-
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
REPUBLIC NATIONAL DISTRIBUTING COMPANY
FOUNDATION INC
Number and street (or P.O. box number if mail is not delivered to street address)
ONE NATIONAL DRIVE
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
ATLANTA
,
GA
30336
A Employer identification number
45-3842838
B
Telephone number (see instructions)
(404) 472-2245
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)
$
81,196
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)
900,000
2
Check
.............
3
Interest on savings and temporary cash investments
245
245
4
Dividends and interest from securities
...
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
b
Gross sales price for all assets on line 6a
7
Capital gain net income (from Part IV, line 2)
...
0
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)
.......
12
Total.
Add lines 1 through 11
........
900,245
245
13
Compensation of officers, directors, trustees, etc.
0
0
0
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
1,005
1,005
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
1,005
1,005
0
25
Contributions, gifts, grants paid
.......
864,323
864,323
26
Total expenses and disbursements.
Add lines 24 and 25
865,328
1,005
864,323
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
34,917
b
Net investment income
(if negative, enter -0-)
0
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
.............
46,279
81,196
81,196
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
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
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)
..........
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)
46,279
81,196
81,196
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
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
........
0
0
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
46,279
81,196
29
Total net assets or fund balances
(see instructions)
.....
46,279
81,196
30
Total liabilities and net assets/fund balances
(see instructions)
.
46,279
81,196
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
46,279
2
Enter amount from Part I, line 27a
.....................
2
34,917
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
81,196
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
81,196
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
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
983,230
127,370
7.719479
2017
1,218,369
117,336
10.383591
2016
594,539
79,088
7.517436
2015
601,472
78,081
7.703180
2014
596,793
74,957
7.961805
2
Total
of line 1, column (d)
.....................
2
41.285491
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
8.257098
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
112,934
5
Multiply line 4 by line 3
......................
5
932,507
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
0
7
Add lines 5 and 6
........................
7
932,507
8
Enter qualifying distributions from Part XII, line 4
,.............
8
864,323
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
0
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
0
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
0
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
0
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
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
0
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
0
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
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)
GA
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
Yes
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
N/A
14
The books are in care of
FRANCIE PURNELL
Telephone no.
(404) 472-2294
Located at
ONE NATIONAL DRIVE
ATLANTA
GA
ZIP+4
30336
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
No
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
EMILE SARTALAMACCHIA
CORP DIRCTR TAX
1.00
0
0
0
809 JEFFERSON HIGHWAY
NEW ORLEANS
,
LA
70121
DENNIS BASHUK
FOUNDATION MGR.
3.00
0
0
0
ONE NATIONAL DRIVE
ATLANTA
,
GA
30336
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
.........................
0
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
0
b
Average of monthly cash balances
.......................
1b
114,654
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
114,654
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
114,654
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
1,720
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
112,934
6
Minimum investment return.
Enter 5% of line 5
..................
6
5,647
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
5,647
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
0
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
5,647
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
5,647
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
5,647
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
864,323
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
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
864,323
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b. See instructions
.................
5
0
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
864,323
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
5,647
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
0
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
593,611
b
From 2015
......
597,568
c
From 2016
......
590,586
d
From 2017
......
1,212,506
e
From 2018
......
976,861
f
Total
of lines 3a through e
........
3,971,132
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
864,323
a
Applied to 2018, but not more than line 2a
0
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2019 distributable amount
.....
5,647
e
Remaining amount distributed out of corpus
858,676
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
4,829,808
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
593,611
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
4,236,197
10
Analysis of line 9:
a
Excess from 2015
....
597,568
b
Excess from 2016
....
590,586
c
Excess from 2017
....
1,212,506
d
Excess from 2018
....
976,861
e
Excess from 2019
....
