Civic Intelligence

Systemic Jia Foundation

990 • Fiscal year 2022 • EIN 82-2564392

Jan 01, 2022 to Dec 31, 2022 • Filed on May 10, 2023

3584 Outlook AvenueCincinnati, OH 45208

(510) 703-9595

Siviq Scores

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

Liabilities / Assets

58th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

2022 filings • 501(c)3 • <$500k nonprofits • Source year 2022

Liabilities / Revenue

58th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

2022 filings • 501(c)3 • <$500k nonprofits • Source year 2022

Net Margin

7th percentile

-87%

Higher net margin than 7% of similar nonprofits.

2022 filings • 501(c)3 • <$500k nonprofits • Source year 2022

Top Officer Pay

78th percentile

$0

Higher top officer pay than 78% of similar nonprofits.

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

2022 filings • 501(c)3 • <$500k nonprofits • Source year 2022

Asset Growth

7th percentile

-62%

Faster asset growth than 7% of similar nonprofits.

2022 filings • 501(c)3 • <$500k nonprofits • Annualized from 2021 to 2022

Revenue Growth

92nd percentile

213%

Faster revenue growth than 92% of similar nonprofits.

2022 filings • 501(c)3 • <$500k nonprofits • Annualized from 2021 to 2022

Assets

Down

$102,078

Down $167,737 (-62%) from 2021

Net Assets

Down

$102,078

Down $167,737 (-62%) from 2021

Liabilities

Flat

$0

Flat from 2021

Revenue

Up

$192,569

Up $131,068 (+213%) from 2021

Expenses

Up

$360,306

Up $115,732 (+47%) from 2021

Net Income

Up

-$167,737

Up $15,336 (+8.4%) from 2021

Historical Trend

Balance Sheet Trend

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

$600K$400K$200K$0Assets 2017: $5,000Liabilities 2017: $0Net Assets 2017: $5,0002017Assets 2018: $4,552Liabilities 2018: $10Net Assets 2018: $4,5422018Assets 2019: $44,098Liabilities 2019: $10Net Assets 2019: $44,0882019Assets 2020: $452,923Liabilities 2020: $35Net Assets 2020: $452,8882020Assets 2021: $269,815Liabilities 2021: $0Net Assets 2021: $269,8152021Assets 2022: $102,078Liabilities 2022: $0Net Assets 2022: $102,0782022Assets 2023: $89,621Liabilities 2023: $0Net Assets 2023: $89,6212023Assets 2024: $106,554Liabilities 2024: $0Net Assets 2024: $106,5542024

Highlighted filing

2022

Assets$102,078
Liabilities$0
Net Assets$102,078

Operations Trend

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

$1.0M$500K$0-$500KRevenue 2017: $5,000Expenses 2017: $0Net Income 2017: $5,0002017Revenue 2018: $0Expenses 2018: $458Net Income 2018: -$4582018Revenue 2019: $90,432Expenses 2019: $50,886Net Income 2019: $39,5462019Revenue 2020: $679,692Expenses 2020: $270,892Net Income 2020: $408,8002020Revenue 2021: $61,501Expenses 2021: $244,574Net Income 2021: -$183,0732021Revenue 2022: $192,569Expenses 2022: $360,306Net Income 2022: -$167,7372022Revenue 2023: $348,552Expenses 2023: $361,009Net Income 2023: -$12,4572023Revenue 2024: $159,459Expenses 2024: $142,526Net Income 2024: $16,9332024

Highlighted filing

2022

Revenue$192,569
Expenses$360,306
Net Income-$167,737
Jump To
Filing Snapshot
Filing Period
Jan 1, 2022 to Dec 31, 2022
Signed
May 10, 2023
Return Version
2022v5.0
Gross Receipts
$192,569
Mission and Program Overview

Mission

1. To support research relating to treatments and cure of systemic juvenile idiopathic arthritis (sjia); 2. Promote increased awareness, knowledge and understanding of sjia by medical professionals, the general public and families affected by sjia; 3. Promote mutual support through building and maintaining an extensive web-based or other network of information and resources for the general public and families.

