| Person Name | Explanation |
|---|---|
| Sarah H Berghorst | *SARAH H BERGHORST, VP/DIRECTOR OF THE BERGHORST FOUNDATION INC., IS THE SOLE OWNER OF AUGUST IMPACT PARTNERS, A DISQUALIFIED PERSON WHICH PROVIDES PHILANTHROPIC CONSULTING SERVICES TO THE FOUNDATION. DURING THE TAXABLE YEAR ENDING DECEMBER 31, 2020, THE FOUNDATION PAID $10,000 FOR PHILANTHROPIC CONSULTING SERVICES RENDERED BY SUCH DISQUALIFIED PERSON AS REPORTED IN FORM 990-PF, PART I, LINE 16C. SUCH FIRM BILLED THE FOUNDATION AT OR BELOW THE RATE IT CHARGES ITS OTHER CLIENTS. |
| Description of Property | Date Acquired | Cost or Other Basis | Prior Years' Depreciation | Computation Method | Rate / Life (# of years) |
Current Year's Depreciation Expense | Net Investment Income | Adjusted Net Income | Cost of Goods Sold Not Included |
|---|
| Identifier | Return Reference | Explanation |
|---|---|---|
| FORM 990-PF, PARTS I AND XV: | FORM 990-PF, PARTS I AND XV: | TOTAL Part I, Line 25, Column (a) and Part XV, Line 3a: $347,183 Less amount counted as a qualifying distribution on Part XII, Line 2: $550 TOTAL Part I, Line 25, Column (d): $346,633 |
| IN-KIND GRANTS | PART I LINE 25 AND PART XV LINE 3A | DISTRIBUTIONS OF PROPERTY VALUE AT FAIR MARKET VALUE AT DATE OF DISTRIBUTION METHOD FOR DETERMINING VALUE OF FACE SHIELDS: ADJUSTED PURCHASE PRICE TOTAL FAIR MARKET VALUE OF PROPERTY: $550 TOTAL BOOK VALUE OF PROPERTY: $534 TOTAL AMOUNT OF GRANTS: $550 FORM 990-PF, PART III, LINE 3 - OTHER INCREASES: $16 DETAILS OF ITEMS GRANTED: DESCRIPTION OF PROPERTY: FACE SHIELDS UNITS: 500 DATE OF DISTRIBUTION: 12/03/2020 GRANT RECIPIENT: MATTHEWS FREE MEDICAL CLINIC FMV OF PROPERTY: $550 BOOK VALUE OF PROPERTY: $534 TOTAL AMOUNT OF GRANT: $550 |
| Name of Stock | End of Year Book Value | End of Year Fair Market Value |
|---|---|---|
| AMERICAN TOWER REIT INC | 20,285 | 155,326 |
| APPLE INC | 2,067,316 | 6,908,372 |
| BMY CONTINGENT VALUE RIGHTS | 27,123 | 8,788 |
| BRISTOL-MYERS SQUIBB CO | 711,831 | 789,890 |
| ENDOLOGIX INC | 61,163 | |
| JOHNSON & JOHNSON | 80,584 | 235,283 |
| QUALCOMM INC | 90,863 | 323,723 |
| Description | Beginning of Year - Book Value | End of Year - Book Value | End of Year - Fair Market Value |
|---|---|---|---|
| FACE SHIELDS | 9,835 | 10,120 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| Administrative Fees | 21,041 | 21,041 | ||
| State or Local Filing Fees | 25 | 25 |
| Description | Amount |
|---|---|
| FMV ADJ FOR FACE SHIELDS GRANT | 16 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| Philanthropic Consulting Srvcs | 10,000 | 10,000 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| 990-PF Estimated Tax for 2020 | 1,200 | |||
| 990-PF Excise Tax for 2019 | 9,415 |