-
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
MCCARTHEY FAMILY FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
610 EAST SOUTH TEMPLE Room 200
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
SALT LAKE CITY
,
UT
84102
A Employer identification number
20-8067695
B
Telephone number (see instructions)
(801) 578-1240
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)
$
38,188,444
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
1,010,930
1,010,930
5a
Gross rents
............
2
2
b
Net rental income or (loss)
2
6a
Net gain or (loss) from sale of assets not on line 10
125,957
b
Gross sales price for all assets on line 6a
13,515,920
7
Capital gain net income (from Part IV, line 2)
...
125,957
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)
.......
-5,880
-5,880
12
Total.
Add lines 1 through 11
........
1,131,009
1,131,009
13
Compensation of officers, directors, trustees, etc.
212,500
106,250
106,250
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
114,719
114,719
17
Interest
...............
1,466
1,466
18
Taxes (attach schedule) (see instructions)
...
40,321
25,125
15,196
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
51,795
51,795
22
Printing and publications
..........
16,571
16,571
23
Other expenses (attach schedule)
.......
229,887
148,080
81,807
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
667,259
280,921
386,338
25
Contributions, gifts, grants paid
.......
2,760,708
2,760,708
26
Total expenses and disbursements.
Add lines 24 and 25
3,427,967
280,921
3,147,046
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-2,296,958
b
Net investment income
(if negative, enter -0-)
850,088
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
.........
1,161,971
247,997
247,997
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
..........
17,048
7,314
7,314
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
30,753,052
29,379,802
37,916,851
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16,282
16,282
16,282
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
31,948,353
29,651,395
38,188,444
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
31,948,353
29,651,395
29
Total net assets or fund balances
(see instructions)
.....
31,948,353
29,651,395
30
Total liabilities and net assets/fund balances
(see instructions)
.
31,948,353
29,651,395
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
31,948,353
2
Enter amount from Part I, line 27a
.....................
2
-2,296,958
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
29,651,395
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
29,651,395
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
Fidelity Intl Index Fund
P
2019-05-31
2019-06-07
b
JPM Core Bond Fund
P
2019-03-29
2019-05-31
c
JPM Managed Inc Fund
P
2019-03-11
2019-11-20
d
PIMCO Short Term Fund
P
2019-03-11
2019-07-03
e
Harbor High Yield Bond
P
2018-01-01
2019-03-11
IShares MSCI EAFE Index Fd
P
2018-01-01
2019-05-31
JPM Core Bond Fund
P
2018-01-01
2019-05-31
JPM Eq Inc Fund
P
2018-01-01
2019-07-25
JPM Global BD Opp Fund
P
2017-07-24
2019-03-11
JPM Managed Inc Fund
P
2017-07-24
2019-09-24
JPM Strat Inc Opp Fund
P
2015-10-01
2019-05-31
PIMCO Commodity
P
2018-01-01
2019-05-31
PIMCO Short Term Fund
P
2018-01-18
2019-07-03
SPDR SP 500 ETF Trust
P
2018-01-01
2019-07-25
Vanguard Total Intl Bond
P
2017-07-24
2019-07-11
Vanguard FTSE Euro ETF
P
2018-01-01
2019-05-31
IShares Gold Trust
P
2018-01-01
2019-12-31
JPM Core Bond Fund
P
2009-06-03
2019-05-31
JPM Strat Inc Opp Fund
P
2009-09-29
2019-03-29
Providence Debt III
P
2018-01-01
2019-12-31
Paradigm Master Fund
P
2018-01-01
2019-12-31
Providence TMT Debt Opp
P
2018-01-01
2019-12-31
Providence Debt III
P
2019-01-01
2019-12-31
(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
630,322
609,878
20,444
b
548,217
540,714
7,503
c
1,021,814
1,020,035
1,779
d
483,286
485,263
-1,977
e
498,702
498,841
-139
1,666,106
1,637,392
28,714
1,817,036
1,828,190
-11,154
319,454
168,530
150,924
621,081
648,776
-27,695
857,435
856,459
976
340,452
335,705
4,747
548,845
877,515
-328,670
513,855
518,584
-4,729
317,980
229,576
88,404
1,024,273
973,283
50,990
1,003,393
931,101
72,292
938
938
1,115,378
1,034,294
81,084
171,461
171,458
3
7,892
-7,892
16,262
-16,262
15,892
15,892
215
-215
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
20,444
b
7,503
c
1,779
d
-1,977
e
-139
28,714
-11,154
150,924
-27,695
976
4,747
-328,670
-4,729
88,404
50,990
72,292
938
81,084
3
-7,892
-16,262
15,892
-215
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
125,957
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
27,534
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
Yes
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2018
2,921,385
39,602,463
000000.073768
2017
2,880,021
39,466,350
000000.072974
2016
3,366,751
38,785,068
000000.086805
2015
2,160,693
42,247,349
000000.051144
2014
2,645,452
43,296,796
000000.061100
2
Total
of line 1, column (d)
.....................
2
000000.345791
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
000000.069158
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
37,421,135
5
Multiply line 4 by line 3
......................
5
2,587,971
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
8,501
7
Add lines 5 and 6
........................
7
2,596,472
8
Enter qualifying distributions from Part XII, line 4
,.............
8
3,147,046
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
8,501
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
8,501
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
8,501
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
17,314
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
17,314
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
16
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
8,797
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
8,797
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)
AK
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
No
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
No
Website address
N/A
14
The books are in care of
Todd F Brashear CPA
Telephone no.
(801) 578-1246
Located at
610 E South Temple Suite 200
Salt Lake City
UT
ZIP+4
84102
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
Sarah J McCarthey
Director
002.00
0
610 E South Temple Suite 200
Salt Lake City
,
UT
84102
Thomas K McCarthey Jr
Director
002.00
0
610 E South Temple Suite 200
Salt Lake City
,
UT
84102
Philip G McCarthey
Director
002.00
0
610 E South Temple Suite 200
Salt Lake City
,
UT
84102
Maureen P McCarthey
Director
002.00
0
610 E South Temple Suite 200
Salt Lake City
,
UT
84102
Todd F Brashear
Executive Director
010.00
150,000
610 E South Temple Suite 200
Salt Lake City
,
UT
84102
John P O'Brien
Secretary Treasurer
002.00
62,500
610 E South Temple Suite 200
Salt Lake City
,
UT
84102
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
Total
number of other employees paid over $50,000
...................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
Mary Kay Lazarus Public Relations Inc
Public Relations
58,125
3075 East Kennedy Drive
Salt Lake City
,
UT
84108
Royce Carlton Inc
Public Lecture Series Speaker
55,000
866 United Nations Plaza
New York
,
NY
10017
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
NONE
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
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
37,135,591
b
Average of monthly cash balances
.......................
1b
855,409
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
37,991,000
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
37,991,000
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
569,865
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
37,421,135
6
Minimum investment return.
Enter 5% of line 5
..................
6
1,871,057
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
1,871,057
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
8,501
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
8,501
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
1,862,556
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
1,862,556
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
1,862,556
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
3,147,046
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
3,147,046
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
8,501
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
3,138,545
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
1,862,556
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
......
580,176
b
From 2015
......
68,862
c
From 2016
......
1,440,068
d
From 2017
......
937,989
e
From 2018
......
960,730
f
Total
of lines 3a through e
........
3,987,825
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
3,147,046
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
.....
1,862,556
e
Remaining amount distributed out of corpus
1,284,490
5
Excess distributions carryover applied to 2019.
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
5,272,315
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)
...
580,176
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
4,692,139
10
Analysis of line 9:
a
Excess from 2015
....
68,862
b
Excess from 2016
....
1,440,068
c
Excess from 2017
....
937,989
d
Excess from 2018
....
960,730
e
Excess from 2019
....
1,284,490
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).)
NONE
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
NONE
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
Todd F Brashear Executive Director
610 East South Temple Ste 200
Salt Lake City
,
UT
84102
(801) 578-1246
b
The form in which applications should be submitted and information and materials they should include:
Grant request letter, supporting documentation, IRS tax-exempt determination letter.
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
Ability Found
2324 S Constitution Blvd
West Valley City
,
UT
84119
PC
Equipment Replacement Program
15,000
Alliance House
1724 South Main Street
Salt Lake City
,
UT
84115
PC
Program Funding
7,500
American Cancer Society
375 East 100 South 1st Floor
Salt Lake City
,
UT
84111
PC
Cancer Research
25,000
American Civil Liberties Union of Utah
355 North 300 West
Salt Lake City
,
UT
84103
PC
Program Funding
14,000
Bad Dog Arts
824 South 400 West B-129
Salt Lake City
,
UT
84101
PC
After School Arts Program
5,000
Ballet West
52 West 200 South
Salt Lake City
,
UT
84101
PC
Program Funding
125,000
Big Brothers Big Sisters of Utah
2121 South State Street 201
South Salt Lake
,
UT
84115
PC
Program Funding
7,350
Boys & Girls Clubs of Greater Salt Lake
PO Box 57071
Murray
,
UT
84107
PC
Program Funding Capital Campaign
125,000
Building Youth Around the World
198 East 4500 South
Murray
,
UT
84107
PC
Program Funding
3,000
Canines With a Cause
3970 South 2700 East
Salt Lake City
,
UT
84124
PC
Program Funding
10,000
Carmel of the Immaculate Heart of Mary
5714 South Holladay Boulevard
Holladay
,
UT
84121
PC
General Operations Funding
25,000
Cathedral of the Madeleine
331 E South Temple
Salt Lake City
,
UT
84111
PC
Repairs Maintenance Endowment
10,000
Catholic Community Services
224 North 2200 West
Salt Lake City
,
UT
84116
PC
Program Funding
150,000
Catholic Youth Organization Athletics
1385 East Spring Lane
Holladay
,
UT
84117
PC
Program Funding
20,000
Columbus Community Center
3495 S West Temple
Salt Lake City
,
UT
84115
PC
Capital Campaign
125,000
Don Moyer Boys & Girls Club
201 East Park Street
Champaign
,
IL
61820
PC
Program Funding
5,000
Eye Care 4 Kids - Utah
6911 South State Street
Midvale
,
UT
84047
PC
Program Funding
10,000
First Step House
440 South 500 East
Salt Lake City
,
UT
84102
PC
Program Funding
15,000
Friends of Arches and Canyonlands
PO Box 1680
Moab
,
UT
84532
PC
Program Funding
10,000
Golden Rule Project
77 South 700 East 200
Salt Lake City
,
UT
84102
PC
Program Funding
5,000
Gonzaga University
University Relations
Spokane
,
WA
99258
PC
Capital Campaign
200,000
Guadalupe School
1385 North 1200 West
Salt Lake City
,
UT
84116
PC
Education Program Funding
6,000
Heart to Heart Adoptions
9669 South 700 East
Sandy
,
UT
84070
PC
Program Funding
20,000
Herreshoff Marine Museum
One Burnside Street
Bristol
,
RI
02809
PC
Seamanship Program Funding
10,000
Humane Society of Utah
4242 South 300 West
Murray
,
UT
84157
PC
Program Funding
5,000
Huntsman Cancer Foundation
500 Huntsman Way
Salt Lake City
,
UT
84108
PC
Capital Campaign
20,000
Immigrant Legal Services
4055 South 700 East Ste 200
Salt Lake City
,
UT
84107
PC
Program Funding
15,000
Intermountain Therapy Animals
4050 South 2700 East
Salt Lake City
,
UT
84124
PC
Program Funding
10,000
Jewish Family Service
1111 East Brickyard Road Suite 218
Salt Lake City
,
UT
84106
PC
Program Funding
7,500
Judge Memorial Catholic High School
650 South 1100 East
Salt Lake City
,
UT
84102
PC
Tuition Assistance Supplies Funding
95,000
Kearns St Ann's Catholic School
430 East 2100 South
Salt Lake City
,
UT
84115
PC
Tuition Assistance Operations Funding
300,000
Little Lambs Foundation for Kids
1125 West 400 North Suite 200
Logan
,
UT
84321
PC
Program Funding
5,000
Loveland Living Planet Aquarium
12033 South Lone Peak Parkway
Draper
,
UT
84020
PC
Program Funding Capital Campaign
55,000
Maliheh Free Clinic
941 East 3300 South
Salt Lake City
,
UT
84106
PC
Program Funding
15,000
National Multiple Sclerosis Society
Utah - Southern Idaho Chapter
Salt Lake City
,
UT
84108
PC
Program Funding Research
80,000
National Speech and Debate Association
401 Railroad Place
West Des Moines
,
IA
50265
PC
Program Funding
5,000
Neighborhood House
1050 West 500 South
Salt Lake City
,
UT
84104
PC
Capital Campaign
75,000
Our Lady of Lourdes Catholic School
1065 East 700 South
Salt Lake City
,
UT
84102
PC
Education Program Funding
3,000
Peace House
700 Round Valley Drive 115
Park City
,
UT
84060
PC
Program Funding Capital Campaign
108,333
People Helping People Inc
205 North 400 West
Salt Lake City
,
UT
84103
PC
Program Funding
5,000
Playworks Education Energized
308 East 4500 South Suite 120
Salt Lake City
,
UT
84107
PC
Program Funding
10,000
Race Swami
2751 South 2700 East
Salt Lake City
,
UT
84109
PC
Program Funding
20,000
Rape Recovery Center
2035 South 1300 East
Salt Lake City
,
UT
84105
PC
Program Funding
5,000
RiteCare of Utah
650 East South Temple
Salt Lake City
,
UT
84102
PC
Program Funding
10,000
Ronald McDonald House Charities
935 East South Temple
Salt Lake City
,
UT
84102
PC
Program Funding Capital Campaign
130,000
Rowland Hall
720 Guardsman Way
Salt Lake City
,
UT
84108
PC
Education Program Funding
25,000
Saint Joseph Catholic High School
1790 Lake Street
Ogden
,
UT
84401
PC
Tuition Assistance
25,000
Saint Vincent de Paul School
1385 East Spring Lane
Salt Lake City
,
UT
84117
PC
Education Program Funding
31,000
Salt Lake Acting Company
168 West 500 North
Salt Lake City
,
UT
84103
PC
Program Funding
10,000
Salt Lake County
Attention Dina Blaes
Salt Lake City
,
UT
84114
PC
Wetlands Improvement Funding
5,000
Sandy Arts Guild
10000 South Centennial Parkway Suit
Sandy
,
UT
84070
PC
Program Funding
5,000
Sego Lily Center for the Abused Deaf
699 E South Temple Suite 105
Salt Lake City
,
UT
84102
PC
Program Funding
3,000
Senior Charity Care Foundation
1555 West 2200 South Suite B
West Valley City
,
UT
84119
PC
Program Funding
10,000
Snowbird Sports Education Foundation
3165 East Millrock Drive Suite 190
Holladay
,
UT
84121
PC
Program Funding
15,000
Spy Hop
669 S West Temple Suite 202
Salt Lake City
,
UT
84101
PC
Capital Campaign
50,000
Success in Education Foundation
111 East Broadway Suite 900
Salt Lake City
,
UT
84111
PC
Education Program Funding
10,000
Summit Land Conservancy
PO Box 1775
Park City
,
UT
84060
PC
Environmental Program Funding
5,000
The Green Urban Lunch Box
1140 South 1100 East
Salt Lake City
,
UT
84105
PC
Program Funding
5,000
The HAPPY FACTORY
896 North 2175 West Circle
Cedar City
,
UT
84721
PC
Program Funding
2,500
The Haven
974 East South Temple
Salt Lake City
,
UT
84102
PC
Program Funding
100,000
The INN Between
1216 East 1300 South
Salt Lake City
,
UT
84105
PC
Program Funding
25,000
THE LEONARDO
209 East 500 South
Salt Lake City
,
UT
84111
PC
Program Funding
10,000
The Madeleine Choir School
205 First Avenue
Salt Lake City
,
UT
84103
PC
Tuition Assistance
75,000
The Salt Lake City Mission
1151 South Redwood Road Suite 106
