efile Public Visual Render
ObjectId: 202243199349101339 - Submission: 2022-11-15
TIN: 27-3400299
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. 1545-0047
20
21
Open to Public Inspection
For calendar year 2021, or tax year beginning
01-01-2021
, and ending
12-31-2021
Name of foundation
FOCUS FOR HEALTH FKA FOCUS AUTISM INC
Number and street (or P.O. box number if mail is not delivered to street address)
67 MOUNTAIN BLVD 201
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WARREN
,
NJ
07059
A Employer identification number
27-3400299
B
Telephone number (see instructions)
(908) 279-7881
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)
$
35,174,944
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)
1,893,286
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
81,779
81,779
5a
Gross rents
............
1,584,432
1,584,432
b
Net rental income or (loss)
876,537
6a
Net gain or (loss) from sale of assets not on line 10
1,122,176
b
Gross sales price for all assets on line 6a
4,928,736
7
Capital gain net income (from Part IV, line 2)
...
1,122,176
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
........
4,681,673
2,788,387
13
Compensation of officers, directors, trustees, etc.
0
0
0
14
Other employee salaries and wages
......
370,506
0
370,506
15
Pension plans, employee benefits
.......
66,117
0
66,117
16a
Legal fees (attach schedule)
.........
1,950
0
1,950
b
Accounting fees (attach schedule)
.......
9,500
4,750
4,750
c
Other professional fees (attach schedule)
....
254,601
0
254,601
17
Interest
...............
195,159
193,905
14,027
18
Taxes (attach schedule) (see instructions)
...
288,391
251,304
37,087
19
Depreciation (attach schedule) and depletion
...
231,117
231,117
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
263,184
102,342
153,342
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
1,680,525
783,418
902,380
25
Contributions, gifts, grants paid
.......
2,116,284
2,116,284
26
Total expenses and disbursements.
Add lines 24 and 25
3,796,809
783,418
3,018,664
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
884,864
b
Net investment income
(if negative, enter -0-)
2,004,969
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2021)
Page 2
Form 990-PF (2021)
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
.............
717,964
248,396
248,396
2
Savings and temporary cash investments
.........
3
Accounts receivable
975
Less: allowance for doubtful accounts
975
975
975
4
Pledges receivable
Less: allowance for doubtful accounts
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)
.......
6,826,319
7,565,716
9,806,746
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
10,906,930
Less: accumulated depreciation (attach schedule)
2,407,024
8,731,022
8,499,906
25,000,000
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
176,289
118,827
118,827
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
16,452,569
16,433,820
35,174,944
17
Accounts payable and accrued expenses
..........
96,284
104,012
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
4,647,201
4,539,128
22
Other liabilities (describe
)
206,274
223,616
23
Total liabilities
(add lines 17 through 22)
.........
4,949,759
4,866,756
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
0
0
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
11,502,810
11,567,064
29
Total net assets or fund balances
(see instructions)
.....
11,502,810
11,567,064
30
Total liabilities and net assets/fund balances
(see instructions)
.
16,452,569
16,433,820
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 29 (must agree with end-of-year figure reported on prior year’s return)
...............
1
11,502,810
2
Enter amount from Part I, line 27a
.....................
2
884,864
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
12,387,674
5
Decreases not included in line 2 (itemize)
5
820,610
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
11,567,064
Form
990-PF
(2021)
Page 3
Form 990-PF (2021)
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
WELLS FARGO - 9007
2021-01-01
2021-12-31
b
TD
2021-01-01
2021-12-31
c
TD
2021-01-01
2021-12-31
d
E-TRADE
2021-01-01
2021-12-31
e
UBS
2021-01-01
2021-12-31
UBS
2021-01-01
2021-12-31
RAYMOND JAMES - J723
2021-01-01
2021-12-31
UBS - 5177
2021-01-01
2021-12-31
CAPITAL GAINS DIVIDENDS
P
(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
1,748,469
1,666,621
81,848
b
291,643
c
407,376
241,338
166,038
d
-54,799
e
2,063,202
1,916,003
147,199
401,290
295,519
105,771
308,309
294,426
13,883
370,503
90
90
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
81,848
b
291,643
c
166,038
d
-54,799
e
147,199
105,771
13,883
370,503
90
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
1,122,176
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
Form
990-PF
(2021)
Page 4
Form 990-PF (2021)
Page
4
Part V
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
All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) 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
0
3
Add lines 1 and 2
...........................
