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
POTOSI RESCUE SQUAD INC
 
Employer identification number

39-1570873
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 2 DAN KLEIBENSTEIN AND ANNETTE KLEIBENSTEIN ARE HUSBAND AND WIFE.
FORM 990, PART VI, SECTION A, LINE 7A ANNUAL ELECTION IS HELD TO ELECT THE OFFICERS OF THE BOARD
FORM 990, PART VI, SECTION A, LINE 7B MEMBERS OF THE GOVERNING BODY ELECT THE OFFICERS OF THE BOARD ANNUALLY
FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS REVIEWED WITH THE BOARD OF TRUSTEES BEFORE SIGNING.
FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATION MAKES ITS GOVERNING AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ONLY UPON REQUEST
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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