[efile GRAPHIC print - DO NOT PROCESS | As Filed Data -] DLN: 93491265006502) rm 990-PF Deparment ofthe Teasiry Ineral 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.qov/Form990PF for instructions and the latest information, Perey foetal For calendar year 2021, or tax year beginning 01-01-2021 and ending 12-31-2021 Tame of auaaean "A Employer identification number 611280215 ber and sre (or Pb number Hs 7 B Telephone number (see instructions) (502) 636-4292 ‘iyo own, sate or province, county, and ZIP or Terelgn posal code OFinal return Damended return 2. Foreign organizations meeting the 85% o hack here ana attach computation. Dadaress change Ei name change H Check type of organization: ‘Section 501(c)(3) exempt private foundation Osection 4947(8)(1) nonexempt charitable trust__ Cl other taxable private foundation Under secon SOMO}, cece are T Fair market value of all assets at end J Accounting method: cash 01 Accrual F ifthe foundation i na 60-month termination |] of year (From Par I, col (c) me Ui: Saten SOM) occ hre fine 16) $603,838 O other (specify) (Part 1, column (d) must be on cash basis) TEESE Anatysis of Revenue and Expenses (Tie) fay pore ow [a osbusenene ‘of amounts in columns (b),(e), and (d) may not necessarily Expenses par |(P) Netinvestment [(c) Adjusted net eal the amounts inclu (2) (se nstutons) secs income come Contributions, afte grants, et, racelved (attach schedule) zie 2 Check ® Lit the foundation is not required to attach Sch. 8 5 eer 3 Interest on savings and temporary cash investments Dividends anc intrest from securities ino 7 1233 Sa Gross rents bb Net rental income oF (loss) g let gain or (loss) from sale of assets not on line 1¢ 1,827 | 6 Net gan oF (oss) Hom sale of © ° | > Gross sales price for al assets on line 6a 182) & Capital gain net income (from Part 1V, line 2). Tar] Net short-term capital gain income modifications 10a Grose sales less returns and allowances bb Less: Cost of goods sold {€ Grass profit or (loss) (attach schedule) 11 Other income (attach schedule) 12 Total, Add ines 1 through tt. swe eee aii Ec % [a8 Compensation of oer, directo, tunes, ee 7 ql 3 2 |14 other employee salaries and wages B |15 Pension plans, employee benefits.» 6 1s | 16a Legal fees (attach schedule). ss ee ee a & |b Accounting fees (attach schedule) E | c other professional fees (attach schedule) z er « ) Z a7 terest 48 Taxes (attach schedule) (see instructions) 19 Depreciation (attach schedule) and depletion 20 Occupancy 24 Travel, conferences, and meetings « 22 Printing and publications 7 23° Other expenses (attach schedule)... oe es [BD Tay 301 3 24 Total operating and administrative expenses. ‘Add lines 13 through 23 bidodbos a0 3,201 ° 25 Contributions, gifts, grants paid. we 53 70 26 Total expenses and disbursements. Add lines 24 and 25 ara 20] 430 27 Subtract ine 26 from tne £2 Excess of revenue over expenses and disbursements, nar| bb _ Net investment income (if negative, enter -0-) dl © Adjusted net income (f negative, enter -0-) For Paperwork Reduction Act Notice, see instructions Tat. No. 7289x Form 990-PF (2021)Form 990-PF (2021) Page 2 GREER] matance sheets Siilie eeandahyeor sneuns ony tseenseuseare) | terber vice [Gay Soak We | te) Far Na Va 2 Accounts receivable Less llomance for doubt accounts 4 Pledges recevabie disqualified persons (attach schedule) (ae instructions) «ss « 7 other notes and leans recelvable (attach schedule) > Less allowance for doubtful accounts vz | 8 Inventories for sale or use | 9 Prepaid exoenses and deferred charges boo00o08 2 roa investments-U.S. and state government obligations (attach schedule bb Investments—corporate stock (attach schedule) vv ev ee Tay aa ae Investments—corprate bonds (attach schedule) 11. nvestments—lad,buldings, and equlpment: base Less: accumulated depreciation (attach schedule) B 13 Investments—other (attach schedule) an Baas Ta Tor 14 Land, buldngs, and equipment: basis Less! accumulated depreciation attach schedule) B 15 Other assets (eserbe Oi cc 13 3 16 Total assets (20 be completed bya flers—aee the 20 Loans rom offers, crectars, rustes, and ether qualified persone Ba ortgages and other notes payable (attach schedule). vs ss 4 22 Other liabilities (describe B______——) 23._Tolalliablities(add ines 17 tvough 22) sv es 7 1 2] Foundations that follow FASB ASC 958, check here PC 3] and complete lines 24,25, 29 and 30. Elaa Net assets without donor restrictions || oundations that do not follow FASB ASC 958, check here P =| Sad complete lines 26 through 30. 