FORM 1023-EZ for HEARTS FOR HEARTS

Field Data
EIN 47-4150028
Case Number EO-2015166-000204
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEARTS FOR HEARTS
Organization’s Mailing Address 4242 IRVINGTON AVENUE
City JACKSONVILLE
State FL
ZIP 32210
Accounting period End 12
Primary contact name TERRI DERKUM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

NICOLE CANNATA
CHIEF EXECUTIVE OFFICER
4324 APPLETON AVE
JACKSONVILLE FL 32210

Officer/Director/Trustee Two

STACEY MERRITT
EXECUTIVE VICE PRESIDENT
4242 IRVINGTON AVENUE
JACKSONVILLE FL 32210

Officer/Director/Trustee Three

LEE ANN WALKER
TREASURER
10814 LINWOOD HILLS DRIVE
JACKSONVILLE FL 32222

Officer/Director/Trustee Four

CANDACE LAUTZENHEISER
SECRETARY
1615 LANDAU ROAD
JACKSONVILLE FL 32225

Officer/Director/Trustee Five

FRED CALDWELL
ADVISORY OFFICER
2133 SWALLOWTAIL LANE
ST. AUGUSTINE FL 32092

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/3/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
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 Yes
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
Signature Title
Signature Date

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