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
2019
Open to Public
Inspection
Name of the organization
BENJAMIN HERSHEY CONVALESCENT HOME
 
Employer identification number

42-0307480
Return Reference Explanation
FORM 990 FOR CERTAIN PAYROLL TAX EXPENSES, AMOUNTS HAVE BEEN ALLOCATED TO PROGRAM AND MANAGEMENT & GENERAL EXPENSES ON PART IX BASED ON THE PAY AMOUNTS ASSOCIATED WITH EACH FUNCTION.
FORM 990, PAGE 6, PART VI, LINE 3 THE CITY OF MUSCATINE IS THE ACTING MANAGEMENT AGENT WHOSE RESPONSIBILTIES INCLUDE: HIRING EMPLOYEES, PROPERTY MAINTENANCE AND ACCOUNTING AND FINANCIAL STATEMENT PREPARATION.
FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PRESENTED AND REVIEWED AT THE BOARD OF DIRECTORS MEETING.
FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. REQUESTS MAY BE MADE DURING NORMAL BUSINESS HOURS BY CONTACTING ANGELA GUCK AT 1808 MULBERRY AVENUE, MUSCATINE, IA 52761.
FORM 990, PART XII CERTAIN AMOUNTS REPORTED IN THIS RETURN ARE NOT SUBJECT TO THE REQUIRED ANNUAL AUDIT UNDER THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 REQUIREMENTS. UNAUDITED AMOUNTS CONSIST OF ROUGHLY 3% OF REVENUES, 8% OF EXPENSES, AND 6% OF TOTAL ASSETS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019


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