-
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
04-01-2019
, and ending
03-31-2020
Name of foundation
OBICI HEALTHCARE FOUNDATION INC
Number and street (or P.O. box number if mail is not delivered to street address)
106 W FINNEY AVENUE
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
SUFFOLK
,
VA
23434
A Employer identification number
51-0249728
B
Telephone number (see instructions)
(757) 539-8810
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)
$
105,498,671
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
...
256,390
256,390
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
4,996,617
b
Gross sales price for all assets on line 6a
13,800,603
7
Capital gain net income (from Part IV, line 2)
...
4,997,631
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)
.......
197,409
3,154,040
0
12
Total.
Add lines 1 through 11
........
5,450,416
8,408,061
0
13
Compensation of officers, directors, trustees, etc.
320,300
0
0
320,300
14
Other employee salaries and wages
......
391,189
0
0
391,189
15
Pension plans, employee benefits
.......
216,995
0
0
172,626
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
47,600
0
0
47,600
c
Other professional fees (attach schedule)
....
711,367
697,870
0
13,497
17
Interest
...............
47,733
0
0
0
18
Taxes (attach schedule) (see instructions)
...
395
0
0
395
19
Depreciation (attach schedule) and depletion
...
94,726
0
0
20
Occupancy
..............
76,807
0
0
77,530
21
Travel, conferences, and meetings
.......
47,752
0
0
50,651
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
407,299
0
0
352,338
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
2,362,163
697,870
0
1,426,126
25
Contributions, gifts, grants paid
.......
7,104,661
4,246,461
26
Total expenses and disbursements.
Add lines 24 and 25
9,466,824
697,870
0
5,672,587
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-4,016,408
b
Net investment income
(if negative, enter -0-)
7,710,191
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
.............
24,790
165,727
165,727
2
Savings and temporary cash investments
.........
5,894,805
2,662,636
2,662,636
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
..........
78,985
21,850
21,850
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
7,741,825
10,438,251
10,438,251
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
106,259,153
90,115,660
90,115,660
14
Land, buildings, and equipment: basis
2,417,471
Less: accumulated depreciation (attach schedule)
1,009,189
1,499,577
1,408,282
1,408,282
15
Other assets (describe
)
760,515
686,265
686,265
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
122,259,650
105,498,671
105,498,671
17
Accounts payable and accrued expenses
..........
31,855
99,322
18
Grants payable
.................
1,275,226
4,133,426
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
1,204,658
1,120,314
22
Other liabilities (describe
)
575,969
273,424
23
Total liabilities
(add lines 17 through 22)
.........
3,087,708
5,626,486
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
119,171,942
99,872,185
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances
(see instructions)
.....
119,171,942
99,872,185
30
Total liabilities and net assets/fund balances
(see instructions)
.
122,259,650
105,498,671
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
119,171,942
2
Enter amount from Part I, line 27a
.....................
2
-4,016,408
3
Other increases not included in line 2 (itemize)
3
14,193
4
Add lines 1, 2, and 3
..........................
4
115,169,727
5
Decreases not included in line 2 (itemize)
5
15,297,542
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
99,872,185
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
NET GAINS/LOSSES FROM SALES OF SECURITIES
P
2020-03-30
b
NET GAINS/LOSSES FROM SALES OF OTHER ASSETS
P
2020-03-30
c
FOREIGN CORPORATION REDEMPTIONS
P
2020-03-30
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
371,029
371,029
b
0
c
13,429,574
8,802,972
4,626,602
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
371,029
b
0
c
4,626,602
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
4,997,631
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
4,997,631
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
Yes
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2018
5,009,791
117,620,262
0.042593
2017
5,353,624
116,763,646
0.045850
2016
5,511,690
107,219,885
0.051405
2015
5,681,173
109,186,883
0.052032
2014
5,283,993
113,701,688
0.046472
2
Total
of line 1, column (d)
.....................
2
0.238352
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
0.047670
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
118,272,343
5
Multiply line 4 by line 3
......................
5
5,638,043
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
77,102
7
Add lines 5 and 6
........................
7
5,715,145
8
Enter qualifying distributions from Part XII, line 4
,.............
8
5,677,233
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
154,204
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
154,204
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
154,204
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
116,200
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
120,000
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
236,200
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
81,996
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
81,996
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.
$
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
Yes
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
Yes
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)
VA
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
HTTP://WWW.OBICIHCF.ORG
14
The books are in care of
ANNETTE C BEUCHLER
Telephone no.
