-
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
10-01-2019
, and ending
09-30-2020
Name of foundation
HERBERT I & ELSA B MICHAEL FOUNDATION
US BANK NATIONAL ASSOCIATION
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 3168
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
PORTLAND
,
OR
97208
A Employer identification number
87-6122556
B
Telephone number (see instructions)
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
6,890,612
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
8,010
8,010
4
Dividends and interest from securities
...
142,600
142,600
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
46,519
b
Gross sales price for all assets on line 6a
2,660,267
7
Capital gain net income (from Part IV, line 2)
...
46,519
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
........
197,129
197,129
13
Compensation of officers, directors, trustees, etc.
85,525
68,420
17,105
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)
....
2,415
1,932
483
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
6,969
5,576
1,393
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
577
461
116
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
95,486
76,389
19,097
25
Contributions, gifts, grants paid
.......
333,000
333,000
26
Total expenses and disbursements.
Add lines 24 and 25
428,486
76,389
352,097
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-231,357
b
Net investment income
(if negative, enter -0-)
120,740
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
.............
50
50
2
Savings and temporary cash investments
.........
47,069
33,692
33,692
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)
397,555
b
Investments—corporate stock (attach schedule)
.......
5,433,355
5,684,820
6,532,546
c
Investments—corporate bonds (attach schedule)
.......
345,000
275,000
324,312
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
1,332
1,332
12
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)
6,224,311
5,994,894
6,890,612
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
........
6,224,311
5,994,894
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)
.....
6,224,311
5,994,894
30
Total liabilities and net assets/fund balances
(see instructions)
.
6,224,311
5,994,894
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
6,224,311
2
Enter amount from Part I, line 27a
.....................
2
-231,357
3
Other increases not included in line 2 (itemize)
3
1,940
4
Add lines 1, 2, and 3
..........................
4
5,994,894
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
5,994,894
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
ALBEMARLE CORP
P
2019-11-26
2020-08-12
b
ARISTA NETWORKS INC
P
2019-01-01
2019-11-04
c
CABOT OIL GAS CORP
P
2019-11-04
2020-03-20
d
CENTENE CORP COM
P
2019-04-22
2019-11-26
e
CITIGROUP INC
P
2018-12-07
2019-11-26
COGNEX CORP
P
2018-12-07
2019-11-26
DENTSU INC
P
2020-02-19
2020-04-03
DOUBLELINE TOTAL RET
P
2019-06-13
2020-02-19
DOUBLELINE TOTAL RET
P
2020-01-07
2020-04-06
ELECTRONIC ARTS INC
P
2019-05-24
2020-05-21
HSBC HOLDINGS PLC
P
2019-12-12
2020-04-03
ISHARES CORE US TREASURY BOND
P
2020-04-06
2020-06-16
ISHARES CORE MSCI
P
2019-06-28
2020-04-29
ISHARES CORE MSCI
P
2019-06-28
2020-05-12
MATCH GROUP INC
P
2020-02-07
2020-08-04
NEUBERGER BERMAN LONG SH INS
P
2019-04-22
2020-02-19
SCHLUMBERGER LTD
P
2020-02-19
2020-04-29
SPLUNK INC
P
2019-06-21
2020-05-27
TIAA CREF
P
2019-01-09
2019-12-12
LYONDELLBASELL INDUSTRIES
P
2019-04-02
2019-11-26
AIA GROUP LTD
P
2017-01-04
2019-12-12
AIA GROUP LTD
P
2017-01-04
2020-02-19
AIR LIQUIDE
P
2018-02-05
2019-10-23
AIR LIQUIDE
P
2017-01-04
2019-12-12
ALBEMARLE CORP
P
2017-03-16
2020-08-12
ALLIANZ SE
P
2017-01-04
2019-12-12
ALPHABET INC
P
2015-07-21
2020-08-12
AMAZON.COM INC
P
2015-07-21
2020-04-29
AMAZON.COM INC
P
2015-07-21
2020-07-07
AMERICAN CAMPUS COMMUNITIES
P
2016-09-06
2019-12-12
AMERICAN CAMPUS COMMUNITIES
P
2016-10-17
2020-04-29
BAIRD AGGREGATE BOND FD INSTL
P
2015-04-10
2020-02-19
BAIRD AGGREGATE BOND FD INSTL
P
2019-06-13
2020-08-17
BIOGEN INC
P
2016-05-23
2019-11-04
CABOT OIL GAS CORP
P
2017-01-04
2020-03-20
CANADIAN NATL
P
2017-01-04
2019-12-12
CENTENE CORP COM
P
2018-03-05
2019-11-26
DELTA AIR LINES INC
P
2019-06-21
2020-07-24
DENTSU INC
P
2019-02-12
2020-04-03
FACEBOOK INC
P
2015-07-21
2020-07-07
FANUC CORPORATION
P
2017-01-04
2019-12-12
FIVE BELOW
P
2019-03-08
2020-03-30
FUCHS PETROLUB
P
2017-01-04
2020-02-19
GRIFOLS SA ADR
P
2017-01-04
2019-12-12
HSBC HOLDINGS PLC
P
2017-01-04
2020-04-03
HORMEL FOODS CORP
P
2018-02-05
2020-02-19
ISHARES RUSSEL 3000 INDEX
P
2010-11-24
2019-12-12
ITAU UNIBANCO HOLDINGS
P
2017-01-04
2019-12-12
LOREAL
P
2017-01-04
2019-12-12
LONZA GROUP
P
2018-05-30
2019-12-12
MASTERCARD INC
P
2016-01-27
2020-02-19
MOHAWK INDS INC
P
2018-03-05
2020-04-29
NASPERS LTD
P
2017-01-04
2019-12-12
LOOMIS SAYLES
P
2012-03-02
2019-12-12
LOOMIS SAYLES
P
2013-08-06
2020-05-28
LOOMIS SAYLES
P
2012-06-13
2020-08-17
NESTLE SA
P
2017-01-04
2019-12-12
NEUBERGER BERMAN LONG SH INS
P
2013-06-04
2019-12-12
NEUBERGER BERMAN LONG SH INS
P
2016-07-06
2020-02-19
PARSLEY ENERGY INC
P
2017-11-21
2019-11-04
PIONEER NAT RES CO
P
2018-02-26
2020-06-01
RINGCENTRAL INC
P
2018-08-02
2019-12-12
RINGCENTRAL INC
P
2018-12-07
2020-02-19
RINGCENTRAL INC
P
2018-12-07
2020-02-07
RBC 30M
P
2017-06-13
2019-12-18
ROYAL DUTCH SHELL PLC
P
2017-01-04
2019-12-12
S P GLOBAL INC
P
2016-05-03
2019-11-26
SALIENT MLP ENERGY INFRASTRUCTURE
P
2018-05-30
2019-12-12
SASOL LTD
P
2017-01-04
2020-04-29
SCHLUMBERGER LTD
P
2017-01-04
2020-04-29
SCHWAB CHARLES CORP
P
2015-07-21
2019-12-12
SCHWAB CHARLES CORP
P
2015-07-21
2020-02-19
SERVICENOW INC
P
2017-03-16
2020-05-27
SONOVA HOLDING
P
2019-04-22
2020-07-09
SPLUNK INC
P
2017-01-04
2020-02-19
SQUARE INC
P
2018-01-10
2019-11-26
SYSMEX CORP
P
2017-01-04
2019-12-12
TIAA CREF
P
2018-07-25
2019-12-12
TAIWAN SEMICONDUCTOR MFG CO LTD
P
2017-01-04
2019-12-12
TAIWAN SEMICONDUCTOR MFG CO LTD
P
2017-01-04
2020-02-19
TC ENERGY CORP
P
2017-01-04
2020-01-07
TYLER TECHNOLOGIES INC
P
2017-09-14
2019-12-12
TYLER TECHNOLOGIES INC
P
2018-12-07
2020-02-19
TYLER TECHNOLOGIES INC
P
2018-12-07
2020-02-07
UNILEVER PLC
P
2017-01-04
2019-12-12
US TREASURY
P
2018-07-25
2019-12-31
US TREASURY
P
2019-01-09
2020-01-31
US TREASURY
P
2018-07-25
2020-03-31
US TREASURY
P
2018-07-25
2020-06-30
UNITED HEALTH GROUP INCORPORATED
P
2016-01-27
2020-02-19
WESTERN DIGITAL CORP
P
2017-11-30
2020-01-07
COAST DIVERSIFIED FUND II LTD
P
1911-11-11
2019-10-25
CHUBB LTD
P
2011-08-18
2019-12-12
CHUBB LTD
P
2011-08-18
2020-02-19
CELGENE CORPORATION COM
P
2015-07-21
2019-11-04
UNRECAPTURED SECTION 1250 GAIN
P
2018-01-01
2019-09-30
CAPITAL GAIN DIST - 20%
P
2018-01-01
2019-09-30
(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
1,455
1,047
408
b
16,581
22,002
-5,421
c
23,983
24,692
-709
d
16,482
14,003
2,479
e
12,228
9,544
2,684
11,256
9,346
1,910
857
1,583
-726
28,059
27,747
312
391,494
399,747
-8,253
6,252
4,863
1,389
4,521
7,098
-2,577
287,097
290,802
-3,705
42,236
48,000
-5,764
130,668
150,699
-20,031
25
19
6
43,358
39,834
3,524
983
1,906
-923
13,135
9,184
3,951
51,159
49,414
1,745
10,757
10,199
558
1,647
906
741
1,479
815
664
13
12
1
1,499
1,009
490
23,189
25,511
-2,322
1,767
1,242
525
19,586
9,055
10,531
14,142
2,926
11,216
18,235
2,926
15,309
1,512
1,687
-175
14,596
20,479
-5,883
67,814
64,906
2,908
45,444
42,042
3,402
6,524
5,384
1,140
4,008
5,501
-1,493
1,543
1,165
378
10,384
8,799
1,585
15,937
25,737
-9,800
1,984
5,344
-3,360
17,130
6,872
10,258
1,509
1,301
208
12,160
19,680
-7,520
1,747
1,700
47
7,701
5,697
2,004
3,989
6,813
-2,824
10,630
7,018
3,612
10,020
3,860
6,160
1,505
1,264
241
1,538
965
573
1,527
1,226
301
2,077
520
1,557
4,018
9,581
-5,563
4,094
4,241
-147
32,613
33,080
-467
20,500
21,739
-1,239
118,184
116,586
1,598
1,564
1,079
485
30,547
25,098
5,449
33,391
27,638
5,753
11,235
18,508
-7,273
143,425
160,000
-16,575
1,609
782
827
2,247
715
1,532
13,218
4,988
8,230
75,954
70,000
5,954
1,549
1,599
-50
9,053
3,559
5,494
95,344
105,457
-10,113
960
5,896
-4,936
2,615
12,761
-10,146
1,589
1,085
504
1,509
1,120
389
8,352
2,051
6,301
13
13
18,450
10,643
7,807
9,270
9,523
-253
1,519
1,305
214
82,596
80,368
2,228
2,684
1,353
1,331
7,915
4,031
3,884
7,036
6,121
915
10,615
6,563
4,052
2,677
1,459
1,218
3,647
2,005
1,642
3,088
2,126
962
100,000
100,000
100,000
100,000
100,000
100,000
100,000
100,000
14,944
5,584
9,360
15,280
18,227
-2,947
414
414
1,536
622
914
1,639
622
1,017
31,352
31,529
-177
63
63
16,537
16,537
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
408
b
-5,421
c
-709
d
2,479
e
2,684
1,910
-726
312
-8,253
1,389
-2,577
-3,705
-5,764
-20,031
6
3,524
-923
3,951
1,745
558
741
664
1
490
-2,322
525
10,531
11,216
15,309
-175
-5,883
2,908
3,402
1,140
-1,493
378
1,585
-9,800
-3,360
10,258
208
-7,520
47
2,004
-2,824
3,612
6,160
241
573
301
1,557
-5,563
-147
-467
-1,239
1,598
485
5,449
5,753
-7,273
-16,575
827
1,532
8,230
5,954
-50
5,494
-10,113
-4,936
-10,146
504
389
6,301
7,807
-253
214
2,228
1,331
3,884
915
4,052
1,218
1,642
962
9,360
-2,947
414
914
1,017
-177
63
16,537
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
46,519
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
-29,143
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
362,295
6,601,991
0.05488
2017
484,143
6,952,571
0.06964
2016
192,985
6,616,779
0.02917
2015
533,437
6,387,361
0.08351
2014
194,066
6,997,180
0.02774
2
Total
of line 1, column (d)
.....................
2
0.264927
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
0.052985
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
6,626,896
5
Multiply line 4 by line 3
......................
5
351,126
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
1,207
7
Add lines 5 and 6
........................
7
352,333
8
Enter qualifying distributions from Part XII, line 4
,.............
8
352,097
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
2,415
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
2,415
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
2,415
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
2,493
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
2,493
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
2
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
76
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
76
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
US BANK NATIONAL ASSOCIATION
Telephone no.
(503) 464-3578
Located at
PO BOX 3168
PORTLAND
OR
ZIP+4
97208
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
US BANK NATIONAL ASSOCIATION
Trustee
0.00
76,413
PO BOX 3168
PORTLAND
,
OR
97208
PETER BILLINGS JR ESQ
CO-TRUSTEE
0.00
1,039
215 S STATE ST STE 1200
SALT LAKE CITY
,
UT
84111
SWENSON LAW FIRM LLC
CO-TRUSTEE
0.00
6,413
648 EASE FIRST SOUTH
SALT LAKE CITY
,
UT
84102
KEITH ODENDAHL
CHAR COMMITTEE
0.00
830
855 N HOMESTEAD BLVD
PRICE
,
UT
84501
RUTH WATKINS
CHAR COMMITTEE
0.00
0
203 PARK BLDG
SALT LAKE CITY
,
UT
84112
MATTHEW DURRANT
CHAR COMMITTEE
0.00
830
450 S STATE STREET
SALT LAKE CITY
,
UT
84114
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
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
6,620,097
b
Average of monthly cash balances
.......................
1b
107,716
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
6,727,813
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
3
Subtract line 2 from line 1d
.........................
3
6,727,813
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
100,917
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
6,626,896
6
Minimum investment return.
Enter 5% of line 5
..................
6
331,345
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
331,345
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
2,415
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
2,415
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
328,930
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
328,930
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
328,930
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
352,097
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
352,097
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b. See instructions
.................
5
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
352,097
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
328,930
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
......
28,004
e
From 2018
......
39,673
f
Total
of lines 3a through e
........
67,677
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
352,097
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)
........
0
d
Applied to 2019 distributable amount
.....
328,930
e
Remaining amount distributed out of corpus
23,167
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
90,844
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
......
90,844
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
28,004
d
Excess from 2018
....
39,673
e
Excess from 2019
....
23,167
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:
ATTN MICHAEL I POLTERSONGA CORBIN
PO BOX 3058
PORTLAND
,
OR
97204
(801) 534-6045
b
The form in which applications should be submitted and information and materials they should include:
WRITTEN FORM, CLEARLY SETTING FORTH THE INTENDED PURPOSE.
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:
FOR BENEFITS OF RESIDENTS AND PERSONS LIVING IN THE STATE OF UTAH.
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
UNIV OF UTAH - COLLEGE OF SCIENCE
1430 E PRESIDENTS CIR RM 220 JTB
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
SCHOLARSHIPS FOR COLLEGE OF SCIENCE
5,000
THE CHILDREN'S CENTER
1855 EAST MEDICAL DRIVE
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
THERAPEUTIC PRESCHOOL
5,000
YWCA OF UTAH
322 EAST 300 SOUTH
SALT LAKE CITY
,
UT
84111
NONE
PUBLIC
CHILDREN'S ADVOCACY & INTERVENTION PROGRAM
7,500
WESTMINSTER COLLEGE
1840 SOUTH 1300 EAST
SALT LAKE CITY
,
UT
84105
NONE
PUBLIC
STUDENT LEADERS IN CIVIC ENGAGEMENT
5,000
CROSSROADS URBAN CENTER
347 SOUTH 400 EAST
SALT LAKE CITY
,
UT
84111
NONE
PUBLIC
EMERGENCY FOOD PANTRY, THRIFT STORE, AND FOOD CO OP
13,500
RAPE RECOVERY CENTER
2035 SOUTH 1300 EAST
SALT LAKE CITY
,
UT
84105
NONE
PUBLIC
PREVENTIVE COMMUNITY EDUCATION PROGRAM
5,000
THE ROAD HOME
210 SOUTH RIO GRANDE ST
SALT LAKE CITY
,
UT
84101
NONE
PUBLIC
SELF-SUFFICIENCY PROGRAM
7,000
UTAH DISPUTE RESOLUTION
645 SOUTH 200 EAST
SALT LAKE CITY
,
UT
84111
NONE
PUBLIC
COMMUNITY MEDIATION CENTER - FAMILY MEDIATION PROGRAM
2,000
CHILDREN'S SERVICE SOCIETY
124 SOUTH 400 EAST 400
SALT LAKE CITY
,
UT
84111
NONE
PUBLIC
GRANDFAMILIES RELATIVES AS PARENTS
5,000
SCOTTISH RITE FOUNDATION OF UTAH
1140 36TH STREET 160
OGDEN
,
UT
84403
NONE
PUBLIC
SPEECH/LANGUAGE THERAPY FOR CHILDREN
7,500
ALLIANCE HOUSE
1724 S MAIN STREET
SALT LAKE CITY
,
UT
84115
NONE
PUBLIC
FUNDING TO ALLOW THOSE WITH SERIOUS MENTAL ILLNESS, WHO HAVE NO MEDICADE INSURANCE, TO BECOME MEMBERS OF ALLIANCE HOUSE
5,000
UNIV OF UTAH - KUED
101 S WASATCH DR
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
PUBLIC TELEVISION BROADCASTING
5,000
NEIGHBORHOOD HOUSE
1050 WEST 500 SOUTH
SALT LAKE CITY
,
UT
84104
NONE
PUBLIC
DAY CARE TUITION ASSISTANCE FOR LOW-INCOME CHILDREN
7,000
GUADALUPE SCHOOLS
340 S GOSHEN STREET
SALT LAKE CITY
,
UT
84104
NONE
PUBLIC
IN HOME PROGRAM
5,000
PLANNED PARENTHOOD OF UTAH
654 SOUTH 900 WEST
SALT LAKE CITY
,
UT
84102
NONE
PUBLIC
EDUCATION PROGRAMS FOR YOUTH & FAMILIES
5,000
BIG BROTHERSBIG SISTERS
151 E 5600 S SUITE 200
MURRAY
,
UT
84107
NONE
PUBLIC
COMMUNITY BASED MENTORING PROGRAM
4,000
COMMUNITY NURSING SERVICES
6949 HIGH TECH DRIVE
SALT LAKE CITY
,
UT
84047
NONE
PUBLIC
UNINSURED/UNDERINSURED PATIENT PROGRAM
5,000
ASSISTANCE LEAGUE OF SLC
PO BOX 9353
SALT LAKE CITY
,
UT
84109
NONE
PUBLIC
FOR OPERATION SCHOOL BELL PROGRAM
5,000
RONALD MCDONALD HOUSE
1135 E SOUTH TEMPLE
SALT LAKE CITY
,
UT
84102
NONE
PUBLIC
SHARE-A-NIGHT PROGRAM
3,000
THE SHARING PLACE
1695 EAST 3300 SOUTH
SALT LAKE CITY
,
UT
84106
NONE
PUBLIC
COMPLICATED GRIEF SUPPORT GROUPS
5,000
JUNIOR LEAGUE - SLC
526 EAST 300 SOUTH
SALT LAKE CITY
,
UT
84101
NONE
PUBLIC
WOMEN HELPING WOMEN
5,000
SOUTH VALLEY SANCTUARY
PO BOX 1028
WEST JORDAN
,
UT
84084
NONE
PUBLIC
DOMESTIC VIOLENCE CRISIS SHELTER
5,000
UNIV OF UTAH - LOWELL BENNION CENTE
200 SOUTH CENTRAL CAMPUS DR RM 101
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
COMMUNITY BUILDING SERVICES
5,000
UNIV OF UTAH - NATURAL HISTORY MUSE
301 WAKARA WAY
SALT LAKE CITY
,
UT
84108
NONE
PUBLIC
FUNDING FOR NATURAL HISTORY MUSEUM
5,000
UNIV OF UTAH - SJ QUINNEY COLLEGE O
332 SOUTH 1400 EAST RM 101
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
SCHOLARSHIPS FOR COLLEGE OF LAW
5,000
UNIV OF UTAH - UNV NEIGHBORHOOD PAR
1060 SOUTH 900 WEST
SALT LAKE CITY
,
UT
84104
NONE
PUBLIC
FACULTY PRACTICE-HEALTH CARE DELIVERY TO LOW-INCOME UTAHNS
10,000
UNIV OF UTAH - WOMENS RESOURCE CENT
200 SOUTH CENTRAL CAMPS DR RM 411
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
YOUTH EDUCATION & SUCCESS/ACADEMIC CONSULTANT
10,000
LEGAL AID SOCIETY OF SLC
205 NORTH 400 WEAT
SALT LAKE CITY
,
UT
84103
NONE
PUBLIC
SELF REPRESENTED FAMILY LAW CLINIC
10,000
NATIONAL ALLIANCE ON MENTAL ILLNESS
1600 W 2200 S 202
WEST VALLEY CITY
,
UT
84119
NONE
PUBLIC
FAMILY TO FAMILY EDUCATION PROGRAM
2,500
BOYS GIRLS CLUB OF GREATER SL
464 CONCORD ST
SALT LAKE CITY
,
UT
84104
NONE
PUBLIC
SMART GIRLS & PASSPORT TO MANHOOD
5,000
ABILITY FOUNDATION
5236 S GREENPINE DR
SALT LAKE CITY
,
UT
84123
NONE
PUBLIC
2011 EQUIPMENT PLACEMENT
5,000
BICYCLE COLLECTIVE
2312 S WEST TEMPLE ST
SALT LAKE CITY
,
UT
84115
NONE
PUBLIC
PROMOTE CYCLING AS AN EFFECTIVE AND SUSTAINABLE FORM OF TRANSPORTATION AND RECREATION
5,000
UTAH LEGAL SERVICES
205 NORTH 400 WEST
SALT LAKE CITY
,
UT
84103
NONE
PUBLIC
LEGAL SERVICES FOR LOW-INCOME FAMILIES
10,000
PREVENT CHILD ABUSE UTAH
2955 HARRISON BLVD STE 104
OGDEN
,
UT
84403
NONE
PUBLIC
PREVENT CHILD ABUSE AND STRENGTHEN FAMILIES
3,000
UTAH CENTER FOR LEGAL INCLUSION
645 S 200 E
SALT LAKE CITY
,
UT
84111
NONE
PUBLIC
FACILITATE EDUCATIONAL OPPORTUNITIES OF THOSE WITH DIVERSE BACKGROUNDS AND ASSIST IN ELIMINATING BIAS IN UTAH'S JUSTICE SYSTEM
5,000
GIRL SCOUTS OF UTAH
PO BOX 57280
SALT LAKE CITY
,
UT
84157
NONE
PUBLIC
HELP GIRLS CREATE POSITIVE CHANGES IN THEIR COMMUNITIES AND BEYOND
2,000
UTAH AIDS FOUNDATION
1408 SOUTH 1100 EAST
SALT LAKE CITY
,
UT
84105
NONE
PUBLIC
PREVENT HIV INFECTION AND HELP THOSE AFFECTED
3,500
UNIV OF UTAH - TEEN MOTHER CHILD PR
295 CHIPETA WAY 2S010
SALT LAKE CITY
,
UT
84108
NONE
PUBLIC
PROVIDE HEALTH CARE FOR PREGNANT TEENS AND THEIR CHILDREN
5,000
ODYSSEY HOUSE
344 E 100 S
SALT LAKE CITY
,
UT
84111
NONE
PUBLIC
CHANGE BEHAVIORS AND LIFESTYLES OF THOSE STRUGGLING WITH DRUG AND ALCOHOL ABUSE
10,000
CAMP HOBE
PO BOX 520755
SALT LAKE CITY
,
UT
84152
NONE
PUBLIC
SUMMER CAMP FOR CHILDREN BEING TREATED FOR CANCER
4,000
FRIENDS FOR SIGHT
661 SOUTH 200 EAST
SALT LAKE CITY
,
UT
84111
NONE
PUBLIC
PROVIDE VISION SCREENING FOR CHILDREN FOR AMBLYOPIA
5,000
JEWISH FAMILY SERVICE
1111 EAST BRICKYARD RD
SALT LAKE CITY
,
UT
84106
NONE
PUBLIC
PROVIDE SUPPORT FOR JEWISH AND SALT LAKE COMMUNITIES
4,000
UNIV OF UTAH - COLLEGE OF EDUCATION
1705 E CAMPUS DR 225 MBH
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
SCHOLARSHIPS FOR COLLEGE OF EDUCATION
5,000
UTAH COUNCIL OF THE BLIND
1301 WEST 500 SOUTH
WOODS CROSS
,
UT
84087
NONE
PUBLIC
ESTABLISH PROGRAMS TO HELP PEOPLE WHO ARE BLIND TO BE MORE INDEPENDENT AND ACTIVE IN THEIR COMMUNITIES
5,000
WASATCH HOMELESS HEALTH CARE INC
404 SOUTH 400 WEST
SALT LAKE CITY
,
UT
84101
NONE
PUBLIC
HELP UTAHANS IMPROVE THEIR HEALTH AND QUALITY OF LIFE BY PROVIDING HIGH QUALITY HEALTH CARE AND SUPPORT SEVICES
5,000
POLIZZI CLINIC
4460 SOUTH HIGHLAND DRIVE SUITE 200
SALT LAKE CITY
,
UT
84124
NONE
PUBLIC
PROVIDE NO-COST PSYCHIATRIC CARE TO LOW-INCOME UNINSURED CHILDREN AND ADULTS
2,000
INN BETWEEN
340 SOUTH GOSHEN ST
SALT LAKE CITY
,
UT
84104
NONE
PUBLIC
HOSPICE FOR THE HOMELESS
7,500
UTAH COMMUNITY ACTION
1307 S 900 W
SALT LAKE CITY
,
UT
84014
NONE
PUBLIC
ASSIST INCOME-ELIGIBLE FAMILIES WITH SERVICES TO HELP THEM ACHIEVE SELF-RELIANCE
5,000
SANDY CLUB
440 EAST 8680 SOUTH
SANDY
,
UT
84070
NONE
PUBLIC
EMPOWER BOYS AND GIRLS BY GIVING THEM A SAFE PLACE TO LEARN AND GROW
2,500
BAD DOG ARTS
824 SOUTH 400 WEST STE B129
SALT LAKE CITY
,
UT
84101
NONE
PUBLIC
CREATIVE ARTS FOR CHILDREN AND ADULTS
2,500
WOMEN OF THE WORLD
3347 S MAIN STREET
SALT LAKE CITY
,
UT
84115
NONE
PUBLIC
SUPPORT REFUGEE AND IMMIGRANT WOMEN AND GIRLS IN UTAH
4,000
ADOPT A NATIVE ELDER
328 W GREGSON AVE
SALT LAKE CITY
,
UT
84115
NONE
PUBLIC
SUPPORT FOR NATIVE NAVAJO ELDERS
3,000
CANCER WELLNESS HOUSE
59 S 1100 E
SALT LAKE CITY
,
UT
84102
NONE
PUBLIC
IMPROVE QUALITY OF LIFE AND WELL-BEING FOR CANCER PATIENTS, CAREGIVERS, AND SURVIVORS
3,000
DISCOVERY GATEWAY
444 W 100 S
SALT LAKE CITY
,
UT
84101
NONE
PUBLIC
INTERACTIVE, HANDS-ON CHILDREN'S MUSEUM
2,500
DONATED DENTAL
1383 S 900 W STE 128
SALT LAKE CITY
,
UT
84104
NONE
PUBLIC
ORAL HEALTH EDUCATION AND TREATMENT FOR THOSE WITH NO OTHER ACCESS TO DENTAL CARE
5,000
JUNIOR ACHIEVEMENT OF UT
515 S 700 E STE 1F
SALT LAKE CITY
,
UT
84102
NONE
PUBLIC
EMPOWER AND PREPARE YOUNG PEOPLE TO SUCCEED IN FINANCE, WORK, AND ENTREPRENEURSHIP
2,500
UTAHNS AGAINST HUNGER
PO BOX 4103
SALT LAKE CITY
,
UT
84101
NONE
PUBLIC
INCREASE ACCESS TO FOOD THROUGH ADVOCACY, OUTREACH, AND EDUCATION
5,000
KIDS ON THE MOVE
475 W 260 N
OREM
,
UT
84057
NONE
PUBLIC
PROVIDE SERVICES TO CHILDREN WITH DISABILITIES AND DEVELOPMENTAL DELAYS
5,000
UNIV OF UTAH - BASIC NEEDS CENTER
195 CENTRAL CAMPUS DR
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
PROVIDE STUDENTS RESOURCES FOR DAY-TO-DAY NEEDS LIKE FOOD, HEALTHCARE, AND FINANCIAL COUNSELING
3,000
WASATCH FORENSIC NURSES
1565 E 3300 S
SALT LAKE CITY
,
UT
84106
NONE
PUBLIC
PROVIDE COMPASSIONATE CARE AND PROFESSIONAL TIMELY COLLECTION OF FORENSIC MEDICAL EVIDENCE FOLLOWING SEXUAL ASSAULT OR RAPE
4,000
UNIV OF UTAH - CENTER FOR COMMUNITY
250 S 1850 E RM 214
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
NUTRITION IN HEALTHY LIVING AND DISEASE PREVENTION
5,000
UNIV OF UTAH - COLLEGE OF SOCIAL WO
395 S 1500 E RM 106
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
SOCIAL WORK EDUCATION
3,500
UNIV OF UTAH - TANNER HUMANITIES CE
215 S CENTRAL CAMPUS DR RM 110
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
ADVANCE HUMANITIES EXPLORATION AND ENGAGEMENT THROUGH RESEARCH AND PUBLIC OUTREACH
5,000
UNIV OF UTAH - U HEALTH ADVANCEMENT
515 E 100 S STE 300
SALT LAKE CITY
,
UT
84102
NONE
PUBLIC
FOSTER PHILANTHROPIC OPPORTUNITIES IN HEALTH CARE
5,000
UNIV OF UTAH - UTAH PRESENTS
1395 E PRESIDENTS CIR
SALT LAKE CITY
,
UT
84104
NONE
PUBLIC
BRING DIVERSE ARTISTIC AND CULTURAL EXPERIENCES TO CAMPUS AND THE REGION
2,500
UNIV OF UTAH - WELLNESS BUS MOBILE
30 S 2000 E
SALT LAKE CITY
,
UT
84112
NONE
PUBLIC
REDUCE CHRONIC ILLNESS THROUGH SCREENINGS, HEALTH COACHING, NUTRITION EDUCTAION, AND REFERRALS
5,000
Total
.................................
3a
333,000
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
14
8,010
4
Dividends and interest from securities
....
14
142,600
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
46,519
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)
..
197,129
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
197,129
(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:
19009920
Software Version:
2019v5.0
Form 990PF - Special Condition Description:
Special Condition Description