Form990-EZ
Department of the Treasury
Internal Revenue Service
Short Form
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
(except black lung benefit trust or private foundation)
bullet Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities, and certain controlling organizations as defined in section 512(b)(13) must file Form 990 (see instructions).
All other organizations with gross receipts less than $200,000 and total assets less than $500,000 at the end of the year may use this form.
bulletThe organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-1150
2012
Open to Public
Inspection
A
For the 2012 calendar year, or tax year beginning 01-01-2012, and ending 12-31-2012
B
Check if applicable:
C Name of organization
ADAMS COLUMBIA COMMUNITY FUND INC
 
Number and street (or P. O. box, if mail is not delivered to street address)PO BOX 70
  Room/suite
City or town, state or country, and ZIP + 4 FRIENDSHIP, WI539340070
D Employer identification number

39-1952457
E Telephone number

F Group Exemption
Number. . bullet  
G Accounting Method: Other (specify) bullet   H Check bulletI Website:bullet   J Tax-exempt status(check only one)—Click to see attachment(   ) bullet(insert no.) or
K Check bullet A Form 990-EZ or Form 990 return is not required though Form 990-N (e-postcard) may be required (see instructions). But if the organization chooses to file a return, be sure to file a complete return.
L Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, line 25, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ . . . . . . . bullet $ 44,012
Part I
Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I)Check if the organization used Schedule O to respond to any question in this Part I...................
VerticalRevenue 1 Contributions, gifts, grants, and similar amounts received............... 1 43,794
2 Program service revenue including government fees and contracts ............ 2  
3 Membership dues and assessments...................... 3  
4 Investment income........................... 4 218
5a Gross amount from sale of assets other than inventory........ 5a  
b Less: cost or other basis and sales expenses........... 5b  
c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ...... 5c  
6 Gaming and fundraising events
a Gross income from gaming (attach Schedule G if greater than $15,000) . 6a  
b Gross income from fundraising events (not including $   of contributions
from fundraising events reported on line 1) (attach Schedule G if the
sum of such gross income and contributions exceeds $15,000) 6b  
c Less: direct expenses from gaming and fundraising events....... 6c  
d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c) 6d  
7a Gross sales of inventory, less returns and allowances........ 7a  
b Less: cost of goods sold................. 7b  
c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) ......... 7c  
8 Other revenue (describe in Schedule O) ..................... 8  
9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8.............. Bullet 9 44,012
VerticalExpenses 10 Grants and similar amounts paid (list in Schedule O) ................. 10 28,198
11 Benefits paid to or for members........................ 11  
12 Salaries, other compensation, and employee benefits................ 12  
13 Professional fees and other payments to independent contractors............ 13  
14 Occupancy, rent, utilities, and maintenance................... 14  
15 Printing, publications, postage, and shipping................... 15  
16 Other expenses (describe in Schedule O) .................... 16 64
17 Total expenses. Add lines 10 through 16 ................. Bullet 17 28,262
VerticalNetAssets 18 Excess or (deficit) for the year (Subtract line 17 from line 9)............ 18 15,750
19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
end-of-year figure reported on prior year’s return)................ 19 110,546
20 Other changes in net assets or fund balances (explain in Schedule O) .......... 20  
21 Net assets or fund balances at end of year. Combine lines 18 through 20.........Bullet 21 126,296
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10642I Form 990-EZ (2012)
Form 990-EZ (2012)
Page 2
Part IIBalance Sheets (see the instructions for Part II)Check if the organization used Schedule O to respond to any question in this Part II.................

