Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 297,106 | 323,837 | 340,065 | 286,967 | 297,196 | 1,545,171 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | 297,106 | 323,837 | 340,065 | 286,967 | 297,196 | 1,545,171 |
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | 1,545,171 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 297,106 | 323,837 | 340,065 | 286,967 | 297,196 | 1,545,171 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 34 | 31 | 33 | 24 | 21 | 143 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | 1,545,314 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III | HOLLYWOOD NEIGHBORHOOD ASSOCIATION - 3 GRANTS - 500.00 TO THE HOLLYWOOD FARMERS MARKET TO BE APPLIED TO THEIR S.N.A.P. PROGRAM. THIS WOULD ASSIST IN PROVIDING LOCAL RESIDENTS WITH LIMITED INCOME TO PURCHASE FRESH, HIGH QUALITY, AND HEALTHY FOODS. 500.00 IN FUNDS FOR MOTHER AND CHILD EDUCATION CENTER TO ASSIST IN INSTALLING A VEGETABLE GARDEN ON THEIR BUSINESS SITE. THIS GARDEN WOULD PROVIDE STAFF THE OPPORTUNITY TO TEACH THEIR CLIENTS SOME BASIC SKILLS THAT WOULD ALLOW THEM TO PROVIDE FRESH FRUIT AND VEGETABLES FOR THEIR FAMILIES. 500.00 IN RESILIENCY GRANT FUNDS BE GIVEN TO THE HOLLYWOOD SENIOR CENTER TO APPLY TO THE PURCHASE OF A COMMERCIAL FREEZER. HOLLYWOOD SENIOR CENTER IS CURRENTLY SEEKING FUNDING TO PURCHASE A COMMERCIAL FREEZER TO SUPPORT OUR WORK DELIVERING FOOD BOXES, FOOD DONATIONS, AND FARMERS MARKET PRODUCE (THROUGH OUR GLEANING PROGRAM WITH THE HOLLYWOOD FARMERS MARKET). SINCE THE ONSET OF COVID-19, MORE THAN 55,765 POUNDS OF FOOD, 1,886 EMERGENCY FOOD BOXES, AND 400 THANKSGIVING MEALS HAVE BEEN DELIVERED TO LOW-INCOME SENIORS AND VETERANS IN THE COMMUNITY. 2,600 GROCERY BAGS HAVE BEEN DELIVERED THROUGH THE ASIAN FOOD PANTRY, A NEW MONTHLY PROGRAM THROUGH OUR PARTNERSHIP WITH CLAY STREET TABLE AND THE GIVING TREE. THE GIVING TREE WILL BE ABSORBED INTO OUR ORGANIZATION IN JULY 2021 WITH A PLAN TO EXPAND THE ASIAN FOOD PANTRY TO MORE ASIAN ELDERS IN NE PORTLAND. BEAUMONT WILSHIRE NEIGHBORHOOD - GAVE OUT TWO RESILIENCY GRANTS- 2,000 NE PORTLAND NONPROFIT COMMUNITY CYCLING CENTER (CCC). AS WE REPORTED, THOSE INITIAL FUNDS WERE USED TO PURCHASE SUPPLIES FOR CARE KITS (INCLUDING HAND SANITIZER, SOAP, TOOTHBRUSHES AND TOOTHPASTE, ANTIBACTERIAL WIPES, AND OTHER PERSONAL CARE PRODUCTS) TO ADD TO CCCS ONGOING PROVISION OF FOOD BOXES DELIVERED BY BICYCLE TRAILERS TO APPROXIMATELY 200 HOUSEHOLDS IN THE CULLY NEIGHBORHOOD EACH FRIDAY. THIS GOING THE LAST MILE APPROACH SUPPORTS COMMUNITY MEMBERS FACING MULTIPLE CHALLENGES WHETHER DUE TO LOSS OF WORK AND INCOME WHEN COVID HIT, LOSS OF CHILDCARE WHEN SCHOOLS CLOSED, MOBILITY CHALLENGES, OR TIGHT WORK SCHEDULES THAT MAKE GETTING TO A FOOD PANTRY OR GROCERY STORE DIFFICULT, NOT TO MENTION FINANCIALLY INACCESSIBLE. AS WE WORKED WITH THE STAFF AT THE COMMUNITY CYCLING CENTER, WE LEARNED THAT THIS WORTHWHILE PROJECT HAS RELIED ON THE MOSTLY-VOLUNTEER LABOR OF A GROUP OF WORKERS DUBBED THE ABC TEAM, WHICH IS FOR ANDANDO EN BICICLETAS Y CAMINANDO (RIDING ON BICYCLES AND WALKING). CCC DESCRIBES THOSE CRITICAL HELPERS AS A GROUP OF LOW-INCOME, IMMIGRANT, BIPOC COMMUNITY MEMBERS WHO WORK TO FURTHER ACTIVE TRANSPORTATION, LARGELY IN THE CULLY AREA. THROUGHOUT THE PANDEMIC, THEIR SUPPORT HAS BEEN CRITICAL IN OUR FOOD DELIVERY OPERATIONS. EACH FRIDAY, THIS GROUP GATHERS TO HELP ASSEMBLE HUNDREDS OF FOOD BOXES AND CARE KITS BEFORE THEY ARE DELIVERED. THE CCC STAFF PROPOSES THAT WE CONTRIBUTE THIS ADDITIONAL GRANT TO THE ABC GROUPS DISCRETIONARY FUNDS, WHICH TYPICALLY HAVE GONE TOWARD THINGS THAT REDUCE BARRIERS TO PARTICIPATION IN EVENTS FOR EXAMPLE, PROVIDING CHILD CARE TO FOLKS WHO OTHERWISE WOULD NOT BE ABLE TO ATTEND GROUP EVENTS, PROVIDING MEALS AT EVENTS, ETC. OVER TIME, THIS COULD EVEN HELP TO EXPAND ABC AS A GROUP, AS THE BIGGEST ISSUE FOR EXPANSION IS COST; GROUP MEMBERS ARE PROVIDED A MODEST STIPEND EACH MONTH FOR THEIR VOLUNTEER TIME TO OFFSET SOME OF THE FINANCIAL BARRIERS THAT TRADITIONAL VOLUNTEERING POSES. WE AT BWNA HAVE SEEN THE COMMUNITY CYCLING CENTERS SUCCESS AT PIVOTING FROM THEIR CORE MISSION OF SUPPORTING THE HEALTHY TRANSPORTATION ALTERNATIVE OF BICYCLING TO DEMONSTRATING THAT BICYCLES CAN BE USED TO DELIVER COMPASSIONATE NEEDS-BASED SERVICES TO THOSE ESPECIALLY STRUGGLING DURING THE COVID CRISIS. WE HAVE BEEN IMPRESSED WITH THE AIM AND DELIVERY OF THAT PROGRAM--AND IN PARTICULAR THE WAY CCC HAS ENLISTED TARGETED COMMUNITY MEMBERS IN PARTICIPATING IN THIS PROGRAM. IN ALL THESE WAYS, WE SEE THIS ENDEAVOR AS MEETING THE EQUITY GOALS EXPRESSED IN PORTLANDS EQUITY TOOLKIT FOR COVID-19 RELIEF AND RECOVERY EFFORTS. MADISON SOUTH NEIGHBORHOOD - GAVE OUT TWO RESILIENCE GRANTS - 1,000 IN GIFTCARDS SPLIT BETWEEN MCDANIEL HIGH SCHOOL AND JASON LEE ELEMENTARY. THE HIGH SCHOOL HAS A PROGRAM WHERE STUDENTS/FAMILIES IN NEED OF EMERGENCY SUPPORT CAN GET 100 GIFT CARDS TO BE USED ON GROCERIES, UTILITY BILLS, TO HELP WITH RENT, ETC. FAMILIES MUST DEMONSTRATE NEED AND THEY HAVE A WHOLE PROCESS AROUND IT AND ALSO THEY TRY TO LINK FAMILIES WITH OTHER RESOURCES FOR ONGOING SUPPORT. 500 TO THE BEACH STREET COMMUNITY GARDEN AND 500 TO MAIN SPRING SERVICES IN MADISON SOUTH AREA, THAT HELPS THE COMMUNITY WITH FOOD, AND CLOTHING. |
| FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CNN MAINTAINS A SIGNED AND DATED CONFLICT OF INTEREST STATEMENT AND DISCLOSURE FORM THAT EACH BOARD MEMBER SIGNS YEARLY. BOARD MEMBERS ARE GIVEN A COPY OF THE FORM. |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION OF THE EXECUTIVE AND OTHER KEY EMPLOYEES IS REVIEWED BY THE ENTIRE BOARD EACH YEAR AS THE NEW FISCAL YEAR BUDGET IS APPROVED. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS & FORM 990 ARE MADE AVAILABLE TO THE GENERAL PUBLIC, (WITHIN FIVE DAYS) UPON REQUEST. |
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| Software Version: |