-
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
08-01-2019
, and ending
07-31-2020
Name of foundation
HERBERT G ABBOT TESTAMENTARY TRUST XXX-XX-XXXX
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 477
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CONCORD
,
NH
033020477
A Employer identification number
02-6004792
B
Telephone number (see instructions)
(877) 773-1229
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)
$
1,979,474
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
...
33,959
33,959
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
55,194
b
Gross sales price for all assets on line 6a
1,027,519
7
Capital gain net income (from Part IV, line 2)
...
55,194
8
Net short-term capital gain
.........
0
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
847
12
Total.
Add lines 1 through 11
........
90,000
89,153
13
Compensation of officers, directors, trustees, etc.
28,619
28,619
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
0
b
Accounting fees (attach schedule)
.......
850
850
0
0
c
Other professional fees (attach schedule)
....
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
181
181
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
0
0
23
Other expenses (attach schedule)
.......
1,510
1,510
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
31,160
31,160
0
0
25
Contributions, gifts, grants paid
.......
96,355
96,355
26
Total expenses and disbursements.
Add lines 24 and 25
127,515
31,160
0
96,355
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-37,515
b
Net investment income
(if negative, enter -0-)
57,993
c
Adjusted net income
(if negative, enter -0-)
...
0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2019)
Form 990-PF (2019)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
2
Savings and temporary cash investments
.........
124,822
61,966
61,966
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
0
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
416,776
380,065
404,296
b
Investments—corporate stock (attach schedule)
.......
923,454
990,263
1,327,070
c
Investments—corporate bonds (attach schedule)
.......
179,558
174,602
186,142
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
0
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
1,644,610
1,606,896
1,979,474
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
1,644,610
1,606,896
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)
.....
1,644,610
1,606,896
30
Total liabilities and net assets/fund balances
(see instructions)
.
1,644,610
1,606,896
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
1,644,610
2
Enter amount from Part I, line 27a
.....................
2
-37,515
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
1,607,095
5
Decreases not included in line 2 (itemize)