858,676
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2019)
Form 990-PF (2019)
Page
11
Part XV
Supplementary Information
(continued)
3
Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
ALEX'S LEMONADE STAND
333 LANCASTER AVE
WYNEEWOOD
,
PA
19355
NONE
PC
COMMUNITY SERVICE
1,000
ALL SAINTS EPSICOPAL CHURCH
100 LOWER MARLBOROR RD
SUNDERLAND
,
MD
20689
NONE
PC
COMMUNITY SERVICE
250
AMERICAN CANCER SOCIETY
132 W 32ND STREET
NEW YORK
,
NY
10001
NONE
PC
MEDICAL RESEARCH
10,000
AMERICAN CRANIOFACIAL ASSOCIATION
522 COMMONS VISTA
HUFFMAN
,
TX
77336
NONE
PC
MEDICAL
1,200
AMERICAN HEART ASSOCIATION
17777 S HARRISON ST
DENVER
,
CO
80210
NONE
PC
MEDICAL RESEARCH
5,000
AMERICAN HEART ASSOCIATION
217 E REDWOOD ST 1100
BALTIMORE
,
MD
21201
NONE
PC
MEDICAL
10,000
AMERICAN LUNG ASSOCIATION
115 W WASHINGTON ST
INDIANAPOLIS
,
IN
46204
NONE
PC
MEDICAL RESEARCH
1,000
ARMED SERVICES YMCA
14040 CENTRAL LOOP
WOODBRIDGE
,
VA
22193
NONE
PC
COMMUNITY SERVICE
10,000
ASHLAND POLICE FOUNDATION
601 ENGLAND ST
ASHLAND
,
VA
23005
NONE
PC
COMMUNITY SERVICE
600
BACK ON MY FEET
201 N CHARLES STREET
BALTIMORE
,
MD
21201
NONE
PC
COMMUNITY SERVICE
1,000
BALTIMORE ANIMAL AND CARE SHELTER
2490 GILES ROAD
BALTIMORE
,
MD
21225
NONE
PC
COMMUNITY SERVICE
2,000
BAPS ENDORSEMENT
81 SUTTONS LANE
PASATAWAY
,
NJ
08854
NONE
PC
RELIGIOUS
1,201
BEAM INC DISTRIBUTORS FOUNDATION
222 MERCHANDISE MART PLAZA
CHICAGO
,
IL
60015
NONE
PC
COMMUNITY SERVICE
25,000
BEN'S GIFTS INC
PO BOX 4558
SILVER SPRINGS
,
MD
20914
NONE
PC
MEDICAL
1,000
BISMARK CANCER CENTER FOUNDATION
500 NORTH 8TH STREET
BISMARK
,
ND
58501
NONE
PC
MEDICAL
500
BOCA WEST CHILDREN'S FOUNDATION
20583 BOCA WEST DRIVE
BOCA RATON
,
FL
33434
NONE
PC
COMMUNITY SERVICE
3,500
BUFFALO GAP FOOD & WINE
PO BOX 728
BUFFALO GAP
,
TX
79508
NONE
PC
COMMUNITY SERVICE
6,000
BYRON GAMBULOS ANIMAL ENRICHMENT ENDOWMENT
2322 N BROADWAY AVE
OKLAHOMA CITY
,
OK
73103
NONE
PC
COMMUNITY SERVICE
2,000
CATHOLIC CHARITIES ARCHDIOCESE OF NEW ORLEANS
1000 HOWARD AVE
NEW ORLEANS
,
LA
70113
NONE
PC
COMMUNITY SERVICE
1,000
CHILDREN OF RESTAURANT EMPLOYEES LTD
1196-C BUCKHEAD CROSSING
WOODSTOCK
,
GA
30189
NONE
PC
COMMUNITY SERVICE
5,000
CHILDREN'S HOSPITAL
