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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
G CAMPBELL O DURHAM M GRONLUND FDN
Number and street (or P.O. box number if mail is not delivered to street address)
10 S DEARBORN IL1-0111
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CHICAGO
,
IL
60603
A Employer identification number
20-5275106
B
Telephone number (see instructions)
(800) 496-2583
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)
$
1,562,869
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
...
34,442
30,302
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
71,054
b
Gross sales price for all assets on line 6a
441,315
7
Capital gain net income (from Part IV, line 2)
...
71,054
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)
.......
12
Total.
Add lines 1 through 11
........
105,496
101,356
13
Compensation of officers, directors, trustees, etc.
18,767
12,293
6,474
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
0
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
3,226
919
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
..........
21,993
13,212
0
6,474
25
Contributions, gifts, grants paid
.......
67,112
67,112
26
Total expenses and disbursements.
Add lines 24 and 25
89,105
13,212
0
73,586
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
16,391
b
Net investment income
(if negative, enter -0-)
88,144
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
.............
13,345
17,490
17,490
2
Savings and temporary cash investments
.........
22,213
22,586
22,586
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)
b
Investments—corporate stock (attach schedule)
.......
907,709
874,399
1,191,802
c
Investments—corporate bonds (attach schedule)
.......
208,819
253,698
257,975
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
73,017
73,196
73,016
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)
1,225,103
1,241,369
1,562,869
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
........
1,225,103
1,241,369
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)
.....
1,225,103
1,241,369
30
Total liabilities and net assets/fund balances
(see instructions)
.
1,225,103
1,241,369
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
1,225,103
2
Enter amount from Part I, line 27a
.....................
2
16,391
3
Other increases not included in line 2 (itemize)
3
1,680
4
Add lines 1, 2, and 3
..........................
4
1,243,174
5
Decreases not included in line 2 (itemize)
5
1,805
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
1,241,369
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
75. ISHARES BARCLAYS 1-3 YEAR TREASURY
2019-01-07
b
1. GILEAD SCIENCES INC
2015-01-08
2019-01-23
c
1. GILEAD SCIENCES INC
2015-01-08
2019-01-23
d
2. GILEAD SCIENCES INC
2015-01-08
2019-01-23
e
1. GILEAD SCIENCES INC
2015-01-08
2019-01-23
1. GILEAD SCIENCES INC
2016-02-10
2019-01-23
1. MASTERCARD INC - CLASS A
2009-05-05
2019-01-23
3. WORLDPAY INC CL A
2017-09-22
2019-01-23
3. GILEAD SCIENCES INC
2019-01-24
1. MASTERCARD INC - CLASS A
2009-05-05
2019-01-24
3. MASTERCARD INC - CLASS A
2019-01-24
5. WORLDPAY INC CL A
2017-09-22
2019-01-24
1. GILEAD SCIENCES INC
2016-02-10
2019-01-25
3. MASTERCARD INC - CLASS A
2012-10-15
2019-01-25
7. WORLDPAY INC CL A
2017-09-22
2019-01-25
1. GILEAD SCIENCES INC
2016-02-10
2019-01-28
2. WORLDPAY INC CL A
2018-10-08
2019-01-28
1. WORLDPAY INC CL A
2017-09-22
2019-01-28
1. GILEAD SCIENCES INC
2016-02-10
2019-01-29
1. WORLDPAY INC CL A
2018-10-08
2019-01-29
1. GILEAD SCIENCES INC
2016-02-10
2019-01-30
5. WORLDPAY INC CL A
2018-10-08
2019-01-30
1043.907 DODGE & COX INCOME FUND
2019-01-31
1. GILEAD SCIENCES INC
2016-02-10
2019-01-31
259. ISHARES BARCLAYS 1-3 YEAR TREASURY
2019-01-31
1. GILEAD SCIENCES INC
2016-02-10
2019-02-01
361.325 DODGE & INTERNATIONAL STOCK FUND
2016-04-05
2019-02-14
4. ANALOG DEVICES INC
2016-10-31
2019-02-19
2. ANALOG DEVICES INC
2019-02-19
5. ANALOG DEVICES INC
2019-02-19
9. ANALOG DEVICES INC
2019-02-19
3. ANALOG DEVICES INC
2019-02-19
2. ANALOG DEVICES INC
2018-09-13
2019-02-19
6. ANALOG DEVICES INC
2018-09-13
2019-02-20
1. ALPHABET INC-CL C
2013-02-08
2019-03-07
1. AMERICAN EXPRESS CO
2018-07-18
2019-03-07
3. APPLE COMPUTER INC
2019-03-07
1. AUTOMATIC DATA PROCESSING INC
2018-10-19
2019-03-07
10. BANK OF AMERICA CORPORATION
2012-11-08
2019-03-07
1. BERKSHIRE HATHAWAY INC DEL CL B
2017-04-20
2019-03-07
1. BIOGEN IDEC INC
2014-05-08
2019-03-07
5. BOSTON SCIENTIFIC CORP
2016-09-15
2019-03-07
2. BRISTOL MYERS SQUIBB CO
2019-03-07
1. BROADCOM INC
2013-05-31
2019-03-07
1. CELGENE CORP.
2015-08-11
2019-03-07
4. CITIGROUP INC NEW
2019-03-07
2. COCA-COLA CO
2018-04-13
2019-03-07
4. COMCAST CORP NEW CL A
2016-02-05
2019-03-07
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-03-07
1. DIAMONDBACK ENERGY INC
2017-05-15
2019-03-07
2. DISNEY WALT CO
2016-10-07
2019-03-07
1. DOLLAR TREE INC
2017-10-27
2019-03-07
5. DOWDUPONT INC
2015-07-15
2019-03-07
2. EOG RESOURCES INC
2016-05-02
2019-03-07
1. ELECTRONIC ARTS
2018-09-20
2019-03-07
1. FACEBOOK INC-A
2015-04-27
2019-03-07
1. FIDELITY NATL INFORMATION SVCS INC
2014-12-18
2019-03-07
2. FISERV INC
2019-01-23
2019-03-07
1. GENERAL DYNAMICS CORP
2016-08-11
2019-03-07
2. HOME DEPOT INC
2012-03-20
2019-03-07
2. HONEYWELL INTL INC
2010-10-22
2019-03-07
1. INTERCONTINENTALEXCHANGE GROUP, INC
2017-01-30
2019-03-07
619. JPMORGAN BETABUILDERS EUROPE ETF
2018-12-24
2019-03-07
7. KEYCORP NEW
2016-03-01
2019-03-07
1. LOWES COS INC
2011-09-22
2019-03-07
2. MARATHON PETROLEUM CORPORATION
2018-03-09
2019-03-07
2. MASTERCARD INC - CLASS A
2012-10-15
2019-03-07
2. MERCK & CO INC
2019-03-07
6. MICROSOFT CORP
2019-03-07
3. MONDELEZ INTERNATIONAL-W/I
2011-09-19
2019-03-07
5. MORGAN STANLEY DEAN WITTER & CO NEW
2013-04-19
2019-03-07
3. NISOURCE INC
2013-10-17
2019-03-07
2. NORFOLK SOUTHN CORP
2019-03-07
1. NVIDIA CORP
2017-10-03
2019-03-07
3. OCCIDENTAL PETE CORP
2014-09-24
2019-03-07
1. PARKER HANNIFIN CORP
2018-01-11
2019-03-07
2. PAYPAL HOLDINGS INC
2018-01-26
2019-03-07
2. PEPSICO INC
2019-03-07
7. PFIZER INC
2019-03-07
2. PHILIP MORRIS INTERNATIONAL
2019-03-07
1. PIONEER NAT RES CO
2015-12-09
2019-03-07
1. PRUDENTIAL FINL INC
2018-12-21
2019-03-07
1. REGENERON PHARMACEUTICALS INC
2019-01-23
2019-03-07
1. ROSS STORES INC
2018-12-11
2019-03-07
1. SVB FINANCIAL GROUP
2015-02-05
2019-03-07
1. SALESFORCE.COM INC
2018-04-13
2019-03-07
2. SCHWAB CHARLES CORP NEW
2015-10-19
2019-03-07
2. STANLEY BLACK & DECKER,INC.
2019-03-07
3. TEXAS INSTRS INC
2016-02-05
2019-03-07
2. UNION PAC CORP
2015-09-29
2019-03-07
2. UNITEDHEALTH GROUP INC
2019-03-07
1. VERTEX PHARMACEUTICALS INC
2014-09-09
2019-03-07
1. VISA INC CLASS A SHARES
2015-10-19
2019-03-07
1. WASTE CONNECTIONS INC
2016-07-26
2019-03-07
4. WELLS FARGO & CO NEW
2011-08-12
2019-03-07
1. WEX INC
2016-05-02
2019-03-07
1. YUM BRANDS INC
2018-11-27
2019-03-07
2. ZIMMER HLDGS INC
2017-11-10
2019-03-07
1. ALLEGION PLC
2015-10-30
2019-03-07
1. ACCENTURE PLC
2014-01-16
2019-03-07
1. LINDE PLC
2018-12-11
2019-03-07
1. MEDTRONIC PLC
2018-04-06
2019-03-07
1. APTIV PLC
2017-05-18
2019-03-07
1. CHUBB LTD
2011-05-23
2019-03-07
1. NXP SEMICONDUCTORS NV
2019-02-19
2019-03-07
2. BIOGEN IDEC INC
2018-10-08
2019-03-14
2. BIOGEN IDEC INC
2016-07-26
2019-03-14
48. BRISTOL MYERS SQUIBB CO
2019-03-14
10. DISNEY WALT CO
2019-03-14
3. ADOBE SYS INC
2012-11-05
2019-04-02
3. ALEXION PHARMACEUTICALS INC
2019-03-14
2019-04-02
2. ALPHABET INC-CL C
2019-04-02
1. ALPHABET INC-CL A
2013-05-22
2019-04-02
1. AMAZON COM INC
2015-03-12
2019-04-02
3. AMERICAN EXPRESS CO
2018-07-18
2019-04-02
12. APPLE COMPUTER INC
2019-04-02
3. AUTOMATIC DATA PROCESSING INC
2019-04-02
46. BANK OF AMERICA CORPORATION
2019-04-02
5. BERKSHIRE HATHAWAY INC DEL CL B
2017-04-20
2019-04-02
23. BOSTON SCIENTIFIC CORP
2019-04-02
4. BROADCOM INC
2019-04-02
6. CELGENE CORP.
2015-08-11
2019-04-02
3. CHARTER COMMUNICATIONS INC-A
2016-02-09
2019-04-02
16. CITIGROUP INC NEW
2019-04-02
11. COCA-COLA CO
2018-04-13
2019-04-02
26. COMCAST CORP NEW CL A
2019-04-02
7. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-04-02
5. DIAMONDBACK ENERGY INC
2017-05-15
2019-04-02
9. DISNEY WALT CO
2019-04-02
5. DOLLAR TREE INC
2017-10-27
2019-04-02
9. EOG RESOURCES INC
2019-04-02
8. ELECTRONIC ARTS
2019-04-02
4. FACEBOOK INC-A
2015-04-27
2019-04-02
6. FIDELITY NATL INFORMATION SVCS INC
2019-04-02
5. FISERV INC
2019-04-02
4. GENERAL DYNAMICS CORP
2019-04-02
5. HOME DEPOT INC
2012-03-20
2019-04-02
9. HONEYWELL INTL INC
2019-04-02
3. INTERCONTINENTALEXCHANGE GROUP, INC
2017-01-31
2019-04-02
32. KEYCORP NEW
2019-04-02
9. LILLY ELI & CO
2019-04-02
6. LOWES COS INC
2011-09-22
2019-04-02
11. MARATHON PETROLEUM CORPORATION
2019-04-02
6. MASTERCARD INC - CLASS A
2012-10-15
2019-04-02
13. MERCK & CO INC
2019-04-02
29. MICROSOFT CORP
2019-04-02
15. MONDELEZ INTERNATIONAL-W/I
2019-04-02
26. MORGAN STANLEY DEAN WITTER & CO NEW
2013-04-19
2019-04-02
2. NETFLIX.COM INC
2018-09-13
2019-04-02
4. NEXTERA ENERGY INC
2019-04-02
14. NISOURCE INC
2019-04-02
5. NORFOLK SOUTHN CORP
2019-04-02
3. NORTHROP GRUMMAN CORP
2019-04-02
3. NVIDIA CORP
2017-10-03
2019-04-02
1. O'REILLY AUTOMOTIVE INC
2017-05-04
2019-04-02
16. OCCIDENTAL PETE CORP
2019-04-02
2. PARKER HANNIFIN CORP
2018-01-11
2019-04-02
8. PAYPAL HOLDINGS INC
2018-01-26
2019-04-02
8. PEPSICO INC
2014-10-13
2019-04-02
31. PFIZER INC
2019-04-02
8. PHILIP MORRIS INTERNATIONAL
2019-04-02
5. PIONEER NAT RES CO
2019-04-02
4. PRUDENTIAL FINL INC
2019-04-02
6. ROSS STORES INC
2018-12-11
2019-04-02
2. SVB FINANCIAL GROUP
2015-02-05
2019-04-02
5. SALESFORCE.COM INC
2018-04-13
2019-04-02
9. SCHWAB CHARLES CORP NEW
2019-04-02
5. STANLEY BLACK & DECKER,INC.
2019-04-02
9. TEXAS INSTRS INC
2019-04-02
6. UNION PAC CORP
2019-04-02
3. UNITED TECHNOLOGIES CORP
2019-04-02
7. UNITEDHEALTH GROUP INC
2019-04-02
2. VERTEX PHARMACEUTICALS INC
2015-04-08
2019-04-02
5. VISA INC CLASS A SHARES
2015-10-19
2019-04-02
6. WASTE CONNECTIONS INC
2016-07-26
2019-04-02
19. WELLS FARGO & CO NEW
2019-04-02
2. WEX INC
2019-04-02
3. YUM BRANDS INC
2018-11-27
2019-04-02
8. ZIMMER HLDGS INC
2019-04-02
4. ALLEGION PLC
2019-04-02
4. ACCENTURE PLC
2019-04-02
4. LINDE PLC
2018-12-11
2019-04-02
7. MEDTRONIC PLC
2019-04-02
6. APTIV PLC
2017-05-18
2019-04-02
6. CHUBB LTD
2019-04-02
5. NXP SEMICONDUCTORS NV
2019-02-19
2019-04-02
973.34 ARTISAN INTL VAL-INST
2019-04-03
632.585 DODGE & INTERNATIONAL STOCK FUND
2016-04-05
2019-04-03
6. DOW INC
2019-04-03
19. DOWDUPONT INC
2019-04-03
7. DOW INC
2019-04-08
1. DOW INC
2017-02-22
2019-04-08
9. DOW INC
2019-04-08
3.369 DOW INC
2019-04-08
1.631 DOW INC
2018-04-09
2019-04-08
1. DOW INC
2018-04-09
2019-04-09
. DOW INC
2019-04-23
16. OCCIDENTAL PETE CORP
2019-04-25
16. OCCIDENTAL PETE CORP
2019-04-25
3. OCCIDENTAL PETE CORP
2019-05-01
1. OCCIDENTAL PETE CORP
2017-02-10
2019-05-01
2. REGENERON PHARMACEUTICALS INC
2019-05-01
1. REGENERON PHARMACEUTICALS INC
2019-02-04
2019-05-01
1. OCCIDENTAL PETE CORP
2018-08-09
2019-05-02
9. OCCIDENTAL PETE CORP
2019-05-02
1. OCCIDENTAL PETE CORP
2018-08-09
2019-05-02
2. OCCIDENTAL PETE CORP
2019-05-02
1. OCCIDENTAL PETE CORP
2018-08-09
2019-05-02
5. OCCIDENTAL PETE CORP
2019-05-03
1. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
8. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
3. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
1. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
2. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
11. SCHWAB CHARLES CORP NEW
2019-05-15
10. SCHWAB CHARLES CORP NEW
2019-05-16
3. SCHWAB CHARLES CORP NEW
2019-05-16
6. SCHWAB CHARLES CORP NEW
2016-06-03
2019-05-16
9. MEDTRONIC PLC
2019-05-16
2. MEDTRONIC PLC
2018-04-11
2019-05-16
6. MEDTRONIC PLC
2018-07-18
2019-05-16
3. MEDTRONIC PLC
2018-07-18
2019-05-17
5. MEDTRONIC PLC
2018-07-18
2019-05-17
2. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
3. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
1. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
24. DELTA AIR LINES INC DEL NEW
2019-06-05
347. ISHARES BARCLAYS 1-3 YEAR TREASURY
2019-06-05
4. PHILIP MORRIS INTERNATIONAL
2018-10-24
2019-06-05
8. PHILIP MORRIS INTERNATIONAL
2017-08-01
2019-06-05
30. BANK OF AMERICA CORPORATION
2019-06-10
7. DOLLAR TREE INC
2019-06-10
24. WELLS FARGO & CO NEW
2019-06-10
4. DOLLAR TREE INC
2018-12-17
2019-06-11
6. DOLLAR TREE INC
2019-06-11
2. DOLLAR TREE INC
2018-12-17
2019-06-11
756.247 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2014-02-04
2019-06-11
. CORTEVA INC
2019-06-13
. DUPONT DE NEMOURS INC-WI
2019-06-13
546.19 DIAMOND HILL LONG/SHORT-Y
2018-11-08
2019-06-14
1147.532 JPM INTERM T/F BND FD - USD - R6 ISIN US48129C1080
2017-04-05
2019-06-14
3. ADOBE SYS INC
2019-06-27
2. SVB FINANCIAL GROUP
2019-08-14
