STRATEGY STUDIO / PUBLIC DATA EXPLORER

HARRY AND THELMA SURRENA MEMORIAL FUND: Form 990PF, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
HARRY AND THELMA SURRENA MEMORIAL FUND (EIN 23-7435554)
Tax period
2015-11-01 to 2016-10-31
Filed
2017-03-09
IRS object ID
201720689349100007
Schema version
2015v3.0
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

FieldValueIRS element (for citing)
Return2017-03-09T15:16:38-07:00ReturnTs
Tax Period End2016-10-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN830232295PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MOHATT RINALDO JOHNSON & GODWIN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 603AddressLine1Txt
CitySHERIDANCityNm
State AbbreviationWYStateAbbreviationCd
ZIP828010603ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2015-11-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN237435554EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HARRY & THELMA SURRENA MEMORIALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHARRBusinessNameControlTxt
Phone3076726494PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1P O BOX 603AddressLine1Txt
CitySHERIDANCityNm
State AbbreviationWYStateAbbreviationCd
ZIP82801ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonROBERT WYATTPersonNm
Person TitleTRUSTEEPersonTitleTxt
Phone3076726494PhoneNum
Signature2017-02-17SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL B JOHNSONPreparerPersonNm
PTINP00912386PTIN
Phone3076726494PhoneNum
Preparation2017-03-09PreparationDt
Self EmployedYes (X)SelfEmployedInd
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$5,530,523FMVAssetsEOYAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Interest On Sav Rev And Expnss$12,709InterestOnSavRevAndExpnssAmt
Interest On Sav Net Invst Incm$12,709InterestOnSavNetInvstIncmAmt
Dividends Rev And Expnss$128,174DividendsRevAndExpnssAmt
Dividends Net Invst Incm$128,174DividendsNetInvstIncmAmt
Net Gain Sale Ast Rev And Expnss$47,583NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$1,326,154GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$47,583CapGainNetIncmNetInvstIncmAmt
Total Rev And Expnss$188,466TotalRevAndExpnssAmt
Total Net Invst Incm$188,466TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$38,982CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$19,491CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$19,491CompOfcrDirTrstDsbrsChrtblAmt
Accounting Fees Rev And Expnss$2,550AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm$1,913AccountingFeesNetInvstIncmAmt
Accounting Fees Chrtbl Prps$637AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss$30,958OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$30,958OtherProfFeesNetInvstIncmAmt
Taxes Rev And Expnss$5,257TaxesRevAndExpnssAmt
Taxes Net Invst Incm$2,429TaxesNetInvstIncmAmt
Taxes Dsbrs Chrtbl$1,491TaxesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$77,747TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$54,791TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$21,619TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$275,000ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$275,000ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$352,747TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$54,791TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$296,619TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses-$164,281ExcessRevenueOverExpensesAmt
Net Investment Income$133,675NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Sav And Temp Cash Invst BOY$136,087SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$74,591SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$74,591SavAndTempCashInvstEOYFMVAmt
Prepaid Expenses EOY$1,663PrepaidExpensesEOYAmt
Prepaid Expenses EOYFMV$1,663PrepaidExpensesEOYFMVAmt
US Government Obligations EOY$150,000USGovernmentObligationsEOYAmt
US Govt Obligations EOYFMV$150,523USGovtObligationsEOYFMVAmt
Corporate Stock BOY$2,789,322CorporateStockBOYAmt
Corporate Stock EOY$2,845,793CorporateStockEOYAmt
Corporate Stock EOYFMV$3,870,343CorporateStockEOYFMVAmt
Corporate Bonds BOY$1,653,248CorporateBondsBOYAmt
Corporate Bonds EOY$1,341,938CorporateBondsEOYAmt
Corporate Bonds EOYFMV$1,348,278CorporateBondsEOYFMVAmt
Other Assets BOY$22,982OtherAssetsBOYAmt
Other Assets EOY$22,982OtherAssetsEOYAmt
Other Assets EOYFMV$85,125OtherAssetsEOYFMVAmt
Total Assets BOY$4,601,639TotalAssetsBOYAmt
Total Assets EOY$4,436,967TotalAssetsEOYAmt
Total Assets EOYFMV$5,530,523TotalAssetsEOYFMVAmt
Other Liabilities BOY$391OtherLiabilitiesBOYAmt
Total Liabilities BOY$391TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind
Capital Stock BOY$2,443,594CapitalStockBOYAmt
Capital Stock EOY$2,443,594CapitalStockEOYAmt
Retained Earning BOY$2,157,654RetainedEarningBOYAmt
Retained Earning EOY$1,993,373RetainedEarningEOYAmt
Tot Net Ast Or Fund Balances BOY$4,601,248TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$4,436,967TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$4,601,639TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$4,436,967TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$4,601,248TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses-$164,281ExcessRevenueOverExpensesAmt
Subtotal$4,436,967SubtotalAmt
Tot Net Ast Or Fund Balances EOY$4,436,967TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (52 entries)

