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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 KNOX FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
3133 WASHINGTON ROAD NW
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
THOMSON
,
GA
30824
A Employer identification number
58-6163728
B
Telephone number (see instructions)
(706) 597-7907
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)
$
90,873,217
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)
342,988
2
Check
.............
3
Interest on savings and temporary cash investments
31,673
31,673
4
Dividends and interest from securities
...
1,778,160
1,778,160
5a
Gross rents
............
382,459
382,459
b
Net rental income or (loss)
213,202
6a
Net gain or (loss) from sale of assets not on line 10
4,642,292
b
Gross sales price for all assets on line 6a
15,617,020
7
Capital gain net income (from Part IV, line 2)
...
4,642,292
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)
.......
105,794
105,794
12
Total.
Add lines 1 through 11
........
7,283,366
6,940,378
13
Compensation of officers, directors, trustees, etc.
181,000
90,500
90,500
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
58,036
29,018
29,018
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
404,213
207,412
196,801
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
97,438
63,672
0
19
Depreciation (attach schedule) and depletion
...
116,888
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
124,669
123,285
1,378
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
982,244
513,887
317,697
25
Contributions, gifts, grants paid
.......
4,105,640
4,105,640
26
Total expenses and disbursements.
Add lines 24 and 25
5,087,884
513,887
4,423,337
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
2,195,482
b
Net investment income
(if negative, enter -0-)
6,426,491
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2019)
Form 990-PF (2019)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
2
Savings and temporary cash investments
.........
824,015
2,246,633
2,246,633
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
..........
40,000
48,106
48,106
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
67,277,734
80,914,043
80,914,043
c
Investments—corporate bonds (attach schedule)
.......
938,099
906,695
906,695
11
Investments—land, buildings, and equipment: basis
6,556,064
Less: accumulated depreciation (attach schedule)
2,138,249
4,532,650
4,417,815
6,556,064
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
481,438
165,358
165,358
14
Land, buildings, and equipment: basis
28,260
Less: accumulated depreciation (attach schedule)
17,580
12,733
10,680
28,260
15
Other assets (describe
)
16,360
8,058
8,058
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
74,123,029
88,717,388
90,873,217
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
)
200
0
23
Total liabilities
(add lines 17 through 22)
.........
200
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
74,122,829
88,717,388
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances
(see instructions)
.....
74,122,829
88,717,388
30
Total liabilities and net assets/fund balances
(see instructions)
.
74,123,029
88,717,388
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
74,122,829
2
Enter amount from Part I, line 27a
.....................
2
2,195,482
3
Other increases not included in line 2 (itemize)
3
12,399,207
4
Add lines 1, 2, and 3
..........................
4
88,717,518
5
Decreases not included in line 2 (itemize)
5
130
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
88,717,388
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
ABBVIE INCORPORATED (ABBV)
2016-12-01
2019-06-11
b
AMERICAN EXPRESS COMPANY (AXP)
2017-04-28
2019-02-20
c
AMERICAN TOWER CORPORATION NEW REIT (AMT)
2016-11-15
2019-02-05
d
AT&T INCORPORATED (T)
2005-09-21
2019-08-08
e
AT&T INCORPORATED (T)
2018-01-19
2019-08-08
AVNET INCORPORATED (AVT)
2017-07-21
2019-12-23
BGC PARTNERS INCORPORATED CLASS A (BGCP)
2017-06-30
2019-10-25
BLACKROCK INCORPORATED (BLK)
2018-07-17
2019-04-02
BRISTOL-MYERS SQUIBB COMPANY (BMY)
2018-04-25
2019-04-02
BROADCOM INCORPORATED (AVGO)
2018-02-12
2019-02-05
BROWN & BROWN INCORPORATED (BRO)
2014-03-07
2019-11-01
BROWN & BROWN INCORPORATED (BRO)
2014-05-29
2019-11-01
BROWN & BROWN INCORPORATED (BRO)
2014-10-07
2019-11-01
CATCHMARK TIMBER TR INCORPORATED CLASS A REIT (CTT)
2017-04-03
2019-11-01
CATCHMARK TIMBER TR INCORPORATED CLASS A REIT (CTT)
2017-02-23
2019-11-01
CELGENE CORPORATION (CELGOLD)
2017-08-01
2019-10-25
CIGNA CORPORATION NEW (CI)
2014-10-03
2019-10-25
COCA COLA COMPANY (KO)
2018-01-30
2019-12-26
COLUMBIA SPORTSWEAR COMPANY (COLM)
2014-11-20
2019-12-23
COMERICA INCORPORATED (CMA)
2018-11-16
2019-08-27
COUSINS PPTYS INCORPORATED COM NEW REIT (CUZ)
2007-08-23
2019-06-20
CRACKER BARREL OLD CTRY STORE (CBRL)
2014-04-22
2019-11-01
CRACKER BARREL OLD CTRY STORE (CBRL)
2017-04-03
2019-11-01
CRACKER BARREL OLD CTRY STORE (CBRL)
2014-03-26
2019-11-01
CULLEN FROST BANKERS INCORPORATED (CFR)
2017-05-26
2019-08-14
CULLEN FROST BANKERS INCORPORATED (CFR)
2018-01-12
2019-08-14
CULLEN FROST BANKERS INCORPORATED (CFR)
2018-01-12
2019-02-06
DISNEY WALT COMPANY COM DISNEY (DIS)
2018-12-06
2019-12-20
DISNEY WALT COMPANY COM DISNEY (DIS)
2019-02-20
2019-12-20
DOW INCORPORATED (DOW)
2019-06-06
2019-12-10
EMPIRE ST RLTY TR INCORPORATED CLASS A REIT (ESRT)
2018-06-26
2019-11-01
ENTERPRISE PRODUCTS PARTNERS L P (EPD)
2014-10-03
2019-10-25
EOG RES INCORPORATED (EOG)
2017-07-21
2019-12-10
EPR PPTYS COM SH BEN INT (EPR)
2015-08-20
2019-11-01
EPR PPTYS COM SH BEN INT (EPR)
2017-10-17
2019-11-01
EPR PPTYS COM SH BEN INT (EPR)
2014-10-07
2019-11-01
EQUITY RESIDENTIAL SH BEN INT REIT (EQR)
2000-07-06
2019-10-01
ESCO TECHNOLOGIES INCORPORATED (ESE)
2016-07-25
2019-12-23
EVERGY INCORPORATED (EVRG)
2018-10-22
2019-12-20
FEDEX CORPORATION (FDX)
2018-02-06
2019-10-25
FIDUS INVT CORPORATION (FDUS)
2014-09-05
2019-10-25
FIRST TRUST
2001-01-01
2019-05-30
FLIR SYSTEMS INCORPORATED (FLIR)
2017-12-05
2019-02-05
GENESIS ENERGY L P UNIT LTD PARTN (GEL)
2017-01-26
2019-08-27
GENUINE PARTS COMPANY (GPC)
2015-03-25
2019-02-20
GENUINE PARTS COMPANY (GPC)
2017-06-05
2019-02-20
GLOBAL PMTS INCORPORATED (GPN)
2019-04-10
2019-09-23
GOLDMAN SACHS INTERNATIONAL EQUITY INSIGHTS FUND CLS A M/F (GCIAX)
2017-12-26
2019-04-02
GOLDMAN SACHS INTERNATIONAL EQUITY INSIGHTS FUND CLS A M/F (GCIAX)
2017-07-25
2019-04-02
GOLDMAN SACHS INTERNATIONAL EQUITY INSIGHTS FUND CLS A M/F (GCIAX)
2018-12-24
2019-04-02
GRANITE PT MTG TR INCORPORATED REIT (GPMT)
2018-06-18
2019-11-01
GRANITE PT MTG TR INCORPORATED REIT (GPMT)
2018-03-02
2019-02-05
GRANITE PT MTG TR INCORPORATED REIT (GPMT)
2018-03-02
2019-11-01
HEXCEL CORPORATION NEW (HXL)
2015-11-20
2019-12-23
HOLLYFRONTIER CORPORATION (HFC)
2014-09-11
2019-10-25
HONEYWELL INTERNATIONAL INCORPORATED (HON)
2015-06-01
2019-04-10
HUBBELL INCORPORATED (HUBB)
2017-06-05
2019-12-26
ISHARES INCORPORATED MSCI EURZONE ETF (EZU)
2017-04-27
2019-02-05
ISHARES TR CORE S&P SCP ETF (IJR)
2018-07-11
2019-08-27
ISHARES TR MSCI AC ASIA ETF (AAXJ)
2019-01-28
2019-10-15
ISHARES TR MSCI AC ASIA ETF (AAXJ)
2018-09-26
2019-10-15
ISHARES TR U.S. FIN SVC ETF (IYG)
2018-06-13
2019-06-24
ISHARES TR U.S. FIN SVC ETF (IYG)
2017-08-31
2019-03-12
ISHARES TR U.S. FIN SVC ETF (IYG)
2017-09-13
2019-06-24
ISHARES TR U.S. FIN SVC ETF (IYG)
2017-09-13
2019-03-12
ISHARES TR U.S. FIN SVC ETF (IYG)
2019-01-28
2019-06-24
JOHNSON & JOHNSON (JNJ)
2018-07-11
2019-11-01
KAMAN CORPORATION (KAMN)
2017-02-22
2019-12-23
KEYCORP (KEY)
2017-09-25
2019-01-09
LANDSTAR SYSTEMS INCORPORATED (LSTR)
2015-06-05
2019-11-01
LAZARD LIMITED SHS A (BERMUDA) (LAZ)
2013-11-05
2019-02-05
LEGGETT & PLATT INCORPORATED (LEG)
2018-05-31
2019-12-23
MARRIOTT INTERNATIONAL INCORPORATED NEW CLASS A (MAR)
2014-10-03
2019-10-25
MARRIOTT INTERNATIONAL INCORPORATED NEW CLASS A (MAR)
2014-01-27
2019-10-25
MEDTRONIC PLC SHS (IRELAND) (MDT)
2016-01-21
2019-12-26
MERCK & COMPANY. INCORPORATED (MRK)
2015-10-01
2019-04-02
MERCK & COMPANY. INCORPORATED (MRK)
2009-08-04
2019-04-02
MERCK & COMPANY. INCORPORATED (MRK)
2018-01-12
2019-04-02
MERCK & COMPANY. INCORPORATED (MRK)
2018-01-12
2019-02-20
MERCK & COMPANY. INCORPORATED (MRK)
2011-01-05
2019-04-02
MESA LABS INCORPORATED (MLAB)
2016-05-04
2019-12-23
MESA LABS INCORPORATED (MLAB)
2014-10-07
2019-12-23
MESA LABS INCORPORATED (MLAB)
2014-10-07
2019-02-05
METHODE ELECTRS INCORPORATED (MEI)
2016-05-04
2019-12-23
METHODE ELECTRS INCORPORATED (MEI)
2017-12-19
2019-12-23
METHODE ELECTRS INCORPORATED (MEI)
2016-11-07
2019-12-23
METHODE ELECTRS INCORPORATED (MEI)
2016-09-13
2019-12-23
METHODE ELECTRS INCORPORATED (MEI)
2018-01-05
2019-12-23
MICROCHIP TECHNOLOGY INCORPORATED (MCHP)
2010-02-04
2019-09-04
MICROCHIP TECHNOLOGY INCORPORATED (MCHP)
2014-10-03
2019-09-04
MICROSOFT CORPORATION (MSFT)
2012-01-23
2019-02-20
MICROSOFT CORPORATION (MSFT)
2012-01-23
2019-12-30
MICROSOFT CORPORATION (MSFT)
2012-01-23
2019-04-10
MICROSOFT CORPORATION (MSFT)
2012-01-23
2019-12-26
MONRO INCORPORATED (MNRO)
2017-04-03
2019-02-05
MSA SAFETY INCORPORATED (MSA)
2017-12-15
2019-12-23
NEWMARK GROUP INCORPORATED CLASS A (NMRK)
2017-06-30
2019-10-25
NOKIA CORP NTS ISIN US654902AB18 5.3750% DUE 05/15/2019 (654902AB1)
2012-08-29
2019-05-15
O REILLY AUTOMOTIVE INCORPORATED NEW (ORLY)
2014-10-03
2019-10-25
OLD REP INTERNATIONAL CORPORATION (ORI)
2016-07-25
2019-02-05
ORACLE CORPORATION (ORCL)
2017-12-05
2019-01-09
ORACLE CORPORATION (ORCL)
2017-08-01
2019-01-30
PAYCHEX INCORPORATED (PAYX)
2015-09-18
2019-04-10
PAYPAL HLDGS INCORPORATED (PYPL)
2017-12-05
2019-02-05
PEOPLES UTD FINL INCORPORATED (PBCT)
2018-08-27
2019-12-26
PEPSICO INCORPORATED (PEP)
2016-10-14
2019-10-25
PLAINS ALL AMERN PIPELINE L P UNIT LTD PARTN (PAA)
2014-09-11
2019-04-22
POWER INTEGRATIONS INCORPORATED (POWI)
2015-11-20
2019-11-01
PROCTER & GAMBLE COMPANY (PG)
2015-11-20
2019-02-20
PROCTER & GAMBLE COMPANY (PG)
2007-05-21
2019-04-10
PROCTER & GAMBLE COMPANY (PG)
2007-05-21
2019-12-26
PROCTER & GAMBLE COMPANY (PG)
2007-05-21
2019-02-20
PROCTER & GAMBLE COMPANY (PG)
2018-02-05
2019-02-20
ROPER TECHNOLOGIES INCORPORATED (ROP)
2017-11-13
2019-02-05
S&P GLOBAL INCORPORATED (SPGI)
2016-06-24
2019-12-26
S&P GLOBAL INCORPORATED (SPGI)
2016-06-24
2019-02-20
SIMULATIONS PLUS INCORPORATED (SLP)
2014-05-08
2019-11-01
SIMULATIONS PLUS INCORPORATED (SLP)
2014-05-09
2019-11-01
SPDR CONSUMER DISCRETIONARY SELECT SECTOR FUND (XLY)
2017-08-31
2019-03-12
SPDR HEALTH CARE SELECT SECTOR FUND (XLV)
2017-08-31
2019-03-12
SUBURBAN PROPANE PARTNERS L P UNIT LTD PARTN (SPH)
2016-10-28
2019-08-27
TEXAS INSTRS INCORPORATED (TXN)
2018-10-16
2019-10-16
TEXAS INSTRS INCORPORATED (TXN)
2018-10-22
2019-10-16
TUPPERWARE BRANDS CORPORATION (TUP)
2014-03-07
2019-02-05
TUPPERWARE BRANDS CORPORATION (TUP)
2014-02-25
2019-02-05
TUPPERWARE BRANDS CORPORATION (TUP)
2013-10-29
2019-02-05
TUPPERWARE BRANDS CORPORATION (TUP)
2013-12-04
2019-02-05
U S PHYSICAL THERAPY INCORPORATED (USPH)
2016-07-25
2019-12-23
U S PHYSICAL THERAPY INCORPORATED (USPH)
2016-07-25
2019-11-01
U S PHYSICAL THERAPY INCORPORATED (USPH)
2016-07-25
2019-02-05
UNITED TECHNOLOGIES CORPORATION (UTX)
2018-07-11
2019-07-22
VANGUARD FTSE EMERGING MARKETS ETF (VWO)
2017-04-27
2019-03-14
VISA INCORPORATED COM CLASS A (V)
2018-01-18
2019-02-20
WABTEC (WAB)
2019-02-26
2019-04-02
WABTEC (WAB)
2019-02-26
2019-03-01
WABTEC (WAB)
2019-02-26
2019-04-02
WABTEC (WAB)
2019-02-26
2019-04-02
WABTEC (WAB)
2019-02-26
2019-03-01
WALMART INCORPORATED (WMT)
2014-11-03
2019-04-02
WATSCO INCORPORATED (WSO)
2014-10-07
2019-11-01
WATSCO INCORPORATED (WSO)
2013-11-12
2019-11-01
WELLTOWER INCORPORATED REIT (WELL)
2014-09-19
2019-10-25
WILEY JOHN & SONS INCORPORATED CLASS A (JW.A)
2013-11-12
2019-11-01
WILEY JOHN & SONS INCORPORATED CLASS A (JW.A)
2017-12-05
2019-11-01
WILEY JOHN & SONS INCORPORATED CLASS A (JW.A)
2014-11-20
2019-11-01
WILEY JOHN & SONS INCORPORATED CLASS A (JW.A)
2016-05-04
2019-11-01
WILEY JOHN & SONS INCORPORATED CLASS A (JW.A)
2014-10-07
2019-11-01
WILLIS TOWERS WATSON PLC LIMITED SHS (IRELAND) (WLTW)
2012-07-18
2019-12-26
WILLIS TOWERS WATSON PLC LIMITED SHS (IRELAND) (WLTW)
2016-01-21
2019-02-20
WILLIS TOWERS WATSON PLC LIMITED SHS (IRELAND) (WLTW)
2012-07-18
2019-02-20
WOODWARD INCORPORATED (WWD)
2013-10-29
2019-12-23
WORLDPAY INCORPORATED CLASS A (3WPOLD)
2018-11-16
2019-04-02
WP CAREY INCORPORATED REIT (WPC)
2011-02-24
2019-04-01
WP CAREY INCORPORATED REIT (WPC)
2011-02-24
2019-01-24
WP CAREY INCORPORATED REIT (WPC)
2011-02-24
2019-01-24
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
311,842
237,357
74,485
b
42,630
31,811
10,819
c
51,155
31,087
20,068
d
256,292
181,188
75,104
e
86,803
94,220
-7,417
42,660
39,003
3,657
125,595
179,467
-53,872
45,902
53,142
-7,240
46,974
51,366
-4,392
54,275
48,311
5,964
9,056
3,721
5,335
39,997
16,021
23,976
75,465
32,164
43,301
37,054
29,712
7,342
12,351
9,214
3,137
216,331
280,230
-63,899
132,249
145,140
-12,891
13,128
11,512
1,616
58,922
25,806
33,116
41,097
57,091
-15,994
6
16
-10
54,729
33,842
20,887
4,691
4,767
-76
9,382
5,850
3,532
292,705
322,202
-29,497
1,687
2,031
-344
224,070
229,486
-5,416
447,862
344,310
103,552
36,710
28,446
8,264
52,888
50,750
2,138
14,576
16,878
-2,302
156,006
119,055
36,951
29,901
37,270
-7,369
19,259
13,470
5,789
21,571
19,556
2,015
42,371
26,954
15,417
2,574,646
360,148
2,214,498
91,071
42,622
48,449
255,950
228,599
27,351
230,695
377,390
-146,695
183,246
231,568
-48,322
2,775
2,775
24,540
23,139
1,401
19,583
22,491
-2,908
10,896
9,451
1,445
27,241
23,473
3,768
50
36
14
439
479
-40
32,325
35,006
-2,681
530
468
62
9,338
9,275
63
15,185
13,448
1,737
22,410
20,172
2,238
37,337
23,463
13,874
264,276
222,692
41,584
40,045
24,951
15,094
22,109
17,675
4,434
37,759
39,402
-1,643
29,477
34,369
-4,892
44,092
43,587
505
43,888
45,963
-2,075
4,106
4,203
-97
95,945
85,492
10,453
3,842
3,324
518
63,370
57,080
6,290
169,161
158,270
10,891
52,537
50,630
1,907
27,647
21,336
6,311
54,566
65,073
-10,507
73,981
43,429
30,552
11,853
11,155
698
32,086
26,277
5,809
89,113
50,220
38,893
198,028
111,600
86,428
22,598
14,976
7,622
20,760
12,412
8,348
52,316
18,784
33,532
20,760
14,538
6,222
78,874
58,153
20,721
41,520
18,284
23,236
50,189
20,356
29,833
25,095
5,983
19,112
41,255
10,769
30,486
56,577
43,041
13,536
47,148
48,959
-1,811
22,002
18,339
3,663
19,645
17,184
2,461
19,645
20,450
-805
264,042
64,041
200,001
144,008
74,037
69,971
53,629
14,760
38,869
14,189
2,657
11,532
59,749
14,760
44,989
78,824
14,760
64,064
31,378
21,457
9,921
58,320
36,645
21,675
106,140
111,679
-5,539
75,000
64,875
10,125
655,216
228,999
426,217
36,043
35,342
701
47,615
48,472
-857
279,286
280,065
-779
57,252
33,227
24,025
64,316
50,714
13,602
49,887
56,832
-6,945
344,793
266,313
78,480
95,998
143,331
-47,333
56,740
32,160
24,580
49,654
38,479
11,175
52,306
31,729
20,577
16,270
8,249
8,021
49,654
31,729
17,925
148,963
126,087
22,876
29,621
25,750
3,871
41,024
15,639
25,385
19,718
10,426
9,292
35,195
5,910
29,285
536
90
446
110,143
89,440
20,703
123,366
109,727
13,639
20,327
15,819
4,508
156,848
122,502
34,346
39,212
29,706
9,506
3,574
10,587
-7,013
3,574
10,050
-6,476
31,613
104,117
-72,504
6,048
19,837
-13,789
22,910
12,093
10,817
11,357
4,837
6,520
38,058
21,163
16,895
52,869
50,011
2,858
41,847
40,303
1,544
36,034
30,588
5,446
1,402
1,470
-68
124
124
1,166
1,222
-56
1,603
1,680
-77
36
38
-2
341,380
265,861
75,519
28,352
13,876
14,476
24,808
13,257
11,551
306,470
211,394
95,076
30,378
31,957
-1,579
19,161
24,108
-4,947
7,478
9,327
-1,849
21,031
22,068
-1,037
28,041
33,048
-5,007
34,230
16,834
17,396
27,281
17,584
9,697
15,346
8,912
6,434
59,699
20,571
39,128
79,625
57,686
21,939
388,993
236,318
152,675
1,336,071
1,420,345
-84,274
324,314
334,548
-10,234
304,171
304,171
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
74,485
b
10,819
c
20,068
d
75,104
e
-7,417
3,657
-53,872
-7,240
-4,392
5,964
5,335
23,976
43,301
7,342
3,137
-63,899
-12,891
1,616
33,116
-15,994
-10
20,887
-76
3,532
-29,497
-344
-5,416
103,552
8,264
2,138
-2,302
36,951
-7,369
5,789
2,015
15,417
2,214,498
48,449
27,351
-146,695
-48,322
2,775
1,401
-2,908
1,445
3,768
14
-40
-2,681
62
63
1,737
2,238
13,874
41,584
15,094
4,434
-1,643
-4,892
505
-2,075
-97
10,453
518
6,290
10,891
1,907
6,311
-10,507
30,552
698
5,809
38,893
86,428
7,622
8,348
33,532
6,222
20,721
23,236
29,833
19,112
30,486
13,536
-1,811
3,663
2,461
-805
200,001
69,971
38,869
11,532
44,989
64,064
9,921
21,675
-5,539
10,125
426,217
701
-857
-779
24,025
13,602
-6,945
78,480
-47,333
24,580
11,175
20,577
8,021
17,925
22,876
3,871
25,385
9,292
29,285
446
20,703
13,639
4,508
34,346
9,506
-7,013
-6,476
-72,504
-13,789
10,817
6,520
16,895
2,858
1,544
5,446
-68
124
-56
-77
-2
75,519
14,476
11,551
95,076
-1,579
-4,947
-1,849
-1,037
-5,007
17,396
9,697
6,434
39,128
21,939
152,675
-84,274
-10,234
304,171
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
4,642,292
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
4,150,010
78,916,963
0.052587
2017
4,010,709
76,696,423
0.052293
2016
3,379,818
67,780,679
0.049864
2015
3,047,967
62,154,570
0.049039
2014
2,796,659
63,947,157
0.043734
2
Total
of line 1, column (d)
.....................
2
0.247517
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
0.049503
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
85,505,818
5
Multiply line 4 by line 3
......................
5
4,232,795
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
64,265
7
Add lines 5 and 6
........................
7
4,297,060
8
Enter qualifying distributions from Part XII, line 4
,.............
8
4,423,337
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
64,265
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
64,265
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
64,265
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
48,106
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
88,106
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
23,841
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
23,841
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
Yes
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
Yes
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
GA
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
NONE
14
The books are in care of
JEFFERSON BA KNOX
Telephone no.
(706) 595-1907
Located at
3133 WASHINGTON RD
THOMSON
GA
ZIP+4
30824
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
JEFFERSON B A KNOX
DIRECTOR
40.00
150,000
37,500
0
P O BOX 26
THOMSON
,
GA
30824
ELIZABETH KNOX HOPKINS
DIRECTOR
10.00
31,000
7,750
0
3133 WASHINGTON ROAD NW
THOMSON
,
GA
30824
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
RAYMOND JAMES FINANCIAL INC
INVESTMENT MANAGEMENT
164,836
880 CARILLON PARKWAY
ST PETERSBURG
,
FL
33716
CRAWFORD INVESTMENT COUNCIL
INVESTMENT MANAGEMENT
144,094
600 GALLERIAS PARKWAY SUITE 1650
ATLANTA
,
GA
30339
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
78,822,490
b
Average of monthly cash balances
.......................
1b
1,401,126
c
Fair market value of all other assets (see instructions)
................
1c
6,584,321
d
Total
(add lines 1a, b, and c)
.........................
1d
86,807,937
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
86,807,937
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
1,302,119
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
85,505,818
6
Minimum investment return.
Enter 5% of line 5
..................
6
4,275,291
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
4,275,291
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
64,265
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
16,678
c
Add lines 2a and 2b
............................
2c
80,943
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
4,194,348
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
4,194,348
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
4,194,348
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
4,423,337
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
4,423,337
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
64,265
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
4,359,072
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
4,194,348
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
2,995,359
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:
$
4,423,337
a
Applied to 2018, but not more than line 2a
2,995,359
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
.....
1,427,978
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
..........
2,766,370
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).)
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:
THE KNOX FOUNDATION
3133 WASHINGTON ROAD
THOMSON
,
GA
30824
(706) 595-1907
b
The form in which applications should be submitted and information and materials they should include:
CONTACT KNOX FOUNDATION FOR FORMS TO SUBMIT WITH ANY APPLICATION FOR FUNDING. MUST BE A 501(C)3 ORGANIZATION TO APPLY.
c
Any submission deadlines:
CONTACT KNOX FOUNDATION FOR SUMBISSION DEADLINES FOR THE YEAR.
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
CONTRIBUTIONS ARE ONLY TO 501(C)3 ORGANIZATIONS.
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
ACTIVITIES COUNCIL OF THOMSON
P O BOX 674
THOMSON
,
GA
30824
N/A
PC
ARTS
20,000
ALZHEIMER'S ASSOCIATION GA CHAPTER
106 SRP DROVE STE A
EVANS
,
GA
30809
N/A
PC
MEDICAL
10,000
AMERICAN CANCER SOCIETY - AUGUSTA
2607 COMMONS BOULEVARD
AUGUSTA
,
GA
30909
N/A
PC
MEDICAL
11,000
AMERICAN CANCER SOCIETY - COLUMBIA
2607 COMMONS BOULEVARD
AUGUSTA
,
GA
30909
N/A
PC
MEDICAL
5,000
AMERICAN CANCER SOCIETY MCDUFFIE &
P O BOX 539
THOMSON
,
GA
30824
N/A
PC
MEDICAL
5,000
AMERICAN RED CROSS
1322 ELLIS STREET
AUGUSTA
,
GA
30901
N/A
PC
SOCIAL SERVICES
150,000
AUGUSTA CHARITY CLASSIC FUND
4129 COLUMBIA ROAD
MARTINEZ
,
GA
30907
N/A
PC
SPONSORSHIP
2,000
AUGUSTA CHORAL SOCIETY
P O BOX 1402
AUGUSTA
,
GA
309031402
N/A
PC
ARTS
38,000
AUGUSTA EXCHANGE CLUB CHARITY
P O BOX 3884
AUGUSTA
,
GA
30914
N/A
PC
SOCIAL SERVICES
6,000
AUGUSTA JEWISH MUSEUM
2623 WASHINGTON RD
AUGUSTA
,
GA
30904
N/A
PC
EDUCATION
25,000
AUGUSTA LOCALLY GROWN
PO BOX 796
EVANS
,
GA
30809
N/A
PC
SOCIAL SERVICES
5,000
AUGUSTA MINI THEATRE INC
2548 DEANS BRIDGE ROAD
AUGUSTA
,
GA
30906
N/A
PC
ARTS
10,000
AUGUSTA MUSEUM OF HISTORY
560 REYNOLDS STREET
AUGUSTA
,
GA
30901
N/A
PC
HISTORY
50,000
AUGUSTA PLAYERS INC
1301 GREENE STREET
AUGUSTA
,
GA
30901
N/A
PC
ARTS
45,000
AUGUSTA PREPARATORY DAY SCHOOL
285 FLOWING WELLS ROAD
MARTINEZ
,
GA
30907
N/A
PC
EDUCATION
10,000
AUGUSTA RESCUE MISSION
526 WALKER ST
AUGUSTA
,
GA
30901
N/A
PC
SOCIAL SERVICES
25,000
AUGUSTA ROWING CLUB
101 RIVERFRONT DRIVE
AUGUSTA
,
GA
30901
N/A
PC
SOCIAL SERVICES
20,000
APPARO ACADEMY
3104 SKINNER MILL RD
AUGUSTA
,
GA
30909
N/A
PC
MEDICAL
51,000
AUGUSTA TRAINING SHOP
1704 JENKINS ST
AUGUSTA
,
GA
30904
N/A
PC
SOCIAL SERVICES
10,000
AUGUSTA UNIVERSITY BIRDIE CLUB
PO BOX 14127
AUGUSTA
,
GA
30919
N/A
PC
SOCIAL SERVICES
17,478
AUGUSTA UNIVERSITY FOUNDATION - EF
1120 15TH STREET FL-1000
AUGUSTA
,
GA
30912
N/A
PC
EDUCATION
30,000
AUGUSTA URBAN MINISTRIES
1405 15TH ST
AUGUSTA
,
GA
30901
N/A
PC
MEDICAL
15,000
AUGUSTA-RICHMOND CO LIBRARY
823 TELFAIR ST
AUGUSTA
,
GA
30901
N/A
PC
EDUCATION
45,000
BOYS & GIRLS CLUB OF THE CSRATHOMSON
206 MILLEDGE ROAD
AUGUSTA
,
GA
30904
N/A
PC
SOCIAL SERVICES
64,800
BOYS & GIRLS CLUB OF PLATEAU
42 COMMUNITY PL
CASHIERS
,
NC
28717
N/A
PC
SOCIAL SERVICES
103,000
CENTER FOR NEW BEGINNINGS
PO BOX 1066
WAYNESBORO
,
GA
30830
N/A
PC
SOCIAL SERVICES
10,000
CHILD ENRICHMENT INC
PO BOX 12036
AUGUSTA
,
GA
309142036
N/A
PC
SOCIAL SERVICES
50,000
CHRIST COMMUNITY HEALTH CENTER
127 TELFAIR ST
AUGUSTA
,
GA
30901
N/A
PC
MEDICAL
40,000
CHURCH OF OUR SAVIOR
4227 COLUMBIA RD
AUGUSTA
,
GA
30907
N/A
PC
CHURCH
8,000
CHURCH OF THE GOOD SHEPHERD
2230 WALTON WAY
AUGUSTA
,
GA
30904
N/A
PC
CHURCH
25,000
COLLEGE OF CHARLESTON FOUNDATION
66 GEORGE STREET
CHARLESTON
,
SC
29424
N/A
PC
EDUCATION
10,000
COLTON BALLET COMPANY OF AUGUSTA
2419 WALTON WAY
AUGUSTA
,
GA
30909
N/A
PC
ARTS
15,000
COMMUNITY FOUNDATION OF THE CSRA
P O BOX 31358
AUGUSTA
,
GA
30903
N/A
PC
SOCIAL SERVICES
4,000
COMMUNITY IN SCHOOLS AUGUSTA -- RIC
P O BOX 1604
AUGUSTA
,
GA
30903
N/A
PC
EDUCATION
14,000
COMMUNITY MINISTRY OF N AUGUSTA
646 E BUENA VISTA AVE
NORTH AUGUSTA
,
SC
29841
N/A
PC
CHURCH
100,000
CSRA HUMANE SOCIETY
425 WOOD STREET
AUGUSTA
,
GA
30904
N/A
PC
SOCIAL SERVICES
25,000
DAVIS LOVE FOUNDATION
100 RETREAT AVENUE
ST SIMONS ISLAND
,
GA
31522
N/A
PC
SOCIAL SERVICES
5,400
EASTER SEALS EAST GEORGIA
P O BOX 2441
AUGUSTA
,
GA
30903
N/A
PC
HEALTH
25,000
EMPTY STOCKING FUND
P O BOX 1928
AUGUSTA
,
GA
30903
N/A
PC
SOCIAL SERVICES
5,000
EPISCOPAL DAY SCHOOL
2248 WALTON WAY
AUGUSTA
,
GA
30904
N/A
PC
EDUCATION
260,000
FAMILY COUNSELING CENTER OF THE CSRA
3711 EXECUTIVE CENTER
MARTINEZ
,
GA
30907
N/A
PC
SOCIAL SERVICES
16,000
FAMILY PROMISE OF AUGUSTA
2177 CENTRAL AVENUE
AUGUSTA
,
GA
30904
N/A
PC
SOCIAL SERVICES
32,500
FAMILY Y OF GREATER AUGUSTA
3570 WHEELER ROAD
AUGUSTA
,
GA
30909
N/A
PC
SOCIAL SERVICES
390,000
FAMILY Y OF THOMSON
521 HILL ST
THOMSON
,
GA
30824
N/A
PC
SOCIAL SERVICES
10,000
FELLOWSHIP OF CHRISTIAN ATHLETES
P O BOX 204168
AUGUSTA
,
GA
30917
N/A
PC
SOCIAL SERVICES
5,000
FIRST TEE OF THE GOLDEN ISLES
3528 DARIEN HWY 232
BRUNSWICK
,
TX
31525
N/A
PC
SOCIAL SERVICES
5,400
FIRST UNITED METHODIST CHURCH OF TH
353 MAIN STREET
THOMSON
,
GA
30824
N/A
PC
CHURCH
13,200
FORCES UNITED
701 GREENE STREET SUITE 1
AUGUSTA
,
GA
30901
N/A
PC
MEDICAL
25,000
FORT GORDON CHRISTMAS HOUSE
PO BOX 7030
FORT GORDON
,
GA
30905
N/A
PC
SOCIAL SERVICES
10,000
GA CAROLINA COUNCIL BSA
4132 MADELINE DRIVE
AUGUSTA
,
GA
30909
N/A
PC
SOCIAL SERVICES
115,000
GA CATTLEMEN'S FOUNDATION
100 CATTLEMENS DRIVE
MACON
,
GA
31220
N/A
PC
SOCIAL SERVICES
5,000
GA PUBLIC BROADCASTING
260 14TH STREET NW
ATLANTA
,
GA
30318
N/A
PC
EDUCATION
7,500
GA STATE GOLF ASSOCIATION
121 VILLAGE PKWY NE BLDG 3
MARIETTA
,
GA
30067
N/A
PC
ATHLETICS
2,500
GA TRUST FOR HISTORIC PRESERVATION
1516 PEACHTREE RD NW
ATLANTA
,
GA
30309
N/A
PC
EDUCATION
5,000
GERTRUDE HERBERT INSTITUTE OF ART
506 TELFAIR STREET
AUGUSTA
,
GA
309012310
N/A
PC
ARTS
350,000
GIRL SCOUTS OF HISTORIC GEORGIA
6869 COLUMBUS ROAD
MACON
,
GA
31052
N/A
PC
SOCIAL SERVICES
15,000
GLASCOCK COUNTY PUBLIC LIBRARY
738 RAILROAD AVE
GIBSON
,
GA
30810
N/A
PC
EDUCATION
1,000
GOLDEN HARVEST FOOD BANK
3310 COMMERCE DRIVE
AUGUSTA
,
GA
30909
N/A
PC
SOCIAL SERVICES
45,000
GREATER AUGUSTA ARTS COUNCIL
P O BOX 1776
AUGUSTA
,
GA
30903
N/A
PC
ARTS
22,000
HALE FOUNDATION
P O BOX 2843
AUGUSTA
,
GA
309142843
N/A
PC
SOCIAL SERVICES
45,000
HARLEM ARTS COUNCIL
375 N LOUISVILLE ST
HARLEM
,
GA
30814
N/A
PC
ARTS
2,000
HERITAGE ACADEMY
333 GREENE STREET
AUGUSTA
,
GA
30901
N/A
PC
EDUCATION
30,000
HIGHLANDS-CASHIERS LAND TRUST
348 S 5TH ST 214
HIGHLANDS
,
NC
28741
N/A
PC
HISTORY
4,000
HISTORIC AUGUSTA INC
P O BOX 37
AUGUSTA
,
GA
30903
N/A
PC
HISTORY
46,500
HOPE HOUSE INC
P O BOX 397
AUGUSTA
,
GA
30914
N/A
PC
SOCIAL SERVICE
15,000
IMPERIAL COMMUNITY THEATRE
749 BROAD STREET
AUGUSTA
,
GA
30901
N/A
PC
ARTS
38,000
JESSYE NORMAN SCHOOL OF THE ARTS
739 GREENE STREET
AUGUSTA
,
GA
30901
N/A
PC
ARTS
55,000
JUD C HICKEY ALZHEIMER'S CARE
1931 CENTRAL AVENUE
AUGUSTA
,
GA
30904
N/A
PC
MEDICAL
20,000
LOWCOUNTRY MARITIME SOCIETY
PO BOX 22751
CHARLESTON
,
SC
29413
N/A
PC
HISTORY
3,000
LUCY CRAFT LANEY MUSEUM
1116 PHILIPS STREET
AUGUSTA
,
GA
30909
N/A
PC
HISTORY
20,000
LYDIA PROJECT
1369 INTERSTATE PARKWAY
AUGUSTA
,
GA
30909
N/A
PC
HEALTH
25,000
LYNNDALE INC
1490 EISENHOWER DR
AUGUSTA
,
GA
30904
N/A
PC
SOCIAL SERVICES
5,000
MACH ACADEMY
1850 CHESTER AVENUE
AUGUSTA
,
GA
30906
N/A
PC
EDUCATION
10,000
MCCALLIE SCHOOL
500 DODDS AVENUE
CHATTANOOGA
,
TN
37404
N/A
PC
EDUCATION
50,000
MOLLYS MILITIA
PO BOX 6816
NORTH AUGUSTA
,
SC
29861
N/A
PC
SOCIAL SERVICES
15,000
MORRIS MUSEUM OF ART
1TENTH STREET
AUGUSTA
,
GA
30901
N/A
PC
ARTS
11,500
NATURE CONSERVATORY OF GA
100 PEACHTREE ST
ATLANTA
,
GA
30303
N/A
PC
HISTORY
20,000
NEW BETHLEHEM COMMUNITY CTR
1336 CONKLIN AVENUE
AUGUSTA
,
GA
30901
N/A
PC
EDUCATION
20,000
PHINIZY CTR FOR WATER SCIENCES
1858 LOCK DAM ROAD
AUGUSTA
,
GA
30906
N/A
PC
EDUCATION
20,000
QUEENS UNIVERSITY OF CHARLOTTE
1900 SELWYN AVENUE
CHARLOTTE
,
NC
28274
N/A
PC
EDUCATION
10,000
RESTART AUGUSTA INC
1500 WRIGHTSBORO RD
AUGUSTA
,
GA
30904
N/A
PC
SOCIAL SERVICES
4,000
RONALD MCDONALD HOUSE
1442 HARPER ST
AUGUSTA
,
GA
30901
N/A
PC
MEDICAL
35,000
SE FIREFIGHTERS BURN FOUNDATION
3614 J DEWEY GRAY CIRCLE
AUGUSTA
,
GA
30909
N/A
PC
MEDICAL
10,000
SACRED HEART CULTURAL CENTER
1301 GREENE STREET
AUGUSTA
,
GA
30901
N/A
PC
CULTURAL
143,000
SALVATION ARMY
PO BOX 921
AUGUSTA
,
GA
30903
N/A
PC
SOCIAL SERVICES
65,000
SE COUNCIL OF FOUNDATION
100 PEACHTREE ST STE 2080
ATLANTA
,
GA
30303
N/A
PC
SOCIAL SERVICES
8,740
ST JOHN UMC
PO BOX 444
AUGUSTA
,
GA
30904
N/A
PC
CHURCH
4,000
STORYLAND THEATRE
PO BOX 14875
AUGUSTA
,
GA
30919
N/A
PC
ARTS
20,000
SYMPHONY ORCHESTRA AUGUSTA
PO BOX 579
AUGUSTA
,
GA
30903
N/A
PC
ARTS
60,000
TALIAFERRO COUNTY LIBRARY
117 ASKIN ST
CRAWFORD
,
GA
30631
N/A
PC
EDUCATION
2,000
THOMSON MCDUFFIE CHAMBER OF COM
149 MAIN STREET
THOMSON
,
GA
30824
N/A
PC
SOCIAL SERVICES
7,000
THOMSON MCDUFFIE CTY LIBRARY
338 MAIN STREET
THOMSON
,
GA
30824
N/A
PC
EDUCATION
7,000
TRINITY ON THE HILL UMC
1330 MONTE SANO AVENUE
AUGUSTA
,
GA
30904
N/A
PC
CHURCH
20,000
TUESDAYS MUSIC LIVE
605 REYNOLDS STREET
AUGUSTA
,
GA
30901
N/A
PC
ARTS
5,000
TURN BACK THE BLOCK
PO BOX 3366
AUGUSTA
,
GA
30914
N/A
PC
SOCIAL SERVICES
20,000
TUTTLE NEWTON
2196 CENTRAL AVENUE
AUGUSTA
,
GA
30904
N/A
PC
SOCIAL SERVICES
3,000
UGA FOUNDATION
394 SOUTH MILLEDGE AVENUE
ATHENS
,
GA
30603
N/A
PC
UNIVERSITY FOUNDATION
99,622
UNITED METHODIST CHILDRENS HOME
353 MAIN STREET
THOMSON
,
GA
30824
N/A
PC
SOCIAL SERVICES
160,000
UNITED WAY MCDUFFIE & WARREN CO
PO BOX 87
THOMSON
,
GA
30824
N/A
PC
SOCIAL SERVICES
10,000
UNITED WAY OF THE CSRA
1765 BROAD STREET
AUGUSTA
,
GA
30904
N/A
PC
SOCIAL SERVICES
10,000
UNIV HEALTH CARE FD DENNIS CUP
2100 CENTRAL AVE STE D-1
AUGUSTA
,
GA
30904
N/A
PC
MEDICAL
2,500
UNIV HEALTH CARE FD MIRACLE MILE
2100 CENTRAL AVE STE D-1
AUGUSTA
,
GA
30904
N/A
PC
MEDICAL
25,000
UNIVERSITY HEALTH CARE FOUNDATION - ED
2100 CENTRAL AVE STE D-1
AUGUSTA
,
GA
30904
N/A
PC
MEDICAL
400,000
UNIVERSITY OF TEXAS FOUNDATION
1601 RIO GRANDE ST
AUSTIN
,
TX
78701
N/A
PC
MEDICAL
25,000
VILLAGE GREEN
28411 NORTHWESTERN HWY
SOUTHFIELD
,
MI
48034
N/A
PC
SOCIAL SERVICES
5,000
WALTON FOUNDATION FOR INDEPENDENCE
523 13TH STREET
AUGUSTA
,
GA
30901
N/A
PC
MEDICAL
25,000
WEE ONE FOUNDATION
11855 ARCHER AVE
LEMONT
,
IL
60439
N/A
PC
ATHLETICS
10,000
WIMBERLY HOUSE MINISTRIES
PO BOX 50
WAYNESBORO
,
GA
30830
N/A
PC
MEDICAL
10,000
Total
.................................
3a
4,105,640
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
...........
14
31,673
4
Dividends and interest from securities
....
14
1,778,160
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
16
213,202
6
Net rental income or (loss) from personal property
7
Other investment income
.....
14
105,794
8
Gain or (loss) from sales of assets other than
inventory
............
18
4,642,292
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
6,771,121
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
6,771,121
(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