FORM 1023-EZ for ECLECTIC INSTITUTE

Field Data
EIN 20-0947552
Case Number EO-2016337-000448
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ECLECTIC INSTITUTE
Organization’s Mailing Address 7109 BLAKE STREET
City EL CERRITO
State CA
ZIP 94530
Accounting period End 12
Primary contact name LORI BJELLAND
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LORI BJELLAND
CEO
7109 BLAKE ST
EL CERRITO CA 94530

Officer/Director/Trustee Two

ISADORA BJELLAND
VICE PRESIDENT
7109 BLAKE STREET
EL CERRITO CA 94530

Officer/Director/Trustee Three

RICHARD PETROW
SECRETARY
1781 GILARDY DRIVE
CONCORD CA 94518

Organization’s website WWW.AYAHJAH.COM
Organization’s email KERISTAGO@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/4/2003
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other 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 No
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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