-
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
LIFEWORKS FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
P O BOX 50276
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
NASHVILLE
,
TN
372050276
A Employer identification number
62-1428468
B
Telephone number (see instructions)
(615) 269-6663
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)
$
3,640,146
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
3
3
4
Dividends and interest from securities
...
85,681
85,681
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
-1,995
b
Gross sales price for all assets on line 6a
2,382,076
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
........
83,689
85,684
13
Compensation of officers, directors, trustees, etc.
74,479
0
0
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
1,321
0
0
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
30,600
0
0
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
10,849
0
0
19
Depreciation (attach schedule) and depletion
...
328
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
46,838
0
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
164,415
0
0
25
Contributions, gifts, grants paid
.......
161,800
161,800
26
Total expenses and disbursements.
Add lines 24 and 25
326,215
0
161,800
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-242,526
b
Net investment income
(if negative, enter -0-)
85,684
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
.............
54,256
11,351
11,356
2
Savings and temporary cash investments
.........
351,975
54,768
54,768
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)
.......
2,771,643
2,924,064
3,570,728
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)
..........
33,668
0
0
14
Land, buildings, and equipment: basis
101,337
Less: accumulated depreciation (attach schedule)
100,936
729
401
401
15
Other assets (describe
)
2,276
2,893
2,893
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
3,214,547
2,993,477
3,640,146
17
Accounts payable and accrued expenses
..........
2,370
2,357
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)
.........
2,370
2,357
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
........
3,212,177
2,991,120
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
0
0
29
Total net assets or fund balances
(see instructions)
.....
3,212,177
2,991,120
30
Total liabilities and net assets/fund balances
(see instructions)
.
3,214,547
2,993,477
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return)
...............
1
3,212,177
2
Enter amount from Part I, line 27a
.....................
2
-242,526
3
Other increases not included in line 2 (itemize)
3
21,469
4
Add lines 1, 2, and 3
..........................
4
2,991,120
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
2,991,120
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
300 SHS HONEYWELL INTL INC
P
2017-06-13
2019-09-27
b
200 SHS RED HAT INC
P
2019-03-01
2019-05-23
c
120 SHS ILLUMINA INC
P
2019-10-30
2019-10-31
d
125 SHS ILLUMINA INC
P
2019-01-30
2019-02-06
e
100 SHS BOEING CO
P
2019-10-21
2019-10-28
190 SHS 3M CO
P
2016-11-04
2019-12-18
100 SHS ILLUMINA INC
P
2019-11-06
2019-11-26
100 SHS ILLUMINA INC
P
2019-07-18
2019-10-28
125 SHS IAC/INTERACTIVE CORP
P
2019-12-12
2019-12-19
500 SHS TWENTY-FIRST CENTURY FOX INC CL B
P
2018-07-30
2019-03-19
20 SHS ALPHABET INC CL A
P
2017-12-04
2019-07-26
150 SHS GENERAL DYNAMICS CORP
P
2018-07-31
2019-01-16
400 SHS ORACLE CORPORATION
P
2017-10-03
2019-07-18
125 SHS GENERAL DYNAMICS CORP
P
2019-09-16
2019-12-16
150 SHS MOHAWK IND INC
P
2019-07-26
2019-10-25
100 SHS PALO ALTO NETWORKS INC
P
2019-05-30
2019-06-18
450 SHS METLIFE
P
2016-07-13
2019-08-12
300 SHS EMERSON ELEC CO
P
2019-10-03
2019-10-18
100 SHS BERKSHIRE HATHAWAY INC CL B
P
2019-07-24
2019-08-05
400 SHS TWENTY-FIRST CENTURY FOX INC CL B
P
2018-09-21
2019-03-19
200 SHS NXP SEMICONDUCTORS NV
P
2018-08-28
2019-08-14
125 SHS CLOROX CO
P
2019-05-01
2019-06-05
100 SHS 3M CO
P
2018-10-31
2019-01-28
800 SHS VIACOM INC CLASS B
P
2016-02-12
2019-12-04
1000 SHS HP INC
P
2013-06-27
2019-08-12
125 SHS INTL FLAVORS & FRAGRANCES INC
P
2019-06-05
2019-06-07
350 SHS CONSUMER STAPLES SELECT SECTOR SPDR ETF
P
2019-01-03
2019-02-14
200 SHS CELGENE CORP
P
2019-07-10
2019-08-14
500 SHS LIBERTY SIRIUS GROUP C
P
2019-02-13
2019-05-29
150 SHS DANAHER CORP
P
2018-10-31
2019-02-25
500 SHS MEREDITH CORP
P
2019-09-09
2019-12-19
100 SHS CONSTELLATION BRANDS INC CLASS A
P
2019-03-12
2019-03-29
125 SHS WHIRLPOOL CORP
P
2019-06-19
2019-06-26
100 SHS HONEYWELL INTL INC
P
2017-06-13
2019-09-12
200 SHS INCYTE CORP
P
2019-01-25
2019-03-06
400 SHS BANK OF NEW YORK MELLON CORP
P
2016-07-11
2019-08-28
100 SHS GENERAL DYNAMICS CORP
P
2018-08-03
2019-01-16
100 SHS CLOROX CO
P
2019-05-01
2019-06-25
100 SHS WHIRLPOOL CORP
P
2019-06-19
2019-07-18
300 SHS TWENTY-FIRST CENTURY FOX INC CL B
P
2018-07-27
2019-03-19
300 SHS TWENTY-FIRST CENTURY FOX INC CL B
P
2019-01-04
2019-03-19
100 SHS MOHAWK IND INC
P
2019-07-26
2019-10-25
300 SHS ACTIVISION BLIZZARD INC
P
2019-06-07
2019-08-12
200 SHS EXXON MOBIL CORP
P
2018-05-15
2019-08-05
200 SHS ANADARKO PETROLEUM
P
2017-05-03
2019-06-24
75 SHS GOLDMAN SACHS GROUP INC
P
2017-10-17
2019-05-30
200 SHS AKAMAI TECHNOLOGIES INC
P
2019-01-16
2019-02-20
100 SHS HCA HEALTHCARE INC
P
2019-07-31
2019-12-03
100 SHS ZIMMER HOLDINGS INC
P
2017-08-25
2019-08-01
100 SHS ZIMMER HOLDINGS INC
P
2017-11-07
2019-08-01
100 SHS HCA HEALTHCARE INC
P
2019-07-31
2019-11-05
75 SHS CIGNA CORP NEW
P
2019-02-06
2019-07-11
700 SHS HP INC
P
2012-01-26
2019-08-12
150 SHS MEDTRONIC PLC
P
2018-10-23
2019-05-22
200 SHS EXXON MOBIL CORP
P
2018-05-31
2019-10-03
250 SHS CISCO SYSTEMS
P
2017-04-27
2019-05-15
100 SHS CHEVRON CORP
P
2018-02-15
2019-03-06
200 SHS VERIZON COMMUNICATIONS CORP
P
2016-06-16
2019-10-18
100 SHS CHEVRON CORP
P
2016-07-15
2019-06-13
100 SHS CHEVRON CORP
P
2019-08-22
2019-09-10
100 SHS TEXAS INSTRUMENTS INC
P
2019-10-25
2019-11-04
200 SHS SPDR UTILITIES SECTOR ETF
P
2018-05-04
2019-07-05
100 SHS CHEVRON CORP
P
2016-07-15
2019-05-09
200 SHS VERIZON COMMUNICATIONS CORP
P
2016-06-16
2019-05-20
500 SHS VIACOM INC CLASS B
P
2015-09-03
2019-11-25
100 SHS CHEVRON CORP
P
2016-09-15
2019-08-05
100 SHS CHEVRON CORP
P
2016-08-08
2019-08-05
200 SHS INTEL CORP
P
2016-11-17
2019-04-17
100 SHS ZIMMER HOLDINGS INC
P
2017-08-25
2019-02-01
75 SHS CLOROX CO
P
2019-05-01
2019-07-02
75 SHS CLOROX CO
P
2019-06-19
2019-07-02
200 SHS ORACLE CORPORATION
P
2017-10-03
2019-07-01
200 SHS CVS HEALTH CORP
P
2018-10-05
2019-08-07
325 SHS NEW YORK TIMES CO CL A
P
2019-07-11
2019-08-05
70 SHS FEDEX CORP
P
2019-09-19
2019-12-17
100 SHS UNITED PARCEL SERVICE CL B
P
2018-03-27
