GRIGSBY FAMILY CHARITABLEFOUNDATION INC: Form 990PF, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- GRIGSBY FAMILY CHARITABLEFOUNDATION INC (EIN 26-0488199)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-10-09
- IRS object ID
- 201102839349100000
- Schema version
- 2010v3.4
- 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
- Compensation Explanation
- Other Assets Schedule
- Other Income Schedule2
- Substantial Contributors Sch
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-10-09T09:25:21-05:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOWLEN HOLT & MINER PA | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 215 FIFTH STREET SUITE 200 | AddressLine1 |
| City | WEST PALM BEACH | City |
| State | FL | State |
| ZIP Code | 33401 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 260488199 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRIGSBY FAMILY CHARITABLE | BusinessNameLine1 |
| Business Name Line2 | FOUNDATION INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GRIG | NameControl |
| Phone | 8134670811 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1230 | AddressLine1 |
| City | OKEECHOBEE | City |
| State | FL | State |
| ZIP Code | 34973 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CAROLYN GRIGSBY | Name |
| Title | DIRECTOR | Title |
| Phone | 8134670811 | Phone |
| Date Signed | 2011-10-05 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROBERT W HENDRIX | Name |
| Phone | 5616593060 | Phone |
| Date Prepared | 2011-10-09 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exempt PF | X | ExemptPF |
| FMV Assets EOY | 244673 | FMVAssetsEOY |
| Method Of Accounting Cash | X | MethodOfAccountingCash |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Received Rev And Expnss | 151500 | ContriReceivedRevAndExpnss |
| Interest On Savings Rev And Expnss | 331 | InterestOnSavingsRevAndExpnss |
| Interest On Savings Net Invst Incm | 28 | InterestOnSavingsNetInvstIncm |
| Interest On Savings Adj Net Incm | 331 | InterestOnSavingsAdjNetIncm |
| Dividends Rev And Expnss | 101 | DividendsRevAndExpnss |
| Dividends Net Invst Incm | 101 | DividendsNetInvstIncm |
| Dividends Adj Net Incm | 101 | DividendsAdjNetIncm |
| Gross Rents Rev And Expnss | 14609 | GrossRentsRevAndExpnss |
| Gross Rents Net Invst Incm | 14609 | GrossRentsNetInvstIncm |
| Gross Rents Adj Net Incm | 14609 | GrossRentsAdjNetIncm |
| Net Rental Income Or Loss | 14609 | NetRentalIncomeOrLoss |
| Other Income Rev And Expnss | -678 | OtherIncomeRevAndExpnss |
| Other Income Adj Net Incm | -678 | OtherIncomeAdjNetIncm |
| Total Revenue And Expenses | 165863 | TotalRevenueAndExpenses |
| Total Net Investment Income | 14738 | TotalNetInvestmentIncome |
| Total Adjusted Net Income | 14363 | TotalAdjustedNetIncome |
| Accounting Fees Rev And Expnss | 1500 | AccountingFeesRevAndExpnss |
| Taxes Rev And Expnss | 124 | TaxesRevAndExpnss |
| Tot Opr Expenses Rev And Expnss | 1624 | TotOprExpensesRevAndExpnss |
| Tot Opr Expenses Net Invst Incm | 0 | TotOprExpensesNetInvstIncm |
| Tot Opr Expenses Dsbrs Chrtbl Prps | 0 | TotOprExpensesDsbrsChrtblPrps |
| Contri Gifts Paid Rev And Expnss | 173000 | ContriGiftsPaidRevAndExpnss |
| Contri Gifts Paid Dsbrs Chrtbl Prps | 173000 | ContriGiftsPaidDsbrsChrtblPrps |
| Total Expenses Rev And Expnss | 174624 | TotalExpensesRevAndExpnss |
| Total Expenses Net Invst Incm | 0 | TotalExpensesNetInvstIncm |
| Total Expenses Dsbrs Chrtbl Prps | 173000 | TotalExpensesDsbrsChrtblPrps |
| Excess Of Revenue Over Expenses | -8761 | ExcessOfRevenueOverExpenses |
| Net Investment Income | 14738 | NetInvestmentIncome |
| Adjusted Net Income | 14363 | AdjustedNetIncome |
Balance Sheets BalanceSheets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | 34886 | CashBOY |
| Cash EOY | 19781 | CashEOY |
| Cash EOYFMV | 19781 | CashEOYFMV |
| Other Assets BOY | 223268 | OtherAssetsBOY |
| Other Assets EOY | 229612 | OtherAssetsEOY |
| Other Assets EOYFMV | 224892 | OtherAssetsEOYFMV |
| Total Assets BOY | 258154 | TotalAssetsBOY |
| Total Assets EOY | 249393 | TotalAssetsEOY |
| Total Assets EOYFMV | 244673 | TotalAssetsEOYFMV |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Org That Follow SFAS117 | X | OrgThatFollowSFAS117 |
| Unrestricted BOY | 258154 | UnrestrictedBOY |
| Unrestricted EOY | 249393 | UnrestrictedEOY |
| Total Net Assets BOY | 258154 | TotalNetAssetsBOY |
| Total Net Assets EOY | 249393 | TotalNetAssetsEOY |
| Total Liabilities Net Assets BOY | 258154 | TotalLiabilitiesNetAssetsBOY |
| Total Liabilities Net Assets EOY | 249393 | TotalLiabilitiesNetAssetsEOY |
Changes In Net Assets Fund Balances ChangesInNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Net Assets Fund Balances BOY | 258154 | TotalNetAssetsFundBalancesBOY |
| Excess Of Revenue Over Expenses | -8761 | ExcessOfRevenueOverExpenses |
| Subtotal | 249393 | Subtotal |
| Total Net Assets Fund Balances EOY | 249393 | TotalNetAssetsFundBalancesEOY |
Qlfy Und Sect4940e For Reduced Tax QlfyUndSect4940eForReducedTax
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable For4942 Tax | false | LiableFor4942Tax |
| Qualifying Distributions Year1 | 743876 | QualifyingDistributionsYear1 |
| Noncharitable Assets Year1 | 245180 | NoncharitableAssetsYear1 |
| Distribution Ratio Year1 | 3.034000 | DistributionRatioYear1 |
| Qualifying Distributions Year2 | 52318 | QualifyingDistributionsYear2 |
| Noncharitable Assets Year2 | 248112 | NoncharitableAssetsYear2 |
| Distribution Ratio Year2 | 0.210864 | DistributionRatioYear2 |
| Qualifying Distributions Year3 | 3021 | QualifyingDistributionsYear3 |
| Noncharitable Assets Year3 | 223535 | NoncharitableAssetsYear3 |
| Distribution Ratio Year3 | 0.013515 | DistributionRatioYear3 |
| Total Distribution Ratio | 3.258379 | TotalDistributionRatio |
| Average Distribution Ratio | 1.086126 | AverageDistributionRatio |
| Net Noncharitable Assets | 239353 | NetNoncharitableAssets |
| Adjusted Noncharitable Assets | 259968 | AdjustedNoncharitableAssets |
| One Percent Net Investment Income | 147 | OnePercentNetInvestmentIncome |
| Adj Nonchrtbl Assets And One | 260115 | AdjNonchrtblAssetsAndOnePct |
| Qualifying Distributions | 173000 | QualifyingDistributions |
Excise Tax Based On Investment Incm ExciseTaxBasedOnInvestmentIncm
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | 295 | InvestmentIncomeExciseTax |
| Subtotal | 295 | Subtotal |
| Tax Based On Investment Income | 295 | TaxBasedOnInvestmentIncome |
| Tax Due | 295 | TaxDue |
| Amount Credited To Next Year | 0 | AmountCreditedToNextYear |
Statements Regarding Activities StatementsRegardingActivities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Activities | false | LegislativePoliticalActivities |
| More Than100 Spent | false | MoreThan100Spent |
| Form1120 POL Filed | false | Form1120POLFiled |
| Activities Not Prev Reported | false | ActivitiesNotPrevReported |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylaws |
| Unrelated Bus Income Over1000 | false | UnrelatedBusIncomeOver1000 |
| Termination Etc | false | TerminationEtc |
