FORM 1023-EZ for CROSSROADS HEALTH & WELLNESS

Field Data
EIN 83-2649402
Case Number EO-2018345-000226
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CROSSROADS HEALTH & WELLNESS
Organization’s Mailing Address 16249 S HOWARD STREET
City PLAINFIELD
State IL
ZIP 60586
Accounting period End 12
Primary contact name SUSANNE HICKEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JILL JENNINGS
PRESIDENT
16249 S HOWARD STREET
PLAINFIELD IL 60586

Officer/Director/Trustee Two

KEVIN JENNINGS
VICE PRESIDENT/DIRECTOR
16249 S HOWARD STREET
PLAINFIELD IL 60586

Officer/Director/Trustee Three

SUSANNE HICKEY
SECRETARY/DIRECTOR
691 WALKER WAY
NEW LENOX IL 60451

Officer/Director/Trustee Four

TERRI CASE
DIRECTOR
584 SARATOGA
AURORA IL 60502

Officer/Director/Trustee Five

DENISE SHOSTEK
DIRECTOR
386 SANDHURST CIR APT 4
GLEN ELLYN IL 60137

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/28/18
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
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 Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JILL JENNINGS
Signature Title PRESIDENT
Signature Date 12/9/18

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