Civic Intelligence

Green Horn Neurosurgery Foundation

EIN 81-2305791 • Lakeland, FL

1325 Lakeland Hills BlvdLakeland, FL 33805
Siviq Scores

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

Liabilities / Assets

64th percentile

0.00x

Higher debt load relative to assets than 64% of similar nonprofits.

<$500k nonprofits • Source year 2021

Liabilities / Revenue

95th percentile

1.00x

Higher debt load relative to revenue than 95% of similar nonprofits.

<$500k nonprofits • Source year 2021

Net Margin

1st percentile

-543000%

Higher net margin than 1% of similar nonprofits.

<$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.

<$500k nonprofits • Source year 2021

Asset Growth

29th percentile

-24%

Faster asset growth than 29% of similar nonprofits.

<$500k nonprofits • Annualized from 2020 to 2021

Revenue Growth

4th percentile

-100%

Faster revenue growth than 4% of similar nonprofits.

<$500k nonprofits • Annualized from 2020 to 2021

Assets

Down

$16,937

Down $5,431 (-24%) from 2020

Liabilities

Flat

$1

Flat from 2020

Net Assets

Down

$16,937

Down $5,431 (-24%) from 2020

Revenue

Down

$1

Down $561 (-100%) from 2020

Expenses

Down

$5,431

Down $6,164 (-53%) from 2020

Net Income

Up

-$5,430

Up $5,603 (+51%) from 2020

Trend Graphs

Balance Sheet Trend

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

$40K$30K$20K$10K$0Assets 2019: $33,401Liabilities 2019: $02019Assets 2020: $22,368Liabilities 2020: $1Net Assets 2020: $22,3682020Assets 2021: $16,937Liabilities 2021: $1Net Assets 2021: $16,9372021

Highlighted filing

2021

Assets$16,937
Liabilities$1
Net Assets$16,937

Operations Trend

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

$30K$20K$10K$0-$10K-$20KRevenue 2019: $9,656Expenses 2019: $22,121Net Income 2019: -$12,4652019Revenue 2020: $562Expenses 2020: $11,595Net Income 2020: -$11,0332020Revenue 2021: $1Expenses 2021: $5,431Net Income 2021: -$5,4302021

Highlighted filing

2021

Revenue$1
Expenses$5,431
Net Income-$5,430

Filings

Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Jan 1, 2021 to Dec 31, 2021
Signed
May 25, 2022
Return Version
2021v4.2
Compensation and Service Providers

Employees

NameTitleFull / Part TimeBaseOtherTotal
Tsz LauDirectorPT$0--
Blake BoeselDirectorPT$0--
Henry Brown JrDirectorPT$0--
Filing and Contact Details

Filer

Filer Name
Green Horn Neurosurgery Foundation
EIN
81-2305791
Address
1325 Lakeland Hills Blvd, Lakeland, FL 33805

Signing Officer

Name
Henry Brown
Title
Director
Phone
7278250099
Signed
2022-05-25
Discuss with paid preparer
Yes

