-
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
ALVIN A MARION BIRNSCHEIN
FOUNDATION INC
Number and street (or P.O. box number if mail is not delivered to street address)
111 E WISCONSIN AVE STE 1800
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MILWAUKEE
,
WI
53202
A Employer identification number
39-6126798
B
Telephone number (see instructions)
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)
$
5,056,787
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
124,165
124,165
124,165
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
435,654
b
Gross sales price for all assets on line 6a
1,263,111
7
Capital gain net income (from Part IV, line 2)
...
435,654
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)
.......
204
204
204
12
Total.
Add lines 1 through 11
........
560,023
560,023
124,369
13
Compensation of officers, directors, trustees, etc.
4,000
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
9,733
4,867
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
57,490
57,490
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
12,656
12,656
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
4,724
4,724
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
88,603
79,737
0
25
Contributions, gifts, grants paid
.......
230,000
230,000
26
Total expenses and disbursements.
Add lines 24 and 25
318,603
79,737
230,000
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
241,420
b
Net investment income
(if negative, enter -0-)
480,286
c
Adjusted net income
(if negative, enter -0-)
...
124,369
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
.............
120,133
124,877
124,877
2
Savings and temporary cash investments
.........
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
..........
4,274
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
3,688,883
3,928,893
4,931,910
c
Investments—corporate bonds (attach schedule)
.......
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)
3,813,290
4,053,770
5,056,787
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
3,809,016
4,053,770
25
Net assets with donor restrictions
............
4,274
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)
.....
3,813,290
4,053,770
30
Total liabilities and net assets/fund balances
(see instructions)
.
3,813,290
4,053,770
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
3,813,290
2
Enter amount from Part I, line 27a
.....................
2
241,420
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
4,054,710
5
Decreases not included in line 2 (itemize)
5
940
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
4,053,770
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
CARNIVAL CORP
P
2019-01-22
2019-10-21
b
BECTON DICKINSON & CO
P
2017-01-19
2019-08-13
c
CVS HEALTH CORPORATION
P
2017-10-26
2019-11-05
d
PFIZER INC
P
2017-10-06
2019-01-18
e
PERNOD RCIARD SA
P
2018-01-17
2019-01-04
INDUSTRIA DE DISENO TEXTIL
P
2016-02-11
2019-01-04
COCA COLA COMPANY
P
2018-02-02
2019-12-26
FORTIVE COPRORAITON
P
2006-07-13
2019-12-26
ORACLE COPRORATION
P
2016-02-08
2019-10-29
VF CORPORATION
P
2011-08-24
2019-12-26
MERCK & CO INC
P
2018-12-26
2019-11-08
ROSS STORES INC
P
2011-08-24
2019-12-26
BANGO BILBAO VIZCAYA
P
2016-02-11
2019-12-13
ABBOT LABORATORIES
P
2019-03-27
2019-10-16
VERTEX PHARMACEUTICSALS INC
P
2019-03-27
2019-11-18
AMAZON.COM INC
P
2014-10-15
2019-11-18
DANAHER CORPORATION
P
2006-07-13
2019-11-18
FORTINET INC
P
2015-04-09
2019-11-18
KONTOOR BRANDS INC
P
2011-08-24
2019-05-31
ROSS STORES INC
P
2011-08-24
2019-11-18
VERISK ANALYTICS INC
P
2015-02-12
2019-10-16
BANCO SANTANDER
P
2018-08-13
2019-06-05
NXP SEMICONDUCTORS
P
2019-01-03
2019-03-01
AERCAP HOLDINGS NV
P
2016-02-11
2019-11-22
DAIMLER AG
P
2018-05-18
2019-08-21
SAP SE
P
2018-01-31
2019-05-17
FIVE9 INC
P
2019-05-01
2019-12-27
CARNIVAL CORP
P
2019-03-22
2019-10-21
BLACKROCK INC
P
2014-01-02
2019-08-13
CYRUSONE INC
P
2017-08-10
2019-08-19
PHILLIPS 66
P
2016-05-16
2019-04-22
SHOPIFY INC
P
2018-05-02
2019-04-29
INDUSTRIA DE DISENO TEXTIL
P
2016-02-11
2019-05-07
COMCAST CORP
P
2018-11-08
2019-12-26
FORTIVE CORPORATION
P
2018-01-25
2019-12-26
ORACLE CORPORATION
P
2017-09-29
2019-10-29
YETI HOLDINGS INC
P
2019-09-26
2019-12-26
MICROSOFT CORP
P
2018-12-26
2019-07-08
ROSS STORES INC
P
2012-03-28
2019-12-26
BANCO BILBAO VIZCAYA
P
2016-05-04
2019-12-13
ABBOT LABORATORIES
P
2019-03-27
2019-11-18
YETI HOLDINGS INC
P
2019-09-26
2019-10-16
AMETEK INC NEW
P
2011-02-10
2019-10-16
ECOLAB INC
P
2012-12-07
2019-10-16
FORTIVE CORPORATION
P
2006-07-13
2019-10-16
KONTOOR BRANDS INC
P
2017-09-12
2019-05-31
SAGE THERAPEUTICS INC
P
2017-09-12
2019-01-09
VERISK ANALYTICS INC
P
2015-02-12
2019-11-18
BANCO SANTANDER
P
2019-04-15
2019-06-05
NXP SEMICONDUCTORS
P
2019-01-03
2019-12-13
AIA GROUP LTD
P
2017-03-13
2019-04-23
DEUTSCH BOERSE AG
P
2017-10-13
2019-06-04
SECOM CO LTD
P
2016-02-11
2019-11-15
CARNIVAL CORP
P
2019-05-17
2019-10-21
BLACKROCK INC
P
2017-01-06
2019-08-13
CYRUSONE INC
P
2017-09-29
2019-08-19
RESIDEO TECHNOLOGIES INC
P
2014-01-02
2019-01-07
UBISOFT ENTERTAINMENT SA
P
2019-05-15
2019-12-09
METTLER-TOLEDO INTERNATIONAL
P
2018-06-29
2019-08-28
COMCAST CORP
P
2017-02-07
2019-12-26
GLOBUS MEDICAL INC
P
2018-01-26
2019-12-26
PACIRA BIOSCIENCES INC
P
2017-07-19
2019-12-26
YUM BRANDS INC
P
2017-09-12
2019-12-26
NEXTERA ENERGY INC
P
2018-12-26
2019-09-25
TRANSDIGM GROUP INCORPORATED
P
2012-03-28
2019-12-26
BANCO BILBAO VIZCAYA
P
2017-01-10
2019-12-13
ACADIA HEALTHCARE CO INC
P
2018-07-27
2019-02-20
YETI HOLDINGS INC
P
2019-09-26
2019-11-18
AMETEK INC NEW
P
2011-02-10
2019-11-18
ECOLAB INC
P
2012-12-07
2019-11-18
FORTIVE CORPORATION
P
2006-07-13
2019-11-18
LIGAND PHARMACEUTICALS INC
P
2017-07-19
2019-08-07
SAGE THERAPEUTICS INC
P
2017-09-12
2019-11-18
VF CORPORATION
P
2011-08-24
2019-10-16
BHP GROUP PLC
P
2018-11-28
2019-10-16
ORANGE
P
2019-04-15
2019-07-29
AIRBUS SE
P
2016-10-12
2019-03-07
DEUTSCH POST AG
P
2018-04-04
2019-12-16
SECOM CO LTD
P
2017-10-05
CME GROUP INC
P
2018-07-11
2019-04-17
CARNIVAL CORP
P
2017-08-11
2019-08-13
HONEYWELL INTL INC
P
2014-01-02
2019-02-22
RESIDEO TECHNOLOGIES INC
P
2014-09-15
2019-01-07
ACCENTURE PLC IRELAND
P
2016-04-14
2019-01-04
RYANAIR HLDGS PLC
P
2017-12-06
2019-01-04
COSTCO WHOLESALE CORP
P
2018-11-08
2019-12-26
GLOBUS MEDICLA INC
P
2018-02-20
2019-12-26
PACIRA BIOSCIENCES INC
P
2018-11-08
2019-12-26
ALCON INC
P
2018-12-26
2019-04-08
ROYAL DUTCH SHELL PLC
P
2018-12-26
2019-12-18
TRANSDIGM GROUP INCORPORATED
P
2018-11-08
2019-12-26
BANCO BILBAO VIZCAYA
P
2017-05-03
2019-12-13
CISCO SYSTEMS INC
P
2019-01-30
2019-10-16
ABBVIE INC
P
2018-01-25
2019-03-27
ANSYS INC
P
2006-09-27
2019-11-18
ELI LILLY & CO
P
2015-09-02
2019-10-16
GLOBUS MEDICAL INC
P
2017-07-19
2019-07-31
LKQ CORPORATION
P
2013-12-20
2019-08-07
SAGE THERAPEUTICS INC
P
2017-11-17
2019-11-18
VF CORPORATION
P
2011-08-24
2019-11-18
BHP GROUP PLC
P
2019-04-15
2019-10-16
PHILIP MORRIS INTERNATIONAL
P
2018-01-25
2019-01-03
AIRBUS SE
P
2016-11-01
2019-03-07
E ON SE
P
2016-02-11
2019-04-23
SEVEN & I HOLDINGS CO
P
2017-07-19
2019-04-25
CVS HEALTH CORPORATION
P
2019-01-22
2019-11-05
CARNIVAL CORP
P
2018-04-23
2019-10-21
JPMORGAN CHASE & CO
P
2014-01-02
2019-08-13
RESIDEO TECHNOLOGES INC
P
2016-06-10
2019-01-07
ADIDAS AG
P
2016-08-04
2019-01-04
RYANAIR HLDGSPLC
P
2017-12-06
2019-06-12
COSTCO WHOLESALE CORP
P
2016-10-11
2019-12-26
INCYTE CORPORATION
P
2015-09-11
2019-12-26
SAGE THERAPEUTICS INC
P
2017-11-17
2019-12-26
ALCON INC
P
2018-12-26
2019-06-20
THE TRAVELERS COMPANIES INC
P
2018-12-26
2019-11-08
UNITEDHEALTH GROUP INC
P
2015-07-29
2019-12-26
BANCO BILBAO VIZCAYA
P
2017-05-03
2019-07-05
CISCO SYSTEMS INC
P
2019-01-30
2019-11-18
ABIOMED INC
P
2017-07-19
2019-11-18
APPLE INC
P
2010-08-09
2019-10-16
ELI LILLY & CO
P
2015-09-02
2019-11-18
GLOBUS MEDICAL INC
P
2018-01-26
2019-07-31
LKQ CORPORAITON
P
2018-01-25
2019-08-07
SALESFORCE.COM INC
P
2017-07-19
2019-11-18
VISA INC
P
2008-07-30
2019-08-07
BRITISH AMERICAN TOBACCO
P
2018-02-28
2019-01-25
PHILIP MORRIS INTERNATIONAL
P
2018-06-26
2019-01-03
ARCELORMITTAL
P
2017-05-05
2019-06-05
ENGIE
P
2016-08-11
2019-12-16
SEVEN & I HOLDINGS CO
P
2017-07-20
2019-04-25
PNC FINANCIAL SVCS GROUP INC
P
2019-03-22
2019-04-22
CARNIVAL CORP
P
2018-05-15
2019-10-21
MARSH & MCLENNAN COMPANIES INC
P
2014-07-25
2019-02-07
SCHLUMBERGER LTD
P
2016-04-20
2019-04-22
ADIDAS AG
P
2016-08-04
2019-01-15
SHOPIFY INC
P
2018-05-02
2019-07-12
DANAHER CORPORATION
P
2006-07-13
2019-12-26
INTERCONTINTENTAL EXCHANGE
P
2007-06-27
2019-12-26
SALESFORCE.COM INC
P
2017-07-19
2019-12-26
ALTRIA GROUP INC
P
2018-12-26
2019-06-06
TRUIST FINANCIAL CORPORATION
P
2018-12-26
2019-12-17
UNITEDHEALTH GROUP INC
P
2016-07-20
2019-12-26
DANAHER CORPORATION
P
2016-06-08
2019-11-14
CORCEPT THERAPEUTICS INC
P
2018-05-03
2019-01-11
ACADIA HLEATHCARE CO INC
P
2016-10-17
2019-02-20
APPLE INC
P
2010-08-09
2019-11-18
EOG RES INC
P
2014-08-07
2019-11-18
GLOBUS MEDICAL INC
P
2018-01-26
2019-10-16
MICROSOFT CORP
P
2016-01-12
2019-10-16
STRYKER CORP
P
2017-06-30
2019-10-16
VISA INC
P
2008-07-30
2019-10-16
DAIMLER AG
P
2019-01-15
2019-08-21
REPSOL SA
P
2018-10-10
2019-09-24
ARCELORMITTAL
P
2017-05-12
2019-06-05
ESSILORLUXOTTICA
P
2017-02-01
2019-12-16
SMITH & NEPHEW
P
2016-02-11
2019-07-22
REALTY INCOME CORP
P
2018-10-03
2019-01-07
CARNIVAL CORP
P
2018-08-29
2019-10-21
MICROSOFT INC
P
2014-01-02
2019-04-22
SCHLUMBERGER LTD
P
2016-04-20
2019-06-07
AIA GROUP LTD
P
2017-01-25
2019-01-04
TENCENT HOLDINGS LIMITE
P
2016-02-11
2019-01-04
DOLLAR GENERAL CORPORATION
P
2016-10-17
2019-05-17
INTUIT INC
P
2019-07-23
2019-12-26
STARBUCKS CORP
P
2016-02-08
2019-09-17
CORNING INC
P
2018-01-22
2019-12-10
AMAZON.COM INC
P
2014-10-15
2019-12-26
VISA INC
P
2008-07-30
2019-12-26
GENERAL DYNAMICS CORP
P
2016-02-11
2019-06-07
EDWARDS LIFESCIENCES CORP
P
2019-09-26
2019-11-18
ALEXION PHARMACEUTICALS INC
P
2014-07-21
2019-10-16
BROADCOM INC
P
2017-07-19
2019-11-18
EPAM SYSTEMS INC
P
2014-03-24
2019-07-31
GLOBUS MEDICALINC
P
2018-01-26
2019-11-18
MICROSOFT CORP
P
2016-01-12
2019-11-18
STRYKER CORP
P
2017-06-30
2019-11-18
VISA INC
P
2008-07-30
2019-11-18
DAIMLER AG
P
2019-04-15
2019-08-21
SEVEN & 1 HOLDINGS CO
P
2019-04-15
2019-04-25
BAIDU INC
P
2017-05-02
2019-08-16
INDUSTRIA DE DISENO TEXTIL
P
2018-08-31
2019-12-16
SUMITOMO MITSUI FINL GROUP
P
2017-06-06
2019-08-15
REALTY INCOME CORP
P
2018-10-03
2019-06-28
CHEVRON CORPORATION
P
2014-01-02
2019-04-22
MICROSOFT CORP
P
2014-01-02
2019-12-20
SCHLUMBERGER LTD
P
2017-03-06
2019-06-07
CHR HANSEN HLDG
P
2016-02-11
2019-09-17
DWAL-MART DE MEXICO S A
P
2016-02-11
2019-01-04
ECOLAB INC
P
2012-12-07
2019-12-26
KLA CORPORATION
P
2017-12-19
2019-12-26
STARBUCKS CORP
P
2016-02-08
2019-04-18
CORNING INC
P
2018-12-26
2019-12-19
ANSYS INC
P
2006-09-27
2019-12-26
WASTE CONNECTIONS INC
P
2006-07-13
2019-12-26
KROGER CO
P
2017-06-13
2019-11-14
EQUINIX INC
P
2019-08-07
2019-11-18
ALEXION PHARMACEUTICALS INC
P
2014-07-21
2019-11-18
COCA COLA COMPANY
P
2018-02-02
2019-10-16
EPAM SYSTEMS INC
P
2014-03-24
2019-10-16
ILLINOIS TOOL WORKS INC
P
2011-02-10
2019-01-30
MICROSOFT CORP
P
2016-01-25
2019-11-18
TRANSDIGM GROUP INCORPORATED
P
2012-03-28
2019-10-16
WASTE CONNECTIONS INC
P
2006-07-13
2019-10-16
INTERNATIONAL CONSOLIDATED
P
2018-12-03
2019-03-06
SUMITOMO MITSUI FINL GROUP
P
2019-04-15
2019-08-15
BAIDU INC
P
2017-05-12
2019-08-16
INTESA SANPAOLO SPA
P
2016-05-20
2019-06-05
SUMITOMO MITSUI FINL GROUP
P
2017-06-21
2019-08-15
SCHLUMBERGER LTD
P
2018-08-29
2019-06-07
CISCO SYSTEMS INC
P
2016-12-16
2019-04-22
MONDELEZ INTERNATIONAL INC
P
2015-09-25
2019-04-22
UNION PACIFIC CORP
P
2014-01-02
2019-04-22
CHUBB LTD
P
2016-02-11
2019-01-04
ABIOMED INC
P
2017-07-19
2019-12-26
ELI LILLY & CO
P
2015-09-02
2019-12-26
LHC GROUP INC
P
2019-02-19
2019-12-26
STARBUCKS CORP
P
2018-08-20
2019-09-17
CORTEVA INC
P
2018-12-26
2019-06-01
APPLE INC
P
2010-08-09
2019-12-26
COMMERCE BANCSHARES INC
P
2019-10-15
2019-12-18
LENNAR CORP
P
2016-02-11
2019-07-05
FIVE9 INC
P
2019-05-01
2019-10-16
ALEXION PHARMACEUTICALS INC
P
2016-11-14
2019-11-18
COCA COLA COMPANY
P
2018-02-02
2019-11-18
EPAM SYSTEMS INC
P
2014-03-24
2019-11-18
INCYTE CORPORORATION
P
2015-09-11
2019-10-16
NETFLIX COM INC
P
2017-12-19
2019-07-23
TRANSIDGM GROUP INCORPORATED
P
2012-03-28
2019-11-18
WASTE CONNECTIONS INC
P
2006-07-13
2019-11-18
INTERNATIONAL CONSOLIDATED
P
2019-01-16
2019-03-06
TESCO PLC
P
2019-05-06
2019-10-22
BANCO SANTANDER
P
2018-02-21
2019-06-05
INTESA SANPAOLO SPA
P
2016-06-30
2019-06-05
TORAY INDUSTRIES INC
P
2017-11-02
2019-11-13
SCHLUMBERGER LTD
P
2019-01-22
2019-06-07
COLGATE PALMOLIVE COMPANY
P
2014-06-03
2019-04-22
NEXTERA ENERGY INC
P
2014-01-02
2019-06-28
UNITEDHEALTH GROUP INC
P
2014-01-02
2019-12-20
CORE LABORATORIES NV
P
2016-02-11
2019-02-19
ALEXION PHARMACEUTICALS INC
P
2016-11-14
2019-12-26
ELI LILLY & CO
P
2016-01-27
2019-12-26
MICROSOFT CORP
P
2017-09-06
2019-12-26
STRYKER CORP
P
2017-06-30
2019-12-26
CORTEVA INC
P
2018-12-26
2019-07-11
APPLE INC
P
2012-02-13
2019-12-26
TYSON FOODS INC
P
2019-06-07
2019-11-14
MICROSOF TCORP
P
2016-02-11
2019-05-02
FIVE 9 INC
P
2019-05-01
2019-11-18
ALPHABET INC CLASS C
P
2006-07-13
2019-11-18
COGNIZANT TECHNOLOGY SOLUTIONS
P
2010-01-08
2019-07-23
FACEBOOK INC
P
2015-07-17
2019-10-16
INCYTE CORPORATION
P
2015-09-11
2019-11-18
NETFLIX COM INC
P
2017-12-19
2019-10-16
ULTA BEAUTY INC
P
2013-08-02
2019-07-31
XPO LOGISTICS INC
P
2017-03-31
2019-02-19
INTESA SANPAOLO SPA
P
2019-08-14
2019-06-05
TORAY INDUSTRIES INC
P
2019-01-07
2019-11-13
BHP GROUP PLC
P
2016-09-08
2019-03-06
ORANGE
P
2016-04-14
2019-07-26
TOTAL SA
P
2016-02-11
2019-06-14
TEXAS INSTRUMETNS INCORPORATED
P
2018-02-27
2019-02-22
COMCAST CORP
P
2017-07-25
2019-04-22
PACKAGING CORP AMER
P
2014-07-02
2019-11-18
WHIRLPOOL CORP
P
2014-01-02
2019-03-22
CORE LABORATORIES NV
P
2016-02-11
2019-05-31
ALPHABET INC CLASS A
P
2014-06-24
2019-12-26
EOG RES INC
P
2014-08-07
2019-12-29
NIKE INC
P
2016-02-08
2019-05-06
STRYKER CORP
P
2017-10-27
2019-12-26
CORTEVA INC
P
2019-06-06
2019-07-11
APPLE INC
P
2018-11-08
2019-12-26
ABBVIE INC
P
2016-02-11
2019-04-17
MONDELEZ INTERNATIONAL INC
P
2016-02-11
2019-10-15
INTUIT INC
P
2019-07-23
2019-11-18
ALPHABET INC CLASS C
P
2010-03-25
2019-11-18
COMCAST CORP
P
2017-02-07
2019-10-16
FACEBOOK INC
P
2015-07-17
2019-11-18
INTERCONTINENTAL EXCHANGE
P
2007-06-27
2019-10-16
NETFLIX COM INC
P
2017-12-19
2019-10-17
ULTA BEAUTY INC
P
2013-08-02
2019-09-03
YUM BRANDS INC
P
2017-09-12
2019-11-18
KUBOTA CORPORATION
P
2018-07-17
2019-03-19
TOTAL S A
P
2019-04-15
2019-06-14
BHP GROUP PLC
P
2017-02-06
2019-03-06
ORANGE
P
2016-04-14
2019-07-29
TOTAL SA
P
2016-10-11
2019-06-14
WHIRLPOOL CORP
P
2019-01-22
2019-03-22
CVS HEALTH CORPORATION
P
2014-01-02
2019-10-01
PACKAGING CORP AMER
P
2015-07-02
2019-11-18
WHIRLPOOL CORP
P
2014-07-22
2019-03-22
CSL LTD
P
2016-02-11
2019-01-04
AMETEK INC
P
2011-02-10
2019-12-26
EOG RES INC
P
2018-11-08
2019-12-26
NVIDIA CORP
P
2018-08-27
2019-02-26
UNILEVER PLC
P
2018-02-20
2019-12-26
DOW INC
P
2018-12-26
2019-04-01
ELI LILLY & CO
P
2018-12-26
2019-12-26
ACADIA HEALTHCARE CO
P
2017-08-11
2019-11-14
NATIONAL FUEL GAS CO
P
2016-02-11
2019-10-15
LHC GROUP INC
P
2019-02-19
2019-10-16
ALPHABET INC CLASS C
P
2015-09-30
2019-11-18
COMCAST CORP
P
2017-02-07
2019-11-18
FIDELITY NATIONAL INFORMATION
P
2017-09-28
2019-10-16
INTERCONTINENTAL EXCHANGE
P
2007-06-27
2019-11-18
PACIRA BIOSCIENCES INC
P
2017-07-19
2019-11-18
UNILEVER PLC
P
2018-02-02
2019-10-16
ARCELORMITTAL
P
2018-10-16
2019-06-05
MURATA MANUFACTURING CO
P
2018-11-19
2019-03-01
ACS ACTIVIDADES
P
2016-12-30
2019-02-27
BHP GROUP PLC
P
2017-02-06
2019-10-16
ROCHE HOLDING LTD
P
2016-02-11
2019-04-23
CISCO SYSTEMS
P
2019-01-30
2019-12-26
ALLERGAN PLC
P
2017-11-02
2019-04-22
CVS HEALTH CORPORATION
P
2014-01-02
2019-11-05
PFIZER INC
P
2009-10-29
2019-01-18
WHIRLPOOL CORP
P
2016-01-22
2019-03-22
HEXAGON
P
2018-02-09
2019-03-07
AUTOMATIC DATA PROCESSING INC
P
2016-02-08
2019-01-16
FACEBOOK INC
P
2016-05-04
2019-11-08
O REILLY AUTOMOTIVE INC
P
2017-04-28
2019-04-24
VERISK ANALYSTICS INC
P
2015-02-12
2019-12-26
DUPONT DE NEMOURS INC
P
2018-01-22
2019-06-07
EPAM SYSTEMS INC
P
2014-03-24
2019-12-26
ACADIA HEALTHCARE CO
P
2017-08-14
2019-11-14
NATIONAL FUEL GAS CO
P
2017-07-10
2019-10-15
LHC GROUP INC
P
2019-02-19
2019-11-18
ALPHABET INC CLASS A
P
2010-03-25
2019-07-23
COSTCO WHOLESALE CORP
P
2016-10-11
2019-10-16
FIDELITY NATIONAL INFORMATION
P
2017-09-28
2019-11-18
KLA CORPORATION
P
2017-12-19
2019-10-16
PAYPAL HOLDINGS INC
P
2017-12-19
2019-10-16
UNILEVER PLC
P
2018-02-02
2019-11-18
ASML HOLDING
P
2019-04-01
2019-07-22
MURATA MANUFACTURING CO
P
2018-11-19
2019-11-06
ACS ACTIVIDADES
P
2016-12-30
2019-03-13
BRITISH AMERICAN TOBACCO
P
2017-10-03
2019-01-25
ROYAL DSM NV
P
2016-02-11
2019-04-23
COCA COLA COMPANY
P
2019-02-14
2019-12-26
ALLERGAN PLC
P
2017-11-02
2019-10-01
CVS HEALTH CORPORATION
P
2016-09-08
2019-11-05
PFIZER INC
P
2016-03-21
2019-01-18
HEXAGON AB
P
2018-04-18
2019-03-07
ICON PLC
P
2016-02-11
2019-01-04
AUTOMATIC DATA PROCESSING INC
P
2016-02-08
2019-05-17
FIDELITY NATIONAL INFORMATION
P
2017-09-28
2019-12-26
O REILLY AUTOMOTIVE INC
P
2016-02-08
2019-04-24
VERTEX PHARMACEUTICALS INC
P
2019-03-27
2019-12-26
DUPONT DE NEMOURS INC
P
2018-01-22
2019-10-29
MICROSOFT CORP
P
2016-01-25
2019-12-26
ADOBE INC
P
2016-02-11
2019-07-05
NOVARTIS AG
P
2016-02-11
2019-11-14
MASTERCARD INCORPORATED
P
2019-08-07
2019-11-18
ALPHABET INC CLASS A
P
2014-06-24
2019-07-23
COSTCO WHOLESALE CORP
P
2016-10-11
2019-01-11
FORTINET INC
P
2015-04-09
2019-07-31
KLA CORPORATION
P
2017-12-19
2019-01-18
PAYPAL HOLDINGS INC
P
2017-12-19
2019-11-18
UNITEDHEALTH GROUP INC
P
2015-07-27
2019-11-18
BAIDU INC
P
2019-01-25
2019-08-16
NASPERS LIMITED
P
2019-04-30
2019-11-05
ACS ACTIVIDADES
P
2016-12-30
2019-07-26
BRITISH AMERICAN TOBACCO
P
2017-12-08
2019-01-25
ROYALDSM NV
P
2016-02-11
2019-12-19
EDWARDS LIFESCIENCE CORP
P
2019-09-26
2019-12-26
APPLE INC
P
2014-01-02
2019-04-17
CVS HEALTH CORPORATION
P
2017-08-29
2019-11-05
PFIZER INC
P
2016-11-09
2019-01-18
HEXAGON AB
P
2018-08-24
2019-03-07
ICON PLC
P
2016-02-11
2019-03-22
BROADCOM INC
P
2017-07-19
2019-12-26
FORTINET INC
P
2015-04-09
2019-12-26
O REILLY AUTOMOTIVE INC
P
2016-02-08
2019-01-03
VF CORPORATION
P
2017-09-12
2019-12-26
HSBC HOLDINGS PLC
P
2018-01-22
2019-08-22
MICROSOFT CORP
P
2016-11-14
2019-12-26
ADOBE INC
P
2016-02-11
2019-11-14
PAYPAL HOLDINGS INC
P
2016-02-11
2019-11-14
SERVICENOW INC
P
2019-07-23
2019-11-18
ALPHABET INC CLASS A
P
2014-06-24
2019-11-18
DANAHER CORPORATION
P
2006-07-13
2019-10-16
FORTINET INC
P
2015-04-09
2019-10-16
KONTOOR BRANDS INC
P
2011-08-24
2019-05-22
ROSS STORES INC
P
2011-08-24
2019-10-16
UNITEDHEALTH GROUP INC
P
2015-07-29
2019-11-18
BAIDU INC
P
2019-04-15
2019-08-16
NASPERS LIMITED
P
2019-05-06
2019-11-05
AERCAP HOLDINGS NV
P
2016-02-11
2019-07-25
CARLSBERG AS
P
2016-02-11
2019-04-23
ROYAL DUTCH SHELL PLC
P
2016-02-11
2019-11-05
EQUINIX INC
P
2019-08-07
2019-12-26
(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
1,594
2,003
-409
b
505
347
158
c
4,072
4,553
-481
d
4,667
3,689
978
e
514
514
325
383
-58
5,980
5,117
863
2,132
411
1,721
9,146
5,730
3,416
3,768
997
2,771
1,502
1,315
187
3,566
568
2,998
6,991
7,616
-625
82
79
3
1,880
1,679
201
10,506
1,832
8,674
4,207
707
3,500
2,185
729
1,456
324
136
188
6,506
1,063
5,443
311
135
176
1,150
1,305
-155
940
730
210
782
347
435
3,685
6,341
-2,656
1,909
1,690
219
2,996
2,403
593
1,163
1,525
-362
6,345
4,694
1,651
2,254
1,755
499
484
394
90
4,067
2,249
1,818
3,198
3,443
-245
90
77
13
4,111
4,073
38
6,998
6,120
878
2,781
2,305
476
3,560
2,567
993
10,584
2,689
7,895
190
233
-43
2,277
2,121
156
32
28
4
89
30
59
390
145
245
69
15
54
199
189
10
5,904
3,705
2,199
2,832
1,347
1,485
267
305
-38
1,722
1,022
700
1,024
633
391
781
630
151
4,652
3,541
1,111
819
1,018
-199
1,269
1,155
114
986
793
193
232
180
52
3,911
5,702
-1,791
3,885
3,489
396
8,618
7,196
1,422
235
186
49
1,951
2,130
-179
6,092
4,617
1,475
1,827
1,346
481
11,330
847
10,483
5,826
7,221
-1,395
1,733
2,744
-1,011
1,119
1,082
37
4,755
1,449
3,306
5,147
1,960
3,187
2,710
557
2,153
2,989
3,947
-958
1,618
815
803
91
26
65
2,717
2,561
156
362
397
-35
158
72
86
583
644
-61
1,565
1,310
255
879
825
54
2,961
2,969
-8
7,950
4,511
3,439
118
95
23
562
459
103
365
595
-230
295
239
56
4,473
3,684
789
136
152
-16
32
31
1
773
759
14
596
357
239
236
332
-96
93
92
1
6,801
9,138
-2,337
5,744
552
5,192
432
324
108
2,413
1,732
681
2,642
3,346
-704
588
343
245
3,487
1,050
2,437
125
149
-24
3,211
5,327
-2,116
505
237
268
843
723
120
2,114
2,474
-360
271
259
12
3,748
5,742
-1,994
329
174
155
74
74
762
571
191
3,759
6,779
-3,020
13,877
7,053
6,824
2,049
2,927
-878
2,304
2,662
-358
1,076
920
156
1,600
1,382
218
13,259
5,452
7,807
4
6
-2
2,835
2,913
-78
1,630
1,310
320
702
112
590
3,871
2,750
1,121
1,867
1,910
-43
2,083
3,497
-1,414
3,742
2,072
1,670
6,984
780
6,204
693
1,311
-618
1,070
1,279
-209
787
1,217
-430
667
678
-11
2,774
3,255
-481
1,340
1,191
149
1,422
2,148
-726
3,670
2,107
1,563
504
877
-373
3,977
2,204
1,773
3,718
1,499
2,219
9,611
1,485
8,126
9,826
3,179
6,647
2,296
1,261
1,035
659
619
40
31
21
10
5,598
2,736
2,862
9,795
5,162
4,633
2,414
2,901
-487
1,677
2,627
-950
20,565
2,867
17,698
1,139
1,701
-562
100
93
7
421
158
263
216
139
77
356
39
317
541
699
-158
1,886
2,431
-545
1,831
2,701
-870
867
643
224
1,700
1,200
500
2,375
2,146
229
948
1,368
-420
3,582
1,078
2,504
2,402
5,339
-2,937
881
670
211
573
238
335
4,200
2,410
1,790
4,525
4,766
-241
1,992
1,160
832
364
372
-8
26,146
4,276
21,870
15,470
1,598
13,872
555
382
173
1,939
1,774
165
202
325
-123
1,876
1,515
361
8,894
1,425
7,469
2,103
1,771
332
10,517
3,693
6,824
5,333
3,627
1,706
6,821
741
6,080
127
175
-48
203
207
-4
1,064
1,962
-898
1,107
971
136
2,439
2,863
-424
3,264
2,655
609
365
365
2,675
632
2,043
574
1,284
-710
2,329
1,634
695
304
284
20
10,891
4,138
6,753
4,456
2,799
1,657
4,752
3,323
1,429
1,432
1,432
12,873
1,150
11,723
15,973
1,836
14,137
13,919
17,495
-3,576
2,235
2,110
125
108
162
-54
160
141
19
188
32
156
10,870
4,513
6,357
7,062
2,458
4,604
521
45
476
550
62
488
2,624
2,794
-170
205
227
-22
1,451
2,801
-1,350
2,756
3,484
-728
2,381
2,831
-450
3,119
5,613
-2,494
509
274
235
251
211
40
357
168
189
514
439
75
3,245
2,765
480
3,923
2,426
1,497
4,074
3,313
761
6,248
3,729
2,519
18
18
578
74
504
24
20
4
2,021
1,273
748
56
53
3
1,724
1,941
-217
4,666
4,131
535
5,408
824
4,584
78
127
-49
4,332
2,618
1,714
5,102
401
4,701
7,394
851
6,543
2,428
2,548
-120
5,501
5,811
-310
3,931
6,170
-2,239
766
678
88
4,504
6,278
-1,774
3,836
4,671
-835
278
269
9
4,694
1,953
2,741
3,236
825
2,411
1,951
2,688
-737
3,908
4,368
-460
5,623
3,504
2,119
4,016
1,983
2,033
4,386
2,929
1,457
1,819
1,821
-2
46,507
11,438
35,069
632
578
54
9,842
3,552
6,290
1,364
1,121
243
1,325
203
1,122
7,494
2,646
4,848
189
95
94
960
1,400
-440
286
187
99
5,642
1,623
4,019
4,478
3,912
566
1,125
1,410
-285
792
784
8
3,394
1,985
1,409
4,138
4,747
-609
2,221
1,711
510
5,070
5,118
-48
294
278
16
3,065
1,921
1,144
2,990
3,591
-601
2,221
4,357
-2,136
4,075
1,744
2,331
2,683
3,401
-718
4,244
2,766
1,478
7,310
5,521
1,789
580
596
-16
578
416
162
10,939
7,339
3,600
17,236
12,375
4,861
2,145
2,243
-98
5,299
1,133
4,166
274
225
49
8,915
4,256
4,659
375
120
255
2,373
1,496
877
9,055
3,855
5,200
2,748
2,155
593
4,673
5,310
-637
317
340
-23
744
553
191
242
272
-30
3,173
2,920
253
130
126
4
1,545
1,770
-225
795
447
348
2,080
2,302
-222
473
256
217
10,573
3,135
7,438
84
106
-22
9,695
17,207
-7,512
4,025
4,061
-36
38
34
4
2,885
2,408
477
4,030
6,879
-2,849
8,612
8,492
120
112
110
2
1,325
604
721
4,012
3,373
639
132
93
39
4,549
1,469
3,080
904
1,040
-136
238
229
9
406
770
-364
433
402
31
3
2
1
2,299
1,901
398
2,556
2,423
133
6,441
6,243
198
280
356
-76
2,579
2,690
-111
5,855
2,403
3,452
1,560
1,588
-28
6,272
7,429
-1,157
4,509
2,695
1,814
5,715
3,539
2,176
1,189
745
444
6,235
2,829
3,406
49
50
-1
12,040
1,774
10,266
5,983
10,256
-4,273
4,216
5,251
-1,035
1,818
1,546
272
4,556
1,137
3,419
299
150
149
2,468
1,678
790
160
112
48
103
75
28
1,951
1,888
63
682
574
108
1,508
1,278
230
735
493
242
1,891
3,745
-1,854
1,548
639
909
4,334
3,634
700
4,165
4,455
-290
1,900
2,591
-691
3,437
2,427
1,010
2,937
3,630
-693
757
402
355
5,448
2,695
2,753
5,394
3,635
1,759
2,378
1,370
1,008
3,955
3,359
596
4,667
5,218
-551
2,693
889
1,804
1,822
447
1,375
1,878
1,325
553
5,336
5,094
242
2,278
1,163
1,115
7,008
3,452
3,556
3,370
1,424
1,946
1,952
1,231
721
2,590
1,867
723
4,378
1,884
2,494
677
1,163
-486
2,422
4,274
-1,852
3
2
1
1,323
2,776
-1,453
3,066
1,136
1,930
3,757
3,549
208
10,874
4,273
6,601
1,289
1,446
-157
806
624
182
2,787
3,280
-493
3,204
1,609
1,595
4,449
3,535
914
4,863
1,563
3,300
4,503
2,969
1,534
4,760
2,843
1,917
1,196
1,347
-151
33,741
12,325
21,416
1,468
372
1,096
1,234
397
837
1,609
1,744
-135
5,292
2,325
2,967
138
24
114
77
35
42
5
2
3
337
55
282
3,831
1,696
2,135
97
169
-72
876
1,491
-615
2,411
1,256
1,155
1,601
1,118
483
1,924
1,354
570
5,197
4,748
449
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
-409
b
158
c
-481
d
978
e
-58
863
1,721
3,416
2,771
187
2,998
-625
3
201
8,674
3,500
1,456
188
5,443
176
-155
210
435
-2,656
219
593
-362
1,651
499
90
1,818
-245
13
38
878
476
993
7,895
-43
156
4
59
245
54
10
2,199
1,485
-38
700
391
151
1,111
-199
114
193
52
-1,791
396
1,422
49
-179
1,475
481
10,483
-1,395
-1,011
37
3,306
3,187
2,153
-958
803
65
156
-35
86
-61
255
54
-8
3,439
23
103
-230
56
789
-16
1
14
239
-96
1
-2,337
5,192
108
681
-704
245
2,437
-24
-2,116
268
120
-360
12
-1,994
155
191
-3,020
6,824
-878
-358
156
218
7,807
-2
-78
320
590
1,121
-43
-1,414
1,670
6,204
-618
-209
-430
-11
-481
149
-726
1,563
-373
1,773
2,219
8,126
6,647
1,035
40
10
2,862
4,633
-487
-950
17,698
-562
7
263
77
317
-158
-545
-870
224
500
229
-420
2,504
-2,937
211
335
1,790
-241
832
-8
21,870
13,872
173
165
-123
361
7,469
332
6,824
1,706
6,080
-48
-4
-898
136
-424
609
2,043
-710
695
20
6,753
1,657
1,429
11,723
14,137
-3,576
125
-54
19
156
6,357
4,604
476
488
-170
-22
-1,350
-728
-450
-2,494
235
40
189
75
480
1,497
761
2,519
504
4
748
3
-217
535
4,584
-49
1,714
4,701
6,543
-120
-310
-2,239
88
-1,774
-835
9
2,741
2,411
-737
-460
2,119
2,033
1,457
-2
35,069
54
6,290
243
1,122
4,848
94
-440
99
4,019
566
-285
8
1,409
-609
510
-48
16
1,144
-601
-2,136
2,331
-718
1,478
1,789
-16
162
3,600
4,861
-98
4,166
49
4,659
255
877
5,200
593
-637
-23
191
-30
253
4
-225
348
-222
217
7,438
-22
-7,512
-36
4
477
-2,849
120
2
721
639
39
3,080
-136
9
-364
31
1
398
133
198
-76
-111
3,452
-28
-1,157
1,814
2,176
444
3,406
-1
10,266
-4,273
-1,035
272
3,419
149
790
48
28
63
108
230
242
-1,854
909
700
-290
-691
1,010
-693
355
2,753
1,759
1,008
596
-551
1,804
1,375
553
242
1,115
3,556
1,946
721
723
2,494
-486
-1,852
1
-1,453
1,930
208
6,601
-157
182
-493
1,595
914
3,300
1,534
1,917
-151
21,416
1,096
837
-135
2,967
114
42
3
282
2,135
-72
-615
1,155
483
570
449
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
435,654
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
-13,163
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
233,000
4,587,789
0.050787
2017
204,500
4,403,256
0.046443
2016
219,882
4,177,214
0.052638
2015
208,665
4,033,554
0.051732
2014
226,802
4,536,041
0.050000
2
Total
of line 1, column (d)
.....................
2
0.251600
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
0.050320
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
4,747,635
5
Multiply line 4 by line 3
......................
5
238,901
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
4,803
7
Add lines 5 and 6
........................
7
243,704
8
Enter qualifying distributions from Part XII, line 4
,.............
8
230,000
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
9,606
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
9,606
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
9,606
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
7,249
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
7,249
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
18
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
2,375
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
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)
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
LICHTSINN & HAENSEL SC
Telephone no.
(414) 276-3400
Located at
111 E WISCONSIN AVE STE 1800
MILWAUKEE
WI
ZIP+4
53202
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
JANET HOEHNEN
DIRECTOR/SEC
000.00
2,000
0
0
930 WESTON HILLS DRIVE
BROKFIELD
,
WI
53045
RONALD JODAT
DIRECTOR/PRE
000.00
2,000
0
0
111 E WISCONSIN AVE STE 1800
MILWAUKEE
,
WI
53202
FRANK W BASTIAN
DIRECTOR / T
000.00
0
0
0
111 E WISCONSIN AVE STE 1800
MILWAUKEE
,
WI
53202
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
4,674,823
b
Average of monthly cash balances
.......................
1b
145,111
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
4,819,934
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
4,819,934
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
72,299
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
4,747,635
6
Minimum investment return.
Enter 5% of line 5
..................
6
237,382
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
237,382
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
9,606
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
9,606
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
227,776
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
227,776
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
227,776
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
230,000
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
230,000
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
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
230,000
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
227,776
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
......
11,892
b
From 2015
......
c
From 2016
......
12,551
d
From 2017
......
e
From 2018
......
10,860
f
Total
of lines 3a through e
........
35,303
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
230,000
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
.....
227,776
e
Remaining amount distributed out of corpus
2,224
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
37,527
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)
...
11,892
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
25,635
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
12,551
c
Excess from 2017
....
d
Excess from 2018
....
10,860
e
Excess from 2019
....
2,224
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
ALVIN A MARION BIRNSCHEIN FOUNDATIO
111 E WISCONSIN AVE STE 1800
MILWAUKEE
,
WI
53202
(414) 276-3400
MAIL@LHLAWFIRM.COM
b
The form in which applications should be submitted and information and materials they should include:
(CONTACT FOUNDATION)
c
Any submission deadlines:
(CONTACT FOUNDATION)
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
(CONTACT FOUNDATION)
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
ACACIA THEATRE COMPANY
3195 S SUPERIOR
MILWAUKEE
,
WI
53207
PUBLIC
GENERAL
5,000
ACTS HOUSING
2414 W VLIET ST
MILWAUKEE
,
WI
53205
PUBLIC
GENERAL
5,000
AUDIO & BRAILLE LITERACY ENHANCEMEN
803 W WELLS
MILWAUKEE
,
WI
53233
PUBLIC
GENERAL
5,000
BETTY BRINN CHILDREN'S MUSEUM
929 E WISCONSIN
MILWAUKEE
,
WI
53202
PUBLIC
GENERAL
20,000
CENTER FOR DEAF-BLIND PER
8306 W LINCOLN AVE
WEST ALLIS
,
WI
53219
PUBLIC
GENERAL
5,000
HISTORIC MILWAUKEE INC
235 E MICHIGAN ST
MILWAUKEE
,
WI
53202
PUBLIC
GENERAL
5,000
HUNGER TASK FORCE
201 S HAWLEY CT
MILWAUKEE
,
WI
53214
PUBLIC
GENERAL
10,000
INDEPENDENCEFIRST
540 S 1ST ST
MILWAUKEE
,
WI
53204
PUBLIC
GENERAL
15,000
KATHY'S HOUSE
600 N 103RD ST
MILWAUKEE
,
WI
53226
PUBLIC
GENERAL
10,000
MARQUETTE UNIVERSITY
PO BOX 1881
MILWAUKEE
,
WI
53201
PUBLIC
GENERAL
25,000
MEDICAL COLLEGE OF WISCONSIN
8701 WATERTOWN PLANK RD
MILWAUKEE
,
WI
53226
PUBLIC
GENERAL
15,000
MILWAUKEE INSTITUTE OF ART
273 E ERIE ST
MILWAUKEE
,
WI
53202
PUBLIC
GENERAL
5,000
PLANNED PARENTHOOD
2207 W WISCONSIN AVE
MILWAUKEE
,
WI
53233
PUBLIC
GENERAL
10,000
PREVENT BLINDNESS WISCONSIN
759 N MILWAUKEE ST 305
MILWAUKEE
,
WI
53202
PUBLIC
GENERAL
5,000
SCHLITZ AUDOBON NATURE
1111 E BROWN DEER RD
BAYSIDE
,
WI
53217
PUBLIC
GENERAL
10,000
SOJOURNER FOUNDATINON
P O BOX 080319
MILWAUKEE
,
WI
53208
PUBLIC
GENERAL
15,000
ST FRANCIS CHILDREN'S CENTER
6700 N PORT WASHINGTON RD
MILWAUKEE
,
WI
53217
PUBLIC
GENERAL
10,000
UNIVERSITY OF WISCONSIN FOUNDATION
1848 UNIVERSITY AVE
MADISON
,
WI
53726
PUBLIC
GENERAL
20,000
WISCONSIN ACADEMY FOR GRA
1337 GREENWAY CROSS
MADISON
,
WI
53713
PUBLIC
GENERAL
5,000
WISCONSIN HUMANE SOCIETY
4500 W WISCONSIN AVE
MILWAUKEE
,
WI
53208
PUBLIC
GENERAL
5,000
ZOOLOGICAL SOCIETY OF MILWAUKEE
10005 W BLUEMOUND RD
MILWAUKEE
,
WI
53226
PUBLIC
GENERAL
25,000
Total
.................................
3a
230,000
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
14
124,165
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
............
14
1,793
433,861
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
OTHER INCOME 306-07804
14
6
b
OTHER INCOME 306-07802
14
5
c
OTHER INCOME 306-07800
14
24
d
OTHER INCOME 320-96883
14
169
e
12
Subtotal. Add columns (b), (d), and (e)
..
126,162
433,861
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
560,023
(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