-
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
RUTH MOTT FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
111 EAST COURT STREET NO 3C
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
FLINT
,
MI
485021649
A Employer identification number
38-2876435
B
Telephone number (see instructions)
(810) 233-0170
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)
$
237,465,716
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
57
57
4
Dividends and interest from securities
...
5,346,202
5,113,028
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
3,282,214
b
Gross sales price for all assets on line 6a
54,100,541
7
Capital gain net income (from Part IV, line 2)
...
4,337,161
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)
.......
26,675
0
12
Total.
Add lines 1 through 11
........
8,655,148
9,450,246
13
Compensation of officers, directors, trustees, etc.
240,000
2,400
237,600
14
Other employee salaries and wages
......
1,242,260
5,316
1,252,396
15
Pension plans, employee benefits
.......
285,901
1,565
290,006
16a
Legal fees (attach schedule)
.........
3,397
0
5,685
b
Accounting fees (attach schedule)
.......
30,900
0
30,900
c
Other professional fees (attach schedule)
....
670,025
545,000
127,419
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
923,219
120,167
112,164
19
Depreciation (attach schedule) and depletion
...
225,237
0
20
Occupancy
..............
139,855
0
139,872
21
Travel, conferences, and meetings
.......
76,379
0
72,382
22
Printing and publications
..........
5,657
0
5,107
23
Other expenses (attach schedule)
.......
2,929,552
562,189
2,500,031
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
6,772,382
1,236,637
4,773,562
25
Contributions, gifts, grants paid
.......
5,897,561
5,960,179
26
Total expenses and disbursements.
Add lines 24 and 25
12,669,943
1,236,637
10,733,741
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-4,014,795
b
Net investment income
(if negative, enter -0-)
8,213,609
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
.............
202,599
255,974
255,974
2
Savings and temporary cash investments
.........
6,689,794
9,896,534
9,896,534
3
Accounts receivable
32,281
Less: allowance for doubtful accounts
89,172
32,281
32,281
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)
992,008
Less: allowance for doubtful accounts
0
1,108,689
992,008
992,008
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
51,330
70,976
70,976
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
116,832,967
137,128,741
137,128,741
c
Investments—corporate bonds (attach schedule)
.......
16,185,395
16,778,834
16,778,834
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
64,833,023
67,319,104
67,319,104
14
Land, buildings, and equipment: basis
8,717,004
Less: accumulated depreciation (attach schedule)
4,062,791
4,723,377
4,654,213
4,654,213
15
Other assets (describe
)
787,051
337,051
337,051
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
211,503,397
237,465,716
237,465,716
17
Accounts payable and accrued expenses
..........
170,317
91,829
18
Grants payable
.................
1,611,860
1,555,109
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
)
900,000
1,279,000
23
Total liabilities
(add lines 17 through 22)
.........
2,682,177
2,925,938
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
208,821,220
234,539,778
29
Total net assets or fund balances
(see instructions)
.....
208,821,220
234,539,778
30
Total liabilities and net assets/fund balances
(see instructions)
.
211,503,397
237,465,716
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
208,821,220
2
Enter amount from Part I, line 27a
.....................
2
-4,014,795
3
Other increases not included in line 2 (itemize)
3
30,183,353
4
Add lines 1, 2, and 3
..........................
4
234,989,778
5
Decreases not included in line 2 (itemize)
5
450,000
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
234,539,778
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
TOBIAS WHITE & CO - NOMINEE (INSPIRE MEDICAL)
P
2019-12-28
2019-12-31
b
TOBIAS WHITE & CO - NOMINEE (INSPIRE MEDICAL)
P
2018-12-29
2019-12-31
c
TOBIAS WHITE & CO - NOMINEE (INSPIRE MEDICAL)
P
2019-12-28
2019-12-31
d
TOBIAS WHITE & CO - NOMINEE (INSPIRE MEDICAL)
