FORM 1023-EZ for MINDFUL LIVING

Field Data
EIN 84-2742309
Case Number EO-2019231-000327
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MINDFUL LIVING
Organization’s Mailing Address 15-921 PARADISE ALA KAI
City KEAAU
State HI
ZIP 96749-7101
Accounting period End 12
Primary contact name SUSAN KIM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUSAN KIM
PRESIDENT
15-921 PARADISE ALA KAI
KEAAU HI 96749

Officer/Director/Trustee Two

PAVEL HAVLICEK
VICE PRESIDENT
15-1947 24TH STREET
KEAAU HI 96749

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/29/18
Organization Incorporation State HI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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 Yes
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 SUSAN KIM
Signature Title PRESIDENT
Signature Date 8/15/19

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