FORM 1023-EZ for MY DIABETES LIFESTYLE CENTER INC

Field Data
EIN 47-1761539
Case Number EO-2014328-000091
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MY DIABETES LIFESTYLE CENTER INC
Organization’s Mailing Address 21216 OLEAN BOULEVARD STE 6
City PORT CHARLOTTE
State FL
ZIP 33952
Accounting period End 12
Primary contact name ASTON HANSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LENITA HANSON
PRESIDENT
21216 OLEAN BOULEVARD STE 6
PORT CHARLOTTE FL 33952

Officer/Director/Trustee Two

MATTHEW CHASE
SECRETARY
1401 TAMIAMI TRAIL
PUNTA GORDA FL 33950

Officer/Director/Trustee Three

ASTON HANSON
TREASURER
21216 OLEAN BOULEVARD STE 6
PORT CHARLOTTE FL 33952

Officer/Director/Trustee Four

JENNIFER COLLINS
VICE PRESIDENT
21216 OLEAN BOULEVARD STE 6
PORT CHARLOTTE FL 33952

Organization’s website
Organization’s email ASTON2491@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/4/2014
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G02 - Management & Technical Assistance
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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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