-
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
CHAMBERS FAMILY FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
800 WILLAMETTE STREET SUITE 750
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
EUGENE
,
OR
97401
A Employer identification number
93-1266648
B
Telephone number (see instructions)
(541) 484-2419
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)
$
21,582,831
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
514,260
514,260
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
1,381,300
b
Gross sales price for all assets on line 6a
6,474,115
7
Capital gain net income (from Part IV, line 2)
...
1,381,300
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)
.......
3
3
12
Total.
Add lines 1 through 11
........
1,895,563
1,895,563
13
Compensation of officers, directors, trustees, etc.
0
0
0
14
Other employee salaries and wages
......
22,170
16,628
5,542
15
Pension plans, employee benefits
.......
1,721
1,291
430
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
4,388
2,194
2,194
c
Other professional fees (attach schedule)
....
181,509
181,509
0
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
47,762
6,191
0
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
3,488
0
3,488
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
261,038
207,813
11,654
25
Contributions, gifts, grants paid
.......
946,573
946,573
26
Total expenses and disbursements.
Add lines 24 and 25
1,207,611
207,813
958,227
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
687,952
b
Net investment income
(if negative, enter -0-)
1,687,750
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
.............
75,565
65,782
65,782
2
Savings and temporary cash investments
.........
272,710
330,274
330,274
3
Accounts receivable
Less: allowance for doubtful accounts
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)
2,124,931
2,164,689
2,189,557
b
Investments—corporate stock (attach schedule)
.......
8,734,168
8,712,193
13,575,624
c
Investments—corporate bonds (attach schedule)
.......
4,122,203
4,585,516
4,653,708
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
628,571
811,120
767,236
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
650
650
650
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
15,958,798
16,670,224
21,582,831
17
Accounts payable and accrued expenses
..........
2,697
3,283
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)
.........
2,697
3,283
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
15,501,150
15,524,038
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
454,951
1,142,903
29
Total net assets or fund balances
(see instructions)
.....
15,956,101
16,666,941
30
Total liabilities and net assets/fund balances
(see instructions)
.
15,958,798
16,670,224
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
15,956,101
2
Enter amount from Part I, line 27a
.....................
2
687,952
3
Other increases not included in line 2 (itemize)
3
22,888
4
Add lines 1, 2, and 3
..........................
4
16,666,941
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
16,666,941
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
CAPITAL GAIN DISTRIBUTIONS
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
6,329,829
5,092,815
1,237,014
b
144,286
144,286
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
1,237,014
b
144,286
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
1,381,300
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
944,904
19,856,615
0.047586
2017
885,132
19,234,101
0.046019
2016
925,602
18,227,975
0.050779
2015
900,143
18,549,396
0.048527
2014
850,854
18,776,363
0.045315
2
Total
of line 1, column (d)
.....................
2
0.238226
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
0.047645
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
20,278,801
5
Multiply line 4 by line 3
......................
5
966,183
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
16,878
7
Add lines 5 and 6
........................
7
983,061
8
Enter qualifying distributions from Part XII, line 4
,.............
8
958,227
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
33,755
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
0
3
Add lines 1 and 2
...........................
3
33,755
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
0
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
33,755
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
29,180
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
29,180
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
163
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
4,738
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
Refunded
11
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.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
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)
OR
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.CHAMBERSFAMILYFOUNDATION.COM
14
The books are in care of
SILVA CHAMBERS TRUSTEE
Telephone no.
(541) 484-2419
Located at
800 WILLAMETTE STREET SUITE 750
EUGENE
OR
ZIP+4
97401
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
SILVA L CHAMBERS
TRUSTEE
5.00
0
0
0
800 WILLAMETTE STREET SUITE 750
EUGENE
,
OR
97401
SCOTT D CHAMBERS
TRUSTEE
2.00
0
0
0
800 WILLAMETTE STREET SUITE 750
EUGENE
,
OR
97401
JULIA STLTNER
TRUSTEE
2.00
0
0
0
800 WILLAMETTE STREET SUITE 750
EUGENE
,
OR
97401
KENDRA GOLDBERG
TRUSTEE
2.00
0
0
0
800 WILLAMETTE STREET SUITE 750
EUGENE
,
OR
97401
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
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
20,154,376
b
Average of monthly cash balances
.......................
