-
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
07-01-2019
, and ending
06-30-2020
Name of foundation
MAX AND HELEN GUERNSEY
CHARITABLE FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 1172
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WATERLOO
,
IA
507041172
A Employer identification number
42-1460664
B
Telephone number (see instructions)
(319) 226-3434
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)
$
40,179,649
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)
5,000
2
Check
.............
3
Interest on savings and temporary cash investments
125,416
115,802
4
Dividends and interest from securities
...
694,087
692,573
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
315,526
b
Gross sales price for all assets on line 6a
10,409,243
7
Capital gain net income (from Part IV, line 2)
...
362,359
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)
.......
1,067,495
0
12
Total.
Add lines 1 through 11
........
2,207,524
1,170,734
13
Compensation of officers, directors, trustees, etc.
33,000
3,750
0
14
Other employee salaries and wages
......
87,145
0
0
15
Pension plans, employee benefits
.......
2,400
0
0
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
16,257
6,503
0
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
217,610
4,978
0
19
Depreciation (attach schedule) and depletion
...
1,599
0
20
Occupancy
..............
16,758
0
0
21
Travel, conferences, and meetings
.......
1,631
0
0
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
172,724
91,076
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
549,124
106,307
0
25
Contributions, gifts, grants paid
.......
1,594,300
1,594,300
26
Total expenses and disbursements.
Add lines 24 and 25
2,143,424
106,307
1,594,300
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
64,100
b
Net investment income
(if negative, enter -0-)
1,064,427
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
.........
566,336
1,915,805
1,915,805
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
15,000
0
0
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
12,742,379
11,060,064
11,060,064
b
Investments—corporate stock (attach schedule)
.......
20,372,740
19,955,753
19,955,753
c
Investments—corporate bonds (attach schedule)
.......
1,264,807
2,243,566
2,243,566
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
4,902,919
4,902,821
4,902,821
14
Land, buildings, and equipment: basis
29,732
Less: accumulated depreciation (attach schedule)
24,166
1,629
5,566
5,566
15
Other assets (describe
)
122,642
96,074
96,074
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
39,988,452
40,179,649
40,179,649
17
Accounts payable and accrued expenses
..........
11,733
10,186
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
)
295,000
0
23
Total liabilities
(add lines 17 through 22)
.........
306,733
10,186
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
39,681,719
40,169,463
29
Total net assets or fund balances
(see instructions)
.....
39,681,719
40,169,463
30
Total liabilities and net assets/fund balances
(see instructions)
.
39,988,452
40,179,649
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
39,681,719
2
Enter amount from Part I, line 27a
.....................
2
64,100
3
Other increases not included in line 2 (itemize)
3
1,682,778
4
Add lines 1, 2, and 3
..........................
4
41,428,597
5
Decreases not included in line 2 (itemize)
5
1,259,134
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
40,169,463
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
340 SHS ACCENTURE PLC
P
2019-11-01
b
22778.594 SHS BOSTON P LNG/SHRT
P
2020-06-10
c
30000 SHS CITIGROUP INC
P
2020-02-14
d
400 SHS CITIGROUP INC
P
2020-06-30
e
1355 SHS COGNIZANT TECH SOLUTIONS
P
2020-06-30
450 SHS DANAHER CORP
P
2019-11-01
1130 SHS EXXON MOBIL CORP
P
2019-11-01
55891.116 SHS FIDELITY NEW MRKTS INC
P
2020-06-30
225 SHS GILEAD SCIENCES INC
P
2020-06-30
9595.846 SHS INV OPP DEVELOP MRKTS
P
2020-01-28
5376.344 SHS INV OPP DEVELOP MRKTS
P
2020-05-07
5600 SHS ISHARES INTERNATIONAL
P
2020-01-09
10 SHS ISHARES MBS
P
2020-03-09
11125 SHS ISHARES RUSSELL MID-CAP
P
2020-01-29
1925 SHS ISHARES RUSSELL 2000
P
2020-06-30
880 SHS LAS VEGAS SANDS CORP
P
2020-06-30
2805 SHS MANULIFE FINANCIAL CORP
P
2020-06-30
45000 SHS NEWMONT MINING CORP
P
2020-03-19
.5 SHS OTIS WORLDWIDE CORP
P
2020-04-21
397 SHS OTIS WORLDWIDE CORP
P
2020-06-30
.374 SHS RAYTHEON TECHNOLOGIES CORP
P
2020-04-29
1390 SHS RAYTHEON TECHNOLOGIES CORP
P
2020-06-30
25000 SHS REGIONS FINANCIAL CO.
P
2019-12-09
30000 SHS SUNTRUST BANKS INC
P
2019-12-05
1940 SHS TOTAL S.A. - ADR
P
2020-06-30
200 SHS TRACTOR SUPPLY CO
P
2019-11-01
1885 SHS UBS GROUP AG
P
2019-11-01
2700 SHS VANGUARD REAL ESTATE ETF
P
2019-10-18
30000 SHS VISA INC.
P
2020-03-09
110 SHS VISA INC. - CLASS A
P
2019-11-01
35000 SHS ROCKWELL COLLINS INC
P
2019-07-15
95000 SHS FFCB
P
2019-09-18
100000 SHS FNMA
P
2019-09-24
100000 SHS CISCO SYSTEMS
P
2020-01-15
100000 SHS FFCB
P
2020-01-29
23582.60 SHS FIDELITY INTL INDEX
P
2019-07-23
23364.486 SHS VANGUARD SHORT-TERM
P
2019-07-23
435.319 SHS VANGUARD 500 INDEX ADMIRAL
P
2019-07-23
1800 SHS HILLIBURTON CO
P
2019-07-24
1350 SHS CHARLES SCHWAB CORP
P
2019-07-24
1480 SHS VANGUARD REAL ESTATE ETF
P
2019-07-24
16200 SHS ISHARES MSCI EMERGING MKTS
P
2019-07-24
107.581 SHS VANGUARD 500 INDEX ADMIRAL
P
2019-07-25
290 SHS YUM BRANDS INC
P
2019-07-26
35 SHS BOOKING HOLDINGS INC
P
2019-08-12
284.727 SHS VANGUARD 500 INDEX ADMIRAL
P
2019-08-16
100000 SHS FNMA
P
2019-09-23
INSTL INSURED MONEY MARKET
P
2019-10-01
INSTL INSURED MONEY MARKET
P
2019-10-04
271.631 SHS VANGUARD 500 INDEX ADMIRAL
P
2019-10-17
4655.493 SHS VANGUARD SHORT-TERM INVEST
P
2019-10-17
INSTL INSURED MONEY MARKET
P
2019-10-18
100000 SHS FHLMC
P
2019-10-28
1433.692 SHS TWEEDY BROWNE GLOBAL
P
2019-10-31
125 SHS KLA CORPORATION
P
2019-11-05
400 SHS NUCOR CORP
P
2019-11-05
350 SHS WELLTOWER INC
P
2019-11-05
550 QUALCOMM INC.
P
2019-11-18
40 SHS ALPHABET INC
P
2019-11-18
25000 SHS FHLB
P
2019-11-18
50000 SHS FHLB
P
2019-11-26
INSTL INSURED MONEY MARKET
P
2019-12-09
100000 SHS FHLB
P
2019-12-16
100000 SHS FHLB
P
2019-12-30
INSTL INSURED MONEY MARKET
P
2019-12-30
INSTL INSURED MONEY MARKET
P
2020-01-08
70 SHS MICROCHIP TECHNOLOGY INC
P
2020-01-14
INSTL INSURED MONEY MARKET
P
2020-01-14
100000 SHS FFCB
P
2020-02-04
485 SHS ILLINOIS TOOL WKS INC
P
2020-02-06
INSTL INSURED MONEY MARKET
P
2020-02-07
5900 SHS FORD MOTOR CO
P
2020-02-18
INSTL INSURED MONEY MARKET
P
2020-02-18
100000 SHS FHLB
P
2020-02-24
45000 SHS FHLMC
P
2020-02-24
50000 SHS FHLMC
P
2020-02-24
720 SHS VANGUARD REAL ESTATE
P
2020-03-06
INSTL INSURED MONEY MARKET
P
2020-03-06
INSTL INSURED MONEY MARKET
P
2020-03-09
INSTL INSURED MONEY MARKET
P
2020-03-12
100000 SHS FFCB
P
2020-03-13
INSTL INSURED MONEY MARKET
P
2020-03-20
5945 SHS FORD MOTOR CO
P
2020-03-23
INSTL INSURED MONEY MARKET
P
2020-03-23
470 SHS AT&T INC
P
2020-03-24
80 SHS BECTON DICKINSON & CO
P
2020-03-24
660 SHS VERIZON COMMUNICATIONS INC
P
2020-03-24
340 SHS MEDTRONIC PLC
P
2020-03-24
INSTL INSURED MONEY MARKET
P
2020-03-24
INSTL INSURED MONEY MARKET
P
2020-04-08
