BASZUCKI FAMILY FOUNDATION: Form 990PF, tax year 2022

View the entire original 990 at ProPublica ↗

Organization: BASZUCKI FAMILY FOUNDATION (EIN 32-0660398)
Tax period: 2022-01-01 to 2022-12-31
Filed: 2023-11-14
IRS object ID: 202323189349103342
Schema version: 2022v5.0
Note: A later return for the same period supersedes this one.
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990-PF
Schedule B
Accounting Fees Schedule
Acty Not Previously Rpt Expln
All Oth Prog Rltd Investments Sch
Distribution From Corpus Election
General Explanation Attachment
Investments Corp Stock Schedule
Investments Govt Obligations Sch
Other Decreases Schedule
Other Expenses Schedule
Other Liabilities Schedule
Other Professional Fees Schedule
Taxes Schedule
Transfers To Controlled Entities

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2023-11-14T14:41:15-06:00	ReturnTs
Tax Period End	2022-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	920460586	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	PWC US TAX LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	1420 5TH AVE STE 2800	AddressLine1Txt
City	SEATTLE	CityNm
State Abbreviation	WA	StateAbbreviationCd
ZIP	981011344	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990PF	ReturnTypeCd
Tax Period Begin	2022-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	320660398	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	THE BASZUCKI FAMILY FOUNDATION	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	BASZ	BusinessNameControlTxt
Phone	6502418740	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	204 2ND AVENUE 522	AddressLine1Txt
City	SAN MATEO	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	944013904	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	JAN BASZUCKI	PersonNm
Person Title	SECRETARY/TREASURER	PersonTitleTxt
Phone	6502418740	PhoneNum
Signature	2023-11-14	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	JAN	PersonFirstNm
Person Last	BASZUCKI	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Field	Value	IRS element (for citing)
IRS Responsible Prty Info Curr	0	IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	KYLE TALLEY	PreparerPersonNm
PTIN	P01239408	PTIN
Phone	2063983000	PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	3	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2022	TaxYr
Build TS	2023-04-26 12:10:37Z	BuildTS

Form 990-PF IRS990PF

Field	Value	IRS element (for citing)
Organization501c3 Exempt PF	Yes (X)	Organization501c3ExemptPFInd
FMV Assets EOY	$25,858,896	FMVAssetsEOYAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

Field	Value	IRS element (for citing)
Contri Rcvd Rev And Expnss	$3,167,500	ContriRcvdRevAndExpnssAmt
Interest On Sav Rev And Expnss	$109,313	InterestOnSavRevAndExpnssAmt
Interest On Sav Net Invst Incm	$109,313	InterestOnSavNetInvstIncmAmt
Dividends Rev And Expnss	$100,894	DividendsRevAndExpnssAmt
Dividends Net Invst Incm	$100,894	DividendsNetInvstIncmAmt
Net Gain Sale Ast Rev And Expnss	$7,417,303	NetGainSaleAstRevAndExpnssAmt
Gross Sales Price	$7,417,323	GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm	$7,417,303	CapGainNetIncmNetInvstIncmAmt
Total Rev And Expnss	$10,795,010	TotalRevAndExpnssAmt
Total Net Invst Incm	$7,627,510	TotalNetInvstIncmAmt
Total Adj Net Incm	$0	TotalAdjNetIncmAmt
Comp Ofcr Dir Trst Rev And Expnss	$0	CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm	$0	CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Adj Net Incm	$0	CompOfcrDirTrstAdjNetIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl	$0	CompOfcrDirTrstDsbrsChrtblAmt
Accounting Fees Rev And Expnss	$58,788	AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm	$29,394	AccountingFeesNetInvstIncmAmt
Accounting Fees Adj Net Incm	$0	AccountingFeesAdjNetIncmAmt
Accounting Fees Chrtbl Prps	$29,394	AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss	$718,519	OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm	$0	OtherProfFeesNetInvstIncmAmt
Other Prof Fees Adj Net Incm	$0	OtherProfFeesAdjNetIncmAmt
Other Prof Fees Dsbrs Chrtbl	$718,519	OtherProfFeesDsbrsChrtblAmt
Taxes Rev And Expnss	$44,847	TaxesRevAndExpnssAmt
Taxes Net Invst Incm	$364	TaxesNetInvstIncmAmt
Taxes Adj Net Incm	$0	TaxesAdjNetIncmAmt
Taxes Dsbrs Chrtbl	$0	TaxesDsbrsChrtblAmt
Other Expenses Rev And Expnss	$108,341	OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm	$245	OtherExpensesNetInvstIncmAmt
Other Expenses Adj Net Incm	$0	OtherExpensesAdjNetIncmAmt
Other Expenses Dsbrs Chrtbl	$108,096	OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss	$930,495	TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm	$30,003	TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Adj Net Incm	$0	TotOprExpensesAdjNetIncmAmt
Tot Opr Expenses Dsbrs Chrtbl	$856,009	TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss	$31,694,969	ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl	$3,880,954	ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss	$32,625,464	TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm	$30,003	TotalExpensesNetInvstIncmAmt
Total Expenses Adj Net Incm	$0	TotalExpensesAdjNetIncmAmt
Total Expenses Dsbrs Chrtbl	$4,736,963	TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses	-$21,830,454	ExcessRevenueOverExpensesAmt
Net Investment Income	$7,597,507	NetInvestmentIncomeAmt
Adjusted Net Income	$0	AdjustedNetIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

Field	Value	IRS element (for citing)
Cash BOY	$23,406,896	CashBOYAmt
Cash EOY	$116,680	CashEOYAmt
Cash EOYFMV	$116,680	CashEOYFMVAmt
US Government Obligations BOY	$0	USGovernmentObligationsBOYAmt
US Government Obligations EOY	$25,292,220	USGovernmentObligationsEOYAmt
US Govt Obligations EOYFMV	$25,292,220	USGovtObligationsEOYFMVAmt
Corporate Stock BOY	$10,316,000	CorporateStockBOYAmt
Corporate Stock EOY	$499,996	CorporateStockEOYAmt
Corporate Stock EOYFMV	$449,996	CorporateStockEOYFMVAmt
Total Assets BOY	$33,722,896	TotalAssetsBOYAmt
Total Assets EOY	$25,908,896	TotalAssetsEOYAmt
Total Assets EOYFMV	$25,858,896	TotalAssetsEOYFMVAmt
Accounts Payable BOY	$0	AccountsPayableBOYAmt
Accounts Payable EOY	$49,647	AccountsPayableEOYAmt
Grants Payable BOY	$0	GrantsPayableBOYAmt
Grants Payable EOY	$27,814,015	GrantsPayableEOYAmt
Other Liabilities BOY	$468,745	OtherLiabilitiesBOYAmt
Other Liabilities EOY	$94,872	OtherLiabilitiesEOYAmt
Total Liabilities BOY	$468,745	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$27,958,534	TotalLiabilitiesEOYAmt
Org Does Not Follow FASB117	Yes (X)	OrgDoesNotFollowFASB117Ind
Capital Stock BOY	$0	CapitalStockBOYAmt
Capital Stock EOY	$0	CapitalStockEOYAmt
Additional Paid In Capital BOY	$0	AdditionalPaidInCapitalBOYAmt
Additional Paid In Capital EOY	$0	AdditionalPaidInCapitalEOYAmt
Retained Earning BOY	$33,254,151	RetainedEarningBOYAmt
Retained Earning EOY	-$2,049,638	RetainedEarningEOYAmt
Tot Net Ast Or Fund Balances BOY	$33,254,151	TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY	-$2,049,638	TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY	$33,722,896	TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY	$25,908,896	TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

Field	Value	IRS element (for citing)
Tot Net Ast Or Fund Balances BOY	$33,254,151	TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses	-$21,830,454	ExcessRevenueOverExpensesAmt
Other Increases	$0	OtherIncreasesAmt
Subtotal	$11,423,697	SubtotalAmt
Other Decreases	$13,473,335	OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY	-$2,049,638	TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (3 entries)

PropertyPropertyDesc	AcquiredAcquiredDt	SoldSoldDt	Gross Sales PriceGrossSalesPriceAmt	Cost Or Other BasisCostOrOtherBasisAmt	Gain Or LossGainOrLossAmt	Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt
PUBLICLY TRADED SECURITIES - ROBLOX CORP (RBLX) CLASS A, 100,000 SHARES	2004-04-06	2022-08-23	$4,137,969	$10	$4,137,959	$4,137,959
PUBLICLY TRADED SECURITIES - ROBLOX CORP (RBLX) CLASS A, 100,000 SHARES	2004-04-06	2022-11-23	$3,182,251	$10	$3,182,241	$3,182,241
CAPITAL GAIN DISTRIBUTION FROM FIDELITY	2021-01-01	2022-12-13	$97,103		$97,103	$97,103

Field	Value	IRS element (for citing)
Capital Gain Net Income	$7,417,303	CapitalGainNetIncomeAmt
Net Short Term Capital Gain Loss	$0	NetShortTermCapitalGainLossAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

Field	Value	IRS element (for citing)
Investment Income Excise Tax	$105,605	InvestmentIncomeExciseTaxAmt
Tax Under Section511	$0	TaxUnderSection511Amt
Subtotal	$105,605	SubtotalAmt
Subtitle A Tax	$0	SubtitleATaxAmt
Tax Based On Investment Income	$105,605	TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx	$93,000	EstimatedPlusOvpmtIncmTxAmt
Exempt Frgn Org Tax Wthld At Srce	$0	ExemptFrgnOrgTaxWthldAtSrceAmt
Extsn Request Income Tax Paid	$15,000	ExtsnRequestIncomeTaxPaidAmt
Backup Withholding Withheld	$0	BackupWithholdingWithheldAmt
Total Payments And Credits	$108,000	TotalPaymentsAndCreditsAmt
Es Penalty	$0	EsPenaltyAmt
Overpayment	$2,395	OverpaymentAmt
Applied To ES Tax	$2,395	AppliedToESTaxAmt
Refund	$0	RefundAmt

Statements Regarding Acty StatementsRegardingActyGrp

Field	Value	IRS element (for citing)
Legislative Political Acty	0	LegislativePoliticalActyInd
More Than100 Spent	0	MoreThan100SpentInd
Form1120 POL Filed	0	Form1120POLFiledInd
Section4955 Organization Tax	$0	Section4955OrganizationTaxAmt
Section4955 Managers Tax	$0	Section4955ManagersTaxAmt
Tax Reimbursed	$0	TaxReimbursedAmt
Activities Not Previously Rpt	Yes (1)	ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws	0	ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Organization Dissolved Etc	0	OrganizationDissolvedEtcInd
Section508e Rqr Satisfied	Yes (1)	Section508eRqrSatisfiedInd
At Least5000 In Assets	Yes (1)	AtLeast5000InAssetsInd
Org Report Or Register State	CA	OrgReportOrRegisterStateCd
Form990 PF Filed With Atty Gen	Yes (1)	Form990PFFiledWithAttyGenInd
Private Operating Foundation	0	PrivateOperatingFoundationInd
New Substantial Contributors	0	NewSubstantialContributorsInd
Own Controlled Entity	Yes (1)	OwnControlledEntityInd
Donor Advised Fund	0	DonorAdvisedFundInd
Comply With Public Insp Rqr	Yes (1)	ComplyWithPublicInspRqrInd
Website Address	N/A	WebsiteAddressTxt
Individual With Books	JIM CONLEY CO THE BASZUCKI FAMILY	IndividualWithBooksNm
Phone	6502418740	PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

Field	Value	IRS element (for citing)
Address Line1	204 2ND AVE 522	AddressLine1Txt
City	SAN MATEO	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	944013904	ZIPCd

Field	Value	IRS element (for citing)
Foreign Accounts Question	0	ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

Field	Value	IRS element (for citing)
Sale Or Exch Disqualified Prsn	0	SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn	0	BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified Prsn	0	FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified Prsn	0	PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn	0	TransferAstDisqualifiedPrsnInd
Payment To Government Official	0	PaymentToGovernmentOfficialInd
Uncorrected Prior Acts	0	UncorrectedPriorActsInd
Undistributed Income PY	0	UndistributedIncomePYInd
Business Holdings	0	BusinessHoldingsInd
Jeopardy Investments	0	JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst	0	UncorrectedPYJeopardyInvstInd
Influence Legislation	0	InfluenceLegislationInd
Influence Election	0	InfluenceElectionInd
Grants To Individuals	0	GrantsToIndividualsInd
Grants To Organizations	0	GrantsToOrganizationsInd
Noncharitable Purpose	0	NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	TitleTitleTxt	Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt	CompensationCompensationAmt	Employee Benefit ProgramEmployeeBenefitProgramAmt	Expense Account Other AllwncExpenseAccountOtherAllwncAmt
DAVID BASZUCKI
204 2ND AVENUE 522	SAN MATEO	CA	944013904	PRESIDENT	1.00	$0	$0	$0
JAN BASZUCKI
204 2ND AVENUE 522	SAN MATEO	CA	944013904	SECRETARY/TREASURER	10.00	$0	$0	$0

Field	Value	IRS element (for citing)
Comp Of Hghst Pd Empl Or NONE	NONE	CompOfHghstPdEmplOrNONETxt
Other Employee Paid Over50k	0	OtherEmployeePaidOver50kCnt

Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Service TypeServiceTypeTxt	CompensationCompensationAmt
HUNGRY HEART MEDIA INC
5450 W WASHINGTON BLVD	LOS ANGELES	CA	90016	COMMUNICATIONS	$252,235
GMMB
1200 WESTLAKE AVE N	SEATTLE	WA	98109	COMMUNICATIONS	$168,303
FARELLA BRAUN MARTEL LLP
ONE BUSH STREET 9TH FLOOR	SAN FRANCISCO	CA	94104	LEGAL SERVICES	$150,808
ARNOLD & PORTER KAYE SCHOLER LLP
601 MASSACHUSETTS AVE NW	WASHINGTON	DC	20001	LEGAL SERVICES	$89,404
VALERIE CONN CONSULTING LLC
2023 32ND AVE S	SEATTLE	WA	981444949	CONSULTING SERVICES	$72,000

Field	Value	IRS element (for citing)
Contractor Paid Over50k	0	ContractorPaidOver50kCnt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

Field	Value	IRS element (for citing)
Description1	NONE	Description1Txt
Expenses1	$0	Expenses1Amt
Description2	NONE	Description2Txt
Expenses2	$0	Expenses2Amt
All Other Program Rltd Invst Tot	$0	AllOtherProgramRltdInvstTotAmt
Total	$0	TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

Field	Value	IRS element (for citing)
Average Monthly FMV Of Sec	$14,861,584	AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances	$11,793,265	AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast	$6,582	FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets	$26,661,431	TotalFMVOfUnusedAssetsAmt
Reduction Claimed	$0	ReductionClaimedAmt
Acquisition Indebtedness	$0	AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast	$26,661,431	AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable	$399,921	CashDeemedCharitableAmt
Net Vl Noncharitable Assets	$26,261,510	NetVlNoncharitableAssetsAmt
Minimum Investment Return	$1,313,076	MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

Field	Value	IRS element (for citing)
Minimum Investment Return	$1,313,076	MinimumInvestmentReturnAmt
Tax Based On Investment Income	$105,605	TaxBasedOnInvestmentIncomeAmt
Total Tax	$105,605	TotalTaxAmt
Distributable Before Adj	$1,207,471	DistributableBeforeAdjAmt
Recoveries Qualfied Distri	$0	RecoveriesQualfiedDistriAmt
Distributable Before Ded	$1,207,471	DistributableBeforeDedAmt
Deduction From Distributable	$0	DeductionFromDistributableAmt
Distributable As Adjusted	$1,207,471	DistributableAsAdjustedAmt

PF Qualifying Distributions PFQualifyingDistributionsGrp

Field	Value	IRS element (for citing)
Expenses And Contributions	$4,736,963	ExpensesAndContributionsAmt
Program Related Invst Total	$0	ProgramRelatedInvstTotalAmt
Qualifying Distributions	$4,736,963	QualifyingDistributionsAmt

Undistributed Income UndistributedIncomeGrp

Field	Value	IRS element (for citing)
Distributable As Adjusted	$1,207,471	DistributableAsAdjustedAmt
Undistributed Income PY	$688,512	UndistributedIncomePYAmt
Total For Prior Years	$0	TotalForPriorYearsAmt
Total Excess Distribution Cyov	$0	TotalExcessDistributionCyovAmt
Qualifying Distributions	$4,736,963	QualifyingDistributionsAmt
Applied To Year1	$688,512	AppliedToYear1Amt
Applied To Prior Years	$0	AppliedToPriorYearsAmt
Treated As Distri From Corpus	$2,840,980	TreatedAsDistriFromCorpusAmt
Applied To Current Year	$1,207,471	AppliedToCurrentYearAmt
Remaining Distri From Corpus	$0	RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus	$0	ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY	$0	ExcessDistributionCyovAppCYAmt
Total Corpus	$2,840,980	TotalCorpusAmt
Prior Year Undistributed Incm	$0	PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax	$0	PriorYearDeficiencyOrTaxAmt
Taxable1	$0	Taxable1Amt
Taxable2	$0	Taxable2Amt
Undistributed Income CY	$0	UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3	$3,167,500	CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5	$0	ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr	$0	ExcessDistriCyovToNextYrAmt

Supplementary Information SupplementaryInformationGrp

Field	Value	IRS element (for citing)
Contributing Manager	DAVID BASZUCKI	ContributingManagerNm
Contributing Manager	JAN BASZUCKI	ContributingManagerNm
Only Contri To Preselected	Yes (X)	OnlyContriToPreselectedInd

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (3 entries)

Address Line1RecipientUSAddress/AddressLine1Txt	CityRecipientUSAddress/CityNm	State AbbreviationRecipientUSAddress/StateAbbreviationCd	ZIPRecipientUSAddress/ZIPCd	Recipient Foundation StatusRecipientFoundationStatusTxt	Grant Or Contribution PurposeGrantOrContributionPurposeTxt	AmtAmt	Address Line2RecipientUSAddress/AddressLine2Txt
THE RESEARCH FOUNDATION FOR THE STATE UNIVERSITY OF NEW YORK
PO BOX 9	ALBANY	NY	12201	PC	A RESEARCH PROJECT TO DEVELOP A DATA-DRIVEN SOFTWARE PLATFORM FOR MODELING COMPUTATIONAL PSYCHIATRY KNOWN AS NEUROBLOX UNDER THE DIRECT SUPERVISION OF L. R. MUJICA-PARODI, PH.D.	$1,154,772
THE MILKEN INSTITUTE
1250 FOURTH STREET 2ND FLOOR	SANTA MONICA	CA	90401	PC	LAUNCH AND FOSTER A NEW SCIENTIFIC COMMUNITY IN METABOLIC PSYCHIATRY.	$2,641,413
UNIVERSITY OF PITTSBURGH
213 PARK PLAZA 128 NORTH CRAIG	PITTSBURGH	PA	15260	PC	TO SUPPORT BIPOLAR DISORDER AND RELATED RESEARCH IN THE MOOD AND BRAIN LAB IN THE DEPARTMENT OF PSYCHIATRY, WHICH IS CURRENTLY BEING CONDUCTED BY MARY PHILIPS, MD.	$84,769	STREE

Field	Value	IRS element (for citing)
Total Grant Or Contri Pd Dur Yr	$3,880,954	TotalGrantOrContriPdDurYrAmt

Grant Or Contri Apprv For Fut GrantOrContriApprvForFutGrp (2 entries)

Address Line1RecipientUSAddress/AddressLine1Txt	CityRecipientUSAddress/CityNm	State AbbreviationRecipientUSAddress/StateAbbreviationCd	ZIPRecipientUSAddress/ZIPCd	Recipient Foundation StatusRecipientFoundationStatusTxt	Grant Or Contribution PurposeGrantOrContributionPurposeTxt	AmtAmt
THE RESEARCH FOUNDATION FOR THE STATE UNIVERSITY OF NEW YORK
PO BOX 9	ALBANY	NY	12201	PC	A RESEARCH PROJECT TO DEVELOP A DATA-DRIVEN SOFTWARE PLATFORM FOR MODELING COMPUTATIONAL PSYCHIATRY KNOWN AS NEUROBLOX UNDER THE DIRECT SUPERVISION OF L. R. MUJICA-PARODI, PH.D.	$1,998,454
THE MILKEN INSTITUTE
1250 FOURTH STREET 2ND FLOOR	SANTA MONICA	CA	90401	PC	LAUNCH AND FOSTER A NEW SCIENTIFIC COMMUNITY IN METABOLIC PSYCHIATRY.	$30,000,000

Field	Value	IRS element (for citing)
Total Grant Or Contri Apprv Fut	$31,998,454	TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp

Field	Value	IRS element (for citing)
Exclusion	14	ExclusionCd
Exclusion	$109,313	ExclusionAmt

Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl

Field	Value	IRS element (for citing)
Exclusion	14	ExclusionCd
Exclusion	$100,894	ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

Field	Value	IRS element (for citing)
Exclusion	18	ExclusionCd
Exclusion	$7,417,303	ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

Field	Value	IRS element (for citing)
Unrelated Business Taxbl Incm	$0	UnrelatedBusinessTaxblIncmAmt
Exclusion	$7,627,510	ExclusionAmt
Related Or Exempt Function Incm	$0	RelatedOrExemptFunctionIncmAmt

Field	Value	IRS element (for citing)
Total Income Producing Acty	$7,627,510	TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

Field	Value	IRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO	0	TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO	0	TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets	0	SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO	0	PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets	0	RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements	0	ReimbursementArrangementsInd
Loans Or Loan Guarantees	0	LoansOrLoanGuaranteesInd
Performance Of Services Etc	0	PerformanceOfServicesEtcInd
Sharing Of Facilities Etc	0	SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EO	0	RelationshipsNonchrtblEOInd

Schedule B IRS990ScheduleB

Field	Value	IRS element (for citing)
Organization501c3 Exempt PF	Yes (X)	Organization501c3ExemptPFInd
General Rule	Yes (X)	GeneralRuleInd

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	1	ContributorNum
Contributor Person	DAVID AND JAN BASZUCKI	ContributorPersonNm

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	204 2ND AVENUE 522	AddressLine1Txt
City	SAN MATEO	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	944013904	ZIPCd

Field	Value	IRS element (for citing)
Total Contributions	$3,167,500	TotalContributionsAmt
Person Contribution	Yes (X)	PersonContributionInd
Noncash Contribution	Yes (X)	NoncashContributionInd

Non Cash Property Contribution NonCashPropertyContributionGrp

Field	Value	IRS element (for citing)
Contributor	1	ContributorNum
Noncash Property	SECURITY (ROBLOX CORP CL A) 100,000 SHARES	NoncashPropertyDesc
Fair Market Value	$3,167,500	FairMarketValueAmt
Received	2022-11-23	ReceivedDt

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

Field	Value	IRS element (for citing)
Category	ACCOUNTING SERVICES	CategoryTxt
Amt	$58,788	Amt
Net Investment Income	$29,394	NetInvestmentIncomeAmt
Adjusted Net Income	$0	AdjustedNetIncomeAmt
Disbursements Charitable Prps	$29,394	DisbursementsCharitablePrpsAmt

Acty Not Previously Rpt Expln ActyNotPreviouslyRptExpln

Field	Value	IRS element (for citing)
Explanation	IN ADDITION TO ITS GRANTMAKING ACTIVITIES, IN 2022 THE FOUNDATION LAUNCHED METABOLIC MIND LLC, A NONPROFIT INITIATIVE WITH A MISSION TO PROVIDE EDUCATION AND RESOURCES IN THE EMERGING FIELD OF METABOLIC PSYCHIATRY, INCLUDING KETOGENIC THERAPIES FOR MENTAL DISORDERS.	ExplanationTxt

All Oth Prog Rltd Investments Sch AllOthProgRltdInvestmentsSch

All Other Program Related Invst AllOtherProgramRelatedInvstGrp

Field	Value	IRS element (for citing)
Desc	NONE	Desc
Amt	$0	Amt

Distribution From Corpus Election DistributionFromCorpusElection

Field	Value	IRS element (for citing)
Election	SEE STATEMENT 16	ElectionDesc

General Explanation Attachment GeneralExplanationAttachment

General Explanation GeneralExplanationGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	Medium ExplanationMediumExplanationTxt	IdentifierIdentifierTxt
PART XII, LINE 4(C) CONDUIT ELECTION STATEMENT	STATEMENT REGARDING STATUS AS A CONDUIT PRIVATE FOUNDATIONTREASURY REGULATION 53.4942(A)-3(C)(2)(IV) ELECTIONTHE BASZUCKI FAMILY FOUNDATION; EIN: 32-0660398TAX YEAR ENDING: 12/31/2022ATTACHMENT TO FORM 990-PF, PART XII UNDISTRIBUTED INCOMETHE FOUNDATION HAD NO REMAINING UNDISTRIBUTED INCOME FOR THE CURRENT (2022) OR PRIOR TAX YEAR (2021) AS REQUIRED BY TREASURY REGULATION 53.4942(A)-3(C)(2)(I). THE FOLLOWING AMOUNTS REPRESENT THE CONTRIBUTIONS MADE TO THE FOUNDATION DURING 2022 AND THE SUBSEQUENT OUT OF CORPUS ELECTION TO DISTRIBUTE AN AMOUNT EQUAL TO ALL CONTRIBUTIONS IN SATISFACTION OF THE REQUIREMENTS OF TREASURY REGULATION 53.4942(A)-3(C)(2) ALLOWING THE FOUNDATION TO QUALIFY AS A CONDUIT FOUNDATION FOR THE 2022 TAX YEAR. AMOUNTS RECEIVED IN 2022 $3,167,500 PART XII, LINE 7AMOUNTS DISTRIBUTED BY 03/15/2023 ($3,167,500) (SEE DETAIL BELOW)REMAINING AMOUNT TO BE DISTRIBUTED $ 0 LINE 7 AMOUNT TREATED AS DISTRIBUTION OUT OF CORPUS TO SATISFY REQUIREMENTS IMPOSED BY IRC SECTION 170(B)(1)(F)(II). THE FOUNDATION MEETS THE REQUIREMENTS OF IRC 170(B)(1)(A)(VII), 170(B)(1)(F)(II) AND 4942(H) SUCH THAT QUALIFYING DISTRIBUTIONS OUT OF CORPUS WERE MADE WITHIN 2.5 MONTHS FOLLOWING THE CLOSE OF THE 2022 TAX YEAR IN AN AMOUNT EQUAL TO 100% OF ALL CONTRIBUTIONS RECEIVED DURING THE 2022 TAX YEAR. THERE IS NO REMAINING UNDISTRIBUTED INCOME FOR THE 2022 AND 2021 TAX YEARS. THEREFORE, THE FOUNDATION QUALIFIES AS A CONDUIT PRIVATE FOUNDATION AND THE 50% CHARITABLE CONTRIBUTION TAX BASE APPLIES UNDER IRC 170(B)(1)(A). _______________________________________________________________________ SIGNATURE AND TITLE DATE
FORM 990-PF, PART VI-A, LINE 11	METABOLIC MIND, LLC204 2ND AVE STE 522SAN MATEO, CA 94401THE BASZUCKI FAMILY FOUNDATION TRANSFERRED $100,000 OF INITIAL FUNDING TO LAUNCH METABOLIC MIND, LLC.	OWNERSHIP OF CONTROLLED ENTITIES

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corporate Stock InvestmentsCorporateStockGrp

Field	Value	IRS element (for citing)
Stock	DOMESTIC EQUITY SECURITIES (KNOW LABS & KETOSWISS)	StockNm
EOY Book Value	$499,996	EOYBookValueAmt
EOYFMV	$449,996	EOYFMVAmt

Investments Govt Obligations Sch InvestmentsGovtObligationsSch

Field	Value	IRS element (for citing)
US Govt Obligations Book Vl EOY	$25,292,220	USGovtObligationsBookVlEOYAmt
US Govt Obligations EOYFMV	$25,292,220	USGovtObligationsEOYFMVAmt
State Local Sec Book Vl EOY	$0	StateLocalSecBookVlEOYAmt
State Local Sec EOYFMV	$0	StateLocalSecEOYFMVAmt

Other Decreases Schedule OtherDecreasesSchedule

Other Decreases Detail OtherDecreasesDetail

Field	Value	IRS element (for citing)
Desc	UNREALIZED LOSS	Desc
Amt	$13,473,335	Amt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (2 entries)

DescDesc	Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt	Net Investment IncomeNetInvestmentIncomeAmt	Adjusted Net IncomeAdjustedNetIncomeAmt	Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt
GENERAL AND ADMINISTRATIVE	$108,096	$0	$0	$108,096
INVESTMENT EXPENSES	$245	$245	$0	$0

Other Liabilities Schedule OtherLiabilitiesSchedule

Other Liabilities Detail OtherLiabilitiesDetail (2 entries)

DescDesc	BOY Book ValueBOYBookValueAmt	EOY Book ValueEOYBookValueAmt
FEDERAL EXCISE TAX PAYABLE	$325,353	$94,872
DEFERRED FEDERAL EXCISE TAX PAYABLE	$143,392	$0

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail

Field	Value	IRS element (for citing)
Category	PROFESSIONAL FEES	CategoryTxt
Amt	$718,519	Amt
Net Investment Income	$0	NetInvestmentIncomeAmt
Adjusted Net Income	$0	AdjustedNetIncomeAmt
Disbursements Charitable Prps	$718,519	DisbursementsCharitablePrpsAmt

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail (2 entries)

CategoryCategoryTxt	AmtAmt	Net Investment IncomeNetInvestmentIncomeAmt	Adjusted Net IncomeAdjustedNetIncomeAmt	Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt
FOREIGN TAX PAID	$364	$364	$0	$0
EXCISE TAX EXPENSE	$44,483	$0	$0	$0

Transfers To Controlled Entities TransfersToControlledEntities

Transfers To Controlled Ent TransfersToControlledEntGrp

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	METABOLIC MINDS LLC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	204 2ND AVE STE 522	AddressLine1Txt
City	SAN MATEO	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	94401	ZIPCd

Field	Value	IRS element (for citing)
EIN	920573910	EIN
Desc	THE BASZUCKI FAMILY FOUNDATION TRANSFERRED $100,000 OF INITIAL FUNDING TO LAUNCH METABOLIC MIND LLC.	Desc
Amt	$100,000	Amt

Field	Value	IRS element (for citing)
Total	$100,000	TotalAmt