2024-03-22T12:35:22-05:00 2023-12-31 420714325 RSM US LLP 227 WEST FIRST STREET SUITE 700 DULUTH MN 55802 990PF 2023-01-01 411873951 THE PATCH FOUNDATION PATC 6127817677 3201 RANKIN ROAD MINNEAPOLIS MN 55418 CAROLYN SAMPLE PRESIDENT 6127817677 2024-03-21 1 CAROLYN SAMPLE 999009999 0 JULIE BOYER P01278549 2187275025 2024-03-21 3 AAL1 IAL1 2023 2023-04-26 12:10:37Z X 4996414 X 20000 2137 2137 160040 160040 45520 802236 45520 227697 207697 0 0 0 2835 1418 1417 45 0 45 2880 1418 1462 1077000 1077000 1079880 1418 1078462 -852183 206279 727779 67899 67899 441063 1005475 1005475 4246916 3490201 3923040 5415758 4563575 4996414 0 0 X 0 0 0 0 5415758 4563575 5415758 4563575 5415758 4563575 5415758 -852183 0 4563575 0 4563575 PUBLICLY TRADED SECURITIES P 802236 756716 45520 45520 45520 2867 0 2867 0 2867 3321 0 0 0 3321 0 454 454 0 0 0 0 0 0 0 0 0 0 0 1 1 MN 1 0 0 0 0 1 N/A THE FOUNDATION 6127817677 3201 RANKIN ROAD MINNEAPOLIS MN 55418 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 CAROLYN SAMPLE 3201 RANKIN RD MINNEAPOLIS MN 55418 PRESIDENT 2.00 0 0 0 ERNEST LINDSTROM-LINDSTROM LAW OFFI 7600 PARKLAWN AVE STE 444 EDINA MN 55435 DIRECTOR 0.50 0 0 0 RONALD K DRAPER 861 OAKGREEN AVE PL N STILLWATER MN 55082 DIRECTOR 0.50 0 0 0 NONE 0 NONE 0 0 4698453 365908 0 5064361 0 0 5064361 75965 4988396 249420 249420 2867 2867 246553 0 246553 0 246553 1078462 0 1078462 246553 0 0 683682 792999 728182 653599 774807 3633269 1078462 0 0 0 246553 831909 0 0 4465178 0 0 0 0 0 0 683682 3781496 792999 728182 653599 774807 831909 CAROLYN SAMPLE CAROLYN P SAMPLE 3201 RANKIN ROAD NE MINNEAPOLIS MN 55418 6127817677 ORGANIZATIONS APPLYING SHOULD PROVIDE INFORMATION SIMILAR TO THAT SET FORTH BELOW: 1. ORGANIZATION NAME AND ADDRESS. 2. STATE IN WHICH APPLICANT IS ORGANIZED AS A NONPROFIT ENTITY. IF NOT SO ORGANIZED, EXPLAIN. 3. ATTACH ANY RULING OR DETERMINATION LETTER FROM INTERNAL REVENUE SERVICE ABOUT EXEMPT STATUS OR PRIVATE FOUNDATION STATUS. 4. COPY OF APPLICANT'S PROPOSED BUDGET AND PURPOSE OF ORGANIZATION. 5. IS APPLICANT CONTROLLED BY, RELATED TO, CONNECT WITH, OR SPONSORED BY ANOTHER ORGANIZATION? IF YES, IDENTIFY PARENT ENTITY. 6. SHOW AMOUNT REQUESTED AND HOW IT WILL BE USED. 7. SIGNED BY AUTHORIZED PERSON. NONE IN AWARDING GRANTS, THE FOUNDATION GIVES PREFERENCE TO MINNESOTA CHARITABLE ORGANIZATIONS. MEDICAL FOUNDATIONS, EDUCATION AND THE ARTS RECEIVE PRIME CONSIDERATION. GRANTS ARE NORMALLY RESTRICTED TO $1,000 OR LESS. APPLICANTS ARE USUALLY NOTIFIED WITHIN TWO MONTHS THAT THEIR APPLICATION HAS BEEN APPROVED OR REJECTED, OR THAT ADDITIONAL INFORMATION IS NEEDED. FOUNDATION DOES NOT PROVIDE APPLICATION FORMS. AGATE HOUSING & SERVICES 2309 NICOLLET AVE MINNEAPOLIS MN 55404 NONE PC PROGRAM SUPPORT 20000 ALASKA CHRISTIAN COLLEGE 35109 ROYAL PLACE SOLDNOTNA AK 99669 NONE PC EDUCATIONAL 7000 BANYAN COMMUNITY 2529 13TH AVE SO MINNEAPOLIS MN 55404 NONE PC EDUCATIONAL 5000 BETHEL UNIVERSITY 3900 BETHEL DR ST PAUL MN 55112 NONE PC EDUCATIONAL 5000 BIG IDEAS 23 S MINNESOTA ST NEW ULM MN 56073 NONE POF EDUCATIONAL 5000 CAMP KNUTSON 11148 MANHATTAN PT BLVD CROSSLAKE MN 56442 NONE PC RELIGIOUS 5000 COURAGE KENNY REHABILITATION INSTITUTE 3915 GOLDEN VALLEY RD MINNEAPOLIS MN 55422 NONE PC HEALTH 20000 COVENANT WORLD RELIEF PO BOX 773420 CHICAGO IL 60677 NONE PC RELIGIOUS 150000 CRISTO REY JESUIT HIGH SCHOOL 2924 4TH AVENUE SOUTH MINNEAPOLIS MN 55408 NONE PC EDUCATIONAL 5000 CROSS SERVICES 12915 WEINAND CIRCLE ROGERS MN 55374 NONE PC PROGRAM SUPPORT 3000 DUNWOODY COLLEGE OF TECHNOLOGY 818 DUNWOODY BLVD MINNEAPOLIS MN 55403 NONE PC EDUCATIONAL 15000 EVANGELICAL COVENANT CHURCH PO BOX 773420 CHICAGO IL 60677 NONE PC RELIGIOUS 200000 FAMILY VALUES FOR LIFE 1280 ARCADE ST ST PAUL MN 55106 NONE PC PROGRAM SUPPORT 5000 FEED MY STARVING CHILDREN 401 93RD AVE NW COON RAPIDS MN 54433 NONE PC RELIGIOUS 30000 GREATER MINNEAPOLIS CRISIS NURSERY 4544 4TH AVE SOUTH MINNEAPOLIS MN 55419 NONE PC PROGRAM SUPPORT 5000 HABITAT FOR HUMANITY 1954 UNIVERSITY AVE W ST PAUL MN 55104 NONE PC PROGRAM SUPPORT 15000 HENNEPIN TECHNICAL COLLEGE 9000 BROOKLYN BLVD BROOKLYN PARK MN 55445 NONE PC EDUCATIONAL 5000 HOMEWARD BOUND 12805 HIGHWAY 55 STE 400 PLYMOUTH MN 55441 NONE PC HEALTH 10000 HOPE ACADEMY 2300 CHICAGO AVE MINNEAPOLIS MN 55404 NONE PC EDUCATIONAL 5000 HOPE DENTAL CLINIC 800 MINNEHAHA AVENUE EAST 465 ST PAUL MN 55106 NONE PC PROGRAM SUPPORT 3000 KIWANIS CLUB OF NE MPLS 729 MARSHALL ST NE MINNEAPOLIS MN 55413 NONE PC PROGRAM SUPPORT 1000 LOAVES AND FISHES 721 KASOTA AVE SE MINNEAPOLIS MN 55414 NONE PC RELIGIOUS 25000 METRO HOPE MINISTRIES 2739 CEDAR AVENUE SOUTH MINNEAPOLIS MN 55407 NONE PC PROGRAM SUPPORT 30000 MINNESOTA ADULT AND TEEN CHALLENGE 740 E 24TH ST MINNEAPOLIS MN 55404 NONE PC PROGRAM SUPPORT 25000 NEW LIFE IN CHRIST MINISTRY PO BOX 456 CLEARWATER MN 55320 NONE PC RELIGIOUS 3000 PEOPLE SERVING PEOPLE 614 SOUTH THIRD STREET MINNEAPOLIS MN 55415 NONE PC PROGRAM SUPPORT 25000 SALEM COVENANT CHURCH 2655 FIFTH STREET NW NEW BRIGHTON MN 55112 NONE PC RELIGIOUS 144000 SCIENCE WITH A MISSION 602 MASSAPOAG AVE SHARON MA 02067 NONE PC PROGRAM SUPPORT 10000 SECOND HARVEST HEARTLAND 7101 WINNETKA AVE N BROOKLYN PARK MN 55428 NONE PC PROGRAM SUPPORT 50000 SHARING & CARING HANDS 425 NORTH SEVENTH ST MINNEAPOLIS MN 55405 NONE PC PROGRAM SUPPORT 7000 SIMPSON HOUSING SERVICES 160 GLENWOOD AVE MINNEAPOLIS MN 55405 NONE PC PROGRAM SUPPORT 25000 SPARTAN FOUNDATION INC 7229 CLINTON AVENUE RICHFIELD MN 55423 NONE PC EDUCATIONAL 7000 SUNSHINE ACRES CHILDREN'S HOME 3405 NORTH HIGLEY ROAD MESA AZ 85215 NONE PC PROGRAM SUPPORT 7000 THE GIDEONS INTERNATIONAL PO BOX 403810 ATLANTA GA 30384 NONE PC RELIGIOUS 5000 THE SALVATION ARMY 2445 PRIOR AVENUE NORTH ROSEVILLE MN 55113 NONE PC RELIGIOUS 100000 THRESHOLD TO NEW LIFE 10031 SARATOGA WAY MAPLE GROVE MN 55369 NONE PC PROGRAM SUPPORT 5000 TRINITY FIRST LUTHERAN SCHOOL 1115 19TH AVE SO MINNEAPOLIS MN 55404 NONE PC EDUCATIONAL 10000 TRUE FRIENDS 10509 108TH ST NW ANNANDALE MN 55302 NONE PC PROGRAM SUPPORT 10000 UNION GOSPEL MISSION 376 WESTERN AVE N ST PAUL MN 55103 NONE PC PROGRAM SUPPORT 10000 UNIVERSITY OF MINNESOTA FOUNDATION 200 OAK STREET SE 500 MINNEAPOLIS MN 55455 NONE PC EDUCATIONAL 50000 UNIVERSITY OF NORTHWESTERN 3003 SNELLING AVE N ST PAUL MN 55113 NONE PC EDUCATIONAL 5000 URBAN HOMEWORKS PO BOX 11267 MINNEAPOLIS MN 55411 NONE PC PROGRAM SUPPORT 5000 1077000 0 14 2137 14 160040 18 45520 0 207697 0 207697 0 0 0 0 0 0 0 0 0 0 X X 1 CAROLYN P SAMPLE 3201 RANKIN ROAD MINNEAPOLIS MN 55418 20000 X ACCOUNTING FEES 2835 1418 1417 MEDTRONIC STOCK 3326201 3624720 CHEVRON 164000 298320 STATE OF MN FILING FEE 25 0 25 MISCELLANEOUS 20 0 20