FORM 1023-EZ for BASA VILLAGE FOUNDATION USA INC

Field Data
EIN 36-4721579
Case Number EO-2015124-000159
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BASA VILLAGE FOUNDATION USA INC
Organization’s Mailing Address 6422 RALSTON AVENUE
City INDIANAPOLIS
State IN
ZIP 46220
Accounting period End 12
Primary contact name CHARLES A RICHMOND
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MICHAEL MILLER
CHAIRMAN
7053 CALLE ESTANCIES
LAS CRUES NM 88007

Officer/Director/Trustee Two

JEFFREY RASLEY
PRESIDENT
6422 RALSTON VENUE
INDIANAPOLIS IN 46220

Officer/Director/Trustee Three

JOEL MEYERS
VICE PRESIDENT COMMUNICATIONS
1482 NW 77TH STREET
SEATTLE WA 98117

Officer/Director/Trustee Four

CHRIS TAYLOR
VICE PRESIDENT TREASURER
2246 GARFLAS DRIVE
PASENDA CA 91104

Officer/Director/Trustee Five

CHARLES RICHMOND
COUNSEL
10585 NORTH MERIDIAN STREET
INDIANAPOLIS IN 46290

Organization’s website WWW.BASAVILLAGEFOUNDATIONUSA.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/4/2013
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q32 - International Economic Development
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 Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
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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