FORM 1023-EZ for BLACK LOTUS PEACE FOUNDATION USA

Field Data
EIN 83-1186275
Case Number EO-2018197-000528
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK LOTUS PEACE FOUNDATION USA
Organization’s Mailing Address 111 DEERWOOD ROAD SUITE 200
City SAN RAMON
State CA
ZIP 94583
Accounting period End 12
Primary contact name ASHWANI VERMA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ASHWANI VERMA
DIRECTOR AND PRESIDENT
111 DEERWOOD ROAD SUITE 200
SAN RAMON CA 94583

Officer/Director/Trustee Two

ANJU MODGIL
DIRECTOR AND SECRETARY
111 DEERWOOD ROAD SUITE 200
SAN RAMONA CA 94583

Officer/Director/Trustee Three

VIVEK MANGESH DHUME
DIRECTOR
111 DEERWOOD ROAD SUITE 200
SAN RAMONA CA 94583

Officer/Director/Trustee Four

MONIKA VERMA
TREASURER
111 DEERWOOD ROAD SUITE 200
SAN RAMON CA 94583

Organization’s website N/A
Organization’s email ASHWANI.VERMA.BLPFUSA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/9/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development N.E.C.
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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 ASHWANI VERMA
Signature Title DIRECTOR AND PRESIDENT
Signature Date 7/13/18

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