BAYCARE CLINIC FOUNDATION LTD: Form 990PF, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: BAYCARE CLINIC FOUNDATION LTD (EIN 39-2000503)
Tax period: 2020-01-01 to 2020-12-31
Filed: 2021-09-10
IRS object ID: 202122539349100307
Schema version: 2020v4.1
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

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2021-09-10T12:33:56-05:00	ReturnTs
Tax Period End	2020-12-31	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	2200 RIVERSIDE DRIVE	AddressLine1Txt
City	GREEN BAY	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54301	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990PF	ReturnTypeCd
Tax Period Begin	2020-01-01	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	164 NORTH BROADWAY	AddressLine1Txt
City	GREEN BAY	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54303	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	JOSEPH HODGSON	PersonNm
Person Title	PRESIDENT	PersonTitleTxt
Phone	9204909046	PhoneNum
Signature	2021-08-25	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	JOSEPH	PersonFirstNm
Person Last	HODGSON	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	DANIEL J YOUNG	PreparerPersonNm
PTIN	P00035095	PTIN
Phone	9204367800	PhoneNum
Preparation	2021-08-25	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	2020	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	$600,190	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	$252,056	ContriRcvdRevAndExpnssAmt
Dividends Rev And Expnss	$7,849	DividendsRevAndExpnssAmt
Dividends Net Invst Incm	$7,849	DividendsNetInvstIncmAmt
Cap Gain Net Incm Net Invst Incm	$0	CapGainNetIncmNetInvstIncmAmt
Total Rev And Expnss	$259,905	TotalRevAndExpnssAmt
Total Net Invst Incm	$7,849	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	$2,935	AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm	$1,467	AccountingFeesNetInvstIncmAmt
Accounting Fees Chrtbl Prps	$1,468	AccountingFeesChrtblPrpsAmt
Other Expenses Rev And Expnss	$3,359	OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm	$853	OtherExpensesNetInvstIncmAmt
Other Expenses Dsbrs Chrtbl	$2,506	OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss	$6,294	TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm	$2,320	TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl	$3,974	TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss	$148,631	ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl	$152,631	ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss	$154,925	TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm	$2,320	TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl	$156,605	TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses	$104,980	ExcessRevenueOverExpensesAmt
Net Investment Income	$5,529	NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

Field	Value	IRS element (for citing)
Cash BOY	$218,655	CashBOYAmt
Cash EOY	$272,387	CashEOYAmt
Cash EOYFMV	$272,387	CashEOYFMVAmt
Sav And Temp Cash Invst BOY	$15,158	SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY	$15,174	SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV	$15,174	SavAndTempCashInvstEOYFMVAmt
Corporate Stock BOY	$228,089	CorporateStockBOYAmt
Corporate Stock EOY	$312,629	CorporateStockEOYAmt
Corporate Stock EOYFMV	$312,629	CorporateStockEOYFMVAmt
Total Assets BOY	$461,902	TotalAssetsBOYAmt
Total Assets EOY	$600,190	TotalAssetsEOYAmt
Total Assets EOYFMV	$600,190	TotalAssetsEOYFMVAmt
Grants Payable BOY	$4,098	GrantsPayableBOYAmt
Total Liabilities BOY	$4,098	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	$457,804	RetainedEarningBOYAmt
Retained Earning EOY	$600,190	RetainedEarningEOYAmt
Tot Net Ast Or Fund Balances BOY	$457,804	TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY	$600,190	TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY	$461,902	TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY	$600,190	TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

Field	Value	IRS element (for citing)
Tot Net Ast Or Fund Balances BOY	$457,804	TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses	$104,980	ExcessRevenueOverExpensesAmt
Other Increases	$37,406	OtherIncreasesAmt
Subtotal	$600,190	SubtotalAmt
Other Decreases	$0	OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY	$600,190	TotNetAstOrFundBalancesEOYAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

