FORM 1023-EZ for FAMILY PRESERVATION SERVICES OF LONG ISLAND INC

Field Data
EIN 35-2496305
Case Number EO-2018117-000050
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FAMILY PRESERVATION SERVICES OF LONG ISLAND INC
Organization’s Mailing Address 732 GLOVER PLACE
City BALDWIN
State NY
ZIP 11510-3505
Accounting period End 12
Primary contact name FERN SIMON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FERN SIMON
PRESIDENT
732 GLOVER PLACE
BALDWIN NY 11510-3505

Officer/Director/Trustee Two

DANA ARNOLD
TREASURER
732 GLOVER PLACE
BALDWIN NY 11510-3505

Officer/Director/Trustee Three

ALISON THOMPSON
SECRETARY
732 GLOVER PLACE
BALDWIN NY 11510-3505

Officer/Director/Trustee Four

WERTS NEISHA
DIRECTOR
732 GLOVER PLACE
BALDWIN NY 11510-3505

Officer/Director/Trustee Five

JOAN BROWSER
DIRECTOR
732 GLOVER PLACE
BALDWIN NY 11510-3505

Organization’s website HTTP://FAMILYPRESERVLI.WORDPRESS.COM
Organization’s email FPSOLI@AOL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/22/14
Organization Incorporation State NY
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: 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 FERN SIMON
Signature Title PRESIDENT
Signature Date 4/25/18

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