FORM 1023-EZ for BEN JACKSON FOUNDATION INC

Field Data
EIN 83-2502445
Case Number EO-2018319-000136
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BEN JACKSON FOUNDATION INC
Organization’s Mailing Address W5327 WINDMILL RIDGE ROAD
City NEW GLARUS
State WI
ZIP 53574
Accounting period End 12
Primary contact name LAURENCE JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAURENCE JACKSON
PRESIDENT & DIRECTOR
W5327 WINDMILL RIDGE ROAD
NEW GLARUS WI 53574

Officer/Director/Trustee Two

JENNIFER JACKSON
SEC/TREASURER & DIRECTOR
W5327 WINDMILL RIDGE ROAD
NEW GLARUS WI 53574

Officer/Director/Trustee Three

ROBERT YEISER
DIRECTOR
9016 DOMINUS LANE
VERONA WI 53593

Officer/Director/Trustee Four

TARA DARNELL
DIRECTOR
607 12TH AVENUE
NEW GLARUS WI 53574

Officer/Director/Trustee Five

HOLLI LEWANDOWSKI
DIRECTOR
227 HILLVIEW ROAD
MICHICOT WI 54228

Organization’s website WWW.BENJACKSONFOUNDATION.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/7/18
Organization Incorporation State WI
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: Yes
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 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 LAURENCE JACKSON
Signature Title PRESIDENT & DIRECTOR
Signature Date 11/13/18

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