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. 1545-0047
2021
Open to Public Inspection
For calendar year 2021, or tax year beginning 01-01-2021 , and ending 12-31-2021
Name of foundation
ADRIAN H JACKSON CHARITABLE TRUST
 
Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 185
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
PITTSBURGH, PA152300185
A Employer identification number

13-6078615
B Telephone number (see instructions)

(412) 234-5565
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$7,302,915
J 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... 168,436 168,029  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 664,740
b Gross sales price for all assets on line 6a 1,940,611
7 Capital gain net income (from Part IV, line 2)... 664,740
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)....... 3,556    
12 Total. Add lines 1 through 11........ 836,732 832,769  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 45,768 27,461   18,307
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).......        
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... 5,253 3,769   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)....... 250     250
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 51,271 31,230 0 18,557
25 Contributions, gifts, grants paid....... 331,938 331,938
26 Total expenses and disbursements. Add lines 24 and 25 383,209 31,230 0 350,495
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 453,523
b Net investment income (if negative, enter -0-) 801,539
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2021)
Form 990-PF (2021)
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......... 20,031 75,342 75,342
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).......      
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).......... 5,139,572 Click to see attachment5,537,650 7,227,573
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) 5,159,603 5,612,992 7,302,915
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........ 5,159,603 5,612,992
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)..... 5,159,603 5,612,992
30 Total liabilities and net assets/fund balances (see instructions). 5,159,603 5,612,992
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
5,159,603
2
Enter amount from Part I, line 27a .....................
2
453,523
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
5,613,126
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
134
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
5,612,992
Form 990-PF (2021)
Form 990-PF (2021)
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 31. J P MORGAN CHASE & CO   2017-11-20 2021-01-07
b 70. TRUIST FINL CORP   2019-11-06 2021-01-07
c 47. DISNEY (WALT) COMPANY HOLDING CO.     2021-01-15
d 7. NVIDIA CORP   2020-01-09 2021-01-21
e 12. SQUARE INC - A   2019-04-11 2021-01-21
110. BRISTOL MYERS SQUIBB CO COM     2021-01-27
140. COMCAST CORP NEW CL A     2021-01-27
90. COCA-COLA CO USD   2019-08-08 2021-02-03
140. PFIZER INC COM   2020-05-04 2021-02-03
230. PFIZER INC COM     2021-02-03
22. PROCTER & GAMBLE CO COM   2018-12-06 2021-02-03
27. APPLE COMPUTER INC COM   2018-08-15 2021-02-04
52. CELANESE CORP DEL   2011-01-12 2021-02-04
7. MICROSOFT CORP COM   2018-04-20 2021-02-04
17. SQUARE INC - A   2019-04-11 2021-02-04
26. DEERE & COMPANY   2017-06-16 2021-02-05
55. TRANE TECHNOLOGIES PLC   2012-02-16 2021-02-05
17. MICROSOFT CORP COM   2018-04-20 2021-02-08
16. SQUARE INC - A   2019-04-11 2021-02-08
390. PFIZER INC COM     2021-02-09
51. APPLE COMPUTER INC COM   2018-08-15 2021-02-11
40. SCHWAB CHARLES CORP NEW   2020-08-04 2021-02-19
300. SCHWAB CHARLES CORP NEW     2021-02-19
64. APPLE COMPUTER INC COM   2018-08-15 2021-02-23
45. APPLE COMPUTER INC COM   2018-08-15 2021-02-25
21. PAYPAL HOLDINGS INC   2019-04-11 2021-02-25
61. DOLLAR GENERAL CORP     2021-03-01
13. NVIDIA CORP   2020-01-09 2021-03-01
11. CHARTER COMMUNICATIONS INC-A   2020-02-03 2021-03-04
11. CHARTER COMMUNICATIONS INC-A   2020-02-03 2021-03-05
21. COSTCO WHSL CORP NEW     2021-03-05
26. NVIDIA CORP     2021-03-05
14. O'REILLY AUTOMOTIVE INC     2021-03-05
111. APPLE COMPUTER INC COM   2018-08-15 2021-03-08
53. PROCTER & GAMBLE CO COM     2021-03-11
25. AMERICAN TOWER CORP-CL A   2018-04-11 2021-03-15
20. EQUINIX INC     2021-03-15
150. NEXTERA ENERGY INC     2021-03-16
17. O'REILLY AUTOMOTIVE INC     2021-03-16
5119.454 BNY MELLON INCOME STK FD CL M   2019-05-06 2021-03-17
8017.103 BNY MELLON FOCUSED EQUITY OPP-M     2021-03-17
2862.176 BNY MELLON MID CAP STK FD CL M   2010-05-13 2021-03-17
2627.258 BNY MELLON HIGH YIELD-I   2009-08-28 2021-03-17
214.592 BNYM GLBL RL EST SEC-Y   2020-08-03 2021-03-17
970.874 BNYM INTL SMALL CAP-Y   2019-05-06 2021-03-17
1484.23 VAN ECK CM COMMODITY INDX-I   2020-08-04 2021-03-17
56. OTIS WORLDWIDE CORP   2019-10-21 2021-03-25
64. OTIS WORLDWIDE CORP   2020-04-08 2021-03-25
170. BANK AMER CORP   2015-02-25 2021-04-06
11. CHARTER COMMUNICATIONS INC-A   2020-02-03 2021-04-16
320. MONDELEZ INTERNATIONAL INC     2021-04-16
20. PROCTER & GAMBLE CO COM   2019-01-02 2021-04-16
96. OTIS WORLDWIDE CORP   2020-04-08 2021-04-20
30. OTIS WORLDWIDE CORP   2020-08-04 2021-04-20
