-
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
08-01-2019
, and ending
07-31-2020
Name of foundation
MERKEL MEM SCHOLARSHIP ENDOWMENT
Number and street (or P.O. box number if mail is not delivered to street address)
6325 S RAINBOW BLVD STE 300
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LAS VEGAS
,
NV
89118
A Employer identification number
23-6799159
B
Telephone number (see instructions)
(888) 730-4933
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)
$
677,561
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
16,669
16,669
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
11,236
b
Gross sales price for all assets on line 6a
456,664
7
Capital gain net income (from Part IV, line 2)
...
11,236
8
Net short-term capital gain
.........
0
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
Total.
Add lines 1 through 11
........
27,905
27,905
13
Compensation of officers, directors, trustees, etc.
10,637
8,510
2,127
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
0
b
Accounting fees (attach schedule)
.......
919
0
0
919
c
Other professional fees (attach schedule)
....
2,135
2,135
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
760
510
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
0
0
23
Other expenses (attach schedule)
.......
4
4
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
14,455
9,024
0
5,181
25
Contributions, gifts, grants paid
.......
30,500
30,500
26
Total expenses and disbursements.
Add lines 24 and 25
44,955
9,024
0
35,681
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-17,050
b
Net investment income
(if negative, enter -0-)
18,881
c
Adjusted net income
(if negative, enter -0-)
...
0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2019)
Form 990-PF (2019)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
2
Savings and temporary cash investments
.........
21,586
31,629
31,629
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
0
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
563,510
536,783
645,932
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)
585,096
568,412
677,561
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
585,096
568,412
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances
(see instructions)
.....
585,096
568,412
30
Total liabilities and net assets/fund balances
(see instructions)
.
585,096
568,412
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
585,096
2
Enter amount from Part I, line 27a
.....................
2
-17,050
3
Other increases not included in line 2 (itemize)
3
490
4
Add lines 1, 2, and 3
..........................
4
568,536
5
Decreases not included in line 2 (itemize)
5
124
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
568,412
Form
990-PF
(2019)
Form 990-PF (2019)
Page
3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a)
List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1 a
8. INV OPP DEVELOP MRKTS-R6
2018-10-09
2019-08-08
b
117.195 AQR MANAGED FUTURES STR-I
2019-02-27
2019-08-08
c
2207.624 AQR MANAGED FUTURES STR-I
2013-07-12
2019-08-08
d
44.176 AQR MANAGED FUTURES STR-I
2018-10-09
2019-08-08
e
107.321 INV BALANCE RISK COMM STR-Y 8611
2019-05-14
2019-08-08
2004.058 INV BALANCE RISK COMM STR-Y 8611
2018-10-09
2019-08-08
59. AMER CENT SMALL CAP GRWTH INST 336
2018-02-09
2019-08-08
44. ARTISAN MID CAP FUND-INSTL 1333
2012-04-10
2019-08-08
65.337 BLACKROCK GL L/S CREDIT-K #1940
2019-02-27
2019-08-08
1988.47 BLACKROCK GL L/S CREDIT-K #1940
2015-11-01
2019-08-08
517.388 DODGE & COX INT'L STOCK FD #1048
2008-10-31
2019-08-08
35.78 DODGE & COX INT'L STOCK FD #1048
2018-10-09
2019-08-08
30.373 DODGE & COX INT'L STOCK FD #1048
2019-02-27
2019-08-08
166. EATON VANCE GLOB MACRO ADV-I 208
2017-10-23
2019-08-08
57. FIDELITY NEW MRKTS INC-Z #3323
2015-11-20
2019-08-08
9. JP MORGAN MID CAP VALUE-I #758
2013-10-09
2019-08-08
131. JOHN HANCOCK II-CURR STR-I 3643
2017-10-23
2019-08-08
1216.158 ASG GLOBAL ALTERNATIVES-Y 1993
2013-10-09
2019-08-08
19.181 ASG GLOBAL ALTERNATIVES-Y 1993
2019-02-27
2019-08-08
67.181 NEUBERGER BERMAN LONG SH-INS #1830
2019-02-27
2019-08-08
881.674 NEUBERGER BERMAN LONG SH-INS #1830
2014-07-10
2019-08-08
6.216 T ROWE PR REAL ESTATE-I #432
2015-12-24
2019-08-08
3.784 T ROWE PR REAL ESTATE-I #432
2019-02-27
2019-08-08
5. SPDR DJ WILSHIRE INTERNATIONAL REAL
2011-10-20
2019-08-08
3. STERLING CAPITAL STRATTON SMALL CAP
2018-02-09
2019-08-08
254. TCW EMRG MKTS INCM-I 4721
2018-07-18
2019-08-08
3. APPLE INC
2019-08-09
2019-09-11
9. CELANESE CORP
2014-02-03
2019-09-11
2. NIKE INC CL B
2019-08-09
2019-09-11
10. PNC FINANCIAL SERVICES GROUP
2019-08-09
2019-09-11
157.02 INV OPP DEVELOP MRKTS-R6
2011-05-25
2019-09-27
12.98 INV OPP DEVELOP MRKTS-R6
2018-10-09
2019-09-27
391. ISHARES CORE MSCI EMERGING
2018-10-05
2019-09-27
26. ISHARES CORE MSCI EMERGING
2019-05-14
2019-09-27
809.749 JPMORGAN HIGH YIELD FUND SS 3580
2019-08-09
2019-10-11
1296.706 JPMORGAN HIGH YIELD FUND SS 3580
2016-04-27
2019-10-11
584.945 JPMORGAN HIGH YIELD FUND SS 3580
2019-04-10
2019-10-11
10. INV OPP DEVELOP MRKTS-R6
2011-05-25
2019-10-21
2. APPLE INC
2019-08-09
2019-10-21
1. BLACKROCK INC
2019-02-26
2019-10-21
9. CISCO SYSTEMS INC
2019-08-09
2019-10-21
8. COGNIZANT TECH SOLUTIONS CRP COM
2019-08-09
2019-10-21
16. DIAGEO PLC - ADR
2019-08-09
2019-10-21
8. EOG RESOURCES, INC
2019-06-11
2019-10-21
13. EOG RESOURCES, INC
2018-11-19
2019-10-21
4. FIDELITY NATL INFORMATION SVCS INC
2019-08-09
2019-10-21
8. JP MORGAN MID CAP VALUE-I #758
2013-10-09
2019-10-21
18. HAIN CELESTIAL GROUP INC
2015-12-18
2019-10-21
5. ISHARES CORE MSCI EMERGING
2019-08-08
2019-10-21
2. LAM RESEARCH CORP COM
2018-08-20
2019-10-21
5. NIKE INC CL B
2019-08-09
2019-10-21
143.109 T ROWE PR OVERSEAS STOCK-I #521
2019-02-27
2019-10-21
19.891 T ROWE PR OVERSEAS STOCK-I #521
2019-05-14
2019-10-21
6. T ROWE PR REAL ESTATE-I #432
2015-12-24
2019-10-21
7. SPDR DJ WILSHIRE INTERNATIONAL REAL
2011-10-20
2019-10-21
1. STERLING CAPITAL STRATTON SMALL CAP
2018-02-09
2019-10-21
14. TJX COMPANIES INC
2019-08-09
2019-10-21
9. TORONTO DOMINION BK ONT COM NEW
2019-07-30
2019-10-21
4. UNION PACIFIC CORP
2019-08-09
2019-10-21
1. UNITED PARCEL SERVICE-CL B
2018-11-19
2019-10-21
5. UNITED PARCEL SERVICE-CL B
2019-08-09
2019-10-21
1. EATON CORP PLC
2019-02-26
2019-10-21
4. EATON CORP PLC
2019-08-09
2019-10-21
4. MEDTRONIC PLC
2019-08-09
2019-10-21
27. UBS GROUP AG
2018-11-19
2019-10-21
74. UBS GROUP AG
2019-04-22
2019-10-21
138. UBS GROUP AG
2018-02-05
2019-10-21
8. TE CONNECTIVITY LTD
2019-08-09
2019-10-21
40. FLEXTRONICS INTL LTD
2018-03-07
2019-10-21
62.963 JOHN HANCOCK II-CURR STR-I 3643
