FORM 1023-EZ for SOUTH EAST ASIA MEDICAL OUTREACH

Field Data
EIN 82-5147280
Case Number EO-2018113-000631
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SOUTH EAST ASIA MEDICAL OUTREACH
Organization’s Mailing Address 2314 OAK STREET 6
City SANTA MONICA
State CA
ZIP 90405
Accounting period End 12
Primary contact name NANCY CITRON-MANSFIELD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NANCY CITRON-MANSFIELD
VP AND DIRECTOR
2314 OAK ST APT 6
SANTA MONICA CA 90405

Officer/Director/Trustee Two

SIERRA MANSFIELD
PRESIDENT AND DIRECTOR
550 N FLORES STREET APT 7
WEST HOLLYWOOD CA 90048

Officer/Director/Trustee Three

KATHERINE PIERCE
SECRETARY
123 OCEAN AVE
LONG BEACH CA 90044

Officer/Director/Trustee Four

SPENCER HIRT
DIRECTOR
13242 AUTUMN MIST CIRCLE
GERMANTOWN CA 20874

Officer/Director/Trustee Five

TERRI ROCK
DIRECTOR
2021 SANTA MONICA BLVD SUITE 335E
SANTA MONICA CA 90404

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/16/17
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q33 - International Relief
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 Yes
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 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 NANCY CITRON-MANSFIELD
Signature Title VP AND DIRECTOR
Signature Date 4/20/18

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