C&K CLARK FAMILY FOUNDATION: Form 990PF, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- C&K CLARK FAMILY FOUNDATION (EIN 20-2047246)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-05-22
- IRS object ID
- 201331429349100503
- Schema version
- 2012v2.0
- 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
- Other Decreases Schedule
- Other Expenses Schedule
- Other Increases Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-22T12:01:55-07:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EDWARD J SERRA CPA PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6118 W Corporate Oaks Drive | AddressLine1 |
| City | Crystal River | City |
| State | FL | State |
| ZIP Code | 34429 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 202047246 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE C&K CLARK FAMILY FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | C&KC | NameControl |
| Phone | 3522708425 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 N SKY GLEN PATH | AddressLine1 |
| City | HERNANDO | City |
| State | FL | State |
| ZIP Code | 34442 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KATHLEEN A CLARK | Name |
| Title | Vice President | Title |
| Date Signed | 2013-05-22 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Edward J Serra CPA | Name |
| PTIN | P00010682 | PTIN |
| Phone | 3527943879 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exempt PF | X | ExemptPF |
| FMV Assets EOY | 357300 | FMVAssetsEOY |
| Method Of Accounting Cash | X | MethodOfAccountingCash |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Received Rev And Expnss | 45000 | ContriReceivedRevAndExpnss |
| Dividends Rev And Expnss | 5273 | DividendsRevAndExpnss |
| Dividends Net Invst Incm | 5273 | DividendsNetInvstIncm |
| Dividends Adj Net Incm | 5273 | DividendsAdjNetIncm |
| Total Revenue And Expenses | 50273 | TotalRevenueAndExpenses |
| Total Net Investment Income | 5273 | TotalNetInvestmentIncome |
| Total Adjusted Net Income | 5273 | TotalAdjustedNetIncome |
| Other Expenses Rev And Expnss | 2771 | OtherExpensesRevAndExpnss |
| Tot Opr Expenses Rev And Expnss | 2771 | TotOprExpensesRevAndExpnss |
| Tot Opr Expenses Net Invst Incm | 0 | TotOprExpensesNetInvstIncm |
| Tot Opr Expenses Dsbrs Chrtbl Prps | 0 | TotOprExpensesDsbrsChrtblPrps |
| Contri Gifts Paid Rev And Expnss | 23750 | ContriGiftsPaidRevAndExpnss |
| Contri Gifts Paid Dsbrs Chrtbl Prps | 23750 | ContriGiftsPaidDsbrsChrtblPrps |
| Total Expenses Rev And Expnss | 26521 | TotalExpensesRevAndExpnss |
| Total Expenses Net Invst Incm | 0 | TotalExpensesNetInvstIncm |
| Total Expenses Dsbrs Chrtbl Prps | 23750 | TotalExpensesDsbrsChrtblPrps |
| Excess Of Revenue Over Expenses | 23752 | ExcessOfRevenueOverExpenses |
| Net Investment Income | 5273 | NetInvestmentIncome |
| Adjusted Net Income | 5273 | AdjustedNetIncome |
Balance Sheets BalanceSheets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Savings And Temp Cash Invst BOY | 12714 | SavingsAndTempCashInvstBOY |
| Savings And Temp Cash Invst EOY | 20198 | SavingsAndTempCashInvstEOY |
| Savings And Temp Cash Invst EOYFMV | 20198 | SavingsAndTempCashInvstEOYFMV |
| Investments Corp Stock EOYFMV | 337102 | InvestmentsCorpStockEOYFMV |
| Investments Other BOY | 3 | InvestmentsOtherBOY |
| Total Assets BOY | 12717 | TotalAssetsBOY |
| Total Assets EOY | 20198 | TotalAssetsEOY |