2019-05-14
2019-12-09
101.224 JOHN HANCOCK II-CURR STR-I 3643
2019-10-25
2019-12-09
1326.797 JOHN HANCOCK II-CURR STR-I 3643
2017-10-23
2019-12-09
4. LAM RESEARCH CORP COM
2018-08-20
2019-12-26
16. ZOETIS INC
2017-04-25
2020-02-03
4. ZOETIS INC
2019-09-27
2020-02-03
9.016 AMER CENT SMALL CAP GRWTH INST 336
2018-02-09
2020-02-14
42.984 AMER CENT SMALL CAP GRWTH INST 336
2019-10-25
2020-02-14
42.294 ARTISAN MID CAP FUND-INSTL 1333
2012-04-10
2020-02-14
19.706 ARTISAN MID CAP FUND-INSTL 1333
2019-10-25
2020-02-14
595.767 JPMORGAN MID CAP VALUE-R6 #2335
2010-12-17
2020-02-14
222.153 T ROWE PR REAL ESTATE-I #432
2015-12-24
2020-02-14
163. SPDR DJ WILSHIRE INTERNATIONAL REAL
2011-10-20
2020-02-14
2. APPLE INC
2019-08-09
2020-02-18
12. CVS HEALTH CORPORATION
2016-02-01
2020-02-18
6. CELANESE CORP
2019-04-22
2020-02-18
4. CELANESE CORP
2018-11-19
2020-02-18
3. DIAGEO PLC - ADR
2019-08-09
2020-02-18
1. EOG RESOURCES, INC
2018-04-10
2020-02-18
11. EOG RESOURCES, INC
2019-06-11
2020-02-18
3. FIDELITY NATL INFORMATION SVCS INC
2019-08-09
2020-02-18
4. HOME DEPOT INC
2019-09-27
2020-02-18
4. JPMORGAN CHASE & CO
2019-09-27
2020-02-18
2. LAM RESEARCH CORP COM
2018-08-20
2020-02-18
7. MICROSOFT CORP
2019-08-09
2020-02-18
2. THERMO FISHER SCIENTIFIC INC
2019-09-27
2020-02-18
5. UNITEDHEALTH GROUP INC
2019-08-09
2020-02-18
21. AT & T INC
2019-09-27
2020-03-19
11. CVS HEALTH CORPORATION
2019-09-27
2020-03-19
3. CVS HEALTH CORPORATION
2018-11-19
2020-03-19
3. CVS HEALTH CORPORATION
2019-09-11
2020-03-19
12. CISCO SYSTEMS INC
2019-08-09
2020-03-19
7. CISCO SYSTEMS INC
2019-12-26
2020-03-19
1. HOME DEPOT INC
2019-09-27
2020-03-19
6. HOME DEPOT INC
2019-08-09
2020-03-19
7. HOME DEPOT INC
2017-03-31
2020-03-19
3. ELI LILLY & CO COM
2016-10-03
2020-03-19
5. ELI LILLY & CO COM
2019-08-09
2020-03-19
5. MICROSOFT CORP
2019-08-09
2020-03-19
12. MONDELEZ INTERNATIONAL INC
2018-11-19
2020-03-19
4. TARGET CORP
2019-08-09
2020-03-19
2. TARGET CORP
2014-02-03
2020-03-19
1. THERMO FISHER SCIENTIFIC INC
2018-11-19
2020-03-19
1. THERMO FISHER SCIENTIFIC INC
2019-09-27
2020-03-19
4. EATON CORP PLC
2019-08-09
2020-03-19
35. EATON CORP PLC
2014-02-03
2020-03-19
13.802 INV OPP DEVELOP MRKTS-R6
2020-02-20
2020-04-03
100.547 INV OPP DEVELOP MRKTS-R6
2011-05-25
2020-04-03
180.833 EATON VANCE GLOB MACRO ADV-I 208
2017-10-23
2020-04-03
18.088 FIDELITY NEW MRKTS INC-Z #3323
2020-02-20
2020-04-03
263. ISHARES CORE MSCI EMERGING
2019-08-08
2020-04-03
1786.448 METROPOLITAN WEST T/R BD-PLN #712
2019-10-25
2020-04-03
1494.126 METROPOLITAN WEST T/R BD-PLN #712
2019-08-09
2020-04-03
865.382 PIMCO TOTAL RET FD-INST #35
2019-08-09
2020-04-03
155.019 PIMCO TOTAL RET FD-INST #35
2020-02-20
2020-04-03
154.53 PIMCO HIGH YIELD FD-INST #108
2019-10-11
2020-04-03
1625.515 T ROWE PR OVERSEAS STOCK-I #521
2017-04-26
2020-04-03
33.243 T ROWE PR OVERSEAS STOCK-I #521
2020-02-20
2020-04-03
8.014 T ROWE PR OVERSEAS STOCK-I #521
2019-05-14
2020-04-03
9. PNC FINANCIAL SERVICES GROUP
2016-01-25
2020-04-06
12. PNC FINANCIAL SERVICES GROUP
2019-08-09
2020-04-06
.357 RAYTHEON TECHNOLOGIES CORP
2019-09-11
2020-04-29
11.968 INV OPP DEVELOP MRKTS-R6
2011-05-25
2020-05-15
166.032 AMER CENT SMALL CAP GRWTH INST 336
2020-04-03
2020-05-15
1072.758 AMER CENT SMALL CAP GRWTH INST 336
2015-07-24
2020-05-15
66.482 ARTISAN MID CAP FUND-INSTL 1333
2012-04-10
2020-05-15
2188.588 PIMCO HIGH YIELD FD-INST #108
2019-10-11
2020-05-15
23.566 T ROWE PR OVERSEAS STOCK-I #521
2017-04-26
2020-05-15
82.628 STERLING CAPITAL STRATTON SMALL CAP
2020-02-20
2020-05-15
256.475 STERLING CAPITAL STRATTON SMALL CAP
2014-07-10
2020-05-15
15. VANGUARD MIDCAP VIPER
2020-02-14
2020-05-15
25. EOG RESOURCES, INC
2019-08-09
2020-06-01
9. EOG RESOURCES, INC
2020-04-06
2020-06-01
1. TJX COMPANIES INC
2019-08-09
2020-06-01
38. TJX COMPANIES INC
2014-02-03
2020-06-01
19. TJX COMPANIES INC
2020-03-19
2020-06-01
51. FLEXTRONICS INTL LTD
2018-03-07
2020-06-01
48.552 INV OPP DEVELOP MRKTS-R6
2011-05-25
2020-06-25
6. APPLE INC
2020-04-06
2020-06-25
34.341 ARTISAN MID CAP FUND-INSTL 1333
2012-04-10
2020-06-25
2. BOEING CO
2019-02-11
2020-06-25
2. BOEING CO
2019-08-09
2020-06-25
16. CVS HEALTH CORPORATION
2014-02-03
2020-06-25
3. DIAGEO PLC - ADR
2019-08-09
2020-06-25
3. DIAGEO PLC - ADR
2014-02-03
2020-06-25
5. DIAGEO PLC - ADR
2020-04-06
2020-06-25
1. GILEAD SCIENCES INC
2014-02-03
2020-06-25
5. GILEAD SCIENCES INC
2020-04-06
2020-06-25
25. HAIN CELESTIAL GROUP INC
2015-12-07
2020-06-25
96. INVESCO OPTIMUM YIELD DIVERS
2020-04-03
2020-06-25
18. JPMORGAN CHASE & CO
2019-08-09
2020-06-25
5. JPMORGAN CHASE & CO
2019-02-26
2020-06-25
18. MANULIFE FINANCIAL CORP
2015-12-18
2020-06-25
99. MANULIFE FINANCIAL CORP
2019-07-30
2020-06-25
125.998 T ROWE PR OVERSEAS STOCK-I #521
2017-04-26
2020-06-25
892.789 JAMES ALPHA GL REAL EST-I
2020-02-20
2020-06-25
16. SPIRIT AEROSYTSEMS HOLD-CL A
2019-07-03
2020-06-25
2. SPIRIT AEROSYTSEMS HOLD-CL A
2018-11-19
2020-06-25
21. SUNCOR ENERGY INC NEW F
2019-09-27
2020-06-25
16. SUNCOR ENERGY INC NEW F
2018-12-28
2020-06-25
71.087 TCW EMRG MKTS INCM-I 4721
2019-10-25
2020-06-25
87.788 TCW EMRG MKTS INCM-I 4721
2020-02-20
2020-06-25
21. TOTAL S.A. - ADR
2014-02-03
2020-06-25
47.838 TOUCHSTONE MID CAP-INST #353
2020-02-20
2020-06-25
70. FLEXTRONICS INTL LTD
2019-08-09
2020-06-25
54. FLEXTRONICS INTL LTD
2020-03-19
2020-06-25
156. FLEXTRONICS INTL LTD
2018-07-12
2020-06-25
CAPITAL GAIN DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
333
312
21
b
1,077
961
116
c
20,288
22,091
-1,803
d
406
402
4
e
662
689
-27
12,365
13,828
-1,463
1,089
1,009
80
1,938
1,775
163
658
639
19
20,024
20,354
-330
20,483
12,545
7,938
1,417
1,521
-104
1,202
1,236
-34
1,690
1,780
-90
869
859
10
344
302
42
1,201
1,258
-57
13,426
13,267
159
212
206
6
974
915
59
12,784
11,422
1,362
180
170
10
110
106
4
191
169
22
231
250
-19
2,141
2,037
104
666
607
59
1,116
470
646
173
165
8
1,361
1,326
35
6,576
5,492
1,084
544
507
37
19,198
19,284
-86
1,277
1,269
8
5,830
5,814
16
9,336
9,190
146
4,212
4,235
-23
431
350
81
481
405
76
453
442
11
426
474
-48
485
501
-16
2,577
2,627
-50
537
700
-163
873
1,268
-395
514
548
-34
316
265
51
398
730
-332
253
242
11
476
337
139
479
413
66
1,534
1,464
70
213
200
13
182
165
17
286
237
49
79
83
-4
836
745
91
512
527
-15
666
675
-9
118
111
7
590
584
6
83
81
2
333
318
15
428
406
22
311
369
-58
853
859
-6
1,590
2,584
-994
748
722
26
417
737
-320
569
561
8
915
910
5
11,994
12,722
-728
1,177
674
503
2,169
882
1,287
542
495
47
180
154
26
860
772
88
1,844
1,679
165
859
817
42
23,926
14,446
9,480
6,020
5,789
231
6,428
5,514
914
638
405
233
861
966
-105
644
629
15
429
402
27
486
493
-7
75
107
-32
820
924
-104
465
411
54
976
919
57
543
471
72
650
337
313
1,311
967
344
674
572
102
1,508
1,250
258
644
804
-160
615
681
-66
168
235
-67
168
192
-24
456
632
-176
266
335
-69
160
230
-70
958
1,266
-308
1,118
1,029
89
408
242
166
680
568
112
737
691
46
541
551
-10
415
330
85
207
133
74
286
232
54
286
286
276
318
-42
2,417
2,249
168
471
619
-148
3,435
3,517
-82
1,727
1,939
-212
230
277
-47
10,362
12,712
-2,350
18,704
18,463
241
15,644
15,544
100
9,121
9,087
34
1,634
1,637
-3
1,201
1,395
-194
13,102
16,304
-3,202
268
366
-98
65
81
-16
845
767
78
1,127
1,591
-464
24
30
-6
443
419
24
2,947
2,268
679
19,041
16,234
2,807
2,867
2,639
228
17,903
19,478
-1,575
207
236
-29
4,535
4,481
54
14,078
20,172
-6,094
2,193
2,785
-592
1,261
1,995
-734
454
353
101
53
53
2,011
1,070
941
1,006
835
171
512
940
-428
2,053
1,655
398
2,164
1,534
630
1,662
1,363
299
342
832
-490
342
700
-358
1,012
1,055
-43
403
493
-90
403
375
28
672
633
39
74
79
-5
372
382
-10
788
902
-114
1,222
1,142
80
1,745
1,994
-249
485
526
-41
242
270
-28
1,328
1,726
-398
1,256
1,264
-8
13,981
16,381
-2,400
363
1,227
-864
45
164
-119
344
664
-320
262
509
-247
554
593
-39
684
762
-78
812
1,154
-342
1,733
2,013
-280
713
730
-17
550
464
86
1,589
1,682
-93
7,591
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
21
b
116
c
-1,803
d
4
e
-27
-1,463
80
163
19
-330
7,938
-104
-34
-90
10
42
-57
159
6
59
1,362
10
4
22
-19
104
59
646
8
35
1,084
37
-86
8
16
146
-23
81
76
11
-48
-16
-50
-163
-395
-34
51
-332
11
139
66
70
13
17
49
-4
91
-15
-9
7
6
2
15
22
-58
-6
-994
26
-320
8
5
-728
503
1,287
47
26
88
165
42
9,480
231
914
233
-105
15
27
-7
-32
-104
54
57
72
313
344
102
258
-160
-66
-67
-24
-176
-69
-70
-308
89
166
112
46
-10
85
74
54
-42
168
-148
-82
-212
-47
-2,350
241
100
34
-3
-194
-3,202
-98
-16
78
-464
-6
24
679
2,807
228
-1,575
-29
54
-6,094
-592
-734
101
941
171
-428
398
630
299
-490
-358
-43
-90
28
39
-5
-10
-114
80
-249
-41
-28
-398
-8
-2,400
-864
-119
-320
-247
-39
-78
-342
-280
-17
86
-93
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
11,236
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
34,751
664,720
0.052279
2017
35,027
694,095
0.050464
2016
35,500
662,129
0.053615
2015
35,700
643,462
0.055481
2014
35,848
720,007
0.049788
2
Total
of line 1, column (d)
.....................
2
0.261627
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
0.052325
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
660,801
5
Multiply line 4 by line 3
......................
5
34,576
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
189
7
Add lines 5 and 6
........................
7
34,765
8
Enter qualifying distributions from Part XII, line 4
,.............
8
35,681
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
189
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
189
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
189
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
292
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
292
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
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
103
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
PA
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
WELLS FARGO BANK NA
Telephone no.
(888) 730-4933
Located at
100 N MAIN ST MAC D4001-117
WINSTON SALEM
NC
ZIP+4
27101
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
No
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
WELLS FARGO BANK N A
TRUSTEE
1
10,637
100 N MAIN ST MAC D4001-117
WINSTON SALEM
,
NC
27101
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
629,422
b
Average of monthly cash balances
.......................
1b
41,442
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
670,864
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
670,864
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
10,063
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
660,801
6
Minimum investment return.
Enter 5% of line 5
..................
6
33,040
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
33,040
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
189
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
189
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
32,851
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
32,851
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
32,851
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
35,681
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
0
b
Cash distribution test (attach the required schedule)
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
35,681
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
189
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
35,492
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
32,851
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
29,473
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
0
b
From 2015
......
0
c
From 2016
......
0
d
From 2017
......
0
e
From 2018
......
0
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
35,681
a
Applied to 2018, but not more than line 2a
29,473
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
.....
6,208
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
..........
26,643
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2015
....
0
b
Excess from 2016
....
0
c
Excess from 2017
....
0
d
Excess from 2018
....
0
e
Excess from 2019
....
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
NONE
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.
NONE
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:
EARLY IRBY
7301 GERMANTOWN AVE
PHILADELPHIA
,
PA
19119
(888) 730-4933
b
The form in which applications should be submitted and information and materials they should include:
ANY
c
Any submission deadlines:
ANY
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
NONE
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
JOHN CONNOR CO NASHOTAH HOUSE
THEOLOGICAL SEMINARY
2777 MISSION ROAD
NASHOTAH
,
WI
53058
NONE
I
SCHOLARSHIP
10,000
CHRISTOPHER MICKLEWRIGHT CO VIRGINIA
THEOLOGICAL SEMINARY
3737 SEMINARY ROAD
ALEXANDRIA
,
VA
22304
NONE
I
SCHOLARSHIP
12,000
KRISTEN OSTENDORFCO GENERAL THEOLOGICAL
SEMINARY
440 21ST STREET
NEW YORK
,
NY
10011
NONE
I
SCHOLARSHIP
8,500
Total
.................................
3a
30,500
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
14
16,669
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
11,236
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)
..
27,905
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
27,905
(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