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CROCKETT FOUNDATION INC. - Florida Company Profile

Company Details

Entity Name: CROCKETT FOUNDATION INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 15 Apr 2005 (20 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 20 Jan 2015 (10 years ago)
Document Number: N05000003896
FEI/EIN Number 202689974

Federal Employer Identification (FEI) Number assigned by the IRS.

Address: 5101 NW 21ST AVE, Fort Lauderdale, FL, 33309, US
Mail Address: 5101 NW 21ST AVE, Fort Lauderdale, FL, 33309, US
ZIP code: 33309
County: Broward
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1184295123 2021-07-09 2021-07-09 401 SW 1ST AVE STE 102, FORT LAUDERDALE, FL, 333012853, US 401 SW 1ST AVE STE 102, FORT LAUDERDALE, FL, 333012853, US

Contacts

Phone +1 754-666-3928

Authorized person

Name MS. REGINE KANZKI
Role VICE PRESIDENT OF OPERATIONS
Phone 9548229370

Taxonomy

Taxonomy Code 251S00000X - Community/Behavioral Health Agency
Is Primary Yes

Key Officers & Management

Name Role Address
CROCKETT ZACHARY Vice President 3129 NW 82ND TERRACE, COOPER CITY, FL, 33024
CROCKETT ZACHARY Director 3129 NW 82ND TERRACE, COOPER CITY, FL, 33024
KEVIN PROPHETE Director 3000 NE 188TH ST UNIT 605, AVENTURA, FL, 33180
STOCKER MICHELE Director 3000 NE 188TH ST UNIT 605, AVENTURA, FL, 33180
Munoz Eric Treasurer 3129 NW 82nd Terr, Cooper City, FL, 33024
Biard Benjamin Director 3129 NW 82nd Terr, Cooper City, FL, 33024
CROCKETT HENRI President 3129 NW 82ND TERRACE, COOPER CITY, FL, 33024
CROCKETT HENRI Director 3129 NW 82ND TERRACE, COOPER CITY, FL, 33024
Henri Crockett Agent 5101 NW 21st ave, Fort Lauderdale, FL, 33309

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2022-01-24 5101 NW 21st ave, 530, Fort Lauderdale, FL 33309 -
CHANGE OF PRINCIPAL ADDRESS 2020-01-15 5101 NW 21ST AVE, STE 530, Fort Lauderdale, FL 33309 -
CHANGE OF MAILING ADDRESS 2020-01-15 5101 NW 21ST AVE, STE 530, Fort Lauderdale, FL 33309 -
REINSTATEMENT 2015-01-20 - -
REGISTERED AGENT NAME CHANGED 2015-01-20 Henri Crockett -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2014-09-26 - -
REINSTATEMENT 2013-03-22 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2012-09-28 - -

Documents

Name Date
ANNUAL REPORT 2024-02-06
ANNUAL REPORT 2023-04-18
ANNUAL REPORT 2022-01-24
AMENDED ANNUAL REPORT 2021-06-01
ANNUAL REPORT 2021-01-14
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-02-08
ANNUAL REPORT 2018-01-22
ANNUAL REPORT 2017-05-02
ANNUAL REPORT 2016-04-14

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
20-2689974 Corporation Unconditional Exemption 3129 NW 82ND TER, PEMBROKE PNES, FL, 33024-3168 2014-03
In Care of Name % HENRI CROCKETT
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Educational Organization, Local Association of Employees, Horticultural Organization, Business League, Voluntary Employees' Beneficiary Association (Govt. Emps.), Mutual Ditch or Irrigation Co., Cemetery Company, Other Mutual Corp. or Assoc.
Deductibility Contributions are deductible.
Foundation Organization that receives a substantial part of its support from a governmental unit or the general public 170(b)(1)(A)(vi)
Tax Period 2023-12
Asset 1,000,000 to 4,999,999
Income 1,000,000 to 4,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 1049612
Income Amount 2176115
Form 990 Revenue Amount 2176115
National Taxonomy of Exempt Entities Philanthropy, Voluntarism and Grantmaking Foundations: Private Grantmaking Foundations
Sort Name -

Publication 78 Data

Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Auto-Revocation List

Description Organizations whose federal tax exempt status was automatically revoked for not filing a Form 990-series return or notice for three consecutive years. Important note: Just because an organization appears on this list, it does not mean the organization is currently revoked, as they may have been reinstated.
Exemption Type 501(c)(3): Religious, educational, charitable, scientific, literary, testing for public safety, fostering national or international amateur sports competition, or prevention of cruelty to children or animals organizations
Revocation Date 2013-05-15
Revocation Posting Date 2013-08-12

