FORM 1023-EZ for MEDIFA EMPOWERMENT INC

Field Data
EIN 81-5432967
Case Number EO-2017093-000463
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MEDIFA EMPOWERMENT INC
Organization’s Mailing Address PO BOX 89
City FAIRPLAY
State CO
ZIP 80440
Accounting period End 3
Primary contact name GEORGE J CESSNA JR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROSELYNE TETEE
PRESIDENT DIRECTOR
PO BOX 53111-00200
NAIROBI CO 80440

Officer/Director/Trustee Two

GEORGE J CESSNA
VICE PRESIDENT DIRECTOR
931 BLUE STEM WAY
FAIRPLAY CO 80440

Officer/Director/Trustee Three

STEPHEN MAIRORI
DIRECTOR
PO BOX 53111-00200
NAIROBI

Officer/Director/Trustee Four

EDWIN KIGEN
DIRECTOR
119 WATER GATE DR
LYNCHBURG VA 24502-2419

Officer/Director/Trustee Five

SUSIE KASPER
TREASURER DIRECTOR
346 QUARRY RD
FAIRPLAY CO 80440

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/2017
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds No
Conducting Activities Outside of United States Yes
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
Signature Title
Signature Date

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