-
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
EDWARD FROELICH CHARITABLE TRUST UW 47F001011
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 3215
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LANCASTER
,
PA
176043215
A Employer identification number
23-6711561
B
Telephone number (see instructions)
(717) 672-2026
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)
$
6,598,648
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
190,413
190,413
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
266,174
b
Gross sales price for all assets on line 6a
9,662,874
7
Capital gain net income (from Part IV, line 2)
...
266,174
8
Net short-term capital gain
.........
0
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
644
644
12
Total.
Add lines 1 through 11
........
457,231
457,231
13
Compensation of officers, directors, trustees, etc.
45,711
45,711
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
750
0
0
0
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
5,569
5,569
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
1,762
1,762
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
0
0
23
Other expenses (attach schedule)
.......
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
53,792
53,042
0
0
25
Contributions, gifts, grants paid
.......
330,900
330,900
26
Total expenses and disbursements.
Add lines 24 and 25
384,692
53,042
0
330,900
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
72,539
b
Net investment income
(if negative, enter -0-)
404,189
c
Adjusted net income
(if negative, enter -0-)
...
0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2019)
Form 990-PF (2019)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
2
Savings and temporary cash investments
.........
231,184
264,102
264,102
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
0
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
797,852
1,281,542
1,282,155
b
Investments—corporate stock (attach schedule)
.......
1,476,950
1,469,895
c
Investments—corporate bonds (attach schedule)
.......
1,958,335
553,787
570,994
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
3,348,450
2,838,158
3,011,502
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)
6,335,821
6,414,539
6,598,648
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
6,335,821
6,414,539
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)
.....
6,335,821
6,414,539
30
Total liabilities and net assets/fund balances
(see instructions)
.
6,335,821
6,414,539
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
6,335,821
2
Enter amount from Part I, line 27a
.....................
2
72,539
3
Other increases not included in line 2 (itemize)
3
6,724
4
Add lines 1, 2, and 3
..........................
4
6,415,084
5
Decreases not included in line 2 (itemize)
5
545
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
6,414,539
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
