FORM 1023-EZ for KAUAI BALLROOM DANCE CLUB HANAPEPECHAPTER

Field Data
EIN 85-1671221
Case Number EO-2020188-000902
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KAUAI BALLROOM DANCE CLUB HANAPEPECHAPTER
Organization’s Mailing Address PO BOX 320
City ELEELE
State HI
ZIP 96705
Accounting period End 12
Primary contact name ALTON MIYAMOTO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANIEL WORKS
PRESIDENT
PO BOX 51007
ELEELE HI 96705

Officer/Director/Trustee Two

ADELA CHAVEZ
TREASURER
4070 PAI STREET
KALAHEO HI 96741

Officer/Director/Trustee Three

GENEVIEVE TAMASHIRO
SECRETARY
PO BOX 37
ELEELE HI 96705

Officer/Director/Trustee Four

ALTON MIYAMOTO
VICE PRESIDENT
PO BOX 746
WAIMEA HI

Officer/Director/Trustee Five

JOHN VISITACION
DIRECTOR
PO BOX 784
ELEELE HI 96705

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/9/2020
Organization Incorporation State HI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A62 - Dance
Organization’s purpose Charitable: No
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 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 ALTON MIYAMOTO
Signature Title VICE PRESIDENT
Signature Date 7/3/2020

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