2021-09-14T17:15:49-05:00 2020-10-31 450250958 EIDE BAILLY LLP 401 N 31ST ST STE 1120 BILLINGS MT 591011281 990PF 2019-11-01 596138602 SAMPLE FOUNDATION INC SAMP 4062450550 PO BOX 279 BILLINGS MT 59103 BARBARA M SAMPLE EXECUTIVE DIRECTOR/PRESIDENT 4062450550 2021-09-13 1 RONALD J YATES JR CPA P00543293 4068962400 2021-09-11 2019 2022-09-23 18:48:47Z X 8237972 X 190478 37588 37588 111979 111979 4357 4967879 4357 11200 11635 11635 356037 165559 11200 0 0 0 10560 5280 5280 20716 20716 0 11377 1377 0 3695 0 1555 1366 0 47903 28739 5280 395000 395000 442903 28739 400280 -86866 136820 11200 67170 60759 60759 2322050 2471642 4847186 3570321 3352514 3326138 29500 25611 7584 3889 3889 5967125 5888804 8237972 0 0 X 5967125 5888804 0 0 0 0 5967125 5888804 5967125 5888804 5967125 -86866 11200 5891459 2655 5888804 BNY MELLON - PUBLICLY TRADED SECURITIES 2020-05-22 2020-10-31 4963527 4963522 5 5 CAPITAL GAINS DIVIDENDS P 4352 4352 4352 4357 0 424332 8292533 0.051170 421933 8474715 0.049787 406451 8074017 0.050341 387278 7833402 0.049439 402667 8048067 0.050033 0.250770 0.050154 8223621 412447 1368 413815 400280 2736 0 2736 0 2736 7355 0 0 7355 X 0 4619 4619 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 4761414 3587440 0 8348854 0 0 8348854 125233 8223621 411181 411181 2736 2736 408445 11200 419645 0 419645 400280 0 400280 0 400280 419645 0 0 2972 8607 1671 25341 38591 400280 0 0 0 400280 0 19365 19365 19226 0 0 0 0 0 0 0 19226 19226 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. ABSAROKEE PUBLIC LIBRARY ABSAROKEE PO BOX 726 ABSAROKEE MT 59001 PC GENERAL SERVICES 10000 ALBERTA BAIR THEATER 2801 3RS AVE N BILLINGS MT 59101 PC GENERAL SERVICES 2000 ATLANTA COMMUNITY FOOD BANK 3400 N DESERT DRIVE ATLANTA GA 30344 PC GENERAL SERVICES 500 BEAR 310 N 4TH ST HAMILTON MT 598403300 PC EQUIPMENT SHED 4000 BILLINGS FAMILY YMCA 402 NORTH 32ND STREET BILLINGS MT 59101 PC FIRST AID EQUIPMENT 6300 BILLINGS PUBLIC SCHOOLS 101 10TH STREET WEST BILLINGS MT 59102 PC ORCHARD ELEMENTARY SCHOOL PLAYGROUND AND MAINTENANCE PROGRAM FOR 2020-2021 15000 BILLINGS SYMPHONY SOCIETY 2721 2ND AVE N 350 BILLINGS MT 59101 PC VIDEO GUITAR LESSONS TO MONTANA STATE WOMEN'S PRISON 3000 BLUE MOUNTAIN CLINIC 610 CALIFORNIA MISSOULA MT 59802 PC GENERAL SERVICES 1000 BOYS & GIRLS CLUB OF FLATHEAD RESERVATION AND LAKE COUNTY PO BOX 334 63055 HWY 93 RONAN MT 59864 PC POLSON CLUB TEEN CENTER KITCHENETTE AND COMMONS 15000 BOYS & GIRLS CLUB OF LEWISTOWN 134 PARK LEWISTOWN MT 59457 PC KITCHEN REMODEL 11400 BOYS & GIRLS CLUB OF MISSOULA COUNTY 1515 FAIRVIEW AVE SUITE 243 MISSOULA MT 59801 PC CLUB VAN TRANSPORTATION 7061 BOYS & GIRLS CLUB OF RICHLAND COUNTY 201 THIRD AVENUE SE SIDNEY MT 59270 PC TECHNOLOGY FOR STUDENT CENTER 10432 BOYS & GIRLS CLUBS OF YELLOWSTONE COUNTY 505 ORCHARD LANE BILLINGS MT 59101 PC MOBILE TECHNOLOGY LAB 15000 BOYS AND GIRLS OF THE HILINE 500 1ST AVENUE HAVRE MT 59501 PC CLEAN AND GREEN 3345 BRIDGERCARE 1288 N 14TH AVE 201 BOZEMAN MT 59715 PC EXAM ROOM LIGHTING 6277 CASA OF LAKE COUNTY PO BOX 511 POLSON MT 59860 PC GENERAL SERVICES 3000 CASA OF YELLOWSTONE COUNTY PO BOX 688 BILLINGS MT 59103 PC LAPTOPS 2101 CENTER FOR MUSIC BY PEOPLE WITH DISABILITES 415 WEST CENTRAL AVENUE MISSOULA MT 59801 PC GENERAL SERVICES 2000 CHILDREN'S ONCOLOGY CAMP FOUNDATION DBA CAMP MAK-A-DREAM PO BOX 1450 MISSOULA MT 59806 PC REPLACE/UPDATE SERVER 2775 CHILD'S PATH INC (FORMERLY COLLIER CHILD CARE RESOURCES INC - CCCR) 2335 TAMIAMI TRL N SUITE 504 ELDER GROVE FL 341034435 PC PLAYGROUND 18000 COMMUNITY COUNSELING AND CORRECTIONAL SERVICES INC 471 E MERCURY STREET BUTTE MT 59701 PC FURNITURE FOR SERVICES 5000 EAGLE MOUNT 6901 GOLDENSTEIN LN BOZEMAN MT 59715 PC GENERAL SERVICES 1000 EASTER SEALS CAMP STAND BY ME 17809 S VAUGHN RD NW VAUGHN WA 98394 PC GENERAL SERVICES 5000 EASTERN MONTANA CASA GAL INC 2705 E MAIN STREET MILES CITY MT 59301 PC TECH EQUIPMENT FOR SATELITE OFFICES 8143 ELDER GROVE PARENT TEACHER ORGANIZATION BILLINGS 1532 S 64TH ST W BILLINGS MT 59106 PC GENERAL SERVICES 10000 EMMA'S HOUSE 310 N 4TH ST HAMILTON MT 59840 PC GENERAL SERVICES 1000 FAMILY PROMISE OF GALLATIN VALLEY PO BOX 475 BOZEMAN MT 59771 PC INCREASE SHELTER CAPACITY 10000 FAMILY SERVICES INC 3927 1ST AVE SOUTH BILLINGS MT 59101 PC GENERAL SERVICES 2500 FLORENCE CRITTENTON HOME & SERVICES 901 N HARRIS HELENA MT 59601 PC PLAYGROUND EQUIPMENT 9000 FOUNTAIN VALLEY SCHOOL 6155 FOUNTAIN VALLEY ROAD COLORADO SPRINGS CO 80911 PC GENERAL SERVICES 2500 FRIENDS OF HEYBROOK RIDGE PO BOX 265 INDEX WA 98256 PC GENERAL SERVICES 3000 FUN TIME EARLY CHILDHOOD ACADEMY 102 12TH STREET NORTH NAPLES FL 34102 PC FOOD SERVICE FUNDING 10000 GARNET PRESERVATION ASSOCIATION PO BOX 18295 MISSOULA MT 59808 PC GENERAL SERVICES 1000 GOLDBAR FIREFIGHTERS ASSOCIATION 601 LEWIS/ PO BOX 376 GOLD BAR WA 98251 PC GENERAL SERVICES 3000 GREAT FALLS SCOTTISH RITE CHILDHOOD LANGUAGE DISORDERS CLINIC 1304 13TH STREET SOUTH GREAT FALLS MT 59405 PC GREAT FALLS SCOTTISH RITE CHILDHOOD LANGUAGE DISORDERS CLINIC TELETHERAPY EQUIPMENT UPGRADE 1425 GUADALUPE CENTER NAPLES FL 509 HOPE CIRCLE IMMOKALEE FL 34142 PC EXPANDING EARLY CHILDHOOD EDUCATION IN A COMMUNITY IN NEED 3345 HAVEN PO BOX 752 BOZEMAN MT 597710752 PC SHELTER ENTRANCE 3000 HEISEY COMMUNITY CENTER AT ST ANN'S 313 7TH ST N GREAT FALLS MT 59401 PC ROOF REPAIR 7500 HIGHLAND RESEARCH AND EDUCATION CENTER 1959 HIGHLANDER WAY NEW MARKET TN 37820 PC GENERAL SERVICES 500 HOFSTRA UNIVERSITY 1000 HEMSTEAD TURNPIKE HEMPSTEAD NY 11549 PC GENERAL SERVICES 250 IMAGINEIF LIBRARY FOUNDATION 44 2ND AVE KALISPELL MT 59901 PC TECH LENDING PROGRAM 5000 INTERMOUNTAIN 3240 DREDGE DRIVE HELENA MT 59602 PC FURNITURE 3345 LAKE COUNTY COMMUNITY HOUSING ORGANIZATION 111 2ND AVENUE SW RONAN MT 59864 PC BUILDING SPACE 12500 MAYNARD INSTITUTE 1400 65TH STREET STE 200 EMERYVILLE CA 94608 PC GENERAL SERVICES 100 MISSION VALLEY AQUATIC 309 RIDGEWATER DR POLSON MT 59860 PC GENERAL SERVICES 1000 MISSOULA AGING SERVICES 337 STEPHENS AVE MISSOULA MT 59801 PC MAS OFFICE RADON MITIGATION 3500 MISSOULA FOOD BANK 1720 WYOMING STREET MISSOULA MT 59801 PC SAFETY ADDTIONS 2980 MISSOULA INTERFAITH COLLABORATIVE 2205 34TH STREET MISSOULA MT 59801 PC FOOD SUPPLIES 5000 MISSOULA PUBLIC LIBRARY 1515 EAST BROADWAY STREET MISSOULA MT 59802 PC GENERAL SERVICES 1000 MONTANA SCHOOL FOR THE DEAF AND BLIND FOUNDATION PO BOX 6576 GREAT FALLS MT 594066576 PC VISUAL ENHANCEMENT EQUIPMENT 10566 MONTANA WILDERNESS SCHOOL PO BOX 1183 BOZEMAN MT 59771 PC YOUTH PROGRAM EQUIPMENT 8000 MOUNTAIN HOME MONTANA 2606 SOUTH AVE WEST MISSOULA MT 59804 PC COVID ADAPTIONS 3500 NAPLES COMMUNITY HOSPITAL 350 7TH ST NORTH NAPLES FL 34102 PC GENERAL SERVICES 1000 NORTHERN PLAINS RESOURCE COUNCIL 3220 S 27TH ST A BILLINGS MT 59101 PC GENERAL SERVICES 2000 OUTDOORS FOR ALL 6344 NE 74TH ST 102 SEATTLE WA 98115 PC GENERAL SERVICES 3000 PATHWAYS EARLY EDUCATION CENTER OF IMMOKALEE 4060 TAMIAMI TRAIL NORTH NAPLES FL 34103 PC EARLY LEARNING ASSESSMENT TOOLS 7100 PROJECT ASCENT PO BOX 1954 THOMPSON FALLS MT 59873 PC PILGRM CREEK PLAYGROUND 10000 RECYCLING WORKS 202 BROOKS ST UNIT 3 MISSOULA MT 59801 PC TRUCK 10000 ROCKY MOUNTAIN COLLEGE 1511 POLY DRIVE BILLINGS MT 59102 PC SERVICES FOR ACADEMIC SUCCESS CULTURAL ENRICHMENT PROGRAM 3500 RONALD MCDONALD HOUSE OF CHARITIES 3003 FORT MISSOULA RD MISSOULA MT 59804 PC GENERAL SERVICES 3000 SAFE HARBOR PO BOX 497 RONAN MT 59864 PC GENERAL SERVICES 2000 SKY VALLEY ARTS COUNCIL STARTUP EVENTS CENTER PO BOX 18 SULTAN WA 98294 PC GENERAL SERVICES 3000 ST LABRE INDIAN SCHOOL EDUCATIONAL ASSOCIATION POST OFFICE BOX 77 ASHLAND MT 59003 PC FOOD PROGRAM 14750 ST PATRICK HOSPITAL (PROVIDENCE) 500 WEST BROADWAY MISSOULA MT 59802 PC GENERAL SERVICES 3000 THE GREATER MISSOULA FAMILY YMCA 3000 SOUTH RUSSELL STREET MISSOULA MT 59801 PC TECH EQUIPMENT FOR AFTER SCHOOL PROGRAM 4050 THE PHOENIX 2239 CHAMPA STREET DENVER CO 80205 PC EQUIPMENT FOR MONTANA PROGRAM 13100 THOREAU ELEMENTARY PTA CHILDCARE SCHOLARSHIP FUND 822 MIAMI PASS MADISON WI 53711 PC GENERAL SERVICES 1000 TREVOR DAY SCHOOL 1 WEST 88TH STREET NEW YORK NY 10128 PC GENERAL SERVICES 300 UNIVERSITY OF MT EXCELLENCE FUND 950 ARTHUR AVE MISSOULA MT 59812 PC GENERAL SERVICES 1500 WATSON CHILDREN'S CENTER 4978 BUCKHOUSE LANE MISSOULA MT 59804 PC MINIVAN 10000 YELLOWSTONE RIVER PARK ASSOCIATION PO BOX 1201 BILLINGS MT 59103 PC GENERAL SERVICES 2500 YOUTH HOMES INC PO BOX 7616 MISSOULA MT 59807 PC BUILDING RENOVATIONS 5900 YWCA MISSOULA 1130 W BROADWAY MISSOULA MT 59802 PC PLAYGROUND 2455 MONTANA NO KID HUNGRY 1625 11TH AVENUE HELENA MT 596204210 PC MEAL SERVICE EQUIPMENT 10000 395000 0 14 37588 14 111979 18 4357 ENTERPRISE PRODS PARTNERS 18 10665 OTHER INCOME 18 970 0 165559 0 165559 0 0 0 0 0 0 0 0 0 0 X X 1 DAVID F SAMPLE 34174 CAMDEN LANE POLSON MT 59860 59002 X 2 JOSEPH S SAMPLE 606 HIGHLAND PARK DRIVE BILLINGS MT 59102 14809 X 3 PATRICK G SAMPLE PO BOX 410 INDEX WA 98256 58980 X 4 BARBARA MSAMPLE 2517 IRVING PLACE BILLINGS MT 59102 57687 X ACCOUNTING FEES 10560 5280 5280 SOFTWARE 2013-06-20 8500 8500 SL 3.000000000000 0 0 SOFTWARE 2015-05-12 7000 7000 SL 3.000000000000 0 0 SOFTWARE 2017-05-20 7000 5638 SL 3.000000000000 1362 0 SOFTWARE 2019-07-02 7000 778 SL 3.000000000000 2333 0 ABBOT LABS 35390 262775 BP AMOCO 57031 40960 BRISTOL MYERS SQUIBB 35931 233800 EMERSON ELECTRIC 17062 388740 JOHNSON & JOHNSON 60089 318095 CANADIAN NATIONAL RAILWAY 30284 546975 PFIZER INC COM 110730 106440 CONOCOPHILLIPS 90469 100170 HONEYWELL INTERNATIONAL INC. 113673 329900 PROCTOR & GAMBLE COMPANY 126593 274200 CHEVRON CORPORATION 153457 104250 PHILLIPS 66 24387 69990 VERIZON COMMUNICATIONS INC. 168020 182368 WEYERHAEUSER COMPANY 121800 174656 ALPHABET INC. 177094 242417 CVS HEALTH CORP COM 180576 168270 INVESCO EXCHANGE TRADED FD TR S&P 500 259845 311310 JP MORGAN CHASE & CO 161297 147060 QUANTA SVCS INC 166261 312150 SELECT SECTOR SPDR TR CONSUMER 232061 285940 QUALCOMM, INC 149592 246720 DREYFUS/U.S. TREASURY OBLIGATIONS AT COST 3225449 3226718 ENTERPRISE PRODUCTS PARTNERS LP AT COST 127065 99420 SOFTWARE 8500 8500 0 SOFTWARE 7000 7000 0 SOFTWARE 7000 7000 0 SOFTWARE 7000 3111 3889 ENTERPRISE PRODUCTS PARTNERS LP BASIS ADJUSTMENT 2655 MISCELLANEOUS ADMINISTRATION 1555 1366 0 ENTERPRISE PRODS PARTNERS 10665 10665 10665 OTHER INCOME 970 970 970 RECOVERY OF AMOUNT TREATED AS QUALIFYING DISTRIBUTION 11200 INVESTMENT/BANK FEES 20716 20716 0 TAXES 11377 1377 0