INSTL INSURED MONEY MARKET
P
2020-05-07
705 SHS MICROCHIP TECHNOLOGY INC
P
2020-06-05
INSTL INSURED MONEY MARKET
P
2020-06-09
5157.298 SHS OAKMARK INTL FUND
P
2020-06-19
8136.696 SHS TWEEDY BROWNE GLOBAL
P
2020-06-19
INSTL INSURED MONEY MARKET
P
2020-06-19
535 SHS BOEING CO
P
2020-06-22
6015 SHS ISHARES CORE MSCI EMERGIN MKTS
P
2020-06-22
800 SHS EXXON MOBIL CORP
P
2020-06-25
CLASS ACTION SETTLEMENTS
P
2019-11-30
AIG SECURITIES LITIGATION
P
2020-01-31
MERCK SECURITIES LITIGATION
P
2020-04-30
CEDAR VALLEY VENTURE FUND NO.1, LC K-1
P
2019-12-31
EVANS BANCSHARES INC K-1
P
2019-12-31
WAVERLY PLASTICS COMPANY, INC K-1
P
2019-12-31
CAPITAL GAINS DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
63,191
25,432
37,759
b
309,561
333,537
-23,976
c
30,317
30,272
45
d
20,046
26,340
-6,294
e
74,361
103,251
-28,890
61,748
18,539
43,209
76,234
81,558
-5,324
790,300
832,767
-42,467
16,718
18,819
-2,101
425,000
379,804
45,196
200,000
161,544
38,456
168,287
160,544
7,743
1,098
1,088
10
664,816
451,843
212,973
271,688
294,633
-22,945
38,236
51,833
-13,597
36,764
48,190
-11,426
47,465
46,310
1,155
23
31
-8
21,943
24,507
-2,564
25
34
-9
83,289
109,005
-25,716
25,370
24,912
458
30,312
29,656
656
74,769
95,702
-20,933
19,323
1,970
17,353
22,243
30,591
-8,348
250,504
205,524
44,980
31,380
30,276
1,104
19,563
5,854
13,709
35,000
41,300
-6,300
95,000
111,795
-16,795
100,000
95,650
4,350
100,000
110,000
-10,000
100,000
113,143
-13,143
973,254
965,000
8,254
250,000
251,636
-1,636
120,000
81,161
38,839
42,583
39,510
3,073
58,251
54,094
4,157
129,419
117,623
11,796
694,847
685,872
8,975
30,000
20,057
9,943
32,616
24,241
8,375
68,284
65,834
2,450
75,000
53,085
21,915
100,000
96,135
3,865
117,689
117,689
0
4,531
4,531
0
75,000
50,643
24,357
50,000
50,140
-140
171,113
171,113
0
100,000
99,150
850
40,000
40,889
-889
21,563
13,603
7,960
22,112
18,482
3,630
31,349
24,212
7,137
49,681
32,802
16,879
52,501
42,968
9,533
25,000
24,750
250
50,000
50,000
0
4,513
4,513
0
100,000
94,750
5,250
100,000
97,620
2,380
10,949
10,949
0
4,596
4,596
0
7,731
5,826
1,905
66,755
66,755
0
100,000
94,250
5,750
88,354
66,115
22,239
93,884
93,884
0
48,735
65,043
-16,308
1,178
1,178
0
100,000
95,750
4,250
45,000
42,975
2,025
50,000
48,688
1,312
67,787
57,222
10,565
157,073
157,073
0
3,222
3,222
0
131,464
131,464
0
100,000
93,000
7,000
67,115
67,115
0
25,563
63,935
-38,372
102,014
102,014
0
13,423
16,863
-3,440
17,695
17,544
151
34,103
32,305
1,798
26,273
28,876
-2,603
600
600
0
3,883
3,883
0
4,181
4,181
0
75,892
58,676
17,216
3,330
3,330
0
100,000
114,384
-14,384
200,000
228,089
-28,089
227,375
227,375
0
101,970
177,087
-75,117
285,768
309,988
-24,220
37,328
63,582
-26,254
78
78
58
58
54
54
8
8
0
702
702
0
0
111,222
111,222
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
37,759
b
-23,976
c
45
d
-6,294
e
-28,890
43,209
-5,324
-42,467
-2,101
45,196
38,456
7,743
10
212,973
-22,945
-13,597
-11,426
1,155
-8
-2,564
-9
-25,716
458
656
-20,933
17,353
-8,348
44,980
1,104
13,709
-6,300
-16,795
4,350
-10,000
-13,143
8,254
-1,636
38,839
3,073
4,157
11,796
8,975
9,943
8,375
2,450
21,915
3,865
0
0
24,357
-140
0
850
-889
7,960
3,630
7,137
16,879
9,533
250
0
0
5,250
2,380
0
0
1,905
0
5,750
22,239
0
-16,308
0
4,250
2,025
1,312
10,565
0
0
0
7,000
0
-38,372
0
-3,440
151
1,798
-2,603
0
0
0
17,216
0
-14,384
-28,089
0
-75,117
-24,220
-26,254
78
58
54
0
0
0
111,222
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
362,359
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
1,442,625
38,265,644
0.037700
2017
1,313,675
31,219,905
0.042078
2016
1,169,020
17,610,522
0.066382
2015
1,252,362
17,873,802
0.070067
2014
1,204,851
19,247,394
0.062598
2
Total
of line 1, column (d)
.....................
