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 10-01-2021 , and ending 09-30-2022
Name of foundation
GEORGIA BLOSSER TRUST
 
Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 0634
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MILWAUKEE, WI532010634
A Employer identification number

43-6018191
B Telephone number (see instructions)

(314) 418-2643
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$4,570,754
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)  
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 151,736 151,515  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 419,599
b Gross sales price for all assets on line 6a 2,684,235
7 Capital gain net income (from Part IV, line 2)... 419,599
8 Net short-term capital gain......... 0
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)....... 2,578 2,578  
12 Total. Add lines 1 through 11........ 573,913 573,692  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 41,904 37,713   4,190
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule).........       0
b Accounting fees (attach schedule)....... 2,500 0 0 2,500
c Other professional fees (attach schedule).... 2,140 2,140   0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... 15,482 5,957   0
19 Depreciation (attach schedule) and depletion... 0 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......   0 0  
22 Printing and publications..........   0 0  
23 Other expenses (attach schedule)....... 650 601   49
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 62,676 46,411 0 6,739
25 Contributions, gifts, grants paid....... 295,728 295,728
26 Total expenses and disbursements. Add lines 24 and 25 358,404 46,411 0 302,467
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 215,509
b Net investment income (if negative, enter -0-) 527,281
c Adjusted net income (if negative, enter -0-)... 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.............   186 186
2 Savings and temporary cash investments......... 102,008 20,953 20,953
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
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 bullet0      
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)....... 2,997,065 Click to see attachment1,840,194 2,169,379
c Investments—corporate bonds (attach schedule)....... 865,816    
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 466,699 Click to see attachment2,785,598 2,380,236
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 4,431,588 4,646,931 4,570,754
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22).........   0
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions...........    
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........ 4,431,588 4,646,931
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)..... 4,431,588 4,646,931
30 Total liabilities and net assets/fund balances (see instructions). 4,431,588 4,646,931
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
4,431,588
2
Enter amount from Part I, line 27a .....................
2
215,509
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
4,647,097
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
166
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
4,646,931
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 1. BANK OF NEW YORK MELLON CORP   1911-11-11 2021-10-01
b 1. BANK OF NEW YORK MELLON CORP   1911-11-11 2021-10-01
c 1028. ASE TECHNOLOGY HOLDING CO LTD A D R   2021-07-27 2021-10-11
d 17. ASTELLAS PHARMA INC A D R   2018-07-31 2021-10-11
e 277. GERDAU S A SPON A D R   2021-07-27 2021-10-11
169. KONINKLIJKE PHILIPS ELECTRS SPONSORED ADR NEW 2000   2021-07-27 2021-10-11
48. STMICROELECTRONICS N V   2021-08-12 2021-10-11
8. TOKYO ELECTRON LTD ADR   2021-07-27 2021-10-11
34. WNS HOLDINGS LTD ADR   2016-01-11 2021-10-11
3.99996 ASML HOLDING NV NY REG SHS   2021-09-13 2021-10-11
4.00004 ASML HOLDING NV NY REG SHS   2021-09-13 2021-10-11
153.00046 ABB LTD A D R     2021-10-25
28.99954 ABB LTD A D R   2021-07-27 2021-10-25
23. ASTELLAS PHARMA INC A D R   2021-07-27 2021-10-25
6. ASTELLAS PHARMA INC A D R   2018-07-31 2021-10-25
40. DASSAULT SYSTEMES S.A. SPA ADR   2021-10-11 2021-10-25
1515. GERDAU S A SPON A D R   2021-07-27 2021-10-25
139. KONINKLIJKE PHILIPS ELECTRS SPONSORED ADR NEW 2000   2021-07-27 2021-10-25
88. NOVARTIS AG SPONSORED ADR   2021-07-27 2021-10-25
12. POSCO A D R     2021-10-25
131. ROYAL DUTCH SHELL PLC A D R   2021-09-27 2021-10-25
2. ASML HOLDING NV NY REG SHS   2021-08-30 2021-10-25
166. ABB LTD A D R     2021-11-05
12. ASTELLAS PHARMA INC A D R   2018-07-31 2021-11-05
256. B H P BILLITON PLC SPON A D R     2021-11-05
75. KONINKLIJKE PHILIPS ELECTRS SPONSORED ADR NEW 2000   2021-07-27 2021-11-05
40. NOVARTIS AG SPONSORED ADR   2021-07-27 2021-11-05
34. POSCO A D R   2021-07-27 2021-11-05
52. PANASONIC CORP A D R   2021-07-27 2021-11-05
8. SAP AKTIENGESELLSCHAFT SPONSORED ADR   2019-02-14 2021-11-05
170. SOFTBANK GROUP CORP UNSP A D R     2021-11-05
271. WIPRO LIMITED A D R   2021-07-27 2021-11-05
49. ACS ACTIVIDADES CONS UNS A D R   2017-05-19 2021-11-09
104. ALBEMARLE CORP   2020-04-23 2021-11-09
58. MICROSOFT CORP COM   2015-05-26 2021-11-09
1457.21 NUVEEN REAL ESTATE SECS I   2010-03-04 2021-11-09
78. ACCENTURE PLC CL A     2021-11-09
51. ABB LTD A D R   2021-07-27 2021-11-29
28. ASTELLAS PHARMA INC A D R   2018-07-31 2021-11-29
592. BARCLAYS PLC ADR     2021-11-29
.99539 DIAGEO PLC SPONSORED ADR NEW   2021-11-05 2021-11-29
5.00461 DIAGEO PLC SPONSORED ADR NEW   2021-11-05 2021-11-29
59.00336 EQUINOR ASA SPON ADR   2021-10-11 2021-11-29
47.99664 EQUINOR ASA SPON ADR   2021-10-11 2021-11-29
32. KONINKLIJKE PHILIPS ELECTRS SPONSORED ADR NEW 2000   2021-07-27 2021-11-29
96. NINTENDO LTD A D R   2021-07-27 2021-11-29
78. NOVARTIS AG SPONSORED ADR   2021-07-27 2021-11-29
28. POSCO A D R   2021-07-27 2021-11-29
51. SAP AKTIENGESELLSCHAFT SPONSORED ADR     2021-11-29
19. SUMITOMO MITSUI FINL GROUP A D R   2021-10-25 2021-11-29
15. WPP PLC SPON A D R   2021-09-27 2021-11-29
272. WIPRO LIMITED A D R   2021-07-27 2021-11-29
19. NOMAD FOODS LTD   2021-07-27 2021-11-29
1. TRINITY INDS INC   1911-11-11 2021-12-09
39. ASTELLAS PHARMA INC A D R   2018-07-31 2021-12-13
26. B A E SYSTEMS P L C A D R   2021-11-05 2021-12-13
14. DBS GROUP HLDGS LTD   2017-07-06 2021-12-13
185. NINTENDO LTD A D R   2021-07-27 2021-12-13
29. NOVARTIS AG SPONSORED ADR   2021-07-27 2021-12-13
49. POSCO A D R   2021-07-27 2021-12-13
16. ROCHE HLDG LTD SPONSORED ADR   2014-10-10 2021-12-13
3. SAP AKTIENGESELLSCHAFT SPONSORED ADR   2021-07-27 2021-12-13
410. SUMITOMO MITSUI FINL GROUP A D R   2021-10-25 2021-12-13
23. WPP PLC SPON A D R   2021-09-27 2021-12-13
16. ABB LTD A D R   2021-07-27 2022-01-14
16. ASTELLAS PHARMA INC A D R   2018-07-31 2022-01-14
5. B A E SYSTEMS P L C A D R   2021-11-05 2022-01-14
28. EQUINOR ASA SPON ADR   2021-10-25 2022-01-14
232. KONINKLIJKE PHILIPS ELECTRS SPONSORED ADR NEW 2000     2022-01-14
50. NINTENDO LTD A D R   2021-07-27 2022-01-14
43.00404 NOVARTIS AG SPONSORED ADR   2021-07-27 2022-01-14
7.99596 NOVARTIS AG SPONSORED ADR   2021-07-27 2022-01-14
29. POSCO A D R   2021-07-27 2022-01-14
18. SAP AKTIENGESELLSCHAFT SPONSORED ADR   2021-07-27 2022-01-14
30. SAP AKTIENGESELLSCHAFT SPONSORED ADR   2019-02-14 2022-01-14
24. WPP PLC SPON A D R   2021-08-12 2022-01-14
80. NOMAD FOODS LTD   2021-07-27 2022-01-14
27. CHECK POINT SOFTWARE TECH COM   2021-07-27 2022-01-14
44. ABB LTD A D R   2021-07-27 2022-01-31
11. CHINA PETROLEUM CHEM A D R   2021-10-11 2022-01-31
89. NINTENDO LTD A D R   2021-07-27 2022-01-31
28. POSCO A D R   2021-07-27 2022-01-31
32. PANASONIC CORP A D R   2021-07-27 2022-01-31
59. ROCHE HLDG LTD SPONSORED ADR     2022-01-31
2. TOKYO ELECTRON LTD ADR   2021-07-27 2022-01-31
27. WPP PLC SPON A D R     2022-01-31
35. ASML HOLDING NV NY REG SHS     2022-01-31
19. ABB LTD A D R   2021-07-27 2022-02-16
3. ADECCO GROUP AG A D R   2021-07-27 2022-02-16
19. ASTELLAS PHARMA INC A D R   2018-07-31 2022-02-16
58. CANON INC ADR REPSTG 5 SHS   2021-08-12 2022-02-16
22. ENDAVA PLC A D R   2021-11-29 2022-02-16
139. NOVO-NORDISK A S ADR     2022-02-16
6. POSCO A D R   2021-07-27 2022-02-16
50. PANASONIC CORP A D R   2021-07-27 2022-02-16
305. SUMITOMO MITSUI FINL GROUP A D R   2022-01-31 2022-02-16
16. TOKYO ELECTRON LTD ADR   2021-07-27 2022-02-16
10. WPP PLC SPON A D R     2022-02-16
24. ATLASSIAN CORP PLC CLASS A     2022-02-16
15. NOMAD FOODS LTD   2021-07-27 2022-02-16
21. CHECK POINT SOFTWARE TECH COM   2021-07-27 2022-02-16
14. INMODE LTD   2021-07-27 2022-02-16
69. ABB LTD A D R   2021-07-27 2022-03-03
2. ADECCO GROUP AG A D R   2021-07-27 2022-03-03
38. CANON INC ADR REPSTG 5 SHS     2022-03-03
76. CHINA PETROLEUM CHEM A D R     2022-03-03
91. CRITEO SA SPON A D R   2021-07-27 2022-03-03
1. DBS GROUP HLDGS LTD   2017-07-06 2022-03-03
52. GENMAB A S SP A D R     2022-03-03
62. NOKIA CORP SPSD A D R   2021-07-27 2022-03-03
25. POSCO A D R   2021-07-27 2022-03-03
129. PANASONIC CORP A D R   2021-07-27 2022-03-03
16. PETRO CHINA COMPANY LTD A D R   2021-10-11 2022-03-03
127. RELX PLC SPON A D R     2022-03-03
4. ROCHE HLDG LTD SPONSORED ADR   2022-01-30 2022-03-03
52. ROCHE HLDG LTD SPONSORED ADR     2022-03-03
48. WPP PLC SPON A D R     2022-03-03
24. ATLASSIAN CORP PLC CLASS A     2022-03-03
99. NOMAD FOODS LTD   2021-07-27 2022-03-03
6. CHECK POINT SOFTWARE TECH COM   2021-07-27 2022-03-03
78. INMODE LTD   2021-07-27 2022-03-03
8. ADECCO GROUP AG A D R   2021-07-27 2022-03-17
69.99991 CRH PLC ADR   2022-01-14 2022-03-17
17.00009 CRH PLC ADR   2022-01-14 2022-03-17
61. CANON INC ADR REPSTG 5 SHS   2021-07-27 2022-03-17
35. CHINA PETROLEUM CHEM A D R   2021-09-13 2022-03-17
12. DBS GROUP HLDGS LTD   2017-07-06 2022-03-17
54. DIAGEO PLC SPONSORED ADR NEW     2022-03-17
132. MIZUHO FNL GRP A D R   2021-07-27 2022-03-17
239. RELX PLC SPON A D R     2022-03-17
61. ROCHE HLDG LTD SPONSORED ADR     2022-03-17
2. TOKYO ELECTRON LTD ADR   2021-07-27 2022-03-17
10. UNITED OVERSEAS BK LTD SPON A D R   2021-07-27 2022-03-17
123. NOMAD FOODS LTD   2021-07-27 2022-03-17
22. CHECK POINT SOFTWARE TECH COM   2021-07-27 2022-03-17
149. ABB LTD A D R     2022-03-31
5. ADECCO GROUP AG A D R   2021-07-27 2022-03-31
197. CRH PLC ADR     2022-03-31
20. CANON INC ADR REPSTG 5 SHS   2021-07-27 2022-03-31
6. CHINA PETROLEUM CHEM A D R     2022-03-31
59. DIAGEO PLC SPONSORED ADR NEW   2022-01-31 2022-03-31
17. EQUINOR ASA SPON ADR   2022-03-17 2022-03-31
40. GENMAB A S SP A D R   2021-07-27 2022-03-31
5. INDUSTRIAS BACHOCO SAB DE CV A D R   2019-02-14 2022-03-31
4. POSCO A D R   2021-07-27 2022-03-31
7. SHINHAN FINANCIAL GROUP A D R   2022-01-14 2022-03-31
15. STMICROELECTRONICS N V   2022-01-31 2022-03-31
43. STMICROELECTRONICS N V   2022-01-14 2022-03-31
85. VALE SA SP A D R   2022-03-17 2022-03-31
234. VODAFONE GROUP PLC A D R   2022-03-03 2022-03-31
17. ADECCO GROUP AG A D R   2021-07-27 2022-04-19
13. DBS GROUP HLDGS LTD   2017-07-06 2022-04-19
19. DIAGEO PLC SPONSORED ADR NEW   2022-01-31 2022-04-19
34.01604 ENI S P A ADR     2022-04-19
25.98396 ENI S P A ADR   2022-03-03 2022-04-19
399.00061 ERICSSON LM TEL SP A D R   2021-12-13 2022-04-19
24.99939 ERICSSON LM TEL SP A D R   2021-12-13 2022-04-19
11. GENMAB A S SP A D R   2021-07-27 2022-04-19
4. HITACHI LTD ADR 10 COM   2021-11-05 2022-04-19
5. NOVO-NORDISK A S ADR   2021-08-12 2022-04-19
73. ROCHE HLDG LTD SPONSORED ADR   2014-10-10 2022-04-19
33. SILICON MOTION TECHNOLOGY CORP A D R   2021-07-27 2022-04-19
33. STMICROELECTRONICS N V   2022-01-31 2022-04-19
83. VODAFONE GROUP PLC A D R   2022-03-03 2022-04-19
6. ATLASSIAN CORP PLC CLASS A   2021-08-30 2022-04-19
1. FERGUSON PLC NEW SHS   2022-01-14 2022-04-19
.3176 WARNER BROS DISCOVERY INC SERIES A   2019-02-14 2022-04-26
910. AMERICAN CAMPUS COMMUNITIES     2022-04-28
1423.683 DOUBLELINE TOTAL RET BD I   2019-08-19 2022-04-28
8185.397 CONGRESS MID CAP GROWTH INS     2022-04-28
7079.839 ROWE T PRICE MID-CAP VALUE FD INC     2022-04-28
11687.419 TIAA CREF INFLATION LNKD BD FD ADV     2022-04-28
106. UNITEDHEALTH GRP INC COM     2022-04-28
340. LYONDELLBASELL INDUSTRIES CL A     2022-04-28
28. ASTELLAS PHARMA INC A D R   2018-07-31 2022-05-02
17. CANON INC ADR REPSTG 5 SHS   2021-07-27 2022-05-02
174. ENI S P A ADR     2022-05-02
357. ERICSSON LM TEL SP A D R     2022-05-02
38. GENMAB A S SP A D R   2021-07-27 2022-05-02
75. NOVARTIS AG SPONSORED ADR     2022-05-02
57. NOVO-NORDISK A S ADR     2022-05-02
42. P T TELEKOMUNIKASI INDONESIA A D R   2022-03-31 2022-05-02
131. SILICON MOTION TECHNOLOGY CORP A D R   2021-07-27 2022-05-02
7. TOKYO ELECTRON LTD ADR   2021-07-27 2022-05-02
1. BANK OF NEW YORK MELLON   1911-11-11 2022-05-05
5. ASTELLAS PHARMA INC A D R   2018-07-31 2022-05-17
5. CRITEO SA SPON A D R   2021-07-27 2022-05-17
7. DEUTSCHE POST AG A D R   2021-08-30 2022-05-17
38. GENMAB A S SP A D R   2021-07-27 2022-05-17
295. GERDAU S A SPON A D R   2022-05-02 2022-05-17
24. NOVARTIS AG SPONSORED ADR   2021-07-27 2022-05-17
119. ORANGE SPON A D R   2022-03-31 2022-05-17
12. P T TELEKOMUNIKASI INDONESIA A D R   2022-03-31 2022-05-17
110. RIO TINTO PLC SPONSORED ADR   2022-03-31 2022-05-17
31. SHINHAN FINANCIAL GROUP A D R     2022-05-17
23. SILICON MOTION TECHNOLOGY CORP A D R   2021-07-27 2022-05-17
21. STMICROELECTRONICS N V   2021-12-17 2022-05-17
18. STMICROELECTRONICS N V   2021-12-17 2022-05-17
10. TOKYO ELECTRON LTD ADR   2021-07-27 2022-05-17
11. FERGUSON PLC NEW SHS     2022-05-17
111. ZIM INTEGRATED SHIPPING SERVIC SHS     2022-05-17
21. ASTELLAS PHARMA INC A D R   2018-07-31 2022-06-03
34. CANON INC ADR REPSTG 5 SHS   2021-07-27 2022-06-03
91. CRITEO SA SPON A D R   2021-07-27 2022-06-03
167. ENI S P A ADR     2022-06-03
18. GENMAB A S SP A D R   2021-07-27 2022-06-03
412. MIZUHO FNL GRP A D R   2021-07-27 2022-06-03
40. P T TELEKOMUNIKASI INDONESIA A D R     2022-06-03
10. TOKYO ELECTRON LTD ADR   2021-07-27 2022-06-03
6. FERGUSON PLC NEW SHS     2022-06-03
97. INMODE LTD     2022-06-03
270. ATT INC   2019-02-14 2022-06-13
430. ABBVIE INC     2022-06-13
33. ALPHABET INC CL A     2022-06-13
201. AMAZON COM INC COM     2022-06-13
57. AMERICAN TOWER CORP     2022-06-13
496. BANK OF AMERICA CORP     2022-06-13
126. BOEING CO     2022-06-13
425. CITIGROUP INC     2022-06-13
1865. DELTA AIR LINES INC     2022-06-13
100. ECOLAB INC COM   2020-04-23 2022-06-13
272. FACEBOOK INC A   2020-04-23 2022-06-13
149. HOME DEPOT INC COM     2022-06-13
63. HONEYWELL INTERNATIONAL INC   2017-07-06 2022-06-13
570. HORMEL FOODS CORPORATIONCOM     2022-06-13
885. INTEL CORP     2022-06-13
75. JP MORGAN CHASE & CO COM   2016-02-29 2022-06-13
45. JOHNSON & JOHNSON   2019-02-14 2022-06-13
53. MASTERCARD INC     2022-06-13
29. MICROSOFT CORP COM   2015-05-26 2022-06-13
226. RINGCENTRAL INC   2020-04-23 2022-06-13
32. S P GLOBAL INC     2022-06-13
347. SPLUNK INC   2020-04-23 2022-06-13
448. TRADE DESK INC THE CLASS A   2020-04-23 2022-06-13
140. 3M CO COM     2022-06-13
58. TRANSDIGM GROUP INC   2020-04-23 2022-06-13
41. TYLER TECHNOLOGIES INC   2020-04-23 2022-06-13
142. UNITEDHEALTH GRP INC COM     2022-06-13
2755. VIATRIS INC     2022-06-13
49. VISA INC     2022-06-13
201. WAL MART STORES INC COM     2022-06-13
65. WARNER BROS DISCOVERY INC SERIES A   2019-02-14 2022-06-13
375. WESTERN DIGITAL CORP COM   2019-02-14 2022-06-13
85. CHUBB LTD     2022-06-13
13. DEUTSCHE POST AG A D R     2022-06-17
88. ENI S P A ADR   2021-10-25 2022-06-17
227. GLAXO SMITHKLINE P L C A D R     2022-06-17
107. MIZUHO FNL GRP A D R   2021-07-27 2022-06-17
7. NICE SYSTEMS LTD-SPONSORED ADR   2022-06-03 2022-06-17
9. POSCO A D R   2021-07-27 2022-06-17
17. P T TELEKOMUNIKASI INDONESIA A D R   2022-03-03 2022-06-17
10. TOKYO ELECTRON LTD ADR   2021-07-27 2022-06-17
21. WOODSIDE PETROLEUM LTD A D R   2022-06-01 2022-06-17
6. ATLASSIAN CORP PLC CLASS A     2022-06-17
7. FERGUSON PLC NEW SHS     2022-06-17
.0916 WOODSIDE PETROLEUM LTD A D R   2022-06-01 2022-06-23
61. CHINA PETROLEUM CHEM A D R   2021-09-27 2022-07-06
20. DEUTSCHE POST AG A D R     2022-07-06
26. ENI S P A ADR     2022-07-06
291. ERICSSON LM TEL SP A D R   2022-06-03 2022-07-06
9. GENMAB A S SP A D R     2022-07-06
119. GLAXO SMITHKLINE P L C A D R   2022-05-02 2022-07-06
227. MIZUHO FNL GRP A D R     2022-07-06
32. POSCO A D R   2021-07-27 2022-07-06
55. P T TELEKOMUNIKASI INDONESIA A D R   2022-03-03 2022-07-06
23. RIO TINTO PLC SPONSORED ADR   2022-03-03 2022-07-06
14. SILICON MOTION TECHNOLOGY CORP A D R   2021-07-27 2022-07-06
1. TOKYO ELECTRON LTD ADR   2021-07-27 2022-07-06
302. WOODSIDE PETROLEUM LTD A D R   2022-06-01 2022-07-06
9. ATLASSIAN CORP PLC CLASS A     2022-07-06
25. FERGUSON PLC NEW SHS     2022-07-06
27. ZIM INTEGRATED SHIPPING SERVIC SHS   2021-07-27 2022-07-06
266. ARCELORMITTAL CLASS A N Y REGISTRY     2022-07-20
33. CHINA PETROLEUM CHEM A D R     2022-07-20
102. COMPANIA DE MINAS BUENAVENTURA S A   2022-07-06 2022-07-20
173. ENI S P A ADR     2022-07-20
204. MIZUHO FNL GRP A D R     2022-07-20
601. MIZUHO FNL GRP A D R   2015-10-20 2022-07-20
11. NESTLE S A SPONSORED ADR REPSTG REG SH   2021-12-13 2022-07-20
108. NOVARTIS AG SPONSORED ADR     2022-07-20
16. STMICROELECTRONICS N V     2022-07-20
2. TOKYO ELECTRON LTD ADR   2021-07-27 2022-07-20
6. UNITED OVERSEAS BK LTD SPON A D R   2021-07-27 2022-07-20
17. FERGUSON PLC NEW SHS   2021-07-27 2022-07-20
12. ZIM INTEGRATED SHIPPING SERVIC SHS   2021-07-27 2022-07-20
193. GSK PLC SPONSORED A D R     2022-07-25
.4 GSK PLC SPONSORED A D R   2022-02-16 2022-07-29
33. CHINA PETROLEUM CHEM A D R     2022-08-03
207. COMPANIA DE MINAS BUENAVENTURA S A   2022-07-06 2022-08-03
92. ENI S P A ADR     2022-08-03
339. MIZUHO FNL GRP A D R   2015-10-20 2022-08-03
6. ORIX CORP SPONS A D R   2022-01-14 2022-08-03
290. RIO TINTO PLC SPONSORED ADR     2022-08-03
1. TOKYO ELECTRON LTD ADR   2021-07-27 2022-08-03
4. ATLASSIAN CORP PLC CLASS A   2021-07-29 2022-08-03
11. FERGUSON PLC NEW SHS   2022-03-31 2022-08-03
13. ZIM INTEGRATED SHIPPING SERVIC SHS   2021-07-27 2022-08-03
57. ANGLO AMERICAN PLC SPON A D R     2022-08-17
8.00023 B H P BILLITON LIMITED A D R   2022-04-19 2022-08-17
37.99977 B H P BILLITON LIMITED A D R     2022-08-17
88. ENI S P A ADR   2021-11-29 2022-08-17
133. KT CORP SP A D R   2021-07-27 2022-08-17
112. NOVARTIS AG SPONSORED ADR     2022-08-17
80. NOVARTIS AG SPONSORED ADR     2022-08-17
37. POSCO A D R   2021-07-27 2022-08-17
21. RIO TINTO PLC SPONSORED ADR   2022-06-17 2022-08-17
66. SHINHAN FINANCIAL GROUP A D R     2022-08-17
14. TOKYO ELECTRON LTD ADR   2021-07-27 2022-08-17
6. UNITED OVERSEAS BK LTD SPON A D R   2021-07-27 2022-08-17
16. FERGUSON PLC NEW SHS   2022-03-31 2022-08-17
34. ZIM INTEGRATED SHIPPING SERVIC SHS   2021-07-27 2022-08-17
13. ANGLO AMERICAN PLC SPON A D R   2022-03-31 2022-08-18
95. B H P BILLITON LIMITED A D R     2022-08-18
43. NOVARTIS AG SPONSORED ADR   2022-06-17 2022-08-18
9. ORIX CORP SPONS A D R   2021-08-12 2022-08-18
189. PETRO CHINA COMPANY LTD A D R     2022-08-18
6. SHINHAN FINANCIAL GROUP A D R     2022-08-18
4. UNITED OVERSEAS BK LTD SPON A D R   2021-07-27 2022-08-18
1. FERGUSON PLC NEW SHS   2022-03-31 2022-08-18
6. FERGUSON PLC NEW SHS   2021-07-27 2022-08-18
87. B H P BILLITON LIMITED A D R     2022-08-23
45. CHINA PETROLEUM CHEM A D R     2022-08-23
128. PETRO CHINA COMPANY LTD A D R     2022-08-23
54. PETRO CHINA COMPANY LTD A D R   2021-07-27 2022-08-23
3. ATLASSIAN CORP PLC CLASS A   2021-07-29 2022-08-23
4. FERGUSON PLC NEW SHS   2021-07-27 2022-08-23
48. ZIM INTEGRATED SHIPPING SERVIC SHS   2021-07-27 2022-08-23
74. B H P BILLITON LIMITED A D R   2022-02-16 2022-08-26
187. PETRO CHINA COMPANY LTD A D R     2022-08-26
15. ATLASSIAN CORP PLC CLASS A   2021-07-29 2022-08-26
45. ZIM INTEGRATED SHIPPING SERVIC SHS   2021-07-27 2022-08-26
52.00007 B H P BILLITON LIMITED A D R   2022-02-16 2022-08-31
76.99993 B H P BILLITON LIMITED A D R   2022-02-16 2022-08-31
2. NOVO-NORDISK A S ADR   2022-07-20 2022-08-31
3. ORIX CORP SPONS A D R   2022-03-31 2022-08-31
70. PETRO CHINA COMPANY LTD A D R     2022-08-31
112. PETRO CHINA COMPANY LTD A D R   2021-08-30 2022-08-31
4. ATLASSIAN CORP PLC CLASS A   2021-07-29 2022-08-31
2. FERGUSON PLC NEW SHS   2021-07-27 2022-08-31
23. ZIM INTEGRATED SHIPPING SERVIC SHS   2021-07-27 2022-08-31
19. CANON INC ADR REPSTG 5 SHS   2022-08-03 2022-09-14
285. HALEON PLC SPON ADS A D R     2022-09-14
77. NOVO-NORDISK A S ADR   2022-07-20 2022-09-14
69. SHELL PLC SPON A D R   2022-08-23 2022-09-14
3. UNITED OVERSEAS BK LTD SPON A D R   2021-07-27 2022-09-14
3. FERGUSON PLC NEW SHS   2021-07-27 2022-09-14
226. ASE TECHNOLOGY HOLDING CO LTD A D R   2022-08-26 2022-09-27
40. CANON INC ADR REPSTG 5 SHS   2022-08-03 2022-09-27
7. CRITEO SA SPON A D R   2021-07-27 2022-09-27
6. DEUTSCHE POST AG A D R     2022-09-27
10. DIAGEO PLC SPONSORED ADR NEW   2022-09-14 2022-09-27
11. DSV PANALPINA A S A D R     2022-09-27
203. HALEON PLC SPON ADS A D R     2022-09-27
53. KT CORP SP A D R   2021-07-27 2022-09-27
86.00024 NOVO-NORDISK A S ADR     2022-09-27
10.99976 NOVO-NORDISK A S ADR   2022-07-06 2022-09-27
5. ORIX CORP SPONS A D R   2021-09-27 2022-09-27
2. SHINHAN FINANCIAL GROUP A D R     2022-09-27
35. STMICROELECTRONICS N V     2022-09-27
4. UNITED OVERSEAS BK LTD SPON A D R   2021-07-27 2022-09-27
12. FERGUSON PLC NEW SHS   2021-07-27 2022-09-27
104. ALBEMARLE CORP   2020-04-23 2022-09-28
5120.28 AMERICAN CENTURY DIVERSIFIED BOND I     2022-09-28
52. AMGEN INC COMMON STOCK   2022-06-13 2022-09-28
20. AMGEN INC COMMON STOCK   2019-05-08 2022-09-28
165. APPLE COMPUTER INC COM   2019-06-17 2022-09-28
368. GILEAD SCIENCES INC COM     2022-09-28
530. ISHARES CORE U.S. AGGREGATE BOND ETF     2022-09-28
152. NEXTERA ENERGY INC   2022-06-13 2022-09-28
25. UNITEDHEALTH GRP INC COM   2016-06-22 2022-09-28
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(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 34     34
b 5     5
c 6,946   8,373 -1,427
d 294   278 16
e 1,350   1,636 -286
7,369   7,673 -304
1,981   2,057 -76
831   810 21
2,746   951 1,795
2,909   3,472 -563
2,909   3,472 -563
4,989   5,685 -696
946   1,067 -121
391   398 -7
102   98 4
2,175   2,024 151
7,253   8,946 -1,693
6,652   6,311 341
7,350   8,030 -680
805   955 -150
6,428   5,795 633
1,592   1,951 -359
5,717   6,163 -446
210   196 14
13,213   16,897 -3,684
3,567   3,405 162
3,331   3,650 -319
2,065   2,639 -574
633   621 12
1,191   845 346
4,637   5,362 -725
2,423   2,256 167
258   304 -46
28,226   6,461 21,765
19,435   2,691 16,744
35,673   21,046 14,627
28,558   9,472 19,086
1,766   1,876 -110
449   458 -9
5,872   6,565 -693
203   204 -1
1,022   1,024 -2
1,480   1,563 -83
1,204   1,272 -68
1,139   1,453 -314
5,426   6,513 -1,087
6,238   7,118 -880
1,547   2,174 -627
6,740   7,318 -578
124   127 -3
1,059   1,034 25
2,305   2,264 41
454   504 -50
49     49
603   638 -35
748   813 -65
1,292   837 455
10,841   12,551 -1,710
2,344   2,646 -302
2,942   3,804 -862
815   553 262
414   423 -9
2,746   2,749 -3
1,666   1,585 81
592   589 3
262   262  
159   156 3
812   762 50
7,959   10,261 -2,302
2,852   3,392 -540
3,878   3,924 -46
721   730 -9
1,803   2,251 -448
2,472   2,535 -63
4,120   3,170 950
1,949   1,654 295
2,082   2,124 -42
3,389   3,325 64
1,506   1,619 -113
567   574 -7
5,441   6,038 -597
1,565   2,174 -609
348   382 -34
2,828   2,954 -126
238   203 35
2,079   1,846 233
23,212   26,882 -3,670
664   699 -35
76   101 -25
329   311 18
1,426   1,392 34
2,972   3,535 -563
14,241   15,263 -1,022
353   466 -113
519   597 -78
2,292   2,190 102
1,984   1,620 364
821   678 143
7,568   9,872 -2,304
385   398 -13
2,770   2,586 184
659   761 -102
2,294   2,538 -244
45   67 -22
868   910 -42
3,705   3,935 -230
2,775   3,667 -892
96   60 36
1,685   2,344 -659
308   359 -51
1,491   1,941 -450
1,272   1,541 -269
857   866 -9
3,935   3,993 -58
185   198 -13
2,409   2,669 -260
3,081   3,205 -124
7,021   9,253 -2,232
2,462   2,628 -166
869   739 130
3,215   4,237 -1,022
182   269 -87
3,102   3,722 -620
753   904 -151
1,453   1,452 1
1,593   1,768 -175
1,224   718 506
10,446   11,056 -610
360   376 -16
7,173   7,271 -98
2,900   3,171 -271
241   203 38
474   382 92
2,558   3,265 -707
3,008   2,710 298
4,853   5,478 -625
114   168 -54
7,963   10,094 -2,131
489   476 13
301   303 -2
12,022   12,005 17
648   579 69
1,461   1,762 -301
231   226 5
238   311 -73
236   233 3
656   693 -37
1,881   2,111 -230
1,710   1,576 134
3,882   4,047 -165
341   572 -231
1,255   777 478
3,857   3,866 -9
1,041   1,038 3
795   802 -7
3,374   4,128 -754
211   259 -48
418   484 -66
367   497 -130
573   508 65
3,629   2,525 1,104
2,595   2,002 593
1,231   1,524 -293
1,425   1,436 -11
1,633   2,200 -567
133   170 -37
7   9 -2
58,886   43,980 14,906
13,639   15,376 -1,737
217,240   168,352 48,888
241,281   211,770 29,511
137,561   131,520 6,041
55,511   18,072 37,439
36,081   28,665 7,416
417   458 -41
385   405 -20
4,826   5,178 -352
2,831   3,128 -297
1,295   1,674 -379
6,552   6,865 -313
6,433   5,728 705
1,316   1,350 -34
10,062   7,948 2,114
729   709 20
6     6
75   82 -7
130   201 -71
290   494 -204
1,143   1,674 -531
1,654   1,566 88
2,115   2,190 -75
1,460   1,422 38
347   386 -39
7,576   8,941 -1,365
1,034   1,026 8
2,158   1,396 762
843   968 -125
723   830 -107
1,130   1,013 117
1,360   1,792 -432
7,410   4,690 2,720
322   343 -21
856   809 47
2,346   3,667 -1,321
5,095   4,853 242
541   793 -252
932   1,172 -240
1,184   1,202 -18
1,125   1,013 112
714   920 -206
2,475   5,012 -2,537
5,409   6,139 -730
60,317   17,632 42,685
70,545   26,687 43,858
20,701   14,959 5,742
13,723   8,019 5,704
15,919   11,047 4,872
14,568   24,377 -9,809
19,501   25,149 -5,648
60,219   60,541 -322
15,262   17,719 -2,457
45,401   50,426 -5,025
42,038   21,840 20,198
11,527   8,447 3,080
25,920   19,654 6,266
33,660   33,719 -59
8,684   4,240 4,444
7,702   6,009 1,693
17,257   5,683 11,574
7,107   1,346 5,761
11,421   54,729 -43,308
10,372   5,091 5,281
30,875   46,446 -15,571
19,656   11,915 7,741
19,020   27,985 -8,965
31,844   18,570 13,274
13,019   13,184 -165
67,299   21,287 46,012
29,436   43,405 -13,969
9,483   6,037 3,446
24,109   19,588 4,521
893   1,914 -1,021
19,121   18,032 1,089
16,843   11,661 5,182
476   905 -429
2,217   2,522 -305
9,379   10,173 -794
232   304 -72
1,335   1,403 -68
450   699 -249
468   509 -41
886   1,013 -127
453   452 1
1,044   2,052 -1,008
766   1,056 -290
2   2  
2,655   3,073 -418
719   1,379 -660
566   728 -162
2,138   2,404 -266
297   366 -69
5,109   5,325 -216
507   646 -139
1,388   2,484 -1,096
1,460   1,647 -187
1,301   2,148 -847
1,159   849 310
78   101 -23
6,005   6,499 -494
1,857   2,483 -626
2,708   3,535 -827
1,112   929 183
6,169   8,228 -2,059
1,506   1,660 -154
615   644 -29
3,915   4,785 -870
465   539 -74
1,369   2,431 -1,062
1,283   1,488 -205
9,135   9,882 -747
552   730 -178
163   203 -40
236   229 7
1,988   2,398 -410
614   413 201
8,126   8,659 -533
17   18 -1
1,500   1,633 -133
1,123   1,307 -184
2,123   2,487 -364
789   1,371 -582
511   674 -163
17,106   24,430 -7,324
86   101 -15
887   1,073 -186
1,348   1,511 -163
638   447 191
1,013   1,539 -526
453   620 -167
2,150   2,953 -803
2,087   2,363 -276
1,893   1,897 -4
9,526   9,533 -7
6,804   7,081 -277
1,803   2,872 -1,069
1,254   1,350 -96
1,802   2,126 -324
1,171   1,418 -247
231   229 2
2,021   2,198 -177
1,587   1,170 417
226   344 -118
5,383   7,118 -1,735
3,635   3,495 140
752   854 -102
8,120   7,914 206
161   169 -8
155   153 2
128   137 -9
767   846 -79
5,114   6,287 -1,173
2,096   2,132 -36
5,756   6,839 -1,083
2,428   2,227 201
769   805 -36
486   564 -78
2,315   1,652 663
4,373   5,078 -705
8,861   9,216 -355
3,851   4,023 -172
1,888   1,549 339
2,866   3,568 -702
4,244   5,283 -1,039
213   227 -14
248   303 -55
3,243   3,136 107
5,189   4,784 405
998   1,073 -75
234   282 -48
838   792 46
434   451 -17
1,762   2,340 -578
8,108   8,749 -641
3,746   3,787 -41
116   115 1
346   423 -77
1,170   1,348 -178
868   950 -82
191   282 -91
175   383 -208
1,684   1,766 -82
636   1,311 -675
1,218   1,621 -403
668   756 -88
8,299   9,645 -1,346
1,061   1,215 -154
364   495 -131
48   65 -17
1,176   1,587 -411
147   153 -6
1,260   1,692 -432
27,931   6,461 21,470
47,311   54,898 -7,587
11,866   12,361 -495
4,564   3,496 1,068
24,079   8,013 16,066
23,218   25,717 -2,499
51,003   59,695 -8,692
12,481   11,044 1,437
12,539   3,455 9,084
      110,811
      110,811
      110,811
      110,811
      110,811
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      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
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      110,811
      110,811
      110,811
      110,811
      110,811
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      110,811
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      110,811
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      110,811
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      110,811
      110,811
      110,811
      110,811
      110,811
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      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
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      110,811
      110,811
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      110,811
      110,811
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      110,811
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      110,811
      110,811
      110,811
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      110,811
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      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
      110,811
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       34
b       5
c       -1,427
d       16
e       -286
      -304
      -76
      21
      1,795
      -563
      -563
      -696
      -121
      -7
      4
      151
      -1,693
      341
      -680
      -150
      633
      -359
      -446
      14
      -3,684
      162
      -319
      -574
      12
      346
      -725
      167
      -46
      21,765
      16,744
      14,627
      19,086
      -110
      -9
      -693
      -1
      -2
      -83
      -68
      -314
      -1,087
      -880
      -627
      -578
      -3
      25
      41
      -50
      49
      -35
      -65
      455
      -1,710
      -302
      -862
      262
      -9
      -3
      81
      3
       
      3
      50
      -2,302
      -540
      -46
      -9
      -448
      -63
      950
      295
      -42
      64
      -113
      -7
      -597
      -609
      -34
      -126
      35
      233
      -3,670
      -35
      -25
      18
      34
      -563
      -1,022
      -113
      -78
      102
      364
      143
      -2,304
      -13
      184
      -102
      -244
      -22
      -42
      -230
      -892
      36
      -659
      -51
      -450
      -269
      -9
      -58
      -13
      -260
      -124
      -2,232
      -166
      130
      -1,022
      -87
      -620
      -151
      1
      -175
      506
      -610
      -16
      -98
      -271
      38
      92
      -707
      298
      -625
      -54
      -2,131
      13
      -2
      17
      69
      -301
      5
      -73
      3
      -37
      -230
      134
      -165
      -231
      478
      -9
      3
      -7
      -754
      -48
      -66
      -130
      65
      1,104
      593
      -293
      -11
      -567
      -37
      -2
      14,906
      -1,737
      48,888
      29,511
      6,041
      37,439
      7,416
      -41
      -20
      -352
      -297
      -379
      -313
      705
      -34
      2,114
      20
      6
      -7
      -71
      -204
      -531
      88
      -75
      38
      -39
      -1,365
      8
      762
      -125
      -107
      117
      -432
      2,720
      -21
      47
      -1,321
      242
      -252
      -240
      -18
      112
      -206
      -2,537
      -730
      42,685
      43,858
      5,742
      5,704
      4,872
      -9,809
      -5,648
      -322
      -2,457
      -5,025
      20,198
      3,080
      6,266
      -59
      4,444
      1,693
      11,574
      5,761
      -43,308
      5,281
      -15,571
      7,741
      -8,965
      13,274
      -165
      46,012
      -13,969
      3,446
      4,521
      -1,021
      1,089
      5,182
      -429
      -305
      -794
      -72
      -68
      -249
      -41
      -127
      1
      -1,008
      -290
       
      -418
      -660
      -162
      -266
      -69
      -216
      -139
      -1,096
      -187
      -847
      310
      -23
      -494
      -626
      -827
      183
      -2,059
      -154
      -29
      -870
      -74
      -1,062
      -205
      -747
      -178
      -40
      7
      -410
      201
      -533
      -1
      -133
      -184
      -364
      -582
      -163
      -7,324
      -15
      -186
      -163
      191
      -526
      -167
      -803
      -276
      -4
      -7
      -277
      -1,069
      -96
      -324
      -247
      2
      -177
      417
      -118
      -1,735
      140
      -102
      206
      -8
      2
      -9
      -79
      -1,173
      -36
      -1,083
      201
      -36
      -78
      663
      -705
      -355
      -172
      339
      -702
      -1,039
      -14
      -55
      107
      405
      -75
      -48
      46
      -17
      -578
      -641
      -41
      1
      -77
      -178
      -82
      -91
      -208
      -82
      -675
      -403
      -88
      -1,346
      -154
      -131
      -17
      -411
      -6
      -432
      21,470
      -7,587
      -495
      1,068
      16,066
      -2,499
      -8,692
      1,437
      9,084
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
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 2 419,599
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 7,329
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 7,329
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 5,308
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  
7 Total credits and payments. Add lines 6a through 6d.............. 7 5,308
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 2,021
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet0 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$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
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)
    bulletMO
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
    If "Yes," complete Part XIII .............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 5
    Part VI-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletUS BANK NA Telephone no.bullet (314) 418-8330

    Located atbulletPO BOX 0634MILWAUKEEWI ZIP+4bullet53201
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country? .................
    16   No
    See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........
    1a(1)
     
    No
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person? ..............................
    1a(2)
     
    No
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
    1a(3)
     
    No
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
    Yes
     
    (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)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    No
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals? .............
    5a(5)
     
    No
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........
    5b
     
     
    c
    .........bullet
    d
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant? .................
    5d
     
     
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract? .............................
    6a
     
    No
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    7a
     
    No
    b
    If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .........................
    8
     
    No
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position
    (c) Compensation
    (If not paid, enter
    -0-)
    (d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    US BANK NA TRUSTEE
    1
    41,904    
    PO BOX 387
    ST LOUIS,MO63166
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position
    (c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation
    (e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 7
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part VIII-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1  
    2  
    3  
    4  
    Part VIII-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    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
    5,235,276
    b
    Average of monthly cash balances.......................
    1b
    75,067
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    5,310,343
    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
    5,310,343
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    79,655
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    5,230,688
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    261,534
    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
    261,534
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    7,329
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    7,329
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    254,205
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    254,205
    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
    254,205
    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 7 254,205
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 203,469
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016...... 0
    b From 2017...... 0
    c From 2018...... 0
    d From 2019...... 0
    e From 2020...... 0
    f Total of lines 3a through e ........ 0
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 302,467
    a Applied to 2020, but not more than line 2a 203,469
    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..... 98,998
    e Remaining amount distributed out of corpus 0
    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 0
    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 ..........
    155,207
    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 ......
    0
    10 Analysis of line 9:
    a Excess from 2017.... 0
    b Excess from 2018.... 0
    c Excess from 2019.... 0
    d Excess from 2020.... 0
    e Excess from 2021.... 0
    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).)
    NONE
    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.
    NONE
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    Foundation
    status of
    recipient
    Purpose of grant or
    contribution
    Amount
    Name and address (home or business)
    aPaid during the year
    BLOSSER HOME FOR CRIPPLED CHILDREN
    PO BOX 40
    MARSHALL,MO653400040
    NONE PC GENERAL OPERATING 295,728
    Total .................................bullet 3a 295,728
    bApproved for future payment
    Total .................................bullet 3b  
    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 ............
        18 419,599  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aOTHER INCOME
        1 75  
    bOTHER INCOME     1 2,503  
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) ..   573,913  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    573,913
    (See worksheet in line 13 instructions to verify calculations.)
    Part XV-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow
    Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below?
    See instructions.
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    Firm's EIN SmallBullet
    Firm's address SmallBullet


    Phone no.
    Form 990-PF (2021)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2021 AccountingFeesSchedule
    Name:
    GEORGIA BLOSSER TRUST
    EIN:
    43-6018191
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEE (NON-ALLOC 2,500     2,500

    TY 2021 InvestmentsCorpBondsSchedule
    Name:
    GEORGIA BLOSSER TRUST
    EIN:
    43-6018191
    Name of Bond End of Year Book Value End of Year Fair Market Value
    31420B300 FEDERATED HERMES INS    
    024932600 AMERICAN CENTURY DIV    
    87234N765 TCW EMERGING MARKETS    
    72369L107 PIONEER ILS INTERVAL    
    024932154 AMERICAN CENTURY HIG    
    464287226 ISHARES CORE U.S. AG    
    74440B884 PGIM TOTAL RETURN BO    
    258620103 DOUBLELINE TOTAL RET    

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    GEORGIA BLOSSER TRUST
    EIN:
    43-6018191
    Name of Stock End of Year Book Value End of Year Fair Market Value
    437076102 HOME DEPOT INC 18,600 36,148
    375558103 GILEAD SCIENCES INC 21,550 21,777
    478160104 JOHNSON JOHNSON    
    958102105 WESTERN DIGITAL CORP    
    023135106 AMAZON.COM INC 27,369 74,467
    060505104 BANK OF AMERICA CORP 25,417 43,458
    438516106 HONEYWELL INTERNATIO 25,848 35,398
    91324P102 UNITED HEALTH GROUP 9,144 33,838
    46625H100 J P MORGAN CHASE CO 23,464 43,368
    247361702 DELTA AIR LINES INC    
    00206R102 ATT INC    
    02079K305 ALPHABET INC CL A 14,874 42,086
    440452100 HORMEL FOODS CORP    
    149498107 CAUSEWAY EMERGING MA    
    024835100 AMERICAN CAMPUS COMM    
    78409V104 S P GLOBAL INC 4,250 10,077
    670678507 NUVEEN REAL ESTATE S    
    594918104 MICROSOFT CORP 21,715 108,997
    03027X100 AMERICAN TOWER CORP 30,039 53,246
    77957Y106 T ROWE PRICE MID CAP    
    00287Y109 ABBVIE INC    
    20030N101 COMCAST CORP CL A 34,636 27,130
    92826C839 VISA INC 13,829 29,490
    670678200 NUVEEN SMALL CAP VAL    
    56585A102 MARATHON PETROLEUM C 57,394 88,006
    57636Q104 MASTERCARD INC 10,611 29,003
    74316J458 CONGRESS MID CAP GRO    
    037833100 APPLE INC 18,291 98,813
    458140100 INTEL CORP    
    771195104 ROCHE HOLDINGS LTD S 46,974 51,466
    H1467J104 CHUBB LTD 20,824 30,010
    931142103 WAL MART STORES INC 33,236 47,859
    559222401 MAGNA INTL INC CL 23,614 19,205
    G1151C101 ACCENTURE PLC CL A 22,030 31,905
    23304Y100 DBS GROUP HLDGS LTD    
    48268K101 KT CORP SP A D R 18,869 17,487
    88579Y101 3M CO    
    04623U102 ASTELLAS PHARMA INC 2,027 1,653
    670100205 NOVO NORDISK AS A D    
    05545E209 B H P BILLITON PLC S    
    456463108 INDUSTRIAS BACHOCO S 9,519 9,621
    780259206 ROYAL DUTCH SHELL PL    
    500467501 KONINKLIJKE AHOLD DE 13,294 16,231
    654624105 NIPPON TELEGRAPH TEL 18,424 21,301
    60687Y109 MIZUHO FNL GRP A D R 6,988 4,064
    500472303 KONINKLIJKE PHILIPS    
    226718104 CRITEO SA SPON A D R 18,929 13,515
    012653101 ALBEMARLE CORP 39,368 47,335
    00089H106 ACS ACTIVIDADES CONS    
    92932M101 WNS HOLDINGS LTD ADR 11,149 10,639
    803054204 SAP SE SPONSORED A D    
    17275R102 CISCO SYSTEMS INC 19,717 16,600
    66987V109 NOVARTIS AG A D R 9,765 9,653
    172967424 CITIGROUP INC    
    097023105 BOEING CO    
    031162100 AMGEN INC 13,109 16,905
    882508104 TEXAS INSTRUMENTS IN 26,654 42,565
    09247X101 BLACKROCK INC 34,732 37,969
    4812A1696 JP MORGAN US SMALL C    
    25157Y202 DEUTSCHE POST AG A D 8,649 7,395
    N53745100 LYONDELLBASELL INDUS    
    464288877 ISHARES MSCI EAFE VA    
    88339J105 TRADE DESK INC THE C 4,043 9,082
    278865100 ECOLAB INC 12,935 10,543
    30303M102 FACEBOOK INC A 19,837 14,518
    893641100 TRANSDIGM GROUP INC 8,004 13,121
    848637104 SPLUNK INC    
    89400J107 TRANSUNION 46,051 37,955
    76680R206 RINGCENTRAL INC    
    217204106 COPART INC COM 8,073 12,449
    776696106 ROPER INDS INC 7,987 8,991
    902252105 TYLER TECHNOLOGIES I    
    M9T951109 ZIM INTEGRATED SHIPP    
    92556V106 VIATRIS INC    
    83404D109 SOFTBANK GROUP CORP    
    861012102 STMICROELECTRONICS N    
    M8737E108 TARO PHARMACEUTICAL 2,591 1,079
    71646E100 PETRO CHINA COMPANY    
    006754204 ADECCO GROUP AG A D 2,153 874
    00215W100 ASE TECHNOLOGY HOLDI 3,064 2,570
    138006309 CANON INC SPONS A D 43,034  
    373737105 GERDAU S A SPON A D 6,219 6,432
    654445303 NINTENDO LTD A D R    
    911271302 UNITED OVERSEAS BK L 268 254
    686330101 ORIX CORP SPONS A D 10,669 8,480
    N07059210 ASML HOLDING NV NY R    
    G06242104 ATLASSIAN CORP PLC C    
    M5425M103 INMODE LTD    
    693483109 POSCO A D R    
    M22465104 CHECK POINT SOFTWARE 51,691 46,264
    16941R108 CHINA PETROLEUM CHEM    
    17133Q502 CHUNGHWA TELECOM CO 27,151 23,059
    G3421J106 FERGUSON PLC NEW SHS    
    97651M109 WIPRO LIMITED A D R    
    372303206 GENMAB A S SP A D R 6,900 6,137
    589339209 MERCK KGAA SPONSORED 3,116 2,426
    654902204 NOKIA CORP SPSD A D 15,996 11,807
    824596100 SHINHAN FINANCIAL GR 8,801 6,463
    889110102 TOKYO ELECTRON LTD A    
    000375204 ABB LTD A D R    
    82706C108 SILICON MOTION TECHN    
    92937A102 WPP PLC SPON A D R    
    69832A205 PANASONIC CORP A D R    
    26251A108 DSV PANALPINA A S A 15,369 7,512
    G6564A105 NOMAD FOODS LTD    
    433578507 HITACHI LTD A D R 4,428 3,320
    G6095L109 APTIV PLC 4,706 3,911
    617446448 MORGAN STANLEY 23,873 25,283
    98954M101 ZILLOW GROUP INC 4,511 3,951
    70450Y103 PAYPAL HOLDINGS INC 9,990 11,533
    98419M100 XYLEM INC 9,866 11,182
    81762P102 SERVICENOW INC 11,913 10,195
    92343V104 VERIZON COMMUNICATIO 16,904 12,872
    20825C104 CONOCOPHILLIPS 14,790 13,816
    002824100 ABBOTT LABORATORIES 31,715 28,834
    717081103 PFIZER INC 30,343 27,438
    009066101 AIRBNB INC CL A 9,202 9,769
    30063P105 EXACT SCIENCES CORPO 3,947 3,411
    87612E106 TARGET CORP 17,862 18,400
    15135B101 CENTENE CORP COM 13,039 13,228
    57667L107 MATCH GROUP INC NEW 7,563 5,014
    907818108 UNION PACIFIC CORP 11,273 10,715
    086516101 BEST BUY CO INC 15,733 14,315
    G5494J103 LINDE PLC 14,438 12,940
    29444U700 EQUINIX INC 6,190 5,688
    808513105 SCHWAB CHARLES CORP 16,588 20,052
    149123101 CATERPILLAR INC 49,140 39,215
    00724F101 ADOBE SYS INC 10,847 7,981
    67066G104 NVIDIA CORP 10,227 7,890
    65339F101 NEXTERA ENERGY INC 15,258 16,466
    620076307 MOTOROLA SOLUTIONS I 20,258 22,397
    461202103 INTUIT INC 5,110 5,422
    855244109 STARBUCKS CORP 18,066 21,065
    79466L302 SALESFORCE COM INC 11,730 10,069
    28176E108 EDWARDS LIFESCIENCES 11,097 10,329
    12572Q105 CME GROUP INC 12,089 10,805
    595112103 MICRON TECHNOLOGY IN 6,636 5,661
    22160K105 COSTCO WHSL CORP 8,989 9,445
    697435105 PALO ALTO NETWORKS I 5,151 5,405
    G5960L103 MEDTRONIC PLC 37,885 33,754
    00202F102A P MOLLER MAERSK A 15,907 9,915
    03485P300ANGLO AMERICAN PLC S 6,981 4,425
    05523R107B A E SYSTEMS P L C 11,180 11,081
    088606108B H P BILLITON LIMIT 42,610 32,776
    29446M102EQUINOR ASA SPON ADR 44,942 44,467
    37733W204GSK PLC SPONSORED A 32,064 26,134
    606776201MITSUBISHI ELECTRIC 7,754 6,784
    641069406NESTLE SA SPONSORED 28,776 23,889
    71654V408PETROLEO BRASILEIRO 1,202 1,197
    72341E304PING AN INSURANCE A 6,368 5,579
    756255204RECKITT BENCKISER SP 1,648 1,369
    759530108RELX PLC SPON A D R 41,911 36,757
    80105N105SANOFI A D R 8,867 7,224
    780259305SHELL PLC SPON A D R 26,392 24,183
    977874205WOLTERS KLUWER N V S 3,381 3,132

    TY 2021 InvestmentsOtherSchedule2
    Name:
    GEORGIA BLOSSER TRUST
    EIN:
    43-6018191
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    87245P668 TIAA CREF INFLATION      
    808524847 SCHWAB US REIT ETF AT COST 130,115 104,103
    641224415 NEUBERGER BERMAN EME AT COST 205,064 159,320
    670678200 NUVEEN SMALL CAP VAL AT COST 63,392 73,900
    4812A1696 JP MORGAN US SMALL C AT COST 112,282 104,651
    74440B884 PGIM TOTAL RETURN BO AT COST 250,019 210,493
    464287226 ISHARES CORE U.S. AG AT COST 338,062 301,063
    024932600 AMERICAN CENTURY DIV AT COST 148,388 128,805
    949915482 ALLSPRING SPECIAL MI AT COST 358,086 318,379
    149498107 CAUSEWAY EMERGING MA AT COST 184,014 134,301
    31420B300 FEDERATED HERMES INS AT COST 293,356 247,206
    024932154 AMERICAN CENTURY HIG AT COST 20,909 17,630
    72369L107 PIONEER ILS INTERVAL AT COST 100,000 86,892
    464288877 ISHARES MSCI EAFE VA AT COST 164,743 132,466
    87234N765 TCW EMERGING MARKETS AT COST 49,503 36,875
    779556109 ROWE T PRICE MID-CAP AT COST 367,665 324,152

    TY 2021 OtherDecreasesSchedule
    Name:
    GEORGIA BLOSSER TRUST
    EIN:
    43-6018191
    Description Amount
    COST BASIS ADJ 166


    TY 2021 OtherExpensesSchedule
    Name:
    GEORGIA BLOSSER TRUST
    EIN:
    43-6018191
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    OTHER ALLOCABLE EXPENSE-PRINCI 49 0   49
    ADR FEES 601 601   0


    TY 2021 OtherIncomeSchedule2
    Name:
    GEORGIA BLOSSER TRUST
    EIN:
    43-6018191
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    OTHER INCOME 75 75  
    OTHER INCOME 2,503 2,503  


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    GEORGIA BLOSSER TRUST
    EIN:
    43-6018191
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    OTHER EXPENSE (NON-DEDUCTIBLE 2,140 2,140    


    TY 2021 TaxesSchedule
    Name:
    GEORGIA BLOSSER TRUST
    EIN:
    43-6018191
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 5,798 5,798   0
    FEDERAL TAX PAYMENT - PRIOR YE 4,217 0   0
    FEDERAL ESTIMATES - PRINCIPAL 5,308 0   0
    FOREIGN TAXES ON NONQUALIFIED 159 159   0