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.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
BLACK TAVERN HISTORICAL SOCIETY INC
 
Employer identification number

22-2473090
Return Reference Explanation
FORM 990-EZ, PART I, LINE 16 EXPENSES OFFICE SUPPLIES 1,210 FIRE INSURANCE 3,222 LIABILITY INSURANCE 1,316 WORKERS COMP INSURANCE 190 UTILITIES 3,499 PO BOX FEE 114 PROGRAMS 100 STATE TAX FILING FEES 15 REPAIRS & MAINTENANCE 2,837 GIFTS 645 DUES AND SUBCRIPTIONS 50 NON-INVESTMENT DEPRECIATION 3,797 TOTAL 16,995
FORM 990-EZ, PART I, LINE 20 PRIOR YEAR ADJUSTMENT -1,811
FORM 990-EZ, PART II, LINE 24 22,633 25,822 LESS ACCUMULATED DEPRECIATION 2,975 6,773 TOTAL 19,658 19,049
FORM 990-EZ, PART III, LINE 31 HISTORICAL PRESERVATION AND EDUCATION
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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