FORM 1023-EZ for CROSSROAD OUTREACH INC

Field Data
EIN 47-5179644
Case Number EO-2016014-000397
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CROSSROAD OUTREACH INC
Organization’s Mailing Address 3948 HWY 90
City PACE
State FL
ZIP 32571
Accounting period End 12
Primary contact name LEIGHANN NETTLES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOSEPH ROGERS
PRESIDENT
3948 HIGHWAY 90
PACE FL 32571

Officer/Director/Trustee Two

ANTHONY DAVIS
SECRETARY / TREASURER
3948 HIGHWAY 90
PACE FL 32571

Officer/Director/Trustee Three

PHILIP GREESON
DIRECTOR
3948 HIGHWAY 90
PACE FL 32571

Officer/Director/Trustee Four

RAY CARNLEY
DIRECTOR
3948 HIGHWAY 90
PACE FL 32571

Officer/Director/Trustee Five

JEREMY TOMPKINS
DIRECTOR
3948 HIGHWAY 90
PACE FL 32571

Organization’s website HTTP://CROSSROADOUTREACH.ORG/
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/16/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A50 - Museum, Museum Activities
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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