Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0052
2020
Open to Public Inspection
For calendar year 2020, or tax year beginning 01-01-2020 , and ending 12-31-2020
Name of foundation
AMY'S LEGACY FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)4190 VINEWOOD LN N NO 111477
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
PLYMOUTH, MN55442
A Employer identification number

81-4184096
B Telephone number (see instructions)

(763) 334-3787
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$2,123,962J Accounting method:
 
(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)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 40,395 43,014  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 -45,248
b Gross sales price for all assets on line 6a 3,136,835
7 Capital gain net income (from Part IV, line 2)... 26,246
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)....... Click to see attachment 238 12 0
12 Total. Add lines 1 through 11........ -4,615 69,272 0
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 169,093 8,455 0 160,638
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule)......... Click to see attachment 921 0 0 921
b Accounting fees (attach schedule)....... Click to see attachment 10,058 5,029 0 5,029
c Other professional fees (attach schedule).... Click to see attachment 28,473 17,976 0 10,497
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 20,402 674 0 10,489
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 3,118 110 0 3,004
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 232,065 32,244 0 190,578
25 Contributions, gifts, grants paid....... 2,027,475 2,027,475
26 Total expenses and disbursements. Add lines 24 and 25 2,259,540 32,244 0 2,218,053
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -2,264,155
b Net investment income (if negative, enter -0-) 37,028
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2020)
Form 990-PF (2020)
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
Assets 1 Cash—non-interest-bearing............. 19,904 101,610 101,610
2 Savings and temporary cash investments......... 335,913 195,558 195,558
3 Accounts receivable bullet365
Less: allowance for doubtful accounts bullet     365 365
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
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) bullet  
Less: allowance for doubtful accounts bullet        
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)....... 1,988,857 Click to see attachment496,262 496,262
c Investments—corporate bonds (attach schedule)....... 491,203 0 0
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 1,413,958 Click to see attachment1,330,167 1,330,167
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 4,249,835 2,123,962 2,123,962
Liabilities 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 bullet)    
23 Total liabilities (add lines 17 through 22)......... 0 0
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
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 bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........ 0 0
27 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
28 Retained earnings, accumulated income, endowment, or other funds 4,249,835 2,123,962
29 Total net assets or fund balances (see instructions)..... 4,249,835 2,123,962
30 Total liabilities and net assets/fund balances (see instructions). 4,249,835 2,123,962
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
4,249,835
2
Enter amount from Part I, line 27a .....................
2
-2,264,155
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
138,282
4
Add lines 1, 2, and 3 ..........................
4
2,123,962
5
Decreases not included in line 2 (itemize) bullet
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
2,123,962
Form 990-PF (2020)
Form 990-PF (2020)
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 PUBLICLY TRADED SECURITIES      
b CAPITAL GAIN DISTRIBUTIONS P    
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 3,136,835   3,126,119 10,716
b       15,530
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       10,716
b       15,530
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 26,246
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 ................... 		Bracket 3 0
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
SECTION 4940(e) REPEALED ON DECEMBER 20, 2019 - DO NOT COMPLETE
1 Reserved
(a)
Reserved 		(b)
Reserved 		(c)
Reserved 		(d)
Reserved
2
Reserved...........................
2
3
Reserved...........................
3
4
Reserved...........................
4
5
Reserved...........................
5
6
Reserved...........................
6
7
Reserved...........................
7
8
Reserved,..........................
8
Form 990-PF (2020)
Form 990-PF (2020)
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 Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b Reserved................................ 1 515
c All other domestic foundations enter 1.39% 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........................... 3 515
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- ..... 5 515
6 Credits/Payments:
a 2020 estimated tax payments and 2019 overpayment credited to 2020 6a 5,000
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 6,500
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 11,500
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 10,985
11 Enter the amount of line 10 to be: Credited to 2021 estimated taxBullet10,985 RefundedBullet 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 the instructions
for the 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. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
Yes
 
If "Yes," attach the statement required by General Instruction T.Click to see list of attachments
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)
    bulletMN
    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 2020 or the taxable year beginning in 2020? 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 (2020)
    Form 990-PF (2020)
    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 addressbulletN/A
    14
    The books are in care ofbulletBOB REIS Telephone no.bullet (763) 334-3787

    Located atbullet4190 VINEWOOD LN N SUITE 111-477PLYMOUTHMN ZIP+4bullet55442
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2020, did the foundation have an interest in or a signature or other authority over YesNo
    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 bullet
    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?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (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)?...............
    (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.).......
    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
    Yes
     
    ........bullet
    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 2020?.............
    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 2020, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2020?.............
    If "Yes," list the years bullet20, 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.
    bullet20, 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?......................
    b
    If "Yes," did it have excess business holdings in 2020 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 2020.)..................
    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 2020?
    4b
     
    No
    Form 990-PF (2020)
    Form 990-PF (2020)
    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))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    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
    .........bullet
    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?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d). Click to see attachment
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    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?
    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? .................
    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
    STEVE GROSSER PRESIDENT
    2.00     		0 0 0
    4190 VINEWOOD LN N 111-477
    PLYMOUTH,MN55442
    LIV GROSSER VICE PRESIDENT
    2.00     		0 0 0
    4190 VINEWOOD LN N 111-477
    PLYMOUTH,MN55442
    BOB REIS EXEC DIR/TREASURER/SECRETARY
    40.00     		141,269 25,127 2,697
    4190 VINEWOOD LN N 111-477
    PLYMOUTH,MN55442
    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...................bullet 0
    Form 990-PF (2020)
    Form 990-PF (2020)
    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.............bullet0
    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.........................bullet0
    Form 990-PF (2020)
    Form 990-PF (2020)
    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
    2,583,358
    b
    Average of monthly cash balances.......................
    1b
    909,735
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    3,493,093
    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
    3,493,093
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    52,396
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    3,440,697
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    172,035
    Part XI
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    172,035
    2a
    Tax on investment income for 2020 from Part VI, line 5......
    2a
    515
    b
    Income tax for 2020. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    515
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    171,520
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    171,520
    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
    171,520
    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
    2,218,053
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    2,218,053
    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
    2,218,053
    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 (2020)
    Form 990-PF (2020)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2019     		(c)
    2019     		(d)
    2020
    1 Distributable amount for 2020 from Part XI, line 7 171,520
    2 Undistributed income, if any, as of the end of 2020:
    a Enter amount for 2019 only....... 0
    b Total for prior years:2018, 2017, 2016 0
    3 Excess distributions carryover, if any, to 2020:
    a From 2015......  
    b From 2016...... 6,435
    c From 2017...... 188,398
    d From 2018...... 1,041,054
    e From 2019...... 1,528,827
    fTotal of lines 3a through e........ 2,764,714
    4Qualifying distributions for 2020 from Part
    XII, line 4: bullet$ 2,218,053
    a Applied to 2019, but not more than line 2a 0
    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 2020 distributable amount..... 171,520
    e Remaining amount distributed out of corpus 2,046,533
    5 Excess distributions carryover applied to 2020. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 4,811,247
    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 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2020. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2021 ..........     		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) .......     		0
    8 Excess distributions carryover from 2015 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2021.
    Subtract lines 7 and 8 from line 6a ......     		4,811,247
    10 Analysis of line 9:
    a Excess from 2016.... 6,435
    b Excess from 2017.... 188,398
    c Excess from 2018.... 1,041,054
    d Excess from 2019.... 1,528,827
    e Excess from 2020.... 2,046,533
    Form 990-PF (2020)
    Form 990-PF (2020)
    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 2020, enter the date of the ruling....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    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) 2020 (b) 2019 (c) 2018 (d) 2017
             
    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.)
    1Information Regarding Foundation Managers:
    aList 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).)
    STEVE GROSSER
    LIV GROSSER
    bList 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.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2020)
    Form 990-PF (2020)
    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)
    aPaid during the year
    A ACT OF LOVE ADOPTION
    9561 S 700 E SUITE 101
    SANDY,UT84070     		N/A PC ADOPTION SERVICES 5,000
    AMERICA WORLD ADOPTION
    6723 WHITTIER AVENUE
    MALEAN,VA22101     		N/A PC ADOPTION SERVICES 10,000
    AMERICA WORLD ADOPTION ASSOCIATION MN
    909 9TH STREET NE
    WASECA,MN56093     		N/A PC ADOPTION SERVICES 1,500
    CCAI ADOPTION SERVICES
    6920 SOUTH HOLLY CIRCLE
    CENTENNIAL,CO80112     		N/A PC ADOPTION SERVICES 3,500
    CHILDREN'S HOME SOCIETY
    1605 ESUTIS STREET
    ST PAUL,MN55109     		N/A PC ADOPTION SERVICES 5,000
    EVOLVE
    5850 OMAHA AVE N
    STILLWATER,MN55082     		N/A PC ADOPTION SERVICES 13,700
    HOLT INTERNATIONAL
    250 COUNTRY CLUB ROAD
    EUGENE,OR97401     		N/A PC ADOPTION SERVICES 6,300
    OPEN DOOR ADOPTION
    PO BOX 4
    THOMASVILLE,GA31799     		N/A PC ADOPTION SERVICES 5,000
    PATHWAYS FOR LITTLE FEET
    9 GREENWAY PLAZA SUITE 3150
    HOUSTON,TX77046     		N/A PC ADOPTION SERVICES 5,500
    SHOW HOPE
    230 FRANKLIN ROAD
    FRANKLIN,TN37064     		N/A PC ADOPTION SERVICES 150,000
    SMALL WORLD ADOPTIONS
    PO BOX 1109
    MOUNT JULIET,IL37121     		N/A PC ADOPTION SERVICES 15,000
    AMISTAD WORLDWIDE
    1416 3RD AVE N
    FARGO,ND58102     		N/A PC GENERAL SUPPORT 25,000
    ASSEMBLIES OF GOD WORLD MISSIONS
    1446 N BONNEVILLE AVE
    SPRINGFIELD,MO65082     		N/A PC GENERAL SUPPORT 7,200
    BENJAMIN HOUSE MINISTRIES
    PO BOX 21
    MOORE,SC29369     		N/A PC GENERAL SUPPORT 25,000
    BETHANY CHRISTIAN SERVICES
    3025 HARBOR LN N SUITE 316
    PLYMOUTH,MN55447     		N/A PC GENERAL SUPPORT 10,000
    CHRISTIAN MISSIONS IN MANY LANDS
    PO BOX 13
    SPRING LAKE,NJ07762     		N/A PC GENERAL SUPPORT 6,200
    CHURCH OF GOD WORLD MISSIONS
    2490 KEITH ST PO BOX 8016
    CLEVELAND,TN37320     		N/A PC GENERAL SUPPORT 125,000
    CITY JOY
    720 13TH AVE S
    MINNEAPOLIS,MN55442     		N/A PC GENERAL SUPPORT 6,000
    EVANGELICAL FREE CHURCH OF AMERICA
    901 E 78TH ST
    MINNEAPOLIS,MN55420     		N/A PC GENERAL SUPPORT 75,000
    GLOBAL IMPACT MISSIONS
    PO BOX 23074
    LEXINGTON,KY40514     		N/A PC GENERAL SUPPORT 50,000
    HOPE ACADEMY
    2300 CHICAGO AVE
    MINNEAPOLIS,MN55404     		N/A PC GENERAL SUPPORT 50,000
    HOPE FARM SCHOOL
    3431 11TH AVE S
    MINNEAPOLIS,MN55407     		N/A PC GENERAL SUPPORT 300,000
    HOPE RIDES
    PO BOX 25
    HOPKINS,MN55305     		N/A PC GENERAL SUPPORT 100,000
    LIFESONG FOR ORPHANS
    PO BOX 40
    GRIDLEY,IL61744     		N/A PC GENERAL SUPPORT 265,000
    NEW HOPE CHURCH
    4225 GETTYSBURG AVE N
    NEW HOPE,MN55428     		N/A PC GENERAL SUPPORT 875
    NEW HORIZONS FOR CHILDREN
    9401 MENTOR AVE 309
    MENTOR,OH44060     		N/A PC GENERAL SUPPORT 50,000
    NEW SALEM MISSIONARY BAPTIST CHURCH
    2507 BRYANT AVE N
    MINNEAPOLIS,MN55411     		N/A PC GENERAL SUPPORT 5,000
    PRAISING JESUS FEEDING MINISTRIES
    PO BOX 1942
    METAIRIE,LA70004     		N/A PC GENERAL SUPPORT 9,000
    ROSEBUD HOUSE OF PRAYER
    1404 SKILES LANE
    ARDEN HILLS,MN55112     		N/A PF GENERAL SUPPORT 57,000
    SEND INTERNATIONAL
    PO BOX 513
    FARMINGTON,MI48332     		N/A PC GENERAL SUPPORT 5,000
    TEAM
    PO BOX 1683
    CAROL STREAM,IL60132     		N/A PC GENERAL SUPPORT 10,000
    T-NET INTERNATIONAL
    PO BOX 460579
    AURORA,CO80046     		N/A PC GENERAL SUPPORT 2,000
    TOGETHER FOR GOOD
    845 SUMMIT AVE
    ST PAUL,MN55105     		N/A PC GENERAL SUPPORT 10,000
    TRUE HOPE MINISTRY
    505 UNDERWOOD LANE NW
    ST MICHAEL,MN55376     		N/A PC GENERAL SUPPORT 448,750
    TUSCULUM CHURCH OF CHRIST
    6117 NOLENSVILLE PIKE
    NASHVILLE,TN37211     		N/A PC GENERAL SUPPORT 5,000
    UNIVERSITY OF ST THOMAS
    2115 SUMMIT AVE
    ST PAUL,MN55125     		N/A PC GENERAL SUPPORT 8,250
    URBAN VENTURES
    2924 4TH AVE S
    MINNEAPOLIS,MN55408     		N/A PC GENERAL SUPPORT 30,000
    VOICE OF THE MARTYRS INC
    1815 SE BISON RD
    AURORA,CO80046     		N/A PC GENERAL SUPPORT 100,000
    YWAM ORGANIC
    PO BOX 15579
    COLORADO SPRINGS,CO80935     		N/A PC GENERAL SUPPORT 21,700
    Total .................................bullet 3a 2,027,475
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2020)
    Form 990-PF (2020)
    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.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees 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 40,395  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot 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 -45,248  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aWORKERS COMP INS REFUND     		    01 238  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e).. 0 -4,615 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    -4,615
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		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 (2020)
    Form 990-PF (2020)
    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? ...........
    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.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below?
    See instructions.
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2020)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2020 AccountingFeesSchedule
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEES 7,904 3,952 0 3,952
    BOOKKEEPING 2,154 1,077 0 1,077

