-
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
07-01-2020
, and ending
06-30-2021
Name of foundation
HEALTHY PAWS FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 50034
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
BELLEVUE
,
WA
98015
A Employer identification number
27-0871188
B
Telephone number (see instructions)
(203) 278-2013
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)
$
77,208
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)
393,860
2
Check
.............
3
Interest on savings and temporary cash investments
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)
...
0
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
........
393,860
0
0
13
Compensation of officers, directors, trustees, etc.
0
0
0
0
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
300
0
0
0
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
..........
300
0
0
0
25
Contributions, gifts, grants paid
.......
393,620
393,620
26
Total expenses and disbursements.
Add lines 24 and 25
393,920
0
0
393,620
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-60
b
Net investment income
(if negative, enter -0-)
0
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
1
Cash—non-interest-bearing
.............
77,268
77,208
77,208
2
Savings and temporary cash investments
.........
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)
77,268
77,208
77,208
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
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
........
77,268
77,208
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
0
0
29
Total net assets or fund balances
(see instructions)
.....
77,268
77,208
30
Total liabilities and net assets/fund balances
(see instructions)
.
77,268
77,208
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
77,268
2
Enter amount from Part I, line 27a
.....................
2
-60
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
77,208
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
77,208
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
0
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
0
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
0
6
Credits/Payments:
a
2020 estimated tax payments and 2019 overpayment credited to 2020
6a
0
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
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
0
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
.......
9
0
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.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
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)
WA
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
Yes
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
WWW.HEALTHYPAWSFOUNDATION.ORG
14
The books are in care of
TRACI MONTEFUSCO
Telephone no.
(203) 278-2013
Located at
11120 NE 33RD PL SUITE 200
BELLEVUE
WA
ZIP+4
98004
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
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?
.............
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 JACKSON
CEO
0.00
0
0
0
PO BOX 50034
BELLEVUE
,
WA
98015
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(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
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
ADOPTION GROUP SUPPORT TO ANIMAL RESCUE AND ANIMAL ADOPTION AGENCIES
393,620
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
.........................
0
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
77,240
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
77,240
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
77,240
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
1,159
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
76,081
6
Minimum investment return.
Enter 5% of line 5
..................
6
3,804
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
2a
Tax on investment income for 2020 from Part VI, line 5
......
2a
b
Income tax for 2020. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
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
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
393,620
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
393,620
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
393,620
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
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
......
d
From 2018
......
e
From 2019
......
f
Total
of lines 3a through e
........
4
Qualifying distributions for 2020 from Part
XII, line 4:
$
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
.....
e
Remaining amount distributed out of corpus
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
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
..........
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
......
10
Analysis of line 9:
a
Excess from 2016
....
b
Excess from 2017
....
c
Excess from 2018
....
d
Excess from 2019
....
e
Excess from 2020
....
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
.......
2009-09-26
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
0
0
9,850
6,403
16,253
b
85% of line 2a
.........
0
0
8,373
5,443
13,815
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
393,620
403,525
409,500
184,082
1,390,727
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
0
0
0
0
0
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
393,620
403,525
409,500
184,082
1,390,727
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
77,208
77,268
91,420
98,831
344,727
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
0
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
2,536
2,791
6,570
4,269
16,166
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)
....
0
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
0
(3)
Largest amount of support
from an exempt organization
0
(4)
Gross investment income
0
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(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
PAWSITIVE ALLIANCE
14150 NE 20TH ST F1-233
BELLEVUE
,
WA
98007
NONE
PC
VETERINARY CARE OR SUPPLIES
28,000
HEARTS UNITED FOR ANIMALS
PO BOX 286 AUBURN
AUBURN
,
NE
68305
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
NORTHEAST ANIMAL SHELTER
347 HIGHLAND AVE
SALEM
,
MA
01970
NONE
PC
VETERINARY CARE OR SUPPLIES
11,445
LAST HOPE K9 RESCUE
71 COMMERCIAL ST 184
BOSTON
,
MA
02109
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
NATIONAL MILL DOG RESCUE
PO BOX 88468
COLORADO SPRINGS
,
CO
80908
NONE
PC
VETERINARY CARE OR SUPPLIES
10,000
WINGS OF RESCUE
PO BOX 21747
SEATTLE
,
WA
98111
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
LAKE CHARLES PITBULL RESCUE
419 CONTOUR ST
LAKE CHARLES
,
LA
70605
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
WHISKER CITY
1615 N 183RD ST
SHORELINE
,
WA
98133
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
PASADENA HUMANE
361 S RAYMOND AVE
PASADENA
,
CA
91105
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
KINDNESS RANCH
854 STATE HIGHWAY 270
HARTVILLE
,
WY
82215
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
NW DOG PROJECT
PO BOX 51266 EUGENE
EUGENE
,
OR
97405
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
RESCUED OHIO
PO BOX 382
NEW ALBANY
,
OH
43054
NONE
PC
VETERINARY CARE OR SUPPLIES
1,000
SOUTHERN NEVADA ANIMAL RESCUE
5005 SAINT ANNES DR
LAS VEGAS
,
NV
89149
NONE
PC
VETERINARY CARE OR SUPPLIES
1,000
THE HERMITAGE NO KILL CAT SHELTER
PO BOX 13508
TUCSON
,
AZ
85732
NONE
PC
VETERINARY CARE OR SUPPLIES
1,000
SAVING WITH SOUL PET RESCUE
5202 BROOKWOOD LN
CRESTVIEW
,
FL
32539
NONE
PC
VETERINARY CARE OR SUPPLIES
1,000
TEXAS HUMANE HEROES
10930 E CRYSTAL FALLS PKWY
LEANDER
,
TX
78641
NONE
PC
VETERINARY CARE OR SUPPLIES
1,000
SNAFU RESCUE
2938 AVE F
COUNCIL BLUFFS
,
IA
51501
NONE
PC
VETERINARY CARE OR SUPPLIES
1,000
TAYSIA BLUE RESCUE
5261 N 110TH CIRCLE
OMAHA
,
NE
68164
NONE
PC
VETERINARY CARE OR SUPPLIES
1,000
ANIMAL CARE SANCTUARY
PO BOX A
EAST SMITHFIELD
,
PA
18817
NONE
PC
VETERINARY CARE OR SUPPLIES
1,000
K9'S FOR WARRIORS
114 CAMP K9 RD
PORTE VEDRA
,
FL
32081
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
PET'S FOR PATRIOTS
218 E PARK AVE SUITE 543
LONG BEACH
,
NY
11561
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
RESCUE DOGS RESCUE SOLDIERS
PO BOX 326
CHERRY VALLEY
,
NY
13320
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
RESCUE VILLAGE
15463 CHILLOCHOTE RD
RUSSELL TWP
,
OH
44072
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
PURREVER RANCH
PO BOX 375
COLDWATER
,
MS
38618
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
LILY'S LEGACY
PO BOX 751002
PETALUMA
,
CA
94975
NONE
PC
VETERINARY CARE OR SUPPLIES
10,000
HAWAIIAN HUMANE SOCIETY
2700 WAIALAE AVE
HONOLULU
,
HI
96826
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
HEARTS ALIVE VILLAGE
1750 S RAINBOW BLVD 44
LAS VEGAS
,
NV
89146
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
BAKERSFIELD PET FOOD PANTRY
PO BOX 20801
BAKERSFIELD
,
CA
93390
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
MAGGES PET PANTRY
129 NEW LONDON TURNPIKE
WYOMING
,
RI
02898
NONE
PC
VETERINARY CARE OR SUPPLIES
1,000
BEAUTIES AND BEASTS
PO BOX 783001
WITCHITA
,
KS
67278
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
ANIMAL CARE CENTERS OF NYC
11 PARK PL SUITE 805
NEW YORK
,
NY
10007
NONE
PC
VETERINARY CARE OR SUPPLIES
4,000
ROCKWALL PETS
PO BOX 580
ROYSE CITY
,
TX
75189
NONE
PC
VETERINARY CARE OR SUPPLIES
6,000
SIERRA PACIFIC FURBABIES
12523 LIMONITE AVE 440412
MIRA LOMA
,
CA
91752
NONE
PC
VETERINARY CARE OR SUPPLIES
6,000
BEYOND NINE CAT RESCUE
920 NE 35TH ST
OAKLAND PARK
,
FL
33334
NONE
PC
VETERINARY CARE OR SUPPLIES
6,000
BLACK DOG CLUB
1000 FREEDOM RD
SMITHFIELD
,
NC
27577
NONE
PC
VETERINARY CARE OR SUPPLIES
6,000
PERRY'S PROMISE
126 HILLTOP DR
ROSSVILLE
,
GA
30741
NONE
PC
VETERINARY CARE OR SUPPLIES
6,000
SPCA OF NORTHERN NEVADA
4950 SPECTRUM BLVD
RENO
,
NV
89512
NONE
PC
VETERINARY CARE OR SUPPLIES
2,340
ANOTHER CHANCE ANIMAL RESCUE
251 COUNTRY CLUB RD
SANFORD
,
ME
04073
NONE
PC
VETERINARY CARE OR SUPPLIES
5,430
FRECKLES AND TOMCAT RESCUE
10230 HIGHWAY 87
HARDIN
,
MT
59034
NONE
PC
VETERINARY CARE OR SUPPLIES
3,090
HOMEWARD BOUND IN THE HEATLAND
PO BOX 309231
OMAHA
,
NE
68139
NONE
PC
VETERINARY CARE OR SUPPLIES
2,070
SECOND CHANCE SHERIDAN CAT RESCUE
1850 GABRIELLE CT
SHERADIN
,
WY
82801
NONE
PC
VETERINARY CARE OR SUPPLIES
3,870
GREAT DOG RESCUE
9 BARTLETT ST 316
ANDOVER
,
MA
01810
NONE
PC
VETERINARY CARE OR SUPPLIES
2,580
LIFELINE ANIMAL PLACEMENT AND PROTECTION
310 W 45TH ST
NORTH WITCHITA
,
KS
67204
NONE
PC
VETERINARY CARE OR SUPPLIES
2,070
BARELY USED PETS
844 JACKSON HILL RD
URBANA
,
OH
43078
NONE
PC
VETERINARY CARE OR SUPPLIES
6,720
HOSPICE HEARTS ANIMAL RESCUE
PO BOX 17605
URBANA
,
IL
61803
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
PET CONNECT RESCUE
PO BOX 60714
POTOMOMAC
,
MD
20859
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
RIVER VALLEY ANIMAL PROTECTION LEAGUE
PO BOX 860
CHARLESTOWN
,
NH
03603
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
DAY ONE ANIMAL RESCUE
1101 BALDWIN AVE
MARION
,
NC
28752
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
FURRY FRIENDS ROCKIN RESCUE
PO BOX 7364
BISMARCK
,
ND
58507
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
SOUTHERNTAILS FOR PRECIOUS PAWS
1903 BLEU BAYOU BLVD
JOHNS ISLAND
,
SC
29455
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
SAVE THEM ALL RESCUE SERVICES
13363 CHEYENNE DR
HOT SPRINGS
,
SD
57747
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
ALL BREED DOG RESCUE
491 INDUSTRIAL AVE
WILLISTON
,
VT
05495
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
THE CAT'S VOICE WV
118 POCAHONTAS DR
IRONWOOD
,
WV
25428
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
ONCE UPON A TAIL RESCUE
441 AUTUMN CREEK DR
MADISONVILLE
,
LA
70447
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
HELP ANIMALS LIVE TODAY
6625 MASSACHUSETTS DR
KINGMAN
,
AZ
86409
NONE
PC
VETERINARY CARE OR SUPPLIES
1,250
APOLLO SUPPORT & RESCUE
1170 DOVE HILL
JUSTIN
,
TX
76247
NONE
PC
VETERINARY CARE OR SUPPLIES
750
PAWS ATLANTA
5287 COVINGTON HWY
DECATUR
,
GA
30035
NONE
PC
VETERINARY CARE OR SUPPLIES
500
AUSTIN PETS ALIVE
1156 W CESAR CHAVEZ ST
AUSTIN
,
TX
78703
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
SAN ANTONIO PETS ALIVE
1017 N MAIN AVE STE 200B
SAN ANTONIO
,
TX
78212
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
BIG LOVE RESCUE
15055 FAIRFIELD MEADOWS DR SUITE
130 9
CYPRESS
,
TX
77433
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
WRIGHT-WAY RESCUE
5915 LINCOLN AVE
MORTON GROVE
,
IL
60053
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
GOD'S DOGS RESCUE
12750 TRAWALTER LN
VON ORMY
,
TX
78073
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
SAVING PAWS 4 LOVE
PO BOX 272274
BOCA RATON
,
FL
33427
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
ALL PAWS SAFE HAVEN
5425 BOTANICAL AVE
ST LOUIS
,
MO
63110
NONE
PC
VETERINARY CARE OR SUPPLIES
1,250
NORTHERN LAKES RESCUE
PO BOX 782
PEQUOT LAKES
,
MN
56472
NONE
PC
VETERINARY CARE OR SUPPLIES
750
ANGEL'S RETREAT
361 CORRINE RD
WEST CHESTER
,
PA
19382
NONE
PC
VETERINARY CARE OR SUPPLIES
500
FLYING FUR ANIMAL RESCUE
PO BOX 299
ZIEGLERVILLE
,
PA
19492
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
PAWSITIVE DIFFERENCE PET RESCUE
101 S RAINBOW BLVD STE 20
LAS VEGAS
,
NV
89145
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
FACT ANIMAL RESCUE
PO BOX 4045
QUEENSBURY
,
NY
12804
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
PATH OF HOPE RESCUE
PO BOX 10555
SPOKANE
,
WA
99205
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
KITTEN NUGGETS
2711 HILL ST
NEW SMYRNA BEACH
,
FL
32169
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
HELPLESS HOUNDS
4605 A ADMIRAL BLVD
TULSA
,
OK
74115
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
TURTLE MOUNTAIN ANIMAL RESCUE
PO BOX 896
ROLLA
,
ND
58367
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
SAVING HOPE ANIMAL RESCUE
306 W 7TH ST
FORT WORTH
,
TX
76102
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
DOGS FOREVER
809 ROCKFORD RD SW
CEDAR RAPIDS
,
IA
52404
NONE
PC
VETERINARY CARE OR SUPPLIES
1,250
LABS4RESCUE INC
PO BOX 955
KILLINGWORTH
,
CT
06419
NONE
PC
VETERINARY CARE OR SUPPLIES
500
RESCUE EXPRESS
PO BOX 7309
RANCHO SANTA FE
,
CA
92067
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
HALO K9
3346 JASPER RD
XENIA
,
OH
45385
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
FOR PET'S SAKE RESCUE
246 REINKE RD
LONG BEACH
,
MS
39560
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
PAWS OF PERSERVERANCE
433 KINGS WAY
KALISPELL
,
MT
59901
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
RESCUE ROAD TRIPS
PO BOX 107
WHITE COTTAGE
,
OH
43791
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
HUMAN ANIMAL BOND RESEARCH
1310 L ST NW SUITE 860
WASHINGTON
,
DC
20005
NONE
PC
VETERINARY CARE OR SUPPLIES
25,000
ALBERTS DOG LOUNGE
N7285 WOODFIELD LN
WHITEWATER
,
WI
53190
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
PETS4LIVE FOUNDATION
62 LINDEN BLVD
HICKSVILLE
,
NY
11801
NONE
PC
VETERINARY CARE OR SUPPLIES
1,250
FELINES & CANINES
PO BOX 60616
CHICAGO
,
IL
60660
NONE
PC
VETERINARY CARE OR SUPPLIES
750
GIGI'S RESCUE
1208 CARTWRIGHT CIRCLE N
GOODLETTSVILLE
,
TN
37072
NONE
PC
VETERINARY CARE OR SUPPLIES
750
MOJO'S HOPE
2440 E TUDOR RD PMB 896
ANCHORAGE
,
AK
99507
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
FELINE FRIENDZ IN NEBRASKA
PO BOX 641818
OMAHA
,
NE
68164
NONE
PC
VETERINARY CARE OR SUPPLIES
1,250
MELISSA'S SECOND CHANCES
11015 W 75TH ST
SHAWNEE
,
KS
66214
NONE
PC
VETERINARY CARE OR SUPPLIES
750
ANIMAL RESCUE OF CARROLL
1721 E 10TH ST
CARROLL
,
IA
51401
NONE
PC
VETERINARY CARE OR SUPPLIES
500
SANDI PAWS RESCUE
29 W BARK ST
FOND DU LAC
,
WI
54935
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
SECOND CHANCE AIR
101 CUPOLO CIRCLE
HUNSTVILLE
,
AL
35806
NONE
PC
VETERINARY CARE OR SUPPLIES
5,000
NEEDY PAWS RESCUE
814 HICREST DR
ST LOIUS
,
MO
63125
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
KIND KEEPER ANIMAL RESCUE
1500 LD DR
NORTH MRYTLE BEACH SC
,
SC
29582
NONE
PC
VETERINARY CARE OR SUPPLIES
3,000
NO DOGS LEFT BEHIND
244 5TH AVE SUITE 200
NEW YORK
,
NY
10001
NONE
PC
VETERINARY CARE OR SUPPLIES
3,300
ASPIRE APPALACHIA
PO BOX 1255
JACKSON
,
KY
41339
NONE
PC
VETERINARY CARE OR SUPPLIES
2,500
MICHAEL'S RESCUE
301 ALTEN AVE
GRAND RAPIDS
,
MI
49503
NONE
PC
VETERINARY CARE OR SUPPLIES
1,000
GREATER GOOD CHARITIES
600 UNIVERSITY ST SUITE 100
SEATTLE
,
WA
98101
NONE
PC
VETERINARY CARE OR UPPLIES
25,625
AAHA
PO BOX 5084
CABOT
,
AR
72023
NONE
PC
VETERINARY CARE OR SUPPLIES
1,830
ANIMAL RESCUE NEW ORLEANS
1219 COLISEUM ST
NEW ORLEANS
,
LA
70130
NONE
PC
VETERINARY CARE OR SUPPLIES
750
Total
.................................
3a
393,620
b
Approved for future payment
Total
.................................
3b
0
Form
990-PF
(2020)
Form 990-PF (2020)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
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)
..
0
0
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
0
(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
HEALTHY PAWS FOUNDATION
Employer identification number
27-0871188
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
HEALTHY PAWS FOUNDATION
Employer identification number
27-0871188
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
AON FOUNDATION
PO BOX 81200
CHICAGO
,
IL
60681
$
393,860
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.)
(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
HEALTHY PAWS FOUNDATION
Employer identification number
27-0871188
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
HEALTHY PAWS FOUNDATION
Employer identification number
27-0871188
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:
-
TIN:
TY 2020 AccountingFeesSchedule
Name:
HEALTHY PAWS FOUNDATION
EIN:
27-0871188
Category
Amount
Net Investment Income
Adjusted Net Income
Disbursements for Charitable Purposes
ACCOUNTING FEES
300
0
0
0