FORM 1023-EZ for HEARTLAND SENIOR CARE FOUNDATION

Field Data
EIN 81-4659934
Case Number EO-2017062-000418
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEARTLAND SENIOR CARE FOUNDATION
Organization’s Mailing Address 11209 N FLORIDA AVENUE
City OKLAHOMA CITY
State OK
ZIP 73120-7929
Accounting period End 12
Primary contact name BRENDA HAMPTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRENDA HAMPTON
DIRECTOR
11209 N FLORIDA AVENUE
OKLAHOMA CITY OK 73120-7929

Officer/Director/Trustee Two

LATASHA HODGES
DIRECTOR
5408 N HARVEY AVENUE APT D
OKLAHOMA CITY OK 73118-9312

Officer/Director/Trustee Three

AMY PAYNE
DIRECTOR
11010 N MAY AVENUE
OKLAHOMA CITY OK 73120-7929

Organization’s website
Organization’s email BHAMPTON65@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/9/2016
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E92 - Home Health Care
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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