FORM 1023-EZ for KAUAI NORTH SHORE FOOD PANTRY INC

Field Data
EIN 81-4748610
Case Number EO-2017090-000290
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KAUAI NORTH SHORE FOOD PANTRY INC
Organization’s Mailing Address PO BOX 1172
City KILAUEA
State HI
ZIP 96754
Accounting period End 12
Primary contact name PATRICK OCONNELL JR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KURT LAST
PRESIDENT/DIRECTOR
PO BOX 1172
KILAUEA HI 96754

Officer/Director/Trustee Two

CATHERINE BUTLER
SECRETARY/DIRECTOR
PO BOX 1172
KILAUEA HI 96754

Officer/Director/Trustee Three

PATRICK OCONNELL JR
TREASURER/DIRECTOR
PO BOX 1172
KILAUEA HI 96754

Officer/Director/Trustee Four

ROBIN BON
DIRECTOR
PO BOX 1172
KILAUEA HI 96754

Officer/Director/Trustee Five

MARY WILDER
DIRECTOR
PO BOX 1172
KILAUEA HI 96754

Organization’s website
Organization’s email PAOCO65@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/26/2016
Organization Incorporation State HI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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
Signature Title
Signature Date

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