PATCH FOUNDATION: Form 990PF, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PATCH FOUNDATION (EIN 41-1873951)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-05-03
- IRS object ID
- 202211239349100216
- Schema version
- 2021v4.2
- 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 Stock Schedule
- Other Expenses Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-03T09:02:41-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 227 WEST FIRST STREET SUITE 700 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55802 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411873951 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE PATCH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PATC | BusinessNameControlTxt |
| Phone | 6127817677 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3201 RANKIN ROAD | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55418 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CAROLYN SAMPLE | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 6127817677 | PhoneNum |
| Signature | 2022-05-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CAROLYN | PersonFirstNm |
| Person Last | SAMPLE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JULIE BOYER | PreparerPersonNm |
| PTIN | P01278549 | PTIN |
| Phone | 2187275025 | PhoneNum |
| Preparation | 2022-05-01 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $8,121,279 | FMVAssetsEOYAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Interest On Sav Rev And Expnss | $17 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $17 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $189,700 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $189,700 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $281,124 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $1,037,316 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $281,124 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $470,841 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $470,841 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Net Invst Incm | $0 | CompOfcrDirTrstNetInvstIncmAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $0 | CompOfcrDirTrstDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $2,310 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $1,155 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Chrtbl Prps | $1,155 | AccountingFeesChrtblPrpsAmt |
| Taxes Rev And Expnss | $10,254 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $0 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $0 | TaxesDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $74 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $0 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $74 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $12,638 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $1,155 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $1,229 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $1,110,000 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $1,110,000 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $1,122,638 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $1,155 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $1,111,229 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$651,797 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $469,686 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $38,395 | CashBOYAmt |
| Cash EOY | $615,758 | CashEOYAmt |
| Cash EOYFMV | $615,758 | CashEOYFMVAmt |
| Sav And Temp Cash Invst BOY | $1,122,988 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $650,021 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $650,021 | SavAndTempCashInvstEOYFMVAmt |
| Corporate Stock BOY | $5,759,824 | CorporateStockBOYAmt |
| Corporate Stock EOY | $5,003,631 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $6,855,500 | CorporateStockEOYFMVAmt |
| Total Assets BOY | $6,921,207 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,269,410 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $8,121,279 | TotalAssetsEOYFMVAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
| 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 | $6,921,207 | RetainedEarningBOYAmt |
| Retained Earning EOY | $6,269,410 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $6,921,207 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $6,269,410 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $6,921,207 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $6,269,410 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $6,921,207 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$651,797 | ExcessRevenueOverExpensesAmt |
| Other Increases | $0 | OtherIncreasesAmt |
| Subtotal | $6,269,410 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $6,269,410 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Property | MEDTRONIC PLC | PropertyDesc |
| Gross Sales Price | $1,037,316 | GrossSalesPriceAmt |
| Cost Or Other Basis | $756,192 | CostOrOtherBasisAmt |
| Gain Or Loss | $281,124 | GainOrLossAmt |
| Gains Minus Excess Or Losses | $281,124 | GainsMinusExcessOrLossesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $281,124 | CapitalGainNetIncomeAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $6,529 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $6,529 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $6,529 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $7,760 | EstimatedPlusOvpmtIncmTxAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Extsn Request Income Tax Paid | $0 | ExtsnRequestIncomeTaxPaidAmt |
| Backup Withholding Withheld | $0 | BackupWithholdingWithheldAmt |
| Total Payments And Credits | $7,760 | TotalPaymentsAndCreditsAmt |
| Es Penalty | $0 | EsPenaltyAmt |
| Overpayment | $1,231 | OverpaymentAmt |
| Applied To ES Tax | $1,231 | AppliedToESTaxAmt |
| Refund | $0 | RefundAmt |
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 | MN | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (1) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | 0 | PrivateOperatingFoundationInd |
| New Substantial Contributors | 0 | NewSubstantialContributorsInd |
| Own Controlled Entity | 0 | OwnControlledEntityInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (1) | ComplyWithPublicInspRqrInd |
| Website Address | N/A | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6127817677 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3201 RANKIN ROAD | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55418 | 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 |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (4 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 |
|---|---|---|---|---|---|---|---|---|
| CAROLYN SAMPLE | ||||||||
| 3201 RANKIN RD | MINNEAPOLIS | MN | 55418 | PRESIDENT | 2.00 | $0 | $0 | $0 |
| WILLIAM C PETERSON | ||||||||
| 6724 99TH AVE NORTH | BROOKLYN PARK | MN | 55445 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| ERNEST LINDSTROM-LINDSTROM LAW OFFI | ||||||||
| 7600 PARKLAWN AVE STE 444 | EDINA | MN | 55435 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| RONALD K DRAPER | ||||||||
| 861 OAKGREEN AVE PL N | STILLWATER | MN | 55082 | DIRECTOR | 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 | $9,052,203 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $372,339 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $9,424,542 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $9,424,542 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $141,368 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $9,283,174 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $464,159 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $464,159 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $6,529 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $6,529 | TotalTaxAmt |
| Distributable Before Adj | $457,630 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $457,630 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $457,630 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $1,111,229 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $1,111,229 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $457,630 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $577,445 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $694,784 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $683,682 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $792,999 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $728,182 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $3,477,092 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $1,111,229 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $457,630 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $653,599 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $4,130,691 | 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 | $577,445 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $3,553,246 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $694,784 | ExcessFromYear4Amt |
| Excess From Year3 | $683,682 | ExcessFromYear3Amt |
| Excess From Year2 | $792,999 | ExcessFromYear2Amt |
| Excess From Year1 | $728,182 | ExcessFromYear1Amt |
| Excess From Current Year | $653,599 | ExcessFromCurrentYearAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | CAROLYN SAMPLE | ContributingManagerNm |
Application Submission Info ApplicationSubmissionInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Person | CAROLYN P SAMPLE | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3201 RANKIN ROAD NE | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55418 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 6127817677 | RecipientPhoneNum |
| Form And Info And Materials | ORGANIZATIONS APPLYING SHOULD PROVIDE INFORMATION SIMILAR TO THAT SET FORTH BELOW: 1. ORGANIZATION NAME AND ADDRESS. 2. STATE IN WHICH APPLICANT IS ORGANIZED AS A NONPROFIT ENTITY. IF NOT SO ORGANIZED, EXPLAIN. 3. ATTACH ANY RULING OR DETERMINATION LETTER FROM INTERNAL REVENUE SERVICE ABOUT EXEMPT STATUS OR PRIVATE FOUNDATION STATUS. 4. COPY OF APPLICANT'S PROPOSED BUDGET AND PURPOSE OF ORGANIZATION. 5. IS APPLICANT CONTROLLED BY, RELATED TO, CONNECT WITH, OR SPONSORED BY ANOTHER ORGANIZATION? IF YES, IDENTIFY PARENT ENTITY. 6. SHOW AMOUNT REQUESTED AND HOW IT WILL BE USED. 7. SIGNED BY AUTHORIZED PERSON. | FormAndInfoAndMaterialsTxt |
| Submission Deadlines | NONE | SubmissionDeadlinesTxt |
| Restrictions On Awards | IN AWARDING GRANTS, THE FOUNDATION GIVES PREFERENCE TO MINNESOTA CHARITABLE ORGANIZATIONS. MEDICAL FOUNDATIONS, EDUCATION AND THE ARTS RECEIVE PRIME CONSIDERATION. GRANTS ARE NORMALLY RESTRICTED TO $1,000 OR LESS. APPLICANTS ARE USUALLY NOTIFIED WITHIN TWO MONTHS THAT THEIR APPLICATION HAS BEEN APPROVED OR REJECTED, OR THAT ADDITIONAL INFORMATION IS NEEDED. FOUNDATION DOES NOT PROVIDE APPLICATION FORMS. | RestrictionsOnAwardsTxt |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (45 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| ALASKA CHRISTIAN COLLEGE | |||||||
| 35109 ROYAL PLACE | SOLDNOTNA | AK | 99669 | NONE | PC | EDUCATIONAL | $7,000 |
| BANYAN COMMUNITY | |||||||
| 2529 13TH AVE SO | MINNEAPOLIS | MN | 55404 | NONE | PC | EDUCATIONAL | $5,000 |
| BETHEL UNIVERSITY | |||||||
| 3900 BETHEL DR | ST PAUL | MN | 55112 | NONE | PC | EDUCATIONAL | $5,000 |
| CAMP KNUTSON | |||||||
| 11169 WHITEFISH AVENUE | CROSSLAKE | MN | 56442 | NONE | PC | RELIGIOUS | $5,000 |
| CARE | |||||||
| 111 W ILLINOIS ST 5TH FLOOR | CHICAGO | IL | 60654 | NONE | PC | PROGRAM SUPPORT | $10,000 |
| CATHOLIC CHARITIES | |||||||
| 1200 SECOND AVENUE SO | MINNEAPOLIS | MN | 55403 | NONE | PC | RELIGIOUS | $5,000 |
| COURAGE KENNY REHABILITATION INSTITUTE | |||||||
| 3915 GOLDEN VALLEY RD | MINNEAPOLIS | MN | 55422 | NONE | PC | HEALTH | $20,000 |
| COVENANT WORLD RELIEF | |||||||
| PO BOX 773420 | CHICAGO | IL | 60677 | NONE | PC | RELIGIOUS | $150,000 |
| CRISTO REY JESUIT HIGH SCHOOL | |||||||
| 2924 4TH AVENUE SOUTH | MINNEAPOLIS | MN | 55408 | NONE | PC | EDUCATIONAL | $5,000 |
| CROSS SERVICES | |||||||
| 12915 WEINAND CIRCLE | ROGERS | MN | 55374 | NONE | PC | PROGRAM SUPPORT | $3,000 |
| DUNWOODY COLLEGE OF TECHNOLOGY | |||||||
| 818 DUNWOODY BLVD | MINNEAPOLIS | MN | 55403 | NONE | PC | EDUCATIONAL | $15,000 |
| EVANGELICAL COVENANT CHURCH | |||||||
| PO BOX 773420 | CHICAGO | IL | 60677 | NONE | PC | RELIGIOUS | $200,000 |
| EXODUS LENDING CO HOLY TRINITY CHURCH | |||||||
| 2380 WYCLIFF ST SUITE B-100 | ST PAUL | MN | 55114 | NONE | PC | PROGRAM SUPPORT | $5,000 |
| FAMILY VALUES FOR LIFE | |||||||
| 1280 ARCADE ST | ST PAUL | MN | 55106 | NONE | PC | PROGRAM SUPPORT | $7,000 |
| FEED MY STARVING CHILDREN | |||||||
| 401 93RD AVE NW | COON RAPIDS | MN | 54433 | NONE | PC | RELIGIOUS | $30,000 |
| GREATER MINNEAPOLIS CRISIS NURSERY | |||||||
| 4544 4TH AVE SOUTH | MINNEAPOLIS | MN | 55419 | NONE | PC | PROGRAM SUPPORT | $5,000 |
| HABITAT FOR HUMANITY | |||||||
| 1954 UNIVERSITY AVE W | ST PAUL | MN | 55104 | NONE | PC | PROGRAM SUPPORT | $15,000 |
| HENNEPIN TECHNICAL COLLEGE | |||||||
| 9000 BROOKLYN BLVD | BROOKLYN PARK | MN | 55445 | NONE | PC | EDUCATIONAL | $5,000 |
| HOMEWARD BOUND | |||||||
| 12805 HIGHWAY 55 STE 400 | PLYMOUTH | MN | 55441 | NONE | PC | HEALTH | $10,000 |
| HOPE ACADEMY | |||||||
| 2300 CHICAGO AVE | MINNEAPOLIS | MN | 55404 | NONE | PC | PROGRAM SUPPORT | $5,000 |
| HOPE DENTAL CLINIC | |||||||
| 800 MINNEHAHA AVENUE EAST 465 | ST PAUL | MN | 55106 | NONE | PC | PROGRAM SUPPORT | $3,000 |
| KIWANIS CLUB OF NE MPLS | |||||||
| 729 MARSHALL ST NE | MINNEAPOLIS | MN | 55413 | NONE | PC | PROGRAM SUPPORT | $1,000 |
| LOAVES AND FISHES | |||||||
| 721 KASOTA AVE SE | MINNEAPOLIS | MN | 55414 | NONE | PC | RELIGIOUS | $25,000 |
| METRO HOPE MINISTRIES | |||||||
| 2739 CEDAR AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | NONE | PC | PROGRAM SUPPORT | $30,000 |
| MINNESOTA ADULT AND TEEN CHALLENGE | |||||||
| 740 E 24TH ST | MINNEAPOLIS | MN | 55404 | NONE | PC | PROGRAM SUPPORT | $25,000 |
| NEW LIFE IN CHRIST MINISTRY | |||||||
| PO BOX 456 | CLEARWATER | MN | 55320 | NONE | PC | RELIGIOUS | $3,000 |
| PEOPLE SERVING PEOPLE | |||||||
| 614 SOUTH THIRD STREET | MINNEAPOLIS | MN | 55415 | NONE | PC | PROGRAM SUPPORT | $25,000 |
| RICHFIELD SPARTAN FOUNDATION INC | |||||||
| 7229 CLINTON AVENUE | RICHFIELD | MN | 55423 | NONE | PC | EDUCATIONAL | $7,000 |
| SALEM COVENANT CHURCH | |||||||
| 2655 FIFTH STREET NW | NEW BRIGHTON | MN | 55112 | NONE | PC | RELIGIOUS | $150,000 |
| SCIENCE WITH A MISSION | |||||||
| 602 MASSAPOAG AVE | SHARON | MA | 02067 | NONE | PC | PROGRAM SUPPORT | $10,000 |
| SECOND HARVEST HEARTLAND | |||||||
| 7101 WINNETKA AVE N | BROOKLYN PARK | MN | 55428 | NONE | PC | PROGRAM SUPPORT | $50,000 |
| SHARING & CARING HANDS | |||||||
| 425 NORTH SEVENTH ST | MINNEAPOLIS | MN | 55405 | NONE | PC | PROGRAM SUPPORT | $7,000 |
| SIMPSON HOUSING SERVICES | |||||||
| 160 GLENWOOD AVE | MINNEAPOLIS | MN | 55405 | NONE | PC | PROGRAM SUPPORT | $25,000 |
| ST STEPHEN'S HUMAN SERVICES | |||||||
| 2309 NICOLLET AVE | MINNEAPOLIS | MN | 55404 | NONE | PC | PROGRAM SUPPORT | $20,000 |
| SUNSHINE ACRES CHILDREN'S HOME | |||||||
| 3405 NORTH HIGLEY ROAD | MESA | AZ | 85215 | NONE | PC | PROGRAM SUPPORT | $7,000 |
| THE ARC MINNESOTA | |||||||
| 2446 UNIVERSITY AVE W 110 | ST PAUL | MN | 55114 | NONE | PC | PROGRAM SUPPORT | $10,000 |
| THE GIDEONS INTERNATIONAL | |||||||
| PO BOX 403810 | ATLANTA | GA | 30384 | NONE | PC | RELIGIOUS | $5,000 |
| THE SALVATION ARMY | |||||||
| 2445 PRIOR AVENUE NORTH | ROSEVILLE | MN | 55113 | NONE | PC | RELIGIOUS | $100,000 |
| THRESHOLD TO NEW LIFE | |||||||
| 10031 SARATOGA WAY | MAPLE GROVE | MN | 55369 | NONE | PC | RELIGIOUS | $5,000 |
| TRINITY FIRST LUTHERAN SCHOOL | |||||||
| 1115 19TH AVE SO | MINNEAPOLIS | MN | 55404 | NONE | PC | EDUCATIONAL | $10,000 |
| TRUE FRIENDS | |||||||
| 10509 108TH ST NW | ANNANDALE | MN | 55302 | NONE | PC | PROGRAM SUPPORT | $10,000 |
| UNION GOSPEL MISSION | |||||||
| 376 WESTERN AVE N | ST PAUL | MN | 55103 | NONE | PC | PROGRAM SUPPORT | $10,000 |
| UNIVERSITY OF MINNESOTA FOUNDATION | |||||||
| 200 OAK STREET SE 500 | MINNEAPOLIS | MN | 55455 | NONE | PC | EDUCATIONAL | $50,000 |
| UNIVERSITY OF NORTHWESTERN | |||||||
| 3003 SNELLING AVE N | ST PAUL | MN | 55113 | NONE | PC | EDUCATIONAL | $5,000 |
| URBAN HOMEWORKS | |||||||
| PO BOX 11267 | MINNEAPOLIS | MN | 55411 | NONE | PC | RELIGIOUS | $5,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $1,110,000 | TotalGrantOrContriPdDurYrAmt |
| Total Grant Or Contri Apprv Fut | $0 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $17 | ExclusionAmt |
Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $189,700 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $281,124 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $470,841 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $470,841 | 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 |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEES | CategoryTxt |
| Amt | $2,310 | Amt |
| Net Investment Income | $1,155 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $1,155 | DisbursementsCharitablePrpsAmt |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp (2 entries)
| StockStockNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| MEDTRONIC STOCK | $4,839,631 | $6,620,800 |
| CHEVRON | $164,000 | $234,700 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (2 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| STATE OF MN FILING FEE | $25 | $0 | $25 |
| MISCELLANEOUS FEES | $49 | $0 | $49 |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| EXCISE TAX PAID - ESTIMATE | $7,760 | $0 | $0 |
| EXCISE TAX PAID - PY | $2,494 | $0 | $0 |
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