FORM 1023-EZ for PHABB 5

Field Data
EIN 82-5096048
Case Number EO-2018186-000156
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PHABB 5
Organization’s Mailing Address 535 E 223RD ST
City CARSON
State CA
ZIP 90745
Accounting period End 12
Primary contact name CLARENCE MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CLARENCE MILLER
PRESIDENT
535 E 223RD ST
CARSON CA 90745

Officer/Director/Trustee Two

RHEA MILLER
VICE PRESIDENT/TREASURER
535 E 223RD ST
CARSON CA 90745

Officer/Director/Trustee Three

RODNEY CARR
SECRETARY
175 VALLEY STREET APT 5130
PASADENA CA 91105

Officer/Director/Trustee Four

LYDIA FRIEND
BOARD MEMBER
2511 S SANTA ANA BLVD
LOS ANGELES CA 90059

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/18/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CLARENCE MILLER
Signature Title PRESIDENT
Signature Date 7/2/18

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