Preparer

Firm
Paul C Jensen Attorney at Law LLC
Address
2001 16th Street North, Saint Petersburg, FL 33704
Preparer
Paul C Jensen
Phone
7278250099
Raw XML Appendix207 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
IRS990PF/AnalysisOfRevenueAndExpenses/AdjustedNetIncomeAmt00
IRS990PF/AnalysisOfRevenueAndExpenses/ContriPaidDsbrsChrtblAmt00
IRS990PF/AnalysisOfRevenueAndExpenses/ContriPaidRevAndExpnssAmt00
IRS990PF/AnalysisOfRevenueAndExpenses/ExcessRevenueOverExpensesAmt0-5431
IRS990PF/AnalysisOfRevenueAndExpenses/NetInvestmentIncomeAmt00
IRS990PF/AnalysisOfRevenueAndExpenses/OthEmplSlrsWgsRevAndExpnssAmt04400
IRS990PF/AnalysisOfRevenueAndExpenses/OtherExpensesRevAndExpnssAmt01031
IRS990PF/AnalysisOfRevenueAndExpenses/ScheduleBNotRequiredInd0X
IRS990PF/AnalysisOfRevenueAndExpenses/TotalExpensesDsbrsChrtblAmt00
IRS990PF/AnalysisOfRevenueAndExpenses/TotalExpensesNetInvstIncmAmt00
IRS990PF/AnalysisOfRevenueAndExpenses/TotalExpensesRevAndExpnssAmt05431
IRS990PF/AnalysisOfRevenueAndExpenses/TotalNetInvstIncmAmt00
IRS990PF/AnalysisOfRevenueAndExpenses/TotalRevAndExpnssAmt00
IRS990PF/AnalysisOfRevenueAndExpenses/TotOprExpensesDsbrsChrtblAmt00
IRS990PF/AnalysisOfRevenueAndExpenses/TotOprExpensesNetInvstIncmAmt00
IRS990PF/AnalysisOfRevenueAndExpenses/TotOprExpensesRevAndExpnssAmt05431
IRS990PF/ChgInNetAssetsFundBalancesGrp/ExcessRevenueOverExpensesAmt0-5431
IRS990PF/ChgInNetAssetsFundBalancesGrp/SubtotalAmt016937
IRS990PF/ChgInNetAssetsFundBalancesGrp/TotNetAstOrFundBalancesBOYAmt022368
IRS990PF/ChgInNetAssetsFundBalancesGrp/TotNetAstOrFundBalancesEOYAmt016937
IRS990PF/DistributableAmountGrp/DistributableAsAdjustedAmt0968
IRS990PF/DistributableAmountGrp/DistributableBeforeAdjAmt0968
IRS990PF/DistributableAmountGrp/DistributableBeforeDedAmt0968
IRS990PF/DistributableAmountGrp/MinimumInvestmentReturnAmt0968
IRS990PF/ExciseTaxBasedOnInvstIncmGrp/InvestmentIncomeExciseTaxAmt00
IRS990PF/ExciseTaxBasedOnInvstIncmGrp/SubtitleATaxAmt00
IRS990PF/ExciseTaxBasedOnInvstIncmGrp/TaxBasedOnInvestmentIncomeAmt00
IRS990PF/ExciseTaxBasedOnInvstIncmGrp/TaxUnderSection511Amt00
IRS990PF/FMVAssetsEOYAmt016937
IRS990PF/Form990PFBalanceSheetsGrp/CashBOYAmt022368
IRS990PF/Form990PFBalanceSheetsGrp/CashEOYAmt016937
IRS990PF/Form990PFBalanceSheetsGrp/CashEOYFMVAmt016937
IRS990PF/Form990PFBalanceSheetsGrp/NoDonorRstrNetAssestsBOYAmt022368
IRS990PF/Form990PFBalanceSheetsGrp/NoDonorRstrNetAssestsEOYAmt016937
IRS990PF/Form990PFBalanceSheetsGrp/OrganizationFollowsFASB117Ind0X
IRS990PF/Form990PFBalanceSheetsGrp/TotalAssetsBOYAmt022368
IRS990PF/Form990PFBalanceSheetsGrp/TotalAssetsEOYAmt016937
IRS990PF/Form990PFBalanceSheetsGrp/TotalAssetsEOYFMVAmt016937
IRS990PF/Form990PFBalanceSheetsGrp/TotalLiabilitiesBOYAmt00
IRS990PF/Form990PFBalanceSheetsGrp/TotalLiabilitiesEOYAmt00
IRS990PF/Form990PFBalanceSheetsGrp/TotalLiabilitiesNetAstBOYAmt022368
IRS990PF/Form990PFBalanceSheetsGrp/TotalLiabilitiesNetAstEOYAmt016937
IRS990PF/Form990PFBalanceSheetsGrp/TotNetAstOrFundBalancesBOYAmt022368
IRS990PF/Form990PFBalanceSheetsGrp/TotNetAstOrFundBalancesEOYAmt016937
IRS990PF/InitialReturnFormerPubChrtyInd0X
IRS990PF/MethodOfAccountingCashInd0X
IRS990PF/MinimumInvestmentReturnGrp/AcquisitionIndebtednessAmt00
IRS990PF/MinimumInvestmentReturnGrp/AdjustedTotalFMVOfUnusedAstAmt019653
IRS990PF/MinimumInvestmentReturnGrp/AverageMonthlyCashBalancesAmt019653
IRS990PF/MinimumInvestmentReturnGrp/AverageMonthlyFMVOfSecAmt00
IRS990PF/MinimumInvestmentReturnGrp/CashDeemedCharitableAmt0295
IRS990PF/MinimumInvestmentReturnGrp/FMVAllOtherNoncharitableAstAmt00
IRS990PF/MinimumInvestmentReturnGrp/MinimumInvestmentReturnAmt0968
