DR DONALD N & JANE L BERNING: Form 990PF, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- DR DONALD N & JANE L BERNING (EIN 45-2457323)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-15
- IRS object ID
- 201803199349102740
- Schema version
- 2017v2.3
- 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
- Depreciation Schedule
- Investments Corp Stock Schedule
- Investments Land Schedule2
- Investments Other Schedule2
- Legal Fees Schedule
- Other Expenses Schedule
- Other Income Schedule2
- Other Liabilities Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-15T13:03:20-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Foundation Source | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Hollow Ln Ste 212 | AddressLine1Txt |
| City | Lake Success | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 11042 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 452457323 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Dr Donald N & Jane L Berning Private | BusinessNameLine1Txt |
| Business Name Line2 | Foundation | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % Foundation Source | InCareOfNm |
| Business Name Control | DRDO | BusinessNameControlTxt |
| Phone | 8008391754 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Foundation Source 501 Silverside Rd | AddressLine1Txt |
| City | Wilmington | CityNm |
| State Abbreviation | DE | StateAbbreviationCd |
| ZIP | 198091377 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RONALD JACK TSENSON | PersonNm |
| Person Title | president | PersonTitleTxt |
| Phone | 8008391754 | PhoneNum |
| Signature | 2018-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Jeffrey D Haskell | PreparerPersonNm |
| PTIN | P01345770 | PTIN |
| Phone | 8008391754 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 24.187.244.114 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 06391520183195000045 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2018-11-15 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | A03CA8425FE017993163D7917FD3F5FFAC126974 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 259C731B7C7CCB55DA46458F0098BC0D5A2501CB | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $8,839,615 | FMVAssetsEOYAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $0 | ContriRcvdRevAndExpnssAmt |
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Interest On Sav Rev And Expnss | $1,206 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $1,206 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $1,546 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $1,546 | DividendsNetInvstIncmAmt |
| Gross Rents Rev And Expnss | $13,200 | GrossRentsRevAndExpnssAmt |
| Gross Rents Net Invst Incm | $13,200 | GrossRentsNetInvstIncmAmt |
| Net Rental Income Or Loss | -$7,894 | NetRentalIncomeOrLossAmt |
| Net Gain Sale Ast Rev And Expnss | -$2,973 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $69,334 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $0 | CapGainNetIncmNetInvstIncmAmt |
| Other Income Rev And Expnss | $284,082 | OtherIncomeRevAndExpnssAmt |
| Other Income Net Invst Incm | $272,911 | OtherIncomeNetInvstIncmAmt |
| Total Rev And Expnss | $297,061 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $288,863 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $101,000 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $101,000 | CompOfcrDirTrstDsbrsChrtblAmt |
| Pension Empl Bnft Rev And Expnss | $9,664 | PensionEmplBnftRevAndExpnssAmt |
| Pension Empl Bnft Dsbrs Chrtbl | $9,664 | PensionEmplBnftDsbrsChrtblAmt |
| Legal Fees Rev And Expnss | $2,100 | LegalFeesRevAndExpnssAmt |
| Legal Fees Net Invst Incm | $0 | LegalFeesNetInvstIncmAmt |
| Legal Fees Adj Net Incm | $0 | LegalFeesAdjNetIncmAmt |
| Legal Fees Dsbrs Chrtbl | $2,100 | LegalFeesDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $1,850 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $0 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Adj Net Incm | $0 | AccountingFeesAdjNetIncmAmt |
| Accounting Fees Chrtbl Prps | $1,850 | AccountingFeesChrtblPrpsAmt |
| Taxes Rev And Expnss | $4,990 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $3,690 | TaxesNetInvstIncmAmt |
| Deprec And Dpltn Rev And Expnss | $6,909 | DeprecAndDpltnRevAndExpnssAmt |
| Deprec And Dpltn Net Invst Incm | $6,909 | DeprecAndDpltnNetInvstIncmAmt |
| Deprec And Dpltn Adj Net Incm | $0 | DeprecAndDpltnAdjNetIncmAmt |
| Other Expenses Rev And Expnss | $54,224 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $10,540 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $43,684 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $180,737 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $21,139 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $0 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $158,298 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $309,180 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $309,180 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $489,917 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $21,139 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $0 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $467,478 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$192,856 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $267,724 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $97,513 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $393,981 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $393,981 | SavAndTempCashInvstEOYFMVAmt |
| Corporate Stock BOY | $208,258 | CorporateStockBOYAmt |
| Corporate Stock EOY | $135,951 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $81,658 | CorporateStockEOYFMVAmt |
| Invst Land Cost Or Other Basis | $225,000 | InvstLandCostOrOtherBasisAmt |
| Invst Land Accum Depreciation | $34,545 | InvstLandAccumDepreciationAmt |
| Land Bldg Investments BOY | $197,364 | LandBldgInvestmentsBOYAmt |
| Land Bldg Investments EOY | $190,455 | LandBldgInvestmentsEOYAmt |
| Land Bldg Investments EOYFMV | $225,000 | LandBldgInvestmentsEOYFMVAmt |
| Other Investments BOY | $9,592,168 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $9,188,132 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $8,138,976 | OtherInvestmentsEOYFMVAmt |
| Total Assets BOY | $10,095,303 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,908,519 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $8,839,615 | TotalAssetsEOYFMVAmt |
| Other Liabilities EOY | $6,072 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,072 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
| Retained Earning BOY | $10,095,303 | RetainedEarningBOYAmt |
| Retained Earning EOY | $9,902,447 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $10,095,303 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $9,902,447 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $10,095,303 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $9,908,519 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $10,095,303 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$192,856 | ExcessRevenueOverExpensesAmt |
| Subtotal | $9,902,447 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | $9,902,447 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Property | Publicly-traded Securities | PropertyDesc |
| Gross Sales Price | $69,334 | GrossSalesPriceAmt |
| Cost Or Other Basis | $70,434 | CostOrOtherBasisAmt |
| Gain Or Loss | -$1,100 | GainOrLossAmt |
| Gains Minus Excess Or Losses | -$1,100 | GainsMinusExcessOrLossesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | -$1,100 | CapitalGainNetIncomeAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | false | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $465,928 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $8,646,376 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 0.053887 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $460,551 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $9,297,635 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 0.049534 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $163,388 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $9,392,545 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 0.017395 | DistributionYr3Rt |
| Adjusted Qlfy Distri Yr4 | $214,660 | AdjustedQlfyDistriYr4Amt |
| Net Vl Noncharitable Assets Yr4 | $9,390,695 | NetVlNoncharitableAssetsYr4Amt |
| Distribution Yr4 | 0.022859 | DistributionYr4Rt |
| Adjusted Qlfy Distri Yr5 | $349,522 | AdjustedQlfyDistriYr5Amt |
| Net Vl Noncharitable Assets Yr5 | $5,550,398 | NetVlNoncharitableAssetsYr5Amt |
| Distribution Yr5 | 0.062972 | DistributionYr5Rt |
| Total Distribution | 0.206647 | TotalDistributionRt |
| Average Distribution | 0.041329 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $8,460,894 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $349,680 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $2,677 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $352,357 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $467,478 | QualifyingDistributionsAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Domestic Org Meeting Sect4940e | Yes (X) | DomesticOrgMeetingSect4940eInd |
| Investment Income Excise Tax | $2,677 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $2,677 | SubtotalAmt |
| Tax Based On Investment Income | $2,677 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $1,493 | EstimatedPlusOvpmtIncmTxAmt |
| Extsn Request Income Tax Paid | $225 | ExtsnRequestIncomeTaxPaidAmt |
| Total Payments And Credits | $1,718 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Es Penalty | $7 | EsPenaltyAmt |
| Tax Due | $966 | TaxDueAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | false | LegislativePoliticalActyInd |
| More Than100 Spent | false | MoreThan100SpentInd |
| Form1120 POL Filed | false | Form1120POLFiledInd |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (true) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (true) | AtLeast5000InAssetsInd |
| Org Report Or Register State | DE | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (true) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | false | PrivateOperatingFoundationInd |
| New Substantial Contributors | false | NewSubstantialContributorsInd |
| Own Controlled Entity | false | OwnControlledEntityInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (true) | ComplyWithPublicInspRqrInd |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Foundation Source | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8008391754 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 Silverside Road Suite 123 | AddressLine1Txt |
| City | Wilmington | CityNm |
| State Abbreviation | DE | StateAbbreviationCd |
| ZIP | 198091377 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | false | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | false | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | false | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | false | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | Yes (true) | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | false | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | false | PaymentToGovernmentOfficialInd |
| Acts Fail To Qlfy As Exceptions | false | ActsFailToQlfyAsExceptionsInd |
| Uncorrected Prior Acts | false | UncorrectedPriorActsInd |
| Undistributed Income PY | false | UndistributedIncomePYInd |
| Business Holdings | false | BusinessHoldingsInd |
| Jeopardy Investments | false | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | false | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | false | InfluenceLegislationInd |
| Influence Election | false | InfluenceElectionInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Noncharitable Purpose | false | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (2 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 |
|---|---|---|---|---|---|---|---|---|
| Faith Benson | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Sec | 1.0 | $0 | $0 | $0 |
| Jack Benson | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir, Pres | 1.0 | $101,000 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Summary Of Direct Chrtbl Acty | SummaryOfDirectChrtblActyGrp | |
| Sum Of Program Related Invst | SumOfProgramRelatedInvstGrp |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $95,034 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $241,603 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $8,253,103 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $8,589,740 | TotalFMVOfUnusedAssetsAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $8,589,740 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $128,846 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $8,460,894 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $423,045 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $423,045 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $2,677 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $2,677 | TotalTaxAmt |
| Distributable Before Adj | $420,368 | DistributableBeforeAdjAmt |
| Distributable Before Ded | $420,368 | DistributableBeforeDedAmt |
| Distributable As Adjusted | $420,368 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $467,478 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Charitable Assets Acquis Paid | $0 | CharitableAssetsAcquisPaidAmt |
| Set Aside Suitability Test | $0 | SetAsideSuitabilityTestAmt |
| Set Aside Cash Distri Test | $0 | SetAsideCashDistriTestAmt |
| Qualifying Distributions | $467,478 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $2,677 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $464,801 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $420,368 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $420,634 | UndistributedIncomePYAmt |
| Prior Year1 | 2015 | PriorYear1Yr |
| Prior Year2 | 2014 | PriorYear2Yr |
| Prior Year3 | 2013 | PriorYear3Yr |
| Qualifying Distributions | $467,478 | QualifyingDistributionsAmt |
| Applied To Year1 | $420,634 | AppliedToYear1Amt |
| Applied To Current Year | $46,844 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $0 | RemainingDistriFromCorpusAmt |
| Total Corpus | $0 | TotalCorpusAmt |
| Undistributed Income CY | $373,524 | UndistributedIncomeCYAmt |
| Excess Distri Cyov To Next Yr | $0 | ExcessDistriCyovToNextYrAmt |
| Excess From Current Year | $0 | ExcessFromCurrentYearAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Private Operating Foundations | PrivateOperatingFoundationsGrp |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | NONE | ContributingManagerNm |
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (8 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| GO PANTRY CORPORATION | |||||||
| 2137 WYNDHAM WAY | UNION | KY | 41091 | N/A | PC | General & Unrestricted | $15,000 |
| NORTHERN KENTUCKY AREA DEVELOPMENT DISTRICT | |||||||
| 22 SPIRAL DR | FLORENCE | KY | 41042 | N/A | PC | Meals on Wheels Program | $100,000 |
| NORTHERN KENTUCKY SPORTS CLUB | |||||||
| 11029 PELPHRY LN | WALTON | KY | 41094 | N/A | PC | 14U Division | $7,500 |
| NORTHERN KENTUCKY SPORTS CLUB | |||||||
| 11029 PELPHRY LN | WALTON | KY | 41094 | N/A | PC | 2018 15U Division | $20,000 |
| PADDLING FOR CANCER AWARENESS INC | |||||||
| PO BOX 76213 | HIGHLAND HGTS | KY | 41076 | N/A | PC | General & Unrestricted | $15,000 |
| ST XAVIER HIGH SCHOOL | |||||||
| 600 W N BEND RD | CINCINNATI | OH | 45224 | N/A | PC | General & Unrestricted | $100,000 |
| ST XAVIER HIGH SCHOOL | |||||||
| 600 W N BEND RD | CINCINNATI | OH | 45224 | N/A | PC | General Scholarship Fund | $50,000 |
| SUNRISE CHILDRENS SERVICES | |||||||
| PO BOX 1429 | MT WASHINGTON | KY | 40047 | N/A | PC | General & Unrestricted | $1,680 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $309,180 | TotalGrantOrContriPdDurYrAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees Contracts From Govt Ag | FeesContractsFromGovtAgGrp | |
| Membership Dues And Assmnt | MembershipDuesAndAssmntGrp |
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $1,206 | ExclusionAmt |
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $1,546 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Rntl Incm Re Debt Fincd Prop | NetRntlIncmReDebtFincdPropGrp |
Net Rntl Incm Re Not Debt Fincd Prop NetRntlIncmReNotDebtFincdProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 16 | ExclusionCd |
| Exclusion | -$7,894 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Rental Income Personal Prop | NetRentalIncomePersonalPropGrp | |
| Other Investment Incm Part VII | OtherInvestmentIncmPartVIIGrp |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | -$2,973 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Income Loss From Special Evt | NetIncomeLossFromSpecialEvtGrp | |
| Gross Profit Loss Sls Of Invntry | GrossProfitLossSlsOfInvntryGrp |
Other Revenue Described OtherRevenueDescribedGrp (2 entries)
| DescDesc | ExclusionExclusionCd | ExclusionExclusionAmt |
|---|---|---|
| NET INCOME FROM ANNUITIES | 14 | $272,911 |
| INCOME FROM LIFE INSURANCE POLICIES | 14 | $11,171 |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $275,967 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $275,967 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | false | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | false | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | false | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | false | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | false | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | false | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | false | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | false | RelationshipsNonchrtblEOInd |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | General Consultations | CategoryTxt |
| Amt | $1,850 | Amt |
| Disbursements Charitable Prps | $1,850 | DisbursementsCharitablePrpsAmt |
Depreciation Schedule DepreciationSchedule
Depreciation Property DepreciationPropertyGrp (2 entries)
| PropertyPropertyDesc | AcquiredAcquiredDt | Cost Or Other BasisCostOrOtherBasisAmt | Prior Year DepreciationPriorYearDepreciationAmt | Computation MethodComputationMethodTxt | LifeLifeRt | Current Year ExpenseCurrentYearExpenseAmt | Net Investment IncomeNetInvestmentIncomeAmt | Adjusted Net IncomeAdjustedNetIncomeAmt |
|---|---|---|---|---|---|---|---|---|
| BLDG-1 SUNNYMEADE | 2012-12-31 | $190,000 | $27,636 | SL | 27 | $6,909 | $6,909 | $0 |
| LAND-1 SUNNYMEADE | 2012-12-31 | $35,000 | L |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp (10 entries)
| StockStockNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| BORG WARNER INC | $18,719 | $15,327 |
| CLEAN ENERGY FUELS CORP | $17,609 | $4,060 |
| CONOCOPHILLIPS | $23,859 | $19,211 |
| GENERAL MOTORS COMPANY WARRANT | $1,050 | $2,223 |
| GENERAL MOTORS NOTE 7.25% 2/15 | ||
| GILEAD SCIENCES INC | $12,280 | $7,164 |
| KINDER MORGAN INC | $21,458 | $9,035 |
| MOTORS LIQ CO GUC TR UBI | $306 | $234 |
| POLARIS INDUSTRIES | $15,236 | $12,399 |
| TWITTER INC | $25,434 | $12,005 |
Investments Land Schedule2 InvestmentsLandSchedule2
Investment Land InvestmentLandGrp (2 entries)
| Category Or ItemCategoryOrItemTxt | Cost Or Other BasisCostOrOtherBasisAmt | Accumulated DepreciationAccumulatedDepreciationAmt | Book ValueBookValueAmt |
|---|---|---|---|
| BLDG-1 SUNNYMEADE | $190,000 | $34,545 | $155,455 |
| LAND-1 SUNNYMEADE | $35,000 | $35,000 |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (15 entries)
| Category Or ItemCategoryOrItemTxt | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| AMERICO FINANCIAL - #0057535 | $386,413 | $362,337 |
| AMERICO FINANCIAL - #0059225 | $746,209 | $657,830 |
| ASSURITY LIFE INSURANCE CO - P | $301,000 | $246,314 |
| EQUITRUST #581L | $318,738 | $305,988 |
| AMERICAN NATIONAL DEFERRED | $700,000 | $655,598 |
| ATHENE #148688 | $724,125 | $631,243 |
| AMERICO FINANCIAL - #0060947 | $783,625 | $697,424 |
| ATHENE #138443 | $713,570 | $645,146 |
| EQUITRUST LIFE #642F | $732,409 | $594,065 |
| FIDELITY #1745 | $680,066 | $595,057 |
| FIDELITY #3224 | $893,205 | $788,253 |
| JACKSON NATIONAL #7419 | $374,487 | $374,487 |
| NATIONAL WESTERN LIFE #3591 | $663,445 | $595,948 |
| NATIONAL WESTERN LIFE #9169 | $920,840 | $770,536 |
| NATIONAL WESTERN LIFE #2588 | $250,000 | $218,750 |
Legal Fees Schedule LegalFeesSchedule
Legal Fees LegalFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | General Consultations | CategoryTxt |
| Legal Fees | $2,100 | LegalFeesAmt |
| Disbursements Charitable Prps | $2,100 | DisbursementsCharitablePrpsAmt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (6 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|---|
| Administrative Fees | $43,327 | $43,327 | |
| Bank Charges | $45 | $45 | |
| Payroll Processing Fees | $332 | $332 | |
| Property insurance | $4,713 | $4,713 | |
| PROPERTY MAINTENANCE/EXPENSES | $5,782 | $5,782 | |
| State or Local Filing Fees | $25 | $25 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail (2 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|
| Net income from annuities | $272,911 | $272,911 |
| income from life insurance policies | $11,171 |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PAYROLL TAXES/BENEFIT WITHHELD | Desc |
| EOY Book Value | $6,072 | EOYBookValueAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|
| 990-PF Estimated Tax for 2017 | $1,300 | |
| Property Taxes | $3,690 | $3,690 |
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