FORM 1023-EZ for SICA-USA

Field Data
EIN 46-1296714
Case Number EO-2021020-000075
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SICA-USA
Organization’s Mailing Address 22235 SW FARMINGTON RD
City BEAVERTON
State OR
ZIP 97007
Accounting period End 12
Primary contact name ROSETTA KOACH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROSETTA KOACH
TREASURER
22235 SW FARMINGTON RD
BEAVERTON OR 97007

Officer/Director/Trustee Two

PAUL NELSON
CHAIRMAN
9930 SEWARD PARK AV S APT 213
SEATTLE WA 98118

Officer/Director/Trustee Three

HAMILTON CHEIFETZ
DIRECTOR
4260 SW 48TH PLACE
PORTLAND OR 97221

Officer/Director/Trustee Four

HALIMAH BELLOWS
VICE-CHAIR
6027 18TH AV SW
SEATTLE WA 98106

Officer/Director/Trustee Five

RALPH DAVILA
DIRECTOR
507 ARGOS CIRCLE
WATSONVILLE CA 95076

Organization’s website HTTPS://SICA-USA.ORG/
Organization’s email TREASURER@SICAUSA.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/25/2012
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A20 - Arts, Cultural 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 Yes
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 No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ROSETTA KOACH
Signature Title TREASURER
Signature Date 11/23/2020

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