11 MICHIGAN AVE
WASHINGTON
,
DC
20001
NONE
PC
MEDICAL
3,900
CHILDREN'S MIRACLE NETWORK
200 HENRY CLAY AVENUE
NEW ORLEANS
,
LA
70118
NONE
PC
COMMUNITY SERVICE
5,750
COASTAL BEND FOOD BANK
826 KRILL ST
CORPUS CHRISTI
,
TX
78408
NONE
PC
COMMUNITY SERVICE
750
COASTAL CONSERVATION ASSOCIATION
4061 FORRESTAL AVE
ORLANDO
,
FL
32806
NONE
PC
COMMUNITY SERVICE
5,000
COMMITTEE FOR ECONOMIC DEV OF THE CONFERENCE BOARD
1530 WILSON BLVD
ARLINGTON
,
VA
22209
NONE
PC
COMMUNITY SERVICE
5,000
CRIMESTOPPERS
PO BOX 55249
METAIRIE
,
LA
70055
NONE
PC
COMMUNITY SERVICE
5,000
CYSTIC FIBROSIS FOUNDATION
4550 MONTGOMERY AVE
BETHESDA
,
MD
20814
NONE
PC
MEDICAL
3,000
DAKOTA MEDICAL FOUNDATION
4141 28TH AVE S
FARGO
,
ND
58104
NONE
PC
MEDICAL
1,030
DALLAS AREA HABITAT FOR HUMANITY
2800 N HAMPTON RD
DALLAS
,
TX
75212
NONE
PC
COMMUNITY SERVICE
8,500
DARE TO CARE
5803 FERN VALLEY RD
LOUISVILLE
,
KY
40228
NONE
PC
COMMUNITY SERVICE
500
DENNIS W HOLDER SCHOLARSHIP FUND
4225 INTERWOOD NORTH PARKWAY
HOUSTON
,
TX
77032
NONE
PC
EDUCATION
1,500
DESERT ANGELS INC
PO BOX 210455
AUBUR HILLS
,
MI
48326
NONE
PC
COMMUNITY SERVICE
2,000
DETROIT WINE ORGANIZATION
PO BOX 876
BIRMINGHAM
,
MI
48012
NONE
PC
COMMUNITY SERVICE
7,000
DRESS FOR SUCCESS
32 EAST 31ST STREET
NEW YORK
,
NY
10016
NONE
PC
COMMUNITY SERVICE
500
EDGAR L DOOKY JR & LEAH CHASE FAMILY FOUNDATION
PO BOX 791313
NEW ORLEANS
,
LA
70179
NONE
PC
COMMUNITY SERVICE
1,000
ENCORE ACADEMY
4651 SW 72ND AVE
MIAMI
,
FL
33155
NONE
PC
EDUCATION
300
ESCAPE FAMILY RESOURCE CENTER
1721 PECH ROAD 300
HOUSTON
,
TX
77055
NONE
PC
COMMUNITY SERVICE
2,500
FAMILY AND CHILDREN'S SERVICES
4623 FALLS RD
BALTIMORE
,
MD
21209
NONE
PC
COMMUNITY SERVICE
5,000
FEEDING AMERICA - KENTUCKY'S HEARTLAND
PO BOX 821
ELIZABETHTOWN
,
KY
90037
NONE
PC
COMMUNITY SERVICE
500
FIRST SERVE
3400 N PORTLAND AVE
OKLAHOMA CITY
,
OK
73112
NONE
PC
COMMUNITY SERVICE
2,500
FIRST UNITED METHODIST CHURCH GOLFERS FOR OTHERS
205 JAMES ST
BOERNE
,
TX
78006
NONE
PC
COMMUNITY SERVICE
2,500
FOOD BANK FOR THE HEARTLAND
10525 J STREET
OMAHA
,
NE
68127
NONE
PC
COMMUNITY SERVICE
5,580
FOREKIDS FOUNDATION
11005 LAPALCO BLVD
AVONDALE
,
LA
70094
NONE
PC
COMMUNITY SERVICE
7,500
FORGOTTEN HARVEST