Form 990-N (e-Postcard)

Organization Name CROCKETT FOUNDATION INC
EIN 20-2689974
Tax Year 2009
Beginning of tax period 2009-01-01
End of tax period 2009-12-31
Gross receipts not greater than $50000 Yes
Organization has terminated No
Mailing Address 20810 WEST DIXIE HIGHWAY, MIAMI, FL, 33180, US
Principal Officer's Name HENRI CROCKETT
Principal Officer's Address 20810 WEST DIXIE HIGHWAY, NORTH MIAMI BEACH, FL, 33180, US

Copies of Returns (990, 990-EZ, 990-PF, 990-T)

Organization Name CROCKETT FOUNDATION INC
EIN 20-2689974
Tax Period 202212
Filing Type E
Return Type 990
File View File
Organization Name CROCKETT FOUNDATION INC
EIN 20-2689974
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name CROCKETT FOUNDATION INC
EIN 20-2689974
Tax Period 202012
Filing Type E
Return Type 990
File View File
Organization Name CROCKETT FOUNDATION INC
EIN 20-2689974
Tax Period 201912
Filing Type P
Return Type 990
File View File
Organization Name CROCKETT FOUNDATION INC
EIN 20-2689974
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name CROCKETT FOUNDATION INC
EIN 20-2689974
Tax Period 201612
Filing Type P
Return Type 990
File View File
47-4242216 Corporation Unconditional Exemption 14216 FOURSOME DR, HUDSON, FL, 34667-8559 2015-09
In Care of Name % DEBORAH MROZINSKI
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Educational Organization, Local Association of Employees, Horticultural Organization, Business League, Voluntary Employees' Beneficiary Association (Govt. Emps.), Mutual Ditch or Irrigation Co., Cemetery Company, Other Mutual Corp. or Assoc.
Deductibility Contributions are deductible.
Foundation Organization that receives a substantial part of its support from a governmental unit or the general public 170(b)(1)(A)(vi)
Tax Period 2023-12
Asset 0
Income 0
Filing Requirement 990 - Required to file Form 990-N - Income less than $50,000 per year
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 0
Income Amount 0
Form 990 Revenue Amount 0
National Taxonomy of Exempt Entities Mental Health & Crisis Intervention: Mental Health Treatment F31 Psychiatric, Mental Health Hospital
Sort Name -

Publication 78 Data

Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Determination Letter

Final Letter(s) FinalLetter_47-4242216_CROCKETTFOUNDATIONINC_07162015.tif

Form 990-N (e-Postcard)

