Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0052
2019
Open to Public Inspection
For calendar year 2019, or tax year beginning 10-01-2017 , and ending 09-30-2018
Name of foundation
Washington Square Health Foundation
 
Number and street (or P.O. box number if mail is not delivered to street address)875 North Michigan Ave 3516
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Chicago, IL60611
A Employer identification number

36-1210140
B Telephone number (see instructions)

(312) 664-6488
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$19,768,524J Accounting method:
 
(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)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 4,733
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 378,672 378,672  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 201,028
b Gross sales price for all assets on line 6a 4,711,174
7 Capital gain net income (from Part IV, line 2)... 201,028
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances 0
b Less: Cost of goods sold.... 0
c Gross profit or (loss) (attach schedule)..... 0  
11 Other income (attach schedule)....... 0 0 0
12 Total. Add lines 1 through 11........ 584,433 579,700 0
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 399,185 39,919   359,267
14 Other employee salaries and wages...... 10,813 1,081   9,732
15 Pension plans, employee benefits....... 56,054 5,605   50,449
16a Legal fees (attach schedule)......... Click to see attachment 2,339 234 0 2,105
b Accounting fees (attach schedule)....... Click to see attachment 40,246 4,025 0 36,221
c Other professional fees (attach schedule).... Click to see attachment 2,115 0 0 2,115
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 33,397 2,140 0 19,257
19 Depreciation (attach schedule) and depletion... Click to see attachment 6,405 640 0
20 Occupancy.............. 63,237 6,324   56,913
21 Travel, conferences, and meetings....... 8,108 811   7,297
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 148,829 14,853 0 133,976
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 770,728 75,632 0 677,332
25 Contributions, gifts, grants paid....... 646,779 654,685
26 Total expenses and disbursements. Add lines 24 and 25 1,417,507 75,632 0 1,332,017
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -833,074
b Net investment income (if negative, enter -0-) 504,068
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2019)
Form 990-PF (2019)
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
Assets 1 Cash—non-interest-bearing............. 403,914 223,882 223,882
2 Savings and temporary cash investments......... 2,269,564 4,124,813 4,124,813
3 Accounts receivable bullet15,103
Less: allowance for doubtful accounts bullet   8,871 15,103 15,103
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet   0 0 0
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)..... 0 0 0
7 Other notes and loans receivable (attach schedule) bullet0
Less: allowance for doubtful accounts bullet0 0 0 0
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges.......... 53,743 35,594 35,594
10a Investments—U.S. and state government obligations (attach schedule) 0 0 0
b Investments—corporate stock (attach schedule)....... 16,680,233 Click to see attachment14,691,446 14,691,446
c Investments—corporate bonds (attach schedule)....... 0 Click to see attachment280,509 280,509
11 Investments—land, buildings, and equipment: basis bullet0
Less: accumulated depreciation (attach schedule) bullet0 0   0
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 17,016 Click to see attachment20,174 20,174
14 Land, buildings, and equipment: basis bullet54,619
Less: accumulated depreciation (attach schedule) bullet36,962 22,391 Click to see attachment17,657 17,657
15 Other assets (describe bullet) Click to see attachment410,135 Click to see attachment359,346 Click to see attachment359,346
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 19,865,867 19,768,524 19,768,524
Liabilities 17 Accounts payable and accrued expenses.......... 52,059 45,367
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons 0 0
21 Mortgages and other notes payable (attach schedule)...... 0 0
22 Other liabilities (describe bullet) Click to see attachment391,708 Click to see attachment423,945
23 Total liabilities (add lines 17 through 22)......... 443,767 469,312
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
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 bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 19,422,100 19,299,212
30 Total liabilities and net assets/fund balances (see instructions). 19,865,867 19,768,524
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
19,422,100
2
Enter amount from Part I, line 27a .....................
2
-833,074
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
710,186
4
Add lines 1, 2, and 3 ..........................
4
19,299,212
5
Decreases not included in line 2 (itemize) bullet
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
19,299,212
Form 990-PF (2019)
Form 990-PF (2019)
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 SECURITIES      
b
c
d
e
(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 4,711,174   4,510,146 201,028
b
c
d
e
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     0 201,028
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 201,028
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 ................... 		Bracket 3 0
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?
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))
2018 1,480,074 19,161,568 0.077242
2017 1,165,437 17,510,913 0.066555
2016 1,180,159 19,648,925 0.060062
2015 1,228,244 20,739,957 0.059221
2014 1,437,298 18,914,653 0.075989
2
Total of line 1, column (d) .....................
2
0.339069
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5.0, or by the number of years the foundation has been in existence if less than 5 years ......
3
0.067814
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5......
4
19,942,992
5
Multiply line 4 by line 3......................
5
1,352,414
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
5,041
7
Add lines 5 and 6........................
7
1,357,455
8
Enter qualifying distributions from Part XII, line 4,.............
8
1,332,017
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 (2019)
Form 990-PF (2019)
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 Bullet and enter “N/A" on line 1. Bracket includes lines 1a and 1b
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 10,081
hereBulletand 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 10,081
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 10,081
6 Credits/Payments:
a 2019 estimated tax payments and 2018 overpayment credited to 2019 6a 17,038
b Exempt foreign organizations—tax withheld at source...... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 17,038
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.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 6,957
11 Enter the amount of line 10 to be: Credited to 2020 estimated taxBullet6,957 RefundedBullet 11 0
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
 
 
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
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
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
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)
    bulletIL
    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 2019 or the taxable year beginning in 2019? See the 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
     
    No
    Form 990-PF (2019)
    Form 990-PF (2019)
    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 addressbulletWWW.WSHF.ORG
    14
    The books are in care ofbulletHOWARD NOCHUMSON Telephone no.bullet (312) 664-6488

    Located atbullet875 NORTH MICHIGAN AVE STE 3516CHICAGOIL ZIP+4bullet60611
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over YesNo
    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 bullet
    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?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (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)?...............
    (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.).......
    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
    ........bullet
    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 2019?.............
    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 2019, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2019?.............
    If "Yes," list the years bullet20, 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.
    bullet20, 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?......................
    b
    If "Yes," did it have excess business holdings in 2019 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 2019.)..................
    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 2019?
    4b
     
    No
    Form 990-PF (2019)
    Form 990-PF (2019)
    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:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    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
     
     
    .........bullet
    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?..........
    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?.....................
    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?
    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? .................
    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
    Barbara Berendt Director
    2.000     		7,500 0 0
    875 North Michigan Ave
    Chicago,IL60611
    Catherine M Creticos MD Director
    2.000     		7,750 0 0
    875 North Michigan Ave
    Chicago,IL60611
    Sandy Goldberg PhD Director
    2.000     		8,500 0 0
    875 North Michigan Ave
    Chicago,IL60611
    William N Werner MD MPH Board Chair / Director
    2.000     		21,250 0 0
    875 North Michigan Ave
    Chicago,IL60611
    William B Friedeman Secretary / Director
    2.000     		10,000 0 0
    875 North Michigan Ave
    Chicago,IL60611
    James M Snyder Treasurer / Director
    2.000     		6,750 0 0
    875 North Michigan Ave
    Chicago,IL60611
    Howard Nochumson Executive Director & President
    40.000     		208,684 73,933 0
    875 North Michigan Ave
    Chicago,IL60611
    Catherine Kapella MPH Associate Director & Vice President
    40.000     		128,751 47,067 0
    875 North Michigan Ave
    Chicago,IL60611
    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
     
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2019)
    Form 990-PF (2019)
    Page 7
    Part VIII
    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
     
    Total number of others receiving over $50,000 for professional services.............bullet  
    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.........................bullet0
    Form 990-PF (2019)
    Form 990-PF (2019)
    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
    19,505,129
    b
    Average of monthly cash balances.......................
    1b
    655,028
    c
    Fair market value of all other assets (see instructions)................
    1c
    86,535
    d
    Total (add lines 1a, b, and c).........................
    1d
    20,246,692
    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
    20,246,692
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    303,700
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    19,942,992
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    997,150
    Part XI
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    997,150
    2a
    Tax on investment income for 2019 from Part VI, line 5......
    2a
    10,081
    b
    Income tax for 2019. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    10,081
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    987,069
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    25,694
    5
    Add lines 3 and 4............................
    5
    1,012,763
    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
    1,012,763
    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
    1,332,017
    b
    Program-related investments—total from Part IX-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
    0
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    1,332,017
    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
    1,332,017
    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 (2019)
    Form 990-PF (2019)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2018     		(c)
    2018     		(d)
    2019
    1 Distributable amount for 2019 from Part XI, line 7 1,012,763
    2 Undistributed income, if any, as of the end of 2019:
    a Enter amount for 2018 only....... 0
    b Total for prior years:20, 2014, 2013 0
    3 Excess distributions carryover, if any, to 2019:
    a From 2014...... 502,552
    b From 2015...... 39,421
    c From 2016...... 87,150
    d From 2017...... 101,432
    e From 2018...... 522,795
    fTotal of lines 3a through e........ 1,253,350
    4Qualifying distributions for 2019 from Part
    XII, line 4: bullet$ 1,332,017
    a Applied to 2018, 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 2019 distributable amount..... 1,012,763
    e Remaining amount distributed out of corpus 319,254
    5 Excess distributions carryover applied to 2019.   0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 1,572,604
    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......     		 
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2018. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2019. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2020 ..........     		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 2014 not
    applied on line 5 or line 7 (see instructions) ...     		502,552
    9Excess distributions carryover to 2020.
    Subtract lines 7 and 8 from line 6a ......     		1,070,052
    10 Analysis of line 9:
    a Excess from 2015.... 541,973
    b Excess from 2016.... 87,150
    c Excess from 2017.... 101,432
    d Excess from 2018.... 522,795
    e Excess from 2019.... 319,254
    Form 990-PF (2019)
    Form 990-PF (2019)
    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 2019, enter the date of the ruling....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    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) 2019 (b) 2018 (c) 2017 (d) 2016
    0 0 0   0
    b 85% of line 2a ......... 0 0 0   0
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		1,332,017 1,486,036 0   2,818,053
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		        0
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		1,332,017 1,486,036 0   2,818,053
    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 foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList 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).)
    bList 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.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    HOWARD NOCHUMSON
    875 NORTH MICHIGAN AVE SUITE 3516
    CHICAGO,IL60611
    (312) 664-6488
    bThe form in which applications should be submitted and information and materials they should include:
    Visit the website for the organization's grant guidelines & application: http://wshf.org/general-guidelines/
    cAny submission deadlines:
    GRANT SUBMISSIONS WERE ACCEPTED ON A CONTINUOUS ROLLING BASIS FOR EITHER THE 12/1 OR 6/1 DEADLINES.
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    NONE
    Form 990-PF (2019)
    Form 990-PF (2019)
    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)
    aPaid during the year
