SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990.Right pointing arrow large image Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
THE JEFFREY MODELL FOUNDATION INC
 
Employer identification number

13-3380237
Part I
General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants and
other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in the region (d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in the region
(f) Total expenditures
for and investments
in the region
ARGENTINA 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 30,000
AUSTRIA 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 45,000
CANADA 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 85,000
BELGIUM 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 50,000
BRAZIL 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 35,000
CHILE 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 12,500
CZECH REPUBLIC 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 22,500
FRANCE 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 25,000
UGANDA 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 22,500
ITALY 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 75,000
GERMANY 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 53,000
PERU 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 82,400
SPAIN 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 75,000
AUSTRALIA 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 75,000
INDIA 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 37,500
JAPAN 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 25,000
POLAND 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 25,000
BOSNIA 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 45,000
BULGARIA 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 22,500
ECUADOR 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 3,300
GREECE 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 3,500
HUNGARY 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 10,000
MEXICO 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 30,000
NETHERLANDS 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 62,400
VENEZUELA 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 4,170
SWITZERLAND 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 25,000
SMALL FOREIGN GRANTS 0 0 PROGRAM SERVICES DIAGNOSTIC RESEARCH 15,805
3a Sub-total ....     775,400
b Total from continuation sheets to Part I ...     221,675
c Totals (add lines 3a and 3b)     997,075
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2021
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Schedule F (Form 990) 2021
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Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)
(c) Region (d) Purpose of
grant
(e) Amount of
cash grant
(f) Manner of
cash
disbursement
(g) Amount
of noncash
assistance
(h) Description
of noncash
assistance
(i) Method of
valuation
(book, FMV,
appraisal, other)
ARGENTINA DIAGNOSTIC RESEARCH 30,000        
AUSTRALIA DIAGNOSTIC RESEARCH 75,000        
AUSTRIA DIAGNOSTIC RESEARCH 45,000        
BELGIUM DIAGNOSTIC RESEARCH 50,000        
BOSNIA DIAGNOSTIC RESEARCH 45,000        
BRAZIL DIAGNOSTIC RESEARCH 35,000        
BULGARIA DIAGNOSTIC RESEARCH 22,500        
CANADA DIAGNOSTIC RESEARCH 85,000        
CHILIE DIAGNOSTIC RESEARCH 12,500        
CZECH REPUBLIC DIAGNOSTIC RESEARCH 22,500        
ECUADOR DIAGNOSTIC RESEARCH 3,300        
FRANCE DIAGNOSTIC RESEARCH 25,000        
GERMANY DIAGNOSTIC RESEARCH 53,000        
GREECE DIAGNOSTIC RESEARCH 3,500        
HUNGARY DIAGNOSTIC RESEARCH 10,000        
INDIA DIAGNOSTIC RESEARCH 37,500        
ITALY DIAGNOSTIC RESEARCH 75,000        
JAPAN DIAGNOSTIC RESEARCH 25,000        
MEXICO DIAGNOSTIC RESEARCH 30,000        
NETHERLANDS DIAGNOSTIC RESEARCH 62,400        
PERU DIAGNOSTIC RESEARCH 82,400        
POLAND DIAGNOSTIC RESEARCH 25,000        
SMALL FOREIGN DIAGNOSTIC RESEARCH 15,805        
SPAIN DIAGNOSTIC RESEARCH 75,000        
SWITZERLAND DIAGNOSTIC RESEARCH 25,000        
UGANDA DIAGNOSTIC RESEARCH 22,500        
VENEZUELA DIAGNOSTIC RESEARCH 4,170        
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......MediumBullet
 
3 Enter total number of other organizations or entities .......................MediumBullet
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Schedule F (Form 990) 2021
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Schedule F (Form 990) 2021Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant
(e) Manner of cash
disbursement
(f) Amount of
noncash
assistance
(g) Description
of noncash
assistance
(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2021
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Schedule F (Form 990) 2021
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Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule F (Form 990) 2021
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Schedule F (Form 990) 2021
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Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.
ReturnReference Explanation
Part I, Line 2 - Grantmakers Explanation For Monitoring Use of Funds Outside US The Organization requires written verification of program criteria
Part I, Line 3f - Investments and Expenditures DIAGNOSTIC RESEARCH
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2021
Additional Data


Software ID: 21013475
Software Version: 2021v4.0