** PUBLIC DISCLOSURE COPY non Form ** Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Do not enter social security numbers on this form as it may be made public. Department of the Treasury Internal Revenue Service Information about Form 990 and its instructions is at ,,..,,,, A For the 2014 calendar year, or tax year beginning and ending B rlAddress Lichenge Name L_Jchange Initial D Employer identification number CROSSROADS GRASSROOTS POLICY STRATEGIES Doing business as 27-2753378 Number and street (or P.O. box if mail is not delivered to street address) 45 N. HILL DRIVE return Final return/ terminated IlAmended L_Jreturn F Name and address of principal officer:STEVEN LAW SANE AS C ABOVE on pending Li 4 501(c)(3) [Xi 501(c) ( I Tax-exempt status: J Website: WWW. CROSSROADSGPS . ORG K Form of organization: [XI Corporation 4 (insert no.) 69,128,609 . ' Lillil Yes EIII No for subordinates? Yes =No If "No," attach a list. (see instructions) H(c) Group exemption number L Year of formation: 2 0101 M State of legal domicile: VA Li 4947(a)(1) or Li Other $ I Are all subordinates included? 527 I Briefly describe the organization's mission or most significant activities: ENGAGING IN PUBLIC ,COMMUNICATIONS AND DIRECT CONTACT WITH INTERESTED CONSTITUENCIES TO 2 Check this box 3 Number of voting members of the governing body (Part VI, line la) 3 4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 2 5 Total number of individuals employed in calendar year 2014 (Part V, line 2a) .5 .6 16 .la 0 m 0 Mo. Li if the organization discontinued its operations or disposed of more than 25% of its net assets. 6 Total number of volunteers (estimate if necessary) 7 a Total unrelated business revenue from Part VIII, column (C), line 12 - b Net unrelated business taxable income from Form 990-T, line 34 8 LU Gross receipts H(a) Is this a group return H(b) L_J Trust LJ Association L_J o 8 G . Part II Summary - I Room/suite E Telephone number 1100 202-706-7051 City or town, state or province, country, and ZIP or foreign postal Code WARRENTON, VA 20186 Applrca- - i,.,, nn,,Ifn,,,,,00fl C Name of organization Check if applicable: OMB No. 1545-0047 Return of Organization Exempt From Income Tax Prior Year . 2,687,705. Contributions and grants (Part VIIl, line lh) 9 Program service revenue (Part VIII, line 2g) 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, lOc, and lie) 12 Total revenue - add lines 8through ii (must equal Part VIII, column (A), line 12) 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) 14 Benefits paid to or for members (Part IX, column (A), line 4) 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 16a Professional fundraising fees (Part IX, column (A), line lie) 494,034 b Total fundraising expenses (Part IX, column (D), line 25) 0, 17 Other expenses (Part IX, column (A), lines ha-lid, 1if-24e) 18 Total expenses. Add lines i3-17 (must equal Part IX, column (A), line2S) 22 Net assets or fund balances. Subtract line 2l from line 2o Current Year 69,128,6097 . 0. 0 0 0 706,605. 3,394, 310. 69,128,609. 7 , 612. 13, 626,463 0. 0 1,333,135. 1 , 214, 954 108,000. 160, 125 . . . 2,644,903. .4, 093 , 650 . 50,850,397. 65, 851, 939 699,340. 3,276,670. Beginning of Current Year 129,008. End of Year 5,649,394. 142,978. 2,229,746. 5,506,416. 2,358,754. Total assets (Part X, line 16) 0 0 . - 19 Revenue less expenses. Subtract line l8 from line 12 20 21 2 Total liabilities (Part X, line26) t-an Ii I ugnaiure DIOCK Under penalties of perjury, I declare that I hay i true, correct, and comt"a1jDn of repar othsr4lja flicer) is based on all information of which preparer has any knowledge. STEVEN LAW, 1PR Type or print name and title Here Print/Type preparer's name AREN E. ATCHLEY Firm's name Firm's address Iateu,,/(i/75 - eicer Sign Paid Preparer Use Only this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is I Date .Irqporer's signature lt o 0 C N CO .cs.1 (a (a 0 (0 (44 Q-0 (a I.. (a (a (a rL. (44 144 H 0 0 C,) H 0 0 (a (a 0(a C C 0 E Ui H H o 0 (I) 0 (a 0 0 0 0 0 0 o > t L) a) a) V) a) C a) AA C') a) 0 CL 0 LI. H 0 0 (a a) (0 H 0 0 to 0 0 .Q 0) M 0 C E a) cn 0 a)(a 0 ? U- a) 0 a) . (a a) a) a) C a) >- a) 0 a) - a) a) .0 (a V 0) 1) C Ca) co 0 - = Mv C ca_ . a a) I) a a Ca a • > U_ 0 .CC U E LL W 00) C Cc c >. U. cu -- a) tl) E - t H C a - Ca E 2 Ill - a 0) Ca ,X ,4 (aOH LJW C LL E 0 U- flU) U) U) U) U) U) U) a U) U) U) H U H H o U 0 o 0 0 o 0 0 0 0 0 U) U) U) U) U) U) N c) a_U) U) I_fl U) N U o N .9 WU) -0 C o _ — _ co , _ U) cu o 9a U) t £ I- (1 C) U o CCU) o E U) U) H C U) C C U) .c1 o Er U) U) U) N U) C U 0 H 0 C U) a .2 9 U C C) U] E E0 0 > 0 o C) 0 in a to H z Lli U) U) U) 0 I U) U C) r a N 0 I (U) U) 0 -I (0 0 C U) U) N U] C U) U) 0 U) U) U) U] U] 0 U) N 0 (N N N U)! (U) U) U) to 0 U H C U) El OC) 0 U) U) U) U) o o 0.9 E (CU) Zc —U) (CC) o Z EEN U) U H H 0 0 > U) U) U) 0U) U) g U) HU) U) U) E H a Z H U p HEN H Z U) U) U 0 U) U) U) U) U) 0 U U) o U) U) U) U 0 U)aZ a U)EN z Z, w U) El o EN u) El a a Z 0U)Z o H H N a4 H H H c,4 U) U) UU)U) C)) El U) H U) H U) U)U)C) U)U) ZU)U) ENU)U) OHU) U) 0 U) 0 C U) 0 U) U) U) U) E 0 U- C U) U) C 0 C OD N CU M U) 0 0 U) C 0 C,) 0 C 0 a LU N (N 0 U) U) U (N U) CC go El z cu 0U) U) - > (J c\J U) C - > ci 0 CF) 0) E H rs:1 E- a) >- D C co C 0 0 hui 0 U] cx El El H H El U - a) U] a° 0 H 0 Cl) U] U) -U) U) U) (-) CD LU z 0 H El U H :El U) Cl) N U] z 111 0 El El 0U) 0 CU El U C'] U] U] 0 U E2 U U) Ca vH El 0 El El 0 z H El El 0 z 111 H Cx] CXI 0 z 0 H U] U] U] Mn Q)0 Ca 0 U)— H 0 H El U) U) U) U) cll 0 C U) 0) 0 U) a >' H N CX] 0 El cU:1 U] U] U] Cl) U H U U] '—I 0 U CD 00 LU 0 Cxl p. LU El C'] U rH CD LU cr: 0 Cxl z 0 C'] 0 U 0 0 El z Cx] El U] H El El H El U n r1 0 Cr] Cx] El H z H U] U] U] U] OMP SO U] El 0 Cx-' 0 C El El Cx] Cx] El Cx] LU U] U) 0 0 Ct, El 0 U) cx] El rx ('CU) 0) CL CXI U H El H 0 U) U] H U] U) 0 : aT U] U] Cl] Ca -c U] U] CD III N H z cC 0 U z 0 H Cx] U] PLI Cx] 'xl 0 El z 0 H El El U] z .0 I 1'] Er N C CU 0 U] Ill 0_ -C CU) 0 a 0 E U] U] H 0 to U] El U) C'] U] iUZ U) H U 111 Q) Ei z 0 H 0- —U) CU) 0U) 0 Er cu U) U] U D U) cm 0 U0 - H >LL -Wo 0 -c U) U] CLCl- 111 Cx-] U] El AF z 0 H El N SCHEDULE J (Form 990) Department of the Treasury Internal Revenue Service Compensation Information Name of the organization CROSSROADS GRASSROOTS POLICY STRATEGIES Part I I OMB No. 1545-0047 For certain Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees Complete if the organization