-
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
08-01-2019
, and ending
07-31-2020
Name of foundation
LORETTA A WELLS NURSING SCHOLARSHIP TR
Number and street (or P.O. box number if mail is not delivered to street address)
10 S DEARBORN IL1-0111
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CHICAGO
,
IL
60603
A Employer identification number
39-6364734
B
Telephone number (see instructions)
(800) 496-2583
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)
$
1,648,713
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
...
36,917
36,917
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
93,180
b
Gross sales price for all assets on line 6a
629,417
7
Capital gain net income (from Part IV, line 2)
...
93,180
8
Net short-term capital gain
.........
0
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
........
130,097
130,097
13
Compensation of officers, directors, trustees, etc.
24,479
15,637
8,842
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
0
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
1,371
588
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
0
0
23
Other expenses (attach schedule)
.......
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
25,850
16,225
0
8,842
25
Contributions, gifts, grants paid
.......
69,216
69,216
26
Total expenses and disbursements.
Add lines 24 and 25
95,066
16,225
0
78,058
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
35,031
b
Net investment income
(if negative, enter -0-)
113,872
c
Adjusted net income
(if negative, enter -0-)
...
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
.............
1,262
992
992
2
Savings and temporary cash investments
.........
36,833
39,717
39,717
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
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
0
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)
.......
940,104
891,082
1,180,746
c
Investments—corporate bonds (attach schedule)
.......
242,197
325,151
352,237
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
78,549
77,047
75,021
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)
1,298,945
1,333,989
1,648,713
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
1,298,945
1,333,989
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances
(see instructions)
.....
1,298,945
1,333,989
30
Total liabilities and net assets/fund balances
(see instructions)
.
1,298,945
1,333,989
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
1,298,945
2
Enter amount from Part I, line 27a
.....................
2
35,031
3
Other increases not included in line 2 (itemize)
3
21
4
Add lines 1, 2, and 3
..........................
4
1,333,997
5
Decreases not included in line 2 (itemize)
