| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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| Calendar year (or fiscal year beginning in) | (a) 2021 | (b) 2022 | (c) 2023 | (d) 2024 | (e) 2025 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 182,499 | 128,420 | 176,476 | 196,763 | 261,677 | 945,835 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf .... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | 182,499 | 128,420 | 176,476 | 196,763 | 261,677 | 945,835 |
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | 754,656 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 191,179 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2021 | (b) 2022 | (c) 2023 | (d) 2024 | (e) 2025 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 182,499 | 128,420 | 176,476 | 196,763 | 261,677 | 945,835 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 3,519 | 6,358 | 13,621 | 25,156 | 22,303 | 70,957 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | 1,016,792 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2021 | (b) 2022 | (c) 2023 | (d) 2024 | (e) 2025 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2021 | (b) 2022 | (c) 2023 | (d) 2024 | (e) 2025 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6 | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 | ||||||
| c | Add lines 10a and 10b | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6Total annual distributions. Add lines 1 through 5. | 6 | |
|
7
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
7 | |
| 8 Distributable amount for 2025 from Section C, line 6 | 8 | |
| 9 Line 7 amount divided by Line 8 amount | 9 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2025 |
(iii) Distributable Amount for 2025 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2025 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2025 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2025: | ||||
| a From 2020....... | ||||
| b From 2021....... | ||||
| c From 2022....... | ||||
| d From 2023....... | ||||
| e From 2024....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2025 distributable amount | ||||
|
i
Carryover from 2020 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2025 from Section D, line 6: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2025 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2025, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2025. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2026. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2021..... | ||||
| b Excess from 2022..... | ||||
| c Excess from 2023..... | ||||
| d Excess from 2024..... | ||||
| e Excess from 2025..... | ||||
| Facts And Circumstances Test |
|---|
| OUR FOUNDATION ACCEPTS DONATIONS FROM OUR PROFESSIONAL COLLEAGUES, FROM THE FAMILIES OF GRATEFUL PATIENTS, AND FROM THE GENERAL PUBLIC. IN ADDITION, WE SOLICIT SUPPORT FROM THE OPHTHALMIC BUSINESS COMMUNITY FOR OUR EDUCATIONAL ACTIVITIES. FINALLY, THE PHYSICIANS OF VITREORETINAL SURGERY, AND THE MEMBERS OF OUR BOARD OF DIRECTORS HAVE BEEN STRONG FINANCIAL SUPPORTERS OF OUR FOUNDATION. MOST OF THE DONATIONS TO OUR FOUNDATION HAVE BEEN RELATIVELY SMALL AMOUNTS OF MONEY FROM THE FAMILIES OF GRATEFUL PATIENTS. WE HAVE, HOWEVER, RECEIVED MAJOR RECURRENT ANNUAL DONATIONS FROM THE HELEN LINDSAY FAMILY FOUNDATION, WHICH FAR EXCEED THE CONTRIBUTIONS FROM OUR OTHER DONORS. HELEN LINDSAY WAS A FORMER PATIENT OF OURS, AND HER FAMILY HAS SUPPORTED OUR FOUNDATION BECAUSE OF HER LOSS OF VISION FROM MACULAR DEGENERATION. ALTHOUGH WE ARE GRATEFUL FOR THEIR GENEROUS SUPPORT, THE HELEN LINDSAY FOUNDATION IN NO WAY INFLUENCES, OR CONTROLS OUR FOUNDATION. DONATIONS FROM THE HELEN LINDSAY FOUNDATION HAVE BEEN UNSOLICITED AND THEY HAVE PLACED NO RESTRICTIONS ON THE USE OF THE DONATED FUNDS. CONSEQUENTLY, WE FEEL THAT THEIR FINANCIAL SUPPORT IS ENTIRELY CONSISTENT WITH THE MISSION OF OUR FOUNDATION. IN ADDITION TO THE SUPPORT RECEIVED FROM THE HELEN LINDSAY FOUNDATION, THE ORGANIZATION HAS RECEIVED CONTRIBUTIONS FROM NUMEROUS OTHER INDIVIDUAL DONORS RANGING FROM 21 TO 85 DONORS IN EACH YEAR SINCE 2020.BECAUSE OF THE DISPARITY BETWEEN THE DONATION FROM THE HELEN LINDSAY FOUNDATION AND OUR OTHER DONATIONS WE HAVE FAILED THE PUBLIC SUPPORT TEST (IRS FORM 990) BEGINNING IN 2019. WE CONTINUE TO QUALIFY AS A PUBLIC CHARITY USING THE FACTS AND CIRCUMSTANCES TEST. PART OF THAT TEST IS TO MAINTAIN "A CONTINUOUS AND BONA FIDE PROGRAM" TO ATTRACT OTHER SUPPORT. AS PART OF THIS EFFORT THE BOARD OF DIRECTORS HAVE CONTACTED VARIOUS PRIVATE FOUNDATIONS LOCATED MOSTLY IN MINNESOTA TO SOLICIT SUPPORT FOR OUR FOUNDATION. A SEARCH OF PRIVATE FOUNDATIONS IN MINNESOTA (HTTP://MCF.ORG/MEMBERS#FAMILY) RESULTED IN 14 POSSIBLE FOUNDATIONS THAT APPEARED TO SUPPORT MEDICAL RESEARCH BASED ON INFORMATION FROM THEIR WEBSITESA LETTER AND A PACKET OF INFORMATION INCLUDING A DETAILED DESCRIPTION OF OUR RESEARCH PROGRAM WAS SENT TO THE DIRECTORS OF THESE FOUNDATIONS. THE RESPONSE SO FAR HAS NOT RESULTED IN ADDITIONAL DONATIONS TO OUR FOUNDATION.IN 2022 WE BEGAN WORK WITH A WEBSITE DEVELOPER TO CREATE OUR OWN WEBSITE SEPARATE FROM THE RETINA CONSULTANTS OF MINNESOTA WEBSITE. THE WEBSITE IS NOW ACTIVE WITH THE DOMAIN NAME VRSFOUNDATION.US. THE WEBSITE FEATURES OUR THREE GOALS: RESEARCH, EDUCATION AND COMMUNITY OUTREACH. THE WEBSITE CONTAINS OUR MISSION STATEMENT, THE HISTORY OF THE FOUNDATION AND BIO SKETCHES OF OUR BOARD OF DIRECTORS. THE RESEARCH SECTION LISTS OUR CURRENT RESEARCH PROJECTS AND A LIST OF PRESENTATIONS AND PUBLICATIONS FROM THE PREVIOUS YEAR. RESEARCH APPLICANTS CAN BE DOWNLOAD AND COMPLETED ONLINE. THE EDUCATION SECTION HIGHLIGHTS OUR RETINA UPDATE MEETING AND ALLOWS FOR ONLINE REGISTRATION. FINALLY, THE COMMUNITY OUTREACH SECTION HAS INFORMATION FOR PATIENTS AND THE GENERAL PUBLIC ABOUT RETINAL DISEASE, TREATMENT OPTIONS, AND VISUAL REHABILITATION. THERE ARE LINKS TO OTHER WEBSITES FOR ADDITIONAL INFORMATION ON LOW VISION AIDS, REHABILITATIONS SERVICES, AND PREVENTION OF RETINAL DISEASE. ONLINE DONATIONS TO THE FOUNDATION CAN BE DONE THROUGH THE WEBSITE. WE HAVE ALSO INITIATED A MARKETING PLAN TO RAISE AWARENESS OF OUR FOUNDATION THROUGHOUT OUR CLINICS AND THE OPHTHALMIC COMMUNITY. THIS INVOLVES PROMINENTLY DISPLAYING OUR FOUNDATION BROCHURE IN THE WAITING ROOM OF ALL OUR OFFICES. WE HAVE DISPLAYED INFORMATION ABOUT OUR FOUNDATION AT OUR ANNUAL RETINAL UPDATE MEETING. WE HOPE THESE EFFORTS WILL INCREASE THE NUMBER OF DONATIONS TO OUR FOUNDATION, BUT MAY NOT QUALIFY US UNDER THE PUBLIC SUPPORT TEST. NEVERTHELESS, WE FEEL THAT ALL OF OUR EFFORTS ARE SUFFICIENT FOR THE FACTS AND CIRCUMSTANCES TEST. |
| Return Reference | Explanation |
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| Return Reference | Explanation |
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| FORM 990, PART VI, SECTION A, LINE 1A | THE BOARD OF DIRECTORS MAY BY ACTION OF A MAJORITY OF THE BOARD DESIGNATE TWO OR MORE MEMBERS AS AN EXECUTIVE COMMITTEE WHICH SHALL HAVE AND EXERCISE THE AUTHORITY OF TE BOARD IN MANAGEMENT OF THE CORPORTATION. THE EXECUTIVE COMMITTEE SHALL BE SUBJECT TO CONTROL AND DIRECTION OF THE BOARD. THE BOARD OF DIRECTORS MAY ALSO APPOINT SUCH OTHER COMMITTEES AS IT DEEMS PROPER. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE BOARD MEMBERS WERE PROVIDED AN ELECTRONIC COPY OF THE FORM 990 FOR REVIEW AND DISCUSSION. THE BOARD APPROVED THE FORM 990 ELECTRONICALLY AND RATIFIED THE APPROVAL AT THE NEXT REGULARLY SCHEDULED BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS ANNUALLY COMPLETES AND SIGNS A CONFLICT OF INTEREST STATEMENT. DIRECTORS, OFFICERS AND MANAGEMENT STAFF ARE PROHIBITED FROM ENGAGING IN ACTIVITIES THAT CONSTITUTE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST OBJECTIONABLE TO THE CORPORATION. WHENEVER A DIRECTOR, OFFICER OR MANAGEMENT STAFF PERSON HAS REASON TO BELIEVE THAT HE OR SHE MAY HAVE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THEY PROMPTLY DISCLOSE THE POTENTIAL CONFLICT TO THE EXECUTIVE DIRECTOR OR THE PRESIDENT. THE MATTER IS THEN PRESENTED TO THE BOARD AND ANY APPROPRIATE COMMITTEES. THE INTERESTED PERSON IS GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, THEY LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE INDIVIDUAL WITH THE CONFLICT MAY NOT VOTE ON THE MATTER AND IS NOT COUNTED FOR DETERMINING THE PRESENCE OF A QUORUM. IN ADDRESSING THE CONFLICT OF INTEREST, THE COMMITTEE/BOARD CHAIR CAN APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES AND DETERMINE WHETHER THE CORPORATION COULD OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS ARRANGEMENT IS NOT REASONABLY ATTAINABLE, THE BOARD OR COMMITTEE DETERMINES BY MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST. IF THE BOARD OR A COMMITTEE HAS REASON TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT INFORMS THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORDS THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE MEMBER'S RESPONSE AND MAKING FURTHER INVESTIGATION AS MAY BE WARRANTED, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT TAKES APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. THE FAILURE OF A DIRECTOR, OFFICER OR MANAGEMENT STAFF MEMBER TO ACT IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY MAY RESULT IN REMOVAL OF SUCH PERSON AND THE VOIDING OF RELATED ACTIONS TAKEN BY THE CORPORATION, INCLUDING TRANSACTIONS AND CONTRACTS TO WHICH THE CORPORATION IS A PARTY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
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