FORM 1023-EZ for PURPOSE DRIVEN INC

Field Data
EIN 81-0830766
Case Number EO-2016039-000071
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PURPOSE DRIVEN INC
Organization’s Mailing Address 1501 TEAKWOOD CT
City FORT COLLINS
State CO
ZIP 80525-9647
Accounting period End 12
Primary contact name MARY BUSCH-EXECUTIVE DIRECTOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JASON MUELLER
PRESIDENT
3130 LAKE DR
LOVELAND CO 80538-9998

Officer/Director/Trustee Two

MARY JO LARSEN
VICE PRESIDENT
1814 INDIAN MEADOWS LN
FORT COLLINS CO 80525-9647

Officer/Director/Trustee Three

MELODY LIDMILA
SECRETARY/TREASURER
1208 BRISTLECONE PL
LOVELAND CO 80538-9998

Officer/Director/Trustee Four

MARY BUSCH
EXECUTIVE DIRECTOR-NON-VOTING
1501 TEAKWOOD CT
FORT COLLINS CO 80525-9647

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/3/2015
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 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
Signature Title
Signature Date

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