5) a6 cept stock, rust rincbal or curert fonds os ee ee ee q ; | 27 paisn or capital surplus, or lard bi, and equbment fund "| J 2] 26 Retained earings, accumulate income, endowment, or eter funds aia Ea | 29 Total net assets oF fund balances (see mstuctons) ev sw « aa Ea a 30 ‘Total liabilities and net assets/fund balances (see instructions) « 571,674] 593,953] ‘Analysis of Changes in Net Assets or Fund Balances Total net asses or fund balances at beginning of year—Por TH, ealum (a) The 29 (mus agree with end] Beyer tigue ceported on por yours tar cece 71674 3. Other nereases not included I ne 2 (eaize) 3 3 @ Adding L2and3 ees a 35553 5 Decreases not Include in ine 2(temize) mT 5 3 Total ret assets fund balances at end of year (ine 4 min Ine 5) Part, column (8), Ine 29 $ 35555 Form 990-PF (2021)Form 990-PF (2021) Page 3 Capital Gains and Losses for Tax on Tnvestment Facome 1) (a) and deere te and) of propery (9, el ae, vow eat | oa Qa | oak Pag 2sary brick warehouse, or coman stock 200 she, MLE Cod) Pburchase | Date-aeauled | ate sl S-puchase | (mos dayeye) | (nes day} Ta JP MORGAN a BP MORGAN a ¢- CAPITAL GAINS DIVIDENOS 7 4 a m @ thy rose fs pice Depreciation alowed Cost or ter basis Gain (oes) P crallowabs) pias expense of ale ce) plus) min () A 74 30 b FATE) 310 A 3 35 a Conaglet ony for assets showing gain olin (h) and owned by te fourdauon on 2753769 o ; 0) © 1 cl ann mins Adjusted basis excess Sel () col), but no est than 0) oF EM.W. a6 of 12/31/68 soot 3/33/68 over cas), any Losses trom oh)) ri 30 ® T3190 A 313 a i gain, ato arta Pae ne 7 2 capital gain net income or (net capital loss) tos) erter0-'m Part ne? | 7 pita Loss) 1 2 L827 3 Net short-term capital gain or loss) as defined in sections 1222(5) and (6) XF gain also enter in Par, tne, column () (see instruction) If (loss), entr -O- in Part ines er ce ree | (02 Form 990-PF (2021)Form 990-PF (2021) MEGTR A = cise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see ta 10 Page 4 Exempt operating foundations described in section 4940(d)(2), check here B® L] and enter "N/A" on line 1 Date of ruling or determination letter: {attach copy of letter if necessary-see instructions) All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part, line 42, col. (b) Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0 Ad Ines 1 and 2. : 3 0 Subtle A (income) tx (domestic section 4947(a)4) trusts ane tavabe foundations only. Others ener-0-) [Ta 0 Tax based on investment income, Subtract ine 4 fom ine 3. zero or let, enter -O- 5 0 Credits/ayrens 2021 estimated tax payments and 2020 overpayment credited to 2021 | 6a q Exempt foreign organizations—tax withheld at source sss [6b d Tax id with applation for extension oftime to fle (Form 6868)... [6c d Backup withholding erroneousty wield. ss ws ss ws Dee d ‘Total eats and payments. Add nes 68 rough 66. 0 ese ee ww 2 0 Enter any penalty or underpayment of estimated tax check here] it Form 2220 i attached Tax due, Ifthe total of ines and 8s more than ine 7, enteramountowed» ss = [8 ° Overpayment. fine 7s more than the total fines Sand 6, ener the amount overpatd > [ao Enter the amount of line 10 to Be: ceded to 2022 entimated tax inetundea » [an Statements Regarding Activities Dung the tax year, did the foundation aempt to infec any rata, ale, aoa egiaton ord Yes [Ne itpariipate or intervene in any political eampaign? ta} LHo Did spend rmre then $100 during the year ether recy or indirect) for poi purpotes? See the ineructions for the detniton, Dene e eet teenie nnn tres a» |__| no “the answers "Ys" to ta or 4, attach a detaled descriton ofthe activities and copes of any materials published or catributed by the foundation in connection with the aces Did the foundation fle Form 3120-POL for his year. . te] | no Enter the amount (if any) of tax on pots expentues (section 4955) imposed uring te year: (1) On the foundation. Pm $ © (2) On foundation managers. P $ 9 Ener the reimbursement (any) pid bythe Foundation during the year for poli expenditure tax imposed on foundation manages. B § Q Has the foundation engaged in any actives tat have nt previously been reported to the RS? a No 11 "es" attach a detaed description ofthe activites Has the foundation made ary changes, not previously reported to the IRS, nts governing Instrument, artes cfneorporatin, or blows, o ther sil iruments If "Yes," attach a conformed eopy ofthe changes a No Did the foundation have unrelated business gras Income of $1,000 or more during the ear? aa] [No IF Yes" has fled atx return on Form 990-T or thsyear™ vv vs a sas ab Was there aluldtion, termination, dlsoluton, or substantial contraction during the year? 5 No 104s" attach te statement required by Genera Instruction 7. fre te requirements of section 508(e) relating to sections 4941 through 4945) satisfied ether By language in the governing instrument, or by stat legislation that eecvely amends the governing instrument s0 that ne mandatory cirections that conic with the state aw remain inthe governing Insrument? : . 6 | ves Did he foundation havea last $5,000 asets at anytime cing te year? if Yes," complete Part Ico (©), and Part XIV 7 | ves Ener the states to which the foundation reports or with which fis registered (see Instructions) Per Xf the answer Is "es toe 7, has the foundation fumishes a copy of Form 890-PF to the Atorey General or designate) ofeach state a5 required by Genera Instructon G? IF No,” attach explanation av [ves Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) ‘oF 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII. 1 Yes complete Part XL Deen tent e tet nnn ° No Did any persons become substantial contributors during the tax year? If Yes," attach » schedule ting thei armes and addresses. 10 | Yes Form 990-PF (onl)Form 990- (2021) MERE stetcments Regarding Activities (continued) Fry 2 3 14 15 16 ‘At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of section 512(b)(23)? If "Yes, Did the foundation make a a and enter the amount of tax-exempt interest received or accrued during the year | Las At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over 2 bank, securities, or other financial account in a foreign country?» + + et et ee See the instructions for exceptions and fling requirements for FinCEN Form 114, If "Yes", enter the name of the foreign country Pe Yes 16 Statements Regarding Activities for Which Form 4720 May Be Required ta File Form 4720 if any item is checked in the "Yes" column, unless an exception applies During the year did the foundation (either directly or indirectly) (2) Engage in the sale or exchange, of leasing of property with a dlequaliied person?. (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) 2 disqualified person? « fee Bid bi ool o ole (3) Furish goods, services, or facilities to (or accept them from) a disqualified person?. (4) Pay compensation to, oF pay or reimburse the expenses of, a disqualified person?.. (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)?. (6) Agree to pay money or property to @ 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.). 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 natice regarding disaster assistance? See instructions. Organizations relying on a current notice regarding disaster assistance check here, + + see ee BY Did the foundation engage in prior year in any ofthe acts described in a, other than excepted acts, that were not corrected before the first day of the tax year beginning in 20217 « poo Taxes on fle to catribute income (section 4942) (doesnot appl fr years the foundation was a privat ‘operating foundation defined in section 4942(3)(3) or 4942(3)(5)) At the end of tax year 2021, did the foundation have any undistributed income (Part XI, nes 64 and 62) for tax year(s) beginning before 20217. aloio If "Yes," list the years 20, 20, 20, 20 Are there any years listed in 22 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 apolying section 4942(a)(2) to all years listed, answer "No" and attach statement—see instructions.) « : Ifthe provisions of section 4942(a)(2) are being applied to any ofthe years listed in 2a, lst > 2, 2 _, 2 _, 20 _ Did the foundation hold more than a 2% direct or indirect interest in any business enterorice at any time during the year’. 50 11"Yes" dd ithave excess busines holdings in 2021 a5 a reslt of (4) 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.). Glu ule Bllpiolo © Did the foundation invest during the year any amount in 2 manner that would jeopardize its charitable purposes? Did the foundation make any investment in a prior year (but after December 31, 1968) that could jeopardize its charitable purpose that had net been removed from jeopardy before the first day of the tax year beginning in 20217. 1 years here Yes hacay leac2y fears) feacay leas) hace) tb 1d 2a 2b ab aa 4b Form 990-PF (2021)Form 990-PF (2021) Page 6 MERTEN _stetcments Regarding Activities for which Form 4720 May Be Required (continued) ‘Sa During the year did the foundation pay or incur any amount to Yes | No (2) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?, see [sac] No (2) Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly, any voter registration drive? ee ee eee ee ee ee [Satay No (3) Provide a grant to an individual for travel, study, or other similar purposes?. 5s ev ee ee ee (SR No (4) Provide a grant to an organization other than a charitable, etc., organization described in section 4945(4)(4)(A)? See instructions. 