Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
right arrowDo not enter social security numbers on this form as it may be made public.
right arrowGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
For calendar year 2023, or tax year beginning 01-01-2023 , and ending 12-31-2023
Name of foundation
ROSEMARY L & JOHN P MORTENSEN FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)1967 EAST TELEMARK CIRCLE
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
GREEN BAY, WI54313
A Employer identification number

85-6781091
B Telephone number (see instructions)

(920) 425-9805
C right arrow
G Check all that apply:

D 1. Foreign organizations, check here............. right arrow
2. Foreign organizations meeting the 85%
test, check here and attach computation ... right arrow
E right arrow
H Check type of organization:
F right arrow
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)right arrow$4,556,883J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check right arrow.............
3 Interest on savings and temporary cash investments 1,442 1,442  
4 Dividends and interest from securities... 55,697 55,697  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 318,943
b Gross sales price for all assets on line 6a 1,941,651
7 Capital gain net income (from Part IV, line 2)... 318,943
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 376,082 376,082  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0   0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment
List of Attached Documents:
// Content
3,780 1,890   1,890
c Other professional fees (attach schedule)....        
17 Interest............... 3,679 0   0
18 Taxes (attach schedule) (see instructions)... Click to see attachment
List of Attached Documents:
// Content
30,618 0   0
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 38,077 1,890   1,890
25 Contributions, gifts, grants paid....... 96,244 96,244
26 Total expenses and disbursements. Add lines 24 and 25 134,321 1,890   98,134
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 241,761
b Net investment income (if negative, enter -0-) 374,192
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2023)
Form 990-PF (2023)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............. 2,006,276 62,852 62,852
2 Savings and temporary cash investments.........      
3 Accounts receivable right arrow  
Less: allowance for doubtful accounts right arrow        
4 Pledges receivable right arrow  
Less: allowance for doubtful accounts right arrow        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) right arrow  
Less: allowance for doubtful accounts right arrow        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)....... 1,414,586 Click to see attachment
List of Attached Documents:
// Content
3,025,639 		4,494,031
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
15 Other assets (describe right arrow)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 3,420,862 3,088,491 4,556,883
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe right arrow)    
23 Total liabilities (add lines 17 through 22)......... 0 0
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here right arrow
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions...........    
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here right arrow
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........ 0 0
27 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
28 Retained earnings, accumulated income, endowment, or other funds 3,420,862 3,088,491
29 Total net assets or fund balances (see instructions)..... 3,420,862 3,088,491
30 Total liabilities and net assets/fund balances (see instructions). 3,420,862 3,088,491
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............
1
3,420,862
2
Enter amount from Part I, line 27a .....................
2
241,761
3
Other increases not included in line 2 (itemize) right arrow
3
0
4
Add lines 1, 2, and 3 ..........................
4
3,662,623
5
Decreases not included in line 2 (itemize) right arrowClick to see attachment
List of Attached Documents:
// Content
5
574,132
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
3,088,491
Form 990-PF (2023)
Form 990-PF (2023)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)		 (b)
How acquired
P—Purchase
D—Donation 		(c)
Date acquired
(mo., day, yr.) 		(d)
Date sold
(mo., day, yr.)
1 a PUBLICLY TRADED SECURITIES P    
b
c
d
e
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a 1,941,651   1,622,708 318,943
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a       318,943
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 318,943
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here right arrow and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions) 1 5,201
b All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 5,201
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 5,201
6 Credits/Payments:
a 2023 estimated tax payments and 2022 overpayment credited to 2023 6a 21,680
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld .......... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 21,680
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 54
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......right arrow 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...right arrow 10 16,425
11 Enter the amount of line 10 to be: Credited to 2024 estimated taxright arrow16,425 Refundedright arrow 11 0
Form 990-PF (2023)
Form 990-PF (2023)
Page 4
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. right arrow$ 0(2) On foundation managers.right arrow$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.right arrow$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
round bullet By language in the governing instrument, or
round bullet By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument? ................
6
Yes
 
7
Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
and Part XIV..................................
7
Yes
 
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
right arrowWI
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
8b
Yes
 
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2023 or the taxable year beginning in 2023? See the instructions for Part XIII.
If "Yes," complete Part XIII .............................
9
 
No
10
Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
and addresses. ...............................
10
 
