FORM 1023-EZ for YOUTH OF AMERICA - BACK TO THE ROOTS BOWL GAMES

Field Data
EIN 51-0507551
Case Number EO-2016285-000554
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name YOUTH OF AMERICA - BACK TO THE ROOTS BOWL GAMES
Organization’s Mailing Address PO BOX 950
City KAHUKU
State HI
ZIP 96731
Accounting period End 12
Primary contact name SEMISI LIVAI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SIUAKI LIVAI
PRESIDENT
56-302 HUEHU STREET
KAHUKU HI 96731

Officer/Director/Trustee Two

SEMISI LIVAI
VICE PRESIDENT
56-112 KAHANA STREET
KAHUKU HI 96731

Officer/Director/Trustee Three

SIAOSI LAUTAHA
TREASURER
55-489 IOSEPA STREET
LAIE HI 96762

Officer/Director/Trustee Four

HENRIETTA AUELUA
SECRETARY
56-302 HUEHU STREET
KAHUKU HI 96731

Organization’s website POLYAMERICAN.ORG
Organization’s email INFO@POLYAMERICAN.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/2004
Organization Incorporation State HI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N20 - Recreational and Sporting Camps
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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