FORM 1023-EZ for THE WELLNESS EXPERIMENT

Field Data
EIN 87-2235175
Case Number EO-2021235-000193
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE WELLNESS EXPERIMENT
Organization’s Mailing Address 3786 S SUTTER CREEK
City FLAGSTAFF
State AZ
ZIP 86005
Accounting period End 8
Primary contact name RAYMOND MCCAGE - BOARD MEMBER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JILL DIVINE
DIRECTOR
3786 S SUTTER CREEK
FLAGSTAFF AZ 86005

Organization’s website NA
Organization’s email THEWELLNESSEXPERIMENT@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/17/2021
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I43 - Services to Prisoners and Families - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 JILL DIVINE
Signature Title DIRECTOR
Signature Date 8/19/2021

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