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CREATE YOUR STATEMENT: Form 990EZ, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
CREATE YOUR STATEMENT (EIN 45-4505016)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-04-14
IRS object ID
202201049349200230
Schema version
2021v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-04-14T18:06:02-07:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN842964799PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Kirchner & Jordan CPABusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1427 W Sinto Ave Ste 200AddressLine1Txt
CitySpokaneCityNm
State AbbreviationWAStateAbbreviationCd
ZIP99201ZIPCd
FieldValueIRS element (for citing)
Return Type990EZReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN454505016EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CREATE YOUR STATEMENTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCREABusinessNameControlTxt
Phone5099937000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 18934AddressLine1Txt
CitySPOKANECityNm
State AbbreviationWAStateAbbreviationCd
ZIP99228ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJENNY MOELLERPersonNm
Person TitleExecutive Dir.PersonTitleTxt
Signature2022-04-14SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstJENNYPersonFirstNm
Person LastMOELLERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKYLE JORDAN CPAPreparerPersonNm
PTINP01287966PTIN
Phone5093288844PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
Federated Assurance LevelFAL1FederatedAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990-EZ IRS990EZ

FieldValueIRS element (for citing)
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Website AddressWWW.CREATEYOURSTATEMENT.COMWebsiteAddressTxt
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Gross Receipts$115,594GrossReceiptsAmt
Info In Schedule O Part IYes (X)InfoInScheduleOPartIInd
Contributions Gifts Grants Etc$99,483ContributionsGiftsGrantsEtcAmt
Cost Or Other Basis Expense Sale$0CostOrOtherBasisExpenseSaleAmt
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Special Events Direct Expenses$0SpecialEventsDirectExpensesAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt
Other Revenue Total$16,111OtherRevenueTotalAmt
Total Revenue$115,594TotalRevenueAmt
Salaries Other Comp Empl Bnft$55,849SalariesOtherCompEmplBnftAmt
Occupancy Rent Utlts And Maint$600OccupancyRentUtltsAndMaintAmt
Printing Publications Postage$162PrintingPublicationsPostageAmt
Other Expenses Total$33,232OtherExpensesTotalAmt
Total Expenses$89,843TotalExpensesAmt
Excess Or Deficit For Year$25,751ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY$61,547NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$87,298NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIYes (X)InfoInScheduleOPartIIInd

Cash Savings And Investments CashSavingsAndInvestmentsGrp

FieldValueIRS element (for citing)
BOY$63,314BOYAmt
EOY$83,793EOYAmt

Other Assets Total Detail OtherAssetsTotalDetail

FieldValueIRS element (for citing)
BOY$3,000BOYAmt
EOY$3,505EOYAmt

Form990 Total Assets Form990TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$66,314BOYAmt
EOY$87,298EOYAmt

Sum Of Total Liabilities SumOfTotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,767BOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

FieldValueIRS element (for citing)
BOY$61,547BOYAmt
EOY$87,298EOYAmt
FieldValueIRS element (for citing)
Primary Exempt PurposeSTATEMENT WILL BRING EDUCATION AND AWARENESS TO THE PREVENTION OF DATING ABUSEWHILE PROMOTING LEADERSHIP AND CHARACTER DEVELOPMENT AMONG TODAYS YOUTH.PrimaryExemptPurposeTxt

Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp

FieldValueIRS element (for citing)
Description Program Srvc AccomSTATEMENT IS SPECIFICALLY MEETING A UNIQUE NEED IN WASHINGTON STATE BY FOCUSING ONTHE PREVENTION OF DATING ABUSE AS OPPOSED TO DOMESTIC VIOLENCE VICTIMRECOVERY.LEADERSHIP AND CHARACTER DEVELOPMENT IS ESSENTIAL IN THE STATEMENTPROGRAMS.DescriptionProgramSrvcAccomTxt
Grants And Allocations$55,307GrantsAndAllocationsAmt
Program Service Expenses$17,450ProgramServiceExpensesAmt
FieldValueIRS element (for citing)
Total Program Service Expenses$55,307TotalProgramServiceExpensesAmt

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (12 entries)

TitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmt
HEIDI LAURITZEN
President0$0
Jordan Ferguson
Director0$0
Wendy Watson
Director0$0
ED HOFFMAN
Director0$0
Adriana Berndt
Director0$0
Whitney Rolstad
Director0$0
BRAD MOELLER
Director0$0
YVONNE SMITH
Director0$0
ANNE COWLES
Director0$0
CASSIE ANDERSON
Secretary0$0
ANNE OAKLEY
Director0$0
JENNY MOELLER
Executive Dir.0$0
FieldValueIRS element (for citing)
Activities Not Previously RptfalseActivitiesNotPreviouslyRptInd
Chg Made To Orgnzng Doc Not RptfalseChgMadeToOrgnzngDocNotRptInd
Organization Had UBIfalseOrganizationHadUBIInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Organization Dissolved EtcfalseOrganizationDissolvedEtcInd
Form1120 Pol FiledfalseForm1120PolFiledInd
Made Loans To From OfficersfalseMadeLoansToFromOfficersInd
Tax Imposed Under IRC4911$0TaxImposedUnderIRC4911Amt
Tax Imposed Under IRC4912$0TaxImposedUnderIRC4912Amt
Tax Imposed Under IRC4955$0TaxImposedUnderIRC4955Amt
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
Tax Imposed On Organization Mgr$0TaxImposedOnOrganizationMgrAmt
Tax Reimbursed By Organization$0TaxReimbursedByOrganizationAmt
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJENNY MOELLERPersonNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 18934AddressLine1Txt
CitySPOKANECityNm
State AbbreviationWAStateAbbreviationCd
ZIP99228ZIPCd
FieldValueIRS element (for citing)
Phone5099937000PhoneNum
FieldValueIRS element (for citing)
Foreign Financial AccountfalseForeignFinancialAccountInd
Foreign OfficefalseForeignOfficeInd
Donor Advised FndsfalseDonorAdvisedFndsInd
Operate HospitalfalseOperateHospitalInd
Tanning Services ProvidedfalseTanningServicesProvidedInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
School OperatingfalseSchoolOperatingInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Part VI Of Comp Of Hghst Pd EmplNONEPartVIOfCompOfHghstPdEmplTxt
Part VI Hghst Pd Cntrct Prof SrvcNONEPartVIHghstPdCntrctProfSrvcTxt
Filed Schedule AYes (true)FiledScheduleAInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$144,840CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$89,937CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$145,049CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$92,838CurrentTaxYearMinus1YearAmt
Current Tax Year$99,483CurrentTaxYearAmt
Total$572,147TotalAmt

Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$144,840CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$89,937CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$145,049CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$92,838CurrentTaxYearMinus1YearAmt
Current Tax Year$99,483CurrentTaxYearAmt
Total$572,147TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$0SubstantialContributorsTotAmt
Public Support Total170$572,147PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Total Support$572,147TotalSupportAmt
Public Support CY1701.00000PublicSupportCY170Pct
Public Support PY1701.00000PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (20 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Other Revenue.1PPP Loan Forgiveness $14410
Other Revenue.2Program Revenue $1701
Other Expenses.1001Advertising and Promotion $3834
Other Expenses.1005Travel $278
Other Expenses.1012Insurance $2154
Other Expenses.1EVENT EXPENSES $11307
Other Expenses.2CONTRACT SERVICES $4719
Other Expenses.3GRANT WRITING $2350
Other Expenses.4OFFICE SUPPLIES $1954
Other Expenses.5BANK SERVICE CHARGE $1789
Other Expenses.6BOARD MEETING $940
Other Expenses.7SOFTWARE $900
Other Expenses.8MEALS $770
Other Expenses.9MATERIAL $677
Other Expenses.10OTHER EXPENSES $552
Other Expenses.11EXEMPLICICATION $479
Other Expenses.12AUCTION ACQUISTION $415
Other Expenses.14APPRECIATION $114
Other Assets.1PREPAID EXPENSES - Beginning $0 PREPAID EXPENSES - Ending $3505
Total Liabilities.1001Accounts Payable and Accrued Expenses - Beginning $4767 Accounts Payable and Accrued Expenses - Ending $0

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