6s ee ve et ee sca) No (5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, of for the prevention of cruelty t b fany answer is "Yes" to Sa(1)-(5), did any of the transactions fall to qualify under the exceptions described in ildren or animals?, ss ee ee eee ee (5A5) No Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions. : 5b © Organizations relying on a current notice regarding disaster assistance check « o Ifthe answer is "Yes" to question 5a(4), does the foundation claim exemption from the tax because it maintained expenditure responsibilty for the grant?. 5d If "Yes," attach the statement required by Regulations section 53.4945-5(2). 6a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?. 6 vv tt te ees 6a No b_ Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ob No IF "Yes" to 68, file Form 8870. 7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? Ja No 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 en payment(s) of more than $1,000,000 in remuneration or excess parachute payment during the year?. .-« ea 8 No MTT Mtormation About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors i mn, See instruc t all officers, directors, trustess, foundation managers and their compensat (b) Title, and average | (c) Compensation (IF | _(d) Contributions to (a) Name and address hours per week not paid, enter |employee benefit plans and devoted to position -0-) deferred compensation (e) Expense account, other allowances: See Additional Data Table 2 Compensation of five highest-paid employees (other than those Included on line 1—see instructions). If none, enter "NONE. (@) Contributions te employee benefit | (e) Exoense account, plans and deferred other allowances ‘compensation (b) Title, and average hours per week (©) Compensation devoted to position (a) Name and address of each employee paid more than $50,000, NONE Total number of employees pald over $50,000. ee ee > 2 Form 990-PF (2021)Form 990-PF (2021) Page 7 Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, MERE and contractors (continued) z /e 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 (©) Compensation NONE Total number of athers receiving over $50,000 for professional services. > ‘Summary of Direct Charitable Activities txpatoatons ard cit betes sevad,omteences convanns, ocean papers wooeoes ee ee Expenses 1 ‘Summary of Program-Related Investments (see instructions) the two largest program-elate investments made by the foundation dufing te tx year on Ines 1 and Amount Allether programvrelated Investments. See instructions. 3 Total, Aad lines 1 through 3 GING IE NG No NOON NG ND Nc nD DD GNC CIS o Form 990-PF (2021)Form 990-PF (2021) Page S GEEEEEg Minimum tnvestment Return (al domestic foundations must complete ts pare Foreign foundations, see introns) 1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc. purposes: 2 Average monthly fair market value of securities. Lee ta au.sse Average of monthly cash balances. tb 540,032 Fair market value ofall other assets (see instructions) te 3 Total (add lines 4a, b, and c) 1 381,590 fe Reduction claimed for blockage or other factors reported on lines 1a and te (attach detalled explanation). 6 vv ee te 2 Acquistion indebtedness applicable to line 1 assets, 2 ° 3 Subtract line 2 from ine id. 3 381,590 4 Cash deemed held for charitable activities, Enter 1.5% (0.015) of line 3 (for greater amount, se instrucions)v vk ke ee aan 8,724 5 Net value of noncharitable-use assets. Subtract line & from ine 3 5 572,866 6 _Minimum investment return. Ener 5% (0.05) of ie 5, para |) 28,649 Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign erganizations check here] and do not complete this pat.) 1 Minimum investment returnfrom Par Diline& ss sey ev vv pep ee i 38.683 2a Tox on investment income for 2024 from PartV,ineSs vv vv vs Laat bb Income tax for 2021 (This does not include the tax from Part V.), 2b © Add ines 22 and 26. 2 ° 3 Distributable amount before adjustments, Subtract line 2c fromline 1. se we 3 7.843 4 Recoveries of amounts treated as qualiving distributions 4 3 5 Rddlines 3and 4, 5 7843 6 Deduction from distributable amount (see instruction) 6 3 7___ Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XI, ne 7 7.843 Qualifying Distributions (see instructions) 1 Amounts pad (Induding adminstrative expenses) to accomplish charitable, et, purposes Expenses, contributions gifts, ete.—total from Part I, column (8), line 26. ta 5.430 b Program-related investments—tota rom Part VIILB. « 1b 3 2 Amounts paid to acquire assets used (oF hele for use) directly in carrying out chartable, et, purposes, an 2 3 Amounts set aside for specific charitable projects that saisy Suitability test (prior IRS approval requires), 3a bb Cash distribution test (atach the required schedule). 