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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
DR ARTHUR J & HELEN M HORVAT FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 2907 - TRUST TAX DEPT
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WILSON
,
NC
278942907
A Employer identification number
23-6846849
B
Telephone number (see instructions)
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
5,831,089
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
10
10
4
Dividends and interest from securities
...
126,196
126,196
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
17,883
b
Gross sales price for all assets on line 6a
1,884,023
7
Capital gain net income (from Part IV, line 2)
...
17,883
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)
.......
14,896
12
Total.
Add lines 1 through 11
........
158,985
144,089
13
Compensation of officers, directors, trustees, etc.
84,026
84,026
0
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)
...
2,042
2,042
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
65
0
0
65
23
Other expenses (attach schedule)
.......
11
11
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
86,144
86,079
0
65
25
Contributions, gifts, grants paid
.......
201,197
201,197
26
Total expenses and disbursements.
Add lines 24 and 25
287,341
86,079
0
201,262
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-128,356
b
Net investment income
(if negative, enter -0-)
58,010
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
.............
13,260
-19,734
-19,734
2
Savings and temporary cash investments
.........
241,237
184,938
184,938
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)
.......
3,594,880
3,508,210
4,172,269
c
Investments—corporate bonds (attach schedule)
.......
1,255,569
1,327,536
1,369,246
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
158,002
132,791
124,370
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)
5,262,948
5,133,741
5,831,089
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
........
5,262,948
5,133,741
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)
.....
5,262,948
5,133,741
30
Total liabilities and net assets/fund balances
(see instructions)
.
5,262,948
5,133,741
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
5,262,948
2
Enter amount from Part I, line 27a
.....................
2
-128,356
3
Other increases not included in line 2 (itemize)
3
1,044
4
Add lines 1, 2, and 3
..........................
4
5,135,636
5
Decreases not included in line 2 (itemize)
5
1,895
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
5,133,741
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
30000. US TREASURY NOTE DTD 02/28/2017 1.125% 0
2017-06-29
2019-01-07
b
9000. PNC FUNDING CORP DTD 02/08/10 5.125% 02/
2017-06-29
2019-02-08
c
5. BROWN & BROWN INC
2017-06-23
2019-02-19
d
5. CHURCH & DWIGHT CO
2017-06-23
2019-02-19
e
115.72 CONESTOGA SMALL CAP-INST
2017-06-23
2019-02-19
5. CURTISS WRIGHT CORP
2017-06-23
2019-02-19
5. GENTEX CORP COM
2018-05-29
2019-02-19
2414.879 IVY INTERNATIONAL CORE EQUITY FUND CLASS
2017-06-23
2019-02-19
5. J2 GLOBAL, INC. COMMON
2017-06-23
2019-02-19
306.911 MFS NEW DISCOVERY VALUE-R6
2017-06-23
2019-02-19
2320.723 T ROWE PRICE INTL DISC-I CLOSE TO NEW WA
2017-06-23
2019-02-19
5. UNITED THERAPEUTICS CORP DEL
2017-06-23
2019-02-19
5. URBAN OUTFITTERS INC COMMON
2018-05-29
2019-02-19
20. LAMAR ADVERTISING CO
2018-12-17
2019-02-20
160. LAMAR ADVERTISING CO
2017-06-23
2019-02-20
8000. OCCIDENTAL PETROLEUM COR DTD 12/16/2010
2017-06-29
2019-02-28
4000. US TREASURY BOND DTD 02/15/2006 4.5% 02/
2017-06-29
2019-03-04
108. SYNNEX CORP COMMON
2017-06-23
2019-03-05
15. SYNNEX CORP COMMON
2018-12-17
2019-03-05
652. TE CONNECTIVITY LTD
2017-05-22
2019-03-05
100. TE CONNECTIVITY LTD
2018-12-17
2019-03-05
310. AMERICAN EXPRESS CO COM STK*
2017-11-21
2019-03-11
45. AMERICAN EXPRESS CO COM STK*
2018-12-17
2019-03-11
290. DISCOVER FINL SVCS
2017-06-23
2019-03-11
19328.94 US TREASURY INFL IX BD DTD 04/30/2014 .1
2017-06-29
2019-03-22
18229.56 US TREASURY INFL IX BD DTD 04/30/2014 .1
2017-06-29
2019-03-27
27.76 US TREASURY INFL IX BD DTD 04/30/2014 .1
2019-03-26
2019-03-27
785. CISCO SYS INC
2013-03-25
2019-04-17
650. TRIPADVISOR INC
2018-11-27
2019-04-17
10000. CELGENE CORP DTD 08/12/2015 3.875% 08/15
2018-09-20
2019-04-22
45. BROADRIDGE FINANCIAL SOLUTIONS INC
2017-06-23
2019-04-24
41. CISCO SYS INC
2017-06-23
2019-04-24
5. WINTRUST FINANCIAL CORP
2018-12-17
2019-04-24
50. WINTRUST FINANCIAL CORP
2017-11-21
2019-04-24
2000. COACH INC DTD 06/20/2017 4.125% 07/15/20
2018-07-06
2019-04-25
3000. COACH INC DTD 06/20/2017 4.125% 07/15/20
2018-07-06
2019-04-30
3000. HOME DEPOT INC DTD 12/19/2006 5.875% 12/
2017-06-29
2019-05-02
9000. VISA INC DTD 12/14/2015 2.8% 12/14/2022
2017-06-29
2019-05-02
10000. WELLS FARGO & CO DTD 07/22/2015 2.6% 07/
2018-09-20
2019-05-02
2000. COACH INC DTD 06/20/2017 4.125% 07/15/20
2018-07-06
2019-05-03
2000. COACH INC DTD 06/20/2017 4.125% 07/15/20
2018-07-06
2019-05-07
125. BRUNSWICK CORPORATION COMMON
2018-05-29
2019-05-23
15. BRUNSWICK CORPORATION COMMON
2018-12-17
2019-05-23
45. PRESTIGE CONSUMER HEALTHCARE I COMMON
2018-11-16
2019-05-23
10. SYNOPSYS INC.
2018-12-17
2019-05-23
60. SYNOPSYS INC.
2017-06-23
2019-05-23
10. UNITED THERAPEUTICS CORP DEL
2018-12-17
2019-05-23
50. UNITED THERAPEUTICS CORP DEL
2017-06-23
2019-05-23
.571 KONTOOR BRANDS INC COMMON
2019-02-19
2019-05-28
12000. US TREASURY NOTE DTD 06/30/2014 1.625% 0
2017-06-29
2019-05-31
125. BIG LOTS, INC
2017-06-23
2019-06-05
85. BIG LOTS, INC
2018-11-16
2019-06-05
40. BIG LOTS, INC
2018-12-17
2019-06-05
9000. L3 TECHNOLOGIES INC DTD 12/05/2016 3.85%
2019-03-25
2019-06-07
10000. U S TREASURY NOTES 2.000% 02/28/21
2019-01-07
2019-06-10
9000. US TREASURY NOTE DTD 11/15/2016 2% 11/15
2019-06-07
2019-06-11
9000. US TREASURY NOTE DTD 02/15/2017 2.25% 02
