efile Public Visual Render
ObjectId: 202202859349100815 - Submission: 2022-10-12
TIN: 68-0424794
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0052
20
20
Open to Public Inspection
For calendar year 2020, or tax year beginning
12-01-2020
, and ending
11-30-2021
Name of foundation
JOHNSON AND LOUISE H CLARK
CHARITABLE FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
25521 BIG BASIN WAY
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
SARATOGA
,
CA
95070
A Employer identification number
68-0424794
B
Telephone number (see instructions)
(408) 867-1885
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
2,190,602
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).)
(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
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
30,806
30,806
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
76,987
b
Gross sales price for all assets on line 6a
100,000
7
Capital gain net income (from Part IV, line 2)
...
76,987
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
........
107,793
107,793
13
Compensation of officers, directors, trustees, etc.
0
0
0
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
..........
0
0
0
25
Contributions, gifts, grants paid
.......
96,347
96,347
26
Total expenses and disbursements.
Add lines 24 and 25
96,347
0
96,347
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
11,446
b
Net investment income
(if negative, enter -0-)
107,793
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2020)
Page 2
Form 990-PF (2020)
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
1
Cash—non-interest-bearing
.............
2
Savings and temporary cash investments
.........
22,986
26,643
24,815
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
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)
Less: allowance for doubtful accounts
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)
.......
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
702,604
710,393
2,165,787
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
725,590
737,036
2,190,602
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
)
23
Total liabilities
(add lines 17 through 22)
.........
0
0
Foundations that follow FASB ASC 958, check here
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
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
725,590
737,036
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
0
0
29
Total net assets or fund balances
(see instructions)
.....
725,590
737,036
30
Total liabilities and net assets/fund balances
(see instructions)
.
725,590
737,036
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
725,590
2
Enter amount from Part I, line 27a
.....................
2
11,446
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
737,036
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
737,036
Form
990-PF
(2020)
Page 3
Form 990-PF (2020)
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
229.843 SHS 500 INDEX DUND ADM
P
2007-01-01
2021-11-30
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
100,000
23,013
76,987
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
76,987
b
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
76,987
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
...................
3
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
SECTION 4940(e) REPEALED ON DECEMBER 20, 2019 - DO NOT COMPLETE
1
Reserved
(a)
Reserved
(b)
Reserved
(c)
Reserved
(d)
Reserved
2
Reserved
...........................
2
3
Reserved
...........................
3
4
Reserved
...........................
4
5
Reserved
...........................
5
6
Reserved
...........................
6
7
Reserved
...........................
7
8
Reserved
,..........................
8
Form
990-PF
(2020)
Page 4
Form 990-PF (2020)
Page
4
Part VI
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
and enter “N/A" on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
b
Reserved
................................
1
1,498
c
All other domestic foundations enter 1.39% of line 27b. Exempt foreign organizations enter 4% 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
1,498
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
1,498
6
Credits/Payments:
a
2020 estimated tax payments and 2019 overpayment credited to 2020
6a
224
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
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
224
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
27
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
1,301
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2021 estimated tax
Refunded
11
Part VII-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.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
CA
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 2020 or the taxable year beginning in 2020? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2020)
Page 5
Form 990-PF (2020)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
STEVE CLARK
Telephone no.
(408) 867-1885
Located at
25521 BIG BASIN WAY
SARATOGA
CA
ZIP+4
95070
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2020, did the foundation have an interest in or a signature or other authority over
Yes
No
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
Part VII-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?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
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)?
...............
Yes
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.)
.......
Yes
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
Organizations relying on a current notice regarding disaster assistance check here
........
c
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 2020?
.............
1c
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 2020, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2020?
.............
Yes
No
If "Yes," list the years
20
,
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.
20
,
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?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2020 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 2020.)
..................
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 2020?
4b
No
Form
990-PF
(2020)
Page 6
Form 990-PF (2020)
Page
6
Part VII-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))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
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?
.....
Yes
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
Organizations relying on a current notice regarding disaster assistance check here
.........
c
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?
..........
Yes
No
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?
.....................
Yes
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?
Yes
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?
.................
Yes
No
Part VIII
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
JESSE CLARK
DIRECTOR
0.00
0
0
0
21435 SUMMIT ROAD
LOS GATOS
,
CA
95033
CHARLES CLARK
CFO
0.00
0
0
0
3403 GULFSTREAM STREET
PLEASANTON
,
CA
94588
JOHNSON CLARK JR
DIRECTOR
0.00
0
0
0
3914 HEATHFIELD PLACE
SANTA ROSA
,
CA
95404
SARA CLARK
DIRECTOR
0.00
0
0
0
21435 SUMMIT ROAD
LOS GATOS
,
CA
95033
STEVEN CLARK
PRESIDENT
0.00
0
0
0
25521 BIG BASIN WAY
SARATOGA
,
CA
95070
CANDICE KAUFFMAN
SECRETARY
0.00
0
0
0
21435 SUMMIT ROAD
LOS GATOS
,
CA
95033
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
...................
0
Form
990-PF
(2020)
Page 7
Form 990-PF (2020)
Page
7
Part VIII
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
.............
0
Part IX-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 IX-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
.........................
0
Form
990-PF
(2020)
Page 8
Form 990-PF (2020)
Page
8
Part X
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
2,165,788
b
Average of monthly cash balances
.......................
1b
27,695
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
2,193,483
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
2,193,483
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
32,902
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
2,160,581
6
Minimum investment return.
Enter 5% of line 5
..................
6
108,029
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
108,029
2a
Tax on investment income for 2020 from Part VI, line 5
......
2a
1,498
b
Income tax for 2020. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
1,498
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
106,531
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
106,531
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 XIII, line 1
...
7
106,531
Part XII
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
96,347
b
Program-related investments—total from Part IX-B
..................
1b
0
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 V, line 8, and Part XIII, line 4
4
96,347
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b. See instructions
.................
5
0
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
96,347
Note:
The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
the section 4940(e) reduction of tax in those years.
Form
990-PF
(2020)
Page 9
Form 990-PF (2020)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2019
(c)
2019
(d)
2020
1
Distributable amount for 2020 from Part XI, line 7
106,531
2
Undistributed income, if any, as of the end of 2020:
a
Enter amount for 2019 only
.......
96,347
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2020:
a
From 2015
......
b
From 2016
......
c
From 2017
......
d
From 2018
......
e
From 2019
......
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2020 from Part
XII, line 4:
$
96,347
a
Applied to 2019, but not more than line 2a
96,347
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 2020 distributable amount
.....
0
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2020.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2019. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2020. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2021
..........
106,531
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 2015 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2021.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2016
....
b
Excess from 2017
....
c
Excess from 2018
....
d
Excess from 2019
....
e
Excess from 2020
....
Form
990-PF
(2020)
Page 10
Form 990-PF (2020)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-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 2020, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2020
(b)
2019
(c)
2018
(d)
2017
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
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 X, 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 XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List 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).)
b
List 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.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2020)
Page 11
Form 990-PF (2020)
Page
11
Part XV
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)
a
Paid during the year
ACLU FOUNDATION
125 BROAD STREET 18TH FLOOR
NEW YORK
,
NY
10004
NONE
501(C)(3)
THE ACLU WORKS IN THE COURTS, LEGISLATURES AND COMMUNITIES TO DEFEND AND PRESERVE THE INDIVIDUAL RIGHTS AND LIBERTIESGUARANTEED TO ALL PEOPLE IN THIS COUNTRY BY THECONSTITUTION AND LAWS OF THE UNITED STATES.
1,250
AMERICAN WHITEWATER
PO BOX 1540
COLLOWHEE
,
NC
98723
NONE
501(C)(3)
NATIONAL NON-PROFIT ORGANIZATION WITH A MISSION "TO CONSERVE AND RESTORE AMERICA'S WHITEWATER RESOURCES AND TO ENHANCE OPPORTUNITIES TO ENJOY THEM SAFELY." AMERICAN WHITEWATER IS A MEMBERSHIP ORGANIZATION REPRESENTING A BROAD DIVERSITY OF INDIVIDUAL WHITEWATER ENTHUSIASTS, RIVER CONSERVATIONISTS, AND MORE THAN 100 LOCAL PADDLING CLUB AFFILIATES ACROSS AMERICA. THE ORGANIZATION IS THE PRIMARY ADVOCATE FOR THE PRESERVATION AND PROTECTION OF WHITEWATER RIVERS THROUGHOUT THE UNITED STATES, AND CONNECTS THE INTERESTS OF HUMAN-POWERED RECREATIONAL RIVER USERS WITH ECOLOGICAL AND SCIENCE-BASED DATA TO ACHIEVE THE GOALS WITHIN ITS MISSION.
5,000
ARCHANGEL ANCIENT TREE ARCHIVE
16884 FRONT ST
COPEMISH
,
MI
49625
NONE
501(C)(3)
ARCHANGEL ANCIENT TREE ARCHIVE IS A 501(C)3 NON-PROFIT ORGANIZATION THAT LOCATES AND PROPAGATES THE WORLD'S LARGEST AND MOST ICONIC TREES.
1,000
CHARITY GLOBAL INC DBA CHARITY WATER
511 6TH AVENUE STE 196
NEW YORK
,
NY
10011
NONE
501(C)(3)
NON-PROFIT ORGANIZATION BRINGING CLEAN AND SAFE DRINKING WATER TO PEOPLE IN DEVELOPING NATIONS.
1,000
CURE ALZHEIMER'S FUND
34 WASHINGTON ST SUITE 310
WELLESLEY HILLS
,
MA
02481
NONE
501(C)(3)
FUNDING RESEARCH WITH THE HIGHEST PROBABILITY OF PREVENTING, SLOWING, OR REVERSING ALZHEIMER'S DISEASE.
3,514
DAWG NATION HOCKEY FOUNDATION
PO BOX 182
INDIAN HILLS
,
OH
804540182
NONE
501(C)(3)
DEDICATED TO PROVIDING OPPORTUNITIES FOR PERSONS WITH AND WITHOUT DISABILITIES TO GAIN CONFIDENCE AND INDEPENDENCE THROUGH PARTICIPATION IN NATIONAL AND INTERNATIONAL AMATEUR ICE HOCKEY
4,000
ELECTRONIC FRONTIER FOUNDATON
815 EDDY ST
SAN FRANCISCO
,
CA
94107
NONE
501(C)(3)
NONPROFIT ORGANIZATION DEFENDING CIVIL LIBERTIES IN THE DIGITAL WORLD.
1,000
EVERYTOWN FOR GUN SAFETY SUPPORT FUND
PO BOX 3886
NEW YORK
,
NY
10163
NONE
501(C)(3)
SEEKS TO IMPROVE OUR UNDERSTANDING OF THE CAUSES OF GUN VIOLENCE AND THE MEANS TO REDUCE IT BY CONDUCTING GROUNDBREAKING ORIGINAL RESEARCH, DEVELOPING EVIDENCE BASED POLICIES, AND COMMUNICATING THIS KNOWLEDGE IN THE COURTS AND THE COURT OF PUBLIC OPINION.
750
FACTCHECKORG
202 S 36TH ST
PHILADELPHIA
,
PA
19104
NONE
501(C)(3)
NONPARTISAN,NONPROFIT CONSUMER ADVOCATE FOR VOTERS THAT AIMS TO REDUCE THE LEVEL OF DECEPTION AND CONFUSION IN US POLITICS
6,685
FRIENDS OF BAREFOOT COLLEGE
333 WESTERN AVENUE
CONWAY
,
AR
720346213
NONE
501(C)(3)
TRANSFORMATION OF RURAL COMMUNITIES THROUGH THE EMPOWERMENT OF WOMEN.
1,000
FRIENDS OF SARATOGA LIBRARY
14410 OAK ST
SARATOGA
,
CA
95070
NONE
501(C)(3)
THE FRIENDS OF THE SARATOGA LIBRARIES IS AN ACTIVE COMMUNITY LIBRARY SUPPORT GROUP OF APPROXIMATELY 750 COMMUNITY RESIDENT HOUSEHOLDS AND LIBRARY PATRONS WHO SHOW THEIR SUPPORT FOR THE SARATOGA LIBRARY BY BECOMING MEMBERS.
750
GLOBAL FUND FOR WOMEN
222 SUTTER STREET SUITE 500
SAN FRANCISCO
,
CA
94108
NONE
501(C)(3)
ADVANCEMENT OF RIGHTS OF WOMEN AND GIRLS WORLDWIDE BY INCREASING THE RESOURCES FOR AND INVESTING IN WOMEN-LED ORGANIZATIONS AND WOMEN'S COLLECTIVE LEADERSHIP FOR CHANGE.
750
HABITAT FOR HUMANITY
5702 MARSH DRIVE SUITE T
PACHECO
,
CA
94553
NONE
501(C)(3)
CONSTRUCTION OF HOMES FOR FAMILIES IN NEED
2,500
HEIFER INTERNATIONAL
1 WORLD AVE
LITTLE ROCK
,
AK
72202
NONE
501(C)(3)
WORKS WITH COMMUNITIES TO END WORLD HUNGER AND POVERTY AND TO CARE FOR THE EARTH. WE EMPOWER FAMILIES TO TURN HUNGER AND POVERTY INTO HOPE AND PROSPERITY BY LINKING COMMUNITIES AND HELPING TO BRING SUSTAINABLE AGRICULTURE AND COMMERCE TO AREAS WITH A LONG HISTORY OF POVERTY.
1,000
KQED
2601 MARIPOSA STREET
SAN FRANCISCO
,
CA
94110
NONE
501(C)(3)
SUPPORT OF QUALITY TELEVISION AND RADIO PROGRAMS IN NORTHERN CALIFORNIA.
1,500
MARIE STOPES INTERNATIONAL
PO BOX 35528
WASHINGTON
,
DC
20033
NONE
501(C)(3)
OFFERS INDIVIDUALS AND ORGANIZATIONS IN THE UNITED STATES THE OPPORTUNITY TO HELP VULNERABLE WOMEN AND GIRLS IN 37 COUNTRIES WORLDWIDE DECIDE IF AND WHEN TO HAVE CHILDREN THROUGH ACCESS TO CONTRACEPTION AND SAFE ABORTION.
750
MEXICAN-AMERICAN LEGAL DEFENSE EDUCATION FUND
634 SSPRING ST 12TH FLOOR
LOS ANGELES
,
CA
90014
NONE
501(C)(3)
MALDEF STRIVES TO IMPLEMENT PROGRAMS THAT ARE STRUCTURED TO BRING LATINOS INTO THE MAINSTREAM OF AMERICAN POLITICAL AND SOCIO-ECONOMIC LIFE; PROVIDING BETTER EDUCATIONAL OPPORTUNITIES; ENCOURAGING PARTICIPATION IN ALL ASPECTS OF SOCIETY; AND OFFERING A POSITIVE VISION FOR THE FUTRE.
1,000
MULBERRY SCHOOL
220 BELGATOS RD
LOS GATOS
,
CA
950325011
501(C)(3)
INSPIRES CHILDREN TO A LIFE OF LEARNING AND POSITIVE CONTRIBUTION TO COMMUNITY. BY WEAVING CREATIVITY AND SOCIAL LEARNING INTO EVERY DAY, WE FOSTER INTELLECTUAL AND SOCIAL SUCCESS FOR A LIFETIME
2,000
PLANNED PARENTHOOD
2185 PACHECO STREET
CONCORD
,
CA
94520
NONE
501(C)(3)
WE ARE A TRUSTED HEALTH CARE PROVIDER, AN INFORMED EDUCATOR, A PASSIONATE ADVOCATE, AND A GLOBAL PARTNER HELPING SIMILAR ORGANIZATIONS AROUND THE WORLD. PLANNED PARENTHOOD DELIVERS VITAL REPRODUCTIVE HEALTH CARE, SEX EDUCATION, AND INFORMATION TO MILLIONS OF WOMEN, MEN, AND YOUNG PEOPLE WORLDWIDE.
25,086
PROPUBLICA
155 AVENUE OF THE AMERICAS 13TH
FLOOR
NEW YORK
,
NY
10013
NONE
501(C)(3)
AID IN EXPOSING CORRUPTION, INFORMING THE PUBLIC ABOUT COMPLEX ISSUES, AND USING THE POWER OF INVESTIGATIVE JOURNALISM TO SPUR REFORM.
1,500
REDWOOD EMPIRE FOOD BANK
3990 BRICKWAY BLVD
SANTA ROSA
,
CA
95403
NONE
501(C)(3)
TO PROVIDE FOOD TO PEOPLE IN THE COMMUNITY AND RESPOND TO THE IMMEDIATE NEEDS OF PEOPLE SEEKING HELP THROUGH THE PROVISION OF HEALTHY FOOD AND NUTRITION EDUCATION.
3,514
ROOM TO READ
465 CALIFORNIA ST STE 1000
SAN FRANCISCO
,
CA
94104
NONE
501(C)(3)
EEKS TO TRANSFORM THE LIVES OF MILLIONS OF CHILDREN IN LOW-INCOME COMMUNITIES BY FOCUSING ON LITERACY AND GENDER EQUALITY IN EDUCATION. WORKING IN COLLABORATION WITH LOCAL COMMUNITIES, PARTNER ORGANIZATIONS AND GOVERNMENTS, WE DEVELOP LITERACY SKILLS AND A HABIT OF READING AMONG PRIMARY SCHOOL CHILDREN, AND SUPPORT GIRLS TO COMPLETE SECONDARY SCHOOL WITH THE RELEVANT LIFE SKILLS TO SUCCEED IN SCHOOL AND BEYOND.
750
SHARE WINTER FOUNDATION
PO BOX 25015
BROOKLYN
,
NY
11225
NONE
501(C)(3)
SHARE WINTER FOUNDATION ("SHARE WINTER") IS A GRANTMAKING ORGANIZATION WORKING TO IMPROVE THE LIVES, HEALTH, AND FITNESS OF YOUTH THROUGH WINTER SPORTS.
1,427
SOUTH SKYLINE EMERGENCY PREPAREDNESS
18788 FAVRE RIDGE RD
LOS GATOS
,
CA
95033
NONE
501(C)(3)
AID IN PROMOTING EMERGENCY PREPAREDNESS AND RESPONSE CAPABILITY AT THE NEIGHBORHOOD LEVEL IN THE EVENT OF A DISASTER THAT OVERWHELMS TRADITIONAL EMERGENCY RESPONSE RESOURCES.
1,000
SOUTH SKYLINE FIRESAFE COUNCIL
324 SKYLINE BLVD
LA HONDA
,
CA
94020
NONE
501(C)(3)
PROVIDE EDUCATION AND OUTREACH PROGRAMS FOR FIRE PREVENTION AND PREPAREDNESS TO ALL SOUTH SKYLINE RESIDENTS WITHIN THE COUNCIL AREA IN ORDER TO PREVENT THE LOSS OF LIVES AND REDUCE LOSSES OF PERSONAL AND PUBLIC PROPERTY AND NATURAL RESOURCES FROM WILDFIRE.
2,000
SOUTHERN POVERTY LAW CENTER
400 WASHINGTON AVE
MONTGOMERY
,
AL
36104
NONE
501(C)(3)
DEDICATED TO FIGHTING HATE AND BIGOTRY AND TO SEEKING JUSTICE FOR THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. USING LITIGATION, EDUCATION, AND OTHER FORMS OF ADVOCACY,THE SPLC WORKS TOWARD THE DAY WHEN THE IDEALS OF EQUAL JUSTICE AND EQUAL OPPORTUNITY WILL BE A REALITY.
1,837
ST JUDES CHILDREN'S HOSPITAL
262 DANNY THOMAS PL
MEMPHIS
,
TN
38105
NONE
501(C)(3)
TO HELP IN THE ADVANCEMENT OF CURES AND THE MEANS OF PREVENTION FOR PEDIATRIC CATASTROPHIC DISEASES THROUGH RESEARCH AND TREATMENT.
6,860
THE HALO TRUST USA
1730 RHODE ISLAND AVE NW 403
WASHINGTON
,
DC
20036
NONE
501(C)(3)
LARGEST HUMANITARIAN MINE CLEARANCE ORGANIZATION. WE SAVE LIVES AND RESTORE COMMUNITIES THREATENED BY LANDMINES AND OTHER WEAPONS OF WAR, SUCH AS CLUSTER BOMBS, STOCKPILES OF SMALL ARMS AND IMPROVISED EXPLOSIVE DEVICES (IEDS).
1,000
THE NUNOA PROJECT
77 TEAWASSLE HILL ROAD
LEVERETT
,
MA
01054
NONE
501(C)(3)
HELPING THE PEOPLE AND CAMELIDS OF THE PERUVIAN ALTIPLANO BY SUPPORTING RESEARCH AND EDUCATIONAL PROGRAMS.
3,000
THE SATANIC TEMPLE
64 BRIDGE ST
SALEM
,
MA
019704131
NONE
501(C)(3)
ENCOURAGE BENEVOLENCE AND EMPATHY, REJECT TYRANNICAL AUTHORITY, ADVOCATE PRACTICAL COMMON SENSE, OPPOSE INJUSTICE, AND UNDERTAKE NOBLE PURSUITS
6,660
THE TREVOR PROJCT
PO BOX 69232
WEST HOLLYWOOD
,
CA
90069
NONE
501(C)(3)
THE MISSION OF THE TREVOR PROJECT IS TO END SUICIDE AMONG GAY,LESBIAN, BISEXUAL, TRANSGENDER, QUEER AND QUESTIONING YOUNG PEOPLE.
1,000
UC DAVIS FOUNDATION - DIABETES RESEARCH
ONE SHIELDS AVE
DAVIS
,
CA
95616
NONE
501(C)(3)
THE STUDY OF ISLETS OF LANGERHANS IN THE PANCREAS.
3,514
VERIFIED VOTING FOUNDATION
1608 WALNUT ST 12TH FLOOR
PHILADELPHIA
,
PA
19103
NONE
501(C)(3)
WE ARE A NON-PARTISAN ORGANIZATION FOCUSED EXCLUSIVELY ON THE CRITICAL ROLE TECHNOLOGY PLAYS IN ELECTION ADMINISTRATION
1,000
WIKIMEDIA FOUNDATION
149 NEW MONTGOMERY ST FLOOR 3
SAN FRANCISCO
,
CA
94105
NONE
501(C)(3)
TO ENCOURAGE GROWTH, DEVELOPMENT AND DISTRIBUTION OF FREE, MULTILINGUAL, EDUCATIONAL CONTENT AND PROVIDE FULL CONTENT OF WIKI-BASED PROJECTS TO PUBLIC FREE OF CHARGE.
750
Total
.................................
3a
96,347
b
Approved for future payment
Total
.................................
3b
0
Form
990-PF
(2020)
Page 12
Form 990-PF (2020)
Page
12
Part XVI-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.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees 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
30,806
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not 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
76,987
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)
..
0
107,793
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
107,793
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XVI-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
(2020)
Page 13
Form 990-PF (2020)
Page
13
Part XVII
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?
...........
Yes
No
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.
2022-10-12
May the IRS discuss this return
with the preparer shown below?
See instructions.
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
JEFFREY B SPIEGEL
Preparer's Signature
Date
Check if self-
employed
PTIN
P00351430
Firm's name
SPIEGEL ACCOUNTANCY CORP
Firm's EIN
26-4802175
Firm's address
2300 CONTRA COSTA BLVD STE 425
PLEASANT HILL
,
CA
94523
Phone no.
(925) 977-4000
Form
990-PF
(2020)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description