| Total Assets EOYFMV | 357300 | TotalAssetsEOYFMV |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Org That Follow SFAS117 | X | OrgThatFollowSFAS117 |
| Unrestricted BOY | 12717 | UnrestrictedBOY |
| Unrestricted EOY | 20198 | UnrestrictedEOY |
| Total Net Assets BOY | 12717 | TotalNetAssetsBOY |
| Total Net Assets EOY | 20198 | TotalNetAssetsEOY |
| Total Liabilities Net Assets BOY | 12717 | TotalLiabilitiesNetAssetsBOY |
| Total Liabilities Net Assets EOY | 20198 | TotalLiabilitiesNetAssetsEOY |
Changes In Net Assets Fund Balances ChangesInNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Net Assets Fund Balances BOY | 12717 | TotalNetAssetsFundBalancesBOY |
| Excess Of Revenue Over Expenses | 23752 | ExcessOfRevenueOverExpenses |
| Other Increases | 28729 | OtherIncreases |
| Subtotal | 65198 | Subtotal |
| Other Decreases | 45000 | OtherDecreases |
| Total Net Assets Fund Balances EOY | 20198 | TotalNetAssetsFundBalancesEOY |
Qlfy Und Sect4940e For Reduced Tax QlfyUndSect4940eForReducedTax
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable For4942 Tax | false | LiableFor4942Tax |
| Qualifying Distributions Year1 | 3880 | QualifyingDistributionsYear1 |
| Noncharitable Assets Year1 | 302979 | NoncharitableAssetsYear1 |
| Distribution Ratio Year1 | 0.01281 | DistributionRatioYear1 |
| Qualifying Distributions Year2 | 2500 | QualifyingDistributionsYear2 |
| Noncharitable Assets Year2 | 192137 | NoncharitableAssetsYear2 |
| Distribution Ratio Year2 | 0.01301 | DistributionRatioYear2 |
| Qualifying Distributions Year3 | 2573 | QualifyingDistributionsYear3 |
| Noncharitable Assets Year3 | 139390 | NoncharitableAssetsYear3 |
| Distribution Ratio Year3 | 0.01846 | DistributionRatioYear3 |
| Qualifying Distributions Year4 | 6885 | QualifyingDistributionsYear4 |
| Noncharitable Assets Year4 | 108727 | NoncharitableAssetsYear4 |
| Distribution Ratio Year4 | 0.06332 | DistributionRatioYear4 |
| Qualifying Distributions Year5 | 9060 | QualifyingDistributionsYear5 |
| Noncharitable Assets Year5 | 111518 | NoncharitableAssetsYear5 |
| Distribution Ratio Year5 | 0.08124 | DistributionRatioYear5 |
| Total Distribution Ratio | 0.18884 | TotalDistributionRatio |
| Average Distribution Ratio | 0.03777 | AverageDistributionRatio |
| Net Noncharitable Assets | 349042 | NetNoncharitableAssets |
| Adjusted Noncharitable Assets | 13183 | AdjustedNoncharitableAssets |
| One Percent Net Investment Income | 53 | OnePercentNetInvestmentIncome |
| Adj Nonchrtbl Assets And One | 13236 | AdjNonchrtblAssetsAndOnePct |
| Qualifying Distributions | 23750 | QualifyingDistributions |
Excise Tax Based On Investment Incm ExciseTaxBasedOnInvestmentIncm
| Field | Value | IRS element (for citing) |
|---|---|---|
| Domestic Org Meeting Sect4940e | X | DomesticOrgMeetingSect4940e |
| Investment Income Excise Tax | 53 | InvestmentIncomeExciseTax |
| Subtotal | 53 | Subtotal |
| Tax Based On Investment Income | 53 | TaxBasedOnInvestmentIncome |
| Est Tax Payments And Overpayment | 464 | EstTaxPaymentsAndOverpayment |
| Total Credits And Payments | 464 | TotalCreditsAndPayments |
| Overpayment | 411 | Overpayment |
| Amount Credited To Next Year | 411 | AmountCreditedToNextYear |
Statements Regarding Activities StatementsRegardingActivities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Activities | false | LegislativePoliticalActivities |
