-
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
SPARTANNASH FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
850 76TH ST SW
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
BYRON CENTER
,
MI
49315
A Employer identification number
20-8767495
B
Telephone number (see instructions)
(616) 878-2000
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)
$
2,307,769
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)
1,376,084
2
Check
.............
3
Interest on savings and temporary cash investments
37,621
37,621
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)
.......
100
0
12
Total.
Add lines 1 through 11
........
1,413,805
37,621
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)
.......
15,080
0
0
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
409
0
0
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
2,584
2,584
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
18,073
2,584
0
25
Contributions, gifts, grants paid
.......
1,375,350
1,375,350
26
Total expenses and disbursements.
Add lines 24 and 25
1,393,423
2,584
1,375,350
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
20,382
b
Net investment income
(if negative, enter -0-)
35,037
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
.........
2,102,110
2,140,705
2,140,705
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
167,064
Less: allowance for doubtful accounts
170,204
167,064
167,064
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)
2,272,314
2,307,769
2,307,769
17
Accounts payable and accrued expenses
..........
100
18
Grants payable
.................
9,500
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)
.........
100
9,500
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
2,021,448
2,029,682
25
Net assets with donor restrictions
............
250,766
268,587
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)
.....
2,272,214
2,298,269
30
Total liabilities and net assets/fund balances
(see instructions)
.
2,272,314
2,307,769
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
2,272,214
2
Enter amount from Part I, line 27a
.....................
2
20,382
3
Other increases not included in line 2 (itemize)
3
5,673
4
Add lines 1, 2, and 3
..........................
4
2,298,269
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
2,298,269
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
1,515,480
2,159,147
0.701888
2017
1,550,361
1,876,468
0.826212
2016
1,560,847
1,889,861
0.825906
2015
530,731
1,138,756
0.466062
2014
583,402
703,045
0.829822
2
Total
of line 1, column (d)
.....................
2
3.649890
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
0.729978
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
2,189,162
5
Multiply line 4 by line 3
......................
5
1,598,040
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
350
7
Add lines 5 and 6
........................
7
1,598,390
8
Enter qualifying distributions from Part XII, line 4
,.............
8
1,375,350
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
701
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
701
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
701
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
460
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
460
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
17
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
258
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)
MI
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
CHANDLER KILLEEN
Telephone no.
(616) 878-2539
Located at
850 76TH ST SW
BYRON CENTER
MI
ZIP+4
493158510
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
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
MEREDITH GREMEL
EXECUTIVE DIRECTOR
5.00
0
0
0
850 76TH ST PO BOX 8700
GRAND RAPIDS
,
MI
49518
DAN PERSINGER
SECRETARY
2.00
0
0
0
850 76TH ST PO BOX 8700
GRAND RAPIDS
,
MI
49518
RENE HUNTER
TREASURER
1.00
0
0
0
850 76TH ST PO BOX 8700
GRAND RAPIDS
,
MI
49518
KATHY MAHONEY
ACTING CHAIR
1.00
0
0
0
850 76TH ST PO BOX 8700
GRAND RAPIDS
,
MI
49518
YVONNE TRUPIANO
BOARD MEMBER
1.00
0
0
0
850 76TH ST PO BOX 8700
GRAND RAPIDS
,
MI
49518
AMY MCCLELLAN
BOARD MEMBER
1.00
0
0
0
850 76TH ST PO BOX 8700
GRAND RAPIDS
,
MI
49518
CHANDLER KILLEEN
FOUNDATION ACCOUNTING MANAGER
2.00
0
0
0
850 76TH ST PO BOX 8700
GRAND RAPIDS
,
MI
49518
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
THE FOUNDATION MAKES DIRECT CASH CONTRIBUTIONS TO VARIOUS 501 (C) (3) ORGANIZATIONS.
0
2
ALL EXPENSES ARE INCIDENTAL AND DO NOT RELATE TO ANY PARTICULAR 501 (C) (3) ORGANIZATION.
0
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
2,222,499
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
2,222,499
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
2,222,499
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
33,337
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
2,189,162
6
Minimum investment return.
Enter 5% of line 5
..................
6
109,458
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
109,458
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
701
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
701
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
108,757
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
108,757
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
108,757
Part XII
Qualifying Distributions
(see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26
..........
