FORM 1023-EZ for THE HEARTBURN FOUNDATION

Field Data
EIN 47-2307715
Case Number EO-2014318-000340
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE HEARTBURN FOUNDATION
Organization’s Mailing Address 124 COVINGTON COVE
City GEORGETOWN
State TX
ZIP 78628
Accounting period End 12
Primary contact name MINDI BOZEMAN ZANOWIAK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

F PAUL BUCKLEY III
PRESIDENT; DIRECTOR
124 COVINGTON COVE
GEORGETOWN TX 78628

Officer/Director/Trustee Two

LEZAH PINNELL
VICE PRESIDENT; DIRECTOR
1933 OAKLIEGH WAY
KNOXVILLE TN 37919

Officer/Director/Trustee Three

BLAKE BOOKSTAFF
SECRETARY/TREASURER; DIRECTOR
120 SUBURBAN ROAD SUITE 201
KNOXVILLE TN 37923

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/12/2014
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H05 - Research Institutes and/or Public Policy Analysis
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: Yes
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 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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