-
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
SARVER CHARITABLE TRUST
C/O THE PEOPLES BANK
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 307
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
SMITH CENTER
,
KS
66967
A Employer identification number
48-6298990
B
Telephone number (see instructions)
(785) 282-6682
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)
$
15,271,764
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
1,851
1,851
4
Dividends and interest from securities
...
326,481
326,481
5a
Gross rents
............
41,580
41,580
b
Net rental income or (loss)
41,580
6a
Net gain or (loss) from sale of assets not on line 10
170,709
b
Gross sales price for all assets on line 6a
2,051,699
7
Capital gain net income (from Part IV, line 2)
...
170,709
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)
.......
86,220
86,220
12
Total.
Add lines 1 through 11
........
626,841
626,841
13
Compensation of officers, directors, trustees, etc.
56,240
32,724
23,516
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
3,600
3,600
b
Accounting fees (attach schedule)
.......
4,200
4,200
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
33,842
33,842
19
Depreciation (attach schedule) and depletion
...
445
445
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
36,786
36,786
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
135,113
103,797
31,316
25
Contributions, gifts, grants paid
.......
626,425
620,545
26
Total expenses and disbursements.
Add lines 24 and 25
761,538
103,797
651,861
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-134,697
b
Net investment income
(if negative, enter -0-)
523,044
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
.............
43,875
400
400
2
Savings and temporary cash investments
.........
175,871
445,662
445,662
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
4,303,374
3,579,265
3,573,939
b
Investments—corporate stock (attach schedule)
.......
2,110,508
2,304,408
3,610,270
c
Investments—corporate bonds (attach schedule)
.......
674,103
849,094
889,711
11
Investments—land, buildings, and equipment: basis
805,148
Less: accumulated depreciation (attach schedule)
20,660
784,933
784,488
6,735,347
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
15,903
16,435
16,435
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
8,108,567
7,979,752
15,271,764
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
154,629
160,511
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)
.........
154,629
160,511
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
........
6,433,342
6,433,342
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
1,520,596
1,385,899
29
Total net assets or fund balances
(see instructions)
.....
7,953,938
7,819,241
30
Total liabilities and net assets/fund balances
(see instructions)
.
8,108,567
7,979,752
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
7,953,938
2
Enter amount from Part I, line 27a
.....................
2
-134,697
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
7,819,241
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
7,819,241
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
BAIDU INC
P
2018-10-30
2019-10-08
b
CLARK MO BAB CNTY COURTHOUSE
P
2012-05-18
2019-12-04
c
KANSAS CITY MO
P
2012-05-18
2019-04-01
d
AT&T INC
P
2003-07-21
2019-07-18
e
WALGREENS BOOTS ALLIANCE INC
P
1998-11-03
2019-04-15
EBAY INC COM
P
2018-07-27
2019-02-28
CONAGRA
P
2018-01-30
2019-05-16
KS DEV FIN AUTH REV
P
2012-07-11
2019-11-01
CVS HEALTH CORPORATION
P
2010-03-22
2019-10-31
VANGUARD INDEX FDS 500
P
2000-03-23
2019-07-18
FEDERAL HOME LOAN BANK
P
2019-02-19
2019-08-14
CORALVILLE IA
P
2015-06-25
2019-08-08
LANSING MI GO BAB
P
2011-01-03
2019-05-01
CISCO SYSTEMS INC
P
2010-11-11
2019-05-29
CAPITAL GAIN DISTRIBUTION
P
2019-06-30
FEDERAL HOME LOAN BANK
P
2019-02-07
2019-05-08
DISCOVERY COMMUNICAITONS
P
2016-11-30
2019-01-30
LOWE'S COMPANIES INC
P
2016-08-10
2019-05-29
CLARK MO BAB CNTY COURHTOUSE
P
2010-05-28
2019-12-04
FEDERAL FARM CREDIT
P
2019-02-07
2019-06-11
EBAY INC
P
2015-09-25
2019-05-17
MASTERCARD INC
P
2016-04-08
2019-05-29
COCA COLA COMPANY
P
1997-03-07
2019-04-02
TEXTRON 4% DUE
P
2019-01-30
2019-05-16
GOLDMAN SACHS
P
2017-03-01
2019-07-30
MCKESSON CORPORATION
P
2016-07-18
2019-10-31
HOME DEPOT INC
P
2001-09-18
2019-05-29
VOYA GLOBAL BOND FUND
P
2018-04-17
2019-02-05
OAKMARK INTERNATIONAL
P
2013-02-14
2019-02-05
ORACLE CORPORATION
P
2016-07-29
2019-03-26
ST OF ILLINOIS BAB GO
P
2010-02-02
2019-02-01
AT&T INC
P
2011-09-26
2019-07-18
HAYSVILLE KS
P
2018-11-15
2019-12-04
SALINA KS ARPRT AUTH
P
2012-05-18
2019-09-03
ISHARES INV GRADE CORP
P
2009-04-24
2019-04-15
AMERISOURCEBERGEN CORP
P
2016-04-28
2019-10-31
ISHARES INV GRADE
P
2012-07-30
2019-04-15
VANGUARD EQUITY INCOME ADM
P
2013-03-25
2019-05-30
LOWE'S COMPANIES
P
2003-05-14
2019-05-29
ANALOG DEVICES INC
P
2017-05-30
2019-07-26
ISHARES HIGH YIELD CORPORATE BON DFU
P
2011-09-27
2019-05-16
WELLS FARGO & CO
P
2016-06-29
2019-03-22
MANHATTAN KS SALES TAX BAB
P
2010-11-22
2019-12-02
BARON SELECT FUNDS EMGMKTS RETAIL
P
2014-11-25
2019-02-05
JOHN HANCOCK DISCIPLINED VAL MID CAP
P
2013-03-25
2019-02-12
WHEELING IL GO
P
2017-04-05
2019-05-16
MCDONALDS CORP
P
1997-06-04
2019-02-28
BLACKROCK INC
P
2018-08-07
2019-11-21
JOHNSON CO KS
P
2014-01-02
2019-09-03
WICHITA KS
P
2018-01-23
2019-03-01
POTT CO KS BAB USD 320
P
2009-12-15
2019-09-03
BRANDES INTL SMALL CAP
P
2017-11-02
2019-02-05
JOHNSON CNTY KS
P
2011-03-25
2019-09-03
WILL CNTY ILL
P
2013-09-19
2019-10-01
SPDR S&P 500 ETF
P
2003-05-14
2019-05-29
CIGNA CORP NEW COM
P
2016-06-02
2019-02-15
KANE COOK & DUPAGE CO
P
2013-12-17
2019-05-16
WILL CNTY ILL USD 122
P
2013-09-19
2019-10-01
SEDGWICK CNTY KS
P
2009-09-14
2019-10-01
CVS HEALTH CORPORATION
P
2015-11-20
2019-10-31
KANE COOK & DUPAGE
P
2017-03-24
2019-05-16
WILL CO IL USD ZERO
P
2015-09-09
2019-05-17
VALERO ENERGY CORP
P
2007-02-23
2019-04-23
(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
29,999
50,595
-20,596
b
10,013
11,255
-1,242
c
10,000
10,095
-95
d
12,487
8,760
3,727
e
32,303
14,741
17,562
37,383
34,200
3,183
30,093
30,242
-149
15,000
16,382
-1,382
6,596
3,504
3,092
27,609
13,003
14,606
20,000
20,000
19,613
20,000
-387
10,000
10,040
-40
26,594
10,300
16,294
10,275
10,275
5,114
5,073
41
20,370
20,937
-567
14,918
12,963
1,955
85,106
85,893
-787
44,490
42,879
1,611
20,123
19,333
790
25,356
9,420
15,936
23,325
11,156
12,169
20,366
20,000
366
20,000
19,850
150
198,723
240,865
-42,142
37,987
6,467
31,520
47,024
49,975
-2,951
71,478
75,000
-3,522
13,352
10,250
3,102
60,000
60,048
-48
4,030
3,448
582
5,250
4,888
362
10,000
10,094
-94
11,890
9,614
2,276
25,427
24,830
597
11,890
12,071
-181
9,722
7,500
2,222
3,730
902
2,828
61,082
39,039
22,043
9,462
9,439
23
24,060
23,250
810
30,000
30,658
-658
63,854
57,894
5,960
36,364
33,200
3,164
15,765
17,005
-1,240
56,123
7,268
48,855
97,096
88,441
8,655
25,000
26,505
-1,505
10,000
10,044
-44
100,000
100,450
-450
11,735
15,000
-3,265
50,000
51,601
-1,601
35,000
37,008
-2,008
27,858
8,703
19,155
42,959
40,867
2,092
125,384
133,790
-8,406
15,000
15,970
-970
35,000
35,376
-376
6,596
9,210
-2,614
26,066
27,602
-1,536
34,822
31,081
3,741
24,837
15,016
9,821
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
-20,596
b
-1,242
c
-95
d
3,727
e
17,562
3,183
-149
-1,382
3,092
14,606
-387
-40
16,294
10,275
41
-567
1,955
-787
1,611
790
15,936
12,169
366
150
-42,142
31,520
-2,951
-3,522
3,102
-48
582
362
-94
2,276
597
-181
2,222
2,828
22,043
23
810
-658
5,960
3,164
-1,240
48,855
8,655
-1,505
-44
-450
-3,265
-1,601
-2,008
19,155
2,092
-8,406
-970
-376
-2,614
-1,536
3,741
9,821
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
170,709
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
-18,346
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
