-
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
Capital City Bank Group Foundation Inc
Number and street (or P.O. box number if mail is not delivered to street address)
217 N Monroe Street
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Tallahassee
,
FL
32301
A Employer identification number
59-2276367
B
Telephone number (see instructions)
(850) 402-8450
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)
$
3,012,886
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)
122,060
2
Check
.............
3
Interest on savings and temporary cash investments
26
26
4
Dividends and interest from securities
...
64,286
63,481
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
18,528
b
Gross sales price for all assets on line 6a
18,528
7
Capital gain net income (from Part IV, line 2)
...
18,528
8
Net short-term capital gain
.........
9
Income modifications
...........
10a
Gross sales less returns and allowances
0
b
Less: Cost of goods sold
....
0
c
Gross profit or (loss) (attach schedule)
.....
0
11
Other income (attach schedule)
.......
525
0
0
12
Total.
Add lines 1 through 11
........
205,425
82,035
0
13
Compensation of officers, directors, trustees, etc.
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
0
0
0
0
b
Accounting fees (attach schedule)
.......
0
0
0
0
c
Other professional fees (attach schedule)
....
0
0
0
0
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
727
727
0
0
19
Depreciation (attach schedule) and depletion
...
0
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
61
0
0
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
788
727
0
0
25
Contributions, gifts, grants paid
.......
246,175
246,175
26
Total expenses and disbursements.
Add lines 24 and 25
246,963
727
0
246,175
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-41,538
b
Net investment income
(if negative, enter -0-)
81,308
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
.............
0
2
Savings and temporary cash investments
.........
240,083
124,977
124,977
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
0
4
Pledges receivable
Less: allowance for doubtful accounts
0
0
0
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
0
0
0
7
Other notes and loans receivable (attach schedule)
0
Less: allowance for doubtful accounts
0
0
0
0
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
0
0
0
b
Investments—corporate stock (attach schedule)
.......
1,821,703
1,821,007
2,517,937
c
Investments—corporate bonds (attach schedule)
.......
301,509
371,155
369,972
11
Investments—land, buildings, and equipment: basis
0
Less: accumulated depreciation (attach schedule)
0
0
0
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
0
0
0
14
Land, buildings, and equipment: basis
0
Less: accumulated depreciation (attach schedule)
0
0
0
15
Other assets (describe
)
0
0
0
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
2,363,295
2,317,139
3,012,886
17
Accounts payable and accrued expenses
..........
0
18
Grants payable
.................
5,855
1,237
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
0
0
21
Mortgages and other notes payable (attach schedule)
......
0
0
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
5,855
1,237
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
2,357,440
2,315,902
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
........
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)
.....
2,357,440
2,315,902
30
Total liabilities and net assets/fund balances
(see instructions)
.
2,363,295
2,317,139
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
2,357,440
2
Enter amount from Part I, line 27a
.....................
2
-41,538
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
2,315,902
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
2,315,902
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
CAPITAL GAIN DISTRIBUTIONS LONG TERM
P
b
CAPITAL GAIN DISTRIBUTIONS SHORT TERM
P
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
18,185
18,185
b
343
343
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
0
18,185
b
0
343
c
d
e
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
18,528
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
0
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
194,692
2,744,243
0.070946
2017
263,153
2,596,075
0.101366
2016
233,673
2,436,190
0.095917
2015
207,024
2,499,696
0.082820
2014
238,210
2,603,233
0.091505
2
Total
of line 1, column (d)
.....................
2
0.442554
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
0.088511
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
2,766,440
5
Multiply line 4 by line 3
......................
5
244,860
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
813
7
Add lines 5 and 6
........................
7
245,673
8
Enter qualifying distributions from Part XII, line 4
,.............
8
246,175
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
813
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
3
Add lines 1 and 2
...........................
3
813
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
813
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
4,233
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
4,233
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
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
3,420
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
3,420
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)
FL
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
www.ccbgfoundation.org
14
The books are in care of
Jep Larkin
Telephone no.
(850) 402-8450
Located at
217 N Monroe St
Tallahassee
FL
ZIP+4
32301
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
Jeff Wahlen
Director
1.000
0
0
0
217 N Monroe Street
Tallahassee
,
FL
32301
Dr Alma Littles
Director
1.000
0
0
0
217 N Monroe Street
Tallahassee
,
FL
32301
Janette Wagner
Director
1.000
0
0
0
217 N Monroe Street
Tallahassee
,
FL
32301
William G Smith Jr
Chairman
1.000
0
0
0
217 N Monroe Street
Tallahassee
,
FL
32301
Brooke Hallock
Secretary
1.000
0
0
0
217 N Monroe Street
Tallahassee
,
FL
32301
Jep Larkin
Treasurer
1.000
0
0
0
217 N Monroe Street
Tallahassee
,
FL
32301
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
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
Total
number of others receiving over $50,000 for professional services
.............
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
.........................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
2,581,550
b
Average of monthly cash balances
.......................
1b
227,019
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
2,808,569
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
3
Subtract line 2 from line 1d
.........................
3
2,808,569
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
42,129
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
2,766,440
6
Minimum investment return.
Enter 5% of line 5
..................
6
138,322
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
138,322
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
813
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
813
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
137,509
4
Recoveries of amounts treated as qualifying distributions
................
4
325
5
Add lines 3 and 4
............................
5
137,834
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
137,834
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
246,175
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
246,175
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
813
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
245,362
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
137,834
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
0
b
Total for prior years:
2017
,
2016
,
2015
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
110,854
b
From 2015
......
85,364
c
From 2016
......
115,982
d
From 2017
......
144,673
e
From 2018
......
59,247
f
Total
of lines 3a through e
........
516,120
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
246,175
a
Applied to 2018, but not more than line 2a
0
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2019 distributable amount
.....
137,834
e
Remaining amount distributed out of corpus
108,341
5
Excess distributions carryover applied to 2019.
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
624,461
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
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
110,854
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
513,607
10
Analysis of line 9:
a
Excess from 2015
....
85,364
b
Excess from 2016
....
115,982
c
Excess from 2017
....
144,673
d
Excess from 2018
....
59,247
e
Excess from 2019
....
108,341
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:
Online only
217 N MONROE STREET
TALLAHASSEE
,
FL
32301
www.ccbgfoundation.org
b
The form in which applications should be submitted and information and materials they should include:
Applications will only be accepted online using the submission form on the organization's website. Applications are only accepted from those organizations that are Non-Profit, Charitable Organizations under Section 501(c)(3).
c
Any submission deadlines:
APRIL 1
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Grants are provided only to non-profit, charitable organizations exempt under section 501(c)(3). Further, grants are not given for requests of the following nature: Advertising, Association memberships, Athletic team/event sponsorship, fundraising sponsorship, ticket to attend community functions/fundraisers, professional telephone solicitations, those with religious/political affiliations, those located outside of CCBG's market area.
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
A Better Body
1412 FL GA Hwy
havana
,
FL
32333
none
PC
Education
500
A Full Summer Inc
PO Box 13445
tallahassee
,
FL
32317
none
PC
Social Services
500
A Womens Pregnancy Center
919 W Pensacola St
tallahassee
,
FL
32304
none
PC
Social Services
350
Advocates for Alzheimers Care Inc
611 Bellevue Ave Dublin PO Box 344
dublin
,
GA
31040
none
PC
Community needs
3,000
Alachua Co Organization for Rural Needs
23320 North SR 235
brooker
,
FL
32622
none
PC
Family/Children
1,000
Alachua Conservation Trust Inc
7204 SE CR 234
gainesville
,
FL
32641
none
PC
Arts
100
Alzheimers Association (Leon County)
301 East Tharpe Street
tallahassee
,
FL
32303
none
PC
Social Services
2,500
American Cancer Society - Gainesville
2119 SW 16th Street
gainesville
,
FL
32608
none
PC
Social Services
2,068
American Cancer Society - Tampa
3709 W Jetton Ave
tampa
,
FL
33629
none
PC
Social Services
275
American Heart Association - St Pete
11207 Blue Heron Blvd
st petersburg
,
FL
33716
none
PC
Social Services
150
American Red Cross Washington
431 18th St
washington
,
DC
20006
none
PC
Social Services
250
Americas Second Harvest of the Big Bend
4446 Entrepot Blvd
tallahassee
,
FL
32310
none
PC
Social Services
2,750
Angels of Grace
PO Box 1810 Cairo
cairo
,
GA
39838
none
PC
Social Services
75
Answers Resource Facility
PO Box 706 Keystone Heights
keystone heights
,
FL
32656
none
PC
Social Services
1,000
Big Bend Habitat for Humanity
2921 Roberts Avenue
tallahassee
,
FL
32310
none
PC
Social Services
5,000
Boys and Girls Club of Central Georgia
277 Martin Luther King Jr Blvd Suit
e 202
macon
,
GA
31208
none
PC
Family/Children
280
Boys and Girls Club of Citrus County
PO Box 907
homosassa
,
FL
34448
none
PC
Family/Children
500
Boys and Girls Club of Laurens County
PO Box 461
dudley
,
GA
31022
none
PC
Family/Children
1,500
Bradford County Education Foundation
501 Washington Street
starke
,
FL
32091
none
PC
Education
2,600
Bread Basket Club
PO Box 1111 Valley
valley
,
AL
36854
none
PC
Social Services
500
CARE
1881-B Martin Luther King Jr Blvd
tallahassee
,
FL
32303
none
PC
Social Services
150
Big Bend Hospice Inc
1723 Mahan Center Boulevard
tallahassee
,
FL
32308
None
PC
Social Services
7,500
Capital City Youth Services
2407 Roberts Avenue
tallahassee
,
FL
32310
none
PC
Family/Children
5,000
Chi Omega Social Action Scholarship Found
PO Box 6252
tallahassee
,
FL
32314
none
PC
Family/Children
500
Childrens Home Society of Florida
482 S Keller Road
orlando
,
FL
32810
none
PC
Family/Children
20,000
Christian Family Center Inc
PO Box 149
rockledge
,
GA
30454
none
PC
Social Services
1,000
Christian Service Center
5340 Cusseta Rd
lanett
,
AL
36863
none
PC
Social Services
200
Christys Kitties Rescue and Sanctuary
54 Brewster Rd
crawfordville
,
FL
32327
none
PC
Community needs
650
Circle of Care
2200 35th Place
valley
,
AL
36854
none
PC
Social Services
200
Citizens for Humane Animal Treatment
of Wakulla PO Box 1195
crawfordville
,
FL
32326
none
PC
Social Services
2,100
Citrus Hearing Impaired Program Services
109 NE Crystal Street Suite B
crystal river
,
FL
34428
none
PC
Social Services
1,500
Clamour Theatre Company Inc
PO Box 9055 Fleming Island
fleming island
,
FL
32006
none
PC
Arts
500
Communities in Schools of Bradford Cnty
100 E Call St
starke
,
FL
32091
none
PC
Education
5,082
Communities That Care CLT Inc
6031 NW 1st Place
gainesville
,
FL
32607
none
PC
Community needs
1,500
Community Leadership Academy
3122 Mahan Dr Suite 801-270
tallahassee
,
FL
32308
none
PC
Education
1,000
Concerned Citizens of Bradford County
PO Box 1086
starke
,
FL
32091
none
PC
Education
1,000
Early Learning Coalition of Nature Coast
1564 North Meadowcrest Blvd
crystal river
,
FL
34429
none
PC
Education
1,000
Easter Seals Middle Georgia
PO Box 847
dublin
,
GA
31040
none
PC
Social Services
5,000
Education Foundation of Gilchrist County
P O Box 1816
trenton
,
FL
32693
none
PC
Education
2,000
Elder Care Services Inc (Big Bend Area)
2518 W Tennessee St
tallahassee
,
FL
32304
none
PC
Social Services
2,500
Embrace Community Center Inc
294 SE 43rd Street Suite 100
keystone heights
,
FL
32656
none
PC
Social Services
1,000
Ferst Readers Inc Laurens County
1708 Springdale Road
dublin
,
GA
31021
none
PC
Education
500
Florida Guardian ad Litem Foundation
PO Box 10688
tallahassee
,
FL
32302
none
PC
Social Services
3,000
Florida Kiwanis Foundation Inc
Quincy Kiwanis PO Box 448
quincy
,
FL
323530448
none
PC
Family/Children
500
Florida Recycling Partnership Foundation
730 East Park Avenue
tallahassee
,
FL
32301
none
PC
Community needs
500
Foundation for Rural Education Excellence
PO Box 756
palatka
,
FL
32178
none
PC
Education
500
Gadsden Arts Inc
13 N Madison Street
quincy
,
FL
32351
none
PC
Arts
2,000
Goodwood Museum and Gardens Inc
1600 Miccosukee Road
tallahassee
,
FL
32308
none
PC
Community needs
1,650
Grady County Fine Arts Project Inc
175 Smith Road
cairo
,
GA
39828
none
PC
Arts
500
Grady County Help Agencies Inc
PO Box 1452
cairo
,
GA
39828
none
PC
Social Services
3,000
H Grady Bradshaw Chambers Co Library
3419 20th Avenue
valley
,
AL
36854
none
POF
Family/Children
1,500
Habitat for Humanity of Citrus County
P O Box 1041
crystal river
,
FL
34423
none
PC
Social Services
5,000
Hampton Veteran S Memorial Fund Inc
9749 Hampton Villas Place
hampton
,
FL
32044
none
PC
Community needs
400
Hang Tough Foundaiton Inc
1400 Village Square Blvd Ste 3-272
tallahassee
,
FL
32312
none
PC
Social Services
500
Harmony Baptist Association Incorporated of Bronson FL
PO Box 2557
chiefland
,
FL
32644
none
PC
Education
2,000
Havana History & Heritage Society Inc
204 Second Street NW
havana
,
FL
32327
none
PC
Arts
1,000
Havana Main Street
312 First Street NW
havana
,
FL
32333
none
PC
Community needs
2,000
Helping Hands of the Shelter
4429 N Hyman Hendry Rd
perry
,
FL
32347
none
PC
Community needs
250
Hernando County Fair Association
6436 Broad St
brooksville
,
FL
34601
none
PC
Community needs
250
Holy Comforter Episcopal School Inc
2001 Fleischmann Rd
tallahassee
,
FL
32308
none
PC
Education
2,500
Independence Landing Inc
2910 Kerry Forest Pkwy 231
tallahassee
,
FL
32309
none
PC
Community needs
250
Interfaith Food Closet
PO Box 541
lanett
,
AL
36863
none
PC
Social Services
2,200
Interfaith Hospitality Network Greater Gainesville
PO BOX 5189
gainesville
,
FL
32627
none
PC
Social Services
5,000
Its Meow or Never For Ferals Inc
1179 Iron Bridge Rd
havana
,
FL
32333
none
PC
Social Services
95
Jericho Road Ministries Inc
PO Box 864
brooksville
,
FL
34605
none
PC
Social Services
4,000
John Gilmore Riley Center
419 East Jefferson Street
tallahassee
,
FL
32301
none
PC
Community needs
1,500
Junior Achievement Big Bend
2840 Pablo Ave
tallahassee
,
FL
32308
none
PC
Education
250
Junior League of Tallahassee
PO Box 13428
tallahassee
,
FL
32317
none
PC
Social Services
150
Keep Wakulla County Beautiful
PO Box 700
crawfordville
,
FL
32326
none
PC
Community needs
750
Kiwanis Club of Starke Foundation Inc
PO Box 125
starke
,
FL
32091
none
PC
Community needs
725
Leukemia & Lymphoma Society
2859 Paces Ferry Road SE
atlanta
,
GA
30339
none
PC
Social Services
250
Levy County Education Foundation
PO Box 1386
bronson
,
FL
32621
none
PC
Education
7,500
Macon Area Habitat for Humanity
690 Holt Avenue
macon
,
GA
31204
none
PC
Community needs
3,000
Macon Water Environmental Education Inc
790 2nd Street
macon
,
GA
31202
none
PC
Community needs
3,000
Main Street of Monticello Florida
P O Box 923
monticello
,
FL
32344
none
PC
Arts
1,000
Matheson History Museum
513 E University Ave
gainesville
,
FL
32601
none
PC
Community needs
1,500
Miccosukee Youth Education Foundation
PO Box 5452
tallahassee
,
FL
32314
none
PC
Family/Children
500
National Hook-Up of Black Women Inc
PO Box 1126
quincy
,
FL
32353
none
PC
Education
750
North Central Florida YMCA Inc
5201 NW 34th Blvd
gainesville
,
FL
32605
none
PC
Community needs
2,500
North Florida Comm College Foundation
325 NW Turner Davis Drive
madison
,
FL
32340
none
PC
Education
2,000
Oasis Center for Women and Girls
317 E Call Street
tallahassee
,
FL
32301
none
PC
Social Services
650
Oconee Fall Line Tech College Foundation
560 Pinehill Road
dublin
,
GA
31021
none
PC
Education
1,500
Operation Santa Cause Inc
192 Evergreen Ln
middleburg
,
FL
32068
none
PC
Family/Children
600
Panacea Waterfronts Florida Partnership
PO Box 212
panacea
,
FL
32346
none
PC
Community needs
1,000
Partnership for Stronger Families
15 N Main St
chiefland
,
FL
32626
none
PC
Family/Children
2,500
Pilot Club of St Augustine
PO Box 3761
st augustine
,
FL
32085
none
PC
Family/Children
1,500
Pilot Club of Tallahassee Foundation
3181 Chaires Cross Road
tallahassee
,
FL
32317
none
PC
Education
1,000
Putnam Habitat for Humanity
PO Box 2433
palatka
,
FL
32177
none
PC
Community needs
5,000
Quincy Music Theatre
118 East Washington St
quincy
,
FL
32351
none
PC
Arts
1,500
Red Hills Wounded Warrior Group Inc
1111 Brookwood Dr
tallahassee
,
FL
32308
none
PC
Community needs
500
Robert F Munroe Day School
91 Old Mt Pleasant Rd
quincy
,
FL
32352
none
PC
Education
2,000
Rodeheaver Foundation
PO Box 5
plalatka
,
FL
32178
none
PC
Family/Children
1,000
Rooterville A Sanctuary
5579 Darwood
St melrose
,
FL
32666
none
PC
Community needs
500
Sav-a-Life Lanett Valley Inc
P O Box 46
lanett
,
AL
36863
none
PC
Social Services
1,000
Scholarship America
One Scholarship Way Attn Finance
MINNEAPOLIS
,
MN
55425
none
PC
Education
2,500
South City Foundation
1126 Lee Ave
tallahassee
,
FL
32303
none
PC
Social Services
10,000
St Annes Counseling Center
9870 W Fort Island Trail
crystal river
,
FL
34429
none
PC
Social Services
1,250
Suwannee Foundation for Excellence in Education
1314 Pine Avenue SW
live oak
,
FL
32060
none
PC
Education
2,000
Suwannee River Area Council Boy Scouts
2032 Thomasville Road
tallahassee
,
FL
32308
none
PC
Community needs
200
Tall Timbers Research Inc
13093 Henry Beadel Dr
tallahassee
,
FL
32312
none
PC
Community needs
4,600
Tallahassee Community Chorus
PO Box 13083 Tallahassee
tallahassee
,
FL
32317
none
PC
Arts
500
Tallahassee Friends of Our Parks
1201 Myers Park Dr
tallahassee
,
FL
32301
none
PC
Social Services
2,000
Tallahassee Senior Citizens Foundation
1400 N Monroe Street
tallahassee
,
FL
32303
none
PC
Social Services
1,250
Tallahassee Youth Orchestras
PO Box 21104
tallahassee
,
FL
32303
none
PC
Arts
500
Taylor County United
3254 Grambling Lane
perry
,
FL
32347
none
PC
Social Services
1,000
Taylor Senior Citizens Center
800 W Ash Street
perry
,
FL
32347
none
PC
Social Services
2,000
The Arc of Bradford County
1351 South Water Street
starke
,
FL
32091
none
PC
Education
50
The ARC of Chattahoochee Valley Inc
PO Box 416 6345 Fairfax Bypass
valley
,
AL
36854
none
PC
Community needs
500
The Center for Health Equity Inc
231 E Jefferson Street
quincy
,
FL
323512426
none
PC
Community needs
1,000
The Restoration Center of Florida Inc
PO Box 15513
brooksville
,
FL
34609
none
PC
Community needs
5,000
The Salvation Army Clay County
2795 County Rd 220
middleburg
,
FL
32068
none
PC
Social Services
400
The Tallahassee Community Chorus
P O Box 13083
tallahasse
,
FL
32317
none
PC
Arts
250
The Tallahssee Bach Parley Inc
PO Box 1202
tallahassee
,
FL
32303
none
PC
Arts
500
TLC Childrens Services
PO Box 16322
dublin
,
GA
31040
none
PC
Family/Children
125
Tri-County Outreach
PO Box 2194
chiefland
,
FL
32644
none
PC
Social Services
2,000
True Vine Ministries
PO Box 1259
starke
,
FL
32091
none
PC
Family/Children
500
United in Pink Inc
1515 Bass Road Suite H
macon
,
GA
31210
none
PC
Community needs
3,000
United Methodist Church Hastings Homebou
200 Lattin St
hastings
,
FL
32145
none
PC
Social Services
1,500
United Way of Central Georgia
PO Box 1302
macon
,
GA
312021302
none
PC
Social Services
1,000
United Way of Hernando County
4028 Commercial Way
spring hill
,
FL
34606
none
PC
Social Services
500
Unity Family Community Center
20030 NE 23rd Place
williston
,
FL
32696
none
PC
Social Services
1,000
University of Georgia Foundation
394 S Milledge Ave
athens
,
GA
30602
none
PC
Education
250
Volunteer Florida Foundation
3800 Esplanade Way Suite 180
tallahassee
,
FL
32311
none
PC
Social Services
27,000
Wakulla Pregnancy Center
PO Box 1121
crawfordville
,
FL
32327
none
PC
Social Services
500
Washington County Council on Aging
1348 South Boulevard
chipley
,
FL
32428
none
PC
Social Services
800
We Care Food Pantry
POBox 331
homosassa
,
FL
34448
none
PC
Social Services
2,000
West Point Library Association
100 West 8th St
west point
,
GA
31833
none
PC
Family/Children
1,500
Total
.................................
3a
246,175
b
Approved for future payment
Total
.................................
3b
0
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
26
4
Dividends and interest from securities
....
14
64,286
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
18,528
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
Misc Income
1
525
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
0
83,365
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
83,365
(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:
19010655
Software Version:
2019v5.0
Form 990PF - Special Condition Description:
Special Condition Description