TY 2020 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) RONDA GUSINSKY...................................................................... EXECUTIVE DI	40.00 .................		X	83,762	5,584
(2) RYAN SCARBOROUGH...................................................................... CHAIR	2.00 .................	X	X	0	0
(3) REBECCA LINQUIST...................................................................... VICE CHAIR	2.00 .................	X	X	0	0
(4) CURT RISING...................................................................... TREASURER	2.00 .................	X	X	0	0
(5) CATHERINE CHICOINE...................................................................... SECRETARY	1.50 .................	X	X	0	0
(6) JULAINE ARIENT-ROLLMAN...................................................................... DIRECTOR	1.00 .................	X		0	0
(7) LINDA BOLAND...................................................................... DIRECTOR	1.00 .................	X		0	0
(8) MONTE DIRKS...................................................................... DIRECTOR	1.00 .................	X		0	0
(9) BRIAN GILL...................................................................... DIRECTOR	1.00 .................	X		0	0
(10) BRIAN IVERSON...................................................................... DIRECTOR	1.00 .................	X		0	0
(11) POKEY JACOBSON...................................................................... DIRECTOR	0.50 .................	X		0	0
(12) JACK KAUP...................................................................... DIRECTOR	1.00 .................	X		0	0
(13) SUSAN KELTS...................................................................... DIRECTOR	1.00 .................	X		0	0
(14) SARAH KUIPERS...................................................................... DIRECTOR	0.50 .................	X		0	0
(15) CRAIG PFEIFLE...................................................................... DIRECTOR	1.50 .................	X		0	0
(16) JOHN WALKER...................................................................... DIRECTOR	2.00 .................	X		0	0
(17) TERRY WOLTHUIS...................................................................... DIRECTOR	0.50 .................	X		0	0

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

NORTHERN PLAINS EYE FOUNDATION

Employer identification number

46-0367494

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2020

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..	144,186	102,911	74,517	101,786	90,055	513,455
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	144,186	102,911	74,517	101,786	90,055	513,455
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)..						170,737
6	Public support. Subtract line 5 from line 4.						342,718

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
7	Amounts from line 4..	144,186	102,911	74,517	101,786	90,055	513,455
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	37,614	46,789	34,883	36,984	22,377	178,647
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						692,102

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

First 5 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 2020 (line 6, column (f) divided by line 11, column (f)) .........

49.520 %

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

47.930 %

16a

33 1/3% support test—2020. 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—2019. 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—2020. 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—2019. 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) 2020

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 5 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 2020 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. 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—2019. 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) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) 2020

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 lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2020

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 (explain in Part VI). 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 0.015 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 0.035	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) 2020

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2020 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 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 2020:
a From 2015.......
b From 2016.......
c From 2017.......
d From 2018.......
e From 2019.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2020 distributable amount
i Carryover from 2015 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2020 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2020, 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 2020. 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 2021. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2016.....
b Excess from 2017.....
c Excess from 2018.....
d Excess from 2019.....
e Excess from 2020.....

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

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) 2020

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Name of the organization

NORTHERN PLAINS EYE FOUNDATION

Employer identification number

46-0367494

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

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

Special Rules

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

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

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

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization NORTHERN PLAINS EYE FOUNDATION

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization NORTHERN PLAINS EYE FOUNDATION		Employer identification number 46-0367494

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization NORTHERN PLAINS EYE FOUNDATION			Employer identification number 46-0367494
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

NORTHERN PLAINS EYE FOUNDATION

Employer identification number

46-0367494

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2020

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	1,873,397	1,642,586	1,806,884	1,665,196	1,540,731
b	Contributions ...					50,000
c	Net investment earnings, gains, and losses	214,674	251,016	-140,441	166,584	98,607
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	17,870	20,205	23,857	24,896	24,142
f	Administrative expenses ....
g	End of year balance ......	2,070,201	1,873,397	1,642,586	1,806,884	1,665,196

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

97.000 %

Term endowment SchDMd Bullet

3.000 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .......................