724,223
14,742,061
0.049126
2017
675,490
13,275,791
0.050881
2016
727,423
13,715,095
0.053038
2015
726,252
14,796,656
0.049082
2014
626,275
14,667,540
0.042698
2
Total
of line 1, column (d)
.....................
2
0.244825
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
0.048965
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
15,172,958
5
Multiply line 4 by line 3
......................
5
742,944
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
5,230
7
Add lines 5 and 6
........................
7
748,174
8
Enter qualifying distributions from Part XII, line 4
,.............
8
651,861
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
10,461
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
3
Add lines 1 and 2
...........................
3
10,461
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
10,461
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
7,760
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
7,760
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
2,701
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
KS
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
No
Website address
N/A
14
The books are in care of
THE PEOPLES BANK
Telephone no.
(785) 282-6682
Located at
PO BOX 307
SMITH CENTER
KS
ZIP+4
66967
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
THE PEOPLES BANK
OFFICER
1.00
56,240
0
0
PO BOX 307
SMITH CENTER
,
KS
66967
PETE BOHM
BOARD MEMBER
000.00
0
0
0
632 SOUTH BROADWAY
SALINA
,
KS
67401
GEORGE EAKIN
BOARD MEMBER
000.00
0
0
0
225 SOUTH 8TH
OSBORNE
,
KS
67473
PAUL S GREGORY
BOARD MEMBER
000.00
0
0
0
218 SOUTH 4TH
OSBORNE
,
KS
67473
LANCE R WOLTERS
BOARD MEMBER
000.00
0
0
0
111 MERCURY AVE
OSBORNE
,
KS
67473
MELVIN WILCOXSON
BOARD MEMBER
000.00
0
0
0
2149 C 677 AVENUE
OSBORNE
,
KS
67473
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
N/A
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
8,134,542
b
Average of monthly cash balances
.......................
1b
363,402
c
Fair market value of all other assets (see instructions)
................
1c
6,906,074
d
Total
(add lines 1a, b, and c)
.........................
1d
15,404,018
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
2
Acquisition indebtedness applicable to line 1 assets
..................
2
3
Subtract line 2 from line 1d
.........................
3
15,404,018
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
231,060
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
15,172,958
6
Minimum investment return.
Enter 5% of line 5
..................
6
758,648
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
758,648
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
10,461
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
10,461
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
748,187
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
748,187
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
748,187
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
651,861
b
Program-related investments—total from Part IX-B
..................
1b
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
651,861
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b. See instructions
.................
5
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
651,861
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
748,187
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
620,545
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
c
From 2016
......
d
From 2017
......
e
From 2018
......
f
Total
of lines 3a through e
........
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
651,861
a
Applied to 2018, but not more than line 2a
620,545
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
d
Applied to 2019 distributable amount
.....
31,316
e
Remaining amount distributed out of corpus
5
Excess distributions carryover applied to 2019.
