STRATEGY STUDIO / PUBLIC DATA EXPLORER

IHC HOSPICE INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
IHC HOSPICE INC (EIN 20-0063696)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-06-10
IRS object ID
201421619349300512
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 ReturnHeader

FieldValueIRS element (for citing)
Return2014-06-10T09:07:57-05:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1THE CONE COMPANYBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 3855AddressLine1
CitySAVANNAHCity
StateGAState
ZIP Code314143855ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN200063696EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1IHC HOSPICE INCBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlIHCHBusinessNameControlTxt
Phone9124416594PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13 W PERRY STAddressLine1
CitySAVANNAHCity
StateGAState
ZIP Code31401ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonELLEN BOLCHPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone9124416594PhoneNum
Signature2014-05-20SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJOHN T CONEPreparerPersonNm
PTINP00533153PTIN
Phone9124416594PhoneNum
Preparation2014-06-10PreparationDt
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerELLEN BOLCHPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line13 W PERRY STREETAddressLine1
CitySAVANNAHCity
StateGAState
ZIP Code31401ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$2,022,001GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.THAGROUP.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2003FormationYr
Legal Domicile StateSCLegalDomicileStateCd
Activity Or MissionTHE ORGANIZATION PROVIDES HOSPICE CARE ON AN OUTPATIENT AND IN-HOME BASIS FOR TERMINALLY ILL INDIVIDUALS.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee29TotalEmployeeCnt
Total Volunteers20TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$48,211PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$2,223,805PYProgramServiceRevenueAmt
CY Program Service Revenue$2,022,001CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$2,272,016PYTotalRevenueAmt
CY Total Revenue$2,022,001CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$1,088,782PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$1,205,972CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$1,086,560PYOtherExpensesAmt
CY Other Expenses$876,859CYOtherExpensesAmt
PY Total Expenses$2,175,342PYTotalExpensesAmt
CY Total Expenses$2,082,831CYTotalExpensesAmt
PY Revenues Less Expenses$96,674PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$60,830CYRevenuesLessExpensesAmt
Total Assets BOY$863,164TotalAssetsBOYAmt
Total Assets EOY$875,836TotalAssetsEOYAmt
Total Liabilities BOY$124,746TotalLiabilitiesBOYAmt
Total Liabilities EOY$198,248TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$738,418NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$677,588NetAssetsOrFundBalancesEOYAmt
MissionTHE ORGANIZATION PROVIDES HOSPICE CARE ON AN OUTPATIENT AND IN-HOME BASIS FOR TERMINALLY ILL INDIVIDUALS.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$1,990,427ExpenseAmt
Revenue$2,022,001RevenueAmt
DescHOSPICE CARE SERVICESDesc
Total Program Service Expenses$1,990,427TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntYes (true)BusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document3IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee29EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Form8899 FiledindfalseForm8899Filedind
Form1098 C FiledfalseForm1098CFiledInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldSCStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonTHE ORGANIZATIONPersonNm
Phone9124416594PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13 W PERRY STAddressLine1
CitySAVANNAHCity
StateGAState
ZIP Code31401ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
ELLEN B BOLCH
DIRECTOR/PRE1.00Yes (X)Yes (X)$0$0$0
JOSEPH EBBERWEIN
DIRECTOR/TRE1.00Yes (X)Yes (X)$0$0$0
KATHY PIETTE
DIRECTOR/SEC1.00Yes (X)Yes (X)$0$0$0
IRA RUBY
DIRECTOR1.00Yes (X)$0$0$0
DAVID SMITH
DIRECTOR1.00Yes (X)$0$0$0
HOWARD MORRISON
DIRECTOR1.00Yes (X)$0$0$0
CORA BETT THOMAS
DIRECTOR1.00Yes (X)$0$0$0
MALIK WATKINS
DIRECTOR1.00Yes (X)$0$0$0
EARL LEROY CARTER
DIRECTOR1.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,022,001TotalRevenueColumnAmt
Related Or Exempt Func Income$2,022,001RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$2,022,001TotalProgramServiceRevenueAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,022,001TotalRevenueColumnAmt
Related Or Exempt Func Income$2,022,001RelatedOrExemptFuncIncomeAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,101,256TotalAmt
Program Services$1,101,256ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$34,489TotalAmt
Program Services$34,489ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$70,227TotalAmt
Program Services$70,227ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$974TotalAmt
Management And General$974ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$8,984TotalAmt
Program Services$8,984ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$13,073TotalAmt
Management And General$13,073ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$70,234TotalAmt
Management And General$70,234ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$93TotalAmt
Program Services$93ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$2,975TotalAmt
Management And General$2,975ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$5,148TotalAmt
Management And General$5,148ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$27,724TotalAmt
Program Services$27,724ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
HOME OFFICE COST ALLOC'N$380,202$380,202
DRUGS & BIOLOGICALS$122,493$122,493
MILEAGE/AUTO REIMBURSE$95,858$95,858
MEDICAL DIRECTOR FEES$43,669$43,669

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$105,432TotalAmt
Program Services$105,432ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$2,082,831TotalAmt
Program Services$1,990,427ProgramServicesAmt
Management And General$92,404ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$486,021BOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$50,000BOYAmt
EOY$50,000EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$302,189BOYAmt
EOY$802,670EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
EOY$3,360EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$46,400LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$26,594LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$24,954BOYAmt
EOY$19,806EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$863,164BOYAmt
EOY$875,836EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$124,746BOYAmt
EOY$48,248EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
EOY$150,000EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$124,746BOYAmt
EOY$198,248EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$738,418BOYAmt
EOY$677,588EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$738,418BOYAmt
EOY$677,588EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$863,164BOYAmt
EOY$875,836EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$60,830ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$6,025CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$56,655CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$10,627CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$48,211CurrentTaxYearMinus1YearAmt
Current Tax Year$7,396CurrentTaxYearAmt
Total$128,914TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,565,260CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,030,242CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,501,003CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,223,805CurrentTaxYearMinus1YearAmt
Current Tax Year$2,014,605CurrentTaxYearAmt
Total$11,334,915TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,571,285CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,086,897CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,511,630CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,272,016CurrentTaxYearMinus1YearAmt
Current Tax Year$2,022,001CurrentTaxYearAmt
Total$11,463,829TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$11,463,829PublicSupportTotal509Amt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,571,285CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,086,897CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,511,630CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,272,016CurrentTaxYearMinus1YearAmt
Current Tax Year$2,022,001CurrentTaxYearAmt
Total$11,463,829TotalAmt
FieldValueIRS element (for citing)
Public Support CY5091.00000PublicSupportCY509Pct
Public Support PY5091.00000PublicSupportPY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$46,400OtherCostOrOtherBasisAmt
Depreciation$26,594DepreciationAmt
Book Value$19,806BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$19,806TotalBookValueLandBuildingsAmt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1THA SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
Relationship DescriptionDIRECTOR OWNEDRelationshipDescriptionTxt
Transaction$380,202TransactionAmt
TransactionHOME OFF COST ALLOCNTransactionDesc
Sharing Of RevenuesfalseSharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 2EMPLOYEES OF INTERESTED PERSON
FORM 990, PAGE 6, PART VI, LINE 7AVOTING MEMBERS OF GOVERNING BODY
FORM 990, PAGE 6, PART VI, LINE 11BREVIEWED WITH CPA AND OFFICER
FORM 990, PAGE 6, PART VI, LINE 12CREVIEW WITH DIRECTORS
FORM 990, PAGE 6, PART VI, LINE 15AREVIEW WITH DIRECTORS
FORM 990, PAGE 6, PART VI, LINE 15BREVIEW WITH DIRECTORS
FORM 990, PAGE 6, PART VI, LINE 19UPON REQUEST