1a
1,375,350
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
1,375,350
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
1,375,350
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
108,757
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
......
548,250
b
From 2015
......
473,793
c
From 2016
......
1,466,354
d
From 2017
......
1,456,538
e
From 2018
......
1,403,966
f
Total
of lines 3a through e
........
5,348,901
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
1,375,350
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
.....
108,757
e
Remaining amount distributed out of corpus
1,266,593
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
6,615,494
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)
...
548,250
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
6,067,244
10
Analysis of line 9:
a
Excess from 2015
....
473,793
b
Excess from 2016
....
1,466,354
c
Excess from 2017
....
1,456,538
d
Excess from 2018
....
1,403,966
e
Excess from 2019
....
1,266,593
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
ACTION MINISTRIES
310 MAIN ST
DOWAGIAC
,
MI
49047
PC
FIGHTING HUNGER
1,350
ALBION INTERFAITH MINISTRIES
118 W PORTER
ALBION
,
MI
49224
PC
FIGHTING HUNGER
1,300
ALGER COMMUNITY FOOD PANTRY
312 LYNN STREET
MUNISING
,
MI
49862
PC
FIGHTING HUNGER
750
AMEN FOOD PANTRY
1100 3RD AVE
DICKENSON
,
ND
58601
PC
FIGHTING HUNGER
5,600
ASHLAND FOOD PANTRY
102 S 24TH
ASHLAND
,
NE
68003
PC
FIGHTING HUNGER
1,900
BELLAIRE COMMUNITY FOOD PANTRY
PO BOX 343
BELLAIRE
,
MI
49615
PC
FIGHTING HUNGER
1,450
BELLEVUE FOOD PANTRY
1908 HANCOCK ST
BELLEVUE
,
NE
68005
PC
FIGHTING HUNGER
1,350
BENZIE AREA CHRISTIAN NEIGHBORS
2804 BENZIE HWY
BENZONIZA
,
MI
49616
PC
FIGHTING HUNGER
1,200
BLACK HILLS AREA HABITAT FOR HUMANITY
610 E OMAHA ST
RAPID CITY
,
SD
57701
PC
DIVERSITY & INCLUSION
4,100
BLESSINGS IN A BACKPACK
4121 SHELBYVILLE RD
LOUISVILLE
,
KY
40207
PC
GRANT
5,000
BOYNE CITY FOOD PANTRY
401 STATE ST
BOYNE CITY
,
MI
49712
PC
FIGHTING HUNGER
1,700
BRANCH AREA FOOD PANTRY
22 PIERSON ST
COLDWATER
,
MI
49036
PC
FIGHTING HUNGER
1,400
BRIDGE FOR YOUTH
1111 W 22ND ST
MINNEAPOLIS
,
MN
55405
PC
LEGACY GRANT
15,000
BUIST COMMUNITY ASSISTANCE CENTER
8306 BYRON CENTER AVE
BYRON CENTER
,
MI
49315
PC
FIGHTING HUNGER
1,400
CANNON FALLS FOOD SHELF
511 W BELLE ST
CANNON FALLS
,
MN
55009
PC
FIGHTING HUNGER
2,550
CARO UNITED METHODIST GOOD SAMARITAN
1053 GLENWOOD DR
CARO
,
MI
48723
PC
FIGHTING HUNGER
1,300
CASA DEE ESPERANZA
PO BOX 40115
ST PAUL
,
MN
55104
PC
DIVERSITY & INCLUSION
30,000
CATHOLIC CHARITIES OF ST PAULMINNEAPOLIS
1200 SECOND AVE S
MINNEAPOLIS
,
MN
55403
PC
HEALTH & WELL-BEING
30,000
CATHOLIC CHARITIES OF THE DIOCESE OF STC
911 18TH ST N PO BOX 2390
ST CLOUD
,
MN
56303
CHURCH
FIGHTING HUNGER
5,000
CATHOLIC SOCIAL SERVICES OF SOUTHERN
1020 CENTRAL AVE
AUBURN
,
NE
68305
PC
FIGHTING HUNGER
1,950
CEDAR RIVER CHAPEL FOOD PANTRY
PO BOX 513
BEAVERTON
,
MI
48612
PC
FIGHTING HUNGER
1,200
CENTER FOR WOMEN IN TRANSITION
411 BUTTERNUT DR
HOLLAND
,
MI
49424
PC
GENERAL SUPPORT
10,000
CHARLEVOIX COMMUNITY FOOD PANTRY
100 W HURLBUT AVE
CHARLEVOIX
,
MI
49720
PC
FIGHTING HUNGER
2,300
CHRISTIAN FOOD CUPBOARD OF HUDSON INC
1500 VINE STREET
HUDSON
,
WI
54016
PC
FIGHTING HUNGER
3,000
CHRISTIAN OUTREACH PROGRAM ELKHORN
3434 N 294TH ST
ELKHORN
,
NE
68022
PC
FIGHTING HUNGER
2,050
CITY WELFARE MISSION
710 N 5TH ST
IRONTON
,
OH
45638
PC
FIGHTING HUNGER
2,000
COMMUNITY ACTION CENTER OF NORTHFIELD
1651 JEFFERSON PKWY 200
NORTHFIELD
,
MN
55057
PC
FIGHTING HUNGER
2,550
COMMUNITY ACTION HOUSE
345 WEST 14TH STREET
HOLLAND
,
MI
49423
PC
FIGHTING HUNGER
4,000
COMMUNITY FOOD PANTRY AND EMERGENCY SERVICE
701 N 6TH STREET
BEATRICE
,
NE
68310
PC
FIGHTING HUNGER
2,300
COMMUNITY SHARING OF LEWISTON
4615 MONTMORENCY ST
LEWISTON
,
MI
49756
PC
FIGHTING HUNGER
1,500
COOPERSVILLE CARES
180 68TH AVE
COOPERSVILLE
,
MI
49404
PC
FIGHTING HUNGER
2,400
CRAWFORD COUNTY CHRISTIAN HELP CENTER
300 HURON ST
GRAYLING
,
MI
49738
PC
FIGHTING HUNGER
1,300
DIVINE MERCY PARISH
254 6TH ST
MANISTEE
,
MI
49660
PC
FIGHTING HUNGER
1,350
DOWNRIVER HELPING HANDS INC
310 S PARKER ST
MARINE CITY
,
MI
48039
PC
FIGHTING HUNGER
1,150
EASTERN AVE CHRISTIAN REF CHURCH CHR ED
514 EASTERN AVE SE
GRAND RAPIDS
,
MI
49503
PC
FIGHTING HUNGER
650
ELEANORS PANTRY
221 DREW ST
PAW PAW
,
MI
49079
PC
FIGHTING HUNGER
2,350
FAMILY NETWORK OF WYOMING
1029 44TH STREET SW
WYOMING
,
MI
49519
PC
FIGHTING HUNGER
5,100
FARMINGTON FOOD SHELF
510 WALNUT ST
FARMINGTON
,
MN
55024
PC
FIGHTING HUNGER
1,950
FATHER FRED FOUNDATON
826 HASTINGS
TRAVERSE CITY
,
MI
49685
PC
FIGHTING HUNGER
3,850
FEEDING SOUTH DAKOTA
1111 N CREEK DR
RAPID CITY
,
MI
57703
PC
FIGHTING HUNGER
10,500
FIRST BAPTIST KINGS STOREHOUSE FOOD PANTRY
125 STIMSON ST
CADILLAC
,
MI
49601
PC
FIGHTING HUNGER
1,200
FIRST CONG CHURCH FOOD PANTRY
109 S MAIN
ROSCOMMON
,
MI
48653
PC
FIGHTING HUNGER
1,350
FISHER HOUSE FOUNDATION INC
111 ROCKVILLE PIKE SUITE 420
ROCKVILLE
,
MD
20850
PC
HEALTH & WELL-BEING
10,000
FISHERS OF MEN MINISTRIES
210 W MAIN
ZEELAND
,
MI
49464
PC
FIGHTING HUNGER
5,050
FIVES LOAVES FOOD PANTRY
144 W THIRD ST
NEW RICHMOND
,
WI
54017
PC
FIGHTING HUNGER
2,450
FLAT RIVER OUTREACH MINISTRIES INC
11535 FULTON ST E
LOWELL
,
MI
49331
CHURCH
FIGHTING HUNGER
2,000
FOOD BANK OF EASTERN MICHIGAN
2312 LAPEER RD
FLINT
,
MI
48503
PC
FIGHTING HUNGER
6,700
FOOD BANK OF SOUTH CENTRAL MICHIGAN
5451 WAYNE RD
BATTLE CREEK
,
MI
49037
PC
FIGHTING HUNGER
7,100
FOOD BANK OF SOUTH EASTERN
800 TIDEWATER DR
NORFOLK
,
VA
23504
PC
FIGHTING HUNGER
5,000
FORKIDS INC
4200 COLLEY AVE STE A
NORFOLK
,
VA
23508
PC
GENERAL SUPPORT
10,000
FREMONT AREA HABITAT FOR HUMANITY
PO BOX 932
FREMONT
,
NE
68026
PC
DIVERSITY & INCLUSION
1,000
GENESEE METHODIST CHURCH
7190 N GENESEE RD
GENESEE
,
MI
48437
CHURCH
FIGHTING HUNGER
1,450
GLEANERS FOOD BANK
5924 STERLING DR
HOWELL
,
MI
48843
PC
FIGHTING HUNGER
1,700
GODS KITCHEN
303 SOUTH DIVISION
GRAND RAPIDS
,
MI
49503
PC
FIGHTING HUNGER
15,100
GOOD SAMARITAN
9746 MAIN ST
ELLSWORTH
,
MI
49729
PC
FIGHTING HUNGER
1,200
GOODHUE COUNTY HABITAT FOR HUMANITY
1407 W 4TH ST
RED WING
,
MN
55066
PC
DIVERSITY & INCLUSION
4,200
GRAND RAPIDS HQ
320 STATE ST SE
GRAND RAPIDS
,
MI
49503
PC
GENERAL SUPPORT
10,000
GREAT PLAINS FOOD BANK
1720 3RD AVE N
FARGO
,
ND
58102
PC
FIGHTING HUNGER
6,750
GUIDING LIGHT MISSION
PO BOX 1703
GRAND RAPIDS
,
MI
49501
PC
HEALTH & WELL-BEING
20,000
HABITAT FOR HUMANITY OF COUNCIL BLUFFS
1228 S MAIN
COUNCIL BLUFFS
,
IA
51503
PC
DIVERSITY & INCLUSION
1,500
HABITAT FOR HUMANITY OF GREATER CINCINNATI
4910 PARA DR
CINCINNATI
,
OH
45237
PC
DIVERSITY & INCLUSION
1,500
HABITAT FOR HUMANITY OF KENT COUNTY INC
425 PLEASANT ST SW
GRAND RAPIDS
,
MI
49503
PC
DIVERSITY & INCLUSION
40,000
HABITAT FOR HUMANITY OF MICHIGAN
618 S CREYTS ROAD
LANSING
,
MI
48917
PC
DIVERSITY & INCLUSION
89,000
HABITAT FOR HUMANITY OF OMAHA
1701 N 24TH ST
OMAHA
,
NE
68110
PC
DIVERSITY & INCLUSION
11,000
HABITAT FOR HUMANITY OF SARPY
1001 FORT CROOK RD N SUITE 207
BELLEVUE
,
NE
68005
PC
DIVERSITY & INCLUSION
3,100
HABITAT FOR HUMANITY OF SOUTH CENTRAL MI
1571 BASSETT DR
MANKATO
,
MN
56001
PC
DIVERSITY & INCLUSION
1,800
HABITAT FOR HUMANITY OF WEST CENTRAL MI
PO BOX 1171
WILMAR
,
MN
56201
PC
DIVERSITY & INCLUSION
1,900
HASTINGS FOOD PANTRY
209 W GREEN ST
HASTINGS
,
MI
49058
