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: INVESTMENT INCOME. AMOUNT: 10. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: METRO ROTARY COUNCIL. GRANTEE ADDRESS: 1890 COUNTY HOME ROAD MARION, IA 52302. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 08/26/20. AMOUNT GIVEN: 14,400. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: TOGETHER WE ACHIEVE. GRANTEE ADDRESS: 1150 27TH AVE SE CEDAR RAPIDS, IA 52404. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 06/13/21. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: TANAGER PLACE. GRANTEE ADDRESS: 2309 C ST SW CEDAR RAPIDS, IA 52404. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 06/08/21. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: SAINT LUKE'S HOSPITAL. GRANTEE ADDRESS: 1026 A AVE NE CEDAR RAPIDS, IA 52402. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 06/08/21. AMOUNT GIVEN: 1,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: HACAP. GRANTEE ADDRESS: 1515 HAWKEYE DRIVE HIAWATHA, IA 52233. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 09/08/20. AMOUNT GIVEN: 10,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: ROTARY FOUNDATION INTERNATIONAL GRANT. GRANTEE ADDRESS: 1560 SHERMAN AVE EVANSTON, IL 60201-3698. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 04/29/21. AMOUNT GIVEN: 7,600. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: ROTARY PRIBYL GOLF. GRANTEE ADDRESS: 590 W FOREVERGREEN RD NORTH LIBERTY, IA 52317. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 06/08/21. AMOUNT GIVEN: 768. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: GEMS OF HOPE. GRANTEE ADDRESS: 420 6TH ST SE #140 CEDAR RAPIDS, IA 52401. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 06/08/21. AMOUNT GIVEN: 300. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: MERCY HOSPITAL. GRANTEE ADDRESS: 701 10TH ST SE CEDAR RAPIDS, IA 52403. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 06/08/21. AMOUNT GIVEN: 1,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: EASTERN IOWA ARTS ACADEMY. GRANTEE ADDRESS: 1841 E AVE NE CEDAR RAPIDS, IA 52402. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 06/08/21. AMOUNT GIVEN: 100. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: AFRICAN AMERICAN MUSEUM. GRANTEE ADDRESS: 55 12TH AVE SE CEDAR RAPIDS, IA 52401. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 06/08/21. AMOUNT GIVEN: 100. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: ACADEMY OF SCHOLASTICS AND PERSONAL SUCCESS. GRANTEE ADDRESS: PO BOX 2842 CEDAR RAPIDS, IA 52406. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 06/08/21. AMOUNT GIVEN: 100. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: WAYPOINT FAMILY SERVICES. GRANTEE ADDRESS: 318 5TH ST SE CEDAR RAPIDS, IA 52401. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 06/08/21. AMOUNT GIVEN: 100. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: FOR NEEDS OF CHARITY. GRANTEE NAME: IOWA MUSIC & ARTS ASSOICATION. GRANTEE ADDRESS: PO BOX 2758 CEDAR RAPIDS, IA 52406. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 06/08/21. AMOUNT GIVEN: 100. TOTAL INCLUDED ON FORM 990-EZ, LINE 10: 36,568. |
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: DISTRICT AND INTERNATIONAL DUES. AMOUNT: 33,084. DESCRIPTION: PROGRAM COSTS. AMOUNT: 6,077. DESCRIPTION: OTHER MEMBERSHIP EXPENSES. AMOUNT: 2,736. DESCRIPTION: BANK FEES. AMOUNT: 3,527. DESCRIPTION: CLUB RUNNER. AMOUNT: 1,320. DESCRIPTION: INSURANCE. AMOUNT: 928. DESCRIPTION: PAYROLL TAXES. AMOUNT: 2,184. DESCRIPTION: WAGES. AMOUNT: 28,000. TOTAL TO FORM 990-EZ, LINE 16: 77,856. |
| FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS | DESCRIPTION: UNDEPOSITED FUNDS. BEG. OF YEAR AMOUNT: 463. END OF YEAR AMOUNT: 0. |
| FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES | DESCRIPTION: DUE TO ROTARY FOUNDATION. BEG. OF YEAR AMOUNT: 621. END OF YEAR AMOUNT: 1,200. DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 4,168. END OF YEAR AMOUNT: 475. |
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