099

Officer/Director/Trustee Four

CYNTHIA WATSON
CLINIC DIRECTOR/SECRETARY
10908 WOODBRIDGE RD
OKLAHOMA CITY OK 73008

Officer/Director/Trustee Five

VICKI LIPPOLDT
PAP MANAGER/OFFICER
1016 HARRISON NW
PIEDMONT OK 73078

Organization’s website
Organization’s email INFO@HESTIA-RX.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/20/19
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name TAMMY HERD
Signature Title EXECUTIVE DIRECTOR/PRES
Signature Date 2/22/19

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