FORM 1023-EZ for LIBERTY MEDICAL CENTER OF TEXAS

Field Data
EIN 83-4358450
Case Number EO-2019121-000242
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIBERTY MEDICAL CENTER OF TEXAS
Organization’s Mailing Address 4420 DICKASON AVE APT 1100
City DALLAS
State TX
ZIP 75219
Accounting period End 12
Primary contact name WILLIAM WIDENER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIAM WIDENER
CO-FOUNDER
APT 3302
HOUSTON TX 77002

Officer/Director/Trustee Two

TOXIE TURNER
CO-FOUNDER
4420 DICKASON AVE APT 1100
DALLAS TX 75219

Officer/Director/Trustee Three

BERTTRAN TURNER
DIRECTOR
2116 MARSH LN APT 1005
CARROLLTON TX 75006

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/10/19
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: No
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name WILLIAM WIDENER
Signature Title CO-FOUNDER
Signature Date 4/29/19

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