| More Than100 Spent | false | MoreThan100Spent |
| Form1120 POL Filed | false | Form1120POLFiled |
| Activities Not Prev Reported | false | ActivitiesNotPrevReported |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylaws |
| Unrelated Bus Income Over1000 | false | UnrelatedBusIncomeOver1000 |
| Form990 T Filed | false | Form990TFiled |
| Termination Etc | false | TerminationEtc |
| Requirements Of Sect508e | false | RequirementsOfSect508e |
| At Least5000 In Assets | true | AtLeast5000InAssets |
| Form990 PF Filed With AG | true | Form990PFFiledWithAG |
| Private Operating Foundation | false | PrivateOperatingFoundation |
| New Substantial Contributors | false | NewSubstantialContributors |
| Interest In Controlled Entity | false | InterestInControlledEntity |
| Applicable Insurance Contract | false | ApplicableInsuranceContract |
| Comply With Public Inspection Rqr | true | ComplyWithPublicInspectionRqr |
| Website Address | N/A | WebsiteAddress |
Books In Care Of Business Name BooksInCareOfBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KATHLEEN CLARK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Books In Care Of Phone Number | 3522708425 | BooksInCareOfPhoneNumber |
Books In Care Of US Address BooksInCareOfUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 N SKY GLEN PATH | AddressLine1 |
| City | HERNANDO | City |
| State | FL | State |
| ZIP Code | 34442 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Bank | false | ForeignBank |
Statements Regarding Acty4720 StatementsRegardingActy4720
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exchange With Dsqfly Person | false | SaleOrExchangeWithDsqflyPerson |
| Borrow Or Lend With Dsqfly Person | false | BorrowOrLendWithDsqflyPerson |
| Furnished Goods With Dsqfly Person | false | FurnishedGoodsWithDsqflyPerson |
| Pay Compensation To Dsqfly Person | false | PayCompensationToDsqflyPerson |
| Transfer Assets To Dsqfly Person | false | TransferAssetsToDsqflyPerson |
| Payment To Government Offical | false | PaymentToGovernmentOffical |
| Acts Fail To Qualify As Exceptions | false | ActsFailToQualifyAsExceptions |
| Uncorrected Prior Acts | false | UncorrectedPriorActs |
| Undistributed Income Prior Years | false | UndistributedIncomePriorYears |
| Undistr Income4942a2 Not Applied | false | UndistrIncome4942a2NotApplied |
| Business Holdings | false | BusinessHoldings |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Jeopardy Investments | false | JeopardyInvestments |
| Uncorrected Jeopardy Investments | false | UncorrectedJeopardyInvestments |
| Influence Legislation | false | InfluenceLegislation |
| Influence Election | false | InfluenceElection |
| Grants To Individuals | false | GrantsToIndividuals |
| Grants To Organizations | false | GrantsToOrganizations |
| Noncharitable Purpose | false | NoncharitablePurpose |
| Tr Fail To Qualify As Exceptions | false | TrFailToQualifyAsExceptions |
| Maint Expend Responsibility | false | MaintExpendResponsibility |
| Rcv Funds To Pay Prsnl Bnft Contract | false | RcvFundsToPayPrsnlBnftContract |
| Pay Premiums Prsnl Bnft Contract | false | PayPremiumsPrsnlBnftContract |
| Prohibited Tax Shelter Transactn | false | ProhibitedTaxShelterTransactn |
| Proceeds Or Net Income | false | ProceedsOrNetIncome |
