-
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
CHARLES H MAHAN TRUST XXXXX0009
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
75-6008824
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)
$
3,154,284
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
...
71,907
54,617
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
110,594
b
Gross sales price for all assets on line 6a
1,206,518
7
Capital gain net income (from Part IV, line 2)
...
110,594
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
........
182,501
165,211
13
Compensation of officers, directors, trustees, etc.
41,136
24,469
16,667
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)
....
2,500
2,500
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
1,284
1,284
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)
.......
74
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
44,994
28,253
0
16,667
25
Contributions, gifts, grants paid
.......
146,896
146,896
26
Total expenses and disbursements.
Add lines 24 and 25
191,890
28,253
0
163,563
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-9,389
b
Net investment income
(if negative, enter -0-)
136,958
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
.............
32,165
88,927
88,927
2
Savings and temporary cash investments
.........
43,534
47,339
47,339
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)
.......
1,401,638
1,238,702
1,772,457
c
Investments—corporate bonds (attach schedule)
.......
992,104
1,093,773
1,112,572
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
142,935
133,290
132,989
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
5
5
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
2,612,381
2,602,036
3,154,284
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
........
2,612,381
2,602,036
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)
.....
2,612,381
2,602,036
30
Total liabilities and net assets/fund balances
(see instructions)
.
2,612,381
2,602,036
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
2,612,381
2
Enter amount from Part I, line 27a
.....................
2
-9,389
3
Other increases not included in line 2 (itemize)
3
3,377
4
Add lines 1, 2, and 3
..........................
4
2,606,369
5
Decreases not included in line 2 (itemize)
5
4,333
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
2,602,036
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
. FHLMC
2019-01-17
b
1. GILEAD SCIENCES INC
2014-12-11
2019-01-23
c
5. GILEAD SCIENCES INC
2019-01-23
d
1. GILEAD SCIENCES INC
2015-01-08
2019-01-23
e
2. GILEAD SCIENCES INC
2015-01-08
2019-01-23
2. MASTERCARD INC - CLASS A
2015-04-22
2019-01-23
7. WORLDPAY INC CL A
2018-10-08
2019-01-23
1. WORLDPAY INC CL A
2018-10-08
2019-01-23
9. GILEAD SCIENCES INC
2019-01-24
2. MASTERCARD INC - CLASS A
2015-04-22
2019-01-24
6. MASTERCARD INC - CLASS A
2013-05-09
2019-01-24
1. WORLDPAY INC CL A
2017-09-22
2019-01-24
11. WORLDPAY INC CL A
2018-10-08
2019-01-24
1. GILEAD SCIENCES INC
2016-02-10
2019-01-25
3. GILEAD SCIENCES INC
2016-02-10
2019-01-25
1. GILEAD SCIENCES INC
2016-02-10
2019-01-25
7. MASTERCARD INC - CLASS A
2019-01-25
15. WORLDPAY INC CL A
2017-09-22
2019-01-25
1. GILEAD SCIENCES INC
2016-02-10
2019-01-28
2. GILEAD SCIENCES INC
2016-02-10
2019-01-28
9. WORLDPAY INC CL A
2017-09-22
2019-01-28
2. GILEAD SCIENCES INC
2016-02-10
2019-01-29
2. WORLDPAY INC CL A
2017-09-22
2019-01-29
1. GILEAD SCIENCES INC
2016-02-10
2019-01-30
9. WORLDPAY INC CL A
2017-09-22
2019-01-30
1. GILEAD SCIENCES INC
2016-02-10
2019-01-31
3. GILEAD SCIENCES INC
2019-02-01
2389.817 DODGE & COX INCOME FUND
2019-02-12
1436.782 DOUBLELINE TTL RTRN BND-I
2019-02-12
1226.071 JPM STRAT INC OPP FD - USD - R6 ISIN US48121L1145
2009-02-18
2019-02-12
9. ANALOG DEVICES INC
2018-09-13
2019-02-19
4. ANALOG DEVICES INC
2018-09-13
2019-02-19
11. ANALOG DEVICES INC
2019-02-19
21. ANALOG DEVICES INC
2019-02-19
7. ANALOG DEVICES INC
2018-09-13
2019-02-19
4. ANALOG DEVICES INC
2019-02-19
885.978 CAPITAL GR NON US EQUITY
2019-02-19
1484.346 DODGE & INTERNATIONAL STOCK FUND
2016-07-25
2019-02-19
838.264 T ROWE PR OVERSEAS STOCK-I
2011-02-09
2019-02-19
13. ANALOG DEVICES INC
2019-02-20
1931.567 MFS EMERG MRKTS DEBT-R5
2019-02-20
1750.793 PIMCO SHORT TERM FUND INSTL
2018-01-12
2019-02-20
2232.885 PIMCO SHORT TERM FUND INSTL
2019-02-20
1. ADOBE SYS INC
2012-11-05
2019-03-07
1. AMERICAN EXPRESS CO
2018-07-18
2019-03-07
2. APPLE COMPUTER INC
2006-04-06
2019-03-07
9. BANK OF AMERICA CORPORATION
2018-02-06
2019-03-07
1. BERKSHIRE HATHAWAY INC DEL CL B
2018-09-11
2019-03-07
1. BIOGEN IDEC INC
2018-10-08
2019-03-07
4. BOSTON SCIENTIFIC CORP
2016-09-15
2019-03-07
2. BRISTOL MYERS SQUIBB CO
2017-02-23
2019-03-07
1. BROADCOM INC
2013-04-25
2019-03-07
1. CELGENE CORP.
2016-10-27
2019-03-07
3. CITIGROUP INC NEW
2017-05-15
2019-03-07
2. COCA-COLA CO
2018-04-16
2019-03-07
3. COMCAST CORP NEW CL A
2019-01-29
2019-03-07
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-03-07
1. DIAMONDBACK ENERGY INC
2019-01-08
2019-03-07
2. DISNEY WALT CO
2017-01-30
2019-03-07
1. DOLLAR TREE INC
2017-10-27
2019-03-07
4. DOWDUPONT INC
2018-04-09
2019-03-07
2. EOG RESOURCES INC
2016-09-15
2019-03-07
1. ELECTRONIC ARTS
2018-09-20
2019-03-07
1. FACEBOOK INC-A
2014-07-25
2019-03-07
1. FIDELITY NATL INFORMATION SVCS INC
2015-04-10
2019-03-07
1. FISERV INC
2019-01-25
2019-03-07
1. GENERAL DYNAMICS CORP
2017-02-10
2019-03-07
1. HOME DEPOT INC
2012-03-20
2019-03-07
2. HONEYWELL INTL INC
2013-10-23
2019-03-07
1. INTERCONTINENTALEXCHANGE GROUP, INC
2017-02-01
2019-03-07
118. ISHARES MSCI JAPAN ETF
2018-01-12
2019-03-07
182. ISHARES MSCI JAPAN ETF
2018-01-12
2019-03-07
6. KEYCORP NEW
2018-10-08
2019-03-07
1. LOWES COS INC
2011-08-04
2019-03-07
2. MARATHON PETROLEUM CORPORATION
2018-09-20
2019-03-07
2. MASTERCARD INC - CLASS A
2012-10-15
2019-03-07
2. MERCK & CO INC
2017-10-03
2019-03-07
6. MICROSOFT CORP
2019-03-07
3. MONDELEZ INTERNATIONAL-W/I
2019-03-07
5. MORGAN STANLEY DEAN WITTER & CO NEW
2015-02-06
2019-03-07
1. NEXTERA ENERGY INC
2018-07-18
2019-03-07
3. NISOURCE INC
