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OCTHEALTH LLC 7438 K-1 INC/LOSS PRI - BBI MEDICAL SOLUTIONS -14561 314741 4598247 -7123 4905865 11 BBI Medical - loss from program related investment to promote health & reduce suffering of those affected by early state pressure ulcers DURING THE HOSPITAL STAYS and TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH. Octhealth LLC - income from program related investment TO PROMOTE THE HEALTH OF PEOPLE WHO ARE AFFECTED BY POLLUTED DRINKING WATER BY FUNDING THE DEVELOPMENT OF A WATER MONITORING SYSTEM. false false false false false false false false false false Audit Fees 15000 15000 Jeff Polak * DAVID POLAK (DIRECTOR), JANET POLAK (DIRECTOR) AND JEFF POLAK PRESIDENT/DIRECTOR/EXECUTIVE DIRECTOR), OF DAVID & JANET POLAK FOUNDATION (THE "FOUNDATION"), ARE PRINCIPALS AT THE INVESTMENT MANAGEMENT FIRM POLAK INVESTORS, LLC, A DISQUALIFIED PERSON WHICH PROVIDES INVESTMENT MANAGEMENT SERVICES TO THE FOUNDATION. IN THE TAXABLE YEAR ENDING DECEMBER 31, 2023, THE FOUNDATION PAID $385,347 FOR INVESTMENT MANAGEMENT SERVICES RENDERED BY SUCH DISQUALIFIED PERSON, AS REPORTED IN PART I, LINE 16C. THE REASONABLENESS OF THE PROFESSIONAL FEES WAS ESTABLISHED BY AN OUTSIDE COMPENSATION COMMITTEE, WHICH REVIEWED THE RATES CHARGED BY COMPARABLE INVESTMENT MANAGEMENT FIRMS. NEUROVISION IMAGING INC 1395 GARDEN HIGHWAY SUITE 250 SACRAMENTO CA 95833 2014-12-17 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BRUIN BIOMETRICS LLC 10960 WILSHIRE BLVD SUITE 950 LOS ANGELES CA 90024 2015-05-13 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BIOP MEDICAL LTD 10 OHALIAV ST RAMAT GAN IS 5252263 2017-04-21 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. ONLINE DISRUPTIVE TECHNOLOGIES INC MATAM ADV TECH PK BLD 23 POBX 15050 HAIFA IS 3190501 2017-04-21 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. ORGENESIS LTD ARAD STREET 9 TEL AVIV IS 2017-04-21 305498 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BRYN PHARMA LLC FKA EPI-NOW LLC 518 NORTH HILLCREST ROAD BEVERLY HILLS CA 90210 2018-07-13 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. CYWAT TECHNOLOGIES LTD 168 JABOTINSKY ST BNEI BRAK IS 2018-11-26 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BIO-ACTIVES SYNERYGIO LTD FKA YB MO CHO HITECH VIL 4/9 GIVAT RAM POB 39231 JERUSALEM IS 9129102 2018-04-20 250000 PRI LOAN-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BIO-ACTIVES SYNERYGIO LTD FKA YB MO CHO HITECH VIL 4/9 GIVAT RAM POB 39231 JERUSALEM IS 9129102 2018-07-19 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. MAXQ AI LTD 96 YIGAL ALON STREET ENTRANCE A TEL AVIV IS 6789140 2019-03-19 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. EXTHERA MEDICAL CORPORATION 757 ARNOLD DRIVE SUITE B MARTINEZ CA 94553 2019-12-19 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. YONALINK LTD HADASSAH EIN KEREM HOSP POB 12000 JERUSALEM IS 9112001 2019-11-12 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. AMICROBE INC 3142 TIGER RUN COURT 103 CARLSBAD CA 92010 2019-10-31 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. OCTHEALTH LLC 1395 GARDEN HIGHWAY SUITE 250 SACRAMENTO CA 95833 2021-06-08 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BIO-ACTIVES SYNERGIO LTD HI-TECH VILLAGE UNIT 4/9 POB39231 GIVAT RAM IS 9129102 2021-10-12 100000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. CYWAT TECHNOLOGIES LTD 168 JABOTINSKY ST BNEI BRAK IS 2021-06-15 100000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. NEUROVISION IMAGING INC 1395 GARDEN HIGHWAY SUITE 250 SACRAMENTO CA 95833 2022-06-17 250000 PRI LOAN-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. YAMO PHARMACEUTICALS LLC 400 MADISON AVE STE 11A NEW YORK NY 10017 2022-07-13 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. part I line 6A (990-PF) part I line 6A (990-PF) RECONCILIATION OF NET GAIN/(LOSS) FROM SALES OF ASSETS NOT INCLUDED IN PART IV TOTAL INCLUDED IN PART IV: (DETAILS BELOW) NET GAIN/(LOSS): $1,787,804 TOTAL NOT INCLUDED IN PART IV: PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - UBI NET GAIN/(LOSS): $268,059 TOTAL PART I, LINE 6A: $2,055,863 DETAILS OF ASSETS INCLUDED IN PART IV: PUBLICLY-TRAIDED SECURITIES GROSS SALES PRICE: $26,361,429 BOOK BASIS: $25,671,719 NET GAIN/(LOSS): $689,710 PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - NON UBI NET GAIN/(LOSS): $1,098,094 Form 8865 Form 8865 The Foundation has prepared this form to the best of its ability based on the limited information provided to it by the investment on which the Foundation is reporting and on the basis of having received no information to the contrary. Any missing or incomplete information is due to the Foundation's inability to obtain such information and is not a willful attempt to withhold such information. 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