FORM 1023-EZ for TRI-STATE YOUTHB ASSOCIATION INC

Field Data
EIN 46-3436185
Case Number EO-2016265-000319
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TRI-STATE YOUTHB ASSOCIATION INC
Organization’s Mailing Address 48441 HWY 105
City JEFFERSON
State SD
ZIP 57038
Accounting period End 12
Primary contact name WILLIS STRAWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARTIN MCGLOTHLEN
PRESIDENT
48441 HWY 105
JEFFERSON SD 57038

Officer/Director/Trustee Two

DOUGLAS MARTTIN
VICE PRESIDENT
331 W PINEHURST TRAIL
DAKOTA DUNES SD 57049

Officer/Director/Trustee Three

WILLIS STRAWN
SECRETARY-TREASURER
33283 484TH AVE
JEFFERSON SD 57038

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/22/2013
Organization Incorporation State SD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
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
Signature Title
Signature Date

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