    A Silver Lining Foundation
    134 N LA SALLE ST Ste 1218
    Chicago,IL60602     		  PC Special Designated Grant to A Silver Lining Foundation 5,000
    A Silver Lining Foundation
    134 N LA SALLE ST Ste 1218
    Chicago,IL60602     		  PC Dr. Sandy Goldberg's Board of Director Grant to A Silver Lining Foundation 7,500
    A Silver Lining Foundation
    134 N LA SALLE ST Ste 1218
    Chicago,IL60602     		  PC James M. Snyder's Board of Director Grant to A Silver Lining Foundation 2,000
    A Silver Lining Foundation
    134 N LA SALLE ST Ste 1218
    Chicago,IL60602     		  PC Barbara Berendt's Board of Director Grant to A Silver Lining Foundation 5,000
    A Silver Lining Foundation
    134 N LA SALLE ST Ste 1218
    Chicago,IL60602     		  PC Dr. Catherine M. Creticos' Board of Director Grant to A Silver Lining Foundation 1,250
    A Silver Lining Foundation
    134 N LA SALLE ST Ste 1218
    Chicago,IL60602     		  PC Special Designated Grant to A Silver Lining Foundation 3,500
    A Silver Lining Foundation
    134 N LA SALLE ST Ste 1218
    Chicago,IL60602     		  PC Special Designated Grant to A Silver Lining Foundation for Board Retreat 7,000
    Access Community Health Network
    222 North Canal Street
    Chicago,IL60606     		  PC Medical Legal Partnership 10,000
    Addison Township Food Pantry
    50 East Oak Street
    Addison,IL60101     		  PC Barbara Berendt's Board of Director Grant to Addison Township Food Pantry 500
    Advocate Charitable Foundation
    205 W Touhy Ave Ste 225
    Park Ridge,IL60068     		  PC Construction of the New Creticos Cancer Center 50,000
    Advocate Charitable Foundation
    205 W Touhy Ave Ste 225
    Park Ridge,IL60068     		  PC Dr. William N. Werner's Board of Director Grant to the Angelo P. Creticos, MD Cancer Center at Advocate Illinois Masonic Medical Center 1,000
    Advocate Charitable Foundation
    205 W Touhy Ave Ste 225
    Park Ridge,IL60068     		  PC Dr. Catherine M. Creticos' Board of Director Grant to the Angelo P. Creticos, MD Lectureship Fund at Advocate Illinois Masonic Medical Center 1,000
    Advocate Charitable Foundation
    205 W Touhy Ave Ste 225
    Park Ridge,IL60068     		  PC Dr. Catherine M. Creticos' Board of Director Grant to the Anastasia and Angelo P. Creticos, MD Medical Innovation Endowment at Advocate Illinois Masonic Medical Center 1,000
    Advocate Charitable Foundation
    205 W Touhy Ave Ste 225
    Park Ridge,IL60068     		  PC Dr. Catherine M. Creticos' Board of Director Grant to the Anastasia Creticos Music Fund at Advocate Illinois Masonic Medical Center 500
    Advocate Charitable Foundation
    205 W Touhy Ave Ste 225
    Park Ridge,IL60068     		  PC Dr. Catherine M. Creticos' Board of Director Grant to the Medication Assistance Fund at Advocate Illinois Masonic Medical Center 500
    Alexian Brothers Bonaventure House
    825 WEST WELLINGTON AVENUE
    Chicago,IL60657     		  PC Quality Assurance Manager 12,500
    Alexian Brothers Bonaventure House
    826 WEST WELLINGTON AVENUE
    Chicago,IL60657     		  PC Quality Assurance Manager 12,500
    Alexian Brothers Bonaventure House
    827 WEST WELLINGTON AVENUE
    Chicago,IL60657     		  PC Dr. Catherine M. Creticos' Board of Director Grant to Alexian Brothers Bonaventure House 1,000
    Ann and Robert H Lurie Children's Hospital of Chicago
    225 E CHICAGO AVE PR DPT
    Chicago,IL60611     		  PC Hematology, Oncology and Stem Cell Transplant Research Fellowship Program 30,000
    Ann and Robert H Lurie Children's Hospital of Chicago
    225 E CHICAGO AVE PR DPT
    Chicago,IL60611     		  PC Hematology, Oncology and Stem Cell Transplant Research Fellowship Program 30,000
    Breakthrough Urban Ministries
    PO Box 47200
    Chicago,IL60647     		  PC Behavioral Health for Homeless Adults 10,000
    Chicago Chesed Fund
    7045 N Ridgeway Ave
    Lincolnwood,IL60712     		  PC Howard Nochumson's Board of Director Grant to the Chicago Chesed Fund 1,000
    Chicago Chesed Fund
    7045 N Ridgeway Ave
    Lincolnwood,IL60712     		  PC Mental and Habilitative Health website 10,000
    Chicago Chesed Fund
    7045 N Ridgeway Ave
    Lincolnwood,IL60712     		  PC Howard Nochumson's Board of Director Grant to Chicago Chesed Fund for Program Support 1,000
    Chicago Chesed Fund
    7045 N Ridgeway Ave
    Lincolnwood,IL60712     		  PC Howard Nochumson's Board of Director Grant to the Chicago Chesed Fund 1,000
    Chicago Hearing Society
    1444 W Willow St
    Chicago,IL60642     		  PC Expanding Chicago Hearing Society's Services through New Technology 11,580
    Chicago Women's Health Center
    1025 W Sunnyside Ave Ste 201
    Chicago,IL60640     		  PC Clinical Services Program 10,000
    City Of Hope
    1500 Duarte Rd
    Duarte,CA91010     		  PC Howard Nochumson's Board of Director Grant in Memory of Naomi Miller to be used for Dr. Steven Rosen's Research 500
    CJE SeniorLife
    3003 W Touhy Ave
