-
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
HANSEN-FURNAS FOUNDATION INC
Number and street (or P.O. box number if mail is not delivered to street address)
28 SOUTH WATER STREET SUITE 310
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
BATAVIA
,
IL
60510
A Employer identification number
36-6049894
B
Telephone number (see instructions)
(630) 761-1390
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)
$
980,530
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)
525,100
2
Check
.............
3
Interest on savings and temporary cash investments
1,195
1,195
4
Dividends and interest from securities
...
26,751
27,369
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
701
b
Gross sales price for all assets on line 6a
701
7
Capital gain net income (from Part IV, line 2)
...
701
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)
.......
18,853
0
12
Total.
Add lines 1 through 11
........
572,600
29,265
13
Compensation of officers, directors, trustees, etc.
4,750
0
4,750
14
Other employee salaries and wages
......
25,506
0
25,506
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
13,060
0
13,060
c
Other professional fees (attach schedule)
....
2,984
2,984
0
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
2,209
645
1,915
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
7,560
0
7,560
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
9,387
0
9,387
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
65,456
3,629
62,178
25
Contributions, gifts, grants paid
.......
518,028
518,028
26
Total expenses and disbursements.
Add lines 24 and 25
583,484
3,629
580,206
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-10,884
b
Net investment income
(if negative, enter -0-)
25,636
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2019)
Form 990-PF (2019)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
43,163
32,247
32,247
2
Savings and temporary cash investments
.........
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
804,425
948,283
948,283
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)
..........
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)
847,588
980,530
980,530
17
Accounts payable and accrued expenses
..........
1,428
1,422
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)
.........
1,428
1,422
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
846,160
979,108
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)
.....
846,160
979,108
30
Total liabilities and net assets/fund balances
(see instructions)
.
847,588
980,530
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
846,160
2
Enter amount from Part I, line 27a
.....................
2
-10,884
3
Other increases not included in line 2 (itemize)
3
143,832
4
Add lines 1, 2, and 3
..........................
4
979,108
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
979,108
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
CAPITAL GAINS DIVIDENDS
P
b
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
701
701
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
701
b
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
701
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
611,756
1,244,743
0.491472
2017
513,601
1,084,416
0.473620
2016
568,062
1,171,728
0.484807
2015
585,638
1,022,823
0.572570
2014
501,938
1,098,835
0.456791
2
Total
of line 1, column (d)
.....................
2
2.479260
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
0.495852
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
927,775
5
Multiply line 4 by line 3
......................
5
460,039
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
256
7
Add lines 5 and 6
........................
7
460,295
8
Enter qualifying distributions from Part XII, line 4
,.............
8
580,206
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
256
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
256
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
256
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
304
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
500
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
804
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
548
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
548
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
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)
IL
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
N/A
14
The books are in care of
JOANNE B HANSEN
Telephone no.
(630) 761-1390
Located at
28 SOUTH WATER ST SUITE 310
BATAVIA
IL
ZIP+4
60510
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
No
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
JOANNE B HANSEN
PRESIDENT
2.00
0
0
0
2S502 HEATON DRIVE
BATAVIA
,
IL
60510
THOMAS F CAUGHLIN
DIRECTOR
2.00
750
0
0
729 GREENBRIER TERRACE
CRYSTAL LAKE
,
IL
60014
JAMES HANSEN
DIRECTOR
2.00
0
0
0
822 BRYANT AVENUE
WINNETKA
,
IL
60093
RICHARD W HANSEN
VICE PRESIDENT
2.00
0
0
0
2S502 HEATON DRIVE
BATAVIA
,
IL
60510
KIRSTEN HANSEN BARKLEY
DIRECTOR
2.00
1,000
0
0
2938 NORTH LAKEWOOD
CHICAGO
,
IL
60657
ROBERT F PETERSON
SECRETARY/TREASURER
2.00
1,000
0
0
562 CARRIAGE DRIVE
BATAVIA
,
IL
60510
LISA HANSEN
DIRECTOR
2.00
1,000
0
0
720 LARRABEE UNIT G 04
CHICAGO
,
IL
60610
SCOTT HANSEN
ASST. SECRETARY/TREASURER
2.00
1,000
0
0
928 NORTH EUCLID AVENUE
OAK PARK
,
IL
60302
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
900,654
b
Average of monthly cash balances
.......................
1b
289,671
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
1,190,325
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
1,190,325
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
262,550
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
927,775
6
Minimum investment return.
Enter 5% of line 5
..................
6
46,389
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
46,389
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
256
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
256
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
46,133
4
Recoveries of amounts treated as qualifying distributions
................
4
18,853
5
Add lines 3 and 4
............................
5
64,986
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
64,986
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
580,206
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
580,206
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
256
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
579,950
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
64,986
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
0
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
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:
$
580,206
a
Applied to 2018, but not more than line 2a
0
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2019 distributable amount
.....
64,986
e
Remaining amount distributed out of corpus
515,220
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
515,220
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
406,637
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
......
108,583
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
....
108,583
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:
SCHOLARSHIP COMMITTEE HANSEN-FURNAS
28 S WATER STREET SUITE 310
BATAVIA
,
IL
60510
(630) 761-1390
b
The form in which applications should be submitted and information and materials they should include:
AVAILABLE UPON REQUEST
c
Any submission deadlines:
APPLICATION FORM AND TRANSCRIPT DUE INTO FOUNDATION OFFICE BY 5:00 P.M. MARCH 1
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
SCHOLARSHIPS WILL BE GIVEN ONLY FOR FULL TIME UNDERGRADUATE STUDIES AT AN ACCREDITED COLLEGE OR UNIVERSITY. ONE POST GRADUATE SCHOLARSHIP IS AVAILABLE. PERMANENT OR HOME ADDRESS MUST BE WITHIN TWELVE MILES OF THE BATAVIA GOVERNMENT CENTER, BATAVIA, IL OR IN CLARKE COUNTY IOWA.
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
ASSOCIATION FOR INDIVIDUAL DEVELOPMENT
309 W NEW INDIAN TRAIL CT
AURORA
,
IL
60506
NONE
PC
GENERAL
25,000
ASU FOUNDATION
PO BOX 2260
TEMPE
,
AZ
85280
NONE
PC
IN MEMORY OF TOM CAUGHLIN
34,000
AUGUSTANA
639 38TH STREET
ROCK ISLAND
,
IL
61201
NONE
PC
SCHOLARSHIPS
14,234
AURORA UNIVERSITY
347 S GLADSTONE AVENUE
AURORA
,
IL
60510
NONE
PC
SCHOLARSHIPS
6,000
AURORA UNIVERSITY
347 S GLADSTONE AVENUE
AURORA
,
IL
60510
NONE
PC
GENERAL
5,000
BATAVIA ACCESS - RSVP DRUG PROGRAM
100 N ISLAND AVENUE
BATAVIA
,
IL
60510
NONE
PC
PREFERRED CHARITIES
100
BATAVIA COMM BAND
1201 MAIN STREET
BATAVIA
,
IL
60510
NONE
PC
PREFERRED CHARITIES
500
BATAVIA FIREWORKS FUND
100 N ISLAND AVE
BATAVIA
,
IL
60510
NONE
PC
PREFERRED CHARITIES
500
BATAVIA FOUNDATION
PO BOX 1003
BATAVIA
,
IL
60510
NONE
PC
PREFERRED CHARITIES
4,000
BATAVIA HISTORICAL SOCIETY
155 HOUSTON ST
BATAVIA
,
IL
60510
NONE
PC
GENERAL
11,000
BATAVIA UNITED METHODIST CHURCH
8 N BATAVIA AVE
BATAVIA
,
IL
60510
NONE
PC
PREFERRED CHARITIES
300
BETA THETA CHAPTER OF DELTA KAPPA GAMMA
416 W 12TH ST
AUSTIN
,
TX
78701
NONE
PC
GENERAL
500
BIG ROCK LIBRARY
HINCKLEY RD
BIG ROCK
,
IL
60511
NONE
PC
PREFERRED CHARITIES
3,000
BOSTON UNIVERSITY
ONE SILBER WAY
BOSTON
,
MA
02215
NONE
PC
SCHOLARSHIPS
3,500
BRADLEY
1501 W BRADLEY AVENUE
PEORIA
,
IL
61625
NONE
PC
SCHOLARSHIPS
3,000
BRIGHAM YOUNG UNIVERSITY
A-41 ASB
PROVO
,
UT
84602
NONE
PC
SCHOLARSHIPS
3,000
BUTLER
4600 SUNSET AVE
INDIANAPOLIS
,
IN
46208
NONE
PC
SCHOLARSHIPS
2,500
CARTHAGE
2001 ALFORD PARK DRIVE
KENOSHA
,
WI
53140
NONE
PC
SCHOLARSHIPS
3,000
CASA KANE COUNTY
505 N COUNTY FARM ROAD 3RD FLOOR
SUITE C
WHEATON
,
IL
60187
NONE
PC
GENERAL
12,500
DEPAUL COLLEGE PREP
3633 N CALIFORNIA AVE
CHICAGO
,
IL
60618
NONE
PC
PREFERRED CHARITIES
2,500
DEPAUL UNIVERSITY
2400 N SHEFFIELD AVE
CHICAGO
,
IL
60614
NONE
PC
SCHOLARSHIPS
3,000
ELGIN COMMUNITY COLLEGE
1700 SPARTAN DRIVE
ELGIN
,
IL
60123
NONE
PC
SCHOLARSHIPS
3,000
ELMHURST COLLEGE
190 PROSPECT AVENUE
ELMHURST
,
IL
60126
NONE
PC
SCHOLARSHIPS
3,000
FINE LINE CENTER
37W570 BOLCUM RD
ST CHARLES
,
IL
60175
NONE
PC
PREFERRED CHARITIES
1,000
FLORIDA A&M UNIVERSITY
1601 S MARTIN L KING JR BLVD
TALLAHASSEE
,
FL
32307
NONE
PC
SCHOLARSHIPS
3,500
FOX VALLEY HANDS OF HOPE
200 WHITFIELD DRIVE
GENEVA
,
IL
60134
NONE
PC
GENERAL
13,000
GRACELAND
1 UNIVERSITY PL
LAMONI
,
IA
50140
NONE
PC
SCHOLARSHIPS
6,000
GRAND VALLEY STATE
1 CAMPUS DRIVE
ALLENDALE
,
MI
49401
NONE
PC
SCHOLARSHIPS
6,500
ILLINOIS INSTITUTE OF TECH
10 W 33RD ST PERLSTEIN HALL 206
CHICAGO
,
IL
60616
NONE
PC
SCHOLARSHIPS
6,500
ILLINOIS NATURE CONSERVANCY
8 S MICHAGAN AVE
CHICAGO
,
IL
60603
NONE
PC
PREFERRED CHARITIES
1,000
ILLINOIS STATE UNIVERSITY
CAMPUS BOX 2320
NORMAL
,
IL
617902320
NONE
PC
SCHOLARSHIPS
2,500
IMSA FUND FOR ADVANCEMENT OF EDUCATION
1500 SULLIVAN RD
AURORA
,
IL
60506
NONE
PC
GENERAL
15,000
IOWA STATE UNIVERSITY
0210 BEARDSHEAR HALL
AMES
,
IA
50011
NONE
PC
SCHOLARSHIPS
15,000
JOSHUA TREE COMMUNITY
320 FRANKLIN ST
GENEVA
,
IL
60134
NONE
PC
PREFERRED CHARITIES
2,000
LAZARUS HOUSE
