Form990-EZ
Click to see list of attachments
Department of the Treasury
Internal Revenue Service
Short Form
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
(except black lung benefit trust or private foundation)
bullet Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities, and certain controlling organizations as defined in section 512(b)(13) must file Form 990 (see instructions).
All other organizations with gross receipts less than $200,000 and total assets less than $500,000 at the end of the year may use this form.
bulletThe organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-1150
2011
Open to Public
Inspection
A
For the 2011 calendar year, or tax year beginning 01-01-2011, and ending 12-31-2011
B
Check if applicable:
C Name of organization
INSTITUTE ON RELIGION IN AN AGE OF SCIENCE
 
Number and street (or P. O. box, if mail is not delivered to street address)2636 Lakeview Ave
  Room/suite
City or town, state or country, and ZIP + 4 Rocky River, OH441162562
D Employer identification number

04-6063856
E Telephone number

(440) 331-8743
F Group Exemption
Number. . bullet  
G Accounting method: Other (specify) bullet   H Check bulletI Website:bulletwww.iras.orgJ Tax-Exempt status(check only one)—Click to see attachment(   ) bullet(insert no.) or
K Check bullet A Form 990-EZ or Form 990 return is not required though Form 990-N (e-postcard) may be required (see instructions). But if the organization chooses to file a return, be sure to file a complete return.
L Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts; If gross receipts are $200,000 or more, or if total assets (Part II, line 25, column (B) below) are $500,000 or more,file Form 990 instead of Form 990-EZ........... bullet $ 97,759
Part IRevenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I.)Check if the organization used Schedule O to respond to any question in this Part I...........
VerticalRevenue 1 Contributions, gifts, grants, and similar amounts received............... 1 9,926
2 Program service revenue including government fees and contracts ............ 2 68,697
3 Membership dues and assessments...................... 3 12,752
4 Investment income........................... 4 6,384
5a Gross amount from sale of assets other than inventory........ 5a 0
b Less: cost or other basis and sales expenses........... 5b 0
c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ...... 5c 0
6 Gaming and fundraising events
a Gross income from gaming (attach Schedule G if greater than $15,000) . 6a 0
b Gross income from fundraising events (not including $ 0 of contributions
from fundraising events reported on line 1) (attach Schedule G if the
sum of such gross income and contributions exceeds $15,000) 6b 0
c Less: direct expenses from gaming and fundraising events....... 6c 0
d Net income or (loss) from gaming and fundraising events (Add lines 6a and 6b and subtract line 6c) 6d 0
7a Gross sales of inventory, less returns and allowances........ 7a 0
b Less: cost of goods sold................. 7b 0
c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) ......... 7c 0
8 Other revenue (describe in Schedule O) ..................... 8 0
9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8................. 9 97,759
VerticalExpenses 10 Grants and similar amounts paid (list in Schedule O) ................. 10 0
11 Benefits paid to or for members........................ 11 19,693
12 Salaries, other compensation, and employee benefits................ 12 0
13 Professional fees and other payments to independent contractors............ 13 0
14 Occupancy, rent, utilities, and maintenance................... 14 0
15 Printing, publications, postage, and shipping................... 15 1,019
16 Other expenses (describe in Schedule O) .................... 16 80,640
17 Total expenses. Add lines 10 through 16 .................... 17 101,352
VerticalNetAssets 18 Excess or (deficit) for the year (Subtract line 17 from line 9)............ 18 -3,593
19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
end-of-year figure reported on prior year’s return)................ 19 125,550
20 Other changes in net assets or fund balances (explain in Schedule O) .......... 20 0
21 Net assets or fund balances at end of year. Combine lines 18 through 20.........Bullet 21 121,957
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10642I Form 990-EZ (2011)
Form 990-EZ (2011)
Page 2
Part IIBalance Sheets (see the instructions for Part II.)Check if the organization used Schedule O to respond to any question in this Part II.............

