FORM 1023-EZ for PHOENIX WELLNESS INCORPORATED

Field Data
EIN 47-3926295
Case Number EO-2015148-000346
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PHOENIX WELLNESS INCORPORATED
Organization’s Mailing Address 3817 HEATHER WAY
City SOMERSET
State KY
ZIP 42503
Accounting period End 12
Primary contact name MARK HAMM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARK HAMM
DIRECTOR
3817 HEATHER WAY
SOMERSET KY 42503

Officer/Director/Trustee Two

TINA HAMM
DIRECTOR
3817 HEATHER WAY
SOMERSET KY 42503

Officer/Director/Trustee Three

SANDY COLYER
DIRECTOR
100 EAST SOMERSET CHURCH ROAD
SOMERSET KY 42503

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/6/2015
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 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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