FORM 1023-EZ for ANTHEM SERVICE DOGS INC

Field Data
EIN 83-1076191
Case Number EO-2018225-000485
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ANTHEM SERVICE DOGS INC
Organization’s Mailing Address 4109 N NARCISSUS AVE
City BROKEN ARROW
State OK
ZIP 74012
Accounting period End 12
Primary contact name J DANIEL BEIRUTE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATE FRIEDL
PRESIDENT DIRECTOR
4109 N NARCISSUS AVE
TULSA OK 74012

Officer/Director/Trustee Two

RYAN FRIEDL
VICE-PRESIDENT DIRECTOR
4109 N NARCISSUS AVE
TULSA OK 74012

Officer/Director/Trustee Three

TERRI WOODWORTH
SECRETARY DIRECTOR
24035 S 395 RD
FORT GIBSON OK 74434

Officer/Director/Trustee Four

DEB SCHIDNER
TREASURER DIRECTOR
3316 88TH E AVE
TULSA OK 74145

Organization’s website WWW.ANTHEMSERVICEDOGS.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/28/18
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D61 - Animal Training, Behavior
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 Yes
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 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 KATE FRIEDL
Signature Title PRESIDENT DIRECTOR
Signature Date 8/10/18

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