FORM 1023-EZ for KALIKIMAKA HAVEN

Field Data
EIN 85-3414196
Case Number EO-2020302-000471
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KALIKIMAKA HAVEN
Organization’s Mailing Address 55-050 KAMEHAMEHA HWY
City LAIE
State HI
ZIP 96762
Accounting period End 12
Primary contact name RICHARD VIERRA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RICHARD VIERRA
SEC/TRES
55-050 KAMEHAMEHA HWY
LAIE HI 96762

Officer/Director/Trustee Two

LAURA CHANDLER
VP/DIR
55-050 KAMEHAMEHA HWY
LAIE HI 96762

Officer/Director/Trustee Three

SYLVIA KAPU
PRES/DIR
55-016 KAMEHAMEHA HWY
LAIE HI 96762

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/13/2020
Organization Incorporation State HI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P82 - Developmentally Disabled Centers, Services
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 Yes
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 RICHARD VIERRA
Signature Title SEC/TRES
Signature Date 10/26/2020

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