13260207 765919 CRO28 2016.05050 CROSSROADS REHABILI ...

PUBLIC DISCLOSURE COPY

13260207 765919 CRO28

20 1 6.05050 CROSSROADS REHABIL I TATION CRO28_ 1

?? PUBLIC DISCLOSURE COPY**

990 Form

Return of Organization Exempt From Income Tax

Under sectio n 50 1(c), 527, or 4947{a){1) of the Internal Revenue Code (except privat e foundations)

Department of tho Treasury Internal Revenue Service

Iii-- Do not enter social security numbers on this form as it may be made public.

Information about Form 990 and its instructions is at

A For the 2016 calendar year, or tax year beginning B Check if C Name of organizat ion

applicable:

JUL 1 201 6

and ending J UN 30 2017 '

D Employer identification number

DAddress

c hange

CROSSROADS REHAB ILITAT ION CENTER , INC,

0~~~~8

o lnitial return

DFinal

return/ terminated

Doino business as EASTER SEALS CROSSROADS Number and street (or P.O. box if mail is not delivered to street address) 4 740 KINGSWAY DR I VE

City or town , st at e or province, country, and ZIP or foreign postal code

I 35 - 0869058 Room/suite E Telephone number (3 17)466 - 1000

G Gross receipt s $

19,963,208 .

oAmended ret urn

DAppHca-

lion pending

INDIANAPOLIS, IN 46205

F Name and add ress of principal officer: J . SAME AS C ABOVE

I Tax-exempt status: f X l 501(c)(3) I l 501/c) (

PATRICK SANDY

l .... {insert no.) I

I 4947/a)/1) or I

H(a) Is this a group return

1527

for subordinates? ...... D Yes ~ No H(b) /l,e a ll subordinates included? D Y es 0 No

If "No," attach a list. (see instructions)

J Website: .... WWW . EASTERSEALSCROSSROADS . ORG

K Form of oraanization: Ix 7 Corporation I 7 Trust f 7 Association I I Pa rt 11 Summary

I Other Iii--

H(cl Group exemotion number Iii--

I I L Year of formation: 195 9 M State of leaal domici le: IN

1 Briefly d escribe the organization's mission or most significant activities: SEE SCHEDULE 0

Q)

0

... .... C:

ta C:

2

Check this box

D if the organization discontinued its operations or disposed of more than 25% of its net assets.

Q)

.... >

c0.,

c!S

3 4

Number of voting members of the governing body (Part VI, line 1a) .... ............ ............ ...... . . . ? ???? ?

Number of independent voting members of the governing body (Part VI, line 1b) .. ..... ??? ?????? ... . ... . ..... ....

3 4

VI

:!

.'>:: < 0

. 5 Total number of individuals employed in calendar year 2016 (Part V, line 2a) . . . . . . . . . . ...... . ............ . ........... ... .. . 6 Total number of volunt eers (estimate if necessary) ... . .... ............... ... ... .. ?????????? ?? .. .... . ............ ............

7 a Total unrelated business revenue from Part VIII, co lumn (C), line 12 .... .. .. .. .... .. ..... .... .. ...... . ..... ..............

5 6 7a

b Net unrelated business taxable income from Form 990-T line 34 ? ? ?? ? ?? ? ? ? - .. .... . . . . .. ..... ...... . .... .. ... ..

7b

Prior Year

Q) 8

::,

C: 9

Q)

Contributions and grants (Part VIII, line 1h) Program service revenue (Part VIII, line 2g)

.. .. .. ................. ...... .. ..... ....... ? ? .. . ... .....

. ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

??? ...... . ... ..

. >

Q)

a:

10 11

Investment income (Part VIII, column (A), lines 3, 4, and 7d) .. ..... ???? ? ? ?????? . . . .. . . . . . . . . .. Other revenue (Part VIII, column (A), lines 5, 6d , 8c, 9c, 1Oc, and 11e) ?????

12 Total revenue ? add lines 8 throuah 11 /must eaual Part VIII, column (A), line 12) .........

5,535,4 0 2. 7,408,487 .

785,953. 50,792.

13,780,634 .

13 Grants and similar amount s paid (Part IX, colu mn (A), lines 1-3) ... ? ??????? ??? ? .. ........ .....

14 Benefits paid to or for members (Part IX, column (A), line 4) .... .. .. ... .... .. ...... ... ? ?? ?????

VI 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5?10) ... ......

