-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0052
20
19
Open to Public Inspection
For calendar year 2019, or tax year beginning
01-01-2019
, and ending
12-31-2019
Name of foundation
GIBBS H BROWNELL FUND
Number and street (or P.O. box number if mail is not delivered to street address)
2751 CENTERVILLE RD STE 400
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WILMINGTON
,
DE
19808
A Employer identification number
34-7023040
B
Telephone number (see instructions)
(302) 246-5400
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)
$
1,321,895
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
...
24,078
24,078
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
37,412
b
Gross sales price for all assets on line 6a
298,825
7
Capital gain net income (from Part IV, line 2)
...
37,412
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)
.......
12
Total.
Add lines 1 through 11
........
61,490
61,490
13
Compensation of officers, directors, trustees, etc.
6,063
4,547
1,516
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)
.......
500
0
0
500
c
Other professional fees (attach schedule)
....
18,995
18,995
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
1,619
754
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)
.......
68
68
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
27,245
24,364
0
2,016
25
Contributions, gifts, grants paid
.......
0
0
26
Total expenses and disbursements.
Add lines 24 and 25
27,245
24,364
0
2,016
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
34,245
b
Net investment income
(if negative, enter -0-)
37,126
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
.............
33,255
409
409
2
Savings and temporary cash investments
.........
12,424
30,856
30,856
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)
b
Investments—corporate stock (attach schedule)
.......
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)
..........
765,580
823,265
1,290,630
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)
811,259
854,530
1,321,895
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
........
811,259
854,530
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)
.....
811,259
854,530
30
Total liabilities and net assets/fund balances
(see instructions)
.
811,259
854,530
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
811,259
2
Enter amount from Part I, line 27a
.....................
2
34,245
3
Other increases not included in line 2 (itemize)
3
14,652
4
Add lines 1, 2, and 3
..........................
4
860,156
5
Decreases not included in line 2 (itemize)
5
5,626
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
854,530
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
8. MCCORMICK & CO INC/MD
2017-10-04
2019-01-02
b
5000. US TREASURY BOND 2.000%
2018-12-19
2019-01-02
c
13. CELGENE CORP
2009-01-08
2019-01-03
d
7. CELGENE CORP
2017-10-27
2019-01-03
e
50. CITIGROUP INC
2014-02-06
2019-01-03
13. MCCORMICK & CO INC/MD
2017-10-04
2019-01-03
3. MCCORMICK & CO INC/MD
2017-10-04
2019-01-07
3. CELGENE CORP
2009-01-08
2019-01-08
5. CELGENE CORP
2009-01-08
2019-01-10
3. MCCORMICK & CO INC/MD
2017-08-09
2019-01-10
5. ORIX CORP
2013-12-17
2019-01-11
5. ORIX CORP
2013-12-17
2019-01-15
4. ORIX CORP
2013-12-17
2019-01-16
6. ORIX CORP
2013-12-17
2019-01-16
2. CELGENE CORP
2009-01-08
2019-01-17
1. MCCORMICK & CO INC/MD
2017-08-09
2019-01-17
1. ORIX CORP
2011-01-06
2019-01-17
3. ORIX CORP
2011-01-06
2019-01-17
4. HOYA CORP
2013-11-07
2019-01-18
2. ORIX CORP
2011-01-06
2019-01-18
5. HOYA CORP
2013-11-07
2019-01-22
7. ORIX CORP
2011-01-07
2019-01-22
3. RED HAT INC
2013-11-18
2019-01-22
4. REGENERON PHARMACEUTICALS INC
2017-01-06
2019-01-22
8. HOYA CORP
2013-11-07
2019-01-23
2. MCCORMICK & CO INC/MD
2017-08-09
2019-01-23
7. ORIX CORP
2011-01-07
2019-01-23
7. HOYA CORP
2013-11-07
2019-01-24
3. MARTIN MARIETTA MATERIALS INC
2014-02-07
2019-01-25
8. CELGENE CORP
2009-01-08
2019-01-30
2. RED HAT INC
2013-11-13
2019-01-30
6. CELGENE CORP
2009-05-28
2019-01-31
6. CELGENE CORP
2009-05-28
2019-02-04
7. CELGENE CORP
2009-05-28
2019-02-05
16. MARSH & MCLENNAN COS INC
2012-06-01
2019-02-06
3. RED HAT INC
2013-11-13
2019-02-07
12. CELGENE CORP
2009-05-28
2019-02-08
6. ORACLE CORPORATION
2018-01-31
2019-02-08
31. YUM CHINA HOLDINGS INC
2017-07-07
2019-02-08
7. RENTOKIL INITIAL PLC
2018-10-18
2019-02-11
6000. LOCKHEED MARTIN CORP SR GLBL
2016-02-03
2019-02-20
2000. LOCKHEED MARTIN CORP SR GLBL
2018-06-20
2019-02-20
3000. US TREASURY NOTE 3.375% 11/15/19
2009-12-10
2019-02-20
4000. US TREASURY NOTE 3.375% 11/15/19
2018-01-29
2019-02-20
11. ECOLAB INC
2016-01-05
2019-03-01
104. VALE SA
2016-11-10
2019-03-06
23. HALLIBURTON CO
2015-02-25
2019-03-07
13. HALLIBURTON CO
2018-09-07
2019-03-07
2. REGENERON PHARMACEUTICALS INC
2014-07-30
2019-03-07
12. RENTOKIL INITIAL PLC
2017-06-26
2019-03-07
13. RENTOKIL INITIAL PLC
2018-10-18
2019-03-07
3. REGENERON PHARMACEUTICALS INC
2014-07-28
2019-03-08
1. REGENERON PHARMACEUTICALS INC
2014-07-28
2019-03-11
5. ERSTE GROUP BANK AG
2017-09-06
2019-03-12
21. ERSTE GROUP BANK AG
2018-08-01
2019-03-12
6. YUM CHINA HOLDINGS INC
2016-11-11
2019-03-18
2. BLACKROCK INC
2009-03-30
2019-03-19
.33 FOX CORP B COM
2012-06-01
2019-03-20
71. TWENTY-FIRST CENTY FOX
2005-12-22
2019-03-20
68. TWENTY-FIRST CENTY FOX
2012-06-01
2019-03-20
18. AFLAC INC
2017-06-09
2019-03-22
5. CANADIAN PACIFIC RAILWAY LTD
2017-05-11
2019-03-22
8. YUM CHINA HOLDINGS INC
2016-11-11
2019-03-25
2. ANTHEM INC
2012-06-01
2019-03-27
1. HONEYWELL INTERNATIONAL INC COM
2019-02-04
2019-03-27
8. HONEYWELL INTERNATIONAL INC COM
2019-02-04
2019-03-27
1. BAIDU.COM
2018-01-16
2019-03-28
7. YUM CHINA HOLDINGS INC
2016-11-11
2019-03-28
6. BAIDU.COM
2018-02-15
2019-03-29
3. BAIDU.COM
2018-04-30
2019-03-29
7. YUM CHINA HOLDINGS INC
2016-11-11
2019-04-01
2. RED HAT INC
2013-11-13
2019-04-02
6. YUM CHINA HOLDINGS INC
2016-11-09
2019-04-03
7000. UNITED STATES TREAS BILLS DTD 10/04/2018
2019-01-17
2019-04-04
6. YUM CHINA HOLDINGS INC
2016-11-09
2019-04-04
2. BIOGEN IDEC INC
2018-05-02
2019-04-05
12. MOTOROLA SOLUTIONS INC
2017-03-28
2019-04-05
3. BIOGEN IDEC INC
2018-05-02
2019-04-09
4. YUM CHINA HOLDINGS INC
2016-11-09
2019-04-09
8. QUALCOMM INC
2018-08-15
2019-04-10
2. BIOGEN IDEC INC
2018-05-02
2019-04-11
1. ALCON INC ORD SHS
2019-03-27
2019-04-11
7. ALCON INC ORD SHS
2019-03-27
2019-04-11
5. ALCON INC ORD SHS
2012-06-01
2019-04-11
2.8 ALCON INC ORD SHS
2019-01-07
2019-04-11
3. APPLE COMPUTER INC
2018-09-13
2019-04-12
.4 ALCON INC ORD SHS
2012-06-01
2019-04-12
3. AMGEN INC
2008-04-16
2019-04-15
3. AMGEN INC
2014-04-24
2019-04-15
1. ALCON INC ORD SHS
2012-06-01
2019-04-15
2. BIOGEN IDEC INC
2018-05-02
2019-04-16
3. BIOGEN IDEC INC
2018-05-02
2019-04-16
.2 ALCON INC ORD SHS
2012-06-01
2019-04-18
7. BANK OF NEW YORK MELLON CORP/THE
2011-11-23
2019-04-23
3. SHOPIFY INC CL A
2018-10-31
2019-04-23
5. YUM CHINA HOLDINGS INC
2016-11-09
2019-04-23
5. YUM CHINA HOLDINGS INC
2016-11-09
2019-04-24
6. AFLAC INC
2017-06-09
2019-04-26
19. AFLAC INC
2017-06-09
2019-04-30
13. YUM CHINA HOLDINGS INC
2013-03-13
2019-04-30
6. YUM CHINA HOLDINGS INC
2013-03-13
2019-05-02
7. YUM CHINA HOLDINGS INC
2013-03-13
2019-05-02
19. AFLAC INC
2017-06-09
2019-05-03
12. SCHLUMBERGER LTD
2015-08-27
2019-05-08
18. SCHLUMBERGER LTD
2015-08-27
2019-05-08
5. CANADIAN PACIFIC RAILWAY LTD
2016-03-17
2019-05-09
3. SHOPIFY INC CL A
2018-10-31
2019-05-09
9. SCHLUMBERGER LTD
2015-08-27
2019-05-10
5. SCHLUMBERGER LTD
2010-06-10
2019-05-10
19. SCHLUMBERGER LTD
2011-06-24
2019-05-10
47. WEATHERFORD INTL PLC ORD SHS
2009-04-01
2019-05-15
1279. WEATHERFORD INTL PLC ORD SHS
2016-08-02
2019-05-15
12. YUM CHINA HOLDINGS INC
2013-10-09
2019-05-17
11. PAYPAL HOLDINGS INCORPORATION
2010-08-06
2019-05-23
4. PAYPAL HOLDINGS INCORPORATION
2010-08-06
2019-05-24
4. SPLUNK INC
2017-05-26
2019-05-24
5. PAYPAL HOLDINGS INCORPORATION
2010-08-06
2019-05-29
2. CANADIAN PACIFIC RAILWAY LTD
2016-03-04
2019-05-30
3. RED HAT INC
2013-11-13
2019-05-31
2. TEMENOS AG
2019-02-22
2019-05-31
2. TEMENOS AG
2019-02-22
2019-06-03
2. HONEYWELL INTERNATIONAL INC COM
2019-01-03
2019-06-04
1. HONEYWELL INTERNATIONAL INC COM
2017-03-15
2019-06-04
3. PAYPAL HOLDINGS INCORPORATION
2010-08-06
2019-06-04
80. HALLIBURTON CO
2012-06-01
2019-06-05
17. HALLIBURTON CO
2018-09-07
2019-06-05
110. LONDON STOCK EXCHANGE GROUP PLC
2017-01-30
2019-06-05
7. PAYPAL HOLDINGS INCORPORATION
2010-08-06
2019-06-05
11. STATE STR CORP COM
2012-06-01
2019-06-05
28. AFLAC INC
2017-06-02
2019-06-06
11. STATE STR CORP COM
2012-06-01
2019-06-06
13. STATE STR CORP COM
2012-06-01
2019-06-07
5. PAYPAL HOLDINGS INCORPORATION
2010-08-06
2019-06-10
3. RED HAT INC
2013-11-13
2019-06-10
5. PAYPAL HOLDINGS INCORPORATION
2010-08-06
2019-06-11
3. RED HAT INC
2013-11-13
2019-06-12
7000. UNITED STATES TREAS BILLS DTD 01/03/2019
2019-04-05
2019-06-18
6000. U S TREASURY NOTE FRN DTD 04/30/2019 2.3
2019-06-18
2019-06-19
6. RED HAT INC
2013-11-13
2019-06-21
32. COMCAST CORP
2019-04-02
