FORM 1023-EZ for KEIKI O PALEHUA OHANA

Field Data
EIN 82-1328384
Case Number EO-2017121-000444
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KEIKI O PALEHUA OHANA
Organization’s Mailing Address 96-3168 PIKAKE STREET
City PAHALA
State HI
ZIP 96777
Accounting period End 6
Primary contact name JOANN B FREED
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN AH SAN
PRESIDENT
96-3168 PIKAKE STREET
PAHALA HI 96777

Officer/Director/Trustee Two

LAURA DIAZ
TREASURER
PO BOX 503
PAHALA HI 96777

Officer/Director/Trustee Three

MICHELLE CHACON
SECRETARY
509 OLIVE STREET
SANTA CLARA CA 95062

Officer/Director/Trustee Four

LORIE OBRA
VICE-PRESIDENT
PO BOX 845
PAHALA HI 96777

Officer/Director/Trustee Five

GLORIA CAMBA
DIRECTOR
PO BOX 744
PAHALA HI 96777

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/20/2017
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: 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 Yes
One Third Support Gifts No
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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