Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletInformation 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
C JACKMAN TUW SHRINERS FD 752006301
 
Number and street (or P.O. box number if mail is not delivered to street address)JOHNSON BANK 525 JUNCTION ROAD ST
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MADISON, WI53717
A Employer identification number

39-6542836
B Telephone number (see instructions)

(608) 203-3953
C bullet
G Check all that apply:

D 1. bullet
2. bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$2,336,616J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet Sch. B .............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 70,552 70,068  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 113,053
b Gross sales price for all assets on line 6a 1,008,535
7 Capital gain net income (from Part IV, line 2)... 113,053
8 Net short-term capital gain......... 0
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)....... Click to see attachment 704 704  
12 Total. Add lines 1 through 11........ 184,309 183,825  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 22,726 22,726    
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule).........       0
b Accounting fees (attach schedule)....... Click to see attachment 750 0 0 750
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... Click to see attachment 4,308 305   0
19 Depreciation (attach schedule) and depletion... 0 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......   0 0  
22 Printing and publications..........   0 0  
23 Other expenses (attach schedule).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 27,784 23,031 0 750
25 Contributions, gifts, grants paid....... 116,280 116,280
26 Total expenses and disbursements. Add lines 24 and 25 144,064 23,031 0 117,030
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 40,245
b Net investment income (if negative, enter -0-) 160,794
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2015)
Form 990-PF (2015)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)		 Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing.............      
2 Savings and temporary cash investments......... 47,054 92,657 92,657
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet0      
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule).......      
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 2,019,268 Click to see attachment2,012,521 2,243,959
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 2,066,322 2,105,178 2,336,616
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable..................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22).........   0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted..................    
25 Temporarily restricted...............    
26 Permanently restricted...............    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds........ 2,066,322 2,105,178
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)..... 2,066,322 2,105,178
31 Total liabilities and net assets/fund balances (see instructions). 2,066,322 2,105,178
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year’s return) ...............
1
2,066,322
2
Enter amount from Part I, line 27a .....................
2
40,245
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
2,106,567
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
1,389
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
2,105,178
Form 990-PF (2015)
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.)
1 a 28000. TELEFONICA SA 4.949% 1/15/15     2015-01-15
b 450. BAXTER INTERNATIONAL INC     2015-01-22
c 249. JOHNSON & JOHNSON COM     2015-01-23
d 12000. JEFFERIES GROUP INC 8.500% 7/15/19   2013-04-26 2015-02-06
e 241. JOHNSON & JOHNSON COM   2012-06-01 2015-02-11
15000. OMNICOM GROUP INC 4.450% 8/15/20   2013-09-18 2015-02-12
380. OCCIDENTAL PETE CORP     2015-02-17
130. OCCIDENTAL PETE CORP   2014-02-19 2015-02-17
12000. US TREASURY BOND 7.500% DTD 11/17/1986 DUE 11/15/2016   2010-03-05 2015-02-18
14000. VALE OVERSEAS LTD 5.625% 9/15/19   2014-05-12 2015-03-04
686.184 ALLIANZGI NFJ INTL VAL-INST   2012-09-12 2015-03-25
437.19 BUFFALO GROWTH FUND     2015-03-25
14000. DELPHI CORP 6.125% 5/15/21   2014-01-22 2015-03-25
12000. CITIGROUP INC 8.500% 5/22/19   2014-04-30 2015-03-26
12000. CITIGROUP INC 8.500% 5/22/19   2014-01-15 2015-03-26
455. AT & T INC     2015-04-16
302. KLA-TENCOR CORP   2014-09-05 2015-04-17
25000. TIME WARNER CABLE 8.750% 2/14/19     2015-04-28
10000. U.S. TREASURY BONDS 7.125% 2/15/23   2014-05-14 2015-04-29
