FORM 1023-EZ for NOEL SELVARAJAH CANCER FOUNDATION

Field Data
EIN 83-3086139
Case Number EO-2019079-000437
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NOEL SELVARAJAH CANCER FOUNDATION
Organization’s Mailing Address 4406 MEDALLION DR
City SILVER SPRING
State MD
ZIP 20904
Accounting period End 12
Primary contact name SURESH SELVARAJAH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SURESH SELVARAJAH
PRESIDENT
4406 MEDALLION DR
SILVER SPRING MD 20904

Officer/Director/Trustee Two

PRINCETON J SAMUEL
TREASURER
13223 RINEHILL DR
BELTSVILLE MD 20705

Officer/Director/Trustee Three

AJITH ABRAHAM
DIRECTOR
5981 LYNWOOD CTR RD
BAINBRIDGE ISLAND WA 98110

Officer/Director/Trustee Four

VAYNU OSURI
DIRECTOR
10716 CASPER ST
SILVER SPRING MD 20895

Officer/Director/Trustee Five

JOHN SUJJAN
BOARD MEMBER
13008 BLUE VALLEY PL
SILVER SPRING MD 20904

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/8/19
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
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 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 SURESH SELVARAJAH
Signature Title PRESIDENT
Signature Date 3/18/19

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