-
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
19
Open to Public Inspection
For calendar year 2019, or tax year beginning
01-01-2019
, and ending
12-31-2019
Name of foundation
SCHMIDT-MESSMER PERPCHARTW XXXXX6009
Number and street (or P.O. box number if mail is not delivered to street address)
10 S DEARBORN IL1-0111
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CHICAGO
,
IL
60603
A Employer identification number
61-6232326
B
Telephone number (see instructions)
(800) 496-2583
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)
$
6,997,525
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
...
181,684
181,393
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
224,523
b
Gross sales price for all assets on line 6a
2,632,985
7
Capital gain net income (from Part IV, line 2)
...
224,523
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
........
406,207
405,916
13
Compensation of officers, directors, trustees, etc.
66,070
43,651
22,419
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
0
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
12,564
3,030
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)
.......
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
78,634
46,681
0
22,419
25
Contributions, gifts, grants paid
.......
311,073
311,073
26
Total expenses and disbursements.
Add lines 24 and 25
389,707
46,681
0
333,492
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
16,500
b
Net investment income
(if negative, enter -0-)
359,235
c
Adjusted net income
(if negative, enter -0-)
...
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
1
Cash—non-interest-bearing
.............
2
Savings and temporary cash investments
.........
66,462
182,735
182,735
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
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
3,152,022
2,894,752
4,013,596
c
Investments—corporate bonds (attach schedule)
.......
2,266,522
2,442,284
2,491,736
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
323,087
304,940
309,458
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)
5,808,093
5,824,711
6,997,525
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 FASB ASC 958, check here
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
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
5,808,093
5,824,711
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances
(see instructions)
.....
5,808,093
5,824,711
30
Total liabilities and net assets/fund balances
(see instructions)
.
5,808,093
5,824,711
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
5,808,093
2
Enter amount from Part I, line 27a
.....................
2
16,500
3
Other increases not included in line 2 (itemize)
3
10,610
4
Add lines 1, 2, and 3
..........................
4
5,835,203
5
Decreases not included in line 2 (itemize)
5
10,492
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
5,824,711
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
10000. PACIFIC GAS & ELECTRIC 3.300% 03/15/2027 DTD 03/10/2017
2017-03-07
2019-01-08
b
5000. TRANSCANADA PIPELINE 7.125% 1/15/19
2009-02-05
2019-01-15
c
. FHLMC
2019-01-17
d
1. GILEAD SCIENCES INC
2014-12-11
2019-01-23
e
4. GILEAD SCIENCES INC
2019-01-23
1. GILEAD SCIENCES INC
2015-01-08
2019-01-23
1. GILEAD SCIENCES INC
2015-01-08
2019-01-23
1. MASTERCARD INC - CLASS A
2015-04-22
2019-01-23
4. WORLDPAY INC CL A
2018-10-08