3b 4 Qualifying distributions. Add lines a through 3, Enter here and on Part XIL, Ine 4 4 5.430 Form 990-PF (2021)Form 990-PE (2021) BEEEESME Undistributed tncome (sea instructions) Page 9 @ Corpus (oy Years prior to 2020 ), 2020 (a) 2021 Distributable amount for 2021 from Part X, line 7 EX Uneistributed income, if any, as of the end of 2021 Enter amount fr 2020 only. Total for prior years: 20, 20, 20 Excess distributions carryover, ifany, to 2021 From 2036, . 2 ss 257,85a| From 2017. m 2018, ss Ta From 2019... ss 97,281 From 2020. 323,157 Total of lines 3a through e » 696,06] 4 Qualifying distrivutions for 2028 from Part XI, line 4: § 5.430 22 Applied to 2020, but not more than line 2 b Applied to undistributed income of prior years (Election required—see instructions) € Treated as distributions out of coms (Election required—see instructions). se + + + + 4 Applied to 2021 distributable amount. 539 fe Remaining amount distributed out of corpus 5 Excess distributions carryover applied to 2021 (fan amount appears in column (4), the ‘same amount must be shown in column (a).) 6 Enter the net total of each column as indicated below: 2 Corpus. Add lines 3f, 4c, and de. Subtract line 5 672.886] b Prior years’ undistributed income. Subtract line 4b from line 25 « ter the amount of prior years’ undistributed income for which a notice of deficiency nas. Deen issued, or on which the section 4942(a) tax has been previously assessed. 4. Subtract line 6¢ from line 6b. Taxable amount see instructions » 5 © Undistributed income for 2035 4a from line 2a. Taxable amount—see Instructions Undistributed income for 2021, Subtract” lines 4d and 5 from line 1. This amount must be distributed in 2022 7 Amounts treated as distributions out of corpus to satisfy requirements imposed by Section 170(b)(1)(F) oF 4942(9)(3) (Election may be required - see instructions) « a q 8 Excess distributions carryover from 2046 a applied on line 5 or line 7 (see instructions)». « 9 Excess distributions carryover to 2022. Subtract lines 7 and 8 from line 6a ‘Analysis of line 9: Excess from 207,» . .cess from 2038, Ta cess from 2019,» . 97,281] (cess from 2020, + + + 323,157] Excess from 2021. Form 990-PF (2021)Form 990-PF (2021) Page 10 MEEEEGHM Private Operating Foundations (cee instructions and Pare Vi-A, question 5) a Ifthe foundation has received a ruling or determination letter that itis a private operating foundation, and the ruling is effective for 2021, enter the date of the ruling « Pb check box to indicate wn 1er the organization is @ private operating foundation described in section C) 4942(5)(3) or OI 494265)(5) 2a Enter the lesser of the adjusted net Tax year Prior 3 years: income from Part I or the minimum (e) Total investment return from Part IX for each (@) 2021 (by 2020 (2019 (@) 2018 yearlisted. ss b_ 85% (0.85) of line 2a © Qualifying distributions from Part Xi, Tine 4 for each year listed « d- Amounts included in line 2e not used irectly for active conduct of exempt activities nen © Qualifying distrioutions made directly for active conduct of exempt activities, Subtract line 2d from line 2c + 3. Complete 3a, 5, or cfor the alternative test relied upon: a “Assets” alternative test—enter: (A) Value of ail assets . (2) Value of assets qualifying under section 4942(3)(3)(B)(i) b_ “Endowment” alternative test— enter 2/3 (of minimum investment return shovin in Part IX, line 6 for each year listec “Support” alternative test—enter: (2) Total support other than gross Investment income (interest, dividends, rents, payments fon securities loans (section '512(a)(5)), or royalties) . (2) Support from general public and 5 of more exempt ‘organizations as provided in section 4942())(3)(8)(i). (3) Largest amount of support from an exempt organization (4) Gross investment income ‘Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets at any time during the year—see instructions.) T—Tnformation Regarding Foundation Managers a Listany managers ofthe founcation who have contributed more than 2% ofthe total contributions received by the foundation before the Cose of any tax year (out ony they have controuted more than $5,000). (See section S079(2}) b List any managers of the foundation whe own 10% or more of the stack of a corporation (or an equally large portion of the ‘ownership of & 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 ® C1 if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. Ifthe foundation makes gifts, grants, etc ‘other conditions, complete ems 2a, b, c, and d. See instructions individuals or organizations under ‘a The name, address, and telephone number or e-mail address of the person to whom applications should be addressed CHURCHILL DOWNS INCORPORATED FOUNDA 600 NORTH HURSTBOURNE LANE STE 400 LOUISVILLE, KY 40222 (502) 636-4492 'b The form in which applications should be submitted and information and materials they should include: GRANT APPLICATION IS AVAILABLE ON WEBSITE (WWW.CHURCHILLDOWNSINCORPORATED.COM/CHURCHILL CHARITIES) AND MUST BE SUBMITTED IN THE PROVIDED APPLICATION FORMAT. «© Any submission deadlines: GRANT APPLICATIONS MUST BE SUBMITTED IN ITS ENTIRETY, WITH ALL REQUIREMENTS «d_Any restrictions or limitations on awards, such as by geograph factors FOUNDATION SUPPORT CAN ONLY BE CONTRIBUTED TO NON-PROFIT ORGANIZATIONS CLASSIFIED AS A 501(C)(3) TAX-EXEMPT BY T INTERNAL REVENUE SERVICE. INDIVIDUALS AND PRIVATE FOUNDATIONS ARE NOT ELIGIGLE TO RECEIVE FUNDS. RELIGIOUS ORGANIZATIONS ARE NOT ELIGISLE FOR FOUNDATION SUPPORT EXCEPT THOSE RELIGIOUS EDUCATIONAL INSTITUTIONS THAT ARE CLASSIFIED AS 501(C)3 TAX-EXEMPT, AND ARE FULLY ACCREDITED PUBLIC OR PRIVATE EDUCATIONAL INSTITUTIONS, INCLUDING PRIMARY AND SECONDARY SCHOOLS, ical areas, charitable fields, Kinds of institutions, or other Form 990-PF (2021)Form 990-PF (2021) Page 11 (EEG Supplementary Information (continued) 3 Grants and Contributions Paid During the Year or Approved for Future Payment TF recipient is an individual, Recipient show any relationship to" | Feundatian Purpose of grant or ‘any foundation manager aan ‘contribution eae Name and address (home or business) y a recipient ( ) | or substantial contributor 2 Paid during the year See Acditonal Data Table Total... maa 5430 'b Approved for future payment Total os 0 Form 990-PF (2021)Form 990-P5 (2021) Page 12 MEERA) 2282 of income-Producing Activities Enter gross amounts unless otherwise indicated, 1 Program service revenue: ___ 4g Fees and contracts from government agencies 2 Membership dues and assessments . 3. Interest on savings and temporary cash investments. Unrelated business income Excluded by section 512, 513, or S14 @ Business code: @) Amount © Exclusion code (a) Amount (e) Related or exempt function incom (See instructions.) 4 Dividends and interest from secunties 7 7239] 5 Net rental income or (loss) from real estate: 2 Debt-financed property. bb Not debe-financed property. : 6 Net rental income or (loss) from personal property 7 Other investment incomes s+ + 8 Gain or (loss) from sales of assets other than inventory fal 1,827] 9 Net income o- (loss) from special events 10 Gross profit or (less) from sales of inventory 11 Other revenue: a b q 12 Subtotal. Add columns (6), (4), and (e) - 3,066] Q 43 Total, Add line 12, columns (b), (4), and (¢)- ‘See viorksheet inline 13 instructions to verfy calculations.) 5 EN] Relationship of Activities to the Accomplishment of Exempt Purposes Line No. instructions.) 3,065 a ‘Explain below how each activity for which income is reported in colurnn (@) of Part XV-A contributed Importantly to the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See Form 990-PF (2021)Form 990-PF (2021) Page 13 Information Regarding Transfers To and Transactions and Relationships With Noncharitable GEESE exempt Organizations 4 Did the organization directly or indirectiy engage in any of the following with any other organization described in section 501, (€) (other than section 501(c)(3) organizations) er in section 527, relating to politcal organizations? Yes | No 2 Transfers from the reporting foundation to a noncharitable exempt organization of: (Grn io old o nooo ooo fedacoppono00on (tel No (2) Other assets, ee ee ee ee [ay No bb Other transactions: (4) Sales of assets to a noncharitable exempt organization, © ee ee ee ee [abc No (2) Purchases of assets from a noncharitable exempt organization. © ee ee ee ee eee ee [BCD No (3) Rental of facilities, equipment, or other assets ce ee ee ee fbRI] No (A) Reimbursement arrangements. 2 ee ee ee ee ee feta No (5) Loans or loan guarantees. en b(5)| No (6) Performance of services or membership or fundraising soctations. ee. FAB C6Y No Sharing of facilities, equipment, mailing lists, other assets, or paid employees. . boo oo le No 4 if the answer to any of the above is “es,” complete the following schedule. Colurmn (b) should alvays show the fair market value of the goods, other assets, or services given by the reporting foundation. Ifthe 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. (2) Une o.| (6) Amount ivolved_| (c) Name of nonchartable exempt organization | (4) Description of transfers, transactions, and sharing arrangements ‘as the foundation directly or indirectly affliated with, or related to, one or more tax-exemot organizations described in section 501(c) (other than section 501(c)(3)) or in section 5277... « «ss «+ « Clves MNno b If "Yes," complete the following schedule. (a) Name of organization (b) Type of organization (©) Descristion of relationship Under penalties of perjury, I declare that I have examined this retum, Induding accompanying schedules and statements, and to the best of my knowledge and belle, itis true, correct, ang complete. Declaration of preparer (other than taxpayer) Is based on al Information of Sign] which preparer has any knowledge. Herel = 2022-08-22 ye Signature of officer or trustee Date Te Prit/Type preparers name | Preparers Signature ate ane ° 3 7 Check if self employed» CI pteatsey 5 AMELIA SEBASTIAN Paid Preparer [imaizrane x Preparer DEAN DORTON ALLEN FORD PLLC Ber ena oases Fras adarese 435 N WHITTINGTON PRWTY STE 400 Loursvaue, xv 40222 Phone ne. (502) 589-6080 Form 990-PF (2021)Form 990PF Part VII Line 1 - List all officers, directors, trustees, foundation managers and their compensation (a) Name ane adcress Title, and average hours per week (b) devoted to position (©) Compensation (If not paid, enter “0-) (a) Contributions to cemplayee benett plans and deferred Expense account, (@) other allowances (600 NORTH HURSTBOURNE LANE STE 400 LOUISVILLE, KY 40222 1.00 campensation TORA ABEL PRESIDENT ° 3 ° 600 NORTH HURSTBOURNE LANE STE 100 tounsvie, Ky 40222 Tick ZANGART TREASURER, ° ° ° 600 NORTH HURSTBOURNE LANE STE £00 Tobisvie, xv 40022 CATHY SHIRCUFF SECRETARY ° ° ° 600 NORTH HURSTBOURNE LANE STE 100 {obnsvie, xv 40222 AUSTIN WLLER DIRECTOR ° ° ° 600 NORTH HURSTBOURNE LANE STE 1.00 iouisvie, ky 40222 NEAL CURTIS DIRECTOR ° ° ° 600 NORTH HURSTBOURNE LANE STE 400 Tobnsvie, kv 40022 ICHAEL W ANDERSON EXECUTIVE DIRECTOR ° ° °Form 990PF Part XIV Line 3 - Grants and Contributions Paid During the Year or Approved for Future Payment Recipient Tf recipient is an individual, ] Foundation Purpose of grant or ‘Amount show any relationship to’ | status of ‘contribution Tame and addrezs (home or business) | any foundation manager | recipient Name and address (home or Business) | or Substantial contributor ‘a Paid during the year NONE PUBLIC (CHARITABLE: 31,560 BRIGHT FUTURES FARM, CHARITY 238 OLD FRANKLIN PIKE COCHRANTON, PA 16314 NONE PUBLIC CHARITABLE: 1,400 EQUESTRIAN INC CHARITY 4902 TIMBERLAN STREET TAMPA, FL_ 33624 NONE PUBLIC CHARITABLE 2,470 GALLOPING OUT CHARITY 7301 W 257H ST SUITE 321 NORTH RIVERSIDE, 160546 Total. > 3a 5,430efi GRAPHIC print — DO NOT PROCESS TY 2021 Investments Corporate Stock Schedule Name: CHURCHILL DOWNS INCORPORATED FOUNDATION EIN: 61-1380215 Investments Corporation Stock Schedule Name of Stock End of Year Book | End of Year Fair Value Market Value CORPORATE STOCK | 16,948 | 26,704[efile GRAPHIC int — DO NOT PROCESS TY 2021 Investments - Other Schedule Name: CHURCHILL DOWNS INCORPORATED FOUNDATION EIN: 61-1380215 Investments Other Schedule 2 Category/ Item Listed at Cost or | Book Value _| End of Year Fair FMV Market Value INVESTMENTS FIXED INCOME AT COST 17,007 16,726efi GRAPHIC print — DO NOT PROCESS TY 2021 Other Assets Schedule Name: CHURCHILL DOWNS INCORPORATED FOUNDATION EIN: 61-1380215 Other Assets Schedule Description Beginning of Year- | Endof Year-Book | End of Year- Fair Book Value value Market Value SrcaWZnrionalicosrs af 5 c[efile GRAPHIC print - DO NOT PROCESS DLN: 9349126500651 TY 2021 Other Expenses Schedule Other Expenses Schedule Nam EIN: CHURCHILL DOWNS INCORPORATED FOUNDATION 61-1380215 Description Revenue and Expenses per Net Investment ‘Adjusted Net Disbursements for Income Tncome Charitable Books Purposes INVESTMENT FEES 607 607 0 BANK FEES 2,688 2,688 0 MISCELLANEOUS EXPENSES 6TY 2021 Substantial Contributors Schedule Name: CHURCHILL DOWNS INCORPORATED FOUNDATION EIN: 61-1380215 Substantial Contributors Schedule Name Address (GREEN PASTURES PROGRAM (CDI) 700 CENTRAL AVENUE LOUISVILLE, KY 40208,[efile GRAPHIC print DO NOT PROCESS | As Filed bata] ‘DLN: 93497268006602) Schedule B Schedule of Contributors —eEe (Fox 990) > attach to Form 880, 90-2, or 980F. —— oreo ers 2021 Name ofthe organization Employer identification number CHURCHILL DOWNS INCORPORATED FOUNDATION 61-1380215 Organization type (check one): Filers of: Section Form 900 or 990-2 1 so1(0y (enter number) organization 1 4947(@)(1) nonexempt charitable trust not treated as a private foundation CO 827 political organization Form 990-PF 501(c}(3) exempt private foundation 1 4947(9\1) nonexempt charitable trust treated asa private foundation 1 501(c)(3) taxable private foundation Check if your organization is covered by the General Rule or a Special Rule. Note: Only a section 501()(7), (8), oF (10) organization can check boxes for both the General Rule and a Special Rule. See instructions, General Rule For an organization fling Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in ‘money or other property) from any one contributor. Complete Parts | and Il, See instructions for determining a contributors total contributions, Special Rules For an organization described in section 501(c)(3) fling Form 990 or 990-EZ that met the 333% suppor test of the regulations Under sections 509(a}(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part I line 13, 16a, or 160, and that, received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% af the amount on (j) Farm 980, Part Vill, line th, or (ii) Form 990-E2Z, line 1. Complete Parts | and Il [Z)For an organization described in section 501()(7), (8), or (10) fling Form 990 or 990-EZ that received from any one contributor, during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts |, Il, and Il [For an organization described in section 501(c)(7), (8), or (10) fling Form 990 or 880-£2 that received from any one contributor, during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000, If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc. purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year... = PS Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't fle Schedule B (Form 990, 990-EZ, of 980-PF), but it must answer “No” on Part IV, line 2, ofits Form 980; or check the box on line H of its Form 990-EZ or on its Form 990PF, Part | line 2, to certify that it doesn’t meet the filing requirements of Schedule & (Form 990, 990-EZ, or 990-PF) For Paperwork Reduction Act Notice, see the Instructions Cat No, 05K ‘Schedule B (Form 880) (2021) for Form 990, 990-EZ, or 990-PF.Schedule B (Form 990) (2021) Name of organization CHURCHILL DOWNS INCORPORATED FOUNDATION Page 2 Employer Identification number 61-1380215 Contributors Contributors (see instruction). Use aupicate copies of Pati adltona space Is needed (a) © © @ No. Name, address, and ZIP + 4 Total contributions | Type of contribution CHURCHILL DOWNS Person . 700 CENTRAL AVENUE Os Payrot $2194 7) Noneash TOUISVITIE, KY 40208 {Compete Part for aoncach ‘ontbutons) (@) © © @ No. Name, address, and ZIP + 4 Total contributions | Type of contribution Person Oo Payrot 5) Noneash {Complete Pat for aoneash conbuton, (a) ® © @ No. Name, address, and ZIP + 4 Total contributions | Type of contribution 1 Person O Payrot 1 Noneash {Complete Pat for aoneash orton, (a) ©) © @ No. Name, address, and ZIP + 4 Total contributions | Type of contribution Person 1 _ Payrott S| 5 Noneash {Complete Par tf aoneash soninbutona) @ ©) © @ No, Name, address, and ZIP + 4 Total contributions | Type of contribution Person O_ Payrott 1 Noneash {Complete Par tf aoneash Sonbutona) (@) ©) © @ No, Name, address, and ZIP + 4 Total contributions | Type of contribution 1 Person O_ Payrott 1 Noneash (Compete Part for aoncach Sonbutiona) Sonedule a Form baer bonISchedule 8 (Form 990) (2021) Page 3 Tame of organization Employer Wdentification number CHURCHILL DOWINS INCORPORATED FOUNDATION 611380235 Eo Noncash Property at SRS TTETOR US OOPN Cops PRT F ERORT POOT TOES rc] e) «) No. from| FMV (or estimate) Boe Description of noncash property given Bee (oe estaet Date received @ e () (a) No. from| FMV (or estimate) cen Description of noncash property given peat Date received @ @ ) () No. from| FMV (or estimate) com Description of noneash property given peer Date received ‘ Notte ®) FI (or estimate) ‘@) can Description of noncash property given pe cee) Date received s Not ©) FM (or estimate) ‘a 0. from| (or estima am Description of noncash property given ee Date received @ @ ©) @ No. from| FMV (or estimate) Ho Description of noncash property given Pea los estieat Date received ‘ Sinelule bros eso) bonnySchedule 8 (Form 990) (2021) Name of organization CHURCHILL DOWNS INCORPORATED FOUNDATION Page 4 61-1300215 BRM Exciusivety religious, charitable, etc., contributions to organizations described in section 801(e)(7), (8), oF (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part Il, enter the total of exclusively religious, charitable, etc, contributions of $1,000 or less for the year. (Enter this information once. See instructions.) > $ Use duplicate copies of Pat Ili aditonal space is needed. @ No. from| (b) Purpose of gift (0) Use of gift {(d) Description of how gift is held Part | (e) Transfer of git Transferee's name, address, and ZIP 4 Relationship of transferor to transferee @ ~ No. from| (b) Purpose of gift (6) Use of gitt {(d) Description of how gift is held Part! () Transfer of ait Transferee's name, address, and ZIP 4 Relationship of transferor to transferee @ No, from| (b) Purpose of gitt (6) Use of gitt (4) Description of how gift is held Part! () Transfer of ait Transferee's name, address, and ZIP 4 Relationship of transferor to transferee @ No. from| {b) Purpose of gift (0) Use of gitt (4) Description of how gift is held Part! {e) Transfer of git ‘Transferee's name, address, and ZIP 4 Relationship of transferor to transferee Schedule B (Form 990) (2021)