2
0.278825
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
0.055765
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
39,027,217
5
Multiply line 4 by line 3
......................
5
2,176,353
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
10,644
7
Add lines 5 and 6
........................
7
2,186,997
8
Enter qualifying distributions from Part XII, line 4
,.............
8
1,594,300
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
21,289
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
21,289
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
21,289
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
41,408
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
41,408
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
20,119
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
1,249
Refunded
11
18,870
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)
IA
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
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
WWW.GUERNSEYFOUNDATION.COM
14
The books are in care of
BERGANKDV LTD
Telephone no.
(319) 234-6885
Located at
100 E PARK AVENUE STE 300
WATERLOO
IA
ZIP+4
50704
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
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
THOMAS R PAULSEN
FINANCE COMMITTEE CHAIR
1.00
7,500
0
0
PO BOX 1172
WATERLOO
,
IA
50704
GARY NELSON
TRUSTEE CHAIR
1.00
8,500
0
0
PO BOX 1172
WATERLOO
,
IA
50704
HAROLD B STREVER JR
ADMIN COMMITTEE CHAIR
1.00
8,000
0
0
PO BOX 1172
WATERLOO
,
IA
50704
LOIS M JOHNSON
SECRETARY
1.00
7,000
0
0
PO BOX 1172
WATERLOO
,
IA
50704
SOO GREIMAN
TRUSTEE
1.00
2,000
0
0
PO BOX 1172
WATERLOO
,
IA
50704
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
N/A
0
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
33,250,228
b
Average of monthly cash balances
.......................
1b
1,221,815
c
Fair market value of all other assets (see instructions)
................
1c
5,149,497
d
Total
(add lines 1a, b, and c)
.........................
1d
39,621,540
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
39,621,540
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
594,323
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
39,027,217
6
Minimum investment return.
Enter 5% of line 5
..................
6
1,951,361
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
1,951,361
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
21,289
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
184,677
c
Add lines 2a and 2b
............................
2c
205,966
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
1,745,395
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
1,745,395
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
1,745,395
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
1,594,300
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
1,594,300
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
0
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
1,594,300
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
1,745,395
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
0
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
201,191
c
From 2016
......
327,934
d
From 2017
......
e
From 2018
......
f
Total
of lines 3a through e
........
529,125
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
1,594,300
a
Applied to 2018, but not more than line 2a
0
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2019 distributable amount
.....
1,594,300
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
151,095
151,095
(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
378,030
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
..........
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)
.......
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
......
378,030
10
Analysis of line 9:
a
Excess from 2015
....
50,096
b
Excess from 2016
....
327,934
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
MAX HELEN GUERNSEY CHARITABLE FOUND
PO BOX 1172
WATERLOO
,
IA
507041172
(319) 226-3434
b
The form in which applications should be submitted and information and materials they should include:
APPLICATIONS SHOULD BE SUBMITTED IN WRITING IDENTIFYING THE PURPOSE AND AMOUNT REQUESTED. THE APPLICATION SHOULD BE ACCOMPANIED BY FINANCIAL STATEMENTS AND PROOF OF 501(C)(3) ORGANIZATION STATUS OR VERIFICATION THAT THE ORGANIZATION WILL USE THE FUNDS EXCLUSIVELY FOR PUBLIC PURPOSES OR AS OTHERWISE DESCRIBED IN IRC SECTION 170(C)(1).
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:
ALL AWARDS MUST BE TO CHARITABLE, SCIENTIFIC, LITERARY, OR EDUCATIONAL ORGANIZATIONS WITHIN THE MEANING OF IRC SECTION 501(C)(3) OR EXCLUSIVELY FOR PUBLIC PURPOSES OR AS OTHERWISE DESCRIBED IN IRC SECTION 170(C)(1).
