-
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
PUGDIN MEMORIAL FUND XXXXX0004
Number and street (or P.O. box number if mail is not delivered to street address)
10 S DEARBORN IL1-0111
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CHICAGO
,
IL
60603
A Employer identification number
31-1663740
B
Telephone number (see instructions)
(800) 496-2583
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)
$
5,327,882
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
...
127,097
127,035
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
199,598
b
Gross sales price for all assets on line 6a
1,169,172
7
Capital gain net income (from Part IV, line 2)
...
199,598
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
........
326,695
326,633
13
Compensation of officers, directors, trustees, etc.
53,448
35,502
17,946
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)
...
10,050
3,422
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)
.......
250
250
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
63,748
38,924
0
18,196
25
Contributions, gifts, grants paid
.......
221,523
221,523
26
Total expenses and disbursements.
Add lines 24 and 25
285,271
38,924
0
239,719
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
41,424
b
Net investment income
(if negative, enter -0-)
287,709
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
.............
44,954
66,092
66,092
2
Savings and temporary cash investments
.........
47,123
33,179
33,179
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)
.......
3,189,970
3,041,153
4,089,827
c
Investments—corporate bonds (attach schedule)
.......
707,775
887,310
907,071
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
228,355
231,865
231,713
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)
4,218,177
4,259,599
5,327,882
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
........
4,218,177
4,259,599
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances
(see instructions)
.....
4,218,177
4,259,599
30
Total liabilities and net assets/fund balances
(see instructions)
.
4,218,177
4,259,599
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
4,218,177
2
Enter amount from Part I, line 27a
.....................
2
41,424
3
Other increases not included in line 2 (itemize)
3
5,092
4
Add lines 1, 2, and 3
..........................
4
4,264,693
5
Decreases not included in line 2 (itemize)
