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FISHER KOCH FAMILY FOUNDATION INC: Form 990PF, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
FISHER KOCH FAMILY FOUNDATION INC (EIN 47-2712913)
Tax period
2016-11-01 to 2017-10-31
Filed
2018-03-19
IRS object ID
201840789349100104
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-03-19T11:32:13-05:00ReturnTs
Tax Period End2017-10-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN133573805PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Barash Friedman Friedberg & Adasko CPAsBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11430 BroadwayAddressLine1Txt
CityNew YorkCityNm
State AbbreviationNYStateAbbreviationCd
ZIP10018ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2016-11-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN472712913EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FISHER KOCH FAMILY FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlFISHBusinessNameControlTxt
Phone6312836631PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1C/O BFFA 1430 Broadway No 1208AddressLine1Txt
CityNEW YORKCityNm
State AbbreviationNYStateAbbreviationCd
ZIP10018ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCynthia A FisherPersonNm
Person TitleDirectorPersonTitleTxt
Phone6312836631PhoneNum
Signature2018-03-19SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJerry PersampieriPreparerPersonNm
PTINP00292455PTIN
Phone2126964600PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address68.129.175.166IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-03-19IPDt
IP Tm11:31:01IPTm
IP TimezoneEDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id1E6E83CFB35EFBBF4C378DF93098E3E9665A6E65AtSubmissionCreationDeviceId
At Submission Filing Device Id73628AA6EA1C4D5803420A93E17130C5D84E6402AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$3,516,298FMVAssetsEOYAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Rcvd Rev And Expnss$3,841,751ContriRcvdRevAndExpnssAmt
Dividends Rev And Expnss$40,924DividendsRevAndExpnssAmt
Dividends Net Invst Incm$40,924DividendsNetInvstIncmAmt
Net Gain Sale Ast Rev And Expnss-$459,980NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$3,088,508GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$0CapGainNetIncmNetInvstIncmAmt
Total Rev And Expnss$3,422,695TotalRevAndExpnssAmt
Total Net Invst Incm$40,924TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$0CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$0CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$0CompOfcrDirTrstDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$0TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$0TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$0TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$152,500ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$152,500ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$152,500TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$0TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$152,500TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses$3,270,195ExcessRevenueOverExpensesAmt
Net Investment Income$40,924NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Cash EOY$158CashEOYAmt
Cash EOYFMV$158CashEOYFMVAmt
Sav And Temp Cash Invst EOY$3,270,037SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$3,516,140SavAndTempCashInvstEOYFMVAmt
Other Assets BOY$0OtherAssetsBOYAmt
Other Assets EOY$0OtherAssetsEOYAmt
Other Assets EOYFMV$0OtherAssetsEOYFMVAmt
Total Assets BOY$0TotalAssetsBOYAmt
Total Assets EOY$3,270,195TotalAssetsEOYAmt
Total Assets EOYFMV$3,516,298TotalAssetsEOYFMVAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind
Capital Stock BOY$0CapitalStockBOYAmt
Capital Stock EOY$0CapitalStockEOYAmt
Additional Paid In Capital BOY$0AdditionalPaidInCapitalBOYAmt
Additional Paid In Capital EOY$0AdditionalPaidInCapitalEOYAmt
Retained Earning BOY$0RetainedEarningBOYAmt
Retained Earning EOY$3,270,195RetainedEarningEOYAmt
Tot Net Ast Or Fund Balances BOY$0TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$3,270,195TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$0TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$3,270,195TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$0TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses$3,270,195ExcessRevenueOverExpensesAmt
Other Increases$0OtherIncreasesAmt
Subtotal$3,270,195SubtotalAmt
Other Decreases$0OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$3,270,195TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (2 entries)

