TY 2022 Form 990EZ

(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
MICHAEL RICH FIRE CHIEF	10	0	0	0
MARTIN BLESSING PRESIDENT	2	0	0	0
CODY CRAIGIN DEPUTY CHIEF	5	0	0	0
BRAD MCCORMICK ASSISTANT CHIEF	5	0	0	0

(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

MICHAEL RICH

FIRE CHIEF

MARTIN BLESSING

PRESIDENT

CODY CRAIGIN

DEPUTY CHIEF

BRAD MCCORMICK

ASSISTANT CHIEF

(a) Name and title of each employee

(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

(a) Name and business address of each independent contractor

(b) Type of service

(c) Compensation

- TIN:

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.
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Attach to Form 990 or 990-EZ.
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Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

PINE VILLAGE COMMUNITY FIRE DEPARTMENT

Employer identification number

35-6043744

Return Reference	Explanation
PART I, LINE 16	1) OTHER EXPENSES ADVERTISING AMOUNT 339 2) OTHER EXPENSES CERTIFICATIONS AMOUNT 98 3) OTHER EXPENSES COMMUNICATION EXPENSES AMOUNT 313 4) OTHER EXPENSES MISC EXPENSES AMOUNT 431 5) OTHER EXPENSES EMPLOYEE HEALTH AND SAFETY AMOUNT 5425 6) OTHER EXPENSES EMS EXPENSE AMOUNT 143 7) OTHER EXPENSES FIRE EQUIPMENT PARTS SUPPLIES AND MAINTENANCE AMOUNT 39541 8) OTHER EXPENSES FEES AMOUNT 76 9) OTHER EXPENSES FOOD FOR FIREFIGHTING AMOUNT 387 10) OTHER EXPENSES FUEL AMOUNT 3485 11) OTHER EXPENSES INSURANCE AMOUNT 4657 12) OTHER EXPENSES LICENSE AND PERMITS AMOUNT 452 13) OTHER EXPENSES GROUP MEETING EXPENSES AMOUNT 60 14) OTHER EXPENSES EQUIPMENT REPAIRS AMOUNT 123 15) OTHER EXPENSES OFFICE EXPENSE AMOUNT 1017 16) OTHER EXPENSES MISC FIRE FIGHTING PARTS AND EQUIPMENT AMOUNT 1049 17) OTHER EXPENSES PERSONAL PROTECTIVE EQUIPMENT AMOUNT 33082 18) OTHER EXPENSES PREVENTIVE MAINTENANCE AMOUNT 5889 19) OTHER EXPENSES PUBLIC RELATIONS AMOUNT 1464 20) OTHER EXPENSES PVFD ASSOCIATED COSTS AMOUNT 15105 21) OTHER EXPENSES RESCUE SUPPLIES AMOUNT 63 22) OTHER EXPENSES STATION EQUIPMENT COSTS AMOUNT 15111 23) OTHER EXPENSES SUPPLIES AMOUNT 333 24) OTHER EXPENSES EQUIPMENT TESTING COSTS AMOUNT 1285 25) OTHER EXPENSES TRAILER 28 AMOUNT 132 26) OTHER EXPENSES TRAINING COSTS AMOUNT 863

