Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
|||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| (1)
ST JOHN EV LTHRN CHURCH |
410714299 | 1 | Yes | 0 | |||||
| (2)
MN VALLEY LUTHRN HS |
411351315 | 2 | Yes | 39,970 | |||||
| (3)
MARTIN LUTHER COLLEGE |
410695520 | 2 | Yes | 119,911 | |||||
| Total | 159,881 | ||||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990 Part VI | 1 | THE FOUNDATIONS GOVERNING BODY IS ITS ADVISORY COMMITTEE. NOT ALL MEMBERS OF THE ADVISORY COMMITTEE HAVE EQUAL VOTING RIGHTS. THE COMMITTEE HAS TWO CLASSES OF MEMBERS THE DONOR MEMBER AND WELS WISCONSIN EVANGELICAL LUTHERAN SYNOD MEMBERS. THE DONOR MEMBER, DR. WILLARD ROMBERG, HAS THE RIGHT TO APPOINT ADDITIONAL OR SUCCESSOR MEMBERS TO THE COMMITTEE AND MAY REMOVE ANY WELS MEMBER. |
| Form 990 Part VI | 3 | MARTIN LUTHER COLLEGE PROVIDES MANAGEMENT OVERSIGHT OF THE FOUNDATIONS INVESTMENT ACTIVITIES. |
| Form 990 Part VI | 7A | THE DR. WILLARD E. AND ELLA N. ROMBERG SUPPORTING FOUNDATION HAS LEGAL TRUSTEES WHO GOVERN THE AFFAIRS OF THE FOUNDATION. THE BOARD OF TRUSTEES OF MARTIN LUTHER COLLEGE HAS THE RIGHT TO REMOVE ANY TRUSTEE OF THE FOUNDATION AT ANY TIME AND THE RIGHT TO APPOINT ONE OR MORE ADDITIONAL OR SUCCESSOR TRUSTEES AT ANY TIME. |
| Form 990 Part VI | 7A | ONE MEMBER OF THE ADVISORY COMMITTEE, THE GOVERNING BODY OF THE FOUNDATION, IS THE PRESIDENT OF THE MINNESOTA DISTRICT OF THE WISCONSIN EVANGELICAL LUTHERAN SYNOD OR A PARISH PASTOR CHOSEN BY THE PRESIDENT OF THE SYNOD. |
| Form 990 Part VI | 11 | PRIOR TO BEING FILED, THE FORM 990 WAS REVIEWED BY THE FOUNDATIONS ASSISTANT SECRETARY AND A BOARD MEMBER. |
| Form 990 Part VI | 12C | THE ORGANIZATIONS CONFLICT OF INTEREST POLICY APPLIES TO DIRECTORS, OFFICERS AND EMPLOYEES. EACH INDIVIDUAL IS REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE FORM IDENTIFYING ACTUAL OR POSSIBLE CONFLICTS OF INTEREST. BEFORE ANY BOARD OR COMMITTEE ACTION INVOLVING A CONFLICT OF INTEREST, AN INDIVIDUAL WITH A CONFLICT MUST DISCLOSE ALL RELEVANT FACTS. THE INDIVIDUAL WITH A CONFLICT MAY NOT PARTICIPATE IN, OR BE IN THE ROOM DURING, A DISCUSSION OF THE MATTER, BUT MAY BE ASKED TO PROVIDE MATERIAL FACTS AND TO RESPOND TO QUESTIONS. THE INDIVIDUAL WITH A CONFLICT MAY NOT VOTE ON THE MATTER AND MAY NOT BE IN THE ROOM WHEN THE VOTE IS TAKEN BY THE REMAINING BOARD OR COMMITTEE MEMBERS. |
| Form 990 Part VI | 12C | INDIVIDUALS WHO ARE NOT BOARD OR COMMITTEE MEMBERS, BUT WHO HAVE A CONFLICT OF INTEREST IN REGARDS TO A TRANSACTION, ARE REQUIRE TO DISCLOSE SUCH FACTS TO THE BOARD CHAIR BEFORE ANY ACTION IS TAKEN BY THE ORGANIZATION. WHEN THERE IS UNCERTAINTY ABOUT WHETHER A CONFLICT EXISTS, THE DETERMINATION IS MADE BY THE BOARD CHAIR. |
| Form 990 Part VI | 15 | ALL INDIVIDUALS VOLUNTEER THEIR TIME AND EFFORTS TO FURTHER THE CAUSE OF THE FOUNDATION. |
| Form 990 Part VI | 15 | THE ASSISTANT SECRETARY IS AN EMPLOYEE OF MARTIN LUTHER COLLEGE. HIS COMPENSATION IS DETERMINED BY THE LEADERSHIP OF THE COLLEGE. |
