FORM 1023-EZ for CONTINUOUS IMPROVEMENT LEAN COLLABORATIVE

Field Data
EIN 81-3920440
Case Number EO-2016351-000238
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CONTINUOUS IMPROVEMENT LEAN COLLABORATIVE
Organization’s Mailing Address PO BOX 302
City AUGUSTA
State ME
ZIP 04332-0302
Accounting period End 12
Primary contact name JULITA KLAVINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JULITA KLAVINS
CHAIR, BOARD OF DIRECTORS
100 PURINTON AVE
AUGUSTA ME 04330-4331

Officer/Director/Trustee Two

WALTER LOWELL
VICE-CHAIR, BOARD OF DIRECTORS
19 COLONY DR
AUGSTA ME 04330-6601

Officer/Director/Trustee Three

JOHN RIOUX
SECRETARY, BOARD OF DIRECTORS
55 PEARL ST
AUGUSTA ME 04330-4416

Officer/Director/Trustee Four

JON KIRSCH
BOARD OF DIRECTORS
110 UPLAND RD
LISBON FALLS ME 04252-6104

Officer/Director/Trustee Five

STEPHEN DOMBROWSKI
BOARD OF DIRECTORS
40 DUNCASTER RD
BLOOMFIELD CT 06002-1504

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/9/2016
Organization Incorporation State ME
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B99 - Education N.E.C.
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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