Form990-PF

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 07-01-2010 , and ending 06-30-2011
G
Check all that apply:
Name of foundation
RUNZHEIMER FOUNDATION INC
 

Number and street (or P.O. box number if mail is not delivered to street address)1 RUNZHEIMER PARKWAY   Room/suite
City or town, state, and ZIP code
WATERFORD, WI53185
A Employer identification number

27-2914749
B Telephone number (see page 10 of the instructions)

(262) 971-2659
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$512J 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) 757,000
2 Check bullet
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities......      
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)... 0
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 757,000 0 0
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0 0 0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule)......... Click to see attachment 3,286 0 0 3,286
b Accounting fees (attach schedule)....... Click to see attachment 5,450 0 0 5,450
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see page 14 of the instructions)        
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 1,268 0 0 1,268
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 10,004 0 0 10,004
25 Contributions, gifts, grants paid........ 746,484 746,484
26 Total expenses and disbursements. Add lines 24 and 25 756,488 0 0 756,488
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 512
b Net investment income (if negative, enter -0-) 0
c Adjusted net income (if negative, enter -0-)... 0
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...............   512  
2 Savings and temporary cash investments..........      
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
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...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........      
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 bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 0 512 512
Liabilities 17 Accounts payable and accrued expenses..........    
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)    
23 Total liabilities (add lines 17 through 22).......... 0 0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted....................    
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds......... 0 0
28 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
29 Retained earnings, accumulated income, endowment, or other funds 0 512
30 Total net assets or fund balances (see page 17 of the
instructions).................... 0 512
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 0 512
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 0
2 Enter amount from Part I, line 27a...................... 2 512
3 Other increases not included in line 2 (itemize) bullet 3 0
4 Add lines 1, 2, and 3.......................... 4 512
5 Decreases not included in line 2 (itemize) bullet 5 0
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30.. 6 512
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.)
1a
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
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
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  
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      
2008      
2007      
2006      
2005      
2 Total of line 1, column (d) ...................... 2  
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  
4 Enter the net value of noncharitable-use assets for 2010 from Part X, line 5..... 4  
5 Multiply line 4 by line 3....................... 5  
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6  
7 Add lines 5 and 6......................... 7  
8 Enter qualifying distributions from Part XII, line 4.............. 8  
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 0
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 0
3 Add lines 1 and 2............................ 3 0
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-). 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 0
6 Credits/Payments:
a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a  
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 0
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 0
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2011 estimated taxBullet   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$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
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
     
    No
    10
    Did any persons become substantial contributors during the tax year? If “Yes,” attach a schedule listing their names and addresses.Click to see attachment
    10
    Yes
     
    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 addressbulletN/A
    14
    The books are in care ofbulletDAWN KIRBY Telephone no.bullet (262) 971-2659
    Located atbullet1 RUNZHEIMER PARKWAYWATERFORDWI ZIP+4bullet53185
    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
     
    No
    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
     
     
    .........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
    GREGORY HARPER PRESIDENT
    1.00     		0 0 0
    1 RUNZHEIMER PARKWAY
    WATERFORD,WI53185
    JACKIE STRELOW SECRETARY
    10.00     		0 0 0
    1 RUNZHEIMER PARKWAY
    WATERFORD,WI53185
    DAWN KIRBY TREASURER
    1.00     		0 0 0
    1 RUNZHEIMER PARKWAY
    WATERFORD,WI53185
    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
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    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.............bullet0
    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
     
    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  
    2  
    All other program-related investments. See page 24 of the instructions.
    3  
    Total. Add lines 1 through 3...........................bullet0
    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
    0
    b
    Average of monthly cash balances.......................
    1b
    153,649
    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
    153,649
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) ..............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d..........................
    3
    153,649
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ............................
    4
    2,305
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    151,344
    6
    Minimum investment return. Enter 5% of line 5...................
    6
    7,567
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    7,567
    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
    0
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    7,567
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4.............................
    5
    7,567
    6
    Deduction from distributable amount (see page 25 of the instructions)...........
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1.................................
    7
    7,567
    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
    756,488
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes................................
    2
     
