efile GRAPHIC rint - DO NOT PROCESS As Filed Data - DLN:93493318025574 OMB No 1545-0047 Return of Organization Exempt From Income Tax Form990 Department of the Treasury Internal Revenue Service A For the 2013 calendar year, or tax year beginning 01-01-2013 C Name of organ1zat1on B Check 1f applicable TEAM ORTHO FOUNDATION I Address change Doing Business As I Name change Initial return I Terminated I Amended return I Application pending Open to Public Inspection , 2013, and ending 12-31-2013 D Employer identification number 20-0685151 I I 2013 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) ~Do not enter Social Security numbers on this form as 1t may be made public By law, the I RS generally cannot redact the 1nformat1on on the form ~Information about Form 990 and its 1nstruct1ons 1s at www.IRS.gov/form990 ~ Number and street (or PO box 1f mail 1s not delivered to street address) Room/suite 2906 SECOND STREET NORTH NO 307 E Telephone number (612) 968-3224 City or town, state or province, country, and ZIP or foreign postal code MINNEAPOLJS, MN 55411 G Gross receipts$ 4,362,877 F Name and address of principal officer JOHN LARSON 1170 15TH AVE SE 307 MINNEAPOLIS, MN 55414 I Tax-exempt status J Website:~ P- 501(c)(3) ··- 501(c) ( ) ""Iii (insert no) I Corporation I Trust I 4947(a)(l) or j 527 I Yes I No If "No," attach a list (see 1nstruct1ons) H(c) Assoc1at1on IYesP-No H(b) Are all subordinates 1ncluded7 WWWTEAMORTHO US K Form of organization I 1:r. I H(a) Is this a group return for subord1nates7 P- Other~ number~ Group exemption M State of legal dom1c1le MN L Year of fomnat1on 2004 Summary 1 Briefly describe the organ1zat1on's m1ss1on or most s1gn1f1cant act1v1t1es TO IMPROVE AND ENHANCE THE LIVES OF ORTHOPEDIC PATIENTS THROUGH OUR COMMITMENT TO SUPPORTING RESEARCH, EDUCATION AND ADVANCEMENTS IN ORTHOPEDIC TECHNOLOGY AND TO PROMOTE GOOD MUSCULOSKELETAL HEALTH BY PROVIDING AN ENVIRONMENT FOR OUR MEMBERS TO GET ACTIVE BY TRAINING FOR AND PARTICIPATING IN AMATEUR ATHLETIC EVENTS 2 Check this 3 Number of voting members of the governing body (Part VI, line la) 3 4 Number of independent voting members of the governing body (Part VI, line 1 b) ... -~ Q -~-+~~~1---~~ b Are any governance dec1s1ons of the organ1zat1on reserved to (or subJect to approval by) members, stockholders, or persons other than the governing body7 S a Did the organ1zat1on contemporaneously document the meetings held or written actions undertaken during the year by the following The governing body7 b Each committee with authority to act on behalf of the governing body7 9 Is there any officer, director, trustee, or key employee listed 1n Part VII, Section A, who cannot be reached at the organ1zat1on's ma1l1ng address? If "Yes," provide the names and addresses m Schedule O Sa Yes Sb Yes 9 No Section B. Policies (This Section B reauests information about oolicies not reauired by the Internal Revenue Code.) Yes 10a Did the organ1zat1on have local chapters, branches, or aff1l1ates7 10a b If "Yes," did the organ1zat1on have written pol1c1es and procedures governing the act1v1t1es of such chapters, aff1l1ates, and branches to ensure their operations are consistent with the organ1zat1on's exempt purposes? No No 10b lla Has the organ1zat1on provided a complete copy ofth1s Form 990 to all members of1ts governing body before f1l1ng the form7 11a Yes 12a Yes 12b Yes 12c Yes b Describe 1n Schedule O the process, 1f any, used by the organ1zat1on to review this Form 990 12a Did the organ1zat1on have a written conflict of interest pol1cy7 If "No," go to /me 13 b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to confl1cts7 c Did the organ1zat1on regularly and consistently monitor and enforce compliance with the pol1cy7 If "Yes," descnbe m Schedule O how this was done 13 Did the organ1zat1on have a written wh1stleblower pol1cy7 13 No 14 Did the organ1zat1on have a written document retention and destruction pol1cy7 14 No 15 Did the process for determ1n1ng compensation of the following persons include a review and approval by independent persons, comparab1l1ty data, and contemporaneous substant1at1on of the del1berat1on and dec1s1on7 1Sa No 1Sb No 16a No a The organ1zat1on's CEO, Executive Director, or top management off1c1al b Other officers or key employees of the organ1zat1on If"Yes" to line 15a or 15b, describe the process 1n Schedule O (see 1nstruct1ons) 16a Did the organ1zat1on invest 1n, contribute assets to, or part1c1pate 1n a JO Int venture or s1m1lar arrangement with a taxable entity during the year7 r--~-+~~~t--~~ b If "Yes," did the organ1zat1on follow a written policy or procedure requiring the organ1zat1on to evaluate its part1c1pat1on 1n Joint venture arrangements under applicable federal tax law, and take steps to safeguard the organ1zat1on's exempt status with respect to such arrangements? 16 b Section C. Disclosure f1led~M 17 List the States with which a copy of this Form 990 1s required to be lS Section 6104 requires an organ1zat1on to make its Form 1023(or1024 1f applicable), 990, and 990-T (501(c) (3 )sonly) available for public 1nspect1on Indicate how you made these available Check all that apply N ~~~~~~~~~~~~~~~~~~~~~~~~~~~ I Own website I Another's website P- Upon request I Other (explain 1n Schedule O) 19 Describe 1n Schedule O whether (and 1f so, how) the organ1zat1on made its governing documents, conflict of interest policy, and f1nanc1al statements available to the public during the tax year 20 State the name, physical address, and telephone number of the person who possesses the books and records of the organ1zat1on ~JOHN LARSON 2906 SECOND STREET NORTH 307 MINNEAPOLIS,MN 55411 (612)968-3224 Form 990(2013) Form 9 9 O ( 2 O1 3 ) i@lfdl Page 7 Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check 1f Schedule O contains a response or note to any line 1n this Part VII Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees la Complete this table for all persons required to be listed