21000 GREENFIELD RD
OAK PARK
,
MI
48237
NONE
PC
COMMUNITY SERVICE
1,000
FOUNDATION FOR AUTISM CARE EDUCATION AND SERVICES
18702 AUTUMN BREEZE DR
SPRING
,
TX
77379
NONE
PC
COMMUNITY SERVICE
1,000
FRAIZER HISTORY MUSEUM
829 W MAIN STREET
LOUISVILLE
,
KY
40202
NONE
PC
CULTURAL
5,000
FUNK ZITIELLO FOUNDATION
32 OLD SLIP
NEW YORK
,
NY
10005
NONE
PC
MEDICAL
5,000
GEORGE WASHINGTON'S MOUNT VERNON
PO BOX 110
MOUNT VERNON
,
VA
22121
NONE
PC
CULTRUAL
5,000
GILDA'S CLUB
195 WEST HOUSTON STREET
NEW YORK
,
NY
10014
NONE
PC
COMMUNITY SERVICE
500
GLEANERS COMMUNITY FOOD BANK
2131 BEAUFAIT ST
DETROIT
,
MI
48207
NONE
PC
COMMUNITY SERVICE
4,000
GOD'S PANTRY FOOD BANK
1685 JAGGIE FOX WAY
LEXINGTON
,
KY
40511
NONE
PC
COMMUNITY SERVICE
500
GONZMART FAMILY FOUNDATION
2025 E 7TH AVE
TAMPA
,
FL
33605
NONE
PC
COMMUNITY SERVICE
10,000
GRAND PRAIRIE POLICE ASSOCIATION
PO BOX 531184
GRAND PRAIRIE
,
TX
75053
NONE
PC
COMMUNITY SERVICE
5,000
GREAT PLAINS FOOD BANK
1720 3RD AVE N
FARGO
,
ND
58102
NONE
PC
COMMUNITY SERVICE
1,000
GUMMAKONDA REDDY FOUNDATION
1060 NW 3RD ST
HALLANDALE
,
FL
33009
NONE
PC
COMMUNITY SERVICE
2,000
HARBOR HUMANE SOCIETY
14345 BAGLEY ST
WEST OLIVE
,
MI
49460
NONE
PC
COMMUNITY SERVICE
2,000
HAYMAKERS FOR HOPE
745 ATLANTIC AVE
BOSTON
,
MA
02111
NONE
PC
COMMUNITY SERVICE
500
HEALTHCARE FOR THE HOMELESS
421 FALLSWAY
BALTIMORE
,
MD
21202
NONE
PC
COMMUNITY SERVICE
3,000
HELP IRAQ
25603 BERG RD
SOUTHFIELD
,
MI
48033
NONE
PC
COMMUNITY SERVICE
1,000
HISTIO CURE FOUNDATION
1600 RIVER OAKS BLVD
HOUSTON
,
TX
77019
NONE
PC
MEDICAL RESEARCH
2,500
HOUSE OF RUTH
607 EAST ST CATHERINE STREET
LOUISVILLE
,
KY
40203
NONE
PC
COMMUNITY SERVICE
2,500
HOUSTON METRO FOP LODGE 98
505 N SAM HOUSTON E STE 304
HOUSTON
,
TX
77060
NONE
PC
COMMUNITY SERVICE
1,000
HOUSTON SPCA
7007 OLD KATY RD
HOUSTON
,
TX
77024
NONE
PC
COMMUNITY SERVICE
1,000
HUMANE SOCIETY FOR HAMILTON COUNTY
1721 PLEASANT ST
NOBLESVILLE
,
IN
46060
NONE
PC
COMMUNITY SERVICE
500
HUMANE SOCIETY OF HURON VALLEY
3100 CHERRY HILL RD
ANN ARBOR
,
MI
48105
NONE
PC
COMMUNITY SERVICE
1,000
HY-VEE SANFORD LEGENDS
2210 W PENTAGON PL
SIOUX FALLS
,
SD
57107
NONE
PC
COMMUNITY SERVICE
2,500
INDIANA WAR MEMORIALS FOUNDATION
55 E MICHIGAN STREET
