Civic Intelligence

Fort Morgan Community Hospital Foundation

EIN 84-0776105 • 501(c)3 • Fort Morgan, CO

Profile

To generate and provide support for the Fort Morgan Community Hospital in Fort Morgan, Colorado. This is done by soliciting, receiving and administering funds including donations, contributions, gifts, grants, and bequests of property, both real and personal.

1000 Lincoln StreetFort Morgan, CO 80701

www.fmhospitalfoundation.weebly.com

Siviq Scores

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

Liabilities / Assets

9th percentile

0.00x

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

501(c)3 • $5M-$10M nonprofits • Source year 2024

Liabilities / Revenue

10th percentile

0.00x

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

501(c)3 • $5M-$10M nonprofits • Source year 2024

Net Margin

97th percentile

88%

Higher net margin than 97% of similar nonprofits.

501(c)3 • $5M-$10M nonprofits • Source year 2024

Top Officer Pay

23rd percentile

$0

Higher top officer pay than 23% of similar nonprofits.

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

501(c)3 • $5M-$10M nonprofits • Source year 2024

Asset Growth

73rd percentile

14%

Faster asset growth than 73% of similar nonprofits.

501(c)3 • $5M-$10M nonprofits • Annualized from 2023 to 2024

Revenue Growth

97th percentile

360%

Faster revenue growth than 97% of similar nonprofits.

501(c)3 • $5M-$10M nonprofits • Annualized from 2023 to 2024

Balance Sheet
Liabilities / Assets9th percentile

Assets

Up

$9,045,909

Up $1,097,169 (+14%) from 2023

Liabilities

Flat

$0

Flat from 2023

Net Assets

Up

$9,045,909

Up $1,097,169 (+14%) from 2023

Operations
Liabilities / Revenue10th percentileNet Margin97th percentile

Revenue

Up

$426,285

Up $333,535 (+360%) from 2023

Expenses

Down

$51,714

Down $285,548 (-85%) from 2023

Net Income

Up

$374,571

Up $619,083 (+253%) from 2023

Trend Graphs

Balance Sheet Trend

Asset Growth73rd percentile

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

$10M$5.0M$0Assets 2011: $4,987,054Liabilities 2011: $0Net Assets 2011: $4,987,0542011Assets 2012: $5,562,496Liabilities 2012: $0Net Assets 2012: $5,562,4962012Assets 2013: $6,145,717Liabilities 2013: $0Net Assets 2013: $6,145,7172013Assets 2014: $5,375,394Liabilities 2014: $0Net Assets 2014: $5,375,3942014Assets 2015: $5,251,298Liabilities 2015: $0Net Assets 2015: $5,251,2982015Assets 2016: $5,574,058Liabilities 2016: $0Net Assets 2016: $5,574,0582016Assets 2017: $6,384,762Liabilities 2017: $0Net Assets 2017: $6,384,7622017Assets 2018: $5,862,551Liabilities 2018: $0Net Assets 2018: $5,862,5512018Assets 2019: $6,916,082Liabilities 2019: $0Net Assets 2019: $6,916,0822019Assets 2020: $7,860,473Liabilities 2020: $0Net Assets 2020: $7,860,4732020Assets 2021: $8,546,085Liabilities 2021: $0Net Assets 2021: $8,546,0852021Assets 2022: $7,071,563Liabilities 2022: $0Net Assets 2022: $7,071,5632022Assets 2023: $7,948,740Liabilities 2023: $0Net Assets 2023: $7,948,7402023Assets 2024: $9,045,909Liabilities 2024: $0Net Assets 2024: $9,045,9092024

