Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 43,598 | 45,010 | 38,295 | 43,918 | 43,317 | 214,138 |
| 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 | 43,598 | 45,010 | 38,295 | 43,918 | 43,317 | 214,138 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 214,138 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 43,598 | 45,010 | 38,295 | 43,918 | 43,317 | 214,138 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 13 | 6 | 5 | 5 | 4 | 33 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 13 | 6 | 5 | 5 | 4 | 33 |
| 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.) .. | 8 | 159 | 167 | |||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 43,619 | 45,175 | 38,300 | 43,923 | 43,321 | 214,338 |
| 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 | ||||
| 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 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990-EZ, PART I, LINE 4 - OTHER INVESTMENT INCOME | DESCRIPTION: INTEREST. AMOUNT: 4. |
| FORM 990-EZ, PART I, LINE 8 - OTHER REVENUE | DESCRIPTION: MISCELLANEOUS. AMOUNT: 213. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: CITY OF SYCAMORE. GRANTEE ADDRESS: 308 W STATE ST SYCAMORE, IL 60178. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 09/30/19. AMOUNT GIVEN: 200. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: FAMILY SERVICE AGENCY. GRANTEE ADDRESS: 1325 SYCAMORE ROAD DEKALB, IL 60115. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 08/16/19. AMOUNT GIVEN: 1000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: FEED MY STARVING CHILDREN. GRANTEE ADDRESS: 401 93RD AVENUE NW COONS RAPID, MN 55433. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 11/14/19. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: SALEM FOOD PANTRY. GRANTEE ADDRESS: 1145 DEKALB AVE SYCAMORE, IL 60178. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 03/25/20. AMOUNT GIVEN: 1000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: GOODFELLOWS. GRANTEE ADDRESS: 107 W EXCHANGE ST SYCAMORE, IL 60178. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 01/08/20. AMOUNT GIVEN: 1000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: LIONS DISTRICT 1-J. GRANTEE ADDRESS: 2570 DEKALB AVENUE SYCAMORE, IL 60178. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 08/27/19. AMOUNT GIVEN: 125. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: LIONS ILLINOIS FOUNDATION. GRANTEE ADDRESS: 2814 DEKALB AVENUE SYCAMORE, IL 60178. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 12/13/19. AMOUNT GIVEN: 100. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: TOYS FOR TOTS. GRANTEE ADDRESS: 3034 W FOSTER AVE CHICAGO, IL 60625. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 07/19/19. AMOUNT GIVEN: 100. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: PAYMENTS ON BEHALF OF VISUALLY & HEARING IMPAIRED GRANTEE NAME: PAYMENTS ON BEHALF OF VISUALLY & HEARING IMPAIRED. GRANTEE ADDRESS: 2570 DEKALB AVENUE SYCAMORE, IL 60178. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 10/07/19. AMOUNT GIVEN: 4063. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: SPARTAN FOOD PANTRY. GRANTEE ADDRESS: 240 FAIR ST SYCAMORE, IL 60178. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 03/25/20. AMOUNT GIVEN: 1000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: SYCAMORE FOOD PANTRY/SUMC. GRANTEE ADDRESS: 160 JOHNSON AVENUE SYCAMORE, IL 60178. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 03/25/20. AMOUNT GIVEN: 1000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: SYCAMORE PUMPKIN FEST. GRANTEE ADDRESS: PO BOX SYCAMORE, IL 60178. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 12/12/19. AMOUNT GIVEN: 1500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: DONATIONS. GRANTEE NAME: VOLUNTARY ACTION CENTER-MOW. GRANTEE ADDRESS: 1606 BETHANY ROAD SYCAMORE, IL 60178. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 03/27/20. AMOUNT GIVEN: 750. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: SCHOLARSHIPS. GRANTEE NAME: LISA GUZNSKI. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 02/26/20. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: SCHOLARSHIPS. GRANTEE NAME: LILLIAN NOICU. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 02/26/20. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: SCHOLARSHIPS. GRANTEE NAME: ABIGAIL KRULL. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/19/20. AMOUNT GIVEN: 1000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: SCHOLARSHIPS. GRANTEE NAME: KELSEY MULLIGAN. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/19/20. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: SCHOLARSHIPS. GRANTEE NAME: ASHELY PARKS. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/19/20. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: SCHOLARSHIPS. GRANTEE NAME: IAIN PURDOM. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/19/20. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: SCHOLARSHIPS. GRANTEE NAME: MATTHEW CLEVELAND. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/19/20. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: SCHOLARSHIPS. GRANTEE NAME: AUSTIN BUNGE. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/19/20. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: SCHOLARSHIPS. GRANTEE NAME: BRADFORD EDWARDS. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/19/20. AMOUNT GIVEN: 500. TOTAL INCLUDED ON FORM 990-EZ, LINE 10: 17338. |
| FORM 990-EZ, PART I, LINE 14 | DESCRIPTION: DEPRECIATION. AMOUNT: 209. DESCRIPTION: OTHER EXPENSES. AMOUNT: 296. TOTAL TO FORM 990-EZ, LINE 14: 505. |
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: SUPPLIES/INSURANCE/CONVENTION/OFFICE EXP. AMOUNT: 941. DESCRIPTION: PUMPKIN FEST. AMOUNT: 1528. DESCRIPTION: COMMUNITY SIGN ELECTRICITY. AMOUNT: 207. DESCRIPTION: SKI FOR SIGHT. AMOUNT: 409. DESCRIPTION: SANTA BREAKFAST. AMOUNT: 223. DESCRIPTION: BENCH IN MEMORY OF D HEPKER. AMOUNT: 1186. TOTAL TO FORM 990-EZ, LINE 16: 4494. |
| FORM 990-EZ, PART I, LINE 20 - OTHER CHANGES IN NET ASSETS | DESCRIPTION: BENEFICIAL INTEREST IN ASSETS HELD AT DCCF. AMOUNT: 287. |
| FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS | DESCRIPTION: BENEFICIAL INTEREST ASSETS DCCF. BEG. OF YEAR AMOUNT: 15038. END OF YEAR AMOUNT: 15325. DESCRIPTION: SECURITY DEPOSIT. BEG. OF YEAR AMOUNT: 250. END OF YEAR AMOUNT: 250. DESCRIPTION: OTHER DEPRECIABLE ASSETS. BEG. OF YEAR AMOUNT: 209. END OF YEAR AMOUNT: 0. |
| Software ID: | |
| Software Version: |