FORM 1023-EZ for IBIS FOUNDATION INC

Field Data
EIN 81-2905300
Case Number EO-2016225-000077
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name IBIS FOUNDATION INC
Organization’s Mailing Address 2704 OLD REGISTER ROAD
City STATESBORO
State GA
ZIP 30458
Accounting period End 12
Primary contact name DARIN H VAN TASSELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DARIN VAN TASSELL
PRESIDENT
102 LAKEWOOD DRIVE
STATESBORO GA 30458

Officer/Director/Trustee Two

HEIDI JEFFERS
DIRECTOR
4671 HWY 24
STATESBORO GA 30461

Officer/Director/Trustee Three

JENNIFER WOODARD
DIRECTOR
700 NESMITH PROCTOR ROAD
PEMBROKE GA 31321

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/4/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N64 - Soccer Clubs, Leagues
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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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