FORM 1023-EZ for A KAREN HEART FOUNDATION

Field Data
EIN 82-2983548
Case Number EO-2017312-000172
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name A KAREN HEART FOUNDATION
Organization’s Mailing Address 1613 MILSTEAD RD NE
City CONYERS
State GA
ZIP 30012
Accounting period End 12
Primary contact name MARIEL MELENDEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARIEL MELENDEZ
DIRECTOR
260 E COUNTRY WOODS DR
COVINGTON GA 30016

Officer/Director/Trustee Two

MARIA MELENDEZ
OFFICERS
88 LAUREL AVE
STATEN ISLAND NY 10304

Officer/Director/Trustee Three

ADAM PERRY
OFFICER
94 LAUREL AVE
STATEN ISLAND NY 10304

Officer/Director/Trustee Four

GABRELLA WILLIAMS
OFFICER
1426 FALL RIVERS
CONYERS GA 30013

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/2017
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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