FORM 1023-EZ for HOSPICE HEARTS

Field Data
EIN 47-5247265
Case Number EO-2015281-000370
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HOSPICE HEARTS
Organization’s Mailing Address 908 EAST MAIN STREET
City URBANA
State IL
ZIP 61802
Accounting period End 9
Primary contact name JESSICA SEMPEK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JESSICA SEMPEK
PRESIDENT
713 S MARKET STREET
HOOPESTON IL 60942

Officer/Director/Trustee Two

KELSEY STOCKS
SECRETARY
1114 W DANIEL STREET
CHAMPAIGN IL 61820

Officer/Director/Trustee Three

MICHAEL VAN
TREASURER
1502 VILLAGE PARK WAY
SAVOY IL 61874

Officer/Director/Trustee Four

SARAH ALBERT
VICE PRESIDENT
419 E FAIRLAWN DR
URBANA IL 61801

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/6/2015
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
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 Yes
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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