Form990-PF

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
2019
Open to Public Inspection
For calendar year 2019, or tax year beginning 10-01-2017 , and ending 09-30-2018
Name of foundation
PALLOTTINE FOUNDATION OF BUCKHANNON
WEST VIRGINIA
Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 265
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
BUCKHANNON, WV26201
A Employer identification number

47-4572040
B Telephone number (see instructions)

(713) 560-7451
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$2,155,267J 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) 93,202
2 Check bullet.............
3 Interest on savings and temporary cash investments 20,716 20,716  
4 Dividends and interest from securities... 34,656 34,656  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 58,008
b Gross sales price for all assets on line 6a 734,412
7 Capital gain net income (from Part IV, line 2)... 58,008
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)....... Click to see attachment 120 120  
12 Total. Add lines 1 through 11........ 206,702 113,500  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 75,443 0   75,443
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 2,000 0   2,000
c Other professional fees (attach schedule).... Click to see attachment 8,335 8,335   0
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 26 0   26
19 Depreciation (attach schedule) and depletion... Click to see attachment 3,600 0  
20 Occupancy.............. 11 0   11
21 Travel, conferences, and meetings....... 13,202 0   13,202
22 Printing and publications.......... 166 0   166
23 Other expenses (attach schedule)....... Click to see attachment 4,336 0   4,336
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 107,119 8,335   95,184
25 Contributions, gifts, grants paid....... 121,711 13,930
26 Total expenses and disbursements. Add lines 24 and 25 228,830 8,335   109,114
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -22,128
b Net investment income (if negative, enter -0-) 105,165
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2019)
Form 990-PF (2019)
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............. -47,387 7,375 7,375
2 Savings and temporary cash investments......... 294,460 58,326 58,326
3 Accounts receivable bullet56,169
Less: allowance for doubtful accounts bullet   38,678 56,169 56,169
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..........   108 108
10a Investments—U.S. and state government obligations (attach schedule) 302,365 Click to see attachment302,794 294,176
b Investments—corporate stock (attach schedule)....... 983,637 Click to see attachment1,010,095 1,337,405
c Investments—corporate bonds (attach schedule)....... 193,021 Click to see attachment405,188 398,025
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis bullet15,200
Less: accumulated depreciation (attach schedule) bullet11,517 2,083 Click to see attachment3,683 3,683
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,766,857 1,843,738 2,155,267
Liabilities 17 Accounts payable and accrued expenses.......... 830 649
18 Grants payable.................   107,781
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)......... 830 108,430
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions...........    
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........ 0 0
27 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
28 Retained earnings, accumulated income, endowment, or other funds 1,766,027 1,735,308
29 Total net assets or fund balances (see instructions)..... 1,766,027 1,735,308
30 Total liabilities and net assets/fund balances (see instructions). 1,766,857 1,843,738
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 29 (must agree with end-of-year figure reported on prior year’s return) ...............
1
1,766,027
2
Enter amount from Part I, line 27a .....................
2
-22,128
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
1,743,899
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
8,591
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
1,735,308
Form 990-PF (2019)
Form 990-PF (2019)
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 PUBLICLY TRADED SECURITIES P 2017-10-01 2018-09-30
b PUBLICLY TRADED SECURITIES P 2017-10-01 2018-09-30
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 322,064   322,596 -532
b 412,348   353,808 58,540
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       -532
b       58,540
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 58,008
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))
2018 305,181 1,940,076 0.157304
2017 93,779 1,918,590 0.048879
2016      
2015      
2014      
2
Total of line 1, column (d) .....................
2
0.206183
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
0.103092
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5......
4
2,033,339
5
Multiply line 4 by line 3......................
5
209,621
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
1,052
7
Add lines 5 and 6........................
7
210,673
8
Enter qualifying distributions from Part XII, line 4,.............
8
109,114
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 (2019)
Form 990-PF (2019)
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 2,103
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 0
3 Add lines 1 and 2........................... 3 2,103
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 2,103
6 Credits/Payments:
a 2019 estimated tax payments and 2018 overpayment credited to 2019 6a 576
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 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 576
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.......Bullet 9 1,527
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2020 estimated taxBullet   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$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
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)
    bulletWV
    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 2019 or the taxable year beginning in 2019? 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. Click to see attachment...............................
    10
    Yes
     
    Form 990-PF (2019)
    Form 990-PF (2019)
    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 addressbulletPALLOTINEBUCKHANNON.ORG
    14
    The books are in care ofbulletJANELL RAY Telephone no.bullet (713) 560-7451

    Located atbulletPO BOX 265BUCKHANNONWV ZIP+4bullet26201
    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 2019, 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
     
     
    ........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 2019?.............
    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 2019, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2019?.............
    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
     
     
    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 2019 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 2019.)..................
    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 2019?
    4b
     
    No
    Form 990-PF (2019)
    Form 990-PF (2019)
    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
     
     
    .........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
     
     
    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
    SR MARY GRACE BARILE SAC CHAIR
    1.00     		0 0 0
    PO BOX 265
    BUCKHANNON,WV26201
    SR FRANCESCA LOWIS SAC VICE CHAIR/SECRETARY
    1.00     		0 0 0
    PO BOX 265
    BUCKHANNON,WV26201
    MR S DAVID CREECH TREASURER
    1.00     		0 0 0
    PO BOX 265
    BUCKHANNON,WV26201
    MR MICHAEL TILLMAN BOARD MEMBER
    1.00     		0 0 0
    PO BOX 265
    BUCKHANNON,WV26201
    MR BRYSON VANNOSTRAND AIA BOARD MEMBER
    1.00     		0 0 0
    PO BOX 265
    BUCKHANNON,WV26201
    MS DAYA WRIGHT BOARD MEMBER
    1.00     		0 0 0
    PO BOX 265
    BUCKHANNON,WV26201
    MR R DENNIS XANDER BOARD MEMBER
    1.00     		0 0 0
    PO BOX 265
    BUCKHANNON,WV26201
    JANELL RAY EXECUTIVE DIRECTOR
    40.00     		63,020 12,423 0
    PO BOX 265
    BUCKHANNON,WV26201
    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 0
    Form 990-PF (2019)
    Form 990-PF (2019)
    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.............bullet0
    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 HEALTH & WELLNESS - SERVICES THAT PROMOTE A HEALTHY QUALITY OF LIFE INCLUDING BUT NOT LIMITED TO - DIABETES MANAGEMENT AND TREATMENT PROGRAMS - PRENATAL SERVICES FOR LOW INCOME/UNINSURED/UNDERINSURED - ORAL HEALTH AND HYGIENE EDUCATION PROGRAMS - TRANSPORTATION AND ACCESS TO HEALTHCARE SERVICES IN THIS CATEGORY, FUNDING PROVIDED SERVICES TO FOOD BANKS AND PANTRIES, ORAL HEALTH CARE PREVENTION AND TREATMENT FOR SENIORS, A HEALTHY HOME CARE PROGRAM FOR LOW-INCOME SENIORS, AND A HIGH-RISK DIABETES CASE MANAGEMENT PROGRAM 115,714
    2 LIFESTYLE EDUCATION - SERVICES THAT TARGET LIFESTYLE CONDITIONS THAT THREATEN OUR COMMUNITY INCLUDING BUT NOT LIMITED TO - OBESITY PREVENTION AND TREATMENT PROGRAMS - SUBSTANCE ABUSE AND MENTAL HEALTH PROGRAMS - DOMESTIC VIOLENCE PREVENTION PROGRAMS - HOMELESS ASSISTANCE PROGRAMS IN THIS CATEGORY, FUNDING WAS PROVIDED FOR ADULT AND CHILD DOMESTIC ABUSE SERVICES VICTIMS FUND, A COMMUNITY BABY SHOWER, ELEMENTARY SCHOOL NUTRITIONAL EDUCATION, COMPREHENSIVE COMMUNITY HEALTHY COOKING PROGRAMS, FAMILY EDUCATIONAL SESSIONS, AND CHILD ABUSE PREVENTION COMMUNITY EDUCATION PROGRAMS 57,797
    3 LEADERSHIP DEVELOPMENT - SERVICES THAT PROMOTE IMPROVED HEALTHCARE LEADERSHIP CAPABILITIES FOR 501(C)(3) ORGANIZATIONS IN THE COMMUNITY INCLUDING BUT NOT LIMITED TO - NONPROFIT MANAGEMENT TRAINING - FUNDRAISING AND MARKETING FOR NONPROFIT ORGANIZATIONS - TEAM BUILDING FOR NONPROFIT ORGANIZATIONS - COLLABORATIVE COMMUNITY PARTNERSHIP. FUNDING IN THIS CATEGORY PROVIDED TRAINING FOR CONGREGATIONAL LEADERS AND TEAMS DEVELOPING CHURCH HEALTH MINISTRIES AND STAFF TRAINING FOR CHILD ADVOCACY CENTERS 30,910
    4 SPIRITUAL AND PASTORAL CARE - SERVICES THAT HELP MEET THE RELIGIOUS, SPIRITUAL, EMOTIONAL AND PASTORAL NEEDS OF THE COMMUNITY, INCLUDING BUT NOT LIMITED TO - HOSPICE AND PALLIATIVE CARE PROGRAMS - ALZHEIMERS'S AND DEMENTIA SUPPORT SERVICES - SENIOR ADULTS CARE AND SERVICES - BEREAVEMENT AND GRIEF COUNSELING. FUNDING IN THIS CATEGORY PROVIDED MILEAGE REIMBURSEMENT FOR VOLUNTEERS MAKING HOME VISITS TO SENIORS NEEDING ASSISTANCE WITH A VARIETY OF PERSONAL CARE CHALLENGES 12,474
    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.........................bullet0
    Form 990-PF (2019)
    Form 990-PF (2019)
    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
    2,049,173
    b
    Average of monthly cash balances.......................
    1b
    15,131
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    2,064,304
    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
    2,064,304
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    30,965
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    2,033,339
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    101,667
    Part XI
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    101,667
    2a
    Tax on investment income for 2019 from Part VI, line 5......
    2a
    2,103
    b
    Income tax for 2019. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    2,103
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    99,564
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    99,564
    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
    99,564
    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
    109,114
    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
     
    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
    109,114
    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
    0
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    109,114
    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 (2019)
    Form 990-PF (2019)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2018     		(c)
    2018     		(d)
    2019
    1 Distributable amount for 2019 from Part XI, line 7 99,564
    2 Undistributed income, if any, as of the end of 2019:
    a Enter amount for 2018 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2019:
    a From 2014......  
    b From 2015......  
    c From 2016......  
    d From 2017......  
    e From 2018...... 207,586
    fTotal of lines 3a through e........ 207,586
    4Qualifying distributions for 2019 from Part
    XII, line 4: bullet$ 109,114
    a Applied to 2018, but not more than line 2a 0
    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 2019 distributable amount..... 99,564
    e Remaining amount distributed out of corpus 9,550
    5 Excess distributions carryover applied to 2019. 0 0
    (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 5 217,136
    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 2018. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2019. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2020 ..........     		0
    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 2014 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2020.
    Subtract lines 7 and 8 from line 6a ......     		217,136
    10 Analysis of line 9:
    a Excess from 2015....  
    b Excess from 2016....  
    c Excess from 2017....  
    d Excess from 2018.... 207,586
    e Excess from 2019.... 9,550
    Form 990-PF (2019)
    Form 990-PF (2019)
    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 2019, 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) 2019 (b) 2018 (c) 2017 (d) 2016
             
    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).)
    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 e-mail address of the person to whom applications should be addressed:
    JANELL RAY
    PO BOX 265
    BUCKHANNON,WV26201
    (713) 560-7451
    JERAY@PALLOTTINESAC.ORG
    bThe form in which applications should be submitted and information and materials they should include:
    THE GRANT APPLICATION MUST BE SUBMITTED ONLINE TO PFB AND FOLLOW THE PRESCRIBED GUIDELINES TO RECEIVE CONSIDERATION. THOSE GUIDELINES ARE - ORGANIZATION'S FULL NAME, ADDRESS, PHONE NUMBER, AND EMAIL ADDRESS - CONTACT NAME, ADDRESS, PHONE NUMBER, AND EMAIL ADDRESS - BRIEF DESCRIPTION OF THE ORGANIZATION'S PURPOSE AND MISSION - ORGANIZATION'S TAX-EXEMPT STATUS VERIFICATION - DESCRIPTION OF THE PROBLEM OR NEEDS THE PROJECT WILL ADDRESS - DESIRED PROJECT GOALS AND HOW PROJECT OUTCOMES WILL BE MEASURED. EACH APPROVED GRANTEE MUST SUBMIT AN INTERIM GRANT REPORT AND FINAL GRANT REPORT WHICH INCLUDES GOAL ATTAINMENT, OUTCOMES, AND FINANCIAL REPORT.
    cAny submission deadlines:
    2019 DEADLINES LETTER OF INQUIRY - JUNE 15, 2019, APPLICATIONS - AUGUST 15, 2019
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    THE GRANTEE MUST BE RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT PUBLIC CHARITY WITHIN THE MEANING OF SECTIONS 501(C)(3) AND 509(A)(1) OR (2) OF THE CODE, GRANT REQUEST MUST BE FOR A PROGRAM, PROJECT, OR SERVICE THAT IS COMPATIBLE WITH THE MISSION, VISION, VALUES, AND FUNDING PRIORITIES OF THE PALLOTINE FOUNDATION OF BUCKHANNON (PFB). THE APPLYING ORGANIZATION MUST SUPPORT CLIENTS IN THE REGION SERVED BY ST. JOSEPH'S HOSPITAL IN BUCKHANNON, WEST VIRGINIA , SPECIFICALLY BARBOUR, LEWIS, RANDOLPH, UPSHUR, AND WEBSTER COUNTIES. GRANT REQUESTS FOR/OR FROM THE FOLLOWING WILL NOT BE CONSIDERED - INDIVIDUALS - ENDOWMENTS - SCHOLARSHIPS OR CAPITAL PROJECTS.
    Form 990-PF (2019)
    Form 990-PF (2019)
    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
    MOUNTAIN CAP OF WV - CHILD ADVOCACY CENTER
    26 N KANAWHA ST STE 201
    BUCKHANNON,WV26201     		  PC TO SUPPORT TRAUMA-FOCUSED THERAPY FOR CHILDREN SUFFERING FROM ABUSE AND OTHER TRAUMATIC EVENTS. 13,930
    Total .................................bullet 3a 13,930
    bApproved for future payment
    MID-OHIO VALLEY REGIONAL COUNCIL
    PO BOX 247
    PARKERSBURG,WV26102     		  PC TO SUPPORT PROGRAM WITH MILEAGE REIMBURSEMENT FOR VOLUNTEERS MAKING HOME VISITS TO SENIORS REQUIRING ASSISTANCE WITH HOME AND PERSONAL CARE DUTIES. 7,000
    CATHOLIC CHARITIES WV
    2000 MAIN STREET
    WHEELING,WV26003     		  PC TO SUPPORT COMPREHENSIVE CASE MANAGEMENT PROGRAM TO HELP FAMILIES IMPROVE HEALTH AND WELL-BEING. WELLNESSWORKS PROGRAM INCORPORATES THE DISTRIBUTION OF NUTRITIONALLY SOUND FOOD ITEMS AND WRITTEN EDUCATIONAL MATERIALS FOR INDIVIDUALS WITH CHRONIC HEALTH CONDITIONS, INCLUDING DIABETES, HEART DISEASE, AND HIGH CHOLESTEROL. 15,000
    COMMITTEE ON AGING FOR RANDOLPH COUNTY
    PO BOX 727 1 5TH STREET
    ELKINS,WV26241     		  PC TO SUPPORT MEALS FOR SENIORS, AGES 60 AND OVER, THROUGHOUT RANDOLPH COUNTY FROM NUTRITION SITES AT RANDOLPH COUNTY SENIOR CENTER IN ELKINS AND SATELLITE LOCATIONS THROUGHOUT THE COUNTY. 5,000
    HIGHLAND COMMUNITY BUILDERS
    PO BOX 1579
    ELKINS,WV26241     		  PC TO SUPPORT CONFERENCE AND TRAVEL EXPENSES FOR THE WELLNESS COLLABORATIVE HEALTHY HOME PROGRAM MANAGER ATTENDANCE AT AMERICAN SOCIETY OF AGING LEADERSHIP INSTITUTE'S ANNUAL CONFERENCE. 3,415
    MARSHALL UNIVERSITY RESEARCH CORPORATION
    ONE JOHN MARSHALL DRIVE