177. VF CORP COM   2013-02-07 2015-05-14
280.741 BUFFALO GROWTH FUND   2011-08-17 2015-05-20
255. COMCAST CORP-CL A   2012-03-02 2015-06-08
12000. U.S. TREASURY BONDS 7.125% 2/15/23   2014-05-14 2015-06-17
1963.667 ALLIANZGI NFJ INTL VAL-INST     2015-06-23
55.906 ALLIANZGI NFJ INTL VAL-INST     2015-06-23
2169.198 ARTISAN INTL VALUE FUND-ADV     2015-06-23
137.913 BUFFALO GROWTH FUND   2014-12-18 2015-06-23
263.312 BUFFALO GROWTH FUND   2011-08-17 2015-06-23
5400.54 FMI LARGE CAP FUND     2015-06-23
16000. VALE OVERSEAS 4.625% 9/15/20   2015-03-04 2015-06-23
239. UNITED PARCEL SVC INC CL B   2014-09-17 2015-06-29
16000. U.S. TREASURY NOTES 0.875% 5/15/17   2015-01-15 2015-06-30
14000. U.S. TREASURY NOTES 3.375% 11/15/19     2015-07-13
219. HASBRO INC   2013-10-25 2015-07-23
16000. U.S. TREASURY NOTES 0.875% 5/15/17   2015-01-15 2015-07-27
13000. US TREASURY BOND 7.500% DTD 11/17/1986 DUE 11/15/2016     2015-08-05
279. TIME WARNER INC     2015-08-06
498. INVESCO LIMITED     2015-08-25
45. BLACKROCK INC   2011-11-04 2015-09-03
15000. PETROBRAS INTL FIN 3.875% 1/27/16   2014-10-07 2015-09-14
211.332 AMER CENT DIVERSIFIED BOND INS   2014-10-01 2015-09-30
448.095 DODGE & COX INCOME FD COM   2015-06-23 2015-09-30
250. FMI LARGE CAP FUND   2012-03-15 2015-09-30
596.252 JPMORGAN CORE BOND FUND-SEL   2015-06-23 2015-09-30
646.353 METROPOLITAN WEST T/R BOND-I     2015-09-30
77. NORTHROP CORP COM   2014-09-30 2015-11-18
29000. U.S. TREASURY NOTES 3.125% 5/15/19   2015-04-28 2015-12-03
712. INVESCO LIMITED     2015-12-15
129.534 JPMORGAN CORE BOND FUND-SEL   2015-06-23 2015-12-17
2000. BANK OF AMER MTN 5.625% 7/01/20   2013-09-12 2015-12-18
2000. DEUTSCHE BANK AG MTN 1.400% 2/13/17   2015-07-27 2015-12-18
2000. EATON CORP 2.750% 11/02/22   2015-06-17 2015-12-18
2000. GEN MOTORS FINL CO 6.750% 6/01/18   2015-06-30 2015-12-18
3000. HEWLETT-PACKARD CO 4.650% 12/09/21   2014-02-18 2015-12-18
2000. MEDCO HEALTH SOL 7.125% 3/15/18   2015-04-29 2015-12-18
3000. MORGAN STANLEY MTN 7.300% 5/13/19   2014-04-04 2015-12-18
2000. OMNICOM GROUP INC 5.900% 4/15/16     2015-12-18
3000. US TREASURY BOND 7.500% DTD 11/17/1986 DUE 11/15/2016   2012-11-27 2015-12-18
4000. U.S. TREASURY BONDS 7.125% 2/15/23   2014-05-14 2015-12-18
8000. U.S. TREASURY BONDS 6.625% 2/15/27   2015-02-12 2015-12-18
4000. U.S. TREASURY NOTES 3.125% 5/15/19   2015-04-28 2015-12-18
2000. U.S. TREASURY NOTES 2.000% 2/15/22   2015-06-23 2015-12-18
CAPITAL GAIN DIVIDENDS P    
(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 28,000   29,623 -1,623
b 32,081   29,999 2,082
c 25,492   15,568 9,924
d 14,386   15,313 -927
e 24,154   14,904 9,250
16,419   15,418 1,001
31,312   32,865 -1,553
10,712   12,109 -1,397
13,440   15,292 -1,852
15,262   15,750 -488
15,000   14,039 961
15,000   11,982 3,018
15,277   15,558 -281
14,897   15,313 -416
14,897   15,471 -574
14,927   15,088 -161
17,540   22,144 -4,604
29,554   31,885 -2,331
13,820   13,806 14
12,505   6,714 5,791
10,000   6,701 3,299
14,725   7,459 7,266
16,219   16,568 -349
44,025   40,361 3,664
1,253   1,276 -23
80,000   59,216 20,784
4,908   4,584 324
9,371   6,285 3,086
120,000   95,015 24,985
16,754   16,445 309
23,259   23,823 -564
16,077   16,110 -33
15,073   13,999 1,074
17,397   11,496 5,901
16,071   16,110 -39
14,138   16,565 -2,427
20,832   18,540 2,292
16,669   18,117 -1,448
13,474   7,072 6,402
14,873   15,392 -519
2,282   2,289 -7
6,000   6,134 -134
5,000   4,233 767
7,000   6,940 60
7,000   6,684 316
14,407   10,219 4,188
30,627   31,191 -564
22,211   24,073 -1,862
1,500   1,508 -8
2,224   2,187 37
1,993   1,994 -1
1,940   1,936 4
2,165   2,235 -70
2,992   3,157 -165
2,212   2,297 -85
3,459   3,655 -196
2,027   2,292 -265
3,179   3,822 -643
5,371   5,523 -152
11,438   11,828 -390
4,229   4,302 -73
2,012   1,993 19
      21,904
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a       -1,623
b       2,082
c       9,924
d       -927
e       9,250
      1,001
      -1,553
      -1,397
      -1,852
      -488
      961
      3,018
      -281
      -416
      -574
      -161
      -4,604
      -2,331
      14
      5,791
      3,299
      7,266
      -349
      3,664
      -23
      20,784
      324
      3,086
      24,985
      309
      -564
      -33
      1,074
      5,901
      -39
      -2,427
      2,292
      -1,448
      6,402
      -519
      -7
      -134
      767
      60
      316
      4,188
      -564
      -1,862
      -8
      37
      -1
      4
      -70
      -165
      -85
      -196
      -265
      -643
      -152
      -390
      -73
      19
       
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 113,053
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 ................... 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see 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 110,088 2,389,689 0.046068
2013 105,930 2,244,872 0.047188
2012 105,128 2,081,732 0.0505
2011 101,599 2,714,380 0.03743
2010 108,266 2,037,111 0.053147
2
Total of line 1, column (d) .....................
20.234333
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years . . .
3
0.046867
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
2,382,004
5
Multiply line 4 by line 3......................
5
111,637
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
1,608
7
Add lines 5 and 6........................
7
113,245
8
Enter qualifying distributions from Part XII, line 4.............
8
117,030
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)
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 Bullet and enter “N/A" on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 1,608
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 1,608
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 1,608
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a 3,232
b Exempt foreign organizations—tax withheld at source...... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 3,232
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 1,624
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet1,608 RefundedBullet 11 16
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see Instructions
for definition)?.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletWI
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2015 or the taxable year beginning in 2015 (see instructions for Part XIV)?
    If "Yes," complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............
    11
     
    No
    12
    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).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbullet  
    14
    The books are in care ofbulletJOHNSON BANK - TRUST DEPT Telephone no.bullet (608) 743-1594

    Located atbullet1 S MAIN STJANESVILLEWI ZIP+4bullet53547
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.......bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16 At any time during calendar year 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
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?...............
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).......
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)? ........
    1b
     
    No
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2015?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2015, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2015?.............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
    Yes
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 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.)..................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2015?
    4b
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (Continued)
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? (see instructions)................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ......
    5b
     
