SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
THE PRESBYTERIAN VILLAGE FOUNDATION
D/B/A GRAND JIVANTE FOUNDATION
Employer identification number

42-1253180
Return Reference Explanation
FORM 990-EZ, PART I, LINE 4 - OTHER INVESTMENT INCOME DESCRIPTION: DIVIDEND INCOME. AMOUNT: 10,376. DESCRIPTION: INTEREST INCOME. AMOUNT: 539. TOTAL INCLUDED ON FORM 990-EZ, LINE 4: 10,915.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: PROVIDE CHARITY CARE FOR RESIDENTS OF NURSING HOME. GRANTEE NAME: THE PRESBYTERIAN VILLAGE. GRANTEE ADDRESS: 502 BUTLER STREET ACKLEY, IA 50601. AMOUNT GIVEN: 19,807.
FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES DESCRIPTION: MEETINGS. AMOUNT: 54. DESCRIPTION: TRAVEL. AMOUNT: 17. DESCRIPTION: INSURANCE. AMOUNT: 36. TOTAL TO FORM 990-EZ, LINE 16: 107.
FORM 990-EZ, PART I, LINE 20 - OTHER CHANGES IN NET ASSETS DESCRIPTION: NET UNREALIZED GAIN ON INVESTMENTS. AMOUNT: -3,968. DESCRIPTION: CHANGE IN VALUE OF SPLIT INTEREST. AMOUNT: -3,628. TOTAL TO FORM 990-EZ, LINE 20: -7,596.
FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS DESCRIPTION: ACCOUNTS RECEIVABLES, NET. BEG. OF YEAR AMOUNT: 411. END OF YEAR AMOUNT: 386. DESCRIPTION: PREPAID EXPENSES. BEG. OF YEAR AMOUNT: 35. END OF YEAR AMOUNT: 0. DESCRIPTION: INVESTMENTS - OTHER SECURITIES. BEG. OF YEAR AMOUNT: 99,636. END OF YEAR AMOUNT: 93,593. DESCRIPTION: NOTE RECEIVABLE FROM RELATED PARTY. BEG. OF YEAR AMOUNT: 234,860. END OF YEAR AMOUNT: 234,860.
FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES DESCRIPTION: DUE TO RELATED PARTY. BEG. OF YEAR AMOUNT: 75,568. END OF YEAR AMOUNT: 56,713.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2018


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