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      <IndividualWithBooksNm>JEFFREY C HAVENS</IndividualWithBooksNm>
      <PersonsWithBooksUSAddress>
        <AddressLine1Txt>3025 DICKSON ROAD</AddressLine1Txt>
        <CityNm>ALBANY</CityNm>
        <StateAbbreviationCd>OH</StateAbbreviationCd>
        <ZIPCd>45710</ZIPCd>
      </PersonsWithBooksUSAddress>
      <CntrctWith3rdPrtyForGameRevInd>false</CntrctWith3rdPrtyForGameRevInd>
      <CharitableDistributionRqrInd>false</CharitableDistributionRqrInd>
    </IRS990ScheduleG>
    <IRS990ScheduleI documentId="RetDoc5">
      <GrantRecordsMaintainedInd>false</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>LOCAL CHARITIES</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <CashGrantAmt>93973</CashGrantAmt>
      </RecipientTable>
    </IRS990ScheduleI>
    <IRS990ScheduleO documentId="RetDoc6">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 2, PART III, LINE 4D</FormAndLineReferenceDesc>
        <ExplanationTxt>PROVISION OF SOCIAL &amp; RECREATIONAL ACTIVITIES FOR MEMBERS</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>NO REVIEW WAS OR WILL BE CONDUCTED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>