HANS & CAY JACOBSEN CHARITABLE FOUN DATION INC: Form 990PF, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
HANS & CAY JACOBSEN CHARITABLE FOUN DATION INC (EIN 59-3010451)
Tax period
2016-06-01 to 2017-05-31
Filed
2018-01-17
IRS object ID
201810179349100606
Schema version
2016v3.0
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)
Return2018-01-17T14:29:24-05:00ReturnTs
Tax Period End2017-05-31TaxPeriodEndDt
Disaster ReliefIRC 2017-150 HURRICANE IRMA LATE FILING RELIEFDisasterReliefTxt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN590548468PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PURVIS GRAY & COMPANY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12347 SE 17TH STREETAddressLine1Txt
CityOCALACityNm
State AbbreviationFLStateAbbreviationCd
ZIP34471ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2016-06-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN593010451EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HANS AND CAY JACOBSEN CHARITABLEBusinessNameLine1Txt
Business Name Line2FOUNDATION INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlHANSBusinessNameControlTxt
Phone4078106672PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 2149AddressLine1Txt
CityWINTER PARKCityNm
State AbbreviationFLStateAbbreviationCd
ZIP32790ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTERESA W BORCHECKPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone4078106672PhoneNum
Signature2017-10-24SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMARK A WHITE CPAPreparerPersonNm
PTINP00071001PTIN
Phone3527323872PhoneNum
Preparation2017-10-24PreparationDt

Filing Security Information FilingSecurityInformation

FieldValueIRS element (for citing)
At Submission Creation Device Id7A421216F2781D0B68D6B9E8C282F61784C3F1C3AtSubmissionCreationDeviceId
At Submission Filing Device Id7A421216F2781D0B68D6B9E8C282F61784C3F1C3AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Special ConditionIRC 2017150 HURRICANE IRMA LATE FILING RELIEFSpecialConditionDesc
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$5,237,996FMVAssetsEOYAmt
Method Of Accounting OtherYes (X)MethodOfAccountingOtherInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Dividends Rev And Expnss$103,075DividendsRevAndExpnssAmt
Dividends Net Invst Incm$103,075DividendsNetInvstIncmAmt
Dividends Adj Net Incm$103,075DividendsAdjNetIncmAmt
Net Gain Sale Ast Rev And Expnss$258,559NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$1,942,182GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$258,559CapGainNetIncmNetInvstIncmAmt
Total Rev And Expnss$361,634TotalRevAndExpnssAmt
Total Net Invst Incm$361,634TotalNetInvstIncmAmt
Total Adj Net Incm$103,075TotalAdjNetIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$36,500CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$10,000CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$26,500CompOfcrDirTrstDsbrsChrtblAmt
Accounting Fees Rev And Expnss$16,500AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm$14,026AccountingFeesNetInvstIncmAmt
Accounting Fees Chrtbl Prps$2,474AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss$36,591OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$36,591OtherProfFeesNetInvstIncmAmt
Taxes Rev And Expnss$1,285TaxesRevAndExpnssAmt
Taxes Dsbrs Chrtbl$1,285TaxesDsbrsChrtblAmt
Trav Conf Meeting Rev And Expnss$5,486TravConfMeetingRevAndExpnssAmt
Trav Conf Meeting Net Invst Incm$5,485TravConfMeetingNetInvstIncmAmt
Other Expenses Rev And Expnss$4,450OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$4,450OtherExpensesNetInvstIncmAmt
Tot Opr Expenses Rev And Expnss$100,812TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$70,552TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$30,259TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$530,873ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$530,873ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$631,685TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$70,552TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$561,132TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses-$270,051ExcessRevenueOverExpensesAmt
Net Investment Income$291,082NetInvestmentIncomeAmt
Adjusted Net Income$103,075AdjustedNetIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Cash BOY$73,873CashBOYAmt
Cash EOY$9,556CashEOYAmt
Cash EOYFMV$9,556CashEOYFMVAmt
Corporate Stock BOY$2,541,400CorporateStockBOYAmt
Corporate Stock EOY$2,689,158CorporateStockEOYAmt
Corporate Stock EOYFMV$3,748,354CorporateStockEOYFMVAmt
Corporate Bonds BOY$1,841,395CorporateBondsBOYAmt
Corporate Bonds EOY$1,487,903CorporateBondsEOYAmt
Corporate Bonds EOYFMV$1,480,086CorporateBondsEOYFMVAmt
Total Assets BOY$4,456,668TotalAssetsBOYAmt
Total Assets EOY$4,186,617TotalAssetsEOYAmt
Total Assets EOYFMV$5,237,996TotalAssetsEOYFMVAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind
Unrestricted BOY$4,456,668UnrestrictedBOYAmt
Unrestricted EOY$4,186,617UnrestrictedEOYAmt
Tot Net Ast Or Fund Balances BOY$4,456,668TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$4,186,617TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$4,456,668TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$4,186,617TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$4,456,668TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses-$270,051ExcessRevenueOverExpensesAmt
Subtotal$4,186,617SubtotalAmt
Tot Net Ast Or Fund Balances EOY$4,186,617TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp

FieldValueIRS element (for citing)
PropertyPUBLICLY TRADED SECURITIESPropertyDesc
How AcquiredPHowAcquiredCd
Gross Sales Price$1,935,729GrossSalesPriceAmt
Cost Or Other Basis$1,683,623CostOrOtherBasisAmt
Gain Or Loss$252,106GainOrLossAmt
Gains Minus Excess Or Losses$252,106GainsMinusExcessOrLossesAmt
FieldValueIRS element (for citing)
Capital Gain Net Income$258,559CapitalGainNetIncomeAmt

Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp

FieldValueIRS element (for citing)
Liable Section4942 TaxfalseLiableSection4942TaxInd
Adjusted Qlfy Distri Yr1$300,751AdjustedQlfyDistriYr1Amt
Net Vl Noncharitable Assets Yr1$5,471,777NetVlNoncharitableAssetsYr1Amt
Distribution Yr10.054964DistributionYr1Rt
Adjusted Qlfy Distri Yr2$359,359AdjustedQlfyDistriYr2Amt
Net Vl Noncharitable Assets Yr2$5,994,087NetVlNoncharitableAssetsYr2Amt
Distribution Yr20.059952DistributionYr2Rt
Adjusted Qlfy Distri Yr3$363,866AdjustedQlfyDistriYr3Amt
Net Vl Noncharitable Assets Yr3$5,526,055NetVlNoncharitableAssetsYr3Amt
Distribution Yr30.065846DistributionYr3Rt
Adjusted Qlfy Distri Yr4$281,353AdjustedQlfyDistriYr4Amt
Net Vl Noncharitable Assets Yr4$5,310,615NetVlNoncharitableAssetsYr4Amt
Distribution Yr40.052979DistributionYr4Rt
Adjusted Qlfy Distri Yr5$221,179AdjustedQlfyDistriYr5Amt
Net Vl Noncharitable Assets Yr5$5,121,082NetVlNoncharitableAssetsYr5Amt
Distribution Yr50.043190DistributionYr5Rt
Total Distribution0.276931TotalDistributionRt
Average Distribution0.055386AverageDistributionRt
Net Vl Noncharitable Assets$5,235,118NetVlNoncharitableAssetsAmt
Adj Net Vl Noncharitable Assets$289,952AdjNetVlNoncharitableAssetsAmt
Net Investment Income Pct$2,911NetInvestmentIncomePctAmt
Adj Nonchrtbl Net Invst Incm Pct$292,863AdjNonchrtblNetInvstIncmPctAmt
Qualifying Distributions$561,132QualifyingDistributionsAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Domestic Org Meeting Sect4940eYes (X)DomesticOrgMeetingSect4940eInd
Investment Income Excise Tax$2,911InvestmentIncomeExciseTaxAmt
Subtotal$2,911SubtotalAmt
Tax Based On Investment Income$2,911TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$4,612EstimatedPlusOvpmtIncmTxAmt
Total Payments And Credits$4,612TotalPaymentsAndCreditsAmt
Overpayment$1,701OverpaymentAmt
Applied To ES Tax$1,701AppliedToESTaxAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political ActyfalseLegislativePoliticalActyInd
More Than100 SpentfalseMoreThan100SpentInd
Form1120 POL FiledfalseForm1120POLFiledInd
Activities Not Previously RptfalseActivitiesNotPreviouslyRptInd
Changes To Articles Or BylawsfalseChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Organization Dissolved EtcfalseOrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (true)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (true)AtLeast5000InAssetsInd
Org Report Or Register StateFLOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (true)Form990PFFiledWithAttyGenInd
Private Operating FoundationfalsePrivateOperatingFoundationInd
New Substantial ContributorsfalseNewSubstantialContributorsInd
Own Controlled EntityfalseOwnControlledEntityInd
Donor Advised FundfalseDonorAdvisedFundInd
Comply With Public Insp RqrYes (true)ComplyWithPublicInspRqrInd
Website AddressHCJF.ORGWebsiteAddressTxt