1. SVB FINANCIAL GROUP
2015-02-06
2019-08-14
3. APTIV PLC
2017-05-18
2019-08-14
2. APTIV PLC
2019-08-14
5. APTIV PLC
2019-08-14
3. SVB FINANCIAL GROUP
2015-08-12
2019-08-15
10. APTIV PLC
2019-08-15
501.141 CAPITAL GR NON US EQUITY
2019-09-05
338.296 JPM INTERM T/F BND FD - USD - R6 ISIN US48129C1080
2017-04-05
2019-09-05
390.876 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2019-09-05
301.822 AMER FNDS T/E BND FND AM-F3
2018-01-26
2019-09-05
266. ISHARES SHORT TREASURY BOND
2019-06-05
2019-09-20
1350.317 VANGUARD LTD TRM T/E-ADM
2019-06-14
2019-09-23
12. DISNEY WALT CO
2019-10-25
3. ACCENTURE PLC
2014-04-03
2019-10-25
4. ACCENTURE PLC
2019-10-28
8. NISOURCE INC
2015-01-14
2019-11-11
10. NISOURCE INC
2019-11-11
8. NISOURCE INC
2019-11-12
20. NISOURCE INC
2019-11-12
3. NISOURCE INC
2015-12-03
2019-11-12
1. NISOURCE INC
2015-12-03
2019-11-13
37. CELGENE CORP.
2019-11-21
10. CELGENE CORP.
2019-11-21
143.72 FIDELITY 500 INDEX-INST PRM
2018-02-07
2019-11-22
18. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
2. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
1. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
22. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-26
4. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-27
224.448 JPM INTERM T/F BND FD - USD - R6 ISIN US48129C1080
2019-12-05
649.025 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2014-12-16
2019-12-05
726.159 EQUINOX IMP SYSTEM MACRO-I
2018-11-13
2019-12-09
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
6,273
6,243
30
b
69
102
-33
c
69
102
-33
d
137
203
-66
e
68
102
-34
68
89
-21
198
18
180
247
216
31
203
267
-64
200
18
182
597
113
484
411
360
51
69
89
-20
608
142
466
580
504
76
68
89
-21
166
194
-28
83
72
11
69
89
-20
82
97
-15
70
89
-19
418
485
-67
14,051
14,363
-312
70
89
-19
21,709
21,556
153
70
88
-18
14,341
12,224
2,117
419
257
162
209
128
81
525
318
207
939
829
110
313
191
122
210
184
26
635
553
82
1,147
392
755
108
103
5
519
108
411
151
143
8
285
95
190
199
165
34
316
266
50
198
117
81
103
81
22
267
41
226
86
130
-44
247
158
89
91
89
2
154
117
37
49
53
-4
98
104
-6
228
185
43
102
93
9
269
262
7
183
165
18
97
114
-17
170
82
88
106
63
43
171
161
10
165
151
14
367
99
268
304
90
214
74
58
16
14,377
12,954
1,423
117
75
42
101
19
82
119
141
-22
446
95
351
160
127
33
662
191
471
141
66
75
205
103
102
82
34
48
357
239
118
150
179
-29
198
283
-85
170
208
-38
192
170
22
232
188
44
291
241
50
173
226
-53
137
141
-4
94
80
14
411
398
13
92
81
11
240
120
120
157
119
38
89
57
32
263
210
53
316
149
167
331
173
158
473
136
337
178
93
85
147
77
70
84
49
35
199
98
101
173
94
79
96
89
7
244
221
23
88
65
23
161
84
77
168
161
7
91
78
13
82
71
11
133
68
65
94
93
1
640
685
-45
640
532
108
2,362
2,534
-172
1,144
934
210
812
102
710
406
404
2
2,389
848
1,541
1,198
367
831
1,813
374
1,439
331
309
22
2,307
447
1,860
484
431
53
1,305
506
799
1,022
825
197
885
536
349
1,222
237
985
561
779
-218
1,040
558
482
1,024
803
221
513
490
23
1,045
1,034
11
378
375
3
517
519
-2
1,016
883
133
516
464
52
873
732
141
816
909
-93
684
330
354
681
380
301
447
408
39
685
609
76
973
247
726
1,451
429
1,022
231
174
57
520
343
177
1,160
787
373
655
114
541
663
774
-111
1,435
285
1,150
1,079
818
261
3,455
959
2,496
744
379
365
1,128
534
594
728
741
-13
760
501
259
396
170
226
967
626
341
820
634
186
546
537
9
392
251
141
1,075
1,388
-313
353
416
-63
840
680
160
976
762
214
1,332
1,064
268
710
919
-209
752
698
54
382
319
63
562
484
78
460
240
220
798
596
202
393
257
136
691
535
156
977
471
506
1,020
557
463
397
362
35
1,708
505
1,203
371
247
124
788
385
403
525
297
228
920
626
294
391
185
206
300
268
32
1,017
885
132
370
260
110
702
332
370
708
643
65
634
551
83
494
425
69
848
411
437
470
463
7
34,242
24,685
9,557
26,379
21,400
4,979
334
325
9
703
671
32
400
441
-41
57
64
-7
515
583
-68
193
219
-26
93
107
-14
57
65
-8
19
19
994
1,356
-362
994
1,180
-186
173
206
-33
58
69
-11
682
831
-149
340
425
-85
57
78
-21
516
608
-92
57
77
-20
115
155
-40
57
78
-21
291
390
-99
98
80
18
787
637
150
297
239
58
98
80
18
198
159
39
471
316
155
436
291
145
130
87
43
260
175
85
793
713
80
177
157
20
530
529
1
264
264
442
441
1
326
416
-90
490
625
-135
163
208
-45
1,318
1,284
34
29,330
29,046
284
309
356
-47
618
931
-313
846
345
501
727
645
82
1,114
890
224
427
346
81
640
550
90
213
173
40
15,964
12,796
3,168
9
9
25
25
14,414
14,661
-247
12,554
12,347
207
881
112
769
382
253
129
190
126
64
239
212
27
161
142
19
399
403
-4
560
415
145
793
870
-77
7,101
5,657
1,444
3,765
3,640
125
8,416
6,696
1,720
4,053
3,900
153
29,398
29,387
11
14,921
14,894
27
1,576
1,235
341
549
237
312
735
318
417
210
123
87
261
152
109
208
139
69
521
385
136
78
57
21
26
19
7
3,997
3,443
554
1,080
1,069
11
15,575
13,490
2,085
38
41
-3
4
5
-1
2
2
47
51
-4
8
9
-1
2,473
2,397
76
14,759
11,663
3,096
7,051
7,349
-298
6,029
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
30
b
-33
c
-33
d
-66
e
-34
-21
180
31
-64
182
484
51
-20
466
76
-21
-28
11
-20
-15
-19
-67
-312
-19
153
-18
2,117
162
81
207
110
122
26
82
755
5
411
8
190
34
50
81
22
226
-44
89
2
37
-4
-6
43
9
7
18
-17
88
43
10
14
268
214
16
1,423
42
82
-22
351
33
471
75
102
48
118
-29
-85
-38
22
44
50
-53
-4
14
13
11
120
38
32
53
167
158
337
85
70
35
101
79
7
23
23
77
7
13
11
65
1
-45
108
-172
210
710
2
1,541
831
1,439
22
1,860
53
799
197
349
985
-218
482
221
23
11
3
-2
133
52
141
-93
354
301
39
76
726
1,022
57
177
373
541
-111
1,150
261
2,496
365
594
-13
259
226
341
186
9
141
-313
-63
160
214
268
-209
54
63
78
220
202
136
156
506
463
35
1,203
124
403
228
294
206
32
132
110
370
65
83
69
437
7
9,557
4,979
9
32
-41
-7
-68
-26
-14
-8
19
-362
-186
-33
-11
-149
-85
-21
-92
-20
-40
-21
-99
18
150
58
18
39
155
145
43
85
80
20
1
1
-90
-135
-45
34
284
-47
-313
501
82
224
81
90
40
3,168
9
25
-247
207
769
129
64
27
19
-4
145
-77
1,444
125
1,720
153
11
27
341
312
417
87
109
69
136
21
7
554
11
2,085
-3
-1
-4
-1
76
3,096
-298
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
71,054
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
71,937
1,501,189
0.04792
2017
65,553
1,448,467
0.045257
2016
69,656
1,332,124
0.052289
2015
74,893
1,422,619
0.052644
2014
67,787
1,473,621
0.046
2
Total
of line 1, column (d)
.....................
2
0.24411
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
0.048822
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
1,462,651
5
Multiply line 4 by line 3
......................
5
71,410
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
881
7
Add lines 5 and 6
........................
7
72,291
8
Enter qualifying distributions from Part XII, line 4
,.............
8
73,586
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
881
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
881
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
881
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
1,784
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
1,784
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
903
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
884
Refunded
11
19
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)
UT
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
JP MORGAN CHASE BANK NA
Telephone no.
(800) 496-2583
Located at
10 S DEARBORN ST MC IL 1-0111
CHICAGO
IL
ZIP+4
60603
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
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
JP MORGAN CHASE
TRUSTEE
2
18,767
10 S DEARBORN ST MC IL 1-0111
CHICAGO
,
IL
60603
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
1,467,724
b
Average of monthly cash balances
.......................
1b
17,201
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
1,484,925
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
1,484,925
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
22,274
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
1,462,651
6
Minimum investment return.
Enter 5% of line 5
..................
6
73,133
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
73,133
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
881
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
881
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
72,252
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
72,252
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
72,252
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
73,586
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
73,586
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
881
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
72,705
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
72,252
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
67,110
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
0
b
From 2015
......
0
c
From 2016
......
0
d
From 2017
......
0
e
From 2018
......
0
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
73,586
a
Applied to 2018, but not more than line 2a
67,110
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
.....
6,476
e
Remaining amount distributed out of corpus
0
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
0
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
..........
65,776
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
......
0
10
Analysis of line 9:
a
Excess from 2015
....
0
b
Excess from 2016
....
0
c
Excess from 2017
....
0
d
Excess from 2018
....
0
e
Excess from 2019
....
0
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
Shriners Hospitals for Children
12502 USF PINE DRIVE
Tampa
,
FL
33612
NONE
PC
GENERAL
16,778
The Salvation Army
1370 PENNSYLVANIA ST
Denver
,
CO
80203
NONE
PC
GENERAL
16,778
Catholic Community Services of Utah
745 E 300 ST SOUTH
Salt Lake City
,
UT
84201
NONE
PC
GENERAL
16,778
Salt Lake Community Action Program
4600 REDWOOD RD
Salt Lake City
,
UT
84123
NONE
PC
GENERAL
10,067
Division for the Blind- State Utah
1800 S WEST TEMPLE ST STE 208
Salt Lake City
,
UT
84115
NONE
PC
GENERAL
6,711
Total
.................................
3a
67,112
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
34,442
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
71,054
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
105,496
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
105,496
(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