-
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
07-01-2019
, and ending
06-30-2020
Name of foundation
PVR SCHOLARSHIP FUND
Number and street (or P.O. box number if mail is not delivered to street address)
351 VALLEY BROOK ROAD
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MCMURRAY
,
PA
153173337
A Employer identification number
56-2306640
B
Telephone number (see instructions)
(724) 731-0094
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)
$
1,224,306
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)
123,037
2
Check
.............
3
Interest on savings and temporary cash investments
42,229
42,229
4
Dividends and interest from securities
...
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
b
Gross sales price for all assets on line 6a
7
Capital gain net income (from Part IV, line 2)
...
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
........
165,266
42,229
13
Compensation of officers, directors, trustees, etc.
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
57
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
57
0
0
25
Contributions, gifts, grants paid
.......
102,400
102,400
26
Total expenses and disbursements.
Add lines 24 and 25
102,457
0
102,400
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
62,809
b
Net investment income
(if negative, enter -0-)
42,229
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
.............
7,263
6,806
6,806
2
Savings and temporary cash investments
.........
1,154,234
1,217,500
1,217,500
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)
.......
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
1,161,497
1,224,306
1,224,306
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
............
1,161,497
1,224,306
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
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)
.....
1,161,497
1,224,306
30
Total liabilities and net assets/fund balances
(see instructions)
.
1,161,497
1,224,306
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
1,161,497
2
Enter amount from Part I, line 27a
.....................
2
62,809
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
1,224,306
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
1,224,306
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.)
1a
b
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
b
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
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
78,900
1,115,897
0.070705
2017
69,400
1,053,441
0.065879
2016
62,900
994,384
0.063255
2015
68,576
931,454
0.073623
2014
64,146
880,219
0.072875
2
Total
of line 1, column (d)
.....................
2
0.346337
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
0.069267
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
1,176,750
5
Multiply line 4 by line 3
......................
5
81,510
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
422
7
Add lines 5 and 6
........................
7
81,932
8
Enter qualifying distributions from Part XII, line 4
,.............
8
102,400
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
422
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
3
Add lines 1 and 2
...........................
3
422
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
422
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
1,000
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
1,000
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
578
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
578
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
PA
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
HTTP://WWW.NSSLIFE.ORG/FRATERNAL-PROGRAMS
14
The books are in care of
LINDA M STROM
Telephone no.
(724) 731-0094
Located at
351 VALLEY BROOK ROAD
MCMURRAY
PA
ZIP+4
153173337
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
ANDREW WESNAK
PRESIDENT
1.00
0
0
0
351 VALLEY BROOK ROAD
MCMURRAY
,
PA
153173337
LINDA M STROM
SECRETARY/TR
1.00
0
0
0
351 VALLEY BROOK ROAD
MCMURRAY
,
PA
153173337
MICHAEL CZARNEY
TRUSTEE
1.00
0
0
0
351 VALLEY BROOK ROAD
MCMURRAY
,
PA
153173337
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
AWARDING SCHOLARSHIPS TO INDIVIDUALS THAT ARE MEMBERS OF THE NATIONAL SLOVAK SOCIETY (WHICH IS A 501(C)(8) FRATERNAL BENEFIT SOCIETY) TO HELP DEFRAY THE COSTS OF POST SECONDARY EDUCATION.
102,400
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
N/A
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
0
b
Average of monthly cash balances
.......................
1b
1,194,670
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
1,194,670
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
2
Acquisition indebtedness applicable to line 1 assets
..................
2
3
Subtract line 2 from line 1d
.........................
3
1,194,670
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
17,920
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
1,176,750
6
Minimum investment return.
Enter 5% of line 5
..................
6
58,838
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
58,838
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
422
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
422
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
58,416
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
58,416
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
58,416
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
102,400
b
Program-related investments—total from Part IX-B
..................
1b
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
102,400
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
422
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
101,978
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
58,416
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
20,743
b
From 2015
......
22,651
c
From 2016
......
13,872
d
From 2017
......
17,460
e
From 2018
......
23,934
f
Total
of lines 3a through e
........
98,660
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
102,400
a
Applied to 2018, but not more than line 2a
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
d
Applied to 2019 distributable amount
.....
58,416
e
Remaining amount distributed out of corpus
43,984
5
Excess distributions carryover applied to 2019.
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
142,644
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
20,743
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
121,901
10
Analysis of line 9:
a
Excess from 2015
....
22,651
b
Excess from 2016
....
13,872
c
Excess from 2017
....
17,460
d
Excess from 2018
....
23,934
e
Excess from 2019
....
43,984
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
NATIONAL SLOVAK SOCIETY
351 VALLEY BROOK ROAD
MCMURRAY
,
PA
153173337
(724) 731-0094
b
The form in which applications should be submitted and information and materials they should include:
SEE STATEMENT 3 & 4
c
Any submission deadlines:
SEE STATEMENT 3 & 4
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
SEE STATEMENT 3 & 4
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
ALAYNA MCNEIL
11630 FOGG LAKE RD
MONTAGUE
,
MI
49437
NONE
COLLEGE SCHOLARSHIP
500
ALBERT PETERS III
645 WILLOUGHBY AVE 8
BROOKLYN
,
NY
11206
NONE
COLLEGE SCHOLARSHIP
500
ALEX DYNDA
210 E ARNOLD AVE
PORT ALLEGANY
,
PA
16743
NONE
COLLEGE SCHOLARSHIP
500
ALEXANDER DICKOPF
149 ORCHARD HILL RD
HAVERHILL
,
MA
01835
NONE
COLLEGE SCHOLARSHIP
500
ALEXANDER NOBLE
2505 WYATT LN
RALEIGH
,
NC
27614
NONE
COLLEGE SCHOLARSHIP
600
ALISA CHRISTENSEN
1443 BARON CT
BARTLETT
,
IL
60103
NONE
COLLEGE SCHOLARSHIP
500
ALLISON DAVIS
264 CHESTNUST AVE
MEDIA
,
PA
19063
NONE
COLLEGE SCHOLARSHIP
500
AMANDA REILLY
516 FRANKLIN TER
WASHINGTON
,
PA
15301
NONE
COLLEGE SCHOLARSHIP
500
ANDREW BEYER
8 WILLIAMS ST
RUSSELL
,
PA
16345
NONE
COLLEGE SCHOLARSHIP
500
ANDREW JEFFREY
212 OHARA MANOR DR
PITTSBURGH
,
PA
15238
NONE
COLLEGE SCHOLARSHIP
500
ANDREW KARKOSIAK
7985 TWIN OAKS DRIVE
BROADVIEW HEIGHTS
,
OH
44147
NONE
COLLEGE SCHOLARSHIP
500
ANNE KOLICIUS
212 SOUTH OLD MIDDLETOWN
MEDIA
,
PA
19063
NONE
COLLEGE SCHOLARSHIP
500
ANTHONY SAWARYNSKI
1409 ATLAS LN
NORTHAMPTON
,
PA
18067
NONE
COLLEGE SCHOLARSHIP
500
AUSTIN KARR
5517 US RT 422
SOUTHINGTON
,
OH
44470
NONE
COLLEGE SCHOLARSHIP
500
AUSTIN RAUSO
109 OAKWOOD DR
CLAIRTON
,
PA
15025
NONE
COLLEGE SCHOLARSHIP
500
AVERY CIELINSKI
1004 CATHERINE CT
NAPERVILLE
,
IL
60540
NONE
COLLEGE SCHOLARSHIP
500
BAILEE SEAMAN
278 FLORAL HILL DR
WASHINGTON
,
PA
15301
NONE
COLLEGE SCHOLARSHIP
500
BAILEY DONOFRIO
405 BLUEFIELD DR
OAKDALE
,
PA
15071
NONE
COLLEGE SCHOLARSHIP
500
BAILIE ROHR
80 A ST
BEAVER
,
PA
15009
NONE
COLLEGE SCHOLARSHIP
500
BENJAMIN HAYLETT
12854 WING RD
CONNEAUTVILLE
,
PA
16406
NONE
COLLEGE SCHOLARSHIP
500
BRAD CROMER
106 FAVERSHAM LN
COLUMBIA
,
SC
29229
NONE
COLLEGE SCHOLARSHIP
500
BRADLEY WAITE
1349 OLD STATE RD
WATERFORD
,
PA
16441
NONE
COLLEGE SCHOLARSHIP
500
BRANDEN BOSLEY
280 ROBIN ST
INDIANA
,
PA
15701
NONE
COLLEGE SCHOLARSHIP
500
BRENDAN O'DOHERTY
30403 CRESTVIEW DR
BAY VILLAGE
,
OH
44140
NONE
COLLEGE SCHOLARSHIP
500
BRENDAN PHILBIN
104 PINEWOOD HILLS
LONGMEADOW
,
MA
01106
NONE
COLLEGE SCHOLARSHIP
500
BRENNAN JAMES
9932 SUNSET DR
LENEXA
,
KS
66220
NONE
COLLEGE SCHOLARSHIP
500
BRIANN ALLAN
131 DAHLIA ST
MUNHALL
,
PA
15120
NONE
COLLEGE SCHOLARSHIP
500
BROOKE VOLLMER
204 STONEBRIDGE DR
FINLEYVILLE
,
PA
15332
NONE
COLLEGE SCHOLARSHIP
500
BROOKE WEIR
340 BROWNS RD
WAYNESBURG
,
PA
15370
NONE
COLLEGE SCHOLARSHIP
500
CAITLYN NOWAK
52 GREGORY DR
WEST SENECA
,
NY
14224
NONE
COLLEGE SCHOLARSHIP
500
CALYPSO FARRELL
1114 DEERPATH
DOTHAN
,
AL
36303
NONE
COLLEGE SCHOLARSHIP
500
CAMERON MORGAN
113 CANDLELITE DRIVE
MCMURRAY
,
PA
15317
NONE
COLLEGE SCHOLARSHIP
500
CAROLINE LIHANI
270 N MYRTLE AVE
MONROVIA
,
CA
91016
NONE
COLLEGE SCHOLARSHIP
500
CHRISTOPHER DAY
1217 WILLOWBROOK DR
WASHINGTON
,
PA
15301
NONE
COLLEGE SCHOLARSHIP
500
CHRISTY BAUMEISTER
3605 BURGESS RD
DECKERVILLE
,
MI
48427
NONE
COLLEGE SCHOLARSHIP
500
CLAUDIA CLEMENS
335 FORBES TRAIL ROAD
GREENSBURG
,
PA
15601
NONE
COLLEGE SCHOLARSHIP
500
CODY KNIGHT
1241 COLSTON DRIVE
WESTERVILLE
,
OH
43081
NONE
COLLEGE SCHOLARSHIP
500
DAKOTA VOLZER
115 LINDENVALE DR
MCMURRAY
,
PA
15317
NONE
COLLEGE SCHOLARSHIP
500
DANIEL MARTINELLI
729 W MAIN ST
MONONGAHELA
,
PA
15063
NONE
COLLEGE SCHOLARSHIP
500
DANIELLE BLAHO
131 PINE LAKE DR
TROY
,
MO
63379
NONE
COLLEGE SCHOLARSHIP
500
DAVID COLUMBUS
108 BIRCH DRIVE
BELLE VERNON
,
PA
15012
NONE
COLLEGE SCHOLARSHIP
500
DAVID WASSON JR
2326 JALICE CIR
STATE COLLEGE
,
PA
16801
NONE
COLLEGE SCHOLARSHIP
500
DOMINIC FUNDY
281 HUFFMAN RD
FREDERICKTOWN
,
PA
15333
NONE
COLLEGE SCHOLARSHIP
500
ELENI NICKOLAS
130 HOODRIDGE DR
PITTSBURGH
,
PA
15228
NONE
COLLEGE SCHOLARSHIP
500
ELIJAH MCCLYMONDS
1774 PERRY HWY
PORTERSVILLE
,
PA
16051
NONE
COLLEGE SCHOLARSHIP
600
ELISABETH JONES
835 SPRING CITY RD
PHOENIXVILLE
,
PA
19460
NONE
COLLEGE SCHOLARSHIP
500
ELIZABETH KOSTIC
301 LINDA LN
HOUSTON
,
PA
15342
NONE
COLLEGE SCHOLARSHIP
500
ELIZABETH OSTROWSKI
275 TANNERY RD
REINHOLDS
,
PA
17569
NONE
COLLEGE SCHOLARSHIP
500
EMILY BOLASH
10215 WILLIAM ST
RICHMOND
,
IL
60071
NONE
COLLEGE SCHOLARSHIP
500
EMILY DICKOPF
149 ORCHARD HILL RD
HAVERHILL
,
MA
01835
NONE
COLLEGE SCHOLARSHIP
500
EMILY KOPCHICK
20 TURTLE CREEK DR
MULLICA HILL
,
NJ
08062
NONE
COLLEGE SCHOLARSHIP
500
EMILY VITTECK
16023 S APRIL DR
GULFPORT
,
MS
39503
NONE
COLLEGE SCHOLARSHIP
500
EMMA BOUSHIE
33 ESSEX LN
WOODBURY
,
CT
06798
NONE
COLLEGE SCHOLARSHIP
500
ERICA ANGELO
246 TWIN BRIDGES RD
CHARLEROI
,
PA
15022
NONE
COLLEGE SCHOLARSHIP
500
EVAN KNIGHT
1241 COLSTON DRIVE
WESTERVILLE
,
OH
43081
NONE
COLLEGE SCHOLARSHIP
500
FAITH VANG
1824 VINEYARD CREEK RD
GREENWOOD
,
AR
72936
NONE
COLLEGE SCHOLARSHIP
500
FRANCESCA YANOSICK
