-
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
IRA S& ANNA GALKIN CHARITABLE TR
C/O ROSENSTEINHALPER & MASELLI LLP
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 9567
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
PROVIDENCE
,
RI
02940
A Employer identification number
05-6006231
B
Telephone number (see instructions)
(401) 331-6851
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)
$
3,299,541
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
24,304
24,304
4
Dividends and interest from securities
...
75,252
75,252
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
14,595
b
Gross sales price for all assets on line 6a
1,170,831
7
Capital gain net income (from Part IV, line 2)
...
14,595
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)
.......
12
Total.
Add lines 1 through 11
........
114,151
114,151
13
Compensation of officers, directors, trustees, etc.
30,000
30,000
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
4,450
4,450
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
294
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
22,894
22,894
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
57,638
57,344
0
25
Contributions, gifts, grants paid
.......
167,855
167,855
26
Total expenses and disbursements.
Add lines 24 and 25
225,493
57,344
167,855
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-111,342
b
Net investment income
(if negative, enter -0-)
56,807
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
.............
20,575
52,419
52,419
2
Savings and temporary cash investments
.........
117,905
45,128
45,128
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
2,786,793
2,716,384
3,201,994
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
2,925,273
2,813,931
3,299,541
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
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
........
2,925,273
2,789,570
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
24,361
29
Total net assets or fund balances
(see instructions)
.....
2,925,273
2,813,931
30
Total liabilities and net assets/fund balances
(see instructions)
.
2,925,273
2,813,931
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
2,925,273
2
Enter amount from Part I, line 27a
.....................
2
-111,342
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
2,813,931
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
2,813,931
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
MS SECURITIES
P
2019-12-31
b
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
1,170,831
1,156,236
14,595
b
c
d
e
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
14,595
b
c
d
e
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
14,595
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
170,285
3,076,859
0.055344
2017
152,606
3,054,091
0.049968
2016
131,733
2,791,008
0.047199
2015
130,510
2,863,844
0.045572
2014
102,706
3,069,722
0.033458
2
Total
of line 1, column (d)
.....................
2
0.231541
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
0.046308
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
3,079,730
5
Multiply line 4 by line 3
......................
5
142,616
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
568
7
Add lines 5 and 6
........................
7
143,184
8
Enter qualifying distributions from Part XII, line 4
,.............
8
167,855
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
568
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
3
Add lines 1 and 2
...........................
3
568
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
568
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
800
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
800
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
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
232
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
232
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
RI
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
DAVID GALKIN
Telephone no.
(401) 331-6851
Located at
200 EXCHANGE STREET UNIT 517
PROVIDENCE
RI
ZIP+4
02903
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
DAVID GALKIN
TRUSTEE
2.00
10,000
0
0
200 EXCHANGE STREET UNIT 517
PROVIDENCE
,
RI
02903
HARRIS GALKIN
TRUSTEE
2.00
10,000
0
0
115 FOX RUN
EAST GREENWICH
,
RI
02818
PAULA WASSER
TRUSTEE
2.00
10,000
0
0
121 NANCI-KAREN DRIVE
WARWICK
,
RI
02886
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
N/A
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
3,012,873
b
Average of monthly cash balances
.......................
1b
113,756
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
3,126,629
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
2
Acquisition indebtedness applicable to line 1 assets
..................
2
3
Subtract line 2 from line 1d
.........................
3
3,126,629
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
46,899
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
3,079,730
6
Minimum investment return.
Enter 5% of line 5
..................
6
153,987
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
153,987
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
568
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
568
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
153,419
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
153,419
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
153,419
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
167,855
b
Program-related investments—total from Part IX-B
..................
1b
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
167,855
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
568
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
167,287
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
153,419
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
c
From 2016
......
d
From 2017
......
2,375
e
From 2018
......
17,930
f
Total
of lines 3a through e
........
20,305
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
167,855
a
Applied to 2018, but not more than line 2a
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
d
Applied to 2019 distributable amount
.....
153,419
e
Remaining amount distributed out of corpus
14,436
5
Excess distributions carryover applied to 2019.
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
34,741
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
34,741
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
2,375
d
Excess from 2018
....
17,930
e
Excess from 2019
....
14,436
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.
NONE
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:
PAULA WASSER
C/O RHM LLP 27 DRYDEN LANE
PROVIDENCE
,
RI
02904
(401) 331-6851
b
The form in which applications should be submitted and information and materials they should include:
A REQUEST
c
Any submission deadlines:
NONE
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
NONE
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
4 FREEDOMS FUND
45 W 36TH ST 6TH FLOOR
NEW YORK
,
NY
10018
PUBLIC
GENERAL
3,000
ACLU FOUNDATION
125 BROAD STREET 18TH FL
NEW YORK
,
NY
10004
PUBLIC
GENERAL
6,000
ALZHEIMER'S ASSOCIATION
225 N MICHIGAN AVE FL17
CHICAGO
,
IL
60601
PUBLIC
GENERAL
2,000
ANTI DEFAMATION LEAGUE
605 3RD AVENUE
NEW YORK
,
NY
10158
PUBLIC
GENERAL
500
BONNY EAGLE ICE SKATING
PO BOX 84
HOLLIS
,
ME
04042
PUBLIC
GENERAL
500
BOSTON AREA RAPE CRISIS
99 BISHOP RICHARD ALLEN D
CAMBRIDGE
,
MA
02139
PUBLIC
GENERAL
3,000
BROWN MEDICAL FUND
222 RICHMOND STREET
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
1,000
CAMP SUNSHINE FOUNDATION
35 ACADIA ROAD
CASCO
,
ME
04015
PUBLIC
GENERAL
1,000
CAMP SUREFIRE FOUNDATION
290 HOPE STREET
BRISTOL
,
RI
02809
PUBLIC
GENERAL
2,000
CHILDREN'S FRIENDS FAMILY
153 SUMMER STREET
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
1,000
CHILDREN'S MUSEUM
100 SOUTH STREET
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
160
CHORUS OF EAST PROVIDENCE
PO BOX 14563
EAST PROVIDENCE
,
RI
02914
PUBLIC
GENERAL
3,000
COMMUNITY MUSIC WORKS
1392 WESTMINSTER STREET
PROVIDENCE
,
RI
02909
PUBLIC
GENERAL
1,500
CROSSROADS RI
160 BROAD STREET
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
5,000
DANA FARBER CANCER
450 BROOKLINE AVE
BOSTON
,
MA
02215
PUBLIC
GENERAL
500
DOCS WOUT BORDERS
333 7TH AVE 2ND FLOOR
NEW YORK
,
NY
10001
PUBLIC
GENERAL
2,000
EDESIA
550 ROMANO VINEYARD WAY
NORTH KINGSTOWN
,
RI
02852
PUBLIC
GENERAL
2,000
ENRICH
1395 NOOSENECK HILL ROAD
COVENTRY
,
RI
02816
PUBLIC
GENERAL
1,000
FRACTURED ATLAS
228 PARK AVE SOUTH 56651
NEW YORK
,
NY
10003
PUBLIC
GENERAL
1,200
HABITAT FOR HUMANITY
1555 SHANNOCK ROAD
CHARLESTOWN
,
RI
02813
PUBLIC
GENERAL
500
HITTERS COUNT INC
15 LUND ROAD
SACO
,
ME
04072
PUBLIC
GENERAL
1,750
IMPACT MELANOMA
490 VIRGINIA ROAD 11
CONCORD
,
MA
01742
PUBLIC
GENERAL
2,000
JEWISH ALLIANCE OF GREATER RI
401 ELMGROVE AVE
PROVIDENCE
,
RI
02906
PUBLIC
GENERAL
3,000
JEWISH FAMILY SERVICE
959 NORTH MAIN STREET
PROVIDENCE
,
RI
02904
PUBLIC
GENERAL
1,000
LIFESPAN
167 POINT STREET
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
12,000
MEETING STREET SCHOOL
1000 EDDY ST
PROVIDENCE
,
RI
02905
PUBLIC
GENERAL
2,500
MISC CONTIBUTIONS 250
POBOX 9567
PROVIDENCE
,
RI
02940
PUBLIC
GENERAL
1,445
MSPCA
350 SOUTH HUNTINGTON AVE
JAMAICA PLAIN
,
MA
02130
PUBLIC
GENERAL
300
MUSEUM OF MODERN ART
11 W 53RD STREET
NEW YORK
,
NY
10019
PUBLIC
GENERAL
360
NEW YORK BOTANICAL GARDEN
2900 SOUTHERN BLVD
NEW YORK
,
NY
10458
PUBLIC
GENERAL
275
OCEAN STATE COOPERATIVE
15 DUNCAN ROAD
WARWICK
,
RI
02886
PUBLIC
GENERAL
1,500
PANCREATIC CANCER ACTION NETWORK
1500 ROSECRANS AVENUE STE
MANHATTAN BEACH
,
CA
90266
PUBLIC
GENERAL
2,500
PBS
50 PARK LANE
PROVIDENCE
,
RI
02907
PUBLIC
GENERAL
1,000
PLANNED PARENTHOOD
175 BROAD STREET
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
3,000
PPAC
220 WEYBOSSET STREET
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
4,000
PROSTATE CANCER FOUNDATION
1250 4TH ST
SANTA MONICA
,
CA
90401
PUBLIC
GENERAL
2,000
PROVIDENCE ATHENAEUM
251 BENEFIT ST
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
6,400
PROVIDENCE PUBLIC LIBRARY
150 EMPIRE STREET
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
2,000
RI COMMUNITY FOODBANK
200 NIANTIC AVE
PROVIDENCE
,
RI
02907
PUBLIC
GENERAL
11,000
RI FOUNDATION
1 UNION STATION
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
1,000
RI FREE CLINIC
655 BROAD STREET
PROVIDENCE
,
RI
02907
PUBLIC
GENERAL
8,000
RI PHILHARMONIC
667 WATERMAN AVE
EAST PROVIDENCE
,
RI
02914
PUBLIC
GENERAL
10,500
RI WIND ENSEMBLE
600 MT PLEASANT AVE
PROVIDENCE
,
RI
02908
PUBLIC
GENERAL
1,000
RI ZOOLOGY SOCIETY
1000 ELMWOOD AVENUE
PROVIDENCE
,
RI
02907
PUBLIC
GENERAL
500
RONALD MCDONALD HOUSE
45 GAY STREET
PROVIDENCE
,
RI
02905
PUBLIC
GENERAL
3,000
SHRI SERVICE CORPS
999 MAIN STREET 7080
PAWTUCKET
,
RI
02860
PUBLIC
GENERAL
1,000
SOUTHERN MAINE YOUTH HOCKEY
PO BOX 661
GORHAM
,
ME
04038
PUBLIC
GENERAL
4,500
ST EUSTACE CHURCH
2450 MAIN STREET
LAKE PLACID
,
NY
12946
PUBLIC
GENERAL
1,000
SUMMER CHORUS OF RI
119 HIGH STREET
WESTERLY
,
RI
02891
PUBLIC
GENERAL
1,000
SUSAN G KOMEN BREAST CANCER
13770 NOEL ROAD STE 8018
DALLAS
,
TX
75380
PUBLIC
GENERAL
2,000
TEMPLE BETH EL
70 ORCHARD AVENUE
PROVIDENCE
,
RI
02906
PUBLIC
GENERAL
6,500
TEMPLE SINAI
30 HAGEN AVENUE
CRANSTON
,
RI
02920
PUBLIC
GENERAL
6,000
THE GAMM THEATRE
172 EXCHANGE STREET
PAWTUCKET
,
RI
02860
PUBLIC
GENERAL
3,500
THE GRODEN NETWORK
610 MANTON AVE
PROVIDENCE
,
RI
02909
PUBLIC
GENERAL
2,500
THE GUGGENHEIM MUSEUM
1071 FIFTH AVENUE
NEW YORK
,
NY
10128
PUBLIC
GENERAL
600
TOMORROW FUND
593 EDDY STREET
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
1,000
TRINITY REPERTORY COMPANY
201 WASHINGTON STREET
PROVIDENCE
,
RI
02903
PUBLIC
GENERAL
3,200
V FOUNDATION
14600 WESTON PARKWAY
CARY
,
NC
27513
PUBLIC
GENERAL
2,000
WATERFIRE PROVIDENCE
100 REGENT AVENUE
PROVIDENCE
,
RI
02909
PUBLIC
GENERAL
1,500
WGBH
1 GUEST STREET
BOSTON
,
MA
02135
PUBLIC
GENERAL
365
WHITNEY MUSEUM
99 GANSEVOORT STREET
NEW YORK
,
NY
10014
PUBLIC
GENERAL
300
WILBURY THEATRE GROUP
393 BROAD STREET
PROVIDENCE
,
RI
02907
PUBLIC
GENERAL
7,000
WOMEN INFANT'S DEVELOPMENT FUND
101 DUDLEY STREET
PROVIDENCE
,
RI
02905
PUBLIC
GENERAL
5,000
Total
.................................
3a
167,855
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
14
24,304
4
Dividends and interest from securities
....
14
75,252
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than
inventory
............
18
14,595
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)
..
114,151
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
114,151
(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