5
199
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
1,606,896
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
50. APPLE COMPUTER, INC
2013-07-01
2019-08-01
b
70. APPLE COMPUTER, INC
2013-07-01
2019-08-07
c
500. SYMANTEC CORP COM
2019-04-18
2019-08-21
d
15000. U S TREASURY BOND 2.625% 08/15/2020 DTD 08/15/10
2019-03-28
2019-08-23
e
5000. U S TREASURY BOND 2.625% 08/15/2020 DTD 08/15/10
2013-08-06
2019-08-23
80. DANAHER CORP
2013-12-02
2019-09-11
20. UNIVERSAL DISPLAY CORP COM
2018-01-29
2019-09-11
30. VISA INC. - CL A
2013-12-02
2019-09-11
90. EASTMAN CHEMICAL CO.
2018-01-29
2019-09-18
130. EASTMAN CHEMICAL CO.
2017-10-11
2019-09-20
10000. U S TREASURY BOND 2.625% 08/15/2020 DTD 08/15/10
2019-02-20
2019-09-30
60. MARTIN MARIETTA MATLS INC COM
2017-08-24
2019-10-07
40. MARTIN MARIETTA MATLS INC COM
2016-10-14
2019-10-08
160. PTC INC.
2017-10-30
2019-10-28
70. TIFFANY & CO
2019-07-24
2019-10-28
270. APPLIED MATERIALS
2013-12-02
2019-10-30
130. PTC INC.
2017-10-30
2019-10-30
10. BOOKING HOLDINGS INC
2018-05-22
2019-11-08
5000. US TREASURY NOTES 2.25% 11/15/2027 DTD 11/15/2017
2019-07-26
2019-11-21
5000. US TREASURY NOTE 2.250 11/15/2025 DTD 11/15/2015
2019-07-26
2019-11-21
10000. U S TREASURY BOND 2.625% 08/15/2020 DTD 08/15/10
2011-01-07
2019-11-21
100. DOLLAR GENERAL CORP
2017-06-22
2019-12-04
70. BANK AMER CORP COM
2017-01-13
2019-12-05
140. BANK AMER CORP COM
2019-09-25
2019-12-05
40. DOLLAR GENERAL CORP
2017-06-22
2019-12-05
5000. US TREASURY BOND 2.125% 01/31/2021 DTD 01/31/2014
2016-01-25
2019-12-10
5000. WESTPAC BKG CORP 2.85% 5/13/2026 DTD 05/13/2016
2019-02-20
2019-12-10
30. BANK AMER CORP COM
2017-01-13
2020-01-03
20. CENTENE CORP
2019-07-03
2020-01-03
20. CITIZENS FINANCIAL GROUP INC
2019-09-25
2020-01-03
10. DANAHER CORP
2013-12-02
2020-01-03
20. DUPONT DE NEMOURS INC
2018-09-19
2020-01-03
20. METLIFE INC
2019-09-25
2020-01-03
110. MICROSOFT CORPORATION
2007-05-22
2020-01-03
10. NORFOLK SOUTHERN CORP COMMON
2017-08-08
2020-01-03
10. PFIZER
2019-02-01
2020-01-03
20. SCHWAB CHARLES CORP NEW COM
2019-07-26
2020-01-03
110. TJX COMPANIES INC.
2013-12-02
2020-01-03
10. UNITEDHEALTH GROUP INC COM
2002-12-06
2020-01-03
10. INGERSOLL-RAND PLC SHS
2013-12-02
2020-01-03
170. WEC ENERGY GROUP INC
2013-12-02
2020-01-17
150. WEC ENERGY GROUP INC
2013-12-02
2020-01-23
5000. BERKSHIRE HATHAWAY 2.75% 03/15/2023 DTD 03/15/2016
2019-02-20
2020-01-29
60. CENTENE CORP
2019-07-03
2020-01-29
5000. EXXON MOBIL 2.222% 03/01/2021 DTD 03/03/2016
2019-02-20
2020-01-29
15000. FHLMC 2.375% 1/13/2022 DTD 1/13/2012
2015-06-26
2020-01-29
5000. GENERAL DYNAMICS 3% 05/11/2021 DTD 05/11/2018
2019-02-20
2020-01-29
5000. US TREASURY NOTES 2.25% 11/15/2027 DTD 11/15/2017
2019-07-26
2020-01-29
5000. US TREASURY NOTE 2.75% 02/15/2028 DTD 2/15/2018
2019-02-20
2020-01-29
15000. US TREASURY BOND 2.125% 01/31/2021 DTD 01/31/2014
2017-01-30
2020-01-29
5000. U S TREASURY BOND 2.000% 02/15/2025 DTD 02/17/15
2019-06-25
2020-01-29
5000. US TREASURY NOTES 2% 11/15/2026 DTD 11/15/2016
2019-11-21
