FORM 1023-EZ for HEART SHOT MINISTRY INC

Field Data
EIN 81-3834684
Case Number EO-2016274-000147
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEART SHOT MINISTRY INC
Organization’s Mailing Address 27580 95TH AVE
City DONAHUE
State IA
ZIP 52746
Accounting period End 12
Primary contact name TROY BENDICKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TROY BENDICKSON
BOARD OF DIRECTORS
27580 95TH AVE
DONAHUE GA 52746

Officer/Director/Trustee Two

ROB BROWNE
BOARD OF DIRECTORS
1052 CRYSTAL BROOK WAY
MONROE GA 30655-7315

Officer/Director/Trustee Three

DANA DAVIS
BOARD OF DIRECTORS
4707 KELLOGG DRIVE
LILBURN GA 30047

Officer/Director/Trustee Four

STEVE ELROD
BOARD OF DIRECTORS
3495 GENERAL HOOD TRAIL
NASHVILLE TN 37204

Organization’s website WWW.HEARTSHOT.ORG
Organization’s email TROY@HEARTSHOT.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/16/2016
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N61 - Fishing, Hunting Clubs
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 Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
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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