SCHEDULE O
(Form 990)

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.
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OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
QUIVIRA COMMUNITY CENTER INC
 
Employer identification number

82-4692435
Return Reference Explanation
FORM 990-EZ, PART I, LINE 4 - OTHER INVESTMENT INCOME DESCRIPTION: COUNTRY CLUB BANK INTEREST . AMOUNT: 6.
FORM 990-EZ, PART I, LINE 10 - PAYMENTS TO AFFILIATES AFFILIATE NAME: QUIVIRA, INC. . AFFILIATE ADDRESS: 100 CRESCENT BLVD LAKE QUIVIRA, KS 66217. PURPOSE OF PAYMENT: TO FUND GOLF SIMULATOR FOR LAKE QUIVIRA COUNTRY CLUB. AMOUNT OF PAYMENT: 40,000.
FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES DESCRIPTION: BANK CHARGES. AMOUNT: 25. DESCRIPTION: DELUXE CHECK PRINTING. AMOUNT: 30. TOTAL TO FORM 990-EZ, LINE 16: 55.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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