BAYCARE CLINIC FOUNDATION LTD: Form 990PF, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- BAYCARE CLINIC FOUNDATION LTD (EIN 39-2000503)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-08-11
- IRS object ID
- 201512239349100721
- Schema version
- 2014v5.0
- 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
- Form 990-PF
- Schedule B
- Investments Corp Stock Schedule
- Other Expenses Schedule
- Other Income Schedule2
- Other Increases Schedule
- Substantial Contributors Sch
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-08-11T13:24:02-05:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 391173131 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCHENCK SC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 23819 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543053819 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 392000503 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAYCARE 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 | 2015-08-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DANIEL J YOUNG | PreparerPersonNm |
| PTIN | P00035095 | PTIN |
| Phone | 9204367800 | PhoneNum |
| Preparation | 2015-08-03 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $278,803 | 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 | $314,316 | ContriRcvdRevAndExpnssAmt |
| Dividends Rev And Expnss | $2,011 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $2,011 | DividendsNetInvstIncmAmt |
| Cap Gain Net Incm Net Invst Incm | $0 | CapGainNetIncmNetInvstIncmAmt |
| Other Income Rev And Expnss | $1,420 | OtherIncomeRevAndExpnssAmt |
| Other Income Net Invst Incm | $0 | OtherIncomeNetInvstIncmAmt |
| Other Income Adj Net Incm | $1,420 | OtherIncomeAdjNetIncmAmt |
| Total Rev And Expnss | $317,747 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $2,011 | TotalNetInvstIncmAmt |
| Total Adj Net Incm | $1,420 | TotalAdjNetIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Net Invst Incm | $0 | CompOfcrDirTrstNetInvstIncmAmt |
| Comp Ofcr Dir Trst Adj Net Incm | $0 | CompOfcrDirTrstAdjNetIncmAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $0 | CompOfcrDirTrstDsbrsChrtblAmt |
| Taxes Rev And Expnss | $30 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $0 | TaxesNetInvstIncmAmt |
| Taxes Adj Net Incm | $0 | TaxesAdjNetIncmAmt |
| Taxes Dsbrs Chrtbl | $0 | TaxesDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $171 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $43 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Adj Net Incm | $0 | OtherExpensesAdjNetIncmAmt |
| Other Expenses Dsbrs Chrtbl | $128 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $201 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $43 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $0 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $128 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $248,937 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $241,312 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $249,138 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $43 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $0 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $241,440 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $68,609 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $1,968 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $1,420 | AdjustedNetIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $104,388 | CashBOYAmt |
| Cash EOY | $152,461 | CashEOYAmt |
| Cash EOYFMV | $152,461 | CashEOYFMVAmt |
| Sav And Temp Cash Invst BOY | $15,000 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $15,075 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $15,075 | SavAndTempCashInvstEOYFMVAmt |
| Corporate Stock BOY | $93,880 | CorporateStockBOYAmt |
| Corporate Stock EOY | $111,267 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $111,267 | CorporateStockEOYFMVAmt |
| Total Assets BOY | $213,268 | TotalAssetsBOYAmt |
| Total Assets EOY | $278,803 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $278,803 | TotalAssetsEOYFMVAmt |
| Accounts Payable BOY | $8,500 | AccountsPayableBOYAmt |
| Accounts Payable EOY | $7,625 | AccountsPayableEOYAmt |
| Grants Payable BOY | $40,000 | GrantsPayableBOYAmt |
| Grants Payable EOY | $30,000 | GrantsPayableEOYAmt |
| Total Liabilities BOY | $48,500 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $37,625 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
| 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 | $164,768 | RetainedEarningBOYAmt |
| Retained Earning EOY | $241,178 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $164,768 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $241,178 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $213,268 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $278,803 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $164,768 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $68,609 | ExcessRevenueOverExpensesAmt |
