-
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
M SCHINASI INTL HOSPITAL XXXXX7004
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
13-6029118
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)
$
3,502,401
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
...
93,257
93,104
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
150,053
b
Gross sales price for all assets on line 6a
1,143,741
7
Capital gain net income (from Part IV, line 2)
...
150,053
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
........
243,310
243,157
13
Compensation of officers, directors, trustees, etc.
43,102
25,703
17,400
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)
...
11,783
1,591
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)
.......
250
250
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
55,135
27,294
0
17,650
25
Contributions, gifts, grants paid
.......
144,000
144,000
26
Total expenses and disbursements.
Add lines 24 and 25
199,135
27,294
0
161,650
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
44,175
b
Net investment income
(if negative, enter -0-)
215,863
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
.............
11,283
12,614
12,614
2
Savings and temporary cash investments
.........
42,078
52,107
52,107
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)
.......
1,546,233
1,443,659
1,988,632
c
Investments—corporate bonds (attach schedule)
.......
1,286,268
1,422,392
1,449,048
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
0
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
2,885,862
2,930,772
3,502,401
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
........
2,885,862
2,930,772
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances
(see instructions)
.....
2,885,862
2,930,772
30
Total liabilities and net assets/fund balances
(see instructions)
.
2,885,862
2,930,772
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return)
...............
1
2,885,862
2
Enter amount from Part I, line 27a
.....................
2
44,175
3
Other increases not included in line 2 (itemize)
3
4,180
4
Add lines 1, 2, and 3
..........................
4
2,934,217
5
Decreases not included in line 2 (itemize)
5
3,445
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
2,930,772
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
1. GILEAD SCIENCES INC
2015-01-08
2019-01-23
b
4. GILEAD SCIENCES INC
2015-01-08
2019-01-23
c
1. GILEAD SCIENCES INC
2015-01-08
2019-01-23
d
1. GILEAD SCIENCES INC
2015-01-08
2019-01-23
e
2. MASTERCARD INC - CLASS A
2012-10-15
2019-01-23
5. WORLDPAY INC CL A
2018-10-08
2019-01-23
1. WORLDPAY INC CL A
2018-10-08
2019-01-23
6. GILEAD SCIENCES INC
2019-01-24
1. MASTERCARD INC - CLASS A
2012-10-15
2019-01-24
4. MASTERCARD INC - CLASS A
2012-10-15
2019-01-24
8. WORLDPAY INC CL A
2018-10-08
2019-01-24
1. GILEAD SCIENCES INC
2016-02-10
2019-01-25
2. GILEAD SCIENCES INC
2016-02-10
2019-01-25
5. MASTERCARD INC - CLASS A
2009-07-16
2019-01-25
10. WORLDPAY INC CL A
2017-09-22
2019-01-25
1. GILEAD SCIENCES INC
2016-02-10
2019-01-28
1. GILEAD SCIENCES INC
2016-02-10
2019-01-28
6. WORLDPAY INC CL A
2017-09-22
2019-01-28
1. GILEAD SCIENCES INC
2016-02-10
2019-01-29
1. GILEAD SCIENCES INC
2016-02-10
2019-01-29
1. WORLDPAY INC CL A
2017-09-22
2019-01-29
1. GILEAD SCIENCES INC
2016-02-10
2019-01-30
6. WORLDPAY INC CL A
2017-09-22
2019-01-30
1. GILEAD SCIENCES INC
2016-02-10
2019-01-31
1. GILEAD SCIENCES INC
2016-02-10
2019-02-01
413.303 DODGE & INTERNATIONAL STOCK FUND
2016-02-08
2019-02-07
5989.454 DODGE & COX INCOME FUND
2019-02-07
1361.145 DOUBLELINE TTL RTRN BND-I
2019-02-07
2848.205 PIMCO FDS
2018-01-11
2019-02-07
331. VANGUARD BD INDEX FD INC
2018-12-13
2019-02-07
3265.451 PIMCO INV GRD CRD BND-INST
2018-01-30
2019-02-08
3879.82 PIMCO INV GRD CRD BND-INST
2018-03-15
2019-02-08
3689.912 JPM MULTI SECTOR INC FD - R6
2018-01-11
2019-02-12
7. ANALOG DEVICES INC
2018-09-13
2019-02-19
3. ANALOG DEVICES INC
2018-09-13
2019-02-19
7. ANALOG DEVICES INC
2018-09-13
2019-02-19
7. ANALOG DEVICES INC
2019-02-19
12. ANALOG DEVICES INC
2019-02-19
3. ANALOG DEVICES INC
2019-02-19
813.458 DODGE & INTERNATIONAL STOCK FUND
2019-02-19
2291.971 MFS EMERG MRKTS DEBT-R5
2016-07-25
2019-02-19
9. ANALOG DEVICES INC
2019-02-20
1. ADOBE SYS INC
2012-08-03
2019-03-01
1. ALPHABET INC-CL C
2013-12-13
2019-03-01
1. AMERICAN EXPRESS CO
2018-07-18
2019-03-01
5. APPLE COMPUTER INC
2019-03-01
1. AUTOMATIC DATA PROCESSING INC
2018-12-03
2019-03-01
19. BANK OF AMERICA CORPORATION
2019-03-01
2. BERKSHIRE HATHAWAY INC DEL CL B
2018-09-11
2019-03-01
10. BOSTON SCIENTIFIC CORP
2019-03-01
4. BRISTOL MYERS SQUIBB CO
2017-02-23
2019-03-01
2. BROADCOM INC
2013-04-25
2019-03-01
3. CELGENE CORP.
2019-03-01
1. CHARTER COMMUNICATIONS INC-A
2018-04-13
2019-03-01
7. CITIGROUP INC NEW
2017-05-15
2019-03-01
5. COCA-COLA CO
2018-04-16
2019-03-01
7. COMCAST CORP NEW CL A
2019-01-29
2019-03-01
4. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-03-01
1. DIAMONDBACK ENERGY INC
2019-01-08
2019-03-01
5. DISNEY WALT CO
2019-03-01
401.009 DODGE & INTERNATIONAL STOCK FUND
2009-05-07
2019-03-01
3. DOLLAR TREE INC
2017-10-27
2019-03-01
8. DOWDUPONT INC
2018-04-06
2019-03-01
4. EOG RESOURCES INC
2016-08-05
2019-03-01
3. ELECTRONIC ARTS
2018-09-20
2019-03-01
1. FACEBOOK INC-A
2014-07-25
2019-03-01
3390.97 FEDERATED INST HI YLD BND-R6
2019-02-12
2019-03-01
3. FIDELITY NATL INFORMATION SVCS INC
2019-03-01
2. FISERV INC
2019-03-01
2. GENERAL DYNAMICS CORP
2017-02-10
2019-03-01
2. HOME DEPOT INC
2012-03-20
2019-03-01
4. HONEYWELL INTL INC
2012-06-15
2019-03-01
2. INTERCONTINENTALEXCHANGE GROUP, INC
2017-02-01
2019-03-01
1100. JPMORGAN BETABUILDERS JAPAN ETF
2018-07-19
2019-03-01
266. JPMORGAN BETABUILDERS JAPAN ETF
2019-03-01
14. KEYCORP NEW
2018-10-08
2019-03-01
3. LILLY ELI & CO
2015-07-02
2019-03-01
3. LOWES COS INC
2011-09-28
2019-03-01
4. MARATHON PETROLEUM CORPORATION
2019-03-01
2. MASTERCARD INC - CLASS A
2009-07-16
2019-03-01
3. MERCK & CO INC
2019-03-01
12. MICROSOFT CORP
2019-03-01
6. MONDELEZ INTERNATIONAL-W/I
2019-03-01
11. MORGAN STANLEY DEAN WITTER & CO NEW
2015-12-02
2019-03-01
1. NETFLIX.COM INC
2018-09-13
2019-03-01
1. NEXTERA ENERGY INC
2018-07-18
2019-03-01
8. NISOURCE INC
2015-12-03
2019-03-01
2. NORFOLK SOUTHN CORP
2019-03-01
1. NORTHROP GRUMMAN CORP
2017-10-10
2019-03-01
1. NVIDIA CORP
2018-10-08
2019-03-01
7. OCCIDENTAL PETE CORP
2011-10-18
2019-03-01
1. PARKER HANNIFIN CORP
2018-01-11
2019-03-01
3. PAYPAL HOLDINGS INC
2019-01-23
2019-03-01
4. PEPSICO INC
2018-05-22
2019-03-01
13. PFIZER INC
2018-10-30
2019-03-01
4. PHILIP MORRIS INTERNATIONAL
2017-04-24
2019-03-01
2. PIONEER NAT RES CO
2015-12-09
2019-03-01
1. PRUDENTIAL FINL INC
2018-12-21
2019-03-01
2. ROSS STORES INC
2018-12-11
2019-03-01
3. SALESFORCE.COM INC
2018-10-08
2019-03-01
3. SCHWAB CHARLES CORP NEW
2016-06-03
2019-03-01
2. STANLEY BLACK & DECKER,INC.
2019-03-01
4. TEXAS INSTRS INC
2019-02-19
2019-03-01
3. UNION PAC CORP
2018-02-22
2019-03-01
1. UNITED TECHNOLOGIES CORP
2017-12-11
2019-03-01
3. UNITEDHEALTH GROUP INC
2012-01-19
2019-03-01
1. VERTEX PHARMACEUTICALS INC
2011-12-15
2019-03-01
2. VISA INC CLASS A SHARES
2015-10-19
2019-03-01
4. WASTE CONNECTIONS INC
2016-08-10
2019-03-01
8. WELLS FARGO & CO NEW
2019-03-01
1. WEX INC
2016-05-02
2019-03-01
2. YUM BRANDS INC
2019-03-01
3. ZIMMER HLDGS INC
2018-04-26
2019-03-01
2. ALLEGION PLC
2015-11-19
2019-03-01
2. ACCENTURE PLC
2019-03-01
1. LINDE PLC
2018-12-11
2019-03-01
3. MEDTRONIC PLC
2018-07-18
2019-03-01
3. APTIV PLC
2018-04-26
2019-03-01
2. CHUBB LTD
2012-01-09
2019-03-01
2. NXP SEMICONDUCTORS NV
2019-02-20
2019-03-01
4. BIOGEN IDEC INC
2010-03-19
2019-03-14
3. BIOGEN IDEC INC
2018-10-08
2019-03-14
72. BRISTOL MYERS SQUIBB CO
2019-03-14
15. DISNEY WALT CO
2019-03-14
6. ADOBE SYS INC
2012-08-03
2019-04-02
4. ALEXION PHARMACEUTICALS INC
2019-03-14
2019-04-02
3. ALPHABET INC-CL C
2019-04-02
2. ALPHABET INC-CL A
2016-07-11
2019-04-02
3. AMAZON COM INC
2015-03-12
2019-04-02
6. AMERICAN EXPRESS CO
2019-04-02
23. APPLE COMPUTER INC
2006-04-07
2019-04-02
7. AUTOMATIC DATA PROCESSING INC
2019-04-02
86. BANK OF AMERICA CORPORATION
2019-04-02
10. BERKSHIRE HATHAWAY INC DEL CL B
2019-04-02
42. BOSTON SCIENTIFIC CORP
2019-04-02
9. BROADCOM INC
2013-04-25
2019-04-02
6. CELGENE CORP.
2019-04-02
5. CELGENE CORP.
2019-03-14
2019-04-02
3. CHARTER COMMUNICATIONS INC-A
2016-12-15
2019-04-02
2. CHARTER COMMUNICATIONS INC-A
2018-04-13
2019-04-02
30. CITIGROUP INC NEW
2019-04-02
20. COCA-COLA CO
2019-04-02
50. COMCAST CORP NEW CL A
2019-03-14
2019-04-02
12. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-04-02
3. DIAMONDBACK ENERGY INC
2017-05-15
2019-04-02
5. DIAMONDBACK ENERGY INC
2019-04-02
17. DISNEY WALT CO
2019-04-02
10. DOLLAR TREE INC
2019-04-02
18. EOG RESOURCES INC
2019-04-02
14. ELECTRONIC ARTS
2019-04-02
8. FACEBOOK INC-A
2014-07-25
2019-04-02
11. FIDELITY NATL INFORMATION SVCS INC
2014-12-19
2019-04-02
11. FISERV INC
2019-04-02
7. GENERAL DYNAMICS CORP
2018-12-13
2019-04-02
10. HOME DEPOT INC
2019-04-02
17. HONEYWELL INTL INC
2019-04-02
6. INTERCONTINENTALEXCHANGE GROUP, INC
2019-04-02
59. KEYCORP NEW
2019-04-02
14. LILLY ELI & CO
2019-04-02
12. LOWES COS INC
2011-09-28
2019-04-02
22. MARATHON PETROLEUM CORPORATION
2019-04-02
12. MASTERCARD INC - CLASS A
2009-07-16
2019-04-02
24. MERCK & CO INC
2019-03-14
2019-04-02
54. MICROSOFT CORP
2019-04-02
29. MONDELEZ INTERNATIONAL-W/I
2019-04-02
48. MORGAN STANLEY DEAN WITTER & CO NEW
2019-04-02
2. NETFLIX.COM INC
2018-09-13
2019-04-02
7. NEXTERA ENERGY INC
2019-04-02
27. NISOURCE INC
2019-04-02
11. NORFOLK SOUTHN CORP
2019-04-02
4. NORTHROP GRUMMAN CORP
2019-04-02
7. NVIDIA CORP
2018-10-08
2019-04-02
3. O'REILLY AUTOMOTIVE INC
2017-05-05
2019-04-02
14. OCCIDENTAL PETE CORP
2019-04-02
15. OCCIDENTAL PETE CORP
2019-04-02
3. PARKER HANNIFIN CORP
2018-01-11
2019-04-02
16. PAYPAL HOLDINGS INC
2019-01-23
2019-04-02
9. PEPSICO INC
2018-05-22
2019-04-02
6. PEPSICO INC
2016-02-17
2019-04-02
46. PFIZER INC
2019-04-02
12. PFIZER INC
2018-10-30
2019-04-02
14. PHILIP MORRIS INTERNATIONAL
2017-04-24
2019-04-02
8. PIONEER NAT RES CO
2019-04-02
8. PRUDENTIAL FINL INC
2019-04-02
11. ROSS STORES INC
2018-12-11
2019-04-02
4. SVB FINANCIAL GROUP
2019-04-02
9. SALESFORCE.COM INC
2018-10-08
2019-04-02
16. SCHWAB CHARLES CORP NEW
2019-04-02
9. STANLEY BLACK & DECKER,INC.
2019-04-02
10. TEXAS INSTRS INC
2019-02-19
2019-04-02
8. TEXAS INSTRS INC
2016-03-10
2019-04-02
13. UNION PAC CORP
2019-04-02
6. UNITED TECHNOLOGIES CORP
2019-04-02
15. UNITEDHEALTH GROUP INC
2019-04-02
5. VERTEX PHARMACEUTICALS INC
2011-12-15
2019-04-02
8. VISA INC CLASS A SHARES
2015-10-19
2019-04-02
10. WASTE CONNECTIONS INC
2019-04-02
35. WELLS FARGO & CO NEW
2019-04-02
5. WEX INC
2019-04-02
6. YUM BRANDS INC
2019-04-02
15. ZIMMER HLDGS INC
2019-04-02
9. ALLEGION PLC
2019-04-02
8. ACCENTURE PLC
2014-01-15
2019-04-02
6. LINDE PLC
2018-12-11
2019-04-02
13. MEDTRONIC PLC
2018-07-18
2019-04-02
11. APTIV PLC
2019-04-02
11. CHUBB LTD
2019-04-02
9. NXP SEMICONDUCTORS NV
2019-04-02
2388.806 ARTISAN INTL VAL-INST
2019-04-03
406.203 DODGE & INTERNATIONAL STOCK FUND
2009-05-07
2019-04-03
2.953 DOW INC
2019-04-03
9.047 DOW INC
2019-04-03
9. DOWDUPONT INC
2019-04-03
28. DOWDUPONT INC
2019-04-03
. PFIZER INC
2019-04-03
10. DOW INC
2019-04-08
2. DOW INC
2019-04-08
13. DOW INC
2019-04-08
6. DOW INC
2019-04-08
1. DOW INC
2015-07-15
2019-04-09
. DOW INC
2019-04-23
22. OCCIDENTAL PETE CORP
2019-04-25
23. OCCIDENTAL PETE CORP
2019-04-25
5. OCCIDENTAL PETE CORP
2007-01-12
2019-05-01
1. OCCIDENTAL PETE CORP
2007-01-12
2019-05-01
4. REGENERON PHARMACEUTICALS INC
2019-05-01
1. REGENERON PHARMACEUTICALS INC
2019-01-23
2019-05-01
14. OCCIDENTAL PETE CORP
2007-01-12
2019-05-02
1. OCCIDENTAL PETE CORP
2007-01-12
2019-05-02
1. OCCIDENTAL PETE CORP
2007-01-12
2019-05-02
3. OCCIDENTAL PETE CORP
2007-01-12
2019-05-02
1. OCCIDENTAL PETE CORP
2007-01-12
2019-05-02
1. OCCIDENTAL PETE CORP
2007-01-12
2019-05-03
6. OCCIDENTAL PETE CORP
2007-01-12
2019-05-03
1. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
11. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
5. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
2. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
2. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
16. SCHWAB CHARLES CORP NEW
2019-05-15
14. SCHWAB CHARLES CORP NEW
2019-05-16
4. SCHWAB CHARLES CORP NEW
2019-05-16
9. SCHWAB CHARLES CORP NEW
2019-05-16
9. MEDTRONIC PLC
2019-05-16
4. MEDTRONIC PLC
2019-05-16
11. MEDTRONIC PLC
2019-05-16
4. MEDTRONIC PLC
2019-05-17
7. MEDTRONIC PLC
2019-05-17
3. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
4. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
2. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
15. DELTA AIR LINES INC DEL NEW
2019-06-05
5. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-05
10. PHILIP MORRIS INTERNATIONAL
2017-04-24
2019-06-05
8. PHILIP MORRIS INTERNATIONAL
2018-10-24
2019-06-05
5. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
5. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-07
44. BANK OF AMERICA CORPORATION
2012-11-08
2019-06-10
9. DOLLAR TREE INC
2019-06-10
34. WELLS FARGO & CO NEW
2019-06-10
8. DOLLAR TREE INC
2019-06-11
6. DOLLAR TREE INC
2018-12-17
2019-06-11
3. DOLLAR TREE INC
2018-12-17
2019-06-11
. CORTEVA INC
2019-06-13
. DUPONT DE NEMOURS INC-WI
2019-06-13
3. ADOBE SYS INC
2012-08-03
2019-06-27
66. SPDR TR UNIT SER 1
2019-07-03
. AMGEN INC
2019-07-17
3. SVB FINANCIAL GROUP
2015-02-05
2019-08-14
2. SVB FINANCIAL GROUP
2015-02-05
2019-08-14
5. APTIV PLC
2019-08-14
3. APTIV PLC
2019-08-14
7. APTIV PLC
2017-05-18
2019-08-14
4. SVB FINANCIAL GROUP
2015-02-05
2019-08-15
13. APTIV PLC
2019-08-15
1197. JPMORGAN BETABUILDERS EUROPE ETF
2018-07-13
2019-08-22
1705.857 JPMORGAN CORE BOND FUND ULTRA
2016-10-26
2019-08-22
. GENERAL MOTORS CO
2019-09-05
1. ADOBE SYS INC
2012-08-03
2019-09-20
1. ALEXION PHARMACEUTICALS INC
2019-03-14
2019-09-20
1. ALPHABET INC-CL C
2013-02-08
2019-09-20
4. AMERICAN EXPRESS CO
2019-06-10
2019-09-20
5. APPLE COMPUTER INC
2006-04-07
2019-09-20
2. AUTOMATIC DATA PROCESSING INC
2019-08-14
2019-09-20
17. BANK OF AMERICA CORPORATION
2012-11-08
2019-09-20
2. BERKSHIRE HATHAWAY INC DEL CL B
2018-10-15
2019-09-20
10. BOSTON SCIENTIFIC CORP
2016-12-05
2019-09-20
2. BROADCOM INC
2013-04-25
2019-09-20
6. CELGENE CORP.
2019-09-20
1. CHARTER COMMUNICATIONS INC-A
2016-12-15
2019-09-20
7. CITIGROUP INC NEW
2019-09-20
5. COCA-COLA CO
2018-04-13
2019-09-20
14. COMCAST CORP NEW CL A
2019-05-14
2019-09-20
6. CORTEVA INC
2019-09-20
1. DIAMONDBACK ENERGY INC
2019-01-08
2019-09-20
1. DIAMONDBACK ENERGY INC
2017-05-15
2019-09-20
3. DISNEY WALT CO
2016-12-05
2019-09-20
3. DUPONT DE NEMOURS INC-WI
2019-09-20
5. EOG RESOURCES INC
2016-05-02
2019-09-20
3. ELECTRONIC ARTS
2018-09-20
2019-09-20
2. FACEBOOK INC-A
2014-07-25
2019-09-20
4. FIDELITY NATL INFORMATION SVCS INC
2019-08-14
2019-09-20
6. FISERV INC
2019-09-20
2. GENERAL DYNAMICS CORP
2018-12-13
2019-09-20
3. HOME DEPOT INC
2011-09-29
2019-09-20
4. HONEYWELL INTL INC
2010-10-22
2019-09-20
2. INTERCONTINENTALEXCHANGE GROUP, INC
2017-01-31
2019-09-20
626. ISHARES TR BARCLAYS MBS BD FD
2019-02-08
2019-09-20
1. KEYCORP NEW
2016-03-08
2019-09-20
13. KEYCORP NEW
2018-10-19
2019-09-20
4. LILLY ELI & CO
2019-09-20
3. LOWES COS INC
2011-09-28
2019-09-20
2. MARATHON PETROLEUM CORPORATION
2018-09-20
2019-09-20
5. MARATHON PETROLEUM CORPORATION
2019-09-20
3. MASTERCARD INC - CLASS A
2009-07-16
2019-09-20
1. MCDONALDS CORP
2019-06-10
2019-09-20
2. MERCK & CO INC
2019-03-14
2019-09-20
3. MERCK & CO INC
2016-08-05
2019-09-20
12. MICROSOFT CORP
2009-07-24
2019-09-20
6. MONDELEZ INTERNATIONAL-W/I
2011-08-04
2019-09-20
11. MORGAN STANLEY DEAN WITTER & CO NEW
2019-09-20
1. NETFLIX.COM INC
2018-09-13
2019-09-20
1. NEXTERA ENERGY INC
2018-07-18
2019-09-20
6. NISOURCE INC
2019-09-20
3. NORFOLK SOUTHN CORP
2018-03-09
2019-09-20
1. NORTHROP GRUMMAN CORP
2019-05-20
2019-09-20
2. NVIDIA CORP
2018-06-12
2019-09-20
4. PAYPAL HOLDINGS INC
2019-01-23
2019-09-20
4. PEPSICO INC
2016-02-24
2019-09-20
14. PFIZER INC
2015-04-02
2019-09-20
2. PHILIP MORRIS INTERNATIONAL
2018-10-24
2019-09-20
2. PIONEER NAT RES CO
2016-03-30
2019-09-20
3. PROCTER & GAMBLE CO
2019-06-05
2019-09-20
2. QUALCOMM INC
2019-05-01
2019-09-20
3. ROSS STORES INC
2018-12-11
2019-09-20
2. SALESFORCE.COM INC
2018-10-08
2019-09-20
3. STANLEY BLACK & DECKER,INC.
2016-02-17
2019-09-20
5. TEXAS INSTRS INC
2016-03-10
2019-09-20
3. UNION PAC CORP
2017-05-18
2019-09-20
1. UNITED TECHNOLOGIES CORP
2017-12-07
2019-09-20
3. UNITEDHEALTH GROUP INC
2011-09-16
2019-09-20
830. VANGUARD BD INDEX FD INC
2019-03-01
2019-09-20
1. VERTEX PHARMACEUTICALS INC
2011-12-15
2019-09-20
2. VISA INC CLASS A SHARES
2015-10-19
2019-09-20
2. WASTE CONNECTIONS INC
2016-07-26
2019-09-20
6. WELLS FARGO & CO NEW
2009-03-13
2019-09-20
1. WEX INC
2016-06-01
2019-09-20
2. YUM BRANDS INC
2019-09-20
2. ZIMMER HLDGS INC
2018-04-26
2019-09-20
2. ZIMMER HLDGS INC
2019-09-20
2. ALLEGION PLC
2019-09-20
2. ACCENTURE PLC
2019-09-20
4. LINDE PLC
2019-08-14
2019-09-20
3. CHUBB LTD
2011-05-23
2019-09-20
2. NXP SEMICONDUCTORS NV
2019-02-21
2019-09-20
8069.378 JPMORGAN CORE BOND FUND ULTRA
2016-10-26
2019-09-24
16. DISNEY WALT CO
2019-10-25
4. ACCENTURE PLC
2014-04-22
2019-10-25
5. ACCENTURE PLC
2014-04-22
2019-10-28
10. NISOURCE INC
2019-11-11
13. NISOURCE INC
2019-11-11
10. NISOURCE INC
2019-11-12
26. NISOURCE INC
2019-11-12
2. NISOURCE INC
2013-02-26
2019-11-12
3. NISOURCE INC
2013-02-26
2019-11-13
18. CELGENE CORP.
2009-04-01
2019-11-21
42. CELGENE CORP.
2019-11-21
80. SPDR TR UNIT SER 1
2016-07-15
2019-11-21
23. 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
29. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-26
5. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-27
5. ABBVIE INC
2019-12-20
1. ADOBE SYS INC
2012-08-03
2019-12-20
1. ALEXION PHARMACEUTICALS INC
2019-03-14
2019-12-20
1. ALPHABET INC-CL C
2019-10-25
2019-12-20
1. ALPHABET INC-CL A
2012-07-11
2019-12-20
1. AMAZON COM INC
2019-10-25
2019-12-20
3. AMERICAN EXPRESS CO
2019-06-10
2019-12-20
5. APPLE COMPUTER INC
2006-04-07
2019-12-20
2. AUTOMATIC DATA PROCESSING INC
2019-08-14
2019-12-20
16. BANK OF AMERICA CORPORATION
2019-12-20
2. BERKSHIRE HATHAWAY INC DEL CL B
2019-12-20
10. BOSTON SCIENTIFIC CORP
2016-12-05
2019-12-20
5. BRISTOL MYERS SQUIBB CO
2019-11-21
2019-12-20
1. BROADCOM INC
2013-04-25
2019-12-20
1. CHARTER COMMUNICATIONS INC-A
2016-12-15
2019-12-20
6. CITIGROUP INC NEW
2011-06-13
2019-12-20
5. COCA-COLA CO
2018-04-13
2019-12-20
13. COMCAST CORP NEW CL A
2019-12-20
.529 CORTEVA INC
2019-04-08
2019-12-20
5.471 CORTEVA INC
2017-02-22
2019-12-20
2. DIAMONDBACK ENERGY INC
2017-05-15
2019-12-20
2. DISNEY WALT CO
2016-10-10
2019-12-20
3. DUPONT DE NEMOURS INC-WI
2019-12-20
4. EOG RESOURCES INC
2019-12-20
2. ELECTRONIC ARTS
2018-09-20
2019-12-20
1. ELECTRONIC ARTS
2019-01-29
2019-12-20
1. FACEBOOK INC-A
2014-07-25
2019-12-20
3. FIDELITY NATL INFORMATION SVCS INC
2019-08-14
2019-12-20
7. FISERV INC
2019-07-30
2019-12-20
1. GENERAL DYNAMICS CORP
2016-08-15
2019-12-20
2. HOME DEPOT INC
2011-09-29
2019-12-20
4. HONEYWELL INTL INC
2009-12-16
2019-12-20
1. INTERCONTINENTALEXCHANGE GROUP, INC
2017-01-31
2019-12-20
250. JPMORGAN BETABUILDERS JAPAN ETF
2018-07-19
2019-12-20
318. JPMORGAN BETABUILDERS EUROPE ETF
2019-12-20
13. KEYCORP NEW
2019-12-20
3. LILLY ELI & CO
2019-12-20
3. LOWES COS INC
2011-09-28
2019-12-20
7. MARATHON PETROLEUM CORPORATION
2018-05-14
2019-12-20
2. MASTERCARD INC - CLASS A
2009-07-16
2019-12-20
1. MCDONALDS CORP
2019-06-10
2019-12-20
6. MERCK & CO INC
2019-12-20
12. MICROSOFT CORP
2009-07-24
2019-12-20
7. MONDELEZ INTERNATIONAL-W/I
2019-12-20
11. MORGAN STANLEY DEAN WITTER & CO NEW
2019-12-20
2. NEXTERA ENERGY INC
2018-07-18
2019-12-20
2. NORFOLK SOUTHN CORP
2018-03-09
2019-12-20
1. NORTHROP GRUMMAN CORP
2019-05-20
2019-12-20
1. NVIDIA CORP
2018-06-12
2019-12-20
3. PAYPAL HOLDINGS INC
2018-07-26
2019-12-20
4. PEPSICO INC
2016-02-24
2019-12-20
13. PFIZER INC
2019-12-20
2. PHILIP MORRIS INTERNATIONAL
2018-10-24
2019-12-20
2. PIONEER NAT RES CO
2016-03-30
2019-12-20
3. PROCTER & GAMBLE CO
2019-06-05
2019-12-20
2. QUALCOMM INC
2019-05-01
2019-12-20
2. ROSS STORES INC
2018-12-11
2019-12-20
1. SALESFORCE.COM INC
2018-10-08
2019-12-20
2. SALESFORCE.COM INC
2019-10-28
2019-12-20
2. STANLEY BLACK & DECKER,INC.
2019-12-20
4. TEXAS INSTRS INC
2016-03-10
2019-12-20
3. UNION PAC CORP
2017-05-18
2019-12-20
2. UNITED TECHNOLOGIES CORP
2017-12-07
2019-12-20
4. UNITEDHEALTH GROUP INC
2019-12-20
1. VERTEX PHARMACEUTICALS INC
2011-12-15
2019-12-20
2. VISA INC CLASS A SHARES
2015-10-19
2019-12-20
3. WASTE CONNECTIONS INC
2019-12-20
5. WELLS FARGO & CO NEW
2009-03-13
2019-12-20
1. WEX INC
2016-05-31
2019-12-20
1. YUM BRANDS INC
2018-11-28
2019-12-20
3. ZIMMER HLDGS INC
2018-04-26
2019-12-20
2. ALLEGION PLC
2019-12-20
1. ACCENTURE PLC
2014-04-03
2019-12-20
3. LINDE PLC
2019-12-20
3. CHUBB LTD
2019-12-20
2. NXP SEMICONDUCTORS NV
2019-02-21
2019-12-20
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
69
102
-33
b
273
406
-133
c
68
102
-34
d
68
102
-34
e
397
95
302
412
485
-73
83
97
-14
407
534
-127
200
47
153
796
190
606
658
776
-118
68
89
-21
138
178
-40
1,013
90
923
829
807
22
68
89
-21
68
89
-21
499
484
15
69
89
-20
69
89
-20
82
81
1
69
89
-20
501
484
17
70
89
-19
70
88
-18
16,350
12,804
3,546
80,738
81,243
-505
14,210
14,933
-723
34,008
35,318
-1,310
26,095
25,878
217
33,079
34,009
-930
39,303
39,787
-484
35,681
37,084
-1,403
733
645
88
313
276
37
735
645
90
730
644
86
1,252
766
486
315
191
124
32,856
19,809
13,047
32,523
34,334
-1,811
953
570
383
263
32
231
1,129
537
592
109
103
6
868
49
819
154
147
7
560
576
-16
405
428
-23
403
234
169
210
223
-13
547
78
469
253
313
-60
346
306
40
456
430
26
226
223
3
273
253
20
194
214
-20
105
105
570
551
19
16,389
9,616
6,773
292
278
14
424
511
-87
384
361
23
286
342
-56
162
75
87
32,859
32,587
272
326
191
135
172
170
2
341
368
-27
367
99
268
621
215
406
155
117
38
24,884
26,399
-1,515
6,019
6,383
-364
246
287
-41
381
258
123
311
60
251
251
327
-76
452
36
416
244
193
51
1,345
427
918
283
241
42
468
384
84
360
371
-11
187
170
17
212
153
59
359
301
58
288
293
-5
156
268
-112
466
571
-105
176
208
-32
296
271
25
463
399
64
565
554
11
347
449
-102
285
285
96
80
16
191
161
30
490
454
36
140
87
53
263
212
51
425
430
-5
507
401
106
126
123
3
738
156
582
190
31
159
298
154
144
334
211
123
404
203
201
178
94
84
190
184
6
376
344
32
181
133
48
326
167
159
172
161
11
273
264
9
251
261
-10
269
140
129
187
189
-2
1,281
221
1,060
961
1,027
-66
3,542
2,909
633
1,715
1,557
158
1,628
192
1,436
557
539
18
3,595
1,408
2,187
2,407
1,454
953
5,445
1,121
4,324
666
618
48
4,461
227
4,234
1,129
1,027
102
2,473
1,418
1,055
2,039
2,104
-65
1,621
977
644
2,730
353
2,377
562
624
-62
468
437
31
1,038
874
164
692
612
80
1,937
1,699
238
934
892
42
2,001
1,992
9
665
643
22
309
312
-3
515
525
-10
1,908
1,733
175
1,039
923
116
1,732
1,571
161
1,411
1,592
-181
1,398
602
796
1,253
700
553
988
921
67
1,189
1,203
-14
1,943
369
1,574
2,737
864
1,873
466
350
116
973
1,109
-136
1,812
1,186
626
1,318
241
1,077
1,319
1,774
-455
2,875
216
2,659
2,000
1,954
46
6,441
1,296
5,145
1,439
958
481
2,103
1,091
1,012
734
741
-7
1,325
1,186
139
760
428
332
2,123
1,651
472
1,094
1,149
-55
1,282
1,878
-596
1,182
757
425
933
1,060
-127
999
1,166
-167
532
625
-93
1,679
1,447
232
1,096
899
197
730
597
133
1,980
1,591
389
516
511
5
1,235
1,571
-336
1,190
1,124
66
762
638
124
1,029
887
142
934
505
429
1,448
1,362
86
709
463
246
1,251
910
341
1,100
1,076
24
880
442
438
2,205
1,552
653
792
738
54
3,668
757
2,911
936
157
779
1,264
617
647
871
508
363
1,690
774
916
982
468
514
600
551
49
1,912
1,715
197
831
594
237
1,401
665
736
1,064
964
100
1,176
1,145
31
911
958
-47
1,539
761
778
835
847
-12
84,038
63,778
20,260
16,939
9,741
7,198
164
193
-29
504
585
-81
333
382
-49
1,035
1,179
-144
29
29
571
642
-71
114
125
-11
744
711
33
344
321
23
57
53
4
38
38
1,367
1,540
-173
1,428
1,300
128
288
214
74
58
43
15
1,364
1,665
-301
340
400
-60
803
598
205
57
43
14
57
43
14
172
128
44
57
43
14
58
43
15
349
256
93
98
80
18
1,083
876
207
494
398
96
195
159
36
198
159
39
684
457
227
610
387
223
174
107
67
391
241
150
793
713
80
353
352
1
972
869
103
352
311
41
618
543
75
489
625
-136
653
833
-180
326
416
-90
824
803
21
275
267
8
772
1,122
-350
618
713
-95
274
267
7
273
267
6
55
53
2
55
53
2
55
53
2
56
53
3
1,241
417
824
934
826
108
1,578
461
1,117
853
731
122
640
518
122
320
259
61
17
17
50
50
881
96
785
19,658
14,944
4,714
11
11
573
361
212
380
240
140
398
402
-4
241
212
29
559
496
63
747
481
266
1,031
920
111
27,474
29,698
-2,224
20,556
20,300
256
10
10
277
32
245
106
135
-29
1,232
391
841
470
492
-22
1,105
49
1,056
320
328
-8
510
161
349
418
410
8
431
207
224
570
78
492
597
575
22
424
291
133
492
274
218
272
223
49
652
602
50
174
198
-24
98
104
-6
98
104
-6
397
301
96
215
284
-69
405
414
-9
297
341
-44
380
151
229
531
524
7
628
629
-1
375
344
31
687
101
586
671
181
490
186
116
70
67,666
65,853
1,813
18
11
7
232
232
464
327
137
337
60
277
110
160
-50
275
396
-121
822
54
768
211
201
10
170
163
7
256
192
64
1,677
281
1,396
329
132
197
487
227
260
269
371
-102
224
169
55
177
91
86
541
435
106
373
313
60
350
522
-172
416
362
54
540
395
145
516
482
34
145
178
-33
270
281
-11
367
320
47
156
173
-17
325
242
83
308
303
5
428
279
149
641
276
365
501
322
179
138
122
16
702
150
552
66,909
65,387
1,522
179
31
148
351
154
197
181
99
82
294
81
213
205
92
113
228
183
45
282
227
55
282
226
56
204
131
73
388
160
228
779
745
34
474
205
269
213
188
25
97,236
96,027
1,209
2,101
1,512
589
733
319
414
919
399
520
262
135
127
339
130
209
261
98
163
677
252
425
52
19
33
79
29
50
1,945
349
1,596
4,537
3,910
627
24,792
17,273
7,519
48
53
-5
4
5
-1
2
2
62
67
-5
11
12
-1
451
427
24
328
32
296
109
135
-26
1,351
1,260
91
1,353
286
1,067
1,788
1,720
68
377
369
8
1,398
49
1,349
342
328
14
559
152
407
453
382
71
453
207
246
316
282
34
318
39
279
474
291
183
469
232
237
275
223
52
571
545
26
15
16
-1
154
180
-26
175
208
-33
294
186
108
190
283
-93
329
331
-2
216
227
-11
108
87
21
206
75
131
417
393
24
818
727
91
179
153
26
443
68
375
707
158
549
93
58
35
6,323
5,997
326
8,090
7,808
282
265
145
120
397
236
161
360
60
300
431
548
-117
597
36
561
197
201
-4
550
383
167
1,886
281
1,605
388
154
234
558
226
332
488
339
149
389
290
99
346
313
33
238
261
-23
327
268
59
551
395
156
512
448
64
172
178
-6
294
281
13
379
320
59
176
173
3
230
161
69
165
151
14
330
302
28
330
185
145
514
221
293
540
322
218
300
245
55
1,175
178
997
220
31
189
376
154
222
272
148
124
266
67
199
206
92
114
101
91
10
452
337
115
249
131
118
211
79
132
636
558
78
466
200
266
254
188
66
2,806
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
-33
b
-133
c
-34
d
-34
e
302
-73
-14
-127
153
606
-118
-21
-40
923
22
-21
-21
15
-20
-20
1
-20
17
-19
-18
3,546
-505
-723
-1,310
217
-930
-484
-1,403
88
37
90
86
486
124
13,047
-1,811
383
231
592
6
819
7
-16
-23
169
-13
469
-60
40
26
3
20
-20
19
6,773
14
-87
23
-56
87
272
135
2
-27
268
406
38
-1,515
-364
-41
123
251
-76
416
51
918
42
84
-11
17
59
58
-5
-112
-105
-32
25
64
11
-102
16
30
36
53
51
-5
106
3
582
159
144
123
201
84
6
32
48
159
11
9
-10
129
-2
1,060
-66
633
158
1,436
18
2,187
953
4,324
48
4,234
102
1,055
-65
644
2,377
-62
31
164
80
238
42
9
22
-3
-10
175
116
161
-181
796
553
67
-14
1,574
1,873
116
-136
626
1,077
-455
2,659
46
5,145
481
1,012
-7
139
332
472
-55
-596
425
-127
-167
-93
232
197
133
389
5
-336
66
124
142
429
86
246
341
24
438
653
54
2,911
779
647
363
916
514
49
197
237
736
100
31
-47
778
-12
20,260
7,198
-29
-81
-49
-144
29
-71
-11
33
23
4
38
-173
128
74
15
-301
-60
205
14
14
44
14
15
93
18
207
96
36
39
227
223
67
150
80
1
103
41
75
-136
-180
-90
21
8
-350
-95
7
6
2
2
2
3
824
108
1,117
122
122
61
17
50
785
4,714
11
212
140
-4
29
63
266
111
-2,224
256
10
245
-29
841
-22
1,056
-8
349
8
224
492
22
133
218
49
50
-24
-6
-6
96
-69
-9
-44
229
7
-1
31
586
490
70
1,813
7
137
277
-50
-121
768
10
7
64
1,396
197
260
-102
55
86
106
60
-172
54
145
34
-33
-11
47
-17
83
5
149
365
179
16
552
1,522
148
197
82
213
113
45
55
56
73
228
34
269
25
1,209
589
414
520
127
209
163
425
33
50
1,596
627
7,519
-5
-1
-5
-1
24
296
-26
91
1,067
68
8
1,349
14
407
71
246
34
279
183
237
52
26
-1
-26
-33
108
-93
-2
-11
21
131
24
91
26
375
549
35
326
282
120
161
300
-117
561
-4
167
1,605
234
332
149
99
33
-23
59
156
64
-6
13
59
3
69
14
28
145
293
218
55
997
189
222
124
199
114
10
115
118
132
78
266
66
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
150,053
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
162,641
3,356,615
0.048454
2017
165,253
3,346,361
0.049383
2016
184,341
3,177,478
0.058015
2015
189,342
3,350,514
0.056511
2014
175,458
3,470,355
0.050559
2
Total
of line 1, column (d)
.....................
2
0.262922
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
0.052584
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
3,322,748
5
Multiply line 4 by line 3
......................
5
174,723
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
2,159
7
Add lines 5 and 6
........................
7
176,882
8
Enter qualifying distributions from Part XII, line 4
,.............
8
161,650
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
4,317
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
4,317
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
4,317
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
4,992
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
4,992
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
33
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
642
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
642
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)
NY
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
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
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
JP MORGAN CHASE BANK NA
TRUSTEE
2
43,102
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
N/A
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
3,328,591
b
Average of monthly cash balances
.......................
1b
44,757
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
3,373,348
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
3,373,348
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
50,600
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
3,322,748
6
Minimum investment return.
Enter 5% of line 5
..................
6
166,137
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
166,137
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
4,317
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
4,317
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
161,820
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
161,820
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
161,820
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
161,650
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
161,650
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
161,650
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
161,820
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
91,772
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:
$
161,650
a
Applied to 2018, but not more than line 2a
91,772
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
.....
69,878
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
..........
91,942
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
MORRIS SCHINASI INTL HOSPITAL
10 S DEARBORN ST MC
CHICAGO
,
IL
606032300
NONE
PC
GENERAL
144,000
Total
.................................
3a
144,000
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
93,257
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
150,053
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)
..
243,310
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
243,310
(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