65. YUM BRANDS INC     2021-04-26
70. AMERICAN INTERNATIONAL GROUP   2018-12-19 2021-04-29
100. SYNCHRONY FINANCIAL   2017-05-22 2021-04-29
52. PROCTER & GAMBLE CO COM     2021-05-04
56. NIKE INC CL B     2021-05-07
19. THERMO ELECTRON CORP   2019-02-28 2021-05-14
5. ABBOTT LABORATORIES   2017-01-31 2021-05-19
5. ABBVIE INC   2019-09-20 2021-05-19
1. ADOBE SYS INC COM   2017-04-05 2021-05-19
10. ADVANCED MICRO DEVICES INC   2019-02-19 2021-05-19
2. AIR PRODUCTS AND CHEMICALS INC COMMON   2020-01-10 2021-05-19
1. ALPHABET INC/CA   2015-08-11 2021-05-19
20. AMERICAN INTERNATIONAL GROUP   2018-12-19 2021-05-19
1. AMERICAN TOWER CORP-CL A   2018-04-11 2021-05-19
2. AMERIPRISE FINL INC   2021-02-19 2021-05-19
21. APPLE COMPUTER INC COM   2018-08-15 2021-05-19
3927.764 BNY MELLON FOCUSED EQUITY OPP-M     2021-05-19
856.935 BNY MELLON FOCUSED EQUITY OPP-M   2020-12-10 2021-05-19
435.35 BNY MELLON MID CAP STK FD CL M   2010-05-13 2021-05-19
513.347 BNYM GLBL RL EST SEC-Y   2020-08-03 2021-05-19
20. BANK AMER CORP   2015-02-25 2021-05-19
9613.138 BNYM INTL SMALL CAP-Y     2021-05-19
4068.348 BNYM INTL SMALL CAP-Y   2020-08-03 2021-05-19
20. BOSTON SCIENTIFIC CORP COM   2018-10-18 2021-05-19
3. CME GROUP INC   2019-03-04 2021-05-19
10. CSX CORP COM   2017-01-13 2021-05-19
10. CVS CORP   2019-01-07 2021-05-19
5. CELANESE CORP DEL   2011-01-12 2021-05-19
7. CHEVRONTEXACO CORP   2016-03-03 2021-05-19
10. COCA-COLA CO USD   2019-08-08 2021-05-19
20. COMCAST CORP NEW CL A   2018-11-12 2021-05-19
2. CROWDSTRIKE HOLDINGS INC - A   2020-05-14 2021-05-19
3. DANAHER CORP COMMON   2021-02-03 2021-05-19
3. DEERE & COMPANY   2017-06-16 2021-05-19
2. DISNEY (WALT) COMPANY HOLDING CO.   2017-12-15 2021-05-19
1. EQUINIX INC   2018-04-11 2021-05-19
3. F M C CORP COM NEW   2020-07-15 2021-05-19
6. FACEBOOK INC   2015-05-04 2021-05-19
10. GENERAL MOTORS CO   2021-03-25 2021-05-19
3. HOME DEPOT INC USD 0.05   2017-09-14 2021-05-19
5. HONEYWELL INTL INC   2011-01-12 2021-05-19
4. ILLINOIS TOOL WORKS INC COM   2014-08-15 2021-05-19
1. INTUIT INC COM   2019-11-15 2021-05-19
8. J P MORGAN CHASE & CO   2017-11-20 2021-05-19
2. KLA TENCOR CORP   2019-10-24 2021-05-19
1. ESTEE LAUDER COMPANIES INC CL A   2021-04-16 2021-05-19
3. ELI LILLY & CO COM   2020-06-23 2021-05-19
13. MICROSOFT CORP COM   2018-04-20 2021-05-19
20. MICRON TECHNOLOGY     2021-05-19
1. NETFLIX COM INC   2019-03-20 2021-05-19
4. NIKE INC CL B   2018-02-14 2021-05-19
1. NVIDIA CORP   2020-01-15 2021-05-19
4. PAYPAL HOLDINGS INC   2019-04-11 2021-05-19
10. PHILIP MORRIS INTERNATIONAL     2021-05-19
4. PIONEER NAT RES CO   2015-10-07 2021-05-19
2. PROCTER & GAMBLE CO COM   2019-04-30 2021-05-19
2. S & P GLOBAL INC   2019-06-05 2021-05-19
1. SALESFORCE COM INC   2019-01-07 2021-05-19
1. SEMPRA ENERGY   2020-01-31 2021-05-19
1. SIMON PPTY GROUP INC NEW   2021-03-15 2021-05-19
2. SKYWORKS SOLUTIONS INC   2020-07-16 2021-05-19
3. SQUARE INC - A   2019-04-11 2021-05-19
20. SYNCHRONY FINANCIAL     2021-05-19
3. T -MOBILE US INC   2017-09-11 2021-05-19
6. TEXAS INSTRUMENTS INC   2018-11-02 2021-05-19
1. TRADE DESK INC/THE   2020-03-09 2021-05-19
20. TRUIST FINL CORP   2019-11-06 2021-05-19
3. UNITED HEALTH GROUP INC   2016-10-19 2021-05-19
959.861 VAN ECK CM COMMODITY INDX-I   2020-08-04 2021-05-19
8. VISA INC   2015-10-20 2021-05-19
10. VOYA FINANCIAL INC     2021-05-19
2. YUM BRANDS INC   2018-06-29 2021-05-19
2. ATLASSIAN CORP PLC-CLASS A   2018-04-20 2021-05-19
7. EATON CORP PLC   2012-11-30 2021-05-19
10. HORIZON THERAPEUTICS PUB LTD CO   2020-10-30 2021-05-19
7. MEDTRONIC PLC   2018-06-12 2021-05-19
4. TRANE TECHNOLOGIES PLC   2012-02-16 2021-05-19
145. APPLE COMPUTER INC COM     2021-05-26
20. DEERE & COMPANY   2017-06-16 2021-05-27
23. O'REILLY AUTOMOTIVE INC     2021-05-27
97. ABBOTT LABORATORIES     2021-06-01
113. APPLE COMPUTER INC COM     2021-06-14
38. ELI LILLY & CO COM   2020-06-23 2021-06-14
39. TEXAS INSTRUMENTS INC     2021-06-14
20. YUM BRANDS INC   2020-08-04 2021-06-14
85. YUM BRANDS INC     2021-06-14
160. LAS VEGAS SANDS CORP   2020-09-02 2021-06-15
270. LAS VEGAS SANDS CORP     2021-06-23
50. LUMENTUM HOLDINGS INC   2020-02-24 2021-06-24
16. TEXAS INSTRUMENTS INC   2019-08-07 2021-06-24
46. HOME DEPOT INC USD 0.05     2021-07-06
110. BANK AMER CORP   2015-02-25 2021-07-16
30. J P MORGAN CHASE & CO   2017-11-20 2021-07-16
30. VISA INC   2015-10-20 2021-07-29
70. MONDELEZ INTERNATIONAL INC   2018-07-31 2021-07-30
50. MONDELEZ INTERNATIONAL INC     2021-07-30
71. PHILIP MORRIS INTERNATIONAL     2021-07-30
190. MONDELEZ INTERNATIONAL INC     2021-08-04
123. F M C CORP COM NEW     2021-08-05
40. MICRON TECHNOLOGY   2019-02-13 2021-08-11
11. SQUARE INC - A   2019-04-11 2021-08-11
140. VALERO ENERGY CORP NEW     2021-08-11
46. HOME DEPOT INC USD 0.05     2021-08-17
53. NIKE INC CL B   2018-02-14 2021-08-19
140. COCA-COLA CO USD     2021-08-27
3. ABBOTT LABORATORIES   2019-01-24 2021-09-16
8. ABBVIE INC   2019-09-20 2021-09-16
1. ADOBE SYS INC COM   2017-04-05 2021-09-16
8. ADVANCED MICRO DEVICES INC   2019-02-19 2021-09-16
3. AIR PRODUCTS AND CHEMICALS INC COMMON   2020-01-10 2021-09-16
1. ALPHABET INC/CA   2015-08-11 2021-09-16
10. AMERICAN INTERNATIONAL GROUP   2018-12-19 2021-09-16
1. AMERICAN TOWER CORP-CL A   2018-04-11 2021-09-16
2. AMERIPRISE FINL INC   2021-02-19 2021-09-16
15. APPLE COMPUTER INC COM   2019-08-01 2021-09-16
407.83 BNY MELLON MID CAP STK FD CL M   2010-05-13 2021-09-16
3230.438 BNY MELLON EMERGING MKTS FD CL M SHS   2010-05-13 2021-09-16
10. BANK AMER CORP   2015-02-25 2021-09-16
10. BOSTON SCIENTIFIC CORP COM   2018-10-18 2021-09-16
10. BRISTOL MYERS SQUIBB CO COM   2015-01-08 2021-09-16
3. CME GROUP INC   2019-03-04 2021-09-16
10. CSX CORP COM   2017-01-13 2021-09-16
5. CELANESE CORP DEL   2011-01-12 2021-09-16
10. CENTENE CORP DEL   2020-01-23 2021-09-16
1. CHARTER COMMUNICATIONS INC-A   2020-03-03 2021-09-16
10. CHEVRONTEXACO CORP   2016-03-03 2021-09-16
10. COCA-COLA CO USD   2019-08-15 2021-09-16
10. COMCAST CORP NEW CL A   2018-11-12 2021-09-16
1. COSTCO WHSL CORP NEW   2017-06-29 2021-09-16
3. CROWDSTRIKE HOLDINGS INC - A   2020-05-14 2021-09-16
3. DANAHER CORP COMMON   2021-02-03 2021-09-16
2. DEERE & COMPANY   2017-06-16 2021-09-16
2. DISNEY (WALT) COMPANY HOLDING CO.   2017-12-15 2021-09-16
10. EXELON CORP   2018-11-12 2021-09-16
6. FACEBOOK INC     2021-09-16
10. GENERAL MOTORS CO   2021-03-25 2021-09-16
1. HOME DEPOT INC USD 0.05   2020-03-04 2021-09-16
4. HONEYWELL INTL INC   2011-01-12 2021-09-16
3. ILLINOIS TOOL WORKS INC COM   2014-08-15 2021-09-16
1. INTUIT INC COM   2019-11-15 2021-09-16
6. J P MORGAN CHASE & CO   2017-11-20 2021-09-16
3. KLA TENCOR CORP   2019-10-24 2021-09-16
2. ESTEE LAUDER COMPANIES INC CL A   2021-04-16 2021-09-16
1. ELI LILLY & CO COM   2020-06-23 2021-09-16
10. LIVE NATION INC   2021-03-01 2021-09-16
13. MICROSOFT CORP COM   2018-04-20 2021-09-16
10. MICRON TECHNOLOGY   2019-02-13 2021-09-16
3. NIKE INC CL B   2018-02-14 2021-09-16
6. NVIDIA CORP   2020-01-15 2021-09-16
4. PAYPAL HOLDINGS INC     2021-09-16
5. PHILIP MORRIS INTERNATIONAL   2017-05-12 2021-09-16
4. PIONEER NAT RES CO   2015-10-07 2021-09-16
3. PROCTER & GAMBLE CO COM   2019-04-30 2021-09-16
2. S & P GLOBAL INC   2019-06-05 2021-09-16
2. SALESFORCE COM INC   2019-01-07 2021-09-16
3. SEMPRA ENERGY   2020-01-31 2021-09-16
5. SIMON PPTY GROUP INC NEW   2021-03-15 2021-09-16
2. SKYWORKS SOLUTIONS INC   2020-07-16 2021-09-16
2. SQUARE INC - A   2019-04-11 2021-09-16
20. SYNCHRONY FINANCIAL   2018-08-01 2021-09-16
2. T -MOBILE US INC   2017-09-11 2021-09-16
1. TESLA MOTORS INC   2021-08-11 2021-09-16
4. TEXAS INSTRUMENTS INC   2019-08-07 2021-09-16
10. TRADE DESK INC/THE   2020-03-09 2021-09-16
1. THERMO ELECTRON CORP   2019-02-28 2021-09-16
10. TRUIST FINL CORP   2019-11-06 2021-09-16
3. UNITED HEALTH GROUP INC     2021-09-16
5. VISA INC   2015-10-20 2021-09-16
10. VOYA FINANCIAL INC   2015-10-22 2021-09-16
2. ATLASSIAN CORP PLC-CLASS A   2018-04-20 2021-09-16
5. EATON CORP PLC   2012-11-30 2021-09-16
8. MEDTRONIC PLC   2018-06-12 2021-09-16
5. TRANE TECHNOLOGIES PLC   2012-02-16 2021-09-16
51. APPLE COMPUTER INC COM   2019-08-01 2021-09-20
270. BRISTOL MYERS SQUIBB CO COM     2021-09-20
110. PROCTER & GAMBLE CO COM     2021-09-27
42. FACEBOOK INC   2015-06-02 2021-09-30
38. TEXAS INSTRUMENTS INC     2021-09-30
90. PHILIP MORRIS INTERNATIONAL     2021-10-05
39. SEMPRA ENERGY   2021-03-16 2021-10-07
105. SEMPRA ENERGY     2021-10-07
210. COMCAST CORP NEW CL A     2021-10-11
77. TEXAS INSTRUMENTS INC     2021-10-13
97. DISNEY (WALT) COMPANY HOLDING CO.     2021-10-18
52. APPLE COMPUTER INC COM   2019-08-01 2021-10-25
37. LUMENTUM HOLDINGS INC   2020-02-28 2021-10-25
50. LUMENTUM HOLDINGS INC     2021-10-26
98. FACEBOOK INC     2021-10-27
63. LUMENTUM HOLDINGS INC     2021-10-27
55. TEXAS INSTRUMENTS INC     2021-10-27
57. ADVANCED MICRO DEVICES INC     2021-11-05
190. BOSTON SCIENTIFIC CORP COM     2021-11-05
130. COCA-COLA CO USD     2021-11-05
66. MEDTRONIC PLC     2021-11-05
66. MEDTRONIC PLC     2021-11-15
272. VISA INC     2021-11-19
13. BOOKING HOLDINGS INC     2021-11-22
69. MEDTRONIC PLC     2021-11-23
110. AMERICAN INTERNATIONAL GROUP     2021-11-24
56. EATON CORP PLC   2012-11-30 2021-11-24
48. TRANE TECHNOLOGIES PLC   2012-02-16 2021-11-24
90. COMCAST CORP NEW CL A   2021-03-05 2021-11-26
30. COMCAST CORP NEW CL A   2020-08-04 2021-11-26
37. NIKE INC CL B   2018-02-14 2021-11-26
164. PHILIP MORRIS INTERNATIONAL     2021-12-03
280. COMCAST CORP NEW CL A     2021-12-20
55. SALESFORCE COM INC     2021-12-20
73. MEDTRONIC PLC     2021-12-20
2. MEDTRONIC PLC   2021-03-05 2021-12-20
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CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
(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 4,232   3,069 1,163
b 3,608   3,844 -236
c 8,032   4,739 3,293
d 3,803   1,707 2,096
e 2,629   908 1,721
6,845   6,011 834
6,835   5,178 1,657
4,394   4,825 -431
4,877   5,012 -135
8,012   8,943 -931
2,826   2,023 803
3,654   1,412 2,242
6,546   2,254 4,292
1,685   668 1,017
3,997   1,286 2,711
8,046   3,327 4,719
8,228   1,360 6,868
4,106   1,623 2,483
4,131   1,210 2,921
13,573   13,839 -266
6,842   2,667 4,175
2,469   1,341 1,128
18,520   9,639 8,881
7,915   3,346 4,569
5,515   2,353 3,162
5,360   2,247 3,113
11,656   9,402 2,254
7,108   3,169 3,939
6,753   5,891 862
6,782   5,891 891
6,478   3,363 3,115
12,399   6,358 6,041
6,351   5,399 952
13,054   5,804 7,250
6,743   4,844 1,899
5,401   3,516 1,885
13,408   8,628 4,780
11,332   6,520 4,812
8,207   6,742 1,465
49,300   45,000 4,300
150,000   118,680 31,320
65,000   30,282 34,718
16,000   15,974 26
2,000   1,652 348
15,000   13,000 2,000
8,000   6,189 1,811
3,764   3,982 -218
4,302   2,769 1,533
6,743   2,805 3,938
7,054   5,891 1,163
18,800   13,458 5,342
2,745   1,815 930
6,792   4,153 2,639
2,122   1,875 247
7,534   4,508 3,026
3,413   2,774 639
4,403   2,686 1,717
7,024   4,842 2,182
7,712   3,606 4,106
8,733   4,935 3,798
580   208 372
577   363 214
477   131 346
755   244 511
595   469 126
2,258   694 1,564
1,007   792 215
244   141 103
501   447 54
2,601   1,098 1,503
75,806   58,412 17,394
16,539   14,816 1,723
10,000   4,606 5,394
5,000   3,953 1,047
831   330 501
155,541   129,000 26,541
65,826   50,000 15,826
822   751 71
632   543 89
981   387 594
885   689 196
821   217 604
715   607 108
538   536 2
1,074   766 308
395   154 241
742   721 21
1,064   384 680
336   222 114
712   410 302
347   322 25
1,871   473 1,398
551   548 3
936   480 456
1,097   260 837
924   347 577
417   265 152
1,279   792 487
603   335 268
297   312 -15
588   482 106
3,134   1,241 1,893
1,587   801 786
485   374 111
529   271 258
555   245 310
970   428 542
960   819 141
604   540 64
272   212 60
737   440 297
220   143 77
135   160 -25
121   121  
331   263 68
594   227 367
908   562 346
402   189 213
1,082   571 511
504   222 282
1,193   1,098 95
1,219   437 782
5,500   4,003 1,497
1,788   611 1,177
656   402 254
237   157 80
431   116 315
996   256 740
918   746 172
877   606 271
712   99 613
18,416   7,742 10,674
7,197   2,559 4,638
12,209   10,766 1,443
10,356   6,399 3,957
14,618   6,301 8,317
8,551   6,101 2,450
7,357   4,392 2,965
2,355   1,812 543
10,008   7,956 2,052
8,614   8,104 510
14,362   13,375 987
4,089   4,021 68
3,006   1,926 1,080
14,679   8,472 6,207
4,213   1,815 2,398
4,576   2,970 1,606
7,458   2,292 5,166
4,429   3,029 1,400
3,163   2,787 376
7,080   6,363 717
11,739   11,765 -26
11,490   13,142 -1,652
2,970   1,669 1,301
2,984   832 2,152
9,222   7,714 1,508
14,708   10,674 4,034
8,762   3,596 5,166
7,786   7,518 268
382   211 171
866   581 285
665   131 534
852   195 657
802   704 98
2,876   694 2,182
545   396 149
298   141 157
545   447 98
2,230   814 1,416
10,000   4,315 5,685
45,000   32,014 12,986
407   165 242
450   375 75
613   609 4
568   543 25
309   129 180
769   217 552
617   674 -57
768   499 269
977   868 109
555   538 17
576   383 193
462   159 303
790   231 559
971   721 250
713   256 457
367   222 145
505   460 45
2,238   475 1,763
517   548 -31
337   234 103
882   208 674
656   260 396
574   265 309
953   594 359
1,119   503 616
649   625 24
231   161 70
871   932 -61
3,956   1,241 2,715
748   417 331
474   204 270
1,334   368 966
1,133   433 700
516   556 -40
630   540 90
434   318 116
909   440 469
520   286 234
408   480 -72
666   604 62
357   263 94
509   151 358
979   587 392
259   126 133
757   707 50
788   481 307
732   222 510
559   260 299
556   549 7
1,252   477 775
1,122   382 740
630   407 223
804   116 688
798   183 615
1,050   692 358
930   124 806
7,272   2,769 4,503
16,298   14,580 1,718
15,597   13,041 2,556
14,290   3,385 10,905
7,324   4,465 2,859
8,670   8,612 58
4,906   5,116 -210
13,207   16,387 -3,180
11,112   8,574 2,538
14,422   9,677 4,745
16,561   11,092 5,469
7,728   2,823 4,905
3,030   2,826 204
4,066   4,048 18
30,899   13,340 17,559
5,105   5,208 -103
10,219   7,126 3,093
7,883   1,507 6,376
8,233   6,892 1,341
7,381   7,078 303
8,165   5,812 2,353
7,824   6,447 1,377
54,745   31,343 23,402
30,008   30,634 -626
7,816   7,280 536
6,382   4,409 1,973
9,566   2,045 7,521
9,369   1,187 8,182
4,600   4,894 -294
1,533   1,286 247
6,226   2,511 3,715
14,501   13,403 1,098
13,482   15,413 -1,931
13,621   8,729 4,892
7,254   7,196 58
199   232 -33
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
      131,190
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       1,163
b       -236
c       3,293
d       2,096
e       1,721
      834
      1,657
      -431
      -135
      -931
      803
      2,242
      4,292
      1,017
      2,711
      4,719
      6,868
      2,483
      2,921
      -266
      4,175
      1,128
      8,881
      4,569
      3,162
      3,113
      2,254
      3,939
      862
      891
      3,115
      6,041
      952
      7,250
      1,899
      1,885
      4,780
      4,812
      1,465
      4,300
      31,320
      34,718
      26
      348
      2,000
      1,811
      -218
      1,533
      3,938
      1,163
      5,342
      930
      2,639
      247
      3,026
      639
      1,717
      2,182
      4,106
      3,798
      372
      214
      346
      511
      126
      1,564
      215
      103
      54
      1,503
      17,394
      1,723
      5,394
      1,047
      501
      26,541
      15,826
      71
      89
      594
      196
      604
      108
      2
      308
      241
      21
      680
      114
      302
      25
      1,398
      3
      456
      837
      577
      152
      487
      268
      -15
      106
      1,893
      786
      111
      258
      310
      542
      141
      64
      60
      297
      77
      -25
       
      68
      367
      346
      213
      511
      282
      95
      782
      1,497
      1,177
      254
      80
      315
      740
      172
      271
      613
      10,674
      4,638
      1,443
      3,957
      8,317
      2,450
      2,965
      543
      2,052
      510
      987
      68
      1,080
      6,207
      2,398
      1,606
      5,166
      1,400
      376
      717
      -26
      -1,652
      1,301
      2,152
      1,508
      4,034
      5,166
      268
      171
      285
      534
      657
      98
      2,182
      149
      157
      98
      1,416
      5,685
      12,986
      242
      75
      4
      25
      180
      552
      -57
      269
      109
      17
      193
      303
      559
      250
      457
      145
      45
      1,763
      -31
      103
      674
      396
      309
      359
      616
      24
      70
      -61
      2,715
      331
      270
      966
      700
      -40
      90
      116
      469
      234
      -72
      62
      94
      358
      392
      133
      50
      307
      510
      299
      7
      775
      740
      223
      688
      615
      358
      806
      4,503
      1,718
      2,556
      10,905
      2,859
      58
      -210
      -3,180
      2,538
      4,745
      5,469
      4,905
      204
      18
      17,559
      -103
      3,093
      6,376
      1,341
      303
      2,353
      1,377
      23,402
      -626
      536
      1,973
      7,521
      8,182
      -294
      247
      3,715
      1,098
      -1,931
      4,892
      58
      -33
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
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 2 664,740
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  
Form 990-PF (2021)
Form 990-PF (2021)
Page 4
Part V
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 All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) 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 11,141
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 11,141
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 2,970
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 2,970
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 8,171
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet0 RefundedBullet 11 0
Part VI-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 XIV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletNY
    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 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
    If "Yes," complete Part XIII .............................
    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 (2021)
    Form 990-PF (2021)
    Page 5
    Part VI-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 ofbulletBNY MELLON NA Telephone no.bullet (412) 234-5565

    Located atbulletPO BOX 185PITTSBURGHPA ZIP+4bullet152300185
    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 2021, 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 VI-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? ...........
    1a(1)
     
    No
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person? ..............................
    1a(2)
     
    No
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
    1a(3)
     
    No
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
    Yes
     
    (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)? ......................
    1a(5)
     
    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.) ...............
    1a(6)
     
    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
     
    No
    c
    ........bullet
    d
    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 2021? .............
    1d
     
    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 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    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? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 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 2021.) .....................
    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 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-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))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    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? .............
    5a(5)
     
    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
     
     
    c
    .........bullet
    d
    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? .................
    5d
     
     
    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? .............................
    6a
     
    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?
    7a
     
    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? .........................
    8
     
    No
    Part VII
    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
    BNY MELLON N A TRUSTEE
    1
    45,768    
    PO BOX 185
    PITTSBURGH,PA152300185
    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 (2021)
    Form 990-PF (2021)
    Page 7
    Part VII
    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 VIII-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 VIII-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 (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    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
    7,009,731
    b
    Average of monthly cash balances.......................
    1b
    62,244
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    7,071,975
    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
    7,071,975
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    106,080
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    6,965,895
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    348,295
    Part X
    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 IX, line 6..................
    1
    348,295
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    11,141
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    11,141
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    337,154
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    337,154
    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 XII, line 1 ...
    7
    337,154
    Part XI
    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
     
    b
    Program-related investments—total from Part VIII-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4.
    4
     
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 9
    Part XII
    Undistributed Income (see instructions)
    (a)
    Corpus
    (b)
    Years prior to 2020
    (c)
    2020
    (d)
    2021
    1 Distributable amount for 2021 from Part X, line 7 337,154
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 143,706
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016...... 0
    b From 2017...... 0
    c From 2018...... 0
    d From 2019...... 0
    e From 2020...... 0
    f Total of lines 3a through e ........ 0
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 350,495
    a Applied to 2020, but not more than line 2a 143,706
    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 2021 distributable amount..... 206,789
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2021. 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 2021. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2022 ..........
    130,365
    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 2016 not
    applied on line 5 or line 7 (see instructions) ...
    0
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......
    0
    10 Analysis of line 9:
    a Excess from 2017.... 0
    b Excess from 2018.... 0
    c Excess from 2019.... 0
    d Excess from 2020.... 0
    e Excess from 2021.... 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-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 2021, 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) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    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 IX, 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 XIV
    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 (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    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
    ST LUKES ROOSEVELT HOSPITAL
    ONE GUSTAVE L LEVY PLACE BOX 1049
    NEW YORK,NY10029
    NONE PC GENERAL OPERATING 55,323
    FUND FOR THE BLIND OF VISIONS
    280 PARK AVENUE
    New York,NY10017
    NONE PC GENERAL OPERATING 55,323
    HOSPITAL FOR SPECIAL SURGERY
    535 E 70TH STREET
    NEW YORK,NY10021
    NONE PC GENERAL OPERATING 55,323
    THE CHILDREN'S AID SOCIETY
    711 3RD AVENUE
    New York,NY10017
    NONE PC GENERAL OPERATING 55,323
    SALVATION ARMY
    120 W 14TH STREET
    NEW YORK,NY10011
    NONE PC GENERAL OPERATING 55,323
    NEW YORK UNIVERSITY MEDICAL CENTER
    ONE PARK AVENUE 17TH FLOOR
    NEW YORK,NY10016
    NONE PC GENERAL OPERATING 55,323
    Total .................................bullet 3a 331,938
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 12
    Part XV-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 ....          
    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 ............
        18 664,740  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aFEDERAL TAX REFUND
        1 3,556  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) ..   836,732  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    836,732
    (See worksheet in line 13 instructions to verify calculations.)
    Part XV-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 XV-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 (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

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


    Phone no.
    Form 990-PF (2021)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2021 InvestmentsOtherSchedule2
    Name:
    ADRIAN H JACKSON CHARITABLE TRUST
    EIN:
    13-6078615
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    438516106 HONEYWELL INTL INC AT COST 11,686 37,532
    594918104 MICROSOFT CORP COM AT COST 85,078 214,236
    G06242104 ATLASSIAN CORP PLC-C AT COST 22,249 47,280
    718172109 PHILIP MORRIS INTERN      
    872590104 T -MOBILE US INC AT COST 7,655 12,294
    988498101 YUM BRANDS INC      
    05569M806 BNY MELLON SMALL CAP AT COST 451,672 589,150
    05569M830 BNY MELLON BOND FD C AT COST 609,754 596,446
    101137107 BOSTON SCIENTIFIC CO AT COST 26,533 29,736
    110122108 BRISTOL MYERS SQUIBB      
    437076102 HOME DEPOT INC USD 0 AT COST 18,670 28,636
    64110L106 NETFLIX COM INC AT COST 34,366 42,773
    65339F101 NEXTERA ENERGY INC AT COST 12,766 20,352
    808513105 SCHWAB CHARLES CORP      
    91913Y100 VALERO ENERGY CORP N AT COST 16,952 18,552
    929089100 VOYA FINANCIAL INC AT COST 14,486 29,176
    595112103 MICRON TECHNOLOGY AT COST 30,243 62,411
    742718109 PROCTER & GAMBLE CO      
    87165B103 SYNCHRONY FINANCIAL AT COST 22,956 41,287
    882508104 TEXAS INSTRUMENTS IN AT COST 9,853 12,062
    00724F101 ADOBE SYS INC COM AT COST 20,456 37,426
    03027X100 AMERICAN TOWER CORP- AT COST 12,625 18,428
    20030N101 COMCAST CORP NEW CL      
    254687106 DISNEY (WALT) COMPAN      
    05569M475 BNY MELLON FOCUSED E      
    92826C839 VISA INC      
    05569M509 BNY MELLON MID CAP S AT COST 390,273 594,461
    723787107 PIONEER NAT RES CO AT COST 39,727 47,107
    G5960L103 MEDTRONIC PLC AT COST 14,063 12,000
    002824100 ABBOTT LABORATORIES AT COST 42,879 53,622
    02079K305 ALPHABET INC/CA AT COST 81,689 162,234
    060505104 BANK AMER CORP AT COST 11,160 28,029
    126650100 CVS CORP AT COST 26,016 37,138
    166764100 CHEVRONTEXACO CORP AT COST 35,110 38,843
    30303M102 FACEBOOK INC AT COST 20,209 41,035
    91324P102 UNITED HEALTH GROUP AT COST 48,457 81,347
    023135106 AMAZON COM INC AT COST 57,116 143,377
    150870103 CELANESE CORP DEL AT COST 19,760 42,519
    30161N101 EXELON CORP AT COST 19,196 24,837
    46625H100 J P MORGAN CHASE & C AT COST 34,034 52,414
    244199105 DEERE & COMPANY AT COST 13,574 34,289
    452308109 ILLINOIS TOOL WORKS AT COST 15,383 39,241
    609207105 MONDELEZ INTERNATION      
    654106103 NIKE INC CL B AT COST 19,107 30,667
    026874784 AMERICAN INTERNATION AT COST 28,687 41,508
    037833100 APPLE COMPUTER INC C AT COST 49,523 124,477
    05569M855 BNY MELLON EMERGING AT COST 413,295 465,579
    717081103 PFIZER INC COM AT COST 24,011 32,478
    79466L302 SALESFORCE COM INC      
    G29183103 EATON CORP PLC AT COST 14,549 36,983
    05569M814 BNY MELLON INTERMEDI AT COST 225,680 222,745
    126408103 CSX CORP COM AT COST 15,524 42,488
    22160K105 COSTCO WHSL CORP NEW AT COST 29,447 47,119
    29444U700 EQUINIX INC AT COST 10,304 14,379
    70450Y103 PAYPAL HOLDINGS INC AT COST 34,833 42,808
    00287Y109 ABBVIE INC AT COST 38,498 58,357
    05588F600 BNYM DIVERSIFIED INT AT COST 323,565 375,798
    461202103 INTUIT INC COM AT COST 12,407 27,658
    852234103 SQUARE INC - A AT COST 15,848 22,288
    007903107 ADVANCED MICRO DEVIC AT COST 17,467 48,638
    05569M301 BNY MELLON INCOME ST      
    05569M780 BNY MELLON S/T US GV AT COST 50,000 49,438
    883556102 THERMO ELECTRON CORP AT COST 18,684 34,029
    05588E850 BNY MELLON HIGH YIEL AT COST 205,616 205,316
    09661F701 BNYM INTL SMALL CAP-      
    191216100 COCA-COLA CO USD AT COST 15,719 18,355
    89832Q109 TRUIST FINL CORP AT COST 22,016 31,090
    12572Q105 CME GROUP INC AT COST 32,739 39,981
    482480100 KLA TENCOR CORP AT COST 25,987 48,172
    78409V104 S & P GLOBAL INC AT COST 26,254 46,721
    05569M384 BNY MELLON INTL EQUI AT COST 143,632 148,251
    05587N851 BNYM GLBL DYN BND IN AT COST 50,000 49,835
    16119P108 CHARTER COMMUNICATIO AT COST 22,419 23,471
    05589K400 BNYM FLTNG RT INC-Y AT COST 215,000 222,232
    816851109 SEMPRA ENERGY      
    517834107 LAS VEGAS SANDS CORP      
    009158106 AIR PRODUCTS AND CHE AT COST 35,299 43,509
    302491303 F M C CORP COM NEW      
    05588F709 BNYM GLBL RL EST SEC AT COST 54,395 72,056
    G46188101 HORIZON THERAPEUTICS AT COST 15,006 21,552
    256677105 DOLLAR GENERAL CORP      
    22788C105 CROWDSTRIKE HOLDINGS AT COST 20,156 28,460
    15135B101 CENTENE CORP DEL AT COST 23,644 30,488
    55024U109 LUMENTUM HOLDINGS IN      
    83088M102 SKYWORKS SOLUTIONS I AT COST 13,013 15,049
    67066G104 NVIDIA CORP AT COST 24,703 81,468
    67103H107 O'REILLY AUTOMOTIVE      
    75513E101 RAYTHEON TECHNOLOGIE AT COST 41,268 44,923
    G8994E103 TRANE TECHNOLOGIES P AT COST 8,880 35,961
    921075297 VAN ECK CM COMMODITY AT COST 49,808 62,111
    532457108 ELI LILLY & CO COM AT COST 20,306 30,660
    68902V107 OTIS WORLDWIDE CORP      
    88339J105 TRADE DESK INC/THE AT COST 26,265 52,235
    87234N765 TCW EMERGING MARKETS AT COST 208,500 198,108
    571903202 MARRIOTT INTERNATION AT COST 37,778 40,153
    V7780T103 ROYAL CARIBBEAN CRUI AT COST 30,890 32,298
    88160R101 TESLA MOTORS INC AT COST 21,956 32,760
    538034109 LIVE NATION INC AT COST 32,730 42,131
    03076C106 AMERIPRISE FINL INC AT COST 29,492 38,612
    235851102 DANAHER CORP COMMON AT COST 31,798 43,758
    23804L103 DATADOG INC AT COST 15,341 17,633
    745867101 PULTE GROUP INC AT COST 24,023 28,008
    37045V100 GENERAL MOTORS CO AT COST 36,155 37,523
    57636Q104 MASTERCARD INC AT COST 56,623 59,288
    G1151C101 ACCENTURE PLC IRELAN AT COST 37,557 43,113
    464288273 ISHARES MSCI EAFE SM AT COST 209,492 205,748
    828806109 SIMON PPTY GROUP INC AT COST 27,067 35,149
    518439104 ESTEE LAUDER COMPANI AT COST 28,048 33,688

    TY 2021 OtherDecreasesSchedule
    Name:
    ADRIAN H JACKSON CHARITABLE TRUST
    EIN:
    13-6078615
    Description Amount
    MUTUAL FUND TIMING ADJ 134


    TY 2021 OtherExpensesSchedule
    Name:
    ADRIAN H JACKSON CHARITABLE TRUST
    EIN:
    13-6078615
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    STATE INCOME TAXES - PRINCIPAL 250 0   250


    TY 2021 OtherIncomeSchedule2
    Name:
    ADRIAN H JACKSON CHARITABLE TRUST
    EIN:
    13-6078615
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    FEDERAL TAX REFUND 3,556 0  


    TY 2021 TaxesSchedule
    Name:
    ADRIAN H JACKSON CHARITABLE TRUST
    EIN:
    13-6078615
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 3,460 3,460   0
    FEDERAL ESTIMATES - PRINCIPAL 1,484 0   0
    FOREIGN TAXES ON NONQUALIFIED 309 309   0