FORM 1023-EZ for COLORADO PAIN SOCIETY INC

Field Data
EIN 84-1612314
Case Number EO-2014275-000437
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COLORADO PAIN SOCIETY INC
Organization’s Mailing Address 6950 E BELLEVIEW AVE SUITE 300
City GREENWOOD VILLAGE
State CO
ZIP 80111
Accounting period End 12
Primary contact name DR KEVIN T SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GIANCARLO BAROLAT
PRESIDENT
6950 E BELLEVIEW AVE 300
GREENWOOD VILLAGE CO 80111

Officer/Director/Trustee Two

BRENT DORSTEN
PRESIDENT -ELECT
6950 E BELLEVIEW AVE 300
GREENWOOD VILLAGE CO 80111

Officer/Director/Trustee Three

KEVIN SMITH
TREASURER/SECRETARY
6950 E BELLEVIEW AVE 300
GREENWOOD VILLAGE CO 80111

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/29/2014
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G90 - Medical Disciplines
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 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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