Civic Intelligence

Good Shepherd Medication Management

990 • Fiscal year 2017 • EIN 46-3313048

Jan 01, 2017 to Dec 31, 2017 • Filed on Oct 25, 2018

1256 Union Avenue 3rd FloorMemphis, TN 38104

(877) 521-6337

Siviq Scores

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

Liabilities / Assets

99th percentile

2.70x

Higher debt load relative to assets than 99% of similar nonprofits.

2017 filings • 501(c)3 • $5M-$10M nonprofits • Source year 2017

Liabilities / Revenue

23rd percentile

0.05x

Higher debt load relative to revenue than 23% of similar nonprofits.

2017 filings • 501(c)3 • $5M-$10M nonprofits • Source year 2017

Net Margin

26th percentile

-3.7%

Higher net margin than 26% of similar nonprofits.

2017 filings • 501(c)3 • $5M-$10M nonprofits • Source year 2017

Top Officer Pay

31st percentile

$80,700

Higher top officer pay than 31% of similar nonprofits.

Top officer pay equals 1.5% of source-year revenue.

2017 filings • 501(c)3 • $5M-$10M nonprofits • Source year 2017

Asset Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2017

Revenue Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2017

Assets

$106,421

No earlier filing loaded for comparison.

Net Assets

-$180,537

No earlier filing loaded for comparison.

Liabilities

$286,958

No earlier filing loaded for comparison.

Revenue

$5,525,009

No earlier filing loaded for comparison.

Expenses

$5,731,111

No earlier filing loaded for comparison.

Net Income

-$206,102

No earlier filing loaded for comparison.

Historical Trend

Balance Sheet Trend

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

$30M$20M$10M$0-$10MAssets 2017: $106,421Liabilities 2017: $286,958Net Assets 2017: -$180,5372017Assets 2018: $120,595Liabilities 2018: $349,958Net Assets 2018: -$229,3632018Assets 2019: $4,508,291Liabilities 2019: $514,668Net Assets 2019: $3,993,6232019Assets 2020: $2,325,879Liabilities 2020: $511,257Net Assets 2020: $1,814,6222020Assets 2021: $1,363,068Liabilities 2021: $292,880Net Assets 2021: $1,070,1882021Assets 2022: $810,516Liabilities 2022: $568,224Net Assets 2022: $242,2922022Assets 2023: $345,120Liabilities 2023: $565,446Net Assets 2023: -$220,3262023Assets 2024: $22,897,448Liabilities 2024: $685,793Net Assets 2024: $22,211,6552024

Highlighted filing

2017

Assets$106,421
Liabilities$286,958
Net Assets-$180,537

Operations Trend

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

$30M$20M$10M$0-$10MRevenue 2017: $5,525,009Expenses 2017: $5,731,111Net Income 2017: -$206,1022017Revenue 2018: $6,166,210Expenses 2018: $6,155,036Net Income 2018: $11,1742018Revenue 2019: $4,967,043Expenses 2019: $4,244,057Net Income 2019: $722,9862019Revenue 2020: $2,559,042Expenses 2020: $4,738,043Net Income 2020: -$2,179,0012020Revenue 2021: $1,862,836Expenses 2021: $2,607,270Net Income 2021: -$744,4342021Revenue 2022: $2,347,722Expenses 2022: $3,175,618Net Income 2022: -$827,8962022Revenue 2023: $815,374Expenses 2023: $1,265,218Net Income 2023: -$449,8442023Revenue 2024: $23,018,599Expenses 2024: $586,618Net Income 2024: $22,431,9812024

Highlighted filing

2017

Revenue$5,525,009
Expenses$5,731,111
Net Income-$206,102
Jump To
Filing Snapshot
Filing Period
Jan 1, 2017 to Dec 31, 2017
Signed
Oct 25, 2018
Return Version
2017v2.3
Gross Receipts
$5,525,009
Mission and Program Overview

Mission

Good shepherd medication management exists to glorify god by improving the lives of our members through affordable pharmacy services for the uninsured.

Good shepherd medication management is a community pharmacy that stores, prepares, and dispenses medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Balance Sheet Detail
LineBeginningEndChange
Assets
Inventories for Sale or Use$0$100,000▲ $100,000
Cash and Non-Interest-Bearing Accounts$46,065$6,421▼ $39,644
Total Assets$46,065$106,421▲ $60,356
Liabilities
Unsecured Notes Loans Payable$20,500$268,000▲ $247,500
Other Liabilities$0$18,958▲ $18,958
Total Liabilities$20,500$286,958▲ $266,458
Net Assets / Fund Balance
Unrestricted Net Assets$25,565$-180,537▼ $206,102
Total Net Assets Fund Balance$25,565$-180,537▼ $206,102
Total Liabilities and Net Assets / Fund Balance$46,065$106,421▲ $60,356
Compensation and Service Providers

Employees

NameTitleFull / Part TimeBaseTotal
Dr Philip J BakerCEO/founderFT$80,700$80,700

Board Members and Trustees

NameTitle
Ben GehmanDirector
Carmon HelimanDirector
John Paul KochDirector
Jordan ThomasDirector
Rebecca DerousseDirector
Rick TallyDirector
Revenue and Support

Revenue Composition

Contributions and Grants
$5,086,134
Program Service Revenue
$438,852
Investment Income
$23
Other Revenue
$0
All Other Contributions
$5,086,134
Change in Net Assets
$-206,102

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
Drugs and Medical Supplies1$5,040,645Current Market
Total Noncash Contributions1$5,040,645-

Audited Revenue Reconciliation

Revenue per Audited Statements
$5,525,009
Revenue Not Reported on Financial Statements
$0
Revenue Not Reported on Form 990
$0
Total Revenue per Audited Statements
$5,525,009
Total Revenue per Form 990
$5,525,009
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Grants and Similar Amounts Paid$5,085,225
Salaries, Compensation, and Employee Benefits$402,998
Other Expenses$242,888
Total Fundraising Expense$59,196
Professional Fundraising Fees$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Grants to Domestic Individuals$5,085,225--$5,085,225
Other Salaries and Wages$294,231$13,739-$307,970
Current Officers, Directors, Trustees, and Key Employees-$76,665$4,035$80,700
Advertising--$54,852$54,852
Information Technology$27,684$4,885-$32,569
All Other Expenses$20,186--$20,186
Interest$18,958--$18,958
Occupancy$17,500--$17,500
Payroll Taxes$11,424$2,595$309$14,328
Fees for Services Accounting$13,797--$13,797
Other Expenses$6,823$6,823-$13,646
Office Expenses$8,701$3,729-$12,430
Travel$845$3,378-$4,223
Fees for Services Legal$2,642--$2,642
Insurance$1,920--$1,920
Total Functional Expenses$5,549,101$122,814$59,196$5,731,111

Audited Expense Reconciliation

Line ItemAmount
Expenses per Audited Statements$5,731,111
Total Expenses per Audited Statements$5,731,111
Total Expenses per Form 990$5,731,111
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
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Accrued Interest$18,958
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
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
Yes
Other officer compensation reviewed
Yes
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 11B

A copy of the form 990 is provided to board of directors for review, comments and approval before filing.

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

All board members are regularly reminded of the conflict of interest policies and issues are resolved timely at regular board meetings if needed.

Form 990, Part VI, Section B, Line 15

The board reviewed similar professional positions and approved the compensation of the executive director and all other positions.

Form 990, Part VI, Section C, Line 18

The organization has all required documents for public disclosure in a seperate binder available upon request.

Form 990, Part VI, Section C, Line 19

The organization provides conflict of interest policies and financial statements upon request.

