Form 990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
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Do not enter social security numbers on this form as it may be made public.
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Go to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
For calendar year 2019 or tax year beginning , 2019, and ending , 20
Name of foundation
Number and street (or P.O. box number if mail is not delivered to street address) Room/suite
City or town, state or province, country, and ZIP or foreign postal code
A Employer identification number
B Telephone number (see instructions)
C
If exemption application is pending, check here
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D
1. Foreign organizations, check here . . .
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2. Foreign organizations meeting the 85% test,
check here and attach computation
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E
If private foundation status was terminated under
section 507(b)(1)(A), check here . . . .
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F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here . .
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G Check all that apply: Initial return
Final return
Address change
Initial return of a former public charity
Amended return
Name change
H Check type of organization: Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation
I
Fair market value of all assets at
end of year (from Part II, col. (c),
line 16)
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$
J Accounting method:
Cash Accrual
Other (specify)
(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).)
Revenue
Operating and Administrative Expenses
(a) Revenue and
expenses per
books
(b) Net investment
income
(c) Adjusted net
income
(d) Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2 Check
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if the foundation is not required to attach Sch. B
3
Interest on savings and temporary cash investments
4 Dividends and interest from securities . . . .
5a Gross rents . . . . . . . . . . . . .
b Net rental income or (loss)
6a Net gain or (loss) from sale of assets not on line 10
b
Gross sales price for all assets on line 6a
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 . . . . . . .
13 Compensation of officers, directors, trustees, etc.
14 Other employee salaries and wages . . . . .
15 Pension plans, employee benefits . . . . .
16a Legal fees (attach schedule) . . . . . . .
b Accounting fees (attach schedule) . . . . .
c Other professional fees (attach schedule) . . .
17 Interest . . . . . . . . . . . . . .
18 Taxes (attach schedule) (see instructions) . . .
19 Depreciation (attach schedule) and depletion . .
20 Occupancy . . . . . . . . . . . . .
21 Travel, conferences, and meetings . . . . .
22 Printing and publications . . . . . . . .
23 Other expenses (attach schedule) . . . . .
24 Total operating and administrative expenses.
Add lines 13 through 23 . . . . . . . . .
25 Contributions, gifts, grants paid . . . . . .
26
Total expenses and disbursements. Add lines 24 and 25
27 Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
b Net investment income (if negative, enter -0-) .
c Adjusted net income (if negative, enter -0-) . .
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form 990-PF (2019)