-
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
THE KORFF FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
545 CLARK DR NW
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
COMSTOCK PARK
,
MI
49321
A Employer identification number
38-3190927
B
Telephone number (see instructions)
(616) 301-1305
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)
$
8,105,755
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)
85,394
2
Check
.............
3
Interest on savings and temporary cash investments
689
689
4
Dividends and interest from securities
...
144,980
144,980
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
8,818
b
Gross sales price for all assets on line 6a
4,913,182
7
Capital gain net income (from Part IV, line 2)
...
8,818
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)
.......
17,359
12,694
12
Total.
Add lines 1 through 11
........
257,240
167,181
13
Compensation of officers, directors, trustees, etc.
25,000
18,750
6,250
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
11,650
11,650
0
c
Other professional fees (attach schedule)
....
45,351
45,351
0
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
57,285
1,466
489
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
4,882
3,676
1,206
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
144,168
80,893
7,945
25
Contributions, gifts, grants paid
.......
329,000
329,000
26
Total expenses and disbursements.
Add lines 24 and 25
473,168
80,893
336,945
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-215,928
b
Net investment income
(if negative, enter -0-)
86,288
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
.............
2
Savings and temporary cash investments
.........
50,398
101,555
101,555
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)
.......
6,653,146
6,445,746
7,002,030
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)
..........
997,611
935,809
1,002,170
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)
7,701,155
7,483,110
8,105,755
17
Accounts payable and accrued expenses
..........
2,159
42
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
2,159
42
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
........
0
0
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
7,698,996
7,483,068
29
Total net assets or fund balances
(see instructions)
.....
7,698,996
7,483,068
30
Total liabilities and net assets/fund balances
(see instructions)
.
7,701,155
7,483,110
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
7,698,996
2
Enter amount from Part I, line 27a
.....................
2
-215,928
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
7,483,068
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
7,483,068
Form
990-PF
(2019)
Form 990-PF (2019)
Page
3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a)
List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1 a
PUBLICLY TRADED SECURITIES
b
PARTNERSHIP CAPITAL GAINS
P
c
CAPITAL GAINS DIVIDENDS
P
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
4,879,953
4,898,818
-18,865
b
-5,546
c
33,229
33,229
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
-18,865
b
-5,546
c
33,229
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
8,818
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
239,789
4,514,925
0.053110
2017
217,137
3,011,583
0.072101
2016
202,387
2,776,183
0.072901
2015
193,300
2,964,152
0.065213
2014
177,800
3,107,137
0.057223
2
Total
of line 1, column (d)
.....................
2
0.320548
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
0.064110
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
7,735,426
5
Multiply line 4 by line 3
......................
5
495,918
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
863
7
Add lines 5 and 6
........................
7
496,781
8
Enter qualifying distributions from Part XII, line 4
,.............
8
336,945
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
1,726
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
1,726
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
1,726
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
49,579
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
49,579
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
47,853
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
47,853
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
Yes
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
Yes
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
MI
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
CARRIE SHELNER
Telephone no.
(616) 301-1305
Located at
545 CLARK DR NW
COMSTOCK PARK
MI
ZIP+4
49321
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
MARCAE MANTING
CEO/SECRETARY
0.00
0
0
0
2715 SNOW SE
LOWELL
,
MI
49311
CARRIE SHELNER
PRESIDENT/TREASURER
20.00
25,000
0
0
545 CLARK DR NW
COMSTOCK PARK
,
MI
49321
KIRSTIN JOHNSON
DIRECTOR
0.00
0
0
0
2031 ABILENE COURT
FORT COLLINS
,
CO
80525
BRIENNE GOUBEAUX
DIRECTOR
0.00
0
0
0
901 E VAULT MINE COURT
GREEN VALLEY
,
AZ
85614
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
6,714,081
b
Average of monthly cash balances
.......................
1b
136,973
c
Fair market value of all other assets (see instructions)
................
1c
1,002,170
d
Total
(add lines 1a, b, and c)
.........................
1d
7,853,224
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
7,853,224
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
117,798
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
7,735,426
6
Minimum investment return.
Enter 5% of line 5
..................
6
386,771
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
386,771
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
1,726
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
770
c
Add lines 2a and 2b
............................
