FORM 1023-EZ for SUICIDE-MENDING BROKEN HEARTS INC

Field Data
EIN 84-1766559
Case Number EO-2019143-000273
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SUICIDE-MENDING BROKEN HEARTS INC
Organization’s Mailing Address 1123 HAMMOND ROAD
City LAWRENCEBURG
State KY
ZIP 40342
Accounting period End 12
Primary contact name KRISTI R SHIELDS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KRISTI SHIELDS
PRESIDENT
1123 HAMMOND ROASD
LAWRENCEBURG KY 40342

Officer/Director/Trustee Two

JULIA SHIELDS
VICE-PRESIDENT
1123 HAMMOND ROAD
LAWRENCEBURG KY 40342

Officer/Director/Trustee Three

STEVE CLARK
CHAIRPERSON
1031 PROGRESS PLACE
LAWRENCEBURG KY 40342

Organization’s website
Organization’s email SUICIDEMENDINGBROKENHEARTS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/16/19
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name KRISTI SHIELDS
Signature Title PRESIDENT
Signature Date 5/21/19

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