3
27,869
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
0
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
27,869
6
Credits/Payments:
a
2021 estimated tax payments and 2020 overpayment credited to 2021
6a
39,538
b
Exempt foreign organizations—tax withheld at source
......
6b
0
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
39,538
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
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
11,669
11
Enter the amount of line 10 to be:
Credited to 2022 estimated tax
11,669
Refunded
11
0
Part VI-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 the instructions
for the 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.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
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
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
.........
4a
Yes
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
Yes
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
No
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 XIV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
NJ
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 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
If "Yes," complete Part XIII
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2021)
Page 5
Form 990-PF (2021)
Page
5
Part VI-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
No
Website address
WWW.FOCUSFORHEALTH.ORG
14
The books are in care of
BARRY SEGAL
Telephone no.
(908) 279-7881
Located at
67 MOUNTAIN BLVD STE 201
WARREN
NJ
ZIP+4
07059
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 2021, 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 the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VI-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?
...........
1a(1)
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
..............................
1a(2)
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
...........
1a(3)
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
............
1a(4)
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)?
......................
1a(5)
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.)
...............
1a(6)
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
c
Organizations relying on a current notice regarding disaster assistance check here
........
d
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 2021?
.............
1d
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 2021, did the foundation have any undistributed income (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2021?
....................
2a
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
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?
..............................
3a
No
b
If "Yes," did it have excess business holdings in 2021 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 2021.)
.....................
3b
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 2021?
..
4b
No
Form
990-PF
(2021)
Page 6
Form 990-PF (2021)
Page
6
Part VI-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:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
..........
5a(1)
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
....................
5a(2)
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
.............
5a(3)
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
........................
5a(4)
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?
.............
5a(5)
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
c
Organizations relying on a current notice regarding disaster assistance check
.........
d
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?
.................
5d
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?
.............................
6a
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?
7a
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
.....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.........................
8
No
Part VII
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
MARTIN SEGAL
VICE PRESIDENT
3.00
0
0
0
67 MOUNTAIN BLVD 201
WARREN
,
NJ
07059
BARRY SEGAL
PRESIDENT
5.00
0
0
0
67 MOUNTAIN BLVD 201
WARREN
,
NJ
07059
ROBERT KRAKOW
TRUSTEE
0.50
0
0
0
67 MOUNTAIN BLVD 201
WARREN
,
NJ
07059
BEA PUDELKO
TRUSTEE
0.50
0
0
0
67 MOUNTAIN BLVD 201
WARREN
,
NJ
07059
RICHARD SEGAL
TRUSTEE
0.50
0
0
0
67 MOUNTAIN BLVD 201
WARREN
,
NJ
07059
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
JENNIFER SHORE
EXECUTIVE DIRECTOR
40.00
191,475
0
0
67 MOUNTAIN BLVD
WARREN
,
NJ
07059
LAURA RAWLINS
ASSOCIATE
40.00
60,900
0
0
67 MOUNTAIN BLVD
WARREN
,
NJ
07059
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2021)
Page 7
Form 990-PF (2021)
Page
7
Part VII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
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
STEVE KRAHLING
SPEAKER, RESEARCH
68,000
C/O 67 MOUNTAIN BLVD
WARREN
,
NJ
07059
Total
number of others receiving over $50,000 for professional services
.............
0
Part VIII-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 VIII-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
.........................
0
Form
990-PF
(2021)
Page 8
Form 990-PF (2021)
Page
8
Part IX
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
9,568,399
b
Average of monthly cash balances
.......................
1b
40,265
c
Fair market value of all other assets (see instructions)
................
1c
20,708,338
d
Total
(add lines 1a, b, and c)
.........................
1d
30,317,002
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
0
3
Subtract line 2 from line 1d
.........................
3
30,317,002
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions)
.............................
4
454,755
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3.
............
5
29,862,247
6
Minimum investment return.
Enter 5% (0.05) of line 5
................
6
1,493,112
Part X
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 IX, line 6
..................
1
1,493,112
2a
Tax on investment income for 2021 from Part V, line 5
.......
2a
27,869
b
Income tax for 2021. (This does not include the tax from Part V.)
...
2b
8,366
c
Add lines 2a and 2b
............................
