-
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
William & Sheila Konar Foundation
% ANN MARIE MAHONEY
Number and street (or P.O. box number if mail is not delivered to street address)
75 THRUWAY PARK DRIVE
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
W HENRIETTA
,
NY
14586
A Employer identification number
22-2434846
B
Telephone number (see instructions)
(585) 533-2900
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)
$
136,916,007
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)
6,802,896
2
Check
.............
3
Interest on savings and temporary cash investments
1,313
1,313
4
Dividends and interest from securities
...
3,567,470
3,567,470
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
2,684,781
b
Gross sales price for all assets on line 6a
22,992,502
7
Capital gain net income (from Part IV, line 2)
...
2,684,781
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)
.......
6,640
6,640
12
Total.
Add lines 1 through 11
........
13,063,100
6,260,204
13
Compensation of officers, directors, trustees, etc.
0
14
Other employee salaries and wages
......
195,730
195,730
15
Pension plans, employee benefits
.......
33,567
33,567
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
23,500
17,625
0
5,875
c
Other professional fees (attach schedule)
....
156,375
156,375
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
251,747
250,247
19
Depreciation (attach schedule) and depletion
...
26,933
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
17,217
17,217
22
Printing and publications
..........
3,583
3,583
23
Other expenses (attach schedule)
.......
481,132
402,102
79,030
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
1,189,784
669,974
0
491,377
25
Contributions, gifts, grants paid
.......
6,356,572
6,356,572
26
Total expenses and disbursements.
Add lines 24 and 25
7,546,356
669,974
0
6,847,949
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
5,516,744
b
Net investment income
(if negative, enter -0-)
5,590,230
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
.............
2
Savings and temporary cash investments
.........
2,818,655
2,854,944
2,854,944
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)
.......
114,639,287
120,130,559
133,413,824
c
Investments—corporate bonds (attach schedule)
.......
300,000
300,000
300,000
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
227,699
Less: accumulated depreciation (attach schedule)
85,051
169,583
142,648
142,648
15
Other assets (describe
)
188,473
204,591
204,591
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
118,115,998
123,632,742
136,916,007
17
Accounts payable and accrued expenses
..........
0
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
...........
118,115,998
123,632,742
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)
.....
118,115,998
123,632,742
30
Total liabilities and net assets/fund balances
(see instructions)
.
118,115,998
123,632,742
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
118,115,998
2
Enter amount from Part I, line 27a
.....................
2
5,516,744
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
123,632,742
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
123,632,742
Form
990-PF
(2019)
Form 990-PF (2019)
Page
3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a)
List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1 a
MS #143165 - ST COVERED
P
b
MS #143165 - LT COVERED
P
c
MS #010037 - ST COVERED
P
d
MS #010337 - LT COVERED
P
e
MS #010337 - LT NON-COVERED
P
MS #010039 - ST COVERED
P
MS #010039 - LT COVERED
P
MS #010039 - LT NON-COVERED
P
MS #010041 - ST COVERED
P
MS #010041 - LT COVERED
MS #010042 - ST COVERED
P
MS #010042 - LT COVERED
P
MS #010082 - ST COVERED
P
MS #010082 - LT COVERED
BERNSTEIN #99481 - ST COVERED
P
BERNSTEIN #99481 - LT COVERED
P
BERNSTEIN #99481 - CIL
P
CAPITAL GAIN DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
23,346
23,388
-42
b
491,918
518,884
-26,966
c
339,819
327,031
12,788
d
156,873
151,952
4,921
e
22,076
19,531
2,545
74,050
66,643
7,407
383,540
307,000
76,540
4,263
4,734
-471
4,230
4,035
195
87,572
72,975
14,597
114,092
108,112
5,980
360,869
367,720
-6,851
58,257
69,406
-11,149
240,967
148,667
92,300
2,607,530
2,778,200
-170,670
18,083,695
15,339,443
2,744,252
27
27
134,014
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
-42
b
-26,966
c
12,788
d
4,921
e
2,545
7,407
76,540
-471
195
14,597
5,980
-6,851
-11,149
92,300
-170,670
2,744,252
27
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
2,684,781
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
6,259,762
123,191,517
0.050813
2017
3,649,986
96,496,712
0.037825
2016
2,260,435
25,292,913
0.08937
2015
1,020,662
9,248,199
0.110363
2014
976,696
7,354,808
0.132797
2
Total
of line 1, column (d)
.....................
2
0.421168
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
0.084234
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
126,963,970
5
Multiply line 4 by line 3
......................
5
10,694,683
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
55,902
7
Add lines 5 and 6
........................
7
10,750,585
8
Enter qualifying distributions from Part XII, line 4
,.............
8
6,847,949
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
111,805
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
111,805
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
111,805
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
108,000
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
70,000
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
178,000
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
66,195
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
66,195
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)
NY
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
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
konarfoundation.org
14
The books are in care of
ANN MARIE MAHONEY
Telephone no.
(585) 533-2903
Located at
75 THRUWAY PARK DRIVE
W HENRIETTA
NY
ZIP+4
14586
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
No
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
SHEILA KONAR
Trustee, Hours - As Required
0
0
0
0
75 THRUWAY PARK DRIVE
W HENRIETTA
,
NY
14586
HOWARD KONAR
Trustee, Hours - As Required
0
0
0
0
75 THRUWAY PARK DRIVE
W HENRIETTA
,
NY
14586
RACHAEL GUTTENBERG
Trustee, Hours - As Required
0
0
0
0
75 THRUWAY PARK DRIVE
W HENRIETTA
,
NY
14586
DONALD NOWILL
Trustee, Hours - As Required
0
0
0
0
41 Taylor Crossway
Brookline
,
MA
02146
Lawrence Fine
Trustee, Hours - As Required
0
0
0
0
2 Tiffany Court
Pittsford
,
NY
14534
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
MARILYNN P GRANT
PROGRAM DIRECTOR
40.0
129,594
12,111
227 GENESEE PARK BLVD
ROCHESTER
,
NY
14619
ANN MARIE MAHONEY
OFFICE MANAGER
40.0
48,721
16,187
62 BRIGHT OAKS DR
ROCHESTER
,
NY
14624
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
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
NONE
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
125,699,030
b
Average of monthly cash balances
.......................
1b
3,198,401
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
128,897,431
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
0
3
Subtract line 2 from line 1d
.........................
3
128,897,431
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
1,933,461
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
126,963,970
6
Minimum investment return.
Enter 5% of line 5
..................
6
6,348,199
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
6,348,199
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
111,805
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
111,805
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
6,236,394
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
6,236,394
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
6,236,394
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
6,847,949
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
0
b
Cash distribution test (attach the required schedule)
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
6,847,949
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b. See instructions
.................
5
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
6,847,949
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
6,236,394
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
0
b
Total for prior years:
2017
,
2016
,
2015
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
331,368
c
From 2016
......
1,008,919
d
From 2017
......
e
From 2018
......
205,793
f
Total
of lines 3a through e
........
1,546,080
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
6,847,949
a
Applied to 2018, but not more than line 2a
0
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
.....
6,236,394
e
Remaining amount distributed out of corpus
611,555
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
2,157,635
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
......
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)
.......
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
......
2,157,635
10
Analysis of line 9:
a
Excess from 2015
....
331,368
b
Excess from 2016
....
1,008,919
c
Excess from 2017
....
d
Excess from 2018
....
205,793
e
Excess from 2019
....
611,555
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
NONE - SEE SCHEDULE B
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
NONE
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
Ann Marie Mahoney
75 THRUWAY PARK DRIVE
W Henrietta
,
NY
14586
AMMahoney@konarfoundation.org
b
The form in which applications should be submitted and information and materials they should include:
Submit a letter of intent and provide a brief overview of the organization and the reason for the grant request.
c
Any submission deadlines:
One month prior to the quarterly trustee meetings held mid-March, mid-June, mid-September, mid-Novem
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Grants are awarded in the areas of education, cultural & civic organizations, improvement to health care services, promotion of ethnic/religious/cultural understanding & tolerance, benefits to the Jewish community.
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
Monroe Community College Foundation
Damon City Campus
228 East Main Street
Rochester
,
NY
14604
NONE
PC
Scholarship Support for Students
30,000
Cancer Wellness Connections
7 Brickston Drive
Pittsford
,
NY
14534
NONE
PC
Support for patient care/medical treatments
2,500
Mayo Clinic Foundation
2200 First Street SW
Rochester
,
MN
559050001
NONE
POF
General support for greatest needs at Mayo Clinic
2,500
Chabad Lubavitch
1037 Winton Road South
Rochester
,
NY
14618
NONE
PC
Services for Jewish community
10,000
Garth Fagan Dance
50 Chestnut Street
Rochester
,
NY
14604
NONE
PC
Program support to promote dance in communities
2,500
JCC of Greater Rochester
1200 Edgewood Avenue
Rochester
,
NY
14618
NONE
PC
Urban Design Associates Charettes and Jewish Book Festival
27,500
JCC Rochester Jewish Film Festival
1200 Edgewood Avenue
Rochester
,
NY
14618
NONE
PC
Jewish cultural support through film
25,000
Jewish Community Federation
441 East Avenue
Rochester
,
NY
14607
NONE
PC
Services for Jewish community
500,000
Jewish Family Service
441 East Avenue
Rochester
,
NY
14607
NONE
PC
Services for Jewish families
147,270
Lifespan
1900 South Clinton Avenue
Rochester
,
NY
14618
NONE
PC
Services for geriatric care
20,000
The Little Theatre
240 East Avenue
Rochester
,
NY
14604
NONE
PC
Support of local artists, music & film
50,000
Memorial Art Gallery
500 University Avenue
Rochester
,
NY
146071484
NONE
PC
Program support for the arts
27,500
Rochester Philharmonic Orchestra
108 East Avenue
Rochester
,
NY
14604
NONE
PC
Annual campaign support for local musicians
50,000
United Way
75 College Avenue
Rochester
,
NY
146071009
NONE
PC
General community support services
48,000
US Holocaust Museum
100 Raoul Wallenberg Place SW
Washington
,
DC
200242126
NONE
PC
Tolerance education/promotion of Jewish history
1,270,000
Breast Cancer Coalition of Rochester
10480 University Avenue
Rochester
,
NY
14607
NONE
PC
Support of breast cancer awareness programs/advocacy
2,500
Water for Sudan
PO Box 25551
Rochester
,
NY
14625
NONE
PC
Provide access to clean water for Sudanese communities
2,500
George Eastman Museum
900 East Avenue
Rochester
,
NY
146072298
NONE
PC
Support for museum's activities/programs
303,227
Sisters of St Joseph of Rochester
150 French Road
Rochester
,
NY
146183822
NONE
PC
MEDICAL SUPPORT OF RETIRED SISTERS
3,500
Alzheimer's Association
435 East Henrietta Road
Rochester
,
NY
14602
NONE
PC
Program & services for Alzheimer's patients and special fund raising project
32,910
Al Sigl Center
1000 Elmwood Avenue Suite 300
Rochester
,
NY
146203098
NONE
PC
Support for programs & services to children & families
2,500
Tourette Syndrome Association
42-40 Bell Blvd Suite 205
Bayside
,
NY
113612820
NONE
PC
Program support services
2,500
Dana Farber Cancer Institute
10 Brookline Place West
6th Floor
Brookline
,
MA
02445
NONE
PC
ADOPT-A-LAB PROGRAM
60,000
Jewish Senior Life Foundation
2021 Winton Road South
Rochester
,
NY
14618
NONE
PC
Services for Jewish senior citizens plus repairs & upgrades
100,000
Nazareth College
4245 East Avenue
Rochester
,
NY
14618
NONE
PC
Music Performance Center & Program Support
150,000
University of Rochester
300 E River Rd
PO Box 270032
Rochester
,
NY
14627
NONE
PC
Grants & Program Support
116,239
American Indian College Fund
8444 GREENWOOD BLVD
DENVER
,
CO
80221
NONE
PC
PROMOTE EDUCATION INITIATIVES & OPPORTUNITIES
7,500
American Jewish Joint Community Fund
220 EAST 42ND STREET
NEW YORK
,
NY
10017
NONE
PC
PROGRAM SUPPORT
7,500
BCF Scholarship Fund for BHS
40 WEBSTER PLACE
BROOKLINE
,
MA
02446
NONE
PC
PROGRAM SUPPORT
13,000
East House
259 MONROE AVENUE 200
ROCHESTER
,
NY
14607
NONE
PC
RECOVERY SUPPORT SERVICES
10,000
GEVA Theatre Center
75 WOODBURY BLVD
ROCHESTER
,
NY
14607
NONE
PC
Education Programs
50,000
Greater Rochester Enterprise Foundation
100 CHESTNUT ST 1910
ROCHESTER
,
NY
14604
NONE
POF
Program Support
150,000
Greater Rochester Summer Learning Association
274 NORTH GOODMAN STREET D103
ROCHESTER
,
NY
14617
NONE
PC
Summer LEAP
60,000
Homesteads for Hope
2185 MANITOU ROAD
ROCHESTER
,
NY
14506
NONE
PC
Support Program Services
50,000
Renaissance Academy Charter School
299 KIRK ROAD
ROCHESTER
,
NY
14612
NONE
PC
EXCELLENCE IN EDUCATION INITIATIVE
1,500
Rochester Museum & Science Center
657 EAST AVENUE
ROCHESTER
,
NY
14607
NONE
PC
PROGRAM SUPPORT
32,500
Rochester Police Foundation
115 Liberty Pole Way
ROCHESTER
,
NY
14604
NONE
PC
Field of Dreams
1,000
The Center for Youth Services
905 MONROE AVENUE
ROCHESTER
,
NY
14620
NONE
PC
CRISES NURSERY & Host Homes
55,000
The Children's Agenda
1 SOUTH WASHINGTON STREET 120
ROCHESTER
,
NY
14614
NONE
PC
ADVOCACY PROGRAM
175,765
The Lawrence W & Elyse Fine Community Foundation
441 EAST AVENUE
ROCHESTER
,
NY
14607
Trustee
PF
PROGRAM SUPPORT
13,900
Baden Street Settlement
152 Baden Street
Rochester
,
NY
14605
None
PC
Grant for Program & Services to Youth, Adults & Families
83,275
Borinquen Dance Theatre
121 Fitzhugh Street
Rochester
,
NY
14614
None
PC
Self development & grant program
40,000
Cameron Community Ministries
48 Cameron Street
Rochester
,
NY
14606
None
PC
After School Academy Award
20,000
Carthage College
2001 Alford Park Dr
Kenosha
,
WI
53140
None
PC
M Hancock Designation
5,000
Childrens Institute
274 Goodman Street N
Rochester
,
NY
14607
None
PC
Kids & Trucks
600
Connected Communities
410 Atlantic Avenue
Rochester
,
NY
14609
None
PC
Program Support
174,842
Flower City Arts Center
713 Monroe Avenue
Rochester
,
NY
14607
None
PC
Educational Programs
50,000
Foodlink
1999 Mt Read Blvd
Rochester
,
NY
14615
None
PC
Community Kitchen Institute
150,000
Frank R Williams Scholarship Fund
PO Box 55216
Washington
,
DC
20040
None
PC
B Bethea Designation
5,000
Freedom House
1850 M Street NW
Washington
,
DC
20036
None
PC
Program Support
100,000
Hope Hall School
1612 Buffalo Road
Rochester
,
NY
14624
None
PC
Summer Learning Program
75,000
Lymphatic Education & Research Network
261 Madison Avenue
New York
,
NY
10016
None
PC
Program Support
2,500
NY Funders Alliance
431 E Fayette St
Syracuse
,
NY
13202
None
PC
Support Program Services
2,500
Rochester Childrens Scholarship Fund
131 W Broad Street
Rochester
,
NY
14614
None
PC
D Vega Designation
5,000
Rochester Broadway Theatre League
885 E Main Street
Rochester
,
NY
14605
None
PC
Theatre Arts Education
5,000
Rochester Institute of Technology
1 Lomb Memorial Drive
Rochester
,
NY
14623
None
PC
MCAS Summer Bridge Program
50,000
Southwest Area Neighborhood Association
275 Drive Samuel McCree Way
Rochester
,
NY
14611
None
PC
Support for Nichols Construction & Repairs
87,731
St John Fisher College
3690 East Avenue
Rochester
,
NY
14618
None
PC
Grant for program services
23,907
Livingston County Cares - SUNY Geneseo
1 College Circle
Geneseo
,
NY
14454
None
PC
Home Away From Home
5,000
The Center For Teen Empowerment