INDIANAPOLIS
,
IN
46204
NONE
PC
COMMUNITY SERVICE
1,000
KENTUCKY HARVEST
7705 NATIONAL TURNPIKE
LOUISVILLE
,
KY
40214
NONE
PC
COMMUNITY SERVICE
500
KENTUCKY HUMANE SOCIETY
1000 LYNDON LANE
LOUISVILLE
,
KY
40222
NONE
PC
COMMUNITY SERVICE
500
KIPP INDY PUBLIC SCHOOLS
1740 E 30TH ST
INDIANAPOLIS
,
IN
46218
NONE
PC
EDUCATIONAL
384
LEARN TO READ ST LUCIE COUNTY
811 DELAWARE AVE
FORT PIERCE
,
FL
34950
NONE
PC
COMMUNITY SERVICE
300
LEUKEMIA & LYMPHOMA SOCIETY
9075 N MERIDIAN ST
INDIANAPOLIS
,
IN
46236
NONE
PC
COMMUNITY SERVICE
3,500
LINK STRYJEWSKI FOUNDATION
930 TCHOUPITOULAS ST
NEW ORLEANS
,
LA
70130
NONE
PC
COMMUNITY SERVICE
6,250
LOUISIANA RESTAURANT ASSOCIATION
2700 N ARNOULT
METAIRIE
,
LA
70002
NONE
PC
COMMUNITY SERVICE
2,500
LOUISVILLE URBAN LEAGUE
1535 W BROADWAY
LOUISVILLE
,
KY
40203
NONE
PC
COMMUNITY SERVICE
5,000
LOURDES FOUNDATION INC
621 W CENTER ST
ROCHESTER
,
MN
55902
NONE
PC
COMMUNITY SERVICE
1,500
MARINE CORPS LEAGUE #770
3619 JEFFERSON DAVIS HIGHWAY
STAFFORD
,
VA
22554
NONE
PC
COMMUNITY SERVICE
1,000
MARYLAND SPCA
3300 FALLS RD
BALTIMORE
,
MD
21211
NONE
PC
COMMUNITY SERVICE
680
METHODIST CHILDREN'S HOME SOCIETY
26645 W 6 MILE RD
REDFORD CHARTER TWP
,
MI
48240
NONE
PC
COMMUNITY SERVICE
1,500
MIKIE MAHTOOK FOUNDATION
PO BOX 5122
LAFAYETTE
,
LA
70502
NONE
PC
COMMUNITY SERVICE
200
MUHAMMAD ALI CENTER
144 N 6TH STREET
LOUISVILLE
,
KY
40202
NONE
PC
COMMUNITY SERVICE
10,000
NATIONAL CASA ASSOCIATION
100 PEACHTREE ST NW
ATLANTA
,
GA
30303
NONE
PC
COMMUNITY SERVICE
500
NATIONAL CIVIL RIGHTS MUSEUM
450 MULBERRY ST
MEMPHIS
,
TN
38103
NONE
PC
COMMUNITY SERVICE
5,000
NEW FREEDOM MINISTRIES
3476 152ND ST
CLEVELAND
,
OH
44120
NONE
PC
COMMUNITY SERVICE
500
NEW ORLEANS CULINARY & HOSPITALITY INSTITUTE
1527 THIRD ST
NEW ORLEANS
,
LA
70130
NONE
PC
COMMUNITY SERVICE
100,000
NON COMMISSIONED OFFICERS ASSOCIATION
9330 CORPORATE DRIVE
SELMA
,
TX
78154
NONE
PC
COMMUNITY SERVICE
500
OKLAHOMA CITY POLICE ATHLETIC LEAGUE
1925 DOWNING STREET
OKLAHOMA CITY
,
OK
73120
NONE
PC
COMMUNITY SERVICE
5,500
OMAHA POLICE OFFICERS ASSOCIATION
13445 CRYER AVE
OMAHA
,
NE
68144
NONE
PC
COMMUNITY SERVICE
200
PACK AWAY HUNGER
5230 PARK EMERSON DRIVE
INDIANAPOLIS
,
IN
