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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
ANTIOCH FOUNDATION 1015002041
Number and street (or P.O. box number if mail is not delivered to street address)
230 FRONT STREET NORTH
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LA CROSSE
,
WI
54601
A Employer identification number
36-3779525
B
Telephone number (see instructions)
(608) 782-1148
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)
$
13,113,606
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)
1,317,000
2
Check
.............
3
Interest on savings and temporary cash investments
43,810
43,810
4
Dividends and interest from securities
...
289,592
289,592
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
915,212
b
Gross sales price for all assets on line 6a
7,117,245
7
Capital gain net income (from Part IV, line 2)
...
915,212
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
........
2,565,614
1,248,614
13
Compensation of officers, directors, trustees, etc.
128,858
128,858
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
1,564
0
0
1,564
b
Accounting fees (attach schedule)
.......
2,000
0
0
2,000
c
Other professional fees (attach schedule)
....
20,164
20,164
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
13,187
13,187
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)
.......
48,238
48,238
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
214,011
162,209
0
51,802
25
Contributions, gifts, grants paid
.......
2,731,700
2,731,700
26
Total expenses and disbursements.
Add lines 24 and 25
2,945,711
162,209
0
2,783,502
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-380,097
b
Net investment income
(if negative, enter -0-)
1,086,405
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
.........
16,912
315,321
315,321
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)
..........
0
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
12,244,288
11,542,248
12,798,285
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
12,261,200
11,857,569
13,113,606
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
........
12,261,200
11,857,569
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)
.....
12,261,200
11,857,569
30
Total liabilities and net assets/fund balances
(see instructions)
.
12,261,200
11,857,569
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
12,261,200
2
Enter amount from Part I, line 27a
.....................
2
-380,097
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
11,881,103
5
Decreases not included in line 2 (itemize)
5
23,534
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
11,857,569
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
100. APERGY CORP
2009-02-02
2019-01-03
b
20. GARRETT MOTION INC
2009-02-02
2019-01-03
c
33. RESIDEO TECHNOLOGIES INC
2009-02-02
2019-01-03
d
4222.973 PIMCO INCOME FUND I
2017-12-27
2019-01-04
e
.6 CASS INFORMATION SYSTEMS INC
2009-04-08
2019-01-07
.042 DELL TECHNOLOGIES INC
2014-02-10
2019-01-07
164. AT&T INC
2014-06-19
2019-01-08
8. BOOKING HOLDINGS INC
2015-09-09
2019-01-08
45. CENETENE CORP
2015-06-09
2019-01-08
100. NEOGEN CORP
2009-04-08
2019-01-08
100. PEGASYSTEMS INC
2015-03-18
2019-01-08
40. SPS COMMERCE INC
2011-12-28
2019-01-08
750. SAFRAN S.A. ADR
2018-06-26
2019-01-08
450. SANOFI
2017-10-13
2019-01-08
68. WAL MART STORES INC
2009-07-07
2019-01-08
1265.823 PIMCO INCOME FUND I
2017-12-27
2019-01-09
3571.429 VANGUARD HIGH YIELD ADM
2016-11-15
2019-01-09
49.897 CIGNA CORP NEW
2012-02-13
2019-01-11
75. MICROSOFT CORP
2012-12-06
2019-01-11
196. CHEESECAKE FACTORY INC
2009-04-08
2019-01-15
75. DORMAN PRODUCTS INC
2015-08-12
2019-01-18
5500. SCOR ADR
2017-01-24
2019-01-30
4527.222 INVESCO CONVERTIBLE SECURITIES Y
2017-02-01
2019-01-31
252. HORACE MANN EDUCATORS
2015-09-10
2019-02-21
700. QUALCOMM INC
2017-02-27
2019-02-21
103. ROSS STORES INC
2017-08-28
2019-02-21
100. BAIDU INC ADR
2017-11-28
2019-02-28
250. CONTINENTAL BUILDING PRODUCTS
2016-09-06
2019-03-08
100. CONTINENTAL BUILDING PRODUCTS
2018-03-09
2019-03-08
1000. SPDR EURO STOXX 50 ETF
2017-05-11
2019-03-12
1000. KASIKORNBANK PUB ADR
2015-08-14
2019-03-13
265. ORIX CORP ADR
2014-09-15
2019-03-13
207. RYANAIR HOLDINGS PLC ADR
2015-01-28
2019-03-13
.371 WABTEC
2009-04-08
2019-03-13
2205.882 OAKMARK GLOBAL ADVISOR
2017-10-16
2019-03-15
369.14 OAKMARK GLOBAL ADVISOR
2017-10-16
