FORM 1023-EZ for MARSHALLESE ASSOCIATION OF KAUAI

Field Data
EIN 86-1630442
Case Number EO-2021089-000659
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MARSHALLESE ASSOCIATION OF KAUAI
Organization’s Mailing Address PO BOX 3081
City LIHUE
State HI
ZIP 96766
Accounting period End 12
Primary contact name JEFFERY LATH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEFFERY LATH
PRESIDENT
4691 KALEPA CIRCLE F 5
LIHUE HI 96766

Officer/Director/Trustee Two

PATRICK CLEMENT
VICE PRESIDENT
4743-E ALENAE STREET
KAPAA HI 96746

Officer/Director/Trustee Three

CECE KILMA
SECRETARY
4160 HOALA STREET 11F
LIHUE HI 96766

Officer/Director/Trustee Four

SAM SAMSON
TREASURER
4728 OPUKEA STREET
LIHUE HI 96766

Officer/Director/Trustee Five

HESKIEL JAROM
SERGEANT AT ARMS
5230 PAANUA ROAD APT H102
KOLOA HI 96756

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/28/2020
Organization Incorporation State HI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
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 No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JEFFERY LATH
Signature Title PRESIDENT
Signature Date 2/12/2021

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