-
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
Illinois Children's Healthcare
Foundation
Number and street (or P.O. box number if mail is not delivered to street address)
1200 Jorie Blvd No 301
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Oak Brook
,
IL
60523
A Employer identification number
03-0503425
B
Telephone number (see instructions)
(630) 571-2555
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)
$
155,190,973
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)
1,000
2
Check
.............
3
Interest on savings and temporary cash investments
64
64
4
Dividends and interest from securities
...
3,907,881
3,907,881
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
934,560
b
Gross sales price for all assets on line 6a
3,458,975
7
Capital gain net income (from Part IV, line 2)
...
934,560
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
........
4,843,505
4,842,505
13
Compensation of officers, directors, trustees, etc.
260,000
7,800
252,200
14
Other employee salaries and wages
......
554,214
0
554,214
15
Pension plans, employee benefits
.......
177,175
1,108
176,067
16a
Legal fees (attach schedule)
.........
25,723
0
34,607
b
Accounting fees (attach schedule)
.......
53,968
41,743
12,225
c
Other professional fees (attach schedule)
....
452,906
74,781
413,984
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
144,694
98,513
0
19
Depreciation (attach schedule) and depletion
...
3,660
0
20
Occupancy
..............
63,329
345
62,984
21
Travel, conferences, and meetings
.......
66,781
0
67,703
22
Printing and publications
..........
5,589
0
8,839
23
Other expenses (attach schedule)
.......
97,618
158
86,887
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
1,905,657
224,448
1,669,710
25
Contributions, gifts, grants paid
.......
13,662,884
5,652,099
26
Total expenses and disbursements.
Add lines 24 and 25
15,568,541
224,448
7,321,809
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-10,725,036
b
Net investment income
(if negative, enter -0-)
4,618,057
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
.........
2,305,818
2,128,064
2,128,064
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
..........
25,154
30,962
30,962
10a
Investments—U.S. and state government obligations (attach schedule)
9,906,593
10,475,393
10,475,393
b
Investments—corporate stock (attach schedule)
.......
113,085,568
133,688,543
133,688,543
c
Investments—corporate bonds (attach schedule)
.......
8,477,251
8,841,976
8,841,976
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
126,874
Less: accumulated depreciation (attach schedule)
119,461
11,073
7,413
7,413
15
Other assets (describe
)
57,803
18,622
18,622
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
133,869,260
155,190,973
155,190,973
17
Accounts payable and accrued expenses
..........
58,705
32,570
18
Grants payable
.................
2,353,913
10,364,698
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
)
0
-350,673
23
Total liabilities
(add lines 17 through 22)
.........
2,412,618
10,046,595
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
131,456,642
145,144,378
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)
.....
131,456,642
145,144,378
30
Total liabilities and net assets/fund balances
(see instructions)
.
133,869,260
155,190,973
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
131,456,642
2
Enter amount from Part I, line 27a
.....................
2
-10,725,036
3
Other increases not included in line 2 (itemize)
3
24,412,772
4
Add lines 1, 2, and 3
..........................
4
145,144,378
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
145,144,378
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
Publicly Traded Securities
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
3,458,975
2,524,415
934,560
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
934,560
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
934,560
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
6,877,136
140,045,547
0.049106
2017
6,364,470
134,359,870
0.047369
2016
6,254,212
123,286,423
0.050729
2015
6,628,444
129,525,216
0.051175
2014
6,100,025
132,754,845
0.045950
2
Total
of line 1, column (d)
.....................
2
0.244329
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
0.048866
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
140,060,521
5
Multiply line 4 by line 3
......................
5
6,844,197
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
46,181
7
Add lines 5 and 6
........................
7
6,890,378
8
Enter qualifying distributions from Part XII, line 4
,.............
8
7,321,809
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
46,181
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
46,181
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
46,181
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
64,803
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
64,803
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
18,622
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
18,622
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
IL
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
www.ilchf.org
14
The books are in care of
The Foundation
Telephone no.
(630) 571-2555
Located at
1200 Jorie Blvd No 301
Oak Brook
IL
ZIP+4
605232218
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
Ruth B Rosenthal MD
Chair/Director
5.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Peter Flynn PhD
Vice Chair/Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Philip S Cali
Treasurer/Director
5.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Floyd D Perkins
Secretary/Director
5.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Heather Higgins Alderman
President
40.00
260,000
36,943
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Michael Parker
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Terry F Hatch MD
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Juan Carlos Avila
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Kay L Saving MD
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Billie Wright Adams MD
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Jennifer Cartland PhD
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Nicholas Panomitros DDS
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Icy Cade-Bell MD
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Angie Cantillon
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Barbara H Fiese PhD
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
J Kay Giles
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
George O'Neill Jr
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Myrtis Sullivan MD
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Rudy Valdez DM
Director
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Peter E Doris MD
Board Member Emeritus
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
C William Pollard
Board Member Emeritus
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
James Ryan
Board Member Emeritus
2.00
0
0
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
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
Amy Starin PhD LCSW
Senior Program Offic
40.00
145,500
34,449
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Robert J Egan
Senior Program Offic
40.00
140,000
27,850
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Matthew J Thullen
Program Officer
40.00
97,381
35,916
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Brian Moynihan
Dir of Finance and O
40.00
89,958
19,232
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
Nedranae Hunt
Administrative Manag
40.00
72,694
21,908
0
ICHF 1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
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
Univ of IL-Urbana
Program Consultation and Evaluation
205,594
1010 W Nevada Ste 2080
Urbana
,
IL
61801
Vanguard
Investment Consultant
74,781
PO Box 2600
Valley Forge
,
PA
19482
LearnVentures LLC
Program Consultation and Evaluation
53,144
413 North Grand Ave
Oak Park
,
IL
60302
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
The Illinois Children's Healthcare Foundation works to ensure that every child in Illinois has access to affordable and quality health care by making grants to other not-for-profit organizations that conduct programs designed to address a variety of access issues. Grantmaking is focused in two specific areas: improving the oral health of underserved children and addressing the mental health needs of children. In addition, the Foundation monitors other emerging health issues that the Board of Directors may select as focus areas in the future.The Foundation has no direct charitable activities.
0
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
145,471,101
b
Average of monthly cash balances
.......................
1b
1,911,229
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
147,382,330
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
147,382,330
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
7,321,809
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
140,060,521
6
Minimum investment return.
Enter 5% of line 5
..................
6
7,003,026
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
7,003,026
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
46,181
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
46,181
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
6,956,845
4
Recoveries of amounts treated as qualifying distributions
................
4
1,185
5
Add lines 3 and 4
............................
5
6,958,030
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
6,958,030
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
7,321,809
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
7,321,809
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
46,181
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
7,275,628
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
6,958,030
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
5,687,667
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
c
From 2016
......
d
From 2017
......
e
From 2018
......
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
7,321,809
a
Applied to 2018, but not more than line 2a
5,687,667
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
.....
1,634,142
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
..........
5,323,888
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
....
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
wwwilchforg - All applicants must s
1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
(630) 571-2555
www.ilchf.org
b
The form in which applications should be submitted and information and materials they should include:
Review the open RFP(s) on our website and determine whether your project is a match to the projects being sought for funding. Submit a Letter of Inquiry or Proposal (based on the specific RFP timeline) with the required information by the posting deadline. Be sure to attach all of the requested documentation - incomplete applications will be eliminated from consideration. All applicants must submit their proposals electronically - including all required attachments.
c
Any submission deadlines:
Please visit our website for currently open RFPs. Submission deadlines vary from year to year.
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
You must be either (1) an organization that has been determined by the IRS to be an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986, as amended (the "Code"), that is a public charity described in Section 509(a)(1), (2), or (3) of the Code and that is not a Type III supporting organization within the meaning of Section 4943(f)(5)(A) of the Code; or, (2) a governmental entity described in Section 170(c)(1) or 511(a)(2)(B) of the Code. Your proposed activities must serve Illinois children.
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
Program Officer - Illinois Children
1200 Jorie Blvd Suite 301
Oak Brook
,
IL
60523
(630) 571-2555
b
The form in which applications should be submitted and information and materials they should include:
To propose a project for consideration for Innovation/Emerging Needs Funding, please contact a member of the Foundation's Staff to discuss it. A short project write-up may be submitted to assist during the preliminary conversation.
c
Any submission deadlines:
There is no formal deadline to submit an application.
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Eligible projects will be able to demonstrate: Innovation, Support of evidence-based research and/or best practices, Potential for statewide system change, and Impact on children's healthcare in Illinois. There is no specific dollar amount assigned to engagement funding projects, although it is anticipated that most grants will be less than $250,000. You must be either (1) an organization that has been determined by the IRS to be an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986, as amended (the "Code"), that is a public charity described in Section 509(a)(1), (2), or (3) of the Code and that is not a Type III supporting organization within the meaning of Section 4943(f)(5)(A) of the Code; or, (2) a governmental entity described in Section 170(c)(1) or 511(a)(2)(B) of the Code.