answered "Yes' on Form 990, Part IV, line 23. Attach to Form 990. loo, Information about Schedule J (Form 990) and its instructions is at www Irm 0ny11nrM Q Qn I Open to Public Inspection Employer identification number 27-2753378 - Questions Regarding Compensation Yes No la Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form 990, Part VII, Section A, line la. Complete Part Ill to provide any relevant information regarding these items. First-class or charter travel Housing allowance or residence for personal use LII Travel for companions Payments for business use of personal residence Tax indemnification and gross-up payments Health or social club dues or initiation fees Discretionary spending account Personal services (e.g., maid, chauffeur, chef) b If any of the boxes on line 1 a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part Ill to explain - 2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all directors, trustees, and officers, including the CEO/Executive Director, regarding the items checked in line la? . 2 3 Indicate which, if any, of the following the filing organization used to establish the compensation of the organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part Ill. LI Written employment contract IIXII Compensation survey or study LI Approval by the board or compensation committee Compensation committee Independent compensation consultant [XI Form 990 of other organizations 4 During the year, did any person listed in Form 990, Part VII, Section A, line la, with respect to the filing organization or a related organization: a Receive a severance payment or change-of-control payment? . 4a - b Participate in, or receive payment from, a supplemental rtonqualified retirement plan? . 4b - c Participate in, or receive payment from, an equity-based compensation arrangement? . ... - a The organization? . ... b Any related organization? . 5b X X If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III. Only section 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9. 5 For persons listed in Form 990, Part VII, Section A, line la, did the organization pay or accrue any compensation contingent on the revenues of: - If "Yes" to line 5a or 5b, describe in Part Ill. 6 For persons listed in Form 990, Part VII, Section A, line 1 a, did the organization pay or accrue any compensation contingent on the net earnings of: a The organization? . b Any related organization? - X - X - X If "Yes" to line 6a or 6b, describe in Part Ill. 7 For persons listed in Form 990, Part VII, Section A, line la, did the organization provide any non-fixed payments not described in lines 5 and 6? If "Yes," describe in Part III 8 7 Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the initial contract exception described in Regulations section 53.4958.4(a)(3)? If "Yes," describe in Part III .8 X 9 If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in LHA For Paperwork Reduction Act Notice, seethe Instructions for Form 990. Schedule J (Form 990) 2014 432111 10-13-14 13501116 796448 08041 44 2014.05000 CROSSROADS GRASSROOTS POLIC 08041_1 a) £ 0 O OD a) EaO a (a LL ED 0 0 -g C 0 th C 0 0 C) E 0 U- a) — a, (a (a C C a) C OQcJ NcflLflc -. - 00 -D a) a, -C 0 (I) NvHLflH CNNLfl 0 0 (a Q) H -c C 0 a) Ca -D a) -D CL) a) C (a J a) rH Ca 0) 0 D Ca ZID a) Ca 0 a) cn CL Ca Lfl c— . 9 E 0 - -D LnoccD a) ID 0 CD r- co 0 C 0 rxa) Hca U 1))) D IU a) a) -c Ui 0 0 0 0 CL Oa 1I CL E 0 0 C a).2 Ca 0 E -iw a)Ca 0 Ca N C Ca 0) C 0 HE LflrH NLO C Ca CN cn N C ca(a oa) OtC 0p g U) Ca (a C a) C 0 0 0 0 t 0 0 a) CD CD (a E U) o 0 C) Q- - 0 00 CN 0 0 a) U) U) -D a) .2 = 0> w Ca U)u t - DL0 CLflcJ 5 - - C)LLflrl 0 0 Hr g 02 U)> ow _0 U =; c E a) (a I- C a)a) CL 1W eCU cit c'I a) 61-- 0 C a) H -D C Ca Q) ci 0 ci C) 01 0 c -O - I0 U) cu 1 E Ca z - Ca (a 0 5) U z r4 N :,(a H U (a (a o LL 0 5, a4 El Coo 0) E 0 U-) U) 0 N () c -) a) C.) C,) Lfl N (N (N Cl] H -o (0 0 U) (0 -c (C) U) E- In Cl] 0 U H U) 0 0) -c Cl) U) U) U) 0 0 C t Cl) U) 0 0 U) Cl) 0 C- 0 U) U) C 0 Cl) Cl) a 0 0 Ix U (I) U) - D 0 0 CD E C 0 U) C U) 0 - c'J o 0) 4) ° E' EU) a x U) C 0 U) E 0 C U) -c U) > 0 a U) 0 SCHEDULE 0 (Form 990 or 990-EZ) Department of the Treasury Internal Revenue Service Supplemental Information to Form 990 or 990-EZ Complete to provide information for responses to specific questions on Form 990 or 990-EZ or to provide any additional information. Poo. Attach to Form 990 or 990-EZ. 101, Information about Schedule 0 (Form 990 or 990-EZ) and its instructions is atwww !rc p,w/ nrmQQfl Name of the organization CROSSROADS GRASSROOTS POLICY STRATEGIES 1 OMB No. 1547 (J 1'4 Open to Public Inspection Employer identification number 27-2753378 FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: ADVOCATE POLICY OUTCOMES ON PENDING LEGISLATIVE AND REGULATORY ISSUES SUCH AS: HEALTH CARE REFORM, TAXES, SPENDING AND DEFICITS, CONGRESSIONAL REFORM AND ENERGY AND ENVIRONMENT. THE PURPOSE OF THESE ISSUE ADVOCACY AND GRASSROOTS LOBBYING ACTIVITIES IS TO PROMOTE POLICIES THAT STRENGTHEN THE NATION'S ECONOMY, REDUCE REGULATION OF PRIVATE SECTOR ACTIVITY, AND RESTORE GOVERNMENT TO A SOUND FINANCIAL FOOTING. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: CROSSROADS GPS IS TO EMPOWER PRIVATE CITIZENS TO DETERMINE THE DIRECTION OF GOVERNMENT POLICYMAKING RATHER THAN BEING THE DISENFRANCHISED VICTIMS OF IT. THROUGH ISSUE RESEARCH, PUBLIC COMMUNICATIONS, EVENTS WITH POLICYMAKERS, AND OUTREACH TO INTERESTED CITIZENS, CROSSROADS GPS SEEKS TO ELEVATE UNDERSTANDING OF CONSEQUENTIAL NATIONAL POLICY ISSUES, AND TO BUILD GRASSROOTS SUPPORT FOR LEGISLATIVE AND POLICY CHANGES THAT PROMOTE PRIVATE SECTOR ECONOMIC GROWTH, REDUCE NEEDLESS GOVERNMENT REGULATIONS, IMPOSE STRONGER FINANCIAL DISCIPLINE AND ACCOUNTABILITY ON GOVERNMENT, AND STRENGTHEN AMERICA'S NATIONAL SECURITY. FORM 990, PART VI, SECTION B, LINE 11: ALL BOARD MEMBERS RECEIVE A COPY OF THE FORM 990 BEFORE IT IS FILED WITH THE IRS. DURING THE REVIEW PROCESS THE BOARD DISCUSSES THE FORM 990 WITH ACCOUNTANTS, COUNSEL AND THE CFO. LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule 0 (Form 990 or 990-EZ) (2014) 432211 08-27-14 13501116 796448 08041 47 2014.05000 CROSSROADS GRASSROOTS POLIC 080411 Name of the organization CROSSROADS GRASSROOTS POLICY STRATEGIES 1 Employer identification number 27-2753378 FORM 990, PART VI, SECTION B, LINE 12C: THE ORGANIZATION'S CONFLICT OF INTEREST POLICY REQUIRES ALL INTERESTED