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
AMERICANS FOR INDEPENDENT LIVING
310 UPLAND DRIVE
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
PROGRAM - FURNITURE FOR VETERANS
20,000
BLACK HAWK COUNTY 4H & FFA FAIR
3420 UNIVERSITY AVE SUITE B
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
PROGRAM-FAIR INTERNS & OPERATIONS
10,000
BLACK HAWK COUNTY SHERIFF'S DEPARTMENT
225 E 6TH ST
WATERLOO
,
IA
50703
N/A
EXCLUSIVELY FOR PUBL
SHERIFF'S K9 PROGRAM
1,500
BOYS & GIRLS CLUB OF THE CEDAR VALLEY
515 LIME STREET
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
CAPITAL (YEAR 3 0F 5 - BUILDING PLEDGE)
50,000
BOYS & GIRLS CLUB OF THE CEDAR VALLEY
515 LIME STREET
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
PROJECT LEARN PROGRAM
30,000
BREMER COUNTY HISTORICAL SOCIETY
402 W BREMER AVE
WAVERLY
,
IA
50677
N/A
OTHER PUBLIC CHARITY
CAPITAL - DRAINAGE LINES, SUMP PUMP, FOUNDATION REPAIR
4,500
BREMER COUNTY SHERIFF
111 4TH AVE STREET NE
WAVERLY
,
IA
50677
N/A
EXCLUSIVELY FOR PUBL
PROGRAM - K9 UNIT
2,500
BUCHANAN COUNTY HISTORICAL SOCIETY
100 1ST ST W
INDEPENDENCE
,
IA
50644
N/A
OTHER PUBLIC CHARITY
CAPITAL - CUPOLA RESTORATION ON WAPSIPINICON MILL
20,000
BUTLER COUNTY FAIR ASSOCIATION
101 S MAIN STREET
ALLISON
,
IA
50602
N/A
OTHER PUBLIC CHARITY
CAPITAL - CONSTRUCTION OF MULTI-PURPOSE BUILDING
20,000
CEDAR BEND HUMANE SOCIETY
1166 W AIRLINE HWY
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
20,000
CEDAR FALLS COMMUNITY FOUNDATION
515 MAIN ST
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
10,000
CEDAR FALLS COMMUNITY THEATRE
103 MAIN ST
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
CAPITAL - STAGE SCENERY, PROJECTION, LIGHT ENHANCEMENTS
20,000
CEDAR VALLEY ARBORETUM & BOTANIC GARDENS
1927 E ORANGE RD
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
30,000
CEDAR VALLEY BICYCLE COLLECTIVE
219 W 4TH ST
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
5,500
CEDAR VALLEY CATHOLIC SCHOOLS
3231 WEST 9TH ST
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
PROGRAM - TOGETHER WE ARE BETTER - ELL PROGRAM
15,000
CEDAR VALLEY CRIMESTOPPERS
715 MULBERRY ST
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
PROGRAM - CRIME STOPPER REWARDS
20,000
CEDAR VALLEY FRIENDS OF THE FAMILY
3835 W 9TH ST
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
PROGRAM - VIOLENCE PREVENTION EDUCATION
20,000
CEDAR VALLEY GEARHEADS MINISTRIES INC
3606 SKYVIEW DRIVE
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
20,000
CEDAR VALLEY HOSPICE INC
2101 KIMBALL AVE
WATERLOO
,
IA
50704
N/A
OTHER PUBLIC CHARITY
PALLIATIVE CARE PROGRAM
30,000
CEDAR VALLEY IRISH CULTURAL ASSOCIATION
315 E 5TH ST
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
FAMILY LEARNING ARE PROGRAM
17,000
CEDAR VALLEY PRESCHOOL & CHILDCARE CENTER
724 LANTZ AVE
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
20,000
CEDAR VALLEY PRESCHOOL & CHILDCARE CENTER
724 LANTZ AVE
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
CHILD CARE SCHOLARSHIP ASSISTANCE PROGRAM
5,000
CEDAR VALLEY UNITED WAY
425 CEDAR ST SUITE 300
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
BOOKS FOR BABIES PROGRAM
5,000
CEDAR VALLEY UNITED WAY
425 CEDAR ST SUITE 300
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
2,500
CHRISTIAN COMMUNITY DEVELOPMENT DBA HOUSE OF HOPE
845 W 5TH ST
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
26,500
CHRISTIAN COMMUNITY DEVELOPMENT DBA HOUSE OF HOPE
845 W 5TH ST