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
716,871
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
NONE
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
NONE
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
SARVER CHARITABLE TRUST PAUL GREGO
PO BOX 12
OSBORNE
,
KS
67473
(785) 346-5445
b
The form in which applications should be submitted and information and materials they should include:
SEE ATTACHED
c
Any submission deadlines:
SEE ATTACHED
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
SEE ATTACHED
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
ALTON PRIDE
415 1ST AVE
ALTON
,
KS
67623
PC
CHARITABLE GRANT
1,250
AMERICAN CANCER SOCIETY
1315 SW ARROWHEAD RD C/O
TOPEKA
,
KS
66604
PC
CHARITABLE GRANT
62,055
AMERICAN LEGION AUXILIARY
2891 W 257TH DR
NATOMA
,
KS
67641
PC
CHARITABLE GRANT
1,500
ASSEMBLY OF GOD CHURCH OSBORNE
125 S OAK
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
4,000
BIBLE BAPTIST CHURCH OF OSBORNE
131 SOUTH 2ND
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
4,000
CHRISTIAN CHURCH OF DOWNS
1071 MORGAN AVE
DOWNS
,
KS
67437
PC
CHARITABLE GRANT
4,000
CITY OF DOWNS
715 RAILROAD AVE
DOWNS
,
KS
67437
GOV
CHARITABLE GRANT
1,000
CITY OF OSBORNE
129 S 1ST
OSBORNE
,
KS
67473
GOV
CHARITABLE GRANT
8,100
DOWNS ART COUNCIL
PO BOX 211
DOWNS
,
KS
67437
PC
CHARITABLE GRANT
2,000
DOWNS HIGH SCHOOL ALUMNI ASSOC
PO BOX 93
DOWNS
,
KS
67437
PC
CHARITABLE GRANT
2,000
DOWNS MINISTERIAL ALLIANCE (FOOD BA
345 S HWY 181
DOWNS
,
KS
67437
PC
CHARITABLE GRANT
4,000
DOWNS SENIOR CENTER
514 MORGAN AVE
DOWNS
,
KS
67437
PC
CHARITABLE GRANT
500
FAITH LUTHEAN CHURCH OF OSBORNE
629 N 2ND
OSBORNE
,
KS
67473
I
CHARITABLE GRANT
4,000
FORD FUND
PO BOX 189
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
1,000
FORT HAYS STATE UNIVERSITY FOUNDATI
610 PARK STREET
HAYS
,
KS
67601
PC
CHARITABLE GRANT
62,055
FREE MTHODIST CHURCH OF OSBORNE
724 WEST MAIN STREET
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
4,000
GRACE METHODIST CHURCH OF PORTIS
108 E 5TH
PORTIS
,
KS
67473
PC
CHARITABLE GRANT
4,000
KANSAS NATURAL RESOURCE FOUNDATION
1117 W HWY 24
OSBORNE
,
KS
67473
I
SCHOLARSHIP
250
LEUKEMIA & LYMPHOMA SOCIETY
ATTN JAN R SUMNER 6611
WICHITA
,
KS
67206
PC
CHARITABLE GRANT
62,055
LIGHTHOUSE COUMMUNITY CHURCH OF DOW
901 W BLUNT
DOWNS
,
KS
67437
PC
CHARITABLE GRANT
4,000
LUTHERAN CHURCH OF DOWNS
1019 BLUNT
DOWNS
,
KS
67437
PC
CHARITABLE GRANT
4,000
MT AYE FRIENDS CHURCH
1265 COUNTY 656 AVE
ALTON
,
KS
67623
PC
CHARITABLE GRANT
6,000
NATOMA BASEBALL ASSOCIAITON
906 6TH ST
NATOMA
,
KS
67651
PC
CHARITABLE GRANT
1,500
NATOMA FADD CHAPTER
PO BOX 5
NATOMA
,
KS
67651
PC
CHARITABLE GRANT
250
NATOMA HERITAGE SEEKERS
PO BOX 116
NATOMA
,
KS
67651
PC
CHARITABLE GRANT
1,000
NORTH CENTRAL KANSAS OUTDOOR YOUTH
PO BOX 228
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
1,500
OPTIONS DOMESTIC & SEXUAL VIOLENCE
2716 PLAZA AVE
HAYS
,
KS
67601
PC
CHARITABLE GRANT
1,500
OSBORNE CO GENALOGICAL & HISTORICA
