-
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
02-01-2019
, and ending
01-31-2020
Name of foundation
SARAH DECOIZART PERPETUAL CHARITABLE TR
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
13-7046581
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)
$
40,035,232
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
...
868,963
868,963
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
1,625,192
b
Gross sales price for all assets on line 6a
11,645,225
7
Capital gain net income (from Part IV, line 2)
...
1,625,192
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
........
2,494,155
2,494,155
13
Compensation of officers, directors, trustees, etc.
316,692
201,391
115,301
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)
...
37,544
22,388
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)
.......
750
750
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
354,986
223,779
0
116,051
25
Contributions, gifts, grants paid
.......
1,773,113
1,773,113
26
Total expenses and disbursements.
Add lines 24 and 25
2,128,099
223,779
0
1,889,164
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
366,056
b
Net investment income
(if negative, enter -0-)
2,270,376
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
.............
73,057
287,819
287,819
2
Savings and temporary cash investments
.........
-7,056
700,129
700,129
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)
.......
23,144,155
20,868,473
30,524,832
c
Investments—corporate bonds (attach schedule)
.......
4,416,082
6,985,283
7,301,445
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
2,055,814
1,208,400
1,221,007
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)
29,682,052
30,050,104
40,035,232
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
........
29,682,052
30,050,104
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)
.....
29,682,052
30,050,104
30
Total liabilities and net assets/fund balances
(see instructions)
.
29,682,052
30,050,104
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
29,682,052
2
Enter amount from Part I, line 27a
.....................
2
366,056
3
Other increases not included in line 2 (itemize)
3
1,996
4
Add lines 1, 2, and 3
..........................
4
30,050,104
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
30,050,104
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
52. GILEAD SCIENCES INC
2019-02-01
b
10025.063 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2014-12-31
2019-02-06
c
95923.261 LORD ABBETT SHRT DUR INC-F3
2018-11-06
2019-02-06
d
3815. VANGUARD BD INDEX FD INC
2018-12-21
2019-02-06
e
32460.137 AMG MG PICTET INTL-Z
2016-02-02
2019-02-15
2349.486 ARTISAN INTL VAL-INST
2012-01-26
2019-02-15
189. ANALOG DEVICES INC
2018-09-13
2019-02-19
82. ANALOG DEVICES INC
2018-09-13
2019-02-19
239. ANALOG DEVICES INC
2018-09-13
2019-02-19
372. ANALOG DEVICES INC
2019-02-19
246. ANALOG DEVICES INC
2019-02-19
82. ANALOG DEVICES INC
2019-02-19
310. ANALOG DEVICES INC
2019-02-20
26. ADOBE SYS INC
2012-08-03
2019-03-01
14. ALPHABET INC-CL C
2018-05-07
2019-03-01
8. ALPHABET INC-CL A
2016-07-11
2019-03-01
14. AMAZON COM INC
2015-04-08
2019-03-01
24. AMERICAN EXPRESS CO
2018-07-18
2019-03-01
104. APPLE COMPUTER INC
2010-07-01
2019-03-01
28. AUTOMATIC DATA PROCESSING INC
2018-12-03
2019-03-01
389. BANK OF AMERICA CORPORATION
2019-03-01
62. BERKSHIRE HATHAWAY INC DEL CL B
2018-09-11
2019-03-01
8. BIOGEN IDEC INC
2018-10-08
2019-03-01
197. BOSTON SCIENTIFIC CORP
2016-09-15
2019-03-01
91. BRISTOL MYERS SQUIBB CO
2017-02-23
2019-03-01
40. BROADCOM INC
2013-04-25
2019-03-01
31. CELGENE CORP.
2016-10-28
2019-03-01
21. CHARTER COMMUNICATIONS INC-A
2018-04-13
2019-03-01
139. CITIGROUP INC NEW
2017-05-15
2019-03-01
93. COCA-COLA CO
2018-04-16
2019-03-01
144. COMCAST CORP NEW CL A
2019-01-29
2019-03-01
59. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-03-01
32. DIAMONDBACK ENERGY INC
2019-01-08
2019-03-01
94. DISNEY WALT CO
2017-01-30
2019-03-01
46. DOLLAR TREE INC
2017-10-27
2019-03-01
161. DOWDUPONT INC
2018-04-09
2019-03-01
83. EOG RESOURCES INC
2016-08-05
2019-03-01
57. ELECTRONIC ARTS
2018-09-20
2019-03-01
33. FACEBOOK INC-A
2014-07-25
2019-03-01
51. FIDELITY NATL INFORMATION SVCS INC
2019-03-01
49. FISERV INC
2019-01-25
2019-03-01
30. GENERAL DYNAMICS CORP
2017-02-10
2019-03-01
47. HOME DEPOT INC
2012-03-20
2019-03-01
77. HONEYWELL INTL INC
2012-06-15
2019-03-01
31. INTERCONTINENTALEXCHANGE GROUP, INC
2019-03-01
2000. ISHARES MSCI JAPAN ETF
2018-10-30
2019-03-01
19024.39 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2014-12-31
2019-03-01
264. KEYCORP NEW
2018-10-08
2019-03-01
64. LILLY ELI & CO
2015-07-02
2019-03-01
54. LOWES COS INC
2011-09-28
2019-03-01
89. MARATHON PETROLEUM CORPORATION
2019-03-01
52. MASTERCARD INC - CLASS A
2010-03-04
2019-03-01
79. MERCK & CO INC
2017-10-03
2019-03-01
248. MICROSOFT CORP
2015-02-13
2019-03-01
132. MONDELEZ INTERNATIONAL-W/I
2019-03-01
225. MORGAN STANLEY DEAN WITTER & CO NEW
2015-12-02
2019-03-01
11. NETFLIX.COM INC
2018-09-13
2019-03-01
28. NEXTERA ENERGY INC
2018-07-18
2019-03-01
123. NISOURCE INC
2015-12-03
2019-03-01
53. NORFOLK SOUTHN CORP
2019-03-01
20. NORTHROP GRUMMAN CORP
2017-10-10
2019-03-01
31. NVIDIA CORP
2018-10-08
2019-03-01
10. O'REILLY AUTOMOTIVE INC
2017-05-08
2019-03-01
136. OCCIDENTAL PETE CORP
2019-03-01
16. PARKER HANNIFIN CORP
2018-01-11
2019-03-01
70. PAYPAL HOLDINGS INC
2019-01-23
2019-03-01
71. PEPSICO INC
2018-05-22
2019-03-01
265. PFIZER INC
2018-10-30
2019-03-01
72. PHILIP MORRIS INTERNATIONAL
2019-03-01
40. PIONEER NAT RES CO
2015-12-10
2019-03-01
36. PRUDENTIAL FINL INC
2018-12-21
2019-03-01
7. REGENERON PHARMACEUTICALS INC
2019-03-01
51. ROSS STORES INC
2018-12-11
2019-03-01
16. SVB FINANCIAL GROUP
2019-03-01
42. SALESFORCE.COM INC
2018-10-08
2019-03-01
75. SCHWAB CHARLES CORP NEW
2016-06-03
2019-03-01
43. STANLEY BLACK & DECKER,INC.
2019-03-01
83. TEXAS INSTRS INC
2019-02-19
2019-03-01
24. UNION PAC CORP
2018-02-22
2019-03-01
26. UNITED TECHNOLOGIES CORP
2019-03-01
68. UNITEDHEALTH GROUP INC
2019-03-01
20. VERTEX PHARMACEUTICALS INC
2011-11-29
2019-03-01
40. VISA INC CLASS A SHARES
2015-10-19
2019-03-01
48. WASTE CONNECTIONS INC
2016-08-10
2019-03-01
160. WELLS FARGO & CO NEW
2017-11-20
2019-03-01
22. WEX INC
2016-05-02
2019-03-01
29. YUM BRANDS INC
2019-03-01
71. ZIMMER HLDGS INC
2018-04-26
2019-03-01
41. ALLEGION PLC
2015-11-19
2019-03-01
38. ACCENTURE PLC
2019-03-01
22. LINDE PLC
2018-12-11
2019-03-01
57. MEDTRONIC PLC
2018-07-18
2019-03-01
49. APTIV PLC
2019-03-01
52. CHUBB LTD
2011-07-29
2019-03-01
42. NXP SEMICONDUCTORS NV
2019-02-20
2019-03-01
90. BIOGEN IDEC INC
2018-10-08
2019-03-14
133. BIOGEN IDEC INC
2011-08-16
2019-03-14
2376. BRISTOL MYERS SQUIBB CO
2019-03-14
523. DISNEY WALT CO
2019-03-14
. BANK OF AMERICA CORPORATION
2019-03-20
42292.109 AMG MG PICTET INTL-Z
2016-02-02
2019-04-03
18. ADOBE SYS INC
2012-08-03
2019-04-03
14. ALEXION PHARMACEUTICALS INC
2019-03-14
2019-04-03
11. ALPHABET INC-CL C
2018-05-07
2019-04-03
4. ALPHABET INC-CL A
2016-07-11
2019-04-03
8. AMAZON COM INC
2015-04-08
2019-04-03
17. AMERICAN EXPRESS CO
2018-07-18
2019-04-03
73. APPLE COMPUTER INC
2010-07-01
2019-04-03
22. AUTOMATIC DATA PROCESSING INC
2018-12-03
2019-04-03
274. BANK OF AMERICA CORPORATION
2018-02-06
2019-04-03
32. BERKSHIRE HATHAWAY INC DEL CL B
2018-09-11
2019-04-03
137. BOSTON SCIENTIFIC CORP
2016-09-15
2019-04-03
27. BROADCOM INC
2013-04-25
2019-04-03
35. CELGENE CORP.
2016-10-28
2019-04-03
16. CHARTER COMMUNICATIONS INC-A
2018-04-13
2019-04-03
96. CITIGROUP INC NEW
2017-05-15
2019-04-03
66. COCA-COLA CO
2018-04-16
2019-04-03
156. COMCAST CORP NEW CL A
2019-03-14
2019-04-03
41. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-04-03
26. DIAMONDBACK ENERGY INC
2019-01-08
2019-04-03
51. DISNEY WALT CO
2016-12-08
2019-04-03
32. DOLLAR TREE INC
2017-10-27
2019-04-03
39. DOW INC
2018-04-09
2019-04-03
118. DOWDUPONT INC
2018-04-09
2019-04-03
58. EOG RESOURCES INC
2016-08-05
2019-04-03
45. ELECTRONIC ARTS
2018-09-20
2019-04-03
25. FACEBOOK INC-A
2014-07-25
2019-04-03
36. FIDELITY NATL INFORMATION SVCS INC
2019-04-03
35. FISERV INC
2019-04-03
23. GENERAL DYNAMICS CORP
2017-02-10
2019-04-03
32. HOME DEPOT INC
2019-04-03
54. HONEYWELL INTL INC
2012-06-15
2019-04-03
21. INTERCONTINENTALEXCHANGE GROUP, INC
2017-02-01
2019-04-03
191. KEYCORP NEW
2018-10-08
2019-04-03
44. LILLY ELI & CO
2019-04-03
38. LOWES COS INC
2019-04-03
69. MARATHON PETROLEUM CORPORATION
2018-09-20
2019-04-03
37. MASTERCARD INC - CLASS A
2010-03-04
2019-04-03
76. MERCK & CO INC
2019-03-14
2019-04-03
171. MICROSOFT CORP
2019-04-03
91. MONDELEZ INTERNATIONAL-W/I
2016-02-24
2019-04-03
155. MORGAN STANLEY DEAN WITTER & CO NEW
2015-12-02
2019-04-03
7. NETFLIX.COM INC
2018-09-13
2019-04-03
21. NEXTERA ENERGY INC
2018-07-18
2019-04-03
85. NISOURCE INC
2015-12-03
2019-04-03
34. NORFOLK SOUTHN CORP
2019-04-03
14. NORTHROP GRUMMAN CORP
2017-10-10
2019-04-03
22. NVIDIA CORP
2018-10-08
2019-04-03
7. O'REILLY AUTOMOTIVE INC
2017-05-05
2019-04-03
94. OCCIDENTAL PETE CORP
2014-11-12
2019-04-03
10. PARKER HANNIFIN CORP
2018-01-11
2019-04-03
51. PAYPAL HOLDINGS INC
2019-01-23
2019-04-03
50. PEPSICO INC
2018-05-22
2019-04-03
187. PFIZER INC
2018-10-30
2019-04-03
47. PHILIP MORRIS INTERNATIONAL
2017-04-24
2019-04-03
27. PIONEER NAT RES CO
2019-04-03
26. PRUDENTIAL FINL INC
2018-12-21
2019-04-03
4. REGENERON PHARMACEUTICALS INC
2019-04-03
36. ROSS STORES INC
2018-12-11
2019-04-03
12. SVB FINANCIAL GROUP
2019-04-03
31. SALESFORCE.COM INC
2018-10-08
2019-04-03
51. SCHWAB CHARLES CORP NEW
2016-06-03
2019-04-03
30. STANLEY BLACK & DECKER,INC.
2019-04-03
58. TEXAS INSTRS INC
2019-02-19
2019-04-03
41. UNION PAC CORP
2018-02-22
2019-04-03
18. UNITED TECHNOLOGIES CORP
2017-12-12
2019-04-03
47. UNITEDHEALTH GROUP INC
2010-12-08
2019-04-03
14. VERTEX PHARMACEUTICALS INC
2011-11-29
2019-04-03
27. VISA INC CLASS A SHARES
2015-10-19
2019-04-03
32. WASTE CONNECTIONS INC
2016-08-10
2019-04-03
112. WELLS FARGO & CO NEW
2017-11-20
2019-04-03
15. WEX INC
2016-05-02
2019-04-03
20. YUM BRANDS INC
2018-11-29
2019-04-03
48. ZIMMER HLDGS INC
2018-04-26
2019-04-03
28. ALLEGION PLC
2015-11-19
2019-04-03
27. ACCENTURE PLC
2014-01-16
2019-04-03
21. LINDE PLC
2018-12-11
2019-04-03
42. MEDTRONIC PLC
2018-07-18
2019-04-03
34. APTIV PLC
2018-04-27
2019-04-03
36. CHUBB LTD
2011-07-29
2019-04-03
29. NXP SEMICONDUCTORS NV
2019-04-03
33.333 DOW INC
2018-04-09
2019-04-08
404.667 DOW INC
2019-04-08
67. DOW INC
2019-04-08
22. DOW INC
2017-02-22
2019-04-08
556. DOW INC
2019-04-08
280. DOW INC
2019-04-08
67. DOW INC
2015-07-15
2019-04-09
84799.631 LORD ABBETT SHRT DUR INC-F3
2018-11-06
2019-04-17
990. OCCIDENTAL PETE CORP
2019-04-25
464. OCCIDENTAL PETE CORP
2019-04-25
531. OCCIDENTAL PETE CORP
2019-04-25
212. OCCIDENTAL PETE CORP
2019-05-01
43. OCCIDENTAL PETE CORP
2014-12-10
2019-05-01
133. REGENERON PHARMACEUTICALS INC
2019-05-01
32. REGENERON PHARMACEUTICALS INC
2019-05-01
640. OCCIDENTAL PETE CORP
2019-05-02
45. OCCIDENTAL PETE CORP
2019-05-02
22. OCCIDENTAL PETE CORP
2017-02-10
2019-05-02
129. OCCIDENTAL PETE CORP
2019-05-02
62. OCCIDENTAL PETE CORP
2019-05-02
72. OCCIDENTAL PETE CORP
2017-02-13
2019-05-03
231. OCCIDENTAL PETE CORP
2019-05-03
33. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
480. PRUDENTIAL FINL INC
2019-05-14
231. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
72. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
104. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
707. SCHWAB CHARLES CORP NEW
2019-05-15
624. SCHWAB CHARLES CORP NEW
2019-05-16
156. SCHWAB CHARLES CORP NEW
2019-05-16
399. SCHWAB CHARLES CORP NEW
2019-05-16
554. MEDTRONIC PLC
2018-07-18
2019-05-16
469. MEDTRONIC PLC
2019-05-16
10. MEDTRONIC PLC
2018-07-18
2019-05-16
184. MEDTRONIC PLC
2019-05-17
328. MEDTRONIC PLC
2019-05-17
151. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
174. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
75. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
638. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-05
235. DELTA AIR LINES INC DEL NEW
2019-06-05
784. PHILIP MORRIS INTERNATIONAL
2017-04-24
2019-06-05
3. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
13. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
197. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
224. DELTA AIR LINES INC DEL NEW
2019-06-06
38. 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
34. 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
26. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
47. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
10. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
7. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
8. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
1930. BANK OF AMERICA CORPORATION
2019-06-10
419. DOLLAR TREE INC
2019-06-10
1510. WELLS FARGO & CO NEW
2019-06-10
139. DOLLAR TREE INC
2018-12-17
2019-06-11
462. DOLLAR TREE INC
2019-06-11
150. DOLLAR TREE INC
2018-12-17
2019-06-11
. CORTEVA INC
2019-06-13
. DUPONT DE NEMOURS INC-WI
2019-06-13
144. ADOBE SYS INC
2012-08-03
2019-06-27
8273.93 DODGE & INTERNATIONAL STOCK FUND
2019-08-14
143. SVB FINANCIAL GROUP
2019-08-14
94. SVB FINANCIAL GROUP
2015-02-05
2019-08-14
215. APTIV PLC
2019-08-14
119. APTIV PLC
2018-04-26
2019-08-14
312. APTIV PLC
2019-08-14
167. SVB FINANCIAL GROUP
2015-02-05
2019-08-15
6735.232 OCH-ZIFF OZOFII PRIVATE INVESTORS
2019-08-15
594. APTIV PLC
2019-08-15
. GENERAL MOTORS CO
2019-09-05
3478. ISHARES TR BARCLAYS MBS BD FD
2019-09-26
746. DISNEY WALT CO
2019-10-25
186. ACCENTURE PLC
2019-10-25
238. ACCENTURE PLC
2019-10-28
485. NISOURCE INC
2019-11-11
624. NISOURCE INC
2019-11-11
502. NISOURCE INC
2019-11-12
1257. NISOURCE INC
2019-11-12
113. NISOURCE INC
2013-02-26
2019-11-12
120. NISOURCE INC
2013-02-26
2019-11-13
773. CELGENE CORP.
2019-11-21
2153. CELGENE CORP.
2019-11-21
1125. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
118. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
49. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
3. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
1295. SPDR TR UNIT SER 1
2018-08-22
2019-11-25
1407. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-26
224. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-27
23171.988 EQUINOX IMP SYSTEM MACRO-I
2016-02-02
2019-12-09
37492.567 CRM LNG/SHRT OPPORT-INST
2020-01-09
3. CORTEVA INC
2018-04-09
2020-01-13
295. CORTEVA INC
2020-01-13
241. CORTEVA INC
2020-01-13
285. CORTEVA INC
2020-01-14
52.496 CORTEVA INC
2017-02-22
2020-01-14
248.504 CORTEVA INC
2020-01-14
105. CORTEVA INC
2019-06-27
2020-01-14
85. CORTEVA INC
2019-06-27
2020-01-14
32. CORTEVA INC
2019-06-27
2020-01-14
360. CORTEVA INC
2020-01-15
418. CORTEVA INC
2020-01-15
174. CORTEVA INC
2019-06-28
2020-01-15
34. CORTEVA INC
2019-06-28
2020-01-15
167.105 CORTEVA INC
2019-06-28
2020-01-15
50.895 CORTEVA INC
2020-01-15
259. CORTEVA INC
2020-01-15
15. CORTEVA INC
2016-08-10
2020-01-15
34509.375 CRM LNG/SHRT OPPORT-INST
2016-08-18
2020-01-16
106. CORTEVA INC
2020-01-16
90. CORTEVA INC
2015-07-15
2020-01-16
12. CORTEVA INC
2015-07-15
2020-01-16
20. CORTEVA INC
2015-07-15
2020-01-16
23840.238 EQUINOX IMP SYSTEM MACRO-I
2016-02-02
2020-01-16
868. QUALCOMM INC
2019-05-01
2020-01-23
13. QUALCOMM INC
2019-05-01
2020-01-23
9372.071 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2014-12-31
2020-01-27
3200. SPDR TR UNIT SER 1
2018-08-22
2020-01-27
440. EOG RESOURCES INC
2020-01-28
66. EOG RESOURCES INC
2016-05-02
2020-01-28
17421.603 VANGUARD TTL INTL BND-ADM
2020-01-28
34. EOG RESOURCES INC
2016-05-02
2020-01-29
40. EOG RESOURCES INC
2016-05-02
2020-01-29
27. EOG RESOURCES INC
2016-05-02
2020-01-29
324. EOG RESOURCES INC
2020-01-29
323. EOG RESOURCES INC
2020-01-29
321. EOG RESOURCES INC
2020-01-29
424. EOG RESOURCES INC
2016-03-07
2020-01-30
107. EOG RESOURCES INC
2016-03-07
2020-01-30
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
3,633
4,594
-961
b
200,000
183,559
16,441
c
400,000
398,082
1,918
d
300,529
299,360
1,169
e
285,000
281,511
3,489
80,000
62,412
17,588
19,782
17,415
2,367
8,557
7,556
1,001
25,082
22,022
3,060
38,815
23,740
15,075
25,668
22,636
3,032
8,615
5,216
3,399
32,833
19,620
13,213
6,805
831
5,974
15,818
14,733
1,085
9,088
5,817
3,271
23,192
5,328
17,864
2,601
2,472
129
18,018
3,677
14,341
4,290
4,121
169
11,444
11,879
-435
12,547
13,269
-722
2,655
2,739
-84
7,947
4,605
3,342
4,777
5,063
-286
10,867
1,563
9,304
2,624
3,231
-607
7,255
6,427
828
9,020
8,540
480
4,206
4,154
52
5,669
5,203
466
2,854
3,160
-306
3,339
3,366
-27
10,701
10,367
334
4,448
4,265
183
8,515
10,328
-1,813
7,981
7,493
488
5,462
6,493
-1,031
5,339
2,485
2,854
5,513
3,256
2,257
4,211
4,165
46
5,089
5,521
-432
8,617
2,323
6,294
11,956
4,099
7,857
2,394
1,818
576
109,029
108,288
741
390,000
348,337
41,663
4,615
5,406
-791
8,146
5,503
2,643
5,604
1,088
4,516
5,573
7,273
-1,700
11,747
1,200
10,547
6,415
5,092
1,323
27,768
10,766
17,002
6,215
5,209
1,006
9,568
7,848
1,720
3,927
4,078
-151
5,229
4,744
485
3,261
2,356
905
9,485
8,004
1,481
5,736
5,865
-129
4,795
8,316
-3,521
3,672
2,536
1,136
9,075
11,632
-2,557
2,817
3,332
-515
6,901
6,329
572
8,192
7,089
1,103
11,478
11,284
194
6,264
8,100
-1,836
5,717
5,871
-154
3,469
2,885
584
3,052
3,009
43
4,842
4,112
730
3,978
2,060
1,918
6,799
6,357
442
3,505
2,183
1,322
5,671
4,576
1,095
8,798
8,930
-132
4,029
3,206
823
3,272
3,219
53
16,684
2,890
13,794
3,788
545
3,243
5,945
3,083
2,862
4,010
2,529
1,481
8,043
8,651
-608
3,945
2,072
1,873
2,758
2,665
93
8,881
8,173
708
3,736
2,722
1,014
6,208
3,193
3,015
3,762
3,534
228
5,192
5,023
169
4,108
4,280
-172
6,994
3,472
3,522
3,940
3,959
-19
28,816
30,809
-1,993
42,583
11,148
31,435
116,897
101,385
15,512
59,807
55,473
4,334
1,712
1,712
395,854
366,778
29,076
4,892
575
4,317
1,946
1,886
60
13,249
11,576
1,673
4,836
2,908
1,928
14,593
3,044
11,549
1,898
1,751
147
14,203
2,581
11,622
3,544
3,238
306
7,950
8,333
-383
6,556
6,849
-293
5,273
3,202
2,071
8,266
1,055
7,211
3,280
3,647
-367
5,534
4,897
637
6,258
5,898
360
3,045
2,948
97
6,254
6,214
40
2,340
2,196
144
2,673
2,735
-62
5,745
5,275
470
3,329
2,967
362
2,214
2,519
-305
4,349
5,029
-680
5,567
5,236
331
4,579
5,126
-547
4,361
1,883
2,478
4,109
2,292
1,817
3,149
2,957
192
3,902
4,232
-330
6,235
1,394
4,841
8,712
2,874
5,838
1,629
1,229
400
3,200
3,911
-711
5,657
3,767
1,890
4,196
748
3,448
4,190
5,630
-1,440
8,842
854
7,988
6,327
6,188
139
20,427
3,761
16,666
4,490
3,590
900
6,904
5,407
1,497
2,586
2,595
-9
3,951
3,558
393
2,372
1,628
744
6,592
5,125
1,467
3,792
4,105
-313
4,137
5,902
-1,765
2,766
1,767
999
6,298
8,032
-1,734
1,788
2,082
-294
5,374
4,611
763
6,039
4,992
1,047
8,001
7,963
38
4,109
5,275
-1,166
3,981
3,959
22
2,522
2,084
438
1,651
1,716
-65
3,397
2,902
495
2,840
1,519
1,321
4,997
4,692
305
2,288
1,484
804
4,228
3,189
1,039
6,551
6,240
311
7,001
5,478
1,523
2,375
2,228
147
11,586
1,736
9,850
2,625
381
2,244
4,266
2,081
2,185
2,788
1,686
1,102
5,413
6,056
-643
2,957
1,412
1,545
2,001
1,838
163
6,147
5,525
622
2,623
1,859
764
4,745
2,267
2,478
3,801
3,373
428
3,796
3,701
95
2,895
2,962
-67
4,953
2,403
2,550
2,753
2,733
20
1,904
2,153
-249
23,118
25,895
-2,777
3,830
4,233
-403
1,262
1,390
-128
31,817
33,109
-1,292
16,035
14,885
1,150
3,803
3,529
274
355,310
351,918
3,392
61,496
83,709
-22,213
28,812
36,043
-7,231
32,973
42,261
-9,288
12,214
16,098
-3,884
2,492
3,248
-756
45,356
55,455
-10,099
10,887
12,838
-1,951
36,700
45,822
-9,122
2,585
3,093
-508
1,264
1,507
-243
7,404
8,833
-1,429
3,561
4,203
-642
4,177
4,859
-682
13,427
15,433
-2,006
3,241
2,644
597
47,240
38,238
9,002
22,832
18,398
4,434
7,024
5,734
1,290
10,301
8,283
2,018
30,246
20,414
9,832
27,196
17,601
9,595
6,782
4,220
2,562
17,320
10,692
6,628
48,836
48,816
20
41,425
37,167
4,258
883
881
2
16,182
14,535
1,647
28,969
25,514
3,455
24,632
31,442
-6,810
28,399
36,231
-7,832
12,228
15,617
-3,389
35,040
34,175
865
12,913
12,580
333
60,549
87,994
-27,445
165
160
5
711
695
16
10,809
10,530
279
12,220
11,969
251
2,077
2,030
47
110
107
3
1,872
1,817
55
111
107
4
1,442
1,389
53
2,612
2,511
101
549
534
15
386
374
12
445
427
18
54,424
44,610
9,814
43,501
38,752
4,749
70,065
43,422
26,643
14,824
12,007
2,817
49,271
42,320
6,951
15,990
12,957
3,033
9
9
25
25
42,299
4,600
37,699
316,064
347,367
-31,303
27,293
17,959
9,334
17,869
11,300
6,569
17,093
18,721
-1,628
9,562
10,358
-796
24,905
24,956
-51
31,181
20,076
11,105
1,396,503
811,556
584,947
47,093
42,059
5,034
285
285
376,043
365,246
10,797
97,977
74,332
23,645
34,063
15,532
18,531
43,729
19,418
24,311
12,721
8,156
4,565
16,290
9,542
6,748
13,081
5,916
7,165
32,721
12,222
20,499
2,939
1,092
1,847
3,148
1,160
1,988
83,507
33,872
49,635
232,589
201,201
31,388
2,357
2,588
-231
246
271
-25
102
113
-11
6
7
-1
405,790
370,816
34,974
2,990
3,236
-246
474
515
-41
225,000
241,684
-16,684
378,300
383,726
-5,426
85
99
-14
8,368
9,702
-1,334
6,879
7,833
-954
8,152
9,186
-1,034
1,504
1,689
-185
7,118
7,387
-269
3,006
3,121
-115
2,423
2,527
-104
908
951
-43
10,336
10,671
-335
11,978
12,364
-386
4,987
5,134
-147
970
1,003
-33
4,794
4,931
-137
1,460
1,406
54
7,391
7,135
256
431
413
18
346,474
345,094
1,380
3,058
2,863
195
2,593
2,428
165
349
324
25
581
540
41
234,350
248,654
-14,304
79,756
75,081
4,675
1,196
1,124
72
200,000
171,603
28,397
1,036,007
916,301
119,706
33,910
37,898
-3,988
5,092
5,461
-369
400,000
409,076
-9,076
2,613
2,813
-200
3,071
3,310
-239
2,075
2,234
-159
24,448
26,767
-2,319
24,760
26,283
-1,523
24,284
25,691
-1,407
31,514
30,669
845
8,037
7,740
297
214,013
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
-961
b
16,441
c
1,918
d
1,169
e
3,489
17,588
2,367
1,001
3,060
15,075
3,032
3,399
13,213
5,974
1,085
3,271
17,864
129
14,341
169
-435
-722
-84
3,342
-286
9,304
-607
828
480
52
466
-306
-27
334
183
-1,813
488
-1,031
2,854
2,257
46
-432
6,294
7,857
576
741
41,663
-791
2,643
4,516
-1,700
10,547
1,323
17,002
1,006
1,720
-151
485
905
1,481
-129
-3,521
1,136
-2,557
-515
572
1,103
194
-1,836
-154
584
43
730
1,918
442
1,322
1,095
-132
823
53
13,794
3,243
2,862
1,481
-608
1,873
93
708
1,014
3,015
228
169
-172
3,522
-19
-1,993
31,435
15,512
4,334
1,712
29,076
4,317
60
1,673
1,928
11,549
147
11,622
306
-383
-293
2,071
7,211
-367
637
360
97
40
144
-62
470
362
-305
-680
331
-547
2,478
1,817
192
-330
4,841
5,838
400
-711
1,890
3,448
-1,440
7,988
139
16,666
900
1,497
-9
393
744
1,467
-313
-1,765
999
-1,734
-294
763
1,047
38
-1,166
22
438
-65
495
1,321
305
804
1,039
311
1,523
147
9,850
2,244
2,185
1,102
-643
1,545
163
622
764
2,478
428
95
-67
2,550
20
-249
-2,777
-403
-128
-1,292
1,150
274
3,392
-22,213
-7,231
-9,288
-3,884
-756
-10,099
-1,951
-9,122
-508
-243
-1,429
-642
-682
-2,006
597
9,002
4,434
1,290
2,018
9,832
9,595
2,562
6,628
20
4,258
2
1,647
3,455
-6,810
-7,832
-3,389
865
333
-27,445
5
16
279
251
47
3
55
4
53
101
15
12
18
9,814
4,749
26,643
2,817
6,951
3,033
9
25
37,699
-31,303
9,334
6,569
-1,628
-796
-51
11,105
584,947
5,034
285
10,797
23,645
18,531
24,311
4,565
6,748
7,165
20,499
1,847
1,988
49,635
31,388
-231
-25
-11
-1
34,974
-246
-41
-16,684
-5,426
-14
-1,334
-954
-1,034
-185
-269
-115
-104
-43
-335
-386
-147
-33
-137
54
256
18
1,380
195
165
25
41
-14,304
4,675
72
28,397
119,706
-3,988
-369
-9,076
-200
-239
-159
-2,319
-1,523
-1,407
845
297
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
1,625,192
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
Yes
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2018
1,843,034
38,152,111
0.048308
2017
1,711,870
38,051,371
0.044988
2016
1,828,019
34,846,810
0.052459
2015
1,617,477
36,062,968
0.044851
2014
1,749,188
36,176,246
0.048352
2
Total
of line 1, column (d)
.....................