(See the instructions for Part II.)(A) Beginning of year(B) End of year
22Cash, savings, and investments................
125,550
22
121,957
23Land and buildings....................
0
23
0
24Other assets (describe in Schedule O) ..........
0
24
0
25Total assets......................
125,550
25
121,957
26
Total liabilities (describe in Schedule O) .............
0
26
0
27Net assets or fund balances (line 27 of column (B) must agree with line 21)..
125,550
27
121,957
Part IIIStatement of Program Service Accomplishments (see the instructions for Part III.) Check if the organization used Schedule O to respond to any question in this Part III . Expenses
(Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional for others.)
What is the organization's primary exempt purpose? -To promote creative efforts leading to the formulation, in the light of contemporary knowledge, of effective doctrines and practices for human welfare; -To formulate dynamic and positive relationships between the concepts developed by science and the goals and hopes of humanity expressed through religion; -To state human values and contemporary knowledge in sum universal and valid terms that they may be understood by all peoples, whatever their cultural background and experience, and provide a basis for world-wide cooperation.
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.
28 Conducted week-long conference on topic impacted by both science and religion. (93 people)
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 28a 79,675
29 Sponsored and supported publication of "Zygon," a peer-reviewed journal of science and religion. I is subscribed ty by several thousand people and many libraries and universities.
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 29a 18,810
30 Sponsered internet S&R discussion groups (150 people) and published conference summaries and supplemental information on the internet.
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 30a 180
31 Other program services (describe in Schedule O) ..................
(Grants $   ) If this amount includes foreign grants, check here...MediumBullet		 31a
32 Total program service expenses (add lines 28a through 31a)..............bullet 32 98,665
Part IV List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated. (see the instructions for Part IV.)Check if the organization used Schedule O to respond to any question in this Part IV..........
(a) Name and title (b) Average
hours per week
devoted to position		 (c)Reportable compensation
(Forms W-2/1099-MISC)
(if not paid, enter -0-) 		(d) Health benefits, contributions to employee benefit plans,
and deferred compensation		 (e) Estimated amount
of other compensation
Varadaraja Raman
20 Sutton Point
Pittsford,NY14534
 President10 0 0 0
John Teske
424 Deerfield Dr
Mt Joy,PA175521200
 VP (Conferences)5 0 0 0
Edwin Laurenson
37 Main Street Apt 404
Yonkers,NY10701
 VP Development5 0 0 0
Ursula Goodenough
6124 Kingsbury Avenue
St Louis,MO63112
 VP Interdisciplinary Affairs5 0 0 0
Marjorie Davis
30 Barn Door Hills Road
Granby,CT060352913
 VP Religion8 0 0 0
Solomon Katz
762 E Passyunk Ave
Philadelphia,PA19147
 VP Science4 0 0 0
Lyman Page
16 Oak Street
Kennebunkport,ME04046
 Secretary10 0 0 0
Robert Bercaw
2636 Lakeview Ave
Rocky River,OH44116
 Treasurer12 0 0 0
Jane Bengtson
21313 52nd Avenue W H246
Mountlake Terrace,WA98043
 Council4 0 0 0
Donald Braxton
Juniata College
1700 Moore St
Huntingdon,PA16652
 Council4 0 0 0
Christopher Corbally
2017 East Lee St
Tucson,AZ85719
 Council4 0 0 0
Marion Griswold
74 High St Apt 4
Greenfield,MA01301
 Council4 0 0 0
Katharine Houk
29 Kinderhook St
Chatham,NY12037
 Council4 0 0 0
Joan Hunter
18 Prospect St
Holliston,MA01746
 Council4 0 0 0
Peter Kelley
1325 15th Street NW 1007
Washington,DC20005
 Council4 0 0 0
Normand Laurendeau
5 Mast Lane
Brunswick,ME04011
 Council4 0 0 0
Edward Ordman
4045 Graham Oaks Ct
Memphis,TN38122
 Council4 0 0 0
Katherine Peil
10 Shady Hill Square
Cambridge,MA02138
 Council4 0 0 0
Edmund Robinson
30 Sears Point Road
Chatham,MA02633
 Council4 0 0 0
Dan Solomon
6434 N Mozart No 3
Chicago,IL60645
 Council4 0 0 0
Patricia Bennett
Low Dalby House
Low Dalby
Pickering,No. YorkshireYO18 7LT
UK
 Council4 0 0 0
Jeffrey Dahms
55 Spencer Road
Olinda,VI03788
AS
 Council4 0 0 0
Robert McCue
25120 Range Road 33
Calgary,ABT3Z 1K7
CA
 Council4 0 0 0
Form 990-EZ (2011)
Form 990-EZ (2011)
Page 3
Part VOther Information(Note the Schedule A and personal benefit contract statement requirements in the instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V
Yes
No
33
Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a detailed description of each activity in Schedule O ...................
33
 
No
34
Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy of the amended documents if they reflect a change to the organization’s name. Otherwise, explain the changeon Schedule O (see instructions). ..........................
34
 
No
35a
Did the organization have unrelated business gross income of $1,000 or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)? ............
35a
 
No
b
If ‘Yes’ to line 35a, has the organization filed a Form 990-T for the year? If ‘No,’ provide an explanation in Schedule O.
35b
 
 
c
Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III.
35c
 
No
36
Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If “Yes,” complete applicable parts of Schedule N ................
36
 
No
37a
Enter amount of political expenditures, direct or indirect, as described in the instructions. bullet
37a
0
b
Did the organization file Form 1120-POL for this year?...................
37b
 
No
38a
Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were
any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?..
38a
 
No
b
If “Yes,” complete Schedule L, Part II and enter the total amount involved .
38b
 
39
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on line 9.......
39a
 
b
Gross receipts, included on line 9, for public use of club facilities.....
39b
 
40a
Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
section 4911 bullet0 ; section 4912 bullet0 ; section 4955 bullet0
b
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefittransaction during the year or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I. ......
40b
 
No
c
Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958...bullet0
d
Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization....................bullet0
e
All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If "Yes," complete Form 8886-T. ......................
40e
 
No
41List the states with which a copy of this return is filed. bullet
42aThe organization's books are in care of bulletRobert W Bercaw Telephone no. bullet (440) 331-8743
Located at bullet2636 Lakeview Ave
Rocky River,OH ZIP + 4bullet44116
b
At any time during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)?
Yes
No
42b
 
No
If “Yes,” enter the name of the foreign country: bullet  
See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
c
At any time during the calendar year, did the organization maintain an office outside the U.S.?
42c
 
No
If “Yes,” enter the name of the foreign country: bullet  
43.......bullet
and enter the amount of tax-exempt interest received or accrued during the tax year....bullet43
 
Yes
No
44a
Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead of
Form 990-EZ.................................
44a
 
No
b
Did the organization operate one or more hospital facilities during the year? If ‘Yes,’ Form 990 must be completedinstead of Form990-EZ.............................
44b
 
No
c
Did the organization receive any payments for indoor tanning services during the year?.........
44c
 
No
d
If 'Yes' to line 44c, has the organization filed a Form 720 to report these payments? If ‘No,’ provide an explanationin Schedule O................................
44d
 
 
45a
Did the organization have a controlled entity within the meaning of
section 512(b)(13)?............................
45a
 
No
45b
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule R may need to be completed instead of Form990-EZ (see instructions).....................
45b
 
No
Form 990-EZ (2011)
Form 990-EZ (2011)
Page 4
Yes
No
46
Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition tocandidates for public office? If “Yes,” complete Schedule C, Part I. ..............
46
 
No
Part VI
Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47-49b and 52. Check if the organization used Schedule O to respond to any question in this Part VI ...........
Yes
No
47
Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II .......................
47
 
No
48
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E ....
48
 
No
49a
Did the organization make any transfers to an exempt non-charitable related organization?......
49a
 
No
b
If "Yes," was the related organization a section 527 organization?................
49b
 
 
50
Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a) Name and title of each employee paid more than $100,000 (b) Average
hours per week
devoted to position		 (c) Reportable compensation
(Forms W-2/1099-MISC) 		(d) Health benefits, contributions to employee benefit plans, and deferred compensation (e) Estimated amount of other compensation
NONE
f
Total number of other employees paid over $100,000 .................bullet  

51
Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a) Name and address of each independent contractor paid more than $100,000 (b) Type of service (c) Compensation
NONE
d
Total number of other independent contractors each receiving over $100,000..........bullet  
52
Did the organization complete Schedule A? NOTE:All Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach a completed Schedule A .....................
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
Form 990-EZ (2011)

Additional Data


Software ID: 11000129
Software Version: v1.00

Form 990-EZ, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
INSTITUTE ON RELIGION IN AN AGE OF SCIENCE
 
Employer identification number

04-6063856
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 34,696 26,630 32,723 24,634 22,678 141,361
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... 35 25,528 79,514 30,962 68,697 204,736
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5. 34,731 52,158 112,237 55,596 91,375 346,097
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.     4,000   4,708 8,708
c Add lines 7a and 7b.. 0 0 4,000 0 4,708 8,708
8 Public Support (Subtract line 7c from line 6.)           337,389
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6... 34,731 52,158 112,237 55,596 91,375 346,097
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 4,963 4,719 3,997 3,521 3,265 20,465
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b. 4,963 4,719 3,997 3,521 3,265 20,465
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.). 39,694 56,877 116,234 59,117 94,640 366,562
14
Section C. Computation of Public Support Percentage
15
15
92.041 %
16
16
86.69 %
Section D. Computation of Investment Income Percentage
17
17
5.583 %
18
18
6.36 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID: 11000129
Software Version: v1.00
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 to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
INSTITUTE ON RELIGION IN AN AGE OF SCIENCE
 
Employer identification number

04-6063856
Identifier Return Reference Explanation
F99Z_P01_S00_L02 Form 990-EZ, Part I, Line 2 $59,177 of this item is R&B, which is collected by IRAS and given in its entirity to the conference center.
F99Z_P01_S00_L16 Form 990-EZ, Part I, Line 16 Conference expenses, including R&B (See line 2) were $80,123.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID: 11000129
Software Version: v1.00

TY 2011 ReasonableCauseExplanation
Name:
INSTITUTE ON RELIGION IN AN AGE OF SCIENCE
EIN: 04-6063856
Software ID:11000129
Software Version:v1.00
Explanation:
Form 8868 filed and approved. Notice number: CP211A