Return Reference

Explanation

PART I, LINE 16

1) OTHER EXPENSES ADVERTISING AMOUNT 339 2) OTHER EXPENSES CERTIFICATIONS AMOUNT 98 3) OTHER EXPENSES COMMUNICATION EXPENSES AMOUNT 313 4) OTHER EXPENSES MISC EXPENSES AMOUNT 431 5) OTHER EXPENSES EMPLOYEE HEALTH AND SAFETY AMOUNT 5425 6) OTHER EXPENSES EMS EXPENSE AMOUNT 143 7) OTHER EXPENSES FIRE EQUIPMENT PARTS SUPPLIES AND MAINTENANCE AMOUNT 39541 8) OTHER EXPENSES FEES AMOUNT 76 9) OTHER EXPENSES FOOD FOR FIREFIGHTING AMOUNT 387 10) OTHER EXPENSES FUEL AMOUNT 3485 11) OTHER EXPENSES INSURANCE AMOUNT 4657 12) OTHER EXPENSES LICENSE AND PERMITS AMOUNT 452 13) OTHER EXPENSES GROUP MEETING EXPENSES AMOUNT 60 14) OTHER EXPENSES EQUIPMENT REPAIRS AMOUNT 123 15) OTHER EXPENSES OFFICE EXPENSE AMOUNT 1017 16) OTHER EXPENSES MISC FIRE FIGHTING PARTS AND EQUIPMENT AMOUNT 1049 17) OTHER EXPENSES PERSONAL PROTECTIVE EQUIPMENT AMOUNT 33082 18) OTHER EXPENSES PREVENTIVE MAINTENANCE AMOUNT 5889 19) OTHER EXPENSES PUBLIC RELATIONS AMOUNT 1464 20) OTHER EXPENSES PVFD ASSOCIATED COSTS AMOUNT 15105 21) OTHER EXPENSES RESCUE SUPPLIES AMOUNT 63 22) OTHER EXPENSES STATION EQUIPMENT COSTS AMOUNT 15111 23) OTHER EXPENSES SUPPLIES AMOUNT 333 24) OTHER EXPENSES EQUIPMENT TESTING COSTS AMOUNT 1285 25) OTHER EXPENSES TRAILER 28 AMOUNT 132 26) OTHER EXPENSES TRAINING COSTS AMOUNT 863

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Contributions, gifts, grants, and similar amounts received ....................	1	52,863
2	Program service revenue including government fees and contracts ................	2	58,650
3	Membership dues and assessments .............................	3
4	Investment income ....................................	4	87
5a	Gross amount from sale of assets other than inventory .......	5a
b	Less: cost or other basis and sales expenses ............	5b
c	Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ......	5c
6	Gaming and fundraising events
a	Gross income from gaming (attach Schedule G if greater than $15,000)	6a
b	Gross income from fundraising events (not including $ 6,750 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	6,750
c	Less: direct expenses from gaming and fundraising events ...	6c	1,140
d	Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)	6d	5,610
7a	Gross sales of inventory, less returns and allowances ......	7a
b	Less: cost of goods sold .............	7b
c	Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) .........	7c
8	Other revenue (describe in Schedule O) ....................	8
9	Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 ..............	9	117,210

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; optional for others.)
What is the organization's primary exempt purpose? TOWN AND SURROUNDING AREA FIRE PROTECTION
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 THE ORGANIZAION IS A VOLUNTEER FIRE STATION THAT PROVIDES FIRE AND RES CUE SERVICES TO THE TOWN OF PINE VILLAGE INDIANA AND IMMEDIATE SUROUND ING AREA. (Grants $ ) If this amount includes foreign grants, check here ...			28a	132,062
29 (Grants $ ) If this amount includes foreign grants, check here ...			29a
30 (Grants $ ) If this amount includes foreign grants, check here ...			30a
31 Other program services (describe in Schedule O) ................ (Grants $ ) If this amount includes foreign grants, check here...	31a
32 Total program service expenses (add lines 28a through 31a)..........	32	132,062

Sign Here

	Signature of officer	Date

	Type or print name and title

10	Grants and similar amounts paid (list in Schedule O) ................	10
11	Benefits paid to or for members ......................	11
12	Salaries, other compensation, and employee benefits ................	12
13	Professional fees and other payments to independent contractors ............	13
14	Occupancy, rent, utilities, and maintenance ...................	14
15	Printing, publications, postage, and shipping ...................	15
16	Other expenses (describe in Schedule O) ...................	16	130,923
17	Total expenses. Add lines 10 through 16 .................	17	130,923

18	Excess or (deficit) for the year (Subtract line 17 from line 9) ............	18	-13,713
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	190,884
20	Other changes in net assets or fund balances (explain in Schedule O) ...........	20
21	Net assets or fund balances at end of year. Combine lines 18 through 20 ..........	21	177,171