TY 2015 Form 990PF

- TIN:

Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation

or Section 4947(a)(1) Trust Treated as Private Foundation

Do not enter social security numbers on this form as it may be made public.
bullet

Information about Form 990-PF and its instructions is at www.irs.gov/form990pf.

OMB No. 1545-0052

2015

Open to Public Inspection

For calendar year 2015, or tax year beginning 01-01-2015 , and ending 12-31-2015

Name of foundation
CRIVITZ YOUTH INC

Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 188
Room/suite

City or town, state or province, country, and ZIP or foreign postal code
CRIVITZ, WI541140188

A Employer identification number

23-7088232

B Telephone number (see instructions)

(715) 854-2000

C If exemption application is pending, check here bullet

G Check all that apply: Initial returnInitial return of a former public charity
Final returnAmended return
Address changeName change

D 1. Foreign organizations, check here ............. bullet

2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet

E If private foundation status was terminated
under section 507(b)(1)(A), check here ....... bullet

H Check type of organization: Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trustOther taxable private foundation

F If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here ....... bullet

I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16) bullet

$6,563,645J Accounting method: Cash Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)

	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 instructions).)	(a) Revenue and expenses per books		(b) Net investment income	(c) Adjusted net income	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)	681,917
2	Check Sch. B .............
3	Interest on savings and temporary cash investments	1,703		1,703	1,703
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)...
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).......		584,597		584,597
12	Total. Add lines 1 through 11........	1,268,217		1,703	586,300
13	Compensation of officers, directors, trustees, etc.
14	Other employee salaries and wages......	674,922				674,922
15	Pension plans, employee benefits.......	73,074				73,074
16a	Legal fees (attach schedule).........		650			650
b	Accounting fees (attach schedule).......		14,908		14,908
c	Other professional fees (attach schedule)....
17	Interest...............
18	Taxes (attach schedule) (see instructions)...		727			727
19	Depreciation (attach schedule) and depletion...		215,820		215,820
20	Occupancy..............	72,460				72,460
21	Travel, conferences, and meetings.......	20				20
22	Printing and publications..........	71				71
23	Other expenses (attach schedule).......		330,198			330,198
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	1,382,850		0	230,728	1,152,122
25	Contributions, gifts, grants paid.......	0				0
26	Total expenses and disbursements. Add lines 24 and 25	1,382,850		0	230,728	1,152,122
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	-114,633
b	Net investment income (if negative, enter -0-)			1,703
c	Adjusted net income (if negative, enter -0-)...				355,572

For Paperwork Reduction Act Notice, see instructions.

Cat. No. 11289X Form 990-PF (2015)

Form 990-PF (2015)

Page 2

Part II		Balance Sheets	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing.............	521,004	609,432	609,432
	2	Savings and temporary cash investments.........
	3	Accounts receivable
		Less: allowance for doubtful accounts
	4	Pledges receivable
		Less: allowance for doubtful accounts
	5	Grants receivable.................
	6	Receivables due from officers, directors, trustees, and other
		disqualified persons (attach schedule) (see instructions).....
	7	Other notes and loans receivable (attach schedule)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use..............
	9	Prepaid expenses and deferred charges..........	2,016	720	720
	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
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans.............
	13	Investments—other (attach schedule)..........
	14	Land, buildings, and equipment: basis 7,678,939
		Less: accumulated depreciation (attach schedule) 1,725,446	6,164,998	5,953,493	5,953,493
	15	Other assets (describe )
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	6,688,018	6,563,645	6,563,645
	17	Accounts payable and accrued expenses..........	12,731	12,231
	18	Grants payable..................
	19	Deferred revenue.................	5,743
	20	Loans from officers, directors, trustees, and other disqualified persons
	21	Mortgages and other notes payable (attach schedule)......
	22	Other liabilities (describe )	37,284	33,787
	23	Total liabilities (add lines 17 through 22).........	55,758	46,018
		Foundations that follow SFAS 117, check here
		and complete lines 24 through 26 and lines 30 and 31.
	24	Unrestricted..................	6,631,694	6,517,274
	25	Temporarily restricted...............	566	353
	26	Permanently restricted...............
		Foundations that do not follow SFAS 117, check here
		and complete lines 27 through 31.
	27	Capital stock, trust principal, or current funds........
	28	Paid-in or capital surplus, or land, bldg., and equipment fund
	29	Retained earnings, accumulated income, endowment, or other funds
	30	Total net assets or fund balances (see instructions).....	6,632,260	6,517,627
	31	Total liabilities and net assets/fund balances (see instructions).	6,688,018	6,563,645

Part III

Analysis of Changes in Net Assets or Fund Balances

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) ...............