Report compensation for the calendar year ending with or w1th1n the organ1zat1on's tax year •List all of the organ1zat1on's current officers, directors, trustees (whether 1nd1v1duals or organ1zat1ons), regardless of amount of compensation Enter-0- 1n columns (D), (E), and (F) 1fno compensation was paid •List all of the organ1zat1on's current key employees, 1f any See 1nstruct1ons for def1n1t1on of "key employee" •List the organ1zat1on's five current highest compensated employees (other than an officer, director, trustee or key employee) who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organ1zat1on and any related organ1zat1ons •List all of the organ1zat1on's former officers, key employees, or highest compensated employees who received more than $100,000 of reportable compensation from the organ1zat1on and any related organ1zat1ons •List all of the organ1zat1on's former directors or trustees that received, 1n the capacity as a former director or trustee of the organ1zat1on, more than $10,000 of reportable compensation from the organ1zat1on and any related organ1zat1ons List persons 1n the following order 1nd1v1dual trustees or directors, 1nst1tut1onal trustees, officers, key employees, highest compensated employees, and former such persons I C heck this box 1f neither the organ1zat1on nor any related organ1zat1on compensated any current officer, director, or trustee (A) Name and Title (B) Average hours per week (list any hours for related organ1zat1ons below dotted line) (C) Pos1t1on (do not check more than one box, unless person 1s both an officer and a director/trustee) o...., :J Q.~ =~ ~ E- Ci 2. ...., .... 2 (/) [:[• :;!l. 2(') ~ ~ - ::J a :::<:: ID v- 11> 3 0 "D - v- 0 ~ 11> 11> ~ ID I ::: a:i 'l:l.3" ~x ID (") ,, Q (D) Reportable compensation from the organ 1zat1 on (W- 2/1099MISC) (E) Reportable compensation from related organ1zat1ons (W- 2/1099MISC) (F) Estimated amount of other compensation from the organ 1zat1 on and related organ1zat1ons ::J ...J '1-' ...., 0 3 u I[\ ::; :::l. 'h a [.. [.. <[> C!.. ( 1) HARRISON NELSON 1 00 x x 0 0 0 x x 0 0 0 x 0 0 0 x 0 0 0 88,215 0 0 SECRETARY (2) DR THOMAS F VARECKA MD 1 00 BOARD CHAIR (3) PAT HAGAN 1 00 BOARD MEMBER (4) BOB IWASKEWYCZ 1 00 BOARD MEMBER (5) JOHN W LARSON 60 00 x EXECUTNE DIRECTOR Form 990 ( 2 O 1 3 ) Form 9 9 O ( 2 O1 3 ) i@lf1U p age 8 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) (A) Name and Title (B) Average hours per week (list any hours for related organ1zat1ons below dotted line) (C) Pos1t1on (do not check more than one box, unless person 1s both an officer and a director/trustee) o...., ::J Q.~ :s = ~ §- :s-...., 2. ..+ 2 ij'J ~ oJ:• - :::. ~ ~ a Q -~ ~ ~ oJ:.oJ:.- 2(') ~ :::<:: ID v- 11> 3 "D 0 v- 11> 11> ID I ::: a:i 'l:l.3" ~x ID (") 11 (D) Reportable compensation from the organ1zat1on (W2/1099-MISC) (E) Reportable compensation from related organ1zat1ons (W2/1099-MISC) (F) Estimated amount of other compensation from the organ1zat1on and related organ1zat1ons Q :::. _. [.o ...., 0 3 u I[\ ::; 'h a <[> C!.. lb Sub-Total c Total from continuation sheets to Part VII, Section A d Total (add lines lb and le) ... ... ... 88,215 0 0 2 Total number of 1nd1v1duals (1nclud1ng but not l1m1ted to those listed above) who received more than $100,000 of reportable compensation from the organ1zat1on..-o 3 Did the organ1zat1on list any former officer, director or trustee, key employee, or highest compensated employee on line la7If"Yes,"completeScheduleJforsuch1nd1v1dual 3 No 4 For any 1nd1v1dual listed on line 1a,1s the sum of reportable compensation and other compensation from the organ1zat1on and related organ1zat1ons greaterthan $150,0007 If "Yes,"completeScheduleJforsuch 1nd1v1dual 4 No Did any person listed on line la receive or accrue compensation from any unrelated organ1zat1on or 1nd1v1dual for services rendered to the organ1zat1on7 If "Yes," complete Schedule I for such person 5 No Yes 5 No Section B. Independent Contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organ1zat1on Report compensation for the calendar year ending with or w1th1n the organ1zat1on's tax year (A) Name and business address 2 (B) Description of services (C) Compensation Total number of independent contractors (1nclud1ng but not l1m1ted to those listed above) who received more than $100,000 of compensation from the organ1zat1on ..-o Form 990 ( 2 O 1 3 ) Form 9 9 O ( 2 O1 3 ) i@lfdO Page 9 Statement of Revenue Ch ec k I fS c h e d u Ie 0 con a1ns a response or no t e t o any 1ne 1n th IS P art VI II -!! -!! la Federated campaigns la == = b Membership dues lb E c Fundra1s1ng events le ! .. d Related organ1zat1ons ld e Government grants (contributions) le f All other contributions, gifts, grants, and s1m1lar amounts not included above lf g Noncash contributions included in Imes la-lf $ h Total.Add lines la-lf l.'i::i .... ~ cX ·- l.'i::i ~= E VI ·= 0 :.;::::: .... = .:.: ff) -= -=-= Q) .Q ·;:: 0 0 u ~ b q.. <.;> c ..... d c e v f All other program service revenue g Total. Add lines 2a-2f ~ REGSITRATION FEES 0 &: 3 4 Investment income (1nclud1ng d1v1dends, interest, and other s1m1lar amounts) Income from investment of tax-exempt bond proceeds 5 Royalties 6a Gross rents b Less rental expenses Rental income or (loss) (1) Real c d 3,039 711300 4,010,113 4,010,113 349,725 349,725 I I c d Net gain or (loss) b Sa ev ::I ... ... ... ... 4,359,838 (11) Personal ... (1) Securities (11) Other .... Gross income from fundra1s1ng events (not 1nclud1ng $ ii:> of contributions reported on line le) See Part IV, line 18 ev a: ... - ... Net rental income or (loss) Gross amount from sales of assets other than inventory Less cost or other basis and sales expenses Gain or (loss) 7a ~ I Business Code 2a £, (D) Revenue excluded from tax under sections 512-514 3,0391 l.'i::i c ~ s; (C) Unrelated business revenue I (],l :::; (B) Related or exempt function revenue 0 ~ ~ (A) Total revenue a .c b Less direct expenses 0 c Net income or (loss) from fundra1s1ng events 9a b ... Gross income from gaming act1v1t1es See Part IV, line 19 a b Less direct expenses c Net income or (loss) from gaming act1v1t1es 10a b .... Gross sales of inventory, less returns and allowances a b Less cost of goods sold c Net income or (loss) from sales of inventory Miscellaneous Revenue b ... Business Code 11a b c d A II other revenue e Total.Add lines lla-lld 12 Total revenue. See Instructions ... ... 4,362,877 4,359,838 0 0 Form 990 ( 2 O 1 3 ) Form 9 9 O ( 2 O1 3 ) l@lf!i Page 10 Statement of Functional Expenses Section 501(c)(3)and 501(c)(4)organ1zat1ons must complete all columns All otherorgan1zat1ons must complete column (A) Check if Schedule O contains a resoonse or note to anv line 1n this Part IX Do not include amounts reported on lines 6b, 7b, Sb, 9b, and 10b of Part VIII. 1 Grants and other assistance to governments and organ1zat1ons 1n the U n1ted States See Part IV, line 21 2 Grants and other assistance to 1nd1v1duals 1n the U n1ted States See Part IV, line 22 3 Grants and other assistance to governments, organ1zat1ons, and 1nd1v1duals outside the U n1ted States See Part IV, lines 15 and 16 (A) Total expenses (B) Program service expenses (C) (D) Management and general expenses Fund ra 1smg expenses 72,700 72,700 88,215 79,394 8,821 690,826 621, 743 69,083 4 Benefits paid to or for members 5 Compensation of current officers, directors, trustees, and key employees 6 Compensation not included above, to d1squal1f1ed persons (as defined under section 4958(f)(l )) and persons described 1n section 4958(c)(3)(B) 7 Other salaries and wages 8 Pension plan accruals and contributions (include section 401 (k) and 403(b) employer contributions) 9 Other employee benefits 14,946 13,451 1,495 10 Payroll taxes 72,460 65,214 7,246 11 Fees for services (non-employees) 20,227 1,897 18,330 251,614 251,614 38,513 19,256 a Management b Legal c Accounting d Lobbying e Profess 1ona I fundra 1s 1ng services See Part IV, line 17 f Investment management fees g Other (Ifl1ne llg amount exceeds 10% ofl1ne 25, column (A) amount, list line 1 lg expenses on Schedule O) 12 Advert1s1ng and promotion 13 Office expenses 14 Information technology 15 Royalties 19,257 16 Occupancy 11,010 9,909 1,101 17 Travel 90,605 67,954 22,651 18 Payments of travel or entertainment expenses for any federal, state, or local public off1c1als 222 200 22 121, 197 121, 197 21, 120 21, 120 1,275,215 1,275,215 b EVENT EXPENSES 705,266 705,266 c RAC E SU PP LIES 226,820 226,820 19 Conferences, conventions, and meetings 20 Interest 21 Payments to aff1l1ates 22 Deprec1at1on, depletion, and amort1zat1on 23 Ins ura nee 24 Other expenses Itemize expenses not covered above (List miscellaneous expenses 1n line 24e If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O ) a d RACE FEES PERMITS e A II other expenses 25 Total functional expenses. Add lines 1 through 24e 26 Joint costs. Complete this line only 1fthe organ1zat1on reported 1n column (B) JO Int costs from a combined educational campaign and fundra1s1ng sol1c1tat1on Check here~ j 1ffollow1ng SOP 98-2 (ASC 958-720) 186,176 186,176 361,839 262,253 99,586 4,248,971 4,001,379 247,592 0 Form 990 ( 2 O 1 3 ) Page 11 Form 9 9 O ( 2 O1 3 ) l:tfil!I Balance Sheet Check 1f Schedule O contains a response or note to any line 1n this Part X (B) (A) Beg1nn1ng of year 1 Cash- non-1nterest-bea ring 2 Savings and temporary cash investments 81,032 End of year 1 131,831 2 3 Pledges and grants receivable, net 4 Accounts receivable, net 5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees Complete Part II of Schedule L 3 17,626 4 4,871 5 - 6 Loans and other receivables from other d1squal1f1ed persons (as defined under section 4958(f)(l)), persons described 1n section 4958(c)(3)(B), and contributing employers and sponsoring organ1zat1ons of section 501(c)(9) voluntary employees' benef1c1ary organ1zat1ons (see 1nstruct1ons) Complete Part II of Schedule L 7 Notes and loans receivable, net 8 Inventories for sale or use 166,310 8 216,621 Prepaid expenses and deferred charges 424,593 9 354,034 389,381 10c 335,803 I/I cJ) (,./'> I/> <( 6 9 10a b 7 Land, bu1ld1ngs, and equipment cost or other basis Complete Part VI of Schedule D 10a 591,205 Less accumulated deprec1at1on 10b 255,402 11 Investments-publicly traded securities 11 12 Investments-other securities See Part IV, line 11 12 13 Investments-program- related See Part IV, line 11 13 14 Intangible assets 14 5,700 15 5,700 1,084,642 16 1,048,860 525,410 17 251,845 15 Other assets See Part IV, line 11 16 Total assets. Add lines 1through15 (must equal line 34) 17 Accounts payable and accrued expenses 18 Grants payable 19 Deferred revenue 20 Tax-exempt bond l1ab1l1t1es 20 'I' 21 Escrow or custodial account l1ab1l1ty Complete Part IV of Schedule D 21 -= :.a 22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and d1squal1f1ed persons Complete Part II of Schedule L 22 23 Secured mortgages and notes payable to unrelated third parties 23 24 Unsecured notes and loans payable to unrelated third parties 24 25 Other l1ab1l1t1es (1nclud1ng federal income tax, payables to related third parties, and other l1ab1l1t1es not included on lines 17-24) Complete Part X of Schedule D 25 .9! .;-.; ::::l 26 q_-. 1,134,868 ~ I 19 26 .:::; 27 Unrestricted net assets 27 28 Temporarily restricted net assets 28 ca ;:: 29 ::::! u.. ,fl ,fl 29 ~ p- and complete lines 30 through 34. 0 ,fl Permanently restricted net assets Organizations that do not follow SFAS 117 (ASC 958), check here '- 4_; 985, 180 and complete .:::; - 733,335 lines 27 through 29, and lines 33 and 34. u ~ 609,458 Total liabilities. Add lines 17 through 25 Organizations that follow SFAS 117 (ASC 958), check here ,fl 18 30 Capital stock or trust principal, or current funds 0 30 0 31 Pa1d-1n or capital surplus, or land, bu1ld1ng or equipment fund 0 31 0 Ci 32 Retained earnings, endowment, accumulated income, or other funds -50,226 32 63,680 4_; 33 Total net assets or fund balances -50,226 33 63,680 34 Total l1ab1l1t1es and net assets/fund balances 1,084,642 34 z 1,048,860 Form 990 ( 2 O 1 3 ) Form 9 9 O ( 2 O1 3 ) l!ifil!u Page 12 Reconcilliation of Net Assets Check 1f Schedule O contains a response or note to any line 1n this Part XI 1 Total revenue (must equal Part VIII, column (A), line 12) 2 Total expenses (must equal Part IX, column (A), line 25) 3 Revenue less expenses Subtract line 2 from line 1 4 Net assets or fund balances at beg1nn1ng of year (must equal Part X, line 33, column (A)) 5 1 4,362,877 2 4,248,971 3 113,906 4 -50,226 Net unrealized gains (losses) on investments 5 6 Donated services and use offac1l1t1es 6 7 Investment expenses 7 8 P nor period adJustments 8 9 Other changes 1n net assets or fund balances (explain 1n Schedule O) 9 0 10 Net assets or fund balances at end of year Combine lines 3 through 9 (must equal Part X, line 33, 10 column (B)) l:r.Tili•UI 6 3,680 Financial Statements and Reporting . p- Check 1f Schedule O contains a response or note to any line 1n this Part XII Yes 1 No Accounting method used to prepare the Form 990 I Cash P- Accrual I other If the organ1zat1on changed its method of accounting from a prior year or checked "Other," explain 1n Schedule O 2a Were the organ1zat1on's f1nanc1al statements compiled or reviewed by an independent accountant? 2a No If'Yes,'check a box below to 1nd1cate whether the f1nanc1al statements forthe year were compiled or reviewed on a separate basis, consolidated basis, or both I Separate basis I Consolidated basis I Both consolidated and separate basis b Were the organ1zat1on's f1nanc1al statements audited by an independent accountant? 2b Yes 2c Yes If'Yes,'check a box below to 1nd1cate whether the f1nanc1al statements forthe year were audited on a separate basis, consolidated basis, or both P- Separate basis I Consolidated basis I Both consolidated and separate basis c If "Yes," to line 2a or 2b, does the organ1zat1on have a committee that assumes respons1b1l1ty for oversight of the audit, review, or comp1lat1on of its f1nanc1al statements and selection of an independent accountant? If the organ1zat1on changed either its oversight process or selection process during the tax year, explain 1n Schedule O 3a As a result of a federal award, was the organ1zat1on required to undergo an audit or audits as set forth 1n the s Ing I e A u d It Act and 0 M B c I re u Ia r A -1 3 3 7 b If "Yes," did the organ1zat1on undergo the required audit or aud1ts7 If the organ1zat1on did not undergo the 3a No 3b required audit or audits, explain why 1n Schedule O and describe any steps taken to undergo such audits Form 990(2013) efile GRAPHIC rint - DO NOT PROCESS As Filed Data - DLN:93493318025574 OMB No 1545-0047 SCHEDULE A Public Charity Status and Public Support (Form 990 or 990EZ) Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust. Department of the Treasury Internal Revenue Service Name of the organization 2013 ..,_Attach to Form 990 or Form 990-EZ . ..,_See separate instructions. Open to Public ..,_Information about Schedule A (Form 990 or 990-EZ) and its instructions is at Inspection www.irs. ov form990. Employer identification number TEAM ORTHO FOUNDATION 20-0685151 Reason for Public Charit art. See instructions. The organ1zat1on 1s not a private foundation because 1t 1s (For lines 1through11, check only one box) 4 I I I I 5 I 6 7 I I 8 I An organ1zat1on that normally receives a substantial part of its support from a governmental unit or from the general public described 1n section 170(b)(1)(A)(vi). (Complete Part II ) A community trust described 1n section 170(b)(1)(A)(vi) (Complete Part II ) 9 P- An organ1zat1on that normally receives (1) more than 331/3% of its support from contributions, membership fees, and gross 1 2 3 A church, convention of churches, or assoc1at1on of churches described 1n section 170(b)(1)(A)(i). A school described 1n section 170(b)(1)(A)(ii). (Attach Schedule E ) A hospital or a cooperative hospital service organ1zat1on described 1n section 170(b)(1)(A)(iii). A medical research organ1zat1on operated 1n conJunct1on with a hospital described 1n section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state An organ1zat1on operated for the benefit of a college or un1vers1ty owned or operated by a governmental unit described 1n section 170(b)(1)(A)(iv). (Complete Part II ) A federal, state, or local government or governmental unit described 1n section 170(b)(1)(A)(v). receipts from act1v1t1es related to its exempt funct1ons-subJect to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acqu1 red by the orga n1zat1on after June 3 O, 19 7 5 See section 509(a)(2). (Complete Pa rt I II ) 11 I I e I 10 f g h An organ1zat1on organized and operated exclusively to test for public safety See section 509(a)(4). An organ1zat1on organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organ1zat1ons described 1n section 509(a)(l) or section 509(a)(2) See section 509(a)(3). Check the box that describes the type of supporting organ1zat1on and complete lines lle through llh a I Type I b I Type II c I Type III - Functionally integrated d I Type III - Non-functionally integrated By checking this box, I certify that the organ1zat1on 1s not controlled directly or 1nd1rectly by one or more d1squal1f1ed persons other than foundation managers and other than one or more publicly supported organ1zat1ons described 1n section 509(a)(l) or section 509(a)(2) If the organ1zat1on received a written determ1nat1on from the IRS that 1t 1s a Type I, Type II, or Type III supporting organ1zat1on, check this box I Since August 17, 2006, has the organ1zat1on accepted any gift or contribution from any of the following persons? (i) A person who directly or 1nd1rectly controls, either alone or together with persons described 1n (11) Yes No and (111) below, the governing body of the supported organ1zat1on7 11g(i) (ii) A family member of a person described 1n (1) above7 11g(ii) (iii) A 35% controlled entity of a person described 1n (1) or (11) above7 11g(iii) Provide the following 1nformat1on about the supported organ1zat1on(s) (i) Name of supported organization (ii) EIN (iii) Type of organ1zat1on (described on lines 1- 9 above or I RC section (see instructions)) (iv) Is the organ1zat1on 1n col (i) listed 1n your governing document? Yes No (v) Did you notify the organ1zat1on 1n col (i) of your support? Yes (vi) Is the organ1zat1on 1n col (i) organized 1n the U S 7 No Yes (vii) A mount of monetary support No Total For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ. Cat No 11285F ScheduleA(Form 990or 990-EZ)2013 Sch e du Ie A (Form 9 9 O or 9 9 O- E Z) 2 O1 3 page 2 1@111 Support Schedule for Organizations Described in Sections 170(b)(l)(A)(iv) and 170(b)(l)(A)(vi) (Complete only 1f you checked the box on line 5, 7, or 8 of Part I or 1f the organ1zat1on failed to qualify under Part III. If the organ1zat1on fails to qualify under the tests listed below, please complete Part III.) s ect1on A. Pu bl"IC s uooort Calendar year (or fiscal year beginning in)..,._ Gifts, grants, contributions, and 1 membership fees received (Do not include any "unusual grants") Tax revenues levied for the 2 organ1zat1on's benefit and either paid to or expended on its behalf The value of services or fac1l1t1es 3 furnished by a governmental unit to the organ1zat1on without charge 4 Total. Add lines 1 through 3 5 The portion of total contributions by each person (other than a governmental unit or publicly supported organ1zat1on) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) Public support. Subtract line 5 from 6 line 4 (a) 2009 (b) 2010 (c) 2011 (d)2012 (e)2013 (f) Total (e)2013 (f) Total Section B. Tota Support Calendar year (or fiscal year beginning (a) 2009 (b) 2010 in)..,._ 7 Amounts from line 4 Gross income from interest, 8 d1v1dends, payments received on securities loans, rents, royalties and income from s1m1lar sources Net income from unrelated 9 business act1v1t1es, whether or not the business 1s regularly earned on Other income Do not include gain 10 or loss from the sale of capital assets (Explain 1n Part IV ) Total support (Add lines 7 through 11 10) 12 Gross receipts from related act1v1t1es, etc (see 1nstruct1ons) 13 (c) 2011 (d)2012 I 12 I First five years. If the Form 990 1s for the organ1zat1on's first, second, third, fourth, or fifth tax year as a 50 l(c)(3) organ1zat1on, check this box and stop here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I Section C. Com utation of Public Su ort Percenta e 14 Public support percentage for 2013 (line 6, column (f) d1v1ded by line 11, column (f)) 14 15 Public support percentage for 2012 Schedule A, Part II, line 14 15 331/3°/osupport test-2013. If the organ1zat1on did not check the box on line 13, and line 14 1s 33 1/3% or more, check this box and stop here. The organ1zat1on qual1f1es as a publicly supported organ1zat1on ..,.., b 331/3°/osupport test-2012. If the organ1zat1on did not check a box on line 13or16a, and line 15 1s 33 1/3% or more, check this box and stop here. The organ1zat1on qual1f1es as a publicly supported organ1zat1on ..,.., 17a 10°/o-facts-and-circumstancestest-2013. If the organ1zat1on did not check a box on line 13, 16a, or 16b, and line 14 1s 10% or more, and 1fthe organ1zat1on meets the "facts-and-circumstances" test, check this box and stop here. Explain 1n Part IV how the organ1zat1on meets the "facts-and-circumstances" test The organ1zat1on qual1f1es as a publicly supported organ1zat1on ..,.., b 10°/o-facts-and-circumstances test-2012. If the orga n1zat1on did not check a box on 11 ne 13, 16 a, 16 b, or 1 7 a, and I 1ne 15 1s 10% or more, and 1f the organ1zat1on meets the "facts-and-circumstances" test, check this box and stop here. Explain 1n Part IV how the organ1zat1on meets the "facts-and-circumstances" test The organ1zat1on qual1f1es as a publicly supported organ1zat1on ..,.., 18 Private foundation. If the organ1zat1on did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see 1nstruct1ons 16a Schedule A (Form 990 or 990-EZ) 2013 Sch e du Ie A (Form 9 9 O or 9 9 O- E Z) 2 O1 3 Page 3 M@IOM Support Schedule for Organizations Described in Section 509(a)(2) (Complete only 1f you checked the box on line 9 of Part I or 1f the organ1zat1on failed to qualify under Part II. If the organization falls to qualify under the tests listed below, please complete Part II.) s ect1on A. Pu bl"IC s uooort Calendar year (or fiscal year beginning in)..,._ Gifts, grants, contributions, and 1 membership fees received (Do not include any "unusual grants") Gross receipts from adm1ss1ons, 2 mere ha nd1se sold or services performed, or fac1l1t1es furnished 1n any act1v1ty that 1s related to the organ1zat1on's tax-exempt purpose Gross receipts from act1v1t1es that 3 are not an unrelated trade or business under section 513 Tax revenues levied for the 4 organ1zat1on's benefit and either paid to or expended on its behalf The value of services or fac1l1t1es 5 furnished by a governmental unit to the organ1zat1on without charge 6 Total. Add lines 1 through 5 7a Amounts included on lines 1, 2, and 3 received from d1squa l1f1ed persons b Amounts included on lines 2 and 3 received from other than d1squal1f1ed persons that exceed the greaterof$5,000 or1% of the amount on line 13 for the year c Add lines 7a and 7b Public support (Subtract line 7c 8 from line 6 ) s ec t"ion (a) 2009 (b) 2010 (c) 2011 (d)2012 (e)2013 (f) Total 23,496 1,952 31,595 7,191 3,039 67,273 863,326 1,611,524 2,387,447 3,592,661 4,359,838 12,814, 796 886,822 1,613,476 2,419,042 3,599,852 4,362,877 12,882,069 19,500 19,500 0 19,500 19,500 12,862,569 B T oa t I S uppor t Calendar year (or fiscal year beginning (a) 2009 (b) 2010 (c) 2011 (d)2012 (e)2013 (f) Total in)..,._ 886,822 1,613,476 2,419,042 3,599,852 4,362,877 12,882,069 9 Amounts from line 6 Gross income from interest, 10a d1v1dends, payments received on securities loans, rents, royalties and income from s1m1lar sources Unrelated business taxable b income (less section 511 taxes) from businesses acquired after June 30, 1975 c Add lines lOa and !Ob Net income from unrelated 11 business act1v1t1es not included 1n line !Ob, whether or not the business 1s regularly earned on Other income Do not include 12 gain or loss from the sale of capital assets (Explain 1n Part IV ) Total support. (Add lines 9, lOc, 13 886,822 1,613,476 2,419,042 3,599,852 4,362,877 12,882,069 11,and12) 14 First five years. If the Form 990 1s for the organ1zat1on's first, second, third, fourth, or fifth tax year as a 50 l(c)(3) organ1zat1on, check this box and stop here ..,.., Section C. Computation of Public Support Percentaqe 15 Public support percentage for 2013 (line 8, column (f) d1v1ded by line 13, column (f)) 15 99 850 % 16 Public support percentage from 2012 Schedule A, Part III, line 15 16 99 400 % 0% Section D. Com utation of Investment Income Percenta e 17 Investment income percentage for 2013 (line lOc, column (f) d1v1ded by line 13, column (f)) 17 18 Investment income percentage from 2012 Schedule A, Part III, line 17 18 19a 33 1/3°/o support tests-2013. If the orga n1zat1on did not check the box on 11 ne 14, and 11 ne 15 1s more than 3 3 1/3%, and I 1ne 1 7 1s not more than 33 1/3%, check this box and stop here. The organ1zat1on qual1f1es as a publicly supported organ1zat1on ..,..17 33 1/3°/o support tests-2012. If the organ1zat1on did not check a box on line 14 or line 19a, and line 16 1s more than 33 1/3% and line 18 1s not more than 33 1/3%, check this box and stop here. The organ1zat1on qual1f1es as a publicly supported organ1zat1on ..,.., Private foundation. If the orga n1zat1on did not check a box on I 1ne 14, 19 a, or 19 b, check this box and see 1nstruct1ons ..,.., b 20 Schedule A (Form 990 or 990-EZ) 2013 Sch e du Ie A (Form 9 9 O or 9 9 O- E Z) 2 O1 3 M@i(fM page 4 Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any add1t1onal information. (See instructions). Facts And Circumstances Test Return Reference I Explanation I Schedule A (Form 990 or 990-EZ) 2013 efile GRAPHIC rint - DO NOT PROCESS SCHEDULED DLN:93493318025574 OMB No 1545-0047 Supplemental Financial Statements (Form 990) Department of the Treasury Internal Revenue Service As Filed Data - ~Attach ~Complete if the organization answered "Yes," to Form 990, Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b to Form 990. ~See separate instructions.~ Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990. Name of the organization 2013 Open to Public Inspection Employer identification number TEAM ORTHO FOUNDATION 20-0685151 Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete 1f the oraa rnzat1on a nswe re d " Yes to Form 990 Pa rt IV Iine 6 (a) Donor advised funds (b) Funds and other accounts 1 Total number at end of year 2 Aggregate contributions to (during year) 3 Aggregate grants from (during year) 4 Aggregate value at end of year 5 Did the organ1zat1on inform all donors and donor advisors 1n writing that the assets held 1n donor advised funds are the organ1zat1on's property, subJect to the organ1zat1on's exclusive legal control? Ives Did the organ1zat1on inform all grantees, donors, and donor advisors 1n writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring 1mperm1ss1ble private benef1t7 I 6 l@iil 1 Yes Conservation Easements. Complete 1f the organ1zat1on answered "Yes" to Form 990, Part IV, line 7. Purpose(s) of conservation easements held by the organ1zat1on (check all that apply) I I I 2 Preservation of land for public use (e g, recreation or education) Protection of natural habitat I I Preservation of an historically important land area Preservation ofa cert1f1ed historic structure Preservation of open space Complete lines 2a through 2d 1fthe organ1zat1on held a qual1f1ed conservation contribution 1n the form ofa conservation easement on the last day of the tax year Held at the End of the Year a Total number of conservation easements 2a b Total acreage restricted by conservation easements 2b c Number of conservation easements on a cert1f1ed historic structure included 1n (a) 2c d Number of conservation easements included 1n (c) acquired after 8/17 /06, and not on a historic structure listed 1n the National Register 2d 3 Number of conservation easements mod1f1ed, transferred, released, ext1ngu1shed, or terminated by the organ1zat1on during the tax year~------- 4 Number of states where property subJect to conservation easement 1s located ~------- 5 Does the organ1zat1on have a written policy regarding the periodic monitoring, 1nspect1on, handling of v1olat1ons, and enforcement of the conservation easements 1t holds7 6 Staff and volunteer hours devoted to monitoring, 1nspect1ng, and enforcing conservation easements during the year 7 A mount of expenses incurred 1n monitoring, 1nspect1ng, and enforcing conservation easements during the year 8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4 )(B)(1) and section 170(h)(4 )(B)(11)7 I Yes ~-------~ $ ---------- 9 Ives In Part XIII, describe how the organ1zat1on reports conservation easements 1n its revenue and expense statement, and balance sheet, and include, 1f applicable, the text of the footnote to the organ1zat1on's f1nanc1al statements that describes the organ1zat1on's accounting for conservation easements 1@101 Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Complete 1f the organization answered "Yes" to Form 990, Part IV, line 8. la If the organ1zat1on elected, as permitted under SFAS 116 (ASC 958), not to report 1n its revenue statement and balance sheet works of art, historical treasures, or other s1m1lar assets held for public exh1b1t1on, education, or research 1n furtherance of public service, provide, 1n Part XIII, the text of the footnote to its f1nanc1al statements that describes these items b If the organ1zat1on elected, as permitted under SFAS 116 (ASC 958), to report 1n its revenue statement and balance sheet works of art, historical treasures, or other s1m1lar assets held for public exh1b1t1on, education, or research 1n furtherance of public service, provide the following amounts relating to these items (i) Revenues included 1n Form 990, Part VIII, line 1 ~ $ --------- (ii) Assets included 1n Form 990, Part X ~ $ --------- If the organ1zat1on received or held works of art, historical treasures, or other s1m1lar assets for f1nanc1al gain, provide the following amounts required to be reported underSFAS 116 (ASC 958) relating to these items 2 a Revenues included 1n Form 990, Part VIII, line 1 ~ $ --------- b Assets included 1n Form 990, Part X ~ For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat No 52283D $ Schedule D (Form 990) 2013 Sch e du Ie D (Form 9 9 O ) 2 O1 3 l@IOj 3 page 2 Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (contmued) Using the organ1zat1on's acqu1s1t1on, accession, and other records, check any of the following that are a s1gn1f1cant use of its collection items (check all that apply) a b c I I I Public exh1b1t1on d I Loan or exchange programs Scholarly research e I Other Preservation for future generations 4 P rov1de a description of the organ1zat1on's collections and explain how they further the organ1zat1on's exempt purpose 1n Part XIII 5 During the year, did the organ1zat1on sol1c1t or receive donations of art, historical treasures or other s1m1lar assets to be sold to raise funds rather than to be ma1nta1ned as part of the organ1zat1on's collect1on7 l@i(fj la I Yes Escrow and Custodial Arrangements. Complete 1f the organ1zat1on answered "Yes" to Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21. Is the organ1zat1on an agent, trustee, custodian or other 1ntermed1ary for contributions or other assets not 1n c Iu de d on Form 9 9 O, Pa rt X 7 b If "Yes," explain the arrangement 1n Part XIII and complete the following table c Beg1nn1ng balance le d Add1t1ons during the year ld e D1stribut1ons during the year le f Ending balance lf Ives Amount 2a b Did the organ1zat1on include an amount on Form 990, Part X, line 217 No r Endowment Funds. Complete 1f the orqarnzat1on answered "Yes" to Form 990 Pa rt IV line 10. (a)Current year (b )Prior year b ( c )Two yea rs back (d)Three years back (e)Four years back Beg1nn1ng of year balance b Contributions c Net investment earnings, gains, and losses d Grants or scholarships e Other expenditures for fac1l1t1es and programs f Adm1n1strat1ve expenses g End of year balance 2 I If "Yes," explain the arrangement 1n Part XIII Check here 1fthe explanation has been provided 1n Part XIII -~IOIA•• la Ives Provide the estimated percentage of the current year end balance (line lg, column (a)) held as quasi-endowment~ a Board designated or b Permanent endowment~ c Temporarily restricted endowment~ The percentages 1n lines 2a, 2b, and 2c should equal 100% 3a Are there endowment funds not 1n the possession of the organ1zat1on that are held and adm1n1stered for the organ1zat1on by (ii) related organ1zat1ons b 4 Yes No i 3aCi> i 3a(ii) (i) unrelated organ1zat1ons .I If"Yes" to 3a(11), are the related organ1zat1ons listed as required on Schedule R7 3b Describe 1n Part XIII the intended uses of the organ1zat1on's endowment funds l@lfd Land, Buildings, and Equipment. Complete 1f the organ1zat1on answered 'Yes' to Form 990, Part IV, line lla See Form 990 Part X line 10 Description of property (a) Cost or other basis (investment) (b )Cost or other basis (other) (c) Accumulated deprec1at1on (d) Book value la Land b Bu1ld1ngs c Leasehold improvements d Equipment 59,519 11, 792 47,727 531,686 243,610 288,076 e Other Total. Add lines la through le (Column (d) must equal Form 990, Part X, column (B), !me 10(c).) ~ 335,803 Schedule D (Form 990) 2013 Sch e du Ie D (Form 9 9 O ) 2 O1 3 i@lfdl Page 3 Investments Other Securities. Complete 1f the organization answered 'Yes' to Form 990, Part IV, line llb. See Form 990 Part X line 12 (a) Description of security or category (b)Book value (1nclud1ng name of security) (c) Method of valuation Cost or end-of-year market value (1 )F1nanc1al derivatives (2)Closely-held equity interests Other ~ Total. (Column (b) must equal Fol7Tl 990, Part X, col (8) /me 12) I I ljl§Jj•"O!! Investments-Program Related. Complete 1f the organization answered Yes to Form 990, Part IV, line llc. See Form 990, Part X, line 13. (b) Book value (a) Description of investment ~ Total. (Column (b) must equal Fol7Tl 990, Part X, col (8) /me 13) •:r.•"'••:• (c) Method of valuation Cost or end-of-year market value Other Assets. Complete 1fthe organ1zat1on answered 'Yes' to Form 990, Part IV, line lld See Form 9 9 O, Pa rt X, I1n e 1 5 (b) Book value (a) Description Total. (Column (b) must equal Form 990, Part X, col.(B) l1ne 15.) ~ :r.111•:• Other Liabilities. Complete 1f the organ1zat1on answered 'Yes' to Form 990, Part IV, line lle or llf. See Form 990, Part X, line 25. 1 (a) Description of l1ab1l1ty (b) Book value Federal income taxes Total. (Column (b) must equal Fol7Tl 990, Part X, col (8) /me 25) ~ 2. L1ab1l1ty for uncertain tax pos1t1ons In Part XIII, provide the text of the footnote to the organ1zat1on's f1nanc1al statements that reports the organ1zat1on's l1ab1l1ty for uncertain tax pos1t1ons under FIN 48 (ASC 740) Check here 1fthe text of the footnote has been provided 1n Pa rt XI II pSchedule D (Form 990) 2013 Sch e du Ie D (Form 9 9 O ) 2 O1 3 l!ifil!tl page 4 Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete 1f t h e orqa rnzat1on a nswe re d 'Y es to Farm 990 p art IV Iine 12 a. I 1 Total revenue, gains, and other support per audited f1nanc1al statements 2 4,362,877 Amounts included on line 1 but not on Form 990, Part VIII, line 12 a Net unrealized gains on investments 2a b Donated services and use offac1l1t1es 2b c Recoveries of prior year grants 2c d Other (Describe 1n Part XIII ) 2d e Add lines 2a through 2d 2e Subtract line 2e from line 1 3 3 4 0 4,362,877 Amounts included on Form 990, Part VIII, line 12, but not on line 1 a Investment expenses not included on Form 990, Part VIII, line 7b I 4a I b Other (Describe 1n Part XIII ) c Add lines 4a and 4b 4c Total revenue Add lines 3 and 4c. (This must equal Form 990, Part I, line 12) 5 5 1:r.1.;•:•1• 1 4b 0 4,362,877 Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete If t he orqan1zat1on answere d 'Y es to Farm 990 part IV Iine 12 a. Total expenses and losses per audited f1nanc1al statements 2 1 4,248,971 Amounts included on line 1 but not on Form 990, Part IX, line 25 a Donated services and use offac1l1t1es 2a b Prior year adJustments 2b c Other losses 2c d Other (Describe 1n Part XIII ) 2d e Add lines 2a through 2d 3 2e Subtract line 2e from line 1 4 3 0 4,248,971 Amounts included on Form 990, Part IX, line 25, but not on line 1: a 5 1 Investment expenses not included on Form 990, Part VIII, line 7b b Other (Describe 1n Part XIII ) c Add lines 4a and 4b I 4a I 4b Total expenses Add I1n es 3 and 4c. (Th 1s must e qua I Form 9 9 O, Pa rt I, I 1n e 18 ) •:r.1111•~···· 0 4c 5 4,248,971 Supplemental Information Provide the descriptions required for Part II, lines 3, 5, and 9, Part III, lines la and 4, Part IV, lines lb and 2b, Part V, line 4, Part X, line 2, Part XI, lines 2d and 4b, and Part XII, lines 2d and 4b Also complete this part to provide any add1t1onal 1nformat1on I Return Reference PART X, LINE 2 I Explanation THE FOUNDATION IS EXEMPT FROM INCOME TAXES AS A PUBLIC CHARITY UNDER SECTION 50l(C)(3) OF THE INTERNAL REVENUE CODE MANAGEMENT HAS DETERMINED THAT THE FOUNDATION DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AND ASSOCIATED UNRECOGNIZED TAX BENEFITS THAT MATERIALLY IMPACT THE FINANCIAL STATEMENTS OR RELATED DISCLOSURES THE FOUNDATION'S FEDERAL INFORMATIONAL INCOME TAX RETURNS FOR 2011, 2012, AND 2013 ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY WERE FILED Schedule D (Form 990) 2013 Sch e du Ie D (Form 9 9 O ) 2 O1 3 l:F.Til•;•n• Supplemental Information (continued) Return Reference I Page Explanation 5 I Schedule D (Form 990) 2013 efile GRAPHIC rint - DO NOT PROCESS Schedule I (Form 990) Department of the Treasury Internal Revenue Service Name of the organ1zat1on TEAM ORTHO FOUNDATION As Filed Data - DLN:93493318025574 OMB No 1545-0047 Grants and Other Assistance to Organizations, Governments and Individuals in the United States 2013 Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22. ,... Attach to Form 990 ,... Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990. Open to Public Inspection Employer identification number 20-0685151 General Information on Grants and Assistance 1 Does the organ1zat1on ma1nta1n records to substantiate the amount of the grants or assistance, the grantees' el1g1b1l1ty for the grants or assistance, and the selection criteria used to award the grants or ass1stance7. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 2 Describe 1n Part IV the organ1zat1on's procedures for monitoring the use of grant funds 1n the U n1ted States l@iil I Yes P- No Grants and Other Assistance to Governments and Organizations in the United States. Complete 1f the organ1zat1on answered "Yes" to Form 990, Part IV, line 21, for any rec1p1ent that received more than $5,000. Part II can be duplicated 1f add1t1onal space 1s needed. (a) Name and address of organ1zat1on or government (b)EIN (c) IRC Code section 1f applicable (d) A mount of cash grant (e) A mount of noncash assistance (f) Method of (g) Description of non-cash assistance valuation (book, FMV, appraisal, other) (h) Purpose of grant or assistance (1) SHRINE R'S HOPSITAL 2025 EAST RIVER PARKWAY MINNEAPOLIS, MN 55414 30 ,000 UNRESTRICTED DONATION (2) EXCELON CENTER FOR BONE AND JOINT RESEARCH 700 lOTH AVE SOUTH MINNEAPOLSI,MN 55414 25 ,000 UNRESTRICTED DONATION (3) BACK COUNTRY TRAIL 28950 TAMARACK STREET NW ISANTI, MN 55040 2,700 UNRESTRICTED DONATION 15 ,000 UNRESTRICTED DONATION (4) SHRINE R'S HOPSITAL 2211 NORTH OAK PARK AVENUE CHICAGO,IL 60707 2 Enter total number of section 501 (c)(3) and government organ1zat1ons listed 1n the line 1 table. 3 Enter total number of other organ1zat1ons listed 1n the line 1 table. For Paperwork Reduction Act Notice, see the Instructions for Form 990. ,... . ,... Cat No SOOSSP 2 Schedule I (Form 990) 2013 Sch e du Ie I (Form 9 9 O) 2 O 1 3 pa e 2 Grants and Other Assistance to Individuals in the United States. Complete 1f the organ1zat1on answered "Yes" to Form 990, Part IV, line 22. Part III can be duplicated 1f add1t1onal space 1s needed. (a)Type of grant or assistance :r.1111• (b)N umber of rec1p1ents (c)Amount of cash grant (d)A mount of non-cash assistance (e)Method of valuation (book, FMV, appraisal, other) (f)Descnpt1on of non-cash assistance Supplemental Information. Provide the information required in Part I line 2, Part III column (b), and any other add1t1onal information. Return Reference IExplanation I Schedule I (Form 990) 2013 lefile GRAPHIC print - DO NOT PROCESS SCHEDULE 0 Internal Revenue Service Name of the organ1zat1on DLN:93493318025574I OMB No 1545-0047 Supplemental Information to Form 990 or 990-EZ (Form 990 or 990-EZ) Department of the Treasury I As Filed Data - I 2013 Complete to provide information for responses to specific questions on Open to Public Form 990 or to provide any additional information. Inspection ~Attach to Form 990 or 990-EZ. ~Information about Schedule O (Form 990 or 990-EZ) and its instructions is at www.irs. ov/form990. Employer identification number TEAM ORTHO FOUNDATION 20-0685151 990 Schedule 0, Supplemental Information Return Reference Explanation FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR AND CONTROLLER BEFORE FILING FORM 990, PART VI, SECTION B, LINE 12C THE RJLICY IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS FORM 990, PART VI, SECTION C, LINE 19 URJN WRITIEN REQUEST TO THE ORGANIZATION'S OFFICE FORM 990, PART XII, LINE 2C THE BOARD ASSUMES RESRJNSIBILITY FOR OVERSIGHT OF THE AUDIT