2c
36,235
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
1,456,877
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
1,456,877
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1
...
7
1,456,877
Part XI
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
3,018,664
b
Program-related investments—total from Part VIII-B
..................
1b
0
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 XII, line 4.
4
3,018,664
Form
990-PF
(2021)
Page 9
Form 990-PF (2021)
Page
9
Part XII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2020
(c)
2020
(d)
2021
1
Distributable amount for 2021 from Part X, line 7
1,456,877
2
Undistributed income, if any, as of the end of 2021:
a
Enter amount for 2020 only
.......
0
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2021:
a
From 2016
......
1,374,623
b
From 2017
......
1,611,530
c
From 2018
......
1,322,559
d
From 2019
......
1,778,574
e
From 2020
......
1,636,750
f
Total
of lines 3a through e
........
7,724,036
4
Qualifying distributions for 2021 from Part
XI, line 4:
$
3,018,664
a
Applied to 2020, but not more than line 2a
0
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2021 distributable amount
.....
1,456,877
e
Remaining amount distributed out of corpus
1,561,787
5
Excess distributions carryover applied to 2021.
0
0
(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
9,285,823
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
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
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2019. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2021. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2022
..........
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)
.......
0
8
Excess distributions carryover from 2016 not
applied on line 5 or line 7 (see instructions)
...
1,374,623
9
Excess distributions carryover to 2022.
Subtract lines 7 and 8 from line 6a
......
7,911,200
10
Analysis of line 9:
a
Excess from 2017
....
1,611,530
b
Excess from 2018
....
1,322,559
c
Excess from 2019
....
1,778,574
d
Excess from 2020
....
1,636,750
e
Excess from 2021
....
1,561,787
Form
990-PF
(2021)
Page 10
Form 990-PF (2021)
Page
10
Part XIII
Private Operating Foundations
(see instructions and Part VI-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 2021, 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 IX for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2021
(b)
2020
(c)
2019
(d)
2018
b
85% (0.85) of line 2a
.........
c
Qualifying distributions from Part XI,
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 IX, 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 XIV
Supplementary Information (Complete this part only if the foundation 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).)
BARRY SEGAL
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.
BARRY SEGAL
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. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
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
(2021)
Page 11
Form 990-PF (2021)
Page
11
Part XIV
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
3D GIRLS INC
PO BOX 10924
ATLANTA
,
GA
30310
NONE
N/A
CHARITABLE PURPOSE
14,000
A PARTNERSHIP FOR CHANGE
PO BOX 523
ORADELL
,
NJ
07649
NONE
N/A
CHARITABLE PURPOSE
20,000
AKHIL AUTISM FOUNDATION
ATTN MANISHA LAD 46 HARMON RD
EDISON
,
NJ
08837
NONE
N/A
CHARITABLE PURPOSE
18,750
ALLIANCE FOR NATURAL HEALTH USA
1011 E JEFFERSON ST 204
CHARLOTTESVILLE
,
VA
22902
NONE
N/A
CHARITABLE PURPOSE
60,000
ALLIANCE OF FAMILIES FOR JUSTICE
8 W 126TH ST 3RD FLOOR
NEW YORK
,
NY
10027
NONE
N/A
CHARITABLE PURPOSE
35,000
AMERICAN EXPRESS
PO BOX 1270
NEWARK
,
NJ
07101
NONE
N/A
CHARITABLE PURPOSE
1,659
AMERICA'S BIG SISTERS
21411 BRITTANY DR
FRANKFORT
,
IL
60423
NONE
N/A
CHARITABLE PURPOSE
20,000
AUTISM HEALTHCARE COLLABORATIVE
16 MT BETHEL RD BOX 321
WARREN
,
NJ
07059
NONE
N/A
CHARITABLE PURPOSE
10,000
AUTISM SUPPORT CENTER KENYA
SPECIAL NEEDS AFRICA 2419 SMALLMAN
ST
PITTSBURGH
,
PA
15222
NONE
N/A
CHARITABLE PURPOSE
6,250
BEYOND CELIAC
PO BOX 544
AMBLER
,
PA
19002
NONE
N/A
CHARITABLE PURPOSE
35,000
BLACK WOMEN'S BLUEPRINT INC
PO BOX 24713
BROOKLYN
,
NY
11202
NONE
N/A
CHARITABLE PURPOSE
35,000
BLACKFEM INC
599 MARYLAND AVE
LEXINGTON
,
KY
40508
NONE
N/A
CHARITABLE PURPOSE
30,500
CHIP INTERNATIONAL INC
4024 AMBOY AVENUE
STATEN ISLAND
,
NY
10308
NONE
N/A
CHARITABLE PURPOSE
38,000
EDJA FOUNDATION (NYAKA)
NYAKA AIDS ORPHANS PROJECT PO BOX
339
EAST LANSING
,
MI
48826
NONE
N/A
CHARITABLE PURPOSE
25,000
ELS FOR AUTISM FOUNDATION
KERRY KRUCKEL 3900 MILITARY TRAIL
STE 200
JUPITER
,
FL
33458
NONE
N/A
CHARITABLE PURPOSE
60,000
FATHERS UPLIFT INC
12 SOUTHERN AVE
DORCHESTER
,
MA
02124
NONE
N/A
CHARITABLE PURPOSE
35,000
FIRECRACKER FOUNDATION
2450 DELHI COMMERCE DR STE 9
HOLT
,
MI
48842
NONE
N/A
CHARITABLE PURPOSE
25,000
FLORIDA ALLIANCE TO END HUMAN TRAFFICKING
1400 VILLAGE SQUARE BLVD SUITE
3-110
TALLAHASSEE
,
FL
32312
NONE
N/A
CHARITABLE PURPOSE
50,000
HOLLA
10-41 115TH ST APT 3B
COLLEGE POINT
,
NY
11356
NONE
N/A
CHARITABLE PURPOSE
50,000
HELLOBABY CHICAGO
14 N PEORIA ST STE 2E
CHICAGO
,
IL
60607
NONE
N/A
CHARITABLE PURPOSE
10,000
HELP A COMMUNITY TRUST
N/A
NA
MI
NONE
N/A
CHARITABLE PURPOSE
6,250
IMAGE IMPACT INTERNATIONAL
86 CLIFFORD AVE
PELHAM
,
NY
10803
NONE
N/A
CHARITABLE PURPOSE
5,000
JOYFUL MOTHERHOOD
N/A
NA
MI
NONE
N/A
CHARITABLE PURPOSE
9,375
JUSTICE TEAMS NETWORK
PO BOX 399389
SAN FRANCISCO
,
CA
94139
NONE
N/A
CHARITABLE PURPOSE
15,000
KIDS ARE SACRED
PO BOX 23805
OVERLAND PARK
,
KS
66223
NONE
N/A
CHARITABLE PURPOSE
20,000
KIDSAFE FOUNDATION
20283 STATE ROAD 7 STE 102
BOCA RATON
,
FL
33498
NONE
N/A
CHARITABLE PURPOSE
20,000
MENTEE GLOBAL
1320 DARTFORD CT
NAPERVILLE
,
IL
60540
NONE
N/A
CHARITABLE PURPOSE
10,000
MIDDLE PROJECT INC
50 EAST 7TH STREET
NEW YORK
,
NY
10003
NONE
N/A
CHARITABLE PURPOSE
90,000
MIRROR MEMOIRS
1000 N ALAMEDA ST STE 240
LOS ANGELES
,
CA
90012
NONE
N/A
CHARITABLE PURPOSE
25,000
MOMS HELPING MOMS FOUNDATION
1118 NORTH AVE
PLAINFIELD
,
NJ
07062
NONE
N/A
CHARITABLE PURPOSE
5,000
MORTAR CINCINNATI
1329 VINE ST
CINCINNATI
,
OH
45202
NONE
N/A
CHARITABLE PURPOSE
20,000
MY LIFE MY CHOICE
989 COMMONWEALTH AVE
BOSTON
,
MA
02215
NONE
N/A
CHARITABLE PURPOSE
25,000
MYGOAL INC - AUTISM
PO BOX 531
MONMOUTH JUNCTION
,
NJ
08852
NONE
N/A
CHARITABLE PURPOSE
70,000
NASSAN'S PLACE
NADINE WRIGHT-ARBUBAKRR PO BOX 833
EAST ORANGE
,
NJ
07019
NONE
N/A
CHARITABLE PURPOSE
22,000
NATIONAL BLACK WOMEN'S JUSTICE INSTITUTE
2703 7TH ST MAILBOX 109
BERKELEY
,
CA
94710
NONE
N/A
CHARITABLE PURPOSE
40,000
NATIONAL HEALTH FREEDOM COALITION
1043 GRAND AVE 137
ST PAUL
,
MN
55105
NONE
N/A
CHARITABLE PURPOSE
35,000
OASIS TLC
1 MORGAN RD
MIDDLETOWN
,
NJ
07748
NONE
N/A
CHARITABLE PURPOSE
10,000
ONE CHILD NETWORK & SUPPORT
8 LAGANI AVE RICHMOND HILL
NA
,
ONTARIO
L4B 3EI
CA
NONE
N/A
CHARITABLE PURPOSE
40,000
PEACEWORKS INC (AXAYACATL)
1125 WOOLLEY AVE UNION
UNION
,
NJ
07083
NONE
N/A
CHARITABLE PURPOSE
6,250
PENNSYLVANIA HORTICULTURAL SOCIETY
100 N 20TH ST 5TH FLOOR
PHILADELPHIA
,
PA
19103
NONE
N/A
CHARITABLE PURPOSE
10,000
POAC (PARENTS OF AUTISTIC CHILDREN)
1989 ROUTE 88
BRICK
,
NJ
08724
NONE
N/A
CHARITABLE PURPOSE
50,000
PROJECT HOOD
6330 S KING DR
CHICAGO
,
IL
60637
NONE
N/A
CHARITABLE PURPOSE
10,000
REVIVE A CHILD UGANDA
PLOT 1763 BLOCK 220 BEN KAMULEGEYA
ROAD
NA
16499
UG
NONE
N/A
CHARITABLE PURPOSE
12,500
RISE COLORADO
1595 ELMIRA ST STE 201
AURORA
,
CO
80010
NONE
N/A
CHARITABLE PURPOSE
25,000
ROAR AS ONE
1223 WILSHIRE BLVD STE 834
SANTA MONICA
,
CA
90403
NONE
N/A
CHARITABLE PURPOSE
35,000
SACRED SPACES INC
5915 BEACON ST
PITTSBURGH
,
PA
15217
NONE
N/A
CHARITABLE PURPOSE
35,000
SAFE HARBOR CHILD ACCESS CENTERS
171 MAIN ST 2ND FLOOR
FLEMINGTON
,
NJ
08822
NONE
N/A
CHARITABLE PURPOSE
20,000
SMILE MUMS (FRM NENO) NENO WORLD VISION ALUMNI FOUNDATION
PO BOX 9716
FEDERAL WAY
,
WA
98063
NONE
N/A
CHARITABLE PURPOSE
12,000
SOCIAL CHANGE
23 E 26TH ST APT 2
CHICAGO
,
IL
60616
NONE
N/A
CHARITABLE PURPOSE
40,000
THE BLACK FEMINIST PROJECT
725 FOX STREET APT 1B
BRONX
,
NY
10455
NONE
N/A
CHARITABLE PURPOSE
30,000
THE CONFESS PROJECT
701 W 7TH ST STE 204
LITTLE ROCK
,
AR
72201
NONE
N/A
CHARITABLE PURPOSE
30,000
THE MAMA BEAR EFFECT
11 DENNIS DR
BURLINGTON
,
MA
01803
NONE
N/A
CHARITABLE PURPOSE
15,000
THE MIDLAND FOUNDATION
PO BOX 5026
NORTH BRANCH
,
NJ
08876
NONE
N/A
CHARITABLE PURPOSE
2,500
UNCHAINED AT LAST
208 LENOX AVE 189
WESTFIELD
,
NJ
07090
NONE
N/A
CHARITABLE PURPOSE
40,000
UNIVERSITY OF ILLINOIS FOUNDATION
CASH DESK 1305 W GREEN ST
URBANA
,
IL
61801
NONE
N/A
CHARITABLE PURPOSE
50,000
VILLAGE OF WISDOM
WILLIAM JACKSON 600 E UMSTEAD ST
DURHAM
,
NC
27701
NONE
N/A
CHARITABLE PURPOSE
50,000
VITAMIN ANGELS
PO BOX 4490
SANTA BARBARA
,
CA
93140
NONE
N/A
CHARITABLE PURPOSE
6,500
WOMEN'S HOPE FOR CHANGE
PO BOX 175
NA
,
MCHINJI
MI
NONE
N/A
CHARITABLE PURPOSE
6,250
YES 4 MINNEAPOLIS
231 MARIA AVE
SAINT PAUL
,
MN
55106
NONE
N/A
CHARITABLE PURPOSE
15,000
WEST SIDE JUSTICE CENTER
601 SOUTH CALIFORNIA AVE
CHICAGO
,
IL
60612
NONE
N/A
CHARITABLE PURPOSE
10,000
BLACK MOTHERS BREASTFEEDING ASSOCIATES
19750 BURT RD
DETROIT
,
MI
48219
NONE
N/A
CHARITABLE PURPOSE
2,500
BLACK VILLAGE FOUNDATION
20640 MICHIGAN ISLAND CT
FRANKFORT
,
IL
60423
NONE
N/A
CHARITABLE PURPOSE
25,000
CHICAGO CHANGE
220 NE 38TH ST UNIT 12 FT
LAUDERDALE
,
FL
33334
NONE
N/A
CHARITABLE PURPOSE
25,000
CHICAGO APPLESEED CENTER
750 N LAKE SHORE DRIVE FOURTH FLOOR
CHICAGO
,
IL
60611
NONE
N/A
CHARITABLE PURPOSE
15,000
CHICAGO TORTURE JUSTICE CENTER
641 W 63RD ST
CHICAGO
,
IL
60621
NONE
N/A
CHARITABLE PURPOSE
25,000
SUSTAINABLE SOUTH BRONX
ONE SMITH ST 4TH FLOOR
BROOKLYN
,
NY
11201
NONE
N/A
CHARITABLE PURPOSE
80,000
CHAINLESS CHANGE TOTAL
220 NE 38TH ST UNIT 12 FT
LAUDERDALE
,
FL
33334
NONE
N/A
CHARITABLE PURPOSE
25,000
CONNECT AUTISM TANZANIA
PO BOX 7791 MOSHI TANZANIA
BROOKLYN
,
NY
11201
NONE
N/A
CHARITABLE PURPOSE
25,000
CONTEXTOS
2240 SOUTH MICHIGAN AVE
CHICAGO
,
IL
60621
NONE
N/A
CHARITABLE PURPOSE
5,000
CORAZON CONTENTO GRANADA
1000 2ND AVE 34TH FLOOR
SEATTLE
,
WA
98104
NONE
N/A
CHARITABLE PURPOSE
5,000
URBAN TREE CONNECTION
1445 N 52ND STREET
PHILADELPHIA
,
PA
19131
NONE
N/A
CHARITABLE PURPOSE
10,000
TOGETHER FOR GIRLS INC
1889F NW SUITE 350
WASHINGTON
,
DC
07090
NONE
N/A
CHARITABLE PURPOSE
10,000
SERVICE WOMEN'S ACTION NETWORK
441 4TH ST NW STE 707N
WASHINGTON
,
DC
07090
NONE
N/A
CHARITABLE PURPOSE
15,000
OUT OF JUSTICE
PO BOX 10924
BALTIMORE
,
MD
21218
NONE
N/A
CHARITABLE PURPOSE
15,500
MISSISSPPI RISING COALITION
5 CHANDELUR COVE
OCEAN SPRINGS
,
MS
39564
NONE
N/A
CHARITABLE PURPOSE
15,000
MEN STOPPING VIOLENCE
2785 LAWRENCE HWY STE 112
DECATUR
,
GA
60540
NONE
N/A
CHARITABLE PURPOSE
25,000
HACKENSACK UMC FOUNDATION
160 ESSEX ST
LODI
,
NJ
07644
NONE
N/A
CHARITABLE PURPOSE
25,000
GRACE
4026 WARDS RD
LYNCHBURG
,
VA
24502
NONE
N/A
CHARITABLE PURPOSE
20,000
FFLIC
1307 ORETHA CASTLE HALEY BLVD
NEW ORLEANS
,
LA
70113
NONE
N/A
CHARITABLE PURPOSE
15,000
EQUITY AND TRANSFORMATION
10 W 35TH ST
CHICAGO
,
IL
60616
NONE
N/A
CHARITABLE PURPOSE
25,000
STOP IT NOW
351 PLEASANY ST
NORTHHAMPTON
,
MA
01060
NONE
N/A
CHARITABLE PURPOSE
15,000
HOOD COLLEGE
401 ROSEMONT AVE
FREDERICK
,
MD
21701
NONE
N/A
CHARITABLE PURPOSE
5,000
NJ COALITION AGAINST HUMAN TRAFFICKING
30 CHATHAM RD
SHORT HILLS
,
NJ
07078
NONE
N/A
CHARITABLE PURPOSE
15,000
PREVENTHUMAN TRAFFICKING
4410 MASSACHUSETTS AVE
WASHINGTON
,
DC
20016
NONE
N/A
CHARITABLE PURPOSE
10,000
JUSTICE FOR GEORGIA
1040 W MARIETTA ST
ATLANTA
,
GA
30350
NONE
N/A
CHARITABLE PURPOSE
10,000
JARED HEARTS OF SUCCESS
8343 ROSWELL RD STE 126
ATLANTA
,
GA
30350
NONE
N/A
CHARITABLE PURPOSE
5,000
IMPACTDMV
11010 PELICAN DR
UPPER MARLBORO
,
MD
20772
NONE
N/A
CHARITABLE PURPOSE
5,000
RISE HEALTH
3420 TORINGTON WAY
CHARLOTTE
,
NC
28277
NONE
N/A
CHARITABLE PURPOSE
10,500
ROOTS OF HEALTH
455 MAIN STREET APT 14E
NEW YORK
,
NY
10044
NONE
N/A
CHARITABLE PURPOSE
10,000
SMALL TALKS CHILDREN
3400 PINT TREE RD STE 106
LANSING
,
MI
48911
NONE
N/A
CHARITABLE PURPOSE
10,000
SWEM KIDS
216 MARSHALLS LN SE
ATLANTA
,
GA
30316
NONE
N/A
CHARITABLE PURPOSE
5,000
THE NEXT GEN COME UP
25 BRADFORD AVE
WEST ORANGE
,
NJ
07052
NONE
N/A
CHARITABLE PURPOSE
5,000
TINKS GOLDEN GIRLS
224 HILCREST AVE
SOMERSET
,
NJ
08873
NONE
N/A
CHARITABLE PURPOSE
5,000
UNITED WAY OF HUNTERDON COUNTY
4 WALTER E FORAN BLVD SUITE 401
FLEMINGTON
,
NJ
08822
NONE
N/A
CHARITABLE PURPOSE
5,000
THE FUNDERS NETWORK
6705 SW 5TH AVE
CORAL GABLES
,
FL
33143
NONE
N/A
CHARITABLE PURPOSE
10,000
REBALANCED LIFE WELLNESS ASSOCAITION
584 GRAND CANYON DRIVE
MADISON
,
WI
53718
NONE
N/A
CHARITABLE PURPOSE
10,000
THE MAMA BEAR EFFECT
11 DENNIS DR
BURLINGTON
,
MA
01803
NONE
N/A
CHARITABLE PURPOSE
15,000
Total
.................................
3a
2,116,284
b
Approved for future payment
Total
.................................
3b
0
Form
990-PF
(2021)
Page 12
Form 990-PF (2021)
Page
12
Part XV-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
14
81,779
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
876,537
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than
inventory
............
18
1,122,176
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)
..
0
1,203,955
876,537
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
2,080,492
(See worksheet in line 13 instructions to verify calculations.)
Part XV-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 XV-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
5B
RENTAL INCOME IS GENERATED FROM THE FOUNDATION'S OWNERSHIP OF REAL ESTATE. THIS INCOME IS UTILIZED TO PROMOTE THE FOUNDATION'S MISSION.
8
RENTAL INCOME IS GENERATED FROM THE FOUNDATION'S OWNERSHIP OF REAL ESTATE. THIS INCOME & GAINS FROM THE SALE OF THE REAL ESTATE IS UTILIZED TO PROMOTE THE FOUNDATION'S MISSION.
Form
990-PF
(2021)
Page 13
Form 990-PF (2021)
Page
13
Part XVI
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) (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) (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.
2022-11-12
May the IRS discuss this return
with the preparer shown below?
See instructions.
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
STEVE KREINIK
Preparer's Signature
Date
2022-11-11
Check if self-
employed
PTIN
P00839914
Firm's name
COHNREZNICK LLP
Firm's EIN
22-1478099
Firm's address
1301 AVENUE OF THE AMERICAS
NEW YORK
,
NY
10019
Phone no.
(212) 297-0400
Form
990-PF
(2021)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description