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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
COMMUNITY PATIENT SAFETY COALITION OF
SOUTHWESTERN IN/KY INC
Employer identification number

61-1646052
Return Reference Explanation
FORM 990-EZ, PART I, LINE 8 - OTHER REVENUE DESCRIPTION: INTEREST INCOME. AMOUNT: 514.
FORM 990-EZ, PART I, LINE 14 DESCRIPTION: DEPRECIATION. AMOUNT: 1,618. DESCRIPTION: OTHER EXPENSES. AMOUNT: 851. TOTAL TO FORM 990-EZ, LINE 14: 2,469.
FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES DESCRIPTION: TRAVEL EXPENSE. AMOUNT: 3,553. DESCRIPTION: OFFICE EXPENSES. AMOUNT: 2,487. DESCRIPTION: ADVERTISING. AMOUNT: 766. DESCRIPTION: PAYROLL TAXES. AMOUNT: 5,358. DESCRIPTION: DUES . AMOUNT: 20. TOTAL TO FORM 990-EZ, LINE 16: 12,184.
FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS DESCRIPTION: OTHER DEPRECIABLE ASSETS. BEG. OF YEAR AMOUNT: 1,179. END OF YEAR AMOUNT: 1,472.
FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 129. END OF YEAR AMOUNT: 60.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2017


Additional Data


Software ID:  
Software Version: