-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0052
20
19
Open to Public Inspection
For calendar year 2019, or tax year beginning
10-01-2019
, and ending
09-30-2020
Name of foundation
UNIHEALTH FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
800 WILSHIRE BLVD SUITE 1300
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LOS ANGELES
,
CA
90017
A Employer identification number
95-5004033
B
Telephone number (see instructions)
(213) 630-6500
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)
$
315,423,572
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)
0
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
5,877,856
5,964,532
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
813,937
b
Gross sales price for all assets on line 6a
161,083,172
7
Capital gain net income (from Part IV, line 2)
...
2,276,085
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)
.......
64,946
24,929
12
Total.
Add lines 1 through 11
........
6,756,739
8,265,546
13
Compensation of officers, directors, trustees, etc.
1,054,075
340,963
713,113
14
Other employee salaries and wages
......
505,038
16,860
488,178
15
Pension plans, employee benefits
.......
389,233
126,682
290,307
16a
Legal fees (attach schedule)
.........
15,770
14,735
1,035
b
Accounting fees (attach schedule)
.......
69,748
34,874
34,874
c
Other professional fees (attach schedule)
....
3,227,809
3,074,790
153,018
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
50,622
622
0
19
Depreciation (attach schedule) and depletion
...
13,685
13,685
20
Occupancy
..............
215,436
24,137
191,299
21
Travel, conferences, and meetings
.......
9,394
4,468
4,925
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
261,646
31,806
229,842
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
5,812,456
3,683,622
2,106,591
25
Contributions, gifts, grants paid
.......
12,255,039
12,837,064
26
Total expenses and disbursements.
Add lines 24 and 25
18,067,495
3,683,622
14,943,655
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-11,310,756
b
Net investment income
(if negative, enter -0-)
4,581,924
c
Adjusted net income
(if negative, enter -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
1
Cash—non-interest-bearing
.............
147,695
138,282
138,282
2
Savings and temporary cash investments
.........
1,462,210
700,716
700,716
3
Accounts receivable
Less: allowance for doubtful accounts
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
..........
110,015
119,621
119,621
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
152,272,926
173,476,134
173,476,134
c
Investments—corporate bonds (attach schedule)
.......
25,404,011
26,614,690
26,614,690
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
127,368,857
112,140,179
112,140,179
14
Land, buildings, and equipment: basis
90,400
Less: accumulated depreciation (attach schedule)
63,825
26,214
26,575
26,575
15
Other assets (describe
)
1,408,798
2,207,375
2,207,375
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
308,200,726
315,423,572
315,423,572
17
Accounts payable and accrued expenses
..........
304,977
413,651
18
Grants payable
.................
9,977,860
9,395,835
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
931,778
962,953
23
Total liabilities
(add lines 17 through 22)
.........
11,214,615
10,772,439
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
296,986,111
304,651,133
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
........
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)
.....
296,986,111
304,651,133
30
Total liabilities and net assets/fund balances
(see instructions)
.
308,200,726
315,423,572
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
296,986,111
2
Enter amount from Part I, line 27a
.....................
2
-11,310,756
3
Other increases not included in line 2 (itemize)
3
18,975,778
4
Add lines 1, 2, and 3
..........................
4
304,651,133
5
Decreases not included in line 2 (itemize)
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
304,651,133
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
HS MANAGEMENT PARTNERS
P
b
FIDELITY 500
P
c
VAUGHAN NELSON SMALL CAP VALUE
P
d
ROBECO
P
e
EUROPACIFIC GROWTH FD
P
MATTHEWS PACIFIC TIGER
P
SANDERSON INT'L VALUE FUND
P
ROYCE INTERNATIONAL FUND
P
PIMCO TOTAL RETURN FD
P
WAMCO CORE PLUS FD
P
BRANDYWINE GLOBAL OPPS FUND
P
CRESCENT HIGH INCOME CF
P
MET WEST TOTAL RETURN
P
TEMPLETON GLOBAL
P
CCI CORE BOND FUND
P
PIMCO COMMODITY REAL RTN FD
P
COHEN & STEERS INSTL REALTY
P
BLACKSTONE REAL ESTATE VII LP
P
OAK HILL CAPITAL PARTNERS III, LP
P
OCM OPPORTUNITIES FUND VII, LP
P
OCM OPPORTUNITIES FUND VIIB
P
OCM PRINCIPAL OPPS FUND IV, LP
P
RLH INVESTORS II, LP
P
RLH INVESTORS III, LP
P
RLH INVESTORS IV, LP
P
SIGULER GUFF BRIC OPPS FUND II
P
SILVER LAKE PARTNERS III [1134B]
P
SILVER LAKE PARTNERS IV
P
SILVER LAKE PARTNERS V
P
NEW MOUNTAIN PARTNERS IV
P
INDUSTRY VENTURES PARTNERSHIP HOLDINGS IV, LP
P
RIALTO REAL ESTATE FUND III - DEBT [1172B]
P
RIALTO REAL ESTATE FUND III - PROPERTY [1172A]
P
TRIDENT VII PARALLEL FUND, LP
P
CENTERBRIDGE
P
SVB STRATEGIC INVESTORS IX
P
SVB STRATEGIC INVESTORS X
P
SLP IV CASTLE FEEDER I, LP
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
36,890,303
34,526,760
2,363,543
b
1,000,000
1,014,699
-14,699
c
18,865,557
18,827,265
38,292
d
14,876,288
14,802,107
74,181
e
4,242,273
3,427,600
814,673
126,192
126,192
2,500,000
3,723,299
-1,223,299
3,500,283
3,448,004
52,279
6,213,473
6,328,210
-114,737
3,273,172
3,100,000
173,172
268,897
268,897
125,428
-125,428
34,550,474
33,648,031
902,443
17,256,291
19,856,796
-2,600,505
262,583
262,583
6,718,410
9,392,398
-2,673,988
3,483,293
2,910,952
572,341
435,979
396,782
39,197
184,984
112,541
72,443
84,761
109,963
-25,202
48,410
59,737
-11,327
5,535
157,806
-152,271
132,137
127,746
4,391
1,469,991
840,937
629,054
37,619
37,619
0
287,093
287,093
433,486
433,486
0
727,522
734,218
-6,696
4,675
4,675
0
1,909,502
1,909,502
73,406
73,406
283,790
283,790
0
179,019
179,019
0
104,229
41,074
63,155
118,913
118,156
757
4,397
3,154
1,243
34,616
34,835
-219
495,619
495,619
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
2,363,543
b
-14,699
c
38,292
d
74,181
e
814,673
126,192
-1,223,299
52,279
-114,737
173,172
268,897
-125,428
902,443
-2,600,505
262,583
-2,673,988
572,341
39,197
72,443
-25,202
-11,327
-152,271
4,391
629,054
0
287,093
0
-6,696
0
1,909,502
73,406
0
0
63,155
757
1,243
-219
495,619
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
2,276,085
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
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
Yes
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2018
14,199,220
294,561,422
0.048205
2017
13,618,363
304,342,128
0.044747
2016
13,573,581
290,682,278
0.046696
2015
14,746,129
280,390,741
0.052591
2014
14,920,774
296,478,997
0.050327
2
Total
of line 1, column (d)
.....................
2
0.242566
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
0.048513
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
298,542,536
5
Multiply line 4 by line 3
......................
5
14,483,194
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
45,819
7
Add lines 5 and 6
........................
7
14,529,013
8
Enter qualifying distributions from Part XII, line 4
,.............
8
15,693,655
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
and enter “N/A" on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
b
Domestic foundations that meet the section 4940(e) requirements in Part V, check
1
45,819
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
0
3
Add lines 1 and 2
...........................
3
45,819
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
45,819
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
204,106
b
Exempt foreign organizations—tax withheld at source
......
6b
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
204,106
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
158,287
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
158,287
Refunded
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
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
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)
CA
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 address
UNIHEALTHFOUNDATION.ORG
14
The books are in care of
KATHLEEN SALAZAR
Telephone no.
(213) 630-6500
Located at
800 WILSHIRE BLVD STE 1300
LOS ANGELES
CA
ZIP+4
90017
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 2019, 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 VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 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?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 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))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
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?
.................
Yes
No
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
BRADLEY C CALL
CHAIRMAN & CEO
20.00
250,000
30,000
9,600
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
DAVID S CANNOM MD
DIRECTOR
3.00
38,000
0
0
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
DAVID R CARPENTER
DIRECTOR
3.00
29,500
0
0
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
PATRICK C HADEN
DIRECTOR
3.00
33,500
0
0
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
LYDIA H KENNARD
DIRECTOR
3.00
31,000
0
0
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
CHARLES C REED
DIRECTOR
3.00
33,000
0
0
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
KEITH W RENKEN
DIRECTOR
3.00
31,000
0
0
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
FRANK M SANCHEZ PHD
DIRECTOR
3.00
29,500
0
0
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
ROBERT G SPLAWN MD
DIRECTOR
3.00
34,000
0
0
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
AMY WOHL PHD
DIRECTOR
3.00
34,000
0
0
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
JENNIFER VANORE
PRESIDENT
40.00
275,000
37,690
9,600
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
KATHLEEN H SALAZAR
CFO
40.00
248,875
35,618
0
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
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
KRISTOPHER EAMES
ADM, DIR OF OPERATIO
40.00
126,250
17,796
0
800 WILSHIRE BLVD 1300
LOS ANGELES
,
CA
90017
MERCY SIORDIA
ADM, SR PROGRAM OFFI
40.00
137,510
0
0
800 WILSHIRE BLVD 1300
LOS ANGELES
,
CA
90017
COLETTE BADMAGHARIAN
ADM, PROGRAM ASSOC
40.00
92,596
11,214
0
800 WILSHIRE BLVD 1300
LOS ANGELES
,
CA
90017
ALEXANDER SALAZAR
ADM, ACCOUNTANT
40.00
92,350
10,926
0
800 WILSHIRE BLVD 1300
LOS ANGELES
,
CA
90017
TERRY FRIAS
ADM, EXEC ASSISTANT
40.00
54,894
7,737
0
800 WILSHIRE BLVD 1300
LOS ANGELES
,
CA
90017
Total
number of other employees paid over $50,000
...................
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
CANTERBURY CONSULTING INC
INVESTMENT ADVISORY
206,000
1200 5TH AVE 1725
SEATTLE
,
WA
98101
ONNI 800 WILSHIRE LP
INVESTMENT MGMT
192,955
800 WILSHIRE BLVD
LOS ANGELES
,
CA
90017
HS MANAGEMENT PARTNERS
INVESTMENT MGMT
169,482
598 MADISON AVENUE 14TH FLOOR
NEW YORK
,
NY
10022
SEARCHLIGHT CAPITAL III LP
INVESTMENT MGMT
132,989
745 FIFTH AVENUE 27TH FLOOR
NEW YORK
,
NY
10151
SANDERSON INT'L VALUE FUND
INVESTMENT MGMT
126,692
250 SOUTH WACKER DRIVE SUITE 220
CHICAGO
,
IL
60606
Total
number of others receiving over $50,000 for professional services
.............
25
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
PROGRAM RELATED INVESTMENT LOAN TO NONPROFIT FINANCE FUND (NFF) TO SUPPORT NFF'S ACCELERATING PERMANENT SUPPORTIVE HOUSING FUND WHICH WILL ENABLE NFF TO PROVIDE WORKING CAPITAL AND ACQUISITION AND PREDEVELOPMENT LOANS TO ESTABLISHED NONPROFIT HOUSING DEVELOPERS IN LOS ANGELES COUNTY, CALIFORNIA.
750,000
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
750,000
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
300,862,623
b
Average of monthly cash balances
.......................
1b
2,201,004
c
Fair market value of all other assets (see instructions)
................
1c
25,242
d
Total
(add lines 1a, b, and c)
.........................
1d
303,088,869
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
303,088,869
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
4,546,333
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
298,542,536
6
Minimum investment return.
Enter 5% of line 5
..................
6
14,927,127
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
14,927,127
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
45,819
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
45,819
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
14,881,308
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
14,881,308
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 XIII, line 1
...
7
14,881,308
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
14,943,655
b
Program-related investments—total from Part IX-B
..................
1b
750,000
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
15,693,655
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
45,819
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
15,647,836
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
14,881,308
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
0
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
273,999
c
From 2016
......
d
From 2017
......
e
From 2018
......
f
Total
of lines 3a through e
........
273,999
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
15,693,655
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
.....
14,881,308
e
Remaining amount distributed out of corpus
812,347
5
Excess distributions carryover applied to 2019.
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
1,086,346
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 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)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
1,086,346
10
Analysis of line 9:
a
Excess from 2015
....
273,999
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
812,347
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
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the 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).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
UNIHEALTH FOUNDATION JENNIFER VANOR
800 WILSHIRE BLVD SUITE 1300
LOS ANGELES
,
CA
90017
(213) 630-6500
b
The form in which applications should be submitted and information and materials they should include:
GRANT APPLICATION OUTLINE PROVIDED UPON SUBMISSION OF LETTER OF INQUIRY.
c
Any submission deadlines:
SEE WEBSITE FOR DATES
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
AWARDS RESTRICTED GEOGRAPHICALLY AND PROGRAMMATICALLY.
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)
a
Paid during the year
ALZHEIMER'S GREATER LOS ANGELES
4221 WILSHIRE BLVD SUITE 400
LOS ANGELES
,
CA
90010
N/A
PC
THE SAVVY CAREGIVER: TRANSLATION, TRANSFORMATION, AND FEASIBILITY OF EVIDENCE-BASED PROGRAM FOR DEMENTIA CAREGIVERS
100,000
BET TZEDEK
3250 WILSHIRE BLVD 13TH FLOOR
LOS ANGELES
,
CA
90010
N/A
PC
AGING WITH DIGNITY MEDICAL LEGAL PARTNERSHIP
250,000
BIG SUNDAY
6111 MELROSE AVE
LOS ANGELES
,
CA
90038
N/A
PC
EMERGENCY SUPPORT FOR HEALTHCARE PROFESSIONALS & HEALTHCARE WORKERS
100,000
CALIFORNIA COMMUNITY FOUNDATION
221 S FIGUEROA ST SUITE 400
LOS ANGELES
,
CA
90012
N/A
PC
EARLY CHILDHOOD SYSTEM OF CARE
150,000
CALIFORNIA COMMUNITY FOUNDATION
221 S FIGUEROA ST SUITE 400
LOS ANGELES
,
CA
90012
N/A
PC
NSI: SUPPORTING NON-PROFITS, PARTICULARLY HEALTH AND HUMAN SERVICES ORGANIZATIONS, REACH STRATEGIC ALLIANCES
70,000
CALIFORNIA COMMUNITY FOUNDATION
221 S FIGUEROA ST SUITE 400
LOS ANGELES
,
CA
90012
N/A
PC
COVID-19 LA COUNTY RESPONSE FUND
450,000
CALIFORNIA HEALTH FOUNDATION & TRUST
1215 K STREET 800
SACRAMENTO
,
CA
95814
N/A
PC
COMMUNITIES LIFTING COMMUNITIES: A COMMUNITY HEALTH IMPROVEMENT INITIATIVE FOCUSED ON REDUCING DISPARITIES AND IMPROVING COMMUNITY HEALTH IN THE SOUTHERN CALIFORNIA REGION
100,000
CALIFORNIA HOSPITAL MEDICAL CENTER
1401 S GRAND AVENUE
LOS ANGELES
,
CA
90015
N/A
PC
NEW TOWER PROJECT
5,000
CALIFORNIA SCIENCE CENTER FOUNDATION
700 EXPOSITION PARK DRIVE
LOS ANGELES
,
CA
90037
N/A
PC
ENRICHMENT OF EDUCATIONAL CONTENT INCLUDING LIFE SCIENCES
10,000
CAMBODIAN ASSOCIATION OF AMERICA
2390 PACIFIC AVE
LONG BEACH
,
CA
90806
N/A
PC
ASIAN/PACIFIC ISLANDER STRENGTH-BASED COMMUNITY WELLNESS PROGRAM
100,000
CANCER FOUNDATION OF SANTA BARBARA
601 WEST JUNIPERO ST
SANTA BARBARA
,
CA
93105
N/A
PC
PROVIDE CARE AND COMFORT TO PATIENTS LIVING WITH CANCER
20,000
CANCER SUPPORT COMMUNITY - PASADENA
76 E DEL MAR BLVD SUITE 215
PASADENA
,
CA
91105
N/A
PC
COMMUNITY PARTNERSHIPS OUTREACH
50,000
CEDARS-SINAI MEDICAL CENTER
6500 WILSHIRE BLVD SUITE 1600
LOS ANGELES
,
CA
90048
N/A
PC
IMPROVING HEALTH OUTCOMES FOR SENIORS: ELDERS PRESERVING INDEPENDENCE IN THE COMMUNITY (EPIC)
350,975
CHARITABLE VENTURES OF ORANGE COUNTY
4041 MACARTHUR BLVD SUITE 510
NEWPORT BEACH
,
CA
92660
N/A
PC
SANCTUARY OF HOPE
157,314
CHARLES DREW UNIVERSITY COLLEGE OF MEDICINE
CDU/UCLA MEDICAL EDUCATION PROGRAM
1731 EAST 120TH ST
LOS ANGELES
,
CA
90059
N/A
PC
MEDICAL STUDENT SCHOLARSHIP (2019-2020)
55,000
CHARLES DREW UNIVERSITY COLLEGE OF MEDICINE
CDU/UCLA MEDICAL EDUCATION PROGRAM
1731 EAST 120TH ST
LOS ANGELES
,
CA
90059
N/A
PC
MEDICAL STUDENT SCHOLARSHIP 2020-2021
55,000
CHARLES R DREW UNIVERSITY OF MEDICINE & SCIENCE
1731 EAST 120TH ST
LOS ANGELES
,
CA
90059
N/A
PC
INCREASING THE CALIFORNIA NURSING WORKFORCE: EDUCATION THROUGH DUAL COLLEGE ENROLLMENT
66,976
CHILDREN'S BUREAU
1910 MAGNOLIA AVE
LOS ANGELES
,
CA
90007
N/A
PC
ANNUAL APPEAL
5,000
CHILDREN'S BURN FOUNDATION
5000 VAN NUYS BLVD SUITE 210
SHERMAN OAKS
,
CA
91403
N/A
PC
POST-DISCHARGE NEEDS OF BURNED CHILDREN
5,000
CHILDREN'S BURN FOUNDATION
5000 VAN NUYS BLVD SUITE 210
SHERMAN OAKS
,
CA
91403
N/A
PC
TO OFFER LONG-TERM CARE AND ADDRESS POST-DISCHARGE HEALTH NEEDS
2,500
CHILDREN'S HOSPITAL LOS ANGELES
4650 SUNSET BLVD MS29
LOS ANGELES
,
CA
90027
N/A
PC
INFANT-FAMILY MENTAL HEALTH FROM HOSPITAL TO COMMUNITY
283,436
CITY OF HOPE
1500 EAST DUARTE RD
DUARTE
,
CA
91010
N/A
PC
EXPANDING GERIATRIC MULTIDISCIPLINARY MEDICAL CARE AND SUPPORTIVE CARE SERVICES AT CITY OF HOPE'S ANTELOPE VALLEY COMMUNITY SITE
129,972
CITY OF HOPE
1500 EAST DUARTE RD
DUARTE
,
CA
91010
N/A
PC
GENITO-URINARY CANCERS AND SUPPORTIVE CARE MEDICINE PROGRAM
5,000
COMMUNITY CLINIC ASSOCIATION OF LOS ANGELES COUNTY
445 SOUTH FIGUEROA STREET SUITE
2100
LOS ANGELES
,
CA
90071
N/A
PC
PROMOTING CENSUS 2020 AMONG COMMUNITY HEALTH CENTERS OF SOUTHERN CALIFORNIA
200,000
COMMUNITY HEALTH COUNCILS
3731 STOCKER ST SUITE 201
LOS ANGELES
,
CA
90008
N/A
PC
YOUTH OF COLOR WORKFORCE DEVELOPMENT PIPELINE PROJECT
111,596
COMMUNITY PARTNERS
1000 N ALAMEDA ST SUITE 240
