-
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
PHILO & SARAH BLAISDELL FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
410 SENECA BUILDING
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
BRADFORD
,
PA
16701
A Employer identification number
25-6035748
B
Telephone number (see instructions)
(814) 362-6340
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)
$
11,957,761
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)
6,500
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
266,748
266,748
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
439,608
b
Gross sales price for all assets on line 6a
1,861,112
7
Capital gain net income (from Part IV, line 2)
...
439,608
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
........
712,856
706,356
13
Compensation of officers, directors, trustees, etc.
48,500
16,167
32,333
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
4,013
4,013
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
6,593
5,935
659
c
Other professional fees (attach schedule)
....
85,975
85,975
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
10,063
305
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
4,045
1,348
2,697
21
Travel, conferences, and meetings
.......
472
472
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
29,507
29,507
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
189,168
109,730
69,681
25
Contributions, gifts, grants paid
.......
460,505
460,505
26
Total expenses and disbursements.
Add lines 24 and 25
649,673
109,730
530,186
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
63,183
b
Net investment income
(if negative, enter -0-)
596,626
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
.............
5,912
14,016
14,016
2
Savings and temporary cash investments
.........
175,337
661,368
661,368
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
5,269,705
4,512,909
6,878,968
c
Investments—corporate bonds (attach schedule)
.......
3,954,426
4,280,266
4,403,409
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
9,405,380
9,468,559
11,957,761
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
)
689
685
23
Total liabilities
(add lines 17 through 22)
.........
689
685
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
9,404,691
9,467,874
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)
.....
9,404,691
9,467,874
30
Total liabilities and net assets/fund balances
(see instructions)
.
9,405,380
9,468,559
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
9,404,691
2
Enter amount from Part I, line 27a
.....................
2
63,183
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
9,467,874
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
9,467,874
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
PUBLICY TRADED SECURITIES
P
b
PUBLICY TRADED SECURITIES
P
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
1,404,911
991,167
413,744
b
456,201
430,337
25,864
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
413,744
b
25,864
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
439,608
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
25,864
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
537,992
10,816,067
0.049740
2017
593,038
10,251,593
0.057848
2016
526,244
4,711,878
0.111685
2015
193,083
4,929,085
0.039172
2014
206,526
4,903,957
0.042114
2
Total
of line 1, column (d)
.....................
2
0.300559
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
0.060112
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
11,280,795
5
Multiply line 4 by line 3
......................
5
678,111
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
5,966
7
Add lines 5 and 6
........................
7
684,077
8
Enter qualifying distributions from Part XII, line 4
,.............
8
530,186
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
11,933
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
3
Add lines 1 and 2
...........................
3
11,933
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
11,933
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
6,384
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
12,000
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
18,384
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
71
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
6,380
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
6,380
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
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)
PA
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
RONALD L ORRIS
Telephone no.
(814) 362-6340
Located at
410 SENECA BUILDING
BRADFORD
PA
ZIP+4
16701
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
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
RICHARD E MCDOWELL
TRUSTEE
2.00
0
0
0
19 SCHOOL STREET
BRADFORD
,
PA
16701
GRANT DUKE
TRUSTEE
1.00
0
0
0
138 KENNEDY ST
BRADFORD
,
PA
16701
GEORGE B DUKE
CHAIRMAN
2.00
0
0
0
580 EAST MAIN STREET
BRADFORD
,
PA
16701
HARRIETT B WICK
TRUSTEE
1.00
0
0
0
232 INTERSTATE PARKWAY
BRADFORD
,
PA
16701
HOWARD L FESENMYER
TRUSTEE
1.00
0
0
0
410 SENECA BUILDING
BRADFORD
,
PA
16701
RONALD L ORRIS
EXECUTIVE DI
15.00
48,500
0
0
410 SENECA BUILDING
BRADFORD
,
PA
16701
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
...................
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
.............
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
N/A
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
11,442,620
b
Average of monthly cash balances
.......................
1b
9,964
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
11,452,584
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
2
Acquisition indebtedness applicable to line 1 assets
..................
2
3
Subtract line 2 from line 1d
.........................
3
11,452,584
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
171,789
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
11,280,795
6
Minimum investment return.
Enter 5% of line 5
..................
6
564,040
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
564,040
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
11,933
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
11,933
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
552,107
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
552,107
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
552,107
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
530,186
b
Program-related investments—total from Part IX-B
..................
1b
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
530,186
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
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
530,186
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
552,107
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
c
From 2016
......
232,064
d
From 2017
......
87,914
e
From 2018
......
5,699
f
Total
of lines 3a through e
........
325,677
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
530,186
a
Applied to 2018, but not more than line 2a
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
d
Applied to 2019 distributable amount
.....
530,186
e
Remaining amount distributed out of corpus
5
Excess distributions carryover applied to 2019.
21,921
21,921
(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
303,756
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
303,756
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
210,143
c
Excess from 2017
....
87,914
d
Excess from 2018
....
5,699
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:
PHILO SARAH BLAISDELL FOUNDATION
410 SENECA BUILDING
BRADFORD
,
PA
16701
(814) 362-6340
b
The form in which applications should be submitted and information and materials they should include:
WRITTEN
c
Any submission deadlines:
NONE
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
NONE
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
ANGELA ESCHRICH
UNAVAILABLE
BRADFORD
,
PA
16701
I
CANCER - HELP WITH TRAVEL
1,000
ANGELA YOHE RIMER
UNAVAILABLE
BRADFORD
,
PA
16701
I
CANCER - TRAVEL
1,000
BRANDON HENTON
UNAVAILABLE
BRADFORD
,
PA
16701
I
HELP WITH EXPENSES AFTER FIRE
500
CHAD HAYDEN