P
2018-12-29
2019-12-31
e
TOBIAS WHITE & CO - NOMINEE
P
2018-12-29
2019-12-31
TOBIAS WHITE & CO - NOMINEE
P
2018-12-29
2019-12-31
TOBIAS WHITE & CO - NOMINEE
P
2018-12-29
2019-12-31
TOBIAS WHITE & CO - NOMINEE
P
2019-12-28
2019-12-31
TOBIAS WHITE & CO - NOMINEE
P
2019-12-28
2019-12-31
TOBIAS WHITE & CO - NOMINEE
P
2018-12-29
2019-12-31
VANGUARD SMALL CAP INDEX FUND INST
P
2018-04-30
2019-04-10
VANGUARD DEVELOPED MARKETS IDX IST
P
2018-10-17
2019-12-18
VANGUARD 500 INDEX FUND ADM
P
2013-08-22
2019-04-22
VANGUARD 500 INDEX FUND ADM
P
2013-04-15
2019-07-23
VANGUARD SMALL CAP INDEX FUND INST
P
2019-04-10
TOBIAS WHITE & CO - NOMINEE
P
2018-12-29
2019-12-31
TOBIAS WHITE & CO - NOMINEE
P
2019-12-31
MFO D&D SMID CAP VALUE FUND
P
2019-12-31
MFO D&D SMID CAP VALUE FUND
P
2019-12-31
TOBIAS WHITE & CO - NOMINEE
P
2018-12-29
2019-12-31
TOBIAS WHITE & CO - NOMINEE
P
2019-12-28
2019-12-31
8659 SHS ANAPLAN INC.
P
2014-05-08
2019-07-16
MFO TOWLE FUND
P
2019-12-31
MFO TOWLE FUND
P
2019-12-31
MFO WESTFIELD A
P
2019-12-31
MFO WESTFIELD A
P
2019-12-31
FROM SCH K-1: ARBORETUM III LP
P
2019-12-31
FROM SCH K-1: ANRP (EPE AIV) LP
P
2019-12-31
FROM SCH K-1: ANRP INTERNATIONAL HOLDINGS, LP
P
2019-12-31
FROM SCH K-1: APOLLO NATURAL RESOURCES PARTNERS LP
P
2019-12-31
FROM SCH K-1: APOLLO NATURAL RESOURCES PARTNERS LP
P
2019-12-31
FROM SCH K-1: CROSSLINK VENTURES V, LP
P
2019-12-31
FROM SCH K-1: CROSSLINK VENTURES VI, LP
P
2019-12-31
FROM SCH K-1: CROSSLINK VENTURES VI, LP
P
2019-12-31
FROM SCH K-1: DFJ GROWTH 2013 LP
P
2019-12-31
FROM SCH K-1: DFJ GROWTH 2013 LP
P
2019-12-31
FROM SCH K-1: IMPACT VENTURES III
P
2019-12-31
FROM SCH K-1: TACONIC CRE DISLOCATION FUND LP
P
2019-12-31
FROM SCH K-1: TGAP VENTURE CAPITAL FUND
P
2019-12-31
FROM SCH K-1: TGAP VENTURE CAPITAL FUND
P
2019-12-31
CAPITAL GAINS DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
8,270
2,336
5,934
b
1,014,623
170,959
843,664
c
5,947
1,680
4,267
d
558,370
100,119
458,251
e
43
30
13
4,787,419
3,145,311
1,642,108
6,847,363
8,348,410
-1,501,047
509,418
430,510
78,908
1,969,736
1,900,000
69,736
4,674,867
4,916,312
-241,445
628,130
618,183
9,947
1,300,000
1,206,554
93,446
400,000
228,137
171,863
2,200,000
1,214,340
985,660
2,371,870
2,110,061
261,809
500,000
533,451
-33,451
20
20
0
1,337,847
1,246,891
90,956
3,855,553
3,337,839
517,714
10,697,818
10,403,831
293,987
1,357,322
1,500,000
-142,678
443,830
61,568
382,262
1,285,717
1,597,594
-311,877
3,484,748
3,390,628
94,120
1,121,079
1,200,326
-79,247
2,309,675
1,300,014
1,009,661
10,103
10,103
10,746
10,746
5,390
-5,390
277
277
4,091
4,091
12,593
12,593
5,345
-5,345
96,752
-96,752
1,826
1,826
136,256
136,256
22,310
22,310
205,369
205,369
22,528
-22,528
668,261
-668,261
27,305
27,305
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
5,934
b
843,664
c
4,267
d
458,251
e
13
1,642,108
-1,501,047
78,908
69,736
-241,445
9,947
93,446
171,863
985,660
261,809
-33,451
0
90,956
517,714
293,987
-142,678
382,262
-311,877
94,120
-79,247
1,009,661
10,103
10,746
-5,390
277
4,091
12,593
-5,345
-96,752
1,826
136,256
22,310
205,369
-22,528
-668,261
27,305
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
4,337,161
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
10,976,599
225,062,532
0.048771
2017
10,038,903
217,341,802
0.046189
2016
10,414,760
197,760,946
0.052663
2015
10,689,795
213,223,075
0.050134
2014
10,466,344
221,027,246
0.047353
2
Total
of line 1, column (d)
.....................
2
0.245110
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
0.049022
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
220,408,104
5
Multiply line 4 by line 3
......................
5
10,804,846
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
82,136
7
Add lines 5 and 6
........................
7
10,886,982
8
Enter qualifying distributions from Part XII, line 4
,.............
8
10,889,815
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
82,136
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
82,136
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
82,136
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
185,681
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
185,681
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
103,545
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
103,545
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
Yes
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
HTTP://WWW.RUTHMOTTFOUNDATION.ORG
14
The books are in care of
JOYCE BOBOLTS DIR FIN ADMIN
Telephone no.
(810) 233-0170
Located at
111 EAST COURT STREET SUITE 3C
FLINT
MI
ZIP+4
485021649
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
Yes
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
EI
,
CJ
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
MARYANNE MOTT
CHAIR
15.00
0
0
0
111 E COURT ST SUITE 3C
FLINT
,
MI
48502
LAWRENCE MOON
VICE CHAIR
4.00
0
0
0
111 E COURT ST SUITE 3C
FLINT
,
MI
48502
JOSEPH ROBINSON
TREASURER
5.00
0
0
0
111 E COURT ST SUITE 3C
FLINT
,
MI
48502
SHANNON EASTER WHITE
SECRETARY
3.00
0
0
0
111 E COURT ST SUITE 3C
FLINT
,
MI
48502
GLORIA COLES
TRUSTEE
3.00
0
0
0
111 E COURT ST SUITE 3C
FLINT
,
MI
48502
ROBERT PESTRONK
TRUSTEE
3.50
0
0
0
111 E COURT ST SUITE 3C
FLINT
,
MI
48502
CHARLES MEYNET
TRUSTEE
3.00
0
0
0
111 E COURT ST SUITE 3C
FLINT
,
MI
48502
MARISE STEWART
TRUSTEE
3.00
0
0
0
111 E COURT ST SUITE 3C
FLINT
,
MI
48502
KYLE MCCREE
TRUSTEE
3.00
0
0
0
111 E COURT ST SUITE 3C
FLINT
,
MI
48502
RAQUEL THUEME
PRESIDENT
50.00
240,000
32,066
0
111 E COURT ST SUITE 3C
FLINT
,
MI
48502
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
SEE
N/A
50.00
658,121
122,771
0
STATEMENT 30
ATTACHED
,
MI
48502
Total
number of other employees paid over $50,000
...................