Persons With Books Name PersonsWithBooksName

FieldValueIRS element (for citing)
Business Name Line1CAPITAL CITY TRUST COMPANYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8668209671PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1549AddressLine1Txt
CityTALLAHASSEECityNm
State AbbreviationFLStateAbbreviationCd
ZIP32302ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts QuestionfalseForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified PrsnfalseSaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified PrsnfalseBrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified PrsnfalseFurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified PrsnYes (true)PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified PrsnfalseTransferAstDisqualifiedPrsnInd
Payment To Government OfficialfalsePaymentToGovernmentOfficialInd
Acts Fail To Qlfy As ExceptionsfalseActsFailToQlfyAsExceptionsInd
Undistributed Income PYfalseUndistributedIncomePYInd
Business HoldingsfalseBusinessHoldingsInd
Jeopardy InvestmentsfalseJeopardyInvestmentsInd
Uncorrected PY Jeopardy InvstfalseUncorrectedPYJeopardyInvstInd
Influence LegislationfalseInfluenceLegislationInd
Influence ElectionfalseInfluenceElectionInd
Grants To IndividualsfalseGrantsToIndividualsInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Noncharitable PurposefalseNoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
TERESA W BORCHECK
PO BOX 2149WINTER PARKFL32790PRESIDENT10.00$18,500$0$0
W THOMAS BROOKS
PO BOX 2149WINTER PARKFL32790VICE PRESIDE6.00$6,000$0$0
BRIAN BROOKS
PO BOX 2149WINTER PARKFL32790TREASURER3.00$6,000$0$0
SHANNON MCLIN CARLYLE
PO BOX 2149WINTER PARKFL32790SECRETARY3.00$6,000$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Comp Of Hghst Pd Cntrct Or NONENONECompOfHghstPdCntrctOrNONETxt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Description1N/ADescription1Txt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$5,202,799AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$112,042AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$5,314,841TotalFMVOfUnusedAssetsAmt
Adjusted Total FMV Of Unused Ast$5,314,841AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$79,723CashDeemedCharitableAmt
Net Vl Noncharitable Assets$5,235,118NetVlNoncharitableAssetsAmt
Minimum Investment Return$261,756MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$261,756MinimumInvestmentReturnAmt
Tax Based On Investment Income$2,911TaxBasedOnInvestmentIncomeAmt
Total Tax$2,911TotalTaxAmt
Distributable Before Adj$258,845DistributableBeforeAdjAmt
Distributable Before Ded$258,845DistributableBeforeDedAmt
Distributable As Adjusted$258,845DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

FieldValueIRS element (for citing)
Expenses And Contributions$561,132ExpensesAndContributionsAmt
Qualifying Distributions$561,132QualifyingDistributionsAmt
Pct Sect4940e Org Net Invst Incm$2,911PctSect4940eOrgNetInvstIncmAmt
Adjusted Qualifying Distri$558,221AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$258,845DistributableAsAdjustedAmt
Excess Distribution Cyov Yr3$77,429ExcessDistributionCyovYr3Amt
Excess Distribution Cyov Yr2$70,219ExcessDistributionCyovYr2Amt
Excess Distribution Cyov Yr1$29,200ExcessDistributionCyovYr1Amt
Total Excess Distribution Cyov$176,848TotalExcessDistributionCyovAmt
Qualifying Distributions$561,132QualifyingDistributionsAmt
Applied To Current Year$258,845AppliedToCurrentYearAmt
Remaining Distri From Corpus$302,287RemainingDistriFromCorpusAmt
Total Corpus$479,135TotalCorpusAmt
Undistributed Income CY$0UndistributedIncomeCYAmt
Excess Distri Cyov To Next Yr$479,135ExcessDistriCyovToNextYrAmt
Excess From Year3$77,429ExcessFromYear3Amt
Excess From Year2$70,219ExcessFromYear2Amt
Excess From Year1$29,200ExcessFromYear1Amt
Excess From Current Year$302,287ExcessFromCurrentYearAmt

Supplementary Information SupplementaryInformationGrp

Application Submission Info ApplicationSubmissionInfoGrp

FieldValueIRS element (for citing)
Recipient PersonTERESA BORCHECK PRESIDENTRecipientPersonNm

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 2149AddressLine1Txt
CityWINTER PARKCityNm
State AbbreviationFLStateAbbreviationCd
ZIP32790ZIPCd
FieldValueIRS element (for citing)
Recipient Phone4078106672RecipientPhoneNum
Recipient Email AddressINFO@HCJF.ORGRecipientEmailAddressTxt
Form And Info And MaterialsCONTACT THE FOUNDATION DIRECTLY OR VISIT THE FOUNDATION'S WEBSITE AT WWW.HCJF.ORG FOR INFORMATION REGARDING FORM AND CONTENT OF APPLICATIONSFormAndInfoAndMaterialsTxt
Submission DeadlinesREQUESTS ARE TO BE RECEIVED BY APRIL 15 AND NOVEMBER 1 FOR CONSIDERATION AT THE SEMIANNUAL MEETINGSSubmissionDeadlinesTxt
Restrictions On AwardsGRANTS 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.RestrictionsOnAwardsTxt

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (22 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
BEACON COLLEGE
105 EAST MAIN STREETLEESBURGFL34748GOVFENCING AROUND NEW FIELD$15,000
BOYS & GIRLS CLUB OF LAKE & SUMTER
PO BOX 8906179LEESBURGFL34789PCOPERATING EXPENSES$227,236
BOYS & GIRLS CLUB OF LAKE & SUMTER
PO BOX 8906179LEESBURGFL34789PCPROJECT LEARN - HOLIDAY AND AFTERSCH$25,000
CAMP BOGGY CREEK
30500 BRANTLY BRANCH ROADEUSTISFL32736PC20TH ANNIVERSARY - GENERAL OPERATING$10,000
CAMP BOGGY CREEK
30500 BRANTLY BRANCH ROADEUSTISFL32736PCOPERATING EXPENSES$15,000
CHRISTIAN HOME AND BIBLE SCHOOL
301 W 13TH AVENUEMOUNT DORAFL32757PCSINGLE PARENT PROGRAM$30,000
EARLY LEARNING COALITION
1300 CITIZENS BLVD SUITELEESBURGFL34748PCOPERATING EXPENSES$15,000
EASTER SEALS OF FLORIDA
31600 CAMP CHALLENGE ROADSORRENTOFL32776PCCAMP CHALLENGE$10,000
EDUCATIONAL FOUNDATION OF LAKE COUN
2045 PRUITT STREETLEESBURGFL34748PCUNLOCKED PROGRAM$10,000
EDUCATIONAL FOUNDATION OF LAKE COUN
2045 PRUITT STREETLEESBURGFL34748PCAFTER SCHOOL LAUNDRY$5,805
EDUCATIONAL FOUNDATION OF LAKE COUN
2045 PRUITT STREETLEESBURGFL34748PCROBOTICS CLUB$3,000
HAVEN OF LAKE AND SUMTER
2600 SOUTH STREETLEESBURGFL34748PCSAVE KIDS PROGRAM$25,000
LAKE CARES INC
2001 WEST OLD HWY 441 STMOUNT DORAFL32757PCSUMMER CHILDRENS FEEDING PROGRAM$2,500
LAKE COMMUNITY ACTION AGENCY
501 NORTH BAY STREETEUSTISFL32736PCSCHOOL READINESS AND VPK TO 112 CHIL$15,000
LAKE SUMTER CHILDRENS ADVOCACY
300 S CANAL STREETLEESBURGFL34748PCPURCHASE OF MEDICAL EQUIPMENT$23,232
LAKE SUMTER STATE COLLEGE
9501 US HWY 441LEESBURGFL34748GOVAMBASSADOR PROGRAM$5,600
LAKE COMMUNITY ACTION AGENCY
501 NORTH BAY STREETEUSTISFL32736PCSCHOOL READINESS AND VPK TO 72 CHILD$30,000
LEESBURG AQUATICS CLUB
PO BOX 490475LEESBURGFL34749PCTHERMAL POOL COVERS FOR VENETIAN GAR$5,500
LIFE CONCEPTS DBA QUEST INC
500 E COLONIAL DRIVEORLANDOFL32803PCCAMP THUNDERBIRD$12,000
LIFE TO THE MAX
1414 W MAIN STREETLEESBURGFL34748PCSTEM AFTERSCHOOL$15,000
SOUTHERN SCHOLARSHIP FOUNDATION
PO BOX 14406GAINESVILLEFL32604PCCOLLEGE HOUSING FOR LAKE AND SUMTER$6,000
SUMTER COUNTY YOUTH CENTER INC
PO BOX 2092BUSHNELLFL33513PCSTAFFING FOR HOMEWORK ROOMS$25,000
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$530,873TotalGrantOrContriPdDurYrAmt

Grant Or Contri Apprv For Fut GrantOrContriApprvForFutGrp (2 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
LAKE SUMTER STATE COLLEGE
9501 US HWY 441LEESBURGFL34748GOVDEAN FOR NEW BSN PROGRAM$100,000
BOYS & GIRLS CLUB OF LAKE & SUMTER
PO BOX 8906179LEESBURGFL34789PCSUMMER BRAIN GAIN$25,000
FieldValueIRS element (for citing)
Total Grant Or Contri Apprv Fut$125,000TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$103,075ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Exclusion18ExclusionCd
Exclusion$258,559ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Exclusion$361,634ExclusionAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$361,634TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EOfalseTrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EOfalseTrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of AssetsfalseSalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EOfalsePurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth AssetsfalseRentalOfFacilitiesOthAssetsInd
Reimbursement ArrangementsfalseReimbursementArrangementsInd
Loans Or Loan GuaranteesfalseLoansOrLoanGuaranteesInd
Performance Of Services EtcfalsePerformanceOfServicesEtcInd
Sharing Of Facilities EtcfalseSharingOfFacilitiesEtcInd
Relationships Nonchrtbl EOfalseRelationshipsNonchrtblEOInd

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

FieldValueIRS element (for citing)
CategoryINDIRECT ACCOUNTING FEESCategoryTxt
Amt$16,500Amt
Net Investment Income$14,026NetInvestmentIncomeAmt
Disbursements Charitable Prps$2,474DisbursementsCharitablePrpsAmt

Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule

Investments Corporate Bonds InvestmentsCorporateBondsGrp (15 entries)

BondBondNmEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
AMERICAN EXPRESS CORP 1.55% 9/22/17$100,099$100,044
AMERICAN EXPRESS CR CORP MTN MTNF 2.$99,892$100,629
CVS HEALTH CORP 2.8% 6/20/2020$100,910$102,001
FED ULTRASHORT BOND ISSUE FUND 108$150,000$149,836
GENERAL ELECTRIC 1.50% 07/12/2016
GENERAL ELECTRIC CORP 2.2% 10/18/201$99,990$101,291
IBM CORP 1.25% 2/6/2017
ISHARES CORE US AGGREGATE BOND$192,341$192,080
PNC BANK NA NOTE 2.4% 10/18/2019$50,235$50,560
STRYKER CORP NOTE 1.300% 4/01/2018$74,811$74,845
UNITED HEALTH GROUP INC 1.45% 07/17/$100,074$100,025
US BANCORP 1.95% 11/15/2018$100,424$100,551
US BK NATL ASSN MINNEAPOLIS 2.125% 1$100,476$100,868
VANGUARD INFLAT PROTECTED- IV$170,000$159,270
VANGUARD SHORT TERM BOND INDEX ADM F$148,651$148,086

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corporate Stock InvestmentsCorporateStockGrp (48 entries)

StockStockNmEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
ALLEGRAN PLC$21,958$69,363
ALPHABET INC CL A$63,652$83,903
AMAZON COM INC$53,751$74,597
AMERICAN ELEC PWR INC$16,359$31,224
APPLE INC$33,144$90,128
ARTISAN INTERNATIONAL
ATT INC$18,035$24,467
BERKSHIRE HATHAWAY INC CLASS B NEW$43,056$55,369
BLACKROCK INC$47,153$61,386
BROADCOM LIMITED$32,164$43,106
CHEVRON CORPORATION$35,124$42,944
COGNIZANT TECHNOLOGY SOL CL A$24,258$51,186
COLGATE PALMOLIVE CO COM$40,633$68,724
CVS HEALTH$18,772$41,411
DANAHER CORP DEL COM$48,892$63,705
DODGE COX INTL STOCK FUND$475,308$517,152
EXXON MOBIL CORP$45,441$50,715
FEDERATED INVESTORS INCOME CLASS B$26,915$40,504
FISERV INC COM$18,648$90,202
F5 NETWORKS INC COM$43,256$38,439
GENERAL DYNAMICS CORP COM$17,856$61,991
JOHNSON JOHNSON$35,841$71,820
LABORATORY CORP AMER HLDGS$27,204$45,870
LYONDELLBASEL INDUSTRIES$33,049$30,195
MCKESSON CORP$28,008$60,343
METLIFE INC$17,635$30,607
MICROSOFT CORP$26,846$72,634
NEXTERA ENERGY INC.$12,412$32,531
ORACLE CORP COMMON$23,379$38,128
PRICE T ROWE GROUP INC COM$49,633$51,069
PRICELINE GRP INC COM NEW$38,965$65,698
PROCTER & GAMBLE CO$43,642$60,782
PUBLIC SVC ENTERPRISE GROUP$22,359$29,641
ROPER ENTERPRISES$12,893$40,896
SCHLUMBERGER LTD$51,546$38,970
SCRIPPS NETWORKS INTERACTIVE$26,358$43,374
TARGET GROUP$19,255$20,956
THERMO FISHER SCIENTIFIC INCCOM$20,216$69,980
TRAVELERS COS INC$22,577$57,431
UNION PAC COM$18,000$46,326
UNITED TECHNOLOGIEZ CORP$21,089$35,171
US BANCORP DEL COM NEW$27,252$59,287
VANGUARD SMALL CAP INDEX$333,560$389,542
VANGUARD 500 ETF$499,776$532,008
VERIZON COMMUNICATIONS$30,526$39,178
VF CORPORATION$46,406$78,548
VISA INC$51,759$69,518
WAL MART STORES INC COM$24,597$37,335

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (5 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmt
EXPENSES
WEBSITE$1,060$1,060
POSTAGE$140$140
INSURANCE$1,250$1,250
OTHER EXPENSES$2,000$2,000

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail

FieldValueIRS element (for citing)
CategoryFIDUCIARY FEESCategoryTxt
Amt$36,591Amt
Net Investment Income$36,591NetInvestmentIncomeAmt

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail

FieldValueIRS element (for citing)
CategoryINDIRECT TAXES/LICENSESCategoryTxt
Amt$1,285Amt
Disbursements Charitable Prps$1,285DisbursementsCharitablePrpsAmt

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