FORM 1023-EZ for 100 HEARTS

Field Data
EIN 81-1168016
Case Number EO-2016042-000183
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name 100 HEARTS
Organization’s Mailing Address 767 ROBERT DRIVE
City MOVILLE
State IA
ZIP 51039
Accounting period End 12
Primary contact name ERIN HYTREK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ERIN HYTREK
PRESIDENT
767 ROBERT DRIVE
MOVILLE IA 51039

Officer/Director/Trustee Two

LILLES SLAWIK
VICE PRESIDENT
6649 SE REEDVILLE CREEK DRIVE
HILLSBORO OR 97123

Officer/Director/Trustee Three

MARIBETH CARMICHAEL
SECRETARY
208 PARKWAY STREET
WINCHESTER VA 22601

Officer/Director/Trustee Four

KIMBERLY BROOKS
TREASURER
4521 WOOD LANE
PRINCE GEORGE VA 23875

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/18/2015
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T12 - Fund Raising and/or Fund Distribution
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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