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
JX GIVES BACK FAMILY FOUNDATION INC
C/O MARK MUSKEVITSCH
Number and street (or P.O. box number if mail is not delivered to street address)925 WALNUT RIDGE DRIVE 150
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
HARTLAND, WI53029
A Employer identification number

83-4706547
B Telephone number (see instructions)

(262) 513-5066
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$27,405J 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) 132,811
2 Check right arrow.............
3 Interest on savings and temporary cash investments 4,027 4,027  
4 Dividends and interest from securities...      
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)... 0
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........ 136,838 4,027  
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
2,550 1,275   1,275
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment
List of Attached Documents:
// Content
14 14   0
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment
List of Attached Documents:
// Content
54 0   54
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 2,618 1,289   1,329
25 Contributions, gifts, grants paid....... 234,395 234,395
26 Total expenses and disbursements. Add lines 24 and 25 237,013 1,289   235,724
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -100,175
b Net investment income (if negative, enter -0-) 2,738
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 Savings and temporary cash investments......... 127,580 27,405 27,405
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).......      
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) 127,580 27,405 27,405
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........... 127,580 27,405
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........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 127,580 27,405
30 Total liabilities and net assets/fund balances (see instructions). 127,580 27,405
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
127,580
2
Enter amount from Part I, line 27a .....................
2
-100,175
3
Other increases not included in line 2 (itemize) right arrow
3
0
4
Add lines 1, 2, and 3 ..........................
4
27,405
5
Decreases not included in line 2 (itemize) right arrow
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
27,405
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.)
1a
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
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
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  
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 38
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 38
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 38
6 Credits/Payments:
a 2023 estimated tax payments and 2022 overpayment credited to 2023 6a 0
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 0
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......right arrow 9 38
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...right arrow 10  
11 Enter the amount of line 10 to be: Credited to 2024 estimated taxright arrow   Refundedright arrow 11  
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. Click to see attachment
List of Attached Documents:
// Content
...............................
10
Yes
 
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 arrowMARK MUSKEVISCH Telephone no.right arrow (262) 513-5066

Located atright arrow925 WALNUT RIDGE DRIVE 150HARTLANDWI ZIP+4right arrow53029
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
SARAH JORGENSEN PRESIDENT/DIRECTOR
0.50 		0 0 0
925 WALNUT RIDGE DRIVE 150
HARTLAND,WI53029
SCOTT SCHMITT SECRETARY/DIRECTOR
0.50 		0 0 0
925 WALNUT RIDGE DRIVE 150
HARTLAND,WI53029
RICK R KOBRIGER ASST SECR/DIRECTOR
0.50 		0 0 0
925 WALNUT RIDGE DRIVE 150
HARTLAND,WI53029
JEFF COVELLI OFFICER
0.50 		0 0 0
925 WALNUT RIDGE DRIVE 150
HARTLAND,WI53029
MARK MUSKEVITSCH OFFICER
0.50 		0 0 0
925 WALNUT RIDGE DRIVE 150
HARTLAND,WI53029
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
0
b
Average of monthly cash balances.......................
1b
79,569
c
Fair market value of all other assets (see instructions)................
1c
0
d
Total (add lines 1a, b, and c).........................
1d
79,569
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
79,569
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
1,194
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
78,375
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
3,919
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
3,919
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
38
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
 
c
Add lines 2a and 2b............................
2c
38
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
3,881
4
Recoveries of amounts treated as qualifying distributions................
4
0
5
Add lines 3 and 4............................
5
3,881
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
3,881
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
235,724
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
235,724
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 3,881
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2022 only....... 0
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...... 24,685
d From 2021...... 174,468
e From 2022...... 220,404
f Total of lines 3a through e ........ 419,557
4Qualifying distributions for 2023 from Part
XI, line 4: right arrow$ 235,724
a Applied to 2022, but not more than line 2a 0
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..... 3,881
e Remaining amount distributed out of corpus 231,843
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 5 651,400
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 .......... 		0
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 ...... 		651,400
10 Analysis of line 9:
a Excess from 2019....  
b Excess from 2020.... 24,685
c Excess from 2021.... 174,468
d Excess from 2022.... 220,404
e Excess from 2023.... 231,843
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).)
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 email address of the person to whom applications should be addressed:
bThe form in which applications should be submitted and information and materials they should include:
cAny submission deadlines:
dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
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