    TY 2020 DissolutionStmt
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Dissolution Name Dissolution Address Explanation Dissolution Amount
    SEE PART XV LINE 3A 4190 VINEWOOD LN N 111-477
    PLYMOUTH,MN55442     		ADOPTION SERVICES AND GENERAL SUPPORT 2,027,475


    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2020 ExpenditureResponsibilityStmt
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Grantee's Name Grantee's Address Grant Date Grant Amount Grant Purpose Amount Expended By Grantee Any Diversion By Grantee? Dates of Reports By Grantee Date of Verification Results of Verification
    ROSEBUD HOUSE OF PRAYER
          		1404 SKILES LANE
    ARDEN HILLS,MN55112     		2020-06-26 57,000 GENERAL SUPPORT 57,000   10/07/21 2021-10-07 THE FOUNDATION MADE A GRANT OF $57,000 TO SUPPORT THE MINISTRY OF ROSEBUD HOUSE OF PRAYER. THE GRANT FROM THE FOUNDATION WAS TO BE USED TO HELP FUND THE PURCHASE OF A TRAILER AND PRE-FAB BUILDING AND FOR REPAIRS AND REMODELING OF THE BUILDING; TO BE USED FOR MINISTRY MEETINGS WITH RECENTLY RELEASED INMATES AND FOR PRAYER AND BIBLE STUDIES. PER ACKNOWLEDGEMENT RECEIVED ON OCTOBER 7, 2021, ROSEBUD HOUSE OF PRAYER USED THE DONATION FOR SUCH PURPOSES.

    TY 2020 InvestmentsCorpStockSchedule
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Name of Stock End of Year Book Value End of Year Fair Market Value
    ISHARES CORE S&P 500 ETF 61,189 61,189
    ISHARES GOLD TRUSTET ETF 31,873 31,873
    ISHARES TR ETF INTERMEDIATE 108,380 108,380
    BERKSHIRE HATHAWAY INC DEL CLASS B 20,173 20,173
    COSTCO WHOLESALE CORP 12,917 12,917
    DUKE ENERGY CORP NEW 6,550 6,550
    ILLINOIS TOOL WORKS INC 17,608 17,608
    MERCK & CO INC 14,560 14,560
    MICROSOFT CORP 25,133 25,133
    NUTRIEN LIMITED 8,235 8,235
    PAYPAL HOLDINGS INC 32,554 32,554
    PFIZER INC 10,675 10,675
    PROCTER & GAMBLE CO 17,114 17,114
    RAYTHEON TECHNOLOGIES CORP 7,235 7,235
    UNION PACIFIC CORP 15,617 15,617
    VISA INC CL A 12,327 12,327
    ISHARES S&P MIDCAP 400 GROWTH 17,930 17,930
    ISHARES TRUST CORE 1-5 YEAR USD BOND FUND 44,182 44,182
    VANGUARD SHORT TERM BD ETF 32,010 32,010

    TY 2020 InvestmentsOtherSchedule2
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    ABERDEEN FUNDS FMV 67,097 67,097
    DELAWARE GROUP EQUITY FDS II-V FMV 124,957 124,957
    DOUBLELINE FDS TR TOTAL RETURN FMV 78,115 78,115
    DOUBLELINE FDS TR EMERGING MKTS FMV 56,393 56,393
    INVESCO DEVELOPING MARKETS FUND FMV 50,543 50,543
    JOHN HANCOCK FUNDS III DISCIPLINED FMV 89,881 89,881
    FEDERATED HERMES INSTL PRIME VALUE FMV 70,128 70,128
    PRINCIPAL FDS INC MIDCAP FUND FMV 99,612 99,612
    BLACKROCK STRATEGIES INCOME OP FMV 157,270 157,270
    PGIM HIGH YIELD CLZ FMV 113,174 113,174
    T ROWE PRICE BLUE CHIP GROWTH FUND FMV 120,136 120,136
    AMERICAN BALANCED CL F3 FMV 75,272 75,272
    AMERICAN NEW PERSPECTIVE CL F3 FMV 76,646 76,646
    INVESCO GLOBAL OPPORTUNITIES FMV 25,180 25,180
    JOHN HANCOCK BOND CL R6 FMV 25,852 25,852
    JOHN HANCOCK INTERNATIONAL FMV 13,520 13,520
    JPMORGAN SHORT DURATION BOND C FMV 13,974 13,974
    MFS NEW DISCOVERY CI R6 FMV 23,057 23,057
    MFS VALUE CI R6 FMV 14,281 14,281
    PGIM GLOBAL TOTAL RETURN FMV 5,543 5,543
    PGIM SHORT TERM CORPORATE BOND FMV 29,536 29,536

    TY 2020 LiquidationExplanationStmt
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Statement:
    DURING THE TAX YEAR ENDED DECEMBER 31, 2020, GRANTS PAID OUT RESULTED IN A SUBSTANTIAL CONTRACTION OF THE FUND BALANCE. THE FOUNDATION EXPECTS TO RECEIVE CONTRIBUTIONS IN FUTURE YEARS TO ALLOW FOR THE CONTINUATION OF GRANTS. THERE IS NO PLAN TO WIND DOWN OR TERMINATE THE FOUNDATION.


    TY 2020 LegalFeesSchedule
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES 921 0 0 921


    TY 2020 OtherExpensesSchedule
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PAYROLL SERVICE FEES 135 7 0 128
    OFFICE SUPPLIES & SOFTWARE 2,813 103 0 2,710
    MEALS 141 0 0 141
    MN REGISTRATION FEE 29 0 0 25


    TY 2020 OtherIncomeSchedule2
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    WORKERS COMP INS REFUND 238 12 0


    TY 2020 OtherIncreasesSchedule
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Description Amount
    UNREALIZED GAIN/LOSS 138,262
    PRIOR PERIOD ADJUSTMENT 20


    TY 2020 OtherProfessionalFeesSchedule
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    MANAGEMENT FEES 17,976 17,976 0 0
    SOCIAL WORKER 10,497 0 0 10,497


    TY 2020 TaxesSchedule
    Name:
    AMY'S LEGACY FOUNDATION
    EIN:
    81-4184096
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PAYROLL TAX 11,041 552 0 10,489
    FEDERAL EXCISE TAX 9,239 0 0 0
    FOREIGN TAXES 122 122 0 0