FORM 1023-EZ for REBORN HEROES

Field Data
EIN 81-0749169
Case Number EO-2015356-000008
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name REBORN HEROES
Organization’s Mailing Address 5493 W RUSTIC HILL RD
City HERRIMAN
State UT
ZIP 84096
Accounting period End 12
Primary contact name CHRISTOPHER GREEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHRISTOPHER GREEN
PRESIDENT
5493 W RUSTIC HILL RD
HERRIMAN UT 84096-3406

Officer/Director/Trustee Two

ERNEST BARRERA
VICE PRESIDENT OF OPERATIONS
14496 S FOX CREEK DR
HERRIMAN UT 84096-3459

Officer/Director/Trustee Three

TOM RICH
VICE PRESIDENT OF REVENUE GROWTH
14817 S ALDEN VIEW DR
HERRIMAN UT 84096-3413

Officer/Director/Trustee Four

ADAM WOMBLE
VICE PRESIDENT OF MARKETING
2195 SHADOW WOOD DR
LEHI UT 84043-6583

Officer/Director/Trustee Five

JOSHUA MERCER
TREASURER
14524 S ROSE SUMMIT DR
HERRIMAN UT 84096-3446

Organization’s website WWW.REBORNHEROES.COM
Organization’s email CGREEN@REBORNHEROES.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/20/2015
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F70 - Mental Health Disorders
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 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 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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