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DAVID AND JANET POLAK FOUNDATION: Form 990PF, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
DAVID AND JANET POLAK FOUNDATION (EIN 45-4797578)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-15
IRS object ID
202203199349110700
Schema version
2021v4.2
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 ReturnHeader

FieldValueIRS element (for citing)
Return2022-11-15T19:49:58-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Foundation SourceBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line13333 New Hyde Park Rd Ste 406AddressLine1Txt
CityNew Hyde ParkCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11042ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN454797578EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1David & Janet Polak FoundationBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% Foundation SourceInCareOfNm
Business Name ControlDAVIBusinessNameControlTxt
Phone8008391754PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1Foundation Source 501 Silverside RdAddressLine1Txt
CityWilmingtonCityNm
State AbbreviationDEStateAbbreviationCd
ZIP198091377ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
Personjeffrey polakPersonNm
Person TitlepresidentPersonTitleTxt
Phone8008391754PhoneNum
Signature2022-11-14SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstjeffreyPersonFirstNm
Person LastpolakPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJeffrey D HaskellPreparerPersonNm
PTINP01345770PTIN
Phone8008391754PhoneNum

Additional Filer Information AdditionalFilerInformation

FieldValueIRS element (for citing)
Trusted CustomerTrustedCustomerGrp
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$84,029,483FMVAssetsEOYAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Rcvd Rev And Expnss$0ContriRcvdRevAndExpnssAmt
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Interest On Sav Rev And Expnss$1,484InterestOnSavRevAndExpnssAmt
Interest On Sav Net Invst Incm$1,484InterestOnSavNetInvstIncmAmt
Dividends Rev And Expnss$710,705DividendsRevAndExpnssAmt
Dividends Net Invst Incm$710,705DividendsNetInvstIncmAmt
Net Gain Sale Ast Rev And Expnss$1,764,784NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$61,967,796GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$1,288,244CapGainNetIncmNetInvstIncmAmt
Other Income Rev And Expnss$969,791OtherIncomeRevAndExpnssAmt
Other Income Net Invst Incm$1,029,257OtherIncomeNetInvstIncmAmt
Total Rev And Expnss$3,446,764TotalRevAndExpnssAmt
Total Net Invst Incm$3,029,690TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$235,550CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$235,550CompOfcrDirTrstDsbrsChrtblAmt
Oth Empl Slrs Wgs Rev And Expnss$61,000OthEmplSlrsWgsRevAndExpnssAmt
Oth Empl Slrs Wgs Dsbrs Chrtbl$61,000OthEmplSlrsWgsDsbrsChrtblAmt
Pension Empl Bnft Rev And Expnss$35,140PensionEmplBnftRevAndExpnssAmt
Pension Empl Bnft Dsbrs Chrtbl$35,140PensionEmplBnftDsbrsChrtblAmt
Legal Fees Rev And Expnss$23,115LegalFeesRevAndExpnssAmt
Legal Fees Net Invst Incm$0LegalFeesNetInvstIncmAmt
Legal Fees Adj Net Incm$0LegalFeesAdjNetIncmAmt
Legal Fees Dsbrs Chrtbl$23,115LegalFeesDsbrsChrtblAmt
Other Prof Fees Rev And Expnss$439,482OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$398,604OtherProfFeesNetInvstIncmAmt
Other Prof Fees Dsbrs Chrtbl$40,878OtherProfFeesDsbrsChrtblAmt
Taxes Rev And Expnss$221,960TaxesRevAndExpnssAmt
Taxes Net Invst Incm$13,725TaxesNetInvstIncmAmt
Occupancy Rev And Expnss$74,004OccupancyRevAndExpnssAmt
Occupancy Dsbrs Chrtbl$74,004OccupancyDsbrsChrtblAmt
Trav Conf Meeting Rev And Expnss$56,776TravConfMeetingRevAndExpnssAmt
Trav Conf Meeting Dsbrs Chrtbl$56,776TravConfMeetingDsbrsChrtblAmt
Other Expenses Rev And Expnss$669,224OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$518,825OtherExpensesNetInvstIncmAmt
Other Expenses Dsbrs Chrtbl$102,412OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$1,816,251TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$931,154TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Adj Net Incm$0TotOprExpensesAdjNetIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$628,875TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$2,266,312ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$2,266,312ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$4,082,563TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$931,154TotalExpensesNetInvstIncmAmt
Total Expenses Adj Net Incm$0TotalExpensesAdjNetIncmAmt
Total Expenses Dsbrs Chrtbl$2,895,187TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses-$635,799ExcessRevenueOverExpensesAmt
Net Investment Income$2,098,536NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Sav And Temp Cash Invst BOY$3,036,171SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$5,727,416SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$5,727,416SavAndTempCashInvstEOYFMVAmt
US Government Obligations BOY$33,783,681USGovernmentObligationsBOYAmt
US Government Obligations EOY$25,956,247USGovernmentObligationsEOYAmt
US Govt Obligations EOYFMV$26,219,478USGovtObligationsEOYFMVAmt
Corporate Stock BOY$9,776,068CorporateStockBOYAmt
Corporate Stock EOY$11,487,851CorporateStockEOYAmt
Corporate Stock EOYFMV$16,458,266CorporateStockEOYFMVAmt
Corporate Bonds EOY$1,000,149CorporateBondsEOYAmt
Corporate Bonds EOYFMV$1,047,600CorporateBondsEOYFMVAmt
Other Investments BOY$21,159,666OtherInvestmentsBOYAmt
Other Investments EOY$22,141,023OtherInvestmentsEOYAmt
Other Investments EOYFMV$30,548,462OtherInvestmentsEOYFMVAmt
Other Assets BOY$3,342,999OtherAssetsBOYAmt
Other Assets EOY$4,150,100OtherAssetsEOYAmt
Other Assets EOYFMV$4,028,261OtherAssetsEOYFMVAmt
Total Assets BOY$71,098,585TotalAssetsBOYAmt
Total Assets EOY$70,462,786TotalAssetsEOYAmt
Total Assets EOYFMV$84,029,483TotalAssetsEOYFMVAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind
Retained Earning BOY$71,098,585RetainedEarningBOYAmt
Retained Earning EOY$70,462,786RetainedEarningEOYAmt
Tot Net Ast Or Fund Balances BOY$71,098,585TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$70,462,786TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$71,098,585TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$70,462,786TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$71,098,585TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses-$635,799ExcessRevenueOverExpensesAmt
Subtotal$70,462,786SubtotalAmt
Tot Net Ast Or Fund Balances EOY$70,462,786TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (10 entries)

