FORM 1023-EZ for AQUA DE VIDA MINISTRY

Field Data
EIN 81-3452926
Case Number EO-2020006-000261
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AQUA DE VIDA MINISTRY
Organization’s Mailing Address 40 CHURCH ST
City FREEPORT
State FL
ZIP 32439
Accounting period End 7
Primary contact name SHANE HIERSCHE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JONATHAN O HARA
PRESIDENT
40 CHURCH ST
FREEPORT FL 32439

Officer/Director/Trustee Two

DAWN HYMA
TREASURER
77 EASY ST
FREEPORT FL 32439

Officer/Director/Trustee Three

JEFF HYMA
SECRETARY
77 EASY ST
FREEPORT FL 32439

Officer/Director/Trustee Four

CONNIE JONES
DIRECTOR
184 TWELVE OAKS LANE
FREEPORT FL 32439

Officer/Director/Trustee Five

RICKY CARTER
DIRECTOR
55 MOLLIE RD
PONCE DE LEON FL 32455

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/28/2016
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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 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 JONATHAN O HARA
Signature Title PRESIDENT
Signature Date 1/2/2020

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