-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0052
20
19
Open to Public Inspection
For calendar year 2019, or tax year beginning
01-01-2019
, and ending
12-31-2019
Name of foundation
THE WESTPHAL FAMILY FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
5130 COMMERCIAL CIRCLE
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CONCORD
,
CA
94520
A Employer identification number
91-6491365
B
Telephone number (see instructions)
(925) 808-4370
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)
$
231,152
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)
215,000
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
b
Gross sales price for all assets on line 6a
7
Capital gain net income (from Part IV, line 2)
...
0
8
Net short-term capital gain
.........
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
Total.
Add lines 1 through 11
........
215,000
0
13
Compensation of officers, directors, trustees, etc.
0
0
0
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
60
0
0
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
47
0
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
107
0
0
25
Contributions, gifts, grants paid
.......
224,500
224,500
26
Total expenses and disbursements.
Add lines 24 and 25
224,607
0
224,500
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-9,607
b
Net investment income
(if negative, enter -0-)
0
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2019)
Form 990-PF (2019)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
2
Savings and temporary cash investments
.........
240,759
231,152
231,152
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
240,759
231,152
231,152
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
231,152
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
........
40
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
240,719
29
Total net assets or fund balances
(see instructions)
.....
240,759
231,152
30
Total liabilities and net assets/fund balances
(see instructions)
.
240,759
231,152
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
240,759
2
Enter amount from Part I, line 27a
.....................
2
-9,607
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
231,152
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
231,152
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.)
1a
b
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
b
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
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
219,500
190,957
1.149473
2017
243,000
202,354
1.200866
2016
177,500
44,998
3.944620
2015
187,000
49,606
3.769705
2014
195,000
38,301
5.091251
2
Total
of line 1, column (d)
.....................
2
15.155915
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
3.031183
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
209,695
5
Multiply line 4 by line 3
......................
5
635,624
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
0
7
Add lines 5 and 6
........................
7
635,624
8
Enter qualifying distributions from Part XII, line 4
,.............
8
224,500
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
0
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
0
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
0
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
361
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
361
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
361
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
361
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
CA
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
KIRSTEN OWEN
Telephone no.
(925) 808-4370
Located at
5130 COMMERCIAL CIRCLE
CONCORD
CA
ZIP+4
94520
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
BRUCE A WESTPHAL
TRUSTEE
1.00
0
0
0
5130 COMMERCIAL CIRCLE
CONCORD
,
CA
94520
PATRICIA A WESTPHAL
TRUSTEE
1.00
0
0
0
5130 COMMERCIAL CIRCLE
CONCORD
,
CA
94520
ROGER L WESTPHAL
TRUSTEE
1.00
0
0
0
5130 COMMERCIAL CIRCLE
CONCORD
,
CA
94520
PENNY L WESTPHAL
TRUSTEE
1.00
0
0
0
5130 COMMERCIAL CIRCLE
CONCORD
,
CA
94520
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
THE FOUNDATION GRANTS SCHOLARSHIPS ON AN ANNUAL BASIS TO THE CHILDREN OF BAY ALARM COMPANY EMPLOYEES. POTENTIAL RECIPIENTS MUST BE A HIGH SCHOOL GRADUATE, A HIGH SCHOOL GRADUATE WITHIN THE NEXT 12 MONTHS, OR A RECIPIENT OF A GED WHO IS YOUNGER THAN 23 YEARS OF AGE AT THE TIME THE COMPLETED APPLICATION IS SUBMITTED. THEY MUST BE ENROLLED, ACCEPTED, OR APPLYING TO A TWO OR FOUR YEAR COLLEGE, A TRADE-TECHNICAL SCHOOL, OR SCHOOL OF THE ARTS WHICH OFFERS A DEGREE, CERTIFICATION, LICENSE, OR AN EQUIVALENT TO OBTAINING A POST HIGH SCHOOL DEGREE. POTENTIAL RECIPIENTS MUST COMPLETE AN APPLICATION FORM, PROVIDE TWO REFERENCES, AND BE INTERVIEWED BY THE SCHOLARSHIP COMMITTEE. IN 2019, THE PROGRAM PROVIDED SCHOLARSHIPS TOTALING $52,000 TO TWENTY-TWO INDIVIDUALS.
0
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
NONE
0
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
0
b
Average of monthly cash balances
.......................
1b
212,888
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
212,888
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
212,888
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
3,193
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
209,695
6
Minimum investment return.
Enter 5% of line 5
..................
6
10,485
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
10,485
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
0
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
10,485
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
10,485
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
10,485
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
224,500
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
224,500
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b. See instructions
.................
5
0
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
224,500
Note:
The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
the section 4940(e) reduction of tax in those years.
Form
990-PF
(2019)
Form 990-PF (2019)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2018
(c)
2018
(d)
2019
1
Distributable amount for 2019 from Part XI, line 7
10,485
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
......
193,085
b
From 2015
......
184,520
c
From 2016
......
175,250
d
From 2017
......
232,882
e
From 2018
......
209,952
f
Total
of lines 3a through e
........
995,689
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
224,500
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
.....
10,485
e
Remaining amount distributed out of corpus
214,015
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
1,209,704
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)
...
193,085
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
1,016,619
10
Analysis of line 9:
a
Excess from 2015
....
184,520
b
Excess from 2016
....
175,250
c
Excess from 2017
....
232,882
d
Excess from 2018
....
209,952
e
Excess from 2019
....
214,015
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2019)
Form 990-PF (2019)
Page
11
Part XV
Supplementary Information
(continued)
3
Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
ACTIVE CHARITY
2623 CAMPECHE CT
SAN RAMON
,
CA
94583
NONE
PC
SUPPORT CAUSES OFTEN FOCUSING ON LOCAL ISSUES BENEFITING CHILDREN, VETERANS AND HEALTH.
15,000
ALSTDI
300 TECHNOLOGY SQUARE STE 400
CAMBRIDGE
,
MA
02139
NONE
PC
LEAD THE FIGHT AGAINST ALS BY FUNDING CUTTING EDGE DRUG DEVELOPMENT
3,000
ASSOCIATION FOR THE PRESERVATION OF THE PRESIDENTIAL YACHT POTOMAC
540 WATER STREET
OAKLAND
,
CA
94607
NONE
PC
PRESERVATION OF THE PRESIDENTIAL YACHT POTOMAC
1,500
BAUN (BAY AREA URBAN NETWORK)
4292 KELLER AVE
OAKLAND
,
CA
94605
NONE
PC
TWO MINISTRIES (YOUTH AND CHILDREN) LEADING THE CITY OF OAKLAND TO GOD.
2,000
BAY AREA RESCUE MISSION
PO BOX 1112
RICHMOND
,
CA
94802
NONE
PC
TO PRESENT THE MEANS AND OPPORTUNITY FOR REAL AND LASTING CHANGE TO THE HOMELESS AND NEEDY
1,500
BISHOP O'DOWD
9500 STEARNS AVENUE
OAKLAND
,
CA
94605
NONE
PC
MAKING A DIFFERENCE IN THE EDUCATIONAL PRODUCT PROVIDED TO STUDENTS BOTH ACADEMICALLY AND THROUGH EXTRA-CURRICULAR PROGRAMS.
5,000
BOYS AND GIRLS CLUBS OF OAKLAND
PO BOX 18770
OAKLAND
,
CA
94619
NONE
PC
PROVIDING AFTER-SCHOOL PROGRAMS FOR YOUNG PEOPLE
1,500
BRIGHTER BEGINNINGS
PO BOX 4036
ANTIOCH
,
CA
94531
NONE
PC
SUPPORT HEALTHY BIRTHS AND SUCCESSFUL DEVELOPMENT OF CHILDREN BY PARTNERING WITH PARENTS AND HELPING TO BUILD STRONG COMMUNITIES
500
CHAINBREAKER COLLECTIVE
PO BOX 31666
SANTA FE
,
NM
87594
NONE
PC
ECONOMIC AND ENVIRONMENTAL JUSTICE ORGANIZATION
3,000
CHILDREN'S HOSPITAL OAKLANDUCSF BENIOFF CHILDREN'S HOSPITAL FOUNDATION
PO BOX 45339
SAN FRANCISCO
,
CA
94145
NONE
PC
PROVIDES EXEMPLARY PEDIATRIC CARE, PROVIDING PATIENTS WITH EFFECTIVE AND RESPONSIVE CHILDREN'S CARE
2,500
COUGAR FOOTBALL FUND
PO BOX 6877
MORAGA
,
CA
94556
NONE
PC
ENTITY FORMED TO RAISE FUNDS FOR THE ENHANCMENT OF THE FOOTBALL PROGRAM AND FACILITEIS AT CAMPOLINDO HIGH SCHOOL
2,500
DE LA SALLE HIGH SCHOOL
1130 WINTON DRIVE
CONCORD
,
CA
94518
NONE
PC
GUIDES STUDENTS TO BECOME MEN OF FAITH, INTEGRITY AND SCHOLARSHIP
7,500
DELTA SIGMA PHI FOUNDATION
PO BOX 88507
INDIANAPOLIS
,
IN
46208
NONE
PC
TO PROMOTE EDUCATIONAL AND CHARITABLE PURPOSES BY PROVIDING SCHOLARSHIPS, STUDENT AID AND ASSISTANCE TO NEEDY AND DESERVING STUDENTS AND BY THE DEVELOPMENT OF EDUCATIONAL WORK IN THE CHAPTERS OF DELTA SIGMA PHI FRATERNITY.
2,000
EAST BAY SPCA
8323 BALDWIN STREET
OAKLAND
,
CA
94621
NONE
PC
STRIVE TO ELIMINATE ANIMAL CRUELTY, NEGLECT AND OVERPOPULATION
250
EAST BAY COLLEGE FUND
300 FRANK H OGAWA PLAZA SUITE 430
OAKLAND
,
CA
94512
NONE
PC
SUPPORTS OAKLAND PUBLIC SCHOOL STUDENTS, UNDERREPRESENTED IN HIGHER EDUCATION, TO ACCESS AND SUCCEED IN COLLEGE, EXPANDING THEIR LIFE OPPORTUNITIES
500
GIRLS INC
510 16TH STREET SUITE 100
OAKLAND
,
CA
94612
NONE
PC
INSPIRING ALL GIRLS TO BE STRONG, SMART, AND BOLD
4,500
GIVE ONE DOLLAR A DAY
125 STEINER STREET
SAN FRANCISCO
,
CA
94117
NONE
PC
TO HELP EASE THE FINANCIAL BURDEN OF CHILDREN AND FAMILIES AFFECTED BY ILLENSS AND POVERTY
2,000
GREATER GOOD SCIENCE CENTER
UC BERKELEY 2425 ATHERTON ST 6070
BERKELEY
,
CA
94704
NONE
PC
STUDYING THE PSYCHOLOGY, SOCIOLOGY, AND NEUROSCIENCE OF WELL-BEING, AND TEACHES SKILLS THAT FOSTER A THRIVING, RESILIENT, AND COMPASSIONATE SOCIETY.
