TY 2015 Form 990EZ

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; optional for others.)
What is the organization's primary exempt purpose? To educate the general public by spreading awareness about pediatric cancer and its effects on the children and families suffering through it; provide emotional, educational and financial support for families dealing with pediatric cancer, provide experiences and fulfill wishes of children diagnosed with pediatric cancer; provide other services as needed for families and children diagnosed with pediatric cancer.
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 GIFTS (Grants $ ) If this amount includes foreign grants, check here ...	28a	4,417
29 FINANCIAL AID (Grants $ ) If this amount includes foreign grants, check here ...	29a	22,780
30 (Grants $ ) If this amount includes foreign grants, check here ...	30a
31 Other program services (describe in Schedule O) ................ (Grants $ ) If this amount includes foreign grants, check here...	31a
32 Total program service expenses (add lines 28a through 31a)..........	32	27,197

(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
CINDY BISH Managing Director	40.00	0
MICHAEL BISH Director	5.00	0
CORTNEY HODGES Director	5.00	0
JOSH HAMILTON Director	5.00	0

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

The Sam Bish Foundation

Employer identification number

27-3501579

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....	33,223	40,116	63,937	49,513	36,510	223,299
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	33,223	40,116	63,937	49,513	36,510	223,299
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.						223,299

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..	33,223	40,116	63,937	49,513	36,510	223,299
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...				4	4	8
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 VI.)..
11	Total support. Add lines 7 through 10.						223,307

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

100.000 %

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

100.000 %

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2015

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)		(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.)	0

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

0 %

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

0 %

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000272
Software Version:

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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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

The Sam Bish Foundation

Employer identification number

27-3501579

Return Reference	Explanation
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Brian Aquino-Gomez: 2489 Golden Gales Sq N Apt H, Columbus, OH, 43224; , 565.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Daniel Amjad: 2367 Leeward Ct, Hilliard, OH, 43026; , 350.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Mikyle Bays: 1826 Chandler Dr, Charleston, WV, 25312; , 736.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Anthony Baisden: 64 S Princeton Ave, Columbus, OH, 43222; , 489.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Gabriel Banks: 4655 Eastbury Woods Dr, Columbus, OH, 43230; , 260.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Jharod Bestor: 1885 Somerset Ct East, Columbus, OH, 43227; , 475.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Taylor Bryant-Gartner: 471 King Ct, Newark, OH, 43055; , 950.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Eli Boda: 2601 McGuffey Rd, Columbus, OH, 43211; , 300.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Raychal Cairelli: 1350 Edgeworth Ave Apt B6, Cambridge, OH, 43725; , 800.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Wyatt Carpenter: PO Box 111, Comfort, WV, 25049; , 377.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Kimora Carpenter: 5587 Rockwood Ct, Columbus, OH, 43229; , 503.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Dominic Clarke: 1561 Scenic Valley Place, Lancaster, OH, 43130; , 200.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Aubree Cline: , Cambridge, OH, ; , 24.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Rickayla Coiner: 103 Hudson St Apt F, St Albans, WV, 25177; , 200.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Landyn Dereski: , , , ; , 248.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Mickey Detty: , Grove City, OH, 43123; , 100.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Lexie Edens: , , OH, ; , 16.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Aaliyah Erwin: , , , ; , 96.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Anderson Evans: 200 Tick Ridge Road, Wheelersburg, OH, 45694; , 650.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Wyatt Esno: , , , ; , 20.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Shave Evans: 196 1/2 Apt A North 11th St, Newark, OH, 43055; , 297.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Destiny Freeland: 10 Dodds Road, Otway, OH, 45657; , 528.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Jackie Foster: 402 Ashland Ave Apt F7, Wapakoneta, OH, 45895; , 560.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Alyks Daigle: 527 E Schock Rd, Westerville, OH, 43081; , 625.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Dominick Granata: , Westerville, OH, ; , 81.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Amelia Griffin: , Ada, OH, 45810; , 1285.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Roslynn Green: 213 Main St, Butler, OH, 44822; , 447.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Rylan Hagerty: 14894 TR 152, Arlington, OH, 45814; , 600.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Cory Hardymon: 11325 St. Rt. 53 West, Upper Sandusky, OH, 43351; , 526.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Joby Hawthorne: 523 S 7th St, Coshocton, OH, 43812; , 475.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Kaleb Hively: 1428 Strawberry Rd, Saint Albans, WV, 25177; , 490.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Maggie Holton: 21 Colonial Ct, Barboursville, WV, 25504; , 255.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Raven Hook: 11786 Main St PO Box 394, Adelphia, OH, ; , 240.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Garrett Houston: 36 Turkey Foot Twp Rd, Wheelersburg, OH, 45694; , 219.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Raliya Hussein: 70 Stephen Ave, Columubs, OH, 43222; , 85.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Daniel Hyatt: 509 Rawlings St, Washington Court House, OH, 43160; , 532.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Jazmyn Jewell: 719 N Sandusky, Mount Vernon, OH, 43050; , 104.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Ali Hoden: 1377 Crossing Green Ln, Columbus, OH, 43228; , 240.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Ivory Issac: , , , ; , 14.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Addison Johnson: 4010 Birch St Apt C, Valdosta, GA, 31605; , 587.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Samuel Johnson: , , , ; , 437.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Taryn Jorvig: , Marietta, OH, ; , 150.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Knecht Family: 6195 Albany Way Dr, Westerville, OH, 43081; , 200.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Kaydence Lamp: 812 Heyl Ave, Columbus, OH, 43206; , 370.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; William Lockhart: , , , ; , 207.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Richard Lowe: 4105 Hamilton Blvd Room 130, Groveport, OH, 43125; , 545.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Kaleb McCullar: 515 E Palm Valley Blvd Apt 31, Round Rock, TX, 78664; , 950.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Leah McIntosh: 1354 W Slate Ridge Dr, Canal Winchester, OH, 43110; , 400.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Melvin Melton: 600 Sackman St, Mansfield, OH, 44903; , 446.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Violet Murphy: , , , ; , 49.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Isaac Neumann: , Galion, OH, 44833; , 261.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Lauryn Oliphant: 12694 Bentley Dr, Pickerington, OH, 43147; , 12.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Jaxson Palmer: 205 E Short St Lot 32, Stryker, OH, 43557; , 474.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Yousef Qawasmi: 5844 Ainsley Ave, Columbus, OH, 43230; , 150.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Elody Schrader: , Columbus, OH, ; , 146.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; David Sexton: 404 1/2 Oak St, Marion, OH, 43302; , 498.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Mika Senften: 1795 Brookdale Rd SE Lot 23, Lancaster, OH, ; , 100.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Karter Smith: 16 Smith St, New Lexington, OH, 43764; , 1246.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Asiana Rembert: 1915 Law St, Camden, SC, 29020; , 75.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Katherine Rice: 4550 Hilton Ave Apt B, Columbus, OH, 43228; , 446.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Trinity Riley: 2672 John Steven Way, Reynoldsburg, OH, 43068; , 129.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Brandon Rinehart: 2403 Woodside Ave, Springfield, OH, 45503; , 160.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; William Robertson: 226 A Courtney Way, Statesboro, GA, 30458; , 108.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Gavyn Sandlin: PO Box 2358, Wintersville, OH, 43953; , 437.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Robert Thomas: , Lima, OH, ; , 475.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Liam Varughese: , , , ; , 83.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Eli Wagner: Bexvie Ave Apt C, Columbus, OH, ; , 88.
Form 990EZ, Part I, Line 10	Gift/Grants; Gift; Tyler Wells: 4053 Colonial Place, Grove City, OH, 43123; , 880.
Form 990EZ, Part I, Line 10	4053 Colonial Place; Gift; Jamine Woodgeard: 142 Buckeye Circle, Columbus, OH, 43217; , 650.
Form 990EZ, Part I, Line 10	4053 Colonial Place; Gift; Coraellyna Wilkinson: 492 Cline Ave, Mansfield, OH, 44907; , 912.
Form 990EZ, Part I, Line 10	4053 Colonial Place; Gift; Samantha Worlledge: 927 Sullivan Ave, Columbus, OH, 43223; , 553.
Form 990EZ, Part I, Line 10	4053 Colonial Place; Gift; Reid Zupanc: , Delaware, OH, ; , 11.
Form 990EZ, Part I, Line 16	Office 276.
Form 990EZ, Part I, Line 16	Accounting Fees 500.
Form 990EZ, Part I, Line 16	Bank Service Charges 73.
Form 990EZ, Part I, Line 16	Storage 590.
Form 990EZ, Part I, Line 16	Telephone 910.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000272
Software Version:

1	Contributions, gifts, grants, and similar amounts received ....................	1	85
2	Program service revenue including government fees and contracts ...............	2	0
3	Membership dues and assessments ...........................	3	0
4	Investment income ...........................	4	4
5a	Gross amount from sale of assets other than inventory .....	5a
b	Less: cost or other basis and sales expenses .......	5b	0
c	Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ......	5c	0
6	Gaming and fundraising events
a	Gross income from gaming (attach Schedule G if greater than $15,000)	6a	0
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	36,425
c	Less: direct expenses from gaming and fundraising events ...	6c	7,877
d	Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)	6d	28,548
7a	Gross sales of inventory, less returns and allowances ......	7a
b	Less: cost of goods sold .............	7b	0
c	Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) .........	7c	0
8	Other revenue (describe in Schedule O) ..........	8
9	Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 ..............	9	28,637

(a) Name and business address of each independent contractor	(b) Type of service	(c) Compensation
NONE

Sign Here

	Signature of officer	Date

	Type or print name and title

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

10	Grants and similar amounts paid (list in Schedule O) ............	10	27,197
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	2,535
16	Other expenses (describe in Schedule O) ..............	16	2,349
17	Total expenses. Add lines 10 through 16 ..............	17	32,081

18	Excess or (deficit) for the year (Subtract line 17 from line 9) ............	18	-3,444
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	39,347
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 .......	21	35,903