FORM 1023-EZ for FOCUSED YOUTH INITIATIVE INC

Field Data
EIN 83-0606781
Case Number EO-2018176-000179
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FOCUSED YOUTH INITIATIVE INC
Organization’s Mailing Address 4196 NW 102ND PL
City POLK CITY
State IA
ZIP 50226
Accounting period End 12
Primary contact name GREG MCRAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JARED PETERSON
PRESIDENT/TREASURER/DIRECTOR
4196 NW 102ND PL
POLK CITY IA 50226

Officer/Director/Trustee Two

RYAN SULLIVAN
SECRETARY/DIRECTOR
1703 SW LINDEN ST
ANKENY IA 50023

Officer/Director/Trustee Three

CAMERON DLOUHY
DIRECTOR
601 NW ORCHARD DR
ANKENY IA 50023

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/18
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B99 - Education N.E.C.
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 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 JARED PETERSON
Signature Title PRESIDENT/TREASURER/DIRECTOR
Signature Date 6/21/18

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