Filing and Contact Details

Filer

Filer Name
Good Shepherd Medication Management
EIN
46-3313048
Phone
8775216337
Address
1256 UNION AVENUE 3RD FLOOR, MEMPHIS, TN 38104
Doing Business As
Pharmacy

Signing Officer

Name
Dr Philip J Baker
Title
CEO
Phone
8775216337
Signed
2018-10-25
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Dr Philip J Baker
Formed
2014
Legal Domicile
Tn
Voting Board Members
6
Independent Board Members
6
Employees
12
Volunteers
6

Preparer

Firm
Henderson Hutcherson & Mccullough Pllc
Address
1755 KIRBY PARKWAY SUITE 200, MEMPHIS, TN 38120
Preparer
Richard L Webb CPA
Phone
9016834234
Supplemental Narrative

Additional Explanations

Form 990, Part III, Line 2

The free certified pharmacy technician training program is designed to train unemployed/underemployed and dislocated people to complete board certification at no cost to the student.

FORM 990, PART XII, LINE 2C:

The process of selecting the independent accounting firm has not changed.

Financial Statement Notes

PART X, LINE 2:

The organization follows the accounting guidance for uncertainty in income taxes using the provisions of fasb asc topic 740, income taxes. Based on its evaluation, the organization has concluded that there are no significant uncertain tax positions requiring recognition in its financial statements. The organization's evaluation was performed for the tax years ended december 31, 2014 through december 31, 2017, the years which remain subject to examination by major tax jurisdictions as of the year ended december 31, 2017.

