efile Public Visual Render
ObjectId: 202211339349103191 - Submission: 2022-05-13
TIN: 95-4830299
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0047
20
21
Open to Public Inspection
For calendar year 2021, or tax year beginning
01-01-2021
, and ending
12-31-2021
Name of foundation
THE JULIA STEARNS DOCKWEILER CHARITABLE
FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 3819
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
SAN DIMAS
,
CA
91773
A Employer identification number
95-4830299
B
Telephone number (see instructions)
(909) 851-4407
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
10,195,511
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
224,029
224,029
224,029
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
574,349
b
Gross sales price for all assets on line 6a
2,680,190
7
Capital gain net income (from Part IV, line 2)
...
574,349
8
Net short-term capital gain
.........
32,085
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
Total.
Add lines 1 through 11
........
798,378
798,378
256,114
13
Compensation of officers, directors, trustees, etc.
118,000
35,400
82,600
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
15,857
15,857
b
Accounting fees (attach schedule)
.......
5,150
5,150
c
Other professional fees (attach schedule)
....
66,595
66,595
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
17,093
17,018
75
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
432
259
173
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
9,493
5,695
3,798
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
232,620
124,967
107,653
25
Contributions, gifts, grants paid
.......
294,750
294,750
26
Total expenses and disbursements.
Add lines 24 and 25
527,370
124,967
402,403
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
271,008
b
Net investment income
(if negative, enter -0-)
673,411
c
Adjusted net income
(if negative, enter -0-)
...
256,114
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2021)
Page 2
Form 990-PF (2021)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
94,788
35,858
35,858
2
Savings and temporary cash investments
.........
21,138
27,722
27,722
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
430,675
425,307
431,708
b
Investments—corporate stock (attach schedule)
.......
2,708,525
2,856,964
6,785,627
c
Investments—corporate bonds (attach schedule)
.......
2,374,469
2,402,891
2,379,130
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
354,486
477,393
535,466
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
5,984,081
6,226,135
10,195,511
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
7,095,502
7,095,502
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
-1,111,421
-869,367
29
Total net assets or fund balances
(see instructions)
.....
5,984,081
6,226,135
30
Total liabilities and net assets/fund balances
(see instructions)
.
5,984,081
6,226,135
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return)
...............
1
5,984,081
2
Enter amount from Part I, line 27a
.....................
2
271,008
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
6,255,089
5
Decreases not included in line 2 (itemize)
5
28,954
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
6,226,135
Form
990-PF
(2021)
Page 3
Form 990-PF (2021)
Page
3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a)
List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1 a
SCHWAB CG PASS DISTRIBUTIONS
P
2000-01-01
2021-12-31
b
PER CHARLES SCHWAB STATEMENTS
P
2021-12-01
2021-12-31
c
PER CHARLES SCHWAB STATEMENTS
P
2000-01-01
2021-12-31
d
PER CHARLES SCHWAB STATEMENTS
P
2000-01-01
2021-12-31
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
803
803
b
1,055,428
1,023,343
32,085
c
1,255,443
1,000,840
254,603
d
368,516
81,658
286,858
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
803
b
32,085
c
254,603
d
286,858
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
574,349
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
32,085
Form
990-PF
(2021)
Page 4
Form 990-PF (2021)
Page
4
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a
Exempt operating foundations described in section 4940(d)(2), check here
and enter “N/A" on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
b
All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
3
Add lines 1 and 2
...........................
3
9,360
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
9,360
6
Credits/Payments:
a
2021 estimated tax payments and 2020 overpayment credited to 2021
6a
10,800
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
10,800
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
1,440
11
Enter the amount of line 10 to be:
Credited to 2022 estimated tax
1,440
Refunded
11
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
.........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XIV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
CA
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
If "Yes," complete Part XIII
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2021)
Page 5
Form 990-PF (2021)
Page
5
Part VI-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
LINDA NELSON CPA
Telephone no.
(909) 851-4407
Located at
PO BOX 3819
SAN DIMAS
CA
ZIP+4
91773
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VI-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
...........
1a(1)
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
..............................
1a(2)
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
...........
1a(3)
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
............
1a(4)
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
......................
1a(5)
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
...............
1a(6)
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
..........
1b
No
c
Organizations relying on a current notice regarding disaster assistance check here
........
d
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2021?
.............
1d
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2021, did the foundation have any undistributed income (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2021?
....................
2a
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
..............................
3a
No
b
If "Yes," did it have excess business holdings in 2021 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2021.)
.....................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021?
..