| Requirements Of Sect508e | true | RequirementsOfSect508e |
| At Least5000 In Assets | true | AtLeast5000InAssets |
| States Filed With | FL | StatesFiledWith |
| Form990 PF Filed With AG | true | Form990PFFiledWithAG |
| Private Operating Foundation | false | PrivateOperatingFoundation |
| New Substantial Contributors | true | NewSubstantialContributors |
| Interest In Controlled Entity | false | InterestInControlledEntity |
| Applicable Insurance Contract | false | ApplicableInsuranceContract |
| Comply With Public Inspection Rqr | true | ComplyWithPublicInspectionRqr |
| Website Address | N/A | WebsiteAddress |
| Books In Care Of Person Name | ROBERT W HENDRIX JR | BooksInCareOfPersonName |
| Books In Care Of Phone Number | 5619965612 | BooksInCareOfPhoneNumber |
Books In Care Of US Address BooksInCareOfUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 POST OFFICE BOX 338 | AddressLine1 |
| Address Line2 | 333 SE 2ND STREET | AddressLine2 |
| City | BELLE GLADE | City |
| State | FL | State |
| ZIP Code | 33430 | ZIPCode |
Statements Regarding Acty4720 StatementsRegardingActy4720
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exchange With Dsqfly Person | false | SaleOrExchangeWithDsqflyPerson |
| Borrow Or Lend With Dsqfly Person | false | BorrowOrLendWithDsqflyPerson |
| Furnished Goods With Dsqfly Person | false | FurnishedGoodsWithDsqflyPerson |
| Pay Compensation To Dsqfly Person | false | PayCompensationToDsqflyPerson |
| Transfer Assets To Dsqfly Person | false | TransferAssetsToDsqflyPerson |
| Payment To Government Offical | false | PaymentToGovernmentOffical |
| Undistributed Income Prior Years | false | UndistributedIncomePriorYears |
| Business Holdings | false | BusinessHoldings |
| Jeopardy Investments | false | JeopardyInvestments |
| Uncorrected Jeopardy Investments | false | UncorrectedJeopardyInvestments |
| Influence Legislation | false | InfluenceLegislation |
| Influence Election | false | InfluenceElection |
| Grants To Individuals | false | GrantsToIndividuals |
| Grants To Organizations | false | GrantsToOrganizations |
| Noncharitable Purpose | false | NoncharitablePurpose |
| Rcv Funds To Pay Prsnl Bnft Contract | false | RcvFundsToPayPrsnlBnftContract |
| Pay Premiums Prsnl Bnft Contract | false | PayPremiumsPrsnlBnftContract |
Ofcr Dir Trustees Key Employee Info OfcrDirTrusteesKeyEmployeeInfo
Ofcr Dir Trustees Or Key Employee OfcrDirTrusteesOrKeyEmployee (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation | Contri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtc | Expense Account Other AllowancesExpenseAccountOtherAllowances |
|---|---|---|---|---|---|---|---|---|
| CAROLYN GRIGSBY | ||||||||
| PO BOX 1230 | OKEECHOBEE | FL | 34973 | DIRECTOR | 1.00 | 0 | 0 | 0 |
| WILLIAM GRIGSBY JR | ||||||||
| 518 BEAR ROAD | LAKE PLACID | FL | 33852 | DIRECTOR | 1.00 | 0 | 0 | 0 |
| WILLIAM BARTLETT | ||||||||
| PO BOX 967 | OKEECHOBEE | FL | 34976 | DIRECTOR | 1.00 | 0 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Highest Paid Empl NONE | NONE | CompOfHighestPaidEmplNONE |
| Comp Of Hghst Paid Cntrct NONE | NONE | CompOfHghstPaidCntrctNONE |
Sum Of Program Related Investments SumOfProgramRelatedInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | N/A | Description1 |
Minimum Investment Return MinimumInvestmentReturn
| Field | Value | IRS element (for citing) |
|---|---|---|
| Avg Monthly FMV Of Securities | 0 | AvgMonthlyFMVOfSecurities |
| Avg Monthly Cash Balances | 18106 | AvgMonthlyCashBalances |
| FMV All Other Noncharitable Assets | 224892 | FMVAllOtherNoncharitableAssets |
| Total FMV Of Unused Assets | 242998 | TotalFMVOfUnusedAssets |
| Adj Total FMV Of Unused Assets | 242998 | AdjTotalFMVOfUnusedAssets |
| Cash Deemed Charitable | 3645 | CashDeemedCharitable |
| Net Noncharitable Assets | 239353 | NetNoncharitableAssets |
| Minimum Investment Return | 11968 | MinimumInvestmentReturn |
Distributable DistributableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | 11968 | MinimumInvestmentReturn |
| Tax Based On Investment Income | 295 | TaxBasedOnInvestmentIncome |
| Total Tax | 295 | TotalTax |
| Distributable Amount Before Adj | 11673 | DistributableAmountBeforeAdj |
| Distributable Amount Before Ded | 11673 | DistributableAmountBeforeDed |
| Distributable Amount As Adjusted | 11673 | DistributableAmountAsAdjusted |
Qualifying Distributions QualifyingDistributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | 173000 | ExpensesAndContributions |
| Qualifying Distributions | 173000 | QualifyingDistributions |
| Adj Qualifying Distributions | 173000 | AdjQualifyingDistributions |
Undistributed Income UndistributedIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable Amount As Adjusted | 11673 | DistributableAmountAsAdjusted |
| Excess Distri Carryover Year2 | 37221 | ExcessDistriCarryoverYear2 |
| Excess Distri Carryover Year1 | 731865 | ExcessDistriCarryoverYear1 |
| Total Excess Distri Carryover | 769086 | TotalExcessDistriCarryover |
| Qualifying Distributions | 173000 | QualifyingDistributions |
| Applied To Current Year | 11673 | AppliedToCurrentYear |
| Remaining Distri From Corpus | 161327 | RemainingDistriFromCorpus |
| Total Corpus | 930413 | TotalCorpus |
| Undistributed Income CY | 0 | UndistributedIncomeCY |
| Excess Distri Cyov To Next Year | 930413 | ExcessDistriCyovToNextYear |
| Excess From Year2 | 37221 | ExcessFromYear2 |
| Excess From Year1 | 731865 | ExcessFromYear1 |
| Excess From Current Year | 161327 | ExcessFromCurrentYear |
Supplementary Information SupplementaryInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | CAROLYN GRIGSBY | ContributingManager |
| Only Contributes To Preselected | X | OnlyContributesToPreselected |
Grant Or Contri Paid During Year GrantOrContriPaidDuringYear (3 entries)
| Address Line1RecipientUSAddress/AddressLine1 | CityRecipientUSAddress/City | StateRecipientUSAddress/State | ZIP CodeRecipientUSAddress/ZIPCode | Recipient RelationshipRecipientRelationship | Recipient Foundation StatusRecipientFoundationStatus | Purpose Of Grant Or ContributionPurposeOfGrantOrContribution | AmountAmount |
|---|---|---|---|---|---|---|---|
| OAKVIEW BAPTIST CHURCH | |||||||
| 677 SW 32ND STREET | OKEECHOBEE | FL | 34974 | PUBLIC CHARITY | 509(A)(1) | SUPPORT CHURCH ACTIVITIES | $153,000 |
| ALL SAINTS SCHOOL | |||||||
| MAPLE VALLEY ROAD | MORRISTOWN | TN | 37813 | NON PROFIT CORP | 501(C)(3) | SUPPORT NON PROFIT ACTIVITIES | $15,000 |
| LAKEVIEW CHRISTIAN SCHOOL | |||||||
| 503 KENT AVENUE | LAKE PLACID | FL | 33852 | NON PROFIT CORP | 501(C)(3) | SUPPORT NON PROFIT ACTIVITIES | $5,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Grant Or Contri Paid During Year | 173000 | TotGrantOrContriPaidDuringYear |
Analysis Income Producing Acty AnalysisIncomeProducingActy
Int On Savings And Temp Cash Invst IntOnSavingsAndTempCashInvst
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion Code | 14 | ExclusionCode |
| Exclusion | $331 | ExclusionAmount |
Dividends And Int From Sec Part VII DividendsAndIntFromSecPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion Code | 14 | ExclusionCode |
