1, 100. 591. 591. · 2018. 12. 19. · 9 Prepaid expenses and deferred charges 1, 100. 591. 591. S 10a Investments -U S. and state government obligations (attach schedule) b Investments

( r .,s

Form 990'PF

Department of the TreasuryInternal Revenue Service

2017

For calendar year 2017 or tax year beainnina . 2017. and ending

C^G

-- C

A Employer identification number

WORMSLOE FOUNDATION, INC. 58-603431922^fn. BRYAN STREET, PMB 300 B Telephone number (see instructions)SAVANNAH, GA 31401

C If exemption application is pending, check here

G Check all that apply- Initial return Initial return of a former public charity D 1 Foreign organizations check hereFinal return Amended return

,

Address change Name change 2 Foreign organizations meeting the 85% test, check qnh d h t ttt

H Check type of organization: Section 501(c)(3) exempt private foundationioere an a ac compu a

Section 4947(a)(1) nonexemp charitable trust X Other taxable private foundation E If private foundation status was terminated

I Fair market value of all assets at end of year J Accounting method: }{ Cash Accrual undersection 507(b)(1)(A), check here - 111'.

(from Part ll, column (c), line 16) F] Other (specify) _ _ F If the foundation is in a 60-month termination$ 4,192 , 068. (Part I, column (d) must be on cash basis ) under section 507(b)(1)(B), check here

m.

Part I Analysis of Revenue and (a ) Revenue and (b) Net investment (c) Adjusted net (d) DisbursementsExpenses (The total of amounts in expenses per books income income for charitablecolumns (b), (c), and (d) may not neces- purposessarily equal the amounts in column (a) (cash basis only)(see instructions) )1 Contributions ifts, grants, etc , received ( attach schedule ) 88 , 284.2 Check ► if the foundation is not required to attach Sch B

3 Interest on savings and temporary cash investments 2 , 136. 2 136.4 Dividends and interest from securities 98 , 078. 98 , 078.5a Gross rentsb Net rental income

or (loss ) ® t^rnww., _

I R 6a Net gain or ( loss) from sale of assets not on line 10 90 , 876.E b Gross sales price for all

742 701 ~ ^^+•^, .assets on line 5a

1

7v

E 7 Capital gain net income (from Part IV, line 2) 90,876. 6 1 191N 8 Net short - term capital gain L__1 0 . (J3

U 9 Income modifications 0r1c->, r =- IE 10a Gross sales less r jreturns and

allowances

b Less Cost ofgoods sold

c Gross profit or (loss ) ( attach schedule)

11 Other income (attach schedule)

SEE STATEMENT 1 -5,679.12 Total . Add lines 1 through 11 273 , 695. 191 , 090. 0.13 Compensation of officers, directors , trustees, etc

Oth l l daries aner emp oyee sa wages14

15 Pension plans , employee benefits

A 16a Legal fees (attach schedule)

M b Account i ng fees ( attach sch ) SEE ST 2 7, 550. 7,550.C Other professional fees (attach sch ) SEE ST 3 3,600. 3 , 600.

I 17 Interest

R T 18 Taxes ( attach schedulexsee instrs ) SEE $TM 4 1 65 6. 1, 6 5 6.R A 19 Depreciat i on (attach

m_ 7 T

^

schedule ) and depletion .

I IV 20 OccupancyE 21 Travel , conferences , and meetings

E 22 Print i ng and publications

0 xp 23 Other expenses ( attach schedule)

N SEE STATEMENT 5 25 , 107. 8 , 568. 16 , 539.S 24 Total operating and administrative

E5

expenses . Add lines 13 through 23 37 , 913. 10 , 224. 27 , 689.25 Contributions , gifts, grants paid PMT XV 356 , 300. 356 , 300.26 Total expenses and disbursements.

Add lines 24 and 25 . 394 213. 10 , 224. 0. 383 989.27 Subtract line 26 from l i ne 12:

a Excess of revenue over expenses

and disbursements . -120 , 518.

b Net Investment income ( if negative , enter -0 -) 180 , 866.C Adjusted net Income ( if negative, enter -0) 0.

BAA For Paperwork Reduction Act Notice, see instructions.

Return of Private Foundationor Section 4947(aXl) 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

TEEA0504L 08/25/17

2949120200907 8I OMB No 1545-0052

Form 990•PF (201/)

(9 'xl

11

Form 990-PF (2017) WORMSLOE FOUNDATION. INC - 58-6034319 Paqe 2Attached schedules and amounts in the description

h ld b f d fP t II B l ShBeginning of year End of year

ou e or encolumn s -o -ear amounts onlyar a ance eets(See instructions) (a) Book Value (b) Book Value (c) Fair Market Value

1 Cash - non-Interest-bearing 18,537. 18, 821. 18 , 821.2 Savings and temporary cash investments 121, 211. 42, 166. 42, 166.3 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 otherdisqualified persons (attach schedule) (see instructions)

7 Other notes and loans receivable (attach sch)

S

-----------Less allowance for doubtful accounts

S----------

8 Inventories for sale or use

ET

9 Prepaid expenses and deferred charges 1 , 100. 591. 591.S 10a Investments - U S. and state government

obligations (attach schedule)

b Investments - corporate stock (attach schedule) 1 , 608, 677. 1, 490, 492. 3 , 025 , 618.c Investments - corporate bonds (attach schedule)

11 Investments - land, buildings, andequipment: basis

-----------------Less: accumulated depreciation(attach schedule) '

----

- - - - - - - - - -12 Investments - mortgage loans

13 Investments - other (attach schedule) 270, 081. 346, 944. 1,104,872.14 Land, buildings, and equipment basis'

-----------Less accumulated depreciation(attach schedule) ' __________

15 Other assets (describe'

16 Total assets (to be comprtedby allfirers -_ _

-_ _ _ _ _

see the instructions. Also, see page 1, item I) 2, 019, 606. 1, 899, 014. 4, 192, 068.L 17 Accounts payable and accrued expenses

IA 18 Grants payable

B 19 Deferred revenue

IL 20 Loans from officers, directors, trustees, & other disqualified persons

I 21 Mortgages and other notes payable (attach schedule)

T 22 Other liabilities (describe' )

ES 23 Total liabilities (add lines 17 through 22) . 0. 0.

N F

Foundations that follow SFAS 117, check here . 'and complete lines 24 through 26, and lines 30 and 31.

24 UnrestrictedE UT N 25

Temporarily restricted

D 26 Permanently restricted

S BS AE LT A

Foundations that do not follow SFAS 117, check here 'Xand complete lines 27 through 31.