    Chicago,IL60645     		  PC The Emergency Department Elder-care Navigator (EDEN) Program 8,122
    CJE SeniorLife
    3003 W Touhy Ave
    Chicago,IL60645     		  PC The Emergency Department Elder-care Navigator (EDEN) Program 6,062
    CommunityHealth NFP
    2611 W Chicago Ave
    Chicago,IL60622     		  PC Hypertension Care Group 17,500
    Council on Foundations
    2121 Crystal Drive Ste 700
    Arlington,VA22202     		  PC Foundation Designated Grant 3,100
    Covenant World Relief
    8303 W Higgins Rd
    Chicago,IL60631     		  PC Dr. William N. Werner's Board of Director Grant to support health initiatives for immunizations, maternal and child health and disease prevention 1,000
    Forefront
    208 S LaSalle St Ste 1540
    Chicago,IL60604     		  PC Foundation Designated Grant 721
    Gilda's Club Chicago
    537 N Wells St
    Chicago,IL60654     		  PC 20th Anniversary Awards Dinner 50,000
    Gilda's Club Chicago
    537 N Wells St
    Chicago,IL60654     		  PC Special Designated Grant to Gilda's Club 2,000
    Goldie's Place
    5705 North Lincoln Avenue
    Chicago,IL60659     		  PC James M. Snyder's Board of Director Grant to Goldie's Place 1,000
    Grantmakers In Health
    140 S Dearborn Street Suite 400
    Chicago,IL60603     		  PC Sponsorship of Annual Conference - WiFi Sponsorship 10,000
    Grantmakers In Health
    140 S Dearborn Street Suite 400
    Chicago,IL60603     		  PC Foundation Designated Grant 2,875
    Health and Medicine Policy Research Group
    29 E MADISON ST STE 602
    Chicago,IL60602     		  PC Strengthening the Safety Net in Illinois: Helping Providers Stay Ahead of the Shifting Landscape 15,000
    Heartland Alliance
    208 S LaSalle St Ste 1300
    Chicago,IL60604     		  PC James M. Snyder's Board of Director Grant to Heartland Alliance 1,500
    Howard Brown Health Center
    4025 N Sheridan Rd
    Chicago,IL60613     		  PC Dr. Catherine M. Creticos' Board of Director Grant to Howard Brown Health Center 1,250
    Illinois Association of Free & Charitable Clinics Inc
    42 STEPHEN ST UNIT 416
    LEMONT,IL60439     		  PC The 8th Annual Conference of the Illinois Association of Free and Charitable Clinics- Innovate.Collaborate.Advocate 7,500
    Jackson Hole Children's Museum
    PO BOX 995
    JACKSON,WY83001     		  PC William B. Friedeman's Board of Director Grant to the Jackson Hole Children's Museum in support of the human body themed exhibit, "Inside Out: Discovering the Human Body." 1,000
    JourneyCare
    2050 CLAIRE CT
    GLENVIEW,IL60025     		  PC Hospice Volunteer Expansion in Chicago 16,000
    JourneyCare
    2050 CLAIRE CT
    GLENVIEW,IL60025     		  PC Hospice Volunteer Expansion in Chicago 16,000
    Keshet
    600 Academy Dr Ste 130
    Northbrook,IL60062     		  PC Howard Nochumson's Board of Director Grant for the David Nochumson, Charles Nochumson and Sara Wolf Torah Memorial Scholarship Fund 1,000
    La Rabida Children's Hospital
    6501 S PROMONTORY DR
    Chicago,IL60649     		  PC James M. Snyder's Board of Director Grant to La Rabida Children's Hospital 1,000
    Libenu Foundation
    8052 N Monticello Ste 210
    Skokie,IL60076     		  PC Howard Nochumson's Board of Director Grant to the Libenu Foundation 500
    Meals on Wheels
    314 W Superior St Suite 300
    Chicago,IL60654     		  PC Home Delivered Meals for Individuals with Disabilities Program (HDMID) 25,000
    Mercy Housing Lakefront
    120 S LaSalle St Suite 1850
    Chicago,IL60603     		  PC Mercy Housing Lakefront's Community Health Worker Program 12,500
    Mount Sinai Hospital and Medical Center
    CALIFORNIA AVENUE AT 15TH STREET
    Chicago,IL60608     		  PC Providing Free Mammography Services for Low- Income Women on Chicago's West Side 17,500
    North Park Friendship Center
    3448 W Foster Ave
    Chicago,IL60625     		  PC Dr. William N. Werner's Board of Director Grant toward "the Plate Project" 2,500
    North Park University
    3225 W FOSTER AVE
    Chicago,IL60625     		  PC Dr. William N. Werner's Board of Director Grant to the Summer NPRESS Program at North Park University 2,500
    Northwestern University
    633 Clark St
    Evanston,IL60208     		  PC High-Utilizing Emergency Room Patients: A Strategic Approach to Comprehensive Care 22,500
    Northwestern University
    633 Clark St
    Evanston,IL60208     		  PC Catherine Kapella, MPH's Board Officer Grant to Northwestern University for Dr. Fawzi's Research 5,000
    Project Seed of Suburban Chicago Inc
    6045 N Monticello Ave
    Chicago,IL60659     		  PC Howard Nochumson's Board of Director Grant to Project Seed of Suburban Chicago 1,000
    Ray Graham Association for People with Disabilities
    901 Warrenville Road Ste 500
    Lisle,IL60532     		  PC Dr. Catherine M. Creticos' Board of Director Grant to the Hanson Center Therapeutic Riding Program at Ray Graham Association for People with Disabilities. 1,000
    Rush University Medical Center
