FORM 1023-EZ for 321 COFFEE

Field Data
EIN 82-3946809
Case Number EO-2018205-000122
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name 321 COFFEE
Organization’s Mailing Address CAMPUS BOS 7295 NC STATE UNIVERSITY
City RALEIGH
State NC
ZIP 27695-7295
Accounting period End 7
Primary contact name ELISE ROMOLA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LINDSAY WREGE
CHIEF EXECUTIVE OFFICER
105 GOLDENTHAL CT
CARY NC 27519

Officer/Director/Trustee Two

ELISE ROMOLA
CHIEF OPERATING OFFICER
21392 CHICKACOAN TRAIL DR
ASHBURN VA 20148

Officer/Director/Trustee Three

MICHAEL EVANS
CHIEF FINANCIAL OFFICER
745 CONESTOGA RD
BERWYN PA 19312

Officer/Director/Trustee Four

GREG GERMAIN
ADVISOR
103 REINHOLD LANE
CARY NC 27513

Organization’s website WWW.321COFFEE.COM/
Organization’s email 321COFFEENCSU@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/10/18
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K99 - Food, Agriculture, and Nutrition N.E.C.
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 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 ELISE ROMOLA
Signature Title CHIEF OPERATING OFFICER
Signature Date 7/22/18

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