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
HARVEY SAMUELSEN SCHOLARSHIP TRUST
 
Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 1464
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
DILLINGHAM, AK995761464
A Employer identification number

30-0065137
B Telephone number (see instructions)

(907) 842-4370
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$17,904,495
J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books
(b) Net investment
income
(c) Adjusted net
income
(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 526,072
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 277,056 277,056  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 821,712
b Gross sales price for all assets on line 6a 6,288,892
7 Capital gain net income (from Part IV, line 2)... 821,712
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)....... 100 40  
12 Total. Add lines 1 through 11........ 1,624,940 1,098,808  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 11,291 5,646   5,645
14 Other employee salaries and wages...... 28,806 0   29,541
15 Pension plans, employee benefits....... 4,271 0   4,275
16a Legal fees (attach schedule)......... 514 0   514
b Accounting fees (attach schedule)....... 10,750 0   10,500
c Other professional fees (attach schedule).... 61,047 61,047   0
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... 15,026 0   3,062
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... 92,216 6,463   86,050
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 223,921 73,156   139,587
25 Contributions, gifts, grants paid....... 734,600 773,600
26 Total expenses and disbursements. Add lines 24 and 25 958,521 73,156   913,187
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 666,419
b Net investment income (if negative, enter -0-) 1,025,652
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......... 141,861 198,117 198,117
3 Accounts receivable bullet39,158
Less: allowance for doubtful accounts bullet   11,547 39,158 39,158
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.......... 270 8,828 8,828
10a Investments—U.S. and state government obligations (attach schedule) 855,539 Click to see attachment751,448 751,448
b Investments—corporate stock (attach schedule)....... 13,537,781 Click to see attachment14,998,143 14,998,143
c Investments—corporate bonds (attach schedule)....... 1,477,679 Click to see attachment1,891,244 1,891,244
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 0 Click to see attachment6,293 6,293
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment14,361 Click to see attachment11,264 Click to see attachment11,264
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 16,039,038 17,904,495 17,904,495
Liabilities 17 Accounts payable and accrued expenses.......... 16,681 14,160
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons 167,695 575,752
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22)......... 184,376 589,912
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........... 15,854,662 17,314,583
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........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 15,854,662 17,314,583
30 Total liabilities and net assets/fund balances (see instructions). 16,039,038 17,904,495
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
15,854,662
2
Enter amount from Part I, line 27a .....................
2
666,419
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
793,502
4
Add lines 1, 2, and 3 ..........................
4
17,314,583
5
Decreases not included in line 2 (itemize) bullet
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
17,314,583
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 PUBLICLY TRADED SECURITIES      
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 6,288,892   5,467,180 821,712
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       821,712
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
Bracket 2 821,712
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 14,257
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 14,257
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 23,085
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 10,000
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 33,085
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 18,828
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet18,828 RefundedBullet 11 0
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
  • that conflict with the state law remain in the governing instrument?................
    6
    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)
    bulletAK
    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 addressbulletWWW.BBEDC.COM
    14
    The books are in care ofbulletSTACI FIESER CFO Telephone no.bullet (907) 842-4370

    Located atbullet411 FIRST AVE EASTDILLINGHAMAK ZIP+4bullet995761464
    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)
    Yes
     
    (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
     
    No
    c
    ........bullet
    d
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2021? .............
    1d
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2021.) .....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
    Yes
     
    (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
    .........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
    MARY ANN K JOHNSON PRESIDENT
    0.10
    2,250 0 0
    PO BOX 1464
    DILLINGHAM,AK995761464
    FRITZ SHARP VICE PRESIDENT
    0.10
    2,250 0 0
    PO BOX 1464
    DILLINGHAM,AK995761464
    MICHAEL GOTTSCHALK BOARD MEMBER
    0.10
    2,500 0 0
    PO BOX 1464
    DILLINGHAM,AK995761464
    GERDA KOSBRUK TREASURER
    0.10
    1,166 0 0
    PO BOX 1464
    DILLINGHAM,AK995761464
    KENNETH JENSEN SECRETARY - PART YEAR
    0.10
    1,000 0 0
    PO BOX 1464
    DILLINGHAM,AK995761464
    H ROBIN SAMUELSEN JR EX-OFFICIO BOARD MEMBER
    0.10
    1,125 0 0
    PO BOX 1464
    DILLINGHAM,AK995761464
    HARRY W WASSILY SR SECRETARY
    0.10
    1,000 0 0
    PO BOX 1464
    DILLINGHAM,AK995761464
    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 SCHOLARSHIP PROGRAM PROVIDING SCHOLARSHIPS TO RESIDENTS OF THE 17 BRISTOL BAY CDQ COMMUNITIES TO ATTEND ACCREDITED COLLEGES; IN 2021, 60 INDIVIDUALS RECEIVED SCHOLARSHIPS. 884,806
    2 ACADEMIC SUPPORT PROGRAM PROVIDING CAMPUS SUPPORT TO STUDENTS AT UAF, UAA, AND FORT LEWIS COLLEGE AND OFFERING TUTORING SERVICES TO SCHOLARSHIP RECIPIENTS. 28,381
    3  
    4  
    Part VIII-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    17,011,977
    b
    Average of monthly cash balances.......................
    1b
    144,469
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    17,156,446
    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
    17,156,446
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    257,347
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    16,899,099
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    844,955
    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
    844,955
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    14,257
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    14,257
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    830,698
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    11,547
    5
    Add lines 3 and 4............................
    5
    842,245
    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
    842,245
    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 7 842,245
    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...... 11,781
    d From 2019......  
    e From 2020......  
    f Total of lines 3a through e ........ 11,781
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 913,187
    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..... 842,245
    e Remaining amount distributed out of corpus 70,942
    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 82,723
    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 ......
    82,723
    10 Analysis of line 9:
    a Excess from 2017....  
    b Excess from 2018.... 11,781
    c Excess from 2019....  
    d Excess from 2020....  
    e Excess from 2021.... 70,942
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2021, enter the date of the ruling ....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........
    Tax year Prior 3 years (e) Total
    (a) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    line 4 for each year listed .....
             
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........
             
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....
             
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)
             
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part IX, line 6 for each year listed ..
             
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....
             
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....
             
