-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0052
20
19
Open to Public Inspection
For calendar year 2019, or tax year beginning
08-01-2019
, and ending
07-31-2020
Name of foundation
IRVING A HANSEN MEMORIAL FDN XXXXX4004
Number and street (or P.O. box number if mail is not delivered to street address)
10 S DEARBORN IL1-0111
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CHICAGO
,
IL
60603
A Employer identification number
13-3177338
B
Telephone number (see instructions)
(800) 496-2583
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)
$
8,924,443
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
205,413
205,413
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
148,539
b
Gross sales price for all assets on line 6a
2,353,582
7
Capital gain net income (from Part IV, line 2)
...
148,539
8
Net short-term capital gain
.........
0
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
Total.
Add lines 1 through 11
........
353,952
353,952
13
Compensation of officers, directors, trustees, etc.
125,767
78,852
46,915
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
0
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
4,352
1,129
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
0
0
23
Other expenses (attach schedule)
.......
250
250
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
130,369
79,981
0
47,165
25
Contributions, gifts, grants paid
.......
371,500
371,500
26
Total expenses and disbursements.
Add lines 24 and 25
501,869
79,981
0
418,665
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-147,917
b
Net investment income
(if negative, enter -0-)
273,971
c
Adjusted net income
(if negative, enter -0-)
...
0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2019)
Form 990-PF (2019)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
-152,757
105,134
105,134
2
Savings and temporary cash investments
.........
380,320
140,852
140,852
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
0
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
4,106,218
3,717,461
5,156,347
c
Investments—corporate bonds (attach schedule)
.......
3,006,251
3,228,771
3,522,110
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
0
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
7,340,032
7,192,218
8,924,443
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
7,340,032
7,192,218
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)
.....
7,340,032
7,192,218
30
Total liabilities and net assets/fund balances
(see instructions)
.
7,340,032
7,192,218
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
7,340,032
2
Enter amount from Part I, line 27a
.....................
2
-147,917
3
Other increases not included in line 2 (itemize)
3
103
4
Add lines 1, 2, and 3
..........................
