GOSTOMSKI FOUNDATION: Form 990PF, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- GOSTOMSKI FOUNDATION (EIN 46-6976292)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-01
- IRS object ID
- 201723059349100117
- 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
- Investments Corp Stock Schedule
- Investments Other Schedule2
- Legal Fees Schedule
- Other Assets Schedule
- Other Expenses Schedule
- Other Income Schedule2
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-01T11:11:42-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 320077509 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HARRISON & HELD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 W WACKER DR SUITE 1700 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | 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 | 466976292 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE GOSTOMSKI FOUNDATION | BusinessNameLine1Txt |
| Business Name Line2 | C/O ROBERT T NAPIER HARRISON & HELD | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOST | BusinessNameControlTxt |
| Phone | 3123321111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 W WACKER DRIVE NO 1700 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL M GOSTOMSKI | PersonNm |
| Person Title | TRUSTEE | PersonTitleTxt |
| Phone | 3123321111 | PhoneNum |
| Signature | 2017-11-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARGARET A NAGELA | PreparerPersonNm |
| PTIN | P00439254 | PTIN |
| Phone | 3123321111 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 38.104.243.90 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-01 | IPDt |
| IP Tm | 11:07:10 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 02374B44CFED657A389FA1F0857AA3CA1AD63B3A | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 02374B44CFED657A389FA1F0857AA3CA1AD63B3A | 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 | $5,874,731 | 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 | $42,841 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $42,841 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $64,586 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $64,586 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $949,873 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $3,133,882 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $949,873 | CapGainNetIncmNetInvstIncmAmt |
| Other Income Rev And Expnss | $6,896 | OtherIncomeRevAndExpnssAmt |
| Other Income Net Invst Incm | $6,896 | OtherIncomeNetInvstIncmAmt |
| Total Rev And Expnss | $1,064,196 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $1,064,196 | 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 |
| Legal Fees Rev And Expnss | $11,044 | LegalFeesRevAndExpnssAmt |
| Legal Fees Net Invst Incm | $11,044 | LegalFeesNetInvstIncmAmt |
| Legal Fees Dsbrs Chrtbl | $0 | LegalFeesDsbrsChrtblAmt |
| Other Prof Fees Rev And Expnss | $10,082 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $10,082 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $0 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $148 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $148 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $0 | TaxesDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $36,840 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $36,840 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $0 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $58,114 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $58,114 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $0 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $461,488 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $461,488 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $519,602 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $58,114 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $461,488 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $544,594 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $1,006,082 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $320,171 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $414,078 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $414,078 | SavAndTempCashInvstEOYFMVAmt |
| Corporate Stock BOY | $3,367,307 | CorporateStockBOYAmt |
| Corporate Stock EOY | $2,962,738 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $2,949,906 | CorporateStockEOYFMVAmt |
| Other Investments BOY | $1,813,024 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $2,623,682 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $2,510,747 | OtherInvestmentsEOYFMVAmt |
| Other Assets BOY | -$40,760 | OtherAssetsBOYAmt |
| Other Assets EOY | $3,838 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $0 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $5,459,742 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,004,336 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $5,874,731 | TotalAssetsEOYFMVAmt |
| Total Liabilities BOY | $0 | 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 | $5,459,742 | RetainedEarningBOYAmt |
| Retained Earning EOY | $6,004,336 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $5,459,742 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $6,004,336 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $5,459,742 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $6,004,336 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $5,459,742 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $544,594 | ExcessRevenueOverExpensesAmt |
| Other Increases | $0 | OtherIncreasesAmt |
| Subtotal | $6,004,336 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $6,004,336 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (14 entries)
| PropertyPropertyDesc | AcquiredAcquiredDt | SoldSoldDt | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt | How AcquiredHowAcquiredCd |
|---|---|---|---|---|---|---|---|
| 25,000 CREDIT SUISSE - A/C 14615 | 2015-01-16 | 2016-07-20 | $250,000 | $250,000 | $0 | $0 | |
| 22,000 FASTENAL CO - A/C 14615 | $985,594 | $220 | $985,374 | $985,374 | |||
| UBS A/C 14616 - DETAILS PROVIDED UPON REQUEST | $399,701 | $401,311 | -$1,610 | -$1,610 | |||
| UBS A/C 14616 - DETAILS PROVIDED UPON REQUEST | $50,704 | $54,364 | -$3,660 | -$3,660 | |||
| UBS A/C 14616 - FNMA PRINCIPAL PAYMENTS | $57 | $57 | $57 | ||||
| UBS A/C 14618 - DETAILS PROVIDED UPON REQUEST | $1,231,409 | $1,246,106 | -$13,959 | -$13,959 | |||
| UBS A/C 14618 - DETAILS PROVIDED UPON REQUEST | $113,517 | $123,447 | -$9,584 | -$9,584 | |||
| UBS A/C 16116 - DETAILS PROVIDED UPON REQUEST | $7,123 | $6,313 | $810 | $810 | |||
| UBS A/C 16116 - DETAILS PROVIDED UPON REQUEST | $92,580 | $91,369 | $1,211 | $1,211 | |||
| AXONIC CREDIT OPPORTUNITIES FUND, LP | -$4,196 | -$4,196 | P | ||||
| AXONIC CREDIT OPPORTUNITIES FUND, LP | -$6,208 | -$6,208 | P | ||||
| SPECIAL CREDIT OPPORTUNITIES, L.P. | $467 | $467 | P | ||||
| SPECIAL CREDIT OPPORTUNITIES, L.P. | -$2,026 | -$2,026 | P | ||||
| CAPITAL GAINS DIVIDENDS | $3,197 | $3,197 | $3,197 | P |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $949,873 | CapitalGainNetIncomeAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | 0 | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $797,022 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $4,451,217 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 0.179057 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $598,590 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $3,545,794 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 0.168817 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $230,000 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $3,601,321 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 0.063865 | DistributionYr3Rt |
| Total Distribution | 0.411739 | TotalDistributionRt |
| Average Distribution | 0.137246 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $6,654,867 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $913,354 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $10,061 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $923,415 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $461,488 | QualifyingDistributionsAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $20,122 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $20,122 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $20,122 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $4,824 | EstimatedPlusOvpmtIncmTxAmt |
| Applied To Es Tax | $20,000 | AppliedToEsTaxAmt |
| Total Payments And Credits | $24,824 | TotalPaymentsAndCreditsAmt |
| Overpayment | $4,702 | OverpaymentAmt |
| Applied To ES Tax | $4,702 | 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 | IL | 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 |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROBERT T NAPIER HARRISON & HELD LLP | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3123321111 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 W WACKER DRIVE SUITE 1700 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL M GOSTOMSKI | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O HH 333 W WACKER DR STE 1700 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Title | TRUSTEE | TitleTxt |
| Average Hrs Per Wk Devoted To Pos | 1.00 | AverageHrsPerWkDevotedToPosRt |
| Compensation | $0 | CompensationAmt |
| Employee Benefit Program | $0 | EmployeeBenefitProgramAmt |
| Expense Account Other Allwnc | $0 | ExpenseAccountOtherAllwncAmt |
| 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 | $4,340,247 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $828,971 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $1,586,992 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $6,756,210 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $6,756,210 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $101,343 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $6,654,867 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $332,743 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $332,743 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $20,122 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $20,122 | TotalTaxAmt |
| Distributable Before Adj | $312,621 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $312,621 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $312,621 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $461,488 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $461,488 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $0 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $461,488 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $312,621 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr3 | $161,279 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $426,340 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $575,731 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $1,163,350 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $461,488 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $312,621 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $148,867 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $1,312,217 | 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 | $0 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $1,312,217 | ExcessDistriCyovToNextYrAmt |
| Excess From Year3 | $161,279 | ExcessFromYear3Amt |
| Excess From Year2 | $426,340 | ExcessFromYear2Amt |
| Excess From Year1 | $575,731 | ExcessFromYear1Amt |
| Excess From Current Year | $148,867 | ExcessFromCurrentYearAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | MICHAEL M GOSTOMSKI | ContributingManagerNm |
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (20 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| ALMOST HOME KIDS | |||||||
| 7S721 ROUTE 53 | NAPERVILLE | IL | 60540 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $1,000 |
| BASILICA OF ST STANISLAUS KOSTKA | |||||||
| 625 E 4TH STREET | WINONA | MN | 55987 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $10,500 |
| BOYS & GIRLS CLUBS OF GREATER LA CROSSE | |||||||
| 1331 CLINTON STREET | LA CROSSE | WI | 54603 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $25,000 |
| CATHOLIC CHARITIES OF WINONA | |||||||
| 111 MARKET STREET SUITE 2B | WINONA | MN | 55987 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $25,000 |
| CHRISTIAN BROTHERS OF THE MIDWEST | |||||||
| 7650 COUNTY LINE ROAD | BURR RIDGE | IL | 60527 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $15,000 |
| EAGLE BLUFF ENVIRONMENTAL LEARNING CENTER | |||||||
| 28097 GOODVIEW DRIVE | LANESBORO | MN | 55949 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $20,000 |
| GOOD SHEPHERD LUTHERAN SCHOOL | |||||||
| 3201 COURT STREET | PEKIN | IL | 61554 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $8,000 |
| GREAT RIVER SHAKESPEARE FESTIVAL | |||||||
| 450 JOHNSON STREET | WINONA | MN | 55987 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $10,000 |
| GUNDERSON LUTHERAN MEDICAL FOUNDATION | |||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | NONE | PUBLIC CHARITY | GENERAL PURPOSESGENERAL PURPOSES | $70,000 |
| MINNESOTA MARINE ART MUSEUM | |||||||
| 800 RIVERVIEW DRIVE | WINONA | MN | 55987 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $20,000 |
| MORRIE MILLER ATHLETIC FOUNDATION | |||||||
| 580 E FRONT STREET | WINONA | MN | 55987 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $10,000 |
| PAULIST FATHERS - BOSTON FOUNDATION | |||||||
| 5 PARK STREET | BOSTON | MA | 02108 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $40,000 |
| POLISH CULTURAL INSTITUTE | |||||||
| 350 5TH AVENUE SUITE 4621 | NEW YORK | NY | 10118 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $3,000 |
| SAINT ELIZABETH'S COMMUNITY DEVELOPMENT FOUNDATION | |||||||
| 1200 GRANT BOULEVARD WEST | WABASHA | MN | 55981 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $20,000 |
| SAINT JOHN PAUL II NATIONAL SHRINE | |||||||
| 3900 HAREWOOD ROAD NE | WASHINGTON | DC | 20017 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $5,000 |
| SAINT MARY'S UNIVERSITY OF MINNESOTA | |||||||
| 700 TERRACE HEIGHTS | WINONA | MN | 55987 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $10,000 |
| THE ISLANDER FOUNDATION | |||||||
| 25 GROVE STREET | MINNEAPOLIS | MN | 55401 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $27,000 |
| UNIVERSITY OF WISCONSIN - RIVER FALLS | |||||||
| 410 S 3RD STREET | RIVER FALLS | MN | 54022 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $113,888 |
| WINONA ATHLETIC CLUB | |||||||
| 5TH STREET | WINONA | MN | 55987 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $18,100 |
| WINONA STATE UNIVERSITY | |||||||
| 175 W MARK STREET | WINONA | MN | 55987 | NONE | PUBLIC CHARITY | GENERAL PURPOSES | $10,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $461,488 | 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 | $42,841 | ExclusionAmt |
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $64,586 | ExclusionAmt |
Other Investment Incm Part VII OtherInvestmentIncmPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $6,896 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $949,873 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $1,064,196 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $1,064,196 | 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 |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp (3 entries)
| StockStockNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| UBS A/C Y4 14615 - EQUITIES | $1,486,044 | $1,343,980 |
| UBS A/C Y4 14618 - EQUITIES | $1,011,680 | $1,095,386 |
| UBS A/C Y4 16116 - EQUITIES | $465,014 | $510,540 |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (6 entries)
| Category Or ItemCategoryOrItemTxt | Listed At Cost Or FMVListedAtCostOrFMVCd | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| UBS A/C Y4 14615 - PRIVATE EQUITY | AT COST | $1,755,474 | $1,673,969 |
| UBS A/C Y4 14616 - FIXED INCOME | AT COST | $347,671 | $349,819 |
| AXONIC CREDIT OPPORTUNITIES FUND | AT COST | $0 | $0 |
| LOCUPLETO II - AI, LLC | AT COST | $33,578 | $0 |
| SPECIAL CREDIT OPPORTUNITIES FUND | AT COST | $424,805 | $424,805 |
| BRIGHTWATER HOLDINGS SERIES D | AT COST | $62,154 | $62,154 |
Legal Fees Schedule LegalFeesSchedule
Legal Fees LegalFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | HARRISON & HELD, LLP | CategoryTxt |
| Legal Fees | $11,044 | LegalFeesAmt |
| Net Investment Income | $11,044 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ADJUSTMENT TO BASIS FOR THE VARIOUS INVESTMENTS | Desc |
| BOY Book Value | -$40,760 | BOYBookValueAmt |
| EOY Book Value | $3,838 | EOYBookValueAmt |
| EOYFMV | $0 | EOYFMVAmt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (4 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| UBS INVESTMENT EXPENSES | $1 | $1 | $0 |
| AXONIC CREDIT OPPORTUNITIES FUND, LP | $3,930 | $3,930 | $0 |
| ALPHAKEYS KKR ENERGY INCOME FUND, L.L.C. | $19,154 | $19,154 | $0 |
| SPECIAL CREDIT OPPORTUNITIES L.P. | $13,755 | $13,755 | $0 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail (12 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Adjusted Net IncomeAdjustedNetIncomeAmt |
|---|---|---|---|
| UBS A/C Y4 14615 - OTHER INCOME | $72,288 | $72,288 | $72,288 |
| UBS A/C Y4 14616 - NONDIVIDEND DISTRIBUTIONS | $54 | $54 | $54 |
| UBS A/C Y4 16116 - NONDIVIDEND DISTRIBUTIONS | $105 | $105 | $105 |
| UBS A/C Y4 14618 - NONDIVIDEND DISTRIBUTIONS | $10,786 | $10,786 | $10,786 |
| UBS A/C Y4 14618 - SECTION 1250 GAIN | $5 | $5 | $5 |
| AXONIC CREDIT OPPORTUNITIES FUND, LP | -$13,481 | -$13,481 | -$13,481 |
| ALPHAKEYS KKR ENERGY INCOME FUND, L.L.C. | $19,621 | $19,621 | $19,621 |
| ALPHAKEYS KKR ENERGY INCOME FUND, L.L.C. | $5,202 | $5,202 | $5,202 |
| BRIGHTWATER HOLDINGS SERIES D | -$6,373 | -$6,373 | -$6,373 |
| SPECIAL CREDIT OPPORTUNITIES, L.P. | $26 | $26 | $26 |
| SPECIAL CREDIT OPPORTUNITIES, L.P. | $5,597 | $5,597 | $5,597 |
| LOCUPLETO II - AI, LLC | -$86,934 | -$86,934 | -$86,934 |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail (3 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| UBS ACCOUNT FEES (14616) | $1,793 | $1,793 | $0 |
| UBS ACCOUNT FEES (14618) | $5,608 | $5,608 | $0 |
| UBS ACCOUNT FEES (16116) | $2,681 | $2,681 | $0 |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| FOREIGN TAX UBS 14618 | $106 | $106 | $0 |
| SPECIAL CREDIT FOREIGN TAX | $42 | $42 | $0 |
Comments