-
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
06-01-2019
, and ending
05-31-2020
Name of foundation
DOUG AND TAMRA ADAMS FAMILY FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
1665 BROAD STREET ROAD
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MAIDENS
,
VA
23102
A Employer identification number
26-3862362
B
Telephone number (see instructions)
(804) 784-4908
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)
$
512,629
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
4
Dividends and interest from securities
...
11,755
11,755
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
-2,041
b
Gross sales price for all assets on line 6a
253,163
7
Capital gain net income (from Part IV, line 2)
...
0
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
........
9,714
11,755
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)
.........
b
Accounting fees (attach schedule)
.......
2,500
2,500
0
c
Other professional fees (attach schedule)
....
500
500
0
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
321
0
0
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
6,195
6,195
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
9,516
9,195
0
25
Contributions, gifts, grants paid
.......
25,460
25,460
26
Total expenses and disbursements.
Add lines 24 and 25
34,976
9,195
25,460
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-25,262
b
Net investment income
(if negative, enter -0-)
2,560
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
.............
39,938
23,845
23,845
2
Savings and temporary cash investments
.........
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
366,781
365,878
391,738
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)
..........
102,227
93,961
97,046
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)
508,946
483,684
512,629
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
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
508,946
483,684
29
Total net assets or fund balances
(see instructions)
.....
508,946
483,684
30
Total liabilities and net assets/fund balances
(see instructions)
.
508,946
483,684
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
508,946
2
Enter amount from Part I, line 27a
.....................
2
-25,262
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
483,684
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
483,684
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
18.929 UNITS 22.7196 DELAWARE SMALL CAP CORE F
P
2019-07-01
b
1,140.415 UNITS 7.9500 DOMINI INTL SOCIAL EQUITY
P
2019-07-01
c
584.966 UNITS 15.6599 HARTFORD MUT FDS II INC S
P
2019-07-01
d
1 SHR 41.1250 JOHNSON CONTROLS INTL PLC
P
2019-07-02
e
5 SHR 83.3100 ABBOTT LABS GOLDMAN, SACH
P
2019-07-02
1 SHR 71.6400 ABBVIE INC GOLDMAN, SACHS
P
2019-07-02
1 SHR 294.0500 ADOBE INC BERNSTEIN, SANF
P
2019-07-02
1 SHR 73.8650 AGILENT TECHNOLOGIES INC
P
2019-07-02
1 SHR 101.3500 ALLSTATE CORP BARCLAYS CA
P
2019-07-02
1 SHR 45.2550 APPLIED MATLS INC BARCLAY
P
2019-07-02
2 SHR 164.8000 AUTOMATIC DATA PROCESSING
P
2019-07-02
11 SHR 51.1400 CBRE GROUP INC CL A COM B
P
2019-07-02
1 SHR 54.8800 CVS HEALTH CORP UBS SECUR
P
2019-07-02
9 SHR 92.2400 CELGENE CORP BERNSTEIN, S
P
2019-07-02
1 SHR 54.8100 CISCO SYS INC CREDIT SUIS
P
2019-07-02
1 SHR 70.0100 CITIGROUP INC NEW COM CRE
P
2019-07-02
1 SHR 71.8700 COLGATE PALMOLIVE CO GOLD
P
2019-07-02
1 SHR 61.0200 CONOCOPHILLIPS BERNSTEIN,
P
2019-07-02
1 SHR 87.4500 CONSOLIDATED EDISON INC B
P
2019-07-02
5 SHR 138.6500 DISNEY WALT CO COM DISNEY
P
2019-07-02
2 SHR 193.5100 ECOLAB INC UBS SECURITIES
P
2019-07-02
1 SHR 501.2250 EQUINIX INC REITS BERNSTE
P
2019-07-02
1 SHR 52.5950 GENERAL MLS INC UBS SECUR
P
2019-07-02
20 SHR 20.8000 HP INC CREDIT SUISSE SEC
P
2019-07-02
11 SHR 55.7000 HARTFORD FINL SVCS GROUP
P
2019-07-02
2 SHR 47.9900 INTEL CORP BARCLAYS CAPIT
P
2019-07-02
1 SHR 111.9100 J P MORGAN CHASE & CO GOL
P
2019-07-02
1 SHR 100.2300 LOWES COS INC CREDIT SUIS
P
2019-07-02
1 SHR 55.1000 MARATHON PETE CORP CREDIT
P
2019-07-02
1 SHR 83.6400 MERCK & CO INC NEW COMBA
P
2019-07-02
2 SHR 133.4750 MICROSOFT CORP BERNSTEIN
P
2019-07-02
21 SHR 56.6850 ORACLE CORP BARCLAYS CAPI
P
2019-07-02
1 SHR 94.4221 PVH CORP UBS SECURITIES L
P
2019-07-02
1 SHR 131.1150 PEPSICO INC BARCLAYS CAPI
P
2019-07-02
1 SHR 100.2400 PRUDENTIAL FINL INC BERNS
P
2019-07-02
1 SHR 163.1100 ROCKWELL AUTOMATION INC U
P
2019-07-02
1 SHR 228.2600 S&P GLOBAL INC BARCLAYS C
P
2019-07-02
1 SHR 150.4900 SALESFORCE COM INC UBS SE
P
2019-07-02
11 SHR 50.9300 SOUTHWEST AIRLS CO BERNST
P
2019-07-02
7 SHR 129.9300 UNITED TECHNOLOGIES CORP
P
2019-07-02
1 SHR 85.2300 VALERO ENERGY CORP NEW CR
P
2019-07-02
1.00 SHR 1077.75000 ALPHABET INC CL C COM CRE
P
2019-07-02
8.00 SHR 55.7374000 ISHARES RUSSELL MID-CAP E
P
2019-07-02
1.00 SHR 136.640000 PNC FINL SVCS GROUP INC C
P
2019-07-02
1.00 SHR 52.9100000 TJX COS INC NEW GOLDMAN,
P
2019-07-02
181.603 UNITS 10.7499 TIAA-CREF SOCIAL CHOICE B
P
2019-09-06
1.00 SHR 81.8100000 EATON CORP PLC IRELAND BA
P
2019-09-09
2.00 SHR 121.100000 INGERSOLL-RAND CO LTD IRE
P
2019-09-09
1.00 SHR 107.915000 MEDTRONIC PLC IRELAND GOL
P
2019-09-09
4.00 SHR 73.0900000 AGILENT TECHNOLOGIES INC
P
2019-09-09
5.00 SHR 104.664100 ALLSTATE CORP BERNSTEIN,
P
2019-09-09
1.00 SHR 212.230000 APPLE INC J.P. MORGAN SEC
P
2019-09-09
3.00 SHR 147.103100 AUTODESK INC BERNSTEIN, S
P
2019-09-09
2.00 SHR 223.920000 BIOGEN IDEC INC BERNSTEIN
P
2019-09-09
10.00 SHR 48.5719000 BRISTOL MYERS SQUIBB CO J
P
2019-09-09
1.00 SHR 123.050000 CATERPILLAR INC J.P. MORG
P
2019-09-09
1.00 SHR 48.4600000 CISCO SYS INC BARCLAYS CA
P
2019-09-09
18.00 SHR 60.1174000 HARTFORD FINL SVCS GROUP
P
2019-09-09
3.00 SHR 227.800000 HOME DEPOT INC BERNSTEIN,
P
2019-09-09
2.00 SHR 55.9000000 ISHARES RUSSELL MID-CAP E
P
2019-09-09
4.00 SHR 123.242100 ISHARES MSCI USA ESG SELE
P
2019-09-09
1.00 SHR 113.160000 J P MORGAN CHASE & CO J.P
P
2019-09-09
8.00 SHR 114.783500 LILLY ELI & CO GOLDMAN, S
P
2019-09-09
6.00 SHR 87.9551000 NIKE INC CL B BARCLAYS CA
P
2019-09-09
1.00 SHR 114.290000 PRICE T ROWE GROUP INC BA
P
2019-09-09
1.00 SHR 123.060000 PROCTER & GAMBLE CO GOLDM
P
2019-09-09
1.00 SHR 153.010000 SALESFORCE COM INC BARCLA
P
2019-09-09
1.00 SHR 108.890000 TARGET CORP MORGAN STANLE
P
2019-09-09
7.00 SHR 164.507200 3M CO MORGAN STANLEY & CO
P
2019-09-09
12.00 SHR 58.7940000 VANGUARD TOTAL INTL BOND
P
2019-09-09
152.073 UNITS 24.1500 DELAWARE SMALL CAP CORE F
P
2019-12-19
367.548 UNITS 7.9999 DOMINI INTL SOCIAL EQUITY
P
2019-12-19
86.738 UNITS 16.8600 HARTFORD MUT FDS II INC S
P
2019-12-19
7.00 SHR 109.310900 ALLSTATE CORP GOLDMAN, SA
P
2019-12-19
1.00 SHR 330.165000 GRAINGER W W INC BARCLAYS
P
2019-12-19
23.00 SHR 58.8849000 ISHARES RUSSELL MID-CAP E
P
2019-12-19
15.00 SHR 132.360200 ISHARES MSCI USA ESG SELE
P
2019-12-19
2.00 SHR 154.620000 MICROSOFT CORP MORGAN STA
P
2019-12-19
4.00 SHR 100.065700 NIKE INC CL B UBS SECURIT
P
2019-12-19
18.00 SHR 39.3811000 SCHLUMBERGER LTD CURACAO
P
2019-12-19
3.00 SHR 128.240000 TARGET CORP MORGAN STANLE
P
2019-12-19
4.00 SHR 133.650000 TIFFANY & CO NEW UBS SECU
P
2019-12-19
674.483 UNITS 7.8000 BLACKROCK HIGH YIELD BOND
P
2020-01-21
2,644.670 UNITS 24.2800 DELAWARE SMALL CAP CORE F
P
2020-01-21
7,067.368 UNITS 8.1000 DOMINI INTL SOCIAL EQUITY
P
2020-01-21
1.00 SHR 209.680000 ACCENTURE PLC CL A COM IR
P
2020-01-21
1.00 SHR 94.8232000 EATON CORP PLC IRELAND UB
P
2020-01-21
1.00 SHR 40.8500000 JOHNSON CONTROLS INTL PLC
P
2020-01-21
1.00 SHR 118.950000 MEDTRONIC PLC IRELAND CRE
P
2020-01-21
1.00 SHR 90.8900000 APTIV PLC JERSEY UBS SECU
P
2020-01-21
2.00 SHR 88.5500000 ABBOTT LABS CREDIT SUISSE
P
2020-01-21
1.00 SHR 89.9900000 AGILENT TECHNOLOGIES INC
P
2020-01-21
1.00 SHR 131.190000 AMERICAN EXPRESS CO UBS S
P
2020-01-21
1.00 SHR 128.830000 AMERICAN WTR WKS CO INC N
P
2020-01-21
1.00 SHR 316.300000 APPLE INC MORGAN STANLEY
P
2020-01-21
1.00 SHR 69.2700000 BALL CORP MORGAN STANLEY
P
2020-01-21
1.00 SHR 89.4500000 BEST BUY INC MORGAN STANL
P
2020-01-21
1.00 SHR 61.0900000 CBRE GROUP INC CL A COM C
P
2020-01-21
1.00 SHR 76.1000000 CVS HEALTH CORP J.P. MORG
P
2020-01-21
2.00 SHR 49.3100000 CISCO SYS INC J.P. MORGAN
P
2020-01-21
2.00 SHR 81.1100000 CITIGROUP INC NEW COM UBS
P
2020-01-21
3.00 SHR 47.6600000 COMCAST CORP NEW CL A COM
P
2020-01-21
2.00 SHR 65.2029000 CONOCOPHILLIPS UBS SECURI
P
2020-01-21
1.00 SHR 145.450000 DISNEY WALT CO COM DISNEY
P
2020-01-21
1.00 SHR 222.030000 FACEBOOK INC CL A COM MOR
P
2020-01-21
2.00 SHR 53.9500000 GENERAL MLS INC MORGAN ST
P
2020-01-21
1.00 SHR 63.5000000 GILEAD SCIENCES INC MORGA
P
2020-01-21
1.00 SHR 70.3900000 HESS CORP CREDIT SUISSE S
P
2020-01-21
2.00 SHR 59.9800000 INTEL CORP MORGAN STANLEY
P
2020-01-21
1.00 SHR 278.210000 INTUIT J.P. MORGAN SECURI
P
2020-01-21
1.00 SHR 137.580000 J P MORGAN CHASE & CO J.P
P
2020-01-21
1.00 SHR 143.520000 KIMBERLY CLARK CORP CREDI
P
2020-01-21
1.00 SHR 57.5500000 MARATHON PETE CORP MORGAN
P
2020-01-21
2.00 SHR 91.2300000 MERCK & CO INC NEW COM CR
P
2020-01-21
2.00 SHR 56.2900000 MORGAN STANLEY J.P. MORGA
P
2020-01-21
1.00 SHR 252.370000 NEXTERA ENERGY INC J.P. M
P
2020-01-21
1.00 SHR 139.920000 PEPSICO INC UBS SECURITIE
P
2020-01-21
1.00 SHR 103.763300 PHILLIPS 66 UBS SECURITIE
P
2020-01-21
1.00 SHR 93.4983000 PROLOGIS INC REITS UBS SE
P
2020-01-21
1.00 SHR 183.180000 SALESFORCE COM INC MORGAN
P
2020-01-21
2.00 SHR 83.6189000 STATE STR CORP UBS SECURI
P
2020-01-21
2.00 SHR 62.9800000 TJX COS INC NEW MORGAN ST
P
2020-01-21
1.00 SHR 130.760000 TEXAS INSTRS INC CREDIT S
P
2020-01-21
176.00 SHR 56.8241000 VANGUARD TOTAL INTL BOND
P
2020-01-21
36.235 UNITS 6.1299 BLACKROCK HIGH YIELD BOND
P
2020-03-23
762.498 UNITS 10.5499 CRA QUALIFIED INVESTMENT
P
2020-03-23
2,401.809 UNITS 10.0700 TIAA-CREF SOCIAL CHOICE B
P
2020-03-23
3.00 SHR 80.9700000 MEDTRONIC PLC IRELAND GOL
P
2020-03-24
2.00 SHR 105.150000 ISHARES MSCI USA ESG SELE
P
2020-03-24
21.00 SHR 86.2100000 J P MORGAN CHASE & CO MOR
P
2020-03-24
VANGUARD TOTAL INTL BOND INDEX FUND ETF J.P. MORGAN SECURITIES INC.
P
2020-03-24
4.00 SHR 20.2614000 INGERSOLL RAND INC J.P. M
P
2020-03-27
5.00 SHR 39.1046000 PVH CORP UBS SECURITIES L
P
2020-04-08
9.00 SHR 41.7967000 WELLTOWER INC REITS UBS S
P
2020-04-08
26.0990 PER SHARE INGERSOLL RAND INC CASH I
P
2020-04-13
1,034.985 SHR 13.6399947 HARTFORD MUT FDS II INC
P
2020-04-20
MEDTRONIC PLC IRELAND SAL
P
2020-04-21
1.00 SHR 282.560000 GRAINGER W W INC UBS SECU
P
2020-04-21
1.00 SHR 263.000000 INTUIT CREDIT SUISSE SEC
P
2020-04-21
CAPITAL GAINS DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
430
503
-73
b
9,066
9,671
-605
c
9,161
8,638
523
d
41
35
6
e
416
244
172
72
113
-41
294
146
148
74
60
14
101
89
12
45
51
-6
330
206
124
562
391
171
55
78
-23
830
665
165
55
32
23
70
64
6
72
76
-4
61
46
15
87
81
6
693
521
172
387
268
119
501
414
87
53
50
3
416
469
-53
612
573
39
96
69
27
112
87
25
100
113
-13
55
72
-17
84
65
19
267
141
126
1,190
969
221
94
145
-51
131
118
13
100
97
3
163
192
-29
228
208
20
150
88
62
560
663
-103
909
892
17
85
96
-11
1,078
1,162
-84
1,560
1,352
208
137
143
-6
53
46
7
1,952
1,906
46
82
73
9
242
173
69
108
89
19
292
242
50
523
446
77
212
145
67
441
416
25
448
541
-93
486
662
-176
123
148
-25
48
32
16
1,082
937
145
683
475
208
112
96
16
493
486
7
113
87
26
918
660
258
528
498
30
114
110
4
123
90
33
153
88
65
109
51
58
1,151
1,493
-342
705
676
29
3,673
4,046
-373
2,940
3,117
-177
1,462
1,283
179
765
625
140
330
277
53
1,354
1,107
247
1,985
1,822
163
309
141
168
400
332
68
708
1,242
-534
385
154
231
535
370
165
5,261
5,179
82
64,213
65,767
-1,554
57,246
58,972
-1,726
210
152
58
95
73
22
41
35
6
119
89
30
91
97
-6
177
98
79
90
60
30
131
121
10
129
81
48
316
145
171
69
42
27
89
61
28
61
36
25
76
78
-2
99
63
36
162
127
35
143
126
17
130
91
39
145
104
41
222
192
30
108
100
8
63
68
-5
70
42
28
120
69
51
278
260
18
138
87
51
144
133
11
58
72
-14
182
130
52
113
85
28
252
142
110
140
118
22
104
112
-8
93
80
13
183
88
95
167
178
-11
126
70
56
131
80
51
9,998
9,727
271
222
278
-56
8,044
8,128
-84
24,186
25,439
-1,253
243
267
-24
210
277
-67
1,810
1,827
-17
2,372
2,359
13
81
88
-7
195
709
-514
376
720
-344
11
9
2
14,117
15,539
-1,422
243
259
-16
283
277
6
263
260
3
1,001
1,001
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
-73
b
-605
c
523
d
6
e
172
-41
148
14
12
-6
124
171
-23
165
23
6
-4
15
6
172
119
87
3
-53
39
27
25
-13
-17
19
126
221
-51
13
3
-29
20
62
-103
17
-11
-84
208
-6
7
46
9
69
19
50
77
67
25
-93
-176
-25
16
145
208
16
7
26
258
30
4
33
65
58
-342
29
-373
-177
179
140
53
247
163
168
68
-534
231
165
82
-1,554
-1,726
58
22
6
30
-6
79
30
10
48
171
27
28
25
-2
36
35
17
39
41
30
8
-5
28
51
18
51
11
-14
52
28
110
22
-8
13
95
-11
56
51
271
-56
-84
-1,253
-24
-67
-17
13
-7
-514
-344
2
-1,422
-16
6
3
1,001
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
-2,041
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
32,231
540,869
0.059591
2017
21,895
553,881
0.039530
2016
27,779
522,427
0.053173
2015
22,716
518,578
0.043804
2014
19,025
453,472
0.041954
2
Total
of line 1, column (d)
.....................
2
0.238052
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
0.047610
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
523,731
5
Multiply line 4 by line 3
......................
5
24,935
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
26
7
Add lines 5 and 6
........................
7
24,961
8
Enter qualifying distributions from Part XII, line 4
,.............
8
25,460
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
26
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
26
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
26
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
0
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
0
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
26
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
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.
$
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
No
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)
VA
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
TAMRA ADAMS
Telephone no.
(804) 784-4908
Located at
1665 BROAD STREET ROAD
MAIDENS
VA
ZIP+4
23102
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
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
DOUG ADAMS
PRESIDENT
0.00
0
0
0
1665 BROAD STREET ROAD
MAIDENS
,
VA
23102
TAMRA ADAMS
SECRETARY/TREASURER
0.00
0
0
0
1665 BROAD STREET ROAD
MAIDENS
,
VA
23102
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
NONE
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
486,645
b
Average of monthly cash balances
.......................
1b
45,062
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
531,707
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
531,707
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
7,976
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
523,731
6
Minimum investment return.
Enter 5% of line 5
..................
6
26,187
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
26,187
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
26
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
26
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
26,161
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
26,161
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
26,161
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
25,460
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
25,460
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
26
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
25,434
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
26,161
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
20,605
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:
$
25,460
a
Applied to 2018, but not more than line 2a
20,605
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
.....
4,855
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
..........
21,306
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).)
DOUG ADAMS
TAMRA ADAMS
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
AMERICAN CANCER SOCIETY
4240 PARK PLACE COURT
GLEN ALLEN
,
VA
23060
NONE
PUBLIC CHARITY
GENERAL PURPOSE
500
CENTREVILLE VA FIRE & RESCUE
52 BROADSTREET RD
MANAKINSABOT
,
VA
23103
NONE
PUBLIC CHARITY
GENERAL PURPOSE
500
COURTHOUSE VOL FIRE & RESCUE
2710 FAIRGROUND ROAD
GOOCHLAND
,
VA
23063
NONE
PUBLIC CHARITY
GENERAL PURPOSE
500
GOOCHLAND CASA
PO BOX 910
GOOCHLAND
,
VA
23063
NONE
PUBLIC CHARITY
GENERAL PURPOSE
1,000
GOOCHLAND EDUCATION FOUNDATION
2938-1 RIVER ROAD WEST
GOOCHLAND
,
VA
23063
NONE
PUBLIC CHARITY
GENERAL PURPOSE
2,500
GOOCHLAND HS PTSA
3250 RIVER ROAD W
GOOCHLAND
,
VA
23063
NONE
PUBLIC CHARITY
GENERAL PURPOSE
1,000
KHAN ACADEMY
PO BOX 1630
MOUNTAIN VIEW
,
CA
94042
NONE
PUBLIC CHARITY
GENERAL PURPOSE
365
LITTLE SISTERS OF THE POOR
1503 MICHAEL ROAD
RICHMOND
,
VA
23229
NONE
PUBLIC CHARITY
GENERAL PURPOSE
1,000
MAGGIE L WALKER GOVERNOR'S SCHOOL FOUNDATION
1000 NORTH LOMBARDY STREET
RICHMOND
,
VA
23220
NONE
PUBLIC CHARITY
GENERAL PURPOSE
10,000
NATIONAL PUBLIC RADOP
1111 NORTH CAPITOL ST NE
WASHINGTON
,
DC
20002
NONE
PUBLIC CHARITY
GENERAL PURPOSE
365
PBS FOUNDATION
2100 CRYSTAL DRIVE
ARLINGTON
,
VA
22202
NONE
PUBLIC CHARITY
GENERAL PURPOSE
365
PROJECT ENGAGE RVA
2205 PARKERS HILL DR
MAIDENS
,
VA
23102
NONE
PUBLIC CHARITY
GENERAL PURPOSE
1,500
RANDOLPH ELEMENTARY PTSA
1552 SHEPPARD TOWN RD
CROZIER
,
VA
23039
NONE
PUBLIC CHARITY
GENERAL PURPOSE
3,000
ST MATTHEWS UMC
1706 ST MATTHEWS LANE
RICHMOND
,
VA
23233
NONE
PUBLIC CHARITY
GENERAL PURPOSE
1,000
VA HOLOCAUST MUSEUM
2000 E CARY ST
RICHMOND
,
VA
23223
NONE
PUBLIC CHARITY
GENERAL PURPOSE
1,000
YMCA OF GREATER RICHMOND
2 W FRANKLIN ST
RICHMOND
,
VA
23220
NONE
PUBLIC CHARITY
GENERAL PURPOSE
500
VIRGINIA MUSEUM OF FINE ARTS
2000 N ARTHUR ASHE BLVD
RICHMOND
,
VA
23220
NONE
PUBLIC CHARITY
GENERAL PURPOSE
365
Total
.................................
3a
25,460
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
...........
4
Dividends and interest from securities
....
14
11,755
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
-2,041
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
9,714
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
9,714
(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