Civic Intelligence

Foundation for Mental Health Inc

EIN 31-1180754 • 501(c)3 • Hazleton, IN

Profile

To provide financial support for

3988 East State Road 56Hazleton, IN 47640

n/A

Siviq Scores

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

Liabilities / Assets

Score unavailable

No value available

Liabilities-to-assets requires both liabilities and assets on the latest valid filing.

Source year 2021

Liabilities / Revenue

Score unavailable

No value available

Liabilities-to-revenue requires both liabilities and revenue on the latest valid filing.

Source year 2021

Net Margin

90th percentile

51%

Higher net margin than 90% of similar nonprofits.

501(c)3 • <$500k nonprofits • Source year 2021

Top Officer Pay

81st percentile

$0

Higher top officer pay than 81% of similar nonprofits.

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

501(c)3 • <$500k nonprofits • Source year 2021

Asset Growth

62nd percentile

4.6%

Faster asset growth than 62% of similar nonprofits.

501(c)3 • <$500k nonprofits • Annualized from 2020 to 2021

Revenue Growth

88th percentile

68%

Faster revenue growth than 88% of similar nonprofits.

501(c)3 • <$500k nonprofits • Annualized from 2020 to 2021

Balance Sheet
Liabilities / AssetsScore unavailable

Assets

Up

$376,251

Up $16,441 (+4.6%) from 2020

Liabilities

-

No earlier filing loaded for comparison.

Net Assets

Up

$376,251

Up $16,441 (+4.6%) from 2020

Operations
Liabilities / RevenueScore unavailableNet Margin90th percentile

Revenue

Up

$37,106

Up $15,069 (+68%) from 2020

Expenses

Up

$18,275

Up $1,166 (+6.8%) from 2020

Net Income

Up

$18,831

Up $13,903 (+282%) from 2020

Trend Graphs

Balance Sheet Trend

Asset Growth62nd percentile

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

$400K$300K$200K$100K$0Assets 2010: $260,815Liabilities 2010: $0Net Assets 2010: $260,8152010Assets 2011: $257,710Liabilities 2011: $0Net Assets 2011: $257,7102011Assets 2012: $273,106Liabilities 2012: $0Net Assets 2012: $273,1062012Assets 2013: $291,116Liabilities 2013: $0Net Assets 2013: $291,1162013Assets 2014: $300,344Liabilities 2014: $0Net Assets 2014: $300,3442014Assets 2015: $293,909Liabilities 2015: $0Net Assets 2015: $293,9092015Assets 2016: $290,603Liabilities 2016: $0Net Assets 2016: $290,6032016Assets 2017: $300,332Net Assets 2017: $300,3322017Assets 2020: $359,810Net Assets 2020: $359,8102020Assets 2021: $376,251Net Assets 2021: $376,2512021

Highlighted filing

2021

Assets$376,251
Liabilities-
Net Assets$376,251
Open 2021 Filing

Operations Trend

Revenue Growth88th percentile

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

$40K$20K$0-$20KExpenses 2010: $6,9042010Expenses 2011: $6,9022011Expenses 2012: $5,7122012Revenue 2013: $12,174Expenses 2013: $4,689Net Income 2013: $7,4852013Revenue 2014: $24,178Expenses 2014: $6,613Net Income 2014: $17,5652014Revenue 2015: $13,364Expenses 2015: $10,349Net Income 2015: $3,0152015Revenue 2016: $8,120Expenses 2016: $11,426Net Income 2016: -$3,3062016Revenue 2017: $19,742Expenses 2017: $10,013Net Income 2017: $9,7292017Revenue 2020: $22,037Expenses 2020: $17,109Net Income 2020: $4,9282020Revenue 2021: $37,106Expenses 2021: $18,275Net Income 2021: $18,8312021

Highlighted filing

2021

Revenue$37,106
Expenses$18,275
Net Income$18,831
Open 2021 Filing

Filings

Most recent year

2021 • Form 990EZDetailed filing. Detailed filing data is available for this year.

Open filing
Assets
$376,251
Liabilities
-
Net assets
$376,251
Revenue
$37,106
Expenses
$18,275
Net income
$18,831
Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2021Detailed filing. Detailed filing data is available for this year.$3.76$3.76$0.37$0.18$0.19
2020XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$3.60$3.60$0.22$0.17$0.05
2017XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$3.00$3.00$0.20$0.10$0.10
2016Facts available. Structured filing facts are available, but richer extracted sections are limited.$2.91$0.00$2.91$0.08$0.11$0.03
2015XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$2.94$0.00$2.94$0.13$0.10$0.03
2014Detailed filing. Detailed filing data is available for this year.$3.00$0.00$3.00$0.24$0.07$0.18
2013Detailed filing. Detailed filing data is available for this year.$2.91$0.00$2.91$0.12$0.05$0.07
2012Facts available. Structured filing facts are available, but richer extracted sections are limited.$2.73$0.00$2.73$0.06
2011Facts available. Structured filing facts are available, but richer extracted sections are limited.$2.58$0.00$2.58$0.07
2010Facts available. Structured filing facts are available, but richer extracted sections are limited.$2.61$0.00$2.61$0.07
Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Jan 1, 2021 to Dec 31, 2021
Signed
Aug 1, 2022
Return Version
2021v4.1
Gross Receipts
$119,963
Mission and Program Overview

Mission

To provide financial support for

To provide financial support for junior mental health association of evansville and its parent organization, junior mental health association in indiana (a subsidiary of mental health association in indiana, inc)

Program Services

DescriptionGrantsExpenses
GRANTS MADE TO MENTAL HEALTH OF AMERICA IN INDIANATO SUPPORT PROGRAMS RELTED TO THE MENTAL WELLBEING OF YOUTH.$2,000$2,000
Compensation and Service Providers
Top Officer Pay81st percentile

Employees

NameTitleFull / Part TimeBaseOtherTotal
HELEN KREMZARTreasurer-$0--
CRAIG EARLYVice President-$0--
TAMARA KLAUSMEIERPresident-$0--
SHEILA CORCORANSecretary-$0--
JOHN STEVENSDirector-$0--
Filing and Contact Details

Filer

Filer Name
Foundation for Mental Health Inc
EIN
31-1180754
Phone
8127842326
Address
3988 EAST STATE ROAD 56, HAZLETON, IN 47640

Signing Officer

Name
Helen Kremzar
Title
Treasurer
Phone
8127842326
Signed
2022-08-01

Preparer

Firm
Watler Accounting CPA Pc
Address
1231 MAPLE AVE, TERRE HAUTE, IN 47804
Preparer
Janet L Storey CPA
Phone
6182633567
Supplemental Narrative

Additional Explanations

Pt VI, Line 11B

“The form 990 is reviewed by the treasurer before filing.”

Pt VI, Line 19

“The organization's governing documents are available from the treasurer upon request.”

Pt VI, Line 2

“Sheila corcoran and john stevens, family relationship.”

Form 990EZ, Part I, Line 16

“BANK CHARGES”

Form 990EZ, Part I, Line 16

“Investment advisory fees 3591.”

Form 990EZ, Part I, Line 16

“CONTRIBUTIONS 2600.”

Form 990EZ, Part I, Line 16

“AMORTIZATION 392.”

Form 990EZ, Part I, Line 16

“OFFICE EXPENSE 5000.”

Form 990EZ, Part I, Line 16

“PRINTING/MAILING”

Form 990EZ, Part I, Line 16

“EQUIPMENT RENTALS”

Form 990EZ, Part I, Line 16

“IN KIND EXPENSES”

Form 990EZ, Part I, Line 20

“Unrealized change in basis -2390.”

Raw XML Appendix217 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.

Path#Value
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IRS990EZ/BooksInCareOfDetail/USAddress/CityNm0HAZLETON
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IRS990EZ/Form1120PolFiledInd0false
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IRS990EZ/FundraisingGrossIncomeAmt00
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IRS990EZ/GrossProfitLossSlsOfInvntryAmt00
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IRS990EZ/GrossReceiptsForPublicUseAmt00
IRS990EZ/InfoInScheduleOPartIInd0X
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IRS990EZ/InvestmentIncomeAmt06220
IRS990EZ/LobbyingActivitiesInd0false
IRS990EZ/MadeLoansToFromOfficersInd0false
IRS990EZ/MembershipDuesAmt00
IRS990EZ/MethodOfAccountingCashInd0X
IRS990EZ/NetAssetsOrFundBalancesBOYAmt0359810
IRS990EZ/NetAssetsOrFundBalancesEOYAmt0376251
IRS990EZ/NetAssetsOrFundBalancesGrp/BOYAmt0359810
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IRS990EZ/OfficerDirectorTrusteeEmplGrp/AverageHrsPerWkDevotedToPosRt01.00
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IRS990EZ/OfficerDirectorTrusteeEmplGrp/AverageHrsPerWkDevotedToPosRt31.00
IRS990EZ/OfficerDirectorTrusteeEmplGrp/AverageHrsPerWkDevotedToPosRt41.00
IRS990EZ/OfficerDirectorTrusteeEmplGrp/CompensationAmt00
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IRS990EZ/OfficerDirectorTrusteeEmplGrp/CompensationAmt20
IRS990EZ/OfficerDirectorTrusteeEmplGrp/CompensationAmt30
IRS990EZ/OfficerDirectorTrusteeEmplGrp/CompensationAmt40
IRS990EZ/OfficerDirectorTrusteeEmplGrp/EmployeeBenefitProgramAmt00
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IRS990EZ/OfficerDirectorTrusteeEmplGrp/EmployeeBenefitProgramAmt20
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IRS990EZ/OfficerDirectorTrusteeEmplGrp/EmployeeBenefitProgramAmt40
IRS990EZ/OfficerDirectorTrusteeEmplGrp/ExpenseAccountOtherAllwncAmt00
IRS990EZ/OfficerDirectorTrusteeEmplGrp/ExpenseAccountOtherAllwncAmt10
IRS990EZ/OfficerDirectorTrusteeEmplGrp/ExpenseAccountOtherAllwncAmt20
IRS990EZ/OfficerDirectorTrusteeEmplGrp/ExpenseAccountOtherAllwncAmt30
IRS990EZ/OfficerDirectorTrusteeEmplGrp/ExpenseAccountOtherAllwncAmt40
IRS990EZ/OfficerDirectorTrusteeEmplGrp/PersonNm0HELEN KREMZAR
IRS990EZ/OfficerDirectorTrusteeEmplGrp/PersonNm1CRAIG EARLY
IRS990EZ/OfficerDirectorTrusteeEmplGrp/PersonNm2TAMARA KLAUSMEIER
IRS990EZ/OfficerDirectorTrusteeEmplGrp/PersonNm3SHEILA CORCORAN
IRS990EZ/OfficerDirectorTrusteeEmplGrp/PersonNm4JOHN STEVENS
IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt0TREASURER
IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt1VICE PRESIDENT
IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt2PRESIDENT
IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt3SECRETARY
IRS990EZ/OfficerDirectorTrusteeEmplGrp/TitleTxt4DIRECTOR
IRS990EZ/OperateHospitalInd0false
IRS990EZ/Organization501c3Ind0X
IRS990EZ/OrganizationDissolvedEtcInd0false
IRS990EZ/OrganizationHadUBIInd0false
IRS990EZ/OtherChangesInNetAssetsAmt0-2390
IRS990EZ/OtherExpensesTotalAmt011583
IRS990EZ/PartVIHghstPdCntrctProfSrvcTxt0NONE
IRS990EZ/PartVIOfCompOfHghstPdEmplTxt0NONE
IRS990EZ/PoliticalCampaignActyInd0false
IRS990EZ/PrimaryExemptPurposeTxt0TO PROVIDE FINANCIAL SUPPORT FOR JUNIOR MENTAL HEALTH ASSOCIATION OF EVANSVILLE AND ITS PARENT ORGANIZATION, JUNIOR MENTAL HEALTH ASSOCIATION IN INDIANA (A SUBSIDIARY OF MENTAL HEALTH ASSOCIATION IN INDIANA, INC)
IRS990EZ/PrintingPublicationsPostageAmt06000
IRS990EZ/ProgramServiceRevenueAmt00
IRS990EZ/ProgramSrvcAccomplishmentGrp/DescriptionProgramSrvcAccomTxt0GRANTS MADE TO MENTAL HEALTH OF AMERICA IN INDIANATO SUPPORT PROGRAMS RELTED TO THE MENTAL WELLBEING OF YOUTH.
IRS990EZ/ProgramSrvcAccomplishmentGrp/GrantsAndAllocationsAmt02000
IRS990EZ/ProgramSrvcAccomplishmentGrp/ProgramServiceExpensesAmt02000
IRS990EZ/ProhibitedTaxShelterTransInd0false
IRS990EZ/RelatedOrganizationCtrlEntInd0false
IRS990EZ/SaleOfAssetsGrossAmt0102743
IRS990EZ/ScheduleBNotRequiredInd0X
IRS990EZ/SchoolOperatingInd0false
IRS990EZ/SpecialEventsDirectExpensesAmt00
IRS990EZ/SpecialEventsNetIncomeLossAmt00
IRS990EZ/StatesWhereCopyOfReturnIsFldCd0IN