4
7,192,218
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
7,192,218
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
24. SVB FINANCIAL GROUP
2017-11-30
2019-08-14
b
15. SVB FINANCIAL GROUP
2017-11-30
2019-08-14
c
36. APTIV PLC
2019-08-14
d
20. APTIV PLC
2019-08-14
e
52. APTIV PLC
2017-08-30
2019-08-14
28. SVB FINANCIAL GROUP
2017-11-30
2019-08-15
98. APTIV PLC
2017-08-30
2019-08-15
1450. ISHARES CORE MSCI EAFE ETF
2019-08-23
2650. VANGUARD BD INDEX FD INC
2019-09-20
124. DISNEY WALT CO
2016-12-16
2019-10-25
31. ACCENTURE PLC
2016-12-16
2019-10-25
39. ACCENTURE PLC
2016-12-16
2019-10-28
81. NISOURCE INC
2019-11-11
104. NISOURCE INC
2017-07-18
2019-11-11
83. NISOURCE INC
2017-07-18
2019-11-12
209. NISOURCE INC
2017-07-18
2019-11-12
19. NISOURCE INC
2017-07-18
2019-11-12
20. NISOURCE INC
2017-07-18
2019-11-13
154. CELGENE CORP.
2008-06-20
2019-11-21
333. CELGENE CORP.
2019-11-21
187. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
20. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
8. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
235. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-26
37. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-27
14. ABBVIE INC
2019-12-10
3. ADOBE SYS INC
2016-12-16
2019-12-10
3. ALPHABET INC-CL C
2019-10-25
2019-12-10
1. ALPHABET INC-CL A
2017-10-12
2019-12-10
2. AMAZON COM INC
2019-10-25
2019-12-10
13. AMERICAN EXPRESS CO
2019-06-10
2019-12-10
14. APPLE COMPUTER INC
2012-07-26
2019-12-10
4. AUTOMATIC DATA PROCESSING INC
2019-08-14
2019-12-10
57. BANK OF AMERICA CORPORATION
2013-07-23
2019-12-10
6. BERKSHIRE HATHAWAY INC DEL CL B
2018-10-15
2019-12-10
27. BOSTON SCIENTIFIC CORP
2017-02-15
2019-12-10
16. BRISTOL MYERS SQUIBB CO
2019-11-21
2019-12-10
5. BROADCOM INC
2017-02-15
2019-12-10
3. CHARTER COMMUNICATIONS INC-A
2017-08-30
2019-12-10
19. CITIGROUP INC NEW
2017-08-30
2019-12-10
13. COCA-COLA CO
2018-04-13
2019-12-10
37. COMCAST CORP NEW CL A
2019-05-14
2019-12-10
17. CORTEVA INC
2017-03-24
2019-12-10
5. DIAMONDBACK ENERGY INC
2019-12-10
6. DISNEY WALT CO
2016-12-16
2019-12-10
9. DUPONT DE NEMOURS INC-WI
2017-03-24
2019-12-10
12. EOG RESOURCES INC
2017-02-15
2019-12-10
9. ELECTRONIC ARTS
2018-09-20
2019-12-10
5. FACEBOOK INC-A
2016-11-23
2019-12-10
13. FIDELITY NATL INFORMATION SVCS INC
2019-08-14
2019-12-10
15. FISERV INC
2019-12-10
4. GENERAL DYNAMICS CORP
2017-04-20
2019-12-10
7. HOME DEPOT INC
2016-08-08
2019-12-10
10. HONEYWELL INTL INC
2017-08-30
2019-12-10
4. INTERCONTINENTALEXCHANGE GROUP, INC
2017-10-12
2019-12-10
38. KEYCORP NEW
2017-10-12
2019-12-10
9. LILLY ELI & CO
2016-11-23
2019-12-10
7. LOWES COS INC
2013-07-23
2019-12-10
19. MARATHON PETROLEUM CORPORATION
2018-07-26
2019-12-10
7. MASTERCARD INC - CLASS A
2013-07-23
2019-12-10
4. MCDONALDS CORP
2019-06-10
2019-12-10
15. MERCK & CO INC
2019-03-14
2019-12-10
34. MICROSOFT CORP
2003-01-29
2019-12-10
18. MONDELEZ INTERNATIONAL-W/I
2017-04-20
2019-12-10
30. MORGAN STANLEY DEAN WITTER & CO NEW
2016-10-25
2019-12-10
3. NETFLIX.COM INC
2018-09-13
2019-12-10
4. NEXTERA ENERGY INC
2018-07-18
2019-12-10
7. NORFOLK SOUTHN CORP
2019-12-10
4. NORTHROP GRUMMAN CORP
2019-05-20
2019-12-10
4. NVIDIA CORP
2018-10-08
2019-12-10
1. O'REILLY AUTOMOTIVE INC
2017-10-12
2019-12-10
10. PAYPAL HOLDINGS INC
2019-01-23
2019-12-10
10. PEPSICO INC
2018-05-22
2019-12-10
37. PFIZER INC
2016-08-08
2019-12-10
5. PHILIP MORRIS INTERNATIONAL
2018-10-24
2019-12-10
6. PIONEER NAT RES CO
2017-04-20
2019-12-10
8. PROCTER & GAMBLE CO
2019-06-05
2019-12-10
5. QUALCOMM INC
2019-05-01
2019-12-10
7. ROSS STORES INC
2018-12-11
2019-12-10
9. SALESFORCE.COM INC
2018-10-08
2019-12-10
6. STANLEY BLACK & DECKER,INC.
2016-12-16
2019-12-10
11. TEXAS INSTRS INC
2016-11-23
2019-12-10
8. UNION PAC CORP
2018-02-22
2019-12-10
4. UNITED TECHNOLOGIES CORP
2017-12-11
2019-12-10
9. UNITEDHEALTH GROUP INC
2016-11-23
2019-12-10
2. VERTEX PHARMACEUTICALS INC
2017-02-15
2019-12-10
5. VISA INC CLASS A SHARES
2017-10-12
2019-12-10
6. WASTE CONNECTIONS INC
2017-08-30
2019-12-10
17. WELLS FARGO & CO NEW
2010-06-09
2019-12-10
3. WEX INC
2017-10-12
2019-12-10
4. YUM BRANDS INC
2018-11-29
2019-12-10
10. ZIMMER HLDGS INC
2018-10-30
2019-12-10
5. ALLEGION PLC
2017-10-12
2019-12-10
3. ACCENTURE PLC
2016-12-16
2019-12-10
14. LINDE PLC
2019-08-14
2019-12-10
7. CHUBB LTD
2017-03-24
2019-12-10
6. NXP SEMICONDUCTORS NV
2019-02-20
2019-12-10
1. CORTEVA INC
2017-03-24
2020-01-13
47. CORTEVA INC
2017-03-24
2020-01-13
39. CORTEVA INC
2017-03-24
2020-01-13
.667 CORTEVA INC
2017-03-24
2020-01-14
45.333 CORTEVA INC
2020-01-14
48. CORTEVA INC
2020-01-14
17. CORTEVA INC
2019-06-27
2020-01-14
14. CORTEVA INC
2019-06-27
2020-01-14
5. CORTEVA INC
2019-06-27
2020-01-14
58. CORTEVA INC
2020-01-15
67. CORTEVA INC
2020-01-15
15.667 CORTEVA INC
2019-06-28
2020-01-15
12.333 CORTEVA INC
2016-11-23
2020-01-15
5. CORTEVA INC
2016-11-23
2020-01-15
35. CORTEVA INC
2016-11-23
2020-01-15
42. CORTEVA INC
2016-11-23
2020-01-15
2. CORTEVA INC
2016-11-23
2020-01-15
17. CORTEVA INC
2016-11-23
2020-01-16
15. CORTEVA INC
2016-11-23
2020-01-16
2. CORTEVA INC
2016-11-23
2020-01-16
3. CORTEVA INC
2016-11-23
2020-01-16
140. QUALCOMM INC
2019-05-01
2020-01-23
2. QUALCOMM INC
2019-05-01
2020-01-23
71. EOG RESOURCES INC
2017-02-15
2020-01-28
11. EOG RESOURCES INC
2017-02-15
2020-01-28
6. EOG RESOURCES INC
2017-02-15
2020-01-29
6. EOG RESOURCES INC
2017-02-15
2020-01-29
4. EOG RESOURCES INC
2017-02-15
2020-01-29
52. EOG RESOURCES INC
2017-02-15
2020-01-29
52. EOG RESOURCES INC
2017-02-15
2020-01-29
52. EOG RESOURCES INC
2017-02-15
2020-01-29
68. EOG RESOURCES INC
2017-02-15
2020-01-30
17. EOG RESOURCES INC
2017-02-15
2020-01-30
5. ABBVIE INC
2019-11-11
2020-02-14
1. ADOBE SYS INC
2016-12-16
2020-02-14
4. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-02-14
1. ALPHABET INC-CL C
2019-10-25
2020-02-14
1. AMAZON COM INC
2020-01-28
2020-02-14
4. AMERICAN EXPRESS CO
2019-06-10
2020-02-14
6. APPLE COMPUTER INC
2012-07-26
2020-02-14
4900.002 ARTISAN INTL VAL-INST
2020-02-14
3. AUTOMATIC DATA PROCESSING INC
2019-08-14
2020-02-14
19. BANK OF AMERICA CORPORATION
2013-07-23
2020-02-14
2. BERKSHIRE HATHAWAY INC DEL CL B
2018-10-15
2020-02-14
11. BOSTON SCIENTIFIC CORP
2017-02-15
2020-02-14
6. BRISTOL MYERS SQUIBB CO
2019-11-21
2020-02-14
2. BROADCOM INC
2017-02-15
2020-02-14
1. CHARTER COMMUNICATIONS INC-A
2017-08-30
2020-02-14
8. CITIGROUP INC NEW
2017-08-30
2020-02-14
5. COCA-COLA CO
2018-04-13
2020-02-14
16. COMCAST CORP NEW CL A
2019-05-14
2020-02-14
4. DIAMONDBACK ENERGY INC
2019-01-07
2020-02-14
3. DISNEY WALT CO
2016-12-16
2020-02-14
4. DUPONT DE NEMOURS INC-WI
2017-03-24
2020-02-14
4. ELECTRONIC ARTS
2018-09-20
2020-02-14
1. FACEBOOK INC-A
2020-01-08
2020-02-14
3. FIDELITY NATL INFORMATION SVCS INC
2019-08-14
2020-02-14
8. FISERV INC
2020-02-14
2. GENERAL DYNAMICS CORP
2017-04-20
2020-02-14
2. HOME DEPOT INC
2016-08-08
2020-02-14
5. HONEYWELL INTL INC
2017-08-30
2020-02-14
2. INTERCONTINENTALEXCHANGE GROUP, INC
2017-10-12
2020-02-14
6342.863 JPM US L/C CORE PL FD - USD - R6 ISIN US48129C6030
2020-02-14
16. KEYCORP NEW
2017-10-12
2020-02-14
4. LILLY ELI & CO
2016-11-23
2020-02-14
3. LOWES COS INC
2013-07-23
2020-02-14
8. MARATHON PETROLEUM CORPORATION
2018-07-26
2020-02-14
3. MASTERCARD INC - CLASS A
2013-07-23
2020-02-14
1. MCDONALDS CORP
2019-06-10
2020-02-14
7. MERCK & CO INC
2019-03-14
2020-02-14
14. MICROSOFT CORP
2020-02-14
8. MONDELEZ INTERNATIONAL-W/I
2017-04-20
2020-02-14
13. MORGAN STANLEY DEAN WITTER & CO NEW
2016-10-25
2020-02-14
1. NETFLIX.COM INC
2018-09-13
2020-02-14
2. NEXTERA ENERGY INC
2018-07-18
2020-02-14
2. NORFOLK SOUTHN CORP
2018-05-15
2020-02-14
1. NORTHROP GRUMMAN CORP
2019-05-20
2020-02-14
2. NVIDIA CORP
2018-10-08
2020-02-14
5. PAYPAL HOLDINGS INC
2019-01-23
2020-02-14
4. PEPSICO INC
2018-05-22
2020-02-14
15. PFIZER INC
2016-08-08
2020-02-14
2. PHILIP MORRIS INTERNATIONAL
2018-10-24
2020-02-14
2. PIONEER NAT RES CO
2017-04-20
2020-02-14
3. PROCTER & GAMBLE CO
2019-06-05
2020-02-14
3. ROSS STORES INC
2018-12-11
2020-02-14
4. SALESFORCE.COM INC
2018-10-08
2020-02-14
3. STANLEY BLACK & DECKER,INC.
2016-12-16
2020-02-14
6. TEXAS INSTRS INC
2020-01-23
2020-02-14
1. THERMO ELECTRON CORP
2020-01-14
2020-02-14
3. UNION PAC CORP
2018-02-22
2020-02-14
1. UNITED TECHNOLOGIES CORP
2017-12-11
2020-02-14
4. UNITEDHEALTH GROUP INC
2016-11-23
2020-02-14
2. VERTEX PHARMACEUTICALS INC
2017-02-15
2020-02-14
2. VISA INC CLASS A SHARES
2017-10-12
2020-02-14
3. WASTE CONNECTIONS INC
2017-08-30
2020-02-14
6. WELLS FARGO & CO NEW
2010-06-09
2020-02-14
1. WEX INC
2017-10-12
2020-02-14
1. YUM BRANDS INC
2018-11-29
2020-02-14
4. ZIMMER HLDGS INC
2018-10-30
2020-02-14
3. ALLEGION PLC
2017-10-12
2020-02-14
2. ACCENTURE PLC
2016-12-16
2020-02-14
4. LINDE PLC
2019-08-14
2020-02-14
3. CHUBB LTD
2017-03-24
2020-02-14
3. NXP SEMICONDUCTORS NV
2020-01-23
2020-02-14
45. ELECTRONIC ARTS
2018-09-20
2020-02-25
63. ELECTRONIC ARTS
2020-02-25
15. ACCENTURE PLC
2016-12-16
2020-02-25
71. ACCENTURE PLC
2016-12-16
2020-02-26
179. DISNEY WALT CO
2016-12-16
2020-03-04
410. WELLS FARGO & CO NEW
2010-06-09
2020-03-04
800. ISHARES CORE MSCI EAFE ETF
2017-06-27
2020-03-10
600. ISHARES CORE MSCI EAFE ETF
2020-02-14
2020-03-10
225. ISHARES CORE MSCI EUROPE
2020-02-14
2020-03-10
12. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-03-11
2. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-03-11
1. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-03-11
8. DUPONT DE NEMOURS INC-WI
2017-03-24
2020-03-11
217. DUPONT DE NEMOURS INC-WI
2020-03-11
54. DUPONT DE NEMOURS INC-WI
2019-04-08
2020-03-11
23. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-03-12
13. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-03-12
32. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-03-13
1300. ISHARES CORE MSCI EAFE ETF
2017-06-27
2020-03-16
2100. ISHARES CORE MSCI EAFE ETF
2017-06-27
2020-03-16
600. SPDR TR UNIT SER 1
2020-03-16
200. SPDR TR UNIT SER 1
2018-10-24
2020-03-16
105. UNITED TECHNOLOGIES CORP
2020-03-31
110. COMCAST CORP NEW CL A
2019-05-14
2020-04-16
174. COMCAST CORP NEW CL A
2020-04-16
20. COMCAST CORP NEW CL A
2019-05-14
2020-04-16
2. COMCAST CORP NEW CL A
2017-04-20
2020-04-16
133. COMCAST CORP NEW CL A
2017-04-20
2020-04-16
18. COMCAST CORP NEW CL A
2017-04-20
2020-04-16
27. ROSS STORES INC
2018-12-11
2020-04-16
33. ROSS STORES INC
2018-12-11
2020-04-16
35. ROSS STORES INC
2020-04-16
113. ROSS STORES INC
2020-04-16
562. MARATHON PETROLEUM CORPORATION
2020-04-27
72. ADOBE SYS INC
2016-12-16
2020-05-04
10. ADOBE SYS INC
2016-12-16
2020-05-04
362.847 DODGE & COX INCOME FUND
2018-08-22
2020-05-11
3175.723 DODGE & COX INCOME FUND
2019-12-10
2020-05-11
9478.673 DOUBLELINE TTL RTRN BND-I
2020-05-11
3383.665 VANGUARD TTL INTL BND-ADM
2020-06-09
3609.342 VANGUARD TTL INTL BND-ADM
2019-09-24
2020-06-09
184. BERKSHIRE HATHAWAY INC DEL CL B
2020-06-24
25. ABBVIE INC
2020-06-29
2. ALPHABET INC-CL C
2015-02-10
2020-06-29
1. ALPHABET INC-CL C
2019-10-25
2020-06-29
2. ALPHABET INC-CL A
2017-10-12
2020-06-29
4. AMAZON COM INC
2020-02-25
2020-06-29
12. AMERICAN EXPRESS CO
2019-06-10
2020-06-29
20. APPLE COMPUTER INC
2020-06-29
9. AUTOMATIC DATA PROCESSING INC
2019-08-14
2020-06-29
60. BANK OF AMERICA CORPORATION
2013-07-23
2020-06-29
2. BIOGEN IDEC INC
2020-03-11
2020-06-29
38. BOSTON SCIENTIFIC CORP
2017-02-15
2020-06-29
22. BRISTOL MYERS SQUIBB CO
2019-11-21
2020-06-29
8. BROADCOM INC
2017-02-15
2020-06-29
5. CHARTER COMMUNICATIONS INC-A
2020-04-16
2020-06-29
27. CITIGROUP INC NEW
2017-08-30
2020-06-29
18. COCA-COLA CO
2018-04-13
2020-06-29
30. COMCAST CORP NEW CL A
2020-06-29
15. DIAMONDBACK ENERGY INC
2019-01-07
2020-06-29
5853.994 DODGE & COX INCOME FUND
2020-06-29
7906.168 DOUBLELINE TTL RTRN BND-I
2016-03-23
2020-06-29
7. ELECTRONIC ARTS
2018-11-27
2020-06-29
11. FACEBOOK INC-A
2020-01-08
2020-06-29
12. FIDELITY NATL INFORMATION SVCS INC
2019-08-14
2020-06-29
25. FISERV INC
2020-06-29
6. GENERAL DYNAMICS CORP
2017-04-20
2020-06-29
9. HOME DEPOT INC
2016-08-08
2020-06-29
15. HONEYWELL INTL INC
2017-08-30
2020-06-29
6. INTERCONTINENTALEXCHANGE GROUP, INC
2017-10-12
2020-06-29
4. INTUIT
2020-06-29
550. ISHARES CORE MSCI EAFE ETF
2017-06-27
2020-06-29
1100. JPMORGAN BETABUILDERS CANADA
2018-08-22
2020-06-29
52. KEYCORP NEW
2017-10-12
2020-06-29
12. LILLY ELI & CO
2016-11-23
2020-06-29
14. LOWES COS INC
2020-04-16
2020-06-29
11. MASTERCARD INC - CLASS A
2013-07-23
2020-06-29
4. MCDONALDS CORP
2019-06-10
2020-06-29
21. MERCK & CO INC
2019-03-14
2020-06-29
48. MICROSOFT CORP
2003-02-28
2020-06-29
25. MONDELEZ INTERNATIONAL-W/I
2017-04-20
2020-06-29
43. MORGAN STANLEY DEAN WITTER & CO NEW
2016-10-25
2020-06-29
3. NETFLIX.COM INC
2018-09-13
2020-06-29
6. NEXTERA ENERGY INC
2020-05-04
2020-06-29
10. NORFOLK SOUTHN CORP
2020-06-29
5. NORTHROP GRUMMAN CORP
2019-05-20
2020-06-29
6. NVIDIA CORP
2018-10-08
2020-06-29
3. O'REILLY AUTOMOTIVE INC
2020-04-16
2020-06-29
20. PAYPAL HOLDINGS INC
2020-05-04
2020-06-29
14. PEPSICO INC
2020-06-29
52. PFIZER INC
2016-08-08
2020-06-29
7. PHILIP MORRIS INTERNATIONAL
2018-10-24
2020-06-29
12. PIONEER NAT RES CO
2017-04-20
2020-06-29
12. PROCTER & GAMBLE CO
2019-06-05
2020-06-29
13. SALESFORCE.COM INC
2020-05-04
2020-06-29
8. STANLEY BLACK & DECKER,INC.
2016-12-16
2020-06-29
20. TEXAS INSTRS INC
2020-01-23
2020-06-29
4. THERMO ELECTRON CORP
2020-06-24
2020-06-29
11. UNION PAC CORP
2020-06-29
13. UNITEDHEALTH GROUP INC
2016-11-23
2020-06-29
3. VERTEX PHARMACEUTICALS INC
2017-02-15
2020-06-29
8. VISA INC CLASS A SHARES
2017-10-12
2020-06-29
9. WASTE CONNECTIONS INC
2017-08-30
2020-06-29
7. WEX INC
2020-06-29
11. YUM BRANDS INC
2020-06-29
13. ZIMMER HLDGS INC
2018-10-30
2020-06-29
7. ALLEGION PLC
2017-10-12
2020-06-29
13. LINDE PLC
2019-08-14
2020-06-29
10. CHUBB LTD
2017-03-24
2020-06-29
4. ASML HOLDING NV-NY REG SHS
2020-03-04
2020-06-29
10. NXP SEMICONDUCTORS NV
2020-01-23
2020-06-29
340. KEYCORP NEW
2017-10-12
2020-06-30
39. KEYCORP NEW
2017-10-12
2020-06-30
254. PFIZER INC
2016-08-08
2020-06-30
88. KEYCORP NEW
2017-10-12
2020-07-01
26. KEYCORP NEW
2017-10-12
2020-07-01
152. KEYCORP NEW
2017-10-12
2020-07-01
1. KEYCORP NEW
2017-10-12
2020-07-01
67. KEYCORP NEW
2017-10-12
2020-07-01
5. KEYCORP NEW
2017-10-12
2020-07-01
62. KEYCORP NEW
2020-07-01
128. KEYCORP NEW
2018-10-19
2020-07-02
4. KEYCORP NEW
2018-10-19
2020-07-02
132. KEYCORP NEW
2018-10-19
2020-07-02
7. KEYCORP NEW
2020-07-02
740. PFIZER INC
2016-08-08
2020-07-10
36. PFIZER INC
2016-08-08
2020-07-10
CAPITAL GAIN DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
4,581
5,585
-1,004
b
2,851
3,491
-640
c
2,862
3,134
-272
d
1,607
1,735
-128
e
4,151
4,079
72
5,228
6,516
-1,288
7,770
7,688
82
84,196
88,753
-4,557
213,624
208,937
4,687
16,286
12,887
3,399
5,677
3,806
1,871
7,166
4,788
2,378
2,125
2,106
19
2,715
2,689
26
2,163
2,146
17
5,440
5,404
36
494
491
3
525
517
8
16,637
4,556
12,081
35,974
31,269
4,705
392
430
-38
42
46
-4
17
18
-1
499
541
-42
78
85
-7
1,211
1,197
14
916
310
606
4,031
3,781
250
1,342
1,007
335
3,473
3,440
33
1,571
1,599
-28
3,770
1,147
2,623
674
657
17
1,912
854
1,058
1,327
1,231
96
1,188
686
502
996
903
93
1,574
1,029
545
1,390
1,172
218
1,438
1,289
149
700
579
121
1,587
1,591
-4
437
545
-108
418
517
-99
878
624
254
575
826
-251
897
1,208
-311
920
1,022
-102
1,004
603
401
1,765
1,703
62
1,711
1,586
125
723
753
-30
1,511
962
549
1,739
1,320
419
369
281
88
747
700
47
1,084
591
493
817
315
502
1,114
1,526
-412
2,022
421
1,601
781
804
-23
1,338
1,221
117
5,145
848
4,297
975
804
171
1,489
1,001
488
879
1,112
-233
938
678
260
1,328
1,051
277
1,377
1,253
124
856
1,073
-217
442
208
234
1,037
904
133
1,365
998
367
1,426
1,301
125
420
446
-26
807
1,052
-245
996
854
142
419
432
-13
805
564
241
1,408
1,362
46
943
704
239
1,336
817
519
1,377
1,068
309
582
493
89
2,507
1,377
1,130
442
178
264
913
542
371
542
395
147
912
461
451
590
360
230
397
367
30
1,454
1,146
308
620
443
177
606
368
238
2,862
2,606
256
1,071
952
119
716
564
152
28
32
-4
1,333
1,506
-173
1,113
1,250
-137
19
21
-2
1,297
1,348
-51
1,375
1,426
-51
487
504
-17
399
415
-16
142
148
-6
1,665
1,716
-51
1,920
1,978
-58
449
462
-13
354
344
10
143
140
3
1,004
977
27
1,199
1,173
26
57
56
1
490
475
15
432
419
13
58
56
2
87
84
3
12,864
12,110
754
184
173
11
5,472
7,147
-1,675
849
1,107
-258
461
604
-143
461
604
-143
307
403
-96
3,924
5,235
-1,311
3,986
5,235
-1,249
3,934
5,235
-1,301
5,054
6,845
-1,791
1,277
1,711
-434
472
427
45
377
103
274
413
539
-126
1,513
1,260
253
2,151
1,854
297
539
492
47
1,943
491
1,452
182,525
133,086
49,439
539
493
46
660
285
375
451
410
41
464
280
184
400
335
65
641
411
230
533
391
142
629
543
86
299
223
76
735
688
47
301
411
-110
422
312
110
214
367
-153
437
454
-17
214
214
466
393
73
968
844
124
377
376
1
486
275
211
907
660
247
192
141
51
169,735
86,053
83,682
314
295
19
568
263
305
375
135
240
477
642
-165
1,014
180
834
217
201
16
573
570
3
2,568
341
2,227
473
357
116
725
434
291
381
371
10
554
339
215
421
300
121
367
313
54
578
537
41
611
452
159
584
399
185
551
528
23
178
178
279
351
-72
376
320
56
363
242
121
754
605
149
504
352
152
799
793
6
335
333
2
552
400
152
153
123
30
1,206
612
594
480
178
302
418
217
201
307
197
110
287
163
124
228
120
108
105
92
13
632
458
174
410
266
144
425
246
179
887
745
142
493
408
85
415
410
5
4,768
5,109
-341
6,642
5,695
947
2,967
1,841
1,126
14,033
8,716
5,317
21,158
18,603
2,555
16,697
11,116
5,581
43,891
48,781
-4,890
32,918
38,997
-6,079
9,339
11,190
-1,851
1,004
1,616
-612
167
269
-102
84
135
-51
292
735
-443
8,022
18,351
-10,329
1,996
4,577
-2,581
1,824
3,098
-1,274
996
1,751
-755
2,553
4,310
-1,757
57,621
79,269
-21,648
93,117
128,049
-34,932
147,217
164,732
-17,515
49,388
53,030
-3,642
9,927
12,774
-2,847
4,096
4,730
-634
6,473
6,862
-389
744
860
-116
75
76
-1
4,956
5,036
-80
673
682
-9
2,366
2,177
189
2,892
2,661
231
3,070
2,821
249
9,883
8,999
884
14,744
38,703
-23,959
25,091
7,439
17,652
3,485
1,033
2,452
5,127
4,898
229
44,873
45,000
-127
100,000
102,967
-2,967
77,418
73,767
3,651
82,582
85,000
-2,418
32,736
33,776
-1,040
2,407
2,137
270
2,766
1,075
1,691
1,383
1,260
123
2,769
2,014
755
10,717
7,874
2,843
1,142
1,476
-334
7,201
1,274
5,927
1,313
1,478
-165
1,402
899
503
522
596
-74
1,303
966
337
1,273
1,230
43
2,471
1,646
825
2,550
