FORM 1023-EZ for CROSSROADS EXPERIENCE INC

Field Data
EIN 95-4173012
Case Number EO-2015355-000155
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CROSSROADS EXPERIENCE INC
Organization’s Mailing Address 11923 DEL MAR AVENUE
City CHINO
State CA
ZIP 91710
Accounting period End 12
Primary contact name CONNIE LEGG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JON SCHEU
CHIEF EXECUTIVE OFFICER
11923 DEL MAR AVENUE
CHINO CA 91710

Officer/Director/Trustee Two

CONNIE LEGG
CHIEF FINANCIAL OFFICER
20700 TETON ROAD
APPLE VALLEY CA 92308

Officer/Director/Trustee Three

TRACY TOTTEN
SECRETARY
73 E GRANDVIEW
ARCADIA CA 91006

Officer/Director/Trustee Four

TIM SEALS
CLERGY
6369 DAYLILY COURT
ALTA LOMA CA 91737

Officer/Director/Trustee Five

NANCY DAVIS
VOTING MEMBER
2969 HORACE STREET
RIVERSIDE CA 92506

Organization’s website WWW.CROSSROADS-EXPERIENCE.COM
Organization’s email CROSSROADSEXPERIENCEINC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/14/1988
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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 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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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