2025-07-17T10:37:39-05:00 2022-12-31 920460586 PWC US TAX LLP 1420 5TH AVE STE 2800 SEATTLE WA 981011344 990PF 2022-01-01 320660398 THE BASZUCKI FAMILY FOUNDATION BASZ 6502418740 204 2ND AVENUE 522 SAN MATEO CA 944013904 JAN BASZUCKI SECRETARY/TREASURER 6502418740 2025-05-21 1 0 KYLE TALLEY P01239408 2063983000 2022 2025-03-06 01:10:19Z X X 25858896 X 3167500 109313 109313 100894 100894 7417303 7417323 7417303 10795010 7627510 0 0 0 0 0 58788 29394 0 29394 718519 0 0 718519 44847 364 0 0 108341 245 0 108096 930495 30003 0 856009 31694969 3880954 32625464 30003 0 4736963 -21830454 7597507 0 23406896 116680 116680 0 25292220 25292220 10316000 499996 449996 33722896 25908896 25858896 0 49647 0 27814015 468745 94872 468745 27958534 X 0 0 0 0 33254151 -2049638 33254151 -2049638 33722896 25908896 33254151 -21830454 0 11423697 13473335 -2049638 PUBLICLY TRADED SECURITIES - ROBLOX CORP (RBLX) CLASS A, 100,000 SHARES 2004-04-06 2022-08-23 4137969 10 4137959 4137959 PUBLICLY TRADED SECURITIES - ROBLOX CORP (RBLX) CLASS A, 100,000 SHARES 2004-04-06 2022-11-23 3182251 10 3182241 3182241 CAPITAL GAIN DISTRIBUTION FROM FIDELITY 2021-01-01 2022-12-13 97103 97103 97103 7417303 0 105605 0 105605 0 105605 93000 0 15000 0 105605 0 0 0 0 0 0 0 0 1 0 0 0 1 1 CA 1 0 0 1 0 1 N/A JIM CONLEY CO THE BASZUCKI FAMILY 6502418740 204 2ND AVE 522 SAN MATEO CA 944013904 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 NONE 0 HUNGRY HEART MEDIA INC 5450 W WASHINGTON BLVD LOS ANGELES CA 90016 COMMUNICATIONS 252235 GMMB 1200 WESTLAKE AVE N SEATTLE WA 98109 COMMUNICATIONS 168303 FARELLA BRAUN MARTEL LLP ONE BUSH STREET 9TH FLOOR SAN FRANCISCO CA 94104 LEGAL SERVICES 150808 ARNOLD & PORTER KAYE SCHOLER LLP 601 MASSACHUSETTS AVE NW WASHINGTON DC 20001 LEGAL SERVICES 89404 VALERIE CONN CONSULTING LLC 2023 32ND AVE S SEATTLE WA 981444949 CONSULTING SERVICES 72000 0 NONE 0 NONE 0 0 0 14861584 11793265 6582 26661431 0 0 26661431 399921 26261510 1313076 1313076 105605 105605 1207471 0 1207471 0 1207471 4736963 0 4736963 1207471 688512 0 0 4736963 688512 0 2840980 1207471 0 0 0 2840980 0 0 0 0 0 3167500 0 0 DAVID BASZUCKI JAN BASZUCKI X 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. 1154772 THE MILKEN INSTITUTE 1250 FOURTH STREET 2ND FLOOR SANTA MONICA CA 90401 PC LAUNCH AND FOSTER A NEW SCIENTIFIC COMMUNITY IN METABOLIC PSYCHIATRY. 2641413 UNIVERSITY OF PITTSBURGH 213 PARK PLAZA 128 NORTH CRAIG STREE 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. 84769 3880954 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. 1998454 THE MILKEN INSTITUTE 1250 FOURTH STREET 2ND FLOOR SANTA MONICA CA 90401 PC LAUNCH AND FOSTER A NEW SCIENTIFIC COMMUNITY IN METABOLIC PSYCHIATRY. 30000000 31998454 14 109313 14 100894 18 7417303 0 7627510 0 7627510 0 0 0 0 0 0 0 0 0 0 X X 1 DAVID AND JAN BASZUCKI 204 2ND AVENUE 522 SAN MATEO CA 944013904 3167500 X X 1 SECURITY (ROBLOX CORP CL A) 100,000 SHARES 3167500 2022-11-23 ACCOUNTING SERVICES 58788 29394 0 29394 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. NONE 0 SEE STATEMENT 16 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 OWNERSHIP OF CONTROLLED ENTITIES 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. DOMESTIC EQUITY SECURITIES (KNOW LABS & KETOSWISS) 499996 449996 25292220 25292220 0 0 UNREALIZED LOSS 13473335 GENERAL AND ADMINISTRATIVE 108096 0 0 108096 INVESTMENT EXPENSES 245 245 0 0 FEDERAL EXCISE TAX PAYABLE 325353 94872 DEFERRED FEDERAL EXCISE TAX PAYABLE 143392 0 PROFESSIONAL FEES 718519 0 0 718519 DELINQUENT INTERNATIONAL INFORMATION RETURN SUBMISSION PROCEDURES -REASONABLE CAUSE STATEMENTTAXPAYER: THE BASZUCKI FAMILY FOUNDATIONEIN: 32-0660398INCOME TAX RETURN: FORM 990-PFTAX YEAR ENDED: DECEMBER 31, 2022THIS REASONABLE CAUSE STATEMENT IS BEING FILED PURSUANT TO THE "DELINQUENT INTERNATIONAL INFORMATION RETURN SUBMISSION PROCEDURES" EFFECTIVE JULY 1, 2014.THE BASZUCKI FAMILY FOUNDATION ("THE FOUNDATION") IS FILING AN ORIGINAL FORM 926, RETURN BY A U.S. TRANSFEROR OF PROPERTY TO A FOREIGN CORPORATION, FOR THE TAX YEAR ENDED DECEMBER 31, 2022, TO REPORT A TRANSFER OF CASH TO THE FOLLOWING FOREIGN CORPORATION:KETOSWISS AG (EIN: NONE)THE RELEVANT FACTS ARE AS FOLLOWS:A. THE FOUNDATION WAS ESTABLISHED ON JUNE 3, 2021 AS A NOT-FOR-PROFIT PRIVATE FOUNDATION WITH THE PURPOSE OF MAKING GRANTS, DONATIONS, GIFTS, AND CONTRIBUTIONS TO FULFILL THEFOUNDERS' VISION OF CHARITABLE GIVING. THE FOUNDATION DIRECTS RESOURCES TOWARD THE GREATER GOOD THROUGH MISSION-DRIVEN INVESTMENTS THAT IMPROVE HUMAN HEALTH, GOVERNANCE, AND THE HEALTH OF OUR PLANET. SUPPORT AND INCOME ARE DERIVED PRINCIPALLY FROM SUPPORT BY THE FOUNDERS AND INCOME AND GAINS FROM THE TAXPAYER'S INVESTMENTS.B. DURING THE DECEMBER 31, 2021 TAX YEAR, THE FOUNDATION'S INITIAL TAX YEAR, THERE WAS MINIMAL ACTIVITY AS THE FOUNDATION WAS BEING ESTABLISHED. THE TAXPAYER RECEIVED THE INITIAL FUNDING IN THE FORM OF A STOCK CONTRIBUTION FROM THE FOUNDERS ON NOVEMBER 22, 2021. THE STOCK WAS SUBSEQUENTLY SOLD WITHIN THE FOUNDATION. NO GRANTS WERE MADE, AND NO OTHER ACTIVITY WAS CONDUCTED DURING THE 2021 TAX YEAR.C. DURING THE DECEMBER 31, 2022 TAX YEAR, THE FOUNDATION'S SECOND TAX YEAR, THE FOUNDATION BEGAN TO ESTABLISH REGULAR AND CONTINUOUS ACTIVITIES, INCLUDING MAKING GRANTS AND INVESTING IN ACTIVITIES THAT ALIGNED WITH THE FOUNDATION'S MISSION. DURING THIS YEAR, THE FOUNDATION INVESTED IN KETOSWISS AG, A LIFE SCIENCES COMPANY WORKING TO DEVELOP MEDICAL FOODS TO IMPROVE HUMAN HEALTH, WHOSE PURPOSE IS CONSISTENT WITH THE FOUNDATION'S GOALS.D. KETOSWISS AG IS A FOREIGN CORPORATION. AT THE TIME OF THE TRANSFER, THE FOUNDATION'S ADMINISTRATOR AND EXTERNAL TAX ADVISOR DID NOT IDENTIFY THAT THE CASH CONTRIBUTION WAS MADE DIRECTLY TO A FOREIGN CORPORATION. CONTROLS WERE NOT YET FULLY IN PLACE TO IDENTIFY FOREIGN TRANSFERS AND THE FEDERAL TAX REPORTING REQUIREMENTS ASSOCIATED WITH SUCH TRANSFERS.E. THE FOUNDATION DISCOVERED ITS FAILURE TO COMPLY WITH IRC 6038B, AND FAILURE TO FILE FORM 926, DURING THE PREPARATION OF ITS DECEMBER 31, 2023 TAX RETURN. ONCE THE FAILURE TO FILE THE FORM 926 WAS IDENTIFIED, THE FOUNDATION AND ITS EXTERNAL TAX ADVISOR WORKED TO PREPARE THE FORM 926 AND THE FORM IS NOW BEING FILED UNDER THE IRS'S DELINQUENT INTERNATIONAL INFORMATION RETURN SUBMISSION PROCEDURES.F. THE FOUNDATION IS FILING