Civic Intelligence

Andy and Jordan Dalton Foundation

990 • Fiscal year 2017 • EIN 45-4066146

Jan 01, 2017 to Dec 31, 2017 • Filed on May 10, 2018

59 Cavalier Blvd Ste 310Florence, KY 41042

(859) 746-3431

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

52nd percentile

0.04x

Higher debt load relative to assets than 52% of similar nonprofits.

2017 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2017

Liabilities / Revenue

32nd percentile

0.00x

Higher debt load relative to revenue than 32% of similar nonprofits.

2017 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2017

Net Margin

9th percentile

-30%

Higher net margin than 9% of similar nonprofits.

2017 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2017

Top Officer Pay

49th percentile

$0

Higher top officer pay than 49% of similar nonprofits.

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

2017 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2017

Asset Growth

1st percentile

-77%

Faster asset growth than 1% of similar nonprofits.

2017 filings • 501(c)3 • $500k-$1M nonprofits • Annualized from 2016 to 2017

Revenue Growth

18th percentile

-15%

Faster revenue growth than 18% of similar nonprofits.

2017 filings • 501(c)3 • $500k-$1M nonprofits • Annualized from 2016 to 2017

Assets

Down

$40,317

Down $136,470 (-77%) from 2016

Net Assets

Down

$38,558

Down $138,229 (-78%) from 2016

Liabilities

Up

$1,759

Up $1,759 from 2016

Revenue

Down

$457,283

Down $80,438 (-15%) from 2016

Expenses

Down

$595,512

Down $16,123 (-2.6%) from 2016

Net Income

Down

-$138,229

Down $64,315 (-87%) from 2016

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$300K$200K$100K$0Assets 2011: $1Net Assets 2011: $12011Assets 2012: $36,538Liabilities 2012: $1,777Net Assets 2012: $34,7612012Assets 2013: $126,724Liabilities 2013: $0Net Assets 2013: $126,7242013Assets 2014: $199,975Liabilities 2014: $5,000Net Assets 2014: $194,9752014Assets 2015: $250,701Liabilities 2015: $0Net Assets 2015: $250,7012015Assets 2016: $176,787Liabilities 2016: $0Net Assets 2016: $176,7872016Assets 2017: $40,317Liabilities 2017: $1,759Net Assets 2017: $38,5582017Assets 2018: $131,466Liabilities 2018: $0Net Assets 2018: $131,4662018Assets 2019: $83,200Liabilities 2019: $0Net Assets 2019: $83,2002019Assets 2020: $64,898Net Assets 2020: $64,8982020

Highlighted filing

2017

Assets$40,317
Liabilities$1,759
Net Assets$38,558

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$1.0M$500K$0-$500KRevenue 2011: $12011Expenses 2012: $77,4112012Revenue 2013: $193,363Expenses 2013: $101,400Net Income 2013: $91,9632013Revenue 2014: $334,528Expenses 2014: $266,277Net Income 2014: $68,2512014Revenue 2015: $430,221Expenses 2015: $374,495Net Income 2015: $55,7262015Revenue 2016: $537,721Expenses 2016: $611,635Net Income 2016: -$73,9142016Revenue 2017: $457,283Expenses 2017: $595,512Net Income 2017: -$138,2292017Revenue 2018: $793,266Expenses 2018: $700,358Net Income 2018: $92,9082018Revenue 2019: $624,485Expenses 2019: $672,751Net Income 2019: -$48,2662019Revenue 2020: $71,185Expenses 2020: $89,487Net Income 2020: -$18,3022020

Highlighted filing

2017

Revenue$457,283
Expenses$595,512
Net Income-$138,229
Jump To
Filing Snapshot
Filing Period
Jan 1, 2017 to Dec 31, 2017
Signed
May 10, 2018
Return Version
2017v2.3
Gross Receipts
$655,008
Mission and Program Overview

Mission

The mission of the andy & jj dalton foundation is to show god's love and grace while providing support, resources and experiences to seriously ill and physically challenged children and their families.

The mission of the andy & jordan dalton foundation is to provide daily support, opportunities, resources and life-changing experiences to seriously ill and physically challenged children and their families in cincinnati and fort worth.