Ofcr Dir Trustees Key Employee Info OfcrDirTrusteesKeyEmployeeInfo
Ofcr Dir Trustees Or Key Employee OfcrDirTrusteesOrKeyEmployee (4 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation |
|---|---|---|---|---|---|---|
| LAURA BETH CLARK | ||||||
| 1001 N RANDOLPH ST APT 1018 | ARLINGTON | VA | 22201 | Secretary | 0.00 | 0 |
| EMILY ANN CLARK | ||||||
| 656 WASHINGTON BLVD | BALTIMORE | MD | 21230 | Treasurer | 0.00 | 0 |
| KATHLEEN A CLARK | ||||||
| 1725 N SKY GLEN PATH | HERNANDO | FL | 34442 | Vice President | 0.00 | 0 |
| CHARLES R CLARK MD | ||||||
| 1725 N SKY GLEN PATH | HERNANDO | FL | 34442 | President | 0.00 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Highest Paid Empl NONE | NONE | CompOfHighestPaidEmplNONE |
| Comp Of Hghst Paid Cntrct NONE | NONE | CompOfHghstPaidCntrctNONE |
Minimum Investment Return MinimumInvestmentReturn
| Field | Value | IRS element (for citing) |
|---|---|---|
| Avg Monthly FMV Of Securities | 337102 | AvgMonthlyFMVOfSecurities |
| Avg Monthly Cash Balances | 17255 | AvgMonthlyCashBalances |
| FMV All Other Noncharitable Assets | 0 | FMVAllOtherNoncharitableAssets |
| Total FMV Of Unused Assets | 354357 | TotalFMVOfUnusedAssets |
| Reduction Claimed | 0 | ReductionClaimed |
| Adj Total FMV Of Unused Assets | 354357 | AdjTotalFMVOfUnusedAssets |
| Cash Deemed Charitable | 5315 | CashDeemedCharitable |
| Net Noncharitable Assets | 349042 | NetNoncharitableAssets |
| Minimum Investment Return | 17452 | MinimumInvestmentReturn |
Distributable DistributableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | 17452 | MinimumInvestmentReturn |
| Tax Based On Investment Income | 53 | TaxBasedOnInvestmentIncome |
| Total Tax | 53 | TotalTax |
| Distributable Amount Before Adj | 17399 | DistributableAmountBeforeAdj |
| Distributable Amount Before Ded | 17399 | DistributableAmountBeforeDed |
| Distributable Amount As Adjusted | 17399 | DistributableAmountAsAdjusted |
Qualifying Distributions QualifyingDistributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | 23750 | ExpensesAndContributions |
| Qualifying Distributions | 23750 | QualifyingDistributions |
| One Pct Sect4940e Org Net Invst Incm | 53 | OnePctSect4940eOrgNetInvstIncm |
| Adj Qualifying Distributions | 23697 | AdjQualifyingDistributions |
Undistributed Income UndistributedIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable Amount As Adjusted | 17399 | DistributableAmountAsAdjusted |
| Undistributed Income Prior Year | 3598 | UndistributedIncomePriorYear |
| Excess Distri Carryover Year5 | 4048 | ExcessDistriCarryoverYear5 |
| Excess Distri Carryover Year4 | 1463 | ExcessDistriCarryoverYear4 |
| Total Excess Distri Carryover | 5511 | TotalExcessDistriCarryover |
| Qualifying Distributions | 23750 | QualifyingDistributions |
| Applied To Year1 | 3598 | AppliedToYear1 |
| Treated As Distri From Corpus | 0 | TreatedAsDistriFromCorpus |
| Applied To Current Year | 17399 | AppliedToCurrentYear |
| Remaining Distri From Corpus | 2753 | RemainingDistriFromCorpus |
| Total Corpus | 8264 | TotalCorpus |
| Undistributed Income CY | 0 | UndistributedIncomeCY |
| Excess Distri Cyov From Year5 | 4048 | ExcessDistriCyovFromYear5 |
| Excess Distri Cyov To Next Year | 4216 | ExcessDistriCyovToNextYear |
| Excess From Year4 | 1463 | ExcessFromYear4 |
| Excess From Current Year | 2753 | ExcessFromCurrentYear |
Supplementary Information SupplementaryInformation
Appication Submission Info AppicationSubmissionInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Name | CHARLES KATHLEEN CLARK | RecipientName |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 N SKY GLEN PATH | AddressLine1 |
| City | HERNANDO | City |
| State | FL | State |
| ZIP Code | 34442 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone Number | 3522708425 | RecipientPhoneNumber |
| Form And Info And Materials | NO SPECIFIC FORMAT REQUIRED | FormAndInfoAndMaterials |
| Submission Deadlines | NONE | SubmissionDeadlines |
| Restrictions On Awards | NONE | RestrictionsOnAwards |
Grant Or Contri Paid During Year GrantOrContriPaidDuringYear (24 entries)
| Address Line1RecipientUSAddress/AddressLine1 | CityRecipientUSAddress/City | StateRecipientUSAddress/State | ZIP CodeRecipientUSAddress/ZIPCode | Recipient RelationshipRecipientRelationship | Recipient Foundation StatusRecipientFoundationStatus | Purpose Of Grant Or ContributionPurposeOfGrantOrContribution | AmountAmount |
|---|---|---|---|---|---|---|---|
| GUIDING EYES FOR THE BLIND | |||||||
| 611 Granite Springs Rd | Yorktown Heights | NY | 10598 | NONE | 501c3 | Helping the Blind | $500 |
| HILLSDALE COLLEGE | |||||||
| 33 E College St | Hillsdale | MI | 49242 | NONE | 501c3 | Education | $100 |
| DEFENDERS OF ANIMAL RIGHTS | |||||||
| 57 W Aylesbury Rd | Lutherville | MD | 21093 | NONE | 501c3 | Animal Rights | $500 |
| AERCH DOG FOUNDATION | |||||||
| 601 E Ojai Ave | Ojai | CA | 93023 | NONE | 501c3 | Rescue Dogs | $500 |
| PAULA TAKACS FOUNDATION | |||||||
| PO Box 784146 | Charlotte | NC | 28271 | NONE | 501c3 | Medical Research | $500 |
| AST FOUNDATION | |||||||
| 6 West Dry Creek | Littleton | CO | 80120 | NONE | 501c3 | Education | $500 |
| UNIVERSITY of MD ALUMANI | |||||||
| 1000 Hilltop Circle | Baltimore | MD | 21250 | NONE | 501c3 | Education | $500 |
| THE NUKY FUND | |||||||
| 709 Mall Blvd | Savannah | GA | 31406 | NONE | 501c3 | Education | $300 |
| DELTA GAMMA FOUNDATION | |||||||
| 3250 Riverside Drive | Columbus | OH | 43221 | NONE | 501c3 | Education | $500 |
| UMBF SCHOOL OF NURSING | |||||||
| 11208 Ble Heron | St Petersburg | FL | 33716 | NONE | 501c3 | Education | $1,500 |
| FREDERICK CHURCH OF THE BRETHREN | |||||||
| 201 FAIRVIEW AVE | FREDERICK | MD | 21701 | NONE | 501c3 | IMpoverished Children | $5,000 |
| LIGHTHOUSE FOR THE BLIND | |||||||
| 214 VAN NESS AVENUE | SAN FRANCISCO | CA | 94102 | NONE | 501c3 | Help the Blind | $1,000 |
| WOUNDED WARRIOR PROJECT | |||||||
| 4899 BELFORT ROAD SUITE 300 | JACKSONVILLE | FL | 32256 | NONE | 501c3 | Wounded Veterans | $3,100 |
| FOCCAS | |||||||
| Hwy 41 | Inverenss | FL | 34452 | NONE | 501c3 | Animal Shelter | $1,000 |
| BOYS GIRLS CLUBS OF AMERICA | |||||||
| 1275 PEACHTREE STREET NE | ATLANTA | GA | 30309 | NONE | 501c3 | Education | $1,000 |
| BALTMORE HUMANE SOCIETY | |||||||
| NA | Baltimore | MD | 21201 | NONE | 501c3 | Animal Care | $2,000 |
| UNITY | |||||||
| 1901 NW BLUE PARKWAY | UNITY VILLAGE | MO | 64065 | NONE | 501c3 | Education | $650 |
| JOHNS HOPKINS | |||||||
| 201 N CHARLES SUITE 2500 | BALTIMORE | MD | 21201 | NONE | 501c3 | Education | $500 |
| ALPHA PHI DELTA FOUNDATIONINC | |||||||
| P O BOX 23188 | PITTSBURG | PA | 15222 | NONE | 501c3 | education | $200 |
| KEY CENTER FOUNDATION INC | |||||||
