-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0052
20
20
Open to Public Inspection
For calendar year 2020, or tax year beginning
01-01-2020
, and ending
12-31-2020
Name of foundation
THE GRIMM FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 172
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WAYMART
,
PA
18472
A Employer identification number
38-7194349
B
Telephone number (see instructions)
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
117,173
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
260,600
2
Check
.............
3
Interest on savings and temporary cash investments
147
147
147
4
Dividends and interest from securities
...
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
b
Gross sales price for all assets on line 6a
7
Capital gain net income (from Part IV, line 2)
...
8
Net short-term capital gain
.........
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
Total.
Add lines 1 through 11
........
260,747
147
147
13
Compensation of officers, directors, trustees, etc.
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
0
0
0
25
Contributions, gifts, grants paid
.......
236,129
236,129
26
Total expenses and disbursements.
Add lines 24 and 25
236,129
0
236,129
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
24,618
b
Net investment income
(if negative, enter -0-)
147
c
Adjusted net income
(if negative, enter -0-)
...
147
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
1
Cash—non-interest-bearing
.............
724
8,195
8,195
2
Savings and temporary cash investments
.........
91,831
108,978
108,978
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
92,555
117,173
117,173
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
92,555
117,173
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)
.....
92,555
117,173
30
Total liabilities and net assets/fund balances
(see instructions)
.
92,555
117,173
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
92,555
2
Enter amount from Part I, line 27a
.....................
2
24,618
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
117,173
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
117,173
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.)
1a
b
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
b
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
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
and enter “N/A" on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
b
Reserved
................................
1
2
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
3
Add lines 1 and 2
...........................
3
2
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
2
6
Credits/Payments:
a
2020 estimated tax payments and 2019 overpayment credited to 2020
6a
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
2
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2021 estimated tax
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See 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.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
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 address
N/A
14
The books are in care of
MEGAN SPAULDING
Telephone no.
(570) 488-6660
Located at
PO BOX 172
PO BOX 172
WAYMART
PA
ZIP+4
18472
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2020, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2020?
.............
1c
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2020, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2020?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 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))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
ROBERT C GRIMM
TRUSTEE
1.00
0
0
0
PO BOX 172
WAYMART
,
PA
18472
KARLA D GRIMM
TRUSTEE
1.00
0
0
0
PO BOX 172
WAYMART
,
PA
18472
MEGAN SPAULDING
TRUSTEE
1.00
0
0
0
595 TORREY RD
HONESDALE
,
PA
18431
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
Form
990-PF
(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
.............
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
N/A
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
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
0
b
Average of monthly cash balances
.......................
1b
83,384
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
83,384
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
2
Acquisition indebtedness applicable to line 1 assets
..................
2
3
Subtract line 2 from line 1d
.........................
3
83,384
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
1,251
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
82,133
6
Minimum investment return.
Enter 5% of line 5
..................
6
4,107
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
4,107
2a
Tax on investment income for 2020 from Part VI, line 5
......
2a
2
b
Income tax for 2020. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
2
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
4,105
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
4,105
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
4,105
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
236,129
b
Program-related investments—total from Part IX-B
..................
1b
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
236,129
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
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
236,129
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
4,105
2
Undistributed income, if any, as of the end of 2020:
a
Enter amount for 2019 only
.......
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2020:
a
From 2015
......
b
From 2016
......
c
From 2017
......
85,036
d
From 2018
......
195,203
e
From 2019
......
199,339
f
Total
of lines 3a through e
........
479,578
4
Qualifying distributions for 2020 from Part
XII, line 4:
$
236,129
a
Applied to 2019, but not more than line 2a
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
d
Applied to 2020 distributable amount
.....
4,105
e
Remaining amount distributed out of corpus
232,024
5
Excess distributions carryover applied to 2020.
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
711,602
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
e
Undistributed income for 2019. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
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)
.......
8
Excess distributions carryover from 2015 not
applied on line 5 or line 7 (see instructions)
...
9
Excess distributions carryover to 2021.
Subtract lines 7 and 8 from line 6a
......
711,602
10
Analysis of line 9:
a
Excess from 2016
....
b
Excess from 2017
....
85,036
c
Excess from 2018
....
195,203
d
Excess from 2019
....
199,339
e
Excess from 2020
....