2
0.238958
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
0.047792
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
38,265,543
5
Multiply line 4 by line 3
......................
5
1,828,787
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
22,704
7
Add lines 5 and 6
........................
7
1,851,491
8
Enter qualifying distributions from Part XII, line 4
,.............
8
1,889,164
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
22,704
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
22,704
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
22,704
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
25,600
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
25,600
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
2,896
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
2,896
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
JPMORGAN CHASE BANK NA
Telephone no.
(800) 496-2583
Located at
10 S DEARBORN IL1-0111
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 NA
TRUSTEE
20
280,014
10 S DEARBORN IL1-0111
CHICAGO
,
IL
60603
RICHARD BARTHOLOME CO JPMORGAN
TRUSTEE
10
36,678
270 PARK AVE FL 15
NEW YORK
,
NY
10017
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
37,855,556
b
Average of monthly cash balances
.......................
1b
992,711
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
38,848,267
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
38,848,267
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
582,724
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
38,265,543
6
Minimum investment return.
Enter 5% of line 5
..................
6
1,913,277
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
1,913,277
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
22,704
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
22,704
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
1,890,573
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
1,890,573
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
1,890,573
Part XII
Qualifying Distributions
(see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26
..........
1a
1,889,164
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
1,889,164
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
22,704
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
1,866,460
Note:
The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
the section 4940(e) reduction of tax in those years.
Form
990-PF
(2019)
Form 990-PF (2019)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2018
(c)
2018
(d)
2019
1
Distributable amount for 2019 from Part XI, line 7
1,890,573
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
1,771,965
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:
$
1,889,164
a
Applied to 2018, but not more than line 2a
1,771,965
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
.....
117,199
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
..........
1,773,374
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 e-mail address of the person to whom applications should be addressed:
CASEY BURGESS CASTENEDA CO JPMORGA
270 PARK AVENUE FL 16
NEW YORK
,
NY
10017
(212) 464-0308
NONE
b
The form in which applications should be submitted and information and materials they should include:
DESCRIBE THE PROPOSED USE OF FUNDS
c
Any submission deadlines:
NONE
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
ORGANIZATIONS DESCRIBED IN IRC SECTION 501(C)(3) NO GRANTS ARE MADE TO INDIVIDUALS
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
GULF OF MAINE RESEARCH INSTITUTE
350 COMMERCIAL STREET
PORTLAND
,
ME
04101
NONE
PC
PROGRAM SUPPORT
20,000
MANCHESTER COMMUNITY LIBRARY
PO BOX 1105
MANCHESTER CENTER
,
VT
05255
NONE
PC
PROGRAM SUPPORT
25,000
SECOND CHANCE ANIMAL CENTER
1779 VT ROUTE 7A
ARLINGTON
,
VT
05250
NONE
PC
PROGRAM SUPPORT
30,000
PERKINS SCHOOL FOR THE BLIND
175 NORTH BEACON STREET
WATERTOWN
,
MA
02472
NONE
PC
PROGRAM SUPPORT
60,000
THEODORE ROOSEVELT CONSERVATION PARTNERS
529 14TH STREET NW
WASHINGTON
,
DC
20045
NONE
PC
PROGRAM SUPPORT
25,000
CONSERVATION LAW FOUNDATION
62 SUMMER STREET
BOSTON
,
MA
02110
NONE
PC
PROGRAM SUPPORT
60,000
OPTOMETRIC CENTER OF NEW YORK
33 WEST 42ND STREET
NEW YORK
,
NY
10036
NONE
PC
PROGRAM SUPPORT
50,000
LOWER EAST SIDE TENEMENT MUSEUM
103 ORCHARD STREET
NEW YORK
,
NY
10002
NONE
PC
PROGRAM SUPPORT
19,950
THE PALISADES PARKS CONSERVANCY INC
PO BOX 513
NEW YORK
,
NY
10018
NONE
PC
PROGRAM SUPPORT
35,000
STONE BARNS CENTER FOR FOOD & AGRICULTUR
630 BEDFORD ROAD
POCANTICO HILLS
,
NY
10591
NONE
PC
PROGRAM SUPPORT
75,000
LEADER DOGS FOR THE BLIND
1039 S ROCHESTER RD
ROCHESTER HILLS
,
MI
48307
NONE
PC
PROGRAM SUPPORT
40,000
TROUT UNLIMITED
267 SCRIBNER HILL RD
MANCHESTER
,
ME
04351
NONE
PC
PROGRAM SUPPORT
50,000
NEW ENGLAND AQUARIUM CORP
1 CENTRAL WHARF
BOSTON
,
MA
02110
NONE
PC
PROGRAM SUPPORT
64,906
XERCES SOCIETY INC
628 NE BROADWAY SUITE 200
PORTLAND
,
OR
97232
NONE
PC
PROGRAM SUPPORT
75,000
NATURESERVE
2511 JEFFERSON DAVIS HIGHWAY
ARLINGTON
,
VA
22202
NONE
PC
PROGRAM SUPPORT
60,000
AMERICAN BIRD CONSERVANCY
PO BOX 249
THE PLAINS
,
VA
20198
NONE
PC
GENERAL
40,000
HILDENE THE LINCOLN FAMILY
1005 HILDENE RD
MANCHESTER
,
VT
05255
NONE
PC
GENERAL
25,000
CITY ACCESS NEW YORK
1207 CASTLETON AVE
STATEN ISLAND
,
NY
10310
NONE
PC
PROGRAM SUPPORT
35,000
VISIONS SERVICES FOR THE BLIND
AND VISUALLY IMPAIRED
500 GREENWICH ST 302
NEW YORK
,
NY
10013
NONE
PC
PROGRAM SUPPORT
75,000
LEARNING ALLY
20 ROSZEL RD
PRINCETON
,
NJ
08540
NONE
PC
PROGRAM SUPPORT
30,000
FOUNDATION FIGHTING BLINDNESS
7168 COLUMBIA GATEWAY DR STE 100
COLUMBIA
,
MD
21046
NONE
PC
PROGRAM SUPPORT
75,000
THE VERMONT CENTER FOR ECOSTUDIES
INC
PO BOX 420
NORWICH
,
VT
05055
NONE
PC
GENERAL
50,000
BLACK ROCK FOREST
65 RESERVOIR
CORNWALL
,
NY
12518
NONE
PC
GENERAL
45,000
CANCER CARE INC
275 SEVENTH AVENUE
NEW YORK
,
NY
10001
NONE
PC
GENERAL
25,000
DOWNEST SALMON FEDERATION
PO BOX 201
COLUMBIA FALLS
,
ME
04623
NONE
PC
GENERAL
25,000
FREEDOM GUIDE DOGS FOR BLIND
1210 HARDSCRABBLE ROAD
CASSVILLE
,
NY
13318
NONE
PC
GENERAL
30,000
HELEN KELLER SERVICES
180 LIVINGSTON STREET
BROOKLYN
,
NY
11201
NONE
PC
GENERAL
74,388
LAVELLE SCHOOL FOR THE BLIND
3830 PAULDING AVENUE
BRONX
,
NY
10469
NONE
PC
GENERAL
35,000
MAINE RIVERS
PO BOX 782
YARMOUTH
,
ME
04096
NONE
PC
GENERAL
50,000
MEMORIAL SLOAN-KETTERING CANCER
CENTER
1275 YORK AVENUE
NEW YORK
,
NY
12306
NONE
PC
GENERAL
20,000
NORTHEASTERN ASSOCIATION OF THE
BLIND AT ALBANY INC
301 BLIND WASHINGTON AVENUE
ALBANY
,
NY
12306
NONE
PC
GENERAL
35,000
OCEAN ALLIANCE INC
32 HORTON STREET
GLOUCESTER
,
MA
01930
NONE
PC
GENERAL
32,500
SHEFFIELD LAND TRUST
PO BOX 940 96 MAIN STREET
SHEFFIELD
,
MA
01257
NONE
PC
GENERAL
25,000
UNIVERSITY OF NEW HAMPSHIRE
FOUNDATION
9 EDGEWOOD ROAD
DURHAM
,
NH
03824
NONE
PC
GENERAL
70,369
UNIVERSITY OF PENNSYLVANIA MUSEUM
OF ARCHAEOLOGY AND ANTHROPOLOGY
3260 SUTH STREET
PHILADELPHIA
,
PA
19104
NONE
PC
GENERAL
11,000
THE POLUS CENTER FOR SOCIAL
& ECONOMIC DEVELOPMENT INC
PO BOX 773 6 NORTH MAIN ST
PETERSHAM
,
MA
01366
NONE
PC
GENERAL
40,000
CORNELL UNIVERSITYCORNELL LAB
OF ORNITHOLOGY
375 PINE TREE ROAD
ITHACA
,
NY
14850
NONE
PC
GENERAL
60,000
CONNECTICUT RIVER WATERSHED
15 BANK ROW
GREENFIELD
,
MA
01301
NONE
PC
PROGRAM SUPPORT
75,000
NOTRE DAME ACADEMY
425 SALISBURY STREET
WORCESTER
,
MA
01609
NONE
PC
PROGRAM SUPPORT
100,000
Total
.................................
3a
1,773,113
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
868,963
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
1,625,192
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)
..
2,494,155
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
2,494,155
(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