FORM 1023-EZ for FRIENDS OF MEDICINE LODGE

Field Data
EIN 46-5279774
Case Number EO-2019280-000233
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FRIENDS OF MEDICINE LODGE
Organization’s Mailing Address PO BOX 12
City HYATTVILLE
State WY
ZIP 82428-12
Accounting period End 12
Primary contact name KRISTI ROBISON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KRISTI ROBISON
PRESIDENT
213 SOUTH MAIN STREET
HYATTVILLE WY 82428

Officer/Director/Trustee Two

CAROL DEITESFELD
TREASURER
10890 W 68TH PLACE
ARVADA CO 80004

Officer/Director/Trustee Three

PAULA FAUTH
SECRETARY
209 RIVER STREET
HYATTVILLE WY 82428

Officer/Director/Trustee Four

KEONNA HERMAN
MEMBER-AT-LARGE
1927 HIGHWAY 31
HYATTVILLE WY 82428

Officer/Director/Trustee Five

NANCY JONES
MEMBER-AT-LARGE
2091 HIGHWAY 31
HYATTVILLE WY 82428

Organization’s website
Organization’s email FRIENDSOFMEDICINELODGE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/30/15
Organization Incorporation State WY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W01 - Alliance/Advocacy Organizations
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 Yes
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 KRISTI ROBISON
Signature Title PRESIDENT
Signature Date 10/3/19

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