     
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2015)
    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
    Johnson Bank Trust TRUSTEE
    2     		22,726    
    1 S MAIN ST
    JANESVILLE,WI53547
    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...................bullet 0
    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.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    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  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 8
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    2,357,891
    b
    Average of monthly cash balances.......................
    1b
    60,387
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    2,418,278
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    2,418,278
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    36,274
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    2,382,004
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    119,100
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
    119,100
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    1,608
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    1,608
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    117,492
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    117,492
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    117,492
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    117,030
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
    0
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
    0
    b
    Cash distribution test (attach the required schedule) .................
    3b
    0
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    117,030
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see instructions).................
    5
    1,608
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    115,422
    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)
    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 7 117,492
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only....... 8,464
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2015:
    a From 2010...... 0
    b From 2011...... 0
    c From 2012...... 0
    d From 2013...... 0
    e From 2014...... 0
    fTotal of lines 3a through e........ 0
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 117,030
    a Applied to 2014, but not more than line 2a 8,464
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		0
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2015 distributable amount..... 108,566
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2015. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2014. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2016. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2015 ..........     		8,926
    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) .......     		0
    8Excess distributions carryover from 2010 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......     		0
    10 Analysis of line 9:
    a Excess from 2011.... 0
    b Excess from 2012.... 0
    c Excess from 2013.... 0
    d Excess from 2014.... 0
    e Excess from 2015.... 0
    Form 990-PF (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 section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2015 (b) 2014 (c) 2013 (d) 2012
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see 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).)
    NONE
    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.
    NONE
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    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)
    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)
    aPaid during the year
    SHRINERS HOSPITALS FOR CHILDREN
    % INVESTMENT ACCOUNTING
    2900 ROCKY POINT DR PO BOX 31356
    TAMPA,FL336313356     		NONE PC PROGRAM SUPPORT 116,280
    Total .................................bullet 3a 116,280
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2015)
    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
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3
    Interest on savings and temporary cash investments ...........     		         
    4 Dividends and interest from securities....     14 70,552  
    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 ............     		    18 113,053  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue:
    aMISC INCOME     		    1 704  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   184,309  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13184,309
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 13
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    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.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2015)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2015 AccountingFeesSchedule
    Name:
    C JACKMAN TUW SHRINERS FD 752006301
    EIN:
    39-6542836
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEE (ALLOCABLE 750     750