PERSONS TO DISCLOSE ANY POSSIBLE OR ACTUAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15: OFFICERS' COMPENSATION IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19: UPON REQUEST FORM 990, PART VII, SECTION A: STEVEN LAW AND CALEB CROSBY WERE COMPENSATED FOR THEIR ROLES IN THE DAY-TO-DAY OPERATIONS OF THE ORGANIZATION AND NOT AS OFFICERS. STEVEN LAW WORKS AN AVERAGE OF 17 HOURS PER WEEK FOR THE RELATED ORGANIZATION, AMERICAN CROSSROADS. CALEB CROSBY WAS PAID THROUGH CFC CONSULTING: $105,000 WAS PAID BY THE ORGANIZATION AND $51,000 WAS PAID BY THE RELATED ORGANIZATION, AMERICAN CROSSROADS. FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. PART III, LINE 4A AND 4C 432212 08-27-14 13501116 796448 08041 Schedule 0 (Form 990 or 990-EZ) (2014) — 48 2014.05000 CROSSROADS GRASSROOTS POLIC 080411 Name of the organization 1 27-2753378 Employer identification number CROSSROADS GRASSROOTS POLICY STRATEGIES TOTAL EXPENSES FOR THESE PROGRAM SERVICES INCLUDE AN ALLOCATION OF OVERHEAD, SALARIES AND CONSULTING EXPENSES. 05-27-14 13501116 796448 08041 Schedule 0 (Form 990 or 990-EZ) (2014) 49 2014.05000 CROSSROADS GRASSROOTS POLIC 08041_1 ? CD . Iz 0) C o C . 000 CL oo 0 . a) > C C 0 - > 0 LI 0 a) 0 LO N )- (N a) >' oN 0. (N 0 0) C a) 0 .0 C C- 0 E w a) 0 > C > 0 P CU .0 - C w 0__P_ o a)Q C.) a) a) E 0 ._.0 0 .2 a) 0 0 a) -C-- 0 0) a) a) a) S LO a) 0 a) 0 >' 0 H a) O) L c_ Q,? r . C.) OJQ .2 > 0 a) 0 a) o C- H 0) 0) (! 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C 0 cm C) -°-°E C C- COCa CaCa o E E 00 o a-Ca C > t > C 0 X_ ) 0 C 0 C C 0 Ca Ca a) -00 '5r OCC-Ca Ca 00 CL M C) C) Ca Ca E ()DO 00 ,OO(jj E m a) CC).O OVa) 03 c C 0 ci CE aC) '- 0 C E E CaCaCa.9?a) Ca Ca E (C) a) Ca Ca '5 '5 0 o a) Ca Ca 0 r C° Ca a) 0 Ca:) 3< C)) a) O0)aW1 ,... 0 ) ar...-, a) C - CaCa0O E C Ca C) 0 Ca a) 0 C)) E CC) z In a) Ca N a) a)0r ._ E CO Ja- a-c/)u) a) a) a) a) El 12 DD 0 EE a)a) Ca Ca Ca Ca 00 00 a) G) Ca Ca CC CC) Ca a) C CC) ii CL CF C)) I N Ca C) C 00 > [0 a) C) a) N re-) 0 0-) LC) o z — C)) 0 V) N N 0 C) a) a) a) C)) Ca Ca 0 N E 0 U- 0 = 00 0)00) L) C) C 0 C') >- -c -c o a) CE C) C)) Ca a) E a) C) S_Ca O(0 > a) 9o)) 0 Ca C)) Q) 0 NC,) C a) a) 0 C-) a) > 0 - a) Ca Cl) Ca -c a-) a) E 0 0 UC 0 a) E z 0 >- a) H a) a) Cc >- E 8 —C — CO C 0 0) a) a)ca > t 0 cx] E- rn In Ca NCa 0 Cl) U Ca-- E 0 °E a) .0 > Ca C o H C)) = a) .9 a) 0 - Ct 0) — E C))C) Cl] 0 —C 0. 0 C)) - 0 0 0 C-, a) 0 C)) Cl], C)) 0) C a) -D C))Ca Ca 0) 0 —Ca CC C) Cl] > > 0 E c o 0. 0 C)))) -C 0 Cl] Cl] Ca a) a) 0 U) U 0) C z ED E mc 8 21 C Ca >- 0) C— Ca o0 -o C) € C-)) c — a)O > t a)Ca 5 Ca': Schedule R (Form 99O)2014 CROSSROADS GRASSROOTS POLICY STRATEGIES 272753378 [Pail VII I Supplemental Information Page5 Provide additional information for responses to questions on Schedule R (see instructions). 432165 08-14-14 13501116 796448 08041 Schedule R (Form 990) 2014 54 2014.05000 CROSSROADS GRASSROOTS POLIC 08041_1 N N 0 0 N N 0 N N 0 CS) 0 .0 UJ0 00 <0 N o 0 0 C) 0 0 S S 0 S N a) C 0 0 Ca N Ca a) L) ow 0= 0)00 Ca 0 N )fl LC) 0 0 0 S 0 LO N S LI) Oç)O. 0 00 N N CO (I) C = cr cL ow (ID LI) C a) uj LI) 01 N 0 N C N N 0 CS) 0 CD 0 0 0 0 m m to CO 5 S o a) (0 a 0' o CL, 0 0. CO 000> _J •0 0 = 0 .0 0 )O C 0 N 0 55 0) N-0 m 55 -) z 0. CO 0 cr= 0 is El ui cc CLII) 0 Form 8868 (Rev. 1-2014) Page 2 LX] • If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II and check this box Note. Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form .... 8868. . • If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1). Additional (Not Automatic) 3-Month Extension of Time. Only file the original (no copies needed). Part Ill Enter filer's identifvina number. see instructions Type or f Name of exempt organization or other filer, see instructions. Employer identification number (EIN) or print ROSSROADS GRASSROOTS POLICY STRATEGIES Filebythe due date for 27-2753378 Number, street, and room or suite no. If a P.O. box, see instructions. filing your Social security number (SSN) 5 N. HILL DRIVE, NO. 100 return. See instructions. City, town or post office, state, and ZIP code. For a foreign address, see instructions. ARRENTON, VA 20186 FO- F-1-1 Enter the Return code for the return that this application is for (file a separate application for each return) Return Application Code Is For Form 990 or Form 990-EZ Application Return Is For Code 01 . Form 990-BL 02 Form 1041-A 08 Form 4720 (individual) 03 Form 4720 (other than individual) 09 Form 990-PF 04 Form 5227 10 05 1 Form 6069 11 06 1 Form 8870 12 1 Form 990-T (Sec. 401(a) or 408(a) trust) Form 990-T (trust other than above) . STOP! Do not complete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868. CALEB CROSBY 1615 L STREET NW, STE 1230 - WASHINGTON, DC 20036 2027067051 Fax No. • The books are in the care of Telephone No* . LIII • If the organization does not have an office or place of business in the United States, check this box • If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) LII . If it is for part of the group, check this box box and attach a list with the names and EINs of all members the extension is for. 4 I request an additional 3-month extension of time until 5 For calendar year 2014 NOVEMBER 15, 2015. ________________ , and ending or other tax year beginning If the tax year entered in line 5 is for less than 12 months, check reason: 6 LII . If this is for the whole group, check this L_] Initial return L.J Final return Change in accounting period State in detail why you need the extension 7 ADDITIONAL TIME NEEDED IN ORDER TO OBTAIN ALL NECESSARY INFORMATION. 8a If this application is for Forms 990-BL, 990-PF, 990-1, 4720, or 6069, enter the tentative tax, less any nonrefundable credits. See instructions. tax payments made. Include any prior year overpayment allowed as a credit and any amount paid 0 Sb $ 0 8c $ 0 - previously with Form 8868. C 1 $ Be b If this application is for Forms 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated Balance due. Subtract line 8b from line 8a. Include your payment with this form, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions. Signature and Verification must be completed for Part II only. Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, ills true, correct, and complete, and that I am authorized to prepare this form. Signature Title CPA Date Form 8868 (Rev. 1-2014) 423842 09-15-14 13501116 796448 08041 56 2014.05000 CROSSROADS GRASSROOTS POLIC 080411