27 Capital stock , trust principal , or current funds 26 109. 26 109.

S N 28 Paid-in or capital surplus, or land, bldg, and equipment fund

C0 E

29 Retained earnings, accumulated income, endowment, or other funds 1 493 497. 1 372 , 905.R S 30 Total net assets or fund balances (see instructions) 2 019 606. 1 899 , 014. 1

31 Total liabilities and net assets/fund balances(see instructions) 2, 019, 606. 1 899 , 014. 1

Part III Analysis of (:han es in Net Assets or I-una Balances

1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree withend-of-year figure reported on prior year's return) 1 2 , 019 , 606.

2 Enter amount from Part I, line 27a . . . . . . 2 -120 , 518.

3 Other increases not included in line 2 (itemize) "SEE STATEMENT 6 -3 123 .

4----------------------------

Add lines 1, 2, and 3 . . . . 4 1 , 899 , 211.5 Decreases not included in line 2 (itemize). . . STATEMENT 7SEE 5 197 .

6

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ __ _

Total net assets or fund balances at end of year (line 4_mi_nus Ilne 5) - Part II, column (b), line 30- 6 1 , 899 , 014.BAA TEEA0302L 08/24/17 Form 990-PF (2017)

Form 990-PF (2017) WORMSLOE FOUNDATION, INC. 58-6034319 Page 3artx , i Capita l G ains and Losses for Tax on Investment Income

(a) List and describe the kind(s) of property sold (for example , real estate,2-story brick warehouse , or common stock, 200 shares MLC Company)

(b) How acquiredP - PurchaseD - Donation

(C) Date acquiredImo , day, yr.)

(d) Date soldImo , day, yr )

1a SEE STATEMENT 8b

C

d

e

(e) Gross sales price (0 Depreciation allowed(or allowable )

(g) Cost or other basisplus expense of sale

(h) Gain or (loss)((e) plus (f) minus (g))

a

b

C

de

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31 /69 (I) Gains ( Col (h)

(i) FMV as of 12/31/69 0) Adjusted basisas of 12/31/69

(k) Excess of col (i)over col 0 ), if any

gain minus col (k), but not lessthan -0 -) or Losses ( from col (h))

a

b

C

de

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 90 , 876.3 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 -9, 926.

,Party _ 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 this part blank

Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base periods F1D Yes n No

If 'Yes,' the foundation doesn't qualify under section 4940 ( e). Do not complete this part

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

Base period yearsCalendar year (or tax year

beginning in)

Adjusted qualifying distributionsc)

Net value ofnoncharitable - use assets (col

Distribut ion

ratio(b) divided by col (c))

2016 213,844 . 4 , 099 , 3450 0.0521652015 570 265. 3,354 803. 0.1699852014 212 790. 4,093,165. 0.0519872013 187, 941. 3,859 , 678. 0.0486932012 55 , 415. 3, 389 , 512. 0. 016349

2 Total of line 1, column (d) 2 0.339179

3 Average distribution ratio for the 5 - year base period - divide the total on line 2 bynumber of years the foundation has been in existence if less than 5 years

5 0 , or by the3 0. 067836

4 Enter the net value of nonchantable - use assets for 2017 from Part X , line 5 4 4 , 049 , 016.

5 Multiply line 4 by line 3 5 274 , 669.

6 Enter 1% of net investment income ( 1% of Part 1, line 27b) 6 1 , 809.

7 Add lines 5 and 6 7 276 , 478.

8 Enter qualifying distributions from Part XII, line 4 8 383 , 989.

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

BAA TEEA0303L 08/24/17 Form 990-PF (2017)

Form 990-PF (2017) WORMSLOE FOUNDATION, INC. 58-6034319 Page 4

Part VI Excise Tax Based on Investment Income (Section 4940(a), 4940( b), 4940(e), or 4948 - see instructions )

1 a Exempt operating foundations described in section 4940(d)(2), check here ' u and enter 'N/A' on line 1

Date of ruling or determination letter

Ch

(attach copy of letter if necessary - see instructions)

b Domestic foundations that meet e section 4940(e) requirements in Part V, 1

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

c All other domestic foundations enter 2% of line 27b Exempt foreign organizations enter 4% of Part I, line 12, col. (b) -

Yes No

1a X

1b X

1c X

0.

. 2 X

2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxablefoundations only, others, enter -0-) . 2 0.

3 Add lines 1 and 2 3 1,809.

4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only, others , enter -0-) 4 0.

5 Tax based on investment income . Subtract line 4 from line 3. If zero or less, enter -0- 5 1,809.

6 Credits/Payments.

a 2017 estimated tax pmts and 2016 overpayment credited to 2017 6a 2,400.

b Exempt foreign organizations - tax withheld at source 6b

c Tax paid with application for extension of time to file (Form 8868) 6c 1,000.

d Backup withholding erroneously withheld 6d

7 Total credits and payments Add lines 6a through 6d 7 3, 400.

8 Enter any penalty for underpayment of estimated tax. Check here 11if 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 0.

10 Overpayment . If line 7 is more than the total of lines 5 and 8, enter the amount overpaid 10 1 , 591.11 Enter the amount of line 10 to be Credited to 2018 estimated tax 1,591. Refunded 11 0.

Part VII-A Statements Reciardinq Activities

1 a During the tax year, did the foundation attempt to influence any national, state, or local legislation or did itparticipate or intervene in any political campaign?

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

If the answer is 'Yes' to 1a or 1b, attach a detailed description of the activities and copies of any materials publishedor distributed by the foundation in connection with the activities.

c Did the foundation file Form 1120-POL for this year?

d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year-

(1) On the foundation $- $ 0. (2) On foundation managers B. $

e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax impose

foundation managers ' $ 0.

2 Has the foundation engaged in any activities that have not previously been reported to the IRS?

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

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

b If 'Yes,' has it filed a tax return on Form 990-T for this year?

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

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

3 X

4a X4b N A5 X

1,809.

• 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

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 XV 7

8 a Enter the states to which the foundation reports or with which it is registered See instructions . .

GA

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 Instruct ion G2 If 'No,' attach explanation 8

9 Is the foundation claiming status as a private operatin g foundation within the meaning of section 4942(j )(3) or 4942 (1)(5)for calendar year 2017 or the tax year beginning in 2017 See the instructions for Part XIV . If 'Yes,' complete Part XIV . 9

10 Did any persons become substantial contributors during the tax year ? If 'Yes,' attach a schedule listing their namesand addresses

BAA

X

X

X

X

- 1 10 1 1 XForm 990-PF (2017)

TEEA0304L 08/24/17

Form 990-PF (2017) WORMSLOE FOUNDATION , INC. 58-6034319 Page 5Part VII-A Statements Regarding Activities (continued)

11 At any time during the year, did the foundation, directly or indirectly, own a controlled entityYes No

within the meaning of section 512(b)(13)7 If 'Yes,' attach schedule. See instructions 11 X

12 Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person hadadvisory privileges? If 'Yes,' attach statement. See instructions 12 X

13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? 13 X

Website address ' N/A----------------------------------------

14 The books are in care of -- CRAIG BARROW, III Telephone no (912) 234-5400----------------------------- -------------

Located at ► WORMSLOE LIBRARY SAVANNAH GA ZIP +4 ► 31406----------------------------------- ---------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 N/A

16 At any time during calendar year 2017, did the foundation have an interest in or a signature or other authority over a Yes No

bank, securities, or other financial account in a foreign country? 16 X

See the instructions for exceptions and filing requirements for FinCEN Form 114 If 'Yes,'enter the name of the foreign country '

Part VII- B Statements Regardin g Activities for Which Form 4720 May Be Req uiredFile Form 4720 if any item is checked in the 'Yes' column , unless an exception applies. Yes No

1 a 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? liYes 9 No

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) adisqualified person? Yes X No

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? Yes X No

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? Yes X No

(5) Transfer any income or assets to a disqualified person (or make any of either availablefor the benefit or use of a disqualified person)? Yes No

(6) Agree to pay money or property to a government official? (Exception . Check 'No' if thefoundation agreed to make a grant to or to employ the official for a period after terminationof government service, if terminating within 90 days ) lYes No

b If any answer is 'Yes' to 1 a(1)-(6) did any of the acts fail to qualif under the exceptions described in, yRegulations section 53 4941 (d)-3 or in a current notice regarding disaster assistance? See instructions 1 b N I AOrganizations relying on a current notice regarding disaster assistance, check here

c Did the foundation engage in a prior year in any of the acts described in 1 a other than excepted acts, ,that were not corrected before the first day of the tax year beginning in 20177 1 c X

2 Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was aprivate operating foundation defined in section 49420)(3) or 49420)(5))

a At the end of tax year 2017, did the foundation have any undistributed income (lines 6dand 6e, Part XIII) for tax year(s) beginning before 2017 lYes 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) toall years listed, answer 'No' and attach statement - see instructions) 2b N A

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 businessth ?t t t den erprise a ime uringany e year

11Yes No

b If 'Yes,' did it have excess business holdings in 2017 as a result of (1) any purchase by the foundationor disqualified persons after Mg, 26, 1969, (2 the lapse of the 5 year period (or longer period approvedby the Commissioner under seon 4943(c) 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, todetermine if the foundation had excess business holdings in 2017) .. 3 b N A

4a Did the foundation invest during the year any amount in a manner that would jeopardize itscharitable purposes? 4a X

b Did the foundation make any investment in a prior year (but after December 31, 1969) that couldjeopardize its charitable purpose that had not been removed from jeopardy before the first day ofthe tax year beginning in 2017? .. .. 4b X

BAA Form 990-PF (2017)

TEEA0305L 08/24/17

Form 990-PF (2017) WORMSLOE FOUNDATION, INC. 58-603 4319 Page 6art Statements Regard ing Activities for Wh ich Form 4720 May Be Required (continued)5 a 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))' Yes No

(2) Influence the outcome of any specific public election (see section 4955); or to carryon, directly or indirectly, any voter registration drive? Yes X No

(3) Provide a grant to an individual for travel, study, or other similar purposes? Yes }( No

(4) Provide a grant to an organization other than a charitable, etc , organization described4945 4 A ' St d t t Y Nion )( )in sec ( )( ee ins ruc ions es o

(5) Provide for any purpose other than religious, charitable, scientific, literary, oreducation ev animals?l os s fo the nti of lt h ldt Y Npurp , or r pr on crue i ren ora e e y o c es o

b If any answer is 'Yes' to 5a(1)-(5), did any of the transactions fail to qualify under the exceptionsdescribed in Regulations section 53 4945 or in a current notice regarding disaster assistance?See instructions 5b N A

Organizations relying on a current notice regarding disaster assistance, check here

c If the answer is 'Yes' to question 5a(4), does the foundation claim exemption from thetax because it maintained expenditure responsibility for the grant? N/A Yes NoIf 'Yes,' attach the statement required by Regulations section 53 4945-5(d).

6 a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiumson a personal benefit contract

11Yes

N No

b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract ? 6 b X

If 'Yes' to 6b, file Form 8870

7 a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? 11 Yes X No

t

b If 'Yes,' did the foundation receive any proceeds or have any net income attributable to the transaction? N/A. 7

art VIII Information About Officers , Directors , Trustees , Foundation Managers , Highly Paid Employees,Pand Contractors

1 List all officers , directors , trustees , and found ation managers and their compensation . See instructions.

(a) Name and address

(b) Title, and averagehours per week

devoted to position

(c) Compensation(If not paid ,enter -0-)

(d) Contributions toemployee benefitplans and deferred

compensation

(e) Expense account,other allowances

SEE-STATEMENT 9- - - - - - - _ - _

------------------------0. 0. 0.

------------------------------------------------

------------------------------------------------

------------------------

------------------------

2 Comcensation of five hiahest-Daid emDlovees (other than those included on line 1 - see instructions ). If none. enter 'NONE.'

(a) Name and address of each employeeaid more than $50,000

p

(b) Title, and averagehours per week

devoted to position(c) Compensation

(d) Contributions toemployee benefitplans and deferred

compensation

(e)account,

other alelowances

NONE --------------------------------------------

------------------------------------------------

------------------------------------------------

------------------------------------------------

------------------------------------------------

Total number of other employees paid over $50,000. 0

BAA TEEA0306L 08/24/17 Form 990•FF (2017)

Form 990-PF (2017) WORMSLOE FOUNDATION, INC. 58-6034319 Page 711AR,0V,ill 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 0

Part IX, , 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 I Expensesorganizations and other beneficiaries served, conferences convened, research papers produced, etc

1 N/A-----------------------------------------------------

-----------------------------------------------------

2

3

4

IPartiIX1B4I Summary of Proaram - 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 NLA---------------------------------------------------------------------------------------------------------

2------------------------------------------------------

------------------------------------------------------

All other program - related investments . See instructions

3------------------------------------------------------

------------------------------------------------------

Total . Add lines 1 through 3 1. 1 .0.