    TY 2015 InvestmentsOtherSchedule2
    Name:
    C JACKMAN TUW SHRINERS FD 752006301
    EIN:
    39-6542836
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    OMNICOM GROUP INC 5.900% AT COST 15,577 14,178
    CAPITAL ONE FINL 6.150% AT COST 16,064 15,455
    US TREASURY BONDS 7.500% AT COST 51,507 44,397
    DUETSCHE BANK AG MTN 1.400% AT COST 13,958 13,921
    BEAR STEARNS CO 7.250% AT COST 33,404 30,887
    MEDCO HEALTH SOL 7.125% AT COST 13,779 13,265
    JEFFERIES GROUP INC 5.125% AT COST 15,828 15,601
    GEN MOTORS FINL CO 6.750% AT COST 29,979 29,259
    EXPEDIA INC 7.456% AT COST 15,015 14,487
    GOLDMAN SACHS MTN 7.500% AT COST 32,611 30,895
    MORGAN STANLEY MTN 7.300% AT COST 30,368 28,718
    US TREASUR NOTES 3.125% AT COST 28,917 28,484
    HUSKY ENERGY INC 7.250% AT COST 15,244 13,254
    FORD MOTOR CREDIT CO 8.125% AT COST 33,227 30,622
    BANK OF AMER MTN 5.625% AT COST 13,124 13,329
    EXPEDIA INC 5.950% AT COST 15,890 15,276
    HEWLETT-PACKARD CO 4.650% AT COST 31,265 29,886
    BANK OF AMER CRP 5.700% AT COST 14,774 14,660
    US TREASURY NOTES 2.00% AT COST 13,953 14,025
    EATON CORP 2.750% AT COST 14,485 14,515
    US TREASURY BONDS 7.125% AT COST 60,235 58,748
    CITIGROUP INC 3.875% AT COST 31,525 31,003
    US TREASURY BONDS 6.625% AT COST 74,670 73,739
    DODGE & CONX INCOME FUND AT COST 23,866 23,168
    METROPOLITAN WEST T/R BOND -I AT COST 30,982 30,565
    JPMORGAN CORE BOND FUND-SEL AT COST 21,552 21,367
    AMERPRISE FINANCIAL INC AT COST 19,347 31,394
    AMGEN INC AT COST 35,665 36,362
    ANTHEM INC AT COST 25,304 25,099
    BBH CORE SELECT FUND -N AT COST 74,982 85,981
    BECTON DICKINSON & CO AT COST 46,739 49,771
    BLACKROCK INC AT COST 11,001 23,836
    CARDINAL HEALTH INC AT COST 23,704 48,652
    CISCO SYSTEMS INC AT COST 23,647 24,711
    COMCAST CORP-CL A AT COST 18,639 36,680
    CVS HEALTH CORP AT COST 45,168 45,268
    EXXON MOBILCORP AT COST 31,988 26,971
    FMI LARGE CAP FUND AT COST 102,664 109,197
    HASBRO INC AT COST 23,128 32,737
    HONEYWELL INTL INC AT COST 30,329 49,196
    INTERNATINAL BUSINESS MACHINES AT COST 41,744 30,552
    JP MORGAN CHASE & CO AT COST 50,902 50,579
    LOCKHEED MARTIN CORP AT COST 35,772 48,859
    LOWES COS INC AT COST 18,007 49,046
    MICROSOFT CORP AT COST 30,863 57,699
    NORTHROP GRUMMAN CORPORATION AT COST 20,306 28,888
    PFIZER INC AT COST 43,398 44,385
    PRUDENTIAL FINL INC AT COST 35,249 31,831
    RAYTHEON COMPANY AT COST 24,125 44,955
    SCHLUMBERGER LTD AT COST 36,344 28,388
    TEXAS INSTRUMENTS AT COST 37,948 51,521
    TIME WARNER INC AT COST 21,954 21,729
    TRAVELERS COMPANIES INC AT COST 37,534 51,351
    UNITEDHEALTH GROUP INC AT COST 48,262 48,821
    V F CORP AT COST 13,390 22,597
    WALGREENS BOOTS ALLIANCE INC AT COST 32,860 47,261
    WEC ENERGY GROUP INC AT COST 10,018 13,084
    WELLS FARGO & CO AT COST 40,662 40,553
    WILLIAMS-SONOMA INC AT COST 31,552 32,126
    3M CO AT COST 13,901 26,362
    ARTISAN INTL VALUE FUND ADV AT COST 48,626 69,709
    OAKMARK INTERNATIONAL FD-1 AT COST 45,000 37,679
    OPPENHEIMER DEVELOPING MKT-I AT COST 45,000 37,875
    SCHWAB LAUDUS INTL MARKETMASTE AT COST 45,000 38,550

    TY 2015 OtherDecreasesSchedule
    Name:
    C JACKMAN TUW SHRINERS FD 752006301
    EIN:
    39-6542836
    Description Amount
    COST BASIS ADJUSTMENT ON RETURN OF CAPITAL 1,246
    ROC ADJUSTED ON SALE OF CUSIP XXX-XX-XXXX 140
    ROUNDING 3


    TY 2015 OtherIncomeSchedule2
    Name:
    C JACKMAN TUW SHRINERS FD 752006301
    EIN:
    39-6542836
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    MISC INCOME 704 704  


    TY 2015 TaxesSchedule
    Name:
    C JACKMAN TUW SHRINERS FD 752006301
    EIN:
    39-6542836
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL TAX PAYMENT - PRIOR YE 771 0   0
    FEDERAL ESTIMATES - PRINCIPAL 3,232 0   0
    FOREIGN TAXES ON QUALIFIED FOR 296 296   0
    FOREIGN TAXES ON NONQUALIFIED 9 9   0