Civic Intelligence

Chubb International Shooting Sports Inc

EIN 20-4822048 • 501(c)3 • Elizabethville, PA

Profile

Natl/intl competition in shotgun sports to promote the shotgun sporting clays and olympic style shooting

302 Tennessee AveElizabethville, PA 17023

www.keystoneshootingpark.com

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

51st percentile

0.02x

Higher debt load relative to assets than 51% of similar nonprofits.

501(c)3 • $500k-$1M nonprofits • Source year 2024

Liabilities / Revenue

60th percentile

0.04x

Higher debt load relative to revenue than 60% of similar nonprofits.

501(c)3 • $500k-$1M nonprofits • Source year 2024

Net Margin

65th percentile

13%

Higher net margin than 65% of similar nonprofits.

501(c)3 • $500k-$1M nonprofits • Source year 2024

Top Officer Pay

55th percentile

$0

Higher top officer pay than 55% of similar nonprofits.

Top officer pay equals 0.0% of source-year revenue.

501(c)3 • $500k-$1M nonprofits • Source year 2024

Asset Growth

50th percentile

3.3%

Faster asset growth than 50% of similar nonprofits.

501(c)3 • $500k-$1M nonprofits • Annualized from 2023 to 2024

Revenue Growth

16th percentile

-23%

Faster revenue growth than 16% of similar nonprofits.

501(c)3 • $500k-$1M nonprofits • Annualized from 2023 to 2024

Balance Sheet
Liabilities / Assets51st percentile

Assets

Up

$681,227

Up $21,878 (+3.3%) from 2023

Liabilities

Down

$11,790

Down $15,000 (-56%) from 2023

Net Assets

Up

$669,437

Up $36,878 (+5.8%) from 2023

Operations
Liabilities / Revenue60th percentileNet Margin65th percentile

Revenue

Down

$289,730

Down $84,845 (-23%) from 2023

Expenses

Up

$252,852

Up $14,693 (+6.2%) from 2023

Net Income

Down

$36,878

Down $99,538 (-73%) from 2023

Trend Graphs

Balance Sheet Trend

Asset Growth50th percentile

Grouped bars show assets, liabilities, and net assets across loaded filings.

$800K$600K$400K$200K$0Assets 2011: $194,136Liabilities 2011: $105,3242011Assets 2012: $235,801Liabilities 2012: $91,861Net Assets 2012: $143,9402012Assets 2013: $290,641Liabilities 2013: $58,195Net Assets 2013: $232,4462013Assets 2014: $268,312Liabilities 2014: $43,095Net Assets 2014: $225,2172014Assets 2015: $264,801Liabilities 2015: $54,004Net Assets 2015: $210,7972015Assets 2016: $310,097Liabilities 2016: $78,477Net Assets 2016: $231,6202016Assets 2017: $307,074Liabilities 2017: $73,064Net Assets 2017: $234,0102017Assets 2018: $298,811Liabilities 2018: $67,306Net Assets 2018: $231,5052018Assets 2019: $295,460Liabilities 2019: $36,790Net Assets 2019: $258,6702019Assets 2020: $610,849Liabilities 2020: $26,790Net Assets 2020: $584,0592020Assets 2021: $585,987Liabilities 2021: $26,790Net Assets 2021: $559,1972021Assets 2022: $522,933Liabilities 2022: $26,790Net Assets 2022: $496,1432022Assets 2023: $659,349Liabilities 2023: $26,790Net Assets 2023: $632,5592023Assets 2024: $681,227Liabilities 2024: $11,790Net Assets 2024: $669,4372024

Highlighted filing

2024

Assets$681,227
Liabilities$11,790
Net Assets$669,437
Open 2024 Filing

Operations Trend

Revenue Growth16th percentile

Revenue, expenses, and net income by year, with the latest filing highlighted.

