FORM 1023-EZ for HEART WITHOUT BORDERS

Field Data
EIN 82-3229492
Case Number EO-2018064-000360
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEART WITHOUT BORDERS
Organization’s Mailing Address 16793 PARK AVE
City SONOMA
State CA
ZIP 95476
Accounting period End 12
Primary contact name DARYL REESE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NICHOLAS DALTON
DIRECTOR/PRESIDENT
16793 PARK AVE
SONOMA CA 95476

Officer/Director/Trustee Two

MELISSA BINGHAM
DIRECTOR/VICE PRESIDENT
16793 PARK AVE
SONOMA CA 95476

Officer/Director/Trustee Three

DEANNA FURLONG
DIRECTOR/SECRETARY
16793 PARK AVE
SONOMA CA 95476

Officer/Director/Trustee Four

SHANNON O BRYAN
DIRECTOR/TREASURER
16793 PARK AVE
SONOMA CA 95476

Officer/Director/Trustee Five

LISA CARLSSON
DIRECTOR
16793 PARK AVE
SONOMA CA 95476

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/24/17
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A20 - Arts, Cultural Organizations - Multipurpose
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 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 NICHOLAS DALTON
Signature Title DIRECTOR/PRESIDENT
Signature Date 3/2/18

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