FORM 1023-EZ for LIVING FOUNTAIN YOUTH SENIOR SERVICES

Field Data
EIN 81-3961587
Case Number EO-2016272-000196
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIVING FOUNTAIN YOUTH SENIOR SERVICES
Organization’s Mailing Address 3751 WOODLACE DR
City HUMBLE
State TX
ZIP 77396-4053
Accounting period End 12
Primary contact name CARLA SILVANI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CARLA SILVANI
CEO
3751 WOODLACE DR
HUMBLE TX 77396-4053

Officer/Director/Trustee Two

RANDY RANDOLPH
TREASURER
1582 NW STUTZ PL
SILVERDALE WA 98383-9436

Officer/Director/Trustee Three

MICHELLE BROWN
SECRETARY
9743 8TH PL SW UNIT 101
SEATTLE WA 98106

Officer/Director/Trustee Four

MOIRA VERA
VICE PRESIDENT
11481 GENEVA RD
CINCINNATI OH 45420

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/22/2016
Organization Incorporation State TX
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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