No
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
11
 
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions.................
12
 
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
 
Website addressright arrowN/A
14
The books are in care ofright arrowJASON J KOHOUT Telephone no.right arrow (414) 319-7053

Located atright arrow1967 EAST TELEMARK CIRCLEGREEN BAYWI ZIP+4right arrow54313
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........right arrow
and enter the amount of tax-exempt interest received or accrued during the year ........right arrow
15
 
16 At any time during calendar year 2023, did the foundation have an interest in or a signature or other authority over YesNo
a bank, securities, or other financial account in a foreign country? .................
16   No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country right arrow
Form 990-PF (2023)
Form 990-PF (2023)
Page 5
Part VI-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........
1a(1)
 
No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person? ..............................
1a(2)
 
No
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
1a(3)
 
No
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
1a(4)
 
No
(5) Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)? ......................
1a(5)
 
No
(6) Agree to pay money or property to a government official? (Exception. Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.) ...............
1a(6)
 
No
b
If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........
1b
 
 
c
Organizations relying on a current notice regarding disaster assistance check here ........right arrow
d
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2023? .............
1d
 
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2023, did the foundation have any undistributed income (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2023?....................
2a
 
No
If "Yes," list the years right arrow20, 20, 20, 20
b
Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to all years listed, answer "No" and attach statement—see instructions.) ..............
2b
 
 
c
If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
right arrow20, 20, 20, 20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year? ..............................
3a
 
No
b
If "Yes," did it have excess business holdings in 2023 as a result of (1) any purchase by the foundation
or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2023.) .....................
3b
 
 
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
 
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2023? ..
4b
 
No
Form 990-PF (2023)
Form 990-PF (2023)
Page 6
Part VI-B
Statements Regarding Activities for Which Form 4720 May Be Required (continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
5a(1)
 
No
(2) Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive? ....................
5a(2)
 
No
(3) Provide a grant to an individual for travel, study, or other similar purposes? .............
5a(3)
 
No
(4) Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions ........................
5a(4)
 
No
(5) Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals? .............
5a(5)
 
No
b
If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........
5b
 
 
c
Organizations relying on a current notice regarding disaster assistance check .........right arrow
d
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant? .................
5d
 
 
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract? .............................
6a
 
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
6b
 
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
7a
 
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....
7b
 
 
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year? .........................
8
 
No
Part VII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a) Name and address (b) Title, and average
hours per week
devoted to position 		(c) Compensation
 (If not paid, enter
-0-) 		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
other allowances
JOHN MORTENSEN PRESIDENT
1.00 		0 0 0
1967 EAST TELEMARK CIRCLE
GREEN BAY,WI54313
ROSEMARY MORTENSEN VICE PRESIDENT
1.00 		0 0 0
1967 EAST TELEMARK CIRCLE
GREEN BAY,WI54313
2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a) Name and address of each employee paid more than $50,000 (b) Title, and average
hours per week
devoted to position 		(c) Compensation (d) Contributions to
employee benefit
plans and deferred
compensation 		(e) Expense account,
other allowances
NONE
Total number of other employees paid over $50,000...................right arrow 0
Form 990-PF (2023)
Form 990-PF (2023)
Page 7
Part VII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors (continued)
3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
NONE
Total number of others receiving over $50,000 for professional services.............right arrow0
Part VIII-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
1  
2  
3  
4  
Part VIII-B
Summary of Program-Related Investments (see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
1  
2  
All other program-related investments. See instructions.
3  
Total. Add lines 1 through 3.........................right arrow0
Form 990-PF (2023)
Form 990-PF (2023)
Page 8
Part IX
Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities...................
1a
3,264,274
b
Average of monthly cash balances.......................
1b
242,791
c
Fair market value of all other assets (see instructions)................
1c
0
d
Total (add lines 1a, b, and c).........................
1d
3,507,065
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation) .............
1e
0
2
Acquisition indebtedness applicable to line 1 assets..................
2
0
3
Subtract line 2 from line 1d.........................
3
3,507,065
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
52,606
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
3,454,459
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
172,723
Part X
Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
1
Minimum investment return from Part IX, line 6..................
1
172,723
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
5,201
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
 
c
Add lines 2a and 2b............................
2c
5,201
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
167,522
4
Recoveries of amounts treated as qualifying distributions................
4
0
5
Add lines 3 and 4............................
5
167,522
6
Deduction from distributable amount (see instructions).................
6
0
7
Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
7
167,522
Part XI
Qualifying Distributions (see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
1a
98,134
b
Program-related investments—total from Part VIII-B..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes...............................
2
 
