FORM 1023-EZ for PROACTIVE BEHAVIOR SOLUTIONS

Field Data
EIN 82-4723791
Case Number EO-2018107-000298
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PROACTIVE BEHAVIOR SOLUTIONS
Organization’s Mailing Address 3233 S SHERWOOD FOREST BLVD
City BATON ROUGE
State LA
ZIP 70816
Accounting period End 12
Primary contact name SIMONE SHELTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SIMONE SHELTON
DIRECTOR
18291 MANCHAC PLACE DR
PRAIRIEVILLE LA 70769

Officer/Director/Trustee Two

GARY SHELTON
MEMBER
18291 MANCHAC PLACE DR
PRAIRIEVILLE LA 70769

Officer/Director/Trustee Three

JOHNALYNN JACKSON
ASSISTANT DIRECTOR
11999 LONGRIDGE AVE APT 906
BATON ROUGE LA 70816

Officer/Director/Trustee Four

JIMMIE THOMAS
MEMBER
11024 RED OAK DR
BATON ROUGE LA 70815

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/21/18
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O51 - Youth Community Service Clubs
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 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 SIMONE SHELTON
Signature Title DIRECTOR
Signature Date 3/25/18

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