| Form 990 Part VI | 19 | THE FOUNDATIONS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. THE FOUNDATION DOES NOT PREPARE FINANCIAL STATEMENTS, BUT IT DOES HAVE AN ANNUAL FINANCIAL SUMMARY THAT IS ALSO AVAILABLE UPON REQUEST. |
| Form 990 Part VI Section A Line 1 THE FOUNDATIONS GOVERNING BODY IS ITS ADVISORY COMMITTEE. NOT ALL MEMBERS OF THE ADVISORY COMMITTEE HAVE EQUAL VOTING RIGHTS. THE COMMITTEE HAS TWO CLASSES OF MEMBERS THE DONOR MEMBER AND WELS WISCONSIN EVANGELICAL LUTHERAN SYNOD MEMBERS. THE DONOR MEMBER, DR. WILLARD ROMBERG, HAS THE RIGHT TO APPOINT ADDITIONAL OR SUCCESSOR MEMBERS TO THE COMMITTEE AND MAY REMOVE ANY WELS MEMBER. Form 990 Part VI Section A Line 3 MARTIN LUTHER COLLEGE PROVIDES MANAGEMENT OVERSIGHT OF THE FOUNDATIONS INVESTMENT ACTIVITIES. Form 990 Part VI Section A Line 7A THE DR. WILLARD E. AND ELLA N. ROMBERG SUPPORTING FOUNDATION HAS LEGAL TRUSTEES WHO GOVERN THE AFFAIRS OF THE FOUNDATION. THE BOARD OF TRUSTEES OF MARTIN LUTHER COLLEGE HAS THE RIGHT TO REMOVE ANY TRUSTEE OF THE FOUNDATION AT ANY TIME AND THE RIGHT TO APPOINT ONE OR MORE ADDITIONAL OR SUCCESSOR TRUSTEES AT ANY TIME. Form 990 Part VI Section A Line 7A ONE MEMBER OF THE ADVISORY COMMITTEE, THE GOVERNING BODY OF THE FOUNDATION, IS THE PRESIDENT OF THE MINNESOTA DISTRICT OF THE WISCONSIN EVANGELICAL LUTHERAN SYNOD OR A PARISH PASTOR CHOSEN BY THE PRESIDENT OF THE SYNOD. Form 990 Part VI Section B Line 11 PRIOR TO BEING FILED, THE FORM 990 WAS REVIEWED BY THE FOUNDATIONS ASSISTANT SECRETARY AND A BOARD MEMBER. Form 990 Part VI Section B Line 12C THE ORGANIZATIONS CONFLICT OF INTEREST POLICY APPLIES TO DIRECTORS, OFFICERS AND EMPLOYEES. EACH INDIVIDUAL IS REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE FORM IDENTIFYING ACTUAL OR POSSIBLE CONFLICTS OF INTEREST. BEFORE ANY BOARD OR COMMITTEE ACTION INVOLVING A CONFLICT OF INTEREST, AN INDIVIDUAL WITH A CONFLICT MUST DISCLOSE ALL RELEVANT FACTS. THE INDIVIDUAL WITH A CONFLICT MAY NOT PARTICIPATE IN, OR BE IN THE ROOM DURING, A DISCUSSION OF THE MATTER, BUT MAY BE ASKED TO PROVIDE MATERIAL FACTS AND TO RESPOND TO QUESTIONS. THE INDIVIDUAL WITH A CONFLICT MAY NOT VOTE ON THE MATTER AND MAY NOT BE IN THE ROOM WHEN THE VOTE IS TAKEN BY THE REMAINING BOARD OR COMMITTEE MEMBERS. Form 990 Part VI Section B Line 12C INDIVIDUALS WHO ARE NOT BOARD OR COMMITTEE MEMBERS, BUT WHO HAVE A CONFLICT OF INTEREST IN REGARDS TO A TRANSACTION, ARE REQUIRE TO DISCLOSE SUCH FACTS TO THE BOARD CHAIR BEFORE ANY ACTION IS TAKEN BY THE ORGANIZATION. WHEN THERE IS UNCERTAINTY ABOUT WHETHER A CONFLICT EXISTS, THE DETERMINATION IS MADE BY THE BOARD CHAIR. Form 990 Part VI Section B Line 15 ALL INDIVIDUALS VOLUNTEER THEIR TIME AND EFFORTS TO FURTHER THE CAUSE OF THE FOUNDATION. Form 990 Part VI Section B Line 15 THE ASSISTANT SECRETARY IS AN EMPLOYEE OF MARTIN LUTHER COLLEGE. HIS COMPENSATION IS DETERMINED BY THE LEADERSHIP OF THE COLLEGE. Form 990 Part VI Section C Line 19 THE FOUNDATIONS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. THE FOUNDATION DOES NOT PREPARE FINANCIAL STATEMENTS, BUT IT DOES HAVE AN ANNUAL FINANCIAL SUMMARY THAT IS ALSO AVAILABLE UPON REQUEST. |
| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |