-
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
THE SHANNON FOUNDATION INC
C/O MARY BETH GRENNER CPA LLC
Number and street (or P.O. box number if mail is not delivered to street address)
104 COLONY PARK DRIVE 100
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CUMMING
,
GA
30040
A Employer identification number
58-2309103
B
Telephone number (see instructions)
(770) 886-0334
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)
$
7,017,747
J
Accounting method:
Cash
Accrual
Other (specify)
MODIFIED CASH
(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)
9,516
2
Check
.............
3
Interest on savings and temporary cash investments
28,313
28,313
4
Dividends and interest from securities
...
91,336
91,336
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
257,295
b
Gross sales price for all assets on line 6a
2,647,358
7
Capital gain net income (from Part IV, line 2)
...
257,295
8
Net short-term capital gain
.........
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
Total.
Add lines 1 through 11
........
386,460
376,944
13
Compensation of officers, directors, trustees, etc.
100,000
12,500
50,000
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
7,665
958
3,832
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
5,450
5,450
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
1,711
454
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
28,194
28,051
59
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
143,020
41,963
59,341
25
Contributions, gifts, grants paid
.......
350,000
350,000
26
Total expenses and disbursements.
Add lines 24 and 25
493,020
41,963
409,341
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-106,560
b
Net investment income
(if negative, enter -0-)
334,981
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2019)
Form 990-PF (2019)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
2
Savings and temporary cash investments
.........
33,640
736,802
736,802
3
Accounts receivable
Less: allowance for doubtful accounts
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
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)
.......
4,925,031
4,151,136
5,278,844
c
Investments—corporate bonds (attach schedule)
.......
1,014,471
980,658
1,002,101
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
5,973,142
5,868,596
7,017,747
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
)
2,375
4,389
23
Total liabilities
(add lines 17 through 22)
.........
2,375
4,389
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
5,970,767
5,864,207
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
........
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)
.....
5,970,767
5,864,207
30
Total liabilities and net assets/fund balances
(see instructions)
.
5,973,142
5,868,596
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
5,970,767
2
Enter amount from Part I, line 27a
.....................
2
-106,560
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
5,864,207
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
5,864,207
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
SPDR S&P 500 ETF TRUST
P
2018-12-12
2019-12-23
b
FISERV, INC. CMN
P
2019-10-22
2019-12-12
c
CBS CORP 3.7% 08/15/2024 USD SR LIEN
P
2017-05-08
2019-11-18
d
COCA-COLA COMPANY (THE) CMN
P
2018-05-08
2019-11-05
e
EBAY INC. CMN
P
2016-12-01
2019-10-25
BAXTER INTERNATIONAL INC CMN
P
2019-04-25
2019-09-04
SKYWORKS SOLUTIONS, INC. CMN
P
2018-01-08
2019-09-04
FISERV, INC. CMN
P
2019-01-17
2019-08-09
ANALOG DEVICES, INC. CMN
P
2018-03-26
2019-07-09
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2017-05-17
2019-07-09
ARMSTRONG WORLD INDUSTRIES, INC CMN
P
2018-08-29
2019-06-11
SKYWORKS SOLUTIONS, INC. CMN
P
2018-08-17
2019-06-11
LOWES COMPANIES INC CMN
P
2018-03-22
2019-04-29
ROSS STORES,INC CMN
P
2019-01-08
2019-03-01
FISERV, INC. CMN
P
2019-01-17
2019-02-11
SKYWORKS SOLUTIONS, INC. CMN
P
2018-07-20
2019-01-18
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2019-01-02
2019-01-08
SPDR S&P 500 ETF TRUST
P
2017-05-08
2019-12-23
FISERV, INC. CMN
P
2019-01-17
2019-12-12
MARRIOTT INTERNATIONAL 2.3% 01/15/20
P
2016-06-08
2019-11-13
COCA-COLA COMPANY (THE) CMN
P
2016-12-09
2019-11-05
ENTERPRISE PRODUCTS OPERATING 2.55%
