FORM 1023-EZ for 21C4E

Field Data
EIN 47-1871594
Case Number EO-2015020-000219
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name 21C4E
Organization’s Mailing Address 27 WEST ROAD
City TROY
State NY
ZIP 12180
Accounting period End 12
Primary contact name JEAN HOWARD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAVID GAUTSCHI
DIRECTOR
40 LORDS BEACH ROAD
TRENTON ME 04605

Officer/Director/Trustee Two

LEAH ROLLHAUS
DIRECTOR
2621 PALISADE AVE APT 8K
BRONX NY 10463

Officer/Director/Trustee Three

JEAN HOWARD
DIRECTOR
27 WEST ROAD
TROY NY 12180

Officer/Director/Trustee Four

LIZ POHLMANN
DIRECTOR
27 SECOND AVENUE
TROY NY 12180

Organization’s website 21C4E.COM/21C4E.ORG
Organization’s email INFO@21C4E.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/15/2014
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C02 - Management & Technical Assistance
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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