3a(i)

(ii) Related organizations .......................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....
b	Buildings ....
c	Leasehold improvements
d	Equipment ....	89,714	79,643	10,071
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				10,071

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2020

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	444,747
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	296,272
b	Donated services and use of facilities .........	2b	2,590
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	1,576
e	Add lines 2a through 2d .....................			2e	300,438
3	Subtract line 2e from line 1..................			3	144,309
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	144,309

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	294,608
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a	2,590
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	1,576
e	Add lines 2a through 2d....................			2e	4,166
3	Subtract line 2e from line 1...................			3	290,442
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	290,442

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PAGE 2, PART V, LINE 4	THE ENDOWMENT FUND IS A VEHICLE FOR PROVIDING PERMANENT FUNDING TO FURTHER THE PROGRAMS AND PURPOSES OF THE FOUNDATION.
SCHEDULE D, PAGE 3, PART X	AT DECEMBER 31, 2020, THE FOUNDATION BELIEVES THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS OR LIABILITIES, OR INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS.
SCHEDULE D, PAGE 4, PART XI, LINE 2D	OTHER DIRECT FUNDRAISING EXPENSES 1,576
SCHEDULE D, PAGE 4, PART XII, LINE 2D	OTHER FUNDRAISING DIRECT EXPENSES 1,576

Schedule D (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization
NORTHERN PLAINS EYE FOUNDATION

Employer identification number

46-0367494

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

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

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

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










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

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2020

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 CASINO ROYALE (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	41,411	41,411
2	Less: Contributions . . . .	41,411	41,411
3	Gross income (line 1 minus line 2) . . . . . .

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .
7	Food and beverages . . .
8	Entertainment . . . .
9	Other direct expenses . . .	1,576	1,576
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		1,576
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		-1,576

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2020

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

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

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
NORTHERN PLAINS EYE FOUNDATION

Employer identification number
46-0367494

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2020

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance
(1) GIFT OF SIGHT	4	8,777	FMV	SURGERY FEE
(2) VISIONCARE	10	500	NEGOTIATED	EYE EXAM/GLASSE
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

SCHEDULE I, PAGE 1, PART I, LINE 2

NORTHERN PLAINS EYE FOUNDATION'S (NPEF) GIFT OF SIGHT PROGRAM AWARDS SIGHT-SAVING SURGERY TWICE ANNUALLY TO SELECTED APPLICANTS VIA A COMMITTEE OF EYE CARE PROFESSIONALS AND OTHER QUALIFIED INDIVIDUALS. APPLICANTS MUST BE REFERRED BY AN EYE DOCTOR IN THE GIFT OF SIGHT SERVICE REGION WHO VALIDATES EACH APPLICANT'S SURGICAL AND FINANCIAL NEED, WITH SURGERY TO BE PERFORMED BY A DOCTOR ALSO IN THE GIFT OF SIGHT SERVICE REGION (ADDRESSED IN THE APPLICATION PROCESS). ONCE THE GIFT OF SIGHT AWARD IS MADE AND THE DOCTOR PERFORMING THE SURGERY IS DETERMINED, NPEF, THE RECIPIENT AND DOCTOR COORDINATE WITH THE SURGICAL FACILITY TO SCHEDULE THE SURGERY. NPEF'S EXECUTIVE DIRECTOR REMAINS IN COMMUNICATION WITH ALL PARTIES INVOLVED (RECIPIENT, DOCTOR, SURGICAL FACILITY) AND COORDINATES WITH THE DOCTOR/SURGICAL FACILITY CONCERNING ESTIMATED EXPENSES, WHICH ARE NEGOTIATED AT A MEDICAID FEE STRUCTURE, AS WELL AS ANY OTHER ISSUES CONCERNED, UNTIL EACH SURGERY IS COMPLETED. FOLLOWING THE SURGERY, HEALTH INSURANCE CLAIM FORMS ARE SUBMITTED BY THE DOCTOR/SURGICAL FACILITY TO NPEF, WHERE THE PROCEDURES/FEES ARE REVIEWED AND PAYMENT PROVIDED TO THE DOCTOR/SURGICAL FACILITY. NPEF SCHEDULES A VISIT WITH BOTH THE DOCTOR AND RECIPIENT AT ONE OF THEIR APPOINTMENTS, TO MEET THE RECIPIENT AND PERSONALLY THANK THE DOCTOR AND IDEALLY CAPTURE PHOTOS. NORTHERN PLAINS EYE FOUNDATION'S (NPEF) NEW VISIONCARE PROGRAM PROVIDES A VOUCHER FOR A NO-COST EYE EXAM AND GLASSES TO UNDERSERVED INDIVIDUALS IN THE COMMUNITY. INDIVIDUALS IN NEED MUST MEET CERTAIN CRITERIA AND WORK IN CONJUNCTION WITH NPEF PROGRAM PARTNER, COMMUNITY HEALTH CENTER OF THE BLACK HILLS (CHCBH), WHO MAKES THE REFERRAL BASED ON SAID CRITERIA, ISSUES THE VOUCHER TO THE RECIPIENT, AND SCHEDULES AN APPOINTMENT WITH THE RECIPIENT FOR THE RECIPIENT TO BE SEEN BY ONE OF NPEF'S PARTNERING EYE CARE PROVIDERS. PARTNERING PROVIDERS HAVE AGREED TO PROVIDE AN EYE EXAM AND GLASSES TO THE VOUCHER RECIPIENT WITH NPEF REIMBURSING THE PROVIDER AT A REDUCED FEE OF 50 FOR THEIR SERVICES. INITIAL VOUCHER PAPER WORK IS COMPLETED BY CHCBH AND THE RECIPIENT; RECIPIENT THEN TAKES THE VOUCHER TO THE APPOINTMENT WITH THE PARTICIPATING EYE CARE PROVIDER. UPON COMPLETION OF THE EYE EXAM AND SIGN-OFF BY THE EYE CARE PROVIDER, AND THE RECIPIENT HAVING RECEIVED AND SIGNED FOR RECEIPT OF HIS/HER GLASSES, THE COMPLETED VOUCHER IS RETURNED TO NPEF BY THE EYE CARE PROVIDER. NPEF REVIEWS AND VERFIES VOUCHER COMPLETION AND SIGNATURES PRIOR TO PROVIDING THE 50 REIMBURSEMENT TO THE EYE CARE PROVIDER.

Schedule I (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

NORTHERN PLAINS EYE FOUNDATION

Employer identification number

46-0367494

Return Reference	Explanation
FORM 990, PAGE 2, PART III, LINE 4A	FOLLOWING A YEAR OF RESEARCH AND DEVELOPMENT, NORTHERN PLAINS EYE FOUNDATION (NPEF) LAUNCHED NORTHERN PLAINS EYE FOUNDATION WESTERN SOUTH DAKOTA LIONS CHILDREN'S VISION SCREENING INITIATIVE (CVSI) IN MAY 2012, SUPPORTED BY A STRATEGIC GROUP OF COLLABORATIVE PARTNERS INCLUDING AREA EYE CARE PROFESSIONALS AND LOCAL LIONS CLUBS. WHILE ONLY AN EYE CARE PROFESSIONAL CAN DIAGNOSE AND TREAT A VISION PROBLEM, VISION SCREENINGS IDENTIFY CHILDREN WITH UNDETECTED VISION PROBLEMS WHO ARE IN NEED OF A COMPLETE EYE EXAM. THROUGH CVSI, CHILDREN FROM 6 MONTHS OF AGE THROUGH 5TH GRADE ACROSS THE BLACK HILLS REGION HAVE ACCESS TO FREE VISION SCREENINGS. THE CVSI SCREENINGS ARE ADMINISTERED UTILIZING SPOT PHOTOSCREENING TECHNOLOGY, A NON-INVASIVE APPROACH TO OBTAIN COMPREHENSIVE, ACCURATE VISION SCREENING RESULTS, IN ORDER TO PROVIDE EARLY DETECTION OF POOR VISION OR RISK FACTORS BY WAY OF UNIFORM SCREENING PROCESSES THAT LEAD TO TIMELY DIAGNOSIS AND TREATMENT. CVSI VISION SCREENING RESULTS ARE PROVIDED TO PARENTS OF ALL CHILDREN SCREENED AND INDICATE EITHER NO ADDITIONAL FOLLOW-UP IS REQUIRED OR A COMPLETE EYE EXAM BY AN EYE CARE PROFESSIONAL IS RECOMMENDED. IN THE CASE OF CHILDREN RECOMMENDED FOR A COMPLETE EYE EXAM, ADDITIONAL INFORMATION IS PROVIDED ABOUT WHY THE CHILD IS BEING REFERRED TO AN EYE CARE PROFESSIONAL, THE MEANING OF EYE CONDITIONS IDENTIFIED ON THE SCREENING RESULT, AND A LIST OF EYE CARE PROFESSIONALS IN THE REGION. THOUGH SCREENING EVENTS WERE CANCELLED IN SPRING 2020 DUE TO COVID-19, AS OF MAY 2020, ALMOST 32,000 CVSI FREE VISION SCREENINGS HAVE BEEN ADMINISTERED SINCE PROGRAM INCEPTION. FROM THOSE, 3,681 CHILDREN (OVER 11%), WHOSE RESULTS IDENTIFIED POTENTIAL RISK FACTORS THAT INHIBIT PROPER VISION DEVELOPMENT, HAVE BEEN REFERRED FOR A COMPREHENSIVE EYE EXAM. WITH CVSI EARLY DETECTION, EFFECTIVE TREATMENT IS USUALLY POSSIBLE. IF LEFT UNTREATED, CHILDREN ARE AT RISK OF PERMANENT VISION LOSS, AFFECTING, AMONG OTHER THINGS, ISSUES SUCH AS CHILDHOOD DEVELOPMENT, ACADEMIC ACHIEVEMENT, AND HIGH SCHOOL DROP-OUT RATES. BEGINNING IN THE FALL OF 2014, NPEF WAS AFFORDED THE OPPORTUNITY TO ENGAGE A 4TH YEAR MEDICAL STUDENT AT THE UNIVERSITY OF SOUTH DAKOTA SANFORD SCHOOL OF MEDICINE AND A PARTNERING OPTOMETRIC INTERN FROM THE ILLINOIS COLLEGE OF OPTOMETRY IN A RESEARCH PROJECT RELATED TO NPEF'S CVSI. THE RESEARCH PROJECT CULMINATED IN THE PUBLICATION OF A MANUSCRIPT ENTITLED, "RESULTS OF A PEDIATRIC VISION SCREENING PROGRAM IN WESTERN SOUTH DAKOTA" IN THE MARCH 2015 EDITION OF SOUTH DAKOTA MEDICINE, THE SOUTH DAKOTA STATE MEDICAL ASSOCIATION MEDICAL JOURNAL. SINCE THAT TIME, NPEF CONTINUES TO ENGAGE MEDICAL STUDENTS AT THE UNIVERSITY OF SOUTH DAKOTA SANFORD SCHOOL OF MEDICINE IN ONGOING VOLUNTEER RESEARCH PROJECTS RELATED TO CVSI. SUBSEQUENT RESEARCH PROJECT PAPERS PUBLISHED IN SOUTH DAKOTA MEDICINE INCLUDE "CHILDHOOD VISION SCREENING IN WESTERN SOUTH DAKOTA: EXAMINING BARRIERS TO POST-VISION SCREENING FOLLOW-UP REFERRAL" IN JANUARY 2017, "AN EVALUATION OF SPOT SCREENING EFFICACY FOR CHILDREN IN SOUTH DAKOTA" IN MAY 2018, AND "A REVIEW OF CHILDHOOD VISION SCREENING LAWS AND PROGRAMS ACROSS THE UNITED STATES" IN JULY 2019. A FIFTH RESEARCH PROJECT WAS COMPLETED AND SUBMITTED FOR PUBLICATION IN THE JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS (JPOS), ENTITLED, "MULTI-CLINIC EVALUATION OF THE SPOT PHOTOSCREENER'S EFFICACY FOR DETECTING AMBLYOPIA RISK FACTORS AS COMPARED TO SAME-DAY OPTOMETRISTS' EXAMINATIONS IN 305 WESTERN SOUTH DAKOTA CHILDREN." THE MANUSCRIPT WAS REJECTED BY JPOS IN 2020, HOWEVER REVIEWER COMMENTS WERE PROVIDED AND, BASED ON THIS FEEDBACK, THE MANUSCRIPT IS UNDER RE-WRITE WITH PLANS TO RESUBMIT TO JPOS OR ANOTHER PEER REVIEW JOURNAL IN EARLY 2021.
FORM 990, PAGE 2, PART III, LINE 4B	GIFT OF SIGHT, A CHARITABLE PROGRAM LAUNCHED IN 2008 AS CHRISTMAS GIFT OF SIGHT, AWARDS SIGHT-SAVING SURGERY TO INDIVIDUALS WITHOUT THE FINANCIAL MEANS TO AFFORD THE NECESSARY CARE. IN 2015, NPEF EXPANDED ITS CHRISTMAS GIFT OF SIGHT PROGRAM FROM ANNUAL TO SEMI-ANNUAL SURGERY AWARDS, AND DUE TO THIS, IN 2017, RENAMED THE PROGRAM "GIFT OF SIGHT." IN 2018, THE GIFT OF SIGHT SERVICE AREA WAS EXPANDED FROM EYE CARE CLINICS AND THEIR PATIENTS IN THE BLACK HILLS, TO INCLUDE EYE CARE CLINICS AND THEIR PATIENTS LOCATED EAST OF RAPID CITY, IN THE MOBRIDGE, PIERRE, WINNER, AND CHADRON COMMUNITIES. SINCE ITS INCEPTION, NPEF AND ITS PROGRAM PARTNERS HAVE PROVIDED 85 SIGHT-SAVING SURGERIES THROUGH GIFT OF SIGHT, HELPING THOSE UNDERSERVED IN OUR COMMUNITY REGAIN THEIR VISION, AND MOST IMPORTANTLY, INDEPENDENCE, MOBILITY AND QUALITY OF LIFE.