IRS990PF/MinimumInvestmentReturnGrp/NetVlNoncharitableAssetsAmt019358
IRS990PF/MinimumInvestmentReturnGrp/TotalFMVOfUnusedAssetsAmt019653
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/CompOfHghstPdCntrctOrNONETxt0NONE
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/CompOfHghstPdEmplOrNONETxt0NONE
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/AverageHrsPerWkDevotedToPosRt05.00
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/AverageHrsPerWkDevotedToPosRt15.00
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/AverageHrsPerWkDevotedToPosRt25.00
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/CompensationAmt00
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/CompensationAmt10
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/CompensationAmt20
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/EmployeeBenefitProgramAmt00
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/EmployeeBenefitProgramAmt10
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/EmployeeBenefitProgramAmt20
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/ExpenseAccountOtherAllwncAmt00
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/ExpenseAccountOtherAllwncAmt10
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/ExpenseAccountOtherAllwncAmt20
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/PersonNm0Tsz Lau
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/PersonNm1Blake Boesel
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/PersonNm2Henry Brown Jr
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/TitleTxt0Director
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/TitleTxt1Director
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/TitleTxt2Director
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/AddressLine1Txt01325 Lakeland Hills Boulevard
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/AddressLine1Txt1804 Anchorage Drive
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/AddressLine1Txt22506 W Prospect Road
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/CityNm0Lakeland
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/CityNm1North Palm Beach
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/CityNm2Tampa
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/StateAbbreviationCd0FL
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/StateAbbreviationCd1FL
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/StateAbbreviationCd2FL
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/ZIPCd033805
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/ZIPCd133408
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OfficerDirTrstKeyEmplGrp/USAddress/ZIPCd233629
IRS990PF/OfficerDirTrstKeyEmplInfoGrp/OtherEmployeePaidOver50kCnt00
IRS990PF/Organization501c3ExemptPFInd0X
IRS990PF/PFQualifyingDistributionsGrp/ExpensesAndContributionsAmt00
IRS990PF/StatementsRegardingActy4720Grp/BrrwOrLendDisqualifiedPrsnInd0false
IRS990PF/StatementsRegardingActy4720Grp/BusinessHoldingsInd0false
IRS990PF/StatementsRegardingActy4720Grp/FurnGoodsDisqualifiedPrsnInd0false
IRS990PF/StatementsRegardingActy4720Grp/GrantsToIndividualsInd0false
IRS990PF/StatementsRegardingActy4720Grp/GrantsToOrganizationsInd0false
IRS990PF/StatementsRegardingActy4720Grp/InfluenceElectionInd0false
IRS990PF/StatementsRegardingActy4720Grp/InfluenceLegislationInd0false
IRS990PF/StatementsRegardingActy4720Grp/JeopardyInvestmentsInd0false
IRS990PF/StatementsRegardingActy4720Grp/NoncharitablePurposeInd0false
IRS990PF/StatementsRegardingActy4720Grp/PayCompDisqualifiedPrsnInd0false