    1700 WEST VAN BUREN STREET Room 250
    Chicago,IL60612     		  PC James M. Snyder's Board of Director Grant to the Road Home Project at Rush University Medical Center 2,000
    Second Sense
    65 E Wacker Pl Ste 1010
    Chicago,IL60601     		  PC Orientation and Mobility Training 17,500
    Shirley Ryan AbilityLab
    355East Erie
    Chicago,IL60611     		  PC Advance Human Ability Campaign 50,000
    Sisters Place Inc
    418 Mitchell Avenue
    Clairton,PA15025     		  PC Barbara Brenholts Berendt's Board of Director Grant to Sisters Place in Memory of Mary Jean Donley, Mother of Debra Donley 1,000
    Sonoma Ecology Center
    15000 Arnold Dr
    Eldridge,CA95431     		  PC William B. Friedeman's Board of Director Grant to the Sonoma Ecology Center for the Park Prescription Program 1,000
    St Johns Episcopal Church
    3857 N Kostner Ave
    Chicago,IL60641     		  PC William B. Friedeman's Board of Director Grant to St. John's Episcopal Church 500
    St Johns Episcopal Church
    3857 N Kostner Ave
    Chicago,IL60641     		  PC Mr. William B. Friedeman's Board of Director Grant for the low income utility payment program 2,200
    St Johns Hospital
    800 E Carpenter St
    Springfield,IL62769     		  PC William B. Friedeman's Board of Director Grant to St. John's Hospital Foundation 1,000
    St Leonard's House
    2100 W Warren Blvd
    Chicago,IL60612     		  PC Integrated Behavioral and Physical Health Services Initiative for Formerly Incarcerated Men and Women 7,500
    Swedish Covenant Hospital
    5145 N California Ave
    Chicago,IL60625     		  PC A Silver Lining Foundation Buy A Mom A Mammogram Program at Swedish Covenant Hospital 17,500
    Team Spirit Institute
    7336 N KEDVALE AVE
    Lincolnwood,IL60712     		  PC Howard Nochumson's Board of Director Grant to Team Spirit Institute In Memory of Rabbi Nathan H. Gordon 500
    The Children's Clinic
    320 Lake Street
    Oak Park,IL60302     		  PC Expansion of Oral Health Care for Special Need Patients 12,862
    The Children's Clinic
    320 Lake Street
    Oak Park,IL60302     		  PC Expansion of Oral Health Care for Special Need Patients 12,862
    The Kedzie Center
    4141 N Kedzie Ave Ste 2
    Chicago,IL60618     		  PC Dr. William N. Werner's Board of Director Grant to The Kedzie Center 500
    The Kedzie Center Expanded Mental Health Services Of Chicago Nfp
    4141 N Kedzie Ave Ste 2
    Chicago,IL60618     		  PC Little Explorers Community Expansion Program 9,000
    The Night Ministry
    4711 N Ravenswood Ave
    Chicago,IL60640     		  PC Catherine Kapella, MPH's Foundation Officer Grant to The Night Ministry 2,500
    Torah Academy of Buffalo Grove
    720 Armstrong Dr
    Buffalo Grove,IL60089     		  PC Howard Nochumson's Board of Director Grant to Torah Academy of Buffalo Grove for a Lecture on the Commandment to Guard Your Health 1,000
    Trinity Episcopal Church
    125 E 26th St
    Chicago,IL60616     		  PC William B. Friedeman's Board of Director Grant to Trinity Episcopal Church for the Food Support Program 1,000
    Trinity Episcopal Church
    126 E 26th St
    Chicago,IL60616     		  PC William B. Friedeman's Board of Director Grant to Trinity Episcopal Church for the Food Support Program 500
    Trinity Episcopal Church
    127 E 26th St
    Chicago,IL60616     		  PC Mr. William B. Friedeman's Board of Director Grant to Trinity Episcopal Church 300
    Wood Dale Community United Methodist Church
    206 N Wood Dale Rd
    Wood Dale,IL60191     		  PC Barbara Berendt's Board of Director Grant to Wood Dale Commnity United Methodist Church for the Wood Dale Food Pantry 1,000
    Clearbook
    1835 W Central Rd
    Arlington Heights,IL60005     		  PC PRI Forgiveness 8,183
    Mobile CARE Foundation
    321 N Loomis Ste 202
    Chicago,IL60607     		  PC PRI Forgiveness 24,818
    Total .................................bullet 3a 654,685
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2019)
    Form 990-PF (2019)
    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.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3 Interest on savings and temporary cash
    investments ...........     		         
    4 Dividends and interest from securities....     14 378,672  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot 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 ............     		    18 201,028  
    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).. 0 579,700 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    579,700
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		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 (2019)
    Form 990-PF (2019)
    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) (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? ...........
    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.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2019)
    Additional Data


