CHUCK PETERSEN MEMORIAL SCHOLARSHIP: Form 990EZ, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CHUCK PETERSEN MEMORIAL SCHOLARSHIP (EIN 54-1920205)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-04-10
- IRS object ID
- 202231009349200123
- Schema version
- 2021v4.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-04-10T17:51:44-07:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 541920205 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHUCK PETERSEN MEMORIAL SCHOLARSHIP | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHUC | BusinessNameControlTxt |
| Phone | 4152609498 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 366 Carrera Drive | AddressLine1Txt |
| City | Mill Valley | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94941 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jan McDougal | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 4152609498 | PhoneNum |
| Signature | 2022-04-10 | SignatureDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| OOB Security Verification | 11 | OOBSecurityVerificationCd |
| Last Submission Rqr OOB | 1 | LastSubmissionRqrOOBCd |
| Authentication Assurance Level | AAL2 | AuthenticationAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Website Address | https://chuckpetersen.com/ | WebsiteAddressTxt |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Assoc | Yes (X) | TypeOfOrganizationAssocInd |
| Gross Receipts | $19,034 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Contributions Gifts Grants Etc | $1,500 | ContributionsGiftsGrantsEtcAmt |
| Program Service Revenue | $0 | ProgramServiceRevenueAmt |
| Membership Dues | $0 | MembershipDuesAmt |
| Investment Income | $2,145 | InvestmentIncomeAmt |
| Sale Of Assets Gross | $15,389 | SaleOfAssetsGrossAmt |
| Cost Or Other Basis Expense Sale | $12,265 | CostOrOtherBasisExpenseSaleAmt |
| Gain Or Loss From Sale Of Assets | $3,124 | GainOrLossFromSaleOfAssetsAmt |
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Special Events Direct Expenses | $0 | SpecialEventsDirectExpensesAmt |
| Special Events Net Income Loss | $0 | SpecialEventsNetIncomeLossAmt |
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
| Gross Profit Loss Sls Of Invntry | $0 | GrossProfitLossSlsOfInvntryAmt |
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
| Total Revenue | $6,769 | TotalRevenueAmt |
| Grants And Similar Amounts Paid | $7,500 | GrantsAndSimilarAmountsPaidAmt |
| Benefits Paid To Or For Members | $0 | BenefitsPaidToOrForMembersAmt |
| Salaries Other Comp Empl Bnft | $0 | SalariesOtherCompEmplBnftAmt |
| Fees And Other Pymt To Ind Cntrct | $0 | FeesAndOtherPymtToIndCntrctAmt |
| Occupancy Rent Utlts And Maint | $0 | OccupancyRentUtltsAndMaintAmt |
| Printing Publications Postage | $0 | PrintingPublicationsPostageAmt |
| Other Expenses Total | $0 | OtherExpensesTotalAmt |
| Total Expenses | $7,500 | TotalExpensesAmt |
| Excess Or Deficit For Year | -$731 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $85,081 | NetAssetsOrFundBalancesBOYAmt |
| Other Changes In Net Assets | $11,873 | OtherChangesInNetAssetsAmt |
| Net Assets Or Fund Balances EOY | $96,223 | NetAssetsOrFundBalancesEOYAmt |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,081 | BOYAmt |
| EOY | $96,223 | EOYAmt |
Land And Buildings LandAndBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total Detail OtherAssetsTotalDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Form990 Total Assets Form990TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,081 | BOYAmt |
| EOY | $96,223 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,081 | BOYAmt |
| EOY | $96,223 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | Provide college scholarships | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Srvc Accom | College scholarship awarded to graduating Oconomowoc HS senior Sarah Kopfer | DescriptionProgramSrvcAccomTxt |
| Grants And Allocations | $7,500 | GrantsAndAllocationsAmt |
| Program Service Expenses | $0 | ProgramServiceExpensesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $0 | TotalProgramServiceExpensesAmt |
Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (5 entries)
| TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|
| Jan McDougal | ||||
| President, Director | 2 | $0 | $0 | $0 |
| Marc Petersen | ||||
| Treasurer, Director | 0.5 | $0 | $0 | $0 |
| Ron Petersen | ||||
| Director | 0.5 | $0 | $0 | $0 |
| Marty Petersen | ||||
| Director | 0.5 | $0 | $0 | $0 |
| Barbara Petersen | ||||
| Director | 0.5 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | 0 | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | 0 | OrganizationHadUBIInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Direct Indirect Pltcl Expend | $0 | DirectIndirectPltclExpendAmt |
| Form1120 Pol Filed | 0 | Form1120PolFiledInd |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficersInd |
| Tax Imposed Under IRC4911 | $0 | TaxImposedUnderIRC4911Amt |
| Tax Imposed Under IRC4912 | $0 | TaxImposedUnderIRC4912Amt |
| Tax Imposed Under IRC4955 | $0 | TaxImposedUnderIRC4955Amt |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| Tax Imposed On Organization Mgr | $0 | TaxImposedOnOrganizationMgrAmt |
| Tax Reimbursed By Organization | $0 | TaxReimbursedByOrganizationAmt |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jan McDougal | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 366 Carrera Drive | AddressLine1Txt |
| City | Mill Valley | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94941 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4152609498 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Donor Advised Fnds | 0 | DonorAdvisedFndsInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Tanning Services Provided | 0 | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| School Operating | 0 | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| Part VI Hghst Pd Cntrct Prof Srvc | NONE | PartVIHghstPdCntrctProfSrvcTxt |
| Filed Schedule A | Yes (1) | FiledScheduleAInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $36,156 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $500 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,500 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,500 | CurrentTaxYearAmt |
| Total | $40,656 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $36,156 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $500 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,500 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,500 | CurrentTaxYearAmt |
| Total | $40,656 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $40,656 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $962 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,209 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,953 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,560 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,145 | CurrentTaxYearAmt |
| Total | $7,829 | TotalAmt |
Post1975 UBTI Post1975UBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $962 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,209 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,953 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,560 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,145 | CurrentTaxYearAmt |
| Total | $7,829 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $37,118 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,709 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,953 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,060 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,645 | CurrentTaxYearAmt |
| Total | $48,485 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.83853 | PublicSupportCY509Pct |
| Public Support PY509 | 0.93 | PublicSupportPY509Pct |
| Investment Income CY | 0.16147 | InvestmentIncomeCYPct |
| Investment Income PY | 0.07 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990-EZ, Part I, Line 10 | $7,500 scholarship paid to University of Notre Dame for Sarah Kopfer |
| Form 990-EZ, Part I, Line 20 | Description;Amount^Unrealized change in value of investments;11873^Total;11873^ |