FORM 1023-EZ for THE JOHN A-JACK-KOLBUSH FOUNDATIONINC

Field Data
EIN 82-4262640
Case Number EO-2018264-000254
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE JOHN A-JACK-KOLBUSH FOUNDATIONINC
Organization’s Mailing Address 4 WOODHULL ROAD
City SAVANNAH
State GA
ZIP 31404-8
Accounting period End 12
Primary contact name ANDREW W LOHN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JANET KOLBUSH
CEO DIRECTOR
4 WOODHULL ROAD
SAVANNAH GA 31404-8

Officer/Director/Trustee Two

MARK KOLBUSH
CFO-DIRECTOR
4 WOODHULL ROAD
SAVANNAH GA 31404-8

Officer/Director/Trustee Three

HEATHER NEWSOME
DIRECTOR
2 SAWGRASS CT
SAVANNAH GA 31405-8136

Officer/Director/Trustee Four

LISA KOONS
DIRECTOR
115 OKATIE HIGHWAY
OKATIE SC 29909-3926

Officer/Director/Trustee Five

JAN FEINER
DIRECTOR
56 ROSE HILL DRIVE
BLUFFTON SC 29910-4718

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/6/17
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 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 JANET KOLBUSH
Signature Title CEO DIRECTOR
Signature Date 9/19/18
EIN 82-4262640
Case Number EO-2018264-000254
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE JOHN A-JACK-KOLBUSH FOUNDATION INC
Organization’s Mailing Address 4 WOODHULL ROAD
City SAVANNAH
State GA
ZIP 31404-8
Accounting period End 12
Primary contact name ANDREW W LOHN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JANET KOLBUSH
CEO DIRECTOR
4 WOODHULL ROAD
SAVANNAH GA 31404-8

Officer/Director/Trustee Two

MARK KOLBUSH
CFO-DIRECTOR
4 WOODHULL ROAD
SAVANNAH GA 31404-8

Officer/Director/Trustee Three

HEATHER NEWSOME
DIRECTOR
2 SAWGRASS CT
SAVANNAH GA 31405-8136

Officer/Director/Trustee Four

LISA KOONS
DIRECTOR
115 OKATIE HIGHWAY
OKATIE SC 29909-3926

Officer/Director/Trustee Five

JAN FEINER
DIRECTOR
56 ROSE HILL DRIVE
BLUFFTON SC 29910-4718

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/6/17
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 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 JANET KOLBUSH
Signature Title CEO DIRECTOR
Signature Date 9/19/18

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