92 FOR 22

PO BOX 316
ALLENDALE,MI49400 		  PC PROGRAM SUPPORT 2,000

ADDWC

200 MOODY ST
EUREKA,IL61530 		  PC PROGRAM SUPPORT 2,000

ALDA CHICAGO ( ASSOCIATION OF LATE DEAFENED ADULTS INC )

PO BOX 102
LOMBARD,IL60148 		  PC PROGRAM SUPPORT 2,000

ALGER-MARQUETTE COMMUNITY ACTION

1125 COMMERCE DRIVE
MARQUETTE,MI49855 		  PC PROGRAM SUPPORT 1,000

ALLEGAN COUNTY YOUTH LIVESTOCK LEADERS (ACYLL)

PO BOX 10
ALLEGAN,MI49010 		  PC PROGRAM SUPPORT 2,000

AMERICAN HUEY 369

209 SOUTH BROADWAY
PERU,IN46970 		  PC PROGRAM SUPPORT 2,000

ANSEL BRAINERD COOK CHAPTER NATIONAL SOCIETY DAUGHTERS OF THE AMERICAN REVO

36617 N MARILYN LN
LAKE VILLA,IL60046 		  PC PROGRAM SUPPORT 2,000

ANTIOCH FINE ARTS FOUNDATION

952 MAIN ST
ANTICOH,IL60002 		  PC PROGRAM SUPPORT 750

BABY BLESSINGS

200 S SILVER LAKE ST
OCONOMOWOC,WI53066 		  PC PROGRAM SUPPORT 2,000

BIG CAR MEDIA MEMO TUBE FACTORY ARTSPACE

1125 CRUFT ST
INDIANAPOLIS,IN462035352 		  PC PROGRAM SUPPORT 2,000

BIRTH BRITE COMPANY INC

1410 W GANSON ST
JACKSON,MI49202 		  PC PROGRAM SUPPORT 2,000

BLESSINGS IN A BACKPACK WAUKESHA COUNTY

2010 SPRINGDALE RD
WAUKESHA,WI53186 		  PC PROGRAM SUPPORT 2,000

BLUE LAKE FINE ARTS CAMP

300 EAST CRYSTAL LAKE RD
TWIN LAKE,MI49451 		  PC PROGRAM SUPPORT 2,000

BOXER REBOUND INC

4915 RINGWOOD RD
RINGWOOD,IL60072 		  PC PROGRAM SUPPORT 2,500

BOY SCOUTS TROOP 912 BLOOMINGTON IL

1822 E LINCOLN ST
BLOOMINGTON,IL61701 		  PC PROGRAM SUPPORT 500

BUIST COMMUNITY ASSISTANCE CENTER

870 74TH ST SW STE B
BYRON CENTER,MI49315 		  PC PROGRAM SUPPORT 2,000

CAMP NEW DAY

201 E RIDGE ST
MARQUETTE,MI49855 		  PC PROGRAM SUPPORT 500

CANCER CARE OF MARQUETTE COUNTY

700 W KAYE AVE
MARQUETTE,MI49855 		  PC PROGRAM SUPPORT 2,000

CASA OF EFFINGHAM COUNTY

1901 S 4TH STREET SUITE 211
EFFINGHAM,IL62401 		  PC PROGRAM SUPPORT 2,000

CELEBRATING HIGH SCHOOL INNOVATORS

1100 EAST INDIANA AVE
PONTIAC,IL61764 		  PC PROGRAM SUPPORT 2,000

CENTRAL INDIANA AREA AGENCY ON AGING

8440 WOODFIELD CROSSING BLVD STE
175
INDIANAPOLIS,IN462404359 		  PC PROGRAM SUPPORT 2,000

CHAMPAIGN COUNTY HUMANE SOCIETY

4003 KEARNS DR
CHAMPAIGN,IL61820 		  PC PROGRAM SUPPORT 1,000

CHICAGO AREA MOUNTAIN BIKERS INC

336 PATRICIA LANE
BARTLETT,IL60103 		  PC PROGRAM SUPPORT 3,000

CHILDRENS WISCONSIN FOUNDATION- MEMO MENTAL AND BEHAVIORAL HEALTH

PO BOX 1997
MILWAUKEE,WI53201 		  PC PROGRAM SUPPORT 12,000

CLARK COUNTY HUMANE SOCIETY

PO BOX 127
NEILLSVILLE,WI54456 		  PC PROGRAM SUPPORT 1,000