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)....................
3a
 
b
Cash distribution test (attach the required schedule) .................
3b
 
4
Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4. .......
4
98,134
Form 990-PF (2023)
Form 990-PF (2023)
Page 9
Part XII
Undistributed Income (see instructions)
(a)
Corpus 		(b)
Years prior to 2022 		(c)
2022 		(d)
2023
1 Distributable amount for 2023 from Part X, line 7 167,522
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2022 only....... 35,532
b Total for prior years:20 , 20, 20 0
3 Excess distributions carryover, if any, to 2022:
a From 2018......  
b From 2019......  
c From 2020......  
d From 2021......  
e From 2022......  
f Total of lines 3a through e ........ 0
4Qualifying distributions for 2023 from Part
XI, line 4: right arrow$ 98,134
a Applied to 2022, but not more than line 2a 35,532
b Applied to undistributed income of prior years
(Election required—see instructions)..... 		0
c Treated as distributions out of corpus (Election
required—see instructions)........ 		0
d Applied to 2023 distributable amount..... 62,602
e Remaining amount distributed out of corpus 0
5 Excess distributions carryover applied to 2023. 0 0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6Enter the net total of each column as
indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
b Prior years’ undistributed income. Subtract
line 4b from line 2b .......... 		0
c Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed...... 		0
d Subtract line 6c from line 6b. Taxable amount
—see instructions ........... 		0
e Undistributed income for 2022. Subtract line
4a from line 2a. Taxable amount—see
instructions ............. 		0
f Undistributed income for 2023. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2024 .......... 		104,920
7 Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions) ....... 		0
8 Excess distributions carryover from 2018 not
applied on line 5 or line 7 (see instructions) ... 		0
9 Excess distributions carryover to 2024.
Subtract lines 7 and 8 from line 6a ...... 		0
10 Analysis of line 9:
a Excess from 2019....  
b Excess from 2020....  
c Excess from 2021....  
d Excess from 2022....  
e Excess from 2023....  
Form 990-PF (2023)
Form 990-PF (2023)
Page 10
Part XIII
Private Operating Foundations (see instructions and Part VI-A, question 9)
1a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2023, enter the date of the ruling ...... right arrow
 
b Check box to indicate whether the organization is a private operating foundation described in section or
2a Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part IX for each
year listed .......... 		Tax year Prior 3 years (e) Total
(a) 2023 (b) 2022 (c) 2021 (d) 2020
         
b 85% (0.85) of line 2a .........          
c Qualifying distributions from Part XI,
line 4 for each year listed ..... 		         
d Amounts included in line 2c not used directly
for active conduct of exempt activities .......... 		         
e Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c .... 		         
3 Complete 3a, b, or c for the
alternative test relied upon:
a “Assets" alternative test—enter:
(1) Value of all assets ......          
(2) Value of assets qualifying
under section 4942(j)(3)(B)(i)		          
b “Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part IX, line 6 for each year listed .. 		         
c “Support" alternative test—enter:
(1) Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties) .... 		         
(2) Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii).... 		         
(3) Largest amount of support
from an exempt organization		          
(4) Gross investment income          
Part XIV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1Information Regarding Foundation Managers:
aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
JOHN MORTENSEN
ROSEMARY MORTENSEN
bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here right arrow
aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
ROSEMARY L AND JOHN P MORTENSEN FOU
1967 EAST TELEMARK CIRCLE
GREEN BAY,WI54313
(920) 425-9805
bThe form in which applications should be submitted and information and materials they should include:
APPLICATIONS SHOULD BE IN WRITING. INCLUDE ALL PERTINENT INFORMATION.
cAny submission deadlines:
NONE
dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
NONE
Form 990-PF (2023)
Form 990-PF (2023)
Page 11
Part XIV
Supplementary Information (continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
 Foundation
status of
recipient 		Purpose of grant or
contribution 		Amount
Name and address (home or business)
aPaid during the year

