-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0052
20
18
Open to Public Inspection
For calendar year 2018, or tax year beginning
01-01-2018
, and ending
12-31-2018
Name of foundation
DR ARTHUR J & HELEN M HORVAT FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 2907 - TRUST TAX DEPT
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WILSON
,
NC
278942907
A Employer identification number
23-6846849
B
Telephone number (see instructions)
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
5,026,419
J
Accounting method:
Cash
Accrual
Other (specify)
(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)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
132,423
132,423
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
176,224
b
Gross sales price for all assets on line 6a
2,816,805
7
Capital gain net income (from Part IV, line 2)
...
176,224
8
Net short-term capital gain
.........
0
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
........
308,647
308,647
13
Compensation of officers, directors, trustees, etc.
84,766
84,766
84,766
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
428
428
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
489
489
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
41,494
3,247
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
0
0
23
Other expenses (attach schedule)
.......
9
9
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
127,186
88,022
0
85,683
25
Contributions, gifts, grants paid
.......
212,990
212,990
26
Total expenses and disbursements.
Add lines 24 and 25
340,176
88,022
0
298,673
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-31,529
b
Net investment income
(if negative, enter -0-)
220,625
c
Adjusted net income
(if negative, enter -0-)
...
0
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
1
Cash—non-interest-bearing
.............
6,417
13,260
13,260
2
Savings and temporary cash investments
.........
129,703
241,237
241,237
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
4
Pledges receivable
Less: allowance for doubtful accounts
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)
Less: allowance for doubtful accounts
0
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
52
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
3,859,064
3,594,880
3,390,573
c
Investments—corporate bonds (attach schedule)
.......
1,300,131
1,255,569
1,243,555
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
158,002
137,794
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
5,295,367
5,262,948
5,026,419
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
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow SFAS 117, check here
and complete lines 24 through 26 and lines 30 and 31.
24
Unrestricted
..................
25
Temporarily restricted
...............
26
Permanently restricted
...............
Foundations that do not follow SFAS 117, check here
and complete lines 27 through 31.
27
Capital stock, trust principal, or current funds
........
5,295,367
5,262,948
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)
.....
5,295,367
5,262,948
31
Total liabilities and net assets/fund balances
(see instructions)
.
5,295,367
5,262,948
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
5,295,367
2
Enter amount from Part I, line 27a
.....................
2
-31,529
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
5,263,838
5
Decreases not included in line 2 (itemize)
5
890
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30
.
6
5,262,948
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.)
1 a
13098.065 JANUS HENDERSON INTERNATIONAL OPPT I CUSIP CHG TO 47103X278
2017-06-23
2018-01-09
b
2539.047 JANUS HENDERSON INTERNATIONAL OPPT I CUSIP CHG TO 47103X278 E
2017-09-06
2018-01-09
c
459.76 FED HOME LOAN MTG CORP POOL# G08770 DTD 06/01/2017 3.5% 07/01/2
2017-07-07
2018-01-16
d
496.51 FED HOME LOAN MTG CORP POOL# G08771 DTD 06/01/2017 4% 07/01/204
2017-11-28
2018-01-16
e
339.37 FED HOME LOAN MTG CORP POOL# G08774 DTD 07/01/2017 3.5% 08/01/2
2017-07-07
2018-01-16
331.21 FED HOME LOAN MTG CORP POOL #G08697 DTD 03/01/2016 3% 03/01/204
2017-07-06
2018-01-16
532.44 FED HOME LOAN MTG CORP POOL# G08706 DTD 05/01/2016 3.5% 05/01/2
2017-07-06
2018-01-16
430.48 FED HOME LOAN MTG CORP POOL# G08761 DTD 04/01/2017 3.5% 05/01/2
2017-07-06
2018-01-16
406.84 FED HOME LOAN MTG CORP POOL# G08748 DTD 01/01/2017 3.5% 02/01/2
2017-07-06
2018-01-16
671.1 FED HOME LOAN MTG CORP POOL# G08752 DTD 02/01/2017 4% 03/01/2047
2017-07-06
2018-01-16
513.5 FED HOME LOAN MTG CORP POOL #G18605 DTD 6/1/2016 3% 06/01/2031
2017-09-21
2018-01-16
718.96 FED NATL MTG ASSN POOL# MA2960 DTD 03/01
2017-07-06
2018-01-25
30815.69 FED HOME LOAN MTG CORP POOL #G18605 DTD 6/1/2016 3% 06/01/203
2017-09-21
2018-02-01
360. DR PEPPER SNAPPLE GROUP INC
2017-06-23
2018-02-02
45882.28 FED HOME LOAN MTG CORP POOL# G08761 DTD 04/01/2017 3.5% 05/01
2017-07-06
2018-02-07
388.86 FED HOME LOAN MTG CORP POOL# G08770 DTD 06/01/2017 3.5% 07/01/2
2017-07-07
2018-02-15
389.51 FED HOME LOAN MTG CORP POOL# G08771 DTD 06/01/2017 4% 07/01/204
2017-11-28
2018-02-15
362.67 FED HOME LOAN MTG CORP POOL# G08774 DTD 07/01/2017 3.5% 08/01/2
2017-07-07
2018-02-15
277.86 FED HOME LOAN MTG CORP POOL #G08697 DTD 03/01/2016 3% 03/01/204
2017-07-06
2018-02-15
449.56 FED HOME LOAN MTG CORP POOL# G08706 DTD 05/01/2016 3.5% 05/01/2
2017-07-06
2018-02-15
399.12 FED HOME LOAN MTG CORP POOL# G08761 DTD 04/01/2017 3.5% 05/01/2
2017-07-06
2018-02-15
399.97 FED HOME LOAN MTG CORP POOL# G08748 DTD 01/01/2017 3.5% 02/01/2
2017-07-06
2018-02-15
603.57 FED HOME LOAN MTG CORP POOL# G08752 DTD 02/01/2017 4% 03/01/204
2017-07-06
2018-02-15
563.08 FED NATL MTG ASSN POOL# MA2960 DTD 03/01
2017-07-06
2018-02-26
481.63 FED HOME LOAN MTG CORP POOL #G18605 DTD 6/1/2016 3% 06/01/2031
2017-09-21
2018-02-28
30000. US TREASURY BILL DTD 03/02/2017 0% 03/01
2018-02-02
2018-03-01
45000. US TREASURY BILL DTD 03/02/2017 0% 03/01
2018-02-08
2018-03-01
115. JOHNSON + JOHNSON COM STK
2017-06-23
2018-03-12
470. TORCHMARK CORP
2017-06-23
2018-03-12
105. UNITEDHEALTH GROUP
2011-07-11
2018-03-12
294.54 FED HOME LOAN MTG CORP POOL# G08770 DTD 06/01/2017 3.5% 07/01/2
2017-07-07
2018-03-15
46993.02 FED HOME LOAN MTG CORP POOL# G08770 DTD 06/01/2017 3.5% 07/01
2017-07-07
2018-03-15
276.38 FED HOME LOAN MTG CORP POOL# G08771 DTD 06/01/2017 4% 07/01/204
2017-11-28
2018-03-15
32121.69 FED HOME LOAN MTG CORP POOL# G08771 DTD 06/01/2017 4% 07/01/2
2017-11-28
2018-03-15
272.53 FED HOME LOAN MTG CORP POOL# G08774 DTD 07/01/2017 3.5% 08/01/2
2017-07-07
2018-03-15
47668.09 FED HOME LOAN MTG CORP POOL# G08774 DTD 07/01/2017 3.5% 08/01
2017-07-07
2018-03-15
257.09 FED HOME LOAN MTG CORP POOL #G08697 DTD 03/01/2016 3% 03/01/204
2017-07-06
2018-03-15
39985.55 FED HOME LOAN MTG CORP POOL #G08697 DTD 03/01/2016 3% 03/01/2
2017-07-06
2018-03-15
421.47 FED HOME LOAN MTG CORP POOL# G08706 DTD 05/01/2016 3.5% 05/01/2
2017-07-06
2018-03-15
39229.01 FED HOME LOAN MTG CORP POOL# G08706 DTD 05/01/2016 3.5% 05/01
2017-07-06
2018-03-15
377.37 FED HOME LOAN MTG CORP POOL# G08748 DTD 01/01/2017 3.5% 02/01/2
2017-07-06
2018-03-15
44979.66 FED HOME LOAN MTG CORP POOL# G08748 DTD 01/01/2017 3.5% 02/01
2017-07-06
2018-03-15
475.19 FED HOME LOAN MTG CORP POOL# G08752 DTD 02/01/2017 4% 03/01/204
2017-07-06
2018-03-15
42428.11 FED HOME LOAN MTG CORP POOL# G08752 DTD 02/01/2017 4% 03/01/2
2017-07-06
2018-03-15
75000. US TREASURY BILL DTD 09/14/2017 0% 03/15
2018-02-28
2018-03-15
43407.9 FED NATL MTG ASSN POOL# MA2960 DTD 03/01
2017-07-06
2018-03-20
553.96 FED NATL MTG ASSN POOL# MA2960 DTD 03/01
2017-07-06
2018-03-26
25000. US TREASURY NOTE DTD 05/31/2011 2.375% 0
2017-06-29
2018-04-23
250. BEMIS INC
2017-06-23
2018-05-29
150. MEDNAX INC COMMON
2017-06-23
2018-05-29
180. MEREDITH CORP
2017-06-23
2018-05-29
85. TUPPERWARE CORP COMMON
2017-06-23
2018-05-29
20000. US TREASURY NOTE DTD 05/31/2011 2.375% 0
2017-06-29
2018-05-31
19143.336 GOLDMAN SACHS SATELLITE STRATEGIES PORTF
2017-06-23
2018-06-15
25000. US TREASURY NOTE DTD 06/30/2014 1.625% 0
2017-06-29
2018-06-20
42000. MERCK & CO INC DTD 12/10/2010 3.875% 01/
2017-06-29
2018-07-06
40000. FED NATL MTG ASSN 1.625% 11/27/18
2017-06-29
2018-07-17
22000. OCCIDENTAL PETROLEUM COR DTD 12/16/2010
2017-06-29
2018-07-24
19003.091 GOLDMAN SACHS SATELLITE STRATEGIES PORTF
2017-06-23
2018-07-25
22000. APPLE INC DTD 05/06/2014 3.45% 05/06/202
2017-06-29
2018-08-16
18000. HOME DEPOT INC DTD 12/19/2006 5.875% 12/
2017-06-29
2018-08-16
45. ABBVIE INC
2017-11-21
2018-08-17
30. AMERICAN EXPRESS CO COM STK*
2017-11-21
2018-08-17
65. APPLE COMPUTER COM
2011-07-11
2018-08-17
85. AVERY DENNISON CORP
2017-06-23
2018-08-17
10. BIG LOTS, INC
2017-06-23
2018-08-17
20. BROADRIDGE FINANCIAL SOLUTIONS INC
2017-06-23
2018-08-17
35. BROWN & BROWN INC
2017-06-23
2018-08-17
5. BRUNSWICK CORPORATION COMMON
2018-05-29
2018-08-17
80. CH ROBINSON WORLDWIDE INC
2017-06-23
2018-08-17
10. CARLISLE COMMON
2017-06-23
2018-08-17
10. CARTERS INC COMMON
2017-08-10
2018-08-17
10. CHARLES RIV LABORATORIES INTL INC COM
2017-07-06
2018-08-17
15. CHEESECAKE FACTORY COMMON
2017-06-23
2018-08-17
25. CHURCH & DWIGHT CO
2017-06-23
2018-08-17
15. CIRRUS LOGIC COMMON
2017-06-23
2018-08-17
230. CISCO SYS INC
2013-03-25
2018-08-17
90. COLGATE-PALMOLIVE CO COM STK
2017-06-23
2018-08-17
35. COMMERCE BANCSHARES, INC.
2017-06-23
2018-08-17
25. CONVERGYS CORP
2017-06-23
2018-08-17
5. CRACKER BARREL OLD COUNTRY STORE COMMON
2017-06-23
2018-08-17
15. CURTISS WRIGHT CORP
2017-06-23
2018-08-17
25. DE LUXE CHECK PRINTERS INCORPORATED
2017-06-23
2018-08-17
110. DISCOVER FINL SVCS
2017-06-23
2018-08-17
20. EAST WEST BANCORP INC COMMON
2017-06-23
2018-08-17
35. EXXON MOBIL CORP
2016-09-07
2018-08-17
10. FLIR SYSTEMS INC COMMON
2017-11-21
2018-08-17
20. FACEBOOK INC CL A
2018-03-12
2018-08-17
15. GALLAGHER ARTHUR J
2017-06-23
2018-08-17
10. GENTEX CORP COM
2018-05-29
2018-08-17
75. GENUINE PARTS CO
2017-06-23
2018-08-17
65. GILEAD SCIENCES INC
2013-03-25
2018-08-17
35. HANESBRANDS INC
2017-06-23
2018-08-17
10. HOLLYFRONTIER CORP
2017-11-21
2018-08-17
25. GEO. A. HORMEL & CO*
2017-06-23
2018-08-17
5. HUBBELL INC COMMON
2017-06-23
2018-08-17
190. INTEL CORP
2017-06-23
2018-08-17
10. INTERDIGITAL INC COMMON
2017-06-23
2018-08-17
35. JOHNSON + JOHNSON COM STK
2017-06-23
2018-08-17
15. J2 GLOBAL, INC. COMMON
2017-06-23
2018-08-17
25. LAM RESH CORP
2017-08-08
2018-08-17
20. LAMAR ADVERTISING CO
2017-06-23
2018-08-17
5. MANPOWER INC WIS COMMON
2017-06-23
2018-08-17
125. MARSH & MCLENNAN COS INC
2017-06-23
2018-08-17
55. MCDONALD'S CORP
2017-06-23
2018-08-17
125. MICROSOFT CORP
1995-08-28
2018-08-17
65. PEPSICO INC
2017-06-23
2018-08-17
30. RPM INC OHIO COM
2017-06-23
2018-08-17
50. RAYTHON COMPANY
2017-06-23
2018-08-17
15. RESMED, INC.
2017-06-23
2018-08-17
25. SCHLUMBERGER LTD COMMON
2013-03-25
2018-08-17
10. SONOCO PRODUCTS COMPANY
2018-05-29
2018-08-17
30. STANLEY BLACK & DECKER INC
2017-06-23
2018-08-17
15. SYNOPSYS INC.
2017-06-23
2018-08-17
10. SYNNEX CORP COMMON
2017-06-23
2018-08-17
80. TJX COMPANIES
2011-07-11
2018-08-17
25. 3M COMPANY COMMON
2017-06-23
2018-08-17
5. TORO COMPANY COMMON
2017-06-23
2018-08-17
55. TYSON FOODS INC INC. COMMON
2018-02-02
2018-08-17
15. UGI CORP COM
2017-06-23
2018-08-17
175. US BANCORP
2017-06-23
2018-08-17
55. UNION PACIFIC CORP COMMON STO*
2013-03-25
2018-08-17
10. UNITED THERAPEUTICS CORP DEL
2017-06-23
2018-08-17
30. UNITEDHEALTH GROUP
2014-03-12
2018-08-17
10. URBAN OUTFITTERS INC COMMON
2018-05-29
2018-08-17
85. V F CORP COMMON
2017-06-23
2018-08-17
35. VALERO ENERGY CORP NEW COM
2017-11-21
2018-08-17
75. VARIAN MED SYS INC
2017-06-23
2018-08-17
25. VERIZON COMMUNICATIONS
2017-06-23
2018-08-17
65. WALGREENS BOOTS ALLIANCE INC
2017-06-23
2018-08-17
10. WATSCO INC CL A
2017-06-23
2018-08-17
5. WINTRUST CORP
2017-11-21
2018-08-17
25. WORTHINGTON INDUSTRIES, INC
2017-06-23
2018-08-17
50. ACCENTURE PLC IRELAND SHS
2017-06-23
2018-08-17
90. TE CONNECTIVITY LTD
2016-11-09
2018-08-17
642.218 CONESTOGA SMALL CAP-INST
2017-06-23
2018-08-20
571.215 MFS NEW DISCOVERY VALUE-I
2017-06-23
2018-08-20
40.643 T ROWE PRICE INTL DISC-I CLOSE TO NEW WA
2017-06-23
2018-08-20
20000. US TREASURY NOTE DTD 06/30/2014 1.625% 0
2017-06-29
2018-08-30
35000. JPMORGAN CHASE & CO 4.250% 10/15/20
2017-06-29
2018-09-20
21000. MANULIFE FINL CORP DTD 03/04/2016 4.15%
2017-06-29
2018-09-20
46000. TARGET CORP 2.900% 01/15/22
2017-06-29
2018-09-20
85. APPLE COMPUTER COM
2011-07-11
2018-09-24
16000. BP CAPITAL MARKETS PLC DTD 09/16/2016 3.
2017-08-08
2018-09-24
190. MICROSOFT CORP
1995-08-28
2018-09-24
200. STANLEY BLACK & DECKER INC
2017-06-23
2018-09-24
26000. VISA INC DTD 12/14/2015 2.8% 12/14/2022
2017-06-29
2018-09-28
21000. PNC FUNDING CORP DTD 02/08/10 5.125% 02/
2017-06-29
2018-10-11
31000. BERKSHIRE HATHAWAY INC DTD 3/15/2016 3.1
2017-06-29
2018-10-17
.418 SYNNEX CORP COMMON
2017-06-23
2018-10-31
55. CHURCH & DWIGHT CO
2017-06-23
2018-11-16
25. FLIR SYSTEMS INC COMMON
2017-11-21
2018-11-16
355. HANESBRANDS INC
2017-06-23
2018-11-16
75. HOLLYFRONTIER CORP
2017-11-21
2018-11-16
30. GEO. A. HORMEL & CO*
2017-06-23
2018-11-16
95. INTERDIGITAL INC COMMON
2017-06-23
2018-11-16
75. SYNOPSYS INC.
2017-06-23
2018-11-16
70. WINTRUST CORP
2017-11-21
2018-11-16
120. WORTHINGTON INDUSTRIES, INC
2017-06-23
2018-11-16
245. AVERY DENNISON CORP
2017-06-23
2018-11-27
497. GILEAD SCIENCES INC
2017-03-24
2018-11-27
310. MARSH & MCLENNAN COS INC
2017-06-23
2018-11-27
80. MCDONALD'S CORP
2017-06-23
2018-11-27
90. RAYTHON COMPANY
2017-06-23
2018-11-27
162. SCHLUMBERGER LTD COMMON
2013-03-25
2018-11-27
10. 3M COMPANY COMMON
2017-06-23
2018-11-27
20. 3M COMPANY COMMON
2017-06-23
2018-11-27
500. TYSON FOODS INC INC. COMMON
2018-02-02
2018-11-27
575. US BANCORP
2017-06-23
2018-11-27
105. V F CORP COMMON
2017-06-23
2018-11-27
.95 COMMERCE BANCSHARES, INC.
2018-12-17
2018-12-17
2158.659 DFA COMMODITY STRATEGY PORT
2018-06-15
2018-12-17
2172.154 OAKMARK INTERNATIONAL-INST
2018-01-09
2018-12-17
2630.662 IVY INTERNATIONAL CORE EQUITY FUND CLASS
2017-06-23
2018-12-17
375.329 LAZARD GLOBAL LISTED INFRASTRUCTURE PORT
2018-07-25
2018-12-17
77.16 T ROWE PRICE INTL DISC-I CLOSE TO NEW WA
2017-06-23
2018-12-17
1565.772 VANGUARD MORTGAGE BACKED SECURITIES INDE
2018-03-14
2018-12-17
8000. MERCK & CO INC DTD 12/10/2010 3.875% 01/
2017-06-29
2018-12-18
10000. US TREASURY BOND DTD 02/15/2006 4.5% 02/
2017-06-29
2018-12-18
10000. US TREASURY BOND DTD 02/15/2017 3% 02/15
2017-06-29
2018-12-18
30000. US TREASURY NOTE DTD 06/30/2014 1.625% 0
2017-06-29
2018-12-18
CAPITAL GAIN DIVIDENDS
P
(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
403,551
369,627
33,924
b
78,228
73,048
5,180
c
460
473
-13
d
497
521
-24
e
339
349
-10
331
331
532
548
-16
430
443
-13
407
418
-11
671
707
-36
514
529
-15
719
757
-38
30,975
31,726
-751
42,897
33,418
9,479
46,090
47,187
-1,097
389
400
-11
390
408
-18
363
373
-10
278
277
1
450
463
-13
399
410
-11
400
411
-11
604
636
-32
563
593
-30
482
496
-14
29,977
29,973
4
44,965
44,969
-4
15,258
15,632
-374
40,841
35,535
5,306
23,457
6,122
17,335
295
303
-8
46,920
48,348
-1,428
276
290
-14
32,895
33,678
-783
273
280
-7
47,594
49,039
-1,445
257
257
38,773
39,923
-1,150
421
434
-13
39,131
40,363
-1,232
377
388
-11
44,867
46,259
-1,392
475
500
-25
43,436
44,682
-1,246
74,963
74,963
44,330
45,700
-1,370
554
583
-29
25,017
25,259
-242
10,871
11,744
-873
6,947
8,959
-2,012
8,636
10,204
-1,568
3,822
5,951
-2,129
20,000
20,207
-207
156,210
156,210
24,810
25,126
-316
42,824
44,693
-1,869
39,923
40,192
-269
22,471
23,641
-1,170
155,065
155,065
22,198
23,054
-856
22,190
23,647
-1,457
4,454
4,271
183
3,092
2,831
261
14,119
3,284
10,835
9,106
7,491
1,615
481
472
9
2,658
1,532
1,126
1,045
756
289
324
315
9
7,766
5,368
2,398
1,251
940
311
1,091
882
209
1,213
1,007
206
770
747
23
1,425
1,329
96
641
994
-353
10,565
4,809
5,756
6,068
6,868
-800
2,479
1,868
611
614
606
8
761
823
-62
1,982
1,365
617
1,464
1,732
-268
8,561
6,599
1,962
1,291
1,127
164
2,742
2,965
-223
601
473
128
3,490
3,707
-217
1,084
856
228
241
233
8
7,420
6,758
662
4,750
3,516
1,234
646
787
-141
686
446
240
964
874
90
616
564
52
8,971
6,506
2,465
815
814
1
4,717
4,758
-41
1,199
1,347
-148
4,256
3,935
321
1,516
1,449
67
441
536
-95
10,504
9,806
698
8,857
8,513
344
13,445
710
12,735
7,475
7,613
-138
1,918
1,640
278
9,961
8,117
1,844
1,605
1,175
430
1,570
1,849
-279
557
515
42
4,241
4,277
-36
1,400
1,120
280
972
1,290
-318
8,019
4,387
3,632
5,119
5,325
-206
300
354
-54
3,436
4,130
-694
831
741
90
9,321
8,918
403
8,230
3,786
4,444
1,258
1,324
-66
7,889
4,585
3,304
466
418
48
7,812
4,788
3,024
3,884
2,925
959
8,332
7,862
470
1,374
1,136
238
4,552
4,960
-408
1,717
1,564
153
452
399
53
1,125
1,130
-5
8,251
6,144
2,107
8,359
6,203
2,156
38,578
29,670
8,908
9,585
8,505
1,080
2,861
2,598
263
19,872
20,101
-229
35,691
37,307
-1,616
21,144
22,378
-1,234
45,599
47,467
-1,868
18,731
4,968
13,763
15,010
15,852
-842
21,781
6,362
15,419
30,273
28,514
1,759
25,488
26,631
-1,143
21,531
22,680
-1,149
29,689
31,521
-1,832
33
54
-21
3,611
2,925
686
1,193
1,183
10
5,291
8,109
-2,818
4,765
3,344
1,421
1,374
1,048
326
7,155
7,676
-521
6,751
5,600
1,151
5,430
5,583
-153
5,049
5,426
-377
22,699
21,592
1,107
33,319
34,717
-1,398
26,464
24,319
2,145
14,685
12,383
2,302
15,314
14,611
703
7,427
12,163
-4,736
2,003
2,130
-127
4,006
4,260
-254
29,272
37,545
-8,273
30,804
29,302
1,502
8,268
5,915
2,353
51
55
-4
11,916
12,952
-1,036
44,486
63,796
-19,310
40,644
50,456
-9,812
5,656
6,080
-424
4,262
4,932
-670
32,067
32,224
-157
8,138
8,513
-375
12,123
12,922
-799
9,817
10,324
-507
29,851
30,151
-300
72,133
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
33,924
b
5,180
c
-13
d
-24
e
-10
-16
-13
-11
-36
-15
-38
-751
9,479
-1,097
-11
-18
-10
1
-13
-11
-11
-32
-30
-14
4
-4
-374
5,306
17,335
-8
-1,428
-14
-783
-7
-1,445
-1,150
-13
-1,232
-11
-1,392
-25
-1,246
-1,370
-29
-242
-873
-2,012
-1,568
-2,129
-207
-316
-1,869
-269
-1,170
-856
-1,457
183
261
10,835
1,615
9
1,126
289
9
2,398
311
209
206
23
96
-353
5,756
-800
611
8
-62
617
-268
1,962
164
-223
128
-217
228
8
662
1,234
-141
240
90
52
2,465
1
-41
-148
321
67
-95
698
344
12,735
-138
278
1,844
430
-279
42
-36
280
-318
3,632
-206
-54
-694
90
403
4,444
-66
3,304
48
3,024
959
470
238
-408
153
53
-5
2,107
2,156
8,908
1,080
263
-229
-1,616
-1,234
-1,868
13,763
-842
15,419
1,759
-1,143
-1,149
-1,832
-21
686
10
-2,818
1,421
326
-521
1,151
-153
-377
1,107
-1,398
2,145
2,302
703
-4,736
-127
-254
-8,273
1,502
2,353
-4
-1,036
-19,310
-9,812
-424
-670
-157
-375
-799
-507
-300
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
176,224
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
Part V
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?
Yes
No
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
133,105
5,468,268
0.024341
2016
241,065
5,051,988
0.047717
2015
314,989
5,321,890
0.059187
2014
317,775
5,595,818
0.056788
2013
267,835
5,366,927
0.049905
2
Total
of line 1, column (d)
.....................
2
0.237938
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
0.047588
4
Enter the net value of noncharitable-use assets for 2018 from Part X, line 5
......
4
5,443,402
5
Multiply line 4 by line 3
......................
5
259,041
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
2,206
7
Add lines 5 and 6
........................
7
261,247
8
Enter qualifying distributions from Part XII, line 4
,.............
8
298,673
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
and enter “N/A" on line 1.
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
2,206
here
and 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
0
3
Add lines 1 and 2
...........................
3
2,206
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
0
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
2,206
6
Credits/Payments:
a
2018 estimated tax payments and 2017 overpayment credited to 2018
6a
19,310
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
19,310
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
17,104
11
Enter the amount of line 10 to be:
Credited to 2019 estimated tax
2,208
Refunded
11
14,896
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.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
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
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
Yes
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)
PA
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 address
14
The books are in care of
BRANCH BANKING AND TRUST CO
Telephone no.
(610) 371-2091
Located at
PO BOX 2907 - TRUST TAX DEPT
WILSON
NC
ZIP+4
278942907
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2018, did the foundation have an interest in or a signature or other authority over
Yes
No
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
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?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(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)?
...............
Yes
No
(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.)
.......
Yes
No
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
Organizations relying on a current notice regarding disaster assistance check here
........
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?
.............
Yes
No
If "Yes," list the years
20
,
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
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
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?
......................
Yes
No
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
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))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
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
Organizations relying on a current notice regarding disaster assistance check here
.........
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?
..........
Yes
No
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?
.....................
Yes
No
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?
Yes
No
b
If yes, did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
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?
.................
Yes
No
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
Branch Banking Trust Co
Co-trustee
40
51,566
PO Box 2907 - Trust Tax Dept
Wilson
,
NC
278942907
John R Saurman
Co-Trustee
2
10,000
8368 Fisher Road
Elkins
,
PA
19027
Nicholas D Tellie Esq
Co-trustee
2
10,000
310 East Drinker Street
Dunmore
,
PA
18512
Rose Ann Lavelle
Schlarship Committee
2
6,600
118 Grandview Drive
Pittston
,
PA
18640
Donald H Keffer
Scholarship Committe
2
6,600
56 Ann Drive
Danville
,
PA
17821
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
...................
0
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
.............
0
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
.........................
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
5,411,145
b
Average of monthly cash balances
.......................
1b
115,151
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
5,526,296
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
0
3
Subtract line 2 from line 1d
.........................
3
5,526,296
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
82,894
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
5,443,402
6
Minimum investment return.
Enter 5% of line 5
..................
6
272,170
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
272,170
2a
Tax on investment income for 2018 from Part VI, line 5
......
2a
2,206
b
Income tax for 2018. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
2,206
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
269,964
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
269,964
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
269,964
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
298,673
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
0
b
Cash distribution test (attach the required schedule)
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
298,673
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
2,206
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
296,467
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
269,964
2
Undistributed income, if any, as of the end of 2018:
a
Enter amount for 2017 only
.......
113,181
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2018:
a
From 2013
......
0
b
From 2014
......
0
c
From 2015
......
0
d
From 2016
......
0
e
From 2017
......
0
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2018 from Part
XII, line 4:
$
298,673
a
Applied to 2017, but not more than line 2a
113,181
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2018 distributable amount
.....
185,492
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2018.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
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
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2017. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2018. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2019
..........
84,472
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)
.......
0
8
Excess distributions carryover from 2013 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2019.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2014
....
0
b
Excess from 2015
....
0
c
Excess from 2016
....
0
d
Excess from 2017
....
0
e
Excess from 2018
....
0
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
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
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.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
DR ARTHUR HELEN HORVAT FDN SCHOLA
4320-G WADE HAMPTON BLVD
TAYLORS
,
SC
29687
(866) 608-0001
b
The form in which applications should be submitted and information and materials they should include:
VISIT WWW.CSASCHOLARS.ORG FOR A DETAILED LISTING OF REQUIREMENTS
c
Any submission deadlines:
APRIL 15 ANNUALLY
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
VISIT WWW.CSASCHOLARS.OR FOR A LISTING OF RESTRICTIONS AND LIMITATION
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)
a
Paid during the year
KINGS COLLEGE
56 BROADWAY 5TH FLOOR
NEW YORK
,
NY
10004
NONE
PC
SCHOLARSHIPS
6,750
Kutztown University
15200 KUTZTOWN RD
Kutztown
,
PA
19530
NONE
PC
SCHOLARSHIPS
3,750
Arcadia University
450 SOUTH EASTON ROAD
Glenside
,
PA
19038
NONE
PC
SCHOLARSHIPS
3,750
Thomas Jefferson University
SIDNEY KIMMEL MEDICAL COLLEGE
Philadelphia
,
PA
19107
NONE
PC
SCHOLARSHIPS
5,000
UNIVERSITY OF PENNSYLVANIA
3451 WALNUT ST STE 427
PHILADELPHIA
,
PA
191046205
NONE
PC
SCHOLARSHIPS
3,750
Temple University
1852 NORTH 10 STREET
Philadelphia
,
PA
19122
NONE
PC
SCHOLARSHIPS
26,750
Dickerson College
PO BOX 1773
Carlisle
,
PA
17013
NONE
PC
SCHOLARSHIPS
8,000
ALVERNIA UNIVERSITY
540 UPLAND AVENUE
READING
,
PA
19611
NONE
PC
SCHOLARSHIPS
2,500
Drexel University
3141 CHESTNUT STREET SUITE 225
Philadelphia
,
PA
19104
NONE
PC
SCHOLARSHIPS
16,250
Misericordia College
301 LAKE STREET
Dallas
,
PA
18612
NONE
PC
SCHOLARSHIPS
42,500
MARYWOOD UNIVERSITY
2300 ADAMS AVENUE
SCRANTON
,
PA
18509
NONE
PC
SCHOLARSHIPS
8,000
University of Scranton
OFFICE OF UNDERGRADUATE ADMISSIONS
Scranton
,
PA
18510
NONE
PC
SCHOLARSHIPS
9,250
Wilkes University
84 W SOUTH ST
Wilkes Barre
,
PA
18701
NONE
PC
SCHOLARSHIPS
19,750
Penn State University
UNIVERSITY PARK
State College
,
PA
16801
NONE
PC
SCHOLARSHIPS
32,250
University of Pittsburgh
3550 TERRACE ST
Pittsburgh
,
PA
15261
NONE
PC
SCHOLARSHIPS
8,000
Commonwealth Medical College
525 PINE STREET
Scranton
,
PA
18509
NONE
PC
SCHOLARSHIPS
12,990
UNIVERSITY OF FLORIDA
PO BOX 115500
GAINESVILLE
,
FL
326115500
NONE
PC
SCHOLOARSHIPS
3,750
Total
.................................
3a
212,990
b
Approved for future payment
Total
.................................
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.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
14
132,423
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than
inventory
............
18
176,224
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)
..
308,647
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
308,647
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
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?
...........
Yes
No
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.
May the IRS discuss this return
with the preparer shown below
(see instr.)?
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's EIN
Firm's address
Phone no.
Form
990-PF
(2018)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description
-
TIN:
TY 2018 OtherDecreasesSchedule
Name:
DR ARTHUR J & HELEN M HORVAT FOUNDATION
EIN:
23-6846849
Description
Amount
MUTUAL FUND ADJUSTMENT
890