(757) 539-8810
Located at
106 W FINNEY AVENUE
SUFFOLK
VA
ZIP+4
23434
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
2018
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
Yes
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
R SCOTT CARR
CHAIRMAN
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
LYNNE RABIL
VICE-CHAIRMAN
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
THOMAS WOODWARD III
TREASURER
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
ROBERT C BARCLAY IV
BOARD OF DIRECTORS
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
ROBERT C CLAUD
BOARD OF DIRECTORS
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
PAT EDWARDS
BOARD OF DIRECTORS
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
JEFFREY D FORMAN
BOARD OF DIRECTORS
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
RALPH HOWELL JR
BOARD OF DIRECTORS
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
EMANUEL MYRICK
BOARD OF DIRECTORS
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
BILL PEAK
BOARD OF DIRECTORS
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
MELISSA ROLLINS
BOARD OF DIRECTORS
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
JANICE WHITE
BOARD OF DIRECTORS
1.00
0
0
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
ANNETTE C BEUCHLER
PRESIDENT & CEO / BOARD SECRETARY
40.00
213,948
25,178
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
MICHAEL K BRINKLEY
DIRECTOR OF FINANCE
20.00
29,269
1,008
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
VICTORIA MASTON
DIRECTOR OF ADMINISTRATION
40.00
77,083
11,794
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
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
DIANE NELMS
COMMUNICATIONS MANAG
40.00
76,102
20,450
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
SARAH TAYLOR
PROGRAM OFFICER
40.00
81,000
11,832
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
FIONA CHARLES
PROGRAM OFFICER
40.00
75,563
11,861
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
JESSICA MULLEN
PROGRAM OFFICER
40.00
63,333
9,815
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
ANNA ROBERTS
EXECUTIVE ASSISTANT
40.00
55,542
16,576
0
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
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
CORNERSTONE PARTNERS LLC
INVESTMENT MANAGEMENT
505,655
675 PETER JEFFERSON PKWY STE 160
CHARLOTTESVILLE
,
VA
22911
CATCHAFIRE INC
CAPACITY BUILDING SUPPORT
95,000
31 E 32ND ST 3RD FLOOR
NEW YORK
,
NY
10016
SUNTRUST BANK INC
INVESTMENT CUSTODIAN
88,446
MAIL CODE 0210 / PO BOX 4655
ATLANTA
,
GA
30302
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
115,482,630
b
Average of monthly cash balances
.......................
1b
3,908,575
c
Fair market value of all other assets (see instructions)
................
1c
682,240
d
Total
(add lines 1a, b, and c)
.........................
1d
120,073,445
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
120,073,445
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
1,801,102
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
118,272,343
6
Minimum investment return.
Enter 5% of line 5
..................
6
5,913,617
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
5,913,617
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
154,204
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
154,204
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
5,759,413
4
Recoveries of amounts treated as qualifying distributions
................
4
14,193
5
Add lines 3 and 4
............................
5
5,773,606
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
5,773,606
Part XII
Qualifying Distributions
(see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26
..........
1a
5,672,587
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
4,646
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
5,677,233
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
5,677,233
Note:
The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
the section 4940(e) reduction of tax in those years.
Form
990-PF
(2019)
Form 990-PF (2019)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2018
(c)
2018
(d)
2019
1
Distributable amount for 2019 from Part XI, line 7
5,773,606
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
5,686,222
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:
$
5,677,233
a
Applied to 2018, but not more than line 2a
5,677,233
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
.....
0
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
.............
8,989
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
5,773,606
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:
GRANTS MANAGER
106 W FINNEY AVENUE
SUFFOLK
,
VA
23434
(757) 539-8810
b
The form in which applications should be submitted and information and materials they should include:
APPLICATIONS MUST BE SUBMITTED THROUGH THE FOUNDATION'S GRANT PORTAL ACCESSED THROUGH THE OBICI HEALTHCARE FOUNDATION WEBSITE: HTTPS://OBICIHCF.ORG/HOW-TO-APPLY/ THE FOLLOWING MATERIALS MUST ACCOMPANY THE PRIORITY GRANT APPLICATION: 1. IRS DETERMINATION LETTER OR A WRITTEN DOCUMENT CERTIFYING TAX EXEMPT STATUS 2. PROPOSAL COVER SHEET 3. PROJECT NARRATIVE 4. BUDGET WORKSHEET AND BUDGET NARRATIVE 5. CURRENT AUDITED FINANCIAL STATEMENTS OR 990 6. ANY OTHER SUPPLEMENTAL MATERIAL DETAILED IN THE RFP
c
Any submission deadlines:
PRIORITY GRANTS - DEADLINES VARY BY RFP COMMUNITY ENGAGEMENT GRANTS - NO DEADLINE
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
1. LOBBYING OR POLITICAL PROGRAMS OR EVENTS 2. ACTIVITIES THAT EXCLUSIVELY BENEFIT THE MEMBERS OF SECTARIAN OR RELIGIOUS ORGANIZATIONS 3. ORGANIZATIONS THAT DISCRIMINATE BY RACE, COLOR, CREED, GENDER OR NATIONAL ORIGIN 4. BIOMEDICAL, CLINICAL OR EDUCATIONAL RESEARCH 5. INDIVIDUAL SCHOLARSHIPS 6. DIRECT SUPPORT TO ENDOWMENTS 7. FUNDING THAT SUPPLANTS EXISTING SOURCES OF SUPPORT 8. INDIVIDUALS, INCLUDING PATIENT ASSISTANCE FUNDS 9. PROJECTS OUTSIDE OF THE FOUNDATION'S SERVICE AREA 10. MEETINGS AND CONFERENCES, UNLESS THEY ARE ESSENTIAL TO A LARGER PROJECT 11. DIRECT FUNDING FOR MEDICAL OR SOCIAL SERVICES THAT ARE ALREADY FUNDED THROUGH EXISTING THIRD-PARTY REIMBURSEMENT SOURCES 12. ORGANIZATIONS THAT DO NOT HAVE 501(C)(3) STATUS OR ARE NOT A PUBLIC ENTITY 13. PROJECTS NOT RELATED TO THE FOUNDATION'S MISSION STATEMENT
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
ALBEMARLE REGIONAL HEALTH SERVICES
PO BOX 189
ELIZABETH CITY
,
NC
27907
NONE
GOV
STRENGTHENING THE SAFETY NET
33,814
AMERICAN CANCER SOCIETY
4416 EXPRESSWAY DR
VIRGINIA BEACH
,
VA
23452
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
AMERICAN CANCER SOCIETY
4416 EXPRESSWAY DR
VIRGINIA BEACH
,
VA
23452
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
AMERICAN DIABETES ASSOCIATION
870 GREENBRIER CIRCLE SUITE 404
CHESAPEAKE
,
VA
23320
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
AMERICAN NATIONAL RED CROSS
611 W BRAMBLETON AVENUE
NORFOLK
,
VA
23510
NONE
PC
COMMUNITY ENGAGEMENT GRANT
3,000
ASSOCIATION OF FUNDRAISING PROFESSIONALS VA HAMPTON ROADS CHAPTER
AFP HAMPTON ROADS
NORFOLK
,
VA
23501
NONE
PC
COMMUNITY ENGAGEMENT GRANT
1,000
BLAKEY WEAVER COUNSELING CENTER INC
129 N SARATOGA STREET STE 1
SUFFOLK
,
VA
23434
NONE
PC
STRENGTHENING THE SAFETY NET
25,000
BOYS AND GIRLS CLUBS OF SOUTHEAST VIRGINIA
1300 DIAMOND SPRINGS ROAD SUITE 300
VIRGINIA BEACH
,
VA
23455
NONE
PC
HEALTHY BEHAVIORS
25,000
CENTER FOR NONPROFIT EXCELLENCE
1701-A ALLIED STREET
CHARLOTTESVILLE
,
VA
22903
NONE
PC
CAPACITY BUILDING
192,550
CENTER FOR NONPROFIT EXCELLENCE
1701-A ALLIED STREET
CHARLOTTESVILLE
,
VA
22903
NONE
PC
CAPACITY BUILDING
192,550
CITY OF SUFFOLK
442 WASHINGTON STREET
SUFFOLK
,
VA
23434
NONE
GOV
COMMUNITY ENGAGEMENT GRANT
5,000
COALITION AGAINST POVERTY IN SUFFOLK (CAPS)
PO BOX 1117
SUFFOLK
,
VA
23434
NONE
PC
COMMUNITY ENGAGEMENT GRANT
2,500
COVER 3 FOOTBALL DBA COVER 3 FOUNDATION
125 S COLLEGE DRIVE
FRANKLIN
,
VA
23851
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
COVER 3 FOOTBALL DBA COVER 3 FOUNDATION
125 S COLLEGE DRIVE
FRANKLIN
,
VA
23851
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
EASTERN VIRGINIA MEDICAL SCHOOL
PO BOX 1980
NORFOLK
,
VA
23501
NONE
PC
STRENGTHENING THE SAFETY NET
46,496
FOODBANK OF SOUTHEASTERN VIRGINIA
800 TIDEWATER DRIVE
NORFOLK
,
VA
23504
NONE
PC
HEALTHY BEHAVIORS
100,000
FORKIDS INC
4200 COLLEY AVENUE SUITE A
NORFOLK
,
VA
23508
NONE
PC
STRENGTHENING THE SAFETY NET
25,800
FORKIDS INC
4200 COLLEY AVENUE SUITE A
NORFOLK
,
VA
23508
NONE
PC
STRENGTHENING THE SAFETY NET
25,000
FORKIDS INC
4200 COLLEY AVENUE SUITE A
NORFOLK
,
VA
23508
NONE
PC
STRENGTHENING THE SAFETY NET
17,200
FORKIDS INC
4200 COLLEY AVENUE SUITE A
NORFOLK
,
VA
23508
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
FRANKLIN CITY PUBLIC SCHOOLS
207 W SECOND AVENUE
FRANKLIN
,
VA
23851
NONE
GOV
EARLY CHILDHOOD EDUCATION
10,340
GIRL SCOUT COUNCIL OF THE COLONIAL COAST
912 CEDAR RD
CHESAPEAKE
,
VA
23322
NONE
PC
HEALTHY BEHAVIORS
50,000
GIRLS ON THE RUN OF SOUTH HAMPTON ROADS
287 INDEPENDENCE BLVD STE 120
VIRGINIA BEACH
,
VA
23462
NONE
PC
HEALTHY BEHAVIORS
88,000
HAMPTON ROADS COMMUNITY HEALTH CENTER
664 LINCOLN ST
PORTSMOUTH
,
VA
23704
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
HIGH STREET UNITED METHODIST CHURCH
P O BOX 218
FRANKLIN
,
VA
23851
NONE
PC
COMMUNITY ENGAGEMENT GRANT
2,500
HORIZON HEALTH SERVICES INC
8314 MAIN STREET
IVOR
,
VA
23866
NONE
PC
STRENGTHENING THE SAFETY NET
40,000
HORIZON HEALTH SERVICES INC
8314 MAIN STREET
IVOR
,
VA
23866
NONE
PC
STRENGTHENING THE SAFETY NET
102,000
HORIZON HEALTH SERVICES INC
8314 MAIN STREET
IVOR
,
VA
23866
NONE
PC
STRENGTHENING THE SAFETY NET
68,000
HORIZON HEALTH SERVICES INC
8314 MAIN STREET
IVOR
,
VA
23866
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
ISLE OF WIGHT CHRISTIAN OUTREACH PROGRAM
402 GRACE STREET
SMITHFIELD
,
VA
23430
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
ISLE OF WIGHT COUNTY SCHOOLS
820 W MAIN ST
SMITHFIELD
,
VA
23430
NONE
GOV
EARLY CHILDHOOD EDUCATION
12,859
ISLE OF WIGHT EDUCATION FOUNDATION
PO BOX 113
SMITHFIELD
,
VA
23431
NONE
PC
COMMUNITY ENGAGEMENT GRANT
2,500
JDRF VIRGINIA
1801 LIBBIE AVE 106
RICHMOND
,
VA
23226
NONE
PC
COMMUNITY ENGAGEMENT GRANT
3,700
LIONS CHARITY FOUNDATION OF SOUTHEASTERN VIRGINIA
2357 HAVERSHAM CLOSE
VIRGINIA BEACH
,
VA
23454
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
MARCH OF DIMES INC
2800 ALBANY COURT
VIRGINIA BEACH
,
VA
23456
NONE
PC
COMMUNITY ENGAGEMENT GRANT
2,000
NATIONAL KIDNEY FOUNDATION
1622 E PARHAM RD
RICHMOND
,
VA
23228
NONE
PC
COMMUNITY ENGAGEMENT GRANT
2,500
RX DRUG ACCESS PARTNERSHIP
1500 FOREST AVE SUITE 200
RICHMOND
,
VA
23229
NONE
PC
STRENGTHENING THE SAFETY NET
9,000
RX DRUG ACCESS PARTNERSHIP
1500 FOREST AVE SUITE 200
RICHMOND
,
VA
23229
NONE
PC
STRENGTHENING THE SAFETY NET
6,000
SMART BEGINNINGS SOUTHEAST
209 E CAWSON ST
HOPEWELL
,
VA
23860
NONE
PC
HEALTHY BEHAVIORS
25,000
SOUTHAMPTON COUNTY PUBLIC SCHOOLS
21308 PLANK ROAD
COURTLAND
,
VA
23837
NONE
GOV
EARLY CHILDHOOD EDUCATION
19,927
SOUTHEAST 4-H EDUCATIONAL CENTER
15189 AIRFIELD ROAD
WAKEFIELD
,
VA
23888
NONE
PC
HEALTHY BEHAVIORS
50,000
SOUTHEASTERN VIRGINIA HEALTH SYSTEM
9492 WARWICK BLVD
NEWPORT NEWS
,
VA
23607
NONE
PC
STRENGTHENING THE SAFETY NET
50,000
STRAIGHTEN UP AND FLY RIGHT INC
141 CHURCH STREET
SUFFOLK
,
VA
23434
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
SUFFOLK ART LEAGUE
PO BOX 1086
SUFFOLK
,
VA
23439
NONE
PC
COMMUNITY ENGAGEMENT GRANT
1,000
SUFFOLK CENTER FOR CULTURAL ARTS
100 W FINNEY AVENUE
SUFFOLK
,
VA
23434
NONE
PC
COMMUNITY ENGAGEMENT GRANT
4,000
SUFFOLK CHRISTIAN FELLOWSHIP CENTER
211 E WASHINGTON ST
SUFFOLK
,
VA
23434
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
SUFFOLK MEALS ON WHEELS
2800 GODWIN BLVD
SUFFOLK
,
VA
23434
NONE
PC
STRENGTHENING THE SAFETY NET
5,872
SUFFOLK MEALS ON WHEELS
2800 GODWIN BLVD
SUFFOLK
,
VA
23434
NONE
PC
COMMUNITY ENGAGEMENT GRANT
1,700
SUFFOLK PUBLIC SCHOOLS
100 NORTH MAIN STREET
SUFFOLK
,
VA
23434
NONE
GOV
HEALTHY BEHAVIORS
25,000
SUFFOLK PUBLIC SCHOOLS
100 NORTH MAIN STREET
SUFFOLK
,
VA
23434
NONE
GOV
EARLY CHILDHOOD EDUCATION
45,486
SUFFOLK PUBLIC SCHOOLS
100 NORTH MAIN STREET
SUFFOLK
,
VA
23434
NONE
GOV
HEALTHY BEHAVIORS
50,000
SUFFOLK PUBLIC SCHOOLS
100 NORTH MAIN STREET
SUFFOLK
,
VA
23434
NONE
GOV
EARLY CHILDHOOD EDUCATION
90,000
SUFFOLK PUBLIC SCHOOLS
100 NORTH MAIN STREET
SUFFOLK
,
VA
23434
NONE
GOV
HEALTHY BEHAVIORS
100,000
SURRY COUNTY PUBLIC SCHOOLS
45 SCHOOL ST
SURRY
,
VA
23883
NONE
GOV
EARLY CHILDHOOD EDUCATION
12,966
SUSSEX COUNTY
15080 COURTHOUSE RD
SUSSEX
,
VA
23884
NONE
GOV
COMMUNITY ENGAGEMENT GRANT
1,500
THE CHILDREN'S CENTER
700 CAMPBELL AVE
FRANKLIN
,
VA
23851
NONE
PC
EARLY CHILDHOOD EDUCATION
10,846
THE CHILDREN'S CENTER
700 CAMPBELL AVE
FRANKLIN
,
VA
23851
NONE
PC
HEALTHY BEHAVIORS
50,000
THE CHILDREN'S CENTER
700 CAMPBELL AVE
FRANKLIN
,
VA
23851
NONE
PC
MATERNAL CHILD HEALTH
104,281
THE CHILDREN'S CENTER
700 CAMPBELL AVE
FRANKLIN
,
VA
23851
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
THE DOORWAYS FORMERLY HOSPITALITY HOUSE OF RICHMOND INC
612 E MARSHALL STREET
RICHMOND
,
VA
23219
NONE
PC
COMMUNITY ENGAGEMENT GRANT
4,000
THE GENIEVE SHELTER
2480 PRUDEN STREET SUITE A
SUFFOLK
,
VA
23434
NONE
PC
STRENGTHENING THE SAFETY NET
30,000
THE GENIEVE SHELTER
2480 PRUDEN STREET SUITE A
SUFFOLK
,
VA
23434
NONE
PC
STRENGTHENING THE SAFETY NET
20,000
THE GENIEVE SHELTER
2480 PRUDEN STREET SUITE A
SUFFOLK
,
VA
23434
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
THE SUFFOLK FOUNDATION
110 W FINNEY AVE
SUFFOLK
,
VA
23434
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
THE UP CENTER
150 BOUSH STREET SUITE 500
NORFOLK
,
VA
23510
NONE
PC
STRENGTHENING THE SAFETY NET
18,750
THE UP CENTER
150 BOUSH STREET SUITE 500
NORFOLK
,
VA
23510
NONE
PC
STRENGTHENING THE SAFETY NET
75,551
THE UP CENTER
150 BOUSH STREET SUITE 500
NORFOLK
,
VA
23510
NONE
PC
STRENGTHENING THE SAFETY NET
50,367
THE UP CENTER
150 BOUSH STREET SUITE 500
NORFOLK
,
VA
23510
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
THE YOUTH GROUP INC
PO BOX 124
BOYKINS
,
VA
23827
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
UNIVERSITY OF VIRGINIA
PO BOX 400195
CHARLOTTESVILLE
,
VA
22904
NONE
PC
EARLY CHILDHOOD EDUCATION
500,000
VIRGINIA LEGAL AID SOCIETY INC
513 CHURCH ST
LYNCHBURG
,
VA
24504
NONE
PC
STRENGTHENING THE SAFETY NET
60,000
VIRGINIA LEGAL AID SOCIETY INC
513 CHURCH ST
LYNCHBURG
,
VA
24504
NONE
PC
STRENGTHENING THE SAFETY NET
12,000
VIRGINIA LEGAL AID SOCIETY INC
513 CHURCH ST
LYNCHBURG
,
VA
24504
NONE
PC
STRENGTHENING THE SAFETY NET
109,800
VIRGINIA LEGAL AID SOCIETY INC
513 CHURCH ST
LYNCHBURG
,
VA
24504
NONE
PC
STRENGTHENING THE SAFETY NET
73,200
VIRGINIA SUPPORTIVE HOUSING
PO BOX 8585
RICHMOND
,
VA
23226
NONE
PC
COMMUNITY ENGAGEMENT GRANT
2,500
VOICES FOR KIDS CASA PROGRAM OF SOUTHEAST VIRGINIA
P O BOX 949 409 MAIN STREET
SMITHFIELD
,
VA
23431
NONE
PC
COMMUNITY ENGAGEMENT GRANT
2,300
WALK IN IT INC
108 NIBLICK CIRCLE
SUFFOLK
,
VA
23434
NONE
PC
COMMUNITY ENGAGEMENT GRANT
3,000
WAVERLY RESCUE SQUAD INC
115 BANK ST WAVERLY VA
WAVERLY
,
VA
23890
NONE
PC
COMMUNITY ENGAGEMENT GRANT
4,764
WESTERN TIDEWATER COMMUNITY SERVICES BOARD
7025 HARBOUR VIEW BLVD SUITE 119
SUFFOLK
,
VA
23435
NONE
PC
STRENGTHENING THE SAFETY NET
44,960
WESTERN TIDEWATER COMMUNITY SERVICES BOARD
7025 HARBOUR VIEW BLVD SUITE 119
SUFFOLK
,
VA
23435
NONE
PC
STRENGTHENING THE SAFETY NET
127,414
WESTERN TIDEWATER COMMUNITY SERVICES BOARD
7025 HARBOUR VIEW BLVD SUITE 119
SUFFOLK
,
VA
23435
NONE
PC
STRENGTHENING THE SAFETY NET
84,942
WESTERN TIDEWATER FREE CLINIC
2019 MEADE PARKWAY
SUFFOLK
,
VA
23434
NONE
PC
STRENGTHENING THE SAFETY NET
238,000
WESTERN TIDEWATER FREE CLINIC
2019 MEADE PARKWAY
SUFFOLK
,
VA
23434
NONE
PC
STRENGTHENING THE SAFETY NET
296,400
WESTERN TIDEWATER FREE CLINIC
2019 MEADE PARKWAY
SUFFOLK
,
VA
23434
NONE
PC
STRENGTHENING THE SAFETY NET
197,600
WESTERN TIDEWATER HEALTH DISTRICT
135 HALL AVENUE
SUFFOLK
,
VA
23434
NONE
GOV
MATERNAL CHILD HEALTH
4,800
WESTERN TIDEWATER HEALTH DISTRICT
135 HALL AVENUE
SUFFOLK
,
VA
23434
NONE
GOV
MATERNAL CHILD HEALTH
45,000
WESTERN TIDEWATER HEALTH DISTRICT
135 HALL AVENUE
SUFFOLK
,
VA
23434
NONE
GOV
MATERNAL CHILD HEALTH
263,033
WESTERN TIDEWATER TENNIS ASSOCIATION
136 WYNNWOOD DRIVE
FRANKLIN
,
VA
23851
NONE
PC
COMMUNITY ENGAGEMENT GRANT
2,000
YMCA OF SOUTH HAMPTON ROADS
2769 GODWIN BLVD
SUFFOLK
,
VA
23434
NONE
PC
HEALTHY BEHAVIORS
25,000
YMCA OF SOUTH HAMPTON ROADS
2769 GODWIN BLVD
SUFFOLK
,
VA
23434
NONE
PC
HEALTHY BEHAVIORS
100,000
YMCA OF SOUTH HAMPTON ROADS
2769 GODWIN BLVD
SUFFOLK
,
VA
23434
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
YMCA OF SOUTH HAMPTON ROADS
2769 GODWIN BLVD
SUFFOLK
,
VA
23434
NONE
PC
COMMUNITY ENGAGEMENT GRANT
5,000
Total
.................................
3a
4,232,268
b
Approved for future payment
EASTERN VIRGINIA MEDICAL SCHOOL
PO BOX 1980
NORFOLK
,
VA
23501
NONE
PC
STRENGTHENING THE SAFETY NET
84,640
FOODBANK OF SOUTHEASTERN VIRGINIA
800 TIDEWATER DRIVE
NORFOLK
,
VA
23504
NONE
PC
HEALTHY BEHAVIORS
100,000
FORKIDS INC
4200 COLLEY AVENUE SUITE A
NORFOLK
,
VA
23508
NONE
PC
STRENGTHENING THE SAFETY NET
16,000
FORKIDS INC
4200 COLLEY AVENUE SUITE A
NORFOLK
,
VA
23508
NONE
PC
STRENGTHENING THE SAFETY NET
24,000
FORKIDS INC
4200 COLLEY AVENUE SUITE A
NORFOLK
,
VA
23508
NONE
PC
STRENGTHENING THE SAFETY NET
24,000
FORKIDS INC
4200 COLLEY AVENUE SUITE A
NORFOLK
,
VA
23508
NONE
PC
STRENGTHENING THE SAFETY NET
16,000
GIRLS ON THE RUN OF SOUTH HAMPTON ROADS
287 INDEPENDENCE BLVD STE 120
VIRGINIA BEACH
,
VA
23462
NONE
PC
HEALTHY BEHAVIORS
100,000
GIRLS ON THE RUN OF SOUTH HAMPTON ROADS
287 INDEPENDENCE BLVD STE 120
VIRGINIA BEACH
,
VA
23462
NONE
PC
HEALTHY BEHAVIORS
100,000
HORIZON HEALTH SERVICES INC
8314 MAIN STREET
IVOR
,
VA
23866
NONE
PC
STRENGTHENING THE SAFETY NET
68,000
HORIZON HEALTH SERVICES INC
8314 MAIN STREET
IVOR
,
VA
23866
NONE
PC
STRENGTHENING THE SAFETY NET
68,000
HORIZON HEALTH SERVICES INC
8314 MAIN STREET
IVOR
,
VA
23866
NONE
PC
STRENGTHENING THE SAFETY NET
102,000
HORIZON HEALTH SERVICES INC
8314 MAIN STREET
IVOR
,
VA
23866
NONE
PC
STRENGTHENING THE SAFETY NET
102,000
PAUL D CAMP COMMUNITY COLLEGE FOUNDATION
100 NORTH COLLEGE DRIVE
FRANKLIN
,
VA
23851
NONE
PC
HEALTHY BEHAVIORS
50,000
RX DRUG ACCESS PARTNERSHIP
1500 FOREST AVE SUITE 200
RICHMOND
,
VA
23229
NONE
PC
STRENGTHENING THE SAFETY NET
8,000
RX DRUG ACCESS PARTNERSHIP
1500 FOREST AVE SUITE 200
RICHMOND
,
VA
23229
NONE
PC
STRENGTHENING THE SAFETY NET
12,000
RX DRUG ACCESS PARTNERSHIP
1500 FOREST AVE SUITE 200
RICHMOND
,
VA
23229
NONE
PC
STRENGTHENING THE SAFETY NET
12,000
RX DRUG ACCESS PARTNERSHIP
1500 FOREST AVE SUITE 200
RICHMOND
,
VA
23229
NONE
PC
STRENGTHENING THE SAFETY NET
8,000
SUFFOLK PUBLIC SCHOOLS
100 NORTH MAIN STREET
SUFFOLK
,
VA
23434
NONE
GOV
HEALTHY BEHAVIORS
100,000
SUFFOLK PUBLIC SCHOOLS
100 NORTH MAIN STREET
SUFFOLK
,
VA
23434
NONE
GOV
HEALTHY BEHAVIORS
100,000
THE CHILDREN'S CENTER
700 CAMPBELL AVE
FRANKLIN
,
VA
23851
NONE
PC
MATERNAL CHILD HEALTH
59,518
THE CHILDREN'S CENTER
700 CAMPBELL AVE
FRANKLIN
,
VA
23851
NONE
PC
MATERNAL CHILD HEALTH
89,278
THE CHILDREN'S CENTER
700 CAMPBELL AVE
FRANKLIN
,
VA
23851
NONE
PC
MATERNAL CHILD HEALTH
66,398
THE CHILDREN'S CENTER
700 CAMPBELL AVE
FRANKLIN
,
VA
23851
NONE
PC
MATERNAL CHILD HEALTH
99,597
THE UP CENTER
150 BOUSH STREET SUITE 500
NORFOLK
,
VA
23510
NONE
PC
STRENGTHENING THE SAFETY NET
79,597
THE UP CENTER
150 BOUSH STREET SUITE 500
NORFOLK
,
VA
23510
NONE
PC
STRENGTHENING THE SAFETY NET
51,788
THE UP CENTER
150 BOUSH STREET SUITE 500
NORFOLK
,
VA
23510
NONE
PC
STRENGTHENING THE SAFETY NET
77,683
THE UP CENTER
150 BOUSH STREET SUITE 500
NORFOLK
,
VA
23510
NONE
PC
STRENGTHENING THE SAFETY NET
53,064
VIRGINIA LEGAL AID SOCIETY INC
PO BOX 6200
LYNCHBURG
,
VA
24505
NONE
PC
STRENGTHENING THE SAFETY NET
109,800
VIRGINIA LEGAL AID SOCIETY INC
PO BOX 6200
LYNCHBURG
,
VA
24505
NONE
PC
STRENGTHENING THE SAFETY NET
73,200
VIRGINIA LEGAL AID SOCIETY INC
PO BOX 6200
LYNCHBURG
,
VA
24505
NONE
PC
STRENGTHENING THE SAFETY NET
73,200
VIRGINIA LEGAL AID SOCIETY INC
PO BOX 6200
LYNCHBURG
,
VA
24505
NONE
PC
STRENGTHENING THE SAFETY NET
109,800
WESTERN TIDEWATER COMMUNITY SERVICES BOARD
7025 HARBOUR VIEW BLVD SUITE 119
SUFFOLK
,
VA
23435
NONE
PC
STRENGTHENING THE SAFETY NET
84,942
WESTERN TIDEWATER COMMUNITY SERVICES BOARD
7025 HARBOUR VIEW BLVD SUITE 119
SUFFOLK
,
VA
23435
NONE
PC
STRENGTHENING THE SAFETY NET
84,942
WESTERN TIDEWATER COMMUNITY SERVICES BOARD
7025 HARBOUR VIEW BLVD SUITE 119
SUFFOLK
,
VA
23435
NONE
PC
STRENGTHENING THE SAFETY NET
127,414
WESTERN TIDEWATER COMMUNITY SERVICES BOARD
7025 HARBOUR VIEW BLVD SUITE 119
SUFFOLK
,
VA
23435
NONE
PC
STRENGTHENING THE SAFETY NET
127,414
WESTERN TIDEWATER FREE CLINIC
2019 MEADE PARKWAY
SUFFOLK
,
VA
23434
NONE
PC
STRENGTHENING THE SAFETY NET
288,000
WESTERN TIDEWATER FREE CLINIC
2019 MEADE PARKWAY
SUFFOLK
,
VA
23434
NONE
PC
STRENGTHENING THE SAFETY NET
192,000
WESTERN TIDEWATER FREE CLINIC
2019 MEADE PARKWAY
SUFFOLK
,
VA
23434
NONE
PC
STRENGTHENING THE SAFETY NET
280,200
WESTERN TIDEWATER FREE CLINIC
2019 MEADE PARKWAY
SUFFOLK
,
VA
23434
NONE
PC
STRENGTHENING THE SAFETY NET
186,800
WESTERN TIDEWATER HEALTH DISTRICT
135 HALL AVENUE
SUFFOLK
,
VA
23434
NONE
GOV
MATERNAL CHILD HEALTH
103,586
WESTERN TIDEWATER HEALTH DISTRICT
135 HALL AVENUE
SUFFOLK
,
VA
23434
NONE
GOV
MATERNAL CHILD HEALTH
155,380
WESTERN TIDEWATER HEALTH DISTRICT
135 HALL AVENUE
SUFFOLK
,
VA
23434
NONE
GOV
MATERNAL CHILD HEALTH
106,074
WESTERN TIDEWATER HEALTH DISTRICT
135 HALL AVENUE
SUFFOLK
,
VA
23434
NONE
GOV
MATERNAL CHILD HEALTH
159,111
YMCA OF SOUTH HAMPTON ROADS
2769 GODWIN BLVD
SUFFOLK
,
VA
23434
NONE
PC
HEALTHY BEHAVIORS
100,000
YMCA OF SOUTH HAMPTON ROADS
2769 GODWIN BLVD
SUFFOLK
,
VA
23434
NONE
PC
HEALTHY BEHAVIORS
100,000
Total
.................................
3b
4,133,426
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
256,390
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
197,409
8
Gain or (loss) from sales of assets other than
inventory
............
18
4,996,617
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
5,450,416
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
5,450,416
(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