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Form 99 0-PF Return of Private Foundation OMB No 1545-0052 or Section 4947(aXl) Nonexempt Charitable Trust Treated as a Private Foundation 2005 Department of the Treasury Note : The organization may be able to use a copy of this return to satisfy state 2005 Internal Revenue Se rv ice reporting requirements For calendar year 2005 , or tax year beginning , 2005 , and ending 9 G Check all that apply: Initial return Final return Amended return Address change Name change tp O N LU Use the A Employer identification number IRS label . James and Yvonne Ziemer Family 39-6744914 Otherwise , print Foundation B Telephone number (see instructions) ortype. W227 S4175 Concord Court 262-650-8974 See Specific Waukesha, WI 53189-8001 C If exemption application is pending, check here Instructions. D 1 Foreign organizations , check here H Check type of organization, Section 501(c)(3 exempt private foundation 2 Foreign organizations meeting the 85% test, check Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation here and a tt ach computation . . Fair market value of all assets at end of year J Accounting method- N Cash Accrual E If private foundation status was terminated tinder section 507(b)(1 )(A) check here (from Part ll, column (c), line 16) Other (specify) _ _ _ _ ___ _ __ __ _ , F If the foundation is Ina 60 month termination $ 564, 361. (Part 1, column (d) must be on cash basis.) tinder section 507(b )(1)(B), check here . art Analysis of Revenue and a Revenue and () (b) Net investment (c) Adjusted net (d) Disbursements total Expenses (T he amounts In expenses per books income income for charitable (d) ) may not sates- columns ( b ) , (c), and purposes sanly equal the amounts in column (a) (cash basis only) (see Instructions).) gifts, grants. etc , received (att sch) 1 Contributions, 260,520. �1 2 Ck I Ili I if the foundn is not req to all Sch B 3 Interest on savings and temporary cash investments 277. 277. N/A 4 Dividends and interest from securities 4, 326. 4,326. 5a Gross rents . ... b Net rental income or (loss) 6a Net gain/ ( loss) from sale of assets not on line 10 R E b Gross sales price for a ll assets on line 6a V 7 Capital gain net income (from Part IV, line 2) E 8 Net short -term capital gain N U 9 Income modifications E 10a Gross sales less returns and allowances b Less: Cost of goods sold c Gross profit /( loss) (a tt sch) sdhed'ule) 11 Other income (attach - ' l 1 9 Total=Add -tlnes lfhrou S1i1 265,123. 4,603. ir ctor al tees, etc 1 ompensation f officers, d e 0. R r1 thef P1o'ye ,s jn `e4t�Aa[wa MI) i l fits 1 nslon plans, employee . A D 1a Leg;l e4 h >�c edue) T 17 Ol Ac__ Oil g ees '(atta h sc N o 1 Ot'T r oof ees (attachsch ) See St 1 626. E s E T 17 Interest R R 18 Taxes ( a ttach schedule ) See Stmt 2 16. T T 19 Depreciation ( a ttach schedule ) and depletion N v 20 Occupancy G E 21 Travel, conferences, and meetings A E 22 Printing and publications N D p 23 Other expenses (attach schedule) E N S s 24 Total operatin g and administrative expenses . Add lines 13 through 23 642. 25 Contributions , gifts, grants paid Stmt 3 42, 900. 42,900. 26 Total expenses and disbursements. Add lines 24 and 25 43,542. 0. 42,900. 27 Subtract line 26 from line 12: a Excess of revenue over expenses and disbursements 221, 581. b Net Investment Income ( f negative, enter -0.) . 4,603. C Adjusted net Income ( if negative, enter -0-) BAA For Privacy Act and Paperwork Reduction Act Notice , see the instructions . TEEA0503L 09/19/05 Form 990-PF (2005) �s
Transcript
Page 1: Treated as a Private Foundation 2005 2005990s.foundationcenter.org/990pf_pdf_archive/396/396744914/39674… · Form 990-PF Return of Private Foundation OMB No 1545-0052 or Section

Form 990-PF Return of Private Foundation OMB No 1545-0052

or Section 4947(aXl) Nonexempt Charitable TrustTreated as a Private Foundation 2005

Department of the Treasury Note : The organization may be able to use a copy of this return to satisfy state2005

Internal Revenue Se rv ice reporting requirements

For calendar year 2005 , or tax year beginning , 2005 , and ending 9G Check all that apply: Initial return Final return Amended return Address change Name change

tpO

N

LU

Use the A Employer identification number

IRS label . James and Yvonne Ziemer Family 39-6744914Otherwise ,

print Foundation B Telephone number (see instructions)

ortype. W227 S4175 Concord Court 262-650-8974See Specific Waukesha, WI 53189-8001 C If exemption application is pending, check hereInstructions. D 1 Foreign organizations , check hereH Check type of organization, Section 501(c)(3 exempt private foundation 2 Foreign organizations meeting the 85% test, check

Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation❑

here and a tt ach computation . .

Fair market value of all assets at end of year J Accounting method- N Cash Accrual E If private foundation status was terminated ❑tinder section 507(b)(1 )(A) check here(from Part ll, column (c), line 16) Other (specify) _ _ _ _ _ _ _ _ _ _ _ _ _

,F If the foundation is Ina 60 month termination

$ 564, 361. (Part 1, column (d) must be on cash basis.) tinder section 507(b)(1)(B), check here .art Analysis of Revenue and a Revenue and() (b) Net investment (c) Adjusted net (d) Disbursements

totalExpenses(The amounts In expenses per books income income for charitable

(d)) may not sates-columns (b) , (c), and purposessanly equal the amounts in column (a) (cash basis only)(see Instructions).)

gifts, grants. etc , received (att sch)1 Contributions, 260,520.�1

2 Ck I Ili I if the foundn is not req to all Sch B3 Interest on savings and temporary

cash investments 277. 277. N/A4 Dividends and interest from securities 4, 326. 4,326.5a Gross rents . ...b Net rental income

or (loss)6a Net gain/ ( loss) from sale of assets not on line 10

RE

b Gross sales price for a llassets on line 6a

V 7 Capital gain net income (from Part IV, line 2)

E 8 Net short -term capital gainNU 9 Income modifications

E10a Gross sales less

returns andallowances

b Less: Cost ofgoods sold

c Gross profit /( loss) (a tt sch)sdhed'ule)11 Other income (attach -' l

1 9 Total=Add-tlneslfhrou S1i1 265,123. 4,603.ir ctor al tees, etc1 ompensation f officers, d e 0.R r��

1 thef P1o'ye ,sjn `e4t�Aa[wa MI)il fits1 nslon plans, employee .

AD 1a Leg;l e4 h >�c edue)

T17

OlAc__ Oil g ees '(atta h scN

o 1 Ot'T r oof ees (attachsch) See St 1 626.E sE T 17 InterestR R 18 Taxes ( a ttach schedule) See Stmt 2 16.T T 19 Depreciation ( a ttach schedule ) and depletion

Nv 20 Occupancy

G E 21 Travel, conferences, and meetingsA E 22 Printing and publicationsND p 23 Other expenses (attach schedule)

ENSs

24 Total operatin g and administrativeexpenses . Add lines 13 through 23 642.

25 Contributions , gifts, grants paid Stmt 3 42, 900. 42,900.26 Total expenses and disbursements.

Add lines 24 and 25 43,542. 0. 42,900.27 Subtract line 26 from line 12:

a Excess of revenue over expensesand disbursements 221, 581.

b Net Investment Income ( f negative, enter -0.) . 4,603.C Adjusted net Income ( if negative, enter -0-)

BAA For Privacy Act and Paperwork Reduction Act Notice , see the instructions . TEEA0503L 09/19/05 Form 990-PF (2005)

�s

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Form 990-PF (2005) James and Yvonne Ziemer Family 39-6744914 Pace 2Attached schedules and amounts in the description Beginning of year End of year

Part II Balance Sheets column should be for end-of-year amounts only(See instructions) (a) Book Value (b) Book Value (c) Fair Market Value

1 Cash - non-interest-bearing 9, 010. 25, 071. 25, 071.2 Savings and temporary cash investments3 Accounts receivable .

Less allowance for doubtful accounts b- _ _ _ _ _ _ _ _ _4 Pledges receivable 0. _

Less: allowance for doubtful accounts 11----------5 Grants receivable .

6 Receivables due from officers, directors, trustees, and otherdisqualified persons (attach schedule) (see instructions)

7 Other notes and loans receivable (attach sch) ll�s

----------Less: allowance for doubtful accounts

s---------

8 Inventories for sale or useet 9 Prepaid expenses and deferred chargess 10a Investments - U S and state government

obligations (attach schedule) . .b Investments - corporate stock (attach schedule) 319, 755. 525, 275. 539,290.

c Investments - corporate bonds (attach schedule).

11 Investments - land, buildings, andequipment. basis

Less- accumulated depreciation(attach schedule). ----------

12 Investments - mortgage loans13 Investments - other (attach schedule)14 Land, buildings, and equipment: basis - _ _ _ _ _ _ __ _

Less. accumulated depreciation(attach schedule) . ----------

15 Other assets (describe16 Total assets (to be completed by all filers -

see instructions. Also, see page 1, item I 328, 765. 550, 346. 564, 361.L 17 Accounts payable and accrued expenses . .a 18 Grants payable .b 19 Deferred revenue .

20 Loans from officers, directors, trustees, & other disqualified persons

21 Mortgages and other notes payable (attach schedule) .t 22 Other liabilities (describe.es 23 Total liabilities (add lines 17 through 22) 0. 0.

Organizations that follow SFAS 117, check hereand complete lines 24 through 26 and lines 30 and 31.

N F 24 Unrestrictede ut n 25 Temporarily restricted '

d 26 Permanently restricted ...As a Organizations that do not follow SFAS 117, check here Xs a and complete lines 27 through 31.e It a 27 Capital stock, trust principal, or current funds . . 328, 765. 550,346.s n 28 Paid-in or capital surplus, or land, building, and equipment fund

c 29 Retained earnings, accumulated income, endowment, or other fundsr s 30 Total net assets or fund balances (see instructions) 328, 765. 550,346.

31 Total liabilities and net assets/fund balances(see instructions) 328, 765. 550,346. 1

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 30 (must agree withend-of-year figure reported on prior year's return) 1 328, 765.

2 Enter amount from Part I, line 27a . . . 2 221,581.3 Other increases not included in line 2 (itemize) 10

----------------------------- - 34 Add lines 1, 2, and 3 . . 4 550, 346.

5 Decreases not included in line 2 (itemize) ________________ _____________ _5

6_

Total net assets or fund balances at end of year (line 4 minus line 5 - Part II column (b), line 30 6 550,346.BAA TEEA0302L 09/19/05 Form 990-PF (2005)

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Form 990-PF (2005) James and Yvonne Ziemer Family 39-6744914 Page 3Part 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-sto ry brick warehouse ; or common stock , 200 shares MLC Company)

How acquiredP - PurchaseD - Donation

c Date acquired(month, day, year)

Date sold(month, day, year)

1 a N/Abcde

(e) Gross sales price (f) Depreciation allowed(or allowable)

(g) Cost or other basisplus expense of sale

(h) Gain or (loss)(e) plus (f) minus (g)

abcdeComplete only for assets showing gain in column (h) and owned b the foundation on 12/31/69 (I) Gains ( Column (h)

(i) Fair Market Valueas of 12/31169

0) Adjusted basisas of 12/31/69

(k) Excess of column (1)over column 0), if any

gain minus column ( k), but not lessthan -0 -) or Losses (from column (h))

abcde

2 Capital gain net income or (net capital loss ) If gain, also enter in Part I, Ilne 7If (loss), enter - 0- in Part I, Ilne 7 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 3

[Part V I Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)

If section 4940(d)(2) applies, leave this part blank.

Was the organization liable for the section 4942 tax on the distributable amount of any year in the base period? Yes X❑ No

If 'Yes,' the organization does not qualify under section 4940 (e) Do not complete this part

1 Enter the appropriate amount in each column for each year; see instructions before making any entries.

aBase period years

Calendar year (or tax yearbeginning in)

(b)Adjusted qualifying distributions

c)Net value of

noncharitable-use assetsDistribution ratio

(column (b) divided by column (c))

2004 26,084. 199,143. 0.1309812003 18,018. 182 347. 0.0988122002 13,365. 216,317. 0.0617842001 8,550. 191,942. 0.0445452000

2 Total of line 1, column (d) 2 0.336122

3 Average distribution ratio for the 5-year base period - divide the total on linenumber of years the foundation has been in existence if less than 5 years

2 by 5, or by the3 0 . 084031

4 Enter the net value of noncharitable-use assets for 2005 from Part X, line 5 4 476, 861.

5 Multiply line 4 by line 3 5 40,071.

6 Enter I% of net investment income (I% of Part I, line 27b) 6 46.

7 Add lines 5 and 6 7 40,117.

8 Enter qualifying distributions from Part XII, line 4 8 42,900.If line 8 is equal to or greater than line 7 , check the box in Part VI, line 1 b, and complete that part using a I% tax rate. See thePart VI instructions

BAA Form 990-PF (2005)TEEA0303L 09/19/05

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Form 990-PF (2005) James and Yvonne Ziemer Family 39-6744914 Page 4Part VI Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see instructions)

1 a Exempt operating foundations described in section 4940(d)(2), check here ► and enter 'N/A' on line 1.Date of ruling letter. _ _ _ _ _ _ _ (a ttach copy of ruling letter if necessa ry - see instructions)

b Domestic organizations that meet the section 4940(e) requirements in Part V, 1 46.check here ► X❑ and enter I% of Part I, line 27b

c All other domestic organizations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, column (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 46.4 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 46.6 Credits/Paymentsa 2005 estimated tax pmts and 2004 overpayment credited to 2005 6ab Exempt foreign organizations - tax withheld at source 6bc Tax paid with application for extension of time to file (Form 8868) . . . 6cd Backup withholding erroneously withheld 6d

7 Total credits and payments Add lines 6a through 6d 7 0.8 Enter any penalty for underpayment of estimated tax. Check here LI if Form 2220 is attached 89 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed ► 9 46.

10 Overpayment . If line 7 is more than the total of lines 5 and 8, enter the amount overpaid ► 1011 Enter the amount on line 10 to be: Credited to 2006 estimated tax ► Refunded ► 11

Part VII -A Statements Regarding Activitiesor local le islation or did itfl n n n ti nal statett t td th t1 th t dD

Yes Noy , , gion a emp o in ue ce a a oax year, e organizauring e iaparticipate or intervene in any political campaign? . 1 a X

b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)? .. . . lb X

If the answer is 'Yes' to la or lb, attach a detailed description of the activities and copies of any materials publishedor distributed by the organization in connection with the activities.

c Did the organization file Form 1120-POL for this year? 1 c Xd Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year-

(1) On the organization . ► $ 0. (2) On organization managers ► $ 0.e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed onorganization managers ► $ 0.

2 Has the organization engaged in any activities that have not previously been reported to the IRS? 2 X

If 'Yes,' attach a detailed description of the activities

3 Has the organization made any changes, not previously reported to the IRS, in its governing instrument, articlesof incorporation, or bylaws, or other similar instruments? If 'Yes,' attach a conformed copy of the changes 3 X

4a Did the organization have unrelated business gross income of $1,000 or more during the year? 4a X

b If 'Yes,' has it filed a tax return on Form 990-T for this year? . 4b N IA5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? . . . 5 X

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

• By language in the governing instrument, or

• 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 X

7 Did the organization have at least $5,000 in assets at any time during the year? If 'Yes,' complete Part ll, column (c), and Part XV . . 7 X

8a Enter the states to which the foundation reports or with which it is registered (see instructions )

N/A ----------------------------------------------------b If the answer is 'Yes' to line 7, has the organization 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 X

9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(I)(3) or 4942(1)(5) for calendar year 2005 orthe taxable year beginning in 2005 (see instructions for Part XIV)? If 'Yes,' complete Part XIV . . 9 X

10 Did any persons become substantial contributors during the tax year? .. . . . 10 X

If 'Yes,' attach a schedule listing their names and addresses.11 Did the organization comply with the public inspection requirements for its annual returns and exemption application? 11 X

Web site address ► None----------------------------------- ------12 The books are in care of ► James Ziemer Telephone no. ► 262-650-8

----------------------------- ------- 974------Located at ► W227 S4175 Concord Court, Waukesha WI ZlP + 4 ► 53189-8001----------------------------------- --------

N./-/A13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 - Check here-

and enter the amount of tax-exempt interest received or accrued during the year ►I 13 N/ABAA Form 990-PF (2005)

TEEA0304L 09/19/05

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Form 990-PF (2005) James and Yvonne Ziemer Family 39-6744914 Page 5Part VII-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 No1 a During the year did the organization (either directly or indirectly):

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? [Yes El No

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) adisqualified person?. Yes N No

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? Yes E No(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?. . .. . . Yes N No

(5) Transfer any income or assets to a disqualified person (or make any of either availablefor the benefit or use of a disqualified person)?.. . . . . . .. [Yes XNNo

(6) Agree to pay money or property to a government official? ( Exce ption . Check ' No' if theorganization agreed to make a grant to or to employ the official for a period after terminationof government service , if terminating within 90 days .). . [] Yes XX No

b If any answer is 'Yes ' to la(1)-(6), did any of the acts fail to q ualify under the exceptions described inRegulations section 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)? .Organizations relying on a current notice regarding disaster assistance check here

c Did the organ i zat i on engage in a prior year in any of the acts described in la, other than excepted acts,that were not corrected before the first day of the tax year beginning in 20057

2 Taxes on failure to distribute income ( section 4942) (does not apply for years the organization was aprivate operating foundation defined in section 4942 (1)(3) or 4942()(5)).

a At the end of tax year 2005 , did the organization have any undistributed income ( lines 6dand 6e , Part XIII ) for tax year (s) beginning before 2005 ? .. . [Yes X1 NoIf 'Yes,' list the years 01 20_ - , 20 - , 20_ - , 20_ _

b Are there any years listed in 2a for which the organization 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) toall years listed, answer ' No' and attach statement - see instructions) . . .

c If the provisions of section 4942 (a)(2) are being applied to any of the years listed in 2a , list the years here.11 20_ _ , 20 _ , 20 _ , 20 _

3a Did the organization hold more than a 2% direct or indirect interest in any businessenterprise at any time during the year? . . . ... . E]Yes 0 No

b If 'Yes ,' did it have excess business holdings in 2005 as a result of (1) any purchase by the organizationor disqual i f i ed persons after May 26, 1969, (2) the lapse of the 5 -year period (or longer period approvedby the Commissioner under section 4943 (c)(7) ) to dis pose of holdings acquired by g ift or bequest; or(3) the lapse of the 10 -, 15-, or 20 - year first phase holding period? (Use Schedule C, Form 4720, todetermine if the organization had excess business holdings in 2005.) . .

4a Did the organization invest during the year any amount in a manner that would jeopardize itscharitable purposes? . .

b Did the organization make any investment in a prior year (but after December 31, 1969) that couldjeopardize its charitable purpose that had not been removed from jeopardy before the first day ofthe tax year beginning in 2005? .

5a During the year did the organization pay or incur any amount to(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945 (e))? . . . [ Yes X❑ No

(2) Influence the outcome of any specific public election (see section 4955); or to carryon, directly or indirectly , any voter registration drive? Yes X No

(3) Provide a grant to an individual for travel, study, or other similar purposes ? . Yes X No

(4) Provide a grant to an organization other than a charitable , etc, organization describedin section 509(a)( 1), (2), or (3), or section 4940 (d)(2)? [ Yes No

(5) Provide for any purpose other than religious, charitable , scientific, literary, oreducational purposes , or for the prevention of cruelty to children or animals? [ Yes XI No

1 bl NVA

1cI I X

2bl NVA

3bl NVA1X

4b X

b If any answer is 'Yes ' to 5a(1)-(5), did any of the transactions fail to qualify under the exceptionsdescribed in Regulations section 53 4945 or in a current notice regarding disaster assistance(see instructions) ? . . 5b N AOrganizations relying on a current notice regarding disaster assistance check here

c If the answer is 'Yes ' to question 5a(4), does the organization claim exemption from thetax because it maintained expenditure responsibi li ty for the grant? N/A [ Yes [ NoIf 'Yes ,' attach the statement required by Regulations section 53.4945-5(d).

6a Did the organization, during the year , receive any funds, directly or indirectly , to pay premiumson a personal benefit contract? Des X] No

b Did the organization , during the year, pay premiums, directly or indirectly, on a personal benefit contract? 6b XIf you answered ' Yes' to 6b, also file Form 8870

BAA TEEA0305L 09/19/05 Form 990-PF (2005)

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Form 990-PF 2005) James and Yvonne Ziemer Family 39-6744914 Page 6Part VIII Information About Officers , Directors , Trustees , Foundation Managers , Highly Paid Employees,

and Contractors1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).

(a) Name and address(b) Title and average

hours per weekdevoted to position

(c) Compensation(If not paid , enter -0-)

(d) Contributions toemployee benefitplans and deferred

compensation

(e) Expense account,other allowances

------------------------See Statement 4 0. 0. 0.

------------------------

------------------------

- - - - - - - - - - - - - - -- - - - - - - - -

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 weekdevoted to position

(c) Compensation (d) Contributions toemployee benefitplans and deferred

compensation

(e) Expense account,other allowances

None------------------------

------------------------

------------------------

------------------------

- - - - - - - - - - - - - - -- - - - - - - - -

Total number of other employees paid over $50,00Q3 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) CompensationNone--------------------------------------

--------------------------------------

--------------------------------------

--------------------------------------

--------------------------------------

Total number of others receiving over $50,000 for professional services

Part -IX---A7] 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 I Expensesorgani z ations and other beneficiaries served, conferences convened, research papers produced, etc.

1 The James_and Yvonne Ziemer Family Foundation is orqanized and_operated to make cash donations to cqualifying_Qublic charities. -The--------------------- -------------Foundation does not enaaae in any other direct charitable activities.

2 ------------------------------------------------------

3 ------------------------------------------------------------------------------------------------------------

4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - -

BAA TEEA0306L 09/19/05 Form 990-PF (2005)

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Form 990-PF (2005) James and Yvonne Ziemer Family 39-6744914 Page 7

Part IX-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 Amount1 N/A------------------------------------------------------------------------------------------------------------

2 ------------------------------------------------------------------------------------------------------------

All other program-related investments. See instructions.3 ------------------------------------------------------------------------------------------------------------

Total. Add lines 1 through 3 0.

Part X Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)

blld f tl t h t tk l f t d h dF c, purposes.or use) irec y in carrying ou c ari a e, eair mar et va assets no use (or e1 ue oa Average monthly fair market value of securities 1 a 467,082.b Average of monthly cash balances . 1 b 17,041.c Fair market value of all other assets (see instructions) . . . 1 cd Total (add lines 1a, b and c) 1 d 484,123.e Reduction claimed for blockage or other factors reported on lines la and lc

(attach detailed explanation) . .. 1 e 0.2 Acquisition indebtedness applicable to line 1 assets 2 0.3 Subtract line 2 from line 1d ... . 3 484,123.4 Cash deemed held for charitable activities. Enter 1-1/2% of line 3 (for greater amount, see instructions) 4 7,262.5 Net value of noncharitable -use assets . Subtract line 4 from line 3 Enter here and on Part V, line 4 5 476,861.6 Minimum investment return . Enter 5% of line 5 6 23, 843.

Pa rt XI Distributable Amount (see instructions) (Section 49420)(3) and (1)(5) private operating foundations and certainforeign organizations check here and do not complete this part

1 Minimum investment return from Part X, line 6. . . 1 23, 843.2a Tax on investment income for 2005 from Part VI, line 5 2a 46.b Income tax for 2005 (This does not include the tax from Part VI.) . 2bc Add lines 2a and 2b . . 2c 46.

3 Distributable amount before adjustments. Subtract line 2c from line 1 3 23,797.4 Recoveries of amounts treated as qualifying distributions 4

5 Add lines 3 and 4 . . . 5 23,797.6 Deduction from distributable amount (see instructions) . . 67 Distributable amount as adjusted Subtract line 6 from line 5 Enter here and on Part XIII, line 1 7 23,797.

Part XII Qualifying Distributions (see instructions)

bll h h tl i t td d c, purposes:o accomp is ari a e, eing a m nistrative expenses) c1 Amounts paid (inc ua Expenses, contributions, gifts, etc - total from Part I, column (d), line 26 1 a 42,900.b Program-related investments - total from Part IX-B . . 1 b

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) . . . 3b4 Qualifying distributions . Add lines la through 3b Enter here and on Part V, line 8, and Part XIII, line 4 4 42,900.

5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment incomeEnter 1 %a of Part I, line 27b (see instructions) . . . . 5 46.

6 Adjusted qualifying distributions . Subtract line 5 from line 4. 6 42,854.

Note : The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundationqualifies for the section 4940(e) reduction of tax in those years.

BAA Form 990-PF (2005)

TEEA0307L 11/07/05

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Form 990-PF (2005) James and Yvonne Ziemer Family 39-6744914 Page 8

Part XIII Undistributed Income (see instructions)

(a) brio

(c (d)Corpus Years p r to 2004 2004 2005

1 Distributable amount for 2005 from Part XI,line 7 . 23,797.

2 Undistributed income, if any, as of the end of 2004.a Enter amount for 2004 only 0.b Total for prior years- 20, 20 , 20 0.

3 Excess distributions carryover_

, if any, to 2005:a From 2000 . . . .b From 2001c From 2002 . . 1,520.d From 2003. 8,968.e From 2004 . . 16,159.f Total of lines 3a through e 26,647.

4 Qualifying distributions for 2005 from PartXII, line 4• ► $ 42, 900.

a Applied to 2004, 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 2005 distributable amount 23,797.e Remaining amount distributed out of corpus 19,103.

5 Excess distributions carryover applied to 2005 . . 0. 0.(If an amount appears in column (d), thesame amount must be shown In column (a) )

6 Enter the net total of each column asindicated below:

a Corpus Add lines 3f, 4c, and 4e. Subtract line 5 45, 750.

b Prior years' undistributed income. Subtractline 4b from line 2b . . .. 0.

c Enter the amount of prior years' undistribut-ed income for which a notice of deficiencyhas been issued, or on which the section4942(a) tax has been previously assessed 0.

d Subtract line 6c from line 6b. Taxableamount - see instructions . 0.

e Undistributed income for 2004. Subtract line 4a fromline 2a. Taxable amount - see instructions. 0.

f Undistributed income for 2005. Subtract lines4d and 5 from line 1. This amount must bedistributed in 2006 0.

7 Amounts treated as distributions out ofcorpus to satisfy requirements imposed

4942 3b E) or )by section 170( )(1)( (g)((see instructions) 0.

8 Excess distributions carryover from 2000 notapplied on line 5 or line 7 (see instructions) 0.

9 Excess distributions carryover to 2006.Subtract lines 7 and 8 from line 6a 45, 750.

10 Analysis of line 9:a Excess from 2001b Excess from 2002 1,520.c Excess from 2003 8,968.d Excess from 2004 16, 159.e Excess from 2005 19,103.

BAA Form 990-PF (2005)

TEEA0308L 09/19/05

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Form 990-PF (2005) James and Yvonne Ziemer Family 39-6744914 Page 9Part XIV Private Operating Foundations (see instructions and Part VII-A, question 9) N/A

1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the rulinglo.is effective for 2005, enter the date of the ruling .. .. . .

b Check box to indicate whether the organization is a private o eratin foundation described in section 49420)(3) or 7 49420)(5)2a Enter the lesser of the adjusted net Tax year Prior 3 years

income from Part I or the minimum (a) 2005 (b) 2004 (c) 2003 (d) 2002 (e) Totalinvestment return from Part X foreach year listed . ... .

b 85% of line 2ac Qualifying distributions from Part XII,

line 4 for each year listed . .d Amounts included in line 2c not used directly

for active conduct of exempt activitiese Qualifying distributions made directly

for active conduct of exempt activitiesSubtract line 2d from line 2c

3 Complete 3a, b, or c for thealternative test relied upon

a 'Assets' alternative test - enter:(1) Value of all assets(2) Value of assets qualifying under

section 4942(I)(3)(B)(1) . .. .b 'Endowment' alternative test - Enter 2/3 ofminimum investment return shown in Part X,line 6 for each year listed . .....

c 'Support' alternative test - enter:(1) Total support other than gross

investment income (interest,dividends, rents, paymentson securities loans (section512(a)(5)), or royalties)

(2) Support from general public and 5 ormore exempt organizations as providedin section 4942(I)(3)(B)(uQ

(3) Largest amount of support froman exempt organization

(4) Gross investment incomePart XV Supplementa ry Information (Complete this part only if the organization had $5,000 or more in assets at any time during the year.)

1 Information Regarding Foundation Managers:

a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation before theclose of any tax year (but only if they have contributed more than $5,000) (See section 507(d)(2) )None

b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership ofa partnership or other entity) of which the foundation has a 10% or greater interest.None

2 Information Regarding Contribution , Grant , Gift, Loan , Scholarship , etc, Programs:Check here 1, XI if the organization only makes contributions to preselected charitable organizations and does not accept unsolicited

requests for funds If the organization makes gifts, grants, etc, (see instructions) to individuals or organizations under other conditions,complete items 2a, b, c, and d

a The name, address, and telephone number of the person to whom applications should be addressed:

b The form in which applications should be submitted and information and materials they should include-

c Any submission deadlines:

d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:

BAA TEEA0309L 09/19/05 Form 990-PF (2005)

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Form 990-PF (2005) James and Yvonne Ziemer Family 39-6744914 Page 10Pa rt XV Supplementary Information (continued)3 Grants and Contributions Paid During the Year or Approved for Future Payment

RecipientIf recipient is an individual,show any relationship to

any foundation manager orFoundationFoundationstatus

sof of grant or

contribution AmountName and address (home or business) substantial contributor recipient

a Paid during the year

Total 3ab Approved for future payment

Total 0- 3blBAA TEEA031OL 09/19/05 Form 990-PF (2005)

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Form 990-PF (2005) James and Yvonne Ziemer Family 39-6744914 Page 11

IPart XVI-A Analysis of Income-Producing Activities

Enter

Cf

2345ah

6789

1011

e12 Subtotal13 Total . Add line 12, columns (b), (d), and (e) 13 4, 603.

(See worksheet in the instructions for line 13 to verify calculations

Part XVI-B Relationship of Activities to the Accomplishment of Exempt Purposes

gross amounts unless otherwise indicated Unrelated business income Excluded by section 512, 513, or 514

rogram service revenue

(a)Businesscode

(b)Amount

(c)Exclu-sioncode

(d)Amount

(e)Related or exemptfunction income(see instructions)

Fees and contracts from government agenciesMembership dues and assessmentsInterest on savings and temporary cash investments 14 277.Dividends and interest from securities 14 4, 326.Net rental income or (loss) from real estate,Debt-financed propertyNot debt-financed propertyNet rental income or (loss) from personal propertyOther investment incomeGain or (loss) from sales of assets other than inventoryNet income or (loss) from special eventsGross profit or (loss) from sales of inventoryOther revenue:

Add columns (b), (d), and (e) 4, 603.

BAA TEEA0501L 09/19/05 Form 990-PF (2005)

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Form 990-PF 2005) James and Yvonne Ziemer Family 39-6744914 Page 12Part XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitable

1 Did the organization directly or indirectly engage in any of the following with any other organizationdescribed in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527,relating to political organizations?

a Transfers from the reporting organization to a nonchantable exempt organization of:(1) Cash . .. .... . . .. .. la(2) Other assets . .. la

b Other transactions.(1) Sales of assets to a nonchantable exempt organization 1 b(2) Purchases of assets from a noncharitable exempt organization 1 b(3) Rental of facilities, equipment, or other assets . . 1 b(4) Reimbursement arrangements . . 1 b

(5) Loans or loan guarantees 1 b(6) Performance of services or membership or fundraising solicitations .. . . . . . lb

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees 1 c

YesI No

xX

XXXXXXX

d If the answer to any of the above is ' Yes,' complete the following schedule Column (b) should always show the fair market value ofthe goods, other assets, or services given by the reporting organization . If the organization received less than fair market value inany 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 noncharltable exempt organization (d) Description of transfers, transactions , and sharing arrangementsN/A

2a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizationsdescribed in section 501(c) of the Code (other than section 501(c)(3)) or in section 527' E Yes j No

b If 'Yes .' complete the followina schedule.(a) Name of organization (b) Type of organization (c) Description of relationship

N/A

Under penalties of perjury. I declare that I have examined this return, including accompany -^^'^ ^^a '^ " ^ `^^' ^` ^ ' ^^ '^ ^^ ^^^ ^' ^` ' ^' ^^ ^^' ^^complete Declaration of preparer (other than taxpayer or fiduciary) is based on all informal

stG S gnatu e if officer or trusteeN

r

EPreparer's

Paid signature M r n Bull hR Pre-E parer'S Firm's name (or Michael Bes & :iedrich LL

pp. 'Only employed),f N19 W24133 Riverwood Drive,Only dd dress, ana Waukesha, WI 53188-1174ZIP code

BAA

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2005 Federal Statements Page 1James and Yvonne Ziemer Family

Client 13874-3 Foundation 39-67449142/28/06 10:45AM

Statement 1Form 990-PF , Pa rt I, Line 16cOther Professional Fees

(a) (b) Net (c) (d)Expenses Investment Adjusted Charitableper Books Income Net Income Purposes

Tax preparation fees $ 626.Total 626. 0. 0.

Statement 2Form 990 -PF, Pa rt I , Line 18Taxes

(a) (b) Net (c) (d)Expenses Investment Adjusted Charitableper Books Income Net Income Purposes

IRS $ 16.Total 16. 0. 0.

Statement 3Form 990 -PF, Pa rt I , Line 25Contributions, Gifts, and Grants

Cash Grants and Allocations

Class of Activity:Donee's Name: Junior AchievementDonee's Address:

Relationship of Donee: NoneOrganizational Status of Donee:Amount Given: $ 1,700.

Class of Activity:Donee's Name: UPAFDonee's Address:

Relationship of Donee: NoneOrganizational Status of Donee:Amount Given: 1,000.

Class of Activity:Donee's Name: MDADonee's Address:

Relationship of Donee: NoneOrganizational Status of Donee:Amount Given: 1,250.

Class of Activity:Donee's Name: Susan Komen Race for a CureDonee's Address:

Relationship of Donee: NoneOrganizational Status of Donee:

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2005 Federal StatementsJames and Yvonne Ziemer Family

Client 13874-3 Foundation2/28/06

Statement 3 (continued)Form 990 -PF, Part I , Line 25Contributions , Gifts, and Grants

Amount Given:

Class of Activity:Donee's Name:Donee's Address:

Relationship of Donee:Organizational Status of Donee:Amount Given:

Class of Activity:Donee's Name:Donee's Address:

Relationship of Donee:Organizational Status of Donee:Amount Given:

Class of Activity:Donee's Name:Donee's Address:

Relationship of Donee:Organizational Status of Donee:Amount Given:

Class of Activity:Donee's Name:Donee's Address:

Relationship of Donee:Organizational Status of Donee:Amount Given:

Class of Activity:Donee's Name:Donee's Address:

Relationship of Donee:Organizational Status of Donee:Amount Given:

Class of Activity:Donee's Name:Donee's Address:

Relationship of Donee:Organizational Status of Donee:Amount Given:

Class of Activity:Donee's Name:Donee's Address:

Relationship of Donee:Organizational Status of Donee:

UWM Foundation

None

United Way

None

MGC Endowment Fund

None

Milw Muskies Chapter

None

Channel 10/36 Friends

None

First Stage Children Theatre

None

Crystal Falls Comm Fund

None

$

Page 239-6744914

10:45AM

100.

5,000.

25,000.

200.

500.

200.

250.

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12005Client 13874-32/28/06

Statement 3 (continued)Form 990 -PF, Part I , Line 25Contributions , Gifts, and Grants

Amount Given:

Federal StatementsJames and Yvonne Ziemer Family

Foundation

Class of Activity:Donee's Name:Donee's Address:

Relationship of Donee:Organizational Status of Donee:Amount Given:

Class of Activity:Donee's Name:Donee's Address:

Relationship of Donee:Organizational Status of Donee:Amount Given:

Class of Activity:

UW La Crosse Athletics Fund

La Crosse, WINone

LRBCRF

WINone

Donee's Name: Ride to Cure DiabetesDonee's Address:

WIRelationship of Donee: NoneOrganizational Status of Donee:Amount Given:

Class of Activity:Donee's Name : Boys and Girls ClubsDonee's Address:

Relationship of Donee: NoneOrganizational Status of Donee:Amount Given:

Statement 4Form 990-PF, Part VIII, Line 1List of Officers, Directors, Trustees, and Key Employees

Page 339-6744914

10 45AM

1,000.

5,000.

200.

500.

1,000.

Total 42,900.

Title and Contri- ExpenseAverage Hours Compen- bution to Account/

Name and Address Per Week Devoted sation EBP & DC Other

James Ziemer Trustee $ 0. $ 0. $ 0.W227 S4175 Concord Court NoneWaukesha, WI 53189

Yvonne Ziemer Trustee 0. 0. 0.W227 S4175 Concord Court NoneWaukesha, WI 53189

Total 0. 0.


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