IRS990EZ/SubjectToProxyTaxInd0false
IRS990EZ/TanningServicesProvidedInd0false
IRS990EZ/TotalExpensesAmt018275
IRS990EZ/TotalProgramServiceExpensesAmt02000
IRS990EZ/TotalRevenueAmt037106
IRS990EZ/TransactionWithControlEntInd0false
IRS990EZ/TrnsfrExmptNonChrtblRltdOrgInd0false
IRS990EZ/TypeOfOrganizationCorpInd0X
IRS990EZ/WebsiteAddressTxt0N/A
IRS990ScheduleA/DistributionAllocationsGrp/CarryoverPYNotAppliedAmt00
IRS990ScheduleA/DistributionAllocationsGrp/CYDistriAppDistributableAmt00
IRS990ScheduleA/DistributionAllocationsGrp/CYDistribAppUnderdistriPYAmt00
IRS990ScheduleA/DistributionAllocationsGrp/CYDistributableAsAdjustedAmt00
IRS990ScheduleA/DistributionAllocationsGrp/CyovAppliedUnderdistrCPYAmt00
IRS990ScheduleA/DistributionAllocationsGrp/CyovAppliedUnderdistriPYAmt00
IRS990ScheduleA/DistributionAllocationsGrp/CYTotalAnnualDistributionsAmt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessDistributionAmt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessDistributionCyovAmt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessDistributionCyovYr1Amt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessDistributionCyovYr2Amt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessDistributionCyovYr3Amt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessDistributionCyovYr4Amt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessDistributionCyovYr5Amt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessDistriCyovToNextYrAmt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessFromYear1Amt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessFromYear2Amt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessFromYear3Amt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessFromYear4Amt00
IRS990ScheduleA/DistributionAllocationsGrp/ExcessFromYear5Amt00
IRS990ScheduleA/DistributionAllocationsGrp/RemainingUnderdistriCYAmt00
IRS990ScheduleA/DistributionAllocationsGrp/RemainingUnderdistriPYAmt00
IRS990ScheduleA/DistributionAllocationsGrp/TotalExcessDistributionCyovAmt00
IRS990ScheduleA/DistributionAllocationsGrp/UnderdistributionsAmt00
IRS990ScheduleA/Form990SchASupportingOrgGrp/Contribution35ControlledInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/ContributionControllerInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/ContributionFamilyInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/ControlledDisqualifiedPrsnInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/DisqualifiedPrsnControllIntInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/DisqualifiedPrsnOwnrIntInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/ExcessBusinessHoldingsRulesInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/ListedByNameGoverningDocInd0true
IRS990ScheduleA/Form990SchASupportingOrgGrp/LoanDisqualifiedPersonInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/OrganizationChangeSuprtOrgInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/PaymentSubstantialContribtrInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/SupportedOrgNotOrganizedUSInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/SupportedOrgSectionC456Ind0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/SupportNonSupportedOrgInd0false
IRS990ScheduleA/Form990SchASupportingOrgGrp/SuprtOrgNoIRSDeterminationInd0false
IRS990ScheduleA/Form990SchAType3SprtOrgAllGrp/OfficersCloseRelationshipInd0true
IRS990ScheduleA/Form990SchAType3SprtOrgAllGrp/SupportedOrgVoiceInvestmentInd0false
IRS990ScheduleA/Form990SchAType3SprtOrgAllGrp/TimelyProvidedDocumentsInd0true
IRS990ScheduleA/InvestmentIncomeCYPct00
IRS990ScheduleA/OtherSupportSumAmt00
IRS990ScheduleA/PublicSupportCY170Pct00
IRS990ScheduleA/PublicSupportCY509Pct00
IRS990ScheduleA/PublicSupportTotal509Amt00
IRS990ScheduleA/SupportedOrganizationsCnt01
IRS990ScheduleA/SupportedOrganizationsTotalCnt01
IRS990ScheduleA/SupportedOrgInformationGrp/EIN0237038692
IRS990ScheduleA/SupportedOrgInformationGrp/GoverningDocumentListedInd0true
IRS990ScheduleA/SupportedOrgInformationGrp/OrganizationTypeCd07
IRS990ScheduleA/SupportedOrgInformationGrp/OtherSupportAmt00