1b
433,046
c
Fair market value of all other assets (see instructions)
................
1c
193
d
Total
(add lines 1a, b, and c)
.........................
1d
20,587,615
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
0
3
Subtract line 2 from line 1d
.........................
3
20,587,615
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
308,814
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
20,278,801
6
Minimum investment return.
Enter 5% of line 5
..................
6
1,013,940
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
1,013,940
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
33,755
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
33,755
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
980,185
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
980,185
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
980,185
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
958,227
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
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
958,227
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b. See instructions
.................
5
0
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
958,227
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
980,185
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
947,024
b
Total for prior years:
20
,
20
,
20
0
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
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
958,227
a
Applied to 2018, but not more than line 2a
947,024
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
.....
11,203
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
968,982
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
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:
CHAMBERS FAMILY FOUNDATION
800 WILLAMETTE STREET SUITE 750
EUGENE
,
OR
97401
(541) 484-2419
b
The form in which applications should be submitted and information and materials they should include:
APPLICATION AVAILABLE UPON REQUEST AND ATTACHED TO THIS RETURN
c
Any submission deadlines:
MARCH 31 AND SEPTEMBER 30
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
LANE, BENTON, OR DESCHUTES COUNTY OREGON BENEFITS
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 FAMILY FOR EVERY CHILD
1675 W 11TH AVENUE
EUGENE
,
OR
97402
PC
SUPPORT TO EXPAND THE 15TH NIGHT/HOST HOME/NON-TRADITIONAL MENTOR PROGRAMS.
10,000
ABC HOUSE
PO BOX 68
ALBANY
,
OR
97321
PC
OPERATIONAL SUPPORT FOR THEIR EXPERT ASSESSMENT TEAM AND SUPPORT SERVICES PROGRAM.
6,000
ALS ASSOCIATION CHAPTER OF OREGON & SW WASHINGTON
700 NE MULTNOMAH AVENUE
PORTLAND
,
OR
97232
PC
SUPPORT TOWARDS DIRECT PROGRAM COSTS ASSOCIATED WITH LANE COUNTYS ALS MEDICAL PROGRAM.
5,000
ANGEL HAIR FOUNDATION
PO BOX 2727
EUGENE
,
OR
97402
PC
OPERATIONAL SUPPORT.
410
ANGELS IN THE OUTFIELD
PO BOX 2347
OREGON CITY
,
OR
97405
PC
FUNDS TO FULFILL REFERRALS FROM COMMUNITY PARTNERS FOR YOUTH IMPACTED BY CRIME OR ABUSE.
1,250
ARTS & BUSINESS ALLIANCE OF EUGENE
1401 WILLAMETTE STREET
EUGENE
,
OR
97401
PC
FUNDS TO HELP CREATE AND DISTRIBUTE THE 2020 ART GUIDE AND TO EXPAND THEIR CREATIVE ACADEMY.
5,000
ASSISTANCE LEAGUE OF EUGENE
1149 WILLAMETTE STREET
EUGENE
,
OR
97401
PC
SUPPORT OF OPERATION SCHOOL BELL: PROVIDING NEW CLOTHES FOR LOW-INCOME STUDENTS.
5,000
BOY SCOUTS OF AMERICA OREGON TRAIL COUNCIL INC
2525 MARTIN LUTHER KING JR
BOULEVARD
EUGENE
,
OR
97401
PC
SUPPORT FOR THEIR LIFE SKILLS TRAINING CAMPS FOR THE CHILDREN OF MIGRANT FAMILIES.
2,500
BOYS & GIRLS CLUBS OF WESTERN LANE COUNTY
PO BOX 739
FLORENCE
,
OR
97439
PC
SUPPORT OF THEIR SUMMER BRAIN GAIN PROGRAM FOR LOW INCOME STUDENTS.
2,500
BOYS AND GIRLS CLUBS OF BEND
500 NW WALL STREET
BEND
,
OR
97701
PC
SUPPORT FOR THEIR ACADEMIC SUCCESS PROGRAM DURING THE 2019-2020 SCHOOL YEAR.