2019-01-23
1. WORLDPAY INC CL A
2018-10-08
2019-01-23
5. GILEAD SCIENCES INC
2019-01-24
1. MASTERCARD INC - CLASS A
2015-04-22
2019-01-24
4. MASTERCARD INC - CLASS A
2019-01-24
7. WORLDPAY INC CL A
2018-10-08
2019-01-24
1. GILEAD SCIENCES INC
2016-02-10
2019-01-25
2. GILEAD SCIENCES INC
2019-01-25
1. GILEAD SCIENCES INC
2016-02-10
2019-01-25
5. MASTERCARD INC - CLASS A
2009-05-05
2019-01-25
8. WORLDPAY INC CL A
2017-09-22
2019-01-25
1. WORLDPAY INC CL A
2018-10-08
2019-01-25
1. GILEAD SCIENCES INC
2016-02-10
2019-01-28
1. GILEAD SCIENCES INC
2016-02-10
2019-01-28
6. WORLDPAY INC CL A
2017-09-22
2019-01-28
2. GILEAD SCIENCES INC
2016-02-10
2019-01-29
1. WORLDPAY INC CL A
2017-09-22
2019-01-29
6. WORLDPAY INC CL A
2017-09-22
2019-01-30
1. GILEAD SCIENCES INC
2016-02-10
2019-01-31
1. GILEAD SCIENCES INC
2016-02-10
2019-02-01
6980.186 DODGE & COX INCOME FUND
2019-02-11
2394.636 DOUBLELINE TTL RTRN BND-I
2017-04-17
2019-02-11
10013.896 JOHN HANCOCK INCOME-R6
2015-08-31
2019-02-11
10000. NOVARTIS SECS INVEST LTD
2010-02-19
2019-02-11
6711.409 PIMCO INVESTMENT GRADE CORPORATE BOND FUND
2018-01-31
2019-02-11
4652.227 PIMCO INVESTMENT GRADE CORPORATE BOND FUND
2019-02-11
2250. VANGUARD BD INDEX FD INC
2018-12-12
2019-02-11
7556.747 AMG MG PICTET INTL-Z
2016-02-12
2019-02-14
4337.437 MFS EMERG MRKTS DEBT-R5
2016-07-14
2019-02-14
5000. CATERPILLAR FINL MTN 7.150% 2/15/19
2010-02-22
2019-02-15
5. ANALOG DEVICES INC
2018-09-13
2019-02-19
2. ANALOG DEVICES INC
2018-09-13
2019-02-19
7. ANALOG DEVICES INC
2018-09-13
2019-02-19
11. ANALOG DEVICES INC
2019-02-19
7. ANALOG DEVICES INC
2019-02-19
2. ANALOG DEVICES INC
2016-10-28
2019-02-19
9. ANALOG DEVICES INC
2019-02-20
10000. BANK OF NEW YORK MELLON MTN 2.200% 03/04/2019 DTD 02/04/2014
2014-08-12
2019-03-04
474. JPMORGAN BETABUILDERS JAPAN ETF
2018-07-19
2019-03-05
2460. JPMORGAN BETABUILDERS JAPAN ETF
2019-03-05
1884.153 JPM US L/C CORE PL FD - USD - R6 ISIN US48129C6030
2007-10-16
2019-03-05
8338.466 PIMCO FDS PAC INVT MGMT SER HIGH YLD FD INSTL CL
2016-02-24
2019-03-05
10000. COOPERATIEVE RABOBANK UA 4.5% 01/11/2021 DTD 01/11/2011
2013-09-30
2019-03-07
5000. STRYKER CORP 3.375% 11/01/2025 DTD 10/29/2015
2016-10-27
2019-03-12
4. BIOGEN IDEC INC
2010-06-18
2019-03-14
3. BIOGEN IDEC INC
2018-10-08
2019-03-14
70. BRISTOL MYERS SQUIBB CO
2019-03-14
15. DISNEY WALT CO
2019-03-14
5000. CONS EDISON CO O SR NTS 4.0% 12/01/2028 DTD
2018-11-27
2019-03-28
7193.626 AMG MG PICTET INTL-Z
2016-02-12
2019-03-29
4566.877 ARTISAN INTL VAL-INST
2011-01-31
2019-03-29
3295.971 DODGE & INTERNATIONAL STOCK FUND
2013-07-31
2019-03-29
4998.367 JPM US L/C CORE PL FD - USD - R6 ISIN US48129C6030
2007-10-16
2019-03-29
11333.417 NEUBERGER BERMAN MULTI CAP
2019-03-29
10000. US BANCORP MTN 3.700% 01/30/2024 DTD 01/30/2014
2019-04-01
. PFIZER INC
2019-04-03
2000. CITIGROUP INC 3.750% 06/16/2024 DTD 06/16/2014
2017-04-17
2019-04-04
3000. CITIGROUP INC 3.750% 06/16/2024 DTD 06/16/2014
2017-04-17
2019-04-04
11.673 DOW INC
2019-04-08
1.327 DOW INC
2018-04-09
2019-04-08
2. DOW INC
2019-04-08
1. DOW INC
2017-02-22
2019-04-08
17. DOW INC
2019-04-08
8. DOW INC
2019-04-08
2. DOW INC
2015-07-15
2019-04-09
10000. CITIGROUP INC 3.750% 06/16/2024 DTD 06/16/2014
2019-04-16
. DOW INC
2019-04-23
20. OCCIDENTAL PETE CORP
2019-04-25
11. OCCIDENTAL PETE CORP
2019-04-25
27. OCCIDENTAL PETE CORP
2019-04-25
3. OCCIDENTAL PETE CORP
2018-08-09
2019-04-25
6. OCCIDENTAL PETE CORP
2019-05-01
1. OCCIDENTAL PETE CORP
2006-01-20
2019-05-01
4. REGENERON PHARMACEUTICALS INC
2019-05-01
1. REGENERON PHARMACEUTICALS INC
2019-01-24
2019-05-01
5000. INTEL CORP 2.875% 05/11/2024 DTD 05/11/2017
2018-08-29
2019-05-02
3000. INTEL CORP 2.875% 05/11/2024 DTD 05/11/2017
2018-04-16
2019-05-02
2000. INTEL CORP 2.875% 05/11/2024 DTD 05/11/2017
2018-04-16
2019-05-02
20. OCCIDENTAL PETE CORP
2019-05-02
1. OCCIDENTAL PETE CORP
2007-01-12
2019-05-02
1. OCCIDENTAL PETE CORP
2007-01-12
2019-05-02
4. OCCIDENTAL PETE CORP
2007-01-12
2019-05-02
2. OCCIDENTAL PETE CORP
2007-01-12
2019-05-02
2. OCCIDENTAL PETE CORP
2007-01-12
2019-05-03
7. OCCIDENTAL PETE CORP
2007-01-12
2019-05-03
1. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
15. PRUDENTIAL FINL INC
2019-05-14
7. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
2. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
3. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
21. SCHWAB CHARLES CORP NEW
2019-05-15
19. SCHWAB CHARLES CORP NEW
2019-05-16
5. SCHWAB CHARLES CORP NEW
2019-05-16
12. SCHWAB CHARLES CORP NEW
2019-05-16
17. MEDTRONIC PLC
2018-07-18
2019-05-16
12. MEDTRONIC PLC
2019-05-16
2. MEDTRONIC PLC
2018-07-18
2019-05-16
6. MEDTRONIC PLC
2018-04-09
2019-05-17
10. MEDTRONIC PLC
2019-05-17
5. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
5. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
2. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
5000. TRAVELLERS COS INC
2014-03-17
2019-06-03
5000. CITIGROUP INC 3.300% 04/27/2025 DTD 04/27/2015
2019-06-05
19. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-05
7. DELTA AIR LINES INC DEL NEW
2019-06-05
24. PHILIP MORRIS INTERNATIONAL
2017-04-24
2019-06-05
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
6. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
6. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
59. BANK OF AMERICA CORPORATION
2019-06-10
12. DOLLAR TREE INC
2019-06-10
46. WELLS FARGO & CO NEW
2019-06-10
15. DOLLAR TREE INC
2019-06-11
3. DOLLAR TREE INC
2018-12-17
2019-06-11
5. DOLLAR TREE INC
2018-12-17
2019-06-11
. CORTEVA INC
2019-06-13
. DUPONT DE NEMOURS INC-WI
2019-06-13
10000. BANK OF NOVA SCOTIA 1.650% 06/14/2019 DTD 06/14/2016
2019-06-14
5000. ACE INA HOLDINGS
2015-01-05
2019-06-17
2554.891 DIAMOND HILL LONG/SHORT-Y
2018-11-26
2019-06-18
4. ADOBE SYS INC
2012-08-03
2019-06-27
3897.295 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2019-07-11
5000. MEDTRONIC INC NON-TRADEABLE ASSET
2019-07-12
1266.114 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2014-02-05
2019-07-17
13000. CITIGROUP INC 2.500% 07/29/2019 DTD 07/29/2014
2015-01-26
2019-07-29
700.28 DOUBLELINE TTL RTRN BND-I
2017-04-17
2019-08-01
259.336 EQUINOX IMP SYSTEM MACRO-I
2016-04-27
2019-08-01
56. ISHARES TR 7-10 YR TREAS INDEX FD
2019-02-14
2019-08-01
1166.589 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2014-02-05
2019-08-01
5000. TORONTO-DOMINION BK SR NTS MTN 3.15% 09/17/2020 DTD
2018-09-10
2019-08-01
8000. WESTPAC BANKING CORP
2009-11-16
2019-08-01
10000. PNC FINL SERVICES SR NTS 5.125% 02/08/2020 DTD
2019-08-07
4. SVB FINANCIAL GROUP
2019-08-14
3. SVB FINANCIAL GROUP
2019-08-14
7. APTIV PLC
2019-08-14
4. APTIV PLC
2018-04-26
2019-08-14
9. APTIV PLC
2019-08-14
10000. AMERICAN HONDA FINANCE MTN 2.250% 08/15/2019 DTD 09/09/2014
2014-09-04
2019-08-15
5. SVB FINANCIAL GROUP
2015-02-05
2019-08-15
18. APTIV PLC
2019-08-15
800. ISHARES MISCI EAFE INDEX FUND
2019-08-28
1200. ISHARES TR BARCLAYS MBS BD FD
2019-02-11
2019-09-19
1687. VANGUARD BD INDEX FD INC
2019-09-19
5000. CME GROUP INC 3% SEP 15 2022
2013-09-30
2019-10-11
23. DISNEY WALT CO
2019-10-25
5. ACCENTURE PLC
2019-10-25
7. ACCENTURE PLC
2019-10-28
3000. MANULIFE FINANCIAL CORP 4.150% 03/04/2026 DTD 03/04/2016
2018-08-29
2019-11-01
3000. AMAZON.COM INC SR NTS 2.6% 12/05/2019 DTD
2014-12-02
2019-11-05
15. NISOURCE INC
2019-11-11
19. NISOURCE INC
2019-11-11
15. NISOURCE INC
2019-11-12
38. NISOURCE INC
2019-11-12
3. NISOURCE INC
2013-02-26
2019-11-12
4. NISOURCE INC
2013-02-26
2019-11-13
4000. ANHEUSER-BUSCH INBEV WOR 6.875% 11/15/2019 DTD 03/14/2011
2012-06-21
2019-11-15
5000. BLACKROCK INC SR NTS 3.5% 03/18/2024 DTD
2015-01-28
2019-11-19
5000. MANULIFE FINL CORP SR NTS 4.9% 09/17/2020 DTD
2014-05-02
2019-11-19
15000. MICROSOFT CORP SR NTS 2.375% 02/12/2022 DTD
2018-02-27
2019-11-19
10000. NBCUNIVERSAL MEDIA LLC 4.375% 04/01/2021 DTD 08/19/2011
2014-03-17
2019-11-19
5000. TOTAL CAP INTL SA 2.7% 01/25/2023 DTD 09/25/2012
2018-02-27
2019-11-19
5000. ALTRIA GROUP INC 2.85% 08/09/2022 DTD 08/09/2012
2018-02-27
2019-11-21
65. CELGENE CORP.
2019-11-21
24. CELGENE CORP.
2019-11-21
496.82 FIDELITY 500 INDEX-INST PRM
2019-08-28
2019-11-21
10000. LOWE'S COS INC SR NTS 3.8% 11/15/2021 DTD
2011-11-18
2019-11-21
5000. NUCOR CORP SR NTS 4.0% 08/01/2023 DTD
2015-03-11
2019-11-21
5000. STRYKER CORP SR NTS 3.5% 03/15/2026 DTD
2019-03-12
2019-11-21
5000. TRANSCANADA PIPELINES SR NTS 2.5% 08/01/2022 DTD
2018-02-27
2019-11-21
34. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
4. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
1. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
43. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-26
7. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-27
3009.784 EQUINOX IMP SYSTEM MACRO-I
2016-04-27
2019-12-09
378.43 BLACKSTONE ALT MULTI-STRAT- Y
2019-06-18
2019-12-19
140.713 DOUBLELINE TTL RTRN BND-I
2017-04-17
2019-12-19
510.204 EQUINOX IMP SYSTEM MACRO-I
2016-04-27
2019-12-19
86. ISHARES TR 20+ TREAS INDEX FD
2019-09-19
2019-12-19
236. ISHARES TR 7-10 YR TREAS INDEX FD
2019-09-19
2019-12-19
4712.535 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2019-12-19
356.295 LORD ABBETT SHRT DUR INC-F3
2018-11-13
2019-12-19
1144.689 PIMCO INVESTMENT GRADE CORPORATE BOND FUND
2018-02-23
2019-12-19
275. SCHWAB U.S. TIPS ETF
2018-10-01
2019-12-19
149.85 SIX CIRCLES ULTR SHRT DUR
2018-10-26
2019-12-19
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
7,900
9,965
-2,065
b
5,000
5,266
-266
c
81
81
d
69
106
-37
e
273
415
-142
68
102
-34
68
102
-34
198
92
106
329
388
-59
83
97
-14
339
483
-144
200
92
108
796
220
576
576
679
-103
68
89
-21
138
178
-40
69
89
-20
1,013
91
922
663
576
87
83
97
-14
68
89
-21
68
89
-21
499
432
67
138
178
-40
82
72
10
501
432
69
70
89
-19
70
89
-19
94,093
95,388
-1,295
25,000
25,671
-671
61,886
64,762
-2,876
10,000
10,416
-416
67,919
69,966
-2,047
47,081
47,779
-698
177,410
175,773
1,637
65,517
63,497
2,020
61,592
65,148
-3,556
5,000
5,852
-852
523
461
62
209
184
25
735
645
90
1,148
703
445
730
644
86
210
127
83
953
570
383
10,000
10,087
-87
10,705
11,376
-671
55,503
59,033
-3,530
49,817
38,576
