ANNA MAY FAMILY FOUNDATION: Form 990PF, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- ANNA MAY FAMILY FOUNDATION (EIN 93-1269424)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-08-19
- IRS object ID
- 202212319349100306
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990-PF
- Accounting Fees Schedule
- Investments Corp Stock Schedule
- Other Expenses Schedule
- Other Increases Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-19T14:33:48-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 221 STEWART AVENUE SUITE 301 | AddressLine1Txt |
| City | MEDFORD | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97501 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 931269424 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANNA MAY FAMILY FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ANNA | BusinessNameControlTxt |
| Phone | 5418571040 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1314-B CENTER DRIVE BOX 264 | AddressLine1Txt |
| City | MEDFORD | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97501 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AMY BELKIN | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 5416019915 | PhoneNum |
| Signature | 2022-08-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | AMY | PersonFirstNm |
| Person Last | BELKIN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | APRIL STITH | PreparerPersonNm |
| PTIN | P01245039 | PTIN |
| Phone | 5418571040 | PhoneNum |
| Preparation | 2022-08-05 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $3,569,864 | FMVAssetsEOYAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Interest On Sav Rev And Expnss | $6 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $6 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $56,863 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $56,863 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $147,929 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $401,170 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $147,929 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $204,798 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $204,798 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $42,970 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Net Invst Incm | $21,485 | CompOfcrDirTrstNetInvstIncmAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $21,485 | CompOfcrDirTrstDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $11,985 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $5,992 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Chrtbl Prps | $5,992 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $20,807 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $20,807 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $0 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $4,722 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $2,866 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $1,856 | TaxesDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $2,795 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $0 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $2,795 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $83,279 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $51,150 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $32,128 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $130,000 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $130,000 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $213,279 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $51,150 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $162,128 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$8,481 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $153,648 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $70,288 | CashBOYAmt |
| Cash EOY | $101,178 | CashEOYAmt |
| Cash EOYFMV | $101,178 | CashEOYFMVAmt |
| Sav And Temp Cash Invst BOY | $17,349 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $32,135 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $32,135 | SavAndTempCashInvstEOYFMVAmt |
| Corporate Stock BOY | $2,636,920 | CorporateStockBOYAmt |
| Corporate Stock EOY | $2,585,201 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $3,436,551 | CorporateStockEOYFMVAmt |
| Total Assets BOY | $2,724,557 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,718,514 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $3,569,864 | TotalAssetsEOYFMVAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
| Capital Stock BOY | $0 | CapitalStockBOYAmt |
| Capital Stock EOY | $0 | CapitalStockEOYAmt |
| Additional Paid In Capital BOY | $0 | AdditionalPaidInCapitalBOYAmt |
| Additional Paid In Capital EOY | $0 | AdditionalPaidInCapitalEOYAmt |
| Retained Earning BOY | $2,724,557 | RetainedEarningBOYAmt |
| Retained Earning EOY | $2,718,514 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $2,724,557 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $2,718,514 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $2,724,557 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $2,718,514 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $2,724,557 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$8,481 | ExcessRevenueOverExpensesAmt |
| Other Increases | $2,438 | OtherIncreasesAmt |
| Subtotal | $2,718,514 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $2,718,514 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (3 entries)
| PropertyPropertyDesc | How AcquiredHowAcquiredCd | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt |
|---|---|---|---|---|---|
| UBS - PUBLICLY TRADED SECURITIES | P | $45,006 | $36,922 | $8,084 | $8,084 |
| UBS - PUBLICLY TRADED SECURITIES | P | $330,208 | $216,319 | $113,889 | $113,889 |
| CAPITAL GAINS DIVIDENDS | P | $25,956 | $25,956 | $25,956 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $147,929 | CapitalGainNetIncomeAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $2,136 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $2,136 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $2,136 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $1,514 | EstimatedPlusOvpmtIncmTxAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Extsn Request Income Tax Paid | $0 | ExtsnRequestIncomeTaxPaidAmt |
| Backup Withholding Withheld | $0 | BackupWithholdingWithheldAmt |
| Total Payments And Credits | $1,514 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Es Penalty | $0 | EsPenaltyAmt |
| Tax Due | $622 | TaxDueAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | 0 | LegislativePoliticalActyInd |
| More Than100 Spent | 0 | MoreThan100SpentInd |
| Form1120 POL Filed | 0 | Form1120POLFiledInd |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| Tax Reimbursed | $0 | TaxReimbursedAmt |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | 0 | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (1) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (1) | AtLeast5000InAssetsInd |
| Org Report Or Register State | OR | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (1) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | 0 | PrivateOperatingFoundationInd |
| New Substantial Contributors | 0 | NewSubstantialContributorsInd |
| Own Controlled Entity | 0 | OwnControlledEntityInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (1) | ComplyWithPublicInspRqrInd |
| Website Address | N/A | WebsiteAddressTxt |
| Individual With Books | AMY BELKIN EXECUTIVE DIRECTOR | IndividualWithBooksNm |
| Phone | 5418571040 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1314-B CENTER DRIVE BOX 264 | AddressLine1Txt |
| City | MEDFORD | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97501 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | 0 | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | 0 | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | 0 | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | 0 | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | Yes (1) | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | 0 | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | 0 | PaymentToGovernmentOfficialInd |
| Acts Fail To Qlfy As Exceptions | 0 | ActsFailToQlfyAsExceptionsInd |
| Uncorrected Prior Acts | 0 | UncorrectedPriorActsInd |
| Undistributed Income PY | 0 | UndistributedIncomePYInd |
| Business Holdings | 0 | BusinessHoldingsInd |
| Jeopardy Investments | 0 | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | 0 | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | 0 | InfluenceLegislationInd |
| Influence Election | 0 | InfluenceElectionInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Noncharitable Purpose | 0 | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|---|---|---|---|
| WILL BRAKE | ||||||||
| 1314-B CENTER DRIVE NO 264 | MEDFORD | OR | 97501 | PRESIDENT | 0.50 | $0 | $0 | $0 |
| BELLE SHEPARD | ||||||||
| 1314-B CENTER DRIVE NO 264 | MEDFORD | OR | 97501 | FORMER VICE-PRESIDENT | 0.50 | $0 | $0 | $0 |
| APRIL STITH | ||||||||
| 1314-B CENTER DRIVE NO 264 | MEDFORD | OR | 97501 | TREASURER | 0.50 | $0 | $0 | $0 |
| CHARLEY BOLEN | ||||||||
| 1314-B CENTER DRIVE NO 264 | MEDFORD | OR | 97501 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| STACY BRUBAKER | ||||||||
| 1314-B CENTER DRIVE NO 264 | MEDFORD | OR | 97501 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| AARON HOEFLING | ||||||||
| 1314-B CENTER DRIVE NO 264 | MEDFORD | OR | 97501 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| NANCY MCKINNIS | ||||||||
| 1314-B CENTER DRIVE NO 264 | MEDFORD | OR | 97501 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| MARK MEYER | ||||||||
| 1314-B CENTER DRIVE NO 264 | MEDFORD | OR | 97501 | DIRECTOR | 0.50 | $0 | $0 | $0 |
| AMY BELKIN | ||||||||
| 1314-B CENTER DRIVE NO 264 | MEDFORD | OR | 97501 | EXECUTIVE DIRECTOR & SECRE | 20.00 | $42,970 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Other Employee Paid Over50k | 0 | OtherEmployeePaidOver50kCnt |
| Comp Of Hghst Pd Cntrct Or NONE | NONE | CompOfHghstPdCntrctOrNONETxt |
| Contractor Paid Over50k | 0 | ContractorPaidOver50kCnt |
Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | NONE | Description1Txt |
| Expenses1 | $0 | Expenses1Amt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | NONE | Description1Txt |
| Expenses1 | $0 | Expenses1Amt |
| Total | $0 | TotalAmt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $3,355,038 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $191,023 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $3,546,061 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $3,546,061 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $53,191 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $3,492,870 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $174,644 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $174,644 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $2,136 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $2,136 | TotalTaxAmt |
| Distributable Before Adj | $172,508 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $172,508 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $172,508 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $162,128 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $162,128 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $172,508 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $14,986 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Total Excess Distribution Cyov | $0 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $162,128 | QualifyingDistributionsAmt |
| Applied To Year1 | $14,986 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $147,142 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $0 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $0 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Prior Year Deficiency Or Tax | $0 | PriorYearDeficiencyOrTaxAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $25,366 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $0 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $0 | ExcessDistriCyovToNextYrAmt |
Supplementary Information SupplementaryInformationGrp
Application Submission Info ApplicationSubmissionInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Person | AMY BELKIN | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1314-B CENTER DRIVE BOX 264 | AddressLine1Txt |
| City | MEDFORD | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97501 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 5416019915 | RecipientPhoneNum |
| Form And Info And Materials | WRITTEN | FormAndInfoAndMaterialsTxt |
| Submission Deadlines | NONE | SubmissionDeadlinesTxt |
| Restrictions On Awards | DISTRIBUTIONS WILL BE MADE WHICH PRIMARILY BENEFIT OR HAVE CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES WITHIN JACKSON, JOSEPHINE AND KLAMATH COUNTIES OF OREGON. SECONDARY CONSIDERATION WILL BE GIVEN TO THOSE THAT BENEFIT OR HAVE CHARITABLE, EDUCATIONAL & SCIENTIFIC PURPOSES WITHIN CURRY, LAKE, DOUGLAS, DESCHUTES AND COOS COUNTIES OF OREGON. | RestrictionsOnAwardsTxt |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (27 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| ALS ASSOCIATION OREGON AND SW WASHINGTON CHAPTER | |||||||
| 700 NE MULTNOMAH ST 210 | PORTLAND | OR | 97232 | NONE | PC | ALS FAMILY SUPPORT PROGRAM | $2,500 |
| CASA OF JACKSON COUNTY | |||||||
| 613 MARKET STREET | MEDFORD | OR | 97504 | NONE | PC | CREATING OPPORTUNITIES TO SERVE: VOLUNTEER RECRUITMENT AND BACKGROUND CHECKS | $5,000 |
| COMMUNITY HEALTH CENTER | |||||||
| 19 MYRTLE ST | MEDFORD | OR | 97504 | NONE | PC | EMERGENCY PRESCRIPTION MEDICATION ASSISTANCE/EMERGENCY GRANT | $5,000 |
| COMMUNITY VOLUNTEER NETWORK | |||||||
| 1 W MAIN ST STE 303 | MEDFORD | OR | 97501 | NONE | PC | FOSTER GRANDPARENT PROGRAM OF SOUTHERN OREGON | $3,500 |
| COMMUNITY WORKS INC | |||||||
| 2594 E BARNETT RD | MEDFORD | OR | 97504 | NONE | PC | SAFETY, EDUCATION AND SUPPORT OF LOCAL FAMILIES IN NEED - PROJECT DOVE | $2,000 |
| COMPASS HOUSE INC | |||||||
| 332 W 6TH ST | MEDFORD | OR | 97501 | NONE | PC | EMPLOYMENT PROGRAM | $8,000 |
| CONSUMER CREDIT COUNSELING | |||||||
| 820 CRATER LAKE AVE 202 | MEDFORD | OR | 97504 | NONE | PC | COMMUNITY FINANCIAL EDUCATION WITH ADDITIONAL NEED DUE TO COVID | $6,000 |
| HEARTS WITH A MISSION | |||||||
| 521 EDWARDS ST | MEDFORD | OR | 97501 | NONE | PC | HELP FUND EDUCATION COORDINATOR FOR HOMELESS YOUTH | $5,000 |
| HOPE EQUESTRIAN | |||||||
| PO BOX 396 | EAGLE POINT | OR | 97524 | NONE | PC | ADOPT A RIDER FUND | $6,000 |
| JACKSON COUNTY SEXUAL ASSAULT RESPONSE TEAM | |||||||
| 2305 ASHLAND STREET C-418 | ASHLAND | OR | 97520 | NONE | PC | SEXUAL ASSAULT ACUTE RESPONSE PROGRAM | $6,000 |
| JUNIOR ACHIEVEMENT OF OREGON & SW WA | |||||||
| 7830 FOSTER RD | PORTLAND | OR | 97206 | NONE | PC | CAREER READINESS AND FINANCIAL LITERACY | $4,000 |
| KIDS UNLIMITED | |||||||
| 812 N RIVERSIDE | MEDFORD | OR | 97501 | NONE | PC | EARLY LEARNING LITERACY FOR CHILDREN IN POVERTY IN WHITE CITY | $2,500 |
| MAGDALENE HOME | |||||||
| 12 BLACK OAK DRIVE | MEDFORD | OR | 97501 | NONE | PC | RESIDENT ESSENTIAL NEEDS FUNDS | $2,500 |
| MEDFORD SCHOOL DISTRICT 549C | |||||||
| 500 MONROE | MEDFORD | OR | 97501 | NONE | GOV | EMERGENCY FUNDS FOR BASIC NEEDS/EMERGENCY GRANT | $10,000 |
| OPTIONS FOR HOMELESS RESIDENTS OF ASHLAND | |||||||
| 611 SISKIYOU BLVD UNIT 4 | ASHLAND | OR | 97520 | NONE | PC | JOB MATCH PROGRAM | $5,000 |
| OREGON CONSERVATORY OF PERFORMING ARTS | |||||||
| PO BOX 1359 | MEDFORD | OR | 97501 | NONE | PC | OCPA SCHOLARSHIP PROGRAM | $3,500 |
| RECLAIMING LIVES | |||||||
| 228 EAST MAIN ST SUITE H | MEDFORD | OR | 97501 | NONE | PC | RECOVERY CAFE | $5,000 |
| ROGUE GALLERY & ART CENTER | |||||||
| 40 SO BARTLETT | MEDFORD | OR | 97501 | NONE | PC | ELEMENTARY SCHOOL ARTS OUTREACH PROGRAM | $2,000 |
| ROGUE POWERPACK CHARITABLE FOUNDATION | |||||||
| PO BOX 8369 | MEDFORD | OR | 97501 | NONE | PC | PROVIDES WEEKEND MEALS FOR KIDS | $5,000 |
| ROGUE VALLEY COUNCIL OF GOVERNMENT | |||||||
| 155 N 1ST STR | CENTRAL POINT | OR | 97502 | NONE | PC | EMERGENCY FUND/EMERGENCY GRANT | $5,000 |
| ROGUE VALLEY SMART | |||||||
| 670 SUPERIOR CT STE 108 | MEDFORD | OR | 97504 | NONE | PC | RV SMART READING PROGRAM FOR CHILDREN IN ELEMENTARY SCHOOL | $5,000 |
| ROGUE WORLD MUSIC | |||||||
| 2305 ASHLAND STREET C-421 | ASHLAND | OR | 97520 | NONE | PC | WORLD MUSIC SINGING CLUBS | $3,000 |
| SANCTUARY ONE | |||||||
| 13195 UPPER APPLEGATE RD | JACKSONVILLE | OR | 97530 | NONE | PC | RESCUED ANIMALS EDUCATION PROGRAM | $3,000 |
| ST VINCENT DE PAUL SOCIETY | |||||||
| 2424 NORTH PACIFIC HWY | MEDFORD | OR | 97501 | NONE | PC | EMERGENCY FUND/EMERGENCY GRANT | $5,000 |
| UNITED WAY OF JACKSON COUNTY | |||||||
| 711 E MAIN STE 17 | MEDFORD | OR | 97504 | NONE | PC | FOR HOPE (HELPING OUT PEOPLE EVERY DAY) CHEST, AN EMERGENCY ASSISTANCE FUND, AND BIG IDEA NEXT PROGRAM | $10,000 |
| YMCA ROGUE VALLEY FAMILY YMCA | |||||||
| 522 WEST SIXTH STREET | MEDFORD | OR | 97501 | NONE | PC | FINANCIAL ASSISTANCE FOR CHILD CARE PROJECT | $5,000 |
| WILDFIRE SPECIAL NEEDS TABLE | |||||||
| 1314-B CENTER DRIVE BOX 264 | MEDFORD | OR | 97501 | NONE | PC | WORKING WITH UNMET NEEDS TABLE GROUP TO HELP WILDFIRE SURVIVORS WHO ARE RESETTLING | $5,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $130,000 | TotalGrantOrContriPdDurYrAmt |
| Total Grant Or Contri Apprv Fut | $0 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $6 | ExclusionAmt |
Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $56,863 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $147,929 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $204,798 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $204,798 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | 0 | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | 0 | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | 0 | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | 0 | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | 0 | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | 0 | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | 0 | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | 0 | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | 0 | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | 0 | RelationshipsNonchrtblEOInd |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING | CategoryTxt |
| Amt | $11,985 | Amt |
| Net Investment Income | $5,992 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $5,992 | DisbursementsCharitablePrpsAmt |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp (108 entries)
| StockStockNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| ACCENTRUE PLC IRELAND CL A -7239 | $7,058 | $14,924 |
| AIA GROUP LTD SPON ADR -7239 | $5,151 | $5,565 |
| AIR PROD & CHEMICAL INC -7233 | $10,536 | $13,692 |
| AKZO NOBEL NV SPON ADR -7239 | $5,275 | $6,907 |
| ALCON INC CHF -7239 | $5,163 | $7,841 |
| ALIBABA GROUP HLDG LTD SPON SDR -4823 | $6,900 | $6,533 |
| ALPHABET INC CL A -4823 | $3,390 | $17,382 |
| ALPHABET INC CL C -4823 | $3,682 | $17,362 |
| ALPHABET INC LC C -7233 | $10,343 | $31,829 |
| ALTRIA GROUP INC -7233 | $19,284 | $18,624 |
| AMAZON.COM INC -4823 | $1,672 | $30,009 |
| AMER FUNDS EUROPACIFIC GROWTH FUND CLASS F2 -5850 | $198,370 | $241,745 |
| APPLE INC -7233 | $5,040 | $32,140 |
| ASSA ABLOY AB ADR -7239 | $5,332 | $7,101 |
| AUTODESK INC -4823 | $3,595 | $19,121 |
| AUTOMATIC DATA PROCESSING INC -4823 | $1,398 | $3,945 |
| BERKSHIRE HATHAWAY INC NEW -7233 | $13,933 | $32,591 |
| BLACKROCK INC -7233 | $4,382 | $13,733 |
| BROOKFIELD ASSET MANAGEMENT -7239 | $7,489 | $12,197 |
| CAMECO CORP CANADA CAD -7239 | $2,281 | $5,213 |
| CARMAX INC -7233 | $5,086 | $14,195 |
| CARNIVAL CORP NEW (PAIRED STOCK) -7239 | $4,594 | $2,294 |
| CISCO SYSTEMS -4823 | $4,156 | $9,252 |
| CISCO SYSTEMS -7233 | $4,987 | $12,864 |
| CLOSE BROS GROUP 25 P ORD ADR -7239 | $4,085 | $4,362 |
| COCA COLA EUROPEAN PARTNERS EUR -7239 | $5,244 | $6,040 |
| COLGATE PALMOLIVE CO -4823 | $4,996 | $5,974 |
| DASSAULT SYSTEMS S A SPON ADR -7239 | $5,739 | $11,041 |
| DBS GROUP HLDGS LTD. SPON ADR -7239 | $4,058 | $6,328 |
| DEERE AND CO -4823 | $2,833 | $11,658 |
| ERSTE GROUP BANK AG SPON ADR -7239 | $4,307 | $5,951 |
| EXPEDITORS INTL WASH INC -4823 | $3,872 | $10,743 |
| EXPERIAN PLC SPON ADR -7239 | $4,993 | $7,594 |
| FACTSET RESH SYSTEMS INC -4823 | $2,865 | $8,748 |
| FEDEX CORP -7233 | $10,260 | $16,036 |
| HEINEKEN NV SPON ADR -7239 | $6,104 | $6,899 |
| HOME DEPOT INC -7233 | $9,125 | $21,581 |
| ING GROEP N V NL SPON ADR -7239 | $6,650 | $9,159 |
| JOHNSON & JOHNSON COM -7233 | $10,653 | $12,317 |
| KDDI CORP ADR -7239 | $5,602 | $5,670 |
| KUBOTA CORP ADR JAPAND ADR -7239 | $4,603 | $6,703 |
| LOWES COMPANIES INC -7233 | $1,984 | $11,632 |
| LVMH MOET HENNESSY LOUIS NEW ADR -7239 | $4,155 | $7,944 |
| MAGNA INTL INC CL A SUB CTG CANADA ORD -7239 | $5,233 | $8,013 |
| MARTIN MARIETTA MATERIALS INC -7233 | $9,249 | $19,823 |
| MARUI LTD ADR NEW JAPAN ADR -7239 | $5,519 | $4,401 |
| MICROSOFT CORP -4823 | $3,520 | $24,551 |
| MONSTER BEVERAGE CORP NEW COM -4823 | $3,870 | $14,598 |
| NESTLE S A SPONSORED ADR REPSTG REG SHS SWITZ ADR -7233 | $9,879 | $16,423 |
| NEWMARKET CORP -7233 | $10,713 | $10,624 |
| NIDEC CORP ADR -7239 | $5,983 | $9,532 |
| NORFOLK STHN CORP -7233 | $4,848 | $18,458 |
| NOVARTIS AG SPON ADR -4823 | $11,179 | $11,983 |
| NOVARTIS AG SPON ADR -7239 | $5,658 | $5,511 |
| NOVO NORDISK ADR DENMARK ADR -4823 | $1,833 | $5,712 |
| NVIDIA CORP -4823 | $4,162 | $33,234 |
| O REILLY AUTOMOTIVE INC -7233 | $7,155 | $19,774 |
| ORACLE CORP -4823 | $8,897 | $20,669 |
| PFIZER INC -7233 | $9,211 | $13,050 |
| PIMCO INCOME FUND CLASS I -5850 | $315,325 | $329,042 |
| PIMCO LOW DURATION INSTL CLASS -5850 | $321,966 | $311,798 |
| PROGRESSIVE CORP OHIO -7233 | $4,302 | $12,113 |
| QUALCOMM INC -4823 | $3,334 | $12,069 |
| RECKITT BENCKISER PLC SPON ADR -7239 | $4,312 | $4,778 |
| REGENERON PHARMACEUTICLS INC -4823 | $6,886 | $12,630 |
| ROCHE HLDG LTD SPONS ADR SWITZ ADR -4823 | $8,450 | $11,940 |
| SAFRAN SA ADR -7239 | $6,912 | $5,476 |
| SCHLUMBERGER LTD NETHERLANDS ANTILLES -4823 | $9,552 | $6,050 |
| SCHWAB CHARLES CORP NEW -7233 | $10,614 | $21,446 |
| SEI INVESTMENTS CO -4823 | $4,849 | $6,033 |
| SONY CORP ADR NEW JAPAN ADR -7239 | $6,451 | $13,272 |
| STARBUCKS CORP -4823 | $6,107 | $11,229 |
| SYMRISE AG ADR -7239 | $4,275 | $6,561 |
| TOTAL S.A. FRANCE SPON ADR -7239 | $5,583 | $5,292 |
| UNILEVER NV N Y SHS NEW NETHERLANDS SPON SPON ADR -7239 | $5,635 | $5,325 |
| VANGUARD MID-CAP GORWTH INDEX ADMIRAL -5850 | $76,429 | $186,480 |
| VANGUARD MID-CAP VALUE INDEX ADM -5850 | $115,915 | $190,044 |
| VANGUARD SMALL CAP INDEX FUND ADMIRAL -5850 | $113,136 | $171,972 |
| VERIZON COMMUNICATIONS INC -7233 | $10,329 | $10,236 |
| VISA INC CL A -4823 | $5,865 | $24,272 |
| VISA INC CL A -7233 | $3,744 | $16,687 |
| YUM CHINA HLDGS INC -4823 | $1,573 | $3,190 |
| YUM! BRANDS INC -4823 | $2,521 | $6,526 |
| STORE CAP CORP REIT -7233 | $10,082 | $16,374 |
| TEXAS INSTRUMENTS -7233 | $10,776 | $17,716 |
| ASHTEAD GROUP PLC ORD -7239 | $4,383 | $10,850 |
| CREDICORP LTD -7239 | $5,396 | $5,493 |
| FANUC CORP ADR -7239 | $5,581 | $6,600 |
| MICHELIN COMPAGNIE GENERALE ADR -7239 | $5,882 | $7,542 |
| OTSUKA HLDGS CO LTD UNSPONSORED ADR -7239 | $4,404 | $4,088 |
| RENTOKIL INITIAL PLC SPON ADR -7239 | $5,813 | $7,504 |
| BOEING COMPANY -4823 | $16,173 | $19,931 |
| ILLUMINA INC -4823 | $7,632 | $9,891 |
| INTUITIVE SURGICAL INC NEW -4823 | $3,185 | $6,827 |
| SALESFORCE.COM INC -4823 | $10,276 | $17,535 |
| WALT DISNEY CO (HOLDING CO) -4823 | $13,325 | $15,799 |
| WORKDAY INC CL A -4823 | $3,187 | $6,556 |
| VANGUARD HIGH YIELD CORP FUND ADMIRAL -5850 | $161,989 | $165,441 |
| WESTERN ASSET CORE BOND FUND CLASS I -5850 | $496,390 | $487,638 |
| INVESCO DEVELOPING MARKETS FUND CLASS Y -5850 | $137,032 | $142,895 |
| GLAXO SMITHKLINE PLC ADR -7239 | $6,412 | $7,497 |
| PAN PAC INTL HOLDINGS CORP ADR -7239 | $7,071 | $5,037 |
| CHURCH & DWIGHT CO INC -7233 | $12,904 | $15,068 |
| FISERV INC -7233 | $12,673 | $12,143 |
| META PLATFORMS INC CL A -7233 | $18,748 | $21,526 |
| OLD DOMINION FREIGHT LINES INC -7233 | $8,314 | $12,902 |
| META PLATFORMS INC CL A -4823 | $4,651 | $27,581 |
| VERTEX PHARMACEUTICAL INC -4823 | $10,723 | $11,861 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (2 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| OFFICE EXPENSE | $2,373 | $0 | $2,373 |
| OREGON ANNUAL FILING FEES | $422 | $0 | $422 |
Other Increases Schedule OtherIncreasesSchedule
Other Increases Detail OtherIncreasesDetail (2 entries)
| DescDesc | AmtAmt |
|---|---|
| WASH SALE LOSSES DISALLOWED | $22 |
| NON-TAXABLE DISTRUBTIONS | $2,416 |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ADVISORY FEES | CategoryTxt |
| Amt | $20,807 | Amt |
| Net Investment Income | $20,807 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| FOREIGN TAX | $1,010 | $1,010 | $0 |
| PAYROLL TAXES | $3,712 | $1,856 | $1,856 |
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