6,632,260

Enter amount from Part I, line 27a .....................

-114,633

Other increases not included in line 2 (itemize) bullet

Add lines 1, 2, and 3 ..........................

6,517,627

Decreases not included in line 2 (itemize) bullet

Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .

6,517,627

Form 990-PF (2015)

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
(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)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	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 instructions). If (loss), enter -0- in Part I, line 8 ...................		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? Yes No

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 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))
2014	1,085,801	563,955	1.925333
2013	3,746,245	757,624	4.944729
2012	1,980,349	782,742	2.530015
2011	664,261	442,545	1.501002
2010	700,233	208,306	3.361559

Total of line 1, column (d) .....................

214.262638

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 . . .

2.852528

Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....

640,685

Multiply line 4 by line 3......................

1,827,572

Enter 1% of net investment income (1% of Part I, line 27b)...........

Add lines 5 and 6........................

1,827,589

Enter qualifying distributions from Part XII, line 4.............

1,152,122

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.

Form 990-PF (2015)

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	Exempt operating foundations described in section 4940(d)(2), check here and enter “N/A" on line 1.
	Date of ruling or determination letter: (attach copy of letter if necessary–see instructions)
b	Domestic foundations that meet the section 4940(e) requirements in Part V, check	1	34
	hereand enter 1% of Part I, line 27b...................
c	All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2	Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	2
3	Add lines 1 and 2...........................	3	34
4	Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	4
5	Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- .....	5	34
6	Credits/Payments:

a	2015 estimated tax payments and 2014 overpayment credited to 2015	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
8	Enter any penalty for underpayment of estimated tax. Check hereif Form 2220 is attached.		8
9	Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......		9	34
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...		10
11	Enter the amount of line 10 to be: Credited to 2015 estimated tax	Refunded	11

Part VII-A

Statements Regarding Activities

During the tax year, did the foundation attempt to influence any national, state, or local legislation or did

Yes

it participate or intervene in any political campaign? ....................

Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see Instructions

for definition)?.................................

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.

Did the foundation file Form 1120-POL for this year?.....................

Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the foundation. bullet

$ (2) On foundation managers. bullet

Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. bullet

Has the foundation engaged in any activities that have not previously been reported to the IRS?.......

If "Yes," attach a detailed description of the activities.

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....

Did the foundation have unrelated business gross income of $1,000 or more during the year?........

If "Yes," has it filed a tax return on Form 990-T for this year?...................

Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........

If "Yes," attach the statement required by General Instruction T.

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?................

Yes

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..................................

Yes

Enter the states to which the foundation reports or with which it is registered (see instructions)

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 .

Yes

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 2015 or the taxable year beginning in 2015 (see instructions for Part XIV)?

If "Yes," complete Part XIV.............................

Yes

Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names

and addresses. ...............................

Form 990-PF (2015)

Page 5

Part VII-A

Statements Regarding Activities (continued)

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 instructions) .............

Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had

advisory privileges? If "Yes," attach statement (see instructions).................

Did the foundation comply with the public inspection requirements for its annual returns and exemption application?

Yes

Website address bullet

N/A

The books are in care of bullet

JOHNSON & RENNIE LLC Telephone no. bullet

(906) 863-4457

Located at bullet

900 26TH STMENOMINEEMI ZIP+4 bullet

49858

Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —Check here....... bullet

and enter the amount of tax-exempt interest received or accrued during the year ...... bullet

16 At any time during calendar year 2015, did the foundation have an interest in or a signature or other authority over YesNo

a bank, securities, or other financial account in a foreign country?

