BAYCARE CLINIC FOUNDATION LTD: Form 990PF, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- BAYCARE CLINIC FOUNDATION LTD (EIN 39-2000503)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-10
- IRS object ID
- 202223149349102267
- 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
- Form 990-PF
- Schedule B
- Accounting Fees Schedule
- Investments Corp Stock Schedule
- Other Expenses Schedule
- Other Increases Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-10T14:09:43-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1175 LOMBARDI AVENUE SUITE 200 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54304 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 392000503 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAY CARE CLINIC FOUNDATION LTD | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BAYC | BusinessNameControlTxt |
| Phone | 9204909046 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1035 KEPLER DRIVE | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54311 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANN SEIDL | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 9204909046 | PhoneNum |
| Signature | 2022-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ANN | PersonFirstNm |
| Person Last | SEIDL | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHELLE MULLOY | PreparerPersonNm |
| PTIN | P01241748 | PTIN |
| Phone | 9204367800 | PhoneNum |
| Preparation | 2022-11-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| 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-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $702,936 | FMVAssetsEOYAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $204,816 | ContriRcvdRevAndExpnssAmt |
| Interest On Sav Rev And Expnss | $4 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $4 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $11,143 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $11,143 | DividendsNetInvstIncmAmt |
| Cap Gain Net Incm Net Invst Incm | $0 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $215,963 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $11,147 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Net Invst Incm | $0 | CompOfcrDirTrstNetInvstIncmAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $0 | CompOfcrDirTrstDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $3,949 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $1,975 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Chrtbl Prps | $1,974 | AccountingFeesChrtblPrpsAmt |
| Taxes Rev And Expnss | $77 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $0 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $0 | TaxesDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $1,779 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $523 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $1,256 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $5,805 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $2,498 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $3,230 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $143,613 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $143,613 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $149,418 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $2,498 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $146,843 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $66,545 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $8,649 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $272,387 | CashBOYAmt |
| Cash EOY | $307,691 | CashEOYAmt |
| Cash EOYFMV | $307,691 | CashEOYFMVAmt |
| Sav And Temp Cash Invst BOY | $15,174 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $15,177 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $15,177 | SavAndTempCashInvstEOYFMVAmt |
| Corporate Stock BOY | $312,629 | CorporateStockBOYAmt |
| Corporate Stock EOY | $380,068 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $380,068 | CorporateStockEOYFMVAmt |
| Total Assets BOY | $600,190 | TotalAssetsBOYAmt |
| Total Assets EOY | $702,936 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $702,936 | TotalAssetsEOYFMVAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
| Capital Stock BOY | $0 | CapitalStockBOYAmt |
| Capital Stock EOY | $0 | CapitalStockEOYAmt |
| Additional Paid In Capital BOY | $0 | AdditionalPaidInCapitalBOYAmt |
| Additional Paid In Capital EOY | $0 | AdditionalPaidInCapitalEOYAmt |
| Retained Earning BOY | $600,190 | RetainedEarningBOYAmt |
| Retained Earning EOY | $702,936 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $600,190 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $702,936 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $600,190 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $702,936 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $600,190 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $66,545 | ExcessRevenueOverExpensesAmt |
| Other Increases | $36,201 | OtherIncreasesAmt |
| Subtotal | $702,936 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $702,936 | TotNetAstOrFundBalancesEOYAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $120 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $120 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $120 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $0 | EstimatedPlusOvpmtIncmTxAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Extsn Request Income Tax Paid | $0 | ExtsnRequestIncomeTaxPaidAmt |
| Backup Withholding Withheld | $0 | BackupWithholdingWithheldAmt |
| Total Payments And Credits | $0 | TotalPaymentsAndCreditsAmt |
| Es Penalty | $0 | EsPenaltyAmt |
| Tax Due | $120 | TaxDueAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | 0 | LegislativePoliticalActyInd |
| More Than100 Spent | 0 | MoreThan100SpentInd |
| Form1120 POL Filed | 0 | Form1120POLFiledInd |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| Tax Reimbursed | $0 | TaxReimbursedAmt |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | 0 | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (1) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (1) | AtLeast5000InAssetsInd |
| Org Report Or Register State | WI | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (1) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | 0 | PrivateOperatingFoundationInd |
| New Substantial Contributors | 0 | NewSubstantialContributorsInd |
| Own Controlled Entity | 0 | OwnControlledEntityInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (1) | ComplyWithPublicInspRqrInd |
| Website Address | WWW.BAYCARE.NET/WEBSITE/ABOUT/500--FOUNDATION/IND | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MS JULIE DUCKETT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204909046 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1035 KEPLER DRIVE | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54311 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | 0 | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | 0 | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | 0 | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | 0 | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | 0 | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | 0 | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | 0 | PaymentToGovernmentOfficialInd |
| Uncorrected Prior Acts | 0 | UncorrectedPriorActsInd |
| Undistributed Income PY | 0 | UndistributedIncomePYInd |
| Business Holdings | 0 | BusinessHoldingsInd |
| Jeopardy Investments | 0 | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | 0 | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | 0 | InfluenceLegislationInd |
| Influence Election | 0 | InfluenceElectionInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Noncharitable Purpose | 0 | NoncharitablePurposeInd |
| Transactions Fail To Qlfy As Exc | 0 | TransactionsFailToQlfyAsExcInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|---|---|---|---|
| JOSEPH HODGSON MD | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| MICHAEL MEDICH MD | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| BRUCE NEAL MD | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR/VICE PRESIDENT | 0.50 | $0 | $0 | $0 |
| CHRISTOPHER SORRELLS MD | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR/TREASURER | 0.50 | $0 | $0 | $0 |
| ANN SEIDL | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR/PRESIDENT | 0.50 | $0 | $0 | $0 |
| PAUL LUIKART MD | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| LEANNE DENISSEN | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| NICOLE NISHIDA | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| ANNA PIERCE MD | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| PAM SEIDL | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| JOSEPH BERGMANN MD | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| BRANDON NEWELL DDS | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| WILLIAM WAGNER MD | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Other Employee Paid Over50k | 0 | OtherEmployeePaidOver50kCnt |
| Comp Of Hghst Pd Cntrct Or NONE | NONE | CompOfHghstPdCntrctOrNONETxt |
| Contractor Paid Over50k | 0 | ContractorPaidOver50kCnt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $335,237 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $298,054 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $633,291 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $633,291 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $9,499 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $623,792 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $31,190 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $31,190 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $120 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $120 | TotalTaxAmt |
| Distributable Before Adj | $31,070 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $31,070 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $31,070 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $146,843 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $146,843 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $31,070 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $223,569 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $165,016 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $191,220 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $199,259 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $130,125 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $909,189 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $146,843 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $31,070 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $115,773 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $1,024,962 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Prior Year Deficiency Or Tax | $0 | PriorYearDeficiencyOrTaxAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $223,569 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $801,393 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $165,016 | ExcessFromYear4Amt |
| Excess From Year3 | $191,220 | ExcessFromYear3Amt |
| Excess From Year2 | $199,259 | ExcessFromYear2Amt |
| Excess From Year1 | $130,125 | ExcessFromYear1Amt |
| Excess From Current Year | $115,773 | ExcessFromCurrentYearAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | JOSEPH HODGSON MD | ContributingManagerNm |
| Contributing Manager | BRUCE NEAL MD | ContributingManagerNm |
| Contributing Manager | CHRISTOPHER SORRELLS MD | ContributingManagerNm |
Application Submission Info ApplicationSubmissionInfoGrp (2 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient PhoneRecipientPhoneNum | Form And Info And MaterialsFormAndInfoAndMaterialsTxt | Submission DeadlinesSubmissionDeadlinesTxt | Restrictions On AwardsRestrictionsOnAwardsTxt |
|---|---|---|---|---|---|---|---|
| ANN SEIDL | |||||||
| 164 N BROADWAY | GREEN BAY | WI | 54303 | 9204055382 | THE FORM FOR COMMUNITY-BASED PROGRAMS, PROJECTS AND SERVICES CAN BE DOWNLOADED AT HTTP://WWW.BAYCARE.NET/WEBSITE/ABOUT/500--FOUNDATION/INDEX.ASP | DEADLINES FOR GRANT REQUESTS ARE JANUARY 14, APRIL 14, JULY 14 AND OCTOBER 13. | GENERAL FINANCIAL SUPPORT GRANTS MUST RELATE TO THE OVERALL FOUNDATION MISSION OF PROMOTING THE HEALTH AND WELL-BEING OF NORTHEAST WISCONSIN RESIDENTS. |
| ANN SEIDL | |||||||
| 164 N BROADWAY | GREEN BAY | WI | 54303 | 9204055382 | THE FORM FOR SCHOLARSHIPS CAN BE DOWNLOADED AT HTTP://WWW.BAYCARE.NET/WEBSITE/ABOUT/500--FOUNDATION/INDEX.ASP | THE DEADLINE FOR SCHOLARSHIP APPLICATIONS IS APRIL OF EVERY YEAR. | SCHOLARSHIPS ARE AWARDED TO PRE-SELECTED REGIONAL HIGH SCHOOLS AND COLLEGES AND TO SCHOLARS PURSUING ADVANCED EDUCATION IN THE HEALTHCARE FIELD. |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (100 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| BOY SCOUTS OF AMERICA | |||||||
| 2555 NORTHERN RD | APPLETON | WI | 54912 | NONE | PC | 2020 FRIENDS OF SCOUTING CAMPAIGN | $1,000 |
| BOY SCOUTS OF AMERICA | |||||||
| 2555 NORTHERN RD | APPLETON | WI | 54912 | NONE | PC | 2021 FRIENDS OF SCOUTING CAMPAIGN | $1,000 |
| WISCONSIN UNITED FC | |||||||
| PO BOX 1444 | APPLETON | WI | 54912 | NONE | PC | SELF-DIRECTED DONATION | $2,500 |
| THE RIDGES SANCTUARY | |||||||
| PO BOX 152 | BAILEYS HARBOR | WI | 54202 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| ROBERTO CLEMENTE HEALTH CLINIC | |||||||
| 105 WEST MONUMENT STREET | BALTIMORE | MD | 21201 | NONE | PC | SELF-DIRECTED DONATION | $2,000 |
| BARRON AREA EDUCATION FOUNDATION - SCHOLARSHIP | |||||||
| PO BOX 271 | BARRON | WI | 54812 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| HARVARD COLLEGE FUND | |||||||
| PO BOX 55997 | BOSTON | MA | 022059727 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| OXBOW COMMUNITY SCHOLARSHIP FOUNDATION | |||||||
| 36 OXBOW DR | BRADFORD | VT | 05033 | NONE | PC | SELF-DIRECTED DONATION | $200 |
| AKSHAYA PATRA USA | |||||||
| 6800 OWENSMOUTH AVE SUITE 230 | CANOGA PARK | CA | 91303 | NONE | PC | SELF-DIRECTED DONATION | $1,001 |
| AMERICAN CANCER SOCIETY | |||||||
| PO BOX 630353 | CINCINNATI | OH | 452630353 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| UNIVERSITY OF COLORADO AT COLORADO SPRINGS | |||||||
| 1420 AUSTIN BLUFFS PKWAY | COLORADO SPRINGS | CO | 80918 | NONE | PC | SCHOLARSHIP - REBEKAH BUBOLITZ | $1,000 |
| DE PERE TRACK AND CROSS COUNTY BOOSTER | |||||||
| 1941 CHARLES ST | DE PERE | WI | 54115 | NONE | PC | SELF-DIRECTED DONATION | $3,000 |
| FIRST UNITED PRESBYTERIAN CHURCH | |||||||
| 605 N WEBSTER AVE | DE PERE | WI | 54115 | NONE | PC | SELF-DIRECTED DONATION | $10,000 |
| RIBBON OF HOPE | |||||||
| PO BOX 148 | DE PERE | WI | 54115 | NONE | PC | SELF-DIRECTED DONATION | $500 |
| ST NORBERT COLLEGE | |||||||
| 100 GRANT ST | DE PERE | WI | 54115 | NONE | PC | SCHOLARSHIP - MADISON HERDINA | $2,000 |
| WEST DE PERE SCHOOL DISTRICT | |||||||
