FORM 1023-EZ for HEAVY HEART

Field Data
EIN 84-2835990
Case Number EO-2019238-000673
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEAVY HEART
Organization’s Mailing Address 11752 N WOODLEAF LN
City HIGHLAND
State UT
ZIP 84003
Accounting period End 12
Primary contact name JUSTIN SUTHERLAND
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUSTIN SUTHERLAND
OFFICER, DIRECTOR, TREASURER, SEC
11752 N WOODLEAF LN
HIGHLAND UT 84003

Officer/Director/Trustee Two

ESTEBAN ARAYA
DIRECTOR
11732 N WOODLEAF LN
HIGHLAND UT 84003

Officer/Director/Trustee Three

ANDREW SHELTON
DIRECTOR
2945 WILD MARE WAY
HEBER CITY UT 84032

Officer/Director/Trustee Four

NICHOLE SUTHERLAND
VICE PRESIDENT
11752 N WOODLEAF LN
HIGHLAND UT 84003

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/23/19
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S32 - Rural Development
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 JUSTIN SUTHERLAND
Signature Title OFFICER, DIRECTOR, TREASURER, SEC
Signature Date 8/23/19

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