232,024
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
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
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.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
ROBERT C GRIMM
PO BOX 172
WAYMART
,
PA
18472
(570) 488-6660
b
The form in which applications should be submitted and information and materials they should include:
NAME, ADDRESS, PURPOSE.
c
Any submission deadlines:
BY 12/31
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
NONE.
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)
a
Paid during the year
TOM MAKOSKY
510 PARK STREET
MAYFIELD
,
PA
18433
I
FINANCIAL SUPPORT-MEDICAL NEEDS
1,000
THE KNUTH FUND
N9660 COUNTY ROAD N
APPLETON
,
WI
54915
I
FINANCIAL SUPPORT-MEDICAL NEEDS
300
STACEY BOX
36 TIGHE LANE
HONESDALE
,
PA
18431
I
FINANCIAL SUPPORT-MEDICAL NEEDS
5,000
RON JACOBINA
1213 TONWIN ROAD
ARCHBALD
,
PA
18403
I
SUPPORT-FAMILY FINANCIAL NEEDS
1,000
ROB ANNE DEVINE
6012 BRECKINRIDGE DRIVE
MILTON
,
FL
32570
I
SUPPORT-FAMILY FINANCIAL NEEDS
2,500
PAT CRISPELL
1174 FERRIS AVENUE
BERWICK
,
PA
18603
I
SUPPORT FOR LOCAL MISSIONS
1,750
NEBZYDOSKIWHITE SCHOLARSHIP FUND
409 STOCK FARM ROAD
LAKE ARIEL
,
PA
18436
I
FINANCIAL SUPPORT-CHILDREN EDUCATION
250
K WEIST CHILDREN EDUCATION FUND
820 CHURCH STREET
HONESDALE
,
PA
18431
I
FIANANCIAL SUPPORT-FATHER'S DEATH
1,000
KEVIN HOOVER MEMORIAL FUND
PO BOX 499
HAWLEY
,
PA
18428
I
FINANCIAL SUPPORT-FAMILY NEEDS
1,000
KAY BLACK
1184 FERNWOOD RD
LAKE ARIEL
,
PA
18436
I
SUPPORT FOR GLOBAL MISSIONS
100
JOHN LORI CHUPICK
PO BOX 176
SOUTH CANAAN
,
PA
18459
I
FINANCIAL SUPPORT-MEDICAL NEEDS
1,000
JESSICA JENKINS
68 KING GEORGE ROAD
WARREN
,
NJ
07059
I
FINANCIAL SUPPORT-FAMILY NEEDS
500
JASON MARY LEWIS
35 MISSIONARY RETREAT ROA
JEFFERSON TWP
,
PA
18436
I
FINANCIAL SUPPORT-FAMILY NEEDS
1,000
DEXTER JOHN ASHELY MEM SCHOLARSHIP
30 HEMLOCK ROAD
LAKE ARIEL
,
PA
18436
I
FINANCIAL SUPPORT-EDUC SCHOLARSHIPS
10,000
DEREK BETTY ELLEN BARRETT
6723 MITCHELL STREET
PHILADELPHIA
,
PA
19123
I
SUPPORT FOR LOCAL MISSIONS
500
CHRIS COCCODRILLI
170 BELMONT STREET
WAYMART
,
PA
18472
I
FINANCIAL SUPPORT-MEDICAL NEEDS
1,000
ANTHONY FREDA
PO BOX 121
LAKE ARIEL
,
PA
18436
I
FINANCIAL SUPPORT-DAUGHTERS DEATH
1,500
ALLEN OWENS
15411 VILLA LAGO DRIVE
TOMBALL
,
TX
77377
COUSIN
I
SUPPORT GLOBAL MISSION TRIPS
1,000
AMERICAN HEART ASSOCIATION
7272 GREENVILLE AVE
DALLAS
,
TX
75231
PC
FINANCIAL SUPPORT-HEART/MED RESEARCH
100
AMERICAN PASTORS NETWORK
PO BOX 537
ELVERSON
,
PA
19520
PC
SUPPORT CHURCH/CHRISTIAN TEACHINGS
5,000
BETHEL WOODS
PO BOX 222
LIBERTY
,
NY
12754
PC
SUPPORT LOCAL ARTS, COMM PROGRAMS
3,500
BIBLE CENTERED MINISTIES INT'L
201 GRANITE RUN DRIVE
SUITE 260
LANCASTER
,
PA
17601
PC
SUPPORT CHRISTIAN BELIEFS-CHILDREN
1,200
CALVARY UNITED METHODIST CHURCH
PO BOX J
WAYMART
,
PA
18472
PC
SUPPORT CHURCH/CHRISTIAN TEACHINGS
1,200
CAMP FREEDOM
284 NUMBER 7 ROAD
CARBONDALE
,
PA
18407
PC
SUPPORT-MILITARY/FIRST RESPONDERS
12,500
CANAAN BIBLE CHAPEL
30 HEMLOCK RD
LAKE ARIEL
,
PA
18436
PC
SUPPORT LOCAL CHURCH, EDUC PROGRAMS
1,000
CANAAN CHRISTIAN ACADEMY
30 HEMLOCK RD
LAKE ARIEL
,
PA
18436
PC
SUPPORT LOCAL CHRISTIAN SCHOOL/EDUC
1,530
CARBONDALE YMCA
82 N MAIN STREET
CARBONDALE
,
PA
18407
PC
SUPPORT LOCAL ACTIVITIES AT YMCA
500
CHILD EVANGELISM FELLOWSHIP
461 GROVE STREET
HONESDALE
,
PA
18431
PC
SUPPORT CHRISTIAN BELIEFS-CHILDREN
250
CHRISTIAN LAW ASSOCIATION
PO BOX 8600
MASON
,
OH
45040
PC
SUPPORT - RELIGIOUS LEGAL ASSISTANCE
500
COMMONWEALTH FOUNDATION
225 STATE STREET
SUITE 302
HARRISBURG
,
PA
17101
PC
SUPPORT IDEAS INTO PUBLIC POLICY
15,000
DESSIN ANIMAL SHELTER
138 MILLER ROAD
HONESDALE
,
PA
18431
PC
PROVIDE FOOD & SHELTER-HOMELESS PETS
800
DORFLINGER-SUYDAM WILDLIFE SANCTUAR
PO BOX 356
WHITE MILLS
,
PA
18473
PC
SUPPORT WILDLIFE PRESERVATION
500
ENDLESS MOUNTAIN HEALTH SYSTEMS
HOSPITAL DRIVE
MONTROSE
,
PA
18801
PC
SUPPORT LOCAL HOSPITAL/MEDICAL NEEDS
500
FINAL FRONTIERS FOUNDATION INC
1200 PEACHTREE STREET
LOUISVILLE
,
GA
30434
PC
SUPPORT - WORLDWIDE RELIGIOUS EDUC
500
FLAG
PO BOX 911
COLLEYVILLE
,
TX
76034
PC
SUPPORT FOR CIVICS EDUCATION
1,000
FRIENDS OF THE POOR
2300 ADAMS AVENUE
SCRANTON
,
PA
18509
PC
SUPPORT/PROVIDE MEALS-PEOPLE IN NEED
100
GEO W BUSH PRESIDENTIAL CENTER
2943 SMU BLVD
DALLAS
,
TX
75205
PC
SUPPORT FOR PRESIDENTIAL CENTER
5,000
GHP HOLIDAY LIGHTING FUND
32 COMMERCIAL STREET
SUITE 3
HONESDALE
,
PA
18431
PC
SUPPORT LOCAL ACTIVITIES
100
GRIFFIN POND ANIMAL SHELTER
967 GRIFFIN POND RD
SOUTH ABINGTON TWP
,
PA
18411
PC
PROVIDE FOOD & SHELTER-HOMELESS PETS
100
HIGHLIGHTS FOUNDATION
814 COURT STREET
HONESDALE
,
PA
18431
PC
SUPPORT-CHILDRENS LITERACY WORKSHOPS
250
HOPE MINISTRIES INC
PO BOX 75
KENOZA LAKE
,
NY
12750
PC
SUPPORT OF LOCAL HOMELESS/NEEDY
885
HOSPICE OF THE SACRED HEART
100 WILLIAM STREET
DUNMORE
,
PA
18510
PC
SUPPORT FOR FAMILIES AT END OF LIFE
100
HUMAN RESOURCES CENTER
294 BETHEL SCHOOL RD
HONESDALE
,
PA
18431
PC
SUPPORT MENTAL/PHYSICAL HANDICAPS
500
JEWISH HOME OF EASTERN PA
1101 VINE STREET
SCRANTON
,
PA
18510
PC
FINANCIAL SUPPORT-SENIOR LIVING
100
K-9 HERO HAVEN INC
176 MAHANOY CREEK LANE
HERNDON
,
PA
17830
PC
SUPPORT-WORKING DOG REHAB/ADOPT
250
KEYSTONE MISSION
PO BOX 470
SCRANTON
,
PA
18501
PC
PROVIDE FOOD/CLOTHING TO THE NEEDY
2,493
LACKAWANNA BLIND ASSOCIATION
228 ADAMS AVENUE
SCRANTON
,
PA
18503
PC
FINANCIAL SUPPORT-PROGRAMS FOR BLIND
100
LIGHT OF CHRIST CHURCH
2071 MOOSIC LAKE ROAD
JEFFERSON TWP
,
PA
18436
PC
FINANCIAL SUPPORT-CHURCH TEACHINGS
100
LUTHERAN CHURCH BY THE LAKE
100 12 OAKS DRIVE
MCCORMICK
,
SC
29835
PC
FINANCIAL SUPPORT-CHURCH TEACHINGS
100
MASONIC VILLAGES OF PENNSYLVANIA
1 MASONIC DRIVE
ELIZABETHTOWN
,
PA
17022
PC
FINANCIAL SUPPORT-SENIOR LIVING
250
MEYERS CEMETERY ASSOCIATION
C/O CHARLES BARNES
PO BOX 88
WHITE MILLS
,
PA
18473
PC
FINANCIAL SUPPORT-CEMETERY MAIN/CARE
100
MISSIONARY RETREAT FELLOWSHIP
63 MISSIONARY RD
JEFFERSON TWP
,
PA
18436
PC
PROVIDE HOUSING TO MISSIONARIES
1,000
NAMI SCRANTON & NORTHEAST PA
846 JEFFERSON AVE
SCRANTON
,
PA
18510
PC
FINANCIAL SUPPORT FOR FAMILIES
500
NEP SNO TRAILS
C/O JAY BIANCHI
332 WAYNE STREET
ARCHBALD
,
PA
18403
PC
FINANCIAL SUPPORT-MAINTENANCE
2,500
NEW PATH NOW
10924 GRANT ROAD
PMB 615
HOUSTON
,
TX
77070
PC
SUPPORT CHRISTIAN BELIEFS-TEENAGERS
48,500
OPEN DOOR BAPTIST CHURCH
875 ACADEMY DRIVE
LEBANON
,
PA
17046
PC
FINANCIAL SUPPORT-CHURCH TEACHINGS
2,500
OPTION WOMEN'S CENTER
1329 WYOMING AVENUE
SCRANTON
,
PA
18509
PC
FINANCIAL SUPPORT-WOMEN'S HEALTH
500
OUR LADY OF SNOWS CHURCH
301 S STATE STREET
CLARKS SUMMIT
,
PA
18411
PC
SUPPORT OF LOCAL CHURCH
100
PANCREATIC CANCER ACTION NETWORK
1500 ROSECRANS AVENUE
SUITE 2
MANHATTAN BEACH
,
CA
90266
PC
FINANCIAL SUPPORT-MEDICAL RESEARCH
100
PAUPACK UNITED METHODIST CHURCH
579 ROUTE 507
PAUPACK
,
PA
18451
PC
SUPPORT OF LOCAL CHURCH
100
PECKVILLE ASSEMBLY OF GOD
3364 SCRANTON-CDALE HWY
BLAKELY
,
PA
18447
PC
SUPPORT OF LOCAL CHURCH PROGRAMS
1,000
PENNSYLVANIA ADULT & TEEN CHALLENGE
PO BOX 98
33 TEEN CHALLENGE ROAD
REHRERSBURG
,
PA
19550
PC
FINANCIAL SUPPORT-ADDICTION REHAB
3,000
PENNSYLVANIANS FOR HUMAN LIFE
400 WYOMING AVE SUITE 11
SCRANTON
,
PA
18505
PC
SUPPORT HUMAN LIFE
500
PENSACOLA CHRISTIAN COLLEGE
250 BRENT LANE
PENSACOLA
,
FL
32503
PC
FINANCIAL SUPPORT-EDUCATION
500
THE ROSE PEDALS
C/O POCONO RACEWAY
1234 LONG POND ROAD
LONG POND
,
PA
18334
PC
FINANCIAL SUPPORT-VOLUNTEER SERVICES
500
RACING WITH JESUS MINISTRIES
PO BOX 286
TOLLAND
,
CT
06084
PC
SUPPORT MINISTRY TO RACING COMMUNITY
13,000
SCRANTON CULTURAL CENTER
420 N WASHINGTON AVE
SCRANTON
,
PA
18503
PC
FINANCIAL SUPPORT-COMMUNITY ARTS
1,025
SOUTH CLINTON BAPTIST CHURCH
1845 EASTON TPKE
LAKE ARIEL
,
PA
18436
PC
SUPPORT CHURCH/CHRISTIAN TEACHINGS
1,000
ST FRANCIS OF ASSISI KITCHEN
500 PENN AVENUE
SCRANTON
,
PA
18509
PC
FOOD FOR THE HOMELESS AND NEEDY
600
ST JOSEPHS CENTER FOUNDATION
PO BOX 388
DUNMORE
,
PA
18512
PC
SUPPORT FOR DISABLED CHILDREN/ADULTS
500
ST JUDE CHILDRENS RESEARCH HOSPITAL
PO BOX 50
MEMPHIS
,
TN
38101
PC
SUPPORT-CHILDRENS MEDICAL RESEARCH
100
ST MARY OF MT CARMEL CHURCH
322 CHESTNUT STREET
DUNMORE
,
PA
18512
PC
FINANCIAL SUPPORT-LOCAL CHURCH
100
ST ROSE OF LIMA CHURCH
6 N CHURCH STREET
CARBONDALE
,
PA
18407
PC
FINANCIAL SUPPORT-LOCAL CHURCH
100
THE GIDEONS INTERNATIONAL
PO BOX 140800
NASHVILLE
,
TN
37214
PC
FINANCIAL SUPPORT-RELIGIOUS EDUCATIO
100
THE SALVATION ARMY
LADORE CONFERENCE CENTER
PO BOX G
WAYMART
,
PA
18472
PC
SUPPORT OF LOCAL FAMILIES IN NEED
1,000
THOMPSON HOSE COMPANY
53 WATER STREET
THOMPSON
,
PA
18465
PC
SUPPORT-LOCAL VOLUNTEER FIRE CO
100
TREHAB CENTER
PO BOX 366
MONTROSE
,
PA
18801
PC
SUPPORT DRUG/ALCOHOL ADD/RECOVERY
1,000
TUNKHANNOCK UNITED METHODIST CHURCH
PO BOX 447
TUNKHANNOCK
,
PA
18657
PC
FINANCIAL SUPPORT-LOCAL CHURCH
500
UNITED METHODIST HOMES FOUNDATION
10 ACRE PLACE
BINGHAMTON
,
NY
13904
PC
SUPPORT OF SENIOR LIVING CAMPUSES
500
UNITED NEIGHBORHOOD CENTER
425 ALDER STREET
SCRANTON
,
PA
18505
PC
SUPPORT LOCAL LOW-INCOME FAMILIES
1,000
UNITED WAY OF LACKA & WAYNE CO
615 JEFFERSON AVE
SCRANTON
,
PA
18501
PC
SUPPORT FOR LOCAL FAMILIES IN NEED
1,000
UNITED WAY OF WYOMING VALLEY
NURSES PANTRY
100 N PENNSYLVANIA AVENUE
WILKESBARRE
,
PA
18701
PC
FINANCIAL SUPPORT-NEEDY FAMILIES
500
VICTORY JUNCTION
4500 ADAMS WAY
RANDLEMAN
,
NC
27317
PC
SUPPORT CHILDREN W/TERMINAL ILLNESS
500
VISITING NURSES ASSOCIATION
301 DELAWARE AVE
OLYPHANT
,
PA
18447
PC
FINANCIAL SUPPORT-MEDICAL NEEDS
100
VOLUNTEERS OF AMERICA
25 N RIVER STREET
WILKESBARRE
,
PA
18702
PC
SUPPORT FOR HOUSING/OTHER SVCS
500
WAYMART CHURCH
342 HONESDALE RD
WAYMART
,
PA
18472
PC
SUPPORT LOCAL CHURCH/EDUC PROGRAMS
5,500
WAYMART VOLUNTEER FIRE COMPANY
PO BOX 186
WAYMART
,
PA
18472
PC
SUPPORT COMMUNITY FIRE PROTECTION
1,700
WAYNE COUNTY CHILDREN & YOUTH SVCS
648 PARK ST SUITE C
HONESDALE
,
PA
18431
PC
AIDING CHILDREN IN NEED
100
WAYNE COUNTY COMMUNITY FOUNDATION
214 9TH STREET
HONESDALE
,
PA
18431
PC
SUPPORT LOCAL NEEDS FOR GROWTH
3,000
WAYNE COUNTY HISTORICAL SOCIETY
PO BOX 446
HONESDALE
,
PA
18431
PC
SUPPORT OF HISTORICAL PRESERVATION
500
WAYNE COUNTY PUBLIC LIBRARY
1406 MAIN STREET
HONESDALE
,
PA
18431
PC
SUPPORT OF LOCAL LIBRARY
3,200
WAYNE MEMORIAL HEALTH FOUNDATION
601 PARK STREET
HONESDALE
,
PA
18431
PC
SUPPORT LOCAL HOSPITAL/MEDICAL NEEDS
30,100
WAYNE MEMORIAL HOSPICE
601 PARK STREET
HONESDALE
,
PA
18431
PC
FINANCIAL SUPPORT OF HOSPICE CARE
700
WAYNE WOODLANDS MANOR
37 WOODLANDS MANOR
WAYMART
,
PA
18472
PC
FINANCIAL SUPPORT-SENIOR LIVING
500
WRGN RADIO
2457 ROUTE 118
HUNLOCK CREEK
,
PA
18621
PC
SUPPORT CHRISTIAN VALUES THRU RADIO
500
YOUTH FOR CHRIST
BOX 3691 1613 JACKSON ST
SCRANTON
,
PA
18504
PC
SUPPORT CHRISTIAN TEACHINGS
500
ALLIED SERVICES HOSPICE
100 ABINGTON EXECUTIVE PK
CLARKS SUMMIT
,
PA
18411
PC
SUPPORT OF END OF LIFE CARE
100
BEACH LAKE FREE METHODIST CHURCH
107 MILANVILLE ROAD
BEACH LAKE
,
PA
18405
PC
SUPPORT CHURCH/CHRISTIAN TEACHINGS
100
BETHANY PRESBYTERIAN CHURCH
431 WAYNE STREET
BETHANY
,
PA
18431
PC
SUPPORT CHURCH/CHRISTIAN TEACHINGS
100
CATHOLIC SOCIAL SERVICES
516 FIG STREET
SCRANTON
,
PA
18505
PC
SUPPORT CHURCH TEACHINGS
500
CDD OF PIKE COUNTY LTD
101 POCONO DRIVE
MILFORD
,
PA
18337
PC
SUPPORT CHURCH TEACHINGS
250
CHILDREN'S HOSPITAL OF PHILADELPHIA
3401 CIVIC CENTER BLVD
PHILADELPHIA
,
PA
19104
PC
SUPPORT MEDICAL CARE/RESEARCH
100
DAMASCUS FOOD PANTRY
C/O DORA FAYE HENRY
162 CONKLIN HILL ROAD
DAMASCUS
,
PA
18415
PC
SUPPORT/PROVIDE MEALS-PEOPLE IN NEED
65
DELAWARE VALLEY RAPTOR CENTER
416 CUMMINS HILL ROAD
MILFORD
,
PA
18337
PC
FINANCIAL SUPPORT-EDUCATION
50
DYBERRY DAY CAMP
C/O ARC OF WAYNE COUNTY
PO BOX 1121
HONESDALE
,
PA
18431
PC
FINANCIAL SUPPORT-CHILDRENS PROGRAMS
100
FOREST CITY LIBRARY
531 MAIN STREET
FOREST CITY
,
PA
18421
PC
FINANCIAL SUPPORT-LOCAL LIBRARY
250
FOREST CITY LIONS CLUB
C/O STEVEN TOURJE
PO BOX D
FOREST CITY
,
PA
18421
PC
FINANCIAL SUPPORT-COMMUNITY PROGRAMS
100
FRANK'S PLACE
57 JEFFERSON STREET
SIMPSON
,
PA
18407
PC
FINANCIAL SUPPORT-PROVIDE MEAL-COVID
2,000
GRACE LUTHERAN CHURCH
26 GREENWOOD STREET
HOP BOTTOM
,
PA
18824
PC
FINANCIAL SUPPORT-CHURCH TEACHINGS
100
GRACE RIDGE CHURCH
761 TERRACE STREET
HONESDALE
,
PA
18431
PC
FINANCIAL SUPPORT-CHURCH TEACHINGS
5,000
HARFORD FIRE COMPANY
PO BOX 206
HARFORD
,
PA
18823
PC
SUPPORT LOCAL VOLUNTEER FIRE COMPANY
100
IT TAKES A VILLAGE
259 GRIFFITH ROAD
TYLER HILL
,
PA
18469
PC
SUPPORT FOR FAMILIES IN NEED
500
JAMES WILSON FUNERAL HOME INC
143 GRAVITY ROAD
PO BOX 7
LAKE ARIEL
,
PA
18436
PC
FINANCIAL SUPPORT-FAMILIES IN NEED
9,381
Total
.................................
3a
236,129
b
Approved for future payment
Total
.................................
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.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
147
4
Dividends and interest from securities
....
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than
inventory
............
9
Net income or (loss) from special events:
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)
..
147
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
147
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
Form
990-PF
(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?
...........
Yes
No
b
If "Yes," complete the following schedule.
(a)
Name of organization
(b)
Type of organization
(c)
Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
May the IRS discuss this return
with the preparer shown below?
See instructions.
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's EIN
Firm's address
Phone no.
Form
990-PF
(2020)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description
-
TIN:
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Attach to Form 990, 990-EZ, or 990-PF.
Go to
www.irs.gov/Form990
for the latest information.
OMB No. 1545-0047
20
20
Name of the organization
THE GRIMM FOUNDATION
Employer identification number
38-7194349
Organization type
(check one):
Filers of:
Section:
Form 990 or 990-EZ
501(c)(
) (enter number) organization
4947(a)(1) nonexempt charitable trust
not
treated as a private foundation
527 political organization
Form 990-PF
501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501(c)(3) taxable private foundation
Check if your organization is covered by the
General Rule
or a
Special Rule.
Note:
Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.
Special Rules
For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33
1
/3
% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of
(1)
$5,000 or
(2)
2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000
exclusively
for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions
exclusively
for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an
exclusively
religious, charitable, etc., purpose. Don't complete any of the parts unless the
General Rule
applies to this organization because it received
nonexclusively
religious, charitable, etc., contributions totaling $5,000 or more during the year
.........
$
Caution:
An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it
must
answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613X
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page
2
Name of organization
THE GRIMM FOUNDATION
Employer identification number
38-7194349
Part I
Contributors
Contributors
(see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
1
CHARLES W GRIMM CONSTRUCTION INC
P O BOX X
WAYMART
,
PA
18472
$
250,000
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
2
FAITH FAMILY FELLOWSHIP INC
PO BOX 172
WAYMART
,
PA
18472
$
10,600
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page
3
Name of organization
THE GRIMM FOUNDATION
Employer identification number
38-7194349
Part II
Noncash Property
(see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page
4
Name of organization
THE GRIMM FOUNDATION
Employer identification number
38-7194349
Part III
Exclusively
religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns
(a)
through
(e) and
the following line entry. For organizations completing Part III, enter the total of
exclusively
religious, charitable, etc., contributions of
$1,000 or less
for the year. (Enter this information once. See instructions.)
$
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I
(b) Purpose of gift
(c) Use of gift
(d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP 4
Relationship of transferor to transferee
(a)
No. from Part I
(b) Purpose of gift
(c) Use of gift
(d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP 4
Relationship of transferor to transferee
(a)
No. from Part I
(b) Purpose of gift
(c) Use of gift
(d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP 4
Relationship of transferor to transferee
(a)
No. from Part I
(b) Purpose of gift
(c) Use of gift
(d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP 4
Relationship of transferor to transferee
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Additional Data
Software ID:
Software Version: