FORM 1023-EZ for SMILES OF HAWAII DENTAL PROJECT

Field Data
EIN 82-3930482
Case Number EO-2018012-000225
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SMILES OF HAWAII DENTAL PROJECT
Organization’s Mailing Address 89 HOOKELE STREET STE 203
City KAHULUI
State HI
ZIP 96732
Accounting period End 12
Primary contact name JAMIL NEWIRTH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MELANIE VALLEJOS
PRESIDENT/TREASURER
89 HOOKELE STREET STE 203
KAHULUI HI 96732

Officer/Director/Trustee Two

CARL KOBAYASHI
VICE PRESIDENT
89 HOOKELE STREET STE 203
KAHULUI HI 96732

Officer/Director/Trustee Three

MARA SANDI
SECRETARY
89 HOOKELE STREET STE 203
KAHULUI HI 96732

Organization’s website N/A
Organization’s email MVSMILE1@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/15/17
Organization Incorporation State HI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E32 - Ambulatory Health Center, Community Clinic
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 MELANIE VALLEJOS
Signature Title PRESIDENT/TREASURER
Signature Date 1/10/18

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