213 BEAGLE DR
MOONTOWNSHIP
,
PA
15108
NONE
COLLEGE SCHOLARSHIP
500
GEORGE STRISH IV
205 SUTHERLAND DR
MOUNTAIN TOP
,
PA
18707
NONE
COLLEGE SCHOLARSHIP
600
GRACE HOLKER
9899 KESWICK AVE N
STILLWATER
,
MN
55082
NONE
COLLEGE SCHOLARSHIP
500
GRACE LOTZ
2890 WASHINGTON BLVD
MCKESSPORT
,
PA
15133
NONE
COLLEGE SCHOLARSHIP
500
HAILEY DUROVICH
105 MARLIN DR
ORTELY BEACH
,
NJ
08751
NONE
COLLEGE SCHOLARSHIP
500
HANNAH COLEN
195 HARRISON DR
INDIANA
,
PA
15701
NONE
COLLEGE SCHOLARSHIP
500
HANNAH DAY
710 HIGH ST
BELLE VERNON
,
PA
15012
NONE
COLLEGE SCHOLARSHIP
500
HANNAH DEAN
3955 STATION RD
NEW CASTLE
,
PA
16101
NONE
COLLEGE SCHOLARSHIP
500
HANNAH PERRY
14 MADISON ST
FRANKLIN
,
PA
16323
NONE
COLLEGE SCHOLARSHIP
500
HEATH LEWIS
135 BRICK CHURCH RD
EMLENTON
,
PA
16373
NONE
COLLEGE SCHOLARSHIP
500
HEATHER PERKOVICH
15876 FM 1116
SMILEY
,
TX
78159
NONE
COLLEGE SCHOLARSHIP
500
ISABEL IWANONKIW
2211 FAIRLAND ST
PITTSBURGH
,
PA
15210
NONE
COLLEGE SCHOLARSHIP
500
ISABELA PETRONKA
45 WINDCLIFF ACRE
WASHINGTON
,
PA
15301
NONE
COLLEGE SCHOLARSHIP
500
JACK FARRELL
420 GLENVIEW DR
LOWER BURRELL
,
PA
15068
NONE
COLLEGE SCHOLARSHIP
500
JACOB BALBACH
1886 CARIBOU DR
ALLISON PARK
,
PA
15101
NONE
COLLEGE SCHOLARSHIP
500
JACOB MARTIN
599 PORTER MCNUTT LANE
BELLE VERNON
,
PA
15012
NONE
COLLEGE SCHOLARSHIP
500
JACOB YANOSICK
316 WESTBURY DR
MOON TWP
,
PA
15108
NONE
COLLEGE SCHOLARSHIP
500
JARED LEINS
8828 WOODYHILL RD
RALEIGH
,
NC
27613
NONE
COLLEGE SCHOLARSHIP
500
JARED RITZO
1480 WATERSEDGE DR
VIRGINIA BEACH
,
VA
23452
NONE
COLLEGE SCHOLARSHIP
500
JENNIFER BERTRAND
7141 FITCH ROAD
OLMSTED TWP
,
OH
44138
NONE
COLLEGE SCHOLARSHIP
500
JESSE NATHANSON
11380 FRY RD
EDINBORO
,
PA
16412
NONE
COLLEGE SCHOLARSHIP
500
JESSICA COCHRON
184 WINELAND DRIVE
HERMINIE
,
PA
15637
NONE
COLLEGE SCHOLARSHIP
500
JESSICA GODOR
115 MEADOW DR
TRAFFORD
,
PA
15085
NONE
COLLEGE SCHOLARSHIP
500
JILLIAN BORZA
6637 MENOMINEE PKWY
PALOS HEIGHTS
,
IL
60463
NONE
COLLEGE SCHOLARSHIP
600
JOHN DAY
2384 S MAIN ST
WASHINGTON
,
PA
15301
NONE
COLLEGE SCHOLARSHIP
500
JOSEPH BASTAROLI
814 STATION ST
STURGEON
,
PA
15082
NONE
COLLEGE SCHOLARSHIP
500
JOSEPH BERTRAND
7141 FITCH RD
OLMSTED TWP
,
OH
44138
NONE
COLLEGE SCHOLARSHIP
500
JOSEPH HRUSKA
36 SABER DR
KINGS PARK
,
NY
11754
NONE
COLLEGE SCHOLARSHIP
500
JOSEPH JEFFREY
274 HILLTOP DR
CHESWICK
,
PA
15024
NONE
COLLEGE SCHOLARSHIP
500
JOSEPH MULASKI
513 CEDAR GROVE RD
LEBANON
,
TN
37087
NONE
COLLEGE SCHOLARSHIP
500
JOSEPH TESTA IV
1162 SULLENBERGER RD
LATROBE
,
PA
15650
NONE
COLLEGE SCHOLARSHIP
500
JOSH LEINS
8828 WOODYHILL RD