11,241
72,795
66,757
6,038
10,281
10,571
-290
5,027
5,213
-186
1,281
184
1,097
961
1,027
-66
3,444
3,014
430
1,715
1,641
74
5,339
4,996
343
65,678
60,446
5,232
156,050
125,122
30,928
133,553
127,422
6,131
134,806
102,337
32,469
202,868
143,339
59,529
10,373
10,545
-172
100
100
2,061
2,059
2
3,092
3,089
3
667
755
-88
76
86
-10
114
128
-14
57
64
-7
973
1,021
-48
458
430
28
114
106
8
10,250
10,210
40
19
19
1,242
1,688
-446
683
857
-174
1,677
1,904
-227
186
231
-45
346
378
-32
58
44
14
1,364
1,671
-307
340
407
-67
5,009
4,884
125
3,006
2,933
73
2,004
1,955
49
1,147
873
274
57
43
14
57
43
14
230
171
59
115
85
30
116
85
31
407
299
108
98
80
18
1,476
1,196
280
692
558
134
195
159
36
297
239
58
898
611
287
828
544
284
217
137
80
521
323
198
1,499
1,498
1
1,060
951
109
177
176
1
528
474
54
883
778
105
816
1,041
-225
816
1,041
-225
326
416
-90
5,000
5,891
-891
5,105
4,977
128
1,044
1,018
26
385
375
10
1,854
2,694
-840
55
53
2
55
53
2
329
321
8
327
321
6
55
53
2
55
53
2
55
53
2
56
53
3
55
53
2
1,664
1,590
74
1,246
1,111
135
2,134
986
1,148
1,600
1,374
226
320
259
61
533
432
101
9
9
25
25
10,000
9,936
64
5,000
5,772
-772
67,909
66,682
1,227
1,175
128
1,047
85,000
68,969
16,031
5,153
5,291
-138
27,500
21,435
6,065
13,000
13,138
-138
7,500
7,507
-7
2,500
2,855
-355
6,211
5,853
358
25,000
19,750
5,250
5,052
4,999
53
8,058
7,994
64
10,137
11,375
-1,238
763
530
233
570
373
197
557
610
-53
321
348
-27
718
718
10,000
9,982
18
934
601
333
1,427
1,274
153
49,931
48,043
1,888
129,556
126,164
3,392
135,856
133,010
2,846
5,146
4,922
224
3,021
2,363
658
916
467
449
1,286
585
701
3,335
3,043
292
3,000
2,994
6
393
290
103
496
339
157
391
229
162
989
389
600
78
29
49
105
39
66
4,000
5,191
-1,191
5,323
5,299
24
5,126
5,529
-403
15,209
14,845
364
10,335
10,874
-539
5,111
4,894
217
5,073
4,957
116
7,022
6,076
946
2,593
1,234
1,359
53,721
50,000
3,721
10,309
10,100
209
5,296
5,226
70
5,304
5,009
295
5,053
4,867
186
71
78
-7
8
9
-1
2
2
91
99
-8
15
16
-1
29,225
33,138
-3,913
4,000
4,079
-79
1,500
1,508
-8
5,000
5,617
-617
11,744
12,069
-325
26,040
26,301
-261
100,000
74,606
25,394
1,500
1,479
21
12,500
11,738
762
15,572
14,786
786
1,500
1,500
16,733
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
-2,065
b
-266
c
81
d
-37
e
-142
-34
-34
106
-59
-14
-144
108
576
-103
-21
-40
-20
922
87
-14
-21
-21
67
-40
10
69
-19
-19
-1,295
-671
-2,876
-416
-2,047
-698
1,637
2,020
-3,556
-852
62
25
90
445
86
83
383
-87
-671
-3,530
11,241
6,038
-290
-186
1,097
-66
430
74
343
5,232
30,928
6,131
32,469
59,529
-172
100
2
3
-88
-10
-14
-7
-48
28
8
40
19
-446
-174
-227
-45
-32
14
-307
-67
125
73
49
274
14
14
59
30
31
108
18
280
134
36
58
287
284
80
198
1
109
1
54
105
-225
-225
-90
-891
128
26
10
-840
2
2
8
6
2
2
2
3
2
74
135
1,148
226
61
101
9
25
64
-772
1,227
1,047
16,031
-138
6,065
-138
-7
-355
358
5,250
53
64
-1,238
233
197
-53
-27
18
333
153
1,888
3,392
2,846
224
658
449
701
292
6
103
157
162
600
49
66
-1,191
24
-403
364
-539
217
116
946
1,359
3,721
209
70
295
186
-7
-1
-8
-1
-3,913
-79
-8
-617
-325
-261
25,394
21
762
786
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
224,523
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))
2018
330,637
6,799,452
0.048627
2017
313,072
6,718,294
0.0466
2016
332,245
6,319,234
0.052577
2015
354,237
6,740,642
0.052552
2014
331,921
7,015,684
0.047311
2
Total
of line 1, column (d)
.....................