2019-03-21
100. NEXSTAR MEDIA GROUP INC
2018-01-02
2019-03-21
25. SERVICEMASTER GLOBAL HOLDINGS INC
2015-05-20
2019-03-21
91.827 PIMCO FOREIGN BOND INSTITUTIONAL
2014-05-20
2019-03-26
125. ALLSCRIPTS HEALTHCARE SOLUTIONS INC
2018-06-05
2019-03-29
1050. ALLSCRIPTS HEALTHCARE SOLUTIONS INC
2018-03-09
2019-03-29
250. EL PASO ELECTRIC CO
2017-10-13
2019-03-29
917.431 PIMCO FOREIGN BOND INSTITUTIONAL
2017-02-01
2019-03-29
172. ELLIE MAE INC
2016-01-14
2019-04-01
75. ULTIMATE SOFTWARE GROUP INC
2015-10-20
2019-04-04
600. ACS ACTIVIDADES DE CONSTRUCCION Y SERVIC
2017-06-22
2019-04-17
250. ALLIANZ SE ADR
2012-12-06
2019-04-17
125. CISCO SYSTEMS INC
2013-08-12
2019-04-17
125. INTEL CORP
2009-02-02
2019-04-17
150. TRACTOR SUPPLY CO
2017-03-09
2019-04-17
460. BAKER HUGHES A GE CO
2016-05-18
2019-04-18
400. GLENMEDE SECURED OPTIONS I
2017-06-05
2019-04-18
800. GOLDMAN SACHS INT'L SMALL CAP INSIGHTS I
2014-11-06
2019-04-18
25. POLYONE CORP
2018-06-05
2019-04-18
275. POLYONE CORP
2018-02-09
2019-04-18
75. SERVICEMASTER GLOBAL HOLDINGS INC
2018-10-09
2019-04-18
175. SERVICEMASTER GLOBAL HOLDINGS INC
2015-05-20
2019-04-18
250. VANGUARD HIGH YIELD ADM
2016-11-15
2019-04-18
.474 ACS ACTIVIDADES DE CONSTRUCCION Y SERVIC
2017-06-22
2019-04-22
14000. SPDR EURO STOXX 50 ETF
2017-05-11
2019-04-22
150. AMN HEALTHCARE SERVICES INC
2018-04-26
2019-04-23
2184.954 OAKMARK GLOBAL ADVISOR
2018-10-04
2019-04-24
20328.538 OAKMARK GLOBAL ADVISOR
2017-10-16
2019-04-24
5462.934 PIMCO FOREIGN BOND INSTITUTIONAL
2017-02-01
2019-04-24
4642.525 PIMCO FOREIGN BOND INSTITUTIONAL
2019-01-31
2019-04-24
2300. BANCO SANTANDER MEXICO SA ADR
2017-03-23
2019-05-02
2960. FERGUSON PLC NPV ADR
2018-02-02
2019-05-02
25. GLOBAL BRASS & COPPER HOLDINGS INC
2018-06-25
2019-05-03
250. GLOBAL BRASS & COPPER HOLDINGS INC
2015-04-20
2019-05-03
300. COGNIZANT TECHNOLOGY SOLUTIONS CORP
2014-02-10
2019-05-07
275. MEDNAX INC
2017-09-28
2019-05-13
5. WABTEC
2009-04-08
2019-05-13
100. BERKSHIRE HATHAWAY INC CL B
2014-02-10
2019-05-28
200. OLD DOMINION FREIGHT LINE
2018-08-06
2019-06-04
250. STORA ENSO OYJ ADR
2019-03-08
2019-06-06
1075. STORA ENSO OYJ ADR
2018-03-21
2019-06-06
125. ASGN INC
2017-05-09
2019-06-10
500. SCHWAB (CHARLES) CORP
2016-06-30
2019-06-10
275. SCHWAB (CHARLES) CORP
2018-12-17
2019-06-10
100. CIENA CORP
2018-07-03
2019-06-14
400. RADIAN GROUP INC
2013-08-12
2019-06-14
200. SLEEP NUMBER CORP
2018-06-05
2019-06-14
150. FRESHPET INC
2016-04-27
2019-06-20
125. PAYLOCITY HOLDING CORP
2018-04-18
2019-06-20
300. MEDNAX INC
2019-06-14
2019-06-21
1000. GENERAL ELECTRIC CO
2009-04-08
2019-06-26
9. COUSINS PROPERTIES INC NPV
2018-05-02
2019-06-27
250. WAGEWORKS INC
2017-11-17
2019-07-01
500. AT&T INC
2018-06-15
2019-07-15
200. AGILENT TECHNOLOGIES INC
2012-06-27
2019-07-15
175. AMERICAN EXPRESS CO
2017-09-28
2019-07-15
301. AMERICAN INTERNATIONAL GROUP INC
2013-03-14
2019-07-15
322. BANK NEW YORK MELLON CORP
2012-06-27
2019-07-15
50. BIOGEN INC
2019-06-21
2019-07-15
243. BORG WARNER AUTOMOTIVE INC
2011-12-28
2019-07-15
250. CBS CORP CLASS B
2012-08-16
2019-07-15
525. C H ROBINSON WORLDWIDE INC
2019-05-06
2019-07-15
300. CENETENE CORP
2015-06-09
2019-07-15
300. DISCOVER FINANCIAL SERVICES
2014-06-19
2019-07-15
300. EOG RESOURCES INC
2016-05-18
2019-07-15
225. ELECTRONIC ARTS INC
2019-05-17
2019-07-15
100. F5 NETWORKS INC
2015-08-27
2019-07-15
902. FREEPORT MCMORAN COPPER & GOLD CL B
2015-08-14
2019-07-15
100. GOLDMAN SACHS GROUP INC
2012-12-06
2019-07-15
54. HUMANA INC
2016-07-01
2019-07-15
300. MARATHON PETROLEUM CORP
2016-08-09
2019-07-15
250. ORACLE CORP
2010-02-01
2019-07-15
171. PHILLIP MORRIS INTL INC
2009-02-02
2019-07-15
200. T ROWE PRICE GROUP INC
2015-01-20
2019-07-15
400. WELLS FARGO & CO
2011-05-24
2019-07-15
14044.548 AQR MANAGED FUTURES FD CL I
2017-02-01
2019-07-16
250. ABBOTT LABORATORIES
2014-02-10
2019-07-16
200. ALLSTATE CORP
2009-02-02
2019-07-16
12. ALPHABET INC CL C
2011-02-03
2019-07-16
40. ALPHABET INC CL A
2015-05-20
2019-07-16
200. AMERISOURCEBERGEN CORP
2009-02-02
2019-07-16
400. APPLE INC
2014-02-10
2019-07-16
250. BERKSHIRE HATHAWAY INC CL B
2014-02-10
2019-07-16
30. BOOKING HOLDINGS INC
2016-01-28
2019-07-16
325. CELGENE CORP
2017-11-07
2019-07-16
50. CELGENE CORP
2018-08-13
2019-07-16
38. CHARTER COMMUNICATIONS INC
2010-04-30
2019-07-16
200. CHEVRONTEXACO CORP
2009-09-02
2019-07-16
375. CISCO SYSTEMS INC
2013-08-12
2019-07-16
150. DEERE & CO
2010-03-25
2019-07-16
121. DELL TECHNOLOGIES INC
2014-02-10
2019-07-16
75. DELL TECHNOLOGIES INC
2019-01-11
2019-07-16
350. DELTA AIR LINES INC
2019-06-26
2019-07-16
200. DOVER CORP
2009-02-02
2019-07-16
12094.531 DREIHAUS ACTIVE INCOME FUND
2017-02-01
2019-07-16
350. EDWARDS LIFESCIENCES CORP
2017-11-08
2019-07-16
325. FACEBOOK INC
2018-03-29
2019-07-16
75. FACEBOOK INC
2018-11-02
2019-07-16
1200. FASTENAL CO
2017-07-21
2019-07-16
200. FASTENAL CO
2018-10-16
2019-07-16
442. FEDERATED INVESTORS INC CLASS B
2015-07-10
2019-07-16
25. FEDERATED INVESTORS INC CLASS B
2018-08-13
2019-07-16
200. HONEYWELL INTERNATIONAL INC
2009-02-02
2019-07-16
475. INTEL CORP
2009-02-02
2019-07-16
48392.639 TORTOISE MLP & ENERGY INCOME I
2018-04-02
2019-07-16
400. J P MORGAN CHASE & CO
2009-02-18
2019-07-16
125. MICROSOFT CORP
2012-12-06
2019-07-16
175. MOTOROLA SOLUTIONS INC
2019-05-28
2019-07-16
150. NEXTERA ENERGY INC
2010-06-04
2019-07-16
50. OCCIDENTAL PETROLEUM CORP
2019-06-21
2019-07-16
150. OCCIDENTAL PETROLEUM CORP
2017-11-28
2019-07-16
325. PAYPAL HOLDINGS INC
2017-02-27
2019-07-16
475. PLAINS GP HOLDINGS LP CLASS A
2019-04-18
2019-07-16
350. PUBLIC SERVICE ENTERPRISE GROUP INC
2009-02-18
2019-07-16
125. ROSS STORES INC
2019-06-04
2019-07-16
197. ROSS STORES INC
2017-08-28
2019-07-16
315. STARBUCKS CORP
2019-02-27
2019-07-16
450. TRACTOR SUPPLY CO
2017-08-10
2019-07-16
300. U S BANCORP DEL
2009-02-02
2019-07-16
100. ULTA SALON COSMETICS & FRAGRANCES INC
2018-12-19
2019-07-16
160. UNITED TECHNOLOGIES CORP
2009-02-18
2019-07-16
400. VISA INC
2016-12-19
2019-07-16
200. WAL MART STORES INC
2009-07-07
2019-07-16
100. WELLS FARGO & CO
2011-05-24
2019-07-16
86. ALLERGAN PLC NPV
2013-06-27
2019-07-16
25. ALLERGAN PLC NPV
2019-06-21
2019-07-16
75. NORWEGIAN CRUISE LINE HOLDINGS LTD
2019-01-03
2019-07-16
250. NORWEGIAN CRUISE LINE HOLDINGS LTD
2018-06-25
2019-07-16
400. ALCON INC
2019-06-27
2019-07-16
175. TTM TECHNOLOGIES INC
2019-07-16
2019-07-19
700. TTM TECHNOLOGIES INC
2018-06-05
2019-07-19
307. PERSIMMON PLC ADR
2016-01-04
2019-07-23
750. SK TELECOM CO LTD SPONSORED ADR
2013-01-22
2019-07-23
1100. SMC CORP NPV ADR
2015-02-03
2019-07-23
150. SLEEP NUMBER CORP
2017-01-06
2019-07-26
125. HEICO CORP
2015-06-23
2019-08-01
75. CNOOC LTD ADR
2017-10-26
2019-08-05
50. CANADIAN PACIFIC RAILWAY LTD NPV
2018-11-27
2019-08-05
480. CAPGEMINI S E NPV ADR
2014-02-10
2019-08-05
107. DBS GROUP HOLDINGS LTD ADR
2014-12-09
2019-08-05
150. PJSC LUKOIL ADR
2017-03-20
2019-08-05
425. SCHNEIDER ELECTRIC SE
2018-06-26
2019-08-05
175. SONY CORP ADR
2018-03-21
2019-08-05
250. TAIWAN SEMICONDUCTOR MFG SPON ADR
2012-06-27
2019-08-05
225. UNITED OVERSEAS BANK ADR
2018-02-02
2019-08-05
100. ICON PLC
2013-06-27
2019-08-05
75. STERIS PLC
2018-11-27
2019-08-05
121. CHECK POINT SOFTWARE
2012-08-16
2019-08-05
210. AERCAP HOLDINGS NV
2010-06-04
2019-08-05
3100.00116 OAKMARK INTERNATIONAL INST
2019-04-24
2019-08-06
8517.09884 OAKMARK INTERNATIONAL INST
2019-04-24
2019-08-06
300. CALERES INC NPV
2018-03-22
2019-08-07
96. DORMAN PRODUCTS INC
2015-04-07
2019-08-07
625. EVOLENT HEALTH INC
2018-01-11
2019-08-07
425. GREENHILL & CO INC
2018-03-09
2019-08-07
300. KNIGHT SWIFT TRANSN HLDGS INC
2017-03-30
2019-08-07
150. TRUPANION INC
2018-06-25
2019-08-07
300. 2U INC
2016-07-28
2019-08-07
25. 2U INC
2018-12-12
2019-08-07
275. AMERICAN EAGLE OUTFITTERS INC
2018-12-12
2019-08-13
500. AMERICAN EAGLE OUTFITTERS INC
2017-10-13
2019-08-13
425. SENSATA TECHNOLOGIES HOLDINGS PLC ADR
2018-07-24
2019-08-16
725. AXA SA SPONSORED ADR
2017-10-13
2019-08-29
981. BRIDGESTONE CORP ADR
2014-02-10
2019-08-29
794. MITSUBISHI ELECTRIC CORP
2015-06-23
2019-08-29
325. SINOPEC SHANGHAI PETROCHEMICAL ADR
2017-03-20
2019-08-29
900. TECK RESOURCES LTD ADR
2017-10-26
2019-08-29
450. ORION ENGINEERED CARBONS ADR
2018-03-09
2019-09-13
175. ORION ENGINEERED CARBONS ADR
2019-07-15
2019-09-13
525. ACS ACTIVIDADES DE CONSTRUCCION Y SERVIC
2017-06-22
2019-09-23
300. ASTELLAS PHARAMA INC ADR
2019-03-08
2019-09-23
150. BANCOLOMBIA SA SPONSORED ADR
2019-03-13
2019-09-23
100. BRANDYWINE REALTY TRUST
2015-04-20
2019-09-23
125. CGI INC NPV
2019-03-08
2019-09-23
175. CANADIAN NATL RAILWAY CO NPV
2009-07-07
2019-09-23
125. CASS INFORMATION SYSTEMS INC
2010-01-14
2019-09-23
350. CHINA UNICOM (HONG KONG) LTD ADR
2019-03-08