    (3) Largest amount of support
    from an exempt organization
             
    (4) Gross investment income          
    Part XIV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    BRISTOL BAY ECONOMIC DEVELOPMENT CO
    PO BOX 1464
    DILLINGHAM,AK995761464
    (907) 842-4370
    bThe form in which applications should be submitted and information and materials they should include:
    SEE APPLICATION FORM LOCATED AT HTTPS://WWW.BBEDC.COM/?PAGE_ID=151
    cAny submission deadlines:
    SEE APPLICATION FORM LOCATED AT HTTPS://WWW.BBEDC.COM/?PAGE_ID=151
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    SEE APPLICATION FORM LOCATED AT HTTPS://WWW.BBEDC.COM/?PAGE_ID=151
    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
    PANSY ALAKAYAK
    PO BOX 56
    MANOKOTAK,AK99628
    NONE I EDUCATIONAL SCHOLARSHIP 17,600
    LOGAN BALL
    PO BOX 4
    ALEKNAGIK,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    HILDE BALL
    PO BOX 4
    ALEKNAGIK,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    ALESSANDRA BAVILLA
    PO BOX 758
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    HANNAH BERKOSKI
    PO BOX 1296
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    MOLLY BERKOSKI
    PO BOX 1296
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    MIKAYLA BINDON
    PO BOX 75
    NAKNEK,AK99633
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    LYDIA BINDON
    PO BOX 75
    NAKNEK,AK99633
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    NAIYA BURGRAFF
    PO BOX 380
    KING SALMON,AK99613
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    JENICE COX
    PO BOX 985
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    MICALISHA DELANO
    PO BOX 1236
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    BRITNEY DRAY
    PO BOX 457
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    SYDNEY DRAY
    PO BOX 457
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    CASEY DSCHAAK
    PO BOX 1414
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    CARLY ELDRIDGE
    PO BOX 377
    KING SALMON,AK99613
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    TREVOR FARNSWORTH
    PO BOX 1211
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    JADEN FROST
    PO BOX 176
    TOGIAK,AK99678
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    SARAH FULLER
    PO BOX 913
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    BRISTOL GEORGE
    PO BOX 736
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    BRITNEY GEORGE
    PO BOX 736
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    LUCY GOODE
    PO BOX 296
    KING SALMON,AK99613
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    SHARON HANSEN
    PO BOX 414
    KING SALMON,AK99613
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    KALEB HILL
    PO BOX 534
    NAKNEK,AK99633
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    LOGAN ITO
    PO BOX 558
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    EKO JOHNSON
    PO BOX 105
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    JESSICA JONES
    PO BOX 386
    TOGIAK,AK99678
    NONE I EDUCATIONAL SCHOLARSHIP 17,600
    JEAN KRAUSE
    PO BOX 917
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    SUE LEE
    PO BOX 1214
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    AMBER LOGAN
    PO BOX 552
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    KAYLEE LOPEZ
    PO BOX 797
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    ASHLYN LUCKHURST
    PO BOX 643
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    ANGELICA MARX
    PO BOX 1361
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    ADAM MEAD
    PO BOX 1017
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 17,600
    SARAH MITCHELL
    PO BOX 232
    KING SALMON,AK99613
    NONE I EDUCATIONAL SCHOLARSHIP 17,600
    DENALI MOORCROFT
    PO BOX 44
    KING SALMON,AK99613
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    KATIE MOORE
    PO BOX 1129
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    SILAS NEWMAN
    PO BOX 845
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    LIEUA NICK
    PO BOX 110
    MANOKOTAK,AK99628
    NONE I EDUCATIONAL SCHOLARSHIP 4,600
    CAITLIN O'CONNOR
    PO BOX 1256
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    SHARADON O'CONNOR
    PO BOX 1256
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    TEYA OLSEN
    PO BOX 135
    NAKNEK,AK99633
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    KEESHA PAUL
    PO BOX 184
    MANOKOTAK,AK99628
    GRANDDAUGHTER OF BOARD MEMBER I EDUCATIONAL SCHOLARSHIP 4,600
    ESTHER PEPIN
    PO BOX 323
    KING SALMON,AK99613
    NONE I EDUCATIONAL SCHOLARSHIP 2,300
    LOGAN PHELPS
    PO BOX 135
    NAKNEK,AK99633
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    CONNOR ROMER
    PO BOX 623
    NAKNEK,AK99633
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    VIRGINIA ROQUE
    PO BOX 724
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    SAWYER SANDS
    PO BOX 1011
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    SADIE SANDS
    PO BOX 1101
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    TORIN SCHROEDER
    PO BOX 1435
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    TIERA SCHROEDER
    PO BOX 1435
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    KIMBERLY SEYBERT
    PO BOX 384
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    JENNIFER SHRYOCK
    PO BOX 137
    NAKNEK,AK99633
    DAUGHTER OF BOARD MEMBER I EDUCATIONAL SCHOLARSHIP 17,600
    MARY SWAIN
    PO BOX 265
    KING SALMON,AK99613
    NONE I EDUCATIONAL SCHOLARSHIP 6,500
    ABIGAIL SWANSON
    PO BOX 501
    NAKNEK,AK99633
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    BRYN TENNYSON
    PO BOX 167
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    LYNN VAN VACTOR
    PO BOX 391
    DILLINGHAM,AK99576
    SPOUSE OF BBEDC OFFICER I EDUCATIONAL SCHOLARSHIP 13,000
    ABBEY WHITCOMB
    PO BOX 548
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    THERESA WILLIAMS
    PO BOX 653
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    BRYANT WOMACK
    PO BOX 664
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 13,000
    TRYSH WOMACK
    PO BOX 664
    DILLINGHAM,AK99576
    NONE I EDUCATIONAL SCHOLARSHIP 17,600
    Total .................................bullet 3a 773,600
    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 ...........
             
    4 Dividends and interest from securities ....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6 Net rental income or (loss) from personal property          
    7 Other investment income .....          
    8 Gain or (loss) from sales of assets other than
    inventory ............
        18 821,712  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aBOOK SALE REVENUE
        05 60  
    bMISCELLANEOUS     01 40  
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 0 1,098,868 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    1,098,868
    (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
    Yes
     
    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
    1c 0 BRISTOL BAY ECONOMIC DEVELOPMENT CORP JOINT ACTIVITIES & SHARING RESOURCES
    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
    BRISTOL BAY ECONOMIC DEVELOPMENT CORP 501(C)(4) ENTITIES ARE RELATED AND HAVE COMMON CONTROL
    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
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
     
    Employer identification number

    30-0065137
    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
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
     
    Employer identification number
    30-0065137
    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
    BRISTOL BAY ECONOMIC DEVELOPMENT CORPORATION
     
    PO BOX 1464
     
    DILLINGHAM, AK995761464

    $ 126,072


    (Complete Part II for noncash contributions.)
    (a)
    No.
    (b)
    Name, address, and ZIP + 4
    (c)
    Total contributions
    (d)
    Type of contribution
    2
    ARCTIC STORM MANAGEMENT GROUP LLC
     
    2727 ALASKAN WAY PIER 69
     
    SEATTLE, WA98103

    $ 400,000


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

    $  


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

    $  


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

    $  


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

    $  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 3
    Name of organization
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
     
    Employer identification number

    30-0065137
    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
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
     
    Employer identification number

    30-0065137
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No. from Part I
    (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I
    (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I
    (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I
    (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990) (2021)
    Additional Data


    Software ID:  
    Software Version:  

    TY 2021 AccountingFeesSchedule
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEES 10,750 0   10,500

    TY 2021 InvestmentsCorpBondsSchedule
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    Name of Bond End of Year Book Value End of Year Fair Market Value
    AIR LEASE 12,269 12,269
    AMER AXLE & MANF 8,627 8,627
    AMERICAN EXPRESS 10,018 10,018
    ARES CAPITAL 7,985 7,985
    AT&T 10,675 10,675
    AT&T 10,582 10,582
    BANK OF AMERICA 7,079 7,079
    BANK OF AMERICA 13,681 13,681
    BANK OF AMERICA 26,578 26,578
    BENCHMARK 25,939 25,939
    BOEING 12,000 12,000
    BROADCOM 15,542 15,542
    BROADSTONE 8,745 8,745
    CAN FINANCIAL 14,351 14,351
    CAPITAL ONE 45,590 45,590
    CAPITAL ONE 19,915 19,915
    CAPITAL ONE FINANCIAL 21,754 21,754
    CARMAX 9,850 9,850
    CARMAX 25,672 25,672
    CD COMMERCIAL 22,622 22,622
    CENTENE 11,863 11,863
    CIT GROUP 8,453 8,453
    CITIGROUP 24,273 24,273
    CITIGROUP 13,205 13,205
    CITIGROUP 17,851 17,851
    CITIGROUP 13,126 13,126
    CITIGROUP COMMERCIAL 31,509 31,509
    CNO FINL GROUP 11,494 11,494
    COMM MORTGAGE TRUST 15,267 15,267
    COMM MORTGAGE TRUST 10,492 10,492
    COMM MORTGAGE TRUST 31,628 31,628
    COMM MORTGAGE TRUST 20,928 20,928
    COMM MORTGAGE TRUST 31,558 31,558
    CORP OFFICE PPTY 11,945 11,945
    CORP OFFICE PPTY 10,119 10,119
    CORP OFFICE PPTY 11,736 11,736
    CSAIL 16,054 16,054
    DANA INC 10,973 10,973
    DELL INTL 15,034 15,034
    DELL INTL 5,001 5,001
    DISCOVER 5,004 5,004
    DISH 13,342 13,342
    DUKE ENERGY 13,546 13,546
    EDISON 16,349 16,349
    EDISON 8,449 8,449
    ENERGY TRANSFER 10,601 10,601
    ENERGY TRANSFER 5,166 5,166
    EPR PROPERTIES 6,061 6,061
    EPR PROPERTIES 7,456 7,456
    EQUIFAX 13,441 13,441
    FHLMC 36,465 36,465
    FIRST AMERICAN FINANCIAL 4,383 4,383
    FLEX LTD 11,351 11,351
    FNMA 45,949 45,949
    FNMA 42,329 42,329
    FNMA 24,657 24,657
    FNMA 59,427 59,427
    FNMA 18,722 18,722
    FNMA 55,154 55,154
    FNMA 78,464 78,464
    FORD CR 20,102 20,102
    GENERAL MOTORS 11,743 11,743
    GM FIN 14,897 14,897
    GM FIN 4,946 4,946
    GOLDMAN SACHS 25,574 25,574
    GS MORTGAGE 20,837 20,837
    HALLIBURTON 12,946 12,946
    HCA 10,501 10,501
    HONDA AUTO 19,627 19,627
    HOST HOTELS 6,121 6,121
    HOST HOTELS 3,864 3,864
    HUDSON PACIFIC 16,081 16,081
    HUDSON PACIFIC 15,576 15,576
    HUDSON PACIFIC 10,172 10,172
    HYATT 9,552 9,552
    JP MORGAN CHASE 14,734 14,734
    JPMORGAN CHASE 9,079 9,079
    JPMORGAN CHASE 9,975 9,975
    JPMORGAN CHASE 2,010 2,010
    LIFESTORAGE 15,532 15,532
    MICRON TECH 12,213 12,213
    MYLAN 13,517 13,517
    NASDAQ 10,625 10,625
    NORFOLK SOUTHERN 17,051 17,051
    OCCIDENTAL PET 8,820 8,820
    ONE GAS 11,987 11,987
    ONEMAIN FINANCIAL 12,854 12,854
    ORACLE SYS 9,915 9,915
    PACIFIC GAS & ELEC 12,000 12,000
    PBF HOLDING 6,425 6,425
    PRIMERICA 13,131 13,131
    PRUDENTIAL 11,212 11,212
    RETAIL PPTYS 11,072 11,072
    SAN DIEGO GAS 13,380 13,380
    SEQUOIA MORTGAGE TRUST 14,941 14,941
    SOUTHERN CO 5,000 5,000
    SOUTHERN CO 9,402 9,402
    SOUTHWEST AIRLINES 14,871 14,871
    SOVRAN 12,843 12,843
    SPIRIT REALTY 8,796 8,796
    SUNOCO 8,124 8,124
    SYSCO 17,143 17,143
    TEVA PHARM 20,680 20,680
    TMOBILE 9,045 9,045
    US BANCORP 10,804 10,804
    VALERO 17,550 17,550
    VERISIGN 11,426 11,426
    VERIZON 29,613 29,613
    VERIZON 38,285 38,285
    VERIZON 20,032 20,032
    VMWARE 13,073 13,073
    WELLS FARGO 16,282 16,282
    WELLS FARGO 11,169 11,169
    WELLS FARGO 15,271 15,271
    WESTLAKE CHEM 7,650 7,650
    XLIT 11,929 11,929
    ZIMMER BIOMET 20,945 20,945

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    Name of Stock End of Year Book Value End of Year Fair Market Value
    ACCENTURE 92,859 92,859
    ADVANCED MICRO DEVICES INC 18,419 18,419
    AERCAP HOLDINGS 18,710 18,710
    AFFIRM HLDGS INC COM CL A 7,039 7,039
    AIA GROUP 32,622 32,622
    AKZO NOBEL 42,986 42,986
    ALCON 48,265 48,265
    ALPHABET 147,573 147,573
    ALPHABET INC CL C 164,935 164,935
    AMAZON.COM 93,362 93,362
    AMAZON.COM INC 160,048 160,048
    ANTHEM 48,208 48,208
    AON 58,006 58,006
    APPLE INC 120,925 120,925
    ASHTEAD 66,742 66,742
    ASML HLDG NV SPON ADR 13,534 13,534
    ASSA ABLOY 44,619 44,619
    BROOKFIELD ASSET MGMT 76,562 76,562
    CAMECO CORP 28,440 28,440
    CAPITAL ONE 21,764 21,764
    CARNIVAL CORP 13,521 13,521
    CARVANA 15,762 15,762
    CHIPOTLE MEXICAN GRILL INC 17,483 17,483
    CITIGROUP 55,378 55,378
    CLOSE BROS 26,904 26,904
    COCA COLA 37,753 37,753
    COMCAST 59,893 59,893
    COSTAR GROUP INC 6,559 6,559
    CREDICORP 33,203 33,203
    DANAHER CORP 19,412 19,412
    DASSAULT SYSTEMS 67,737 67,737
    DBS GROUP 39,626 39,626
    DISH NETWORK 24,557 24,557
    DOCUSIGN INC 4,874 4,874
    DOLLAR GEN CORP NEW 10,141 10,141
    DOORDASH INC CL A 10,125 10,125
    ELI LILLY CO 19,059 19,059
    ERSTE GROUP BANK 37,786 37,786
    EVOLUTION AB 8,435 8,435
    EXPERIAN 46,450 46,450
    FANUC 39,897 39,897
    FISERV INC 7,784 7,784
    GENERAL MOTORS 27,615 27,615
    GENL ELEC CO 6,518 6,518
    GENL ELECTRIC 55,926 55,926
    GLAXO SMITHKLINE 45,820 45,820
    GOLDMAN SACHS GROUP 16,067 16,067
    GOLDMAN SACHS GROUP 61,208 61,208
    HARDING LOEVNER INTERNATIONAL EQUITY 1,619,765 1,619,765
    HCA HEALTHCARE 14,387 14,387
    HEINEKEN 42,808 42,808
    HILTON WORLDWIDE 48,045 48,045
    ING GROEP 60,997 60,997
    INTUIT 29,588 29,588
    INTUITIVE SURGICAL 26,948 26,948
    INVESCO DEVELOPING MARKETS FUND CLASS Y 1,220,111 1,220,111
    ISHARES BROAD USD HIGH YIELD BOND ETF 526,120 526,120
    ISHARES CORE U.S. AGGREGATE BOND ETF 874,423 874,423
    KDDI CORP 35,482 35,482
    KUBOTA 41,225 41,225
    LIBERTY BROADBAND 72,817 72,817
    LULULEMON ATHLETICA 11,744 11,744
    LVMH 48,326 48,326
    LYONDELLBASELL INDUSTRIES 12,636 12,636
    MAGNA 50,911 50,911
    MARRIOTT INTL 64,609 64,609
    MARUI 28,927 28,927
    MASTERCARD 26,949 26,949
    META PLATFORMS 106,623 106,623
    META PLATFORMS 100,569 100,569
    MICHELIN 48,037 48,037
    MICROSOFT 171,187 171,187
    MICROSOFT 139,573 139,573
    MONGODB 13,234 13,234
    MORGAN STANLEY 59,387 59,387
    NASPERS 5,642 5,642
    NETFLIX 68,076 68,076
    NETFLIX 26,507 26,507
    NIDEC 55,302 55,302
    NIKE 12,500 12,500
    NOVARTIS 29,565 29,565
    NVIDIA 51,764 51,764
    OTSUKA 24,802 24,802
    PAM PAC 30,940 30,940
    PAYPAL 14,144 14,144
    PIMCO INCOME FUND CLASS I 691,783 691,783
    PIMCO SHORT ASSET INVESTMENT FUND CLASS INST 219,419 219,419
    PINTEREST 7,779 7,779
    PROSUS 13,537 13,537
    RECKITT BENCKISER 29,243 29,243
    RENTOKIL 44,665 44,665
    ROPER TECH 7,378 7,378
    ROSS STORES 11,199 11,199
    S&P GLOBAL 9,911 9,911
    SAFRAN 36,830 36,830
    SAFRAN 20,526 20,526
    SCHWAB CHARLES CORP 8,831 8,831
    SEA LTD 23,266 23,266
    SERVICENOW 35,701 35,701
    SHOPIFY 15,151 15,151
    SNAP 20,975 20,975
    SONY 80,138 80,138
    SQUARE 10,660 10,660
    STRYKER 12,301 12,301
    SYMRISE 40,814 40,814
    SYNOPSIS 17,320 17,320
    TESLA 41,214 41,214
    THERMO FISHER SCIENTIFIC 10,008 10,008
    TOTALENERGIES 32,594 32,594
    UNILEVER 32,758 32,758
    UNITEDHEALTH 63,772 63,772
    UNITEDHEALTH 28,120 28,120
    VANGUARD S&P 500 ETF 3,161,203 3,161,203
    VANGUARD TOTAL INTL STOCK INDEX FUND ETF 1,224,040 1,224,040
    VIRTUS KAR SMALL-CAP CORE FUND CLASS I 941,724 941,724
    VISA 38,357 38,357
    VISA 16,253 16,253
    WALLS FARGO 39,871 39,871
    WALT DISNEY CO 23,698 23,698
    WILLIS TOWERS WATSON 21,849 21,849
    WOODWARD 9,304 9,304
    ZOETIS 12,446 12,446
    ZOOM VIDEO 7,724 7,724

    TY 2021 InvestmentsGovtObligationsSch
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    US Government Securities - End of Year Book Value:

    710,178
    US Government Securities - End of Year Fair Market Value:

    710,178
    State & Local Government Securities - End of Year Book Value:


    41,270
    State & Local Government Securities - End of Year Fair Market Value:


    41,270


    TY 2021 InvestmentsOtherSchedule2
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    RENAISANCE HOLDINGS CL G AT COST 6,293 6,293

    TY 2021 LegalFeesSchedule
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES 514 0   514


    TY 2021 OtherAssetsSchedule
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ACCRUED INTEREST 14,361 11,264 11,264


    TY 2021 OtherExpensesSchedule
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACADEMIC SUPPORT 3,768 0   4,065
    BBEDC ADMINISTRATIVE CHARGE 87,138 6,463   80,675
    INSURANCE 376 0   376
    ADVERTISING 934 0   934


    TY 2021 OtherIncomeSchedule2
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    BOOK SALE REVENUE 60   60
    MISCELLANEOUS 40 40 40


    TY 2021 OtherIncreasesSchedule
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    Description Amount
    NET CHANGE UNRLZD GAIN ON INV 793,502


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT MANAGEMENT FEES 61,047 61,047   0


    TY 2021 TaxesSchedule
    Name:
    HARVEY SAMUELSEN SCHOLARSHIP TRUST
    EIN:
    30-0065137
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXCISE TAXES 12,058 0   0
    PAYROLL TAXES 2,968 0   3,062