$600K$400K$200K$0-$200KRevenue 2011: $76,119Expenses 2011: $57,882Net Income 2011: $18,2372011Revenue 2012: $161,652Expenses 2012: $106,524Net Income 2012: $55,1282012Revenue 2013: $258,523Expenses 2013: $170,017Net Income 2013: $88,5062013Revenue 2014: $226,363Expenses 2014: $120,475Net Income 2014: $105,8882014Revenue 2015: $206,405Expenses 2015: $220,825Net Income 2015: -$14,4202015Revenue 2016: $153,433Expenses 2016: $128,049Net Income 2016: $25,3842016Revenue 2017: $172,939Expenses 2017: $170,550Net Income 2017: $2,3892017Revenue 2018: $185,860Expenses 2018: $188,365Net Income 2018: -$2,5052018Revenue 2019: $149,432Expenses 2019: $122,267Net Income 2019: $27,1652019Revenue 2020: $529,730Expenses 2020: $204,342Net Income 2020: $325,3882020Revenue 2021: $316,456Expenses 2021: $341,318Net Income 2021: -$24,8622021Revenue 2022: $327,499Expenses 2022: $384,145Net Income 2022: -$56,6462022Revenue 2023: $374,575Expenses 2023: $238,159Net Income 2023: $136,4162023Revenue 2024: $289,730Expenses 2024: $252,852Net Income 2024: $36,8782024

Highlighted filing

2024

Revenue$289,730
Expenses$252,852
Net Income$36,878
Open 2024 Filing

Filings

Most recent year

2024 • Form 990Detailed filing. Detailed filing data is available for this year.

Open filing
Assets
$681,227
Liabilities
$11,790
Net assets
$669,437
Revenue
$289,730
Expenses
$252,852
Net income
$36,878
Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2024Detailed filing. Detailed filing data is available for this year.$6.81$0.12$6.69$2.90$2.53$0.37
2023Detailed filing. Detailed filing data is available for this year.$6.59$0.27$6.33$3.75$2.38$1.36
2022Detailed filing. Detailed filing data is available for this year.$5.23$0.27$4.96$3.27$3.84$0.57
2021Detailed filing. Detailed filing data is available for this year.$5.86$0.27$5.59$3.16$3.41$0.25
2020Detailed filing. Detailed filing data is available for this year.$6.11$0.27$5.84$5.30$2.04$3.25
2019Detailed filing. Detailed filing data is available for this year.$2.95$0.37$2.59$1.49$1.22$0.27
2018Detailed filing. Detailed filing data is available for this year.$2.99$0.67$2.32$1.86$1.88$0.03
2017Detailed filing. Detailed filing data is available for this year.$3.07$0.73$2.34$1.73$1.71$0.02
2016Detailed filing. Detailed filing data is available for this year.$3.10$0.78$2.32$1.53$1.28$0.25
2015Detailed filing. Detailed filing data is available for this year.$2.65$0.54$2.11$2.06$2.21$0.14
2014Detailed filing. Detailed filing data is available for this year.$2.68$0.43$2.25$2.26$1.20$1.06
2013Detailed filing. Detailed filing data is available for this year.$2.91$0.58$2.32$2.59$1.70$0.89
2012Facts available. Structured filing facts are available, but richer extracted sections are limited.$2.36$0.92$1.44$1.62$1.07$0.55
2011Summary only. Only limited summary data is available for this year.$1.94$1.05$0.76$0.58$0.18
Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Jan 1, 2024 to Dec 31, 2024
Signed
Sep 29, 2025
Return Version
2024v5.2
Gross Receipts
$289,730
Mission and Program Overview

Mission

Natl/intl competition in shotgun sports

Natl/intl competition in shotgun sports to promote the shotgun sporting clays and olympic style shooting

Balance Sheet Detail
LineBeginningEndChange
Assets
Land, Buildings, and Equipment, Net$560,555$597,415▲ $36,860
Inventories for Sale or Use$54,529$53,747▼ $782
Cash and Non-Interest-Bearing Accounts$38,829$28,857▼ $9,972
Loans From Officers Directors$26,790$11,790▼ $15,000
Savings and Temporary Cash Investments$5,436$1,208▼ $4,228
Total Assets$659,349$681,227▲ $21,878
Other Assets Total$0$0→ $0
Liabilities
Total Liabilities$26,790$11,790▼ $15,000
Net Assets / Fund Balance
Net Assets Without Donor Restrictions$632,559$669,437▲ $36,878
Total Net Assets Fund Balance$632,559$669,437▲ $36,878
Total Liabilities and Net Assets / Fund Balance$659,349$681,227▲ $21,878