46203
NONE
PC
COMMUNITY SERVICE
616
PALM BEACH INDIA ASSOCIATION
PO BOX 31225
PALM BEACH GARDENS
,
FL
33420
NONE
PC
COMMUNITY SERVICE
3,000
PROVINCE OF ST JOSEPH OF THE CAPUCHIN ORDER INC
1820 MT ELLIOT ST
DETROIT
,
MI
48207
NONE
PC
COMMUNITY SERVICE
1,500
RDNC RELIEF FUND
ONE NATIONAL DRIVE
ATLANTA
,
GA
30336
AFFILIATE
PC
COMMUNITY SERVICE
228,810
RETT SYNDROME RESEARCH TRUST
67 UNDER CLIFF ROAD
TRUMBULL
,
CT
06611
NONE
PC
MEDICAL
7,500
SAMUEL WAXMAN CANCER RESEARCH FDN
420 LEXINGTON AVE
NEW YORK
,
NY
10170
NONE
PC
MEDICAL
10,000
SEMINOLE REGION CHARITY GOLF TOURNAMENT
PO BOX 3070
BOCA RATON
,
FL
33431
NONE
PC
COMMUNITY SERVICE
10,000
SONG OF KELLEN FOUNDATION
4101 NE 26TH AVENUE
LIGHTHOUSE POINT
,
FL
33064
NONE
PC
EDUCATION
5,000
SONOMA VALLEY VINTNERS & GROWERS
783 BROADWAY
SONOMA
,
CA
95476
NONE
PC
COMMUNITY SERVICE
35,000
SOS CHILDREN'S VILLAGES
3681 NW 59TH PLACE
COCNUT CREEK
,
FL
33073
NONE
PC
COMMUNITY SERVICE
5,000
SOUTHERN ENVIRONMENTAL LAW CENTER
201 WEST MAIN ST
CHARLOTTESVILLE
,
VA
22902
NONE
PC
COMMUNITY SERVICE
500
SPECIAL OLYMPICS
PO BOX 8483
OMAHA
,
NE
68108
NONE
PC
COMMUNITY SERVICE
1,000
SPONSORS FOR EDUCATIONAL OPPORTUNITY
55 EXCHANGE PLACE
NEW YORK
,
NY
10005
NONE
PC
EDUCATION
5,000
ST PATRICK'S CHURCH - ELKHORN
107 W WALWORTH ST
ELKHORN
,
WI
53121
NONE
PC
COMMUNITY SERVICE
3,152
ST PETER'S ITALIAN CATHOLIC CHURCH
1039 N BROADWAY
LOS ANGELES
,
CA
90012
NONE
PC
COMMUNITY SERVICE
1,000
SUSAN G KOMEN CENTRAL INDIANA
3500 DEPAUW BLVD
INDIANAPOLIS
,
IN
46268
NONE
PC
COMMUNITY SERVICE
5,000
TALES OF THE COCKTAIL FOUNDATION
900 CAMP ST
NEW ORLEANS
,
LA
70130
NONE
PC
COMMUNITY SERVICE
2,500
THE BANQUET
900 E 8TH ST
SIOUX FALLS
,
SD
57103
NONE
PC
COMMUNITY SERVICE
2,500
THE FOUNDATION FOR ADVANCING ALCOHOL EDUCATION
2345 CRYSTAL DRIVE
ARLINGTON
,
VA
22202
NONE
PC
EDUCATION
9,000
THE HEALING HOUSE
707 LEE ST
LAFAYETTE
,
LA
70506
NONE
PC
COMMUNITY SERVICE
2,000
THE JOEL CORNETTE FOUNDATION
5768 WHITECHAPEL DRIVE
CINCINNATI
,
OH
45236
NONE
PC
COMMUNITY SERVICE
3,000
THE MICHAEL J FOX FOUNDATION
PO BOX 4777
NEW YORK
,
NY
10163
NONE
PC
COMMUNITY SERVICE
25,000
THE SALVATION ARMY
615 SLATERS LANE
ALEXANDRIA
,
VA
22314
NONE
PC
COMMUNITY SERVICE
500
THE VIRGINIA GENTLEMEN FOUNDATION
2420 ATLANTIC AVENUE SUITE 201
VIRGINIA BEACH
,
VA
23451
NONE
PC
COMMUNITY SERVICE
8,000
THEODORE ROOSEVELT MEDORA FOUNDATION
PO BOX 1696
BISMARCK
,
ND
58502
NONE
PC
COMMUNITY SERVICE
500
TODAY FOUNDATION
PO BOX 790
BRUSH PRAIRIE
,
WA
98606
NONE
PC
COMMUNITY SERVICE
2,500
TODAY'S HARBOR FOR CHILDREN
514 BAYRIDGE RD
LA PORTE
,
TX
77571
NONE
PC
COMMUNITY SERVICE
3,500
TOMMIE FRAZIER FOUNDATION
18209 LILLIAN ST
OMAHA
,
NE
68136
NONE
PC
COMMUNITY SERVICE
1,000
TOYS FOR TOTS
PO BOX 303
LAKELAND
,
FL
33802
NONE
PC
COMMUNITY SERVICE
21,200
TOYS FOR TOTS
PO BOX 19524
LOUISVILLE
,
KY
40259
NONE
PC
COMMUNITY SERVICE
2,000
TRAVIS FREDERICK BLOCKING OUT HUNGER FDN
59 CAVALIER BLVD
FLORENCE
,
KY
41042
NONE
PC
COMMUNITY SERVICE
17,000
UCP OF CENTRAL FLORIDA
3305 S ORANGE AVE
ORLANDO
,
FL
32806
NONE
PC
MEDICAL
25,000
UJA-FEDERATION OF NEW YORK
130 E 59TH STREET
NEW YORK
,
NY
10022
NONE
PC
RELIGIOUS
20,000
UNITED NEGRO COLLEGE FUND
1805 7TH ST NW
WASHINGTON
,
DC
20001
NONE
PC
EDUCATION
5,000
UNIVERSITY OF LOUISIANA - LAFAYETTE FOUNDATION
705 E ST MARY BLVD
LAFAYETTE
,
LA
70503
NONE
PC
EDUCATION
1,000
UNIVERSITY OF THE INCARNATE WORD
4301 BROADWAY
SAN ANTONIO
,
TX
78209
NONE
PC
EDUCATIONAL
9,000
VARIETY - THE CHILDREN'S CHARITY
505 5TH AVE
DES MOINES
,
IA
50309
NONE
PC
COMMUNITY SERVICE
2,000
VISUALLY IMPAIRED PRESCHOOL SERVICES
110 WEST 42ND ST
INDIANAPOLIS
,
IN
46208
NONE
PC
COMMUNITY SERVICE
1,000
WINGS FOR LIFE
1630 STEWART ST
SANTA MONICA
,
CA
90404
NONE
PC
MEDICAL
1,000
YOUNG LEADERSHIP COUNCIL
PO BOX 56909
NEW ORLEANS
,
LA
70156
NONE
PC
COMMUNITY SERVICE
7,500
YWCA CASS CLAY
3000 S UNIVERSITY DR
FARGO
,
ND
58103
NONE
PC
COMMUNITY SERVICE
1,970
Total
.................................
3a
864,323
b
Approved for future payment
Total
.................................
3b
0
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
245
4
Dividends and interest from securities
....
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
............
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)
..
0
245
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
245
(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