FORM 1023-EZ for HEALTHY HEARTS HEALTHY MINDS INC

Field Data
EIN 87-1992220
Case Number EO-2021217-000331
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEALTHY HEARTS HEALTHY MINDS INC
Organization’s Mailing Address 6728 WHITEFISH LAKE RD
City THREE LAKES
State WI
ZIP 54562-9340
Accounting period End 12
Primary contact name DILAROM ST LOUIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DILAROM ST LOUIS
PRESIDENT
6728 WHITEFISH LAKE RD
THREE LAKES WI 54562-9340

Officer/Director/Trustee Two

KRISTA POLOMIS
TREASURER
1439 GREENLEAF LN
WOODRUFF WI 54568-9816

Officer/Director/Trustee Three

DAWN QUEDNOW
SECRERTARY
W1825 WILDERNESS AVE
RIB LAKE WI 54470-9626

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/26/2021
Organization Incorporation State WI
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 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 DILAROM ST LOUIS
Signature Title PRESIDENT
Signature Date 8/3/2021

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