FORM 1023-EZ for ROBERT F BARKLEY DDS FOUNDATION

Field Data
EIN 81-1078050
Case Number EO-2016027-000128
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROBERT F BARKLEY DDS FOUNDATION
Organization’s Mailing Address 1116 FORT STREET MALL
City HONOLULU
State HI
ZIP 96813
Accounting period End 12
Primary contact name MARY JEAN CASTILLO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JON BARKLEY
PRESIDENT
PO BOX 893785
MILILANI HI 96789

Officer/Director/Trustee Two

MARY JEAN CASTILLO
VICE PRESIDENT
1330 A MOANALUALANI PLACE
HONOLULU HI 96819

Officer/Director/Trustee Three

NOEL HENRY
SECRETARY/TREASURER
1116 FORT STREET MALL
HONOLULU HI 96813

Officer/Director/Trustee Four

JACQUELINE HUGHES
DIRECTOR
3313 ST ANDREWS DRIVE
CHAMBERSBURG PA 17202

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/21/2015
Organization Incorporation State HI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
Literary: Yes
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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