1191.77 AMG RENAISSANCE LG CAP GRTH FD CL Z
2015-07-06
2019-10-10
b
9081.694 AMG RENAISSANCE LG CAP GRTH FD CL Z
2015-07-06
2019-11-26
c
4907.275 AQR MULTI STRATEGY ALTERNATIVE FD CL I
2015-07-06
2019-11-26
d
11909.927 ACADIAN EMERGING MARKETS PORT INV CL
2012-05-31
2019-10-10
e
5280.749 JOHCM INTERNATIONAL SELECT FD CL I
2015-08-03
2019-10-10
30000. AMERICAN HONDA CORP 2.600% 11/16/22
2017-11-13
2019-11-26
53000. AMERICAN HONDA CORP 2.600% 11/16/22
2017-11-13
2019-12-13
10000. ANHEUSER BUSCH INBEV 4.000% 04/13/28 WORLDWIDE INC
2018-03-20
2019-03-08
101000. APPLE INC 1.800% 09/11/24
2019-09-04
2019-10-24
62000. BB&T CORP 3.050% 06/20/22
2019-03-11
2019-11-25
26000. BP CAPITAL MKTS PLC 3.279% 09/19/27
2017-09-14
2019-11-26
37000. BANK OF AMERICA CORP 3.550% 03/05/24
2018-02-28
2019-11-26
11000. BANK OF MONTREAL 2.350% 09/11/22
2017-09-06
2019-03-13
42000. BANK OF MONTREAL 2.350% 09/11/22
2017-09-06
2019-10-24
16000. BANK OF NY MELLON 3.500% 04/28/23
2018-04-23
2019-03-15
30000. BANK OF NY MELLON 3.500% 04/28/23
2018-04-23
2019-04-25
15000. BANK OF NY MELLON 3.500% 04/28/23
2018-04-23
2019-04-25
30000. BANK OF NY MELLON 3.500% 04/28/23
2018-04-23
2019-04-26
98000. BANK OF NOVA SCOTIA 2.450% 09/19/22
2017-09-14
2019-11-12
338.295 BARON EMERGING MARKETS FD INSTL CL
2019-10-10
2019-12-27
63000. BLACKROCK INC 3.250% 04/30/29
2019-04-17
2019-11-07
11000. BP CAP MKTS AMER INC 3.588% 04/14/27
2018-12-17
2019-11-26
44000. CHEVRON CORP 2.498% 03/03/22
2017-02-28
2019-11-26
27000. COMCAST CORP 4.150% 10/15/28
2018-10-02
2019-11-26
88000. WALT DISNEY CO 1.750% 08/30/24
2019-09-03
2019-10-25
1405.226 DODGE & COX INTL STOCK FUND -1048
2017-02-02
2019-10-10
52.673 DOUBLELINE TOTAL RETURN BOND FD CL I
2016-03-23
2019-12-30
37000. EXXON MOBIL CORP 2.019% 08/16/24
2019-08-13
2019-11-26
26865.13 FEDERATED KAUFMANN LG CAP FD INSTL SHARES
2010-07-02
2019-12-27
117633.377 FEDERATED STRAT VAL DIVID FD INSTL CL -662
2011-08-17
2019-12-27
1301.666 SALIENT INTL SMALL CAP FD INSTL CL
2017-02-02
2019-10-10
32000. GENERAL DYNAMICS 3.375% 05/15/23
2018-05-08
2019-10-21
34000. GLAXOSMITHKLINE CAP INC 3.375% 05/15/23
2018-05-10
2019-10-22
9733.57 GS INTL SM CAP INSIGHT FD INSTL SHS
2019-10-10
2019-11-26
31.761 GOLDMAN SACHS STRAT INC FD INSTL SHS
2014-09-17
2019-12-30
1470.358 OAKMARK INTL SMALL CAP FD INSTL CL
2017-02-02
2019-10-10
1895.928 OAKMARK INTL LARGE BLEND FD INSTL CL
2017-02-02
2019-10-10
1000. JPMORGAN CHASE 3.514% 06/18/22
2018-06-11
2019-03-05
26000. JPMORGAN CHASE 3.514% 06/18/22
2018-06-11
2019-10-22
34000. JPMORGAN CHASE 4.452% 12/05/29
2018-11-28
2019-03-01
15000. JPMORGAN CHASE 3.207% 04/01/23
2019-03-15
2019-11-26
3747.588 JOHN HANCOCK III DISCP VAL MID CAP FD CL I
2017-05-17
2019-11-26
399.23 JOHN HANCOCK III DISCP VAL MID CAP FD CL I
2019-10-10
2019-11-26
43000. JOHNSON & JOHNSON 2.250% 03/03/22
2017-02-28
2019-11-26
83000. ELI LILLY & CO 3.375% 03/15/29
2019-02-20
2019-04-05
30000. MERCK & CO INC 2.900% 03/07/24
2019-03-05
2019-04-26
15000. MERCK & CO INC 3.400% 03/07/29
2019-03-05
2019-04-08
13000. MERCK & CO INC 3.400% 03/07/29
2019-03-05
2019-04-24
15000. MERCK & CO INC 3.400% 03/07/29
2019-03-05
2019-07-01
21000. MERCK & CO INC 3.400% 03/07/29
2019-03-05
2019-07-03
45000. MICROSOFT CORP 2.400% 08/08/26
2016-08-01
2019-11-26
12000. MICROSOFT CORP 2.400% 02/06/22
2017-01-30
2019-11-26
112000. ORACLE CORP 2.625% 02/15/23
2017-11-07
2019-11-14
120.955 PERRITT MICROCAP OPPORTUNITIES FD
2012-05-31
2019-10-10
16652.542 PIMCO ALL ASSET FUND INSTL CL
2013-10-08
2019-11-26
31298.116 PIMCO STOCKSPLUS INTL FD INSTL CL
2018-04-20
2019-10-10
73000. ROYAL BK OF CANADA 2.150% 10/26/20
2017-10-18
2019-03-14
17000. ROYAL BK OF CANADA 3.700% 10/05/23
2018-10-01
2019-03-19
10000. SANOFI 3.375% 06/19/23
2018-06-12
2019-03-12
16000. SANOFI 3.375% 06/19/23
2018-06-12
2019-03-15
16000. SANOFI 3.375% 06/19/23
2018-06-12
2019-03-21
33000. SANOFI 3.375% 06/19/23
2018-06-12
2019-04-11
34000. SHELL INTL FIN BV 3.500% 11/13/23
2018-11-07
2019-11-26
61000. SHELL INTL FIN BV 3.500% 11/13/23
2018-11-07
2019-12-13
43000. 3M CO 2.000% 02/14/25
2019-08-19
2019-10-28
43000. 3M CO 2.375% 08/26/29
2019-08-19
2019-11-07
31000. TORONTO DOMINION BK 3.500% 07/19/23
2018-07-12
2019-11-26
58000. TORONTO DOMINION BK 3.500% 07/19/23
2018-07-12
2019-12-23
53000. TOTAL CAP INTL SA 3.750% 04/10/24
2019-04-05
2019-10-18
17000. TOTAL CAP INTL SA 3.750% 04/10/24
2019-04-05
2019-10-18
16000. TOTAL CAPITAL INTL 3.455% 02/19/29
2019-02-11
2019-04-04
32000. TOTAL CAPITAL INTL 3.455% 02/19/29
2019-02-11
2019-04-05
28000. TOTAL CAP INTL SA 2.434% 01/10/25
2019-07-08
2019-10-21
33000. TOTAL CAP INTL SA 2.434% 01/10/25
2019-11-07
2019-11-26
90000. TOYOTA MOTOR CR CORP 3.450% 09/20/23
2018-09-17
2019-01-03
28000. TOYOTA MOTOR CREDIT 3.350% 01/08/24
2019-01-03
2019-03-08
1243.471 UMB VALUE FD CL L -1368
2017-05-17
2019-11-26
81000. UNITED PARCEL SVC 2.500% 04/01/23
2017-11-09
2019-03-04
32000. UNITED PARCEL SVC 3.400% 03/15/29
2019-03-13
2019-04-05
14000. UNITED PARCEL SVC 2.200% 09/01/24
2019-08-13
2019-10-29
73000. US BANCORP 3.150% 04/27/27
2017-04-24
2019-02-05
6000. US BANCORP 3.375% 02/05/24
2019-01-28
2019-04-26
15000. US BANCORP 3.375% 02/05/24
2019-01-28
2019-04-30
9000. US BANCORP 3.375% 02/05/24
2019-01-28
2019-05-01
28000. US TREAS NOTES 1.375% 07/31/19
2018-10-10
2019-03-01
16000. US TREAS NOTES 1.375% 07/31/19
2018-10-10
2019-03-11
26000. US TREAS NOTES 1.375% 07/31/19
2018-10-10
2019-04-11
33000. US TREAS NOTES 1.375% 07/31/19
2018-10-10
2019-04-17
18000. US TREAS NOTES 1.375% 07/31/19
2018-11-29
2019-05-02
17000. US TREAS NOTES 1.375% 07/31/19
2018-10-10
2019-05-02
11000. US TREAS NOTES 1.375% 07/31/19
2019-01-07
2019-06-12
22000. US TREAS NOTES 1.375% 07/31/19
2018-11-29
2019-06-12
7000. US TREAS NOTES 1.375% 07/31/19
2019-01-28
2019-07-16
17000. US TREAS NOTES 1.375% 07/31/19
2019-01-07
2019-07-16
28000. US TREAS NOTES 2.750% 08/31/23
2018-10-10
2019-01-07
29000. US TREAS NOTES 2.750% 08/31/23
2019-01-03
2019-01-16
36000. US TREAS NOTES 2.750% 08/31/23
2019-01-03
2019-01-28
12000. US TREAS NOTES 2.750% 09/15/21
2018-09-27
2019-03-05
45000. US TREAS NOTES 2.750% 09/15/21
2018-10-11
2019-03-11
101000. US TREAS NOTES 2.875% 10/31/23
2018-12-13
2019-02-20
40000. US TREAS NOTES 3.125% 11/15/28
2019-02-05
2019-02-11
29000. US TREAS NOTES 3.125% 11/15/28
2019-02-05
2019-02-20
10000. US TREAS NOTES 2.625% 02/15/29
2019-03-08
2019-03-13
17000. US TREAS NOTES 2.625% 02/15/29
2019-04-05
2019-04-16
31000. US TREAS NOTES 2.625% 02/15/29
2019-04-05
2019-04-17
143000. US TREAS NOTES 2.625% 02/15/29
2019-04-24
2019-08-01
9000. US TREAS NOTES 2.500% 02/28/21
2019-03-14
2019-03-15
59000. US TREAS NOTES 2.500% 02/28/21
2019-03-14
2019-05-01
146000. US TREAS NOTES 2.375% 02/29/24
2019-03-04
2019-03-05
38000. US TREAS NOTES 2.375% 02/29/24
2019-03-12
2019-03-13
33000. US TREAS NOTES 2.375% 02/29/24
2019-03-21
2019-04-05
3000. US TREAS NOTES 2.250% 04/30/24
2019-05-01
2019-07-29
7000. US TREAS NOTES 2.250% 04/30/24
2019-05-02
2019-08-02
84000. US TREAS NOTES 2.250% 04/30/24
2019-05-08
2019-08-13
107000. US TREAS NOTES 2.250% 04/30/24
2019-05-29
2019-08-19
34000. US TREAS NOTES 2.375% 05/15/29
2019-07-03
2019-08-01
29000. US TREAS NOTES 2.375% 05/15/29
2019-11-07
2019-11-26
7000. US TREAS NOTES 1.500% 02/28/19
2018-04-23
2019-02-11
348000. US TREAS NOTES 1.500% 02/28/19
2018-07-25
2019-02-21
12000. US TREAS NOTES 1.500% 10/31/19
2019-02-21
2019-04-16
66000. US TREAS NOTES 1.500% 10/31/19
2019-02-21
2019-05-08
55000. US TREAS NOTES 1.500% 10/31/19
2019-02-21
2019-07-16
159000. US TREAS NOTES 1.500% 10/31/19
2019-02-21
2019-08-01
21000. US TREAS NOTES 1.500% 10/31/19
2019-02-21
2019-09-04
23000. US TREAS NOTES 1.500% 10/31/19
2019-02-21
2019-09-11
220000. US TREAS NOTES 1.500% 10/31/19
2019-03-26
2019-10-09
166000. US TREAS NOTES 1.500% 10/31/19
2019-08-20
2019-10-09
157000. US TREAS NOTES 1.250% 03/31/21
2019-10-09
2019-11-26
61000. US TREAS NOTES 2.125% 03/31/24
2019-04-11
2019-04-16
68000. US TREAS NOTES 2.125% 03/31/24
2019-04-26
2019-05-01
28000. US TREAS NOTES 2.125% 03/31/24
2019-04-26
2019-07-08
30000. US TREAS NOTES 2.125% 03/31/24
2019-04-30
2019-08-13
3000. US TREAS NOTES 2.000% 05/31/24
2019-06-12
2019-08-14
14000. US TREAS NOTES 2.000% 05/31/24
2019-06-12
2019-08-19
87000. US TREAS NOTES 2.000% 05/31/24
2019-07-16
2019-09-03
14000. US TREAS NOTES 2.000% 05/31/24
2019-07-16
2019-09-04
97000. US TREAS NOTES 2.625% 07/15/21
2018-07-31
2019-02-25
56000. US TREAS NOTES 1.750% 07/31/24
2019-08-01
2019-09-04
8000. US TREAS NOTES 1.750% 07/31/24
2019-08-01
2019-09-05
120000. US TREAS NOTES 1.750% 07/31/24
2019-08-01
2019-10-09
72000. US TREAS NOTES 1.750% 07/31/24
2019-08-01
2019-11-26
16000. US TREAS NOTES 1.625% 08/15/29
2019-11-07
2019-11-26
97000. US TREAS NOTES 1.250% 08/31/24
2019-10-21
2019-11-07
59000. US TREAS NOTES 1.250% 08/31/24
2019-10-24
2019-11-26
220000. US TREAS NOTES 1.375% 10/15/22
2019-10-24
2019-11-26
1460.635 VANGUARD MID CAP VAL IDX FD ADM CL
2019-10-10
2019-12-11
1268.432 VANGUARD MID CAP GRTH IDX FD ADM CL
2019-10-10
2019-12-11
2294.488 VANGUARD EMRG MKTS STK IDX FD ADM CL
2013-10-08
2019-10-10
8379.205 VICTORY TRIVALENT INTL SMALL CAP FD I SHS
2019-10-10
2019-11-26
8115.59 VIRTUS VONTOBEL EMRG MKTS OPPORT FD CL I -1736
2013-10-08
2019-10-10
91000. WALMART INC 2.850% 07/08/24
2019-04-16
2019-10-18
67000. WELLS FARGO 2.625% 07/22/22
2018-03-19
2019-10-24
27000. WELLS FARGO 3.750% 01/24/24
2019-01-16
2019-10-24
89000. WESTPAC BKG CORP 3.650% 05/15/23
2018-05-08
2019-05-29
3453. VALUE STOCK FD
2010-01-05
2019-09-30
CAPITAL GAIN DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
15,350
13,825
1,525
b
125,509
105,348
20,161
c
34,400
48,582
-14,182
d
222,120
188,799
33,321
e
118,500
106,407
12,093
30,531
30,000
531
54,005
53,000
1,005
9,990
9,922
68
100,606
100,770
-164
63,476
61,998
1,478
27,398
26,000
1,398
38,494
37,000
1,494
10,817
10,985
-168
42,517
41,943
574
16,336
15,983
353
30,736
29,967
769
15,357
14,984
373
30,769
29,967
802
99,086
97,822
1,264
5,000
4,575
425
67,201
62,490
4,711
11,772
10,725
1,047
44,700
44,000
700
30,505
26,987
3,518
87,183
87,641
-458
56,490
56,167
323
563
572
-9
37,183
37,000
183
775,328
637,216
138,112
674,039
781,937
-107,898
19,473
22,467
-2,994
33,533
31,877
1,656
35,557
33,841
1,716
116,608
109,600
7,008
294
334
-40
20,938
22,467
-1,529
42,677
44,934
-2,257
1,009
1,000
9
26,608
26,000
608
35,579
34,000
1,579
15,360
15,000
360
83,384
82,634
750
8,883
8,300
583
43,449
42,883
566
84,651
82,872
1,779
30,374
29,915
459
15,340
14,916
424
13,282
12,927
355
15,964
14,916
1,048
22,476
20,882
1,594
45,900
44,916
984
12,165
11,974
191
114,193
111,926
2,267
2,703
2,986
-283
196,500
201,387
-4,887
239,118
258,503
-19,385
72,294
72,958
-664
17,422
16,965
457
10,219
9,983
236
16,354
15,972
382
16,395
15,972
423
33,840
32,943
897
35,885
33,858
2,027
64,344
60,745
3,599
42,747
42,742
5
42,447
42,535
-88
32,748
30,958
1,790
60,863
57,921
2,942
57,066
54,772
2,294
18,292
17,689
603
16,334
16,000
334
32,740
32,000
740
28,508
28,000
508
33,484
33,332
152
90,420
89,824
596
28,523
27,992
531
79,545
80,204
-659
79,853
80,751
-898
32,534
31,962
572
14,062
13,988
74
71,982
72,956
-974
6,151
5,998
153
15,406
14,996
410
9,241
8,998
243
27,742
27,724
18
15,852
15,843
9
25,762
25,744
18
32,700
32,675
25
17,848
17,854
-6
16,856
16,833
23
10,922
10,932
-10
21,843
21,821
22
6,959
6,961
-2
16,901
16,894
7
28,310
27,613
697
29,282
29,391
-109
36,284
36,643
-359
12,063
11,950
113
45,287
44,783
504
102,756
101,501
1,255
41,609
41,438
171
30,174
30,042
132
10,013
10,000
13
17,050
17,162
-112
31,084
31,337
-253
151,312
144,535
6,777
9,010
9,006
4
59,233
59,041
192
144,951
144,904
47
37,933
37,921
12
33,110
32,988
122
3,056
2,998
58
7,180
6,992
188
86,490
83,801
2,689
110,699
107,783
2,916
35,254
35,163
91
30,585
30,528
57
6,957
6,957
345,993
345,993
11,922
11,916
6
65,565
65,540
25
54,679
54,618
61
158,058
157,894
164
20,871
20,854
17
22,857
22,840
17
218,893
218,504
389
165,165
165,400
-235
156,172
156,246
-74
60,211
60,459
-248
67,572
67,382
190
28,335
27,782
553
30,708
29,773
935
3,067
3,019
48
14,335
14,089
246
89,579
87,510
2,069
14,435
14,080
355
97,292
96,617
675
57,140
55,961
1,179
8,117
7,994
123
121,889
119,916
1,973
72,473
71,949
524
15,815
15,571
244
94,848
95,682
-834
58,062
58,057
5
218,673
218,659
14
88,661
83,300
5,361
84,592
80,000
4,592
77,347
78,311
-964
116,303
109,600
6,703
88,054
78,315
9,739
94,787
90,889
3,898
66,969
64,680
2,289
28,533
26,951
1,582
91,783
88,976
2,807
45,007
54,532
-9,525
27,465
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
1,525
b
20,161
c
-14,182
d
33,321
e
12,093
531
1,005
68
-164
1,478
1,398
1,494
-168
574
353
769
373
802
1,264
425
4,711
1,047
700
3,518
-458
323
-9
183
138,112
-107,898
-2,994
1,656
1,716
7,008
-40
-1,529
-2,257
9
608
1,579
360
750
583
566
1,779
459
424
355
1,048
1,594
984
191
2,267
-283
-4,887
-19,385
-664
457
236
382
423
897
2,027
3,599
5
-88
1,790
2,942
2,294
603
334
740
508
152
596
531
-659
-898
572
74
-974
153
410
243
18
9
18
25
-6
23
-10
22
-2
7
697
-109
-359
113
504
1,255
171
132
13
-112
-253
6,777
4
192
47
12
122
58
188
2,689
2,916
91
57
6
25
61
164
17
17
389
-235
-74
-248
190
553
935
48
246
2,069
355
675
1,179
123
1,973
524
244
-834
5
14
5,361
4,592
-964
6,703
9,739
3,898
2,289
1,582
2,807
-9,525
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
266,174
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
342,695
6,423,840
0.053347
2017
343,074
6,609,296
0.051908
2016
346,808
6,520,730
0.053185
2015
434,585
6,856,044
0.063387
2014
342,228
7,258,376
0.047149
2
Total
of line 1, column (d)
.....................
2
0.268976
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
0.053795
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
6,339,883
5
Multiply line 4 by line 3
......................
5
341,054
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
4,042
7
Add lines 5 and 6
........................
7
345,096
8
Enter qualifying distributions from Part XII, line 4
,.............
8
330,900
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
8,084
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
8,084
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
8,084
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
2,267
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
10,000
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
12,267
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
4,183
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
4,183
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
PA
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
14
The books are in care of
FULTON BANK NA
Telephone no.
(717) 672-2026
Located at
ONE PENN SQUARE
LANCASTER
PA
ZIP+4
17602
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
No
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
FULTON BANK N A
TRUSTEE
0
45,711
PO BOX 3215
LANCASTER
,
PA
176043215
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
6,134,997
b
Average of monthly cash balances
.......................
1b
301,432
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
6,436,429
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
6,436,429
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
96,546
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
6,339,883
6
Minimum investment return.
Enter 5% of line 5
..................
6
316,994
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
316,994
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
8,084
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
8,084
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
308,910
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
308,910
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
308,910
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
330,900
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
330,900
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
330,900
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
308,910
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
......
0
b
From 2015
......
48,179
c
From 2016
......
26,675
d
From 2017
......
19,365
e
From 2018
......
23,785
f
Total
of lines 3a through e
........
118,004
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
330,900
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
.....
308,910
e
Remaining amount distributed out of corpus
21,990
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
139,994
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)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
139,994
10
Analysis of line 9:
a
Excess from 2015
....
48,179
b
Excess from 2016
....
26,675
c
Excess from 2017
....
19,365
d
Excess from 2018
....
23,785
e
Excess from 2019
....
21,990
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
HEMPFIELD HIGH SCHOOL
200 STANLEY AVENUE
LANDISVILLE
,
PA
17538
N/A
PC
EDUCATION SCHOLARSHIPS
2,000
BOY SCOUTS OF AMERICA TROOP #90
3825 CONCORDIA ROAD
COLUMBIA
,
PA
17512
N/A
PC
OPERATIONS
1,200
BSA TROOP # 349
PENNSYLVANIA DUTCH COUNCIL 524
630 JANET AVE SUITE B114
LANCASTER
,
PA
17601
N/A
PC
GENERAL
1,000
MOUNTVILLE ELEMENTARY SCHOOL
HEMPFIELD SCHOOL DISTRICT
200 COLLEGE AVE
MOUNTVILLE
,
PA
17554
N/A
PC
OUTDOOR CLASSROOM SUPPORT
8,200
HEMPFIELD POWER PACKS
HEMPFIELD SCHOOL DISTRICT
200 CHURCH STREET
LANDISVILLE
,
PA
17538
N/A
PC
SCHOOL FOOD INSECURITY
500
AMERICAN CANCER SOCIETY INC
250 WILLIAMS ST NW SUITE 400
ATLANTA
,
GA
30303
N/A
PC
OPERATIONS
2,000
THE SALVATION ARMY
440 WEST NYACK RD
WEST NYACK
,
NY
10994
N/A
PC
LANCASTER, PA OPERATIONS
110,300
MOUNTVILLE YOUTH ATHLETIC ASSOCIATION
PO BOX 415
MOUNTVILLE
,
PA
17554
N/A
PC
OPERATIONS
2,000
LANCASTER PUBLIC LIBRARY
MOUNTVILLE BRANCH
125 N DUKE STREET
LANCASTER
,
PA
17602
N/A
PC
MOUNTVILLE BRANCH
26,200
MOUNTVILLE COMMUNITY
SERVICES FOUNDATION
PO BOX 94
MOUNTVILLE
,
PA
17554
N/A
POF
COMMUNITY SERVICES &
50,350
HEMPFIELD AREA RECREATION
COMMISSION
950 CHURCH STREET
LANDISVILLE
,
PA
17538
N/A
PC
EVERYONE BELONGS CAMPAIGN
1,500
FAITH FRIENDSHIP MINISTRIES INC
128 W MAIN STREET
MOUNTVILLE
,
PA
17554
N/A
PC
OPERATIONS
5,000
WATER STREET MINISTRIES
210 S PRINCE STREET
LANCASTER
,
PA
176047267
N/A
PC
OPERATIONS
110,300
MOUNTVILLE FIRE COMPANY
26 N LEMON STREET
MOUNTVILLE
,
PA
17554
N/A
PC
FIRE PREVENTION, PROTECTION
10,350
Total
.................................
3a
330,900
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
14
190,413
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
266,174
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
OTHER INCOME
14
644
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
457,231
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
457,231
(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