3,000
CAMP TAMARACK
19696 SUNSHINE WAY
BEND
,
OR
97702
PC
SCHOLARSHIP FUNDS FOR LAPINE MIDDLE SCHOOL STUDENTS TO ATTEND THEIR WINTER WELLNESS CAMP.
5,000
CASA OF LANE COUNTY
174 DEADMOND FERRY ROAD
SPRINGFIELD
,
OR
97477
PC
SUPPORT FOR "SERVING THE NEED": A SERVICE CAPACITY EXPANSION PROGRAM.
15,125
CASA-VOICES FOR CHILDREN-CORVALLIS
129 NW 4TH STREET SUITE B
CORVALLIS
,
OR
97330
PC
OPERATIONAL SUPPORT TO CONTINUE TO SERVE ABUSED AND NEGLECTED BENTON CITY CHILDREN.
5,000
CASCADE FOOTHILLS LIBRARY
PO BOX 12
DEXTER
,
OR
97431
PC
SUPPORT FOR THEIR WEEKLY STORY TIME PROGRAM AND THEIR 2019 SUMMER READING PROGRAM.
2,700
CASCADE HEALTH FOUNDATION
2650 SUZANNE WAY SUITE 200
EUGENE
,
OR
97408
PC
FUNDS TOWARDS THE COSTS TO REBUILD THE GAZEBO LOCATED ON THE PETE MOORE HOSPICE HOUSE PROPERTY.
25,000
CENTRAL OREGON ENVIRONMENTAL CENTER INC
16 NW KANSAS AVENUE
BEND
,
OR
97703
PC
OPERATING SUPPORT FOR THE GARDEN FOR EVERY SCHOOL PROGRAM IN BEND-LAPINE SCHOOLS.
5,000
CHILDREN'S MIRACLE NETWORK
PO BOX 10905
EUGENE
,
OR
97440
PC
OPERATIONAL SUPPORT THROUGH LOCAL "MR." PAGEANTS.
250
CHRISTIANS AS FAMILY ADVOCATES
921 COUNTRY CLUB ROAD SUITE 222
EUGENE
,
OR
97401
PC
SUPPORT FOR EXPANSION OF SAFE FAMILIES FOR CHILDREN PROGRAM.
5,000
COMMUNITY FOOD FOR CRESWELL
PO BOX 351
CRESWELL
,
OR
97426
PC
SUPPORT TOWARDS COBALT ACTIVITY CENTER KITCHEN RENOVATION.
10,000
CORNERSTONE COMMUNITY HOUSING
PO BOX 11923
EUGENE
,
OR
97440
PC
SUPPORT FOR HEALTHY HOMES PROGRAM.
10,000
CORVALLIS CLINIC FOUNDATION
444 NW ELKS DRIVE
CORVALLIS
,
OR
97330
PC
FUNDS TO COVER FOOD COSTS TO EXPAND THEIR COOK FOR CANCER PROGRAM.
7,500
CORVALLIS LION'S CLUB- YOUTH ACTIVITIES FUND
1849 NW 9TH SUITE 8
CORVALLIS
,
OR
97330
PC
2019 LIVESTOCK AUCTION PURCHASES.
4,176
CORVALLIS MONTESSORI SCHOOL
2730 NW GREELEY AVENUE
CORVALLIS
,
OR
97330
PC
OPERATIONAL SUPPORT.
500
CORVALLIS MULTICULTURAL LITERACY CENTER
2638 NW JACKSON AVENUE
CORVALLIS
,
OR
97333
PC
SUPPORT OF THEIR ENGLISH AS A SECOND LANGUAGE PROGRAM.
1,000
COTTAGE THEATRE INC
700 VILLAGE DRIVE
COTTAGE GROVE
,
OR
97424
PC
FUNDS TOWARDS SUPPORTING A SOUND UPGRADE AS PART OF THEIR ACT III REMODEL.
6,000
COUNCIL ON AGING OF CENTRAL OREGON
373 NE GREENWOOD AVENUE
BEND
,
OR
97701
PC
SUPPORT FOR DESCHUTES COUNTY MEALS-ON-WHEELS PROGRAM.
5,000
CRESWELL CLUBHOUSE
996 A STREET
CRESWELL
,
OR
97426
PC
SCHOLARSHIP SUPPORT FOR ELEMENTARY YOUTH INTERESTED IN THEIR YOUTH DEVELOPMENT PROGRAM.