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IRS990ScheduleA/SubstantialContributorsAmtGrp/TotalAmt00
IRS990ScheduleA/Total509Grp/CurrentTaxYearAmt05524986
IRS990ScheduleA/Total509Grp/TotalAmt05524986
IRS990ScheduleA/TotalSupportCalendarYearGrp/CurrentTaxYearAmt05525009
IRS990ScheduleA/TotalSupportCalendarYearGrp/TotalAmt05525009
IRS990/ScheduleBRequiredInd01
IRS990ScheduleD/ExpensesNotReportedAmt00
IRS990ScheduleD/ExpensesNotRptFinclStmtAmt00
IRS990ScheduleD/ExpensesSubtotalAmt05731111
IRS990ScheduleD/FootnoteTextInd0X
IRS990ScheduleD/OtherLiabilitiesOrgGrp/Amt018958
IRS990ScheduleD/OtherLiabilitiesOrgGrp/Desc0ACCRUED INTEREST
IRS990ScheduleD/RevenueNotReportedAmt00
IRS990ScheduleD/RevenueNotReportedFinclStmtAmt00
IRS990ScheduleD/RevenueSubtotalAmt05525009
IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0THE ORGANIZATION FOLLOWS THE ACCOUNTING GUIDANCE FOR UNCERTAINTY IN INCOME TAXES USING THE PROVISIONS OF FASB ASC TOPIC 740, INCOME TAXES. BASED ON ITS EVALUATION, THE ORGANIZATION HAS CONCLUDED THAT THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS REQUIRING RECOGNITION IN ITS FINANCIAL STATEMENTS. THE ORGANIZATION'S EVALUATION WAS PERFORMED FOR THE TAX YEARS ENDED DECEMBER 31, 2014 THROUGH DECEMBER 31, 2017, THE YEARS WHICH REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS AS OF THE YEAR ENDED DECEMBER 31, 2017.
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0PART X, LINE 2:
IRS990ScheduleD/TotalBookValueLandBuildingsAmt00
IRS990ScheduleD/TotalExpensesPerForm990Amt05731111
IRS990ScheduleD/TotalLiabilityAmt018958
IRS990ScheduleD/TotalRevenuePerForm990Amt05525009
IRS990ScheduleD/TotalRevEtcAuditedFinclStmtAmt05525009
IRS990ScheduleD/TotExpnsEtcAuditedFinclStmtAmt05731111
IRS990ScheduleI/GrantRecordsMaintainedInd01
IRS990ScheduleI/GrantsOtherAsstToIndivInUSGrp/GrantTypeTxt0PRESCRIPTION MEDICATIONS
IRS990ScheduleI/GrantsOtherAsstToIndivInUSGrp/NonCashAssistanceAmt05055279
IRS990ScheduleI/GrantsOtherAsstToIndivInUSGrp/NonCashAssistanceDesc0PRESCRIPTION MEDICATION DISTRIBUTED TO QUALIFED AND ELIGIBLE MEMBERS
IRS990ScheduleI/GrantsOtherAsstToIndivInUSGrp/RecipientCnt02000
IRS990ScheduleI/GrantsOtherAsstToIndivInUSGrp/ValuationMethodUsedDesc0RETAIL VALUE OF SIMILAR MEDICATIONS
IRS990ScheduleI/SupplementalInformationDetail/ExplanationTxt0GOOD SHEPHERD MEDICATION MANAGEMENT GENERALLY RECEIVES PRESCRIPTION MEDICATIONS DONATED FROM HOSPITALS, NURSING HOMES AND OTHER SOURCES IN ORDER TO PROPERLY REDISPENSE THE MEDICATIONS TO UNINSURED INDIVIDUALS. ALTHOUGH GOOD SHEPHERD MEDICATION MANAGEMENT RECEIVED A MONTHLY SUBSCRIPTION FEE FROM THE INDIVIDUALS, THE ORGANIZATION MONITORS MEMBERS' FINANCIAL RESOURCES IN ORDER TO INSURE THE MEMBER IS QUALIFIED.
IRS990ScheduleI/SupplementalInformationDetail/FormAndLineReferenceDesc0PART I, LINE 2:
IRS990/ScheduleJRequiredInd00
IRS990ScheduleM/AnyPropertyThatMustBeHeldInd00
IRS990ScheduleM/DrugsAndMedicalSuppliesGrp/ContributionCnt01
IRS990ScheduleM/DrugsAndMedicalSuppliesGrp/MethodOfDeterminingRevenuesTxt0CURRENT MARKET
IRS990ScheduleM/DrugsAndMedicalSuppliesGrp/NonCashCheckboxInd0X
IRS990ScheduleM/DrugsAndMedicalSuppliesGrp/NoncashContributionsRptF990Amt05040645
IRS990ScheduleM/ReviewProcessUnusualNCGiftsInd00
IRS990ScheduleM/ThirdPartiesUsedInd00
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0THE FREE CERTIFIED PHARMACY TECHNICIAN TRAINING PROGRAM IS DESIGNED TO TRAIN UNEMPLOYED/UNDEREMPLOYED AND DISLOCATED PEOPLE TO COMPLETE BOARD CERTIFICATION AT NO COST TO THE STUDENT.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1A COPY OF THE FORM 990 IS PROVIDED TO BOARD OF DIRECTORS FOR REVIEW, COMMENTS AND APPROVAL BEFORE FILING.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2ALL BOARD MEMBERS ARE REGULARLY REMINDED OF THE CONFLICT OF INTEREST POLICIES AND ISSUES ARE RESOLVED TIMELY AT REGULAR BOARD MEETINGS IF NEEDED.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THE BOARD REVIEWED SIMILAR PROFESSIONAL POSITIONS AND APPROVED THE COMPENSATION OF THE EXECUTIVE DIRECTOR AND ALL OTHER POSITIONS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4THE ORGANIZATION HAS ALL REQUIRED DOCUMENTS FOR PUBLIC DISCLOSURE IN A SEPERATE BINDER AVAILABLE UPON REQUEST.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5THE ORGANIZATION PROVIDES CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS UPON REQUEST.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6THE PROCESS OF SELECTING THE INDEPENDENT ACCOUNTING FIRM HAS NOT CHANGED.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART III, LINE 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION B, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION B, LINE 15
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART VI, SECTION C, LINE 18
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6FORM 990, PART XII, LINE 2C:
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IRS990/SignificantChangeInd00
IRS990/SignificantNewProgramSrvcInd01
IRS990/StatesWhereCopyOfReturnIsFldCd0TN
IRS990/SubjectToProxyTaxInd00
IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TempOrPermanentEndowmentsInd00
IRS990/TerminateOperationsInd00
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IRS990/TotalAssetsEOYAmt0106421
IRS990/TotalAssetsGrp/BOYAmt046065
IRS990/TotalAssetsGrp/EOYAmt0106421
IRS990/TotalCompGreaterThan150KInd00
IRS990/TotalContributionsAmt05086134
IRS990/TotalEmployeeCnt012
IRS990/TotalFunctionalExpensesGrp/FundraisingAmt059196
IRS990/TotalFunctionalExpensesGrp/ManagementAndGeneralAmt0122814
IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt05549101
IRS990/TotalFunctionalExpensesGrp/TotalAmt05731111
IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesBOYAmt020500
IRS990/TotalLiabilitiesEOYAmt0286958
IRS990/TotalLiabilitiesGrp/BOYAmt020500
IRS990/TotalLiabilitiesGrp/EOYAmt0286958
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt025565
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt0-180537
IRS990/TotalOtherCompensationAmt00
IRS990/TotalProgramServiceExpensesAmt05549101
IRS990/TotalProgramServiceRevenueAmt0438852
IRS990/TotalReportableCompFromOrgAmt080700
IRS990/TotalRevenueGrp/ExclusionAmt023
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt0438852
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt05525009
IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
IRS990/TotalVolunteersCnt06
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt046065
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt0106421
IRS990/TotReportableCompRltdOrgAmt00
IRS990/TravelGrp/ManagementAndGeneralAmt03378
IRS990/TravelGrp/ProgramServicesAmt0845
IRS990/TravelGrp/TotalAmt04223
IRS990/TrnsfrExmptNonChrtblRltdOrgInd00
IRS990/TypeOfOrganizationCorpInd0X
IRS990/UnrelatedBusIncmOverLimitInd00
IRS990/UnrestrictedNetAssetsGrp/BOYAmt025565
IRS990/UnrestrictedNetAssetsGrp/EOYAmt0-180537
IRS990/UnsecuredNotesLoansPayableGrp/BOYAmt020500
IRS990/UnsecuredNotesLoansPayableGrp/EOYAmt0268000
IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine1Txt02166 CUBA MILLINGTON RD
IRS990/USAddress/CityNm0MILLLINGTON
IRS990/USAddress/StateAbbreviationCd0TN
IRS990/USAddress/ZIPCd038053
IRS990/VotingMembersGoverningBodyCnt06
IRS990/VotingMembersIndependentCnt06
IRS990/WebsiteAddressTxt0HTTPS://WWW.GOODSHEPHEALTH.COM
IRS990/WhistleblowerPolicyInd01
ReturnHeader/BuildTS02018-06-14 16:35:46Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0DR PHILIP J BAKER
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0CEO
ReturnHeader/BusinessOfficerGrp/PhoneNum08775216337
ReturnHeader/BusinessOfficerGrp/SignatureDt02018-10-25
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0GOOD SHEPHERD MEDICATION MANAGEMENT
ReturnHeader/Filer/BusinessNameControlTxt0GOOD
ReturnHeader/Filer/EIN0463313048
ReturnHeader/Filer/PhoneNum08775216337
ReturnHeader/Filer/USAddress/AddressLine1Txt01256 UNION AVENUE 3RD FLOOR
ReturnHeader/Filer/USAddress/CityNm0MEMPHIS
ReturnHeader/Filer/USAddress/StateAbbreviationCd0TN
ReturnHeader/Filer/USAddress/ZIPCd038104
ReturnHeader/FilingSecurityInformation/AtSubmissionCreationDeviceId0051C84D0ABFEA07CCEC9B3C159600078FAC59651
ReturnHeader/FilingSecurityInformation/AtSubmissionFilingDeviceId00A2F32D72A99803037CD48DE13657401618F9368
ReturnHeader/FilingSecurityInformation/FilingLicenseTypeCd0P
ReturnHeader/FilingSecurityInformation/IPAddress/IPv4AddressTxt064.88.174.3
ReturnHeader/FilingSecurityInformation/IPDt02018-10-25
ReturnHeader/FilingSecurityInformation/IPTimezoneCd0CD
ReturnHeader/FilingSecurityInformation/IPTm019:02:22
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0621114363
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0HENDERSON HUTCHERSON & MCCULLOUGH PLLC
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt01755 KIRBY PARKWAY SUITE 200
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0MEMPHIS
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0TN
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd038120

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