RALEIGH
,
NC
27613
NONE
COLLEGE SCHOLARSHIP
500
JOSHUA MARTIN
599 PORTER MCNUTT LN
ROSTRAVER TWP
,
PA
15012
NONE
COLLEGE SCHOLARSHIP
500
JOSHUA THOMPSON
8180 S VALDAI CT
AURORA
,
CO
80016
NONE
COLLEGE SCHOLARSHIP
500
JOSIAH JASTER
18101 LINCOLN RD
NEW LOTHROP
,
MI
48460
NONE
COLLEGE SCHOLARSHIP
500
JOSIE APPLEGARTH
11481 BEARD RD
NEW SPRINGFIELD
,
OH
44443
NONE
COLLEGE SCHOLARSHIP
500
JULIA BRADFORD
12070 JESSE DR
EDINBORO
,
PA
16412
NONE
COLLEGE SCHOLARSHIP
500
JULIA VALERO
1035 DALLAS DR
JEANNETTE
,
PA
15644
NONE
COLLEGE SCHOLARSHIP
500
JUSTIN GLOWACKI
120 ASH LN
MOUNTAIN TOP
,
PA
18707
NONE
COLLEGE SCHOLARSHIP
500
KAGAN GILTINAN
10031 STRATHFIELD LN
HIGHLANDS RANCH
,
CO
80126
NONE
COLLEGE SCHOLARSHIP
500
KAITLYN GOODREAU
4927 RT 155
PORT ALLEGANY
,
PA
16743
NONE
COLLEGE SCHOLARSHIP
500
KAITLYN HOUMAN
519 DELAWARE ST
MAYFIELD
,
PA
18433
NONE
COLLEGE SCHOLARSHIP
500
KALSIE WALKER
703 6TH ST
WEST BROWNSVILLE
,
PA
15417
NONE
COLLEGE SCHOLARSHIP
500
KAMERON FORREST
9 BRYANT AVE
COLLINGSWOOD
,
NJ
08108
NONE
COLLEGE SCHOLARSHIP
500
KATELYN DENMAN
103 SCENERY BLVD
MONESSEN
,
PA
15062
NONE
COLLEGE SCHOLARSHIP
500
KATELYN KENNEDY
1665 HAWK RD
HOME
,
PA
15747
NONE
COLLEGE SCHOLARSHIP
500
KATHERINE VESTER
322 BRENTWOOD DRIVE
NORTH TONAWANDA
,
NY
14120
NONE
COLLEGE SCHOLARSHIP
500
KATIE MCCLYMONDS
1774 PERRY HWY
PORTERSVILLE
,
PA
16051
NONE
COLLEGE SCHOLARSHIP
500
KAYLA BOSLEY
280 ROBIN STREET
INDIANA
,
PA
15701
NONE
COLLEGE SCHOLARSHIP
500
KEELIA HERING
9971 W LAW RD
NORTH EAST
,
PA
16428
NONE
COLLEGE SCHOLARSHIP
500
KELLY HOWARD
113 SLEEPY HOLLOW RD
PITTSBURGH
,
PA
15216
NONE
COLLEGE SCHOLARSHIP
500
KELLY PARRISH
5393 STATUTE DR
COLORADO SPRINGS
,
CO
80922
NONE
COLLEGE SCHOLARSHIP
500
KELSEA VAN VLIET
449 BRAMHALL ROAD
RAHWAY
,
NJ
07065
NONE
COLLEGE SCHOLARSHIP
500
KELSEE LAZOR
20002 RT 286 HWY E
CHERRY TREE
,
PA
15724
NONE
COLLEGE SCHOLARSHIP
500
KELSEY KENNEDY
1665 HAWK RD
HOME
,
PA
15747
NONE
COLLEGE SCHOLARSHIP
600
KENNETH KYSOR
109 CHESTNUT STREET
PORT ALLEGANY
,
PA
16743
NONE
COLLEGE SCHOLARSHIP
500
KERRY HOWARD
113 SLEEPY HOLLOW RD
PITTSBURGH
,
PA
15216
NONE
COLLEGE SCHOLARSHIP
500
KRISTEN COLLINS
236 STANFORD AVE
PITTSBURGH
,
PA
15229
NONE
COLLEGE SCHOLARSHIP
500
LAINA RAYMAN
1500 SONTINO LN
JEFFERSON HILLS
,
PA
15025
NONE
COLLEGE SCHOLARSHIP
500
LAURA PAYNE
12677 BISCAYNE DR
PHILADELPHIA
,
PA
19154
NONE
COLLEGE SCHOLARSHIP
500
LAUREN DYNDA
210 E ARNOLD AVE
PORT ALLEGANY
,
PA
16743
NONE
COLLEGE SCHOLARSHIP
500
LAUREN KANAVY
80 WOODLAWN ST
PITTSBURGH
,
PA
15205
NONE
COLLEGE SCHOLARSHIP
500
