-
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
THE GELVIN FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 837
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
EUFAULA
,
OK
74432
A Employer identification number
73-1419663
B
Telephone number (see instructions)
(918) 452-3703
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)
$
10,465,929
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
52,504
52,504
4
Dividends and interest from securities
...
105,593
105,593
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
419,934
b
Gross sales price for all assets on line 6a
1,247,654
7
Capital gain net income (from Part IV, line 2)
...
272,654
8
Net short-term capital gain
.........
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
6,829
6,829
12
Total.
Add lines 1 through 11
........
584,860
437,580
13
Compensation of officers, directors, trustees, etc.
72,000
72,000
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
6,185
6,185
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
6,363
6,363
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
7,119
7,119
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
91,667
19,667
72,000
25
Contributions, gifts, grants paid
.......
418,600
418,600
26
Total expenses and disbursements.
Add lines 24 and 25
510,267
19,667
490,600
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
74,593
b
Net investment income
(if negative, enter -0-)
417,913
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2019)
Form 990-PF (2019)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
112,033
161,834
161,834
2
Savings and temporary cash investments
.........
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
2,549
2,549
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
5,651,801
6,065,930
8,304,585
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
2,368,686
1,966,837
1,996,961
14
Land, buildings, and equipment: basis
1,495
Less: accumulated depreciation (attach schedule)
1,495
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
8,132,520
8,197,150
10,465,929
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
)
59
23
Total liabilities
(add lines 17 through 22)
.........
59
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
8,132,461
8,197,150
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
........
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)
.....
8,132,461
8,197,150
30
Total liabilities and net assets/fund balances
(see instructions)
.
8,132,520
8,197,150
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
8,132,461
2
Enter amount from Part I, line 27a
.....................
2
74,593
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
8,207,054
5
Decreases not included in line 2 (itemize)
5
9,904
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
8,197,150
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.)
1a
b
c
d
e
(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
b
c
d
e
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
b
c
d
e
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
272,654
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
483,476
10,118,262
0.047783
2017
458,832
9,890,710
0.046390
2016
444,665
9,175,956
0.048460
2015
456,931
9,386,135
0.048681
2014
434,400
9,461,403
0.045913
2
Total
of line 1, column (d)
.....................
2
0.237227
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
0.047445
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
10,041,809
5
Multiply line 4 by line 3
......................
5
476,434
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
4,179
7
Add lines 5 and 6
........................
7
480,613
8
Enter qualifying distributions from Part XII, line 4
,.............
8
490,600
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
4,179
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
3
Add lines 1 and 2
...........................
3
4,179
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
4,179
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
6,770
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
6,770
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
2,591
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
2,591
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
OK
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
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
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
THERESE STARR
Telephone no.
(918) 452-3703
Located at
PO BOX 837
EUFAULA
OK
ZIP+4
74432
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
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
THERESE STARR
PRES/TREAS
10.00
36,000
0
0
PO BOX 837
EUFAULA
,
OK
74432
TERRY DOVERSPIKE
VPRES/SECRE
10.00
36,000
0
0
900 ONEOK PLAZA
TULSA
,
OK
74103
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
N/A
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
7,758,832
b
Average of monthly cash balances
.......................
1b
168,394
c
Fair market value of all other assets (see instructions)
................
1c
2,267,504
d
Total
(add lines 1a, b, and c)
.........................
1d
10,194,730
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
2
Acquisition indebtedness applicable to line 1 assets
..................
2
3
Subtract line 2 from line 1d
.........................
3
10,194,730
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
152,921
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
10,041,809
6
Minimum investment return.
Enter 5% of line 5
..................
6
502,090
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
502,090
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
4,179
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
4,179
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
497,911
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
497,911
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
497,911
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
490,600
b
Program-related investments—total from Part IX-B
..................
1b
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
490,600
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
4,179
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
486,421
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
497,911
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
486,266
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
c
From 2016
......
d
From 2017
......
e
From 2018
......
f
Total
of lines 3a through e
........
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
490,600
a
Applied to 2018, but not more than line 2a
486,266
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
d
Applied to 2019 distributable amount
.....
4,334
e
Remaining amount distributed out of corpus
5
Excess distributions carryover applied to 2019.
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
493,577
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
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:
THERESE STARR
P O BOX 837
EUFALA
,
OK
74432
(918) 452-3703
LPCSTARR@YAHOO.COM
b
The form in which applications should be submitted and information and materials they should include:
APPLICATION, IN ANY FORM, MUST BE SUBMITTED IN WRITING BY THE CHIEF EXECUTIVE OFFICER, MUST INCLUDE A BRIEF DESCRIPTION OF THE ORGANIZATION AND THE PROGRAM NEEDING FUNDING AND INCLUDE EVIDENCE OF CHARITABLE, TAX EXEMPT STATUS.
c
Any submission deadlines:
SEE STATEMENT
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
SEE STATEMENT
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
A NEW LEAF INC
P O BOX 35903
TULSA
,
OK
74153
NONE
CHARITABLE
APPLIANCES
5,000
AKDAR TEMPLE SHRINERS INTL
2808 S SHERIDAN
TULSA
,
OK
74129
NONE
CHARITABLE
HOSPITAL TRANSPORTATION
2,000
ALZHEIMER'S DISEASE & RELATED DISOR
2123 N CLASSEN BLVD
OKLAHOMA CITY
,
OK
73106
NONE
CHARITABLE
DIGITAL CONFERENING EQUIPMENT
4,500
AMERICAN DIABETES ASSOCIATION
6600 S YALE
TULSA
,
OK
74136
NONE
CHARITABLE
PRINTING EXPENSES
5,000
AMYOTROPHIC LATERAL SCLEROSIS ASSN
1300 WILSON BLVD
ARLINGTON
,
VA
22209
NONE
CHARTIABLE
EDUCATIONAL MATERIALS
1,000
ARTS & HUMANITIES COUCIL OF TULSA
2210 S MAIN
TULSA
,
OK
74114
NONE
CHARITABLE
PROGRAM EXPENSES
4,000
BRADY CRAFT ALLIANCE INC
108 E RECONCILIATION W
TULSA
,
OK
74103
NONE
CHARITABLE
EXHIBIT EXPENSES
2,000
BROKEN ARROW NEIGHBORS INC
315 W COLLEGE
BROKEN ARROW
,
OK
74012
NONE
CHARITABLE
CAPITAL CAMPAIGN
2,500
CAMPFIRE USA GREEN COUNTRY
706 S BOSTON
TULSA
,
OK
74119
NONE
CHARITABLE
CLUB EXPENSES
3,000
CAR CARE CLINIC INC
2008 E PINE
TULSA
,
OK
74110
NONE
CHARITABLE
CAPITAL CAMPAIGN
3,000
CENTENARIANS OF OKLAHOMA
3510 EAST 32ND STREET
TULSA
,
OK
74135
NONE
CHARITABLE
EQUIPMENT & SUPPLIES
2,500
CENTER FOR INDIVIDUALS WITH PHYSICA
815 S UTICA
TULSA
,
OK
74104
NONE
CHARITABLE
CLIENT NAVIGATION SYSTEM
8,000
CHAMBER MUSIC TULSA
2210 S MAIN
TULSA
,
OK
74114
NONE
CHARITABLE
PROGRAM EXPENSES
2,500
CHILD ABUSE NETWORK
2828 S SHERIDAN
TULSA
,
OK
74129
NONE
CHARITABLE
COMPUTER EQUIPMENT
5,000
CLAREHOUSE INC
7617 S MINGO RD
TULSA
,
OK
74133
NONE
CHARITABLE
NEW HEAT PUMP
6,000
COMMUNITY ACTION PROJECT OF TULSA
4606 S GARNETT
TULSA
,
OK
74146
NONE
CHARITABLE
THERAPEUTIC CHAIRS
3,500
COMMUNITY ACTION RESOURCES INCE
3636 NORTH PEORIA AVE
TULSA
,
OK
74106
NONE
CHARITABLE
MENTORING PROGRAM SUPPLIES
2,000
COMMUNITY FOOD BANK OF EASTERN OKLA
1304 N KENOSHA
TULSA
,
OK
74106
NONE
CHARITABLE
FOOD PANTRY PROGRAM
5,000
COUNSELING & RECOVERY SERVICES OF O
6126 S 32ND PLACE
TULSA
,
OK
74135
NONE
CHARITABLE
EMERGENCY VAN REPAIRS
6,000
CREEK COUNTY LITERACY PROGRAM INC
15 N POPLAR ST
SAPULPA
,
OK
74066
NONE
CHARITABLE
TUTORING BOOKS AND SUPPLIES
4,000
CRIME PREVENTION NETWORK
2121 S COLUMBIA
TULSA
,
OK
74114
NONE
CHARITABLE
CRIME STOPPERS PROGRAM
3,500
CROSSROADS INC
1888 E 15TH
TULSA
,
OK
74104
NONE
CHARITABLE
OFFICE EQUIPMENT
4,000
DVIS INC
3124 E APACHE
TULSA
,
OK
74110
NONE
CHARITABLE
SECURITY EQUIPMENT
5,000
EMERGENCY INFANT SERVICES
222 S HOUSTON
TULSA
,
OK
74127
NONE
CHARITABLE
INFANT FOOD AND FORMULA
7,500
FAB LAB TULSA INC
710 S LEWIS
TULSA
,
OK
74104
NONE
CHARITABLE
PROGRAM SUPPLIES
1,000
FAMILY & CHILDREN'S SERVICES
650 SOUTH PEORIA
TULSA
,
OK
74120
NONE
CHARITABLE
RESOURCE ROOM SUPPLIES
5,000
FIRST STEP MALE DIVERSION PROGRAM
321 S FRANKFORT
TULSA
,
OK
74119
NONE
CHARITABLE
COMPUTERS
2,000
FOUNDATION FOR TULSA SCHOOLS
3027 S HEW HAVEN
TULSA
,
OK
74114
NONE
CHARITABLE
EVENT EXPENSES
5,000
GAINING GROUND INC
9801 S HOUSTON
JENKS
,
OK
74037
NONE
CHARITABLE
LITERACY SUPPLIES
1,500
GILCREASE MUSEUM MANAGEMENT TRUST
1400 N GILCREASE MUSEUM R
TULSA
,
OK
74127
NONE
CHARITABLE
EXHIBIT EXPENSES
2,500
GLOBAL GARDENS
P O BOX 52034
TULSA
,
OK
74152
NONE
CHARITABLE
SUMMER PROGRAM SUPPLIES
4,500
HOPE
4010 W NEW ORLEANS
BROKEN ARROW
,
OK
74012
NONE
CHARITABLE
TESTING SUPPLIES
4,000
HARMONY PROJECT TULSA
9 E 4TH 1001
TULSA
,
OK
74103
NONE
CHARITABLE
MUSICAL INSTRUMENTS
2,500
HARVEST HOUSE
1439 E 71ST
TULSA
,
OK
74136
NONE
CHARITBLE
VISION CARE PROGRAM SUPPLIES
1,500
HELPING HANDS MINISTRY
700 S BOSTON
TULSA
,
OK
74119
NONE
CHARITABLE
BASIC NEEDS ASSISTANCE
3,500
HIV RESOURCE CONSORTIUM TULSA CARE
3712 E 11TH
TULSA
,
OK
74112
NONE
CHARITABLE
SECURITY SYSTEM
3,000
HONOR BUNKER INC
6365 E 41ST
TULSA
,
OK
74135
NONE
CHARITABLE
PRINTING EXPENSES
4,000
HOPE HOUSE MC ALESTER
1210 E CHEROKEE AVE
MC ALESTER
,
OK
74501
NONE
CHARITABLE
SECURITY EQUIPMENT
3,200
HOPE'S CROSSING CAMP INC
P O BOX 4423
TULSA
,
OK
74159
NONE
CHARITABLE
SUMMER CAM PROGRAM EXPENSES
1,500
HOSPICE OF GREEN COUNTRY INC
1120 S BOSTON SUITE 200
TULSA
,
OK
74119
NONE
CHARITABLE
PROGRAM SUPPLIES
3,500
