FORM 1023-EZ for WELLNESS PERSONIFIED

Field Data
EIN 81-4032580
Case Number EO-2016321-000205
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name WELLNESS PERSONIFIED
Organization’s Mailing Address 8705 SE 50TH STREET
City MERCER ISLAND
State WA
ZIP 98040-4603
Accounting period End 12
Primary contact name MARY BROWNING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MATTHEW BRYNILDSON
DIRECTOR AND PRESIDENT/CEO
8705 SE 50TH STREET
MERCER ISLAND WA 98040-4603

Officer/Director/Trustee Two

MARY BROWNING
SECRETARY AND TREASURER/CFO
8705 SE 50TH STREET
MERCER ISLAND WA 98040-4603

Officer/Director/Trustee Three

MAGGIE FOX
DIRECTOR
14200 73RD AVENUE NE APT E201
KIRKLAND WA 98034-4029

Officer/Director/Trustee Four

THERESA POWERS
DIRECTOR
17829 28TH AVENUE NE
LAKE FOREST PARK WA 98155-4005

Organization’s website WWW.WELLNESSPERSONIFIED.ORG
Organization’s email MARY.BROWNING@WELLNESSPERSONIFIED.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/27/2016
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
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 Yes
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
Signature Title
Signature Date

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