2c
2,496
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
384,275
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
384,275
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
384,275
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
336,945
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
336,945
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
336,945
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
384,275
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
......
27,258
b
From 2015
......
47,362
c
From 2016
......
65,456
d
From 2017
......
69,137
e
From 2018
......
20,578
f
Total
of lines 3a through e
........
229,791
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
336,945
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
.....
336,945
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
47,330
47,330
(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
182,461
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
182,461
10
Analysis of line 9:
a
Excess from 2015
....
27,290
b
Excess from 2016
....
65,456
c
Excess from 2017
....
69,137
d
Excess from 2018
....
20,578
e
Excess from 2019
....
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or 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
ACTION INSTITUTE
161 OTTAWA AVE NW STE 301
GRAND RAPIDS
,
MI
49503
NONE
PC
EDUCATIONAL
1,000
ALBION COLLEGE
611 E PORTER ST
ALBION
,
MI
49224
NONE
PC
EDUCATIONAL
3,000
ALLIANCE DEFENDING FREEDOM-BLACKSTONE LEGAL FELLOWSHIP
15100 N 90TH STREET
SCOTTSDALE
,
AZ
85260
NONE
PC
RELIGIOUS
5,000
ALZHEIMERS ASSOCIATION
225 N MICHIGAN AVE FL 17
CHICAGO
,
IL
60601
NONE
PC
CHARITABLE
1,000
AMERICAN CANCER SOCIETY
PO BOX 22718
OKLAHOMA CITY
,
OK
73123
NONE
PC
CHARITABLE
1,000
AMERICAN FOUNDATION FOR SUICIDE PREVENTION
120 WALL STREET 29TH FLOOR
NEW YORK
,
NY
10005
NONE
PC
CHARITABLE
1,000
AMERICAN HEART ASSOCIATION
208 S LASALLE ST STE 1500
CHICAGO
,
IL
60604
NONE
PC
CHARITABLE
2,000
AMERICAN RED CROSS
1050 FULLER AVE NE
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
5,000
AQUINAS COLLEGE
1700 FULTON ST E
GRAND RAPIDS
,
MI
49506
NONE
PC
EDUCATIONAL
20,000
ASSOCIATION FOR THE BLIND AND VISUALLY IMPAIRED
456 CHERRY ST SE
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
2,000
BEYOND 26
4340 BURLINGAME AVE SW
WYOMING
,
MI
49509
NONE
PC
CHARITABLE
2,000
BLANDFORD NATURE CENTER
1715 HILLBURN AVE NW
GRAND RAPIDS
,
MI
49504
NONE
PC
EDUCATIONAL
1,500
BOYS AND GIRLS CLUB OF GRAND RAPIDS
235 STRAIGHT AVE NW
GRAND RAPIDS
,
MI
49504
NONE
PC
EDUCATIONAL
2,000
BOYSTOWN
14100 CRAWFORD ST
BOYSTOWN
,
NE
68010
NONE
PC
CHARITABLE
1,000
BROKEN SHOVELS FARM
8640 DAHLIA ST
HENDERSON
,
CO
80640
NONE
PC
EDUCATIONAL
1,500
CAMP AO WA KIYA
48401 WEST THOMAS ST
SHELBY
,
MI
49455
NONE
PC
EDUCATIONAL
2,000
CARS FOR A CAUSE GRAND RAPIDS LIONS CLUB CHARITIES
258 MORRIS AVE SE