(A) Beginning of year(B) End of year
22Cash, savings, and investments................
110,546
22
126,296
23Land and buildings....................
0
23
0
24Other assets (describe in Schedule O) ..........
0
24
0
25Total assets......................
110,546
25
126,296
26
Total liabilities (describe in Schedule O) .............
0
26
0
27Net assets or fund balances (line 27 of column (B) must agree with line 21)..
110,546
27
126,296
Part IIIStatement of Program Service Accomplishments (see the instructions for Part III) Check if the organization used Schedule O to respond to any question in this Part III . Expenses
(Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional for others.)
What is the organization's primary exempt purpose? RECEIVE & DISTRIBUTE CHARITABLE DONATION
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.
28 DIRECT CONTRIBUTIONS TO THREE INDIVIDUAL FAMILIES TO ASSIST WITH LIVING EXPENSES WITH NEEDS FOLLOWING PERSONAL TRAGEDIES OR ILLNESS WITH INCOME NEEDS
(Grants $ 6,600) If this amount includes foreign grants, check here ...MediumBullet		 28a  
29 DIRECT CONTRIBUTIONS TO 21 COMMUNITY SERVICE ORGANIZATIONS FOR COMMUNITY PROJECTS BENEFITING MULTIPLE COMMUNITES AND PEOPLE
(Grants $ 21,598) If this amount includes foreign grants, check here ...MediumBullet		 29a  
30
(Grants $   ) If this amount includes foreign grants, check here ...MediumBullet 		30a
31 Other program services (describe in Schedule O)
(Grants $   ) If this amount includes foreign grants, check here...MediumBullet		 31a
32 Total program service expenses (add lines 28a through 31a).......... bullet 32 0
Part IV
List of Officers, Directors, Trustees, and Key Employees List each one even if not compensated (see the instructions for Part IV)Check if the organization used Schedule O to respond to any question in this Part IV............
(a) Name and title (b) Average
hours per week
devoted to position		 (c)Reportable compensation
(Forms W-2/1099-MISC) (if not paid, enter -0-) 		(d) Health benefits, contributions to employee benefit plans,
and deferred compensation		 (e) Estimated amount
of other compensation
DEBRA GERZMEHLEDIRECTOR 1.00 0 0 0
PATRICIA BARTSCHSECRETARY 4.00 0 0 0
NANCY AKKERMANDIRECTOR 1.00 0 0 0
ALLEN STEAVICE-CHAIRMAN 1.00 0 0 0
BILL TAYLORDIRECTOR 1.00 0 0 0
SUE WOHLFERTDIRECTOR 1.00 0 0 0
EILEEN NAPRALLADIRECTOR 1.00 0 0 0
RON WORMETCHAIRMAN 1.00 0 0 0
GINNY JOYCEDIRECTOR 1.00 0 0 0
GALE NEEFDIRECTOR 1.00 0 0 0
KAREN DECKERTREASURER 1.00 0 0 0
Form 990-EZ (2012)
Form 990-EZ (2012)
Page 3
Part V
Other Information
(Note the Schedule A and personal benefit contract statement requirements in the
instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V.......
Yes
No
33
Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a detailed description of each activity in Schedule O ...................
33
 
No
34
Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy of the amended documents if they reflect a change to the organization’s name. Otherwise, explain the changeon Schedule O (see instructions) ..........................
34
 
No
35a
Did the organization have unrelated business gross income of $1,000 or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)? ............
35a
 
No
b
If "Yes," to line 35a, has the organization filed a Form 990-T for the year? If "No," provide an explanation in Schedule O
35b
 
 
c
Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III
35c
 
No
36
Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If “Yes,” complete applicable parts of Schedule N ................
36
 
No
37a
Enter amount of political expenditures, direct or indirect, as described in the instructions. bullet
37a
 
b
Did the organization file Form 1120-POL for this year?...................
37b
 
No
38a
Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were
any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?..
38a
 
No
b
If “Yes,” complete Schedule L, Part II and enter the total amount involved .
38b
 
39
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on line 9.......
39a
 
b
Gross receipts, included on line 9, for public use of club facilities.....
39b
 
40a
Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
section 4911 bullet   ; section 4912 bullet   ; section 4955 bullet  
b
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefittransaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I ......
40b
 
No
c
Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958...bullet  
d
Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization...........................bullet  
e
All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If "Yes," complete Form 8886-T ......................
40e
 
No
41List the states with which a copy of this return is filed. bulletWI
42aThe organization's books are in care of bulletPATRICIA BARTSCH Telephone no. bullet (608) 339-3346
Located at bulletW13165 APACHE AVENUEPLAINFIELD,WI ZIP + 4bullet54966
b
At any time during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)?
Yes
No
42b
 
No
If “Yes,” enter the name of the foreign country: bullet
See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
c
At any time during the calendar year, did the organization maintain an office outside the U.S.?
42c
 
No
If “Yes,” enter the name of the foreign country: bullet
43.......bullet
and enter the amount of tax-exempt interest received or accrued during the tax year....bullet43
 
Yes
No
44a
Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead of
Form 990-EZ................................
44a
 
No
b
Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be completedinstead of Form 990-EZ.............................
44b
 
No
c
Did the organization receive any payments for indoor tanning services during the year?.........
44c
 
No
d
If "Yes," to line 44c, has the organization filed a Form 720 to report these payments? If "No," provide an
explanation in Schedule O ............................
44d
 
 
45a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?.........
45a
 
No
45b
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule R may need to be completed instead of Form 990-EZ (see instructions)......................
45b
 
No
Form 990-EZ (2012)
Form 990-EZ (2012)
Page 4
Yes
No
46
Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition tocandidates for public office? If “Yes,” complete Schedule C, Part I. ..............
46
 
No
Part VI
Section 501(c)(3) organizations only All section 501(c)(3) organizations must answer questions 47-49b and 52, and complete the tables for lines 50 and 51 Check if the organization used Schedule O to respond to any question in this Part VI ................
Yes
No
47
Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II .......................
47
 
No
48
Is the organization a school as described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E ..
48
 
No
49a
Did the organization make any transfers to an exempt non-charitable related organization?......
49a
 
No
b
If "Yes," was the related organization a section 527 organization?................
49b
 
 
50
Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a) Name and title of each employee paid more than $100,000 (b) Average
hours per week
devoted to position		 (c) Reportable compensation
(Forms W-2/1099-MISC) 		(d) Health benefits, contributions to employee benefit plans, and deferred compensation (e) Estimated amount of other compensation
NONE
f
Total number of other employees paid over $100,000 .................bullet  

51
Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a) Name and address of each independent contractor paid more than $100,000 (b) Type of service (c) Compensation
NONE
d
Total number of other independent contractors each receiving over $100,000..........bullet  
52
Did the organization complete Schedule A? NOTE: All Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach a completed Schedule A ...............bullet
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 officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name bullet

Firm's EIN bullet
Firm's address bullet



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
Form 990-EZ (2012)


Form 990-EZ, Special Condition Description:
Special Condition Description

Additional Data


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SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
ADAMS COLUMBIA COMMUNITY FUND INC
 
Employer identification number

39-1952457
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... 30,962 44,351 44,430 44,257 43,794 207,794
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 30,962 44,351 44,430 44,257 43,794 207,794
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.           207,794
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4.. 30,962 44,351 44,430 44,257 43,794 207,794
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... 397 319 412 412 218 1,758
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).           209,552
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
99.160 %
15
15
99.050 %
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
ADAMS COLUMBIA COMMUNITY FUND INC
 
Employer identification number

39-1952457
Identifier Return Reference Explanation
O01 List of grants and similar amounts paid Part I line 10 ACTIVITY GAS CARDS FOR MEDICAL APPOINTMENTS GRANTEE ROGER EICHSTEADT STREET N276 16TH DR CITY, STATE, ZIP WAUTOMA WI 54982 RELATIONSHIP NONE AMOUNT 800 ACTIVITY TIRES AND GAS CARD FOR MEDICAL APPT GRANTEE ROSALYN S JENSEN STREET CO: RENEWAL UNLMTD 2900 RED FOX RUN CITY, STATE, ZIP PORTAGE WI 53901 RELATIONSHIP NONE AMOUNT 1,000 ACTIVITY FINANCIAL ASSISTANCE AFTER SURGERY GRANTEE JOHN E KNOPH FAMILY STREET 2900 RED FOX RUN CITY, STATE, ZIP PORTAGE WI 53901 RELATIONSHIP NONE AMOUNT 4,800 ACTIVITY PURCHASE LED FOR SQUAD SPOTLIGHTS GRANTEE MARQUETTE COUNTY SHERIFF DEPARTMENT STREET 67 W PARK ST CITY, STATE, ZIP MONTELLO WI 53949 RELATIONSHIP NONE AMOUNT 750 ACTIVITY FINANCIAL ASSISTANCE FOR PROGRAM GRANTEE WAUSHARA COUNTY BLUE RIBBON KIDS DA STREET PO BOX 686 CITY, STATE, ZIP WAUTOMA WI 54982 RELATIONSHIP NONE AMOUNT 500 ACTIVITY PROCEEDS FOR PURCHASE OF BOAT GAS GRANTEE FISHING HAS NO BOUNDARIES STREET PO BOX 375 CITY, STATE, ZIP HAYWARD WI 54843 RELATIONSHIP NONE AMOUNT 1,000 ACTIVITY CRIBS AND SAFE SLEEPING MATERIALS GRANTEE ADAMS COUNTY PUBLIC HEALTH STREET 108 E NORTH STREET CITY, STATE, ZIP FRIENDSHIP WI 53934 RELATIONSHIP NONE AMOUNT 1,300 ACTIVITY ADVERTISING AND POSTAGE FOR EVENT GRANTEE FAITH IN ACTION ADAMS COUNTY STREET PO BOX 555 CITY, STATE, ZIP FRIENDSHIP WI 53934 RELATIONSHIP NONE AMOUNT 550 ACTIVITY SPONSORSHIP FOR FAMILIES IN NEED GRANTEE WAUSHARA COUNTY KIDS CAMP STREET PO BOX 1230 CITY, STATE, ZIP WAUTOMA WI 54982 RELATIONSHIP NONE AMOUNT 500 ACTIVITY REFIGERATOR FOR NEW BUILDING GRANTEE KIGNSTON HISTORICAL SOCIETY STREET PO BOX 72 CITY, STATE, ZIP KINGSTON WI 53939 RELATIONSHIP NONE AMOUNT 500 ACTIVITY ENTERTAINMENT FOR KIDS DAY PROGRAM GRANTEE ADAMS CO KIDS DAY C/O MAUREEN BRUCE STREET PO BOX 40 CITY, STATE, ZIP FRIENDSHIP WI 53934 RELATIONSHIP NONE AMOUNT 550 ACTIVITY SPONSORSHIP FOR FAMILIES IN NEED GRANTEE EASTER SEALS WISCONSIN STREET 101 NOB HILL RD CITY, STATE, ZIP MADISON WI 53713 RELATIONSHIP NONE AMOUNT 4,000 ACTIVITY EMERGENCY FUND FOR FAMILIES IN NEED GRANTEE MARQUETTE COUNTY SALVATION ARMY STREET W2155 EAGLE COURT CITY, STATE, ZIP NESHKORO WI 54960 RELATIONSHIP NONE AMOUNT 750 ACTIVITY SCHOOLSUPPLIES FOR CHILDREN IN NEED GRANTEE CLOTHES FOR KIDS PROGRAM STREET 103 E MAPLE AVE CITY, STATE, ZIP BEAVER DAM WI 53916 RELATIONSHIP NONE AMOUNT 1,000 ACTIVITY MATERIALS FOR QUILTS FOR COMMUNITY GRANTEE COMMUNITY QUILTERS C/0 ARLENE GRAHA STREET 569 N CEDAR ST SUITE 3 CITY, STATE, ZIP ADAMS WI 53910 RELATIONSHIP NONE AMOUNT 500 ACTIVITY CLOTHES DRYER FOR FIRE STATION GRANTEE PARDEEVILLE FIRE DEPARTMENT STREET 110 3RD ST CITY, STATE, ZIP PARDEEVILLE WI 53954 RELATIONSHIP NONE AMOUNT 449 ACTIVITY EMS EQUIPMENT GRANTEE BIG FLATS FIRE DEPARTMENT STREET 1104 COUNTY HWY C CITY, STATE, ZIP ARKDALE WI 54613 RELATIONSHIP NONE AMOUNT 1,079 ACTIVITY SPONSORSHIP FOR NEEDY FAMILIES GRANTEE FAMILY SKI DAY PROGRAM STREET PO BOX 686 CITY, STATE, ZIP WAUTOMA WI 54982 RELATIONSHIP NONE AMOUNT 300 ACTIVITY FINGER PULSE OXIMETER AND OXYGEN KI GRANTEE NEW CHESTER FIRE DEPARTMENT STREET PO BOX 64 CITY, STATE, ZIP GRAND MARSH WI 53936 RELATIONSHIP NONE AMOUNT 695 ACTIVITY FOOD FOR COMMUNITY THANKSGIVING GRANTEE IMMANUEL LUTHERAN CHURCH STREET PO BOX 219 CITY, STATE, ZIP ADAMS WI 53910 RELATIONSHIP NONE AMOUNT 500 ACTIVITY MICROWAVE REFIGERATOR AND FREEZER GRANTEE ADAMS COUNTY HISTORICAL SOCIETY STREET PO BOX 264 CITY, STATE, ZIP FRIENDSHIP WI 53934 RELATIONSHIP NONE AMOUNT 700 ACTIVITY TRAILER FOR 6 WHEELER AND EQUIPMENT GRANTEE RIO VOLUNTEER FIRE DEPARTMENT STREET PO BOX 248 CITY,
O02 Description of other expenses Part I line 16 DESCRIPTION AMOUNT ANNUAL REPORT AND LICENSE FEE 64
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


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