FORM 1023-EZ for HEART UNFAILURE INCORPORATED

Field Data
EIN 47-4634383
Case Number EO-2019140-000200
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEART UNFAILURE INCORPORATED
Organization’s Mailing Address 3918 LE MAY AVE
City DALLAS
State TX
ZIP 75216
Accounting period End 12
Primary contact name BRITTANY CLAYBORNE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRITTANY CLAYBORNE
CEO
3918 LE MAY AVE
DALLAS TX 75216

Officer/Director/Trustee Two

SHANNON EDDINS
DIRECTOR
3918 LE MAY AVE
DALLAS TX 75216

Officer/Director/Trustee Three

AMANDA MORALES
DIRECTOR
3918 LE MAY AVE
DALLAS TX 75216

Officer/Director/Trustee Four

FAITH BANDA
DIRECTOR
3918 LE MAY AVE
DALLAS TX 75216

Officer/Director/Trustee Five

OTIS CLAYBORNE
DIRECTOR
3918 LE MAY AVE
DALLAS TX 75216

Organization’s website
Organization’s email HEARTUNFAILURE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/28/15
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name BRITTANY CLAYBORNE
Signature Title CEO
Signature Date 5/16/19
EIN 47-4634383
Case Number EO-2015212-000574
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEART UNFAILURE INC
Organization’s Mailing Address 3918 LE MAY AVE
City DALLAS
State TX
ZIP 75216
Accounting period End 12
Primary contact name BRITTANY CLAYBORNE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRITTANY CLAYBORNE
PRESIDENT
3918 LE MAY AVE
DALLAS TX 75216

Officer/Director/Trustee Two

O BENJAMIN CLAYBORNE
DIRECTOR
3918 LE MAY AVE
DALLAS TX 75216

Officer/Director/Trustee Three

SHANNON EDDINS
DIRECTOR
1013 PHILLIPS DR
ENNIS TX 75119

Officer/Director/Trustee Four

AMANDA MORALES
DIRECTOR
2118 ARBOR CREEK DR
CARROLLTON TX 75010

Organization’s website HEARTUNFAILURE.COM
Organization’s email HEARTUNFAILURE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/28/2015
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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
Signature Title
Signature Date

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