CLOVERFIELDS FOUNDATION: Form 990PF, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- CLOVERFIELDS FOUNDATION (EIN 20-1919362)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-10-09
- IRS object ID
- 201712829349100506
- Schema version
- 2016v3.0
- 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
- Investments Other Schedule2
- Other Decreases Schedule
- Other Expenses Schedule
- Other Increases Schedule
- Other Liabilities Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-10-09T10:28:55-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410223337 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DORSEY & WHITNEY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 S 6TH ST STE 1500 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201919362 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLOVERFIELDS FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLOV | BusinessNameControlTxt |
| Phone | 6124926440 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O DEAN BARR 50 S 6TH ST NO 1500 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554021498 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEPHEN J HEMSLEY | PersonNm |
| Person Title | DIR, PRESIDENT & TREAS | PersonTitleTxt |
| Phone | 6124926440 | PhoneNum |
| Signature | 2017-09-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DEAN D BARR | PreparerPersonNm |
| PTIN | P00005626 | PTIN |
| Phone | 6123402600 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 170.112.1.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-09-16 | IPDt |
| IP Tm | 18:43:14 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | C2AEB2E99CB8C284634A7F756EE3244E165BBE2D | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | AFD1374F89352E82E27ED5861037FD12B89EFF54 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $26,401,439 | 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 | $97 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $97 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $334,691 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $334,691 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $492,671 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $3,902,606 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $492,671 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $827,459 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $827,459 | 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 | $7,000 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $0 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Chrtbl Prps | $0 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $145,662 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $145,662 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $0 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $85,514 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $0 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $0 | TaxesDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $360 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $0 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $0 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $238,536 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $145,662 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $0 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $2,334,620 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $2,334,620 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $2,573,156 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $145,662 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $2,334,620 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$1,745,697 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $681,797 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $6,856,325 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $5,428,472 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $5,428,472 | SavAndTempCashInvstEOYFMVAmt |
| Corporate Stock BOY | $12,532,780 | CorporateStockBOYAmt |
| Corporate Stock EOY | $12,116,610 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $17,352,967 | CorporateStockEOYFMVAmt |
| Invst Land Cost Or Other Basis | $4,607,141 | InvstLandCostOrOtherBasisAmt |
| Land Bldg Investments BOY | $4,607,141 | LandBldgInvestmentsBOYAmt |
| Land Bldg Investments EOY | $4,607,141 | LandBldgInvestmentsEOYAmt |
| Land Bldg Investments EOYFMV | $3,370,000 | LandBldgInvestmentsEOYFMVAmt |
| Other Investments BOY | $250,000 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $250,000 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $250,000 | OtherInvestmentsEOYFMVAmt |
| Total Assets BOY | $24,246,246 | TotalAssetsBOYAmt |
| Total Assets EOY | $22,402,223 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $26,401,439 | TotalAssetsEOYFMVAmt |
| Other Liabilities BOY | $682 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $0 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $682 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
| 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 | $24,245,564 | RetainedEarningBOYAmt |
| Retained Earning EOY | $22,402,223 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $24,245,564 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $22,402,223 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $24,246,246 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $22,402,223 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $24,245,564 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$1,745,697 | ExcessRevenueOverExpensesAmt |
| Other Increases | $400 | OtherIncreasesAmt |
| Subtotal | $22,500,267 | SubtotalAmt |
| Other Decreases | $98,044 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $22,402,223 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Property | PUBLICLY TRADED SECURITIES | PropertyDesc |
| Gross Sales Price | $3,902,606 | GrossSalesPriceAmt |
| Cost Or Other Basis | $3,409,935 | CostOrOtherBasisAmt |
| Gain Or Loss | $492,671 | GainOrLossAmt |
| Gains Minus Excess Or Losses | $492,671 | GainsMinusExcessOrLossesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $492,671 | CapitalGainNetIncomeAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | 0 | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $2,300,568 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $24,416,202 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 0.094223 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $1,742,188 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $24,724,198 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 0.070465 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $758,833 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $21,421,018 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 0.035425 | DistributionYr3Rt |
| Adjusted Qlfy Distri Yr4 | $2,619,806 | AdjustedQlfyDistriYr4Amt |
| Net Vl Noncharitable Assets Yr4 | $19,918,409 | NetVlNoncharitableAssetsYr4Amt |
| Distribution Yr4 | 0.131527 | DistributionYr4Rt |
| Adjusted Qlfy Distri Yr5 | $2,596,576 | AdjustedQlfyDistriYr5Amt |
| Net Vl Noncharitable Assets Yr5 | $16,445,165 | NetVlNoncharitableAssetsYr5Amt |
| Distribution Yr5 | 0.157893 | DistributionYr5Rt |
| Total Distribution | 0.489533 | TotalDistributionRt |
| Average Distribution | 0.097907 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $22,317,203 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $2,185,010 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $6,818 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $2,191,828 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $2,334,620 | QualifyingDistributionsAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Domestic Org Meeting Sect4940e | Yes (X) | DomesticOrgMeetingSect4940eInd |
| Investment Income Excise Tax | $6,818 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $6,818 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $6,818 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $19,473 | EstimatedPlusOvpmtIncmTxAmt |
| Applied To Es Tax | $3,000 | AppliedToEsTaxAmt |
| Total Payments And Credits | $22,473 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Overpayment | $15,655 | OverpaymentAmt |
| Applied To ES Tax | $15,655 | 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 |
| Individual With Books | DEAN D BARR DORSEY WHITNEY LLP | IndividualWithBooksNm |
| Phone | 6124926440 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 SOUTH 6TH STREET SUITE 1500 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554021498 | 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 |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (3 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 |
|---|---|---|---|---|---|---|---|---|
| STEPHEN J HEMSLEY | ||||||||
| 622 FERNDALE ROAD WEST | WAYZATA | MN | 55391 | DIR, PRESIDENT & TREAS | 1.00 | $0 | $0 | $0 |
| BARBARA K HEMSLEY | ||||||||
| 622 FERNDALE ROAD WEST | WAYZATA | MN | 55391 | DIRECTOR, SECRETARY | 0.50 | $0 | $0 | $0 |
| MATTHEW S HEMSLEY | ||||||||
| 4620 MOORELAND AVENUE | EDINA | MN | 55424 | 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 | $16,342,554 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $6,314,505 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $22,657,059 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $22,657,059 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $339,856 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $22,317,203 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $1,115,860 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $1,115,860 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $6,818 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $6,818 | TotalTaxAmt |
| Distributable Before Adj | $1,109,042 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $1,109,042 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $1,109,042 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $2,334,620 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $2,334,620 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $6,818 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $2,327,802 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $1,109,042 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $1,799,718 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $1,673,624 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr2 | $512,813 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $1,080,646 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $5,066,801 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $2,334,620 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $1,109,042 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $1,225,578 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $6,292,379 | 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 | $1,799,718 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $4,492,661 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $1,673,624 | ExcessFromYear4Amt |
| Excess From Year2 | $512,813 | ExcessFromYear2Amt |
| Excess From Year1 | $1,080,646 | ExcessFromYear1Amt |
| Excess From Current Year | $1,225,578 | ExcessFromCurrentYearAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | STEPHEN J HEMSLEY | ContributingManagerNm |
| Contributing Manager | BARBARA K HEMSLEY | ContributingManagerNm |
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (27 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| AMERICAN DIABETES ASSOCIATION | |||||||
| 1245 E BRICKYARD ROAD SUITE 30 | SALT LAKE CITY | UT | 84106 | N/A | PUBLIC CHARITY | TOUR DE CURE | $25,000 |
| BASILICA OF ST MARY'S | |||||||
| BOX 50010 | MINNEAPOLIS | MN | 554050010 | N/A | PUBLIC CHARITY | GENERAL OPERATING FUND | $35,000 |
| BISHOP MCDEVITT HIGH SCHOOL | |||||||
| 125 ROYAL AVE | WYNCOTE | PA | 190951198 | N/A | PUBLIC CHARITY | GENERAL OPERATING FUND | $50,000 |
| CHURCH OF THE ASCENSION | |||||||
| 1726 DUPONT AVE N | MINNEAPOLIS | MN | 55411 | N/A | PUBLIC CHARITY | FUNDING FOR THE ASCENSION CATHOLIC SCHOOL | $50,000 |
| COMMONWEAL FOUNDATION | |||||||
| 475 RIVERSIDE DRIVE | NEW YORK | NY | 10115 | N/A | PUBLIC CHARITY | GENERAL OPERATING FUND | $25,000 |
| CRISTO REY JESUIT HIGH SCHOOL | |||||||
| 2924 4TH AVE S | MINNEAPOLIS | MN | 554084194 | N/A | PUBLIC CHARITY | GENERAL OPERATING FUND | $50,000 |
| FIGHTING CHANCE INC | |||||||
| 901 HENNEPIN AVENUE | MINNEAPOLIS | MN | 55403 | N/A | PRIVATE FOUNDATION | GENERAL OPERATING FUND | $50,000 |
| FORDAM UNIVERSITY | |||||||
| 888 7TH AVE | NEW YORK | NY | 10019 | N/A | PUBLIC CHARITY | FOOTBALL OFFICE RENOVATIONS AND FORDHAM FUND SCHOLARSHIPS | $50,000 |
| GEORGETOWN UNIVERSITY | |||||||
| BOX 571253 | WASHINGTON | DC | 200571253 | N/A | PUBLIC CHARITY | CLASS OF 1964 ENDOWED FUND | $600,000 |
| GUTHRIE THEATRE | |||||||
| 818 SOUTH 2ND STREET | MINNEAPOLIS | MN | 55415 | N/A | PUBLIC CHARITY | GENERAL OPERATING FUND | $10,000 |
| INNER CITY TENNIS | |||||||
| 4005 NICOLLET AVE S | MINNEAPOLIS | MN | 55409 | N/A | PUBLIC CHARITY | GENERAL OPERATING FUND | $25,000 |
| INTERFAITH OUTREACH & COMMUNITY PARTNERS | |||||||
| 1605 COUNTY ROAD 101 | PLYMOUTH | MN | 554472708 | N/A | PUBLIC CHARITY | STABILIZE STRENGTHEN AND THRIVE CAMPAIGN | $200,000 |
| INTERFAITH OUTREACH & COMMUNITY PARTNERS | |||||||
| 1605 COUNTY ROAD 101 | PLYMOUTH | MN | 554472708 | N/A | PUBLIC CHARITY | 2016 SLEEP OUT | $150,000 |
| MINNEAPOLIS INSTITUTE OF ARTS | |||||||
| 2400 THIRD AVE S | MINNEAPOLIS | MN | 55404 | N/A | PUBLIC CHARITY | GENERAL OPERATING FUND | $25,000 |
| MINNEAPOLIS INSTITUTE OF ARTS | |||||||
| 2400 THIRD AVE S | MINNEAPOLIS | MN | 55404 | N/A | PUBLIC CHARITY | ART IN BLOOM PROGRAM | $1,000 |
| ST BARTHOLOMEW CATHOLIC FAITH COMMUNITY | |||||||
| 630 E WAYZATA BLVD | WAYZATA | MN | 55391 | N/A | PUBLIC CHARITY | GENERAL OPERATING FUND | $7,500 |
| ST OLAF CHURCH | |||||||
| 215 S 8TH STREET | MINNEAPOLIS | MN | 55402 | N/A | PUBLIC CHARITY | GENERAL OPERATING FUND | $10,000 |
| TEENAGER'S INC | |||||||
| 105 BETHLEHEM PIKE | PHILADELPHIA | PA | 19118 | N/A | PUBLIC CHARITY | GENERAL OPERATING FUND | $5,000 |
| THE CHILDREN'S THEATRE | |||||||
| 2400 THIRD AVE S | MINNEAPOLIS | MN | 554043597 | N/A | PUBLIC CHARITY | CAPITAL CAMPAIGN | $100,000 |
| THE CHILDREN'S THEATRE | |||||||
| 2400 THIRD AVE S | MINNEAPOLIS | MN | 554043597 | N/A | PUBLIC CHARITY | FUNDING FOR CURTAIN CALL BALL | $20,000 |
| THE LEAD PROJECT | |||||||
| 5640 ELLIOT AVENUE | MINNEAPOLIS | MN | 55417 | N/A | PUBLIC CHARITY | GENERAL OPERATING FUND | $5,000 |
| THE MINNEAPOLIS FOUNDATION | |||||||
| 800 IDS CENTER 80 S 8TH STREET | MINNEAPOLIS | MN | 55402 | N/A | PUBLIC CHARITY | PAY IT FORWARD FOREVER FUND | $25,000 |
| THE SAINT PAUL SEMINARY | |||||||
| 2260 SUMMIT AVENUE | ST PAUL | MN | 551051094 | N/A | PUBLIC CHARITY | I WILL GIVE YOU SHEPHERDS CAMPAIGN | $200,000 |
| UNITED HEALTHCARE CHILDREN'S FOUNDATION | |||||||
| MN012-S286 PO BOX 41 | MINNEAPOLIS | MN | 554400041 | N/A | PUBLIC CHARITY | FUNDING FOR MEDICAL GRANTS OF CHILDREN IN NEED | $7,500 |
| UNIVERSITY OF MINNESOTA FOUNDATION | |||||||
| 200 OAK STREET SE SUITE 500 | MINNEAPOLIS | MN | 554552010 | N/A | PUBLIC CHARITY | CHILDREN'S HEALTH DISCOVERY FUND | $8,620 |
| UNIVERSITY OF MINNESOTA FOUNDATION | |||||||
| 200 OAK STREET SE SUITE 500 | MINNEAPOLIS | MN | 554552010 | N/A | PUBLIC CHARITY | UROLOGIC CANCER TREATMENT OUTCOMES RESEARCH | $100,000 |
| UNIVERSITY OF ST THOMAS | |||||||
| 2115 SUMMIT AVENUE | ST PAUL | MN | 551051096 | N/A | PUBLIC CHARITY | CLOVERFIELDS ENDOWED SCHOLARSHIP | $500,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $2,334,620 | 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 | $97 | ExclusionAmt |
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $334,691 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $492,671 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $827,459 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $827,459 | 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 | DORSEY & WHITNEY | CategoryTxt |
| Amt | $7,000 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp (34 entries)
| StockStockNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| 2900 SHS ACE LIMITED | $0 | $0 |
| 1069 SHS ADIENT PLC | $49,799 | $62,643 |
| 2570 SHS ALLERGAN PLC | $0 | $0 |
| 651 SHS ALPHABET INC (CLASS C) | $283,180 | $502,455 |
| 175 SHS ALPHABET INC (CLASS A) | $41,166 | $138,679 |
| 19,100 SHS AMERICAN INTERNATIONAL GROUP INC | $973,650 | $1,247,421 |
| 2310 SHS APPLE INC | $198,107 | $267,544 |
| 6200 SHS BALL CORP | $439,671 | $465,434 |
| 2200 SHS CELGENE CORP | $123,185 | $254,650 |
| 1500 SHS CHEVRON | $115,815 | $176,550 |
| 5000 SHS CHUBB CORP | $0 | $0 |
| 5909 SHS CHUBB LTD | $465,117 | $780,697 |
| 18,000 SHS CIT GROUP INC | $827,732 | $768,240 |
| 9800 SHS CITIGROUP INC | $492,328 | $582,414 |
| 2300 SHS COMCAST CORP | $41,829 | $158,815 |
| 9500 SHS DANAHER CORP | $533,951 | $739,480 |
| 10,000 SHS DELPHI AUTOMOTIVE | $506,132 | $673,500 |
| 12,900 SHS DELTA AIR LINES INC | $407,763 | $634,551 |
| 4750 SHS FORTIVE CORPORATION | $166,124 | $254,743 |
| 28,900 SHS GENERAL ELECTRIC COMPANY | $748,918 | $913,240 |
| 4300 SHS GILEAD SCIENCES INC | $334,880 | $307,923 |
| 12,800 SHS JOHNSON CONTROLS INC | $0 | $0 |
| 10,696 SHS JOHNSON CONTROLS | $488,700 | $440,568 |
| 8300 SHS JPMORGAN CHASE & CO | $483,321 | $716,207 |
| 11,400 SHS KINDER MORGAN INC | $0 | $0 |
| 4000 SHS METLIFE INC | $136,200 | $215,560 |
| 2300 SHS MICROSOFT CORP | $64,083 | $142,922 |
| 18,800 SHS ORACLE CORP | $605,748 | $722,860 |
| 13,600 SHS REPUBLIC SERVICES INC | $0 | $0 |
| 5500 SHS SCHLUMBERGER LTD | $454,474 | $461,725 |
| 5800 SHS THERMO FISHER SCIENTIFIC INC | $485,185 | $818,380 |
| 5800 SHS UNITED PARCEL SVC INC | $517,128 | $664,912 |
| 24,000 SHS UNITEDHEALTH GROUP | $1,802,064 | $3,840,960 |
| 2200 SHS WHIRLPOOL CORP | $330,360 | $399,894 |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category Or Item | GATHER INC | CategoryOrItemTxt |
| Listed At Cost Or FMV | AT COST | ListedAtCostOrFMVCd |
| Book Value | $250,000 | BookValueAmt |
| EOYFMV | $250,000 | EOYFMVAmt |
Other Decreases Schedule OtherDecreasesSchedule
Other Decreases Detail OtherDecreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | STOCK BASIS ADJ (DONOR BASIS VS FMV) | Desc |
| Amt | $98,044 | Amt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (2 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| OTHER | $260 | $0 | $0 |
| WIRE FEES | $100 | $0 | $0 |
Other Increases Schedule OtherIncreasesSchedule
Other Increases Detail OtherIncreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PRIOR YEAR BASIS ADJUSTMENT | Desc |
| Amt | $400 | Amt |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO CLOVER FIELDS CAPITAL, LLC DUE TO BANK ERROR | Desc |
| BOY Book Value | $682 | BOYBookValueAmt |
| EOY Book Value | $0 | EOYBookValueAmt |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | INVESTMENT FEES | CategoryTxt |
| Amt | $145,662 | Amt |
| Net Investment Income | $145,662 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| REAL ESTATE TAXES | $72,014 | $0 | $0 |
| EXCISE TAXES | $13,500 | $0 | $0 |
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