PropertyPropertyDescAcquiredAcquiredDtSoldSoldDtGross Sales PriceGrossSalesPriceAmtCost Or Other BasisCostOrOtherBasisAmtGain Or LossGainOrLossAmtGains Minus Excess Or LossesGainsMinusExcessOrLossesAmt
Boston Beer Company2016-12-312017-03-31$3,028,405$3,492,600-$464,195-$464,195
Vanguard Index FDS2017-03-312017-10-31$60,103$55,888$4,215$4,215
FieldValueIRS element (for citing)
Capital Gain Net Income-$459,980CapitalGainNetIncomeAmt

Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp

FieldValueIRS element (for citing)
Liable Section4942 Tax0LiableSection4942TaxInd
Adjusted Qlfy Distri Yr1$0AdjustedQlfyDistriYr1Amt
Net Vl Noncharitable Assets Yr1$0NetVlNoncharitableAssetsYr1Amt
Distribution Yr10.000000DistributionYr1Rt
Adjusted Qlfy Distri Yr2$0AdjustedQlfyDistriYr2Amt
Net Vl Noncharitable Assets Yr2$0NetVlNoncharitableAssetsYr2Amt
Distribution Yr20.000000DistributionYr2Rt
Total Distribution0.000000TotalDistributionRt
Average Distribution0.000000AverageDistributionRt
Net Vl Noncharitable Assets$2,961,874NetVlNoncharitableAssetsAmt
Adj Net Vl Noncharitable Assets$0AdjNetVlNoncharitableAssetsAmt
Net Investment Income Pct$409NetInvestmentIncomePctAmt
Adj Nonchrtbl Net Invst Incm Pct$409AdjNonchrtblNetInvstIncmPctAmt
Qualifying Distributions$152,500QualifyingDistributionsAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Domestic Org Meeting Sect4940eYes (X)DomesticOrgMeetingSect4940eInd
Investment Income Excise Tax$409InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$409SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$409TaxBasedOnInvestmentIncomeAmt
Total Payments And Credits$0TotalPaymentsAndCreditsAmt
Tax Due$409TaxDueAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (1)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateDEOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating Foundation0PrivateOperatingFoundationInd
New Substantial ContributorsYes (1)NewSubstantialContributorsInd
Own Controlled Entity0OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressN/AWebsiteAddressTxt
Individual With BooksBFFAIndividualWithBooksNm
Phone2126964600PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line11430 Broadway suite 1208AddressLine1Txt
CityNEW YORKCityNm
State AbbreviationNYStateAbbreviationCd
ZIP10022ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified Prsn0FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified Prsn0PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To Individuals0GrantsToIndividualsInd
Grants To Organizations0GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
charles J koch
186 park streetnewtonMA02458manager5.00$0$0$0
Cynthia A Fisher
186 park streetnewtonMA02458director5.00$0$0$0
Elizabeth F Koch
186 park streetnewtonMA02458director1.00$0$0$0
Emily F Koch
186 park streetnewtonMA02458director1.00$0$0$0
Megan Koch Popp
10 Mount Veron StreetCharlestonMA02129director1.00$0$0$0
charles J koch
174 Longfellow StreetPortlandME04103director1.00$0$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Other Employee Paid Over50k0OtherEmployeePaidOver50kCnt
Comp Of Hghst Pd Cntrct Or NONENONECompOfHghstPdCntrctOrNONETxt
Contractor Paid Over50k0ContractorPaidOver50kCnt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$2,992,201AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$14,778AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$3,006,979TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$3,006,979AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$45,105CashDeemedCharitableAmt
Net Vl Noncharitable Assets$2,961,874NetVlNoncharitableAssetsAmt
Minimum Investment Return$148,094MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$148,094MinimumInvestmentReturnAmt
Tax Based On Investment Income$409TaxBasedOnInvestmentIncomeAmt
Total Tax$409TotalTaxAmt
Distributable Before Adj$147,685DistributableBeforeAdjAmt
Recoveries Qualfied Distri$0RecoveriesQualfiedDistriAmt
Distributable Before Ded$147,685DistributableBeforeDedAmt
Deduction From Distributable$0DeductionFromDistributableAmt
Distributable As Adjusted$147,685DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

FieldValueIRS element (for citing)
Expenses And Contributions$152,500ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Qualifying Distributions$152,500QualifyingDistributionsAmt
Pct Sect4940e Org Net Invst Incm$409PctSect4940eOrgNetInvstIncmAmt
Adjusted Qualifying Distri$152,091AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$147,685DistributableAsAdjustedAmt
Undistributed Income PY$0UndistributedIncomePYAmt
Total For Prior Years$0TotalForPriorYearsAmt
Total Excess Distribution Cyov$0TotalExcessDistributionCyovAmt
Qualifying Distributions$152,500QualifyingDistributionsAmt
Applied To Year1$0AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$147,685AppliedToCurrentYearAmt
Remaining Distri From Corpus$4,815RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$4,815TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$0UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$0ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$4,815ExcessDistriCyovToNextYrAmt
Excess From Current Year$4,815ExcessFromCurrentYearAmt

Supplementary Information SupplementaryInformationGrp

FieldValueIRS element (for citing)
Contributing Managercharles J kochContributingManagerNm
Only Contri To PreselectedYes (X)OnlyContriToPreselectedInd

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (4 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
The Dorothy Koch Family Foundation
2102 Maiden LaneRoanokeVA24015PFSupport the foundation$50,000
Council for Economic Education
122 E 42nd St Ste 2600new yorkNY10168501c3Support the foundation$1,000
Fitmoney Inc
1188 center st 3newtonMA02459501c3Support the foundation$100,000
Newton Schools foundation
po box 590020newtonMA02460501c3Support the foundation$1,500
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$152,500TotalGrantOrContriPdDurYrAmt
Total Grant Or Contri Apprv Fut$0TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp

FieldValueIRS element (for citing)
Related Or Exempt Function Incm$40,924RelatedOrExemptFunctionIncmAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Related Or Exempt Function Incm-$459,980RelatedOrExemptFunctionIncmAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$0UnrelatedBusinessTaxblIncmAmt
Exclusion$0ExclusionAmt
Related Or Exempt Function Incm-$419,056RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty-$419,056TotalIncomeProducingActyAmt

Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp

Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp (2 entries)

Line NumberLineNumberTxtRelationship StatementRelationshipStatementTxt
4Dividends earned on temporary investments
8Capital loss on selling stock

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EOYes (1)RelationshipsNonchrtblEOInd

Relationship Schedule Detail RelationshipScheduleDetail (2 entries)

Organization TypeOrganizationTypeDescRelationship DescriptionRelationshipDescriptionTxt
Fit Money inc
501 c 3common director
The dorothy Koch Family Foundation
501 c 3common director

Schedule B IRS990ScheduleB

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
General RuleYes (X)GeneralRuleInd

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
Contributor1ContributorNum
Contributor PersonC James KochContributorPersonNm

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1186 Park StreetAddressLine1Txt
CityWest NewtonCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02458ZIPCd
FieldValueIRS element (for citing)
Total Contributions$3,841,751TotalContributionsAmt
Noncash ContributionYes (X)NoncashContributionInd

Non Cash Property Contribution NonCashPropertyContributionGrp

FieldValueIRS element (for citing)
Contributor1ContributorNum
Noncash Property22000 shares of boston beer company's stockNoncashPropertyDesc
Fair Market Value$3,841,751FairMarketValueAmt
Received2016-12-31ReceivedDt

Other Assets Schedule OtherAssetsSchedule

Other Assets Schedule OtherAssetsScheduleGrp (2 entries)

BOY Book ValueBOYBookValueAmt
$0
$0

Substantial Contributors Sch SubstantialContributorsSch

Substantial Contributor Detail SubstantialContributorDetail

FieldValueIRS element (for citing)
PersonJames KochPersonNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1186 park streetAddressLine1Txt
CitynewtonCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02458ZIPCd

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