FORM 1023-EZ for TROLLWAY DIABETES INCORPORATED

Field Data
EIN 87-2035160
Case Number EO-2021224-000216
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TROLLWAY DIABETES INCORPORATED
Organization’s Mailing Address 640 S 1ST ST
City MOUNT HOREB
State WI
ZIP 53572-2462
Accounting period End 12
Primary contact name JILL KIETZKE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JILL KIETZKE
DIRECTOR
640 S 1ST ST
MOUNT HOREB WI 53572-2462

Officer/Director/Trustee Two

ROBERT KIETZKE
DIRECTOR
803 NORSK RIDGE
MOUNT HOREB WI 53572-2462

Officer/Director/Trustee Three

KARI CATALDO
DIRECTOR
304 WESTRIDGE PARKWAY
VERONA WI 53593

Officer/Director/Trustee Four

GREGORY CLARK
DIRECTOR
212 STERLING DRIVE
OREGON WI 53575

Organization’s website TROLLWAYDIABETES.ORG
Organization’s email DIABETESRN@TROLLWAYDIABETESCARE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/19/2021
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G99 - Diseases, Disorders, Medical Disciplines N.E.C.
Organization’s purpose Charitable: Yes
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 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 Yes
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 JILL KIETZKE
Signature Title DIRECTOR
Signature Date 8/10/2021

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