PATCH FOUNDATION: Form 990PF, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PATCH FOUNDATION (EIN 41-1873951)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-05-06
- IRS object ID
- 201331269349100508
- Schema version
- 2012v2.1
- 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
- Form 990-PF
- Accounting Fees Schedule
- Investments Corp Stock Schedule
- Investments Govt Obligations Sch
- Investments Other Schedule2
- Other Expenses Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-06T09:00:02-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420714325 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 NICOLLET MALL SUITE 1100 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411873951 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE PATCH FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PATC | NameControl |
| Phone | 6127817677 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3201 RANKIN ROAD | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55418 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CAROLYN SAMPLE | Name |
| Title | PRESIDENT | Title |
| Phone | 6127817677 | Phone |
| Date Signed | 2013-05-02 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TODD A JACKSON | Name |
| PTIN | P00092672 | PTIN |
| Phone | 6123324300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exempt PF | X | ExemptPF |
| FMV Assets EOY | 6614789 | FMVAssetsEOY |
| Method Of Accounting Cash | X | MethodOfAccountingCash |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Not Required To Attach Schedule B | X | NotRequiredToAttachScheduleB |
| Interest On Savings Rev And Expnss | 17 | InterestOnSavingsRevAndExpnss |
| Interest On Savings Net Invst Incm | 17 | InterestOnSavingsNetInvstIncm |
| Dividends Rev And Expnss | 204173 | DividendsRevAndExpnss |
| Dividends Net Invst Incm | 189644 | DividendsNetInvstIncm |
| Net Gain Sale Assets Rev And Expnss | 32792 | NetGainSaleAssetsRevAndExpnss |
| Gross Sales Price | 452928 | GrossSalesPrice |
| Capital Gain Net Incm Net Invst Incm | 0 | CapitalGainNetIncmNetInvstIncm |
| Total Revenue And Expenses | 236982 | TotalRevenueAndExpenses |
| Total Net Investment Income | 189661 | TotalNetInvestmentIncome |
| Comp Ofcr Dir Trst Rev And Expnss | 0 | CompOfcrDirTrstRevAndExpnss |
| Comp Ofcr Dir Trst Net Invst Incm | 0 | CompOfcrDirTrstNetInvstIncm |
| Comp Ofcr Dir Trst Dsbrs Chrtbl Prps | 0 | CompOfcrDirTrstDsbrsChrtblPrps |
| Accounting Fees Rev And Expnss | 1700 | AccountingFeesRevAndExpnss |
| Accounting Fees Net Invst Incm | 850 | AccountingFeesNetInvstIncm |
| Accounting Fees Dsbrs Chrtbl Prps | 850 | AccountingFeesDsbrsChrtblPrps |
| Taxes Rev And Expnss | 3298 | TaxesRevAndExpnss |
| Taxes Net Invst Incm | 0 | TaxesNetInvstIncm |
| Taxes Dsbrs Chrtbl Prps | 0 | TaxesDsbrsChrtblPrps |
| Other Expenses Rev And Expnss | 84 | OtherExpensesRevAndExpnss |
| Other Expenses Net Invst Incm | 59 | OtherExpensesNetInvstIncm |
| Other Expenses Dsbrs Chrtbl Prps | 25 | OtherExpensesDsbrsChrtblPrps |
| Tot Opr Expenses Rev And Expnss | 5082 | TotOprExpensesRevAndExpnss |
| Tot Opr Expenses Net Invst Incm | 909 | TotOprExpensesNetInvstIncm |
| Tot Opr Expenses Dsbrs Chrtbl Prps | 875 | TotOprExpensesDsbrsChrtblPrps |
| Contri Gifts Paid Rev And Expnss | 700000 | ContriGiftsPaidRevAndExpnss |
| Contri Gifts Paid Dsbrs Chrtbl Prps | 700000 | ContriGiftsPaidDsbrsChrtblPrps |
| Total Expenses Rev And Expnss | 705082 | TotalExpensesRevAndExpnss |
