FORM 1023-EZ for THE DERSE LEVIN FOUNDATION

Field Data
EIN 82-2531840
Case Number EO-2017284-000284
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE DERSE LEVIN FOUNDATION
Organization’s Mailing Address 6825 E TENNESSEE AVE SUITE 621
City DENVER
State CO
ZIP 80224
Accounting period End 12
Primary contact name JENNIFER DERSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER DERSE
PRESIDENT AND DIRECTOR
6825 E TENNESSEE AVE
DENVER CO 80224

Officer/Director/Trustee Two

BRETT LEVIN
VICE PRESIDENT AND DIRECTOR
6825 E TENNESSEE AVE
DENVER CO 80224

Officer/Director/Trustee Three

ADAM JURY
SECRETARY AND DIRECTOR
6825 E TENNESSEE AVE
DENVER CO 80224

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/18/2017
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 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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