Field	Value	IRS element (for citing)
Investment Income Excise Tax	$77	InvestmentIncomeExciseTaxAmt
Tax Under Section511	$0	TaxUnderSection511Amt
Subtotal	$77	SubtotalAmt
Subtitle A Tax	$0	SubtitleATaxAmt
Tax Based On Investment Income	$77	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	$77	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	164 NORTH BROADWAY	AddressLine1Txt
City	GREEN BAY	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54303	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/PRESIDENT	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 OF MARKETING/PR	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	$269,641	AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances	$269,597	AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast	$0	FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets	$539,238	TotalFMVOfUnusedAssetsAmt
Reduction Claimed	$0	ReductionClaimedAmt
Acquisition Indebtedness	$0	AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast	$539,238	AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable	$8,089	CashDeemedCharitableAmt
Net Vl Noncharitable Assets	$531,149	NetVlNoncharitableAssetsAmt
Minimum Investment Return	$26,557	MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

Field	Value	IRS element (for citing)
Minimum Investment Return	$26,557	MinimumInvestmentReturnAmt
Tax Based On Investment Income	$77	TaxBasedOnInvestmentIncomeAmt
Total Tax	$77	TotalTaxAmt
Distributable Before Adj	$26,480	DistributableBeforeAdjAmt
Recoveries Qualfied Distri	$0	RecoveriesQualfiedDistriAmt
Distributable Before Ded	$26,480	DistributableBeforeDedAmt
Deduction From Distributable	$0	DeductionFromDistributableAmt
Distributable As Adjusted	$26,480	DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

Field	Value	IRS element (for citing)
Expenses And Contributions	$156,605	ExpensesAndContributionsAmt
Program Related Invst Total	$0	ProgramRelatedInvstTotalAmt
Qualifying Distributions	$156,605	QualifyingDistributionsAmt
Pct Sect4940e Org Net Invst Incm	$0	PctSect4940eOrgNetInvstIncmAmt
Adjusted Qualifying Distri	$156,605	AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

Field	Value	IRS element (for citing)
Distributable As Adjusted	$26,480	DistributableAsAdjustedAmt
Undistributed Income PY	$0	UndistributedIncomePYAmt
Total For Prior Years	$0	TotalForPriorYearsAmt
Excess Distribution Cyov Yr5	$239,750	ExcessDistributionCyovYr5Amt
Excess Distribution Cyov Yr4	$223,569	ExcessDistributionCyovYr4Amt
Excess Distribution Cyov Yr3	$165,016	ExcessDistributionCyovYr3Amt
Excess Distribution Cyov Yr2	$191,220	ExcessDistributionCyovYr2Amt
Excess Distribution Cyov Yr1	$199,259	ExcessDistributionCyovYr1Amt
Total Excess Distribution Cyov	$1,018,814	TotalExcessDistributionCyovAmt
Qualifying Distributions	$156,605	QualifyingDistributionsAmt
Applied To Year1	$0	AppliedToYear1Amt
Applied To Prior Years	$0	AppliedToPriorYearsAmt
Treated As Distri From Corpus	$0	TreatedAsDistriFromCorpusAmt
Applied To Current Year	$26,480	AppliedToCurrentYearAmt
Remaining Distri From Corpus	$130,125	RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus	$0	ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY	$0	ExcessDistributionCyovAppCYAmt
Total Corpus	$1,148,939	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	$239,750	ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr	$909,189	ExcessDistriCyovToNextYrAmt
Excess From Year4	$223,569	ExcessFromYear4Amt
Excess From Year3	$165,016	ExcessFromYear3Amt
Excess From Year2	$191,220	ExcessFromYear2Amt
Excess From Year1	$199,259	ExcessFromYear1Amt
Excess From Current Year	$130,125	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

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SEE THE LIST OF CONTRIBUTIONS	BusinessNameLine1Txt

Recipient US Address RecipientUSAddress

Field	Value	IRS element (for citing)
Address Line1	ATTACHED BY FAX	AddressLine1Txt
City	GREEN BAY	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54301	ZIPCd

Field	Value	IRS element (for citing)
Recipient Relationship	NONE	RecipientRelationshipTxt
Recipient Foundation Status	N/A	RecipientFoundationStatusTxt
Grant Or Contribution Purpose	SEE THE LIST OF CONTRIBUTIONS ATTACHED BY FAX.	GrantOrContributionPurposeTxt
Amt	$148,631	Amt

Field	Value	IRS element (for citing)
Total Grant Or Contri Pd Dur Yr	$148,631	TotalGrantOrContriPdDurYrAmt
Total Grant Or Contri Apprv Fut	$0	TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp

Field	Value	IRS element (for citing)
Exclusion	14	ExclusionCd
Exclusion	$7,849	ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

Field	Value	IRS element (for citing)
Unrelated Business Taxbl Incm	$0	UnrelatedBusinessTaxblIncmAmt
Exclusion	$7,849	ExclusionAmt
Related Or Exempt Function Incm	$0	RelatedOrExemptFunctionIncmAmt

Field	Value	IRS element (for citing)
Total Income Producing Acty	$7,849	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
DR AND MRS KEVIN WIENKERS
1	2863 CIRCLE SHORE DR	GREEN BAY	WI	54302	$21,000	Yes (X)
DR STEPHEN BRADA
2	700 TERRAVIEW DRIVE	GREEN BAY	WI	54301	$6,287	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 CHRISTOPHER SORRELLS
5	3317 STAR CREEK CT	GREEN BAY	WI	54311	$24,000	Yes (X)
DR JOSEPH HODGSON
6	3510 BOWER CREEK ROAD	DE PERE	WI	54115	$12,000	Yes (X)
BAY CARE HEALTH SYSTEMS
7	164 N BROADWAY	GREEN BAY	WI	54303	$16,000	Yes (X)
CLIFTONLARSONALLEN LLP
8	2200 RIVERSIDE DRIVE	GREEN BAY	WI	54301	$5,000	Yes (X)
DR JOSEPH VALLEY
9	164 N BROADWAY	GREEN BAY	WI	54303	$10,772	Yes (X)
AURORA HEALTH CARE
10	750 W VIRGINIA ST PO BOX 341880	MILWAUKEE	WI	53204	$12,000	Yes (X)
DR DANIEL GALE
11	164 N BROADWAY	GREEN BAY	WI	54303	$5,000	Yes (X)
DR MICHAEL MEDICH
12	2940 LUMBER LN	GREEN BAY	WI	54313	$35,970	Yes (X)
BAY CARE - ANESTHESIA DEPARTMENT
13	1035 KEPLER DR	GREEN BAY	WI	54311	$5,000	Yes (X)

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

Field	Value	IRS element (for citing)
Category	CLIFTONLARSONALLEN LLP	CategoryTxt
Amt	$2,935	Amt
Net Investment Income	$1,467	NetInvestmentIncomeAmt
Disbursements Charitable Prps	$1,468	DisbursementsCharitablePrpsAmt

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corporate Stock InvestmentsCorporateStockGrp (2 entries)

StockStockNm	EOY Book ValueEOYBookValueAmt	EOYFMVEOYFMVAmt
VANGUARD BALANCED INDEX FD	$276,311	$276,311
VANGUARD BALANCED INDEX ADMIRAL	$36,318	$36,318

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (3 entries)

DescDesc	Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt	Net Investment IncomeNetInvestmentIncomeAmt	Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt
ADMINISTRATIVE EXPENSES	$400	$100	$300
MARKETING EXPENSES	$2,907	$727	$2,180
BANK SERVICE CHARGES	$52	$26	$26

Other Increases Schedule OtherIncreasesSchedule

Other Increases Detail OtherIncreasesDetail

Field	Value	IRS element (for citing)
Desc	UNREALIZED GAIN/LOSS ON INVESTMENTS	Desc
Amt	$37,406	Amt