LOS ANGELES
,
CA
90012
N/A
PC
TRANSFORMING LA THROUGH PARTNERSHIP: AN APPROACH TO MENTAL HEALTH AND COMMUNITY WELLBEING
300,000
DAVID GEFFEN SCHOOL OF MEDICINE AT UCLA
HEALTH SCIENCES DEVELOPMENT 10889
WILSHIRE BLVD SUITE 1200
LOS ANGELES
,
CA
90024
N/A
PC
MEDICAL STUDENT SCHOLARSHIP 2020-2021
55,000
DIRECT RELIEF
6100 WALLACE BECKNELL ROAD
SANTA BARBARA
,
CA
93117
N/A
PC
COVID-19 RESPONSE IN CALIFORNIA
100,000
DOWNTOWN WOMEN'S CENTER
442 S SAN PEDRO ST
LOS ANGELES
,
CA
90011
N/A
PC
AGING IN PLACE FOR FORMERLY HOMELESS WOMEN
150,000
EMANATE HEALTH FOUNDATION
1041 WEST BADILLO STREET
COVINA
,
CA
91722
N/A
PC
NUTRITION FOR LIFE
120,050
ESPERANZA COMMUNITY HOUSING CORPORATION
3655 S GRAND AVE SUITE 280
LOS ANGELES
,
CA
90007
N/A
PC
HEALTHY BREATHING PROGRAM
100,000
EXPERIENCE CAMPS
PO BOX 5099
WESTPORT
,
CT
06881
N/A
PC
MENTAL HEALTH SERVICES
2,500
GLENDALE MEMORIAL HEALTH FOUNDATION
1420 S CENTRAL AVE
GLENDALE
,
CA
91204
N/A
PC
COMPASSIONATE CARE SERVICES (CCS) PROGRAM (FORMERLY INTEGRATED SUPPORTIVE CARE (ISC) ACROSS A CONTINUUM OF CARE SETTINGS)
65,981
GOOD SAMARITAN HOSPITAL
1225 WILSHIRE BLVD
LOS ANGELES
,
CA
90017
N/A
PC
COMPLEX HEALTHCARE COORDINATION AND PALLIATIVE CARE AT GOOD SAMARITAN HOSPITAL
103,998
HOPE
21231 HAWTHORNE BLVD
TORRANCE
,
CA
90503
N/A
PC
HOUSING SERVICES PROGRAM
75,000
HAYNES FAMILY OF PROGRAMS
233 W BASELINE RD BOX 400
LA VERNE
,
CA
91750
N/A
PC
TRAUMA-INFORMED ARTS ENRICHMENT PROGRAM
75,158
HEALTHIMPACT
663 13TH STREET SUITE 300
OAKLAND
,
CA
94612
N/A
PC
ESTABLISH A STATEWIDE APPROACH TO ADVANCING INTERPROFESSIONAL EDUCATION AND COLLABORATIVE PRACTICE
23,410
HERALD CHRISTIAN HEALTH CENTER
8841 GARVEY AVE
ROSEMEAD
,
CA
91770
N/A
PC
INTEGRATION OF SOCIAL SERVICES IN A PRIMARY CARE SETTING
50,000
HOPE BUILDERS
801 N BROADWAY
SANTA ANA
,
CA
92701
N/A
PC
HEALTHCARE TRAINING PROGRAM
50,000
HUNTINGTON HOSPITAL
DEVELOPMENT OFFICE 100 W CALIFORNIA
BLVD
PASADENA
,
CA
91105
N/A
PC
PASADENA TRAUMA-INFORMED CARE INITIATIVE
260,047
INNER CITY LAW CENTER
1309 EAST SEVENTH STREET
LOS ANGELES
,
CA
91340
N/A
PC
HEALTH AND HOUSING INFRASTRUCTURE EXPANSION PROJECT
100,000
KECK SCHOOL OF MEDICINE OF USC
OFFICE OF DEVELOPMENT 1975 ZONAL
AVE KAM 516
LOS ANGELES
,
CA
90033
N/A
PC
ONLINE CONTACT TRACING FOR COVID-19
75,000
KECK SCHOOL OF MEDICINE OF USC
1975 ZONAL AVE
LOS ANGELES
,
CA
90033
N/A
PC
MEDICAL STUDENT SCHOLARSHIP 2020-2021
55,000
LA FAMILY HOUSING
7843 LANKERSHIM BLVD
NORTH HOLLYWOOD
,
CA
91605
N/A
PC
CAPACITY BUILDING TO EXPAND HEALTH SERVICES FOR PEOPLE EXPERIENCING HOMELESSNESS
153,720
LOMA LINDA UNIVERSITY
11060 ANDERSON STREET MAGAN HALL
SUITE B
LOMA LINDA
,
CA
92350
N/A
PC
CHILD ABUSE PEDIATRIC (CAP) FELLOWSHIP
90,000
LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
11175 CAMPUS ST CP-A1108
LOMA LINDA
,
CA
92350
N/A
PC
MEDICAL STUDENT SCHOLARSHIP 2020-2021
55,000
LOS ANGELES CHRISTIAN HEALTH CENTERS
202 W 1ST STREET SUITE 4-0435
LOS ANGELES
,
CA
90012
N/A
PC
EXPANSIONS AND IMPLEMENTATION OF INTEGRATED HEALTH AND HOUSING STRATEGIES
200,000
MASSACHUSETTS INSTITUTE OF TECHNOLOGY
600 MEMORIAL DR 3RD FL
CAMBRIDGE
,
MA
021394819
N/A
PC
KENNARD AND REEVES SCHOLARSHIP FUND
25,000
MENDEZ NATIONAL INSTITUTE OF TRANSPLANTATION FOUNDATION
2600 WEST OLIVE AVENUE 500
BURBANK
,
CA
91505
N/A
PC
ADVANCEMENT OF THE ART AND SCIENCE OF ORGAN TRANSPLANTATION
2,500
MIND OC
18650 MACARTHUR BLVD
IRVINE
,
CA
92612
N/A
PC
EVALUATING BE WELL OC: A NEW APPROACH FOR MENTAL HEALTH SYSTEM TRANSFORMATION THE SOURCE, THE FORCE, THE SPARK AND THE REASON (SOFO SPARE)
