FORM 1023-EZ for SEPSIS SURVIVORS INC

Field Data
EIN 47-1208296
Case Number EO-2015043-000279
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SEPSIS SURVIVORS INC
Organization’s Mailing Address 70033 MIRAGE COVE DRIVE SUITE 9
City RANCHO MIRAGE
State CA
ZIP 92270
Accounting period End 12
Primary contact name ANGELA LEMBO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANGELA LEMBO
PRESIDENT
70033 MIRAGE COVE DRIVE SUITE 9
RANCHO MIRAGE CA 92270

Officer/Director/Trustee Two

DOMINIC LEMBO
VICE PRESIDENT
70033 MIRAGE COVE DRIVE SUITE 9
RANCHO MIRAGE CA 92270

Officer/Director/Trustee Three

MARY ZEISE
TREASURER
9945 BRIAR ROAD APT 101
BLOOMINGTON MN 55437

Organization’s website WWW.SEPSIS-SURVIVORS.ORG
Organization’s email ANGIE@SEPSIS-SURVIVORS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/17/2014
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
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 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 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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