FORM 1023-EZ for LIFESTYLE MEDICINE RESEARCH AND EDUCATION INSTITUTE

Field Data
EIN 84-4619170
Case Number EO-2020093-000140
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIFESTYLE MEDICINE RESEARCH AND EDUCATION INSTITUTE
Organization’s Mailing Address 1151 S ASPEN AVE
City BROKEN ARROW
State OK
ZIP 74012
Accounting period End 12
Primary contact name LINDA DICK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LINDA DICK
PRESIDENT/TREAS/SECRETARY/DIRECTOR
10487 S 86TH E AVE
TULSA OK 74133

Officer/Director/Trustee Two

PERCY BROWN
DIRECTOR
1151 S ASPEN AVE
BROKEN ARROW OK 74012

Officer/Director/Trustee Three

RITA CARBUHN
DIRECTOR
1151 S ASPEN AVE
BROKEN ARROW OK 74012

Organization’s website HTTP://WWW.LIFESTYLEMEDINSTITUTE.COM
Organization’s email DRWENDYDICK@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/2020
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K40 - Nutrition Programs
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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 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 LINDA DICK
Signature Title PRESIDENT/TREAS/SECRETARY/DIRECTOR
Signature Date 3/31/2020

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