| Exclusion | $101 | ExclusionAmount |
Net Rntl Incm Re Not Debt Fincd Prop NetRntlIncmReNotDebtFincdProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion Code | 18 | ExclusionCode |
| Exclusion | $14,609 | ExclusionAmount |
Other Revenue Described OtherRevenueDescribed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | WCW HOLDINGS, LTD | Description |
| Business Code | 111000 | BusinessCode |
| Unrelated Business Income | -$678 | UnrelatedBusinessIncomeAmount |
Subtotals Part XVIA SubtotalsPartXVIA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Income | -$678 | UnrelatedBusinessIncomeAmount |
| Exclusion | $15,041 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Part XVIA | 14363 | TotalPartXVIA |
Trnsfr Tr Rln With Noncharitable EO TrnsfrTrRlnWithNoncharitableEO
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Noncharitable EO | false | TrnsfrOfCashToNoncharitableEO |
| Trnsfr Oth Assets Noncharitable EO | false | TrnsfrOthAssetsNoncharitableEO |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssets |
| Purchase Assets Noncharitable EO | false | PurchaseAssetsNoncharitableEO |
| Rental Of Facilities Etc | false | RentalOfFacilitiesEtc |
| Reimbursement Arrangements | false | ReimbursementArrangements |
| Loans Or Loan Guarantees | false | LoansOrLoanGuarantees |
| Performance Of Services Etc | false | PerformanceOfServicesEtc |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtc |
| Relationships Noncharitable E Os | false | RelationshipsNoncharitableEOs |
Schedule B IRS990ScheduleB
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | X | Organization501c3ExemptPF |
| General Rule | X | GeneralRule |
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | 1 | ContributorNumber |
| Contributor Name Individual | CARYOLN GRIGSBY | ContributorNameIndividual |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1230 | AddressLine1 |
| City | OKEECHOBEE | City |
| State | FL | State |
| ZIP Code | 34973 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | 151500 | AggregateContributions |
| Person Contribution Type | X | PersonContributionType |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees AccountingFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEES | Category |
| Amount | $1,500 | Amount |
Compensation Explanation CompensationExplanation
Compensation Compensation (3 entries)
| CAROLYN GRIGSBY |
| WILLIAM GRIGSBY JR |
| WILLIAM BARTLETT |
Other Assets Schedule OtherAssetsSchedule
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | W.C.W. HOLDINGS, LTD 1% INVESTMENT | Description |
| BOY Book Value | 223268 | BOYBookValue |
| EOY Book Value | 229612 | EOYBookValue |
| EOYFMV | 224892 | EOYFMV |
Other Income Schedule2 OtherIncomeSchedule2
Other Income OtherIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | WCW HOLDINGS, LTD | Description |
| Revenue And Expenses Per Books | -678 | RevenueAndExpensesPerBooks |
| Adjusted Net Income | -678 | AdjustedNetIncome |
Substantial Contributors Sch SubstantialContributorsSch
Substantial Contributor SubstantialContributor
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person Name | CAROLYN GRIGSBY | PersonName |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1230 | AddressLine1 |
| City | OKEECHOBEE | City |
| State | FL | State |
| ZIP Code | 34973 | ZIPCode |
Taxes Schedule TaxesSchedule
Taxes Taxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | FEDERAL EXCISE TAX | Category |
| Amount | $124 | Amount |