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
TRUSTEE GRANT - OPERATING SUPPORT
5,000
CITY OF CLARKSVILLE
115 W SUPERIOR ST
CLARKSVILLE
,
IA
50619
N/A
EXCLUSIVELY FOR PUBL
CAPITAL - PARK IMPROVEMENTS
20,000
CITY OF DYSART
424 MAIN ST PO BOX 212
DYSART
,
IA
52224
N/A
EXCLUSIVELY FOR PUBL
CAPITAL - AMBULANCE
30,000
CITY OF EVANSDALE
911 S EVANSDALE RD
EVANSDALE
,
IA
50707
N/A
EXCLUSIVELY FOR PUBL
CAPITAL - IN CAR/BODY CAMERA SYSTEM
10,000
CITY OF HUDSON
401 5TH ST PO BOX 480
HUDSON
,
IA
50643
N/A
EXCLUSIVELY FOR PUBL
CAPITAL - LIBRARY IMPROVEMENTS
5,000
CITY OF INDEPENDENCE
331 1ST ST EAST
INDEPENDENCE
,
IA
50644
N/A
EXCLUSIVELY FOR PUBL
POLICE K-9 PROGRAM
2,500
CITY OF TRIPOLI
303 MAIN ST PO BOX 587
TRIPOLI
,
IA
50676
N/A
EXCLUSIVELY FOR PUBL
CAPITAL - PARK IMPROVEMENTS
3,000
CITY OF WAVERLY
200 1ST ST NE
WAVERLY
,
IA
50677
N/A
EXCLUSIVELY FOR PUBL
CAPITAL - WAVERLY BALL DIAMONDS
25,000
COMMUNITY FDN OF NE IA - B H COUNTY COVID-19 FUND
3117 GREENHILL CIRCLE
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT - COUNTY COVID-19 FUND
50,000
COMMUNITY UNITED CHILDCARE CENTER
1026 E SEERLY BLVD
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
CAPITAL - PASSENGER VAN
30,000
CONSUMER CREDIT COUNSELING SVC OF NE IOWA INC
1003 WEST 4TH ST
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
20,000
EMBARC
620 W 5TH ST
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
GARDENING FOR THE FUTURE PROGRAM
15,000
EXCEPTIONAL PERSONS INC
760 ANSBOROUGH AVE
WATERLOO
,
IA
50704
N/A
OTHER PUBLIC CHARITY
CHILD CARE SCHOLARSHIP ASSISTANCE PROGRAM
10,000
FAMILIES HELPING FAMILIES OF IOWA
3516 CENTER POINT RD NE
CEDAR RAPIDS
,
IA
52402
N/A
OTHER PUBLIC CHARITY
SHOE VOUCHER PROGRAM
5,000
FAMILY & CHILDREN'S COUNCIL OF BLACK HAWK COUNTY
316 W 5TH ST
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
PARENT EDUCATION/SEXUAL ABUSE PREVENTION PROGRAMS
20,000
FAMILY YMCA OF BLACK HAWK COUNTY
669 S HACKETT RD
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
22,500
FAYETTE COUNTY FOOD SHELF
107 E WATER ST PO BOX 711
FAYETTE
,
IA
52142
N/A
OTHER PUBLIC CHARITY
CAPITAL - FINAL PHASE BUILDING PROJECT
15,000
FRIENDS OF NATIONAL CATTLE CONGRESS
257 ANSBOROUGH AVE
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
DISCOVERY PROGRAM
20,000
FRIENDSHIP VILLAGE FOUNDATION
3631 9TH ST
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
CHILD CARE SCHOLARSHIP ASSISTANCE PROGRAM
12,000
GIRL SCOUTS OF EASTERN IA & WESTERN ILL
510 MULBERRY ST
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
STEM PROGRAMMING
25,000
GRIN & GROW LTD
608 W 4TH ST
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
30,000
GROUT MUSEUM INC
503 SOUTH ST
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
SCIENCE OUTREACH PROGRAM
30,000
HAWKEYE COMMUNITY COLLEGE FOUNDATION
1501 E ORANGE RD PO BOX 8015
WATERLOO
,
IA
50704
N/A
OTHER PUBLIC CHARITY
HAWKEYE CELEBRATES THE ARTS PROGRAM
15,000
HAWKEYE COMMUNITY COLLEGE
1501 E ORANGE RD
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
SHIRLEY KREGER SCHOLARSHIP PROGRAM
5,000
HORIZONS A FAMILY SERVICE ALLIANCE
819 W 5TH ST SE PO BOX 667
CEDAR RAPIDS
,
IA
52406
N/A
OTHER PUBLIC CHARITY
FAMILY SUPPORT & SURVIVORS PROGRAM
5,000
IOWA GARDENING FOR GOOD
2191 340TH ST
MADRID
,
IA
50156
N/A
OTHER PUBLIC CHARITY
VOLUNTEER GARDENING PROGRAM
9,000
IOWA HEARTLAND HABITAT FOR HUMANITY
803 W 5TH ST
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
AFFORDABLE HOME OWNERSHIP PROGRAM
