Form990-PF
Click to see attachment

Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Nonexempt Charitable Trust
Treated as a Private Foundation
Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0052
2010
For calendar year 2010, or tax year beginning 01-01-2010 , and ending 12-31-2010
G
Check all that apply:
Name of foundation
HEMOPHILIA OUTREACH OF WISCONSIN
FOUNDATION INC

Number and street (or P.O. box number if mail is not delivered to street address)2060 BELLEVUE STREET   Room/suite
City or town, state, and ZIP code
GREEN BAY, WI54311
A Employer identification number

39-1858104
B Telephone number (see page 10 of the instructions)

(920) 965-0606
C bullet
D 1. bullet
H Check type of organization:
2. bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$11,546,145J Accounting method:
 
(Part I, column (d) must be on cash basis.)
E bullet
F bullet
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see page 11 of the instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 22,690
2 Check bullet
3 Interest on savings and temporary cash investments 33,897 33,897 33,897
4 Dividends and interest from securities...... 7,151 7,151 7,151
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 Click to see attachment -1,371
b Gross sales price for all assets on line 6a 939,498
7 Capital gain net income (from Part IV, line 2)...  
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances 5,525,245
b Less: Cost of goods sold.... 4,188,657
c Gross profit or (loss) (attach schedule)..... Click to see attachment 1,336,588 1,336,588
11 Other income (attach schedule)....... Click to see attachment 11,380   11,380
12 Total. Add lines 1 through 11........ 1,410,335 41,048 1,389,016
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 55,385   55,385  
14 Other employee salaries and wages...... 384,250   170,226 214,024
15 Pension plans, employee benefits....... 112,348   57,657 54,691
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... Click to see attachment 33,579 6,028 24,796 2,755
17 Interest...............        
18 Taxes (attach schedule) (see page 14 of the instructions) Click to see attachment 790   790  
19 Depreciation (attach schedule) and depletion... Click to see attachment 66,920   66,920
20 Occupancy.............. 19,689   15,554 4,135
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 345,220   244,086 101,134
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 1,018,181 6,028 635,414 376,739
25 Contributions, gifts, grants paid........ 73,500 73,500
26 Total expenses and disbursements. Add lines 24 and 25 1,091,681 6,028 635,414 450,239
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 318,654
b Net investment income (if negative, enter -0-) 35,020
c Adjusted net income (if negative, enter -0-)... 753,602
For Privacy Act and Paperwork Reduction Act Notice, see page 30 of the instructions.
Cat. No. 11289X Form 990-PF (2010)
Form 990-PF (2010)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)		 Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............... 297 265 265
2 Savings and temporary cash investments.......... 2,771,761 2,900,412 2,900,412
3 Accounts receivable bullet1,101,734
Less: allowance for doubtful accounts bullet143,231 871,102 958,503 958,503
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use............... 847,936 638,101 638,101
9 Prepaid expenses and deferred charges........... 14,124 11,427 11,427
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 4,616,094 Click to see attachment5,119,680 5,119,680
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet2,143,903
Less: accumulated depreciation (attach schedule) bullet226,146 1,976,971 Click to see attachment1,917,757 1,917,757
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 11,098,285 11,546,145 11,546,145
Liabilities 17 Accounts payable and accrued expenses.......... 602,864 218,481
18 Grants payable...................    
19 Deferred revenue..................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet) Click to see attachment5,731 Click to see attachment15,485
23 Total liabilities (add lines 17 through 22).......... 608,595 233,966
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................... 10,489,690 11,312,179
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds.........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see page 17 of the
instructions).................... 10,489,690 11,312,179
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 11,098,285 11,546,145
Part III Analysis of Changes in Net Assets or Fund Balances
1 Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree
with end-of-year figure reported on prior year’s return)............... 1 10,489,690
2 Enter amount from Part I, line 27a...................... 2 318,654
3 Other increases not included in line 2 (itemize) bulletClick to see attachment 3 503,835
4 Add lines 1, 2, and 3.......................... 4 11,312,179
5 Decreases not included in line 2 (itemize) bullet 5  
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30.. 6 11,312,179
Form 990-PF (2010)
Form 990-PF (2010)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.) 		(b) How acquired
P—Purchase
D—Donation 		(c) Date acquired
(mo., day, yr.) 		(d) Date sold
(mo., day, yr.)
1 a PUBLICLY TRADED SECURITIES P 2008-06-30 2010-09-30
b
c
d
e
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 894,760   940,869 -46,109
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a       -46,109
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 -46,109
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see pages 13 and 17 of the instructions).
If (loss), enter -0- in Part I, line 8 . . . . . . . . . . . . . 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)

If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If “Yes,” the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2009 458,473 6,021,152 0.076144
2008 205,945 6,152,282 0.033475
2007 2,239,188 5,328,724 0.420211
2006 799,553 5,471,689 0.146125
2005 482,563 4,802,333 0.100485
2 Total of line 1, column (d) ...................... 2 0.776440
3 Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years. . . 		3 0.155288
4 Enter the net value of noncharitable-use assets for 2010 from Part X, line 5..... 4 7,622,369
5 Multiply line 4 by line 3....................... 5 1,183,662
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 350
7 Add lines 5 and 6......................... 7 1,184,012
8 Enter qualifying distributions from Part XII, line 4.............. 8 457,944
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See
the Part VI instructions on page 18.
Form 990-PF (2010)
Form 990-PF (2010)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a Bulletand enter “N/A” on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 700
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2  
3 Add lines 1 and 2............................ 3 700
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-). 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 700
6 Credits/Payments:
a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a 1,176
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 1,176
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 476
11 Enter the amount of line 10 to be: Credited to 2011 estimated taxBullet476 Refunded Bullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?.............................
1b
 
No
If the answer is “Yes” to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If “Yes,” attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If “Yes,” attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If “Yes,” has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If “Yes,” attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If “Yes,” complete Part II, col. (c), and Part XV.
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see page 19 of the
    instructions)bulletWI
    b
    If the answer is “Yes” to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If “No,” attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2010 or the taxable year beginning in 2010 (see instructions for Part XIV on
    page 27)? If “Yes,” complete Part XIV...........................
    9
    Yes
     
    10
    Did any persons become substantial contributors during the tax year? If “Yes,” attach a schedule listing their names and addresses.
    10
     
    No
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see page 20 of the instructions) .......
    11
     
    No
    12
    Did the foundation acquire a direct or indirect interest in any applicable insurance contract before August 17, 2008?
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletWWW.HEMOPHILIAOUTREACH.ORG
    14
    The books are in care ofbulletKATHLEEN AMMERMAN Telephone no.bullet (920) 965-0606
    Located atbullet2060 BELLEVUE STREETGREEN BAYWI ZIP+4bullet543116281
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16
    At any time during calendar year 2010, did the foundation have an interest in or a signature or other authority over
    a bank, securities, or other financial account in a foreign country? .................
    16
     
     
    See page 20 of the instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes", enter the name of the foreign country bullet  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 5
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the “Yes” column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?.........................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?.................
    (6) Agree to pay money or property to a government official? (Exception. Check “No”
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).........
    b
    If any answer is “Yes” to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions)?...
    1b
     
    No
    .........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2010?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2010, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2010?...............
    If “Yes,” list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer “No” and attach statement—see page 20 of the instructions.) .........
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business
    enterprise at any time during the year?.....................
    b
    If “Yes,” did it have excess business holdings in 2010 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2010.)....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2010?
    4b
     
    No
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?...............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see page 22 of the instructions)...
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?........
    b
    If any answer is “Yes” to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see page 22 of the instructions)?
    5b
     
     
    .........bullet
    c
    If the answer is “Yes” to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?............
    If “Yes,” attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay
    premiums on a personal benefit contract?....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If “Yes” to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 6
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see page 22 of the instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to
    employee benefit plans
    and deferred compensation     		(e) Expense account,
    other allowances
    JEANNE DEGROOTClick to see attachment MEMBER
    1.00     		0 0 0
    2265 SAMANTHA ST APT 95
    2265 SAMANTHA ST APT 95
    DEPERE,WI54115
    BRIAN CHARLIERClick to see attachment MEMBER
    1.00     		0 0 0
    1236 BENJAMIN CT
    1236 BANJAMIN CT
    GREEN BAY,WI54311
    LINDA ROETHLEClick to see attachment MEMBER
    1.00     		0 0 0
    1515 WESTMEATH AVE
    1515 WESTMEATH AVE
    GREEN BAY,WI54313
    MATT BRAULTClick to see attachment PRESIDENT
    1.00     		0 0 0
    3014 SAYBROOK CIRCLE
    3014 SAYBROOK CIR
    GREEN BAY,WI54311
    CHRIS KNURRClick to see attachment MEMBER
    1.00     		0 0 0
    1807 GROSS AVE
    1807 GROSS AVE
    GREEN BAY,WI54304
    ROBYN DAVISClick to see attachment MEMBER
    1.00     		0 0 0
    618 E MISSION RD
    618 E MISSION RD
    GREEN BAY,WI54301
    KEN ZEHRENClick to see attachment MEMBER
    1.00     		0 0 0
    217 PAUL DRIVE
    217 PAUL DRIVE
    KIMBERLY,WI54136
    PEGGY MAIERClick to see attachment MEMBER
    1.00     		0 0 0
    316 LONGVIEW AVE
    316 LONGVIEW AVE
    GREEN BAY,WI54301
    DEBBIE ARMBRUSTERClick to see attachment EXEC DIRECTO
    40.00     		55,385 10,624 0
    229 OAK HILL DRIVE
    229 OAK HILL DRIVE
    GREEN BAY,WI54301
    KEVIN VERHAGENClick to see attachment MEMBER
    1.00     		0 0 0
    5516 BROWN RD
    5516 BROWN RD
    LITTLE SUAMICO,WI54141
    GREG FITZGERALDClick to see attachment MEMBER
    1.00     		0 0 0
    W8883 STATE RD 96
    W8883 STATE RD 96
    HORTONVILLE,WI54944
    MARK SEMRAUClick to see attachment MEMBER
    1.00     		0 0 0
    1280 BEECHWOOD CT
    1280 BEECHWOOD CT
    GREEN BAY,WI54313
    KRISTIN SIOLKAClick to see attachment SECRETARY
    1.00     		0 0 0
    2453 ROBIN LANE
    2453 ROBIN LANE
    GREEN BAY,WI54303
    AMANDA BOOKTERClick to see attachment TREASURER
    1.00     		0 0 0
    432 JEFFERSON ST
    432 JEFFERSON ST
    OCONTO,WI54153
    2 Compensation of five highest-paid employees (other than those included on line 1—see page 23 of the instructions).
    If none, enter “NONE.”
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    KATHLEEN AMMERMANClick to see attachment MEDICAL DIR
    40.00     		64,458 11,208  
    241 SAVAGE ST
    241 SAVAGE ST
    GREEN BAY,WI54311
    KAY STREETClick to see attachment MEDICAL CARE
    40.00     		65,237 13,409  
    1279 POND VIEW CIRCLE
    1279 POND VIEW CIRCLE
    DE PERE,WI54115
    Total number of other employees paid over $50,000...................bullet  
    3 Five highest-paid independent contractors for professional services (see page 23 of the instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet  
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 SEE ATTACHED SUMMARY 450,239
    2  
    3  
    4  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 7
    Part IX-B
    Summary of Program-Related Investments (see page 23 of the instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1 N/A  
    2  
    All other program-related investments. See page 24 of the instructions.
    3  
    Total. Add lines 1 through 3...........................bullet  
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
    see page 24 of the instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    4,748,672
    b
    Average of monthly cash balances.......................
    1b
    2,989,774
    c
    Fair market value of all other assets (see page 24 of the instructions)............
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    7,738,446
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) ..............
    1e
     
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
     
    3
    Subtract line 2 from line 1d..........................
    3
    7,738,446
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ............................
    4
    116,077
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    7,622,369
    6
    Minimum investment return. Enter 5% of line 5...................
    6
    381,118
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
     
    2a
    Tax on investment income for 2010 from Part VI, line 5......
    2a
     
    b
    Income tax for 2010. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
     
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
     
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4.............................
    5
     
    6
    Deduction from distributable amount (see page 25 of the instructions)...........
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1.................................
    7
     
    Part XII
    Qualifying Distributions (see page 25 of the instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    450,239
    b
    Program-related investments—total from Part IX-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes................................
    2
    7,705
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    457,944
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see page 26 of the instructions)............
    5
     
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4...............
    6
    457,944
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 8
    Part XIII
    Undistributed Income (see page 26 of the instructions)
    (a)
    Corpus     		(b)
    Years prior to 2009     		(c)
    2009     		(d)
    2010
    1 Distributable amount for 2010 from Part XI, line 7  
    2 Undistributed income, if any, as of the end of 2010:
    a Enter amount for 2009 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2010:
    a From 2005.......  
    b From 2006.......  
    c From 2007.......  
    d From 2008.......  
    e From 2009.......  
    fTotal of lines 3a through e.........  
    4Qualifying distributions for 2010 from Part
    XII, line 4: bullet$ 457,944
    a Applied to 2009, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see page 26 of the instructions)    		  
    c Treated as distributions out of corpus (Election
    required—see page 26 of the instructions)...     		 
    d Applied to 2010 distributable amount.....  
    e Remaining amount distributed out of corpus 457,944
    5 Excess distributions carryover applied to 2010.    
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 457,944
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable
    amount—see page 27 of the instructions ...     		 
    e Undistributed income for 2009. Subtract line
    4a from line 2a. Taxable amount—see page 27
    of the instructions ...........     		 
    f Undistributed income for 2010. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2011 ..........     		 
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see page 27
    of the instructions) ...........     		 
    8Excess distributions carryover from 2005 not
    applied on line 5 or line 7 (see page 27 of the
    instructions) .............     		 
    9Excess distributions carryover to 2011.
    Subtract lines 7 and 8 from line 6a ......     		 
    10 Analysis of line 9:
    a Excess from 2006....  
    b Excess from 2007....  
    c Excess from 2008....  
    d Excess from 2009....  
    e Excess from 2010....  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 9
    Part XIV
    Private Operating Foundations (see page 27 of the instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2010, enter the date of the ruling.......bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2010 (b) 2009 (c) 2008 (d) 2007
    381,118 301,058 307,614 266,436 1,256,226
    b 85% of line 2a ......... 323,950 255,899 261,472 226,471 1,067,792
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		457,944 458,473 205,945 2,240,220 3,362,582
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ....     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		457,944 458,473 205,945 2,240,220 3,362,582
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets” alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment” alternative test— enter 2⁄3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		254,079 200,705 205,076 177,624 837,484
    c “Support” alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see page 27 of the instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    NONE
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    NONE
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number of the person to whom applications should be addressed:
    HEMOPHILIA OUTREACH CENTRE
    2060 BELLEVUE STREET
    GREEN BAY,WI54311
    (920) 965-0606
    bThe form in which applications should be submitted and information and materials they should include:
    SEE ATTACHED APPLICANT INFORMATION FORM
    cAny submission deadlines:
    SEE ATTACHED APPLICANT INFORMATION FORM
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    SEE ATTACHED APPLICANT INFORMATION FORM
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 10
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    GREAT LAKES
    HEMOPHILIA FDN
    PO BOX 704
    MILWAUKEE,WI53201     		  501(C)3 FINANCIAL ASSISTANC 25,000
    PATIENT SERVICES INC
    PO BOX 1602
    MIDLOTHIAN,VA23113     		  501(C)3 PREMIUM ASSISTANCE 20,000
    SCHOLARSHIPS INC
    PO BOX 1873
    GREEN BAY,WI54305     		  501(C)3 EDUCATIONAL SCHOLARSHIP 28,500
    Total .................................bullet 3a 73,500
    bApproved for future payment
    Total ..................................bullet 3b  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 11
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See page 28 of
    the instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3Interest on savings and temporary cash investments     14 33,897  
    4 Dividends and interest from securities....     14 7,151  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory     18 -1,371  
    9 Net income or (loss) from special events:     1 6,234  
    10 Gross profit or (loss) from sales of inventory..         1,336,588
    11 Other revenue: aMISC. INCOME         26
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   45,911 1,336,614
    13Total. Add line 12, columns (b), (d), and (e)...................
    131,382,525
    (See worksheet in line 13 instructions on page 28 to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the organization’s exempt purposes (other than by providing funds for such purposes). (See
    page 28 of the instructions.)
    1A PROVIDING MEDICAL CARE AND GUIDANCE TO THOSE LIVING WITH
    10 A BLEEDING DISORDER. COMPREHENSIVE SERVICES MAY INCLUDE
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 12
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section
    Yes
    No
    501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash....................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements............................
    1b(4)
     
    No
    (5) Loans or loan guarantees..............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is “Yes,” complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If “Yes,” complete the following schedule.
    (a) Name of organization (b) Type of organization (c) Description of relationship
    SignHere
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    Signature of officer or trustee Date Title
    PaidPreparersUseOnly Preparer's SignatureBullet Date PTIN
    Firm's namebullet



    Firm's addressbullet







         		Firm's EINbullet
    Phone no.
    Form 990-PF (2010)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    OMB No. 1545-0047
    2010
    Name of organization
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    Employer identification number

    39-1858104
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule—
    Special Rules
    ......................... Arrow Bullet   $    
    Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
    Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
    Page 1 of 1 of Part I
    Name of organization
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC         		Employer identification number

    39-1858104
    Part I
    Contributors (see Instructions)
    		     
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
    1
     
     

    GREAT LAKES HEMOPHILIA FOUNDATION    
    PO BOX 704
       
    MILWAUKEE, WI   532010704

    		$19,437




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
    Page 1 of 1 of Part II
    Name of organization
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC         		Employer identification number

    39-1858104
    Part II
    Noncash Property (see Instructions)
    		     
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
    Page 1 of 1 of Part III
    Name of organization
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC         		Employer identification number

    39-1858104
    Part III
    Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
    aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
    For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
    contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2010 CompensationExplanation
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Person Name Explanation
    JEANNE DEGROOT  
    BRIAN CHARLIER  
    LINDA ROETHLE  
    MATT BRAULT  
    CHRIS KNURR  
    ROBYN DAVIS  
    KEN ZEHREN  
    PEGGY MAIER  
    DEBBIE ARMBRUSTER  
    KEVIN VERHAGEN  
    GREG FITZGERALD  
    MARK SEMRAU  
    KRISTIN SIOLKA  
    AMANDA BOOKTER  

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2010 DepreciationSchedule
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    OFFICE EQUIPMENT       CLASS LIFE   66,920   66,920  
    PROGRAM EQUIPMENT       CLASS LIFE          
    LEASEHOLD IMPROVMENTS       CLASS LIFE          

    TY 2010 EmployeeCompensationExpln
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Employee Explanation
    KATHLEEN AMMERMAN  
    KAY STREET  

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2010 GainLossSaleOtherAssetsSch
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Name Date Acquired How Acquired Date Sold Purchaser Name Gross Sales Price Basis Basis Method Sales Expenses Total (net) Accumulated Depreciation
    SALES INCENTIVE-SUB RISK OF FORFEITU 2010-06 PURCHASE 2010-09   44,738       44,738  

    TY 2010 GeneralExplanationAttachment
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Identifier Return Reference Explanation
    GENERAL RETURN INFORMATION   FORM 990-PF, PART II, LINE 6 RECEIVABLES FROM OFFICERS AND DIREC AS AN ACTIVITY FUNCTIONALLY RELATED AND ARE SUBJECT TO THE SAME TERMS A GENERAL PUBLIC. FORM 990-PF, PART VII-B, QUESTION 1 MEDICAL CARE AND PRODUCT ARE FURNIS FAMILY MEMBERS AND CREDIT IS EXTEND OTHER PATIENT OF THE CENTER. MILEAG AND OFFICERS ARE REIMBURSED WHEN RE EXEMPT PURPOSE OF THE FOUNDATION AN DOCUMENTATION.
    GENERAL ELECTIONS    

    TY 2010 InvestmentsCorpStockSchedule
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Name of Stock End of Year Book Value End of Year Fair Market Value
    AXA SAM STRATEGIC ASSET MGMT    
    GUARANTEED ANNUITY AXA 170 775,942 775,942
    PRINCIPAL PROTECTION ANNUIT 278 1,258,269 1,258,269
    RETIREMENT CORNERSTONE 977,883 977,883
    GUARANTEED ANNUITY AXA 847 542,595 542,595
    GUARANTEED ANNUITY AXA 936 1,564,991 1,564,991

    TY 2010 LandEtcSchedule2
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    OFFICE EQUIPMENT/COMPUTERS 37,661 27,610 10,051 10,051
    FURNITURE AND FIXTURES 120,006 49,414 70,592 70,592
    PROGRAM EQUIPMENT 33,936 22,211 11,725 11,725
    BUILDING IMPROVEMENTS 12,930 2,379 10,551 10,551
    LAND PURCHASE 437,682   437,682 437,682
    BUILDINGS 1,435,471 113,488 1,321,983 1,321,983
    LAND IMPROVEMENT 66,217 11,044 55,173 55,173


    TY 2010 OtherExpensesSchedule
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FUND RAISERS        
    SUPPLIES 5,120   5,120  
    EXPENSES        
    ADULT LEARNER 1,000     1,000
    ADULT PHYSICIAN CONTRACT 116,848   116,848  
    ADVANCED EDUCATION FOR CONSUM 17,261     17,261
    AUTO MILEAGE-BUSINESS 710   710  
    AUTO MILEAGE-PROGRAMS 3,777   3,777  
    BOARD EXPENSES 3,748   3,748  
    BUSINESS INSURANCE 25,178   25,178  
    BUSINESS OUTREACH 1,042     1,042
    BUSINESS PERMITS/LICENSES 670   670  
    CAR RENTAL - PROGRAMS 104   104  
    CAR RENTAL-BUSINESS 60   60  
    CHRISTMAS CELEBRATION 5,458     5,458
    CLINIC STAFFING EXPENSES 2,151   2,151  
    COMMUNITY NIGHT 1,523     1,523
    COMMUNITY PICNIC 1,667     1,667
    COMPUTER NETWORK EXPENSE 3,392     3,392
    CONSUMER ED. 2,441     2,441
    COURIER MILEAGE 2,998   2,998  
    EQUIPMENT RENTAL 2,140   2,140  
    FACTOR SHIPPING 245   245  
    FITNESS PROGRAM 1,096     1,096
    FURNITURE & FIXTURE EXPENSE 320   320  
    LAB BILL 5,788   5,788  
    MAINTENANCE 21,494   16,979 4,515
    MARKETING EXPENSE 929     929
    MASSAGE PROGRAM 328     328
    MEDICAL BILLING EXPENSE 1,350   1,350  
    MEDICAL SUPPLIES 10,876   10,876  
    MEMBERSHIPS 5,400   5,400  
    NUTRITION EDUCATION 5,568     5,568
    OFFICE EQUIPMENT EXPENSE 627   627  
    OFFICE EXPENSE 6,999   6,298 701
    OTHER SOCIAL OUTREACH 7,558     7,558
    POSTAGE/OTHER SHIPPING 2,722   2,722  
    PROFESSIONAL LICENSES 172   172  
    PROGRAM EQUIPMENT EXPENSE 204     204
    PSYCHOSOCIAL SERVICES PROGRAM 20,577     20,577
    RECRUITMENT 24,916   24,916  
    STAFF OTHER ED. 2,857     2,857
    STAFF PROGRAM ED. 21,323     21,323
    TELEPHONE 5,256   4,729 527
    TELEPHONE EQUIPMENT 179   160 19
    WELLNESS SUPPORT 1,148     1,148


    TY 2010 OtherIncomeSchedule2
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    FUND RAISERS 11,354   11,354
    MISC. INCOME 26   26


    TY 2010 OtherIncreasesSchedule
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Description Amount
    UNREALIZED GAIN ON SECURITIES 464,109
    PRIOR YEAR REALIZED LOSS RECOGNIZED 39,726


    TY 2010 OtherLiabilitiesSchedule
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Description Beginning of Year - Book Value End of Year - Book Value
    CREDIT CARD DEBT 365  
    PAYROLL LIABILITIES 5,366  
    FICA-EMPLOYEE   336
    FICA-COMPANY   336
    MEDICARE-EMPLOYEE   79
    MEDICARE-COMPANY   79
    SUTA   377
    SAM'S CREDIT CARD   163
    BANK OF LUXEMBURG MASTERCARD   2,270
    CAPITAL ONE VISA   996
    ACCRUED RETIREE MEDICAL   10,849


    TY 2010 OtherProfessionalFeesSchedule
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 10,142   9,128 1,014
    ATTORNEY FEES 4,332   3,899 433
    OTHER PROFESSIONAL FEES 13,077   11,769 1,308
    INVESTMENT MNGMENT FEE EXPENSE 6,028 6,028    


    TY 2010 SalesOfInventoryList 
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104

    Category Gross Sales Cost of Goods Sold Net (Gross Sales Minus
    Cost of Goods Sold)
    MEDISOFT INCOME 5,525,245 4,188,657 1,336,588

    TY 2010 TaxesSchedule
    Name:
    HEMOPHILIA OUTREACH OF WISCONSIN
    FOUNDATION INC
    EIN: 39-1858104
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL INVESTMENT INCOME TAX 600   600  
    PROPERTY TAX EXPENSE 190   190