Balance Sheet Detail
LineBeginningEndChange
Assets
Savings and Temporary Cash Investments$85,450--
Cash and Non-Interest-Bearing Accounts$78,319$30,530▼ $47,789
Inventories for Sale or Use$12,958$9,780▼ $3,178
Accounts Receivable$60$7▼ $53
Total Assets$176,787$40,317▼ $136,470
Liabilities
Accounts Payable and Accrued Expenses-$1,759-
Total Liabilities$0$1,759▲ $1,759
Net Assets / Fund Balance
Unrestricted Net Assets$176,787$38,558▼ $138,229
Total Net Assets Fund Balance$176,787$38,558▼ $138,229
Total Liabilities and Net Assets / Fund Balance$176,787$40,317▼ $136,470
Compensation and Service Providers

Board Members and Trustees

NameTitle
Andy DaltonPresident
Charles StanfieldTreasurer/se
Jordan DaltonVice Preside

Highest Paid Contractors

ContractorServicesLocationCompensation
ProlanthropyGen. Footnote59 CAVALIER BLVD STE 310, Florence, KY 41042$158,181
Revenue and Support

Revenue Composition

Contributions and Grants
$317,114
Program Service Revenue
$506
Investment Income
$11
Other Revenue
$139,652
All Other Contributions
$161,963
Change in Net Assets
$-138,229

Noncash Contribution Practices

Property subject to holding requirements
No
Reviewed unusual noncash gifts
No
Third parties used for noncash contributions
No

Noncash Contributions

Contribution TypeContribution CountReported AmountValuation Method
Other Non Cash Contri Table8$69,643Fair Market Value
Total Noncash Contributions8$69,643-
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$595,512
Total Fundraising Expense$54,296
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Services Other$286,132$3,675$29,620$319,427
Fees for Services Management$79,091$79,091-$158,182
Advertising$24,967$11,359$7,940$44,266
Conferences and Meetings$34,559$1,672-$36,231
Travel$7,459$614$11,052$19,125
Office Expenses$3,816$1,173$4,384$9,373
Fees for Services Legal-$5,770$98$5,868
Insurance$1,419-$1,202$2,621
Fees for Services Accounting-$419-$419
Total Functional Expenses$437,443$103,773$54,296$595,512
Fundraising, Events, and Gaming
Fundraising activities
Yes
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Fundraising Gross Income$337,377
Fundraising Direct Expenses$197,725
Professional Fundraising Fees$0

Fundraising Events

EventGross ReceiptsGross RevenueDirect ExpensesNet Income
Celebrity Waite$216,796$150,225$49,557$100,668
Fiesta & Goal$146,539$99,584$29,592$69,992
Total Events$492,528$337,377$193,598$143,779
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
No
Backup withholding compliance
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

Governance Explanations

Form 990, Page 6, Part VI, Line 2

Andy dalton jordan dalton president vice pres husband/wife

Form 990, Page 6, Part VI, Line 11B

Form 990 reviewed by board of directors prior to signature and filing

Form 990, Page 6, Part VI, Line 12C

Conflict of interest policy is reviewed and discussed at meetings as applicable

Form 990, Page 6, Part VI, Line 19

All governing documents available upon request

Form 990, Page 7, Part VII

Foundation management;sponsorship development & management;program management; event planning & facilitation;communications management; financial management; administration;social media management;executive board development & management.

Filing and Contact Details

Filer

Filer Name
Andy and Jordan Dalton Foundation
EIN
45-4066146
Phone
8597463431
Address
59 CAVALIER BLVD STE 310, FLORENCE, KY 41042
Doing Business As
Andy and Jj Dalton Foundation

Signing Officer

Name
Andy Dalton
Title
President
Phone
8597463431
Signed
2018-05-10

Organization Details

Principal Officer
Andy Dalton
Formed
2011
Legal Domicile
Oh
Voting Board Members
3
Independent Board Members
3
Employees
0

Preparer

Firm
Keith & Associates Pllc
Address
715 BAKEWELL ST, COVINGTON, KY 41011-1227
Preparer
R Frederick Keith
Phone
8592616800
Supplemental Narrative

Additional Explanations

FORM 990 - ORGANIZATION'S MISSION

The mission of the andy & jordan dalton foundation is to provide daily support, opportunities, resources and life-changing experiences to seriously ill and physically challenged children and their families in cincinnati and fort worth.

Form 990, Page 2, Part III, Line 4D

Other accomplishments of the foundation include the andy & jordan hub. The hub provides patients and their families access to entertainment and educational resources, including ipads, computers, mobile television and theater systems and gaming consoles to help pass the time during hospital stays. Hubs are located at the cincinnati children's hospital medical center, cook children's medical center, texas children's hospital - west campus, and the redwood school.

