FORM 1023-EZ for THE WELLNESS INITIATIVE

Field Data
EIN 84-3101462
Case Number EO-2019266-000362
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE WELLNESS INITIATIVE
Organization’s Mailing Address 1060 QUARRY PARK DRIVE
City SANDY
State UT
ZIP 84094
Accounting period End 12
Primary contact name PATTIE S CHRISTENSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PATRICK BARNES
TRUSTEE/DIRECTOR
951 RIVER WALK DRIVE
RIVERTON UT 84065

Officer/Director/Trustee Two

LORI HIGGINS
TRUSTEE/DIRECTOR
206 TORY STREET
MIDDLETON DE 19709

Officer/Director/Trustee Three

JENNIFER ROHN
TRUSTEE/DIRECTOR
1719 S MAIN STREET
SALT LAKE CITY UT 84115

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/19/19
Organization Incorporation State UT
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 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 PATRICK BARNES
Signature Title TRUSTEE/DIRECTOR
Signature Date 9/19/19

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