FORM 1023-EZ for CROSSROADS COMMUNITY FOUNDATION INC

Field Data
EIN 43-2094631
Case Number EO-2017233-000084
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CROSSROADS COMMUNITY FOUNDATION INC
Organization’s Mailing Address 2929 N 7TH ST
City TERRE HAUTE
State IN
ZIP 47804
Accounting period End 12
Primary contact name KEITH TAYLOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEITH TAYLOR
PRESIDENT
3643 EAST EVANS AVE
TERRE HAUTE IN 47805

Officer/Director/Trustee Two

NICKOLAS CHALOS
SECRETARY
2201 HULMAN ST
TERRE HAUTE IN 47803

Officer/Director/Trustee Three

MICHAEL BUDNIK
TREASURER
2929 N 7TH ST
TERRE HAUTE IN 47804

Officer/Director/Trustee Four

KRIS TAYLOR
BUSINESS ADMINISTRATOR
2929 N 7TH ST
TERRE HAUTE IN 47804

Officer/Director/Trustee Five

DEENA CHANEY
BUSINESS ADMINISTRATOR
2929 N 7TH ST
TERRE HAUTE IN 47804

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/16/2005
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X12 - Fund Raising and/or Fund Distribution
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 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 Yes
One Third Support Gifts No
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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