2022-09-13T12:00:09-05:00 2021-10-31 450250958 EIDE BAILLY LLP 401 N 31ST ST STE 1120 BILLINGS MT 591011281 990PF 2020-11-01 596138602 SAMPLE FOUNDATION INC SAMP 4062450550 PO BOX 279 BILLINGS MT 59103 BARBARA M SAMPLE EXECUTIVE DIRECTOR/PRESIDENT 4062450550 2022-09-12 1 BARBARA SAMPLE 999009999 RONALD J YATES JR CPA P00543293 4068962400 2022-09-08 2 AAL1 IAL1 2020 2023-04-26 12:10:37Z X 10070504 X 167486 3165 3165 117004 117004 7550 3205225 7550 10834 10834 306039 138553 0 0 0 11200 5600 5600 22620 22620 0 1581 1581 0 3500 0 2356 2106 0 41257 31907 5600 455006 455006 496263 31907 460606 -190224 106646 60759 49357 49357 2471642 2471638 6824065 3352514 3180396 3189693 36500 29111 3889 7389 7389 5888804 5708780 10070504 10200 0 10200 X 5888804 5698580 0 0 0 0 5888804 5698580 5888804 5708780 5888804 -190224 0 5698580 0 5698580 BNY MELLON - PUBLICLY TRADED SECURITIES 2021-05-22 2021-10-31 3197673 3197675 -2 -2 CAPITAL GAINS DIVIDENDS P 7552 7552 7552 7550 1482 0 1482 0 1482 4619 0 0 0 4619 X 0 3137 3137 0 0 0 0 0 0 0 0 0 0 0 1 1 MT 1 0 0 0 0 1 SAMPLEFOUNDATION.ORG JOSEPH S SAMPLE 4062450550 606 HIGHLAND PARK DRIVE BILLINGS MT 59102 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 JOSEPH S SAMPLE 606 HIGHLAND PARK DRIVE BILLINGS MT 59102 CHAIRMAN 0.10 0 0 0 BRIDGET SAMPLE JOYNER 1298 TAMMANY LN HAMILTON MT 59840 TREASURER 0.10 0 0 0 BARBARA SAMPLE 2517 IRVING PLACE BILLINGS MT 59102 EXEC. DIRECTOR/PRESIDENT 1.00 0 0 0 DAVID F SAMPLE 34174 CAMDEN LANE POLSON MT 59860 DIRECTOR 0.10 0 0 0 PATRICK G SAMPLE PO BOX 410 INDEX WA 98256 DIRECTOR 0.10 0 0 0 NONE 0 NONE 0 0 6274893 3398147 0 9673040 0 0 9673040 145096 9527944 476397 476397 1482 1482 474915 0 474915 0 474915 460606 0 460606 0 460606 474915 0 0 19226 19226 460606 0 0 0 460606 0 14309 14309 4917 0 0 0 0 0 0 0 4917 4917 JOSEPH S SAMPLE BARBARA SAMPLE DAVID F SAMPLE PATRICK G SAMPLE BARBARA SAMPLE PO BOX 279 BILLINGS MT 591030279 4062565567 LETTER GIVING ORGANIZATIONAL BACKGROUND AND PURPOSES, SPECIFIC NEED & AMOUNT REQUESTED. ATTACH 501(C)(3) IRS DETERMINATION LETTER. AUGUST 1 GENERALLY LIMITED TO ORGANIZATIONS IN THE STATE OF MONTANA & COLLIER COUNTY FLORIDA. NO GRANTS WILL BE PROVIDED TO RELIGIOUS OR POLITICAL ORGANIZATIONS OR TAX SUPPORTED INSTITUTIONS. AJAY MT PO BOX 923 HELENA MT 59624 PC GENERAL SERVICES 3000 ANGELA'S PIAZZA 420 GRAND AVE BILLINGS MT 59101 PC AIR CONDITIONER 3400 BILLINGS