FORM 1023-EZ for CROSSROADS SHELTER AID

Field Data
EIN 85-2800822
Case Number EO-2020288-000055
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CROSSROADS SHELTER AID
Organization’s Mailing Address 811 HENNESSEE BRIDGE RD
City ROCK ISLAND
State TN
ZIP 38581
Accounting period End 7
Primary contact name ASHLEY BOULDIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ASHLEY BOULDIN
PRESIDENT/DIRECTOR/FOUNDER
811 HENNESSEE BRIDGE RD
ROCK ISLAND TN 38581

Officer/Director/Trustee Two

SHELBY HICE-SMITH
DIRECTOR/CO-TREASURER/CO-SECRETARY
109 WESTWOOD DR
MCMINNVILLE TN 37110

Officer/Director/Trustee Three

RACHELLE CRUZ
DIRECTOR/CO-SECRETARY/CO-TREASURER
232 ONEAL DR
ROCK ISLAND TN 38581

Organization’s website
Organization’s email ABOULDIN87TN@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/14/2020
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
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 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 Yes
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 ASHLEY BOULDIN
Signature Title PRESIDENT/DIRECTOR/FOUNDER
Signature Date 10/12/2020

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