FORM 1023-EZ for OUR HEART SPEAKS INC

Field Data
EIN 47-5255336
Case Number EO-2016130-000252
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name OUR HEART SPEAKS INC
Organization’s Mailing Address 89 MAIN STREET SUITE 112
City MEDWAY
State MA
ZIP 02053
Accounting period End 12
Primary contact name TRACEY BOLOTNICK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DR KEITH RAFAL
PRESIDENT, TREASURER, CLERK
89 MAIN STREET SUITE 112
MEDWAY MA 02053

Officer/Director/Trustee Two

DR AITHAN SHAPIRA
DIRECTOR
154 BEACON STREET NO 4
BOSTON MA 02116

Officer/Director/Trustee Three

DR ASHLEY DUGGAN
DIRECTOR
12 RIDGE AVENUE
NEWTON MA 02459

Officer/Director/Trustee Four

JANIS OREL
DIRECTOR
34 HAYDEN ROWE STREET
HOPKINTON MA 01748

Organization’s website OURHEARTSPEAKS.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/7/2015
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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 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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