FORM 1023-EZ for POSITIVE IMPACT INC

Field Data
EIN 36-4897662
Case Number EO-2018128-000507
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POSITIVE IMPACT INC
Organization’s Mailing Address 1811 W 21ST PLACE SUITE 2
City CHICAGO
State IL
ZIP 60608
Accounting period End 12
Primary contact name ANDREW GRANT HENSEL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREW HENSEL
PRESIDENT, TREASURER, SECRETARY
1811 W 21ST PL UNIT 2
CHICAGO IL 60608

Officer/Director/Trustee Two

CHRIS ANDERSON
BOARD MEMBER
1001 S STATE ST UNIT 2505
CHICAGO IL 60605

Officer/Director/Trustee Three

SHANG LIN
BOARD MEMBER
2647 W LOGAN BLVD
CHICAGO IL 60647

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/17/18
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P01 - Alliance/Advocacy Organizations
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 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 ANDREW HENSEL
Signature Title PRESIDENT, TREASURER, SECRETARY
Signature Date 5/1/18

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