2020-01-29
70. DUPONT DE NEMOURS INC
2019-06-13
2020-02-10
122. DUPONT DE NEMOURS INC
2018-04-13
2020-02-10
70. MICROSOFT CORPORATION
2007-05-22
2020-02-21
230. APPLIED MATERIALS
2013-12-02
2020-02-27
.832 INGERSOLL RAND INC
2013-12-02
2020-04-02
3000. BB&T CORP 2.75% 04/01/2022 DTD 03/21/2017
2019-02-20
2020-04-06
3000. BP CAP MKTS AMER 4.234% 11/06/2028 DTD 11/06/2018
2019-02-20
2020-04-06
2000. COMCAST CORP 2.85% 01/15/2023 DTD 01/14/2013
2019-02-20
2020-04-06
2000. JP MORGAN CHASE 3.25% 09/23/2022 DTD 09/24/2012
2019-02-20
2020-04-06
4000. JPMORGAN CHASE & CO 3.2% 06/15/2026 DTD 06/07/2016
2019-02-25
2020-04-06
2000. MANULIFE FINANCIAL 4.15% 03/04/2026 DTD 03/04/2016
2019-02-20
2020-04-06
2000. MORGAN STANLEY 3.125% 07/27/2026 DTD 07/25/2016
2019-12-10
2020-04-06
5000. ONTARIO PROVINCE 2.2% 10/03/2022 DTD 10/03/2017
2019-02-25
2020-04-06
2000. PROVINCE OF QUEBEC 2.750% 08/25/2021 DTD 08/25/11
2019-02-20
2020-04-06
3000. ROYAL BANK OF CANADA 2.75% 2/01/2022 DTD 01/31/2017
2019-02-20
2020-04-06
2000. STATE STREET CORP 3.55% 08/18/2025 DTD 02/18/2016
2019-02-20
2020-04-06
3000. TOYOTA MOTOR CR 2.6% 01/11/2022 DTD 01/09/2017
2019-02-20
2020-04-06
3000. US BANCORP 3.15% 04/27/2027 DTD 04/27/2017 CALLABLE 03/27/2027
2019-02-20
2020-04-06
6000. US TREASURY NOTE 1.875% 09/30/2022 DTD 10/02/2017
2020-01-29
2020-04-06
10000. US TREASURY BOND 2.125% 01/31/2021 DTD 01/31/2014
2019-05-16
2020-04-06
15000. US TREASURY BOND 2.125% 01/31/2021 DTD 01/31/2014
2019-03-28
2020-04-06
5000. US TREASURY NOTE 2.25% 11/15/2024 DTD 11/17/2014
2020-01-29
2020-04-06
4000. US TREASURY NOTE 2.25% 11/15/2024 DTD 11/17/2014
2015-04-02
2020-04-06
4000. U S TREASURY BOND 2.000% 02/15/2025 DTD 02/17/15
2019-05-16
2020-04-06
4000. US TREASURY NOTE 2.250 11/15/2025 DTD 11/15/2015
2020-01-29
2020-04-06
10000. U S TREAS. BONDS 1.75% 05/15/2022 DTD 05/15/2012
2020-01-29
2020-04-06
10000. U.S. TREASURY NOTE 1.125% 09/30/2021 DTD 09/30/2016
2019-08-23
2020-04-06
10000. US TREASURY NOTE 2.250% 12/31/2023 DTD 01/03/2017
2020-01-29
2020-04-06
9000. US TREASURY BOND 2.5% 08/15/2023 DTD 08/15/2013
2019-12-10
2020-04-06
2000. U.S. TREASURY NOTE 1.625% 08/15/2029 DTD 08/15/2019
2019-08-23
2020-04-06
2000. WELLS FARGO 4.15% 01/24/2029 DTD 01/24/2019
2019-07-26
2020-04-06
290. CITIZENS FINANCIAL GROUP INC
2015-03-30
2020-04-07
240. CITIZENS FINANCIAL GROUP INC
2019-09-25
2020-04-07
20. COCA COLA CO
2019-11-21
2020-04-07
161. COCA COLA CO
2016-07-29
2020-04-07
50. COSTCO WHSL CORP NEW
2018-01-26
2020-04-07
430. DISCOVERY COMMUNICATIONS-C
2019-04-30
2020-04-07
130. EXPEDIA INC DEL COM NEW
2019-12-30
2020-04-07
90. HUNTINGTON INGALLS INDS INC COM
2019-08-02
2020-04-07
158. INGERSOLL RAND INC
2013-12-02
2020-04-07
57. JACOBS ENGR GROUP INC DEL
2018-02-12
2020-04-07
430. MGM RESORTS INTERNATIONAL
2018-05-14
2020-04-07
350. MGM RESORTS INTERNATIONAL
2019-05-01
2020-04-07
100. OCCIDENTAL PETROLEUM CO
2019-12-04
2020-04-07
430. OCCIDENTAL PETROLEUM CO
2018-04-25
2020-04-07
150. RAYTHEON TECHNOLOGIES
2018-11-28
2020-04-07
