Return of Private Foundation OMB No. 1545-0052

Form 990-PF or Section 4947(a)(1) Charitable Trust Treated as a Private Foundation

(See separate instructions.) Department of the Treasury

Internal Revenue Service Note: You may be able to use a copy of this return to satisfy state reporting requirements.

For the calendar year 1991, or fiscal year beginning , 1991, and ending , 19

Name of organization A

Please type,

print, or

attach label.

See Specific

Instructions.

Number, street, and room (or P.O. box number) B

City or town, state, and ZIP code C If application pending, check here ©

D Foreign organizations, check here ©

H Check type of organization: Exempt private foundation E If your private foundation status terminated

4947(a)(1) trust (see instruction C) Other taxable private foundation under section 507(b)(1)(A), check here ©

I Fair market value of assets at end of J Accounting method: Cash Accrual

year (from Part II, col. (c), line 16)

F If the foundation is in a 60-month termination

under section 507(b)(1)(B), check here © Other (specify)

(Part I column (d) must be on cash basis.) G If address changed, check here ©

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).)

(d) Disbursements

for charitable

purposes

(a) Revenue and

expenses per

books

(c) Adjusted net

income

(b) Net investment

income

1 Contributions, gifts, grants, etc., received (attach schedule)

2 Contributions from split-interest trusts

3 Interest on savings and temporary cash investments

4 Dividends and interest from securities

5a Gross rents

b (Net rental income or (loss) )

6 Net gain or (loss) from sale of assets not on line 10

7 Capital gain net income (from Part IV, line 2)

8 Net short-term capital gain

Revenue

9 Income modifications

10a Gross sales minus returns and allowances

b Minus: Cost of goods sold

c Gross profit or (loss) (attach schedule)

11 Other income (attach schedule)

12 Total (add lines 1 through 11)

13 Compensation of officers, directors, trustees, etc.

14 Other employee salaries and wages

15 Pension plans, employee benefits

16a Legal fees (attach schedule)

b Accounting fees (attach schedule)

c Other professional fees (attach schedule)

17 Interest

18 Taxes (attach schedule)

Please attach check or money order here.

19 Depreciation (attach schedule) and depletion

20 Occupancy

21 Travel, conferences, and meetings

22 Printing and publications

23 Other expenses (attach schedule)

Total operating and administrative expenses

(add lines 13 through 23)

24

Operating and Administrative Expenses

25 Contributions, gifts, grants paid

Total expenses and disbursements (add lines 24

and 25)

26

Excess of revenue over expenses and disbursements (line 12 minus line 26)27a

b Net investment income (if negative, enter “-0-”) 

c Adjusted net income (if negative, enter “-0-”)

For Paperwork Reduction Act Notice, see page 1 of the instructions. Cat. No. 11289X

Employer identification number

State registration number (see instruction F)

Part I

Form 990-PF (1991)
Form 990-PF (1991) Page 2

Attached schedules and amounts in the description column Beginning of year End of year Balance Sheets should be for end-of-year amounts only. (See instructions.) (a) Book Value (b) Book Value (c) Fair Market Value

1 Cash—non-interest-bearing

2 Savings and temporary cash investments

3 Accounts receivable ©

minus: allowance for doubtful accounts ©

4 Pledges receivable ©

minus: 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) ©

minus: allowance for doubtful accounts ©

8 Inventories for sale or use

9 Prepaid expenses and deferred charges

Assets

10a Investments—U.S. and state government obligations (attach schedule)

b Investments—corporate stock (attach schedule)

c Investments—corporate bonds (attach schedule)

11 Investments—land, buildings, and equipment: basis ©

minus: accumulated depreciation (attach schedule) ©

12 Investments—mortgage loans

13 Investments—other (attach schedule)

14 Land, buildings, and equipment: basis ©

minus: accumulated depreciation (attach schedule) ©

15 Other assets (describe © )

16 Total assets (completed by all filers—see instructions)

17 Accounts payable and accrued expenses

18 Grants payable

19 Support and revenue designated for future periods (attach schedule)

20 Loans from officers, directors, trustees, and other disqualified persons

21 Mortgages and other notes payable (attach schedule)

Liabilities

22 Other liabilities (describe © )

23 Total liabilities (add lines 17 through 22)

Organizations that use fund accounting, check here ©

and complete lines 24 through 27 and lines 31 and 32.

