PETCOFF FOUNDATION INC: Form 990PF, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PETCOFF FOUNDATION INC (EIN 85-2999243)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-14
- IRS object ID
- 202243189349103964
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-14T13:27:18-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 201640706 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE VANDERBLOEMEN GROUP LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 215 W NORTH ST | AddressLine1Txt |
| City | WAUKESHA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53188 | 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 | 852999243 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PETCOFF FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PETC | BusinessNameControlTxt |
| Phone | 2626501099 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 139A COTTONWOOD AVENUE | AddressLine1Txt |
| City | HARTLAND | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53029 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN A PETCOFF | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 2626501099 | PhoneNum |
| Signature | 2022-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JOHN | PersonFirstNm |
| Person Last | PETCOFF | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RICHARD MCCORMICK | PreparerPersonNm |
| PTIN | P00606209 | PTIN |
| Phone | 2625740374 | PhoneNum |
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 | $3,165,002 | FMVAssetsEOYAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $3,104,594 | ContriRcvdRevAndExpnssAmt |
| Interest On Sav Rev And Expnss | $4 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $4 | InterestOnSavNetInvstIncmAmt |
| Interest On Savings Adj Net Incm | $4 | InterestOnSavingsAdjNetIncmAmt |
| Net Gain Sale Ast Rev And Expnss | -$287,441 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $826,652 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $671,415 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $2,817,157 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $671,419 | TotalNetInvstIncmAmt |
| Total Adj Net Incm | $4 | 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 |
| Other Prof Fees Rev And Expnss | $5,685 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $5,083 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Adj Net Incm | $0 | OtherProfFeesAdjNetIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $602 | OtherProfFeesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $5,685 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $5,083 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $0 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $602 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $1,200 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $1,200 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $6,885 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $5,083 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $0 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $1,802 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $2,810,272 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $666,336 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $4 | AdjustedNetIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash EOY | $140,997 | CashEOYAmt |
| Cash EOYFMV | $140,997 | CashEOYFMVAmt |
| Corporate Stock BOY | $405,558 | CorporateStockBOYAmt |
| Corporate Stock EOY | $3,074,833 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $3,024,005 | CorporateStockEOYFMVAmt |
| Total Assets BOY | $405,558 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,215,830 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $3,165,002 | 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 | $405,558 | RetainedEarningBOYAmt |
| Retained Earning EOY | $3,215,830 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $405,558 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $3,215,830 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $405,558 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $3,215,830 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $405,558 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $2,810,272 | ExcessRevenueOverExpensesAmt |
| Other Increases | $0 | OtherIncreasesAmt |
| Subtotal | $3,215,830 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $3,215,830 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (4 entries)
| PropertyPropertyDesc | AcquiredAcquiredDt | SoldSoldDt | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt |
|---|---|---|---|---|---|---|
| 100 SH FISERV | 1995-01-15 | 2021-02-26 | $11,620 | $160 | $11,460 | $11,460 |
| 850 SH MODERNA | 2021-01-11 | 2021-10-01 | $279,529 | $99,351 | $180,178 | $180,178 |
| 2500 SH FISERV | 1995-01-15 | 2021-11-10 | $252,699 | $4,000 | $248,699 | $248,699 |
| 850 SH MODERNA | 2020-09-04 | 2021-10-01 | $282,804 | $51,726 | $231,078 | $231,078 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $671,415 | CapitalGainNetIncomeAmt |
| Net Short Term Capital Gain Loss | $180,178 | NetShortTermCapitalGainLossAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $9,262 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $9,262 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $9,262 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $0 | 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 | $0 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Es Penalty | $0 | EsPenaltyAmt |
| Tax Due | $9,262 | 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 | 0 | 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 | 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 |
| Individual With Books | JOHN FITZGERALD | IndividualWithBooksNm |
| Phone | 2626501099 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1620 SILVERNAIL RD | AddressLine1Txt |
| City | PEWAUKEE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53072 | 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 |
|---|---|---|---|---|---|---|---|---|
| JOHN A PETCOFF | ||||||||
| W304N7160 HIGHWAY E | HARTLAND | WI | 53029 | PRESIDENT | 0.00 | $0 | $0 | $0 |
| MARK K WOJCIK | ||||||||
| 2400 TALBOTS LANE | BROOKFIELD | WI | 53045 | DIRECTOR | 0.00 | $0 | $0 | $0 |
| DAVID D ROSENWALD | ||||||||
| 2315 RUSTIC WOODS COURT | WAUKESHA | WI | 53188 | DIRECTOR | 0.00 | $0 | $0 | $0 |
| JOHN M FITZGERALD | ||||||||
| 8001 E MAGUEY DRIVE | TUCSON | AZ | 85750 | DIRECTOR | 0.00 | $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 | $781,514 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $50,227 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $831,741 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $831,741 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $12,476 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $819,265 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $40,963 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $40,963 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $9,262 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $9,262 | TotalTaxAmt |
| Distributable Before Adj | $31,701 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $31,701 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $31,701 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $1,802 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Charitable Assets Acquis Paid | $602 | CharitableAssetsAcquisPaidAmt |
| Qualifying Distributions | $2,404 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $31,701 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $1,703 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Total Excess Distribution Cyov | $0 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $2,404 | QualifyingDistributionsAmt |
| Applied To Year1 | $1,703 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $701 | 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 | $31,000 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $0 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $0 | ExcessDistriCyovToNextYrAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | JOHN A PETCOFF | ContributingManagerNm |
| Shareholder Manager | JOHN A PETCOFF | ShareholderManagerNm |
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN MEMORIAL PARK | BusinessNameLine1Txt |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13235 W CAPITOL DR | AddressLine1Txt |
| City | BROOKFIELD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53005 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Foundation Status | PC | RecipientFoundationStatusTxt |
| Grant Or Contribution Purpose | CHARITABLE DONATION TO THE CHAPEL | GrantOrContributionPurposeTxt |
| Amt | $1,200 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $1,200 | 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) |
|---|---|---|
| Related Or Exempt Function Incm | $4 | RelatedOrExemptFunctionIncmAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Related Or Exempt Function Incm | -$287,441 | RelatedOrExemptFunctionIncmAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $0 | ExclusionAmt |
| Related Or Exempt Function Incm | -$287,437 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | -$287,437 | TotalIncomeProducingActyAmt |
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp (2 entries)
| Line NumberLineNumberTxt | Relationship StatementRelationshipStatementTxt |
|---|---|
| 3 | PROVIDE INCOME TO SUPPORT THE FOUNDATION'S CHARITABLE INTENTIONS |
| 8 | PROVIDE INCOME TO SUPPORT THE FOUNDATION'S CHARITABLE INTENTIONS |
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 (2 entries)
| ContributorContributorNum | Address Line1ContributorUSAddress/AddressLine1Txt | CityContributorUSAddress/CityNm | State AbbreviationContributorUSAddress/StateAbbreviationCd | ZIPContributorUSAddress/ZIPCd | Total ContributionsTotalContributionsAmt | Noncash ContributionNoncashContributionInd |
|---|---|---|---|---|---|---|
| JOHN A PETCOFF | ||||||
| 1 | W304N7160 HIGHWAY E | HARTLAND | WI | 53029 | $2,283,403 | Yes (X) |
| JOHN A PETCOFF | ||||||
| 2 | W304N7160 HIGHWAY E | HARTLAND | WI | 53029 | $821,191 | Yes (X) |
Non Cash Property Contribution NonCashPropertyContributionGrp (2 entries)
| ContributorContributorNum | Noncash PropertyNoncashPropertyDesc | Fair Market ValueFairMarketValueAmt | ReceivedReceivedDt |
|---|---|---|---|
| 1 | 21900 SH FISERV | $2,283,403 | 2021-12-29 |
| 2 | 1700 SHARES MODERNA INC. | $821,191 | 2021-08-10 |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp (8 entries)
| StockStockNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| 3600 SH FISERV INC. | $1,600 | $103,790 |
| 21900 SH FISERV INC. | $35,040 | $2,273,001 |
| 1150 SH DIREXION DAILY 20+ YEAR | $61,272 | $62,629 |
| 998 SH DIREXION DAILY | $60,040 | $64,002 |
| 6037 SH MERCK & CO | $497,603 | $462,676 |
| 228 SH MODERNA INC. | $59,861 | $57,907 |
| UNREALIZED GAIN ON DONATED FISERV INC 2020 CONTRIBUTION | $111,054 | $0 |
| UNREALIZED GAIN ON DONATED FISERV INC 2021 CONTRIBUTION | $2,248,363 | $0 |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ADVISOR FEES | CategoryTxt |
| Amt | $5,685 | Amt |
| Net Investment Income | $5,083 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $602 | DisbursementsCharitablePrpsAmt |