| 400 REID ST STE W | DE PERE | WI | 54115 | NONE | PC | SELF-DIRECTED DONATION | $2,000 |
| PENISULA MUSIC FESTIVAL | |||||||
| PO BOX 340 | EPHRAIM | WI | 54211 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| NORTHERN SKY THEATER | |||||||
| PO BOX 273 | FISH CREEK | WI | 54212 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| PENINSULA PLAYERS THEATRE FOUNDATION INC | |||||||
| W4351 PENINSULA PLAYERS RD | FISH CREEK | WI | 542129725 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| GIBRALTAR FIRE DEPARTMENT | |||||||
| PO BOX 850 | FISH CREEK | WI | 54212 | NONE | PC | MATZKE MEMORIAL (UTV PURCHASE) | $12,650 |
| MARIAN UNIVERSITY | |||||||
| 45 S NATIONAL AVE | FOND DU LAC | WI | 549354699 | NONE | PC | SCHOLARSHIP - LEAH WYPISZENSKI | $2,000 |
| FRIENDS OF THE BAY BEACH WILDLIFE SANCTUARY INC | |||||||
| 1660 EAST SHORE DR | GREEN BAY | WI | 54302 | NONE | PC | SELF-DIRECTED DONATION | $500 |
| NWTC EDUCATIONAL FOUNDATION | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | BOARD | $10,000 |
| BOOKS FOR A BETTER TOMORROW | |||||||
| 525 S MADISON ST | GREEN BAY | WI | 54301 | NONE | PC | BOARD AND DONOR ADVISED DONATION | $2,000 |
| GREEN BAY AREA CATHOLIC EDUCATION | |||||||
| 1822 RIVERSIDE DR | GREEN BAY | WI | 54301 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| ST FRANCIS CATHEDRAL | |||||||
| 139 S MADISON | GREEN BAY | WI | 54301 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| YMCA | |||||||
| 235 N JEFFERSON ST | GREEN BAY | WI | 54301 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| CENTER FOR CHILDHOOD SAFETY | |||||||
| 1870 COFRIN DRIVE | GREEN BAY | WI | 54302 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| GOLDEN HOUSE | |||||||
| 1120 UNIVERSITY AVE | GREEN BAY | WI | 54302 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| PAUL'S PANTRY INC | |||||||
| 1529 LEO FRIGO WAY | GREEN BAY | WI | 54302 | NONE | PC | SELF-DIRECTED DONATION | $4,100 |
| ST BERNARD CONGREGATION | |||||||
| 2040 HILLSIDE LN | GREEN BAY | WI | 543024098 | NONE | PC | SELF-DIRECTED DONATION | $5,000 |
| NEW COMMUNITY SHELTER INC | |||||||
| 301 MATHER STREET | GREEN BAY | WI | 54303 | NONE | PC | SELF-DIRECTED DONATION | $600 |
| NOTRE DAME ACADEMY | |||||||
| 610 MARYHILL DR | GREEN BAY | WI | 54303 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| HAND-N-HAND OF NORTHEASTERN WISCONSIN INC | |||||||
| 1707 S ONEIDA ST | GREEN BAY | WI | 54304 | NONE | PC | BOARD AND DONOR ADVISED DONATION | $5,000 |
| HAPPILY EVER AFTER ANIMAL SANCTUARY | |||||||
| 2255 FOX LANE | GREEN BAY | WI | 54304 | NONE | PC | SELF-DIRECTED DONATION | $2,500 |
| ST JOHN THE EVANGELIST HOMELESS SHELTER | |||||||
| PO BOX 1743 | GREEN BAY | WI | 54305 | NONE | PC | BOARD | $1,661 |
| ST JOHN THE EVANGELIST HOMELESS SHELTER | |||||||
| PO BOX 1743 | GREEN BAY | WI | 54305 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| BROWN COUNTY UNITED WAY | |||||||
| PO BOX 1593 | GREEN BAY | WI | 543051593 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| FAMILY SERVICES | |||||||
| PO BOX 22308 | GREEN BAY | WI | 543052308 | NONE | PC | SELF-DIRECTED DONATION | $600 |
| BISHIP'S APPEAL CATHOLIC DIOCESE | |||||||
| PO BOX 23001 | GREEN BAY | WI | 543053001 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| THE SALVATION ARMY | |||||||