2017-06-29
2019-06-12
12000. US TREASURY NOTE DTD 02/15/2017 2.25% 02
2017-06-29
2019-06-21
14000. U S TREASURY NOTES 2.000% 07/31/20
2018-10-11
2019-06-25
5000. US TREASURY BOND DTD 11/16/2015 3% 11/15
2017-06-29
2019-06-28
13000. US TREASURY NOTE DTD 06/30/2014 1.625% 0
2017-06-29
2019-06-30
15. ABBVIE INC
2017-11-21
2019-07-01
10. APPLE COMPUTER COM
2014-03-12
2019-07-01
10. AVERY DENNISON CORP
2017-06-23
2019-07-01
5. BIOGEN INC COMMON
2018-11-27
2019-07-01
5. BOOT BARN HOLDINGS INC COMMON
2019-05-23
2019-07-01
5. BROWN & BROWN INC
2017-06-23
2019-07-01
20. CH ROBINSON WORLDWIDE INC
2017-06-23
2019-07-01
5. CARLISLE COMMON
2017-06-23
2019-07-01
5. CIRRUS LOGIC COMMON
2017-06-23
2019-07-01
20. COLGATE-PALMOLIVE CO COM STK
2017-06-23
2019-07-01
168.667 CONESTOGA SMALL CAP-INST
2017-06-23
2019-07-01
6643.007 DFA COMMODITY STRATEGY PORT
2018-06-15
2019-07-01
5. DE LUXE CHECK PRINTERS INCORPORATED
2017-06-23
2019-07-01
10. WALT DISNEY COMPANY THE
2018-11-27
2019-07-01
10. DISCOVER FINL SVCS
2017-06-23
2019-07-01
5. EAST WEST BANCORP INC COMMON
2017-06-23
2019-07-01
10. FACEBOOK INC CL A
2018-03-12
2019-07-01
20. GENUINE PARTS CO
2017-06-23
2019-07-01
3797.587 OAKMARK INTERNATIONAL-INST
2018-01-09
2019-07-01
45. INTEL CORP
2017-06-23
2019-07-01
38.299 IVY INTERNATIONAL CORE EQUITY FUND CLASS
2017-06-23
2019-07-01
10. JOHNSON + JOHNSON COM STK
2017-06-23
2019-07-01
5. KONTOOR BRANDS INC COMMON
2017-06-23
2019-07-01
5. LAM RESH CORP
2017-08-08
2019-07-01
504.686 LAZARD GLOBAL LISTED INFRASTRUCTURE PORT
2018-07-25
2019-07-01
20. MARSH & MCLENNAN COS INC
2017-06-23
2019-07-01
10. MCDONALD'S CORP
2017-06-23
2019-07-01
25. MICROSOFT CORP
2016-04-22
2019-07-01
15. PAYPAL HOLDINGS INC
2018-11-27
2019-07-01
15. PEPSICO INC
2017-06-23
2019-07-01
25. PFIZER INC COM STK
2018-09-24
2019-07-01
5. PROCTER & GAMBLE CO COM STK*
2018-11-27
2019-07-01
10. RAYTHON COMPANY
2017-06-23
2019-07-01
5. RESMED, INC.
2017-06-23
2019-07-01
92.639 T ROWE PRICE INTL DISC-I CLOSE TO NEW WA
2017-06-23
2019-07-01
50. TJX COMPANIES
2017-06-23
2019-07-01
5. US BANCORP
2017-06-23
2019-07-01
15. UNION PACIFIC CORP COMMON STO*
2013-03-25
2019-07-01
10. UNITEDHEALTH GROUP
2017-06-23
2019-07-01
20. V F CORP COMMON
2017-06-23
2019-07-01
20. VALERO ENERGY CORP NEW COM
2017-11-21
2019-07-01
34.898 VANGUARD MORTGAGE BACKED SECURITIES INDE
2018-03-14
2019-07-01
20. VARIAN MED SYS INC
2017-06-23
2019-07-01
25. VERIZON COMMUNICATIONS
2017-06-23
2019-07-01
15. WALGREENS BOOTS ALLIANCE INC
2017-06-23
2019-07-01
5. WATSCO INC CL A
2017-06-23
2019-07-01
10. ACCENTURE PLC IRELAND SHS
2017-06-23
2019-07-01
50. CHURCH & DWIGHT CO
2017-06-23
2019-07-02
160. JOHNSON + JOHNSON COM STK
2017-06-23
2019-07-15
10.143 KONTOOR BRANDS INC COMMON
2019-02-19
2019-07-15
90. KONTOOR BRANDS INC COMMON
2017-06-23
2019-07-15
2.857 KONTOOR BRANDS INC COMMON
2018-12-17
2019-07-15
10000. AT&T INC DTD 06/05/2019 3.8% 02/15/2027
2019-02-08
2019-08-01
9000. MANULIFE FINL CORP DTD 03/04/2016 4.15%
2017-06-29
2019-08-01
10000. SHELL INTERNATIONAL FIN DTD 09/12/2016 2
2019-03-22
2019-08-02
4000. WILLIAMS PARTNERS LP DTD 11/17/2011 4% 1
2018-07-24
2019-08-02
4000. U S TREASURY NOTES 3.125% 05/15/21
2019-08-02
2019-08-15
22727. US TREASURY INFL INDEX BD DTD 7/29/2011
2017-06-29
2019-08-15
.2 US TREASURY INFL INDEX BD DTD 7/29/2011
2019-08-15