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
1,000
CATHEDRAL OF ST ANDREW
265 SHELDON SE
GRAND RAPIDS
,
MI
49503
NONE
PC
RELIGIOUS
5,000
CATHOLIC CHARITIES OF WEST MICHIGAN
40 JEFFERSON AVE SE
GRAND RAPIDS
,
MI
49503
NONE
PC
RELIGIOUS
2,000
CATHOLIC INFORMATION CENTER
360 DIVISION AVE S
GRAND RAPIDS
,
MI
49503
NONE
PC
RELIGIOUS
4,000
CHILDREN'S ADVOCACY CENTER OF KENT COUNTY
2855 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49506
NONE
PC
CHARITABLE
3,000
CLARK RETIREMENT COMMUNITY FOUNDATION
1551 FRANKLIN ST SE
GRAND RAPIDS
,
MI
49506
NONE
PC
CHARITABLE
15,000
COLLEGE FOR CREATIVE STUDIES
201 E KIRBY ST
DETROIT
,
MI
48202
NONE
PC
EDUCATIONAL
3,000
COMMUNITY SPAY NEUTER INITIATIVE (CSNIP)
1675 VIEWPOND DR SE
KENTWOOD
,
MI
49508
NONE
PC
CHARITABLE
1,000
CONGREGATION OF ST JOSEPH
3430 ROCKY RIVER DR
CLEVELAND
,
OH
44111
NONE
PC
RELIGIOUS
1,000
CONSERVATION RESOURCE ALLIANCE
1881 9TH ST
ZEELAND
,
CO
80302
NONE
PC
CHARITABLE
3,000
D A BLODGETT ST JOHNS
805 LEONARD ST NE OFC
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
30,000
DAVENPORT UNIVERSITY
6191 KRAFT AVE SE
GRAND RAPIDS
,
MI
49512
NONE
PC
EDUCATIONAL
1,000
DOMINICAN SISTERS OF GRAND RAPIDS
2025 E FULTON ST
GRAND RAPIDS
,
MI
49503
NONE
PC
RELIGIOUS
2,000
DOOR INTERNATIONAL
135 N STATE ST SUITE 200
ZEELAND
,
MI
49464
NONE
PC
CHARITABLE
1,000
DWELLING PLACE
101 SHELDON BLVD SE SUITE 2
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
5,000
ELE'S PLACE
2000 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
5,000
EQUINE ASSISTED DEVELOPMENT
3224 32ND ST SE
GRAND RAPIDS
,
MI
49512
NONE
PC
CHARITABLE
2,000
EQUINE VOICES RESCUE SANCTUARY
PO BOX 1685
GREEN VALLEY
,
AZ
85622
NONE
PC
CHARITABLE
5,000
EVANS SCHOLARS FOUNDATION
1110 JORIE BLVD
OAK BROOK
,
IL
60523
NONE
PC
CHARITABLE
1,000
FAITH HOSPICE
2100 RAYBROOK ST SE 300
GRAND RAPIDS
,
MI
49546
NONE
PC
CHARITABLE
2,000
FEEDING AMERICA
864 W RIVER CENTER DR NE
COMSTOCK PARK
,
MI
49321
NONE
PC
CHARITABLE
5,000
THE FIRST TEE
3450 36TH ST SE
KENTWOOD
,
MI
49512
NONE
PC
CHARITABLE
1,000
FOUNDATION FOR CATHOLIC SECONDARY EDUCATION
360 DIVISION AVE S
GRAND RAPIDS
,
MI
49503
NONE
PC
EDUCATIONAL
2,000
FRANCISCAN LIFE PROCESS CENTER
11650 DOWNES ST
LOWELL
,
MI
49331
NONE
PC
RELIGIOUS
2,000
FREDERICK MEIJER GARDENS
1000 E BELTLINE AVE NE
GRAND RAPIDS
,
MI
49525
NONE
PC
EDUCATIONAL
5,000
GERALD R FORD PRESIDENTIAL FOUNDATION
303 PEARL ST NW
GRAND RAPIDS
,
MI
49504
NONE
PC
EDUCATIONAL
1,000
GRAND RAPIDS ART MUSEUM
101 MONROE CTR NW
GRAND RAPIDS
,
MI
49503
NONE
PC
EDUCATIONAL
1,000
GRAND RAPIDS BALLET COMPANY
341 ELLSWORTH AVE SW
GRAND RAPIDS
,
MI
49503
NONE
PC
EDUCATIONAL
1,000
GIRLS SCOUTS OF MICHIGAN
601 W MAPLE STREET
KALAMAZOO
,
MI
49008
NONE
PC
CHARITABLE
1,000
GRACE EPISCOPAL CHURCH ENDOWMENT
1815 HALL ST SE
GRAND RAPIDS
,
MI
49506
NONE
PC
RELIGIOUS
500
GRAND RAPIDS COMMUNITY COLLEGE FOUNDATION
143 BOSTWICH AVE NE
GRAND RAPIDS
,
MI
49503
NONE
PC
EDUCATIONAL
1,000
GRAND RAPIDS PUBLIC MUSEUM
272 PEARL ST NW
GRAND RAPIDS
,
MI
49504
NONE
PC
EDUCATIONAL
1,000
GRAND RAPIDS SYMPHONY
300 OTTAWA AVE NW STE 100
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
1,000
GUIDING LIGHT MISSION
255 S DIVISION AVE
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
1,000
GVSU SEIDMAN COLLEGE OF BUSINESS
301 W FULTON ST
GRAND RAPIDS
,
MI
49501
NONE
PC
EDUCATIONAL
5,000
HABITAT FOR HUMANITY
425 PLEASANT STREET SW
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
1,500
HELEN DEVOS CHILDREN'S HOSPITAL
100 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
2,000
HIGHER GROUND AT LAKE LOUISE
10750 STAFFORD RD
BOYNE FALLS
,
MI
49713
NONE
PC
CHARITABLE
5,000
HOSPICE OF MICHIGAN
2366 OAK VALLEY DR
ANN ARBOR
,
MI
48103
NONE
PC
CHARITABLE
3,000
HUMANE SOCIETY OF KENT CO
3077 WILSON DR NW
GRAND RAPIDS
,
MI
49534
NONE
PC
CHARITABLE
2,000
INDIAN TRAILS CAMP
O-1859 LAKE MICHIGAN DR NW
GRAND RAPIDS
,
MI
49534
NONE
PC
EDUCATIONAL
2,000
JOHN BALL ZOO SOCIETY
1300 FULTON ST W
GRAND RAPIDS
,
MI
49504
NONE
PC
EDUCATIONAL
2,000
THE LAND CONSERVANCY OF WEST MICHIGAN HIGHLANDS
400 ANN ST NW
GRAND RAPIDS
,
MI
49504
NONE
PC
CHARITABLE
5,000
LEUKEMIA AND LYMPHOMA SOCIETY
549 OTTAWA AVE SUITE 307
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
2,000
LOWELL ARTS
149 S HUDSON ST
LOWELL
,
MI
49331
NONE
PC
EDUCATIONAL
2,000
LOWELL FAIRGROUND
225 S HUDSON ST
LOWELL
,
MI
49331
NONE
PC
CHARITABLE
1,000
LOWELL FARM AND WILDLIFE CENTER
12494 VERGENNES ST SE
LOWELL
,
MI
49331
NONE
PC
EDUCATIONAL
2,000
MACKENZIE'S ANIMAL SANCTUARY
8935 THOMPSON RD
LAKE ODESSA
,
MI
48849
NONE
PC
CHARITABLE
1,000
RILEY MACKENZIE FUND
PO BOX 27
PARIS
,
MI
49338
NONE
PC
CHARITABLE
1,000
MARY FREE BED REHABILITATION HOSPITAL
235 WEALTHY ST SE
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
15,000
MEL TROTTER MINISTRIES
225 COMMERCE SW
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
1,000
METRO HEALTH HOSPITAL FOUNDATION
5900 BYRON CENTER AVE
WYOMING
,
MI
49519
NONE
PC
CHARITABLE
5,000
NATIONAL MULTIPLE SCLEROSIS SOCIETY
PO BOX 4527
NEW YORK
,
NY
10163
NONE
PC
CHARITABLE
1,000
NAZARETH ASSOCIATION OF WEST MICHIGAN
PO BOX 224
NAZARETH
,
MI
49074
NONE
PC
CHARITABLE
1,000
PARKINSON'S ASSOCIATION OF WEST MICHIGAN
260 JEFFERSON AVE SE 210
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
2,000
PINE REST CHRISTIAN MENTAL HEALTH
PO BOX 165
GRAND RAPIDS
,
MI
49501
NONE
PC
CHARITABLE
1,000
PORTER HILLS FOUNDATION
4450 CASCADE RD STE 200
GRAND RAPIDS
,
MI
49546
NONE
PC
CHARITABLE
5,000
ROOSEVELT PARK MINISTRIES
1530 GRANDVILLE AVE SW
GRAND RAPIDS
,
MI
49503
NONE
PC
RELIGIOUS
2,500
SALVATION ARMY
1215 FULTON ST E
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
1,000
SAN JUAN DIEGO ACADEMY
1650 GODFREY SW
WYOMING
,
MI
49509
NONE
PC
EDUCATIONAL
2,000
SENIOR NEIGHBORS
900 N MAIN STREET
ELOY
,
AZ
85131
NONE
PC
CHARITABLE
5,000
SPECTRUM HEALTH FOUNDATION
100 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
9,000
ST ANN'S PARISH AND IT'S MISSIONS
2161 LEONARD ST NW
GRAND RAPIDS
,
MI
49504
NONE
PC
RELIGIOUS
15,000
ST MARY'S DORAN FOUNDATION
200 JEFFERSON AVE SE
GRAND RAPIDS
,
MI
49503
NONE
PC
RELIGIOUS
10,000
ST CECILIA MUSIC CENTER
24 RANSON NE
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
1,000
SWEET HOUSE FOUNDATION
254 E FULTON ST SE
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
1,000
THE POTTERS HOUSE
6777 WEST KIEST BLVD
DALLAS
,
TX
75236
NONE
PC
CHARITABLE
6,500
TUBAC HISTORICAL SOCIETY
9 PLAZA RD
TUBAC
,
AZ
85646
NONE
PC
EDUCATIONAL
2,000
TUBAC CENTER FOR THE ARTS
9 PLAZA RD
TUBAC
,
AZ
85646
NONE
PC
EDUCATIONAL
2,000
WASHINGTON UNIVERSITY IN ST LOUIS
1 BROOKINGS DR
ST LOUIS
,
MO
63130
NONE
PC
EDUCATIONAL
25,000
WGVU BROADCASTING
301 W FULTON ST
GRAND RAPIDS
,
MI
49504
NONE
PC
CHARITABLE
1,000
WAHLS THERAPEUTIC LIFESTYLE RESEARCH FUND
PO BOX 4550
IOWA CITY
,
IA
52244
NONE
PC
CHARITABLE
2,500
WILDLIFE REHAB CENTER
1504 UNION AVE NE
GRAND RAPIDS
,
MI
49505
NONE
PC
CHARITABLE
2,000
WOLF SANCTUARY
PO BOX 1544
LAPORTE
,
CO
80535
NONE
PC
CHARITABLE
1,500
WOUNDED WARRIOR PROJECT
4899 BELFORT ROAD SUITE 300
JACKSONVILLE
,
FL
32256
NONE
PC
CHARITABLE
5,000
YMCA OF GREATER GRAND RAPIDS
475 LAKE MICHIGAN DR NW
GRAND RAPIDS
,
MI
49504
NONE
PC
CHARITABLE
1,000
Total
.................................
3a
329,000
b
Approved for future payment
AC BURGY FUND
17116 G-DRIVE N
MARSHALL
,
MI
49068
NONE
PC
CHARITABLE
25,000
ALTERNATIVES IN MOTION
201 MATILDA ST NE
GRAND RAPIDS
,
MI
49503
NONE
PC
CHARITABLE
3,000
ARTHRITIS FOUNDATION OF MI
1050 WILSHIRE DR STE 302
TROY
,
MI
48084
NONE
PC
CHARITABLE
1,000
CHILDRENS LEUKEMIA FOUNDATION
5455 CORPORATE DR
TROY
,
MI
48098
NONE
PC
CHARITABLE
1,000
HILLSDALE COLLEGE-VANANDEL GRADUATE SCHOOL OF STATESMANSHIP
33 E COLLEGE ST
HILLSDALE
,
MI
49242
NONE
PC
EDUCATIONAL
5,000
KENDALL MEMORIAL SCHOOL FOUNDATION
111 DIVISION AVE N
GRAND RAPIDS
,
MI
49503
NONE
PC
EDUCATIONAL
2,000
MARINER'S CHURCH
170 E JEFFERSON AVE
DETROIT
,
MI
48226
NONE
PC
RELIGIOUS
5,000
SPECIAL OLYMPICS MICHIGAN
160 68TH ST SW
GRAND RAPIDS
,
MI
49548
NONE
PC
CHARITABLE
1,000
EQUINE VOICES RESCUE SANCTUARY
PO BOX 1685
GRAND RAPIDS
,
MI
49512
NONE
PC
CHARITABLE
5,000
Total
.................................
3b
48,000
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
689
4
Dividends and interest from securities
....
14
144,980
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
.....
211110
4,665
01
12,694
8
Gain or (loss) from sales of assets other than
inventory
............
18
8,818
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)
..
4,665
167,181
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
171,846
(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