AN AMENDED RETURN FOR FISCAL YEAR DECEMBER 31, 2022 TO TRANSMIT THE ORIGINAL FORM 926 THAT SHOULD HAVE BEEN FILED WITH THE ORIGINAL FORM 990-PF, RETURN OF PRIVATE FOUNDATION, FILED FOR THE YEAR. THE AMENDED RETURN REPORTS NO ADDITIONAL TAX DUE AS THERE IS NO CHANGE TO THE FOUNDATION'S LIABILITY FOR THE DECEMBER 31, 2022 TAX YEAR AS A RESULT OF THE FILING OF THE FORM 926.G. THE FOUNDATION'S ADMINISTRATOR AND EXTERNAL TAX ADVISOR HAVE ESTABLISHED TAX RETURN REVIEW PROCEDURES WITH THE GOAL OF IDENTIFYING TRANSFERS OF CASH OR PROPERTY TO FOREIGN CORPORATIONS SO THE TRANSFERS CAN BE REPORTED ON TIMELY FILED FORMS 926. THE FOUNDATION IS NOT UNDER IRS EXAMINATION AS OF THE DATE THIS FORM 926 IS BEING FILED. THE FOUNDATION HAS NOT BEEN PREVIOUSLY CONTACTED REGARDING AN INCOME TAX EXAMINATION OR A REQUEST FOR A DELINQUENT INTERNATIONAL INFORMATION RETURN.APPLICABLE PROVISIONS OF THE INTERNAL REVENUE MANUALPURSUANT TO IRM 20.1.9.1.5(4), A DETERMINATION WITH RESPECT TO WHETHER REASONABLE CAUSE EXISTS REQUIRES CONSIDERATION OF THE FACTORS SET FORTH IN IRM 20.1.1. SEE ALSO IRM 20.1.9.3.5(1) (TAXPAYER MUST MAKE AN AFFIRMATIVE SHOWING OF ALL FACTS ALLEGED AS REASONABLE CAUSE). UNDER IRM 20.1.1.3.2, WHETHER REASONABLE CAUSE EXISTS IS BASED ON ALL OF THE FACTS AND CIRCUMSTANCES AND IS GENERALLY GRANTED WHEN THE TAXPAYER EXERCISED ORDINARY BUSINESS CARE AND PRUDENCE" IN DETERMINING ITS TAX OBLIGATIONS, BUT NEVERTHELESS FAILS TO COMPLY WITH THOSE OBLIGATIONS. GENERALLY, "ANY REASON WHICH ESTABLISHES THAT THE TAXPAYER EXERCISED ORDINARY BUSINESS CARE AND PRUDENCE, BUT NEVERTHELESS WAS UNABLE TO COMPLY WITH A PRESCRIBED DUTY WITHIN THE PRESCRIBED TIME, WILL BE CONSIDERED." IRM 20.1.1.3.2(3)(A).APPLICABLE FACTORS FOR ESTABLISHING REASONABLE CAUSE INCLUDE: THE TAXPAYER'S EFFORTS TO REPORT ENTITIES TIMELY FOLLOWING THE DISCOVERY OF MISSING INFORMATION RETURNS; THE TAXPAYER'S PRIOR COMPLIANCE HISTORY; AND THE TAXPAYER'S EFFORTS TO ENSURE FAILURE TO REPORT ENTITIES DOES NOT OCCUR AGAIN.SEE GENERALLY, IRM 20.1.9.7.5(1) (REASONABLE CAUSE SHOULD BE CONSIDERED AFTER TAXPAYER HAS FILED FOR ALL OPEN YEARS). AS MENTIONED EARLIER, THE FOUNDATION'S ACTIVITIES COMMENCED DURING THE 2022 TAX YEAR WHEN CONTROLS WERE NOT FULLY IN PLACE TO IDENTIFY FOREIGN TRANSFERS AND THE FEDERAL TAX REPORTING REQUIREMENTS ASSOCIATED WITH SUCH TRANSFERS.THE FOUNDATION ACTED PROMPTLY TO PREPARE THE ENCLOSED FORM 926 SO THAT IT COULD BE FILED FOR THE DECEMBER 31, 2022 TAX YEAR.THE FOUNDATION OTHERWISE TIMELY FILED ITS FORM 990-PF FOR THE TAX YEAR DECEMBER 31, 2022.IN LIGHT OF THE INFORMATION SET FORTH ABOVE, THE FOUNDATION RESPECTFULLY SUBMITS THAT THE REQUIREMENTS OF THE "DELINQUENT INTERNATIONAL INFORMATION RETURN SUBMISSION PROCEDURES" ARE MET AND RESPECTFULLY REQUESTS THAT NO CIVIL PENALTY BE ASSESSED WITH RESPECT TO THE FORM 926 FILED WITH THE FORM 990-PF (AMENDED) FOR THE TAX YEAR ENDED DECEMBER 31, 2022. FOREIGN TAX PAID 364 364 0 0 EXCISE TAX EXPENSE 44483 0 0 0 METABOLIC MIND LLC 204 2ND AVE STE 522 SAN MATEO CA 94401 920573910 THE BASZUCKI FAMILY FOUNDATION TRANSFERRED $100,000 OF INITIAL FUNDING TO LAUNCH METABOLIC MIND LLC. 100000 100000