IRS990PF/StatementsRegardingActy4720Grp/PaymentToGovernmentOfficialInd0false
IRS990PF/StatementsRegardingActy4720Grp/PayPremiumsPrsnlBnftCntrctInd0false
IRS990PF/StatementsRegardingActy4720Grp/ProhibitedTaxShelterTransInd0false
IRS990PF/StatementsRegardingActy4720Grp/RcvFndsToPayPrsnlBnftCntrctInd0false
IRS990PF/StatementsRegardingActy4720Grp/SaleOrExchDisqualifiedPrsnInd0false
IRS990PF/StatementsRegardingActy4720Grp/SubjToTaxRmnrtnExPrchtPymtInd0false
IRS990PF/StatementsRegardingActy4720Grp/TransferAstDisqualifiedPrsnInd0false
IRS990PF/StatementsRegardingActy4720Grp/UncorrectedPriorActsInd0false
IRS990PF/StatementsRegardingActy4720Grp/UncorrectedPYJeopardyInvstInd0false
IRS990PF/StatementsRegardingActy4720Grp/UndistributedIncomePYInd0false
IRS990PF/StatementsRegardingActy4720Grp/UndistrIncmSect4942a2NotAppInd0false
IRS990PF/StatementsRegardingActyGrp/ActivitiesNotPreviouslyRptInd0false
IRS990PF/StatementsRegardingActyGrp/AtLeast5000InAssetsInd0true
IRS990PF/StatementsRegardingActyGrp/ChangesToArticlesOrBylawsInd0false
IRS990PF/StatementsRegardingActyGrp/ComplyWithPublicInspRqrInd0true
IRS990PF/StatementsRegardingActyGrp/DonorAdvisedFundInd0false
IRS990PF/StatementsRegardingActyGrp/ForeignAccountsQuestionInd0false
IRS990PF/StatementsRegardingActyGrp/Form1120POLFiledInd0false
IRS990PF/StatementsRegardingActyGrp/Form990PFFiledWithAttyGenInd0true
IRS990PF/StatementsRegardingActyGrp/IndividualWithBooksNm0Henry Brown Jr
IRS990PF/StatementsRegardingActyGrp/LegislativePoliticalActyInd0false
IRS990PF/StatementsRegardingActyGrp/LocationOfBooksUSAddress/AddressLine1Txt02506 W Prospect Road
IRS990PF/StatementsRegardingActyGrp/LocationOfBooksUSAddress/CityNm0Tampa
IRS990PF/StatementsRegardingActyGrp/LocationOfBooksUSAddress/StateAbbreviationCd0FL
IRS990PF/StatementsRegardingActyGrp/LocationOfBooksUSAddress/ZIPCd033629
IRS990PF/StatementsRegardingActyGrp/MoreThan100SpentInd0false
IRS990PF/StatementsRegardingActyGrp/NewSubstantialContributorsInd0false
IRS990PF/StatementsRegardingActyGrp/OrganizationDissolvedEtcInd0false
IRS990PF/StatementsRegardingActyGrp/OrgReportOrRegisterStateCd0FL
IRS990PF/StatementsRegardingActyGrp/OwnControlledEntityInd0false
IRS990PF/StatementsRegardingActyGrp/PhoneNum08137146526
IRS990PF/StatementsRegardingActyGrp/PrivateOperatingFoundationInd0false
IRS990PF/StatementsRegardingActyGrp/Section508eRqrSatisfiedInd0true
IRS990PF/StatementsRegardingActyGrp/UnrelatedBusIncmOverLimitInd0false
IRS990PF/SupplementaryInformationGrp/OnlyContriToPreselectedInd0X
IRS990PF/SupplementaryInformationGrp/TotalGrantOrContriApprvFutAmt00
IRS990PF/SupplementaryInformationGrp/TotalGrantOrContriPdDurYrAmt00
IRS990PF/TrnsfrTransRlnNonchrtblEOGrp/LoansOrLoanGuaranteesInd0false
IRS990PF/TrnsfrTransRlnNonchrtblEOGrp/PerformanceOfServicesEtcInd0false
IRS990PF/TrnsfrTransRlnNonchrtblEOGrp/PurchaseOfAssetsNonchrtblEOInd0false
IRS990PF/TrnsfrTransRlnNonchrtblEOGrp/ReimbursementArrangementsInd0false
IRS990PF/TrnsfrTransRlnNonchrtblEOGrp/RelationshipsNonchrtblEOInd0false
IRS990PF/TrnsfrTransRlnNonchrtblEOGrp/RentalOfFacilitiesOthAssetsInd0false
IRS990PF/TrnsfrTransRlnNonchrtblEOGrp/SalesOrExchangesOfAssetsInd0false
IRS990PF/TrnsfrTransRlnNonchrtblEOGrp/SharingOfFacilitiesEtcInd0false
IRS990PF/TrnsfrTransRlnNonchrtblEOGrp/TrnsfrOfCashToNonchrtblEOInd0false
IRS990PF/TrnsfrTransRlnNonchrtblEOGrp/TrnsfrOtherAssetNonchrtblEOInd0false
IRS990PF/UndistributedIncomeGrp/DistributableAsAdjustedAmt0968
IRS990PF/UndistributedIncomeGrp/ExcessDistributionCyovAppCYAmt0968
IRS990PF/UndistributedIncomeGrp/ExcessDistributionCyovYr1Amt04698
IRS990PF/UndistributedIncomeGrp/ExcessDistributionCyovYr2Amt014017
IRS990PF/UndistributedIncomeGrp/ExcessDistributionCyovYr3Amt03122
IRS990PF/UndistributedIncomeGrp/ExcessDistributionCyovYr4Amt09408
IRS990PF/UndistributedIncomeGrp/ExcessDistributionCyovYr5Amt015241
IRS990PF/UndistributedIncomeGrp/ExcessDistriCyovAppCYCorpusAmt0968
IRS990PF/UndistributedIncomeGrp/ExcessDistriCyovFromYr5Amt014273
IRS990PF/UndistributedIncomeGrp/ExcessDistriCyovToNextYrAmt031245
IRS990PF/UndistributedIncomeGrp/ExcessFromYear1Amt04698
IRS990PF/UndistributedIncomeGrp/ExcessFromYear2Amt014017
IRS990PF/UndistributedIncomeGrp/ExcessFromYear3Amt03122
IRS990PF/UndistributedIncomeGrp/ExcessFromYear4Amt09408
IRS990PF/UndistributedIncomeGrp/TotalCorpusAmt045518
IRS990PF/UndistributedIncomeGrp/TotalExcessDistributionCyovAmt046486
IRS990PF/UndistributedIncomeGrp/UndistributedIncomeCYAmt00
OtherExpensesSchedule/OtherExpensesScheduleGrp/AdjustedNetIncomeAmt00
OtherExpensesSchedule/OtherExpensesScheduleGrp/AdjustedNetIncomeAmt10
OtherExpensesSchedule/OtherExpensesScheduleGrp/Desc0Merchant Fees
OtherExpensesSchedule/OtherExpensesScheduleGrp/Desc1Professional Fees
OtherExpensesSchedule/OtherExpensesScheduleGrp/DisbursementsCharitablePrpsAmt00
OtherExpensesSchedule/OtherExpensesScheduleGrp/DisbursementsCharitablePrpsAmt10
OtherExpensesSchedule/OtherExpensesScheduleGrp/NetInvestmentIncomeAmt00
OtherExpensesSchedule/OtherExpensesScheduleGrp/NetInvestmentIncomeAmt10
OtherExpensesSchedule/OtherExpensesScheduleGrp/RevenueAndExpensesPerBooksAmt0381
OtherExpensesSchedule/OtherExpensesScheduleGrp/RevenueAndExpensesPerBooksAmt1650
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/AuthenticationAssuranceLevelCd0AAL2
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/IdentityAssuranceLevelCd0IAL1
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/OOBSecurityVerificationCd011
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/TrustedCustomerCd00
ReturnHeader/BuildTS02022-09-23 18:48:47Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd0true
ReturnHeader/BusinessOfficerGrp/PersonNm0Henry Brown
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0Director
ReturnHeader/BusinessOfficerGrp/PhoneNum07278250099
ReturnHeader/BusinessOfficerGrp/SignatureDt02022-05-25
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0Green Horn Neurosurgery Foundation
ReturnHeader/Filer/BusinessNameControlTxt0GREE
ReturnHeader/Filer/EIN0812305791
ReturnHeader/Filer/USAddress/AddressLine1Txt01325 Lakeland Hills Blvd
ReturnHeader/Filer/USAddress/CityNm0Lakeland
ReturnHeader/Filer/USAddress/StateAbbreviationCd0FL
ReturnHeader/Filer/USAddress/ZIPCd033805
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0200066544
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0Paul C Jensen Attorney at Law LLC
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt02001 16th Street North
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0Saint Petersburg
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0FL
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd033704
ReturnHeader/PreparerPersonGrp/PhoneNum07278250099
ReturnHeader/PreparerPersonGrp/PreparationDt02022-07-06
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0Paul C Jensen
ReturnHeader/ReturnTs02022-07-06T14:36:54-04:00
ReturnHeader/ReturnTypeCd0990PF
ReturnHeader/SigningOfficerGrp/PersonFullName/PersonFirstNm0Henry
ReturnHeader/SigningOfficerGrp/PersonFullName/PersonLastNm0Brown
ReturnHeader/TaxPeriodBeginDt02021-01-01
ReturnHeader/TaxPeriodEndDt02021-12-31
ReturnHeader/TaxYr02021

Document Assets

No mirrored PDF or thumbnail assets are attached yet.