FORM 1023-EZ for INCLUSION REVOLUTION INC

Field Data
EIN 84-3132691
Case Number EO-2019345-000293
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name INCLUSION REVOLUTION INC
Organization’s Mailing Address 1415 2ND ST UNIT 506
City SARASOTA
State FL
ZIP 34236
Accounting period End 12
Primary contact name BEVERLEY R SHRIVER III
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BEVERLEY SHRIVER
PREIDENT
1415 2ND ST UNIT 506
SARASOTA FL 34236

Officer/Director/Trustee Two

WILLIAM DANFORTH
TREASURER
112 BUCKINGHAM RD
PITTSBURGH PA 15215

Officer/Director/Trustee Three

CHRISTOPHER CUSHMAN
SECRETARY
2310 MILFORD CR
SARASOTA FL 34239

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/23/2019
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P82 - Developmentally Disabled Centers, 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 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 BEVERLEY SHRIVER
Signature Title PREIDENT
Signature Date 12/9/2019

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