| PO BOX 11243 | GREEN BAY | WI | 543071243 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - CHRISTOPHER CHENEY | $500 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - SUSAN CHRISTIANSEN | $500 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - MARLEE CURRY | $500 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - COURTNAY HILLS | $500 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - MICHAEL NICKELL | $500 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - REBEKAH BUBOLITZ | $1,000 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - TRACY GRETZON | $500 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - ANDREW HYNNEK | $500 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - CORLEEN KROLL | $500 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - AIMEE VORPAHL | $500 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - ELLIOTT CHIER | $1,000 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - VICTORIA GOODNOE | $1,000 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - MELISSA KINCANNON | $1,000 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - BENNETT KRINGS | $1,000 |
| NWTC | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SCHOLARSHIP - HAYDEN WEININGER | $1,000 |
| NWTC EDUCATIONAL FOUNDATION | |||||||
| PO BOX 19042 | GREEN BAY | WI | 543079042 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| BELLIN COLLEGE OF NURING | |||||||
| 3201 EATON RD | GREEN BAY | WI | 54311 | NONE | PC | SELF-DIRECTED DONATION | $500 |
| CELEBRATION CHURCH | |||||||
| 3475 HUMBOLDT RD | GREEN BAY | WI | 54311 | NONE | PC | SELF-DIRECTED DONATION | $4,800 |
| FREEDOM HOUE | |||||||
| 2997 ST ANTHONY DR | GREEN BAY | WI | 54311 | NONE | PC | SELF-DIRECTED DONATION | $500 |
| GREATER GREEN BAY HABITAT FOR HUMANITY | |||||||
| 1967 ALLOUEZ AVE | GREEN BAY | WI | 54311 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| NOTRE DAME ACADEMY | |||||||
| 3496 AMBER LANE | GREEN BAY | WI | 54311 | NONE | PC | SELF-DIRECTED DONATION | $150 |
| UNIVERSITY OF GREEN BAY | |||||||
| 2420 NICOLET DR | GREEN BAY | WI | 54311 | NONE | PC | GRIFFIN SCHOLARSHIP - ALEXIS PAYE | $500 |
| PINE LAKE SAILING SCHOOL | |||||||
| PO BOX 436 | HARTLAND | WI | 53029 | NONE | PC | SELF-DIRECTED DONATION | $300 |
| COMPRESS AND SHOCK | |||||||
| 3929 WHITETAIL CT | HOBART | WI | 54155 | NONE | PC | BOARD AND DONOR ADVISED DONATION | $1,000 |
| COMPRESS AND SHOCK | |||||||
| 3929 WHITETAIL CT | HOBART | WI | 54155 | NONE | PC | DONOR ADVISED DONATION | $3,000 |
| INDIANA UNIVERSITY FOUNDATION | |||||||
| PO BOX 6460 | INDIANAPOLIS | WI | 462066460 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| HINDU TEMPLE OF NORTH EAST WISCONSIN | |||||||
| 911 DELANGLADE ST | KAUKAUNA | WI | 54130 | NONE | PC | SELF-DIRECTED DONATION | $1,001 |
| UNIVERSITY OF WISCONSIN-LA CROSSE | |||||||
| 1725 STATE ST | LA CROSSE | WI | 54601 | NONE | PC | SCHOLARSHIP- LAUREN BROMAN | $2,000 |
| IOWA-GRANT EDUCATIONAL FOUNDATION | |||||||
| PO BOX 124 | LIVINGSTON | WI | 53554 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| BIG DOG RESCUE RANCH | |||||||
| 14444 OKEECHOBEE BLVD | LOXAHATCHEE GROVES | FL | 33470 | NONE | PC | SELF-DIRECTED DONATION | $10,000 |
| COMBAT BLINDNESS FOUNDATION | |||||||
| PO BOX 5322 | MADISON | WI | 537050332 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| FRIENDS OF PBS WISCONSIN | |||||||
| 821 UNIVERSITY AVENUE | MADISON | WI | 53706 | NONE | PC | SELF-DIRECTED DONATION | $2,500 |
| WISCONSIN PUBLIC RADIO | |||||||
| 821 UNIVERSITY AVE | MADISON | WI | 53706 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| UNIVERSITY OF MADISON | |||||||
| 333 E CAMPUS MALL 10501 | MADISON | WI | 537151383 | NONE | PC | GRIFFIN SCHOLARSHIP - KEVIN KONOP | $500 |
| UNIVERSITY OF MADISON | |||||||
| 333 E CAMPUS MALL 10501 | MADISON | WI | 537151383 | NONE | PC | GRIFFIN SCHOLARSHIP - LAUREN SHEFCHIK | $500 |
| UNIVERSITY OF MADISON | |||||||
| 333 E CAMPUS MALL 10501 | MADISON | WI | 537151383 | NONE | PC | GRIFFIN SCHOLARSHIP - SKYLAR ROTTER | $500 |
| UNIVERSITY OF WISCONSIN MADISON | |||||||
| 333 E CAMPUS MALL 10501 | MADISON | WI | 537151383 | NONE | PC | SCHOLARSHIP - LYDIA MCMORROW | $2,000 |
| UNIVERSITY OF WISCONSIN MADISON | |||||||
| 333 E CAMPUS MALL 10501 | MADISON | WI | 537151383 | NONE | PC | SCHOLARSHIP - LEAH HEIM | $2,000 |
| PETER'S PANTRY | |||||||
| 843 S 21ST STREET | MANITOWOC | WI | 54220 | NONE | PC | BOARD | $1,500 |
| NORTHERN MICHIGAN UNIVERSITY | |||||||
| 1401 PRESQUE ISLE AVE | MARQUETTE | MI | 498555301 | NONE | PC | SCHOLARSHIP - MIA STRAZNY | $2,000 |
| PREVENT BLINDNESS- WISCONSIN | |||||||
| 759 NORTH MILWAUKEE ST STE 305 | MILWAUKEE | WI | 532023745 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| UNIVERSITY OF MILWAUKEE | |||||||
| 2100 E KENWOOD BLVD | MILWAUKEE | WI | 53211 | NONE | PC | GRIFFIN SCHOLARSHIP - ADDISON GRANT | $500 |
| WISCONSIN MEDICAL ALUMNI ASSOCIATION FUND | |||||||
| BOX 78236 | MILWAUKEE | WI | 532780236 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| UNIVERSITY OF WISCONSIN FOUNDATION | |||||||
| US BANK LOCKBOX 78807 | MILWAUKEE | WI | 532780807 | NONE | PC | SELF-DIRECTED DONATION | $3,400 |
| UNIVERSITY OF WISCONSIN FOUNDATION - MED 1981 | |||||||
| US BANK LOCKBOX 78807 | MILWAUKEE | WI | 532780807 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| UWF-MEDICAL ALUMNI ASSOCIATION | |||||||
| PO BOX 78807 | MILWAUKEE | WI | 532780807 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| BRETHREN CHARITY FUND INC | |||||||
| 12386 WEST NATIONAL ROAD | NEW CARLISLE | OH | 45344 | NONE | PC | SELF-DIRECTED DONATION | $1,500 |
| RESEARCH TO PREVENT BLINDNESS | |||||||
| 360 LEXINGTON AVE FL 22 | NEW YORK | NY | 100176528 | NONE | PC | SELF-DIRECTED DONATION | $150 |
| CHRISTINE ANN DOMESTIC ABUSE SERVICE | |||||||
| 206 ALGOMA BLVD | OSHKOSH | WI | 54901 | NONE | PC | SELF-DIRECTED DONATION | $200 |
| OSHKOSH YACHT CLUB | |||||||
| 1939 WASHINGTON AVE | OSHKOSH | WI | 54901 | NONE | PC | SELF-DIRECTED DONATION | $250 |
| THE PAINE ART CENTER | |||||||
| 1410 ALGOMA BLVD | OSHKOSH | WI | 54901 | NONE | PC | SELF-DIRECTED DONATION | $250 |
| ALL SAINTS LUTHERAN | |||||||
| 1072 HONEY CREEK RD | OSHKOSH | WI | 54904 | NONE | PC | SELF-DIRECTED DONATION | $600 |
| AMERICAN RED CROSS | |||||||
| 515 WASHBURN STREET | OSHKOSH | WI | 54904 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| UNIVERSITY OF WISCONSIN-PLATTEVILLE FOUNDATION | |||||||
| 1 UNIVERSITY PLAZA | PLATTEVILLE | WI | 538183099 | NONE | PC | SELF-DIRECTED DONATION | $500 |
| CHRISTAR | |||||||
| 1500 INTERNATIONAL PARKWAY STE 300 | RICHARDSON | TX | 75081 | NONE | PC | SELF-DIRECTED DONATION | $2,400 |
| FOUNDATION OF AMERICAN ACADEMY OF OPTHALMOLOGY | |||||||
| 655 BEACH STREET | SAN FRANCISCO | CA | 941091336 | NONE | PC | SELF-DIRECTED DONATION | $1,000 |
| UNIVERSITY OF STEVENS POINT | |||||||
| 1108 FREMONT ST RM 102 | STEVENS POINT | WI | 54481 | NONE | PC | GRIFFIN SCHOLARSHIP - ALEX SCHMITZ | $500 |
| DOOR COUNTY LAND TRUST | |||||||
| PO BOX 65 | STURGEON BAY | WI | 54235 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| COMPASSIONATE CARE ALS | |||||||
| PO BOX 1052 | WEST FALMOUTH | MA | 02574 | NONE | PC | SELF-DIRECTED DONATION | $100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $143,613 | TotalGrantOrContriPdDurYrAmt |
| Total Grant Or Contri Apprv Fut | $0 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $4 | ExclusionAmt |
Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $11,143 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $11,147 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $11,147 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | 0 | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | 0 | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | 0 | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | 0 | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | 0 | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | 0 | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | 0 | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | 0 | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | 0 | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | 0 | RelationshipsNonchrtblEOInd |
