FORM 1023-EZ for DAVID SAMUEL FILLERS MEMORIAL SCHOLARSHIP FUND INC

Field Data
EIN 82-1446876
Case Number EO-2017130-000403
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DAVID SAMUEL FILLERS MEMORIAL SCHOLARSHIP FUND INC
Organization’s Mailing Address 94 ROCK ROAD
City VESTAL
State NY
ZIP 13850
Accounting period End 12
Primary contact name THOMAS A CONLON JR ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANN SERBONICH
SECRETARY AND DIRECTOR
94 ROCK ROAD
VESTAL NY 13850

Officer/Director/Trustee Two

ANDREW FILLERS
VICE PRESIDENT AND DIRECTOR
431 S CODY COURT
LAKEWOOD CO 80226

Officer/Director/Trustee Three

JONATHAN FILLERS
PRESIDENT AND DIRECTOR
18 BOLAND ROAD
BINGHAMTON NY 13905

Officer/Director/Trustee Four

MICHAEL FILLERS
TREASURER AND DIRECTOR
18 BOLAND ROAD
BINGHAMTON NY 13905

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/27/2017
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 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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