JACK PRIBAZ FOUNDATION: Form 990EZ, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- JACK PRIBAZ FOUNDATION (EIN 45-4104433)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-07-11
- IRS object ID
- 202241929349200719
- Schema version
- 2021v4.2
- 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 | 2022-07-11T13:22:34-04:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 364240478 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Quality Back Office | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 47 E Chicago Avenue Suite 314 | AddressLine1Txt |
| City | Naperville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60540 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 454104433 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE JACK PRIBAZ FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JACK | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 813 | AddressLine1Txt |
| City | Wheaton | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60187 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Mike Pribaz | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 6303033857 | PhoneNum |
| Signature | 2022-06-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Mike | PersonFirstNm |
| Person Last | Pribaz | PersonLastNm |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Gary Grottke CPA | PreparerPersonNm |
| PTIN | P01578334 | PTIN |
| Phone | 6304280640 | PhoneNum |
| Preparation | 2022-07-11 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| OOB Security Verification | 00 | OOBSecurityVerificationCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| 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 Cash | Yes (X) | MethodOfAccountingCashInd |
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Gross Receipts | $76,105 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Contributions Gifts Grants Etc | $65,817 | ContributionsGiftsGrantsEtcAmt |
| Investment Income | $18 | InvestmentIncomeAmt |
| Fundraising Gross Income | $10,270 | FundraisingGrossIncomeAmt |
| Special Events Net Income Loss | $10,270 | SpecialEventsNetIncomeLossAmt |
| Cost Of Goods Sold | $22,127 | CostOfGoodsSoldAmt |
| Gross Profit Loss Sls Of Invntry | -$22,127 | GrossProfitLossSlsOfInvntryAmt |
| Total Revenue | $53,978 | TotalRevenueAmt |
| Fees And Other Pymt To Ind Cntrct | $5,036 | FeesAndOtherPymtToIndCntrctAmt |
| Printing Publications Postage | $375 | PrintingPublicationsPostageAmt |
| Other Expenses Total | $4,431 | OtherExpensesTotalAmt |
| Total Expenses | $9,842 | TotalExpensesAmt |
| Excess Or Deficit For Year | $44,136 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $85,779 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $129,915 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part II | Yes (X) | InfoInScheduleOPartIIInd |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,779 | BOYAmt |
| EOY | $129,929 | 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 | $85,779 | BOYAmt |
| EOY | $129,929 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $14 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,779 | BOYAmt |
| EOY | $129,915 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | FUND RESEARCH & TREATMENT OF EPILEPSY | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Srvc Accom | PROVIDE GRANTS FOR MEDICAL RESEARCH AND EDUCATION | DescriptionProgramSrvcAccomTxt |
| 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 |
|---|---|---|---|---|
| Mike Pribaz | ||||
| President | 10.00 | $0 | $0 | $0 |
| Brian Baird | ||||
| Director | 3.00 | $0 | $0 | $0 |
| Liz Pribaz | ||||
| VICE PRESIDENT | 5.00 | $0 | $0 | $0 |
| Gina Volenilek | ||||
| Director | 3.00 | $0 | $0 | $0 |
| Jim Thompson | ||||
| Director | 3.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | false | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | false | OrganizationHadUBIInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Form1120 Pol Filed | false | Form1120PolFiledInd |
| Made Loans To From Officers | false | MadeLoansToFromOfficersInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Quality Back Office LLC | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 47 E Chicago Ave Ste 314 | AddressLine1Txt |
| City | Naperville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60540 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6304280640 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Foreign Office | false | ForeignOfficeInd |
| Donor Advised Fnds | false | DonorAdvisedFndsInd |
| Operate Hospital | false | OperateHospitalInd |
| Tanning Services Provided | false | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| School Operating | false | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| Part VI Hghst Pd Cntrct Prof Srvc | NONE | PartVIHghstPdCntrctProfSrvcTxt |
| Filed Schedule A | Yes (true) | 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 | $48,560 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $15,221 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $106,880 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,674 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $65,817 | CurrentTaxYearAmt |
| Total | $243,152 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $36,400 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $77,089 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $24,264 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | -$5,906 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,270 | CurrentTaxYearAmt |
| Total | $142,117 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $84,960 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $92,310 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $131,144 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $768 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $76,087 | CurrentTaxYearAmt |
| Total | $385,269 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $385,269 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $135 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $132 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $175 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $50 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18 | CurrentTaxYearAmt |
| Total | $510 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $135 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $132 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $175 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $50 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18 | CurrentTaxYearAmt |
| Total | $510 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $85,095 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $92,442 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $131,319 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $818 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $76,105 | CurrentTaxYearAmt |
| Total | $385,779 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99870 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99850 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule G IRS990ScheduleG
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| List of grants and similar amounts paid Part I line 10 | Activity Medical Research Grantee BAYLOR COLLEGE OF MEDICINE Street ONE BAYLOR PLAZA City, State, Zip Houston, TX 77030Relationship NONE Activity Medical Research Grantee Lurie Childrens Hospital Street 225 E Chicago Ave City, State, Zip Chicago, IL 60611Relationship none |
| Description of other expenses Part I line 16 | Description AmountSupplies 163Bank Fees/Paypal Fees 525Insurance 991Bad debt 2,380Registration Fees 10Event Expense 362 |
| Description of total liabilities Part II line 26 | Category Beginning of Year End of YearCredit Card 0 14 |