FORM 1023-EZ for FAMILY AND YOUTH SERVICES

Field Data
EIN 87-1274535
Case Number EO-2021183-000175
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FAMILY AND YOUTH SERVICES
Organization’s Mailing Address 15601 FOLIAGE AVENUE SOUTH 139
City APPLE VALLEY
State MN
ZIP 55124
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

MOHAMED WEHELIE
BOARD DIRECTOR
12208 17TH AVENUE SOUTH B
BURNSVILLE MN 55337

Officer/Director/Trustee Two

SAGAL HUSSEIN
BOARD DIRECTOR
20948 HOLIDAY AVENUE
LAKEVILLE MN 55044

Officer/Director/Trustee Three

IRSHA ELMI
BOARD DIRECTOR
50 SNELLING AVENUE NORTH 406
SAINT PAUL MN 55104

Officer/Director/Trustee Four

UBAH DHIBLIWE
BOARD DIRECTOR
15601 FOLIAGE AVENUE SOUTH 139
APPLE VALLEY MN 55124

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/17/2021
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: Yes
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 UBAH DHIBLIWE
Signature Title BOARD DIRECTOR
Signature Date 6/29/2021

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