DAVID AND JANET POLAK FOUNDATION: Form 990PF, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- DAVID AND JANET POLAK FOUNDATION (EIN 45-4797578)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-15
- IRS object ID
- 202143209349100204
- Schema version
- 2020v4.1
- 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
- Compensation Explanation
- Depreciation Schedule
- Expenditure Responsibility Stmt
- General Explanation Attachment
- Investments Corp Stock Schedule
- Investments Govt Obligations Sch
- Investments Other Schedule2
- Legal Fees Schedule
- Other Assets Schedule
- Other Expenses Schedule
- Other Income Schedule2
- Other Increases Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-15T23:23:16-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
| Disaster Relief | New York-Hurricane Ida | DisasterReliefTxt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Foundation Source | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Hollow Ln Ste 212 | AddressLine1Txt |
| City | Lake Success | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 11042 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 454797578 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | David & Janet Polak Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % Jeff Polak | InCareOfNm |
| Business Name Control | DAVI | BusinessNameControlTxt |
| Phone | 8008391754 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Foundation Source 501 Silverside Rd | AddressLine1Txt |
| City | Wilmington | CityNm |
| State Abbreviation | DE | StateAbbreviationCd |
| ZIP | 198091377 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jeff Polak | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 8008391754 | PhoneNum |
| Signature | 2021-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Jeff | PersonFirstNm |
| Person Last | Polak | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Jeffrey D Haskell | PreparerPersonNm |
| PTIN | P01345770 | PTIN |
| Phone | 8008391754 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | TrustedCustomerGrp |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $77,927,007 | FMVAssetsEOYAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $0 | ContriRcvdRevAndExpnssAmt |
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Interest On Sav Rev And Expnss | $66,750 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $66,750 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $887,181 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $887,181 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $1,647,887 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $28,649,648 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $1,468,254 | CapGainNetIncmNetInvstIncmAmt |
| Other Income Rev And Expnss | $634,921 | OtherIncomeRevAndExpnssAmt |
| Other Income Net Invst Incm | $555,329 | OtherIncomeNetInvstIncmAmt |
| Total Rev And Expnss | $3,236,739 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $2,977,514 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $222,800 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $222,800 | CompOfcrDirTrstDsbrsChrtblAmt |
| Oth Empl Slrs Wgs Rev And Expnss | $210,000 | OthEmplSlrsWgsRevAndExpnssAmt |
| Oth Empl Slrs Wgs Dsbrs Chrtbl | $210,000 | OthEmplSlrsWgsDsbrsChrtblAmt |
| Pension Empl Bnft Rev And Expnss | $40,707 | PensionEmplBnftRevAndExpnssAmt |
| Pension Empl Bnft Dsbrs Chrtbl | $40,707 | PensionEmplBnftDsbrsChrtblAmt |
| Legal Fees Rev And Expnss | $16,907 | LegalFeesRevAndExpnssAmt |
| Legal Fees Net Invst Incm | $0 | LegalFeesNetInvstIncmAmt |
| Legal Fees Adj Net Incm | $0 | LegalFeesAdjNetIncmAmt |
| Legal Fees Dsbrs Chrtbl | $16,907 | LegalFeesDsbrsChrtblAmt |
| Other Prof Fees Rev And Expnss | $418,029 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $386,250 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $31,779 | OtherProfFeesDsbrsChrtblAmt |
| Interest Rev And Expnss | $49,530 | InterestRevAndExpnssAmt |
| Interest Net Invst Incm | $49,530 | InterestNetInvstIncmAmt |
| Taxes Rev And Expnss | $195,674 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $28,110 | TaxesNetInvstIncmAmt |
| Occupancy Rev And Expnss | $24,502 | OccupancyRevAndExpnssAmt |
| Occupancy Dsbrs Chrtbl | $24,502 | OccupancyDsbrsChrtblAmt |
| Trav Conf Meeting Rev And Expnss | $404 | TravConfMeetingRevAndExpnssAmt |
| Trav Conf Meeting Dsbrs Chrtbl | $404 | TravConfMeetingDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $626,699 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $471,610 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $98,164 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $1,805,252 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $935,500 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $0 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $645,263 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $2,755,032 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $2,755,032 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $4,560,284 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $935,500 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $0 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $3,400,295 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$1,323,545 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $2,042,014 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $13,205,819 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $3,036,171 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $3,036,171 | SavAndTempCashInvstEOYFMVAmt |
| US Government Obligations BOY | $24,269,959 | USGovernmentObligationsBOYAmt |
| US Government Obligations EOY | $33,783,681 | USGovernmentObligationsEOYAmt |
| US Govt Obligations EOYFMV | $34,150,982 | USGovtObligationsEOYFMVAmt |
| Corporate Stock BOY | $10,626,824 | CorporateStockBOYAmt |
| Corporate Stock EOY | $9,776,068 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $12,635,157 | CorporateStockEOYFMVAmt |
| Other Investments BOY | $20,967,644 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $21,159,666 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $24,922,961 | OtherInvestmentsEOYFMVAmt |
| Other Assets BOY | $3,342,999 | OtherAssetsBOYAmt |
| Other Assets EOY | $3,342,999 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $3,181,736 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $72,413,245 | TotalAssetsBOYAmt |
| Total Assets EOY | $71,098,585 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $77,927,007 | TotalAssetsEOYFMVAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
| Retained Earning BOY | $72,413,245 | RetainedEarningBOYAmt |
| Retained Earning EOY | $71,098,585 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $72,413,245 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $71,098,585 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $72,413,245 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $71,098,585 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $72,413,245 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$1,323,545 | ExcessRevenueOverExpensesAmt |
| Other Increases | $8,885 | OtherIncreasesAmt |
| Subtotal | $71,098,585 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | $71,098,585 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (11 entries)
| PropertyPropertyDesc | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt | How AcquiredHowAcquiredCd | AcquiredAcquiredDt | SoldSoldDt |
|---|---|---|---|---|---|---|---|
| Publicly-traded Securities | $24,661,274 | $23,456,233 | $1,205,041 | $1,205,041 | |||
| Passthrough K1 Capital Gain/(Loss) | $222,117 | ||||||
| 1150 UNION INVESTORS LLC | $7,593 | $7,593 | P | 2016-05-31 | 2020-06-25 | ||
| LATITUDE MGMT RE CAPITAL III INC | $125,000 | $125,000 | P | 2013-05-23 | 2020-06-01 | ||
| LATITUDE MGMT RE CAPITAL III INC | $100,000 | $100,000 | P | 2013-05-23 | 2020-07-21 | ||
| LATITUDE MGMT RE CAPITAL III INC | $75,000 | $75,000 | P | 2020-09-15 | |||
| LATITUDE MGMT RE CAPITAL III INC | $50,000 | $50,000 | P | 2013-10-15 | 2020-10-15 | ||
| LATITUDE MGMT RE CAPITAL III INC | $75,000 | $75,000 | P | 2020-11-16 | |||
| LATITUDE MGMT RE CAPITAL III INC | $25,000 | $25,000 | P | 2014-05-14 | 2020-12-16 | ||
| TRINITY CAPITAL FUND III, L.P | $3,530,781 | $3,530,775 | $6 | $6 | P | 2017-12-13 | 2020-01-16 |
| DISTRIBUTIONS IN EXCESS OF BASIS | $41,090 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $1,468,254 | CapitalGainNetIncomeAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $28,384 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $28,384 | SubtotalAmt |
| Tax Based On Investment Income | $28,384 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $85,336 | EstimatedPlusOvpmtIncmTxAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Total Payments And Credits | $85,336 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Overpayment | $56,952 | OverpaymentAmt |
| Applied To ES Tax | $28,400 | AppliedToESTaxAmt |
| Refund | $28,552 | RefundAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | false | LegislativePoliticalActyInd |
| More Than100 Spent | false | MoreThan100SpentInd |
| Form1120 POL Filed | false | Form1120POLFiledInd |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (true) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (true) | AtLeast5000InAssetsInd |
| Org Report Or Register State | CA | OrgReportOrRegisterStateCd |
| Org Report Or Register State | DE | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (true) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | false | PrivateOperatingFoundationInd |
| New Substantial Contributors | false | NewSubstantialContributorsInd |
| Own Controlled Entity | false | OwnControlledEntityInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (true) | ComplyWithPublicInspRqrInd |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jeff Polak | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3106014296 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1725 Green Acres | AddressLine1Txt |
| City | Beverly Hills | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90210 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | false | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | false | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | false | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | Yes (true) | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | Yes (true) | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | false | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | false | PaymentToGovernmentOfficialInd |
| Acts Fail To Qlfy As Exceptions | false | ActsFailToQlfyAsExceptionsInd |
| Uncorrected Prior Acts | false | UncorrectedPriorActsInd |
| Undistributed Income PY | false | UndistributedIncomePYInd |
| Business Holdings | false | BusinessHoldingsInd |
| Jeopardy Investments | false | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | false | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | false | InfluenceLegislationInd |
| Influence Election | false | InfluenceElectionInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Noncharitable Purpose | false | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (5 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 Polak | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir | 1.0 | $0 | $0 | $0 |
| Janet Polak | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir | 1.0 | $0 | $0 | $0 |
| Jeff Polak | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir, Pres, executive dir | 40.0 | $222,800 | $11,000 | $0 |
| Robert Polak | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir | 1.0 | $0 | $0 | $0 |
| Jonathan Seltzer | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir | 1.0 | $0 | $0 | $0 |
Compensation Highest Paid Empl CompensationHighestPaidEmplGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee BenefitsEmployeeBenefitsAmt |
|---|---|---|---|---|---|---|---|
| Noreen L Rubio | |||||||
| 4301 MANDALAY DRIVE | LOS ANGELES | CA | 90063 | ADMINISTRATIVE ASST | 40.0 | $60,000 | |
| Karen Springer | |||||||
| PO BOX 574 | PALO ALTO | CA | 94302 | PROGRAM ADVISOR | 40.0 | $150,000 | $0 |
Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Service TypeServiceTypeTxt | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Polak Investors LLC | |||||
| 1880 Century Park East Suite 811 | Los Angeles | CA | 90067 | Investment Mgmt | $374,402 |
| Foundation Source | |||||
| 55 Walls Drive 3rd Fl | Fairfield | CT | 06824 | Administrative | $86,452 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Summary Of Direct Chrtbl Acty | SummaryOfDirectChrtblActyGrp | |
| Sum Of Program Related Invst | SumOfProgramRelatedInvstGrp |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $42,953,189 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $8,850,476 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $24,578,787 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $76,382,452 | TotalFMVOfUnusedAssetsAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $76,382,452 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $1,145,737 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $75,236,715 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $3,761,836 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $3,761,836 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $28,384 | TaxBasedOnInvestmentIncomeAmt |
| Income Tax | $34,963 | IncomeTaxAmt |
| Total Tax | $63,347 | TotalTaxAmt |
| Distributable Before Adj | $3,698,489 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $8,885 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $3,707,374 | DistributableBeforeDedAmt |
| Distributable As Adjusted | $3,707,374 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $3,400,295 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Charitable Assets Acquis Paid | $0 | CharitableAssetsAcquisPaidAmt |
| Set Aside Suitability Test | $0 | SetAsideSuitabilityTestAmt |
| Set Aside Cash Distri Test | $0 | SetAsideCashDistriTestAmt |
| Qualifying Distributions | $3,400,295 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $0 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $3,400,295 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $3,707,374 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $3,339,727 | UndistributedIncomePYAmt |
| Prior Year1 | 2018 | PriorYear1Yr |
| Prior Year2 | 2017 | PriorYear2Yr |
| Prior Year3 | 2016 | PriorYear3Yr |
| Qualifying Distributions | $3,400,295 | QualifyingDistributionsAmt |
| Applied To Year1 | $3,339,727 | AppliedToYear1Amt |
| Applied To Current Year | $60,568 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $0 | RemainingDistriFromCorpusAmt |
| Total Corpus | $0 | TotalCorpusAmt |
| Undistributed Income CY | $3,646,806 | UndistributedIncomeCYAmt |
| Excess Distri Cyov To Next Yr | $0 | ExcessDistriCyovToNextYrAmt |
| Excess From Current Year | $0 | ExcessFromCurrentYearAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Private Operating Foundations | PrivateOperatingFoundationsGrp |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | NONE | ContributingManagerNm |
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (59 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| AMCHA INITIATIVE | |||||||
| 517 BETHANY CURVE | SANTA CRUZ | CA | 95060 | N/A | PC | General & Unrestricted | $30,000 |
| AMERICAN FRIENDS OF ISRAELI NAVY SEALS INC | |||||||
| 138 W 133RD ST | NEW YORK | NY | 10030 | N/A | PC | scholarship fund to four candidates | $21,000 |
| AMERICAN SOCIETY FOR TECHNION- ISRAEL INSTITUTE OF | |||||||
| 55 EAST 59TH ST | NEW YORK | NY | 10022 | N/A | PC | the David & Janet Polak Family Distance learning studio fund | $1,000,000 |
| AMERICAN SOCIETY FOR TECHNION- ISRAEL INSTITUTE OF | |||||||
| 55 EAST 59TH ST | NEW YORK | NY | 10022 | N/A | PC | General & Unrestricted | $5,000 |
| AMERICANS FOR BEN-GURION UNIVERSITY INC | |||||||
| 1001 AVE OF THE AMERICAS FL 19 | NEW YORK | NY | 10018 | N/A | PC | General & Unrestricted | $20,000 |
| ASSOCIATION FOR THE STUDY OF THE MIDDLE EAST AND A | |||||||
| PO BOX 2241 | BALA CYNWYD | PA | 19004 | N/A | PC | General & Unrestricted | $5,000 |
| AYN RAND INSTITUTE THE CENTER FOR THE ADVANCEMENT | |||||||
| 6 HUTTON CENTRE DR STE 600 | SANTA ANA | CA | 92707 | N/A | PC | the Free Books to Teacher program: distribution of books throughout the Los Angeles area | $25,000 |
| AYN RAND INSTITUTE THE CENTER FOR THE ADVANCEMENT | |||||||
| 6 HUTTON CENTRE DR STE 600 | SANTA ANA | CA | 92707 | N/A | PC | ARC Israel fund | $10,000 |
| BEIT TSHUVAH | |||||||
| 8831 VENICE BLVD | LOS ANGELES | CA | 90034 | N/A | PC | General & Unrestricted | $1,500 |
| BUCKLEY SCHOOL | |||||||
| 3900 STANSBURY AVE | SHERMAN OAKS | CA | 91423 | N/A | PC | General & Unrestricted | $7,500 |
| CEDARS-SINAI MEDICAL CENTER | |||||||
| 8700 BEVERLY BLVD | W HOLLYWOOD | CA | 90048 | N/A | PC | the Polak Family Fellowship fund in Precision Healthcare, board of governors innovation center | $100,000 |
| CEDARS-SINAI MEDICAL CENTER | |||||||
| 8700 BEVERLY BLVD | W HOLLYWOOD | CA | 90048 | N/A | PC | General & Unrestricted | $25,000 |
| CENTRAL FUND OF ISRAEL | |||||||
| 461 CENTRAL AVE | CEDARHURST | NY | 11516 | N/A | PC | Palestinian Media Watch fund | $25,000 |
| COMMITTEE FOR ACCURACY IN MIDDLE EAST REPORTING IN | |||||||
| PO BOX 35040 | BOSTON | MA | 02135 | N/A | PC | General & Unrestricted | $10,000 |
| CONCERN FOUNDATION | |||||||
| 11111 W OLYMPIC BLVD STE 214 | LOS ANGELES | CA | 90064 | N/A | PC | General & Unrestricted | $6,000 |
| CUFI CHURCH ASSOCIATION | |||||||
| PO BOX 1307 | SAN ANTONIO | TX | 78295 | N/A | PC | General & Unrestricted | $10,000 |
| DAVID HOROWITZ FREEDOM CENTER | |||||||
| 14724 VENTURA BLVD STE 820 | SHERMAN OAKS | CA | 91403 | N/A | PC | General & Unrestricted | $10,000 |
| ENDOWMENT FOR MIDDLE EAST TRUTH | |||||||
| 700 STONINGTON RD | SILVER SPRING | MD | 20902 | N/A | PC | General & Unrestricted | $10,000 |
| FOUNDATION FOR INDIVIDUAL RIGHTS IN EDUCATION INC | |||||||
| 510 WALNUT ST STE 1250 | PHILADELPHIA | PA | 19106 | N/A | PC | General & Unrestricted | $5,000 |
| FRIENDS OF ELNET | |||||||
| 5215 OLD ORCHARD RD STE 880 | SKOKIE | IL | 60077 | N/A | PC | General & Unrestricted | $30,000 |
| FRIENDS OF SHEBA MEDICAL CENTER INC | |||||||
| 6505 WILSHIRE BLVD NO 615 | LOS ANGELES | CA | 90048 | N/A | PC | General & Unrestricted | $5,000 |
| FRIENDS OF THE ISRAEL DEFENSE FORCES | |||||||
| 60 E 42ND ST | NEW YORK | NY | 10165 | N/A | PC | IMPACT! Scholarship fund | $48,000 |
| FRIENDS OF THE ISRAEL DEFENSE FORCES - LOS ANGELES | |||||||
| 6505 WILSHIRE BLVD STE 625 | LOS ANGELES | CA | 90048 | N/A | PC | IMPACT! Scholarship fund | $52,000 |
| HAROLD GRINSPOON FOUNDATION | |||||||
| 67 HUNT ST STE 100 | AGAWAM | MA | 01001 | N/A | SO I | pj library program book fund in domestic and international communities | $91,112 |
| HILLCREST COUNTRY CLUB CHARITABLE FUND | |||||||
| 10000 W PICO BLVD | LOS ANGELES | CA | 90064 | N/A | PC | General & Unrestricted | $5,000 |
| HONEST REPORTING COM INC | |||||||
| 165 E 56TH ST 2ND FL | NEW YORK | NY | 10022 | N/A | PC | General & Unrestricted | $3,000 |
| IMERMAN ANGELS | |||||||
| 205 W RANDOLPH ST 19TH FL | CHICAGO | IL | 60606 | N/A | PC | General & Unrestricted | $5,000 |
| INVEST FOR KIDS INC | |||||||
| 875 N MICHIGAN AVE STE 3400 | CHICAGO | IL | 60611 | N/A | PC | General & Unrestricted | $5,000 |
| ISRAEL CANCER RESEARCH FUND INC | |||||||
| 52 VANDERBILT AVE S1510 | NEW YORK | NY | 10017 | N/A | PC | General & Unrestricted | $5,000 |
| ISRAEL CHRISTIAN NEXUS | |||||||
| 11039 MCCORMICK ST | N HOLLYWOOD | CA | 91601 | N/A | PC | General & Unrestricted | $1,000 |
| ISRAEL EMERGENCY ALLIANCE - STANDWITHUS | |||||||
| PO BOX 341069 | LOS ANGELES | CA | 90034 | N/A | PC | General & Unrestricted | $200,000 |
| ISRAEL TENNIS CENTERS FOUNDATION INC | |||||||
| 57 W 38TH ST STE 605 | NEW YORK | NY | 10018 | N/A | PC | General & Unrestricted | $3,600 |
| JEWBELONG INC | |||||||
| PO BOX 3013 | UPR MONTCLAIR | NJ | 07043 | N/A | PC | General & Unrestricted | $5,000 |
| JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES | |||||||
| 6505 WILSHIRE BLVD STE 800 | LOS ANGELES | CA | 90048 | N/A | PC | General & Unrestricted | $45,000 |
| JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES | |||||||
| 6505 WILSHIRE BLVD STE 800 | LOS ANGELES | CA | 90048 | N/A | PC | the Guard Force program to expand current Community security efforts, development and launch of a computer-based training program of advanced situational awareness | $75,000 |
| JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES | |||||||
| 6505 WILSHIRE BLVD STE 800 | LOS ANGELES | CA | 90048 | N/A | PC | PJ Library Program books fund | $18,000 |
| LAWFARE PROJECT INC | |||||||
| 633 3RD AVE FL 21 | NEW YORK | NY | 10017 | N/A | PC | General & Unrestricted | $30,000 |
| LOS ANGELES JEWISH HOME FOR THE AGING | |||||||
| 7150 TAMPA AVE | RESEDA | CA | 91335 | N/A | PC | General & Unrestricted | $25,000 |
| MAKE A WISH FOUNDATION OF GREATER LOS ANGELES | |||||||
| 11390 W OLYMPIC BLVD STE 300 | LOS ANGELES | CA | 90064 | N/A | PC | General & Unrestricted | $10,000 |
| MANHATTAN INSTITUTE FOR POLICY RESEARCH INC | |||||||
| 52 VANDERBILT AVE | NEW YORK | NY | 10017 | N/A | PC | General & Unrestricted | $5,000 |
| MASSACHUSETTS INSTITUTE OF TECHNOLOGY | |||||||
| 600 MEMORIAL DR BLDG W98-300 | CAMBRIDGE | MA | 02139 | N/A | PC | General & Unrestricted | $10,000 |
| MIDDLE EAST FORUM | |||||||
| 1650 MARKET ST STE 3600 | PHILADELPHIA | PA | 19103 | N/A | PC | annual Israel victory project | $40,000 |
| MIDDLE EAST MEDIA AND RESEARCH INSTITUTE INC | |||||||
| PO BOX 27837 | WASHINGTON | DC | 20038 | N/A | PC | General & Unrestricted | $20,000 |
| MOISHE HOUSE | |||||||
| 441 SAXONY RD NO BARN 2 | ENCINITAS | CA | 92024 | N/A | PC | community building fund in Los Angeles | $45,000 |
| PACIFIC LEGAL FOUNDATION | |||||||
| 555 CAPITOL MALL STE 1290 | SACRAMENTO | CA | 95814 | N/A | PC | General & Unrestricted | $5,000 |
| PRAGER UNIVERSITY FOUNDATION | |||||||
| 15021 VENTURA BLVD 552 | SHERMAN OAKS | CA | 91403 | N/A | PC | General & Unrestricted | $100,000 |
| PROCLAIMING JUSTICE TO THE NATIONS INC | |||||||
| PO BOX 682711 | FRANKLIN | TN | 37068 | N/A | PC | General & Unrestricted | $30,000 |
| REPORT INC - RESEARCH EVALUATION PROMOTING OR | |||||||
| PMB 225 1121 N BETHLEHEM PIKE STE 6 | SPRING HOUSE | PA | 19477 | N/A | PC | General & Unrestricted | $30,000 |
| SIMON WIESENTHAL CENTER INC | |||||||
| 1399 S ROXBURY 2ND FL | LOS ANGELES | CA | 90035 | N/A | PC | Moriah Films' comprehensive documentary about the life and legacy of david ben-gurion project | $70,000 |
| STUDENTS RUN AMERICA | |||||||
| 5252 CREBS AVE | TARZANA | CA | 91356 | N/A | PC | General & Unrestricted | $5,000 |
| THE JEWISH HOME AND SENIOR LIVING FOUNDATION | |||||||
| 302 SILVER AVE | SAN FRANCISCO | CA | 94112 | N/A | PC | the Emergency Covid19 Response Program | $10,000 |
| THE JEWISH INSTITUTE FOR NATIONAL SECURITY OF AMER | |||||||
| 1101 14TH ST NW STE 1030 | WASHINGTON | DC | 20005 | N/A | PC | The Fight Against the Conditioning of Military Aid to israel project | $134,820 |
| THE JEWISH INSTITUTE FOR NATIONAL SECURITY OF AMER | |||||||
| 1101 14TH ST NW STE 1030 | WASHINGTON | DC | 20005 | N/A | PC | General & Unrestricted | $10,000 |
| THE MAPLE COUNSELING CENTER | |||||||
| 439 N CANON DR STE 209 | BEVERLY HILLS | CA | 90210 | N/A | PC | General & Unrestricted | $2,500 |
| TRIBE MEDIA CORP | |||||||
| 3250 WILSHIRE BLVD STE 1250 | LOS ANGELES | CA | 90010 | N/A | PC | General & Unrestricted | $65,000 |
| TURNING POINT USA INC | |||||||
| 4940 EAST BEVERLY RD | PHOENIX | AZ | 85044 | N/A | PC | General & Unrestricted | $50,000 |
| UNIVERSITY OF SOUTHERN CALIFORNIA | |||||||
| 1150 S OLIVE ST 25TH FL | LOS ANGELES | CA | 90015 | N/A | PC | Technion|USC Postdoctoral Fellowship fund | $80,000 |
| WASHINGTON INSTITUTE FOR NEAR EAST POLICY | |||||||
| 1111 19TH ST NW STE 500 | WASHINGTON | DC | 20036 | N/A | PC | General & Unrestricted | $5,000 |
| YOUNG AMERICA'S FOUNDATION | |||||||
| 11480 COMMERCE PARK DR STE 600 | RESTON | VA | 20191 | N/A | PC | to reach broader youth audiences through the campaign to drive up and maximize views for ben shapiro's top lectures on youtube | $50,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $2,755,032 | TotalGrantOrContriPdDurYrAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees Contracts From Govt Ag | FeesContractsFromGovtAgGrp | |
| Membership Dues And Assmnt | MembershipDuesAndAssmntGrp |
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $66,750 | ExclusionAmt |
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $887,181 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Rntl Incm Re Debt Fincd Prop | NetRntlIncmReDebtFincdPropGrp | |
| Net Rntl Incm Re Not Debt Fincd Prop | NetRntlIncmReNotDebtFincdProp | |
| Net Rental Income Personal Prop | NetRentalIncomePersonalPropGrp | |
| Other Investment Incm Part VII | OtherInvestmentIncmPartVIIGrp |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business | 525990 | BusinessCd |
| Unrelated Business Taxbl Incm | $240,117 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | 18 | ExclusionCd |
| Exclusion | $1,407,770 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Income Loss From Special Evt | NetIncomeLossFromSpecialEvtGrp | |
| Gross Profit Loss Sls Of Invntry | GrossProfitLossSlsOfInvntryGrp |
Other Revenue Described OtherRevenueDescribedGrp (2 entries)
| DescDesc | BusinessBusinessCd | Unrelated Business Taxbl IncmUnrelatedBusinessTaxblIncmAmt | ExclusionExclusionCd | ExclusionExclusionAmt |
|---|---|---|---|---|
| K-1 Inc/Loss | 525990 | $38,427 | 14 | $559,221 |
| Federal Tax Refund | 01 | $37,273 |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $278,544 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $2,958,195 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $3,236,739 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | false | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | false | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | false | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | false | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | false | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | false | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | false | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | false | RelationshipsNonchrtblEOInd |
Compensation Explanation CompensationExplanation
Compensation Explanation CompensationExplanationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jeff Polak | PersonNm |
| 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, 2020, THE FOUNDATION PAID $374,402 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 (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | GrantGrantDt | GrantGrantAmt | Purpose Of GrantPurposeOfGrantTxt | Any Diversion By GranteeAnyDiversionByGranteeTxt | Dates Of Reports By GranteeDatesOfReportsByGranteeTxt | Results Of VerificationResultsOfVerificationTxt | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NeuroVision Imaging LLC | |||||||||||||
| 1395 Garden Highway Suite 250 | Sacramento | CA | 95833 | 2014-12-17 | $250,000 | PRI INVEST-SEE GENERAL EXPLANATION FOR ADDITIONAL INFORMATION | 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 were made. | ||||
| Bruin Biometrics LLC | |||||||||||||
| 10960 Wilshire Blvd Suite 950 | Los Angeles | CA | 90024 | 2015-05-13 | $250,000 | 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 were made. | ||||
| Biop Medical LTD | |||||||||||||
| 2017-04-21 | $250,000 | 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 were made. | 10 Haeliav St | Ramat Gan | IS | 5252263 | ||||
| Online Disruptive Technologies Inc | |||||||||||||
| 2017-04-21 | $250,000 | 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 were made. | MATAM Adv Tech Pk bld 23 pobx 15050 | haifa | IS | 3190501 | ||||
| Orgenesis Ltd | |||||||||||||
| 2017-04-21 | $305,498 | 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 were made. | Arad Street 9 | Tel Aviv | IS | |||||
| Bryn Pharma LLC fka EPI-Now LLC | |||||||||||||
| 518 North Hillcrest Road | Beverly Hills | CA | 90210 | 2018-07-13 | $250,000 | 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 were made. | ||||
| CyWat Technologies Ltd | |||||||||||||
| 2018-11-26 | $250,000 | 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 were made. | 168 Jabotinsky St | Bnei Brak | IS | |||||
| Y&B Mothers Choice Ltd | |||||||||||||
| 2018-04-20 | $250,000 | 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 were made. | HiTech Vil 4/9 givat ram POB 39231 | jerusalem | IS | 9129102 | ||||
| Y&B Mothers Choice Ltd | |||||||||||||
| 2018-07-19 | $250,000 | 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 were made. | HiTech Vil 4/9 givat ram POB 39231 | Jerusalem | IS | 9129102 | ||||
| MaxQ AI Ltd | |||||||||||||
| 2019-03-19 | $250,000 | PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION | NO | The 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 A | Tel Aviv | IS | 6789140 | |||||
| ExThera Medical Corporation | |||||||||||||
| 757 Arnold Drive Suite B | Martinez | CA | 94553 | 2019-12-19 | $250,000 | 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 report from the grantee; therefore, no independent verification of the report was made. | ||||
| YonaLink Ltd | |||||||||||||
| 2019-11-12 | $250,000 | 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 report from the grantee; therefore, no independent verification of the report was made. | Hadassah Ein Kerem Hosp POB 12000 | Jerusalem | IS | 9112001 | ||||
| Amicrobe Inc | |||||||||||||
| 3142 Tiger Run Court 103 | Carlsbad | CA | 92010 | 2019-10-31 | $250,000 | 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 report from the grantee; therefore, no independent verification of the report was made. | ||||
General Explanation Attachment GeneralExplanationAttachment
General Explanation GeneralExplanationGrp (10 entries)
| IdentifierIdentifierTxt | Form And Line ReferenceFormAndLineReferenceDesc | Medium ExplanationMediumExplanationTxt |
|---|---|---|
| FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | PRI RECIPIENT: NeuroVision Imaging, LLC DATES AND AMOUNTS OF PRI: 12/17/2014 $250,000 5/17/2018 $37,502 PURPOSE OF PRI: Research and development of diagnostic tools for early-stage detection of Alzheimer's disease and other degenerative neurological disorders. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED FULL AND COMPLETE FINANCIAL REPORTS OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 3/25/2015 FOR FYE 12/31/2014 DATE OF REPORT: 5/18/2016 FOR FYE 12/31/2015 DATE OF REPORT: 6/7/2017 FOR FYE 12/31/2016 DATE OF REPORT: 5/11/2018 FOR FYE 12/31/2017 DATE OF REPORT: 11/1/2019 FOR FYE 12/31/2018 DATE OF REPORT: 6/2/2020 FOR FYE 12/31/2019 DATE OF REPORT: 6/28/2021 FOR FYE 12/31/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. |
| FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | PRI RECIPIENT: BRUIN BIOMETRICS, LLC DATE AND AMOUNT OF PRI: 5/13/2015 $250,000 PURPOSE OF PRI: TO PROMOTE THE HEALTH AND REDUCE THE SUFFERING OF THOSE AFFECTED BY EARLY-STAGE PRESSURE ULCERS DURING THEIR HOSPITAL STAYS AND TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH IN THE PUBLIC INTEREST. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORTS OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 5/24/2016 FOR FYE 12/31/2015 DATE OF REPORT: 6/29/2017 FOR FYE 12/31/2016 DATE OF REPORT: 5/15/2018 FOR FYE 12/31/2017 DATE OF REPORT: 6/14/2019 FOR FYE 12/31/2018 DATE OF REPORT: 4/22/2020 FOR FYE 12/31/2019 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. |
| FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | PRI RECIPIENT: BIOP MEDICAL LTD DATES AND AMOUNTS OF PRI: 4/21/2017 $250,000 PURPOSE OF PRI: TO PROMOTE THE HEALTH AND REDUCE THE SUFFERING OF THOSE AFFECTED BY DISEASE AND TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH IN THE PUBLIC INTEREST. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 6/4/2018 FOR FYE 12/31/2017 DATE OF REPORT: 2/12/2019 FOR FYE 12/31/2018 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. IN CONNECTION WITH THIS PROGRAM RELATED INVESTMENT ("PRI"), THE FOUNDATION HAS MADE NUMEROUS GOOD FAITH ATTEMPTS TO CONTACT THE INVESTEE AND REQUEST THE OVERDUE ANNUAL REPORTS FROM THE INVESTEE WITH RESPECT TO THE PRI, WHICH ATTEMPTS HAVE BEEN DOCUMENTED BY THE FOUNDATION, BUT HAS NOT BEEN ABLE TO OBTAIN SUCH REPORTS. PER SECTION 53.4945-5(E)(2) OF THE TREASURY REGULATIONS, THE FAILURE OF THE INVESTEE TO SUBMIT SUCH REPORTS WILL NOT RESULT IN A TAXABLE EXPENDITURE FOR THE FOUNDATION BECAUSE THE FOUNDATION (I) MADE THE PRI IN ACCORDANCE WITH PARAGRAPH (B) OF SAID SECTION OF THE REGULATIONS, (II) HAS COMPLIED WITH THE REPORTING REQUIREMENTS CONTAINED IN PARAGRAPH (D) OF SAID SECTION OF THE REGULATIONS, (III) MADE A REASONABLE EFFORT TO OBTAIN THE REQUIRED REPORTS, AND (IV) WILL WITHHOLD ALL FUTURE PRI PAYMENTS TO THE INVESTEE UNTIL SUCH REPORT IS FURNISHED. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. |
| FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | PRI RECIPIENT: ONLINE DISRUPTIVE TECHNOLOGIES, INC. DATE AND AMOUNT OF PRI: 4/21/2017 $250,000 PURPOSE OF PRI: TO PROMOTE THE HEALTH AND REDUCE THE SUFFERING OF THOSE AFFECTED BY CANCER AND TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH IN THE PUBLIC INTEREST. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 6/6/2018 FOR FYE 12/31/2017 DATE OF REPORT: 2/12/2019 FOR FYE 12/31/2018 DATE OF REPORT: 6/1/2020 FOR FYE 12/31/2019 DATE OF REPORT: 8/18/2021 FOR FYE 12/31/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. |
| FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | PRI RECIPIENT: Bryn Pharma LLC f/k/a EPI-Now LLC DATE AND AMOUNT OF PRI: 7/13/2018 $250,000 PURPOSE OF PRI: To promote the health of those who require epinephrine and to advance scientific understanding through research in the public interest. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 8/23/2019 FOR FYE 12/31/2018 DATE OF REPORT: 10/24/2020 FOR FYE 12/31/2019 DATE OF REPORT: 8/2/2021 FOR FYE 12/21/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. appreciation of property. |
| FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | PRI RECIPIENT: Orgenesis Ltd. DATE AND AMOUNT OF PRI: 4/21/2017 $305,498 PURPOSE OF PRI: To promote the health and reduce the suffering of those affected by diabetes by way of researching and bringing to clinical trial the Company technology solution. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED FULL AND COMPLETE FINANCIAL REPORTS OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 9/9/2018 FOR FYE 12/31/2017 DATE OF REPORT: 10/20/2020 FOR FYE 12/31/2018 DATE OF REPORT: 10/20/2020 FOR FYE 12/31/2019 DATE OF REPORT: 5/20/2021 FOR FYE 12/31/2020 THE FOUNDATION EXERCISED AN OPTION TO EXCHANGE ITS INTEREST IN THE INVESTEE FOR THE STOCK IN THE PARENT COMPANY OF THE INVESTED. THIS WAS DONE TO PRESERVE THE PRI AND NOT TO GENERATE INCOME OR FOR THE APPRECIATION OF PROPERTY. THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. |
| FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | PRI RECIPIENT: CyWat Technologies Ltd DATE AND AMOUNT OF PRI: 11/26/2018 $250,000 PURPOSE OF PRI: To promote the health of people who are affected by polluted drinking water by funding the development of a water monitoring system that is distributed throughout the entire water grid and which can immediately detect potential dangers. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 6/18/2019 FOR FYE 12/31/2018 DATE OF REPORT: 1/13/2020 FOR FYE 12/31/2019 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. |
| FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY | PRI RECIPIENT: Y&B MOTHERS CHOICE LTD. DATE AND AMOUNT OF PRI: 4/20/2018 $250,000 PURPOSE OF PRI: TO PROMOTE HEALTH BY FUNDING RESEARCH INTO DEVELOPING NON HAZARDOUS, NATURAL PRODUCTS THAT DO NOT ENDANGER HUMAN HEALTH. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2018 DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2019 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. PRI RECIPIENT: Y&B MOTHERS CHOICE LTD. DATE AND AMOUNT OF PRI: 7/19/2018 $250,000 PURPOSE OF PRI: TO PROMOTE HEALTH BY FUNDING RESEARCH INTO DEVELOPING NON HAZARDOUS, NATURAL PRODUCTS THAT DO NOT ENDANGER HUMAN HEALTH. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2018 DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2019 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. PRI RECIPIENT: MAXQ AI, LTD DATE OF PRI: 3/19/2019 $250,000 PURPOSE OF PRI: TO PROMOTE THE DEVELOPMENT OF A PRODUCT THAT WILL SUBSTANTIALLY BENEFIT THE PUBLIC BY INCORPORATING SOPHISTICATED ARTIFICIAL INTELLIGENCE INTO DIAGNOSTIC RADIOLOGY. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 10/13/2020 FOR FYE 12/31/2019 DATE OF REPORT: 7/20/2021 FOR FYE 12/31/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. PRI RECIPIENT: EXTHERA MEDICAL CORPORATION DATE AND AMOUNT OF PRI: 12/19/2019 $250,000 PURPOSE OF PRI: TO FUND THE DEVELOPMENT AND/OR DISTRIBUTION OF CURRENT AND FUTURE MEDICAL TECHNOLOGY, INCLUDING WITHOUT LIMITATION THE SERAPH BLOOD FILTER DEVICE, THAT HAVE A DEMONSTRABLE DEMAND FOR HUMANITARIAN USE IN DEVELOPING COUNTRIES AND THAT OFFER BREAK-THROUGH TECHNOLOGY FOR USE IN THE TREATMENT OF INTRACTABLE OR EMERGING PUBLIC-HEALTH THREATS. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 2/2/2021 FOR FYE 12/31/2019 DATE OF REPORT: 6/30/2021 FOR FYE 12/31/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. PRI RECIPIENT: YonaLink Ltd. DATE AND AMOUNT OF PRI: 11/12/2019 $250,000 PURPOSE OF PRI: To finance provision of the YonaLink Automated Study Manager Technology to nonprofit academic hospitals for free or at substantially below cost. The Technology has the potential to significantly improve the quality and efficiency of processing data for clinical research studies in the public interest. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 4/6/2021 FOR FYE 12/31/2019 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. PRI RECIPIENT: AMICROBE, INC. DATE AND AMOUNT OF PRI: 10/31/2019 $250,000 PURPOSE OF PRI: TO FUND THE DEVELOPMENT AND COMMERCIALIZATION OF AMICIDIN-ALPHA SURGICAL GEL AND ITS AMICIDIN-BETA SOLUTION, TOGETHER WITH RELATED WORK AND MEDICAL PRODUCTS HAVING SIMILAR PURPOSES. THIS HAS THE POTENTIAL TO PROVIDE BREAKTHROUGH TECHNOLOGICAL SOLUTIONS TO THE GROWING THREAT OF ANTIBIOTIC RESISTANCE AROUND THE WORLD. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED FULL AND COMPLETE FINANCIAL REPORTS OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 12/28/2020 FOR FYE 12/31/2019 DATE OF REPORT: 8/4/2021 FOR FYE 12/31/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. |
| Forms 8865 | Forms 8865 | The Foundation has prepared these forms 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. |
| Part I line 6a | 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): $1,407,770 TOTAL NOT INCLUDED IN PART IV: PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - UBI NET GAIN/(LOSS): $240,117 TOTAL PART I, LINE 6A: $1,647,887 DETAILS OF ASSETS INCLUDED IN PART IV: PUBLICLY-TRAIDED SECURITIES GROSS SALES PRICE: $24,661,274 BOOK BASIS: $23,516,717 NET GAIN/(LOSS): $1,144,557 PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - NON UBI NET GAIN/(LOSS): $222,117 SALES OF OTHER ITEMIZED ASSETS GROSS SALES PRICE: $3,988,374 BOOK BASIS: $3,988,368 NET GAIN/(LOSS): $6 DISTRIBUTIONS IN EXCESS OF BASIS NET GAIN/(LOSS): $41,090 |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp (61 entries)
| StockStockNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| AMERICAN AXLE & MFG HOLDINGS I | $251,018 | $183,480 |
| B2 GOLD CORP COM NPV | $150,587 | $236,320 |
| BANK OF AMERICA CORP | $113,640 | $363,720 |
| BARRICK GOLD CORPORATION | $768,039 | $569,500 |
| BAYER A G SPONSORED ADR | $198,370 | $118,720 |
| BERRY PLASTICS GROUP INC | $118,805 | $168,570 |
| BP PLC SPONSORED ADR | $102,249 | $61,560 |
| CABOT OIL & GAS CORP | $32,348 | $32,560 |
| CAMECO CORPORATION | $19,784 | $13,400 |
| CHENIERE ENERGY INC | $120,095 | $120,060 |
| CITIGROUP INC | $248,049 | $308,300 |
| CLIFFS NATURAL RESOURCES INC. | $50,603 | $58,240 |
| COMPASS MINERALS INTERNATIONAL | $253,526 | $308,600 |
| COMSTOCK RES INC | $18,674 | $17,480 |
| CONSTELLIUM NV | $136,767 | $83,940 |
| COPPER MOUNTAIN MINI NG CORP | $78,225 | $198,800 |
| COVANTA HOLDING CORP | $83,405 | $65,650 |
| CROWN HOLDINGS INC | $185,100 | $501,000 |
| CVS CAREMARK CORP | $466,000 | $683,000 |
| DANA HOLDING CP | $68,217 | $97,600 |
| DELTA AIR LINES INC | $24,396 | $80,420 |
| ELDORADO GOLD CORP COM NPV | $218,701 | $238,860 |
| ENDEAVOUR MINING CORP | $141,284 | $162,425 |
| FIDELITY CONSERV INC BD FD | $8,564 | $8,587 |
| FIRST QUANTUM MINERALS LTD | $17,953 | $35,940 |
| FLUTTER ENTERTAINMENT ORD SHS | $59,804 | $91,895 |
| FTS INTERNATIONAL INC | $321,080 | $276,826 |
| GENERAL MOTORS | $361,740 | $416,400 |
| GOLD FIELDS LTD ADS | $140,581 | $241,020 |
| GOLDEN STAR RESOURCES LTD | $13,940 | $14,840 |
| GRAPHIC PACKAGING CORP COM STK | $41,828 | $50,820 |
| HALLIBURTON COMPANY | $226,736 | $113,400 |
| HOLCIM N | $256,612 | $283,350 |
| HUDBAY MINERALS INC | $133,864 | $175,000 |
| IVANHOE MINES LTD | $60,260 | $162,000 |
| JAPAN SMALLER CAPITALIZATION F | $365,092 | $414,032 |
| JET2 PLC | $78,926 | $195,470 |
| JOHNSON & JOHNSON | $231,728 | $393,450 |
| KAZATOMPROM JSC NAC GDR | $147,503 | $180,000 |
| KBR INC | $91,500 | $92,790 |
| KIRKLAND LAKE GOLD LTD | $268,643 | $338,868 |
| LAFARGEHOLCIM LTD ADR | $67,245 | $108,400 |
| MARKET VECTORS VIETNAM ETF | $40,705 | $34,980 |
| MERCK & CO INC | $381,120 | $654,400 |
| MICRON TECHNOLOGY | $325,144 | $902,159 |
| MICROSOFT CORP | $28,785 | $222,420 |
| NEWMONT GOLDCORP CORPORATION | $574,088 | $949,615 |
| NOVAGOLD RESOURCES | $69,977 | $174,060 |
| NUVEEN MLT STR I&G | $9,760 | $9,500 |
| OCEANAGOLD CORPORATION COM | $103,358 | $78,400 |
| PFIZER INC | $490,753 | $736,200 |
| PHILIP MORRIS INTL | $8,916 | $8,279 |
| PRETIUM RESOURCES INC | $86,644 | $114,800 |
| TEVA PHARMACEUTICAL INDUSTRIES | $36,513 | $9,650 |
| THE MOSAIC CO | $169,858 | $92,040 |
| TOREX GOLD RESOURCES | $181,332 | $225,600 |
| TPG RE FINANCE TRUST INC | $2,013 | $1,062 |
| TRUIST FINANCIAL CORPORATION | $30,848 | $47,930 |
| TURQUOISE HILL RESOURCES LTD | $85,140 | $62,100 |
| VALARIS PLC | $382,692 | $175 |
| VIATRIS ORD SHS | $26,941 | $46,494 |
Investments Govt Obligations Sch InvestmentsGovtObligationsSch
| Field | Value | IRS element (for citing) |
|---|---|---|
| US Govt Obligations Book Vl EOY | $30,238,616 | USGovtObligationsBookVlEOYAmt |
| US Govt Obligations EOYFMV | $30,426,972 | USGovtObligationsEOYFMVAmt |
| State Local Sec Book Vl EOY | $3,545,065 | StateLocalSecBookVlEOYAmt |
| State Local Sec EOYFMV | $3,724,010 | StateLocalSecEOYFMVAmt |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (33 entries)
| Category Or ItemCategoryOrItemTxt | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| AIR U.S. LIFE FUND III, LP | $2,020,814 | $2,011,592 |
| AIR US LIFE FUND IV, LP | $2,033,480 | $2,029,825 |
| ALTAIR - PACIFIC COAST CPTL PT | $496,156 | $592,192 |
| ALTAIR DIRECT LENDING FUND, LL | $212,783 | $173,946 |
| ALTAIR EUROPEAN R E OPPORTUNIT | $659,098 | $311,089 |
| ALTAIR SENIOR HOUSING FUND (AE | $182,992 | $740,403 |
| ANAGENESIS CAPITAL PARTNERS SB | $897,667 | $1,037,522 |
| ASM CONNAUGHT HOUSE FUND III L | $1,000,000 | $1,172,884 |
| BROAD ST REAL ESTATE CREDIT PT | $181,145 | |
| BW GAS & CONVENIENCE ONSHORE F | $424,573 | $2,379,072 |
| DORCHESTER CAPITAL SECONDARIES | $188,581 | $212,717 |
| ENLIGHTENMENT CAPITAL SOLUTION | $984,325 | $1,624,449 |
| FALCON EDGE INDIA I LP | $556,167 | $701,113 |
| FIRST EAGLE CLO EQUITY FUND I, | $834,921 | $823,393 |
| FOURTHSTONE SMALL-CAP FINANCIA | $251,807 | $263,874 |
| GOLDMAN SACHS VINTAGE FUND V L | $302,066 | $142,137 |
| GRANITE CREEK FLEXCAP II, L.P | $402,725 | $480,818 |
| GS DISTRESSED OPPORTUNITIES FU | $133,187 | $157,249 |
| GSO CAPITAL SOLUTIONS FUND II | $6,463 | $6,463 |
| GSO CAPITAL SOLUTIONS FUND II | $79,926 | $63,937 |
| GSO CAPITAL SOLUTIONS FUND II | $287,336 | $124,603 |
| GSO ENERGY SELECT OPPORTUNITIE | $272,291 | $294,771 |
| GSO ENERGY SELECT OPPORTUNITIE | $59,065 | $59,065 |
| GSO ENERGY SELECT OPPORTUNITIE | $1,434 | $1,434 |
| GSO ENERGY SELECT OPPORTUNITIE | $66,759 | $40,366 |
| LATITUDE MGMT REAL ESTATE CAPI | $500,000 | $496,683 |
| LATITUDE MGMT REAL ESTATE CAPI | $1,500,000 | $1,502,157 |
| PCCP EQUITY VII, LP | $2,533,796 | $3,065,724 |
| PCCP EQUITY VIII, LP | $556,154 | $638,614 |
| SILVERPEAK CREDIT OPPORTUNITIE | $263,639 | $274,117 |
| SILVERPEAK CREDIT OPPORTUNITIE | $1,670,998 | $1,684,065 |
| THE EDGBASTON ASIAN EQUITY TRU | $1,249,841 | $1,104,920 |
| BERNIE L MADOFF - CLAIM RECEIV | $530,622 | $530,622 |
Legal Fees Schedule LegalFeesSchedule
Legal Fees LegalFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | General Consultations | CategoryTxt |
| Legal Fees | $16,907 | LegalFeesAmt |
| Disbursements Charitable Prps | $16,907 | DisbursementsCharitablePrpsAmt |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp (15 entries)
| DescDesc | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| PRI - AMICROBE, INC | $250,000 | $250,000 |
| 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 | $250,000 | $250,000 |
| 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 - ONLINE DISRUPTIVE | $250,000 | $250,000 |
| PRI - ORGENESIS - 32,052 SHARE | $294,397 | $144,234 |
| 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 - YONALINK LTD | $250,000 | $250,000 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (31 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|---|
| Administrative Fees | $86,452 | $86,452 | |
| Bank Charges | $8,879 | $8,879 | |
| K-1 Exp 1150 UNION INVESTORS L | $4,554 | $4,554 | |
| K-1 Exp AIR U.S. LIFE FUND III | $91,232 | $91,232 | |
| K-1 Exp AIR US LIFE FUND IV, L | $30,250 | $30,250 | |
| K-1 Exp ALTAIR - PACIFIC COAST | $19,138 | $19,017 | |
| K-1 Exp ALTAIR DIRECT LENDING | $489 | $489 | |
| K-1 Exp ALTAIR SENIOR HOUSING | $4,125 | $2,721 | |
| K-1 Exp ANAGENESIS CAPITAL PAR | $132,910 | $131,625 | |
| K-1 Exp BW GAS & CONVENIENCE O | $809 | $492 | |
| K-1 Exp ENLIGHTENMENT CAPITAL | $34,886 | $34,886 | |
| K-1 Exp FALCON EDGE INDIA I LP | $9,168 | $9,168 | |
| K-1 Exp FIRST EAGLE CLO EQUITY | $22,404 | $12,436 | |
| K-1 Exp FOURTHSTONE SMALL-CAP | $256 | $256 | |
| K-1 Exp GRANITE CREEK FLEXCAP | $75,426 | $75,318 | |
| K-1 Exp GSO CAPITAL SOLUTIONS | $7,606 | $2,264 | |
| K-1 Exp GSO CAPITAL SOLUTIONS | $6,899 | $6,861 | |
| K-1 Exp GSO ENERGY SELECT OPPO | $40,973 | $4,422 | |
| K-1 Exp GSO ENERGY SELECT OPPO | $1,326 | $926 | |
| K-1 Exp GSO ENERGY SELECT OPPO | $173 | $173 | |
| K-1 Exp GSO ENERGY SELECT OPPO | $3,281 | $2,026 | |
| K-1 Exp PCCP EQUITY VII, LP | $22,725 | $22,718 | |
| K-1 Exp PCCP EQUITY VIII, LP | $5,652 | $5,649 | |
| K-1 Exp SILVERPEAK CREDIT OPPO | $2,274 | $2,274 | |
| K-1 Exp THE EDGBASTON ASIAN EQ | $3,100 | $2,974 | |
| Office & Supplies | $30 | $30 | |
| Postage/Delivery Service | $107 | $107 | |
| Registered Agent Fee | $125 | $125 | |
| State or Local Filing Fees | $235 | $235 | |
| Website Hosting/Support | $480 | $480 | |
| PARKING FEES | $10,735 | $10,735 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail (24 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|
| K-1 Inc/Loss 1150 UNION INVESTORS LLC | -$634 | -$634 |
| K-1 Inc/Loss AIR U.S. LIFE FUND III, LP | $77,177 | $77,177 |
| K-1 Inc/Loss AIR US LIFE FUND IV, LP | $1,162 | $1,162 |
| K-1 Inc/Loss ALTAIR - PACIFIC COAST CPTL PTNRS EQU | $26,431 | $29,704 |
| K-1 Inc/Loss ALTAIR DIRECT LENDING FUND, LLC | $85 | $85 |
| K-1 Inc/Loss ALTAIR SENIOR HOUSING FUND (AEW), LLC | -$53,339 | -$3,834 |
| K-1 Inc/Loss ANAGENESIS CAPITAL PARTNERS SBIC FUND | $58,817 | $110,745 |
| K-1 Inc/Loss BW GAS & CONVENIENCE ONSHORE FUND, LP | -$42,126 | -$42,126 |
| K-1 Inc/Loss ENLIGHTENMENT CAPITAL SOLUTIONS FUND | $64,777 | $64,777 |
| K-1 Inc/Loss FIRST EAGLE CLO EQUITY FUND I, LP | $74,756 | $57,584 |
| K-1 Inc/Loss FOURTHSTONE SMALL-CAP FINANCIALS FD L | $270 | $270 |
| K-1 Inc/Loss GRANITE CREEK FLEXCAP II, L.P | $84,052 | $84,052 |
| K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II AIV-1 L | -$135 | -$40 |
| K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II AIV-2 L | $102,302 | $1,300 |
| K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II LP | $1,189 | $1,108 |
| K-1 Inc/Loss GSO ENERGY SELECT OPPORTUNITIES FUND | $46,917 | -$391 |
| K-1 Inc/Loss GSO ENERGY SELECT OPPORTUNITIES FUND | $10,185 | $6,289 |
| K-1 Inc/Loss PCCP EQUITY VII, LP | -$9,522 | $972 |
| K-1 Inc/Loss PCCP EQUITY VIII, LP | -$11,451 | $394 |
| K-1 Inc/Loss SILVERPEAK CREDIT OPPORTUNITIES OFFSH | $163,608 | $163,608 |
| K-1 Inc/Loss THE EDGBASTON ASIAN EQUITY TRUST | $49,168 | $49,168 |
| K-1 Inc/Loss TRINITY CAPITAL FUND III, L.P | -$47,679 | -$47,679 |
| Federal Tax Refund | $37,273 | |
| Foreign Currency Gain | $1,638 | $1,638 |
Other Increases Schedule OtherIncreasesSchedule
Other Increases Detail OtherIncreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RETURNED GRANT NEXT FISCAL YEAR | Desc |
| Amt | $8,885 | Amt |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail (3 entries)
| CategoryCategoryTxt | AmtAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|---|
| Administration of Foundation | $29,721 | $29,721 | |
| Investment Management Services | $386,250 | $386,250 | |
| Website Development | $2,058 | $2,058 |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (6 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|
| 990-PF Estimated Tax for 2020 | $32,700 | |
| 990-T Extension for 2019 | $1,800 | |
| 990-T Income Tax for 2019 | $91,871 | |
| Foreign Tax Paid | $28,110 | $28,110 |
| STATE TAXES WITHHELD BY PTSHP | $2,984 | |
| STATE UBTI TAX 2019 | $38,209 |