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Form SbGdl ('trrw +r , - - Page 2
<br /> • If yt%u are filing for an Additional (n ` • stomatic) 3 -Month Extension, complete on yt II and check this boX , , }{
<br /> ' r � ,
<br /> r Note: Only complete Part !1 if you have aCready�been granted an automartc 3-month extension on a previously filed Form 8868.
<br /> • If are filing for an Automatic 3 -Month Extension , core plete onlPart 1 on pagecrDIfffl' 1
<br />.
<br /> Additional not automatic 3 -Month Eittension of Time - Must File original and One Co
<br /> T e or Name of Exempt Organization Employer identification number
<br /> print INDIAN RIVER MEMORIAL HOSPITAL INC . 59 - 2496294
<br /> File by the Number, street, and room or suite no. If a P.O. box, see instructions. For IRS use only
<br /> extended 1000 36TH STREET -
<br /> due date for
<br /> riling the City, town or post office, state, and ZIP code. For a foreign address, see instructions. - '- ; - =
<br /> return. See - `` � s
<br /> instructions. O BEACH ,
<br /> VER B E FL 3 2 9 6 0 r„t x�� ;�:��• ,�.;,
<br /> Check type of return to be filed (File to separate application for each return) : R
<br /> Form 990 ❑ Form 990-EZ ❑ Form 990-T (sec. 401 (a) or 408 (a) trust) Form 1041 -A Form 5227 F1Form 8870
<br /> Form990-BL Form 990-PF Form 990-T (trust other than above) Form 4720Form 6069
<br /> STOP: Do not complete Part II if you were not already granted an automatic 3 -month extension on . al previously filed Form 8868.
<br /> • If the organization does not have an office or place of business in the United States, check this box, , 00 * 00000
<br /> , , , , YPLJ
<br /> • If this is for a Group .Return, enter the or anization's four digit Group Exemption NumberZGEN . If this is
<br /> for 'the whole group , check this box - )OW - I . If it is for part of the group, check thisbox - ► and attach a list
<br /> with the
<br /> names and ENS of all members the extension is for. . _
<br /> 4 1 request an additional 3-month extension of time until 08 / 15 / 2002 -
<br /> 5 For calendar year , or other tax year beginning 10 01 2000 and ending 09 30 . 2001
<br /> 6 If this tax year is for less than 12 months, check reason: Initial return Final return Change in accounting period
<br /> 7 Stats+ nsion ADDITIONAL TIME IS NECESSARY TO GATHER
<br /> 4 ACCURATE AND TIMELY RETURN
<br /> EXTENSION APPROVED -, 990-PF, 990-T, 4720 , or 6069 , enter the tentative tax, less any
<br /> 6 2002 S - N
<br /> UN 990-T, 4720 , or 6069 , enter any refundable credits and estimated
<br /> or year overpayment allowed as a credit and any . amount paid
<br /> LINDAWEISKOFF. FIELD SUBMISSION PROCESSING. OGDEN _ _� �'•
<br /> . . . . . . . . . . . . . . . . . . . . . . . . .
<br />._ . . : . : . . . . . . ;
<br /> ie 8a. Include your payment with this form,- or, if required, deposit
<br /> _ _.. ..y using EFTPS (Electronic Federal - Tax Payment System). See
<br /> Instructions a
<br /> : . : : .
<br /> . . . . . . . . . . . .
<br /> Signature and Verification `
<br /> Under penalties of perjury, 1 declare that 1 have examined this form, including accompanying schedules and statements, and
<br />to the best of my knowledge and belief,
<br /> it is true, correct, and complete, and that I am authorized to prepare this form
<br /> Signature 1L 1it�Yft �� Title ► L �l}' Date ►
<br /> _ 0 Notice to Applicant - To Be Completed by the IRS
<br /> We have approved this application . Please attach this form to the organization's return.
<br /> We have . not approved this application. However, we have granted a 10-day grace period from the later of the date shown
<br /> below or the due
<br /> date of the organization's return '(ihcluding any prior extensions). This grace period is considered to be a valid extension
<br /> of time for elections
<br /> otherwise required to be made on a. timely return . Please attach this form to the organization's return
<br /> ❑ We have not approved{his application. After considering the reasons stated in item 7, we cannot grant your request for an extension
<br /> of time
<br /> 11rT pp I : I j
<br /> to file. We are niitrgrr Jhg�a 10'-day grace. period
<br /> ❑ We cannot consider this application because it was filed after the due date of the return for which an extension was requested.
<br /> Other
<br /> Director Date
<br /> Alternate Mailing Address - Enter the address if you want the copy of this application for an additional 3-month extension
<br /> returned to an address different than the one entered above.
<br /> Name ,(
<br /> PRICEWATERHOUSECOOPERS LLP G O 71 ✓ea D
<br /> Type or Number and street (include suite, room, or apt. no.) Or a P.O. box number
<br /> print
<br /> 101 EAST KENNEDY BLVD SUITE 1500
<br /> City or town , province or state, and country (including postal or ZIP code)
<br /> JsA TAMPA FL 33602
<br /> OF8055 2- 000 Form 8868 ( 12 .2000 )
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