FORM 1023-EZ for ACHIEVE INC

Field Data
EIN 37-1860566
Case Number EO-2018136-000607
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ACHIEVE INC
Organization’s Mailing Address 16417 CR 325
City BUENA VISTA
State CO
ZIP 81211-9110
Accounting period End 12
Primary contact name JENNIFER DAVIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER DAVIS
DIRECTOR, EXECUTIVE DIRECTOR, TRSR
16417 CR 325
BUENA VISTA CO 81211-9110

Officer/Director/Trustee Two

MICHAEL DILILLO
DIRECTOR AND SECRETARY
16417 CR 325
BUENA VISTA CO 81211-9110

Officer/Director/Trustee Three

MATTEO DILILLO
DIRECTOR
16417 CR 325
BUENA VISTA CO 81211-9110

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/31/17
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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 Yes
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 JENNIFER DAVIS
Signature Title DIRECTOR, EXECUTIVE DIRECTOR, TRSR
Signature Date 5/14/18

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