FORM 1023-EZ for COMMUNITY LEARNING INITIATIVE INC

Field Data
EIN 83-4642136
Case Number EO-2019210-000533
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY LEARNING INITIATIVE INC
Organization’s Mailing Address 5 FIELDS LANE
City WAYLAND
State MA
ZIP 1778
Accounting period End 12
Primary contact name SAMUEL OPOKU-AGYEMANG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SAMUEL OPOKU-AGYEMANG
DIRECTOR, PRESIDENT, SECRETARY
5 FIELDS LANE
WAYLAND MA 1778

Officer/Director/Trustee Two

ADAM KROTMAN
DIRECTOR
6530 GREENWOOD AVENUE N
SEATTLE WA 98103

Officer/Director/Trustee Three

ELLEN TOHN
DIRECTOR
5 FIELDS LANE
WAYLAND MA 1778

Officer/Director/Trustee Four

SENA KATAKO
DIRECTOR, TREASURER
424 WHITON ST
JERSEY CITY NJ 7304

Organization’s website
Organization’s email COMMUNITYLEARNINGINITIATIVE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/29/19
Organization Incorporation State DE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B70 - Libraries
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
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 SAMUEL OPOKU-AGYEMANG
Signature Title DIRECTOR, PRESIDENT, SECRETARY
Signature Date 7/27/19

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