FORM 1023-EZ for IMPACTIVE FOUNDATION

Field Data
EIN 82-3928281
Case Number EO-2018043-000130
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name IMPACTIVE FOUNDATION
Organization’s Mailing Address 738 LONGRIDGE RD
City OAKLAND
State CA
ZIP 94610-2325
Accounting period End 12
Primary contact name LOUIS WILLACY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LOUIS WILLACY
PRESIDENT; DIRECTOR
738 LONGRIDGE RD
OAKLAND CA 94610-2325

Officer/Director/Trustee Two

RAMCESS JEAN-LOUIS
DIRECTOR
134 YEW RD
CHELTENHAM PA 19012-1204

Officer/Director/Trustee Three

EDWIN PHILOGENE
DIRECTOR
1011 SOUTH 46TH ST APT 2
PHILADELPHIA PA 19143-3750

Organization’s website WWW.IMPACTIVE.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/16/17
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 LOUIS WILLACY
Signature Title PRESIDENT; DIRECTOR
Signature Date 2/8/18

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