LUTSEY FAMILY FOUNDATION INC: Form 990PF, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
LUTSEY FAMILY FOUNDATION INC (EIN 39-1657029)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-12
IRS object ID
202143169349104339
Schema version
2020v4.1
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

FieldValueIRS element (for citing)
Return2021-11-12T15:39:17-06:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12200 RIVERSIDE DRIVEAddressLine1Txt
CityGREEN BAYCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54301ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN391657029EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1LUTSEY FAMILY FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlLUTSBusinessNameControlTxt
Phone9203399823PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line16177 KIEHNAU ROADAddressLine1Txt
CityEGG HARBORCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54209ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTHOMAS LUTSEYPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone9203399823PhoneNum
Signature2021-11-12SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstTHOMASPersonFirstNm
Person LastLUTSEYPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHELLE MULLOYPreparerPersonNm
PTINP01241748PTIN
Phone9204367800PhoneNum
Preparation2021-11-12PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$6,060,387FMVAssetsEOYAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Rcvd Rev And Expnss$0ContriRcvdRevAndExpnssAmt
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Dividends Rev And Expnss$126,248DividendsRevAndExpnssAmt
Dividends Net Invst Incm$126,248DividendsNetInvstIncmAmt
Net Gain Sale Ast Rev And Expnss$340,976NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$3,372,269GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$340,976CapGainNetIncmNetInvstIncmAmt
Total Rev And Expnss$467,224TotalRevAndExpnssAmt
Total Net Invst Incm$467,224TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$0CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$0CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$0CompOfcrDirTrstDsbrsChrtblAmt
Accounting Fees Rev And Expnss$10,489AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm$5,244AccountingFeesNetInvstIncmAmt
Accounting Fees Chrtbl Prps$5,245AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss$490OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$245OtherProfFeesNetInvstIncmAmt
Other Prof Fees Dsbrs Chrtbl$245OtherProfFeesDsbrsChrtblAmt
Taxes Rev And Expnss$15,912TaxesRevAndExpnssAmt
Taxes Net Invst Incm$4,179TaxesNetInvstIncmAmt
Taxes Dsbrs Chrtbl$0TaxesDsbrsChrtblAmt
Other Expenses Rev And Expnss$63,530OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$38,535OtherExpensesNetInvstIncmAmt
Other Expenses Dsbrs Chrtbl$6,954OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$90,421TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$48,203TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$12,444TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$256,295ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$256,295ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$346,716TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$48,203TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$268,739TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses$120,508ExcessRevenueOverExpensesAmt
Net Investment Income$419,021NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Sav And Temp Cash Invst BOY$183,506SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$123,806SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$123,806SavAndTempCashInvstEOYFMVAmt
US Government Obligations BOY$72,988USGovernmentObligationsBOYAmt
US Government Obligations EOY$68,623USGovernmentObligationsEOYAmt
US Govt Obligations EOYFMV$75,285USGovtObligationsEOYFMVAmt
Corporate Stock BOY$4,941,400CorporateStockBOYAmt
Corporate Stock EOY$5,251,626CorporateStockEOYAmt
Corporate Stock EOYFMV$5,594,408CorporateStockEOYFMVAmt
Corporate Bonds BOY$39,402CorporateBondsBOYAmt
Corporate Bonds EOY$42,929CorporateBondsEOYAmt
Corporate Bonds EOYFMV$47,969CorporateBondsEOYFMVAmt
Other Investments BOY$235,004OtherInvestmentsBOYAmt
Other Investments EOY$105,824OtherInvestmentsEOYAmt
Other Investments EOYFMV$218,919OtherInvestmentsEOYFMVAmt
Total Assets BOY$5,472,300TotalAssetsBOYAmt
Total Assets EOY$5,592,808TotalAssetsEOYAmt
Total Assets EOYFMV$6,060,387TotalAssetsEOYFMVAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind
No Donor Rstr Net Assests BOY$5,472,300NoDonorRstrNetAssestsBOYAmt
No Donor Rstr Net Assests EOY$5,592,808NoDonorRstrNetAssestsEOYAmt
Tot Net Ast Or Fund Balances BOY$5,472,300TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$5,592,808TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$5,472,300TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$5,592,808TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$5,472,300TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses$120,508ExcessRevenueOverExpensesAmt
Other Increases$0OtherIncreasesAmt
Subtotal$5,592,808SubtotalAmt
Other Decreases$0OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$5,592,808TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (4 entries)

PropertyPropertyDescHow AcquiredHowAcquiredCdGross Sales PriceGrossSalesPriceAmtCost Or Other BasisCostOrOtherBasisAmtGain Or LossGainOrLossAmtGains Minus Excess Or LossesGainsMinusExcessOrLossesAmt
PUBLICLY TRADED SECURITIESP$3,370,279$3,014,839$355,440$355,440
INVESTMENT K1SP$16,454-$16,454-$16,454
SECURITIES LITIGATION PROCEEDSP$63$63$63
CAPITAL GAINS DIVIDENDSP$1,927$1,927$1,927
FieldValueIRS element (for citing)
Capital Gain Net Income$340,976CapitalGainNetIncomeAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Investment Income Excise Tax$5,824InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$5,824SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$5,824TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$8,933EstimatedPlusOvpmtIncmTxAmt
Exempt Frgn Org Tax Wthld At Srce$0ExemptFrgnOrgTaxWthldAtSrceAmt
Extsn Request Income Tax Paid$0ExtsnRequestIncomeTaxPaidAmt
Backup Withholding Withheld$0BackupWithholdingWithheldAmt
Total Payments And Credits$8,933TotalPaymentsAndCreditsAmt
Es Penalty$0EsPenaltyAmt
Overpayment$3,109OverpaymentAmt
Applied To ES Tax$3,109AppliedToESTaxAmt
Refund$0RefundAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (1)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateWIOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating Foundation0PrivateOperatingFoundationInd
New Substantial ContributorsYes (1)NewSubstantialContributorsInd
Own Controlled Entity0OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressN/AWebsiteAddressTxt
Individual With BooksTHOMAS LUTSEYIndividualWithBooksNm
Phone9203399823PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line16177 KIEHNAU ROADAddressLine1Txt
CityEGG HARBORCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54209ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified PrsnYes (1)FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified Prsn0PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Acts Fail To Qlfy As Exceptions0ActsFailToQlfyAsExceptionsInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To Individuals0GrantsToIndividualsInd
Grants To Organizations0GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
THOMAS J LUTSEY
6177 KIEHNAU ROADEGG HARBORWI54209PRESIDENT1.00$0$0$0
SHARON L LUTSEY
PO BOX 22074GREEN BAYWI54305DIRECTOR1.00$0$0$0
MATTHEW T LUTSEY
PO BOX 22074GREEN BAYWI54305DIRECTOR1.00$0$0$0
JEFFREY K LUTSEY
PO BOX 22074GREEN BAYWI54305DIRECTOR0.00$0$0$0
NICHOLAS P LUTSEY
PO BOX 22074GREEN BAYWI54305DIRECTOR0.00$0$0$0
ANDREW J LUTSEY
PO BOX 22074GREEN BAYWI54305DIRECTOR0.00$0$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Other Employee Paid Over50k0OtherEmployeePaidOver50kCnt
Comp Of Hghst Pd Cntrct Or NONENONECompOfHghstPdCntrctOrNONETxt
Contractor Paid Over50k0ContractorPaidOver50kCnt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$5,317,944AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$291,110AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$5,609,054TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$5,609,054AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$84,136CashDeemedCharitableAmt
Net Vl Noncharitable Assets$5,524,918NetVlNoncharitableAssetsAmt
Minimum Investment Return$276,246MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$276,246MinimumInvestmentReturnAmt
Tax Based On Investment Income$5,824TaxBasedOnInvestmentIncomeAmt
Total Tax$5,824TotalTaxAmt
Distributable Before Adj$270,422DistributableBeforeAdjAmt
Recoveries Qualfied Distri$0RecoveriesQualfiedDistriAmt
Distributable Before Ded$270,422DistributableBeforeDedAmt
Deduction From Distributable$0DeductionFromDistributableAmt
Distributable As Adjusted$270,422DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

FieldValueIRS element (for citing)
Expenses And Contributions$268,739ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Qualifying Distributions$268,739QualifyingDistributionsAmt
Pct Sect4940e Org Net Invst Incm$0PctSect4940eOrgNetInvstIncmAmt
Adjusted Qualifying Distri$268,739AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$270,422DistributableAsAdjustedAmt
Undistributed Income PY$256,917UndistributedIncomePYAmt
Total For Prior Years$0TotalForPriorYearsAmt
Total Excess Distribution Cyov$0TotalExcessDistributionCyovAmt
Qualifying Distributions$268,739QualifyingDistributionsAmt
Applied To Year1$256,917AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$11,822AppliedToCurrentYearAmt
Remaining Distri From Corpus$0RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$0TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$258,600UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$0ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$0ExcessDistriCyovToNextYrAmt

Supplementary Information SupplementaryInformationGrp

Application Submission Info ApplicationSubmissionInfoGrp

FieldValueIRS element (for citing)
Recipient PersonTOM LUTSEYRecipientPersonNm

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line16177 KIEHNAU ROADAddressLine1Txt
CityEGG HARBORCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54209ZIPCd
FieldValueIRS element (for citing)
Recipient Phone9203399823RecipientPhoneNum
Form And Info And MaterialsNO STANDARD FORM OR APPLICATION PROCESS IS REQUIRED BY THE FOUNDATION.FormAndInfoAndMaterialsTxt
Submission DeadlinesNONESubmissionDeadlinesTxt
Restrictions On AwardsNONERestrictionsOnAwardsTxt

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (30 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
AMERICAN HEART ASSOCIATION
PO BOX 50035PRESCOTTAZ863045035NONEPCMEDICAL RESEARCH SUPPORT$200
BIG BROTHERS BIG SISTERS GREEN BAY
1345 W MASON ST 210GREEN BAYWI54303NONEPCBOWL-A-THON$473
BOYS AND GIRLS CLUB OF DOOR COUNTY
55 S 3RD AVESTURGEON BAYWI54235NONEPCFOOD PROGRAMS$10,000
BOYS AND GIRLS CLUB OF DOOR COUNTY
55 S 3RD AVESTURGEON BAYWI54235NONEPCSUMMER REMOTE LEARNING PROGRAMS$10,000
BOYS AND GIRLS CLUB OF DOOR COUNTY
55 S 3RD AVESTURGEON BAYWI54235NONEPCGENERAL SUPPORT FOR ANNUAL OPERATIONS$19,000
CATHOLIC YOUTH EXPEDITIONS
1000 WISCONSIN 96APPLETONWI54914NONEPCTO FUND PROGRAMS THAT SUPPORT THE ORGANIZATION'S RELIGIOUS BELIEFS$500
DEPERE CHRISTIAN OUTREACH
506 BUTLER STREETDE PEREWI54115NONEPCTO SUPPORT COMMUNITY OUTREACH EFFORTS$5,000
DOOR COUNTY ECONOMIC DEVELOPMENT
222 N 3RD AVESTURGEON BAYWI54235NONEPCSPONSOR LOCAL DEVELOPMENT EFFORTS$200
DOOR COUNTY LAND TRUST
PO BOX 65STURGEON BAYWI54235NONEPCSPONSOR FOR NATURE PRESERVES$300
FAMILY FARMED
7115 W NORTH AVE 504OAK PARKIL60302NONEPCGENERAL SUPPORT FOR ANNUAL OPERATIONS$10,000
FEED AND CLOTHE MY PEOPLE
204 N 14TH AVESTURGEON BAYWI54235NONEPCTO FEED AND CLOTHE THOSE IN NEED$476
GOLDEN HOUSE
PO BOX 727GREEN BAYWI54305NONEPCGOLD RIBBON BBQ$25,000
GREATER GREEN BAY COMMUNITY FOUNDATION
320 N BROADWAY STREET SUITE 260GREEN BAYWI54303NONEPCSCHOLARSHIPS$41,000
HOUSE OF HOPE GREEN BAY
1660 CHRISTIANA STGREEN BAYWI54303NONEPCKEY TO HOPE PLEDGE/TOUCHDOWN FOR HOPE CAPITAL CAMPAIGN$40,000
JACKIE NITSCHKE CENTER INC
630 CHERRY STREETGREEN BAYWI54301NONEPCH.A.L.O. CAMPAIGN$5,000
JACKSONPORT FIRE DEPARTMENT
6622 MEMORIAL DRIVEEGG HARBORWI54209NONEPCGENERAL OPERATIONS OF THE FIRE DEPARTMENT$5,000
NEW COMMUNITY SHELTER
301 MATHER STGREEN BAYWI54303NONEPCWINTER COAT CAMPAIGN AND GENERAL OPERATIONS$15,000
NOTRE DAME ACADEMY
610 MARYHILL DRIVEGREEN BAYWI54303NONEPCSTUDENT SUPPORT FOR EDUCATION$500
PRIESTS OF THE SACRED HEART
6889 S LOVERS LANE RDFRANKLINWI53132NONEPCGENERAL OPERATIONS$1,600
REST HAVEN CEMETARY PROJECT
3115 MERCEDES DRGREEN BAYWI54313NONEPCTREE REMOVAL$300
RIDGES SANCTUARY
8270 WISCONSIN 57BAILEYS HARBORWI54202NONEPCFESTIVAL OF NATURE SPONSORSHIP$2,500
UNIVERSITY OF NEBRASKA FOUNDATION
2285 S 67TH ST 200OMAHANE68106NONEPCLYMPHOMA STUDY$25,000
FEEDING AMERICA EASTERN WISCONSIN
1700 W FOND DU LAC AVENUEMILWAUKEEWI53205NONEPCTO SUPPORT HUNGER RELIEF$20,000
LAKESHORE CAP INC
PO BOX 2315MANITOWOCWI54220NONEPCTO SUPPORT COMMUNITY, FAMILY, CHILD, AND HOUSING SERVICES$2,000
ST VINCENT DE PAUL
1529 LEO FRIGO WAYGREEN BAYWI54302NONEPCPROVIDE FOR COMMUNITY NEEDS$2,500
SECOND HARVEST FOODBANK
2802 DAIRY DRIVEMADISONWI53718NONEPCADOPT-A-DAIRY COW PROGRAM$560
SUAMICO UNITED METHODIST CHURCH
3266 LAKEVIEW DRSUAMICOWI54173NONEPCRELIGIOUS SUPPORT$500
SUNSHINE HOUSE INC
55 WEST YEW STREETSTURGEON BAYWI54235NONEPCSUPPORT PROGRAMS FOR SPECIAL NEEDS INDIVIDUALS$436
ENCOMPASS EARLY EDUCATION AND CARE
PO BOX 1627GREEN BAYWI54305NONEPCCHILD CARE AND EDUCATION$13,000
BETSYS BLANKETS INC
3510 NORTH HAMILTON AVENUECHICAGOIL60618NONEPCTO PROVIDE BLANKETS AND BEDDING$250
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$256,295TotalGrantOrContriPdDurYrAmt
Total Grant Or Contri Apprv Fut$0TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$126,248ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Exclusion18ExclusionCd
Exclusion$340,976ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$0UnrelatedBusinessTaxblIncmAmt
Exclusion$467,224ExclusionAmt
Related Or Exempt Function Incm$0RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$467,224TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EO0RelationshipsNonchrtblEOInd

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

FieldValueIRS element (for citing)
CategoryTAX PREPARATION FEECategoryTxt
Amt$10,489Amt
Net Investment Income$5,244NetInvestmentIncomeAmt
Disbursements Charitable Prps$5,245DisbursementsCharitablePrpsAmt

Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule

Investments Corporate Bonds InvestmentsCorporateBondsGrp

FieldValueIRS element (for citing)
BondML #2183 CORPORATE BONDSBondNm
EOY Book Value$42,929EOYBookValueAmt
EOYFMV$47,969EOYFMVAmt

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corporate Stock InvestmentsCorporateStockGrp (9 entries)

StockStockNmEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
ML #2176 EQUITIES$1,832,368$2,373,108
ML #2183 MUTUAL FDS/CLOSED END FDS$127,405$133,422
ML #2017$1,662,330$1,688,638
BLACKSTONE ALTERNATIVES SOLUTION 2014 TRUST$123,196$107,440
BREP EUROPE IV REAL ESTATE FUND$231,250$83,763
CRESCENT VI MEZZANINE$279,750$81,872
BLACKSTONE ALTERNATIVES SOLUTION IV FUND$301,000$316,836
BLACKSTONE ALTERNATIVES SOLUTION V FUND$141,000$146,385
ML #2184 EQUITIES$553,327$662,944

Investments Govt Obligations Sch InvestmentsGovtObligationsSch

FieldValueIRS element (for citing)
US Govt Obligations Book Vl EOY$68,623USGovtObligationsBookVlEOYAmt
US Govt Obligations EOYFMV$75,285USGovtObligationsEOYFMVAmt
State Local Sec Book Vl EOY$0StateLocalSecBookVlEOYAmt
State Local Sec EOYFMV$0StateLocalSecEOYFMVAmt

Investments Other Schedule2 InvestmentsOtherSchedule2

Investments Other InvestmentsOtherGrp (3 entries)

Category Or ItemCategoryOrItemTxtListed At Cost Or FMVListedAtCostOrFMVCdBook ValueBookValueAmtEOYFMVEOYFMVAmt
GREEN BAY PACKERS SUPER BOWL RINGAT COST$20,000$20,000
ACP POWER AND ENERGY REAL ASSETFUNDAT COST$0$128,472
LS REAL ESTATE RECOVERTY IV TRUSTAT COST$85,824$70,447

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (7 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
WIRE FEE$180$90$90
MERRILL LYNCH BROKERAGE FEES$28,505$28,505$0
LUTSEY ENTERPRISES MANAGEMENT FEE$11,000$5,500$5,500
OUTSIDE SERVICES$2,729$1,365$1,364
BANK SERVICE CHARGES$431$431$0
MISC$2,014$0$0
OTHER INVESTMENT EXPENSES PARTNERSHIPS$18,671$2,644$0

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail

FieldValueIRS element (for citing)
CategoryE&S ENTREPRENEUR ADVISORSCategoryTxt
Amt$490Amt
Net Investment Income$245NetInvestmentIncomeAmt
Disbursements Charitable Prps$245DisbursementsCharitablePrpsAmt

Substantial Contributors Sch SubstantialContributorsSch

Substantial Contributor Detail SubstantialContributorDetail

FieldValueIRS element (for citing)
PersonJEFFREY G JACOBSONPersonNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1127 CHEVY CHASE DRIVEAddressLine1Txt
CityWAYZATACityNm
State AbbreviationMNStateAbbreviationCd
ZIP55391ZIPCd

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail (2 entries)

CategoryCategoryTxtAmtAmtNet Investment IncomeNetInvestmentIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
MERRILL LYNCH FOREIGN TAXES$4,179$4,179$0
EXCISE TAX$11,733$0$0

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