    Software ID: 17005876
    Software Version: 2017v2.2


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2017 AccountingFeesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Accounting Fees 40,246 4,025   36,221

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    TY 2017 DepreciationSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    Equipment           6,405 640    

    TY 2017 InvestmentsCorpBondsSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Name of Bond End of Year Book Value End of Year Fair Market Value
    CORPORATE BONDS 280,509 280,509

    TY 2017 InvestmentsCorpStockSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Name of Stock End of Year Book Value End of Year Fair Market Value
    DOM. SMALL CAP MUTUAL FUNDS 2,076,605 2,076,605
    DOM. LARGE CAP MUTUAL FUNDS 4,951,567 4,951,567
    DOMESTIC EQUITY FUNDS 41,027 41,027
    FIXED INCOME 0 0
    INTERNATIONAL EQUITY FUNDS 5,501,158 5,501,158
    DOM. MIDDLE CAP MUTUAL FUNDS 2,023,368 2,023,368
    COMMINGLED EQUITY FUNDS 97,721 97,721

    TY 2017 InvestmentsOtherSchedule2
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    LONG-TERM GROWTH EQUITY FUND FMV 20,174 20,174

    TY 2017 LandEtcSchedule2
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    EQUIPMENT 54,619 36,962 17,657 17,657


    TY 2017 LegalFeesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES 2,339 234   2,105


    TY 2017 OtherAssetsSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    RENT SECURITY DEPOSIT 6,971 6,971 6,971
    PROGRAM RELATED INVESTMENTS 403,164 352,375 352,375


    TY 2017 OtherExpensesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INSURANCE 70,735 7,074   63,661
    OFFICE SUPPLIES 13,777 1,378   12,399
    BOARD EXPENSES 36,685 3,668   33,017
    DUES & SUBSCRIPTIONS 5,929 593   5,336
    SERVICE CONTRACTS 17,558 1,756   15,802
    BANK CHARGES 1,036 104   932
    DIABETES PROGRAM MEETING 301     301
    MISCELLANEOUS 2,808 280   2,528


    TY 2017 OtherIncreasesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Description Amount
    UNREALIZED GAINS 710,186


    TY 2017 OtherLiabilitiesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Description Beginning of Year - Book Value End of Year - Book Value
    EMPLOYEE BENEFIT PLAN 391,708 423,945


    TY 2017 OtherProfessionalFeesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    CONSULTING FEES 2,115     2,115


    TY 2017 TaxesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    17005876
    Software Version:
    2017v2.2
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL EXCISE TAX 12,000      
    Payroll Tax 21,397 2,140   19,257