FORM 1023-EZ for BEHAVIORLYTICS A SOCIAL CHANGE AGENCY
| Field | Data |
|---|---|
| EIN | 85-3085632 |
| Case Number | EO-2021055-000003 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | BEHAVIORLYTICS A SOCIAL CHANGE AGENCY |
| Organization’s Mailing Address | 905 CARLYON AVE SE |
| City | OLYMPIA |
| State | WA |
| ZIP | 98501 |
| Accounting period End | 12 |
| Primary contact name | HOLLI HENNINGSEN JERDES |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
HOLLI JERDES
EXECUTIVE DIRECTOR
905 CARLYON AVE SE
OLYMPIA WA 98501
Officer/Director/Trustee Two
HOLLI HENNINGSEN JERDES
BOARD PRESIDENT
905 CARLYON AVE SE
OLYMPIA WA 98501
Officer/Director/Trustee Three
KAVINDA SENEVERATINA
BOARD VICE PRESIDENT
1814 216TH PL NE
SAMMAMISH WA 98704
Officer/Director/Trustee Four
NISSA VAN ETTEN
BOARD SECRETERY
12632 CALISTOGA WAY
AUSTIN TX 78732
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 8/12/2020 |
| Organization Incorporation State | WA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | B12 - Fund Raising and/or Fund Distribution |
| 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 | 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 | No |
| 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 | HOLLI HENNINGSEN JERDES |
| Signature Title | BOARD PRESIDENT |
| Signature Date | 12/23/2020 |
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