PC
FIGHTING HUNGER
2,000
HEART AND HAND
9220 KINNEVILLE RD
EATON RAPIDS
,
MI
48827
PC
FIGHTING HUNGER
2,200
HEARTLAND HOPE MISSION
5210 SOUTH 21ST ST
OMAHA
,
NE
68102
PC
FIGHTING HUNGER
1,500
HOLY FAMILY ACCESS-6 FOOD PANTRY
9669 KRAFT AVE
CALEDONIA
,
MI
49316
PC
FIGHTING HUNGER
2,600
HOLY FAMILY CHURCH - OMAHA
1715 IZARD ST
OMAHA
,
NE
68102
CHURCH
FIGHTING HUNGER
650
HONOR AND REMEMBER INC
PO BOX 16834
CHESAPEAKE
,
VA
23328
PC
MILITARY
100,000
HOOSIERS HILLS FOOD BANK
2333 W INDUSTRIAL PARK DR
BLOOMINGTON
,
IN
47402
PC
FIGHTING HUNGER
5,000
HOSPICE OF THE VALLEY
1510 E FLOWER ST
PHOENIX
,
AZ
85014
PC
HEALTH & WELL-BEING
5,000
INNER CITY CHRISTIAN FEDERATION
920 CHERRY ST
GRAND RAPIDS
,
MI
49506
PC
GENERAL SUPPORT
10,000
INTERCULTURAL SENIOR CENTER
3010 R ST
OMAHA
,
NE
68107
PC
FIGHTING HUNGER
2,250
JEREMIAH PROGRAM
3104 FIECHTNER DR
FARGO
,
SD
58103
PC
GENERAL SUPPORT
5,000
JOHN KNOX PRESBYTERIAN CHURCH
4150 KALAMAZOO AVENEUE SE
GRAND RAPIDS
,
MI
49508
CHURCH
FIGHTING HUNGER
1,400
JOSEPHS COAT WASHINGTON COUNTY FOOD
1737 WASHINGTON ST
BLAIR
,
NE
68008
PC
FIGHTING HUNGER
1,700
KAIR
PO BOX 766
KALKASKA
,
MI
49646
PC
FIGHTING HUNGER
1,450
KEARNEY AREA HABITAT FOR HUMANITY
PO BOX 1452
KEARNEY
,
NE
69103
PC
DIVERSITY & INCLUSION
2,750
KIDS PAC INC
3725 FRONTAGE RD N STE 1
LAKELAND
,
FL
33810
PC
GENERAL SUPPORT
5,000
LAKE AGASSIZ HABITAT FOR HUMANITY
210 1TH ST N
MOORHEAD
,
MN
55404
PC
DIVERSITY & INCLUSION
5,250
LEGACY COMMUNITY CENTER LLC
26 WEST GRAND AVE
CHIPPEWA FALLS
,
WI
54729
PC
GENERAL SUPPORT
6,850
LESLIE COMMUNITY OUTREACH
614 MILL ST
LESLIE
,
MI
49251
PC
FIGHTING HUNGER
1,450
LINCOLN LANCASTER COUNTRY HABITAT
144 N ANTELOPE VALLEY PKWY
LINCOLN
,
NE
68503
PC
DIVERSITY & INCLUSION
1,000
KENNEDY FOUNDATION
4152 EAST PARIS AVE SE
GRAND RAPIDS
,
MI
49512
PC
GENERAL SUPPORT
9,500
LOAVES & FISHES
1121 JACKSON ST NE 143
MINNEPAOLIS
,
MN
55413
PC
FIGHTING HUNGER
10,000
LOVE INC
326 N FERRY ST
GRAND HAVEN
,
MI
49417
PC
FIGHTING HUNGER
4,000
LOVE INC
3300 VAN BUREN
HUDSONVILLE
,
MI
49426
PC
FIGHTING HUNGER
3,250
LOVE INC OF ALLENDALE
11620 - 60TH AVE
ALLENDALE
,
MI
49401
PC
FIGHTING HUNGER
2,150
MAMRELUND FOOD PANTRY
4085 LUTHERAN CHURCH RD
KENT CITY
,
MI
49330
PC
FIGHTING HUNGER
1,700
MANCELONA FOOD PANTRY
201 N MAPLE PO BOX 252
MANCELONA
,
MI
49659
PC
FIGHTING HUNGER
1,200
MANNA FOOD BANK
116 E GONZALEZ ST
PENSACOLA
,
FL
32501
PC
FIGHTING HUNGER
5,000
MANNA FOOD PROJECT
8791 MCBRIDE PARK COURT
HARBOR SPRINGS
,
MI
49740
PC
FIGHTING HUNGER
2,350
MARYLAND FOOD BANK
2200 HALETHORPE FARMS RD
BALTIMORE
,
MD
21227
PC
FIGHTING HUNGER
5,000
MEEKER COUNTY EMERGENCY FOOD SHELF
118 N SIBLEY AVE
LITCHFIELD
,
MN
55355
PC
FIGHTING HUNGER
2,900
MEL TROTTER MINISTRIES
225 COMMERCE SW
GRAND RAPIDS
,
MI
49503
PC
FIGHTING HUNGER
5,000
MID MICHIGAN COMMUNITY ACTION AGENCY
1574 E WASHINGTON RD PO BOX 768
FARWELL
,
MI
48622
PC
FIGHTING HUNGER
1,550
MID NEBRASKA FOOD BANK
114 E 11TH ST
KEARNEY
,
NE
68847
PC
FIGHTING HUNGER
2,800
MIDLAND COUNTY EMERGENCY FOOD NETWORK
PO BOX 2521
MIDLAND
,
MI
48641
PC
FIGHTING HUNGER
1,500
MILLS COUNTY STOREHOUSE
PO BOX 289
GLENWOOD
,
IA
51534
PC
FIGHTING HUNGER
1,400
MOHMS PLACE
1435 N 15TH ST
COUNCIL BLUFFS
,
IA
51501
PC
FIGHTING HUNGER
1,500
N STREET VILLAGE
1333 N STREET NW
WASHINGTON
,
DC
20005
PC
GENERAL SUPPORT
5,000
NEIGHBORHOOD FOOD PANTRY MINISTRIES
189 WOODLAWN AVE
BATTLE CREEK
,
MI
49307
PC
FIGHTING HUNGER
1,500
NEIGHBORS INC
222 GRAND AVE W
SOUTH ST PAUL
,
MN
55075
PC
HEALTH & WELL-BEING
10,000
NORTH END COMMUNITY MINISTRY
214 SPENCER NE
GRAND RAPIDS
,
MI
49505
PC
FIGHTING HUNGER
1,150
NORTH KENT COMMUNTY SERVICES
10075 NORTHLAND
ROCKFORD
,
MI
49341
PC
FIGHTNG HUNGER
2,000
NORTHWEST FOOD PANTRY
1224 DAVIS NW
GRAND RAPIDS
,
MI
49504
PC
FIGHTING HUNGER
2,150
OAKWOOD NEIGHBORHOOD
3320 LAIRD AVENUE
KALAMAZOO
,
MI
490085403
PC
FIGHTING HUNGER
3,550
OGEMAW COUNTY CLERGY FELLOWSHIP FOOD
100 E HOUGHTON AVE
WEST BRANCH
,
MI
48661
PC
FIGHTING HUNGER
1,900
OPEN DOOR MISSION
2828 N 23 ST E
OMAHA
,
NE
68110
PC
GENERAL SUPPORT
20,000
OPERATION HOMEFRONT INC
1355 CENTRAL PARKWAY SOUTH STE 100
SAN ANTONIO
,
TX
78232
PC
MILITARY
100,000
OTSEGO COUNTY COMMUNITY FOOD PANTRY
PO BOX 1976
GAYLORD
,
MI
49734
PC
FIGHTING HUNGER
2,400
OUR DAILY BREAD
2333 W INDUSTRIAL PARK DR
BELLEFONTAINE
,
OH
43311
PC
FIGHTING HUNGER
5,000
OUTREACH EAST
PO BOX 61
DAVISON
,
MI
48423
PC
FIGHTING HUNGER
1,600
PERSPECTIVES INC
3381 GORHAM AVE
ST LOUIS PARK
,
MN
55426
PC
HEALTH & WELL-BEING
10,000
PHELPS COMMUNITY PANTRY
202 W AVE
HOLDERGE
,
NE
68949
PC
FIGHTING HUNGER
1,650
PROJECT HOPE INC
PO BOX 464
PRUDENVILLE
,
MI
48651
PC
FIGHTING HUNGER
1,650
RED WINGS AREA FOOD SHELF
1755 OLD W MAIN ST
RED WING
,
MN
55066
PC
FIGHTING HUNGER
4,000
REGIONAL FOOD BANK OF OKLAHOMA INC
3355 S PURDUE AVE
OKLAHOMA CITY
,
OK
73179
PC
FIGHTING HUNGER
5,000
RESURRECTION LIFE CHURCH ROCKFORD