Highlighted filing

2024

Assets$9,045,909
Liabilities$0
Net Assets$9,045,909
Open 2024 Filing

Operations Trend

Revenue Growth97th percentile

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

$1.5M$1.0M$500K$0-$500KRevenue 2011: $294,618Expenses 2011: $26,632Net Income 2011: $267,9862011Revenue 2012: $280,296Expenses 2012: $60,198Net Income 2012: $220,0982012Revenue 2013: $222,226Expenses 2013: $62,078Net Income 2013: $160,1482013Revenue 2014: $1,107,245Expenses 2014: $1,451,391Net Income 2014: -$344,1462014Revenue 2015: $149,937Expenses 2015: $69,096Net Income 2015: $80,8412015Revenue 2016: $237,944Expenses 2016: $64,649Net Income 2016: $173,2952016Revenue 2017: $244,522Expenses 2017: $53,055Net Income 2017: $191,4672017Revenue 2018: $258,334Expenses 2018: $55,682Net Income 2018: $202,6522018Revenue 2019: $307,307Expenses 2019: $186,641Net Income 2019: $120,6662019Revenue 2020: $28,706Expenses 2020: $51,241Net Income 2020: -$22,5352020Revenue 2021: $747,796Expenses 2021: $285,697Net Income 2021: $462,0992021Revenue 2022: $117,004Expenses 2022: $46,877Net Income 2022: $70,1272022Revenue 2023: $92,750Expenses 2023: $337,262Net Income 2023: -$244,5122023Revenue 2024: $426,285Expenses 2024: $51,714Net Income 2024: $374,5712024

Highlighted filing

2024

Revenue$426,285
Expenses$51,714
Net Income$374,571
Open 2024 Filing

Filings

Most recent year

2024 • Form 990XML pending. An XML filing is linked for this year, but detailed extraction is still pending.

Open filing
Assets
$9,045,909
Liabilities
$0
Net assets
$9,045,909
Revenue
$426,285
Expenses
$51,714
Net income
$374,571
Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2024XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$9.05$0.00$9.05$0.43$0.05$0.37
2023Summary only. Only limited summary data is available for this year.$7.95$0.00$7.95$0.09$0.34$0.24
2022Facts available. Structured filing facts are available, but richer extracted sections are limited.$7.07$0.00$7.07$0.12$0.05$0.07
2021Summary only. Only limited summary data is available for this year.$8.55$0.00$8.55$0.75$0.29$0.46
2020XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$7.86$0.00$7.86$0.03$0.05$0.02
2019XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$6.92$0.00$6.92$0.31$0.19$0.12
2018Summary only. Only limited summary data is available for this year.$5.86$0.00$5.86$0.26$0.06$0.20
2017XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$6.38$0.00$6.38$0.24$0.05$0.19
2016Facts available. Structured filing facts are available, but richer extracted sections are limited.$5.57$0.00$5.57$0.24$0.06$0.17
2015XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$5.25$0.00$5.25$0.15$0.07$0.08
2014Detailed filing. Detailed filing data is available for this year.$5.38$0.00$5.38$1.11$1.45$0.34
2013Detailed filing. Detailed filing data is available for this year.$6.15$0.00$6.15$0.22$0.06$0.16
2012Summary only. Only limited summary data is available for this year.$5.56$0.00$5.56$0.28$0.06$0.22
2011Summary only. Only limited summary data is available for this year.$4.99$0.00$4.99$0.29$0.03$0.27
Latest Detailed Filing

The latest 2024 filing currently has linked XML that has not been fully parsed yet. Showing the latest detailed filing from 2022 below.

Jump To
Filing Snapshot
Filing Period
Jan 1, 2022 to Dec 31, 2022
Signed
Jun 1, 2023
Return Version
2022v5.0
Gross Receipts
$1,848,325
Mission and Program Overview

Mission

To generate and provide support for the Fort Morgan Community Hospital in Fort Morgan, Colorado. This is done by soliciting, receiving and administering funds including donations, contributions, gifts, grants, and bequests of property, both real and personal.

To provide support for the Fort Morgan Community Hospital or its successor. This is done by soliciting, receiving and administering fund, including donations, contributions, gifts, grants, and bequests of property, both real and personal.

Balance Sheet Detail
LineBeginningEndChange
Assets
Investments in Publicly Traded Securities$8,243,366$6,840,595▼ $1,402,771
Savings and Temporary Cash Investments$268,575$196,824▼ $71,751
Total Assets$8,546,085$7,071,563▼ $1,474,522
Other Assets Total$34,144$34,144→ $0
Liabilities
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Net Assets With Donor Restrictions$7,338,345$5,774,623▼ $1,563,722
Net Assets Without Donor Restrictions$1,207,740$1,296,940▲ $89,200
Total Net Assets Fund Balance$8,546,085$7,071,563▼ $1,474,522
Total Liabilities and Net Assets / Fund Balance$8,546,085$7,071,563▼ $1,474,522
Compensation and Service Providers
Top Officer Pay23rd percentile

Board Members and Trustees

NameTitle
Jeff MorfordPresident
Andy McClaryVice President
Geoff TaylorTrustee
Kim PrevostTrustee
Roger SeguraTrustee
Alix KeenanSecretary/Treasurer
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$117,004
Other Revenue
$0
Change in Net Assets
$70,127
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$46,877
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Service Investment Mgmnt Fees-$44,429-$44,429
Fees for Services Accounting-$1,250-$1,250
Insurance-$1,002-$1,002
Other Expenses-$10-$10
Total Functional Expenses$0$46,877$0$46,877
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
Yes
Annual disclosure for covered persons
Yes
Backup withholding compliance
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 B, Line 11B

“Form 990 is presented to the Board of Directors at a regular board meeting before the form 990 is filed with the IRS.”

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

“A copy of the conflict of interest policy is provided to each Board Member at the beginning of the year. They review and sign to affirm no conflicts exist, if a conflict does exsist, it is documented and reviewed by the whole board to determine if it disqualifies a Board Member from serving on the Board of the Foundation.”

Form 990, Part VI, Section C, Line 19

“The governing documents, conflict of interest policy and financial information can be requested by mailing a request to the Fort Morgan Community Hospital Foundation at 1000 Lincoln Street, Fort Morgan, CO 80701.”

Filing and Contact Details

Filer

Filer Name
Fort Morgan Community Hospital Foundation
EIN
84-0776105
Phone
7203349185
Address
1000 Lincoln Street, Fort Morgan, CO 80701

Signing Officer

Name
Andrew Petrick
Title
Trustee
Phone
7203349185
Signed
2023-06-01
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Andrew Petrick
Formed
1978
Legal Domicile
Co
Voting Board Members
6
Independent Board Members
6
Employees
0

Preparer

Firm
Liittjohann Kauffman and Pederson CPAs
Address
420 East Platte Avenue, Fort Morgan, CO 80701
Preparer
David Kauffman
Phone
9708674922
Raw XML Appendix336 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
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IRS990/AdvertisingGrp/TotalAmt00
IRS990/AllOtherExpensesGrp/TotalAmt00
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IRS990/BackupWthldComplianceInd0true
IRS990/BenefitsToMembersGrp/TotalAmt00
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IRS990/BooksInCareOfDetail/PhoneNum09705423346
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IRS990/BooksInCareOfDetail/USAddress/CityNm0Fort Morgan
IRS990/BooksInCareOfDetail/USAddress/StateAbbreviationCd0CO
IRS990/BooksInCareOfDetail/USAddress/ZIPCd080701
IRS990/BusinessRlnWith35CtrlEntInd0false
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IRS990/BusinessRlnWithOrgMemInd0false
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IRS990/CollectionsOfArtInd0false
IRS990/CompCurrentOfcrDirectorsGrp/TotalAmt00
IRS990/CompDisqualPersonsGrp/TotalAmt00
IRS990/CompensationFromOtherSrcsInd0false
IRS990/CompensationProcessCEOInd0false
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IRS990/ConferencesMeetingsGrp/TotalAmt00
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IRS990/ConservationEasementsInd0false
IRS990/ConsolidatedAuditFinclStmtInd0false
IRS990/CreditCounselingInd0false
IRS990/CYBenefitsPaidToMembersAmt00
IRS990/CYContributionsGrantsAmt00
IRS990/CYGrantsAndSimilarPaidAmt00
IRS990/CYInvestmentIncomeAmt0117004
IRS990/CYOtherExpensesAmt046877
IRS990/CYOtherRevenueAmt00
IRS990/CYProgramServiceRevenueAmt00
IRS990/CYRevenuesLessExpensesAmt070127
IRS990/CYSalariesCompEmpBnftPaidAmt00
IRS990/CYTotalExpensesAmt046877
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IRS990/CYTotalProfFndrsngExpnsAmt00
IRS990/CYTotalRevenueAmt0117004
IRS990/DecisionsSubjectToApprovaInd0false
IRS990/DeductibleArtContributionInd0false
IRS990/DeductibleNonCashContriInd0false
IRS990/DelegationOfMgmtDutiesInd0false
IRS990/DepreciationDepletionGrp/TotalAmt00
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IRS990/DescribedInSection501c3Ind0true
IRS990/DisregardedEntityInd0false
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IRS990/DonorAdvisedFundInd0false
IRS990/DonorRestrictionNetAssetsGrp/BOYAmt07338345
IRS990/DonorRestrictionNetAssetsGrp/EOYAmt05774623
IRS990/DonorRstrOrQuasiEndowmentsInd0false
IRS990/ElectionOfBoardMembersInd0false
IRS990/EmployeeCnt00
IRS990/EngagedInExcessBenefitTransInd0false
IRS990/EscrowAccountInd0false
IRS990/ExcsTaxSect4951Or4952Or4953Ind0false
IRS990/FamilyOrBusinessRlnInd0false
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IRS990/FeesForServicesAccountingGrp/ManagementAndGeneralAmt01250
IRS990/FeesForServicesAccountingGrp/TotalAmt01250
IRS990/FeesForServicesLegalGrp/TotalAmt00
IRS990/FeesForServicesLobbyingGrp/TotalAmt00
IRS990/FeesForServicesManagementGrp/TotalAmt00
IRS990/FeesForServicesOtherGrp/TotalAmt00
IRS990/FeesForSrvcInvstMgmntFeesGrp/ManagementAndGeneralAmt044429
IRS990/FeesForSrvcInvstMgmntFeesGrp/TotalAmt044429
IRS990/ForeignActivitiesInd0false
IRS990/ForeignFinancialAccountInd0false
IRS990/ForeignGrantsGrp/TotalAmt00
IRS990/ForeignOfficeInd0false
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IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt0000.50
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt1000.50
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt2000.50
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt3000.50
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt4000.50
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt5001.00
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd0X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd1X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd2X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd3X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd4X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd5X
IRS990/Form990PartVIISectionAGrp/OfficerInd0X
IRS990/Form990PartVIISectionAGrp/OfficerInd1X
IRS990/Form990PartVIISectionAGrp/OfficerInd2X
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt00
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt10
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt20
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt30
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt40
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt50
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IRS990/Form990PartVIISectionAGrp/PersonNm1Geoff Taylor
IRS990/Form990PartVIISectionAGrp/PersonNm2Roger Segura
IRS990/Form990PartVIISectionAGrp/PersonNm3Alix Keenan
IRS990/Form990PartVIISectionAGrp/PersonNm4Andy McClary
IRS990/Form990PartVIISectionAGrp/PersonNm5Jeff Morford
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt00
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt10
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt20
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IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt50
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt00
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IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt50
IRS990/Form990PartVIISectionAGrp/TitleTxt0Trustee
IRS990/Form990PartVIISectionAGrp/TitleTxt1Trustee
IRS990/Form990PartVIISectionAGrp/TitleTxt2Trustee
IRS990/Form990PartVIISectionAGrp/TitleTxt3Secretary/Treasurer
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IRS990/Form990PartVIISectionAGrp/TitleTxt5President
IRS990/Form990ProvidedToGvrnBodyInd0true
IRS990/FormationYr01978
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IRS990/FSAuditedInd0false
IRS990/FundraisingActivitiesInd0false
IRS990/GainOrLossGrp/SecuritiesAmt0-21383
IRS990/GamingActivitiesInd0false
IRS990/GoverningBodyVotingMembersCnt06
IRS990/GrantsToDomesticIndividualsGrp/TotalAmt00
IRS990/GrantsToDomesticOrgsGrp/TotalAmt00
IRS990/GrantsToIndividualsInd0false
IRS990/GrantsToOrganizationsInd0false
IRS990/GrantToRelatedPersonInd0false
IRS990/GrossAmountSalesAssetsGrp/SecuritiesAmt01709938
IRS990/GrossReceiptsAmt01848325
IRS990/GroupReturnForAffiliatesInd0false
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IRS990/IndependentAuditFinclStmtInd0false
IRS990/IndependentVotingMemberCnt06
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IRS990/InvestmentIncomeGrp/TotalRevenueColumnAmt0138387
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IRS990/InvestmentsPubTradedSecGrp/BOYAmt08243366
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IRS990/IRPDocumentCnt00
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IRS990/MethodOfAccountingAccrualInd0X
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IRS990/MoreThan5000KToIndividualsInd0false
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IRS990/NoListedPersonsCompensatedInd0X
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IRS990/OccupancyGrp/TotalAmt00
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IRS990/Organization501c3Ind0X
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IRS990/OtherExpensesGrp/Desc0Taxes on investments
IRS990/OtherExpensesGrp/Desc1Permits and licenses
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IRS990/RoyaltiesGrp/TotalAmt00
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IRS990ScheduleA/SupportedOrgInformationGrp/SupportedOrganizationName/BusinessNameLine1Txt0Colorado Plains Medical Center
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IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0Form 990 is presented to the Board of Directors at a regular board meeting before the form 990 is filed with the IRS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1A copy of the conflict of interest policy is provided to each Board Member at the beginning of the year. They review and sign to affirm no conflicts exist, if a conflict does exsist, it is documented and reviewed by the whole board to determine if it disqualifies a Board Member from serving on the Board of the Foundation.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2The governing documents, conflict of interest policy and financial information can be requested by mailing a request to the Fort Morgan Community Hospital Foundation at 1000 Lincoln Street, Fort Morgan, CO 80701.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0Form 990, Part VI, Section B, Line 11b
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1Form 990, Part VI, Section B, Line 12c
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2Form 990, Part VI, Section C, Line 19
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IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine1Txt012000 N Washington St Ste 300
IRS990/USAddress/CityNm0Thornton
IRS990/USAddress/StateAbbreviationCd0CO
IRS990/USAddress/ZIPCd080241
IRS990/VotingMembersGoverningBodyCnt06
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IRS990/WebsiteAddressTxt0www.fmhospitalfoundation.weebly.com
IRS990/WhistleblowerPolicyInd0false
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/AuthenticationAssuranceLevelCd0AAL1
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/IdentityAssuranceLevelCd0IAL1
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/TrustedCustomerCd02
ReturnHeader/BuildTS02023-04-26 12:10:37Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd0true
ReturnHeader/BusinessOfficerGrp/PersonNm0Andrew Petrick
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0Trustee
ReturnHeader/BusinessOfficerGrp/PhoneNum07203349185
ReturnHeader/BusinessOfficerGrp/SignatureDt02023-06-01
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0Fort Morgan Community Hospital Foundation
ReturnHeader/Filer/BusinessNameControlTxt0FORT
ReturnHeader/Filer/EIN0840776105
ReturnHeader/Filer/PhoneNum07203349185
ReturnHeader/Filer/USAddress/AddressLine1Txt01000 Lincoln Street
ReturnHeader/Filer/USAddress/CityNm0Fort Morgan
ReturnHeader/Filer/USAddress/StateAbbreviationCd0CO
ReturnHeader/Filer/USAddress/ZIPCd080701
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0841074472
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0Liittjohann Kauffman and Pederson CPAs
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt0420 East Platte Avenue
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0Fort Morgan
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0CO
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd080701
ReturnHeader/PreparerPersonGrp/PhoneNum09708674922
ReturnHeader/PreparerPersonGrp/PreparationDt02023-08-15
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0David Kauffman
ReturnHeader/ReturnTs02023-08-15T12:41:54-00:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/SigningOfficerGrp/PersonFullName/PersonFirstNm0Andrew
ReturnHeader/SigningOfficerGrp/PersonFullName/PersonLastNm0Petrick
ReturnHeader/TaxPeriodBeginDt02022-01-01
ReturnHeader/TaxPeriodEndDt02022-12-31
ReturnHeader/TaxYr02022

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