2
0.247667
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
0.049533
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
6,695,103
5
Multiply line 4 by line 3
......................
5
331,629
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
3,592
7
Add lines 5 and 6
........................
7
335,221
8
Enter qualifying distributions from Part XII, line 4
,.............
8
333,492
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
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
7,185
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
7,185
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
7,185
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
8,176
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
8,176
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
991
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
991
Refunded
11
0
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)
KY
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.
...............................
10
No
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 address
14
The books are in care of
JP MORGAN CHASE BANK N A
Telephone no.
(800) 496-2583
Located at
10 S DEARBORN ST MC IL1-0111
CHICAGO
IL
ZIP+4
60603
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 2019, 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
No
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 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?
.............
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 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))?
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
JP MORGAN CHASE BANK N A
TRUSTEE
4
66,070
10 S DEARBORN ST MC IL1-0111
CHICAGO
,
IL
60603
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
(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
.............
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
(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
6,703,441
b
Average of monthly cash balances
.......................
1b
93,618
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
6,797,059
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
6,797,059
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
101,956
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
6,695,103
6
Minimum investment return.
Enter 5% of line 5
..................
6
334,755
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
334,755
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
7,185
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
7,185
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
327,570
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
327,570
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
327,570
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
333,492
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
333,492
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
333,492
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
327,570
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
311,070
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
0
b
From 2015
......
0
c
From 2016
......
0
d
From 2017
......
0
e
From 2018
......
0
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
333,492
a
Applied to 2018, but not more than line 2a
311,070
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
.....
22,422
e
Remaining amount distributed out of corpus
0
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).)
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 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
..........
305,148
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
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2015
....
0
b
Excess from 2016
....
0
c
Excess from 2017
....
0
d
Excess from 2018
....
0
e
Excess from 2019
....
0
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
.......
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)
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.)
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).)
NONE
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.
NONE
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 email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
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)
a
Paid during the year
MISSIONARIES OF CHARITY INC
SR M LETICIA MC SUPERIOR
335 E 145TH ST
NEW YORK
,
NY
104515800
NONE
PC
GENERAL
44,439
SOCIETY FOR PROPAGATION FAITH
366 5TH AVE 12TH FL
NEW YORK
,
NY
100181256
NONE
PC
GENERAL
44,439
WHAS CRUSADE FOR CHILDREN
520 W CHESTNUT ST
LOUISVILLE
,
KY
402022200
NONE
PC
GENERAL
44,439
SALVATION ARMY
PO BOX 1149
LOUISVILLE
,
KY
402011149
NONE
PC
GENERAL
44,439
NAZARETH LITERARY & BENEVOLENT INST
SCN CENTER BOX 172
NAZARETH
,
KY
400480172
NONE
PC
GENERAL
44,439
LITTLE SISTERS OF THE POOR
15 AUDUBON PLAZA DR
LOUISVILLE
,
KY
402171371
NONE
PC
GENERAL
44,439
CHILDREN'S HOSPITAL FOUNDATION
NORTON HEALTHCARE
224 E BROADWAY FL 5
LOUISVILLE
,
KY
402022025
NONE
PC
GENERAL
44,439
Total
.................................
3a
311,073
b
Approved for future payment
Total
.................................
3b
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.)
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
181,684
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
224,523
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)
..
406,207
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
406,207
(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
(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?
...........
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
(2019)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description