FORM 1023-EZ for HEART OF REVIVAL

Field Data
EIN 27-3479276
Case Number EO-2014365-000163
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEART OF REVIVAL
Organization’s Mailing Address 1029 SOUTH 10TH STREET
City LEBANON
State OR
ZIP 97355-1284
Accounting period End 12
Primary contact name ED SKIPPER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

EDWARD SKIPPER
EXECUTIVE DIRECTOR
1029 SOUTH 10TH STREET
LEBANON OR 97355-1284

Officer/Director/Trustee Two

HANNAH BROWNELL
TREASURER
2190 16TH AVENUE SE
ALBANY OR 97322-6837

Officer/Director/Trustee Three

JON DENHAM
DIRECTOR
38363 3RD STREET
CRAWFORDSVILLE OR 97336

Officer/Director/Trustee Four

WARREN STROUP
DIRECTOR
3000 SOUTH SANTIAM HIGHWAY
LEBANON OR 97355-3870

Officer/Director/Trustee Five

LYNN KOEHN
DIRECTOR
3000 SOUTH SANTIAM HIGHWAY
LEBANON OR 97355-3870

Organization’s website HEARTOFREVIVAL.NET
Organization’s email ESKIP@CENTURYTEL.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/17/2010
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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