FORM 1023-EZ for W W HASTINGS INDIAN HOSPITAL

Field Data
EIN 82-0581688
Case Number EO-2015338-000353
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name W W HASTINGS INDIAN HOSPITAL
Organization’s Mailing Address 100 S BLISS AVE
City TAHLEQUAH
State OK
ZIP 74464
Accounting period End 12
Primary contact name JIMMIE HOLLAND
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

COLLEEN KETCHER
PRESIDENT
671 S VILLAGE DR APT 3
TAHLEQUAH OK 74464

Officer/Director/Trustee Two

ROBERT SOONTAY
VICE PRESIDENT
21152 S FORREST DR
TAHLEQUAH OK 74464

Officer/Director/Trustee Three

ROSE FAUCETT
SECRETARY
301 S BLUFF AVE
TAHLEQUAH OK 74464

Officer/Director/Trustee Four

JIMMIE HOLLAND
TREASURER
PO BOX 102
TAHLEQUAH OK 74465

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/13/2013
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E12 - Fund Raising and/or Fund Distribution
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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