Asset Categories

AssetBook ValueDepreciationBasis
Leasehold Improvements$527,938$240,679$768,617
Equipment$69,477$268,342$337,819
Land$0-$0
Other Assets Org$0--
Compensation and Service Providers
Top Officer Pay55th percentile

Board Members and Trustees

NameTitle
Allen B Chubb JrPresident/treasurer
Robert C McjiltonVice President
Jeffrey D UnderkofflerBoard Member
Timur IssatayevBoard Member
Theodore a KrumreichSecretary
Revenue and Support

Revenue Composition

Contributions and Grants
$136,369
Program Service Revenue
$152,455
Investment Income
$0
Other Revenue
$906
All Other Contributions
$132,101
Change in Net Assets
$36,878
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$252,852
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Depreciation Depletion$70,579$0$0$70,579
Occupancy$12,296$0$0$12,296
Other Expenses$9,794$0$0$9,794
Insurance$8,568$0$0$8,568
Office Expenses$3,441$0$0$3,441
Fees for Services Accounting$2,375$0$0$2,375
Travel$1,512$0$0$1,512
Information Technology$649$0$0$649
Total Functional Expenses$252,852$0$0$252,852
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Loans from Officers, Directors, Trustees, and Key Employees$26,790$11,790▼ $15,000
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
Yes
Annual disclosure for covered persons
Yes
Audit committee
No
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
No
Key decisions subject to board approval
No
Management duties delegated
No
Filing and Contact Details

Filer

Filer Name
Chubb International Shooting Sports Inc
EIN
20-4822048
Phone
7179039009
Address
302 TENNESSEE AVE, ELIZABETHVILLE, PA 17023

Signing Officer

Name
Allen B Chubb Jr
Title
President
Phone
7179039009
Signed
2025-09-29
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Allen B Chubb Jr
Formed
2006
Legal Domicile
Pa
Voting Board Members
5
Independent Board Members
5
Employees
0
Volunteers
5

Preparer

Firm
Custer Faust and Associates PC
Address
300 Union St, Millersburg, PA 17061
Preparer
John J Faust CPA
Phone
7176922124
Supplemental Narrative

Additional Explanations

Pt VI, Line 11B

“Each member reviews financial statements and 990 before filing”

Pt VI, Line 12C

“Reviews invoices and any contracts”

Pt VI, Line 19

“UPON REQUEST”

Pt VI, Line 8B

“MINUTES OF MEETINGS”

Raw XML AppendixShowing 400 of 407 raw XML fields

This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.