    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
    756,488
    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
    0
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4...............
    6
    756,488
    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 7,567
    2 Undistributed income, if any, as of the end of 2010:
    a Enter amount for 2009 only....... 0
    b Total for prior years:20, 20, 20 0
    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......... 0
    4Qualifying distributions for 2010 from Part
    XII, line 4: bullet$ 756,488
    a Applied to 2009, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see page 26 of the instructions)    		 0
    c Treated as distributions out of corpus (Election
    required—see page 26 of the instructions)...     		0
    d Applied to 2010 distributable amount..... 7,567
    e Remaining amount distributed out of corpus 748,921
    5 Excess distributions carryover applied to 2010. 0 0
    (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 5 748,921
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		0
    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......     		0
    d Subtract line 6c from line 6b. Taxable
    amount—see page 27 of the instructions ...     		0
    e Undistributed income for 2009. Subtract line
    4a from line 2a. Taxable amount—see page 27
    of the instructions ...........     		0
    f Undistributed income for 2010. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2011 ..........     		0
    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) ...........     		0
    8Excess distributions carryover from 2005 not
    applied on line 5 or line 7 (see page 27 of the
    instructions) .............     		0
    9Excess distributions carryover to 2011.
    Subtract lines 7 and 8 from line 6a ......     		748,921
    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.... 748,921
    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
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		         
    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 ....     		         
    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...     		         
    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).)
    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.
    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:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    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
    4-H (TEAM FIRST AID)
    912 MAGNOLIA DRIVE
    WAUKESHA,WI53188     		NONE 501(C )(3) GENERAL SUPPORT 500
    ALS ASSOCIATION NE OHIO CHAPTER
    2500 E 22ND STREET SUITE 102
    CLEVELAND,OH441159707     		NONE 501(C )(3) GENERAL SUPPORT 50
    AMERICAN CANCER SOCIETY
    PO BOX 902
    PEWAUKEE,WI530729910     		NONE 501(C )(3) GENERAL SUPPORT 40
    AMERICAN CANCER SOCIETY (RELAY FOR LIFE)
    PO BOX 902
    PEWAUKEE,WI53072     		NONE 501(C )(3) GENERAL SUPPORT 100
    AMERICAN DIABETES ASSOCIATION
    2323 N MAYFAIR ROAD SUITE 502
    WAUWATOSA,WI53226     		NONE 501(C )(3) GENERAL SUPPORT 100
    AMERICAN LEGION
    32906 SEIDEL DRIVE
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 500
    AMERICAN LUNG ASSOCIATION (MEMORIAL FOR FEURING)
    1301 PENSYLVANIA AVENUE NW SUITE
    800
    WASHINGTON,DC20004     		NONE 501(C )(3) GENERAL SUPPORT 50
    AMVETS RIDERS OF WISCONSIN
    4614 SHEARD ROAD
    KANSASVILLE,WI53139     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    AUTISM SOCIETY OF SOUTHEASTERN WI
    9733 W SAINT MARTINS ROAD
    FRANKLIN,WI53132     		NONE 501(C )(3) GENERAL SUPPORT 500
    AUTISM SPEAKS
    2 PARK AVENUE 11TH FLOOR
    NEW YORK,NY10016     		NONE 501(C )(3) GENERAL SUPPORT 25
    BOSS (10U ORANGE)
    W294 SPRING PRAIRIE ROAD
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 500
    BAY INTER-FAITH HOUSING
    27100 KNICKERBOCKER ROAD
    BAY VILLAGE,OH44140     		NONE 501(C )(3) GENERAL SUPPORT 3,000
    BAY LANE MIDDLE SCHOOL
    400 MILWAUKEE AVENUE
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 1,000
    BAY LANE MIDDLE SCHOOL
    400 MILWAUKEE AVENUE
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 1,000
    BEREA ANIMAL RESCUE FUNDS
    390 BARRETT ROAD PO BOX 544
    BEREA,OH44017     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 500
    BEREA HIGH SCHOOL
    165 E BAGLEY ROAD
    BEREA,OH44017     		NONE 501(C )(3) EDUCATIONAL SUPPORT 2,500
    BEREA HIGH SCHOOL
    165 E BAGLEY ROAD
    BEREA,OH44017     		NONE 501(C )(3) EDUCATIONAL SUPPORT 2,000
    BEREA HIGH SCHOOL
    165 E BAGLEY ROAD
    BEREA,OH44017     		NONE 501(C )(3) EDUCATIONAL SUPPORT 2,280
    BHS SCHOLARSHIPS INC
    441 MILWAUKEE AVENUE
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 13,000
    BLESSING HOUSE
    5440 GROVE AVENUE
    LORAIN,OH44055     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    BOY SCOUT TROOP 324
    5224 BAYFIELD DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 350
    BOY SCOUT TROOP 332
    6909 GLENN COURT
    WIND LAKE,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 100
    BOY SCOUTS OF AMERICA
    2319 NORTHWESTERN AVENUE
    RACINE,WI53404     		NONE 501(C )(3) GENERAL SUPPORT 500
    BOY SCOUTS OF AMERICA
    2319 NORTHWESTERN AVENUE
    RACINE,WI53404     		NONE 501(C )(3) GENERAL SUPPORT 50
    BOY SCOUTS OF AMERICA (PACK 369)
    33515 FAIRVIEW COURT
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    BOY SCOUTS OF AMERICA (TROOP 332)
    4728 FAIRWAY DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 100
    BOY SCOUTS OF AMERICA (TROOP 372)
    33107 WASHINGTON AVENUE
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    BOY SCOUTS OF AMERICA TROOP 324
    4728 FAIRWAY DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    BOY SCOUTS OF AMERICA TROOP 334
    4728 FAIRWAY DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 200
    BRECKSVILLE-BROADVIEW HEIGHTS CITY SCHOOL DISTRICT
    6638 MILL ROAD
    BRECKSVILLE,OH44141     		NONE 501(C )(3) EDUCATIONAL SUPPORT 2,000
    BROOKLYN ANIMAL SHELTER INC
    8300 MEMPHIS AVENUE
    BROOKLYN,OH44144     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 2,500
    BROOKLYN CITY SCHOOLS (SCHOLARSHIPS)
    9200 BIDDULPH ROAD
    BROOKLYN,OH44144     		NONE 501(C )(3) EDUCATIONAL SUPPORT 5,000
    BURLINGTON AREA SCHOOL DISTRICT
    100 N KANE STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 2,000
    BURLINGTON BLAZE BASEBALL
    1141 SPRING VALLEY ROAD
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 500
    BURLINGTON COMMUNITY FUND LTD (VETERANS TERRACE AT ECHO PARK)
    PO BOX 546
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 25,000
    BURLINGTON GIRLS SOFTBALL LEAGUE
    225 N KANE STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 450
    BURLINGTON HIGH SCHOOL
    400 MCCANNA PARKWAY
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 500
    BURLINGTON HIGH SCHOOL
    400 MCCANNA PARKWAY
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 3,000
    BURLINGTON HIGH SCHOOL
    400 MCCANNA PARKWAY
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 500
    BURLINGTON HIGH SCHOOL (ATHLETIC ASSOCIATION)
    400 MCCANNA PARKWAY
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 500
    BURLINGTON HIGH SCHOOL (STEM)
    400 MCCANNA PARKWAY
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 1,000
    BURLINGTON LITTLE LEAGUE
    PO BOX 159
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 500
    BURLINGTON LITTLE LEAGUE (ROCKETS BASEBALL)
    35317 RIDGE ROAD
    BULRINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 715
    BURLINGTON PUBLIC LIBRARY
    166 EAST JEFFERSON STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 10,000
    BURLINGTON ROTARY
    27411 NORTH LAKE DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 4,600
    CARE ALLIANCE HEALTH CENTER
    1530 ST CLAIR AVENUE
    CLEVELAND,OH44114     		NONE 501(C )(3) GENERAL SUPPORT 2,500
    CATHOLIC CENTRAL ENDOWMENT
    148 MCHENRY STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 50
    CATHOLIC CENTRAL HIGH SCHOOL
    148 MCHENRY STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 100
    CEDAR RIDGE FOUNDATION INC
    3011 NORTH CEDAR RIDGE RD
    OCONOMOWOC,WI53066     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    CHILDREN'S HOSPITAL & HEALTH SYSTEMS FOUNDATION
    P O BOX 1997 MS3050
    MILWAUKEE,WI53201     		NONE 501(C )(3) GENERAL SUPPORT 100
    CHILDREN'S HOSPITAL & HEALTH SYSTEMS FOUNDATION (BRIGGS & AL'S RUN & WALK)
    P O BOX 1997 MS3050
    MILWAUKEE,WI53201     		NONE 501(C )(3) GENERAL SUPPORT 251
    CHILDREN'S HOSPITAL & HEALTH SYSTEMS FOUNDATION (BRIGGS & AL'S RUN & WALK)
    P O BOX 1997 MS3050
    MILWAUKEE,WI53201     		NONE 501(C )(3) GENERAL SUPPORT 30
    CHILDRENS HOSPITAL OF WISCONSIN FOUNDATION
    55836 WATERFORD LANE STE A
    APPLETON,WI54913     		NONE 501(C )(3) GENERAL SUPPORT 150
    CHILDRENS HOSPITAL OF WISCONSIN INC (JOEY O'BRIEN FOUNDATION)
    30300 LAKE HILL DRIVE
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    CHILDREN'S HOSPITAL OF WISCONSIN INC
    MS 3050 PO BOX 1997
    MILWAUKEE,WI53201     		NONE 501(C )(3) GENERAL SUPPORT 7,500
    CHOCOLATEFEST
    PO BOX 720
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 17,600
    CHRIST LUTHERAN CHURCH
    S89 W22970 MAPLE AVENUE
    BIG BEND,WI53103     		NONE 501(C )(3) GENERAL SUPPORT 100
    CITY OF BURLINGTON FIRE DEPARTMENT
    165 WASHINGTON STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    CITY OF BURLINGTON POLICE DEPARTMENT
    224 E JEFFERSON STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 2,500
    CITY OF BURLINGTON POLICE DEPARTMENT
    224 E JEFFERSON STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    CLEVELAND FOODBANK INC
    15500 SOUTH WATERLOO ROAD
    CLEVELAND,OH44110     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    CLEVELAND RYDERS YOUTH ORGANIZATION INC
    PO BOX 25074
    CLEVELAND,OH44125     		NONE 501(C )(3) GENERAL SUPPORT 2,550
    CLEVELAND ZOOLOGICAL SOCIETY
    3900 WILDLIFE WAY
    CLEVELAND,OH44109     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    COLUMBIA LOCAL SCHOOLS (SCHOLARSHIPS)
    25796 ROYALTON ROAD
    COLUMBIA STATION,OH44028     		NONE 501(C )(3) EDUCATIONAL SUPPORT 5,000
    COOPER ELEMENTARY SCHOOL
    249 CONKEY STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 6,000
    COPS N KIDS READING CENTER INC
    800 VILLA STREET
    RACINE,WI53403     		NONE 501(C )(3) GENERAL SUPPORT 10,000
    CROSS LUTHERAN CHURCH (CROP WALK BIKE OR RUN)
    126 CHAPEL TERRACE
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 500
    CUB SCOUT PACK 361
    4711 E 88TH STREET
    GARFIELD HEIGHTS,OH44125     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    CUB SCOUTS (PACK 323 WATERFORD)
    404 FOX ISLE PARK DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    CUB SCOUTS (PACK 324 WATERFORD)
    6226 STONEHEDGE COURT
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    CUB SCOUTS OF SE WISCONSIN (PACK 332)
    26055 WEST LOOMIS RD
    WIND LAKE,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 2,500
    CUSHING PARENT TEACHER ORGANIZATION PTO
    227 GENESSEE STREET
    DELAFIELD,WI53108     		NONE 501(C )(3) EDUCATIONAL SUPPORT 25
    CYSTIC FIBROSIS FOUNDATION
    740 LAKEVIEW PLAZA
    WORTHINGTON,OH43085     		NONE 501(C )(3) GENERAL SUPPORT 500