UNAVAILABLE
BRADFORD
,
PA
16701
I
DAUGTERS CANCER TRAVEL EXPENSE
500
DAVID MEANS
UNAVAILABLE
BRADFORD
,
PA
16701
I
HELP WITH ILLNESS EXPENSES
500
DENISE DOUTHIT
UNAVAILABLE
BRADFORD
,
PA
16701
I
CANCER TREATMENT EXPENSES
1,000
EMILY SHELLHAMMER
UNAVAILABLE
BRADFORD
,
PA
16701
I
DONATION FOR TRIP
500
HEATHER BELL
UNAVAILABLE
BRADFORD
,
PA
16701
I
BACKPACKS FOR STUDENTS
500
JACK GORTON
UNAVAILABLE
BRADFORD
,
PA
16701
I
DONATION
305
JIM FINLAND
UNAVAILABLE
BRADFORD
,
PA
16701
I
HEALTH DONATION
600
JIM KLEPPINGER
UNAVAILABLE
BRADFORD
,
PA
16701
I
MEDICINE FOR WIFE AND RENT
350
JUDY MCCLELLAND
UNAVAILABLE
BRADFORD
,
PA
16701
I
ILLNESS EXPENSES
500
KATE CHRIS TINGLEY
UNAVAILABLE
BRADFORD
,
PA
16701
I
EXPENSES FOR SONS TREATMENT
1,000
LINDA SCHAFFER
UNAVAILABLE
BRADFORD
,
PA
16701
I
CANCER TREATMENT TRAVEL EXPENSES
500
LISA HARVEY
UNAVAILABLE
BRADFORD
,
PA
16701
I
RONALD MCDONALD HOUSE
500
LORI FREER
UNAVAILABLE
BRADFORD
,
PA
16701
I
SHOES FOR KIDS & EXPENSES WHILE SICK
3,000
MARTIN CAUSER
UNAVAILABLE
BRADFORD
,
PA
16701
I
SENIOR CITIZENS EXP
300
MEGAN MULLER
UNAVAILABLE
BRADFORD
,
PA
16701
I
ILLNESS EXENSES
500
MICHELE KICIOR
UNAVAILABLE
BRADFORD
,
PA
16701
I
STEPPING UP FOR KIDS
4,000
NICHOLAS CONOR
UNAVAILABLE
BRADFORD
,
PA
16701
I
EXPENSES DURING CANCER CARE
3,000
RACHAEL BLAIR
UNAVAILABLE
BRADFORD
,
PA
16701
I
HELP WITH CHRISTMAS
600
ROBERT BRANDI SHUGARS
UNAVAILABLE
BRADFORD
,
PA
16701
I
TIPS / CHRISTMAS GIFT
200
SHALENE WYMER
UNAVAILABLE
BRADFORD
,
PA
16701
I
EXPENSES DURING CANCER CARE
1,000
SHERRY JORDAN
UNAVAILABLE
BRADFORD
,
PA
16701
I
HELP WITH CHRISTMAS
1,000
STACIE CAREY
UNAVAILABLE
BRADFORD
,
PA
16701
I
DAUGHTER HAS CANCER - HOUSE EXPENSE
1,000
TAYLOR TARAHTEEFF
UNAVAILABLE
BRADFORD
,
PA
16701
I
TRAINGING / DESIGN PROGRAM
225
JAMES KEPPINGER
UNAVAILABLE
LAKEWOOD
,
NY
14750
PC
REPAIRS TO VEHICLE
500
JOSEPHINE PAYNE
UNAVAILABLE
BRADFORD
,
PA
16701
I
TIRES FOR VEHICLE
404
ADVENTURES IN MISSIONS
6000 WELLSPRING TRAIL
GAINESVILLE
,
GA
30506
PC
MISSION TRIP
500
ALLEGHENY NATIONAL FOREST
4 FARM COLONY DRIVE
WARREN
,
PA
16365
PC
HISTORY CHANNEL PROJECT
5,000
ALS ASSOCIATION
1300 WILSON BOULEVARD
SUITE 600
ARLINGTON
,
VA
22209
PC
ALS WALK
200
AMERICAN CANCER SOCIETY
95 MAIN STREET
BRADFORD
,
PA
16701
PC
SKI FOR CANCER
500
AMERICAN FOUNDATION FOR SUICIDE PRE
UNAVAILABLE
BUFFALO
,
NY
06390
PC
DARKNESS WALK
500
BACK THE BLUE 5K
1300 PENNSYLVANIA AVE NW
SUITE 190 614
WASHINGTON
,
DC
20004
PC
5K DONATION
1,000
BEACON LIGHT BEHAVIORAL
800 E MAIN ST
BRADFORD
,
PA
16701
PC
APPEAL
10,000
BIG 30 COMMITTEE
UNAVAILABLE
BRADFORD
,
PA
16701
PC
ANNUAL APPEAL
1,611
BIG BROTHER BIG SISTERS
5100 PEACH ST
