FORM 1023-EZ for PLEASANT HEARTS PET FOOD PANTRY

Field Data
EIN 82-3579479
Case Number EO-2018032-000153
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PLEASANT HEARTS PET FOOD PANTRY
Organization’s Mailing Address 406 BARTH AVE SE
City GRAND RAPIDS
State MI
ZIP 49506
Accounting period End 12
Primary contact name HEATHER CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RACHEL JENSEN
CHIEF OPERATING OFFICER
954 LAKE MICHIGAN DR
GRAND RAPIDS MI 49504

Officer/Director/Trustee Two

HEATHER CLARK
CHIEF FINANCIAL OFFICER
862 EMERALD AVE NE
GRAND RAPIDS MI 49503

Officer/Director/Trustee Three

COURTNEY STUART
OFFICER
52 BENJAMIN AVE SE
GRAND RAPIDS MI 49506

Officer/Director/Trustee Four

AMY SEBOLT
OFFICER
934 BENJAMIN AVE NE
GRAND RAPIDS MI 49503

Officer/Director/Trustee Five

JENN GAVIN
OFFICER
428 PLEASANT ST SE
GRAND RAPIDS MI 49503

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/1/17
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D19 - Nonmonetary Support 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 HEATHER CLARK
Signature Title CHIEF FINANCIAL OFFICER
Signature Date 1/30/18

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