FORM 1023-EZ for MINDFULLY APPLIED

Field Data
EIN 83-2710911
Case Number EO-2019036-000582
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MINDFULLY APPLIED
Organization’s Mailing Address 122 N CORTEZ ST SUITE 107
City PRESCOTT
State AZ
ZIP 86301
Accounting period End 12
Primary contact name JOSEPH R BROUSSARD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOSEPH BROUSSARD
DIRECTOR
1652 MORNING STONE DR
PRESCOTT TX 86305-1101

Organization’s website
Organization’s email MINDFULLYAPPLIED@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/18/18
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JOSEPH BROUSSARD
Signature Title DIRECTOR
Signature Date 1/18/19

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