IRON GATE
501 S CINCINNATI
TULSA
,
OK
74119
NONE
CHARITABLE
SHELF STABLE MILK FOR FOOD PANTRY
5,000
JOY IN THE CAUSE COMPANY
3939 S HARVARD 185
TULSA
,
OK
74135
NONE
CHARITABLE
BACKPACK SUPPLIES
2,000
JUNIOR ACHIEVEMENT OF OKLA
3947 S 103RD E AVE
TULSA
,
OK
74146
NONE
CHARITABLE
PROGRAM EXPENSES
3,000
LEGAL AID SERVICES OF OKLAHOMA
907 SOUTH DETROIT
TULSA
,
OK
74119
NONE
CHARITABLE
COMPUTER EQUIPMENT & SOFTWARE
3,600
LIFE SENIOR SERVICES INC
5950 E 31ST
TULSA
,
OK
74135
NONE
CHARITABLE
EXERCISE EQUIPMENT
4,000
LIVING ARTS OF TULSA
307 E RECONCILIATION WAY
TULSA
,
OK
74120
NONE
CHARITABLE
EQUIPMENT & SUPPLIES
2,500
MC INTOSH COUNTY YOUTH & FAMILY EDU
107 MC KINLEY STREET
EUFALA
,
OK
74432
NONE
CHARITABLE
CAPITAL EQUIPMENT
14,500
MEALS ON WHEELS OF METRO TULSA
1260 E 31ST
TULSA
,
OK
74112
NONE
CHARITABLE
REMODELING & EQUIPMENT
5,000
MENTAL HEALTH ASSOC OF TULSA
1870 S BOULDER
TULSA
,
OK
74119
NONE
CHARITABLE
REPAIRS TO TRANSITIONAL HOME
4,000
NEW HOPE CAMP INC
4122 W 55TH PL
TULSA
,
OK
74107
NONE
CHARITABLE
SUMMER CAMP PROGRAM EXPENSES
10,000
NEW WORKFORCE DIRECTIONS
907 S DETROIT 830
TULSA
,
OK
74120
NONE
CHARITABLE
JOB TRAINING PROGRAM EXPENSES
3,500
NEWVIEW OKLAHOMA INC
501 N DOUGLAS
OKLAHOMA CITY
,
OK
73106
NONE
CHARITABLE
TRANSPORTATION VOUCHERS
3,000
OKLAHOMA BAPTIST HOMES FOR CHILDREN
12700 E 76TH ST NORTH
OWASSO
,
OK
74055
NONE
CHARITABLE
APPLIANCES
2,500
OKLAHOMA BOTANICAL GARDEN INC
5323 W 31ST ST NORTH
TULSA
,
OK
74127
NONE
CHARITABLE
SIGNS
2,500
OKLAHOMA CARING FOUNDATION
1400 S BOSTON
TULSA
,
OK
74119
NONE
CHARITABLE
SUPPLIES FOR CARING VAN VACCINE PROG
4,000
OKLAHOMA CENTER FOR NON-PROFITS
1145 S UTICA
TULSA
,
OK
74104
NONE
CHARITABLE
COMPUTER EQUIPMENT
3,000
OKLAHOMA PROJECT WOMAN
2727 E 21ST 602
TULSA
,
OK
74114
NONE
CHARITABLE
DIAGNOSTIC EXPENSES
4,500
OKMULGEE COUNTY HOMELESS SHELTER I
214 N MORTON
OKMULGEE
,
OK
74447
NONE
CHARITABLE
EQUIPMENT
5,000
OPERATION AWARE
7226 E 41ST
TULSA
,
OK
74145
NONE
CHARITABLE
EDUCATIONAL MATERIALS PRINTING
2,500
OSAGE FOREST OF PEACE
141 MONASTERY RD
SAND SPRINGS
,
OK
74063
NONE
CHARITABLE
SEPTIC SYSTEM
2,000
PARENT CHILD CENTER OF TULSA
1420 S BOSTON
TULSA
,
OK
74119
NONE
CHARITABLE
REMODEL TO ADD THERAPEUTIC PLAYROOM
3,000
PARKSIDE INC
1228 S TRENTON
TULSA
,
OK
74120
NONE
CHARITABLE
INTERACTIVE ELECTRONIC EQUIPMENT
2,300
PETS HELPING PEOPLE
2234 E 56TH PLACE
TULSA
,
OK
74105
NONE
CHARITABLE
NEW KENNEL EQUIPMENT
5,000
PHILBROOK MUSEUM OF ART
2727 S ROCKFORD
TULSA
,
OK
74114
NONE
CHARITABLE
EXHIBIT EXPENSES
3,500
RESONANCE CENTER FOR WOMEN INC
1608 S ELWOOD
TULSA
,
OK
74119
NONE
CHARITABLE
COMPUTER EQUIPMENT
4,000
REVITALIZE T-TOWN
14 E 7TH
TULSA
,
OK
74119
NONE
CHARITABLE
COMPUTER & OFFICE EQUIPMENT
3,500
RIVER PARKS FOUNDATION
2424 E 21ST
TULSA
,
OK
74114
NONE
CHARITABLE
FREEDOMFEST SPONSORSHIP
5,000
ROGERS COUNTY VOLUNTEERS FOR YOUTH
1700 S LYNN RIGGS BLVD A
CLAREMORE
,
OK
74017
NONE
CHARITABLE
LAPTOPS
2,500
RSVP
5756 E 31ST
TULSA
,
OK
74135
NONE
CHARITABLE
PROGRAM EXPENSES
3,000
SALVATION ARMY
924 S HUDSON
TULSA
,
OK
74111
NONE
CHARITABLE
PROGRAM EXPENSES
10,000
SHOW INC
425 W WELLS BLVD
SAPULPA
,
OK
74066
NONE
CHARITABLE
EMPLOYMENT PROGRAM SUPPLIES
5,000
SOUTH PEORIA NEIGHBORHOOD CONNECTIO
1208 E 58TH
TULSA
,
OK
74105
NONE
CHARITABLE
SOFTWARE & EQUIPMENT
4,000
STAND IN THE GAP
3939 S HARVARD 120
TULSA
,
OK
74135
NONE
CHARITABLE
COMPUTER EQUIPMENT
4,000
STREET SCHOOL INC
1135 S YALE
TULSA
,
OK
74112
NONE
CHARITABLE
COMPUTER EQUIPMENT
3,000
TEXANNA LADY CRAFTERS
RT 4 BOX 214
EUFAULA
,
OK
74432
NONE
CHARITABLE
BUILDING REPAIRS & EQUIPMENT
2,500
THE LITTLE LIGHT HOUSE INC
5120 E 36TH
TULSA
,
OK
74135
NONE
CHARITABLE
EQUIPMENT
4,000
THE NATURE CONSERVANCY
2727 E 21ST 203
TULSA
,
OK
74114
NONE
CHARITABLE
OFFICE EQUIPMENT
5,000
TOWN & COUNTRY SCHOOL
8906 E 34TH
TULSA
,
OK
74145
NONE
CHARITABLE
ONLINE CURRICULUM
4,100
TSHA INC
8740 E 11TH SUITE A
TULSA
,
OK
74112
NONE
CHARITABLE
WOOD BLINDS
3,400
TULSA ADVOCATES FOR THE PROTECTION
P O BOX 14044
TULSA
,
OK
74159
NONE
CHARITABLE
FOSTER FAMILY SUPPLIES & EQUIPMENT
5,000
TULSA AIR & SPACE MUSEUM
3624 N 74TH E AVE
TULSA
,
OK
74115
NONE
CHARITABLE
EQUIPMENT & CARPET
5,500
TULSA AREA UNITED WAY
1430 S BOULDER
TULSA
,
OK
74119
NONE
CHARITABLE
GENERAL PROGRAM SUPPORT
10,000
TULSA BALET THEATRE
1212 E 45TH PL
TULSA
,
OK
74105
NONE
CHARITABLE
PRODUCTION EXPENSES
5,500
TULSA BOY'S HOME
P O BOX 1101
TULSA
,
OK
74101
NONE
CHARITABLE
MEDICAL SUPPLIES
4,000
TULSA CHILDREN'S MUSEUM
560 N MAYBELLE
TULSA
,
OK
74127
NONE
CHARITABLE
COMPUTER EQUIPMENT
2,800
TULSA COMMUNITY FDN DBA 501TECHNET
7020 S YALE 400
TULSA
,
OK
74136
NONE
CHARITABLE
SOFTWARE
5,000
TULSA COUNTY MEDICAL SOCIETY FOUNDA
5315 S LEWIS
TULSA
,
OK
74105
NONE
CHARITABLE
COMPUTER EQUIPMENT
2,000
TULSA GIRLS ART SCHOOL PROJECT
2202 E ADMIRAL
TULSA
,
OK
74110
NONE
CHARITABLE
ART SUPPLIES
1,500
TULSA GLOBAL ALLIANCE
600 S COLLEGE
TULSA
,
OK
74104
NONE
CHARITABLE
EVENT EXPENSES
2,500
TULSA COUNTY HISTORICAL SOCIETY
2445 S PEORIA
TULSA
,
OK
74114
NONE
CHARITABLE
EXHIBIT SUPPORT
5,000
TULSA HUB SYNDICATE
601 W 3RD
TULSA
,
OK
74127
NONE
CHARITABLE
TRAILER FOR PROGRAMS
2,500
TULSA INTERNATIONAL MAYFEST
402 S MAIN
TULSA
,
OK
74103
NONE
CHARITABLE
SPONSORSHIP
11,000
TULSA LAWYERS FOR CHILDREN
907 S DETROIT 735
TULSA
,
OK
74120
NONE
CHARITABLE
OFFICE EQUIPMENT
2,500
TULSA LIBRARY TRUST
400 CIVIC CENTER DR
TULSA
,
OK
74103
NONE
CHARITABLE
LITERACY PROGRAMS
1,000
TULSA OPERA
1610 S BOULDER
TULSA
,
OK
74119
NONE
CHARITABLE
HIGH SCHOOL OUTREACHPROGRAM
6,500
TULSA ORATORIO CHORUS
111 E 1ST
TULSA
,
OK
74103
NONE
CHARITABLE
PRODUCTION EXPENSES
5,000
TULSA SPCA
P O BOX 581898
TULSA
,
OK
74158
NONE
CHARITABLE
KENNEL EQUIPMENT
2,500
TULSA SYMPHONY ORCHESTRA
117 N BOSTON
TULSA
,
OK
74119
NONE
CHARITABLE
PRODUCTION EXPENSES
3,500
TULSA ZOO FRIENDS
6421 E 36TH S NORTH
TULSA
,
OK
74115
NONE
CHARITABLE
EXHIBIT EXPENSES
2,500
TWELVE & TWELVE INC
6333 E SKELLY DR
TULSA
,
OK
74135
NONE
CHARITABLE
RESIDENTIAL PROGRAM EXPENSES
2,500
UNION PUBLIC SCHOOLS
8506 E 61ST
TULSA
,
OK
741331926
NONE
CHARITABLE
RUNNING CLUB EXPENSES
4,000
UNIVERSITY OF OKLAHOMA FOUNDATION
4502 E 41ST
TULSA
,
OK
74135
NONE
CHARITABLE
MEDICAL SUPPLIES
3,000
UP WITH TREES
1102 S BOSTON
TULSA
,
OK
74119
NONE
CHARITABLE
WATERLINE FOR SEEDBEDS
2,200
VISION EUFALA
17 HOSPITAL DRIVE
EUFALA
,
OK
74432
NONE
CHARITABLE
ART PROJECT FOR PARK
1,000
VIZAVANCE
2506 E 21ST STE B
TULSA
,
OK
74114
NONE
CHARITABLE
COMPUTER EQUIPMENT & SOFTWARE
3,500
YOUNG WOMEN'S CHRISTIAN ASSOCIATION
1910 S LEWIS
TULSA
,
OK
74104
NONE
CHARITABLE
PHONE SYTEM
5,000
YOUTH SERVICES OF TULSA
311 S MAIN
TULSA
,
OK
74114
NONE
CHARITABLE
GAS STOVE
4,000
Total
.................................
3a
418,600
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
...........
14
52,504
4
Dividends and interest from securities
....
14
105,593
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
............
14
385,016
34,918
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
MISCELLANEOUS
6,829
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
543,113
41,747
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
584,860
(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