214 WALNUT ST
ST CHARLES
,
IL
60174
NONE
PC
GENERAL
10,000
LIVING WELL CANCER RESOURCE CENTER
442 WILLIAMSBURG AVE
GENEVA
,
IL
60134
NONE
PC
PREFERRED CHARITIES
15,000
LIVING WELL CANCER RESOURCE CENTER
442 WILLIAMSBURG AVE
GENEVA
,
IL
60134
NONE
PC
GENERAL
500
MEALS ON WHEELS
1550 CRYSTAL DRIVE SUITE 1004
ARLINGTON
,
VA
22202
NONE
PC
PREFERRED CHARITIES
1,000
MUTUAL GROUND
418 OAK AVE
AURORA
,
IL
60506
NONE
PC
GENERAL
20,000
NATIONAL PARKS
1110 VERMONT AVE NW SUITE 200
WASHINGTON
,
DC
20005
NONE
PC
PREFERRED CHARITIES
100
NORMAL PUBLIC RADIO
848 E GRAND AVE
CHICAGO
,
IL
60611
NONE
PC
PREFERRED CHARITIES
1,000
NEW YORK MEDICAL COLLEGE
40 SUNSHINE COTTAGE RD
VALHALLA
,
NY
10595
NONE
PC
LETO M. FURNAS SCHOLARSHIP
5,000
NIGHT MINISTRY
4711 N RAVENSWOOD AVE
CHICAGO
,
IL
60640
NONE
PC
PREFERRED CHARITIES
500
NORTH CENTRAL COLLEGE
30 NORTH BRAINARD ST
NAPERVILLE
,
IL
60540
NONE
PC
SCHOLARSHIPS
10,500
NORTHERN ILLINOIS FOOD BANK
273 DEARBORN COURT
GENEVA
,
IL
60134
NONE
PC
GENERAL
10,000
NORTHERN ILLINOIS UNIVERSITY
SWEN PARSON HALL 245
DEKALB
,
IL
601152828
NONE
PC
SCHOLARSHIPS
6,000
PRAIRIE RIVERS NETWORK
1605 S STATE ST SUITE 1
CHAMPAIGN
,
IL
61820
NONE
PC
PREFERRED CHARITIES
500
PURDUE
475 STADIUM MALL DRIVE SCHLEMAN
HALL ROOM 305
WEST LAFAYETTE
,
IN
47907
NONE
PC
CARL FURNAS SCHOLARSHIP
28,794
PURDUE
475 STADIUM MALL DRIVE SCHLEMAN
HALL ROOM 305
WEST LAFAYETTE
,
IN
47907
NONE
PC
SCHOLARSHIPS
16,000
ROSE-HULMAN INSTITUTE OF TECHNOLOGY (WILLIAM & ROSEANN LISMAN MEMORIAL)
5500 WABASH AVENUE
TERRE HAUTE
,
IN
47803
NONE
PC
SCHOLARSHIPS
15,000
SOUTHWESTERN COMMUNITY COLLEGE
1501 W TOWNLINE ST
CRESTON
,
IA
50801
NONE
PC
SCHOLARSHIPS
3,000
ST AMBROSE
518 WEST LOCUST
DAVENPORT
,
IA
52803
NONE
PC
SCHOLARSHIPS
2,500
ST LOUIS UNIVERSITY
ONE GRAND BOULEVARD
ST LOUIS
,
MO
631032907
NONE
PC
SCHOLARSHIPS
3,500
SUICIDE PREVENTION SERVICES
528 S BATAVIA AVE 1
BATAVIA
,
IL
60510
NONE
PC
GENERAL
20,000
TAYLOR UNIVERSITY
236 W READE AVE
UPLAND
,
IN
46989
NONE
PC
SCHOLARSHIPS
2,500
TRI CITY HEALTH PARTNERSHIP
318 WALNUT ST
ST CHARLES
,
IL
60174
NONE
PC
GENERAL
10,000
TRI-CITY FAMILY SERVICES
1120 RANDALL CT
GENEVA
,
IL
60134
NONE
PC
GENERAL
10,000
UNIVERSITY OF ILLINOIS CHICAGO
1200 W HARRISON ST
AURORA
,
IL
60607
NONE
PC
SCHOLARSHIPS
7,000
UNIVERSITY OF ILLINOIS SPRINGFIELD
ONE UNIVERSITY PLAZA
SPRINGFIELD
,
IL
62703
NONE
PC
SCHOLARSHIPS
3,000
UNIVERSITY OF ILLINOIS URBANA
620 E JOHN ST
CHAMPAIGN
,
IL
61820
NONE
PC
SCHOLARSHIPS
8,500
UNIVERSITY OF IOWA
UNIVERSITY OF IOWA
IOWA CITY
,
IA
52242
NONE
PC
SCHOLARSHIPS
11,500
UNIVERSITY OF KENTUCKY
UNIVERSITY OF KENTUCKY
LEXINGTON
,
KY
40506
NONE
PC
SCHOLARSHIPS
3,000
UNIVERSITY OF MINNESOTA
UNIVERSITY OF MINNESOTA
MINNEAPOLIS
,
MN
55455
NONE
PC
SCHOLARSHIPS
2,500
UNIVERSITY OF NORTH CAROLINA