PropertyPropertyDescHow AcquiredHowAcquiredCdAcquiredAcquiredDtSoldSoldDtGross Sales PriceGrossSalesPriceAmtCost Or Other BasisCostOrOtherBasisAmtGain Or LossGainOrLossAmtGains Minus Excess Or LossesGainsMinusExcessOrLossesAmt
38.00-AMAZON.COM INCP2014-02-052015-11-05$24,827$13,129$11,698$11,698
1054.00-FIREEYE INCP2014-12-122016-08-31$14,987$31,293-$16,306-$16,306
1814.22-DODGE & COX INCOME FUNDP2012-07-272016-05-26$24,710$25,000-$290-$290
7621.95-OPPENHEIMER INTERNATIONAL BOP2010-12-072016-01-27$41,768$50,000-$8,232-$8,232
352.00-APACHE CORPP2012-08-202016-04-28$20,070$31,467-$11,397-$11,397
894.00-FIREEYE INCP2015-11-052016-08-31$12,712$20,037-$7,325-$7,325
1801.15-DODGE & COX INCOME FUNDP2013-04-112016-05-26$24,532$25,000-$468-$468
1502.14-OPPENHEIMER INTERNATIONAL BOP2011-04-062016-01-27$8,232$9,884-$1,652-$1,652
888.00-BB&T CORPP2012-04-122016-10-12$34,393$27,621$6,772$6,772
1609.00-GENERAL ELECTRIC COP2008-12-022016-04-18$49,889$27,700$22,189$22,189
3599.71-DODGE & COX INCOME FUNDP2015-04-012016-05-26$49,028$50,000-$972-$972
1537.38-OPPENHEIMER INTERNATIONAL BOP2011-04-062016-10-12$9,040$10,116-$1,076-$1,076
347.00-BB&T CORPP2014-04-152016-10-12$13,440$13,516-$76-$76
50000.00-MCKESSON CORP .95% 04 DEC 2P2013-11-212015-12-04$50,000$50,000
1242.55-T ROWE PRICE MID-CAP VALUE FP2009-09-172016-05-26$34,381$25,000$9,381$9,381
480.77-OPPENHEIMER INTERNATIONAL BONP2011-11-232016-10-12$2,827$3,000-$173-$173
52.00-BHP BILLITON LIMITED ADR EACHP2009-09-172015-12-10$1,302$3,587-$2,285-$2,285
102.00-MOTORS LIQUIDATION CO GUC TRUP2015-11-13$1,650$1,650$1,650
1057.53-T ROWE PRICE MID-CAP VALUE FP2012-07-272016-05-26$29,262$25,000$4,262$4,262
4097.12-OPPENHEIMER INTERNATIONAL BOP2013-04-112016-10-12$24,091$27,000-$2,909-$2,909
150.00-BHP BILLITON LIMITED ADR EACHP2010-03-122015-12-10$3,757$11,815-$8,058-$8,058
940.00-NORDSTROM INCP2014-01-212016-10-19$50,028$55,937-$5,909-$5,909
3671.07-TEMPLETON GLOBAL BOND FUND/UP2010-12-072016-01-27$40,896$50,000-$9,104-$9,104
4088.82-OPPENHEIMER INTERNATIONAL BOP2014-03-032016-10-12$24,042$24,778-$736-$736
150.00-BHP BILLITON LIMITED ADR EACHP2010-06-022015-12-10$3,757$9,602-$5,845-$5,845
288.00-PHILIP MORRIS INTERNATIONAL IP2011-09-262016-03-11$27,755$18,529$9,226$9,226
817.26-TEMPLETON GLOBAL BOND FUND/UNP2011-04-062016-01-27$9,104$11,344-$2,240-$2,240
LITIGATION PROCEEDSP2014-01-012015-12-17$931$931$931
354.00-BHP BILLITON LIMITED ADR EACHP2013-01-222015-12-10$8,867$27,505-$18,638-$18,638
289.00-PHILIP MORRIS INTERNATIONAL IP2011-09-262016-03-11$27,852$18,593$9,259$9,259
759.89-OPPENHEIMER DEVELOPING MARKETP2012-12-032016-07-07$25,798$25,798
159.00-DEERE & COP2011-07-112015-12-14$12,413$13,297-$884-$884
1000.00-PUBLIC STORAGE 6.5%P2011-04-052016-04-15$25,000$25,000
1420.46-OPPENHEIMER DEVELOPING MARKEP2013-04-112016-07-07$50,000$50,000
300.00-DEERE & COP2011-08-262015-12-14$23,421$22,871$550$550
883.00-TERADATA CORPP2013-08-232015-11-05$22,484$53,864-$31,380-$31,380
674.40-OPPENHEIMER DEVELOPING MARKETP2013-10-032016-07-07$25,000$25,000
150.00-DEERE & COP2011-10-252015-12-14$11,711$11,055$656$656
140.00-TERADATA CORPP2014-08-012015-11-05$3,565$5,935-$2,370-$2,370
759.40-OPPENHEIMER DEVELOPING MARKETP2012-12-032016-07-08$25,798$25,798
75.00-DEERE & COP2013-01-292015-12-14$5,855$7,129-$1,274-$1,274
1307.00-US BANCORPP2013-11-262016-10-27$58,742$51,457$7,285$7,285
1419.53-OPPENHEIMER DEVELOPING MARKEP2013-04-112016-07-08$50,000$50,000
575.00-EMC CORP/MAP2010-02-242016-08-31$16,625$10,061$6,564$6,564
239.00-UNITEDHEALTH GROUP INCP2011-05-192016-04-18$30,481$12,106$18,375$18,375
673.96-OPPENHEIMER DEVELOPING MARKETP2013-10-032016-07-08$25,000$25,000
600.00-EMC CORP/MAP2010-03-122016-08-31$17,348$11,332$6,016$6,016
240.00-UNITEDHEALTH GROUP INCP2011-05-192016-04-18$30,608$12,157$18,451$18,451
1913.88-OPPENHEIMER MAIN STREET SMALP2007-12-122016-05-26$51,943$40,000$11,943$11,943
1830.00-EMC CORP/MAP2013-01-222016-08-31$52,911$44,258$8,653$8,653
3852.08-DODGE & COX INCOME FUNDP2009-09-172016-05-26$52,465$50,000$2,465$2,465
370.23-OPPENHEIMER MAIN STREET SMALLP2013-04-112016-05-26$10,048$10,000$48$48
FieldValueIRS element (for citing)
Capital Gain Net Income$47,583CapitalGainNetIncomeAmt
Net Short Term Capital Gain Loss-$7,325NetShortTermCapitalGainLossAmt

Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp

FieldValueIRS element (for citing)
Liable Section4942 TaxfalseLiableSection4942TaxInd
Adjusted Qlfy Distri Yr1$308,616AdjustedQlfyDistriYr1Amt
Net Vl Noncharitable Assets Yr1$5,532,056NetVlNoncharitableAssetsYr1Amt
Distribution Yr10.055787DistributionYr1Rt
Adjusted Qlfy Distri Yr2$303,292AdjustedQlfyDistriYr2Amt
Net Vl Noncharitable Assets Yr2$5,560,400NetVlNoncharitableAssetsYr2Amt
Distribution Yr20.054545DistributionYr2Rt
Adjusted Qlfy Distri Yr3$258,436AdjustedQlfyDistriYr3Amt
Net Vl Noncharitable Assets Yr3$5,125,398NetVlNoncharitableAssetsYr3Amt
Distribution Yr30.050423DistributionYr3Rt
Adjusted Qlfy Distri Yr4$244,959AdjustedQlfyDistriYr4Amt
Net Vl Noncharitable Assets Yr4$4,807,448NetVlNoncharitableAssetsYr4Amt
Distribution Yr40.050954DistributionYr4Rt
Adjusted Qlfy Distri Yr5$234,756AdjustedQlfyDistriYr5Amt
Net Vl Noncharitable Assets Yr5$4,609,464NetVlNoncharitableAssetsYr5Amt
Distribution Yr50.050929DistributionYr5Rt
Total Distribution0.262638TotalDistributionRt
Average Distribution0.052528AverageDistributionRt
Net Vl Noncharitable Assets$5,544,325NetVlNoncharitableAssetsAmt
Adj Net Vl Noncharitable Assets$291,232AdjNetVlNoncharitableAssetsAmt
Net Investment Income Pct$1,337NetInvestmentIncomePctAmt
Adj Nonchrtbl Net Invst Incm Pct$292,569AdjNonchrtblNetInvstIncmPctAmt
Qualifying Distributions$296,619QualifyingDistributionsAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Domestic Org Meeting Sect4940eYes (X)DomesticOrgMeetingSect4940eInd
Investment Income Excise Tax$1,337InvestmentIncomeExciseTaxAmt
Subtotal$1,337SubtotalAmt
Tax Based On Investment Income$1,337TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$3,000EstimatedPlusOvpmtIncmTxAmt
Total Payments And Credits$3,000TotalPaymentsAndCreditsAmt
Overpayment$1,663OverpaymentAmt
Applied To ES Tax$1,663AppliedToESTaxAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political ActyfalseLegislativePoliticalActyInd
More Than100 SpentfalseMoreThan100SpentInd
Form1120 POL FiledfalseForm1120POLFiledInd
Activities Not Previously RptfalseActivitiesNotPreviouslyRptInd
Changes To Articles Or BylawsfalseChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Organization Dissolved EtcfalseOrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (true)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (true)AtLeast5000InAssetsInd
Org Report Or Register StateWYOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (true)Form990PFFiledWithAttyGenInd
Private Operating FoundationfalsePrivateOperatingFoundationInd
New Substantial ContributorsfalseNewSubstantialContributorsInd
Own Controlled EntityfalseOwnControlledEntityInd
Donor Advised FundfalseDonorAdvisedFundInd
Comply With Public Insp RqrYes (true)ComplyWithPublicInspRqrInd
Website AddressN/AWebsiteAddressTxt

Persons With Books Name PersonsWithBooksName

FieldValueIRS element (for citing)
Business Name Line1MOHATT RINALDO JOHNSON & GODWINBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3076726494PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 603AddressLine1Txt
CitySHERIDANCityNm
State AbbreviationWYStateAbbreviationCd
ZIP82801ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts QuestionfalseForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified PrsnfalseSaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified PrsnfalseBrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified PrsnfalseFurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified PrsnYes (true)PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified PrsnfalseTransferAstDisqualifiedPrsnInd
Payment To Government OfficialfalsePaymentToGovernmentOfficialInd
Acts Fail To Qlfy As ExceptionsfalseActsFailToQlfyAsExceptionsInd
Undistributed Income PYfalseUndistributedIncomePYInd
Business HoldingsfalseBusinessHoldingsInd
Jeopardy InvestmentsfalseJeopardyInvestmentsInd
Uncorrected PY Jeopardy InvstfalseUncorrectedPYJeopardyInvstInd
Influence LegislationfalseInfluenceLegislationInd
Influence ElectionfalseInfluenceElectionInd
Grants To IndividualsfalseGrantsToIndividualsInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Noncharitable PurposefalseNoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
RALPH C ROBINSON
PO BOX 27BUFFALOWY82834TRUSTEE4.00$12,994$0$0
JOHN PRADERE
PO BOX 603SHERIDANWY82801TRUSTEE4.00$12,994$0$0
ROBERT WYATT
PO BOX 603SHERIDANWY82081TRUSTEE4.00$12,994$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Comp Of Hghst Pd Cntrct Or NONENONECompOfHghstPdCntrctOrNONETxt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Description1N/ADescription1Txt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$5,394,681AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$148,950AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$85,125FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$5,628,756TotalFMVOfUnusedAssetsAmt
Adjusted Total FMV Of Unused Ast$5,628,756AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$84,431CashDeemedCharitableAmt
Net Vl Noncharitable Assets$5,544,325NetVlNoncharitableAssetsAmt
Minimum Investment Return$277,216MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$277,216MinimumInvestmentReturnAmt
Tax Based On Investment Income$1,337TaxBasedOnInvestmentIncomeAmt
Total Tax$1,337TotalTaxAmt
Distributable Before Adj$275,879DistributableBeforeAdjAmt
Distributable Before Ded$275,879DistributableBeforeDedAmt
Distributable As Adjusted$275,879DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