2019-08-15
5000. FED NATL MTG ASSN DTD 02/05/2016 1.375%
2018-08-23
2019-08-30
9000. HSBC HOLDINGS PLC HOLDINGS PLC DTD 04/05/2011 5.1% 04/05/2021
2018-04-19
2019-09-04
230. GENUINE PARTS CO
2017-06-23
2019-09-24
290. VARIAN MED SYS INC
2017-06-23
2019-09-24
80. SONOCO PRODUCTS COMPANY
2018-05-29
2019-10-08
105. RESMED, INC.
2017-06-23
2019-11-05
15. RESMED, INC.
2018-12-17
2019-11-05
10. AMC NETWORKS INC-A COMMON
2018-11-16
2019-11-07
10. ABBVIE INC
2017-11-21
2019-11-07
10. AVERY DENNISON CORP
2017-06-23
2019-11-07
10. BOOT BARN HOLDINGS INC COMMON
2019-05-23
2019-11-07
5. BROADRIDGE FINANCIAL SOLUTIONS INC
2017-06-23
2019-11-07
25. BROWN & BROWN INC
2017-06-23
2019-11-07
10. CH ROBINSON WORLDWIDE INC
2017-06-23
2019-11-07
10. CADENCE DESIGN SYS INC COM RTS EXP 02/09/2006
2019-03-05
2019-11-07
5. CARLISLE COMMON
2017-06-23
2019-11-07
10. CHARLES RIV LABORATORIES INTL INC COM
2017-07-06
2019-11-07
20. CISCO SYS INC
2017-06-23
2019-11-07
20. COLGATE-PALMOLIVE CO COM STK
2017-06-23
2019-11-07
15. COMCAST CORP NEW CL A
2019-04-17
2019-11-07
15. COMMERCE BANCSHARES, INC.
2017-06-23
2019-11-07
10. DE LUXE CHECK PRINTERS INCORPORATED
2017-06-23
2019-11-07
10. WALT DISNEY COMPANY THE
2018-11-27
2019-11-07
10. DISCOVER FINL SVCS
2017-06-23
2019-11-07
15. EXXON MOBIL CORP
2017-06-23
2019-11-07
10. FLIR SYSTEMS INC COMMON
2017-11-21
2019-11-07
10. GALLAGHER ARTHUR J
2017-06-23
2019-11-07
15. GENTEX CORP COM
2018-05-29
2019-11-07
10. HEALTHEQUITY INC COMMON
2019-11-05
2019-11-07
10. HOLLYFRONTIER CORP
2017-11-21
2019-11-07
10. GEO. A. HORMEL & CO*
2017-06-23
2019-11-07
25. INTEL CORP
2017-06-23
2019-11-07
10. LUMENTUM HOLDINGS INC COMMON
2018-11-16
2019-11-07
15. MARSH & MCLENNAN COS INC
2017-06-23
2019-11-07
15. MICROSOFT CORP
2016-04-22
2019-11-07
10. NAT'L INSTRUMENTS CORP COMMON
2019-03-05
2019-11-07
75. NATUS MEDICAL INC COMMON
2019-11-05
2019-11-07
15. OMEGA HEALTHCARE INVESTORS INC REIT
2019-02-20
2019-11-07
15. PAYPAL HOLDINGS INC
2018-11-27
2019-11-07
10. PEPSICO INC
2017-06-23
2019-11-07
20. PFIZER INC COM STK
2018-09-24
2019-11-07
10. PRESTIGE CONSUMER HEALTHCARE I COMMON
2018-11-16
2019-11-07
15. RPM INC OHIO COM
2017-06-23
2019-11-07
10. SEI INVESTMENTS CO
2019-04-24
2019-11-07
25. TJX COMPANIES
2017-06-23
2019-11-07
10. TORO COMPANY COMMON
2017-06-23
2019-11-07
10. UGI CORP COM
2017-06-23
2019-11-07
20. US BANCORP
2017-06-23
2019-11-07
10. UNION PACIFIC CORP COMMON STO*
2013-03-25
2019-11-07
15. URBAN OUTFITTERS INC COMMON
2018-05-29
2019-11-07
10. V F CORP COMMON
2017-06-23
2019-11-07
10. VALERO ENERGY CORP NEW COM
2017-11-21
2019-11-07
15. VERIZON COMMUNICATIONS
2017-06-23
2019-11-07
10. WALGREENS BOOTS ALLIANCE INC
2017-06-23
2019-11-07
10. ACCENTURE PLC IRELAND SHS
2017-06-23
2019-11-07
114.386 DFA GLOBAL REAL ESTATE SEC PORT
2019-07-01
2019-11-08
598.12 OAKMARK INTERNATIONAL-INST
2018-01-09
2019-11-08
18680.999 IVY INTERNATIONAL CORE EQUITY FUND CLASS
2017-06-23
2019-11-08
252.718 MFS NEW DISCOVERY VALUE-R6
2017-06-23
2019-11-08
9000. US TREASURY BOND DTD 05/15/2018 2.875% 0
2019-08-15
2019-11-08
4000. AT&T INC DTD 05/04/2015 4.5% 05/15/2035
2018-09-28
2019-11-22
3000. ABBVIE INC DTD 9/18/2018 4.25% 11/14/202
2019-03-27
2019-11-22
4000. AMERICAN ELECTRIC POWER DTD 11/13/2017 3
2018-08-23
2019-11-22
4000. APACHE CORP DTD 08/23/2018 4.375% 10/15/
2018-08-14
2019-11-22
2000. APPLE INC DTD 05/06/2014 3.45% 05/06/202
2017-06-29
2019-11-22
3000. BANK OF AMERICA CORP DTD 01/11/2013 3.3%
2018-07-06
2019-11-22
4000. BANK OF MONTREAL DTD 06/28/2019 2.5% 06/
2019-06-25
2019-11-22
3000. BERKSHIRE HATHAWAY INC DTD 3/15/2016 3.1
2017-06-29
2019-11-22
3000. BOSTON PROPERTIES LP DTD 06/21/2019 3.4%
2019-06-12
2019-11-22
3000. CAPITAL ONE FINANCIAL CO DTD 02/05/2015
2018-09-28
2019-11-22
3000. CINTAS CORP NO. 2 DTD 03/14/2017 3.7% 04
2018-07-24
2019-11-22
2000. CISCO SYSTEMS INC SYSTEMS INC DTD 11/17/
2018-08-17
2019-11-22
2000. CITIGROUP INC DTD 01/26/2012 5.875% 01/3
2018-04-16
2019-11-22
3000. THE COCA-COLA CO DTD 09/06/2019 2.125% 0
2019-09-04
2019-11-22
4000. COMCAST CORP DTD 10/05/2018 4.15% 10/15/2028
2018-10-02
2019-11-22
2000. CONAGRA BRANDS INC DTD 10/22/2018 5.3% 1
2019-04-22
2019-11-22
1000. CONOCOPHILLIPS DTD 1/29/2009 6.5% 02/01/
2019-03-08
2019-11-22
2000. CONSTELLATION BRANDS INC DTD 10/29/2018
2019-02-28
2019-11-22
4000. CROWN CASTLE INTL CORP DTD 04/15/2014 4.
2018-09-20
2019-11-22
4000. DUKE ENERGY CORP DTD 10/11/2013 3.95% 10
2018-08-23
2019-11-22
5000. FED NATL MTG ASSN DTD 11/3/00 6.625% 11/
2019-02-26
2019-11-22
5000. FED NATL MTG ASSN DTD 02/05/2016 1.375%
2018-08-23
2019-11-22
11000. FED NATL MTG ASSN DTD 04/26/2016 2.125%
2018-07-17
2019-11-22
10000. FED NATL MTG ASSN DTD 01/23/2018 2.375%
2018-08-23
2019-11-22
5000. FED NATL MTG ASSN 2.625% 09/06/24
2018-07-17
2019-11-22
10000. FED HOME LN MTG CORP 2.375% 01/13/22
2018-08-23
2019-11-22
4000. FISERV INC DD 06/24/2019 3.2% 07/01/2026
2019-06-10
2019-11-22
20000. GEORGIA ST TXBL-SER B DTD 07/12/2018 3.2
2018-06-20
2019-11-22
1000. GOLDMAN SACHS NOTE DTD 1/28/2011 6.25% 0
2019-07-31
2019-11-22
3000. GOLDMAN SACHS GROUP INC DTD 02/25/2016 2
2018-09-28
2019-11-22
3000. HCP INC DTD 08/14/2014 3.875% 08/15/2024
2018-09-21
2019-11-22
2000. HOLLYFRONTIER CORP DTD 03/22/2016 5.875%
2018-07-24
2019-11-22
2000. HOME DEPOT INC DTD 12/19/2006 5.875% 12/
2017-06-29
2019-11-22
3000. INVESCO FINANCE PLC DTD 11/08/2012 3.125
2018-09-20
2019-11-22
10000. JPMORGAN CHASE & CO 4.250% 10/15/20
2017-06-29
2019-11-22
5000. KIMCO REALTY CORP DTD 03/30/2015 4.25% 0
2018-09-24
2019-11-22
2000. KINDER MORGAN INC DTD 03/01/2018 4.3% 03
2018-11-07
2019-11-22
4000. METLIFE INC DTD 11/13/2013 4.875% 11/13/
2018-08-24
2019-11-22
4000. MITSUBISHI UJF FINANCIAL GRP DTD 02/22/2017 2.998% 02/22/2022
2018-09-20
2019-11-22
7000. MORGAN STANLEY DTD 07/23/2015 4% 07/23/2
2018-09-20
2019-11-22
3000. NATIONAL RURAL UTILITIES COOP DTD 01/31/2019 3.7% 03/15/2029
2019-03-29
2019-11-22
10000. NEW YORK ST DORM AUTH SALES TAX REV TXBL- REF-SER D DTD 07/19/2
2018-07-12
2019-11-22
4000. NUCOR CORP DTD 04/26/2018 3.95% 05/01/20
2018-09-28
2019-11-22
2000. PEPSICO INC DTD 10/06/2016 3.45% 10/06/2
2019-02-15
2019-11-22
2000. PFIZER INC DTD 03/11/2019 3.9% 03/15/203
2019-03-04
2019-11-22
3000. SHERWIN-WILLIAMS CO DTD 05/16/2017 3.45%
2018-08-16
2019-11-22
3000. SHIRE ACQ INV IRELAND DA DTD 09/23/2016
2019-06-10
2019-11-22
3000. SUMITOMO MITSUI FINL GRP DTD 07/12/2017
2018-09-20
2019-11-22
9000. TARGET CORP 2.900% 01/15/22
2017-06-29
2019-11-22
4000. TORONTO DOMINION BANK DTD 07/13/2016 1.8
2018-10-17
2019-11-22
9000. US TREASURY BOND DTD 02/15/2006 4.5% 02/
2017-06-29
2019-11-22
8000. US TREASURY BOND DTD 11/16/2015 3% 11/15
2017-06-29
2019-11-22
6000. US TREASURY BOND DTD 02/15/2017 3% 02/15
2017-06-29
2019-11-22
6000. US TREASURY NOTE DTD 08/15/2016 1.5% 08/
2019-08-01
2019-11-22
10000. US TREASURY BOND DTD 11/15/2018 3.125% 1
2019-01-07
2019-11-22
4000. US TREASURY NOTE DTD 02/15/2017 2.25% 02
2019-08-01
2019-11-22
9000. US TREASURY NOTE DTD 02/15/2017 2.25% 02
2017-06-29
2019-11-22
13000. U S TREASURY NOTES 1.750% 05/15/23
2017-06-29
2019-11-22
4000. UNITED TECHNOLOGIES CORP DTD 8/16/2018 4
2019-06-20
2019-11-22
3000. VENTAS REALTY LP DTD 4/17/2014 3.75% 05/
2018-08-17
2019-11-22
2000. VERIZON COMMUNICATIONS DTD 03/11/2015 4.
2018-08-16
2019-11-22
10000. WASHINGTON ST TXBL-SER T DTD 09/12/2018 3.45% 08/01/2029-2028
2018-08-30
2019-11-22
3000. WELLS FARGO & CO DTD 10/25/2016 3% 10/23
2019-06-11
2019-11-22
2000. WESTLAKE CHEMICAL CORP DTD 11/28/2017 4.
2018-07-24
2019-11-22
3000. WESTPAC BANKING CORP DTD 01/25/2018 2.65
2018-10-17
2019-11-22
.55 COMMERCE BANCSHARES, INC.
2018-12-17
2019-12-02
305. GENUINE PARTS CO
2017-06-23
2019-12-16
85. GENUINE PARTS CO
2018-12-17
2019-12-16
355. PFIZER INC COM STK
2018-09-24
2019-12-16
60. AMC NETWORKS INC-A COMMON
2018-11-16
2019-12-19
45. CHEESECAKE FACTORY COMMON
2017-06-23
2019-12-19
100. DORMAN PRODUCTS, INC COMMON
2019-05-22
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
29,947
29,898
49
b
9,194
9,720
-526
c
146
108
38
d
325
266
59
e
6,440
5,346
1,094
601
455
146
103
116
-13
40,932
46,317
-5,385
422
449
-27
4,717
4,579
138
140,636
148,341
-7,705
596
662
-66
150
209
-59
1,536
1,371
165
12,286
11,682
604
8,164
8,597
-433
4,893
5,169
-276
10,506
12,721
-2,215
1,459
1,201
258
53,796
51,481
2,315
8,251
7,979
272
33,920
29,255
4,665
4,924
4,753
171
20,532
17,397
3,135
19,344
19,348
-4
18,244
18,248
-4
28
47
-19
44,238
22,210
22,028
32,953
39,765
-6,812
10,262
9,828
434
5,252
3,446
1,806
2,332
1,319
1,013
379
342
37
3,792
3,988
-196
1,934
1,915
19
2,907
2,873
34
3,784
3,941
-157
9,030
9,219
-189
9,973
9,904
69
1,935
1,915
20
1,945
1,915
30
5,687
7,868
-2,181
682
681
1
1,321
1,711
-390
1,174
855
319
7,045
4,538
2,507
850
1,071
-221
4,249
6,617
-2,368
17
20
-3
11,992
12,060
-68
3,448
5,898
-2,450
2,345
3,505
-1,160
1,103
1,140
-37
9,362
9,169
193
10,011
9,892
119
8,954
9,007
-53
9,141
8,981
160
12,247
11,975
272
14,013
13,794
219
5,473
5,156
317
13,000
13,066
-66
1,105
1,424
-319
2,018
764
1,254
1,183
881
302
1,174
1,610
-436
178
153
25
170
108
62
1,684
1,342
342
704
470
234
224
331
-107
1,439
1,526
-87
10,235
7,792
2,443
35,939
39,858
-3,919
206
346
-140
1,415
1,137
278
786
600
186
237
282
-45
1,935
1,854
81
2,086
1,802
284
87,762
111,535
-23,773
2,159
1,541
618
661
735
-74
1,392
1,359
33
146
112
34
955
787
168
7,712
8,176
-464
2,016
1,569
447
2,065
1,548
517
3,386
1,295
2,091
1,725
1,223
502
1,973
1,757
216
1,093
1,099
-6
551
463
88
1,710
1,623
87
618
392
226
5,973
5,921
52
2,641
1,717
924
265
255
10
2,575
1,032
1,543
2,431
1,851
580
1,763
1,063
700
1,684
1,671
13
736
718
18
2,790
2,097
693
1,416
1,136
280
820
1,145
-325
818
782
36
1,867
1,229
638
3,676
2,659
1,017
21,561
21,749
-188
329
349
-20
2,916
2,261
655
93
82
11
10,459
9,789
670
9,797
9,590
207
10,048
9,647
401
4,117
4,042
75
4,108
4,095
13
22,865
23,287
-422
4,983
4,844
139
9,409
9,462
-53
22,167
20,723
1,444
33,790
30,400
3,390
4,456
4,116
340
15,173
8,196
6,977
2,168
1,651
517
415
591
-176
820
949
-129
1,322
881
441
382
305
77
599
383
216
941
540
401
791
671
120
666
588
78
788
470
318
1,268
1,007
261
964
644
320
1,334
1,526
-192
668
638
30
995
762
233
523
693
-170
1,328
1,137
191
843
600
243
1,093
1,221
-128
529
473
56
912
570
342
440
349
91
611
611
543
446
97
416
349
67
1,451
856
595
657
417
240
1,548
1,177
371
2,160
777
1,383
430
466
-36
2,405
2,583
-178
621
533
88
1,511
1,223
288
1,333
1,171
162
737
879
-142
379
380
-1
1,106
820
286
624
571
53
1,484
858
626
774
709
65
470
494
-24
1,182
1,019
163
1,771
688
1,083
459
627
-168
865
531
334
1,010
836
174
907
681
226
588
763
-175
1,888
1,229
659
1,408
1,341
67
14,911
17,567
-2,656
331,027
358,714
-27,687
4,220
3,770
450
9,691
10,006
-315
4,412
3,745
667
3,292
3,068
224
4,153
3,800
353
4,044
3,994
50
2,124
2,096
28
3,103
2,960
143
4,044
3,999
45
3,166
3,050
116
3,145
2,994
151
3,093
2,834
259
3,260
2,947
313
2,730
2,428
302
2,767
2,465
302
2,939
2,999
-60
4,504
3,998
506
2,322
2,069
253
1,447
1,312
135
2,264
2,061
203
4,241
4,130
111
4,232
4,069
163
7,233
6,736
497
4,981
4,844
137
11,245
10,324
921
10,220
9,836
384
5,217
4,919
298
10,149
9,888
261
4,149
4,002
147
21,494
20,099
1,395
1,398
1,344
54
3,029
2,961
68
3,198
2,931
267
2,236
2,153
83
2,770
2,628
142
3,079
2,948
131
10,204
10,659
-455
5,372
4,484
888
2,162
1,942
220
4,954
4,287
667
4,079
3,915
164
7,551
6,999
552
3,290
3,120
170
10,221
10,000
221
4,355
4,001
354
2,142
1,864
278
2,274
1,974
300
3,161
2,866
295
3,014
2,981
33
3,148
2,838
310
9,207
9,287
-80
3,995
3,838
157
12,209
11,630
579
9,241
8,249
992
6,963
6,195
768
5,922
5,888
34
11,130
10,384
746
4,147
4,130
17
9,331
8,981
350
13,058
12,831
227
4,511
4,403
108
3,160
2,983
177
2,492
2,021
471
10,792
10,000
792
3,077
2,981
96
2,005
1,855
150
3,021
2,951
70
37
30
7
32,141
27,481
4,660
8,957
9,023
-66
13,898
15,610
-1,712
2,328
3,546
-1,218
1,758
2,241
-483
7,349
8,181
-832
8,765
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
49
b
-526
c
38
d
59
e
1,094
146
-13
-5,385
-27
138
-7,705
-66
-59
165
604
-433
-276
-2,215
258
2,315
272
4,665
171
3,135
-4
-4
-19
22,028
-6,812
434
1,806
1,013
37
-196
19
34
-157
-189
69
20
30
-2,181
1
-390
319
2,507
-221
-2,368
-3
-68
-2,450
-1,160
-37
193
119
-53
160
272
219
317
-66
-319
1,254
302
-436
25
62
342
234
-107
-87
2,443
-3,919
-140
278
186
-45
81
284
-23,773
618
-74
33
34
168
-464
447
517
2,091
502
216
-6
88
87
226
52
924
10
1,543
580
700
13
18
693
280
-325
36
638
1,017
-188
-20
655
11
670
207
401
75
13
-422
139
-53
1,444
3,390
340
6,977
517
-176
-129
441
77
216
401
120
78
318
261
320
-192
30
233
-170
191
243
-128
56
342
91
97
67
595
240
371
1,383
-36
-178
88
288
162
-142
-1
286
53
626
65
-24
163
1,083
-168
334
174
226
-175
659
67
-2,656
-27,687
450
-315
667
224
353
50
28
143
45
116
151
259
313
302
302
-60
506
253
135
203
111
163
497
137
921
384
298
261
147
1,395
54
68
267
83
142
131
-455
888
220
667
164
552
170
221
354
278
300
295
33
310
-80
157
579
992
768
34
746
17
350
227
108
177
471
792
96
150
70
7
4,660
-66
-1,712
-1,218
-483
-832
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
17,883
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
296,467
5,443,402
0.054464
2017
133,105
5,468,268
0.024341
2016
241,065
5,051,988
0.047717
2015
314,989
5,321,890
0.059187
2014
317,775
5,595,818
0.056788
2
Total
of line 1, column (d)
.....................
2
0.242497
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
0.048499
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
5,402,969
5
Multiply line 4 by line 3
......................
5
262,039
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
580
7
Add lines 5 and 6
........................
7
262,619
8
Enter qualifying distributions from Part XII, line 4
,.............
8
201,262
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
1,160
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
1,160
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
1,160
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
2,208
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
2,208
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
1,048
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
1,048
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)
PA
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 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
BRANCH BANKING AND TRUST CO
Telephone no.
(610) 371-2091
Located at
PO BOX 2907 - TRUST TAX DEPT
WILSON
NC
ZIP+4
278942907
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 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
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
Branch Banking Trust Co
Co-trustee
40
50,426
PO Box 2907 - Trust Tax Dept
Wilson
,
NC
278942907
John R Saurman
Co-Trustee
2
10,000
8368 Fisher Road
Elkins
,
PA
19027
Nicholas D Tellie Esq
Co-trustee
2
10,000
310 East Drinker Street
Dunmore
,
PA
18512
Rose Ann Lavelle
Schlarship Committee
2
6,800
118 Grandview Drive
Pittston
,
PA
18640
Donald H Keffer
Scholarship Committe
2
6,800
56 Ann Drive
Danville
,
PA
17821
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(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
5,329,116
b
Average of monthly cash balances
.......................
1b
156,132
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
5,485,248
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
0
3
Subtract line 2 from line 1d
.........................
3
5,485,248
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
82,279
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
5,402,969
6
Minimum investment return.
Enter 5% of line 5
..................
6
270,148
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
270,148
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
1,160
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
1,160
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
268,988
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
268,988
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
268,988
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
201,262
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
201,262
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
201,262
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
268,988
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
84,472
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:
$
201,262
a
Applied to 2018, but not more than line 2a
84,472
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
.....
116,790
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
..........
152,198
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).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
DR ARTHUR HELEN HORVAT FDN SCHOLA
4320-G WADE HAMPTON BLVD
TAYLORS
,
SC
29687
(866) 608-0001
b
The form in which applications should be submitted and information and materials they should include:
VISIT WWW.CSASCHOLARS.ORG FOR A DETAILED LISTING OF REQUIREMENTS
c
Any submission deadlines:
APRIL 15 ANNUALLY
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
VISIT WWW.CSASCHOLARS.OR FOR A LISTING OF RESTRICTIONS AND LIMITATION
Form
990-PF
(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
KINGS COLLEGE
56 BROADWAY 5TH FLOOR
NEW YORK
,
NY
10004
NONE
PC
SCHOLARSHIPS
8,500
PHILADELPHIA COLLEGE OF
OSTEOPATHIC MEDICINE
4190 CITY AVENUE
PHILADELPHIA
,
PA
19131
NONE
PC
SCHOLARSHIPS
8,750
Thomas Jefferson University
SIDNEY KIMMEL MEDICAL COLLEGE
Philadelphia
,
PA
19107
NONE
PC
SCHOLARSHIPS
3,918
Temple University
1852 NORTH 10 STREET
Philadelphia
,
PA
19122
NONE
PC
SCHOLARSHIPS
31,779
Dickinson College
PO BOX 1773
Carlisle
,
PA
17013
NONE
PC
SCHOLARSHIPS
8,500
ALVERNIA UNIVERSITY
540 UPLAND AVENUE
READING
,
PA
19611
NONE
PC
SCHOLARSHIPS
4,250
Drexel University
3141 CHESTNUT STREET SUITE 225
Philadelphia
,
PA
19104
NONE
PC
SCHOLARSHIPS
17,500
Misericordia College
301 LAKE STREET
Dallas
,
PA
18612
NONE
PC
SCHOLARSHIPS
23,750
MARYWOOD UNIVERSITY
2300 ADAMS AVENUE
SCRANTON
,
PA
18509
NONE
PC
SCHOLARSHIPS
6,750
University of Scranton
OFFICE OF UNDERGRADUATE ADMISSIONS
Scranton
,
PA
18510
NONE
PC
SCHOLARSHIPS
11,000
Wilkes University
84 W SOUTH ST
Wilkes Barre
,
PA
18701
NONE
PC
SCHOLARSHIPS
17,000
Penn State University
UNIVERSITY PARK
State College
,
PA
16801
NONE
PC
SCHOLARSHIPS
30,250
University of Pittsburgh
3550 TERRACE ST
Pittsburgh
,
PA
15261
NONE
PC
SCHOLARSHIPS
11,750
Commonwealth Medical College
525 PINE STREET
Scranton
,
PA
18509
NONE
PC
SCHOLARSHIPS
17,500
Total
.................................
3a
201,197
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
...........
14
10
4
Dividends and interest from securities
....
14
126,196
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
17,883
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
OTHER REVENUE
1
14,896
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
158,985
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
158,985
(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