-
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
SHIPPY FOUNDATION
C/O THE CLARK ESTATES INC
Number and street (or P.O. box number if mail is not delivered to street address)
ONE ROCKEFELLER PLAZA 31ST FLOOR
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
NEW YORK
,
NY
10020
A Employer identification number
20-4083744
B
Telephone number (see instructions)
(212) 977-6900
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)
$
36,730,327
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
57,563
57,563
4
Dividends and interest from securities
...
65,544
718,478
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
64,880
b
Gross sales price for all assets on line 6a
4,987,237
7
Capital gain net income (from Part IV, line 2)
...
929,549
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)
.......
2,985,920
-41,075
12
Total.
Add lines 1 through 11
........
3,173,907
1,664,515
13
Compensation of officers, directors, trustees, etc.
65,435
0
65,435
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
3,571
3,571
0
17
Interest
...............
49,536
18
Taxes (attach schedule) (see instructions)
...
80,431
154,551
0
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
306,935
257,233
74,040
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
456,372
464,891
139,475
25
Contributions, gifts, grants paid
.......
1,624,950
1,628,954
26
Total expenses and disbursements.
Add lines 24 and 25
2,081,322
464,891
1,768,429
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
1,092,585
b
Net investment income
(if negative, enter -0-)
1,199,624
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
.........
1,550,905
2,029,751
2,029,751
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)
1,494,741
1,499,962
1,499,860
b
Investments—corporate stock (attach schedule)
.......
14,781,164
13,252,175
15,997,178
c
Investments—corporate bonds (attach schedule)
.......
2,683,199
2,362,912
2,607,864
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
11,273,354
13,731,148
14,595,674
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)
31,783,363
32,875,948
36,730,327
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
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
........
31,783,363
32,875,948
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
0
0
29
Total net assets or fund balances
(see instructions)
.....
31,783,363
32,875,948
30
Total liabilities and net assets/fund balances
(see instructions)
.
31,783,363
32,875,948
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
31,783,363
2
Enter amount from Part I, line 27a
.....................
2
1,092,585
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
32,875,948
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
32,875,948
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
1900 AT&T INC
2018-10-11
2019-04-17
b
1600 AT&T INC
2018-10-29
2019-04-17
c
2435 AT&T INC
2018-12-06
2019-04-17
d
1600 AT&T INC
2018-12-20
2019-04-17
e
2500 FIAT CHRYSLER
2019-02-28
2019-11-06
2400 FIAT CHRYSLER
2019-02-28
2019-11-07
300 FIAT CHRYSLER
2019-02-28
2019-11-11
1900 FIAT CHRYSLER
2019-03-01
2019-11-11
500 FIAT CHRYSLER
2019-03-01
2019-11-22
3000 FIAT CHRYSLER
2019-03-12
2019-11-22
700 FIAT CHRYSLER
2019-03-13
2019-11-22
700 GOLDMAN SACHS
2018-12-10
2019-11-21
250 GOLDMAN SACHS
2018-12-11
2019-11-21
300 GOLDMAN SACHS
2018-12-17
2019-11-21
525 IBM CORP
2018-10-11
2019-04-17
600 IBM CORP
2018-11-01
2019-04-17
1000000 T 1.5 11/30/19
2019-05-01
2019-11-30
500000 T 1.50 1/31/19
2018-09-05
2019-01-31
500000 T 1.50 5/31/19
2018-10-31
2019-05-31
1000000 T 1.625 4/30/19
2019-01-02
2019-04-30
500000 T 1.625 7/31/19
2018-12-04
2019-07-31
1000 CVS CAREMARK
2016-11-01
2019-06-17
550 CVS CAREMARK
2016-11-03
2019-06-17
900 CVS CAREMARK
2016-11-08
2019-06-17
1300 CVS CAREMARK
2017-10-17
2019-06-17
650 CVS CAREMARK
2017-10-26
2019-06-17
325 CVS CAREMARK
2017-10-27
2019-06-17
1000 CVS CAREMARK
2018-02-26
2019-06-17
1100 CVS CAREMARK
2018-03-23
2019-06-17
1000 FACEBOOK INC A
2018-11-19
2019-11-27
350 FACEBOOK INC A
2018-11-20
2019-11-27
GENERATION IM GLOBAL EQUITY FD
P
GENERATION IM GLOBAL EQUITY FD
P
CLARK BP LLC
P
CLARK BP LLC
P
CBPS LLC
P
CBPS LLC
P
CLARK FUND LLC
P
CLARK FUND LLC
P
CLARK FOCUS LLC
P
CLARK FOCUS LLC
P
CLARK FOCUS II LLC
P
CLARK FOCUS II LLC
P
CWS LLC
P
FEDERAL PARTNERS LP
P
FEDERAL PARTNERS LP
P
CLARK PARTNERS I LP
P
CLARK PARTNERS I LP
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
60,859
60,636
223
b
51,250
47,228
4,022
c
77,995
74,122
3,873
d
51,249
45,840
5,409
e
39,600
36,899
2,701
38,386
35,423
2,963
4,812
4,428
384
30,476
28,036
2,440
7,409
7,378
31
44,455
43,345
1,110
10,373
10,001
372
152,988
122,700
30,288
54,639
43,967
10,672
65,566
50,870
14,696
72,057
74,063
-2,006
82,351
69,325
13,026
1,000,000
1,000,000
0
500,000
500,000
0
500,000
500,000
0
1,000,000
1,000,000
0
500,000
500,000
0
54,412
83,763
-29,351
29,927
45,122
-15,195
48,971
63,643
-14,672
70,736
94,031
-23,295
35,368
46,340
-10,972
17,684
22,211
-4,527
54,412
67,898
-13,486
59,854
67,960
-8,106
201,043
131,856
69,187
70,365
45,272
25,093
130,817
629,412
54,060
178,007
4,165
27,899
-120,088
46,423
-56,984
-143,208
30,753
21,793
7,316
-13,712
65,053
58
2,905
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
223
b
4,022
c
3,873
d
5,409
e
2,701
2,963
384
2,440
31
1,110
372
30,288
10,672
14,696
-2,006
13,026
0
0
0
0
0
-29,351
-15,195
-14,672
-23,295
-10,972
-4,527
-13,486
-8,106
69,187
25,093
130,817
629,412
54,060
178,007
4,165
27,899
-120,088
46,423
-56,984
-143,208
30,753
21,793
7,316
-13,712
65,053
58
2,905
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
929,549
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
1,826,370
33,462,865
0.054579
2017
1,738,429
33,648,288
0.051665
2016
1,561,650
30,931,138
0.050488
2015
1,738,952
32,810,129
0.053000
2014
1,736,050
28,245,588
0.061463
2
Total
of line 1, column (d)
.....................
2
0.271195
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
0.054239
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
33,372,274
5
Multiply line 4 by line 3
......................
5
1,810,079
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
11,996
7
Add lines 5 and 6
........................
7
1,822,075
8
Enter qualifying distributions from Part XII, line 4
,.............
8
1,768,429
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
23,992
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
23,992
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
23,992
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
53,300
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
53,300
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
514
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
28,794
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
28,794
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)
DE
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
RICHARD C VANISON ASST TREASURER
Telephone no.
(212) 977-6900
Located at
ONE ROCKEFELLER PLAZA 31ST FLOOR
NEW YORK
NY
ZIP+4
10020
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
ANNE L PERETZ
PRESIDENT/DIRECTOR
1.00
0
0
0
ONE ROCKEFELLER PLAZA 31ST FLOOR
NEW YORK
,
NY
10020
DAVID L FARNSWORTH
CHAIRMAN/DIRECTOR
20.00
65,435
39,046
0
ONE ROCKEFELLER PLAZA 31ST FLOOR
NEW YORK
,
NY
10020
ANNE E FARNSWORTH
VICE PRESIDENT/DIRECTOR
1.00
0
0
0
ONE ROCKEFELLER PLAZA 31ST FLOOR
NEW YORK
,
NY
10020
JESSE W PERETZ
VICE PRES/TREASURER/DIRECT
1.00
0
0
0
ONE ROCKEFELLER PLAZA 31ST FLOOR
NEW YORK
,
NY
10020
EVGENIA S PERETZ
VICE PRES,SECRETARY/DIRECT
1.00
0
0
0
ONE ROCKEFELLER PLAZA 31ST FLOOR
NEW YORK
,
NY
10020
RICHARD C VANISON
ASST. TREASURER
1.00
0
0
0
ONE ROCKEFELLER PLAZA 31ST FLOOR
NEW YORK
,
NY
10020
WILLIAM T BURDICK
ASST. SECRETARY
1.00
0
0
0
ONE ROCKEFELLER PLAZA 31ST FLOOR
NEW YORK
,
NY
10020
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
THE CLARK ESTATES INC
INVESTMENT ADVISORY
257,700
ONE ROCKEFELLER PLAZA
NEW YORK
,
NY
10020
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
33,452,953
b
Average of monthly cash balances
.......................
1b
1,544,271
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
34,997,224
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
34,997,224
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
1,624,950
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
33,372,274
6
Minimum investment return.
Enter 5% of line 5
..................
6
1,668,614
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
1,668,614
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
23,992
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
23,992
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
1,644,622
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
1,644,622
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
1,644,622
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
1,768,429
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
1,768,429
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b. See instructions
.................
5
0
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
1,768,429
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
1,644,622
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
0
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
374,021
b
From 2015
......
127,146
c
From 2016
......
38,309
d
From 2017
......
104,537
e
From 2018
......
201,648
f
Total
of lines 3a through e
........
845,661
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
1,768,429
a
Applied to 2018, but not more than line 2a
0
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2019 distributable amount
.....
1,644,622
e
Remaining amount distributed out of corpus
123,807
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
969,468
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
374,021
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
595,447
10
Analysis of line 9:
a
Excess from 2015
....
127,146
b
Excess from 2016
....
38,309
c
Excess from 2017
....
104,537
d
Excess from 2018
....
201,648
e
Excess from 2019
....
123,807
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 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
ARLINGTON BOYS AND GIRLS CLUB
60 POND LANE
ARLINGTON
,
MA
02474
NONE
GENERAL
2,000
BETH ISRAEL DEACONESS MEDICAL CENTER
330 BROOKLINE AVENUE OV
BOSTON
,
MA
02215
NONE
GENERAL
5,000
BOSTON ARTS ACADEMY
11 CHARLES STREET
DORCHESTER
,
MA
02122
NONE
GENERAL
25,000
BOSTON COLLEGIATE CHARTER SCHOOL FOUNDATION
215 SYDNEY STREET
DORCHESTER
,
MA
02125
NONE
GENERAL
50,000
BOSTON DEBATE LEAGUE
54 CANAL STREET 4TH FLOOR
BOSTON
,
MA
02114
NONE
GENERAL
50,000
BOTTOM LINE
500 AMORY STREET
JAMAICA PLAIN
,
MA
02130
NONE
GENERAL
25,000
BUILD BOSTON
745 ATLANTIC AVENUE 8TH FLOOR
BOSTON
,
MA
02111
NONE
GENERAL
35,000
CAMBRIDGE FRIENDS SCHOOL
5 CADBURY ROAD
CAMBRIDGE
,
MA
02140
NONE
GENERAL
1,000
CODMAN ACADEMY FOUNDATION
637 WASHINGTON STREET
DORCHESTER
,
MA
02124
NONE
GENERAL
30,000
COOLIDGE CORNER THEATER FOUNDATION
290 HARVARD STREET
BROOKLINE
,
MA
02446
NONE
GENERAL
1,000
CONCORD ACADEMY
166 MAIN STREET
CONCORD
,
MA
01742
NONE
GENERAL
8,000
EPIPHANY SCHOOL
154 CENTRE STREET
DORCHESTER
,
MA
02124
NONE
GENERAL
50,000
FOOD BANK FOR NEW YORK CITY
39 BROADWAY 10TH FLOOR
NEW YORK
,
NY
10006
NONE
GENERAL
3,000
FOOD LINK INC
32 OLDHAM ROAD
ARLINGTON
,
MA
02474
NONE
GENERAL
1,000
GATEWAY TO HIGHER EDUCATIONRFCUNY
160 CONVENT AVENUE WILLIW ADMIN
BUILDING ROOM A218E
NEW YORK
,
NY
10031
NONE
GENERAL
50,000
GEMS
201 WEST 148TH STREET GROUND FLOOR
NEW YORK
,
NY
10039
NONE
GENERAL
8,000
GREATER BOSTON FOOD BANK
70 SOUTH BAY AVENUE
BOSTON
,
MA
02118
NONE
GENERAL
4,000
HOFSTRA UNIVERSITY NORTHWELL SCHOOL OF MEDICINE
500 HOFSTRA UNIVERSITY
HEMPSTEAD
,
NY
11549
NONE
GENERAL
25,000
INTERFAITH POWER & LIGHT
369 PINE STREET SUITE 700
SAN FRANCISCO
,
CA
94101
NONE
GENERAL
2,000
JEWISH HOME LIFECARE MANHATTAN
12 WEST 106TH STREET KAUFFMAN 3RD
FLOOR
NEW YORK
,
NY
10025
NONE
GENERAL
50,000
KIDS IN NEED DISTRIBUTORS
6917 ARLINGTON ROAD 302
BETHESDA
,
MD
20814
NONE
GENERAL
15,000
LEGAL OUTREACH
36-14 35TH STREET
LONG ISLAND CITY
,
NY
11106
NONE
GENERAL
40,000
MARIN SHAKESPEARE COMPANY
PO BOX 4053
SAN RAFAEL
,
CA
94913
NONE
GENERAL
2,000
NEW YORK CITY URBAN DEBATE LEAGUE
25 BROADWAY 12TH FLOOR
NEW YORK
,
NY
10004
NONE
GENERAL
100,000
NEW YORK OPPORTUNITY NETWORK
85 BROAD STREET 6TH FLOOR
NEW YORK
,
NY
10004
NONE
GENERAL
50,000
ORCHARD GARDEN K-8 PILOT SCHOOL
906 ALBANY STREET
ROXBURY
,
MA
02119
NONE
GENERAL
60,000
OUTER CAPE HEALTH SERVICES INC
PO BOX 598
HARWICH PORT
,
MA
02646
NONE
GENERAL
3,000
PASSIM FOLK MUSIC AND CULTURAL CENTER
26 CHURCH STREET SUITE 300
CAMBRIDGE
,
MA
02138
NONE
GENERAL
3,000
PAYOMET PERFORMING ARTS CENTER
PO BOX 1202
TURO
,
MA
02666
NONE
GENERAL
2,000
PEACE ACTION EDUCATION FUND
8630 FENTON STREET SUITE 524
SILVER SPRING
,
MD
20910
NONE
GENERAL
2,000
PEACE FIRST
25 KINGSTON STREET 6TH FLOOR
BOSTON
,
MA
02111
NONE
GENERAL
60,000
PHILLIPS BROOKS HOUSE
1 HARVARD YARD
CAMBRIDGE
,
MA
02138
NONE
HSHS - HARVARD SQUARE HOMELESS SHELTER
3,000
ROW NEW YORK
252 WEST 37TH STREET 4TH FLOOR
NEW YORK
,
NY
10018
NONE
GENERAL
30,000
SAINT ANN'S SCHOOL
129 PIERREPONT STREET
BROOKLYN HEIGHTS
,
NY
11201
NONE
GENERAL
40,000
SKIP
PO BOX 538
PROVINCETOWN
,
MA
02657
NONE
GENERAL
5,000
STREET LAB INC THE UNI PROJECT
6 VARICK STREET 10B
NEW YORK
,
NY
10013
NONE
GENERAL
15,000
TEAK FELLOWSHIP
16 WEST 22ND STREET 3RD FLOOR
NEW YORK
,
NY
10010
NONE
GENERAL
50,000
THE ART OF PROBLEM SOLVING INITIATIVE INC
55 EXCHANGE PLACE SUITE 603
NEW YORK
,
NY
10005
NONE
BEAM
50,000
THE OLIVER SCHOLARS PROGRAM INC
80 MAIDEN LANE 7TH FLOOR
NEW YORK
,
NY
10038
NONE
GENERAL
50,000
THE PARENTING JOURNEY
366 SOMERVILLE AVENUE
SOMERVILLE
,
MA
02143
NONE
GENERAL
7,000
THE WRITING REVOLUTION
22 COURTLAND STREET 33RD FLOOR
NEW YORK
,
NY
10007
NONE
GENERAL
50,000
UNITED POLICYHOLDERS
381 BUSH STREET 8TH FLOOR
SAN FRANCISCO
,
CA
94104
NONE
GENERAL
5,000
URBAN ASSEMBLY INC
90 BROAD STREET
NEW YORK
,
NY
10004
NONE
GENERAL
199,950
URBAN DOVE
21-21 41ST AVENUE SUITE 2-D
LONG ISLAND CITY
,
NY
11101
NONE
GENERAL
35,000
HYDE SQUARE TASK FORCE
PO BOX 301871
JAMAICA PLAIN
,
MA
02130
NONE
GENERAL
25,000
WEST END HOUSE INC
105 ALLSTON STREET
ALLSTON
,
MA
02134
NONE
GENERAL
35,000
TEACH FOR AMERICA INC
60 CANAL STREET 5TH FLOOR
BOSTON
,
MA
02114
NONE
GENERAL
50,000
MOTT HAVEN ACADEMY CHARTER SCHOOL
170 BROWN PLACE
BRONX
,
NY
10454
NONE
GENERAL
50,000
STUDENT LEADERSHIP NETWORK INC
322 EIGHTH AVENUE 4TH FLOOR
NEW YORK
,
NY
10001
NONE
GENERAL
50,000
SUMMER SEARCH
90 BROAD STREET SUITE 701
NEW YORK
,
NY
10004
NONE
GENERAL
25,000
BOSTON PREPARATORY CHARTER PUBLIC SCHOOL
885 RIVER STREET
HYDE PARK
,
MA
02136
NONE
GENERAL
50,000
TRUSTEES OF TUFTS COLLEGE
80 GEORGE STREET
MEDFORD
,
MA
02115
NONE
TISCH COLLEGE RESEARCH FUND - CAPITAL
25,000
COMMONWEALTH SCHOOL
151 COMMONWEALTH AVENUE
BOSTON
,
MA
02116
NONE
GENERAL
1,000
MINDS MATTER OF SAN FRANCISCO
PO BOX 2511
SAN FRANCISCO
,
CA
94126
NONE
GENERAL
3,000
AIDS SUPPORT GROUP CAPE COD
148A COMMERCIAL STREET
PROVINCETOWN
,
MA
02657
NONE
GENERAL
3,000
HELPING OUR WOMEN
34 CONWELL STREET
PROVINCETOWN
,
MA
02657
NONE
GENERAL
2,000
ALLIANCE FOR QUALITY EDUCATION
94 CENTRAL AVENUE
ALBANY
,
NY
12206
NONE
GENERAL
4,000
Total
.................................
3a
1,624,950
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
57,563
4
Dividends and interest from securities
....
14
65,544
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
14
2,985,920
8
Gain or (loss) from sales of assets other than
inventory
............
18
64,880
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
3,173,907
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
3,173,907
(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