FORM 1023-EZ for SAM CARE

Field Data
EIN 86-2526324
Case Number EO-2021096-001513
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SAM CARE
Organization’s Mailing Address 13198 MEADOW LANE
City SAVAGE
State MN
ZIP 55378
Accounting period End 12
Primary contact name KEILLEN CURTIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HALIMA MAHAMUD
BOARD CHAIR
15423 MARYLAND AVENUE
SAVAGE MN 55378

Officer/Director/Trustee Two

RAHMO AHMED
BOARD DIRECTOR
14268 IRVING AVENUE S 149
BURNSVILLE MN 55306

Officer/Director/Trustee Three

AMINA HERSI
BOARD DIRECTOR
4206 WEST 141 STREET
SAVAGE MN 55378

Officer/Director/Trustee Four

FOSIYA ELMI
BOARD DIRECTOR
630 CEDAR AVENUE
MINNEAPOLIS MN 55454

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/10/2021
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
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 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 HALIMA MAHAMUD
Signature Title BOARD CHAIR
Signature Date 3/10/2021

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