FORM 1023-EZ for LAO GOLF OF OREGON

Field Data
EIN 82-2192660
Case Number EO-2017201-000461
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAO GOLF OF OREGON
Organization’s Mailing Address 17955 NW RAPID ST
City BEAVERTON
State WA
ZIP 97006
Accounting period End 12
Primary contact name PHET MOUNSAVATH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PHET MOUNSAVATH
COO
8014 NE 103RD CT
VANCOUVER WA 98662

Officer/Director/Trustee Two

KLEIN ADITH
CEO
17955 NW RAPID ST
BEAVERTON OR 97006

Officer/Director/Trustee Three

NALI THANASOUK
CFO
2862 SE ELLIOTT DR
GRESHAM OR 97080

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/18/2017
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P22 - Urban League
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 Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers Yes
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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