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 |
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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.") .. | ||||||
| 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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 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.") . | 70,000 | 182,449 | 252,449 | |||
| 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 | 48,546 | 48,546 | ||||
| 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 | 118,546 | 182,449 | 300,995 | |||
| 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. | 24,000 | 20,000 | 44,000 | |||
| c | Add lines 7a and 7b.. | 24,000 | 20,000 | 44,000 | |||
| 8 | Public support. (Subtract line 7c from line 6.) | 256,995 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 118,546 | 182,449 | 300,995 | |||
| 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.).. | 118,546 | 182,449 | 300,995 | |||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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 | ||||
| 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. |
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| 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. |
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|
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. |
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|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
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| 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..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| 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 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: BOBS HOUSE FOR DOGS. GRANTEE ADDRESS: P.O. BOX 15 EAU CLAIRE, WI 54702. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: BOYS & GIRLS CLUBS OF THE GCV. GRANTEE ADDRESS: 1005 OXFORD AVENUE EAU CLAIRE, WI 54703. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: CHILDRENS MUSEUM OF EAU CLAIRE. GRANTEE ADDRESS: 220 S BARSTOW STREET EAU CLAIRE, WI 54701. AMOUNT GIVEN: 9,483. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: CHIPPEWA HUMANE ASSOCIATION. GRANTEE ADDRESS: P.O. BOX 562 CHIPPEWA FALLS, WI 54729. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: CHIPPEWA VALLEY FREE CLINIC. GRANTEE ADDRESS: 1030 OAK RIDGE DRIVE EAU CLAIRE, WI 54701. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: CHIPPEWA VALLEY MUSEUM. GRANTEE ADDRESS: 1204 E HALF MOON DRIVE EAU CLAIRE, WI 54703. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: CHIPPEWA VALLEY THEATRE GUILD. GRANTEE ADDRESS: 102 W GRAND AVENUE EAU CLAIRE, WI 54703. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: EAU CLAIRE COUNTY HUMANE ASSOCIATION. GRANTEE ADDRESS: 3900 OLD TOWN HALL ROAD EAU CLAIRE, WI 54701. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: FAMILY PROMISE OF THE CHIPPEWA VALLEY. GRANTEE ADDRESS: 309 E LAKE STREET EAU CLAIRE, WI 54701. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: FAMILY RESOURCE CENTER. GRANTEE ADDRESS: 4800 GOLF ROAD SUITE, 450 #61 EAU CLAIRE, WI 54701. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: FAMILY SUPPORT CENTER. GRANTEE ADDRESS: 403 N HIGH STREET CHIPPEWA FALLS, WI 54729. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: FIERCE FREEDOM. GRANTEE ADDRESS: 2519 NORTH HILLCREST PARKWAY, SUITE 200 ALTOONA, WI 54720. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: GIRL SCOUTS OF NORTHWESTERN GREAT LAKES. GRANTEE ADDRESS: 4693 N LYNNDALE DRIVE APPLETON, WI 54913. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: JUNIOR ACHIEVEMENT OF WISCONSIN - NORTHWEST AND GRANTEE NAME: JUNIOR ACHIEVEMENT OF WISCONSIN - NORTHWEST AND. GRANTEE ADDRESS: 2004 HIGHLAND AVENUE, SUITE 2C EAU CLAIRE, WI 54701. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: CONFLUENCE COUNCIL INC. GRANTEE ADDRESS: 128 GRAHAM AVENUE EAU CLAIRE, WI 54701. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: SCULPTURE TOUR EAU CLAIRE. GRANTEE ADDRESS: P.O. BOX 1411 EAU CLAIRE, WI 54702. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: THE COMMUNITY TABLE. GRANTEE ADDRESS: 320 PUTNAM STREET EAU CLAIRE, WI 54703. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: UCP WESTERN WISCONSIN. GRANTEE ADDRESS: 2153 EASTRIDGE CENTER STREET EAU CLAIRE, WI 54701. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: YMCA OF THE CHIPPEWA VALLEY. GRANTEE ADDRESS: 700 GRAHAM AVENUE EAU CLAIRE, WI 54701. AMOUNT GIVEN: 9,484. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: GRANT PAID. GRANTEE NAME: VISIT EAU CLAIRE. GRANTEE ADDRESS: 128 GRAHAM AVENUE, SUITE 234 EAU CLAIRE, WI 54701. AMOUNT GIVEN: 2,000. TOTAL INCLUDED ON FORM 990-EZ, LINE 10: 182,195. |
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: MISCELLANOUS EXPENSES. AMOUNT: 240. |
| Software ID: | |
| Software Version: |