FORM 1023-EZ for MAIKAI HEALTH CORPORATION

Field Data
EIN 84-3395089
Case Number EO-2020024-000210
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MAIKAI HEALTH CORPORATION
Organization’s Mailing Address 868 ULULANI STREET SUITE 102
City HILO
State HI
ZIP 96720
Accounting period End 12
Primary contact name MISTY PACHECO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BREEANI SUMERA-LEE
PRESIDENT
11 SILVA STREET
HILO HI 96720

Officer/Director/Trustee Two

MISTY PACHECO
VICE PRESIDENT
PO BOX 120
HILO HI 96720-0120

Officer/Director/Trustee Three

KEALANI CANDA
SECRETARY-TREASURER
868 ULULANI STREET SUITE 102
HILO HI 96720

Officer/Director/Trustee Four

SYDNEY TATSUNO
MEMBER
974 KUKUAU STREET
HILO HI 96720-6035

Officer/Director/Trustee Five

SUPAKIT WONGWIWATTHANANUKIT
MEMBER
50 MAILE STREET APT 22
HILO HI 96720-4381

Organization’s website WWW.MAIKAIHEALTH.ORG
Organization’s email MISTY.PACHECO@MAIKAIHEALTH.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/7/2019
Organization Incorporation State HI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E21 - Community Health Systems
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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MISTY PACHECO
Signature Title VICE PRESIDENT
Signature Date 1/22/2020

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