FAMILY SERVICES PO BOX 1020 BILLINGS MT 59103 PC VEHICLE FOR FOOD DISTRIBUTION 7500 BILLINGS FAMILY YMCA 402 NORTH 32ND STREET BILLINGS MT 59101 PC SECURITY CAMERAS 4728 BILLINGS PUBLIC SCHOOLS 101 10TH STREET WEST BILLINGS MT 59102 PC ORCHARD PLAYGROUND 15000 BILLINGS SYMPHONY SOCIETY 2721 2ND AVE N 350 BILLINGS MT 59101 PC SOUND SYSTEM 3000 BLUE MOUNTAIN CLINIC 610 NO CALIFORNIA ST RONAN MT 59802 PC GENERAL SERVICES 1000 BOYS & GIRLS CLUB OF MISSOULA COUNTY 1515 FAIRVIEW AVE SUITE 243 MISSOULA MT 59801 PC VAN 7750 BOYS & GIRLS CLUB OF RICHLAND COUNTY PO BOX 416 SIDNEY MT 59270 PC FACILITY UPDATES 15000 BOYS & GIRLS CLUB OF THE FLATHEAD RESERVATION AND LAKE COUNTY PO BOX 334 RONAN MT 59864 PC B&G SPORTS EQUIPMENT 15000 BOYS & GIRLS CLUB OF THE NORTHERN CHEYENNE NATION 101 CHEYENNE AVENUE LAME DEER MT 59043 PC GENERAL SERVICES 6000 BOYS & GIRLS CLUBS OF YELLOWSTONE COUNTY 505 ORCHARD LANE BILLINGS MT 59101 PC PLAY STRUCTURE 15000 BRIDGERCARE 1288 N 14TH AVE 201 BOZEMAN MT 59715 PC EXAM TABLES,DEFIBILLATOR 8500 CASA OF LAKE COUNTY PO BOX 511 POLSON MT 598600511 PC BD DESIGNATED 3000 CENTER FOR COMMUNITY STEWARDSHIP 116 NORTH FEW ST SUITE 3 MADISON WI 59703 PC BD DESIGNATED 1000 CHILD'S PATH INC (FORMERLY COLLIER CHILD CARE RESOURCES INC - CCCR) 15275 COLLIER BOULEVARD 201-359 NAPLES FL 34119 PC ROOF REPAIR 20800 CHILDREN'S ONCOLOLOGY CAMP MAKE A DREAM 2110 S JOHNSON ST MISSOULA MT 59801 PC MATTRESSES FOR CABINS 3000 EAGLE MOUNT BILLINGS 1140 16TH STREET 12 BILLINGS MT 59102 PC TRANSPORTATION PROJECT 15000 EAGLE MOUNT BOZEMAN 6901 GOLDENSTEIN LANE BOZEMAN MT 59715 PC ACCESSIBLE VEHICLES 7500 EASTER SEALS 300 MERCER ST 210E SEATTLE WA 98119 PC BD. 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MISSOULA MT 59801 PC FURNITURE 4000 MISSOULA ART MUSEUM 335 NORTH PATTEE STREET MISSOULA MT 59802 PC ENVIRONMENT CONTROL 20000 MISSOULA BUTTERFLY HOUSE AND INSECTARIUM PO BOX 8885 MISSOULA MT 59807 PC MICROSCOPE STATIONS 7000 MISSOULA FAMILY YMCA 3000 SOUTH RUSSELL MISSOULA MT 59801 PC CPR EQUIMENT 5390 MISSOULA INTERFAITH COLLABORATIVE 2205 34TH STREET MISSOULA MT 59801 PC SNOW PLOW 8000 MISSOULA PUBLIC LIBRARY 455 E MAIN MISSOULA MT 59802 PC DESIGNATED 1000 MONTANA FREE PRESS PO BOX 1425 HELENA MT 59624 PC OFFICE EQUIPMENT 4485 MONTANA NON PROFIT ASSN 7 WEST 6TH AVENUE STE 504 HELENA MT 59624 PC DESIGNATED 3000 FRIENDS OF MONTANA PUBLIC BROADCASTING MONTANA STATE UNIVERSITY BOZEMAN MT 59715 PC DESIGNATED 3000 MONTANA SCHOOL FOR THE DEAF AND BLIND FOUNDATION 3911 CENTRAL AVENUE GREAT FALLS MT 594066576 PC VISUAL ENHANCEMENT EQUIPMENT 10566 MOUNTAIN HOME MONTANA 2606 SOUTH AVE WEST MISSOULA MT 59804 PC WASHER/DRYER 5200 NORTH MISSOULA COMMUNITY DEVELOPMENT CORPORATION 1500 BURNS STREET MISSOULA MT 59802 PC SWING SET 4130 NORTHERN PLAINS RESOURCE 220 S 27TH ST A BILLINGS MT 59101 PC DESIGNATED 4000 PED WILLOW LEARNING CENTER 700 SOUTH AVE WEST SUITE C MISSOULA MT 59801 PC CLASS FOR INCARCERATED 3204 REACH INC 322 GALLATIN PARK DRIVE BOZEMAN MT 59715 PC NEW WINDOWS 4585 ROCKY MOUNTAIN COLLEGE 1511 POLY DRIVE BILLINGS MT 59102 PC ARTS ENRICHMENT 3500 RONALD MCDONALD HOUSE 3003 FT MISSOULA RD MISSOULA MT 59840 PC DESIGNATED 3000 SAFE HARBOR PO BOX 497 RONAN MT 59864 PC BRIDGING BEGINNINGS 12000 ST JOSEPH HOSPITAL PROVIDENCE 6 THIRTEENTH AVE EAST POLSON MT 59860 PC DESIGNATED 3500 STARTUP EVENT CENTER 14315 366TH AVE SE SULTAN WA 98294 PC DESIGNATED 1000 STOP AAPI HATE 17 WALTER LUM PLACE SAN FRANCISCO CA 94108 PC DESIGNATED 1000 THE BOYCE L ANSLEY SCHOOL 120 RALPH MCGILL BLVD 3STE B1 ATLANTA GA 30308 PC DESIGNATED 1000 THRIVE 400 EAST BABCOCK ST BOZEMAN MT 59715 PC DESIGNATED 1700 TROY PUBLIC SCHOOL DISTRICT 501 E KALISPELL AVE TROY MT 59935 PC TRACK AND FIELD EQUIPMENT 10000 UNIVERSITY OF MONTANA EXCELLENCE FUND PO BOX 7159 MISSOULA MT 598077159 PC DESIGNATED 1500 WATSON'S CHILDREN'S CENTER 4978 BUCKHOUSE LN MISSOULA MT 59804 PC DESIGNATED 2000 WILD AND SCENIC INSTITUTE PO BOX 554 MOUNTLAKE TERRACE WA 98043 PC DESIGNATED 2000 YELLOWSTONE ART MUSEUM 401 N 27TH ST BILLINGS MT 59101 PC DESIGNATED 3000 YOUTH DYNAMICS 2334 LEWIS AVENUE BILLINGS MT 59102 PC BUILDING CONSTRUCTION 6000 YRPA PO BOX 1201 BILLINGS MT 59103 PC DESIGNATED 5000 YWCA MISSOULA 1800 S 3RD ST W MISSOULA MT 59801 PC PLAY STRUCTURE 4570 455006 0 14 3165 14 117004 18 7550 ENTERPRISE PRODS PARTNERS 18 10770 OTHER INCOME 18 64 0 138553 0 138553 0 0 0 0 0 0 0 0 0 0 X X 1 DAVID F SAMPLE 34174 CAMDEN LANE POLSON MT 59860 50652 X 2 JOSEPH S SAMPLE 606 HIGHLAND PARK DRIVE BILLINGS MT 59102 16716 X 3 PATRICK G SAMPLE PO BOX 410 INDEX WA 98256 50660 X 4 BARBARA MSAMPLE 2517 IRVING PLACE BILLINGS MT 59102 49458 X ACCOUNTING FEES 11200 5600 5600 SOFTWARE 2013-06-20 8500 8500 SL 3.000000000000 0 0 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