FORM 1023-EZ for ACHOT INC

Field Data
EIN 81-3567333
Case Number EO-2016280-000370
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ACHOT INC
Organization’s Mailing Address 25118 189TH STREET
City BETTENDORF
State IA
ZIP 52722
Accounting period End 12
Primary contact name JEFFREY D JACOBS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JACKI GUINN
DIRECTOR
25118 189TH STREET
BETTENDORF IA 52722

Officer/Director/Trustee Two

MINDY KRUSE
DIRECTOR
1015 27TH AVENUE COURT
MOLINE IL 61265

Officer/Director/Trustee Three

JENNIFER ROWE
DIRECTOR
PO BOX 549
RAPIDS CITY IL 61278

Officer/Director/Trustee Four

ELIZABETH TINSMAN
DIRECTOR
660 RIVERVIEW TERRACE
BETTENDORF IA 52722

Organization’s website
Organization’s email GUINNJACKIM@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/26/2016
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P60 - Emergency Assistance (Food, Clothing, Cash)
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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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