    HUNTINGTON,WV25755     		  PC TO SUPPORT THE WEST VIRGINIA WISDOM TOOTH PROJECT WHICH PROVIDES DENTAL CARE EDUCATION, TAILORED TREATMENT PLANS, DENTAL HYGIENE PRODUCTS, AND ORAL CANCER SCREENINGS FOR THE SENIOR POPULATION AT SENIOR CENTERS AND CONGREGATE MEAL SITES. 13,098
    MARSHALL UNIVERSITY RESEARCH CORPORATION
    ONE JOHN MARSHALL DRIVE
    HUNTINGTON,WV25755     		  PC TO SUPPORT CARE COORDINATION/COMMUNITY HEALTH WORKER PROJECT FOR HIGH RISK DIABETES PATIENTS - PATIENT CARE IS COORDINATED BY A TEAM COMPRISED OF A HEALTH CARE PROVIDER, A NURSE, AND A COMMUNITY HEALTH WORKER. 15,500
    MILAN PUSKAR HEALTH RIGHT
    341 SPRUCE STREET PO BOX 1519
    MORGANTOWN,WV26505     		  PC TO SUPPORT EXPANSION OF THE LIGHT PROJECT'S HARM REDUCTION PROGRAM TO LEWIS AND UPSHUR COUNTIES. 3,000
    MOVRC RURAL GRANDPARENTS PROGRAM
    PO BOX 247
    PARKERSBURG,WV26102     		  PC TO SUPPORT "FIT TO SERVE" PHYSICALS FOR FOSTER GRANDPARENT PROGRAM PARTICIPANTS. 2,000
    NICHOLAS COUNTY FAMILY RESOURCE NETWORK
    503 BROAD STREET PO BOX 406
    SUMMERSVILLE,WV26651     		  PC TO SUPPORT EXTENSION OF NICHOLAS COUNTY CHILD ADVOCACY CENTER SERVICES TO WEBSTER COUNTY. 10,000
    UPSHUR COUNTY FAMILY RESOURCE NETWORK
    PO BOX 2115
    BUCKHANNON,WV26201     		  PC TO SUPPORT BUCKHANNON ANNUAL CHILDREN'S FESTIVAL ANNUAL AND THE COMMUNITY BABY SHOWER WHICH SHARES INFORMATION ON CHILDHOOD IMMUNIZATIONS, DANGERS OF SMOKING & DRUG USE, PARENTING SKILLS, HEALTHY EATING, AND EXERCISE. 1,000
    WEBSTER COUNTY FAMILY RESOURCE NETWORK
    PO BOX 389
    WEBSTER SPRINGS,WV26288     		  PC TO SUPPORT HEALTHY WAYS = HEALTHY DAYS PROGRAM: SIX-WEEK SERIES OF CLASSES THAT WILL COVER FOOD SAFETY, SANITATION PRACTICES, FOOD PRESERVATION, HEALTHY FOOD CHOICES, SHOPPING, AND HEALTHY FOOD PREPARATION, WITH A SPECIAL FOCUS ON HEALTHY CHOICES FOR DIABETICS. 7,448
    WEBSTER COUNTY HEALTH DEPARTMENT
    112 BELL STREET SUITE C
    WEBSTER SPRINGS,WV26288     		  PC TO SUPPORT HEALTH MATTERS: FOUR-WEEK PROGRAM TO ADDRESS OBESITY AND DIABETES THROUGH HEALTHY EATING AND EXERCISE. 820
    WEST VIRGINIA COUNCIL OF CHURCHES
    2207 WASHINGTON STREET E
    CHARLESTON,WV25311     		  PC TO SUPPORT VISTA WORKERS IN LEWIS AND UPSHUR COUNTIES TO ADDRESS SUBSTANCE USE DISORDER BY RAISING AWARENESS IN CONGREGATIONS AND COMMUNITIES. 7,000
    WOMEN'S AID IN CRISIS INC
    PO BOX 2062
    ELKINS,WV26241     		  PC TO SUPPORT VICTIMS SERVICES FUND TO ASSIST ADULT, TEEN, AND CHILD VICTIMS OF DOMESTIC VIOLENCE, SEXUAL ASSAULT, DATING VIOLENCE, STALKING, AND HUMAN TRAFFICKING WITH PERSONAL ITEMS, TRANSPORTATION, MEDICAL NEEDS, RELOCATION SERVICES, AND SUPPORT SERVICES. 17,500
    Total .................................bullet 3b 107,781
    Form 990-PF (2019)
    Form 990-PF (2019)
    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 ...........     		    14 20,716  
    4 Dividends and interest from securities....     14 34,656  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6 Net rental income or (loss) from personal property          
    7 Other investment income.....     14 120  
    8 Gain or (loss) from sales of assets other than
    inventory ............     		900099 58,008      
    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).. 58,008 55,492 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    113,500
    (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 (2019)
    Form 990-PF (2019)
    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 (2019)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors

    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
    OMB No. 1545-0047
    2019
    Name of the organization
    PALLOTTINE FOUNDATION OF BUCKHANNON
    WEST VIRGINIA
    Employer identification number

    47-4572040
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ






    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
    or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2
    Name of organization
    PALLOTTINE FOUNDATION OF BUCKHANNON
    WEST VIRGINIA         		Employer identification number
    47-4572040
    Part I
    Contributors
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
    PALLOTTINE MISSIONARY SISTERS
     
    2810 N STAUNTON RD
     
    HUNTINGTON, WV25702

    		$ 93,202


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
    Page 3
    Name of organization
    PALLOTTINE FOUNDATION OF BUCKHANNON
    WEST VIRGINIA         		Employer identification number

    47-4572040
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
    Page 4
    Name of organization
    PALLOTTINE FOUNDATION OF BUCKHANNON
    WEST VIRGINIA         		Employer identification number

    47-4572040
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2017 AccountingFeesSchedule
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING 2,000 0   2,000

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

    TY 2017 DepreciationSchedule
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    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
    MANAGEMENT SOFTWARE 2016-09-30 10,000 7,917 SL 24.000000000000 2,083 0    
    SOFTWARE 2018-02-28 5,200   SL 24.000000000000 1,517 0    

    TY 2017 InvestmentsCorpBondsSchedule
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    Name of Bond End of Year Book Value End of Year Fair Market Value
    MORGAN STANLEY INVESTMENTS 405,188 398,025

    TY 2017 InvestmentsCorpStockSchedule
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    Name of Stock End of Year Book Value End of Year Fair Market Value
    MORGAN STANLEY INVESTMENTS 1,010,095 1,337,405

    TY 2017 InvestmentsGovtObligationsSch
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    US Government Securities - End of Year Book Value:

    302,794
    US Government Securities - End of Year Fair Market Value:

    294,176
    State & Local Government Securities - End of Year Book Value:


    0
    State & Local Government Securities - End of Year Fair Market Value:


    0


    TY 2017 LandEtcSchedule2
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    MANAGEMENT SOFTWARE 10,000 10,000 0  
    SOFTWARE 5,200 1,517 3,683  


    TY 2017 OtherDecreasesSchedule
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    Description Amount
    UNREALIZED GAIN(LOSS) ON INVESTMENTS 8,591


    TY 2017 OtherExpensesSchedule
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    MEMBERSHIPS AND DUES 1,749 0   1,749
    INSURANCE 837 0   837
    STAFF DEVELOPMENT 59 0   59
    WEBSITE SERVICES 996 0   996
    SUPPLIES 265 0   265
    TELEPHONE & TELECOMMUNICATIONS 430 0   430


    TY 2017 OtherIncomeSchedule2
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    CAPITAL GAINS 120 120 120


    TY 2017 OtherProfessionalFeesSchedule
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BROKERAGE FEES 8,335 8,335   0


    TY 2017 SubstantialContributorsSch
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    Name Address
    PALLOTTINE MISSIONARY SISTERS 2810 N STAUNTON RD
    HUNTINGTON,WV25702
    PALLOTTINE RETREAT CENTER 15270 OLD HALLS FERRY ROAD
    FLORISSANT,MO63034


    TY 2017 TaxesSchedule
    Name:
    PALLOTTINE FOUNDATION OF BUCKHANNON
     
    WEST VIRGINIA
    EIN:
    47-4572040
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LICENSES 26 0   26