2019-09-23
275. DAIWA HOUSE INDUSTRY CO LTD ADR
2019-07-23
2019-09-23
400. DANONE NPV ADR
2019-06-06
2019-09-23
700. ENERPLUS CORP NPV
2019-05-02
2019-09-23
150. ENSIGN GROUP INC
2018-10-30
2019-09-23
100. EXPONENT INC
2016-11-22
2019-09-23
100. FIRST HORIZON NATIONAL CORP
2018-02-15
2019-09-23
175. GRAPHIC PACKAGING HLDG CO
2019-08-08
2019-09-23
150. HEALTHSTREAM INC
2015-06-23
2019-09-23
600. KDDI CORP ADR
2014-02-10
2019-09-23
150. MAGNA INTERNATIONAL INC CLASS A
2015-01-28
2019-09-23
500. MANULIFE FINANCIAL CORP
2014-02-10
2019-09-23
150. NINTENDO CO LTD ADR
2019-07-01
2019-09-23
175. NIPPON TELEGRAPH & TELEPHONE ADR
2009-08-07
2019-09-23
100. OLD NATIONAL BANCORP
2009-10-20
2019-09-23
100. PRA GROUP INC
2016-08-24
2019-09-23
375. PETROLEO BRASILEIRO SA ADR
2019-03-08
2019-09-23
100. POWER INTEGRATIONS INC
2009-04-08
2019-09-23
125. PROS HOLDINGS
2014-12-09
2019-09-23
225. SPS COMMERCE INC
2011-12-28
2019-09-23
475. SBERBANK RUSSIA SP ADR
2019-05-02
2019-09-23
700. SCHWAB MID CAP ETF
2016-11-16
2019-09-23
300. TIM PARTICIPACOES S A NPV ADR
2019-03-13
2019-09-23
1125. VANGUARD FTSE DEVELOPED MARKETS ETF
2016-10-24
2019-09-23
1750. VANGUARD LARGE CAP ETF
2018-05-02
2019-09-23
175. YUM CHINA HOLDINGS INC
2019-03-13
2019-09-23
200. ARCH CAPITAL GROUP LTD
2019-07-23
2019-09-23
100. NXP SEMICONDUCTORS NV
2015-04-07
2019-09-23
7000. AMERICAN BEACON GLOBAL EV FRNT MRKT INC
2018-03-01
2019-09-24
1000. FIDELITY ADVISOR NEW MARKETS INCOME Z
2015-07-02
2019-09-24
8500. GLENMEDE SECURED OPTIONS I
2018-07-31
2019-09-24
3450. GOLDMAN SACHS INT'L SMALL CAP INSIGHTS I
2014-11-06
2019-09-24
4200. OAKMARK INTERNATIONAL INST
2019-04-24
2019-09-24
10000. LORD ABBETT INFLATION FOCUSED I
2018-07-31
2019-09-24
8000. PIMCO INCOME FUND I
2017-12-27
2019-09-24
2700. VANGUARD HIGH YIELD ADM
2016-11-15
2019-09-24
200. DBS GROUP HOLDINGS LTD ADR
2014-12-09
2019-10-07
15201.165 AMERICAN BEACON GLOBAL EV FRNT MRKT INC
2018-07-10
2019-10-08
22709.575 EATON VANCE FLOATING RATE I
2016-10-06
2019-10-08
2200. EATON VANCE FLOATING RATE I
2019-07-17
2019-10-08
5156.676 FIDELITY ADVISOR NEW MARKETS INCOME Z
2019-07-17
2019-10-08
6460.58 FIDELITY ADVISOR NEW MARKETS INCOME Z
2016-03-02
2019-10-08
40227.708 VANGUARD HIGH YIELD ADM
2016-11-15
2019-10-08
150. ENSIGN GROUP INC
2018-10-30
2019-10-23
311. BEACON ROOFING SUPPLY INC
2018-08-06
2019-10-31
175. RITCHIE BROS AUCTIONEERS INC
2017-12-18
2019-10-31
300. ROYAL DUTCH SHELL PLC SPONS ADR B
2018-05-30
2019-12-12
100. FORWARD AIR CORP
2018-10-03
2019-12-27
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
2,837
895
1,942
b
244
70
174
c
650
197
453
d
50,000
52,390
-2,390
e
32
12
20
2
1
1
5,109
5,689
-580
13,564
9,882
3,682
5,223
3,249
1,974
5,762
697
5,065
4,985
2,154
2,831
3,366
1,082
2,284
22,807
21,488
1,319
19,163
22,391
-3,228
6,419
3,266
3,153
15,000
15,684
-684
20,000
20,571
-571
9,692
9,090
602
7,648
2,009
5,639
8,876
2,540
6,336
6,977
3,774
3,203
22,551
19,181
3,370
104,262
109,684
-5,422
10,083
8,753
1,330
36,472
29,530
6,942
9,656
6,113
3,543
16,139
24,323
-8,184
6,732
5,490
1,242
2,693
2,786
-93
36,242
39,198
-2,956
24,100
26,351
-2,251
18,459
19,062
-603
15,326
14,566
760
27
28
-1
60,000
76,676
-16,676
10,000
12,831
-2,831
10,609
7,858
2,751
1,173
624
549
1,000
987
13
1,198
1,595
-397
10,059
13,225
-3,166
14,528
13,144
1,384
10,000
9,608
392
16,980
10,497
6,483
24,755
1,720
23,035
5,412
4,457
955
6,015
3,340
2,675
7,081
3,297
3,784
7,322
1,694
5,628
15,600
11,152
4,448
11,724
24,779
-13,055
4,900
5,008
-108
9,184
7,888
1,296
718
1,074
-356
7,900
9,386
-1,486
3,712
3,235
477
8,662
4,368
4,294
1,455
1,440
15
4
4
535,702
496,680
39,022
7,503
10,124
-2,621
62,031
70,000
-7,969
577,127
580,406
-3,279
59,546
55,964
3,582
50,604
50,000
604
18,924
19,047
-123
20,688
23,795
-3,107
1,083
810
273
10,830
3,874
6,956
17,388
14,389
2,999
7,925
9,779
-1,854
351
384
-33
20,180
11,290
8,890
26,942
28,349
-1,407
2,561
3,304
-743
11,012
20,683
-9,671
7,170
6,462
708
21,757
12,714
9,043
11,966
12,367
-401
4,275
2,696
1,579
9,284
5,536
3,748
7,667
5,061
2,606
7,511
1,221
6,290
12,368
7,059
5,309
7,312
7,744
-432
10,190
10,228
-38
325
325
12,705
15,137
-2,432
16,810
16,882
-72
13,990
5,488
8,502
22,370
14,233
8,137
16,946
11,724
5,222
13,888
6,823
7,065
11,495
14,244
-2,749
9,623
7,754
1,869
13,322
9,032
4,290
44,514
46,614
-2,100
16,365
10,830
5,535
24,237
18,597
5,640