16
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
MFO MANAGEMENT COMPANY
INVEST. MGMT. & CONSULTING & ACCTG
560,000
111 E COURT ST SUITE 3D
FLINT
,
MI
48502
SMITH GROUP INC
APPLEWOOD MASTER PLAN
94,364
500 GRISWOLD SUITE 1700
DETROIT
,
MI
48226
GIVINGDATA LLC
GRANTS MANAGEMENT SYSTEM & SOFTWARE
64,535
45 PROSPECT STREET
CAMBRIDGE
,
MA
02139
NETSOURCE ONE
COMPUTER CONSULTING, MONITORING & EQUIP.
63,116
5454 HAMPTON PLACE
SAGINAW
,
MI
48604
TRUE IMPACT LLC
GRANTEE OUTCOME TRACKING SYSTEM & SW
55,000
74 KENT STREET 10
BROOKLINE
,
MA
02445
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
GENERAL INFORMATION - SEE STATEMENT 26
0
2
PRESERVATION/OPERATION OF APPLEWOOD ESTATE - SEE STATEMENT 27
1,284,379
3
COLLECTIONS - SEE STATEMENT 28
489,480
4
APPLEWOOD EDUCATION & EVENTS - SEE STATEMENT 29
499,856
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
158,874,332
b
Average of monthly cash balances
.......................
1b
7,996,381
c
Fair market value of all other assets (see instructions)
................
1c
56,893,860
d
Total
(add lines 1a, b, and c)
.........................
1d
223,764,573
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
223,764,573
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
3,356,469
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
220,408,104
6
Minimum investment return.
Enter 5% of line 5
..................
6
11,020,405
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
11,020,405
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
82,136
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
10,676
c
Add lines 2a and 2b
............................
2c
92,812
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
10,927,593
4
Recoveries of amounts treated as qualifying distributions
................
4
5,866
5
Add lines 3 and 4
............................
5
10,933,459
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
10,933,459
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
10,733,741
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
156,074
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
10,889,815
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
82,136
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
10,807,679
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
10,933,459
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
10,523,856
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:
$
10,889,815
a
Applied to 2018, but not more than line 2a
10,523,856
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
.....
365,959
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
10,567,500
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
RUTH MOTT FOUNDATION
111 E COURT ST SUITE 3C
FLINT
,
MI
485021649
(810) 233-0170
b
The form in which applications should be submitted and information and materials they should include:
POTENTIAL GRANTEES ARE ENCOURAGED TO GO TO WWW.RUTHMOTTFOUNDATION.ORG FOR INFORMATION ON THE RUTH MOTT FOUNDATION GRANT PROCESS AND GUIDELINES.
c
Any submission deadlines:
BOARD APPROVES GRANTS 3 TIMES A YEAR (FEB/MARCH, JUNE & OCT). SEE WEBSITE FOR SPECIFIC DEADLINES.
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
THE RUTH MOTT FOUNDATION BELIEVES IN COMMUNITY VITALITY, WHICH EMERGES FROM SAFE AND VIBRANT NEIGHBORHOODS THAT ARE HOME TO HEALTHY, FINANCIALLY SECURE FAMILIES AND CHILDREN. TO ACHIEVE THIS IN OUR COMMUNITY, WE ARE FOCUSING OUR EFFORTS ON NORTH FLINT, THE AREA WHERE WE BELIEVE OUR EFFORTS CAN MAKE THE BIGGEST DIFFERENCE. WE DEFINE NORTH FLINT AS THE CITY LIMITS ON THE WEST, NORTH AND EAST, AND FLUSHING ROAD/5TH AVENUE/LONGWAY BOULEVARD CORRIDOR TO THE SOUTH. GRANTS MUST ADDRESS YOUTH, SAFETY, ECONOMIC OPPORTUNITY, OR NEIGHBORHOODS. MORE SPECIFIC GUIDELINES CAN BE FOUND ON THE FOUNDATION'S WEBSITE - WWW.RUTHMOTTFOUNDATION.ORG.
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
ACTIVE BOYS IN CHRIST
2715 N AVERILL AVE
FLINT
,
MI
48506
NONE
PC
ABC YOUTH PROGRAM
27,835
AFRICAN DRUM AND DANCE PARENTS ASSOCIATION
PO BOX 310108
FLINT
,
MI
48531
NONE
PC
GENERAL OPERATING SUPPORT
20,000
ASBURY COMMUNITY DEVELOPMENT CORPORATION
1653 DAVISON ROAD
FLINT
,
MI
48506
NONE
PC
GENERAL OPERATING SUPPORT
112,500
ASHFORD 75 LLC
5000 SOUTH LINCOLN TRACE AVE
SMYRNA
,
GA
30080
NONE
I
2012 - 2018 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
485
BANGTOWN STUDIO ON THE GO
615 S SAGINAW STREET SUITE 6019
FLINT
,
MI
48502
NONE
PC
STUDIO ON THE GO EXPANSION
27,500
BETHEL UNITED METHODIST CHURCH
1309 N BALLENGER HWY
FLINT
,
MI
48504
NONE
PC
BETHEL CDF FREEDOM SCHOOL
20,000
BIG BROTHERS BIG SISTERS OF FLINT AND GENESEE COUNTY
410 EAST 2ND STREET
FLINT
,
MI
48503
NONE
PC
OUT OF SCHOOL TIME MENTORING PROGRAM
65,000
BOYS AND GIRLS CLUB OF GREATER FLINT
3701 N AVERILL AVE
FLINT
,
MI
48506
NONE
PC
GENERAL OPERATING SUPPORT
70,000
CATHOLIC CHARITIES OF SHIAWASSEE & GENESEE COUNTIES
901 CHIPPEWA STREET
FLINT
,
MI
48503
NONE
PC
MR. GAINES GARDENING PROGRAM PLUS
85,000
CENTER FOR HIGHER EDUCATIONAL ACHIEVEMENT (CHEA)
1920 MARYLAND AVE
FLINT
,
MI
48506
NONE
PC
CHEA NORTH FLINT ADULT EDUCATION PROGRAM
35,000
CHILD CARE NETWORK WASHTENAW REGIONAL 4C
3941 RESEARCH PARK DR STE C
ANN ARBOR
,
MI
48108
NONE
PC
FAMILY SUPPORT PROGRAM
60,000
CHILD CARE NETWORK WASHTENAW REGIONAL 4C
3941 RESEARCH PARK DR STE C
ANN ARBOR
,
MI
48108
NONE
PC
FAMILY SUPPORT PROGRAM
60,000
CITY OF FLINT
CITY HALL 1101 SOUTH SAGINAW STREET
FLINT
,
MI
48502
NONE
GOV
IMAGINE FLINT - NEIGHBORHOOD PLANNING INITIATIVE
202,000
CLINGMAN FOUNDATION
6099 CALKINS RD
FLINT
,
MI
48532
NONE
PC
ACADEMIC IMPROVEMENT COLLEGE READINESS PROGRAM
32,800
COMMUNITY FOUNDATION OF GREATER FLINT
500 S SAGINAW STREET SUITE 200
FLINT
,
MI
48502
NONE
PC
NEIGHBORHOOD SMALL GRANTS PROGRAM
90,000
COUNCIL OF MICHIGAN FOUNDATIONS
ONE S HARBOR AVE SUITE 8
GRAND HAVEN
,
MI
49417
NONE
PC
PHILANTHROPIC CAPACITY
14,400
CPSA COURIER INC
109 WELCH BOULEVARD
FLINT
,
MI
48503
NONE
PC
GENERAL OPERATING SUPPORT
41,120
CRIM FITNESS FOUNDATION
452 S SAGINAW STREET SUITE 1
FLINT
,
MI
48502
NONE
PC
SAFE & ACTIVE NORTH FLINT
49,120
CRIME STOPPERS OF FLINT AND GENESEE COUNTY
210 E FIFTH ST
FLINT
,
MI
48502
NONE
PC
NORTH FLINT PROJECT
50,220
EASTSIDE COMPASSIONATE MISSION CENTERINC
PO BOX 90238
FLINT
,
MI
48509
NONE
PC
EMPOWERING THROUGH EMPLOYMENT
7,232
EL BALLET FOLKLORICO ESTUDIANTIL
5211 E CARPENTER RD
FLINT
,
MI
48506
NONE
PC
MEXICAN FOLKLORICO DANCE AND MUSIC PROGRAMS FOR RICHFIELD PUBLIC SCHOOLS
15,000
EVERGREEN COMMUNITY DEVELOPMENT INITITATIVE
4121 MARTIN LUTHER KING AVE
FLINT
,
MI
48505
NONE
PC
GENERAL OPERATING SUPPORT
150,000
EVERGREEN COMMUNITY DEVELOPMENT INITITATIVE
4121 MARTIN LUTHER KING AVE
FLINT
,
MI
48505
NONE
PC
LOVE MARIE'S CLUB
10,000
FAIR FOOD NETWORK
1250 NORTH MAIN STREET NORTH SUITE
ANN ARBOR
,
MI
48104
NONE
PC
INNOVATING TECHNOLOGY AND EXPANDING GEOGRAPHIES
80,000
FAITH FOUNDATION RESOURCES
4225 MILLER ROAD SUITE 176
FLINT
,
MI
48507
NONE
PC
ANNUAL FUNDRAISER
500
FAITH FOUNDATION RESOURCES
4225 MILLER ROAD SUITE 176
FLINT
,
MI
48507
NONE
PC
HELPING YOUNG PEOPLE WITH EMPLOYMENT (HYPE) PROGRAM
65,000
FEDEX ASHFORD 75 LLC
PO BOX 371461
PITTSBURG
,
PA
152057461
NONE
I
2012 - 2018 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
46
FLINT CHILDREN'S MUSEUM
1602 W UNIVERSITY AVE
FLINT
,
MI
48504
NONE
PC
PLAYING AND LEARNING TOGETHER
30,000
FLINT CULTURAL CENTER CORPORATION
1310 E KEARSLEY ST
FLINT
,
MI
48503
NONE
PC
SLOAN MUSEUM OF DISCOVERY - NORTH FLINT COLLABORATION
89,164
FLINT DISTRICT LIBRARY
DBA FLINT PUBLIC LIBRARY 1026 EAST
KEARSLEY STREET
FLINT
,
MI
48503
NONE
GOV
FLINT PUBLIC LIBRARY TRANSFORMED CAPITAL CAMPAIGN
250,000
FLINT INSTITUTE OF ARTS
1120 EAST KEARSLEY STREET
FLINT
,
MI
48503
NONE
PC
START AND START PARENTING SKILLS WORKSHOPS PROJECT
45,000
FLINT INSTITUTE OF ARTS
1120 EAST KEARSLEY STREET
FLINT
,
MI
48503
NONE
PC
FLINT INSTITUTE OF ARTS ENDOWMENT FUND
10,000
FLINT POLICE FOUNDATION
2125 BIRCHWOOD CT
TRAVERSE CITY
,
MI
49686
NONE
PC
NORTH END COMMUNITY CRIME STRATEGY (NECCS)
228,000
GENESEE CHAMBER FOUNDATION
519 S SAGINAW STREET STE 200
FLINT
,
MI
48502
NONE
PC
FLINTSIDE: ON THE GROUND
37,260
GENESEE COUNTY HABITAT FOR HUMANITY
101 BURTON STREET
FLINT
,
MI
48503
NONE
PC
CREATING CONSTRUCTION JOBS BY REPAIRING FLINT HOMES
142,000
GENESEE COUNTY HABITAT FOR HUMANITY
101 BURTON STREET
FLINT
,
MI
48503
NONE
PC
HERITAGE & HARMONY
1,000
GENESEE COUNTY LAND BANK AUTHORITY
452 SOUTH SAGINAW STREET SECOND
FLOOR
FLINT
,
MI
48502
NONE
PC
CLEAN AND GREEN
267,400
GENESEE COUNTY LAND BANK AUTHORITY
452 SOUTH SAGINAW STREET SECOND
FLOOR
FLINT
,
MI
48502
NONE
PC
CLEAN AND GREEN
267,400
GENESEE COUNTY PARKS AND RECREATION COMMISSION
5045 STANLEY ROAD
FLINT
,
MI
48506
NONE
GOV
NORTH FLINT PUBLIC SAFETY STRATEGY
410,168
GEORGIA STATE UNIVERSITY
PO BOX 4040
ATLANTA
,
GA
30302
NONE
I
2013 - 2019 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
5,000
GIRLS ON THE RUN MID MICHIGAN INC
PO BOX 1836
OWOSSO
,
MI
48867
NONE
PC
GREATER FLINT PROGRAM ACCESS INITIATIVE
10,000
GRANTMAKERS FOR EFFECTIVE ORGANIZATIONS
1725 DESALES STREET NW SUITE 404
WASHINGTON
,
DC
20036
NONE
PC
PHILANTHROPIC CAPACITY AND GEO LEADERSHIP CIRCLE
6,500
GREATER FLINT ARTS COUNCIL
816 SOUTH SAGINAW ST
FLINT
,
MI
48502
NONE
PC
SHOP FLOOR THEATRE COMPANY (SFTC) CREATIVE LEARNING PROGRAM
35,000
GST MICHIGAN WORKS INC
711 N SAGINAW ST SUITE 300
FLINT
,
MI
48503
NONE
PC
JOBS FOR MICHIGAN'S GRADUATES - OUT OF SCHOOL
54,000
HISPANIC TECHNOLOGY AND COMMUNITY CENTER DBA LATINX TECH & COMMUNITY CTR
2101 LEWIS STREET
FLINT
,
MI
48506
NONE
PC
GENERAL OPERATING SUPPORT
75,000
INSTITUTE OF RHYMES
PO BOX 4074
FLINT
,
MI
48504
NONE
PC
BUILDING MEN OF EXCELLENCE
390
INSTITUTE OF RHYMES
PO BOX 4074
FLINT
,
MI
48504
NONE
PC
BUILDING MEN OF EXCELLENCE
20,000
INVOLVEDDAD
709 SPELLMAN DR
FLINT
,
MI
48503
NONE
PC
IMPACT - FATHER ENGAGEMENT
75,000
JP MORGAN CHASE DANCE SOLUTIONS
PO BOX 15918
WILMINGTON
,
DE
19850
NONE
I
2015 - 2021 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
290
JP MORGAN CHASE UNIVERSITY OF MICHI
PO BOX 15918
WILMINGTON
,
DE
19850
NONE
I
2015 - 2021 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
107
KENTAKEE ATHLETIC AND SOCIAL CLUBS
4208 COMSTOCK AVENUE
FLINT
,
MI
48504
NONE
PC
BERSTON BICYCLE CLUB PROJECT
24,300
LOCAL INITIATIVES SUPPORT CORPORATION
MICHIGAN LISC 201 W KALAMAZOO AVE
310
KALAMAZOO
,
MI
49007
NONE
PC
LISC FLINT STRATEGY
75,000
MADE INSTITUTE
503 GARLAND ST
FLINT
,
MI
48503
NONE
PC
GENERAL OPERATING SUPPORT
77,000
MARIN COMMUNITY FOUNDATION
5 HAMILTON LANDING SUITE 200
NOVATO
,
CA
94949
NONE
PC
RMF DONOR ADVISED FUND
390,000
METRO COMMUNITY DEVELOPMENT INC
MOTT FOUNDATION BUILDING 503 S
SAGINAW ST SUITE 804
FLINT
,
MI
48502
NONE
PC
NORTH FLINT SUSTAINABLE HOUSING AND ECONOMIC PROGRAM
132,000
MICHIGAN COUNCIL ON CRIME AND DELINQUENCY
1679 BROADWAY ST
ANN ARBOR
,
MI
48105
NONE
PC
NATION OUTSIDE FLINT CHAPTER
38,000
MICHIGAN CROSSROADS COUNCIL BOY SCOUTS OF AMERICA
137 S MARKETPLACE BLVD
LANSING
,
MI
48917
NONE
PC
URBAN SCOUTING PROGRAM
15,000
MICHIGAN LEAGUE FOR PUBLIC POLICY
1223 TURNER STREET SUITE G-1
LANSING
,
MI
48906
NONE
PC
EMPOWERING NORTH FLINT RESIDENTS
40,000
MOTHERLY INTERCESSION
PO BOX 311109
FLINT
,
MI
48531
NONE
PC
RACS AND IN-TOUCH READY TO WORK
40,000
MOTHERLY INTERCESSION
PO BOX 311109
FLINT
,
MI
48531
NONE
PC
ANNUAL FUNDRAISER
500
NATIONAL COMMITTEE FOR RESPONSIVE PHILANTHROPY
1900 L STREET NW SUITE 825
WASHINGTON
,
DC
20036
NONE
PC
PHILANTHROPIC CAPACITY
4,400
NEIGHBORHOOD ENGAGEMENT HUB
3216 MARTIN LUTHER KING AVE
FLINT
,
MI
48505
NONE
PC
OPERATING SUPPORT: NEIGHBORHOOD DEVELOPMENT
105,000
NEIGHBORHOOD ENGAGEMENT HUB
3216 MARTIN LUTHER KING AVE
FLINT
,
MI
48505
NONE
PC
THE PORCH PROJECT
14,025
NEW COMMUNITY BAPTIST CHURCH
1375 LAVENDER AVENUE
FLINT
,
MI
48504
NONE
PC
WORKING ACTIVELY INTENTIONALLY TOGETHER - THE PHOENIX PROGRAM
100,000
OAKLAND COMMUNITY COLLEGE
2480 OPDYKE RD ACCOUNTS RECEIVABLE
BLOOMFIELD HILLS
,
MI
48304
NONE
I
2015 - 2021 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
1,900
PEAK GRANTMAKING
1666 K STREET NW SUITE 440
WASHINGTON
,
DC
20006
NONE
PC
PHILANTHROPIC CAPACITY
3,000
PROJECT SYNCERE INC
9012 S STONY ISLAND AVENUE
CHICAGO
,
IL
60617
NONE
PC
STEMNETICS
30,000
RE-CONNECTIONS INC
PO BOX 51
FENTON
,
MI
48430
NONE
PC
GENERAL OPERATING SUPPORT
4,360
RE-CONNECTIONS INC
PO BOX 51
FENTON
,
MI
48430
NONE
PC
GENERAL OPERATING SUPPORT
20,000
SIPI INC
PO BOX 362
FLINT
,
MI
48501
NONE
NC
NORTH FLINT CAPACITY BUILDING
70,440
SPECIALIZED EMPLOYMENT SERVICES INC
DBA FLINT STRIVE 1108 LAPEER RD
FLINT
,
MI
48503
NONE
PC
NORTHSIDE IMPACT STRATEGIC PLAN
140,000
SPHINX ORGANIZATION
400 RENAISSANCE CENTER SUITE 2550
DETROIT
,
MI
48243
NONE
PC
SPHINX OVERTURE:MUSIC EDUCATION & YTH DEVELOPMENT PRGRM
95,000
ST LUKE NEW LIFE CENTER INC
3115 LAWNDALE AVENUE
FLINT
,
MI
48504
NONE
PC
NORTH FLINT WOMEN'S EMPLOYMENT PREPARATION
105,000
SYLVESTER BROOME EMPOWERMENT VILLAGE
4119 N SAGINAW ST SUITE 104
FLINT
,
MI
48505
NONE
PC
NORTH FLINT NEIGHBORHOOD ACTION COUNCIL
91,600
SYLVESTER BROOME EMPOWERMENT VILLAGE
4119 N SAGINAW ST SUITE 104
FLINT
,
MI
48505
NONE
PC
GENERAL OPERATING SUPPORT
150,000
SYLVESTER BROOME EMPOWERMENT VILLAGE
4119 N SAGINAW ST SUITE 104
FLINT
,
MI
48505
NONE
PC
NEWS MOVEMENT
40,000
TAPOLOGY INC
2145 ARMSTRONG RD
MT MORRIS
,
MI
48458
NONE
PC
TAPOLOGY GENERAL PROJECT SUPPORT
120,000
THE FLINT INSTITUTE OF MUSIC INC
1025 EAST KEARSLEY STREET
FLINT
,
MI
48503
NONE
PC
COMMUNITY PROGRAMS
58,660
UNITED WAY OF GENESEE COUNTY
111 E COURT ST SUITE 3A
FLINT
,
MI
48502
NONE
PC
JACKSON PARK YOUTH LEAGUE - RBI
22,000
UNITED WAY OF GENESEE COUNTY
111 E COURT ST SUITE 3A
FLINT
,
MI
48502
NONE
PC
FRIENDS OF BERSTON - GENERAL OPERATING SUPPORT
130,000
UNITED WAY OF GENESEE COUNTY
111 E COURT ST SUITE 3A
FLINT
,
MI
48502
NONE
PC
STEMLETICS
35,475
UNIVERSITY MUSICAL SOCIETY
BURTON MEMORIAL TOWER 881 N
UNIVERSITY AVE
ANN ARBOR
,
MI
48109
NONE
PC
YO-YO MA DAY OF ACTION FLINT RESIDENCY
3,500
UNIVERSITY OF MICHIGAN - FLINT
OFFICE OF FINANCIAL AID 277
PAVILION
FLINT
,
MI
485021950
NONE
I
2014 - 2020 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
2,400
UNIVERSITY OF MICHIGAN - FLINT
OFFICE OF FINANCIAL AID 277
PAVILION
FLINT
,
MI
485021950
NONE
I
2014 - 2020 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
2,600
UNIVERSITY OF MICHIGAN - FLINT
OFFICE OF FINANCIAL AID 277
PAVILION
FLINT
,
MI
485021950
NONE
I
2014 - 2020 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
3,355
URBAN RENAISSANCE CENTER
2505 N CHEVROLET AVENUE
FLINT
,
MI
48504
NONE
PC
GENERAL OPERATING SUPPORT
187,547
YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER FLINT
411 EAST THIRD STREET
FLINT
,
MI
48503
NONE
PC
SAFE PLACES
120,000
YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER FLINT
411 EAST THIRD STREET
FLINT
,
MI
48503
NONE
PC
SHOOTING FOR THE STARS - SUMMER ENGAGEMENT ACADEMY
18,680
Total
.................................
3a
5,960,179
b
Approved for future payment
BOYS AND GIRLS CLUB OF GREATER FLINT
3701 N AVERILL AVENUE
FLINT
,
MI
48506
NONE
PC
GENERAL OPERATING SUPPORT
80,000
DELTA RESEARCH AND EDUCATIONAL FOUNDATION
1703 NEW HAMPSHIRE AVENUE NW
WASHINGTON
,
DC
20009
NONE
PC
DELTA SIGMA THETA SORORITY, INC. - ACADEMY; EMBODI; GEMS(AEG): EMPOWERED
19,000
EASTERN MICHIGAN UNIVERSITY
OFFICE OF FINANCIAL AID 403 PIERCE
HALL
YPSILANTI
,
MI
48197
NONE
I
2014 - 2020 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
5,000
FLINT DISTRICT LIBRARY
DBA FLINT PUBLIC LIBRARY 1026 EAST
KEARSLEY ST
FLINT
,
MI
48503
NONE
GOV
FLINT PUBLIC LIBRARY TRANSFORMED CAPITAL CAMPAIGN
750,000
GST MICHIGAN WORKS INC
711 N SAGINAW ST SUITE 300
FLINT
,
MI
48503
NONE
PC
JOBS FOR MICHIGAN'S GRADUATES - OUT OF SCHOOL
27,000
LEGAL SERVICES OF EASTERN MICHIGAN
436 S SAGINAW STREET SUITE 101
FLINT
,
MI
48502
NONE
PC
NORTH FLINT LEGAL OUTREACH PROGRAM
59,500
METRO COMMUNITY DEVELOPMENT INC
MOTT FOUNDATION BUILDING 503 S
SAGINAW ST
FLINT
,
MI
48502
NONE
PC
NORTH FLINT SUSTAINABLE HOUSING AND ECONOMIC PROGRAM
95,000
MOTT COMMUNITY COLLEGE
1401 E COURT ST CURTICE-MOTT
COMPLEX - CM1117K
FLINT
,
MI
485032089
NONE
PC
FLINT AND GENESEE LITERACY NETWORK OPERATING SUPPORT
126,875
MOTT COMMUNITY COLLEGE
PRAHL COLLEGE CENTER PCCLL11 1401
EAST COURT STREET
FLINT
,
MI
48503
NONE
I
2014 - 2020 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
5,000
MOTT COMMUNITY COLLEGE
PRAHL COLLEGE CENTER PCCLL11 1401
EAST COURT STREET
FLINT
,
MI
48503
NONE
I
2014 - 2020 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
795
MOTT COMMUNITY COLLEGE
PRAHL COLLEGE CENTER PCCLL11 1401
EAST COURT STREET
FLINT
,
MI
48503
NONE
I
2014 - 2020 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
2,655
MOTT COMMUNITY COLLEGE
PRAHL COLLEGE CENTER PCCLL11 1401
EAST COURT STREET
FLINT
,
MI
48503
NONE
I
2014 - 2020 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
105
MOTT COMMUNITY COLLEGE
PRAHL COLLEGE CENTER PCCLL11 1401
EAST COURT STREET
FLINT
,
MI
48503
NONE
I
2015 - 2021 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
8,138
MOTT COMMUNITY COLLEGE
PRAHL COLLEGE CENTER PCCLL11 1401
EAST COURT STREET
FLINT
,
MI
48503
NONE
I
2015 - 2021 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
10,000
MOTT COMMUNITY COLLEGE
PRAHL COLLEGE CENTER PCCLL11 1401
EAST COURT STREET
FLINT
,
MI
48503
NONE
I
2015 - 2021 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
10,000
MOTT COMMUNITY COLLEGE
PRAHL COLLEGE CENTER PCCLL11 1401
EAST COURT STREET
FLINT
,
MI
48503
NONE
I
2015 - 2021 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
10,000
NEIGHBORHOOD ENGAGEMENT HUB
3216 MARTIN LUTHER KING AVE
FLINT
,
MI
48505
NONE
PC
GENERAL OPERATING
105,000
SIPI INC
PO BOX 362
FLINT
,
MI
48501
NONE
NC
NORTH FLINT CAPACITY BUILDING
70,440
UNITED WAY OF GENESEE COUNTY
111 E COURT ST SUITE 3A
FLINT
,
MI
48502
NONE
PC
FRIENDS OF BERSTON - GENERAL OPERATING SUPPORT
100,000
UNIVERSITY OF MICHIGAN - FLINT
OFFICE OF FINANCIAL AID 277
PAVILION
FLINT
,
MI
485021950
NONE
I
2014 - 2020 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
5,000
UNIVERSITY OF MICHIGAN - FLINT
OFFICE OF FINANCIAL AID 277
PAVILION
FLINT
,
MI
485021950
NONE
I
2014 - 2020 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
5,000
UNIVERSITY OF MICHIGAN - FLINT
OFFICE OF FINANCIAL AID 277
PAVILION
FLINT
,
MI
485021950
NONE
I
2015 - 2021 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
107
UNIVERSITY OF MICHIGAN - FLINT
OFFICE OF FINANCIAL AID 277
PAVILION
FLINT
,
MI
485021950
NONE
I
2015 - 2021 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
6,959
UNIVERSITY OF MICHIGAN - FLINT
OFFICE OF FINANCIAL AID 277
PAVILION
FLINT
,
MI
485021950
NONE
I
2015 - 2021 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
9,225
WESTERN MICHIGAN UNIVERSITY
STUDENT FINANCIAL AID OFFICE 1903
WEST MICHIGAN AVENUE
KALAMAZOO
,
MI
490085337
NONE
I
2015 - 2021 BSIP SCHOLARSHIP AWARDS - IRS DETERMINATION LETTER ON FILE
10,000
YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER FLINT
411 EAST THIRD STREET
FLINT
,
MI
48503
NONE
PC
SHOOTING FOR THE STARS-SUMMER ENGAGEMENT ACADEMY
15,560
YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER FLINT
411 EAST THIRD STREET
FLINT
,
MI
48503
NONE
PC
HEART OF WORSHIP DANCE STUDIO
18,750
Total
.................................
