efile Public Visual Render
ObjectId: 201842009349100409 - Submission: 2018-07-19
TIN: 13-4088264
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0052
20
17
Open to Public Inspection
For calendar year 2017, or tax year beginning
01-01-2017
, and ending
12-31-2017
Name of foundation
The David Family Foundation Inc
Number and street (or P.O. box number if mail is not delivered to street address)
c/o Jack David 210 West 90th St
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
New York
,
NY
10024
A Employer identification number
13-4088264
B
Telephone number (see instructions)
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year
(from Part II, col. (c),
line 16)
$
2,568,992
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
320,884
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
4,565
4,565
4,565
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
221,643
b
Gross sales price for all assets on line 6a
1,135,046
7
Capital gain net income (from Part IV, line 2)
...
638,381
8
Net short-term capital gain
.........
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
Total.
Add lines 1 through 11
........
547,092
642,946
4,565
13
Compensation of officers, directors, trustees, etc.
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
5,474
3,652
5,474
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
1,906
212
1,906
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
353
103
353
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
7,733
3,967
7,733
25
Contributions, gifts, grants paid
.......
277,000
277,000
26
Total expenses and disbursements.
Add lines 24 and 25
284,733
3,967
284,733
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
262,359
b
Net investment income
(if negative, enter -0-)
638,979
c
Adjusted net income
(if negative, enter -0-)
...
4,565
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2017)
Page 2
Form 990-PF (2017)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
5,031
156,113
156,113
2
Savings and temporary cash investments
.........
102,985
2,891
2,891
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
201
Less: allowance for doubtful accounts
201
201
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
1,300,085
1,511,255
2,409,787
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
1,408,101
1,670,460
2,568,992
17
Accounts payable and accrued expenses
..........
18
Grants payable
..................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow SFAS 117, check here
and complete lines 24 through 26 and lines 30 and 31.
24
Unrestricted
..................
1,408,101
1,670,460
25
Temporarily restricted
...............
26
Permanently restricted
...............
Foundations that do not follow SFAS 117, check here
and complete lines 27 through 31.
27
Capital stock, trust principal, or current funds
........
28
Paid-in or capital surplus, or land, bldg., and equipment fund
29
Retained earnings, accumulated income, endowment, or other funds
30
Total net assets or fund balances
(see instructions)
.....
1,408,101
1,670,460
31
Total liabilities and net assets/fund balances
(see instructions)
.
1,408,101
1,670,460
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year’s return)
...............
1
1,408,101
2
Enter amount from Part I, line 27a
.....................
2
262,359
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
1,670,460
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30
.
6
1,670,460
Form
990-PF
(2017)
Page 3
Form 990-PF (2017)
Page
3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a)
List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1 a
806 ACTIVISION
P
2016-07-11
2017-11-30
b
431 XILINX INC
P
2017-01-06
2017-12-22
c
430 XILINX INC
P
2017-01-06
2017-07-19
d
806 NINTENDO C
P
2016-07-11
2017-04-20
e
809 APACHE COR
P
2016-09-16
2017-04-27
31 AMAZON.COM
P
2008-12-04
2017-11-29
13 AMAZON.COM
P
2008-12-04
2017-07-21
11 AMAZON.COM
P
2008-12-04
2017-07-21
25 AMAZON.COM
P
2008-12-04
2017-01-26
26 AMAZON.COM
P
2008-12-04
2017-01-11
122 ALIGN TECH
P
2016-08-12
2017-11-29
237 NETFLIX CO
P
2012-01-04
2017-11-29
135 NETFLIX CO
P
2012-09-20
2017-11-29
263 NETFLIX CO
P
2012-01-04
2017-10-18
170 NETFLIX CO
P
2012-09-20
2017-10-16
168 NETFLIX CO
P
2012-09-20
2017-07-14
107 NETFLIX CO
P
2012-01-04
2017-07-14
100 NETFLIX CO
P
2012-01-04
2017-06-02
473 NETFLIX CO
P
2012-01-04
2017-04-26
177 NETFLIX CO
P
2012-01-04
2017-04-26
151 NETFLIX CO
P
2012-01-04
2017-01-11
497 NETFLIX CO
P
2012-01-04
2017-01-11
21 NETFLIX CO
P
2012-01-04
2017-01-11
109 NETFLIX CO
P
2012-01-04
2017-01-11
2855 NXSTAGE ME
P
2014-01-14
2017-05-10
116 NXSTAGE ME
P
2014-01-14
2017-03-17
1370 NXSTAGE ME
P
2014-01-14
2017-03-17
185 CAVIUM INC
P
2017-01-12
2017-10-26
408 CAVIUM INC
P
2016-12-07
2017-10-26
296 ULTA BEAUT
P
2015-09-08
2017-08-03
3820 PACIFIC BI
P
2017-02-14
2017-06-20
153 YOOX NET-A
P
2009-12-03
2017-03-14
375 YOOX NET-A
P
2011-03-18
2017-03-14
455 TRIPADVISO
P
2011-12-27
2017-02-23
153 FACEBOOK I
P
2013-04-05
2017-11-29
3667 DIRTT ENVI
P
2014-04-10
2017-09-21
2511 DIRTT ENVI
P
2014-04-09
2017-09-21
414 2U INC COM
P
2015-06-01
2017-11-08
70 ARISTA NET
P
2016-05-13
2017-06-02
1304 ZAYO GROUP
P
2016-07-21
2017-02-14
263 ZAYO GROUP
P
2016-07-21
2017-01-12
16 THE TRADE
P
2016-09-21
2017-02-28
434 SNAP INC C
P
2017-06-22
2017-11-08
520 SNAP INC C
P
2017-06-22
2017-08-11
546 OKTA INC C
P
2017-04-07
2017-06-28
38 OKTA INC C
P
2017-04-07
2017-06-28
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
49,180
34,154
15,026
b
28,824
25,816
3,008
c
27,472
25,757
1,715
d
24,517
22,937
1,580
e
38,689
47,627
-8,938
35,293
1,489
33,804
13,049
624
12,425
11,042
529
10,513
20,579
1,201
19,378
20,263
1,249
19,014
30,703
11,792
18,911
44,261
2,726
41,535
25,212
1,107
24,105
50,949
3,025
47,924
33,592
1,393
32,199
26,442
1,377
25,065
16,841
1,231
15,610
16,016
1,150
14,866
70,364
5,441
64,923
26,331
2,051
24,280
19,452
1,750
17,702
64,024
5,717
58,307
2,705
242
2,463
14,041
1,254
12,787
65,336
35,681
29,655
3,224
1,450
1,774
38,082
17,158
20,924
12,308
11,709
599
27,144
26,383
761
73,126
49,251
23,875
12,355
20,458
-8,103
3,503
1,104
2,399
8,586
4,685
3,901
19,688
11,700
7,988
26,306
4,300
22,006
14,638
10,336
4,302
10,023
7,111
2,912
26,132
11,708
14,424
10,305
4,812
5,493
39,771
38,513
1,258
7,988
7,768
220
597
288
309
6,076
7,718
-1,642
6,209
9,247
-3,038
12,909
13,000
-91
899
646
253
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
15,026
b
3,008
c
1,715
d
1,580
e
-8,938
33,804
12,425
10,513
19,378
19,014
18,911
41,535
24,105
47,924
32,199
25,065
15,610
14,866
64,923
24,280
17,702
58,307
2,463
12,787
29,655
1,774
20,924
599
761
23,875
-8,103
2,399
3,901
7,988
22,006
4,302
2,912
14,424
5,493
1,258
220
309
-1,642
-3,038
-91
253
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
638,381
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
-12,109
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
Yes
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2016
234,748
1,495,777
0.15694
2015
153,675
1,589,086
0.09671
2014
85,655
1,206,689
0.07098
2013
100,663
710,206
0.14174
2012
104,654
406,357
0.25754
2
Total
of line 1, column (d)
.....................
2
0.723911
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by the number of years the foundation has been in existence if less than 5 years
......
3
0.144782
4
Enter the net value of noncharitable-use assets for 2017 from Part X, line 5
......
4
2,082,731
5
Multiply line 4 by line 3
......................
5
301,542
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
6,390
7
Add lines 5 and 6
........................
7
307,932
8
Enter qualifying distributions from Part XII, line 4
,.............
8
284,733
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.
Form
990-PF
(2017)
Page 4
Form 990-PF (2017)
Page
4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a
Exempt operating foundations described in section 4940(d)(2), check here
and enter “N/A" on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
b
Domestic foundations that meet the section 4940(e) requirements in Part V, check
1
12,780
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
3
Add lines 1 and 2
...........................
3
12,780
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
12,780
6
Credits/Payments:
a
2017 estimated tax payments and 2016 overpayment credited to 2017
6a
3,288
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
10,000
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
13,288
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
508
11
Enter the amount of line 10 to be:
Credited to 2018 estimated tax
508
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see Instructions
for definition)?
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
Yes
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
No
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
NY
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2017 or the taxable year beginning in 2017 (see instructions for Part XIV)?
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
Yes
Form
990-PF
(2017)
Page 5
Form 990-PF (2017)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions)
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement (see instructions)
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
Jack David
Telephone no.
(212) 362-5869
Located at
210 W 90th St
New York
NY
ZIP+4
10024
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—Check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2017, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
16
No
See instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)?
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2017?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2017, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2017?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
No
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2017 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2017.)
..................
3b
No
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2017?
4b
No
Form
990-PF
(2017)
Page 6
Form 990-PF (2017)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(Continued)
5a
During the year did the foundation pay or incur any amount to:
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? (see instructions)
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)?
......
5b
No
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If yes, did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
No
Form
990-PF
(2017)
Page 7
Form 990-PF (2017)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation (see instructions).
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
Jack David
Dir, Pres, Trea
0.00
0
351 Bruning Road
New Hartford
,
CT
06057
Melanie M Kirkpatrick David
V.P.
0.00
0
351 Bruning Road
New Hartford
,
CT
06057
Nicole David Channing
Director
0.00
0
1060 Worlds Fair Park Drive Ap
Knoxville
,
TN
37916
Zachary B David
Director
0.00
0
33 East Gowen Avenue
Philadelphia
,
PA
19119
Jacqueline M David
Director
0.00
0
210 W 90 St Apt 10K
New York
,
NY
10024
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2017)
Page 8
Form 990-PF (2017)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations,see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
2,059,325
b
Average of monthly cash balances
.......................
1b
54,930
c
Fair market value of all other assets (see instructions)
................
1c
193
d
Total
(add lines 1a, b, and c)
.........................
1d
2,114,448
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
3
Subtract line 2 from line 1d
.........................
3
2,114,448
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
31,717
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
2,082,731
6
Minimum investment return.
Enter 5% of line 5
..................
6
104,137
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
104,137
2a
Tax on investment income for 2017 from Part VI, line 5
......
2a
12,780
b
Income tax for 2017. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
12,780
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
91,357
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
91,357
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
91,357
Part XII
Qualifying Distributions
(see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26
..........
1a
284,733
b
Program-related investments—total from Part IX-B
..................
1b
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
284,733
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b (see instructions)
.................
5
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
284,733
Note:
The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
the section 4940(e) reduction of tax in those years.
Form
990-PF
(2017)
Page 9
Form 990-PF (2017)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2016
(c)
2016
(d)
2017
1
Distributable amount for 2017 from Part XI, line 7
91,357
2
Undistributed income, if any, as of the end of 2017:
a
Enter amount for 2016 only
.......
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2017:
a
From 2012
......
84,376
b
From 2013
......
69,285
c
From 2014
......
31,124
d
From 2015
......
79,100
e
From 2016
......
163,245
f
Total
of lines 3a through e
........
427,130
4
Qualifying distributions for 2017 from Part
XII, line 4:
$
284,733
a
Applied to 2016, but not more than line 2a
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2017 distributable amount
.....
91,357
e
Remaining amount distributed out of corpus
193,376
5
Excess distributions carryover applied to 2017.
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
620,506
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
e
Undistributed income for 2016. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
f
Undistributed income for 2017. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2018
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
8
Excess distributions carryover from 2012 not
applied on line 5 or line 7 (see instructions)
...
84,376
9
Excess distributions carryover to 2018.
Subtract lines 7 and 8 from line 6a
......
536,130
10
Analysis of line 9:
a
Excess from 2013
....
69,285
b
Excess from 2014
....
31,124
c
Excess from 2015
....
79,100
d
Excess from 2016
....
163,245
e
Excess from 2017
....
193,376
Form
990-PF
(2017)
Page 10
Form 990-PF (2017)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2017, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2017
(b)
2016
(c)
2015
(d)
2014
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the organization had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
Jack David
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under
other conditions, complete items 2a, b, c, and d.
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2017)
Page 11
Form 990-PF (2017)
Page
11
Part XV
Supplementary Information
(continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
Commentary Inc
561 Seventh Ave 16th Floor
New York
,
NY
10018
None
PC
To clarify & enlighten public opinion.
6,000
Metropolitan Opera
Lincoln Center
New York
,
NY
10023
None
PC
To support culture and the arts.
6,000
American Enterprise Institute for P
1150 Seventeenth Street NW
Washington
,
DC
20036
None
PC
To support policy research.
25,000
Council on Foreign Relations Inc
58 East 68th St
New York
,
NY
10065
None
PC
To promote foreign policy research.
1,000
Federalist Society for Law Public P
1015 18th St NW Suite 425
Washington
,
DC
20036
None
PC
To support objective law research.
4,000
Fountain House Inc
425 W 47th St
New York
,
NY
10036
None
PC
To support programs for people with mental illness.
6,000
Lincoln Center Theater
Lincoln Center
New York
,
NY
10023
None
PC
To support culture and the arts.
3,000
Manhattan Institute for Policy Rese
52 Vanderbilt Ave
New York
,
NY
10017
None
PC
To support policy research.
30,000
Memorial Sloan-Kettering Cancer Cen
1275 York Ave
New York
,
NY
10065
None
PC
To support cancer research and treatment.
3,000
New York-Presbyterian Fund Inc
525 East 68th St
New York
,
NY
10065
None
PC
To support hospital.
2,500
Hudson Institute Inc
1015 15th St NW 6th Fl
Washington
,
DC
20005
None
PC
To support policy research.
93,000
Washington Institute for Near East
1828 L Street NW Suite 1050
Washington
,
DC
20036
None
PC
To support research and informed debate.
4,000
Gilder Lehrman Institute of America
19 W 44th Street Suite 500
New York
,
NY
10036
None
PC
To promote history education
5,000
Committee for Human Rights in N Kor
1001 Connecticut Ave NW Suite 435
Washington
,
DC
20036
None
PC
To promote human rights in North Korea
15,000
Foreign Policy Initiative
11 Dupont Circle NW Suite 325
Washington
,
DC
20036
None
PC
To promote active US foreign policy
5,000
The Fund for American Studies
1706 New Hampshire Ave NW
Washington
,
DC
20009
None
PC
To inspire certain values in future leaders.
5,000
Institute for Justice
901 N Glebe Road Suite 900
Arlington
,
VA
22203
PC
To promote civil liberties.
20,000
The Middle East Media Research Inst
1819 L Street NW- 5th Floor
Washington
,
DC
20036
PC
To inform the debate over U.S. policy in the Middle East
6,000
University of Michigan
3003 South State Street Suite 8000
Ann Arbor
,
MI
48109
PC
To promote art
1,000
George W Bush Presidential Center
2943 SMU Boulevard
Dallas
,
TX
75205
PC
To support North Korean refugees.
2,500
National Association of Scholars
8 W 38th St Suite 503
New York
,
NY
10018
To promote higher education reform.
3,000
Doe Fund Inc
232 East 84th St
New York
,
NY
10028
PC
To help end the cycle of homelessness and incarceration.
1,000
The Goldwater Institute
500 East Coronado Road
Phoenix
,
AZ
85004
PC
To advance the principles of limited government, economic feedom, free speech, healthcare, equal protection etc.
5,000
Foundation for Individual Rights in
510 Walnut St Suite 1250
Philadelphia
,
PA
19106
PC
To promote individual rights in higher education.
10,000
Center for Strategic International
1800 K Street NW
Washington
,
DC
20006
PC
To promote international security.
15,000
Total
.................................
3a
277,000
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2017)
Page 12
Form 990-PF (2017)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash investments
...........
14
4
Dividends and interest from securities
....
14
4,565
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than inventory
............
221,643
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
4,565
221,643
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
226,208
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
Form
990-PF
(2017)
Page 13
Form 990-PF (2017)
Page
13
Part XVII
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
1
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Yes
No
a
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1)
Cash
...................................
1a(1)
No
(2)
Other assets
.................................
1a(2)
No
b
Other transactions:
(1)
Sales of assets to a noncharitable exempt organization
....................
1b(1)
No
(2)
Purchases of assets from a noncharitable exempt organization
..................
1b(2)
No
(3)
Rental of facilities, equipment, or other assets
.......................
1b(3)
No
(4)
Reimbursement arrangements
...........................
1b(4)
No
(5)
Loans or loan guarantees
.............................
1b(5)
No
(6)
Performance of services or membership or fundraising solicitations
................
1b(6)
No
c
Sharing of facilities, equipment, mailing lists, other assets, or paid employees
..............
1c
No
d
If the answer to any of the above is "Yes," complete the following schedule. Column
(b)
should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column
(d)
the value of the goods, other assets, or services received.
(a)
Line No.
(b)
Amount involved
(c)
Name of noncharitable exempt organization
(d)
Description of transfers, transactions, and sharing arrangements
2a
Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?
...........
Yes
No
b
If "Yes," complete the following schedule.
(a)
Name of organization
(b)
Type of organization
(c)
Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
2018-07-19
May the IRS discuss this return
with the preparer shown below
(see instr.)?
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Fraidel Freitag CPA
Preparer's Signature
Date
Check if self-
employed
PTIN
P01386238
Firm's name
S D Belsky & Associates CPAs
Firm's EIN
13-3313244
Firm's address
21 W 47th St 7th Floor
New York
,
NY
10036
Phone no.
(212) 869-0052
Form
990-PF
(2017)
Additional Data
Software ID:
17005038
Software Version:
2017v2.2
Form 990PF - Special Condition Description:
Special Condition Description