16 No

See instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country bullet

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

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? YesNo

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person?......................YesNo

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? YesNo

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? YesNo

(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)?...............YesNo

(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.).......YesNo

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 instructions)? ........

Organizations relying on a current notice regarding disaster assistance check here........ bullet

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 2015?.............

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)):

At the end of tax year 2015, did the foundation have any undistributed income (lines 6d

and 6e, Part XIII) for tax year(s) beginning before 2015?.............YesNo

If "Yes," list the years bullet

20, 20, 20, 20

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 instructions.) ..............

If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.

20, 20, 20, 20

Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at

any time during the year?......................YesNo

If "Yes," did it have excess business holdings in 2015 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 2015.)..................

Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?

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 2015?

Form 990-PF (2015)

Page 6

Part VII-B

Statements Regarding Activities for Which Form 4720 May Be Required (Continued)

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))? YesNo

(2) Influence the outcome of any specific public election (see section 4955); or to carry

on, directly or indirectly, any voter registration drive?.............YesNo

(3) Provide a grant to an individual for travel, study, or other similar purposes? YesNo

(4) Provide a grant to an organization other than a charitable, etc., organization described

in section 4945(d)(4)(A)? (see instructions)................YesNo

(5) Provide for any purpose other than religious, charitable, scientific, literary, or

educational purposes, or for the prevention of cruelty to children or animals?.....YesNo

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 instructions)? ......

Organizations relying on a current notice regarding disaster assistance check here......... bullet

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?..........YesNo

If "Yes," attach the statement required by Regulations section 53.4945–5(d).

Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on

a personal benefit contract?.....................YesNo

Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....

If "Yes" to 6b, file Form 8870.

At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? YesNo

If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....

Form 990-PF (2015)

Page 7

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 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
LYNELLE CAINE	BOARD MEMBER 1.00	0	0	0
N7351 LEFT FOOT LAKE ROAD CRIVITZ,WI54114	BOARD MEMBER 1.00	0	0	0
ROBERT F BERNDT	TREASURE 1.00	0	0	0
N7362 HIDEAWAY LANE CRIVITZ,WI54114	TREASURE 1.00	0	0	0
CAROLINE REPENNING	PRESIDENT 1.00	0	0	0
610 LAURIE LANE NORTHFIELD,IL60093	PRESIDENT 1.00	0	0	0
PATRICK MANS	BOARD MEMBER 1.00	0	0	0
W4390 WILLOW HEIGHT LANE PORTERFIELD,WI54159	BOARD MEMBER 1.00	0	0	0
CHAD SCHROEDER	VICE PRESIDE 1.00	0	0	0
N8191 ST PAUL ROAD CRIVITZ,WI54114	VICE PRESIDE 1.00	0	0	0
THOMAS WHITE	BOARD MEMBER 1.00	0	0	0
1307 GEORGE STREET CRIVITZ,WI54114	BOARD MEMBER 1.00	0	0	0
BARBARA J WEITING	SECRETARY 1.00	0	0	0
W6386 COUNTY X WAUSAUKEE,WI54177	SECRETARY 1.00	0	0	0

2 Compensation of five highest-paid employees (other than those included on line 1—see 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...................

3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a) Name and address of each person paid more than $50,000	(b) Type of service	(c) Compensation
NONE

Total number of others receiving over $50,000 for professional services............. bullet

Part IX-A

Summary of Direct Charitable Activities

List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.	Expenses
1	THE ONLY ACTIVITY OF CRIVITZ YOUTH, INC. IS OWNERSHIP, ADMINISTRATION AND SUPPORT OF THE CRIVITZ YOUTH CENTER IN CRIVITZ, WISCONSIN	1,152,122
2


3


4

Part IX-B

Summary of Program-Related Investments (see instructions)

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.	Amount
1	N/A
2


All other program-related investments. See instructions.
3

Total. Add lines 1 through 3......................... bullet

Form 990-PF (2015)

Page 8

Part X

Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see instructions.)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,

purposes:

Average monthly fair market value of securities...................

Average of monthly cash balances.......................

650,442

Fair market value of all other assets (see instructions)................

Total (add lines 1a, b, and c).........................

