FORM 1023-EZ for LIFE SOURCE COMMUNITY CENTRE

Field Data
EIN 47-2386253
Case Number EO-2014345-000397
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE SOURCE COMMUNITY CENTRE
Organization’s Mailing Address PO BOX 7080
City KAMUELA
State HI
ZIP 96743
Accounting period End 12
Primary contact name BILL CONEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WILLIAM CONEY
DIRECTOR
PO BOX 7080
KAMUELA HI 96743

Officer/Director/Trustee Two

MEI-JEN STOKESBARY
DIRECTOR
PO BOX 6370
KAMUELA HI 96743

Officer/Director/Trustee Three

EVERETT KNOWLES
DIRECTOR
PO BOX 1783
KAMUELA HI 96743

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/1/2014
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: Yes
Scientific: Yes
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 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
Signature Title
Signature Date

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