25,000
IOWA LEGAL AID
607 SYCAMORE ST SUITE 304
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
LEGAL CLINC PROGRAM - CUNNINGHAM SCHOOL
25,000
JESSE COSBY NEIGHBORHOOD CENTER
1112 MOBILE ST
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
25,000
JOB FOUNDATION
4600 UNIVERSITY AVE STE 1
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
FINANCIAL STEWARDSHIP & MENTORING PROGRAM
10,000
JUNIOR ACHIEVEMENT OF EASTERN IOWA
425 CEDAR ST SUITE 320
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
FINANCIAL LITERACY FAIR PROGRAM
15,000
JUNIOR ACHIEVEMENT OF EASTERN IOWA
425 CEDAR ST SUITE 320
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
STEM PROGRAMMING
15,000
LEADER VALLEY FOUNDATION
360 WESTFIELD AVE SUITE 200
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
LEADER IN ME PROGRAMMING
13,000
LOVE INC
4807 UNIVERSITY AVE SUITE 202
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
WHEELS FOR WORK PROGRAM
2,500
METROPOLITAN CHORALE
PO BOX 1616
WATERLOO
,
IA
50704
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
5,000
NATIONAL ALLIANCE ON MENTAL ILLNESS
1825 LOGAN AVE
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
MENTAL HEALTH SERVICES
6,000
NORTH END CULTURAL CENTER
PO BOX 2761
WATERLOO
,
IA
50704
N/A
OTHER PUBLIC CHARITY
HIP HOP LITERACY PROGRAM
11,000
NORTH STAR COMMUNITY SERVICES
3420 UNIVERSITY AVE STE C
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
15,000
NORTH STAR COMMUNITY SERVICES
3420 UNIVERSITY AVE STE C
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
CAPITAL - HVAC REPLACEMENT
15,000
NORTH TAMA SENIOR CENTER INC
212 N MAIN ST
TRAER
,
IA
50675
N/A
OTHER PUBLIC CHARITY
CAPITAL - FLOORING AND EQUIPMENT
4,000
NORTHEAST IOWA FOOD BANK
PO BOX 2397
WATERLOO
,
IA
50704
N/A
OTHER PUBLIC CHARITY
KID'S CAF/SUMMER FEEDING PROGRAMS
25,000
PEACE COMMUNITY MEALS
1800 11TH ST SE
WAVERLY
,
IA
50677
N/A
OTHER PUBLIC CHARITY
COMMUNITY MEALS PROGRAM
7,500
PEOPLE'S COMMUNITY HEALTH CLINIC
905 FRANKLIN ST
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
PEOPLES CLINIC GARDEN PROGRAM
14,000
RIVERVIEW CENTER INC
2055 KIMBALL AVE SUITE 355
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
VIOLENCE PREVENTION & EARLY INTERVENTION PROGRAM
15,000
RONALD MCDONALD HOUSE CHARITIES
720 HAWKINS DR
IOWA CITY
,
IA
52246
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
30,000
SALVATION ARMY
89 FRANKLIN ST
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
30,000
SARTORI HEALTH CARE FOUNDATION
515 COLLEGE ST
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
RED SLEIGH PROGRAM
1,500
SENIOR CITIZENS GROUP OF WAVERLY INC
506 EAST BREMER AVE
WAVERLY
,
IA
50677
N/A
OTHER PUBLIC CHARITY
CAPITAL - KITCHEN UPGRADE & REMODEL
20,000
SMALL WORLD PRESCHOOL
3475 KIMBALL AVE
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
CAPITAL - PLAYGROUND EQUIPMENT
10,000
ST TIMOTHY CHILDCARE & PRESCHOOL
1 THELMA CT
HUDSON
,
IA
50634
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
20,000
ST VINCENT DE PAUL
320 BROADWAY ST
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
700
SUCCESSLINK INC
229 E PARK AVE
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
PROGRAM SUPPORT - TOGETHER FOR YOUTH
30,000
SUNRISE EXCHANGE CLUB
250 ANSBOROUGH AVE 2134
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT - PETTING ZOO
1,000
THE LARRABEE CENTER INC
117 11TH ST
WAVERLY
,
IA
50677
N/A
OTHER PUBLIC CHARITY
EMPLOYMENT SUPPORT SERVICES PROGRAM
15,000
TRANSFORMATIONS BY CEDAR VALLEY ANGELS
PO BOX 11
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
LOVE BOX PROGRAM
20,000
TRI COUNTY CHILD & FAMILY DEVELOPMENT COUNCIL INC
205 ADAMS ST
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
DENTAL HEALTH PROGRAM
30,000
UNI FOUNDATION
204 COMMONS
CEDAR FALLS
,
IA
50614
N/A
OTHER PUBLIC CHARITY
KALEIDOSCOPE SERIES FOR YOUTH PROGRAM
30,000
UNI FOUNDATION
204 COMMONS
CEDAR FALLS
,
IA
50614
N/A
OTHER PUBLIC CHARITY
SUZUKI SCHOOL ORCHESTRA PROGRAM
4,000
UNI FOUNDATION
204 COMMONS
CEDAR FALLS
,
IA
50614
N/A
OTHER PUBLIC CHARITY
ELL COLLEGE PREP ACADEMY PROGRAM
10,000
UNI FOUNDATION
204 COMMONS
CEDAR FALLS
,
IA
50613
N/A
OTHER PUBLIC CHARITY
STURGIS YOUTH THEATRE PROGRAM
4,100
VINTON-SHELLSBURG SCHOOLS
210 W 21ST ST
VINTON
,
IA
52349
N/A
OTHER PUBLIC CHARITY
CAPITAL - BAND UNIFORMS
5,000
VOLUNTEER CENTER OF THE CEDAR VALLEY
2101 KIMBALL AVE SUITE 136
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
10,000
WARTBURG COMMUNITY SYMPHONY ASS'N INC
PO BOX 3
WAVERLY
,
IA
50677
N/A
OTHER PUBLIC CHARITY
GUEST SOLOIST/CONDUCTOR PROGRAM
6,000
WATERLOO COMMUNITY FOUNDATION
PO BOX 1253 425 CEDAR ST 320
WATERLOO
,
IA
50704
N/A
OTHER PUBLIC CHARITY
KOATS 4 KIDS PROGRAM
10,000
WATERLOO COMMUNITY MEALS INC
1207 KIMBALL AVE
WATERLOO
,
IA
50702
N/A
OTHER PUBLIC CHARITY
COMMUNITY MEALS PROGRAM
2,000
WATERLOO COMMUNITY PLAYHOUSE
224 COMMERCIAL ST
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT - CHILDREN'S THEATER
30,000
WATERLOO SCHOOLS FOUNDATION
201 TOWER PARK SUITE 106
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
CAMP INVENTION PROGRAM
18,000
WATERLOO SCHOOLS FOUNDATION
312 RACHAEL ST
WATERLOO
,
IA
50701
N/A
OTHER PUBLIC CHARITY
STOPPING THE SUMMER SLIDE READING PROGRAM
12,000
WATERLOOCEDAR FALLS SYMPHONY
8201 DAKOTA ST 17
CEDAR FALLS
,
IA
50614
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
25,000
WAVERLY HEALTHCARE FOUNDATION
312 9TH ST SW
WAVERLY
,
IA
50677
N/A
OTHER PUBLIC CHARITY
REACH OUT AND READ PROGRAM
12,000
WAVERLY SHELL ROCK UNITED WAY
805 W BREMER AVE 4
WAVERLY
,
IA
50677
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
2,500
WILDWOOD HILLS INC
2552 UNION LANE
ST CHARLES
,
IA
50240
N/A
OTHER PUBLIC CHARITY
SCHOLARSHIPS - NEXT STEPS PROGRAM
20,000
WINNEBAGO COUNCIL OF BOY SCOUTS OF AMERICA
2929 AIRPORT BOULEVARD
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
20,000
YOUTH ART TEAM
212 E 4TH ST
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
OPERATING SUPPORT
25,000
YWCA OF BLACK HAWK COUNTY
425 LAFAYETTE ST
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
LANGUAGE, ADVOCACY, RESOURCES & SUPPORT PROGRAM
10,000
YWCA OF BLACK HAWK COUNTY
425 LAFAYETTE ST
WATERLOO
,
IA
50703
N/A
OTHER PUBLIC CHARITY
PARENTS ACHIEVING SUCCESS WITH SUPPORT PROGRAM
10,000
CITY OF WATERLOO
715 MULBERRY ST
WATERLOO
,
IA
50703
N/A
EXCLUSIVELY FOR PUBL
POLICE K-9 PROGRAM
8,500
Total
.................................
3a
1,594,300
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
...........
522100
9,614
14
115,802
4
Dividends and interest from securities
....
522100
1,514
14
692,573
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
522100
1,067,495
8
Gain or (loss) from sales of assets other than
inventory
............
531390
-46,833
18
362,359
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)
..
1,031,790
1,170,734
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
2,202,524
(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