Civic Intelligence

Csa

990 • Fiscal year 2016 • EIN 46-2240919

Jul 01, 2015 to Jun 30, 2016 • Filed on Nov 12, 2016

6000 Aurora Ave Suite BDes Moines, IA 50322

(515) 883-1776

Siviq Scores

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

Liabilities / Assets

83rd percentile

0.62x

Higher debt load relative to assets than 83% of similar nonprofits.

2016 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2016

Liabilities / Revenue

61st percentile

0.19x

Higher debt load relative to revenue than 61% of similar nonprofits.

2016 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2016

Net Margin

67th percentile

9.1%

Higher net margin than 67% of similar nonprofits.

2016 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2016

Top Officer Pay

Score unavailable

No value available

This filing does not contain officer compensation rows.

Source year 2016

Asset Growth

82nd percentile

19%

Faster asset growth than 82% of similar nonprofits.

2016 filings • 501(c)3 • $1M-$5M nonprofits • Annualized from 2014 to 2016

Revenue Growth

63rd percentile

8.6%

Faster revenue growth than 63% of similar nonprofits.

2016 filings • 501(c)3 • $1M-$5M nonprofits • Annualized from 2014 to 2016

Assets

Up

$1,393,298

Up $412,497 (+42%) from 2014

Net Assets

Up

$534,370

Up $568,788 (+1653%) from 2014

Liabilities

Down

$858,928

Down $156,291 (-15%) from 2014

Revenue

Up

$4,540,223

Up $688,038 (+18%) from 2014

Expenses

Up

$4,125,284

Up $238,681 (+6.1%) from 2014

Net Income

Up

$414,939

Up $449,357 (+1306%) from 2014

Historical Trend

Balance Sheet Trend

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

$3.0M$2.0M$1.0M$0-$1.0MAssets 2014: $980,801Liabilities 2014: $1,015,219Net Assets 2014: -$34,4182014Assets 2016: $1,393,298Liabilities 2016: $858,928Net Assets 2016: $534,3702016Assets 2017: $1,416,839Liabilities 2017: $748,286Net Assets 2017: $668,5532017Assets 2018: $1,405,081Liabilities 2018: $619,817Net Assets 2018: $785,2642018Assets 2019: $1,441,244Liabilities 2019: $609,665Net Assets 2019: $831,5792019Assets 2021: $1,766,101Liabilities 2021: $521,705Net Assets 2021: $1,244,3962021Assets 2022: $1,745,665Liabilities 2022: $720,712Net Assets 2022: $1,024,9532022Assets 2023: $2,135,172Liabilities 2023: $1,205,749Net Assets 2023: $929,4232023Assets 2025: $2,989,490Liabilities 2025: $2,203,553Net Assets 2025: $785,9372025

Highlighted filing

2016

Assets$1,393,298
Liabilities$858,928
Net Assets$534,370

Operations Trend

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

$6.0M$4.0M$2.0M$0-$2.0MRevenue 2014: $3,852,185Expenses 2014: $3,886,603Net Income 2014: -$34,4182014Revenue 2016: $4,540,223Expenses 2016: $4,125,284Net Income 2016: $414,9392016Revenue 2017: $4,586,505Expenses 2017: $4,452,322Net Income 2017: $134,1832017Revenue 2018: $4,232,478Expenses 2018: $4,115,844Net Income 2018: $116,6342018Revenue 2019: $3,921,236Expenses 2019: $3,874,978Net Income 2019: $46,2582019Revenue 2021: $5,054,101Expenses 2021: $4,718,864Net Income 2021: $335,2372021Revenue 2022: $4,208,012Expenses 2022: $4,161,537Net Income 2022: $46,4752022Revenue 2023: $4,368,685Expenses 2023: $4,494,505Net Income 2023: -$125,8202023Revenue 2025: $5,186,874Expenses 2025: $5,371,628Net Income 2025: -$184,7542025

Highlighted filing

2016

Revenue$4,540,223
Expenses$4,125,284
Net Income$414,939
Jump To
Filing Snapshot
Filing Period
Jul 1, 2015 to Jun 30, 2016
Signed
Nov 12, 2016
Return Version
2015v2.1
Gross Receipts
$4,540,223
Mission and Program Overview

Mission

To partner with individuals, families, providers, and the community to promote growth and resilience in individuals living in central iowa with disabilities such as mental illness, brain injury, intellectual disabilities and other developmental disabilities.

