FORM 1023-EZ for SHAOLIN MASTER QI GONG

Field Data
EIN 47-2279599
Case Number EO-2015216-000204
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SHAOLIN MASTER QI GONG
Organization’s Mailing Address 3209 FIR AVE
City ALAMEDA
State CA
ZIP 94502
Accounting period End 8
Primary contact name CAXTON FUNG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WEIDONG LIU
CHIEF EXECUTIVE OFFICER
6710 LION WAY APT 219
OAKLAND CA 94621-3375

Officer/Director/Trustee Two

CAXTON FUNG
CHIEF FINANCIAL OFFICER
3209 FIR AVE
ALAMEDA CA 94502-6945

Officer/Director/Trustee Three

DAVID DOYLE
DIRECTOR
316 FAIRHAVEN ROAD
ALAMEDA CA 94501-5963

Officer/Director/Trustee Four

KENNEY HUI
DIRECTOR
620 SILVER AVENUE
SAN FRANCISCO CA 94134-1051

Officer/Director/Trustee Five

BYRON BROWN
DIRECTOR
7451 RUSH RIVER DRIVE APT 7
SACRAMENTO CA 95831-5247

Organization’s website WWW.SHAOLINMASTER.ORG
Organization’s email CAXTON.SHAOLINMASTER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/8/2014
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B28 - Specialized Education Institutions
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 Yes
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
Signature Title
Signature Date

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