    DARE (DRUG ABUSE RESISTANCE EDUCATION)
    1000 55TH ST
    KENOSHA,WI53140     		NONE 501(C )(3) EDUCATIONAL SUPPORT 2,500
    DANCEWORKS INC
    1661 N WATER STREET
    MILWAUKEE,WI53202     		NONE 501(C )(3) GENERAL SUPPORT 3,000
    DAWN E PETERSEN FOUNDATION INC
    7754 BRAEGER ROAD
    THREE LAKES,WI54562     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    DAZZLER BOOSTER CLUB
    216 NORTH MILWAUKEE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 500
    DEFOREST FOOTBALL
    926 STONECRESS COURT
    SUN PRAIRIE,WI53590     		NONE 501(C )(3) GENERAL SUPPORT 1,500
    DROUGHT SCHOOL
    21016 W 7 MILE RD
    FRANKSVILLE,WI53126     		NONE 501(C )(3) EDUCATIONAL SUPPORT 1,300
    FEEDING AMERICA EASTERN WISCONSIN
    1700 W FOND DU LAC AVENUE
    MILWAUKEE,WI53205     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    FIRST CHURCH OF CHRIST SCIENTIST
    133 W JEFFERSON STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 1,500
    FIRST CHURCH OF CHRISTIAN SCIENTIST
    210 MASSACHUSETTS AVENUE PO5-15
    BOSTON,MA021153195     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    FISCHER HOUSE FOUNDATION
    2154 ARTHUR AVENUE SUITE 926
    LAKEWOOD,OH44107     		NONE 501(C )(3) GENERAL SUPPORT 2,500
    FOCUS ON COMMUNITY INC
    1220 MOUND AVE SUIT 307
    RACINE,WI53404     		NONE 501(C )(3) GENERAL SUPPORT 9,000
    FOREST PARK MIDDLE SCHOOL
    8255 W FOREST HILL AVENUE
    FRANKLIN,WI53132     		NONE 501(C )(3) EDUCATIONAL SUPPORT 2,500
    FOX RIVER CHRISTIAN CHURCH (SHOES UNTO OTHERS KENYA)
    S46 W24130 LAWNSDALE ROAD
    WAUKESHA,WI53189     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    FOX RIVER MIDDLE SCHOOL
    921 W MAIN STREET
    WATERFORD,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 6,000
    FOX RIVER MIDDLE SCHOOL (TREES FOR TOMORROW)
    921 W MAIN STREET
    WATERFORD,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 2,000
    FOX ROVER WATERSHED CAUSE INC
    PO BOX 297
    WATEFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 500
    FRIENDS OF PERRY'S VICTORY AND INTERNATIONAL PEACE MEMORIAL INC
    PO BOX 549
    PUTINBAY,OH534560549     		NONE 501(C )(3) GENERAL SUPPORT 500
    GENESIS HOUSE
    PO BOX 718
    LORAIN,OH44052     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    GENOA CITY LIONS CLUB (BRYNN THORNBURGH BENEFIT FUND)
    N1798 NORTH DAISY DRIVE
    GENOA CITY,WI53128     		NONE 501(C )(3) GENERAL SUPPORT 500
    GOLDEN RETRIEVER RESCUE OF WI
    PO BOX 84
    WATERTOWN,WI53094     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 35
    GOLDEN RETRIEVER RESCUE OF WI
    PO BOX 84
    WATERTOWN,WI53094     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 250
    GOODWILL INDUSTRIES INC
    408 9TH STREET
    CANTON,OH44707     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    GRACE CHURCH
    257 KENDALL STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 100
    GREYHOUND ADOPTION OF OHIO INC
    7122 COUNTRY LANE
    CHAGRIN FALLS,OH44023     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 500
    HALO OF RACINE
    2000 DEKOVEN AVENUE UNIT 1
    RACINE,WI53403     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    HALO INC
    2000 DEKOVEN AVENUE UNIT 1
    RACINE,WI53403     		NONE 501(C )(3) GENERAL SUPPORT 100
    HALO INC
    2000 DEKOVEN AVENUE UNIT 1
    RACINE,WI53403     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    HAYLOFTERS INC
    PO BOX 164
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 6,000
    HISPANIC BUSINESS & PROFESSIONAL ASSOCIATION
    PO BOX 081644
    RACINE,WI53408     		NONE 501(C )(3) GENERAL SUPPORT 4,750
    HISPANIC BUSINESS & PROFESSIONAL ASSOCIATION (FIESTA 2010)
    PO BOX 081644
    RACINE,WI53408     		NONE 501(C )(3) GENERAL SUPPORT 4,750
    HONOR OUR MILITARY (AKA VETERANS DAY PARADE OF MILWAUKEE INC)
    P O BOX 684
    MILWAUKEE,WI532010684     		NONE 501(C )(3) GENERAL SUPPORT 2,525
    HONOR OUR MILITARY INC (VETERANS DAY PARADE OF MILWAUKEE INC)
    P O BOX 684
    MILWAUKEE,WI532010684     		NONE 501(C )(3) GENERAL SUPPORT 10,000
    HOPE SAFE HOUSE OF RACINE ANIMAL SHELTER
    1911 TAYLOR AVENUE
    RACINE,WI53403     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 1,000
    HUNGER TASK FORCE (JELL-O DRIVE)
    201 S HAWLEY CT
    MILWAUKEE,WI53214     		NONE 501(C )(3) GENERAL SUPPORT 550
    IN HIS ARMS PRESCHOOL
    417 S KANE
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 100
    JUVENILE DIABETES RESEARCH FOUNDATION INTERNATIONAL
    3333 NORTH MAYFAIR ROAD SUITE 107
    WAUWATOSA,WI53222     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    KARCHER MIDDLE SCHOOL
    225 ROBERT ST
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 1,000
    KARCHER MIDDLE SCHOOL
    225 ROBERT ST
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 500
    KARCHER MIDDLE SCHOOL
    225 ROBERT ST
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 350
    KARCHER MIDDLE SCHOOL
    225 ROBERT ST
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 2,500
    KENOSHA PUBLIC MUSEUM
    5500 FIRST AVENUE
    KENOSHA,WI53140     		NONE 501(C )(3) GENERAL SUPPORT 4,000
    KENOSHA RACINE BIKE CLUB (2 WHEELS FOR 2 COUNTIES)
    PO BOX 085602
    RACINE,WI534085602     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    KIWANIS CLUB OF BURLINGTON
    P O BOX 522
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 250
    KIWANIS INTERNATIONAL FOUNDATION INC
    2380 HWY 44 SUITE H
    OSHKOSH,WI54904     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    LAKE ERIE ISLANDS HISTORICAL SOCIETY
    PO BOX 25
    PUTIN BAY,OH43456     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    LAKE ERIE JUNIOR NATURE AND SCIENCE CENTER
    28728 WOLF ROAD
    BAY VILLAGE,OH44140     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    LAKELAND ANIMAL SHELTER
    PO BOX 1000
    ELKHORN,WI53121     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 100
    LAKELAND ANIMAL SHELTER
    PO BOX 1000
    ELKHORN,WI53121     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 1,900
    LILLIE'S FAIRTRADE
    W62 N553 WASHINGTON AVENUE
    CEDARBURG,WI53012     		NONE 501(C )(3) GENERAL SUPPORT 100
    LINCOLN LUTHERAN HOME OF RACINE INC
    2000 DOMANIK DR
    RACINE,WI53404     		NONE 501(C )(3) GENERAL SUPPORT 7,000
    LOVE INC
    480 SOUTH PINE STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 500
    LOVE INC
    480 SOUTH PINE STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 2,738
    LOVE INC (ADOPT A FAMILY)(REIMBURSEMENT TO PEGGY BLOCK FOR PURCHASE OF DON
    480 SOUTH PINE STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 238
    LOVE INC
    480 SOUTH PINE STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 500
    LOVE INC
    480 SOUTH PINE STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 50
    LUTHERAN BLIND MISSION
    7550 WATSON ROAD
    ST LOUIS,MO631194409     		NONE 501(C )(3) GENERAL SUPPORT 100
    MAKE A DIFFERENCE WISCONSIN INC (EMPOWER STUDENTS)
    710 N PLANKINTON AVENUE SUITE 310
    MILWAUKEE,WI53203     		NONE 501(C )(3) EDUCATIONAL SUPPORT 1,000
    MAKE A WISH FOUNDATION OF WISCONSIN
    13195 W HAMPTON AVENUE
    BUTLER,WI53007     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    MAKE A WISH FOUNDATION OF WISCONSIN
    13195 W HAMPTON AVENUE
    BUTLER,WI53007     		NONE 501(C )(3) GENERAL SUPPORT 600
    MARGARETANN'S PLACE
    912 N HAWLEY ROAD STE 220
    MILWAUKEE,WI532133222     		NONE 501(C )(3) GENERAL SUPPORT 520
    MARGARETANN'S PLACE (WI CHAPTER OF HOPE FOR GRIEVING CHILDREN)
    912 N HAWLEY ROAD STE 220
    MILWAUKEE,WI532133222     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    MATTHEW SALEM CAMPING FOUNDATION INC
    PO BOX 670178
    NORTHFIELD,OH44067     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    MCKINLEY MIDDLE SCHOOL
    2340 MOHR AVENUE
    RACINE,WI53405     		NONE 501(C )(3) EDUCATIONAL SUPPORT 5,000
    MCKINLEY MIDDLE SCHOOL
    2340 MOHR AVENUE
    RACINE,WI53405     		NONE 501(C )(3) EDUCATIONAL SUPPORT 4,500
    MELISSA KEMPKEN BENEFIT FUND
    2532 FOX KNOLL DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 500
    MOTHERS AGAINST DRUNK DRIVING (MADD)
    PO BOX 758521
    TOPEKA,KS666758521     		NONE 501(C )(3) GENERAL SUPPORT 30
    MUSKEGOWIND LAKE YOUTH FOOTBALL
    8520 HALVERSON ROAD
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 500
    NAMI RACINE (BIKE 'N HIKE)
    2300 DEKOVEN AVENUE
    RACINE,WI53403     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    NAMI WISCONSIN INC (RACINE COUNTY)
    2300 DEKOVEN AVENUE
    RACINE,WI53403     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    NATIONAL MS SOCIETY
    32924 HILL VALLEY ROAD
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 25
    NEW BERLIN SCHOOL DISTRICT
    4295 S ADELL AVENUE
    NEW BERLIN,WI53151     		NONE 501(C )(3) EDUCATIONAL SUPPORT 100
    OCONOMOWOC MEMORIAL HOSPITAL FOUNDATIONS
    791 SUMMIT AVENUE
    OCONOMOWOC,WI53066     		NONE 501(C )(3) GENERAL SUPPORT 25
    OHIO STATE UNIVERSITY
    240 W LAKE STREET UNIT C
    OAK HARBOR,OH43449     		NONE 501(C )(3) EDUCATIONAL SUPPORT 5,000
    OLD WORLD WISCONSIN FOUNDATION INC
    123 E MAIN STREET
    EAGLE,WI53119     		NONE 501(C )(3) GENERAL SUPPORT 10,000
    OUR HOPE OF BURLINGTON INC
    PO BOX 131
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 500
    OUR HOPE OF BURLINGTON INC
    PO BOX 131
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 1,500
    OUR HOPE OF BURLINGTON INC
    PO BOX 131
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 50
    PARENTS TEACHERS AND COMMUNITY UNITED FOUNDATION
    10991 MEMPHIS AVENUE
    BROOKLYN,OH44144     		NONE 501(C )(3) EDUCATIONAL SUPPORT 3,074
    PARMA ANIMAL SHELTHER INC
    PO BOX 347321
    PARMA,OH44134     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 500
    PELOTONIA CO JAMES CANCER FUND INC (BIKE TOUR)
    351 W NATIONWIDE BLVD
    COLUMBUS,OH43215     		NONE 501(C )(3) GENERAL SUPPORT 50
    POWERS ELEMENTARY SCHOOL
    185 FOREST STREET
    AMHERST,OH44001     		NONE 501(C )(3) EDUCATIONAL SUPPORT 3,770
    PROJECT CAPE
    PO BOX 510791
    MILWAUKEE,WI53203     		NONE 501(C )(3) GENERAL SUPPORT 100,000
    PUBLIC ANIMAL WELFARE SOCIETY INC (PAWS)
    10991 MEMPHIS AVENUE
    BROOKLYN,OH44144     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 500
    RACINE COUNTY FOOD BANK
    2000 DEKOVEN AVE
    RACINE,WI53202     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    RACINE HERITAGE MUSEUM
    701 MAIN STREET
    RACINE,WI53403     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    RACINE KENOSHA COMMUNITY ACTION AGENCY INC
    2113 NORTH WISCONSIN STREET
    RACINE,WI53402     		NONE 501(C )(3) GENERAL SUPPORT 1,500
    RACINE PUBLIC LIBRARY
    245 MAIN STREET GARDEN LEVEL
    RACINE,WI53403     		NONE 501(C )(3) GENERAL SUPPORT 1,440
    RACINE ZOO
    200 GOOLD STREET
    RACINE,WI53402     		NONE 501(C )(3) GENERAL SUPPORT 4,000
    RACINE ZOO
    200 GOOLD STREET
    RACINE,WI53402     		NONE 501(C )(3) GENERAL SUPPORT 4,325
    RACINEKENOSHA COMMUNITY ACTION AGENCY
    2113 NORTH WISCONSIN STREET
    RACINE,WI53402     		NONE 501(C )(3) GENERAL SUPPORT 1,500
    RAINBOW CONNECTION ANIMAL FOUNDATION INC
    PO BOX 94143
    CLEVELAND,OH44101     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 500
    RALLY FOR THE CURE
    108 N WISCONSIN STREET
    ELKHORN,WI53121     		NONE 501(C )(3) GENERAL SUPPORT 1,540
    RAYMOND SCHOOL
    2659 76TH STREET
    FRANKSVILLE,WI53126     		NONE 501(C )(3) EDUCATIONAL SUPPORT 3,000
    REBEL GOLF OUTING (RACINE HORLICK HIGH SCHOOL)
    5817 WOODLAND HILLS DRIVE
    RACINE,WI53406     		NONE 501(C )(3) EDUCATIONAL SUPPORT 5,000
    REGGIE WHITE SLEEP DISORDERS RESEARCH & EDUCATION FOUNDATION
    2356 S 102ND STREET
    WEST ALLIS,WI53227     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    REGGIE WHITE SLEEP DISORDERS RESEARCH & EDUCATION FOUNDATION
    2356 S 102ND STREET
    WEST ALLIS,WI53227     		NONE 501(C )(3) GENERAL SUPPORT 100
    ROBERT MASON BENEFIT FUND (MCU FINANCIAL CENTER CU)
    2657 BROWNS LAKE DRIVE
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 500
    ROCHESTER AREA HISTORICAL SOCIETY
    2441 BECK DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 500
    ROCHESTER FIRE DEPARTMENT (ANNUAL DONATION)
    PO BOX 38
    ROCHESTER,WI53167     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    RONALD MCDONALD HOUSE CHARITIES OF EASTERN WISCONSIN INC
    8948 WATERTOWN PLANK ROAD
    MILWAUKEE,WI532264802     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    SAFE HARBOR HUMANE SOCIETY
    PO BOX 2306
    KENOSHA,WI531412306     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 500
    SCHOLASTIC SHOOTING SPORTS FOUNDATION
    165 BAY RIDGE LANE
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 2,500
    SECOND CHANCE PARTNERS FOR EDUCATION INC
    892 MAIN STREET SUITE E
    PEWAUKEE,WI53072     		NONE 501(C )(3) EDUCATIONAL SUPPORT 10,200
    SHALOM CENTER OF THE INTERFAITH NETWORD
    1713 62ND STREET
    KENOSHA,WI53143     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    SMILES
    N2666 COUNTY ROAD K
    DARIEN,WI53114     		NONE 501(C )(3) GENERAL SUPPORT 3,500
    SOJOURNER FAMILY PEACE CENTER
    PO BOX 080319
    MILWAUKEE,WI53208     		NONE 501(C )(3) GENERAL SUPPORT 500
    SOJOURNER FAMILY PEACE CENTER (AWEAR FASHION SHOW)
    PO BOX 080319
    MILWAUKEE,WI53208     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    SPECIAL OLYMPICS
    1611 SOUTH BROWNS LAKE DRIVE
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 10,000
    SPECIAL OLYMPICS WISCONSIN
    6150 TAYLOR AVENUE
    RACINE,WI53403     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    ST THOMAS SCHOOL
    305 S FIRST STREET
    WATERFORD,WI53185     		NONE 501(C )(3) EDUCATIONAL SUPPORT 640
    ST CHARLES (COLD HANDS WARM HEARTS)
    440 KENDALL STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 500
    ST CHARLES SCHOOL
    440 KENDALL STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 100
    ST PAUL'S LUTHERAN SCHOOL
    210 EAST PLEASANT ST
    OCONOMOWOC,WI53066     		NONE 501(C )(3) EDUCATIONAL SUPPORT 100
    STARS & STRIPES HONOR FLIGHT INC
    PO BOX 636
    PORT WASHINGTON,WI53074     		NONE 501(C )(3) GENERAL SUPPORT 500
    STARS AND STRIPES HONOR FIGHT
    PO BOX 636
    PORT WASHINGTON,WI53074     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    STARS AND STRIPES HONOR FIGHT
    PO BOX 636
    PORT WASHINGTON,WI53074     		NONE 501(C )(3) GENERAL SUPPORT 100
    STAY A WHILE CAT SHELTER
    8800 AKINS ROAD
    NORTH ROYALTON,OH44133     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 500
    SUDDEN INFANT DEATH SYNDROME - SIDS CENTER OF INDIANA INC (SHOOT FORE SAM
    7197 W CHRISTIAN DRIVE
    NEW PALESTINE,IN46163     		NONE 501(C )(3) GENERAL SUPPORT 500
    SUSAN RIDDLE (HARDSHIP - MEDICAL BILLS)
    424 STORLE
    BURLINGTON,WI53105     		EMPLOYEE   MEDICAL ASSISTANCE FOR NEEDY INDIVIDUAL 1,000
    TEEN CHALLENGE
    PO BOX 250771
    MILWAUKEE,WI532259943     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    THE CATHE (COMMUNITY ARTS TECHNOLOGY HEALTH EDUCATION)
    125 E STATE STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 10,000
    THE LEUKEMIA & LYMPHONA SOCIETY
    1311 MAMARONECK AVENUE
    WHITE PLAINS,NY10605     		NONE 501(C )(3) GENERAL SUPPORT 100
    TICHIGAN VOLUNTEER FIRE CO INC
    28835 SUNFLOWER LANE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 500
    TICHIGAN VOLUNTEER FIRE CO INC
    8205 BIG BEND ROAD
    WATERFORD,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    TOWN OF BURLINGTON FIRE DEPARTMENT
    32288 BUSHNELL ROAD
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    TOWN OF BURLINGTON POLICE DEPARTMENT
    32288 BUSHNELL ROAD
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    TOWN OF WATERFORD POLICE DEPARTMENT
    415 N MILWAUKEE AVENUE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    TRANSITIONAL HOUSING INC
    1545 WEST 25TH STREET
    CLEVELAND,OH441133103     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    TRANSITIONAL HOUSING INC
    1545 WEST 25TH STREET
    CLEVELAND,OH441133103     		NONE 501(C )(3) GENERAL SUPPORT 2,500
    TRANSITIONAL LIVING CENTER INC
    480 S PINE STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 20,000
    TRANSITIONAL LIVING CENTER INC
    480 S PINE STREET
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 100
    UNITED SERVICE ORGANIZATIONS INC (USO OF NORTHERN OHIO)
    20637 EMERALD PARKWAY
    CLEVELAND,OH44135     		NONE 501(C )(3) GENERAL SUPPORT 3,000
    UNITED WAY OF RACINE COUNTY INC
    2000 DOMANIK DRIVE
    RACINE,WI53404     		NONE 501(C )(3) GENERAL SUPPORT 15,000
    UNITED WAY OF RACINE COUNTY INC
    2000 DOMANIK DRIVE
    RACINE,WI53404     		NONE 501(C )(3) GENERAL SUPPORT 10,000
    URBAN ECOLOGY CENTER
    1500 E PARK PLACE
    MILWAUKEE,WI53211     		NONE 501(C )(3) GENERAL SUPPORT 100
    URBAN ECOLOGY CENTER
    1500 E PARK PLACE
    MILWAUKEE,WI53211     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    UW PARKSIDE
    900 WOOD ROAD
    KENOSHA,WI53144     		NONE 501(C )(3) EDUCATIONAL SUPPORT 5,000
    UWP PARKSIDE BENEVOLENT FOUNDATION
    900 WOOD ROAD PO BOX 2000
    KENOSHA,WI531412000     		NONE 501(C )(3) EDUCATIONAL SUPPORT 1,000
    VETERANS ASSISTANCE PROGRAM
    21425 SPRING STREET COTTAGE 16
    UNION GROVE,WI53182     		NONE 501(C )(3) GENERAL SUPPORT 3,646
    VILLAGE OF CALEDONIA
    6922 NICHOLSON ROAD
    CALEDONIA,WI53108     		NONE 501(C )(3) GENERAL SUPPORT 2,500
    VILLAGE OF ROCHESTER (RECYCLING MAGNETS FOR NEWSLETTER)
    203 W MAIN STREET
    ROCHESTER,WI53167     		NONE 501(C )(3) GENERAL SUPPORT 325
    VILLAGE OF WATERFORD
    123 N RIVER STREET
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    VILLAGE OF WATERFORD FIRE & RESCUE
    122 N 2ND STREET
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    VILLAGE OF WATERFORD POLICE DEPARTMENT
    122 N 2ND STREET
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 2,000
    WALLER SCHOOL
    608 BROWNS LAKE DRIVE
    BURLINGTON,WI53105     		NONE 501(C )(3) EDUCATIONAL SUPPORT 500
    WASHINGTON CALDWELL SCHOOL
    8937 BIG BEND ROAD
    WATERFORD,WI53185     		NONE 501(C )(3) EDUCATIONAL SUPPORT 250
    WASHINGTON CALDWELL SCHOOL (WATERFORD AREA TEEN NIGHT)
    8937 BIG BEND ROAD
    WATERFORD,WI53185     		NONE 501(C )(3) EDUCATIONAL SUPPORT 500
    WATERFORD CHAMBER OF COMMERCE (FARMERS MARKET)
    102 E MAIN STREET
    WATERFORD,WI53185     		NONE 501(C )(6) COMMUNITY SUPPORT 4,000
    WATERFORD CHAMBER OF COMMERCE (GOLF HOLE SPONSORSHIP)
    102 E MAIN STREET
    WATERFORD,WI53185     		NONE 501(C )(6) COMMUNITY SUPPORT 800
    WATERFORD CHAMBER OF COMMERCE (HOT AIR BALLOON EVENT)
    102 E MAIN STREET
    WATERFORD,WI53185     		NONE 501(C )(6) COMMUNITY SUPPORT 4,000
    WATERFORD GRADE SCHOOL
    819 W MAIN STREET
    WATERFORD,WI53185     		NONE 501(C )(3) EDUCATIONAL SUPPORT 3,000
    WATERFORD HIGH SCHOOL
    100 FIELD DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) EDUCATIONAL SUPPORT 3,000
    WATERFORD HIGH SCHOOL
    100 FIELD DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) EDUCATIONAL SUPPORT 177
    WATERFORD HIGH SCHOOL
    100 FIELD DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) EDUCATIONAL SUPPORT 3,000
    WATERFORD HIGH SCHOOL
    100 FIELD DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) EDUCATIONAL SUPPORT 5,000
    WATERFORD HIGH SCHOOL
    100 FIELD DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) EDUCATIONAL SUPPORT 3,250
    WATERFORD HIGH SCHOOL ( SCHOLARSHIPS)
    100 FIELD DRIVE
    WATERFORD,WI53185     		NONE 501(C )(3) EDUCATIONAL SUPPORT 13,000
    WATERFORD LIONESS CLUB (ANNUAL SANTA BREAKFAST)
    PO BOX 235
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 1,000
    WATERFORD LIONS CLUB
    32906 SEIDEL DRIVE
    BURLINGTON,WI53105     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    WATERFORD PUBLIC LIBRARY
    101 N RIVER ROAD
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 4,245
    WATERFORD PUBLIC LIBRARY
    101 N RIVER ROAD
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 500
    WATERFORD PUBLIC LIBRARY
    101 N RIVER ROAD
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 100
    WATERFORD YOUTH BASEBALL
    640 WOODLAND CIRCLE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    WAUKESHA MEMORIAL HOSPITAL FOUNDATION
    725 AMERICAN AVENUE
    WAUKESHA,WI53188     		NONE 501(C )(3) GENERAL SUPPORT 50
    WIGS FOR KIDS
    24231 CENTER RIDGE ROAD
    WEST LAKE,OH44145     		NONE 501(C )(3) GENERAL SUPPORT 1,500
    WIGS FOR KIDS INC
    24231 CENTER RIDGE ROAD
    WEST LAKE,OH44145     		NONE 501(C )(3) GENERAL SUPPORT 500
    WILLOW CREEK RANCH INC
    8608 HAZEL LANE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 10,000
    WIND LAKE CHAMBER OF COMMERCE (FARMERS MARKET)
    4249 E WIND LAKE ROAD
    UNION GROVE,WI53185     		NONE   COMMUNITY SUPPORT 5,000
    WIND LAKE SCREAMING EAGLES (WIND LAKE YOUTH BASEBALL)
    6705 BRIAN DRIVE
    WIND LAKE,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 500
    WINDY WATERS SERVICE AREA GIRL SCOUTS (GSWISE)
    208 N 5TH STREET
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 2,500
    WISCONSIN FASTPITCH SOFTBALL COACHES ASSOCIATION
    8621 BONNIE LANE
    WATERFORD,WI53185     		NONE 501(C )(3) GENERAL SUPPORT 500
    WISCONSIN HUMANE SOCIETY
    4500 W WISCONSIN AVENUE
    MILWAUKEE,WI53208     		NONE 501(C )(3) PREVENTION OF CRUELTY TO ANIMALS 500
    WISCONSIN LIONS CAMP
    3834 COUNTY ROAD A
    ROSHOLT,WI54473     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    WOMEN'S RESOURCE CENTER OF RACINE INC
    PO BOX 1764
    RACINE,WI53401     		NONE 501(C )(3) GENERAL SUPPORT 2,600
    YMCA OF GREATER CLEVELAND FOUNDATION
    1575 COLUMBIA ROAD
    WESTLAKE,OH44145     		NONE 501(C )(3) GENERAL SUPPORT 5,000
    YORKVILLE ELEMENTARY SCHOOL
    18621 WASHINGTON AVE
    UNION GROVE,WI53182     		NONE 501(C )(3) EDUCATIONAL SUPPORT 1,000
    Total .................................bullet 3a 746,484
    bApproved for future payment
    Total ..................................bullet 3b 0
    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          
    4 Dividends and interest from securities....          
    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          
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e).. 0 0 0
    13Total. Add line 12, columns (b), (d), and (e)...................
    130
    (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.)
    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
    RUNZHEIMER FOUNDATION INC
     
    Employer identification number

    27-2914749
    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
    RUNZHEIMER FOUNDATION INC
          		Employer identification number

    27-2914749
    Part I
    Contributors (see Instructions)
    		     
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
    1
     
     

    RUNZHEIMER INTERNATIONAL LTD    
    1 RUNZHEIMER PARKWAY
       
    WATERFORD, WI   53185

    		$757,000




    (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
    RUNZHEIMER FOUNDATION INC
          		Employer identification number

    27-2914749
    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
    RUNZHEIMER FOUNDATION INC
          		Employer identification number

    27-2914749
    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 AccountingFeesSchedule
    Name:
    RUNZHEIMER FOUNDATION INC
    EIN: 27-2914749
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 5,450 0 0 5,450

    TY 2010 LegalFeesSchedule
    Name:
    RUNZHEIMER FOUNDATION INC
    EIN: 27-2914749
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES 3,286 0 0 3,286


    TY 2010 OtherExpensesSchedule
    Name:
    RUNZHEIMER FOUNDATION INC
    EIN: 27-2914749
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    OFFICE SUPPLIES 434 0 0 434
    MISCELLANEOUS EXPENSE 550 0 0 550
    BANK FEES 284 0 0 284


    TY 2010 SubstantialContributorsSch
    Name:
    RUNZHEIMER FOUNDATION INC
    EIN: 27-2914749
    Name Address
    RUNZHEIMER INTERNATIONAL LTD 1 RUNZHEIMER PARKWAY
    WATERFORD,WI531853599