-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0052
20
19
Open to Public Inspection
For calendar year 2019, or tax year beginning
01-01-2019
, and ending
12-31-2019
Name of foundation
THE MILES FOUNDATION INC
Number and street (or P.O. box number if mail is not delivered to street address)
5049 EDWARDS RANCH ROAD SUITE 280
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
FORT WORTH
,
TX
761094133
A Employer identification number
75-2739180
B
Telephone number (see instructions)
(817) 293-5555
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)
$
54,418,627
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)
275,000
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
523,476
523,476
5a
Gross rents
............
178,455
178,455
b
Net rental income or (loss)
44,913
6a
Net gain or (loss) from sale of assets not on line 10
1,280,431
b
Gross sales price for all assets on line 6a
10,973,368
7
Capital gain net income (from Part IV, line 2)
...
1,280,431
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)
.......
1,755,078
3,559,723
12
Total.
Add lines 1 through 11
........
4,012,440
5,542,085
13
Compensation of officers, directors, trustees, etc.
261,000
130,500
130,500
14
Other employee salaries and wages
......
341,867
34,187
307,680
15
Pension plans, employee benefits
.......
101,498
25,375
76,124
16a
Legal fees (attach schedule)
.........
159,568
91,106
68,462
b
Accounting fees (attach schedule)
.......
151,559
22,734
128,825
c
Other professional fees (attach schedule)
....
573,940
412,181
161,759
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
242,958
150,747
27,446
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
124,686
31,171
93,514
21
Travel, conferences, and meetings
.......
62,643
15,661
46,982
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
6,494,921
155,020
29,529
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
8,514,640
1,068,682
1,070,821
25
Contributions, gifts, grants paid
.......
2,713,323
2,713,323
26
Total expenses and disbursements.
Add lines 24 and 25
11,227,963
1,068,682
3,784,144
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-7,215,523
b
Net investment income
(if negative, enter -0-)
4,473,403
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
.............
658,301
1,319,906
1,319,906
2
Savings and temporary cash investments
.........
664,051
794,356
794,356
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)
9,960,165
Less: allowance for doubtful accounts
0
15,088,424
9,960,165
9,960,165
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
448,773
464,314
468,354
b
Investments—corporate stock (attach schedule)
.......
12,921,973
13,151,390
15,400,279
c
Investments—corporate bonds (attach schedule)
.......
1,080,652
738,834
751,315
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
2,279,585
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
25,444,121
25,817,257
25,612,045
14
Land, buildings, and equipment: basis
382,622
Less: accumulated depreciation (attach schedule)
270,415
379,602
112,207
112,207
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
58,965,482
52,358,429
54,418,627
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
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
........
0
0
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
58,965,482
52,358,429
29
Total net assets or fund balances
(see instructions)
.....
58,965,482
52,358,429
30
Total liabilities and net assets/fund balances
(see instructions)
.
58,965,482
52,358,429
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
58,965,482
2
Enter amount from Part I, line 27a
.....................
2
-7,215,523
3
Other increases not included in line 2 (itemize)
3
608,470
4
Add lines 1, 2, and 3
..........................
4
52,358,429
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
52,358,429
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
MINERAL INTERESTS
P
b
PUBLICLY TRADED SECURITIES
P
c
FLOW-THROUGH FROM PARTNERSHIPS
P
d
REAL PROPERTY - N. BEACH STREET
P
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
504,400
300,000
204,400
b
7,504,104
6,894,779
609,325
c
16,706
16,706
d
2,948,158
2,498,158
450,000
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
204,400
b
609,325
c
16,706
d
450,000
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
1,280,431
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
Yes
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2018
3,000,211
74,827,876
0.040095
2017
3,188,152
62,260,415
0.051207
2016
2,581,093
50,870,011
0.050739
2015
2,743,611
37,308,543
0.073538
2014
2,594,284
47,338,803
0.054802
2
Total
of line 1, column (d)
.....................
2
0.270381
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
0.054076
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
55,809,407
5
Multiply line 4 by line 3
......................
5
3,017,949
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
44,734
7
Add lines 5 and 6
........................
7
3,062,683
8
Enter qualifying distributions from Part XII, line 4
,.............
