ARDEN HEIGHTS-BOULEVARD JEWISH CENTER

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-07-16
Business code	813000
Sponsor’s telephone number	7189486782
Plan sponsor’s address	1766 ARTHUR KILL RD, STATEN ISLAND, NY, 103121356

Signature of

Role	Plan administrator
Date	2016-09-11
Name of individual signing	CRAIG JARVIS
Role	Employer/plan sponsor
Date	2016-09-11
Name of individual signing	CRAIG JARVIS

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-07-16
Business code	813000
Sponsor’s telephone number	7189486782
Plan sponsor’s address	1766 ARTHUR KILL RD, STATEN ISLAND, NY, 103121356

Signature of

Role	Plan administrator
Date	2017-01-24
Name of individual signing	CRAIG JARVIS
Role	Employer/plan sponsor
Date	2017-01-24
Name of individual signing	CRAIG JARVIS

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-07-16
Business code	813000
Sponsor’s telephone number	7189486782
Plan sponsor’s address	1766 ARTHUR KILL RD, STATEN ISLAND, NY, 103121356

Signature of

Role	Plan administrator
Date	2015-09-22
Name of individual signing	CRAIG JARVIS
Role	Employer/plan sponsor
Date	2015-09-22
Name of individual signing	CRAIG JARVIS

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-07-16
Business code	813000
Sponsor’s telephone number	7189486782
Plan sponsor’s address	1766 ARTHUR KILL RD, STATEN ISLAND, NY, 103121356

Signature of

Role	Plan administrator
Date	2014-05-25
Name of individual signing	CRAIG JARVIS
Role	Employer/plan sponsor
Date	2014-05-25
Name of individual signing	CRAIG JARVIS

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-07-16
Business code	813000
Sponsor’s telephone number	7189486782
Plan sponsor’s address	1766 ARTHUR KILL RD, STATEN ISLAND, NY, 103121356

Signature of

Role	Plan administrator
Date	2013-05-26
Name of individual signing	CRAIG JARVIS
Role	Employer/plan sponsor
Date	2013-05-26
Name of individual signing	CRAIG JARVIS

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-07-16
Business code	813000
Sponsor’s telephone number	7189486782
Plan sponsor’s address	1766 ARTHUR KILL RD, STATEN ISLAND, NY, 103121356

Plan administrator’s name and address

Administrator’s EIN	237325106
Plan administrator’s name	ARDEN HEIGHTS BOULEVARD JEWISH CENTER
Plan administrator’s address	1766 ARTHUR KILL RD, STATEN ISLAND, NY, 103121356
Administrator’s telephone number	7189486782

Signature of

Role	Plan administrator
Date	2012-06-03
Name of individual signing	CRAIG JARVIS
Role	Employer/plan sponsor
Date	2012-06-03
Name of individual signing	CRAIG JARVIS

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-07-16
Business code	813000
Sponsor’s telephone number	7189486782
Plan sponsor’s address	1766 ARTHUR KILL RD, STATEN ISLAND, NY, 103121356

Plan administrator’s name and address

Administrator’s EIN	237325106
Plan administrator’s name	ARDEN HEIGHTS BOULEVARD JEWISH CENTER
Plan administrator’s address	1766 ARTHUR KILL RD, STATEN ISLAND, NY, 103121356
Administrator’s telephone number	7189486782

Signature of

Role	Plan administrator
Date	2011-06-30
Name of individual signing	CRAIG JARVIS
Role	Employer/plan sponsor
Date	2011-06-30
Name of individual signing	CRAIG JARVIS

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2006-07-16
Business code	813000
Sponsor’s telephone number	7189486782
Plan sponsor’s address	1766 ARTHUR KILL RD, STATEN ISLAND, NY, 103121356

Plan administrator’s name and address

Administrator’s EIN	237325106
Plan administrator’s name	ARDEN HEIGHTS BOULEVARD JEWISH CENTER
Plan administrator’s address	1766 ARTHUR KILL RD, STATEN ISLAND, NY, 103121356
Administrator’s telephone number	7189486782

Signature of

Role	Plan administrator
Date	2010-05-30
Name of individual signing	CRAIG JARVIS
Role	Employer/plan sponsor
Date	2010-05-30
Name of individual signing	CRAIG JARVIS

In Care of Name	-
Group Exemption Number	0000
Subsection	Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation	Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification	Religious Organization
Deductibility	Contributions are deductible.
Foundation	Church 170(b)(1)(A)(i)
Tax Period	-
Asset	0
Income	0
Filing Requirement	990 - Not required to file (church)
PF Filing Requirement	No 990-PF return
Accounting Period	Jun
Asset Amount	-
Income Amount	-
Form 990 Revenue Amount	-
National Taxonomy of Exempt Entities	-
Sort Name	-

Publication 78 Data

Description	Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List	Yes
Deductibility	Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)