4b
No
Form
990-PF
(2021)
Page 6
Form 990-PF (2021)
Page
6
Part VI-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
..........
5a(1)
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
....................
5a(2)
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
.............
5a(3)
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
........................
5a(4)
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.............
5a(5)
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
........
5b
c
Organizations relying on a current notice regarding disaster assistance check
.........
d
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
.................
5d
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.............................
6a
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
7a
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
.....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.........................
8
No
Part VII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
CARYL CRAHAN
Trustee
1.00
16,000
830 WOODLAND DRIVE
SANTA BARBARA
,
CA
93108
C QUINN BRADY JR
Managing Truste
1.00
24,000
48-537 VISTA PALOMINO
LA QUINTA
,
CA
92253
BETTY BRADY
Trustee
1.00
16,000
48-537 VISTA PALOMINO
LA QUINTA
,
CA
92253
CHRISTIE CRAHAN
Trustee
1.00
16,000
3105 SPARR BLVD
GLENDALE
,
CA
91208
LINDA NELSON
SEC/ TREASURER
5.00
30,000
PO BOX 3819
SAN DIMAS
,
CA
91773
HILARY CRAHAN
Trustee
1.00
16,000
C/O PO BOX 3819
SAN DIMAS
,
CA
91773
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
Form
990-PF
(2021)
Page 7
Form 990-PF (2021)
Page
7
Part VII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
Part VIII-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part VIII-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2021)
Page 8
Form 990-PF (2021)
Page
8
Part IX
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
9,265,075
b
Average of monthly cash balances
.......................
1b
56,106
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
9,321,181
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
3
Subtract line 2 from line 1d
.........................
3
9,321,181
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions)
.............................
4
139,818
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3.
............
5
9,181,363
6
Minimum investment return.
Enter 5% (0.05) of line 5
................
6
459,068
Part X
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part IX, line 6
..................
1
459,068
2a
Tax on investment income for 2021 from Part V, line 5
.......
2a
9,360
b
Income tax for 2021. (This does not include the tax from Part V.)
...
2b
c
Add lines 2a and 2b
............................
2c
9,360
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
449,708
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
449,708
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1
...
7
449,708
Part XI
Qualifying Distributions
(see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26
..........
1a
402,403
b
Program-related investments—total from Part VIII-B
..................
1b
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part XII, line 4.
4
402,403
Form
990-PF
(2021)
Page 9
Form 990-PF (2021)
Page
9
Part XII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2020
(c)
2020
(d)
2021
1
Distributable amount for 2021 from Part X, line 7
449,708
2
Undistributed income, if any, as of the end of 2021:
a
Enter amount for 2020 only
.......
289,236
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2021:
a
From 2016
......
b
From 2017
......
c
From 2018
......
d
From 2019
......
e
From 2020
......
f
Total
of lines 3a through e
........
4
Qualifying distributions for 2021 from Part
XI, line 4:
$
402,403
a
Applied to 2020, but not more than line 2a
289,236
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2021 distributable amount
.....
113,167
e
Remaining amount distributed out of corpus
5
Excess distributions carryover applied to 2021.
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
e
Undistributed income for 2019. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
f
Undistributed income for 2021. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2022
..........
336,541
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
8
Excess distributions carryover from 2016 not
applied on line 5 or line 7 (see instructions)
...
9
Excess distributions carryover to 2022.
Subtract lines 7 and 8 from line 6a
......
10
Analysis of line 9:
a
Excess from 2017
....
b
Excess from 2018
....
c
Excess from 2019
....
d
Excess from 2020
....
e
Excess from 2021
....
Form
990-PF
(2021)
Page 10
Form 990-PF (2021)
Page
10
Part XIII
Private Operating Foundations
(see instructions and Part VI-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2021, enter the date of the ruling
......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part IX for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2021
(b)
2020
(c)
2019
(d)
2018
b
85% (0.85) of line 2a
.........
c
Qualifying distributions from Part XI,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part IX, line 6 for each year listed
..
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XIV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2021)
Page 11
Form 990-PF (2021)
Page
11
Part XIV
Supplementary Information
(continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
BLESSED SACRAMENT SCHOOL
6657 W SUNSET BLVD
HOLLYWOOD
,
CA
90028
NONE
NC
EDUCATIONAL- GENERAL FUND
750
BRAILLE INSTITUTE OF AMERICA INC
741 N VERMONT AVE
LOS ANGELES
,
CA
90029
NONE
NC
NEW CONSTRUCTION
15,000
CAMBRIDGE IN AMERICA
1120 AVENUE OF THE AMERICAS 17TH F
NEW YORK
,
NY
10036
NONE
NC
RECRUITING WOMEN FROM THE US FOR PHD PROGRAMS
1,000
CLAREMONT INSTITUTE FOR THE STUDY O
1317 W FOOTHILL BLVD SUITE 120
UPLAND
,
CA
91786
NONE
NC
EDUCATIONAL FELLOWSHIP FOR YOUNG LEADERS
5,000
DIRECT RELIEF
6100 WALLACE BECKNELL ROAD
SANTA BARBARA
,
CA
93117
NONE
NC
DIRECT RELIEF- DOMESTIC AND INTERNATIONAL PROGRAMS
10,000
EXCEPTIONAL MINDS
13400 RIVERSIDE DRIVE SUITE 211
SHERMAN OAKS
,
CA
91423
NONE
NC
APPRENTICESHIP PROGRAM
10,000
FREEDOM ALLIANCE
22570 MARKEY COURT SUITE 240
DULLES
,
VA
20166
NONE
NC
SCHOLARSHIPS IN SOUTHERN CA AREA
10,000
GUIDE DOGS FOR THE BLIND
350 LOS RANCHITOS ROAD
SAN RAFAEL
,
CA
94915
NONE
NC
VETERINARIAN CARE FOR GUIDE DOGS
5,000
HILLSDALE COLLEGE
33 EAST COLLEGE STREET
HILLSDALE
,
MI
49242
NONE
NC
FOR PROGRAMS- "THE CONSTITUTION 101", THE WRITINGS OF JANE AUSTEN, AND OTHER ONLINE COURSES.
2,000
HOMEBOY INDUSTRIES
130 WEST BRUNO STREET
LOS ANGELES
,
CA
90012
NONE
NC
TATTOO REMOVAL PROGRAM
5,000
HOSPITALLER FOUNDATION OF CALIFORNI
2468 SOUTH ST ANDREWS PLACE
LOS ANGELES
,
CA
90018
NONE
NC
FOR SUPPORT AND CARE OF ALZHEIMER'S PATIENTS.
5,000
LOS ANGELES ORPHANAGE GUILD
149 S BARRINGTON AVE SUITE 332
LOS ANGELES
,
CA
90049
NONE
NC
UNRESTRICTED GIFT FOR GENERAL OPERATIONS
3,000
LOS ANGELES PHILHARMONIC YOLA
151 S GRAND AVE
LOS ANGELES
,
CA
90012
NONE
NC
UNRESTRICTED GIFT FOR GENERAL OPERATIONS
10,000
LAS MADRINAS
625 MAGNOLIA AVE
PASADENA
,
CA
91106
NONE
NC
ENDOWMENT FOR CHIEF OF NEUROLOGY CHAIR AT CHILDREN'S HOSPITAL LOS ANGELES
35,000
LOYOLA MARYMOUNT UNIVERSITY
1 LMU DRIVE
LOS ANGELES
,
CA
90045
NONE
NC
FOR PRESERVATION OF THE ART AND LITERATURE ARCHIVES
1,000
LOYOLA MARYMOUNT UNIVERSITY
1 LMU DRIVE
LOS ANGELES
,
CA
90045
NONE
NC
FOR SUPPORT OF THE HENRY DOCKWEILER HISTORY MEDAL
5,000
LOYOLA HIGH SCHOOL
1901 VENICE BLVD
LOS ANGELES
,
CA
90006
NONE
NC
FOR DOCKWEILER SCHOLARSHIP ENDOWMENT FUND
10,000
MARYMOUNT HIGH SCHOOL
10643 SUNSET BLVD
LOS ANGELES
,
CA
90077
NONE
NC
FOR SCHOLARSHIP FUND
10,000
MUSIC ACADEMY OF THE WEST
1070 FAIRWAY ROAD
SANTA BARBARA
,
CA
93108
NONE
NC
RESTRICTED GRANT FOR THE COLLABORATIVE PIANO STUDIO, SCHOLARSHIP AND OTHER PROGRAMS
25,000
RONALD REAGAN PRESIDENTIAL FOUNDATI
40 PRESIDENTIAL DRIVE
SIMI VALLEY
,
CA
93065
NONE
NC
FOR EDUCATIONAL AND SPEAKER PROGRAMS
5,000
SEE INTERNATIONAL
175 CREMONA DRIVE SUITE 100
SANTA BARBARA
,
CA
93117
NONE
NC
FOR PURCHASE OF MEDICL SUPPLIES AND EQUIPMENT
10,000
SISTERS SERVANTS OF MARY MINISTERS
2131 WEST 27TH STREET
LOS ANGELES
,
CA
90018
NONE
NC
UNRESTRICTED GRANT FOR GENERAL OPERATIONS
10,000
USC CARUSO CATHOLIC CENTER
844 32ND STREET
LOS ANGELES
,
CA
90007
NONE
NC
UNRESTRICTED GRANT FOR GENERAL OPERATIONS
10,000
USC LIBRARIES
UNIVERSITY PARK CAMPUS USC DML 100
LOS ANGELES
,
CA
90089
NONE
NC
FOR THE PRESERVATION OF MEMORABILIA OF THE FIRST CENTIRY FAMILIES OF LOS ANGELES
1,000
USC NORRIS COMPREHENSIVE CANCER CEN
1441 EASTLAKE AVE SUITE 8302
LOS ANGELES
,
CA
90089
NONE
NC
IN SUPPORT OF CANCER RESEARCH
25,000
VERBUM DEI HIGH SCHOOL
11100 SOUTH CENTRAL AVENUE
LOS ANGELES
,
CA
90059
NONE
NC
FOR ENDOWMENT SCHOLARSHIP FUND
25,000
VINCENTIAN FATHERS AND BROTHERS
13663 RIDER TRAIL NORTH
EARTH CITY
,
MO
63045
NONE
NC
IN SUPPORT OF VINCENTIAN SEMINARIANS
12,500
MUSIC CENTER FOUNDERS
200 N SPRING STREET
LOS ANGELES
,
CA
90012
NONE
NC
ASSISTANCE FOR THE INDEPENDENCE PROGRAM
1,000
YOUNG AMERICAN'S FOUNDATION
217 STATE STREET
SANTA BARBARA
,
CA
93101
NONE
NC
FOR EDUCATIONAL PROGRAMS AND THE REAGAN RANCH ROUNDTABLE
15,000
LA PHILHARMONIC YOUNG COMPOSERS
151 S GRAND AVE
LOS ANGELES
,
CA
90012
NC
UNRESTRICTED GRANT FOR GENERAL OPERATIONS
5,000
BROTHERS HELPERS INC
215 FOOTHILL BLVD
LA CANADA FLINTRIDGE
,
CA
91011
NC
UNRESTRICTED GRANT FOR GENERAL OPERATIONS
7,500
Total
.................................
3a
294,750
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2021)
Page 12
Form 990-PF (2021)
Page
12
Part XV-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
224,029
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than
inventory
............
574,349
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
224,029
574,349
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
798,378
(See worksheet in line 13 instructions to verify calculations.)
Part XV-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
Form
990-PF
(2021)
Page 13
Form 990-PF (2021)
Page
13
Part XVI
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
1
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Yes
No
a
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1)
Cash
...................................
1a(1)
No
(2)
Other assets
.................................
1a(2)
No
b
Other transactions:
(1)
Sales of assets to a noncharitable exempt organization
....................
1b(1)
No
(2)
Purchases of assets from a noncharitable exempt organization
..................
1b(2)
No
(3)
Rental of facilities, equipment, or other assets
.......................
1b(3)
No
(4)
Reimbursement arrangements
...........................
1b(4)
No
(5)
Loans or loan guarantees
.............................
1b(5)
No
(6)
Performance of services or membership or fundraising solicitations
................
1b(6)
No
c
Sharing of facilities, equipment, mailing lists, other assets, or paid employees
..............
1c
No
d
If the answer to any of the above is "Yes," complete the following schedule. Column
(b)
should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column
(d)
the value of the goods, other assets, or services received.
(a)
Line No.
(b)
Amount involved
(c)
Name of noncharitable exempt organization
(d)
Description of transfers, transactions, and sharing arrangements
2a
Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) (other than section 501(c)(3)) or in section 527?
...........
Yes
No
b
If "Yes," complete the following schedule.
(a)
Name of organization
(b)
Type of organization
(c)
Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
2022-05-05
May the IRS discuss this return
with the preparer shown below?
See instructions.
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Daniel B Blomberg
Preparer's Signature
Date
Check if self-
employed
PTIN
P00640043
Firm's name
Daniel B Blomberg Inc
Firm's EIN
47-1371717
Firm's address
216 N Glendora Ave Suite 207
Glendora
,
CA
91741
Phone no.
(626) 610-4350
Form
990-PF
(2021)
Additional Data
Software ID:
21013475
Software Version:
2021v4.0
Form 990PF - Special Condition Description:
Special Condition Description