8
3,784,144
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
44,734
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
0
3
Add lines 1 and 2
...........................
3
44,734
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
0
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
44,734
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
104,049
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
21,000
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
125,049
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
80,315
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
80,315
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
Yes
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
Yes
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)
TX
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
Yes
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
Yes
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
WWW.MILESFDN.ORG
14
The books are in care of
GRANT COATES
Telephone no.
(817) 293-5555
Located at
5049 EDWARDS RANCH ROAD STE 280
FORT WORTH
TX
ZIP+4
76109
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
No
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
C GRANT COATES
CEO/DIRECTOR
40.00
231,000
43,179
0
5049 EDWARDS RANCH ROAD SUITE 280
FORT WORTH
,
TX
76109
JACK L BURDETT
CHAIRMAN
5.00
15,000
0
0
5049 EDWARDS RANCH ROAD SUITE 280
FORT WORTH
,
TX
76109
SHERRY A WILSON
DIRECTOR
5.00
15,000
0
0
5049 EDWARDS RANCH ROAD SUITE 280
FORT WORTH
,
TX
76109
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
SARA REDINGTON
DIRECTOR OF COMMUNIC
40.00
144,259
47,075
0
5049 EDWARDS RANCH ROAD STE 280
FORT WORTH
,
TX
76109
KATE WISNIEWSKI
DIRECTOR OF PROGRAMS
40.00
109,160
31,928
0
5049 EDWARDS RANCH ROAD STE 280
FORT WORTH
,
TX
76109
LAUREN JANCOSKI
EXECUTIVE ASSISTANT
40.00
46,648
11,079
0
5049 EDWARDS RANCH ROAD STE 280
FORT WORTH
,
TX
76109
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
MCR CAPITAL ADVISORS CORPORATION
CFO/FINANCIAL SERVICES
128,400
13601 PRESTON ROAD SUITE 417W
DALLAS
,
TX
75240
KPMG LLP
ACCOUNTING SERVICES
101,396
2323 ROSS AVE 1400
DALLAS
,
TX
75201
DEPLOYED INC
TECHNOLOGY SERVICES
87,651
9600 ESCARPMENT BLVD
AUSTIN
,
TX
78749
JARED P HARRELL
LEGAL SERVICES
66,000
4710 121ST STREET
LUBBOCK
,
TX
79424
BONDS ELLIS EPPICH SCHAFER JONES LLP
LEGAL SERVICES
54,520
420 THROCKMORTON STREET
FORT WORTH
,
TX
76102
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
15,785,058
b
Average of monthly cash balances
.......................
1b
1,598,825
c
Fair market value of all other assets (see instructions)
................
1c
39,275,413
d
Total
(add lines 1a, b, and c)
.........................
1d
56,659,296
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
0
3
Subtract line 2 from line 1d
.........................
3
56,659,296
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
849,889
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
55,809,407
6
Minimum investment return.
Enter 5% of line 5
..................
6
2,790,470
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
2,790,470
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
44,734
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
44,734
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
2,745,736
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
2,745,736
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
2,745,736
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
3,784,144
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
3,784,144
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
44,734
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
3,739,410
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
2,745,736
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
3,614,594
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
c
From 2016
......
d
From 2017
......
e
From 2018
......
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
3,784,144
a
Applied to 2018, but not more than line 2a
3,614,594
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2019 distributable amount
.....
169,550
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
2,576,186
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2019)
Form 990-PF (2019)
Page
11
Part XV
Supplementary Information
(continued)
3
Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
AB CHRISTIAN LEARNING CENTER
5005 BRENTWOOD STAIR ROAD SUITE 207
FORT WORTH
,
TX
76112
PC
2019 SUMMER FREEDOM SCHOOLS
26,000
AVANCE INC
2060 SINGLETON BLVD SUITE 103
DALLAS
,
TX
75212
PC
FUEL SERIES & 19-20 PEC & 2019-2020 REVJEN R-SQUARED PARTICIPATION
39,500
BEN HOGAN FOUNDATION
PO BOX 121518
FORT WORTH
,
TX
76121
PC
2019 BEN HOGAN CLASSIC IN FORT HOOD
30,000
BRUCE SHULKEY ELEMENTARY
5533 WHITMAN AVENUE
FORT WORTH
,
TX
76133
GOV
02/22/19 SUBSTITUTES FOR MS. HURD TRAINING
200
CAMP FIRE FIRST TEXAS
2700 MEACHAM BLVD
FORT WORTH
,
TX
76137
PC
EARLY CHILDHOOD APPRENTICESHIP AND SCHOOL READINESS
45,000
CASA OF TARRANT COUNTY
101 SUMMIT AVENUE SUITE 505
FORT WORTH
,
TX
76102
PC
2019 EDUCATIONAL ADVOCACY WORK
10,000
CENTER FOR NONPROFIT MANAGEMENT
6688 NORTH CENTRAL EXPY SUITE 1025
DALLAS
,
TX
75206
PC
2019 FORT WORTH OUTCOMES-BASED PROGRAM EVALUATION INSTITUTE
20,000
CENTER FOR TRANSFORMING LIVES
512 W 4TH STREET
FORT WORTH
,
TX
76102
PC
2019-2020 EARLY EDUCATION PROGRAMMING
30,000
CHILD CARE ASSOCIATES
3000 E BELKNAP STREET
FORT WORTH
,
TX
76111
PC
TX CHILD CARE TOOLS AND MOMENTUM
39,000
COMMUNIO FOUNDATION
5901 KINGSTOWNE VILLAGE PKWY SUITE
102
ALEXANDRIA
,
VA
22315
PC
2019 TARRANT VIABILITY PROJECT & COMMUNIO TARRANT COUNTY
100,000
COMMUNITIES FOUNDATION OF TEXAS INC
5500 CARUTH HAVEN LANE
DALLAS
,
TX
75225
PC
2019 NORTH TEXAS GIVING DAY & TEGAC MEMBERSHIP
10,000
COMMUNITIES IN SCHOOLS OF GREATER TARRANT COUNTY
5601 BRIDGE STREET SUITE 501
FORT WORTH
,
TX
76112
PC
2019 PARTNERSHIP WITH IDEA RISE CAMPUS
24,000
CRISTO REY FORT WORTH
2633 ALTAMESA BLVD
FORT WORTH
,
TX
76133
PC
2019 GENERAL OPERATIONS SUPPORT
25,000
DECATUR INDEPENDENT SCHOOL DISTRICT
307 S CATES STREET
DECATUR
,
TX
76234
GOV
2019-2020 AVID PROGRAMMING SUPPORT
20,000
DONORSTRUST
1800 DIAGONAL STREET SUITE 280
ALEXANDRIA
,
VA
22314
PC
THE MILES FOUNDATION DONOR ADVISED FUND & THE GRANT COATES FAMILY FUND
617,000
EDUCATIONAL FIRST STEPS
2815 GASTON AVENUE
DALLAS
,
TX
75226
PC
2019-2020 WEDGWOOD SUPPORT
12,000
FIRST3YEARS
1199 S BELTLINE ROAD SUITE 100
COPPELL
,
TX
76102
PC
INVOICE 1158 - BABY DAY DONATION & 2019 ROFW
35,798
FORT WORTH INDEPENDENT SCHOOL DISTRICT
100 N UNIVERSITY
FORT WORTH
,
TX
76107
GOV
2019 ABYDOS TRAINER
1,500
FORTRESS YOUTH DEVELOPMENT CENTER
PO BOX 422
FORT WORTH
,
TX
76101
PC
BRIDGES OUT OF POVERTY PROGRAM & 2019-2020 PEC SUPPORT
32,500
GREAT HEARTS TEXAS
824 BROADWAY SUITE 101
SAN ANTONIO
,
TX
78215
PC
GENERAL SUPPORT