3b
1,555,109
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
57
4
Dividends and interest from securities
....
900099
51,836
14
5,294,366
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than
inventory
............
18
3,282,214
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
"HUGS AROUND YOUR NECK" BOOK SALES
85
b
APPLEWOOD 100TH ANNIVERSARY BOOK SALES
1,075
c
CS MOTT BIOGRAPHY BOOK SALES
25,457
d
MISCELLANEOUS INCOME
58
e
12
Subtotal. Add columns (b), (d), and (e)
..
51,836
8,576,637
26,675
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
8,655,148
(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
"HUGS AROUND YOUR NECK" BOOK SALES - A CHILDREN'S BOOK WAS WRITTEN BY APPLEWOOD STAFF IN MEMORY OF ONE OF RUTH MOTT'S FORMER EMPLOYEES. THE BOOK IS SCIENTIFICALLY ACCURATE AND TOUCHES ON THE THEMES OF SCIENCE, INCLUDING BUTTERFLIES AND FLOWERS, AND DIVERSITY AND INCLUSION. THE MAIN PURPOSE OF THE BOOK IS TO BE USED AS A PROGRAMMING TOOL FOR YEARS TO COME. IT IS ALSO BEING SOLD TO THE GENERAL PUBLIC.
11B
"APPLEWOOD - THE CHARLES STEWART MOTT ESTATE, ONE HUNDRED YEARS OF STORIES, 1916-2016"- THE BOOK RECOUNTS STORIES OF THE MOTT FAMILY AND THEIR LIVES AT APPLEWOOD. AFTER C.S.'S PASSING HIS WIDOW, RUTH, WANTED TO SHARE HIS STORY AND BEGAN A RESTORATION PROCESS WITH INTENTIONS OF EVENTUALLY OPENING APPLEWOOD TO THE PUBLIC. THE BOOK PROVIDES ACCESS AND INSIGHTS THAT YOU CANNOT FIND IN PUBLIC RECORDS. IN MR. MOTT'S OWN WORDS YOU WILL READ OF THE KEEN INTEREST HE TOOK IN EVERY DETAIL OF THE LANDSCAPING AND GARDENS. THE BOOK SHARES THE STORIES OF THE PEOPLE WHO LIVED THERE, WORKED THERE, OR SIMPLY VISITED AND CELEBRATES THE UNIQUE AND LARGELY PRIVATE PAST OF APPLEWOOD. IT PRESENTS PHOTOS AND DETAILS OF FURNISHINGS, ARTWORK AND THE LANDSCAPE THAT SURROUNDS IT. THE BOOK IS BEING SOLD TO THE GENERAL PUBLIC.
11C
"THE LIFE OF CHARLES STEWART MOTT"-THE BOOK REFLECTS THE LIFE OF MOTT WHOSE NAME TODAY IS MOST WIDELY RECOGNIZABLE WHEN USED IN CONNECTION WITH THE WORD FOUNDATION. BUT PHILANTHROPY IS ONLY ONE REASON THE LIFE OF MOTT - ENTREPRENEUR, INDUSTRIALIST, BANKER, MAYOR, AND SOMETIMES EVEN COWBOY IS WORTH KNOWING ABOUT TODAY. MOTT WAS BORN TEN YEARS AFTER THE DEATH OF ABRAHAM LINCOLN AND ONE YEAR BEFORE THE 1876 CENTENNIAL OF THE FOUNDING OF THE UNITED STATES. HE NOT ONLY LIVED THROUGH THE MOST DRAMATIC TECHNOLOGICAL SHIFT AND PERIOD OF ECONOMIC GROWTH THAT HAD YET BEEN KNOWN, BUT HE ACTIVELY PARTICIPATED IN AND CONTRIBUTED TO THESE EVENTS AS A MAJOR INNOVATOR AND LEADER AT GENERAL MOTORS, AS A PUBLIC OFFICIAL, AND AS A PHILANTHROPIST. THIS VIVID BIOGRAPHY PORTRAYS A COMPLEX, BRILLIANT, OFTEN CONTRADICTORY, AND ULTIMATELY FASCINATING MAN. THE BOOK IS BEING SOLD TO THE GENERAL PUBLIC.
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)
Yes
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
1b(6)
270,384
SMALL BUSINESS ASSOCIATION OF MI (HEALTH INS PROVIDER)
GROUP HEALTH INSURANCE
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