PropertyPropertyDescGross Sales PriceGrossSalesPriceAmtCost Or Other BasisCostOrOtherBasisAmtGain Or LossGainOrLossAmtGains Minus Excess Or LossesGainsMinusExcessOrLossesAmtHow AcquiredHowAcquiredCdAcquiredAcquiredDtSoldSoldDt
Publicly-traded Securities$61,542,796$61,283,184$259,612$259,612
Passthrough K1 Capital Gain/(Loss)$1,028,632
LATITUDE MGMT REAL ESTATE CAPITAL III INC$25,000$25,000P2014-05-142021-01-21
LATITUDE MGMT REAL ESTATE CAPITAL III INC$25,000$25,000P2014-05-142021-06-01
LATITUDE MGMT REAL ESTATE CAPITAL III INC$100,000$100,000P2021-06-30
LATITUDE MGMT REAL ESTATE CAPITAL III INC$75,000$75,000P2021-07-23
LATITUDE MGMT REAL ESTATE CAPITAL III INC$50,000$50,000P2021-09-15
LATITUDE MGMT REAL ESTATE CAPITAL III INC$50,000$50,000P2015-08-242021-10-20
LATITUDE MGMT REAL ESTATE CAPITAL III INC$50,000$50,000P2015-11-302021-11-29
LATITUDE MGMT REAL ESTATE CAPITAL III INC$50,000$50,000P2015-12-282021-12-17
FieldValueIRS element (for citing)
Capital Gain Net Income$1,288,244CapitalGainNetIncomeAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Investment Income Excise Tax$29,170InvestmentIncomeExciseTaxAmt
Subtotal$29,170SubtotalAmt
Tax Based On Investment Income$29,170TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$43,700EstimatedPlusOvpmtIncmTxAmt
Exempt Frgn Org Tax Wthld At Srce$0ExemptFrgnOrgTaxWthldAtSrceAmt
Total Payments And Credits$43,700TotalPaymentsAndCreditsAmt
Form2220 AttachedYes (X)Form2220AttachedInd
Es Penalty$0EsPenaltyAmt
Overpayment$14,530OverpaymentAmt
Applied To ES Tax$14,530AppliedToESTaxAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political ActyfalseLegislativePoliticalActyInd
More Than100 SpentfalseMoreThan100SpentInd
Form1120 POL FiledfalseForm1120POLFiledInd
Activities Not Previously RptfalseActivitiesNotPreviouslyRptInd
Changes To Articles Or BylawsfalseChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Organization Dissolved EtcfalseOrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (true)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (true)AtLeast5000InAssetsInd
Org Report Or Register StateCAOrgReportOrRegisterStateCd
Org Report Or Register StateDEOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (true)Form990PFFiledWithAttyGenInd
Private Operating FoundationfalsePrivateOperatingFoundationInd
New Substantial ContributorsfalseNewSubstantialContributorsInd
Own Controlled EntityfalseOwnControlledEntityInd
Donor Advised FundfalseDonorAdvisedFundInd
Comply With Public Insp RqrYes (true)ComplyWithPublicInspRqrInd

Persons With Books Name PersonsWithBooksName

FieldValueIRS element (for citing)
Business Name Line1Foundation SourceBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8008391754PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line1501 Silverside Road Suite 123AddressLine1Txt
CityWilmingtonCityNm
State AbbreviationDEStateAbbreviationCd
ZIP198091377ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts QuestionfalseForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified PrsnfalseSaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified PrsnfalseBrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified PrsnYes (true)FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified PrsnYes (true)PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified PrsnfalseTransferAstDisqualifiedPrsnInd
Payment To Government OfficialfalsePaymentToGovernmentOfficialInd
Acts Fail To Qlfy As ExceptionsfalseActsFailToQlfyAsExceptionsInd
Uncorrected Prior ActsfalseUncorrectedPriorActsInd
Undistributed Income PYfalseUndistributedIncomePYInd
Business HoldingsfalseBusinessHoldingsInd
Jeopardy InvestmentsfalseJeopardyInvestmentsInd
Uncorrected PY Jeopardy InvstfalseUncorrectedPYJeopardyInvstInd
Influence LegislationfalseInfluenceLegislationInd
Influence ElectionfalseInfluenceElectionInd
Grants To IndividualsfalseGrantsToIndividualsInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Noncharitable PurposefalseNoncharitablePurposeInd
Transactions Fail To Qlfy As ExcfalseTransactionsFailToQlfyAsExcInd
Maintained Expenditure RspnsYes (true)MaintainedExpenditureRspnsInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
David Polak
Foundation Source 501 Silverside RdWilmingtonDE198091377Dir1.0$0$0$0
Janet Polak
Foundation Source 501 Silverside RdWilmingtonDE198091377Dir1.0$0$0$0
Jeff Polak
Foundation Source 501 Silverside RdWilmingtonDE198091377Dir, Pres, Executive Dir40.0$235,550$11,000$0
Robert Polak
Foundation Source 501 Silverside RdWilmingtonDE198091377Dir1.0$0$0$0
Jonathan Seltzer
Foundation Source 501 Silverside RdWilmingtonDE198091377Dir1.0$0$0$0

Compensation Highest Paid Empl CompensationHighestPaidEmplGrp

FieldValueIRS element (for citing)
PersonNoreen L RubioPersonNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line13850 N Wilke RdAddressLine1Txt
CityArlington HeightsCityNm
State AbbreviationILStateAbbreviationCd
ZIP60004ZIPCd
FieldValueIRS element (for citing)
TitleADMINISTRATIVE ASSTTitleTxt
Average Hrs Per Wk Devoted To Pos40.0AverageHrsPerWkDevotedToPosRt
Compensation$61,000CompensationAmt

Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdService TypeServiceTypeTxtCompensationCompensationAmt
Polak Investors LLC
1880 Century Park East Suite 811Los AngelesCA90067Investment Mgmt$383,363
Foundation Source
55 Walls Drive 3rd FlFairfieldCT06824Administrative$87,942

Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp

FieldValueIRS element (for citing)
Description1AKLA PROGRAM - WILL INTRODUCE PARTICIPANTS TO EXCITING & INSPIRING NEW WAYS OF LOOKING AT THEIR JEWISH VALUES & CONNECT THEM WITHIN THEIR OWN LIVES & LA JEWISH COMMUNITYDescription1Txt
Expenses1$36,022Expenses1Amt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Description1OCTHEALTH LLC-PROMOTE HEALTH OF PPL AFFECTED BY AGE-RELATED MACULAR DEGENERATION, ADVANCE SCIENTIFIC UNDERSTANDING, PROVIDE EARLY INTERVENTION AND ACCESS TO SCREENINGDescription1Txt
Expenses1$250,000Expenses1Amt
Description2CYWAT TECHNOLOGIES LTD - TO PROMOTE THE HEALTH OF PEOPLE WHO ARE AFFECTED BY POLLUTED DRINKING WATER BY FUNDING THE DEVELOPMENT OF A WATER MONITORING SYSTEMDescription2Txt
Expenses2$250,000Expenses2Amt
All Other Program Rltd Invst Tot$307,101AllOtherProgramRltdInvstTotAmt
Total$807,101TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$45,444,507AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$4,515,382AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$31,526,077FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$81,485,966TotalFMVOfUnusedAssetsAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$81,485,966AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$1,222,289CashDeemedCharitableAmt
Net Vl Noncharitable Assets$80,263,677NetVlNoncharitableAssetsAmt
Minimum Investment Return$4,013,184MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$4,013,184MinimumInvestmentReturnAmt
Tax Based On Investment Income$29,170TaxBasedOnInvestmentIncomeAmt
Income Tax$70,431IncomeTaxAmt
Total Tax$99,601TotalTaxAmt
Distributable Before Adj$3,913,583DistributableBeforeAdjAmt
Distributable Before Ded$3,913,583DistributableBeforeDedAmt
Distributable As Adjusted$3,913,583DistributableAsAdjustedAmt

PF Qualifying Distributions PFQualifyingDistributionsGrp

FieldValueIRS element (for citing)
Expenses And Contributions$2,895,187ExpensesAndContributionsAmt
Program Related Invst Total$807,101ProgramRelatedInvstTotalAmt
Charitable Assets Acquis Paid$0CharitableAssetsAcquisPaidAmt
Set Aside Suitability Test$0SetAsideSuitabilityTestAmt
Set Aside Cash Distri Test$0SetAsideCashDistriTestAmt
Qualifying Distributions$3,702,288QualifyingDistributionsAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$3,913,583DistributableAsAdjustedAmt
Undistributed Income PY$3,646,806UndistributedIncomePYAmt
Prior Year12019PriorYear1Yr
Prior Year22018PriorYear2Yr
Prior Year32017PriorYear3Yr
Qualifying Distributions$3,702,288QualifyingDistributionsAmt
Applied To Year1$3,646,806AppliedToYear1Amt
Applied To Current Year$55,482AppliedToCurrentYearAmt
Remaining Distri From Corpus$0RemainingDistriFromCorpusAmt
Total Corpus$0TotalCorpusAmt
Undistributed Income CY$3,858,101UndistributedIncomeCYAmt
Excess Distri Cyov To Next Yr$0ExcessDistriCyovToNextYrAmt
Excess From Current Year$0ExcessFromCurrentYearAmt
FieldValueIRS element (for citing)
Private Operating FoundationsPrivateOperatingFoundationsGrp

Supplementary Information SupplementaryInformationGrp

FieldValueIRS element (for citing)
Contributing ManagerNONEContributingManagerNm
Only Contri To PreselectedYes (X)OnlyContriToPreselectedInd

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (72 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
AMCHA INITIATIVE
517 BETHANY CURVESANTA CRUZCA95060N/APCGeneral & Unrestricted$20,000
AMERICAN FRIENDS OF ISRAELI NAVY SEALS INC
138 W 133RD STNEW YORKNY10030N/APCto provide scholarships to seven candidates and gift vouchers for soldiers in financial need at Passover of 2022$34,100
AMERICAN FRIENDS OF THE ISRAEL MUSEUM
545 5TH AVE RM 920NEW YORKNY10017N/APCGeneral & Unrestricted$5,000
AMERICAN FRIENDS OF THE ISRAEL PHILHARMONIC ORCHES
555 W 5TH ST 35TH FLLOS ANGELESCA90013N/APCGeneral & Unrestricted$15,000
AMERICAN SOCIETY FOR TECHNION-ISRAEL INST OF TECH
55 EAST 59TH ST 14TH FLOORNEW YORKNY10022N/APCPilot of the ATS Polak Family Israel Institute$30,000
AMERICAN SOCIETY FOR TECHNION-ISRAEL INST OF TECH
55 EAST 59TH ST 14TH FLOORNEW YORKNY10022N/APCGeneral & Unrestricted$200,000
AMERICAN YOUTH SYMPHONY INC
841 APOLLO ST STE 344EL SEGUNDOCA90245N/APCGeneral & Unrestricted$5,000
AMERICANS FOR BEN-GURION UNIVERSITY INC
1001 AVE OF THE AMERICAS FL 19NEW YORKNY10018N/APCSupport of Part Two - Phase Two of the Ben-Gurion Digital Archives Transformation Project$100,000
AMERICANS FOR BEN-GURION UNIVERSITY INC
1001 AVE OF THE AMERICAS FL 19NEW YORKNY10018N/APCSupport of Part Two - Phase One of the Ben-Gurion Digital Archives Transformation Project collections) of the Ben-Gurion Digital Archives Transformation Project$100,000
ASSOC FOR THE STUDY OF THE MIDDLE EAST AND AFRICA
PO BOX 2241BALA CYNWYDPA19004N/APCGeneral & Unrestricted$5,000
AYN RAND INST CENTER FOR ADVANCEMNT OF OBJECTIVISM
6 HUTTON CENTRE DR STE 600SANTA ANACA92707N/APCFree Books to Teachers program, ARC-I's work in Israel, and funding to develop an essay-contest appeal to schools in the LA area$37,500
BARAK BALLET
1709 STEWART STSANTA MONICACA90404N/APCGeneral & Unrestricted$5,000
BEIT TSHUVAH
8831 VENICE BLVDLOS ANGELESCA90034N/APCGeneral & Unrestricted$5,000
BUCKLEY SCHOOL
3900 STANSBURY AVESHERMAN OAKSCA91423N/APCGeneral & Unrestricted$10,000
CEDARS-SINAI MEDICAL CENTER
8700 BEVERLY BLVDW HOLLYWOODCA90048N/APCthe Polak Family Fellowship in Precision Healthcare, supporting the Board of Governors Innovation Center$100,000
CEDARS-SINAI MEDICAL CENTER
8700 BEVERLY BLVDW HOLLYWOODCA90048N/APCGeneral & Unrestricted$25,000
CENTRAL FUND OF ISRAEL
461 CENTRAL AVECEDARHURSTNY11516N/APCGeneral & Unrestricted$35,000
COMMITTEE FOR ACCURACY IN MIDDLE EAST REPORTING IN
PO BOX 35040BOSTONMA02135N/APCGeneral & Unrestricted$10,000
CONCERN FOUNDATION
11111 W OLYMPIC BLVD STE 214LOS ANGELESCA90064N/APCGeneral & Unrestricted$6,000
CROHNS AND COLITIS FOUNDATION OF AMERICA
3010 WESTCHESTER AVEPURCHASENY10577N/APCGeneral & Unrestricted$2,500
CUFI CHURCH ASSOCIATION
PO BOX 1307SAN ANTONIOTX78295N/APCGeneral & Unrestricted$20,000
DAVID HOROWITZ FREEDOM CENTER
14724 VENTURA BLVD STE 820SHERMAN OAKSCA91403N/APCGeneral & Unrestricted$15,000
ENDOWMENT FOR MIDDLE EAST TRUTH
700 STONINGTON RDSILVER SPRINGMD20902N/APCGeneral & Unrestricted$20,000
FOUNDATION FOR ECONOMIC EDUCATION INC
1819 PEACHTREE RD NE STE 300ATLANTAGA30309N/APCGeneral & Unrestricted$5,000
FOUNDATION FOR INDIVIDUAL RIGHTS IN EDUCATION INC
510 WALNUT ST STE 1250PHILADELPHIAPA19106N/APCGeneral & Unrestricted$5,000
FRIENDS OF ELNET
5215 OLD ORCHARD RD STE 880SKOKIEIL60077N/APCGeneral & Unrestricted$100,000
FRIENDS OF ISRAEL SCI-TECH SCHOOLS INC
477 MADISON AVE 6TH FLNEW YORKNY10022N/APCGeneral & Unrestricted$5,000
FRIENDS OF SHEBA MEDICAL CENTER INC
6505 WILSHIRE BLVD STE 615LOS ANGELESCA90048N/APCGeneral & Unrestricted$10,000
FRIENDS OF THE ISRAEL DEFENSE FORCES
60 E 42ND STNEW YORKNY10165N/APCsponsor 12 IMPACT! Scholars$48,000
FRIENDS OF THE ISRAEL DEFENSE FORCES - LOS ANGELES
6505 WILSHIRE BLVD STE 625LOS ANGELESCA90048N/APCsponsor 13 additional IMPACT! Scholarship students$52,000
HAROLD GRINSPOON FOUNDATION
67 HUNT ST STE 100AGAWAMMA01001N/ASO IGeneral & Unrestricted$18,000
HAROLD GRINSPOON FOUNDATION
67 HUNT ST STE 100AGAWAMMA01001N/ASO ITo support children receiving the monthly gift of Jewish children's books through PJ Library domestic communities as well as Latin America and Scotland$88,612
HILLSDALE COLLEGE
33 E COLLEGE STHILLSDALEMI49242N/APCGeneral & Unrestricted$5,000
HONEST REPORTING COM INC
165 E 56TH ST 2ND FLNEW YORKNY10022N/APCGeneral & Unrestricted$5,000
IMERMAN ANGELS
205 W RANDOLPH ST 19TH FLCHICAGOIL60606N/APCGeneral & Unrestricted$5,000
ISRAEL CANCER RESEARCH FUND INC
52 VANDERBILT AVE S1510NEW YORKNY10017N/APCResearch Career Development Award Program$49,500
ISRAEL CHRISTIAN NEXUS
11039 MCCORMICK STN HOLLYWOODCA91601N/APCGeneral & Unrestricted$1,000
ISRAEL EMERGENCY ALLIANCE - STANDWITHUS
PO BOX 341069LOS ANGELESCA90034N/APCGeneral & Unrestricted$200,000
ISRAEL TENNIS CENTERS FOUNDATION INC
165 E 56TH ST 2ND FLNEW YORKNY10022N/APCGeneral & Unrestricted$5,000
JEWBELONG INC
60 FERNWOOD RDSUMMITNJ07901N/APCGeneral & Unrestricted$5,000
JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES
6505 WILSHIRE BLVD STE 800LOS ANGELESCA90048N/APCbook costs for PJ Library Program$18,000
JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES
6505 WILSHIRE BLVD STE 800LOS ANGELESCA90048N/APCGeneral & Unrestricted$40,000
JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES
6505 WILSHIRE BLVD STE 800LOS ANGELESCA90048N/APCexpanding the Community Security Initiative (CSI)$75,000
JEWISH WOMENS THEATRE
3435 OCEAN PARK BLVD STE 107 85SANTA MONICACA90405N/APCGeneral & Unrestricted$2,500
LAWFARE PROJECT INC
633 THIRD AVE 21ST FLOORNEW YORKNY10017N/APCGeneral & Unrestricted$25,000
LOS ANGELES JEWISH HOME FOR THE AGING
7150 TAMPA AVERESEDACA91335N/APCGeneral & Unrestricted$25,000
LOS ANGELES PHILHARMONIC ASSOCIATION
151 S GRAND AVELOS ANGELESCA90012N/APCGeneral & Unrestricted$5,000
MAKE A WISH FOUNDATION OF GREATER LOS ANGELES
11390 W OLYMPIC BLVD STE 300LOS ANGELESCA90064N/APCGeneral & Unrestricted$15,000
MANHATTAN INSTITUTE FOR POLICY RESEARCH INC
52 VANDERBILT AVENEW YORKNY10017N/APCGeneral & Unrestricted$5,000
MASSACHUSETTS INSTITUTE OF TECHNOLOGY
600 MEMORIAL DR BLDG W98-300CAMBRIDGEMA02139N/APCMISTI MIT - Israel Summer Program$40,000
MIDDLE EAST FORUM
1650 MARKET ST STE 3600PHILADELPHIAPA19103N/APCannual Israel Victory Project$40,000
MIDDLE EAST MEDIA AND RESEARCH INSTITUTE INC
PO BOX 27837WASHINGTONDC20038N/APCGeneral & Unrestricted$5,000
MOISHE HOUSE
441 SAXONY RD NO BARN 2ENCINITASCA92024N/APCto support community building efforts in Los Angeles$50,000
MUSEUM ASSOCIATES
5905 WILSHIRE BLVDLOS ANGELESCA90036N/APCGeneral & Unrestricted$5,000
PACIFIC LEGAL FOUNDATION
555 CAPITOL MALL STE 1290SACRAMENTOCA95814N/APCGeneral & Unrestricted$5,000
PARDES INSTITUTE OF JEWISH STUDIES NORTH AMERICA
54 W 40TH STNEW YORKNY10018N/APCGeneral & Unrestricted$5,000
PERFORMING ARTS CENTER OF LOS ANGELES COUNTY
135 N GRAND AVELOS ANGELESCA90012N/APCGeneral & Unrestricted$5,000
PRAGER UNIVERSITY FOUNDATION
15021 VENTURA BLVD 552SHERMAN OAKSCA91403N/APCGeneral & Unrestricted$50,000
PROCLAIMING JUSTICE TO THE NATIONS INC
PO BOX 682711FRANKLINTN37068N/APCGeneral & Unrestricted$30,000
REMEMBER US THE HOLOCAUST BNAI MITZVAH PROJECT
1112 MONTANA AVE 182SANTA MONICACA90403N/APCGeneral & Unrestricted$3,600
REPORT INC-RESEARCHEVALUATIONPROMOTING ORG RESP
PMB 225 1121 N BETHLEHEM PIKE STE 6SPRING HOUSEPA19477N/APCNGO Monitor$50,000
ROAD RUNNERS CLUB OF AMERICA
9854 NATIONAL BLVD 534LOS ANGELESCA90034N/APCLos Angeles Running Club's yearly track permits from the City of Santa Monica$5,000
SIMON WIESENTHAL CENTER INC
1399 S ROXBURY 2ND FLLOS ANGELESCA90035N/APCMoriah Films' comprehensive documentary about the life and legacy of David Ben-Gurion$70,000
STUDENTS RUN AMERICA
5252 CREBS AVETARZANACA91356N/APCGeneral & Unrestricted$5,000
THE JEWISH INSTITUTE FOR NATIONAL SECURITY OF AMER
1101 14TH ST NW STE 1030WASHINGTONDC20005N/APCGeneral & Unrestricted$100,000
THE MAPLE COUNSELING CENTER
439 N CANON DR STE 209BEVERLY HILLSCA90210N/APCGeneral & Unrestricted$5,000
THE OPEN TEMPLE
1422 ELECTRIC AVEVENICECA90291N/APCGeneral & Unrestricted$10,000
TRIBE MEDIA CORP
3250 WILSHIRE BLVD STE 1250LOS ANGELESCA90010N/APCGeneral & Unrestricted$50,000
TURNING POINT USA INC
4940 EAST BEVERLY RDPHOENIXAZ85044N/APCGeneral & Unrestricted$50,000
UNITED STATES HOLOCAUST MEMORIAL MUSEUM
100 RAOUL WALLENBERG PL SWWASHINGTONDC20024N/APCGeneral & Unrestricted$5,000
UNIVERSITY OF SOUTHERN CALIFORNIA
3551 TROUSDALE PKWY ADM 160LOS ANGELESCA90089N/APCFurthering the mission of the USC Center for the Political Future$50,000
WASHINGTON INSTITUTE FOR NEAR EAST POLICY
1111 19TH ST NW STE 500WASHINGTONDC20036N/APCGeneral & Unrestricted$5,000
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$2,266,312TotalGrantOrContriPdDurYrAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

FieldValueIRS element (for citing)
Fees Contracts From Govt AgFeesContractsFromGovtAgGrp
Membership Dues And AssmntMembershipDuesAndAssmntGrp

Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$1,484ExclusionAmt

Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$710,705ExclusionAmt
FieldValueIRS element (for citing)
Net Rntl Incm Re Debt Fincd PropNetRntlIncmReDebtFincdPropGrp
Net Rntl Incm Re Not Debt Fincd PropNetRntlIncmReNotDebtFincdProp
Net Rental Income Personal PropNetRentalIncomePersonalPropGrp
Other Investment IncomeOtherInvestmentIncomeGrp

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Business525990BusinessCd
Unrelated Business Taxbl Incm$496,644UnrelatedBusinessTaxblIncmAmt
Exclusion18ExclusionCd
Exclusion$1,268,140ExclusionAmt
FieldValueIRS element (for citing)
Net Income Loss From Special EvtNetIncomeLossFromSpecialEvtGrp
Gross Profit Loss Sls Of InvntryGrossProfitLossSlsOfInvntryGrp

Other Revenue Described OtherRevenueDescribedGrp (4 entries)

DescDescBusinessBusinessCdUnrelated Business Taxbl IncmUnrelatedBusinessTaxblIncmAmtExclusionExclusionCdExclusionExclusionAmt
K-1 Inc/Loss525990-$79,48114$1,036,290
STATE TAX REFUND01$11,927
CLASS ACTION LAWSUIT PROCEEDS01$399
FOREIGN CURRENCY GAIN01$656

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$417,163UnrelatedBusinessTaxblIncmAmt
Exclusion$3,029,601ExclusionAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$3,446,764TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EOfalseTrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EOfalseTrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of AssetsfalseSalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EOfalsePurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth AssetsfalseRentalOfFacilitiesOthAssetsInd
Reimbursement ArrangementsfalseReimbursementArrangementsInd
Loans Or Loan GuaranteesfalseLoansOrLoanGuaranteesInd
Performance Of Services EtcfalsePerformanceOfServicesEtcInd
Sharing Of Facilities EtcfalseSharingOfFacilitiesEtcInd
Relationships Nonchrtbl EOfalseRelationshipsNonchrtblEOInd

All Oth Prog Rltd Investments Sch AllOthProgRltdInvestmentsSch

All Other Program Related Invst AllOtherProgramRelatedInvstGrp (3 entries)

DescDescAmtAmt
CYWAT TECHNOLOGIES LTD - TO PROMOTE THE HEALTH OF PEOPLE WHO ARE AFFECTED BY POLLUTED DRINKING WATER BY FUNDING THE DEVELOPMENT OF A WATER MONITORING SYSTEM$7,101
BIO-ACTIVES SYNERGIO LTD. - TO PROMOTE HEALTH BY FUNDING RESEARCH INTO DEVELOPING NON-HAZARDOUS, NATURAL PRODUCTS THAT DO NOT ENDANGER HUMAN HEALTH$100,000
BARAK BALLET - TO DEVELOP AND PRODUCE A LIVE DANCE PERFORMANCE ENTITLED MEMORYHOUSE$200,000

Compensation Explanation CompensationExplanation

Compensation Explanation CompensationExplanationGrp

FieldValueIRS element (for citing)
PersonJeff PolakPersonNm
Short Explanation* 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, 2021, THE FOUNDATION PAID $383,363 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.ShortExplanationTxt

Depreciation Schedule DepreciationSchedule

Expenditure Responsibility Stmt ExpenditureResponsibilityStmt

Expenditure Responsibility ExpenditureResponsibilityGrp (16 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdGrantGrantDtGrantGrantAmtPurpose Of GrantPurposeOfGrantTxtAny Diversion By GranteeAnyDiversionByGranteeTxtDates Of Reports By GranteeDatesOfReportsByGranteeTxtResults Of VerificationResultsOfVerificationTxtAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCd
NEUROVISION IMAGING LLC
1395 GARDEN HIGHWAY SUITE 250SACRAMENTOCA958332014-12-17$250,000PRI INVEST-SEE GEN EXPLAN FOR PURPOSE & ADDTL DETAILS RE AMT, AMT EXPENDED, & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
BRUIN BIOMETRICS LLC
10960 WILSHIRE BLVD SUITE 950LOS ANGELESCA900242015-05-13$250,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
BIOP MEDICAL LTD
2017-04-21$250,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.10 HAELIAV STRAMAT GANIS5252263
ONLINE DISRUPTIVE TECHNOLOGIES INC
2017-04-21$250,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.MATAM ADV TECH PK BLD 23 POBX 15050HAIFAIS3190501
ORGENESIS LTD
2017-04-21$305,498PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.ARAD STREET 9TEL AVIVIS
BRYN PHARMA LLC FKA EPI-NOW LLC
518 NORTH HILLCREST ROADBEVERLY HILLSCA902102018-07-13$250,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
CYWAT TECHNOLOGIES LTD
2018-11-26$250,000PRI INVEST-SEE GEN EXPLAN FOR PURPOSE & ADDTL DETAILS RE AMT, AMT EXPENDED, & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.168 JABOTINSKY STBNEI BRAKIS
BIO-ACTIVES SYNERYGIO LTD FKA YB MO CHO
2018-04-20$250,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.HITECH VIL 4/9 GIVAT RAM POB 39231JERUSALEMIS9129102
BIO-ACTIVES SYNERYGIO LTD FKA YB MO CHO
2018-07-19$250,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.HITECH VIL 4/9 GIVAT RAM POB 39231JERUSALEMIS9129102
MAXQ AI LTD
2019-03-19$250,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.96 YIGAL ALON STREET ENTRANCE ATEL AVIVIS6789140
EXTHERA MEDICAL CORPORATION
757 ARNOLD DRIVE SUITE BMARTINEZCA945532019-12-19$250,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORT WAS MADE.
YONALINK LTD
2019-11-12$250,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORT WAS MADE.HADASSAH EIN KEREM HOSP POB 12000JERUSALEMIS9112001
AMICROBE INC
3142 TIGER RUN COURT 103CARLSBADCA920102019-10-31$250,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORT WAS MADE.
OCTHEALTH LLC
1395 GARDEN HIGHWAY SUITE 250SACRAMENTOCA958332021-06-08$250,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESNONE NECESSARY
BIO-ACTIVES SYNERGIO LTD
2021-10-12$100,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESNONE NECESSARYHI-TECH VILLAGE UNIT 4/9 POB39231GIVAT RAMIS9129102
CYWAT TECHNOLOGIES LTD
2021-06-15$100,000PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSIONNOSEE GENERAL EXPLANATION FOR REPORT DATESTHE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.168 JABOTINSKY STBNEI BRAKIS

General Explanation Attachment GeneralExplanationAttachment

General Explanation GeneralExplanationGrp (3 entries)

IdentifierIdentifierTxtForm And Line ReferenceFormAndLineReferenceDescMedium ExplanationMediumExplanationTxt
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): $1,268,140 TOTAL NOT INCLUDED IN PART IV: PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - UBI NET GAIN/(LOSS): $496,644 TOTAL PART I, LINE 6A: $1,764,784 DETAILS OF ASSETS INCLUDED IN PART IV: PUBLICLY-TRAIDED SECURITIES GROSS SALES PRICE: $61,461,953 BOOK BASIS: $61,303,288 NET GAIN/(LOSS): $158,665 PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - NON UBI NET GAIN/(LOSS): $1,028,632 SALES OF OTHER ITEMIZED ASSETS GROSS SALES PRICE: $505,843 BOOK BASIS: $425,000 NET GAIN/(LOSS): $80,843
Form 8865Form 8865The 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.
Form 990-PFForm 990-PFOne or more partnerships have provided a Schedule K-3 for the tax year in which they have checked one or more of the boxes in Part I but not provided sufficient back-up information to allow the Foundation to verify why such boxes were checked or the extent to which the checking of such boxes affects any item on this return. The Foundation has prepared this return to the best of its ability and without any foreign filings for such partnerships based on the information provided to it by these partnerships 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.

Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule

Investments Corporate Bonds InvestmentsCorporateBondsGrp

FieldValueIRS element (for citing)
BondEDISON INTL BOND PERPETUAL - 5BondNm
EOY Book Value$1,000,149EOYBookValueAmt
EOYFMV$1,047,600EOYFMVAmt

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corporate Stock InvestmentsCorporateStockGrp (67 entries)

StockStockNmEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
AMERICAN AXLE & MFG HOLDINGS I$251,018$205,260
ARCH COAL, INC$84,323$91,320
B2 GOLD CORP COM NPV$150,587$165,846
BANK OF AMERICA CORP$113,640$533,880
BARRICK GOLD CORPORATION$757,502$475,000
BAYER A G SPONSORED ADR$198,370$106,080
BERRY PLASTICS GROUP INC$220,739$368,900
BP PLC SPONSORED ADR$102,249$79,890
CAMECO CORPORATION$19,784$21,810
CENTURY ALUMINUM COMPANY$150,170$198,720
CHENIERE ENERGY INC$200,948$304,260
CITIGROUP INC$248,049$301,950
CLIFFS NATURAL RESOURCES INC.$122,035$174,160
COMPASS MINERALS INTERNATIONAL$202,745$204,320
COMSTOCK RES INC$82,955$121,350
CONSOL ENERGY, INC$73,339$68,130
CONSTELLIUM NV$136,767$107,460
COPPER MOUNTAIN MINI NG CORP$78,225$379,052
COTERRA ENERGY INC$312,903$361,266
CROWN HOLDINGS INC$185,100$553,100
CVS CAREMARK CORP$466,000$1,031,600
DANA HOLDING CP$68,217$114,100
ELDORADO GOLD CORP COM NPV$218,701$168,300
ENDEAVOUR MINING CORP$206,264$218,696
FIDELITY CONSERV INC BD FD$8,589$8,586
FIRST QUANTUM MINERALS LTD$17,953$48,000
FLUTTER ENTERTAINMENT ORD SHS$59,804$70,875
FTS INTERNATIONAL INC$321,080$378,473
GENERAL MOTORS$361,740$586,300
GOLD FIELDS LTD ADS$140,581$285,740
GOLDEN STAR RESOURCES LTD$13,940$15,320
GRAFTECH INTERNATIONAL LTD$294,224$295,750
GRAPHIC PACKAGING CORP COM STK$41,828$58,500
HALLIBURTON COMPANY$226,736$137,220
HOLCIM LTD SPON ADS$57,245$100,900
HOLCIM N$513,587$495,500
HUDBAY MINERALS INC$186,121$217,500
IVANHOE MINES LTD$60,260$246,000
JAPAN SMALLER CAPITALIZATION F$365,092$360,446
JET2 PLC$78,926$151,021
JOHNSON & JOHNSON$231,728$427,675
KAZATOMPROM JSC NAC GDR$147,503$367,500
KIRKLAND LAKE GOLD LTD$289,047$365,426
MARKET VECTORS VIETNAM ETF$40,705$42,480
MERCK & CO INC$362,950$613,120
MICRON TECHNOLOGY$325,144$1,117,801
MICROSOFT CORP$28,785$336,320
NEWMONT GOLDCORP CORPORATION$574,088$983,389
NEXGEN ENERGY LTD$83,653$117,990
NOVAGOLD RESOURCES$108,485$137,200
NUVEEN MLT STR I&G$9,760$9,760
OCEANAGOLD CORPORATION COM$142,250$103,800
ORGANON & CO$18,170$24,360
PEABODY ENERGY CORP$60,905$50,350
PFIZER INC$441,678$1,062,900
PHILIP MORRIS INTL$8,916$9,500
PRETIUM RESOURCES INC$109,012$169,080
TEVA PHARMACEUTICAL INDUSTRIES$36,513$8,010
THE MOSAIC CO$261,023$275,030
TOREX GOLD RESOURCES$181,332$155,700
TPG RE FINANCE TRUST INC$2,013$1,232
TRUIST FINANCIAL CORPORATION$30,848$58,550
TURQUOISE HILL RESOURCES LTD$98,774$98,700
UNITED STATES STEEL CORP$23,905$23,810
VALARIS LTD WTS EXP 04/29/2028$220,170$314
VALARIS PLC COM CL A$161,969
VIATRIS ORD SHS$90,189$87,688

Investments Govt Obligations Sch InvestmentsGovtObligationsSch

FieldValueIRS element (for citing)
US Govt Obligations Book Vl EOY$23,334,689USGovtObligationsBookVlEOYAmt
US Govt Obligations EOYFMV$23,402,860USGovtObligationsEOYFMVAmt
State Local Sec Book Vl EOY$2,621,558StateLocalSecBookVlEOYAmt
State Local Sec EOYFMV$2,816,618StateLocalSecEOYFMVAmt

Investments Other Schedule2 InvestmentsOtherSchedule2

Investments Other InvestmentsOtherGrp (35 entries)

Category Or ItemCategoryOrItemTxtBook ValueBookValueAmtEOYFMVEOYFMVAmt
AIR U.S. LIFE FUND III, LP$2,074,320$2,073,099
AIR US LIFE FUND IV, LP$2,069,383$2,133,872
ALPHA WAVE (F/K/A FALCON EDGE)$557,691$1,487,359
ALTAIR - PACIFIC COAST CPTL PT$714,364$942,515
ALTAIR DIRECT LENDING FUND, LL$171,854$156,702
ALTAIR EUROPEAN R E OPPORTUNIT$659,098$308,408
ALTAIR SENIOR HOUSING FUND (AE$188,269$618,063
ANAGENESIS CAPITAL PARTNERS SB$1,120,878$1,783,921
ASM CONNAUGHT HOUSE FUND III L$1,000,000$1,289,574
AVANTE CAPITAL PARTNERS SBIC I$146,430$142,105
BROAD ST REAL ESTATE CREDIT PT$60,000$244,636
BW GAS & CONVENIENCE ONSHORE F$249,192$3,082,224
DORCHESTER CAPITAL SECONDARIES$461,887$581,433
ENLIGHTENMENT CAPITAL SOLUTION$1,256,641$2,640,217
FIRST EAGLE CLO EQUITY FUND I,$643,264$612,135
FOURTHSTONE SMALL-CAP FINANCIA$315,314$404,796
GOLDMAN SACHS VINTAGE FUND V L$302,066$134,705
GRANITE CREEK FLEXCAP II, L.P$795,402$1,232,897
GS DISTRESSED OPPORTUNITIES FU$133,187$203,944
GSO CAPITAL SOLUTIONS FUND II$6,436$5,737
GSO CAPITAL SOLUTIONS FUND II$77,877$51,753
GSO CAPITAL SOLUTIONS FUND II$287,881$153,222
GSO ENERGY SELECT OPPORTUNITIE$321,560$303,953
GSO ENERGY SELECT OPPORTUNITIE$58,054$51,753
GSO ENERGY SELECT OPPORTUNITIE$1,409$1,256
GSO ENERGY SELECT OPPORTUNITIE$41,371$36,346
LATITUDE MGMT REAL ESTATE CAPI$75,000$65,274
LATITUDE MGMT REAL ESTATE CAPI$2,000,000$2,011,389
PCCP EQUITY VII, LP$1,883,263$3,243,232
PCCP EQUITY VIII, LP$665,012$794,793
QS CAPITAL STRATEGIES II, L.P$281,655$264,946
SILVERVIEW CREDIT OPPORTUNITES$172,223$179,901
SILVERVIEW CREDIT OPPORTUNITES$1,592,815$1,646,743
THE EDGBASTON ASIAN EQUITY TRU$1,350,605$1,258,937
BERNIE L MADOFF - CLAIM RECEIV$406,622$406,622

Legal Fees Schedule LegalFeesSchedule

Legal Fees LegalFeesGrp

FieldValueIRS element (for citing)
CategoryGeneral ConsultationsCategoryTxt
Legal Fees$23,115LegalFeesAmt
Disbursements Charitable Prps$23,115DisbursementsCharitablePrpsAmt

Other Assets Schedule OtherAssetsSchedule

Other Assets Schedule OtherAssetsScheduleGrp (18 entries)

DescDescEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
PRI - AMICROBE, INC$250,000$250,000
PRI - BARAK BALLET$200,000$200,000
PRI - BIOP MEDICAL$250,000$250,000
PRI - BRUIN_BIOMETRICS$250,000$250,000
PRI - BRYN PHARMA LLC F/K/A EP$250,000$250,000
PRI - CYWAT TECH$507,100$507,101
PRI - EXTHERA MEDICAL CORP$250,000$250,000
PRI - MAXQ AI, LTD$250,000$250,000
PRI - MOTHERS CHOICE$250,000$250,000
PRI - MOTHERS CHOICE (2)$250,000$250,000
PRI - OCTHEALTH LLC - 15,000 U$250,000$250,000
PRI - ONLINE DISRUPTIVE$250,000$250,000
PRI - ORGENESIS - 32,052 SHARE$294,398$183,658
PRI - ORGENESIS WTS - 32,052 U$11,100
PRI - SER A1 PFD (82,175 UNITS$250,000$250,000
PRI - SER A2 PFD (15,408 UNITS$37,502$37,502
PRI - SYNERGIO BIO ACTIVES LTD$100,000$100,000
PRI - YONALINK LTD$250,000$250,000

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (34 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmtNet Investment IncomeNetInvestmentIncomeAmt
Administrative Fees$87,942$87,942
Bank Charges$2,837$2,837
Cell Phone Expense$1,699$1,699
Foundation Dues & Memberships$3,600$3,600
Insurance Premiums$1,192$1,192
K-1 Exp AIR U.S. LIFE FUND III$132,085$132,085
K-1 Exp AIR US LIFE FUND IV, L$22,556$22,556
K-1 Exp ALPHA WAVE (F/K/A FALC$11,471$11,471
K-1 Exp ALTAIR - PACIFIC COAST$17,488$17,205
K-1 Exp ALTAIR DIRECT LENDING$1,732$1,732
K-1 Exp ALTAIR SENIOR HOUSING$3,165$3,099
K-1 Exp ANAGENESIS CAPITAL PAR$168,069$164,680
K-1 Exp AVANTE CAPITAL PARTNER$21,404$21,020
K-1 Exp BW GAS & CONVENIENCE O$534$57
K-1 Exp ENLIGHTENMENT CAPITAL$19,851$19,779
K-1 Exp FIRST EAGLE CLO EQUITY$16,202$11,170
K-1 Exp FOURTHSTONE SMALL-CAP$5,756$5,756
K-1 Exp GRANITE CREEK FLEXCAP$9,486$9,349
K-1 Exp GSO CAPITAL SOLUTIONS$3,306$828
K-1 Exp GSO CAPITAL SOLUTIONS$5,058$5,053
K-1 Exp GSO ENERGY SELECT OPPO$37,274$3,604
K-1 Exp GSO ENERGY SELECT OPPO$1,011$906
K-1 Exp GSO ENERGY SELECT OPPO$25$25
K-1 Exp GSO ENERGY SELECT OPPO$2,050$398
K-1 Exp PCCP EQUITY VII, LP$32,641$32,634
K-1 Exp PCCP EQUITY VIII, LP$6,306$6,305
K-1 Exp QS CAPITAL STRATEGIES$41,033$40,894
K-1 Exp SILVERVIEW CREDIT OPPO$1,071$1,071
K-1 Exp THE EDGBASTON ASIAN EQ$4,401$4,311
Postage/Delivery Service$160$160
Registered Agent Fee$125$125
State or Local Filing Fees$290$290
Website Hosting/Support$547$547
PARKING FEES$6,857$6,857

Other Income Schedule2 OtherIncomeSchedule2

Other Income Detail OtherIncomeDetail (24 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmt
K-1 Inc/Loss AIR US LIFE FUND IV, LP-$242-$242
K-1 Inc/Loss ALTAIR - PACIFIC COAST CPTL PTNRS EQU$300$5,627
K-1 Inc/Loss ALTAIR DIRECT LENDING FUND, LLC$2,465$2,465
K-1 Inc/Loss ALTAIR SENIOR HOUSING FUND (AEW), LLC-$27,958$26
K-1 Inc/Loss ANAGENESIS CAPITAL PARTNERS SBIC FUND$206,444$295,357
K-1 Inc/Loss AVANTE CAPITAL PARTNERS SBIC III, LP$16,149$16,488
K-1 Inc/Loss BW GAS & CONVENIENCE ONSHORE FUND, LP-$102,921
K-1 Inc/Loss ENLIGHTENMENT CAPITAL SOLUTIONS FUND$70,016$72,443
K-1 Inc/Loss FIRST EAGLE CLO EQUITY FUND I, LP$154,554$142,034
K-1 Inc/Loss FOURTHSTONE SMALL-CAP FINANCIALS FD L$6,201$6,201
K-1 Inc/Loss GRANITE CREEK FLEXCAP II, L.P$152,194$152,008
K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II AIV-1 L-$27
K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II AIV-2 L$86,482$58,507
K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II LP$26,683$26,344
K-1 Inc/Loss GSO ENERGY SELECT OPPORTUNITIES FUND$137,046-$1,239
K-1 Inc/Loss GSO ENERGY SELECT OPPORTUNITIES FUND$3,609$1,225
K-1 Inc/Loss PCCP EQUITY VII, LP-$16,352$9,325
K-1 Inc/Loss PCCP EQUITY VIII, LP$6,008$5,585
K-1 Inc/Loss QS CAPITAL STRATEGIES II, L.P$22,688$22,578
K-1 Inc/Loss SILVERVIEW CREDIT OPPORTUNITES OFFSHO$157,272$157,272
K-1 Inc/Loss THE EDGBASTON ASIAN EQUITY TRUST$56,198$56,198
Class Action Lawsuit Proceeds$399$399
Foreign Currency Gain$656$656
State Tax Refund$11,927

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail (4 entries)

CategoryCategoryTxtAmtAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmtNet Investment IncomeNetInvestmentIncomeAmt
WEBSITE DEVELOPMENT$10,878$10,878
Investment Management Services$398,604$398,604
Philanthropic Consulting Srvcs$15,000$15,000
LOGO DESIGN SERVICES$15,000$15,000

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail (5 entries)

CategoryCategoryTxtAmtAmtNet Investment IncomeNetInvestmentIncomeAmt
990-PF Estimated Tax for 2021$15,300
990-T Extension for 2020$124,500
Foreign Tax Paid$13,725$13,725
STATE UBTI TAX 2020$55,800
STATE UBTI TAX 2019$12,635