100,000
IDEA PUBLIC SCHOOLS TARRANT COUNTY
2833 CROCKETT STREET
FORT WORTH
,
TX
76107
PC
2019 CIS PARTNERSHIP AT RISE CAMPUS
50,000
IMPOSSIBLE POSSIBILITIES
PO BOX 470906
FORT WORTH
,
TX
76147
PC
MAVENS MILESTONES
5,000
JUNIOR ACHIEVEMENT OF THE CHISHOLM TRAIL
6300 RIDGLEA PL STE 400
FORT WORTH
,
TX
76116
PC
FUEL SERIES PARTICIPATION WITH REVJEN
7,500
LEADERSHIP ACADEMY AT JOHN T WHITE
7300 JOHN T WHITE ROAD
FORT WORTH
,
TX
76120
GOV
HOSPITALITY FUND & FAMILY MATH NIGHT 2019
3,500
LENA POPE HOME INC
3200 SANGUINET STREET
FORT WORTH
,
TX
76107
PC
2019-2020 STAFF DEVELOPMENT
15,000
LITERACY CONNEXUS
3020 S CHERRY LANE 123168
FORT WORTH
,
TX
76121
PC
2019 READY FOR SCHOOL PROGRAMMING
5,000
LVTRISE
8201 CALMONT AVENUE
FORT WORTH
,
TX
76116
PC
COMMUNITY CENTER CAMPAIGN
25,000
MOMENTOUS INSTITUTE
106 E 10TH STREET
DALLAS
,
TX
75203
PC
2019 CHANGING THE ODDS CONFERENCE
5,000
NEW DAY SERVICES
6816 CAMP BOWIE BLVD W SUITE 112
FORT WORTH
,
TX
76116
PC
2019-2020 STRATEGIC PLANNING SUPPORT
7,375
NEW TEACHER CENTER
1205 PACIFIC AVENUE
SANTA CRUZ
,
CA
95060
PC
2019-2020 FWISD COACHING SUPPORT
25,000
NORTH TEXAS COMMUNITY FOUNDATION
306 W 7TH STREET SUITE 1045
FORT WORTH
,
TX
76102
PC
THE MILES FOUNDATION COMMUNITY FUND, 2019 ELA SUPPORT & READ FORT WORTH SUPPORT
262,700
NORTHSIDE INTER-COMMUNITY AGENCY
1600 CIRCLE PARK BLVD
FORT WORTH
,
TX
76164
PC
CIRCLE OF WINNERS
5,000
PROJECT TRANSFORMATION OF CENTRAL TEXAS
1310 S COLLARD STREET
FORT WORTH
,
TX
76105
PC
SUMMER PROGRAMMING SUPPORT
30,000
READING PARTNERS
2910 SWISS AVENUE
DALLAS
,
TX
75204
PC
2019 SUPPORT
35,000
RIVERTREE ACADEMY INC
5443 BONNELL AVENUE
FORT WORTH
,
TX
76107
PC
2019-2020 GENERAL OPERATIONS SUPPORT
25,000
SOUTHERN METHODIST UNIVERSITY-CENTER ON RESEARCH AND EVALUATION
3140 DYER STREET
DALLAS
,
TX
75205
PC
IDEA DATA EVALUATION
4,000
STAND TOGETHER TRUST
2300 WILSON BOULEVARD SUITE 500
ARLINGTON
,
VA
22201
PC
ACE SCHOLARSHIP PROGRAM AND KOCHS EDUCATION ADVOCACY GROUP
125,000
STAR SPONSORSHIP PROGRAM INC
6707 BRENTWOOD STAIR ROAD SUITE 205
FORT WORTH
,
TX
76112
PC
2019-2020 PROGRAMMING SUPPORT
20,000
TENEO
2605 W 8TH STREET
AUSTIN
,
TX
78703
PC
2019 CHIEF OF STAFF SUPPORT
50,000
TEXAS BOOK FESTIVAL
1023 SPRINGDALE ROAD BUILDING 14
SUITE B
AUSTIN
,
TX
78701
PC
TARRANT COUNTY READING ROCKSTARS
10,000
TEXAS CHARTER SCHOOL ASSOCIATION
3801 S CAPITAL OF TEXAS HWY SUITE
330
AUSTIN
,
TX
78704
PC
PUBLIC NARRATIVE AND COMMUNICATIONS SUPPORT
25,000
TEXAS EDUCATION AGENCY
WILLIAM B TRAVIS BUILDING CONGRESS
AVENUE
AUSTIN
,
TX
78701
GOV
TEXAS PRESCHOOL DEVELOPMENT GRANT
25,000
TEXAS PUBLIC POLICY FOUNDATION
901 CONGRESS AVENUE
AUSTIN
,
TX
78701
PC
SUPPORT OF LLC, LITIGATION AND EDUCATION FREEDOM INITIATIVES