Q)

.... VI

C:

16a Professional fundraising fees (Part IX, column (A), line 11e) ...... .... ...... .. .... .... ......... ..

Q)

Q. b Total fundraising expenses (Part IX, column (D}, line 25)

353,450 ,

)(

w 17 Other expenses (Part IX, column (A), lines 11a-11 d, 11 f-24e) ... .... ........ ......... .. .... .. .....

18 Total expenses. Add lines 13?17 (must equal Part IX, column (A), line 25) ..... ..... .........

44 , 742. 0.

8 , 448, 725 . 0.

4,80 1, 52 6. 13,294,993 .

19 Revenue less exoenses. Subtract line 18 from line 12 ..... ?????????? ?-

*~~~ . "la

20 21

Tot al assets (Part X, line 16) .............. ..... ..... .... .. . . . . . . . . ?? ????? .. ... ... .... .. .............. .... Tot al liabilities (Part X, line 26) ...... ??? ????? ? ????? ? .. .. .. ..... ........ ..... .. ... . . . . . . . ...........

i1 22 Net assets or fund balances. Subtract line 21 from line 20 .... ...... ...

I I Pa rt II Signature Block

?? ????? ????? ???? ...

4 85,641 .

Beainnina of Current Year 34,01 7 ,746. 2,400,714 . 31,617,03 2.

25 25 34 9 94 5 0. 0.

Current Year 3, 591,916 . 8, 478,601. 966,628. 117,775,

13, 154,920 . 54,577. 0.

9,697,07 1. 0.

5,469,920. 15,221,568 . - 2,066,648 , End of Year 33,32 4 , 463 .

2,568, 40 8 . 30,756 , 055 ,

Under penalties of perjury, I declare that I have examined this return, inclu ding accompanying schedules and statements, and to the best of my knowledge and belief, it is

true, correct, an

ptete:-Beel

all information of which preparer has any knowledge.

Sign H er e

Preparer's signature Paid Preparer Use On ly Firm' s address ... 5342 W. VERMONT STREET

INDIANAPOLIS I N 46 224 May the IRS d iscuss this return with the preparer shown above? (see instructions) 632001 11- 11-16 LHA For Pa perw ork R eduction Act N otice, see the separate instruct ions.

Date

Check D

PTIN

if

self-employed 0 1 06 2 615

Firm's EIN

35 - 1489521

Phone no,317 - 241 - 2999

D [KJ Yes

No

Form 990 (2016)

Form990 2016

CROSSROADS REHABILITATION CENTER, INC.

Part Ill Statement of Program Service Accomplishments

Check if Schedule O contains a response or note to any line in this Part Ill ... Briefly describe the organization's mission: EASTERSEALS CROSSROADS PURPOSE IS TO CHANGE THE WAY THE WORLD DEFINES AND VIEWS DISABILITY BY MAKING PROFOUND AND POSITIVE DIFFERENCES IN PEOPLE'S LIVES EVERY DAY.

35-0869058

Pa e 2

2 Did the organization undertake any significant program services during the year which were not listed on the

prior Form 990 or 990-EZ? .......... ......... ................

....... ........ .. ........ ........... ................ ....... ........ ..... .

D ves !TI No

If "Yes, " describe these new services on Schedule 0 .

D 3 Did the organization cease conducting, or make sign ificant changes in how it conducts, any program services? .......... .. .... ..

Yes [TI No

If "Yes, " describe these changes on Schedule 0.

4 Describe the organization's program service accomplishment s for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501 (c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4a {Code: _ _ _ _ ) {Expenses S

1 , 7 5 9 , 7 7 0. including grants of S _ _ _ _ _ _ _1_5.:..'7_ 2 1_ _. ) {Revenues _ _ _ _ _ _1 .:'.._6 _6_0.:..'_42__8_.