650,442

Reduction claimed for blockage or other factors reported on lines 1a and

1c (attach detailed explanation) .............

Acquisition indebtedness applicable to line 1 assets..................

Subtract line 2 from line 1d.........................

650,442

Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see

instructions) .............................

9,757

Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4

640,685

Minimum investment return. Enter 5% of line 5..................

32,034

Part XI

Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here bullet

and do not complete this part.)

Minimum investment return from Part X, line 6....................

Tax on investment income for 2015 from Part VI, line 5......

Income tax for 2015. (This does not include the tax from Part VI.)...

Add lines 2a and 2b............................

Distributable amount before adjustments. Subtract line 2c from line 1............

Recoveries of amounts treated as qualifying distributions................

Add lines 3 and 4............................

Deduction from distributable amount (see instructions).................

Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...

Part XII

Qualifying Distributions (see instructions)

Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:

Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........

1,152,122

Program-related investments—total from Part IX-B..................

Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,

purposes...............................

Amounts set aside for specific charitable projects that satisfy the:

Suitability test (prior IRS approval required)....................

Cash distribution test (attach the required schedule) .................

Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4

1,152,122

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 instructions).................

Adjusted qualifying distributions. Subtract line 5 from line 4..............

1,152,122

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 (2015)

Page 9

Part XIII

Undistributed Income (see instructions)

		(a) Corpus	(b) Years prior to 2014	(c) 2014	(d) 2015
1 Distributable amount for 2015 from Part XI, line 7
2 Undistributed income, if any, as of the end of 2015:
a Enter amount for 2014 only.......
b Total for prior years:20, 20, 20
3 Excess distributions carryover, if any, to 2015:
a From 2010......
b From 2011......
c From 2012......
d From 2013......
e From 2014......
fTotal of lines 3a through e........
4Qualifying distributions for 2015 from Part
XII, line 4: $ 1,152,122
a Applied to 2014, but not more than line 2a
b Applied to undistributed income of prior years (Election required—see instructions).....
c Treated as distributions out of corpus (Election required—see instructions)........
d Applied to 2015 distributable amount.....
e Remaining amount distributed out of corpus		1,152,122
5 Excess distributions carryover applied to 2015.
(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		1,152,122
b Prior years’ undistributed income. Subtract line 4b from line 2b ..........
c Enter the amount of prior years’ undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed......
d Subtract line 6c from line 6b. Taxable amount —see instructions ...........
e Undistributed income for 2014. Subtract line 4a from line 2a. Taxable amount—see instructions .............
f Undistributed income for 2016. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2015 ..........
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (Election may be required - see instructions) .......
8Excess distributions carryover from 2010 not applied on line 5 or line 7 (see instructions) ...
9Excess distributions carryover to 2016. Subtract lines 7 and 8 from line 6a ......
10 Analysis of line 9:
a Excess from 2011....
b Excess from 2012....
c Excess from 2013....
d Excess from 2014....
e Excess from 2015....

Form 990-PF (2015)

Page 10

Part XIV

Private Operating Foundations (see 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 2015, enter the date of the ruling....... bullet

b Check box to indicate whether the organization is a private operating foundation described in section4942(j)(3) or4942(j)(5)

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) 2015	(b) 2014	(c) 2013	(d) 2012	(e) Total
	32,034	28,198	37,881	39,137	137,250
b 85% of line 2a .........	27,229	23,968	32,199	33,266	116,662
c Qualifying distributions from Part XII, line 4 for each year listed .....	1,152,122	1,085,801	3,746,276	1,980,349	7,964,548
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 ....	1,152,122	1,085,801	3,746,276	1,980,349	7,964,548
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...	21,356	18,799	25,254	26,091	91,500
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 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).)