ERIE
,
PA
16509
PC
APPEAL
1,000
BOSER MARTKET
UNAVAILABLE
BRADFORD
,
PA
16701
PC
CHRISTMAS TREE FOR VETERANS
40
BOY SCOUTS OF AMERICA
1161 E MAIN STREET
BRADFORD
,
PA
16701
PC
ANNUAL APPEAL
700
BRADFORD AMERICAN LEGION
22 PINE ST
BRADFORD
,
PA
16701
PC
ANNUAL APPEAL / BASEBALL
425
BRADFORD AREA CHAMBER OF COMMERCE
121 MAIN ST
BRADFORD
,
PA
16701
PC
CHAMBER AUCTION
74
BRADFORD AREA HIGH SCHOOL SWIM
81 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
ANNUAL APPEAL / DONATION
600
BRADFORD AREA HS BASEBALL BOOSTERS
81 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
DONATION
300
BRADFORD AREA HS VOLLEYBALL BOOSTER
81 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
DONATION
300
BRADFORD AREA PUBLIC LIBRARY
67 WEST WASHINGTON ST
BRADFORD
,
PA
16701
PC
APPEAL
10,000
BRADFORD AREA SCHOOL DISTRICT
150 LORANA AVE
BRADFORD
,
PA
16701
PC
EDUCATION
600
BRADFORD BOYS BASKETBALL
81 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
DONATION
300
BRADFORD CHAMBER OF COMMERCE
121 MAIN STREET
BRADFORD
,
PA
16701
PC
APPEAL
2,337
BRADFORD CHRISTIAN ACADEMY
36 MAIN STREET
16 MAIN STEET
BRADFORD
,
PA
16701
PC
APPEAL & CONFERENCE
6,000
BRADFORD CHRISTIAN YOUTH GROUP
UNAVAILABLE
BRADFORD
,
PA
16701
PC
APPEAL
1,000
BRADFORD CLUB
32-40 BOYLSTON STREET
BRADFORD
,
PA
16701
PC
BENEFIT FOR CANCER PATIENTS
750
BRADFORD CREATIVE AND PERFORMING AR
10 MAIN STREET
BRADFORD
,
PA
16701
PC
APPEAL
5,385
BRADFORD ECUMENICAL HOME
100 ST FRANCIS DR
BRADFORD
,
PA
16701
PC
APPEAL
350
BRADFORD EDUCATIONAL FOUNDATION
300 CAMPUS DRIVE
BRADFORD
,
PA
16701
PC
SCHOLARSHIPS
25,500
BRADFORD ELITE BASKETBALL
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATION
300
BRADFORD HIGH SCHOOL
81 INTERSTATE PKWY
BRADFORD
,
PA
16701
GOV
DECA / DONATION
1,300
BRADFORD HIGH SCHOOL LITERACY CLUB
81 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
DONATION
300
BRADFORD HIGH SCHOOL SKI CLUB
140 LORANA AVE
BRADFORD
,
PA
16701
PC
DONATION
300
BRADFORD HOSPITAL FOUNDATION
116 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
MEALS ON WHEELS AND ANNUAL PLEDGE
600
BRADFORD LADY OWLS BASKETBALL
81 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
APPEAL & BOOSTER CLUB
300
BRADFORD LIBRARY
67 WEST WASHINGTON ST
BRADFORD
,
PA
16701
PC
MEMORIAL / FUNDRAISER
500
BRADFORD LITTLE THEATRE
18 WELCH AVENUE
PO BOX 255
BRADFORD
,
PA
16701
PC
APPEAL
1,500
BRADFORD MANOR
50 LANGMAID LN
BRADFORD
,
PA
16701
PC
ACTIVITIES FOR PATIENTS
300
BRADFORD OWLS CROSS COUNTRY
81 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
DONATION
300
BRADFORD OWLS FOOTBALL
81 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
BOOSTERS CLUB
300
BRADFORD REGIONAL MEDICAL CENTER
116 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
HOSPITAL EVENT
55
BRADFORD ROTARY CLUB
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATION / COATS FOR KIDS
2,500
BRADFORD SENIOR CENTER
60 CAMPUS DRIVE
BRADFORD
,
PA
16701
PC
ANNUAL APPEAL
2,042
BRADFORD ZIPPO LIGHTER CLUB
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATION
788
BRIGHT ALTERNATIVES
90 BOYLSTON ST
BRADFORD
,
PA
16701
PC
APPEAL
1,500
BRMC FOUNDATION
116 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
GAS CARDS FOR DRIVERS / ANNUAL APPEA
37,500
CAMP JJ
PO BOX 446
BRADFORD
,
PA
16701
PC
APPEAL
2,000
CAMP PENUEL
ARLINE RD
ELDRED
,
PA
16731
PC
APPEAL
2,000
CARE FOR CHILDREN
PO BOX 616
20 RUSSELL BOULEVARD
BRADFORD
,
PA
16701
PC
APPEAL & TOURNAMENT & KIDS SAFETY
16,000
CASA OF MCKEAN COUNTY
17137 ROUTE 6
SMETHPORT
,
PA
16749
PC
LEGAL & HERO RUN
3,250
CHAPEL RIDGE
100 ST FRANCIS DR
BRADFORD
,
PA
16701
PC
FURNITURE
149
CLUSTER OF METHODIST CHURCH
UNAVAILABLE
BRADFORD
,
PA
16701
PC
PRESCRIPTION PROGRAM FOR ELDERLY
1,000
CRUTCHES FOR AFRICA
284 S FRANKLIN ST
DENVER
,
CO
80209
PC
SHIPPING EXPENSES
500
DEFENDERS OF FREEDOM
320 HWY 121 SUITE 208
COPPELL
,
TX
75019
PC
FUNDRAISER
500
DERRICK CITY FIRE DEPT
PO BOX 58 451 DERRICK ROA
DERRICK
,
PA
16727
PC
EQUIPMENT
200
DESTINATIONS BRADFORD
1 MAIN STREET
BRADFORD
,
PA
16701
PC
SEMI-ANNUAL APPEAL
10,000
DICKINSON CENTER
43 SERVIDEA DRIVE
RIDGEWAY
,
PA
15853
PC
DONATION
300
DOWN UNDER SPORTS
1755 N 400E STE 201
NORTH LOGAN
,
UT
84341
PC
SPONSOR
400
DOWNTOWN BUSINESS AUTHORITY
UNAVAILABLE
BRADFORD
,
PA
16701
PC
VETERAN SQUARE
306
DOWNTOWN BUSINESS DISTRICT COUNCIL
UNAVAILABLE
BRADFORD
,
PA
16701
PC
FLOWERS FOR DOWNTOWN AND CHRISTMAS
3,500
ELDRED WORLD WAR II MUSEUM
201 MAIN STREET
ELDRED
,
PA
16731
PC
APPEAL
2,500
ELF FUND
PO BOX 287
BRADFORD
,
PA
16701
PC
APPEAL
2,000
EVAN-KIRVAK CANCER RESEARCH FUND
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATION
500
EVERGREEN ELM INC
71 MAIN ST
BRADFORD
,
PA
16701
PC
APPEAL
10,000
EXCHANGE CLUB OF BRADFORD
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATION
1,000
FESTA ITALIANA
1 FESTIVAL WAY
BRADFORD
,
PA
16701
PC
APPEAL
2,500
FIRST METHODIST CHURCH
23 CHAMBERS ST
BRADFORD
,
PA
16701
PC
LIVE 2 LEAD CONFERENCE
1,000
FIRST NIGHT BRADFORD
PO BOX 706
BRADFORD
,
PA
16701
PC
ANNUAL APPEAL
2,000
FIRST PRESBYTERIAN CHURCH
54 EAST CORYDON STREET
BRADFORD
,
PA
16701
PC
FIRE VICTIMES ON MAIN ST
1,000
FLOYD FRETZ MIDDLE SCHOOL
140 LORANA AVE
BRADFORD
,
PA
16701
PC
PANTRY PROGRAM
1,000
FOOTREST VOLLEYBALL TOURNAMENT
299 BIG SHANTY RD
LEWIS RUN
,
PA
16738
PC
TOURNAMENT
200
FRIENDSHIP TABLE
UNAVAILABLE
BRADFORD
,
PA
16701
PC
APPEAL& WASHER AND DRYER
10,500
FUTURES (BRAD CENTER)
1 FUTURES WAY
BRADFORD
,
PA
16701
PC
ANNUAL APPEAL
16,000
GOLF FORE HEROES
1401 WEST WARREN ROAD
BRADFORD
,
PA
16701
PC
WOUNDED WARRIORS
1,500
HABITAT FOR HUMANITY
54 E CORYDON ST
PO BOX 292
BRADFORD
,
PA
16701
PC
APPEAL
2,500
JCC FOUNDATION
525 FALCONER ST
JAMESTOWN
,
NY
14701
PC
ANNUAL APPEAL
800
KIDS & CANCER
PO BOX 1299
BRADFORD
,
PA
16701
PC
ANNUAL APPEAL
6,000
KINZUA OUTDOORS
3389 W WASHINGTON ST
BRADFORD
,
PA
16701
PC
KIDS FISHING DERBY
500
KINZUA VALLEY TRAIL
31 CCC ROAD
WESTLINE
,
PA
16751
PC
FUNDRAISER
500
KIWANIS CLUB
UNAVAILABLE
BRADFORD
,
PA
16701
PC
MOVIES FOR KIDS
3,050
LANDMARK SOCIETY
133 S FITZHUGH ST
ROCHESTER
,
NY
14608
PC
REPAIR COOK FARM
3,500
LEADERSHIP MCKEAN
121 MAIN STREET
BRADFORD
,
PA
16701
PC
APPEAL
1,000
LEEK
UNAVAILABLE
BRADFORD
,
PA
16701
PC
WOUNDED WARRIORS
1,000
LITTLE SLUGGERS
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATION
300
MARILYN HORNE MUSEUM
2 MARILYN HORNE WAY
BRADFORD
,
PA
16701
PC
DONATION
397
MATTRESSES ACROSS MCKEAN COUNTY
UNAVAILABLE
BRADFORD
,
PA
16701
PC
MATTRESSES FOR UNDERPRIVILEGED KIDS
1,000
MAYFLY PROJECT
UNAVAILABLE
BRADFORD
,
PA
16701
PC
PROJECT FOR FOSTER CHILDREN
1,000
MCKEAN COUNTY ART COUNCIL
80 EAST CORYDON ST
BRADFORD
,
PA
16701
PC
APPEAL
1,000
MCKEAN COUNTY FAIR
7172 PA-46
SMETHPORT
,
PA
16749
PC
EDUCATION PROGRAM
650
MCKEAN COUNTY SPECIAL OLYMPICS
UNAVAILABLE
BRADFORD
,
PA
16701
PC
APPEAL
1,500
MILLERSVILLE UNIVERSITY
40 DILWORTH ROAD
MILLERSVILLE
,
PA
17551
PC
FUNDRAISER
300
MUSIC OWL BOOSTERS
81 INTERSTATE PKWY
BRADFORD
,
PA
16701
PC
APPEAL
1,300
NFLB
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATION
5,000
NO NAME
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATIO FOR CHRISTMAS
400
NORMADIC DESIGNS INC
UNAVAILABLE
BRADFORD
,
PA
16701
PC
FILM FOR KIDS
1,500
OAK HILL CEMETARY
212 E MAIN ST
BRADFORD
,
PA
16701
PC
DONATION FOR REPAIRS
1,000
OPEN ARM CHURCH
105 SMITH AVE
PORT ALLEGANY
,
PA
16743
PC
SCHOOL CLOTHES FOR UNDERPRIVILEGED
1,000
PENN BRAD OIL MUSEUM
901 SOUTH AVE
CUSTER CITY
,
PA
16725
PC
APPEAL & FUNDRAISER
350
PENN STATE MARATHON
UNAVAILABLE
STATE COLLEGE
,
PA
16802
PC
HERSHEY CHILDRENS HOSPITAL
500
PENN STATE UNIVERSITY
201 OLD MAIN
UNIVERSITY PARK
,
PA
16802
PC
EMT TRAINING
600
POTTER COUNTY EDUCATION COUNCIL
5 WATER ST
COUDERSPORT
,
PA
16915
PC
EMT PROGRAM
5,000
PROTOCOL 80 INC
15 N KENDALL AVE
BRADFORD
,
PA
16701
PC
MOVING SMART BOARDS FOR SCHOOLS
1,450
PUMPKIN FEST
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATION
3,000
RAYS OF HOPE
280 CHESTNUT STREET
SPRINGFIELD
,
MA
01199
PC
DONATION
500
RELAY FOR LIFE
250 WILLIAMS STREET NW
ATLANTA
,
GA
30303
PC
DONATION
1,000
RISE
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATION
800
SALVATION ARMY
111 JACKSON AVE
PO BOX 314
BRADFORD
,
PA
16701
PC
APPEAL
2,000
SARAH BLAISDELL ZIPPO OPEN
UNAVAILABLE
BRADFORD
,
PA
16701
PC
BENEFIT FOR SPCA
3,000
SAWYER EVANGELICAL CHURCH
777 S KENDALL AVE
BRADFORD
,
PA
16701
PC
COMMUNITY EVENT
250
SECOND HARVEST
1507 GRIMM DRIVE
ERIE
,
PA
16501
PC
APPEAL
300
SENECA HIGHLAND TECH CTR
219 EDISON BATES DRIVE
PORT ALLEGANY
,
PA
16743
PC
DONATION
350
SONS OF LEGION POST 108
UNAVAILABLE
BRADFORD
,
PA
16701
PC
APPEAL
400
SPCA
80 GLENWOOD AVE
BRADFORD
,
PA
16701
PC
APPEAL
10,000
ST BERNARDS CHURCH
95 E CORYDON ST
BRADFORD
,
PA
16701
PC
HANDICAP LIFT
200
ST JUDE'S CHILDREN'S HOSPITAL
262 DANNY THOMAS PLACE
MEMPHIS
,
TN
38105
PC
DONATION
50
STREET DREAM CAR CLUB
130 WILLIAMS STREET
BRADFORD
,
PA
16701
PC
CAR SHOW BENEFIT CITY FIRE DEPT
1,000
SUPER USER TECHNOLOGIES INC
80 E CORYDON ST
BRADFORD
,
PA
16701
PC
DONATION
400
SWNY-NWPA GOLF TOURNAMENT
UNAVAILABLE
BRADFORD
,
PA
16701
PC
HOSPICES FOUNDATION
500
TERRY REILY MEMORIAL GOLF
UNAVAILABLE
BRADFORD
,
PA
16701
PC
FUNDRAISER
500
THE LEARNING CENTER
90 JACKSON AVE
BRADFORD
,
PA
16701
PC
DONATION / APPEAL
6,000
TUNA VALLEY TRAIL ASSOCIATION
PO BOX 1003
BRADFORD
,
PA
16701
PC
APPEAL AND MEMORIAL RACE
1,500
UNITED WAY OF BRADFORD
161 MAIN STREET
BRADFORD
,
PA
16701
PC
APPEAL & RED FEATHER AWARD BREAKFAST
11,793
UNIVERSITY OF PITTSBURGH AT BRADFOR
300 CAMPUS DRIVE
BRADFORD
,
PA
16701
PC
DONATION
3,147
UNIVERSITY OF PITTSBURGH BRADFORD
300 CAMPUS DRIVE
BRADFORD
,
PA
16701
PC
BLOCK PARTY FOR PITT STUDENTS
600
VFW
406 W 34TH STREET
KANSAS CITY
,
MO
64111
PC
DONATION
800
WESB
1490 ST FRANCIS DR
BRADFORD
,
PA
16701
PC
THANKSGIVING DINNER
500
WILLOWCREEK TRIATHALON
UNAVAILABLE
BRADFORD
,
PA
16701
PC
VETERANS TRAVEL
1,500
WPSU
100 INNOVATION BOULEVARD
SUITE 238
STATE COLLEGE
,
PA
16803
PC
DONATION - OPIOID FILM
5,000
YMCA OF BRADFORD
59 BOYLSTON ST
BRADFORD
,
PA
16701
PC
APPEAL & CAPITAL CAMPAIGN
65,500
YWCA OF BRADFORD
24 W CORYDON ST
BRADFORD
,
PA
16701
PC
APPEAL
53,466
ZIPPO CLUB
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATION
506
ZONTA CLUB
UNAVAILABLE
BRADFORD
,
PA
16701
PC
DONATION
700
Total
.................................
3a
460,505
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
266,748
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
439,608
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)
..
706,356
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
706,356
(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