THE ROBERTS FAMILY FOUNDATION: Form 990PF, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
THE ROBERTS FAMILY FOUNDATION (EIN 74-2269660)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-04-08
IRS object ID
201440989349100709
Schema version
2013v3.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2014-04-08T12:32:10-07:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1HARKER MELLINGER CPAs LLCBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11470 Sugarland Dr Ste 1AddressLine1
CitySheridanCity
StateWYState
ZIP Code82801ZIPCode
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN742269660EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1THE ROBERTS FAMILY FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlROBEBusinessNameControlTxt
Phone3076720785PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11470 SUGARLAND DRIVE SUITE 1AddressLine1
CitySHERIDANCity
StateWYState
ZIP Code82801ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDONALD B ROBERTSPersonNm
Person TitlePRESIDENTPersonTitleTxt
Signature2014-04-08SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonALICIA COX CPAPreparerPersonNm
PTINP00633076PTIN
Phone3076720785PhoneNum
Self EmployedYes (X)SelfEmployedInd
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-12-30 17:16:21ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$1,682,151FMVAssetsEOYAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Interest On Sav Rev And Expnss$3InterestOnSavRevAndExpnssAmt
Interest On Sav Net Invst Incm$3InterestOnSavNetInvstIncmAmt
Interest On Savings Adj Net Incm$3InterestOnSavingsAdjNetIncmAmt
Dividends Rev And Expnss$42,924DividendsRevAndExpnssAmt
Dividends Net Invst Incm$42,924DividendsNetInvstIncmAmt
Dividends Adj Net Incm$42,924DividendsAdjNetIncmAmt
Net Gain Sale Ast Rev And Expnss$499,619NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$1,708,054GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$499,619CapGainNetIncmNetInvstIncmAmt
Net ST Capital Gain Adj Net Incm$574NetSTCapitalGainAdjNetIncmAmt
Total Rev And Expnss$542,546TotalRevAndExpnssAmt
Total Net Invst Incm$542,546TotalNetInvstIncmAmt
Total Adj Net Incm$43,501TotalAdjNetIncmAmt
Taxes Rev And Expnss$1,489TaxesRevAndExpnssAmt
Taxes Net Invst Incm$1,191TaxesNetInvstIncmAmt
Taxes Dsbrs Chrtbl$298TaxesDsbrsChrtblAmt
Other Expenses Rev And Expnss$9,498OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$7,598OtherExpensesNetInvstIncmAmt
Other Expenses Dsbrs Chrtbl$1,900OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$10,987TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$8,789TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$2,198TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$34,900ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$34,900ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$45,887TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$8,789TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$37,098TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses$496,659ExcessRevenueOverExpensesAmt
Net Investment Income$533,757NetInvestmentIncomeAmt
Adjusted Net Income$43,501AdjustedNetIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Sav And Temp Cash Invst BOY$16,299SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$46,111SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$46,111SavAndTempCashInvstEOYFMVAmt
Prepaid Expenses EOY$800PrepaidExpensesEOYAmt
Corporate Stock BOY$1,183,609CorporateStockBOYAmt
Corporate Stock EOY$1,649,656CorporateStockEOYAmt
Corporate Stock EOYFMV$1,636,040CorporateStockEOYFMVAmt
Total Assets BOY$1,199,908TotalAssetsBOYAmt
Total Assets EOY$1,696,567TotalAssetsEOYAmt
Total Assets EOYFMV$1,682,151TotalAssetsEOYFMVAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind
Retained Earning BOY$1,199,908RetainedEarningBOYAmt
Retained Earning EOY$1,696,567RetainedEarningEOYAmt
Tot Net Ast Or Fund Balances BOY$1,199,908TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$1,696,567TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$1,199,908TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$1,696,567TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$1,199,908TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses$496,659ExcessRevenueOverExpensesAmt
Subtotal$1,696,567SubtotalAmt
Tot Net Ast Or Fund Balances EOY$1,696,567TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (78 entries)

PropertyPropertyDescHow AcquiredHowAcquiredCdAcquiredAcquiredDtSoldSoldDtGross Sales PriceGrossSalesPriceAmtCost Or Other BasisCostOrOtherBasisAmtGain Or LossGainOrLossAmtGains Minus Excess Or LossesGainsMinusExcessOrLossesAmt
6.2850 SEI EMERGING MARKETS DEBT FD #98P2012-06-182013-01-11$73$72$1$1
36.7220 SEI EMERGING MARKETS DEBT FD #98P2012-06-182013-02-04$424$420$4$4
82.9960 SEI MULTI-ASSETT ACCUM-AP2012-06-182013-02-04$871$831$40$40
60.0550 SEI MULTI-ASSET ACCUM-AP2012-06-182013-03-11$639$601$38$38
11.3920 SEI MULTI-ASSET ACCUM-AP2012-06-182013-03-18$122$114$8$8
99.6260 SEI MULTI-ASSET CAP STRAB-AP2012-06-062013-02-04$1,004$996$8$8
14.1320 SEI MULTI-ASSET CAP STRAB-AP2012-06-062013-03-11$143$141$2$2
66.7680 SEI MULTI-ASSET INFL-AP2012-01-012013-01-30$673$649$24$24
53.2750 SEI MULTI-ASSET INFL-AP2012-06-182013-02-04$537$521$16$16
3.6720 SEI EMERGING MARKETS DEBT FD #98P2012-06-182013-10-11$38$42-$4-$4
23.4632 SEI EMERGING MARKETS DEBT FD #98P2012-06-182013-10-25$251$268-$17-$17
15.6198 SEI EMERGING MARKETS DEBT FD #98P2011-01-012013-10-25$167$178-$11-$11
49.2330 SEI MULTI-ASSET ACCUM-AP2012-06-182013-10-12$511$493$18$18
65.7560 SEI MULTI-ASSET ACCUM-AP2012-06-182013-10-25$695$658$37$37
3.2810 SIMT US FIXED INCOME FUND CLASS AP2010-08-262013-03-11$34$35-$1-$1
8.2090 SIMT US FIXED INCOME FUND CLASS AP2011-01-012013-06-18$85$89-$4-$4
1.4540 SIMT US FIXED INCOME FUND CLASS AP2010-10-122013-10-11$15$16-$1-$1
320.2950 SEI GLOBAL MANAGED VOLATILITY FUND-AP2009-11-032013-01-30$3,267$2,444$823$823
66.0650 SEI GLOBAL MANAGED VOLATILITY FUND-AP2009-11-032013-02-04$673$504$169$169
364.6190 SEI GLOBAL MANAGED VOLATILITY FUND-AP2009-11-032013-03-11$3,927$2,782$1,145$1,145
103.5140 SEI GLOBAL MANAGED VOLATILITY FUND-AP2009-11-032013-04-11$1,153$790$363$363
198.7910 SEI GLOBAL MANAGED VOLATILITY FUND-AP2009-11-032013-05-30$2,211$1,517$694$694
2.8650 SEI INST HIGH YIELD BOND FUND #59P2009-11-032013-01-11$22$19$3$3
137.3570 SEI INST HIGH YIELD BOND FUND #59P2009-11-032013-01-30$1,073$913$160$160
73.0040 SEI INST HIGH YIELD BOND FUND #59P2009-01-012013-03-11$572$490$82$82
41.7680 SEI INST HIGH YIELD BOND FUND #59P2009-01-012013-09-06$319$286$33$33
105.7010 SEI INST TR US MGD VOLATILITY-AP2009-11-032013-01-30$1,519$1,004$515$515
15.0110 SEI INST TR US MGD VOLATILITY-AP2009-11-032013-02-04$215$143$72$72
132.2520 SEI INST TR US MGD VOLATILITY-AP2009-11-032013-03-11$1,986$1,256$730$730
161.3590 SEI INST TR US MGD VOLATILITY-AP2009-11-032013-05-30$2,551$1,533$1,018$1,018
44.0220 SEI INST TR US MGD VOLATILITY-AP2009-11-032013-07-11$710$418$292$292
53.06000 SEI INST TR US MGD VOLATILITY-AP2009-11-032013-10-25$887$504$383$383
1.4415 SEI SHORT-DURATION GOVT FUND #45P2011-07-082013-06-18$15$15
1.5135 SEI SHORT-DURATION GOVT FUND #45P2011-07-082013-06-18$16$16
53.9880 SIMT LARGE CAP FUND-AP2011-07-082013-02-04$657$659-$2-$2
58.3130 SIMT LARGE CAP FUND-AP2011-07-082013-03-11$739$711$28$28
6.1750 SIMT LARGE CAP FUND-AP2011-07-082013-03-18$78$75$3$3
17.7220 SIMT LARGE CAP FUND-AP2011-07-082013-05-30$238$216$22$22
49.3760 SIMT LARGE CAP FUND-AP2011-07-082013-06-18$663$602$61$61
31.6150 SIMT LARGE CAP FUND-AP2011-07-082013-07-11$432$386$46$46
17.5050 SIMT LARGE CAP FUND-AP2011-07-082013-09-06$239$214$25$25
18.4080 SIMT LARGE CAP FUND-AP2011-07-082013-09-17$260$225$35$35
99.9600 SIMT MULTI-STRATEGY ALT FUND-CLAP2010-06-162013-01-30$968$989-$21-$21
16.8190 SIMT MULTI-STRATEGY ALT FUND-CLAP2010-06-162013-02-04$163$166-$3-$3
12.0426 SIMT MULTI-STRATEGY ALT FUND-CLAP2010-06-162013-03-11$116$120-$4-$4
4.1544 SIMT MULTI-STRATEGY ALT FUND-CLAP2010-06-162013-03-11$40$41-$1-$1
14.8380 SIMT MULTI-STRATEGY ALT FUND-CLAP2010-06-162013-06-18$144$147-$3-$3
.8779 SIMT MULTI-STRATEGY ALT FUND-CLAP2010-06-162013-09-06$9$9
11.0991 SIMT MULTI-STRATEGY ALT FUND-CLAP2010-06-162013-09-06$108$110-$2-$2
57.3140 SIMT US FIXED INCOME FUND CLASS AP2011-07-082013-10-11$581$600-$19-$19
282.822 SEI INSTL MANAGED TR MULTI ASSET CAPP2013-01-012013-11-19$2,831$2,835-$4-$4
588.656 SEI INSTL MANAGED TR MULTI-INFLATIONP2013-01-012013-11-19$5,533$5,747-$214-$214
390.475 SEI INSTL MANAGED TR MULTI-ASSET ACCUMP2013-01-012013-11-19$4,108$4,027$81$81
134.011 SEI INSTL MANAGED TR STR ALTERNATIVEP2013-01-012013-11-19$1,329$1,287$42$42
96.215 SEI INSTL MANAGED TR LARGE CAP AP2013-01-012013-11-19$1,424$1,124$300$300
132.946 SEL INSTL MANAGED TR REAL RETURN AP2013-01-012013-11-19$1,359$1,373-$14-$14
254.197 SEI INSTL MANAGED TR FIXED INACOME FD AP2013-01-012013-11-19$2,585$2,629-$44-$44
184.673 SEI INSTL MANAGED TR SIMT GL MGDP2012-12-272013-11-19$2,118$1,788$330$330
50.146 SEI INSTL MANAGED TR ENHANCED INCOME AP2013-01-012013-11-19$381$379$2$2
76.404 SEI INSTL MANAGED TR MANAGED VOLATILITYP2013-01-012013-11-19$1,306$1,115$191$191
292.013 SEI INSTL MANAGED TR HIGH YIELD BD CL AP2013-01-012013-11-19$2,272$2,264$8$8
79.788 SEI DAILY INC TR SH TERM GOVT CL AP2013-01-012013-11-19$840$843-$3-$3
330.334 SEI INTL TR EMERG MKT DEBT FUNDP2013-01-012013-11-19$3,412$3,630-$218-$218
44830. FR INTERSTATE BANCSYSTEM COMMONP2005-01-012013-11-22$1,166,456$734,005$432,451$432,451
4547.237 SEI INSTL MANAGED TR MULTI ASSET CAP STAP2005-01-012013-11-19$45,518$45,496$22$22
4482.109 SEI INSTL MANAGED TR MULTI-INFLATION MANP2005-01-012013-11-19$42,132$43,806-$1,674-$1,674
4214.522 SEI INSTL MANAGED TR MULTI-ASSET ACCUMP2005-01-012013-11-19$44,337$42,189$2,148$2,148
3781.510 SEI INSTL MANAGED TR STR ALTERNATIVEP2005-01-012013-11-19$37,513$37,578-$65-$65
1277.517 SEI INSTL MANAGED TR LARGE CAP AP2005-01-012013-11-19$18,907$14,955$3,952$3,952
1758.981 SEL INSTL MANAGED TR REAL RETURN AP2005-01-012013-11-19$17,977$18,777-$800-$800
3525.285 SEI INSTL MANAGED TR FIXED INCOME FD AP2005-01-012013-11-19$35,852$36,960-$1,108-$1,108
6157.805 SEI INSTL MANAGED TR SIMT GL MGDP2005-01-012013-11-19$70,630$53,523$17,107$17,107
2437.168 SEI INSTL MANAGED TR ENHANCED INCOME AP2005-01-012013-11-19$18,522$18,157$365$365
2555.591 SEI INSTL MANAGED TR MANAGED VOLATILITYP2005-01-012013-11-19$43,675$31,714$11,961$11,961
4722.387 SEI INSTL MANAGED TR HIGH YIELD BD CL AP2005-01-012013-11-19$36,740$35,339$1,401$1,401
2207.497 SEI DAILY INC TR SH TERM GOVT CL AP2005-01-012013-11-19$23,245$23,593-$348-$348
1511.183 SEI INTL TR EMERGING MKT DEBT FUNDP2005-01-012013-11-19$15,611$17,274-$1,663-$1,663
L/T CAPITAL GAINSP2001-01-012013-12-31$28,608$28,608$28,608
FieldValueIRS element (for citing)
Capital Gain Net Income$499,619CapitalGainNetIncomeAmt
Net Short Term Capital Gain Loss$574NetShortTermCapitalGainLossAmt

Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp

FieldValueIRS element (for citing)
Liable Section4942 TaxfalseLiableSection4942TaxInd
Adjusted Qlfy Distri Yr1$44,747AdjustedQlfyDistriYr1Amt
Net Vl Noncharitable Assets Yr1$1,134,152NetVlNoncharitableAssetsYr1Amt
Distribution Yr10.03945DistributionYr1Rt
Adjusted Qlfy Distri Yr2$86,700AdjustedQlfyDistriYr2Amt
Net Vl Noncharitable Assets Yr2$1,063,381NetVlNoncharitableAssetsYr2Amt
Distribution Yr20.08153DistributionYr2Rt
Adjusted Qlfy Distri Yr3$134,585AdjustedQlfyDistriYr3Amt
Net Vl Noncharitable Assets Yr3$1,394,468NetVlNoncharitableAssetsYr3Amt
Distribution Yr30.09651DistributionYr3Rt
Adjusted Qlfy Distri Yr4$82,139AdjustedQlfyDistriYr4Amt
Net Vl Noncharitable Assets Yr4$1,362,020NetVlNoncharitableAssetsYr4Amt
Distribution Yr40.06031DistributionYr4Rt
Adjusted Qlfy Distri Yr5$89,657AdjustedQlfyDistriYr5Amt
Net Vl Noncharitable Assets Yr5$1,710,014NetVlNoncharitableAssetsYr5Amt
Distribution Yr50.05243DistributionYr5Rt
Total Distribution0.33024TotalDistributionRt
Average Distribution0.06605AverageDistributionRt
Net Vl Noncharitable Assets$1,402,686NetVlNoncharitableAssetsAmt
Adj Net Vl Noncharitable Assets$92,645AdjNetVlNoncharitableAssetsAmt
Net Investment Income Pct$5,338NetInvestmentIncomePctAmt
Adj Nonchrtbl Net Invst Incm Pct$97,983AdjNonchrtblNetInvstIncmPctAmt
Qualifying Distributions$37,098QualifyingDistributionsAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Investment Income Excise Tax$10,675InvestmentIncomeExciseTaxAmt
Subtotal$10,675SubtotalAmt
Tax Based On Investment Income$10,675TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$800EstimatedPlusOvpmtIncmTxAmt
Total Payments And Credits$800TotalPaymentsAndCreditsAmt
Form2220 AttachedYes (X)Form2220AttachedInd
Es Penalty$2EsPenaltyAmt
Tax Due$9,877TaxDueAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political ActyfalseLegislativePoliticalActyInd
More Than100 SpentfalseMoreThan100SpentInd
Form1120 POL FiledfalseForm1120POLFiledInd
Activities Not Previously RptfalseActivitiesNotPreviouslyRptInd
Changes To Articles Or BylawsfalseChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Form990 T FiledfalseForm990TFiledInd
Organization Dissolved EtcfalseOrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (true)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (true)AtLeast5000InAssetsInd
Form990 PF Filed With Atty GenYes (true)Form990PFFiledWithAttyGenInd
Private Operating FoundationfalsePrivateOperatingFoundationInd
New Substantial ContributorsfalseNewSubstantialContributorsInd
Own Controlled EntityfalseOwnControlledEntityInd
Donor Advised FundfalseDonorAdvisedFundInd
Comply With Public Insp RqrYes (true)ComplyWithPublicInspRqrInd
Website AddressN/AWebsiteAddressTxt

Persons With Books Name PersonsWithBooksName

FieldValueIRS element (for citing)
Business Name Line1DONALD B ROBERTSBusinessNameLine1
FieldValueIRS element (for citing)
Phone3076720785PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line11470 SUGARLAND DR SUITE 1AddressLine1
CitySHERIDANCity
StateWYState
ZIP Code82801ZIPCode
FieldValueIRS element (for citing)
Foreign Accounts QuestionfalseForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified PrsnfalseSaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified PrsnfalseBrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified PrsnfalseFurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified PrsnfalsePayCompDisqualifiedPrsnInd
Transfer Ast Disqualified PrsnfalseTransferAstDisqualifiedPrsnInd
Payment To Government OfficialfalsePaymentToGovernmentOfficialInd
Acts Fail To Qlfy As ExceptionsfalseActsFailToQlfyAsExceptionsInd
Uncorrected Prior ActsfalseUncorrectedPriorActsInd
Undistributed Income PYfalseUndistributedIncomePYInd
Undistr Incm Sect4942a2 Not AppfalseUndistrIncmSect4942a2NotAppInd
Business HoldingsfalseBusinessHoldingsInd
Excess Business HoldingsfalseExcessBusinessHoldingsInd
Jeopardy InvestmentsfalseJeopardyInvestmentsInd
Uncorrected PY Jeopardy InvstfalseUncorrectedPYJeopardyInvstInd
Influence LegislationfalseInfluenceLegislationInd
Influence ElectionfalseInfluenceElectionInd
Grants To IndividualsfalseGrantsToIndividualsInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Noncharitable PurposefalseNoncharitablePurposeInd
Transactions Fail To Qlfy As ExcfalseTransactionsFailToQlfyAsExcInd
Maintained Expenditure RspnsfalseMaintainedExpenditureRspnsInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Proceeds Or Net IncomefalseProceedsOrNetIncomeInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (3 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmt
STACEY ROBERTS
20 PINE LANESHERIDANWY82801Vice President0.00$0
DONALD B ROBERTS
20 PINE LANESHERIDANWY82801PRESIDENT1.00$0
JAY MCGINNIS
417 NORTH JEFFERSON STREETSHERIDANWY82801Secretary0.00$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Comp Of Hghst Pd Cntrct Or NONENONECompOfHghstPdCntrctOrNONETxt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$1,387,542AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$36,505AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$1,424,047TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Adjusted Total FMV Of Unused Ast$1,424,047AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$21,361CashDeemedCharitableAmt
Net Vl Noncharitable Assets$1,402,686NetVlNoncharitableAssetsAmt
Minimum Investment Return$70,134MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$70,134MinimumInvestmentReturnAmt
Tax Based On Investment Income$10,675TaxBasedOnInvestmentIncomeAmt
Total Tax$10,675TotalTaxAmt
Distributable Before Adj$59,459DistributableBeforeAdjAmt
Distributable Before Ded$59,459DistributableBeforeDedAmt
Distributable As Adjusted$59,459DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

FieldValueIRS element (for citing)
Expenses And Contributions$37,098ExpensesAndContributionsAmt
Qualifying Distributions$37,098QualifyingDistributionsAmt
Adjusted Qualifying Distri$37,098AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$59,459DistributableAsAdjustedAmt
Excess Distribution Cyov Yr2$22,327ExcessDistributionCyovYr2Amt
Total Excess Distribution Cyov$22,327TotalExcessDistributionCyovAmt
Qualifying Distributions$37,098QualifyingDistributionsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$37,098AppliedToCurrentYearAmt
Excess Distri Cyov App CY Corpus$22,327ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$22,327ExcessDistributionCyovAppCYAmt
Undistributed Income CY$34UndistributedIncomeCYAmt

Supplementary Information SupplementaryInformationGrp

FieldValueIRS element (for citing)
Only Contri To PreselectedYes (X)OnlyContriToPreselectedInd

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (6 entries)

Address Line1RecipientUSAddress/AddressLine1CityRecipientUSAddress/CityStateRecipientUSAddress/StateZIP CodeRecipientUSAddress/ZIPCodeRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
CVC
GENERALSHERIDANWY82801none501(c)GENERAL$5,000
WYOMING INDEPENDENT LIVING
GENERALSHERIDANWY82801none501(c)GENERAL$3,900
CENTER FOR DISPUTE RESOLUTION
GENERALSHERIDANWY82801none501(c)GENERAL$7,500
SHERIDAN COUNTY MUSEUM
GENERALSHERIDANWY82801none501(c)GENERAL$5,000
VOLUNTEERS OF AMERICA
GENERALSHERIDANWY82801none501(c)GENERAL$12,500
CHILDREN'S CENTER
GENERALSHERIDANWY82801nonePUBLICGENERAL$1,000
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$34,900TotalGrantOrContriPdDurYrAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$3ExclusionAmt

Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$42,924ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Exclusion18ExclusionCd
Exclusion$499,619ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Exclusion$542,546ExclusionAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$542,546TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EOfalseTrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EOfalseTrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of AssetsfalseSalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EOfalsePurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth AssetsfalseRentalOfFacilitiesOthAssetsInd
Reimbursement ArrangementsfalseReimbursementArrangementsInd
Loans Or Loan GuaranteesfalseLoansOrLoanGuaranteesInd
Performance Of Services EtcfalsePerformanceOfServicesEtcInd
Sharing Of Facilities EtcfalseSharingOfFacilitiesEtcInd
Relationships Nonchrtbl EOfalseRelationshipsNonchrtblEOInd

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp

FieldValueIRS element (for citing)
DescAnnual feesDesc
Revenue And Expenses Per Books$9,498RevenueAndExpensesPerBooksAmt
Net Investment Income$7,598NetInvestmentIncomeAmt
Disbursements Charitable Prps$1,900DisbursementsCharitablePrpsAmt

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail (2 entries)

CategoryCategoryTxtAmtAmtNet Investment IncomeNetInvestmentIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
EXCISE TAX$791$633$158
FOREIGN TAXES$698$558$140

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