2019-03-06
100 SHS UNITED PARCEL SERVICE CL B
P
2018-03-06
2019-03-06
35 SHS ILLUMINA INC
P
2019-10-25
2019-10-28
300 SHS MEREDITH CORP
P
2019-09-09
2019-12-20
150 SHS ANADARKO PETROLEUM
P
2015-01-08
2019-04-24
200 SHS BANK OF NEW YORK MELLON CORP
P
2017-02-10
2019-02-20
50 SHS L3HARRIS TECHNOLOGIES INC
P
2019-01-24
2019-07-31
200 SHS ALTRIA GROUP INC
P
2019-05-06
2019-08-27
250 SHS BANK OF NEW YORK MELLON CORP
P
2016-07-13
2019-08-26
100 SHS UNITED PARCEL SERVICE CL B
P
2018-03-06
2019-01-30
500 SHS HP INC
P
2012-01-26
2019-08-05
70 SHS MICROSOFT CORP
P
2016-07-12
2019-07-12
150 SHS MOLSON COORS BREWING CO CLASS B
P
2019-04-12
2019-04-30
150 SHS SPDR ENERGY SECTOR ETF
P
2019-02-19
2019-05-07
150 SHS SPDR UTILITIES SECTOR ETF
P
2018-12-10
2019-12-12
420 SHS VIACOM INC CLASS B
P
2015-09-03
2019-11-07
400 SHS BAKER HUGHES CO
P
2019-09-12
2019-09-18
200 SHS SANOFI-AVENTIS ADR
P
2019-06-20
2019-10-25
200 SHS SANOFI-AVENTIS ADR
P
2019-09-13
2019-10-25
200 SHS SANOFI-AVENTIS ADR
P
2019-07-11
2019-10-25
60 SHS SAREPTA THERAPEUTICS INC
P
2019-03-06
2019-06-28
100 SHS ELECTRONIC ARTS INC
P
2018-11-29
2019-01-08
150 SHS MOLSON COORS BREWING CO CLASS B
P
2019-04-12
2019-10-23
100 SHS INCYTE CORP
P
2019-01-25
2019-02-25
60 SHS UNITED TECHNOLOGIES CORP
P
2015-01-08
2019-10-25
100 SHS BAXTER INTL
P
2018-11-09
2019-08-01
75 SHS WALMART INC
P
2018-02-26
2019-08-15
200 SHS ISHARES MSCI EMERGING MKTS INDEX ETF
P
2019-02-01
2019-05-09
200 SHS BANK OF NEW YORK MELLON CORP
P
2016-07-11
2019-08-27
200 SHS METLIFE
P
2016-07-13
2019-01-03
50 SHS FEDEX CORP
P
2018-09-18
2019-11-12
250 SHS FLUOR CORP
P
2017-02-17
2019-01-03
25 SHS ILLUMINA INC
P
2019-11-08
2019-11-26
50 SHS FEDEX CORP
P
2018-09-18
2019-05-23
75 SHS NXP SEMICONDUCTORS NV
P
2018-09-06
2019-04-30
150 SHS OCCIDENTAL PETROLEUM
P
2019-06-11
2019-08-01
25 SHS ILLUMINA INC
P
2019-07-18
2019-10-23
150 SHS CONSUMER STAPLES SELECT SECTOR SPDR ETF
P
2019-01-03
2019-01-30
100 SHS PHILIP MORRIS INTERNATIONAL
P
2019-08-27
2019-10-04
75 SHS NXP SEMICONDUCTORS NV
P
2018-09-06
2019-08-01
1000 SHS FORD MOTOR CO
P
2017-05-31
2019-01-03
100 SHS QUALCOMM CORP
P
2018-03-13
2019-04-17
100 SHS PHILIP MORRIS INTERNATIONAL
P
2019-08-27
2019-09-25
100 SHS AGILENT TECHNOLOGIES INC
P
2019-04-23
2019-09-18
50 SHS CLOROX CO
P
2019-05-10
2019-07-02
25 SHS ILLUMINA INC
P
2019-07-18
2019-10-28
100 SHS STARBUCKS CORP
P
2019-01-03
2019-04-25
40 SHS CIGNA CORP NEW
P
2018-03-27
2019-11-08
100 SHS STARBUCKS CORP
P
2018-12-14
2019-04-09
50 SHS FEDEX CORP
P
2018-09-18
2019-08-28
50 SHS FEDEX CORP
P
2018-10-01
2019-08-28
300 SHS KKR & CO CLASS A
P
2019-06-04
2019-08-12
50 SHS DANAHER CORP
P
2018-10-31
2019-12-10
133.334 SHS DOW INC
P
2018-05-04
2019-04-26
300 SHS KKR & CO CLASS A
P
2019-05-08
2019-08-05
300 SHS VIACOM INC CLASS B
P
2015-09-03
2019-11-26
75 SHS STARBUCKS CORP
P
2018-06-22
2019-08-01
50 SHS MOHAWK IND INC
P
2019-07-30
2019-10-25
150 SHS KRAFT HEINZ
P
2016-11-10
2019-02-15
200 SHS MEREDITH CORP
P
2019-10-15
2019-12-20
250 SHS CONAGRA INC
P
2019-02-15
2019-05-10
100 SHS QUALCOMM CORP
P
2019-05-16
2019-05-22
100 SHS EXXON MOBIL CORP
P
2018-05-15
2019-08-14
250 SHS KRAFT HEINZ
P
2016-11-10
2019-05-30
75 SHS ISHARES US REAL ESTATE ETF
P
2019-05-23
2019-07-11
100 SHS EXXON MOBIL CORP
P
2018-07-30
2019-08-27
25 SHS ILLUMINA INC
P
2019-07-18
2019-09-04
25 SHS ILLUMINA INC
P
2019-07-18
2019-09-04
150 SHS SCHLUMBERGER NV
P
2016-07-13
2019-02-19
100 SHS EXXON MOBIL CORP
P
2018-07-30
2019-10-03
200 SHS ROCHE HLDG LTD ADR
P
2018-12-11
2019-05-07
200 SHS ROCHE HLDG LTD ADR
P
2018-11-20
2019-05-07
200 SHS ROCHE HLDG LTD ADR
P
2018-11-30
2019-04-22
200 SHS ROCHE HLDG LTD ADR
P
2018-12-11
2019-04-22
100 SHS GILEAD SCIENCES INC
P
2016-08-24
2019-08-02
100 SHS GILEAD SCIENCES INC
P
2017-02-14
2019-08-02
75 SHS QUALCOMM CORP
P
2018-03-13
2019-11-06
100 SHS ANADARKO PETROLEUM
P
2014-12-23
2019-04-16
100 SHS SPDR ENERGY SECTOR ETF
P
2019-02-20
2019-05-07
50 SHS TEXAS INSTRUMENTS INC
P
2019-12-03
2019-12-12
50 SHS TEXAS INSTRUMENTS INC
P
2019-10-23
2019-12-12
50 SHS TEXAS INSTRUMENTS INC
P
2019-10-23
2019-12-12
50 SHS TEXAS INSTRUMENTS INC
P
2019-10-25
2019-12-12
50 SHS TEXAS INSTRUMENTS INC
P
2019-10-31
2019-12-12
20 SHS ILLUMINA INC
P
2019-07-18
2019-10-23
100 SHS GILEAD SCIENCES INC
P
2016-08-24
2019-05-31
150 SHS METLIFE
P
2016-07-13
2019-03-25
20 SHS ILLUMINA INC
P
2019-07-18
2019-10-28
150 SHS ALTRIA GROUP INC
P
2019-05-16
2019-09-18
150 SHS METLIFE
P
2017-08-09
2019-01-03
43.326 SHS WALT DISNEY CO
P
2015-08-27
2019-08-06
40 SHS SAREPTA THERAPEUTICS INC
P
2019-03-06
2019-07-11
100 SHS ORACLE CORPORATION
P
2017-10-03
2019-07-10
30 SHS APPLE COMPUTER
P
2013-04-22
2019-03-25
100 SHS CVS HEALTH CORP
P
2018-09-14
2019-08-07
100 SHS QUALCOMM CORP
P
2018-03-13
2019-04-12
100 SHS INTEL CORP
P
2018-06-19
2019-10-25
100 SHS INTEL CORP
P
2018-07-03
2019-10-25
25 SHS BERKSHIRE HATHAWAY INC CL B
P
2019-07-24
2019-12-03
100 SHS COCA COLA CO
P
2017-05-04
2019-07-23
30 SHS 3M CO
P
2019-04-25
2019-07-24
75 SHS ANADARKO PETROLEUM
P
2015-01-08
2019-04-25
100 SHS COCA COLA CO
P
2017-05-04
2019-07-23
75 SHS ANADARKO PETROLEUM
P
2015-01-08
2019-05-29
100 SHS DELL TECHNOLOGIES INC CLASS C
P
2019-07-01
2019-08-30
75 SHS ANADARKO PETROLEUM
P
2017-05-03
2019-06-18
100 SHS OCCIDENTAL PETROLEUM
P
2019-06-11
2019-08-01
200 SHS DEVON ENERGY CORP
P
2015-01-08
2019-01-16
30 SHS APPLE COMPUTER
P
2013-04-22
2019-02-06
50 SHS NESTLE SA ADR
P
2017-07-28
2019-06-25
100 SHS INTEL CORP
P
2018-06-19
2019-07-22
200 SHS KKR & CO CLASS A
P
2019-05-08
2019-08-12
40 SHS SAREPTA THERAPEUTICS INC
P
2019-03-06
2019-03-20
30 SHS FEDEX CORP
P
2018-10-01
2019-12-17
200 SHS KKR & CO CLASS A
P
2019-05-24
2019-08-05
50 SHS NXP SEMICONDUCTORS NV
P
2018-09-06
2019-08-05
50 SHS NXP SEMICONDUCTORS NV
P
2018-08-28
2019-08-05
200 SHS VIACOM INC CLASS B
P
2016-02-12
2019-11-26
250 SHS FLUOR CORP
P
2017-02-17
2019-08-12
100 SHS ACTIVISION BLIZZARD INC
P
2019-06-20
2019-08-12
250 SHS HP INC
P
2012-01-26
2019-05-23
50 SHS CELGENE CORP
P
2019-07-12
2019-08-14
50 SHS CELGENE CORP
P
2019-07-23
2019-08-14
100 SHS METLIFE
P
2016-08-05
2019-08-12
200 SHS DEVON ENERGY CORP
P
2015-01-08
2019-01-03
25 SHS CIGNA CORP NEW
P
2019-02-27
2019-07-11
150 SHS KRAFT HEINZ
P
2019-05-07
2019-05-28
100 SHS BANK OF NEW YORK MELLON CORP
P
2016-07-13
2019-07-10
100 SHS ISHARES MSCI EMERGING MKTS INDEX ETF
P
2019-02-01
2019-05-07
20 SHS APPLE COMPUTER
P
2013-04-22
2019-07-29
100 SHS SCHLUMBERGER NV
P
2016-09-20
2019-05-07
133.332 SHS CORTEVA INC COM
P
2018-05-04
2019-08-05
180 SHS VIACOM INC CLASS B
P
2019-04-05
2019-11-07
25 SHS FEDEX CORP
P
2018-06-20
2019-05-23
500 SHS FORD MOTOR CO
P
2017-06-02
2019-01-03
25 SHS WHIRLPOOL CORP
P
2019-06-19
2019-07-18
50 SHS ANADARKO PETROLEUM
P
2014-12-23
2019-04-24
50 SHS QUALCOMM CORP
P
2018-03-13
2019-05-22
20 SHS FEDEX CORP
P
2018-10-01
2019-11-12
20 SHS 3M CO
P
2019-05-10
2019-09-03
20 SHS 3M CO
P
2019-04-25
2019-09-03
200 SHS TEVA PHARMACEUTICAL ADR
P
2018-10-02
2019-03-11
50 SHS GILEAD SCIENCES INC
P
2016-07-18
2019-05-31
25 SHS WALMART INC
P
2018-03-02
2019-11-14
25 SHS WALMART INC
P
2018-02-26
2019-11-14
20 SHS SAREPTA THERAPEUTICS INC
P
2019-04-12
2019-07-11
200 SHS TEVA PHARMACEUTICAL ADR
P
2018-10-05
2019-04-09
200 SHS TEVA PHARMACEUTICAL ADR
P
2018-10-05
2019-04-17
100 SHS KRAFT HEINZ
P
2016-11-10
2019-05-30
2 SHS ALPHABET INC CL A
P
2017-06-28
2019-07-26
175 SHS PROSHARES ULTRA VIX SHORT-TERM FUTURES ETF
P
2019-08-30
2019-12-24
50 SHS BANK OF NEW YORK MELLON CORP
P
2017-02-10
2019-07-10
50 SHS BANK OF NEW YORK MELLON CORP
P
2016-07-13
2019-08-27
50 SHS SCHLUMBERGER NV
P
2016-07-13
2019-05-07
100 SHS FLUOR CORP
P
2019-04-05
2019-08-12
33.333 SHS DOW INC
P
2018-05-31
2019-04-26
33.333 SHS DOW INC
P
2018-10-10
2019-04-26
200 SHS GENERAL ELECTRIC CO
P
2019-02-27
2019-08-14
33 SHS DOW INC
P
2019-04-01
2019-04-26
25 SHS ANADARKO PETROLEUM
P
2017-05-03
2019-05-29
100 SHS TEVA PHARMACEUTICAL ADR
P
2018-10-09
2019-03-27
10 SHS 3M CO
P
2016-11-04
2019-09-03
200 SHS GENERAL ELECTRIC CO
P
2019-04-01
2019-08-28
5 SHS ILLUMINA INC
P
2019-07-18
2019-10-23
100 SHS TEVA PHARMACEUTICAL ADR
P
2018-10-09
2019-04-05
5 SHS ILLUMINA INC
P
2019-08-21
2019-10-28
5 SHS ILLUMINA INC
P
2019-07-18
2019-10-28
50 SHS CORTEVA INC COM
P
2019-04-04
2019-08-05
47 SHS CORTEVA INC COM
P
2019-06-12
2019-08-05
66 SHS RESIDEO TECHNOLOGIES INC
P
2017-06-13
2019-01-30
100 SHS PROSHARES ULTRA VIX SHORT-TERM FUTURES ETF
P
2019-11-20
2019-12-24
30 SHS METLIFE
P
2016-08-24
2019-01-03
33.333 SHS CORTEVA INC COM
P
2018-10-10
2019-08-05
33.333 SHS CORTEVA INC COM
P
2019-04-01
2019-08-05
33.002 SHS CORTEVA INC COM
P
2018-05-31
2019-08-05
100 SHS GENERAL ELECTRIC CO
P
2019-04-01
2019-08-14
2.921 SHS WALT DISNEY CO
P
2018-07-30
2019-08-06
4 SHS WABTEC CORP
P
2019-02-28
2019-03-06
1.753 SHS WALT DISNEY CO
P
2018-07-27
2019-08-06
0.763 SHS WALT DISNEY CO
P
2015-08-27
2019-04-03
0.95 SHS FOX CORP CLASS B
P
2019-03-19
2019-05-28
0.333 SHS DUPONT DE NEMOURS INC
P
2018-10-10
2019-07-03
0.297 SHS WABTEC CORP
P
2019-02-28
2019-03-13
0.333 SHS DOW INC
P
2019-04-01
2019-07-29
0.331 SHS CORTEVA INC COM
P
2018-05-31
2019-06-27
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
50,114
38,903
11,211
b
37,150
36,584
566
c
35,926
35,246
680
d
35,292
34,254
1,038
e
34,314
32,976
1,338
32,122
31,821
301
32,112
29,475
2,637
30,698
30,269
429
29,688
27,215
2,473
24,935
22,470
2,465
24,570
20,444
4,126
24,508
29,840
-5,332
23,092
19,538
3,554
22,510
23,924
-1,414
21,547
20,279
1,268
20,899
20,270
629
20,821
16,328
4,493
20,574
19,146
1,428
20,028
20,743
-715
19,947
17,732
2,215
19,830
18,654
1,176
19,303
19,107
196
19,207
19,078
129
19,180
25,616
-6,436
19,120
11,596
7,524
18,918
17,112
1,806
18,862
17,651
1,211
18,688
18,770
-82
18,545
20,154
-1,609
18,243
14,783
3,460
17,536
17,608
-72
17,507
16,856
651
17,360
17,672
-312
17,087
12,968
4,119
16,714
15,457
1,257
16,343
15,476
867
16,338
19,385
-3,047
15,577
15,286
291
15,021
14,138
883
14,960
13,428
1,532
14,960
14,343
617
14,365
13,519
846
14,313
13,395
918
14,088
16,374
-2,286
14,058
10,269
3,789
13,974
17,790
-3,816
13,908
12,720
1,188
13,699
13,448
251
13,670
11,373
2,297
13,670
10,922
2,748
13,573
13,448
125
13,507
14,066
-559
13,384
9,364
4,020
13,309
13,935
-626
13,274
16,260
-2,986
12,942
8,459
4,483
12,382
11,198
1,184
12,200
10,631
1,569
12,153
10,710
1,443
12,106
11,852
254
12,102
11,934
168
12,090
10,315
1,775
12,061
10,710
1,351
12,036
10,631
1,405
11,903
21,535
-9,632
11,850
9,968
1,882
11,850
10,127
1,723
11,729
6,993
4,736
11,542
11,373
169
11,541
11,464
77
11,541
11,439
102
11,524
9,769
1,755
11,461
15,740
-4,279
11,405
11,219
186
11,325
10,576
749
10,914
10,415
499
10,914
10,675
239
10,744
9,942
802
10,716
10,565
151
10,614
11,746
-1,132
10,602
9,114
1,488
10,461
7,067
3,394
10,258
10,782
-524
10,230
9,837
393
10,104
10,675
-571
9,795
6,688
3,107
9,724
3,735
5,989
9,532
9,052
480
9,447
9,920
-473
9,433
8,388
1,045
9,352
18,090
-8,738
9,344
8,684
660
9,228
8,921
307
9,228
8,824
404
9,228
8,614
614
8,925
8,075
850
8,865
9,234
-369
8,848
9,052
-204
8,702
7,728
974
8,623
6,881
1,742
8,475
6,324
2,151
8,430
6,953
1,477
8,244
8,560
-316
8,208
7,738
470
8,168
7,257
911
8,068
12,515
-4,447
8,035
14,105
-6,070
8,028
7,346
682
8,004
12,452
-4,448
7,910
7,040
870
7,858
7,290
568
7,853
8,068
-215
7,838
7,565
273
7,797
7,271
526
7,795
7,040
755
7,786
11,130
-3,344
7,748
5,825
1,923
7,698
7,271
427
7,694
7,566
128
7,694
7,295
399
7,674
7,522
152
7,673
6,211
1,462
7,514
6,758
756
7,487
6,514
973
7,456
12,452
-4,996
7,456
12,092
-4,636
7,428
6,932
496
7,382
4,928
2,454
7,357
8,440
-1,083
7,263
7,212
51
7,210
12,921
-5,711
7,182
3,840
3,342
7,182
6,137
1,045
7,165
12,233
-5,068
7,144
7,036
108
7,040
6,065
975
6,948
8,303
-1,355
6,898
8,187
-1,289
6,842
20,388
-13,546
6,804
6,565
239
6,789
8,137
-1,348
6,727
7,567
-840
6,727
7,567
-840
6,720
11,835
-5,115
6,637
8,137
-1,500
6,532
6,372
160
6,532
6,208
324
6,502
6,453
49
6,502
6,372
130
6,478
8,210
-1,732
6,478
6,774
-296
6,384
4,368
2,016
6,339
8,404
-2,065
6,298
6,683
-385
6,288
5,860
428
6,288
5,910
378
6,288
5,910
378
6,288
5,967
321
6,288
5,876
412
6,282
6,459
-177
6,249
8,210
-1,961
6,235
5,443
792
6,139
6,022
117
6,130
7,865
-1,735
6,126
7,232
-1,106
6,086
4,430
1,656
6,085
5,341
744
6,033
4,885
1,148
5,746
1,700
4,046
5,731
7,757
-2,026
5,656
5,825
-169
5,536
5,253
283
5,536
5,061
475
5,466
5,320
146
5,406
4,382
1,024
5,403
5,728
-325
5,400
5,873
-473
5,375
4,382
993
5,332
5,873
-541
5,277
5,198
79
5,244
3,851
1,393
5,239
4,860
379
5,208
11,929
-6,721
5,201
1,700
3,501
5,193
4,214
979
5,088
5,253
-165
4,952
4,808
144
4,915
5,384
-469
4,854
7,293
-2,439
4,842
4,824
18
4,831
4,693
138
4,831
4,664
167
4,807
6,404
-1,597
4,787
14,105
-9,318
4,771
4,587
184
4,762
3,344
1,418
4,672
4,599
73
4,672
4,467
205
4,627
3,627
1,000
4,621
11,929
-7,308
4,502
4,521
-19
4,458
4,884
-426
4,318
3,935
383
4,228
4,280
-52
4,206
1,133
3,073
4,025
7,557
-3,532
4,023
1,824
2,199
4,008
5,390
-1,382
4,002
6,341
-2,339
3,893
5,659
-1,766
3,755
3,592
163
3,538
4,202
-664
3,474
2,912
562
3,227
4,862
-1,635
3,156
3,520
-364
3,156
3,819
-663
3,149
4,406
-1,257
3,125
4,330
-1,205
3,101
2,201
900
3,101
2,318
783
3,043
2,437
606
2,916
4,272
-1,356
2,872
4,272
-1,400
2,737
6,901
-4,164
2,457
1,893
564
2,210
5,652
-3,442
2,159
2,279
-120
2,052
1,967
85
2,012
3,945
-1,933
1,915
3,984
-2,069
1,839
2,147
-308
1,839
1,998
-159
1,838
2,154
-316
1,821
1,773
48
1,777
1,284
493
1,593
2,143
-550
1,578
1,675
-97
1,576
2,012
-436
1,571
1,614
-43
1,540
2,143
-603
1,535
1,447
88
1,535
1,463
72
1,509
610
899
1,418
1,173
245
1,364
1,544
-180
1,263
1,637
-374
1,225
1,099
126
1,006
432
574
1,006
387
619
996
459
537
919
1,006
-87
410
323
87
282
312
-30
246
194
52
86
78
8
36
38
-2
24
36
-12
21
23
-2
16
18
-2
10
5
5
0
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
11,211
b
566
c
680
d
1,038
e
1,338
301
2,637
429
2,473
2,465
4,126
-5,332
3,554
-1,414
1,268
629
4,493
1,428
-715
2,215
1,176
196
129
-6,436
7,524
1,806
1,211
-82
-1,609
3,460
-72
651
-312
4,119
1,257
867
-3,047
291
883
1,532
617
846
918
-2,286
3,789
-3,816
1,188
251
2,297
2,748
125
-559
4,020
-626
-2,986
4,483
1,184
1,569
1,443
254
168
1,775
1,351
1,405
-9,632
1,882
1,723
4,736
169
77
102
1,755
-4,279
186
749
499
239
802
151
-1,132
1,488
3,394
-524
393
-571
3,107
5,989
480
-473
1,045
-8,738
660
307
404
614
850
-369
-204
974
1,742
2,151
1,477
-316
470
911
-4,447
-6,070
682
-4,448
870
568
-215
273
526
755
-3,344
1,923
427
128
399
152
1,462
756
973
-4,996
-4,636
496
2,454
-1,083
51
-5,711
3,342
1,045
-5,068
108
975
-1,355
-1,289
-13,546
239
-1,348
-840
-840
-5,115
-1,500
160
324
49
130
-1,732
-296
2,016
-2,065
-385
428
378
378
321
412
-177
-1,961
792
117
-1,735
-1,106
1,656
744
1,148
4,046
-2,026
-169
283
475
146
1,024
-325
-473
993
-541
79
1,393
379
-6,721
3,501
979
-165
144
-469
-2,439
18
138
167
-1,597
-9,318
184
1,418
73
205
1,000
-7,308
-19
-426
383
-52
3,073
-3,532
2,199
-1,382
-2,339
-1,766
163
-664
562
-1,635
-364
-663
-1,257
-1,205
900
783
606
-1,356
-1,400
-4,164
564
-3,442
-120
85
-1,933
-2,069
-308
-159
-316
48
493
-550
-97
-436
-43
-603
88
72
899
245
-180
-374
126
574
619
537
-87
87
-30
52
8
-2
-12
-2
-2
5
0
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
-1,995
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
197,359
3,525,025
0.055988
2017
192,348
3,534,622
0.054418
2016
198,750
3,375,065
0.058888
2015
332,064
3,726,620
0.089106
2014
303,514
4,035,271
0.075215
2
Total
of line 1, column (d)
.....................
2
0.333615
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
0.066723
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
3,341,640
5
Multiply line 4 by line 3
......................
5
222,964
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
857
7
Add lines 5 and 6
........................
7
223,821
8
Enter qualifying distributions from Part XII, line 4
,.............
8
161,800
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
1,714
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
1,714
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
1,714
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
3,200
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
3,200
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
29
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
1,457
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
1,457
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)
TN
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
BAKER SULLIVAN HOOVER PLC
Telephone no.
(615) 255-6143
Located at
35 PEABODY STREET SUITE 310
NASHVILLE
TN
ZIP+4
37210
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
GEORGE N BULLARD
DIRECTOR
10.00
0
0
0
PO BOX 50276
NASHVILLE
,
TN
37205
PATRICIA BULLARD
TRUSTEE
25.00
0
0
0
PO BOX 50276
NASHVILLE
,
TN
37205
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
LIFEWORKS IS PRIMARILY A GRANT MAKING FOUNDATION ENABLING OTHER CHARITABLE ORGANIZATIONS TO FURTHER THEIR CHARITABLE ACTIVITIES. EXPENSES LISTED HERE ARE ACTUAL GRANTS MADE DURING YEAR.
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
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
3,226,505
b
Average of monthly cash balances
.......................
1b
166,023
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
3,392,528
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
3,392,528
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
50,888
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
3,341,640
6
Minimum investment return.
Enter 5% of line 5
..................
6
167,082
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
167,082
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
1,714
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
1,714
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
165,368
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
165,368
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
165,368
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
161,800
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
161,800
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
161,800
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
165,368
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
......
111,799
b
From 2015
......
147,635
c
From 2016
......
30,806
d
From 2017
......
17,635
e
From 2018
......
24,243
f
Total
of lines 3a through e
........
332,118
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
161,800
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
.....
161,800
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
3,568
3,568
(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
328,550
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)
...
108,231
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
220,319
10
Analysis of line 9:
a
Excess from 2015
....
147,635
b
Excess from 2016
....
30,806
c
Excess from 2017
....
17,635
d
Excess from 2018
....
24,243
e
Excess from 2019
....
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or 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
HEALING STONES FOUNDATION
PO BOX 50276
NASHVILLE
,
TN
37205
PUBLIC
FURTHER CHARITY PURPOSE
144,000
SWAN BALL
1200 FOREST PARK DRIVE
NASHVILLE
,
TN
37205
PUBLIC
FURTHER CHARITY PURPOSE
1,800
TN PARKS AND GREENWAYS FOUNDATION
1213 16TH AVE S
NASHVILLE
,
TN
37212
PUBLIC
FURTHER CHARITY PURPOSE
10,000
UNIVERSITY OF GEORGIA
SOUTH JACKSON STREET
ATHENS
,
GA
30602
PUBLIC
FURTHER CHARITY PURPOSE
5,000
WEHELPANIMALSNET
PO BOX 1007
FRANKLIN
,
TN
37065
PUBLIC
FURTHER CHARITY PURPOSE
1,000
Total
.................................
3a
161,800
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
...........
14
3
4
Dividends and interest from securities
....
14
85,681
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
-1,995
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
83,689
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
83,689
(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