FORM 1023-EZ for KHMER COMMUNITY OF SEATTLE KING COUNTY

Field Data
EIN 91-1577475
Case Number EO-2019345-000387
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KHMER COMMUNITY OF SEATTLE KING COUNTY
Organization’s Mailing Address 10025 16TH AVE SW
City SEATTLE
State WA
ZIP 98146
Accounting period End 12
Primary contact name THYDA ROS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SEILA HA
PRESIDENT
10433 5TH AVE SW
SEATTLE WA 98146

Officer/Director/Trustee Two

SOPHORN SIM
VICE PRESIDENT
11015 5TH AVE SW
SEATTLE WA 98146

Officer/Director/Trustee Three

THYDA ROS
TREASURE
13119 DES MOINES MEMORIAL DR S
BURIEN WA 98168

Officer/Director/Trustee Four

KALYANA LIM
SECRETARY
18213 8TH PLACE WEST
LYNNWOOD WA 98037

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/8/1984
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name THYDA ROS
Signature Title TREASURE
Signature Date 12/9/2019

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