UNIVERSITY OF NORTH CAROLINA
CHAPEL HILL
,
NC
275992200
NONE
PC
SCHOLARSHIPS
1,750
UNIVERSITY OF RICHMOND
28 WEST HAMTON WAY
RICHMOND
,
VA
23173
NONE
PC
SCHOLARSHIPS
3,000
WAUBONSEE COMMUNITY COLLEGE
ROUTE 47 AT HARTER ROAD
SUGAR GROVE
,
IL
60554
NONE
PC
SCHOLARSHIPS
8,500
YMCA LAKEWOOD
9715 LAKEWOOD DR SW
LAKEWOOD
,
WA
98499
NONE
PC
PREFERRED CHARITIES
500
BAYLOR UNIVERSITY
1311 S 5TH STREET
WACO
,
TX
76706
NONE
PC
SCHOLARSHIPS
2,500
DRAKE UNIVERSITY
2507 UNIVERSITY AVE
DES MOINES
,
IA
50311
NONE
PC
SCHOLARSHIPS
6,500
ELLSWORTH COMMUNITY COLLEGE
1100 COLLEGE AVE
IOWA FALLS
,
IA
50126
NONE
PC
SCHOLARSHIPS
2,500
EMORY UNIVERSITY
201 DOWMAN DR
ATLANTA
,
GA
30322
NONE
PC
SCHOLARSHIPS
3,000
LEWIS UNIVERSITY
1 UNIVERSITY PKWY
ROMEOVILLE
,
IL
60446
NONE
PC
SCHOLARSHIPS
3,500
LOYOLA UNIVERSITY
1032 W SHERIDAN RD
CHICAGO
,
IL
60660
NONE
PC
SCHOLARSHIPS
5,000
ST JOHNS UNIVERSITY
8000 UTOPIA PKWY
JAMAICA
,
NY
11439
NONE
PC
SCHOLARSHIPS
3,500
UNC CHAPEL HILL
UNIVERSITY OF NORTH CAROLINA
CHAPEL HILL
,
NC
275992200
NONE
PC
SCHOLARSHIPS
1,750
UNIVERSITY OF NEBRASKA
1400 R ST
LINCOLN
,
NE
68588
NONE
PC
SCHOLARSHIPS
3,000
MEDICAL UNIVERSITY OF SOUTH CAROLINA LIBRARIES
171 ASHLEY AVE SUITE 419
CHARLESTON
,
SC
29425
NONE
PC
LETO M. FURNAS SCHOLARSHIP
5,000
BATAVIA LIBRARY
10 S BATAVIA AVE
BATAVIA
,
IL
60510
NONE
PC
GENERAL
1,000
ARIZONA SERVICES PROJECT
PO BOX 6565
GOODYEAR
,
AZ
85338
NONE
PC
GENERAL
500
VINTAGE RACERS FOR RESCUES
1010 RYANS WAY
ALTON
,
VA
24520
NONE
PC
GENERAL
2,000
ST AMBROSE
518 WEST LOCUST
DAVENPORT
,
IA
52803
NONE
PC
LETO M. FURNAS SCHOLARSHIP
5,000
SIMPSON
2211 COLLEGE VIEW DR
REDDING
,
CA
96003
NONE
PC
SCHOLARSHIP
6,000
STATE UNIVERSITY OF NEW YORK
2 UNION AVE
SARATOGA SPRINGS
,
NY
12866
NONE
PC
SCHOLARSHIP
2,500
UNIVERSITY OF FLORIDA
205 FLETCHER DRIVE
GAINESVILLE
,
FL
326112015
NONE
PC
SCHOLARSHIPS
2,500
UNIVERSITY OF WISCONSIN - PARKSIDE
900 WOOD RD
KENOSHA
,
WI
53144
NONE
PC
SCHOLARSHIP
3,000
VIRGINIA POLYTECHNIC INSTITUTE
1425 S MAIN ST
BLACKSBURG
,
VA
24061
NONE
PC
SCHOLARSHIPS
3,500
Total
.................................
3a
518,028
b
Approved for future payment
Total
.................................
3b
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
14
1,195
4
Dividends and interest from securities
....
14
26,751
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
............
14
701
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
SCHOLARSHIP REFUNDS
18,853
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
0
28,647
18,853
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
47,500
(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.)
11A
REFUNDS FROM SCHOLARSHIPS WILL BE USED FOR FUTURE SCHOLARSHIPS
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