NANCY BUCK RANSOM FOUNDATION

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

if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under
other conditions, complete items 2a, b, c, and d.

aThe name, address, and telephone number or email address 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 (2015)

Page 11

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)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year

Total ................................. 3a

bApproved for future payment

Total ................................. 3b

Form 990-PF (2015)

Page 12

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 instructions.)
1Program service revenue:	(a) Business code	(b) Amount	(c) Exclusion code	(d) Amount	(e) Related or exempt function income (See instructions.)
aTUITION AND REGISTRATION					370,226
bREIMBURSE FOOD PROGRAM - WI					27,206
cFOOD					22,399
dBOWLING CENTER INCOME					5,548
eBIRTHDAY PARTIES					1,178
fDANCES					4,227
SWIMMING					3,288
TRIPS AND TOURS					75
SPECIAL EVENTS					40
MEMBERSHIP					2,253
DAY PASSES					614
COMMUNITY CENTER FEES					113,329
PHYSICAL THERAPY FEES					4,801
SILVER SNEAKERS FEES					17,831
MERCHANDISE SALES					109
SPECIAL EVENTS					683
CLASS FEES					929
TRIPS AND TOURS					1,871
DAILY FEES					1,884
OCCASIONAL BUILDING RENTALS					2,372
gFees and contracts from government agencies
2 Membership dues and assessments....
3 Interest on savings and temporary cash investments ...........			14	1,703
4 Dividends and interest from securities....
5 Net rental income or (loss) from real estate:
aDebt-financed property......
bNot debt-financed property.....
6 Net rental income or (loss) from personal property
7 Other investment income.....
8 Gain 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: aOTHER GENERAL INCOME			41	2,633
bOTHER GENERAL INCOME			41	114
cOTHER GENERAL INCOME			41	450
dOTHER GENERAL INCOME			41	221
eOTHER GENERAL INCOME			41	316
fLOSS/(GAIN) ON DISPOSAL OF			41
gROUNDING			41
12 Subtotal. Add columns (b), (d), and (e)..				5,437	580,863

13Total. Add line 12, columns (b), (d), and (e)..................

13586,300

(See worksheet in line 13 instructions to verify calculations.)

Part XVI-B

Relationship of Activities to the Accomplishment of Exempt Purposes

Line No.	Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See instructions.)
1A	ALL REPORTED REVENUES ARE DERIVED DIRECTLY FROM THE ACTIVITIES OF CRIVITZ YOUTH, INC. WHICH RELATE TO PROVIDING FACILITIES FOR THE DEVELOPMENT AND ENJOYMENT OF THE YOUTH OF CRIVITZ, WISCONSIN.

Form 990-PF (2015)

Page 13

Part XVII

Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations

Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

Yes

Transfers from the reporting foundation to a noncharitable exempt organization of:

(1) Cash...................................

1a(1)

(2) Other assets.................................

1a(2)

Other transactions:

(1) Sales of assets to a noncharitable exempt organization....................

1b(1)

(2) Purchases of assets from a noncharitable exempt organization..................

1b(2)

(3) Rental of facilities, equipment, or other assets.......................

1b(3)

(4) Reimbursement arrangements...........................

1b(4)

(5) Loans or loan guarantees.............................

1b(5)

(6) Performance of services or membership or fundraising solicitations................

1b(6)

Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............

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

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?...........YesNo

If "Yes," complete the following schedule.

(a) Name of organization	(b) Type of organization	(c) Description of relationship

Sign Here

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) is based on all information of which preparer has any knowledge.
				May the IRS discuss this return with the preparer shown below (see instr.)? Yes No
	Signature of officer or trustee	Date	Title

Paid Preparer Use Only	Print/Type preparer's name	Preparer's Signature	Date	Check if self- employed	PTIN
	Firm's name				Firm's EIN
	Firm's address				Phone no.

Form 990-PF (2015)

Additional Data

Software ID:
Software Version:

Form 990PF - Special Condition Description:

Special Condition Description

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

CRIVITZ YOUTH INC

Employer identification number

23-7088232

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... 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 on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization CRIVITZ YOUTH INC

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
1	NANCY BUCK RANSOM FOUNDATION PO BOX 1299 PEBBLE BEACH, CA93952	$ 670,000	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization CRIVITZ YOUTH INC		Employer identification number 23-7088232

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization CRIVITZ YOUTH INC			Employer identification number 23-7088232
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose 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

(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

(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

(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) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

TY 2015 AccountingFeesSchedule

Name:

CRIVITZ YOUTH INC

EIN:

23-7088232

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
PROFESSIONAL SERVICES - ACCOUNTI	14,908		14,908

- TIN:

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

TY 2015 DepreciationSchedule

Name:

CRIVITZ YOUTH INC

EIN:

23-7088232

Description of Property	Date Acquired	Cost or Other Basis	Prior Years' Depreciation	Computation Method	Rate / Life (# of years)	Current Year's Depreciation Expense	Net Investment Income	Adjusted Net Income	Cost of Goods Sold Not Included
DEPRECIATION						215,820

- TIN:

TY 2015 LandEtcSchedule2

Name:

CRIVITZ YOUTH INC

EIN:

23-7088232

Category / Item	Cost / Other Basis	Accumulated Depreciation	Book Value	End of Year Fair Market Value
	6,699,406	1,725,446	4,973,960
LAND	979,533		979,533

- TIN:

TY 2015 LegalFeesSchedule

Name:

CRIVITZ YOUTH INC

EIN:

23-7088232

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
LEGAL FEES	650			650

- TIN:

TY 2015 OtherAssetsSchedule

Name:

CRIVITZ YOUTH INC

EIN:

23-7088232

Description	Beginning of Year - Book Value	End of Year - Book Value	End of Year - Fair Market Value
ROUNDING

- TIN:

TY 2015 OtherExpensesSchedule

Name:

CRIVITZ YOUTH INC

EIN:

23-7088232

Description	Revenue and Expenses per Books	Disbursements for Charitable Purposes
EXPENSES
TELEPHONE	2,755	2,755
TELEPHONE	747	747
FAX	607	607
BUILDING REPAIRS	5,782	5,782
ADVERTISING	297	297
EQUIPMENT REPAIRS	1,644	1,644
CONTRACTED OUT	760	760
PUBLIC RELATIONS	2,931	2,931
FUNDRAISING EXPENSE
OTHER PURCHASED SERVICES	13,715	13,715
OTHER PURCHASED SERVICES	8,570	8,570
OTHER PURCHASED SERVICES
OFFICE SUPPLIES
JANITORIAL SUPPLIES	17,822	17,822
SUPPLIES	546	546
SUPPLIES	1,437	1,437
POSTAGE AND SHIPPING	290	290
GROUNDS MAINTENANCE	4,395	4,395
GROUND SUPPLIES	3,874	3,874
CLEANING SERVICES	67,452	67,452
FOOD SUPPLIES	25,240	25,240
FOOD SUPPLIES
NON-FOOD SUPPLIES	1,293	1,293
NON-FOOD SUPPLIES
INTERNET EXPENSE
COMPUTER EXPENSES & REPAIRS	368	368
COMPUTER EXPENSES & REPAIRS	13	13
MEALS AND LODGING	4	4
EQUIPMENT - PURCHASES	3,070	3,070
EQUIPMENT - PURCHASES	1,795	1,795
GASOLINE	2,978	2,978
VEHICLE REPAIRS	2,676	2,676
AUTOMOBILE INSURANCE	2,526	2,526
COMMERCIAL PACKAGE INSURANCE	34,326	34,326
UMBRELLA INSURANCE	4,891	4,891
WORKER'S COMPENSATION INSUR.	18,133	18,133
SKATEBOARD PARK INSURANCE	1,482	1,482
CHILD DEVELOP. CENTER INSUR.	1,273	1,273
TEEN CENTER INSURANCE
SPECIAL EVENTS
OTHER DUES AND FEES	112	112
OTHER DUES AND FEES	341	341
OTHER DUES AND FEES	1,139	1,139
OTHER DUES AND FEES	811	811
OTHER PURCHASED SERVICES	1,750	1,750
OTHER DUES AND FEES	10	10
ADVERTISING
SUPPLIES	5,992	5,992
STAFF DEVELOPMENT	1,891	1,891
TELEPHONE
EQUIPMENT REPAIRS	5,911	5,911
CONTRACTED SWIM	1,890	1,890
PUBLIC RELATIONS
FOOD SUPPLIES
INTERNET EXPENSE
COMPUTER EXPENSES & REPAIRS	882	882
EQUIPMENT - PURCHASES	2,441	2,441
SPECIAL EVENTS	40	40
STUDENT ART AWARD
EQUIPMENT REPAIRS	1,435	1,435
MERCHANDISE
SATELLITE RADIO
CONTRACTED OUT
BIRTHDAY PARTY EXPENSES
STAFF DEVELOPMENT	179	179
GARBAGE	1,292	1,292
CONTRACTED OUT	26,382	26,382
EDUCATIONAL SUPPLIES	1,715	1,715
FIELD TRIPS	483	483
STAFF DEVELOPMENT	575	575
ADVERTISING	1,821	1,821
CABLE T.V.	741	741
ARCHITECTS	-30	-30
PUBLIC RELATIONS	637	637
MERCHANDISE	354	354
SATELLITE RADIO	372	372
OTHER PURCHASED SERVICES	4,131	4,131
FOOD SUPPLIES	1,974	1,974
INTERNET EXPENSE	1,114	1,114
SPECIAL EVENTS	568	568
STAFF DEVELOPMENT	20	20
TELEPHONE	750	750
ADVERTISING	163	163
CABLE T.V.	827	827
CONTRACTED D.J.	3,225	3,225
SUPPLIES	310	310
FOOD SUPPLIES	17,579	17,579
NON-FOOD SUPPLIES	908	908
INTERNET EXPENSE	884	884
DANCE MATERIALS	205	205
COMPUTER EXPENSES & REPAIRS	369	369
EQUIPMENT - PURCHASES	1,888	1,888
TEEN CENTER INSURANCE	304	304
TRIPS AND TOURS	649	649
SPECIAL EVENTS	370	370
BIRTHDAY PARTY EXPENSES	235	235
OTHER DUES AND FEES	71	71
SUPPLIES	592	592
ART STUDENT AWARD	200	200
SUPPLIES	10	10
ROUNDING	-6	-6

