BETA

HAL F JUCKETTE FAMILY FOUNDATION: Form 990PF, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
HAL F JUCKETTE FAMILY FOUNDATION (EIN 47-4055880)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-05-19
IRS object ID
202001409349100870
Schema version
2019v5.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2020-05-19T13:22:45-05:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN440615592PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1HARDEN CUMMINS MOSS & MILLER LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1515 WASHINGTON ST PO BOX 620AddressLine1Txt
CityCHILLICOTHECityNm
State AbbreviationMOStateAbbreviationCd
ZIP64601ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN474055880EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HAL F JUCKETTE FAMILY FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHALFBusinessNameControlTxt
Phone6606462336PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 620AddressLine1Txt
CityCHILLICOTHECityNm
State AbbreviationMOStateAbbreviationCd
ZIP64601ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMICHAEL F TURNERPersonNm
Person TitleTREASURERPersonTitleTxt
Phone6606462336PhoneNum
Signature2020-05-18SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL F TURNERPreparerPersonNm
PTINP00590320PTIN
Phone6606462336PhoneNum
Preparation2020-05-18PreparationDt
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$4,733,895FMVAssetsEOYAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Interest On Sav Rev And Expnss$324InterestOnSavRevAndExpnssAmt
Interest On Sav Net Invst Incm$324InterestOnSavNetInvstIncmAmt
Cap Gain Net Incm Net Invst Incm$0CapGainNetIncmNetInvstIncmAmt
Other Income Rev And Expnss$730,044OtherIncomeRevAndExpnssAmt
Other Income Net Invst Incm$730,044OtherIncomeNetInvstIncmAmt
Total Rev And Expnss$730,368TotalRevAndExpnssAmt
Total Net Invst Incm$730,368TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$30,000CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$7,500CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$22,500CompOfcrDirTrstDsbrsChrtblAmt
Legal Fees Rev And Expnss$150LegalFeesRevAndExpnssAmt
Legal Fees Net Invst Incm$0LegalFeesNetInvstIncmAmt
Legal Fees Dsbrs Chrtbl$150LegalFeesDsbrsChrtblAmt
Accounting Fees Rev And Expnss$919AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm$689AccountingFeesNetInvstIncmAmt
Accounting Fees Chrtbl Prps$230AccountingFeesChrtblPrpsAmt
Other Expenses Rev And Expnss$12OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$12OtherExpensesNetInvstIncmAmt
Other Expenses Dsbrs Chrtbl$0OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$31,081TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$8,201TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$22,880TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$228,000ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$228,000ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$259,081TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$8,201TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$250,880TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses$471,287ExcessRevenueOverExpensesAmt
Net Investment Income$722,167NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Sav And Temp Cash Invst BOY$252,707SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$93,950SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$93,950SavAndTempCashInvstEOYFMVAmt
Other Investments BOY$4,009,901OtherInvestmentsBOYAmt
Other Investments EOY$4,639,945OtherInvestmentsEOYAmt
Other Investments EOYFMV$4,639,945OtherInvestmentsEOYFMVAmt
Total Assets BOY$4,262,608TotalAssetsBOYAmt
Total Assets EOY$4,733,895TotalAssetsEOYAmt
Total Assets EOYFMV$4,733,895TotalAssetsEOYFMVAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind
No Donor Rstr Net Assests BOY$4,262,608NoDonorRstrNetAssestsBOYAmt
No Donor Rstr Net Assests EOY$4,733,895NoDonorRstrNetAssestsEOYAmt
Tot Net Ast Or Fund Balances BOY$4,262,608TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$4,733,895TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$4,262,608TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$4,733,895TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$4,262,608TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses$471,287ExcessRevenueOverExpensesAmt
Other Increases$0OtherIncreasesAmt
Subtotal$4,733,895SubtotalAmt
Other Decreases$0OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$4,733,895TotNetAstOrFundBalancesEOYAmt

Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp

FieldValueIRS element (for citing)
Liable Section4942 Tax0LiableSection4942TaxInd
Adjusted Qlfy Distri Yr1$146,134AdjustedQlfyDistriYr1Amt
Net Vl Noncharitable Assets Yr1$4,340,607NetVlNoncharitableAssetsYr1Amt
Distribution Yr10.033667DistributionYr1Rt
Adjusted Qlfy Distri Yr2$51,909AdjustedQlfyDistriYr2Amt
Net Vl Noncharitable Assets Yr2$2,844,866NetVlNoncharitableAssetsYr2Amt
Distribution Yr20.018247DistributionYr2Rt
Adjusted Qlfy Distri Yr3$1,875AdjustedQlfyDistriYr3Amt
Net Vl Noncharitable Assets Yr3$1,069,470NetVlNoncharitableAssetsYr3Amt
Distribution Yr30.001753DistributionYr3Rt
Adjusted Qlfy Distri Yr4$850AdjustedQlfyDistriYr4Amt
Net Vl Noncharitable Assets Yr4$0NetVlNoncharitableAssetsYr4Amt
Distribution Yr40.000000DistributionYr4Rt
Total Distribution0.053667TotalDistributionRt
Average Distribution0.013417AverageDistributionRt
Net Vl Noncharitable Assets$4,484,557NetVlNoncharitableAssetsAmt
Adj Net Vl Noncharitable Assets$60,169AdjNetVlNoncharitableAssetsAmt
Net Investment Income Pct$7,222NetInvestmentIncomePctAmt
Adj Nonchrtbl Net Invst Incm Pct$67,391AdjNonchrtblNetInvstIncmPctAmt
Qualifying Distributions$250,880QualifyingDistributionsAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Domestic Org Meeting Sect4940eYes (X)DomesticOrgMeetingSect4940eInd
Investment Income Excise Tax$7,222InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$7,222SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$7,222TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$114EstimatedPlusOvpmtIncmTxAmt
Extsn Request Income Tax Paid$0ExtsnRequestIncomeTaxPaidAmt
Backup Withholding Withheld$0BackupWithholdingWithheldAmt
Total Payments And Credits$114TotalPaymentsAndCreditsAmt
Es Penalty$0EsPenaltyAmt
Tax Due$7,108TaxDueAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (1)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateMOOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating Foundation0PrivateOperatingFoundationInd
New Substantial Contributors0NewSubstantialContributorsInd
Own Controlled Entity0OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressN/AWebsiteAddressTxt
Individual With BooksMICHAEL F TURNERIndividualWithBooksNm
Phone6606462336PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 620AddressLine1Txt
CityCHILLICOTHECityNm
State AbbreviationMOStateAbbreviationCd
ZIP64601ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified Prsn0FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified PrsnYes (1)PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Acts Fail To Qlfy As Exceptions0ActsFailToQlfyAsExceptionsInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To Individuals0GrantsToIndividualsInd
Grants To Organizations0GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
JOYCE E JUCKETTE
2316 COUNTRY CLUB DRIVECHILLICOTHEMO64601PRESIDENT0.50$5,000$0$0
HOLLY STADTMUELLER
6801 NW MONTICELLO CTKANSAS CITYMO64152VICE-PRESIDENT0.50$5,000$0$0
LISA D STEELE
2527 W POLK STREETCHILLICOTHEMO64601VICE-PRESIDENT0.50$5,000$0$0
TERI L NEUROTH
9027 N HUNTER AVENUEKANSAS CITYMO64157VICE-PRESIDENT0.50$5,000$0$0
ROBERT COWHERD
903 JACKSON STREET PO BOX 228CHILLICOTHEMO64601SECRETARY0.50$5,000$0$0
MICHAEL F TURNER
515 WASHINGTON STREET PO BOX 620CHILLICOTHEMO64601TREASURER0.50$5,000$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Other Employee Paid Over50k0OtherEmployeePaidOver50kCnt
Comp Of Hghst Pd Cntrct Or NONENONECompOfHghstPdCntrctOrNONETxt
Contractor Paid Over50k0ContractorPaidOver50kCnt

Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp

FieldValueIRS element (for citing)
Description1N/ADescription1Txt
Expenses1$0Expenses1Amt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$0AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$213,974AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$4,338,876FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$4,552,850TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$4,552,850AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$68,293CashDeemedCharitableAmt
Net Vl Noncharitable Assets$4,484,557NetVlNoncharitableAssetsAmt
Minimum Investment Return$224,228MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$224,228MinimumInvestmentReturnAmt
Tax Based On Investment Income$7,222TaxBasedOnInvestmentIncomeAmt
Total Tax$7,222TotalTaxAmt
Distributable Before Adj$217,006DistributableBeforeAdjAmt
Recoveries Qualfied Distri$0RecoveriesQualfiedDistriAmt
Distributable Before Ded$217,006DistributableBeforeDedAmt
Deduction From Distributable$0DeductionFromDistributableAmt
Distributable As Adjusted$217,006DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

FieldValueIRS element (for citing)
Expenses And Contributions$250,880ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Qualifying Distributions$250,880QualifyingDistributionsAmt
Pct Sect4940e Org Net Invst Incm$7,222PctSect4940eOrgNetInvstIncmAmt
Adjusted Qualifying Distri$243,658AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$217,006DistributableAsAdjustedAmt
Undistributed Income PY$211,765UndistributedIncomePYAmt
Total For Prior Years$0TotalForPriorYearsAmt
Total Excess Distribution Cyov$0TotalExcessDistributionCyovAmt
Qualifying Distributions$250,880QualifyingDistributionsAmt
Applied To Year1$211,765AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$39,115AppliedToCurrentYearAmt
Remaining Distri From Corpus$0RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$0TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$177,891UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$0ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$0ExcessDistriCyovToNextYrAmt

Supplementary Information SupplementaryInformationGrp

FieldValueIRS element (for citing)
Contributing ManagerJOYCE E JUCKETTEContributingManagerNm
Only Contri To PreselectedYes (X)OnlyContriToPreselectedInd

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (16 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
CENTRAL MISSOURI HONOR FLIGHT
1400 FORUM BLVD STE 7-A BOX 334COLUMBIAMO65203NONEPCHONOR FLIGHTS FOR VETERANS$2,500
FARMERS' ELECTRIC AREA YOUTH BENEFIT FUND
PO BOX 680CHILLICOTHEMO64601NONEPCMEDICAL EXPENSES FOR CHILDREN$10,000
FELLOWSHIP OF CHRISTIAN ATHLETES
PO BOX 1073CHILLICOTHEMO64601NONEPCCHRISTIAN MINISTRY$20,000
GRAND RIVER AREA FAMILY YMCA
1725 LOCUST STREETCHILLICOTHEMO64601NONEPCMEALS FOR CHILDREN$5,000
HEDRICK MEDICAL CENTER FOUNDATION
2799 NORTH WASHINGTON STREETCHILLICOTHEMO64601NONEPCHOSPITAL GARDENS$5,000
LIVINGSTON COUNTY HUMANE SOCIETY
PO BOX 1214CHILLICOTHEMO64601NONEPCANIMAL SHELTER$10,000
LIVINGSTON COUNTY VETERANS ASSOCIATION
PO BOX 1141CHILLICOTHEMO64601NONEPCVETERANS BUILDING$15,000
MINISTERIAL ALLIANCE
900 JACKSON STREETCHILLICOTHEMO64601NONEPCOPERATION HELP MINISTRY$25,000
CHILLICOTHE AREA CHRISTIAN BUILDERS
PO BOX 913CHILLICOTHEMO64601NONEPCHOUSING FOR POOR$20,000
CHILLICOTHE UNITED METHODIST CHURCH
1414 WALNUT STREETCHILLICOTHEMO64601NONEPCBEDS FOR CHILDREN$3,000
VETERANS COMMUNITY PROJECT
8900 TROOST AVENUEKANSAS CITYMO64131NONEPCTINY HOUSES FOR HOMELESS VETERANS$50,000
CITY OF CHILLICOTHE
715 WASHINGTON STREETCHILLICOTHEMO64601N/AGOVPARK IMPROVEMENTS$25,000
OATS TRANSIT
607 US HIGHWAY 36 BUSINESSCHILLICOTHEMO64601NONEPCTRANSPORTATION$10,000
COLLEGE OF THE OZARKS
100 OPPORTUNITY AVENUEPOINT LOOKOUTMO65726NONEPCEDUCATION$22,500
FRIENDS OF PARKVILLE ANIMAL SHELTER
1356 NW HWY 9PARKVILLEMO64152NONEPCANIMAL SHELTER$2,500
CULTURAL CORNER ART GUILD & GALLERY
424 LOCUST STREETCHILLICOTHEMO64601NONEPCEDUCATION$2,500
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$228,000TotalGrantOrContriPdDurYrAmt

Grant Or Contri Apprv For Fut GrantOrContriApprvForFutGrp

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1HOPE HAVEN INDUSTRIESBusinessNameLine1Txt

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line1304 CLAY STREETAddressLine1Txt
CityCHILLICOTHECityNm
State AbbreviationMOStateAbbreviationCd
ZIP64601ZIPCd
FieldValueIRS element (for citing)
Recipient RelationshipNONERecipientRelationshipTxt
Recipient Foundation StatusPCRecipientFoundationStatusTxt
Grant Or Contribution PurposeSHELTERED WORKSHOP BUILDINGGrantOrContributionPurposeTxt
Amt$50,000Amt
FieldValueIRS element (for citing)
Total Grant Or Contri Apprv Fut$50,000TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$324ExclusionAmt

Other Investment Incm Part VII OtherInvestmentIncmPartVIIGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$730,044ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$0UnrelatedBusinessTaxblIncmAmt
Exclusion$730,368ExclusionAmt
Related Or Exempt Function Incm$0RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$730,368TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EO0RelationshipsNonchrtblEOInd

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

FieldValueIRS element (for citing)
CategoryACCOUNTING FEESCategoryTxt
Amt$919Amt
Net Investment Income$689NetInvestmentIncomeAmt
Disbursements Charitable Prps$230DisbursementsCharitablePrpsAmt

Investments Other Schedule2 InvestmentsOtherSchedule2

Investments Other InvestmentsOtherGrp

FieldValueIRS element (for citing)
Category Or ItemNEW YORK LIFE VARIABLE ANNUITYCategoryOrItemTxt
Listed At Cost Or FMVFMVListedAtCostOrFMVCd
Book Value$4,639,945BookValueAmt
EOYFMV$4,639,945EOYFMVAmt

Legal Fees Schedule LegalFeesSchedule

Legal Fees LegalFeesGrp

FieldValueIRS element (for citing)
CategoryLEGAL FEESCategoryTxt
Legal Fees$150LegalFeesAmt
Net Investment Income$0NetInvestmentIncomeAmt
Disbursements Charitable Prps$150DisbursementsCharitablePrpsAmt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp

FieldValueIRS element (for citing)
DescWIRE TRANSFER FEEDesc
Revenue And Expenses Per Books$12RevenueAndExpensesPerBooksAmt
Net Investment Income$12NetInvestmentIncomeAmt
Disbursements Charitable Prps$0DisbursementsCharitablePrpsAmt

Other Income Schedule2 OtherIncomeSchedule2

Other Income Detail OtherIncomeDetail

FieldValueIRS element (for citing)
DescNEW YORK LIFE ANNUITY INCOMEDesc
Revenue And Expenses Per Books$730,044RevenueAndExpensesPerBooksAmt
Net Investment Income$730,044NetInvestmentIncomeAmt
Adjusted Net Income$730,044AdjustedNetIncomeAmt

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