ACTS 18 FOUNDATION

2145 S ONEIDA STREET GREEN BAY
GREEN BAY,WI54304 		  PC PROVIDE FUNDING FOR RESEARCH 1,000

ALZHEIMER'S ASSOCIATION

620 SOUTH 76TH STREET SUITE 160
MILWAUKEE,WI53214 		  PC PROVIDE FUNDING FOR RESEARCH 40

AMERICAN HEART ASSOCIATION

PO BOX 840692
DALLAS,TX75284 		  PC PROVIDE FUNDING FOR RESEARCH 409

COLLEGEREADY

715 SUPERIOR ROAD SUITE 102
GREEN BAY,WI54311 		  PC PROVIDE FUNDING FOR RESEARCH 6,000

CP TELETHON

2801 S WEBSTER AVENUE
GREEN BAY,WI54301 		  PC PROVIDE FUNDING FOR RESEARCH 15,000

FEEDING AMERICA

1700 W FOND DU LAC AVENUE
MILWAUKEE,WI53205 		  PC PROVIDE FUNDING FOR RESEARCH 100

FOUNDATIONS HEALTH & WHOLENESS INC - ETHICS IN ACTION 2022

1061 W MASON STREET
GREEN BAY,WI54303 		  PC PROVIDE FUNDING FOR RESEARCH 15,000

GOLDEN HOUSE

600 S WEBSTER AVE2
GREEN BAY,WI54302 		  PC PROVIDE FUNDING FOR RESEARCH 300

GREEN BAY SOUTHWEST HIGH SCHOOL

1331 PACKERLAND DRIVE
GREEN BAY,WI54304 		  PC PROVIDE FUNDING FOR RESEARCH 810

KIWANIS CLUB OF DE PERE FOUNDATION

PO BOX 5981
DE PERE,WI54115 		  PC PROVIDE FUNDING FOR RESEARCH 232

LEARNING GATE COMMUNITY SCHOOL

16215 HANNA RD
LUTZ,FL33549 		  PC PROVIDE FUNDING FOR RESEARCH 350

MISSION EDUCATION INC

416 GEORGE STREET
DE PERE,WI54115 		  PC PROVIDE FUNDING FOR RESEARCH 500

NICOLET NATIONAL BANK FOUNDATION

111 NORTH WASHINGTON STREET
GREEN BAY,WI54305 		  PC PROVIDE FUNDING FOR RESEARCH 4,000

PAN-MASS CHALLENGE

77 FOURTH AVENUE
NEEDHAM,MA02494 		  PC PROVIDE FUNDING FOR RESEARCH 500

PAUL'S PANTRY

1513 LEO FRIGO WAY
GREEN BAY,WI54302 		  PC PROVIDE FUNDING FOR RESEARCH 300

PREBLE GIRLS VOLLEYBALL BOOSTER CLUB

2222 DECKNER AVENUE
GREEN BAY,WI54302 		  PC PROVIDE FUNDING FOR RESEARCH 250

ST BALDRICK'S FOUNDATION

1333 SOUTH MAYFLOWER AVENUE SUITE
400
MONROVIA,CA91016 		  PC PROVIDE FUNDING FOR RESEARCH 102

ST JOHN'S MINISTRIES

PO BOX 1743
GREEN BAY,WI54305 		  PC PROVIDE FUNDING FOR RESEARCH 300

ST JUDE CHILDREN'S HOSPITAL

501 ST JUDE PLAC
PLACE MEMPHIS,TN38105 		  PC PROVIDE FUNDING FOR RESEARCH 1,350

AMERICAN RED CROSS OF NORTHEAST WISCONSIN

121 N BADER STREET
GREEN BAY,WI54302 		  PC PROVIDE FUNDING FOR RESEARCH 5,000

