-
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
FIS FOUNDATION INC
Number and street (or P.O. box number if mail is not delivered to street address)
601 RIVERSIDE AVE
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
JACKSONVILLE
,
FL
32204
A Employer identification number
26-1628191
B
Telephone number (see instructions)
(904) 438-6529
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)
$
652,667
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)
1,025,000
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
.........
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
........
1,025,000
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)
.......
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)
.......
998
0
0
998
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
998
0
0
998
25
Contributions, gifts, grants paid
.......
1,423,560
1,423,560
26
Total expenses and disbursements.
Add lines 24 and 25
1,424,558
0
0
1,424,558
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-399,558
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
.............
1,039,580
652,667
652,667
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)
1,039,580
652,667
652,667
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
58,200
70,845
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)
.........
58,200
70,845
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
981,380
581,822
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
........
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)
.....
981,380
581,822
30
Total liabilities and net assets/fund balances
(see instructions)
.
1,039,580
652,667
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
981,380
2
Enter amount from Part I, line 27a
.....................
2
-399,558
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
581,822
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
581,822
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
No
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)
WI
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
FIS
Telephone no.
(904) 438-6529
Located at
601 RIVERSIDE AVE
JACKSONVILLE
FL
ZIP+4
32204
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
GARY NORCROSS
PRESIDENT
0.00
0
0
0
601 RIVERSIDE AVE
JACKSONVILLE
,
FL
32204
JAMES WOODALL
VICE PRESIDENT
0.00
0
0
0
601 RIVERSIDE AVE
JACKSONVILLE
,
FL
32204
JAMES WOODALL
TREASURER
0.00
0
0
0
601 RIVERSIDE AVE
JACKSONVILLE
,
FL
32204
ELYN RAFTERY
SECRETARY
0.00
0
0
0
601 RIVERSIDE AVE
JACKSONVILLE
,
FL
32204
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
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
792,330
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
792,330
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
792,330
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
11,885
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
780,445
6
Minimum investment return.
Enter 5% of line 5
..................
6
39,022
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
39,022
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
0
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
39,022
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
39,022
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
39,022
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
1,424,558
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
1,424,558
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
1,424,558
Note:
The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
the section 4940(e) reduction of tax in those years.
Form
990-PF
(2020)
Form 990-PF (2020)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2019
(c)
2019
(d)
2020
1
Distributable amount for 2020 from Part XI, line 7
39,022
2
Undistributed income, if any, as of the end of 2020:
a
Enter amount for 2019 only
.......
0
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2020:
a
From 2015
......
1,249,916
b
From 2016
......
1,139,287
c
From 2017
......
1,522,970
d
From 2018
......
1,369,947
e
From 2019
......
1,236,361
f
Total
of lines 3a through e
........
6,518,481
4
Qualifying distributions for 2020 from Part
XII, line 4:
$
1,424,558
a
Applied to 2019, but not more than line 2a
0
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2020 distributable amount
.....
39,022
e
Remaining amount distributed out of corpus
1,385,536
5
Excess distributions carryover applied to 2020.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
7,904,017
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2019. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2020. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2021
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2015 not
applied on line 5 or line 7 (see instructions)
...
1,249,916
9
Excess distributions carryover to 2021.
Subtract lines 7 and 8 from line 6a
......
6,654,101
10
Analysis of line 9:
a
Excess from 2016
....
1,139,287
b
Excess from 2017
....
1,522,970
c
Excess from 2018
....
1,369,947
d
Excess from 2019
....
1,236,361
e
Excess from 2020
....
1,385,536
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 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
YMCA OF NORTHEAST FLORIDA
40 E ADAMS ST STE 210
JACKSONVILLE
,
FL
32202
PUBLIC CHARITY
GENERAL CONTRIBUTION
60,000
LEUKEMIA AND LYMPHOMA SOCIETY
3 INTERNATIONAL DRIVE SUITE 200
RYE BROOK
,
NY
10573
PUBLIC CHARITY
GENERAL CONTRIBUTION
110,000
AMERICAN HEART ASSOCIATION
7272 GREENVILLE AVENUE
DALLAS
,
TX
75231
PUBLIC CHARITY
GENERAL CONTRIBUTION
75,000
LEADERSHIP JACKSONVILLE
40 EAST ADAMS STREET SUITE 230
JACKSONVILLE
,
FL
32202
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
NORTH FLORIDA SCHOOL OF SPECIAL EDUCATION
223 MILL CREEK RD
JACKSONVILLE
,
FL
32211
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
CHANGING HOMELESSNESS INC
660 PARK STREET
JACKSONVILLE
,
FL
32204
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
UNF FOUNDATION
1 UNF DR FL 2900
JACKSONVILLE
,
FL
32224
PUBLIC CHARITY
GENERAL CONTRIBUTION
25,000
AHIMSA HOUSE
PO BOX 2173
TUCKER
,
GA
30085
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,250
PANCREATIC CANCER ACTION NETWORK
1500 ROSECRANS AVE SUITE 200
MANHATTAN BEACH
,
CA
90266
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
HANDS ON ORLANDO INC
1850 LEE RD STE 220
WINTER PARK
,
FL
32789
PRIVATE FOUNDATION
GENERAL CONTRIBUTION
50,000
AMERICAN DIABETES ASSOCIATION
197 GREENCREST DRIVE
PONTE VEDRA BEACH
,
FL
32082
PUBLIC CHARITY
GENERAL CONTRIBUTION
25,000
NANNA'S BABIES
N78W14573 APPLETON AVE
MENOMONEE FALLS
,
WI
53051
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,500
ROLAND CRISIS CLOSET
PO BOX 90
ROLAND
,
AR
72135
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
FLAMINGO CHARITIES INC
5729 CEDAR OAKS DR FL
JACKSONVILLE
,
FL
32210
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
ARKANSAS FREEDOM FUND
6017 SPRINGWOOD CIR
BRYANT
,
AR
72022
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
RECYCLE BIKES FOR KIDS
717 E 10TH ST
LITTLE ROCK
,
AR
72202
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
AR KIDS READ
PO BOX 22701
LITTLE ROCK
,
AR
72221
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
ARTHRITIS FOUNDATION ARKANSAS
1355 PEACHTREE ST SUITE 600
ATLANTA
,
GA
30309
PRIVATE FOUNDATION
GENERAL CONTRIBUTION
2,000
FAULKNER COUNTY CIRCLE OF FRIENDS
900 ABBEY CT
ALPHARETTA
,
GA
30004
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,500
ST JUDE CHILDREN'S RESEARCH HOSPITAL
501ST JUDEPLACE
MEMPHIS
,
TN
38105
PUBLIC CHARITY
GENERAL CONTRIBUTION
500
ARKANSAS STEM COALITION
423 MAIN STREET SUITE 400
LITTLE ROCK
,
AR
72201
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
CARTI FOUNDATION
8901 CARTI WAY
LITTLE ROCK
,
AR
72205
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,500
CENTERS FOR YOUTH AND FAMILIES FOUNDATION
6501 W 12TH ST
LITTLE ROCK
,
AR
72204
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,500
KIPP JACKSONVILLE SCHOOLS
1440 MCDUFF AVENUE N
JACKSONVILLE
,
FL
32254
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
WREATHS ACROSS AMERICA
PO BOX 249 4 POINT STREET
COLUMBIA FALLS
,
ME
04623
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,500
JACKSONVILLE SCHOOL FOR AUTISM
9000 SOUTHSIDE BLVD BLDG 900
JACKSONVILLE
,
FL
32256
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
2019 NY COMMON PANTRY
8 EAST 109TH STREET
NEW YORK
,
NY
10029
PUBLIC CHARITY
GENERAL CONTRIBUTION
4,000
RONALD MCDONALD OF NEW YORK
405 EAST 73RD STREET
NEW YORK
,
NY
10021
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
THE KENOCHAS COMMUNITY FOUNDATION
600 52ND ST 110
KENOSHA
,
WI
53140
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
ONE JAX
1 UNF DRIVE
JACKSONVILLE
,
FL
32224
PUBLIC CHARITY
GENERAL CONTRIBUTION
50,000
SHARE FOOD PROGRAM
2901 W HUNTING PARK AVENUE
PHILADELPHIA
,
PA
19129
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
ASPHALT GREEN INC
555 EAST 90TH ST
NEW YORK
,
NY
10128
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
QUEST INC
PO BOX 531125
ORLANDO
,
FL
32853
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,950
FC SPORTS FOUNDATION SIDELINE WINE & DINE
1 CITRUS BOWL PLACE
ORLANDO
,
FL
32805
PRIVATE FOUNDATION
GENERAL CONTRIBUTION
1,600
JACKSONVILLE ZOO
370 ZOO PKWY
JACKSONVILLE
,
FL
32218
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
AMERICAN CANCER SOCIETY OF PINELLA COUTNY
4801 86TH AVE
PINELLAS PARK
,
FL
33782
PUBLIC CHARITY
GENERAL CONTRIBUTION
3,000
STRONGER THAN STIGMA
9672 WEXFORD RD
JACKSONVILLE
,
FL
32257
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
THE PATRICK HEINOLD FOUNDATION INC
3840-1 WILLIAMSBURG PARK BLVD
JACKSONVILLE
,
FL
32257
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
ANGLES FOR ALLISON
2905 CORINTHIAN AVE SUITE 2
JACKSONVILLE
,
FL
32210
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
JUVENILE DIABETES FOUNDATION
200 VESEY STREET 28TH FLOOR 14TH
FLOOR
NEW YORK
,
NY
10281
PRIVATE FOUNDATION
GENERAL CONTRIBUTION
10,000
CHILDRENS HUNGER ALLIANCE
1105 SCHROCK ROAD SUITE 505
COLUMBUS
,
OH
43229
PUBLIC CHARITY
GENERAL CONTRIBUTION
25,000
FREE STORE FOODBANK INC
1141 CENTRAL PARKWAY
CINCINNATI
,
OH
45202
PUBLIC CHARITY
GENERAL CONTRIBUTION
25,000
AMERICAN HEART ASSOCIATION
7272 GREENVILLE AVENUE
DALLAS
,
TX
75231
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
HISPANIC FEDERATION
55 EXCHANGE PLACE 5TH FLOOR
NEW YORK
,
NY
10005
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
FOLDS OF HONOR NORTH TEXAS
4159 HERSCHEL AVENUE
DALLAS
,
TX
75219
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
RONALD MCDONALD HOUSE OF CHARITIES
ONE KROC DRIVE
OAK BROOK
,
IL
60523
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
GARRETT COLLEGE FOUNDATIONI CAN SWIM
687 MOSSER ROAD
MCHENRY
,
MD
21541
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
KITSAP HUMANE SOCIETY
9167 DICKEY RD NW
SILVERDALE
,
WA
98383
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
THE KANSAS CITY HOSPICE AND PALLIVATE CARE
9001 STATE LINE RD 300
KANSAS CITY
,
MO
64114
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
GIRL SCOUTS OF HAWAII
410 ATKINSON DRIVE SUITE 2E1 BOX 3
HONOLULU
,
HI
96814
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
PARTNERS FOR HEALTH
1720 CAMPDEN DRIVE
COLLIERVILLE
,
TN
38017
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
ST JUDE CHILDREN'S RESEARCH HOSPITAL
501ST JUDEPLACE
MEMPHIS
,
TN
38105
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
NATIONAL CHRISTIAN FOUNDATION
11625 RAINWATER DRIVE SUITE 500
ALPHARETTA
,
GA
30009
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
LLS
3 INTERNATIONAL DRIVE SUITE 200
RYE BROOK
,
NY
10573
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
AMERICAN CANCER SOCIETY
1430 PRUDENTIAL DRIVE
JACKSONVILLE
,
FL
32207
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
DKMS
100 BROADWAY 6TH FLOOR
NEW YORK
,
NY
10005
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
UNITED WAY OF NE FL
40 E ADAMS ST 200
JACKSONVILLE
,
FL
32202
PUBLIC CHARITY
GENERAL CONTRIBUTION
50,000
FOUNDATION FIGHTING BLINDNESS
6925 OAKLAND MILLS ROAD 701
COLUMBIA
,
MD
21297
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
BEST BUDDIES
4130 SALISBURY RD SUITE 2200
JACKSONVILLE
,
FL
32216
PUBLIC CHARITY
GENERAL CONTRIBUTION
400
LUTHERAN SERVICES FL INC
3627 W WATERS AVE
TAMPA
,
FL
33614
PUBLIC CHARITY
GENERAL CONTRIBUTION
100,000
LLS GEROGIA CHAPTER
PO BOX 735317
DALLAS
,
TX
75373
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
BEST BUDDIES
4130 SALISBURY RD SUITE 2200
JACKSONVILLE
,
FL
32216
PUBLIC CHARITY
GENERAL CONTRIBUTION
200
CHILDREN'S HOSPITAL OF SAN ANTONIO
333 N SANTA ROSA ST
SAN ANTONIO
,
TX
78207
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
TEXAS ELKS CHILDREN'S SERVICES
1963 FM1586
GONZALES
,
TX
78629
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
NORTH TEXAS FOOD BANK
3677 MAPLESHADE LN
PLANO
,
TX
75075
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
ATLANTA HABITAT FOR HUMANITY
824 MEMORIAL DR SE
ATLANTA
,
GA
30316
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
FISCHER HOUSE WISCONSIN
5000 W NATIONAL AVE BLDG 150
MILWAUKEE
,
WI
53295
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
LLS
3 INTERNATIONAL DRIVE SUITE 200
RYE BROOK
,
NY
10573
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,100
TOYS FOR TOTS
18251 QUANTICO GATEWAY DRIVE
TRIANGLE
,
VA
22172
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
UNITED PERFORMING ARTS FOUNDATION
301 W WISCONSIN AVE 600
MILWAUKEE
,
WI
53203
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
YMCA OF FLORIDA'S FIRST COAST
40 E ADAMS ST STE 210
JACKSONVILLE
,
FL
32202
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,500
BIG BROTHERS BIG SISTERS NE FL
40 E ADAMS ST 220
JACKSONVILLE
,
FL
32202
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
CATHEDERAL DISTRICT JAX
4446-1A HENDRICKS AVE 389
JACKSONVILLE
,
FL
32207
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
MOVEMBER FOUNDATION
PO BOX 1595
CULVER CITY
,
CA
90232
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
STANCO
909 15TH ST
MODESTO
,
CA
95354
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
ERASE HUMAN TRAFFICKING
6025 STAGE ROAD SUITE 42-163
MEMPHIS
,
TN
38134
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
BEST BUDDIES INTERNATIONAL
100 SOUTHEAST SECOND ST SUITE 2200
MIAMI
,
FL
33131
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
MAKE-A-WISH MICHIGAN
7600 GRAND RIVER AVENUE SUITE 175
BRIGHTON
,
MI
48114
PRIVATE FOUNDATION
GENERAL CONTRIBUTION
450
PHILADUNDANCE
3616 SOUTH GALLOWAY STREET
PHILADELPHIA
,
PA
19148
PUBLIC CHARITY
GENERAL CONTRIBUTION
4,000
2020 NY COMMON PANTRY
8 E 109TH ST
NEW YORK
,
NY
10029
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
GWINNETT COUNTY COMMUNITY MENTORING
437 OLD PEACHTREE RD NW
SUWANEE
,
GA
30024
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,250
MAKE-A-WISH CENTRAL & NORTHERN FL
3938 SUNBEAM RD SUITE 3
JACKSONVILLE
,
FL
32257
PRIVATE FOUNDATION
GENERAL CONTRIBUTION
2,600
STEM2 HUB
139 PONTE VEDRA BLVD
PONTE VEDRA BEACH
,
FL
32082
PUBLIC CHARITY
GENERAL CONTRIBUTION
25,000
WOLFSON'S CHILDREN'S HOSPITAL
800 PRUDENTIAL DRIVE
JACKSONVILLE
,
FL
32207
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
LLS
3 INTERNATIONAL DRIVE SUITE 200
RYE BROOK
,
NY
10573
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
YEARUP
45 MILK ST 9TH FLOOR
BOSTON
,
MA
02109
PUBLIC CHARITY
GENERAL CONTRIBUTION
50,000
CATHEDRAL ARTS PROJECT
207 N LAURA ST SUITE 300
JACKSONVILLE
,
FL
32202
PUBLIC CHARITY
GENERAL CONTRIBUTION
45,000
THE DONNA FOUNDATION
11762 MARCO BEACH DRIVE SUITE 6
JACKSONVILLE
,
FL
32224
PRIVATE FOUNDATION
GENERAL CONTRIBUTION
15,000
A SPECIAL WISH FOUNDATION CLEVELAND CHAPTER
23 PUBLIC SQUARE
BRECKSVILLE
,
OH
44141
PUBLIC CHARITY
GENERAL CONTRIBUTION
260
BAPTIST FOUNDATION
841 PRUDENTIAL DRIVE SUITE 1300
JACKSONVILLE
,
FL
32207
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
DOWN SYNDROME ASSOCIATION
8011 PHILIPS HWY 7
JACKSONVILLE
,
FL
32256
PUBLIC CHARITY
GENERAL CONTRIBUTION
750
MERCY KEEPERS
2021 9TH AVE S
ST PETERSBURG
,
FL
33712
PUBLIC CHARITY
GENERAL CONTRIBUTION
3,000
GATOR BOWL SPORTS
1 GATOR BOWL BLVD
JACKSONVILLE
,
FL
32202
PUBLIC CHARITY
GENERAL CONTRIBUTION
15,000
EAST
981 OLD LEBANON DIRT ROAD
HERMITAGE
,
TN
37076
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
MCKENZIE WILSON BOYS AND GIRLS CLUB
820 SEAGATE AVENUE
JACKSONVILLE BEACH
,
FL
32250
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
GENERATION W INC
2320 3RD ST S
JACKSONVILLE BEACH
,
FL
32250
PUBLIC CHARITY
GENERAL CONTRIBUTION
20,000
SECOND HARVEST FOOD BANK OF CENTRAL FLORIDA
411 MERCY DR
ORLANDO
,
FL
32805
PUBLIC CHARITY
GENERAL CONTRIBUTION
8,975
BABY DJ INC
2500 MAITLAND CENTER PKWY STE 400
MAITLAND
,
FL
32751
PUBLIC CHARITY
GENERAL CONTRIBUTION
8,975
SPECIAL HEARTS FARM
1100 E MAPLE ST
WINTER GARDEN
,
FL
34787
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
SOUTHEASTERN GUIDE DOGS INC
4210 77TH ST E
PALMETTO
,
FL
34221
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,600
SUPPORT THE TROOPS INC
29807 STATE ROAD 54
WESLEY CHAPEL
,
FL
33545
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,600
AFFN - ARMED FORCES FINANCIAL NETWORK
11601 ROOSEVELT BLVD
ST PETERSBURG
,
FL
33716
PRIVATE FOUNDATION
GENERAL CONTRIBUTION
2,600
GCADV
2295 PARKLAKE DRIVE SUITE 130
ATLANTA
,
GA
30345
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
THE CALVARY FUND
1740 EASTCHESTER RD
BRONX
,
NY
10461
PUBLIC CHARITY
GENERAL CONTRIBUTION
25,000
SALVATION ARMY
615 SLATERS LANE
ALEXANDRIA
,
VA
22314
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
MARINE TOYS FOR TOTS
18251 QUANTICO GATEWAY DRIVE
TRIANGLE
,
VA
22172
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
ALZHEIMER'S ASSOCIATION
225 N MICHIGAN AVE FLOOR 17
CHICAGO
,
IL
60601
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
SAN ANTONIO FOOD BANK
5200 ENRIQUE M BARRERA PKWY
SAN ANTONIO
,
TX
78227
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
THE VITAMIN BRIDGE
PO BOX 2843
COPPELL
,
TX
75019
PUBLIC CHARITY
GENERAL CONTRIBUTION
500
DEPELCHIN'S CHILDREN'S GROUP
4950 MEMORIAL DRIVE
HOUSTON
,
TX
77007
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
HOUSTON FOOD BANK
535 PORTWALL ST
HOUSTON
,
TX
77029
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
WARRIOR DOG FOUNDATION
5930 ROYAL LANE STE E 355
DALLAS
,
TX
75230
PUBLIC CHARITY
GENERAL CONTRIBUTION
500
THE BELL CENTER
1700 29TH CT S
BIRMINGHAM
,
AL
35209
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
SHELBY HUMANE SOCIETY
381 MCDOW RD
COLUMBIANA
,
AL
35051
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
KULTURE CITY
723 MONTGOMERY HWY
VESTAVIA HILLS
,
AL
35216
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
KRISTINA'S ROAD TO RESCUE
116 CAHABA FOREST DR
TRUSSVILLE
,
AL
35173
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
SERVED
1213 HIGHLAND DR
FAIRFIELD
,
AL
35064
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
GRACE KLEIN COMMUNITY INC
1678 MONTGOMERY HWY 104
BIRMINGHAM
,
AL
35216
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
FISHES LOAVES & LOVE
PO BOX 222
LEEDS
,
AL
35094
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
CHESTER COUNTY FOOD BANK
650 PENNSYLVANIA DRIVE
EXTON
,
PA
19341
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
DAILY BREAD COMMUNITY FOOD PANTRY
3938B RIDGE PIKE
COLLEGEVILLE
,
PA
19426
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
CHESTER COUNTY YOUTH SERVICES
601 WESTTOWN RD SUITE 310
WEST CHESTER
,
PA
19380
PUBLIC CHARITY
GENERAL CONTRIBUTION
3,000
FEED MY STARVING CHILDREN
401 93RD AVE NW
COON RAPIDS
,
MN
55433
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
VALLEY OUTREACH
1911 CURVE CREST BLVD W
STILLWATER
,
MN
55082
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
SECOND HARVEST HEARTLAND
7101 WINNETKA AVENUE N
BROOKLYN PARK
,
MN
55428
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
SAFE HANDS ANIMAL RESCUE
3732 10TH AVE S
MINNEAPOLIS
,
MN
55407
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
WOUNDED WARRIOR PROJECT
4899 BELFORT ROAD SUITE 300
JACKSONVILLE
,
FL
32256
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,000
ST JUDES CHILDREN'S RESEARCH HOSPITAL
501ST JUDEPLACE
MEMPHIS
,
TN
38105
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
THE SALVATION ARMY
615 SLATERS LANE
ALEXANDRIA
,
VA
22314
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
CAMP SMILE-A-MILE
1600 2ND AVE S
BIRMINGHAM
,
AL
35233
PUBLIC CHARITY
GENERAL CONTRIBUTION
1,000
HOPE FOR A BETTER LIFE
4727 SUNBEAM RD
JACKSONVILLE
,
FL
32257
PUBLIC CHARITY
GENERAL CONTRIBUTION
2,500
COMMUNITIES IN SCHOOLS
6261 DUPONT STATION COURT E
JACKSONVILLE
,
FL
32217
PUBLIC CHARITY
GENERAL CONTRIBUTION
5,000
THE DONNA FOUNDATION
11762 MARCO BEACH DRIVE SUITE 6
JACKSONVILLE
,
FL
32224
PRIVATE FOUNDATION
GENERAL CONTRIBUTION
17,500
AMERICAN CANCER SOCIETY
1430 PRUDENTIAL DRIVE
JACKSONVILLE
,
FL
32207
PUBLIC CHARITY
GENERAL CONTRIBUTION
50,000
FOLDED FLAG FOUNDATION
1550 S PAVILION CENTER DRIVE
LAS VEGAS
,
NV
89135
PRIVATE FOUNDATION
GENERAL CONTRIBUTION
150,000
UNIV OF ARKANSAS FOUNDATION
535 RESEARCH CENTER BLVD STE 120
FAYETTEVILLE
,
AR
72701
PUBLIC CHARITY
GENERAL CONTRIBUTION
25,000
THE CHILDREN'S PANTRY OF JACKSONVILLE
2935 DAWN ROAD
JACKSONVILLE
,
FL
32207
PUBLIC CHARITY
GENERAL CONTRIBUTION
10,000
Total
.................................
3a
1,423,560
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
FIS FOUNDATION INC
Employer identification number
26-1628191
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
FIS FOUNDATION INC
Employer identification number
26-1628191
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
FIDELITY NATIONAL INFORMATION SERVICES INC
601 RIVERSIDE AVE
JACKSONVILLE
,
FL
32204
$
1,025,000
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
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
FIS FOUNDATION INC
Employer identification number
26-1628191
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
FIS FOUNDATION INC
Employer identification number
26-1628191
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 OtherExpensesSchedule
Name:
FIS FOUNDATION INC
EIN:
26-1628191
Description
Revenue and Expenses per Books
Net Investment Income
Adjusted Net Income
Disbursements for Charitable Purposes
BANK FEES
998
0
0
998