Salt Lake City
,
UT
84110
PC
Program Funding
5,000
The Sharing Place
1695 East 3300 South
Salt Lake City
,
UT
84106
PC
Program Funding
5,000
Their Story is Our Story
PO Box 970771
Orem
,
UT
84097
PC
Program Funding
6,025
Therapy Animals of Utah
2459 West 300 North
Provo
,
UT
84601
PC
Program Funding
3,000
Ulster Project Utah
c/o Our Saviors Lutheran Church
Salt Lake City
,
UT
84124
PC
Program Funding
5,000
United States Association of Blind Athle
1 Olympic Plaza
Colorado Springs
,
CO
80909
PC
Program Funding
10,000
University of Utah School of Music
1375 East Presidents Circle 204
Salt Lake City
,
UT
84112
PC
Music Education Funding
17,500
USHOFF
PO Box 540094
North Salt Lake
,
UT
84054
PC
Program Funding
900
Utah Food Bank
3150 South 900 West
Salt Lake City
,
UT
84119
PC
Program Funding
10,000
Utah Health & Human Rights Project
225 South 200 East Ste 250
Salt Lake City
,
UT
84111
PC
Program Funding
30,000
Utah Law Related Education
645 South 200 East Suite 101
Salt Lake City
,
UT
84111
PC
Program Funding
20,000
Utah Museum of Fine Arts
Marcia and John Price Museum Buildi
Salt Lake City
,
UT
84112
PC
Fine Arts Program Funding
10,000
UTAH OPEN LANDS Conservation Association
1488 South Main Street
Salt Lake City
,
UT
84115
PC
Conservation Program Funding
10,000
Utah Pride Center
PO Box 1078
Salt Lake City
,
UT
84110
PC
Program Funding
25,000
Utah SymphonyUtah Opera
123 West South Temple
Salt Lake City
,
UT
84101
PC
Musical Arts Program Funding
25,000
Valley Recreation & Rehabilitation Camp
C/O Scott Hoffman
Ogden
,
UT
84403
PC
Program Funding
5,000
Veterans of Foreign Wars
Post 7442
West Jordan
,
UT
84081
PC
Program Funding
3,000
Volunteers of America Utah
435 West Bearcat Dr
Salt Lake City
,
UT
84115
PC
Program Funding
35,000
Wasatch Community Gardens
824 South 400 West Ste 127
Salt Lake City
,
UT
84101
PC
Program Funding
45,000
Weber State University
1265 Village Drive Dept 4018
Ogden
,
UT
84408
PC
Education Program Funding
25,000
West Ridge Academy
5500 West Bagley Park Road
West Jordan
,
UT
84081
PC
Program Funding
10,000
Westminster College
1840 South 1300 East
Salt Lake City
,
UT
84105
PC
Student Emergency/Hardship Fund
76,500
Womens Retreat House
340 West 2550 North
Pleasant View
,
UT
84414
PC
Program Funding
20,000
Youthlinc
1140 East Brickyard Road Suite 76
Salt Lake City
,
UT
84106
PC
Program Funding
2,500
YWCA Utah
322 East 300 South
Salt Lake City
,
UT
84111
PC
Program Funding
4,500
Red Butte Gardens
300 Wakara Way
Salt Lake City
,
UT
84108
PC
Environmental Program Funding
13,600
Total
.................................
3a
2,760,708
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
1,010,930
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
16
2
6
Net rental income or (loss) from personal property
7
Other investment income
.....
24
5,880
8
Gain or (loss) from sales of assets other than
inventory
............
18
125,957
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)
..
1,131,009
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
1,131,009
(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:
19009610
Software Version:
19.2.1.0
Part VI Line 7 - Tax Paid with the Original Return:
17,314
Form 990PF - Special Condition Description:
Special Condition Description