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
SOUTHBURY MIDDLEBURY SCHOLARSHIP
FOUNDATION
Employer identification number

22-2471012
Return Reference Explanation
FORM 990, PAGE 6, PART VI, LINE 11B A COPY OF THE RETURN WAS REVIEWED BY OFFICERS OF THE ORGANIZATION PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC
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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