392 Genesee Street
Rochester
,
NY
14611
None
PC
Program Services & Visionary Sponsorship
102,500
The Strong Museum
1 Manhattan Square
Rochester
,
NY
14607
None
PC
The BIG Piano and support of program services
120,000
Theta Alpha Zeta Chapter
Unknown
Rochester
,
NY
14604
None
PC
Scholarship support
1,500
University of Rochester Warner School of Education
500 Wilson Blvd
Rochester
,
NY
14627
None
PC
A12059-CUES
830,000
Young Women's College Prep Foundation
133 Hoover Drive
Rochester
,
NY
14615
None
POF
J Gkourlias Designation
5,000
YWCA of Rochester & Monroe County
175 N Clinton Ave
Rochester
,
NY
14604
None
PC
Program Support
1,200
Bishop Kearney
125 Kings Highway S
Rochester
,
NY
14617
None
PC
Family Emergency Fund
25,000
City of Rochester
30 Church Street
Rochester
,
NY
14614
None
PC
Special programs - Inspiring Beauty & Distinguished Gentlemen
6,000
Foundation of Jewish Federation of Rochester
255 East Avenue Suite 201
Rochester
,
NY
14604
None
POF
Program Services
112,500
Friends & Foundation of Rochester Library
115 South Avenue
Rochester
,
NY
14604
None
PC
Support Program Services
11,880
Heritage Christian Services
275 Kenneth Drive Suite 100
Rochester
,
NY
14623
None
PC
Support Program Services
10,000
Ibero-American Action League
817 E Main Street
Rochester
,
NY
14605
None
PC
Premier Sponsor
4,900
Jewish Federation of Greater Rochester
255 East Avenue
Rochester
,
NY
14604
None
PC
Support Program Services
160,000
NY Newspapers Foundation
252 Hudson Avenue
Albany
,
NY
12210
None
PC
Literacy Program
2,500
OWN Rochester
30 Church Street
Rochester
,
NY
14614
None
PC
Grant for program services to strengthen local economy
200,000
Pathstone
400 East Avenue
Rochester
,
NY
14607
None
PC
Champion of Diversity Project and other program services
8,500
St John's Home Foundation
150 Highland Avenue
Rochester
,
NY
14620
None
PC
Program Services
2,500
The Commissary
250 East Main Street
Rochester
,
NY
14604
None
PC
Downtown Kitchen Incubator
50,000
The Links Foundation - Rochester Chapter
1200 Massachusetts Ave NW
Washington
,
DC
20005
None
PC
Program Services
2,600
The Women's Foundation of Genesee Valley
494 East Avenue
Rochester
,
NY
14607
None
PC
Girls Literacy Initiative
7,500
United for Christchurch Mosque Shootings
Unknown
Christchurch
NZ
None
NC
Support shooting victims
1,054
University of Rochester Medical Center
601 Elmwood Avenue
Rochester
,
NY
14642
None
PC
CHAMPP Program
115,772
University Preparatory Charter School
1290 Lake Avenue
Rochester
,
NY
14613
None
PC
Bridging Technology Gap
50,000
Urban League of Rochester
265 N Clinton Ave
Rochester
,
NY
14605
None
PC
Program services
2,500
William Warfield Scholarship Fund
PO Box 31992
Rochester
,
NY
14603
None
PC
Classical Vocal Competition
9,500
Woodland Golf Club Scholarship Foundation
1897 Washington Street
Auburndale
,
MA
02466
None
PC
Support young golfers with scholarships
12,000
Total
.................................
3a
6,356,572
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
1,313
4
Dividends and interest from securities
....
14
3,567,470
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than
inventory
............
18
2,684,781
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
MISCELLANEOUS PORTFOLIO INCOME
6,640
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
6,260,204
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
6,260,204
(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