8,000
CRESWELL FIRST - CRESWELL COMMUNITY SINGERS
PO BOX 1
CRESWELL
,
OR
97426
PC
SUPPORT TO BUILD THEIR SHEET MUSIC LIBRARY DUE TO AN INCREASE IN MEMBERS.
2,000
CROSS ROAD ASSEMBLY OF GOD
PO BOX 3347
FLORENCE
,
OR
97439
PC
SUPPORT TO EXPAND THEIR FOOD BACKPACK FOR KIDS PROGRAM.
5,000
DAISY CHAIN - CREATING HEALTHY ALLIANCES IN NEW MOTHERING
PO BOX 10375
EUGENE
,
OR
97440
PC
SUPPORT TOWARDS UPGRADING AND EXPANDING PROGRAMS AND INFRASTRUCTURE.
5,000
EDUCATION FOUNDATION FOR BEND-LA PINE SCHOOLS
PO BOX 1436
BEND
,
OR
97709
PC
SUPPORT FOR INNOVATIVE STEAM CLASSROOM GRANTS FOR K-12 EDUCATORS.
4,350
EUGENE CHRISTIAN SCHOOL
2895 CHAD DRIVE
EUGENE
,
OR
97408
PC
FUNDS TO CONTINUE EXPANDING TECHNOLOGY-BASED LEARNING OPTIONS.
1,700
EUGENE CIVIC ALLIANCE
PO BOX 5338
EUGENE
,
OR
97405
PC
CAPITAL CAMPAIGN SUPPORT FOR CIVIC PARK PROJECT.
300,000
EUGENE CONCERT CHOIR
1590 WILLAMETTE STREET SUITE 400
EUGENE
,
OR
97401
PC
FUNDS FOR THE PRODUCTION COSTS OF THEIR COMMUNITY HOLIDAY CONCERT, CHRISTMAS CLASSICS.
5,000
EUGENE MISSION INC
PO BOX 1149
EUGENE
,
OR
97440
PC
FUNDS FOR EQUIPMENT NEEDED TO PROVIDE CENTRALIZED CONTROL OF ACCESS AND EGRESS OF THE MAIN LODGE.
20,942
EUGENE OPERA
1590 WILLAMETTE STREET
EUGENE
,
OR
97401
PC
FUNDS FOR THE COSTS RELATED TO THE SET RENTAL AND SCENERY FOR THEIR UPCOMING PRODUCTION OF TOSCA.
5,000
EUGENE SCIENCE CENTER
2300 LEO HARRIS PARKWAY
EUGENE
,
OR
97401
PC
FUNDS FOR PURCHASING CONSTRUCTION MATERIALS AND THE CONSTRUCTION OF A NEW OUTDOOR CLASSROOM.
10,000
EUGENE SYMPHONY ASSOCIATION INC
115 WEST 8TH AVENUE SUITE 115
EUGENE
,
OR
97401
PC
SUPPORT FOR THEIR 2019 FREE SUMMER OUTDOOR CONCERT.
30,000
EVERY CHILD LANE COUNTY
375 COBURG ROAD SUITE B
EUGENE
,
OR
97401
PC
OPERATING SUPPORT TO FURTHER RALLY THE COMMUNITY AROUND THE FOSTER CRISIS IN LANE COUNTY.
23,000
FOOD FOR LANE COUNTY
770 BAILEY HILL ROAD
EUGENE
,
OR
97402
PC
OPERATIONAL SUPPORT.
10,000
FRIENDS OF BUFORD PARK & MT PISGAH
PO BOX 5266
EUGENE
,
OR
97405
PC
GENERAL SUPPORT OF THEIR STEWARDSHIP PROGRAM.
37,000
FRIENDS OF CHILD ADVOCACY CENTER DBA KIDS FIRST
2675 MARTIN LUTHER KING BOULEVARD
EUGENE
,
OR
97401
PC
SUPPORT OF RENOVATING THEIR NEW BUILDING.
7,000
GIVING PLATE INC
1245 SE 3RD STREET
BEND
,
OR
97702
PC
SUPPORT FOR THE KID'S KORNER, BACKPACKS FOR BEND, AND MONTHLY FOOD BOX PROGRAMS.
