FORM 1023-EZ for 4 CORNERS DIABETES AND MEDICATION COUNSELING

Field Data
EIN 86-1822672
Case Number EO-2021085-000050
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name 4 CORNERS DIABETES AND MEDICATION COUNSELING
Organization’s Mailing Address 12478 COUNTY ROAD 29
City DOLORES
State CO
ZIP 81323
Accounting period End 1
Primary contact name DAVID KITLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID KITLEY
CHAIRMAN
12478 COUNTY ROAD 29
DOLORES CO 81323

Officer/Director/Trustee Two

CHERYL KITLEY
DIRECTOR
12478 CR 29
DOLORES CO 81323

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/22/2021
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
Organization’s purpose Charitable: No
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 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 DAVID KITLEY
Signature Title CHAIRMAN
Signature Date 2/8/2021

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