24a Current unrestricted fund

b Current restricted fund

25 Land, buildings, and equipment fund

26 Endowment fund

27 Other funds (describe © )

Organizations not using fund accounting, check here ©

and complete lines 28 through 32.

28 Capital stock or trust principal

29 Paid-in capital or capital surplus 

30 Retained earnings or accumulated income

Fund Balances or Net Assets

31 Total fund balances or net assets (see instructions)

32 Total liabilities and fund balances/net assets (see instructions)

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 31 1

(must agree with end-of-year figure reported on prior year’s return)

2 Enter amount from Part I, line 27a 2

3 Other increases not included in line 2 (itemize) © 3

4 Add lines 1, 2, and 3 4

5 Decreases not included in line 2 (itemize) © 5

6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 31 6

Part III

Part II
Form 990-PF (1991) Page 3

Capital Gains and Losses for Tax on Investment Income

(b) How acquired

P—Purchase

D—Donation

(d) Date sold

(mo., day, yr.)

(c) Date acquired

(mo., day, yr.)

(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.

1

(h) Gain or (loss)

(e) plus (f) minus (g)

(f) Depreciation allowed

(or allowable)

(e) Gross sales price

minus expense of sale (g) Cost or other basis

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Losses (from col. (h)) 

Gains (excess of col. (h) gain over col. (k),

but not less than “-0-”) (k) Excess of col. (i)

over col. (j), if any

(j) Adjusted basis

as of 12/31/69 (i) F.M.V. as of 12/31/69

If gain, also enter in Part I, line 7 2 Capital gain net income or (net capital loss) If (loss), enter “-0-” in Part I, line 7 2

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

Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income

(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)

If section 4940(d)(2) applies, leave Part V blank.

Were you liable for the section 4942 tax on the distributable amount of any year in the base period? Yes No

If “Yes,” you do not qualify under section 4940(e). Do not complete this part.

1 Enter the appropriate amount in each column for each year; see instructions before making any entries.

(a)

Base period years

Calendar year (or fiscal year beginning in)

(d)

Distribution ratio

(col. (b) divided by col. (c))

(b)

Adjusted qualifying distributions

(c)

Net value of noncharitable-use assets

1990

1989

1988

1987

1986

2 Total of line 1, column (d) 2

Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by

the number of years the foundation has been in existence if less than 5 years

3

3

4 Enter the net value of noncharitable-use assets for 1991 from Part X, line 5 4

5 Multiply line 4 by line 3 5

6 Enter 1% of net investment income (1% of Part I, line 27b) 6

7 Add lines 5 and 6 7

8 Enter qualifying distributions from Part XII, line 4 8

If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See

the Part VI instructions.

Part V

Part IV

$ %

%
Form 990-PF (1991) Page 4

Excise Tax 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.

Give date of ruling letter (attach copy of ruling letter if necessary–see instructions)

Domestic organizations that meet the section 4940(e) requirements in Part V, check 1

here and enter 1% of Part I, line 27b

b

c All other domestic organizations enter 2% of line 27b. Exempt foreign organizations enter 4% of line 27b

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

4 Tax under subtitle A (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter “-0-”) 4

5 Tax on investment income (line 3 minus line 4 (but not less than “-0-”)) 5

6 Credits/Payments:

a 1991 estimated tax payments and 1990 overpayment credited to 1991 6a

b Exempt foreign organizations—tax withheld at source 6b

c Tax paid with application for extension of time to file (Form 2758) 6c

d Backup withholding erroneously withheld 6d

7 Total credits and payments (add lines 6a through d) 7

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

11 Enter the amount of line 10 you want: Credited to 1992 estimated tax © Refunded © 11

Statements Regarding Activities

File Form 4720 if you answer ‘‘No’’ to question 10b, 11b, or 14b or ‘‘Yes’’ to question 10c, 12b, 13a, 13b, or 14a(2), unless an exception applies. No

During the tax year, did you attempt to influence any national, state, or local legislation or did you participate

or intervene in any political campaign?

1a

1a

b Did you spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)? 1b

If you answered ‘‘Yes’’ to 1a or 1b, attach a detailed description of the activities and copies of any materials

published or distributed by the organization in connection with the activities.

c Did you file Form 1120-POL, U.S. Income Tax Return for Certain Political Organizations, for this year? 1c

2 Have you engaged in any activities that have not previously been reported to the Internal Revenue Service? 2

If ‘‘Yes,’’ attach a detailed description of the activities.

Have you made any changes, not previously reported to the IRS, in your governing instrument, articles of

incorporation, or bylaws, or other similar instruments? If “Yes,” attach a conformed copy of the changes

3

3

4a Did you have unrelated business gross income of $1,000 or more during the year? 4a

4b b If “Yes,” have you filed a tax return on Form 990-T, Exempt Organization Business Income Tax Return, for this year?

5 5

If ‘‘Yes,’’ attach the schedule required by General Instruction T.

6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:

● By language written into 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

Did you have at least $5,000 in assets at any time during the year? 7 7

If ‘‘Yes,’’ complete Part II, column (c), and Part XV.

8a Enter the states to which the foundation reports or with which it is registered (see instructions) ©

If you answered “Yes” to line 7, have you furnished a copy of Form 990-PF to the Attorney General (or his

or her designate) of each state as required by General Instruction G? If “No,” attach explanation

b

8b

9 Are you claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for

calendar year 1991 or fiscal year beginning in 1991 (see instructions for Part XIV)? If ‘‘Yes,’’ complete Part XIV 9

10 Self-dealing (section 4941):

a During the year did you (either directly or indirectly):

Engage in the sale or exchange, or leasing of property with a disqualified person? 10a(1) (1)

Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person? 10a(2) (2)

Furnish goods, services, or facilities to (or accept them from) a disqualified person? 10a(3) (3)

Pay compensation to or pay or reimburse the expenses of a disqualified person? 10a(4) (4)

Transfer any of your income or assets to a disqualified person (or make any of either available for the

benefit or use of a disqualified person)?

(5) 10a(5)

Agree to pay money or property to a government official? (Exception: Check “No” if you agreed to

make a grant to or to employ the official for a period after he or she terminates government service,

if he or she is terminating within 90 days.)

(6)

10a(6)

Was there a liquidation, termination, dissolution, or substantial contraction during the year?

Yes

Part VII

Part VI

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Form 990-PF (1991) Page 5

Statements Regarding Activities (continued)

Yes No If you answered “Yes” to any of questions 10a(1) through (6), were the acts you engaged in excepted acts

as described in Regulations sections 53.4941(d)-3 and 4?

10b

10b

Did you engage in a prior year in any of the acts described in 10a, other than excepted acts, that were

acts of self-dealing not corrected by the first day of your tax year beginning in 1991?

c

10c

11 Taxes on failure to distribute income (section 4942) (does not apply for years you were a private operating

foundation as defined in section 4942(j)(3) or 4942(j)(5)):

Did you at the end of tax year 1991 have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s)

beginning before 1991? If “Yes,” list the years ©

a

, , , . 11a

If 11a is “Yes,” are you applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets)

to the undistributed income for ALL such years? (If “Yes,” attach statement—see instructions.)

b

11b

c If the provisions of section 4942(a)(2) are being applied to ANY of the years listed in 11a, list the years here.

, , , .