100,000
MLK COMMUNITY HEALTH FOUNDATION
1680 E 120TH STREET
LOS ANGELES
,
CA
90059
N/A
PC
MLK COMMUNITY MEDICAL GROUP
1,000,000
ORANGE COUNTY'S UNITED WAY
18012 MITCHELL SOUTH
IRVINE
,
CA
92614
N/A
PC
COVID-19 PANDEMIC RELIEF
350,000
PARKTREE COMMUNITY HEALTH CENTER
1450 EAST HOLT AVE
POMONA
,
CA
91767
N/A
PC
POMONA COMMUNITY HEALTH CENTER EXPANSION OF SERVICES
317,215
PATH
340 N MADISON AVE
LOS ANGELES
,
CA
90004
N/A
PC
BRIDGE TO HEALTH AND HOUSING
150,000
PATH OF LIFE MINISTRIES
1240 PALMYRITA AVE SUITE A
RIVERSIDE
,
CA
92507
N/A
PC
MAYORS INITIATIVE FOR ENDING HOMELESSNESS THROUGH HEALTH AND WHOLENESS
100,000
PROJECT ANGEL FOOD
922 VINE STREET
LOS ANGELES
,
CA
90038
N/A
PC
INCREASING SUSTAINABILITY AND CAPACITY BUILDING FOR HOME-DELIVERED MEALS AND NUTRITION
100,000
PROVIDENCE HEALTH & SERVICES FOUNDATION
VALLEY REGIONAL OFFICE 501 S BUENA
VISTA ST
BURBANK
,
CA
91505
N/A
PC
COMPLEX CARE MANAGEMENT PROGRAM
331,039
PROYECTO PASTORAL
135 N MISSION ROAD
LOS ANGELES
,
CA
90033
N/A
PC
PROMESA BOYLE HEIGHTS WELLNESS INITIATIVE
53,612
PUBLIC HEALTH FOUNDATION ENTERPRISES INC
13300 CROSSROADS PKWY NORTH
CITY OF INDUSTRY
,
CA
91746
N/A
PC
STRATEGIC PLAN IMPLEMENTATION
31,139
RADIANT HEALTH CENTERS
17982 SKY PARK CIRCLE SUITE J
IRVINE
,
CA
926146408
N/A
PC
MEDICALLY TAILORED MEALS (MTM) PILOT PROJECT
50,000
SANTA BARBARA COTTAGE HOSPITAL
PO BOX 689 PUEBLO AT BATH STREET
SANTA BARBARA
,
CA
93102
N/A
PC
MEDICAL RESPITE PROGRAM
208,067
SANTA BARBARA FOUNDATION
1111 CHAPALA ST STE 200
SANTA BARBARA
,
CA
93101
N/A
PC
COVID-19 JOINT RESPONSE EFFORT
100,000
SIERRA HEALTH FOUNDATION CENTER FOR HEALTH PROGRAM MANAGEMENT
1321 GARDEN HIGHWAY SUITE 210
SACRAMENTO
,
CA
95833
N/A
PC
SAN JOAQUIN VALLEY HEALTH FUND (SJVHF) COVID-19 RESPONSE CLUSTER
100,000
SOUTHERN CALIFORNIA GRANTMAKERS
1000 N ALAMEDA ST SUITE 230
LOS ANGELES
,
CA
90012
N/A
PC
PROGRAM DESIGN FOR PHILANTHROPIC FOUNDATIONS ON (1) DISASTER RELIEF/PREPAREDNESS FUNDING STRATEGIES AND (2) VETERAN HEALTH
100,000
SOUTHSIDE COALITION OF COMMUNITY HEALTH CENTERS
1400 S GRAND AVE SUITE 711
LOS ANGELES
,
CA
90015
N/A
PC
CARE COORDINATION PROJECT
190,177
ST CAMILLUS CENTER FOR SPIRITUAL CARE
1911 ZONAL AVE
LOS ANGELES
,
CA
90033
N/A
PC
CLINICAL PASTORAL EDUCATION PROGRAM AT LAC USC MEDICAL CENTER
100,000
THE GIVING BANK AT HOLY FAMILY CHURCH
1527 FREMONT AVE
SOUTH PASADENA
,
CA
91030
N/A
PC
GIVING BANK FOOD PANTRY FOR COMMUNITY HEALTH
50,000
THE LA TRUST
333 S BEAUDRY AVE 29TH FL
LOS ANGELES
,
CA
90017
N/A
PC
INTEGRATING WELLNESS CENTER HEALTH SERVICES DATA WITH LAUSD ACADEMIC DATA-THE L.A. TRUST'S DATA XCHANGE
100,000
THE REGENTS OF UNIVERSITY OF CALIFORNIA AT IRVINE
100 THEORY SUITE 250
IRVINE
,
CA
92617
N/A
PC
SEXUAL ASSAULT NURSE EXAMINERS (SANE) PROGRAM
221,670
UC DAVIS SCHOOL OF MEDICINE
ONE SHIELDS AVE 2ND FLOOR
DAVIS
,
CA
95616
N/A
PC
MEDICAL STUDENT SCHOLARSHIP 2020-2021
55,000
UC RIVERSIDE SCHOOL OF MEDICINE
SCHOOL OF MEDICINE EDUCATION
BUILDING 900 UNIVERSITY AVE 2608
RIVERSIDE
,
CA
92521
N/A
PC
MEDICAL STUDENT SCHOLARSHIP 2020-2021
55,000
UC SAN FRANCISCO
533 PARNASSES AVE SUITE U-109 UCSF
BOX 0131
SAN FRANCISCO
,
CA
94143
N/A
PC
PROACTIVE PALLIATIVE CARE (PRO-PC)
199,996
UCI SCHOOL OF MEDICINE
200 S MANCHESTER SUITE 835
ORANGE
,
CA
92868
N/A
PC
SOCIAL WORK INTERVENTION FOR TRANSFORMING DEMENTIA HEALTH CARE: SWIFT-DC
125,000
UCLA DEVELOPMENT
UCLA DEVELOPMENT 10920 WILSHIRE
BLVD SUITE 1508
LOS ANGELES
,
CA
90024
N/A
PC
DEVELOPING A MENTAL HEALTH MODEL FOR PEDIATRIC PALLIATIVE CARE/PROJECT CARE (COMFORT AND REFLECTIVE EXPRESSION)
195,842
UCLA DEVELOPMENT
UCLA DEVELOPMENT 10920 WILSHIRE
BLVD SUITE 1508
LOS ANGELES
,
CA
90024
N/A
PC
COMMUNITY-BASED CLINICAL EDUCATION PROGRAM
249,700
UCLA HEALTH
CHIEF EXECUTIVE OFFICER UCLA
HOSPITAL SYSTEM 757 WESTWOOD PLAZA
LOS ANGELES
,
CA
90024
N/A
PC
UPSTREAM OBESITY SOLUTIONS
250,000
UCLA HEALTH SOUND BODY SOUND MIND
11100 SANTA MONICA BLVD SUITE 1910
LOS ANGELES
,
CA
90025
N/A
PC
HUNTINGTON PARK COMMUNITY HEALTH IMPROVEMENT PROJECT
87,500
UCSD SCHOOL OF MEDICINE
9500 GILMAN DRIVE 0606
LA JOLLA
,
CA
92093
N/A
PC
MEDICAL STUDENT SCHOLARSHIP 2020-2021
55,000
UCSF SCHOOL OF MEDICINE
UNIVERSITY DEVELOPMENT AND ALUMNI
RELATIONS 220 MONTGOMERY STREET 5TH
SAN FRANCISCO
,
CA
94104
N/A
PC
MEDICAL STUDENT SCHOLARSHIP 2020-2021
55,000
UNITED WAY OF GREATER LOS ANGELES
1150 S OLIVE ST SUITE T500
LOS ANGELES
,
CA
90015
N/A
PC
UNITED WAY LOS ANGELES
25,000
UNITED WAY OF GREATER LOS ANGELES
1150 S OLIVE ST SUITE T500
LOS ANGELES
,
CA
90015
N/A
PC
SAN GABRIEL VALLEY/SPA 3 HEALTHCARE AND HOMELESS SYSTEM INTEGRATION PATIENT NAVIGATOR PROJECT
300,000
UNITED WAY OF GREATER LOS ANGELES
1150 S OLIVE ST SUITE T500
LOS ANGELES
,
CA
90015
N/A
PC
PANDEMIC RELIEF FUND
450,000
UNITED WAY OF GREATER LOS ANGELES
1150 S OLIVE ST SUITE T500
LOS ANGELES
,
CA
90015
N/A
PC
HEALTH PATHWAYS EXPANSION
150,000
UNITED WAY OF THE INLAND VALLEYS
1835 CHICAGO AVE STE B
RIVERSIDE
,
CA
92507
N/A
PC
INLAND SOCAL COVID-19 FUND
100,000
UNIVERSITY OF CALIFORNIA IRVINE
836 HEALTH SCIENCES ROAD
IRVINE
,
CA
92617
N/A
PC
MEDICAL STUDENT SCHOLARSHIP 2020-2021
55,000
UNIVERSITY OF SOUTHERN CALIFORNIA
1985 ZONAL AVE
LOS ANGELES
,
CA
90089
N/A
PC
USC ATHLETIC DEPARTMENT CLINICAL SPORT PSYCHOLOGY SERVICES
50,000
USC SCHOOL OF PHARMACY
CENTER FOR HEALTH PROFESSIONS SUITE
217H 1540 ALCAZAR STREET
LOS ANGELES
,
CA
90033
N/A
PC
FOTONOVELA PROJECT ON OPIOID PREVENTION AND TREATMENT
50,000
USC UNIVERSITY RELATIONS
3716 S HOPE ST SUITE 262
LOS ANGELES
,
CA
90007
N/A
PC
ALLIED-HEALTH PROGRAMS: DENTAL ASSISTANT CERTIFICATE, MEDICAL ASSISTING CERTICIE AND PHARMACY TECHNICIAN PROGRAMS
150,000
VISTA DEL MAR CHILD AND FAMILY SERVICES
3200 MOTOR AVE
LOS ANGELES
,
CA
90034
N/A
PC
RESIDENTIAL TREATMENT REHABILITATION SERVICES FOR YOUTH
85,000
VOLUNTEERS OF AMERICA INC
3600 WILSHIRE BLVD
LOS ANGELES
,
CA
90005
N/A
PC
BATTLE-BUDDY-BRIDGE (B3)
220,487
VOLUNTEERS OF AMERICA INC
3600 WILSHIRE BLVD
LOS ANGELES
,
CA
90005
N/A
PC
BATTLE-BUDDY-BRIDGE (B3)
220,487
WEINGART CENTER ASSOCIATION
566 S SAN PEDRO ST
LOS ANGELES
,
CA
90013
N/A
PC
IMPROVING HOMELESS CLIENT OUTCOMES THROUGH A CLINICALLY-BASED APPROACH
125,000
WELLNEST
3031 S VERMONT AVE
LOS ANGELES
,
CA
90007
N/A
PC
DAY TREATMENT INTENSIVE PROGRAM
75,000
WESTERNU COLLEGE OF OSTEOPATHIC MEDICINE OF THE PACIFIC
309 E SECOND ST
POMONA
,
CA
91766
N/A
PC
MEDICAL STUDENT SCHOLARSHIP 2020-2021
55,000
WESTSIDE FAMILY HEALTH CENTER
1711 OCEAN PARK BLVD
SANTA MONICA
,
CA
90405
N/A
PC
SUPPORTING CHWS THROUGH TRAINING
250,000
WHITTIER COLLEGE
13406 E PHILADELPHIA ST
WHITTIER
,
CA
90601
N/A
PC
IMPROVING WHITTIER COLLEGE STUDENT HEALTH/WELLNESS
100,000
WMMC CHARITABLE FOUNDATION
1720 CESAR E CHAVEZ AVE
LOS ANGELES
,
CA
90033
N/A
PC
HOMELESS NAVIGATION PILOT PROJECT
125,000
YOUNG MENS CHRISTIAN ASSOCIATION OF ORANGE COUNTY
13821 NEWPORT AVE SUITE 200
TUSTIN
,
CA
92780
N/A
PC
CHILDCARE FOR ESSENTIAL WORKERS COVID-19 FUND
50,000
Total
.................................
