FORM 1023-EZ for ANGELHEART INC

Field Data
EIN 47-3828943
Case Number EO-2015163-000401
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ANGELHEART INC
Organization’s Mailing Address 11116 E 117TH ST NO
City COLLINSVILLE
State OK
ZIP 74021
Accounting period End 12
Primary contact name JANE NIEMEYER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JANE NIEMEYER
DIRECTOR
11116 E 117TH ST N
COLLINSVILLE OK 74021

Officer/Director/Trustee Two

ANGELA WRIGHT
DIRECTOR
1502 W 115TH ST
JENKS OK 74037

Officer/Director/Trustee Three

LINDSEY RICHMOND
SECRETARY/TREASURER
507 W 128TH ST S
JENKS OK 74037

Officer/Director/Trustee Four

LINDA FRAZIER
DIRECTOR
4707 OAKLEAF DR
TULSA OK 74132

Officer/Director/Trustee Five

CHRISSY FAGELMAN
DIRECTOR
119 N HAWTHORNE HOLLOW CIRCLE
THE WOODLANDS TX 77384

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/9/2015
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
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 Yes
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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