Balance Sheet Detail
LineBeginningEndChange
Assets
Intangible Assets$719,000$719,000→ $0
Accounts Receivable$325,293$331,608▲ $6,315
Cash and Non-Interest-Bearing Accounts$35,340$221,845▲ $186,505
Prepaid Expenses and Deferred Charges$23,840$73,927▲ $50,087
Land, Buildings, and Equipment, Net$26,833$46,918▲ $20,085
Total Assets$1,130,306$1,393,298▲ $262,992
Liabilities
Unsecured Notes Loans Payable$490,136$485,227▼ $4,909
Accounts Payable and Accrued Expenses$520,739$373,701▼ $147,038
Total Liabilities$1,010,875$858,928▼ $151,947
Net Assets / Fund Balance
Unrestricted Net Assets$119,431$534,370▲ $414,939
Total Net Assets Fund Balance$119,431$534,370▲ $414,939
Total Liabilities and Net Assets / Fund Balance$1,130,306$1,393,298▲ $262,992

Asset Categories

AssetBook ValueDepreciationBasis
Equipment$46,918$20,991$67,909
Leasehold Improvements$0$11,332$11,332
Compensation and Service Providers

Employees

NameTitleFull / Part TimeBaseTotal
Christina SmithPresidentFT$84,802$84,802

Board Members and Trustees

NameTitle
Scott AtwoodChair
Christopher NussVice Chair
Dave WeisDirector
Lewis EatonDirector
Lyndell SheetsDirector
Kelly SwiftSecretary
William VaughnTreasurer
Revenue and Support

Revenue Composition

Contributions and Grants
$7,732
Program Service Revenue
$4,532,491
Investment Income
$0
Other Revenue
$0
All Other Contributions
$7,732
Change in Net Assets
$414,939

Audited Revenue Reconciliation

Revenue per Audited Statements
$4,540,223
Revenue Not Reported on Financial Statements
$0
Revenue Not Reported on Form 990
$0
Total Revenue per Audited Statements
$4,540,223
Total Revenue per Form 990
$4,540,223
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Salaries, Compensation, and Employee Benefits$3,340,241
Other Expenses$785,043
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Other Salaries and Wages$2,242,082$161,119-$2,403,201
Other Employee Benefits$613,946--$613,946
Payroll Taxes$214,739$23,553-$238,292
Occupancy-$166,056-$166,056
Office Expenses$9,816$110,793-$120,609
Information Technology-$116,772-$116,772
Travel$105,946--$105,946
Current Officers, Directors, Trustees, and Key Employees-$84,802-$84,802
Conferences and Meetings-$33,325-$33,325
Interest-$31,382-$31,382
Insurance-$31,155-$31,155
Fees for Services Accounting-$16,552-$16,552
Advertising-$11,310-$11,310
Depreciation Depletion-$8,426-$8,426
Fees for Services Management-$5,087-$5,087
Other Expenses$912$4,535-$912
Fees for Services Legal-$429-$429
Total Functional Expenses$3,319,988$805,296$0$4,125,284

Audited Expense Reconciliation

Line ItemAmount
Expenses per Audited Statements$4,125,284
Total Expenses per Audited Statements$4,125,284
Total Expenses per Form 990$4,125,284
Expenses Not Reported on Financial Statements$0
Expenses Not Reported on Form 990$0
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
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Backup withholding compliance
Yes
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, Part VI, Section B, Line 11

Draft of 990 is provided to board prior to filing. Once approved by the board, the return is signed and filed.

Form 990, Part VI, Section B, Line 12C

Board members review conflict of interest polcies annualy and discuss issues.