TEEA0307L 08/24/17

Form 990-PF (2017) WORMSLOE FOUNDATION, INC. 58-6034319 Page 8Part-X, 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 , purposesa Average monthly fair market value of securities

b Average of monthly cash balances

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

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

e Reduction claimed for blockage or other factors reported on lines 1 a and

lc (attach detailed explanation) 1 e

2 Acquisition indebtedness applicable to line 1 assets

3 Subtract line 2 from line ld

4 Cash deemed held for charitable activities Enter 1.1/2% of line 3(for greater amount, see instructions)

5 Net value of noncharitable-use assets . Subtract line 4 from line 3 Enter here and on Part V, line 4

6 Minimum investment return . Enter 5% of line 5

1 Minimum investment return from Part X, line 6 1

2a Tax on investment income for 2017 from Part VI, line 5 2a 1, 809.

b Income tax for 2017 (This does not include the tax from Part VI) 2b

c Add lines 2a and 2b 2c

3 Distributable amount before adjustments Subtract line 2c from line 1 3

4 Recoveries of amounts treated as qualifying distributions 4

5 Add lines 3 and 4 5

6 Deduction from distributable amount (see instructions) 6

7 Distributable amount as adjusted Subtract line 6 from line 5. Enter here and on Part XIII, line 1 7

Part XII Qualifying Distributions (see instructions)

1 Amounts paid (including administrative expenses) to accomplish charitable, etc., purposesa Expenses, contributions, gifts, etc - total from Part I, column (d), line 26

b Program-related investments - total from Part IX-B

2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc , purposes

3 Amounts set aside for specific charitable projects that satisfy thea Suitability test (prior IRS approval required)

b Cash distribution test (attach the required schedule)

4 Qualifying distributions . Add lines 1a through 3b Enter here and on Part V, line 8; and Part XI H, line 4

5 Foundations 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

6 Adjusted qualifying distributions . Subtract line 5 from line 4

2, 852,531.153,273.

1, 104,872.

4, 110,676.

0.

4, 110, 676.

61,660.4, 049, 016.

202,451.oundations

202,451.

1,809.200,642.

200,642.

200,642.

383,989.

1 4 1 383,989.

5 1,809.6 382,180.

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


Distributable Amount (see instructions) (Section 49420)(3) and (j)(5) private operatingand certain foreign organizations, check here' nand do not complete this part.)

TEEA0308L 09/12/17


Part XIII, Undistributed Income (see instructions)

1 Distributable amount for 2017 from Part XI,line 7

2 Undistributed income, if any, as of the end of 2017-

a Enter amount for 2016 only

b Total for prior years' 20 , 20 20

3 Excess distributions carryover, if any, to 2017

a From 2012

b From 2013 1,794,cFrom 2014 12,750.d From 2015 405, 043 .e From 2016 11,256.f Total of lines 3a through e

4 Qualifying distributions for 2017 from Part

XII, line 4 " $ 383,989.a Applied to 2016, but not more than line 2a

b Applied to undistributed income of prior year!(Election required - see instructions)

c Treated as distributions out of corpus(Election required - see instructions)

d Applied to 2017 distributable amount

e Remaining amount distributed out of corpus

5 Excess distributions carryover applied to 2017(If an amount appears in column (d), thesame amount must be shown in column (a)

6 Enter the net total of each column asindicated below:

a Corpus. Add lines 3f, 4c, and 4e Subtract line 5

b Prior years' undistributed income Subtractline 4b from line 2b

c Enter the amount of prior years' undistributedincome for which a notice of deficiency hasbeen issued, or on which the section 4942(a)tax has been previously assessed

d Subtract line 6c from line 6b Taxableamount - see instructions

e Undistributed income for 2016 Subtract line 4a fromline 2a Taxable amount - see instructions

f Undistributed income for 2017 Subtract lines4d and 5 from line 1. This amount must bedistributed in 2018

7 Amounts treated as distributions out ofcorpus to satisfy requirements imposed bysection 170(b)(1)(F) or 4942(g)(3) (Electionmay be required - see instructions)

8 Excess distributions carryover from 2012 notapplied on line 5 or line 7 (see instructions)

9 Excess distributions carryover to 2018.Subtract lines 7 and 8 from line 6a

10 Analysis of line 9

a Excess from 2013 1 , 794.b Excess from 2014 12 , 750.c Excess from 2015 405 043 .

d Excess from 2016 11 , 256.

e Excess from 2017 1 83,347.

BAA

(a) (b) (c) (d)Corpus Years

prior to 2016 2016 2017

200, 642.

0.0

430,843.

0.

0.

0.00,64

183,347.

0.

614,190.

0.

0.

0.

0.

614,190.

Form 990-PF (2017)

TEEA0309L 08/24/17


Part XIV Private Operating Foundations (see instructions and Part VII - A, question 9) N/,A1 a If the'foundation has received a ruling or determination letter that it is a private operating foundation , and the ruling /

is effective for 2017, enter the date of the ruling - '

b Check box to indicate whether the foundation is a private operating foundation described in section 4942(f)(3),d 4942(1)(5)

2 a Enter the lesser of the adjusted net Tax year Prior 3 years (e) Totalincome from Part I or the minimuminvestment return from Part X for (a) 2017 (b) 2016 (c) 2015 (d),2014

each year listed

b85%ofline 2a

c Qualifying distributions from Part XII,line 4 for each year listed

d Amounts included in line 2c not used directlyfor active conduct of exempt activities

e Qualifying distributions made directlyfor active conduct of exem pt activitiesSubtract line 2d from line 2c

3 Complete 3a, b, or c for thealternative test relied upon

a 'Assets' alternative test - enter:

(1) Value of all assets

(2) Value of assets qualifying undersection 4942()(3)(B)(i)

b 'Endowment ' alternative test - enter 2/3 ofminimum investment return shown in Part X,line 6 for each year listed

c 'Support' alternative test - enter.

(1) Total support other than grossinvestment income ( interest,dividends, rents , paymentson securities loans (section512(a)(5)), or royalties)

(2) Support from general public and 5 ormore exempt organizations as providedin section 4942(I)(3)(B)(ui)

(3) Largest amount of support froman exempt organization

(4) Gross investment income

gPart XVI Supplementary Information (Complete this part only if the foundation had $5,000 or more inassets 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 theclose of any tax year (but only if they have contributed more than $5,000) (See section 507(d)(2).)

SEE STATEMENT 10

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 ofa partnership or other entity) of which the foundation has a 10% or greater interest

NONE

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

Check here " F1 if the foundation only makes contributions to preselected charitable organizations and doesnot accept unsolicited

requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under other conditions, complete items2a, 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

SEE STATEMENT 11b The form in which applications should be submitted and information and materials they should include

SEE STATEMENT FOR LINE 2A

c Any submission deadlines:

SEE STATEMENT FOR LINE 2Ad Any restrictions or limitations on awards, such as by geographical areas , charitable fields, kinds of institutions, or other factors.

SEE STATEMENT FOR LINE 2A

BAA TEEA0310L 09/14/17 Form 990•PF (2017)


Part XNA Supplementary Information (continued)3 Grants and Contributions Paid During the Year or Approved for Future Payment

RecipientIf recipient is an individual ,show any relationship toany foundation manager

Foundationstatus of Purpose of

grant orcontribution

Amount

Name and address (home or business) or substantial contributor recipient

a Paid during the year

SEE STATEMENT 12

Total 3a 356,300.b Approved for future payment

Total 3 blBAA TEEA0501L 08/24/17 Form 990-PF(2017)

Form 990-PF (2017 ) WORMSLOE FOUNDATION, INC. 58-6034319 Page 12

gross amounts unless otherwise indicated

1 Program service revenue-

a

b

c

d

e

f

g Fees and contracts 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 or (loss) from special events

10 Gross profit or (loss) from sales of inventory

11 Other revenue-

a SEE ATTACHED LOSS SCHb

c

d

e

12 Subtotal. Add columns (b), (d), and (e)

13 Total. Add line 12, columns (b), (d), and (e)

Unrelated business income

(a) (b)Business Amountcode

Excluded by section 512, 513, or 514 (e)

(c) (d) Related or exemptExclu- Amount function incomeSion (See instructions )code

7

13 185,411.

BAA TEEA0502L 08124/17 Form 990•PF (2017)

Form 990-PF (2017) WORMSLOE FOUNDATION, INC. 58-6034319 Page 13Part XVII Information Regarding Transfers to and Transactions and Relationships With Noncharitable

Exempt OrganizationsYes No

Did the organization directly or indirectly engage in any of the following with any other organizationdescribed in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527,relating to political organizations?

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

(1) Cash 1 a (1) X

(2) Other assets 1 a (2) X

b Other transactions.

(1) Sales of assets to a noncharitable exempt organization 1 b (1) X

(2) Purchases of assets from a nonchantable exempt organization. 1 b (2) X

(3) Rental of facilities, equipment, or other assets 1 b (3) X

(4) Reimbursement arrangements 1 b (4) X

(5) Loans or loan guarantees 1 b (5) X

(6) Performance of services or membership or fundraising solicitations - 1 b (6) X

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees 1 c X

d If the answer to any of the above is 'Yes,' complete the following schedule Column (b) should always show the fair market value ofthe goods, other assets, or services given by the reporting foundation If the foundation received less than fair market value inany 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

N/A

2 a Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizationsdescribed in section 501 (c) of the Code (other than section 501(c)(3 )) or in section 5277 .. E]Yes Fx1 No

b If 'Yes,' complete the following schedule

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

N/A

Under penalt o perjury, I declar t I have examined this return, including accom pan ^^

Schedule B ,(Form 990, 990-EZ,or 990-PF)

Department of the TreasuryInternal Revenue Service

Name of the organization

Schedule of ContributorsAttach to Form 990, Form 990-EZ, or Form 990-PF.

Go to www.irs.gov/Form990 for the latest information.

LOE FOUNDATION, INC.

OMB No 1545-0047

2017

58-6034319

number

Organization type (check one)

Filers of: Section:

Form 990 or 990 -EZ F] 501 (c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

U 527 political organization

Form 990-PF 501 (c)(3) exempt private foundation

fl 4947(a)(1) nonexempt charitable trust treated as a private foundationFX 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(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule See instructions

General Rule

X Foran organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or

property) from any one contributor Complete Parts I and II See instructions for determining a contributor's total contributions

Special Rules

U For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33-1/3% support test of the regulationsunder sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990 Part II, line 13, 16a, or 16b, and thatreceived from any one contributor, during the year, total contributions of the greater o (1) $5,000 or (2) 2% of the amount on (1)Form 990, Part VIII, line 1 h, or (u) Form 990-EZ, line 1 Complete Parts I and II

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,during the year, total contributions of more than $ 1,000 exclusi vely for religious, charitable, scientific, literary, or educationalpurposes , or for the prevention of cruelty to children or animals Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ 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 No.

Caution . An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990, 990-EZ, or990-PF), but it must answer 'No' on Part IV, line 2, of its Form 990, or check the box on line H of its Form 990-EZ or on its Form 990-PF,Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF)

BAA For Paperwork Reduction Act Notice , see the instructions for Form 990 , 990-EZ , or 990 - PF. Schedule B (Form 990, 990-EZ , or 990-PF) (2017)

TEEA0701L 08/09/17

Schedule B (Form 990, 990-EZ, or 990-PF) (2017) Page 1 of 1 of Part IName of organization Employer identification number

WORMSLOE FOUNDATION, INC. 58-6034319

I g Pa=rt^l Contributors (see instructions). Use duplicate copies of Part I if additional space is needed

(a) (b) (c) (d)Number Name , address , and ZIP + 4 Total Type of contribution

contributions

1 CRAIG & DIANA BARROW IIIPerson

_------------------------------------- Payroll

22 -W. - BRYAN ST_ PMB 300 ____________________ $_____ 50L784_ Noncash 1XI

SAANNH, GA 31401______(Complete Part fornoncashcontrlbutions

(a) (b) (c) (d)Number Name, address, and ZIP + 4 Total Type of contribution

contributions

2 CRAIG BELL & GILES EPerson

- - - - -------- ________________Payroll

41 _DEARBORN STREET----------------------------- $_ 11500_ Noncash El

SALEM, MA 01970 __________________________(Complete Part II fornoncash contributions)


contributions

3 MR. AND MRS. MARK V. SMITHPerson

----------------------------------- - -q

Payroll

141 FAIRWINDS-ROAD - - - - - -__________________

------------ $______5,000_ Noncash

SAVANNAH, GA 31410 ________________________(Complete Part II for(Complete

contributions)


contributions

4 ALAN ELSASPerson X^

-------------------------------------q

Payroll

1177 AVE OF THE AMER1_41ST_FLR-------------- -----------------$_____ 10, 000_ Noncash

NEW YORK _NY 10036_2714 ______________ _ _ _ - _ _(Complete Part fornoncashcontrlbutlons

(a) (b) (c) (d)Number Name , address, and ZIP + 4 Total Type of contribution

contributions

5 FOUNDATIONSHADY DALEPerson

------------------------------------ - Payroll

P.O.-BOX -8306 - - - - ---Noncash

SAVANNGA 31412_p

(a) (b) (d)Number Name , address , and ZIP + 4 Type of contribution

-

Person

--- Payroll

Noncash

Complete Part 11 for_____________________________________ oncashcontributions.)

RAA TEEA0702L 08/09/17 Schedule B (Form 990 . 990-EZ. or 990-PF) (2017)

Schedule B (Form 990 , 990-EZ , or 990 -PF) (2017) Page 1 to 1 of Part IIName of organization Employer identification number


Part II Noncash Property (see instructions) Use duplicate copies of Part II if additional space is needed

(a) No. (b) (c) (d)from Description of noncash property given FMV (or estimate) Date receivedPart I (See instructions.)

2400 SH PLAINS -ALL -AMERICAN ____________________1---- ----------------------------------------

-------------------------------------------------------------------------------- $ 50,

784 .----------- --- -----


----

----------------------------------------

----------------------------------------

----------------------------------------

---------------------------------------- ---------- -- -----


----

----------------------------------------

---------------------------------------

----------------------------------------

----------------------------------------

$----------- --- -----


----

----------------------------------------

----------------------------------------

----------------------------------------

----------------------------------------

$----------- -- -----


----

----------------------------------------

---------------------------------------

----------------------------------------

---------------------------------------- ---------- -- -----


----

----------------------------------------

----------------------------------------

----------------------------------------

Ree Schedule B (Form 990. 990-EZ . or 990-PR (2017)

TEEA0703L 08/09/17

Schedule B (Form 990 , 990-EZ , or 990 -PF) (2017) Page 1 to 1 of Part III

Name of organization ' Employer identification number

WORMSLOE FOUNDATION, INC. 58-6034319Part III Exclusively religious , charitable , etc., contributions to organizations described in section 501(c)(7), (8),

or (10) that total more than $1 ,000 for the year from any one contributor. Complete columns (a) through (e) andthe following line entry For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,

contributions of $1,000 or less for the year (Enter this information once See instructions) $ -RZAUse duplicate copies of Part III if additional space is needed

(a)No. fromPart I

Purpose of gift Useof

giftd

Description of how gift is held

----

N/A -----------------

--------------------

-----------------------------------------

--------------------

-------------------------------------------

---------------------

(e)Transfer of gift

Transferee ' s name , address , and ZIP + 4 Relationship of transferor to transferee

----------------------------------

----------------------------------

----------------------------------

---------------------------

------------ ---------------

---------------------------

aNo. fromPart l

bPurpose of gift

cUseof gift

dDescription of how gift is held

----

- - - - - - - - - - - - - - - - - - -

--------------------

-----------------------------------------

--------------------

-------------------------------------------

------ ---------------

(e)Transfer of gift

Transferee ' s name , address, and ZIP + 4 Relationship of transferor to transferee

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

----------------------------------

----------------------------------

---------------------------

---------------------------

---------------------------

(a)No. fromPart I

(b)Purpose of gift

(c)Use of gift

(d)Description of how gift is held

----

- - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - -

-------------------

--------------------

--------------------

--------------------

---------------------

------------------------------------------

(e)Transfer of gift

Transferee's name , address, and ZIP + 4 Relationship of transferor to transferee

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

---------------------------------------------------------------------

-------------------------------------------------------

---------------------------

(a)No. fromPart I

(b)Purpose of gift

(c)Use of gift

(d)Description of how gift is held

----

- - - - - - - - - - - - - - - - - - -

-------------------

-------------------

--------------------

--------------------

--------------------

------ ---------------

---------------------

---------------------

(e)Transfer of gift

Transferee ' s name , address, and ZIP + 4 Relationship of transferor to transferee

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

-----------------------------------

-----------------------------------

------------ ---------------------------- ---------------

------------- ---------------

BAA Schedule B (Form 990, 990-EZ, or 990-PF) (2017)TEEA0704L 08/09/17

2017 FEDERAL STATEMENTS PAGE 1

WORMSLOE FOUNDATION , INC. 58-6034319

STATEMENT 1FORM 990 - PF, PART I , LINE 11OTHER INCOME

(A) (B) NET (C)REVENUE INVESTMENT ADJUSTED

PER BOOKS INCOME NET INCOME

SEE ATTACHED LOSS SCH $ -5 , 679.679 $TOTAL -5 0 0., . .

STATEMENT 2FORM 990 - PF, PART I , LINE 16BACCOUNTING FEES

(A) (B) NET (C) (D)EXPENSES INVESTMENT ADJUSTED CHARITABLEPER BOOKS INCOME NET INCOME PURPOSES

CHISOLM ACCOUNTING $ 5,100. $ 5,100.KRT CPAS PC 2,450. 2,450.

TOTAL $ 7,550. $ 0. 0. $ 7,550.

STATEMENT 3FORM 990-PF , PART I , LINE 16COTHER PROFESSIONAL FEES


NICOLE ISENBARGER, CONSULTANT $ 3 600.TOTAL 3,600. 0. 0.

$ 3 600.3,600.

STATEMENT 4FORM 990-PF , PART I, LINE 18TAXES


US TREASURY $ 1 , 656.TOTAL 1,656.

$ 1 , 656.1,656. 0. 0.



STATEMENT 5FORM 990 - PF, PART I , LINE 23OTHER EXPENSES


1231 LOSSES $ 1,473. $ 1,473.HONORARIUM 1,000. $ 1,000.K-1 ACTIVITIES: INVESTMENT EXP 546. 546.K-1 ACTIVITIES: MISC EXP 75. 75.K-A ACTIVITIES: MANAGEMENT FEES 6,474. 6,474.OFFICE & TRAVEL EXPENSE 631. 631.REPAIRS AND MAINTENANCE

TOTAL14 908.25,107. 8,588. $ 0. $

14,908.16,539.

STATEMENT 6FORM 990-PF, PART III, LINE 3OTHER INCREASES

NONTAXABLE DISTRIBUTIONS $ 123.TOTAL $ 123.

STATEMENT 7FORM 990-PF, PART III, LINE 5OTHER DECREASES

NON-DEDUCTIBLE EXPENSES FROM K-1S $ 197.TOTAL 197.

STATEMENT 8FORM 990- PF, PART IV, LINE 1CAPITAL GAINS AND LOSSES FOR TAX ON INVESTMENT INCOME

(B) HOW (C) DATE (D) DATEITEM (A) DESCRIPTION ACQUIRED ACQUIRED SOLD1 CITIZENS BANK CD PURCHASED 5/25/2017 8/31/20172 KINDER MORGAN INC PURCHASED 10/25/20 16 2/22/20173 MARATHON OIL CORP PURCHASED 8/31/201.6 2/13/20174 METABANK CD PURCHASED 3/23/20-17 6/30/20175 OMEGA HEALTHCARE PURCHASED 5/02/2017 11/07/20176 PLAINS ALL AMERICAN PIPELINE PURCHASED 11/07/2017 11/07/20177 CITIZENS BANK CD PURCHASED 2/28/2017 6/08/20178 DOWDUPONT INC PURCHASED 5/20/20 10 9/01/20179 GENERAL ELECTRIC CO PURCHASED 6/27/2011 10/11/201710 MACYS INC PURCHASED 5/18/2016 11/29/201711 PENSKE AUTOMOTIVE GP PURCHASED 3/22/20 16 4/19/201712 QUALCOMM INC PURCHASED 8/02/2016 10/24/201713 STARWOOD PPTY TRUST PURCHASED VARIOUS 3/27/201714 SCORPIO TANKERS INC PURCHASED 7/11/2016 11/08/201715 EXXON MOBIL CORP PURCHASED VARIOUS 8/21/201716 FROM CHATHAM SMALL CAP LP K-1 PURCHASED VARIOUS 12/31/201717 FROM CHATHAM SMALL CAP LP K-1 PURCHASED VARIOUS 12/31/2017

2017 FEDERAL STATEMENTS

WORMSLOE FOUNDATION , INC.

PAGE 3

58-6034319

STATEMENT 8 (CONTINUED)FORM 990-PF, PART IV, LINE 1CAPITAL GAINS AND LOSSES FOR TAX ON INVESTMENT INCOME

(B) HOW (C) DATE (D) DATEITEM (A) DESCRIPTION ACQUIRED ACQUIRED SOLD18 FROM BSR TRUST LLC K-1 PURCHASED VARIOUS 12/31/201719 FROM BSR TRUST LLC K-1 PURCHASED VARIOUS 12/31/201720 FROM APOLLO GLOBAL K-1 PURCHASED VARIOUS 12/31/201721 FROM APOLLO GLOBAL K-1 PURCHASED VARIOUS 12/31/2017

(E) (F) (G) (H) (I) (J) (K) (L)GROSS DEPREC. COST GAIN FMV ADJ. BAS. EXCESS GAIN

ITEM SALES ALLOWED BASIS (LOSS) 12/31/69 12/31/69 (I)-(J) (LOSS)1 10,000. 10,000. 0. $ 0.2 53,034. 54,992. -1,958. -1,958.3 62,756. 61,382. 1,374. 1,374.4 10,000. 10,000. 0. 0.5 55,393. 65,758. -10,365. -10,365.6 51,807. 50,784. 1,023. 1,023.7 50,000. 50,000. 0. 0.8 27. 11. 16. 16.9 45,155. 37,108. 8,047. 8,047.10 44,976. 61,792. -16,816. -16,816.11 93,764. 80,202. 13,562. 13,562.12 53,403. 60,183. -6,780. -6,780.13 67,394. 62,552. 4,842. 4,842.14 33,196. 43,988. -10,792. -10,792.15 37,601. 1,041. 36,560. 36,560.16 0. 2,030. -2,030. -2,030.17 72,587. 0. 72,587. 72,587.18 102. 0. 102. 102.19 99. 0. 99. 99.20 0. 2. -2. -2.21 1,407. 0. 1,407. 1,407.

TOTAL $ 90,876.

STATEMENT 9FORM 990-PF, PART VIII, LINE 1LIST OF OFFICERS , DIRECTORS , TRUSTEES , AND KEY EMPLOYEES

TITLE AND CONTRI- EXPENSEAVERAGE HOURS COMPEN- BUTION TO ACCOUNT/

NAME AND ADDRESS PER WEEK DEVOTED SATION EBP & DC OTHER

MRS.DIANA D. BARROW CHAIRMAN $ 0. $ 0. $ 0.7601 SKIDAWAY ROAD 2.00SAVANNAH, GA 31401

MR. CRAIG BARROW, III TREASURER 0. 0. 0.7601 SKIDAWAY ROAD 5.00SAVANNAH, GA 31406

DORINDA DALLMEYER TRUSTEE 0. 0. 0.3246 BOOGER HILL ROAD 1.00DANIELSVILLE, GA 30633

2017 FEDERAL STATEMENTS PACE 4


STATEMENT 9 (CONTINUED)FORM 990-PF, PART VIII, LINE 1LIST OF OFFICERS , DIRECTORS , TRUSTEES , AND KEY EMPLOYEES

TITLE AND CONTRI- EXPENSEAVERAGE HOURS COMPEN- BUTION TO ACCOUNT/

NAME AND ADDRESS PER WEEK DEVOTED SATION EBP & DC OTHER

MR. J. WILEY ELLIS TRUSTEE $ 0. $ 0. $ 0.P.O. BOX 9946 1.00SAVANNAH, GA 31412

MR. THORNTON D. BARROW TRUSTEE 0. 0. 0.221 MARINERS WAY 1.00SAVANNAH, GA 31419-9308

MRS. ELFRIDA B. SINKLER TRUSTEE 0. 0. 0.2180 ROSEBANK ROAD 1.00WADMALAW ISLAND, SC 29487

MRS. BRANDY LORETTA BARROW TRUSTEE 0. 0. 0.221 MARINERS WAY 1.00SAVANNAH, GA 31419-9308

MS. JULIET CHISOLM SECRETARY 0. 0. 0.5 WATERFORD LANE 5.00SAVANNAH, GA 31411

DR. CHARLES KNAPP TRUSTEE 0. 0. 0.310 INDIAN PIPE DRIVE 1.00BIG CANOE, GA 30143

SARAH ROSS PRESIDENT 0. 0. 0.P.O. BOX 40 4.00ROARING GAP, NC 28668

DR. DAN NADENICEK TRUSTEE 0. 0. 0.285 S. JACKSON STREET 1.00ATHENS, GA 30602

TOTAL 0. $ 0. 0.

STATEMENT 10FORM 990-PF , PART XV, LINE 1AFOUNDATION MANAGERS - 2% OR MORE CONTRIBUTORS

MR. CRAIG BARROW, IIIMRS. ELFRIDA B. SINKLER

STATEMENT 11FORM 990-PF, PART XV, LINE 2A-DAPPLICATION SUBMISSION INFORMATION

NAME OF GRANT PROGRAM:NAME: CRAIG BARROW, IIICARE OF:



STATEMENT 11 (CONTINUED)FORM 990- PF, PART XV, LINE 2A-DAPPLICATION SUBMISSION INFORMATION

STREET ADDRESS: P.O. BOX 8346CITY, STATE, ZIP CODE: SAVANNAH, GA 31412TELEPHONE:E-MAIL ADDRESS:FORM AND CONTENT: LETTERSUBMISSION DEADLINES:RESTRICTIONS ON AWARDS: LIMITED TO THE PRESERVATION AND STUDY OF AGRICULTURE,

HORTICULTURE, FORESTRY AND HISTORIC SITES AND DOCUMENTS.

STATEMENT 12FORM 990-PF , PART XV, LINE 3ARECIPIENT PAID DURING THE YEAR

FOUND-DONEE ATION PURPOSE OF

NAME AND ADDRESS RELATIONSHIP STATUS GRANT AMOUNT

THE UNIVERSITY OF GA PRESS N/A T/E BOOK PUBLICATION $ 6,000.ATHENS GA

WORMSLOE INSTITUTE FORENVIRON HISTORYISLE OF HOPESAVANNAH GA 31406

UNIV OF GA FDN - GRADUATESCHOOL279 WILLIAMS STREETATHENS GA 30602

UGA COLLEGE OFENVIRONMENTAL DESIGN285 S. JACKSON STREETATHENS GA 30602

BARTRAM TRAIL CONFERENCE168 N . CREST ROADCHATTANOOGA TN 37404

N/A

N/A

N/A

N/A

DAUFUSKIE ISLAND HISTORICAL N/AFOUNDATIONP.O. BOX 52DAUFUSKIE ISLAND SC 29915

T/E HISTORICAL 126,500.1PRESERVATION

T/E EDUCATIONAL 27,500.

T/E NATURAL 191,000.RESOURSESPRESERVATION

WE ENVIRONMENTAL 5,000.1

T/E ENVIRONMENTAL 300.1

TOTAL 356,300. 1

Wormsloe Foundation, Inc58-6034319

Year ended 12/31/17

Part I, Line 11 - Other Income/(Loss)

Other Income/(Loss) Amount

1 NW Quadrant Partners , L.P. 7,758

2 Apollo Global Management LLC 503

3 BSR Trust LLC (6,430)

4 Energy Transfer Partners (850)

5 Enterprise Products Partners LP (6,660)Total (5,679)

Wormsloe Foundation, Inc

58-6034319Year ended 12/31/17

Part I. Line 3 - Interest

Interest Amount

1 NW Quadrant Partners, L.P 462 BSR Trust LLC 7373 Chatham Small Cap Partnership 644 Enterprise Products Partners LP 125 Energy Transfer Partners 196 Stifel , Nicolaus & Company 1697 Apollo Global Management LLC 1,089

Total 2,136

Part I. Line 4 - Dividends

Dividends Amount

1 Chatham Small Cap Partnership2 Lazard Ltd3 Apollo Global Management LLC4 Energy Transfer Partners5 Stifel, Nicolaus & Company

Total

Part II, Line 1 - Cash

Cash

4,8782,4541,119

2089,607

98,078

Cost 12/31/17 FMV 12/31/17

1 South State Bank 18 , 821 18,821

Total 18 , 821 18,821

Part II, Line 2 - Savings and Temporary Cash Investments

Savings and Temporary Cash Investments Cost 12/31/17 FMV 12/31/17

1 Stifel, Nicolas & Company - Money Market 42,166 42,166

42,166 42,166

Wormsloe Foundation, Inc58-6034319

Year ended 12/31/17

Part II, Line 10b - Corporate Stocks

Corporate Stocks # of Shares Cost 12/31/17 FMV 12/31/17

1 Abbvie Inc 1,000 20,561 96,710

2 AFLAC Inc. 1,000 28,399 87,780

3 AT & T Inc 2,000 49,331 77,760

4 Abbott Laboratories 1,000 18,961 57,070

5 Altria Group Inc 2,000 34,028 142,820

6 American Tower Corp 500 21,710 71,335

7 Apple, Inc. 500 54,418 84,615

8 Aqua America Inc 1,875 33,311 73,556

9 Automatic Data Processing Inc 1,000 35,543 117,190

10 Bristol Myers Squibb Co 2,000 19,703 122,560

11 CVS Health Corp 1,000 13,832 72,500

12 Cisco Systems Inc 2,000 38,336 76,600

13 Coca-Cola Company 1,200 46,179 55,056

14 Costco Wholesale Corp. 1,000 33,276 186,120

15 Dowdupont Inc 1,538 42,011 109,536

16 Exxon Mobil Corp 2,000 6,689 167,280

17 Ford Motor Company 4,000 49,670 49,960

18 Genuine Parts Company 1,000 35,521 95,010

19 Hanesbrands Inc 2,500 53,055 52,275

20 Intel Corp 2,000 52,127 92,320

21 International Business Machines 500 67,435 76,710

22 Johnson & Johnson Common 1,000 37,240 139,720

23 Macy's Inc. 2,000 44,914 50,380

24 Merck & Company 1,500 56,258 84,405

25 Murphy USA Inc 1,000 32,896 80,360

26 On Semiconductor Corp 2,000 31,655 41,880

27 Oracle Corp 2,000 79,049 94,560

28 Pfizer Inc 1,500 49,433 54,330

29 Qualcomm Inc 1,000 52,227 64,020

30 Southern Company 1,500 71,431 72,135

31 Synchrony Financial 1,500 41,695 57,915

32 Verizon Communications 2,000 76,624 105,860

33 Vodofone Group Pic 2,000 58,575 63,800

34 Wal-Mart Stores Inc 1,000 48,718 98,750

35 XL Bermuda' 1,500 55,681 52,740

1,490,492

TB

3,025,618

Wormsloe Foundation, Inc.58-6034319

Year ended 12/31/17

Part II, Line 13 - Investments (Other)

Investments ( Other) Cost 12/31/17 FMV 12/31/17

1 Chatham Small Cap Partnership I, L P 320, 344 646,8872 BSR Trust LLC (Summit Housing ) ( 41,967) 200,0003 Northwest Quadrant Partners LP (106,394) -4 Apollo Global Mgmt LLC 57, 694 100,4105 Larard Ltd Shares A 32 , 030 52,5006 Energy Transfer Partners 41 , 691 44,8007 Enterprise Products Partners LP 43, 546 60,275

346,944 1,104,872

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Documents

1, 100. 591. 591. · 2018. 12. 19. · 9 Prepaid expenses and deferred charges 1, 100. 591. 591. S 10a Investments -U S. and state government obligations (attach schedule) b Investments