FORM 1023-EZ for INTENTIONAL HEART INC

Field Data
EIN 82-5474611
Case Number EO-2018269-000093
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name INTENTIONAL HEART INC
Organization’s Mailing Address 9552 SILVER BUTTONWOOD ST
City ORLANDO
State FL
ZIP 32832
Accounting period End 12
Primary contact name SHANNON TIBBETTS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHANNON TIBBETTS
PRESIDENT
24 BLUE SKY DR
WESTERLY RI 2891

Officer/Director/Trustee Two

CHRISTOPHER TIBBETTS
TREASURER
24 BLUE SKY DR
WESTERLY RI 2891

Officer/Director/Trustee Three

RAMONA CRABTREE-FALKNER
BOARD MEMBER
273 BROOKDALE LOOP
CLERMONT FL 34711

Officer/Director/Trustee Four

RUTH TURECKOVA
BOARD MEMBER
25 URSO DRIVE
WESTERLY RI 2891

Officer/Director/Trustee Five

TERRI HARPER
BOARD MEMBER
1207 MANDARIN LANE
FRUITLAND PARK FL 34731

Organization’s website INTENTIONALHEART.ORG
Organization’s email CONNECT@INTENTIONALHEART.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/28/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P50 - Personal Social Services
Organization’s purpose Charitable: Yes
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 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 SHANNON TIBBETTS
Signature Title PRESIDENT
Signature Date 9/24/18

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