FORM 1023-EZ for MILLPOND WELLNESS INITIATIVE INC

Field Data
EIN 84-2575939
Case Number EO-2020008-000203
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MILLPOND WELLNESS INITIATIVE INC
Organization’s Mailing Address 3650 BOSTON ROAD STE 188
City LEXINGTON
State KY
ZIP 40514
Accounting period End 12
Primary contact name JUSTIN PEARCE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUSTIN PEARCE
PRESIDENT
529 WHITFIELD DR
LEXINGTON KY 40515

Officer/Director/Trustee Two

ELISABETH SMITH
TREASURER
2224 WILMINGTON LANE
LEXINGTON KY 40513

Officer/Director/Trustee Three

AMY HAMBLIN
SECRETARY
3604 NILES DRIVE
LEXINGTON KY 40517

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/15/2019
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 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 JUSTIN PEARCE
Signature Title PRESIDENT
Signature Date 1/6/2020

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