12 Taxes on excess business holdings (section 4943):

a Did you hold more than a 2% direct or indirect interest in any business enterprise at any time during the year? 12a

If “Yes,” did you have excess business holdings in 1991 as a result of (1) any purchase by you 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 you

had excess business holdings in 1991. )

b

12b

13 Taxes on investments that jeopardize charitable purposes (section 4944):

a Did you invest during the year any amount in a manner that would jeopardize your charitable purposes? 13a

b Did you make any investment in a prior year (but after December 31, 1969) that could jeopardize your charitable

purpose that you had not removed from jeopardy on the first day of your tax year beginning in 1991? 13b

14 Taxes on taxable expenditures (section 4945) and political expenditures (section 4955):

a During the year did you pay or incur any amount to:

Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? 14a(1) (1)

Influence the outcome of any specific public election (see section 4955); or to carry on, directly or

indirectly, any voter registration drive?

(2)

14a(2)

Provide a grant to an individual for travel, study, or other similar purposes? 14a(3) (3)

Provide a grant to an organization, other than a charitable, etc., organization described in section

509(a)(1), (2), or (3), or section 4940(d)(2)?

(4)

14a(4)

Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or

for the prevention of cruelty to children or animals?

(5)

14a(5)

If you answered ‘‘Yes’’ to any of questions 14a(1) through (5), were all such transactions excepted

transactions as described in Regulations section 53.4945?

b

14b

If you answered ‘‘Yes’’ to question 14a(4), do you claim exemption from the tax because you maintained

expenditure responsibility for the grant?

c

14c

If ‘‘Yes,’’ attach the statement required by Regulations section 53.4945–5(d).

15 Did any persons become substantial contributors during the tax year? 15

If ‘‘Yes,’’ attach a schedule listing their names and addresses.

16 During this tax year, did you maintain any part of your accounting/tax records on a computerized system? 16

17a Did anyone request to see either your annual return or exemption application (or both)? 17a

b If “Yes,” did you comply pursuant to the instructions? (See General Instruction Q.) 17b

18 The books are in care of © Telephone no. ©

Located at ©

19 Section 4947(a)(1) charitable trusts filing Form 990-PF in lieu of Form 1041, U.S. Fiduciary Income Tax Return.—Check here © 

19

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):

(e) Compensation 

(If not paid, enter 

-0-)

(c) Contributions

to employee

benefit plans

(b) Title, and average

hours per week

devoted to position

(d) Expense account,

other allowances (a) Name and address

©

and enter the amount of tax-exempt interest received or accrued during the year ©

Part VIII

Part VII
Form 990-PF (1991) Page 6

Information About Officers, Directors, Trustees, etc. (continued)

2 Compensation of five highest paid employees (other than those included on line 1—see instructions). If none, enter “NONE.”

(c) Contributions to

employee benefit

plans

(d) Expense account,

other allowances

(b) Title and time

devoted to position (a) Name and address of employees paid more than $30,000 (e) Compensation

Total number of other employees paid over $30,000 ©

3 Five highest paid persons for professional services—(see instructions). If none, enter “NONE.”

(a) Name and address of persons paid more than $30,000 (b) Type of service (c) Compensation

Total number of others receiving over $30,000 for professional services ©

Summary of Direct Charitable Activities

Summary of Program-Related Investments

Part VIII

Part IX-A

Part IX-B

Expenses 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.

Describe any program-related investments made by the foundation during the tax year. Amount

1

2

3

4

1

2

3
Form 990-PF (1991) Page 7

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

b Program-related investments—total of lines 1-3 of Part IX-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 4

5

5

6

Qualifying distributions (add lines 1a through 3b). (Enter in Part V, line 8 and Part XIII, line 4.)

6

Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment

income—enter 1% of Part I, line 27b (see instructions)

Adjusted qualifying distributions (line 4 minus line 5)

Note:The amount on line 6 will be used in Part V, column (b), when calculating the section 4940(e) reduction of tax in subsequent

years.

Minimum Investment Return (All organizations must complete this part.)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,

purposes:

1

a Average monthly fair market value of securities 1a

b Average of monthly cash balances 1b

c Fair market value of all other assets (see instructions) 1c

d Total (add lines 1a, b, and c) 1d

1e

Reduction claimed for blockage or other factors (attach detailed

explanation) ©

e

2 Acquisition indebtedness applicable to line 1 assets 2

3 Line 1d minus line 2 3

4

Cash deemed held for charitable activities—Enter 11

⁄2% of line 3 (for greater amount, see

instructions)

4

5 Net-value of noncharitable-use assets—Line 3 minus line 4 (Enter in Part V, line 4.) 5

6 Minimum investment return (Enter 5% of line 5.) 6

(Section 4942(j)(3) and (j)(5) private operating foundations

check here © and do not complete this part.) Distributable Amount (see instructions)

1 Minimum investment return from Part X, line 6 1

2a Tax on investment income for 1991 from Part VI, line 5 2a

b Income tax under subtitle A, for 1991 2b

c Line 2a plus line 2b 2c

3 Distributable amount before adjustments (line 1 minus line 2c) 3

4a Recoveries of amounts treated as qualifying distributions 4a

b Income distributions from section 4947(a)(2) trusts 4b

c Line 4a plus line 4b 4c

5 Line 3 plus line 4c 5

6 Deduction from distributable amount (see instructions) 6

7 Distributable amount as adjusted (line 5 minus line 6) (Also enter in Part XIII, line 1.) 7

Part X

Part XI

Part XII
Form 990-PF (1991) Page 8

Undistributed Income (see instructions)

(a) (b) (c) (d)

Corpus Years prior to 1990 1990 1991

1 Distributable amount for 1991 from Part XI,

line 7

2 Undistributed income, if any, as of the end of 1990:

a Enter amount for 1990 only

b Total for prior years: 19 ,19 ,19

3 Excess distributions carryover, if any, to 1991:

a From 1986

b

c

From 1987

From 1988

d

e

From 1989

f Total of lines 3a through e

4 Qualifying distributions for 1991 from Part

XII, line 4: $

a Applied to 1990, but not more than line 2a

Applied to undistributed income of prior

years (Election required—see instructions)

b

Treated as distributions out of corpus

(Election required—see instructions)

c

d Applied to 1991 distributable amount 

e Remaining amount distributed out of corpus

5 Excess distributions carryover applied to 1991.

(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

Prior years’ undistributed income (line 2b

minus line 4b)

b

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

c

Subtract line 6c from line 6b. Taxable

amount—see instructions

d

Undistributed income for 1990 (line 2a minus

line 4a). Taxable amount—see instructions 

e

Undistributed income for 1991 (line 1 minus

lines 4d and 5). This amount must be

distributed in 1992

f

7 Amounts treated as distributions out of corpus

to satisfy requirements imposed by section

170(b)(1)(E) or 4942(g)(3) (see instructions)

8 Excess distributions carryover from 1986 not

applied on line 5 or line 7 (see instructions)

9 Excess distributions carryover to 1992 (line

6a minus lines 7 and 8)

10 Analysis of line 9:

Excess from 1991

a Excess from 1987

b Excess from 1988

c

d

Excess from 1989

Excess from 1990

e

From 1990

Part XIII
Form 990-PF (1991) Page 9

Private Operating Foundations (see instructions and Part VII, question 9)

If the foundation has received a ruling or determination letter that it is a private operating

foundation, and the ruling is effective for 1991, enter the date of the ruling ©

1a

b Check box to indicate whether you are a private operating foundation described in section 4942(j)(3) or 4942(j)(5).

Enter the lesser of the adjusted net

income from Part I or the minimum

investment return from Part X (for

1991; previously Part IX)

2a Tax year Prior 3 years

(a) 1991 (b) 1990 (c) 1989 (d) 1988 (e) Total

b 85% of line 2a

Qualifying distributions from Part XII, line 4

(for 1991; previously Part XIII, line 6)

c

d Amounts included in line 2c not used directly

for active conduct of exempt activities

e

Complete 3a, b, or c for the

alternative test on which you rely:

3

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 X, line 6, (for

1991; previously Part IX, line 6)

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)

(4) Gross investment income

Supplementary Information (Complete this part only if you had $5,000 or more in assets at any time during the year—see instructions.)

1 Information Regarding Foundation Managers:

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).)

a

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.

b

2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:

Check here © if you only make contributions to preselected charitable organizations and do not accept unsolicited

requests for funds. If you make gifts, grants, etc., (see instructions) to individuals or organizations under other conditions,

complete items 2a, b, c, and d.

a The name, address, and telephone number 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:

Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other

factors:

d

Qualifying distributions made directly

for active conduct of exempt activities

(line 2c minus line 2d)

Largest amount of support

from an exempt organization

Part XIV

Part XV
Form 990-PF (1991) Page 10

Supplementary Information (continued)

3 Grants and Contributions Paid During the Year or Approved for Future Payment

If recipient is an individual,

show any relationship to

any foundation manager 

or substantial contributor

Foundation

status of

recipient

Recipient Purpose of grant or

contribution Amount

Name and address (home or business)

a Paid during the year

Total © 3a

b Approved for future payment

3bTotal ©

Part XV
Form 990-PF (1991) Page 11

Analysis of Income-Producing Activities

Unrelated business income Excluded by section 512, 513, or 514 (e) Enter gross amounts unless otherwise indicated. Related or exempt

function income

(See instructions.) (a) (b) (c) (d)

Business code Amount Exclusion code Amount 1 Program service revenue:

(a)

(b)

(c)

(d)

(e)

(f)

(g) Fees from government agencies

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

9 Net income from special fundraising 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))

13 TOTAL (add line 12, columns (b), (d), and (e)) ©

(See worksheet for line 13 instructions to verify calculations.)

Relationship of Activities to the Accomplishment of Exempt Purposes

Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the

accomplishment of your exempt purposes (other than by providing funds for such purposes). (See instructions.)

Line No.

Ä

Part XVI-A

Part XVI-B
Form 990-PF (1991) Page 12

Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations

Yes No Did the organization directly or indirectly engage in any of the following with any other organization described in section

501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

1

a Transfers from the reporting organization to a noncharitable exempt organization of:

Cash 1a(i) (i)

Other assets a(ii) (ii)

b Other Transactions:

Sales of assets to a noncharitable exempt organization b(i) (i)

Purchases of assets from a noncharitable exempt organization b(ii) (ii)

Rental of facilities or equipment b(iii) (iii)

Reimbursement arrangements b(iv) (iv)

b(v) (v) Loans or loan guarantees

Performance of services or membership or fundraising solicitations b(vi) (vi)

c Sharing of facilities, equipment, mailing lists or other assets, or paid employees c

If the answer to any of the above is “Yes,” complete the following schedule. The “Amount involved” column below should

always indicate the fair market value of the goods, other assets, or services given by the reporting organization. If the

organization received less than fair market value in any transaction or sharing arrangement, indicate in column (d) the value

of the goods, other assets, or services received.

d

(a) Line no. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements

Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations

described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?

2a

Yes No

bIf “Yes,” complete the following schedule.

(a) Name of organization (b) Type of organization (c) Description of relationship

Public Inspection

1 Enter the date the notice of availability of the annual return appeared in a newspaper ©

2 Enter the name of the newspaper ©

Check here © if you have attached a copy of the newspaper notice as required by the instructions. (If the notice is not

attached, the return will be considered incomplete.)

3

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 or fiduciary) is based on all information of which preparer has any knowledge.

Signature of officer or trustee Date © Title

Date Preparer’s social security no. Preparer’s

signature Check if

self-employed ©

Firm’s name (or 

yours if self-employed)

and address

Paid

Preparer’s

Use Only

E.I. No. ©

Please Sign Here

ZIP code ©

Social security no.

Part XVII

Part XVIII

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