26,913
26,497
416
20,857
21,918
-1,061
14,516
12,508
2,008
9,931
9,461
470
21,147
11,574
9,573
15,522
9,528
5,994
16,194
12,306
3,888
14,860
5,820
9,040
13,966
6,421
7,545
22,100
16,264
5,836
18,776
10,999
7,777
122,609
139,970
-17,361
20,797
9,298
11,499
20,918
4,102
16,816
13,851
3,640
10,211
46,169
14,138
32,031
17,872
3,691
14,181
81,749
30,269
51,480
53,417
28,225
25,192
56,722
31,217
25,505
29,861
37,686
-7,825
4,594
4,561
33
15,791
2,097
13,694
24,965
13,295
11,670
21,701
9,892
11,809
24,906
9,223
15,683
6,805
3,161
3,644
4,218
3,379
839
22,081
19,586
2,495
19,852
3,748
16,104
112,600
128,617
-16,017
66,400
32,981
33,419
66,399
54,707
11,692
15,323
11,311
4,012
37,404
26,628
10,776
6,234
5,162
1,072
14,794
14,508
286
837
558
279
35,026
6,071
28,955
23,374
6,436
16,938
367,784
387,738
-19,954
45,665
8,508
37,157
17,173
3,348
13,825
30,050
26,598
3,452
31,168
7,390
23,778
2,551
2,541
10
7,653
10,248
-2,595
39,132
12,388
26,744
11,880
11,343
537
21,234
10,234
11,000
13,377
11,788
1,589
21,083
10,890
10,193
28,410
22,202
6,208
50,637
28,177
22,460
15,897
4,515
11,382
35,710
27,222
8,488
21,307
7,172
14,135
71,975
22,911
49,064
22,988
9,568
13,420
4,521
2,750
1,771
14,181
10,664
3,517
4,122
3,272
850
3,822
3,063
759
12,741
11,973
768
24,167
24,126
41
1,656
1,884
-228
6,625
12,119
-5,494
15,506
18,188
-2,682
18,056
13,508
4,548
20,980
14,982
5,998
7,249
3,464
3,785
17,036
3,854
13,182
11,276
9,729
1,547
11,420
10,133
1,287
11,462
6,900
4,562
7,749
6,472
1,277
11,718
8,069
3,649
6,838
6,961
-123
9,369
8,584
785
9,995
3,392
6,603
8,275
9,434
-1,159
15,103
3,577
11,526
10,861
8,528
2,333
13,146
6,110
7,036
10,818
2,477
8,341
66,712
73,842
-7,130
183,288
202,877
-19,589
4,512
8,357
-3,845
6,799
4,830
1,969
3,975
13,565
-9,590
5,951
9,871
-3,920
10,106
9,404
702
4,554
5,860
-1,306
3,987
10,645
-6,658
332
1,499
-1,167
4,472
5,000
-528
8,131
6,560
1,571
18,678
22,146
-3,468
16,642
21,916
-5,274
18,256
17,409
847
18,786
21,245
-2,459
9,141
18,650
-9,509
15,014
19,213
-4,199
7,702
9,816
-2,114
2,995
3,223
-228
4,032
3,750
282
4,221
4,575
-354
7,524
7,383
141
1,493
1,416
77
9,697
8,205
1,492
15,669
3,469
12,200
6,960
2,521
4,439
3,651
4,109
-458
9,078
8,076
1,002
7,048
6,527
521
5,642
6,030
-388
7,479
5,637
1,842
7,069
3,074
3,995
1,628
1,965
-337
2,488
2,489
-1
3,990
4,615
-625
7,932
5,440
2,492
8,023
7,265
758
9,170
9,095
75
7,384
6,974
410
8,465
3,892
4,573
1,751
1,036
715
3,533
2,980
553
4,894
5,130
-236
9,249
1,735
7,514
7,606
3,195
4,411
10,866
3,043
7,823
6,883
6,826
57
40,078
30,821
9,257
4,242
4,764
-522
46,653
41,468
5,185
240,060
180,861
59,199
8,011
7,180
831
8,257
7,457
800
10,611
10,053
558
60,620
66,290
-5,670
14,840
15,443
-603
108,460
109,055
-595
39,158
34,017
5,141
96,264
104,322
-8,058
112,600
118,700
-6,100
95,520
98,979
-3,459
15,930
15,552
378
14,274
12,098
2,176
130,426
142,466
-12,040
199,390
200,753
-1,363
19,316
19,558
-242
76,267
77,282
-1,015
95,552
98,094
-2,542
235,734
231,712
4,022
6,223
5,269
954
9,625
4,366
5,259
7,152
5,069
2,083
17,178
21,435
-4,257
6,933
6,376
557
44,635
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
1,942
b
174
c
453
d
-2,390
e
20
1
-580
3,682
1,974
5,065
2,831
2,284
1,319
-3,228
3,153
-684
-571
602
5,639
6,336
3,203
3,370
-5,422
1,330
6,942
3,543
-8,184
1,242
-93
-2,956
-2,251
-603
760
-1
-16,676
-2,831
2,751
549
13
-397
-3,166
1,384
392
6,483
23,035
955
2,675
3,784
5,628
4,448
-13,055
-108
1,296
-356
-1,486
477
4,294
15
39,022
-2,621
-7,969
-3,279
3,582
604
-123
-3,107
273
6,956
2,999
-1,854
-33
8,890
-1,407
-743
-9,671
708
9,043
-401
1,579
3,748
2,606
6,290
5,309
-432
-38
-2,432
-72
8,502
8,137
5,222
7,065
-2,749
1,869
4,290
-2,100
5,535
5,640
416
-1,061
2,008
470
9,573
5,994
3,888
9,040
7,545
5,836
7,777
-17,361
11,499
16,816
10,211
32,031
14,181
51,480
25,192
25,505
-7,825
33
13,694
11,670
11,809
15,683
3,644
839
2,495
16,104
-16,017
33,419
11,692
4,012
10,776
1,072
286
279
28,955
16,938
-19,954
37,157
13,825
3,452
23,778
10
-2,595
26,744
537
11,000
1,589
10,193
6,208
22,460
11,382
8,488
14,135
49,064
13,420
1,771
3,517
850
759
768
41
-228
-5,494
-2,682
4,548
5,998
3,785
13,182
1,547
1,287
4,562
1,277
3,649
-123
785
6,603
-1,159
11,526
2,333
7,036
8,341
-7,130
-19,589
-3,845
1,969
-9,590
-3,920
702
-1,306
-6,658
-1,167
-528
1,571
-3,468
-5,274
847
-2,459
-9,509
-4,199
-2,114
-228
282
-354
141
77
1,492
12,200
