-
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
Avidia Charitable Foundation Inc
Number and street (or P.O. box number if mail is not delivered to street address)
42 Main Street
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Hudson
,
MA
01749
A Employer identification number
04-3371516
B
Telephone number (see instructions)
(978) 567-3569
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)
$
4,396,176
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
91
91
4
Dividends and interest from securities
...
95,659
95,659
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
127,814
b
Gross sales price for all assets on line 6a
280,481
7
Capital gain net income (from Part IV, line 2)
...
127,814
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)
.......
12
Total.
Add lines 1 through 11
........
223,564
223,564
13
Compensation of officers, directors, trustees, etc.
0
0
0
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
7,000
0
0
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
35
0
35
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
7,035
0
35
25
Contributions, gifts, grants paid
.......
187,300
187,300
26
Total expenses and disbursements.
Add lines 24 and 25
194,335
0
187,335
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
29,229
b
Net investment income
(if negative, enter -0-)
223,564
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
.............
7,093
13,759
13,759
2
Savings and temporary cash investments
.........
141,615
149,608
149,608
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)
1,159,972
1,362,355
1,362,355
b
Investments—corporate stock (attach schedule)
.......
2,476,116
2,870,454
2,870,454
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
3,784,796
4,396,176
4,396,176
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
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
3,784,796
4,396,176
29
Total net assets or fund balances
(see instructions)
.....
3,784,796
4,396,176
30
Total liabilities and net assets/fund balances
(see instructions)
.
3,784,796
4,396,176
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
3,784,796
2
Enter amount from Part I, line 27a
.....................
2
29,229
3
Other increases not included in line 2 (itemize)
3
582,151
4
Add lines 1, 2, and 3
..........................
4
4,396,176
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
4,396,176
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
Pubicly Traded Securities
b
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
280,481
152,667
127,814
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
127,814
b
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
127,814
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
157,225
3,898,474
0.040330
2017
164,510
3,288,465
0.050026
2016
154,500
2,650,122
0.058299
2015
124,469
2,281,459
0.054557
2014
102,275
1,670,389
0.061228
2
Total
of line 1, column (d)
.....................
2
0.264440
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
0.052888
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
4,064,822
5
Multiply line 4 by line 3
......................
5
214,980
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
2,236
7
Add lines 5 and 6
........................
7
217,216
8
Enter qualifying distributions from Part XII, line 4
,.............
8
187,335
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
4,471
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
4,471
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
4,471
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
7,358
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
1,700
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
9,058
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
31
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
4,556
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
4,556
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
MA
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
Margaret B Melo Sullivan
Telephone no.
(978) 567-3569
Located at
42 Main Street
Hudson
MA
ZIP+4
01749
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
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
Mark O'Connell
President
0.20
0
0
0
42 Main Street
Hudson
,
MA
01749
Margaret B Melo Sullivan
Treasurer
0.20
0
0
0
42 Main Street
Hudson
,
MA
01749
Mikala Geurtsen
Clerk
0.20
0
0
0
42 Main Street
Hudson
,
MA
01749
Paul Blazar
Director
0.20
0
0
0
42 Main Street
Hudson
,
MA
01749
Nancy Carlson
Director
0.20
0
0
0
42 Main Street
Hudson
,
MA
01749
Neil Flanigan
Director
0.20
0
0
0
42 Main Street
Hudson
,
MA
01749
Michael Girard
Director
0.20
0
0
0
42 Main Street
Hudson
,
MA
01749
Paul McGrath
Director
0.20
0
0
0
42 Main Street
Hudson
,
MA
01749
Brian Parker
Director
0.20
0
0
0
42 Main Street
Hudson
,
MA
01749
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
3,905,905
b
Average of monthly cash balances
.......................
1b
220,818
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
4,126,723
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
4,126,723
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
61,901
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
4,064,822
6
Minimum investment return.
Enter 5% of line 5
..................
6
203,241
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
203,241
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
4,471
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
4,471
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
198,770
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
198,770
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
198,770
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
187,335
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
187,335
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
187,335
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
198,770
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
......
8,349
b
From 2015
......
21,313
c
From 2016
......
25,652
d
From 2017
......
6,676
e
From 2018
......
f
Total
of lines 3a through e
........
61,990
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
187,335
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
.....
187,335
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
11,435
11,435
(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
50,555
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
......
50,555
10
Analysis of line 9:
a
Excess from 2015
....
18,227
b
Excess from 2016
....
25,652
c
Excess from 2017
....
6,676
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:
Margaret B Melo Sullivan
42 Main Street
Hudson
,
MA
01749
(978) 567-3569
b
The form in which applications should be submitted and information and materials they should include:
Forms available at above address.
c
Any submission deadlines:
See Application
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
See Application
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
A Place to Turn
99 Hartford Street
Natick
,
MA
01760
None
PC
To purchase nutritional perishable food items for our pantry clients
2,000
Abby Kelley Foster House Inc
52 High Street
Worcester
,
MA
01609
None
PC
There is a critical unmet need for affordable housing units in and around Worcester, and Abby's House helps meet that need. The preservation of affordable, supportive housing units in particular is extremely important to maintain for those in poverty who cannot afford market rate rents. By making hte building accessible, we can serve a wider range of ages and physical abilities.
4,000
Algonquin Athletic Booster Club Inc
POBox 303
Northborough
,
MA
01532
None
PC
Scoreboard sign
5,000
Apple Tree Arts
One Grafton Common
Grafton
,
MA
01519
None
PC
Annual Theatre Arts Program
2,800
Assabet Valley Mastersingers
POBox 911
Northborough
,
MA
01532
None
PC
Partial funding assistance for the 2019-2020 season and commission of a New York Unity in Diversity by Cynthia Wong in honor of AVM's 40th Anniversary
1,500
Big Brother Big Sister of Central MAMetrowest Inc
484 Main Street Suite 360
Worcester
,
MA
01608
None
PC
To support the MYSTEAM program, mentoring youth in science, technology, engineering, arts, and math
8,000
Big Brothers Big Sisters
484 Main Street Suite 360
Worcester
,
MA
01608
None
PC
Big Celebration Casino Royale
5,500
Boys and Girls Club of MetroWest
169 Pleasant Street
Marlborough
,
MA
01752
None
PC
Summer camp underwriting and after school support
25,000
Clear Path for Veterans New England
84 Antieam Street
Devens
,
MA
01434
None
PC
To defray the costs of providing a woodworking workshop for veterans and service members
1,400
Community Harvest Project
37 Wheeler Road
North Grafton
,
MA
01536
None
PC
To support the addition of six new crops for increased variety of nutritious foods which will allow food to be distributed to food insecure individuals to prevent them from experiencing a poor diet due to poverty
2,500
Community Legal Aid Inc
405 Main Street
Worcester
,
MA
01608
None
PC
Language Access Project which will help pay for a portion of the organizations interpretation and translation expenses in Worcester County
2,500
Daniel's Table
10 Pearl Street
Framingham
,
MA
01702
None
PC
To help support and fund the Freezer program in which nutritious meals are prepared so that members of the Framingham community can pick up
5,000
Edward M Kennedy Community Health Center
650 Lincoln Street
Worcester
,
MA
01605
None
PC
Funding to assist to purchase one Polycom wireless for interpretation services
2,000
Facing Cancer Together Inc
410 Washington Street
Brighton
,
MA
02135
None
PC
Funding for Metrowest cancer support programming
1,500
Foundation for MetroWest
3 Eliot Street
Natick
,
MA
01760
None
PC
Connects philanthropic opportunity with demonstrated need
5,000
Framingham Public Library
49 Lexington Street
Framingham
,
MA
01702
None
PC
Requesting funding assistance for a new 3d printer and supplies
2,500
Framingham State University Foundation Inc
100 State Street
Framingham
,
MA
01701
None
PC
Framingham State University's Entrepreneur Innovation Center is sponsoring a unique startup - style pitch competition called "Hackachusetts", as a platform for students working in teams to "hack or solve metro west communities' social and economic problems.
2,500
Fresh Start Furniture Bank
16 Bent Drive
Hudson
,
MA
01749
None
PC
General operating expenses as they only have one part time person
2,500
Hoops and Homework Inc
56 Agnes Drive
Framingham
,
MA
01701
None
PC
To assist in the scholarship program which allows children of families who qualify to attend our programs
2,500
Horace Mann Educational Associates Inc (HMEA)
8 Forge Park East
Franklin
,
MA
02038
None
PC
Purchase of fitness equipment and additional school furnishings
2,000
Horizons for Homeless Children
1705 Columbus Avenue
Roxbury
,
MA
02119
None
PC
Support the operation of playspaces in Framingham shelters
2,500
Hudson Maynard Adult Learning Center
69 Brigham Street
Hudson
,
MA
01749
None
PC
To support educationally disadvantaged adults, especially those with limited English proficiency to help increase their educational opportunities
4,000
Irving Street Park Framingham
City Hall
Framingham
,
MA
01702
None
GOV
To provide residents including low income seniors with a much needed green space
2,500
John Andrew Mazie Memorial Foundation
4 Franklin Commons
Framingham
,
MA
01702
None
PC
To support their new expansion through Marlborough High School
2,500
Marlboro Public Library
35 West Main Street
Marlborough
,
MA
01752
None
PC
Library Renovation
3,100
Massachusetts Adoption Resource Exchange Inc
19 Needham Street Suite 206
Newton
,
MA
02461
None
PC
Finding adoptive homes for kids in foster care in the Northern and Central regions
1,500
MetroWest Legal Services
63 Fountain Street Suite 304
Framingham
,
MA
01702
None
PC
Assistance in funding the Eviction Defense Project
2,500
Metrowest YMCA
280 Old Connecticut Path
Framingham
,
MA
01702
None
PC
Capital Campaign; Expansion and renovation project meeting the community needs.
10,000
Oak Hill Community Development Corp
24 Blake Street
Westborough
,
MA
01581
None
PC
Continued support enabling staff to connect low income housing in Metrowest with clean energy programming, assessments, and support to lower utility costs
5,000
OARS
23 Bradford Street
Concord
,
MA
01742
None
PC
Water Wise Workshops
2,000
Our Father's House
POBox 7251
Fitchburg
,
MA
01420
None
PC
To assist in purchasing new bed sheets, towels, blankets, and pillows for the individual and family shelter
2,000
OUT Metrowest
POBox 2122
Framingham
,
MA
01703
None
PC
Funding for a website update; reformatting to highlight location changes, program additions, easy to navigate language options, and short videos
3,000
Pastoral Counseling Centers
7 Church Street
Westborough
,
MA
01581
None
PC
To subsidize counseling costs for those in financial need either because they have no insurance or cannot afford the co pay
2,500
Polus Center for Social and Economic Development
PO Box 773 6 North Main Street
Petersham
,
MA
01366
None
PC
Envision Success Project: career exploration and internships for the youth with vision impairements
3,000
Provision Ministry Inc
7 Thomas Newton Drive
Westborough
,
MA
01581
None
PC
To help bring more essential items to the under served in Central and Middlesex MA.
2,500
Rangers on Track
PO Box 627
Westborough
,
MA
01581
None
PC
Capital Campaign
5,000
RIA House Inc - Ready Inspire Act
330 Cochituate Road 1784
Framingham
,
MA
01701
None
PC
To help fund the Sisters Leading Sisters support group in 2020
1,500
Rise Above Foundation
PO Box 174
Northbridge
,
MA
01534
None
PC
To allow to provide 50+ children experiencing foster care with extracurricular activities
1,500
SMILE Mass
66 Dudley Road
Sudbury
,
MA
01776
None
PC
To purchase three additional beach wheelchairs at the cost of $2,000 each
2,000
Sophia's Fund Inc
80 Northborough Road East
Marlborough
,
MA
01752
None
PC
To continue to provide the ever increasing need of financial assistance to children fighting cancer and their families
2,500
Special Olympics
512 Forest Street
Marlborough
,
MA
01752
None
PC
Capital Campaign - Inclusive Community Partner
5,000
Spectrum Health Services Inc
10 Mechanic Street
Worcester
,
MA
01608
None
PC
Ensuring access to quality outpatient treatment for individuals in the Leominster and Fitchburg area regardless of their ability to pay
6,000
Straight Ahead Ministries
791 Main Street
Worcester
,
MA
01610
None
PC
Seeking support for the Central MA Juvenile Institutional Program
1,500
The Learning Center for the Deaf
848 Central Street
Framingham
,
MA
01701
None
PC
Seeks to purchase new educational technology equipment for secondary age deaf and hard of hearing children in our two schools: Marie Philip School and Walden School. They have updated the curriculum with particular emphasis on 21st century teaching and learning goals.
2,500
United Way
46 Park Street
Framingham
,
MA
01702
None
PC
Corporate 5K $5000, Shining Star Event $1000, Golf Tournament $500
6,500
Westborough Rotary Club
PO Box 903
Westborough
,
MA
01581
None
PC
Yearly Sponsorship/ Autumn Gala
6,000
YMCA of Central MA
766 Main Street
Worcester
,
MA
01610
None
PC
150th Annual Capital Campaign
8,000
YWCA of Central MA
One Salem Square
Worcester
,
MA
01610
None
PC
To support the renovation of the YWCA's transitional housing program as part of a larger renovation of its downtown facility.
5,000
Total
.................................
3a
187,300
b
Approved for future payment
Big Brother Big Sister of Central MAMetrowest Inc
484 Main Street Suite 360
Worcester
,
MA
01608
None
PC
To support the MYSTEAM program, mentoring youth in science, technology, engineering, arts, and math
20,000
YWCA of Central Mass Inc
One Salem Square
Westborough
,
MA
01608
None
PC
To support the renovation of the YWCA's transitional housing program as part of a larger renovation of its downtown facility.
10,000
Total
.................................
3b
30,000
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
91
4
Dividends and interest from securities
....
14
95,659
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
127,814
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
0
223,564
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
223,564
(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