2015-12-02
2019-03-07
1. NORFOLK SOUTHN CORP
2018-05-16
2019-03-07
1. NVIDIA CORP
2018-10-08
2019-03-07
3. OCCIDENTAL PETE CORP
2019-03-07
2. PAYPAL HOLDINGS INC
2019-01-23
2019-03-07
1. PEPSICO INC
2015-10-28
2019-03-07
6. PFIZER INC
2018-10-30
2019-03-07
1. PHILIP MORRIS INTERNATIONAL
2017-05-18
2019-03-07
1. PIONEER NAT RES CO
2016-11-08
2019-03-07
1. PRUDENTIAL FINL INC
2018-12-21
2019-03-07
1. ROSS STORES INC
2018-12-11
2019-03-07
1. SVB FINANCIAL GROUP
2015-08-12
2019-03-07
1. SALESFORCE.COM INC
2018-10-08
2019-03-07
2. SCHWAB CHARLES CORP NEW
2016-06-03
2019-03-07
1. STANLEY BLACK & DECKER,INC.
2015-11-20
2019-03-07
2. TEXAS INSTRS INC
2019-02-19
2019-03-07
1. UNION PAC CORP
2018-02-22
2019-03-07
1. UNITED TECHNOLOGIES CORP
2017-12-12
2019-03-07
2. UNITEDHEALTH GROUP INC
2016-09-15
2019-03-07
1. VERTEX PHARMACEUTICALS INC
2015-09-29
2019-03-07
1. VISA INC CLASS A SHARES
2015-10-19
2019-03-07
1. WASTE CONNECTIONS INC
2016-08-10
2019-03-07
4. WELLS FARGO & CO NEW
2009-12-15
2019-03-07
1. WEX INC
2016-05-02
2019-03-07
1. ZIMMER HLDGS INC
2018-04-26
2019-03-07
1. ALLEGION PLC
2015-11-20
2019-03-07
1. ACCENTURE PLC
2016-02-09
2019-03-07
1. MEDTRONIC PLC
2018-07-18
2019-03-07
1. APTIV PLC
2018-04-26
2019-03-07
2. CHUBB LTD
2016-08-17
2019-03-07
1. NXP SEMICONDUCTORS NV
2019-02-20
2019-03-07
3950.218 BLCKRCK HI YLD BND PORT-K
2019-03-08
7. BIOGEN IDEC INC
2010-03-22
2019-03-14
3. BIOGEN IDEC INC
2018-10-08
2019-03-14
110. BRISTOL MYERS SQUIBB CO
2019-03-14
24. DISNEY WALT CO
2019-03-14
4. ADOBE SYS INC
2019-03-29
4. ALEXION PHARMACEUTICALS INC
2019-03-14
2019-03-29
3. ALPHABET INC-CL C
2019-03-29
2. ALPHABET INC-CL A
2016-07-11
2019-03-29
2. AMAZON COM INC
2015-06-30
2019-03-29
4. AMERICAN EXPRESS CO
2018-07-18
2019-03-29
19. APPLE COMPUTER INC
2006-04-06
2019-03-29
6. AUTOMATIC DATA PROCESSING INC
2018-12-03
2019-03-29
72. BANK OF AMERICA CORPORATION
2019-03-29
8. BERKSHIRE HATHAWAY INC DEL CL B
2019-03-29
36. BOSTON SCIENTIFIC CORP
2019-03-29
7. BROADCOM INC
2013-04-25
2019-03-29
9. CELGENE CORP.
2019-03-29
4. CHARTER COMMUNICATIONS INC-A
2018-04-13
2019-03-29
25. CITIGROUP INC NEW
2017-05-15
2019-03-29
18. COCA-COLA CO
2019-03-29
42. COMCAST CORP NEW CL A
2019-03-14
2019-03-29
11. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-03-29
6. DIAMONDBACK ENERGY INC
2019-03-29
14. DISNEY WALT CO
2019-03-29
9. DOLLAR TREE INC
2017-10-27
2019-03-29
21.576 DOWDUPONT INC
2019-03-29
9.424 DOWDUPONT INC
2019-03-29
15. EOG RESOURCES INC
2016-08-05
2019-03-29
12. ELECTRONIC ARTS
2018-09-20
2019-03-29
6. FACEBOOK INC-A
2014-07-25
2019-03-29
9. FIDELITY NATL INFORMATION SVCS INC
2019-03-29
9. FISERV INC
2019-03-29
3. GENERAL DYNAMICS CORP
2017-02-10
2019-03-29
3. GENERAL DYNAMICS CORP
2018-12-13
2019-03-29
9. HOME DEPOT INC
2019-03-29
14. HONEYWELL INTL INC
2019-03-29
5. INTERCONTINENTALEXCHANGE GROUP, INC
2019-03-29
50. KEYCORP NEW
2019-03-29
13. LILLY ELI & CO
2019-03-29
10. LOWES COS INC
2019-03-29
18. MARATHON PETROLEUM CORPORATION
2019-03-29
10. MASTERCARD INC - CLASS A
2012-10-15
2019-03-29
21. MERCK & CO INC
2019-03-14
2019-03-29
45. MICROSOFT CORP
2019-03-29
24. MONDELEZ INTERNATIONAL-W/I
2019-03-29
41. MORGAN STANLEY DEAN WITTER & CO NEW
2019-03-29
2. NETFLIX.COM INC
2018-09-13
2019-03-29
5. NEXTERA ENERGY INC
2019-03-29
23. NISOURCE INC
2019-03-29
9. NORFOLK SOUTHN CORP
2019-03-29
4. NORTHROP GRUMMAN CORP
2019-03-29
6. NVIDIA CORP
2018-10-08
2019-03-29
2. O'REILLY AUTOMOTIVE INC
2019-03-29
25. OCCIDENTAL PETE CORP
2019-03-29
3. PARKER HANNIFIN CORP
2018-01-11
2019-03-29
13. PAYPAL HOLDINGS INC
2019-01-23
2019-03-29
14. PEPSICO INC
2018-05-22
2019-03-29
31. PFIZER INC
2018-10-30
2019-03-29
18. PFIZER INC
2019-03-29
13. PHILIP MORRIS INTERNATIONAL
2019-03-29
7. PIONEER NAT RES CO
2019-03-29
7. PRUDENTIAL FINL INC
2019-03-29
1. REGENERON PHARMACEUTICALS INC
2019-01-31
2019-03-29
10. ROSS STORES INC
2018-12-11
2019-03-29
3. SVB FINANCIAL GROUP
2019-03-29
8. SALESFORCE.COM INC
2018-10-08
2019-03-29
14. SCHWAB CHARLES CORP NEW
2019-03-29
8. STANLEY BLACK & DECKER,INC.
2019-03-29
16. TEXAS INSTRS INC
2019-02-19
2019-03-29
10. UNION PAC CORP
2019-03-29
4. UNITED TECHNOLOGIES CORP
2017-12-11
2019-03-29
12. UNITEDHEALTH GROUP INC
2019-03-29
4. VERTEX PHARMACEUTICALS INC
2019-03-29
7. VISA INC CLASS A SHARES
2015-10-19
2019-03-29
9. WASTE CONNECTIONS INC
2016-08-10
2019-03-29
30. WELLS FARGO & CO NEW
2019-03-29
4. WEX INC
2016-05-02
2019-03-29
6. YUM BRANDS INC
2019-03-29
13. ZIMMER HLDGS INC
2019-03-29
7. ALLEGION PLC
2019-03-29
7. ACCENTURE PLC
2019-03-29
6. LINDE PLC
2018-12-11
2019-03-29
12. MEDTRONIC PLC
2018-07-18
2019-03-29
9. APTIV PLC
2019-03-29
9. CHUBB LTD
2019-03-29
8. NXP SEMICONDUCTORS NV
2019-03-29
5100.492 T ROWE PR OVERSEAS STOCK-I
2019-04-01
. PFIZER INC
2019-04-03
17. DOW INC
2019-04-08
3. DOW INC
2019-04-08
1. DOW INC
2017-02-22
2019-04-08
22. DOW INC
2019-04-08
11. DOW INC
2019-04-08
3. DOW INC
2015-07-15
2019-04-09
. DOW INC
2019-04-23
16. OCCIDENTAL PETE CORP
2019-04-25
24. OCCIDENTAL PETE CORP
2019-04-25
7. OCCIDENTAL PETE CORP
2019-04-25
33. OCCIDENTAL PETE CORP
2019-04-25
9. OCCIDENTAL PETE CORP
2019-05-01
2. OCCIDENTAL PETE CORP
2017-02-10
2019-05-01
6. REGENERON PHARMACEUTICALS INC
2019-05-01
1. REGENERON PHARMACEUTICALS INC
2019-01-23
2019-05-01
26. OCCIDENTAL PETE CORP
2019-05-02
2. OCCIDENTAL PETE CORP
2017-02-13
2019-05-02
1. OCCIDENTAL PETE CORP
2017-02-13
2019-05-02
5. OCCIDENTAL PETE CORP
2019-05-02
2. OCCIDENTAL PETE CORP
2008-10-15
2019-05-02
3. OCCIDENTAL PETE CORP
2008-10-15
2019-05-03
9. OCCIDENTAL PETE CORP
2008-10-15
2019-05-03
1. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
19. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
10. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
3. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
4. PRUDENTIAL FINL INC
2018-12-21
2019-05-14
28. SCHWAB CHARLES CORP NEW
2019-05-15
25. SCHWAB CHARLES CORP NEW
2019-05-16
6. SCHWAB CHARLES CORP NEW
2015-01-14
2019-05-16
17. SCHWAB CHARLES CORP NEW
2019-05-16
13. MEDTRONIC PLC
2019-05-16
9. MEDTRONIC PLC
2019-05-16
19. MEDTRONIC PLC
2019-05-16
8. MEDTRONIC PLC
2019-05-17
13. MEDTRONIC PLC
2019-05-17
6. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
7. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
3. PARKER HANNIFIN CORP
2018-01-11
2019-05-20
10000. FL ST BRD OF EDU PUB EDU UNLIMITED TAX C 5% JUN 01 2022
2015-01-08
2019-06-03
26. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-05
9. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-05
31. PHILIP MORRIS INTERNATIONAL
2017-04-24
2019-06-05
1. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
8. DELTA AIR LINES INC DEL NEW
2019-06-06
9. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
2. DELTA AIR LINES INC DEL NEW
2017-12-13
2019-06-06
596. ISHARES BARCLAYS 1-3 YEAR TREASURY
2019-02-20
2019-06-06
323. ISHARES BARCLAYS 1-3 YEAR TREASURY
2019-02-20
2019-06-06
598. ISHARES BARCLAYS 1-3 YEAR TREASURY
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
2. 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
263. ISHARES BARCLAYS 1-3 YEAR TREASURY
2018-12-13
2019-06-07
78. BANK OF AMERICA CORPORATION
2019-06-10
17. DOLLAR TREE INC
2019-06-10
61. WELLS FARGO & CO NEW
2019-06-10
17. DOLLAR TREE INC
2019-06-11
7. DOLLAR TREE INC
2018-12-17
2019-06-11
6. DOLLAR TREE INC
2018-12-17
2019-06-11
2688.172 BOSTON PART GL LG/SH EQ-INST
2018-11-26
2019-06-14
2090.592 VANGUARD INTERMEDIATE TERM TAX
2019-02-20
2019-06-14
6. ADOBE SYS INC
2012-08-03
2019-06-27
. AMGEN INC
2019-07-17
6. SVB FINANCIAL GROUP
2019-08-14
3. SVB FINANCIAL GROUP
2015-02-05
2019-08-14
9. APTIV PLC
2019-08-14
5. APTIV PLC
2019-08-14
12. APTIV PLC
2019-08-14
7. SVB FINANCIAL GROUP
2015-02-05
2019-08-15
24. APTIV PLC
2019-08-15
475. ISHARES MISCI EAFE INDEX FUND
2019-08-27
. GENERAL MOTORS CO
2019-09-05
840. ISHARES SHORT TREASURY BOND
2019-09-24
1013.255 VANGUARD INTERMEDIATE TERM TAX
2018-07-20
2019-09-25
3258.657 VANGUARD INTERMEDIATE TERM TAX
2019-09-25
30. DISNEY WALT CO
2019-10-25
7. ACCENTURE PLC
2019-10-25
10. ACCENTURE PLC
2019-10-28
20. NISOURCE INC
2019-11-11
25. NISOURCE INC
2019-11-11
20. NISOURCE INC
2019-11-12
51. NISOURCE INC
2019-11-12
4. NISOURCE INC
2013-02-26
2019-11-12
5. NISOURCE INC
2013-02-26
2019-11-13
340.368 AMER FNDS INTL VNTG-F3
2013-06-07
2019-11-21
38. CELGENE CORP.
2019-11-21
80. CELGENE CORP.
2019-11-21
140. SPDR TR UNIT SER 1
2019-11-21
115. SPDR TR UNIT SER 1
2018-12-27
2019-11-21
45. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
5. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
2. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
3032.018 EV GLBL MACR ABS RTRN-R6
2017-04-20
2019-11-25
57. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-26
9. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-27
25000. MACEDONIA OH VAR PURP LTD TAX 3.75% 12/01/2019 DTD
2010-09-10
2019-12-02
3. ABBVIE INC
2019-11-11
2019-12-04
1. ADOBE SYS INC
2012-08-03
2019-12-04
1. ALEXION PHARMACEUTICALS INC
2019-03-14
2019-12-04
1. ALPHABET INC-CL C
2019-10-25
2019-12-04
3. AMERICAN EXPRESS CO
2019-06-10
2019-12-04
4. APPLE COMPUTER INC
2006-04-06
2019-12-04
2. AUTOMATIC DATA PROCESSING INC
2019-08-14
2019-12-04
16. BANK OF AMERICA CORPORATION
2019-12-04
2. BERKSHIRE HATHAWAY INC DEL CL B
2018-09-11
2019-12-04
448.43 BLACKROCK NTL MUNI-K
2017-04-25
2019-12-04
462.11 BLACKSTONE ALT MULTI-STRAT-Y
2018-11-09
2019-12-04
8. BOSTON SCIENTIFIC CORP
2016-09-15
2019-12-04
4. BRISTOL MYERS SQUIBB CO
2019-11-21
2019-12-04
1. BROADCOM INC
2019-12-04
244.141 CRM LNG/SHRT OPPORT-INST
2016-12-09
2019-12-04
1690.331 AMER FNDS INTL VNTG-F3
2013-06-07
2019-12-04
1. CHARTER COMMUNICATIONS INC-A
2016-12-15
2019-12-04
6. CITIGROUP INC NEW
2019-12-04
4. COCA-COLA CO
2018-04-13
2019-12-04
11. COMCAST CORP NEW CL A
2019-05-14
2019-12-04
5. CORTEVA INC
2019-12-04
1. DIAMONDBACK ENERGY INC
2017-05-15
2019-12-04
1. DIAMONDBACK ENERGY INC
2019-01-08
2019-12-04
2. DISNEY WALT CO
2016-10-27
2019-12-04
233.645 DOUBLELINE TTL RTRN BND-I
2014-04-01
2019-12-04
3. DUPONT DE NEMOURS INC-WI
2019-12-04
3. EOG RESOURCES INC
2016-08-05
2019-12-04
2. ELECTRONIC ARTS
2019-12-04
1. FACEBOOK INC-A
2014-07-25
2019-12-04
3. FIDELITY NATL INFORMATION SVCS INC
2019-08-14
2019-12-04
5. FISERV INC
2019-12-04
1. GENERAL DYNAMICS CORP
2018-12-13
2019-12-04
2. HOME DEPOT INC
2011-09-29
2019-12-04
3. HONEYWELL INTL INC
2019-12-04
2. INTERCONTINENTALEXCHANGE GROUP, INC
2017-01-31
2019-12-04
175. ISHARES SHORT TREASURY BOND
2019-12-04
1321.004 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2019-12-04
11. KEYCORP NEW
2019-12-04
3. LILLY ELI & CO
2015-07-02
2019-12-04
592.417 LORD ABBETT SHRT DUR INC-F3
2018-11-09
2019-12-04
2. LOWES COS INC
2011-09-28
2019-12-04
5. MARATHON PETROLEUM CORPORATION
2019-12-04
2. MASTERCARD INC - CLASS A
2012-10-15
2019-12-04
1. MCDONALDS CORP
2019-06-10
2019-12-04
4. MERCK & CO INC
2019-03-14
2019-12-04
10. MICROSOFT CORP
2015-02-13
2019-12-04
5. MONDELEZ INTERNATIONAL-W/I
2016-02-24
2019-12-04
9. MORGAN STANLEY DEAN WITTER & CO NEW
2015-12-02
2019-12-04
1. NETFLIX.COM INC
2018-09-13
2019-12-04
1. NEXTERA ENERGY INC
2018-07-18
2019-12-04
2. NORFOLK SOUTHN CORP
2018-05-15
2019-12-04
1. NORTHROP GRUMMAN CORP
2019-05-20
2019-12-04
1. NVIDIA CORP
2018-10-08
2019-12-04
1. O'REILLY AUTOMOTIVE INC
2017-05-05
2019-12-04
3. PAYPAL HOLDINGS INC
2019-01-23
2019-12-04
2. PEPSICO INC
2018-05-22
2019-12-04
11. PFIZER INC
2019-12-04
2. PHILIP MORRIS INTERNATIONAL
2018-10-24
2019-12-04
2. PIONEER NAT RES CO
2019-12-04
2. PROCTER & GAMBLE CO
2019-06-05
2019-12-04
2. QUALCOMM INC
2019-05-01
2019-12-04
2. ROSS STORES INC
2018-12-11
2019-12-04
3. SALESFORCE.COM INC
2018-10-08
2019-12-04
750.751 SIX CIRCLES TAX AW U/S DUR
2018-10-24
2019-12-04
2. STANLEY BLACK & DECKER,INC.
2019-12-04
938.438 AMER FNDS T/E BND FND AM-F3
2018-01-23
2019-12-04
3. TEXAS INSTRS INC
2019-02-19
2019-12-04
3. UNION PAC CORP
2019-12-04
1. UNITED TECHNOLOGIES CORP
2017-12-11
2019-12-04
3. UNITEDHEALTH GROUP INC
2013-06-13
2019-12-04
2. VISA INC CLASS A SHARES
2015-10-19
2019-12-04
2. WASTE CONNECTIONS INC
2016-08-10
2019-12-04
5. WELLS FARGO & CO NEW
2009-03-16
2019-12-04
1. WEX INC
2016-05-02
2019-12-04
1. YUM BRANDS INC
2018-11-29
2019-12-04
3. ZIMMER HLDGS INC
2018-10-30
2019-12-04
2. ALLEGION PLC
2015-11-19
2019-12-04
1. ACCENTURE PLC
2014-04-22
2019-12-04
4. LINDE PLC
2019-08-14
2019-12-04
2. CHUBB LTD
2012-01-09
2019-12-04
1. NXP SEMICONDUCTORS NV
2019-02-20
2019-12-04
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
53
53
b
69
106
-37
c
342
508
-166
d
68
102
-34
e
136
203
-67
397
183
214
577
679
-102
83
97
-14
610
852
-242
399
183
216
1,193
331
862
82
74
8
905
1,067
-162
68
89
-21
207
267
-60
69
89
-20
1,418
363
1,055
1,244
1,111
133
68
89
-21
136
178
-42
749
666
83
138
178
-40
164
148
16
69
89
-20
752
666
86
70
89
-19
210
265
-55
32,215
32,354
-139
15,000
16,110
-1,110
14,112
12,319
1,793
942
829
113
417
369
48
1,154
1,013
141
2,191
1,342
849
730
644
86
420
255
165
11,500
10,245
1,255
59,953
54,134
5,819
8,500
7,303
1,197
1,377
823
554
27,409
28,778
-1,369
17,158
17,280
-122
21,882
22,051
-169
256
34
222
108
103
5
346
20
326
255
274
-19
199
217
-18
316
342
-26
158
94
64
103
111
-8
267
39
228
86
105
-19
184
184
90
89
1
115
108
7
49
54
-5
98
105
-7
228
221
7
102
93
9
214
257
-43
182
181
1
96
114
-18
169
75
94
106
65
41
85
85
164
184
-20
183
49
134
303
165
138
74
59
15
6,306
7,487
-1,181
9,726
11,548
-1,822
100
129
-29
101
20
81
118
163
-45
445
95
350
161
129
32
662
316
346
141
133
8
204
180
24
188
170
18
82
58
24
178
151
27
149
268
-119
197
256
-59
192
181
11
116
102
14
249
255
-6
86
114
-28
136
175
-39
94
80
14
91
81
10
238
138
100
157
151
6
88
58
30
131
108
23
210
215
-5
165
134
31
123
124
-1
471
268
203
179
100
79
146
77
69
84
53
31
198
104
94
173
94
79
122
115
7
88
67
21
161
94
67
91
88
3
82
87
-5
264
251
13
93
94
-1
29,508
29,097
411
2,241
386
1,855
961
1,027
-66
5,412
4,678
734
2,744
2,589
155
1,064
134
930
542
539
3
3,507
1,748
1,759
2,346
1,454
892
3,561
869
2,692
438
412
26
3,600
188
3,412
957
883
74
1,975
1,833
142
1,602
1,728
-126
1,385
841
544
2,104
274
1,830
849
941
-92
1,388
1,224
164
1,555
1,536
19
841
803
38
1,673
1,673
567
589
-22
611
630
-19
1,554
1,450
104
944
834
110
1,142
1,381
-239
499
604
-105
1,435
1,354
81
1,224
1,367
-143
997
452
545
1,017
578
439
795
760
35
506
552
-46
506
515
-9
1,724
414
1,310
2,224
1,097
1,127
379
293
86
787
1,050
-263
1,682
1,123
559
1,095
202
893
1,081
1,452
-371
2,348
475
1,873
1,745
1,710
35
5,289
2,042
3,247
1,196
1,005
191
1,728
1,444
284
711
741
-30
963
847
116
659
443
216
1,681
1,351
330
1,076
1,173
-97
1,077
1,610
-533
776
506
270
1,659
2,113
-454
515
625
-110
1,347
1,175
172
1,711
1,398
313
1,316
1,320
-4
764
636
128
1,146
1,461
-315
1,070
1,086
-16
643
559
84
411
429
-18
932
806
126
667
403
264
1,263
1,211
52
600
408
192
1,088
855
233
1,699
1,721
-22
1,670
1,335
335
514
493
21
2,954
1,420
1,534
737
336
401
1,089
540
549
798
478
320
1,442
771
671
767
377
390
599
551
48
1,657
1,491
166
635
466
169
1,231
635
596
1,052
964
88
1,090
1,057
33
717
784
-67
1,258
633
625
710
753
-43
52,688
43,313
9,375
104
104
971
1,089
-118
172
191
-19
57
63
-6
1,259
1,269
-10
630
587
43
170
190
-20
38
38
994
1,249
-255
1,491
1,928
-437
435
538
-103
2,049
2,480
-431
519
634
-115
116
139
-23
2,046
2,491
-445
340
400
-60
1,491
1,777
-286
115
135
-20
57
67
-10
287
309
-22
115
88
27
174
133
41
523
398
125
98
80
18
1,870
1,513
357
988
796
192
293
239
54
396
319
77
1,198
809
389
1,090
708
382
261
162
99
738
456
282
1,146
1,144
2
793
714
79
1,678
1,504
174
704
630
74
1,148
1,009
139
979
1,249
-270
1,142
1,458
-316
489
625
-136
10,100
10,100
1,428
1,393
35
495
481
14
2,394
3,479
-1,085
55
53
2
439
428
11
491
481
10
109
107
2
50,379
49,910
469
27,286
27,049
237
50,511
49,954
557
55
53
2
55
53
2
111
107
4
55
53
2
22,249
21,895
354
2,200
1,311
889
1,765
1,566
199
2,830
1,269
1,561
1,813
1,556
257
747
605
142
640
518
122
28,710
30,000
-1,290
30,000
29,331
669
1,762
192
1,570
14
14
1,145
758
387
570
361
209
716
783
-67
402
434
-32
958
850
108
1,307
842
465
1,903
1,699
204
29,647
29,861
-214
18
18
92,857
92,821
36
14,682
14,115
567
47,218
45,669
1,549
3,940
3,011
929
1,282
588
694
1,837
832
1,005
525
355
170
653
384
269
521
263
258
1,328
504
824
104
39
65
131
48
83
5,000
3,639
1,361
4,105
1,918
2,187
8,642
7,515
1,127
43,435
37,103
6,332
35,679
28,529
7,150
94
104
-10
10
12
-2
4
5
-1
26,712
26,951
-239
121
131
-10
19
21
-2
25,000
25,000
261
256
5
302
32
270
116
135
-19
1,319
1,260
59
354
369
-15
1,050
40
1,010
337
328
9
531
222
309
436
428
8
5,000
4,848
152
5,014
4,931
83
343
187
156
232
226
6
308
38
270
2,500
2,441
59
25,000
18,070
6,930
464
291
173
446
363
83
216
178
38
479
473
6
124
191
-67
81
104
-23
81
104
-23
297
188
109
2,500
2,544
-44
190
326
-136
217
271
-54
202
227
-25
198
75
123
407
393
14
572
529
43
179
172
7
427
68
359
523
177
346
187
117
70
19,332
19,331
1
30,000
22,044
7,956
210
220
-10
356
258
98
2,500
2,459
41
232
40
192
302
412
-110
574
95
479
193
201
-8
353
326
27
1,496
434
1,062
266
197
69
441
314
127
305
371
-66
233
169
64
377
300
77
346
313
33
209
268
-59
441
252
189
314
271
43
273
200
73
420
381
39
165
178
-13
260
290
-30
248
213
35
162
173
-11
228
161
67
465
454
11
7,500
7,508
-8
309
213
96
12,500
12,162
338
360
323
37
516
374
142
146
123
23
838
192
646
362
154
208
180
106
74
266
75
191
198
94
104
99
92
7
442
344
98
244
133
111
199
80
119
818
745
73
301
140
161
116
94
22
5,390
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
53
b
-37
c
-166
d
-34
e
-67
214
-102
-14
-242
216
862
8
-162
-21
-60
-20
1,055
133
-21
-42
83
-40
16
-20
86
-19
-55
-139
-1,110
1,793
113
48
141
849
86
165
1,255
5,819
1,197
554
-1,369
-122
-169
222
5
326
-19
-18
-26
64
-8
228
-19
1
7
-5
-7
7
9
-43
1
-18
94
41
-20
134
138
15
-1,181
-1,822
-29
81
-45
350
32
346
8
24
18
24
27
-119
-59
11
14
-6
-28
-39
14
10
100
6
30
23
-5
31
-1
203
79
69
31
94
79
7
21
67
3
-5
13
-1
411
1,855
-66
734
155
930
3
1,759
892
2,692
26
3,412
74
142
-126
544
1,830
-92
164
19
38
-22
-19
104
110
-239
-105
81
-143
545
439
35
-46
-9
1,310
1,127
86
-263
559
893
-371
1,873
35
3,247
191
284
-30
116
216
330
-97
-533
270
-454
-110
172
313
-4
128
-315
-16
84
-18
126
264
52
192
233
-22
335
21
1,534
401
549
320
671
390
48
166
169
596
88
33
-67
625
-43
9,375
104
-118
-19
-6
-10
43
-20
38
-255
-437
-103
-431
-115
-23
-445
-60
-286
-20
-10
-22
27
41
125
18
357
192
54
77
389
382
99
282
2
79
174
74
139
-270
-316
-136
35
14
-1,085
2
11
10
2
469
237
557
2
2
4
2
354
889
199
1,561
257
142
122
-1,290
669
1,570
14
387
209
-67
-32
108
465
204
-214
18
36
567
1,549
929
694
1,005
170
269
258
824
65
83
1,361
2,187
1,127
6,332
7,150
-10
-2
-1
-239
-10
-2
5
270
-19
59
-15
1,010
9
309
8
152
83
156
6
270
59
6,930
173
83
38
6
-67
-23
-23
109
-44
-136
-54
-25
123
14
43
7
359
346
70
1
7,956
-10
98
41
192
-110
479
-8
27
1,062
69
127
-66
64
77
33
-59
189
43
73
39
-13
-30
35
-11
67
11
-8
96
338
37
142
23
646
208
74
191
104
7
98
111
119
73
161
22
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
110,594
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
149,306
3,207,832
0.046544
2017
144,442
3,107,208
0.046486
2016
100,240
2,957,338
0.033895
2015
59,015
2,960,547
0.019934
2014
2
Total
of line 1, column (d)
.....................
2
0.146859
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
0.036715
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
3,007,797
5
Multiply line 4 by line 3
......................
5
110,431
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
1,370
7
Add lines 5 and 6
........................
7
111,801
8
Enter qualifying distributions from Part XII, line 4
,.............
8
163,563
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
1,370
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
1,370
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
1,370
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
968
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
3,160
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
4,128
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
2,758
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
1,372
Refunded
11
1,386
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)
TX
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
JPMORGAN 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
JPMORGAN CHASE BANK NA
TRUSTEE
2
41,136
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
2,944,277
b
Average of monthly cash balances
.......................
1b
109,319
c
Fair market value of all other assets (see instructions)
................
1c
5
d
Total
(add lines 1a, b, and c)
.........................
1d
3,053,601
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
3,053,601
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
45,804
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
3,007,797
6
Minimum investment return.
Enter 5% of line 5
..................
6
150,390
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
150,390
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
1,370
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
1,370
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
149,020
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
149,020
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
149,020
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
163,563
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
163,563
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
1,370
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
162,193
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
149,020
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
146,896
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:
$
163,563
a
Applied to 2018, but not more than line 2a
146,896
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
.....
16,667
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
..........
132,353
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
ATTN RACHEL MEHLENBACHER
2900 N ROCKY POINT DR
TAMPA
,
FL
336071435
NONE
PC
GENERAL OPERATING
36,724
SCOTTISH RITE HOSPITAL
ATTN WILLIAM R HUSTON
2222 WELBORN ST
DALLAS
,
TX
752193993
NONE
PC
GENERAL OPERATING
36,724
MASONIC HOME AND SCHOOL OF TX
ATTN CFO/CIO
338 GRAPEVINE HWY
HURST
,
TX
760542409
NONE
PC
GENERAL OPERATING
73,448
Total
.................................
3a
146,896
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
71,907
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
110,594
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)
..
182,501
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
182,501
(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