| Field | Data |
|---|---|
| EIN | 82-3004602 |
| Case Number | EO-2018036-000210 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | KOA COMMUNITY CLINIC INC |
| Organization’s Mailing Address | 75-5995 KUAKINI HWY SUITE 445 |
| City | KAILUA KONA |
| State | HI |
| ZIP | 96740 |
| Accounting period End | 12 |
| Primary contact name | CORINNE DE SOTO |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
ALEXIS BRIELLE MELE
DIRECTOR AND PRESIDENT
2735 WASHINGTON STREET
EUGENE OR 97405
JEFF FOSTER
DIRECTOR AND TREASURER
PO BOX 894
CAPTAIN COOK HI 96745
MAUREEN DATTA
DIRECTOR AND SECRETARY
PO BOX 608
CAPTAIN COOK HI 96745
TANE DATTA
VICE PRESIDENT
PO BOX 1070
CAPTAIN COOK HI 96745
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 8/31/17 |
| Organization Incorporation State | HI |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E99 - Health - General and Rehabilitative N.E.C. |
| 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 | MAUREEN DATTA |
| Signature Title | DIRECTOR AND SECRETARY |
| Signature Date | 2/2/18 |
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