COMMUNITY HARVEST FOOD BANK

999 E TILLMAN ROAD
FORT WAYNE,IN46816 		  PC PROGRAM SUPPORT 1,000

CRAINE HOUSE

6130 N MICHIGAN ROAD
INDIANAPOLIS,IN46228 		  PC PROGRAM SUPPORT 2,000

CRISIS NURSERY CENTER EFFINGHAM

924 N MERCHANT ST
EFFINGHAM,IL62401 		  PC PROGRAM SUPPORT 2,000

CRISIS NURSERY CHAMPAIGN IL

1309 W HILL ST
URBANA,IL61801 		  PC PROGRAM SUPPORT 2,000

CUSTOM CANINES SERVICE DOG ACADEMY

2310 MUSTANG WAY
MADISON,WI53718 		  PC PROGRAM SUPPORT 2,000

CYCLING WITHOUT AGE

6103 MORNING VIEW LANE
WESTON,WI54476 		  PC PROGRAM SUPPORT 2,000

DAILY BREAD SOUP KITCHEN

116 N FIRST ST
CHAMPAIGN,IL61820 		  PC PROGRAM SUPPORT 2,500

DAYBREAK OF LISLE

820 DIVISION ST
LISLE,IL60532 		  PC PROGRAM SUPPORT 2,000

DE PERE CHRISTIAN OUTREACH FOOD PANTRY

1827 CHICAGO STREET
DEPERE,WI54115 		  PC PROGRAM SUPPORT 1,000

DEBORAH'S PLACE

2822 W JACKSON BLVD
CHICAGO,IL60612 		  PC PROGRAM SUPPORT 2,000

DEKALB HUMANE SOCIETY INC

PO BOX 806 5730 COUNTY ROAD 11A
AUBURN,IN46706 		  PC PROGRAM SUPPORT 1,000

DOGSINVESTS INC

W383 CARLIN TRAIL
PALMYRA,WI53156 		  PC PROGRAM SUPPORT 1,000

DRIVING FOR DYSLEXIA

7304 E STOP 11 RD
INDIANAPOLIS,IN46259 		  PC PROGRAM SUPPORT 2,000

DUPAGE TOWNSHIP FOOD PANTRY

241 CANTERBURY LANE
BOLINGBROOK,IL60440 		  PC PROGRAM SUPPORT 1,000

EASTERN ILLINOIS FOODBANK

2405 NORTH SHORE DRIVE
URBANA,IL61802 		  PC PROGRAM SUPPORT 1,000

EASTVIEW CHRISTIAN CHURCH

1500 NORTH AIRPORT RD
NORMAL,IL61761 		  PC PROGRAM SUPPORT 1,000

EFFINGHAM COUNTY FISH HUMAN SERVICES

708 S LINDEN
EFFINGHAM,IL62401 		  PC PROGRAM SUPPORT 2,000

EFFINGHAM COUNTY FISH ORGAN

708 S LINDEN
EFFINGHAM,IL62401 		  PC PROGRAM SUPPORT 1,000

EFFINGHAM ROAD HOME

1200 N 4TH ST
EFFINGHAM,IL62402 		  PC PROGRAM SUPPORT 2,000

ELMHURST-YORKFIELD FOOD PANTRY

1083 S YORK ST
ELMHURST,IL60126 		  PC PROGRAM SUPPORT 1,000

EVERY CHILD CAN READ INC

33 SOUTH 7TH ST
RICHMOND,IN47374 		  PC PROGRAM SUPPORT 2,000

FAMILY NETWORK OF WYOMING

1029 44TH ST SW
WYOMING,MI49509 		  PC PROGRAM SUPPORT 1,000

FAMILY PROMISE OF GRAND RAPIDS

516 CHERRY STREET SE
GRAND RAPIDS,MI49503 		  PC PROGRAM SUPPORT 2,000

FELLOW MORTALS INC

W4632 PALMER ROAD LAKE GENEVA
LAKE GENEVA,WI53147 		  PC PROGRAM SUPPORT 2,000

FLIGHT TO THE NORTH POLE LTD

PO BOX 2143
BROOKFIELD,WI53008 		  PC PROGRAM SUPPORT 1,000

FOREST COUNTY HUMANE SOCIETY

PO BOX 57 701 INDUSTRIAL PARKWAY
CRANDON,WI54520 		  PC PROGRAM SUPPORT 1,000

FORT MEMORIAL HOSPITAL FOUNDATION INC (MEMO-MAMMOGRAM VOUCHER PROGRAM)

611 SHERMAN AVE EAST
FORT ATKINSON,WI53538 		  PC PROGRAM SUPPORT 3,500

FOSTERING COMMUNITY

2103 SPRINGBROOK N
WAUKESHA,WI53186 		  PC PROGRAM SUPPORT 1,000

FREEDOM FASTPITCH CLUB INC

N3885 SHAMROCK CIR
FREEDOM,WI549139234 		  PC PROGRAM SUPPORT 1,000

FREEDOM RIDERS OF INDIANA

11327 ROBINAIR DR
FORT WAYNE,IN46818 		  PC PROGRAM SUPPORT 500

FRIENDS OF THE EVJUE SCHOOL FOREST OF MERRILL INC

PO BOX 221
MERRILL,WI54452 		  PC PROGRAM SUPPORT 2,000

GATEWAY TECHNICAL COLLEGE FOUNDATION INC MEMO NICK COVELLI SCHOLARSHIP

3520 30TH AVE
KENOSHA,WI53144 		  PC PROGRAM SUPPORT 3,000

GEORGE T GOODWIN COMMUNITY CENTER

3935 W MOORESVILLE ROAD
INDIANAPOLIS,IN46221 		  PC PROGRAM SUPPORT 1,000

GIRLS ON THE RUN SOUTHEASTERN WISCONSIN

5775 N GLEN PARK ROAD STE 203
MILWAUKEE,WI53209 		  PC PROGRAM SUPPORT 2,000

GOT YOUR SIX SUPPORT DOGS

6 SCHILBER COURT
MARYVILLE,IL62062 		  PC PROGRAM SUPPORT 2,000

GREAT LAKES DRYHOOTCH

1030 EAST BRADY STREET
MILWAUKEE,WI53202 		  PC PROGRAM SUPPORT 2,000

GREATER CHICAGO FOOD DEPOSITORY

4100 W ANN LURIE PLACE
CHICAGO,IL60632 		  PC PROGRAM SUPPORT 1,000

GREATER GREEN BAY YMCA

235 N JEFFERSON ST
GREEN BAY,WI54301 		  PC PROGRAM SUPPORT 500

GWENDOLYN'S GIFTS

6209 MID RIVERS MALL DRIVE STE 124
ST PETERS,MO63304 		  PC PROGRAM SUPPORT 2,500

HARTLAND AREA FOOD PANTRY

555 S INDUSTRIAL DR SUITE 7
HARTLAND,WI53029 		  PC PROGRAM SUPPORT 1,000

HEALING PATRIOTS

W10928 W LAKE POINT DR
LODI,WI53555 		  PC PROGRAM SUPPORT 2,000

HEART OF MORTON

16 NEWBERRY CT
MORTON,IL61550 		  PC PROGRAM SUPPORT 2,500

HOOSIER VETERAN'S ASSISTANCE FOUNDATION

964 N PENNSYLVANIA ST
INDIANAPOLIS,IN46204 		  PC PROGRAM SUPPORT 2,000

HOPE PKGS

PO BOX 1263
HOLLAND,MI49422 		  PC PROGRAM SUPPORT 2,000

HUMANE FORT WAYNE ALLEN COUNTY SPCA

4914 S HANNA STREET
FORT WAYNE,IN46806 		  PC PROGRAM SUPPORT 2,000

INDIANA BLIND CHILDREN'S FOUNDATION

7725 N COLLEGE AVE
INDIANAPOLIS,IN46240 		  PC PROGRAM SUPPORT 2,000

INTEGRATED COMMUNITY SOLUTIONS

2605 S ONEIDA STREET SUITE 106
GREEN BAY,WI54304 		  PC PROGRAM SUPPORT 2,000

JC YOUTH FOUNDATION

2838 W WEIDMAN
MT PLEASANT,MI48858 		  PC PROGRAM SUPPORT 1,000

JOHNATHON DANIEL LUOMA FOUNDATION

237734 TROY STREET
WAUSAU,WI54403 		  PC PROGRAM SUPPORT 2,000

JOHNSON COUNTY COMMUNITY FOUNDATION

PO BOX 217
FRANKLIN,IN46131 		  PC PROGRAM SUPPORT 2,000

KALAMAZOO LOAVES & FISHES

901 PORTAGE ST
KALAMAZOO,MI49001 		  PC PROGRAM SUPPORT 1,000

LAFAYETTE URBAN MINISTRY (LUM)

420 N 4TH STREET
LAFAYETTE,IN479012213 		  PC PROGRAM SUPPORT 1,000

LAND OF LINCOLN HONOR FLIGHT

57 COUNTRY PLACE
SPRINGFIELD,IL62703 		  PC PROGRAM SUPPORT 2,000

LIFE DECISIONS

3107 E STATE ST
ROCKFORD,IL61108 		  PC PROGRAM SUPPORT 2,000

LOST WOODS ANIMAL SANCTUARY

2025 LOUISE ST
CRYSTAL LAKE,IL600142526 		  PC PROGRAM SUPPORT 500

LUCCI'S HOUSE BULLY RESCUE

4433 INGLESIDE LN
INDIANAPOLIS,IN46227 		  PC PROGRAM SUPPORT 1,000

MAKE A WISH

200 E WASHINGTON ST STE 2F
APPLETON,WI54911 		  PC PROGRAM SUPPORT 500

MICHIGAN HUMANE

30300 TELEGRAPH RD STE 220
BINGHAM FARMS,MI48025 		  PC PROGRAM SUPPORT 500

MID MICHIGAN COMMUNITY ACTION

2300 E LUDINGTON DRIVE
CLARE,MI48617 		  PC PROGRAM SUPPORT 1,000

MILWAUKEE CHILDREN'S CHOIR

427 E STEWART ST STE 100
MILWAUKEE,WI53207 		  PC PROGRAM SUPPORT 500

MUSIC FOR ALL KIDS

PO BOX 453
MARQUETTE,MI49855 		  PC PROGRAM SUPPORT 700

NEVER FORGOTTEN HONOR FLIGHT

225780 RIB MOUTAIN DRIVE 234
WAUSAU,WI54401 		  PC PROGRAM SUPPORT 2,000

NEVER SAY NEVER INC

PO BOX 824 LAKE GENEVA WI 53147
LAKE GENEVA,WI53147 		  PC PROGRAM SUPPORT 2,500

NINE13SPORTS

1271 W 29TH STREET
INDIANAPOLIS,IN46208 		  PC PROGRAM SUPPORT 2,000

NO MORE SIDELINES - KENT COUNTY

10388 KALAMAZOO AVE
CALEDONIA,MI49316 		  PC PROGRAM SUPPORT 2,500

NOQUEMANON TRAIL NETWORK (NTN)

PO BOX 746
MARQUETTE,MI49855 		  PC PROGRAM SUPPORT 2,000

NORTHERN IL FOOD BANK - JOLIET

171 S LARKIN AVE
JOILET,IL60436 		  PC PROGRAM SUPPORT 1,000

OCONOMOWOC FOOD PANTRY

PO BOX 832
OCONOMOWOC,WI53066 		  PC PROGRAM SUPPORT 2,000

OPEN ARMS MISSION - IL

PO BOX 79 - 1548 MAIN STREET
ANTICOH,IL60002 		  PC PROGRAM SUPPORT 1,000

OPERATION CHARLIE BRAVO

1670 E NORTH STREET
CROWN POINT,IN46307 		  PC PROGRAM SUPPORT 2,000

OTSEGO COUNTY FOOD PANTRY

116 E 5TH ST
GAYLORD,MI49735 		  PC PROGRAM SUPPORT 1,000

PEWAUKEE INTERCHURCH LAY COUNCILPEWAUKEE FOOD PANTRY

642 MAIN ST
PEWAUKEE,WI53072 		  PC PROGRAM SUPPORT 1,000

RACCOON RIDGE REHAB

13137 E 1100 NORTH RD
CHENOA,IL61726 		  PC PROGRAM SUPPORT 500

ROCK RIVER VALLEY FOOD PANTRY

421 S ROCKTON AVE
ROCKFORD,IL61102 		  PC PROGRAM SUPPORT 1,000

SAINT VINCENT DE PAUL ( IN MEMO - SVDP FOOD PANTRY)

2119 PRESQUE ISLE AVENUE
MARQUETTE,MI49855 		  PC PROGRAM SUPPORT 1,000

SALVATION ARMY NILES PANTRY

424 N 15TH ST
NILES,MI49120 		  PC PROGRAM SUPPORT 1,000

SECUREFUTURES FOUNDATION INC

710 N PLANKINTON AVENUE SUITE 1400
MILWAUKEE,WI53203 		  PC PROGRAM SUPPORT 2,000

SHEETS FROM HOME

2741 APRIL SPRINGS VIEW
CARMEL,IN46074 		  PC PROGRAM SUPPORT 2,000

SHINING ABILITIES NFP

300 N MILWAUKEE AVE STE J
LAKE VILLA,IL60046 		  PC PROGRAM SUPPORT 2,000

SHRINERS HOSPITALS FOR CHILDREN

314 WEST LAHMAN STREET
FRANKLIN GROVE,IL61031 		  PC PROGRAM SUPPORT 2,500

SIERRA DELTA

811 E WASHINGTON AVENUE SUITE 400
MADISON,WI53703 		  PC PROGRAM SUPPORT 2,000

SOUTH MILWAUKEE HUMAN CONCERN

PO BOX 314 - 1029 MILWAUKEE AVE
SOUTH MILWAUKEE,WI53172 		  PC PROGRAM SUPPORT 1,000

SOUTH WOOD COUNTY HUMANE SOCIETY

3621 64TH STREET N
WISCONSIN RAPIDS,WI54494 		  PC PROGRAM SUPPORT 750

SOUTHEASTERN ILLINOIS COMMUNITY FOUNDATION

PO BOX 1211
EFFINGHAM,IL62401 		  PC PROGRAM SUPPORT 2,000

SOUTHWESTERN WI COMMUNITY ACTION PROGRAM

149 NORTH IOWA STREET
DODGEVILLE,WI53533 		  PC PROGRAM SUPPORT 1,000

SPECIAL OLYMPIC OF ILLINOIS

605 E WILLOW ST
NORMAL,IL61761 		  PC PROGRAM SUPPORT 2,000

ST JOSEPHS FOOD PROGRAM

1465 OPPORTUNITY WAY A
MENASHA,WI54952 		  PC PROGRAM SUPPORT 1,000

STABEN HOUSE

149 SOUTH GENESEE STREET
WAUKEGAN,IL60085 		  PC PROGRAM SUPPORT 2,000

START THE CYCLE

PO BOX 815
MARQUETTE,MI49855 		  PC PROGRAM SUPPORT 2,695

STIR-N-UP HOPE

17336 N ST RD 162
FERDINAND,IN47352 		  PC PROGRAM SUPPORT 2,000

TAPS

100 TAPS LN
PEKIN,IL61554 		  PC PROGRAM SUPPORT 1,000

TAYLOR COUNTY AUTISM SUPPORT GROUP

PO BOX 4
MEDFORD,WI54451 		  PC PROGRAM SUPPORT 2,500

THE ALEX AND ALI FOUNDATION

126 W JENNINGS ST
NEWBURGH,IN47630 		  PC PROGRAM SUPPORT 2,500

THE BUDDY FOUNDATION

65 W SEEGERS RD
ARLINGTON HEIGHTS,IL60005 		  PC PROGRAM SUPPORT 500

THE JULIAN CENTER

2011 NORTH MERIDIAN STREET
INDIANAPOLIS,IN46202 		  PC PROGRAM SUPPORT 2,000

THE NEIGHBORS PLACE (MEMO -SHARE YOUR HOLIDAYS)

1114 GRAND AVENUE
WAUSAU,WI54403 		  PC PROGRAM SUPPORT 1,000

THE OUTREACH HOUSE

805 SOUTH MAIN STREET
LOMBARD,IL60148 		  PC PROGRAM SUPPORT 2,000

THE RIVER FOOD PANTRY

2201 DARWIN RD
MADISON,WI53704 		  PC PROGRAM SUPPORT 1,000

THE STOREHOUSE

4411 PLAINFIELD AVE NE
GRAND RAPIDS,MI49525 		  PC PROGRAM SUPPORT 2,000

THORNTON TOWNSHIP PANTRY

333 E 162ND ST
SOUTH HOLLAND,IL60472 		  PC PROGRAM SUPPORT 1,000

TUNNEL TO TOWERS FOUNDATION

2361 HYLAN BLVD
STATEN ISLAND,NY10306 		  PC PROGRAM SUPPORT 1,000

UNITED STROKE ALLIANCE

8000 N UNIVERSITY ST
PEORIA,IL61615 		  PC PROGRAM SUPPORT 2,000

UPPER PENINSULA HOSPICE ASSOCIATION

1125 WEST RIDGE STREET
MARQUETTE,MI498553190 		  PC PROGRAM SUPPORT 2,000

VETERAN'S PATH TO HOPE

805 S MCHENRY AVE SUITE D
CRYSTAL LAKE,IL60014 		  PC PROGRAM SUPPORT 2,000

WAUKESHA FOOD PANTRY

1301 SENTRY DR
WAUKESHA,WI53186 		  PC PROGRAM SUPPORT 2,000

WAUKESHA ROTARY CLUB CHARITABLE FUND INC

PO BOX 1876 765 CRESTWOOD DR
WAUKESHA,WI53188 		  PC PROGRAM SUPPORT 2,500

WAUNAKEE LIONS CLUB FOUNDATION

57 CHEROKEE CR 201
MADISON,WI53704 		  PC PROGRAM SUPPORT 1,000

WE CARE INC

622 W JACKSON
MORTON,IL61550 		  PC PROGRAM SUPPORT 1,000

WESTERN AVENUE COMMUNITY CENTER

1208 BUNN STREET
BLOOMINGTON,IL61701 		  PC PROGRAM SUPPORT 2,000

WISCONSIN VEST-A-DOG

4459 ROCKINGHAM DR
JANESVILLE,WI53546 		  PC PROGRAM SUPPORT 2,000

WOMEN'S CENTER MARQUETTE

1310 S FRONT STREET
MARQUETTE,MI49855 		  PC PROGRAM SUPPORT 2,000

WOOFGANG RESCUE

1906 MELVIN AVE
RACINE,WI53404 		  PC PROGRAM SUPPORT 1,000

WTI FOUNDATION MEMO WOMEN OF WYOTECH SCHOLARSHIP

1889 VENTURE DRIVE
LARAMIE,WY82070 		  PC PROGRAM SUPPORT 3,000
Total .................................right arrow 3a 234,395
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 4,027  
4 Dividends and interest from securities ....          
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 ............ 		         
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) .. 0 4,027 0
13Total. Add line 12, columns (b), (d), and (e)..................
13
4,027
(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.
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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
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Name of the organization
JX GIVES BACK FAMILY FOUNDATION INC
C/O MARK MUSKEVITSCH
Employer identification number

83-4706547
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




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
Special Rules
......... 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) (2023)
Schedule B (Form 990) (2023) Page 2
Name of organization
JX GIVES BACK FAMILY FOUNDATION INC
C/O MARK MUSKEVITSCH 		Employer identification number
83-4706547
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
1
JX ENTERPRISES INC
 
925 WALNUT RIDGE DRIVE STE 150
 
WAUKESHA, WI53029

$ 125,302


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)
Schedule B (Form 990) (2023)
Page 3
Name of organization
JX GIVES BACK FAMILY FOUNDATION INC
C/O MARK MUSKEVITSCH 		Employer identification number

83-4706547
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) (2023)
Schedule B (Form 990) (2023)
Page 4
Name of organization
JX GIVES BACK FAMILY FOUNDATION INC
C/O MARK MUSKEVITSCH 		Employer identification number

83-4706547
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2023)
Additional Data


Software ID:  
Software Version:  

TY 2023 AccountingFeesSchedule
Name:
JX GIVES BACK FAMILY FOUNDATION INC
 
C/O MARK MUSKEVITSCH
EIN:
83-4706547
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
TAX PREPARATION FEES 2,550 1,275   1,275

TY 2023 OtherExpensesSchedule
Name:
JX GIVES BACK FAMILY FOUNDATION INC
 
C/O MARK MUSKEVITSCH
EIN:
83-4706547
Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
WI DEPARTMENT OF FINANCIAL INSTITUTIONS 25 0   25
MERCHANT SERVICE FEES 29 0   29


TY 2023 SubstantialContributorsSch
Name:
JX GIVES BACK FAMILY FOUNDATION INC
 
C/O MARK MUSKEVITSCH
EIN:
83-4706547
Name Address
JX ENTERPRISES INC
  		925 WALNUT RIDGE DRIVE 150
HARTLAND,WI53029


TY 2023 TaxesSchedule
Name:
JX GIVES BACK FAMILY FOUNDATION INC
 
C/O MARK MUSKEVITSCH
EIN:
83-4706547
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
EXCISE TAXES PAID 14 14   0