5
8
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
1,333,989
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
4. SVB FINANCIAL GROUP
2019-08-14
b
2. SVB FINANCIAL GROUP
2015-02-05
2019-08-14
c
6. APTIV PLC
2019-08-14
d
3. APTIV PLC
2019-08-14
e
8. APTIV PLC
2019-08-14
4. SVB FINANCIAL GROUP
2015-02-05
2019-08-15
15. APTIV PLC
2019-08-15
362. JPMORGAN BETABUILDERS EUROPE ETF
2019-08-19
2019-08-23
38. JPMORGAN BETABUILDERS EUROPE ETF
2019-08-19
2019-08-23
135. ISHARES TR BARCLAYS MBS BD FD
2019-02-01
2019-09-24
200. VANGUARD BD INDEX FD INC
2019-03-04
2019-09-24
20. DISNEY WALT CO
2019-10-25
5. ACCENTURE PLC
2019-10-25
6. ACCENTURE PLC
2019-10-28
13. NISOURCE INC
2019-11-11
16. NISOURCE INC
2019-11-11
13. NISOURCE INC
2019-11-12
32. NISOURCE INC
2019-11-12
3. NISOURCE INC
2013-02-26
2019-11-12
3. NISOURCE INC
2013-02-26
2019-11-13
59. CELGENE CORP.
2019-11-21
17. CELGENE CORP.
2019-11-21
70. ISHARES MISCI EAFE INDEX FUND
2017-05-11
2019-11-22
20. SPDR TR UNIT SER 1
2019-11-22
50. SPDR TR UNIT SER 1
2018-02-07
2019-11-22
29. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
3. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
1. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-25
37. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-26
6. RTS BRISTOL-MYERS SQUIBB-CVR
2019-11-21
2019-11-27
12. ABBVIE INC
2019-12-06
2. ADOBE SYS INC
2012-08-03
2019-12-06
3. ALEXION PHARMACEUTICALS INC
2019-03-14
2019-12-06
1. ALPHABET INC-CL C
2019-10-25
2019-12-06
1. ALPHABET INC-CL C
2014-05-08
2019-12-06
1. ALPHABET INC-CL A
2016-07-11
2019-12-06
1. AMAZON COM INC
2019-10-25
2019-12-06
9. AMERICAN EXPRESS CO
2019-12-06
14. APPLE COMPUTER INC
2006-04-06
2019-12-06
5. AUTOMATIC DATA PROCESSING INC
2019-08-14
2019-12-06
41. BANK OF AMERICA CORPORATION
2012-11-08
2019-12-06
6. BERKSHIRE HATHAWAY INC DEL CL B
2019-12-06
25. BOSTON SCIENTIFIC CORP
2019-12-06
15. BRISTOL MYERS SQUIBB CO
2019-11-21
2019-12-06
5. BROADCOM INC
2019-12-06
3. CHARTER COMMUNICATIONS INC-A
2019-12-06
18. CITIGROUP INC NEW
2019-12-06
13. COCA-COLA CO
2019-12-06
35. COMCAST CORP NEW CL A
2019-12-06
16. CORTEVA INC
2019-12-06
4. DIAMONDBACK ENERGY INC
2019-12-06
1. DIAMONDBACK ENERGY INC
2017-05-15
2019-12-06
6. DISNEY WALT CO
2016-10-27
2019-12-06
8. DUPONT DE NEMOURS INC-WI
2019-12-06
11. EOG RESOURCES INC
2019-12-06
8. ELECTRONIC ARTS
2019-12-06
4. FACEBOOK INC-A
2014-07-25
2019-12-06
7. FIDELITY NATL INFORMATION SVCS INC
2019-08-14
2019-12-06
1. FIDELITY NATL INFORMATION SVCS INC
2015-04-10
2019-12-06
16. FISERV INC
2019-12-06
5. GENERAL DYNAMICS CORP
2018-12-13
2019-12-06
6. HOME DEPOT INC
2011-09-29
2019-12-06
10. HONEYWELL INTL INC
2010-03-22
2019-12-06
5. INTERCONTINENTALEXCHANGE GROUP, INC
2019-12-06
762.86 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2019-12-06
36. KEYCORP NEW
2019-12-06
8. LILLY ELI & CO
2019-12-06
7. LOWES COS INC
2019-12-06
18. MARATHON PETROLEUM CORPORATION
2019-12-06
7. MASTERCARD INC - CLASS A
2009-07-16
2019-12-06
3. MCDONALDS CORP
2019-06-10
2019-12-06
14. MERCK & CO INC
2019-03-14
2019-12-06
32. MICROSOFT CORP
2019-12-06
18. MONDELEZ INTERNATIONAL-W/I
2019-12-06
29. MORGAN STANLEY DEAN WITTER & CO NEW
2019-12-06
2. NETFLIX.COM INC
2018-09-13
2019-12-06
4. NEXTERA ENERGY INC
2018-07-18
2019-12-06
6. NORFOLK SOUTHN CORP
2019-12-06
1. NORTHROP GRUMMAN CORP
2017-10-10
2019-12-06
2. NORTHROP GRUMMAN CORP
2019-05-20
2019-12-06
4. NVIDIA CORP
2018-10-08
2019-12-06
1. O'REILLY AUTOMOTIVE INC
2017-05-05
2019-12-06
9. PAYPAL HOLDINGS INC
2019-01-23
2019-12-06
10. PEPSICO INC
2019-12-06
35. PFIZER INC
2019-12-06
5. PHILIP MORRIS INTERNATIONAL
2018-10-24
2019-12-06
5. PIONEER NAT RES CO
2019-12-06
8. PROCTER & GAMBLE CO
2019-06-05
2019-12-06
6. QUALCOMM INC
2019-05-01
2019-12-06
7. ROSS STORES INC
2018-12-11
2019-12-06
8. SALESFORCE.COM INC
2018-10-08
2019-12-06
5. STANLEY BLACK & DECKER,INC.
2019-12-06
9. TEXAS INSTRS INC
2019-02-19
2019-12-06
2. TEXAS INSTRS INC
2016-03-10
2019-12-06
7. UNION PAC CORP
2019-12-06
3. UNITED TECHNOLOGIES CORP
2019-12-06
9. UNITEDHEALTH GROUP INC
2019-12-06
2. VERTEX PHARMACEUTICALS INC
2011-12-15
2019-12-06
5. VISA INC CLASS A SHARES
2015-10-19
2019-12-06
6. WASTE CONNECTIONS INC
2019-12-06
13. WELLS FARGO & CO NEW
2019-12-06
3. WEX INC
2016-05-02
2019-12-06
3. YUM BRANDS INC
2018-11-29
2019-12-06
9. ZIMMER HLDGS INC
2019-12-06
6. ALLEGION PLC
2019-12-06
3. ACCENTURE PLC
2014-04-22
2019-12-06
10. LINDE PLC
2019-12-06
7. CHUBB LTD
2019-12-06
6. NXP SEMICONDUCTORS NV
2019-12-06
759.526 EQUINOX IMP SYSTEM MACRO-I
2018-11-08
2019-12-09
760.654 CRM LNG/SHRT OPPORT-INST
2020-01-09
1. CORTEVA INC
2017-02-22
2020-01-13
5.49 CORTEVA INC
2019-04-08
2020-01-13
.51 CORTEVA INC
2020-01-13
5. CORTEVA INC
2020-01-13
6. CORTEVA INC
2020-01-14
6. CORTEVA INC
2019-06-27
2020-01-14
2. CORTEVA INC
2020-01-14
2. CORTEVA INC
2019-06-27
2020-01-14
1. CORTEVA INC
2019-06-27
2020-01-14
7. CORTEVA INC
2020-01-15
8. CORTEVA INC
2019-06-28
2020-01-15
2.448 CORTEVA INC
2019-06-28
2020-01-15
.552 CORTEVA INC
2015-06-18
2020-01-15
1. CORTEVA INC
2015-06-18
2020-01-15
5. CORTEVA INC
2020-01-15
5. CORTEVA INC
2020-01-15
1. CORTEVA INC
2015-07-15
2020-01-15
704.148 CRM LNG/SHRT OPPORT-INST
2016-12-07
2020-01-16
2. CORTEVA INC
2015-07-15
2020-01-16
1. CORTEVA INC
2015-07-15
2020-01-16
1. CORTEVA INC
2015-07-15
2020-01-16
749.067 EQUINOX IMP SYSTEM MACRO-I
2018-11-08
2020-01-16
18. QUALCOMM INC
2019-05-01
2020-01-23
9. EOG RESOURCES INC
2020-01-28
1. EOG RESOURCES INC
2016-05-24
2020-01-28
1. EOG RESOURCES INC
2016-05-24
2020-01-29
1. EOG RESOURCES INC
2016-05-24
2020-01-29
1. EOG RESOURCES INC
2016-05-24
2020-01-29
7. EOG RESOURCES INC
2020-01-29
7. EOG RESOURCES INC
2020-01-29
6. EOG RESOURCES INC
2020-01-29
9. EOG RESOURCES INC
2016-03-07
2020-01-30
2. EOG RESOURCES INC
2016-03-07
2020-01-30
300.422 AMER FNDS INTL VNTG-F3
2016-04-05
2020-01-31
4. ABBVIE INC
2020-02-12
1. ADOBE SYS INC
2012-08-03
2020-02-12
1. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-02-12
1. ALPHABET INC-CL C
2015-01-15
2020-02-12
1. ALPHABET INC-CL A
2016-07-11
2020-02-12
1. AMAZON COM INC
2020-01-28
2020-02-12
3. AMERICAN EXPRESS CO
2019-05-16
2020-02-12
4. APPLE COMPUTER INC
2006-04-06
2020-02-12
1. AUTOMATIC DATA PROCESSING INC
2018-12-03
2020-02-12
12. BANK OF AMERICA CORPORATION
2012-11-08
2020-02-12
2. BERKSHIRE HATHAWAY INC DEL CL B
2018-10-15
2020-02-12
8. BOSTON SCIENTIFIC CORP
2020-02-12
5. BRISTOL MYERS SQUIBB CO
2019-11-21
2020-02-12
2. BROADCOM INC
2013-04-25
2020-02-12
1. CHARTER COMMUNICATIONS INC-A
2016-12-15
2020-02-12
6. CITIGROUP INC NEW
2020-02-12
3. COCA-COLA CO
2018-04-13
2020-02-12
11. COMCAST CORP NEW CL A
2019-03-14
2020-02-12
3. DIAMONDBACK ENERGY INC
2017-05-15
2020-02-12
1. DISNEY WALT CO
2016-10-10
2020-02-12
3. DUPONT DE NEMOURS INC-WI
2020-02-12
3. ELECTRONIC ARTS
2018-09-20
2020-02-12
2. FACEBOOK INC-A
2020-01-08
2020-02-12
3. FIDELITY NATL INFORMATION SVCS INC
2020-02-12
6. FISERV INC
2019-07-18
2020-02-12
1. GENERAL DYNAMICS CORP
2018-12-13
2020-02-12
2. HOME DEPOT INC
2011-09-29
2020-02-12
3. HONEYWELL INTL INC
2020-02-12
1. INTERCONTINENTALEXCHANGE GROUP, INC
2017-01-31
2020-02-12
10. KEYCORP NEW
2018-10-19
2020-02-12
3. LILLY ELI & CO
2020-02-12
2. LOWES COS INC
2011-09-22
2020-02-12
6. MARATHON PETROLEUM CORPORATION
2018-05-14
2020-02-12
3. MASTERCARD INC - CLASS A
2009-07-16
2020-02-12
1. MCDONALDS CORP
2019-06-10
2020-02-12
4. MERCK & CO INC
2019-03-14
2020-02-12
10. MICROSOFT CORP
2008-08-06
2020-02-12
5. MONDELEZ INTERNATIONAL-W/I
2020-02-12
9. MORGAN STANLEY DEAN WITTER & CO NEW
2020-02-12
1. NETFLIX.COM INC
2018-09-13
2020-02-12
1. NEXTERA ENERGY INC
2018-07-18
2020-02-12
2. NORFOLK SOUTHN CORP
2018-05-15
2020-02-12
1. NORTHROP GRUMMAN CORP
2017-10-10
2020-02-12
2. NVIDIA CORP
2020-02-12
3. PAYPAL HOLDINGS INC
2019-01-23
2020-02-12
3. PEPSICO INC
2016-02-17
2020-02-12
11. PFIZER INC
2020-02-12
1. PHILIP MORRIS INTERNATIONAL
2018-10-24
2020-02-12
2. PIONEER NAT RES CO
2016-03-22
2020-02-12
2. PROCTER & GAMBLE CO
2019-06-05
2020-02-12
2. ROSS STORES INC
2018-12-11
2020-02-12
1. SALESFORCE.COM INC
2019-10-28
2020-02-12
2. SALESFORCE.COM INC
2018-10-08
2020-02-12
2. STANLEY BLACK & DECKER,INC.
2020-02-12
4. TEXAS INSTRS INC
2020-01-23
2020-02-12
1. THERMO ELECTRON CORP
2020-01-14
2020-02-12
3. UNION PAC CORP
2017-05-18
2020-02-12
1. UNITED TECHNOLOGIES CORP
2017-12-08
2020-02-12
3. UNITEDHEALTH GROUP INC
2010-12-02
2020-02-12
1. VERTEX PHARMACEUTICALS INC
2011-12-15
2020-02-12
2. VISA INC CLASS A SHARES
2015-10-19
2020-02-12
2. WASTE CONNECTIONS INC
2016-07-26
2020-02-12
4. WELLS FARGO & CO NEW
2009-02-05
2020-02-12
2. YUM BRANDS INC
2018-11-28
2020-02-12
3. ZIMMER HLDGS INC
2020-02-12
1. ALLEGION PLC
2015-11-18
2020-02-12
1. ACCENTURE PLC
2014-04-22
2020-02-12
2. LINDE PLC
2019-04-08
2020-02-12
2. CHUBB LTD
2008-12-10
2020-02-12
2. NXP SEMICONDUCTORS NV
2020-01-23
2020-02-12
245. ISHARES MISCI EAFE INDEX FUND
2017-05-11
2020-02-14
512. JPMORGAN BETABUILDERS JAPAN ETF
2018-07-26
2020-02-14
107. JPMORGAN BETABUILDERS JAPAN ETF
2018-07-26
2020-02-14
5. ELECTRONIC ARTS
2020-02-25
8. ELECTRONIC ARTS
2020-02-25
2. ACCENTURE PLC
2014-04-22
2020-02-25
8. ACCENTURE PLC
2014-04-03
2020-02-26
22. DISNEY WALT CO
2020-03-04
50. WELLS FARGO & CO NEW
2020-03-04
705. ISHARES MISCI EAFE INDEX FUND
2020-03-05
1. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-03-11
1. DUPONT DE NEMOURS INC-WI
2020-03-11
8.938 DUPONT DE NEMOURS INC-WI
2019-04-08
2020-03-11
24.062 DUPONT DE NEMOURS INC-WI
2020-03-11
3. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-03-12
2. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-03-12
4. ALEXION PHARMACEUTICALS INC
2019-03-14
2020-03-13
303.35 FIDELITY 500 INDEX-INST PRM
2019-12-06
2020-03-17
200. ISHARES MISCI EAFE INDEX FUND
2020-03-23
13. UNITED TECHNOLOGIES CORP
2020-03-31
282.326 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2014-02-04
2020-04-08
14. COMCAST CORP NEW CL A
2019-03-14
2020-04-16
22. COMCAST CORP NEW CL A
2020-04-16
1. COMCAST CORP NEW CL A
2019-01-29
2020-04-16
17. COMCAST CORP NEW CL A
2020-04-16
2. COMCAST CORP NEW CL A
2018-10-19
2020-04-16
3. ROSS STORES INC
2018-12-11
2020-04-16
4. ROSS STORES INC
2018-12-11
2020-04-16
4. ROSS STORES INC
2018-12-11
2020-04-16
14. ROSS STORES INC
2020-04-16
80. SPDR TR UNIT SER 1
2020-04-24
68. MARATHON PETROLEUM CORPORATION
2020-04-27
9. ADOBE SYS INC
2012-08-03
2020-05-04
1. ADOBE SYS INC
2012-08-03
2020-05-04
135. ISHARES TR 7-10 YR TREAS INDEX FD
2019-02-13
2020-05-11
477.961 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2014-02-04
2020-05-11
305.929 AMER FNDS INTL VNTG-F3
2016-04-05
2020-05-15
1314.406 BLACKSTONE ALT MULTI-STRAT-Y
2020-06-02
3083.165 JPM GL RES ENH IDX FD - USD - R6 ISIN US48129C2070
2020-06-11
647.11 VANGUARD TOT BD MKT IDX-ADM
2015-12-04