BOYS AND GIRL CLUB OF GREATER GREEN BAY

1451 UNIVERSITY AVE
GREEN BAY,WI54302 		  PC PROVIDE FUNDING FOR RESEARCH 27

CHALLENGED ATHLETES FOUNDATION

9591 WAPLES ST
SAN DIEGO,CA92121 		  PC PROVIDE FUNDING FOR RESEARCH 75

CHILD CRISIS OF ARIZONA

817 N COUNTRY CLUB DR
MESA,AZ85201 		  PC PROVIDE FUNDING FOR RESEARCH 300

CHILDREN'S OF WISCONSIN

8915 W CONNELL CT PO BOX 1997
MILWAUKEE,WI53226 		  PC PROVIDE FUNDING FOR RESEARCH 100

COREWELL (SPECTRUM) HEALTH FOUNDATION

701 S GREENVILLE WEST DRIVE SUITE 1
GREENVILLE,MI48838 		  PC PROVIDE FUNDING FOR RESEARCH 1,000

COTTONWOOD CREEK CHURCH

1015 SAM SAYBURN TOLLWAY
ALLEN,TX75013 		  PC PROVIDE FUNDING FOR RESEARCH 300

DEPERE CENTRAL LACROSSE CLUB

1700 CHICAGO STREET
DE PERE,WI54115 		  PC PROVIDE FUNDING FOR RESEARCH 250

DISABLED AMERICAN VETERANS

1253 SCHEURING RD SUITE A
DE PERE,WI54115 		  PC PROVIDE FUNDING FOR RESEARCH 100

ECUMENICAL PARTNERSHIP OF HOUSING

PO BOX 524
GREEN BAY,WI54305 		  PC PROVIDE FUNDING FOR RESEARCH 15,200

ESSENTIA HEALTH FOUNDATION

400 EAST THIRD STREET
DULUTH,MN55805 		  PC PROVIDE FUNDING FOR RESEARCH 1,000

EXCEPTIONAL EQUESTRAINS

1130 ORLANDO DRIVE
DE PERE,WI54115 		  PC PROVIDE FUNDING FOR RESEARCH 1,000

GIVE BIG GREEN BAY

400 S WASHINGTON STREET
GREEN BAY,WI54301 		  PC PROVIDE FUNDING FOR RESEARCH 13,975

GREEN BAY BOY CHOIR & GIRL CHOIR

321 SOUTH MADISON
GREEN BAY,WI54301 		  PC PROVIDE FUNDING FOR RESEARCH 250

HOUSE OF HOPE

1660 CHRISTIANA ST
GREEN BAY,WI54303 		  PC PROVIDE FUNDING FOR RESEARCH 100

JDRF ONE WALK

1800 APPLETON ROAD SUITE 2
MENASHA,WI54952 		  PC PROVIDE FUNDING FOR RESEARCH 83

MAUI STRONG FUND

827 FORT STREET MALL
HONOLULU,HI96813 		  PC PROVIDE FUNDING FOR RESEARCH 300

MS SOCIETY

PO BOX 91891
WASHINGTON,DC20090 		  PC PROVIDE FUNDING FOR RESEARCH 20

NEIGHBORWORKS GREEN BAY

437 S JACKSON STREET
GREEN BAY,WI54301 		  PC PROVIDE FUNDING FOR RESEARCH 3,000

NEW COMMUNITY SHELTER

301 MATHER ST
GREEN BAY,WI54303 		  PC PROVIDE FUNDING FOR RESEARCH 103

SEEDS OF HOPE

PO BOX 28555
GREEN BAY,WI53424 		  PC PROVIDE FUNDING FOR RESEARCH 750

SERVING FROM THE HEART (LLS)

