FORM 1023-EZ for USA-CAMBODIA BASKETBALL ASSOCIATION INC

Field Data
EIN 82-1077413
Case Number EO-2017097-000407
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name USA-CAMBODIA BASKETBALL ASSOCIATION INC
Organization’s Mailing Address 2 PINE ST
City LOWELL
State MA
ZIP 01851
Accounting period End 12
Primary contact name SOKHARY CHAU
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SOKHARY CHAU
PRESIDENT DIRECTOR
120 B ST
LOWELL MA 01851

Officer/Director/Trustee Two

SOEUM SOK
TREASURER DIRECTOR
15 MERCIER ST
DRACUT MA 01826

Officer/Director/Trustee Three

KEVIN COUGHLIN
CLERK DIRECTOR
3 PINE RIDGE ROAD
WESTFORD MA 01886

Officer/Director/Trustee Four

RADY MOM
DIRECTOR
642 WILDER ST
LOWELL MA 01851

Officer/Director/Trustee Five

PEK MITH
DIRECTOR
75 NEWBRIDGE ROAD
LOWELL MA 01854

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/16/2017
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
Conducting Activities Outside of United States Yes
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
Signature Title
Signature Date

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