Schedule B IRS990ScheduleB
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| General Rule | Yes (X) | GeneralRuleInd |
Contributor Information ContributorInformationGrp (13 entries)
| ContributorContributorNum | Address Line1ContributorUSAddress/AddressLine1Txt | CityContributorUSAddress/CityNm | State AbbreviationContributorUSAddress/StateAbbreviationCd | ZIPContributorUSAddress/ZIPCd | Total ContributionsTotalContributionsAmt | Person ContributionPersonContributionInd | Noncash ContributionNoncashContributionInd |
|---|---|---|---|---|---|---|---|
| DR AND MRS KEVIN WIENKERS | |||||||
| 1 | 2863 CIRCLE SHORE DR | GREEN BAY | WI | 54302 | $21,555 | Yes (X) | Yes (X) |
| DR STEPHEN BRADA | |||||||
| 2 | 700 TERRAVIEW DRIVE | GREEN BAY | WI | 54301 | $7,193 | Yes (X) | |
| DR BRUCE NEAL | |||||||
| 3 | 1515 BRADBURY COURT | GREEN BAY | WI | 54313 | $7,500 | Yes (X) | |
| DR ALEXANDER ROITSTEIN | |||||||
| 4 | 2411 WANDERING SPRINGS CIRCLE | GREEN BAY | WI | 54311 | $25,000 | Yes (X) | |
| DR JOSEPH HODGSON | |||||||
| 5 | 3510 BOWER CREEK ROAD | DE PERE | WI | 54115 | $12,000 | Yes (X) | |
| BAY CARE HEALTH SYSTEMS | |||||||
| 6 | 164 N BROADWAY | GREEN BAY | WI | 54303 | $16,000 | Yes (X) | |
| ASSOCIATED BANK | |||||||
| 7 | 433 MAIN ST | GREEN BAY | WI | 54301 | $5,000 | Yes (X) | |
| DR JOSEPH VALLEY | |||||||
| 8 | 164 N BROADWAY | GREEN BAY | WI | 54303 | $11,161 | Yes (X) | |
| AURORA HEALTH CARE | |||||||
| 9 | 750 W VIRGINIA ST PO BOX 341880 | MILWAUKEE | WI | 53204 | $6,000 | Yes (X) | |
| BELLIN HEALTH | |||||||
| 10 | 744 SOUTH WEBSTER AVENUE PO BOX 234 | GREEN BAY | WI | 543053400 | $6,508 | Yes (X) | |
| DR JARED BOYD | |||||||
| 11 | 4673 ROYAL VISTA | DE PERE | WI | 54115 | $12,000 | Yes (X) | |
| DR CHRIS HOWSON | |||||||
| 12 | 1128 CROWN POINTE CIRCLE | SUAMICO | WI | 54173 | $9,424 | Yes (X) | |
| DR PAUL LUIKART | |||||||
| 13 | 684 MARBLE ROCK CIRCLE | GREEN BAY | WI | 54311 | $5,000 | Yes (X) | |
Non Cash Property Contribution NonCashPropertyContributionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | 1 | ContributorNum |
| Noncash Property | MASTERCARD STOCK | NoncashPropertyDesc |
| Fair Market Value | $20,097 | FairMarketValueAmt |
| Received | 2021-12-01 | ReceivedDt |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | CLIFTONLARSONALLEN LLP | CategoryTxt |
| Amt | $3,949 | Amt |
| Net Investment Income | $1,975 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $1,974 | DisbursementsCharitablePrpsAmt |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp (3 entries)
| StockStockNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| VANGUARD BALANCED INDEX FD | $315,591 | $315,591 |
| VANGUARD BALANCED INDEX ADMIRAL | $41,481 | $41,481 |
| MASTERCARD INCORPORATED | $22,996 | $22,996 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (2 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| ADMINISTRATIVE EXPENSES | $1,467 | $367 | $1,100 |
| BANK SERVICE CHARGES | $312 | $156 | $156 |
Other Increases Schedule OtherIncreasesSchedule
Other Increases Detail OtherIncreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | UNREALIZED GAIN/LOSS ON INVESTMENTS | Desc |
| Amt | $36,201 | Amt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | FEDERAL EXCISE TAX | CategoryTxt |
| Amt | $77 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |