-
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
11-01-2019
, and ending
10-31-2020
Name of foundation
ROBERT M BEREN FOUNDATION INC
C/O DONNA STUCKY
Number and street (or P.O. box number if mail is not delivered to street address)
2020 N BRAMBLEWOOD
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WICHITA
,
KS
67206
A Employer identification number
48-0990309
B
Telephone number (see instructions)
(316) 265-3311
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)
$
101,579,309
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)
5,206,403
2
Check
.............
3
Interest on savings and temporary cash investments
3,623
3,623
4
Dividends and interest from securities
...
1,338,236
1,338,236
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
7,244,468
b
Gross sales price for all assets on line 6a
20,903,884
7
Capital gain net income (from Part IV, line 2)
...
7,244,468
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
........
13,792,730
8,586,327
13
Compensation of officers, directors, trustees, etc.
0
0
0
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
2,882
0
2,882
b
Accounting fees (attach schedule)
.......
1,440
0
1,440
c
Other professional fees (attach schedule)
....
481,271
478,175
3,096
17
Interest
...............
12
12
0
18
Taxes (attach schedule) (see instructions)
...
150,101
0
7,842
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
4,302,038
0
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
4,937,744
478,187
15,260
25
Contributions, gifts, grants paid
.......
4,867,717
4,867,717
26
Total expenses and disbursements.
Add lines 24 and 25
9,805,461
478,187
4,882,977
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
3,987,269
b
Net investment income
(if negative, enter -0-)
8,108,140
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
.............
-1,203,944
568,848
568,848
2
Savings and temporary cash investments
.........
3,809,118
4,482,841
4,482,841
3
Accounts receivable
-345
Less: allowance for doubtful accounts
-25
-345
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)
7,936,335
0
0
b
Investments—corporate stock (attach schedule)
.......
35,894,375
45,531,475
96,527,620
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)
..........
70,272
14,450
0
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
46,506,131
50,597,269
101,579,309
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
-596,372
-492,503
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)
.........
-596,372
-492,503
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
0
0
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
47,102,503
51,089,772
29
Total net assets or fund balances
(see instructions)
.....
47,102,503
51,089,772
30
Total liabilities and net assets/fund balances
(see instructions)
.
46,506,131
50,597,269
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
47,102,503
2
Enter amount from Part I, line 27a
.....................
2
3,987,269
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
51,089,772
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
51,089,772
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
GODADDY INC
2019-11-22
2020-03-16
b
GODADDY INC
2019-11-22
2020-03-17
c
GODADDY INC
2019-12-04
2020-03-17
d
KAR AUCTION SVCS INC
2019-06-25
2020-04-02
e
CITIGROUP INC
2016-08-17
2019-12-16
RECKITT BENCKISER GROUP PLC
2011-03-15
2020-01-17
CAPITAL ONE FINL CORP
2016-06-30
2020-01-10
DUNKIN BRANDS GROUP INC
2018-02-22
2020-03-18
KAR AUCTION SVCS INC
2019-02-01
2020-04-02
KAR AUCTION SVCS INC
2019-02-07
2020-04-02
KAR AUCTION SVCS INC
2019-02-21
2020-04-02
PFIZER INC
2015-12-10
2020-02-18
PFIZER INC
2016-02-01
2020-02-18
PFIZER INC
2016-02-25
2020-02-18
RECKITT BENCKISER GROUP PLC
2000-02-07
2020-01-02
RECKITT BENCKISER GROUP PLC
2000-02-02
2020-01-02
RECKITT BENCKISER GROUP PLC
2003-03-03
2020-01-17
CARRIER GLOBAL CORP
2018-11-27
2020-04-03
INTERNATIONAL BUSINESS MACHS CORP
2000-12-27
2020-06-16
INTERNATIONAL BUSINESS MACHS CORP
2005-06-16
2020-06-16
JOHNSON & JOHNSON CO
1989-08-04
2020-07-23
JOHNSON & JOHNSON CO
2010-06-09
2020-07-23
OTIS WORLDWIDE CORP
2020-04-07
OTIS WORLDWIDE CORP
2018-11-27
2020-06-04
RAYTHEON TECHNOLOGIES CORP
2018-11-27
2020-06-22
WELLS FARGO & CO
2010-06-21
2020-02-04
WELLS FARGO & CO
2010-10-19
2020-02-04
BOA SECURITIES LITIGATION
2020-10-31
(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
794,114
1,141,124
-347,010
b
471,386
691,590
-220,204
c
471,386
667,593
-196,207
d
539,285
1,191,115
-651,830
e
1,931,528
1,165,505
766,023
634,182
376,889
257,293
2,235,798
1,381,823
853,975
1,049,721
1,476,942
-427,221
248,071
469,198
-221,127
161,786
311,310
-149,524
129,429
226,617
-97,188
1,310,004
1,167,073
142,931
272,917
225,864
47,053
236,528
198,209
38,319
2,040,531
244,082
1,796,449
2,530,259
279,901
2,250,358
24,392
4,631
19,761
18,568
28,416
-9,848
184,270
128,099
56,171
737,081
462,493
274,588
1,500,561
65,999
1,434,562
1,500,561
583,843
916,718
23
23
35,174
42,605
-7,431
82,926
94,799
-11,873
1,525,073
908,684
616,389
238,293
125,012
113,281
37
37
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
-347,010
b
-220,204
c
-196,207
d
-651,830
e
766,023
257,293
853,975
-427,221
-221,127
-149,524
-97,188
142,931
47,053
38,319
1,796,449
2,250,358
19,761
-9,848
56,171
274,588
1,434,562
916,718
23
-7,431
-11,873
616,389
113,281
37
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
7,244,468
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
Yes
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2018
4,795,839
89,164,640
0.053786
2017
3,072,040
76,896,262
0.039950
2016
4,039,537
71,829,412
0.056238
2015
3,370,562
68,280,116
0.049364
2014
2,248,312
69,500,978
0.032349
2
Total
of line 1, column (d)
.....................
2
0.231687
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
0.046337
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
99,519,112
5
Multiply line 4 by line 3
......................
5
4,611,417
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
81,081
7
Add lines 5 and 6
........................
7
4,692,498
8
Enter qualifying distributions from Part XII, line 4
,.............
8
4,882,977
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
81,081
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
0
3
Add lines 1 and 2
...........................
3
81,081
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
0
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
81,081
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
108,425
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
108,425
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
199
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
27,145
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
27,145
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
KS
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
Yes
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
THE FOUNDATION
Telephone no.
(316) 265-3311
Located at
2020 N BRAMBLEWOOD
WICHITA
KS
ZIP+4
67206
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Yes
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
ROBERT M BEREN
PRESIDENT
1.00
0
0
0
13840 LE MANS WAY
PALM BEACH GARDENS
,
FL
33410
CHARLES B SPRADLIN JR
SECRETARY
1.00
0
0
0
2020 N BRAMBLEWOOD
WICHITA
,
KS
67206
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
FIRST MANHATTAN COMPANY
INVESTMENT ADVICE
474,604
399 PARK AVENUE
NEW YORK
,
NY
10022
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
88,316,317
b
Average of monthly cash balances
.......................
1b
12,718,314
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
101,034,631
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
0
3
Subtract line 2 from line 1d
.........................
3
101,034,631
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
1,515,519
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
99,519,112
6
Minimum investment return.
Enter 5% of line 5
..................
6
4,975,956
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
4,975,956
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
81,081
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
81,081
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
4,894,875
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
4,894,875
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
4,894,875
Part XII
Qualifying Distributions
(see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26
..........
1a
4,882,977
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
4,882,977
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
81,081
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
4,801,896
Note:
The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
the section 4940(e) reduction of tax in those years.
Form
990-PF
(2019)
Form 990-PF (2019)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2018
(c)
2018
(d)
2019
1
Distributable amount for 2019 from Part XI, line 7
4,894,875
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
2,988,835
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
c
From 2016
......
d
From 2017
......
e
From 2018
......
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
4,882,977
a
Applied to 2018, but not more than line 2a
2,988,835
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2019 distributable amount
.....
1,894,142
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
3,000,733
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
ROBERT M BEREN
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2019)
Form 990-PF (2019)
Page
11
Part XV
Supplementary Information
(continued)
3
Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
BEREN SEA FOUNDATION
2020 N BRAMBLEWOOD ST
WICHITA
,
KS
67206
NONE
PC
GENERAL
2,500,000
JEWISH FEDERATION OF PALM BEACH
220 SUNRISE AVENUE SUITE 202
PALM BEACH
,
FL
33480
NONE
PC
ANNUAL CAMPAIGN
650,000
JEWISH COMMUNAL FUND
575 MADISON AVENUE SUITE 703
NEW YORK
,
NY
10022
NONE
PC
FUND #182
600,000
ROBERT M BEREN ACADEMY
11333 CLIFFWOOD DRIVE
HOUSTON
,
TX
770356011
NONE
PC
GENERAL FUND
300,000
TIKVAH FUND
165 EAST 56TH STREET 4TH FLOOR
NEW YORK
,
NY
10022
NONE
PC
DONATION
150,000
FOUNDATION FOR JEWISH CAMP INC
253 WEST 35TH STREET 4TH FLOOR
NEW YORK
,
NY
10016
NONE
PC
GENERAL FUND
100,000
OHR TORAH STONE
49 WEST 45TH STREET SUITE 701
NEW YORK
,
NY
10036
NONE
PC
GENERAL FUND
100,000
THE JEWISH POLICY CENTER
50 F ST NW STE 100
WASHINGTON DC
,
DC
20000
NONE
PC
DONATION
100,000
AIEF-AMERICAN ISRAEL EDUCATION FUND
900 SOUTH PINE ISLAND RD ST 320
PLANTATION
,
FL
33323
NONE
PC
GENERAL FUND
75,000
BRANDEIS CENTER
1717 PENNSYLVANIA AVE NW ST 1025
WASHINGTON
,
DC
20005
NONE
PC
DONATION
50,000
HILLEL THE FOUNDATION FOR JEWISH CAMPUS LIFE
800 EIGHTH STREET NW
WASHINGTON
,
DC
200013724
NONE
PC
INTERNATIONAL BOARD OF GOVERNORS
50,000
HARVARD HILLEL
52 MOUINT AUBURN ST
CAMBRIDGE
,
MA
02138
NONE
PC
GRADUATE PROGRAM
25,000
UNITED WAY OF PALM BEACH COUNTY
477 S ROSEMARY AVENUE STE 230
WEST PALM BEACH
,
FL
33401
NONE
PC
GENERAL FUND
25,000
YESHIVA UNIVERSITY
500 WEST 185TH STREET BH 704
NEW YORK
,
NY
100333201
NONE
PC
ANNUAL HANUKKAH DINNER &
25,000
PALM BEACH ORTHODOX SYNAGOGUE
120 NORTH COUNTY ROAD
PALM BEACH
,
FL
33480
NONE
PC
GENERAL FUND
19,800
BRANDON GARSON LEGACY FUND
PO BOX 5121
WESTPORT
,
CT
06881
NONE
PC
DONATION
15,000
BRIGHAM AND WOMEN'S HOSPITAL
116 HUNTINGTON AVENUE 3RD FLOOR
BOSTON
,
MA
021165712
NONE
PC
DONATION
10,000
BIRTHRIGHT ISRAEL FOUNDATION
711 THIRD AVENUE 10TH FLOOR
NEW YORK
,
NY
10017
NONE
PC
DONATION
5,500
GARDENS JEWISH EXPERIENCE
180 BENT TREE DR
PALM BEACH GARDENS
,
FL
33418
NONE
PC
GENERAL FUND
5,000
ISRAEL TENNIS CENTERS FOUNDATION
3275 WEST HILLSBORO BOULEVARD SUITE
102
DEERFIELD BEACH
,
FL
33442
NONE
PC
GENERAL FUND
5,000
JEWISH NATIONAL FUND
78 RANDALL AVE
ROCKVILLE
,
NY
11570
NONE
PC
ANNUAL FUND
5,000
WORLD JEWISH CONGRESS AMERICAN SECTION
501 MADISON AVENUE
NEW YORK
,
NY
10022
NONE
PC
DONATION
5,000
ALPERT JEWISH FAMILY SERVICE
5841 CORPORATE WAY STE 200
WEST PALM BEACH
,
FL
33407
NONE
PC
GENERAL FUND
3,600
FRIENDS OF UNITED HATZALAH OF ISRAEL
208 EAST 51 STREET SUITE 303
NEW YORK
,
NY
10022
NONE
PC
GENERAL FUND
3,000
HILLELOF BROWARD AND PALM BEACH
777 GLADES ROAD BLDG LY-3A
BOCA RATON
,
FL
33431
NONE
PC
GENERAL FUND
3,000
AJC OF PALM BEACH
1900 NW CORPORATE BLVD SUITE 210W
BOCA RATON
,
FL
33432
NONE
PC
GLOBAL JEWISH ADVOCACY
2,500
AMERICAN FRIENDS OF MAGEN DAVID ADOM
3300 PGA BLVD SUITE 970
PALM BEACH GARDENS
,
FL
33410
NONE
PC
GENERAL FUND
2,000
JUPITER MEDICAL CENTER FOUNDATION
1210 S OLD DIXIE HWY
JUPITER
,
FL
334587205
NONE
PC
FRENCHMAN'S CREEK
2,000
NEFESH B'NEFESH
50 EISENHOWER DRIVE
PARAMUS
,
NJ
07652
NONE
PC
GENERAL FUND
2,000
AHAVATH ACHIM -HEBREW CONGREGATION
1850 NORTH WOODLAWN
WICHTA
,
KS
67208
NONE
PC
GENERAL FUND
1,800
INTERNATIONAL AAE INC
1225 EAST 14TH ST
BROOKLYN
,
NY
12230
NONE
PC
YOUTH CENTER
1,800
US FRIENDS OF THE MENACHEM BEGIN HERITAGE FOUNDATION
4525 SAGUARO TRI
INDIANAPOLIS
,
IN
46268
NONE
PC
DONATION
1,800
AMERICAN FRIENDS OF SHALVA
315 5TH AVE
NEW YORK
,
NY
10016
NONE
PC
DONATION
1,550
HEBREW CONGREGATION
1850 NORTH WOODLAWN
WICHITA
,
KS
67208
NONE
PC
CONTRIBUTION PLEDGE 2020
1,365
AYN RAND INSTITUTE
2121 ALTON PARKWAY SUITE 250
IRVINE
,
CA
92606
NONE
PC
GENERAL FUND
1,000
CHABAD HOUSE LUBAVITCH OF PALM BEACH
844 PROSPERITY FARMS RD
NORTH PALM BEACH
,
FL
33408
NONE
PC
DONATION
1,000
FOUNDATION FOR PERIPHERAL NEUROPATHY
485 HALF DAY ROAD STE 350
BUFFALO GROVE
,
IL
60089
NONE
PC
GENERAL FUND
1,000
FRIENDS OF HARVARD UNIVERSITY CENTER
6 DIVINITY AVENUE
CAMBRIDGE
,
MA
02138
NONE
PC
GENERAL FUND
1,000
FRIENDS OF THE IDF
29 EAST MADISON STREET
CHICAGO
,
IL
60602
NONE
PC
GENERAL FUND
1,000
INSTITUTE FOR HUMANE STUDIES
3434 WASHINGTON BOULEVARD
ARLINGTON
,
VA
22201
NONE
PC
GENERAL FUND
1,000
KANSAS HISTORICAL FOUNDATION
6425 SW 6TH AVENUE
TOPEAKA
,
KS
666151099
NONE
PC
GENERAL FUND
1,000
NCSY
7200 W CAMINO REAL STE 214
BOCA RATON
,
FL
33432
NONE
PC
GENERAL FUND
1,000
RAYMOND F KRAVIS CENTER FOR THE PERFORMING ARTS
701 OKEECHOBEE BLVD
WEST PALM BEACH
,
FL
33401
NONE
PC
EDUCATION AND OUTREACH PROGRAMS
1,000
EISENHOWER FOUNDATION
PO BOX 295
ABILENE
,
KS
67410
NONE
PC
GENERAL FUND
992
AMERICAN CANCER SOCIETY
PO BOX 13300
TAMPA
,
FL
336813300
NONE
PC
ANNUAL FUND DRIVE
500
AMERICAN HEART ASSOCIATION
11207 BLUE HERON BLVD N
ST PETERSBURG
,
FL
33716
NONE
PC
GENERAL FUND
500
AMERICAN RED CROSS
PO BOX 628205
ORLANDO
,
FL
32862
NONE
PC
GENERAL FUND
500
CHABAD AT CLINTON
8 DWIGHT AVENUE
CLINTON
,
NY
133231614
NONE
PC
DONATION
500
FRIENDS OF THE JEWISH CHAPEL
326 FIRST ST SUITE 22
ANAPOLIS
,
MD
21403
NONE
PC
GENERAL FUND
500
SOUTHERN INSTITUTE FOR EDUCATION AND RESEARCH
MR BOX 1692 31 MCALISTER DRIVE
NEW ORLEANS
,
LA
701185554
NONE
PC
GENERAL FUND
500
ST JUDE CHILDERN'S HOSPITAL
262 DANNY THOMAS PL
MEMPHIS
,
TN
38105
NONE
PC
GENERAL FUND
500
STAND WITH US
1801 W OLYPIC BLVD
PASADENA
,
CA
911992215
NONE
PC
GENERAL FUND
500
TRUMAN LIBRARY INSTITUTE
500 WEST US HIGHWAY 24
INDEPENDENCE
,
MO
64050
NONE
PC
DONATION
500
NATIONAL JEWISH HEALTH
1400 JACKSON STREET
DENVER
,
CO
802062762
NONE
PC
GENERAL FUND
450
TELSHE YESHIVA
28400 EUCLID AVE
WICKLIFFE
,
OH
44092
NONE
PC
DONATION
360
CAPITAL RESEARCH CENTER
PO BOX 98239
WASHINGTION
,
DC
200908239
NONE
PC
DONATION
250
ALZHEIMER'S ACCOCIATION
3323 W COMMERCIAL BOULEVARD SUITE
260
FORT LAUDERDALE
,
FL
333093447
NONE
PC
GENERAL FUND
200
ARTHRITIS FOUNDATION
400 HIBISCUS STREET SUITE 100
WEST PALM BEACH
,
FL
33401
NONE
PC
GENERAL FUND
200
THE USO
PO BOX 96860
WASHINGTON DC
,
DC
20077
NONE
PC
GENERAL FUND
200
PROSTATE CANCER FOUNDATION
1250 4TH ST
SANTA MONICA
,
CA
90401
NONE
PC
GENERAL FUND
200
WOUNDED WARRIOR PROJECT
PO BOX 758539
TOPEKA
,
KS
666758539
NONE
PC
DONATION
200
AMERICAN KIDNEY FUND
PO BOX 11038
LEWISTON
,
ME
04243
NONE
PC
GENERAL FUND
100
FRIENDS OF HARVARD JUDAICA COLLECTION
WIDENER LIBRARY M
CAMBRIDGE
,
MA
02138
NONE
PC
GENERAL FUND
100
FURRY FRIENDS
100 CAPITAL STREET
JUPITER
,
FL
33458
NONE
PC
GENERAL FUND
100
LEUKEMIA & LYMPHOMA SOCITY
PO BOX 98011
WASHINGTON
,
DC
200908011
NONE
PC
GENERAL FUND
100
NATIONAL MULTIPLE SCLEROSIS
PO BOX 4594
NEW YORK
,
NY
101634594
NONE
PC
GENERAL FUND
100
RAYMER SOCIETY FOR THE ARTS
212 S MAIN STREET
LINDSBORG
,
KS
67456
NONE
PC
GENERAL FUND
100
ROSE HILL CEMETARY
6841 EAST 62ND AVE
COMMERCE CITY
,
CO
80022
NONE
PC
GENERAL FUND
250
BRITISH BOARD OF DEPUTIES CHARITABLE FOUNDATION
8 SYDNEY GROVE
LONDON
,
LONDON
UK
NONE
PC
DONATION
3,600
Total
.................................
3a
4,867,717
b
Approved for future payment
Total
.................................
3b
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
14
3,623
4
Dividends and interest from securities
....
14
1,338,236
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
7,244,468
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
0
8,586,327
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
8,586,327
(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