150,000
THE CONCILIO
400 S ZANG BLVD SUITE 300
DALLAS
,
TX
75208
PC
2019-2020 PEC SUPPORT
51,500
THE ESSILOR VISION FOUNDATION
13515 NORTH STEMMONS FREEWAY
DALLAS
,
TX
75234
PC
FORT WORTH VISION VAN
20,000
THE FIRST TEE OF FORT WORTH
1900 ROCKWOOD PARK DRIVE NORTH
FORT WORTH
,
TX
76114
PC
FUEL SERIES & 2019-2020 CAPACITY BUILDING
67,500
THE GATEHOUSE
670 WESTPORT PARKWAY
GRAPEVINE
,
TX
76051
PC
2019-2020 EARLY CHILDHOOD PROGRAMMING
25,000
THE GEORGE W BUSH FOUNDATION
6116 N CENTRAL EXPRESSWAY SUITE 400
DALLAS
,
TX
75206
PC
PRESIDENTIAL LEADERSHIP SCHOLARS PROGRAMMING
25,000
THE LINCOLN NETWORK
2443 FILMORE STREET 380-3386
SAN FRANCISCO
,
CA
941151800
PC
SCHOOL CHOICE PRODUCT DEVELOPMENT
150,000
THE OAKRIDGE SCHOOL
5900 W PIONEER PKWY
ARLINGTON
,
TX
76013
GOV
LAUSANNE CONFERENCE
900
THE PARENTING CENTER
2928 WEST 5TH STREET
FORT WORTH
,
TX
76107
PC
2019-2020 PEC SUPPORT
22,800
THE PHILANTHROPY ROUNDTABLE
1120 20TH STRET NW SUITE 550 SOUTH
WASHINGTON
,
DC
20036
PC
TEXAS-BASED SCHOOL CHOICE INITIATIVES
25,000
TRINITY CHRISTIAN ACADEMY
4594 E 1-20 SERVICE RD SOUTH
WILLOW PARK
,
TX
76087
PC
2019 T-CAMP
3,500
TRINITY VALLEY SCHOOL
7500 DUTCH BRANCH ROAD
FORT WORTH
,
TX
76132
PC
2019 TVS SUMMER CAMP MEALS
3,000
UNITED COMMUNITY CENTERS INC
1200 E MADDOX AVENUE
FORT WORTH
,
TX
76104
PC
SUMMER TRANS., I CAN READ, CITY CENTERS
76,550
UNIVERSITY OF OKLAHOMA FOUNDATION INC
307 W BROOKS STREET ROOM 105
NORMAN
,
OK
73019
PC
MBA DALLAS CORPORATE SCHOLARS ON BEHALF OF JACK BURDETT
25,000
UNT DALLAS FOUNDATION
7300 UNIVERSITY HILS BLVD
DALLAS
,
TX
75241
PC
FORT WORTH PRINCIPAL PARTICIPATION IN PIC
20,000
UNT HEALTH SCIENCE CENTER FOUNDATION
3500 CAMP BOWIE BLVD EAD 802
FORT WORTH
,
TX
76107
PC
2019 PLEDGE FULFILLMENT
25,000
UPLIFT EDUCATION
3000 PEGASUS PARK DRIVEF
DALLAS
,
TX
75247
PC
PRE-K SUPPORT AT UPLIFT ASCEND
25,000
WATERSTONE SUPPORT FOUNDATION INC
10807 NEW ALLEGIANCE DRIVE SUITE
240
COLORADO SPRINGS
,
CO
80921
SO II
2019 RIVERTREE FARM SUPPORT
15,000
Total
.................................
3a
2,713,323
b
Approved for future payment
Total
.................................
3b
0
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
523,476
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
16
44,913
6
Net rental income or (loss) from personal property
7
Other investment income
.....
15
3,668,591
8
Gain or (loss) from sales of assets other than
inventory
............
18
1,280,431
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
PARTNERSHIP INCOME - UBI
523000
-1,913,513
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
-1,913,513
5,517,411
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
3,603,898
(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