-
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
POLLY A LEVEE CHARITABLE TRUST - TRUST A -
Number and street (or P.O. box number if mail is not delivered to street address)
116 ALLEGHENY CENTER MALL P8YB3502L
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
PITTSBURGH
,
PA
15212
A Employer identification number
23-2735661
B
Telephone number (see instructions)
(412) 762-3792
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
11,153,997
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
353,308
353,308
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
34,764
b
Gross sales price for all assets on line 6a
2,326,107
7
Capital gain net income (from Part IV, line 2)
...
34,764
8
Net short-term capital gain
.........
0
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
Total.
Add lines 1 through 11
........
388,072
388,072
13
Compensation of officers, directors, trustees, etc.
36,170
28,936
7,234
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
0
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
10,762
2,044
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
0
0
23
Other expenses (attach schedule)
.......
3,195
3,195
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
50,127
34,175
0
7,234
25
Contributions, gifts, grants paid
.......
515,499
515,499
26
Total expenses and disbursements.
Add lines 24 and 25
565,626
34,175
0
522,733
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-177,554
b
Net investment income
(if negative, enter -0-)
353,897
c
Adjusted net income
(if negative, enter -0-)
...
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
.............
190,760
457,175
457,175
2
Savings and temporary cash investments
.........
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
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
0
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
341,606
1,066,358
1,167,966
c
Investments—corporate bonds (attach schedule)
.......
1,092,334
4,106,368
5,001,577
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
4,678,717
3,639,627
4,527,279
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
6,303,417
9,269,528
11,153,997
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
6,228,428
9,240,986
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
74,989
28,542
29
Total net assets or fund balances
(see instructions)
.....
6,303,417
9,269,528
30
Total liabilities and net assets/fund balances
(see instructions)
.
6,303,417
9,269,528
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
6,303,417
2
Enter amount from Part I, line 27a
.....................
2
-177,554
3
Other increases not included in line 2 (itemize)
3
3,388,256
4
Add lines 1, 2, and 3
..........................
4
9,514,119
5
Decreases not included in line 2 (itemize)
5
244,591
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
9,269,528
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
29. AIA GROUP LTD SPONSORED ADR
2017-03-21
2019-01-03
b
65. SECOM LTD UNSPON ADR
2016-09-19
2019-01-04
c
98. ENGIE ADR SEDOL BYY9W15
2016-09-19
2019-01-08
d
29. BRITISH AMERICAN TOBBACCO PLC SPONSORED ADR
2018-03-01
2019-01-24
e
41. BRITISH AMERICAN TOBBACCO PLC SPONSORED ADR
2018-11-14
2019-01-24
128. BRITISH AMERICAN TOBBACCO PLC SPONSORED ADR
2017-10-12
2019-01-24
36. SMITH & NEPHEW PLC SPDN ADR
2016-09-19