Form 990, Part VI, Section C, Line 18

AVAILABLE IN OFFICE

Form 990, Part VI, Section C, Line 19

AVAILABLE IN OFFICE

Filing and Contact Details

Filer

Filer Name
C S a
EIN
46-2240919
Phone
5158831776
Address
6000 AURORA AVE SUITE B, DES MOINES, IA 50322
Doing Business As
Community Support Advocates

Signing Officer

Name
Christina Smith
Title
President
Phone
5158831776
Signed
2016-11-12
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Christina Smith
Formed
2013
Legal Domicile
Ia
Voting Board Members
8
Independent Board Members
8
Employees
78
Volunteers
31

Preparer

Firm
Schnurr&companycpas Plc
Address
218 SE 16TH ST SUITE 101, AMES, IA 50010
Preparer
Murray a Stanley CPA
Phone
5152336300
Supplemental Narrative

Additional Explanations

Form 990, Part III, Line 2

In fy2016, csa started an art access program that is a series of workshops for providing opportunities for members to engage, learn about, and create art as a way to promote growth and resilience in the individuals and families csa serves.

FORM 990, PART XII, LINE 2C:

The review process has not changed.

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IRS990/ProgSrvcAccomActy2Grp/Desc0INTEGRATED SERVICES UTILIZES A TEAM APPROACH TO PROVIDE "WRAP-AROUND" SUPPORT SERVICES TO ADULTS WITH DISABILITIES. IT IS DESIGNED FOR INDIVIDUALS WITH MULTIPLE AREAS OF SUPPORT NEEDS WHO HAVE A MENTAL ILLNESS, INTELLECTUAL DISABILITY OR OTHER DEVELOPMENTAL DISABILITY. TEAMS ASSIST INDIVIDUALS IN ACCESSING APPROPRIATE AND SAFE HOUSING, NEEDED MEDICAL AND BEHAVIORAL HEALTH SERVICES AND INTERRELATED SOCIAL, VOCATIONAL AND EDUCATIONAL SERVICES.
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IRS990/ProgSrvcAccomActy3Grp/Desc0THE INTEGRATED HEALTH HOME PROGRAM PROVIDES WHOLE HEALTH COORDINATED CARE FOR YOUTH AND ADULTS, AGE 16 AND OLDER, WITH A SERIOUS MENTAL ILLNESS OR SERIOUS EMOTIONAL DISTURBANCE WHO ARE MEDICAID ELIGIBLE. THIS PROGRAM IS DESIGNED TO ADDRESS THE UNIQUE MENTAL HEALTH, PHYSICAL AND SOCIAL NEEDS OF YOUNG PEOPLE AND THEIR FAMILIES AS THEY TRANSITION INTO ADULTHOOD.
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IRS990/ProgSrvcAccomActyOtherGrp/Desc0SERVICE COORDINATION SERVICES PROVIDE SUPPORT TO INDIVIDUALS WHO MAY NOT BE ELIGIBLE FOR MEDICAID WHO HAVE AN INTELLECTUAL DISABILITY, OTHER DEVELOPMENTAL DISABILITY OR MENTAL ILLNESS CURRENTLY UNDER TREATMENT. SERVICE COORDINATION IS OFTEN WHERE AN INDIVIDUAL IN CRISIS IS SUPPORTED IN NAVIGATING THE DISABILITY SUPPORT SYSTEM. SERVICE COORDINATION SERVICES ASSIST INDIVIDUALS IN QUALIFYING FOR AND ACCESSING THE NEEDED SUPPORTS TO LIVE, WORK AND SOCIALIZE WITHIN THEIR COMMUNITY.
IRS990/ProgSrvcAccomActyOtherGrp/ExpenseAmt0285095
IRS990/ProgSrvcAccomActyOtherGrp/RevenueAmt0479621
IRS990/ProhibitedTaxShelterTransInd00
IRS990/PYBenefitsPaidToMembersAmt00
IRS990/PYContributionsGrantsAmt00
IRS990/PYExcessBenefitTransInd00
IRS990/PYGrantsAndSimilarPaidAmt00
IRS990/PYInvestmentIncomeAmt00
IRS990/PYOtherExpensesAmt0741378
IRS990/PYOtherRevenueAmt09267
IRS990/PYProgramServiceRevenueAmt04223772
IRS990/PYRevenuesLessExpensesAmt0153849
IRS990/PYSalariesCompEmpBnftPaidAmt03337812
IRS990/PYTotalExpensesAmt04079190
IRS990/PYTotalProfFndrsngExpnsAmt00
IRS990/PYTotalRevenueAmt04233039
IRS990/QuidProQuoContributionsInd00
IRS990/RcvFndsToPayPrsnlBnftCntrctInd00
IRS990/ReconcilationRevenueExpnssAmt0414939
IRS990/RegularMonitoringEnfrcInd01
IRS990/RelatedEntityInd00
IRS990/RelatedOrganizationCtrlEntInd00
