Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 13,965 | 8,701 | 3,177 | 11,171 | 16,395 | 53,409 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | 3,530 | 3,915 | 7,243 | 7,544 | 6,654 | 28,886 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | 17,495 | 12,616 | 10,420 | 18,715 | 23,049 | 82,295 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 82,295 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 17,495 | 12,616 | 10,420 | 18,715 | 23,049 | 82,295 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 438 | 2,057 | 2,495 | |||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 438 | 2,057 | 2,495 | |||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 17,495 | 12,616 | 10,420 | 19,153 | 25,106 | 84,790 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990-EZ, Part I, Line 4 - Other Investment Income | Description: DIVIDENDS. Amount: 2,057. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: Nick Magos Cancer Callout. Grantee Address: PO Box 646 Bedminster, NJ 07921. Grantee Relationship: none. Date of Gift: 09/27/18. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: Law Enforcement United Inc. Grantee Address: PO Box 2126 Chesapeake, VA 23327. Grantee Relationship: none. Date of Gift: 02/28/18. Amount Given: 1,500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: SAINT VINCENT ACADEMY. Grantee Address: 228 W. MARKET STREET NEWARK, NJ 07103. Grantee Relationship: NONE. Date of Gift: 10/02/17. Amount Given: 300. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: EDUCATIONAL. Grantee Name: AUTOMOTIVE TRAINING CENTER. Grantee Address: 900 JOHNSVILLE BLVD WARMINSTER, PA 18974. Grantee Relationship: NONE. Date of Gift: 10/31/17. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: EDUCATIONAL. Grantee Name: COLGATE UNIVERSITY. Grantee Address: 13 OAK DRIVE HAMILTON, NY 13346. Grantee Relationship: NONE. Date of Gift: 01/15/18. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: MEMORIAL SLOAN KETTERING CANCER. Grantee Address: 136 MOUNTAINVIEW BLVD BASKING RIDGE, NJ 07920. Grantee Relationship: NONE. Date of Gift: 01/18/18. Amount Given: 250. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: HUNTERDON HEALTHCARE FOUNDATION. Grantee Address: 9100 WESCOTT DRIVE FLEMINGTON, NJ 08822. Grantee Relationship: NONE. Date of Gift: 02/28/18. Amount Given: 100. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: SOMERSET ELKS. Grantee Address: 375 UNION AVENUE BRIDGEWATER, NJ 08807. Date of Gift: 04/26/18. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: TEAMWORK UNLIMITED FOUNDATION. Grantee Address: 53 FERRIS ROAD EDISON, NJ 08817. Grantee Relationship: NONE. Date of Gift: 04/26/18. Amount Given: 200. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: CYSTIC FIBROSIS FOUNDATION. Grantee Address: 4550 MONTGOMERY AVENUE BETHESDA, MD 20814. Grantee Relationship: NONE. Date of Gift: 05/18/18. Amount Given: 250. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: SPECIAL OLYMPICS NEW JERSEY. Grantee Address: 3 PRINCESS ROAD LAWRENCEVILLE, NJ 08646. Grantee Relationship: NONE. Date of Gift: 06/08/18. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: EDUCATIONAL. Grantee Name: WEST VIRGINIA UNIVERSITY. Grantee Address: PO BOX 6201 MORGANTOWN, WV 26506. Grantee Relationship: NONE. Date of Gift: 06/28/18. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: THE STAY SAFE FOUNDATION. Grantee Address: 27 E. MAIN STREET ROCKAWAY, NJ 07866. Grantee Relationship: NONE. Date of Gift: 07/20/18. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: EDUCATIONAL. Grantee Name: DOMINICAN COLLEGE. Grantee Address: 470 WEATERN HIGHWAY ORANGEBURG, NY 10962. Grantee Relationship: NONE. Date of Gift: 08/21/18. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: KATIE KING FOUNDATION. Grantee Address: 34 AUTUMN DRIVE BASKING RIDGE, NJ 07920. Grantee Relationship: NONE. Date of Gift: 08/23/18. Amount Given: 4,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: HACKENSACK UNIVERSITY MEDICAL. Grantee Address: 160 ESSEX STREET LODI, NJ 07644. Grantee Relationship: NONE. Date of Gift: 08/23/18. Amount Given: 500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: SOMERSET PATRIOTS CHILDRENS FOUNDATION. Grantee Address: 1 PATRIOTS PARK BRIDGEWATER, NJ 08807. Grantee Relationship: NONE. Date of Gift: 08/26/18. Amount Given: 1,350. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: CHARITABLE. Grantee Name: MICHAEL J. WIELGUS II FOUNDATION. Grantee Address: PO BOX 225 CRANFORD, NJ 07016. Grantee Relationship: NONE. Date of Gift: 08/26/18. Amount Given: 100. Total included on Form 990-EZ, line 10: 16,550. |
| Form 990-EZ, Part I, Line 16 - Other Expenses | Description: STATE FILING FEES. Amount: 125. |
| Form 990-EZ, Part I, Line 20 - Other Changes in Net Assets | Description: Unrealized Gain on Investments. Amount: 8,910. |
| Software ID: | |
| Software Version: |