-
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
1ST SOURCE FOUNDATION 480008010
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 1602
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
SOUTH BEND
,
IN
46634
A Employer identification number
35-6034211
B
Telephone number (see instructions)
(574) 235-2790
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)
$
39,910,919
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
...
941,925
941,925
941,925
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
592,425
b
Gross sales price for all assets on line 6a
3,437,573
7
Capital gain net income (from Part IV, line 2)
...
592,425
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
........
1,534,350
1,534,350
941,925
13
Compensation of officers, directors, trustees, etc.
129,098
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)
.......
1,900
1,900
0
0
c
Other professional fees (attach schedule)
....
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
21,813
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
..........
152,811
1,900
0
0
25
Contributions, gifts, grants paid
.......
1,724,844
1,724,844
26
Total expenses and disbursements.
Add lines 24 and 25
1,877,655
1,900
0
1,724,844
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-343,305
b
Net investment income
(if negative, enter -0-)
1,532,450
c
Adjusted net income
(if negative, enter -0-)
...
941,925
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
.........
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)
2,445,070
968,753
968,753
b
Investments—corporate stock (attach schedule)
.......
22,302,497
20,817,823
31,577,166
c
Investments—corporate bonds (attach schedule)
.......
4,563,446
7,108,228
7,166,022
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
0
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
120,628
195,628
198,978
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
29,431,641
29,090,432
39,910,919
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
........
29,431,641
29,090,432
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)
.....
29,431,641
29,090,432
30
Total liabilities and net assets/fund balances
(see instructions)
.
29,431,641
29,090,432
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
29,431,641
2
Enter amount from Part I, line 27a
.....................
2
-343,305
3
Other increases not included in line 2 (itemize)
3
2,096
4
Add lines 1, 2, and 3
..........................
4
29,090,432
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
29,090,432
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
3000. AT&T INC
2014-01-30
2019-01-30
b
1500. GENERAL MILLS INC
2012-09-20
2019-01-30
c
21910.604 OAKMARK INTERNATIONAL-INST
2015-05-20
2019-03-15
d
8952.551 OAKMARK INTERNATIONAL-INST
2014-03-21
2019-03-22
e
2000. ISHARES RUSSELL 1000 GROWTH INDEX FUND
2016-08-24
2019-03-22
8699.435 OAKMARK INTERNATIONAL-INST
2015-06-09
2019-07-15
640. ALCON INC
2012-09-17
2019-07-19
2000. ISHARES RUSSELL 1000 VALUE ETF
2018-01-26
2019-09-09
2000. ISHARES RUSSELL 1000 GROWTH INDEX FUND
2016-08-30
2019-09-09
2000. ISHARES RUSSELL 1000 GROWTH INDEX FUND
2016-08-30
2019-10-03
14810.428 LORD ABBETT SHRT DUR INC-I
2019-10-03
2019-10-08
3000. ISHARES RUSSELL 1000 GROWTH INDEX FUND
2016-08-30
2019-11-13
1879.699 T ROWE PR MID CAP GROW-I
2015-07-22
2019-11-13
2000. ISHARES RUSSELL 1000 GROWTH INDEX FUND
2016-08-04
2019-11-25
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
88,165
109,036
-20,871
b
65,561
60,839
4,722
c
500,000
566,870
-66,870
d
200,000
230,804
-30,804
e
299,712
211,135
88,577
200,000
223,953
-23,953
38,524
18,713
19,811
256,431
262,876
-6,445
321,830
210,811
111,019
313,199
209,558
103,641
62,500
62,500
501,646
314,323
187,323
180,000
154,451
25,549
340,729
209,279
131,450
69,276
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
-20,871
b
4,722
c
-66,870
d
-30,804
e
88,577
-23,953
19,811
-6,445
111,019
103,641
187,323
25,549
131,450
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
592,425
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
1,494,255
34,361,557
0.043486
2017
1,363,671
33,070,711
0.041235
2016
1,317,135
29,533,823
0.044598
2015
1,342,205
28,703,399
0.046761
2014
1,105,123
27,366,546
0.040382
2
Total
of line 1, column (d)
.....................
2
0.216462
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
0.043292
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
36,359,993
5
Multiply line 4 by line 3
......................
5
1,574,097
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
15,325
7
Add lines 5 and 6
........................
7
1,589,422
8
Enter qualifying distributions from Part XII, line 4
,.............
8
1,724,844
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
15,325
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
15,325
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
15,325
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
79,966
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
79,966
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
64,641
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
64,641
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)
IN
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
Yes
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
14
The books are in care of
1ST SOURCE BANK
Telephone no.
(574) 235-2119
Located at
100 N MICHIGAN
SOUTH BEND
IN
ZIP+4
46601
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
2011
,
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
Yes
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
REX MARTIN
DIRECTOR
1
0
100 N MICHIGAN
SOUTH BEND
,
IN
46601
JAMES SEITZ
DIRECTOR
1
0
100 N MICHIGAN
SOITH BEND
,
IN
46601
CHRISTOPHER MURPHY III
DIRECTOR
1
0
100 N MICHIGAN
SOUTH BEND
,
IN
46601
JOHN AFFLECK GRAVES
DIRECTOR
1
0
100 N MICHIGAN
SOUTH BEND
,
IN
46601
JOHN PHAIR
DIRECTOR
1
0
100 N MICHIGAN
SOUTH BEND
,
IN
46601
1ST SOURCE BANK
TRUSTEE
0
129,098
100 N MICHIGAN
SOUTH BEND
,
IN
46601
ANDREA SHORT
MEMBER
1
0
100 N MICHIGAN
SOUTH BEND
,
IN
46601
RON ZELTWANGER
MEMBER
1
0
100 N MICHIGAN
SOUTH BEND
,
IN
46601
KEVIN MURPHY
MEMBER
1
0
100 N MICHIGAN
SOUTH BEND
,
IN
46601
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
36,913,698
b
Average of monthly cash balances
.......................
1b
0
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
36,913,698
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
36,913,698
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
553,705
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
36,359,993
6
Minimum investment return.
Enter 5% of line 5
..................
6
1,818,000
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
1,818,000
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
15,325
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
15,325
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
1,802,675
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
1,802,675
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
1,802,675
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
1,724,844
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
1,724,844
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
15,325
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
1,709,519
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
1,802,675
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
1,684,699
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:
$
1,724,844
a
Applied to 2018, but not more than line 2a
1,684,699
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
.....
40,145
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
..........
1,762,530
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 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
UNITED WAY OF MARSHALL COUNTY
2701 NORTH MICHIGAN STREET
PLYMOUTH
,
IN
46563
NONE
PC
GENERAL SUPPORT
2,700
UNITED WAY OF WHITLEY COUNTY
PO BOX 464
COLUMBIA CITY
,
IN
46725
NONE
PC
CHARITABLE CONTRIBUTION
315
PACT INC
505 DON HOVEY DRIVE
VALPARAISO
,
IN
46383
NONE
PC
CHARITABLE CONTRIBUTION
2,985
DISMAS INC
DISMAS HOUSE OF INDIANA
521 S ST JOSEPH STREET
SOUTH BEND
,
IN
46601
NONE
PC
GENERAL SUPPORT
20,000
SOUTH BEND HERITAGE FOUNDATION
803 LINCOLNWAY WEST
SOUTH BEND
,
IN
46616
NONE
PC
CHARITABLE CONTRIBUTION
3,000
THE CROSSING EDUCATION CENTER
2930 S NAPPANEE STREET
ELKHART
,
IN
46517
NONE
NONE
CHARITABLE CONTRIBUTION
2,000
MARSHALL COUNTY EDC
2864 MILLER DRIVE
PLYMOUTH
,
IN
46563
NONE
NONE
CHARITABLE CONTRIBUTION
10,000
NEIGHBORLINK PORTER COUNTY
PO BOX 2071
CHESTERTON
,
IN
46304
NONE
PC
GENERAL SUPPORT
25,000
KELLY CARES
FOOTBALL 101 GUGLIELMINO COMPLEX
SOUTH BEND
,
IN
46617
NONE
PC
CHARITABLE CONTRIBUTION
10,000
HOLY CROSS VILLAGE FOUNDATION INC
54515 STATE ROAD 933 NORTH
NOTRE DAME
,
IN
46556
NONE
SO
GENERAL SUPPORT
25,000
WAGON WHEEL CENTER FOR THE ARTS
2515 E CENTER STREET
WARSAW
,
IN
46580
NONE
PC
GENERAL SUPPORT
500
100 BLACK MEN OF GREATER SOUTH BEND
2043 SOUTH BEND AVENUE
SOUTH BEND
,
IN
46637
NONE
PC
CHARITABLE CONTRIBUTION
5,000
SOUTH BEND PARKS FOUNDATION INC
SOUTH BEND VENUES PARKS & ARTS
301 S ST LOUIS BLVD
SOUTH BEND
,
IN
46617
NONE
PC
STUDEBAKER ELECTRIC
45,000
HOSPICE FOUNDATION
501 COMFORT PLACE
MISHAWAKA
,
IN
46545
NONE
PC
HELPING HANDS AWARD DINNER
10,000
UNITED WAY OF WELLS COUNTY
122 LAMAR STREET SUITE 118
BLUFFTON
,
IN
46714
NONE
PC
CHARITABLE CONTRIBUTION
180
MARSHALL COUNTY BLUEBERRY FESTIVAL
P O BOX 639
PLYMOUTH
,
IN
46563
NONE
NONE
CHARITABLE CONTRIBUTION
5,000
CRIME STOPPERS INC
OFFICER KAYLA MILLER
COORDINATOR
SOUTH BEND
,
IN
46601
NONE
PC
CHARITABLE CONTRIBUTION
1,000
YOUTH SERVICE BUREAU
OF ST JOSEPH COUNTY INC
ATTENTION JENNIFER PICKERING
SOUTH BEND
,
IN
46628
NONE
NONE
CHARITABLE CONTRIBUTION
10,000
HABITAT FOR HUMANITY
OF ST JOSEPH COUNTY
402 EAST SOUTH STREET
SOUTH BEND
,
IN
46601
NONE
NONE
CHARITABLE CONTRIBUTION
30,000
COMMUNITY FDN OF ELKHART COUNTY
101 SOUTH MAIN STREET
ELKHART
,
IN
46516
NONE
PC
GENERAL SUPPORT
50,000
UNITED WAY OF LAPORTE COUNTY
115 EAST 4TH STREET
MICHIGAN CITY
,
IN
46360
NONE
PC
CHARITABLE CONTRIBUTION
7,160
SOUTH BEND MUSEUM OF ART
120 S DR MARTIN LUTHER KING JR B
SOUTH BEND
,
IN
46601
NONE
PC
LEADER SPONSOR/ARTLIGHT
1,800
ST VINCENT DEPAUL SOCIETY
OF ST JOSEPH COUNTY
520 CRESCENT AVENUE
SOUTH BEND
,
IN
466171920
NONE
PC
VINTAGE SPONSOR
7,500
UNITED WAY OF ALLEN COUNTY
334 E BERRY STREET
FORT WAYNE
,
IN
468022708
NONE
PC
CHARITABLE CONTRIBUTION
3,660
LASALLE COUNCIL
BOY SCOUTS OF AMERICA
1340 SOUTH BEND AVENUE
SOUTH BEND
,
IN
46617
NONE
PC
MAYORS LUNCHEON
3,500
ST MARY'S COLLEGE
ATTN BURSAR'S OFFICE
141 LEMANS HALL
NOTRE DAME
,
IN
46556
NONE
PC
GENERAL SUPPORT
47,500
INNOVATION PARK AT NOTRE DAME
1400 E ANGELA BLVD
SOUTH BEND
,
IN
46617
NONE
GROUP
CHARITABLE CONTRIBUTION
5,000
YMCA OF MICHIANA INC
1201 NORTHSIDE BOULEVARD
SOUTH BEND
,
IN
46615
NONE
PC
GENERAL SUPPORT
27,500
YWCA GREATER LAFAYETTE
605 N 6TH STREET
LAFAYETTE
,
IN
47901
NONE
NONE
CHARITABLE CONTRIBUTION
12,500
YWCA NORTH CENTRAL INDIANA
ATTN SUSAN TYBON
1102 S FELLOWS ST
SOUTH BEND
,
IN
46601
NONE
PC
CHARITABLE CONTRIBUTION
50,000
FAMILY & CHILDREN'S CENTER
ATTN MARK MULLANEY
PRESIDENT CEO
SOUTH BEND
,
IN
466173094
NONE
NONE
CHARITABLE CONTRIBUTIONA
9,000
UNITED WAY OF GREATER LAFAYETTE
1114 EAST STATE STREET
LAFAYETTE
,
IN
47905
NONE
PC
CHARITABLE CONTRIBUTION
540
JUNIOR ACHIEVEMENT OF NO INDIANA
550 E WALLEN ROAD
FORT WAYNE
,
IN
46825
NONE
NONE
CHARITABLE CONTRIBUTION
113,155
BASHOR HOMES EDUCATION ENDOWMENT FND
DON PHILLIPS
PO BOX 843
GOSHEN
,
IN
46527
NONE
NONE
CHARITABLE CONTRIBUTION
60,000
UNITED WAY OF ELKHART COUNTY
P O BOX 3048
ELKHART
,
IN
46515
NONE
PC
CHARITABLE CONTRIBUTION
6,780
LOGAN CENTER
2505 EAST JEFFERSON BLVD
SOUTH BEND
,
IN
46615
NONE
PC
CHARITABLE CONTRIBUTION
54,500
KID'S CLOSET MINISTRY
NORTH JUDSON UNITED METHODIST CHURCH
210 CENTRAL AVE
NORTH JUDSON
,
IN
46366
NONE
CHURCH
GENERAL SUPPORT
1,000
BETHANY LUTHERAN CHURCH
102 G STREET
LAPORTE
,
IN
46350
NONE
CHURCH
GENERAL SUPPORT
25,000
THE STANLEY CLARK SCHOOL
3123 MIAMI STREET
SOUTH BEND
,
IN
46614
NONE
PC
KALEIDOSCOPE DINNER &
5,000
UNITED WAY OF KOSCIUSKO COUNTY
PO BOX 923
WARSAW
,
IN
46581
NONE
PC
CHARITABLE CONTRIBUTION
1,130
LAPORTE COUNTY AGRICULTURAL ASSOC
2581 WEST STATE ROAD 2
LAPORTE
,
IN
46350
NONE
PC
GENERAL SUPPORT
10,000
FORT WAYNE RESCUE MISSION MINISTRIES
301 WEST SUPERIOR STREET
FORT WAYNE
,
IN
46802
NONE
PC
GENERAL SUPPORT
26,000
ADEC
19670 STATE ROAD 120
BRISTOL
,
IN
46507
NONE
PC
CHARITABLE CONTRIBUTION
7,577
UNITED WAY OF ST JOSEPH COUNTY
P O BOX 6396
SOUTH BEND
,
IN
46660
NONE
PC
CHARITABLE CONTRIBUTION
71,500
TRITON SCHOOL CORP
100 TRITON DRIVE
BOURBON
,
IN
46504
NONE
SCHOOL
GENERAL SUPPORT
11,762
GOODWILL INDUSTRIES
1805 WESTERN AVENUE
SOUTH BEND
,
IN
46619
NONE
PC
CHARITABLE CONTRIBUTION
50,000
PLYMOUTH COMMUNITY SCHOOL CORP
LINCOLN JUNIOR HIGH SCHOOL
220 N LIBERTY STREET
PLYMOUTH
,
IN
46563
NONE
GOV
EQUIPMENT
5,000
PATHFINDER SERVICES
ATTN DIANA LAUX
2824 THEATER AVENUE
HUNTINGTON
,
IN
46750
NONE
PC
VITA PROGRAM
5,000
THE HISTORY MUSEUM
808 W WASHINGTON
SOUTH BEND
,
IN
46601
NONE
PC
CHARITABLE CONTRIBUTION
10,000
UNITED WAY OF HUNTINGTON COUNTY
PO BOX 347
HUNTINGTON
,
IN
46750
NONE
PC
CHARITABLE CONTRIBUTION
315
OPPORTUNITY ENTERPRISES INC
2801 EVANS AVE
VALPARAISO
,
IN
46383
NONE
PC
RESPITE AT LAKESIDE CAPITAL
11,000
REAL SERVICES INC
1151 S MICHIGAN STREET
SOUTH BEND
,
IN
46601
NONE
PC
CATERING FOOD TRUCK
22,500
BIG BROTHERS BIG SISTERS
OF ST JOSEPH COUNTY
218 W WASHINGTON STREET
SOUTH BEND
,
IN
46601
NONE
NONE
CHARITABLE CONTRIBUTION
5,000
HOMEBOUND MEALS INC
611 WEST BERRY STREET
FORT WAYNE
,
IN
46802
NONE
PC
EMR AWARD
5,000
GROUP HOMES FOR CHILDREN
3307 LONGLOIS DRIVE
LAFAYETTE
,
IN
47904
NONE
PC
GENERAL SUPPORT
7,875
BIG BROTHERS BIG SISTERS OF NEI INC
1005 W RUDISILL BLVD
FORT WAYNE
,
IN
46807
NONE
PC
GENERAL SUPPORT
5,000
LACASA DE AMISTAD
746 SOUTH MEADE STREET
SOUTH BEND
,
IN
46619
NONE
NONE
CHARITABLE CONTRIBUTION
100,000
DUNELAND YMCA
215 ROOSEVELT STREET
CHESTERTON
,
IN
46304
NONE
PC
EARLY LEARNING ACADEMY
25,000
UNION TOWNSHIP SCHOOL CORPORATION
WHEELER HIGH SCHOOL ROBOTICS
587 W 300 NORTH
VALPARAISO
,
IN
46385
NONE
PUBLIC SCHOOL
GENERAL SUPPORT
3,100
MARSHALL COUNTY NEIGHBORHOOD SERV
402 W GARRO ST
PLYMOUTH
,
IN
46563
NONE
PC
CHARITABLE CONTRIBUTION
1,000
LACASA INC
202 N COTTAGE AVENUE
GOSHEN
,
IN
46528
NONE
PC
CHARITABLE CONTRIBUTION
10,000
THE STUDEBAKER NATIONAL MUSEUM
201 S CHAPIN STREET
SOUTH BEND
,
IN
46601
NONE
PC
HALL OF CHAMPIONS DINNER
10,000
SOUTH BEND CIVIC THEATRE
403 NORTH MAIN STREET
SOUTH BEND
,
IN
46601
NONE
NONE
CHARITABLE CONTRIBUTION
2,000
PORTER COUNTY PARKS FOUNDATION INC
C/O BRYAN WAISANEN
P O BOX 428
VALPARAISO
,
IN
46384
NONE
PC
GENERAL SUPPORT
5,000
FISCHOFF NAT'L CHAMBER OF MUSIC ASSN
303 BROWNSON HALL
NOTRE DAME
,
IN
46556
NONE
PC
CHARITABLE CONTRIBUTION
13,500
THE FOUNDATION OF SJHS
THE FOUNDATION OF SAINT JOSEPH
HEALTH SYSTEM
SOUTH BEND
,
IN
46617
NONE
NONE
CHARITABLE CONTRIBUTION
2,500
SOUTH BEND ALUMNI ASSOCIATION
215 S DR MARTIN LUTHER KING JR BLV
SOUTH BEND
,
IN
46601
NONE
PC
CHARITABLE CONTRIBUTION
7,500
HABITAT FOR HUMANITY OF ELKHART CTY
P O BOX 950
GOSHEN
,
IN
46527
NONE
PC
CHARITABLE CONTRIBUTION
5,000
HABITAT FOR HUMANITY
OF GREATER FORT WAYNE
2020 E WASHINGTON BLVD
FORT WAYNE
,
IN
46603
NONE
NONE
CHARITABLE CONTRIBUTION
10,000
VALPARAISO PARKS & RECREATION FDN
3210 CAMPBELL STREET
VALPARAISO
,
IN
46385
NONE
NONE
CHARITABLE CONTRIBUTION
1,000
CENTER FOR THE HOMELESS
813 SOUTH MICHIGAN STREET
SOUTH BEND
,
IN
46601
NONE
PC
CHARITABLE CONTRIBUTION
1,750
BOYS & GIRLS CLUB OF FORT WAYNE
2609 FAIRFIELD AVENUE
FORT WAYNE
,
IN
46807
NONE
PC
GENERAL SUPPORT
5,000
MICHIANA DOWN SYNDROME
51201 OLD COTTAGE DRIVE
GRANGER
,
IN
46530
NONE
NONE
CHARITABLE CONTRIBUTION
500
RONALD MCDONALD HOUSE CHARITIES
OF MICHIANA
615 N MICHIGAN 3RD FLOOR
SOUTH BEND
,
IN
46601
NONE
NONE
CHARITABLE CONTRIBUTION
16,750
DOWNTOWN GOSHEN INC
234 S MAIN STREET SUITE 4
GOSHEN
,
IN
46526
NONE
NONE
CHARITABLE CONTRIBUTION
12,000
IBA FOUNDATION INC
8425 WOODFIELD CROSSING BLVD
INDIANAPOLIS
,
IN
46240
NONE
SOUNK
GENERAL SUPPORT
2,000
MEMORIAL OPERA HOUSE FOUNDATION INC
104 INDIANA AVENUE
VALPARAISO
,
IN
46383
NONE
PC
GENERAL SUPPORT
5,000
SOUTH BEND-ELKHART REGIONAL FDN INC
635 S LAFAYETTE BLVD SUITE 123
SOUTH BEND
,
IN
46601
NONE
SO
GENERAL SUPPORT
100,000
UNITED WAY OF STARKE COUNTY
C/O NORTHERN INDIANA COMMUNITY FDN
P O BOX 807
ROCHESTER
,
IN
46975
NONE
PC
CHARITABLE CONTRIBUTION
990
HABITAT FOR HUMANITY PORTER COUNTY
2411 BEECH STREET SUITE L
VALPARAISO
,
IN
46383
NONE
NONE
CHARITABLE CONTRIBUTION
15,000
BOYS AND GIRLS CLUB OF MARSHALL CTY
314 E JEFFERSON STREET
PLYMOUTH
,
IN
46563
NONE
PC
CHARITABLE CONTRIBUTION
25,000
PORTER COUNTY COMMUNITY FOUNDATION
1401 CALUMET AVE
VALPARAISO
,
IN
46383
NONE
NONE
CHARITABLE CONTRIBUTION
5,000
INDIANA DUNES ENVIR LEARNING CENTER
DBA DUNES LEARNING CENTER
700 HOWE ROAD
CHESTERTON
,
IN
46304
NONE
PC
TECHNOLOGY UPDATES
15,840
NORTHEAST INDIANA INNOVATION CENTER
3201 STELLHORN ROAD
FORT WAYNE
,
IN
46815
NONE
PC
CHARITABLE CONTRIBUTION
2,000
STARKE COUNTY YOUTH CLUB
P O BOX 442
KNOX
,
IN
46534
NONE
NONE
CHARITABLE CONTRIBUTION
2,500
COMMUNITY TRANSPORTATION NETWORK
5601 INDUSTRIAL ROAD
FORT WAYNE
,
IN
46825
NONE
NONE
CHARITABLE CONTRIBUTION
20,000
BLUE JACKET INC
27826 S CALHOUN ST
FORT WAYNE
,
IN
46802
NONE
NONE
CHARITABLE CONTRIBUTION
10,000
INDIANA UNIVERSITY SOUTH BEND
1234 N NOTRE DAME AVENUE
SOUTH BEND
,
IN
46617
NONE
PC
CHARITABLE CONTRIBUTION
22,500
ARGOS COMMUNITY SCHOOLS
410 N FIRST STREET
ARGOS
,
IN
46501
NONE
SCHOOL
SUPPORT
2,200
CARDINAL SERVICES
504 NORTH BAY DRIVE
WARSAW
,
IN
46580
NONE
NONE
CHARITABLE CONTRIBUTION
50,000
UNITED WAY OF PORTER COUNTY
PO BOX 2028
VALPARAISO
,
IN
46384
NONE
PC
CHARITABLE CONTRIBUTION
4,020
MARSHALL COUNTY 4-H FAIR ASSOCIATION
15715 MICHIGAN ROAD
ARGOS
,
IN
46501
NONE
NONE
GENERAL SUPPORT
5,000
SOUTH BEND SYMPHONY ORCHESTRA
127 N MICHIGAN STREET
SOUTH BEND
,
IN
46601
NONE
PC
CHARITABLE CONTRIBUTION
35,000
SCHOLARSHIP FOUNDATION OF ST JOSEPH
COUNTY INC
3515 NORTH MAIN STREET
MISHAWAKA
,
IN
46545
NONE
PC
CHARITABLE CONTRIBUTION
5,000
UNITED WAY OF FULTON COUNTY
P O BOX 583
ROCHESTER
,
IN
46975
NONE
PC
CHARITABLE CONTRIBUTION
405
DEKALB COUNTY ED PARTNERSHIP INC
4483 COUNTY ROAD 19 - SUITE 3
AUBURN
,
IN
46706
NONE
PC
GENERAL SUPPORT
1,000
COMMUNITY DEVELOPMENT CORPORATION
600 E THIRD STREET 201
MISHAWAKA
,
IN
46544
NONE
PC
GENERAL SUPPORT
20,000
UNITED WAY OF SOUTHWEST MICHIGAN
2015 LAKEVIEW AVE
ST JOSEPH
,
MI
49085
NONE
PC
CHARITABLE CONTRIBUTION
6,490
UNITED WAY OF BATTLE CREEKKALAMAZOO
709 S WESTNEDGE AVENUE
KALAMAZOO
,
MI
49007
NONE
PC
CHARITABLE CONTRIBUTION
315
SALVATION ARMY KROC CENTER
900 W WESTERN AVENUE
SOUTH BEND
,
IN
46601
NONE
AN ARM OF STATE
GENERAL SUPPORT
10,000
YMCA OF GREATER KALAMAZOO
1001 WEST MAPLE STREET
KALAMAZOO
,
MI
49008
NONE
PC
CHARITABLE CONTRIBUTION
15,000
SOUTHWESTERN MICHIGAN COLLEGE
ATTN SUSAN B COULSTON
VP CHIEF BUSINESS OFFICER
DOWAGIAC
,
MI
49047
NONE
SOUNK
CHARITABLE CONTRIBUTION
25,000
LAKELAND HEALTH FOUNDATION
1234 NAPIER AVENUE
ST JOSEPH
,
MI
49085
NONE
PC
CHARITABLE DONTRIBUTION
25,000
CORNERSTONE ALLIANCE
80 WEST MAIN STREET
BENTON HARBOR
,
MI
49022
NONE
PC
WBC CELEBRATION
7,500
LAKELAND IMMEDIATE CARE CENTER
DBA CASSOPOLIS FAMILY CLINIC
261 M-62 NORTH
CASSOPOLIS
,
MI
49031
NONE
PC
GENERAL SUPPORT
25,000
BOYS & GIRLS CLUB OF BENTON HARBOR
600 NATE WELLS SENIOR DR
BENTON HARBOR
,
MI
49022
NONE
NONE
CHARITABLE CONTRIBUTION
10,000
THE MUSIC VILLAGE
P O BOX 11004
SOUTH BEND
,
IN
46634
NONE
NONE
CHARITABLE
10,000
ELKHART EDUCATION FOUNDATION
2746 OLD US 20 W SUITE B
ELKHART
,
IN
46514
NONE
PC
GENERAL SUPPORT
1,000
SPINA BIFIDA ASSOCIATION
1600 WILSON BLVD SUITE 800
ARLINGTON
,
VA
22209
NONE
PC
GENERAL SUPPORT
500
CROSS COMMUNITY INC
707 SHERMAN AVENUE
SOUTH BEND
,
IN
46616
NONE
PC
GENERAL SUPPORT
10,000
INTERFAITH COMMUNITY PADS INC
7871 W 400 NORTH
MICHIGAN CITY
,
IN
46360
NONE
PC
GENERAL SUPPORT
18,000
REES THEATER INC
12638 EMERALD COURT
PLYMOUTH
,
IN
46563
NONE
PC
CHARITABLE CONTRIBUTION
25,000
C2 YOUR HEALTH WOMEN'S INITIATIVE
19009 LAYDEN STREET
SOUTH BEND
,
IN
46637
NONE
PUBLIC BENEFIT CORP
GENERAL SUPPORT
2,550
Total
.................................
3a
1,724,844
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
941,925
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
592,425
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)
..
1,534,350
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
1,534,350
(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