-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0047
20
21
Open to Public Inspection
For calendar year 2021, or tax year beginning
01-01-2021
, and ending
12-31-2021
Name of foundation
REPUBLIC NATIONAL DISTRIBUTING COMPANY
FOUNDATION INC
Number and street (or P.O. box number if mail is not delivered to street address)
ONE NATIONAL DRIVE
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
ATLANTA
,
GA
30336
A Employer identification number
45-3842838
B
Telephone number (see instructions)
(404) 472-2245
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
115,984
J
Accounting method:
Cash
Accrual
Other (specify)
(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)
1
Contributions, gifts, grants, etc., received (attach schedule)
901,241
2
Check
.............
3
Interest on savings and temporary cash investments
414
414
4
Dividends and interest from securities
...
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
........
901,655
414
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)
...
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
1,130
1,130
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
1,130
1,130
0
25
Contributions, gifts, grants paid
.......
964,750
964,750
26
Total expenses and disbursements.
Add lines 24 and 25
965,880
1,130
964,750
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-64,225
b
Net investment income
(if negative, enter -0-)
0
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
1
Cash—non-interest-bearing
.............
180,209
115,984
115,984
2
Savings and temporary cash investments
.........
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
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)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
180,209
115,984
115,984
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
)
23
Total liabilities
(add lines 17 through 22)
.........
0
0
Foundations that follow FASB ASC 958, check here
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
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
180,209
115,984
29
Total net assets or fund balances
(see instructions)
.....
180,209
115,984
30
Total liabilities and net assets/fund balances
(see instructions)
.
180,209
115,984
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
180,209
2
Enter amount from Part I, line 27a
.....................
2
-64,225
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
115,984
5
Decreases not included in line 2 (itemize)
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
115,984
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
P
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
0
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
0
b
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
0
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
...................
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
and enter “N/A" on line 1.
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
0
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
0
6
Credits/Payments:
a
2021 estimated tax payments and 2020 overpayment credited to 2021
6a
0
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
0
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
.......
9
0
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2022 estimated tax
Refunded
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.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
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
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)
GA
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
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
No
Website address
N/A
14
The books are in care of
FRANCIE PURNELL
Telephone no.
(404) 472-2294
Located at
ONE NATIONAL DRIVE
ATLANTA
GA
ZIP+4
30336
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over
Yes
No
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
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
Organizations relying on a current notice regarding disaster assistance check here
........
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
20
,
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.
20
,
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
No
c
Organizations relying on a current notice regarding disaster assistance check here
.........
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
EMILE SARTALAMACCHIA
CORP DIRCTR TAX
1.00
0
0
0
809 JEFFERSON HIGHWAY
NEW ORLEANS
,
LA
70121
DENNIS BASHUK
FOUNDATION MGR.
3.00
0
0
0
ONE NATIONAL DRIVE
ATLANTA
,
GA
30336
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
...................
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
Total
number of others receiving over $50,000 for professional services
.............
0
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
.........................
0
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
0
b
Average of monthly cash balances
.......................
1b
265,209
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
265,209
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
265,209
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions)
.............................
4
3,978
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3.
.......
5
261,231
6
Minimum investment return.
Enter 5% (0.05) of line 5
................
6
13,062
Part X
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part IX, line 6
..................
1
13,062
2a
Tax on investment income for 2021 from Part V, line 5
.......
2a
b
Income tax for 2021. (This does not include the tax from Part V.)
...
2b
c
Add lines 2a and 2b
............................
2c
0
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
13,062
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
13,062
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
13,062
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
13,062
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
......
590,586
b
From 2017
......
1,212,506
c
From 2018
......
976,861
d
From 2019
......
858,676
e
From 2020
......
1,792,239
f
Total
of lines 3a through e
........
5,430,868
4
Qualifying distributions for 2021 from Part
XI, line 4:
$
964,750
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
.....
13,062
e
Remaining amount distributed out of corpus
951,688
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).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
6,382,556
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)
...
590,586
9
Excess distributions carryover to 2022.
Subtract lines 7 and 8 from line 6a
......
5,791,970
10
Analysis of line 9:
a
Excess from 2017
....
1,212,506
b
Excess from 2018
....
976,861
c
Excess from 2019
....
858,676
d
Excess from 2020
....
1,792,239
e
Excess from 2021
....
951,688
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
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
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.)
1
Information Regarding Foundation Managers:
a
List 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).)
b
List 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.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any 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)
a
Paid during the year
AL COPELAND FOUNDATION
2601 SEVERNE AVE
MAETAIRIE
,
LA
70002
NONE
PC
COMMUNITY SERVICE
1,500
ALZHEIMER'S ASSOC OK CHAPTER
2448E 81ST STREET
TULSA
,
OK
74133
NONE
PC
COMMUNITY SERVICE
1,500
AMERICAN CANCER SOCIETY
132 W 32ND STREET
NEW YORK
,
NY
10001
NONE
PC
MEDICAL RESEARCH
25,000
AMERICAN HEART ASSOCIATION TULSA CHAPTER
2227 SKELLY DR
TULSA
,
OK
74105
NONE
PC
COMMUNITY SERVICE
1,500
AMERICAN HEART ASSOCIATION
7272 GREENVILLE AVE
DALLAS
,
TX
75231
NONE
PC
COMMUNITY SERVICE
5,000
ANIMAL DEFENSE LEAGUE OF TEXAS
11300 NACOGDOCHES
SAN ANTONIO
,
TX
78217
NONE
PC
ANIMAL SHELTER
3,000
AREA 270 STARS
205 SOLAR DR
WALKERSVILLE
,
MD
21793
NONE
PC
COMMUNITY SERVICE
1,000
ARMED SERVICES YMCA
14040 CENTRAL LOOP
WOODBRIDGE
,
VA
22193
NONE
PC
COMMUNITY SERVICE
10,000
ASIAN AMERICAN LEGAL DEFENSE & EDUCATION FUND
99 HUDSON ST
NEW YORK
,
NY
10013
NONE
PC
COMMUNITY SERVICE
31,000
BACK ON MY FEET
201 N CHARLES STREET
BALTIMORE
,
MD
21201
NONE
PC
COMMUNITY SERVICE
1,000
BDS MEMORIAL FOUNDATION
1015 N PAULINA ST
CHICAGO
,
IL
60622
NONE
PC
COMMUNITY SERVICE
500
BENS FRIENDS
90 ALEXANDER ST
CHARLESTON
,
SC
29403
NONE
PC
COMMUNITY SERVICE
5,000
BLUE RIDGE AREA FOOD BANK
PO BOX 937
VERONA
,
VA
24482
NONE
PC
COMMUNITY SERVICE
1,500
BOCA WEST CHILDREN'S FOUNDATION
20583 BOCA WEST DRIVE
BOCA RATON
,
FL
33434
NONE
PC
COMMUNITY SERVICE
3,500
BOYS & GIRLS CLUB OF CHAFEE CITY
PO BOX 1430-CN
SALIDA
,
CO
81201
NONE
PC
COMMUNITY SERVICE
3,000
BUFFALO GAP FOOD & WINE
PO BOX 728
BUFFALO GAP
,
TX
79508
NONE
PC
COMMUNITY SERVICE
4,500
BYRON GAMBULOS ANIMAL ENRICHMENT ENDOWMENT
2322 N BROADWAY AVE
OKLAHOMA CITY
,
OK
73103
NONE
PC
COMMUNITY SERVICE
2,000
CAFE HOPE
1 TIMBERLANE DR
GRETNA
,
LA
70056
NONE
PC
COMMUNITY SERVICE
3,000
CAFE RECONCILE
1631 ORETHA CASTLE HALEY BLVD
NEW ORLEANS
,
LA
70113
NONE
PC
COMMUNITY SERVICE
3,000
CAMERON K GALLAGHER FOUNDATION
9700 GAYTON RD
ROCHMOND
,
VA
23238
NONE
PC
COMMUNITY SERVICE
500
CAROLINE SYMMES FOUNDATION
12441 CREEKWOOD LN
CARMEL
,
IN
46032
NONE
PC
COMMUNITY SERVICE
1,000
CHILDRENS INN DOMESTIC VIOLENCE CTR
801 N SYCAMORE AVE
DENVER
,
CO
57104
NONE
PC
COMMUNITY SERVICE
450
COLORADO RESTAURANT ASSOCIATION
430 E 7TH AVE
DENVER
,
CO
80203
NONE
PC
COMMUNITY SERVICE
10,000
CONNECTING POINT OF PARK CITIES
4516 LOVERS LANE
DALLAS
,
TX
75225
NONE
PC
COMMUNITY SERVICE
5,000
CRISIS CENTER OF COMAL COUNTY
1547 COMMON ST
NEW BRAUNFELS
,
TX
78130
NONE
PC
COMMUNITY SERVICE
750
DARE TO CARE
5803 FERN VALLEY RD
LOUISVILLE
,
KY
40228
NONE
PC
COMMUNITY SERVICE
1,000
DESERT ANGELS INC
PO BOX 210455
AUBUR HILLS
,
MI
48326
NONE
PC
COMMUNITY SERVICE
1,000
DETROIT WINE ORGANIZATION
PO BOX 876
BIRMINGHAM
,
MI
48012
NONE
PC
COMMUNITY SERVICE
7,000
EMERIL LAGASSE FOUNDATION
829 ST CHARLES AVENUE
NEW ORLEANS
,
LA
70130
NONE
PC
COMMUNITY SERVICE
25,000
FEED MORE INC
1415 RHOADMILLER ST
RICHMOND
,
VA
23220
NONE
PC
COMMUNITY SERVICE
4,000
FEEDING AMERICA - KENTUCKY'S HEARTLAND
4900 PUERTO RICO AVE
WASHINGTON
,
DC
20017
NONE
PC
COMMUNITY SERVICE
500
FEEDING AMERICA
161 NORTH CLARK ST
CHICAGO
,
IL
60601
NONE
PC
COMMUNITY SERVICE
4,500
FEEDING AMERICA INC
PO BOX 96749
WASHINGTON
,
DC
20001
NONE
PC
COMMUNITY SERVICE
10,000
FEEDING SOUTHWEST VIRGINA
1025 ELECTRIC RD
SALEM
,
VA
24153
NONE
PC
COMMUNITY SERVICE
1,500
FIRST SERVE
3400 N PORTLAND AVE
OKLAHOMA CITY
,
OK
73112
NONE
PC
COMMUNITY SERVICE
2,500
FLORIDA GULF COAST UNIVERSITY FUND
10501 FGCU BLVD S
FT MYERS
,
FL
33965
NONE
PC
EDUCATION
6,500
FOOD BANK FOR THE HEARTLAND
10525 J STREET
OMAHA
,
NE
68127
NONE
PC
COMMUNITY SERVICE
2,500
FOOD GATHERERS
1 CARROT WAY
ANN ARBOR
,
MI
48105
NONE
PC
COMMUNITY SERVICE
500
FOODBANK OF SOUTHEASTERN VIRGINIA
800 TIDEWATER DR
NORFOLK
,
VA
23504
NONE
PC
COMMUNITY SERVICE
1,500
FOREKIDS FOUNDATION
11005 LAPALCO BLVD
AVONDALE
,
LA
70094
NONE
PC
COMMUNITY SERVICE
5,000
FORGOTTEN HARVEST
21000 GREENFIELD RD
OAK PARK
,
MI
48237
NONE
PC
COMMUNITY SERVICE
500
FOUNDATION FOR AUTISM CARE EDUCATION AND SERVICES
18702 AUTUMN BREEZE DR
SPRING
,
TX
77379
NONE
PC
COMMUNITY SERVICE
1,000
FRAIZER HISTORY MUSEUM
829 W MAIN STREET
LOUISVILLE
,
KY
40202
NONE
PC
CULTURAL
5,000
FSU FOUNDATION
325 W COLLEGE AVE
TALLAHASSEE
,
FL
32301
NONE
PC
EDUCATION
100,000
FUND FOR THE ARTS
623 W MAIN ST
LOUISVILLE
,
KY
44641
NONE
PC
EDUCATION
10,000
GAY & LESBIAN ALLIANCE AGAINST DEFAMATION
1801 W OLYMPIC BLVD
PASADENA
,
CA
90006
NONE
PC
COMMUNITY SERVICE
1,000
GIRLS ON THE RUN NEBRASKA
4600 VALLEY RD 321
LINCOLN
,
NE
68510
NONE
PC
COMMUNITY SERVICE
2,500
GLEANERS COMMUNITY FOOD BANK
2131 BEAUFAIT ST
DETROIT
,
MI
48207
NONE
PC
COMMUNITY SERVICE
1,200
GLEANERS FOOD BANK
3737 WALDEMERE AVE
INDIANAPOLIS
,
IN
46241
NONE
PC
COMMUNITY SERVICE
1,000
GOD'S PANTRY FOOD BANK
1685 JAGGIE FOX WAY
LEXINGTON
,
KY
40511
NONE
PC
COMMUNITY SERVICE
1,000
GONZMART FAMILY FOUNDATION
2025 E 7TH AVE
TAMPA
,
FL
33605
NONE
PC
COMMUNITY SERVICE
10,000
GREAT PLAINS FOOD BANK
1720 3RD AVE N
FARGO
,
ND
58102
NONE
PC
COMMUNITY SERVICE
1,000
GUMMAKONDA REDDY FOUNDATION
1060 NW 3RD ST
HALLANDALE
,
FL
33009
NONE
PC
COMMUNITY SERVICE
3,800
HABITAT FOR HUMANITY
332 WEST LAMAR STREET
AMERICUS
,
GA
31709
NONE
PC
COMMUNITY SERVICE
1,000
HEALTHCARE FOR THE HOMELESS
421 FALLSWAY
BALTIMORE
,
MD
21202
NONE
PC
COMMUNITY SERVICE
5,000
HEARTLAND HOPE MISSION
2021 U ST
OMAHA
,
NE
68107
NONE
PC
COMMUNITY SERVICE
2,000
HEMOPHILIA FOUNDATION OF MICHIGAN
1921 W MICHIGAN AVE
YPSILANTI
,
MI
48197
NONE
PC
MEDICAL
500
HOME OF THE INNOCENTS
1100 E MARKET ST
LOUISVILLE
,
KY
40206
NONE
PC
COMMUNITY SERVICE
2,500
HOUSE OF RUTH
607 EAST ST CATHERINE STREET
LOUISVILLE
,
KY
40203
NONE
PC
COMMUNITY SERVICE
2,500
HOUSE OF SHINE
334 S BARTON ST
GRAPEVINE
,
TX
76051
NONE
PC
COMMUNITY SERVICE
2,500
HUMANE SOCIETY FOR HAMILTON COUNTY
1721 PLEASANT ST
NOBLESVILLE
,
IN
46060
NONE
PC
COMMUNITY SERVICE
1,000
HY-VEE SANFORD LEGENDS
2210 W PENTAGON PL
SIOUX FALLS
,
SD
57107
NONE
PC
COMMUNITY SERVICE
2,500
INDIANA AIDS FUND INC
429 E VERMONT ST
INDIANAPOLIS
,
IN
46202
NONE
PC
MEDICAL
750
INDIANAPOLIS MUSEUM OF ART
4000 MICHIGAN RD
INDIANAPOLIS
,
IN
46208
NONE
PC
EDUCATION
500
INDIANAPOLIS SYMPHONY ORCHESTRA
32 E WASHINGTON ST
INDIANAPOLIS
,
IN
46204
NONE
PC
EDUCATION
500
JONATHANS PLACE
6065 DUCK CREEK DR
GARLAND
,
TX
75043
NONE
PC
COMMUNITY SERVICE
2,500
KENTUCKY HARVEST
7705 NATIONAL TURNPIKE
LOUISVILLE
,
KY
40214
NONE
PC
COMMUNITY SERVICE
1,000
KENTUCKY STATE TREASURER
PUBLIC PROTECTION CABINET
FRANKFORT
,
KY
40601
NONE
PC
COMMUNITY SERVICE
10,000
KIDS IN NEED OF A DIFFERENCE
209 MORTON LANE
WINTER SPRINGS
,
FL
32708
NONE
PC
COMMUNITY SERVICE
2,000
KROGER CO ZERO HUNGER ZERO WASTE FOUNDATION
1014 VINE ST
CINCINNATI
,
OH
45202
NONE
PC
COMMUNITY SERVICE
3,000
LEUKEMIA & LYMPHOMA SOCIETY
PO BOX 22446
NEW YORK
,
NY
10006
NONE
PC
MEDICAL
5,000
LOUISVILLE URBAN LEAGUE
1535 W BROADWAY
LOUISVILLE
,
KY
40203
NONE
PC
COMMUNITY SERVICE
2,500
LOVE CITY INC
344 N 26TH ST
LOUISVILLE
,
KY
40212
NONE
PC
COMMUNITY SERVICE
1,000
MAKE A WISH FOUNDATION FL
4491 S STATE RD 7
FT LAUDERDALE
,
FL
33314
NONE
PC
MEDICAL
5,000
MAKE A WISH FOUNDATION NEBRASKA
4742 N 24TH STREET SUITE 400
PHOENIX
,
AZ
85016
NONE
PC
COMMUNITY SERVICE
500
MARINE CORPS LEAGUE #770
PO BOX 711
MT AIRY
,
MD
21771
NONE
PC
COMMUNITY SERVICE
1,000
MARINE TOYS FOR TOTS FOUNDATION
18251 QUANTICO GATEWAY DRIVE
TRIANGLE
,
VA
22172
NONE
PC
COMMUNITY SERVICE
5,000
MOUNT VERNON LADIES ASSOCIATION
3200 MOUNT VERNON MEMORIAL HIGHWAY
ALEXANDRIA
,
VA
22121
NONE
PC
COMMUNITY SERVICE
5,000
MUHAMMAD ALI CENTER
144 N 6TH STREET
LOUISVILLE
,
KY
40202
NONE
PC
COMMUNITY SERVICE
10,000
NEW ORLEANS CULINARY & HOSPITALITY INSTITUTE
1527 THIRD ST
NEW ORLEANS
,
LA
70130
NONE
PC
COMMUNITY SERVICE
200,000
NICHOLLS CULINARY INSTITUTE
PO BOX 2074
THIBODAUX
,
LA
70301
NONE
PC
EDUCATION
10,000
NO MORE EMPTY POTS
8511 N 30TH STREET
OMAHA
,
NE
68112
NONE
PC
COMMUNITY SERVICE
1,500
NON COMMISSIONED OFFICERS ASSOCIATION
9330 CORPORATE DRIVE
SELMA
,
TX
78154
NONE
PC
COMMUNITY SERVICE
500
NORTH DAKOTA FOP
PO BOX 711
FARGO
,
ND
58102
NONE
PC
COMMUNITY SERVICE
250
OKLAHOMA CITY POLICE ATHLETIC LEAGUE
1925 DOWNING STREET
OKLAHOMA CITY
,
OK
73120
NONE
PC
COMMUNITY SERVICE
6,500
OLD NEWS BOYS OF FLINT
6255 TAYLOR DR
FLINT
,
MI
48507
NONE
PC
COMMUNITY SERVICE
500
OMAHA POLICE OFFICERS ASSOCIATION
13445 CRYER AVE
OMAHA
,
NE
68144
NONE
PC
COMMUNITY SERVICE
1,100
OPERATION HOMEFRONT
1355 CENTRAL PARKWAY S
SAN ANTONIO
,
TX
78232
NONE
PC
COMMUNITY SERVICE
1,000
PARKLAND CARES INC
5769 W SUNRISE BLVD
FORT LAUDERDALE
,
FL
33311
NONE
PC
COMMUNITY SERVICE
1,200
PFLAG OMAHA
PO BOX 390064
OMAHA
,
NE
68101
NONE
PC
COMMUNITY SERVICE
650
PROVINCE OF ST JOSEPH OF THE CAPUCHIN ORDER INC
1820 MT ELLIOT ST
DETROIT
,
MI
48207
NONE
PC
COMMUNITY SERVICE
1,500
RILEY'S CHILDREN FOUNDATION
30 SOUTH MERIDIAN
INDIANAPOLIS
,
IN
46204
NONE
PC
MEDICAL
250
RNDC RELIEF FUND
1 NATIONAL DRIVE
ATLANTA
,
GA
30336
NONE
PC
COMMUNITY SERVICE
100,500
RONALD MCDONALD HOUSE CHARITIES OF RICHMOND
2330 MONUMENT AVENUE
RICHMOND
,
VA
23220
NONE
PC
COMMUNITY SERVICE
2,500
RONALD MCDONALD HOUSE DETROIT
4707 ST ANTOINE ST
DETROIT
,
MI
48201
NONE
PC
COMMUNITY SERVICE
1,000
RUGERIO PROMISE FOUNDATION
2220 N CANTON CENTER
CANTON
,
MI
48178
NONE
PC
COMMUNITY SERVICE
500
SIOUX FALLS ARE HUMANE SOCIETY
3720 E BENSON RD
SIOUX FALLS
,
SD
57104
NONE
PC
ANIMAL SHELTER
450
SOS CHILDREN'S VILLAGES
3681 NW 59TH PLACE
COCNUT CREEK
,
FL
33073
NONE
PC
COMMUNITY SERVICE
5,000
SPECIAL OLYMPICS
PO BOX 8483
OMAHA
,
NE
68108
NONE
PC
COMMUNITY SERVICE
500
STEPHEN CENTER
2723 Q STREET
OMAHA
,
NE
68107
NONE
PC
COMMUNITY SERVICE
1,500
STUDENT LEADERSHIP NETWORK
322 8TH AVENUE
NEW YORK
,
NY
10001
NONE
PC
EDUCATION
5,000
SYCAMORE FOUNDATION
8688 RUFFIAN LANE
NEWBURG
,
IN
47630
NONE
PC
COMMUNITY SERVICE
500
TENACIOUSLY TEAL
720 WEST WUKSHIRE BLVD
OKLAHOMA CITY
,
OK
73116
NONE
PC
COMMUNITY SERVICE
1,000
TEXAS RANGERS BASEBALL FOUNDATION
1000 BALLPARK WAY
ARLINGTON
,
TX
76011
NONE
PC
COMMUNITY SERVICE
5,000
THE BANQUET
900 E 8TH ST
SIOUX FALLS
,
SD
57103
NONE
PC
COMMUNITY SERVICE
1,500
THE BERNIE GRACE FOUNDATION
14926 MOSS ARCH
SAN ANTONIO
,
TX
78232
NONE
PC
COMMUNITY SERVICE
500
THE CONDUCTIVE EDUCATION CENTER OF METRO DETRIOT
2500 42153 BLAIRMOUNT DR
STERLING HTS
,
MI
48313
NONE
PC
EDUCATION
2,500
THE DELEUZE FAMILY CHARITABLE FUND
8383 SILVERADO TRAIL
NAPA
,
CA
94558
NONE
PC
COMMUNITY SERVICE
5,000
THE RAINBOW CONNECTION
621 W UNIVERSITY
ROCHESTER
,
MI
48307
NONE
PC
COMMUNITY SERVICE
1,800
THE RICHMOND FISHER HOUSE
5012 MONUMENT AVE
RICHMOND
,
VA
23230
NONE
PC
COMMUNITY SERVICE
2,000
THE SPIRIT HUB INDEPENDENT DISTILLERY PRESERVATION
6428 NORTH RIDGEWAY AVE
LINCOLNWOOD
,
IL
60712
NONE
PC
COMMUNITY SERVICE
5,000
THE TREVOR PROJECT
PO BOX 69232
WEST HOLLYWOOD
,
CA
90046
NONE
PC
COMMUNITY SERVICE
1,600
THE VETERANS HONOR FLIGHT OF NDNM
PO BOX 644
WEST FARGO
,
ND
58078
NONE
PC
COMMUNITY SERVICE
1,000
THEODORE ROOSEVELT MEDORA FOUNDATION
PO BOX 1696
BISMARCK
,
ND
58502
NONE
PC
COMMUNITY SERVICE
1,000
TODAY'S HARBOR FOR CHILDREN
514 BAYRIDGE RD
LA PORTE
,
TX
77571
NONE
PC
COMMUNITY SERVICE
1,500
TOUR DE KOMEN INC
7400 STAMFORD CT
FISHERS
,
IN
46038
NONE
PC
COMMUNITY SERVICE
3,000
TOYS FOR TOTS
PO BOX 303
LAKELAND
,
FL
33802
NONE
PC
COMMUNITY SERVICE
1,000
TYLER ALITZ MEMORIAL FUND
6339 N 105TH ST
OMAHA
,
NE
68124
NONE
PC
COMMUNITY SERVICE
1,000
UCP OF CENTRAL FLORIDA
3305 S ORANGE AVE
ORLANDO
,
FL
32806
NONE
PC
MEDICAL
73,000
UJA-FEDERATION OF NEW YORK
130 E 59TH STREET
NEW YORK
,
NY
10022
NONE
PC
RELIGIOUS
50,000
UNDERDOG FOUNDATION
102 S MAIN AVE
WAGNER
,
SD
57380
NONE
PC
COMMUNITY SERVICE
500
UNIVERSITY OF THE INCARNATE WORD
4301 BROADWAY
SAN ANTONIO
,
TX
78209
NONE
PC
EDUCATIONAL
2,500
UNIVERSITY OF TX AT AUSTIN GIFT OP
PO BO 7458
AUSTIN
,
TX
73301
NONE
PC
EDUCATION
25,000
UTSA
1 UTSA CIRCLE
SAN ANTONIO
,
TX
78249
NONE
PC
EDUCATION
1,000
VARIETY - THE CHILDREN'S CHARITY
505 5TH AVE
DES MOINES
,
IA
50309
NONE
PC
COMMUNITY SERVICE
1,000
VIRGINIA PENINSULA FOODBANK
2401 ALUMINUM AVE
HAMPTON
,
VA
23661
NONE
PC
COMMUNITY SERVICE
1,500
WHEELER MISSION
205 E NEW YORK ST
INDIANAPOLIS
,
IN
46204
NONE
PC
COMMUNITY SERVICE
500
WINGS FOR LIFE
1630 STEWART ST
SANTA MONICA
,
CA
90404
NONE
PC
MEDICAL
2,000
WOMEN OF THE VINE
417 WASHINGTON ST
TAPPAN
,
NY
10983
NONE
PC
COMMUNITY SERVICE
10,000
WOUNDED WARRIOR PROJECTS
4899 BELFORT ROAD STE 300
JACKSONVILLE
,
FL
32256
NONE
PC
COMMUNITY SERVICE
1,500
YOUNG LEADERSHIP COUNCIL
PO BOX 56909
NEW ORLEANS
,
LA
70156
NONE
PC
COMMUNITY SERVICE
7,500
YWCA CASS CLAY
3000 S UNIVERSITY DR
FARGO
,
ND
58103
NONE
PC
COMMUNITY SERVICE
2,000
Total
.................................
3a
964,750
b
Approved for future payment
Total
.................................
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.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
14
414
4
Dividends and interest from securities
....
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not 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
414
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
414
(See worksheet in line 13 instructions to verify calculations.)
Part XV-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
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?
...........
Yes
No
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.
May the IRS discuss this return
with the preparer shown below?
See instructions.
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's EIN
Firm's address
Phone no.
Form
990-PF
(2021)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description
-
TIN:
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Attach to Form 990, 990-EZ, or 990-PF.
Go to
www.irs.gov/Form990
for the latest information.
OMB No. 1545-0047
20
21
Name of the organization
REPUBLIC NATIONAL DISTRIBUTING COMPANY
FOUNDATION INC
Employer identification number
45-3842838
Organization type
(check one):
Filers of:
Section:
Form 990 or 990-EZ
501(c)(
) (enter number) organization
4947(a)(1) nonexempt charitable trust
not
treated as a private foundation
527 political organization
Form 990-PF
501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501(c)(3) taxable private foundation
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
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.
Special Rules
For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33
1
/3
% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of
(1)
$5,000 or
(2)
2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000
exclusively
for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions
exclusively
for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an
exclusively
religious, charitable, etc., purpose. Don't complete any of the parts unless the
General Rule
applies to this organization because it received
nonexclusively
religious, charitable, etc., contributions totaling $5,000 or more during the year
.........
$
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. 30613X
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page
2
Name of organization
REPUBLIC NATIONAL DISTRIBUTING COMPANY
FOUNDATION INC
Employer identification number
45-3842838
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
REPUBLIC NATIONAL DISTRIBUTING CO LLC
ONE NATIONAL DRIVE
ATLANTA
,
GA
30336
$
900,000
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page
3
Name of organization
REPUBLIC NATIONAL DISTRIBUTING COMPANY
FOUNDATION INC
Employer identification number
45-3842838
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
REPUBLIC NATIONAL DISTRIBUTING COMPANY
FOUNDATION INC
Employer identification number
45-3842838
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.)
$
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:
-
TIN:
TY 2021 OtherExpensesSchedule
Name:
REPUBLIC NATIONAL DISTRIBUTING COMPANY
FOUNDATION INC
EIN:
45-3842838
Description
Revenue and Expenses per Books
Net Investment Income
Adjusted Net Income
Disbursements for Charitable Purposes
BANK CHARGES
1,130
1,130
0
-
TIN:
TY 2021 SubstantialContributorsSch
Name:
REPUBLIC NATIONAL DISTRIBUTING COMPANY
FOUNDATION INC
EIN:
45-3842838
Name
Address
REPUBLIC NATIONAL DISTRIBUTING CO
ONE NATIONAL DRIVE
ATLANTA
,
GA
30336