2,531
19
1,359
1,832
-473
799
802
-3
1,167
1,124
43
627
1,540
-913
85,000
78,894
6,106
85,000
85,861
-861
914
595
319
2,420
2,353
67
1,574
1,572
2
2,408
2,598
-190
890
1,129
-239
2,214
1,236
978
2,140
1,980
160
543
422
121
1,152
1,177
-25
31,461
33,537
-2,076
24,388
27,420
-3,032
624
958
-334
1,940
788
1,152
1,863
1,328
535
3,201
661
2,540
730
804
-74
1,594
1,710
-116
9,468
1,135
8,333
1,262
1,117
145
2,031
1,435
596
1,335
1,112
223
1,426
1,363
63
1,717
1,501
216
1,537
1,566
-29
2,193
1,610
583
1,263
1,119
144
3,351
2,463
888
1,830
1,213
617
1,690
1,829
-139
492
624
-132
1,142
2,104
-962
1,405
1,281
124
2,378
2,089
289
1,100
939
161
2,491
2,644
-153
1,396
1,390
6
1,811
1,271
540
3,766
1,989
1,777
851
267
584
1,524
868
656
822
592
230
1,141
940
201
958
1,009
-51
1,527
1,490
37
696
621
75
2,743
2,420
323
1,263
1,359
-96
1,452
1,207
245
1,120
1,367
-247
4,137
6,263
-2,126
474
718
-244
8,224
8,933
-709
1,055
1,621
-566
316
479
-163
1,776
2,800
-1,024
12
18
-6
778
1,234
-456
59
92
-33
724
1,117
-393
1,552
2,286
-734
47
71
-24
1,548
2,357
-809
83
125
-42
24,950
26,026
-1,076
1,211
1,266
-55
48,527
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
-1,004
b
-640
c
-272
d
-128
e
72
-1,288
82
-4,557
4,687
3,399
1,871
2,378
19
26
17
36
3
8
12,081
4,705
-38
-4
-1
-42
-7
14
606
250
335
33
-28
2,623
17
1,058
96
502
93
545
218
149
121
-4
-108
-99
254
-251
-311
-102
401
62
125
-30
549
419
88
47
493
502
-412
1,601
-23
117
4,297
171
488
-233
260
277
124
-217
234
133
367
125
-26
-245
142
-13
241
46
239
519
309
89
1,130
264
371
147
451
230
30
308
177
238
256
119
152
-4
-173
-137
-2
-51
-51
-17
-16
-6
-51
-58
-13
10
3
27
26
1
15
13
2
3
754
11
-1,675
-258
-143
-143
-96
-1,311
-1,249
-1,301
-1,791
-434
45
274
-126
253
297
47
1,452
49,439
46
375
41
184
65
230
142
86
76
47
-110
110
-153
-17
73
124
1
211
247
51
83,682
19
305
240
-165
834
16
3
2,227
116
291
10
215
121
54
41
159
185
23
-72
56
121
149
152
6
2
152
30
594
302
201
110
124
108
13
174
144
179
142
85
5
-341
947
1,126
5,317
2,555
5,581
-4,890
-6,079
-1,851
-612
-102
-51
-443
-10,329
-2,581
-1,274
-755
-1,757
-21,648
-34,932
-17,515
-3,642
-2,847
-634
-389
-116
-1
-80
-9
189
231
249
884
-23,959
17,652
2,452
229
-127
-2,967
3,651
-2,418
-1,040
270
1,691
123
755
2,843
-334
5,927
-165
503
-74
337
43
825
19
-473
-3
43
-913
6,106
-861
319
67
2
-190
-239
978
160
121
-25
-2,076
-3,032
-334
1,152
535
2,540
-74
-116
8,333
145
596
223
63
216
-29
583
144
888
617
-139
-132
-962
124
289
161
-153
6
540
1,777
584
656
230
201
-51
37
75
323
-96
245
-247
-2,126
-244
-709
-566
-163
-1,024
-6
-456
-33
-393
-734
-24
-809
-42
-1,076
-55
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
148,539
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
415,121
8,412,984
0.049343
2017
339,922
8,589,049
0.039576
2016
226,667
7,903,268
0.02868
2015
334,141
7,414,143
0.045068
2014
26,925
7,888,581
0.003413
2
Total
of line 1, column (d)
.....................
2
0.16608
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
0.033216
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
8,589,788
5
Multiply line 4 by line 3
......................
5
285,318
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
2,740
7
Add lines 5 and 6
........................
7
288,058
8
Enter qualifying distributions from Part XII, line 4
,.............
8
418,665
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
2,740
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
2,740
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
2,740
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
4,968
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
4,968
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
