FORM 1023-EZ for CROSSROAD FAMILY PROVIDER NETWORKREVENUE PROCURE 2014-11

Field Data
EIN 43-2011349
Case Number EO-2015063-000103
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CROSSROAD FAMILY PROVIDER NETWORKREVENUE PROCURE 2014-11
Organization’s Mailing Address 19023 LEAPWOOD AVE
City CARSON
State CA
ZIP 90746-1948
Accounting period End 6
Primary contact name PRISCILLA CARTER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PRISCILLA CARTER
DIRECTOR/CEO
19023 LEAPWOOD AVE
CARSON CA 90746-1048

Officer/Director/Trustee Two

JAY CARTER
PRESIDENT
19023 LEAPWOOD AVE
CARSON CA 90746-1048

Officer/Director/Trustee Three

PATRICIA DAUGHTREY
SECRETARY
5024 3/4 HAYTER AVE
LAKEWOOD CA 90712

Officer/Director/Trustee Four

REGINA HIREMATH
BOARD MEMBER
2980 CARRILLO WAY
CARLSBAD CA 92009-3027

Officer/Director/Trustee Five

RODERICK CARTER
BOARD MEMBER
504 E CASWELL
COMPTON CA 90220

Organization’s website
Organization’s email CROSSROADFAMILYSERVICES@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/2/2003
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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