2020-06-11
652.742 VANGUARD TTL INTL BND-ADM
2019-09-24
2020-06-11
22. BERKSHIRE HATHAWAY INC DEL CL B
2020-06-24
43. KEYCORP NEW
2020-06-30
5. KEYCORP NEW
2016-03-02
2020-06-30
33. PFIZER INC
2020-06-30
11. KEYCORP NEW
2020-07-01
3. KEYCORP NEW
2016-03-01
2020-07-01
20. KEYCORP NEW
2020-07-01
9. KEYCORP NEW
2016-03-01
2020-07-01
1. KEYCORP NEW
2016-03-01
2020-07-01
8. KEYCORP NEW
2016-03-01
2020-07-01
16. KEYCORP NEW
2016-03-01
2020-07-02
17. KEYCORP NEW
2020-07-02
1. KEYCORP NEW
2016-02-29
2020-07-02
7. ABBVIE INC
2019-11-11
2020-07-09
1. ALPHABET INC-CL C
2015-01-15
2020-07-09
1. AMAZON COM INC
2020-02-25
2020-07-09
3. AMERICAN EXPRESS CO
2019-05-16
2020-07-09
5. APPLE COMPUTER INC
2006-04-06
2020-07-09
3. AUTOMATIC DATA PROCESSING INC
2018-12-03
2020-07-09
17. BANK OF AMERICA CORPORATION
2020-07-09
270.684 BLACKSTONE ALT MULTI-STRAT-Y
2019-06-18
2020-07-09
10. BOSTON SCIENTIFIC CORP
2016-12-05
2020-07-09
6. BRISTOL MYERS SQUIBB CO
2019-11-21
2020-07-09
2. BROADCOM INC
2013-04-25
2020-07-09
1. CHARTER COMMUNICATIONS INC-A
2020-04-16
2020-07-09
8. CITIGROUP INC NEW
2020-06-30
2020-07-09
5. COCA-COLA CO
2018-04-13
2020-07-09
8. COMCAST CORP NEW CL A
2018-10-19
2020-07-09
4. DIAMONDBACK ENERGY INC
2017-05-15
2020-07-09
2. ELECTRONIC ARTS
2020-07-09
3. FACEBOOK INC-A
2020-01-08
2020-07-09
3. FIDELITY NATL INFORMATION SVCS INC
2014-12-19
2020-07-09
3. FISERV INC
2019-07-18
2020-07-09
4. FISERV INC
2019-06-14
2020-07-09
2. GENERAL DYNAMICS CORP
2018-12-13
2020-07-09
3. HOME DEPOT INC
2011-09-29
2020-07-09
4. HONEYWELL INTL INC
2009-12-16
2020-07-09
2. INTERCONTINENTALEXCHANGE GROUP, INC
2017-01-31
2020-07-09
1. INTUIT
2020-02-25
2020-07-09
250. ISHARES MISCI EAFE INDEX FUND
2020-07-09
600. ISHARES US TREASURY BOND ETF
2020-03-05
2020-07-09
3. LILLY ELI & CO
2020-07-09
4. LOWES COS INC
2020-04-16
2020-07-09
2. MASTERCARD INC - CLASS A
2009-07-16
2020-07-09
1. MCDONALDS CORP
2019-06-10
2020-07-09
6. MERCK & CO INC
2020-07-09
13. MICROSOFT CORP
2020-07-09
7. MONDELEZ INTERNATIONAL-W/I
2011-09-09
2020-07-09
12. MORGAN STANLEY DEAN WITTER & CO NEW
2020-07-09
1. NETFLIX.COM INC
2018-09-13
2020-07-09
3. NEXTERA ENERGY INC
2020-06-30
2020-07-09
3. NORFOLK SOUTHN CORP
2018-03-09
2020-07-09
2. NORTHROP GRUMMAN CORP
2020-06-24
2020-07-09
1. NVIDIA CORP
2018-06-12
2020-07-09
1. O'REILLY AUTOMOTIVE INC
2020-06-30
2020-07-09
6. PAYPAL HOLDINGS INC
2020-07-09
3. PEPSICO INC
2016-02-17
2020-07-09
10. PFIZER INC
2015-06-04
2020-07-09
2. PHILIP MORRIS INTERNATIONAL
2018-10-24
2020-07-09
3. PIONEER NAT RES CO
2016-03-30
2020-07-09
4. PROCTER & GAMBLE CO
2019-06-05
2020-07-09
4. SALESFORCE.COM INC
2020-05-04
2020-07-09
2. STANLEY BLACK & DECKER,INC.
2016-02-17
2020-07-09
5. TEXAS INSTRS INC
2020-07-09
1. THERMO ELECTRON CORP
2020-06-24
2020-07-09
3. UNION PAC CORP
2017-05-18
2020-07-09
3. UNITEDHEALTH GROUP INC
2010-12-02
2020-07-09
1. VERTEX PHARMACEUTICALS INC
2011-12-15
2020-07-09
2. VISA INC CLASS A SHARES
2015-10-19
2020-07-09
2. WASTE CONNECTIONS INC
2016-07-26
2020-07-09
1. WEX INC
2020-04-29
2020-07-09
3. YUM BRANDS INC
2018-11-28
2020-07-09
4. ZIMMER HLDGS INC
2020-06-30
2020-07-09
2. ALLEGION PLC
2020-07-09
4. LINDE PLC
2020-07-09
3. CHUBB LTD
2008-12-10
2020-07-09
1. ASML HOLDING NV-NY REG SHS
2020-03-04
2020-07-09
3. NXP SEMICONDUCTORS NV
2020-01-23
2020-07-09
84. PFIZER INC
2020-07-10
4. PFIZER INC
2016-11-09
2020-07-10
CAPITAL GAIN 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
763
505
258
b
380
240
140
c
477
522
-45
d
241
261
-20
e
639
598
41
747
481
266
1,189
1,062
127
8,188
8,303
-115
860
872
-12
14,601
14,168
433
16,159
15,767