2,228
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
2,228
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
NY
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
14
The books are in care of
JPMORGAN CHASE BANK NA
Telephone no.
(800) 496-2583
Located at
10 S DEARBORN IL1-0111
CHICAGO
IL
ZIP+4
60603
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
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
JPMORGAN CHASE BANK NA
TRUSTEE
10
99,575
10 S DEARBORN IL1-0111
CHICAGO
,
IL
60603
ANDREW L TANSEY
TRUSTEE
10
13,096
DAVIDSON DAWSON CLARK 60 E 42ND
NEW YORK
,
NY
101653802
JUDITH HIBBERD
CO-TRUSTEE
10
13,096
251 MILLBROOK RD
LARAMIE
,
WY
82070
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
8,481,699
b
Average of monthly cash balances
.......................
1b
238,898
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
8,720,597
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
8,720,597
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
130,809
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
8,589,788
6
Minimum investment return.
Enter 5% of line 5
..................
6
429,489
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
429,489
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
2,740
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
2,740
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
426,749
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
426,749
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
426,749
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
418,665
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
418,665
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
2,740
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
415,925
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
426,749
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
369,218
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
0
b
From 2015
......
0
c
From 2016
......
0
d
From 2017
......
0
e
From 2018
......
0
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
418,665
a
Applied to 2018, but not more than line 2a
369,218
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
.....
49,447
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
377,302
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2015
....
0
b
Excess from 2016
....
0
c
Excess from 2017
....
0
d
Excess from 2018
....
0
e
Excess from 2019
....
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
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
DOCTORS WITHOUT BORDERS
40 RECTOR ST 16TH FLOOR
NEW YORK
,
NY
10006
NONE
PC
GENERAL
90,000
AVERA FOUNDATION
212 E 11TH ST 100
SIOUX FALLS
,
SD
57104
NONE
PC
GENERAL
50,000
JOHNS HOPKINS UNIVERSITY
3400 N CHARLES ST
BALTIMORE
,
MD
21218
NONE
PC
GENERAL
20,000
COLD SPRING HARBOR LABORATORY
1 BUNGTOWN RD COLD SPRING HARBOR
NEW YORK
,
NY
11724
NONE
PC
GENERAL
25,000
SALK INSTITUTE FOR BIOLOGICAL
10010 N TORREY PINES RD
LA JOLLA
,
CA
92037
NONE
PC
GENERAL
35,000
CANCER RESEARCH INSTITUTE
29 BROADWAY 4TH FLOOR
NEW YORK
,
NY
10006
NONE
PC
GENERAL
50,000
CANCER CARE INC
274 SEVENTH AVENUE
NEW YORK
,
NY
10001
NONE
PC
GENERAL
50,000
LUSTGARTEN FOUNDATION
415 CROSSWAYS PARK DRIVE SUITE D
WOODBURY
,
NY
11797
NONE
PC
GENERAL
51,500
Total
.................................
3a
371,500
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
14
205,413
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
148,539
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)
..
353,952
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
353,952
(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