2020-01-07T10:53:31-06:00 2019-05-31 410746749 CLIFTONLARSONALLEN LLP 420 SOUTH ORANGE AVENUE SUITE 500 ORLANDO FL 32801 990PF 2018-06-01 593010451 HANS AND CAY JACOBSEN CHARITABLE FOUNDATION INC HANS 4078106672 PO BOX 2149 WINTER PARK FL 32790 TERESA W BORCHECK PRESIDENT 4078106672 2019-12-17 1 AMY CHAPMAN P00843460 4078021200 2019-12-17 67.137.57.251 2019-12-17 15:44:47 ES P 1B5EB360EE328A9676587C14C3A24D68B6871257 CEF5B9F4E6ECDFA9762AA49441F704C31E18C10F 2018 2020-11-06 18:47:13Z X 5250139 X 1000 X 5715 5715 97912 97912 57978 1710338 57978 296 296 162901 161901 44000 12000 32000 1094 547 547 880 0 880 20500 16400 4100 36794 18397 18397 6193 0 0 6728 6728 0 4132 3501 631 120321 57573 56555 180250 180250 300571 57573 236805 -137670 104328 270414 400835 400835 0 451253 456731 2415438 2132831 3481087 743453 325163 324795 602864 584417 586691 4032169 3894499 5250139 0 0 X 4032169 3894499 4032169 3894499 4032169 3894499 4032169 -137670 0 3894499 0 3894499 PUBLICLY TRADED SECURITIES 1708002 1652360 55642 55642 CAPITAL GAINS DIVIDENDS P 2336 2336 2336 57978 0 350285 5305021 0.066029 558221 5235118 0.106630 300751 5471777 0.054964 359359 5994087 0.059952 363866 5526055 0.065846 0.353421 0.070684 5242553 370565 1043 371608 236805 2087 0 2087 0 2087 3880 0 0 3880 38 1755 1755 0 0 0 0 0 0 0 0 0 0 0 1 1 FL 1 0 0 0 0 1 N/A CAPITAL CITY TRUST COMPANY 8668209671 PO BOX 1549 TALLAHASSEE FL 32302 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TERESA W BORCHECK PO BOX 2149 WINTER PARK FL 32790 PRESIDENT 10.00 20000 0 0 W THOMAS BROOKS PO BOX 2149 WINTER PARK FL 32790 VICE PRESIDENT 6.00 8000 0 0 BRIAN BROOKS PO BOX 2149 WINTER PARK FL 32790 TREASURER 3.00 8000 0 0 SHANNON MCLIN CARLYLE PO BOX 2149 WINTER PARK FL 32790 SECRETARY 3.00 8000 0 0 NONE 0 NONE 0 0 4986764 335625 0 5322389 0 0 5322389 79836 5242553 262128 262128 2087 2087 260041 0 260041 0 260041 236805 0 236805 0 236805 260041 0 0 77429 70219 29200 302287 88914 568049 236805 0 0 0 236805 0 23236 23236 544813 0 0 0 0 0 0 54193 490620 70219 29200 302287 88914 TERESA W BORCHECK PO BOX 2149 WINTER PARK FL 32790 4078106672 INFO@HCJF.ORG CONTACT THE FOUNDATION DIRECTLY OR VISIT THE FOUNDATION'S WEBSITE AT WWW.HJCF.ORG FOR INFORMATION REGARDING FORM AND CONTENT OF APPLICATIONS. REQUESTS ARE TO BE RECEIVED BY APRIL 15 AND NOVEMBER 1 FOR CONSIDERATION AT THE SEMIANNUAL MEETINGS GRANTS ARE GENERALLY RESTRICTED TO PROGRAMS WHICH ASSIST CHILDREN AND YOUNG ADULTS IN THE AREAS OF HEALTH, EDUCATION, CULTURE, RECREATION, AND ANY OTHER PROGRAMS THAT WILL ADD TO THE BETTERMENT OF THEIR LIFE AND THEIR PARTICIPATION AS GOOD CITIZENS. GRANTS ARE GENERALLY RESTRICTED TO PROGRAMS CONDUCTED IN LAKE AND/OR SUMTER COUNTY FLORIDA. CHRISTIAN HOME AND BIBLE SCHOOL (MOUNT DORA CHRISTIAN ACADEMY 301 W 13TH AVENUE MOUNT DORA FL 32757 N/A PC 1/2 OF GRANT TO COVER COST OF A VAN FOR THE CHILDREN'S HOME 21750 CHRISTIAN HOME AND BIBLE SCHOOL (MOUNT DORA CHRISTIAN ACADEMY 301 W 13TH AVENUE MOUNT DORA FL 32757 N/A PC 1/2 OF COMMITMENT FOR SINGLE PARENT MINISTRY REHAB OF LIVING QUARTERS 25000 EASTER SEALS CAMP CHALLENGE 2010 CROSBY WAY WINTER PARK FL 32792 N/A PC CAMP CHALLENGE CAMP SCHOLARSHIPS 21000 EDUCATIONAL FOUNDATION OF LAKE COUNTY TO THE SCOTT STRONG MEMORIAL SCHOLARS 2045 PRUITT STREET LEESBURG FL 34748 N/A PC SCOTT STRONG MEMORIAL SCHOLARSHIP FUND 10000 HAVEN OF LAKE AND SUMTER COUNTY 2600 SOUTH STREET LEESBURG FL 34748 N/A PC SAFE ALTERNATIVES FOR KIDS EXPOSED TO VIOLENCE 25000 LAKE COMMUNITY ACTION AGENCY INC 501 N BAY STREET EUSTIS FL 32726 N/A PC LAKE COUNTY CHILDREN'S PROGRAM 15000 LAKE SUMTER CHILDREN'S ADVOCACY CENTER 300 S CANAL STREET LEESBURG FL 34748 N/A PC CASE MANAGER/FAMILY ADVOCATE 25000 LAKE SUMTER STATE COLLEGE 9501 US HWY 441 LEESBURG FL 34788 N/A GOV NURSING PROGRAM FUNDING 20000 RODEHEAVER FOUNDATION PO BOX 5 PALATKA FL 32178 N/A PC TUTORING PROGRAM FOR RESIDENTS 10000 SUMTER COUNTY 4-H FOUNDATION INC 2400 BART DAVIS RD ALCOLU SC 29001 N/A PC ARENA WRANGLERS WILDWOOD CHAPTER - FUNDING FOR STUDENTS THAT DON'T HAVE THE FINANCIAL MEANS 7500 180250 CAMP BOGGY CREEK 30500 BRANTLEY BRANCH RD EUSTIS FL 32736 N/A PC CAMPERSHIPS FOR LAKE & SUMTER STUDENTS 20000 CENTRAL FLORIDA BIBLE CAMP INC 23813 COUNTY 44A EUSTIS FL 32736 N/A PC RENOVATIONS TO CABIN FOR STAFF 15000 CHRISTIAN HOME AND BIBLE SCHOOL (MOUNT DORA CHRISTIAN ACADEMY 301 W 13TH AVENUE MOUNT DORA FL 32757 N/A PC 2/2 OF COMMITMENT FOR SINGLE PARENT MINISTRY REHAB OF LIVING QUARTERS 25000 EASTER SEALS CAMP CHALLENGE 2010 CROSBY WAY WINTER PARK FL 32792 N/A PC CAMP CHALLENGE CAMP SCHOLARSHIPS 25000 EDUCATIONAL FOUNDATION OF LAKE COUNTY INC 2045 PRUITT STREET LEESBURG FL 34748 N/A PC ACT READING PREPERATION COURSE 10000 LAKE CARE INC 2001 WEST OLD HIGHWAY 441 SUITE 1 MOUNT DORA FL 32757 N/A PC LAKE COUNTY FOOD BANK SERVICES 7500 LAKE SUMTER STATE COLLEGE 9501 US HWY 441 LEESBURG FL 34748 N/A GOV NURSING PROGRAM FUNDING 80000 LIFE TO THE MAX INC 1414 W MAIN STREET LEESBURG FL 34748 N/A PC STEM PROGRAM 15000 QUEST INC PO BOX 531125 ORLANDO FL 32853 N/A PC CAMPERSHIPS FOR LAKE & SUMTER STUDENTS TO CAMP THUNDERBIRD 12000 SOUTHERN SCHOLARSHIP FOUNDATION INC 322 STADIUM DR TALLAHASSEE FL 32304 N/A PC SPONSOR LAKE & SUMTER STUDENTS IN SSF HOUSING ON FLORIDA COLLEGE CAMPSUS 6000 SUMTER YOUTH CENTER PO BOX 2092 BUSHNELL FL 33513 N/A PC HOMEWORK/TUTORIAL SUMMER READING PROGRAM 31250 SUNRISE ARC INC 35201 RADIO ROAD LEESBURG FL 34788 N/A PC STUDENT PROGRAM COSTS 8000 254750 14 5715 14 97912 18 57978 LITIGATION/SETTLEMENT FEES 296 0 161901 0 161901 0 0 0 0 0 0 0 0 0 0 ACCOUNTING FEES 20500 16400 4100 CVS HELATH CORP 2.8% 7/20/20 100400 100047 ORACLE CORP 2.25% 10/08/19 74618 74908 PNC BANK NA NOTE 2.4% 10/18/19 50048 49972 US BK NATL ASSN MINNEAPOLIS 2.125% 10/28/19 100097 99868 ALPHABET INC CLA A 63652 94053 AMAZON COM INC 49759 124255 AMERICAN ELEC PWR INC 16359 37462 APPLE INC 33144 103291 ARTISTA NETWORKS INC 55836 48429 AT&T INC 18035 19418 BERKSHIRE HATHAWAY INC CLASS B NEW 43056 66136 BLACKROCK INC 47153 62334 BOOKING HLDGS INC 38965 57968 BROADCOM INC COM 32164 45295 CHEVRON CORPORATION 35124 47248 COGNIZANT TECHNOLOGY SOL CL A 24258 47376 COLGATE PALMOLIVE CO COM 40633 62658 CVS HEALTH CORP 18772 28227 DANAHER CORP DEL COM 48892 99008 DODGE & COX INTL FUND 260371 279052 EXXON MOBIL CORP 45441 44585 FISERV INC COM 13041 86547 GENERAL DYNAMICS CORP COM 17856 49050 JOHNSON & JOHNSON 35841 73444 KONTOOR BRANDS INC COM 1752 4186 LABORATORY CORP AMER HLDGS 27204 53661 LYONDELLBASEL INDUSTRIES NV 33049 27844 MARATHON PETE CORP COM 35704 26306 MICROSOFT CORP 26846 128627 NEXTERA ENERGY INC 12412 45588 ORACLE CORP COMMON 23379 42504 PRICE T ROWE GROUP INC COM 49633 73327 PRIMECAP ODYSSEY GROWTH 110000 98499 PROCTOR & GAMBLE CO COM 43642 71008 PUBLIC SERVICE ENTERPRISE GROUP COM 22359 38782 ROPER TECHNOLOGIES INC 12893 61906 TARGET CORP 19254 30571 THERMO FISHER SCIENTIFIC INC COM 20216 108127 TRAVELERS COS INC 22577 66962 UNION PAC CORP 18000 70048 UNITED TECHNOLOGIES CORP 21089 36627 US BANCORP DEL COM NEW 27252 58483 VANGUARD 500 ETF 253012 307237 VANGUARD CONSUMER DISCRETIONARY ETF 21600 25035 VANGUARD SMALL-CAP INDEX FUND 256515 336434 VERIZON COMMUNICATIONS 30526 45654 VF CORPORATION 29209 81880 VISA INC 51759 117771 WALMART INC COM 24597 48184 451253 456731 0 0 DODGE & COX INCOME FUND AT COST 200000 199422 FEDERATED ULTRASHORT INSTL BOND FUND AT COST 150000 150000 VANGUARD S/T INFLATION PROTECTED INDEX FUND AT COST 151553 154563 VANGUARD SHORT TERM BOND INDEX ADM FUND AT COST 82864 82706 LEGAL FEES 880 0 880 POSTAGE 574 574 0 MEMBERSHIP 750 750 0 INSURANCE 1281 1281 0 INTERNET EXPENSES 70 70 0 OFFICE SUPPLIES 195 195 0 WEBSITE FEES 1262 631 631 LITIGATION/SETTLEMENT FEES 296 296 0 FIDUCIARY FEES 36794 18397 18397 EXCISE TAXES 6193 0 0