P
2015-06-16
2019-10-15
BRUNSWICK CORP. CMN
P
2019-08-06
2019-09-04
SKYWORKS SOLUTIONS, INC. CMN
P
2017-12-06
2019-09-04
INTERCONTINENTAL EXCHANGE INC CMN
P
2019-03-01
2019-08-09
APTIV PLC CMN
P
2017-12-20
2019-07-09
MOTOROLA SOLUTIONS INC CMN
P
2017-03-09
2019-07-09
BAXTER INTERNATIONAL INC CMN
P
2019-05-14
2019-06-11
SKYWORKS SOLUTIONS, INC. CMN
P
2018-01-08
2019-06-11
VULCAN MATERIALS CO CMN
P
2018-07-12
2019-04-18
COCA-COLA COMPANY (THE) CMN
P
2018-01-29
2019-02-14
LOWES COMPANIES INC CMN
P
2018-03-22
2019-02-11
MOLSON COORS BEVERAGE CO CMN CLASS
P
2017-09-13
2019-01-17
MOLSON COORS BEVERAGE CO CMN CLASS
P
2017-09-13
2019-01-08
SPDR S&P 500 ETF TRUST
P
2016-11-25
2019-12-23
INTERCONTINENTAL EXCHANGE INC CMN
P
2019-02-12
2019-12-12
TYCO ELECTRONICS GROUP S.A. 3.5% 02/
P
2015-02-02
2019-11-13
ELANCO ANIMAL HEALTH INCORPORA CMN
P
2019-05-07
2019-11-05
SABRE CORPORATION CMN
P
2019-08-09
2019-10-04
CISCO SYSTEMS, INC. CMN
P
2017-08-24
2019-09-04
VULCAN MATERIALS CO CMN
P
2018-07-12
2019-09-04
INTERCONTINENTAL EXCHANGE INC CMN
P
2019-02-12
2019-08-09
ARMSTRONG WORLD INDUSTRIES, INC CMN
P
2018-07-31
2019-07-09
S&P GLOBAL INC. CMN
P
2018-10-18
2019-07-09
CISCO SYSTEMS, INC. CMN
P
2017-07-19
2019-06-11
VULCAN MATERIALS CO CMN
P
2018-05-11
2019-06-11
VULCAN MATERIALS CO CMN
P
2018-05-23
2019-04-18
COCA-COLA COMPANY (THE) CMN
P
2018-01-26
2019-02-14
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2019-01-02
2019-02-11
COCA-COLA COMPANY (THE) CMN
P
2018-01-26
2019-01-16
MOTOROLA SOLUTIONS INC CMN
P
2017-09-07
2019-01-08
ALPHABET INC. CMN CLASS A
P
2018-05-08
2019-12-12
LOWES COMPANIES INC CMN
P
2019-09-26
2019-12-12
INSPERITY INC CMN
P
2019-10-01
2019-11-07
ELANCO ANIMAL HEALTH INCORPORA CMN
P
2019-04-17
2019-11-05
SABRE CORPORATION CMN
P
2019-04-25
2019-10-04
CISCO SYSTEMS, INC. CMN
P
2017-08-17
2019-09-04
ANALOG DEVICES, INC. CMN
P
2018-04-05
2019-08-19
LOWES COMPANIES INC CMN
P
2018-03-22
2019-08-09
BAXTER INTERNATIONAL INC CMN
P
2019-05-14
2019-07-09
S&P GLOBAL INC. CMN
P
2018-10-12
2019-07-09
COCA-COLA COMPANY (THE) CMN
P
2019-03-29
2019-06-11
KENNAMETAL INC. CMN
P
2018-02-06
2019-06-07
ANALOG DEVICES, INC. CMN
P
2018-03-26
2019-04-17
COCA-COLA COMPANY (THE) CMN
P
2017-11-29
2019-02-14
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2017-05-17
2019-02-11
ALPHABET INC. CMN CLASS A
P
2018-05-08
2019-01-08
SKYWORKS SOLUTIONS, INC. CMN
P
2018-01-08
2019-01-08
ALPHABET INC. CMN CLASS A
P
2017-08-22
2019-12-12
MC DONALDS CORP CMN
P
2019-11-05
2019-12-12
CISCO SYSTEMS, INC. CMN
P
2017-08-17
2019-11-06
ELECTRONIC ARTS CMN
P
2018-10-31
2019-11-05
PEPSICO, INC. 4.5% 01/15/2020 SR LIE
P
2015-02-02
2019-09-30
COCA-COLA COMPANY (THE) CMN
P
2016-12-09
2019-09-04
ANALOG DEVICES, INC. CMN
P
2018-03-26
2019-08-19
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2017-05-17
2019-08-09
CISCO SYSTEMS, INC. CMN
P
2017-07-19
2019-07-09
SABRE CORPORATION CMN
P
2019-04-25
2019-07-09
EBAY INC. CMN
P
2016-12-01
2019-06-11
KENNAMETAL INC. CMN
P
2018-01-31
2019-06-07
EBAY INC. CMN
P
2017-11-29
2019-04-17
COCA-COLA COMPANY (THE) CMN
P
2017-05-17
2019-02-14
MOTOROLA SOLUTIONS INC CMN
P
2017-03-09
2019-02-11
ANALOG DEVICES, INC. CMN
P
2018-08-24
2019-01-08
VULCAN MATERIALS CO CMN
P
2018-05-23
2019-01-08
ANALOG DEVICES, INC. CMN
P
2018-09-10
2019-12-12
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2017-08-22
2019-12-12
COCA-COLA COMPANY (THE) CMN
P
2019-03-29
2019-11-06
FISERV, INC. CMN
P
2019-10-22
2019-11-05
THERMO FISHER SCIENTIFIC INC. 3.15%
P
2018-05-02
2019-09-27
EBAY INC. CMN
P
2016-12-01
2019-09-04
ALPHABET INC. CMN CLASS A
P
2018-05-08
2019-08-09
MOTOROLA SOLUTIONS INC CMN
P
2017-03-09
2019-08-09
COCA-COLA COMPANY (THE) CMN
P
2019-03-29
2019-07-09
SKYWORKS SOLUTIONS, INC. CMN
P
2018-01-08
2019-07-09
ELANCO ANIMAL HEALTH INCORPORA CMN
P
2019-06-06
2019-06-11
MOLSON COORS BEVERAGE CO CMN CLASS
P
2017-09-07
2019-05-29
EBAY INC. CMN
P
2016-12-01
2019-04-17
COCA-COLA COMPANY (THE) CMN
P
2016-12-09
2019-02-14
S&P GLOBAL INC. CMN
P
2018-10-18
2019-02-11
ANALOG DEVICES, INC. CMN
P
2018-06-25
2019-01-08
DISALLOWED LOSSES
P
2019-12-31
2019-12-31
APTIV PLC CMN
P
2017-12-14
2019-12-12
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2017-05-17
2019-12-12
ALPHABET INC. CMN CLASS A
P
2018-05-08
2019-11-05
INTERCONTINENTAL EXCHANGE INC CMN
P
2019-02-12
2019-11-05
ELANCO ANIMAL HEALTH INCORPORA CMN
P
2019-08-07
2019-09-26
ELANCO ANIMAL HEALTH INCORPORA CMN
P
2019-08-07
2019-09-04
ANALOG DEVICES, INC. CMN
P
2018-03-26
2019-08-09
S&P GLOBAL INC. CMN
P
2018-10-12
2019-08-09
EBAY INC. CMN
P
2016-12-01
2019-07-09
VULCAN MATERIALS CO CMN
P
2018-05-11
2019-07-09
ELECTRONIC ARTS CMN
P
2018-10-31
2019-06-11
MOLSON COORS BEVERAGE CO CMN CLASS
P
2017-06-12
2019-05-29
ARMSTRONG WORLD INDUSTRIES, INC CMN
P
2018-08-29
2019-04-02
ALPHABET INC. CMN CLASS A
P
2019-02-06
2019-02-11
SKYWORKS SOLUTIONS, INC. CMN
P
2018-01-08
2019-02-11
ANALOG DEVICES, INC. CMN
P
2018-03-26
2019-01-08
DISALLOWED LOSSES
P
2018-12-31
2019-12-31
ARMSTRONG WORLD INDUSTRIES, INC CMN
P
2019-10-31
2019-12-12
MOTOROLA SOLUTIONS INC CMN
P
2017-03-09
2019-12-12
ANALOG DEVICES, INC. CMN
P
2018-09-10
2019-11-05
LOWES COMPANIES INC CMN
P
2019-09-26
2019-11-05
ELANCO ANIMAL HEALTH INCORPORA CMN
P
2019-04-17
2019-09-26
ELECTRONIC ARTS CMN
P
2018-10-31
2019-09-04
APTIV PLC CMN
P
2017-12-20
2019-08-09
SKYWORKS SOLUTIONS, INC. CMN
P
2018-01-08
2019-08-09
ELANCO ANIMAL HEALTH INCORPORA CMN
P
2019-06-06
2019-07-09
ARMSTRONG WORLD INDUSTRIES, INC CMN
P
2018-10-08
2019-06-28
FISERV, INC. CMN
P
2019-01-17
2019-06-11
MOLSON COORS BEVERAGE CO CMN CLASS
P
2016-12-11
2019-05-29
AT&T INC. 5.0% 03/01/2021 SER WI SR
P
2016-04-05
2019-03-27
ANALOG DEVICES, INC. CMN
P
2018-08-10
2019-02-11
VULCAN MATERIALS CO CMN
P
2018-05-23
2019-02-11
APTIV PLC CMN
P
2017-12-20
2019-01-08
BAXTER INTERNATIONAL INC CMN
P
2019-04-25
2019-12-12
S&P GLOBAL INC. CMN
P
2018-10-12
2019-12-12
APTIV PLC CMN
P
2017-12-14
2019-11-05
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2019-10-22
2019-11-05
APTIV PLC CMN
P
2017-12-14
2019-09-17
FISERV, INC. CMN
P
2019-01-17
2019-09-04
ARMSTRONG WORLD INDUSTRIES, INC CMN
P
2018-07-31
2019-08-09
VULCAN MATERIALS CO CMN
P
2018-07-12
2019-08-09
ELANCO ANIMAL HEALTH INCORPORA CMN
P
2019-04-17
2019-07-09
ARMSTRONG WORLD INDUSTRIES, INC CMN
P
2018-08-29
2019-06-28
INTERCONTINENTAL EXCHANGE INC CMN
P
2019-03-01
2019-06-11
MOLSON COORS BEVERAGE CO CMN CLASS
P
2016-12-01
2019-05-29
EBAY INC. CMN
P
2017-11-29
2019-03-21
ANALOG DEVICES, INC. CMN
P
2018-06-25
2019-02-11
ELECTRONIC ARTS CMN
P
2018-10-31
2019-02-06
BAXTER INTERNATIONAL INC CMN
P
2018-12-04
2019-01-08
BAXTER INTERNATIONAL INC CMN
P
2018-12-04
2019-12-12
SABRE CORPORATION CMN
P
2019-04-25
2019-12-12
ARMSTRONG WORLD INDUSTRIES, INC CMN
P
2019-10-31
2019-11-05
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2017-05-17
2019-11-05
ALPHABET INC. CMN CLASS A
P
2018-05-08
2019-09-04
INTERCONTINENTAL EXCHANGE INC CMN
P
2019-02-12
2019-09-04
BAXTER INTERNATIONAL INC CMN
P
2019-05-14
2019-08-09
JPMORGAN CHASE & CO. LINKED TO BASKE
P
2018-01-30
2019-08-01
ELECTRONIC ARTS CMN
P
2018-10-31
2019-07-09
ARMSTRONG WORLD INDUSTRIES, INC CMN
P
2018-07-31
2019-06-28
KENNAMETAL INC. CMN
P
2018-02-06
2019-06-11
JPMORGAN CHASE & CO. LINKED TO EURO
P
2017-05-12
2019-05-16
EBAY INC. CMN
P
2017-07-21
2019-03-21
APTIV PLC CMN
P
2017-12-20
2019-02-11
MOTOROLA SOLUTIONS INC CMN
P
2017-09-07
2019-01-25
CISCO SYSTEMS, INC. CMN
P
2017-07-19
2019-01-08
BRUNSWICK CORP. CMN
P
2019-10-25
2019-12-12
SKYWORKS SOLUTIONS, INC. CMN
P
2017-12-06
2019-12-12
BAXTER INTERNATIONAL INC CMN
P
2019-04-25
2019-11-05
MOTOROLA SOLUTIONS INC CMN
P
2017-03-09
2019-11-05
ANALOG DEVICES, INC. CMN
P
2018-04-05
2019-09-04
LOWES COMPANIES INC CMN
P
2018-03-22
2019-09-04
CISCO SYSTEMS, INC. CMN
P
2017-08-24
2019-08-09
KENNAMETAL INC. CMN
P
2018-03-05
2019-07-10
FISERV, INC. CMN
P
2019-01-17
2019-07-09
ARMSTRONG WORLD INDUSTRIES, INC CMN
P
2018-07-09
2019-06-28
LOWES COMPANIES INC CMN
P
2018-03-22
2019-06-11
CISCO SYSTEMS, INC. CMN
P
2017-07-19
2019-05-14
MOLSON COORS BEVERAGE CO CMN CLASS
P
2017-09-13
2019-03-11
BAXTER INTERNATIONAL INC CMN
P
2018-12-04
2019-02-11
MOTOROLA SOLUTIONS INC CMN
P
2017-03-09
2019-01-25
COCA-COLA COMPANY (THE) CMN
P
2018-01-26
2019-01-08
CISCO SYSTEMS, INC. CMN
P
2016-12-01
2019-12-12
VULCAN MATERIALS CO CMN
P
2018-05-11
2019-12-12
BRUNSWICK CORP. CMN
P
2019-10-25
2019-11-05
S&P GLOBAL INC. CMN
P
2018-10-12
2019-11-05
APTIV PLC CMN
P
2017-12-20
2019-09-04
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2017-05-17
2019-09-04
CISCO SYSTEMS, INC. CMN
P
2017-07-19
2019-08-09
KENNAMETAL INC. CMN
P
2018-02-06
2019-07-10
INTERCONTINENTAL EXCHANGE INC CMN
P
2019-03-01
2019-07-09
EBAY INC. CMN
P
2016-12-01
2019-06-20
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2019-02-25
2019-06-11
MOLSON COORS BEVERAGE CO CMN CLASS
P
2017-06-12
2019-05-08
MOLSON COORS BEVERAGE CO CMN CLASS
P
2017-06-12
2019-03-11
CISCO SYSTEMS, INC. CMN
P
2017-07-19
2019-02-11
WESTINGHOUSE AIR BRAKE TECHNOL CMN
P
2018-11-01
2019-01-25
EBAY INC. CMN
P
2018-05-21
2019-01-08
COCA-COLA COMPANY (THE) CMN
P
2017-02-14
2019-12-12
CISCO SYSTEMS, INC. CMN
P
2017-08-18
2019-11-26
CISCO SYSTEMS, INC. CMN
P
2019-10-02
2019-11-05
SKYWORKS SOLUTIONS, INC. CMN
P
2017-12-06
2019-11-05
APTIV PLC CMN
P
2017-12-14
2019-09-04
MOTOROLA SOLUTIONS INC CMN
P
2017-03-09
2019-09-04
COCA-COLA COMPANY (THE) CMN
P
2016-12-09
2019-08-09
KENNAMETAL INC. CMN
P
2018-01-31
2019-07-10
LOWES COMPANIES INC CMN
P
2018-03-22
2019-07-09
ALPHABET INC. CMN CLASS A
P
2019-02-06
2019-06-11
MOTOROLA SOLUTIONS INC CMN
P
2017-03-09
2019-06-11
FISERV, INC. CMN
P
2019-03-18
2019-04-30
ANALOG DEVICES, INC. CMN
P
2018-09-10
2019-03-08
COCA-COLA COMPANY (THE) CMN
P
2018-01-26
2019-02-11
WESTINGHOUSE AIR BRAKE TECHNOL CMN
P
2017-10-23
2019-01-25
EBAY INC. CMN
P
2017-07-21
2019-01-08
ELANCO ANIMAL HEALTH INCORPORA CMN
P
2019-05-07
2019-12-12
CISCO SYSTEMS, INC. CMN
P
2017-08-17
2019-11-26
CISCO SYSTEMS, INC. CMN
P
2017-08-17
2019-11-05
VULCAN MATERIALS CO CMN
P
2018-07-12
2019-11-05
ARMSTRONG WORLD INDUSTRIES, INC CMN
P
2018-07-31
2019-09-04
S&P GLOBAL INC. CMN
P
2018-10-12
2019-09-04
ELANCO ANIMAL HEALTH INCORPORA CMN
P
2019-08-07
2019-08-09
ALPHABET INC. CMN CLASS A
P
2019-02-06
2019-07-09
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2019-03-18
2019-07-09
ANALOG DEVICES, INC. CMN
P
2018-03-26
2019-06-11
S&P GLOBAL INC. CMN
P
2018-10-18
2019-06-11
FISERV, INC. CMN
P
2019-01-17
2019-04-30
ANALOG DEVICES, INC. CMN
P
2018-08-10
2019-03-08
EBAY INC. CMN
P
2017-07-21
2019-02-11
ROSS STORES,INC CMN
P
2019-01-08
2019-01-24
KENNAMETAL INC. CMN
P
2018-01-31
2019-01-08
ELECTRONIC ARTS CMN
P
2018-10-31
2019-12-12
CISCO SYSTEMS, INC. CMN
P
2016-12-01
2019-11-26
COCA-COLA COMPANY (THE) CMN
P
2019-03-29
2019-11-05
VULCAN MATERIALS CO CMN
P
2018-05-11
2019-11-05
BAXTER INTERNATIONAL INC CMN
P
2019-05-14
2019-09-04
SABRE CORPORATION CMN
P
2019-08-09
2019-09-04
ELECTRONIC ARTS CMN
P
2018-10-31
2019-08-09
ALPHABET INC. CMN CLASS A
P
2018-05-08
2019-07-09
MEDTRONIC PUBLIC LIMITED COMPA CMN
P
2019-02-25
2019-07-09
APTIV PLC CMN
P
2017-12-20
2019-06-11
SABRE CORPORATION CMN
P
2019-04-25
2019-06-11
JPMORGAN CHASE & CO. LINKED TO S&P 5
P
2017-10-25
2019-04-30
CISCO SYSTEMS, INC. CMN
P
2017-07-19
2019-03-01
ELECTRONIC ARTS CMN
P
2018-10-31
2019-02-11
SKYWORKS SOLUTIONS, INC. CMN
P
2018-08-17
2019-01-18
LOWES COMPANIES INC CMN
P
2018-03-22
2019-01-08
(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
287,638
239,413
48,225
b
458
403
55
c
26,258
25,325
933
d
4,468
3,568
900
e
6,611
5,063
1,548
1,221
1,063
158
987
1,312
-325
1,250
904
346
5,330
4,345
985
197
166
31
2,473
1,824
649
1,555
1,917
-362
9,107
7,035
2,072
5,415
5,208
207
930
829
101
3,947
5,560
-1,613
2,892
3,069
-177
402,372
300,078
102,294
688
452
236
25,047
24,897
150
6,571
5,256
1,315
50,000
50,000
1,043
1,010
33
1,063
1,346
-283
644
541
103
1,062
1,204
-142
2,199
1,057
1,142
2,472
2,441
31
74
101
-27
990
1,017
-27
8,714
9,136
-422
968
858
110
4,556
6,556
-2,000
857
1,240
-383
230,110
158,565
71,545
1,279
1,068
211
25,736
25,522
214
1,127
1,271
-144
5,065
5,839
-774
331
219
112
1,573
1,398
175
1,013
839
174
1,957
1,365
592
1,847
1,498
349
3,145
1,756
1,389
1,038
1,015
23
4,949
5,127
-178
4,127
4,356
-229
1,971
1,929
42
22,792
23,473
-681
1,424
1,033
391
1,345
1,056
289
1,296
1,209
87
5,833
8,328
-2,495
55
62
-7
1,299
1,356
-57
3,027
1,996
1,031
11,005
9,020
1,985
887
772
115
4,309
4,044
265
462
372
90
4,585
4,149
436
6,886
9,349
-2,463
9,044
7,304
1,740
6,466
6,405
61
269
250
19
1,084
1,056
28
904
1,413
-509
1,345
938
407
3,139
3,055
84
2,397
1,559
838
786
734
52
50,356
50,356
3,068
2,313
755
2,557
2,126
431
3,662
2,995
667
5,583
3,161
2,422
893
882
11
991
712
279
611
925
-314
6,759
6,476
283
8,347
8,029
318
942
569
373
9,056
10,574
-1,518
1,638
2,051
-413
2,232
1,796
436
3,017
2,208
809
2,155
1,912
243
1,355
1,311
44
52,159
48,911
3,248
835
575
260
2,377
2,113
264
1,233
569
664
3,400
3,077
323
2,379
3,029
-650
913
908
5
783
1,233
-450
827
630
197
1,376
1,261
115
1,744
1,685
59
9,394
10,816
-1,422
579
579
1,144
1,006
138
1,564
1,165
399
2,588
2,113
475
1,790
1,525
265
2,565
3,024
-459
1,612
1,921
-309
1,762
1,479
283
2,029
1,487
542
876
602
274
4,401
4,061
340
1,233
1,193
40
2,237
3,530
-1,293
7,293
6,315
978
1,102
1,122
-20
979
1,211
-232
1,693
2,008
-315
27
27
1,882
1,858
24
1,134
569
565
1,366
1,134
232
1,456
1,429
27
2,645
3,072
-427
1,167
1,101
66
1,251
1,290
-39
1,693
2,221
-528
1,477
1,427
50
3,242
2,301
941
981
829
152
615
986
-371
52,274
52,274
2,135
1,990
145
1,268
1,538
-270
864
1,118
-254
747
683
64
1,354
929
425
859
755
104
4,548
4,489
59
4,752
4,445
307
848
603
245
1,901
1,365
536
2,376
2,161
215
1,846
1,706
140
2,456
1,754
702
2,041
1,854
187
783
1,284
-501
2,536
2,342
194
102
97
5
5,006
5,687
-681
1,185
1,227
-42
1,910
1,568
342
1,341
1,356
-15
1,921
1,951
-30
529
416
113
2,362
2,113
249
1,507
1,220
287
3,084
2,747
337
540,798
555,000
-14,202
1,195
1,193
2
2,260
1,570
690
936
1,223
-287
136,939
150,000
-13,061
1,678
1,637
41
914
1,032
-118
12,671
9,387
3,284
2,827
2,075
752
909
896
13
2,894
2,499
395
3,411
3,341
70
1,404
732
672
2,287
1,913
374
893
686
207
2,087
1,249
838
3,315
4,196
-881
1,677
1,356
321
2,260
1,658
602
1,355
1,201
154
2,455
1,501
954
5,649
8,327
-2,678
1,436
1,363
73
4,301
3,007
1,294
2,798
2,856
-58
2,367
1,532
835
2,136
1,903
233
789
777
12
2,004
1,487
517
168
172
-4
3,547
2,745
802
835
511
324
1,790
2,359
-569
2,861
2,472
389
10,704
7,335
3,369
5,556
5,282
274
5,858
8,737
-2,879
300
441
-141
2,703
1,820
883
1,014
1,280
-266
330
424
-94
2,163
1,612
551
5,305
3,591
1,714
6,832
6,624
208
1,385
1,346
39
1,175
1,174
1
1,252
569
683
3,723
2,943
780
3,282
4,879
-1,597
1,366
1,115
251
3,274
3,367
-93
1,770
894
876
2,022
1,949
73
7,900
7,090
810
2,524
2,468
56
17,233
19,451
-2,218
510
618
-108
1,592
1,797
-205
2,902
1,996
906
7,262
4,741
2,521
1,687
1,525
162
1,318
956
362
1,034
743
291
1,505
1,543
-38
2,249
2,245
4
4,928
4,591
337
2,419
2,126
293
2,008
1,685
323
6,419
5,501
918
3,897
3,506
391
893
909
-16
13,184
13,248
-64
863
1,218
-355
832
734
98
8,886
5,773
3,113
7,360
6,527
833
703
634
69
698
610
88
1,802
1,921
-119
1,191
1,193
-2
2,249
2,113
136
1,281
1,205
76
994
1,118
-124
920
949
-29
114,550
100,000
14,550
9,704
6,035
3,669
10,054
8,990
1,064
3,255
4,289
-1,034
1,168
1,029
139
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
48,225
b
55
c
933
d
900
e
1,548
158
-325
346
985
31
649
-362
2,072
207
101
-1,613
-177
102,294
236
150
1,315
33
-283
103
-142
1,142
31
-27
-27
-422
110
-2,000
-383
71,545
211
214
-144
-774
112
175
174
592
349
1,389
23
-178
-229
42
-681
391
289
87
-2,495
-7
-57
1,031
1,985
115
265
90
436
-2,463
1,740
61
19
28
-509
407
84
838
52
755
431
667
2,422
11
279
-314
283
318
373
-1,518
-413
436
809
243
44
3,248
260
264
664
323
-650
5
-450
197
115
59
-1,422
579
138
399
475
265
-459
-309
283
542
274
340
40
-1,293
978
-20
-232
-315
27
24
565
232
27
-427
66
-39
-528
50
941
152
-371
145
-270
-254
64
425
104
59
307
245
536
215
140
702
187
-501
194
5
-681
-42
342
-15
-30
113
249
287
337
-14,202
2
690
-287
-13,061
41
-118
3,284
752
13
395
70
672
374
207
838
-881
321
602
154
954
-2,678
73
1,294
-58
835
233
12
517
-4
802
324
-569
389
3,369
274
-2,879
-141
883
-266
-94
551
1,714
208
39
1
683
780
-1,597
251
-93
876
73
810
56
-2,218
-108
-205
906
2,521
162
362
291
-38
4
337
293
323
918
391
-16
-64
-355
98
3,113
833
69
88
-119
-2
136
76
-124
-29
14,550
3,669
1,064
-1,034
139
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
257,295
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
3,606
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
410,446
6,576,648
0.062410
2017
289,791
6,546,019
0.044270
2016
275,992
6,274,517
0.043986
2015
181,450
6,749,826
0.026882
2014
284,185
6,886,369
0.041268
2
Total
of line 1, column (d)
.....................
2
0.218816
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
0.043763
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
6,540,106
5
Multiply line 4 by line 3
......................
5
286,215
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
3,350
7
Add lines 5 and 6
........................
7
289,565
8
Enter qualifying distributions from Part XII, line 4
,.............
8
409,341
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
3,350
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
3
Add lines 1 and 2
...........................
3
3,350
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
3,350
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
2,588
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
2,000
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
4,588
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
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
1,238
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
1,238
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(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)
GA
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
MARY BETH GRENNER CPA
Telephone no.
(770) 886-0334
Located at
104 COLONY PARK DR 100
CUMMING
GA
ZIP+4
30040
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
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
MARY J SHANNON
C/O MARY BETH GRENNER CPA LLC
DIRECTOR
10.00
0
0
0
104 COLONY PARK DR 100
CUMMING
,
GA
30040
DAVID D SHANNON
C/O MARY BETH GRENNER CPA LLC
DIRECTOR
10.00
25,000
0
0
104 COLONY PARK DR 100
CUMMING
,
GA
30040
LIAM SHANNON
DIRECTOR
10.00
25,000
0
0
104 COLONY PARK DR 100
CUMMING
,
GA
30040
EAMON SHANNON
DIRECTOR
10.00
25,000
0
0
104 COLONY PARK DR 100
CUMMING
,
GA
30040
BRETTANY SHANNON
DIRECTOR
10.00
25,000
0
0
104 COLONY PARK DR 100
CUMMING
,
GA
30040
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
...................
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
.............
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
6,498,798
b
Average of monthly cash balances
.......................
1b
140,904
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
6,639,702
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
2
Acquisition indebtedness applicable to line 1 assets
..................
2
3
Subtract line 2 from line 1d
.........................
3
6,639,702
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
99,596
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
6,540,106
6
Minimum investment return.
Enter 5% of line 5
..................
6
327,005
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
327,005
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
3,350
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
3,350
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
323,655
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
323,655
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
323,655
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
409,341
b
Program-related investments—total from Part IX-B
..................
1b
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
409,341
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
3,350
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
405,991
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
323,655
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
c
From 2016
......
d
From 2017
......
e
From 2018
......
55,102
f
Total
of lines 3a through e
........
55,102
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
409,341
a
Applied to 2018, but not more than line 2a
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
d
Applied to 2019 distributable amount
.....
323,655
e
Remaining amount distributed out of corpus
85,686
5
Excess distributions carryover applied to 2019.
(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
140,788
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
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
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
140,788
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
55,102
e
Excess from 2019
....
85,686
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).)
PHILIP SHANNON JR
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
AMERICAN CIVIL LIBERTIES UNION FOUN
125 BROAD STREET
18TH FL
NEW YORK
,
NY
10004
N/A
509(A)
CIVIL LIBERTIES
1,000
ATLANTA COMMUNITY FOOD BANK
732 JOSEPH E LOWEREY BLVD
ATLANTA
,
GA
30318
N/A
509(A)
HUNGER
5,000
ATLANTA HUMANE SOCIETY
981 HOWELL MILL ROAD NW
ATLANTA
,
GA
30318
N/A
509(A)
PREVENT ANIMAL CRUELTY
1,000
ATLANTA JUNIOR ROWING ASSOC
PO BOX 126
ROSWELL
,
GA
30077
N/A
509(A)
PROVIDE ROWING OPPORTUNITIES
5,000
CENTER FOR REPRODUCTIVE RIGHTS
199 WATER STREET
22ND FL
NEW YORK
,
NY
10038
N/A
509(A)
HUMAN RIGHTS
1,500
CRISTO REY ATLANTA JESUIT HIGH SCHO
222 PIEDMONT AVE NE
ATLANTA
,
GA
30308
N/A
509(A)
EDUCATION
5,000
CUMBERLAND ACADEMY OF GEORGIA
650 A MOUNT VERNON HWY NE
ATLANTA
,
GA
30328
N/A
509(A)
EDUCATION
3,000
DICKINSON COLLEGE
PO BOX 1773
CARLISLE
,
PA
17013
N/A
509(A)
EDUCATION
1,000
DOCTORS WITHOUT BORDERS USA
333 7TH AVENUE 2ND FLOOR
NEW YORK
,
NY
10001
N/A
509(A)
EMERGENCY CARE
1,000
DOWNTOWN WOMEN'S CENTER
442 S SAN PEDRO ST
LOS ANGELES
,
CA
90013
N/A
509(A)
END HOMELESSNESS FOR WOMEN
1,000
DRAKE HOUSE
10500 CLARA DR
ROSWELL
,
GA
30075
N/A
509(A)
AFFORDABLE HOUSING
10,000
ECHO PARK FILM CENTER
1200 N ALVARADO ST
LOS ANGELES
,
CA
90026
N/A
509(A)
PROVIDE NEIGHBORHOOD MICROCINEMA
1,000
EMORY UNIVERSITY
1762 CLIFTON ROAD NE
SUITE 1400
ATLANTA
,
GA
303224001
N/A
509(A)
EDUCATION
10,000
ENVIRONMENT DEFENSE ACTION FUND
1875 CONNECTICUT AVE NW
SUITE 600
WASHINGTON
,
DC
20009
N/A
509(A)
ENVIRONMENT
5,000
FISHERMAN'S COMMUNITY HOSPITAL
3301 OVERSEAS HIGHWAY
MARATHON
,
FL
33050
N/A
509(A)
REBUILD HOSPITAL AFTER HURRICANE
5,000
FREEWAVES
6522 HOLLYWOOD BLVD
LOS ANGELES
,
CA
90028
N/A
509(A)
OUT THE WINDOW PROJECT
5,250
FRIENDS OF THE LOS ANGELES RIVER
570 W AVENUE 26 250
LOS ANGELES
,
CA
90065
N/A
509(A)
ENVIRONMENTAL PROTECTION
1,000
GOD'S LOVE WE DELIVER
166 AVENUE OF THE AMERICA
NEW YORK
,
NY
10013
N/A
509(A)
MEALS TO HOMEBOUND
4,000
GREY NUNS OF THE SACRED HEART
ATTN EILEEN DICKERSON
1750 QUARY ROAD
YARDLEY
,
PA
19067
N/A
509(A)
NURSING HOME
3,000
HENRY MILLER LIBRARY
48603 HIGHWAY ONE
BIG SUR
,
CA
93920
N/A
509(A)
LIBRARY
500
HOMEBOY INDUSTRIES
DEVELOPMENT OFFICE
130 W BRUNO STREET
LOS ANGELES
,
CA
90012
N/A
509(A)
PREVENTION OF GANG LIFE
1,000
INTERNATIONAL REFUGEE ASSISTANCE PR
URBAN JUSTICE CENTER
40 RECTOR STREET 9TH FLO
NEW YORK
,
NY
10006
N/A
509(A)
HUMAN RIGHTS FOR REFUGEES
1,000
LEGAL OUTREACH
36-14 35TH STREET
LONG ISLAND CITY
,
NY
11106
N/A
509(A)
LAW RELATED EDUCATIONAL ASSIST
5,000
LOS ANGELES SPCA
5026 WEST JEFFERSON BOULE
LOS ANGELES
,
CA
90016
N/A
509(A)
SPAYING CATS
1,000
LOS ANGELES WALKS
2351 SILVER RIDGE AVE
LOS ANGELES
,
CA
90039
N/A
509(A)
SAFETY AND COMMUNITY DEVELOPMENT
1,000
MALDEF
634 S SPRING STREET
11TH FLOOR
LOS ANGELES
,
CA
90014
N/A
509(A)
LATINO CIVIL RIGHTS
1,000
MERCY CARE FOUNDATION
5134 PEACHTREE ROAD
CHAMBLEE
,
GA
30341
N/A
509(A)
HEALTHCARE FOR HOMELESS
5,000
MOTE MARINE LABORATORY AND AQUARIUM
1600 KEN THOMPSON PARKWAY
SARASOTA
,
FL
34236
N/A
509(A)
CORAL REEF RESTORATION
15,000
MY FRIEND'S PLACE
PO BOX 3867
HOLLYWOOD
,
CA
90078
N/A
509(A)
SERVICES FOR HOMELESS TEENS
2,000
NAACP LEGAL DEFENSE FUND
40 RECTOR ST -5TH FLOOR
NEW YORK
,
NY
10006
N/A
509(A)
LEGAL DEFENSE AND EDUCATIONAL FUND
2,000
NATIONAL IMMIGRATION LAW CENTER
3450 WILSHIRE BLVD
108-62
LOS ANGELES
,
CA
90010
N/A
509(A)
PROTECT RIGHTS OF IMMIGRANTS WITH LO
1,000
NATURAL RESOURCES DEFENSE COUNCIL
40 WEST 20TH
11TH FLOOR
NEW YORK
,
NY
10011
N/A
509(A)
ENVIRONMENTAL PROTECTION
1,000
NATURAL RESOURCES DEFENSE COUNCIL
40 WEST 20TH
11TH FLOOR
NEW YORK
,
NY
10011
N/A
509(A)
ENVIRONMENTAL PROTECTION
5,000
ONSTAGE ATLANTA INC
2969 E PONCE DE LEON AVE
DECATUR
,
GA
30030
N/A
509(A)
PROMOTING ARTS IN COMMUNITY
7,000
PAIDEIA SCHOOL
ATTN DEVELOPMENT
1509 PONCE DE LEON AVENUE
ATLANTA
,
GA
30307
N/A
509(A)
EDUCATION
7,000
PALAMA SETTLEMENT
810 N VINEYARD BLVD
HONOLULU
,
HI
96817
N/A
509(A)
SOCIAL WORK IN HI
54,000
PARA LA NATURALEZA
PO BOX 9023554
SAN JUAN
,
PR
00902
N/A
509(A)
CONSERVATION OF NATURAL ECOSYSTEM
4,000
PLANNED PARENTHOOD
123 WILLIAM ST 10TH FL
NEW YORK
,
NY
10038
N/A
509(A)
HEALTH CARE
1,000
PLANNED PARENTHOOD
123 WILLIAM ST 10TH FL
NEW YORK
,
NY
10038
N/A
509(A)
HEALTH CARE
4,000
PLANNED PARENTHOOD
123 WILLIAM ST 10TH FL
NEW YORK
,
NY
10038
N/A
509(A)
HEALTH CARE
5,000
PROPUBLICA
155 AVENUE OF THE AMERICA
13TH FLOOR
NEW YORK
,
NY
10013
N/A
509(A)
INVESTIGATIVE JOURNALISM IN PUBLIC I
2,000
SAVE THE HORSES
PO BOX 1123
BALL GROUND
,
GA
30107
N/A
509(A)
ANIMAL RESCUE
5,000
SISTERS OF NOTRE DAME DE NAMUR
TRI-PROVINCE DEVELOPMENT
PO BOX 157
STEVENSON
,
MD
21153
N/A
509(A)
ASSIST RETIRED AND INFIRMED NUNS
3,000
ST VINCENT DE PAUL
ST PETER CHANEL CHURCH
11330 WOODSTOCK RD
ROSWELL
,
GA
30075
N/A
509(A)
EMERGENCY FINANCIAL ASSISTANCE
5,000
THE DRESSAGE FOUNDATION
1314 O ST
SUITE 305
LINCOLN
,
NE
68508
N/A
509(A)
ADVANCEMENT OF DRESSAGE IN US
4,000
THE MARK D HOUSTON MEMORIAL FUND
11503 PARSONS RD
MANOR
,
TX
78653
N/A
509(A)
ADDICTION TREAMENT
10,000
THE MOJAVE DESERT LAND TRUST
61732 TWENTYNINE PALMS HW
JOSHUA TREE
,
CA
92252
N/A
509(A)
LAND PRESERVATION
1,000
THE PLACE OF FORSYTH COUNTY INC
2550 THE PLACE CIRCLE
CUMMING
,
GA
30040
N/A
509(A)
EMERGENCY ASSISTANCE
15,000
THE TREVOR PROJECT
ATTN DEVELOPMENT
PO BOX 69232
WEST HOLLYWOOD
,
CA
90069
N/A
509(A)
SUPPORT PROJECT FOR LGBT YOUTH
1,000
THE TREVOR PROJECT
ATTN DEVELOPMENT
PO BOX 69232
WEST HOLLYWOOD
,
CA
90069
N/A
509(A)
SUPPORT PROJECT FOR LGBT YOUTH
2,000
THEATRE ARTS STUDIO
4848 E CACTUS RD
SUITE 406
SCOTTSDALE
,
AZ
85254
N/A
509(A)
ENRICH CULTURAL LIFE OF THE COMMUNIT
5,000
THORNE
1240 ROSECRANS AVE
SUITE 120
MANHATTAN BEACH
,
CA
90266
N/A
509(A)
COMBAT ONLINE CHILD SEXUAL ABUSE
1,000
TRINITY WASHINGTON UNIVERSITY
DBA TRINITY WASHINGTON UN
125 MICHIGAN AVE NE
WASHINGTON
,
DC
20017
N/A
509(A)
EDUCATION
40,000
TRINITY WASHINGTON UNIVERSITY
DBA TRINITY WASHINGTON UN
125 MICHIGAN AVE NE
WASHINGTON
,
DC
20017
N/A
509(A)
EDUCATION
5,000
TRINITY WASHINGTON UNIVERSITY
DBA TRINITY WASHINGTON UN
125 MICHIGAN AVE NE
WASHINGTON
,
DC
20017
N/A
509(A)
EDUCATION
40,000
UNIVERSITY OF GEORGIA
221 PARK HALL
ATHENS
,
GA
30602
N/A
509(A)
EDUCATION
6,000
UNIVERSITY OF SOUTHERN CALIFORNIA
UNIVERSITY PARK CAMPUS
ADM 160 MC 4017
LOS ANGELES
,
CA
900894017
N/A
509(A)
EDUCATION
4,250
VANDERBILT UNIVERSITY
PMB 407727
NASHVILLE
,
TN
372407727
N/A
509(A)
EDUCATION
7,500
WATERKEEPER ALLIANCE
180 MAIDEN LANE
STE 603
NEW YORK
,
NY
10038
N/A
509(A)
DEDICATED TO CLEAN WATER
1,000
Total
.................................
3a
350,000
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
...........
14
28,313
4
Dividends and interest from securities
....
14
91,336
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
............
257,295
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)
..
119,649
257,295
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
376,944
(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