3233 TEN MILE RD NE
ROCKFORD
,
MI
49341
PC
FIGHTING HUNGER
2,750
RESURRECTION OF THE LORD CHRISTIAN SERVICES
423 CEDAR ST
STANDISH
,
MI
48658
CHURCH
FIGHTING HUNGER
1,450
RICE COUNTY HABITAT FOR HUMANITY
204 7TH ST W PMB 128
NORTHFIELD
,
MN
55057
PC
DIVERSITY & INCLUSION
2,600
RIVER FALLS FOOD PANTRY
222 N MAIN ST
RIVER FALLS
,
WI
54022
PC
FIGHTNIG HUNGER
3,000
ROBESON COUNTY CHURCH & COMMUNITY
600 W 5TH ST
LUMBERTON
,
NC
28358
PC
FIGHTING HUNGER
5,000
SACRED HEART CATHOLIC CHURCH
5300 N US 23
OSCODA
,
MI
48750
CHURCH
FIGHTING HUNGER
1,000
SALVATION ARMY
601 S WASHINGTON ST
BISMARCK
,
ND
58504
PC
FIGHTING HUNGER
16,000
SALVATION ARMY
302 EXCHANGE ST
OWOSSO
,
MI
48750
PC
FIGHTING HUNGER
1,250
SAN ANTONIO FOOD BANK
5200 N 1ST AVE
SAN ANTONIO
,
TX
782272209
PC
FIGHTING HUNGER
5,000
SAUNDERS COUNTY FOOD PANTRY
PO BOX 11
WAHOO
,
NE
68066
PC
FIGHTING HUNGER
2,100
SECOND HELPINGS
1121 SOUTHEASTERN AVE
INDIANAPOLIS
,
IN
46202
PC
FIGHTING HUNGER
5,000
SENCA
1700 STONE 103
FALLS CITY
,
NE
68102
PC
FIGHTING HUNGER
1,800
SIENA FRANCIS HOUSE OF HOMELESS SHELTER
1702 NICHOLAS ST
OMAHA
,
NE
68102
PC
FIGHTING HUNGER
1,250
SOJOURNER PROJECT INC
PO BOX 272
HOPKINS
,
MN
55343
PC
DIVERSITY & INCLUSION
10,000
SOLID GROUND
3521 ENTURY AVE N
WHITE BEAR LAKE
,
MN
55110
PC
HEALTH & WELL-BEING
10,000
SOMERSET COMMUNITY FOOD PANTRY
203 CHURCH HILL RD
SOMERSET
,
WI
54025
PC
FIGHTING HUNGER
1,500
SOUTH COUNTY COMMUNITY SERVICES
105 S KALAMAZOO
VICKSBURG
,
MI
49097
PC
FIGHTING HUNGER
3,000
SOUTHSIDE COMMUNITY KITCHEN
800 W BARNES AVE
LANSING
,
MI
48910
PC
FIGHTING HUNGER
1,450
SPECIAL OLYMPICS IOWA
551 SE DOVETRAIL RD
GRIMES
,
IA
50111
PC
DIVERSITY & INCLUSION
1,300
SPECIAL OLYMPICS MICHIGAN
1120 SOUTH MISSON STREET
MT PLEASANT
,
MI
48858
PC
DIVERSITY & INCLUSION
165,000
SPECIAL OLYMPICS MINNESOTA
100 WASHINGTON AVE S
MINNEAPOLIS
,
MN
55401
PC
DIVERSITY & INCLUSION
15,000
SPECIAL OLYMPICS NORTH DAKOTA
2616 S 26TH ST
GRAND FORKS
,
ND
58201
PC
DIVERSITY & INCLUSION
29,000
SPECIAL OLYMPICS OHIO INC
620 SECOND ST
CHESAPEAKE
,
OH
45619
PC
DIVERSITY & INCLUSION
4,200
SPECIAL OLYMPICS OMAHA
9427 F ST
OMAHA
,
NE
68127
PC
DIVERSITY & INCLUSION
25,000
SPECIAL OLYMPICS SOUTH DAKOTA
800 E I-90 LANE
SIOUX FALLS
,
SD
57104
PC
DIVERSITY & INCLUSION
6,200
SPECIAL OLYMPICS WISCONSIN
2310 CROSSROADS DR 1000
MADISON
,
WI
53718
PC
DIVERSITY & INCLUSION
9,500
ST BARTHOLOMEW COMMUNITY FOOD PANTRY
789 RYNO ROAD
MIO
,
MI
48647
PC