- TIN:

TY 2015 OtherIncomeSchedule2

Name:

CRIVITZ YOUTH INC

EIN:

23-7088232

Description	Revenue And Expenses Per Books	Adjusted Net Income
TUITION AND REGISTRATION	370,226	370,226
REIMBURSE FOOD PROGRAM - WI	27,206	27,206
FOOD	22,399	22,399
BOWLING CENTER INCOME	5,548	5,548
BIRTHDAY PARTIES	1,178	1,178
DANCES	4,227	4,227
SWIMMING	3,288	3,288
TRIPS AND TOURS	75	75
SPECIAL EVENTS	40	40
MEMBERSHIP	2,253	2,253
DAY PASSES	614	614
COMMUNITY CENTER FEES	113,329	113,329
PHYSICAL THERAPY FEES	4,801	4,801
SILVER SNEAKERS FEES	17,831	17,831
MERCHANDISE SALES	109	109
SPECIAL EVENTS	683	683
CLASS FEES	929	929
TRIPS AND TOURS	1,871	1,871
DAILY FEES	1,884	1,884
OCCASIONAL BUILDING RENTALS	2,372	2,372
OTHER GENERAL INCOME	2,633	2,633
OTHER GENERAL INCOME	114	114
OTHER GENERAL INCOME	450	450
OTHER GENERAL INCOME	221	221
OTHER GENERAL INCOME	316	316

- TIN:

TY 2015 OtherLiabilitiesSchedule

Name:

CRIVITZ YOUTH INC

EIN:

23-7088232

Description	Beginning of Year - Book Value	End of Year - Book Value
ROUNDING		2
BANK OVERDRAFT - CHECKING	5,548	1,905
SALES TAX PAYABLE	284	258
ACCRUED PAYROLL	26,097	26,720
ACCRUED PAYROLL TAXES	337	1,491
STATE WITHHOLDING - WI	3,243	1,598
SIMPLE - LIABILITY	1,775	1,813

- TIN:

TY 2015 TaxesSchedule

Name:

CRIVITZ YOUTH INC

EIN:

23-7088232

Category	Amount	Disbursements for Charitable Purposes
990 TAXES	32	32
LICENSING	365	365
FOOD SERVICE LICENSE	330	330