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          <ZIPCd>94087</ZIPCd>
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      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <DonorAdvisedFndsInd>false</DonorAdvisedFndsInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <TanningServicesProvidedInd>false</TanningServicesProvidedInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TransactionWithControlEntInd>false</TransactionWithControlEntInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>false</TrnsfrExmptNonChrtblRltdOrgInd>
      <PartVIOfCompOfHghstPdEmplTxt>NONE</PartVIOfCompOfHghstPdEmplTxt>
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        <CurrentTaxYearMinus1YearAmt>71222</CurrentTaxYearMinus1YearAmt>
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        <FormAndLineReferenceDesc>INSURANCE</FormAndLineReferenceDesc>
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        <ExplanationTxt>$4,664</ExplanationTxt>
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