440. SCHWAB CHARLES CORP NEW COM
2019-07-26
2020-04-07
340. VENTAS INC COM REIT
2019-06-06
2020-04-07
90. WOODWARD INC
2020-01-23
2020-04-07
44. COCA COLA CO
2016-07-29
2020-04-08
110. EQUITABLE HOLDINGS INC
2018-05-23
2020-04-08
27. JACOBS ENGR GROUP INC DEL
2018-02-12
2020-04-08
122. MICROSOFT CORPORATION
2020-04-07
2020-04-08
52. RESTAURANT BRANDS INTERNATIONAL INC
2020-02-21
2020-04-08
150. CARRIER GLOBAL CORP
2018-11-28
2020-04-13
75. OTIS WORLDWIDE CORP
2018-11-28
2020-04-13
310. LKQ CORP COM
2020-02-24
2020-04-16
20. CENTENE CORP
2017-12-19
2020-04-21
3000. US TREASURY NOTES 2.25% 11/15/2027 DTD 11/15/2017
2018-01-19
2020-04-29
16000. US TREASURY BOND 2.125% 01/31/2021 DTD 01/31/2014
2019-02-20
2020-04-29
1000. U S TREASURY BOND 2.000% 02/15/2025 DTD 02/17/15
2019-05-16
2020-04-29
1000. U S TREASURY BOND 2.000% 02/15/2025 DTD 02/17/15
2018-10-30
2020-04-29
2000. U S TREAS. BONDS 1.75% 05/15/2022 DTD 05/15/2012
2020-01-29
2020-04-29
7000. U.S. TREASURY NOTE 1.625% 08/15/2029 DTD 08/15/2019
2019-11-21
2020-04-29
4. ALPHABET INC CL-C
2020-04-07
2020-05-01
7. BROADCOM INC
2020-04-07
2020-05-01
17. DOLLAR GENERAL CORP
2020-04-07
2020-05-01
41. DOLLAR TREE INC COM
2019-12-04
2020-05-01
96. MORGAN STANLEY GROUP INC. DEAN
2017-03-30
2020-05-01
30. WAL MART STORES INC
2020-04-07
2020-05-01
10. BOEING CO
2020-01-03
2020-05-11
100. BOEING CO
2013-12-02
2020-05-11
48. APPLIED MATERIALS
2020-04-17
2020-05-13
230. APPLIED MATERIALS
2013-12-02
2020-05-13
31. CARMAX INC
2018-10-01
2020-05-13
30. CARMAX INC
2019-12-30
2020-05-13
33.804 LIBERTY MEDIA CORP - RIGHT
2020-05-21
2020-05-21
33. LIBERTY MEDIA CORP - RIGHT
2020-05-21
2020-05-29
1. LIBERTY MEDIA CORP - RIGHT
2020-05-21
2020-06-03
46. NEXSTAR MEDIA GROUP INC - CL A
2020-01-23
2020-06-03
132. PERFORMANCE FOOD GROUP CO
2020-04-07
2020-06-03
16. DOLLAR TREE INC COM
2019-12-04
2020-06-05
17. NEXSTAR MEDIA GROUP INC - CL A
2020-01-23
2020-06-05
52. PERFORMANCE FOOD GROUP CO
2020-04-07
2020-06-05
3000. BANK OF AMERICA 3.248% 10/21/2027 DTD 10/21/2016
2019-02-20
2020-06-18
2000. BP CAP MKTS AMER 4.234% 11/06/2028 DTD 11/06/2018
2019-02-20
2020-06-18
115. PFIZER
2020-04-08
2020-06-18
730. PFIZER
2019-02-01
2020-06-18
5000. BANK OF NOVA SCOTIA 2.8% 07/21/2021 DTD 07/21/2014
2019-02-20
2020-06-30
8000. PROVINCE OF QUEBEC 2.750% 08/25/2021 DTD 08/25/11
2019-02-25
2020-06-30
4000. US TREASURY BOND 2.125% 01/31/2021 DTD 01/31/2014
2018-05-15
2020-06-30
5000. US TREASURY NOTES 2% 11/15/2026 DTD 11/15/2016
2019-11-21
2020-06-30
6. ALPHABET INC CL-C
2020-04-07
2020-07-08
7. ALPHABET INC CL-C
2018-09-19
2020-07-08
46. BROADCOM INC
2020-04-07
2020-07-08
93. DOLLAR TREE INC COM
2020-02-27
2020-07-08
58. FACEBOOK INC-A
2019-11-21
2020-07-08
20. MICROSOFT CORPORATION
2007-05-22
2020-07-08
106. MICROSOFT CORPORATION
2020-04-07
2020-07-08
89. KKR & CO INC - A
2019-08-28
2020-07-15
16. ASPEN TECHNOLOGY INC
2020-02-11
2020-07-21
97. DROPBOX INC - CLASS A
2020-07-15
2020-07-21
11. INTL FLAVORS & FRAGRANCES INC
2019-04-10
2020-07-21
78. KKR & CO INC - A
2019-08-28
2020-07-21
10. MARTIN MARIETTA MATLS INC COM
2020-04-07
2020-07-21
43. MICRON TECHNOLOGY INC COM
2020-06-05
2020-07-21
20. MIDDLEBY CORP
2019-07-18
2020-07-21
54. MORGAN STANLEY GROUP INC. DEAN
2017-03-30
2020-07-21
21. NEXSTAR MEDIA GROUP INC - CL A
2020-02-27
2020-07-21
20. UNIVERSAL DISPLAY CORP COM
2018-01-29
2020-07-21
23. WAL MART STORES INC
2020-04-07
2020-07-21
130. BOSTON SCIENTIFIC
2018-07-06
2020-07-29
3000. ONTARIO PROVINCE 2.2% 10/03/2022 DTD 10/03/2017
2020-07-09
2020-07-31
2000. ROYAL BANK OF CANADA 2.75% 2/01/2022 DTD 01/31/2017
2019-02-20
2020-07-31
1000. TOYOTA MOTOR CR 2.6% 01/11/2022 DTD 01/09/2017
2019-02-20
2020-07-31
3000. TOYOTA MOTOR CR 2.6% 01/11/2022 DTD 01/09/2017
2020-07-09
2020-07-31
6000. US TREASURY NOTE 2.250 11/15/2025 DTD 11/15/2015
2020-07-09
2020-07-31
3000. U.S. TREASURY NOTE 1.125% 09/30/2021 DTD 09/30/2016
2020-07-09
2020-07-31
5000. US TREASURY NOTES 2% 11/15/2026 DTD 11/15/2016
2019-11-21
2020-07-31
CAPITAL GAIN DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
10,446
2,931
7,515
b
13,713
4,103
9,610
c
11,793
12,139
-346
d
15,127
15,033
94
e
5,042
5,040
2
11,141
4,580
6,561
3,870
3,240
630
5,249
1,538
3,711
6,477
8,907
-2,430
9,388
11,540
-2,152
10,067
10,007
60
15,732
11,114
4,618
10,539
6,975
3,564
10,772
10,582
190
9,003
6,608
2,395
14,905
4,639
10,266
8,684
8,598
86
18,819
20,720
-1,901
5,197
5,087
110
5,162
5,091
71
10,072
9,794
278
15,344
7,186
8,158
2,321
1,611
710
4,641
4,099
542
6,211
2,851
3,360
5,025
5,036
-11
5,083
4,782
301
1,047
690
357
1,224
1,032
192
799
714
85
1,546
573
973
1,245
2,627
-1,382
1,018
950
68
17,520
3,403
14,117
1,960
1,174
786
390
428
-38
940
881
59
6,729
3,475
3,254
2,895
209
2,686
1,327
567
760
16,414
7,009
9,405
14,767
6,184
8,583
5,157
5,001
156
3,922
3,097
825
5,011
4,957
54
15,261
15,126
135
5,086
5,012
74
5,267
5,085
182
5,460
5,041
419
15,086
15,066
20
5,141
5,051
90
5,163
5,097
66
3,612
5,215
-1,603
6,295
10,901
-4,606
12,434
2,166
10,268
13,237
3,951
9,286
18
12
6
3,025
2,982
43
3,173
3,154
19
2,060
1,994
66
2,056
2,011
45
4,140
3,899
241
1,995
2,064
-69
2,038
2,067
-29
5,106
4,903
203
2,050
2,003
47
3,066
2,992
74
2,105
2,040
65
3,009
2,982
27
3,110
2,970
140
6,231
6,070
161
10,150
9,982
168
15,225
14,966
259
5,409
5,187
222
4,327
4,061
266
4,295
3,952
343
4,379
4,171
208
10,307
10,073
234
10,104
9,922
182
10,687
10,275
412
9,639
9,261
378
2,174
2,018
156
2,168
2,176
-8
5,727
7,061
-1,334
4,740
8,285
-3,545
941
1,061
-120
7,575
7,089
486
15,250
9,945
5,305
8,046
12,374
-4,328
7,392
13,924
-6,532
17,457
19,012
-1,555
3,944
2,281
1,663
4,724
3,627
1,097
5,906
13,822
-7,916
4,807
9,077
-4,270
1,385
4,089
-2,704
5,955
35,225
-29,270
8,720
11,189
-2,469
15,477
18,893
-3,416
9,385
20,774
-11,389
5,502
10,808
-5,306
2,075
1,920
155
1,678
2,400
-722
2,204
1,718
486
20,135
20,196
-61
2,193
3,416
-1,223
2,138
3,214
-1,076
3,494
4,902
-1,408
6,142
10,073
-3,931
1,342
1,010
332
3,358
2,899
459
16,161
15,874
287
1,071
988
83
1,071
942
129
2,063
2,014
49
7,651
6,972
679
5,259
4,793
466
1,814
1,807
7
2,948
2,863
85
3,180
3,664
-484
3,674
4,191
-517
3,669
3,692
-23
1,297
3,325
-2,028
12,975
13,440
-465
2,493
2,530
-37
11,944
3,951
7,993
2,306
2,290
16
2,232
2,624
-392
357
357
13
13
4,203
5,927
-1,724
3,824
3,432
392
1,514
1,430
84
1,698
2,191
-493
1,643
1,352
291
3,311
2,881
430
2,334
2,100
234
3,812
3,993
-181
24,200
26,915
-2,715
5,120
4,985
135
8,223
8,012
211
3,996
3,938
58
5,493
5,091
402
8,949
7,190
1,759
10,440
8,195
2,245
14,510
11,872
2,638
8,348
8,181
167
13,825
11,517
2,308
4,200
619
3,581
22,257
17,547
4,710
3,106
2,290
816
1,561
2,056
-495
2,197
1,961
236
1,420
1,432
-12
2,795
2,007
788
2,257
1,874
383
2,224
2,330
-106
1,709
2,759
-1,050
2,825
2,358
467
1,752
2,642
-890
3,081
3,240
-159
3,052
2,831
221
5,131
4,300
831
3,120
3,119
1
2,073
1,995
78
1,032
994
38
3,095
3,093
2
6,627
6,608
19
3,034
3,034
5,512
5,090
422
324
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
7,515
b
9,610
c
-346
d
94
e
2
6,561
630
3,711
-2,430
-2,152
60
4,618
3,564
190
2,395
10,266
86
-1,901
110
71
278
8,158
710
542
3,360
-11
301
357
192
85
973
-1,382
68
14,117
786
-38
59
3,254
2,686
760
9,405
8,583
156
825
54
135
74
182
419
20
90
66
-1,603
-4,606
10,268
9,286
6
43
19
66
45
241
-69
-29
203
47
74
65
27
140
161
168
259
222
266
343
208
234
182
412
378
156
-8
-1,334
-3,545
-120
486
5,305
-4,328
-6,532
-1,555
1,663
1,097
-7,916
-4,270
-2,704
-29,270
-2,469
-3,416
-11,389
-5,306
155
-722
486
-61
-1,223
-1,076
-1,408
-3,931
332
459
287
83
129
49
679
466
7
85
-484
-517
-23
-2,028
-465
-37
7,993
16
-392
357
13
-1,724
392
84
-493
291
430
234
-181
-2,715
135
211
58
402
1,759
2,245
2,638
167
2,308
3,581
4,710
816
-495
236
-12
788
383
-106
-1,050
467
-890
-159
221
831
1
78
38
2
19
422
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
55,194
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
94,819
1,909,930
0.049645
2017
96,439
1,957,026
0.049278
2016
75,585
1,873,646
0.040341
2015
97,229
1,796,866
0.05411
2014
96,337
1,942,042
0.049606
2
Total
of line 1, column (d)
.....................
2
0.24298
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
0.048596
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
1,925,599
5
Multiply line 4 by line 3
......................
5
93,576
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
580
7
Add lines 5 and 6
........................
7
94,156
8
Enter qualifying distributions from Part XII, line 4
,.............
8
96,355
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
580
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
580
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
580
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
868
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
868
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
288
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
288
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
NH
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
TD Bank NA
Telephone no.
(877) 773-1229
Located at
143 NORTH MAIN STREET
CONCORD
NH
ZIP+4
03302
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
TD Bank NA
TRUSTEE
1
28,619
143 North Main Street
CONCORD
,
NH
033020477
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
NONE
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
1,872,655
b
Average of monthly cash balances
.......................
1b
82,268
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
1,954,923
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
1,954,923
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
29,324
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
1,925,599
6
Minimum investment return.
Enter 5% of line 5
..................
6
96,280
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
96,280
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
580
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
580
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
95,700
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
95,700
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
95,700
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
96,355
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
96,355
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
580
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
95,775
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
95,700
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
0
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
0
b
From 2015
......
1,560
c
From 2016
......
0
d
From 2017
......
1,165
e
From 2018
......
1,052
f
Total
of lines 3a through e
........
3,777
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
96,355
a
Applied to 2018, but not more than line 2a
0
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2019 distributable amount
.....
95,700
e
Remaining amount distributed out of corpus
655
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
4,432
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
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
4,432
10
Analysis of line 9:
a
Excess from 2015
....
1,560
b
Excess from 2016
....
0
c
Excess from 2017
....
1,165
d
Excess from 2018
....
1,052
e
Excess from 2019
....
655
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.
NONE
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
SPAULDING YOUTH CENTER
72 SPAULDING ROAD
NORTHFIELD
,
NH
03276
NONE
501(C)(3)
DAILY OPERATIONS
24,089
CONCORD FEMALE CHARITABLE SOCIETY
ATTN JUDY FOX
CONCORD
,
NH
033022611
NONE
501(C)(3)
DAILY OPERATIONS
24,089
CONCORD HOSPITAL
RICHARD FORD
250 PLEASANT STREET
CONCORD
,
NH
03301
NONE
501(C)(3)
DAILY OPERATIONS
48,177
Total
.................................
3a
96,355
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
14
33,959
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
55,194
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
990PF REFUND
1
847
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
90,000
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
90,000
(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