Balance Sheet Detail
LineBeginningEndChange
Assets
Cash and Non-Interest-Bearing Accounts$269,815$102,078▼ $167,737
Rtn Earn Endowment Incm Other Fnds$269,815$102,078▼ $167,737
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Total Assets$269,815$102,078▼ $167,737
Liabilities
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Total Net Assets Fund Balance$269,815$102,078▼ $167,737
Total Liabilities and Net Assets / Fund Balance$269,815$102,078▼ $167,737
Compensation and Service Providers

Board Members and Trustees

NameTitle
Jonathan BoutelleDirector
Matthew MightDirector
Rashmi SinhaDirector
Revenue and Support

Revenue Composition

Contributions and Grants
$192,569
Program Service Revenue
$0
Investment Income
$0
Other Revenue
$0
All Other Contributions
$192,569
Change in Net Assets
$-167,737
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Grants and Similar Amounts Paid$317,626
Other Expenses$42,680
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Grants to Domestic Orgs$201,625--$201,625
Foreign Grants$116,001--$116,001
Conferences and Meetings$25,304--$25,304
Fees for Services Accounting-$7,848-$7,848
Fees for Services Legal-$2,550-$2,550
Fees for Services Other$1,127--$1,127
Office Expenses-$162-$162
Other Expenses$50$0-$50
Total Functional Expenses$344,107$16,199$0$360,306
International Activity

Grant and Assistance Recipients

RecipientLocationCategoryPurposeAmount
CINCINNATI CHILDREN'S HOSPITALCincinnati, OHSection 501(c)(3)This Grant Has Been Provided to Fund the Research to Find Treatments and Cure of Systemic Juvenile Idiopathic Arthritis.$150,000
The Ucla FoundationLos Angeles, CASection 501(c)(3)This Grant Has Been Provided to Fund the Research to Find Treatments and Cure of Systemic Juvenile Idiopathic Arthritis.$26,625

International Summary

Offices
0
Employees
0
Spending
$141,001

International Compliance

Foreign grant records maintained
Yes
Activity in boycott countries
No
Foreign corporation ownership
No
Foreign partnership interest
No
Interest in foreign trust
No
Passive foreign investment company interest
No
Transfers to foreign corporations
No

International Activities

RegionActivityServicesOfficesEmployeesSpending
Europe (including Iceland & Greenland)Grants Used to Fund Key European Researchers to Advance the Study of Systemic Jia.---$141,001
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
Business relationship with 35% controlled entity
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, Part VI, Section A, Line 2

Jonathan boutelle, director - husband of rashmi sinha rashmi sinha, director - wife of jonathan boutelle

Form 990, Part VI, Section B, Line 11B

The signing board member will review the form 990 before it is released to the taxing authorities. The other board members will receive the final copy of the filed tax return.

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

To ensure the foundation operates in a manner consistent with charitable purposes and does not engage in activities that could jeopardize its tax-exempt status, a periodic review shall be conducted and will include the following: 1. Assess whether compensation arrangements and benefits are reasonable, based on competent survey information, and the result of arm's length bargaining. 2. Assess whether partnerships, joint ventures, and arrangements with management organizations conform to the foundation's written policies, are properly recorded, reflect reasonable investment or payments for goods and services, further charitable purposes and do not result in inurement, impermissible private benefit or in an excess benefit transaction.

Form 990, Part VI, Section C, Line 19

The documents are available for public inspection via the state of california registry of charitable trusts website. Www.rct.doj.ca.gov the foundation intends to publish the information in their website in the near future.

Form 990, Part VII Contact Addresses for Officers, Directors, Etc

Jonathan boutelle - 3584 outlook ave, cincinnati, oh 45208. Rashmi sinha - 3584 outlook ave, cincinnati, oh 45208. Matthew might - 510 20th st. S, birmingham, al 35210.

