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
KLOCKOW HARVEY R AND DORIS 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

35-2070029
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$1,831,044J 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... 55,807 55,649  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 47,409
b Gross sales price for all assets on line 6a 325,758
7 Capital gain net income (from Part IV, line 2)... 47,409
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)....... Click to see attachment
List of Attached Documents:
// Content
840    
12 Total. Add lines 1 through 11........ 104,056 103,058  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 24,538 18,403   6,134
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
1,062 0 0 1,062
c Other professional fees (attach schedule).... Click to see attachment
List of Attached Documents:
// Content
2,846 1,068   1,778
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... Click to see attachment
List of Attached Documents:
// Content
936 936   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
12 12    
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 29,394 20,419 0 8,974
25 Contributions, gifts, grants paid....... 85,000 85,000
26 Total expenses and disbursements. Add lines 24 and 25 114,394 20,419 0 93,974
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -10,338
b Net investment income (if negative, enter -0-) 82,639
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............. 1,747 308 308
2 Savings and temporary cash investments......... 77,627 63,641 63,641
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)....... 280,312 Click to see attachment
List of Attached Documents:
// Content
214,599 		524,921
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).......... 1,220,495 Click to see attachment
List of Attached Documents:
// Content
1,288,928 		1,242,174
14 Land, buildings, and equipment: basis right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
15 Other assets (describe right arrow)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,580,181 1,567,476 1,831,044
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........ 1,580,181 1,567,476
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)..... 1,580,181 1,567,476
30 Total liabilities and net assets/fund balances (see instructions). 1,580,181 1,567,476
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............
1
1,580,181
2
Enter amount from Part I, line 27a .....................
2
-10,338
3
Other increases not included in line 2 (itemize) right arrow
3
0
4
Add lines 1, 2, and 3 ..........................
4
1,569,843
5
Decreases not included in line 2 (itemize) right arrowClick to see attachment
List of Attached Documents:
// Content
5
2,367
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
1,567,476
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 22. ALPHABET INC CL C   2020-04-06 2023-01-25
b 21. APPLE INC   2020-04-06 2023-01-25
c 1. BOOKING HOLDINGS INC   2021-07-26 2023-01-25
d 6. CELANESE CORP     2023-01-25
e 4. CELANESE CORP     2023-01-25
20. CITIGROUP INC.   2019-08-09 2023-01-25
10. WALT DISNEY CO   2022-06-24 2023-01-25
2. LAM RESEARCH CORP COM     2023-01-25
121.687 T ROWE PR OVERSEAS STOCK-I #521   2021-07-27 2023-01-25
27. SUNCOR ENERGY INC NEW F   2015-07-07 2023-01-25
69.86 TOUCHSTONE MID CAP-R6 #355   2020-02-20 2023-01-25
8. VANGUARD MIDCAP VIPER   2022-04-26 2023-01-25
2. BLACKROCK INC   2020-04-06 2023-02-09
4. COGNIZANT TECH SOLUTIONS CRP COM   2022-10-18 2023-02-09
25. COGNIZANT TECH SOLUTIONS CRP COM     2023-02-09
48. FIDELITY NATL INFORMATION SVCS INC     2023-02-09
62. FIDELITY NATL INFORMATION SVCS INC     2023-02-09
40. INTERPUBLIC GROUP COS INC   2020-10-26 2023-02-09
10. JPMORGAN CHASE & CO     2023-02-09
55. LAS VEGAS SANDS CORP     2023-02-09
8. UNION PACIFIC CORP   2010-11-12 2023-02-09
10. WASTE MANAGEMENT INC     2023-02-09
11. WALT DISNEY CO   2022-06-24 2023-03-17
23. MANULIFE FINANCIAL CORP   2022-10-18 2023-03-17
118. MANULIFE FINANCIAL CORP     2023-03-17
9. ABBVIE INC   2023-01-25 2023-05-17
6. ABBVIE INC   2021-10-12 2023-05-17
6. ADVANCED MICRO DEVICES INC   2023-02-09 2023-05-17
1. BLACKROCK INC   2020-04-06 2023-05-17
8. BLACKSTONE INC   2023-02-09 2023-05-17
5. BOEING CO   2022-10-25 2023-05-17
2. BROADCOM INC   2019-07-03 2023-05-17
11. CVS HEALTH CORPORATION   2023-01-25 2023-05-17
8. CVS HEALTH CORPORATION     2023-05-17
16. CISCO SYSTEMS INC     2023-05-17
7. COGNIZANT TECH SOLUTIONS CRP COM   2016-08-24 2023-05-17
28.129 DELAWARE SMALL CAP CORE-R6   2022-10-18 2023-05-17
1260.321 DELAWARE SMALL CAP CORE-R6   2022-04-27 2023-05-17
4. DIAGEO PLC - ADR     2023-05-17
2. ELECTRONIC ARTS INC   2022-10-18 2023-05-17
4. ELECTRONIC ARTS INC     2023-05-17
6. META PLATFORMS INC   2021-04-08 2023-05-17
8. HASBRO INC   2021-04-08 2023-05-17
1. HOME DEPOT INC   2022-12-06 2023-05-17
13. INTERPUBLIC GROUP COS INC   2020-10-26 2023-05-17
8. JPMORGAN CHASE & CO   2020-04-06 2023-05-17
7. LAS VEGAS SANDS CORP   2020-04-06 2023-05-17
4. ELI LILLY & CO COM   2023-01-25 2023-05-17
3. ELI LILLY & CO COM   2016-10-03 2023-05-17
45. MANULIFE FINANCIAL CORP   2016-03-01 2023-05-17
9. MERCK & CO INC NEW     2023-05-17
14. MICROSOFT CORP     2023-05-17
2. MICROSOFT CORP   2015-08-31 2023-05-17
10. MONDELEZ INTERNATIONAL INC   2018-07-27 2023-05-17
4. NIKE INC CL B   2020-04-06 2023-05-17
26. RTX CORP     2023-05-17
31. REGIONS FINL CORP NEW   2022-08-22 2023-05-17
8. SYSCO CORP     2023-05-17
3. TARGET CORP   2020-04-06 2023-05-17
2. THERMO FISHER SCIENTIFIC INC   2010-02-11 2023-05-17
12. TORONTO DOMINION BK ONT COM NEW   2023-02-09 2023-05-17
17. TOTAL S.A. - ADR   2022-06-24 2023-05-17
26.385 TOUCHSTONE MID CAP-R6 #355   2022-10-18 2023-05-17
372.496 TOUCHSTONE MID CAP-R6 #355     2023-05-17
8. UNILEVER PLC - ADR   2020-02-03 2023-05-17
2. UNION PACIFIC CORP   2010-11-12 2023-05-17
4. UNITED PARCEL SERVICE-CL B   2023-02-09 2023-05-17
1. UNITEDHEALTH GROUP INC   2022-10-18 2023-05-17
5. UNITEDHEALTH GROUP INC   2010-02-11 2023-05-17
304. VANGUARD MIDCAP VIPER     2023-05-17
3. VISA INC-CLASS A SHRS   2023-02-09 2023-05-17
3. WASTE MANAGEMENT INC   2020-09-15 2023-05-17
5. EATON CORP PLC     2023-05-17
1. EATON CORP PLC   2021-04-08 2023-05-17
7. GARMIN LTD     2023-05-17
5. TE CONNECTIVITY LTD   2021-11-19 2023-05-17
96. CVS HEALTH CORPORATION   2010-11-12 2023-06-15
3. WALT DISNEY CO   2023-05-17 2023-06-15
52. WALT DISNEY CO   2010-02-11 2023-06-15
12. ELECTRONIC ARTS INC   2020-04-06 2023-06-15
3. HASBRO INC   2022-10-18 2023-06-15
93. HASBRO INC     2023-06-15
7. LAS VEGAS SANDS CORP   2022-10-18 2023-06-15
72. LAS VEGAS SANDS CORP     2023-06-15
3. ELI LILLY & CO COM     2023-06-15
96. SYSCO CORP   2020-04-06 2023-06-15
7. EATON CORP PLC   2021-04-08 2023-06-15
10. ABBVIE INC   2021-10-12 2023-12-04
2. ADOBE SYS INC   2023-06-15 2023-12-04
10. ADVANCED MICRO DEVICES INC   2023-06-15 2023-12-04
23. ALPHABET INC CL C     2023-12-04
2. BLACKROCK INC     2023-12-04
20. BLACKSTONE INC     2023-12-04
8. BOEING CO     2023-12-04
1. BOOKING HOLDINGS INC   2023-05-17 2023-12-04
2. BROADCOM INC   2019-07-03 2023-12-04
17. CELANESE CORP   2023-06-15 2023-12-04
22. CISCO SYSTEMS INC   2011-10-11 2023-12-04
27. CITIGROUP INC.     2023-12-04
7. DIAGEO PLC - ADR   2020-04-06 2023-12-04
3. META PLATFORMS INC   2021-04-08 2023-12-04
166. FIDELITY NEW MRKTS INC-Z #3323     2023-12-04
213. GLDMN SCHS GQP PRT INTL-R6 #4946   2023-05-18 2023-12-04
4. HOME DEPOT INC     2023-12-04
15. JPMORGAN CHASE & CO     2023-12-04
1. LAM RESEARCH CORP COM   2023-05-17 2023-12-04
1. LAM RESEARCH CORP COM   2020-04-06 2023-12-04
3. ELI LILLY & CO COM   2016-12-08 2023-12-04
71. MANULIFE FINANCIAL CORP     2023-12-04
4. MCDONALDS CORP   2023-06-15 2023-12-04
11. MERCK & CO INC NEW   2023-06-15 2023-12-04
7. MERCK & CO INC NEW   2021-08-30 2023-12-04
19. MICROSOFT CORP     2023-12-04
15. MONDELEZ INTERNATIONAL INC     2023-12-04
10. NIKE INC CL B     2023-12-04
6. RTX CORP   2023-02-09 2023-12-04
17. RTX CORP     2023-12-04
84. REGIONS FINL CORP NEW     2023-12-04
47. SUNCOR ENERGY INC NEW F     2023-12-04
2. THERMO FISHER SCIENTIFIC INC   2023-06-15 2023-12-04
9. TORONTO DOMINION BK ONT COM NEW   2023-02-09 2023-12-04
8. TORONTO DOMINION BK ONT COM NEW     2023-12-04
23. TOTAL S.A. - ADR   2022-06-24 2023-12-04
147. TOUCHSTONE MID CAP-R6 #355   2020-05-15 2023-12-04
5. UNION PACIFIC CORP   2010-11-12 2023-12-04
4. UNITED PARCEL SERVICE-CL B   2023-02-09 2023-12-04
4. UNITED PARCEL SERVICE-CL B   2020-04-06 2023-12-04
1. UNITEDHEALTH GROUP INC   2023-06-15 2023-12-04
3. UNITEDHEALTH GROUP INC     2023-12-04
29. VANGUARD MIDCAP VIPER     2023-12-04
2. VISA INC-CLASS A SHRS   2023-02-09 2023-12-04
5. VISA INC-CLASS A SHRS   2021-12-17 2023-12-04
6. WASTE MANAGEMENT INC   2020-09-15 2023-12-04
8. EATON CORP PLC   2021-04-08 2023-12-04
21. GARMIN LTD   2020-05-28 2023-12-04
148. INTERPUBLIC GROUP COS INC   2020-10-26 2023-12-15
6. ELI LILLY & CO COM   2016-12-08 2023-12-15
29. RTX CORP     2023-12-15
4. EATON CORP PLC   2021-04-08 2023-12-15
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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 2,138   1,271 867
b 2,944   1,333 1,611
c 2,298   2,204 94
d 718   610 108
e 479   376 103
1,018   1,314 -296
1,044   972 72
939   710 229
1,448   1,604 -156
897   742 155
3,120   2,940 180
1,705   1,812 -107
1,432   898 534
266   244 22
1,661   1,523 138
3,534   4,593 -1,059
4,565   7,313 -2,748
1,476   757 719
1,400   995 405
3,164   2,431 733
1,621   361 1,260
1,522   1,183 339
1,027   1,069 -42
403   376 27
2,068   1,925 143
1,280   1,327 -47
854   650 204
605   500 105
643   449 194
648   733 -85
1,017   730 287
1,296   569 727
740   939 -199
538   403 135
756   415 341
436   403 33
718   726 -8
32,176   34,545 -2,369
712   529 183
248   245 3
497   512 -15
1,432   1,869 -437
495   770 -275
282   318 -36
473   246 227
1,090   713 377
414   287 127
1,741   1,383 358
1,306   242 1,064
862   632 230
1,033   693 340
4,374   3,582 792
625   87 538
775   430 345
464   334 130
2,502   2,561 -59
499   686 -187
588   365 223
475   286 189
1,053   94 959
729   824 -95
1,019   873 146
1,193   1,086 107
16,837   14,421 2,416
432   471 -39
394   90 304
669   740 -71
480   532 -52
2,401   165 2,236
62,085   68,311 -6,226
695   688 7
504   352 152
838   723 115
168   140 28
720   680 40
605   824 -219
6,530   2,915 3,615
276   273 3
4,791   1,568 3,223
1,540   1,269 271
184   205 -21
5,718   8,845 -3,127
412   256 156
4,238   2,919 1,319
1,360   229 1,131
7,006   4,230 2,776
1,352   981 371
1,443   1,084 359
1,206   958 248
1,183   1,240 -57
2,995   1,069 1,926
1,511   739 772
2,309   1,741 568
1,875   1,110 765
3,118   2,662 456
1,846   569 1,277
2,411   1,961 450
1,054   376 678
1,278   1,316 -38
992   891 101
953   935 18
1,989   2,490 -501
4,068   3,791 277
1,294   1,291 3
2,363   1,280 1,083
708   564 144
708   242 466
1,754   202 1,552
1,410   994 416
1,144   1,165 -21
1,154   1,203 -49
734   536 198
6,991   550 6,441
1,069   644 425
1,150   685 465
498   585 -87
1,411   1,452 -41
1,478   1,814 -336
1,531   1,263 268
995   1,056 -61
547   618 -71
486   456 30
1,523   1,181 342
7,371   4,898 2,473
1,167   226 941
622   740 -118
622   376 246
547   468 79
1,640   586 1,054
6,417   6,477 -60
511   459 52
1,278   1,063 215
1,046   703 343
1,823   1,122 701
2,606   1,914 692
4,842   2,800 2,042
3,382   403 2,979
2,328   2,271 57
939   561 378
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
      490
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       867
b       1,611
c       94
d       108
e       103
      -296
      72
      229
      -156
      155
      180
      -107
      534
      22
      138
      -1,059
      -2,748
      719
      405
      733
      1,260
      339
      -42
      27
      143
      -47
      204
      105
      194
      -85
      287
      727
      -199
      135
      341
      33
      -8
      -2,369
      183
      3
      -15
      -437
      -275
      -36
      227
      377
      127
      358
      1,064
      230
      340
      792
      538
      345
      130
      -59
      -187
      223
      189
      959
      -95
      146
      107
      2,416
      -39
      304
      -71
      -52
      2,236
      -6,226
      7
      152
      115
      28
      40
      -219
      3,615
      3
      3,223
      271
      -21
      -3,127
      156
      1,319
      1,131
      2,776
      371
      359
      248
      -57
      1,926
      772
      568
      765
      456
      1,277
      450
      678
      -38
      101
      18
      -501
      277
      3
      1,083
      144
      466
      1,552
      416
      -21
      -49
      198
      6,441
      425
      465
      -87
      -41
      -336
      268
      -61
      -71
      30
      342
      2,473
      941
      -118
      246
      79
      1,054
      -60
      52
      215
      343
      701
      692
      2,042
      2,979
      57
      378
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
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 47,409
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 1,149
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 1,149
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 1,149
6 Credits/Payments:
a 2023 estimated tax payments and 2022 overpayment credited to 2023 6a 660
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.............. 7 660
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 9 489
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 arrow0 Refundedright arrow 11 0
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 arrowIN
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 		24,538    
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
1,735,881
b
Average of monthly cash balances.......................
1b
47,642
c
Fair market value of all other assets (see instructions)................
1c
0
d
Total (add lines 1a, b, and c).........................
1d
1,783,523
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
1,783,523
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
26,753
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
1,756,770
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
87,839
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
87,839
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
1,149
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
 
c
Add lines 2a and 2b............................
2c
1,149
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
86,690
4
Recoveries of amounts treated as qualifying distributions................
4
0
5
Add lines 3 and 4............................
5
86,690
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
86,690
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
93,974
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
93,974
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 86,690
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2022 only....... 78,643
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$ 93,974
a Applied to 2022, but not more than line 2a 78,643
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..... 15,331
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 .......... 		71,359
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

OHANA HERITAGE FOUNDATION

53131 QUINCE RD
SOUTH BEND,IN46628 		NONE PC GENERAL OPERATING 5,000

ST PAUL'S MEMORIAL UNITED METHODIST

1001 W COLFAX AVE
SOUTH BEND,IN46616 		NONE PC GENERAL OPERATING 5,000

HEROES CAMP INC

PO BOX 6564
SOUTH BEND,IN466600000 		NONE PC GENERAL OPERATING 5,000

GIRLS ON THE RUN MICHIANA

51160 BITTERSWEET RD STE 202
GRANGER,IN465308857 		NONE PC GENERAL OPERATING 5,000

KINGDOM LIFE CHRISTIAN CATHEDRAL INC

707 SHERMAN AVE
SOUTH BEND,IN466161260 		NONE PC GENERAL OPERATING 2,500

ACTING ENSEMBLE INC

602 E MISHAWAKA AVE
MISHAWAKA,IN465456816 		NONE PC GENERAL OPERATING 2,500

GIRL SCOUTS OF NORTHERN INDIANA MICHIANA

10008 DUPONT CIRCLE DR E
FORT WAYNE,IN468251630 		NONE PC GENERAL OPERATING 3,500

UNITED WAY OF ST JOSEPH COUNTY INC

3517 E JEFFERSON BLVD
SOUTH BEND,IN466153033 		NONE PC GENERAL OPERATING 2,750

LA CASA DE AMISTAD INC

3423 S MICHIGAN ST
SOUTH BEND,IN466140000 		NONE PC GENERAL OPERATING 5,000

ST MARGARETS HOUSE

117 N LAFAYETTE BLVD
SOUTH BEND,IN466010000 		NONE PC GENERAL OPERATING 3,000

PUBLIC EDUCATION FOUNDATION INC

215 S DR MARTIN LUTHER KING JR BLVD
SOUTH BEND,IN466012003 		NONE PC GENERAL OPERATING 5,000

CHRIST CHILD SOCIETY OF SOUTH BEND INC

2366 MIRACLE LN
MISHAWAKA,IN465453012 		NONE PC GENERAL OPERATING 4,750

FAMILY CHILDRENS CENTER

1707 MAIN STREET
LA CROSSE,WI546010000 		NONE PC GENERAL OPERATING 3,000

HOOSIERS FEEDING THE HUNGRY INC

4490A STATE ROAD 327
GARRETT,IN467389702 		NONE PC GENERAL OPERATING 2,500

ALLIANCE INC

8003 CORPORATE DR
NOTTINGHAM,MD212364977 		NONE PC GENERAL OPERATING 4,500

BOOKS 4 KIDS PROGRAM

221 S MAIN ST PO BOX 21
ARLINGTON,SD572120000 		NONE PC GENERAL OPERATING 3,000

CULTIVATE CULINARY SCHOOL AND CATERING I

1403 PRAIRIE AVE
SOUTH BEND,IN466131605 		NONE PC GENERAL OPERATING 5,000

BRIGHT BEGINNINGS FAMILY CHILDCARE INC

1818 S MAIN ST
SOUTH BEND,IN466132222 		NONE PC GENERAL OPERATING 4,000

ENSEMBLE CONCEPT21 INC

2220 TRAILRIDGE S
MISHAWAKA,IN465446618 		NONE PC GENERAL OPERATING 2,000

HABITAT FOR HUMANITY

285 PEACHTREE CENTER AVE
ATLANTA,GA30303 		NONE PC GENERAL OPERATING 5,000

FIVE STAR LIFE INC

2204 CALIFORNIA RD
ELKHART,IN46514 		NONE PC GENERAL OPERATING 2,500

ST PAUL'S MEMORIAL CHURCH INC

1700 UNIVERSITY AVE
CHARLOTTESVILLE,VA22903 		NONE PC GENERAL OPERATING 4,500
Total .................................right arrow 3a 85,000
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 55,807  
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 47,409  
9 Net income or (loss) from special events:          
10 Gross profit or (loss) from sales of inventory          
11 Other revenue:
aFEDERAL TAX REFUND 		    1 840  
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e) ..   104,056  
13Total. Add line 12, columns (b), (d), and (e)..................
13
104,056
(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:
KLOCKOW HARVEY R AND DORIS FDN
EIN:
35-2070029
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
TAX PREPARATION FEE (NON-ALLOC 1,062     1,062

TY 2023 InvestmentsCorpStockSchedule
Name:
KLOCKOW HARVEY R AND DORIS FDN
EIN:
35-2070029
Name of Stock End of Year Book Value End of Year Fair Market Value
46625H100 JPMORGAN CHASE & CO 2,974 15,139
91324P102 UNITEDHEALTH GROUP I 958 15,268
02079K107 ALPHABET INC CL C 4,414 32,555
883556102 THERMO FISHER SCIENT 1,142 7,431
11135F101 BROADCOM INC 5,126 21,209
517834107 LAS VEGAS SANDS CORP    
09260D107 BLACKSTONE INC 4,565 11,259
126650100 CVS HEALTH CORPORATI    
75513E101 RTX CORP 6,986 8,162
654106103 NIKE INC CL B 2,456 4,994
192446102 COGNIZANT TECH SOLUT 4,522 6,798
911312106 UNITED PARCEL SERVIC 4,038 8,019
25243Q205 DIAGEO PLC - ADR 2,972 6,118
037833100 APPLE INC 3,190 50,058
254687106 WALT DISNEY CO    
56501R106 MANULIFE FINANCIAL C 5,801 10,033
460690100 INTERPUBLIC GROUP CO    
94106L109 WASTE MANAGEMENT INC 3,775 6,448
H84989104 TE CONNECTIVITY LTD 4,674 8,149
907818108 UNION PACIFIC CORP 1,128 6,141
594918104 MICROSOFT CORP 3,492 46,629
58933Y105 MERCK & CO INC NEW 5,288 11,011
867224107 SUNCOR ENERGY INC NE 8,653 11,374
09857L108 BOOKING HOLDINGS INC 7,765 14,189
87612E106 TARGET CORP 1,973 5,554
512807108 LAM RESEARCH CORP CO 2,816 11,749
285512109 ELECTRONIC ARTS INC 3,913 6,841
150870103 CELANESE CORP 4,721 12,740
89151E109 TOTALENERGIES SE -SP 9,040 13,139
891160509 TORONTO DOMINION BK 8,030 9,758
G29183103 EATON CORP PLC 6,252 13,486
17275R102 CISCO SYSTEMS INC 2,704 8,134
09247X101 BLACKROCK INC 3,071 8,118
H2906T109 GARMIN LTD 5,641 8,227
172967424 CITIGROUP INC. 7,507 9,208
097023105 BOEING CO 4,596 10,687
92826C839 VISA INC-CLASS A SHR 7,213 11,195
904767704 UNILEVER PLC - ADR 5,102 4,703
00287Y109 ABBVIE INC 5,854 8,523
609207105 MONDELEZ INTERNATION 4,504 7,605
31620M106 FIDELITY NATL INFORM    
532457108 ELI LILLY & CO COM 1,545 13,407
871829107 SYSCO CORP    
418056107 HASBRO INC    
30303M102 META PLATFORMS INC 8,930 17,698
7591EP100 REGIONS FINL CORP NE 5,939 6,008
437076102 HOME DEPOT INC 6,587 7,278
00724F101 ADOBE INC 6,224 7,756
007903107 ADVANCED MICRO DEVIC 5,126 8,992
580135101 MCDONALDS CORP 5,827 5,930
855244109 STARBUCKS CORP COM 7,565 7,201

TY 2023 InvestmentsOtherSchedule2
Name:
KLOCKOW HARVEY R AND DORIS FDN
EIN:
35-2070029
Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
24610B826 DELAWARE SMALL CAP C      
722005667 PIMCO COMMODITY REAL AT COST 97,282 70,379
89155T490 TOUCHSTONE MID CAP-R AT COST 42,171 74,346
057071854 BAIRD AGGREGATE BOND AT COST 470,188 426,967
693390700 PIMCO TOTAL RET FD-I AT COST 263,452 230,902
31641Q755 FIDELITY NEW MRKTS I AT COST 41,976 36,647
77956H435 T ROWE PR OVERSEAS S AT COST 90,775 91,674
74440Y884 PGIM HIGH YIELD-Q 10 AT COST 40,405 36,477
872365713 TCW EMRG MRKTS INC-P AT COST 66,781 56,168
922908629 VANGUARD MIDCAP VIPE AT COST 54,284 92,823
38147N269 GLDMN SCHS GQP PRT I AT COST 49,301 54,840
72201R833 PIMCO ENHANCED SHORT AT COST 35,390 35,525
921937793 VANGUARD LONG-TERM B AT COST 36,923 35,426

TY 2023 OtherDecreasesSchedule
Name:
KLOCKOW HARVEY R AND DORIS FDN
EIN:
35-2070029
Description Amount
MUTUAL FUND TIMING ADJ 1,939
PY RETURN OF CAPITAL ADJUSTMENT 399
ROC ON CY SALES 26
ROUNDING 3


TY 2023 OtherExpensesSchedule
Name:
KLOCKOW HARVEY R AND DORIS FDN
EIN:
35-2070029
Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
INVESTMENT EXPENSES - ADR FEES 12 12   0


TY 2023 OtherIncomeSchedule2
Name:
KLOCKOW HARVEY R AND DORIS FDN
EIN:
35-2070029
Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
FEDERAL TAX REFUND 840 0  


TY 2023 OtherProfessionalFeesSchedule
Name:
KLOCKOW HARVEY R AND DORIS FDN
EIN:
35-2070029
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
GRANT ADMIN FEE 1,778     1,778
INVESTMNT MNGMNT FEES (NON-DED 1,068 1,068    


TY 2023 TaxesSchedule
Name:
KLOCKOW HARVEY R AND DORIS FDN
EIN:
35-2070029
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
FOREIGN TAXES 935 935   0
FOREIGN TAXES ON NONQUALIFIED 1 1   0