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IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearAmt0152455
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus1YearAmt0126334
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus2YearsAmt0321197
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus3YearsAmt0201154
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/CurrentTaxYearMinus4YearsAmt0117864
IRS990ScheduleA/GrossReceiptsAdmissionsGrp/TotalAmt0919004
IRS990ScheduleA/GrossReceiptsNonUnrltBusGrp/TotalAmt00
IRS990ScheduleA/InvestmentIncomeAndUBTIGrp/CurrentTaxYearAmt00
IRS990ScheduleA/InvestmentIncomeAndUBTIGrp/CurrentTaxYearMinus1YearAmt08
IRS990ScheduleA/InvestmentIncomeAndUBTIGrp/CurrentTaxYearMinus4YearsAmt011
IRS990ScheduleA/InvestmentIncomeAndUBTIGrp/TotalAmt019
IRS990ScheduleA/InvestmentIncomeCYPct00.00000
IRS990ScheduleA/InvestmentIncomePYPct00.00000
IRS990ScheduleA/OtherSupportSumAmt00
IRS990ScheduleA/PubliclySupportedOrg509a2Ind0X
IRS990ScheduleA/PublicSupportCY170Pct00
IRS990ScheduleA/PublicSupportCY509Pct01.00000
IRS990ScheduleA/PublicSupportPY509Pct01.00000
IRS990ScheduleA/PublicSupportTotal509Amt01818845
IRS990ScheduleA/SubstAndDsqlfyPrsnsTotGrp/TotalAmt00
IRS990ScheduleA/SubstantialContributorsAmtGrp/TotalAmt00
IRS990ScheduleA/TaxRevLeviedOrgnztnlBnft509Grp/TotalAmt00
IRS990ScheduleA/ThirtyThrPctSuprtTestsCY509Ind0X
IRS990ScheduleA/Total509Grp/CurrentTaxYearAmt0288824
IRS990ScheduleA/Total509Grp/CurrentTaxYearMinus1YearAmt0374577
IRS990ScheduleA/Total509Grp/CurrentTaxYearMinus2YearsAmt0327500
IRS990ScheduleA/Total509Grp/CurrentTaxYearMinus3YearsAmt0304225
IRS990ScheduleA/Total509Grp/CurrentTaxYearMinus4YearsAmt0523719
IRS990ScheduleA/Total509Grp/TotalAmt01818845
IRS990ScheduleA/TotalSupportCalendarYearGrp/TotalAmt01818864
IRS990ScheduleB/ContributorInformationGrp/ContributorBusinessName/BusinessNameLine10RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorNum0RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/AddressLine10RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/AddressLine20RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/City0RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/State0RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/ZIPCode0RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/TotalContributionsAmt0RESTRICTED
IRS990/ScheduleBRequiredInd0true
IRS990ScheduleD/EquipmentGrp/BookValueAmt069477
IRS990ScheduleD/EquipmentGrp/DepreciationAmt0268342
IRS990ScheduleD/EquipmentGrp/OtherCostOrOtherBasisAmt0337819
IRS990ScheduleD/LandGrp/BookValueAmt00
IRS990ScheduleD/LandGrp/InvestmentCostOrOtherBasisAmt00
IRS990ScheduleD/LandGrp/OtherCostOrOtherBasisAmt00
IRS990ScheduleD/LeaseholdImprovementsGrp/BookValueAmt0527938
IRS990ScheduleD/LeaseholdImprovementsGrp/DepreciationAmt0240679
IRS990ScheduleD/LeaseholdImprovementsGrp/OtherCostOrOtherBasisAmt0768617
IRS990ScheduleD/OtherAssetsOrgGrp/BookValueAmt00
IRS990ScheduleD/OtherAssetsOrgGrp/Desc0DEPOSITS
IRS990ScheduleD/TotalBookValueLandBuildingsAmt0597415
IRS990ScheduleD/TotalBookValueOtherAssetsAmt00
IRS990/ScheduleJRequiredInd0false
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/BalanceDueAmt00
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/BalanceDueAmt111790
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/BoardOrCommitteeApprovalInd0true
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/BoardOrCommitteeApprovalInd1true
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/DefaultInd0false
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/DefaultInd1false
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/LoanPurposeTxt0START UP
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/LoanPurposeTxt1EQUIPMENT
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/LoanToOrganizationInd0X
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/LoanToOrganizationInd1X
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/OriginalPrincipalAmt057214
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/OriginalPrincipalAmt141790
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/PersonNm0ALLEN B CHUBB JR
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/PersonNm1ALLEN B CHUBB JR
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/RelationshipWithOrgTxt0PRESIDENT
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/RelationshipWithOrgTxt1PRESIDENT
