FORM 1023-EZ for KATHY A JANSSEN FOUNDATION

Field Data
EIN 46-4648446
Case Number EO-2014226-000294
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KATHY A JANSSEN FOUNDATION
Organization’s Mailing Address 5360 INVERRARY LANE
City COMMERCE TOWNSHIP
State MI
ZIP 48382
Accounting period End 12
Primary contact name MARK JANSSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARK JANSSEN
TRUSTEE
5360 INVERRARY LANE
COMMERCE TWP MI 48382

Officer/Director/Trustee Two

BRANDON JANSSEN
TRUSTEE
5360 INVERRARY LANE
COMMERCE TWP MI 48382

Officer/Director/Trustee Three

KRIS JANSSEN
TRUSTEE
844 BYRON AVE
MILFORD MI 48381

Officer/Director/Trustee Four

JUSTIN JANSSEN
TRUSTEE
5360 INVERRARY LANE
COMMERCE TWP MI 48382

Officer/Director/Trustee Five

TAYLOR JANSSEN
TRUSTEE
5360 INVERRARY LANE
COMMERCE TWP MI 48382

Organization’s website
Organization’s email KAJFOUND@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/23/2014
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B12 - Fund Raising and/or Fund Distribution
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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