FORM 1023-EZ for POTLUCK RX ORGANIC HEALTH INC

Field Data
EIN 85-1252748
Case Number EO-2020157-000247
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POTLUCK RX ORGANIC HEALTH INC
Organization’s Mailing Address 7140 LAS VISTAS DRIVE
City LAS CRUCES
State NM
ZIP 88005
Accounting period End 12
Primary contact name GEOFFREY LEWIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LISA LEWIS
PRESIDENT
7140 LAS VISTAS DRIVE
LAS CRUCES NM 88005

Officer/Director/Trustee Two

CYNTHIA RODIGUEZ
VICE PRESIDENT
3085 ECLIPSE RIDGE LANE
LAS CRUCES NM 88004

Officer/Director/Trustee Three

JOSE GARCIA
BOARD MEMBER
3085 ECLIPSE RIDGE LANE
LAS CRUCES NM 88004

Officer/Director/Trustee Four

DR CYNTHIA CLAUSON
BOARD MEMBER
11510 E 24TH
SPOKANE WA 99206

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/28/2020
Organization Incorporation State NM
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E80 - Health, General and Financing
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: Yes
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 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 LISA LEWIS
Signature Title PRESIDENT
Signature Date 6/3/2020

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