| Total Expenses Net Invst Incm | 909 | TotalExpensesNetInvstIncm |
| Total Expenses Dsbrs Chrtbl Prps | 700875 | TotalExpensesDsbrsChrtblPrps |
| Excess Of Revenue Over Expenses | -468100 | ExcessOfRevenueOverExpenses |
| Net Investment Income | 188752 | NetInvestmentIncome |
Balance Sheets BalanceSheets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | 29262 | CashBOY |
| Cash EOY | 39214 | CashEOY |
| Cash EOYFMV | 39214 | CashEOYFMV |
| Savings And Temp Cash Invst BOY | 224272 | SavingsAndTempCashInvstBOY |
| Savings And Temp Cash Invst EOY | 166356 | SavingsAndTempCashInvstEOY |
| Savings And Temp Cash Invst EOYFMV | 166356 | SavingsAndTempCashInvstEOYFMV |
| Investments Govt Oblig BOY | 525000 | InvestmentsGovtObligBOY |
| Investments Govt Oblig EOY | 255000 | InvestmentsGovtObligEOY |
| Investments Govt Oblig EOYFMV | 269081 | InvestmentsGovtObligEOYFMV |
| Investments Corp Stock BOY | 354571 | InvestmentsCorpStockBOY |
| Investments Corp Stock EOY | 321950 | InvestmentsCorpStockEOY |
| Investments Corp Stock EOYFMV | 397338 | InvestmentsCorpStockEOYFMV |
| Investments Other BOY | 4144953 | InvestmentsOtherBOY |
| Investments Other EOY | 4027438 | InvestmentsOtherEOY |
| Investments Other EOYFMV | 5742800 | InvestmentsOtherEOYFMV |
| Total Assets BOY | 5278058 | TotalAssetsBOY |
| Total Assets EOY | 4809958 | TotalAssetsEOY |
| Total Assets EOYFMV | 6614789 | TotalAssetsEOYFMV |
| Total Liabilities BOY | 0 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Org That Do Not Follow SFAS117 | X | OrgThatDoNotFollowSFAS117 |
| Capital Stock BOY | 0 | CapitalStockBOY |
| Capital Stock EOY | 0 | CapitalStockEOY |
| Paid In Or Capital Surplus BOY | 0 | PaidInOrCapitalSurplusBOY |
| Paid In Or Capital Surplus EOY | 0 | PaidInOrCapitalSurplusEOY |
| Retained Earnings BOY | 5278058 | RetainedEarningsBOY |
| Retained Earnings EOY | 4809958 | RetainedEarningsEOY |
| Total Net Assets BOY | 5278058 | TotalNetAssetsBOY |
| Total Net Assets EOY | 4809958 | TotalNetAssetsEOY |
| Total Liabilities Net Assets BOY | 5278058 | TotalLiabilitiesNetAssetsBOY |
| Total Liabilities Net Assets EOY | 4809958 | TotalLiabilitiesNetAssetsEOY |
Changes In Net Assets Fund Balances ChangesInNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Net Assets Fund Balances BOY | 5278058 | TotalNetAssetsFundBalancesBOY |
| Excess Of Revenue Over Expenses | -468100 | ExcessOfRevenueOverExpenses |
| Other Increases | 0 | OtherIncreases |
| Subtotal | 4809958 | Subtotal |
| Other Decreases | 0 | OtherDecreases |
| Total Net Assets Fund Balances EOY | 4809958 | TotalNetAssetsFundBalancesEOY |
Capital Gains And Losses CapitalGainsAndLosses
Capital Gains And Losses Info CapitalGainsAndLossesInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Asset | PUBLICLY TRADED SECURITIES | DescriptionOfAsset |
| Gross Sales Price | 452928 | GrossSalesPrice |
| Cost Or Other Basis | 500036 | CostOrOtherBasis |
| Gain Or Loss | -47108 | GainOrLoss |
| Gains Minus Excess Or Losses | -47108 | GainsMinusExcessOrLosses |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | -47108 | CapitalGainNetIncome |
Qlfy Und Sect4940e For Reduced Tax QlfyUndSect4940eForReducedTax
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable For4942 Tax | 0 | LiableFor4942Tax |
| Qualifying Distributions Year1 | 516025 | QualifyingDistributionsYear1 |
| Noncharitable Assets Year1 | 6563116 | NoncharitableAssetsYear1 |
| Distribution Ratio Year1 | 0.078625 | DistributionRatioYear1 |
| Qualifying Distributions Year2 | 420225 | QualifyingDistributionsYear2 |
| Noncharitable Assets Year2 | 6583022 | NoncharitableAssetsYear2 |
| Distribution Ratio Year2 | 0.063835 | DistributionRatioYear2 |
| Qualifying Distributions Year3 | 353125 | QualifyingDistributionsYear3 |
| Noncharitable Assets Year3 | 6380069 | NoncharitableAssetsYear3 |
| Distribution Ratio Year3 | 0.055348 | DistributionRatioYear3 |
| Qualifying Distributions Year4 | 959585 | QualifyingDistributionsYear4 |
| Noncharitable Assets Year4 | 1974911 | NoncharitableAssetsYear4 |
| Distribution Ratio Year4 | 0.485888 | DistributionRatioYear4 |
| Qualifying Distributions Year5 | 119325 | QualifyingDistributionsYear5 |
| Noncharitable Assets Year5 | 1259839 | NoncharitableAssetsYear5 |
| Distribution Ratio Year5 | 0.094714 | DistributionRatioYear5 |
| Total Distribution Ratio | 0.778410 | TotalDistributionRatio |
| Average Distribution Ratio | 0.155682 | AverageDistributionRatio |
| Net Noncharitable Assets | 6142529 | NetNoncharitableAssets |
| Adjusted Noncharitable Assets | 956281 | AdjustedNoncharitableAssets |
| One Percent Net Investment Income | 1888 | OnePercentNetInvestmentIncome |
| Adj Nonchrtbl Assets And One | 958169 | AdjNonchrtblAssetsAndOnePct |
| Qualifying Distributions | 700875 | QualifyingDistributions |
Excise Tax Based On Investment Incm ExciseTaxBasedOnInvestmentIncm
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | 3775 | InvestmentIncomeExciseTax |
| Tax Under Section511 | 0 | TaxUnderSection511 |
| Subtotal | 3775 | Subtotal |
| Subtitle A Tax | 0 | SubtitleATax |
| Tax Based On Investment Income | 3775 | TaxBasedOnInvestmentIncome |
| Est Tax Payments And Overpayment | 3200 | EstTaxPaymentsAndOverpayment |
| Total Credits And Payments | 3200 | TotalCreditsAndPayments |
| Tax Due | 575 | TaxDue |
Statements Regarding Activities StatementsRegardingActivities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Activities | 0 | LegislativePoliticalActivities |
| More Than100 Spent | 0 | MoreThan100Spent |
| Form1120 POL Filed | 0 | Form1120POLFiled |
| Sect4955 Tax On Organization | 0 | Sect4955TaxOnOrganization |
| Sect4955 Tax On Managers | 0 | Sect4955TaxOnManagers |
| Reimbursement Of Tax | 0 | ReimbursementOfTax |
| Activities Not Prev Reported | 0 | ActivitiesNotPrevReported |
| Changes To Articles Or Bylaws | 0 | ChangesToArticlesOrBylaws |
| Unrelated Bus Income Over1000 | 0 | UnrelatedBusIncomeOver1000 |
| Termination Etc | 0 | TerminationEtc |
| Requirements Of Sect508e | 1 | RequirementsOfSect508e |
| At Least5000 In Assets | 1 | AtLeast5000InAssets |
| States Filed With | MN | StatesFiledWith |
| Form990 PF Filed With AG | 1 | Form990PFFiledWithAG |
| Private Operating Foundation | 0 | PrivateOperatingFoundation |
| New Substantial Contributors | 0 | NewSubstantialContributors |
| Interest In Controlled Entity | 0 | InterestInControlledEntity |
| Applicable Insurance Contract | 0 | ApplicableInsuranceContract |
| Comply With Public Inspection Rqr | 1 | ComplyWithPublicInspectionRqr |
| Website Address | N/A | WebsiteAddress |
Books In Care Of Business Name BooksInCareOfBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Books In Care Of Phone Number | 6127817677 | BooksInCareOfPhoneNumber |
Books In Care Of US Address BooksInCareOfUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3201 RANKIN ROAD | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55418 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Bank | 0 | ForeignBank |
Statements Regarding Acty4720 StatementsRegardingActy4720
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exchange With Dsqfly Person | 0 | SaleOrExchangeWithDsqflyPerson |
| Borrow Or Lend With Dsqfly Person | 0 | BorrowOrLendWithDsqflyPerson |
| Furnished Goods With Dsqfly Person | 0 | FurnishedGoodsWithDsqflyPerson |
| Pay Compensation To Dsqfly Person | 0 | PayCompensationToDsqflyPerson |
| Transfer Assets To Dsqfly Person | 0 | TransferAssetsToDsqflyPerson |
| Payment To Government Offical | 0 | PaymentToGovernmentOffical |
| Uncorrected Prior Acts | 0 | UncorrectedPriorActs |
| Undistributed Income Prior Years | 0 | UndistributedIncomePriorYears |
| Business Holdings | 0 | BusinessHoldings |
| Jeopardy Investments | 0 | JeopardyInvestments |
| Uncorrected Jeopardy Investments | 0 | UncorrectedJeopardyInvestments |
| Influence Legislation | 0 | InfluenceLegislation |
| Influence Election | 0 | InfluenceElection |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Noncharitable Purpose | 0 | NoncharitablePurpose |
| Rcv Funds To Pay Prsnl Bnft Contract | 0 | RcvFundsToPayPrsnlBnftContract |
| Pay Premiums Prsnl Bnft Contract | 0 | PayPremiumsPrsnlBnftContract |
| Prohibited Tax Shelter Transactn | 0 | ProhibitedTaxShelterTransactn |
Ofcr Dir Trustees Key Employee Info OfcrDirTrusteesKeyEmployeeInfo
Ofcr Dir Trustees Or Key Employee OfcrDirTrusteesOrKeyEmployee (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation | Contri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtc | Expense Account Other AllowancesExpenseAccountOtherAllowances |
|---|---|---|---|---|---|---|---|---|
| WILLIAM C PETERSON | ||||||||
| 6724 99TH AVE NORTH | BROOKLYN PARK | MN | 55445 | DIRECTOR | 0.50 | 0 | 0 | 0 |
| CAROLYN SAMPLE | ||||||||
| 3201 RANKIN RD | MINNEAPOLIS | MN | 55418 | PRESIDENT | 2.00 | 0 | 0 | 0 |
| ERNEST LINDSTROM-LINDSTROM LAW OFFI | ||||||||
| 7600 PARKLAWN AVE STE 444 | EDINA | MI | 55435 | DIRECTOR | 0.50 | 0 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Highest Paid Empl NONE | NONE | CompOfHighestPaidEmplNONE |
| Tot Number Of Oth Empl Paid Over50k | 0 | TotNumberOfOthEmplPaidOver50k |
| Comp Of Hghst Paid Cntrct NONE | NONE | CompOfHghstPaidCntrctNONE |
| Tot Number Of Cntrct Paid Over50k | 0 | TotNumberOfCntrctPaidOver50k |
Sum Of Program Related Investments SumOfProgramRelatedInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Minimum Investment Return MinimumInvestmentReturn
| Field | Value | IRS element (for citing) |
|---|---|---|
| Avg Monthly FMV Of Securities | 6009848 | AvgMonthlyFMVOfSecurities |
| Avg Monthly Cash Balances | 226222 | AvgMonthlyCashBalances |
| FMV All Other Noncharitable Assets | 0 | FMVAllOtherNoncharitableAssets |
| Total FMV Of Unused Assets | 6236070 | TotalFMVOfUnusedAssets |
| Reduction Claimed | 0 | ReductionClaimed |
| Acquisition Indebtedness | 0 | AcquisitionIndebtedness |
| Adj Total FMV Of Unused Assets | 6236070 | AdjTotalFMVOfUnusedAssets |
| Cash Deemed Charitable | 93541 | CashDeemedCharitable |
| Net Noncharitable Assets | 6142529 | NetNoncharitableAssets |
| Minimum Investment Return | 307126 | MinimumInvestmentReturn |
Distributable DistributableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | 307126 | MinimumInvestmentReturn |
| Tax Based On Investment Income | 3775 | TaxBasedOnInvestmentIncome |
| Total Tax | 3775 | TotalTax |
| Distributable Amount Before Adj | 303351 | DistributableAmountBeforeAdj |
| Recoveries Qlfy Distributions | 0 | RecoveriesQlfyDistributions |
| Distributable Amount Before Ded | 303351 | DistributableAmountBeforeDed |
| Deduction Fr Distributable | $0 | DeductionFrDistributableAmount |
| Distributable Amount As Adjusted | 303351 | DistributableAmountAsAdjusted |
Qualifying Distributions QualifyingDistributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | 700875 | ExpensesAndContributions |
| Program Related Investments Total | 0 | ProgramRelatedInvestmentsTotal |
| Qualifying Distributions | 700875 | QualifyingDistributions |
| One Pct Sect4940e Org Net Invst Incm | 0 | OnePctSect4940eOrgNetInvstIncm |
| Adj Qualifying Distributions | 700875 | AdjQualifyingDistributions |
Undistributed Income UndistributedIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable Amount As Adjusted | 303351 | DistributableAmountAsAdjusted |
| Undistributed Income Prior Year | 0 | UndistributedIncomePriorYear |
| Total For Prior Years | 0 | TotalForPriorYears |
| Excess Distri Carryover Year5 | 56531 | ExcessDistriCarryoverYear5 |
| Excess Distri Carryover Year4 | 862119 | ExcessDistriCarryoverYear4 |
| Excess Distri Carryover Year3 | 37229 | ExcessDistriCarryoverYear3 |
| Excess Distri Carryover Year2 | 93591 | ExcessDistriCarryoverYear2 |
| Excess Distri Carryover Year1 | 190767 | ExcessDistriCarryoverYear1 |
| Total Excess Distri Carryover | 1240237 | TotalExcessDistriCarryover |
| Qualifying Distributions | 700875 | QualifyingDistributions |
| Applied To Year1 | 0 | AppliedToYear1 |
| Applied To Prior Years | 0 | AppliedToPriorYears |
| Treated As Distri From Corpus | 0 | TreatedAsDistriFromCorpus |
| Applied To Current Year | 303351 | AppliedToCurrentYear |
| Remaining Distri From Corpus | 397524 | RemainingDistriFromCorpus |
| Excess Distri Cyov App CY Corpus | 0 | ExcessDistriCyovAppCYCorpus |
| Excess Distri Cyov Applied CY | 0 | ExcessDistriCyovAppliedCY |
| Total Corpus | 1637761 | TotalCorpus |
| Prior Year Undistributed Income | 0 | PriorYearUndistributedIncome |
| Prior Year Deficiency Or Tax | 0 | PriorYearDeficiencyOrTax |
| Taxable Amount1 | 0 | TaxableAmount1 |
| Taxable Amount2 | 0 | TaxableAmount2 |
| Undistributed Income CY | 0 | UndistributedIncomeCY |
| Distri From Corpus170b1 E Or4942g3 | 0 | DistriFromCorpus170b1EOr4942g3 |
| Excess Distri Cyov From Year5 | 56531 | ExcessDistriCyovFromYear5 |
| Excess Distri Cyov To Next Year | 1581230 | ExcessDistriCyovToNextYear |
| Excess From Year4 | 862119 | ExcessFromYear4 |
| Excess From Year3 | 37229 | ExcessFromYear3 |
| Excess From Year2 | 93591 | ExcessFromYear2 |
| Excess From Year1 | 190767 | ExcessFromYear1 |
| Excess From Current Year | 397524 | ExcessFromCurrentYear |
Supplementary Information SupplementaryInformation
Appication Submission Info AppicationSubmissionInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Name | CAROLYN P SAMPLE | RecipientName |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3201 RANKIN ROAD NE | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55418 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone Number | 6127817677 | RecipientPhoneNumber |
| Form And Info And Materials | SEE STATEMENT 7 | FormAndInfoAndMaterials |
| Submission Deadlines | SEE STATEMENT 7 | SubmissionDeadlines |
| Restrictions On Awards | SEE STATEMENT 7 | RestrictionsOnAwards |
Grant Or Contri Paid During Year GrantOrContriPaidDuringYear (42 entries)
| Address Line1RecipientUSAddress/AddressLine1 | CityRecipientUSAddress/City | StateRecipientUSAddress/State | ZIP CodeRecipientUSAddress/ZIPCode | Recipient RelationshipRecipientRelationship | Recipient Foundation StatusRecipientFoundationStatus | Purpose Of Grant Or ContributionPurposeOfGrantOrContribution | AmountAmount |
|---|---|---|---|---|---|---|---|
| AMERICAN HEART ASSOCIATION | |||||||
| 4701 WEST 77TH STREET | MINNEAPOLIS | MN | 55435 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $1,000 |
| AMERICAN LUNG ASSOCIATION | |||||||
| PO BOX 7000 | ALBERT LEA | MN | 56007 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $1,000 |
| ARC OF HENNEPIN COUNTY | |||||||
| 106 NORTH CHESTNUT STREET | CHASKA | MN | 55318 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $5,000 |
| CAMP KNUTSON | |||||||
| 11169 WHITE FISH AVENUE | CROSSLAKE | MN | 56442 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $5,000 |
| CARE | |||||||
| 151 ELLIS STREET NE | ATLANTA | GA | 30303 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $5,000 |
| CATHOLIC CHARITIES | |||||||
| 1200 SECOND AVENUE SO | MINNEAPOLIS | MN | 55403 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $5,000 |
| CHILDREN'S HOME SOCIETY | |||||||
| 1605 EUSTIS STREET | ST PAUL | MN | 55108 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $3,000 |
| COURAGE CENTER | |||||||
| 3915 GOLDEN VALLEY ROAD | MINNEAPOLIS | MN | 55422 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $7,000 |
| COVENANT RETIREMENT COMMUNITIES OF MN | |||||||
| 5800 ST CROIX AVENUE N | GOLDEN VALLEY | MN | 55422 | NONE | RELIGIOUS | PROGRAM SUPPORT | $5,000 |
| COVENANT WORLD RELIEF | |||||||
| 5101 NORTH FRANCISCO AVENUE | CHICAGO | IL | 60625 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $75,000 |
| DUNWOODY COLLEGE OF TECHNOLOGY | |||||||
| 818 DUNWOODY BLVD | MINNEAPOLIS | MN | 55403 | NONE | EDUCATIONAL | PROGRAM SUPPORT | $5,000 |
| EAST SIDE NEIGHBORHOOD | |||||||
| 1700 SECOND STREET NE | MINNEAPOLIS | MN | 55413 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $2,000 |
| EVANGELICAL COVENANT CHURCH | |||||||
| 5101 NORTH FRANCISCO AVENUE | CHICAGO | IL | 60625 | NONE | RELIGIOUS | PROGRAM SUPPORT | $75,000 |
| FEED MY STARVING CHILDREN | |||||||
| 401 93RD AVE NW | COON RAPIDS | MN | 55433 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $7,000 |
| FRIENDSHIP VENTURES | |||||||
| 10509 108TH STREET NW | ANNANDALE | MN | 55302 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $8,000 |
| GREATER MINNEAPOLIS CRISIS NURSERY | |||||||
| 5400 GLENWOOD AVE | GOLDEN VALLEY | MN | 55422 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $2,000 |
| HABITAT FOR HUMANITY | |||||||
| 121 HABITAT STREET | AMERICUS | GA | 31709 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $5,000 |
| HOMEWARD BOUND | |||||||
| 13895 INDUSTRIAL PARK BLVD 100 | PLYMOUTH | MN | 55441 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $8,000 |
| HOUSE OF CHARITY | |||||||
| 510 SOUTH EIGHTH STREET | MINNEAPOLIS | MN | 55404 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $12,000 |
| KIWANIS CLUB OF NE MINNEAPOLIS | |||||||
| C/O WALT SENTYRZ 1612 SECOND ST NE | MINNEAPOLIS | MN | 554131138 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $1,000 |
| LITTLE BROTHERS FRIENDS OF THE ELDERLY | |||||||
| 1845 EAST LAKE STREET | MINNEAPOLIS | MN | 55407 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $10,000 |
| LITTLE SISTERS OF THE POOR | |||||||
| 330 EXCHANGE STREET S | ST PAUL | MN | 55102 | NONE | RELIGIOUS | PROGRAM SUPPORT | $3,000 |
| LOAVES AND FISHES | |||||||
| 1917 LOGAN AVENUE SOUTH | MINNEAPOLIS | MN | 55403 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $5,000 |
| MARCH OF DIMES | |||||||
| 1275 MAMARONECK AVENUE | WHITE PLAINS | NY | 10605 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $1,000 |
| METRO HOPE MINISTRIES | |||||||
| 2739 CEDAR AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $20,000 |
| MINNEAPOLIS HEART INSTITUTE FOUNDATION | |||||||
| 920 EAST 28TH STREET 100 | MINNEAPOLIS | MN | 55407 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $5,000 |
| MINNESOTA TEEN CHALLENGE | |||||||
| 1619 PORTLANT AVENUE SOUTH | MINNEAPOLIS | MN | 55404 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $10,000 |
| NORTHEAST SENIOR SERVICES | |||||||
| 2580 KENZIE TERRACE SUITE 2A | ST ANTHONY | MN | 55418 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $3,000 |
| PEOPLE SERVING PEOPLE | |||||||
| 614 SOUTH THIRD STREET | MINNEAPOLIS | MN | 55415 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $12,000 |
| SALEM COVENANT CHURCH | |||||||
| 2655 FIFTH STREET NW | NEW BRIGHTON | MN | 55112 | NONE | RELIGIOUS | PROGRAM SUPPORT | $260,000 |
| SECOND HARVEST FOOD BANK | |||||||
| 1140 GERVAIS AVENUE | ST PAUL | MN | 55109 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $12,000 |
| SHARING & CARING HANDS | |||||||
| 525 NORTH 7TH STREET | MINNEAPOLIS | MN | 554051523 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $2,000 |
| SIMPSON HOUSING SERVICES | |||||||
| 2740 FIRST AVENUE SOUTH | MINNEAPOLIS | MN | 55408 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $15,000 |
| SISTER KENNY FOUNDATION | |||||||
| 800 EAST 28TH STREET | MINNEAPOLIS | MN | 55407 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $7,000 |
| SUNSHINE ACRES | |||||||
| 3405 NORTH HIGLEY ROAD | MESA | AZ | 85215 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $5,000 |
| THE GIDEONS | |||||||
| PO BOX 140800 | NASHVILLE | TN | 37214 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $3,000 |
| THE SALVATION ARMY | |||||||
| 2445 PRIOR AVENUE NORTH | ROSEVILLE | MN | 55113 | NONE | RELIGIOUS | PROGRAM SUPPORT | $50,000 |
| UNION GOSPEL MISSION | |||||||
| 77 NINTH STREET E | ST PAUL | MN | 55101 | NONE | RELIGIOUS | PROGRAM SUPPORT | $10,000 |
| UNIVERSITY OF MINNESOTA FOUNDATION | |||||||
| 200 OAK STREET SE 500 | MINNEAPOLIS | MN | 55455 | NONE | EDUCATIONAL | PROGRAM SUPPORT | $25,000 |
| NORTH HENNEPIN COMMUNITY COLLEGE | |||||||
| 7411 85TH AVENUE NORTH | BROOKLYN PARK | MN | 55445 | NONE | EDUCATIONAL | PROGRAM SUPPORT | $2,000 |
| SCIENCE WITH A MISSION | |||||||
| 602 MASSAPOAG AVE | SHARON | MA | 02067 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $2,000 |
| LYMPHOMA RESEARCH FOUNDATION | |||||||
| 115 BROADWAY SUITE 1301 | NEW YORK | NY | 10006 | NONE | PUBLIC CHARITY | PROGRAM SUPPORT | $1,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Grant Or Contri Paid During Year | 700000 | TotGrantOrContriPaidDuringYear |
| Tot Grant Or Contri Approved Future | 0 | TotGrantOrContriApprovedFuture |
Analysis Income Producing Acty AnalysisIncomeProducingActy
Int On Savings And Temp Cash Invst IntOnSavingsAndTempCashInvst
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion Code | 14 | ExclusionCode |
| Exclusion | $17 | ExclusionAmount |
Dividends And Int From Sec Part VII DividendsAndIntFromSecPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion Code | 14 | ExclusionCode |
| Exclusion | $204,173 | ExclusionAmount |
Gain Sales Assets Oth Than Invntry GainSalesAssetsOthThanInvntry
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion Code | 18 | ExclusionCode |
| Exclusion | $32,792 | ExclusionAmount |
Subtotals Part XVIA SubtotalsPartXVIA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Income | $0 | UnrelatedBusinessIncomeAmount |
| Exclusion | $236,982 | ExclusionAmount |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Part XVIA | 236982 | TotalPartXVIA |
Trnsfr Tr Rln With Noncharitable EO TrnsfrTrRlnWithNoncharitableEO
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Noncharitable EO | 0 | TrnsfrOfCashToNoncharitableEO |
| Trnsfr Oth Assets Noncharitable EO | 0 | TrnsfrOthAssetsNoncharitableEO |
| Sales Or Exchanges Of Assets | 0 | SalesOrExchangesOfAssets |
| Purchase Assets Noncharitable EO | 0 | PurchaseAssetsNoncharitableEO |
| Rental Of Facilities Etc | 0 | RentalOfFacilitiesEtc |
| Reimbursement Arrangements | 0 | ReimbursementArrangements |
| Loans Or Loan Guarantees | 0 | LoansOrLoanGuarantees |
| Performance Of Services Etc | 0 | PerformanceOfServicesEtc |
| Sharing Of Facilities Etc | 0 | SharingOfFacilitiesEtc |
| Relationships Noncharitable E Os | 0 | RelationshipsNoncharitableEOs |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees AccountingFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEES | Category |
| Amount | $1,700 | Amount |
| Net Investment Income | 850 | NetInvestmentIncome |
| Disbursements Charitable Prps | 850 | DisbursementsCharitablePrps |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corp Stock InvestmentsCorpStock (3 entries)
| Name Of StockNameOfStock | EOY Book ValueEOYBookValue | EOYFMVEOYFMV |
|---|---|---|
| 3M | 157950 | 181058 |
| TECO | 0 | 0 |
| CHEVRON | 164000 | 216280 |
Investments Govt Obligations Sch InvestmentsGovtObligationsSch
| Field | Value | IRS element (for citing) |
|---|---|---|
| US Govt Securities EOY Book Value | 0 | USGovtSecuritiesEOYBookValue |
| US Govt Securities EOYFMV | 0 | USGovtSecuritiesEOYFMV |
| State Local Securities EOY Book Val | 255000 | StateLocalSecuritiesEOYBookVal |
| State Local Securities EOYFMV | 269081 | StateLocalSecuritiesEOYFMV |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category Or Item | O.N. EQUITY - MEDTRONIC STOCK | CategoryOrItem |
| Listed At Cost Or FMV | AT COST | ListedAtCostOrFMV |
| Book Value | 4027438 | BookValue |
| EOYFMV | 5742800 | EOYFMV |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | Revenue And Expenses Per BooksRevenueAndExpensesPerBooks | Net Investment IncomeNetInvestmentIncome | Disbursements Charitable PrpsDisbursementsCharitablePrps |
|---|---|---|---|
| STATE OF MN FILING FEE | 25 | 0 | 25 |
| BANK FEES | 32 | 32 | 0 |
| CHECKS/PRINTING & POSTAGE | 27 | 27 | 0 |
Taxes Schedule TaxesSchedule
Taxes Taxes (2 entries)
| CategoryCategory | AmountAmount | Net Investment IncomeNetInvestmentIncome | Disbursements Charitable PrpsDisbursementsCharitablePrps |
|---|---|---|---|
| FEDERAL EXCISE TAX PAID - 12/31/2011 | $98 | 0 | 0 |
| ESTIMATED EXCISE TAX PAID - CURRENT YEAR | $3,200 | 0 | 0 |
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