FORM 1023-EZ for HEART BEAT 4 HAITI

Field Data
EIN 81-5145299
Case Number EO-2017034-000267
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEART BEAT 4 HAITI
Organization’s Mailing Address 8201 PETERS ROAD SUITE 1000
City PLANTATION
State FL
ZIP 33324
Accounting period End 12
Primary contact name ROBERT ANDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT ANDERSON
PRESIDENT
2583 NW 49TH AVE 104
LAUDERDALE LAKES FL 33313

Officer/Director/Trustee Two

DIANA BLANCO
VICE PRESIDENT
2583 NW 49TH AVE 104
LAUDERDALE LAKES FL 33313

Officer/Director/Trustee Three

NICOLE CHRISTOPHE
DIRECTOR
120 NW 56TH ST
FORT LAUDERDALE FL 33309

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/1/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
Gaming Activity No
Disaster relief assistance Yes
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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