307 W MAIN
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
230
OSBORNE COMMUNITY FOUNDATION
128 N 1ST
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
7,100
OSBORNE COUNTY FAIR BOARD
231 W NEW HAMPSHIRE
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
15,000
OSBORNE COUNTY KLA
2691 C 685 AVE
LUCAS
,
KS
67648
PC
CHARITABLE GRANT
2,500
OSBORNE COUNTY MEMORIAL HOSPITAL
424 W NEW HAMPSHIRE ST
OSBORNE
,
KS
67473
GOV
CHARITABLE GRANT
11,890
OSBORNE HIGH SCHOOL ALUMNI
PO BOX 74
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
1,000
OSBORNE MINISTERIAL ALLIANCE (FOOD
125 S OAK
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
4,000
OSBORNE POLICE DEPARTMENT
128 N 1ST
OSBORNE
,
KS
67473
GOV
CHARITABLE GRANT
3,000
OSBORNE PUBLIC LIBRARY
325 W MAIN
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
3,000
OSBORNE SENIOR CENTER
108 W MAIN
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
1,500
OSBORNE USD 392
213 W ADAMS
OSBORNE
,
KS
67473
GOV
CHARITABLE GRANT
1,500
PEACH LUTHERAN CHURCH OF NATOMA
705 5TH
NATOMA
,
KS
67651
PC
CHARITABLE GRANT
4,000
PLEASANT PLAIN CHURCH
2780 W 160TH DR
ALTON
,
KS
67623
PC
CHARITABLE GRANT
4,000
ROSE VALLEY CHURCH
107 COUNTY 685 AVE
DOWNS
,
KS
67437
PC
CHARITABLE GRANT
4,000
SHINE
217 W NEW HAMPSHIRE
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
1,500
SOLOMON VALLEY TRANSPORTATION
PO BOX 70
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
10,000
ST ALOYSIUS CATHOLIC CHURCH
203 N ELM
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
62,055
ST MARYS CATHOLIC CHURCH OF DOWNS
1312 PRENTISS STREET
DOWNS
,
KS
67437
PC
CHARITABLE GRANT
4,000
TEEN CHALLENGE OF THE MIDWEST
209 NICHOLAS AVE
ALTON
,
KS
67623
PC
CHARITABLE GRANT
15,000
THE SALVATION ARMY
PO BOX 412577
KANSAS CITY
,
MO
64141
PC
CHARITABLE GRANT
62,055
UNITED CHRISTIAN CHURCH OF OSBORNE
212 N 2ND
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
4,000
UNITED METHODIST CHURCH OF ALTON
408 MILL ST
ALTON
,
KS
67623
PC
CHARITABLE GRANT
4,000
UNITED METHODIST CHURCH OF DOWNS
1000 MORGAN AVE
DOWNS
,
KS
67437
PC
CHARITABLE GRANT
4,000
UNITED METHODIST CHURCH OF NATOMA
804 4TH ST
NATOMA
,
KS
67651
PC
CHARITABLE GRANT
4,000
UNITED METHODIST CHURCH OF OSBORNE
PO BOX 287
OSBORNE
,
KS
67473
PC
CHARITABLE GRANT
4,000
ADRIANNA BERGMANN
1105 PRENTISS ST
DOWNS
,
KS
67437
I
SCHOLARSHIP
1,400
AFFTIN CONWAY
761 W 210 DR
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,700
ALLISON GRABAST
332 N 2ND
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,400
ANDREA CADY
11720 W 118TH TERRACE
APT 427
OVERLAND PARK
,
KS
66210
I
SCHOLARSHIP
2,000
ANDRES FAUDEX INOSTROZA
300 E VERMONT
APT L1
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
ANNA PETERSON
917 MILL
ALTON
,
KS
67623
I
SCHOLARSHIP
2,000
ASHTON BAXA
201 S 5TH
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,400
BENJAMIN BOERSMA
298 N 10 RD
CAWKER CITY
,
KS
67430
I
SCHOLARSHIP
1,700
BEY LEE BRUMMET
402 LAKE DR
CAWKER CITY
,
KS
67430
I
SCHOLARSHIP
1,400
BILLY NEUMANN
515 W NEW HAMPSHIRE
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,000
BRENDAN BERTLAND
334 S 2ND
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,400
BRETTON BOLTERS
68 S 120TH AVE
PORTIS
,
KS
67474
I
SCHOLARSHIP
1,400
BRITTANI CONVERSE
1020 2ND ST
DOWNS
,
KS
67437
I
SCHOLARSHIP
2,000
CAITLYN MILLER
102 GEMINI AVE
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
CALEB HAKE
609 LOCUST ST
CAWKER CITY
,
KS
67430
I
SCHOLARSHIP
2,000
CAROLINA HARZMAN
288 COUNTY 685 AVE
DOWNS
,
KS
67437
I
SCHOLARSHIP
1,400
CASSANDRA KINZIE
9 CIRCLE DR
DOWNS
,
KS
67437
I
SCHOLARSHIP
1,400
CULLEN GRABAST
332 N 2ND
OISBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
DARRNELL HOLLOWAY
214 S 1ST
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,400
DAVID HINDMAN
146 S MORSE DR
PHILLIPSBURG
,
KS
67661
I
SCHOLARSHIP
1,400
DEAN MASTERS
804 4TH ST
NATOMA
,
KS
67651
I
SCHOLARSHIP
2,000
DEREK NAEGELE
PO BOX 67
PORTIS
,
KS
67474
I
SCHOLARSHIP
1,400
DILLON PETERSON
917 MILL
ALTON
,
KS
67623
I
SCHOLARSHIP
1,400
DRAKE DEBOLT
2 CIRCLE DRIVE
DOWNS
,
KS
67437
I
SCHOLARSHIP
1,400
DRAKE KOOPS
345 S HWY 181
DOWNS
,
KS
67437
I
SCHOLARSHIP
2,000
DYLAN PRUTER
PO BOX 67
NATOMA
,
KS
67651
I
SCHOLARSHIP
1,400
DYLEN TRECEK
549 COUNTY 657 AVE
ALTON
,
KS
67623
I
SCHOLARSHIP
1,400
EMMA CARLIN
2016 W 90TH DR
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
ERIN BROWN
1015 ROSS ST
DOWNS
,
KS
67437
I
SCHOLARSHIP
1,400
ETHAN DICKERSON
18344 FAIRPORT RD
PARADISE
,
KS
67658
I
SCHOLARSHIP
1,400
HANNAH CHAMBRAY
PO BOX 265
NATOMA
,
KS
67651
I
SCHOLARSHIP
2,000
HOLLY TANIS
242 C ROAD
CAWKER CITY
,
KS
67430
I
SCHOLARSHIP
2,000
ISAAC SCHOEN
26094 280TH ROAD
DOWNS
,
KS
67651
I
SCHOLARSHIP
2,000
JAYDE BLAINE
617 70TH ROAD
CAWKER CITY
,
KS
67430
I
SCHOLARSHIP
1,700
JENNA DIBBEL
409 W NEW HAMPSHIRE
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
JENNA KETTER
313 W 160TH DR
NATOMA
,
KS
67651
I
SCHOLARSHIP
2,000
JEREMY LONG
665 COUNTY 685 DR
PORTIS
,
KS
67474
I
SCHOLARSHIP
1,400
JESSA COCKERHAM
525 COUNTY 388 DR
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,700
JESSICA ENGLER
673 W HWY 24
DOWNS
,
KS
67437
I
SCHOLARSHIP
2,000
JORDAN WHERRY
313 S 1ST
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,400
JOSHUA ARNOLDY
51 S 50TH AVE
DOWNS
,
KS
67437
I
SCHOLARSHIP
1,700
KADE MILLER
102 GEMINI AVE
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
KAELAN CAMERON
213 N LOCUST
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
LAKIN SPRICK
403 N PENNSYLVANIA AVE
HOLYROOD
,
KS
67450
I
SCHOLARSHIP
1,700
LEE CARLIN
2016 W 90TH DR
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,400
LEONIE HARZMAN
288 COUNTY 685 AVE
DOWNS
,
KS
67437
I
SCHOLARSHIP
2,000
LOGAN SPRICK
800 APOLLO AVE
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,700
LORYN SPRICK
800 APOLLO AVE
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
LUKAS SPRICK
800 APOLLO AVE
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
MATTHEW SEWARD
242 C ROAD
CAWKER CITY
,
KS
67430
I
SCHOLARSHIP
1,000
MAVERICK LEROCK
535 N 2ND
OSBORNE
,
KS
67473
I
SCHOLARSHIP
700
MEGAN LAROCQUE
336 70 ROAD
CAWKER CITY
,
KS
67430
I
SCHOLARSHIP
2,000
NICHOLAS CADY
515 W MAIN
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
NICHOLAS SCHMITT
300 10 ROAD
CAWKER CITY
,
KS
67430
I
SCHOLARSHIP
1,400
NICHOLE HALL
213 N 5TH
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
OLIVIA ENGLER
673 W HWY 24
DOWNS
,
KS
67437
I
SCHOLARSHIP
2,000
PARKER WOLTERS
217 W NEW HAMPSHIRE
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
PEYTON OSTMEYER
820 N 2ND
NATOMA
,
KS
67651
I
SCHOLARSHIP
2,000
PIERCE WOLTERS
217 W NEW HAMPSHIRE
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
RACHEL MILLER
112 W 2ND
GLEN ELDER
,
KS
67446
I
SCHOLARSHIP
2,000
ROXTON BROWN
130 VAN BUREN ST
OSBORNE
,
KS
67473
I
SCHOLARSHIP
2,000
SAGE SCHAEFLI
320 LAKE DR
CAWKER CITY
,
KS
67430
I
SCHOLARSHIP
1,700
SARAH PELTON
5713 181TH ST
PARADISE
,
KS
67658
I
SCHOLARSHIP
2,000
SARAH SEIFERT
312 S 2ND
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,400
SAVANNAH NOEL
PO BOX 53
PORTIS
,
KS
67474
I
SCHOLARSHIP
1,700
SHAY ENDSLEY
809 DIVISION
DOWNS
,
KS
67437
I
SCHOLARSHIP
1,000
SHAY SCHWEITZER
1020 2ND ST
DOWNS
,
KS
67437
I
SCHOLARSHIP
1,400
SHAYLA GRIFFIN
2495 13 ROAD
PLAINVILLE
,
KS
67663
I
SCHOLARSHIP
2,100
SHEILA ELMORE
1306 4TH ST
DOWNS
,
KS
67437
I
SCHOLARSHIP
2,000
SHELBY SENGER
PO BOX 3
GLEN ELDER
,
KS
67446
I
SCHOLARSHIP
1,400
SPENCER HEISE
1006 COUNTY 388 DR
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,400
TANNER CONWAY
119 S 10TH
OSBORNE
,
KS
67473
I
SCHOLARSHIP
1,400
TATEM ZEIGLER
2820 HWY 18
NATOMA
,
KS
67651
I
SCHOLARSHIP
2,000
TOREN WOLTERS
607 DIVISION
DOWNS
,
KS
67437
I
SCHOLARSHIP
1,700
TRENTON BRUMMER
1531 S 1ST AVE
TIPTON
,
KS
67485
I
SCHOLARSHIP
1,400
TRISTEN WINKEL
1677 GLEN LANE
GLEN ELDER
,
KS
67446
I
SCHOLARSHIP
1,400
TRYSTAN SCHLAEFLI
246 W HWY 24
DOWNS
,
KS
67437
I
SCHOLARSHIP
2,000
TYRON GRUWELL
300 E ALLEN ST
GLEN ELDER
,
KS
67446
I
SCHOLARSHIP
1,700
Total
.................................
3a
620,545
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
...........
1,851
4
Dividends and interest from securities
....
326,481
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
41,580
6
Net rental income or (loss) from personal property
7
Other investment income
.....
86,220
8
Gain or (loss) from sales of assets other than
inventory
............
170,709
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)
..
626,841
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
626,841
(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.)
3
ALL INVESTMENT INCOME USED IN CONTRIBUTION DISTRIBUTIONS
4
ALL INVESTMENT INCOME USED IN CONTRIBUTION DISTRIBUTIONS
5B
ALL INVESTMENT INCOME USED IN CONTRIBUTION DISTRIBUTIONS
7
ALL INVESTMENT INCOME USED IN CONTRIBUTION DISTRIBUTIONS
8
PRINCIPAL INCOME (LOSS) GENERATED NOT SUBJECT TO DISTRIBUT
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