Organization Name CROCKETT FOUNDATION INC
EIN 47-4242216
Tax Year 2024
Beginning of tax period 2024-01-01
End of tax period 2024-12-31
Gross receipts not greater than $50000 Yes
Organization has terminated No
Mailing Address 14216 Foursome Dr, Hudson, FL, 34667, US
Principal Officer's Name Deborah Whiting
Principal Officer's Address 14216 Foursome Dr, Hudson, FL, 34667, US
Organization Name CROCKETT FOUNDATION INC
EIN 47-4242216
Tax Year 2023
Beginning of tax period 2023-01-01
End of tax period 2023-12-31
Gross receipts not greater than $50000 Yes
Organization has terminated No
Mailing Address 14216 Foursome Dr, Hudson, FL, 34667, US
Principal Officer's Name Deborah Whiting
Principal Officer's Address 14216 Foursome Dr, Hudson, FL, 34667, US
Organization Name CROCKETT FOUNDATION INC
EIN 47-4242216
Tax Year 2022
Beginning of tax period 2022-01-01
End of tax period 2022-12-31
Gross receipts not greater than $50000 Yes
Organization has terminated No
Mailing Address 14216 Foursome Dr, Hudson, FL, 34667, US
Principal Officer's Name Deborah Whiting
Principal Officer's Address 14216 Foursome Dr, Hudson, FL, 34667, US
Organization Name CROCKETT FOUNDATION INC
EIN 47-4242216
Tax Year 2021
Beginning of tax period 2021-01-01
End of tax period 2021-12-31
Gross receipts not greater than $50000 Yes
Organization has terminated No
Mailing Address 14216 Foursome Dr, Hudson, FL, 34667, US
Principal Officer's Name Deborah Whiting
Principal Officer's Address 14216 Foursome Dr, Hudson, FL, 34667, US
Organization Name CROCKETT FOUNDATION INC
EIN 47-4242216
Tax Year 2020
Beginning of tax period 2020-01-01
End of tax period 2020-12-31
Gross receipts not greater than $50000 Yes
Organization has terminated No
Mailing Address 14216 Foursome Dr, Hudson, FL, 34667, US
Principal Officer's Name Debbie Whiting
Principal Officer's Address 14216 Foursome Dr, Hudson, FL, 34667, US
Website URL crockettfoundation.com
Organization Name CROCKETT FOUNDATION INC
EIN 47-4242216
Tax Year 2019
Beginning of tax period 2019-01-01
End of tax period 2019-12-31
Gross receipts not greater than $50000 Yes
Organization has terminated No
Mailing Address 6604 Point Comfort Ln, Charlotte, NC, 28226, US
Principal Officer's Name Deborah Mrozinski
Principal Officer's Address 6604 Point Comfort Ln, Charlotte, NC, 28226, US
Website URL crockettfoundation.com
Organization Name CROCKETT FOUNDATION INC
EIN 47-4242216
Tax Year 2018
Beginning of tax period 2018-01-01
End of tax period 2018-12-31
Gross receipts not greater than $50000 Yes
Organization has terminated No
Mailing Address 6604 Point Comfort Ln, Charlotte, NC, 28226, US
Principal Officer's Name Deborah Whiting
Principal Officer's Address 6604 Point Comfort Ln, Charlotte, NC, 28226, US
Website URL crockettfoundation.com
Organization Name CROCKETT FOUNDATION INC
EIN 47-4242216
Tax Year 2017
Beginning of tax period 2017-01-01
End of tax period 2017-12-31
Gross receipts not greater than $50000 Yes
Organization has terminated No
Mailing Address 6604 Point Comfort Ln, Charlotte, NC, 28226, US
Principal Officer's Name Deborah Mrozinski
Principal Officer's Address 6604 Point Comfort Ln, Charlotte, NC, 28226, US
Website URL crockettfoundation.com
Organization Name CROCKETT FOUNDATION INC
EIN 47-4242216
Tax Year 2016
Beginning of tax period 2016-01-01
End of tax period 2016-12-31
Gross receipts not greater than $50000 Yes
Organization has terminated No
Mailing Address 6025 BLakeney Park Dr Ste 130, Charlotte, NC, 28277, US
Principal Officer's Name Deborah Mrozinski
Principal Officer's Address 6604 Point Comfort Ln, Charlotte, NC, 28226, US
Website URL crockettfoundation.com

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
4797108404 2021-02-06 0455 PPS 401 SW 1st Ave Ste 102, Fort Lauderdale, FL, 33301-2853
Loan Status Date 2022-07-14
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 121675.02
Loan Approval Amount (current) 121675.02
Undisbursed Amount 0
Franchise Name -
Lender Location ID 437582
Servicing Lender Name Banesco USA
Servicing Lender Address 3155 NW 77th Ave, Miami, FL, 33122
Rural or Urban Indicator U
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address Fort Lauderdale, BROWARD, FL, 33301-2853
Project Congressional District FL-23
Number of Employees 50
NAICS code 813211
Borrower Race Black or African American
Borrower Ethnicity Not Hispanic or Latino
Business Type Non-Profit Organization
Originating Lender ID 437582
Originating Lender Name Banesco USA
Originating Lender Address Miami, FL
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 123300.73
Forgiveness Paid Date 2022-06-09
7483707205 2020-04-28 0455 PPP 401 SW 1st Ave Suite 102, FORT LAUDERDALE, FL, 33301-2853
Loan Status Date 2022-02-11
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 117487.45
Loan Approval Amount (current) 117487.45
Undisbursed Amount 0
Franchise Name -
Lender Location ID 437582
Servicing Lender Name Banesco USA
Servicing Lender Address 3155 NW 77th Ave, Miami, FL, 33122
Rural or Urban Indicator U
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address FORT LAUDERDALE, BROWARD, FL, 33301-2853
Project Congressional District FL-23
Number of Employees 37
NAICS code 813211
Borrower Race Black or African American
Borrower Ethnicity Not Hispanic or Latino
Business Type Non-Profit Organization
Originating Lender ID 437582
Originating Lender Name Banesco USA
Originating Lender Address Miami, FL
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 119488
Forgiveness Paid Date 2022-01-04

Date of last update: 02 Apr 2025

Sources: Florida Department of State