3a
12,837,064
b
Approved for future payment
PROJECT ANGEL FOOD
922 VINE STREET
LOS ANGELES
,
CA
90038
N/A
PC
INCREASING SUSTAINABILITY AND CAPACITY BUILDING FOR HOME-DELIVERED MEALS AND NUTRITION
200,000
THE LA TRUST
333 S BEAUDRY AVE 29TH FL
LOS ANGELES
,
CA
90017
N/A
PC
INTEGRATING WELLNESS CENTER HEALTH SERVICES DATA WITH LAUSD ACADEMIC DATA-THE L.A. TRUST'S DATA XCHANGE
100,000
CITY OF HOPE
1500 EAST DUARTE RD
DUARTE
,
CA
91010
N/A
PC
EXPANDING GERIATRIC MULTIDISCIPLINARY MEDICAL CARE AND SUPPORTIVE CARE SERVICES AT CITY OF HOPE'S ANTELOPE VALLEY COMMUNITY SITE
370,028
CHARLES R DREW UNIVERSITY OF MEDICINE & SCIENCE
1731 EAST 120TH ST
LOS ANGELES
,
CA
90059
N/A
PC
INCREASING THE CALIFORNIA NURSING WORKFORCE: EDUCATION THROUGH DUAL COLLEGE ENROLLMENT
133,024
UC SAN FRANCISCO
533 PARNASSES AVE SUITE U-109
SAN FRANCISCO
,
CA
94104
N/A
PC
PROACTIVE PALLIATIVE CARE (PRO-PC)
399,986
WMMC CHARITABLE FOUNDATION
1720 CESAR E CHAVEZ AVE
LOS ANGELES
,
CA
90033
N/A
PC
HOMELESS NAVIGATION PILOT PROJECT
125,000
PUBLIC HEALTH FOUNDATION ENTERPRISES INC
13300 CROSSROADS PKWY NORTH
CITY OF INDUSTRY
,
CA
91746
N/A
PC
STRATEGIC PLAN IMPLEMENTATION
68,861
WESTSIDE FAMILY HEALTH CENTER
1711 OCEAN PARK BLVD
SANTA MONICA
,
CA
90405
N/A
PC
SUPPORTING CHWS THROUGH TRAINING
500,000
USC UNIVERSITY RELATIONS
3716 S HOPE ST SUITE 262
LOS ANGELES
,
CA
90089
N/A
PC
ALLIED-HEALTH PROGRAMS: DENTAL ASSISTANT CERTIFICATE, MEDICAL ASSISTING CERTICIE AND PHARMACY TECHNICIAN PROGRAMS
150,000
MIND OC
18650 MACARTHUR BLVD
IRVINE
,
CA
92612
N/A
PC
EVALUATING BE WELL OC: A NEW APPROACH FOR MENTAL HEALTH SYSTEM TRANSFORMATION THE SOURCE, THE FORCE, THE SPARK AND THE REASON (SOFO SPARE)
100,000
YMCA OF METROPOLITAN LOS ANGELES
625 S NEW HAMPSHIRE AVE
LOS ANGELES
,
CA
90020
N/A
PC
ADDRESSING YOUTH HEALTH IN UNDERSERVED AREAS OF LOS ANGELES: THE LA YMCAS PHYSICAL LEARNING ACTIVITIES FOR YOUTH (PLAY)
450,000
THE REGENTS OF UNIVERSITY OF CALIFORNIA AT IRVINE
100 THEORY SUITE 250
IRVINE
,
CA
92619
N/A
PC
SEXUAL ASSAULT NURSE EXAMINERS (SANE) PROGRAM
228,152
LOS ANGELES CHRISTIAN HEALTH CENTERS
202 W 1ST STREET SUITE 4-0435
LOS ANGELES
,
CA
90012
N/A
PC
EXPANSIONS AND IMPLEMENTATION OF INTEGRATED HEALTH AND HOUSING STRATEGIES
150,000
LOMA LINDA UNIVERSITY
11060 ANDERSON STREET MAGAN HALL
SUITE B
LOMA LINDA
,
CA
92350
N/A
PC
CHILD ABUSE PEDIATRIC (CAP) FELLOWSHIP
180,000
LA FAMILY HOUSING
7843 LANKERSHIM BLVD
NORTH HOLLYWOOD
,
CA
91605
N/A
PC
CAPACITY BUILDING TO EXPAND HEALTH SERVICES FOR PEOPLE EXPERIENCING HOMELESSNESS
346,280
CEDARS-SINAI MEDICAL CENTER
6500 WILSHIRE BLVD SUITE 1600
LOS ANGELES
,
CA
90048
N/A
PC
IMPROVING HEALTH OUTCOMES FOR SENIORS: ELDERS PRESERVING INDEPENDENCE IN THE COMMUNITY (EPIC)
147,800
LIFT INC
1910 MAGNOLIA AVE SUITE 404
LOS ANGELES
,
CA
90007
N/A
PC
LIFT-LOS ANGELES: BREAKING THE INTERGENERATIONAL CYCLE OF POVERTY AND PREVENTING COMMUNITY HEALTH INEQUITIES THROUGH MEDICAL-FINANCIAL PARTNERSHIPS
300,000
GRYD FOUNDATION
1933 S BROADWAY SUITE 1111
LOS ANGELES
,
CA
90007
N/A
PC
GRYD FOUNDATION YOUTH SQUAD 360 HEALTH & WELLNESS PROJECT
200,000
SUSAN G KOMEN ORANGE COUNTY
2817 MCGAW AVENUE
IRVINE
,
CA
92614
N/A
PC
A PILOT PROGRAM TO PROVIDE NAVIGATION SERVICES TO IMPROVE BREAST HEALTH IN ORANGE COUNTY
699,659
UNION STATION HOMELESS SERVICES
825 E ORANGE GROVE BLVD
PASADENA
,
CA
91104
N/A
PC
GENERAL SUPPORT
100,000
KECK MEDICINE OF USC
HEALTH SCIENCES CAMPUS 1450 BIGGY
STREET
LOS ANGELES
,
CA
90089
N/A
PC
GENERAL SUPPORT
50,000
THE GIVING BANK AT HOLY FAMILY CHURCH
1527 FREMONT AVE
SOUTH PASADENA
,
CA
91030
N/A
PC
GENERAL SUPPORT
50,000
FOOD FINDERS INC
10539 HUMBOLT STREET
LOS ALAMITOS
,
CA
90720
N/A
PC
GENERAL SUPPORT
50,000
RONALD MCDONALD HOUSE CHARITIES OF SOUTHERN CALIFORNIA
4560 FOUNTAIN AVE
LOS ANGELES
,
CA
90029
N/A
PC
GENERAL SUPPORT
100,000
Total
.................................
3b
5,198,790
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.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
14
5,877,856
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than
inventory
............
18
813,937
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
PASSTHROUGH UBTI INCOME/LOSS
900099
38,059
b
MISCELLANEOUS INCOME
01
1,958
c
PROGRAM RELATED INVESTMENT INTEREST
14
24,929
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
38,059
6,693,751
24,929
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
6,756,739
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
11C
INTEREST INCOME EARNED ON PROGRAM RELATED INVESTMENT LOAN
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?
...........
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.
May the IRS discuss this return
with the preparer shown below
(see instr.)
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's EIN
Firm's address
Phone no.
Form
990-PF
(2019)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description