IRS990/ReportInvestmentsOtherSecInd00
IRS990/ReportLandBuildingEquipmentInd01
IRS990/ReportOtherAssetsInd00
IRS990/ReportOtherLiabilitiesInd00
IRS990/ReportProgramRelatedInvstInd00
IRS990/RevenueAmt01861876
IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearAmt04504206
IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearMinus1YearAmt04198461
IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearMinus2YearsAmt03821143
IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/TotalAmt012523810
IRS990ScheduleA/GrossInvestmentIncome170Grp/CurrentTaxYearMinus2YearsAmt01450
IRS990ScheduleA/GrossInvestmentIncome170Grp/TotalAmt01450
IRS990ScheduleA/GrossReceiptsRltdActivitiesAmt0121267
IRS990ScheduleA/PublicOrganization170Ind0X
IRS990ScheduleA/PublicSupportCY170Pct00.99990
IRS990ScheduleA/PublicSupportPY170Pct00.99980
IRS990ScheduleA/PublicSupportTotal170Amt012523810
IRS990ScheduleA/ThirtyThrPctSuprtTestsCY170Ind0X
IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearAmt04504206
IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearMinus1YearAmt04198461
IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearMinus2YearsAmt03821143
IRS990ScheduleA/TotalCalendarYear170Grp/TotalAmt012523810
IRS990ScheduleA/TotalSupportAmt012525260
IRS990/ScheduleBRequiredInd00
IRS990ScheduleD/EquipmentGrp/BookValueAmt046918
IRS990ScheduleD/EquipmentGrp/DepreciationAmt020991
IRS990ScheduleD/EquipmentGrp/OtherCostOrOtherBasisAmt067909
IRS990ScheduleD/ExpensesNotReportedAmt00
IRS990ScheduleD/ExpensesNotRptFinclStmtAmt00
IRS990ScheduleD/ExpensesSubtotalAmt04125284
IRS990ScheduleD/LeaseholdImprovementsGrp/BookValueAmt00
IRS990ScheduleD/LeaseholdImprovementsGrp/DepreciationAmt011332
IRS990ScheduleD/LeaseholdImprovementsGrp/OtherCostOrOtherBasisAmt011332
IRS990ScheduleD/RevenueNotReportedAmt00
IRS990ScheduleD/RevenueNotReportedFinclStmtAmt00
IRS990ScheduleD/RevenueSubtotalAmt04540223
IRS990ScheduleD/TotalBookValueLandBuildingsAmt046918
IRS990ScheduleD/TotalExpensesPerForm990Amt04125284
IRS990ScheduleD/TotalRevenuePerForm990Amt04540223
IRS990ScheduleD/TotalRevEtcAuditedFinclStmtAmt04540223
IRS990ScheduleD/TotExpnsEtcAuditedFinclStmtAmt04125284
IRS990/ScheduleJRequiredInd00
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0IN FY2016, CSA STARTED AN ART ACCESS PROGRAM THAT IS A SERIES OF WORKSHOPS FOR PROVIDING OPPORTUNITIES FOR MEMBERS TO ENGAGE, LEARN ABOUT, AND CREATE ART AS A WAY TO PROMOTE GROWTH AND RESILIENCE IN THE INDIVIDUALS AND FAMILIES CSA SERVES.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1DRAFT OF 990 IS PROVIDED TO BOARD PRIOR TO FILING. ONCE APPROVED BY THE BOARD, THE RETURN IS SIGNED AND FILED.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2BOARD MEMBERS REVIEW CONFLICT OF INTEREST POLCIES ANNUALY AND DISCUSS ISSUES.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3AVAILABLE IN OFFICE
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4AVAILABLE IN OFFICE
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5THE REVIEW PROCESS HAS NOT CHANGED.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART III, LINE 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION B, LINE 11
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION C, LINE 18
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PART XII, LINE 2C:
IRS990/SchoolOperatingInd00
IRS990/SignificantChangeInd00
IRS990/SignificantNewProgramSrvcInd01
IRS990/SubjectToProxyTaxInd00
IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TempOrPermanentEndowmentsInd00
IRS990/TerminateOperationsInd00
IRS990/TotalAssetsBOYAmt01130306
IRS990/TotalAssetsEOYAmt01393298
IRS990/TotalAssetsGrp/BOYAmt01130306
IRS990/TotalAssetsGrp/EOYAmt01393298
IRS990/TotalCompGreaterThan150KInd00
IRS990/TotalContributionsAmt07732
IRS990/TotalEmployeeCnt078
IRS990/TotalFunctionalExpensesGrp/FundraisingAmt00
IRS990/TotalFunctionalExpensesGrp/ManagementAndGeneralAmt0805296
IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt03319988
IRS990/TotalFunctionalExpensesGrp/TotalAmt04125284
IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesBOYAmt01010875
IRS990/TotalLiabilitiesEOYAmt0858928
IRS990/TotalLiabilitiesGrp/BOYAmt01010875
IRS990/TotalLiabilitiesGrp/EOYAmt0858928
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt0119431
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt0534370
IRS990/TotalOtherCompensationAmt00
IRS990/TotalOtherProgSrvcExpenseAmt0285095
IRS990/TotalOtherProgSrvcRevenueAmt0479621
IRS990/TotalProgramServiceExpensesAmt03319988
IRS990/TotalProgramServiceRevenueAmt04532491
IRS990/TotalReportableCompFromOrgAmt084802
IRS990/TotalRevenueGrp/ExclusionAmt00
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt04532491
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt04540223
IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
IRS990/TotalVolunteersCnt031
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt01130306
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt01393298
IRS990/TotReportableCompRltdOrgAmt00
IRS990/TravelGrp/ProgramServicesAmt0105946
IRS990/TravelGrp/TotalAmt0105946
IRS990/TrnsfrExmptNonChrtblRltdOrgInd00
IRS990/TypeOfOrganizationCorpInd0X
IRS990/UnrelatedBusIncmOverLimitInd00
IRS990/UnrestrictedNetAssetsGrp/BOYAmt0119431
IRS990/UnrestrictedNetAssetsGrp/EOYAmt0534370
IRS990/UnsecuredNotesLoansPayableGrp/BOYAmt0490136
IRS990/UnsecuredNotesLoansPayableGrp/EOYAmt0485227
IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine1Txt06000 AURORA AVE SUITE B
IRS990/USAddress/CityNm0DES MOINES
IRS990/USAddress/StateAbbreviationCd0IA
IRS990/USAddress/ZIPCd050322
IRS990/VotingMembersGoverningBodyCnt08
IRS990/VotingMembersIndependentCnt08
IRS990/WebsiteAddressTxt0WWW.TEAMCSA.ORG
IRS990/WhistleblowerPolicyInd01
ReturnHeader/BuildTS02017-02-10 21:41:12Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0CHRISTINA SMITH
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0PRESIDENT
ReturnHeader/BusinessOfficerGrp/PhoneNum05158831776
ReturnHeader/BusinessOfficerGrp/SignatureDt02016-11-12
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0C S A
ReturnHeader/Filer/BusinessNameControlTxt0CSA
ReturnHeader/Filer/EIN0462240919
ReturnHeader/Filer/PhoneNum05158831776
ReturnHeader/Filer/USAddress/AddressLine1Txt06000 AURORA AVE SUITE B
ReturnHeader/Filer/USAddress/CityNm0DES MOINES
ReturnHeader/Filer/USAddress/StateAbbreviationCd0IA
ReturnHeader/Filer/USAddress/ZIPCd050322
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0205925131
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0SCHNURR&COMPANYCPAS PLC
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt0218 SE 16TH ST SUITE 101
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0AMES
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0IA
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd050010
ReturnHeader/PreparerPersonGrp/PhoneNum05152336300

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