2019-02-07
16. NXP SEMICONDUCTORS ISIN NL0009538784 SEDOL B505PN7
2018-12-18
2019-02-07
63. ROYAL DSM N V SPONSORED ADR
2016-09-19
2019-02-20
442. INTERNATIONAL CONS SPONS ADR
2018-11-29
2019-02-27
.355 ACS ACTIVIDADES CONS-UNS ADR ADR SEDOL B3F8LH3
2017-01-03
2019-02-28
209. ACS ACTIVIDADES CONS-UNS ADR ADR SEDOL B3F8LH3
2017-01-03
2019-03-01
115. BHP GROUP PLC ADR
2016-09-19
2019-03-01
27. AIRBUS SE ADR
2016-10-19
2019-03-05
1. MERCK & CO XXX-XX-XXXX
2001-01-01
2019-03-08
97. KUBOTA CORP SPON ADR
2018-06-26
2019-03-14
495. LLOYDS TSB GROUP PLC SPONSORED ADR
2017-10-12
2019-03-15
30. CARLSBERG AS SPON ADR
2016-09-19
2019-04-17
88. ROCHE HOLDINGS LTD ADR
2016-09-19
2019-04-23
85. SEVEN & I HOLDINGS UNSPN ADR
2019-04-08
2019-04-23
327. SEVEN & I HOLDINGS UNSPN ADR
2017-08-08
2019-04-23
1. FEDERAL HOME LOAN MORTGAGE CORP XXX-XX-XXXX
2001-01-01
2019-04-24
59760.956 AQR MANAGED FUTURES STRATEGY FUND CLASS I
2016-09-12
2019-05-01
2606. ISHARES TIPS BOND ETF
2016-09-12
2019-05-01
22599.982 JPMORGAN VALUE ADVANTAGE-INS FD 1400
2013-08-29
2019-05-01
19444.444 MAINSTAY EPOCH GLOBAL EQUITY YIELD FUND CLASS I
2016-09-12
2019-05-01
6909. UBS E-TRACS ALERIAN MLP INFRASTRUCTURE ETN ETF
2015-09-03
2019-05-01
47. AERCAP HOLDINGS NV ISIN NL0000687663 SEDOL B1HHKD3
2016-09-19
2019-05-02
15. SAP SE SPONSORED ADR
2018-02-06
2019-05-15
1. PFIZER INC XXX-XX-XXXX
2001-01-01
2019-05-16
22. ROYAL DUTCH SHELL PLC ADR A
2016-09-19
2019-05-17
120. DEUTSCHE BOERSE AG UNSPN ADR
2017-10-24
2019-05-23
112. INTESA SAN PAOLO SPA
2018-08-13
2019-05-31
392. INTESA SAN PAOLO SPA
2016-09-19
2019-05-31
68. ARCELORMITTAL CLASS REG ADR SEDOL BD4H9V1
2018-11-27
2019-06-03
91. ARCELORMITTAL CLASS REG ADR SEDOL BD4H9V1
2019-05-14
2019-06-03
255. ARCELORMITTAL CLASS REG ADR SEDOL BD4H9V1
2017-05-18
2019-06-03
342.52 BANCO SANTANDER S A ADR
2018-08-13
2019-06-04
1209.48 BANCO SANTANDER S A ADR
2018-02-27
2019-06-04
142. TOTAL FINA S A
2016-09-19
2019-06-06
.666 CORTEVA INC-W/I
2019-05-06
2019-06-12
.666 DUPONT DE NEMOURS INC-WI
2019-05-06
2019-06-12
222. CORTEVA INC-W/I
2019-05-06
2019-06-19
1. BANK OF AMERICA XXX-XX-XXXX
2001-01-01
2019-06-19
78. AERCAP HOLDINGS NV ISIN NL0000687663 SEDOL B1HHKD3
2016-09-19
2019-07-01
37. AIA GROUP LTD SPONSORED ADR
2017-03-21
2019-07-02
467. ORANGE ADR
2016-09-19
2019-07-09
5. ASML HOLDING NV-NY SEDOL B908F01
2019-03-26
2019-07-18
.76 ACS ACTIVIDADES CONS-UNS ADR ADR SEDOL B3F8LH3
2017-01-03
2019-07-30
21. ESSILOR INTL ADR
2017-02-09
2019-08-06
54. BAE SYSYTEMS PLC SPONSORED ADR
2017-10-10
2019-08-08
57. CARLSBERG AS SPON ADR
2016-09-19
2019-08-08
994. SUMITOMO MITSUI FINANCIAL GROUP INC SPON ADR
2017-06-14
2019-08-09
6. BAIDU INC
2019-01-15
2019-08-14
28. BAIDU INC
2019-05-17
2019-08-14
35. BAIDU INC
2017-05-03
2019-08-14
72. DAIMLER AG-UNSPONSORED ADR SEDOL BYVH331
2019-01-15
2019-08-19
423. DAIMLER AG-UNSPONSORED ADR SEDOL BYVH331
2018-05-18
2019-08-19
70. OTSUKA HOLDINGS LTD ADR SEDOL B76XH88
2016-09-19
2019-08-23
31. SMITH & NEPHEW PLC SPDN ADR
2016-09-19
2019-08-23
18. NORTHROP GRUMMAN CORPORATION
2019-05-06
2019-08-28
230. QUEST DIAGNOSTICS INC
2019-05-06
2019-09-09
143. REPSOL SA SPONSORED ADR
2018-10-03
2019-09-20
14. NXP SEMICONDUCTORS ISIN NL0009538784 SEDOL B505PN7
2018-12-18
2019-10-04
109. MURATA MFG CO LTD ADR UNSPON ADR
2018-11-15
2019-10-10
75. BHP GROUP PLC ADR
2018-11-23
2019-10-11
83. BHP GROUP PLC ADR
2017-02-13
2019-10-11
771. TESCO PLC SPON ADR
2019-04-30
2019-10-15
34. NASPERS LTD ADR
2019-05-03
2019-10-31
110. NASPERS LTD ADR
2019-04-26
2019-10-31
40. ROYAL DUTCH SHELL PLC ADR A
2016-09-19
2019-11-01
9. MURATA MFG CO LTD ADR UNSPON ADR
2018-11-15
2019-11-05
46. DEUTSCHE POST AG SPON ADR
2018-04-18
2019-11-13
38. TORAY INDUSTRIES - ADR ISIN US8908802064
2018-12-26
2019-11-15
440. TORAY INDUSTRIES - ADR ISIN US8908802064
2017-12-01
2019-11-15
14. AERCAP HOLDINGS NV ISIN NL0000687663 SEDOL B1HHKD3
2016-09-19
2019-11-18
312. SECOM LTD UNSPON ADR
2016-09-19
2019-11-26
39. ROCHE HOLDINGS LTD ADR
2016-09-19
2019-12-04
488. LLOYDS TSB GROUP PLC SPONSORED ADR
2017-10-12
2019-12-10
5. ASML HOLDING NV-NY SEDOL B908F01
2019-03-26
2019-12-10
CAPITAL GAIN 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
953
757
196
b
1,419
1,219
200
c
1,476
1,518
-42
d
921
1,703
-782
e
1,302
1,499
-197
4,066
8,412
-4,346
1,455
1,186
269
1,451
1,230
221
1,623
1,040
583
7,017
7,021
-4
3
2
1
1,867
1,223
644
5,330
3,115
2,215
859
401
458
386
386
6,684
8,087
-1,403
1,669
1,779
-110
759
556
203
2,866
2,726
140
1,435
1,549
-114
5,519
6,665
-1,146
107
107
516,335
600,000
-83,665
295,098
299,529
-4,431
800,491
625,000
175,491
354,278
350,000
4,278
152,784
196,917
-44,133
2,419
1,860
559
1,898
1,591
307
53
53
1,418
1,055
363
1,640
1,275
365
1,357
1,755
-398
4,751
5,471
-720
1,009
1,503
-494
1,351
1,587
-236
3,785
5,620
-1,835
1,526
1,751
-225
5,388
8,588
-3,200
7,517
6,737
780
17
18
-1
49
50
-1
5,994
6,001
-7
73
73
4,027
3,087
940
1,626
966
660
7,164
7,046
118
1,124
933
191
6
4
2
1,421
1,222
199
1,493
1,789
-296
1,666
1,056
610
6,702
7,771
-1,069
570
1,009
-439
2,659
3,218
-559
3,324
6,408
-3,084
827
1,017
-190
4,860
8,385
-3,525
1,420
1,532
-112
1,468
1,021
447
6,598
5,241
1,357
24,045
22,558
1,487
2,231
2,860
-629
1,524
1,076
448
1,433
1,345
88
3,233
2,936
297
3,578
2,907
671
7,117
7,650
-533
960
1,770
-810
3,107
5,653
-2,546
2,341
1,918
423
127
111
16
1,717
2,152
-435
535
518
17
6,191
7,860
-1,669
829
554
275
6,810
5,879
931
1,495
1,208
287
1,547
1,754
-207
1,396
933
463
538
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
196
b
200
c
-42
d
-782
e
-197
-4,346
269
221
583
-4
1
644
2,215
458
386
-1,403
-110
203
140
-114
-1,146
107
-83,665
-4,431
175,491
4,278
-44,133
559
307
53
363
365
-398
-720
-494
-236
-1,835
-225
-3,200
780
-1
-1
-7
73
940
660
118
191
2
199
-296
610
-1,069
-439
-559
-3,084
-190
-3,525
-112
447
1,357
1,487
-629
448
88
297
671
-533
-810
-2,546
423
16
-435
17
-1,669
275
931
287
-207
463
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
34,764
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
497,024
10,604,961
0.046867
2017
862,600
10,848,676
0.079512
2016
762,092
10,848,047
0.070252
2015
722,581
11,346,633
0.063682
2014
204,857
5,788,136
0.035393
2
Total
of line 1, column (d)
.....................
2
0.295706
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
0.059141
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
10,673,795
5
Multiply line 4 by line 3
......................
5
631,259
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
3,539
7
Add lines 5 and 6
........................
7
634,798
8
Enter qualifying distributions from Part XII, line 4
,.............
8
522,733
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
7,078
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
7,078
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
7,078
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
7,445
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
7
Total credits and payments. Add lines 6a through 6d
..............
7
7,445
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
367
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
367
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.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
PA
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
14
The books are in care of
PNC BANK NA
Telephone no.
(412) 762-3792
Located at
116 ALLEGHENY CENTER MALL
PITTSBURGH
PA
ZIP+4
15212
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
No
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
PNC BANK NA
Co-Trustee
6
36,170
1600 Market Street 29th Floor
Philadelphia
,
PA
191037240
John R Latourette Jr Esquire
Co-Trustee
1
0
1500 Market Street
Philadelphia
,
PA
191022100
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
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
10,836,392
b
Average of monthly cash balances
.......................
1b
-52
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
10,836,340
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
10,836,340
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
162,545
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
10,673,795
6
Minimum investment return.
Enter 5% of line 5
..................
6
533,690
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
533,690
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
7,078
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
7,078
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
526,612
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
526,612
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
526,612
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
522,733
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
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
0
b
Cash distribution test (attach the required schedule)
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
522,733
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
522,733
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
526,612
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
......
0
b
From 2015
......
191,074
c
From 2016
......
243,210
d
From 2017
......
321,342
e
From 2018
......
0
f
Total
of lines 3a through e
........
755,626
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
522,733
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
.....
522,733
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
3,879
3,879
(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
751,747
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
......
751,747
10
Analysis of line 9:
a
Excess from 2015
....
187,195
b
Excess from 2016
....
243,210
c
Excess from 2017
....
321,342
d
Excess from 2018
....
0
e
Excess from 2019
....
0
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
Abramson Center for Jewish Life
1425 HORSHAM ROAD
NORTH WALES
,
PA
19454
NONE
PC
GENERAL PURPOSE
135,000
Friends of Ski Mountain Mining History
c/o Park City Museum
PO BOX 555
Park City
,
UT
84060
NONE
PC
GENERAL SUPPORT
3,333
Paws & Claws Animal Adoption & Care
Center Inc
104 SUBLET AVENUE
Diamondville
,
WY
83116
NONE
PC
GENERAL SUPPORT
3,333
Women's Community Revitalization Project
100 WEST OXFORD STREET E-2300
Philadelphia
,
PA
19122
NONE
PC
GENERAL SUPPORT
3,000
STREET DOG COALITION
220 JACKSON AVENUE
FORT COLLINS
,
CO
80521
NONE
PC
GENERAL SUPPORT
5,000
ENVIRONMENTAL DEFENSE FUND
257 PARK AVENUE SOUTH 17TH FLOOR
New York
,
NY
10010
NONE
PC
GENERAL SUPPORT
5,000
NAACP LEGAL DEFENSE & EDUC FUND INC
40 RECTOR STREET 5TH FLOOR
New York
,
NY
10006
NONE
PC
GENERAL SUPPORT
3,000
Alzheimer's Disease and Related Disorder
Association
919 N MICHIGAN STREET SUITE 1100
Chicago
,
IL
50611
NONE
PC
GENERAL PURPOSE
8,000
AMERICAN FOUNDATION FOR SUICIDE
PREVENTIon
120 WALL ST FL 29
NEW YORK
,
NY
100054015
NONE
PC
GENERAL PURPOSE
10,000
Boys & Girls Clubs of America
1275 PEACHTREE STREET NE
Atlanta
,
GA
303093506
NONE
PC
JAMES A. LA VEA
50,000
American Heart Association
ONE PENN CENTER
Philadelphia
,
PA
19103
NONE
PC
GENERAL SUPPORT
1,000
MONTGOMERY CHILD ADVOCACY PROJECT
409 CHERRY ST
NORRISTOWN
,
PA
194014734
NONE
PC
GENERAL PURPOSE
15,000
Minding Your Mind
124 SIBLEY AVE
ARDMORE
,
PA
190032312
NONE
PC
GENERAL PURPOSE
10,000
University of Colorado Hospital
Foundation
7901 E LOWRY BLVD STE 300
DENVER
,
CO
802306511
NONE
PC
GENERAL SUPPORT
15,000
Lutheran Settlement House
1340 FRANKFORD AVE
Philadelphia
,
PA
19125
NONE
PC
GENERAL SUPPORT
2,000
Magee Rehabilitation Hospital
Norah Salmon
1513 RACE ST
PHILADELPHIA
,
PA
191021125
NONE
PC
JERRY SEGAL GOLF CLASSIC
10,000
VARIETY CLUB CAMP & DEVELOPMENT CENTER
FOR HANDICAPPED CHILDREN
PO BOX 609
WORCESTER
,
PA
194900609
NONE
PC
PHILADELPHIA CAMP
5,000
PHILABUNDANCE
3616 S GALLOWAY ST
PHILADELPHIA
,
PA
191485402
NONE
PC
GENERAL SUPPORT
5,000
ALS Association Greater Philadelphia Cha
321 NORRISTOWN RD STE 260
Pittsburgh
,
PA
190022755
NONE
PC
2017 GRANT SUPPORT
20,000
POLICE ATHLETIC LEAGUE OF
PHILADELPHIA
3068 BELGRADE ST
PHILADELPHIA
,
PA
19134
NONE
PC
GENERAL PURPOSE
35,000
SKYS THE LIMIT FUND
4546 EL CAMINO REAL STE 282
LOS ALTOS
,
CA
940221068
NONE
PC
GENERAL AND PROGRAM SUPPORT
50,000
SPECTRUM INC
31 ELMWOOD AVE
BURLINGTON
,
VT
054014347
NONE
PC
GENERAL PURPOSE
20,000
COMMITTEE ON TEMPORARY SHELTER
PO BOX 1616
BURLINGTON
,
VT
054021616
NONE
PC
GENERAL PURPOSE
2,500
COPLEY HEALTH SYSTEMS INC
528 WASHINGTON HWY
MORRISVILLE
,
VT
056618973
NONE
PC
GENERAL PURPOSE
5,000
STOWE RESCUE SQUAD INC
PO BOX 291
STOWE
,
VT
056720291
NONE
PC
GENERAL PURPOSE
5,000
RONALD MCDONALD HOUSE CHARITIES INC
ONE KROC DR
OAK BROOK
,
IL
605230000
NONE
PC
HIT EM FOR THE HOUSE
5,000
Thurgood Marshall College Fund Inc
901 F STREET NW SUITE 300
Washington
,
DC
20004
NONE
PC
GENERAL SUPPORT
3,000
NATIVE AMERICAN HERITAGE ASSOCIATION
PO BOX 512
Rapid City
,
SD
57709
NONE
PC
GENERAL SUPPORT
10,000
BREAD FOR THE CITY INC
1525 7TH ST NW
WASHINGTON
,
DC
200013201
NONE
PC
GENERAL PURPOSE
2,000
Legal Aid Society of the District of
Columbia
1331 H STREET NW SUITE 350
Washington
,
DC
20005
NONE
PC
GENERAL SUPPORT
6,000
Smithsonian Institution Office of the
Comptroller
PO BOX 9016
Pittsfield
,
ME
012029016
NONE
PC
GENERAL PURPOSE
2,000
NATIONAL ALLIANCE ON MENTAL
ILLNESS
5830 MOUNT MORIAH RD STE 6
MEMPHIS
,
TN
381151628
NONE
PC
GENERAL SUPPORT
15,000
WILLS EYE FOUNDATION INC
840 WALNUT ST SUITE 1530
PHILADELPHIA
,
PA
191075109
NONE
PC
MCNAMARA, MD FUND
5,000
SUMMIT FOUNDATION
PO BOX 4000
BRECKENRIDGE
,
CO
804244000
NONE
PC
GENERAL PURPOSE
10,000
Turning Point Lincoln Countys
Self- Help Center
PO BOX 64
Kemmerer
,
WY
83101
NONE
PC
GENERAL SUPPORT
3,333
DENVER DUMB FRIENDS LEAGUE
2080 S QUEBEC ST
DENVER
,
CO
802313204
NONE
PC
GENERAL PURPOSE
5,000
NATIVE AMERICAN RIGHTS FUND
1506 BROADWAY
BOULDER
,
CO
803026217
NONE
PC
GENERAL PURPOSE
10,000
FOOD BANK OF THE ROCKIES
10700 E 45TH AVE
DENVER
,
CO
802392906
NONE
PC
GENERAL AND TOTES ($2K)
10,000
Youth Law Center
832 FOLSOM STREET
San Francisco
,
CA
94107
NONE
PC
GENERAL SUPPORT
3,000
Total
.................................
3a
515,499
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
14
353,308
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than
inventory
............
18
34,764
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)
..
388,072
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
388,072
(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