Form990-PF
Click to see attachment

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0052
2018
Open to Public Inspection
For calendar year 2018, or tax year beginning 01-01-2018 , and ending 12-31-2018
Name of foundation
Carlsen Muir Family Foundation
 
Number and street (or P.O. box number if mail is not delivered to street address)107 Jumper Court
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Folsom, CA95630
A Employer identification number

82-3157713
B Telephone number (see instructions)

(916) 351-5596
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$15,793,324J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet.............
3 Interest on savings and temporary cash investments 135 135 135
4 Dividends and interest from securities...      
5a Gross rents............ 1,341,960 1,341,960 1,341,960
b Net rental income or (loss) 774,067
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)...  
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 1,342,095 1,342,095 1,342,095
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 2,500     2,500
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule)......... Click to see attachment 13,999 13,999 13,999  
b Accounting fees (attach schedule)....... Click to see attachment 2,500 2,500 2,500  
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 3,705      
19 Depreciation (attach schedule) and depletion... Click to see attachment 186,909 186,909 186,909
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see list of attachments 381,472 381,472 30,217 243
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 591,085 584,880 233,625 2,743
25 Contributions, gifts, grants paid....... 629,777 629,777
26 Total expenses and disbursements. Add lines 24 and 25 1,220,862 584,880 233,625 632,520
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 121,233
b Net investment income (if negative, enter -0-) 757,215
c Adjusted net income (if negative, enter -0-)... 1,108,470
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2018)
Form 990-PF (2018)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............. 16,420 77,112 77,112
2 Savings and temporary cash investments......... 80,000 357,179 357,179
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule).......      
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet8,622,241
Less: accumulated depreciation (attach schedule) bullet202,485 8,606,665 Click to see attachment8,419,756 15,340,000
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment131,357 Click to see attachment101,628 Click to see attachment19,033
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 8,834,442 8,955,675 15,793,324
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22).........   0
Net Assets or Fund Balances Foundations that follow SFAS 117, check here bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................. 8,834,442 8,955,675
25 Temporarily restricted...............    
26 Permanently restricted...............    
Foundations that do not follow SFAS 117, check here bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see instructions)..... 8,834,442 8,955,675
31 Total liabilities and net assets/fund balances (see instructions). 8,834,442 8,955,675
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 with end-of-year figure reported on prior year’s return) ...............
1
8,834,442
2
Enter amount from Part I, line 27a .....................
2
121,233
3
Other increases not included in line 2 (itemize) bullet
3
 
4
Add lines 1, 2, and 3 ..........................
4
8,955,675
5
Decreases not included in line 2 (itemize) bullet
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
8,955,675
Form 990-PF (2018)
Form 990-PF (2018)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)		 (b)
How acquired
P—Purchase
D—Donation 		(c)
Date acquired
(mo., day, yr.) 		(d)
Date sold
(mo., day, yr.)
1a
b
c
d
e
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2  
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Part V
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 foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If "Yes," the foundation 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.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2017      
2016      
2015      
2014      
2013      
2
Total of line 1, column (d) .....................
2
 
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5.0, or by the number of years the foundation has been in existence if less than 5 years ......
3
 
4
Enter the net value of noncharitable-use assets for 2018 from Part X, line 5......
4
 
5
Multiply line 4 by line 3......................
5
 
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
 
7
Add lines 5 and 6........................
7
 
8
Enter qualifying distributions from Part XII, line 4,.............
8
 
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.
Form 990-PF (2018)
Form 990-PF (2018)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket includes lines 1a and 1b
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b Domestic foundations that meet the section 4940(e) requirements in Part V, check 1 15,144
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2  
3 Add lines 1 and 2........................... 3 15,144
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 15,144
6 Credits/Payments:
a 2018 estimated tax payments and 2017 overpayment credited to 2018 6a 2,000
b Exempt foreign organizations—tax withheld at source...... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c 15,000
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 17,000
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. Click to see attachment 8 26
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 1,830
11 Enter the amount of line 10 to be: Credited to 2019 estimated taxBullet1,830 RefundedBullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition).................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
No
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • 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
     
    No
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bullet
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2018 or the taxable year beginning in 2018? See the instructions for Part XIV.
    If "Yes," complete Part XIV .............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletJuno Commercial Real Estate Telephone no.bullet (916) 359-2814

    Located atbullet401 Watt Avenue Suite 200SacramentoCA ZIP+4bullet95864
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2018, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country? .................
    16   No
    See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet  
    Part 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
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?...............
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).......
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ........
    1b
     
    No
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2018?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2018, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2018?.............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
    No
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 2018 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2018.)..................
    3b
     
    No
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2018?
    4b
     
    No
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ......
    5b
     
    No
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
    No
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .................
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    James R Carlsen President
    1.00     		500    
    107 Jumper Ct
    Folsom,CA95630
    Beth Carlsen CFO
    1.00     		500    
    107 Jumper Ct
    Folsom,CA95630
    David Leland Carlsen Director
    1.00     		500    
    107 Jumper Ct
    Folsom,CA95630
    Kathleen Marie Carlsen Director
    1.00     		500    
    107 Jumper Ct
    Folsom,CA95630
    Mac Carlsen Director
    1.00     		500    
    107 Jumper Ct
    Folsom,CA95630
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet  
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet  
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1  
    2  
    3  
    4  
    Part 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. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 8
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    0
    b
    Average of monthly cash balances.......................
    1b
    265,356
    c
    Fair market value of all other assets (see instructions)................
    1c
    15,340,000
    d
    Total (add lines 1a, b, and c).........................
    1d
    15,605,356
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
     
    3
    Subtract line 2 from line 1d.........................
    3
    15,605,356
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    234,080
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    15,371,276
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    768,564
    Part XI
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    768,564
    2a
    Tax on investment income for 2018 from Part VI, line 5......
    2a
    15,144
    b
    Income tax for 2018. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    15,144
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    753,420
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    753,420
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    753,420
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    632,520
    b
    Program-related investments—total from Part IX-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    632,520
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b. See instructions.................
    5
     
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    632,520
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2017     		(c)
    2017     		(d)
    2018
    1 Distributable amount for 2018 from Part XI, line 7 753,420
    2 Undistributed income, if any, as of the end of 2018:
    a Enter amount for 2017 only....... 67,350
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2018:
    a From 2013......  
    b From 2014......  
    c From 2015......  
    d From 2016......  
    e From 2017......  
    fTotal of lines 3a through e........  
    4Qualifying distributions for 2018 from Part
    XII, line 4: bullet$ 632,520
    a Applied to 2017, but not more than line 2a 67,350
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		 
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2018 distributable amount..... 565,170
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2018.    
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5  
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		 
    e Undistributed income for 2017. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		 
    f Undistributed income for 2018. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2019 ..........     		188,250
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		 
    8 Excess distributions carryover from 2013 not
    applied on line 5 or line 7 (see instructions) ...     		 
    9Excess distributions carryover to 2019.
    Subtract lines 7 and 8 from line 6a ......     		 
    10 Analysis of line 9:
    a Excess from 2014....  
    b Excess from 2015....  
    c Excess from 2016....  
    d Excess from 2017....  
    e Excess from 2018....  
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 10
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2018, enter the date of the ruling....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2018 (b) 2017 (c) 2016 (d) 2015
             
    b 85% of line 2a .........          
    c 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 activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    James R Carlsen
    Beth Carlsen
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 11
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    A Home Away
    Fort Mason Building 33
    San Francisco,CA94123     		NA   Home Away offers an academic and outdoor education program during summer months that includes reading, writing, and STEM activities, as well as trips to cultural institutions and natural destinations. 5,000
    ALS Sacramento
    2717 Cottage Way suite 17
    Sacramento,CA95825     		NA   To discover treatments and cure for ALS, and to serve, advocate for, and empower people affected by ALS to live their lives to the fullest. 2,500
    American Cancer Society
    1545 River Park Drive Suite 100
    Sacramento,CA95815     		    Attack cancer from every angle. Promote healthy lifestyles to help you prevent cancer. Research cancer and its causes to find more answers and better treatments. Fight for lifesaving policy changes. Provide everything from emotional support to the latest cancer information for those who have been touched by cancer. 5,000
    American Red Cross
    1565 Exposition Blvd
    Sacramento,CA95815     		NA   The deadly Camp Fire in California is now 100% contained. The Red Cross began its relief response more than two weeks ago and remains on the ground, providing shelter, food and comfort to those impacted by these devastating fires. 10,000
    Angela Hospice
    14100 Newburgh Rd
    Livonia,MI48154     		NA   General Operation of their Angela Hospice Care Center. Open since 1994, our inpatient Care Center provides a home away from home for hospice patients. The hospice team supports patients around the clock, and family and friends may visit at any time. 1,000
    Anne Carlsen Center
    PO Box 8000
    Jamestown,ND58402     		    To assist in a $13 million Building Fund to construct a new state of the art Anne Carlsen Center 10,000
    Big BrothersBig Sisters
    800 Howe Avenue Suite 440
    Sacramento,CA95825     		NA   To provide children facing adversity with professionally-supported one-to-one mentoring relationships that impact their lives forever. To increase the number of successful mentoring relationships for all children who need them, contributing to brighter futures, better schools, and stronger communities. 25,391
    Boy Scouts of America-GEC
    PO Box 1355
    Sacramento,CA95853     		NA   Help prepare young people to serve, lead, experience adventure, develop character, and shape future leaders. 5,780
    Brady Center
    840 First Street NE Suite 400
    Washington,DC20002     		NA   Too often guns in the home result in tragedies and too often these tragedies occur because there is unsafe access to those guns. There are over 300 million guns in America. Most are owned by law-abiding citizens without harmful or dangerous intent, yet a gun in the home results in more than two-thirds of all gun deaths. Nearly 1.7 million children live in a home with a loaded, unlocked gun. Every year thousands of kids are killed by firearms as a result. Our mission is to make sure our children are safe.Millions of guns are sold every year with no questions asked transactions. Only 60 percent of all gun sales are conducted with a background check. Today, eight states have background checks across all gun sales. Every day, 89 people die from gun violence. Policies such as expanding background checks to cover all gun sales would help keep guns out of the hands of criminals, felons, domestic abusers, and other illegal purchasers. Background checks are supported by 90 percent of Americans, 1,000
    California Waterfowl Assoc
    1346 Blue Oak Blvd
    Roseville,CA95678     		NA   California Waterfowl finds its strength in a set of clear core values. These values define our organization and guide us in our hunt for a better California. Stewardship: Finding Common GroundCalifornia Waterfowl serves as a bridge to connect hunters and non-hunters, public and private interests, young and old toward a common goal of conserving and enjoying our natural resources. By building strong partnerships and family involvement, the Association is connecting with Californians of all interests to inspire stewardship of our wetlands and wildlife resources.Heritage: Hunter DrivenCalifornia Waterfowl believes that hunting deeply connects people to the natural world and generates the knowledge and commitment to conserve our treasured resources. This passion for active involvement in nature motivates hunters to make vital investments in conserving California for our children and grandchildren. Education: Focused on the FutureCalifornia Waterfowl stimulates youths and adults to value wa 5,000
    Crossover Basketball America
    8550 Blue Maiden Way
    Elk Grove,CA95624     		NA   Develops student skills in various sports, as well as teaches them life skills. 5,000
    Cure Alzeimer's Fund
    34 Washington Street Suite 200
    Wellesley Hills,MA02481     		NA   Cure Alzheimer's Fund distributed grants for the Alzheimer's Genome Project initiative. After three years and approximately $3 million, the Project delivered it's first major milestone on time and on budget which was the identification of over 70 new genes conferring either risk for or protection against Alzheimer's disease. Confirmation and follow-up study are now underway to determine the genes with the highest potential for development of effective therapies. Headquartered at Massachusetts General Hospital, the Project includes researchers from several other United States research institutions. 5,000
    Domus Pacis
    PO Box 3366
    Breckenridge,CO80424     		NA   Very few people will be untouched by cancer. Cancer is a disease that shatters normalcyin your thoughts, conversations, interactions and expectations. With the awareness that cancer is a disease with far reaching effects, a variety of support programs have sprung up. Most programs support the patient physically, emotionally and spiritually. Others assist the caregivers in understanding the needs of the patient. The common focus is on understanding cancer.What remain untouched are the needs of the circle supporting and affected by the illness of a loved one. The purpose of the Domus Pacis Family Respite is to begin addressing those needsprimarily, the need to briefly escape from a life of cancer. It is our belief that by providing a carefree family vacation, a much needed harmony begins to flourish. Healing begins on many levels within all participants.Given the time consuming nature of cancer treatment, the commitment to organizing a family get-away may be a low priority. Most of us ar 1,000
    Lake Almanor Community Foundation
    501 PENINSULA DR
    LAKE ALMANOR,CA96137     		NA   TO BENEFIT COMMUNITY THROUGH ARTS AND MUSIC 650
    The V Foundation
    14600 Weston Parkway
    Cary,NC27513     		NA   Cancer research 500
    First Tee Sacramento
    3704 Marconi Avenue Suite 1
    Sacramento,CA95821     		NA   The First Tee started as a way to bring an affordable junior golf program to youth and communities that did not have them. This supports character education in youths. 500
    SF MOMA
    151 Third Street
    San Francisco,CA94103     		NA   Museum of modern art - SFMOMA believes the art of our time is vital and shares it with passion and purpose, and that art and the creative process can open minds and help build a better world. For that reason, we assemble unparalleled collections, create exhilarating exhibitions, and develop engaging public programs that connect with our community 150
    Network for Good
    1140 Connecticut Ave NW 700
    Washington,DC20036     		NA   Network for Good powers more digital giving than any other platform, 500
    American Heart Assoc
    National Center 7272 Greenville Ave
    Dallas,TX75231     		NA   The American Heart Association and American Stroke Association publish medical guidelines and scientific statements on various cardiovascular disease and stroke topics. AHA/ASA volunteer scientists and healthcare professionals write the statements. The statements are supported by scientific studies published in recognized journals and have a rigorous review and approval process. Scientific statements generally include a review of data available on a specific subject, an evaluation on its relationship to overall cardiovascular disease science, and often an AHA/ASA position on the basis of that evaluation. 1,000
    Cistic Fibrosis Foundation
    1540 River Park Dr Ste 215
    Sacramento,CA95815     		NA   The mission of the Cystic Fibrosis Foundation is to cure cystic fibrosis and to provide all people with the disease the opportunity to lead full, productive lives by funding research and drug development, promoting individualized treatment, and ensuring access to high-quality, specialized care. 500
    Aerospace Museum of CA
    3200 Freedom Park Drive
    McClellan,CA95652     		NA   The Aerospace Museum of California is an aviation museum located in North Highlands, California on the grounds of the former McClellan Air Force Base. It features displays of authentic military and civilian aircraft as well as space vehicle replicas 100
    FAA Veterans Parade
    800 Independence Avenue SW
    Washington,DC20591     		NA   Parade is a moving timeline of American military history, honoring those who have served and sacrificed from the American Revolution to the present day. It draws on the tradition of Memorial Day parades, going back to the beginning of the holiday just after the Civil War, to create a family friendly event aimed at calling attention to the true meaning of Memorial Day honoring our fallen heroes. 500
    Menlo College Athletic
    1000 El Camino Real
    Atherton,CA94027     		NA   Supports college athletic programs for students 100
    Friends of Folsom CERT
    535 Glenn Drive
    Folsom,CA95630     		NA   Friends of Folsom Cert is a nonprofit focused on fundraising related to public safety, disaster preparedness and relief. Founded in 2011, Friends of Folsom Cert is headquartered in Folsom, CA. 500
    Fregoso Foundation
    1601 Lomita Way
    El Dorado Hills,CA95762     		NA   The Fregoso Outdoor Foundation values outdoor recreation and the many benefits you can gain from choosing to use your leisure time outdoors. Whether you are hunting, waterskiing, snowboarding, or participating in one of our fishing derbys, the Fregoso Outdoor Foundation focuses on providing first class sporting and recreational programs. The foundation uses the physical, emotional, and social interests of our warriors and their families, as well as recognizing developmental principles, to offer diversified activities that help gain self-confidence and self-esteem, re-enforce active lifestyles, increase self-reliance; and the skills to adopt a constructive new hobby. We partner with professional outfitters to provide the knowledge and skills so all our participants are receiving the best possible experience. Our goal as a foundation is to offer programs where our veterans, military members, and families can learn or gain the skills and interests of an activity that will get them togethe 5,100
    First Response Chaplains
    14806 Echo Ridge Road
    Nevada City,CA95959     		NA   To support Pastor Toby in his efforts to ease suffering in disaster impacted areas all over the world. 2,000
    Folsom Arts Association
    PO Box 234
    Folsom,CA95763     		NA   The Johnny Cash Art Trail will set the stage for a world-class public art experience to celebrate and honor The Man in Black. The project includes eight larger-than-life public art pieces and a three-acre park honoring the man in black. The art will be a collaboration between Sacramento artist Adam Romo, the Fine Art Studios of Rotblatt-Amrany and the RRM Design Group. The pieces will include two 7-foot tall bronze guitar picks at the trailheads, a 40-foot statue of Cash and a Ring of Fire that will glow like flame. Plans include a 3-acre park at the corner of East Natoma Street and Folsom Lake Crossing.A Johnny Cash Trail Art Experience fundraising effort continues, and the Folsom Arts Association, is accepting contributions in order to complete the park and art installations. To date thousands of dollars been donated to the Johnny Cash Trail Project through the FAA. Donors can purchase a plaque on the Donor wall located adjacent to the trail at the corner of E. Natoma and Folsom Lake 5,000
    Folsom Athletic Boosters
    PO Box 6162
    Folsom,CA95763     		NA   Help student athletes who may need funds for equipment, transportation or fees. 1,000
    Girl Scouts Heart of Central CA
    6601 Elvas Avenue
    Sacramento,CA95819     		NA   Science Technology Engineering and Math (STEM) programs have caught on quickly at GSHCC because Girl Scouts are curious, motivated and adventurous by nature. Our organization is uniquely positioned to address gender inequity in STEM education and enrichment locally. We recognize that STEM educational opportunities for girls are necessary now more than ever. In order to provide girls with empowering, hands-on STEM learning opportunities, GSHCC opened the regions first girl-led, girl-build STEM Center + MakerSpace in November 2017. This unique facility will host a variety of structured and open-format maker and design-thinking activities that encourage girls to embrace the spirit of scientific discovery in their lives. The STEM Center + MakerSpace is an investment in the next generation of Go-getters, Innovators, Risk-takers, and Leaders (G.I.R.L.s), and will serve as a hub for girl innovation, exploration and discovery for Girl Scouts throughout our 18-county region. 5,000
    Guide Dogs of America
    13445 Glenoaks Boulevard
    Sylmar,CA91342     		NA   Puppy raisers are the cornerstone of our training program at Guide Dogs of America. At the heart of every successful guide dog team is a puppy raiser who embraced the opportunity to raise a special puppy, teach him to feel safe in the world, and help him learn the skills necessary to become a well-mannered canine citizenPuppies are placed with carefully screened foster families, known as puppy raisers, when they are 8 weeks old. The puppy raisers job is to provide a loving first home, teach basic obedience and proper house manners to stay off furniture, not to jump on counters, not to chew inappropriate items in the home, etc. They also provide ongoing urban socialization, carefully exposing the dogs to a wide variety of public settings and teaching them to be calm and confident in all situations. Thanks to our dedicated puppy raisers, the dogs are well prepared to return to GDA at 16 to 18 months old, when they begin 4 to 6 months of formal guide-work training.GDA supports our puppy r 5,000
    HART of Folsom
    PO Box 6327
    Folsom,CA95763     		NA   Assist in general operations of temporarily housing feeding dinner to the homeless of Folsom, CA during the months of December through March. 5,000
    Journey Church
    450 Blue Ravine
    Folsom,CA95630     		NA   Deferred Maintenance Building $5,000 The Balance for General Operations, Missions, Evangelism, Disaster Assistance, Support for PCUSA 16,706
    MedShare
    2937 Alvardo Street
    San Leandro,CA94577     		NA   Biomedical Equipment Training & Repair Service focuses on providing quality, functional medical equipment including biomedical engineering training to those in need. 10,000
    Memorial Presbyterian Church
    1310 Ashman Street
    Midland,MI48640     		NA   General Operations of the church 5,000
    National Parks Foundation
    1110 Vermont Avenue NW
    Washington,DC20005     		NA   We focus on promoting programs and projects that protect precious landscapes and wilderness, historical sites, and places of cultural significance.We work to keep trails clear through our Active Trails program, partner with collaborators like the White House to get kids outdoors through Open OutDoors for Kids, and most importantly, raise and allocate critical funds to keep our national parks safe. And with the ongoing support of fellow park lovers, well continue for years to come. 1,000
    North Valley Community Foundati
    240 Main Street Suite 260
    Chico,CA95928     		NA   To support the victims of the Camp Fire in Butte County, CA and, in addition to meeting their basic needs, will focus on.Tragically, the Camp Fire in Butte County has been declared the most devastating and deadliest wildfire in California history. The healing and recovery needs are massive based on the levels of trauma and tragedy inflicted 11,000
    Operation Hope
    859 E Vista Way
    Vista,CA92084     		NA   General Operations of Emergency Bridge Housing 5,000
    Powerhouse Ministries
    311 Market Street
    Folsom,CA95630     		NA   Support the Women and Childrens Transformation Center. They strive to break the cycle of life-destroying forces and choices. The children of PTC benefit from excellent care, counseling and community, giving them the hope of a much brighter future. The Powerhouse Transformation Center is one of the few no-cost residential recovery programs in Northern California. The center addresses all aspects of a womans life within a safe, caring community. We know for life transformation there are no quick fixes. The program is tailored to each womans personal development needs, dreams and life goals. It consists of five phases and lasts approximately two years. 25,150
    Regents of U of Michigan
    500 S State Street
    Ann Arbor,MI48109     		NA   To encourage excellence for the final projects of Professor Peter Allens Real Estate Development class. The final goal being to develop open minded, creative, and progressive thinkers who will ultimately enter into the career of Real Estate Development. 3,500
    Salv Army Sac Rehab Center
    1615 D Street
    Sacramento,CA95814     		NA   In Sacramento, The Salvation Army's Adult Rehabilitation Centers help residents to combat their addictions, build the work and social skills needed to re-enter the workforce, regain health and stability, and restore families that have been disrupted due to substance abuse.Through holistic work-therapy, group and individual counseling, life skill development, and spiritual direction, residents learn to abandon substance reliance. For over 100 years, The Salvation Army's no-fee rehabilitation programs have provided emotional, spiritual and social assistance to those struggling with drug and alcohol addiction. 10,000
    Seneca Hospital
    PO Box 160
    Chester,CA96020     		NA   Seneca Hospital Auxiliary volunteer service support 1,000
    SF Marin Food Bank
    900 Pennsylvania Avenue
    San Francisco,CA94107     		NA   Home Delivered GroceriesFor thousands of homebound residents in San Francisco, a weekly knock on the door brings a delivery of fresh groceries and a friendly visit. Every bag includes a balance of nutritious foods such as fresh fruits and vegetables, low-fat dairy, lean protein, and whole grains. Thanks to the support of the San Francisco Department of Aging and Adult Services (DAAS), we continue to expand this program that serves as a lifeline for so many people.Many participants are unable to visit our pantries because of mobility challenges, but they still have the desire and ability to prepare meals at home. They benefit greatly from the autonomy that comes with cooking and preparing their own meals with fresh groceries delivered to their homes. 5,000
    Theatre for Children
    2700 Capitol Avenue
    Sacramento,CA95816     		NA   $150,000 Last portion of $250,000 Pledge of $26million Building Fund for new theatre. Sponsored Box Office 152,500
    Ticket to Dream
    1400 Rocky Ridge Drive Suite 280
    Roseville,CA95661     		NA   Ticket to Dream Foundation is dedicated to creating hope and opportunity for foster children across the nation, so they can just be kids 250,450
    Twin Lakes Food Bank
    327 Montrose Drive
    Folsom,CA95630     		NA   Every human being has a fundamental right to access to food. No person deserves to go hungry. The reality is that food insecurity impacts one in six Americans who report running out of food at least once a year. We serve individuals, families, senior citizens and homeless who are desperate for groceries for themselves and their families.Money goes to general operations 5,000
    Wildland Firefighter Foundation
    2049 Airport Way
    Boise,ID83705     		NA   The role of the Wildland Firefighter Foundation is to honor past, present, and future wildland firefighters by helping maintain and grow the national monument established for those who have lost their lives, operate a financial fund providing assistance to the families of fallen and wildland firefighters and to injured firefighters, and partner with private and interagency organizations to educate the public about wildland fires and promote excellence and safety in firefighting.We provide financial assistance, immediate and ongoing emotional support, advocacy, and recognition to fallen and injured wildland firefighters. We present program information and in some instances, onsite crisis support, to government and private fire agencies and other organizations.Survivor family members are forever a part of the Foundation's purpose. We continue to provide emotional support and in some cases financial support many years after a firefighter's death. Additional support may include holiday par 12,500
    Young Life
    PO Box 826
    Folsom,CA95763     		NA   Help hire and train staff and provide essential administrative support to the area. Also support operating expenses such as salaries and other ministry costs and can help send kids to Young Life camps. 1,200
    Total .................................bullet 3a 629,777
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3 Interest on savings and temporary cash
    investments ...........     		      135  
    4 Dividends and interest from securities....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....     16 774,067  
    6 Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8 Gain or (loss) from sales of assets other than
    inventory ............     		         
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   774,202  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    774,202
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 13
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2018)
    Additional Data


    Software ID: 18007218
    Software Version: 2018v3.1


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2018 AccountingFeesSchedule
    Name:
    Carlsen Muir Family Foundation
    EIN:
    82-3157713
    Software ID:
    18007218
    Software Version:
    2018v3.1
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Hullen Accountancy 2,500 2,500 2,500 0

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2018 AmortizationSchedule
    Name:
    Carlsen Muir Family Foundation
    EIN:
    82-3157713
    Software ID:
    18007218
    Software Version:
    2018v3.1
    Description of Amortized Expenses Date Acquired, Completed, or Expended Amount Amortized Deduction for Prior Years Amortization Method Current Year Amortization Net Investment Income Adjusted Net Income Total Amount of Amortization
    PFX Pet Renewal Comm 2017-12-01 64,798 44,998 3.0000 19,800     64,798
    Standard lease renewal 2017-12-01 49,647 20,685 5.0000 9,929     30,614

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2018 DepreciationSchedule
    Name:
    Carlsen Muir Family Foundation
    EIN:
    82-3157713
    Software ID:
    18007218
    Software Version:
    2018v3.1
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    Seaport 185 Bldg 2017-12-01 836,967 322,630 SL 37.4000 22,379 22,379 22,379  
    Seaport 185 Bldg 2017-12-01 35,939 15,233 SL 39.0000 922 922 922  
    Building 2017-12-01 3,479,330 817,773 SL 39.0000 89,214 89,214 89,214  
    Tenant Improvements 2017-12-01 2,901,383 827,870 SL 39.0000 74,394 74,394 74,394  

    TY 2018 InvestmentsLandSchedule2
    Name:
    Carlsen Muir Family Foundation
    EIN:
    82-3157713
    Software ID:
    18007218
    Software Version:
    2018v3.1
    Category/ Item Cost/Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    Buildings 7,253,619 202,485 7,051,134 11,811,800
    Land 1,368,622   1,368,622 3,528,200

    TY 2018 LegalFeesSchedule
    Name:
    Carlsen Muir Family Foundation
    EIN:
    82-3157713
    Software ID:
    18007218
    Software Version:
    2018v3.1
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    WKB Klomparens Attorney 13,999 13,999 13,999 0


    TY 2018 OtherAssetsSchedule
    Name:
    Carlsen Muir Family Foundation
    EIN:
    82-3157713
    Software ID:
    18007218
    Software Version:
    2018v3.1
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    Net Intangible Assets 131,357 101,628 19,033


    TY 2018 OtherExpensesSchedule
    Name:
    Carlsen Muir Family Foundation
    EIN:
    82-3157713
    Software ID:
    18007218
    Software Version:
    2018v3.1
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Amortization 29,729 29,729 29,729  
    Bank Fees 159 159 159  
    Postage 6 6 6 6
    Prior year variance in reported income 12 12 12 12
    Rental Expenses 351,255 351,255    
    State Registry 225 225 225 225
    Supplies 86 86 86  


    TY 2018 TaxesSchedule
    Name:
    Carlsen Muir Family Foundation
    EIN:
    82-3157713
    Software ID:
    18007218
    Software Version:
    2018v3.1
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Federal taxes 3,680      
    FTB 25