Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0052
2020
Open to Public Inspection
For calendar year 2020, or tax year beginning 01-01-2020 , and ending 12-31-2020
Name of foundation
SUSANNA ANGUE POULSON FUND
 
Number and street (or P.O. box number if mail is not delivered to street address)6325 S RAINBOW BLVD STE 300
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LAS VEGAS, NV89118
A Employer identification number

23-6933346
B Telephone number (see instructions)

(888) 730-4933
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$751,463J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 18,596 18,544  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 20,292
b Gross sales price for all assets on line 6a 338,488
7 Capital gain net income (from Part IV, line 2)... 20,292
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........ 38,888 38,836  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 10,507 9,457   1,051
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule).........       0
b Accounting fees (attach schedule)....... Click to see attachment 958 0 0 958
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... Click to see attachment 653 289   0
19 Depreciation (attach schedule) and depletion... 0 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......   0 0  
22 Printing and publications..........   0 0  
23 Other expenses (attach schedule)....... Click to see attachment 4 4    
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 12,122 9,750 0 2,009
25 Contributions, gifts, grants paid....... 28,800 28,800
26 Total expenses and disbursements. Add lines 24 and 25 40,922 9,750 0 30,809
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -2,034
b Net investment income (if negative, enter -0-) 29,086
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2020)
Form 990-PF (2020)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing.............      
2 Savings and temporary cash investments......... 28,910 23,431 23,431
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet0      
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule).......   Click to see attachment138,486 230,419
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 558,318 Click to see attachment423,061 497,613
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 587,228 584,978 751,463
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22).........   0
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions...........    
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........ 587,228 584,978
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)..... 587,228 584,978
30 Total liabilities and net assets/fund balances (see instructions). 587,228 584,978
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
587,228
2
Enter amount from Part I, line 27a .....................
2
-2,034
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
585,194
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
216
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
584,978
Form 990-PF (2020)
Form 990-PF (2020)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)		 (b)
How acquired
P—Purchase
D—Donation 		(c)
Date acquired
(mo., day, yr.) 		(d)
Date sold
(mo., day, yr.)
1 a 15. ZOETIS INC   2017-04-25 2020-02-03
b 4. ZOETIS INC   2019-09-27 2020-02-03
c 21.993 AMER CENT SMALL CAP GRWTH INST 336   2019-10-25 2020-02-14
d 29.007 AMER CENT SMALL CAP GRWTH INST 336   2018-02-09 2020-02-14
e 8.297 ARTISAN MID CAP FUND-INS 1333   2019-10-25 2020-02-14
52.703 ARTISAN MID CAP FUND-INS 1333   2012-04-10 2020-02-14
583.223 JPMORGAN MID CAP VALUE-R6 #2335   2010-12-17 2020-02-14
218.337 T ROWE PR REAL ESTATE-I #432   2016-01-25 2020-02-14
160. SPDR DJ WILSHIRE INTERNATIONAL R ETF   2011-10-20 2020-02-14
4. APPLE INC   2019-08-09 2020-02-18
1. BLACKROCK INC   2018-08-08 2020-02-18
15. CVS HEALTH CORPORATION   2014-02-25 2020-02-18
11. CELANESE CORP   2014-02-25 2020-02-18
1. CELANESE CORP   2019-02-26 2020-02-18
6. COGNIZANT TECH SOLUTIONS CRP COM   2016-03-16 2020-02-18
3. DIAGEO PLC - ADR   2019-08-09 2020-02-18
2. EOG RESOURCES, INC   2018-04-10 2020-02-18
4. EOG RESOURCES, INC   2019-06-11 2020-02-18
5. FIDELITY NATL INFORMATION SVCS INC   2019-08-09 2020-02-18
10. GILEAD SCIENCES INC   2017-03-24 2020-02-18
16. HAIN CELESTIAL GROUP INC   2015-12-17 2020-02-18
2. HOME DEPOT INC   2019-08-09 2020-02-18
2. LAM RESEARCH CORP COM   2018-07-24 2020-02-18
3. LAS VEGAS SANDS CORP   2018-07-27 2020-02-18
3. LAS VEGAS SANDS CORP   2019-02-26 2020-02-18
21. MANULIFE FINANCIAL CORP   2019-04-22 2020-02-18
10. MICROSOFT CORP   2019-08-09 2020-02-18
16. MONDELEZ INTERNATIONAL INC   2019-08-09 2020-02-18
4. NIKE INC CL B   2019-08-09 2020-02-18
4. TARGET CORP   2014-02-25 2020-02-18
2. THERMO FISHER SCIENTIFIC INC   2019-12-24 2020-02-18
6. EATON CORP PLC   2018-11-19 2020-02-18
46. FLEXTRONICS INTL LTD   2018-03-07 2020-02-18
97.721 INV OPP DEVELOP MRKTS-R6 7038   2011-05-25 2020-04-03
13.668 INV OPP DEVELOP MRKTS-R6 7038   2020-02-20 2020-04-03
175.292 EATON VANCE GLOB MACRO ADV-I 208   2017-10-26 2020-04-03
16.786 FIDELITY NEW MRKTS INC-Z #3323   2020-02-20 2020-04-03
258. ISHARES CORE MSCI EMERGING ETF   2019-08-08 2020-04-03
1624.141 METROPOLITAN WEST T/R BD-PLN #712   2019-08-08 2020-04-03
1583.254 METROPOLITAN WEST T/R BD-PLN #712   2019-10-25 2020-04-03
841.862 PIMCO TOTAL RET FD-INST #35   2019-08-08 2020-04-03
153.788 PIMCO TOTAL RET FD-INST #35   2020-02-20 2020-04-03
148.976 PIMCO HIGH YIELD FD-INST #108   2019-10-11 2020-04-03
1598.536 T ROWE PR OVERSEAS STOCK-I #521   2017-04-27 2020-04-03
33.424 T ROWE PR OVERSEAS STOCK-I #521   2020-02-20 2020-04-03
7. HOME DEPOT INC   2019-08-09 2020-04-06
6. HOME DEPOT INC   2017-03-31 2020-04-06
13. PNC FINANCIAL SERVICES GROUP   2019-05-28 2020-04-06
8. PNC FINANCIAL SERVICES GROUP   2015-09-01 2020-04-06
12. EATON CORP PLC   2019-08-09 2020-04-06
27. EATON CORP PLC   2014-02-25 2020-04-06
.352 RAYTHEON TECHNOLOGIES CORP   2019-09-11 2020-04-29
18.555 INV OPP DEVELOP MRKTS-R6 7038   2011-05-25 2020-05-15
1051.813 AMER CENT SMALL CAP GRWTH INST 336   2015-07-28 2020-05-15
164.202 AMER CENT SMALL CAP GRWTH INST 336   2020-04-03 2020-05-15
69.794 ARTISAN MID CAP FUND-INS 1333   2012-04-10 2020-05-15
2148.332 PIMCO HIGH YIELD FD-INST #108   2019-10-11 2020-05-15
44.602 T ROWE PR OVERSEAS STOCK-I #521   2017-04-27 2020-05-15
8.448 JAMES ALPHA GL REAL EST-I   2020-02-20 2020-05-15
7.675 STERLING CAPITAL STRATTON SMALL CAP   2019-08-08 2020-05-15
81.438 STERLING CAPITAL STRATTON SMALL CAP   2020-02-20 2020-05-15
243.752 STERLING CAPITAL STRATTON SMALL CAP   2014-10-20 2020-05-15
14.281 TCW EMRG MKTS INCM-I 4721   2020-02-20 2020-05-15
17. VANGUARD MIDCAP VIPER   2020-02-14 2020-05-15
1. BLACKROCK INC   2019-02-26 2020-05-22
16. CVS HEALTH CORPORATION   2014-02-25 2020-05-22
31. EOG RESOURCES, INC   2019-08-09 2020-05-22
867.987 JAMES ALPHA GL REAL EST-I   2020-02-20 2020-06-25
10. CVS HEALTH CORPORATION   2014-02-25 2020-07-24
12. COGNIZANT TECH SOLUTIONS CRP COM   2019-08-09 2020-07-24
1. APPLE INC   2019-08-09 2020-08-25
33. HAIN CELESTIAL GROUP INC   2015-12-17 2020-08-25
7. TORONTO DOMINION BK ONT COM NEW   2019-07-30 2020-08-25
4. UNITED PARCEL SERVICE-CL B   2017-03-24 2020-08-25
15. TJX COMPANIES INC   2020-04-06 2020-09-14
38. TJX COMPANIES INC   2014-02-25 2020-09-14
7. TE CONNECTIVITY LTD   2017-05-30 2020-09-14
47.409 INV OPP DEVELOP MRKTS-R6 7038   2011-05-25 2020-09-25
47.687 ARTISAN MID CAP FUND-INS 1333   2012-04-10 2020-09-25
109. INVESCO OPTIMUM YIELD DIVERS   2020-04-03 2020-09-25
1676.504 METROPOLITAN WEST T/R BD-PLN #712   2015-06-15 2020-09-25
940.232 METROPOLITAN WEST T/R BD-PLN #712   2019-12-10 2020-09-25
382.083 METROPOLITAN WEST T/R BD-PLN #712   2020-05-15 2020-09-25
323.701 PIMCO TOTAL RET FD-INST #35   2019-10-25 2020-09-25
228.21 PIMCO TOTAL RET FD-INST #35   2020-05-15 2020-09-25
319.172 PIMCO TOTAL RET FD-INST #35   2019-08-08 2020-09-25
108.699 T ROWE PR OVERSEAS STOCK-I #521   2017-04-27 2020-09-25
49.575 TCW EMRG MKTS INCM-I 4721   2020-02-20 2020-09-25
53.382 TOUCHSTONE MID CAP-INST #353   2020-02-20 2020-09-25
48. APPLE INC   2014-02-25 2020-09-28
1. BOEING CO   2019-11-08 2020-09-28
1. BOEING CO   2019-02-11 2020-09-28
8. CVS HEALTH CORPORATION   2014-02-25 2020-09-28
10. GILEAD SCIENCES INC   2017-03-24 2020-09-28
13. HAIN CELESTIAL GROUP INC   2019-08-09 2020-09-28
7. JPMORGAN CHASE & CO   2019-08-09 2020-09-28
2. LAM RESEARCH CORP COM   2019-08-09 2020-09-28
6. MICROSOFT CORP   2019-08-09 2020-09-28
13. MONDELEZ INTERNATIONAL INC   2018-11-19 2020-09-28
7. MONDELEZ INTERNATIONAL INC   2020-04-06 2020-09-28
10. NIKE INC CL B   2017-10-30 2020-09-28
1. THERMO FISHER SCIENTIFIC INC   2018-11-19 2020-09-28
13. UNILEVER N.V. - ADR   2020-02-03 2020-09-28
7. UNITED PARCEL SERVICE-CL B   2017-03-24 2020-09-28
2. UNITEDHEALTH GROUP INC   2020-07-24 2020-09-28
25.427 INV OPP DEVELOP MRKTS-R6 7038   2011-05-25 2020-12-09
514.706 EV GL MACR ABS RTRN ADV-R6 #1072   2017-10-26 2020-12-09
452. INVESCO OPTIMUM YIELD DIVERS   2020-04-03 2020-12-09
245.581 PIMCO TOTAL RET FD-INST #35   2019-12-10 2020-12-09
43.881 T ROWE PR OVERSEAS STOCK-I #521   2017-04-27 2020-12-09
47.454 TOUCHSTONE MID CAP-INST #353   2020-02-20 2020-12-09
93.072 TRIBUTARY SMALL CO-INST PLUS #1705   2020-05-15 2020-12-09
18. VANGUARD MIDCAP VIPER   2020-02-14 2020-12-09
1. VANGUARD MIDCAP VIPER   2020-09-25 2020-12-09
36. AT & T INC   2018-02-13 2020-12-14
1. BLACKROCK INC   2019-02-26 2020-12-14
11. CME GROUP INC   2014-02-25 2020-12-14
3. CME GROUP INC   2020-04-06 2020-12-14
4. CELANESE CORP   2014-02-25 2020-12-14
6. COGNIZANT TECH SOLUTIONS CRP COM   2016-03-16 2020-12-14
5. DIAGEO PLC - ADR   2018-11-19 2020-12-14
24. GILEAD SCIENCES INC   2019-08-09 2020-12-14
1. LAM RESEARCH CORP COM   2019-08-09 2020-12-14
6. NIKE INC CL B   2017-10-30 2020-12-14
36. SPIRIT AEROSYTSEMS HOLD-CL A   2016-10-03 2020-12-14
25. SUNCOR ENERGY INC NEW F   2018-11-19 2020-12-14
6. SYSCO CORP   2020-08-25 2020-12-14
10. TOTAL S.A. - ADR   2018-11-19 2020-12-14
4. UNITED PARCEL SERVICE-CL B   2014-02-25 2020-12-14
4. TE CONNECTIVITY LTD   2016-11-08 2020-12-14
140. FLEXTRONICS INTL LTD   2018-03-07 2020-12-14
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(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a 2,033   862 1,171
b 542   495 47
c 440   395 45
d 580   496 84
e 362   344 18
2,298   2,092 206
23,422   13,930 9,492
5,917   5,655 262
6,310   5,412 898
1,277   810 467
564   489 75
1,076   1,117 -41
1,180   857 323
107   103 4
415   353 62
486   493 -7
149   214 -65
298   327 -29
775   685 90
670   676 -6
420   656 -236
488   422 66
650   347 303
204   213 -9
204   187 17
411   383 28
1,873   1,381 492
955   879 76
408   330 78
471   226 245
674   654 20
627   416 211
606   848 -242
3,338   3,418 -80
467   613 -146
1,674   1,872 -198
213   257 -44
10,165   12,470 -2,305
17,005   16,896 109
16,577   16,370 207
8,873   8,840 33
1,621   1,624 -3
1,158   1,343 -185
12,884   16,065 -3,181
269   368 -99
1,314   1,477 -163
1,127   882 245
1,224   1,720 -496
753   697 56
926   940 -14
2,084   1,601 483
24   29 -5
687   649 38
18,670   16,028 2,642
2,915   2,243 672
3,010   2,771 239
17,573   19,093 -1,520
393   448 -55
116   167 -51
421   592 -171
4,470   4,416 54
13,380   19,139 -5,759
102   124 -22
2,486   3,157 -671
504   442 62
1,011   1,152 -141
1,609   2,474 -865
13,593   15,908 -2,315
641   720 -79
745   751 -6
495   202 293
1,017   1,031 -14
341   410 -69
634   438 196
830   690 140
2,102   1,269 833
697   576 121
2,108   1,658 450
2,540   1,893 647
1,478   1,297 181
18,324   17,062 1,262
10,277   9,684 593
4,176   4,073 103
3,541   3,376 165
2,497   2,435 62
3,492   3,342 150
1,126   1,092 34
395   430 -35
2,069   2,246 -177
5,514   895 4,619
166   354 -188
166   404 -238
464   515 -51
627   668 -41
437   289 148
673   769 -96
674   392 282
1,255   829 426
740   693 47
399   366 33
1,244   552 692
428   232 196
787   765 22
1,181   704 477
607   601 6
1,314   889 425
5,621   5,507 114
6,587   5,377 1,210
2,593   2,561 32
521   441 80
2,114   1,996 118
2,748   1,852 896
3,670   3,343 327
204   172 32
1,118   1,351 -233
691   442 249
1,971   1,088 883
538   545 -7
518   210 308
474   352 122
800   779 21
1,442   1,526 -84
495   196 299
829   331 498
1,315   2,132 -817
456   842 -386
452   347 105
443   570 -127
679   384 295
474   275 199
2,333   1,953 380
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
      3,673
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       1,171
b       47
c       45
d       84
e       18
      206
      9,492
      262
      898
      467
      75
      -41
      323
      4
      62
      -7
      -65
      -29
      90
      -6
      -236
      66
      303
      -9
      17
      28
      492
      76
      78
      245
      20
      211
      -242
      -80
      -146
      -198
      -44
      -2,305
      109
      207
      33
      -3
      -185
      -3,181
      -99
      -163
      245
      -496
      56
      -14
      483
      -5
      38
      2,642
      672
      239
      -1,520
      -55
      -51
      -171
      54
      -5,759
      -22
      -671
      62
      -141
      -865
      -2,315
      -79
      -6
      293
      -14
      -69
      196
      140
      833
      121
      450
      647
      181
      1,262
      593
      103
      165
      62
      150
      34
      -35
      -177
      4,619
      -188
      -238
      -51
      -41
      148
      -96
      282
      426
      47
      33
      692
      196
      22
      477
      6
      425
      114
      1,210
      32
      80
      118
      896
      327
      32
      -233
      249
      883
      -7
      308
      122
      21
      -84
      299
      498
      -817
      -386
      105
      -127
      295
      199
      380
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 20,292
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
SECTION 4940(e) REPEALED ON DECEMBER 20, 2019 - DO NOT COMPLETE
1 Reserved
(a)
Reserved 		(b)
Reserved 		(c)
Reserved 		(d)
Reserved
2
Reserved...........................
2
3
Reserved...........................
3
4
Reserved...........................
4
5
Reserved...........................
5
6
Reserved...........................
6
7
Reserved...........................
7
8
Reserved,..........................
8
Form 990-PF (2020)
Form 990-PF (2020)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b Reserved................................ 1 404
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........................... 3 404
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- ..... 5 404
6 Credits/Payments:
a 2020 estimated tax payments and 2019 overpayment credited to 2020 6a 528
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 528
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 124
11 Enter the amount of line 10 to be: Credited to 2021 estimated taxBullet124 RefundedBullet 11 0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletPA
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2020 or the taxable year beginning in 2020? See the instructions for Part XIV.
    If "Yes," complete Part XIV .............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletWELLS FARGO BANK NA Telephone no.bullet (888) 730-4933

    Located atbullet100 N MAIN ST MAC D4001-117WINSTON SALEMNC ZIP+4bullet27101
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2020, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country? .................
    16   No
    See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?...............
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).......
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ........
    1b
     
    No
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2020?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2020, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2020?.............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 2020 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2020.)..................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2020?
    4b
     
    No
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ......
    5b
     
    No
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d). Click to see attachment
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .................
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    WELLS FARGO BANK N A TRUSTEE
    1     		10,507    
    100 N MAIN ST MAC D4001-117
    WINSTON SALEM,NC27101
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1  
    2  
    3  
    4  
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 8
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    638,737
    b
    Average of monthly cash balances.......................
    1b
    25,172
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    663,909
    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
    663,909
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    9,959
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    653,950
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    32,698
    Part XI
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    32,698
    2a
    Tax on investment income for 2020 from Part VI, line 5......
    2a
    404
    b
    Income tax for 2020. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    404
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    32,294
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    32,294
    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
    32,294
    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
    30,809
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
    0
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
    0
    b
    Cash distribution test (attach the required schedule) .................
    3b
    0
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    30,809
    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
    30,809
    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 32,294
    2 Undistributed income, if any, as of the end of 2020:
    a Enter amount for 2019 only....... 14,632
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2020:
    a From 2015...... 0
    b From 2016...... 0
    c From 2017...... 0
    d From 2018...... 0
    e From 2019...... 0
    fTotal of lines 3a through e........ 0
    4Qualifying distributions for 2020 from Part
    XII, line 4: bullet$ 30,809
    a Applied to 2019, but not more than line 2a 14,632
    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..... 16,177
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2020. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2020. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2021 ..........     		16,117
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		0
    8 Excess distributions carryover from 2015 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2021.
    Subtract lines 7 and 8 from line 6a ......     		0
    10 Analysis of line 9:
    a Excess from 2016.... 0
    b Excess from 2017.... 0
    c Excess from 2018.... 0
    d Excess from 2019.... 0
    e Excess from 2020.... 0
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 10
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2020, enter the date of the ruling....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2020 (b) 2019 (c) 2018 (d) 2017
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    NONE
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    NONE
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 11
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    RICHARD VAUS IVANHOE LODGE 384
    1422 BRIGHTON STREET
    PHILADELPHIA,PA19111     		NONE NC CHARITABLE WORK AND PURPOSE 28,800
    Total .................................bullet 3a 28,800
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3 Interest on savings and temporary cash
    investments ...........     		         
    4 Dividends and interest from securities....     14 18,596  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6 Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8 Gain or (loss) from sales of assets other than
    inventory ............     		    18 20,292  
    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)..   38,888  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    38,888
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 13
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
    Yes
     
    (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
    1a(1) 28,800 RICHARD VAUS IVANHOE LODGE 384 CHARITABLE WORK AND PURPOSE
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below?
    See instructions.
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


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


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2020 AccountingFeesSchedule
    Name:
    SUSANNA ANGUE POULSON FUND
    EIN:
    23-6933346
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEE (NON-ALLOC 958     958

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

    TY 2020 ExpenditureResponsibilityStmt
    Name:
    SUSANNA ANGUE POULSON FUND
    EIN:
    23-6933346
    Grantee's Name Grantee's Address Grant Date Grant Amount Grant Purpose Amount Expended By Grantee Any Diversion By Grantee? Dates of Reports By Grantee Date of Verification Results of Verification
    RICHARD VAUS IVANHOE LODGE 384
          		1422 BRIGHTON ST
    PHILADELPHIA,PA19111     		2020-12-28 28,800 CHARITABLE WORK AND PURPOSES 28,800 TO THE FDNS KNOWLEDGE, NO FUNDS HAVE BEEN DIVERTED 9/17/2021    

    TY 2020 InvestmentsCorpStockSchedule
    Name:
    SUSANNA ANGUE POULSON FUND
    EIN:
    23-6933346
    Name of Stock End of Year Book Value End of Year Fair Market Value
    02079K107 ALPHABET INC CL C 5,236 12,263
    75513E101 RAYTHEON TECHNOLOGIE 2,483 2,145
    150870103 CELANESE CORP 2,202 4,678
    172967424 CITIGROUP INC. 5,745 6,659
    031162100 AMGEN INC 2,216 2,069
    11135F101 BROADCOM INC 4,720 7,443
    Y2573F102 FLEX LTD 1,719 3,308
    037833100 APPLE INC 4,226 18,046
    254687106 WALT DISNEY CO 2,609 5,254
    532457108 ELI LILLY & CO COM 2,131 4,221
    871829107 SYSCO CORP 2,870 4,530
    883556102 THERMO FISHER SCIENT 1,691 4,658
    911312106 UNITED PARCEL SERVIC 2,653 4,715
    517834107 LAS VEGAS SANDS CORP 4,574 5,483
    92826C839 VISA INC-CLASS A SHR 3,120 4,156
    097023105 BOEING CO 3,301 3,639
    192446102 COGNIZANT TECH SOLUT 2,758 4,261
    285512109 ELECTRONIC ARTS INC 3,517 5,600
    126650100 CVS HEALTH CORPORATI 3,100 3,552
    94106L109 WASTE MANAGEMENT INC 3,255 3,892
    867224107 SUNCOR ENERGY INC NE 3,086 1,946
    G5960L103 MEDTRONIC PLC 3,684 4,334
    907818108 UNION PACIFIC CORP 2,604 5,622
    09260D107 BLACKSTONE GROUP INC 3,095 3,759
    609207105 MONDELEZ INTERNATION 3,146 4,268
    17275R102 CISCO SYSTEMS INC 3,802 5,370
    594918104 MICROSOFT CORP 4,454 18,016
    654106103 NIKE INC CL B 2,435 5,517
    56501R106 MANULIFE FINANCIAL C 3,981 4,740
    58933Y105 MERCK & CO INC NEW 3,503 4,335
    H84989104 TE CONNECTIVITY LTD 1,826 3,390
    00206R102 AT & T INC 4,943 4,372
    25243Q205 DIAGEO PLC - ADR 3,327 4,288
    512807108 LAM RESEARCH CORP CO 1,936 4,723
    87612E106 TARGET CORP 2,045 5,296
    91324P102 UNITEDHEALTH GROUP I 2,817 8,416
    405217100 HAIN CELESTIAL GROUP 1,329 2,449
    31620M106 FIDELITY NATL INFORM 3,072 3,537
    891160509 TORONTO DOMINION BK 4,359 4,344
    89151E109 TOTAL S.A. - ADR 3,779 3,227
    904767704 UNILEVER PLC - ADR 2,477 2,656
    09247X101 BLACKROCK INC 2,847 5,772
    09857L108 BOOKING HOLDINGS INC 1,349 2,227
    46625H100 JPMORGAN CHASE & CO 4,464 7,243

    TY 2020 InvestmentsOtherSchedule2
    Name:
    SUSANNA ANGUE POULSON FUND
    EIN:
    23-6933346
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    00206R102 AT & T INC      
    097023105 BOEING COMPANY      
    512807108 LAM RESEARCH CORP CO      
    91324P102 UNITEDHEALTH GROUP I      
    77956H435 T ROWE PR OVERSEAS S AT COST 18,789 22,550
    339128100 JP MORGAN MID CAP VA      
    02079K107 ALPHABET INC/CA      
    H84989104 TE CONNECTIVITY LTD      
    609207105 MONDELEZ INTERNATION      
    037833100 APPLE COMPUTER INC C      
    192446102 COGNIZANT TECH SOLUT      
    254687106 WALT DISNEY CO      
    437076102 HOME DEPOT INC      
    654106103 NIKE INC CL B      
    Y2573F102 FLEXTRONICS INTL LTD      
    126650100 CVS/CAREMARK CORPORA      
    594918104 MICROSOFT CORP      
    89151E109 TOTAL FINA ELF S.A.      
    907818108 UNION PACIFIC CORP      
    26875P101 EOG RESOURCES, INC      
    56501R106 MANULIFE FINANCIAL C      
    87612E106 TARGET CORP      
    150870103 CELANESE CORP      
    592905764 METROPOLITAN WEST T/ AT COST 61,200 64,049
    848574109 SPIRIT AEROSYTSEMS H      
    98978V103 ZOETIS INC      
    867224107 SUNCOR ENERGY INC NE      
    779919307 T ROWE PR REAL ESTAT      
    46434G103 ISHARES CORE MSCI EM      
    78463X863 SPDR DJ WILSHIRE INT      
    17275R102 CISCO SYSTEMS INC      
    532457108 ELI LILLY & CO COM      
    883556102 THERMO FISHER SCIENT      
    911312106 UNITED PARCEL SERVIC      
    172967424 CITIGROUP INC      
    277923264 EATON VANCE GLOB MAC      
    12572Q105 CME GROUP INC      
    872540109 TJX COS INC NEW      
    405217100 HAIN CELESTIAL GROUP      
    09247X101 BLACKROCK INC      
    58933Y105 MERCK & CO INC NEW      
    517834107 LAS VEGAS SANDS CORP      
    G29183103 EATON CORP PLC      
    693475105 PNC FINANCIAL SERVIC      
    85917K546 STERLING CAPITAL STR      
    25243Q205 DIAGEO PLC - ADR      
    04314H600 ARTISAN MID CAP FUND AT COST 16,897 23,306
    025083320 AMER CENT SMALL CAP      
    87234N765 TCW EMRG MKTS INCM-I AT COST 27,951 29,861
    375558103 GILEAD SCIENCES INC      
    46625H100 JPMORGAN CHASE & CO      
    00143W859 INV OPP DEVELOP MRKT AT COST 18,511 30,461
    922908629 VANGUARD MIDCAP VIPE AT COST 37,574 52,313
    693390841 PIMCO HIGH YIELD FD-      
    G5960L103 MEDTRONIC PLC      
    755111507 RAYTHEON CO      
    31620M106 FIDELITY NATL INFORM      
    11135F101 BROADCOM INC      
    31641Q755 FIDELITY NEW MRKTS I AT COST 14,762 15,016
    285512109 ELECTRONIC ARTS INC      
    693390700 PIMCO TOTAL RET FD-I AT COST 34,304 35,838
    891160509 TORONTO DOMINION BK      
    46090F100 INVESCO OPTIMUM YIEL AT COST 12,072 15,504
    89609H704 TRIBUTARY SMALL CO-I AT COST 10,134 15,221
    89154Q562 TOUCHSTONE SANDS EM AT COST 22,213 23,043
    74440Y884 PGIM HIGH YIELD-Q 10 AT COST 75,828 81,595
    464287655 ISHARES RUSSELL 2000 AT COST 23,737 30,781
    89155T649 TOUCHSTONE MID CAP-I AT COST 34,712 44,039
    27830W108 EV GL MACR ABS RTRN AT COST 14,377 14,036

    TY 2020 OtherDecreasesSchedule
    Name:
    SUSANNA ANGUE POULSON FUND
    EIN:
    23-6933346
    Description Amount
    MUTUAL FUND TIMING ADJ 82
    TAX LOT BASIS ADJ 102
    COST BASIS ADJUSTMENT 32


    TY 2020 OtherExpensesSchedule
    Name:
    SUSANNA ANGUE POULSON FUND
    EIN:
    23-6933346
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT EXPENSES - ADR FEES 4 4   0


    TY 2020 TaxesSchedule
    Name:
    SUSANNA ANGUE POULSON FUND
    EIN:
    23-6933346
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 274 274   0
    FEDERAL ESTIMATES - PRINCIPAL 364 0   0
    FOREIGN TAXES ON NONQUALIFIED 15 15   0