FORM 990, PAGE 2, PART III, LINE 4D	1)RESEARCH, IN CONJUNCTION WITH CVSI AS DESCRIBED IN THE LAST PARAGRAPH OF 4A 2)NORTHERN PLAINS EYE FOUNDATION DR. PAUL L. ZIMMERMAN MEMORIAL SCHOLARSHIP ENDOWMENT ESTABLISHED WITH THE UNIVERSITY OF SOUTH DAKOTA FOUNDATION, AWARDS A SCHOLARSHIP TO A FOURTH YEAR UNIVERSITY OF SOUTH DAKOTA SANFORD SCHOOL OF MEDICINE STUDENT WITH EXPRESSED INTEREST IN OPHTHALMOLOGY 3)RESEARCH STUDY ON NEEDS ASSESSMENT OF LOCAL COMMUNITY-BASED EYE CARE, LAUNCHED IN OCTOBER 2020 WITH THE ASSISTANCE OF TWO USD SANFORD SCHOOL OF MEDICINE OPHTHALMOLOGY STUDENTS IN PARTNERSHIP WITH COMMUNITY HEALTH CENTER OF THE BLACK HILLS 4)SOUTH DAKOTA OPTOMETRIC SOCIETY EXHIBIT/SPONSORSHIP 5)NEWSLETTER 6)WORKPLACE VISION WELLNESS 7)RESOURCE CENTER FOR EYE-RELATED INFORMATION/NEEDS
FORM 990, PAGE 6, PART VI, LINE 11B	THE ANNUAL TAX FORM 990 IS PREPARED BY OUR CPA FIRM FROM INFORMATION PROVIDED BY MANAGEMENT. THE EXECUTIVE DIRECTOR, THE ASSOCIATE DIRECTOR, THE FINANCE COMMITTEE, AND EXECUTIVE COMMITTEE OF THE BOARD ARE PROVIDED COPIES OF THE FORM 990 DRAFT FOR REVIEW AND INPUT, PRIOR TO FILING. A COPY OF THE FORM IS ALSO DISTRIBUTED TO THE FULL BOARD PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 12C	THE ANNUAL PROCESS INCLUDES: 1.THE POLICY IS REVIEWED WITH ALL OFFICERS AND BOARD, COMMITTEE, AND STAFF MEMBERS. 2.ALL OFFICERS AND BOARD, COMMITTEE, AND STAFF MEMBERS COMPLETE THE INQUIRY FORM ANNUALLY, NOTING ANY CONFLICT OR POTENTIAL CONFLICT IN WRITING. 3.A SUMMARY OF ANY DISCLOSURES IS COMPILED AND FILED BY THE EXECUTIVE DIRECTOR. 4.THE EXECUTIVE DIRECTOR FORWARDS COPIES OF THE DISCLOSURE STATEMENTS TO THE BOARD CHAIRPERSON, WHO THEN CONFERS WITH LEGAL COUNSEL IF NECESSARY. 5.THE BOARD CHAIRPERSON THEN MAKES A FINAL DETERMINATION WHETHER ANY CONFLICTS ARE SUFFICIENTLY SERIOUS TO REQUIRE THE PERSON NO LONGER PARTICIPATES IN THE ROLE OF DIRECTOR, OFFICER, COMMITTEE MEMBER, ETC.
FORM 990, PAGE 6, PART VI, LINE 15A	THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE SALARY, RECOMMENDS ANY INCREASES, AND GIVES APPROVAL. DATA LOOKED AT INCLUDES EMPLOYEE'S EXPERIENCE LEVEL AND CREDENTIALS, ALONG WITH LOCAL COMPENSATION COMPARISONS AND WHAT IS HAPPENING ECONOMICALLY IN THE REGION. EXECUTIVE COMPENSATION IS APPROVED BY THE FINANCE COMMITTEE AND ULTIMATELY, THE BOARD OF DIRECTORS, AS PART OF THE ANNUAL BUDGET APPROVAL PROCESS.
FORM 990, PAGE 6, PART VI, LINE 15B	SAME PERSON AS ABOVE.
FORM 990, PAGE 6, PART VI, LINE 19	UPON REQUEST, IT WILL BE EVALUATED.
FORM 990, PART XI, LINE 9	OTHER DIRECT FUNDRAISING EXPENSES 1,576 OTHER FUNDRAISING DIRECT EXPENSES -1,576

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	101,786	90,055
9	Program service revenue (Part VIII, line 2g) .........		0
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	125,439	55,621
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-11,928	-1,367
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	215,297	144,309
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	10,325	10,777
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	189,732	192,036
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 48,009
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	89,935	87,629
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	289,992	290,442
19	Revenue less expenses. Subtract line 18 from line 12.......	-74,695	-146,133
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	2,983,697	3,154,887
21	Total liabilities (Part X, line 26).............	53,967	75,018
22	Net assets or fund balances. Subtract line 21 from line 20.....	2,929,730	3,079,869

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 44,490 including grants of $ ) (Revenue $ )
	FOLLOWING A YEAR OF RESEARCH AND DEVELOPMENT, NORTHERN PLAINS EYE FOUNDATION (NPEF) LAUNCHED NORTHERN PLAINS EYE FOUNDATION WESTERN SOUTH DAKOTA LIONS CHILDREN'S VISION SCREENING INITIATIVE (CVSI) IN MAY 2012, SUPPORTED BY A STRATEGIC GROUP OF COLLABORATIVE PARTNERS INCLUDING AREA EYE CARE PROFESSIONALS AND LOCAL LIONS CLUBS. WHILE ONLY AN EYE CARE PROFESSIONAL CAN DIAGNOSE AND TREAT A VISION PROBLEM, VISION SCREENINGS IDENTIFY CHILDREN WITH UNDETECTED VISION PROBLEMS WHO ARE IN NEED OF A COMPLETE EYE EXAM. THROUGH CVSI, CHILDREN FROM 6 MONTHS OF AGE THROUGH 5TH GRADE ACROSS THE BLACK HILLS REGION HAVE ACCESS TO FREE VISION SCREENINGS. THE CVSI SCREENINGS ARE ADMINISTERED UTILIZING SPOT PHOTOSCREENING TECHNOLOGY, A NON-INVASIVE APPROACH TO OBTAIN COMPREHENSIVE, ACCURATE VISION SCREENING RESULTS, IN ORDER TO PROVIDE EARLY DETECTION OF POOR VISION OR RISK FACTORS BY WAY OF UNIFORM SCREENING PROCESSES THAT LEAD TO TIMELY DIAGNOSIS AND TREATMENT. CVSI VISION SCREENING RESULTS ARE PROVIDED TO PARENTS OF ALL CHILDREN SCREENED AND INDICATE EITHER NO ADDITIONAL FOLLOW-UP IS REQUIRED OR A COMPLETE EYE EXAM BY AN EYE CARE PROFESSIONAL IS RECOMMENDED. IN THE CASE OF CHILDREN RECOMMENDED FOR A COMPLETE EYE EXAM, ADDITIONAL INFORMATION IS PROVIDED ABOUT WHY THE CHILD IS BEING REFERRED TO AN EYE CARE PROFESSIONAL, THE MEANING OF EYE CONDITIONS IDENTIFIED ON THE SCREENING RESULT, AND A LIST OF EYE CARE PROFESSIONALS IN THE REGION. THOUGH SCREENING EVENTS WERE CANCELLED IN SPRING 2020 DUE TO COVID-19, AS OF MAY 2020, ALMOST 32,000 CVSI FREE VISION SCREENINGS HAVE BEEN ADMINISTERED SINCE PROGRAM INCEPTION. FROM THOSE, 3,681 CHILDREN (OVER 11%), WHOSE RESULTS IDENTIFIED POTENTIAL RISK FACTORS THAT INHIBIT PROPER VISION DEVELOPMENT, HAVE BEEN REFERRED FOR A COMPREHENSIVE EYE EXAM. WITH CVSI EARLY DETECTION, EFFECTIVE TREATMENT IS USUALLY POSSIBLE. IF LEFT UNTREATED, CHILDREN ARE AT RISK OF PERMANENT VISION LOSS, AFFECTING, AMONG OTHER THINGS, ISSUES SUCH AS CHILDHOOD DEVELOPMENT, ACADEMIC ACHIEVEMENT, AND HIGH SCHOOL DROP-OUT RATES. BEGINNING IN THE FALL OF 2014, NPEF WAS AFFORDED THE OPPORTUNITY TO ENGAGE A 4TH YEAR MEDICAL STUDENT AT THE UNIVERSITY OF SOUTH DAKOTA SANFORD SCHOOL OF MEDICINE AND A PARTNERING OPTOMETRIC INTERN FROM THE ILLINOIS COLLEGE OF OPTOMETRY IN A RESEARCH PROJECT RELATED TO NPEF'S CVSI. THE RESEARCH PROJECT CULMINATED IN THE PUBLICATION OF A MANUSCRIPT ENTITLED, "RESULTS OF A PEDIATRIC VISION SCREENING PROGRAM IN WESTERN SOUTH DAKOTA" IN THE MARCH 2015 EDITION OF SOUTH DAKOTA MEDICINE, THE SOUTH DAKOTA STATE MEDICAL ASSOCIATION MEDICAL JOURNAL. SINCE THAT TIME, NPEF CONTINUES TO ENGAGE MEDICAL STUDENTS AT THE UNIVERSITY OF SOUTH DAKOTA SANFORD SCHOOL OF MEDICINE IN ONGOING VOLUNTEER RESEARCH PROJECTS RELATED TO CVSI. SUBSEQUENT RESEARCH PROJECT PAPERS PUBLISHED IN SOUTH DAKOTA MEDICINE INCLUDE "CHILDHOOD VISION SCREENING IN WESTERN SOUTH DAKOTA: EXAMINING BARRIERS TO POST-VISION SCREENING FOLLOW-UP REFERRAL" IN JANUARY 2017, "AN EVALUATION OF SPOT SCREENING EFFICACY FOR CHILDREN IN SOUTH DAKOTA" IN MAY 2018, AND "A REVIEW OF CHILDHOOD VISION SCREENING LAWS AND PROGRAMS ACROSS THE UNITED STATES" IN JULY 2019. A FIFTH RESEARCH PROJECT WAS COMPLETED AND SUBMITTED FOR PUBLICATION IN THE JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS (JPOS), ENTITLED, "MULTI-CLINIC EVALUATION OF THE SPOT PHOTOSCREENER'S EFFICACY FOR DETECTING AMBLYOPIA RISK FACTORS AS COMPARED TO SAME-DAY OPTOMETRISTS' EXAMINATIONS IN 305 WESTERN SOUTH DAKOTA CHILDREN." THE MANUSCRIPT WAS REJECTED BY JPOS IN 2020, HOWEVER REVIEWER COMMENTS WERE PROVIDED AND, BASED ON THIS FEEDBACK, THE MANUSCRIPT IS UNDER RE-WRITE WITH PLANS TO RESUBMIT TO JPOS OR ANOTHER PEER REVIEW JOURNAL IN EARLY 2021.

4b	(Code: ) (Expenses $ 26,857 including grants of $ 8,777 ) (Revenue $ )
	GIFT OF SIGHT, A CHARITABLE PROGRAM LAUNCHED IN 2008 AS CHRISTMAS GIFT OF SIGHT, AWARDS SIGHT-SAVING SURGERY TO INDIVIDUALS WITHOUT THE FINANCIAL MEANS TO AFFORD THE NECESSARY CARE. IN 2015, NPEF EXPANDED ITS CHRISTMAS GIFT OF SIGHT PROGRAM FROM ANNUAL TO SEMI-ANNUAL SURGERY AWARDS, AND DUE TO THIS, IN 2017, RENAMED THE PROGRAM "GIFT OF SIGHT." IN 2018, THE GIFT OF SIGHT SERVICE AREA WAS EXPANDED FROM EYE CARE CLINICS AND THEIR PATIENTS IN THE BLACK HILLS, TO INCLUDE EYE CARE CLINICS AND THEIR PATIENTS LOCATED EAST OF RAPID CITY, IN THE MOBRIDGE, PIERRE, WINNER, AND CHADRON COMMUNITIES. SINCE ITS INCEPTION, NPEF AND ITS PROGRAM PARTNERS HAVE PROVIDED 85 SIGHT-SAVING SURGERIES THROUGH GIFT OF SIGHT, HELPING THOSE UNDERSERVED IN OUR COMMUNITY REGAIN THEIR VISION, AND MOST IMPORTANTLY, INDEPENDENCE, MOBILITY AND QUALITY OF LIFE.

4c	(Code: ) (Expenses $ 31,719 including grants of $ 500 ) (Revenue $ )
	OUR NEWEST PROGRAM, VISIONCARE, FOR WHICH THE PILOT LAUNCHED AT THE END OF 2019, FOCUSES ON GIVING ACCESS TO NO-COST EYE EXAMS AND GLASSES, CRITICAL TO ONE'S OVERALL HEALTH AND WELLBEING, TO PEOPLE WITH NO OTHER OPTION FOR CARE, PROVIDING A SIMPLE BUT POWERFUL PATH TO HELPING PEOPLE SEE BETTER TO LIVE BETTER. SEE SCHEDULE I PART IV FOR MORE INFORMATION.

	(Code: ) (Expenses $ 29,374 including grants of $ ) (Revenue $ )
	1)RESEARCH, IN CONJUNCTION WITH CVSI AS DESCRIBED IN THE LAST PARAGRAPH OF 4A 2)NORTHERN PLAINS EYE FOUNDATION DR. PAUL L. ZIMMERMAN MEMORIAL SCHOLARSHIP ENDOWMENT ESTABLISHED WITH THE UNIVERSITY OF SOUTH DAKOTA FOUNDATION, AWARDS A SCHOLARSHIP TO A FOURTH YEAR UNIVERSITY OF SOUTH DAKOTA SANFORD SCHOOL OF MEDICINE STUDENT WITH EXPRESSED INTEREST IN OPHTHALMOLOGY 3)RESEARCH STUDY ON NEEDS ASSESSMENT OF LOCAL COMMUNITY-BASED EYE CARE, LAUNCHED IN OCTOBER 2020 WITH THE ASSISTANCE OF TWO USD SANFORD SCHOOL OF MEDICINE OPHTHALMOLOGY STUDENTS IN PARTNERSHIP WITH COMMUNITY HEALTH CENTER OF THE BLACK HILLS 4)SOUTH DAKOTA OPTOMETRIC SOCIETY EXHIBIT/SPONSORSHIP 5)NEWSLETTER 6)WORKPLACE VISION WELLNESS 7)RESOURCE CENTER FOR EYE-RELATED INFORMATION/NEEDS

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 29,374 including grants of $ ) (Revenue $ )
4e	Total program service expenses132,440

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization

		Business Code
2a
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....

1	Briefly describe the organization’s mission or most significant activities: TO PROTECT AND PRESERVE VISION AND RESTORE SIGHT FOR PEOPLE OF THE NORTHERN PLAINS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	16
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	16
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	4
6	Total number of volunteers (estimate if necessary) .............	6	75
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	83,762	5,584

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	41,411
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	48,644

g	Noncash contributions included in lines 1a - 1f:$		1g	316

h Total. Add lines 1a-1f.......		90,055

3 Investment income (including dividends, interest, and othersimilar amounts) ......			22,377			22,377
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		1,435,429	7a
b	Less: cost or other basis and sales expenses		1,402,185	7b
c	Gain or (loss)		33,244	7c
d	Net gain or (loss).........			33,244	33,244
8a	Gross income from fundraising events (not including $ 41,411of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b	1,576
c	Net income or (loss) from fundraising events..			-1,576			-1,576
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MISCELLANEOUS		900099	209			209
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			209
12	Total revenue. See instructions.....			144,309	33,244		21,010

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,500	1,500
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	9,277	9,277
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	83,761	54,445	12,564	16,752
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	83,799	21,053	52,668	10,078
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	10,585	4,234	4,763	1,588
9	Other employee benefits .......	1,116	447	502	167
10	Payroll taxes ...........	12,775	5,110	5,749	1,916
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........	13,179		6,590	6,589
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	7,230	3,788	2,082	1,360
12	Advertising and promotion ....	2,720	2,625	71	24
13	Office expenses .......	15,026	9,211	3,569	2,246
14	Information technology ......	12,102	4,840	5,446	1,816
15	Royalties ..
16	Occupancy ...........	26,164	10,857	11,481	3,826
17	Travel ............	667	596	53	18
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	1,169	620	412	137
20	Interest ...........	62	25	28	9
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	3,049	1,220	1,372	457
23	Insurance ...	4,694	2,037	1,993	664
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	DUES AND SUBSCRIPTIONS	905	362	407	136
b	MISCELLANEOUS	662	193	243	226
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	290,442	132,440	109,993	48,009
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			26,290	1	33,506
2	Savings and temporary cash investments .........			255,571	2	201,991
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............				4
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............				8
9	Prepaid expenses and deferred charges ......			1,538	9	816
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	89,714
b	Less: accumulated depreciation	10b	79,643	13,359	10c	10,071
11	Investments—publicly traded securities .			2,681,948	11	2,905,488
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			4,991	15	3,015
16	Total assets. Add lines 1 through 15 (must equal line 33)...			2,983,697	16	3,154,887

17	Accounts payable and accrued expenses .....	53,967	17	75,018
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D		25
26	Total liabilities. Add lines 17 through 25..	53,967	26	75,018

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	1,043,139	27	994,688
28	Net assets with donor restrictions ...........	1,886,591	28	2,085,181
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	2,929,730	32	3,079,869
33	Total liabilities and net assets/fund balances ........	2,983,697	33	3,154,887