Filing and Contact Details

Filer

Filer Name
Systemic Jia Foundation
EIN
82-2564392
Phone
5107039595
Address
3584 OUTLOOK AVENUE, CINCINNATI, OH 45208

Signing Officer

Name
Jonathan Boutelle
Title
Director
Phone
5107039595
Signed
2023-05-10
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Jonathan Boutelle
Formed
2017
Legal Domicile
CA
Voting Board Members
3
Independent Board Members
1
Employees
0
Volunteers
0

Preparer

Firm
Altum Pr LLC
Address
RQ
Preparer
John T Advani
Phone
4083200260
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IRS990/ProgSrvcAccomActyOtherGrp/Desc0NEXTGEN 2022 CONFERENCE:NEXTGEN CONFERENCE ORGANIZED VIRTUALLY FROM FEBRUARY 16 TO FEBRUARY 18, 2022. THE PURPOSE OF THE CONFERENCE IS TO ADVANCE THERAPIES FOR SJIA, STILL'S DISEASE AND MAS WITH SPECIAL EMPHASIS ON CLINICAL TRIALS AND OPTIONS FOR REFRACTORY DISEASE.
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IRS990ScheduleF/GrantsToOrgOutsideUSGrp/PurposeOfGrantTxt1THIS GRANT HAS BEEN PROVIDED TO FUND THE RESEARCH TO FIND TREATMENTS AND CURE OF SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS.
IRS990ScheduleF/GrantsToOrgOutsideUSGrp/RegionTxt0EUROPE (INCLUDING ICELAND & GREENLAND)
IRS990ScheduleF/GrantsToOrgOutsideUSGrp/RegionTxt1EUROPE (INCLUDING ICELAND & GREENLAND)
IRS990ScheduleF/InterestInForeignTrustInd00
IRS990ScheduleF/PassiveForeignInvestmestCoInd00
IRS990ScheduleF/SubtotalEmployeesCnt00
IRS990ScheduleF/SubtotalOfficesCnt00
IRS990ScheduleF/SubtotalSpentAmt0141001
IRS990ScheduleF/SupplementalInformationDetail/FormAndLineReferenceDesc0PART III ACCOUNTING METHOD:
IRS990ScheduleF/TotalEmployeeCnt00
IRS990ScheduleF/TotalOfficeCnt00
IRS990ScheduleF/TotalOtherOrgCnt02
IRS990ScheduleF/TotalSpentAmt0141001
IRS990ScheduleF/TransferToForeignCorpInd00
IRS990ScheduleI/GrantRecordsMaintainedInd01
IRS990ScheduleI/RecipientTable/CashGrantAmt026625
IRS990ScheduleI/RecipientTable/CashGrantAmt1150000
IRS990ScheduleI/RecipientTable/IRCSectionDesc0SECTION 501(C)(3)
IRS990ScheduleI/RecipientTable/IRCSectionDesc1SECTION 501(C)(3)
IRS990ScheduleI/RecipientTable/NonCashAssistanceAmt00
IRS990ScheduleI/RecipientTable/NonCashAssistanceAmt10
IRS990ScheduleI/RecipientTable/PurposeOfGrantTxt0THIS GRANT HAS BEEN PROVIDED TO FUND THE RESEARCH TO FIND TREATMENTS AND CURE OF SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS.
IRS990ScheduleI/RecipientTable/PurposeOfGrantTxt1THIS GRANT HAS BEEN PROVIDED TO FUND THE RESEARCH TO FIND TREATMENTS AND CURE OF SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS.
IRS990ScheduleI/RecipientTable/RecipientBusinessName/BusinessNameLine1Txt0THE UCLA FOUNDATION
IRS990ScheduleI/RecipientTable/RecipientBusinessName/BusinessNameLine1Txt1CINCINNATI CHILDREN'S HOSPITAL
IRS990ScheduleI/RecipientTable/RecipientEIN0952250801
IRS990ScheduleI/RecipientTable/RecipientEIN1131083393
IRS990ScheduleI/RecipientTable/USAddress/AddressLine1Txt010889 WILSHIRE BLVD 1100
IRS990ScheduleI/RecipientTable/USAddress/AddressLine1Txt13333 BURNET AVENUE
IRS990ScheduleI/RecipientTable/USAddress/CityNm0LOS ANGELES
IRS990ScheduleI/RecipientTable/USAddress/CityNm1CINCINNATI
IRS990ScheduleI/RecipientTable/USAddress/StateAbbreviationCd0CA
IRS990ScheduleI/RecipientTable/USAddress/StateAbbreviationCd1OH
IRS990ScheduleI/RecipientTable/USAddress/ZIPCd090024
IRS990ScheduleI/RecipientTable/USAddress/ZIPCd145229
IRS990ScheduleI/Total501c3OrgCnt02
IRS990/ScheduleJRequiredInd00
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0JONATHAN BOUTELLE, DIRECTOR - HUSBAND OF RASHMI SINHA RASHMI SINHA, DIRECTOR - WIFE OF JONATHAN BOUTELLE
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1THE SIGNING BOARD MEMBER WILL REVIEW THE FORM 990 BEFORE IT IS RELEASED TO THE TAXING AUTHORITIES. THE OTHER BOARD MEMBERS WILL RECEIVE THE FINAL COPY OF THE FILED TAX RETURN.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2TO ENSURE THE FOUNDATION OPERATES IN A MANNER CONSISTENT WITH CHARITABLE PURPOSES AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX-EXEMPT STATUS, A PERIODIC REVIEW SHALL BE CONDUCTED AND WILL INCLUDE THE FOLLOWING: 1. ASSESS WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. 2. ASSESS WHETHER PARTNERSHIPS, JOINT VENTURES, AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO THE FOUNDATION'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENTS FOR GOODS AND SERVICES, FURTHER CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THE DOCUMENTS ARE AVAILABLE FOR PUBLIC INSPECTION VIA THE STATE OF CALIFORNIA REGISTRY OF CHARITABLE TRUSTS WEBSITE. WWW.RCT.DOJ.CA.GOV THE FOUNDATION INTENDS TO PUBLISH THE INFORMATION IN THEIR WEBSITE IN THE NEAR FUTURE.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4JONATHAN BOUTELLE - 3584 OUTLOOK AVE, CINCINNATI, OH 45208. RASHMI SINHA - 3584 OUTLOOK AVE, CINCINNATI, OH 45208. MATTHEW MIGHT - 510 20TH ST. S, BIRMINGHAM, AL 35210.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION A, 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 C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC
IRS990ScheduleR/AssetExchangeInd00
IRS990ScheduleR/AssetPurchaseFromOtherOrgInd00
IRS990ScheduleR/AssetSaleToOtherOrgInd00
IRS990ScheduleR/DivRelatedOrganizationInd00
IRS990ScheduleR/GiftGrntCapContriFromOthOrgInd00
IRS990ScheduleR/GiftGrntOrCapContriToOthOrgInd00
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ControlledOrganizationInd00
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt0THE SINHA-BOUTELLE FOUNDATION
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/EIN0463792029
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt0SECTION 501(C)(3)
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd0CA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt0FINDING CURE FOR SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt0PRIVATE FOUNDATION
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt03584 OUTLOOK AVENUE
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm0CINCINNATI
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/StateAbbreviationCd0OH
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/ZIPCd045208
IRS990ScheduleR/LoansOrGuaranteesFromOthOrgInd00
IRS990ScheduleR/LoansOrGuaranteesToOtherOrgInd00
IRS990ScheduleR/PaidEmployeesSharingInd00
IRS990ScheduleR/PerformOfServicesByOtherOrgInd00
IRS990ScheduleR/PerformOfServicesForOthOrgInd00
IRS990ScheduleR/ReceiptOfIntAnntsRntsRyltsInd00
IRS990ScheduleR/ReimbursementPaidByOtherOrgInd00
IRS990ScheduleR/ReimbursementPaidToOtherOrgInd00
IRS990ScheduleR/RentalOfFacilitiesToOthOrgInd00
IRS990ScheduleR/RentalOfFcltsFromOthOrgInd00
IRS990ScheduleR/SharingOfFacilitiesInd00
IRS990ScheduleR/TransferFromOtherOrgInd00
IRS990ScheduleR/TransferToOtherOrgInd00
IRS990/SchoolOperatingInd00
IRS990/SignificantChangeInd00
IRS990/SignificantNewProgramSrvcInd00
IRS990/StatesWhereCopyOfReturnIsFldCd0CA
IRS990/SubjectToExcsTaxNetInvstIncInd00
IRS990/SubjectToProxyTaxInd00
IRS990/SubjToTaxRmnrtnExPrchtPymtInd00
IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TerminateOperationsInd00
IRS990/TotalAssetsBOYAmt0269815
IRS990/TotalAssetsEOYAmt0102078
IRS990/TotalAssetsGrp/BOYAmt0269815
IRS990/TotalAssetsGrp/EOYAmt0102078
