-
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
GARY AND MARY WEST FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
505 LOMAS SANTA FE DRIVE SUITE 230
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
SOLANA BEACH
,
CA
92075
A Employer identification number
47-0793015
B
Telephone number (see instructions)
(858) 369-3160
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)
$
145,102,325
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)
6,403,198
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
6,647,245
6,647,245
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
1,447,033
b
Gross sales price for all assets on line 6a
9,538,910
7
Capital gain net income (from Part IV, line 2)
...
1,447,033
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)
.......
531,901
531,901
12
Total.
Add lines 1 through 11
........
15,029,377
8,626,179
13
Compensation of officers, directors, trustees, etc.
518,475
72,213
505,146
14
Other employee salaries and wages
......
645,273
170,873
366,828
15
Pension plans, employee benefits
.......
166,968
27,670
107,429
16a
Legal fees (attach schedule)
.........
42,782
5,594
25,510
b
Accounting fees (attach schedule)
.......
40,826
20,413
18,712
c
Other professional fees (attach schedule)
....
1,860,100
616,269
1,161,041
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
139,136
12,122
45,346
19
Depreciation (attach schedule) and depletion
...
154,416
38,604
20
Occupancy
..............
144,816
36,204
126,011
21
Travel, conferences, and meetings
.......
174,074
22,813
162,278
22
Printing and publications
..........
3,429
857
2,566
23
Other expenses (attach schedule)
.......
213,144
34,578
180,621
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
4,103,439
1,058,210
2,701,488
25
Contributions, gifts, grants paid
.......
10,731,809
11,085,100
26
Total expenses and disbursements.
Add lines 24 and 25
14,835,248
1,058,210
13,786,588
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
194,129
b
Net investment income
(if negative, enter -0-)
7,567,969
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
.............
357,973
417,560
417,560
2
Savings and temporary cash investments
.........
30,468,662
30,102,216
30,102,216
3
Accounts receivable
366,073
Less: allowance for doubtful accounts
340,565
366,073
366,073
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
..........
1,159,736
1,074,422
1,074,422
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
77,077,275
80,817,661
80,817,661
c
Investments—corporate bonds (attach schedule)
.......
2,998,091
2,556,573
2,556,573
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
25,637,867
26,021,142
26,021,142
14
Land, buildings, and equipment: basis
945,782
Less: accumulated depreciation (attach schedule)
757,150
334,667
188,632
188,632
15
Other assets (describe
)
1,741,088
3,558,046
3,558,046
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
140,115,924
145,102,325
145,102,325
17
Accounts payable and accrued expenses
..........
576,981
652,830
18
Grants payable
.................
1,428,674
1,388,818
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
)
800
65,500
23
Total liabilities
(add lines 17 through 22)
.........
2,006,455
2,107,148
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
138,109,469
142,995,177
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)
.....
138,109,469
142,995,177
30
Total liabilities and net assets/fund balances
(see instructions)
.
140,115,924
145,102,325
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
138,109,469
2
Enter amount from Part I, line 27a
.....................
2
194,129
3
Other increases not included in line 2 (itemize)
3
4,691,579
4
Add lines 1, 2, and 3
..........................
4
142,995,177
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
142,995,177
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
ARIAS RESOURCE CAPITAL
P
2010-12-31
2019-02-28
b
BLUE RIVER ARBITRAGE
P
2008-03-03
2019-10-31
c
BOND - ELM PARK ADVANTEDGE
P
2017-07-31
2019-12-31
d
BOND - WBB TERM LOAN
P
2017-11-30
2019-11-30
e
ELM PARK CREDIT OPP FUND II
P
2016-10-31
2019-10-31
ELM PARK CREDIT III
P
2018-12-31
2019-10-31
EMERGING EUROPE
P
2008-06-13
2019-12-31
ETON PARK OVERSEAS FUND
P
2007-08-31
2019-10-31
FORTRESS MSR
P
2012-12-31
2019-12-31
GREEN COURT PARTNERS III
P
2011-12-30
2019-08-31
GS MIDDLE MARKET LENDING CORP
P
2017-07-31
2019-05-31
KAYNE ANDERSON RE DEBT
P
2018-02-28
2019-12-31
MARATHON EUROPEAN CREDIT
P
2014-04-30
2019-11-30
OAKTREE RE DEBT FUND CAYMAN
P
2015-10-31
2019-12-31
OAKTREE RE DEBT II FEED CAYMAN
P
2017-05-31
2019-09-30
OHA EUROPEAN SCF OFFSHORE
P
2014-05-31
2019-10-31
OHA SCF PARALLEL
P
2011-12-30
2019-12-31
OLEA SPECIAL OPP
P
2018-09-30
2019-09-30
PUBLICLY TRADED SECURITIES
SCG ATLAS
P
2016-01-31
2019-09-30
STARWOOD OPPORTUNITY FUND
P
2016-01-31
2019-12-31
SUMMIT WATER DEVELOPMENT
P
2011-12-30
2019-09-30
VWH OFFSHORE FUND LP
P
2018-03-31
2019-03-31
(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
163,311
57,535
105,776
b
2,519,045
2,363,154
155,891
c
68,757
68,757
0
d
323,644
323,644
0
e
68,112
68,112
0
3,889
3,889
0
204,908
87,295
117,613
1,217
1,217
0
54,613
54,613
0
678,341
678,341
0
110,931
110,931
0
164,799
163,916
883
33,935
16,508
17,427
283,442
283,442
0
15,281
15,281
0
52,789
52,789
0
48,071
48,071
547,001
547,001
0
3,958,455
2,905,965
1,052,490
45,409
45,409
0
35,568
35,568
0
33,025
84,143
-51,118
124,367
124,367
0
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
105,776
b
155,891
c
0
d
0
e
0
0
117,613
0
0
0
0
883
17,427
0
0
0
48,071
0
1,052,490
0
0
-51,118
0
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
1,447,033
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
19,039,931
149,575,032
0.127294
2017
11,725,472
153,244,653
0.076515
2016
14,755,876
124,845,664
0.118193
2015
10,169,809
127,289,606
0.079895
2014
26,675,168
144,477,442
0.184632
2
Total
of line 1, column (d)
.....................
2
0.586529
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
0.117306
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
139,795,937
5
Multiply line 4 by line 3
......................
5
16,398,902
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
75,680
7
Add lines 5 and 6
........................
7
16,474,582
8
Enter qualifying distributions from Part XII, line 4
,.............
8
16,346,528
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
151,359
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
151,359
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
151,359
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
185,302
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
185,302
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
33,943
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
33,943
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
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)
CA
,
NE
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
Yes
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
WWW.GMWF.ORG
14
The books are in care of
SHELLEY LYFORD
Telephone no.
(858) 369-3160
Located at
505 LOMAS SANTA FE DRIVE 230
SOLANA BEACH
CA
ZIP+4
92075
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
No
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
GARY L WEST
CO-CHAIRMAN
2.00
0
0
0
505 LOMAS SANTA FE DRIVE SUITE 230
SOLANA BEACH
,
CA
92075
MARY E WEST
CO-CHAIRMAN
2.00
0
0
0
505 LOMAS SANTA FE DRIVE SUITE 230
SOLANA BEACH
,
CA
92075
SHELLEY LYFORD
PRESIDENT, CEO, & TREASURE
20.00
288,850
18,689
0
505 LOMAS SANTA FE DRIVE SUITE 230
SOLANA BEACH
,
CA
92075
MARC HARPER
DIRECTOR & SECRETARY
2.00
0
0
0
505 LOMAS SANTA FE DRIVE SUITE 230
SOLANA BEACH
,
CA
92075
TIM LASH
EXECUTIVE VICE PRESIDENT
20.00
178,375
11,700
0
505 LOMAS SANTA FE DRIVE SUITE 230
SOLANA BEACH
,
CA
92075
DR ZIA AGHA
CHIEF MEDICAL OFFICER
8.00
51,250
0
0
505 LOMAS SANTA FE DRIVE SUITE 230
SOLANA BEACH
,
CA
92075
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
JOHN LITTLE
DIRECTOR OF FINANCE
35.00
178,914
29,339
0
505 LOMAS SANTA FE DRIVE SUITE 230
SOLANA BEACH
,
CA
92075
LINDSAY GOLDSMITH
SENIOR ACCOUNTANT
40.00
127,050
8,967
0
505 LOMAS SANTA FE DRIVE SUITE 230
SOLANA BEACH
,
CA
92075
VYAN NGUYEN
PROGRAM OFFICER
30.00
118,800
10,993
0
505 LOMAS SANTA FE DRIVE SUITE 230
SOLANA BEACH
,
CA
92075
BRENDA SCHMITTHENNER
PROGRAM OFFICER
20.00
93,350
21,998
0
505 LOMAS SANTA FE DRIVE SUITE 230
SOLANA BEACH
,
CA
92075
LEXY HARSHMAN
OPERATIONS MANAGER
40.00
99,729
12,469
0
505 LOMAS SANTA FE DRIVE SUITE 230
SOLANA BEACH
,
CA
92075
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
WEST FAMILY INVESTMENTS INC
INVESTMENT MANAGEMENT
533,615
1603 ORRINGTON SUITE 810
EVANSTON
,
IL
60201
WEST MANAGEMENT COMPANY INC
ADVOCACY AND ADMINISTRATION
526,111
5800 ARMADA DRIVE SUITE 100
CARLSBAD
,
CA
92008
PCE CONSULTING LLC
ACUTE CARE ADVOCACY
268,800
5500 PRESTON ROAD SUITE 250
DALLAS
,
TX
75205
COMMUNICATION PARTNERS & ASSOCIATES LLC
ADVOCACY AND MEDIA OUTREACH
95,000
250 GREENWICH ST SUITE 4620
NY
,
NY
10007
WATERFORD LIFE SCIENCES TOTAL
ADVOCACY COMMUNICATIONS
86,400
1666 CONNECTICUT AVE NW SUITE 500
WASHINGTON
,
DC
20009
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
A MULTI-DIMENSIONAL RESEARCH PROJECT TO: 1) CREATE A MODEL FOR CARE COORDINATION AT A LOW-INCOME SENIOR WELLNESS CENTER BETWEEN VARIOUS CO-LOCATED NON-PROFIT ORGANIZATIONS AND PRIMARY CARE PHYSICIANS; 2) USE THE COORDINATED SYSTEM TO RESEARCH IMPACT OF PARTICIPATING SERVICES ON THE HEALTH OUTCOMES OF SENIORS, 3) FINDINGS MAY BE USED TO REPLICATE SIMILAR SERVICE MODELS IN OTHER COMMUNITIES.
32,800
2
ADVOCATE FOR HEALTH CARE INTERESTS OF OLDER ADULTS THROUGH OUTREACH TO MEDIA, POLICY MAKERS AND EXECUTIVES IN HEALTH CARE AND INSURANCE. IN PARTICULAR, GUIDE RESEARCH AND ADVOCACY TO IMPLEMENT TELEHEALTH IN SENIOR COMMUNITIES AND REDUCE UNNECESSARY EMERGENCY DEPARTMENT TRANSFERS. ADVOCACY AND RESEARCH IS CONDUCTED WITH THE GOAL OF BETTER CARE, WHEN NEEDED, AT LOWER COSTS TO THE PAYOR.
341,759
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
THE FOUNDATION'S PROGRAM-RELATED INVESTMENT IS COMPRISED OF A CREDIT AGREEMENT TO CIVICA, A NON-PROFIT ORGANIZATION, WITH BORROWINGS AVAILABLE UP TO $9,000,000. ADVANCES UNDER THE CREDIT AGREEMENT BEAR INTEREST AT 5.00% PER ANNUM, WITH PRINCIPAL AND INTEREST DUE AUGUST 2030. ADVANCES UNDER THE CREDIT AGREEMENT WERE $2,559,940, INCLUDING PAYMENT IN KIND INTEREST OF $24,729 IN 2019. SEE PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY STATEMENT FOR ADDITIONAL INFORMATION.
2,559,940
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
2,559,940
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
110,004,696
b
Average of monthly cash balances
.......................
1b
28,818,468
c
Fair market value of all other assets (see instructions)
................
1c
3,101,645
d
Total
(add lines 1a, b, and c)
.........................
1d
141,924,809
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
141,924,809
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
2,128,872
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
139,795,937
6
Minimum investment return.
Enter 5% of line 5
..................
6
6,989,797
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
6,989,797
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
151,359
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
151,359
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
6,838,438
4
Recoveries of amounts treated as qualifying distributions
................
4
328,729
5
Add lines 3 and 4
............................
5
7,167,167
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
7,167,167
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
13,786,588
b
Program-related investments—total from Part IX-B
..................
1b
2,559,940
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
16,346,528
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b. See instructions
.................
5
0
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
16,346,528
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
7,167,167
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
0
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
19,573,324
b
From 2015
......
3,946,700
c
From 2016
......
8,651,201
d
From 2017
......
4,448,144
e
From 2018
......
11,616,167
f
Total
of lines 3a through e
........
48,235,536
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
16,346,528
a
Applied to 2018, but not more than line 2a
0
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2019 distributable amount
.....
7,167,167
e
Remaining amount distributed out of corpus
9,179,361
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
57,414,897
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
19,573,324
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
37,841,573
10
Analysis of line 9:
a
Excess from 2015
....
3,946,700
b
Excess from 2016
....
8,651,201
c
Excess from 2017
....
4,448,144
d
Excess from 2018
....
11,616,167
e
Excess from 2019
....
9,179,361
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).)
GARY L WEST
MARY E WEST
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 SOCIETY ON AGING
575 MARKET STREET SUITE 2100
SAN FRANCISCO
,
CA
941052869
NONE
PC
TO SUPPORT THE 2020 WEST HEALTH POLICY SUMMIT FOCUSED ON HEALTHCARE COSTS DURING THE 2020 AGING IN AMERICA CONFERENCE.
25,000
CALIFORNIA FOUNDATION ON AGING
1310 AVENIDA SEBASTIANI
SONOMA
,
CA
95476
NONE
PC
TO SUPPORT THE CREATION OF A WHITE PAPER WITH RECOMMENDATIONS TO INFORM THE MASTER PLAN FOR AGING.
3,000
CHALLENGE CENTER
5540 LAKE PARK WAY
LA MESA
,
CA
91942
NONE
PC
TO SUPPORT THE HEALTH, WELLNESS, AND INDEPENDENCE INITIATIVE FOR SENIORS.
37,500
CHALLENGE CENTER
5540 LAKE PARK WAY
LA MESA
,
CA
91942
NONE
PC
TO SUPPORT THE HEALTH, WELLNESS, AND INDEPENDENCE INITIATIVE FOR SENIORS WITH FALLS CLASS PROGRAM DEVELOPMENT AND PILOT.
40,000
GARY AND MARY WEST HEALTH POLICY CENTER INC
1909 K ST NW SUITE 730
WASHINGTON
,
DC
20006
NONE
POF
TO SUPPORT AND DEVELOP INNOVATIVE HEALTHCARE DELIVERY MODELS AND ALTERNATIVE PAYMENT MODELS TO IMPROVE CARE AND ACCESS FOR SENIORS.
6,140,000
GARY AND MARY WEST SENIOR DENTAL CENTER INC
1525 4TH AVENUE
SAN DIEGO
,
CA
92101
NONE
PC
CAPITAL GRANT FOR START UP CONSTRUCTION AND DENTAL EQUIPMENT AT SAN MARCOS OUTPATIENT DENTAL CLINIC.
950,000
GARY AND MARY WEST SENIOR DENTAL CENTER INC
1525 4TH AVENUE
SAN DIEGO
,
CA
92101
NONE
PC
TO PROVIDE ORAL HEALTHCARE FOR PACE AND COMMUNITY SENIORS IN AN INTEGRATED, COMMUNITY-BASED MODEL OF CARE AT THE SAN MARCOS OUTPATIENT DENTAL CLINIC.
314,325
GARY AND MARY WEST SENIOR DENTAL CENTER INC
1525 4TH AVENUE
SAN DIEGO
,
CA
92101
NONE
PC
TO PROVIDE LOW-INCOME SENIORS WITH ORAL HEALTHCARE THROUGH AN INTEGRATED, COMMUNITY-BASED MODEL OF CARE AT THE DOWNTOWN SAN DIEGO OUTPATIENT DENTAL CLINIC.
1,084,161
GARY AND MARY WEST SENIOR DENTAL CENTER INC
1525 4TH AVENUE
SAN DIEGO
,
CA
92101
NONE
PC
CAPITAL GRANT TO INCREASE ACCESS TO DENTAL CARE AND EFFICIENCY AT THE DOWNTOWN SAN DIEGO OUTPATIENT DENTAL CLINIC.
200,000
GENERATIONS UNITED INC
25 EAST STREET NW 3RD FLOOR
WASHINGTON
,
DC
20001
NONE
PC
TO SUPPORT THE 2019 STRATEGIC PLAN.
20,000
GENERATIONS UNITED INC
25 EAST STREET NW 3RD FLOOR
WASHINGTON
,
DC
20001
NONE
PC
TO SUPPORT GRANDDORM INTERGENERATIONAL HOUSING PILOT.
15,000
GRANTMAKERS IN AGING
901 NORTH GLEBE ROAD SUITE 200
ARLINGTON
,
VA
22203
NONE
PC
TO SUPPORT GRANTMAKERS IN AGING LEADERSHIP.
7,500
GRANTMAKERS IN HEALTH
1100 CONNECTICUT AVENUE NW SUITE
1200
WASHINGTON
,
DC
200364110
NONE
PC
TO SUPPORT GENERAL OPERATIONS.
11,500
INTERCULTURAL SENIOR CENTER
5545 CENTER STREET
OMAHA
,
NE
68106
NONE
PC
TO SUPPORT CASE MANAGEMENT SERVICES, TRANSPORTATION, AND INTERPRETATION.
25,000
INTERCULTURAL SENIOR CENTER
5545 CENTER STREET
OMAHA
,
NE
68107
NONE
PC
TO SUPPORT CORE OPERATIONS INCLUDING SOCIAL WORK, HEALTH AND WELLNESS PROGRAMS, AND TRANSPORTATION SERVICES.
30,000
INTERFAITH COMMUNITY SERVICES INC
550 WEST WASHINGTON AVENUE SUITE B
ESCONDIDO
,
CA
92025
NONE
PC
TO SUPPORT CASE MANAGEMENT, HEALTH NAVIGATION, AND NUTRITION SERVICES.
50,000
INTERFAITH COMMUNITY SERVICES INC
550 WEST WASHINGTON AVENUE SUITE B
ESCONDIDO
,
CA
92025
NONE
PC
TO SUPPORT CASE MANAGEMENT, HEALTH NAVIGATION, AND NUTRITION SERVICES.
37,500
LEGAL AID SOCIETY OF SAN DIEGO INC
110 SOUTH EUCLID AVENUE
SAN DIEGO
,
CA
92114
NONE
PC
TO SUPPORT BENEFITS COUNSELING AND COMPUTER LAB FOR SENIORS.
133,000
MEALS ON WHEELS AMERICA
1550 CRYSTAL DRIVE NO 1004
ARLINGTON
,
VA
22202
NONE
PC
TO SUPPORT HEALTHCARE INFRASTRUCTURE AND INNOVATION PROJECT.
112,500
MEALS-ON-WHEELS GREATER SAN DIEGO
2254 SAN DIEGO AVENUE SUITE 200
SAN DIEGO
,
CA
92110
NONE
PC
TO SUPPORT CHANGE OF CONDITION MONITORING AND CARE NAVIGATION PROJECT.
56,000
MERRYMAKERS ASSOCIATION
12020 SHAMROCK PLAZA SUITE 200
OMAHA
,
NE
68154
NONE
PC
TO PROVIDE LIVE MUSIC THERAPY AND ENTERTAINMENT TO SENIORS.
16,800
NATIONAL FOUNDATION OF DENTISTRY FOR THE HANDICAPPED
1800 15TH STREET SUITE 100
DENVER
,
CO
80202
NONE
PC
TO SUPPORT SAN DIEGO COUNTY DONATED DENTAL SERVICES PROGRAM.
25,000
OMAHA COMMUNITY FOUNDATION
3555 FARNAM STREET SUITE 222
OMAHA
,
NE
68131
NONE
PC
TO SUPPORT DONOR ADVISED FUND.
534,750
OUTLOOK NEBRASKA INC
4125 S 72ND STREET
OMAHA
,
NE
68127
NONE
PC
TO SUPPORT ADAPTIVE TECHNOLOGY TRAINING FOR SENIORS WITH VISION LOSS.
30,000
OUTLOOK NEBRASKA INC
4125 S 72ND STREET
OMAHA
,
NE
68127
NONE
PC
TO SUPPORT ADAPTIVE TECHNOLOGY TRAINING FOR VISUALLY-IMPAIRED SENIORS.
30,000
PROJECT HOUSEWORKS
2316 SOUTH 24TH STREET
OMAHA
,
NE
68108
NONE
PC
TO SUPPORT SAFETY IMPROVEMENTS AND HOME REPAIRS FOR LOW-INCOME SENIOR HOMEOWNERS.
50,000
PROJECT HOUSEWORKS
2316 SOUTH 24TH STREET
OMAHA
,
NE
68108
NONE
PC
TO SUPPORT HOME REPAIRS FOR SENIORS.
50,000
SAN DIEGO CENTER FOR CHILDREN
3002 ARMSTRONG STREET
SAN DIEGO
,
CA
92111
NONE
PC
TO SUPPORT GENERAL OPERATIONS.
250
SAN DIEGO REGIONAL ECONOMIC DEVELOPMENT FOUNDATION
530 B STREET 7TH FLOOR
SAN DIEGO
,
CA
92101
NONE
PC
TO SUPPORT STEM TALENT AND PROMOTE AGING RESEARCH IN SAN DIEGO.
25,000
SAN DIEGO SENIORS COMMUNITY FOUNDATION
626 TARENTO DRIVE
SAN DIEGO
,
CA
92106
NONE
PC
ORGANIZATIONAL START-UP SUPPORT.
50,000
SAN DIEGO SENIORS COMMUNITY FOUNDATION
626 TARENTO DRIVE
SAN DIEGO
,
CA
92106
NONE
PC
TO SUPPORT SUSTAINABILITY AND DONOR CULTIVATION.
50,000
SERVING SENIORS
525 14TH STREET SUITE 200
SAN DIEGO
,
CA
92101
NONE
PC
TO SUPPORT GARY & MARY WEST SENIOR WELLNESS CENTER OPERATIONS.
157,500
SERVING SENIORS
525 14TH STREET SUITE 200
SAN DIEGO
,
CA
92101
NONE
PC
TO SUPPORT GARY & MARY WEST SENIOR WELLNESS CENTER OPERATIONS.
128,694
SERVING SENIORS
525 14TH STREET SUITE 200
SAN DIEGO
,
CA
92101
NONE
PC
TO SUPPORT GARY & MARY WEST SENIOR WELLNESS CENTER OPERATIONS.
150,000
SERVING SENIORS
525 14TH STREET SUITE 200
SAN DIEGO
,
CA
92101
NONE
PC
TO SUPPORT THE ARTOPIA ART CONTEST, AN ACTIVITY OF SERVING SENIORS' CIVIC ENGAGEMENT GROUP.
700
SERVING SENIORS
525 14TH STREET SUITE 200
SAN DIEGO
,
CA
92101
NONE
PC
TO SUPPORT GARY & MARY WEST SENIOR WELLNESS CENTER OPERATIONS.
50,000
SERVING SENIORS
525 14TH STREET SUITE 200
SAN DIEGO
,
CA
92101
NONE
PC
TO SUPPORT INTEGRATED DENTAL & WELLNESS COORDINATION.
125,000
SERVING SENIORS
525 14TH STREET SUITE 200
SAN DIEGO
,
CA
92101
NONE
PC
FUNDRAISING EVENT.
630
ST JOSEPH'S REGIONAL MEDICAL CENTER
703 MAIN STREET
PATERSON
,
NJ
07503
NONE
PC
TO SUPPORT FUNDRAISING EVENT HONORING DR. MARK ROSENBERG.
8,160
THE SALK INSTITUTE FOR BIOLOGICAL STUDIES
10010 NORTH TORREY PINES ROAD
LA JOLLA
,
CA
92037
NONE
PC
FUNDRAISING EVENT.
630
THE SAN DIEGO FOUNDATION
2508 HISTORIC DECATUR ROAD SUITE
200
SAN DIEGO
,
CA
92106
NONE
PC
TO SUPPORT AGE-FRIENDLY COMMUNITIES INITIATIVE.
25,000
THE SCAN FOUNDATION
3800 KILROY AIRPORT WAY SUITE 400
LONG BEACH
,
CA
90806
NONE
PC
TO SUPPORT THE CALIFORNIA MASTER PLAN FOR AGING PROJECT.
125,000
UNIVERSITY OF CALIFORNIA SAN FRANCISCO
220 MONTGOMERY STREET FIFTH FLOOR
SAN FRANCISCO
,
CA
94104
NONE
PC
TO SUPPORT THE EMERGING LEADERS IN AGING PROGRAM.
50,000
UNIVERSITY OF ROCHESTER
265 CRITTENDEN BOULEVARD CU 420694
ROCHESTER
,
NY
14642
NONE
PC
TO SUPPORT THE 2019 D.HEALTH SUMMIT.
50,000
VOLUNTEERS ASSISTING SENIORS
1941 SOUTH 42ND STREET SUITE 312
OMAHA
,
NE
68105
NONE
PC
TO SUPPORT THE SENIOR BENEFITS COUNSELING PROGRAM.
40,000
VOLUNTEERS ASSISTING SENIORS
1941 SOUTH 42ND STREET SUITE 312
OMAHA
,
NE
68105
NONE
PC
TO SUPPORT GENERAL OPERATIONS.
20,000
Total
.................................
3a
11,085,100
b
Approved for future payment
APPLE TREE DENTAL
2442 MOUNDS VIEW BLVD
MOUNDS VIEW
,
MN
55112
NONE
PC
TO SUPPORT STATE ORAL HEALTH PROGRAMS TO ACTIVELY PARTNER WITH THEIR STATE AGING AND DISABILITY SERVICES AND AREA AGENCIES ON AGING.
49,450
CHALLENGE CENTER
5540 LAKE PARK WAY
LA MESA
,
CA
91942
NONE
PC
TO SUPPORT THE HEALTH, WELLNESS, AND INDEPENDENCE INITIATIVE FOR SENIORS WITH FALLS CLASS PROGRAM DEVELOPMENT AND PILOT.
40,000
CIVICA RX
2912 EXECUTIVE PARKWAY SUITE 325
LEHI
,
UT
84043
NONE
NC
PROGRAM RELATED LOAN COMMITTMENT.
6,464,789
GARY AND MARY WEST SENIOR DENTAL CENTER INC
1525 4TH AVENUE
SAN DIEGO
,
CA
92101
NONE
PC
TO PROVIDE LOW-INCOME SENIORS WITH ORAL HEALTHCARE THROUGH AN INTEGRATED, COMMUNITY-BASED MODEL OF CARE AT THE DOWNTOWN SAN DIEGO OUTPATIENT DENTAL CLINIC.
1,239,728
INTERCULTURAL SENIOR CENTER
5545 CENTER STREET
OMAHA
,
NE
68106
NONE
PC
TO SUPPORT CORE OPERATIONS INCLUDING SOCIAL WORK, HEALTH AND WELLNESS PROGRAMS, AND TRANSPORTATION SERVICES.
30,000
INTERFAITH COMMUNITY SERVICES INC
550 WEST WASHINGTON AVENUE SUITE B
ESCONDIDO
,
CA
92025
NONE
PC
TO SUPPORT CASE MANAGEMENT, HEALTH NAVIGATION AND NUTRITION SERVICES.
37,500
LEGAL AID SOCIETY OF SAN DIEGO INC
110 SOUTH EUCLID AVENUE
SAN DIEGO
,
CA
92114
NONE
PC
TO SUPPORT BENEFITS COUNSELING AND COMPUTER LAB FOR LOW-INCOME SENIORS.
209,000
MEALS-ON-WHEELS GREATER SAN DIEGO
2254 SAN DIEGO AVENUE SUITE 200
SAN DIEGO
,
CA
92110
NONE
PC
TO SUPPORT CHANGE OF CONDITION MONITORING AND CARE NAVIGATION PROJECT.
56,000
PROJECT HOUSEWORKS
2316 SOUTH 24TH STREET
OMAHA
,
NE
68108
NONE
PC
RESPONSIVE GRANT FOR REPAIRS IN SENIORS' HOMES DUE TO MARCH 2019 FLOODING.
50,000
PROJECT HOUSEWORKS
2316 SOUTH 24TH STREET
OMAHA
,
NE
68108
NONE
PC
TO SUPPORT HOME REPAIRS FOR SENIORS.
50,000
SAN DIEGO SENIORS COMMUNITY FOUNDATION
626 TARENTO DRIVE
SAN DIEGO
,
CA
92106
NONE
PC
TO SUPPORT SUSTAINABILITY AND DONOR CULTIVATION.
50,000
SERVING SENIORS
525 14TH STREET SUITE 200
SAN DIEGO
,
CA
92101
NONE
PC
TO SUPPORT GARY & MARY WEST SENIOR WELLNESS CENTER OPERATIONS.
150,000
SERVING SENIORS
525 14TH STREET SUITE 200
SAN DIEGO
,
CA
92101
NONE
PC
TO SUPPORT INTEGRATED DENTAL & WELLNESS COORDINATION.
125,000
Total
.................................
3b
8,551,467
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
6,647,245
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
.....
14
531,901
8
Gain or (loss) from sales of assets other than
inventory
............
18
1,447,033
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)
..
0
8,626,179
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
8,626,179
(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)
Yes
(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
1a(1)
2,559,940
CIVICA RX
EXPENDITURE RESPONSIBILITY GRANT
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
CIVICA RX
SOCIAL WELFARE ORG
A DIRECTOR OF THE FOUNDATION IS ALSO A DIRECTOR OF CIVICA RX.
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