-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0052
20
19
Open to Public Inspection
For calendar year 2019, or tax year beginning
01-01-2019
, and ending
12-31-2019
Name of foundation
THE COUCH FAMILY FOUNDATION
C/O MOTT PHILANTHROPIC
Number and street (or P.O. box number if mail is not delivered to street address)
800 BOYLSTON STREET NO 1560
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
BOSTON
,
MA
02199
A Employer identification number
10-0000573
B
Telephone number (see instructions)
(603) 643-3441
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)
$
94,849,383
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)
25,253,432
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
1,192,879
1,192,879
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
8,285,688
b
Gross sales price for all assets on line 6a
53,555,668
7
Capital gain net income (from Part IV, line 2)
...
27,727,934
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)
.......
84,818
84,818
12
Total.
Add lines 1 through 11
........
34,816,817
29,005,631
13
Compensation of officers, directors, trustees, etc.
30,000
0
30,000
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
15,050
0
0
c
Other professional fees (attach schedule)
....
631,842
631,842
0
17
Interest
...............
48
48
0
18
Taxes (attach schedule) (see instructions)
...
260,188
56,685
3,503
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
352,285
0
340,407
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
1,289,413
688,575
373,910
25
Contributions, gifts, grants paid
.......
2,920,800
2,920,800
26
Total expenses and disbursements.
Add lines 24 and 25
4,210,213
688,575
3,294,710
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
30,606,604
b
Net investment income
(if negative, enter -0-)
28,317,056
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
.............
918,996
2,125,393
2,125,393
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
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
37,392,590
60,365,452
79,149,347
c
Investments—corporate bonds (attach schedule)
.......
7,871,390
12,673,166
13,127,874
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
0
446,703
446,769
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)
46,182,976
75,610,714
94,849,383
17
Accounts payable and accrued expenses
..........
7,618
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)
.........
7,618
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
0
0
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
46,175,358
75,610,714
29
Total net assets or fund balances
(see instructions)
.....
46,175,358
75,610,714
30
Total liabilities and net assets/fund balances
(see instructions)
.
46,182,976
75,610,714
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
46,175,358
2
Enter amount from Part I, line 27a
.....................
2
30,606,604
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
76,781,962
5
Decreases not included in line 2 (itemize)
5
1,171,248
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
75,610,714
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
BBH WEALTH STRATEGIES, LLC - ALTAROCK PARTNERS SERIES
P
b
BBH WEALTH STRATEGIES, LLC - ALTAROCK PARTNERS SERIES
P
c
BBH WEALTH STRATEGIES, LLC - BURGUNDYEMERGING MARKET
P
d
BBH WEALTH STRATEGIES, LLC - BURGUNDYEMERGING MARKET
P
e
BBH WEALTH STRATEGIES, LLC - CLARKSTON CAPITAL PARTNERS SMALL-MID CAP SERIES
P
BBH WEALTH STRATEGIES, LLC - CLARKSTON CAPITAL PARTNERS SMALL-MID CAP SERIES
P
BBH WEALTH STRATEGIES, LLC - SELECT EQUITY SERIES
P
BBH WEALTH STRATEGIES, LLC - SELECT EQUITY SERIES
P
1818 PARTNERS, LP C/O BBH & CO
P
1818 PARTNERS, LP C/O BBH & CO
P
BBH WEALTH STRATEGIES, LLC - GQG PARTNERS EMERGING MARKETS EQUITY SERIES
P
BBH WEALTH STRATEGIES, LLC - GQG PARTNERS EMERGING MARKETS EQUITY SERIES
P
BBH WEALTH STRATEGIES, LLC - BARE MID-LARGE CAP SERIES
P
BROWN BROTHERS 0719
P
BROWN BROTHERS 0719
P
DISTRIBUTION FROM HITCHWOOD CAPITAL PARTNERS
P
DISTRIBUTION FROM OAKTREE OPPS SUB TRUST
P
DISTRIBUTION FROM SANDTON CREDIT SOLUTIONS IV SUB TRUST
P
DISTRIBUTION FROM CAPITAL PARTNERS V-1 SUB TRUST
P
CAPITAL GAINS DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
12,118
12,118
b
61,660
61,660
c
6,017
6,017
d
171,129
171,129
e
5,295
5,295
128,231
128,231
274,931
274,931
162,221
162,221
760
760
229,390
229,390
20,202
-20,202
5,615
5,615
90,724
-90,724
11,105,455
10,268,414
837,041
32,952,625
7,074,523
25,878,102
7,736,472
7,736,472
0
51,351
51,351
0
13,608
13,608
0
572,440
572,440
0
66,350
66,350
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
12,118
b
61,660
c
6,017
d
171,129
e
5,295
128,231
274,931
162,221
760
229,390
-20,202
5,615
-90,724
837,041
25,878,102
0
0
0
0
66,350
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
27,727,934
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
2,199,117
59,370,205
0.037041
2017
3,108,235
55,637,974
0.055865
2016
1,877,472
47,480,299
0.039542
2015
1,056,813
43,843,541
0.024104
2014
636,873
38,651,256
0.016477
2
Total
of line 1, column (d)
.....................
2
0.173029
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
0.034606
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
76,637,796
5
Multiply line 4 by line 3
......................
5
2,652,128
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
283,171
7
Add lines 5 and 6
........................
7
2,935,299
8
Enter qualifying distributions from Part XII, line 4
,.............
8
3,294,710
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
283,171
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
283,171
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
283,171
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
287,448
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
40,000
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
327,448
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
44,277
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
44,277
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)
NH
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
No
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
Yes
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
ANDERSEN TAX LLC
Telephone no.
(617) 292-8400
Located at
125 HIGH STREET 16TH FLOOR
BOSTON
MA
ZIP+4
02110
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
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
RICHARD W COUCH
TRUSTEE
1.00
0
0
0
23 BERRILL FARMS LANE
HANOVER
,
NH
03755
BARBARA J COUCH
TRUSTEE
1.00
0
0
0
23 BERRILL FARMS LANE
HANOVER
,
NH
03755
BROOKE FREELAND
MANAGER
15.00
0
0
0
2716 HARRIS BLVD
AUSTIN
,
TX
78703
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
0
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
76,676,383
b
Average of monthly cash balances
.......................
1b
1,128,486
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
77,804,869
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
77,804,869
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
1,167,073
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
76,637,796
6
Minimum investment return.
Enter 5% of line 5
..................
6
3,831,890
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
3,831,890
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
283,171
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
283,171
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
3,548,719
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
3,548,719
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
3,548,719
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
3,294,710
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
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
3,294,710
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
283,171
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
3,011,539
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
3,548,719
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
2,185,831
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
c
From 2016
......
d
From 2017
......
e
From 2018
......
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
3,294,710
a
Applied to 2018, but not more than line 2a
2,185,831
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
.....
1,108,879
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
2,439,840
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
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).)
RICHARD W COUCH
BARBARA J COUCH
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
COBSCOOK COMMUNITY LEARNING
10 COMMISSARY POINT RD
LUBEC
,
ME
04652
PUBLIC
GENERAL SUPPORT
1,000
MVYOUTH
PO BOX 654
EDGARTOWN
,
MA
02539
PUBLIC
GENERAL SUPPORT
1,518
FRIENDS OF NORRIS COTTON CANCER CENTER
ONE MEDICAL CENTER DRIVE
LEBANON
,
NH
03756
PUBLIC
GENERAL SUPPORT
10,000
FRIENDS OF NORRIS COTTON CANCER CENTER
ONE MEDICAL CENTER DRIVE
LEBANON
,
NH
03756
PUBLIC
GENERAL SUPPORT
5,000
UPPER VALLEY HAVEN
713 HARTFORD AVENUE
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
5,000
UPPER VALLEY HAVEN
713 HARTFORD AVENUE
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
5,000
AMERICAN PRECISION MUSEUM
196 MAIN ST PO BOX 679
WINDSOR
,
VT
05089
PUBLIC
GENERAL SUPPORT
1,000
SOUTHEASTERN VERMONT COMMUNITY ACTION
91 BUCK DR
WESTMINSTER
,
VT
05158
PUBLIC
GENERAL SUPPORT
10,000
THE SPACE ON MAIN
174 MAIN STREET
BRADFORD
,
VT
05033
PUBLIC
GENERAL SUPPORT
5,000
SPECIAL NEEDS SUPPORT CENTER
12 FLYNN STREET
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
10,000
MONTSHIRE MUSEUM OF SCIENCE
ONE MONTSHIRE ROAD
NORWICH
,
VT
05055
PUBLIC
GENERAL SUPPORT
5,000
NEW HAMPSHIRE CENTER FOR NONPROFITS
84 SILK FARM ROAD
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
5,000
SECOND GROWTH
PO BOX 5227
WEST LEBANON
,
NH
03784
PUBLIC
GENERAL SUPPORT
10,000
SPARK COMMUNITY CENTER
75 BANK ST
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
5,000
CAMP JABERWOCKY
200 GREENWOOD AVE
VINEYARD HAVEN
,
MA
02568
PUBLIC
GENERAL SUPPORT
7,500
FORD SAYRE MEMORIAL SKI COUNCIL
PO BOX 471
HANOVER
,
NH
03755
PUBLIC
GENERAL SUPPORT
5,000
FRIENDS OF THE CHILMARK PUBLIC LIBRARY
PO BOX 434
CHILMARK
,
MA
02535
PUBLIC
GENERAL SUPPORT
2,000
CLAREMONT EARLY CHILDHOOD PROGRAM
111 SOUTH STREET
CLAREMONT
,
NH
03743
PUBLIC
GENERAL SUPPORT
23,160
DISMAS OF VT
103 PARK AVENUE
RUTLAND
,
VT
05701
PUBLIC
GENERAL SUPPORT
2,500
UPPER VALLEY SNOW SPORTS FOUNDATION
161 WHALEBACK MOUNTAIN RD
ENFIELD
,
NH
03749
PUBLIC
GENERAL SUPPORT
25,000
CLAREMONT LEARNING PARTNERSHIP
169 MAIN ST
CLAREMONT
,
NH
03743
PUBLIC
GENERAL SUPPORT
66,300
HEALTH STRATEGIES OF NEW HAMPSHIRE
ONE PILLSBURY STREET SUITE 301
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
1,000
DARTMOUTH COLLEGE - THAYER SCHOOL OF ENGINEERING
14 ENGINEERING DR
HANOVER
,
NH
03755
PUBLIC
GENERAL SUPPORT
25,000
MT ASCUTNEY HOSPITAL AND HEALTH CENTER
PO BOX 101
BROWNSVILLE
,
VT
05037
PUBLIC
GENERAL SUPPORT
6,600
UPPER VALLEY HAVEN
713 HARTFORD AVENUE
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
35,000
HEADREST
14 CHURCH STREET
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
15,000
AVA GALLERY AND ART CENTER
11 BANK STREET
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
25,000
MT ASCUTNEY HOSPITAL AND HEALTH CENTER
PO BOX 101
BROWNSVILLE
,
VT
05037
PUBLIC
GENERAL SUPPORT
63,309
OPERA NORTH
20 WEST PARK STREET
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
10,000
PUBLIC HEALTH COUNCIL OF THE UPPER VALLEY
ONE COURT STREET 378
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
5,000
CHANGING PERSPECTIVES
PO BOX 694
BRADFORD
,
VT
05033
PUBLIC
GENERAL SUPPORT
9,000
ISLAND GROWN INITIATIVE
PO BOX 622
VINEYARD HAVEN
,
MA
02569
PUBLIC
GENERAL SUPPORT
10,000
LEBANON OUTING CLUB
60 SPRING STREET
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
15,000
THE MAYHEW PROGRAM
293 W SHORE RD
BRISTOL
,
NH
03222
PUBLIC
GENERAL SUPPORT
7,000
VERMONT PBS
10 EAST ALLEN ST SUITE 202
WINOOSKI
,
VT
05404
PUBLIC
GENERAL SUPPORT
5,000
WINDSOR EARLY CHILDHOOD CENTER
20 BRIDGE ST
WINDSOR
,
VT
05089
PUBLIC
GENERAL SUPPORT
10,000
ZACH'S PLACE ENRICHMENT CENTER
73 CENTRAL STREET SUITE A PO BOX
634
WOODSTOCK
,
VT
05091
PUBLIC
GENERAL SUPPORT
10,000
COVER HOME REPAIR
158 SOUTH MAIN STREET
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
15,000
RAISING A READER - MA
9B HAMILTON PLACE 3RD FL
BOSTON
,
MA
02108
PUBLIC
GENERAL SUPPORT
10,000
VSA VERMONT
21 CARMICHAEL ST 206
ESSEX JUNCTION
,
VT
05452
PUBLIC
GENERAL SUPPORT
5,000
PENTANGLE ARTS
31 THE GREEN
WOODSTOCK
,
VT
05091
PUBLIC
GENERAL SUPPORT
5,000
GOOD BEGINNINGS OF THE UPPER VALLEY
PO BOX 5054
WEST LEBANON
,
NH
03784
PUBLIC
GENERAL SUPPORT
21,175
NEW HAMPSHIRE CHILDREN'S TRUST
10 FERRY ST 315
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
7,500
NORTH COUNTRY EDUCATION SERVICES AGENCY
300 GORHAM HILL ROAD
GORHAM
,
NH
03581
PUBLIC
GENERAL SUPPORT
2,550
UPPER VALLEY HAVEN
713 HARTFORD AVENUE
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
25,000
GIFT OF ADOPTION
2001 WAUKEGAN ROAD
TECHNY
,
IL
60082
PUBLIC
GENERAL SUPPORT
1,000
GLOBAL CAMPUSES FOUNDATION
43 S MAIN STREET
RANDOLPH
,
VT
05060
PUBLIC
GENERAL SUPPORT
7,500
THE HITCHCOCK FOUNDATION
ONE MEDICAL CENTER DRIVE
LEBANON
,
NH
03756
PUBLIC
GENERAL SUPPORT
10,000
CHILDREN'S LITERACY FOUNDATION
1536 LOOMIS HILL ROAD
WATERBURY CENTER
,
VT
05677
PUBLIC
GENERAL SUPPORT
30,000
MARIPOSA MUSEUM
26 MAIN ST
PETERBOROUGH
,
NH
03458
PUBLIC
GENERAL SUPPORT
500
WILLING HANDS ENTERPRISES
PO BOX 172
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
10,000
ISLAND FOOD PANTRY
CHURCH ST
VINEYARD
,
MA
02568
PUBLIC
GENERAL SUPPORT
5,000
UPPER VALLEY AQUATICS CENTER
100 ARBORETUM LN
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
5,000
UPPER VALLEY AQUATICS CENTER
100 ARBORETUM LN
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
10,000
MASSACHUSETTS AUDUBON SOCIETY
346 GRAPEVINE RD
WENHAM
,
MA
01984
PUBLIC
GENERAL SUPPORT
12,885
UPPER VALLEY TRAILS ALLIANCE
PO BOX 1215
NORWICH
,
VT
05055
PUBLIC
GENERAL SUPPORT
10,000
MARTHA'S VINEYARD BOYS AND GIRLS CLUB
PO BOX 654
EDGARTOWN
,
MA
02539
PUBLIC
GENERAL SUPPORT
7,500
TWINSTATE MAKERSPACES
46 MAIN STREET
CLAREMONT
,
NH
03743
PUBLIC
GENERAL SUPPORT
15,000
LEBANON OPERA HOUSE
51 N PARK ST
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
15,000
LYME NURSERY SCHOOL
155 DARTMOUTH COLLEGE HWY
LYME
,
NH
03768
PUBLIC
GENERAL SUPPORT
10,000
NH BUSINESS COMMUNITY FOR THE ARTS
49 SOUTH MAIN STREET SUITE 205
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
2,250
DARTMOUTH COLLEGE
6066 DEVELOPMENT OFFICE
HANOVER
,
NH
03755
PUBLIC
GENERAL SUPPORT
10,000
DARTMOUTH HITCHCOCK MEMORIAL HOSPITAL
ONE MEDICAL CENTER DRIVE
LEBANON
,
NH
03756
PUBLIC
GENERAL SUPPORT
120,000
THE FAMILY PLACE
319 US ROUTE 5 SOUTH
NORWICH
,
VT
05055
PUBLIC
GENERAL SUPPORT
20,000
REACHING HIGHER NEW HAMPSHIRE
40 NORTH MAIN STREET SUITE 204
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
1,500
AVA GALLERY AND ART CENTER
11 BANK STREET
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
16,000
FUTURE IN SIGHT
25 WALKER ST
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
10,000
GOOD NEIGHBOR HEALTH CLINIC
70 NORTH MAIN STREET
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
20,000
PLANNED PARENTHOOD OF NORTHERN NEW ENGLAND
784 HERCULES DRIVE SUITE 110
COLCHESTER
,
VT
05446
PUBLIC
GENERAL SUPPORT
25,000
PLANNED PARENTHOOD OF NORTHERN NEW ENGLAND
784 HERCULES DRIVE SUITE 110
COLCHESTER
,
VT
05446
PUBLIC
GENERAL SUPPORT
25,000
ALOHA FOUNDATION - HULBERT OUTDOOR CENTER
2968 LAKE MOREY RD
FAIRLEE
,
VT
05045
PUBLIC
GENERAL SUPPORT
5,000
GIRLS ON THE RUN VT
801 EAST MOREHEAD STREET
CHARLOTTE
,
NC
28202
PUBLIC
GENERAL SUPPORT
5,245
TLC FAMILY RESOURCE CENTER
109 PLEASANT ST
CLAREMONT
,
NH
03743
PUBLIC
GENERAL SUPPORT
74,249
VISIONS FOR CREATIVE HOUSING SOLUTIONS
8 SUNRISE FARM LN
ENFIELD
,
NH
03748
PUBLIC
GENERAL SUPPORT
20,000
BIG BROTHERS BIG SISTERS OF CC AND THE ISLANDS
1934 FALMOUTH ROAD
CENTERVILLE
,
MA
02632
PUBLIC
GENERAL SUPPORT
15,000
CENTER FOR SCHOOL SUCCESS
79 EAST WILDER ROAD
WEST LEBANON
,
NH
03784
PUBLIC
GENERAL SUPPORT
5,000
GREEN MOUNTAIN CHILDREN'S CENTER
92 FARMVU DR
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
10,000
GREEN MOUNTAIN CHILDREN'S CENTER
92 FARMVU DR
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
30,000
GREEN MOUNTAIN CHILDREN'S CENTER
92 FARMVU DR
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
30,878
ORANGE COUNTY PARENT CHILD CENTER
693 VT-110
TUNBRIDGE
,
VT
05077
PUBLIC
GENERAL SUPPORT
30,000
TWIN PINES HOUSING TRUST
240 SOUTH MAIN STREET
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
15,000
VINS
6565 WOODSTOCK ROAD ROUTE 4 PO BOX
1281
QUECHEE
,
VT
05059
PUBLIC
GENERAL SUPPORT
15,000
DISMAS OF VT
103 PARK AVENUE
RUTLAND
,
VT
05701
PUBLIC
GENERAL SUPPORT
10,000
GRANITE UNITED WAY
22 CONCORD ST 2
MANCHESTER
,
NH
03101
PUBLIC
GENERAL SUPPORT
10,000
HAMPSHIRE COOPERATIVE NURSERY SCHOOL
104 LYME RD
HANOVER
,
NH
03755
PUBLIC
GENERAL SUPPORT
10,000
DARTMOUTH HITCHCOCK MEMORIAL HOSPITAL
ONE MEDICAL CENTER DRIVE
LEBANON
,
NH
03756
PUBLIC
GENERAL SUPPORT
30,000
GOOD BEGINNINGS OF THE UPPER VALLEY
PO BOX 5054
WEST LEBANON
,
NH
03784
PUBLIC
GENERAL SUPPORT
8,000
NEW HAMPSHIRE CHARITABLE FOUNDATION
37 PLEASANT STREET
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
50,000
SAFELINE
PO BOX 368
CHELSEA
,
VT
05038
PUBLIC
GENERAL SUPPORT
8,810
UPPER VALLEY HOSTEL
17 SOUTH STREET
HANOVER
,
NH
03755
PUBLIC
GENERAL SUPPORT
5,000
HANOVER NH ROTARY CHARITIES
PO BOX 381
HANOVER
,
NH
03755
PUBLIC
GENERAL SUPPORT
5,000
POSITIVE TRACKS
35 SOUTH MAIN STREET
HANOVER
,
NH
03755
PUBLIC
GENERAL SUPPORT
20,000
UPPER VALLEY INTERFAITH PROJECT
PO BOX 187
MERIDEN
,
NH
03770
PUBLIC
GENERAL SUPPORT
5,000
BRIDGEWATER AREA COMMUNITY FOUNDATION
7335 US-4
BRIDGEWATER
,
VT
05034
PUBLIC
GENERAL SUPPORT
25,000
REVELS NORTH
PO BOX 415
HANOVER
,
NH
03755
PUBLIC
GENERAL SUPPORT
2,500
UPPER VALLEY TEACHER TRAINING PROGRAM
194 DARTMOUTH COLLEGE HIGHWAY ROUTE
4
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
50,000
WAYPOINT
318 5TH ST SE
CEDAR RAPIDS
,
IA
52401
PUBLIC
GENERAL SUPPORT
20,000
THE YARD
PO BOX 405
CHILMARK
,
MA
02535
PUBLIC
GENERAL SUPPORT
9,000
WHITE RIVER PARTNERSHIP
4266 VT-14
SOUTH ROYALTON
,
VT
05068
PUBLIC
GENERAL SUPPORT
2,500
TWIN RIVER CHILDREN'S CENTER
76 SEMINARY HILL RD
WEST LEBANON
,
NH
03784
PUBLIC
GENERAL SUPPORT
10,000
DARTMOUTH HITCHCOCKDHH
ONE MEDICAL CENTER DRIVE
LEBANON
,
NH
03756
PUBLIC
GENERAL SUPPORT
1,000
BRADLEY UNIVERSITY
1501 W BRADLEY AVE
PEORIA
,
IL
61625
PUBLIC
GENERAL SUPPORT
10,000
COLGATE UNIVERSITY
13 OAK DRIVE
HAMILTON
,
NY
13346
PUBLIC
GENERAL SUPPORT
10,000
FRIENDS OF WLRN
172 NE 15TH STREET
MIAMI
,
FL
33132
PUBLIC
GENERAL SUPPORT
1,000
UPPER VALLEY SNOW SPORTS FOUNDATION
160 WHALEBACK MOUNTAIN RD
ENFIELD
,
NH
03748
PUBLIC
GENERAL SUPPORT
25,000
MONTSHIRE MUSEUM OF SCIENCE
ONE MONTSHIRE ROAD
NORWICH
,
VT
05055
PUBLIC
GENERAL SUPPORT
12,000
TEXAS CIVIL RIGHTS PROJECT
1405 MONTOPOLIS DR
AUSTIN
,
TX
78741
PUBLIC
GENERAL SUPPORT
2,500
UNIVERSITY OF TEXAS AUSTIN - LITERACY FIRST
200 W 24TH STREET
AUSTIN
,
TX
78705
PUBLIC
GENERAL SUPPORT
5,000
NH WOMEN'S FOUNDATION
2 DELTA DRIVE
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
5,000
VALLEY COOPERATIVE PRESCHOOL
551 LOWER PLAIN
BRADFORD
,
VT
05033
PUBLIC
GENERAL SUPPORT
25,000
SAIL MARTHA'S VINEYARD
79 BEACH RD
VINEYARD HAVEN
,
MA
02568
PUBLIC
GENERAL SUPPORT
7,500
BREAKTHROUGH CENTRAL TEXAS
1050 E 11TH ST
AUSTIN
,
TX
78702
PUBLIC
GENERAL SUPPORT
5,000
CHILMARK COMMUNITY CENTER
520 S RD
CHILMARK
,
MA
02535
PUBLIC
GENERAL SUPPORT
2,000
MARTHA'S VINEYARD HOSPITAL
1 HOSPITAL RD
OAK BLUFFS
,
MA
02557
PUBLIC
GENERAL SUPPORT
10,000
THE FAMILY PLACE
319 US ROUTE 5 SOUTH
NORWICH
,
VT
05055
PUBLIC
GENERAL SUPPORT
30,000
BARN ARTS CENTER FOR THE ARTS
130 TREMONT RD
BASS HARBOR
,
ME
04653
PUBLIC
GENERAL SUPPORT
2,500
CHILDREN'S CENTER OF THE UPPER VALLEY
178 MECHANIC ST
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
50,000
GREEN MOUNTAIN CHILDREN'S CENTER
92 FARMVU DR
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
13,871
GREEN MOUNTAIN CHILDREN'S CENTER
92 FARMVU DR
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
115,225
NEW HAMPSHIRE HUMANITIES
117 PLEASANT STREET
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
7,500
NEW HAMPSHIRE PUBLIC RADIO
2 PILSBURY STREET
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
10,000
SOCIETY FOR THE PROTECTION OF NH FORESTS
54 PORTSMOUTH STREET
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
5,000
UPPER VALLEY LAND TRUST
19 BUCK ROAD
HANOVER
,
NH
03755
PUBLIC
GENERAL SUPPORT
15,000
VISITING NURSE AND HOSPICE OF NH AND VT
PO BOX 976
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
2,500
GRAFTON COUNTY SENIOR CITIZENS COUNCIL
10 CAMBELL STREET
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
17,000
MAPLE LEAF CHILDREN'S CENTER
2596 VT-113
THETFORD
,
VT
05074
PUBLIC
GENERAL SUPPORT
10,000
NEW HAMPSHIRE WOMEN'S FOUNDATION
2 DELTA DRIVE
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
10,000
UPPER VALLEY HUMANE SOCIETY
300 OLD ROUTE 10
ENFIELD
,
NH
03748
PUBLIC
GENERAL SUPPORT
5,000
VITAL COMMUNITIES
195 NORTH MAIN STREET
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
10,000
ACE MV
100 EDGARTOWN VINEYARD HAVEN RD
OAK BLUFFS
,
MA
02557
PUBLIC
GENERAL SUPPORT
10,000
NEW HAMPSHIRE CHARITABLE FOUNDATION
37 PLEASANT STREET
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
10,000
NEW HAMPSHIRE CHARITABLE FOUNDATION
37 PLEASANT STREET
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
159,125
SPRINGFIELD AREA PARENT CHILD CENTER
6 MAIN ST
NORTH SPRINGFIELD
,
VT
05150
PUBLIC
GENERAL SUPPORT
15,000
WEST CENTRAL BEHAVIOR HEALTH
9 HANOVER STREET SUITE 2
LEBANON
,
NH
03766
PUBLIC
GENERAL SUPPORT
30,000
CROTCHED MOUNTAIN FOUNDATION
1 VERNEY DRIVE
GREENFIELD
,
NH
03047
PUBLIC
GENERAL SUPPORT
25,000
GOVERNOR'S INSTITUTE OF VT
20 W CANAL ST
WINOOSKI
,
VT
05404
PUBLIC
GENERAL SUPPORT
4,000
NORTHERN STAGE
PO BOX 4287
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
10,000
SAFEART
19-40 HAZEN ST
EAST ELMHURST
,
NY
11370
PUBLIC
GENERAL SUPPORT
6,000
CASA OF NH
PO BOX 1327
MANCHESTER
,
NH
03105
PUBLIC
GENERAL SUPPORT
10,000
CASA OF NH
PO BOX 1327
MANCHESTER
,
NH
03105
PUBLIC
GENERAL SUPPORT
25,000
FRIENDS OF NORRIS COTTON CANCER CENTER
ONE MEDICAL CENTER DRIVE
LEBANON
,
NH
03756
PUBLIC
GENERAL SUPPORT
5,000
FRIENDS OF NORRIS COTTON CANCER CENTER
ONE MEDICAL CENTER DRIVE
LEBANON
,
NH
03756
PUBLIC
GENERAL SUPPORT
10,000
NHADACA
130 PEMBROKE RD 100
CONCORD
,
NH
03301
PUBLIC
GENERAL SUPPORT
5,000
UPPER VALLEY HABITAT FOR HUMANITY
5 S MAIN ST 307
WHITE RIVER JUNCTION
,
VT
05001
PUBLIC
GENERAL SUPPORT
20,000
WAYPOINT
318 5TH ST SE
CEDAR RAPIDS
,
IA
52401
PUBLIC
GENERAL SUPPORT
20,000
WOODSTOCK COMMUNITY PRESCHOOL
54 RIVER STREET
WOODSTOCK
,
VT
05091
PUBLIC
GENERAL SUPPORT
10,000
HOPE ON HAVEN HILL
326 ROCHESTER HILL RD
ROCHESTER
,
NH
03867
PUBLIC
GENERAL SUPPORT
10,000
ROOM TO GROW
142 BERKLEY STREET
BOSTON
,
MA
02116
PUBLIC
GENERAL SUPPORT
10,000
NEW HAMPSHIRE ACADEMY OF SCIENCE
95 DARTMOUTH COLLEGE HWY
LYME
,
NH
03768
PUBLIC
GENERAL SUPPORT
68,650
DUPAGE CHILDREN'S MUSEUM
301 N WASHINGTON ST
NAPERVILLE
,
IL
60540
PUBLIC
GENERAL SUPPORT
2,500
GIFT OF ADOPTION
2001 WAUKEGAN ROAD
TECHNY
,
IL
60082
PUBLIC
GENERAL SUPPORT
2,500
UPPER VALLEY WALDORF SCHOOL
80 BLUFF RD
QUECHEE
,
VT
05059
PUBLIC
GENERAL SUPPORT
10,000
ERIKSON INSTITUTE
451 N LASALLE DR
CHICAGO
,
IL
60654
PUBLIC
GENERAL SUPPORT
5,000
CARING COMMUNITY PRESCHOOL
449 ROUTE 244
POST MILLS
,
VT
05058
PUBLIC
GENERAL SUPPORT
7,500
THE MORTON ARBORETUM
4100 IL-53
LISLE
,
IL
60532
PUBLIC
GENERAL SUPPORT
5,000
CHICAGO BOTANIC GARDENS
1000 LAKE COOK RD
GLENCOE
,
IL
60022
PUBLIC
GENERAL SUPPORT
2,500
NEW HEIGHTS YOUTH
50 E 118TH ST
NEW YORK
,
NY
10035
PUBLIC
GENERAL SUPPORT
10,000
FIDELITY DONOR ADVISED FUND
PO BOX 770001
CINCINNATI
,
OH
45277
PUBLIC
GENERAL SUPPORT
500,000
Total
.................................
3a
2,920,800
b
Approved for future payment
Total
.................................
3b
0
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
....
1,192,879
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
.....
84,818
8
Gain or (loss) from sales of assets other than
inventory
............
8,285,688
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
0
9,563,385
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
9,563,385
(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.)
1
N/A
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