IRS990/TotalCompGreaterThan150KInd00
IRS990/TotalContributionsAmt0192569
IRS990/TotalEmployeeCnt00
IRS990/TotalFunctionalExpensesGrp/FundraisingAmt00
IRS990/TotalFunctionalExpensesGrp/ManagementAndGeneralAmt016199
IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt0344107
IRS990/TotalFunctionalExpensesGrp/TotalAmt0360306
IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesBOYAmt00
IRS990/TotalLiabilitiesEOYAmt00
IRS990/TotalLiabilitiesGrp/BOYAmt00
IRS990/TotalLiabilitiesGrp/EOYAmt00
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt0269815
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt0102078
IRS990/TotalOtherCompensationAmt00
IRS990/TotalOtherProgSrvcExpenseAmt025304
IRS990/TotalProgramServiceExpensesAmt0344107
IRS990/TotalReportableCompFromOrgAmt00
IRS990/TotalRevenueGrp/ExclusionAmt00
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt00
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt0192569
IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
IRS990/TotalVolunteersCnt00
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt0269815
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt0102078
IRS990/TotReportableCompRltdOrgAmt00
IRS990/TrnsfrExmptNonChrtblRltdOrgInd00
IRS990/TypeOfOrganizationCorpInd0X
IRS990/UnrelatedBusIncmOverLimitInd00
IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine1Txt03584 OUTLOOK AVENUE
IRS990/USAddress/CityNm0CINCINNATI
IRS990/USAddress/StateAbbreviationCd0OH
IRS990/USAddress/ZIPCd045208
IRS990/VotingMembersGoverningBodyCnt03
IRS990/VotingMembersIndependentCnt01
IRS990/WebsiteAddressTxt0WWW.SYSTEMICJIA.ORG
IRS990/WhistleblowerPolicyInd00
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/AuthenticationAssuranceLevelCd0AAL1
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/IdentityAssuranceLevelCd0IAL1
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/TrustedCustomerCd03
ReturnHeader/BuildTS02023-04-26 12:10:37Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0JONATHAN BOUTELLE
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0DIRECTOR
ReturnHeader/BusinessOfficerGrp/PhoneNum05107039595
ReturnHeader/BusinessOfficerGrp/SignatureDt02023-05-10
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0SYSTEMIC JIA FOUNDATION
ReturnHeader/Filer/BusinessNameControlTxt0SYST
ReturnHeader/Filer/EIN0822564392
ReturnHeader/Filer/PhoneNum05107039595
ReturnHeader/Filer/USAddress/AddressLine1Txt03584 OUTLOOK AVENUE
ReturnHeader/Filer/USAddress/CityNm0CINCINNATI
ReturnHeader/Filer/USAddress/StateAbbreviationCd0OH
ReturnHeader/Filer/USAddress/ZIPCd045208
ReturnHeader/IRSResponsiblePrtyInfoCurrInd01
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0660974586
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0ALTUM PR LLC
ReturnHeader/PreparerFirmGrp/PreparerForeignAddress/AddressLine1Txt01225 PONCE DE LEON AVENUE SUITE
ReturnHeader/PreparerFirmGrp/PreparerForeignAddress/AddressLine2Txt0GF-1
ReturnHeader/PreparerFirmGrp/PreparerForeignAddress/CityNm0SAN JUAN
ReturnHeader/PreparerFirmGrp/PreparerForeignAddress/CountryCd0RQ
ReturnHeader/PreparerFirmGrp/PreparerForeignAddress/ForeignPostalCd000907
ReturnHeader/PreparerPersonGrp/PhoneNum04083200260
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0JOHN T ADVANI
ReturnHeader/PreparerPersonGrp/SelfEmployedInd0X
ReturnHeader/ReturnTs02023-05-10T09:42:09-05:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/SigningOfficerGrp/PersonFullName/PersonFirstNm0JONATHAN
ReturnHeader/SigningOfficerGrp/PersonFullName/PersonLastNm0BOUTELLE

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