5,000
GOOD SAMARITAN HOSPITAL FOUNDATION - CORVALLIS
3600 NW SAMARITAN DRIVE
CORVALLIS
,
OR
97333
PC
CAPITAL CONSTRUCTION COSTS FOR A GUEST HOUSE, SIMILAR TO A RONALD MCDONALD HOUSE ONLY FOR ADULTS.
4,500
HABITAT FOR HUMANITY - LA PINE SUNRIVER
PO BOX 3364
SUNRIVER
,
OR
97707
PC
FUNDS FOR DIRECT COSTS ASSOCIATED WITH THE CONSTRUCTIONOF LA PINES NEW PUTNEY PLACE DEVELOPMENT.
5,000
HEALTHY MOVES
PO BOX 11348
EUGENE
,
OR
97440
PC
SUPPORT TO EXPAND THEIR TRAINER-IN-RESIDENCE PROGRAM, PROVIDING PE TO LOCAL SCHOOLS.
5,000
HIGH DESERT MUSEUM
59800 S HIGHWAY 97
BEND
,
OR
97702
PC
SUPPORT FOR THE STEAM EDUCATIONAL PROGRAM DURING THE 2019-2020 SCHOOL YEAR.
5,000
HOME LIFE INC
2068 NW FILMORE AVENUE
CORVALLIS
,
OR
97330
PC
OPERATIONAL SUPPORT OF THEIR CLIENT ACTIVITIES PROJECT.
4,600
HUERTO DE LA FAMILIA (FAMILY GARDEN)
1672 WILLAMETTE STREET
EUGENE
,
OR
97401
PC
OPERATIONAL SUPPORT FOR THEIR ORGANIC GARDEN PROGRAM.
10,000
KIDSPORTS (EMERALD KIDSPORTS FOUNDATION)
2190 POLK STREET
EUGENE
,
OR
97405
PC
FUNDS TOWARDS SCHOLARSHIPS FOR CHILDREN IN NEED OF FINANCIAL ASSISTANCE.
10,000
LANE ARTS COUNCIL
1590 WILLAMETTE STREET SUITE 200
EUGENE
,
OR
97401
PC
SUPPORT FOR THEIR ARTS EDUCATION PROGRAMS DIRECTLY SERVING YOUTH IN SCHOOLS THROUGHOUT LANE COUNTY.
5,000
LANE COUNTY YOUTH AUCTION
119 BALLARD EXTENSION HALL OSU
CORVALLIS
,
OR
97331
PC
SUPPORT OF THE 2019 YOUTH LIVESTOCK AUCTION.
4,551
LOOKING GLASS COMMUNITY SERVICES
1790 W 11TH AVENUE SUITE 200
EUGENE
,
OR
97402
PC
OPERATIONAL SUPPORT FOR THEIR STATION 7 YOUTH EMERGENCY SHELTER.
5,000
MAKE A WISH FOUNDATION OF OREGON
2000 SW FIRST AVENUE SUITE 410
PORTLAND
,
OR
97201
PC
FUNDS TOWARDS DIRECT WISH COSTS FOR THE 25 LANE COUNTY YOUTH ELIGIBLE FOR A WISH.
7,500
MAMA I'M LOW
PO BOX 5173
EUGENE
,
OR
97405
PC
SUPPORT FOR THEIR FREE SUMMER CAMPS FOR LANE COUNTY CHILDREN LIVING WITH TYPE 1 DIABETIES.
5,000
MEDICAL TEAMS INTERNATIONAL
PO BOX 10
PORTLAND
,
OR
97207
PC
FUNDS TO SUPPORT 8 MOBILE DENTAL CLINICS IN THE LANE, BENTON AND DESCHUTES COUNTIES.
6,250
MIDDLE FORK WILLAMETTE WATERSHED COUNCIL
PO BOX 27
LOWELL
,
OR
97452
PC
SUPPORT FOR THEIR WATERSHED EDUCATION PROGRAM (WEP).
7,000
MOUNTAINSTAR FAMILY RELIEF NURSERY
2125 NE DAGGETT LANE
BEND
,
OR
97701
PC
SUPPORT FOR THEIR THERAPEUTIC EARLY CHILDHOOD PROGRAM (TECP).
3,000
NATURE CONSERVANCY-OREGON CHAPTER
87200 RATHBONE ROAD
EUGENE
,
OR
97402
PC
OPERATIONAL SUPPORT FOR THE WILLAMETTE CONFLUENCE PROJECT.
5,000
NORTHWEST ASSOCIATION FOR BLIND ATHLETES
PO BOX 65265
VANCOUVER
,
WA
98665
PC
SUPPORT FOR THEIR SPORTS OUTREACH PROGRAM FOR BLIND OR VISUALLY IMPAIRED PEOPLE.
4,000
O'HARA CATHOLIC SCHOOL
715 W 18TH AVENUE
EUGENE
,
OR
97402
PC
GENERAL OPERATING SUPPORT.
469
OLD MILL CENTER FOR CHILDREN AND FAMILIES INC
1650 SW 45TH PLACE
CORVALLIS
,
OR
97333
PC
SUPPORT FOR NEW PARENTING SUPPORT GROUPS IN THEIR NURSERIES.
12,500
ONE HOPE
379 COBURG ROAD SUITE B
EUGENE
,
OR
97401
PC
GENERAL OPERATIONAL SUPPORT.
14,300
OPERATION WARM
PO BOX 822431
PHILADELPHIA
,
PA
19182
PC
FUNDS TO PROVIDE ECONOMICALLY DISADVANTAGED STUDENTS IN LANE COUNTY WITH A WINTER COAT.
7,500
OPHELIA'S PLACE
1577 PEARL STREET SUITE 100
EUGENE
,
OR
97401
PC
SUPPORT TO INCREASE THEIR OUT OF SCHOOL SKILL-BUILDING PROGRAM.
10,000
PARENTING NOW
86 CENTENNIAL LOOP
EUGENE
,
OR
97401
PC
SUPPORT OF PARENTING: THE FIRST 3 YEARS AND THE FREE CONCURRENT CHILDREN'S PROGRAM.
5,000
PHILOMATH COMMUNITY SERVICES INC
PO BOX 1334
PHILOMATH
,
OR
97370
PC
SUPPORT FOR THEIR PLILOMATH COMMUNITY GLEANERS PROGRAM.
1,500
PLEASANT HILL EDUCATION FOUNDATION
PO BOX 636
PLEASANT HILL
,
OR
97455
PC
HOLIDAY DONATIONS OF $500 FOR 10 FAMILIES IN NEED WITHIN THE PLEASANT HILL SCHOOL DISTRICT.
5,000
PLEASANT HILL HIGH SCHOOL
36386 HIGHWAY 58
PLEASANT HILL
,
OR
97455
GOV
GENERAL OPERATING SUPPORT OF THEIR ANNUAL JAZZ FESTIVAL.
3,000
PLEASANT HILL LUTHERAN CHURCH
84421 GAUPP LANE
PLEASANT HILL
,
OR
97455
PC
GENERAL OPERATING SUPPORT.
5,000
POWER ON WITH LIMB LOSS
1048 LAUREL AVENUE
SPRINGFIELD
,
OR
97478
PC
FUNDS TOWARDS PROVIDING MONTHLY ATHLETIC CHALLENGES FOR PEOPLE WHO HAVE EXPERIENCED LIMB LOSS.
8,000
RELIEF NURSERY INC
1720 W 25TH AVENUE
EUGENE
,
OR
97405
PC
SUPPORT TO EXPAND THEIR THERAPEUTIC EARLY CHILDHOOD PROGRAM CLASSES.
30,000
RIDEABLE
PO BOX 71092
SPRINGFIELD
,
OR
97475
PC
OPERATIONAL SUPPORT FOR THEIR THERAPEUTIC CLASSES.
3,000
SACRED HEART MEDICAL CENTER FOUNDATION
PO BOX 10905
EUGENE
,
OR
97401
PC
GENERAL OPERATING SUPPORT.
3,000
SCHOOL GARDEN PROJECT OF LANE COUNTY
PO BOX 26004
EUGENE
,
OR
97403
PC
OPERATIONAL SUPPORT.
10,000
SIUSLAW WATERSHED COUNCIL (SWC)
PO BOX 422
MAPLETON
,
OR
97453
PC
SUPPORT OF THEIR OUTREACH AND EDUCATION COORDINATOR POSITION DELIVERING ECOLOGY CURRICULUM.
3,000
SPONSORS INC
338 HIGHWAY 99 NORTH
EUGENE
,
OR
97402
PC
FUNDS TO HELP FURNISH THE 10 TINY HOUSE UNITS WITH FURNITURE AND APPLIANCES.
8,000
SPOTLIGHT THEATER OF PLEASANT HILL
PO BOX 802
PLEASANT HILL
,
OR
97455
PC
FUNDS TOWARDS THE COSTS TO UPGRADE THE STAGE LIGHTING AND SOUND SYSTEM.
5,000
SPRINGFIELD HIGH SCHOOL
875 7TH STREET
SPRINGFIELD
,
OR
97477
GOV
FUNDS TOWARDS PURCHASING INSTRUMENTS AND NEW MUSIC FOR SHS CONCERT AND MARCHING BAND.
1,000
SPRINGFIELD YOUNG READERS
PO BOX 72470
SPRINGFIELD
,
OR
97475
PC
FUNDS TO PURCHASE BOOKS FOR SPRINGFIELD AREA CHILDREN TO HELP FOSTER LITERACY SKILLS.
3,000
ST VINCENT DE PAUL SOCIETY OF LANE COUNTY INC
PO BOX 24608
EUGENE
,
OR
97402
PC
ANNUAL OPERATING SUPPORT FOR THEIR GIRLS YOUTH HOUSE PROGRAM, SERVING HOMELESS TEENS.
10,000
UMPQUA COMMUNITY DEVELOPMENT CORPORATION
605 SE KANE STREET
ROSEBURG
,
OR
97470
PC
FUNDS TO BUY A COMMERCIAL GENERATOR FOR THEIR SUBSIDIZED APARTMENTS HOUSING AT RISK INDIVIDUALS.
5,000
UNIVERSITY OF OREGON FOUNDATION
1720 E 13TH AVENUE SUITE 410
EUGENE
,
OR
97403
PC
CONTINUED SUPPORT TO PRESERVE THE KEZI ARCHIVES.
10,000
VERY LITTLE THEATRE INC
2350 HILYARD
EUGENE
,
OR
97405
PC
GENERAL OPERATING SUPPORT.
5,000
VOLUNTEERS IN MEDICINE CLINIC
2260 MARCOLA ROAD
SPRINGFIELD
,
OR
97477
PC
OPERATIONAL SUPPPORT.
30,000
VOLUNTEERS IN MEDICINE CLINIC OF THE CASCADES
2300 NE NEFF ROAD
BEND
,
OR
97701
PC
OPERATIONAL SUPPORT.
5,000
WELLMAMA INC-EUGENE
150 SHELTON MCMURPHEY BOULEVARD
EUGENE
,
OR
97401
PC
FUNDS FOR STAFF TO ATTEND ANNUAL POSTPARTUM SUPPORT INTERNATIONAL TRAINING CONFERENCE.
7,000
WILLAMETTE RIVERKEEPER
1515 SE WATER AVENUE SUITE 102
PORTLAND
,
OR
97214
PC
OPERATIONAL SUPPORT FOR THEIR LOCAL RIVER GUARDIANS PROGRAM TO KEEP THE WILLAMETTE RIVER HEALTHY.
8,000
WONDERLAND EXPRESS INC
PO BOX 3589
SUNRIVER
,
OR
97707
PC
FUNDS TO HELP PUT ON AN ANNUAL HOLIDAY EVENT FOR VULNERABLE CHILDREN AND THEIR FAMILIES.
2,000
YWCA OF GREATER PORTLAND
PO BOX 4587
PORTLAND
,
OR
97208
PC
FUNDS TO SUPPORT THEIR FAMILY PRESERVATION PROJECT.
3,000
Total
.................................
3a
946,573
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
...........
4
Dividends and interest from securities
....
14
514,260
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
.....
14
3
8
Gain or (loss) from sales of assets other than
inventory
............
18
1,381,300
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
0
1,895,563
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
1,895,563
(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