-
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 POCONO CHARITABLE FOUNDATION
% TIMOTHY TOOLE PRESIDENT
Number and street (or P.O. box number if mail is not delivered to street address)
PO Box 65929
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
TUCSON
,
AZ
857285929
A Employer identification number
86-1045072
B
Telephone number (see instructions)
(520) 297-3243
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)
$
102,739
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
1,561,810
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
8,935
8,935
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
150,363
b
Gross sales price for all assets on line 6a
1,504,727
7
Capital gain net income (from Part IV, line 2)
...
1,259,080
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
........
1,721,108
1,268,015
13
Compensation of officers, directors, trustees, etc.
0
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
10,070
5,035
0
5,035
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
5,632
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
15,702
5,035
0
5,035
25
Contributions, gifts, grants paid
.......
2,057,000
2,057,000
26
Total expenses and disbursements.
Add lines 24 and 25
2,072,702
5,035
0
2,062,035
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-351,594
b
Net investment income
(if negative, enter -0-)
1,262,980
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
.........
126,779
102,739
102,739
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)
.......
327,554
0
0
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)
454,333
102,739
102,739
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
...........
454,333
102,739
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
........
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances
(see instructions)
.....
454,333
102,739
30
Total liabilities and net assets/fund balances
(see instructions)
.
454,333
102,739
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
454,333
2
Enter amount from Part I, line 27a
.....................
2
-351,594
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
102,739
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
102,739
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
7223 SHARES OF BERKSHIRE HATHAWAY B NEW
D
2019-12-31
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
1,504,727
245,647
1,259,080
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
1,259,080
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
1,259,080
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
Yes
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2018
2,255,836
1,462,706
1.542235
2017
2,698,322
2,068,138
1.304711
2016
1,161,445
1,793,387
0.647627
2015
753,746
1,698,943
0.443656
2014
621,000
1,553,853
0.399652
2
Total
of line 1, column (d)
.....................
2
4.337881
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
0.867576
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
992,708
5
Multiply line 4 by line 3
......................
5
861,250
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
12,630
7
Add lines 5 and 6
........................
7
873,880
8
Enter qualifying distributions from Part XII, line 4
,.............
8
2,062,035
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
12,630
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
3
Add lines 1 and 2
...........................
3
12,630
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
12,630
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
9,600
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
5,000
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
14,600
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
136
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
1,834
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
1,834
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
Yes
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
No
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)
AZ
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
Yes
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
TIMOTHY TOOLE PRESIDENT
Telephone no.
(520) 297-3243
Located at
PO BOX 65929
TUCSON
AZ
ZIP+4
85728
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
TIMOTHY J TOOLE
PRESIDENT AND DIRECTOR
5.0
0
0
0
PO Box 65929
TUCSON
,
AZ
857285929
MOLLY C TOOLE
VICE PRESIDENT AND DIRECTOR
3.0
0
0
0
PO Box 65929
TUCSON
,
AZ
857285929
ELIZABETH TOOLE GOODROW
SECRETARY AND DIRECTOR
3.0
0
0
0
PO Box 65929
TUCSON
,
AZ
857285929
THOMAS D TOOLE
TREASURER AND DIRECTOR
5.0
0
0
0
PO Box 65929
TUCSON
,
AZ
857285929
JAMES D TOOLE III
DIRECTOR
5.0
0
0
0
PO Box 65929
TUCSON
,
AZ
857285929
MOLLY TOOLE ROMAN
DIRECTOR
5.0
0
0
0
PO Box 65929
TUCSON
,
AZ
857285929
SARAH TOOLE COTTINGHAM
DIRECTOR
5.0
0
0
0
PO Box 65929
TUCSON
,
AZ
857285929
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
Total
number of other employees paid over $50,000
...................
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
Total
number of others receiving over $50,000 for professional services
.............
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
N/A
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
535,484
b
Average of monthly cash balances
.......................
1b
472,341
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
1,007,825
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
2
Acquisition indebtedness applicable to line 1 assets
..................
2
0
3
Subtract line 2 from line 1d
.........................
3
1,007,825
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
15,117
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
992,708
6
Minimum investment return.
Enter 5% of line 5
..................
6
49,635
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
49,635
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
12,630
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
12,630
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
37,005
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
37,005
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
37,005
Part XII
Qualifying Distributions
(see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26
..........
1a
2,062,035
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
0
b
Cash distribution test (attach the required schedule)
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
2,062,035
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
12,630
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
2,049,405
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
37,005
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
0
b
Total for prior years:
2017
,
2016
,
2015
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
676,012
c
From 2016
......
d
From 2017
......
592,856
e
From 2018
......
1,214,358
f
Total
of lines 3a through e
........
2,483,226
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
2,062,035
a
Applied to 2018, but not more than line 2a
0
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
d
Applied to 2019 distributable amount
.....
37,005
e
Remaining amount distributed out of corpus
2,025,030
5
Excess distributions carryover applied to 2019.
(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
4,508,256
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
......
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)
.......
1,026,810
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
3,481,446
10
Analysis of line 9:
a
Excess from 2015
....
676,012
b
Excess from 2016
....
c
Excess from 2017
....
592,856
d
Excess from 2018
....
1,214,358
e
Excess from 2019
....
998,220
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).)
TIMOTHY J TOOLE
MOLLY C TOOLE
ELIZABETH TOOLE GOODROW
THOMAS D TOOLE
JAMES D TOOLE III
MOLLY TOOLE ROMAN
SARAH TOOLE COTTINGHAM
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
NONE
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
THE POCONO CHARITABLE FOUNDATION
PO BOX 65929
TUCSON
,
AZ
85728
(520) 297-3243
b
The form in which applications should be submitted and information and materials they should include:
THE POCONO CHARITABLE FOUNDATION Requests for funds - No specified forms
c
Any submission deadlines:
THE POCONO CHARITABLE FOUNDATION None.
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
THE POCONO CHARITABLE FOUNDATION CONTRIBUTIONS ARE MADE TO THOSE ORGANIZATIONS WHICH THE GOVERNING BODY DETERMINES TO BE THE MOST WORTHY AND THE MOST IN NEED OF FUNDS.
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
Arizona Right to Life
4633 N 54th Street
Phoenix
,
AZ
85018
None
PC
To empower women and their babies during the journey called life
5,000
Assistance League of Tucson
1307 N Alvernon Way
Tucson
,
AZ
85712
None
PC
Volunteers working in the Tucson community to help those in need.
2,000
Banner Alzheimer's Institute
2901 N Central Ave Ste 160
Phoenix
,
AZ
85012
None
PC
Ending Alzheimer's before we lose another generation
500,000
Ben's Bells Project - Tucson
40 WEST BROADWAY BLVD
TUCSON
,
AZ
85701
None
PC
To inspire, educate, and motivate people to realize the impact of intentional kindness, and to empower individuals to act according to that awareness, thereby strengthening ourselves, our relationships and our communities.
2,000
CATHOLIC BISHOP OF N ALASKA
1312 PEGER ROAD
FAIRBANKS
,
AK
997095199
None
PC
Focus on education for adults and youth offering catechetical formation and training.
2,000
CATHOLIC COMMUNITY SERVICE
140 W SPEEDWAY BLVD STE 230
TUCSON
,
AZ
85705
None
PC
To help those in need by offering services such as foster care, counseling, senior nutrition, and family services.
25,000
Catholic Foundation
400 E Monroe St Phoenix
Phoenix
,
AZ
85004
None
PC
providing ongoing financial support for the future of Catholic education and communications in the Diocese of Phoenix
10,000
Catholic Foundation - Notre Dame ACE
PO BOX 5746
TUCSON
,
AZ
85705
None
PC
For the benefit of the Notre Dame ACE Academies campaign.
25,000
CENTER FOR THE HOMELESS
813 S MICHIGAN ST
SOUTH BEND
,
IN
46601
None
PC
To provide emergency and transitional housing for the homeless.
5,000
CHILDRENS DIABETES FOUNDATION
1775 Aurora Court
Aurora
,
CO
80045
None
PC
To raise funds to support the Barbara Davis Center for Childhood Diabetes in Denver.
10,000
College of the Holy Cross
1 College Street
Worcester
,
MA
01610
None
PC
To educate students who, as leaders in business, professional, and civic life, would live by the highest intellectual and ethical standards. standards.
100,000
Community Food Bank of So AZ
3003 S COUNTRY CLUB RD
TUCSON
,
AZ
85726
None
PC
Through education, advocacy, and the acquisition, storage, and distribution of food, we will anticipate and meet the food needs of the hungry in our community.
50,000
CONGREGATION OF THE HOLY CROSS
835 CLINTON AVE
BRIDGEPORT
,
CT
066042393
None
PC
Specializes in religious organizations to educate and help people in need.
50,000
CORONADO HOSPITAL FOUNDATION
250 PROSPECT PLACE
CORONADO
,
CA
92118
None
PC
To raise funds from individuals and businesses for programs, services, and equipment needs of Sharp Coronado Hospital and Healthcare Center.
2,000
Covenant House
461 Eighth Avenue
New York
,
NY
10001
None
PC
providing residential services to vulnerable homeless, runaway and exploited youth
5,000
INJURED MARINE SEMPER FI FUND
825 COLLEGE BLVD SUITE 102 PMB 609
OCEANSIDE
,
CA
92057
None
PC
To alleviate the financial burden incurred by the wounded, injured, or seriously ill service members and their families so their focus can be on recovery.
5,000
LITTLE SISTERS OF THE POOR GALLUP NM
1900 MARK AVENUE
GALLUP
,
NM
87301
NONE
PC
To care for the elderly poor in the spirit of humble service.
50,000
Marine Corp Scholarship Foundation
909 N Washington St STE 400
Alexandria
,
VA
22314
None
PC
provide scholarships to every eligible child of a Marine.
5,000
MARYWOOD UNIVERSITY
2300 ADAMS AVENUE
SCRANTON
,
PA
185091598
None
PC
To provide an education in the IHM tradition of academic excellence.
300,000
Mission of Mercy
360 E Coronado Road 160
Phoenix
,
AZ
85004
None
PC
providing free health care and medications.
50,000
Salpointe Catholic High School
1545 E Copper St
Tucson
,
AZ
85719
None
PC
To offer students a holistic education which inspires the pursuit of excellence, affirms the dignity of individuals, encourages faith and commitment to service and develops an awareness of the world community.
260,000
San Miguel Catholic High School
6601 S SAN FERNANDO RD
Tucson
,
AZ
857566644
None
PC
Special school for the blind, handicapped, etc.
50,000
St Francis of Assisi Church
PO Box 566
Bushnell
,
FL
335130030
None
PC
Religious organization to help those in need.
50,000
St Jude Parish
1515 N Greenville Avenue
Allen
,
TX
75002
None
PC
To provide a safe and secure environment for minors and vulnerable adults in the faith communities within our Diocese.
5,000
St Thomas More Catholic Newman Center (UofA)
1615 E 2nd St
Tucson
,
AZ
85719
None
PC
Seeks to allow Catholic students to attend a public university with an environment and community that supports their Catholic faith and encourages them to grow deeper in faith and relationship with God.
5,000
St Thomas More Catholic Newman Center (Wash St)
820 NE B Street
Pullman
,
WA
99163
None
PC
Offers Newman ministry for the Catholic students of Washington State University. A ministry of the Diocese of Spokane, we seek to bring the entire WSU community closer to Christ and His Church.
5,000
Father Bill's & Mainspring
430 Belmont St
Brockton
,
MA
02301
None
PC
Committed to ending and preventing homelessness in Southern Massachusetts with programs that provide emergency and permanent housing and help people obtain skills, jobs, housing, and services.
5,000
St Mary's (Holy Mothers Collaborative)
392 Hanover St
Hanover
,
MA
02339
None
PC
To move forward in faith in a spirit of radical hospitality.
4,000
My Brother's Keeper Inc
PO BOX 338
Easton
,
MA
02356
None
PC
To bring the Love and Hope of Jesus Christ to those we serve by delivering furniture and food to local families in need.
4,000
Our Lady of Fatima and Immaculate Conception
724 Main St
New london
,
NH
03257
None
PC
A Catholic faith community called by God to holiness that seeks to contribute time, talent, and other resources in a spirit of service, based on their baptismal commitment.
4,000
St Basil Salvatorian Center
30 East st
Methuen
,
MA
01844
None
PC
To offer people the experience of renewal, healing, unity, and transformation through Gods unconditional love and boundless mercy.
4,000
Orange Grove Middle School
1911 E Orange Grove Road
TUCSON
,
AZ
85718
None
PC
To ensure that each student achieves intellectual and personal excellence, and is well prepared for college and career pathways.
5,000
St Michael's School - Annual Fun
602 N Wilmot Rd
Tucson
,
AZ
857112702
None
PC
To maintain our beautiful campus, provide scholarships, and to meet the short long term operating needs of the school.
5,000
Alzheimer's Association - Denver
455 Sherman St 500
Denver
,
CO
80203
None
PC
To empower and support individuals, families, care partners and communities affected by dementia
2,500
Andra Heart
1015 W Prince Road 131 PMB 135
TUCSON
,
AZ
85705
None
PC
community-engaged teaching and research grounded in the Catholic social tradition.
2,500
Catholic Charities
PO 100728
Denver
,
CO
802500728
NONE
PC
Inspired by Gods love and compassion, Catholic Charities extends the healing ministry of Jesus Christ to the poor and those in need.
15,000
Cascia Hall Preparatory School
2520 South Yorktown Avenue
Tulsa
,
OK
741142803
None
PC
Strives to develop its students into lifelong scholars in pursuit of the Augustinian values of truth, unity, and love.
2,500
Monte Cassino School
2206 S Lewis Avenue
Tulsa
,
OK
74114
None
PC
To embody the Benedictine commitment to excellence and serve primarily to promote school programs that ensure the strong have something to strive for and that the weak have nothing to fear.
22,500
SCRANTON PREPARATORY SCHOOL
1000 WYOMING AVENUE
SCRANTON
,
PA
185091598
None
PC
To form a learning community of men and women distinguished by its commitment to competence, to conscience and to compassion.
5,000
MATTHEW 25
52 QUEEN STREET
WORSCESTER
,
MA
016101437
None
PC
To provide housing, food, and other related services to people in need.
4,000
Univeristy of Notre Dame
1 Po Security Building
Notre Dame
,
IN
46556
None
PC
To support education.
102,500
Steele Children's Research Center
1501 N Campbell Avenue Room 3301
TUCSON
,
AZ
85724
None
PC
To teach, to heal, to discover.
25,000
Ara Parseghian Medical Research Fnd
3530 E CAMPO ABIERTO STE 105
TUCSON
,
AZ
85718
None
PC
To promote research targeted at the understanding and cure of Niemann Pick Type C (NP-C) Disease.
5,000
Chapman University
One University Drive
Orange
,
CA
92866
None
PC
To support education
2,500
Gonzaga University
502 E Boone Ave
Spokane
,
WA
99258
None
PC
To support education
2,500
JDRF Rocky Mountain Chapter
2727 Bryant ST 380
Denver
,
CO
80211
None
PC
Accelerating life-changing breakthroughs to cure, prevent and treat type 1 diabetes and its complications
2,500
LifeMoves
FKA Innvision Shelter Network 181 C
Menlo Park
,
CA
94025
None
PC
to help homeless families and individuals rapidly return to stable housing and achieve self-sufficiency
15,000
Smith-Kettlewell Eye Research Institute
2318 Fillmore St
San Francisco
,
CA
94115
None
PC
to create a unique environment for research on human vision increase the understanding of normal vision in support of vision disorders, clinical research to develop new diagnostic procedures and treatments for visual and other sensory disorders, and engineering research to produce better techniques for aid and rehabilitation of the blind and partially sighted
10,000
TMC Foundation
5301 E Grant Rd
Tucson
,
AZ
85712
None
PC
improving the health and quality of life in our community
5,000
Missionary Society of St James the Apostle
24 Clark Street
Boston
,
MA
02109
none
PC
The members undertake to be present with the poor who seek to be freed from systems and situations that perpetuate all forms of injustices and deny them their dignity and rights; and to inspire all, especially the young, to build a society more fully human and therefore more fully Christian. This demands a commitment to a ministry of evangelization where works of social action and human development are seen as an authentic expression of evangelical charity, and where a profound respect for the culture, values and traditions guides the ministry of the missionary and develops a more authentic integration of the fullness of the gospel message and the richness of the native cultural heritage.
2,000
Univ of Notre Dame - Center for Social Concerns
Geddes Hall Building 1212
Notre Dame
,
IN
46556
none
PC
To enact Catholic social teaching through community-engaged research, teaching, and learning
10,000
St Patrick's Cemeteries
143 City Park Avenue
New Orleans
,
LA
70119
none
PC
The ministry of the New Orleans Catholic Cemeteries is to provide people of all faiths a graceful and dignified burial in keeping with the Gospel of Jesus Christ and to offer pastoral care to the family members and friends of the deceased.
2,000
St Thomas Preschool
5150 N Valley View Road
Tucson
,
AZ
85718
NONE
PC
St. Thomas Preschool is a premier early childhood education center here in Tucson. St. Thomas promotes lifelong learning founded in Christianity through a safe, creative, & spiritual environment that nurtures the whole Child.
5,000
Preeclampsia Foundation
3840 W Eau Gallie Blvd
Suite 104
Melbourne
,
FL
32934
NONE
PC
To improve the outcomes of hypertensive disorders of pregnancy by educating, supporting and engaging the community, improving healthcare practices, and finding a cure.
5,000
Spondylitis Association of America
16360 Roscoe Blvd Ste 100
Van Nuys
,
CA
91406
NONE
PC
ADVANCING AND DIRECTLY SPONSORING AXIAL SPONDYLOARTHRITIS RESEARCH, ACCELERATING DIAGNOSIS, SUPPORTING OPTIMUM TREATMENT FOR THE INDIVIDUAL, ADVANCING AWARENESS, AND PUBLIC AND HEALTH CARE PROFESSIONAL EDUCATION IN AXIAL SPONDYLOARTHRITIS. SPONDYLOARTHRITIS
5,000
Alzheimer's Association
225 N Michigan Avenue floor 17
Chicago
,
IL
60601
NONE
PC
To advance our understanding of Alzheimer's disease, identify new treatment strategies, improve care for people with dementia and further our knowledge of brain health and disease prevention.
5,000
Children's Diabetes Foundation - Denver
4380 S Syracuse Street Suite 430
Denver
,
CO
80237
NONE
PC
To raise funds to support the Barbara Davis Center for Diabetes, where thousands of patients of all ages from all over the world receive the finest diabetes care available.
2,500
Mila's Miracle Foundation Inc
PO Box 19675
Boulder
,
CO
80308
NONE
PC
To find a cure for Batten disease and to fund scientific advances which can be used to combat additional genetic diseases affecting hundreds of millions of people all over the world.
170,000
Regis Jesuit Hogh School
6300 S Lewiston Way
Aurora
,
CO
80016
None
PC
To support education
5,000
Emergency Infant Services
222 S Houston Avenue
Tulsa
,
OK
74127
none
PC
provides support for thousands of infants and toddlers annually.
5,000
Province of Our Mother of Good Counsel
2060 North Vermont Avenue
Los Angels
,
CA
90027
None
PC
to serve the Church in schools, parishes and missionsservice to which God calls us.
7,500
Total
.................................
3a
2,057,000
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
14
8,935
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
150,363
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)
..
159,298
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
159,298
(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