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
2020
Open to Public Inspection
For calendar year 2020, or tax year beginning 04-01-2020 , and ending 03-31-2021
Name of foundation
OMRON FOUNDATION INC
C/O OMCA
% JAMES P EBERHART
Number and street (or P.O. box number if mail is not delivered to street address)2895 GREENSPOINT PARKWAY NO 100
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
HOFFMAN ESTATES, IL60169
A Employer identification number

36-3644055
B Telephone number (see instructions)

(847) 843-7900
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$2,301,752J 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) 420,365
2 Check bullet.............
3 Interest on savings and temporary cash investments 6,928 6,928  
4 Dividends and interest from securities... 3,203 3,203  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)...  
8 Net short-term capital gain.........  
9 Income modifications........... 675
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 430,496 10,131 675
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0      
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 368 0 0 0
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 5,097 5,097 0 0
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 5,465 5,097 0 0
25 Contributions, gifts, grants paid....... 700,688 700,688
26 Total expenses and disbursements. Add lines 24 and 25 706,153 5,097 0 700,688
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -275,657
b Net investment income (if negative, enter -0-) 5,034
c Adjusted net income (if negative, enter -0-)... 675
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2020)
Form 990-PF (2020)
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.............      
2 Savings and temporary cash investments......... 2,663,209 2,301,752 2,301,752
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
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) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule).......      
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 2,663,209 2,301,752 2,301,752
Liabilities 17 Accounts payable and accrued expenses.......... 86,475 0
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22)......... 86,475 0
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........ 0  
27 Paid-in or capital surplus, or land, bldg., and equipment fund 0  
28 Retained earnings, accumulated income, endowment, or other funds 2,576,734 2,301,752
29 Total net assets or fund balances (see instructions)..... 2,576,734 2,301,752
30 Total liabilities and net assets/fund balances (see instructions). 2,663,209 2,301,752
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
2,576,734
2
Enter amount from Part I, line 27a .....................
2
-275,657
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
675
4
Add lines 1, 2, and 3 ..........................
4
2,301,752
5
Decreases not included in line 2 (itemize) bullet
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
2,301,752
Form 990-PF (2020)
Form 990-PF (2020)
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.)
1a
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
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
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  
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  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
SECTION 4940(e) REPEALED ON DECEMBER 20, 2019 - DO NOT COMPLETE
1 Reserved
(a)
Reserved 		(b)
Reserved 		(c)
Reserved 		(d)
Reserved
2
Reserved...........................
2
3
Reserved...........................
3
4
Reserved...........................
4
5
Reserved...........................
5
6
Reserved...........................
6
7
Reserved...........................
7
8
Reserved,..........................
8
Form 990-PF (2020)
Form 990-PF (2020)
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 for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b Reserved................................ 1 70
c All other domestic foundations enter 1.39% 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 70
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 70
6 Credits/Payments:
a 2020 estimated tax payments and 2019 overpayment credited to 2020 6a 240
b Exempt foreign organizations—tax withheld at source...... 6b 0
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.............. 7 240
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 10 170
11 Enter the amount of line 10 to be: Credited to 2021 estimated taxBullet170 RefundedBullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? Click to see attachment....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 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 changesClick to see attachment....
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.Click to see attachment
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 2020 or the taxable year beginning in 2020? 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 (2020)
    Form 990-PF (2020)
    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 addressbulletHTTPS://WWW.OMRONFOUNDATION.OMRON.COM/
    14
    The books are in care ofbulletJAMES P EBERHART Telephone no.bullet (224) 520-7665

    Located atbullet2895 GREENSPOINT PARKWAY NO 100HOFFMAN ESTATESIL ZIP+4bullet60169
    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 2020, 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 2020?.............
    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 2020, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2020?.............
    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 2020 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 2020.)..................
    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 2020?
    4b
     
    No
    Form 990-PF (2020)
    Form 990-PF (2020)
    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
    K BLAKE THATCHER SECRETARY/DIRECTOR
    1.0     		0 0 0
    2895 GREENSPOINT PARKWAY
    HOFFMAN ESTATES,IL60169
    NIGEL BLAKEWAY PRESIDENT/DIRECTOR
    2.0     		0 0 0
    2895 GREENSPOINT PARKWAY
    HOFFMAN ESTATES,IL60169
    JAMES P EBERHART TREASURER/V.P./DIRECTOR
    1.0     		0 0 0
    2895 GREENSPOINT PARKWAY
    HOFFMAN ESTATES,IL60169
    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  
    Form 990-PF (2020)
    Form 990-PF (2020)
    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.........................bullet  
    Form 990-PF (2020)
    Form 990-PF (2020)
    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
    0
    b
    Average of monthly cash balances.......................
    1b
    717,913
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    717,913
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
     
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    717,913
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    10,769
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    707,144
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    35,357
    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
    35,357
    2a
    Tax on investment income for 2020 from Part VI, line 5......
    2a
    70
    b
    Income tax for 2020. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    70
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    35,287
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    675
    5
    Add lines 3 and 4............................
    5
    35,962
    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
    35,962
    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
    700,688
    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
    0
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
    0
    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
    700,688
    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
    0
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    700,688
    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 (2020)
    Form 990-PF (2020)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2019     		(c)
    2019     		(d)
    2020
    1 Distributable amount for 2020 from Part XI, line 7 35,962
    2 Undistributed income, if any, as of the end of 2020:
    a Enter amount for 2019 only....... 0
    b Total for prior years:2018, 2017, 2016 0
    3 Excess distributions carryover, if any, to 2020:
    a From 2015...... 477,041
    b From 2016...... 569,480
    c From 2017...... 536,440
    d From 2018...... 601,544
    e From 2019...... 725,901
    fTotal of lines 3a through e........ 2,910,406
    4Qualifying distributions for 2020 from Part
    XII, line 4: bullet$ 700,688
    a Applied to 2019, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		 
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		 
    d Applied to 2020 distributable amount..... 35,962
    e Remaining amount distributed out of corpus 664,726
    5 Excess distributions carryover applied to 2020.    
    (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 3,575,132
    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 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2020. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2021 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		 
    8 Excess distributions carryover from 2015 not
    applied on line 5 or line 7 (see instructions) ...     		477,041
    9Excess distributions carryover to 2021.
    Subtract lines 7 and 8 from line 6a ......     		3,098,091
    10 Analysis of line 9:
    a Excess from 2016.... 569,480
    b Excess from 2017.... 536,440
    c Excess from 2018.... 601,544
    d Excess from 2019.... 725,901
    e Excess from 2020.... 664,726
    Form 990-PF (2020)
    Form 990-PF (2020)
    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 2020, 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) 2020 (b) 2019 (c) 2018 (d) 2017
             
    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.)
    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:
    KEVIN BUTALEK
    2895 GREENSPOINT PARKWAY SUITE 100
    HOFFMAN ESTATES,IL60169
    (224) 520-7660
    OFI@omron.com
    bThe form in which applications should be submitted and information and materials they should include:
    HTTPS://WWW.OMRONFOUNDATION.OMRON.COM/GUIDELINES.PHP HTTPS://WWW.OMRONFOUNDATION.OMRON.COM/FILES/OFI%20GRANT%20APPLICATIO N%20FOR%20OMRON%20FOUNDATION%20INC%208-29-13.PDF
    cAny submission deadlines:
    APPLICATIONS ARE CONSIDERED THROUGHOUT THE YEAR.
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    SEE FUNDING EXCLUSIONS ON "GUIDELINES" WEBPAGE: HTTPS://WWW.OMRONFOUNDATION.OMRON.COM/GUIDELINES.PHP
    Form 990-PF (2020)
    Form 990-PF (2020)
    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
    Advocate Hospice Foundation
    3075 Highland Parkway Suite 600
    Downers Grove,IL605159872     		NONE PC CHARITABLE AND EDUCATION 500
    Alameda County Community Food
    PO Box 2599
    Oakland,CA946140599     		NONE PC CHARITABLE AND EDUCATION 200
    American Heart Association
    208 S LaSalle St Suite 1500
    Chicago,IL60604     		NONE PC CHARITABLE AND EDUCATION 11,871
    American Red Cross
    8550 Arlington Blvd
    Fairfax,GA22031     		NONE PC CHARITABLE AND EDUCATION 400
    American Red Cross - San Francisco
    1663 Market St
    San Francisco,CA94103     		NONE PC CHARITABLE AND EDUCATION 100
    American Red Cross Greater Chicago
    The Rauner Ctr 2200 W Harrison Str
    Chicago,IL60612     		NONE PC CHARITABLE AND EDUCATION 375
    Anderson Japanese Gardens
    318 Spring Creek Road
    Rockford,IL61107     		NONE PC CHARITABLE AND EDUCATION 1,500
    Ann & Robert Lurie Children's
    225 East Chicago Ave
    Chicago,IL60611     		NONE PC CHARITABLE AND EDUCATION 225
    ARCO A Community Resource
    901 North 4th Street
    Monroe,LA71201     		NONE PC CHARITABLE AND EDUCATION 1,000
    Bartlett High School
    701 W Schick Rd
    Bartlett,IL60103     		NONE PC CHARITABLE AND EDUCATION 2,500
    Beyond Hunger
    848 Lake Street
    Oak Park,IL60301     		NONE PC CHARITABLE AND EDUCATION 1,000
    Big Brothers Big Sisters Kansas City
    1709 Walnut St
    Kansas City,MO64108     		NONE PC CHARITABLE AND EDUCATION 1,500
    Boys and Girls Clubs of King County
    603 Stewart St Unit 300
    Seattle,WA98101     		NONE PC CHARITABLE AND EDUCATION 523
    California Academy of Sciences
    55 Music Concourse Dr
    San Francisco,CA94118     		NONE PC CHARITABLE AND EDUCATION 100
    Cals Angels
    2422 W Main St Unit 3B
    St Charles,IL60175     		NONE PC CHARITABLE AND EDUCATION 5,200
    Caregivers
    1765 Goodyear Avenue Suite 205
    Ventura,CA93003     		NONE PC CHARITABLE AND EDUCATION 2,500
    Caring For Kids Clothing
    335 Prairie Ave
    Winthrop Harbor,IL60096     		NONE PC CHARITABLE AND EDUCATION 500
    CDC Foundation
    600 Peachtree St Suite 1000
    Atlanta,GA30308     		NONE PC CHARITABLE AND EDUCATION 20
    Charleston Symphony Orchestra
    PO Box 30818
    Charleston,SC29417     		NONE PC CHARITABLE AND EDUCATION 800
    Chicago Hope For Kids
    641 W Lake St Suite 200
    Chicago,IL60661     		NONE PC CHARITABLE AND EDUCATION 1,500
    Chicago Public Media
    848 East Grand Avenue
    Chicago,IL60611     		NONE PC CHARITABLE AND EDUCATION 60
    Chico State University
    400 West First Street
    Chico,CA959290156     		NONE PC CHARITABLE AND EDUCATION 110,000
    Child Care Resources
    46000 Park Road Suite 400
    Charlotte,NC28209     		NONE PC CHARITABLE AND EDUCATION 5,000
    Children's Cancer Research Fund Inc
    7301 Ohms Ln Ste 460
    Minneapolis,MN55439     		NONE PC CHARITABLE AND EDUCATION 200
    Childrens Hospital Los Angeles
    4650 Sunset Blvd
    Los Angeles,CA90027     		NONE PC CHARITABLE AND EDUCATION 5,000
    Christian Youth Theater
    1545 Pioneer Way
    El Cajon,CA92020     		NONE PC CHARITABLE AND EDUCATION 20
    Church World Service
    28606 Philips St
    Eikhart,IN46515     		NONE PC CHARITABLE AND EDUCATION 50
    Coastal Carolina Council BSA
    9297 Medical Plaza Dr
    North Charleston,SC29406     		NONE PC CHARITABLE AND EDUCATION 200
    Community Foundation of NCW
    9 S Wenatchee Ave
    Wenatchee,WA98801     		NONE PC CHARITABLE AND EDUCATION 1,000
    Community Kitchen
    37 Mechanic Street
    Keene,NH03431     		NONE PC CHARITABLE AND EDUCATION 250
    Compassion International
    12290 Voyager Parkway
    Colorado Spring,CO80921     		NONE PC CHARITABLE AND EDUCATION 972
    Concordia Language Villages
    901 9th St S
    Moorhead,MN56562     		NONE PC CHARITABLE AND EDUCATION 15,000
    Cornell University
    130 E Seneca Street Suite 400
    Ithaca,NY14850     		NONE PC CHARITABLE AND EDUCATION 100
    Cradles to Crayons
    4141 W George Street
    Chicago,IL60641     		NONE PC CHARITABLE AND EDUCATION 5,000
    DePaul University
    1 E Jackson Boulevard
    Chicago,IL606042201     		NONE PC CHARITABLE AND EDUCATION 50
    Direct Relief
    27 S La Patera Lane
    Santa Barbara,CA93117     		NONE PC CHARITABLE AND EDUCATION 5,614
    Doctors Without Borders
    PO Box 5030
    Hagarstown,MD217415030     		NONE PC CHARITABLE AND EDUCATION 150
    Doctors Without Borders USA Inc
    40 Rector Street 16th Floor
    New York,NY10006     		NONE PC CHARITABLE AND EDUCATION 750
    Dupage Pads
    601 W Liberty
    Wheaton,IL60187     		NONE PC CHARITABLE AND EDUCATION 204
    Dutchess Outreach
    29 North Hamilton St Suite 220
    Poughkeepsie,NY12601     		NONE PC CHARITABLE AND EDUCATION 100
    Easterseals
    141 W Jackson Blvd Suite 1400A
    Chicago,IL60604     		NONE PC CHARITABLE AND EDUCATION 350
    EduCare Foundation
    16134 Wyandotte Street
    Van Nuys,CA91406     		NONE PC CHARITABLE AND EDUCATION 5,000
    El Camino Health
    2500 Grant Road PAR 116
    Mountain View,CA94040     		NONE PC CHARITABLE AND EDUCATION 250
    Feed My Starving Children
    1072 National Parkway
    Schaumburg,IL60173     		NONE PC CHARITABLE AND EDUCATION 5,100
    Feeding America
    35 E Wacker Drive Suite 2000
    Chicago,IL60601     		NONE PC CHARITABLE AND EDUCATION 1,375
    Feeding America (Washington DC)
    PO Box 96749
    Washington,DC200906749     		NONE PC CHARITABLE AND EDUCATION 300
    FIRST Illinois Robotics
    PO Box 82
    Prospect Heights,IL600700082     		NONE PC CHARITABLE AND EDUCATION 5,000
    First Responders Children's Foundation
    38 East 32nd Street Suite 602
    New York,NY10016     		NONE PC CHARITABLE AND EDUCATION 50
    FIRST Washington
    21238 68th Ave S
    Kent,WA98032     		NONE PC CHARITABLE AND EDUCATION 5,400
    FIUTS University of Washington
    PO Box 355855
    Seattle,WA98195     		NONE PC CHARITABLE AND EDUCATION 3,000
    Food For The Poor
    6401 Lyons Road
    Coconut Creek,FL33073     		NONE PC CHARITABLE AND EDUCATION 150
    Gigi's Playhouse
    2350 W Higgins Rd
    Hoffman Estates,IL60169     		NONE PC CHARITABLE AND EDUCATION 20,242
    Girls In Tech Inc
    6074 Old Quarry Loop
    Oakland,CA94605     		NONE PC CHARITABLE AND EDUCATION 1,000
    Glenmary Sisters
    PO Box 22264
    Owensboro,KY423042264     		NONE PC CHARITABLE AND EDUCATION 4,000
    Greater Chicago Food Depositor
    PO Box 74008557
    Chicago,IL606748557     		NONE PC CHARITABLE AND EDUCATION 100
    Habitat for Humanity
    21031 Ventura Blvd Suite 610
    Woodland Hills,CA91364     		NONE PC CHARITABLE AND EDUCATION 7,500
    Harper College Educational Foundation
    1200 W Algonquin Road
    Palatine,IL60067     		NONE PC CHARITABLE AND EDUCATION 10,000
    HealthCorps Inc
    33 Irving Place 3rd Floor
    New York,NY10003     		NONE PC CHARITABLE AND EDUCATION 50,350
    Heifer International
    1 World Ave
    Little Rock,AR72202     		NONE PC CHARITABLE AND EDUCATION 765
    Hope4Harper
    PO Box 116952
    Carrollton,TX75011     		NONE PC CHARITABLE AND EDUCATION 1,500
    House of Ruth
    PO Box 459
    Claaremont,CA91711     		NONE PC CHARITABLE AND EDUCATION 129
    Internet Archive
    300 Funston Avenue
    San Francisco,CA94118     		NONE PC CHARITABLE AND EDUCATION 103
    Japan America Society of Chicago
    1 N LaSalle St Ste 2475
    Chicago,IL60602     		NONE PC CHARITABLE AND EDUCATION 500
    Journey Care
    2050 Claire Court
    Glenview,IL60025     		NONE PC CHARITABLE AND EDUCATION 125
    Kent Schools Foundation
    12033 SE 256th St
    Kent,WA980306503     		NONE PC CHARITABLE AND EDUCATION 5,000
    Kent Youth and Family Services
    232 2nd Ave Suite 201
    Kent,WA98032     		NONE PC CHARITABLE AND EDUCATION 2,000
    KQED
    50 Beale St 5th Floor
    San Francisco,CA94105     		NONE PC CHARITABLE AND EDUCATION 60
    LA Family Housing
    7843 Lankershim Blvd
    North Hollywood,CA91605     		NONE PC CHARITABLE AND EDUCATION 5,000
    Los Angeles Regional Food Bank
    1734 E 41st Street
    Los Angeles,CA900581502     		NONE PC CHARITABLE AND EDUCATION 800
    Lupus LA
    8383 Wilshire Blvd Suite 232
    Beverly Hills,CA90211     		NONE PC CHARITABLE AND EDUCATION 2,500
    M5M Foundation
    1410 Lakeside Parkway
    Flower Mound,TX75028     		NONE PC CHARITABLE AND EDUCATION 200
    Make A Wish Foundation of America
    1702 E Highland Ave No 400
    Phoenix,AZ85016     		NONE PC CHARITABLE AND EDUCATION 100
    Marine Toys for Tots Foundation
    18251 Quantico Gateway Dr
    Triangle,VA22172     		NONE PC CHARITABLE AND EDUCATION 100
    Marklund
    1 South 450 Wyatt Drive
    Geneva,IL60134     		NONE PC CHARITABLE AND EDUCATION 15,000
    Mayor's Fund Los Angeles
    200 N Spring Street 305B
    Los Angeles,CA90012     		NONE PC CHARITABLE AND EDUCATION 5,000
    Meals on Wheels America
    1550 Crystal Dr Suite 1004
    Arlington,VA22202     		NONE PC CHARITABLE AND EDUCATION 103
    MEND-Meet Each Need with Dignity
    10641 N San Francisco Road
    Pacoima,CA91331     		NONE PC CHARITABLE AND EDUCATION 10,000
    Mercy Corps Dept W
    PO Box 80020
    Prescott,AZ863049801     		NONE PC CHARITABLE AND EDUCATION 103
    Miami Hoshuko Inc
    8755 SW 16th St
    Miami,FL33165     		NONE PC CHARITABLE AND EDUCATION 300
    Midtown Educational Foundation
    718 S Loomis St
    Chicago,IL60607     		NONE PC CHARITABLE AND EDUCATION 100
    Monadnock Humane Society
    101 W Swanzey Road
    Swanzey,NH03446     		NONE PC CHARITABLE AND EDUCATION 250
    Montevideo Education Foundation
    13000 Breadmoor Dr
    San Ramon,CA94583     		NONE PC CHARITABLE AND EDUCATION 700
    Montevideo Elementary School
    13000 Breadmoor Dr
    San Ramon,CA94583     		NONE PC CHARITABLE AND EDUCATION 200
    Nashua Center
    18 Simon St
    Nashua,NH03060     		NONE PC CHARITABLE AND EDUCATION 150
    National Merit Scholarship Corporation
    1560 Sherman Ave Ste 200
    Evanston,IL602014897     		NONE PC CHARITABLE AND EDUCATION 17,850
    National Parks Foundation
    1500 K Street NW Suite 700
    Washington,DC20005     		NONE PC CHARITABLE AND EDUCATION 100
    North Central College
    30 N Brainard St
    Naperville,IL60540     		NONE PC CHARITABLE AND EDUCATION 73,000
    Northern Illinois Food Bank
    273 Dearborn Court
    Geneva,IL60134     		NONE PC CHARITABLE AND EDUCATION 10,600
    Northern Illinois University foundation
    1425 Lincoln Highway
    Dekalb,IL60115     		NONE PC CHARITABLE AND EDUCATION 100
    Northwest Harvest
    PO Box 12272
    Seattle,WA98102     		NONE PC CHARITABLE AND EDUCATION 10,500
    Nutritional Therapy for IBD
    921 Pine Hallow Road
    Mount Pleasant,SC29464     		NONE PC CHARITABLE AND EDUCATION 1,000
    Olive Branch Mission
    6310 S Claremont Ave
    Chicago,IL60636     		NONE PC CHARITABLE AND EDUCATION 150
    Omni Youth Services Inc
    1111 W Lake Cook Rd
    Buffalo Grove,IL600891926     		NONE PC CHARITABLE AND EDUCATION 4,000
    Open Heart Kitchen
    1141 Catalina Dr Mailbox 137
    Livermore,CA94550     		NONE PC CHARITABLE AND EDUCATION 10,000
    Operation Smile
    3641 Faculty Blvd
    Virginia Beach,VA23453     		NONE PC CHARITABLE AND EDUCATION 150
    Parts and Crafts
    577 Somerville Ave
    Somerville,MA02143     		NONE PC CHARITABLE AND EDUCATION 500
    Pleasanton Partners in Education
    4659 B Bernal Ave
    Pleasanton,CA94566     		NONE PC CHARITABLE AND EDUCATION 5,000
    Portal School Community Organization
    1188 Wunderlich Drive
    San Jose,CA95129     		NONE PC CHARITABLE AND EDUCATION 425
    RAICES
    1900 Saint James Place Unit 450
    Houston,TX77056     		NONE PC CHARITABLE AND EDUCATION 100
    Rebuilding Together
    999 N Capitol St NE Suite 701
    Washington,DC20002     		NONE PC CHARITABLE AND EDUCATION 53
    Respiratory Health Assc of Met
    1440 W Washington Blvd
    Chicago,IL606071878     		NONE PC CHARITABLE AND EDUCATION 25,000
    Rett's Syndrome Foundation
    4600 Devitt Drive
    Cincinnati,OH45246     		NONE PC CHARITABLE AND EDUCATION 1,000
    Ripple Productions-Cafe Nordo
    109 South Main Street
    Seattle,WA98104     		NONE PC CHARITABLE AND EDUCATION 500
    Robotics Education and Competition
    1519 I-30 West
    Greenville,TX75402     		NONE PC CHARITABLE AND EDUCATION 10,000
    Salvation Army of Northeast Florida
    5631 Van Dyke Road
    Lutz,FL33558     		NONE PC CHARITABLE AND EDUCATION 50
    Samaritan's Purse
    PO Box 3000
    Boone,NC28607     		NONE PC CHARITABLE AND EDUCATION 200
    San Antonio Food Bank
    5200 Old Hwy 90 W
    San Antonio,TX78227     		NONE PC CHARITABLE AND EDUCATION 200
    San Fernando Valley Rescue Mission
    PO Box 8073
    Van Nuys,CA914098073     		NONE PC CHARITABLE AND EDUCATION 5,000
    Second Harvest Food Bank
    750 Curtner Ave
    San Jose,CA95125     		NONE PC CHARITABLE AND EDUCATION 550
    Shepherd's Gate
    1660 Portola Ave
    Livermore,CA94551     		NONE PC CHARITABLE AND EDUCATION 1,000
    Shriners Hospital for Children
    2900 N Rocky Point Drive
    Tampa,FL33607     		NONE PC CHARITABLE AND EDUCATION 225
    SHS First Robotics
    70 Thornton Ferry Road II
    Amherst,NH03031     		NONE PC CHARITABLE AND EDUCATION 2,500
    Somebody Cares St Augustine
    PO Box 840081
    St Augustine Beach,FL32080     		NONE PC CHARITABLE AND EDUCATION 1,200
    Southern Poverty Law Center
    400 Washington Ave
    Montgomery,AL36104     		NONE PC CHARITABLE AND EDUCATION 800
    St Baldrick's Foundation
    1333 South Mayflower Avenue Suite
    Monrovia,CA91016     		NONE PC CHARITABLE AND EDUCATION 250
    St Catherine School
    8524 8th Avenue NE
    Seattle,WA98115     		NONE PC CHARITABLE AND EDUCATION 1,000
    St Francis House
    70 Washington St
    St Augustine,FL32084     		NONE PC CHARITABLE AND EDUCATION 350
    Stanford University
    326 Galvez Street
    Stanford,CA94305     		NONE PC CHARITABLE AND EDUCATION 200
    Streamwood High School
    701 W Schaumburg Rd
    Streamwood,IL60107     		NONE PC CHARITABLE AND EDUCATION 7,500
    Syracuse University
    640 Skytop Road Suite 240
    Syracuse,NY13244     		NONE PC CHARITABLE AND EDUCATION 180
    The Association of Former Students
    505 George Bush Drive
    College Station,TX77840     		NONE PC CHARITABLE AND EDUCATION 200
    The Barstool Fund CO 30 Day Fund Inc
    1314 Rugby Road
    Charlottesville,VA22903     		NONE PC CHARITABLE AND EDUCATION 103
    The Childrens Ranch
    4007 Verdant Street
    Los Angeles,CA90039     		NONE PC CHARITABLE AND EDUCATION 2,500
    The Harbour
    1440 Renaissance Dr Ste 240
    Park Ridge,IL60068     		NONE PC CHARITABLE AND EDUCATION 2,700
    The Nashua Center
    18 Simon Street
    Nashua,NH03060     		NONE PC CHARITABLE AND EDUCATION 5,000
    The Salvation Army
    615 Slaters Lane PO Box 269
    Alexandria,VA22314     		NONE PC CHARITABLE AND EDUCATION 350
    The Soup Ladies
    PO Box 896
    Buckley,WA98321     		NONE PC CHARITABLE AND EDUCATION 1,000
    Theater Masil
    6233 Blossom Ave
    San Jose,CA95123     		NONE PC CHARITABLE AND EDUCATION 50
    Thief River Falls Area Food Shelf
    PO Box 802
    River Falls,MN56701     		NONE PC CHARITABLE AND EDUCATION 1,000
    Together We Rise Corporation
    580 W Lambert Rd Suite A
    Brea,CA92821     		NONE PC CHARITABLE AND EDUCATION 5,000
    Trinity University
    One Trinity Place
    San Antonio,TX78212     		NONE PC CHARITABLE AND EDUCATION 180
    Tunnel to Towers Foundation
    2361 Hylan Blvd
    Staten Island,NY10306     		NONE PC CHARITABLE AND EDUCATION 250
    Unicef USA
    125 Maiden Lane
    New York,NY10038     		NONE PC CHARITABLE AND EDUCATION 105
    United Way of the Bay Area
    550 Kearny St
    San Francisco,CA94108     		NONE PC CHARITABLE AND EDUCATION 100
    University District Food Bank
    5017 Roosevelt Way NE
    Seattle,WA98105     		NONE PC CHARITABLE AND EDUCATION 977
    University of California San Francisco
    1600 Divisadero St
    San Francisco,CA94115     		NONE PC CHARITABLE AND EDUCATION 200
    University of Michigan Dearborn
    4901 Evergreen Rd 1040B
    Dearborn,MI48128     		NONE PC CHARITABLE AND EDUCATION 100,000
    Urban League of Metropolitan Seattle
    105 14th Ave Ste 200
    Seattle,WA98122     		NONE PC CHARITABLE AND EDUCATION 1,000
    Valley Care Charitable Foundation
    1111 E Stanley Blvd
    Livermore,CA94550     		NONE PC CHARITABLE AND EDUCATION 5,000
    Vision House
    PO Box 2951
    Renton,WA98056     		NONE PC CHARITABLE AND EDUCATION 50
    Washington Ladyhawks Fastpitch
    13422 115th Ave E
    Puyallup,WA98374     		NONE PC CHARITABLE AND EDUCATION 200
    Wellspring Family Services
    1900 Rainier Avenue
    Seattle,WA98144     		NONE PC CHARITABLE AND EDUCATION 500
    West Seattle Food Bank
    3419 SW Morgan St
    Seattle,WA98126     		NONE PC CHARITABLE AND EDUCATION 250
    WestSide Baby
    10002 14th Ave SW
    Seattle,WA98146     		NONE PC CHARITABLE AND EDUCATION 5,501
    When The Saints
    6614 Clayton Rd Suite 379
    St Louis,MO63117     		NONE PC CHARITABLE AND EDUCATION 100
    Winning Futures
    27500 Cosgrove
    Warren,MI48092     		NONE PC CHARITABLE AND EDUCATION 25,000
    World Health Organization
    1750 Pennsylvania Ave NW Suite 300
    Washington,DC20006     		NONE PC CHARITABLE AND EDUCATION 100
    WSU Foundation
    255 E Main St Suite 301 PO Box 6
    Pullman,WA991641925     		NONE PC CHARITABLE AND EDUCATION 50
    Total .................................bullet 3a 700,688
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2020)
    Form 990-PF (2020)
    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 ...........     		    14 6,928  
    4 Dividends and interest from securities....     14 3,203  
    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 ............     		         
    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)..   10,131  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    10,131
    (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 (2020)
    Form 990-PF (2020)
    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 instructions.
    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 (2020)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors

    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
    OMB No. 1545-0047
    2020
    Name of the organization
    OMRON FOUNDATION INC
    C/O OMCA
    Employer identification number

    36-3644055
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ






    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
    or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2020)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2
    Name of organization
    OMRON FOUNDATION INC
    C/O OMCA         		Employer identification number
    36-3644055
    Part I
    Contributors
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
    OMRON ELECTRONICS LLC
    2895 GREENSPOINT Parkway
     
    HOFFMAN ESTATES, IL60169

    		$ 120,635


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
    OMRON ELECTRONIC COMPONENTS LLC
    2895 GREENSPOINT Parkway
     
    HOFFMAN ESTATES, IL60169

    		$ 107,255


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    3
    OMRON HEALTHCARE INC
    1925 WEST FIELD COURT
     
    LAKE FOREST, IL60045

    		$ 144,320


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    4
    Omron Canada Inc
    802 - 100 Consilium Place
     
    Scarborough, ONM1H 3E3CA

    		$ 48,106


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
    Page 3
    Name of organization
    OMRON FOUNDATION INC
    C/O OMCA         		Employer identification number

    36-3644055
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
    Page 4
    Name of organization
    OMRON FOUNDATION INC
    C/O OMCA         		Employer identification number

    36-3644055
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
    Additional Data


    Software ID:  
    Software Version:  

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2020 DepreciationSchedule
    Name:
    OMRON FOUNDATION INC
     
    C/O OMCA
    EIN:
    36-3644055
    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

    TY 2020 OtherExpensesSchedule
    Name:
    OMRON FOUNDATION INC
     
    C/O OMCA
    EIN:
    36-3644055
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BANK FEES 5,097 5,097 0 0


    TY 2020 OtherIncreasesSchedule
    Name:
    OMRON FOUNDATION INC
     
    C/O OMCA
    EIN:
    36-3644055
    Description Amount
    RECOVERY OF PRIOR YEAR QUALIFIED 0
    DISTRIBUTIONS 675


    TY 2020 TaxesSchedule
    Name:
    OMRON FOUNDATION INC
     
    C/O OMCA
    EIN:
    36-3644055
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXCISE TAXES 368 0 0 0