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
SAMARITAN FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 97
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
HAVILAND, OH458510097
A Employer identification number

34-1957355
B Telephone number (see instructions)

(419) 622-4611
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$22,508,105J 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) 2,927,955
2 Check right arrow.............
3 Interest on savings and temporary cash investments 101,931 101,931 101,931
4 Dividends and interest from securities... 124,655 124,655 124,655
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 Click to see attachment
List of Attached Documents:
// Content
435,782
b Gross sales price for all assets on line 6a 1,869,813
7 Capital gain net income (from Part IV, line 2)...  
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 3,590,323 226,586 226,586
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc.        
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule)......... Click to see attachment
List of Attached Documents:
// Content
200 200    
b Accounting fees (attach schedule)....... Click to see attachment
List of Attached Documents:
// Content
3,225 1,613 1,613 1,612
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment
List of Attached Documents:
// Content
3,124      
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 6,549 1,813 1,613 1,612
25 Contributions, gifts, grants paid....... 3,935,922 3,935,922
26 Total expenses and disbursements. Add lines 24 and 25 3,942,471 1,813 1,613 3,937,534
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -352,148
b Net investment income (if negative, enter -0-) 224,773
c Adjusted net income (if negative, enter -0-)... 224,973
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.............      
2 Savings and temporary cash investments......... 5,701,155 585,776 585,776
3 Accounts receivable right arrow  
Less: allowance for doubtful accounts right arrow        
4 Pledges receivable right arrow  
Less: allowance for doubtful accounts right arrow        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) right arrow  
Less: allowance for doubtful accounts right arrow        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)   3,000,000 3,000,000
b Investments—corporate stock (attach schedule)....... 4,921,754 Click to see attachment
List of Attached Documents:
// Content
6,696,389 		18,922,329
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
15 Other assets (describe right arrow)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 10,622,909 10,282,165 22,508,105
Liabilities 17 Accounts payable and accrued expenses..........   10,000
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) Click to see attachment
List of Attached Documents:
// Content
220 		Click to see attachment
List of Attached Documents:
// Content
1,624
23 Total liabilities (add lines 17 through 22)......... 220 11,624
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........... 10,622,689 10,270,541
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........    
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)..... 10,622,689 10,270,541
30 Total liabilities and net assets/fund balances (see instructions). 10,622,909 10,282,165
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
10,622,689
2
Enter amount from Part I, line 27a .....................
2
-352,148
3
Other increases not included in line 2 (itemize) right arrow
3
 
4
Add lines 1, 2, and 3 ..........................
4
10,270,541
5
Decreases not included in line 2 (itemize) right arrow
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
10,270,541
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.)
1a
b
c
d
e
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2  
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 3,124
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  
3 Add lines 1 and 2........................... 3 3,124
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 3,124
6 Credits/Payments:
a 2023 estimated tax payments and 2022 overpayment credited to 2023 6a 1,500
b Exempt foreign organizations—tax withheld at source...... 6b  
c Tax paid with application for extension of time to file (Form 8868)... 6c 1,500
d Backup withholding erroneously withheld .......... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 3,000
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. Click to see attachment
List of Attached Documents:
// Content
8 2
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......right arrow 9 126
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...right arrow 10  
11 Enter the amount of line 10 to be: Credited to 2024 estimated taxright arrow   Refundedright arrow 11  
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 arrowOH
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 arrowTODD STOLLER Telephone no.right arrow (419) 622-4611

Located atright arrowPO BOX 97HAVILANDOH ZIP+4right arrow45851
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)
 
No
(5) Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)? ......................
1a(5)
 
No
(6) Agree to pay money or property to a government official? (Exception. Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.) ...............
1a(6)
 
No
b
If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........
1b
 
 
c
Organizations relying on a current notice regarding disaster assistance check here ........right arrow
d
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2023? .............
1d
 
 
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
CRAIG STOLLER PRESIDENT
0.50 		0 0 0
12783 RD 82 APT 16
PAULDING,OH45879
TODD STOLLER VICE PRESIDE
0.50 		0 0 0
4824 ROAD 71
PAYNE,OH45880
HOLLY BLUME SEC - TREAS
0.50 		0 0 0
14027 ROAD 12
SCOTT,OH45886
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  
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 arrow  
Part VIII-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
1  
2  
3  
4  
Part VIII-B
Summary of Program-Related Investments (see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
1 N/A  
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
18,200,321
b
Average of monthly cash balances.......................
1b
2,015,398
c
Fair market value of all other assets (see instructions)................
1c
0
d
Total (add lines 1a, b, and c).........................
1d
20,215,719
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation) .............
1e
 
2
Acquisition indebtedness applicable to line 1 assets..................
2
 
3
Subtract line 2 from line 1d.........................
3
20,215,719
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
303,236
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
19,912,483
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
995,624
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
995,624
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
3,124
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
 
c
Add lines 2a and 2b............................
2c
3,124
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
992,500
4
Recoveries of amounts treated as qualifying distributions................
4
 
5
Add lines 3 and 4............................
5
992,500
6
Deduction from distributable amount (see instructions).................
6
 
7
Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
7
992,500
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
3,937,534
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
3,937,534
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 7 992,500
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2022 only.......  
b Total for prior years:20 , 20, 20  
3 Excess distributions carryover, if any, to 2022:
a From 2018...... 1,117,667
b From 2019...... 921,199
c From 2020...... 1,502,454
d From 2021...... 1,733,552
e From 2022...... 1,472,610
f Total of lines 3a through e ........ 6,747,482
4Qualifying distributions for 2023 from Part
XI, line 4: right arrow$ 3,937,534
a Applied to 2022, but not more than line 2a  
b Applied to undistributed income of prior years
(Election required—see instructions)..... 		 
c Treated as distributions out of corpus (Election
required—see instructions)........ 		 
d Applied to 2023 distributable amount..... 992,500
e Remaining amount distributed out of corpus 2,945,034
5 Excess distributions carryover applied to 2023.    
(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 9,692,516
b Prior years’ undistributed income. Subtract
line 4b from line 2b .......... 		 
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...... 		 
d Subtract line 6c from line 6b. Taxable amount
—see instructions ........... 		 
e Undistributed income for 2022. Subtract line
4a from line 2a. Taxable amount—see
instructions ............. 		 
f Undistributed income for 2023. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2024 .......... 		0
7 Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions) ....... 		 
8 Excess distributions carryover from 2018 not
applied on line 5 or line 7 (see instructions) ... 		1,117,667
9 Excess distributions carryover to 2024.
Subtract lines 7 and 8 from line 6a ...... 		8,574,849
10 Analysis of line 9:
a Excess from 2019.... 921,199
b Excess from 2020.... 1,502,454
c Excess from 2021.... 1,733,552
d Excess from 2022.... 1,472,610
e Excess from 2023.... 2,945,034
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).)
bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here right arrow
aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
TODD CRAIG STOLLER
PO BOX 97
HAVILAND,OH45851
(419) 622-4611
bThe form in which applications should be submitted and information and materials they should include:
SEE ATTACHED APPLICATION FORM
cAny submission deadlines:
NONE
dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
SEE ATTACHED
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
RAY KUPFERSMITH JR


824 W WAYNE ST
PAULDING,OH45879 		NONE PRIVATE MEDICAL EXPENSES 50,200

AMERICAN HEART ASSOCIATION

PO BOX 78851
PHOENIX,AZ850628851 		  PUBLIC HUMANITARIAN 1,000

APOSTOLIC CHRISTIAN ALMS FUND
-LATTY
4186 RD 71
PAYNE,OH45880 		  PUBLIC HUMANITARIAN 150,000

ASHES TO GLORY FOUNDATION

PO BOX 532176
LIVONIA,MI48153 		  PUBLIC HUMANITARIAN 50,000

CARE

NORMAN SENSENIG 5192
OLIVESBURG GREENWICH RD
GREENWICH,OH44837 		NONE PUBLIC HUMANITARIAN 1,000

CHRISTIAN AID MINISTRIES

PO BOX 360
BERLIN,OH446100360 		  PUBLIC BIBLES 15,000

CHRISTIAN AID MINISTRIES

PO BOX 361
BERLIN,OH446100361 		  PUBLIC CHARITY 300,000

CHRISTIAN AID MINISTRIES

PO BOX 362
BERLIN,OH446100362 		  PUBLIC UKRAINE CRISIS 25,000

CHRISTIAN AID MINISTRIES

PO BOX 363
BERLIN,OH446100363 		  PUBLIC AID FOR DISABLED IN RESTRICTED COUNT 10,000

CHRISTIAN AID MINISTRIES

PO BOX 364
BERLIN,OH446100364 		  PUBLIC BIBLICAL DICIPLESHIP 10,000

CHRISTIAN AID MINISTRIES

PO BOX 365
BERLIN,OH446100365 		  PUBLIC DISASTER RESPONSE SERVICE/ RAPID RES 10,000

CHRISTIAN AID MINISTRIES

PO BOX 366
BERLIN,OH446100366 		  PUBLIC WORLD HUNGER FUND 10,000

CHRISTIAN AID MINISTRIES

PO BOX 367
BERLIN,OH446100367 		  PUBLIC BIBLES FOR RESTRICTED COUNTRIES 10,000

CHRISTIAN AID MINISTRIES

PO BOX 368
BERLIN,OH446100368 		  PUBLIC BILLBOARD EVANGELISM 10,000

CHRISTIAN AID MINISTRIES

PO BOX 369
BERLIN,OH446100369 		  PUBLIC MIDDLE EAST MINISTRIES 25,000

CHRISTIAN AID MINISTRIES

PO BOX 370
BERLIN,OH446100370 		  PUBLIC MEDICINES FOR MULTITUDES 5,000

CHRISTIAN AID MINISTRIES

PO BOX 372
BERLIN,OH446100372 		  PUBLIC BIBLE DISTRIBUTION 200,000

GALILEAN HOME MINISTRIES

PO BOX 880
LIBERTY,KY425390880 		  PUBLIC CHARITY 250,000

JUST NEIGHBORS INTERFAITH HOMELES

2925 E STATE
FORT WAYNE,IN46805 		  PUBLIC CHARITY 10,000

LOVING SHEPHERD MINISTRIES

PO BOX 375
BLUFFTON,IN46714 		  PUBLIC CHARITY 100,000

MIDWEST FOOD BANK

5601 DIVISION DR
FT MYERS,FL33905 		  PUBLIC HUMANITARIAN 50,000

PAULDING CO AREA FOUNDATION

101 E PERRY ST
PAULDING,OH45879 		  PUBLIC SCHOLARSHIPS 500

SHRINERS HOSPITALS FOR CHILDREN

2900 ROCKY POINT DR
TAMPA,FL33607 		  PUBLIC HUMANITARIAN 100,000

ST JUDE CHILDRENS RESEARCH HOSPITAL

501 ST JUDE PLACE
MEMPHIS,TN38105 		  PUBLIC HUMANITARIAN 100,000

THE RESCUE MISSION

PO BOX 11116
FORT WAYNE,IN468551116 		  PUBLIC HUMANITARIAN 1,014,050

WEST OHIO FOOD BANK

PO BOX 1566
LIMA,OH458021566 		  PUBLIC HUMANITARIAN 15,000

CHIEF SUPERMARKETS

1107 S SHANNON ST
VAN WERT,OH45891 		NONE PUBLIC CHARITY 7,838

CHRISTIAN CHILD CARE COALITION

4102 N W DONDEE LN
TOPEKA,KS66618 		  PUBLIC CHARITY 2,000

COVENANT HOUSE

PO BOX 96393 WASHINGTON
WASHINGTON DC,DC200777114 		  PUBLIC CHARITY 5,000

HEARTEN HOUSE

DCIC PO BOX 807
AUBURN,IN46706 		  PUBLIC GALA 10,000

APOSTOLIC CHRISTIAN ALMS FUND - LAT

DUANE SINN 14725 RD 72
HAVILAND,OH45852 		  PUBLIC CHURCH UPKEEP 1,000

BARREN HEIGHTS

11420 WATTERSON CT 800
LOUISVILLE,KY40299 		  PUBLIC CHARITY 2,500

HANDS OF HOPE

1030 W WAYNE STREET
PAULDING,OH45879 		  PUBLIC CHARITY 10,000

LIFEWISE PAULDING EXEMPTED

PO BOX 226
PAULDING,OH45879 		  PUBLIC CHARITY 100,000

MUSTARD SEED FURNITURE BANK

3636 ILLINOIS ROAD
FT WAYNE,IN46804 		  PUBLIC CHARITY 20,000

OPERATION REBIRTH

1638 APPLE RD
ST PARIS,OH43072 		  PUBLIC CHARITY 20,000

AMERICAN RED CROSS

1111 RESEARCH DR
TOLEDO,OH43614 		  PUBLIC HOME FIRE ASSISTANCE 10,000

APOSTOLIC CHRISTIAN ALMS FUND LATTY

DUANE SINN 14725 RD 72
HAVILAND,OH45853 		  PUBLIC HARVEST CALL 250,000

APOSTOLIC CHRISTIAN ALMS FUND LATTY

DUANE SINN 14725 RD 73
HAVILAND,OH45854 		  PUBLIC FELLOWSHIP HALL UPKEEP 50,000

APOSTOLIC CHRISTIAN ALMS FUND LATTY

DUANE SINN 14725 RD 74
HAVILAND,OH45855 		  PUBLIC GIDEON BIBLE DISTRIBUTION 10,000

APOSTOLIC CHRISTIAN ALMS FUND LATTY

DUANE SINN 14725 RD 75
HAVILAND,OH45856 		  PUBLIC LOCAL BIBLE DISTRIBUTION 10,000

APOSTOLIC CHRISTIAN ALMS FUND - JUN

MICHAEL SCHNEIDER 16624
PAULDING,OH45879 		  PUBLIC CHARITY/ASSISTANCE TO THE POOR 25,000

APOSTOLIC CHRISTIAN CHURCH OF JUNCT

C/O ANDY MANZ 1016 EMERA
PAULDING,OH45879 		  PUBLIC UKRAINE RELIEF - POLAND 50,000

APOSTOLIC CHRISTIAN HARVEST CALL

3984 RD 117
HAVILAND,OH45851 		  PUBLIC COAT COLLECTION 20,000

APOSTOLIC CHRISTIAN HARVEST CALL

PO BOX 3797
WEST LAFAYETTE,IN47996 		  PUBLIC HURRICANE IAN 100,000

BOOMERANG BACKPACK

4616 EAST DUPONT ROAD
SUITE C
FORT WAYNE,IN46825 		  PUBLIC CHARITY 2,500

GATEWAY WOODS

14505 KLOPFENSTEIN RD
PO BOX 151
LEO,IN46765 		  PUBLIC CHARITY 25,000

HAVILAND DRAINAGE

PO BOX 97
HAVILAND,OH45851 		NONE PUBLIC KROGER GIFT CARDS 1,600

LIFE WISE

5375 GRACE ST
HILLIARD,OH43026 		  PUBLIC DEFIANCE AREA CHARITY 100,000

PAULDING COUNTY AG SOCIETY

PO BOX 222
PO BOX 222
PAULDING,OH45879 		  PUBLIC FAIR AUCTION 12,873

PENNY PITCH

2915 MAPLES RD
FORT WAYNE,IN46816 		  PUBLIC CHARITY 10,000

UNITED WAY OF PAULDING COUNTY

101 E PERRY ST
PAULDING,OH45879 		  PUBLIC CHARITY 25,000

VAN WERT AREA ECONOMIC DEVELOPMENT

145 EAST MAIN ST
VAN WERT,OH45891 		  PUBLIC BUILD YOUR FUTURE 2,500

APOSTOLIC CHRISTIAN COUNTRY VILLA

MARK SINN 20302 RD 48
GROVER HILL,OH45849 		  PUBLIC EUTSLER FIRE FUND 1,500

APOSTOLIC NURSING HOME AUXILLARY

7100 APPLECREEK RD
SMITHVILLE,OH44677 		  PUBLIC AUXILARY AUCTION 4,000

BREAKLOOSE

PO BOX 82530
ROCHESTER,MI48308 		  PUBLIC CHARITY 2,500
CALEB WEIBLE


340 GRANT ST
VAN WERT,OH45891 		  PRIVATE MEDICAL EXPENSES 2,000

CANCER CARE TEAM

ATTN KOEN HOLWELL 3240 WA
ONORO,MN55356 		  PUBLIC CHARITY 5,000

CARING AND SHARING FOOD PANTRY

103 N MAIN ST
PAULDING,OH45879 		  PUBLIC CHARITY-NEW BUILDING FUND 75,000

COMMUNITY HARVEST FOOD BANK

POBOX 10967
FT WAYNE,IN46855 		  PUBLIC CHARITY 25,000

COMMUNITY HEALTH PROFESSIONALS

250 DOOLEY DR
SUITE A
PAULDING,OH45879 		  PUBLIC BEACON AUCTION AND DINNER 5,730

COMPASSION INTERNATIONAL

COMPASSION INTERNATIONAL
COLORADO SPRINGS,CO80997 		  PUBLIC CHARITY 20,000
CORBIN BRANSON


13366 STATE ROUTE 709
OHIO CITY,OH45874 		  PRIVATE HOUSE FIRE 1,000
DEREK AND ADDIE LELS


6025 SLADE RD
GREENVILLE,OH45331 		  PRIVATE MEDICAL EXPENSES 10,000

DEN HERDER FUNERAL HOME

PO BOX 27
PAULDING,OH45879 		  PRIVATE FUNERAL EXPENSES- QUINTON HART 5,000
DENNIS STABLER


5623 RD 71
PAYNE,OH45880 		  PRIVATE CHARITY-FIRE 2,000

DEFIANCE CO FURNITURE BANK

715 JEFFERSON AVE
DEFIANCE,OH43512 		  PUBLIC CHARITY 2,500

FAMILY PROMISE OF GWINNETT COUNTY

POBOX 464971
LAWRENCEVILLE,GA30042 		  PUBLIC CHARITY 1,000

FIRST BAPTIST CHURCH

1399 JEFFERSON AVE
DEFIANCE,OH43512 		  PUBLIC RENOVATION PROJECT 15,000

FEEDING ME WHILE SERVING YOU PROJEC

2469 E DUBLIN GRANVILLE R
COLUMBUS,OH43229 		  PUBLIC CHARITY 2,500

GIVE SEND GOCOM - RIDE4ALEX

8 THE GRN STE A
DOVER,DE199013618 		  PRIVATE ALEX HOPSON-MEDICAL EXPENSES 2,500

INDIANA BARNSTORMERS

6627 COUNTY RD 68
SPENCERVILLE,IN46788 		  PUBLIC CHARITY 150

KAITLYN'S COTTAGE

1260 RALSTON AVE
DEFIANCE,OH43512 		  PUBLIC CHARITY 10,000
KAREN TRESSLER


POBOX 437 220 W VINE ST
SHERWOOD,OH43556 		  PRIVATE SKYLIE MEDICAL BILLS 2,500

KENNFELD GROUP

10305 LIBERTY UNION RD
VAN WERT,OH45891 		  PUBLIC GATEWAY WOODS AUCTION ITEM DONATION 1,350

KINGS'S CROSS CHURCH

334 FLORENCE AVE
DEFIANCE,OH43512 		  PUBLIC CHARITY 2,500

KROGERCOM

1014 VINE ST
CINCINNATI,OH45202 		  PUBLIC KROGER GIFT CARDS 1,600

LIFE SONG FOR ORPHANS

PO BOX 40
GRIDLEY,IL61744 		  PUBLIC UKRAINE RELIEF/GREATEST NEED 150,000
LISA BROTHERS


7901 ST RT 114
HAVILAND,OH45851 		  PRIVATE NICK SCHLEUTER MEDICAL EXPENSES 2,500

LOVE-HEITMEYER FUNERAL HOME-INC

810 WALNUT ST
PO BOX 191
OAKWOOD,OH45873 		  PRIVATE FUNERAL EXPENSES 6,511

MAD DOG WRESTLING

1755 PALMER DR
DEFIANCE,OH43512 		  PUBLIC DONATION 150
MATT AND RACHAEL PLETSCHER


7286 JACKMAN RD
IDA,MI48140 		  PRIVATE MEDICAL EXPENSES 5,000
NAOMY YANEZ


408 N MAIN ST
PAYNE,OH45880 		  PRIVATE MEDICAL BILLS 1,000
NICOLE PARKER


PO BOX 97
INDIGNANT AID
HAVILAND,OH45851 		  PRIVATE RENT ASSISTANCE 500

OUR DAILY BREAD MINISTRIES

POBOX 264
GRAND RAPIDS,MI495010254 		  PUBLIC CHARITY 1,000

PLC HEALTH CLINIC

215 N MARKET ST
VAN WERT,OH45891 		  PUBLIC CHARITY 1,000

PRISON FELLOWSHIP

POBOX1550
MERRIFIELD,VA22116 		  PUBLIC CHARITY 20,000

REDEMPTION HOUSE MINISTRIES

POBOX 12008
FT WAYNE,IN46802 		  PUBLIC CHARITY 15,000

RONALD MCDONALD HOUSE CHARITIES OF

3883 MONROE ST
TOLEDO,OH43606 		  PUBLIC CHARITY 20,000
ROSS AND KATIE SIEFKER


4186 SR 634
CONTINENTAL,OH45831 		  PRIVATE MEDICAL EXPENSES 5,000

SALVATION ARMY OF VAN WERT

120 N CHERRY ST
VAN WERT,OH45891 		  PUBLIC CHARITY 500

SALVATION ARMY OF VAN WERT

120 N CHERRY ST
VAN WERT,OH45891 		  PUBLIC ANGEL TREE 5,000

ST JOHN THE EVANGELIST CHURCH

331 E 2ND ST
DELPHOS,OH45833 		  PUBLIC IN MEMORY OF LEANN GORDON 1,000

ST JOSEPH MISSIONS

3505 LAKE AVE
FT WAYNE,IN46805 		  PUBLIC WOMENS SHELTER 10,000

STOWE MISSION OF CENTRAL OHIO

PO BOX 6341
COLUMBUS,OH43206 		  PUBLIC CHARITY 5,000
TAMMY ROWE


5761 ST RT 500
PAYNE,OH45880 		  PRIVATE CHARITY/FUNERAL EXPENSE 2,000
TED AND MACEY WONDERLAND


13194 ST RT 18
SHERWOOD,OH43556 		  PRIVATE MEDICAL EXPENSES 5,000
TERESA WOOD


881 SILVER LN
JEFFERSON CITY,TN37760 		  PRIVATE MEDICAL EXPENSES 1,000
TRACY SILVER


881 SILVER LN
JEFFERSON CITY,TN37760 		  PRIVATE MEDICAL EXPENSES 1,000

TRAVIS BURKHART FOUNDATION

10274 N 200 E
PLAINVILLE,IN47568 		  PUBLIC CHARITY 2,500

VILLAGE OF OAKWOOD

PO BOX 457
OAKWOOD,OH45873 		  PUBLIC AED TRAINER 1,370
WILLIAM HENRY HOWARD JR


828 KENOSHA RD
KETTERING,OH45429 		  PRIVATE HOUSE FIRE 2,000

WOODBURN CHRISTIAN CHILDRENS HOME

PO BOX 459
WOODBURN,IN46797 		  PUBLIC CHARITY 20,000

ADRIEL

414 NORTH DETROIT ST
WEST LIBERTY,OH43357 		    CHARITY 15,000

APOSTOLIC CHRISTIAN ALMS FUND-JUNCT

MICHEAL SCHNEIDER
16624 RD 156
PAULDING,OH45879 		    CHARITY 25,000

APOSTOLIC CHRISTIAN- CHURCH

TIM SINN
3984 RD 117
HAVILAND,OH45851 		    LOCAL SEWING FUND 5,000

TRINE UNIVERSITY

ONE UNIVERSITY AVENUE
ANGOLA,IN46703 		    SCHOLARSHIPS 2,000
Total .................................right arrow 3a 3,935,922
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 ........... 		    14 101,931  
4 Dividends and interest from securities ....     14 124,655  
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 ............ 		    14 435,782  
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) ..   662,368  
13Total. Add line 12, columns (b), (d), and (e)..................
13
662,368
(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
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Name of the organization
SAMARITAN FOUNDATION
 
Employer identification number

34-1957355
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990) (2023)
Schedule B (Form 990) (2023) Page 2
Name of organization
SAMARITAN FOUNDATION
  		Employer identification number
34-1957355
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
1
MODERN PLASTIC RECOVERY INC
 
PO BOX 38
 
HAVILAND, OH45851

$ 394,900


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
7
INSOURCE TECHNOLOGIES
12124 RD 111
 
PAULDING, OH45879

$ 13,790


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
2
HAVILAND DRAINAGE PRODUCTS CO
 
PO BOX 97
 
HAVILAND, OH45851

$ 1,004,365


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
8
MELVENE STOLLER
4824 RD 71
 
PAYNE, OH45880

$ 6,000


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
3
HAVILAND PLASTIC PRODUCTS CO
 
PO BOX 38
 
HAVILAND, OH45851

$ 1,315,000


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
4
HAVILAND CULVERT COMPANY INC
 
PO BOX 97
 
HAVILAND, OH45851

$ 23,500


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)
Name of organization
SAMARITAN FOUNDATION
  		Employer identification number
34-1957355
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
5
HAVILAND ENERGY LLC
 
100 WEST MAIN STREET
 
HAVILAND, OH45851

$ 158,900


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
6
CLINT HOLLY BLUME
14027 ROAD 12
 
SCOTT, OH45886

$ 10,000


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

$  


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

$  


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

$  


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

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)
Schedule B (Form 990) (2023)
Page 3
Name of organization
SAMARITAN FOUNDATION
  		Employer identification number

34-1957355
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
Schedule B (Form 990) (2023)
Schedule B (Form 990) (2023)
Page 4
Name of organization
SAMARITAN FOUNDATION
  		Employer identification number

34-1957355
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990) (2023)
Additional Data


Software ID:  
Software Version:  

TY 2023 AccountingFeesSchedule
Name:
SAMARITAN FOUNDATION
EIN:
34-1957355
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
ACCOUNTING FEES 3,225 1,613 1,613 1,612

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

TY 2023 GainLossSaleOtherAssetsSch
Name:
SAMARITAN FOUNDATION
EIN:
34-1957355
Name Date Acquired How Acquired Date Sold Purchaser Name Gross Sales Price Basis Basis Method Sales Expenses Total (net) Accumulated Depreciation
TD AMERITRADE ST   PURCHASE     732,521 697,534     34,987  
TD AMERITRADE LT   PURCHASE     1,137,292 736,497     400,795  

TY 2023 InvestmentsCorpStockSchedule
Name:
SAMARITAN FOUNDATION
EIN:
34-1957355
Name of Stock End of Year Book Value End of Year Fair Market Value
BERKSHIRE HATHAWAY 1,858,024 9,308,826
WAL-MART 262,748 835,545
AMERICAN EXPRESS 81,820 374,680
GENERAL ELECTRIC 121,709 79,769
SHERWIN WILLIAMS 575,364 4,210,650
US BANCORP 141,115 302,960
WABTEC CORP 2,030 3,299
BLOCK INC 233,222 154,700
INVESTCO QQQ TRUST 569,103 778,088
NVIDIA CORP 40,669 99,044
PAYPAL HOLDINGS INC 36,841 24,564
VANGUARD S&P 500 41,339 43,680
DOLLAR GENERAL CORP 166,217 156,343
GE HEALTHCARE 47,805 30,928
CALUMET SPECIALTY PRODUCTS 17,000 17,870
MUTUAL FUND 1,240,128 1,240,128
CHARLES SCHWAB 1,261,255 1,261,255

TY 2023 LegalFeesSchedule
Name:
SAMARITAN FOUNDATION
EIN:
34-1957355
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
  200 200    


TY 2023 OtherLiabilitiesSchedule
Name:
SAMARITAN FOUNDATION
EIN:
34-1957355
Description Beginning of Year - Book Value End of Year - Book Value
EXCISE TAX PAYABLE 220 1,624


TY 2023 TaxesSchedule
Name:
SAMARITAN FOUNDATION
EIN:
34-1957355
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
EXCISE TAX 3,124