JACK PRIBAZ FOUNDATION: Form 990EZ, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- JACK PRIBAZ FOUNDATION (EIN 45-4104433)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-05-15
- IRS object ID
- 201741359349204094
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-15T14:10:33-04:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
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 | 600 S Washington St Ste 105 | AddressLine1Txt |
| City | Naperville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60540 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | 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 | 6302546909 | PhoneNum |
| Signature | 2017-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Gary Grottke | PreparerPersonNm |
| PTIN | P01578334 | PTIN |
| Phone | 6304280640 | PhoneNum |
| Preparation | 2017-05-15 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 108.170.24.234 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-05-15 | IPDt |
| IP Tm | 14:20:41 | IPTm |
| Federal Original Submission Id | 1558372017135m5cooal | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2017-05-15 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | C210281665B89944D5EBD9817D1AAC14FAA63842 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | C210281665B89944D5EBD9817D1AAC14FAA63842 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | 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 | $99,939 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Contributions Gifts Grants Etc | $11,574 | ContributionsGiftsGrantsEtcAmt |
| Investment Income | $135 | InvestmentIncomeAmt |
| Fundraising Gross Income | $88,230 | FundraisingGrossIncomeAmt |
| Special Events Direct Expenses | $19,952 | SpecialEventsDirectExpensesAmt |
| Special Events Net Income Loss | $68,278 | SpecialEventsNetIncomeLossAmt |
| Total Revenue | $79,987 | TotalRevenueAmt |
| Grants And Similar Amounts Paid | $15,000 | GrantsAndSimilarAmountsPaidAmt |
| Fees And Other Pymt To Ind Cntrct | $53,000 | FeesAndOtherPymtToIndCntrctAmt |
| Other Expenses Total | $15,301 | OtherExpensesTotalAmt |
| Total Expenses | $83,301 | TotalExpensesAmt |
| Excess Or Deficit For Year | -$3,314 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $98,256 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $94,942 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part II | Yes (X) | InfoInScheduleOPartIIInd |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $138,956 | BOYAmt |
| EOY | $137,692 | 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 | $138,956 | BOYAmt |
| EOY | $137,692 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,700 | BOYAmt |
| EOY | $42,750 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,256 | BOYAmt |
| EOY | $94,942 | 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 | 600 S Washington Ste 105 | 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 |
| School Operating | false | SchoolOperatingInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| 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 | $125,071 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $120,985 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $138,669 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $80,833 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,574 | CurrentTaxYearAmt |
| Total | $477,132 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $94,205 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $88,230 | CurrentTaxYearAmt |
| Total | $182,435 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $125,071 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $120,985 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $138,669 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $175,038 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $99,804 | CurrentTaxYearAmt |
| Total | $659,567 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $659,567 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $116 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $73 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $191 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $95 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $135 | CurrentTaxYearAmt |
| Total | $610 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $116 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $73 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $191 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $95 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $135 | CurrentTaxYearAmt |
| Total | $610 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $26,875 | CurrentTaxYearMinus4YearsAmt |
| Total | $26,875 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $152,062 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $121,058 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $138,860 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $175,133 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $99,939 | CurrentTaxYearAmt |
| Total | $687,052 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.96000 | PublicSupportCY509Pct |
| Public Support PY509 | 0.95340 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Email Solicitations | Yes (X) | EmailSolicitationsInd |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | false | AgrmtProfFundraisingActyInd |
| Licensed States | IL | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
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 RESEARCH Grantee BAYLOR COLLEGE OF MEDICINE Street ONE BAYLOR PLAZA City, State, Zip Houston, TX 77030Relationship NONE Amount 15,000Activity Epilepsy Foundation Relationship none |
| Description of other expenses Part I line 16 | Description AmountInsurance 855Travel 1,345Conference 12,320Other 781 |
| Description of total liabilities Part II line 26 | Category Beginning of Year End of YearGrant payable 40,700 42,750 |