4,439
-458
1,002
521
-388
1,842
3,995
-337
-1
-625
2,492
758
75
410
4,573
715
553
-236
7,514
4,411
7,823
57
9,257
-522
5,185
59,199
831
800
558
-5,670
-603
-595
5,141
-8,058
-6,100
-3,459
378
2,176
-12,040
-1,363
-242
-1,015
-2,542
4,022
954
5,259
2,083
-4,257
557
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
915,212
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
2,015,127
13,580,073
0.148389
2017
1,334,587
13,241,011
0.100792
2016
1,148,830
11,656,502
0.098557
2015
1,101,319
11,812,489
0.093233
2014
909,977
11,573,415
0.078626
2
Total
of line 1, column (d)
.....................
2
0.519597
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
0.103919
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
13,208,993
5
Multiply line 4 by line 3
......................
5
1,372,665
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
10,864
7
Add lines 5 and 6
........................
7
1,383,529
8
Enter qualifying distributions from Part XII, line 4
,.............
8
2,783,502
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
10,864
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
10,864
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
10,864
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
6,456
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
6,456
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
4,408
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
0
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)
WI
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
Yes
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
14
The books are in care of
TRUST POINT INC
Telephone no.
(608) 782-1148
Located at
230 FRONT STREET NORTH
LA CROSSE
WI
ZIP+4
54601
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
Trust Point Inc
Trustee
1
57,383
230 Front Street North
La Crosse
,
WI
54601
Vicky L Kunz
Trustee
1
0
N2151 Sunset Lane
La Crosse
,
WI
54601
Jill A Swanson Zietlow
Trustee
1
0
1301 7th Street SW
Rochester
,
MN
55902
Ryan M Donovan
Trustee
1
3,725
7045 Milner Mountain Ranch Rd
Loveland
,
CO
80538
Daniel L Kunz
Trustee
1
65,000
N2151 Sunset Lane
La Crosse
,
WI
54601
Scott P Zietlow
Trustee
1
0
1301 7th Street SW
Rochester
,
MN
55902
Emily J K Rick
Trustee
1
0
N3009 Welsh Coulee Rd
La Crosse
,
WI
54601
Matthew Zietlow
Trustee
1
2,750
1301 7th St SW
Rochester
,
MN
55902
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
13,410,145
b
Average of monthly cash balances
.......................
1b
0
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
13,410,145
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
13,410,145
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
201,152
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
13,208,993
6
Minimum investment return.
Enter 5% of line 5
..................
6
660,450
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
660,450
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
10,864
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
10,864
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
649,586
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
649,586
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
649,586
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
2,783,502
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
2,783,502
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
10,864
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
2,772,638
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
649,586
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
......
351,827
b
From 2015
......
529,163
c
From 2016
......
569,991
d
From 2017
......
684,148
e
From 2018
......
1,349,031
f
Total
of lines 3a through e
........
3,484,160
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
2,783,502
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
.....
649,586
e
Remaining amount distributed out of corpus
2,133,916
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
5,618,076
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)
...
351,827
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
5,266,249
10
Analysis of line 9:
a
Excess from 2015
....
529,163
b
Excess from 2016
....
569,991
c
Excess from 2017
....
684,148
d
Excess from 2018
....
1,349,031
e
Excess from 2019
....
2,133,916
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).)
DONALD AND LAVONNE ZIETLOW SCOTT A
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:
Brenda Stuhr
230 Front Street North
La Crosse
,
WI
54601
(608) 782-1148
b
The form in which applications should be submitted and information and materials they should include:
www.antiochfoundation.org
c
Any submission deadlines:
9/15-10/15
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Supports faith, education, medicine, and humanitarian need
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
LIGHTHOUSE YOUTH CENTER
5641 N 68TH STREET
MILWAUKEE
,
WI
53218
NONE
PUBLIC
YOUTH DEVELOPMENT
40,000
3 Hopeful Hearts
1749 DEWEESE ST
Fort Collins
,
CO
80526
NONE
PUBLIC
OPERATING EXPENSES
40,000
Time of Grace
PO BOX 301
Milwaukee
,
WI
53201
NONE
PUBLIC
ESTABLISH VIRTUAL CHURCH IN
40,000
Mississippi Valley Archaeology Center
University of Wisconsin - La Crosse
1725 STATE ST
La Crosse
,
WI
54601
NONE
PUBLIC
ENDOWMENT FUND
2,500
WELS Conference of Staff Ministers
c/o Good Shepherd Lutheran Church
9191 COCHRANS CROSSING DR
The Woodlands
,
TX
77381
NONE
PUBLIC
STAFF MINISTER CONFERENCE
3,000
WISCONSIN LUTHERAN INSTITUTIONAL
MINISTRIES
1833 EXECUTIVE DRIVE
OCONOMOWOC
,
WI
53066
NONE
PUBLIC
MINISTRIES
50,000
VICTORY OF THE LAMB LUTHERAN CHURCH
9037 S CORDGRASS CIRCLE W
FRANKLIN
,
WI
53132
NONE
PUBLIC
MINISTRY
12,500
JUNIOR ACHIEVEMENT OF WI - COULEE REGION
2715 LOSEY BLVD
LA CROSSE
,
WI
54601
NONE
PUBLIC
PROGRAM MATERIAL COSTS
3,000
316 NOW
PO BOX 28876
GREENFIELD
,
WI
532280876
NONE
PUBLIC
JOY-FILLED CHILDREN OF THE
20,000
WELS WORLD MISSIONS
N16 W23377 STONE RIDGE DRIVE
WAUKESHA
,
WI
53188
NONE
PUBLIC
MINISTRY
30,000
FIRST EVANGELICAL LUTHERAN CHURCH
LA CROSSE
400 WEST AVE
LA CROSSE
,
WI
54601
NONE
PUBLIC
MINISTRY
1,236,000
ABIDING WORD LUTHERAN CHURCH - HOUSTON
17123 RED OAK DR
HOUSTON
,
TX
77090
NONE
PUBLIC
MINISTRY
10,000
ST PAUL'S LUTHERAN CHURCH - MUSKEGO
S66 W14325 JANESVILLE ROAD
MUSKEGO
,
WI
53150
NONE
PUBLIC
MINISTRY
10,000
LUTHER HIGH SCHOOL
1501 WILSON ST
ONALASKA
,
WI
54650
NONE
PUBLIC
RISE UP AND BUILD PROJECT
130,000
CHRISTIANS FORWARD - SOUTHEAST ASIA
14583 W WATSON LN
SURPRISE
,
AZ
85379
NONE
PUBLIC
PRODUCE DVD FOR PROMOTIONAL
21,000
RESURRECTION AND LIFE LUTHERAN CHURCH
4520 19TH AVE NW
ROCHESTER
,
MN
55901
NONE
PUBLIC
MINISTRY
100,000
CROWN OF LIFE LUTHERAN CHURCH
32725 RYAN ROAD
WARREN
,
MI
48092
NONE
PUBLIC
SANCTUARY REMODELING
30,000
THE SON EXPERIENCE
C/O PILGRIM CHURCH
MINNEAPOLIS
,
MN
55409
NONE
PUBLIC
ADDITIONAL STAFF EXPENSES
20,000
ASSOCIATION OF LUTHERAN HIGH SCHOOLS
1200 OAKDALE AVE
WEST ST PAUL
,
MN
55118
NONE
PUBLIC
2017 CHRISTIAN LEADERSHIP
5,000
GRACE EVANGELICAL LUTHERAN CHURCH
1209 N BROADWAY
MILWAUKEE
,
WI
53202
NONE
PUBLIC
REDUCE MORTGAGE PAYMENTS
45,000
PRINCE OF PEACE LUTHERAN CHURCH
3601 S GARDEN RIDGE BLVD
FLOWER MOUND
,
TX
75028
NONE
PUBLIC
MORNINGS WITH MOMMY AND
30,000
MOUNT CALVARY GRACE LUTHERAN SCHOOL
1614 PARK AVE
LA CROSSE
,
WI
54601
NONE
PUBLIC
EDUCATION
25,000
THE CORE
N2740 FRENCH ROAD
APPLETON
,
WI
54913
NONE
PUBLIC
MINISTRY
40,000
BOYS AND GIRLS CLUB OF ROCHESTER
1026 EAST CENTER STREET
ROCHESTER
,
MN
55904
NONE
PUBLIC
YOUTH SERVICES
10,000
JUNIOR ACHIEVEMENT - WOLF RIVER AREA
PO BOX 573
SHAWANO
,
WI
54166
NONE
PUBLIC
EDUCATION
3,000
JUNIOR ACHIEVEMENT - NW CENTRAL
REGION
2904 RIB MOUNTAIN DRIVE
WAUSAU
,
WI
54401
NONE
PUBLIC
EDUCATION
3,000
WELS CENTRAL AFRICA MEDICAL MISSION
N16W23377 STONE RIDGE DRIVE
WAUKESHA
,
WI
53188
NONE
PUBLIC
HUMANITARIAN AID
30,000
ST CROIX LUTHERAN ACADEMY
1200 OAKDALE AVE
WEST ST PAUL
,
MN
55118
NONE
PUBLIC
EDUCATION
15,000
LA CASA DE ESPERANZA
410 ARCADIAN AVE
WAUKESHA
,
WI
53186
NONE
PUBLIC
EDUCATION
15,000
ST JOHN'S EVANGELICAL LUTHERAN SCHOOL
SPARTA
419 JEFFERSON STREET
SPARTA
,
WI
54656
NONE
PUBLIC
EDUCATION