FieldValueIRS element (for citing)
Expenses And Contributions$296,619ExpensesAndContributionsAmt
Qualifying Distributions$296,619QualifyingDistributionsAmt
Pct Sect4940e Org Net Invst Incm$1,337PctSect4940eOrgNetInvstIncmAmt
Adjusted Qualifying Distri$295,282AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$275,879DistributableAsAdjustedAmt
Excess Distribution Cyov Yr1$17,903ExcessDistributionCyovYr1Amt
Total Excess Distribution Cyov$17,903TotalExcessDistributionCyovAmt
Qualifying Distributions$296,619QualifyingDistributionsAmt
Applied To Current Year$275,879AppliedToCurrentYearAmt
Remaining Distri From Corpus$20,740RemainingDistriFromCorpusAmt
Total Corpus$38,643TotalCorpusAmt
Undistributed Income CY$0UndistributedIncomeCYAmt
Excess Distri Cyov To Next Yr$38,643ExcessDistriCyovToNextYrAmt
Excess From Year1$17,903ExcessFromYear1Amt
Excess From Current Year$20,740ExcessFromCurrentYearAmt

Supplementary Information SupplementaryInformationGrp

Application Submission Info ApplicationSubmissionInfoGrp

FieldValueIRS element (for citing)
Recipient PersonSURRENA MEMORIAL FUNDRecipientPersonNm

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line1BOX 27AddressLine1Txt
CityBUFFALOCityNm
State AbbreviationWYStateAbbreviationCd
ZIP82834ZIPCd
FieldValueIRS element (for citing)
Recipient Phone3076845574RecipientPhoneNum
Form And Info And MaterialsWRITTEN APPLICATIONFormAndInfoAndMaterialsTxt
Submission DeadlinesNONESubmissionDeadlinesTxt
Restrictions On AwardsCHARITABLE, RELIGIOUS, SCIENTIFIC, & EDUCATIONAL PURPOSES IN THE U.S.RestrictionsOnAwardsTxt

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (25 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmtBusiness Name Line2RecipientBusinessName/BusinessNameLine2Txt
BREAD OF LIFE
PO BOX 909BUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$7,500
BUFFALO SENIOR CENTER
671 W FETTERMANBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$10,000
CHILD ADVOCACY CENTER
40 E WORKS STSHERIDANWY82801NONEEXEMPT ORGGENERAL OPERATIONS$4,000
CHILDREN'S CENTER
863 HIGHLAND AVESHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$30,000
CHILDREN'S CENTER - BUFFALO
151 KLONDIKEBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$50,000
CLEARMONT COMMUNITY LIBRA
PO BOX 26CLEARMONTWY82835NONEEXEMPT ORG.GENERAL OPERATIONS$5,000
GENESIS FOUNDATION
444 CRESCENT DRSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$25,000
HABITAT FOR HUMANITY - BUFFALO
615 BURRITT AVEBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$7,500
JOHNSON COUNTY LIBRARY
171 N ADAMSBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$5,000FOUNDATION
JOHNSON COUNTY YMCA
101 SOUTH KLONDIKEBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$20,000
LUNCH TOGETHER SOUP KITCHEN
102 S CONNER STSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$7,500
METHODIST CHURCH
132 N ADAMS AVEBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$5,000OF BUFFALO WYOMING
METHODIST CHURCH
215 W WORKSSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$15,000OF SHERIDAN WYOMING
MOUNTAIN PLAINS HERITAGE
PO BOX 27BUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$2,500
SCOTTISH RITE CHILDHOOD
8 RIVERBEND COURTSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$5,000LANGUAGE CLINIC C/O TOM NEIGHBORS
SENIOR CITIZENS COUNCIL
211 SMITH STREETSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$10,000
SHERIDAN COLLEGE
3059 COFFEEN AVESHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$10,000FOUNDATION
SHERIDAN COUNTY LIBRARY
335 W ALGERSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$5,000FOUNDATION INC
SHERIDAN COUNTY YMCA
417 NORTH JEFFERSONSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$20,000
STORY BRANCH LIBRARY
PO BOX 188STORYWY82842NONEEXEMPT ORG.GENERAL OPERATIONS$5,000
STORY COMMUNITY CHURCH
PO BOX 415STORYWY82842NONEEXEMPT ORG.GENERAL OPERATIONS$5,000
THE FOOD GROUP
PO BOX 1500SHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$2,000
TONGUE RIVER BRANCH
PO BOX 909RANCHESTERWY82839NONEEXEMPT ORG.GENERAL OPERATIONS$5,000LIBRARY
TONGUE RIVER CHILD'S
84 DAYTON STREETRANCHESTERWY82839NONEEXEMPT ORG.GENERAL OPERATIONS$10,000PLACE
VOLUNTEERS OF AMERICA OF
PO BOX 6291SHERIDANWY82801NONEEXEMPT ORG.HOMELESS SHELTER$4,000WYOMING AND MONTANA
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$275,000TotalGrantOrContriPdDurYrAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$12,709ExclusionAmt

Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$128,174ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Exclusion18ExclusionCd
Exclusion$47,583ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Exclusion$188,466ExclusionAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$188,466TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EOfalseTrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EOfalseTrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of AssetsfalseSalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EOfalsePurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth AssetsfalseRentalOfFacilitiesOthAssetsInd
Reimbursement ArrangementsfalseReimbursementArrangementsInd
Loans Or Loan GuaranteesfalseLoansOrLoanGuaranteesInd
Performance Of Services EtcfalsePerformanceOfServicesEtcInd
Sharing Of Facilities EtcfalseSharingOfFacilitiesEtcInd
Relationships Nonchrtbl EOfalseRelationshipsNonchrtblEOInd

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

FieldValueIRS element (for citing)
CategoryACCOUNTING FEESCategoryTxt
Amt$2,550Amt
Net Investment Income$1,913NetInvestmentIncomeAmt
Disbursements Charitable Prps$637DisbursementsCharitablePrpsAmt

Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule

Investments Corporate Bonds InvestmentsCorporateBondsGrp (19 entries)

BondBondNmEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
ANTHEM INC$50,218$50,745
BLACKROCK INC$50,000$56,187
CSX CORP 6.25%$50,545$53,840
DODGE & COX INCOME FUND
EATON VANCE FLOATING RATE FUND$150,000$145,977
EATON CORP$50,092$50,489
ELI LILLY & CO$25,606$25,571
GENERAL ELECTRIC CAP 5.1%$100,000$108,493
MCKESSON CORP
MORGAN STANLEY 2.8%$50,908$51,739
OPPENHEIMER INTERNATIONAL BOND FUND$75,222$72,455
PUBLIC STORAGE
TEMPLETON GLOBAL BOND FUND$138,656$120,876
TENNESSEE VALLEY AUTHORITY$49,980$50,548
VANGUARD HIGH YIELD CORPORATE FUND$400,000$409,979
VANGUARD INTERMEDIATE-TERM INVEST
VANGUARD SHORT TERM CORP FUND
VANGUARD SHORT-TERM INVESTMENT GRADE$100,000$100,623
WELLS FARGO & CO 2.5%$50,711$50,756

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corporate Stock InvestmentsCorporateStockGrp (66 entries)

StockStockNmEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
AMAZON
AMERICAN EUROPACIFIC GROWTH FUND$93,447$115,512
AMERICAN EXPRESS$88,098$86,762
APACHE CORPORATION$24,846$32,911
APPLE COMPUTER INC$92,272$159,297
BAKER HUGHES INC$79,359$92,186
BB&T CORPORATION
BERKSHIRE HATHAWAY INC - CL B$24,782$45,743
BHP BILLITON LIMITED ADR
BOEING CO$24,398$56,972
BRISTOL MYERS SQUIBB$33,335$46,264
CELGENE$68,883$108,413
CHEVRON CORP$21,270$44,833
CISCO SYSTEMS$38,308$55,623
CITIGROUP$147,032$139,340
COSTCO WHOLESALE CORPORATION$19,753$51,163
DEERE & COMPANY
DFA EMERGING MARKETS SMALL CAP$50,000$49,014
DFA COMMODITY STRATEGY PORTFOLIO$50,000$56,647
DFA US SMALL CAP PORTFOLIO$100,000$105,434
DU PONT E I DE NEMOURS & COMPANY$40,222$61,498
EMC CORPORATION
EMERSON ELECTRIC CO$25,155$40,696
EXELON CORPORATION$56,036$57,135
EXXON MOBIL CORP$32,438$67,906
FEDEX CORP$52,594$64,498
FIREEYE INC
FORD MOTOR COMPANY$54,807$57,322
GENERAL ELECTRIC CO$34,320$46,851
GENERAL MOTORS$11,304$26,228
GILEAD SCIENCES INC.$35,492$67,887
GOLDMAN SACHS INTERNATIONAL SMALL CA$50,000$56,893
HARBOR INTERNATIONAL FUND$88,089$109,325
J.P. MORGAN CHASE & CO$80,474$154,242
JACOBS ENGINEERING$60,572$59,111
LOWE'S COS INC$49,483$47,455
MCKESSON CORPORATION$57,508$61,042
MICROSOFT CORPORATION$56,814$109,474
MONDELEZ INTERNATIONAL INC$33,956$69,073
NIKE INC$48,563$46,316
NORDSTROM
OPPENHEIMER DEVELOPING MARKETS FD$100,798$96,913
OPPENHEIMER MAIN STREET SMALL & MID
PEPSICO$19,897$69,358
PHILIP MORRIS INTERNATIONAL
PRINCIPAL GLOBAL REAL ESTATE SEC$150,000$161,820
PROCTOR & GAMBLE CO$27,473$51,957
QUALCOMM INC$54,307$93,528
ROCHE HOLDINGS AG SPN ADR EACH REP$65,440$71,487
SCHLUMBERGER LIMITED$35,803$41,305
SKYWORKS SOLUTIONS INC$32,544$99,560
SOUTHERN CO$6,839$51,570
STARBUCKS CORP$50,288$43,730
T ROWE PRICE MID CAP FUND$50,000$74,196
T ROWE PRICE MID CAP VALUE FUND
TARGET CORP$58,634$76,496
TENN VALLEY AUTH 6/1/28
TERADATA CORP
UNION PACIFIC$55,942$62,079
UNITEDHEALTH GROUP INC$31,308$79,427
US BANCORP
VANGUARD 500 INDEX FUND$50,000$56,542
VANGUARD MID-CAP INDEX FUND$100,000$101,795
WAL-MART STORES INC$25,737$28,288
WALT DISNEY$47,632$102,701
WELLS FARGO & CO$59,541$58,525

Investments Govt Obligations Sch InvestmentsGovtObligationsSch

FieldValueIRS element (for citing)
US Govt Obligations Book Vl EOY$150,000USGovtObligationsBookVlEOYAmt
US Govt Obligations EOYFMV$150,523USGovtObligationsEOYFMVAmt

Other Assets Schedule OtherAssetsSchedule

Other Assets Schedule OtherAssetsScheduleGrp

FieldValueIRS element (for citing)
DescMINERAL RIGHTSDesc
BOY Book Value$22,982BOYBookValueAmt
EOY Book Value$22,982EOYBookValueAmt
EOYFMV$85,125EOYFMVAmt

Other Liabilities Schedule OtherLiabilitiesSchedule

Other Liabilities Detail OtherLiabilitiesDetail

FieldValueIRS element (for citing)
DescFEDERAL TAXES PAYABLEDesc
BOY Book Value$391BOYBookValueAmt

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail

FieldValueIRS element (for citing)
CategoryINVESTMENT MANAGEMENT FEESCategoryTxt
Amt$30,958Amt
Net Investment Income$30,958NetInvestmentIncomeAmt

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail (3 entries)

CategoryCategoryTxtAmtAmtNet Investment IncomeNetInvestmentIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
PAYROLL TAXES$2,982$1,491$1,491
EXCISE TAXES$1,337
FOREIGN TAXES$938$938