JJS FOUNDATION INC: Form 990PF, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- JJS FOUNDATION INC (EIN 27-0520587)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-05-13
- IRS object ID
- 201421339349102682
- Schema version
- 2013v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990-PF
- Schedule B
- Accounting Fees Schedule
- Other Expenses Schedule
- Other Liabilities Schedule
- Substantial Contributors Sch
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-05-13T18:14:08-07:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES BOHL CPA PC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Johnson Ave | AddressLine1 |
| City | RONKONKOMA | City |
| State | NY | State |
| ZIP Code | 11779 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 270520587 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JJS FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JJSF | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 CANAL ROAD | AddressLine1 |
| City | PORT JEFF STATION | City |
| State | NY | State |
| ZIP Code | 11776 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GRACE BOHL | PersonNm |
| Person Title | Secretary | PersonTitleTxt |
| Signature | 2014-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JAMES BOHL CPA | PreparerPersonNm |
| PTIN | P00183099 | PTIN |
| Phone | 6316764995 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-12-30 17:16:21Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $7,151 | FMVAssetsEOYAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $23,000 | ContriRcvdRevAndExpnssAmt |
| Interest On Sav Rev And Expnss | $1 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $1 | InterestOnSavNetInvstIncmAmt |
| Interest On Savings Adj Net Incm | $1 | InterestOnSavingsAdjNetIncmAmt |
| Total Rev And Expnss | $23,001 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $1 | TotalNetInvstIncmAmt |
| Total Adj Net Incm | $1 | TotalAdjNetIncmAmt |
| Accounting Fees Rev And Expnss | $500 | AccountingFeesRevAndExpnssAmt |
| Trav Conf Meeting Rev And Expnss | $1,775 | TravConfMeetingRevAndExpnssAmt |
| Printing And Pub Rev And Expnss | $133 | PrintingAndPubRevAndExpnssAmt |
| Other Expenses Rev And Expnss | $9,539 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Dsbrs Chrtbl | $600 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $11,947 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $0 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $600 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $8,911 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $8,911 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $20,858 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $0 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $9,511 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $2,143 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $1 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $1 | AdjustedNetIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $5,008 | CashBOYAmt |
| Cash EOY | $7,151 | CashEOYAmt |
| Cash EOYFMV | $7,151 | CashEOYFMVAmt |
| Total Assets BOY | $5,008 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,151 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $7,151 | TotalAssetsEOYFMVAmt |
| Other Liabilities BOY | $1 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $1 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $1 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1 | TotalLiabilitiesEOYAmt |
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
| Unrestricted BOY | $5,007 | UnrestrictedBOYAmt |
| Unrestricted EOY | $7,150 | UnrestrictedEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $5,007 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $7,150 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $5,008 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $7,151 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $5,007 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $2,143 | ExcessRevenueOverExpensesAmt |
| Subtotal | $7,150 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | $7,150 | TotNetAstOrFundBalancesEOYAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $0 | InvestmentIncomeExciseTaxAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | false | LegislativePoliticalActyInd |
| More Than100 Spent | false | MoreThan100SpentInd |
| Form1120 POL Filed | false | Form1120POLFiledInd |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | false | Form990TFiledInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | false | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (true) | AtLeast5000InAssetsInd |
| Org Report Or Register State | NY | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (true) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | false | PrivateOperatingFoundationInd |
| New Substantial Contributors | Yes (true) | NewSubstantialContributorsInd |
| Own Controlled Entity | false | OwnControlledEntityInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (true) | ComplyWithPublicInspRqrInd |
| Website Address | N/A | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRACE BOHL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6314671972 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 61 FOREST DRIVE | AddressLine1 |
| City | RONKONKOMA | City |
| State | NY | State |
| ZIP Code | 11779 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | false | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | false | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | false | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | false | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | false | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | false | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | false | PaymentToGovernmentOfficialInd |
| Acts Fail To Qlfy As Exceptions | false | ActsFailToQlfyAsExceptionsInd |
| Uncorrected Prior Acts | false | UncorrectedPriorActsInd |
| Undistributed Income PY | false | UndistributedIncomePYInd |
| Undistr Incm Sect4942a2 Not App | false | UndistrIncmSect4942a2NotAppInd |
| Business Holdings | false | BusinessHoldingsInd |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| Jeopardy Investments | false | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | false | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | false | InfluenceLegislationInd |
| Influence Election | false | InfluenceElectionInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Noncharitable Purpose | false | NoncharitablePurposeInd |
| Transactions Fail To Qlfy As Exc | false | TransactionsFailToQlfyAsExcInd |
| Maintained Expenditure Rspns | false | MaintainedExpenditureRspnsInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Proceeds Or Net Income | false | ProceedsOrNetIncomeInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt |
|---|---|---|---|---|---|---|
| JACK SEFERIAN | ||||||
| 201 CANAL ROAD | PORTJEFFERSON STATION | NY | 11776 | President | 1.00 | $0 |
| HAIG SEFERIAN | ||||||
| 188 OLD FIELD ROAD | SETAUKET | NY | 11733 | Vice President | 1.00 | $0 |
| GRACE BOHL | ||||||
| 61 FOREST DRIVE | RONKONKOMA | NY | 11779 | Secretary | 20.00 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Comp Of Hghst Pd Cntrct Or NONE | NONE | CompOfHghstPdCntrctOrNONETxt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $0 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $0 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $0 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Adjusted Total FMV Of Unused Ast | $0 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $0 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $0 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $0 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $0 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $9,511 | ExpensesAndContributionsAmt |
| Qualifying Distributions | $9,511 | QualifyingDistributionsAmt |
| Adjusted Qualifying Distri | $9,511 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $0 | DistributableAsAdjustedAmt |
| Excess Distribution Cyov Yr4 | $3,785 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $13,216 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $14,780 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $10,910 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $42,691 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $9,511 | QualifyingDistributionsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Remaining Distri From Corpus | $9,511 | RemainingDistriFromCorpusAmt |
| Total Corpus | $52,202 | TotalCorpusAmt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Excess Distri Cyov To Next Yr | $52,202 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $3,785 | ExcessFromYear4Amt |
| Excess From Year3 | $13,216 | ExcessFromYear3Amt |
| Excess From Year2 | $14,780 | ExcessFromYear2Amt |
| Excess From Year1 | $10,910 | ExcessFromYear1Amt |
| Excess From Current Year | $9,511 | ExcessFromCurrentYearAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | JACK SEFERIAN | ContributingManagerNm |
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (11 entries)
| Address Line1RecipientUSAddress/AddressLine1 | CityRecipientUSAddress/City | StateRecipientUSAddress/State | ZIP CodeRecipientUSAddress/ZIPCode | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| BARBAR'S TEAM OF HOPE | |||||||
| 122 MCKINLEY STREET | MASSAPEQUA | NY | 11762 | NONE | 501(c)(3) | HELP FIGHT MS | $1,200 |
| THE JOURNEY CHURCH | |||||||
| 424 COLUMBUS AVENUE | EAST PATCHOGUE | NY | 11772 | NONE | CHURCH | ADOPT A FAMILY - HOLIDAY | $731 |
| CONNETQUOT YOUTH ASSOCIATION | |||||||
| 550 EASTON STREET | RONKONKOMA | NY | 11779 | NONE | NOT FOR P | SPECIAL NEEDS TBALL FIELD | $1,181 |
| CONNETQUOT CENTRAL OFFICE | |||||||
| 130 CHEROKEE STREET | RONKNOKOMA | NY | 11779 | NONE | PUBLIC SC | SCHOOL SUPPLIES FOR NEEDY | $166 |
| EPILEPSY FOUNDATION OF NY | |||||||
| 506 STEWART AVENUE | GARDEN CITY | NY | 11530 | NONE | 501(c)(3) | CARING FOR PEOPLE IN NEED | $1,000 |
| ST JOSEPH CHURCH | |||||||
| 45 CHURCH STREET | RONKONKOMA | NY | 11779 | NONE | CHURCH | FOOD DRIVE | $100 |
| NEX GEN FOUNDATION | |||||||
| 2127 LAKELAND AVENUE | RONKONKOMA | NY | 11779 | NONE | 501(c)(3) | SPECIAL NEEDS BASKET BALL | $1,000 |
| MARYKAY CITERA | |||||||
| 121 WYNDHAM DRIVE | ALLENTOWN | PA | 18104 | NONE | INDVIDUAL | CLOTHES | $542 |
| MS CHRISTINE FERRAUIOLO | |||||||
| 8 DARALYN LANE | BOHEMIA | NY | 11716 | NONE | INDVIDUAL | CLOTHES/FOOD | $1,504 |
| MAKE A DIFFERENCE FOUNDATION | |||||||
| 16 LOCUST AVENUE | MEDFORD | NY | 11763 | NONE | NOT FOR P | CLOTHING FOR VETS | $920 |
| PRONTO OF LI INC | |||||||
| 128 PINE AIRE DRIVE | BAY SHORE | NY | 11708 | NONE | PUBLIC SC | SCHOOL SUPPLIES | $567 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $8,911 | TotalGrantOrContriPdDurYrAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Related Or Exempt Function Incm | $1 | RelatedOrExemptFunctionIncmAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Related Or Exempt Function Incm | $1 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $1 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | false | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | false | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | false | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | false | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | false | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | false | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | false | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | false | RelationshipsNonchrtblEOInd |
Schedule B IRS990ScheduleB
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| General Rule | Yes (X) | GeneralRuleInd |
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | 1 | ContributorNum |
| Contributor Person | JACK SEFERIAN | ContributorPersonNm |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 CANAL ROAD | AddressLine1 |
| City | PORTJEFFERSON STAT | City |
| State | NY | State |
| ZIP Code | 11776 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | $22,000 | TotalContributionsAmt |
| Person Contribution | Yes (X) | PersonContributionInd |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amt | $500 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (6 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|
| Communication | $1,165 | |
| Dues & Subscriptions | $60 | |
| Equipment | $600 | |
| Insurance | $4,932 | $600 |
| Supplies | $156 | |
| Utilities | $2,626 |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Rounding | Desc |
| BOY Book Value | $1 | BOYBookValueAmt |
| EOY Book Value | $1 | EOYBookValueAmt |
Substantial Contributors Sch SubstantialContributorsSch
Substantial Contributor Detail SubstantialContributorDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JACK SEFERIAN | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 CANAL ROAD | AddressLine1 |
| City | PORT JEFFERSON STAT | City |
| State | NY | State |
| ZIP Code | 11776 | ZIPCode |