| Other Increases | $7,801 | OtherIncreasesAmt |
| Subtotal | $241,178 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $241,178 | TotNetAstOrFundBalancesEOYAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | 0 | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $251,659 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $201,565 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 1.248525 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $197,909 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $166,966 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 1.185325 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $270,376 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $155,669 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 1.736865 | DistributionYr3Rt |
| Adjusted Qlfy Distri Yr4 | $248,967 | AdjustedQlfyDistriYr4Amt |
| Net Vl Noncharitable Assets Yr4 | $120,583 | NetVlNoncharitableAssetsYr4Amt |
| Distribution Yr4 | 2.064694 | DistributionYr4Rt |
| Adjusted Qlfy Distri Yr5 | $224,539 | AdjustedQlfyDistriYr5Amt |
| Net Vl Noncharitable Assets Yr5 | $91,338 | NetVlNoncharitableAssetsYr5Amt |
| Distribution Yr5 | 2.458331 | DistributionYr5Rt |
| Total Distribution | 8.693740 | TotalDistributionRt |
| Average Distribution | 1.738748 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $235,366 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $409,242 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $20 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $409,262 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $241,440 | QualifyingDistributionsAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $39 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $39 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $39 | TaxBasedOnInvestmentIncomeAmt |
| Total Payments And Credits | $0 | TotalPaymentsAndCreditsAmt |
| Tax Due | $39 | 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 | Yes (1) | 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 VIRGINIA VISSERS | 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 |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (6 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 |
| WILLIAM WITMER 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 | 0.50 | $0 | $0 | $0 |
| ANN SEIDL | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR OF MARKETING/PR | 0.50 | $0 | $0 | $0 |
| LESLEY O'CONNELL | ||||||||
| 164 NORTH BROADWAY | GREEN BAY | WI | 54303 | DIRECTOR/EMPLOYEE REP | 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 | $103,071 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $135,879 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $238,950 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $238,950 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $3,584 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $235,366 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $11,768 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $11,768 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $39 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $39 | TotalTaxAmt |
| Distributable Before Adj | $11,729 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $11,729 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $11,729 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $241,440 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $241,440 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $0 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $241,440 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $11,729 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $219,972 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $242,938 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $262,593 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $189,586 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $241,611 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $1,156,700 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $241,440 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $11,729 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $229,711 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $1,386,411 | 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 | $219,972 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $1,166,439 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $242,938 | ExcessFromYear4Amt |
| Excess From Year3 | $262,593 | ExcessFromYear3Amt |
| Excess From Year2 | $189,586 | ExcessFromYear2Amt |
| Excess From Year1 | $241,611 | ExcessFromYear1Amt |
| Excess From Current Year | $229,711 | 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 ATTACHMENT | BusinessNameLine1Txt |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | SEE ATTACHMENT | AddressLine1Txt |
| City | SEE ATTACHMENT | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 99999 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Relationship | NONE | RecipientRelationshipTxt |
| Recipient Foundation Status | EXEMPT | RecipientFoundationStatusTxt |
| Grant Or Contribution Purpose | CHARITABLE PURPOSES OF THE RECIPIENT | GrantOrContributionPurposeTxt |
| Amt | $241,312 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $241,312 | TotalGrantOrContriPdDurYrAmt |
Grant Or Contri Apprv For Fut GrantOrContriApprvForFutGrp
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE ATTACHMENT | BusinessNameLine1Txt |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | SEE ATTACHMENT | AddressLine1Txt |
| City | SEE ATTACHMENT | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 99999 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Relationship | NONE | RecipientRelationshipTxt |
| Recipient Foundation Status | EXEMPT | RecipientFoundationStatusTxt |
| Grant Or Contribution Purpose | CHARITABLE PURPOSES OF THE RECIPIENT | GrantOrContributionPurposeTxt |
| Amt | $7,625 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Apprv Fut | $7,625 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $2,011 | ExclusionAmt |
Other Revenue Described OtherRevenueDescribedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Exclusion | 01 | ExclusionCd |
| Exclusion | $1,420 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $3,431 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $3,431 | 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 (16 entries)
| ContributorContributorNum | Address Line1ContributorUSAddress/AddressLine1Txt | CityContributorUSAddress/CityNm | State AbbreviationContributorUSAddress/StateAbbreviationCd | ZIPContributorUSAddress/ZIPCd | Total ContributionsTotalContributionsAmt | Person ContributionPersonContributionInd |
|---|---|---|---|---|---|---|
| DR AHMET DERVISH | ||||||
| 1 | 778 STONEWOOD LANE | ONEIDA | WI | 54155 | $14,640 | Yes (X) |
| DR AND MRS KEVIN WIENKERS | ||||||
| 2 | 2863 CIRCLE SHORE DR | GREEN BAY | WI | 54302 | $26,808 | Yes (X) |
| DR PER ANDERAS | ||||||
| 3 | 2824 MT CAROL DRIVE | GREEN BAY | WI | 54311 | $12,529 | Yes (X) |
| DR SCOTT GAGE | ||||||
| 4 | 3071 GOTHIC COURT | GREEN BAY | WI | 54313 | $80,250 | Yes (X) |
| DR STEPHEN BRADA | ||||||
| 5 | 700 TERRAVIEW DRIVE | GREEN BAY | WI | 54301 | $6,260 | Yes (X) |
| DR MAX OTS | ||||||
| 6 | 2455 SHIRLEY ROAD | DE PERE | WI | 54115 | $5,000 | Yes (X) |
| BAY CARE HEALTH SYSTEMS | ||||||
| 7 | 164 N BROADWAY | GREEN BAY | WI | 54303 | $6,012 | Yes (X) |
| DR PAUL SUMMERSIDE | ||||||
| 8 | 614 RANDALL AVE | DE PERE | WI | 54115 | $9,115 | Yes (X) |
| DR BRUCE NEAL | ||||||
| 9 | 1515 BRADBURY COURT | GREEN BAY | WI | 54313 | $10,350 | Yes (X) |
| DR ALEXANDER ROITSTEIN | ||||||
| 10 | 2411 WANDERING SPRINGS CIRCLE | GREEN BAY | WI | 54311 | $50,000 | Yes (X) |
| DR STEVEN STROMAN | ||||||
| 11 | 2452 WILDWOOD DRIVE | GREEN BAY | WI | 54302 | $6,000 | Yes (X) |
| NILGUN FRENGELL | ||||||
| 12 | PO BOX 4347 | MONROE | LA | 71211 | $5,000 | Yes (X) |
| DR CHRISTOPHER SORRELLS | ||||||
| 13 | 3317 STAR CREEK CT | GREEN BAY | WI | 54311 | $12,000 | Yes (X) |
| DR JOSEPH HODGSON | ||||||
| 14 | 3510 BOWER CREEK ROAD | DE PERE | WI | 54115 | $6,000 | Yes (X) |
| DR MARK DUFFY | ||||||
| 15 | 4480 WYANDOT TRAIL | GREEN BAY | WI | 54313 | $5,700 | Yes (X) |
| DR ROBERT LIMONI | ||||||
| 16 | 3072 BAY SETTLEMENT ROAD | GREEN BAY | WI | 54311 | $6,000 | Yes (X) |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Stock | VANGUARD BALANCED INDEX FD | StockNm |
| EOY Book Value | $111,267 | EOYBookValueAmt |
| EOYFMV | $111,267 | EOYFMVAmt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ADMINISTRATIVE EXPENSES | Desc |
| Revenue And Expenses Per Books | $171 | RevenueAndExpensesPerBooksAmt |
| Net Investment Income | $43 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $128 | DisbursementsCharitablePrpsAmt |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Revenue And Expenses Per Books | $1,420 | RevenueAndExpensesPerBooksAmt |
| Adjusted Net Income | $1,420 | AdjustedNetIncomeAmt |
Other Increases Schedule OtherIncreasesSchedule
Other Increases Detail OtherIncreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | UNREALIZED GAIN/LOSS ON INVESTMENTS | Desc |
| Amt | $7,801 | Amt |
Substantial Contributors Sch SubstantialContributorsSch
Substantial Contributor Detail SubstantialContributorDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR ALEXANDER ROITSTEIN | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2411 WANDERING SPRINGS CIRCLE | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54311 | ZIPCd |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | FEDERAL EXCISE TAX | CategoryTxt |
| Amt | $30 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |