-
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
Broadcom Foundation
% Maria Wronski
Number and street (or P.O. box number if mail is not delivered to street address)
4041 MacArthur Blvd Ste 510
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Newport Beach
,
CA
92660
A Employer identification number
26-4754581
B
Telephone number (see instructions)
(949) 464-4138
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)
$
114,957,908
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)
0
2
Check
.............
3
Interest on savings and temporary cash investments
57,232
57,232
4
Dividends and interest from securities
...
2,583,241
2,542,325
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
2,181,684
b
Gross sales price for all assets on line 6a
36,841,616
7
Capital gain net income (from Part IV, line 2)
...
2,181,684
8
Net short-term capital gain
.........
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
12
12
Total.
Add lines 1 through 11
........
4,822,169
4,781,253
13
Compensation of officers, directors, trustees, etc.
379,134
379,134
14
Other employee salaries and wages
......
255,189
255,189
15
Pension plans, employee benefits
.......
142,425
142,425
16a
Legal fees (attach schedule)
.........
1,030
0
0
1,030
b
Accounting fees (attach schedule)
.......
15,300
0
0
15,300
c
Other professional fees (attach schedule)
....
454,981
427,916
27,065
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
64,126
15,126
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
14,650
14,650
21
Travel, conferences, and meetings
.......
75,870
75,870
22
Printing and publications
..........
1,143
1,143
23
Other expenses (attach schedule)
.......
255,283
255,283
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
1,659,131
443,042
0
1,167,089
25
Contributions, gifts, grants paid
.......
4,154,959
4,154,959
26
Total expenses and disbursements.
Add lines 24 and 25
5,814,090
443,042
0
5,322,048
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-991,921
b
Net investment income
(if negative, enter -0-)
4,338,211
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2019)
Form 990-PF (2019)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
2
Savings and temporary cash investments
.........
4,097,187
6,116,956
6,116,956
3
Accounts receivable
14,530
Less: allowance for doubtful accounts
5,431
14,530
14,530
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
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
9,864,031
8,787,015
8,811,444
b
Investments—corporate stock (attach schedule)
.......
58,535,558
58,011,277
81,443,897
c
Investments—corporate bonds (attach schedule)
.......
19,736,388
18,316,896
18,571,081
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
92,238,595
91,246,674
114,957,908
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
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
92,238,595
91,246,674
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)
.....
92,238,595
91,246,674
30
Total liabilities and net assets/fund balances
(see instructions)
.
92,238,595
91,246,674
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
92,238,595
2
Enter amount from Part I, line 27a
.....................
2
-991,921
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
91,246,674
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
91,246,674
Form
990-PF
(2019)
Form 990-PF (2019)
Page
3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a)
List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1 a
Publicly-traded Securities
b
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
36,841,616
34,659,932
2,181,684
b
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
2,181,684
b
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
2,181,684
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
5,119,001
105,171,400
0.048673
2017
4,916,345
104,165,868
0.047197
2016
4,777,585
100,717,221
0.047436
2015
3,164,284
102,054,206
0.031006
2014
4,444,245
103,243,892
0.043046
2
Total
of line 1, column (d)
.....................
2
0.217358
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
0.043472
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
107,419,492
5
Multiply line 4 by line 3
......................
5
4,669,740
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
43,382
7
Add lines 5 and 6
........................
7
4,713,122
8
Enter qualifying distributions from Part XII, line 4
,.............
8
5,322,048
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
43,382
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
43,382
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
43,382
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
98,419
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
98,419
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
55,037
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
44,000
Refunded
11
11,037
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)
CA
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
14
The books are in care of
Maria Wronski
Telephone no.
(949) 464-4138
Located at
4041 MACARTHUR BLVD STE 510
Newport Beach
CA
ZIP+4
92660
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
Paula Golden
Executive Dir, Pres
40.0
270,810
32,342
0
4041 MacArthur Blvd Ste 510
ste 510
Newport Beach
,
CA
92660
Carl McKinzie
director
1.0
0
0
0
4041 MacArthur Blvd Ste 510
ste 510
Newport Beach
,
CA
92660
Henry Samueli
director
1.0
0
0
0
4041 MacArthur Blvd Ste 510
ste 510
Newport Beach
,
CA
92660
Maria Wronski
CFO, Sec
20.0
108,324
34,234
0
4041 MacArthur Blvd Ste 510
ste 510
Newport Beach
,
CA
92660
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
NICOLAOS ALEXOPOULOS
Foundation Person
40.0
108,324
6,499
4041 MACARTHUR BLVD SUITE 501
NEWPORT BEACH
,
CA
92660
CAROL MCDONALD
EXECUTIVE ADMIN
40.0
93,404
24,832
4041 MACARTHUR BLVD SUITE 501
NEWPORT BEACH
,
CA
92660
Total
number of other employees paid over $50,000
...................
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
Covington Capital Management
Investment Mgt
385,063
601 South Figueroa St Ste 2000
Los Angeles
,
CA
90017
Foundation Source
Administrative
96,000
55 Walls Drive 3rd fl
Fairfield
,
CT
06824
Spectrum Reach
ADVERTISING
59,463
PO Box 846888
Los Angeles
,
CA
90084
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
.........................
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
104,845,970
b
Average of monthly cash balances
.......................
1b
4,209,352
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
109,055,322
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
2
Acquisition indebtedness applicable to line 1 assets
..................
2
0
3
Subtract line 2 from line 1d
.........................
3
109,055,322
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
1,635,830
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
107,419,492
6
Minimum investment return.
Enter 5% of line 5
..................
6
5,370,975
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
5,370,975
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
43,382
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
43,382
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
5,327,593
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
5,327,593
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
5,327,593
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
5,322,048
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
5,322,048
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
43,382
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
5,278,666
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
5,327,593
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
5,103,575
b
Total for prior years:
2017
,
2016
,
2015
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
c
From 2016
......
d
From 2017
......
e
From 2018
......
f
Total
of lines 3a through e
........
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
5,322,048
a
Applied to 2018, but not more than line 2a
5,103,575
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
d
Applied to 2019 distributable amount
.....
218,473
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
(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
..........
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
...........
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
5,109,120
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)
.......
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
NONE
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
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
AMERICAN FRIENDS OF THE TEL AVIV UNIVERSITY INC
39 BROADWAY RM 1510
NEW YORK
,
NY
10006
N/A
PC
Charitable Event
50,000
ARIZONA SCIENCE CENTER
600 E WASHINGTON ST
PHOENIX
,
AZ
85004
N/A
PC
Support for Regional Science Fair
5,000
AUSTIN SCIENCE EDUCATION FOUNDATION
704 W GIBSON ST
AUSTIN
,
TX
78704
N/A
PC
Support for Regional Science Fair
5,000
BAY AREA DISCOVERY MUSEUM
557 MCREYNOLDS RD
SAUSALITO
,
CA
94965
N/A
PC
Mobile STEM Education "Try It Truck" for Bay Area
10,000
BEIJING TSINGHUA UNIVERSITY
1 TSINGHUA YUAN HAIDIAN DISTRIct
BEIJING
CH
N/A
PC
2019 KKT Workshop Participant Support
20,000
BLACK GIRLS CODE INC
PO BOX 640926
SAN FRANCISCO
,
CA
94164
N/A
PC
Afterschool STEM programs
5,000
BOYS AND GIRLS CLUBS OF THE NORTH VALLEY
601 WALL ST
CHICO
,
CA
95928
N/A
PC
General & Unrestricted
5,000
CALIFORNIA ACADEMY OF SCIENCES
55 MUSIC CONCOURSE DR GOLDEN GATE P
SAN FRANCISCO
,
CA
94118
N/A
PC
Science Action Club Support
5,000
CALIFORNIA SCIENCE CENTER FOUNDATION
700 EXPOSITION PARK DR
LOS ANGELES
,
CA
90037
N/A
PC
Support for CA delegates from California Science & Engineering Fair to attend ISEF
20,000
CALIFORNIA STATE UNIVERSITY EAST BAY FOUNDATION IN
25800 CARLOS BEE BLVD SA 2750
HAYWARD
,
CA
94542
N/A
PC
Summer Coding Program aligned with STEM Ecosystem expansion to provide STEM pathways for underrepresented youth in Hayward, San Leandro and San Lorenzo
25,000
CENTER FOR THE INNOVATIVE TRAINING OF YOUTH INC
4910 DREXEL DR BOX 61
NEW ORLEANS
,
LA
70125
N/A
PC
STEM NOLA's purchase of Raspberry Pis for the new coding lab project for youth in New Orleans
5,000
CHILDREN NOW
1404 FRANKLIN ST STE 700
OAKLAND
,
CA
94612
N/A
PC
General Support for California STEM Ecosystems Initiative
20,000
CHILDREN NOW
1404 FRANKLIN ST STE 700
OAKLAND
,
CA
94612
N/A
PC
oversight of Bay Area STEM Ecosystem and expanding ecosystem capacity as a regional leader through outreach and engagement of Hayward, San Leandro, and San Lorenzo unified school districts with targeted focus on STEM access and pathways for underrepresented youth
100,000
CHILDREN NOW
1404 FRANKLIN ST STE 700
OAKLAND
,
CA
94612
N/A
PC
Planning grant for Fresno County Office of Education to create a plan for sustainable and STEM Network/Ecosystem in the Central Valley
25,000
CHILDREN NOW
1404 FRANKLIN ST STE 700
OAKLAND
,
CA
94612
N/A
PC
Two convening of STEM stakeholders to examine issues of sustainability of California STEM ecosystems and alignment with Cal State University system in ecosystem regions
30,000
COLORADO STATE SCIENCE FAIR INC
CSU CAMPUS DELIVERY 1802
FORT COLLINS
,
CO
80523
N/A
PC
General & Unrestricted
5,000
COMMUNIVERSITY FOUNDATION
1107 LAKEVIEW DR
FAIRFIELD
,
IA
52556
N/A
PC
Raspberry Pi Workshop in South Africa Township
3,000
COMPUTER HISTORY MUSEUM
1401 N SHORELINE BLVD
MOUNTAIN VIEW
,
CA
94043
N/A
PC
Broadcom Presents: Design_CODE_Build project
360,000
DISCOVERY SCIENCE FOUNDATION
2500 N MAIN ST
SANTA ANA
,
CA
92705
N/A
PC
Discovery Science Cube of Orange County's 2020 ISEF Program Development
20,000
DISCOVERY SCIENCE FOUNDATION
2500 N MAIN ST
SANTA ANA
,
CA
92705
N/A
PC
Discovery Science Cube of Orange County's STEM Education Outreach/Coding Programs
125,000
ENVISION EXCELLENCE IN STEM EDUCATION
2108 LAMBERTON RD
CLEVELAND HEIGHTS
,
OH
44118
N/A
PC
(SFN) National STEM Ecosystem Initiatives (TIES)
100,000
ENVISION EXCELLENCE IN STEM EDUCATION
2108 LAMBERTON RD
CLEVELAND HEIGHTS
,
OH
44118
N/A
PC
Israel STEM Ecosystem Initiative (TIES)
25,000
ENVISION EXCELLENCE IN STEM EDUCATION
2108 LAMBERTON RD
CLEVELAND HEIGHTS
,
OH
44118
N/A
PC
Puerto Rico STEM Ecosystem Initiative (TIES)
5,000
FRIENDS OF THE UNIVERSITY OF HONG KONG LTD
1321 SYDNEY DR
SUNNYVALE
,
CA
94087
N/A
PC
2019 Asia/Pacific University Student Workshop Support
50,000
FUNDACION DR RAUL GARCIA RINALDI
PO BOX 8816
SAN JUAN
,
PR
00910
N/A
PC
Puerto Rico Metropolitan Science Fair fund
5,000
GIRL SCOUTS OF ORANGE COUNTY
9500 TOLEDO WAY
IRVINE
,
CA
92618
N/A
PC
STEM Badge and Coding Activities
20,000
GIRLS INCORPORATED OF ORANGE COUNTY
1815 ANAHEIM AVE
COSTA MESA
,
CA
92627
N/A
PC
Afterschool STEM Programs
10,000
GIVE2ASIA
2201 BROADWAY ST 4TH FL
OAKLAND
,
CA
94612
N/A
PC
Keio University for the 2019 KKT Workshop Host Support
35,000
GREATER SAN DIEGO SCIENCE AND ENGINEERING FAIR INC
PO BOX 15547
SAN DIEGO
,
CA
92175
N/A
PC
Support for Regional Science Fair
2,500
GWINNETT COUNTY PUBLIC SCHOOLS FOUNDATION FUND INC
437 OLD PEACHTREE RD NW
SUWANEE
,
GA
30024
N/A
PC
Support for Regional Science Fair
5,000
HACK FOUNDATION
8605 SANTA MONICA BLVD STE 86294
WEST HOLLYWOOD
,
CA
90069
N/A
PC
Science and Us Makeathon at MIT
3,000
IMPERIAL COLLEGE FOUNDATION INC
PO BOX 80526
ATLANTA
,
GA
30366
N/A
PC
Charitable Event
50,000
INTERNATIONAL MEDICAL CORPS
12400 WILSHIRE BLVD STE 1500
LOS ANGELES
,
CA
90025
N/A
PC
Emergency Relief Work in the Bahamas following Hurricane Dorian
10,000
IRVINE PUBLIC SCHOOLS FOUNDATION
1 POST STE 250
IRVINE
,
CA
92618
N/A
PC
Lead Sponsor of Irvine Public School District Science Fair
30,000
KAIST U S FOUNDATION INC
C/O CKP 3435 WILSHIRE BLVD NO 2240
LOS ANGELES
,
CA
90010
N/A
SO I
2019 KKT Workshop Participant Support
20,000
MASSACHUSETTS SCIENCE & ENGINEERING FAIR INC
955 MASSACHUSETTS AVE 350
CAMBRIDGE
,
MA
02139
N/A
PC
Support for Regional Science Fair
5,000
MINNESOTA ACADEMY OF SCIENCE
970 RAYMOND AVE STE 103
SAINT PAUL
,
MN
55114
N/A
PC
Support for Regional Science Fair
5,000
NCTU FOUNDATION
PO BOX 2793
CUPERTINO
,
CA
95015
N/A
PC
National Chaio Tung University Participation in the 2019 Asia Pacific Workshop
25,000
NETHERLAND-AMERICA FOUNDATION INCORPORATED
505 8TH AVE STE 12A-05
NEW YORK
,
NY
10018
N/A
PC
University of Groningen for the preparation and travel for students and professors to the 2019 EMEA Workshop in Delhi, India
25,000
OCTANE FOUNDATION FOR INNOVATION
65 ENTERPRISE
ALISO VIEJO
,
CA
92656
N/A
SO I
Development and implementation of guidelines and application of post graduate -- entrepreneurial and incubator methodologies for student participants in university workshops
20,000
ORANGE COUNTY COMMUNITY FOUNDATION
4041 MACARTHUR BLVD STE 510
NEWPORT BEACH
,
CA
92660
N/A
PC
30th Anniversary Annual Meeting Fund
5,000
ORANGE COUNTY COMMUNITY FOUNDATION
4041 MACARTHUR BLVD STE 510
NEWPORT BEACH
,
CA
92660
N/A
PC
Support for OC Workforce Development Initiatives
10,000
ORANGE COUNTY DEPARTMENT OF EDUCATION
200 KALMUS DR
COSTA MESA
,
CA
92626
N/A
GOV
One Time Prep for 2020 ISEF
25,000
ORANGE COUNTY SCIENCE AND ENGINEERING FAIR INC
PO BOX 11151
SANTA ANA
,
CA
92711
N/A
PC
Support for Regional Science Fair
50,000
RASPBERRY PI FOUNDATION NORTH AMERICA INC
1111 BROADWAY FL 3
OAKLAND
,
CA
94607
N/A
PC
Coolest Projects in North America
20,000
RASPBERRY PI FOUNDATION NORTH AMERICA INC
1111 BROADWAY FL 3
OAKLAND
,
CA
94607
N/A
PC
Support for Pi Academy in the US
30,000
RBSEF INC
PO BOX 13314
READING
,
PA
19612
N/A
PC
Support for Regional Science Fair
5,000
REGENTS UNIVERSITY OF CALIFORNIA LOS ANGELES
10920 WILSHIRE BLVD STE 620
LOS ANGELES
,
CA
90024
N/A
PC
UCLA Broadcom Fellowship Fund, under the direction of the Dean of the Henry Samueli School of Engineering & Applied Sciences
150,000
RENAISSANCE YOUTH CENTER
3485 3RD AVE
BRONX
,
NY
10456
N/A
PC
3D printer and Raspberry Pis for use in the "Code the Bronx" program
3,500
RENAISSANCE YOUTH CENTER
3485 3RD AVE
BRONX
,
NY
10456
N/A
PC
Code the Bronx Program
25,000
REUBEN H FLEET SCIENCE CENTER
1875 EL PRADO
SAN DIEGO
,
CA
92101
N/A
PC
Preparation for 2020 ISEF
5,000
RIVERSIDE COUNTY OFFICE OF EDUCATION FOUNDATION
3939 13TH ST
RIVERSIDE
,
CA
92501
N/A
PC
Riverside Regional Science Fair Support
2,500
RUDOLF STEINER FOUNDATION INC
1002A OREILLY AVE
SAN FRANCISCO
,
CA
94129
N/A
PC
RSF Social Finance - The Numi Foundation fund
5,000
SAN MATEO COUNTY OFFICE OF EDUCATION
101 TWIN DOLPHIN DR
REDWOOD CITY
,
CA
94065
N/A
GOV
Support for San Mateo County Regional Science Fair
20,000
SANTA CLARA VALLEY SCIENCE FAIR ASN
PO BOX 307
LOS ALTOS
,
CA
94023
N/A
PC
Support for Regional Science Fair
5,000
SCIENCE BUDDIES
560 VALLEY WAY
MILPITAS
,
CA
95035
N/A
PC
Support for increasing online Science & Engineering Programs
50,000
SILICON VALLEY EDUCATION FOUNDATION
1400 PARKMOOR AVE STE 200
SAN JOSE
,
CA
95126
N/A
PC
Elevate Math Program
20,000
SMITHSONIAN INSTITUTION
647 CONTEES WHARF RD
EDGEWATER
,
MD
21037
N/A
PC
Inner City STEM engagement (with SSP) DC MASTERS
20,000
SOCIETY FOR SCIENCE & THE PUBLIC
1719 N ST NW
WASHINGTON
,
DC
20036
N/A
PC
Broadcom MASTERS Program
1,819,959
SOCIETY FOR SCIENCE & THE PUBLIC
1719 N ST NW
WASHINGTON
,
DC
20036
N/A
PC
Charitable Event
15,000
SOCIETY FOR SCIENCE & THE PUBLIC
1719 N ST NW
WASHINGTON
,
DC
20036
N/A
PC
to support bringing four team leaders to BRCM MASTERS International
10,000
SOCIETY FOR SCIENCE & THE PUBLIC
1719 N ST NW
WASHINGTON
,
DC
20036
N/A
PC
Department of Defense - Defense STEM Education Consortium (DSEC)
8,000
SOCIETY FOR SCIENCE & THE PUBLIC
1719 N ST NW
WASHINGTON
,
DC
20036
N/A
PC
Special Outreach - PT Staff Position fund
50,000
SOUTH SAN FRANCISCO FRIENDS OF THE LIBRARY
840 W ORANGE AVE
S SAN FRAN
,
CA
94080
N/A
PC
Local Support for Bay Area Ecosystem
20,000
THE AMERICAN IRELAND FUND
10 POST OFC SQ STE 1205
BOSTON
,
MA
02109
N/A
PC
The University College Dublin Foundation CLG
50,000
THE FOUNDATION AT FCOE
1111 VAN NESS AVE 3RD FL
FRESNO
,
CA
93721
N/A
PC
Central Valley Regional Science Fair (Fresno)
5,000
UNIVERSITY OF CALIFORNIA IRVINE FOUNDATION
100 THEORY STE 250
IRVINE
,
CA
92617
N/A
PC
FABCamp Scholarship and OC Outreach for underserved middle schoolers
35,000
UNIVERSITY OF CALIFORNIA IRVINE FOUNDATION - THE H
5200 ENGINEERING HALL
IRVINE
,
CA
92697
N/A
PC
2019 Asia/Pacific University Student Workshop Support
50,000
UNIVERSITY OF CALIFORNIA IRVINE FOUNDATION - THE H
5200 ENGINEERING HALL
IRVINE
,
CA
92697
N/A
PC
APW Partnership with Alabama A&M University
17,500
UNIVERSITY OF CALIFORNIA IRVINE FOUNDATION - THE H
5200 ENGINEERING HALL
IRVINE
,
CA
92697
N/A
PC
OC STEM Ecosystem Initiative
100,000
UNIVERSITY OF CALIFORNIA IRVINE FOUNDATION - THE H
5200 ENGINEERING HALL
IRVINE
,
CA
92697
N/A
PC
UCI Broadcom Fellowship fund
150,000
UNIVERSITY OF CALIFORNIA IRVINE FOUNDATION - THE H
5200 ENGINEERING HALL
IRVINE
,
CA
92697
N/A
PC
UCI K-14 Future Innovators Initiative & ASPIRE/INSPIRE Programs
75,000
WOMENS HIGH-TECH COALITION
C/O 499 S CAPITAL ST SW
WASHINGTON
,
DC
20003
N/A
PC
DC STEM Fair
5,000
Total
.................................
3a
4,154,959
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
14
57,232
4
Dividends and interest from securities
....
14
2,583,241
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
2,181,684
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
CLASS ACTION LAWSUIT PROCEEDS
01
12
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
4,822,169
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
4,822,169
(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