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/WrittenAgreementInd0false
IRS990ScheduleL/LoansBtwnOrgInterestedPrsnGrp/WrittenAgreementInd1false
IRS990ScheduleL/TotalBalanceDueAmt011790
IRS990/ScheduleORequiredInd0true
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0EACH MEMBER REVIEWS FINANCIAL STATEMENTS AND 990 BEFORE FILING
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1REVIEWS INVOICES AND ANY CONTRACTS
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2UPON REQUEST
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3MINUTES OF MEETINGS
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0Pt VI, Line 11b
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1Pt VI, Line 12c
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2Pt VI, Line 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3Pt VI, Line 8b
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IRS990/SignificantChangeInd0false
IRS990/SignificantNewProgramSrvcInd0false
IRS990/StatesWhereCopyOfReturnIsFldCd0PA
IRS990/SubjectToProxyTaxInd0false
IRS990/TaxablePartyNotificationInd0false
IRS990/TaxExemptBondsInd0false
IRS990/TerminateOperationsInd0false
IRS990/TotalAssetsBOYAmt0659349
IRS990/TotalAssetsEOYAmt0681227
IRS990/TotalAssetsGrp/BOYAmt0659349
IRS990/TotalAssetsGrp/EOYAmt0681227
IRS990/TotalCompGreaterThan150KInd0false
IRS990/TotalContributionsAmt0136369
IRS990/TotalEmployeeCnt00
IRS990/TotalFunctionalExpensesGrp/FundraisingAmt00
IRS990/TotalFunctionalExpensesGrp/ManagementAndGeneralAmt00
IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt0252852
IRS990/TotalFunctionalExpensesGrp/TotalAmt0252852
IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesBOYAmt026790
IRS990/TotalLiabilitiesEOYAmt011790
IRS990/TotalLiabilitiesGrp/BOYAmt026790
IRS990/TotalLiabilitiesGrp/EOYAmt011790
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt0632559
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt0669437
IRS990/TotalProgramServiceExpensesAmt0252852
IRS990/TotalProgramServiceRevenueAmt0152455
IRS990/TotalRevenueGrp/ExclusionAmt00
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt0153361
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt0289730
IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
IRS990/TotalVolunteersCnt05
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt0659349
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt0681227
IRS990/TravelGrp/FundraisingAmt00
IRS990/TravelGrp/ManagementAndGeneralAmt00
IRS990/TravelGrp/ProgramServicesAmt01512
IRS990/TravelGrp/TotalAmt01512
IRS990/TrnsfrExmptNonChrtblRltdOrgInd0false
IRS990/TypeOfOrganizationCorpInd0X
IRS990/UnrelatedBusIncmOverLimitInd0false
IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine1Txt0302 TENNESSEE AVE
IRS990/USAddress/CityNm0ELIZABETHVILLE
IRS990/USAddress/StateAbbreviationCd0PA
IRS990/USAddress/ZIPCd017023
IRS990/VotingMembersGoverningBodyCnt05
IRS990/VotingMembersIndependentCnt05
IRS990/WebsiteAddressTxt0WWW.KEYSTONESHOOTINGPARK.COM
IRS990/WhistleblowerPolicyInd0true
ReturnHeader/BuildTS02025-03-06 01:10:19Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd0true
ReturnHeader/BusinessOfficerGrp/PersonNm0ALLEN B CHUBB JR
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0PRESIDENT
ReturnHeader/BusinessOfficerGrp/PhoneNum07179039009
ReturnHeader/BusinessOfficerGrp/SignatureDt02025-09-29
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0CHUBB INTERNATIONAL SHOOTING SPORTS INC
ReturnHeader/Filer/BusinessNameControlTxt0CHUB
ReturnHeader/Filer/EIN0204822048
ReturnHeader/Filer/PhoneNum07179039009
ReturnHeader/Filer/USAddress/AddressLine1Txt0302 TENNESSEE AVE
ReturnHeader/Filer/USAddress/CityNm0ELIZABETHVILLE
ReturnHeader/Filer/USAddress/StateAbbreviationCd0PA
ReturnHeader/Filer/USAddress/ZIPCd017023
ReturnHeader/IRSResponsiblePrtyInfoCurrInd0true
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0203999483
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0Custer Faust and Associates PC
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt0300 Union St
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0Millersburg
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0PA
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd017061
ReturnHeader/PreparerPersonGrp/PhoneNum07176922124

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