FORM 1023-EZ for PATIENT HEARTS

Field Data
EIN 81-3339122
Case Number EO-2016221-000090
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PATIENT HEARTS
Organization’s Mailing Address 5118 OTSEGO CT
City ENCINO
State CA
ZIP 91436
Accounting period End 12
Primary contact name MICHAEL BALL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL BALL
PRESIDENT / EXECUTIVE DIRECTOR
5118 OTSEGO CT
ENCINO CA 91436

Officer/Director/Trustee Two

EVIE MEYER
VICE PRESIDENT / SECRETARY
8731 VINE VALLEY DR
SUN VALLEY CA 91352

Officer/Director/Trustee Three

RAYMOND MUNOZ
DIRECTOR / TREASURER
5480 BROMELY DR
OAK PARK CA 91377

Officer/Director/Trustee Four

ROSHAN SONTHALIA
DIRECTOR
3015 ALMA AVE
MANHATTAN BEACH CA 90266

Officer/Director/Trustee Five

JOSEPH ROGERS
DIRECTOR
923 E THIRD ST APT 201
LOS ANGELES CA 90404

Organization’s website WWW.PATIENTHEARTS.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/14/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 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 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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