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
2023
Open to Public Inspection
For calendar year 2023, or tax year beginning 01-01-2023 , and ending 12-31-2023
Name of foundation
JOHANSEN T H FAMILY FDN
 
Number and street (or P.O. box number if mail is not delivered to street address)6325 S RAINBOW BLVD STE 300
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LAS VEGAS, NV89118
A Employer identification number

41-6014249
B Telephone number (see instructions)

(888) 730-4933
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$982,465J 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      
4 Dividends and interest from securities... 26,471 26,373  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 2,419
b Gross sales price for all assets on line 6a 292,739
7 Capital gain net income (from Part IV, line 2)... 2,419
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).......      
12 Total. Add lines 1 through 11........ 28,890 28,792  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 12,606 9,454   3,151
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)....... Click to see attachment
List of Attached Documents:
// Content
1,061 0 0 1,061
c Other professional fees (attach schedule).... Click to see attachment
List of Attached Documents:
// Content
673 673   0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... Click to see attachment
List of Attached Documents:
// Content
3,215 769   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)....... Click to see attachment
List of Attached Documents:
// Content
32 7   25
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 17,587 10,903 0 4,237
25 Contributions, gifts, grants paid....... 40,000 40,000
26 Total expenses and disbursements. Add lines 24 and 25 57,587 10,903 0 44,237
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -28,697
b Net investment income (if negative, enter -0-) 17,889
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2023)
Form 990-PF (2023)
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............. 276 308 308
2 Savings and temporary cash investments......... 35,270 21,017 21,017
3 Accounts receivable right arrow  
Less: allowance for doubtful accounts right arrow     0 0
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 arrow0      
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)....... 187,213 Click to see attachment
List of Attached Documents:
// Content
166,749 		369,599
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).......... 589,706 Click to see attachment
List of Attached Documents:
// Content
595,595 		591,541
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) 812,465 783,669 982,465
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
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........ 812,465 783,669
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)..... 812,465 783,669
30 Total liabilities and net assets/fund balances (see instructions). 812,465 783,669
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
812,465
2
Enter amount from Part I, line 27a .....................
2
-28,697
3
Other increases not included in line 2 (itemize) right arrowClick to see attachment
List of Attached Documents:
// Content
3
171
4
Add lines 1, 2, and 3 ..........................
4
783,939
5
Decreases not included in line 2 (itemize) right arrowClick to see attachment
List of Attached Documents:
// Content
5
270
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
783,669
Form 990-PF (2023)
Form 990-PF (2023)
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 11. ALPHABET INC CL C   2018-08-16 2023-01-25
b 11. APPLE INC     2023-01-25
c 1. BOOKING HOLDINGS INC   2020-10-26 2023-01-25
d 55.068 CALVERT EMERG MRKTS EQTY-R6 #1258   2022-06-01 2023-01-25
e 5. CELANESE CORP     2023-01-25
5. WALT DISNEY CO   2022-06-24 2023-01-25
12. ISHARES TRUST ISHARES ESG AW ETF   2022-05-31 2023-01-25
1. LAM RESEARCH CORP COM   2022-05-07 2023-01-25
29. NUVEEN ESG MID-CAP GROWTH ET ETF   2022-05-31 2023-01-25
4606.728 PIMCO TOTAL RETURN III-INSTL 105   2022-06-01 2023-01-25
24.129 PARNASSUS MID CAP FUND-INS #1012   2022-06-01 2023-01-25
122.251 TCW EMRG MRKTS INC-PLAN #5721   2020-06-01 2023-01-25
1936.337 TIAA-CREF SOC CHOICE BD-INST #1859   2022-06-01 2023-01-25
1. BLACKROCK INC   2023-01-25 2023-02-09
18. COGNIZANT TECH SOLUTIONS CRP COM   2016-05-06 2023-02-09
31. FIDELITY NATL INFORMATION SVCS INC     2023-02-09
38. FIDELITY NATL INFORMATION SVCS INC     2023-02-09
25. INTERPUBLIC GROUP COS INC     2023-02-09
6. JPMORGAN CHASE & CO   2018-12-21 2023-02-09
34. LAS VEGAS SANDS CORP   2015-10-28 2023-02-09
5. UNION PACIFIC CORP   2010-06-14 2023-02-09
6. WASTE MANAGEMENT INC   2020-10-26 2023-02-09
7. WALT DISNEY CO   2022-06-24 2023-03-17
88. MANULIFE FINANCIAL CORP     2023-03-17
6. ABBVIE INC   2023-01-25 2023-05-17
3. ABBVIE INC   2021-10-13 2023-05-17
4. ADVANCED MICRO DEVICES INC   2023-02-09 2023-05-17
1. BLACKROCK INC   2014-06-12 2023-05-17
3. BLACKSTONE INC   2023-02-09 2023-05-17
1. BOEING CO   2017-05-09 2023-05-17
1145.306 BOSTON TRUST SMALL CAP FUND     2023-05-17
1. BROADCOM INC   2019-07-03 2023-05-17
9. CVS HEALTH CORPORATION   2023-01-25 2023-05-17
3. CVS HEALTH CORPORATION   2018-08-16 2023-05-17
8. CISCO SYSTEMS INC   2013-03-06 2023-05-17
8. CITIGROUP INC.   2014-03-27 2023-05-17
4. COGNIZANT TECH SOLUTIONS CRP COM   2016-05-06 2023-05-17
2. DIAGEO PLC - ADR   2018-12-21 2023-05-17
3. ELECTRONIC ARTS INC   2019-10-16 2023-05-17
3. META PLATFORMS INC   2021-03-15 2023-05-17
3. HASBRO INC   2022-02-10 2023-05-17
1. HOME DEPOT INC   2022-12-06 2023-05-17
6. INTERPUBLIC GROUP COS INC   2020-10-26 2023-05-17
5. JPMORGAN CHASE & CO     2023-05-17
2. LAS VEGAS SANDS CORP   2015-10-28 2023-05-17
446.766 CLEARBRIDGE SMALL CAP-IS #5264     2023-05-17
4. ELI LILLY & CO COM     2023-05-17
21. MANULIFE FINANCIAL CORP   2017-05-09 2023-05-17
5. MERCK & CO INC NEW   2023-01-25 2023-05-17
5. MERCK & CO INC NEW     2023-05-17
9. MICROSOFT CORP     2023-05-17
5. MONDELEZ INTERNATIONAL INC   2018-08-16 2023-05-17
2. NIKE INC CL B   2017-10-26 2023-05-17
227. NUVEEN ESG MID-CAP GROWTH ET ETF   2022-05-31 2023-05-17
362.276 PARNASSUS MID CAP FUND-INS #1012   2022-06-01 2023-05-17
14. RTX CORP     2023-05-17
13. REGIONS FINL CORP NEW   2022-08-22 2023-05-17
12. SUNCOR ENERGY INC NEW F   2023-03-17 2023-05-17
3. SYSCO CORP   2020-08-25 2023-05-17
2. TARGET CORP   1998-10-30 2023-05-17
3. TORONTO DOMINION BK ONT COM NEW   2023-02-09 2023-05-17
8. TOTAL S.A. - ADR   2022-06-24 2023-05-17
4. UNILEVER PLC - ADR   2020-02-03 2023-05-17
1. UNION PACIFIC CORP   2010-06-14 2023-05-17
2. UNITED PARCEL SERVICE-CL B   2023-02-09 2023-05-17
2. UNITEDHEALTH GROUP INC   2023-01-25 2023-05-17
2. UNITEDHEALTH GROUP INC     2023-05-17
1. VISA INC-CLASS A SHRS   2023-02-09 2023-05-17
2. WASTE MANAGEMENT INC   2020-10-26 2023-05-17
6. EATON CORP PLC     2023-05-17
4. GARMIN LTD   2020-06-09 2023-05-17
3. TE CONNECTIVITY LTD   2021-11-19 2023-05-17
62. CVS HEALTH CORPORATION     2023-06-15
4. WALT DISNEY CO   2022-06-24 2023-06-15
30. WALT DISNEY CO   2009-05-14 2023-06-15
8. ELECTRONIC ARTS INC     2023-06-15
62. HASBRO INC     2023-06-15
51. LAS VEGAS SANDS CORP     2023-06-15
2. ELI LILLY & CO COM   2022-08-10 2023-06-15
62. SYSCO CORP     2023-06-15
4. EATON CORP PLC   2022-08-22 2023-06-15
4. APPLE INC     2023-08-10
1. ELI LILLY & CO COM   2017-05-09 2023-08-10
2. MICROSOFT CORP   2023-01-25 2023-08-10
1682.109 PARNASSUS MID CAP FUND-INS #1012   2022-06-01 2023-08-10
1. THERMO FISHER SCIENTIFIC INC   2023-06-15 2023-08-10
1. UNITEDHEALTH GROUP INC   2022-09-08 2023-08-10
2. ABBVIE INC   2021-10-13 2023-09-21
2. ADVANCED MICRO DEVICES INC   2023-06-15 2023-09-21
8. ALPHABET INC CL C   2018-08-16 2023-09-21
8. APPLE INC   2009-05-14 2023-09-21
4. BLACKSTONE INC   2023-02-09 2023-09-21
2. BOEING CO   2017-05-09 2023-09-21
56.156 CALVERT HIGH YIELD BOND-R6 #1290   2022-06-01 2023-09-21
52.185 CALVERT EMERG MRKTS EQTY-R6 #1258   2022-06-01 2023-09-21
2. CELANESE CORP   2023-06-15 2023-09-21
6. CISCO SYSTEMS INC   2013-03-06 2023-09-21
6. CITIGROUP INC.   2014-03-27 2023-09-21
2. DIAGEO PLC - ADR   2018-12-21 2023-09-21
2. ELECTRONIC ARTS INC   2018-12-21 2023-09-21
2. META PLATFORMS INC   2021-04-08 2023-09-21
56. ISHARES TRUST ISHARES ESG AW ETF   2023-05-17 2023-09-21
58. ISHARES ESG AWARE US AGGREGA ETF   2023-01-25 2023-09-21
4. JPMORGAN CHASE & CO   2011-06-24 2023-09-21
50.584 JH III DISC M/C VAL FD-I 3633   2023-08-10 2023-09-21
16. MANULIFE FINANCIAL CORP   2017-05-09 2023-09-21
4. MERCK & CO INC NEW   2023-06-15 2023-09-21
4. MICROSOFT CORP   2015-10-28 2023-09-21
4. MONDELEZ INTERNATIONAL INC   2018-08-16 2023-09-21
2. NIKE INC CL B   2017-10-26 2023-09-21
46. NUVEEN ESG MID-CAP GROWTH ET ETF   2023-08-10 2023-09-21
143.488 PIMCO LOW DURATION II-INSTL 107   2023-05-17 2023-09-21
232.877 PIMCO TOTAL RETURN III-INSTL 105   2022-06-01 2023-09-21
49.795 PARNASSUS MID CAP FUND-INS #1012   2022-06-01 2023-09-21
4. RTX CORP   2023-02-09 2023-09-21
12. REGIONS FINL CORP NEW   2022-08-22 2023-09-21
2. STARBUCKS CORP COM   2023-06-15 2023-09-21
10. SUNCOR ENERGY INC NEW F   2023-03-17 2023-09-21
2. SUNCOR ENERGY INC NEW F   2015-10-28 2023-09-21
434.057 TCW EMRG MRKTS INC-PLAN #5721   2020-06-01 2023-09-21
301.974 TIAA-CREF SOC CHOICE BD-INST #1859   2022-06-01 2023-09-21
2. TARGET CORP   1998-10-30 2023-09-21
6. TORONTO DOMINION BK ONT COM NEW   2023-02-09 2023-09-21
6. TOTAL S.A. - ADR   2023-06-15 2023-09-21
612.717 TOUCHSTONE IMPACT BND-R6 #1560   2022-08-10 2023-09-21
2. UNILEVER PLC - ADR   2020-02-03 2023-09-21
2. UNITED PARCEL SERVICE-CL B   2023-02-09 2023-09-21
2. VISA INC-CLASS A SHRS   2023-02-09 2023-09-21
2. WASTE MANAGEMENT INC   2020-10-26 2023-09-21
1. EATON CORP PLC   2022-10-18 2023-09-21
1. EATON CORP PLC   2021-02-10 2023-09-21
2. GARMIN LTD   2020-06-09 2023-09-21
1. TE CONNECTIVITY LTD   2022-10-18 2023-09-21
1. TE CONNECTIVITY LTD   2021-11-19 2023-09-21
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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 1,069   666 403
b 1,542   120 1,422
c 2,298   1,740 558
d 969   926 43
e 599   585 14
522   486 36
854   845 9
470   454 16
1,078   1,093 -15
35,886   37,913 -2,027
865   908 -43
773   907 -134
17,679   18,298 -619
716   742 -26
1,196   1,090 106
2,282   3,038 -756
2,798   4,407 -1,609
923   588 335
840   573 267
1,956   1,632 324
1,013   183 830
913   683 230
653   680 -27
1,542   1,594 -52
854   885 -31
427   326 101
403   333 70
643   309 334
243   275 -32
203   187 16
17,935   18,480 -545
648   285 363
605   768 -163
202   220 -18
378   173 205
369   379 -10
249   242 7
356   283 73
373   287 86
716   1,006 -290
186   290 -104
282   318 -36
218   114 104
681   254 427
118   96 22
26,994   29,092 -2,098
1,741   1,341 400
402   375 27
574   546 28
574   372 202
2,812   2,290 522
388   211 177
232   114 118
8,241   8,555 -314
12,285   13,632 -1,347
1,347   1,385 -38
209   288 -79
342   347 -5
220   174 46
317   41 276
182   206 -24
479   411 68
216   235 -19
197   37 160
335   370 -35
961   982 -21
961   1,072 -111
232   229 3
336   228 108
1,006   926 80
411   392 19
363   495 -132
4,217   4,085 132
369   389 -20
2,764   717 2,047
1,027   708 319
3,812   5,962 -2,150
3,002   2,361 641
907   608 299
4,525   2,736 1,789
773   592 181
718   626 92
523   81 442
652   469 183
60,304   63,298 -2,994
550   528 22
504   528 -24
306   218 88
194   248 -54
1,054   484 570
1,401   35 1,366
445   365 80
403   373 30
1,300   1,366 -66
800   877 -77
251   231 20
319   130 189
251   285 -34
313   283 30
239   153 86
593   623 -30
3,955   4,116 -161
2,644   2,804 -160
590   158 432
1,300   1,347 -47
304   286 18
430   437 -7
1,291   212 1,079
285   169 116
185   114 71
1,688   1,811 -123
1,300   1,320 -20
1,700   1,917 -217
1,700   1,874 -174
292   390 -98
211   266 -55
189   203 -14
343   289 54
69   57 12
2,600   3,221 -621
2,600   2,854 -254
238   41 197
368   412 -44
396   353 43
5,300   5,778 -478
102   118 -16
313   370 -57
476   459 17
317   228 89
210   142 68
210   122 88
211   196 15
123   115 8
123   165 -42
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
      1,521
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       403
b       1,422
c       558
d       43
e       14
      36
      9
      16
      -15
      -2,027
      -43
      -134
      -619
      -26
      106
      -756
      -1,609
      335
      267
      324
      830
      230
      -27
      -52
      -31
      101
      70
      334
      -32
      16
      -545
      363
      -163
      -18
      205
      -10
      7
      73
      86
      -290
      -104
      -36
      104
      427
      22
      -2,098
      400
      27
      28
      202
      522
      177
      118
      -314
      -1,347
      -38
      -79
      -5
      46
      276
      -24
      68
      -19
      160
      -35
      -21
      -111
      3
      108
      80
      19
      -132
      132
      -20
      2,047
      319
      -2,150
      641
      299
      1,789
      181
      92
      442
      183
      -2,994
      22
      -24
      88
      -54
      570
      1,366
      80
      30
      -66
      -77
      20
      189
      -34
      30
      86
      -30
      -161
      -160
      432
      -47
      18
      -7
      1,079
      116
      71
      -123
      -20
      -217
      -174
      -98
      -55
      -14
      54
      12
      -621
      -254
      197
      -44
      43
      -478
      -16
      -57
      17
      89
      68
      88
      15
      8
      -42
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
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 2,419
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  
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) 1 249
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........................... 3 249
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- ..... 5 249
6 Credits/Payments:
a 2023 estimated tax payments and 2022 overpayment credited to 2023 6a 1,752
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 1,752
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.......right arrow 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...right arrow 10 1,503
11 Enter the amount of line 10 to be: Credited to 2024 estimated taxright arrow252 Refundedright arrow 11 1,251
Form 990-PF (2023)
Form 990-PF (2023)
Page 4
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$   (2) On foundation managers.right arrow$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.right arrow$  
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:
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 arrowMN
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 2023 or the taxable year beginning in 2023? 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
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 arrowWELLS FARGO BANK NA Telephone no.right arrow (800) 352-3705

Located atright arrow100 N MAIN ST FL 5D4001-052WINSTON SALEMNC ZIP+4right arrow27101
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 2023, 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
Form 990-PF (2023)
Form 990-PF (2023)
Page 5
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
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 2023? .............
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 2023, did the foundation have any undistributed income (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2023?....................
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 2023 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 2023.) .....................
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 2023? ..
4b
 
No
Form 990-PF (2023)
Form 990-PF (2023)
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
WELLS FARGO BANK N A TRUSTEE
1 		12,606    
100 N MAIN ST FL 5D4001-052
WINSTONSALEM,NC27101
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 (2023)
Form 990-PF (2023)
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  
2  
All other program-related investments. See instructions.
3  
Total. Add lines 1 through 3.........................right arrow  
Form 990-PF (2023)
Form 990-PF (2023)
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
912,871
b
Average of monthly cash balances.......................
1b
24,347
c
Fair market value of all other assets (see instructions)................
1c
0
d
Total (add lines 1a, b, and c).........................
1d
937,218
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
937,218
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
14,058
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
923,160
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
46,158
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
46,158
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
249
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
 
c
Add lines 2a and 2b............................
2c
249
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
45,909
4
Recoveries of amounts treated as qualifying distributions................
4
0
5
Add lines 3 and 4............................
5
45,909
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
45,909
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
44,237
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
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)....................
3a
0
b
Cash distribution test (attach the required schedule) .................
3b
0
4
Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4. .......
4
44,237
Form 990-PF (2023)
Form 990-PF (2023)
Page 9
Part XII
Undistributed Income (see instructions)
(a)
Corpus 		(b)
Years prior to 2022 		(c)
2022 		(d)
2023
1 Distributable amount for 2023 from Part X, line 7 45,909
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2022 only....... 37,932
b Total for prior years:20 , 20, 20 0
3 Excess distributions carryover, if any, to 2022:
a From 2018...... 0
b From 2019...... 0
c From 2020...... 0
d From 2021...... 0
e From 2022...... 0
f Total of lines 3a through e ........ 0
4Qualifying distributions for 2023 from Part
XI, line 4: right arrow$ 44,237
a Applied to 2022, but not more than line 2a 37,932
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 2023 distributable amount..... 6,305
e Remaining amount distributed out of corpus 0
5 Excess distributions carryover applied to 2023. 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 2022. Subtract line
4a from line 2a. Taxable amount—see
instructions ............. 		0
f Undistributed income for 2023. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2024 .......... 		39,604
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 2018 not
applied on line 5 or line 7 (see instructions) ... 		0
9 Excess distributions carryover to 2024.
Subtract lines 7 and 8 from line 6a ...... 		0
10 Analysis of line 9:
a Excess from 2019.... 0
b Excess from 2020.... 0
c Excess from 2021.... 0
d Excess from 2022.... 0
e Excess from 2023.... 0
Form 990-PF (2023)
Form 990-PF (2023)
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 2023, 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) 2023 (b) 2022 (c) 2021 (d) 2020
         
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 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 (2023)
Form 990-PF (2023)
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

TEDFORD HOUSING

PO BOX 958
BRUNSWICK,ME040110958 		NONE PC GENERAL OPERATING 4,000

OASIS HEALTH NETWORK INC

66 BARIBEAU DRIVE
BRUNSWICK,ME040113230 		NONE PC GENERAL OPERATING 1,250

WIDOWS MIGHT

PO BOX 1738
MAPLE GROVE,MN55311 		NONE PC GENERAL OPERATING 500

STORYCORPS INC

80 HANSON PLACE 2ND FLOOR
BROOKLYN,NY112170000 		NONE PC GENERAL OPERATING 500

MICHAEL J FOX FOUNDATION FOR PARKINSONS

PO BOX 4777
NEW YORK,NY101634777 		NONE PC GENERAL OPERATING 1,000

CONGREGATIONAL CHRISTIAN CHURCHES

PO BOX 288
OAK CREEK,WI53154 		NONE PC GENERAL OPERATING 4,500

DOOR COMMUNITY AUDITORIUM

3926 WI-42
FISH CREEK,WI54212 		NONE PC GENERAL OPERATING 500

NEWBERG EARLY BIRDS ROTARY FOUNDATION

1102 N SPRINGBROOK RD 103
NEWBERG,OR971322007 		NONE PC GENERAL OPERATING 1,500

FRIENDS OF EGG HARBOR LIBRARY INC

290 MATHISTOWN RD
LITTLE EGG HARBOR TWP,NJ08087 		NONE PC GENERAL OPERATING 1,000

HARPSWELL HERITAGE LAND TRUST

153 HARPSWELL NECK ROAD
HARPSWELL,ME040790000 		NONE PC GENERAL OPERATING 250

YAMHILL COUNTY HISTORICAL SOCIETY

11275 SW DURHAM LN
MCMINNVILLE,OR971288614 		NONE PC GENERAL OPERATING 500

DELTA GAMMA FOUNDATION

3250 RIVERSIDE DR
UPPER ARLNGTN,OH432211725 		NONE PC GENERAL OPERATING 1,000

SHRINERS HOSPITALS FOR CHILDREN

POST OFFICE BOX 31356
TAMPA,FL336310000 		NONE PC GENERAL OPERATING 500

MILWAUKEE ART MUSEUM INC

700 N ART MUSEUM DR
MILWAUKEE,WI532024007 		NONE PC GENERAL OPERATING 500

PLANNED PARENTHOOD OF WISCONSN INC

302 N JACKSON ST
MILWAUKEE,WI532025904 		NONE PC GENERAL OPERATING 500

SHEPHERD OF THE BAY LUTHERAN CHURCH

PO BOX 27
ELLISON BAY,WI542100027 		NONE PC GENERAL OPERATING 500

PATHFINDERS MILWAUKEE INC

4200 N HOLTON ST STE 400
MILWAUKEE,WI532121064 		NONE PC GENERAL OPERATING 1,500

MILLER ART CENTER FOUNDATION INC

107 S 4TH AVE
STURGEON BAY,WI542352203 		NONE PC GENERAL OPERATING 1,500

Minnesota Odd Fellows Home Inc

815 FOREST AVE
Northfield,MN550571643 		NONE PC GENERAL OPERATING 1,500

MAYO CLINIC

200 FIRST STREET SW
ROCHESTER,MN55905 		NONE PC GENERAL OPERATING 1,000

MILWAUKEE HOMELESS VETERANS INITIATIVE

PO BOX 14575
WEST ALLIS,WI53214 		NONE PC GENERAL OPERATING 1,500

MASONIC-EASTERN STAR HOME FOR CHILDREN

2415 NORTH MAIN STREET
FREMONT,NE68026 		NONE PC GENERAL OPERATING 1,000

OREGON RIGHT TO LIFE EDUCATION FOUNDATIO

4335 RIVER RD N
KEIZER,OR973035506 		NONE PC GENERAL OPERATING 500

DOOR COUNTY HOUSING PARTNERSHIP INC

PO BOX 342
BAILEYS HBR,WI542020342 		NONE PC GENERAL OPERATING 1,000

HABITAT FOR HUMANITY

285 PEACHTREE CENTER AVE
ATLANTA,GA30303 		NONE PC GENERAL OPERATING 500

GEORGE FOX UNIVERSITY

414 N MERIDIAN ST
NEWBERG,OR971322697 		NONE PC GENERAL OPERATING 6,000

LUTHERAN COMMUNITY SERVICES NORTHWEST

4040 S 188TH ST SUITE 300
SEATAC,WA98188 		NONE PC GENERAL OPERATING 1,000

FRIENDSVIEW MANOR

1301 FULTON STREET
NEWBERG,OR971321850 		NONE PC GENERAL OPERATING 1,500

PROVIDENCE NEWBERG HEALTH FOUNDATION

1001 PROVIDENCE DRIVE
NEWBERG,OR971320000 		NONE PC GENERAL OPERATING 2,500

COMMUNITY AND SHELTER ASSIST CORP

20508 SW ROY ROGERS RD 155
SHERWOOD,OR971400000 		NONE PC GENERAL OPERATING 500
Total .................................right arrow 3a 40,000
bApproved for future payment
Total ................................. right arrow 3b  
Form 990-PF (2023)
Form 990-PF (2023)
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 ....     14 26,471  
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 2,419  
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) ..   28,890  
13Total. Add line 12, columns (b), (d), and (e)..................
13
28,890
(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 (2023)
Form 990-PF (2023)
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 (2023)
Additional Data


Software ID:  
Software Version:  


Form 990PF - Special Condition Description:
Special Condition Description

TY 2023 AccountingFeesSchedule
Name:
JOHANSEN T H FAMILY FDN
EIN:
41-6014249
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
TAX PREPARATION FEE (NON-ALLOC 1,061     1,061

TY 2023 InvestmentsCorpStockSchedule
Name:
JOHANSEN T H FAMILY FDN
EIN:
41-6014249
Name of Stock End of Year Book Value End of Year Fair Market Value
09857L108 BOOKING HOLDINGS INC 6,585 10,642
00287Y109 ABBVIE INC 4,294 6,199
87612E106 TARGET CORP 472 3,276
31620M106 FIDELITY NATL INFORM    
904767704 UNILEVER PLC - ADR 3,159 2,909
285512109 ELECTRONIC ARTS INC 2,295 4,104
17275R102 CISCO SYSTEMS INC 2,353 5,608
09260D107 BLACKSTONE INC 3,732 8,379
883556102 THERMO FISHER SCIENT 1,851 5,308
460690100 INTERPUBLIC GROUP CO 1,797 3,101
532457108 ELI LILLY & CO COM 1,614 11,658
037833100 APPLE INC 680 29,842
89151E109 TOTALENERGIES SE -SP 6,755 8,962
G29183103 EATON CORP PLC 4,786 10,114
907818108 UNION PACIFIC CORP 695 4,667
56501R106 MANULIFE FINANCIAL C 4,670 7,094
150870103 CELANESE CORP 4,985 9,478
25243Q205 DIAGEO PLC - ADR 2,256 4,224
654106103 NIKE INC CL B 1,936 3,691
254687106 WALT DISNEY CO    
91324P102 UNITEDHEALTH GROUP I 2,035 11,056
097023105 BOEING CO 4,359 7,820
512807108 LAM RESEARCH CORP CO 2,319 8,616
126650100 CVS HEALTH CORPORATI    
11135F101 BROADCOM INC 3,687 14,511
871829107 SYSCO CORP    
891160509 TORONTO DOMINION BK 5,713 6,591
H2906T109 GARMIN LTD 4,902 6,684
92826C839 VISA INC-CLASS A SHR 4,946 7,811
192446102 COGNIZANT TECH SOLUT 3,198 4,381
46625H100 JPMORGAN CHASE & CO 2,250 10,546
02079K107 ALPHABET INC CL C 3,071 21,844
609207105 MONDELEZ INTERNATION 3,079 5,287
867224107 SUNCOR ENERGY INC NE 6,279 7,850
594918104 MICROSOFT CORP 4,261 32,339
911312106 UNITED PARCEL SERVIC 3,591 5,660
517834107 LAS VEGAS SANDS CORP    
58933Y105 MERCK & CO INC NEW 4,455 7,740
94106L109 WASTE MANAGEMENT INC 2,829 4,478
H84989104 TE CONNECTIVITY LTD 3,114 4,918
75513E101 RTX CORP 7,029 7,741
09247X101 BLACKROCK INC 2,470 6,494
172967424 CITIGROUP INC. 5,604 6,533
30303M102 META PLATFORMS INC 6,483 11,327
418056107 HASBRO INC    
437076102 HOME DEPOT INC 5,052 5,545
7591EP100 REGIONS FINL CORP NE 4,687 4,671
00724F101 ADOBE INC 4,309 5,369
007903107 ADVANCED MICRO DEVIC 3,788 6,339
580135101 MCDONALDS CORP 4,370 4,448
855244109 STARBUCKS CORP COM 3,954 3,744

TY 2023 InvestmentsOtherSchedule2
Name:
JOHANSEN T H FAMILY FDN
EIN:
41-6014249
Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
131649766 CALVERT EMERG MRKTS AT COST 18,716 18,214
101156602 BOSTON TRUST SMALL C      
52471E316 CLEARBRIDGE SMALL CA      
693390866 PIMCO TOTAL RETURN I AT COST 40,504 37,984
67092P409 NUVEEN ESG MID-CAP G AT COST 35,886 39,748
46435G516 ISHARES TRUST ISHARE AT COST 83,151 86,493
131582272 CALVERT HIGH YIELD B AT COST 28,828 28,645
701765505 PARNASSUS MID CAP FU AT COST 37,945 38,610
89155T300 TOUCHSTONE IMPACT BN      
87245R672 TIAA-CREF SOC CHOICE AT COST 59,288 56,776
872365713 TCW EMRG MRKTS INC-P AT COST 60,438 58,025
46435U549 ISHARES ESG AWARE US AT COST 57,279 56,667
47803W703 JOHN HANCOCK-DISC M/ AT COST 27,734 28,483
693390791 PIMCO LOW DURATION I AT COST 28,037 28,080
89155T433 TOUCHSTONE IMPACT BN AT COST 117,789 113,816

TY 2023 OtherDecreasesSchedule
Name:
JOHANSEN T H FAMILY FDN
EIN:
41-6014249
Description Amount
PY RETURN OF CAPITAL ADJUSTMENT 262
ROC ON CY SALES 4
TAX LOT BASIS ADJUSTMENT 4


TY 2023 OtherExpensesSchedule
Name:
JOHANSEN T H FAMILY FDN
EIN:
41-6014249
Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
FILING FEE/STATE TAX 25 0   25
INVESTMENT EXPENSES - ADR FEES 7 7   0


TY 2023 OtherIncreasesSchedule
Name:
JOHANSEN T H FAMILY FDN
EIN:
41-6014249
Description Amount
MUTUAL FUND TIMING ADJ 162
ROUNDING 9


TY 2023 OtherProfessionalFeesSchedule
Name:
JOHANSEN T H FAMILY FDN
EIN:
41-6014249
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
INVESTMNT MNGMNT FEES (NON-DED 673 673    


TY 2023 TaxesSchedule
Name:
JOHANSEN T H FAMILY FDN
EIN:
41-6014249
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
FOREIGN TAXES 722 722   0
FEDERAL TAX PAYMENT - PRIOR YE 694 0   0
FEDERAL ESTIMATES - PRINCIPAL 1,752 0   0
FOREIGN TAXES ON NONQUALIFIED 47 47   0