BEVERLY J JEWELL MEMORIAL FOUNDATION: Form 990PF, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- BEVERLY J JEWELL MEMORIAL FOUNDATION (EIN 20-8828495)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-06-01
- IRS object ID
- 202301529349100625
- Schema version
- 2022v5.0
- 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
- Accounting Fees Schedule
- Investments Corp Bonds Schedule
- Investments Corp Stock Schedule
- Investments Other Schedule2
- Other Expenses Schedule
- Other Increases Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-06-01T14:00:33-05:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 361561860 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE NORTHERN TRUST COMPANY | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 803878 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60680 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208828495 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE BEVERLY J JEWELL MEMORIAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JEWE | BusinessNameControlTxt |
| Phone | 3126306000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 803878 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60680 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PETER MOORE | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 3126306000 | PhoneNum |
| Signature | 2023-05-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (true) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3126306000 | PhoneNum |
| Preparation | 2023-05-05 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | TrustedCustomerGrp |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $9,045,243 | FMVAssetsEOYAmt |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Dividends Rev And Expnss | $236,722 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $237,771 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $26,229 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $1,253,003 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $26,229 | CapGainNetIncmNetInvstIncmAmt |
| Net ST Capital Gain Adj Net Incm | $0 | NetSTCapitalGainAdjNetIncmAmt |
| Total Rev And Expnss | $262,951 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $264,000 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $84,000 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $84,000 | CompOfcrDirTrstDsbrsChrtblAmt |
| Oth Empl Slrs Wgs Net Invst Incm | $0 | OthEmplSlrsWgsNetInvstIncmAmt |
| Oth Empl Slrs Wgs Adj Net Incm | $0 | OthEmplSlrsWgsAdjNetIncmAmt |
| Oth Empl Slrs Wgs Dsbrs Chrtbl | $0 | OthEmplSlrsWgsDsbrsChrtblAmt |
| Pension Empl Bnft Net Invst Incm | $0 | PensionEmplBnftNetInvstIncmAmt |
| Pension Empl Bnft Adj Net Incm | $0 | PensionEmplBnftAdjNetIncmAmt |
| Legal Fees Dsbrs Chrtbl | $0 | LegalFeesDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $2,500 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $1,250 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Adj Net Incm | $0 | AccountingFeesAdjNetIncmAmt |
| Accounting Fees Chrtbl Prps | $1,250 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $84,937 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $40,011 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $44,926 | OtherProfFeesDsbrsChrtblAmt |
| Interest Dsbrs Chrtbl | $0 | InterestDsbrsChrtblAmt |
| Taxes Rev And Expnss | $6,213 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $1,339 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $0 | TaxesDsbrsChrtblAmt |
| Deprec And Dpltn Rev And Expnss | $0 | DeprecAndDpltnRevAndExpnssAmt |
| Deprec And Dpltn Net Invst Incm | $0 | DeprecAndDpltnNetInvstIncmAmt |
| Trav Conf Meeting Net Invst Incm | $0 | TravConfMeetingNetInvstIncmAmt |
| Trav Conf Meeting Adj Net Incm | $0 | TravConfMeetingAdjNetIncmAmt |
| Printing And Pub Net Invst Incm | $0 | PrintingAndPubNetInvstIncmAmt |
| Printing And Pub Adj Net Incm | $0 | PrintingAndPubAdjNetIncmAmt |
| Other Expenses Rev And Expnss | $372 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Dsbrs Chrtbl | $372 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $178,022 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $42,600 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $0 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $130,548 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $400,150 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $400,150 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $578,172 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $42,600 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $0 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $530,698 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$315,221 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $221,400 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $153,318 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $267,014 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $267,014 | SavAndTempCashInvstEOYFMVAmt |
| Acct Rcvbl EOY | $0 | AcctRcvblEOYAmt |
| Acct Rcvbl EOYFMV | $0 | AcctRcvblEOYFMVAmt |
| Other Rcvbl Allwnc Dbtfl Acct | $0 | OtherRcvblAllwncDbtflAcctAmt |
| Corporate Stock BOY | $3,160,576 | CorporateStockBOYAmt |
| Corporate Stock EOY | $2,521,030 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $5,245,158 | CorporateStockEOYFMVAmt |
| Corporate Bonds BOY | $3,211,024 | CorporateBondsBOYAmt |
| Corporate Bonds EOY | $3,337,184 | CorporateBondsEOYAmt |
| Corporate Bonds EOYFMV | $3,062,322 | CorporateBondsEOYFMVAmt |
| Other Investments BOY | $254,825 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $339,313 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $470,749 | OtherInvestmentsEOYFMVAmt |
| Total Assets BOY | $6,779,743 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,464,541 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $9,045,243 | TotalAssetsEOYFMVAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
| Capital Stock BOY | $6,779,743 | CapitalStockBOYAmt |
| Capital Stock EOY | $6,464,541 | CapitalStockEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $6,779,743 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $6,464,541 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $6,779,743 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $6,464,541 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $6,779,743 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$315,221 | ExcessRevenueOverExpensesAmt |
| Other Increases | $19 | OtherIncreasesAmt |
| Subtotal | $6,464,541 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $6,464,541 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (28 entries)
| PropertyPropertyDesc | AcquiredAcquiredDt | SoldSoldDt | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt | How AcquiredHowAcquiredCd |
|---|---|---|---|---|---|---|---|
| 2447.98 MFO INVESCO DEVELOPING MARKETS FUND | 2019-12-13 | 2022-03-01 | $100,000 | $85,548 | $14,452 | $14,452 | |
| 354.67 MFO INVESCO DEVELOPING MARKETS FUND | 2021-12-14 | 2022-03-04 | $13,736 | $16,518 | -$2,782 | -$2,782 | |
| 4590.79 MFO INVESCO DEVELOPING MARKETS FUND | 2016-11-18 | 2022-03-04 | $177,801 | $150,316 | $27,485 | $27,485 | |
| 100. BOEING CO COM | 2017-09-12 | 2022-05-04 | $15,218 | $23,987 | -$8,769 | -$8,769 | |
| 14624.64 MFO CAUSEWAY CAP MGMT TR INTL VALUE FD INSTL CL | 2019-12-19 | 2022-11-03 | $206,207 | $219,832 | -$13,625 | -$13,625 | |
| 13557.14 MFO DFA INVT DIMENSIONS GROUP INC INTL REAL ESTATE SECS PORT | 2017-02-24 | 2022-03-31 | $61,956 | $66,023 | -$4,067 | -$4,067 | |
| 26.98 MFO DIMENSIONAL FUND ADVISORS INTERNATIONAL VALUE PORTFOLIO | 2021-12-15 | 2022-10-26 | $439 | $506 | -$67 | -$67 | |
| 12489.05 MFO DIMENSIONAL FUND ADVISORS INTERNATIONAL VALUE PORTFOLIO | 2018-12-18 | 2022-10-26 | $203,322 | $216,788 | -$13,466 | -$13,466 | |
| 5296.61 MFO DOUBLELINE CORE FIXED INCOME FUND I | 2020-12-07 | 2022-09-20 | $50,000 | $58,798 | -$8,798 | -$8,798 | |
| 7803.79 MFO DOUBLELINE CORE FIXED INCOME FUND I | 2015-01-16 | 2022-11-03 | $70,000 | $86,335 | -$16,335 | -$16,335 | |
| 3500. MFC FLEXSHARES TR INTL QUALITY DIVIDEND INDEX FD | 2018-04-20 | 2022-05-04 | $78,811 | $83,963 | -$5,152 | -$5,152 | |
| 6000. MFC FLEXSHARES TR INTL QUALITY DIVIDEND INDEX FD | 2016-08-29 | 2022-05-05 | $133,424 | $137,160 | -$3,736 | -$3,736 | |
| 100. MFC ISHARES TR RUSSELL 3000 INDEX FD | 2021-06-03 | 2022-11-03 | $21,502 | $25,008 | -$3,506 | -$3,506 | |
| 5170.63 MFB NORTHERN FUNDS BD INDEX FD | 2020-12-17 | 2022-05-31 | $50,000 | $55,992 | -$5,992 | -$5,992 | |
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P | |||||
| CAPITAL GAIN DIVIDENDS | $70,587 | P |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $26,229 | CapitalGainNetIncomeAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $3,077 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $3,077 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $3,077 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $4,600 | EstimatedPlusOvpmtIncmTxAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Extsn Request Income Tax Paid | $0 | ExtsnRequestIncomeTaxPaidAmt |
| Total Payments And Credits | $4,600 | TotalPaymentsAndCreditsAmt |
| Es Penalty | $0 | EsPenaltyAmt |
| Overpayment | $1,523 | OverpaymentAmt |
| Applied To ES Tax | $1,523 | AppliedToESTaxAmt |
| Refund | $0 | RefundAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | false | LegislativePoliticalActyInd |
| More Than100 Spent | false | MoreThan100SpentInd |
| Form1120 POL Filed | false | Form1120POLFiledInd |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (true) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (true) | AtLeast5000InAssetsInd |
| Org Report Or Register State | WA | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (true) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | false | PrivateOperatingFoundationInd |
| New Substantial Contributors | false | NewSubstantialContributorsInd |
| Own Controlled Entity | false | OwnControlledEntityInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (true) | ComplyWithPublicInspRqrInd |
| Website Address | N/A | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN TRUST COMPANY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3126306000 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O PO BOX 803878 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60680 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | false | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | false | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | false | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | false | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | false | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | false | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | false | PaymentToGovernmentOfficialInd |
| Uncorrected Prior Acts | false | UncorrectedPriorActsInd |
| Undistributed Income PY | false | UndistributedIncomePYInd |
| Business Holdings | false | BusinessHoldingsInd |
| Jeopardy Investments | false | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | false | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | false | InfluenceLegislationInd |
| Influence Election | false | InfluenceElectionInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Noncharitable Purpose | false | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
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 |
|---|---|---|---|---|---|---|
| PETER P MOORE | ||||||
| PO BOX 1508 | RICHLAND | WA | 99352 | PRESIDENT | 20 | $84,000 |
| SCOTT MOORE | ||||||
| 41 LIVING WATERS LN | SEQUIM | WA | 98382 | DIRECTOR | 20 | $0 |
| MIKE JEWELL | ||||||
| 8538 N 84TH ST | SCOTTSDALE | AZ | 85250 | DIRECTOR | 20 | $0 |
| JAMI PRIGGE | ||||||
| 450 SUNDANCE DR | RICHLAND | WA | 99352 | DIRECTOR | 20 | $0 |
| CYD WALLBAUM | ||||||
| 3605 CLINTON WAY | YAKIMA | WA | 98902 | DIRECTOR | 20 | $0 |
| SARA FELERICO | ||||||
| 130 WARING | MEMPHIS | TN | 38117 | DIRECTOR | 20 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Other Employee Paid Over50k | 0 | OtherEmployeePaidOver50kCnt |
Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN TRUST COMPANY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 803878 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60680 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Service Type | ADVISORY FEES | ServiceTypeTxt |
| Compensation | $59,901 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contractor Paid Over50k | 0 | ContractorPaidOver50kCnt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Summary Of Direct Chrtbl Acty | SummaryOfDirectChrtblActyGrp | |
| Sum Of Program Related Invst | SumOfProgramRelatedInvstGrp |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $9,814,190 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $0 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $9,814,190 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $9,814,190 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $147,213 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $9,666,977 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $483,349 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $483,349 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $3,077 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $3,077 | TotalTaxAmt |
| Distributable Before Adj | $480,272 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $480,272 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $480,272 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $530,698 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Charitable Assets Acquis Paid | $0 | CharitableAssetsAcquisPaidAmt |
| Set Aside Suitability Test | $0 | SetAsideSuitabilityTestAmt |
| Set Aside Cash Distri Test | $0 | SetAsideCashDistriTestAmt |
| Qualifying Distributions | $530,698 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $480,272 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $400,149 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $0 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $0 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $0 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $0 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $0 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $0 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $530,698 | QualifyingDistributionsAmt |
| Applied To Year1 | $400,149 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $130,549 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $0 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $0 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Prior Year Deficiency Or Tax | $0 | PriorYearDeficiencyOrTaxAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $349,723 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $0 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $0 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $0 | ExcessFromYear4Amt |
| Excess From Year3 | $0 | ExcessFromYear3Amt |
| Excess From Year2 | $0 | ExcessFromYear2Amt |
| Excess From Year1 | $0 | ExcessFromYear1Amt |
| Excess From Current Year | $0 | ExcessFromCurrentYearAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | NA | ContributingManagerNm |
| Shareholder Manager | NA | ShareholderManagerNm |
Application Submission Info ApplicationSubmissionInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Person | PETER P MOORE | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1508 | AddressLine1Txt |
| City | RICHLAND | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 99352 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 5095515210 | RecipientPhoneNum |
| Form And Info And Materials | INFORMATION REGARDING THE ASSOCIATION AMOUNT REQUESTED | FormAndInfoAndMaterialsTxt |
| Submission Deadlines | NOVEMBER 1, 2022 | SubmissionDeadlinesTxt |
| Restrictions On Awards | ORGANIZATIONS PROVIDING MEDICAL CARE MEDICAL RESEARCH, ETC FOR CHILDREN'S MEDICAL NEEDS | RestrictionsOnAwardsTxt |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (11 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt | Business Name Line2RecipientBusinessName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|---|---|
| KADLEC MEDICAL CENTER | ||||||||
| 888 SWIFT BLVD | Richland | WA | 99352 | NONE | PUBLIC | GENERAL | $50,000 | |
| SHINER'S HOSPITAL FOR CHILDREN | ||||||||
| 2900 N ROCKY POINT DRIVE | Tampa | FL | 33607 | NONE | PUBLIC | GENERAL | $50,000 | |
| MARY BRIDGE CHILDREN'S FOUNDATION | ||||||||
| 311 S L ST | Tacoma | WA | 98405 | NONE | PUBLIC | GENERAL | $50,000 | |
| ST JUDE'S CHILDREN'S RESEARCH HOSPITAL | ||||||||
| 501 ST JUDE PLACE | Memphis | TN | 38105 | NONE | PUBLIC | GENERAL | $35,000 | |
| CITY OF REFUGE | ||||||||
| 1300 JOSEPH E BOONE BLVD NW | Atlanta | GA | 30314 | NONE | PUBLIC | GENERAL | $20,000 | |
| CHILDREN'S DEVELOPMENTAL CENTER | ||||||||
| 1549 GEORGIA AVE | Richland | WA | 99352 | NONE | PUBLIC | GENERAL | $25,000 | |
| OKIZU FOUNDATION | ||||||||
| 16 DIGITAL DR | Novato | CA | 94949 | NONE | PUBLIC | GENERAL | $30,000 | |
| OPERATION SMILE | ||||||||
| 3641 FACULTY BLVD | Virginia Beach | VA | 23453 | NONE | PUBLIC | GENERAL | $35,150 | |
| CAMP PRIME TIME | ||||||||
| 6 S 2ND ST STE 815 | Yakima | WA | 98901 | NONE | PUBLIC | GENERAL | $25,000 | |
| UW SCHOOL OF DENTISTRY | ||||||||
| PO BOX 357136 | Camano Island | WA | 98282 | NONE | PUBLIC | GENERAL | $30,000 | PETER DOMOTO FUND FOR CHILDREN |
| LE BONHEUR CHILDRENS HOSPITAL FOUNDATION | ||||||||
| 848 ADAMS AVE | Memphis | TN | 38103 | NONE | PUBLIC | GENERAL | $50,000 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $400,150 | TotalGrantOrContriPdDurYrAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees Contracts From Govt Ag | FeesContractsFromGovtAgGrp | |
| Membership Dues And Assmnt | MembershipDuesAndAssmntGrp | |
| Int On Sav And Temp Cash Invst | IntOnSavAndTempCashInvstGrp |
Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $236,722 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Rntl Incm Re Debt Fincd Prop | NetRntlIncmReDebtFincdPropGrp | |
| Net Rntl Incm Re Not Debt Fincd Prop | NetRntlIncmReNotDebtFincdProp | |
| Net Rental Income Personal Prop | NetRentalIncomePersonalPropGrp | |
| Other Investment Income | OtherInvestmentIncomeGrp |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $26,229 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Income Loss From Special Evt | NetIncomeLossFromSpecialEvtGrp | |
| Gross Profit Loss Sls Of Invntry | GrossProfitLossSlsOfInvntryGrp |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $262,951 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $262,951 | TotalIncomeProducingActyAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Rln Of Acty To Accom Of Exmpt Prps | RlnOfActyToAccomOfExmptPrpsGrp |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | false | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | false | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | false | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | false | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | false | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | false | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | false | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | false | RelationshipsNonchrtblEOInd |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | TAX PREPARATION FEES | CategoryTxt |
| Amt | $2,500 | Amt |
| Net Investment Income | $1,250 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $1,250 | DisbursementsCharitablePrpsAmt |
Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule
Investments Corporate Bonds InvestmentsCorporateBondsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond | SEE ATTACHMENT | BondNm |
| EOY Book Value | $3,337,184 | EOYBookValueAmt |
| EOYFMV | $3,062,322 | EOYFMVAmt |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Stock | SEE ATTACHMENT | StockNm |
| EOY Book Value | $2,521,030 | EOYBookValueAmt |
| EOYFMV | $5,245,158 | EOYFMVAmt |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (2 entries)
| Category Or ItemCategoryOrItemTxt | Listed At Cost Or FMVListedAtCostOrFMVCd | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| SEE ATTACHMENT | AT COST | $197,120 | $250,217 |
| SEE ATTACHMENT | AT COST | $142,193 | $220,532 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (2 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| P.O. BOX FEE | $347 | $0 | $347 |
| WA SECRETARY OF STATE FEE | $25 | $0 | $25 |
Other Increases Schedule OtherIncreasesSchedule
Other Increases Detail OtherIncreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | TAX COST ADJ | Desc |
| Amt | $19 | Amt |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| ADVISORY FEES | $59,901 | $14,975 | $44,926 |
| INVESTMENT MANAGER FEES | $25,036 | $25,036 |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (3 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| EXCISE TAXES | $274 | $0 | $0 |
| ESTIMATED TAXES | $4,600 | $0 | $0 |
| FOREIGN TAXES | $1,339 | $1,339 | $0 |
Comments