IRS990ScheduleA/SupportedOrgInformationGrp/SupportAmt03000
IRS990ScheduleA/SupportedOrgInformationGrp/SupportedOrganizationName/BusinessNameLine1Txt0MENTAL HEALTH ASSOC
IRS990ScheduleA/SupportingOrganization509a3Ind0X
IRS990ScheduleA/SupportingOrgType3NonFuncInd0X
IRS990ScheduleA/SupportSumAmt03000
IRS990ScheduleA/TrustIntegralPartTestInd0X
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0THE FORM 990 IS REVIEWED BY THE TREASURER BEFORE FILING.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE FROM THE TREASURER UPON REQUEST.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2SHEILA CORCORAN AND JOHN STEVENS, FAMILY RELATIONSHIP.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3BANK CHARGES
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4INVESTMENT ADVISORY FEES 3591.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5CONTRIBUTIONS 2600.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6AMORTIZATION 392.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7OFFICE EXPENSE 5000.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt8PRINTING/MAILING
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt9EQUIPMENT RENTALS
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt10IN KIND EXPENSES
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt11UNREALIZED CHANGE IN BASIS -2390.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0Pt VI, Line 11b
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1Pt VI, Line 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2Pt VI, Line 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3Form 990EZ, Part I, Line 16
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4Form 990EZ, Part I, Line 16
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5Form 990EZ, Part I, Line 16
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6Form 990EZ, Part I, Line 16
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7Form 990EZ, Part I, Line 16
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc8Form 990EZ, Part I, Line 16
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc9Form 990EZ, Part I, Line 16
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc10Form 990EZ, Part I, Line 16
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc11Form 990EZ, Part I, Line 20
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/AuthenticationAssuranceLevelCd0AAL1
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ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/TrustedCustomerCd03
ReturnHeader/BuildTS02022-09-23 18:48:47Z
ReturnHeader/BusinessOfficerGrp/PersonNm0HELEN KREMZAR
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0TREASURER
ReturnHeader/BusinessOfficerGrp/PhoneNum08127842326
ReturnHeader/BusinessOfficerGrp/SignatureDt02022-08-01
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0FOUNDATION FOR MENTAL HEALTH INC
ReturnHeader/Filer/BusinessNameControlTxt0FOUN
ReturnHeader/Filer/EIN0311180754
ReturnHeader/Filer/PhoneNum08127842326
ReturnHeader/Filer/USAddress/AddressLine1Txt03988 EAST STATE ROAD 56
ReturnHeader/Filer/USAddress/CityNm0HAZLETON
ReturnHeader/Filer/USAddress/StateAbbreviationCd0IN
ReturnHeader/Filer/USAddress/ZIPCd047640
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0351906081
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0WATLER ACCOUNTING CPA PC
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt01231 MAPLE AVE
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0TERRE HAUTE
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0IN
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd047804
ReturnHeader/PreparerPersonGrp/PhoneNum06182633567
ReturnHeader/PreparerPersonGrp/PreparationDt02022-11-14
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0JANET L STOREY CPA
ReturnHeader/ReturnTs02022-11-14T11:49:49-08:00
ReturnHeader/ReturnTypeCd0990EZ
ReturnHeader/SigningOfficerGrp/PersonFullName/PersonFirstNm0HELEN
ReturnHeader/SigningOfficerGrp/PersonFullName/PersonLastNm0KREMZAR
ReturnHeader/TaxPeriodBeginDt02021-01-01
ReturnHeader/TaxPeriodEndDt02021-12-31
ReturnHeader/TaxYr02021

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