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 08-01-2021 , and ending 07-31-2022
Name of foundation
LEVI RAY & SHOUP FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)2401 WEST MONROE STREET
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
SPRINGFIELD, IL62704
A Employer identification number

32-6007063
B Telephone number (see instructions)

(217) 793-3800
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$22,500,934J 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) 1,000,000
2 Check bullet.............
3 Interest on savings and temporary cash investments 6,629 6,629 6,629
4 Dividends and interest from securities... 596,742 596,742 596,742
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)... 0
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 1,603,371 603,371 603,371
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0 0 0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 748 0 0 0
c Other professional fees (attach schedule).... Click to see attachment 22,260 22,260 0 0
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 6,000 0 0 0
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 15 0 0 0
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 29,023 22,260 0 0
25 Contributions, gifts, grants paid....... 1,011,450 1,011,450
26 Total expenses and disbursements. Add lines 24 and 25 1,040,473 22,260 0 1,011,450
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 562,898
b Net investment income (if negative, enter -0-) 581,111
c Adjusted net income (if negative, enter -0-)... 603,371
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............. 36,070    
2 Savings and temporary cash investments......... 2,167,860 1,170,423 1,170,423
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
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 bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule) 645,826 Click to see attachment445,927 439,011
b Investments—corporate stock (attach schedule)....... 8,009,824 Click to see attachment9,806,128 13,284,960
c Investments—corporate bonds (attach schedule)....... 7,933,271 Click to see attachment7,933,271 7,606,540
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
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) 18,792,851 19,355,749 22,500,934
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 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........ 0 0
27 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
28 Retained earnings, accumulated income, endowment, or other funds 18,792,851 19,355,749
29 Total net assets or fund balances (see instructions)..... 18,792,851 19,355,749
30 Total liabilities and net assets/fund balances (see instructions). 18,792,851 19,355,749
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
18,792,851
2
Enter amount from Part I, line 27a .....................
2
562,898
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
19,355,749
5
Decreases not included in line 2 (itemize) bullet
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
19,355,749
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.)
1a
b
c
d
e
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2  
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		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 8,077
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 8,077
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 8,469
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 8,469
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 10 392
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet392 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$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
     
    No
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XIV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletIL
    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. Click to see attachment...............................
    10
    Yes
     
    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 ofbulletMIKE GORISZEWSKI Telephone no.bullet (217) 793-3800

    Located atbullet2401 WEST MONROE STREETSPRINGFIELDIL ZIP+4bullet627041439
    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)
     
    No
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)? ......................
    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
     
     
    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
    RICHARD H LEVI TRUSTEE
    1.00     		0 0 0
    2401 WEST MONROE ST
    SPRINGFIELD,IL62704
    AGNES E LEVI TRUSTEE
    1.00     		0 0 0
    4601 GULF SHORE BLVD N PH2
    NAPLES,FL34103
    LINDSAY M MATTHEWS TRUSTEE
    1.00     		0 0 0
    1708 JOSEPHINE PLACE
    SPRINGFIELD,IL62704
    RYAN M LEVI TRUSTEE
    1.00     		0 0 0
    1640 ILLINI ROAD
    SPRINGFIELD,IL62704
    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.........................bullet0
    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
    22,134,649
    b
    Average of monthly cash balances.......................
    1b
    2,769,705
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    24,904,354
    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
    24,904,354
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    373,565
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    24,530,789
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    1,226,539
    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
    1,226,539
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    8,077
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    8,077
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    1,218,462
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    1,218,462
    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
    1,218,462
    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 1,218,462
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 993,022
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016......  
    b From 2017......  
    c From 2018......  
    d From 2019......  
    e From 2020......  
    f Total of lines 3a through e ........ 0
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 1,011,450
    a Applied to 2020, but not more than line 2a 993,022
    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..... 18,428
    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 ..........     		1,200,034
    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....  
    b Excess from 2018....  
    c Excess from 2019....  
    d Excess from 2020....  
    e Excess from 2021....  
    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).)
    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.
    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
    ABRAHAM LINCOLN COUNCIL OF BOY SCOUTS
    5231 SOUTH 6TH STREET ROAD
    SPRINGFIELD,IL62703     		  UNRELATED TO PROVIDE YOUNG PEOPLE WITH AN APPRECIATION OF THE OUTDOORS THROUGH PROGRAMS THAT TEACH LEADERSHIP, COMMUNITY SERVICE AND PROVIDE OUTDOOR ADVENTURE. 5,000
    AMERICAN BUSINESS CLUB OF SPRINGFIELD
    PO BOX 1273
    SPRINGFIELD,IL62705     		  UNRELATED TO PROVIDE SPECIALLY ENGINEERED TRICYCLES TO THOSE WITH PHYSICAL AND/OR DEVELOPMENTAL DISABILITIES 10,000
    AMERICAN LUNG ASSOCIATION
    2501 CHATHAM ROAD STE 200
    SPRINGFIELD,IL62704     		  UNRELATED TO ASSIST THOSE AFFECTED BY LUNG DISEASE IN THE UNITED STATES 5,000
    AMERICAN RED CROSS
    431 18TH STREET
    WASHINGTON,DC20006     		  UNRELATED TO PROVIDE ASSISTANCE TO THOSE IMPACTED BY HURRICANE IDA 5,000
    AMIGOS EN CRISTO MINISTRIES
    PO BOX 1225
    SPRINGFIELD,IL62705     		  UNRELATED SUPPORT ORGANIZATION'S MISSION PROGRAMS IN JUAREZ, MEXICO 10,000
    ANIMAL PROTECTIVE LEAGUE
    1001 TAINTOR ROAD
    SPRINGFIELD,IL62702     		  UNRELATED TO ASSIST ORGANIZATION IN ITS PROTECTION OF DOMESTIC ANIMALS 1,000
    ASSOCIATION FOR FRONTOTEMPORAL DEGENERATION
    2700 HORIZON DRIVE SUITE 120
    KING OF PRUSSIA,PA19406     		  UNRELATED TO ASSIST ORGANIZATION IN ITS EFFORTS TO FUND RESEARCH TO BETTER UNDERSTAND THE CAUSES OF FTD, AND TO PROMOTE DRUG DISCOVERY FOR THE FIRST FTD THERAPEUTICS. 1,000
    BIG BROTHER BIG SISTER
    444 SOUTH GRAND AVENUE WEST
    SPRINGFIELD,IL62704     		  UNRELATED TO ASSIST ORGANIZATION IN SERVING KIDS IN NEED OF A POSITIVE ROLE MODEL. 5,000
    BLESSED SACRAMENT PARISH
    1725 SOUTH WALNUT
    SPRINGFIELD,IL62704     		  UNRELATED TO IMPROVE THE EDUCATION OF YOUTH ATTENDING BLESSED SACRAMENT SCHOOL. 1,500
    BOYS & GIRLS CLUB OF CENTRAL ILLINOIS
    300 S 15TH STREET
    SPRINGFIELD,IL62708     		  UNRELATED ASSIST ORGANIZATION IN ITS PROGRAMS TO ENABLE YOUNG PEOPLE TO ACQUIRE SKILLS AND QUALITIES NEEDED TO BECOME RESPONSIBLE CITIZENS AND LEADERS 10,000
    CAPE VINEYARD COMMUNITY CHURCH
    923 SE TERRACE
    CAPE CORAL,FL33904     		  UNRELATED TO SUPPORT CHURCH'S TWO ROOFS, ONE PARTNERSHIP CAMPAIGN. 5,000
    CAPITAL AREA CAREER CENTER
    2201 TORONTO ROAD
    SPRINGFIELD,IL62712     		  UNRELATED TO ASSIST ORGANIZATION IN PROVIDING VARIOUS CAREER OPTIONS TO STUDENTS, AND INCREASE THEIR EMPLOYMENT OPPORTUNITIES THROUGH TECHNICAL AND WORKPLACE SKILL DEVELOPMENT. 2,000
    CAPTAINS FOR CLEAN WATER INC
    PO BOX 1653
    FORT MYERS,FL33902     		  UNRELATED TO SUPPORT ORGANIZATION'S EFFORTS FOR THE ELIMINATION OF HARMFUL, LARGE-SCALE LAKE OKEECHOBEE DISCHARGES INTO THE CALOOSAHATCHEE AND ST. LUCIE RIVER ESTUARIES. 5,000
    CHRIST THE KING
    1930 BARBERRY DRIVE
    SPRINGFIELD,IL62704     		  UNRELATED TO ADVANCE THE LEARNING OF THOSE ATTENDING CHRIST THE KING SCHOOL. 58,750
    CITY OF SPRINGFIELD - ONE STOP CHRISTMAS SHOP
    800 EAST MONROE
    SPRINGFIELD,IL62704     		  UNRELATED TO PROVIDE CLOTHING FOR THOSE IN NEED 1,000
    COASTAL CONSERVATION ASSOCIATION OF FLORIDA
    PO BOX 568886
    ORLANDO,FL32856     		  UNRELATED TO ASSIST ORGANIZATION IN ITS MISSION TO ADVISE AND EDUCATE THE PUBLIC ON CONSERVATION OF MARINE RESOURCES. 5,000
    CONTACT MINISTRIES
    1100 EAST ADAMS
    SPRINGFIELD,IL62703     		  UNRELATED TO ASSIST ORGANIZATION IN SERVING THE GREATER SPRINGFIELD, IL COMMUNITY BY PROVIDING REFERRALS, FOOD, CLOTHING, SHELTER, FINANCIAL ASSISTANCE AND OTHER ASSISTANCE. 7,000
    CRIME STOPPERS OF SANGAMON & MENARD COUNTIES
    PO BOX 1059
    SPRINGFIELD,IL62705     		  UNRELATED TO ASSIST LAW ENFORCEMENT IN THE APPREHENSION AND CONVICTION OF CRIMINALS THROUGH MAKING FUNDS AVAILABLE FOR USE AS REWARDS IN CONNECTION THEREWITH. 1,000
    DING DARLING WILDLIFE SOCIETY
    1 WILDLIFE DRIVE
    SANIBEL,FL33957     		  UNRELATED TO CONSERVE AND PROTECT THE J.N. "DING" DARLING NATIONAL WILDLIFE REFUGE 7,500
    EASTERN ILLINOIS UNIVERSITY FOUNDATION
    600 LINCOLN DRIVE
    CHARLESTON,IL61920     		  UNRELATED TO HELP ORGANIZATION IMPROVE THE EDUCATION OF THOSE ATTENDING EASTERN ILLINOIS UNIVERSITY 100,000
    EDISON SAILING CENTER
    1420 DEL RIO DRIVE
    FORT MYERS,FL33901     		  UNRELATED TO PROVIDE SUPPORT FOR ORGANIZATION'S MISSION TO TEACH CHILDREN AN YOUTH 8-18 THE PASSION FOR SAILING 2,400
    FAMILY SERVICE CENTER OF SANGAMON COUNTY
    730 EAST VINE STREET
    SPRINGFIELD,IL62703     		  UNRELATED ASSIST ORGANIZATION WITH ITS MISSION TO IMPROVE THE LIVES OF PEOPLE IN CENTRAL ILLINOIS TRHOUGH EXCELLENT FOSTER CARE, ADOPTION SERVICES AND FAMILY SUPPORT 10,000
    FESTIVAL OF TREES - THE BABY FOLD
    108 EAST WILLOW STREET
    NORMAL,IL61761     		  UNRELATED TO ASSIST ORGANIZATION IN ITS SERVICE TO CHILDREN AND FAMILIES ACCROSS CENTRAL ILLINOIS 1,000
    FRIEND IN DEED
    PO BOX 15
    SPRINGFIELD,IL62705     		  UNRELATED TO HELP SPRINGFIELD AREA RESIDENTS THAT ARE IN NEED DURING THE HOLIDAY SEASON. 10,000
    FRIENDS OF FOSTER CHILDREN OF PALM BEACH COUNTY INC
    4100 OKEECHOBEE BLVD
    WEST PALM BEACH,FL33409     		  UNRELATED TO ASSIST ORGANIZATION IN TRANSFORMING THE LIVES OF FOSTER CHILDREN THROUGH SERVICES, SUPPORT AND EDUCATION TO OVERCOME THE EFFECTS OF CHILD ABUSE AND NEGLECT. 25,000
    FRIENDS OF SANGAMON COUNTY ANIMAL CONTROL
    PO BOX 9742
    SPRINGFIELD,IL62791     		  UNRELATED TO ASSIST THE ORGANIZATION IN FINDING NEW HOMES FOR HOMELESS AND ABANDONED DOGS 25,000
    GEORGES MALAIKA FOUNDATION
    244 FIFTH AVENUE STE N225
    NEW YORK,NY10001     		  UNRELATED TO EDUCATE YOUNG AFRICAN GIRLS IN THE DEMOCRATIC REPUBLIC OF CONGO 10,000
    GIRL SCOUTS OF CENTRAL ILLINOIS
    3020 BAKER DRIVE
    SPRINGFIELD,IL62703     		  UNRELATED TO ASSIST IN BUILDING GIRLS OF COURAGE, CONFIDENCE AND CHARACTER WHO MAKE THE WORLD A BETTER PLACE. 5,000
    GIRLS ON THE RUN OF CENTRAL ILLINOIS
    907 CLOCKTOWER DRIVE
    SPRINGFIELD,IL62704     		  UNRELATED TO ASSIST ORGANIZATION IN HELPING GIRLS ENHANCE THEIR SOCIAL, EMOTIONAL AND PHYSICAL SKILLS AND BEHAVIORS TO SUCCESSFULLY NAVIGATE LIFE EXPERIENCES 2,500
    HEART OF WES BARR FOUNDATION
    PO BOX 482
    CHATHAM,IL62629     		  UNRELATED TO PROVIDE ASSISTANCE TO LOCAL NOT-FOR-PROFIT ORGANIZATIONS IN THE SPRINGFIELD, IL AREA. 10,000
    HOPE ORPHAN HOME FOUNDATION
    24948 QUARRY AVENUE
    ATHENS,IL62613     		  UNRELATED TO ASSIST ORGANIZATION IN SERVING CHILDREN IN SIERRA LEONE 500
    HOPE SCHOOL FOUNDATION
    15 EAST HAZEL DELL LANE
    SPRINGFIELD,IL62703     		  UNRELATED PROVIDE CARE TO CHILDREN AND YOUNG ADULTS HAVING MULTIPLE DISABILITIES 6,000
    HUMANE SOCIETY OF NAPLES
    370 AIRPORT - PULLING ROAD NORTH
    NAPLES,FL34104     		  UNRELATED TO ASSIST ORGANIZATION IN SERVING THE PUBLIC BY PROVIDING CARE, SHELTER AND PLACEMENT INTO LOVING HOMES FOR ORPHANED ANIMALS IN THE COLLIER COUNTY AREA THROUGH PET ADOPTIONS. 25,000
    ILLINOIS COLLEGE
    1101 WEST COLLEGE AVENUE
    JACKSONVILLE,IL62650     		  UNRELATED TO ASSIST WITH THE CRISPIN HALL RENOVATION 100,000
    ILLINOIS STATE POLICE HERITAGE FOUNDATION INC
    PO BOX 8168
    SPRINGFIELD,IL62791     		  UNRELATED PROVIDE ASSISTANCE TO PRESERVE AND PRESENT THE HISTORY, EVOLUTION AND DEVELOPMENT OF THE STATE POLICE, PROVIDE A MEANS TO FOSTER POSITIVE RELATIONS THROUGH INTERACTIONS WITH THE PUBLIC. EDUCATE THE YOUTH AND INCREASE GENERAL KNOWLEDGE OF POLICE WORK THROUGH THE MUSEUM USING MOBILE EXHIBITS AT COMMUNITY EVENTS STATEWIDE. 10,000
    ILLINOIS STEWARDSHIP ALLIANCE
    230 BROADWAY SUITE 200
    SPRINGFIELD,IL62701     		  UNRELATED ASSIST ORGANIZATION IN ITS MISSION TO CULTIVATE LOCAL FOOD AND FARM SYSTEM THAT IS ECONOMICALLY VIABLE, SOCIALLY JUST AND ENVIRONMENTALLY SUSTAINABLE. 4,000
    ILLINOIS SYMPHONY ORCHESTRA
    524 E CAPITOL AVENUE
    SPRINGFIELD,IL62701     		  UNRELATED TO ASSIST ORGANIZATION IN ITS MISSION TO PROVIDE EXCEPTIONAL LIVE ORCHESTRAL PERFORMANCES AND PROGRAMS. 5,000
    KIDZEUM
    412 EAST ADAMS
    SPRINGFIELD,IL62701     		  UNRELATED TO ASSIST ORGANIZATION IN ITS MISSION TO SERVE AS A PLACE OF LEARNING AND DISCOVERY THROUGH PLAY FOR CHILDREN OF ALL ABILITIES 22,000
    LEWIS PARK & TRAILS
    3200 VICTORIA DRIVE
    SPRINGFIELD,IL62704     		  UNRELATED TO ASSIST ORGANIZATION IN REPAIRING BRIDGES THROUGHOUT LEWIS PARK & TRAILS 2,000
    LINCOLN LAND COMMUNITY COLLEGE FOUNDATION
    5250 SHEPHERD ROAD
    SPRINGFIELD,IL62794     		  UNRELATED TO ASSIST ORGANIZATION IN SERVING THE STUDENTS OF LINCOLN LAND COMMUNITY COLLEGE 500
    MERCY COMMUNITIES
    1344 N 5TH STREET
    SPRINGFIELD,IL62702     		  UNRELATED TO PROVIDE SUPPORT TO HOMELESS MOTHERS AND THEIR CHILDREN 40,000
    MARINE VETS MOTORCYCLE CLUB CENTRAL ILLINOIS CHAPTER
    5953 IRON BRIDGE ROAD
    CHATHAM,IL62629     		  UNRELATED TO FUND CAUSES THAT SUPPORT VETERANS 500
    MEMORIAL MEDICAL CENTER FOUNDATION
    1000 CHURCHILL ROAD
    SPRINGFIELD,IL62702     		  UNRELATED TO ASSIST ORGANIZATION IN PROVIDING HEALTH CARE TO THOSE IN THE SPRINGFIELD AREA 10,000
    NAPLES THERAPEUTIC RIDING CENTER
    206 RIDGE DRIVE
    NAPLES,FL34108     		  UNRELATED TO ASSIST ORGANIZATION IN ITS MISSION TO IMPROVE THE LIVES OF CHILDREN AND ADULTS WITH PHYSICAL, SOCIAL AND MENTAL HEALTH NEEDS THROUGH THERAPEUTIC RIDING AND OTHER EQUINE RELATED PROGRAMS. 25,000
    ORTHOPEDIC CENTER OF ILLINOIS FOUNDATION
    1301 S KOKE MILL ROAD
    SPRINGFIELD,IL62711     		  UNRELATED TO SUPPORT PROJECTS PROMOTING PATIENT EDUCATION, CONTINUING MEDICAL EDUCATION AND REGIONAL CHARITABLE ORGANIZATIONS 5,000
    PARTNERS FOR BREAST CANCER CARE INC
    9470 HEALTHPARK CIRCLE
    FORT MYERS,FL33908     		  UNRELATED TO ASSIST ORGANIZATION IN ITS MISSION TO RULE OUT BREAST CANCER IN THE FORT MYERS COMMUNITY. 1,500
    PRAIRIE HEART FOUNDATION
    619 E MADISON STREET
    SPRINGFIELD,IL62701     		  UNRELATED TO PROVIDE WORLD CLASS HEART CARE TO THE SPRINGFIELD AREA 10,000
    PROJECT THIRD DAY NFP
    24654 RT 4
    CARLINVILLE,IL62626     		  UNRELATED TO SUPPORT ORGANIZATION'S MISSION IN PROVIDING FOOD FOR CHILDREN IN THE CARLINVILLE, IL COMMUNITY AND SURROUNDING AREAS. 10,000
    RAINBOW VILLAGE PROPERTIES
    1240 DAUTEL LANE
    SAINT LOUIS,MO63146     		    TO ASSIST ORGANIZATION IN PROVIDING LIFETIME HOUSING ACCESSIBLE AND AVAILABLE FOR PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. 6,200
    REFUGE RANCH
    9350M CASCADE ROAD
    ROCHESTER,IL62563     		  UNRELATED TO ASSIST ORGANIZATION IN RESCUING NEGLECTED AND ABUSED HORSES AND PROVIDING MENTORING PROGRAMS FOR CHILDREN USING HORSES 100,000
    RUTLEDGE YOUTH FOUNDATION
    151 N BRUNS LANE
    SPRINGFIELD,IL62702     		  UNRELATED TO SERVE ABUSED AND NEGLECTED YOUTH 5,000
    SACRED HEART GRIFFIN HIGH SCHOOL
    1200 W WASHINGTON
    SPRINGFIELD,IL62702     		  UNRELATED TO IMPROVE THE EDUCATION OF YOUTH ATTENDING SACRED-HEART GRIFFIN 110,500
    SIU FOUNDATION
    PO BOX 19677
    SPRINGFIELD,IL62794     		  UNRELATED TO PROVIDE ASSISTANCE FOR CRITICAL AND INNOVATIVE CANCER RESEARCH AND COMPASSIONATE PATIENT PROGRAMS. FUNDS DIRECTLY SUPPORT PATIENT CARE AT SIMMONS CANCER CENTER INSTITUTE AT SIU MEDICINE. 15,000
    SOUTHWEST FLORIDA HORSE RESCUE INC
    14811 STATE ROAD 31
    PUNTA GORDA,FL33982     		  UNRELATED TO ASSIST ORGANIZATION IN SAVING THE LIVES OF LOCAL HORSES FROM ABUSE, NEGLECT AND SLAUGHTER; BY PROVIDING THE BEST VET, FARRIER, AND FEED TO BRING THESE HORSES BACK TO HEALTH IN A SAFE AND POSITIVE ENVIRONMENT. 3,000
    SPARC
    232 BRUNS LANE
    SPRINGFIELD,IL62702     		  UNRELATED TO HELP ORGANIZATION SERVE THOSE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 50,000
    SPRINGFIELD ART ASSOCIATION
    700 NORTH 4TH STREET
    SPRINGFIELD,IL62702     		  UNRELATED TO SUPPORT THE SPRINGFIELD AREA ARTS 1,000
    SPRINGFIELD BLACK CHAMBER OF COMMERCE
    PO BOX 2095
    SPRINGFIELD,IL62705     		  UNRELATED TO PROVIDE SUPPORT FOR ORAGANIZATION'S 217 BLACK RESTAURANT WEEKEND 2,500
    SPRINGFIELD PUBLIC SCHOOLS FOUNDATION
    1900 WEST MONROE
    SPRINGFIELD,IL62704     		  UNRELATED TO ASSIST ORGANIZATION IN SUPPORTING SCHOOL DISTRICT 186 IN ITS EFFORTS TO PROVIDE STUDENTS WITH HIGH QUALITY EDUCATION EXPERIENCE. 5,000
    SPRINGFIELD YMCA
    701 SOUTH 4TH
    SPRINGFIELD,IL62703     		  UNRELATED TO ASSIST ORGANIZATION IN SERVING YOUTH IN THE SPRINGFIELD COMMUNITY THROUGH THE STRONG KIDS FUND 4,500
    SPRINGFIELD ZOOLOGICAL SOCIETY
    1100 EAST LAKE SHORE DRIVE
    SPRINGFIELD,IL62712     		  UNRELATED TO ASSIST ORGANIZATION IN PROVIDING EXHIBITS AND SUPPORT TO THE EDUCATIONAL AND CONSERVATION EFFORTS OF THE HENSON ROBINSON ZOO, 1,000
    ST JOHN'S BREADLINE
    PO BOX 12055
    SPRINGFIELD,IL62791     		  UNRELATED TO ASSIST ORGANIZATION IN ITS MISSION TO PROVIDE HEALTHY FOOD TO THE HUNGRY. 10,000
    ST PATRICK CATHOLIC SCHOOL
    1800 SOUTH GRAND AVENUE EAST
    SPRINGFIELD,IL62703     		  UNRELATED TO IMPROVE THE EDUCATION OF YOUTH ATTENDING ST. PATRICK'S SCHOOL. 25,000
    THE 217 DINNER
    4263 OLD ROUTE 36 11
    SPRINGFIELD,IL62707     		  UNRELATED TO ASSIST ORGANIZATION IN FEEDING SPRINGFIELD'S HOMELESS AROUND THANKSGIVING. 250
    THE ALZHEIMER'S ASSOCIATION ILLINOIS CHAPTER
    2309 W WHITE OAKS DRIVE STE E
    SPRINGFIELD,IL62704     		  UNRELATED TO ELIMINATE ALZHEIMER'S DISEASE THROUGH ADVANCEMENTS IN RESEARCH, CARE AND SUPPORT FOR THOSE AFFECTED AND TO REDUCE THE RISK OF DEMENTIA 1,000
    THE MACOUPIN CENTER FOR THE DEVOLPMENTALLY DISABLED
    700 E ELM STREET
    CARLINVILLE,IL62626     		  UNRELATED TO ASSIST ORGANIZATION WITH ITS DAY LEARNIGN CENTER THAT SERVES ADULTS WITH DISABILITIES IN MACOUPIN COUNTY. 10,000
    THE OUTLET
    PO BOX 2864
    SPRINGFIELD,IL62708     		  UNRELATED TO SUPPORT ORGANIZATION'S MENTORING PROGRAM FOR FATHERLESS YOUTH IN THE SPRINGFIELD AREA. 10,000
    THE RICKY KING CHILDREN'S FUND
    2390 TAMIAMI TRAIL N STE 100
    NAPLES,FL34103     		  UNRELATED TO ASSIST ORGANIZATION IN ENRICHING THE LIVES OF CHILDREN WITH DISABILITIES IN SOUTHWEST FLORIDA 1,000
    THE SHELTER FOR ABUSED WOMEN AND CHILDREN
    PO BOX 10102
    NAPLES,FL34101     		  UNRELATED TO ASSIST ORGANIZATION IN ITS MISSION TO LEAD AND COLLABORATE WITH THE COMMUNITY TO PREVENT, PROTECT AND PREVAIL OVER DOMESTIC VIOLENCE AND HUMAN TRAFFICKING THROUGH ADVOCACY, EMPOWERMENT AND SOCIAL CHANGE. 25,000
    UNIVERSITY OF ILLINOIS FOUNDATION
    1305 WEST GREEN STREET
    URBANA,IL61801     		  UNRELATED TO PROVIDE ASSISTANCE TO THE UNIVERSITY OF ILLINOIS - SPRINGFIELD 100
    VACHEL LINDSAY ELEMENTARY SCHOOL
    3600 FIELDING DRIVE
    SPRINGFIELD,IL62711     		  UNRELATED TO IMPROVE THE EDUCATION OF YOUTH ATTENDING VACHEL LINDSAY SCHOOL 250
    WOODEN IT BE LOVELY
    501 S DOUGLAS AVENUE
    SPRINGFIELD,IL62704     		  UNRELATED TO ASSIST ORGANIZATION IN OFFERING HOPE AND EMPLOYMENT TO WOMEN HEALING FROM LIVES OF POVERTY, ADDICTION, AND ABUSE. 1,500
    Total .................................bullet 3a 1,011,450
    bApproved for future payment
    Total .................................bullet 3b 0
    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 ...........     		    01 6,629  
    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 ............     		         
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 0 603,371 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    603,371
    (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
    Schedule B
    (Form 990)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors

    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
    OMB No. 1545-0047
    2021
    Name of the organization
    LEVI RAY & SHOUP FOUNDATION
     
    Employer identification number

    32-6007063
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ






    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
    or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990) (2021)
    Schedule B (Form 990) (2021) Page 2
    Name of organization
    LEVI RAY & SHOUP FOUNDATION
          		Employer identification number
    32-6007063
    Part I
    Contributors
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
    LEVI RAY & SHOUP INC
     
    2401 WEST MONROE STREET
     
    SPRINGFIELD, IL62704

    		$ 1,000,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 3
    Name of organization
    LEVI RAY & SHOUP FOUNDATION
          		Employer identification number

    32-6007063
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 4
    Name of organization
    LEVI RAY & SHOUP FOUNDATION
          		Employer identification number

    32-6007063
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990) (2021)
    Additional Data


    Software ID:  
    Software Version:  

    TY 2021 AccountingFeesSchedule
    Name:
    LEVI RAY & SHOUP FOUNDATION
    EIN:
    32-6007063
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX FILING FEES 748 0 0 0

    TY 2021 InvestmentsCorpBondsSchedule
    Name:
    LEVI RAY & SHOUP FOUNDATION
    EIN:
    32-6007063
    Name of Bond End of Year Book Value End of Year Fair Market Value
    AMERICAN INTL, 3.9%, DUE 4/1/2026 517,265 498,580
    CITIGROUP, 6.875%, DUE 6/1/2025 1,012,720 867,280
    FORD MOTOR CREDIT, 3.5%, DUE 9/20/2026 700,000 641,298
    FORD MOTOR CREDIT, 4.542%, DUE 8/1/2026 1,020,000 971,000
    JEFFRIES GROUP, 4.85%, DUE 1/15/2027 1,019,800 1,013,630
    HEWLETT PACKARD, 4.05%, DUE 9/15/2022 991,800 1,001,460
    MORGAN STANLEY, 3.7%, DUE 10/23/2024 1,005,000 1,005,190
    PNC BANK N PITTSBURGH PA, 3.8%, DUE 7/25/2023 618,186 603,372
    WELLS FARGO, 4.125%, DUE 8/15/2023 1,048,500 1,004,730

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    LEVI RAY & SHOUP FOUNDATION
    EIN:
    32-6007063
    Name of Stock End of Year Book Value End of Year Fair Market Value
    SPDR S&P 500 ETF 8,560,942 12,436,742
    AT&T INC 951,781 712,513
    WARNER BROS DISCOVERY INC 293,405 135,705

    TY 2021 InvestmentsGovtObligationsSch
    Name:
    LEVI RAY & SHOUP FOUNDATION
    EIN:
    32-6007063
    US Government Securities - End of Year Book Value:

    0
    US Government Securities - End of Year Fair Market Value:

    0
    State & Local Government Securities - End of Year Book Value:


    445,927
    State & Local Government Securities - End of Year Fair Market Value:


    439,011


    TY 2021 OtherExpensesSchedule
    Name:
    LEVI RAY & SHOUP FOUNDATION
    EIN:
    32-6007063
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ANNUAL FILING FEE - ILLINOIS 15 0 0 0


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    LEVI RAY & SHOUP FOUNDATION
    EIN:
    32-6007063
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TRUST ACCOUNT FEES 22,260 22,260 0 0


    TY 2021 SubstantialContributorsSch
    Name:
    LEVI RAY & SHOUP FOUNDATION
    EIN:
    32-6007063
    Name Address
    LEVI RAY & SHOUP INC
          		2401 WEST MONROE STREET
    SPRINGFIELD,IL62704


    TY 2021 TaxesSchedule
    Name:
    LEVI RAY & SHOUP FOUNDATION
    EIN:
    32-6007063
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FY22 ESTIMATED TAX 6,000 0 0 0