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
Advocate Charitable Foundation
3075 Highland Parkway Suite 600
Downers Grove
,
IL
60515
None
PC
TEACH_2_Reach: Training to Expand Access to Clinically-Effective Care Health/Oral Health Care to Reach Vulnerable Children
75,000
Ann & Robert H Lurie Childrens Hospital of Chicago
225 E Chicago Ave Box 282
Chicago
,
IL
60611
None
PC
Early Childhood Mental Health Consultation Pilot
100,000
Aunt Marthas Health And Wellness Inc
19990 Governors Hwy
Olympia Fields
,
IL
60461
None
PC
Aunt Martha's Expanded Pediatric Oral Health
74,000
Board of Trustees of Southern Illinois University
2800 College Avenue Building 286
Alton
,
IL
62002
None
PC
Graduate Programs Patient Clinic at the Southern Illinois University School of Dental Medicine
1,000,000
Board of Trustees of the U of Illinois
506 S Wright St 209 Hab Mc 339
Urbana
,
IL
61801
None
PC
Construction of UIC Pediatric Dentistry Ambulatory Surgery Center
500,000
Centerstone of Illinois Inc
902 W Main Street
W Frankfort
,
IL
62896
None
PC
Building Compassionate Communities
350,000
Central Illinois Foodbank
1937 E Cook St
Springfield
,
IL
62791
None
PC
2019 Food Nutrition Program
25,000
Community Foundation of Kankakee River Valey
701 S Harrison Ave
Kankakee
,
IL
60901
None
PC
CMHI 2.0 Implementation - Project SUN - A Strong & Unified Network
350,000
Community Health Improvement Council of Decatur
2905 North Main Street Suite B
Decatur
,
IL
62526
None
PC
Childhood Dental Medical Integration Program
75,000
Community Nurse Health Association
23 Calendar Ave
La Grange
,
IL
60525
None
PC
Oral Health Integration and Community Outreach
71,000
Eastern Illinois Foodbank
2405 N Shore Dr
Urbana
,
IL
61802
None
PC
2019 Food Nutrition Program
25,000
Erie Family Health Center Inc
1701 West Superior Street
Chicago
,
IL
60622
None
PC
Westside H3: Developing a Seamless Approach to Behavioral Health Screening and Treatment for Children on Chicago's Westside
20,000
Erie Family Health Foundation Inc
1701 W Superior St
Chicago
,
IL
60622
None
PC
Expanding Access to Integrated Oral Healthcare for Children at Erie Evanston/Skokie Health Center
75,000
Forefront
208 S LaSalle Street Suite 1540
Chicago
,
IL
60604
None
PC
General Operating
12,590
Glenview School District #34
1401 Greenwood Road
Glenview
,
IL
60026
None
GOV
Glenview 34 Teacher-Child Partnership
5,000
Grantmakers for Effective Organizations
1725 Desales Street Nw Ste 404
Washington
,
DC
20036
None
PC
General Operating
2,090
Grantmakers In Health
1100 Connecticut Ave NW Suite 1200
Washington
,
DC
20036
None
PC
General Operating
22,465
Greater Chicago Food Depository
4100 W Ann Lurie Pl
Chicago
,
IL
60632
None
PC
2019 Food Nutrition Program
25,000
Health and Medicine Policy Research Group
29 E Madison St Ste 602
Chicago
,
IL
60602
None
PC
Advancing Trauma-Informed Illinois Health Departments to Improve Child Health
60,000
Heartland International Health Center
3048 N Wilton 2nd Floor
Chicago
,
IL
60657
None
PC
School-as-Population: A New Approach to Integrated Pediatric Medical and Dental Care
25,000
Heritage Behavioral Health Center
151 N Main St
Decatur
,
IL
62523
None
PC
CMHI Implementation Grant - Community Together
350,000
Howard Brown Health Center
4025 N Sheridan Rd
Chicago
,
IL
60613
None
PC
Pediatric Dental-Medical Integration at Howard Brown Health
61,818
Howard Brown Health Center
4025 N Sheridan Rd
Chicago
,
IL
60640
None
PC
Child-Friendly Dentistry: Creating Capacity for Pediatric Dental Care at Howard Brown Health 63rd Street
191,813
Kane County Health Department
1240 Highland Avenue
Aurora
,
IL
60506
None
GOV
CMHI 2.0 Implementation - Kane County System of Care Project
350,000
Lawndale Christian Health Center
3860 W Ogden Ave
Chicago
,
IL
60623
None
PC
LCHC Continued Oral Health Integration
75,000
Legal Council for Health Justice
17 N State St Suite 900
Chicago
,
IL
60602
None
PC
New Approaches to Childhood Lead Poisoning
200,000
Livingston County Commission on Children and Youth
PO Box 504
Pontiac
,
IL
61764
None
PC
CMHI Mentoring Year 2 Continuation
25,000
Loma Linda University
PO Box 2000
Loma Linda
,
IL
92354
None
PC
Cook County Demonstration of the MEND Program
188,195
Macoupin County Public Health Department
805 North Broad Street
Carlinville
,
IL
62626
None
GOV
Project KISS - Keeping Illinois Smiles Super!
63,229
Memorial Health System
701 N 1st St
Springfield
,
IL
62781
None
PC
CMHI Mentoring Year 2 Continuation
24,999
Metropolitan Family Services
One North Dearborn 10th Flr
Chicago
,
IL
60602
None
PC
Healthy Minds, Healthy Children, Healthy Chicago (H3)
20,000
Metropolitan Family Services
One North Dearborn 10th Flr
Chicago
,
IL
60602
None
PC
Playful Learning
30,000
Northern Illinois Food Bank
273 Dearborn Court
Geneva
,
IL
60134
None
PC
2019 Food Nutrition Program
25,000
Northwestern University
633 Clark Street
Evanston
,
IL
60208
None
PC
Acceptability and Refinement of the Fathers and Babies Course
20,000
Peoria Citizens Committee for Economic Opportunity Inc
711 W McBean St
Peoria
,
IL
61605
None
PC
2019 Food Nutrition Program
25,000
Primo Center for Women and Children
6212 S Sangamon St
Chicago
,
IL
60621
None
PC
Kids Connected
350,000
Promise Healthcare NFP
819 Bloomington Road
Champaign
,
IL
61820
None
PC
SmileHealthy Oral Health Integration
75,000
River Bend Food Reservoir
4040 Kimmel Drive
Davenport
,
IA
52802
None
PC
2019 Food Nutrition Program
25,000
Sargent Shriver National Center on Poverty Law
67 E Madison St Ste 2000
Chicago
,
IL
60603
None
PC
Children's Oral Health Advocacy Project
25,000
Sargent Shriver National Center on Poverty Law
67 E Madison St Ste 2000
Chicago
,
IL
60603
None
PC
Children's Mental Health Access Advocacy Project
80,000
Shawnee Health Service and Development Corp
109 California St
Carterville
,
IL
62918
None
PC
Integration of Dental and Primary Care
75,000
SIHF Healthcare
2041 Goose Lake Road
Sauget
,
IL
62206
None
PC
Oral Health Integration at SIHF Healthcare
75,000
Southwest Organizing Project
2558 W 63rd St
Chicago
,
IL
60629
None
PC
Southwest System of Care Project
80,900
Southwest Organizing Project
2558 W 63rd St
Chicago
,
IL
60629
None
PC
Southwest System of Care Network (SWSOC)
273,000
St Jude Children's Research Hospital
501 St Jude Place
Memphis
,
TN
38105
None
PC
General Operating
1,000
St Louis Area Food Bank Inc
70 Corporate Woods Drive
Bridgeton
,
MO
63044
None
PC
2019 Food Nutrition Program
25,000
Tri-State Food Bank Inc
801 E Michigan St
Evansville
,
IN
47711
None
PC
2019 Food Nutrition Program
25,000
Total
.................................
3a
5,652,099
b
Approved for future payment
Board of Trustees of the U of Illinois
506 S Wright St 209 Hab Mc 339
Urbana
,
IL
61801
None
PC
Medicaid Access Study: Oral Health Access for Children in Illinois
89,676
Centerstone of Illinois Inc
902 W Main Street
W Frankfort
,
IL
62896
None
PC
Building Compassionate Communities
1,750,000
Community Foundation of Kankakee River Valey
701 S Harrison Ave
Kankakee
,
IL
60901
None
PC
CMHI 2.0 Implementation - Project SUN - A Strong & Unified Network
1,750,000
Heritage Behavioral Health Center
151 N Main St
Decatur
,
IL
62523
None
PC
CMHI Implementation Grant - Community Together
1,750,000
Kane County Health Department
1240 Highland Avenue
Aurora
,
IL
60506
None
GOV
CMHI 2.0 Implementation - Kane County System of Care Project
1,750,000
Metropolitan Family Services
One North Dearborn 10th Flr
Chicago
,
IL
60602
None
PC
Playful Learning
60,000
Primo Center for Women and Children
6212 S Sangamon St
Chicago
,
IL
60621
None
PC
Kids Connected
1,750,000
Southwest Organizing Project
2558 W 63rd St
Chicago
,
IL
60629
None
PC
Southwest System of Care Network (SWSOC)
261,000
Transitions of Western Illinois Inc
PO Box 3646
Quincy
,
IL
62305
None
PC
Universal Screening in Schools Learning Collaborative 2.0
73,000
Total
.................................
3b
9,233,676
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
14
64
4
Dividends and interest from securities
....
14
3,907,881
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
934,560
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
0
4,842,505
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
4,842,505
(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