HANSEN FAMILY FOUNDATION: Form 990PF, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- HANSEN FAMILY FOUNDATION (EIN 41-1740710)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-05-11
- IRS object ID
- 201731319349102393
- 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 Other Schedule2
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-11T15:29:39-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baker Tilly Virchow Krause LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 S 6th St 2300 | 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 | 411740710 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hansen Family Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HANS | BusinessNameControlTxt |
| Phone | 9529129895 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15413 Milan Way | AddressLine1Txt |
| City | Naples | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34110 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HARVEY HANSEN | PersonNm |
| Person Title | TRUSTEE | PersonTitleTxt |
| Phone | 9529129895 | PhoneNum |
| Signature | 2017-05-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Therese M Nelson CPA | PreparerPersonNm |
| PTIN | P00035774 | PTIN |
| Phone | 6128764500 | PhoneNum |
| Preparation | 2017-05-10 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 38.88.188.75 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-05-10 | IPDt |
| IP Tm | 13:55:12 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2519A5C6D4FE43330A9B665C55E2C286A0409372 | 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 | $3,968,410 | 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 |
| Dividends Rev And Expnss | $77,009 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $77,009 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $96,286 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $2,126,968 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $96,286 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $173,295 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $173,295 | 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 | $12,000 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $0 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Chrtbl Prps | $12,000 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $55,278 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $55,278 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $0 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $1,105 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $1,080 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $25 | TaxesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $68,383 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $56,358 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $12,025 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $190,200 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $190,200 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $258,583 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $56,358 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $202,225 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$85,288 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $116,937 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $123,940 | CashBOYAmt |
| Cash EOY | $629,581 | CashEOYAmt |
| Cash EOYFMV | $629,581 | CashEOYFMVAmt |
| Other Investments BOY | $3,518,764 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $2,927,835 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $3,338,829 | OtherInvestmentsEOYFMVAmt |
| Total Assets BOY | $3,642,704 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,557,416 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $3,968,410 | 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 | $3,642,704 | RetainedEarningBOYAmt |
| Retained Earning EOY | $3,557,416 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $3,642,704 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $3,557,416 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $3,642,704 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $3,557,416 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $3,642,704 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$85,288 | ExcessRevenueOverExpensesAmt |
| Other Increases | $0 | OtherIncreasesAmt |
| Subtotal | $3,557,416 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $3,557,416 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (5 entries)
| PropertyPropertyDesc | How AcquiredHowAcquiredCd | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt |
|---|---|---|---|---|---|
| FIDELITY SHORT TERM GAIN | P | $1,676,787 | $1,665,290 | $11,497 | $11,497 |
| FIDELITY LONG TERM GAIN | P | $416,324 | $365,392 | $50,932 | $50,932 |
| FIDELITY CASH IN LIEU | P | $28 | $28 | $28 | |
| FIDELITY RETURN OF PRINCIPAL | P | $251 | $251 | $251 | |
| Capital Gains Dividends | P | $33,578 | $33,578 | $33,578 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $96,286 | CapitalGainNetIncomeAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | 0 | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $210,624 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $4,166,845 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 0.050548 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $204,175 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $4,291,284 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 0.047579 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $182,125 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $4,033,582 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 0.045152 | DistributionYr3Rt |
| Adjusted Qlfy Distri Yr4 | $174,525 | AdjustedQlfyDistriYr4Amt |
| Net Vl Noncharitable Assets Yr4 | $3,678,273 | NetVlNoncharitableAssetsYr4Amt |
| Distribution Yr4 | 0.047448 | DistributionYr4Rt |
| Adjusted Qlfy Distri Yr5 | $164,600 | AdjustedQlfyDistriYr5Amt |
| Net Vl Noncharitable Assets Yr5 | $3,714,211 | NetVlNoncharitableAssetsYr5Amt |
| Distribution Yr5 | 0.044316 | DistributionYr5Rt |
| Total Distribution | 0.235043 | TotalDistributionRt |
| Average Distribution | 0.047009 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $3,899,472 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $183,310 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $1,169 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $184,479 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $202,225 | 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 | $1,169 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $1,169 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $1,169 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $4,868 | EstimatedPlusOvpmtIncmTxAmt |
| Total Payments And Credits | $4,868 | TotalPaymentsAndCreditsAmt |
| Overpayment | $3,699 | OverpaymentAmt |
| Applied To ES Tax | $3,699 | 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 | HARVEY C HANSEN TRUSTEE | IndividualWithBooksNm |
| Phone | 9529129895 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15413 MILAN WAY | AddressLine1Txt |
| City | NAPLES | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34110 | 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 |
|---|---|---|---|---|---|---|---|---|
| HARVEY C HANSEN | ||||||||
| 15413 MILAN WAY | NAPLES | FL | 34110 | TRUSTEE | 0.00 | $0 | $0 | $0 |
| CARL M HANSEN | ||||||||
| 4960 LINCOLN DRIVE | EDINA | MN | 55436 | TRUSTEE | 0.00 | $0 | $0 | $0 |
| KELSEY L PIQUETTE | ||||||||
| 4505 GILFORD DRIVE | EDINA | MN | 55435 | TRUSTEE | 0.00 | $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 | $3,708,652 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $250,203 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $3,958,855 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $3,958,855 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $59,383 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $3,899,472 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $194,974 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $194,974 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $1,169 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $1,169 | TotalTaxAmt |
| Distributable Before Adj | $193,805 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $193,805 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $193,805 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $202,225 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $202,225 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $1,169 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $201,056 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $193,805 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $189,230 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Total Excess Distribution Cyov | $0 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $202,225 | QualifyingDistributionsAmt |
| Applied To Year1 | $189,230 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $12,995 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $0 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $0 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Prior Year Deficiency Or Tax | $0 | PriorYearDeficiencyOrTaxAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $180,810 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $0 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $0 | ExcessDistriCyovToNextYrAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (17 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| ALZHEIMER'S FOUNDATION OF AMERICA | |||||||
| 322 EIGHTH AVE 7TH FLOOR | NEW YORK | NY | 10001 | N/A | 501C3 | CHARITABLE | $500 |
| AMERICAN LUNG ASSOCIATION | |||||||
| 490 CONCORDIA AVE | SAINT PAUL | MN | 55103 | N/A | 501C3 | CHARITABLE | $1,000 |
| AVOW HOSPICE | |||||||
| 1095 WHIPPORWILL LANE | NAPLES | FL | 34105 | N/A | 501C3 | CHARITABLE | $250 |
| CHILDRENS CANCER RESEARCH | |||||||
| 7801 EAST BUSH LAKE RD STE 130 | MINNEAPOLIS | MN | 55439 | N/A | 501C3 | MEDICAL | $35,000 |
| MAJESTIC HILLS RANCH | |||||||
| 24580 DAKOTA AVENUE | LAKEVILLE | MN | 55044 | N/A | 501C3 | CHARITABLE | $5,000 |
| MAYO CLINIC | |||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | N/A | 501C3 | MEDICAL | $15,000 |
| MINNEAPOLIS HEART INSTITUTE FOUNDATION | |||||||
| 920 EAST 28TH STREET STE 100 | MINNEAPOLIS | MN | 55407 | N/A | 501C3 | MEDICAL | $10,000 |
| MINNESOTANS MILITARY APPRECIATION FUND | |||||||
| PO BOX 2070 | MINNEAPOLIS | MN | 55402 | N/A | 501C3 | CHARITABLE | $12,500 |
| MYOSITIS ASSOCIATION | |||||||
| 1737 KING STREET STE 600 | ALEXANDRIA | VA | 22314 | N/A | 501C3 | CHARITABLE | $1,000 |
| NCH HEALTHCARE FOUNDATION | |||||||
| PO BOX 234 | NAPLES | FL | 34106 | N/A | 501C3 | CHARITABLE | $10,000 |
| NORWAY HOUSE | |||||||
| 913 E FRANKLIN AVE | MINNEAPOLIS | MN | 55404 | N/A | 501C3 | CHARITABLE | $1,500 |
| PATRIOT PAWS | |||||||
| 254 RANCH TRAIL | ROCKWALL | TX | 75032 | N/A | 501C3 | CHARITABLE | $6,000 |
| SHRINERS HOSPITALS FOR CHILDREN | |||||||
| 2900 ROCKY POINT DRIVE | TAMPA | FL | 33607 | N/A | 501C3 | CHARITABLE | $10,000 |
| TEXAS CHRISTIAN UNIVERISTY | |||||||
| 2800 S UNIVERSITY DR | FORT WORTH | TX | 76129 | N/A | 501C3 | EDUCATIONAL | $5,000 |
| THE BLAKE SCHOOL | |||||||
| 110 BLAKE ROAD | HOPKINS | MN | 55343 | N/A | 501C3 | CHARITABLE | $20,000 |
| USA HIGH SCHOOL CLAY TARGET LEAGUE | |||||||
| 1408 NORTHLAND DRIVE | MENDOTA HEIGHTS | MN | 55120 | N/A | 501C3 | CHARITABLE | $7,000 |
| WISHES & MORE | |||||||
| 961 HILLWIND ROAD | FRIDLEY | MN | 55432 | N/A | 501C3 | CHARITABLE | $50,450 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $190,200 | TotalGrantOrContriPdDurYrAmt |
| Total Grant Or Contri Apprv Fut | $0 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $77,009 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $96,286 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $173,295 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $173,295 | 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 | ACCOUNTING FEES | CategoryTxt |
| Amt | $12,000 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $12,000 | DisbursementsCharitablePrpsAmt |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category Or Item | STOCKS & BONDS | CategoryOrItemTxt |
| Listed At Cost Or FMV | AT COST | ListedAtCostOrFMVCd |
| Book Value | $2,927,835 | BookValueAmt |
| EOYFMV | $3,338,829 | EOYFMVAmt |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| MANAGEMENT FEES | $55,268 | $55,268 | $0 |
| INVESTMENT EXPENSES | $10 | $10 | $0 |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| FOREIGN TAX WITHHELD | $1,080 | $1,080 | $0 |
| MINNESOTA FILING FEE | $25 | $0 | $25 |