FIGHTING HUNGER
3,650
ST CHARLES IN HELENA
230 E VIENNA ST
CLIO
,
MI
48420
PC
FIGHTING HUNGER
1,750
ST CROIX VALLEY HABITAT FOR HUMANITY
116 E ELM ST
RIVER FALLS
,
WI
54022
PC
DIVERSITY & INCLUSION
7,000
ST IGNACE AREA HOPE
PO BOX 170
SAINT IGNACE
,
MI
49781
PC
FIGHTING HUNGER
2,350
ST MARY'S FOOD PANTRY
423 FIRST STREEET
GRAND RAPIDS
,
MI
49504
PC
FIGHTING HUNGER
2,100
ST PETER AREA FOOD SHELF
35615 398TH LANE
ST PETER
,
MN
56082
PC
FIGHTING HUNGER
2,750
ST PIUS C CHURCH
3937 WILSON AVE
GRANDVILLE
,
MI
49418
CHURCH
FIGHTING HUNGER
1,600
ST SAVIOURS FOOD PANTRY
4136 MYRTLE AVE
CINCINNATI
,
OH
45236
PC
FIGHTING HUNGER
2,150
ST STEPHEN EVANGELICAL LUTHERAN CHURCH
32900 NORTH WAVERLY RD
LANSING
,
MI
48906
PC
FIGHTING HUNGER
1,250
ST THOMAS LUTHERAN CHURCH
332 S WESTERN AVE
CHEBOYGAN
,
MI
49721
CHURCH
FIGHTING HUNGER
1,900
TEAM RED WHITE AND BLUE INC
5428 EISENHOWER AVE
ALEXANDRIA
,
VA
22304
PC
MILITARY
100,000
TOGETHER INC OF METROPOLITAN OMAHA
812 SOUTH 24TH ST
OMAHA
,
ME
68108
PC
FIGHTING HUNGER
6,950
TRI-CITIES FOOD PANTRY
302 AMERICAN PKWY
PAPILLION
,
NE
68046
PC
FIGHTING HUNGER
1,450
TWIN CITIES HABITAT FOR HUMANITY
1954 UNIVERSITY AVE W
ST PAUL
,
MN
55104
PC
DIVERSITY & INCLUSION
1,800
UNITED CHURCH OUTREACH MINISTRY INC
1131 CHICAGO DR SW
WYOMING
,
MI
49509
CHURCH
FIGHTING HUNGER
5,000
VALLEY RESCUE MISSION
2903 SECOND AVE
COLUMBUS
,
GA
31904
PC
GENERAL SUPPORT
5,000
VEAP
9600 ALDRICH AVE S
BLOOMINGTON
,
MN
55420
PC
GENERAL SUPPORT
5,000
VETSHOUSE INCORPORATE
1005 BENNINGTON RD
VIRGINIA BEACH
,
VA
23464
PC
HEALTH & WELL-BEING
30,000
WEST OHIO FOOD BANK
1380 E KIBBY ST
LIMA
,
OH
458021566
PC
FIGHTING HUNGER
5,000
WESTMINSTER PRESBYTERIAN CHURCH
47 JEFFERSON AVE SE
GRAND RAPIDS
,
MI
49503
CHURCH
FIGHTING HUNGER
4,100
WESTSIDE APOSTOLATE
1232 BRIDGE ST NW
GRAND RAPIDS
,
MI
49503
PC
FIGHTING HUNGER
2,250
WILLIAMSTON FOOD BANK
439 E CHURCH ST
WILLIAMSTON
,
MI
48895
PC
FIGHTING HUNGER
2,700
WOMEN'S RESOURCE CENTER
720 ELMWOOD SUITE 2
TRAVERSE CITY
,
MI
49684
PC
GENERAL SUPPORT
10,000
Total
.................................
3a
1,375,350
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
37,621
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
RECOVERIES OF AMOUNTS TREATED AS QUALIFYING DISTRIBUTIONS
100
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
100
37,621
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
37,721
(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