LAUREN MICHAEL
8603 BROWNELL RD
CLYMER
,
NY
14724
NONE
COLLEGE SCHOLARSHIP
500
LAUREN THOMAS
21 REDWING DR
WASHINGTON
,
PA
15301
NONE
COLLEGE SCHOLARSHIP
500
LAURYN LUBECKI
131 SUNNY DR
NEW STANTON
,
PA
15672
NONE
COLLEGE SCHOLARSHIP
500
LEAH MILLER
1967 MILL RD
PUXSUTAWNEY
,
PA
15767
NONE
COLLEGE SCHOLARSHIP
500
LESLIE PETERS
6204 CHARING CROSS
MECHANICSBURG
,
PA
17050
NONE
COLLEGE SCHOLARSHIP
500
LORALEE NEMETZ
200 SPRING RD
BROWNSVILLE
,
PA
15417
NONE
COLLEGE SCHOLARSHIP
500
LORENZO GIACOMINO
204 COMMODORE DR
MCDONALD
,
PA
15057
NONE
COLLEGE SCHOLARSHIP
500
LUCY RACE
2430 LINDALE CT
NORTH HUNTINGDON
,
PA
15642
NONE
COLLEGE SCHOLARSHIP
500
LUKE WEBB
344 FRUITWOOD DR
BETHEL PARK
,
PA
15102
NONE
COLLEGE SCHOLARSHIP
500
MACEY HANES
221 TREASURE LAKE
DUBOIS
,
PA
15801
NONE
COLLEGE SCHOLARSHIP
500
MADALYNN EGER
5516 SHIPLEY CT
CENTREVILLE
,
VA
20120
NONE
COLLEGE SCHOLARSHIP
500
MADELYN HANK
29600 WESTMINSTER DR
NORTH OLMSTEAD
,
OH
44070
NONE
COLLEGE SCHOLARSHIP
500
MADISON BENDER
5495 E PINE LAKE ROAD
PETERSBURG
,
OH
44454
NONE
COLLEGE SCHOLARSHIP
500
MADISON CODELUPPI
1005 4TH ST EXT
CHARLEROI
,
PA
15022
NONE
COLLEGE SCHOLARSHIP
500
MADISON KARR
5517 US RT 422
SOUTHINGTON
,
OH
44470
NONE
COLLEGE SCHOLARSHIP
500
MADISON LOTZ
2890 WASHINGTON BLVD
MCKEESPORT
,
PA
15133
NONE
COLLEGE SCHOLARSHIP
500
MADYSON MAYNARD
2255 BEECHWOOD DR
WESTLAKE
,
OH
44145
NONE
COLLEGE SCHOLARSHIP
500
MANDY XIONG
3470 EICHSTADT RD
OSHKOSH
,
WI
54901
NONE
COLLEGE SCHOLARSHIP
500
MARGARET BEYER
8 WILLIAM ST
RUSSELL
,
PA
16345
NONE
COLLEGE SCHOLARSHIP
500
MARIA STRISH
205 SUTHERLAND DR
MOUNTAIN TOP
,
PA
18707
NONE
COLLEGE SCHOLARSHIP
500
MARIAH JEFFREY
274 HILLTOP DR
CHESWICK
,
PA
15024
NONE
COLLEGE SCHOLARSHIP
500
MARK BENO
501 S 9TH AVE
ELRIDGE
,
IA
52748
NONE
COLLEGE SCHOLARSHIP
500
MARLIE APPLEGARTH
11481 BEARD RD
NEW SPRINGFIELD
,
OH
44443
NONE
COLLEGE SCHOLARSHIP
600
MARY KOPCHICK
20 TURTLE CREEK DR
MULLICA HILL
,
NJ
08062
NONE
COLLEGE SCHOLARSHIP
500
MATTHEW VANG
3094 HERROD AVE
ATWATER
,
CA
95301
NONE
COLLEGE SCHOLARSHIP
500
MCCAULEY FOX
395 N BROOKLYNSIDE RD
PORT ALLEGANY
,
PA
16743
NONE
COLLEGE SCHOLARSHIP
500
MEGAN KROPF
507 BOWER HILL RD
PITTSBURGH
,
PA
15228
NONE
COLLEGE SCHOLARSHIP
1,000
MELANIE STEVANS
422 CENTER CHURCH ROAD
MCMURRAY
,
PA
15317
NONE
COLLEGE SCHOLARSHIP
1,000
MELVIN SANCHEZ
3945 STARFORD RD
STARFORD
,
PA
15777
NONE
COLLEGE SCHOLARSHIP
500
MESHACH MALLEY
500 EAST MAYNARD AVE
COLUMBUS
,
OH
43202
NONE
COLLEGE SCHOLARSHIP
500
MICAH KURKA
3945 STARFORD RD
STARFORD
,
PA
15777
NONE
COLLEGE SCHOLARSHIP
500
MICHAEL DEPAUW
2165 BEN BRUSH PL
LEWIS CENTER
,
OH
43035
NONE
COLLEGE SCHOLARSHIP
500
MICHAEL KANAVY
80 WOODLAWN ST
PITTSBURGH
,
PA
15205
NONE
COLLEGE SCHOLARSHIP
500
MICHAEL KIRSCH
48 BRADFORD AVE
PITTSBURGH
,
PA
15205
NONE
COLLEGE SCHOLARSHIP
600
MICHAEL MCKENZIE
2140 WILDFLOWER AVE
DORR
,
MI
49323
NONE
COLLEGE SCHOLARSHIP
500
MICHAELA BUTWIN
4951 RALEIGH ST
DENVER
,
CO
80212
NONE
COLLEGE SCHOLARSHIP
500
MIRA TERRETTE
306 LOWER PORTAGE RD
PORT ALLEGANY
,
PA
16743
NONE
COLLEGE SCHOLARSHIP
500
MORGAN DUBE
2545 BROWN AVE
GRAPEVILLE
,
PA
15634
NONE
COLLEGE SCHOLARSHIP
500
NATALIE CIACCHI
13819 SHELDON BLVD
MIDDLEBURG HEIGHTS
,
OH
44130
NONE
COLLEGE SCHOLARSHIP
500
NATALIE ZINSKI
222 MEADOWGROVE CIR
CARNEGIE
,
PA
15106
NONE
COLLEGE SCHOLARSHIP
500
NICHOLAS BRADFORD
12070 JESSE DRIVE
EDINBORO
,
PA
16412
NONE
COLLEGE SCHOLARSHIP
500
NICHOLAS BROWN
2305 STAFFORD CIR
STATE COLLEGE
,
PA
16801
NONE
COLLEGE SCHOLARSHIP
500
NICHOLAS HANSEL
375 MAIN ST
RAMEY
,
PA
16671
NONE
COLLEGE SCHOLARSHIP
500
NICHOLAS REGEL
5306 FIELDCREST DR
PITTSBURGH
,
PA
15236
NONE
COLLEGE SCHOLARSHIP
500
NICHOLAS RENICK
2728 QUANCE RD
MCKEAN
,
PA
16426
NONE
COLLEGE SCHOLARSHIP
500
NICHOLAS STUTZ
375 W BREWSTER RD
BUTLER
,
PA
16001
NONE
COLLEGE SCHOLARSHIP
500
NICOLE HUDAK
8057 AMBER LN
BRECKSVILLE
,
OH
44141
NONE
COLLEGE SCHOLARSHIP
500
NICOLE LABORIE
245 HOME AVE
BUTLER
,
PA
16001
NONE
COLLEGE SCHOLARSHIP
500
NOAH BROSOVIC
108 COVE CT
MCDONALD
,
PA
150572185
NONE
COLLEGE SCHOLARSHIP
500
NOAH MULASKI
513 CEDAR GROVE RD
LEBANON
,
TN
37087
NONE
COLLEGE SCHOLARSHIP
600
PAIGE REISS
27028 CASCADE CT
OLMSTED FALLS
,
OH
44138
NONE
COLLEGE SCHOLARSHIP
500
PATRICK FLINT
66 ANNIN RD
WEST CALDWELL
,
NJ
07006
NONE
COLLEGE SCHOLARSHIP
500
PATRICK O'DOHERTY
30403 CRESTVIEW DR
BAY VILLAGE
,
OH
44140
NONE
COLLEGE SCHOLARSHIP
500
PATRICK PHILBIN
104 PINEWOOD HILLS
LONGMEADOW
,
MA
01106
NONE
COLLEGE SCHOLARSHIP
500
PAULINA PREVOZNIK
9406 BEAUREGARD AVE
MANASSAS
,
VA
20110
NONE
COLLEGE SCHOLARSHIP
500
PHILIP COLEN
195 HARRISON DR
INDIANA
,
PA
15701
NONE
COLLEGE SCHOLARSHIP
500
RACHEL PHILLIS
285 FISCHER RD
WASHINGTON
,
PA
15301
NONE
COLLEGE SCHOLARSHIP
500
RACHEL PHILLIS
285 FISCHER RD
WASHINGTON
,
PA
15301
NONE
COLLEGE SCHOLARSHIP
500
RACHEL SIMS
1115 RYMERS SWITCH LN
FRIENDSWOOD
,
TX
77546
NONE
COLLEGE SCHOLARSHIP
500
RHIANNA CHRISTENSEN
1443 BARON CT
BARTLETT
,
IL
60103
NONE
COLLEGE SCHOLARSHIP
500
RICHARD NOVAK
1189 TRANTER AVE
PITTSBURGH
,
PA
15220
NONE
COLLEGE SCHOLARSHIP
500
ROBERT HEINS
215 ROWLAND PARK BLVD
WILMINGTON
,
DE
19803
NONE
COLLEGE SCHOLARSHIP
500
ROBERT HEINS
215 ROWLAND PARK BLVD
WILMINGTON
,
DE
19803
NONE
COLLEGE SCHOLARSHIP
500
RORY SIMS
1115 RYMERS SWITCH LN
FRIENDSWOOD
,
TX
77546
NONE
COLLEGE SCHOLARSHIP
500
RYLEIGH TESTA
4495 SULLENBERGER RD
LATROBE
,
PA
15650
NONE
COLLEGE SCHOLARSHIP
500
SAMANTHA BUGAY
1900 FIR RD
COMMODORE
,
PA
15729
NONE
COLLEGE SCHOLARSHIP
500
SARA ANN BUZA
324 MIKULA RD
FAYETTE CITY
,
PA
15438
NONE
COLLEGE SCHOLARSHIP
500
SARA CHERNICKY
160 DALE AVE
CAMBRIDGE SPRINGS
,
PA
16403
NONE
COLLEGE SCHOLARSHIP
500
SARA HOLDEN
110 EAST SUMMIT DR
LITTLESTOWN
,
PA
17340
NONE
COLLEGE SCHOLARSHIP
500
SARAH BURNS
14717 FOXBORO CT
HOLLAND
,
MI
49424
NONE
COLLEGE SCHOLARSHIP
500
SARAH REYNOLDS
1815 FRANKLIN RUN CT
PITTSBURGH
,
PA
15237
NONE
COLLEGE SCHOLARSHIP
500
SARAH SMITH
12089 RT 286 HWY EAST
COMMODORE
,
PA
15729
NONE
COLLEGE SCHOLARSHIP
500
SICILIA CIPALLA
821 KENNETH AVE 2
CAROLINA BEACH
,
NC
28428
NONE
COLLEGE SCHOLARSHIP
500
STEPHEN DAY III
1217 WILLOWBROOK DR
WASHINGTON
,
PA
15301
NONE
COLLEGE SCHOLARSHIP
500
THERESA NOVAK
909 THORNHILL DR
NEWARK
,
DE
19702
NONE
COLLEGE SCHOLARSHIP
500
TRENTON ROBISON
5456 WOODLAWN DR
EDINBORO
,
PA
16412
NONE
COLLEGE SCHOLARSHIP
500
TREVOR WEIMANN
8 ROMA DR
FARMINGTON
,
CT
06032
NONE
COLLEGE SCHOLARSHIP
500
TRISTAN PHILLIPS
927 EAST GLENMERE DRIVE
CHANDLER
,
AZ
85225
NONE
COLLEGE SCHOLARSHIP
500
TROY DONOFRIO
405 BLUEFIELD DR
OAKDALE
,
PA
15071
NONE
COLLEGE SCHOLARSHIP
600
WILLIAM QUINTANA
447 SPRING HOLLOW DR
MIDDLETOWN
,
DE
19709
NONE
COLLEGE SCHOLARSHIP
500
XAVIER PREVOZNIK
9406 BEAUREGARD AVE
MANASSAS
,
VA
20110
NONE
COLLEGE SCHOLARSHIP
500
ZACHARY NICKOLAS
130 HOODRIDGE DR
PITTSBURGH
,
PA
15228
NONE
COLLEGE SCHOLARSHIP
500
ZACHARY TOTH
3616 GRACE ST
MUNHALL
,
PA
15120
NONE
COLLEGE SCHOLARSHIP
500
Total
.................................
3a
102,400
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
14
42,229
4
Dividends and interest from securities
....
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
............
9
Net income or (loss) from special events:
1
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)
..
42,229
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
42,229
(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
Yes
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
1c
2,500
NAT'L SLOVAK SOCIETY
FREE USE OF FACILITIES, EQUIPMENT
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
NAT'L SLOVAK SOCIETY
501(C)(8)
COMMON DIRECTORS
NSS HERITAGE MUSEUM
501(C)(3)
COMMON DIRECTORS
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