FORM 1023-EZ for CROSSROADS BEHAVIORAL HEALTH INC
| Field | Data |
|---|---|
| EIN | 85-0610902 |
| Case Number | EO-2020118-000198 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | CROSSROADS BEHAVIORAL HEALTH INC |
| Organization’s Mailing Address | 409 WEST NEW CIRCLE ROAD |
| City | LEXINGTON |
| State | KY |
| ZIP | 40511 |
| Accounting period End | 12 |
| Primary contact name | DAVID WATERS |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
DAVID WATERS
EXECUTIVE DIRECTOR
1969 SANDERSVILLE ROAD
LEXINGTON KY 40511
Officer/Director/Trustee Two
FAITH KAIN
DIRECTOR
118 KNOLLWOOD DRIVE
HIGHLAND HEIGHTS KY 41076
Officer/Director/Trustee Three
SHANE BEALL
DIRECTOR
1145 WEST LEXINGTON AVENUE SUITE C
WINCHESTER KY 40391
| Organization’s website | CROSSROADSCOUNSELINGKY.COM |
|---|---|
| Organization’s email | DWATERS@CROSSROADSCOUNSELINGKY.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 4/1/2020 |
| Organization Incorporation State | KY |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | F60 - Counseling, Support Groups |
| Organization’s purpose | Charitable: Yes Religious: No 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 | Yes |
| 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 | 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 | DAVID WATERS |
| Signature Title | EXECUTIVE DIRECTOR |
| Signature Date | 4/23/2020 |
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