6,500
BOARD FOR WORLD OUTREACH
6 BROWNS COURT
MANKATO
,
MN
56001
NONE
PUBLIC
EDUCATION AND OUTREACH
26,000
APTIV
3000 SOUTH AVE
LA CROSSE
,
WI
54061
NONE
PUBLIC
DISABILITY PROGRAMS
1,000
LEE CARLSON CENTER
7954 UNIVERSITY AVE NE
FRIDLEY
,
MN
55432
NONE
PUBLIC
MEDICAL
30,000
KOINE MUSIC MINISTRIES
2036 N 2ND STREET
MILWAUKEE
,
WI
53212
NONE
PUBLIC
MINISTRY
24,000
CROSSTRAIN COACHING NETWORK
PO BOX 13
LAVEEN
,
AZ
85339
NONE
PUBLIC
MINISTRY
15,000
ST PAUL'S LUTHERAN CHURCH MILWAUKEE
3521 N 80TH STREET
MILWAUKEE
,
WI
53222
NONE
PUBLIC
MINISTRY
10,000
DANUBE AREA ATHLETIC CLUB
PO BOX 192
RENVILLE
,
MN
56284
NONE
PUBLIC
YOUTH PROGRAMS
10,000
MT OLIVE LUTHERAN CHURCH - MANKATO
1123 MARSH STREET
MANKATO
,
MN
56001
NONE
PUBLIC
MINISTRY
20,000
ST JOHN'S LUTHERAN CHURCH - HASTINGS
202 W 8TH STREET
HASTINGS
,
MN
55033
NONE
PUBLIC
MINISTRY
10,000
THE COMPASS CENTER
1704 S CLEVELAND AVE
SIOUX FALLS
,
SD
57103
NONE
PUBLIC
COUNSELING AND EDUCATION
20,000
CAMP SHILOH
3335 FM 21
PITTSBURG
,
TX
75686
NONE
PUBLIC
MINISTRY
1,000
KINGDOM PREP LUTHERAN HIGH SCHOOL
2520 N WAUWATOSA AVE
WAUWATOSA
,
WI
53213
NONE
PUBLIC
EDUCATION
50,000
ST MATTHEW'S EVANGELICAL LUTHERAN
CHURCH - POUND
PO BOX 115
POUND
,
WI
54161
NONE
PUBLIC
MINISTRY
5,000
ST LUKE'S LUTHERAN SCHOOL - OAKFIELD
245 S 2ND STREET
OAKFIELD
,
WI
53065
NONE
PUBLIC
MINISTRY
10,000
JUNIOR ACHIEVEMENT DANE COUNTY AREA
2800 ROYAL AVE
MONONA
,
WI
53713
NONE
PUBLIC
EDUCATION
3,000
BETHLEHEM LUTHERAN CHURCH - LAKEVILLE
16296 FALLBROOK DRIVE
LAKEVILLE
,
MN
55044
NONE
PUBLIC
MINISTRY
40,000
HORSESENSE
PO BOX 906
LA CROSSE
,
WI
54602
NONE
PUBLIC
DISABILITY PROGRAMS
10,000
ETERNAL LOVE EVANGELICAL LUTHERAN CHURCH
1011 MIDWAY ROAD
APPLETON
,
WI
54915
NONE
PUBLIC
MINISTRY
30,000
ST PAUL'S LUTHERAN SCHOOL - ONALASKA
1201 MAIN STREET
ONALASKA
,
WI
54650
NONE
PUBLIC
EDUCATION
5,000
FAIRVIEW LUTHERAN CHURCH - MILWAUKEE
137 N 66TH STREET
MILWAUKEE
,
WI
53213
NONE
PUBLIC
MINISTRY
40,000
COMMUNITY SUPPORT NETWORK
1736 ROTH STREET
MADISON
,
WI
53704
NONE
PUBLIC
DISABILITY PROGRAMS
8,700
JUNIOR ACHIEVEMENT OF WI - APPLETON
300 N APPLETON STREET
APPLETON
,
WI
54911
NONE
PUBLIC
EDUCATION
7,500
LIVING WORD EVANGELICAL LUTHERAN CHURCH
2712 SUSSEX AVE
WAUKESHA
,
WI
53188
NONE
PUBLIC
MINISTRY
30,000
STAR OF BETHLEHEM LUTHERAN CHURCH
3700 S CASPER DRIVE
NEW BERLIN
,
WI
53151
NONE
PUBLIC
MINISTRY
20,000
KETTLE MORAINE LUTHERAN HIGH SCHOOL
3399 DIVISION STREET
JACKSON
,
WI
53037
NONE
PUBLIC
EDUCATION
30,000
SALEM LUTHERAN CHURCH AND SCHOOL
STILLWATER
14940 62ND STREET N
STILLWATER
,
MN
55082
NONE
PUBLIC
MINISTRY
20,000
AMERICAN CANCER SOCIETY INC
8317 ELDERBERRY ROAD
MADISON
,
WI
53717
NONE
PUBLIC
MEDICAL
10,000
TRUTH IN LOVE MINISTRY
1002 W SANETTA STREET
NAMPA
,
ID
83651
NONE
PUBLIC
MINISTRY
20,000
LUTHERAN HOME ASSOCIATION
337 S MERIDIAN ST
BELLE PLAINE
,
MN
56011
NONE
PUBLIC
MINISTRY
55,000
KINGDOM WORKERS
N19W24075 RIVERWOOD DRIVE
WAUKESHA
,
WI
53188
NONE
PUBLIC
COMMUNITY
40,000
CENTER FOR URBAN TEACHING
2600 W WISCONSIN AVE
MILWAUKEE
,
WI
53233
NONE
PUBLIC
EDUCATION
30,000
POUDRE VALLEY HEALTH SYSTEM FOUNDATION
2315 E HARMONY ROAD
FORT COLLINS
,
CO
80528
NONE
PUBLIC
MEDICAL
30,000
THAI VILLAGE
233 KLEINE STREET
DEERFIELD
,
WI
53531
NONE
PUBLIC
EDUCATION
15,000
CHAPLAINS IN SCHOOLS
2225 N 1ST STREET
MILWAUKEE
,
WI
53212
NONE
PUBLIC
MINISTRY
30,000
Total
.................................
3a
2,731,700
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
...........
14
43,810
4
Dividends and interest from securities
....
14
289,592
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
915,212
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)
..
1,248,614
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
1,248,614
(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