FORM 1023-EZ for WELLNESS CANVAS

Field Data
EIN 82-4858781
Case Number EO-2018127-000104
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WELLNESS CANVAS
Organization’s Mailing Address 9106 NW 66TH LANE
City PARKLAND
State FL
ZIP 33067
Accounting period End 12
Primary contact name DAVID HOLMBERG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID HOLMBERG
DIRECTOR
550 WEST 45TH ST APT 745
NEW YORK NY 10036

Officer/Director/Trustee Two

NANCY ROSENBLUM
DIRECTOR
107 WEST 11TH STREET APT 4
NEW YORK FL 10011

Officer/Director/Trustee Three

TALIA POCKHAI
DIRECTOR/CHIEF EXECUTIVE OFFICER
9106 NW 66TH LANE
PARKLAND FL 33067

Officer/Director/Trustee Four

ALEJANDRA MEDINA
DIRECTOR
473 W MESCALERO DR
ODESSA TX 79763

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/15/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F12 - Fund Raising and/or Fund Distribution
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 Yes
Donation of funds Yes
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 TALIA POCKHAI
Signature Title DIRECTOR/CHIEF EXECUTIVE OFFICER
Signature Date 5/5/18

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