5
5,094
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
4,259,599
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
. FHLMC
2019-01-17
b
1. GILEAD SCIENCES INC
2015-01-08
2019-01-23
c
9. GILEAD SCIENCES INC
2015-01-08
2019-01-23
d
2. GILEAD SCIENCES INC
2015-01-08
2019-01-23
e
3. GILEAD SCIENCES INC
2015-01-08
2019-01-23
4. MASTERCARD INC - CLASS A
2012-10-15
2019-01-23
11. WORLDPAY INC CL A
2018-10-08
2019-01-23
1. WORLDPAY INC CL A
2018-10-08
2019-01-23
15. GILEAD SCIENCES INC
2019-01-24
3. MASTERCARD INC - CLASS A
2012-10-15
2019-01-24
9. MASTERCARD INC - CLASS A
2012-10-15
2019-01-24
11. WORLDPAY INC CL A
2017-09-22
2019-01-24
7. WORLDPAY INC CL A
2018-10-08
2019-01-24
2. GILEAD SCIENCES INC
2016-02-10
2019-01-25
5. GILEAD SCIENCES INC
2016-02-10
2019-01-25
1. GILEAD SCIENCES INC
2016-02-10
2019-01-25
12. MASTERCARD INC - CLASS A
2012-10-15
2019-01-25
22. WORLDPAY INC CL A
2017-09-22
2019-01-25
2. GILEAD SCIENCES INC
2016-02-10
2019-01-28
4. GILEAD SCIENCES INC
2016-02-10
2019-01-28
14. WORLDPAY INC CL A
2017-09-22
2019-01-28
3. GILEAD SCIENCES INC
2016-02-10
2019-01-29
3. WORLDPAY INC CL A
2017-09-22
2019-01-29
1. GILEAD SCIENCES INC
2016-02-10
2019-01-30
1. GILEAD SCIENCES INC
2016-02-10
2019-01-30
2. GILEAD SCIENCES INC
2016-02-10
2019-01-30
15. WORLDPAY INC CL A
2017-09-22
2019-01-30
1. GILEAD SCIENCES INC
2016-02-10
2019-01-31
1. GILEAD SCIENCES INC
2016-02-10
2019-01-31
4. GILEAD SCIENCES INC
2019-02-01
4575.828 AMG MG PICTET INTL-Z
2019-02-04
10568.253 PIMCO INVESTMENT GRADE CORPORATE BOND FUND
2018-09-05
2019-02-04
5564.831 AMG MG PICTET INTL-Z
2016-01-28
2019-02-14
13. ANALOG DEVICES INC
2018-09-13
2019-02-19
6. ANALOG DEVICES INC
2018-09-13
2019-02-19
17. ANALOG DEVICES INC
2019-02-19
4. ANALOG DEVICES INC
2018-09-13
2019-02-19
39. ANALOG DEVICES INC
2019-02-19
6. ANALOG DEVICES INC
2019-02-19
22. ANALOG DEVICES INC
2019-02-20
1. ADOBE SYS INC
2012-08-03
2019-03-06
1. AMERICAN EXPRESS CO
2018-07-18
2019-03-06
4. APPLE COMPUTER INC
2006-04-06
2019-03-06
1. AUTOMATIC DATA PROCESSING INC
2018-12-03
2019-03-06
16. BANK OF AMERICA CORPORATION
2013-09-19
2019-03-06
1. BERKSHIRE HATHAWAY INC DEL CL B
2018-09-11
2019-03-06
8. BOSTON SCIENTIFIC CORP
2016-09-15
2019-03-06
4. BRISTOL MYERS SQUIBB CO
2019-03-06
1. BROADCOM INC
2013-04-26
2019-03-06
8. CELGENE CORP.
2019-03-06
1. CHARTER COMMUNICATIONS INC-A
2018-04-13
2019-03-06
5. CITIGROUP INC NEW
2017-05-02
2019-03-06
4. COCA-COLA CO
2018-04-13
2019-03-06
4. COMCAST CORP NEW CL A
2019-01-29
2019-03-06
2. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-03-06
1. DIAMONDBACK ENERGY INC
2019-01-08
2019-03-06
4. DISNEY WALT CO
2016-12-16
2019-03-06
1. DOLLAR TREE INC
2017-10-27
2019-03-06
6. DOWDUPONT INC
2019-03-06
3. EOG RESOURCES INC
2016-05-25
2019-03-06
1. ELECTRONIC ARTS
2018-09-20
2019-03-06
2. FACEBOOK INC-A
2014-07-25
2019-03-06
2. FIDELITY NATL INFORMATION SVCS INC
2014-12-19
2019-03-06
1. FISERV INC
2019-01-25
2019-03-06
1. GENERAL DYNAMICS CORP
2018-12-13
2019-03-06
2. HOME DEPOT INC
2012-03-20
2019-03-06
3. HONEYWELL INTL INC
2012-06-15
2019-03-06
1. INTERCONTINENTALEXCHANGE GROUP, INC
2017-01-31
2019-03-06
892. JPMORGAN BETABUILDERS JAPAN ETF
2018-07-19
2019-03-06
1300. JPMORGAN BETABUILDERS JAPAN ETF
2019-03-06
11. KEYCORP NEW
2018-10-19
2019-03-06
2. LOWES COS INC
2011-09-28
2019-03-06
3. MARATHON PETROLEUM CORPORATION
2018-07-26
2019-03-06
2. MASTERCARD INC - CLASS A
2012-10-15
2019-03-06
3. MERCK & CO INC
2016-08-05
2019-03-06
10. MICROSOFT CORP
2002-08-29
2019-03-06
6. MONDELEZ INTERNATIONAL-W/I
2014-08-13
2019-03-06
9. MORGAN STANLEY DEAN WITTER & CO NEW
2013-11-12
2019-03-06
1. NEXTERA ENERGY INC
2018-07-18
2019-03-06
5. NISOURCE INC
2015-01-14
2019-03-06
2. NORFOLK SOUTHN CORP
2018-05-15
2019-03-06
1. NORTHROP GRUMMAN CORP
2017-10-10
2019-03-06
1. NVIDIA CORP
2018-10-08
2019-03-06
5. OCCIDENTAL PETE CORP
2009-10-15
2019-03-06
1. PARKER HANNIFIN CORP
2018-01-11
2019-03-06
2. PAYPAL HOLDINGS INC
2019-01-23
2019-03-06
3. PEPSICO INC
2018-05-22
2019-03-06
6. PFIZER INC
2015-04-08
2019-03-06
5. PFIZER INC
2018-10-30
2019-03-06
3. PHILIP MORRIS INTERNATIONAL
2017-04-24
2019-03-06
1. PIONEER NAT RES CO
2015-12-09
2019-03-06
2. PRUDENTIAL FINL INC
2018-12-21
2019-03-06
2. ROSS STORES INC
2018-12-11
2019-03-06
2. SALESFORCE.COM INC
2018-10-08
2019-03-06
3. SCHWAB CHARLES CORP NEW
2016-06-03
2019-03-06
2. STANLEY BLACK & DECKER,INC.
2015-11-13
2019-03-06
3. TEXAS INSTRS INC
2019-02-19
2019-03-06
2. UNION PAC CORP
2018-02-22
2019-03-06
1. UNITED TECHNOLOGIES CORP
2017-12-11
2019-03-06
3. UNITEDHEALTH GROUP INC
2012-01-19
2019-03-06
1. VERTEX PHARMACEUTICALS INC
2011-12-15
2019-03-06
2. VISA INC CLASS A SHARES
2015-10-19
2019-03-06
2. WASTE CONNECTIONS INC
2016-07-26
2019-03-06
6. WELLS FARGO & CO NEW
2012-06-05
2019-03-06
1. WEX INC
2016-05-02
2019-03-06
1. YUM BRANDS INC
2018-11-29
2019-03-06
2. ZIMMER HLDGS INC
2018-04-26
2019-03-06
2. ALLEGION PLC
2019-03-06
1. ACCENTURE PLC
2014-01-16
2019-03-06
2. MEDTRONIC PLC
2018-07-18
2019-03-06
2. APTIV PLC
2018-04-26
2019-03-06
2. CHUBB LTD
2012-01-09
2019-03-06
2. NXP SEMICONDUCTORS NV
2019-02-20
2019-03-06
12. BIOGEN IDEC INC
2010-06-18
2019-03-14
4. BIOGEN IDEC INC
2018-10-08
2019-03-14
169. BRISTOL MYERS SQUIBB CO
2019-03-14
37. DISNEY WALT CO
2019-03-14
. BANK OF AMERICA CORPORATION
2019-03-20
7. ADOBE SYS INC
2012-08-03
2019-04-01
5. ALEXION PHARMACEUTICALS INC
2019-03-14
2019-04-01
4. ALPHABET INC-CL C
2019-04-01
2. ALPHABET INC-CL A
2016-07-11
2019-04-01
3. AMAZON COM INC
2015-03-12
2019-04-01
7. AMERICAN EXPRESS CO
2018-07-18
2019-04-01
28. APPLE COMPUTER INC
2019-04-01
8. AUTOMATIC DATA PROCESSING INC
2018-12-03
2019-04-01
103. BANK OF AMERICA CORPORATION
2019-04-01
12. BERKSHIRE HATHAWAY INC DEL CL B
2018-10-15
2019-04-01
51. BOSTON SCIENTIFIC CORP
2019-04-01
11. BROADCOM INC
2019-04-01
4. CELGENE CORP.
2019-04-01
10. CELGENE CORP.
2019-03-14
2019-04-01
1. CHARTER COMMUNICATIONS INC-A
2018-04-13
2019-04-01
4. CHARTER COMMUNICATIONS INC-A
2016-12-15
2019-04-01
37. CITIGROUP INC NEW
2017-05-02
2019-04-01
25. COCA-COLA CO
2018-04-13
2019-04-01
59. COMCAST CORP NEW CL A
2019-03-14
2019-04-01
16. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-04-01
10. DIAMONDBACK ENERGY INC
2019-04-01
19. DISNEY WALT CO
2016-12-05
2019-04-01
13. DOLLAR TREE INC
2019-04-01
44. DOWDUPONT INC
2019-04-01
22. EOG RESOURCES INC
2019-04-01
17. ELECTRONIC ARTS
2018-09-20
2019-04-01
9. FACEBOOK INC-A
2014-07-25
2019-04-01
13. FIDELITY NATL INFORMATION SVCS INC
2014-12-19
2019-04-01
14. FISERV INC
2019-04-01
8. GENERAL DYNAMICS CORP
2018-12-13
2019-04-01
12. HOME DEPOT INC
2012-03-20
2019-04-01
20. HONEYWELL INTL INC
2012-06-15
2019-04-01
8. INTERCONTINENTALEXCHANGE GROUP, INC
2017-01-31
2019-04-01
71. KEYCORP NEW
2018-10-19
2019-04-01
19. LILLY ELI & CO
2019-04-01
14. LOWES COS INC
2011-09-28
2019-04-01
26. MARATHON PETROLEUM CORPORATION
2018-07-26
2019-04-01
14. MASTERCARD INC - CLASS A
2009-05-05
2019-04-01
29. MERCK & CO INC
2019-03-14
2019-04-01
65. MICROSOFT CORP
2002-08-29
2019-04-01
34. MONDELEZ INTERNATIONAL-W/I
2019-04-01
59. MORGAN STANLEY DEAN WITTER & CO NEW
2019-04-01
3. NETFLIX.COM INC
2018-09-13
2019-04-01
8. NEXTERA ENERGY INC
2018-07-18
2019-04-01
32. NISOURCE INC
2015-01-14
2019-04-01
13. NORFOLK SOUTHN CORP
2019-04-01
5. NORTHROP GRUMMAN CORP
2019-04-01
9. NVIDIA CORP
2019-04-01
3. O'REILLY AUTOMOTIVE INC
2017-05-05
2019-04-01
30. OCCIDENTAL PETE CORP
2019-04-01
6. OCCIDENTAL PETE CORP
2009-10-15
2019-04-01
4. PARKER HANNIFIN CORP
2018-01-11
2019-04-01
19. PAYPAL HOLDINGS INC
2019-01-23
2019-04-01
11. PEPSICO INC
2018-05-22
2019-04-01
8. PEPSICO INC
2016-02-17
2019-04-01
70. PFIZER INC
2019-04-01
17. PHILIP MORRIS INTERNATIONAL
2017-04-24
2019-04-01
11. PIONEER NAT RES CO
2019-04-01
9. PRUDENTIAL FINL INC
2019-04-01
2. REGENERON PHARMACEUTICALS INC
2019-04-01
14. ROSS STORES INC
2018-12-11
2019-04-01
5. SVB FINANCIAL GROUP
2019-04-01
11. SALESFORCE.COM INC
2018-10-08
2019-04-01
20. SCHWAB CHARLES CORP NEW
2019-04-01
11. STANLEY BLACK & DECKER,INC.
2019-04-01
21. TEXAS INSTRS INC
2019-02-19
2019-04-01
15. UNION PAC CORP
2019-04-01
6. UNITED TECHNOLOGIES CORP
2019-04-01
18. UNITEDHEALTH GROUP INC
2019-04-01
5. VERTEX PHARMACEUTICALS INC
2011-12-15
2019-04-01
10. VISA INC CLASS A SHARES
2015-10-19
2019-04-01
12. WASTE CONNECTIONS INC
2016-07-26
2019-04-01
43. WELLS FARGO & CO NEW
2019-04-01
6. WEX INC
2019-04-01
8. YUM BRANDS INC
2019-04-01
19. ZIMMER HLDGS INC
2019-04-01
10. ALLEGION PLC
2019-04-01
10. ACCENTURE PLC
2019-04-01
8. LINDE PLC
2018-12-11
2019-04-01
16. MEDTRONIC PLC
2018-07-18
2019-04-01
13. APTIV PLC
2019-04-01
14. CHUBB LTD
2012-01-09
2019-04-01
11. NXP SEMICONDUCTORS NV
2019-04-01
2521.856 DODGE & INTERNATIONAL STOCK FUND
2010-08-31
2019-04-02
. PFIZER INC
2019-04-03
28. DOW INC
2019-04-08
4. DOW INC
2017-02-22
2019-04-08
1. DOW INC
2017-02-22
2019-04-08
35. DOW INC
2019-04-08
18. DOW INC
2019-04-08
4. DOW INC
2015-07-15
2019-04-09
55. OCCIDENTAL PETE CORP
2019-04-25
7. OCCIDENTAL PETE CORP
2018-08-09
2019-04-25
63. OCCIDENTAL PETE CORP
2019-04-25
13. OCCIDENTAL PETE CORP
2019-05-01
3. OCCIDENTAL PETE CORP
2017-02-13
2019-05-01
8. REGENERON PHARMACEUTICALS INC
2019-05-01
2. REGENERON PHARMACEUTICALS INC
2019-05-01
40. OCCIDENTAL PETE CORP
2019-05-02
3. OCCIDENTAL PETE CORP
2006-01-20
2019-05-02
1. OCCIDENTAL PETE CORP
2006-01-20
2019-05-02
8. OCCIDENTAL PETE CORP
2019-05-02
4. OCCIDENTAL PETE CORP
2007-01-12
2019-05-02
5. OCCIDENTAL PETE CORP
2007-01-12
2019-05-03
14. OCCIDENTAL PETE CORP
2007-01-12
2019-05-03
2. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
30. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
15. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
5. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
6. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
44. SCHWAB CHARLES CORP NEW
2019-05-15
39. SCHWAB CHARLES CORP NEW
2019-05-16
10. SCHWAB CHARLES CORP NEW
2019-05-16
25. SCHWAB CHARLES CORP NEW
2019-05-16
11. MEDTRONIC PLC
2019-05-16
24. MEDTRONIC PLC
2019-05-16
30. MEDTRONIC PLC
2019-05-16
12. MEDTRONIC PLC
2019-05-17
20. MEDTRONIC PLC
2019-05-17
9. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
11. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
5. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
40. DELTA AIR LINES INC DEL NEW
2019-06-05
15. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-05
27. PHILIP MORRIS INTERNATIONAL
2017-04-24
2019-06-05
23. PHILIP MORRIS INTERNATIONAL
2018-10-24
2019-06-05
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
11. DELTA AIR LINES INC DEL NEW
2019-06-06
15. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
2. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
2. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
2. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
3. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
121. BANK OF AMERICA CORPORATION
2019-06-10
26. DOLLAR TREE INC
2019-06-10
95. WELLS FARGO & CO NEW
2019-06-10
27. DOLLAR TREE INC
2019-06-11
11. DOLLAR TREE INC
2018-12-17
2019-06-11
9. DOLLAR TREE INC
2018-12-17
2019-06-11
. CORTEVA INC
2019-06-13
. DUPONT DE NEMOURS INC-WI
2019-06-13
1785.563 DIAMOND HILL LONG/SHORT-Y
2018-11-30
2019-06-14
9. ADOBE SYS INC
2012-08-03
2019-06-27
9. SVB FINANCIAL GROUP
2019-08-14
6. SVB FINANCIAL GROUP
2015-02-05
2019-08-14
14. APTIV PLC
2019-08-14
7. APTIV PLC
2019-08-14
20. APTIV PLC
2017-05-18
2019-08-14
10. SVB FINANCIAL GROUP
2015-02-05
2019-08-15
37. APTIV PLC
2019-08-15
. GENERAL MOTORS CO
2019-09-05
458. ISHARES TR BARCLAYS MBS BD FD
2019-02-04
2019-09-19
627. VANGUARD BD INDEX FD INC
2019-09-19
47. DISNEY WALT CO
2019-10-25
12. ACCENTURE PLC
2014-01-15
2019-10-25
15. ACCENTURE PLC
2019-10-28
30. NISOURCE INC
2019-11-11
39. NISOURCE INC
2019-11-11
32. NISOURCE INC
2019-11-12
79. NISOURCE INC
2019-11-12
7. NISOURCE INC
2013-02-26
2019-11-12
8. NISOURCE INC
2013-02-26
2019-11-13
53. CELGENE CORP.
2007-12-17
2019-11-21
131. CELGENE CORP.
2019-11-21
295.618 FIDELITY 500 INDEX-INST PRM
2018-07-13
2019-11-22
528. ISHARES CORE MSCI EAFE ETF
2018-01-24
2019-11-22
71. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
7. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
3. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
89. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-26
14. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-27
8. ABBVIE INC
2019-12-04
1. ADOBE SYS INC
2012-08-03
2019-12-04
2. ALPHABET INC-CL C
2019-10-25
2019-12-04
1. AMAZON COM INC
2019-10-25
2019-12-04
8. AMERICAN EXPRESS CO
2019-06-10
2019-12-04
9. APPLE COMPUTER INC
2006-04-07
2019-12-04
3. AUTOMATIC DATA PROCESSING INC
2019-08-14
2019-12-04
33. BANK OF AMERICA CORPORATION
2013-04-18
2019-12-04
4. BERKSHIRE HATHAWAY INC DEL CL B
2018-10-15
2019-12-04
18. BOSTON SCIENTIFIC CORP
2016-12-05
2019-12-04
10. BRISTOL MYERS SQUIBB CO
2019-11-21
2019-12-04
3. BROADCOM INC
2019-12-04
2. CHARTER COMMUNICATIONS INC-A
2016-12-15
2019-12-04
12. CITIGROUP INC NEW
2010-05-26
2019-12-04
8. COCA-COLA CO
2018-04-13
2019-12-04
24. COMCAST CORP NEW CL A
2019-05-14
2019-12-04
11. CORTEVA INC
2019-12-04
1. DIAMONDBACK ENERGY INC
2017-05-15
2019-12-04
2. DIAMONDBACK ENERGY INC
2019-01-08
2019-12-04
4. DISNEY WALT CO
2016-10-10
2019-12-04
6. DUPONT DE NEMOURS INC-WI
2017-02-22
2019-12-04
7. EOG RESOURCES INC
2016-05-02
2019-12-04
6. ELECTRONIC ARTS
2019-12-04
3. FACEBOOK INC-A
2014-07-25
2019-12-04
7. FIDELITY NATL INFORMATION SVCS INC
2019-08-14
2019-12-04
10. FISERV INC
2019-12-04
3. GENERAL DYNAMICS CORP
2018-12-13
2019-12-04
4. HOME DEPOT INC
2011-09-29
2019-12-04
7. HONEYWELL INTL INC
2010-03-19
2019-12-04
3. INTERCONTINENTALEXCHANGE GROUP, INC
2017-01-31
2019-12-04
24. KEYCORP NEW
2018-10-19
2019-12-04
5. LILLY ELI & CO
2019-12-04
5. LOWES COS INC
2011-09-28
2019-12-04
12. MARATHON PETROLEUM CORPORATION
2019-12-04
5. MASTERCARD INC - CLASS A
2009-05-05
2019-12-04
2. MCDONALDS CORP
2019-06-10
2019-12-04
10. MERCK & CO INC
2019-03-14
2019-12-04
21. MICROSOFT CORP
2002-08-29
2019-12-04
12. MONDELEZ INTERNATIONAL-W/I
2011-09-19
2019-12-04
19. MORGAN STANLEY DEAN WITTER & CO NEW
2016-02-25
2019-12-04
2. NETFLIX.COM INC
2018-09-13
2019-12-04
3. NEXTERA ENERGY INC
2018-07-18
2019-12-04
5. NORFOLK SOUTHN CORP
2018-05-15
2019-12-04
2. NORTHROP GRUMMAN CORP
2019-05-20
2019-12-04
2. NVIDIA CORP
2018-06-12
2019-12-04
1. O'REILLY AUTOMOTIVE INC
2017-05-05
2019-12-04
7. PAYPAL HOLDINGS INC
2019-01-23
2019-12-04
7. PEPSICO INC
2016-02-17
2019-12-04
23. PFIZER INC
2015-04-02
2019-12-04
3. PHILIP MORRIS INTERNATIONAL
2018-10-24
2019-12-04
3. PIONEER NAT RES CO
2016-03-22
2019-12-04
5. PROCTER & GAMBLE CO
2019-06-05
2019-12-04
3. QUALCOMM INC
2019-05-01
2019-12-04
4. ROSS STORES INC
2018-12-11
2019-12-04
6. SALESFORCE.COM INC
2018-10-08
2019-12-04
4. STANLEY BLACK & DECKER,INC.
2016-02-17
2019-12-04
7. TEXAS INSTRS INC
2019-02-19
2019-12-04
1. TEXAS INSTRS INC
2016-03-10
2019-12-04
6. UNION PAC CORP
2017-05-18
2019-12-04
3. UNITED TECHNOLOGIES CORP
2019-12-04
6. UNITEDHEALTH GROUP INC
2011-09-16
2019-12-04
2. VERTEX PHARMACEUTICALS INC
2011-12-15
2019-12-04
3. VISA INC CLASS A SHARES
2015-10-19
2019-12-04
4. WASTE CONNECTIONS INC
2016-07-26
2019-12-04
10. WELLS FARGO & CO NEW
2011-08-12
2019-12-04
2. WEX INC
2016-06-01
2019-12-04
3. YUM BRANDS INC
2018-11-29
2019-12-04
6. ZIMMER HLDGS INC
2019-12-04
4. ALLEGION PLC
2019-12-04
2. ACCENTURE PLC
2014-04-22
2019-12-04
7. LINDE PLC
2019-08-14
2019-12-04
4. CHUBB LTD
2019-12-04
4. NXP SEMICONDUCTORS NV
2019-12-04
13. ABBVIE INC
2019-11-11
2019-12-06
3. ADOBE SYS INC
2012-08-03
2019-12-06
5. ALEXION PHARMACEUTICALS INC
2019-03-14
2019-12-06
2. ALPHABET INC-CL C
2015-01-15
2019-12-06
1. ALPHABET INC-CL A
2012-07-11
2019-12-06
1. AMAZON COM INC
2019-10-25
2019-12-06
1. AMAZON COM INC
2015-03-12
2019-12-06
9. AMERICAN EXPRESS CO
2019-06-10
2019-12-06
15. APPLE COMPUTER INC
2006-04-07
2019-12-06
5. AUTOMATIC DATA PROCESSING INC
2019-08-14
2019-12-06
45. BANK OF AMERICA CORPORATION
2019-12-06
7. BERKSHIRE HATHAWAY INC DEL CL B
2019-12-06
27. BOSTON SCIENTIFIC CORP
2016-12-05
2019-12-06
16. BRISTOL MYERS SQUIBB CO
2019-11-21
2019-12-06
6. BROADCOM INC
2013-05-17
2019-12-06
6164.514 AMER FNDS INTL VNTG-F3
2019-12-06
4. CHARTER COMMUNICATIONS INC-A
2019-12-06
19. CITIGROUP INC NEW
2019-12-06
14. COCA-COLA CO
2018-04-13
2019-12-06
38. COMCAST CORP NEW CL A
2019-05-14
2019-12-06
17. CORTEVA INC
2019-12-06
6. DIAMONDBACK ENERGY INC
2019-12-06
6. DISNEY WALT CO
2016-10-10
2019-12-06
9. DUPONT DE NEMOURS INC-WI
2019-12-06
12. EOG RESOURCES INC
2019-12-06
9. ELECTRONIC ARTS
2018-09-20
2019-12-06
5. FACEBOOK INC-A
2014-07-25
2019-12-06
9. FIDELITY NATL INFORMATION SVCS INC
2019-08-14
2019-12-06
19. FISERV INC
2019-12-06
5. GENERAL DYNAMICS CORP
2018-12-13
2019-12-06
7. HOME DEPOT INC
2011-09-29
2019-12-06
11. HONEYWELL INTL INC
2010-03-19
2019-12-06
4. INTERCONTINENTALEXCHANGE GROUP, INC
2017-01-31
2019-12-06
610.826 JPMORGAN CORE BOND FUND ULTRA
2019-11-25
2019-12-06
39. KEYCORP NEW
2019-12-06
10. LILLY ELI & CO
2019-12-06
8. LOWES COS INC
2011-09-28
2019-12-06
20. MARATHON PETROLEUM CORPORATION
2019-12-06
7. MASTERCARD INC - CLASS A
2009-05-05
2019-12-06
3. MCDONALDS CORP
2019-06-10
2019-12-06
15. MERCK & CO INC
2019-03-14
2019-12-06
35. MICROSOFT CORP
2002-08-29
2019-12-06
18. MONDELEZ INTERNATIONAL-W/I
2019-12-06
32. MORGAN STANLEY DEAN WITTER & CO NEW
2019-12-06
2. NETFLIX.COM INC
2018-09-13
2019-12-06
4. NEXTERA ENERGY INC
2018-07-18
2019-12-06
6. NORFOLK SOUTHN CORP
2018-03-09
2019-12-06
3. NORTHROP GRUMMAN CORP
2019-05-20
2019-12-06
5. NVIDIA CORP
2018-06-12
2019-12-06
1. O'REILLY AUTOMOTIVE INC
2017-05-05
2019-12-06
10. PAYPAL HOLDINGS INC
2019-01-23
2019-12-06
10. PEPSICO INC
2016-02-24
2019-12-06
38. PFIZER INC
2015-04-02
2019-12-06
5. PHILIP MORRIS INTERNATIONAL
2018-10-24
2019-12-06
6. PIONEER NAT RES CO
2019-12-06
8. PROCTER & GAMBLE CO
2019-06-05
2019-12-06
5. QUALCOMM INC
2019-05-01
2019-12-06
7. ROSS STORES INC
2018-12-11
2019-12-06
7. SALESFORCE.COM INC
2019-10-28
2019-12-06
2. SALESFORCE.COM INC
2018-10-08
2019-12-06
6. STANLEY BLACK & DECKER,INC.
2016-02-17
2019-12-06
11. TEXAS INSTRS INC
2016-03-10
2019-12-06
8. UNION PAC CORP
2017-05-18
2019-12-06
3. UNITED TECHNOLOGIES CORP
2019-12-06
9. UNITEDHEALTH GROUP INC
2011-09-16
2019-12-06
449.678 VANGUARD TTL INTL BND-ADM
2019-09-24
2019-12-06
3. VERTEX PHARMACEUTICALS INC
2011-12-15
2019-12-06
6. VISA INC CLASS A SHARES
2015-10-19
2019-12-06
7. WASTE CONNECTIONS INC
2019-12-06
14. WELLS FARGO & CO NEW
2019-12-06
3. WEX INC
2019-12-06
4. YUM BRANDS INC
2019-12-06
9. ZIMMER HLDGS INC
2019-12-06
6. ALLEGION PLC
2019-12-06
3. ACCENTURE PLC
2014-04-22
2019-12-06
10. LINDE PLC
2019-12-06
8. CHUBB LTD
2011-05-23
2019-12-06
6. NXP SEMICONDUCTORS NV
2019-02-20
2019-12-06
1640.577 EQUINOX IMP SYSTEM MACRO-I
2016-01-28
2019-12-09
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
66
66
b
69
102
-33
c
615
914
-299
d
137
203
-66
e
204
305
-101
793
190
603
906
1,067
-161
83
97
-14
1,017
1,336
-319
599
142
457
1,790
427
1,363
905
793
112
576
679
-103
136
178
-42
345
445
-100
69
89
-20
2,431
570
1,861
1,824
1,585
239
136
178
-42
271
356
-85
1,165
1,009
156
207
267
-60
246
216
30
69
89
-20
70
89
-19
139
178
-39
1,253
1,081
172
70
89
-19
70
89
-19
279
354
-75
39,444
42,651
-3,207
106,634
106,474
160
48,247
48,539
-292
1,361
1,198
163
626
553
73
1,784
1,564
220
417
368
49
4,069
2,488
1,581
630
380
250
2,330
1,392
938
256
32
224
109
103
6
698
40
658
153
147
6
461
236
225
201
214
-13
318
186
132
211
207
4
272
39
233
690
833
-143
341
306
35
312
298
14
182
178
4
154
145
9
99
107
-8
100
105
-5
458
416
42
101
93
8
327
382
-55
276
249
27
95
114
-19
345
151
194
213
127
86
85
85
167
172
-5
369
99
270
463
160
303
75
58
17
20,030
21,407
-1,377
29,175
31,196
-2,021
186
196
-10
205
40
165
179
241
-62
450
95
355
242
191
51
1,116
251
865
281
212
69
375
268
107
188
169
19
135
77
58
358
300
58
281
293
-12
153
268
-115
330
393
-63
173
208
-35
193
181
12
350
300
50
251
208
43
209
213
-4
261
337
-76
139
143
-4
191
160
31
189
161
28
313
303
10
136
87
49
268
210
58
316
323
-7
332
267
65
126
123
3
716
156
560
181
31
150
296
154
142
169
99
70
300
182
118
175
94
81
96
92
4
246
229
17
179
132
47
162
84
78
184
176
8
165
174
-9
266
140
126
184
189
-5
3,842
552
3,290
1,281
1,369
-88
8,315
6,616
1,699
4,231
3,808
423
15
15
1,896
224
1,672
679
673
6
4,768
2,081
2,687
2,393
1,454
939
5,415
1,121
4,294
780
721
59
5,324
277
5,047
1,289
1,177
112
2,933
1,249
1,684
2,447
2,461
-14
1,974
1,152
822
3,349
420
2,929
373
415
-42
932
875
57
346
306
40
1,383
1,165
218
2,378
2,206
172
1,170
1,114
56
2,362
2,350
12
831
857
-26
1,032
1,049
-17
2,128
1,904
224
1,336
1,201
135
2,404
2,786
-382
2,118
1,821
297
1,750
1,936
-186
1,515
678
837
1,467
828
639
1,240
1,183
57
1,370
1,375
-5
2,317
593
1,724
3,214
1,065
2,149
614
465
149
1,150
1,268
-118
2,466
1,600
866
1,487
282
1,205
1,575
2,088
-513
3,332
256
3,076
2,412
2,361
51
7,718
1,630
6,088
1,693
1,186
507
2,558
1,570
988
1,093
1,112
-19
1,531
1,355
176
905
494
411
2,505
1,951
554
1,365
1,418
-53
1,639
2,407
-768
1,169
757
412
2,004
2,332
-328
401
471
-70
706
833
-127
1,996
1,718
278
1,345
1,098
247
978
797
181
2,991
2,421
570
1,507
1,908
-401
1,678
1,552
126
855
720
135
818
853
-35
1,308
1,129
179
1,148
631
517
1,765
1,665
100
878
579
299
1,526
1,105
421
2,271
2,259
12
2,562
1,741
821
796
737
59
4,400
932
3,468
930
157
773
1,572
771
801
1,047
595
452
2,081
1,223
858
1,169
559
610
804
735
69
2,426
2,175
251
925
659
266
1,759
835
924
1,420
1,285
135
1,455
1,409
46
1,069
1,132
-63
1,974
977
997
1,018
1,035
-17
104,254
76,286
27,968
269
269
1,600
1,773
-173
229
252
-23
57
63
-6
2,003
1,914
89
1,031
949
82
227
210
17
3,416
4,138
-722
435
538
-103
3,912
4,428
-516
749
882
-133
174
202
-28
2,728
3,313
-585
680
798
-118
2,294
2,282
12
172
133
39
57
44
13
459
352
107
230
171
59
290
214
76
814
598
216
196
159
37
2,953
2,389
564
1,483
1,195
288
488
398
90
594
478
116
1,882
1,257
625
1,700
1,080
620
435
268
167
1,085
670
415
970
968
2
2,116
1,903
213
2,650
2,373
277
1,055
940
115
1,766
1,552
214
1,468
1,874
-406
1,795
2,290
-495
815
1,041
-226
2,197
2,141
56
824
802
22
2,085
3,030
-945
1,776
2,050
-274
55
53
2
604
588
16
818
802
16
109
107
2
110
107
3
111
107
4
167
160
7
55
53
2
55
53
2
3,412
1,381
2,031
2,699
2,389
310
4,408
2,458
1,950
2,879
2,469
410
1,173
950
223
959
777
182
9
9
25
25
47,121
47,320
-199
2,644
288
2,356
1,718
1,096
622
1,141
721
420
1,113
1,216
-103
562
496
66
1,596
1,416
180
1,867
1,202
665
2,933
2,620
313
32
32
49,447
48,018
1,429
50,493
49,483
1,010
6,173
4,475
1,698
2,198
997
1,201
2,756
1,196
1,560
787
456
331
1,018
487
531
834
329
505
2,056
768
1,288
182
68
114
210
77
133
5,726
1,321
4,405
14,152
12,270
1,882
32,036
28,950
3,086
33,693
37,212
-3,519
149
163
-14
15
16
-1
6
7
-1
189
205
-16
30
32
-2
697
684
13
302
32
270
2,646
2,521
125
1,763
1,720
43
944
984
-40
2,360
89
2,271
505
493
12
1,098
375
723
873
820
53
773
373
400
586
564
22
931
104
827
924
582
342
894
480
414
432
356
76
1,046
1,032
14
275
358
-83
81
104
-23
161
208
-47
594
371
223
382
560
-178
504
579
-75
606
683
-77
598
226
372
949
917
32
1,147
1,054
93
537
515
22
855
135
720
1,221
293
928
280
174
106
460
429
31
592
416
176
578
101
477
724
962
-238
1,437
91
1,346
388
402
-14
884
814
70
3,141
527
2,614
639
265
374
932
462
470
611
741
-130
700
508
192
945
750
195
691
626
65
418
522
-104
442
252
190
735
633
102
955
697
258
877
792
85
246
267
-21
391
421
-30
620
534
86
245
259
-14
456
322
134
934
908
26
619
372
247
841
753
88
120
55
65
1,032
644
388
436
368
68
1,678
299
1,379
446
63
383
543
231
312
360
198
162
534
245
289
396
185
211
298
275
23
889
682
207
488
263
225
399
159
240
1,429
1,303
126
605
276
329
467
376
91
1,137
1,111
26
916
96
820
571
673
-102
2,686
1,005
1,681
1,341
286
1,055
1,749
1,720
29
1,749
374
1,375
1,091
1,107
-16
4,056
148
3,908
850
821
29
1,520
478
1,042
1,560
1,352
208
1,190
559
631
968
903
65
1,892
207
1,685
91,913
63,041
28,872
1,882
1,164
718
1,447
755
692
762
624
138
1,682
1,634
48
432
551
-119
499
624
-125
887
557
330
574
840
-266
882
993
-111
927
1,022
-95
1,005
377
628
1,247
1,179
68
2,178
1,973
205
918
859
59
1,499
236
1,263
1,935
461
1,474
377
233
144
7,293
7,324
-31
768
530
238
1,203
805
398
932
161
771
1,209
1,570
-361
2,033
128
1,905
586
603
-17
1,334
1,221
113
5,298
878
4,420
970
397
573
1,604
688
916
614
741
-127
939
678
261
1,147
869
278
1,039
939
100
1,060
1,304
-244
446
252
194
1,046
904
142
1,375
988
387
1,458
1,309
149
417
446
-29
803
842
-39
997
854
143
418
432
-14
797
564
233
1,107
1,058
49
316
303
13
954
559
395
1,345
607
738
1,379
859
520
441
367
74
2,526
449
2,077
10,419
10,590
-171
671
94
577
1,091
462
629
637
346
291
759
341
418
600
277
323
396
367
29
1,340
1,019
321
738
394
344
607
239
368
2,053
1,861
192
1,218
546
672
716
564
152
15,930
17,242
-1,312
1,844
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
66
b
-33
c
-299
d
-66
e
-101
603
-161
-14
-319
457
1,363
112
-103
-42
-100
-20
1,861
239
-42
-85
156
-60
30
-20
-19
-39
172
-19
-19
-75
-3,207
160
-292
163
73
220
49
1,581
250
938
224
6
658
6
225
-13
132
4
233
-143
35
14
4
9
-8
-5
42
8
-55
27
-19
194
86
-5
270
303
17
-1,377
-2,021
-10
165
-62
355
51
865
69
107
19
58
58
-12
-115
-63
-35
12
50
43
-4
-76
-4
31
28
10
49
58
-7
65
3
560
150
142
70
118
81
4
17
47
78
8
-9
126
-5
3,290
-88
1,699
423
15
1,672
6
2,687
939
4,294
59
5,047
112
1,684
-14
822
2,929
-42
57
40
218
172
56
12
-26
-17
224
135
-382
297
-186
837
639
57
-5
1,724
2,149
149
-118
866
1,205
-513
3,076
51
6,088
507
988
-19
176
411
554
-53
-768
412
-328
-70
-127
278
247
181
570
-401
126
135
-35
179
517
100
299
421
12
821
59
3,468
773
801
452
858
610
69
251
266
924
135
46
-63
997
-17
27,968
269
-173
-23
-6
89
82
17
-722
-103
-516
-133
-28
-585
-118
12
39
13
107
59
76
216
37
564
288
90
116
625
620
167
415
2
213
277
115
214
-406
-495
-226
56
22
-945
-274
2
16
16
2
3
4
7
2
2
2,031
310
1,950
410
223
182
9
25
-199
2,356
622
420
-103
66
180
665
313
32
1,429
1,010
1,698
1,201
1,560
331
531
505
1,288
114
133
4,405
1,882
3,086
-3,519
-14
-1
-1
-16
-2
13
270
125
43
-40
2,271
12
723
53
400
22
827
342
414
76
14
-83
-23
-47
223
-178
-75
-77
372
32
93
22
720
928
106
31
176
477
-238
1,346
-14
70
2,614
374
470
-130
192
195
65
-104
190
102
258
85
-21
-30
86
-14
134
26
247
88
65
388
68
1,379
383
312
162
289
211
23
207
225
240
126
329
91
26
820
-102
1,681
1,055
29
1,375
-16
3,908
29
1,042
208
631
65
1,685
28,872
718
692
138
48
-119
-125
330
-266
-111
-95
628
68
205
59
1,263
1,474
144
-31
238
398
771
-361
1,905
-17
113
4,420
573
916
-127
261
278
100
-244
194
142
387
149
-29
-39
143
-14
233
49
13
395
738
520
74
2,077
-171
577
629
291
418
323
29
321
344
368
192
672
152
-1,312
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
199,598
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
244,339
5,109,354
0.047822
2017
227,427
4,957,703
0.045873
2016
235,693
4,554,428
0.05175
2015
252,850
4,816,003
0.052502
2014
233,515
4,940,730
0.047263
2
Total
of line 1, column (d)
.....................
2
0.24521
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
0.049042
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
5,023,884
5
Multiply line 4 by line 3
......................
5
246,381
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
2,877
7
Add lines 5 and 6
........................
7
249,258
8
Enter qualifying distributions from Part XII, line 4
,.............
8
239,719
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
5,754
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
5,754
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
5,754
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
3,627
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
3,627
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
2,127
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
0
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)
NY
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
JP MORGAN CHASE BANK NA
Telephone no.
(800) 496-2583
Located at
10 S DEARBORN ST MC IL 1-0111
CHICAGO
IL
ZIP+4
60603
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
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
JP MORGAN CHASE BANK N A
TRUSTEE
2
53,448
10 S DEARBORN ST MC IL 1-0111
CHICAGO
,
IL
60603
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
5,013,333
b
Average of monthly cash balances
.......................
1b
87,057
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
5,100,390
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
5,100,390
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
76,506
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
5,023,884
6
Minimum investment return.
Enter 5% of line 5
..................
6
251,194
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
251,194
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
5,754
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
5,754
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
245,440
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
245,440
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
245,440
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
239,719
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
239,719
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
239,719
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
245,440
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
221,522
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
0
b
From 2015
......
0
c
From 2016
......
0
d
From 2017
......
0
e
From 2018
......
0
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
239,719
a
Applied to 2018, but not more than line 2a
221,522
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
.....
18,197
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
227,243
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2015
....
0
b
Excess from 2016
....
0
c
Excess from 2017
....
0
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
HADASSAH MEDICAL RELIEF
50 WEST 58TH ST
NEW YORK
,
NY
10019
NONE
PC
GENERAL
110,761
UJA-FEDERATION OF NEW YORK
130 EAST 59TH STREET
NEW YORK
,
NY
10022
NONE
PC
GENERAL
55,381
AMERICAN COMMITTEE FOR THE
WEIZMANN INSTITUTE 0F SCIENCE
633 THIRD AVE FL 20
NEW YORK
,
NY
10017
NONE
PC
GENERAL
55,381
Total
.................................
3a
221,523
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
127,097
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
199,598
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)
..
326,695
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
326,695
(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