Form 990, Part IX, Line 11G

Contract services 11,064 0 0 bank fees 0 3,675 1,230 holiday hearts expenses 17,810 0 0 king for a day expenses 1,947 0 0 date & night expenses 12,095 0 0 jungle event expenses 325 0 0 hub expenses 12,659 0 0 general assistance expense 6,057 0 0 other program expenses 555 0 0 childrens hospital- program 223,620 0 0 celebrity waiter night contract services 0 0 7,273 banking/merchant 0 0 4,858 0 0 0 stadium tour contract services 0 0 1,360 bank fees 0 0 26 0 0 0 fiesta & goal contract services 0 0 7,420 merchant / bank fees 0 0 3,253 0 0 0 jungle contract services 0 0 3,914 bank fees 0 0 286 total 286,132 3,675 29,620

Raw XML Appendix375 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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IRS990ScheduleG/FundraisingEventInformationGrp/EntertainmentEvent2Amt03108
IRS990ScheduleG/FundraisingEventInformationGrp/EntertainmentOtherEventsAmt01705
IRS990ScheduleG/FundraisingEventInformationGrp/EntertainmentTotalEventsAmt08815
IRS990ScheduleG/FundraisingEventInformationGrp/Event1Nm0CELEBRITY WAITE
IRS990ScheduleG/FundraisingEventInformationGrp/Event2Nm0FIESTA & GOAL
IRS990ScheduleG/FundraisingEventInformationGrp/FoodAndBeverageEvent1Amt050846
IRS990ScheduleG/FundraisingEventInformationGrp/FoodAndBeverageEvent2Amt06896
IRS990ScheduleG/FundraisingEventInformationGrp/FoodAndBeverageOtherEventsAmt022114
IRS990ScheduleG/FundraisingEventInformationGrp/FoodAndBeverageTotalEventsAmt079856
IRS990ScheduleG/FundraisingEventInformationGrp/GrossReceiptsEvent1Amt0216796
IRS990ScheduleG/FundraisingEventInformationGrp/GrossReceiptsEvent2Amt0146539
IRS990ScheduleG/FundraisingEventInformationGrp/GrossReceiptsOtherEventsAmt0129193
IRS990ScheduleG/FundraisingEventInformationGrp/GrossReceiptsTotalAmt0492528
IRS990ScheduleG/FundraisingEventInformationGrp/GrossRevenueEvent1Amt0150225
IRS990ScheduleG/FundraisingEventInformationGrp/GrossRevenueEvent2Amt099584
IRS990ScheduleG/FundraisingEventInformationGrp/GrossRevenueOtherEventsAmt087568
IRS990ScheduleG/FundraisingEventInformationGrp/GrossRevenueTotalEventsAmt0337377
IRS990ScheduleG/FundraisingEventInformationGrp/NetIncomeSummaryAmt0143779
IRS990ScheduleG/FundraisingEventInformationGrp/OthDirectExpnssOtherEventsAmt03365
IRS990ScheduleG/FundraisingEventInformationGrp/OthDirectExpnssTotalEventsAmt082514
IRS990ScheduleG/FundraisingEventInformationGrp/OtherDirectExpensesEvent1Amt049557
IRS990ScheduleG/FundraisingEventInformationGrp/OtherDirectExpensesEvent2Amt029592
IRS990ScheduleG/FundraisingEventInformationGrp/OtherEventsTotalCnt04
IRS990ScheduleG/FundraisingEventInformationGrp/RentFacilityCostsEvent1Amt01693
IRS990ScheduleG/FundraisingEventInformationGrp/RentFacilityCostsEvent2Amt01710
IRS990ScheduleG/FundraisingEventInformationGrp/RentFcltyCostsOtherEventsAmt019010
IRS990ScheduleG/FundraisingEventInformationGrp/RentFcltyCostsTotalEventsAmt022413
IRS990/ScheduleJRequiredInd0false
IRS990ScheduleM/AnyPropertyThatMustBeHeldInd0false
IRS990ScheduleM/OtherNonCashContriTableGrp/ContributionCnt08
IRS990ScheduleM/OtherNonCashContriTableGrp/MethodOfDeterminingRevenuesTxt0FAIR MARKET VALUE
IRS990ScheduleM/OtherNonCashContriTableGrp/NonCashCheckboxInd0X
IRS990ScheduleM/OtherNonCashContriTableGrp/NoncashContributionsRptF990Amt069643
IRS990ScheduleM/ReviewProcessUnusualNCGiftsInd0false
IRS990ScheduleM/ThirdPartiesUsedInd0false
IRS990/ScheduleORequiredInd0true
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0THE MISSION OF THE ANDY & JORDAN DALTON FOUNDATION IS TO PROVIDE DAILY SUPPORT, OPPORTUNITIES, RESOURCES AND LIFE-CHANGING EXPERIENCES TO SERIOUSLY ILL AND PHYSICALLY CHALLENGED CHILDREN AND THEIR FAMILIES IN CINCINNATI AND FORT WORTH.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1OTHER ACCOMPLISHMENTS OF THE FOUNDATION INCLUDE THE ANDY & JORDAN HUB. THE HUB PROVIDES PATIENTS AND THEIR FAMILIES ACCESS TO ENTERTAINMENT AND EDUCATIONAL RESOURCES, INCLUDING IPADS, COMPUTERS, MOBILE TELEVISION AND THEATER SYSTEMS AND GAMING CONSOLES TO HELP PASS THE TIME DURING HOSPITAL STAYS. HUBS ARE LOCATED AT THE CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER, COOK CHILDREN'S MEDICAL CENTER, TEXAS CHILDREN'S HOSPITAL - WEST CAMPUS, AND THE REDWOOD SCHOOL.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2ANDY DALTON JORDAN DALTON PRESIDENT VICE PRES HUSBAND/WIFE
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3FORM 990 REVIEWED BY BOARD OF DIRECTORS PRIOR TO SIGNATURE AND FILING
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4CONFLICT OF INTEREST POLICY IS REVIEWED AND DISCUSSED AT MEETINGS AS APPLICABLE
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5ALL GOVERNING DOCUMENTS AVAILABLE UPON REQUEST
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6FOUNDATION MANAGEMENT;SPONSORSHIP DEVELOPMENT & MANAGEMENT;PROGRAM MANAGEMENT; EVENT PLANNING & FACILITATION;COMMUNICATIONS MANAGEMENT; FINANCIAL MANAGEMENT; ADMINISTRATION;SOCIAL MEDIA MANAGEMENT;EXECUTIVE BOARD DEVELOPMENT & MANAGEMENT.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7CONTRACT SERVICES 11,064 0 0 BANK FEES 0 3,675 1,230 HOLIDAY HEARTS EXPENSES 17,810 0 0 KING FOR A DAY EXPENSES 1,947 0 0 DATE & NIGHT EXPENSES 12,095 0 0 JUNGLE EVENT EXPENSES 325 0 0 HUB EXPENSES 12,659 0 0 GENERAL ASSISTANCE EXPENSE 6,057 0 0 OTHER PROGRAM EXPENSES 555 0 0 CHILDRENS HOSPITAL- PROGRAM 223,620 0 0 CELEBRITY WAITER NIGHT CONTRACT SERVICES 0 0 7,273 BANKING/MERCHANT 0 0 4,858 0 0 0 STADIUM TOUR CONTRACT SERVICES 0 0 1,360 BANK FEES 0 0 26 0 0 0 FIESTA & GOAL CONTRACT SERVICES 0 0 7,420 MERCHANT / BANK FEES 0 0 3,253 0 0 0 JUNGLE CONTRACT SERVICES 0 0 3,914 BANK FEES 0 0 286 TOTAL 286,132 3,675 29,620
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990 - ORGANIZATION'S MISSION
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PAGE 2, PART III, LINE 4D
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PAGE 6, PART VI, LINE 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PAGE 6, PART VI, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PAGE 6, PART VI, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PAGE 6, PART VI, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6FORM 990, PAGE 7, PART VII
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7FORM 990, PART IX, LINE 11G
IRS990/SchoolOperatingInd0false
IRS990/SignificantChangeInd0false
IRS990/SignificantNewProgramSrvcInd0false
IRS990/StatesWhereCopyOfReturnIsFldCd0OH
IRS990/SubjectToProxyTaxInd0false
IRS990/TaxablePartyNotificationInd0false
IRS990/TaxExemptBondsInd0false
IRS990/TempOrPermanentEndowmentsInd0false
IRS990/TerminateOperationsInd0false
IRS990/TotalAssetsBOYAmt0176787
IRS990/TotalAssetsEOYAmt040317
IRS990/TotalAssetsGrp/BOYAmt0176787
IRS990/TotalAssetsGrp/EOYAmt040317
IRS990/TotalCompGreaterThan150KInd0false
IRS990/TotalContributionsAmt0317114
IRS990/TotalEmployeeCnt00
IRS990/TotalFunctionalExpensesGrp/FundraisingAmt054296
IRS990/TotalFunctionalExpensesGrp/ManagementAndGeneralAmt0103773
IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt0437443
IRS990/TotalFunctionalExpensesGrp/TotalAmt0595512
IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesEOYAmt01759
IRS990/TotalLiabilitiesGrp/BOYAmt00
IRS990/TotalLiabilitiesGrp/EOYAmt01759
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt0176787
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt038558
IRS990/TotalOtherProgSrvcExpenseAmt0140605
IRS990/TotalProgramServiceExpensesAmt0437443
IRS990/TotalProgramServiceRevenueAmt0506
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt0517
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt0457283
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt0176787
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt040317
IRS990/TravelGrp/FundraisingAmt011052
IRS990/TravelGrp/ManagementAndGeneralAmt0614
IRS990/TravelGrp/ProgramServicesAmt07459
IRS990/TravelGrp/TotalAmt019125
IRS990/TrnsfrExmptNonChrtblRltdOrgInd0false
IRS990/TypeOfOrganizationCorpInd0X
IRS990/UnrelatedBusIncmOverLimitInd0false
IRS990/UnrestrictedNetAssetsGrp/BOYAmt0176787
IRS990/UnrestrictedNetAssetsGrp/EOYAmt038558
IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine1Txt02692 MADISON ROAD SUITE N1 148
IRS990/USAddress/CityNm0CINCINNATI
IRS990/USAddress/StateAbbreviationCd0OH
IRS990/USAddress/ZIPCd045208
IRS990/VotingMembersGoverningBodyCnt03
IRS990/VotingMembersIndependentCnt03
IRS990/WebsiteAddressTxt0WWW.ANDYDALTON.ORG
IRS990/WhistleblowerPolicyInd0false
ReturnHeader/BuildTS02018-06-14 16:35:46Z
ReturnHeader/BusinessOfficerGrp/PersonNm0ANDY DALTON
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0PRESIDENT
ReturnHeader/BusinessOfficerGrp/PhoneNum08597463431
ReturnHeader/BusinessOfficerGrp/SignatureDt02018-05-10
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0ANDY AND JORDAN DALTON FOUNDATION
ReturnHeader/Filer/BusinessNameControlTxt0ANDY
ReturnHeader/Filer/EIN0454066146
ReturnHeader/Filer/PhoneNum08597463431
ReturnHeader/Filer/USAddress/AddressLine1Txt059 CAVALIER BLVD STE 310
ReturnHeader/Filer/USAddress/CityNm0FLORENCE
ReturnHeader/Filer/USAddress/StateAbbreviationCd0KY
ReturnHeader/Filer/USAddress/ZIPCd041042
ReturnHeader/FilingSecurityInformation/AtSubmissionCreationDeviceId0AC5B6BAE6E3687DC18A9672CB8468E550B8228BA
ReturnHeader/FilingSecurityInformation/AtSubmissionFilingDeviceId0AB59085E2CEDF6A0DC2B892FA2A6FCB9ADF1898C
ReturnHeader/FilingSecurityInformation/FilingLicenseTypeCd0P
ReturnHeader/FilingSecurityInformation/IPAddress/IPv4AddressTxt0216.196.229.226
ReturnHeader/FilingSecurityInformation/IPDt02018-09-27
ReturnHeader/FilingSecurityInformation/IPTimezoneCd0CD
ReturnHeader/FilingSecurityInformation/IPTm016:56:30
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0352349774
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0KEITH & ASSOCIATES PLLC
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt0715 BAKEWELL ST
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0COVINGTON
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0KY
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd0410111227
ReturnHeader/PreparerPersonGrp/PhoneNum08592616800
ReturnHeader/PreparerPersonGrp/PreparationDt02018-09-17
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0R FREDERICK KEITH
ReturnHeader/ReturnTs02018-09-27T17:56:30-04:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/TaxPeriodBeginDt02017-01-01
ReturnHeader/TaxPeriodEndDt02017-12-31
ReturnHeader/TaxYr02017

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