2019-06-26
17000. FEDERAL NATIONAL MORTGAGE ASSN
2016-12-15
2019-07-09
2000. FEDERAL NATIONAL MORTGAGE ASSN
2019-02-25
2019-07-09
9000. US TREASURY NOTE 3.375% 11/15/19
2010-03-30
2019-07-09
8. ILLINOIS TOOL WKS INC
2012-06-01
2019-07-11
1. ILLINOIS TOOL WKS INC
2019-01-03
2019-07-11
9. MOTOROLA SOLUTIONS INC
2017-03-27
2019-07-11
17. UMICORE SA
2018-05-15
2019-07-11
1. METTLER-TOLEDO INTL INC
2005-12-22
2019-07-15
1. METTLER-TOLEDO INTL INC
2018-07-26
2019-07-15
3. METTLER-TOLEDO INTL INC
2005-12-22
2019-07-16
9. PAYPAL HOLDINGS INCORPORATION
2010-08-06
2019-07-16
2000. U S TREASURY NOTE FRN DTD 04/30/2019 2.3
2019-06-18
2019-07-19
10. PAYPAL HOLDINGS INCORPORATION
2010-08-06
2019-07-22
20. COCA COLA CO
2005-12-22
2019-07-25
30. RENTOKIL INITIAL PLC
2017-06-26
2019-07-25
36. CAPITAL ONE FINANCIAL CORP COM
2012-06-01
2019-07-30
10. RENTOKIL INITIAL PLC
2016-08-02
2019-07-30
23. COCA COLA CO
2005-12-22
2019-07-31
23. COCA COLA CO
2005-12-22
2019-08-02
22. LONDON STOCK EXCHANGE GROUP PLC
2015-11-09
2019-08-05
17. RENTOKIL INITIAL PLC
2016-08-02
2019-08-05
32. ANADARKO PETE CORP
2008-10-24
2019-08-09
88. ANADARKO PETE CORP
2016-01-12
2019-08-09
.21 OCCIDENTAL PETROLEUM CORP
2006-09-25
2019-08-09
9. AKAMAI TECHNOLOGIES INC
2009-07-30
2019-08-13
37. WELLS FARGO & CO
2011-04-15
2019-08-13
28. WELLS FARGO & CO
2008-11-14
2019-08-13
1. EQUINIX INC
2018-02-13
2019-08-16
59. METLIFE INC COM
2010-07-09
2019-08-19
2. COSTCO WHOLESALE CORP
2019-01-04
2019-08-21
2. RENTOKIL INITIAL PLC
2016-08-02
2019-08-22
2. LONDON STOCK EXCHANGE GROUP PLC
2015-11-09
2019-08-23
3. RENTOKIL INITIAL PLC
2016-08-02
2019-08-23
5. CANADIAN PACIFIC RAILWAY LTD
2016-03-04
2019-08-26
8. CATERPILLAR INC
2018-03-13
2019-08-26
50. SCHLUMBERGER LTD
2010-08-24
2019-08-27
5. CATERPILLAR INC
2018-02-06
2019-08-28
1. LONDON STOCK EXCHANGE GROUP PLC
2015-11-09
2019-08-28
3. LONDON STOCK EXCHANGE GROUP PLC
2015-11-09
2019-08-29
16. LONDON STOCK EXCHANGE GROUP PLC
2015-11-09
2019-08-30
6. CATERPILLAR INC
2018-03-01
2019-09-04
7. CATERPILLAR INC
2018-04-26
2019-09-06
8. CANADIAN PACIFIC RAILWAY LTD
2016-03-04
2019-09-09
43. LONDON STOCK EXCHANGE GROUP PLC
2015-11-09
2019-09-09
20. RENTOKIL INITIAL PLC
2016-08-02
2019-09-09
15. HONG KONG EXCHANGES & CLEARING LTD
2018-03-13
2019-09-10
11. NESTLE SA
2018-10-17
2019-09-10
2. ECOLAB INC
2016-01-04
2019-09-11
17. HONG KONG EXCHANGES & CLEARING LTD
2018-03-13
2019-09-12
9. HONG KONG EXCHANGES & CLEARING LTD
2019-07-02
2019-09-12
31. HONG KONG EXCHANGES & CLEARING LTD
2015-04-10
2019-09-13
7000. US BANCORP MTNS BK ENT FR DTD 04/27/2017
2018-06-20
2019-09-13
1000. US BANCORP MTNS BK ENT FR DTD 04/27/2017
2019-04-09
2019-09-13
32. HONG KONG EXCHANGES & CLEARING LTD
2015-04-10
2019-09-16
5000. ENTERPRISE PRODUCTS OPERATING LP
2015-11-20
2019-09-17
2000. ENTERPRISE PRODUCTS OPERATING LP
2019-03-28
2019-09-17
6. TEXAS INSTRUMENTS INC
2012-04-05
2019-10-02
3. ANTHEM INC
2012-06-01
2019-10-03
.38 CERENCE INC COM
2014-03-20
2019-10-08
7000. CVS HEALTH CORPORATION DTD 03/09/2018 3.
2018-03-13
2019-10-10
6. CHIPOTLE MEXICAN GRILL INC CLASS A
2017-07-18
2019-10-10
5. US BANCORP
2012-06-01
2019-10-11
8000. VISA INC SR GLBL NT
2018-01-26
2019-10-17
7000. APPLE INC 2.400% 05/03/23
2018-10-23
2019-10-29
19. GRUBHUB INC
2019-02-12
2019-10-29
17. CHECK POINT SOFTWARE TECH LT
2013-06-26
2019-10-29
14. CHECK POINT SOFTWARE TECH LT
2013-06-21
2019-10-30
18. GRUBHUB INC
2019-04-05
2019-11-01
18000. FHLMC 2.375% 01/13/22
2018-01-29
2019-11-06
2000. FHLMC 2.375% 01/13/22
2019-02-26
2019-11-06
54. XEROX HOLDINGS CORP
2012-06-01
2019-11-07
2. QUALCOMM INC
2018-05-23
2019-11-18
14. QUALCOMM INC
2019-08-01
2019-11-18
4. DIAGEO PLC SPONSORED ADR NEW
2016-08-12
2019-11-25
.99 DISH NETWORK CORP RT
2019-11-27
2019-11-28
18. ROGERS COMMUNICATIONS INC
2018-11-27
2019-12-02
31. SUNCOR ENERGY INC
2013-12-17
2019-12-02
3. ICON PLC
2018-07-10
2019-12-02
6. SHISEIDO LTD ADR
2015-05-29
2019-12-05
1. BLACKROCK INC
2009-03-30
2019-12-09
6000. BANK OF AMERICA CORP FR DTD 04/19/2016 3
2017-03-24
2019-12-11
2000. BANK OF AMERICA CORP FR DTD 04/19/2016 3
2019-03-12
2019-12-11
5. NESTLE SA
2016-09-19
2019-12-13
14. RENTOKIL INITIAL PLC
2016-08-02
2019-12-13
5. SUNCOR ENERGY INC
2013-12-17
2019-12-13
8. SUNCOR ENERGY INC
2019-02-07
2019-12-13
1. BLACKROCK INC
2009-03-30
2019-12-16
10. SUNCOR ENERGY INC
2019-02-07
2019-12-17
6. SUNCOR ENERGY INC
2009-09-01
2019-12-17
1. ANHEUSER-BUSCH INBEV SA/NV
2017-11-01
2019-12-18
3. ANHEUSER-BUSCH INBEV SA/NV
2017-11-01
2019-12-18
6. SUNCOR ENERGY INC
2009-09-01
2019-12-18
12. SUNCOR ENERGY INC
2009-09-01
2019-12-18
7. ANHEUSER-BUSCH INBEV SA/NV
2018-03-06
2019-12-19
6. SUNCOR ENERGY INC
2009-09-01
2019-12-19
10. SUNCOR ENERGY INC
2009-09-01
2019-12-19
5. SUNCOR ENERGY INC
2015-10-29
2019-12-19
22. SUNCOR ENERGY INC
2015-10-29
2019-12-20
1. OUTSIDE 1099
2019-01-01
2019-12-31
1. OUTSIDE 1099
2000-01-01
2019-12-31
1. BROKER 1099
2019-01-31
2019-12-31
1. BROKER 1099
2019-01-31
2019-12-31
1. BROKER 1099
2019-01-31
2019-12-31
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
1,086
793
293
b
4,942
4,926
16
c
1,070
331
739
d
576
727
-151
e
2,652
2,462
190
1,778
1,294
484
415
299
116
262
76
186
434
127
307
420
289
131
384
420
-36
385
420
-35
308
336
-28
461
366
95
174
51
123
140
96
44
78
49
29
232
148
84
229
104
125
155
99
56
287
130
157
543
346
197
526
140
386
1,629
1,439
190
444
208
236
277
192
85
535
345
190
395
182
213
526
337
189
702
203
499
352
92
260
528
129
399
526
125
401
615
146
469
1,450
509
941
537
138
399
1,049
250
799
304
309
-5
1,255
1,006
249
159
146
13
5,959
6,035
-76
1,986
1,979
7
3,018
2,978
40
4,023
4,052
-29
1,870
1,249
621
1,291
827
464
643
887
-244
363
473
-110
824
620
204
274
221
53
297
272
25
1,207
900
307
408
300
108
87
105
-18
366
456
-90
259
160
99
876
252
624
13
4
9
2,651
1,049
1,602
2,539
1,152
1,387
893
697
196
1,004
675
329
345
213
132
574
134
440
157
146
11
1,260
1,068
192
164
260
-96
304
187
117
987
1,533
-546
493
751
-258
319
186
133
366
92
274
273
158
115
6,959
6,959
267
158
109
482
548
-66
1,687
1,008
679
712
822
-110
175
105
70
455
508
-53
470
548
-78
56
58
-2
389
363
26
278
157
121
156
143
13
595
678
-83
22
13
9
572
130
442
572
341
231
56
31
25
460
548
-88
690
822
-132
11
6
5
339
125
214
673
414
259
222
131
91
221
110
111
297
232
65
954
736
218
607
271
336
284
125
159
332
146
186
959
724
235
483
876
-393
724
1,313
-589
1,098
633
465
776
414
362
353
597
-244
196
291
-95
746
1,216
-470
2
538
-536
64
8,693
-8,629
496
243
253
1,208
96
1,112
440
35
405
478
251
227
551
43
508
442
252
190
554
138
416
344
284
60
349
276
73
336
263
73
168
122
46
323
26
297
1,691
2,365
-674
359
618
-259
1,854
1,085
769
772
61
711
615
444
171
1,505
1,064
441
611
444
167
736
524
212
581
43
538
556
138
418
572
43
529
555
138
417
6,960
6,959
1
6,016
5,997
19
1,127
276
851
1,353
1,210
143
16,952
17,015
-63
1,994
1,991
3
9,038
8,921
117
1,169
441
728
146
126
20
1,533
756
777
121
238
-117
822
56
766
822
617
205
2,464
168
2,296
1,082
78
1,004
2,009
1,999
10
1,187
87
1,100
1,062
411
651
764
502
262
3,241
1,798
1,443
251
148
103
1,217
473
744
1,204
473
731
440
217
223
445
252
193
1,888
1,119
769
5,192
3,261
1,931
10
30
-20
799
149
650
1,708
1,121
587
1,293
799
494
550
434
116
2,701
2,155
546
551
411
140
56
30
26
42
20
22
82
44
38
1,172
629
543
915
1,247
-332
1,572
2,821
-1,249
570
767
-197
21
10
11
63
30
33
339
158
181
713
908
-195
863
1,024
-161
1,898
1,007
891
944
424
520
552
297
255
469
557
-88
1,207
880
327
393
224
169
515
586
-71
272
323
-51
943
981
-38
7,308
6,751
557
1,044
1,002
42
961
1,013
-52
5,156
4,850
306
2,062
2,013
49
761
195
566
713
201
512
5
6
-1
7,123
7,007
116
4,941
2,278
2,663
269
151
118
8,228
8,201
27
7,103
6,757
346
644
1,516
-872
1,910
841
1,069
1,566
687
879
604
1,342
-738
18,273
17,881
392
2,030
1,995
35
2,030
1,117
913
181
116
65
1,269
1,000
269
650
480
170
1
1
859
961
-102
964
1,042
-78
491
412
79
416
121
295
496
126
370
6,380
6,105
275
2,127
2,005
122
523
394
129
397
208
189
159
168
-9
255
262
-7
504
126
378
323
328
-5
194
184
10
80
123
-43
241
368
-127
194
184
10
387
368
19
562
810
-248
195
184
11
325
307
18
163
147
16
711
648
63
5
-5
2,960
1
2,959
2
1,287
-1,285
2
6,348
-6,346
6,945
6,753
192
23
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
293
b
16
c
739
d
-151
e
190
484
116
186
307
131
-36
-35
-28
95
123
44
29
84
125
56
157
197
386
190
236
85
190
213
189
499
260
399
401
469
941
399
799
-5
249
13
-76
7
40
-29
621
464
-244
-110
204
53
25
307
108
-18
-90
99
624
9
1,602
1,387
196
329
132
440
11
192
-96
117
-546
-258
133
274
115
109
-66
679
-110
70
-53
-78
-2
26
121
13
-83
9
442
231
25
-88
-132
5
214
259
91
111
65
218
336
159
186
235
-393
-589
465
362
-244
-95
-470
-536
-8,629
253
1,112
405
227
508
190
416
60
73
73
46
297
-674
-259
769
711
171
441
167
212
538
418
529
417
1
19
851
143
-63
3
117
728
20
777
-117
766
205
2,296
1,004
10
1,100
651
262
1,443
103
744
731
223
193
769
1,931
-20
650
587
494
116
546
140
26
22
38
543
-332
-1,249
-197
11
33
181
-195
-161
891
520
255
-88
327
169
-71
-51
-38
557
42
-52
306
49
566
512
-1
116
2,663
118
27
346
-872
1,069
879
-738
392
35
913
65
269
170
1
-102
-78
79
295
370
275
122
129
189
-9
-7
378
-5
10
-43
-127
10
19
-248
11
18
16
63
-5
2,959
-1,285
-6,346
192
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
37,412
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
2017
2016
2015
2014
2
Total
of line 1, column (d)
.....................
2
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
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
5
Multiply line 4 by line 3
......................
5
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
7
Add lines 5 and 6
........................
7
8
Enter qualifying distributions from Part XII, line 4
,.............
8
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
743
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
743
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
743
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
865
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
865
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
122
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
122
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)
OH
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
ARDEN TRUST COMPANY
Telephone no.
(302) 246-5400
Located at
2751 CENTERVILLE RD STE 400
WILMINGTON
DE
ZIP+4
19808
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
ARDEN TRUST COMPANY
TRUSTEE
1
6,063
2751 CENTERVILLE RD STE 400
WILMINGTON
,
DE
19808
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
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
1,191,578
b
Average of monthly cash balances
.......................
1b
41,508
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
1,233,086
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
1,233,086
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
18,496
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
1,214,590
6
Minimum investment return.
Enter 5% of line 5
..................
6
60,730
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
60,730
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
743
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
743
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
59,987
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
59,987
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
59,987
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
2,016
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
2,016
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
2,016
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
59,987
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
52,742
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
0
b
From 2015
......
0
c
From 2016
......
0
d
From 2017
......
0
e
From 2018
......
0
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
2,016
a
Applied to 2018, but not more than line 2a
2,016
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
.............
50,726
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
59,987
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
....
0
b
Excess from 2016
....
0
c
Excess from 2017
....
0
d
Excess from 2018
....
0
e
Excess from 2019
....
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2019)
Form 990-PF (2019)
Page
11
Part XV
Supplementary Information
(continued)
3
Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
Total
.................................
3a
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
24,078
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
37,412
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)
..
61,490
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
61,490
(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