Form 990-AR (1979)

Page 4

Grants and Contributions Paid or Approved for

Future Payment During the Year

Recipient

Concise statement of

Amount

urpose of grant or
Name and address (home or business) Substantial contribution
Paid during year
Total. se 7 Té

Approved for future payment

Total. 6. 6 6 6 ee ee ee

a

A notice has been published that this Annual Report is available for public inspection at the grincipal offices of the foundation, and copies of this
Annual Report have been furnished to the Attorney General (or his/her designate) of each State entitled to receive reports as required by instruction F.

> Signature of foundation manager

>

> Preparers signature

> Preparer’s address

Instructions

‘A. Annual Report.—An annual report is re-
quired from the foundation managers (as defined
in section 4946(b)) of every organization which
is a private foundation, including a nonexempt
trust described in section 4947(a)(1) which is
treated as a private foundation, having at least
$5,000 of assets at any time during a taxable
year. A private foundation may use this form for
its annual reporting requirements.

If you prefer not to use this form, you may pre-
pare the report in printed, typewritten or any
other form you choose, provided it readily and
legibly discloses the information required by sec-
tion 6056 and the regulations thereunder.

The annual report 1s in addition to and not in
lieu of submitting the information required on
Form 990-PF under section 6033.

B, Where and When to File—

(1) Tax-exempt private foundation.—File the
report at the time and place specified for filing
Form 990-PF, Return of Private Foundation
Exempt from Income Tax.

(2) Nonexempt trust described in section 4947
(a)(1) and treated as a private foundation —
File the report at the time and place specified
for filing Form 5227, Return of Nonexempt
Charitable or Split-nterest Trust Treated as a
Private Foundation under section 4947(a) of the
Internal Revenue Code.

C. Public Inspection of Private Foundation’s
Annual Reports.—As a foundation manager, you
must make the annual report required by section
6056 available at the principal office of the foun.
dation for inspection during regular business
hours or, if you choose, you may furnish a copy
free of charge to such persons requesting in-
spection, provided these persons do so at the
time and manner prescribed in section 6104(d)
and the regulations thereunder.

The notice must be published not later than
the day prescribed for filing the annual report
(including any extensions of time for filing), in
@ newspaper having general circulation in the
county in which the principal office of the private
foundation is located. The notice must state that
the annual report of the private foundation is
available at its principal office during regular
business hours for inspection by any citizen who
so requests within 180 days after the date of the

publication. It must also show the address of the
private foundation's principal office and the
name of its principal manager. A private foun-
dation may designate in addition to its principal
office, or (if the foundation has no principal
office or none other than the residence of a sub-
stantial contributor or foundation manager) in-
stead of such office, any other location where its
annual report is available.

The term “newspaper having general circula-
tion" will include any newspaper or journal
which is permitted to publish statements in satis-
faction of State statutory requirements relating
to transfer of title to real estate or other similar
legal notices.

A copy of the notice must be attached to the
annual report filed with the Internal Revenue
Service. Because IRS also makes the annual
report available for public inspection under
section 6104(d), the report and any attach-
ments should be of such quality that they can
be reproduced photographically.

A private foundation which has terminated its
status as such under section 507(b)(1)(A), by
distributing all its net assets to one or more pub:
lic chariti>s without retaining any right, title or
interest in such assets, does not have to publish
Notice of availability of its annual report or fur-
nish such report to the public for the taxable
year in which it so terminates (Reg. 1.507—
2(a)(6)). Be sure to check the box on page 2.

D. Signature and Verification—The report
must be signed by the foundation manager.

E. List of States.—A private foundation is re-
quired to attach to its Form 930-PF a list of all
States:

(1) to which the organization reports in any
fashion concerning its organization, assets, or
activities, and

(2) with which the organization has registered
(or which it has otherwise notified in any man.
ner) that it intends to be, or is a charitable
organization or that it is, or intends to be, a
holder of property devoted to a charitable
purpose.

F. Furnishing of Copies to State Officers; List-
ing of States.—If the organization has at least
$5,000 in assets at any time during the year the
foundation managers must furnish a copy of
this annual report to the Attorney General (or
his/her designate) of (1) each State listed for

Form 990-PF, (2) the State in which the
principal office of the foundation is located, and
(3) the State in which the foundation was incor-
porated or organized. The report must be fur-
nished at the same time it is sent to IRS. In
addition, the foundation managers must provide
upon request a copy of the annual report to the
Attorney General or other appropriate State offi-
cer of any other State. The foundation manager
must also attach to the report a copy of the
Form 990-PF (or Form 5227 for a 4947(a)(1)
trust) and a copy of the Form 4720 (if any) filed
by the foundation with IRS for the year.

G. Penalty for Failure to File Report and No-
tice on Time.—If a private foundation fails to
file the annual report on or before the due date,
‘or to comply with the requirements under in-
struction C, there will be imposed on the person
{anyone under a duty to perform the act) a $10
penalty for each day during which the failure con-
tinues, not to exceed $5,000. (See section 6652
(d)(3).)

The penalty of $10.00 a day for failure to file
may also be charged if a report is submitted with
information omitted. Therefore, please be sure
to make an entry in each part of the form even
the ones that do not apply to you. If a part or
line item does not apply, enter N/A" (not ap-
plicable). (See Rev. Rul. 77-162, 1977-1 C.
400, for details.) If more than one person is
liable, all such persons will be jointly and sev-
erally liable with respect to such failure.

Organizations that have given notice under
section 508(b) as to their foundation status and
have not received a letter from IRS containing a
determination as to such status—refer to Rev.
Proc. 79-8, 1979-1 C.B. 487, or later revisions
for rules relating to relief from the penalty pro-
vision of section 6652. {f the failure to file the
annual report or comply with instruction C is
willful, there will be imposed, in addition to the
amount mentioned above, a penalty of $1,000
for each such report or notice. (See section
6685.)

H. Foreign Organizations.—A foreign orga
zation which has received substantially all of its
support (other than gross investment income)
from sources outside the United States will not
be subject to the requirements of instructions
Cand F above.

3 U.S.GPO:1979-0-283-062

EtW 430814328


Form 990-AR

1979
Annual Report

of Private
Foundation

Name

Under Section 6056 of the Internal Revenue Code

This Annual Report and

the annual return of the Foundation
filed on Form 990-PF are available for
public inspection. Consult an

Internal Revenue Service office for
further information.

of the
Internal
Revenue
Service


Form 990-AR (1979)

Page 2
Annual report for calendar year 1979, or fiscal year beginning +1979, and ending 19
Name of organization Employer identification number
Address of principal office
If books and records are not at above address, specify where they are kept Name of principal officer of foundation

Public Inspection (See instruction C):
(a) Enter date the notice of availability of annual report appeared in newspaper p>
(b) Enter name of newspaper >

(c) Check here > [] if you have attached a copy of the newspaper notice as require
attached, the report will be considered incomplete.)

yy instruction C. (If the notice is not

Check this box if your private foundation status
Check box for type of annual return B [] Form 990-PF [J Form 5227 terminated under section 507(b)(1)(A) D>

0

Revenues
1 Amount of gifts, grants, bequests, and contributions received for the year

2 Gross income forthe year . .

3 Total. 2 ww ew ee

Disbursements and Expenses

4 Disbursements for the year for exempt (charitable) purposes (including administrative expenses) .

5 Expenses attributable to gross income (item 2 above) for the year

Foundation Managers
6 List all managers of the foundation (see section 4946(b)):

i ‘Address where manager may be contacted
Name and title ‘during normal business hours

6a List here any managers of the foundation (see section 4946(b)) who have contributed 2 percent of the total contributions

Received by the foundation before the close of any taxable year (but only if they have contributed more than $5,000). (See section
7 (d)(2).)

6b List here any managers of the foundation (see section 4946(b)) who own 10 percent 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 percent or greater
interest.



Form 990-AR (1979)

Page 3

Balance Sheet Per Books

at the Beginning of the Year

Assets

Cash 2 2 ee ee ee ee ee

Accounts and notes receivable . . . .

Inventories . 6. 6 1 ee ew ee ef,

Securities
Government obligations. . . . . «

Corporatebonds . . 2 ww ew we
Corporate stocks. . . 1. 2. 2 we
Mortgageloans . 2. . 2. 1. 1. we
Realestate . . .
Less: Depreciation .

Other assets...

Less: Depreciation .

Liabilities
Accounts payable. . . . . .
Contributions, gifts, grants,
etc, payable... . . .
Bonds and notes payable . . .
Mortgages payable . . . . .

Other liabilities. . . .

Total liabilities. . . . . . .

Net Worth

Principal fund. 2...

Income fund . . .

Total net worth . 2. wwe

Total assets.

Total liabilities and net worth.

Itemized Statement of Securities and All Other Assets Held at the Close of the Texable Year

Asset

Book value

Market value

Total sw ee ee ee