FORM 1023-EZ for HEARTWORK WELLNESS COLLABORATIVE

Field Data
EIN 84-1987880
Case Number EO-2019164-000277
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEARTWORK WELLNESS COLLABORATIVE
Organization’s Mailing Address 530 E MAIN STREET SUITE 530
City RICHMOND
State VA
ZIP 23219
Accounting period End 12
Primary contact name LAUREN HOFFMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAUREN HOFFMAN
EXECUTIVE DIRECTOR
2330 WOODMONT DR
N CHESTERFIELD VA 23235

Officer/Director/Trustee Two

ASHLEY COLEMAN
PRESIDENT
12447 WALNUT HILL DR
ROCKVILLE VA 23146

Officer/Director/Trustee Three

SUZANNE TAYLOR
TREASURER
740 GREENCASTLE RD
N CHESTERFIELD VA 23236

Officer/Director/Trustee Four

STEPHANIE HOFFMAN
SECRETARY
4202 MUD CITY LOOP
MORRISTOWN VT 5661

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/30/19
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F30 - Mental Health Treatment - Multipurpose and N.E.C.
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 ASHLEY COLEMAN
Signature Title PRESIDENT
Signature Date 6/11/19

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