SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
JAN PETERSON CHILD DAY CARE CENTER
 
Employer identification number

74-3080058
Return Reference Explanation
FORM 990, PAGE 6, PART VI, LINE 2 CARL ROWE BETTE ROWE MARRIED CARL ROWE PHILLIP SAUCEDO EMPLOYED BY MANGAGEMNT COMPANY LAVAY RUDY PAULA MERRITT RELATED MARGARET LUGGAR CARL ROWE RELATED
FORM 990, PAGE 6, PART VI, LINE 3 INTEGRATED CARE COMMUNITES, INC. HANDLES MANAGEMENT AND ACCOUNTING.
FORM 990, PAGE 6, PART VI, LINE 11B DRAFT OF TAX RETURN REVIEWED BY PRESIDENT AND EXECUTIVE DIRECTOR PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 19 UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


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