392
2,627
2,008
619
916
418
498
1,102
492
610
341
227
114
418
245
173
339
166
173
833
311
522
78
29
49
79
29
50
6,374
5,519
855
1,837
503
1,334
4,758
4,542
216
6,219
5,769
450
15,547
13,496
2,051
61
67
-6
6
7
-1
2
2
79
85
-6
13
14
-1
1,050
1,026
24
611
64
547
342
404
-62
1,343
1,260
83
1,343
515
828
1,341
727
614
1,749
1,720
29
1,091
1,097
-6
3,786
139
3,647
850
821
29
1,384
389
995
1,337
1,266
71
1,102
583
519
907
846
61
1,577
195
1,382
1,412
903
509
1,370
1,086
284
708
580
128
1,549
1,454
95
406
523
-117
333
420
-87
83
104
-21
887
564
323
510
752
-242
809
969
-160
824
911
-87
804
301
503
970
917
53
139
64
75
1,834
1,660
174
918
859
59
1,285
203
1,082
1,759
416
1,343
471
292
179
17,500
12,920
4,580
709
687
22
962
680
282
815
140
675
1,088
1,445
-357
2,033
126
1,907
586
603
-17
1,245
1,140
105
4,844
1,039
3,805
970
684
286
1,454
848
606
614
741
-127
939
678
261
1,147
901
246
346
293
53
693
626
67
848
1,073
-225
446
252
194
942
814
128
1,375
998
377
1,342
1,300
42
417
446
-29
669
710
-41
997
854
143
502
519
-17
797
564
233
1,266
1,211
55
795
526
269
1,101
968
133
245
110
135
1,206
856
350
441
369
72
2,526
401
2,125
447
63
384
910
385
525
546
310
236
704
261
443
600
282
318
297
275
22
1,340
1,032
308
738
397
341
607
239
368
2,053
1,858
195
1,066
418
648
716
565
151
7,375
7,671
-296
7,675
7,627
48
28
33
-5
156
163
-7
14
17
-3
143
149
-6
172
178
-6
172
178
-6
57
59
-2
57
59
-2
28
30
-2
201
207
-6
229
236
-7
70
72
-2
16
15
1
29
28
1
143
139
4
143
138
5
29
27
2
7,070
7,034
36
58
54
4
29
27
2
29
27
2
7,363
7,566
-203
1,654
1,557
97
694
745
-51
77
83
-6
77
82
-5
77
82
-5
77
82
-5
528
569
-41
537
566
-29
454
458
-4
669
651
18
150
145
5
4,275
3,209
1,066
388
342
46
372
32
340
104
135
-31
1,514
502
1,012
1,514
727
787
2,166
1,854
312
400
359
41
1,301
40
1,261
178
147
31
418
114
304
455
410
45
338
184
154
334
280
54
647
77
570
534
291
243
477
336
141
179
134
45
507
438
69
223
312
-89
142
93
49
161
281
-120
329
341
-12
422
428
-6
444
191
253
718
580
138
188
172
16
481
68
413
543
120
423
94
58
36
197
179
18
432
251
181
249
38
211
352
470
-118
1,002
54
948
216
201
15
333
326
7
1,839
270
1,569
294
136
158
507
220
287
379
371
8
271
169
102
424
300
124
364
293
71
542
529
13
355
271
84
438
299
139
416
380
36
88
89
-1
275
281
-6
246
213
33
241
161
80
190
151
39
379
303
76
336
198
138
530
529
1
335
333
2
556
322
234
155
123
32
904
114
790
242
31
211
415
154
261
200
100
100
192
66
126
210
183
27
476
341
135
138
66
72
212
80
132
434
370
64
328
97
231
276
273
3
16,952
15,899
1,053
12,365
12,577
-212
2,585
2,628
-43
530
541
-11
843
690
153
396
159
237
1,581
632
949
2,600
2,038
562
2,036
724
1,312
44,170
42,471
1,699
84
135
-51
36
94
-58
330
763
-433
890
2,007
-1,117
238
404
-166
153
269
-116
319
539
-220
26,710
33,281
-6,571
9,430
11,764
-2,334
1,229
1,577
-348
5,000
4,777
223
521
558
-37
818
806
12
38
36
2
633
613
20
75
72
3
263
242
21
351
322
29
351
322
29
1,225
1,115
110
22,636
18,686
3,950
1,784
4,506
-2,722
3,136
288
2,848
349
32
317
16,359
14,050
2,309
9,000
8,087
913
3,870
3,267
603
12,500
14,185
-1,685
60,183
47,421
12,762
7,500
6,918
582
15,000
15,372
-372
3,914
3,760
154
523
559
-36
61
55
6
1,069
1,137
-68
132
120
12
36
33
3
234
216
18
105
96
9
12
11
1
93
85
8
194
171
23
199
180
19
12
11
1
685
597
88
1,506
502
1,004
3,156
1,968
1,188
271
359
-88
1,913
49
1,864
438
442
-4
383
161
222
2,650
2,918
-268
345
207
138
349
335
14
645
77
568
529
506
23
395
410
-15
221
223
-2
315
288
27
152
415
-263
276
170
106
727
642
85
410
191
219
285
290
-5
381
356
25
279
344
-65
744
101
643
570
158
412
184
116
68
308
294
14
15,416
14,323
1,093
16,846
16,514
332
499
245
254
543
379
164
589
36
553
185
201
-16
461
386
75
2,774
348
2,426
353
153
200
570
262
308
504
371
133
753
719
34
517
435
82
575
605
-30
419
261
158
419
420
-1
1,094
730
364
399
299
100
335
344
-9
141
178
-37
278
421
-143
489
427
62
795
643
152
277
186
91
652
645
7
388
348
40
501
322
179
875
114
761
293
31
262
384
154
230
191
100
91
156
136
20
260
274
-14
471
478
-7
202
132
70
890
739
151
372
145
227
392
302
90
353
410
-57
2,832
2,783
49
135
129
6
8,334
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
258
b
140
c
-45
d
-20
e
41
266
127
-115
-12
433
392
619
498
610
114
173
173
522
49
50
855
1,334
216
450
2,051
-6
-1
-6
-1
24
547
-62
83
828
614
29
-6
3,647
29
995
71
519
61
1,382
509
284
128
95
-117
-87
-21
323
-242
-160
-87
503
53
75
174
59
1,082
1,343
179
4,580
22
282
675
-357
1,907
-17
105
3,805
286
606
-127
261
246
53
67
-225
194
128
377
42
-29
-41
143
-17
233
55
269
133
135
350
72
2,125
384
525
236
443
318
22
308
341
368
195
648
151
-296
48
-5
-7
-3
-6
-6
-6
-2
-2
-2
-6
-7
-2
1
1
4
5
2
36
4
2
2
-203
97
-51
-6
-5
-5
-5
-41
-29
-4
18
5
1,066
46
340
-31
1,012
787
312
41
1,261
31
304
45
154
54
570
243
141
45
69
-89
49
-120
-12
-6
253
138
16
413
423
36
18
181
211
-118
948
15
7
1,569
158
287
8
102
124
71
13
84
139
36
-1
-6
33
80
39
76
138
1
2
234
32
790
211
261
100
126
27
135
72
132
64
231
3
1,053
-212
-43
-11
153
237
949
562
1,312
1,699
-51
-58
-433
-1,117
-166
-116
-220
-6,571
-2,334
-348
223
-37
12
2
20
3
21
29
29
110
3,950
-2,722
2,848
317
2,309
913
603
-1,685
12,762
582
-372
154
-36
6
-68
12
3
18
9
1
8
23
19
1
88
1,004
1,188
-88
1,864
-4
222
-268
138
14
568
23
-15
-2
27
-263
106
85
219
-5
25
-65
643
412
68
14
1,093
332
254
164
553
-16
75
2,426
200
308
133
34
82
-30
158
-1
364
100
-9
-37
-143
62
152
91
7
40
179
761
262
230
91
20
-14
-7
70
151
227
90
-57
49
6
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
93,180
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
81,950
1,589,063
0.051571
2017
73,440
1,638,562
0.04482
2016
72,047
1,499,584
0.048045
2015
81,666
1,460,169
0.055929
2014
77,866
1,603,122
0.048571
2
Total
of line 1, column (d)
.....................
2
0.248936
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
0.049787
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
1,597,540
5
Multiply line 4 by line 3
......................
5
79,537
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
1,139
7
Add lines 5 and 6
........................
7
80,676
8
Enter qualifying distributions from Part XII, line 4
,.............
8
78,058
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.
Form
990-PF
(2019)
Form 990-PF (2019)
Page
4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a
Exempt operating foundations described in section 4940(d)(2), check here
and enter “N/A" on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
b
Domestic foundations that meet the section 4940(e) requirements in Part V, check
1
2,277
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
2,277
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
2,277
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
1,192
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
1,900
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
3,092
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
2
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
813
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
813
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.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
WI
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
14
The books are in care of
JP MORGAN CHASE BANK NA
Telephone no.
(800) 496-2583
Located at
10 S DEARBORN ST MC IL 1-0111
CHICAGO
IL
ZIP+4
60603
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
No
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
JP MORGAN CHASE BANK N A
TRUSTEE
2
24,479
10 S DEARBORN ST MC IL 1-0111
CHICAGO
,
IL
60603
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
.........................
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
1,585,609
b
Average of monthly cash balances
.......................
1b
36,259
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
1,621,868
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
1,621,868
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
24,328
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
1,597,540
6
Minimum investment return.
Enter 5% of line 5
..................
6
79,877
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
79,877
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
2,277
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
2,277
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
77,600
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
77,600
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
77,600
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
78,058
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
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
0
b
Cash distribution test (attach the required schedule)
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
78,058
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b. See instructions
.................
5
0
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
78,058
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
77,600
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
69,214
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
0
b
From 2015
......
0
c
From 2016
......
0
d
From 2017
......
0
e
From 2018
......
0
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
78,058
a
Applied to 2018, but not more than line 2a
69,214
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
.....
8,844
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
..........
68,756
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
....
0
b
Excess from 2016
....
0
c
Excess from 2017
....
0
d
Excess from 2018
....
0
e
Excess from 2019
....
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2019)
Form 990-PF (2019)
Page
11
Part XV
Supplementary Information
(continued)
3
Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
CATHY GUTHU
UNIVERSITY OF WISCONSIN - GREEN BAY
2420 NICOLET DRIVE
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,596
ALEXANDER RIEGELMAN
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,000
ALLISON HALLFRISCH
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 WEST MASON STREET
GREEN BAY
,
WI
54307
NONE
I
SCHOLARSHIP
944
ANA NIETO
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,000
BLAKE WHITNEY
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
3,450
BREANNA WEBER
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 WEST MASON STREET
GREEN BAY
,
WI
54307
NONE
I
SCHOLARSHIP
944
BRITTENY LARDINOIS
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
3,000
CASANDRA JEFREY
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
3,000
DANIELLE GANSER
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 WEST MASON STREET
GREEN BAY
,
WI
54307
NONE
I
SCHOLARSHIP
944
DAOUDA ZOURE
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,000
ELIZABETH HETTRICH
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,000
ELIZABETH VANDERBERG
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,500
EMMA ASHMAN
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,000
HANNAH GOHDE
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 WEST MASON STREET
GREEN BAY
,
WI
54307
NONE
I
SCHOLARSHIP
944
HOLLY NYQUIST
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,500
JACOB MENARD
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,000
JACQUELINE AUSLOOS
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,500
JACQUELINE SOWL
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 WEST MASON STREET
GREEN BAY
,
WI
54307
NONE
I
SCHOLARSHIP
944
JANE BISHOP
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,500
JOSHUA SCHNEPF
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,000
KAISA DAVISON
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,000
KATELYN KABACINSKI
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
3,000
KATHLEEN HYDE
UNIVERSITY OF WISCONSIN - GREEN BAY
2420 NICOLET DRIVE
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,595
KATHLEEN JOHNSON
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,500
KELSEY MARINEAU
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,500
KENNEDY MACHARIA GITIRI
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 WEST MASON STREET
GREEN BAY
,
WI
54307
NONE
I
SCHOLARSHIP
944
KRISTEN STUEBNER
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
3,000
LAUREN CHAMBERLAIN
BELLIN COLLEGE
3201 EATON ROAD
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,000
MADISON MORTIER
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 WEST MASON STREET
GREEN BAY
,
WI
54307
NONE
I
SCHOLARSHIP
944
MCKENNA EVANCHECK
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 WEST MASON STREET
GREEN BAY
,
WI
54307
NONE
I
SCHOLARSHIP
944
MICHAEL JOHNSON
UNIVERSITY OF WISCONSIN - GREEN BAY
2420 NICOLET DRIVE
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,595
MORGAN SEIDL
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 WEST MASON STREET
GREEN BAY
,
WI
54307
NONE
I
SCHOLARSHIP
944
SHANNON BUKOURICZ
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 WEST MASON STREET
GREEN BAY
,
WI
54307
NONE
I
SCHOLARSHIP
944
TARA KERSCHER
UNIVERSITY OF WISCONSIN - GREEN BAY
2420 NICOLET DRIVE
GREEN BAY
,
WI
54311
NONE
I
SCHOLARSHIP
2,596
TIFFINY GRAY
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 WEST MASON STREET
GREEN BAY
,
WI
54307
NONE
I
SCHOLARSHIP
944
Total
.................................
3a
69,216
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
14
36,917
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
93,180
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)
..
130,097
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
130,097
(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