8,000
LAFAYETTE PARTNERS IN EDUCATION
PO BOX 923 3450 GOLDEN GATE WAY
LAFAYETTE
,
CA
94549
NONE
PC
ENHANCES AND EXPANDS THE EDUCATIONAL OPPORTUNITIES FOR ALL STUDENTS IN LAFAYETTE'S SIX PUBLIC SCHOOLS IN CA
2,000
LAFAYETTE WATER POLO FOUNDATION
1015 HAMPTON ROAD
LAFAYETTE
,
CA
94549
NONE
PC
ADVANCE CURRENT AND FUTURE PLAYERS AT ALL LEVELS, WITH PRIORITIES BEING PLAYER DEVELOPMENT, COACH SUPPORT AND AWARD RECOGNITION FOR ATHLETIC, ACADEMIC AND LEADERSHIP ACHIEVEMENTS
2,000
LINDSAY WILDLIFE EXPERIENCE
1931 FIRST AVENUE
WALNUT CREEK
,
CA
94597
NONE
PC
PROTECTING AND PRESERVING OUR NATIVE WILDLIFE
4,500
MAKE SANTA FE INC
2879 ALL TRADES ROAD
SANTA FE
,
NM
87507
NONE
PC
BRINGS CREATIVE ENTREPRENEURS TOGETHER TO EXPERIMENT AND CREATE IN A COLLABORATIVE FORMAT
5,000
METAMORPHOSIS DOCUMENTATION PROJECT (MDP)
6 CAMINO DEL SOL
SANTA FE
,
NM
87508
NONE
PC
VALUES HISTORIC CULTURES AND RITUALS AS NECESSARY FOR SOCIETIES TO SURVIVE AND THRIVE IN THE MODERN WORLD
3,000
MT DIABLO SILVERADO COUNCIL - BRIONES DISTRICT TROOP 237
800 ELLINWOOD WAY
PLEASANT HILL
,
CA
94523
NONE
PC
HELPS DELIVER HIGH QUALITY SCOUTING PROGRAMS TO YOUNG PEOPLE
1,000
NO BARRIERS USA
224 CANYON AVE SUITE 207
FORT COLLINS
,
CO
80521
NONE
PC
SERVES INDIVIDUALS WITH PHYSICAL DISABILITIES
2,000
NORCAL LACROSSE FOUNDATION
1721 ALHAMBRA LANE
OAKLAND
,
CA
94611
NONE
PC
DEDICATED TO PROMOTING THE GROWTH OF LACROSSE IN NO. CA BY PROVIDING SUPPORT TO INSPIRE PARTICIPATION WHILE PROTECTING THE INTEGRITY OF THE SPORT
3,500
OAKLAND LACROSSE CLUB
1970 BROADWAY SUITE 920
OAKLAND
,
CA
94612
NONE
PC
BUILDING SELF CONFIDENT YOUTH EMPOWERED TO SHAPE THEIR WORLD
7,500
OAKLAND PROMISE
300 FRANK H OGAWA PLAZA SUIRE 430
OAKLAND
,
CA
94612
NONE
PC
A CRADLE-TO-CAREER INITIATIVE WITH THE VISION TO ENSURE THAT ALL OAKLAND CHILDREN GRADUATE FROM HIGH SCHOOL WITH THE SKILLS, EXPECTATIONS AND RESOURCES TO COMPLETE COLLEGE AND SUCCEED IN THE CAREER OF THEIR CHOICE
2,000
OKIZU FOUNDATION
83 HAMILTON DRIVE SUITE 200
NOVATO
,
CA
94949
NONE
PC
PROVIDING WEEK-LONG CAMPS FOR CHILDREN WITH CANCER, OR FOR SIBLINGS; WEEKEND PROGRAMS FOR FAMILIES, OR TEENS AND SIBLINGS
5,000
PIEDMONT EDUCATION FUND
401 HIGHLAND AVENUE
PIEDMONT
,
CA
94611
NONE
PC
PROMOTE ACADEMIC EXCELLENCE, CHAMPION INNOVATION AND PROVIDE SUSTAINED FINANCIAL SUPPORT TO THE PIEDMONT UNIIFIED SCHOOL DISTRICT
5,000
SANTA FE ART INSTITUTE
PO BOX 24044
SANTA FE
,
NM
87502
NONE
PC
CULTIVATE CREATIVE LEADERSHIP & INVEST IN COMMUNITY, CULTER AND PLACE TO RE-IMAGINE A MORE EQUITABLE WORLD
5,000
SANTA FE DREAMERS PROJECT
PO BOX 8009
SANTA FE
,
NM
87504
NONE
PC
PROVIDES FREE LEGAL REPRESENTATION TO NM IMMIGRANT COMMUNITY
4,000
SHELTER INC
1333 WILLOW PASS RD SUITE 206
CONCORD
,
CA
94520
NONE
PC
WORKING TO PREVENT HOMELESSNESS AMONG LOW INCOME RESIDENTS OF CONTRA COSTA COUNTRY
10,000
ST MARY'S CENTER (A FRIENDLY MANOR INC)
925 BROCKHURST STREET
OAKLAND
,
CA
94608
NONE
PC
DROP-IN CENTER AND RESIDENCE FOR HOMELESS WOMEN
500
STEPHEN J WAMPLER FOUNDATION INC
941 ORANGE AVENUE STE 440
CORONADO
,
CA
92118
NONE
PC
PROVIDING WILDERNESS EXPERIENCE FOR DISABLED CHILDREN
5,000
STRIVE FOR CHANGE FOUNDATION
PO BOX 22584
OAKLAND
,
CA
94609
NONE
PC
MAKE GRANTS TO LOCAL NON-PROFITS THAT OFFER SUCCESSFUL PROGRAMS TO HELP THE WORKING POOR GAIN TRAINING, TOOLS AND OPPORTUNITIES TO SUPPORT THEMSELVES
2,250
UNIVERSITY OF SAN FRANCISCO
PO BOX 45363
SAN FRANCISCO
,
CA
94145
NONE
PC
TO PROMOTE LERANING IN THE JESUIT CATHOLIC TRADITION
13,000
WATERSIDE WORKSHOPS
84 BOLIVAR DRIVE
BERKELEY
,
CA
94710
NONE
PC
ALTERNATIVE APPROACH TO EDUCATION AND REVITALIZATION OF UNDER USED BUILDINGS IN URBAN PARK
1,500
WOUNDED WARRIOR PROJECT
PO BOX 758541
TOPEKA
,
KS
66675
NONE
PC
CHARTIY AND VETERAN SERVICE ORGANIZATION THAT OFFERS A VARIETY OF PROGRAMS, SERVICES AND EVENTS FOR WOUNDED VETERANS OF THE MILITARY FOLLOWING 9/11/2001
2,000
ALS - THERAPY DEVELOPMENT INSTITUTE
300 TECHNOLOGY SQUARE STE 400
CAMBRIDGE
,
MA
02139
NONE
PC
LEAD THE FIGHT AGAINST ALS BY FUNDING CUTTING EDGE DRUG DEVELOPMENT
25,000
DURAN DYLAN CO MOORPARK COLLEGE
7075 CAMPUS ROAD
MOORPARK
,
CA
93021
NONE
NC
SCHOLARSHIP FBO DYLAN DURAN
250
FISHER AARON CO CSU CHICO
FINANCIAL AID SCHOLARSHIP OFFICE
CHICO
,
CA
95929
NONE
NC
SCHOLARSHIP FBO AARON FISHER
2,500
GARZON MARIA (CAMILA RAMOS) CO CSU EAST BAY
25800 CARLOS BEE BOULEVARD
HAYWARD
,
CA
94542
NONE
NC
SCHOLARSHIP FBO MARIA GARZON
4,000
GUZMAN ALEXANDRA CO CSU SACRAMENTO
6000 J STREET
SACRAMENTO
,
CA
95819
NONE
NC
SCHOLARSHIP FBO ALEXANDRA GUZMAN
4,000
HAMMOND AIDEN CO BIOLA UNIVERSITY
13800 BIOLA AVENUE
LA MIRADA
,
CA
90639
NONE
NC
SCHOLARSHIP FBO AIDEN HAMMOND
2,000
HOFER MITCH C0 LOS MEDANOS COLLEGE
2700 E LELAND ROAD
PITTSBURGH
,
CA
94565
NONE
NC
SCHOLARSHIP FBO MITCH HOFER
250
INOCENCIO KAIA CO COLLEGE OF SAN MATEO
1700 W HILLSDALE BOULEVARD
SAN MATEO
,
CA
94402
NONE
NC
SCHOLARSHIP FBO KAIA INOCENCIO
500
JIMENEZ VALERIA CO CSU FULLERTON
PO BOX 6808
FULLERTON
,
CA
92834
NONE
NC
SCHOLARSHIP FBO VALERIA JIMENEZ
3,000
LEDESMA RAQUEL CO LIFE PACIFIC UNIVERSITY
1100 WEST COVINA BOULEVARD
SAN DIMAS
,
CA
91773
NONE
NC
SCHOLARSHIP FBO RAQUEL LEDESMA
1,500
LILLENTHAL KALI CO CAL STATE CHANNEL ISLANDS
ONE UNIVERSITY DRIVE
CAMARILLO
,
CA
93012
NONE
NC
SCHOLARSHIP FBO KALI LILLENTHAL
2,000
LOWE JENNA CO UNIVERSITY OF BOULDER COLORADO
77 UCB
BOULDER
,
CO
80309
NONE
NC
SCHOLARSHIP FBO JENNA LOWE
4,000
MARGALIT YONATAN CO TUFTS UNIVERSITY
419 BOSTON AVENUE DOWLING HALL
MEDFORD
,
MA
02155
NONE
NC
SCHOLARSHIP FBO YONATHAN MARGALIT
4,000
MAY HANNAH CO CSU CHICO
FINANCIAL AID SCHOLARSHIP OFFICE
CHICO
,
CA
95929
NONE
NC
SCHOLARSHIP FBO HANNA MAY
4,000
MILLER LAUREN CO CALIFORNIA BAPTIST UNIVERSITY
8432 MAGNOLIA AVENUE
RIVERSIDE
,
CA
92504
NONE
NC
SCHOLARSHIP FBO LAUREN MILLER
1,500
PORATH CHLOE CO UC DAVIS
PO BOX 989062
WEST SACRAMENTO
,
CA
95798
NONE
NC
SCHOLARSHIP FBO CHLOE PORATH
4,000
REARDON JESSICA CO SAN DIEGO STATE UNIVERSITY
5500 CAMPANILE DRIVE
SAN DIEGO
,
CA
92182
NONE
NC
SCHOLARSHIP FBO JESSICA REARDON
3,000
REYNOLDS DAISY CO SANTA ROSA JUNIOR COLLEGE
1501 MENDOCINO AVENUE PLOVER HALL
SANTA ROSA
,
CA
95401
NONE
NC
SCHOLARSHIP FBO DAISY REYNOLDS
1,000
SMITH MITCHELL CO DIABLO VALLEY COLLEGE
321 GOLF CLUB ROAD
PLEASANT HILL
,
CA
94523
NONE
NC
SCHOLARSHIP FBO MITCHELL SMITH
1,500
WHEELER SOPHIE CO UNIVERSITY OF NEVADA RENO
MAILSTOP 0076 UNIVERSITY OF NEVADA
RENO
RENO
,
NV
89557
NONE
NC
SCHOLARSHIP FBO SOPHIE WHEELER
2,000
WHEELER SYDNEY CO SAN DIEGO STATE UNIVERSITY
5500 CAMPANILE DRIVE
SAN DIEGO
,
CA
92182
NONE
NC
SCHOLARSHIP FBO SYDNEY WHEELER
3,000
WILLIAMS AISHA CO SAN JOSE STATE UNIVERSITY
ONE WASHINGTON SQUARE
SAN JOSE
,
CA
95192
NONE
NC
SCHOLARSHIP FBO AISHA WILLIAMS
2,000
REYNOLDS DAISY CO SONOMA STATE UNIVERSITY
1501 MENDOCINO AVENUE PLOVER HALL
SANTA ROSA
,
CA
95401
NONE
NC
SCHOLARSHIP FBO DAISY REYNOLDS
2,000
CHILDREN'S GLAUCOMA FOUNDATION
1 UNIVERSITY ROAD
BOSTON
,
MA
02215
NONE
PC
RECIPIENT RETURNED PRIOR YEAR CONTRIBUTION TO TAXPAYER IN 2019
-1,000
Total
.................................
3a
224,500
b
Approved for future payment
Total
.................................
3b
0
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
....
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
............
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
0
0
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
0
(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