FORM 1023-EZ for GAIUS KEIO FOUNDATION

Field Data
EIN 81-0767313
Case Number EO-2016162-000275
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GAIUS KEIO FOUNDATION
Organization’s Mailing Address 509 COPHER CT
City EULESS
State TX
ZIP 76040
Accounting period End 12
Primary contact name ANITIMONI HALATOA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANITIMONI HALATOA
PRESIDENT
509 COPHER CT
EUILESS TX 76040

Officer/Director/Trustee Two

SAMUELA VAENUKU
SEC
509 COPHER CT
EULESS TX 76040

Officer/Director/Trustee Three

SUMIONE WOLFGRAM
TRES
509 COPHER CT
EULESS TX 76040

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/8/2015
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O99 - Youth Development N.E.C.
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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