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
THE BLACKHORSE FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)454 SOUTH MAIN STREET
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WILKESBARRE, PA18701
A Employer identification number

23-2725907
B Telephone number (see instructions)

(570) 822-1151
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$8,486,145J 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) 328,642
2 Check bullet.............
3 Interest on savings and temporary cash investments 465 465  
4 Dividends and interest from securities... 162,090 162,090  
5a Gross rents............ 3,375 3,375  
b Net rental income or (loss) -655
6a Net gain or (loss) from sale of assets not on line 10 117,168
b Gross sales price for all assets on line 6a 260,541
7 Capital gain net income (from Part IV, line 2)... 117,651
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........ 611,740 283,581  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0   0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 2,311 2,311   0
19 Depreciation (attach schedule) and depletion... Click to see attachment 258 258  
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 1,970 1,461   0
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 4,539 4,030   0
25 Contributions, gifts, grants paid....... 470,050 470,050
26 Total expenses and disbursements. Add lines 24 and 25 474,589 4,030   470,050
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 137,151
b Net investment income (if negative, enter -0-) 279,551
c Adjusted net income (if negative, enter -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......... 118,831 167,342 167,342
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)      
b Investments—corporate stock (attach schedule)....... 1,216,354 Click to see attachment1,137,267 8,318,803
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet   24,907    
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) 1,360,092 1,304,609 8,486,145
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 1,360,092 1,304,609
29 Total net assets or fund balances (see instructions)..... 1,360,092 1,304,609
30 Total liabilities and net assets/fund balances (see instructions). 1,360,092 1,304,609
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
1,360,092
2
Enter amount from Part I, line 27a .....................
2
137,151
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
56,629
4
Add lines 1, 2, and 3 ..........................
4
1,553,872
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
249,263
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
1,304,609
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 225 COMMUNITY BK SYS D 2004-06-15 2021-05-06
b 2000 ENERGY TRANSFER D 1993-10-13 2021-05-21
c FRAC VMWARE INC CL A P 2008-07-21 2021-11-12
d 5904 AMERICAN MOVIL D 2001-02-08 2021-10-05
e 1256 COMMUNITY BK SYS D 2021-05-04 2021-05-06
FRAC VMWARE INC CL A P 1995-02-03 2021-11-02
REAL ESTATE D 2014-01-01 2021-10-21
CAPITAL GAINS 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 17,982   1,092 16,890
b 19,619   35,000 -15,381
c 16   4 12
d 103,220   60,446 42,774
e 100,379   893 99,486
75   6 69
19,000 2,428 47,877 -26,449
250     250
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       16,890
b       -15,381
c       12
d       42,774
e       99,486
      69
      -26,449
      250
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 2 117,651
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 3,886
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 3,886
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 2,211
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 2,211
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 1,675
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 taxBullet   RefundedBullet 11  
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
Yes
 
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
Yes
 
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)
    bulletPA
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 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 ofbulletRONALD W SIMMS Telephone no.bullet (570) 822-1151

    Located atbullet454 MAIN STREETWILKESBARREPA ZIP+4bullet18701
    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
    RONALD W SIMMS PRESIDENT
    5.00     		0 0 0
    454 SOUTH MAIN STREET
    WILKESBARRE,PA18701
    RHEA P SIMMS SECRETARY
    5.00     		0 0 0
    454 SOUTH MAIN STREET
    WILKESBARRE,PA18701
    RICHARD A ROSE TREASURER
    5.00     		0 0 0
    454 SOUTH MAIN STREET
    WILKESBARRE,PA18701
    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 N/A 0
    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
    7,550,641
    b
    Average of monthly cash balances.......................
    1b
    234,197
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    7,784,838
    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
    7,784,838
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    116,773
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    7,668,065
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    383,403
    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
    383,403
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    3,886
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
    1,231
    c
    Add lines 2a and 2b............................
    2c
    5,117
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    378,286
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    378,286
    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
    378,286
    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 7 378,286
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 0
    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...... 80,481
    f Total of lines 3a through e ........ 80,481
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 470,050
    a Applied to 2020, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		0
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2021 distributable amount..... 378,286
    e Remaining amount distributed out of corpus 91,764
    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 5 172,245
    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 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		0
    8 Excess distributions carryover from 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 ......     		172,245
    10 Analysis of line 9:
    a Excess from 2017....  
    b Excess from 2018....  
    c Excess from 2019....  
    d Excess from 2020.... 80,481
    e Excess from 2021.... 91,764
    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).)
    RONALD W SIMMS
    RHEA P SIMMS
    RICHARD A ROSE
    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
    ADOPT A FAMILY OF THE PALM BEACHES
    1712 2ND AVE N
    LAKE WORTH,FL33460     		NONE PUBLIC CHARITABLE 1,000
    ALLIED SERVICES FOUNDATION-STEVE DAVISOVITZ-RYANS RUN
    100 ABINGTON IND PARK
    CLARKS SUMMIT,PA18411     		NONE PUBLIC CHARITABLE 100
    AMERICAN CANCER SOCIETY
    71 N FRANKLIN ST STE 110
    WILKESBARRE,PA18701     		NONE PUBLIC CHARITABLE 1,000
    AMERICAN HEART ASSOCIATION-NEPA GO RED
    444 LIBERTY AVE STE 1300
    PITTSBURGH,PA15222     		NONE PUBLIC CHARITABLE 1,000
    ANNUNCIATION GREEK ORTHODOX CHURCH
    32 E ROSS ST
    WILKESBARRE,PA18701     		NONE PUBLIC CHARITABLE 1,000
    ARTHRITIS FOUNDATION
    57 N FRANKLIN ST
    WILKESBARRE,PA18701     		NONE PUBLIC CHARITABLE 100
    BACK MOUNTAIN MEMORIAL LIBRARY
    96 HUNTSVILLE RD
    DALLAS,PA18612     		NONE PUBLIC CHARITABLE 100
    BACK MOUNTAIN POLICE ASSOCIATION
    PO BOX 1731
    SHAVERTOWN,PA18708     		NONE PUBLIC CHARITABLE 100
    BENEVENTO-MAYO FOUNDATION
    1575 WYOMING AVE
    FORTY FORT,PA18704     		NONE PUBLIC CHARITABLE 1,000
    BLOOMSBURG UNIVERSITY-BLOOMON-MEMORIAL MARY ALBANO
    50 E MAIN ST 4TH FL
    BLOOMSBURG,PA178151301     		NONE PUBLIC CHARITABLE 1,000
    CASA OF LUZERNE COUNTY
    667 N RIVER ST
    PLAINS,PA18705     		NONE PUBLIC CHARITABLE 5,000
    CENTER FOR EXCELLENCE IN EDUCATION
    8201 GREENSBORO DR STE 215
    MCLEAN,VA22102     		NONE PUBLIC CHARITABLE 10,000
    CHILDREN SERVICE CENTER
    335 S FRANKLIN ST
    WILKESBARRE,PA18702     		NONE PUBLIC CHARITABLE 50,000
    CITY OF WILKES-BARRE-4TH OF JULY CELEBRATION
    40 E MARKET ST
    WILKESBARRE,PA18711     		NONE PUBLIC CHARITABLE 1,000
    CITY OF WILKES-BARRE-SANTA PARADE
    40 E MARKET ST
    WILKESBARRE,PA18711     		NONE PUBLIC CHARITABLE 1,000
    CONNECTIONS EDUCTIONS CENTER
    1310 OLD CONGRES AVE STE 100
    WEST PALM BEACH,FL33409     		NONE PUBLIC CHARITABLE 1,000
    DREXEL UNIVERSITY
    3141 CHESTNUT ST STE 301
    PHILADELPHIA,PA19104     		NONE PUBLIC CHARITABLE 225,000
    FAMILY SERVICE ASSOCIATION
    31 W MARKET ST
    WILKESBARRE,PA18701     		NONE PUBLIC CHARITABLE 100
    FINE ARTS FIESTA
    PO BOX 2053
    WILKESBARRE,PA18701     		NONE PUBLIC CHARITABLE 1,000
    FORK OVER LOVE
    345 MARKET ST
    KINGSTON,PA18704     		NONE PUBLIC CHARITABLE 500
    FRANKLIN & MARSHALL
    415 HARRISBURG AVE
    LANCASTER,PA17603     		NONE PUBLIC CHARITABLE 1,000
    GEISINGER HEALTH FOUNDATION
    100 N ACADEMY AVE
    DANVILLE,PA17822     		NONE PUBLIC CHARITABLE 3,000
    HAZLETON ROTARY SCHOLARSHIP FUND
    8 W BROAD ST STE 50
    HAZLETON,PA18201     		NONE PUBLIC CHARITABLE 1,000
    JOHNS HOPKINS INSTITUTE
    600 N WOLFE ST
    BALTIMORE,MD21287     		NONE PUBLIC CHARITABLE 1,000
    KINGSTON POLICE DEPARTMENT
    500 WYOMING AVE
    KINGSTON,PA18704     		NONE PUBLIC CHARITABLE 1,000
    KINGSTON FIRE DEPARTMENT
    600 WYOMING AVE
    KINGSTON,PA18704     		NONE PUBLIC CHARITABLE 1,000
    LUZERNE COUNTY HISTORICAL
    49 S FRANKLIN ST
    WILKESBARRE,PA18701     		NONE PUBLIC CHARITABLE 200
    LUZERNE COUNTY RIVERFRONT PARKS
    56 PUBLIC SQUARE
    WILKESBARRE,PA18701     		NONE PUBLIC CHARITABLE 30,000
    NORTH BRANCH LAND TRUST
    11 CARVERTON RD
    TRUCKSVILLE,PA18708     		NONE PUBLIC CHARITABLE 1,000
    NORTHWEST QUARTERBACK CLUB
    PO BOX 6
    SHICKSHINNY,PA18655     		NONE PUBLIC CHARITABLE 500
    OSTERHOUT LIBRARY
    71 S FRANKLIN ST
    WILKESBARRE,PA18702     		NONE PUBLIC CHARITABLE 500
    PAN MASS CHALLENGE-DANA FARBER CANCER INSTITUTE
    77 FOURTH AVE
    NEEDHAM,MA02494     		NONE PUBLIC CHARITABLE 5,000
    SAFE (AUTISM SUPPORT)
    275 MUNDY ST 201
    WILKESBARRE,PA18702     		NONE PUBLIC CHARITABLE 100
    SPIN
    10501 DRUMMOND RD
    PHILADELPHIA,PA19154     		NONE PUBLIC CHARITABLE 500
    ST JUDE CHILDRENS RESEARCH HOSPITAL
    501 ST JUDE PLACE
    MEMPHIS,TN38105     		NONE PUBLIC CHARITABLE 5,500
    ST JOSEPH MARELLO PARISH
    237 WILLIAMS ST
    PITTSTON,PA18640     		NONE PUBLIC CHARITABLE 1,000
    ST VINCENT DE PAUL SOUP KITCHEN
    39 E JACKSON ST
    WILKESBARRE,PA18701     		NONE PUBLIC CHARITABLE 1,000
    SUSAN G KOMEN FOUNDATION
    125 N WASHINGTON AVE STE 260
    SCRANTON,PA18503     		NONE PUBLIC CHARITABLE 1,000
    THE ROONEY GOLF FOUNDATION
    1111 N CONGRESS AVE
    WEST PALM BEACH,FL33409     		NONE PUBLIC CHARITABLE 1,000
    UNITED WAY
    7525 HICKOEY HILLS CT
    WHITE CREEK,TN37189     		NONE PUBLIC CHARITABLE 2,000
    VOLUNTEERS IN MEDICINE
    190 N PENNSYLVANIA AVE
    WILKESBARRE,PA18701     		NONE PUBLIC CHARITABLE 5,000
    WILKES UNIVERSITY-PSC SCHOLARSHIP FUND
    84 W SOUTH ST
    WILKESBARRE,PA18766     		NONE PUBLIC CHARITABLE 101,000
    WILKES UNIVERSITY-SORDONI ART GALLERY
    141 S MAIN ST
    WILKESBARRE,PA18701     		NONE PUBLIC CHARITABLE 1,000
    WOMEN IN AVIATION NEPA
    2001 WYOMING AVE
    KINGSTON,PA18704     		NONE PUBLIC CHARITABLE 1,000
    WYOMING SEMINARY
    201 N SPRAGUE AVE
    KINGSTON,PA18704     		NONE PUBLIC CHARITABLE 500
    WYOMING SEMINARY-DAVE CORSONDR PAUL GRIESMER
    201 N SPRAGUE AVE
    KINGSTON,PA18704     		NONE PUBLIC CHARITABLE 1,000
    WYOMING SEMINARY-DOUGLAS MASLOW MEMORIAL
    201 N SPRAGUE AVE
    KINGSTON,PA18704     		NONE PUBLIC CHARITABLE 1,000
    WYOMING VALLEY ART LEAGUE
    130 S FRANKLIN ST
    WILKESBARRE,PA18701     		NONE PUBLIC CHARITABLE 1,000
    WYOMING VALLEY CHILDREN ASSOCIATION
    1135 WYOMING AVE
    FORTY FORT,PA18704     		NONE PUBLIC CHARITABLE 250
    Total .................................bullet 3a 470,050
    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 ...........     		    14 465  
    4 Dividends and interest from securities ....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property..... 531120 -655      
    6 Net rental income or (loss) from personal property          
    7 Other investment income .....          
    8 Gain or (loss) from sales of assets other than
    inventory ............     		    18 117,168  
    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) .. -655 279,723 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    279,068
    (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
    THE BLACKHORSE FOUNDATION
     
    Employer identification number

    23-2725907
    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
    THE BLACKHORSE FOUNDATION
          		Employer identification number
    23-2725907
    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
    RICHARD A AND VIRGINIA ROSE
    225 OLDFIELD ROAD
     
    SHAVERTOWN, PA18708

    		$ 60,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
    MARGARET SIMMS
    743 SUTTON ROAD
     
    SHAVERTOWN, PA18708

    		$ 49,990


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    3
    RICHARD A AND VIRGINIA ROSE
    225 OLDFIELD ROAD
     
    SHAVERTOWN, PA18708

    		$ 118,362


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    4
    RONALD W AND RHEA P SIMMS
    12940 BRYNWOOD
     
    PALM BEACH GARDENS, FL33418

    		$ 100,290


    (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
    THE BLACKHORSE FOUNDATION
          		Employer identification number

    23-2725907
    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
    2
    		 673 COMMUNITY BK SYSTEMS $ 49,990 2021-12-31
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
    3
    		 1481 COMMUNITY BK SYSTEMS $ 118,362 2021-05-31
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
    4
    		 1000 MORGAN STANLEY $ 100,290 2021-12-31
    (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
    THE BLACKHORSE FOUNDATION
          		Employer identification number

    23-2725907
    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:  

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

    TY 2021 DepreciationSchedule
    Name:
    THE BLACKHORSE FOUNDATION
    EIN:
    23-2725907
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    LAND 2014-01-01 15,000   L   0 0    
    BUILDING 2014-01-01 12,077 2,170 SL 39.000000000000 258 258    
    LAND - DEMOLITION 2021-09-28 20,800   L   0 0    

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    THE BLACKHORSE FOUNDATION
    EIN:
    23-2725907
    Name of Stock End of Year Book Value End of Year Fair Market Value
    M&T BANK CORP 96,811 1,789,207
    AMERICA MOVIL 39,543 1,477,700
    INGERSOLL RAND 12,358 109,139
    AIR PRODUCTS 307,324 1,521,300
    CA WATER SERVICE GROUP 52,100 215,580
    QUALCOMM 36,917 182,870
    CCNFB 34,029 53,000
    PROCTOR AND GAMBLE 54,630 163,580
    ENERGY TRANSFER LP 135,825 905,300
    AECOM 9,287 34,885
    PHILLIPS 66 9,509 28,984
    COMMUNITY BANK SYST 19,782 303,655
    DELL TECHNOLOGIES 6,668 74,538
    CDK GLOBAL INC 2,574 6,929
    FORD MOTOR COMPANY 53,410 103,850
    LAS VEGAS SANDS CORP 354 3,199
    L3 TECHNOLOGIES 137,524 554,424
    UGI CORP NEW 35,023 57,388
    WP CAREY INC 13,607 63,179
    WENDYS 12,355 60,818
    CORTEVA INC 2,852 39,384
    TRANE TECHNOLOGIES 42,636 404,060
    MORGAN STANLEY 14,129 98,160
    VMWARE INC 8,020 67,674

    TY 2021 OtherDecreasesSchedule
    Name:
    THE BLACKHORSE FOUNDATION
    EIN:
    23-2725907
    Description Amount
    CONTRIBUTIONS OF SECURITIES RECORDED ON COST BASIS 249,263


    TY 2021 OtherExpensesSchedule
    Name:
    THE BLACKHORSE FOUNDATION
    EIN:
    23-2725907
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    OTHER EXPENSE - K-1 ENERGY TRANSFER LP 127 0   0
    OTHER EXPENSE - K-1 USAC 1 0   0
    OTHER EXPENSE - K-1 ENERGY TRANSFER LP 1 0   0
    PROFESSIONAL FEES 350 0   0
    BANK FEES 25 0   0
    OTHER EXPENSE - K-1 SUNOCO LP 5 0   0
    INSURANCE 1,052 1,052   0
    UTILITIES 409 409   0


    TY 2021 OtherIncreasesSchedule
    Name:
    THE BLACKHORSE FOUNDATION
    EIN:
    23-2725907
    Description Amount
    BOOK DIFFERENCE IN BASIS OF INVESTMENTS 56,629


    TY 2021 TaxesSchedule
    Name:
    THE BLACKHORSE FOUNDATION
    EIN:
    23-2725907
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    REAL ESTATE TAXES 2,311 2,311   0