2020-07-15T11:28:48-05:00 2019-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1200 PORTLAND OR 97205 990PF 2019-01-01 474432319 DUTCH BROS FOUNDATION DUTC 5419554700 300 NORTH VALLEY DR GRANTS PASS OR 97526 KEITH THOMAJAN SECRETARY/TREASURER 5419554700 2020-07-12 1 WENDY CAMPOS P00448102 5032421447 2020-07-12 2019 2022-09-23 18:48:47Z X X 5828357 X 5681521 0 287 0 5681808 0 0 0 0 21922 0 21922 15655 0 15655 1114 0 1114 45837 0 45837 1254 0 0 85782 0 84528 1874517 1874517 1960299 0 1959045 3721509 0 593602 1367797 1367797 25000 25000 25000 25000 1488246 4435560 4435560 2106848 5828357 5828357 0 0 X 0 0 0 0 2106848 5828357 2106848 5828357 2106848 5828357 2106848 3721509 0 5828357 0 5828357 0 4821074 383808 12.561161 2228719 343114 6.495564 1695982 228806 7.412314 231978 19209 12.076527 38.545566 9.636392 989477 9534988 0 9534988 4906359 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 OR 1 0 0 1 0 1 N/A RYAN ADAMS 5419554700 300 NORTH VALLEY DR GRANTS PASS OR 97526 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 TRAVIS BOERSMA 300 NORTH VALLEY DR GRANTS PASS OR 97526 DIRECTOR/PRESIDENT 1.00 0 0 0 BRIAN MAXWELL 300 NORTH VALLEY DR GRANTS PASS OR 97526 SECRETARY/TREASURER 1.00 0 0 0 BRANT BOERSMA 300 NORTH VALLEY DR GRANTS PASS OR 97526 DIRECTOR 1.00 0 0 0 CHRISTINE SCHMIDT 300 NORTH VALLEY DR GRANTS PASS OR 97526 DIRECTOR 1.00 0 0 0 AMBER BOERSMA 300 NORTH VALLEY DR GRANTS PASS OR 97526 DIRECTOR 1.00 0 0 0 NONE 0 NONE 0 IN 2017 DUTCH BROS FOUNDATION FORMERLY KNOWN AS LOVE ABOUNDS FOUNDATION ENTERED INTO A 10-YEAR LEASE AGREEMENT WITH JOSEPHINE COUNTY AND IN THE CURRENT YEAR INCURRED EXPENSES ASSOCIATED WITH THE DEVELOPMENT OF A MULTI-USE TURF FIELD AT THE JOSEPHINE COUNTY FAIRGROUNDS. THE FIELD WILL BE USED FOR VARIOUS YOUTH SOCCER, SOFTBALL, AND FOOTBALL ACTIVITIES. ACTIVELY ENGAGING YOUTH TO LEARN, GROW, AND BECOME THE BEST VERSION OF THEMSELVES AND SUPPORTING YOUTH SPORTS IS A KEY CHARITABLE PURPOSE OF THE FOUNDATION. THE DEVELOPMENT OF THIS TURF FIELD WILL BE IN-LINE WITH THE FOUNDATION'S CORE PURPOSE OF SERVING THE YOUTH IN THE COMMUNITY. ONCE THE FIELD IS COMPLETE THERE WILL BE A NOMINAL CHARGE FOR USE OF THE FIELD EQUAL TO WHAT THE SCHOOL DISTRICT CHARGES FOR USE OF THEIR FIELDS. 2947314 0 0 1004545 0 1004545 0 0 1004545 15068 989477 49474 49474 0 49474 287 49761 0 49761 1959045 0 2947314 4906359 0 4906359 49761 0 0 231436 1684542 2211563 4801384 8928925 4906359 0 0 0 49761 4856598 0 0 13785523 0 0 0 0 0 0 0 13785523 231436 1684542 2211563 4801384 4856598 TRAVIS BOERSMA JAMIE STACEY PO BOX 1929 GRANTS PASS OR 97528 5419554700 UPON INVITATION, APPLICANTS ARE REQUIRED TO SUBMIT TAX ID NUMBER AND DESCRIPTION OF THEIR PROGRAM. NO FORM IS REQUIRED TO BE SUBMITTED. ROLLING DEADLINE - APPLICATIONS BY INVITATION ONLY. AWARDS ARE NOT GIVEN TO POLITICAL OR RELIGION-BASED ORGANIZATIONS. AWARDING IS FOCUSED ON THE SEVEN STATES IN WHICH DUTCH BROS. COFFEE CURRENTLY EXISTS. ADDITIONALLY, AWARDS MAY INCLUDE PHILANTHROPY THAT ENCOMPASSES DUTCH BROS. COFFEE SUPPLY LINE, SUCH AS COFFEE BEANS, DAIRY, ETC., WHICH HAPPENS IN DIVERSE LOCATIONS. MUSCULAR DYSTROPHY ASSOCIATION 4800 SW MACADAM AVENUE SUITE 205 PORTLAND OR 97239 PC DRINK ONE FOR DANE 1349483 OHSU FOUNDATION MAIL STOP 45 PO BOX 4000 PORTLAND OR 97208 PC KNIGHT CANCER INSTITUTE 302388 FUNDACION CARCAFE CARRERA 11A NO 5-167 CARTAGOVALLE DEL CAUCA CO NC ORIGINS PROJECT 70000 GLASSWING INTERNATIONAL 55 EXCHANGE PLACE SUITE 405 NEW YORK NY 10005 PC YEAR 1 OF 3 - ADDED PROJECT COMPONENTS 54214 ALBIE AWARE 1851 HERITAGE LANE SUITE 299 SACRAMENTO CA 95815 PC TO SUPPORT BREAST CANCER AWARENESS AND SERVICES 31132 LINFIELD COLLEGE 900 SE BAKER STREET MCMINNVILLE OR 97128 PC SOCCER/LACROSSE FIELD COMPLEX PROJECT 25000 GRANTS PASS ATHLETIC BOOSTERS 725 NE DEAN DRIVE GRANTS PASS OR 97526 PC MEL INGRAM FIELD RE-TURF PROJECT 20000 SOUTHERN OREGON UNIVERSITY 1250 SISKIYOU BOULEVARD ASHLAND OR 97520 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 10000 YOUTH 71 FIVE MINISTRIES 1051 SE M STREET GRANTS PASS OR 97526 PC JOSEPHINE CO PROGRAM EXPANSION ON BEHALF OF EMERGING LEADERS FOR AT RISK YOUTH 5000 JOSEPHINE COUNTY EDUCATIONAL FUND PO BOX 908 GRANTS PASS OR 97528 PC WISEMAN SCHOLARSHIP CONTRIBUTION 4000 HELPING HANDS INTERNATIONAL 600 WHITMAN PLACE MEDFORD OR 97501 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 1580 ROC FOOD PANTRY 564 SW FOUNDRY STREET GRANTS PASS OR 97526 PC LOVE ABOUNDS GIVEBACK 1000 KNIGHT CANCER INSTITUTE 1121 SW SALMON STREET SUITE 100 PORTLAND OR 97205 PC BCA MUGS 720 1874517 GRANTS PASS YMCA PO BOX 5439 GRANTS PASS OR 97527 PC TO SUPPORT POSITIVE AND CONSTRUCTIVE ENVIRONMENT FOR YOUTH SPORTS IN SOUTHERN OREGON 80000 JOSEPHINE COUNTY EDUCATIONAL FUND PO BOX 908 GRANTS PASS OR 97528 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 25000 CHARITABLE PARTNERSHIP FUND PO BOX 13276 PORTLAND OR 97213 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 25000 NATIVE AMERICAN YOUTH AND FAMILY CENTER 5135 NE COLUMBIA BOULEVARD PORTLAND OR 97218 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 10000 COLLEGE DREAMS 2158 NE INDUSTRY DRIVE GRANTS PASS OR 97526 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 10000 LATINO NETWORK 410 NE 18TH AVENUE PORTLAND OR 97232 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 10000 METROPOLITAN FAMILY SERVICES 1808 SE BELMONT STREET PORTLAND OR 97214 PC TO FIGHT HUNGER IN COMMUNITIES THROUGH SUPPORT OF LOCAL FOOD BANKS 10000 OREGON SHAKESPEARE FESTIVAL PO BOX 158 ASHLAND OR 97520 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 10000 OREGON COAST AQUARIUM 2820 SE FERRY SLIP ROAD NEWPORT OR 97365 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 10000 TREES WATER & PEOPLE 633 REMINGTON STREET FORT COLLINS CO 80524 PC TO HELP COMMUNITIES TO PROTECT, CONSERVE, AND MANAGE THEIR NATURAL RESOURCES 10000 UNITED WAY OF THE COLUMBIA WILLAMETTE 619 SW 11TH AVENUE PORTLAND OR 97205 PC TO FIGHT HUNGER IN COMMUNITIES THROUGH SUPPORT OF LOCAL FOOD BANKS 10000 THE FRIENDS OF THE OREGON CAVES PO BOX 2195 GRANTS PASS OR 97528 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 10000 BEAVERTON HIGH SCHOOL SUCCESS FUND PO BOX 892 BEAVERTON OR 97075 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 10000 REBECCA BENDER INITIATIVE 560 NE F STREET SUITE A628 GRANTS PASS OR 97526 PC ELEVATE ACADEMY 10000 NORTH VALLEY HIGH SCHOOL 6741 MONUMENT DRIVE GRANTS PASS OR 97526 GOV VOLLEYBALL PROGRAM 2000 CAMPUS COMPACT OF OREGON 620 SW 5TH AVENUE SUITE 910 PORTLAND OR 97204 PC TO FULFILL YOUNG PEOPLES' EDUCATIONAL EXPERIENCE AND PROMOTE THEIR WELLBEING 1000 FUNDACION CARCAFE CARRERA 11A NO 5-167 CARTAGOVALLE DEL CAUCA CO NC ORIGINS PROJECT 30000 273000 REFUND OF PRIOR YEAR GRANTS 01 287 0 287 0 287 0 0 0 0 0 0 0 0 0 0 X X 1 BOERSMA BROS LLC PO BOX 1929 GRANTS PASS OR 97528 3483669 X 2 DB FRANCHISING LLC PO BOX 1929 GRANTS PASS OR 97528 1231613 X 3 JIM THOMPSON PO BOX 1929 GRANTS PASS OR 97528 123146 X 4 AARON EASTMAN PO BOX 1929 GRANTS PASS OR 97528 61660 X 5 TY SULLIVAN PO BOX 1929 GRANTS PASS OR 97528 48555 X 6 CALEB BERKEY PO BOX 1929 GRANTS PASS OR 97528 47182 X 7 BRENT GENESIS WILSON PO BOX 1929 GRANTS PASS OR 97528 36321 X 8 BRIAN WIGHT PO BOX 1929 GRANTS PASS OR 97528 33772 X 9 CHRIS STEWART PO BOX 1929 GRANTS PASS OR 97528 30565 X 10 TORANI 233 EAST HARRIS AVENUE FAIR OAKS CA 94080 25000 X 11 JEFF MEEGAN YARNALL PO BOX 1929 GRANTS PASS OR 97528 24331 X 12 DAN RICHARDSON PO BOX 1929 GRANTS PASS OR 97528 23782 X 13 KENNY STROMER PO BOX 1929 GRANTS PASS OR 97528 23011 X 14 ABE MENSHENFRIEND PO BOX 1929 GRANTS PASS OR 97528 22653 X 15 KEVIN MURPHY PO BOX 1929 GRANTS PASS OR 97528 22199 X 16 DUTCH BROS LLC PO BOX 1929 GRANTS PASS OR 97528 22000 X 17 RYAN HAWKINS PO BOX 1929 GRANTS PASS OR 97528 20234 X 18 RITA TRAVIS PICKERN PO BOX 1929 GRANTS PASS OR 97528 20108 X 19 STEVE NIKOL GRUBBS PO BOX 1929 GRANTS PASS OR 97528 20050 X 20 SEAN PROVOST PO BOX 1929 GRANTS PASS OR 97528 20000 X 21 SHANE JENN ROBERTS PO BOX 1929 GRANTS PASS OR 97528 16422 X 22 NATE FRARY PO BOX 1929 GRANTS PASS OR 97528 15183 X 23 KERRY KEVIN PARKER PO BOX 1929 GRANTS PASS OR 97528 14479 X 24 BOB LENGWIN PO BOX 1929 GRANTS PASS OR 97528 13974 X 25 MATT MICHELLE CAMERON PO BOX 1929 GRANTS PASS OR 97528 13921 X 26 BRAD MEGHAN BARNES PO BOX 1929 GRANTS PASS OR 97528 13852 X 27 TINA THOMPSON MIKE GONZALES PO BOX 1929 GRANTS PASS OR 97528 13769 X 28 KORY SPENCER PO BOX 1929 GRANTS PASS OR 97528 13566 X 29 BRIAN MATTIE PLACE PO BOX 1929 GRANTS PASS OR 97528 12801 X 30 ANDREW SHAYNA RANDALL PO BOX 1929 GRANTS PASS OR 97528 12259 X 31 CARRIE WALL PO BOX 1929 GRANTS PASS OR 97528 11448 X 32 MARC LEE PO BOX 1929 GRANTS PASS OR 97528 11250 X 33 CHRIS ERIN RESNER PO BOX 1929 GRANTS PASS OR 97528 10514 X 34 KAYLEIGH SLOVER PO BOX 1929 GRANTS PASS OR 97528 10210 X 35 JESSICA SIMON PO BOX 1929 GRANTS PASS OR 97528 10150 X 36 KYLE HAILEY GARRETT PO BOX 1929 GRANTS PASS OR 97528 10135 X 37 JOE LAWLESS PO BOX 1929 GRANTS PASS OR 97528 10025 X 38 PACTIV 1000 DIAMOND AVENUE RED BLUFF CA 96080 10000 X 39 CLAYTON REINHART PO BOX 1929 GRANTS PASS OR 97528 9711 X 40 DAVE EMILY BEAMER PO BOX 1929 GRANTS PASS OR 97528 9452 X 41 JEFF BRANDI BULLER PO BOX 1929 GRANTS PASS OR 97528 8944 X 42 DERRICK DANIELLE FLECK PO BOX 1929 GRANTS PASS OR 97528 8766 X 43 JARED NUNNEMAKER PO BOX 1929 GRANTS PASS OR 97528 8716 X 44 ANDY JILL HEAD PO BOX 1929 GRANTS PASS OR 97528 8287 X 45 JEREMY HEATHER MAUEL PO BOX 1929 GRANTS PASS OR 97528 6210 X 46 TONY JANTZER PO BOX 1929 GRANTS PASS OR 97528 6109 X 47 ERIN BATES PO BOX 1929 GRANTS PASS OR 97528 5834 X 48 MIKE BOJARSKI PO BOX 1929 GRANTS PASS OR 97528 5671 X 49 JIMMY DANIELLE CROCKER PO BOX 1929 GRANTS PASS OR 97528 5511 X 50 MARK KARLA LUNA PO BOX 1929 GRANTS PASS OR 97528 5292 X ACCOUNTING FEES 15655 0 15655 FUNDACION CARCAFE CARRERA 11A NO 5-167 CARTAGOVALLE DEL CAUCA CO 2019-04-15 100000 COFFEE ORIGINS PROJECT (COLOMBIA)- A SOCIAL INTERVENTION PROJECT FOR SUSTAINABILITY COFFEE GROWING, FOOD SECURITY FOR FARMERS AND FAMILIES, AND EDUCATION FOR HEALTHY EATING HABITS AND NUTRITION. 70000 5/15/2019, 6/15/2019, 7/15/2019, 8/15/2019, 9/15/2019, 10/15/2019, 11/15/201 AMENDED RETURN FORM 990-PF THIS RETURN HAS BEEN AMENDED TO REPORT AND PROVIDE SPECIFIC INFORMATION FOR AN EXPENDITURE RESPONSIBILITY GRANT MADE BY DUTCH BROS FOUNDATION TO FUNDACION CARCAFE. THE AMENDED RETURN REPORTS THE FOLLOWING CHANGES: PART VII-B, LINE 5A(4) IS ANSWERED YES.PART VII-B, LINE 5B IS ANSWERED YES.PART VII-B, LINE 5C IS ANSWERED YES.ATTACHED IS AN EXPENDITURE RESPONSIBILITY STATEMENT (STATEMENT 8) FOR THE FUNDACION CARCAFE GRANT IN THE AMOUNT OF $100,000 EXECUTED ON APRIL 15, 2019. THE AMOUNT EXPENDED DURING THE YEAR WAS $70,000. PART XV, LINE 3B HAS INCREASED FROM $243,000 TO $273,000 FOR THE ADDITIONAL PROMISE TO PAY OF $30,000 TO FUNDACION CARCAFE. IN ADDITION, PART XV, LINE 3A RECIPIENT NAME HAS BEEN UPDATED FROM THE FRIENDS OF THE OREGON CAVES WHICH HAD A DUPLICATE LISTING OF A $10,000 GRANT TO THE CORRECT RECIPIENT, OR SOUTHERN OREGON UNIVERSITY. LEGAL FEES 21922 0 21922 LAAM PROJECT COSTS 1488246 4435560 4435560 INSURANCE 1254 0 0 REFUND OF PRIOR YEAR GRANTS 287 287 CONSULTING FEES 1114 0 1114