FORM 1023-EZ for FOUNTAIN OF JACOB
| Field | Data |
|---|---|
| EIN | 86-1101279 |
| Case Number | EO-2018320-000219 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | FOUNTAIN OF JACOB |
| Organization’s Mailing Address | 25 1ST AVENUE NE SUITE 105 |
| City | HICKORY |
| State | NC |
| ZIP | 28601 |
| Accounting period End | 12 |
| Primary contact name | ANNIE JACKSON |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
ANNIE JACKSON
PRESIDENT
1729 PEACHTREE ROAD
CHARLOTTE NC 28216
Officer/Director/Trustee Two
ERNEST NETTLES
CHAIRMAN
547 ROMFORD ROAD
COLUMBIA NC 29203
Officer/Director/Trustee Three
BRODERICK DERR
BOARD MEMBER
1750 20TH AVE DR NE 8
HICKORY NC 28601
Officer/Director/Trustee Four
SHIRLEY JEFFERSON
BOARD MEMBER
3724 JACKSON LANE
ELLENWOOD GA 30294
Officer/Director/Trustee Five
CAROLYN CHAPMAN
BOARD MEMBER
9005 MEREDITH HILL TERRACE
NORTH CHESTERFIELD VA 23237
| Organization’s website | |
|---|---|
| Organization’s email | FOUNTAINOFJACOB@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 4/13/04 |
| Organization Incorporation State | NC |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | P50 - Personal Social Services |
| Organization’s purpose | Charitable: Yes Religious: Yes Educational: Yes Scientific: Yes 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 | No |
| 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 | Yes |
| Correctness Declaration | Yes |
| Signature Name | ANNIE JACKSON |
| Signature Title | PRESIDENT |
| Signature Date | 11/14/18 |
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