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
CROUSE SURVIVORS TRUST
 
Number and street (or P.O. box number if mail is not delivered to street address)6325 S RAINBOW BLVD STE 300
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LAS VEGAS, NV89118
A Employer identification number

43-6368647
B Telephone number (see instructions)

(888) 730-4933
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$916,001J 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... 25,210 25,155  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 25,353
b Gross sales price for all assets on line 6a 435,008
7 Capital gain net income (from Part IV, line 2)... 25,353
8 Net short-term capital gain......... 0
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 50,563 50,508  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 12,632 11,369   1,263
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule).........       0
b Accounting fees (attach schedule)....... Click to see attachment 1,068 0 0 1,068
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... Click to see attachment 705 397   0
19 Depreciation (attach schedule) and depletion... 0 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......   0 0  
22 Printing and publications..........   0 0  
23 Other expenses (attach schedule)....... Click to see attachment 6 6    
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 14,411 11,772 0 2,331
25 Contributions, gifts, grants paid....... 37,000 37,000
26 Total expenses and disbursements. Add lines 24 and 25 51,411 11,772 0 39,331
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -848
b Net investment income (if negative, enter -0-) 38,736
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............. 1,286 1,848 1,848
2 Savings and temporary cash investments......... 29,191 14,660 14,660
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
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 bullet0      
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).......   Click to see attachment162,356 289,720
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 679,495 Click to see attachment530,184 609,773
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) 709,972 709,048 916,001
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
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........ 709,972 709,048
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)..... 709,972 709,048
30 Total liabilities and net assets/fund balances (see instructions). 709,972 709,048
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
709,972
2
Enter amount from Part I, line 27a .....................
2
-848
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
51
4
Add lines 1, 2, and 3 ..........................
4
709,175
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
127
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
709,048
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 6. ZOETIS INC   2019-08-21 2020-02-03
b 19. ZOETIS INC   2017-05-16 2020-02-03
c 39.588 AMER CENT SMALL CAP GRWTH INST 336   2019-10-25 2020-02-14
d 31.412 AMER CENT SMALL CAP GRWTH INST 336   2018-02-09 2020-02-14
e 79. ARTISAN MID CAP FUND-INS 1333   2016-04-26 2020-02-14
723.206 JPMORGAN MID CAP VALUE-R6 #2335   2016-04-26 2020-02-14
270.567 T ROWE PR REAL ESTATE-I #432   2016-01-25 2020-02-14
198. SPDR DJ WILSHIRE INTERNATIONAL R ETF   2017-01-20 2020-02-14
2. APPLE INC   2019-08-21 2020-02-18
3. BLACKROCK INC   2019-02-27 2020-02-18
17. CVS HEALTH CORPORATION   2017-08-09 2020-02-18
1. CVS HEALTH CORPORATION   2019-09-10 2020-02-18
9. CITIGROUP INC.   2019-04-22 2020-02-18
33. HAIN CELESTIAL GROUP INC   2015-12-17 2020-02-18
7. JPMORGAN CHASE & CO   2018-12-04 2020-02-18
15. MICROSOFT CORP   2019-08-21 2020-02-18
1. MICROSOFT CORP   2018-11-20 2020-02-18
24. MONDELEZ INTERNATIONAL INC   2019-08-21 2020-02-18
17. SUNCOR ENERGY INC NEW F   2019-10-01 2020-02-18
22. SUNCOR ENERGY INC NEW F   2018-11-20 2020-02-18
8. TARGET CORP   2019-08-21 2020-02-18
6. TOTAL S.A. - ADR   2019-10-01 2020-02-18
13. TOTAL S.A. - ADR   2018-11-20 2020-02-18
7. UNION PACIFIC CORP   2019-08-21 2020-02-18
1. HOME DEPOT INC   2019-08-21 2020-03-04
15. HOME DEPOT INC   2017-04-04 2020-03-04
10. CVS HEALTH CORPORATION   2019-09-10 2020-03-16
7. ELI LILLY & CO COM   2016-10-03 2020-03-16
1. UNION PACIFIC CORP   2019-10-01 2020-03-16
2. UNION PACIFIC CORP   2011-06-07 2020-03-16
12. EATON CORP PLC   2019-08-21 2020-03-16
35. EATON CORP PLC   2012-12-06 2020-03-16
10.658 INV OPP DEVELOP MRKTS-R6 7038   2020-02-20 2020-04-03
131.967 INV OPP DEVELOP MRKTS-R6 7038   2017-01-26 2020-04-03
230.741 EATON VANCE GLOB MACRO ADV-I 208   2017-10-26 2020-04-03
24.397 FIDELITY NEW MRKTS INC-Z #3323   2020-02-20 2020-04-03
3.711 FIDELITY NEW MRKTS INC-Z #3323   2016-04-26 2020-04-03
320. ISHARES CORE MSCI EMERGING ETF   2019-08-08 2020-04-03
4015.847 METROPOLITAN WEST T/R BD-PLN #712   2019-08-08 2020-04-03
1261.351 PIMCO TOTAL RET FD-INST #35   2019-08-08 2020-04-03
201.434 PIMCO HIGH YIELD FD-INST #108   2019-10-11 2020-04-03
16. PNC FINANCIAL SERVICES GROUP   2015-05-27 2020-04-03
12.534 T ROWE PR OVERSEAS STOCK-I #521   2020-02-20 2020-04-03
2013.021 T ROWE PR OVERSEAS STOCK-I #521   2017-04-26 2020-04-03
.357 RAYTHEON TECHNOLOGIES CORP   2019-09-10 2020-04-29
11.475 INV OPP DEVELOP MRKTS-R6 7038   2017-01-26 2020-05-15
191.801 AMER CENT SMALL CAP GRWTH INST 336   2020-04-03 2020-05-15
1294.823 AMER CENT SMALL CAP GRWTH INST 336   2016-04-26 2020-05-15
77.814 ARTISAN MID CAP FUND-INS 1333   2016-04-26 2020-05-15
2626.578 PIMCO HIGH YIELD FD-INST #108   2019-10-11 2020-05-15
19.171 T ROWE PR OVERSEAS STOCK-I #521   2017-04-26 2020-05-15
104.268 STERLING CAPITAL STRATTON SMALL CAP   2019-08-08 2020-05-15
302.68 STERLING CAPITAL STRATTON SMALL CAP   2016-04-26 2020-05-15
17. VANGUARD MIDCAP VIPER   2020-02-14 2020-05-15
14. AT & T INC   2019-10-01 2020-08-26
56. AT & T INC   2018-02-13 2020-08-26
5. APPLE INC   2011-02-24 2020-08-26
4. APPLE INC   2019-08-21 2020-08-26
7. BOEING CO   2018-11-20 2020-08-26
1. BOEING CO   2020-03-16 2020-08-26
43. EOG RESOURCES, INC   2018-04-12 2020-08-26
27. ELECTRONIC ARTS INC   2019-02-14 2020-08-26
31. HAIN CELESTIAL GROUP INC   2020-04-03 2020-08-26
30. HAIN CELESTIAL GROUP INC   2018-11-20 2020-08-26
18. JPMORGAN CHASE & CO   2018-11-20 2020-08-26
5. JPMORGAN CHASE & CO   2019-10-01 2020-08-26
9. SPIRIT AEROSYTSEMS HOLD-CL A   2020-04-03 2020-08-26
45. SPIRIT AEROSYTSEMS HOLD-CL A   2016-10-03 2020-08-26
39. TJX COMPANIES INC   2011-10-05 2020-08-26
13. TJX COMPANIES INC   2019-10-01 2020-08-26
5. THERMO FISHER SCIENTIFIC INC   2020-04-03 2020-08-26
3. THERMO FISHER SCIENTIFIC INC   2018-11-20 2020-08-26
39. UNILEVER N.V. - ADR   2020-02-03 2020-08-26
7. VISA INC-CLASS A SHRS   2020-03-16 2020-08-26
214. FLEXTRONICS INTL LTD   2018-11-20 2020-08-26
23. APPLE INC   2011-02-24 2020-09-15
6. APPLE INC   2011-02-24 2020-10-20
12. CVS HEALTH CORPORATION   2019-08-21 2020-10-20
24. AT & T INC   2018-02-13 2020-10-26
12. CME GROUP INC   2012-06-07 2020-10-26
4. CME GROUP INC   2020-08-26 2020-10-26
7. NIKE INC CL B   2020-08-26 2020-10-26
5. NIKE INC CL B   2017-11-07 2020-10-26
7. UNITED PARCEL SERVICE-CL B   2019-02-27 2020-10-26
99. FLEXTRONICS INTL LTD   2020-04-03 2020-10-26
118. FLEXTRONICS INTL LTD   2018-11-20 2020-10-26
20. AT & T INC   2019-08-21 2020-11-03
49. SPIRIT AEROSYTSEMS HOLD-CL A   2020-04-03 2020-11-03
7. TE CONNECTIVITY LTD   2020-08-26 2020-11-03
2. TE CONNECTIVITY LTD   2018-11-20 2020-11-03
98.22 INV OPP DEVELOP MRKTS-R6 7038   2017-01-26 2020-12-09
47. AT & T INC   2018-07-12 2020-12-09
1. ALPHABET INC CL C   2020-08-26 2020-12-09
27. APPLE INC   2011-02-24 2020-12-09
16.599 ARTISAN MID CAP FUND-INS 1333   2016-04-26 2020-12-09
4. BROADCOM INC   2019-08-21 2020-12-09
20. CVS HEALTH CORPORATION   2019-08-21 2020-12-09
33. CISCO SYSTEMS INC   2019-08-21 2020-12-09
25. CITIGROUP INC.   2019-04-22 2020-12-09
535.43 EV GL MACR ABS RTRN ADV-R6 #1072   2017-10-26 2020-12-09
1. ELECTRONIC ARTS INC   2019-12-24 2020-12-09
10. ELECTRONIC ARTS INC   2019-02-14 2020-12-09
711. INVESCO OPTIMUM YIELD DIVERS   2020-04-03 2020-12-09
8. JPMORGAN CHASE & CO   2020-10-26 2020-12-09
4. JPMORGAN CHASE & CO   2019-02-27 2020-12-09
1. LAM RESEARCH CORP COM   2020-08-26 2020-12-09
2. LAM RESEARCH CORP COM   2019-08-21 2020-12-09
80. MANULIFE FINANCIAL CORP   2019-04-22 2020-12-09
1696.165 METROPOLITAN WEST T/R BD-PLN #712   2019-12-10 2020-12-09
1331.619 METROPOLITAN WEST T/R BD-PLN #712   2016-04-26 2020-12-09
7. MICROSOFT CORP   2019-08-21 2020-12-09
4. MICROSOFT CORP   2020-08-26 2020-12-09
25. MONDELEZ INTERNATIONAL INC   2018-11-20 2020-12-09
11. NIKE INC CL B   2017-10-24 2020-12-09
355.006 PIMCO TOTAL RET FD-INST #35   2019-08-08 2020-12-09
1076.48 PIMCO TOTAL RET FD-INST #35   2019-12-10 2020-12-09
215.193 T ROWE PR OVERSEAS STOCK-I #521   2017-04-26 2020-12-09
1071.378 JAMES ALPHA GL REAL EST-I   2020-02-20 2020-12-09
79. SUNCOR ENERGY INC NEW F   2015-07-07 2020-12-09
5. TARGET CORP   2020-08-26 2020-12-09
4. TARGET CORP   2019-08-21 2020-12-09
3. THERMO FISHER SCIENTIFIC INC   2011-02-24 2020-12-09
1. THERMO FISHER SCIENTIFIC INC   2020-04-03 2020-12-09
26. TORONTO DOMINION BK ONT COM NEW   2019-07-02 2020-12-09
33. TOTAL S.A. - ADR   2017-08-09 2020-12-09
138.572 TOUCHSTONE MID CAP-INST #353   2020-02-20 2020-12-09
122.509 TRIBUTARY SMALL CO-INST PLUS #1705   2020-05-15 2020-12-09
7. UNITED PARCEL SERVICE-CL B   2017-03-24 2020-12-09
2. UNITED PARCEL SERVICE-CL B   2011-08-12 2020-12-09
3. UNITEDHEALTH GROUP INC   2019-08-21 2020-12-09
2. UNITEDHEALTH GROUP INC   2020-08-26 2020-12-09
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(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 813   762 51
b 2,575   1,231 1,344
c 792   711 81
d 628   537 91
e 3,444   3,284 160
29,044   25,953 3,091
7,332   7,010 322
7,809   7,211 598
638   427 211
1,693   1,359 334
1,220   1,319 -99
72   64 8
699   636 63
867   1,261 -394
950   820 130
2,810   2,086 724
187   102 85
1,432   1,310 122
510   531 -21
660   711 -51
941   843 98
292   312 -20
632   723 -91
1,278   1,148 130
234   219 15
3,508   2,196 1,312
545   636 -91
946   565 381
127   158 -31
253   101 152
921   935 -14
2,687   1,494 1,193
364   478 -114
4,508   4,457 51
2,204   2,464 -260
310   374 -64
47   56 -9
12,607   15,467 -2,860
42,046   41,638 408
13,295   13,253 42
1,565   1,811 -246
1,365   1,536 -171
101   138 -37
16,225   20,191 -3,966
24   29 -5
425   388 37
3,404   2,620 784
22,983   18,851 4,132
3,355   3,235 120
21,485   23,343 -1,858
169   192 -23
5,723   5,818 -95
16,614   23,693 -7,079
2,486   3,157 -671
421   527 -106
1,683   2,054 -371
2,516   243 2,273
2,012   853 1,159
1,203   2,405 -1,202
172   137 35
1,863   4,151 -2,288
3,851   2,850 1,001
1,026   839 187
993   675 318
1,792   1,964 -172
498   588 -90
182   168 14
909   2,696 -1,787
2,076   548 1,528
692   730 -38
2,129   1,406 723
1,278   790 488
2,294   2,295 -1
1,471   1,120 351
2,264   2,088 176
2,677   279 2,398
702   73 629
712   746 -34
653   871 -218
1,909   643 1,266
636   702 -66
893   780 113
638   357 281
1,172   810 362
1,386   754 632
1,652   951 701
550   703 -153
960   913 47
713   671 42
204   165 39
5,075   3,317 1,758
1,471   1,573 -102
1,774   1,640 134
3,278   328 2,950
870   690 180
1,666   1,155 511
1,462   1,241 221
1,471   1,604 -133
1,471   1,723 -252
5,847   5,729 118
132   109 23
1,323   957 366
10,361   8,458 1,903
967   808 159
483   423 60
498   351 147
995   415 580
1,438   1,420 18
17,691   17,692 -1
13,889   13,539 350
1,484   973 511
848   878 -30
1,444   1,210 234
1,522   602 920
3,749   3,717 32
11,368   11,313 55
2,556   2,158 398
18,996   19,694 -698
1,410   2,233 -823
865   764 101
692   407 285
1,380   166 1,214
460   281 179
1,467   1,531 -64
1,472   1,671 -199
6,172   5,830 342
3,618   2,438 1,180
1,176   756 420
336   131 205
1,027   724 303
685   617 68
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
      5,493
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       51
b       1,344
c       81
d       91
e       160
      3,091
      322
      598
      211
      334
      -99
      8
      63
      -394
      130
      724
      85
      122
      -21
      -51
      98
      -20
      -91
      130
      15
      1,312
      -91
      381
      -31
      152
      -14
      1,193
      -114
      51
      -260
      -64
      -9
      -2,860
      408
      42
      -246
      -171
      -37
      -3,966
      -5
      37
      784
      4,132
      120
      -1,858
      -23
      -95
      -7,079
      -671
      -106
      -371
      2,273
      1,159
      -1,202
      35
      -2,288
      1,001
      187
      318
      -172
      -90
      14
      -1,787
      1,528
      -38
      723
      488
      -1
      351
      176
      2,398
      629
      -34
      -218
      1,266
      -66
      113
      281
      362
      632
      701
      -153
      47
      42
      39
      1,758
      -102
      134
      2,950
      180
      511
      221
      -133
      -252
      118
      23
      366
      1,903
      159
      60
      147
      580
      18
      -1
      350
      511
      -30
      234
      920
      32
      55
      398
      -698
      -823
      101
      285
      1,214
      179
      -64
      -199
      342
      1,180
      420
      205
      303
      68
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
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 25,353
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  
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................................ 1 538
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........................... 3 538
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- ..... 5 538
6 Credits/Payments:
a 2020 estimated tax payments and 2019 overpayment credited to 2020 6a 620
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 620
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 82
11 Enter the amount of line 10 to be: Credited to 2021 estimated taxBullet82 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$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
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)
    bulletAZ
    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 ofbulletWELLS FARGO BANK NA Telephone no.bullet (888) 730-4933

    Located atbullet100 N MAIN ST MAC D4001-117WINSTON SALEMNC ZIP+4bullet27101
    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
     
    No
    ........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
     
     
    .........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).
    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
    WELLS FARGO BANK N A TRUSTEE
    1     		12,632    
    100 N MAIN ST MAC D4001-117
    WINSTON SALEM,NC27101
    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.........................bullet  
    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
    798,057
    b
    Average of monthly cash balances.......................
    1b
    18,010
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    816,067
    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
    816,067
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    12,241
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    803,826
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    40,191
    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
    40,191
    2a
    Tax on investment income for 2020 from Part VI, line 5......
    2a
    538
    b
    Income tax for 2020. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    538
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    39,653
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    39,653
    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
    39,653
    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
    39,331
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
    0
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
    0
    b
    Cash distribution test (attach the required schedule) .................
    3b
    0
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    39,331
    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
    39,331
    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 39,653
    2 Undistributed income, if any, as of the end of 2020:
    a Enter amount for 2019 only....... 37,988
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2020:
    a From 2015...... 0
    b From 2016...... 0
    c From 2017...... 0
    d From 2018...... 0
    e From 2019...... 0
    fTotal of lines 3a through e........ 0
    4Qualifying distributions for 2020 from Part
    XII, line 4: bullet$ 39,331
    a Applied to 2019, but not more than line 2a 37,988
    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..... 1,343
    e Remaining amount distributed out of corpus 0
    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 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 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 ..........     		38,310
    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 ......     		0
    10 Analysis of line 9:
    a Excess from 2016.... 0
    b Excess from 2017.... 0
    c Excess from 2018.... 0
    d Excess from 2019.... 0
    e Excess from 2020.... 0
    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).)
    NONE
    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.
    NONE
    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
    ADELPHI UNIVERSITY
    ATTN AMY HARRISON
    GARDEN CITY,NY115304213     		NONE PC GENERAL OPERATING 37,000
    Total .................................bullet 3a 37,000
    bApproved for future payment
    Total .................................bullet 3b  
    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 25,210  
    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 25,353  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   50,563  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    50,563
    (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:
    CROUSE SURVIVORS TRUST
    EIN:
    43-6368647
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEE (NON-ALLOC 1,068     1,068

    TY 2020 InvestmentsCorpStockSchedule
    Name:
    CROUSE SURVIVORS TRUST
    EIN:
    43-6368647
    Name of Stock End of Year Book Value End of Year Fair Market Value
    512807108 LAM RESEARCH CORP CO 2,455 6,140
    17275R102 CISCO SYSTEMS INC 2,867 5,549
    126650100 CVS HEALTH CORPORATI 2,016 3,825
    09247X101 BLACKROCK INC 3,585 7,215
    594918104 MICROSOFT CORP 3,380 20,685
    25243Q205 DIAGEO PLC - ADR 3,518 6,352
    254687106 WALT DISNEY CO 2,343 6,522
    92826C839 VISA INC-CLASS A SHR 3,562 5,031
    285512109 ELECTRONIC ARTS INC 3,134 4,308
    89151E109 TOTAL S.A. - ADR 4,339 4,191
    172967424 CITIGROUP INC. 6,403 8,016
    H2906T109 GARMIN LTD 4,466 5,145
    871829107 SYSCO CORP 3,893 6,312
    94106L109 WASTE MANAGEMENT INC 4,984 5,425
    75513E101 RAYTHEON TECHNOLOGIE 4,832 4,863
    911312106 UNITED PARCEL SERVIC 2,133 5,052
    09857L108 BOOKING HOLDINGS INC 3,426 4,455
    H84989104 TE CONNECTIVITY LTD 2,459 4,359
    G5960L103 MEDTRONIC PLC 3,729 4,451
    654106103 NIKE INC CL B 2,243 5,942
    517834107 LAS VEGAS SANDS CORP 5,299 5,960
    609207105 MONDELEZ INTERNATION 3,610 4,911
    192446102 COGNIZANT TECH SOLUT 4,109 5,982
    375558103 GILEAD SCIENCES INC 650 1,690
    904767704 UNILEVER PLC - ADR 3,609 4,406
    G29183103 EATON CORP PLC 2,882 3,124
    00206R102 AT & T INC 3,813 3,883
    037833100 APPLE INC 5,352 22,823
    907818108 UNION PACIFIC CORP 1,411 5,830
    883556102 THERMO FISHER SCIENT 387 3,260
    46625H100 JPMORGAN CHASE & CO 4,499 9,276
    891160509 TORONTO DOMINION BK 4,411 4,401
    405217100 HAIN CELESTIAL GROUP 1,975 4,015
    867224107 SUNCOR ENERGY INC NE 3,433 2,584
    031162100 AMGEN INC 3,448 3,219
    532457108 ELI LILLY & CO COM 3,322 5,572
    Y2573F102 FLEX LTD 1,835 4,333
    09260D107 BLACKSTONE GROUP INC 3,898 4,666
    460690100 INTERPUBLIC GROUP CO 2,838 3,528
    31620M106 FIDELITY NATL INFORM 3,777 4,102
    02079K107 ALPHABET INC CL C 4,565 14,015
    11135F101 BROADCOM INC 5,138 7,443
    87612E106 TARGET CORP 1,425 4,943
    91324P102 UNITEDHEALTH GROUP I 2,291 9,468
    097023105 BOEING CO 2,022 4,067
    56501R106 MANULIFE FINANCIAL C 5,824 7,039
    150870103 CELANESE CORP 2,688 6,107
    58933Y105 MERCK & CO INC NEW 4,078 5,235

    TY 2020 InvestmentsOtherSchedule2
    Name:
    CROUSE SURVIVORS TRUST
    EIN:
    43-6368647
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    89151E109 TOTAL FINA ELF S.A.      
    911312106 UNITED PARCEL SERVIC      
    02079K107 ALPHABET INC/CA      
    254687106 WALT DISNEY CO      
    339128100 JP MORGAN MID CAP VA      
    77956H435 T ROWE PR OVERSEAS S AT COST 23,034 27,651
    517834107 LAS VEGAS SANDS CORP      
    172967424 CITIGROUP INC      
    12572Q105 CME GROUP INC      
    126650100 CVS/CAREMARK CORPORA      
    883556102 THERMO FISHER SCIENT      
    907818108 UNION PACIFIC CORP      
    405217100 HAIN CELESTIAL GROUP      
    025083320 AMER CENT SMALL CAP      
    87234N765 TCW EMRG MKTS INCM-I AT COST 34,390 36,612
    150870103 CELANESE CORP      
    592905764 METROPOLITAN WEST T/ AT COST 74,399 78,137
    46434G103 ISHARES CORE MSCI EM      
    78463X863 SPDR DJ WILSHIRE INT      
    98978V103 ZOETIS INC      
    437076102 HOME DEPOT INC      
    532457108 ELI LILLY & CO COM      
    693475105 PNC FINANCIAL SERVIC      
    04314H600 ARTISAN MID CAP FUND AT COST 21,221 28,585
    46625H100 JPMORGAN CHASE & CO      
    G29183103 EATON CORP PLC      
    25243Q205 DIAGEO PLC - ADR      
    Y2573F102 FLEXTRONICS INTL LTD      
    872540109 TJX COS INC NEW      
    91324P102 UNITEDHEALTH GROUP I      
    867224107 SUNCOR ENERGY INC NE      
    85917K546 STERLING CAPITAL STR      
    277923264 EATON VANCE GLOB MAC      
    848574109 SPIRIT AEROSYTSEMS H      
    512807108 LAM RESEARCH CORP CO      
    56501R106 MANULIFE FINANCIAL C      
    09247X101 BLACKROCK INC      
    00206R102 AT & T INC      
    097023105 BOEING COMPANY      
    654106103 NIKE INC CL B      
    26875P101 EOG RESOURCES, INC      
    87612E106 TARGET CORP      
    58933Y105 MERCK & CO INC NEW      
    375558103 GILEAD SCIENCES INC      
    779919307 T ROWE PR REAL ESTAT      
    H84989104 TE CONNECTIVITY LTD      
    609207105 MONDELEZ INTERNATION      
    037833100 APPLE COMPUTER INC C      
    17275R102 CISCO SYSTEMS INC      
    192446102 COGNIZANT TECH SOLUT      
    594918104 MICROSOFT CORP      
    922908629 VANGUARD MIDCAP VIPE AT COST 49,011 64,305
    11135F101 BROADCOM INC      
    755111507 RAYTHEON CO      
    00143W859 INV OPP DEVELOP MRKT AT COST 21,652 37,351
    693390700 PIMCO TOTAL RET FD-I AT COST 42,056 43,945
    285512109 ELECTRONIC ARTS INC      
    31620M106 FIDELITY NATL INFORM      
    693390841 PIMCO HIGH YIELD FD-      
    31641Q755 FIDELITY NEW MRKTS I AT COST 18,328 18,402
    891160509 TORONTO DOMINION BK      
    G5960L103 MEDTRONIC PLC      
    89155T649 TOUCHSTONE MID CAP-I AT COST 42,476 54,001
    89154Q562 TOUCHSTONE SANDS EM AT COST 27,237 28,109
    89609H704 TRIBUTARY SMALL CO-I AT COST 12,426 18,664
    46090F100 INVESCO OPTIMUM YIEL AT COST 14,789 18,999
    74440Y884 PGIM HIGH YIELD-Q 10 AT COST 94,410 99,961
    464287655 ISHARES RUSSELL 2000 AT COST 37,102 37,840
    27830W108 EV GL MACR ABS RTRN AT COST 17,653 17,211

    TY 2020 OtherDecreasesSchedule
    Name:
    CROUSE SURVIVORS TRUST
    EIN:
    43-6368647
    Description Amount
    COST BASIS ADJUSTMENT 127


    TY 2020 OtherExpensesSchedule
    Name:
    CROUSE SURVIVORS TRUST
    EIN:
    43-6368647
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT EXPENSES - ADR FEES 6 6   0


    TY 2020 OtherIncreasesSchedule
    Name:
    CROUSE SURVIVORS TRUST
    EIN:
    43-6368647
    Description Amount
    MUTUAL FUND TIMING ADJ 51


    TY 2020 TaxesSchedule
    Name:
    CROUSE SURVIVORS TRUST
    EIN:
    43-6368647
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 378 378   0
    FEDERAL ESTIMATES - PRINCIPAL 308 0   0
    FOREIGN TAXES ON NONQUALIFIED 19 19   0