2875 HILLCREST COURT
GREEN BAY,WI54313 		  PC PROVIDE FUNDING FOR RESEARCH 1,000

SMITHSONIAN INSITITUTION

PO BOX 37012
WASHINGTON,DC20013 		  PC PROVIDE FUNDING FOR RESEARCH 1,000

SYBLE HOPP SCHOOL

755 SCHEURING ROAD D
DE PERE,WI54115 		  PC PROVIDE FUNDING FOR RESEARCH 500

THE SALVATION ARMY

626 UNION COURT
GREEN BAY,WI54303 		  PC PROVIDE FUNDING FOR RESEARCH 1,000

THE WIND

6469 PARKLAND DR
SARASOTA,FL34243 		  PC PROVIDE FUNDING FOR RESEARCH 360

THORN

222 N PACIFIC COAST HIGHWAY 10TH
FLOOR
EL SEGUNDO,CA90245 		  PC PROVIDE FUNDING FOR RESEARCH 108

TIM TEBOW FOUNDATION

2220 COUNTY RD 210 W STE 108 PMB
317
JACKSONVILLE,FL32259 		  PC PROVIDE FUNDING FOR RESEARCH 200

TRINI FOUNDATION

PO BOX 1257
WORTHINGTON,OH43085 		  PC PROVIDE FUNDING FOR RESEARCH 300

VETERANS BENEFIT

1983 PAINT HORSE TRAIL
DE PERE,WI54115 		  PC PROVIDE FUNDING FOR RESEARCH 1,000

WISCONSIN HUMANE SOCIETY

4500 W WISCONSIN AVE
MILWAUKEE,WI53208 		  PC PROVIDE FUNDING FOR RESEARCH 1,000

ZION LUTHERAN WAYSIDE CHURCH

8378 COUNTY W
GREENLEAF,WI54126 		  PC PROVIDE FUNDING FOR RESEARCH 300
Total .................................right arrow 3a 96,244
bApproved for future payment
Total ................................. right arrow 3b 0
Form 990-PF (2023)
Form 990-PF (2023)
Page 12
Part XV-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
Related or exempt
function income
(See instructions.)
1Program service revenue: (a)
Business code 		(b)
Amount 		(c)
Exclusion code 		(d)
Amount
a
b
c
d
e
f
gFees and contracts from government agencies          
2 Membership dues and assessments ....          
3 Interest on savings and temporary cash
investments ........... 		    14 1,442  
4 Dividends and interest from securities .... 900099 55,697      
5 Net rental income or (loss) from real estate:
aDebt-financed property......          
bNot debt-financed property.....          
6 Net rental income or (loss) from personal property          
7 Other investment income .....          
8 Gain or (loss) from sales of assets other than
inventory ............ 		    18 318,943  
9 Net income or (loss) from special events:          
10 Gross profit or (loss) from sales of inventory          
11 Other revenue: a
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e) .. 55,697 320,385 0
13Total. Add line 12, columns (b), (d), and (e)..................
13
376,082
(See worksheet in line 13 instructions to verify calculations.)
Part XV-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
DownArrow 		Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
Form 990-PF (2023)
Form 990-PF (2023)
Page 13
Part XVI
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
1
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Yes
No
a
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1) Cash...................................
1a(1)
 
No
(2) Other assets.................................
1a(2)
 
No
b
Other transactions:
(1) Sales of assets to a noncharitable exempt organization....................
1b(1)
 
No
(2) Purchases of assets from a noncharitable exempt organization..................
1b(2)
 
No
(3) Rental of facilities, equipment, or other assets.......................
1b(3)
 
No
(4) Reimbursement arrangements...........................
1b(4)
 
No
(5) Loans or loan guarantees.............................
1b(5)
 
No
(6) Performance of services or membership or fundraising solicitations................
1b(6)
 
No
c
Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
1c
 
No
d
If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
(a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
2a
Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
b
If "Yes," complete the following schedule.

(a) Name of organization (b) Type of organization (c) Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
right arrow right arrow
May the IRS discuss this return
with the preparer shown below?
See instructions.
Signature of officer or trustee Date Title
Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date Check if self-
employed right arrow		 PTIN
Firm's name SmallBullet
 Firm's EIN SmallBullet
Firm's address SmallBullet


 Phone no.
Form 990-PF (2023)
Additional Data


Software ID:  
Software Version:  


Form 990PF - Special Condition Description:
Special Condition Description

TY 2023 AccountingFeesSchedule
Name:
ROSEMARY L & JOHN P MORTENSEN FOUNDATION
EIN:
85-6781091
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
CLIFTONLARSONALLEN 3,780 1,890   1,890

TY 2023 InvestmentsCorpStockSchedule
Name:
ROSEMARY L & JOHN P MORTENSEN FOUNDATION
EIN:
85-6781091
Name of Stock End of Year Book Value End of Year Fair Market Value
BROADCOM 1,141,723 2,232,500
AUTOZONE INC 248,000 258,561
GENERAL ELECTRIC CO 120,250 127,630
NVIDIA CORP 500,610 495,220
BONDBLOXX CCC RTD USD HG 365,639 386,200
TESLA INC 649,417 993,920

TY 2023 OtherDecreasesSchedule
Name:
ROSEMARY L & JOHN P MORTENSEN FOUNDATION
EIN:
85-6781091
Description Amount
REVERSE PRIOR YEAR BASIS ADJUSTMENT 574,132


TY 2023 TaxesSchedule
Name:
ROSEMARY L & JOHN P MORTENSEN FOUNDATION
EIN:
85-6781091
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
FEDERAL TAXES 30,618 0   0