FORM 1023-EZ for ROOSEVELT JACKSON FOUNDATION

Field Data
EIN 46-1719905
Case Number EO-2021272-000246
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ROOSEVELT JACKSON FOUNDATION
Organization’s Mailing Address 2470 PUGHSLEY RD
City STAPLETON
State GA
ZIP 30823
Accounting period End 12
Primary contact name CHRISTINE GORDON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTINE GORDON
DIRECTOR
2470 PUGHSLEY RD
STAPLETON GA 30823

Organization’s website
Organization’s email ROOSEVELTJACKSONFOUNDATION.01@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/14/1914
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name CHRISTINE GORDON
Signature Title DIRECTOR
Signature Date 9/27/2021
EIN 46-1719905
Case Number EO-2015026-000095
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROOSEVELT JACKSON FOUNDATION INC
Organization’s Mailing Address 2407 BREAM AVENUE
City AUGUSTA
State GA
ZIP 30906
Accounting period End 12
Primary contact name CHRISTINE GORDON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHRISTINE GORDON
DIRECTOR
2407 BREAM AVENUE
AUGUSTA GA 30906

Officer/Director/Trustee Two

ROOSEVELT JACKSON
BOARD MEMBER
190 PONDEROSA ROAD
BUENA VISTA GA 31803

Officer/Director/Trustee Three

MICHAEL JOHNSON
BOARD MEMBER
8160 VETERANS PARKWAY APT 1111
COLUMBUA GA 31909

Officer/Director/Trustee Four

HARLIN WILLIAMS
BOARD MEMBER
4923 FULCHER ROAD
HEPHZIBAH GA 30815

Officer/Director/Trustee Five

KEVIN BROWN
BOARD MEMBER
PO BOX 138
BUENA VISTA GA 31803

Organization’s website
Organization’s email CGGBIZ@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/15/2014
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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