EMPLOYMENT - SERVICES OUR CONSUMERS RECEIVE THROUGH THE EMPLOYMENT

DIVISION ARE BASED ON INDIVIDUAL NEEDS AND ARE DESIGNED TO PROMOTE THE

HIGHEST LEVEL OF INDEPENDENCE POSSIBLE. SERVICES RANGE FROM CAREER

COUNSELING THROUGH OUR COMMUNITY BASED ASSESSMENT PROGRAM TO

COMPREHENS I VE JOB PLACEMENT ASSISTANCE INCLUDING JOB SEEKING SKILLS

TRAINING, INTERNSHIPS, JOB COACHING, AND LONG TERM JOB RETENTION . OUR

EMPLOYMENT CONSULTANTS PLACED 135 JOB SEEKERS WITH DISABILITIES IN JOBS

THAT MATCHED THEIR INTEREST, PREFERENCES AND ABILITIES. OF THOSE

PERSONS SECURING EMPLOYMENT, 88% RETAINED EMPLOYMENT FOR AT LEAST 6

MONTHS. THROUGH THE PROJECT SEARCH SCHOOL-TO-WORK TRANSITION PROGRAM

WE PROVIDED 9 MONTHS OF INTENSIVE VOCATIONAL TRAINING OPPORTUNITIES TO

27 STUDENTS WITH DISAB ILIT IES AGED 18-22 DURING THEIR SENIOR YEAR OF

4b {Code: _ _ _ _ ) (Expenses S

4 , 15 5 , 7 0 9 ? including grants of S

3 8, 6 0 9 . ) (Revenue S

MEDICAL - MEDICAL REHABILITATION SERVICES REPRESENT A RANGE OF PROGRAMS

DESIGNED TO ASSIST CHILDREN AND ADULTS, WITH DISABIL ITIES TO BE AS

I NDEPENDENT AS POSSIBLE. EARLY INTERVENTION SERVICES PROVIDE HOME - BASED

SERVICES FOR CHILDREN LESS THAN THREE YEARS OF AGE . CHILDREN ' S THERAPY

SERVICES PROVIDE OCCUPATIONAL, PHYSICAL, AND SPEECH THERAPY SERVICES

FOR CHILDREN WITH A WIDE RANGE OF DIFFERENT DISABILITIES. THESE

SERVICES MAY ASSIST A CHILD TO LEARN TO WALK FOR THE FIRST TIME OR TO

BE ABLE TO CARE FOR THEMSELVES. OUR UNIQUELY TRAINED STAFF IN OUR

2,691,233 . )

AUGMENTATIVE COMMUNICATION PROGRAM CAN ASSIST CHILDREN AND YOUNG ADULTS USE COMPUTERS OR OTHER TECHNOLOGY TO COMMUNICATE WITH THEIR LOVED ONES. OUR MEDICAL SOCIAL WORK STAFF PROVIDES SUPPORT TO THE CHILD AND FAMILY THROUGH THE CHALLENGE REHABILITATION . THE DRIVER EVALUATION AND

4c {Code: _ _ _ _ ) {Expenses$

3,083,684. includingg,ants ofS _ _ _ _ _ __ __ _ _ ) (RevenueS _ __ _ _ _-3'-,0__0_7 .:..9,__0 _5_. )

CROSSROADS INDUSTRIAL SERVICES - CROSSROADS INDUSTRIAL SERVICES (CIS)

IS A SOCIAL ENTERPRI SE WITH A MISSION TO PROVIDE EMPLOYMENT FOR PEOPLE

WITH DISABILITIES . WE OPERATE IN THE TWO BUSINESS SEGMENTS OF CONTRACT

MANUFACTURING AND DOCUMENT SCANNING. THOSE PERSONS EMPLOYED AT THIS

LOCATION ARE INDIVIDUALS THAT MAY REQUIRE SUPPORT IN ORDER TO MAINTAIN

EMPLOYMENT . AT CIS, WE CAN DESIGN SUPPORTS AROUND THE INDIVIDUAL' S

NEEDS SO THAT THEY CAN WORK AND EARN A LIVING WAGE, ALL PERSONS

EMPLOYED RECEIVE MINIMUM WAGE OR BETTER AND ARE ELIGIBLE FOR OTHER

BENEFITS, INCLUDING HEALTH CARE, RETIREMENT AND PAID TIME OFF , CIS

RECEIVES NO FUNDING FROM THE STATE OR FEDERAL GOVERNMENT.

4d Other program services (Describe in Schedule 0 .)

(Expenses S

3 , 718 , 10 8 ? including grants of S

24 7 . ) (R evenue S

1 ,624,868 .)

4e Total program service expenses~

12,717,271 .

632002 11- 11- 16

SEE SCHEDULE O FOR CONTINUATION(S)

2

Form 990 (2016)

1 3260207 765919 CRO28

2016 .0 5 050 CROSSROADS REHABILITATION CRO28_ 1

Form 990 12016\

CROSSROADS REHABILITATION CENTER INC.

I Part IV I Checklist of Required Schedules

35- 0869058

Paae 3

1 Is the organization described in section 50 1(c)(3) or 4947(a)(1) (other than a private foundation)?

If " Yes," complete Schedule A ..... . ...... .. .... ....... ....... ......... ................ ...... ........ .......... ................ ........ ....... ...... ....... .......... 2 Is the organization required to complete Schedule B, Schedule of Contributors? ........... ....... ...... .............. . .... .. ............... 3 Did t he organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for

public office? If "Yes, " complete Schedule C, Part I ........ ....... .. ...... .. ......................... ........................................ ..... ...... .. 4 Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501 (h) election in effect

during the tax year? If "Yes," complete Schedule C, Part II ...... . ... ........ ...... ...... ........ ....... ......... ...... ..... .. ........ ...... ........... ..... 5 Is the organization a section 501(c)(4), 501 (c)(5), or 501 (c)(6) organization that receives membership dues, assessments, o r

similar amounts as defined in Revenue Procedure 98?19? If "Yes," complete Schedule C, Part Ill .......... ........ .. ...... .... ..... ...... 6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to

provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule o, Part I

7 Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part 11 ....... ...... ....... ........... .........

8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete

Schedule D, Part Ill ... ............. ............. ....... ............ .. ................ .............................. ... ..... .. .. .... ........................... ..... .. .... 9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability, serve as a custodian for

amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services?

If "Yes," complete Schedule D, Part IV ........ ................................................. ................................ .... ... .. .. ..................... 10 Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent

endowments, or quasi?endowments? If "Yes," complete Schedule D, Part V ...................... ....... ........ ................... .. ..... .... .... 11 If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X

as applicable.

a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes, " complete Schedule o,

Part VI .... ...... .. .. . ... . ....... ...... ... ... .. .... .. ... . ..... ............... ............ ... ....... ......... .. ............. ..... ... .. ........ .. ............... b Did the organization report an amount for investments ? other securities in Part X, line 12 that is 5% or more of its total

assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII .... ........ ...... ......... .... ....... .. ... .............. ..... .... .. ... c Did the organization report an amount for investments ? program related in Part X, line 13 that is 5% or more of its total

assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII ... .............. .................... ..... ........ ................ ..... d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in

Yes No

X 2 X

3

X

4

X

5

X

6

X

7

X

8

X

9

X

10 X I

11a X

11b

X

11 c

X

Part X, line 16? If "Yes," complete Schedule D, Part IX .... ....... ....... ................... ..... ....... ............. ......... ................. .. ..... ....... .. 1-=-1..:.1=-d4-_--1-_x_

e Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X ...... .... ....... 11e X

f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses

the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule o, Part X ......... .. i---;1c...:1.:...f4-_--1-_x_

12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete

Schedule D, Parts XI and XII ............................ ..... .... .... ....... ...... ............ .............. ....... ....... ........ .... ...... .. ....... ..... ...... . .... b Was the organization included in consolidated, independent audited financial statements for the tax year?

12a X

If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional .... ...... ..... l-"12"'b"-+---1-x_

13 Is the organization a school described in section 170(b)(1)(A)(li)? If "Yes," complete Schedule E ..... ....... ...... ....... ...... ..... ..... . 1---'1'-"3'---+----1-x_

14a Did the organization maintain an office, employees, or agents outside of the Unit ed States? ....... ..... .. ... .. .................. ..... .

14a

X

b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business,

investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000

or more? If "Yes," complete Schedule F, Parts I and IV .... .... .. ..... ...... ............. ............. ...... .. ... ... ...... .. ...... ....... ..... . ........ .. .. 1--14-"b"-+----+-x_ 15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance t o or for any

foreign organization? If " Yes, " complete Schedule F, Parts II and IV .... ...... .. .... ......... ... .. .. .... ... ... ... ...... ......... .. ...... ...... . ..... . t--1'-5" '-+----+-x_ 16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to

or for foreign individuals? If "Yes," complete Schedule F, Parts Ill and IV .. .. ...... .... ... ........... ... .......... .. .............. . ......... .... .. .. t--1'-"6'-+----+x-_ 17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,

column (A), lines 6 and 11 e? If "Yes, " complete Schedule G, Part I ........................................ ............ ...... .................. .. ..... 17

X

18 Did the organization report more than $ 15,000 total of fundraising event gross income and contributions on Part VIII, lines

1c and 8a? /f "Yes," complete Schedule G, Part II .. ... ..... ................. ... .................... ... ... .... ... ......... .............. ...... .... ...... . 19 Did the organization report more than $ 15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes,"

18 X

-

r, o~..+ Ill ..... .. ...... ... ... . ....................... ... .. ....... ...................... ... ... ..... . . ... .. . ... .. ... .... .. .... .. . ... .. .... .. .

19 X

Form 990 (2016)

632003 11- 11- 16

13260207 765919 CRO28

3 2016 .0 5050 CROSSROADS REHABILITATION CRO28 1

Form 990 12016\

CROSSROADS REHABILITATION CENTER, INC .

I Part IV I Checklist of Required Schedules (continued!

35- 0869058

Paae 4

Yes No

20a Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H ........ .. .... .. ............. .... ............... i-=20:::;a=--i-_--1_x_

b If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? .... .. .. .... . .... ...... ..... . t-=20-'-b=--i---1-2 1 Did the organization report more than $5,000 of grants or other assistance to any domestic organization or

domestic government on Part IX, column (A), line 1? If "Yes," complete Schedule/, Parts I and II ....... ...... .. ... ......... .............. 21

X

22 Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on

Part IX, column (A), line 2? If "Yes, " complete Schedule I, Parts I and Ill ......... ....... ........ ............... .... .. ... ............ ....... ...... . 22 X 23 Did the organization answer "Yes" to Part VII, Section A, line 3, 4 , or 5 about compensation of the organizat ion's current

and former officers, directors, trustees, key employees, and highest compensated employees? ff "Yes, " complete

Schedule J ......... ...... ...... ...................................................... ........................... ....... ...... ...... ......... ................. ................ 24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the

23 X

last day of the year, that was issued after December 3 1, 2002? If "Yes, " answer tines 24b through 24d and complete

Schedule K. If "No ", go to line 25a .......... ....... ..... .. ............ ............ ........ .................... .............. ................... ........ . ..... .... . b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease

24a X 24b X

any tax-exempt bonds? ... ................ ............................................................... ................. ..... ....... ............................ ....... i-=24..:.c=--i-_--1_x_ d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? .......... ... ..... .. ..... ........ 1-2=-4..:.d=--i-_--1x__ 25a Section 501{c)(3), 501{c)(4}, and 501(c)(29) organizations. Did the organization engage in an excess benefit

transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ........................ ..... ..... .. ..... ..... 25a

X

b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and

that the transaction has not been reported on any of the organizat ion's prior Forms 990 or 990-EZ? ff "Yes," complete

Schedule L, Part I ................. .. ....... ...... ......... ........... ...... ...... ................. ............................... ...... ............. ............... ... .... 25b

X

26 Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or

former officers, directors, t rustees, key employees, highest compensated employees, or disqualified persons? ff "Yes,"

complete Schedule L, Part II ...... .............. ...... ....... ....... ...... ................................ .. ...... ...... ...... ...... ............ ....... .. .......... . 26

X

27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial

contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member

of any of these persons? If "Yes," complete Schedule L, Part Ill ... ...... ....... .... .. .... .............. .......................... ................ .. 27

X

28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV

instructions for applicable filing thresholds, conditions, and exceptions):

a A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part JV

28a

X

b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV

28b

X

c An entity of which a current or former officer, d irector, trustee, or key employee (or a family member thereof) was an officer,

director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV. ... ........... ..... .. ....... ........... ...... ...... ...... ... t-=2.c.8c=--i--- 1 -x29 Did t he organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M .... ........... ........... l-'2'""'9'--+- - 1 -x30 Did the organization receive contributions of art, historical t reasures, or other similar assets, or qualified conservation

contributions? If "Yes," complete Schedule M ..... ...... ................................. ...... ..... .. .... ...... ...... ....... ........ .......... .. .... ....... . 30

X

31 Did the organization liquidate, t erminate, or dissolve and cease operations?

If "Yes," complete Schedule N, Part I ......... ...... ..... ............. .. ..... ................ .. .. .... .. ................. .. ............ ....... .... ............ ..... 31

X

32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete

Schedule N, Part JI ............. ....... .. ...... ................... .. ............ .... .... .......... ................................. ..... .. ...... ..... ... ... ............ .... 32

X

33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations

sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ............... ...... ............. .. ...... ...... ..... ...... ........... 33

X

34 Was the organization related to any tax-exempt or t axable entity? If "Yes," complete Schedule R, Part II, Ill, or IV, and

Part V, line 1 ...... ............ .. ...................... .... .. ....... ........... ............ ....... ...... ........... .. ...... .... .......... ..... ..... ..... .. ...... ...... ... .... 34

X

35a Did the organization have a controlled entity within the meaning of section 51 2(b)(13)? .... ...... ..... ...... ........ ............. ........ 1-35=a=--i-_--1_x_

b If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity

within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part v, tine 2 . ........ ...... ...... ..... ...... ............ .......... 1-35=b=--i----1- -

36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization?

If "Yes," complete Schedule R, Part V, line 2 .. ............ .. ..... ...... ....... ..... .. ......................... . ............. ..... ....... ..................

36

X

37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization

and that is treated as a partnership for f ederal income t ax purposes? If "Yes," complete Schedule R, Part VI .. .................. . 37

X

38 Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 b and 19?

Note. All Form 990 filers are required to complete Schedule O ...... ... ...... ...... ............ ..... ....... ..... ...

38 X

Form 990 (2016)

6 32004 11-11- 16

1 326020 7 7659 1 9 CRO28

4 2016.05050 CROSSROADS REHABILITATION CRO28 1

Form990 2016

CROSSROADS REHABILITATION CENTER INC.

Part V Statements Regarding Other IRS Filings and Tax Compliance

Check if Schedule O contains a response or note to any line in this Part V

35 - 08690 58

1a Enter the number reported in Box 3 of Form 1096. Enter ?O? if not applicable

I 1a I

b Enter the number of Forms W-2G included in line 1a. Enter ?O? if not applicable .... .. ..... .. .......

1b

c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming

92 0

1c

Pa e 5

n

Yes No

X I

b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

2b X

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instruct ions)

3a Did the organizat ion have unrelated business gross income of $1 ,000 or more during the year? ............. .... .. ...... ... .. ...... .. .. 3a

X

b If "Yes," has it filed a Fo rm 990-T for this year? If "No," to line 3b, provide an explanation in Schedule O .. .. ..... .. ... ............... 3b

4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a

financial account in a foreign country (such as a bank account, securities account , or other financial account)?

4a

X

b If "Yes," enter the name of the foreign country: .... _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?

5a

X

b Did any taxable party notify the organization that it was or is a party t o a prohibited tax shelter transaction? ..... .................. .. . 5b

X

c If "Yes," to line 5a or 5b, did the organization file Form 8886-T? .. .. . ......... _........... ....... ....... ......................... ............... . .. 5c

6a Does the organization have annual gross receipts that are normally greater than $100,000, and d id the organization solicit

any contributions that were not tax deductible as charitable contributions?

6a

X

b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts

were not tax deductible?

6b

7 Organizations that may receive deductible contributions under section 170{c).

a Did the organization receive apayment in excess of $75 madepartly as a contribution and partly for goods and services provided to the payor? 7a X

b If "Yes," did the organization notify the dono r of the value of the goods or services provided?

7b X

c Did the organizatio n sell, exchange, or otherwise dispose of tangible personal property for which it was required

d :;..~ ::~;:d~!~::he?~~~~~;~;~~~~~-~-~?~~?;;;~~?~~~;~~?~~~;~~~? ???:::?..::::.? ::::.?: ::::: ?::::.?:::::?:::::: ::?? .. ?j??;~?? j?? ..... .............. . 7c

X

e Did the organization receive any f unds, directly or indirectly, to pay premiums on a personal benefit contract?

7e

X

f Did the organizatio n, during the year, pay premiums, directly or indirectly, on a personal benefit contract? .. ........... ...... .. ..... 7f

X

g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ... 7q Nil\

h If the organization received a contribution of cars, boats, airplanes, or ot her vehicles, did the organization file a Form 1098-C? 7h Nil\

8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the

N/A

sponsoring organization have excess business holdings at any time during the year?

8

9 Sponsoring organ izations maintaining donor advised funds. a Did the sponsoring organization make any taxable distributions under section 4966? b Did the sponsoring organization make a distribution t o a donor, donor advisor, or related person?

N/A

9a

N/A

9b

10 Section 501(c){7) organizations. Ent er: a Initiation fees and capital contributions included on Part VIII, line 12

N/A I ma I

b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities .. ..... ....... .. 10b

11 Section 501{c){12) or ganizations. Enter: a Gross income from members or shareholders

N/A

11 a

b Gross income from other sources {Do not net amounts due or paid t o other sources against

amounts due or received from them.) .................... ..... .................. .. ....... _.. .............. ............ ..... "'-'-1-'-1b~------ --1

12a Section 4947{a}{ 1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041 ?

12a

I I b If "Yes, " enter the amount of tax-exempt interest received or accrued during the year .....NJA:.. . 12b ' - - - " = " - - ' - - - - - - -- - 1

13 Section 501(c){29) qualified nonprofit health insurance issuers.

a Is the organization licensed to issue qualified health plans in more than one state? .. ... .. ........... ...... ... ......... ..... ...... N/A ????? 13a Note. See the instructions for additional information the organization must report on Schedule 0.

b Enter the amount of reserves the organization is required to maintain by t he states in which the organization is licensed to issue qualified health plans

I 13b I

c Enter the amount of reserves on hand

13c

14a Did the organizatio n receive any payments for indoor tanning services during the tax year? ..... ............................ . ..........

b If "Yes," has it filed a Form 720 to reoort these oavments? If " hi~ " M~.,;r10 :>n

o in ,..._.__...,.,10 ............... .. .. .... .. ..

14a

X

14b

Form 990 (2016)

632005 11- 11- 16

1 326 0 20 7 765919 CRO28

5

2016.0 5 0 5 0 CROSSROADS REHABILITATION CRO28 1

Form 990 2016

CROSSROADS REHABILITATION CENTER INC.

35-0869058

Pa e 6

Part VI Governance, Management, and Disclosure For each "Yes" response to lines 2 through lb below, and tor a "No " response

to line Ba, Bb, or 1Ob below, describe the circumstances, processes, or changes in Schedule 0. See instructions.

Check if Schedule O contains a response or note to any line in this Part VI

Section A. Governing Body and Management

1a Enter the number of voting members of the governing body at the end of the tax year ........ . ........ 1a If there are material differences in voting rights among members of the governing body, or if the governing

Yes No 25

body delegated broad authority to an executive committee or similar committee, explain in Schedule 0.

b Enter the number of voting members included in line 1a, above, who are independent

1b

25

2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other

officer, director, trustee, or key employee?

2

X

3 Did the organization delegate control over management duties customarily performed by or under the direct supervision

of officers, directors, or trustees, or key employees t o a management company or other person?

3

X

4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ......... ..... 4

X

5 Did the organization become aware during the year of a significant diversion of the organization's assets?

5

X

6 Did the organization have members or stockholders?

6

X

7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or

more members of the governing body?

7a

X

b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or

persons other than the governing body? ............. ................... ..................... ... ................. ........ ...... ............................. .... 7b

X

8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

a The governing body? ................ ... ......................... .... ................ ..... ...... ........ ...... ....... .. .... .. ...... ...... ........ ..... ... ...... . ......... b Each committee with authority to act on behalf of the governing body? 9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the

Sa X Sb X

oroanization 's mailino address? If "V=~ " M~.,;,.,~ +hn "~~"~ and

Section B. Policies

in ".. "'" O ...... ....... ... ...................... ..... ..... 9

X

10a Did the organization have local chapters, branches, or affiliates? .. .... .. ..... .. .... ............ .. ....... ........ ....... ............ b If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates,

Yes No

10a

X

and branches to ensure their operations are consistent with the organization's exempt purposes? ......... ................... 11 a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?

b Describe in Schedule O the process, if any, used by the organization to review this Form 990.

10b 11a X

12a Did the organization have a written conflict of interest policy? If "No," go to line 13

.................... .

b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? .

c Did the organization regularly and consistently monitor and enforce compliance w ith the policy? If "Yes, " describe

12a X 12b X

in Schedule O how this was done . .................... ......................................... ............ ................

... ... ..... .. . .....

13 Did the organization have a written whistleblower policy? .... .. ...... ...... ...... ...... .. .......................................

14 Did the organization have a written document retention and destruction policy? . .......................... ..... ........ ....... .....

15 Did the process for determining compensation of the following persons include a review and approval by independent

12c X 13 X 14 X

persons, comparability data, and contemporaneous substant iation of the deliberation and decision?

a The organization's CEO, Executive Director, or top management official ................. ...... ....... ............ ........ ...... ....... ........ b Other officers or key employees of the organization .. .. ...... ...... ........ ............. .......................

If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).

15a X 15b X

16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a

taxable entity during the year? ................. ...................................

.............. ....... ... ..... ........ .

b If "Yes, " did the organization follow a written policy or procedure requiring the organization to evaluate its participation

16a

X

in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's

exem t status with res ect to such arran ements? .

16b

Section C. Disclosure

17 List the states with which a copy of this Form 990 is required to be filed ..,__I_N_ _ _ _ __ _ _ __ _ _ _ _ _ _ _ _ _ _ __ _ _ __

18 Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only) available

for public inspection. Indicate how you made these available. Check all that apply.

CK::] Own website

D Another's website

CK::J Upon request

D Other (explain in Schedule O)

19 Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial

statements available to the public during the tax year.

20 State the name, address, and telephone number of t he person who possesses the o rganization's books and records: ..,_ _ _ __ _ _ _ __ SUSAN SAUNDERS, CFO - 317 - 466 - 1000

4 74 0 KINGSWAY DRIVE, INDIANAPOLI S IN 462 05

632006 11- 11-16

1 326 0207 765919 CRO28

Form 990 (201 6) 6

2016.05050 CROSSROADS REHABILITATION CRO28_ 1

Form990 2016

CROSSROADS REHABILITATION CENTER, I NC.

35- 0869058

Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated

Employees, and Independent Contractors

Pa e 7

Check if Schedule O contains a response or note to any line in this Part Vil

D

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensat ed Employees

1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization 's tax year.

? List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0? in columns (D), (E), and (F) if no compensation was paid.

? List all of the organization's c urrent key employees, if any. See instructions for definition of "key employee."

? List the organization 's five curre nt highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations.

? List all of the organization's former officers, key employees. and highest compensated employees who received more than $ 100,000 of reportable compensation from the organization and any related organizations.

? List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organizatio n. more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional tru stees; officers; key employees; highest compensated employees; and former such persons.

n Check this box if neither the oraanization nor anv related oraanization comoensated anv cu rrent officer director or trustee.

(A) Name and Title

( 1) STEPHEN ORANDER CHAIR ( 2) PAULA TAYLOR- WHITFIELD

(B)

Average hours per

week

(C)

Position

(do not check more than on e box, unless person is bo th an officer and a direc tor/ trustee}

(list any

B ~

hours for "5

rel ated

0

organizations ~

below ] ?;;

line)

~

1. 00

~

I 5

= ~

- 11 ~ E

! j .S"E

"" "'=

X

X

1. 00

(D)

Reportable compensation

fro m the organization (W-2/1099-MISC)

(E)

Reportable compensation from related organizati ons (yV-2/1099-MISC)

(F)

Estimated amount of

other compensation

from the organizati on and related organ izati ons

0.

0.

o.

BOARD FIRST VICE CHAI R ( 3) PHILI P BELT

X

X

1. 00

0.

0.

0.

BOARD SECOND VICE CHAIR ( 4) KENNETH KOBE

X

X

1.00

0.

0.

0.

TREASURER ( 5) J. PATR I CK SANDY

X

X

37 .50

0.

0.

0.

PRES ! D E N T / CEO ( 6) PH ILIP WHISTLER

X

X

1.00

174,585.

0.

1 7 ,885.

DIRECTOR

( 7) c. DAVI D MOORE

X 1.00

0.

0.

0.

DIRECTOR ( 8) KRISTA HOFFMANN- LONGTIN

X

1 .00

0.

0.

0.

DIRECTOR ( 9) DARLISA E . DAVIS

X

1 . 00

0.

0.

0.

DI RECTOR ( 10) RI CHARD COPPLE

X

1.00

0.

0.

0.

DIRECTOR (11) REBECCA FELDMAN

X

1.00

0.

0.

0.

DIRECTOR ( 1 2 ) BRADLEY MOORE

X

1 . 00

0.

0.

0.

DIRECTOR ( 13) DEAN WESELI

X

1.00

0.

0.

0.

DI RECTOR ( 14 ) JIM HAMMOND

X

1.00

0.

0.

0.

DIRECTOR ( 15) DAWN NEAL

X

1.00

0.

0.

0.

DIRECTOR ( 16) BILL COLEMAN

X

1.00

0.

0.

0.

DIRECTOR ( 17) STEPHEN GI LLMAN

X

1. 00

0.

0.

0.

DIRECTOR

X

0.

0.

0.

632007 11- 11- 16

13260207 765919 CRO28

Form 990 (2016) 7

2 01 6 .0 5050 CROSSROADS REHABILITATI ON CRO28_ 1

 ................
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