FORM 1023-EZ for MED ALLIANCE INTERNATIONAL

Field Data
EIN 47-3920062
Case Number EO-2016041-000244
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MED ALLIANCE INTERNATIONAL
Organization’s Mailing Address P O BOX 364
City SUGARLAND
State TX
ZIP 77487-0364
Accounting period End 12
Primary contact name GRACE DAMA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GRACE DAMA
CHAIRPERSON
P O BOX 364
SUGARLAND TX 77487-0364

Officer/Director/Trustee Two

VICTORIA DAMA
DIRECTOR
16607 WILSONS CREEK LANE
HOUSTON TX 77083

Officer/Director/Trustee Three

LAWRENCE EDE
DIRECTOR
P O BOX 711465
HOUSTON TX 77271

Officer/Director/Trustee Four

AGNES OSIRE
DIRECTOR
11850 FM 1960 RD W
HOUSTON TX 77065

Officer/Director/Trustee Five

MIKE SENI
DIRECTOR
4220 N 57 LANE
PHOENIX AZ 85031

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/21/2015
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T30 - Public Foundations
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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