| 130 HEIGHTS AVE | INVERNESS | FL | 34452 | NONE | 501c3 | Education | $1,000 |
| MEDICAL ALUMNI ASSOCIATION | |||||||
| 522 W LOMBARD STREET | BALTIMORE | MD | 21201 | NONE | 501c3 | Education | $1,000 |
| FLORIDA SHERIFFS YOUTH RANCH | |||||||
| P O BOX 2000 | LIVE OAK | FL | 32060 | NONE | 501c3 | education | $500 |
| SALVATON ARMY | |||||||
| Hwy 41 | Inverness | FL | 34452 | NONE | 501c3 | Homeless | $400 |
| PI KAPPA ALPHA EDUCATION FOUNDATION | |||||||
| 8347 WEST RANGE COVE | MEMPHIS | TN | 38125 | NONE | 501c3 | education | $1,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Grant Or Contri Paid During Year | 23750 | TotGrantOrContriPaidDuringYear |
Analysis Income Producing Acty AnalysisIncomeProducingActy
Dividends And Int From Sec Part VII DividendsAndIntFromSecPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $5,273 | ExclusionAmount |
Subtotals Part XVIA SubtotalsPartXVIA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $5,273 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Part XVIA | 5273 | TotalPartXVIA |
Trnsfr Tr Rln With Noncharitable EO TrnsfrTrRlnWithNoncharitableEO
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Noncharitable EO | false | TrnsfrOfCashToNoncharitableEO |
| Trnsfr Oth Assets Noncharitable EO | false | TrnsfrOthAssetsNoncharitableEO |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssets |
| Purchase Assets Noncharitable EO | false | PurchaseAssetsNoncharitableEO |
| Rental Of Facilities Etc | false | RentalOfFacilitiesEtc |
| Reimbursement Arrangements | false | ReimbursementArrangements |
| Loans Or Loan Guarantees | false | LoansOrLoanGuarantees |
| Performance Of Services Etc | false | PerformanceOfServicesEtc |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtc |
| Relationships Noncharitable E Os | false | RelationshipsNoncharitableEOs |
Schedule B IRS990ScheduleB
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | X | Organization501c3ExemptPF |
| General Rule | X | GeneralRule |
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | 1 | ContributorNumber |
| Contributor Name Individual | CHARLES KATHLEEN CLARK Unitrust | ContributorNameIndividual |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 N Sky Glen Path | AddressLine1 |
| City | Hernando | City |
| State | FL | State |
| ZIP Code | 34442 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | 45000 | AggregateContributions |
| Noncash Contribution Type | X | NoncashContributionType |
Noncash Property NoncashProperty
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number From Part I | 1 | ContributorNumberFromPartI |
| Noncash Property Description | United Health Care Stock | NoncashPropertyDescription |
| Fair Market Value | 45000 | FairMarketValue |
| Date Received | 2012-12-15 | DateReceived |
Other Decreases Schedule OtherDecreasesSchedule
Other Decreases OtherDecreases
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | adjusted basis in corp stock | Description |
| Amount | $45,000 | Amount |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | Revenue And Expenses Per BooksRevenueAndExpensesPerBooks |
|---|---|
| PROFESSIONAL FEES | 2724 |
| POSTAGE & SHIPPING | 47 |
Other Increases Schedule OtherIncreasesSchedule
Other Increases OtherIncreases
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | assets sold | Description |
| Amount | $28,729 | Amount |