Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
right arrowDo not enter social security numbers on this form as it may be made public.
right arrowGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
For calendar year 2022, or tax year beginning 01-01-2022 , and ending 12-31-2022
Name of foundation
THE BLACKHORSE FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)454 SOUTH MAIN STREET
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WILKESBARRE, PA18701
A Employer identification number

23-2725907
B Telephone number (see instructions)

(570) 822-1151
C right arrow
G Check all that apply:

D 1. Foreign organizations, check here............. right arrow
2. Foreign organizations meeting the 85%
test, check here and attach computation ... right arrow
E right arrow
H Check type of organization:
F right arrow
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)right arrow$8,298,904J 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)  
2 Check right arrow.............
3 Interest on savings and temporary cash investments 516 516  
4 Dividends and interest from securities... 203,919 203,919  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 233,316
b Gross sales price for all assets on line 6a 320,575
7 Capital gain net income (from Part IV, line 2)... 233,316
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........ 437,751 437,751  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0   0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)...        
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment
List of Attached Documents:
// Content
3,492 3,492   0
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 3,492 3,492   0
25 Contributions, gifts, grants paid....... 260,350 260,350
26 Total expenses and disbursements. Add lines 24 and 25 263,842 3,492   260,350
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 173,909
b Net investment income (if negative, enter -0-) 434,259
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2022)
Form 990-PF (2022)
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......... 167,342 478,010 478,010
3 Accounts receivable right arrow  
Less: allowance for doubtful accounts right arrow        
4 Pledges receivable right arrow  
Less: allowance for doubtful accounts right arrow        
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) right arrow  
Less: allowance for doubtful accounts right arrow        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)....... 1,137,267 Click to see attachment
List of Attached Documents:
// Content
1,073,332 		7,820,894
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
15 Other assets (describe right arrow)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,304,609 1,551,342 8,298,904
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe right arrow)    
23 Total liabilities (add lines 17 through 22)......... 0 0
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here right arrow
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 right arrow
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........ 0 0
27 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
28 Retained earnings, accumulated income, endowment, or other funds 1,304,609 1,551,342
29 Total net assets or fund balances (see instructions)..... 1,304,609 1,551,342
30 Total liabilities and net assets/fund balances (see instructions). 1,304,609 1,551,342
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............
1
1,304,609
2
Enter amount from Part I, line 27a .....................
2
173,909
3
Other increases not included in line 2 (itemize) right arrowClick to see attachment
List of Attached Documents:
// Content
3
72,824
4
Add lines 1, 2, and 3 ..........................
4
1,551,342
5
Decreases not included in line 2 (itemize) right arrow
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
1,551,342
Form 990-PF (2022)
Form 990-PF (2022)
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 2000 FORD MOTOR CO D 2011-08-08 2022-03-14
b 2550 WENDYS CO D 2012-03-09 2022-03-14
c 166 CDK GLOBAL D 2006-02-16 2022-03-14
d 833 CORTEVA D 2009-03-12 2022-03-14
e 1327 DELL TECH D 2008-07-21 2022-03-14
3000 FORD MOTOR CO D 2010-01-06 2022-03-14
85 LAS VEGAS SANDS D 2009-04-20 2022-03-14
584 VMWARE INC P 2008-07-21 2022-03-14
PASS THRU-ENERGY TRANSFER D 2012-03-26 2022-12-31
PASS THRU-ENERGY TRANSFER D 2012-03-26 2022-12-31
CAPITAL GAINS DIVIDENDS P    
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a 31,525   20,020 11,505
b 53,554   12,355 41,199
c 7,881   2,574 5,307
d 45,125   2,852 42,273
e 67,745   7,695 60,050
47,288   33,390 13,898
2,789   354 2,435
63,349   8,019 55,330
254     254
1,044     1,044
21     21
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       11,505
b       41,199
c       5,307
d       42,273
e       60,050
      13,898
      2,435
      55,330
      254
      1,044
      21
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 2 233,316
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 (2022)
Form 990-PF (2022)
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 right arrow 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) 1 6,036
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 6,036
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 6,036
6 Credits/Payments:
a 2022 estimated tax payments and 2021 overpayment credited to 2022 6a 3,900
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 3,900
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2221 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......right arrow 9 2,136
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...right arrow 10  
11 Enter the amount of line 10 to be: Credited to 2023 estimated taxright arrow   Refundedright arrow 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. right arrow$ 0(2) On foundation managers.right arrow$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.right arrow$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
Yes
 
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
Yes
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
round bullet By language in the governing instrument, or
round bullet 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)
right arrowPA
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 2022 or the taxable year beginning in 2022? 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 (2022)
Form 990-PF (2022)
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 addressright arrowN/A
14
The books are in care ofright arrowRONALD W SIMMS Telephone no.right arrow (570) 822-1151

Located atright arrow454 MAIN STREETWILKESBARREPA ZIP+4right arrow18701
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........right arrow
and enter the amount of tax-exempt interest received or accrued during the year ........right arrow
15
 
16 At any time during calendar year 2022, 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 right arrow
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 ........right arrow
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 2022? .............
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 2022, did the foundation have any undistributed income (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2022?....................
2a
 
No
If "Yes," list the years right arrow20, 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.
right arrow20, 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 2022 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 2022.) .....................
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 2022? ..
4b
 
No
Form 990-PF (2022)
Form 990-PF (2022)
Page 6
Part VI-B
Statements Regarding Activities for Which Form 4720 May Be Required (continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
5a(1)
 
No
(2) Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive? ....................
5a(2)
 
No
(3) Provide a grant to an individual for travel, study, or other similar purposes? .............
5a(3)
 
No
(4) Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions ........................
5a(4)
 
No
(5) Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals? .............
5a(5)
 
No
b
If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........
5b
 
 
c
Organizations relying on a current notice regarding disaster assistance check .........right arrow
d
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant? .................
5d
 
 
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract? .............................
6a
 
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
6b
 
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
7a
 
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....
7b
 
 
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year? .........................
8
 
No
Part VII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a) Name and address (b) Title, and average
hours per week
devoted to position 		(c) Compensation
 (If not paid, enter
-0-) 		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
other allowances
RONALD W SIMMS PRESIDENT
5.00 		0 0 0
454 SOUTH MAIN STREET
WILKESBARRE,PA18701
RHEA P SIMMS SECRETARY
5.00 		0 0 0
454 SOUTH MAIN STREET
WILKESBARRE,PA18701
RICHARD A ROSE TREASURER
5.00 		0 0 0
454 SOUTH MAIN STREET
WILKESBARRE,PA18701
2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a) Name and address of each employee paid more than $50,000 (b) Title, and average
hours per week
devoted to position 		(c) Compensation (d) Contributions to
employee benefit
plans and deferred
compensation 		(e) Expense account,
other allowances
NONE
Total number of other employees paid over $50,000...................right arrow 0
Form 990-PF (2022)
Form 990-PF (2022)
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.............right arrow0
Part VIII-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
1  
2  
3  
4  
Part VIII-B
Summary of Program-Related Investments (see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
1 N/A 0
2  
All other program-related investments. See instructions.
3  
Total. Add lines 1 through 3.........................right arrow0
Form 990-PF (2022)
Form 990-PF (2022)
Page 8
Part IX
Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities...................
1a
7,938,334
b
Average of monthly cash balances.......................
1b
471,579
c
Fair market value of all other assets (see instructions)................
1c
0
d
Total (add lines 1a, b, and c).........................
1d
8,409,913
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
8,409,913
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
126,149
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
8,283,764
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
414,188
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
414,188
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
6,036
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
1,104
c
Add lines 2a and 2b............................
2c
7,140
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
407,048
4
Recoveries of amounts treated as qualifying distributions................
4
0
5
Add lines 3 and 4............................
5
407,048
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
407,048
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
260,350
b
Program-related investments—total from Part VIII-B..................
1b
0
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
260,350
Form 990-PF (2022)
Form 990-PF (2022)
Page 9
Part XII
Undistributed Income (see instructions)
(a)
Corpus 		(b)
Years prior to 2021 		(c)
2021 		(d)
2022
1 Distributable amount for 2022 from Part X, line 7 407,048
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2021 only....... 0
b Total for prior years:20, 20, 20 0
3 Excess distributions carryover, if any, to 2022:
a From 2017......  
b From 2018......  
c From 2019......  
d From 2020...... 80,481
e From 2021...... 91,764
f Total of lines 3a through e ........ 172,245
4Qualifying distributions for 2022 from Part
XI, line 4: right arrow$ 260,350
a Applied to 2021, 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 2022 distributable amount..... 260,350
e Remaining amount distributed out of corpus 0
5 Excess distributions carryover applied to 2022. 146,698 146,698
(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 25,547
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 2021. Subtract line
4a from line 2a. Taxable amount—see
instructions ............. 		0
f Undistributed income for 2022. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2023 .......... 		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 2017 not
applied on line 5 or line 7 (see instructions) ... 		0
9 Excess distributions carryover to 2023.
Subtract lines 7 and 8 from line 6a ...... 		25,547
10 Analysis of line 9:
a Excess from 2018....  
b Excess from 2019....  
c Excess from 2020....  
d Excess from 2021.... 25,547
e Excess from 2022....  
Form 990-PF (2022)
Form 990-PF (2022)
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 2022, enter the date of the ruling ...... right arrow
 
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 IX for each
year listed .......... 		Tax year Prior 3 years (e) Total
(a) 2022 (b) 2021 (c) 2020 (d) 2019
         
b 85% (0.85) of line 2a .........          
c Qualifying distributions from Part XI,
line 4 for each year listed ..... 		         
d Amounts included in line 2c not used directly
for active conduct of exempt activities .......... 		         
e Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c .... 		         
3 Complete 3a, b, or c for the
alternative test relied upon:
a “Assets" alternative test—enter:
(1) Value of all assets ......          
(2) Value of assets qualifying
under section 4942(j)(3)(B)(i)		          
b “Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part IX, line 6 for each year listed .. 		         
c “Support" alternative test—enter:
(1) Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties) .... 		         
(2) Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii).... 		         
(3) Largest amount of support
from an exempt organization		          
(4) Gross investment income          
Part XIV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1Information Regarding Foundation Managers:
aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
RONALD W SIMMS
RHEA P SIMMS
RICHARD A ROSE
bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here right arrow
aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
bThe form in which applications should be submitted and information and materials they should include:
cAny submission deadlines:
dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form 990-PF (2022)
Form 990-PF (2022)
Page 11
Part XIV
Supplementary Information (continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
 Foundation
status of
recipient 		Purpose of grant or
contribution 		Amount
Name and address (home or business)
aPaid during the year

ADOPT A FAMILY OF THE PALM BEACHES

1712 2ND AVE N
LAKE WORTH,FL33460 		NONE PUBLIC CHARITABLE 1,000

ALLIED SERVICES FOUNDATION-STEVE DAVISOVITZ-RYANS RUN

100 ABINGTON IND PARK
CLARKS SUMMIT,PA18411 		NONE PUBLIC CHARITABLE 100

ALZHEIMER'S FOUNDATION OF AMERICA-IMO MIRTA ACOSTA

322 8TH AVE 16TH FL
NEW YORK,NY10001 		NONE PUBLIC CHARITABLE 250

AMERICA 250 PA

2 N MAIN ST
PITTSTON,PA18640 		NONE PUBLIC CHARITABLE 10,000

AMERICAN CANCER SOCIETY

71 N FRANKLIN ST STE 110
WILKESBARRE,PA18701 		NONE PUBLIC CHARITABLE 1,000

ANNUNCIATION GREEK ORTHODOX CHURCH

32 E ROSS ST
WILKESBARRE,PA18701 		NONE PUBLIC CHARITABLE 1,000

ARTHRITIS FOUNDATION

57 N FRANKLIN ST
WILKESBARRE,PA18701 		NONE PUBLIC CHARITABLE 100

BACK MOUNTAIN MEMORIAL LIBRARY

96 HUNTSVILLE RD
DALLAS,PA18612 		NONE PUBLIC CHARITABLE 100

BAPS ENDOWMENT-SWAMINARAYAN SANSTHA

PO BOX 60
WINDSOR,CT06095 		NONE PUBLIC CHARITABLE 5,000

BRIDGEWATER CHURCH

2 CHURCH ST
TUNKHANNOCK,PA18657 		NONE PUBLIC CHARITABLE 500

CASA OF LUZERNE COUNTY

667 N RIVER ST
PLAINS,PA18705 		NONE PUBLIC CHARITABLE 5,000

CENTER FOR EXCELLENCE IN EDUCATION

8201 GREENSBORO DR STE 215
MCLEAN,VA22102 		NONE PUBLIC CHARITABLE 10,000

CITY OF WILKES-BARRE-ST PATRICK'S DAY PARADE

40 E MARKET ST
WILKESBARRE,PA18711 		NONE PUBLIC CHARITABLE 1,000

CITY OF WILKES-BARRE-4TH OF JULY CELEBRATION

40 E MARKET ST
WILKESBARRE,PA18711 		NONE PUBLIC CHARITABLE 1,000

CITY OF WILKES-BARRE-SANTA PARADE

40 E MARKET ST
WILKESBARRE,PA18711 		NONE PUBLIC CHARITABLE 1,000

COLONIAL WILLIAMSBURG

PO BOX 1776
WILLIAMSBURG,VA23187 		NONE PUBLIC CHARITABLE 1,000

EASTERN PRELACY OF ARMENIAN APOSTOLIC CHURCH

138 E 39TH ST
NEW YORK,NY10016 		NONE PUBLIC CHARITABLE 250

FM KIRBY CENTER FOR THE PERFORMING ARTS

71 PUBLIC SQUARE
WILKESBARRE,PA18702 		NONE PUBLIC CHARITABLE 1,000

FINE ARTS FIESTA

PO BOX 2053
WILKESBARRE,PA18701 		NONE PUBLIC CHARITABLE 1,000

FORK OVER LOVE

345 MARKET ST
KINGSTON,PA18704 		NONE PUBLIC CHARITABLE 500

FRANKLIN & MARSHALL

415 HARRISBURG AVE
LANCASTER,PA17603 		NONE PUBLIC CHARITABLE 1,000

GEISINGER COMMONWEALTH SCHOOL OF MEDICINE

325 PINE ST
SCRANTON,PA18509 		NONE PUBLIC CHARITABLE 5,000

GOLFING FOR GRIFFIN FOUNDATION

53 DARO RD
HUNTINGTON MILLS,PA18622 		NONE PUBLIC CHARITABLE 1,000

GOOD SHEPHERD ACADEMY-ENDOWMENT OF THE ARTS

316 N MAPLE AVE
KINGSTON,PA18704 		NONE PUBLIC CHARITABLE 1,500

HABITAT FOR HUMANITY

303 MARKET ST
KINGTSON,PA18704 		NONE PUBLIC CHARITABLE 100

HENRY CANCER CENTER AT GEISINGER-IMO KAREN MEDURA

1000 E MOUNTAIN DR
WILKESBARRE,PA18702 		NONE PUBLIC CHARITABLE 250

HOSPITAL FOR SPECIAL SURGERY HSS FOUNDATION

535 E 70TH ST
NEW YORK,NY10021 		NONE PUBLIC CHARITABLE 2,500

JOHNS HOPKINS INSTITUTIONS

600 N WOLFE ST
BALTIMORE,MD21287 		NONE PUBLIC CHARITABLE 1,000

KEYSTONE MISSION

PO BOX 470
SCRANTON,PA18501 		NONE PUBLIC CHARITABLE 250

KIDNEY CANCER ASSOCIATION-IMO JOSEPH GLOWATCH

PO BOX 676226
DALLAS,TX77526 		NONE PUBLIC CHARITABLE 500

KINGS COLLEGE

133 N RIVER ST
WILKESBARRE,PA18711 		NONE PUBLIC CHARITABLE 5,000

KINGSTON POLICE DEPARTMENT

500 WYOMING AVE
KINGSTON,PA18704 		NONE PUBLIC CHARITABLE 1,000

KINGSTON FIRE DEPARTMENT

600 WYOMING AVE
KINGSTON,PA18704 		NONE PUBLIC CHARITABLE 1,000

LUZERNE COUNTY HISTORICAL SOCIETY

49 S FRANKLIN ST
WILKESBARRE,PA18701 		NONE PUBLIC CHARITABLE 100

MEALS ON WHEELS

190 S SPRAGUE AVE
KINGSTON,PA18704 		NONE PUBLIC CHARITABLE 1,000

MISERICORDIA UNIVERSITY

301 LAKE ST
DALLAS,PA18612 		NONE PUBLIC CHARITABLE 5,000

MOVING RIVER MINISTRIES

453 S MAIN ST
WILKESBARRE,PA18702 		NONE PUBLIC CHARITABLE 500

NATIONAL CENTRE FOR PADRE PIO INC

PO BOX 206
BARTO,PA19504 		NONE PUBLIC CHARITABLE 1,000

NORTH BRANCH LAND TRUST

11 CARVERTON RD
TRUCKSVILLE,PA18708 		NONE PUBLIC CHARITABLE 1,000

NORTHEASTERN PA PHILHARMONIC-IMO MARLENE LYONS

PO BOX 4525
SCRANTON,PA18505 		NONE PUBLIC CHARITABLE 250

NORTHWEST QUARTERBACK CLUB

PO BOX 6
SHICKSHINNY,PA18655 		NONE PUBLIC CHARITABLE 500

OSTERHOUT LIBRARY-IMO JOSEPH PASTERNAK

71 S FRANKLIN ST
WILKESBARRE,PA18702 		NONE PUBLIC CHARITABLE 100

OSTERHOUT LIBRARY

71 S FRANKLIN ST
WILKESBARRE,PA18702 		NONE PUBLIC CHARITABLE 500

OUR LADY OF GOOD COUNSEL

611 KNOWLES AVE
SOUTHHAMPTON,PA18966 		NONE PUBLIC CHARITABLE 1,000

PA STATE POLICE TROOP P CAMP CADET

PO BOX 4005
WYOMING,PA18644 		NONE PUBLIC CHARITABLE 250

POTTSVILLE HIGH SCHOOL-IMO CONNIE & JACK MCDONALD

16TH ST ELK
POTTSVILLE,PA17901 		NONE PUBLIC CHARITABLE 250

RIVERFRONT PARKS COMMITTEE

57 N FRANKLIN ST
WILKESBARRE,PA18701 		NONE PUBLIC CHARITABLE 35,000

SS PETER & PAUL FOOD PANTRY

13 HUDSON RD
PLAINS,PA18705 		NONE PUBLIC CHARITABLE 1,000

ST JUDE CHILDRENS RESEARCH HOSPITAL

501 ST JUDE PLACE
MEMPHIS,TN38105 		NONE PUBLIC CHARITABLE 5,000

ST JUDE CHILDRENS RESEARCH HOSPITAL-IMO JOHN MOSES

501 ST JUDE PLACE
MEMPHIS,TN38105 		NONE PUBLIC CHARITABLE 1,000

ST JOSEPH MARELLO PARISH

237 WILLIAMS ST
PITTSTON,PA18640 		NONE PUBLIC CHARITABLE 1,000

ST MARY'S ANTIOCHIAN CHURCH-IMO JPSEPH MORRASH

905 S MAIN ST
WILKESBARRE,PA18702 		NONE PUBLIC CHARITABLE 1,000

ST NICHOLASST MARY'S CHURCH

250 S WASHINGTON ST
WILKESBARRE,PA18702 		NONE PUBLIC CHARITABLE 10,000

ST PATRICK'S CHURCH

242 S 20TH ST
PHILADELPHIA,PA19103 		NONE PUBLIC CHARITABLE 2,500

THE LANDS AT HILLSIDE FARMS

65 HILLSIDE RD
TRUCKSVILLE,PA18708 		NONE PUBLIC CHARITABLE 1,000

THE LUZERNE FOUNDATION-HOMETOWN HEROES 5K

34 S RIVER ST
WILKESBARRE,PA18702 		NONE PUBLIC CHARITABLE 1,000

THE LUZERNE FOUNDATION-IMO AVA FELLERMAN

34 S RIVER ST
WILKESBARRE,PA18702 		NONE PUBLIC CHARITABLE 500

THE ROONEY GOLF FOUNDATION

1111 N CONGRESS AVE
WEST PALM BEACH,FL33409 		NONE PUBLIC CHARITABLE 1,000

TRINITY COLLEGE OF DUBLIN

GRAFTON ST COLLEGE GREEN
  DUBLIN  
EI 		NONE PUBLIC CHARITABLE 10,000

UNITED WAY OF WYOMING VALLEY

100 N PENNSYLVANIA AVE 2ND FL
WILKESBARRE,PA18701 		NONE PUBLIC CHARITABLE 2,500

VOLUNTEERS IN MEDICINE

190 N PENNSYLVANIA AVE
WILKESBARRE,PA18701 		NONE PUBLIC CHARITABLE 1,000

WILKES UNIVERSITY

84 W SOUTH ST
WILKESBARRE,PA18766 		NONE PUBLIC CHARITABLE 30,000

WILKES UNIVERSITY-IMO ESTHER DAVIDOVITZ

84 W SOUTH ST
WILKESBARRE,PA18766 		NONE PUBLIC CHARITABLE 1,000

WILKES UNIVERSITY-PSC SCHOLARSHIP

84 W SOUTH ST
WILKESBARRE,PA18766 		NONE PUBLIC CHARITABLE 50,000

WILKES UNIVERSITY-SORDONI ART

141 S MAIN ST
WILKESBARRE,PA18701 		NONE PUBLIC CHARITABLE 30,000

WOMEN IN AVIATION NEPA CHAPTER

2001 WYOMING AVE
KINGSTON,PA18704 		NONE PUBLIC CHARITABLE 1,000

WYOMING SEMINARY-IMO MARCELL ISCOVITZ

201 N SPRAGUE AVE
KINGSTON,PA18704 		NONE PUBLIC CHARITABLE 250

WYOMING SEMINARY-IMO PAULA DALEY

201 N SPRAGUE AVE
KINGSTON,PA18704 		NONE PUBLIC CHARITABLE 1,000

WYOMING VALLEY ART LEAGUE

130 S FRANKLIN ST
WILKESBARRE,PA18701 		NONE PUBLIC CHARITABLE 1,000

WYOMING VALLEY CHILDREN ASSOCIATION

1135 WYOMING AVE
FORTY FORT,PA18704 		NONE PUBLIC CHARITABLE 250
Total .................................right arrow 3a 260,350
bApproved for future payment
Total ................................. right arrow 3b 0
Form 990-PF (2022)
Form 990-PF (2022)
Page 12
Part XV-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
Related or exempt
function income
(See instructions.)
1Program service revenue: (a)
Business code 		(b)
Amount 		(c)
Exclusion code 		(d)
Amount
a
b
c
d
e
f
gFees and contracts from government agencies          
2 Membership dues and assessments ....          
3 Interest on savings and temporary cash
investments ........... 		    14 516  
4 Dividends and interest from securities ....     14 203,919  
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 ............ 		    18 233,316  
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) .. 0 437,751 0
13Total. Add line 12, columns (b), (d), and (e)..................
13
437,751
(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 (2022)
Form 990-PF (2022)
Page 13
Part XVI
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
1
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Yes
No
a
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1) Cash...................................
1a(1)
 
No
(2) Other assets.................................
1a(2)
 
No
b
Other transactions:
(1) Sales of assets to a noncharitable exempt organization....................
1b(1)
 
No
(2) Purchases of assets from a noncharitable exempt organization..................
1b(2)
 
No
(3) Rental of facilities, equipment, or other assets.......................
1b(3)
 
No
(4) Reimbursement arrangements...........................
1b(4)
 
No
(5) Loans or loan guarantees.............................
1b(5)
 
No
(6) Performance of services or membership or fundraising solicitations................
1b(6)
 
No
c
Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
1c
 
No
d
If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
(a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
2a
Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
b
If "Yes," complete the following schedule.

(a) Name of organization (b) Type of organization (c) Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
right arrow right arrow
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 Check if self-
employed right arrow		 PTIN
Firm's name SmallBullet
 Firm's EIN SmallBullet
Firm's address SmallBullet


 Phone no.
Form 990-PF (2022)
Additional Data


Software ID:  
Software Version:  


Form 990PF - Special Condition Description:
Special Condition Description

TY 2022 InvestmentsCorpStockSchedule
Name:
THE BLACKHORSE FOUNDATION
EIN:
23-2725907
Name of Stock End of Year Book Value End of Year Fair Market Value
M&T BANK CORP 96,811 1,689,949
AMERICA MOVIL 39,543 1,274,000
INGERSOLL RAND 12,358 92,169
AIR PRODUCTS 307,324 1,541,300
CA WATER SERVICE GROUP 52,100 181,920
QUALCOMM 36,917 109,940
CCNFB 34,029 46,000
PROCTOR AND GAMBLE 54,630 151,560
ENERGY TRANSFER LP 135,825 1,305,700
AECOM 9,287 38,303
PHILLIPS 66 9,509 41,632
COMMUNITY BANK SYST 19,782 256,647
L3 TECHNOLOGIES 137,524 541,346
UGI CORP NEW 35,023 46,338
WP CAREY INC 13,191 60,176
TRANE TECHNOLOGIES 42,636 336,180
MORGAN STANLEY 14,129 85,020
AMERICA MOVIL DIVIDEND IN TRANSIT 22,714 22,714

TY 2022 OtherExpensesSchedule
Name:
THE BLACKHORSE FOUNDATION
EIN:
23-2725907
Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
OFFICE EXPENSE 992 992   0
PROFESSIONAL FEES 2,500 2,500   0


TY 2022 OtherIncreasesSchedule
Name:
THE BLACKHORSE FOUNDATION
EIN:
23-2725907
Description Amount
BOOK DIFFERENCE IN BASIS OF INVESTMENTS 72,824