Form990-PF
Click to see attachment

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 01-01-2020 , and ending 12-31-2020
Name of foundation
David & Janet Polak Foundation
 
% Jeff Polak
Number and street (or P.O. box number if mail is not delivered to street address)Foundation Source 501 Silverside Rd
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Wilmington, DE198091377
A Employer identification number

45-4797578
B Telephone number (see instructions)

(800) 839-1754
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$77,927,007J 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) 0
2 Check bullet.............
3 Interest on savings and temporary cash investments 66,750 66,750  
4 Dividends and interest from securities... 887,181 887,181  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 1,647,887
b Gross sales price for all assets on line 6a 28,649,648
7 Capital gain net income (from Part IV, line 2)... 1,468,254
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)....... Click to see attachment 634,921 555,329  
12 Total. Add lines 1 through 11........ 3,236,739 2,977,514  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 222,800     222,800
14 Other employee salaries and wages...... 210,000     210,000
15 Pension plans, employee benefits....... 40,707     40,707
16a Legal fees (attach schedule)......... Click to see attachment 16,907 0 0 16,907
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... Click to see attachment 418,029 386,250   31,779
17 Interest............... 49,530 49,530    
18 Taxes (attach schedule) (see instructions)... Click to see attachment 195,674 28,110    
19 Depreciation (attach schedule) and depletion...      
20 Occupancy.............. 24,502     24,502
21 Travel, conferences, and meetings....... 404     404
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 626,699 471,610   98,164
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 1,805,252 935,500 0 645,263
25 Contributions, gifts, grants paid....... 2,755,032 2,755,032
26 Total expenses and disbursements. Add lines 24 and 25 4,560,284 935,500 0 3,400,295
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -1,323,545
b Net investment income (if negative, enter -0-) 2,042,014
c Adjusted net income (if negative, enter -0-)...  
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......... 13,205,819 3,036,171 3,036,171
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) 24,269,959 Click to see attachment33,783,681 34,150,982
b Investments—corporate stock (attach schedule)....... 10,626,824 Click to see attachment9,776,068 12,635,157
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).......... 20,967,644 Click to see attachment21,159,666 24,922,961
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment3,342,999 Click to see attachment3,342,999 Click to see attachment3,181,736
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 72,413,245 71,098,585 77,927,007
Liabilities 17 Accounts payable and accrued expenses..........    
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)......... 0 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........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds 72,413,245 71,098,585
29 Total net assets or fund balances (see instructions)..... 72,413,245 71,098,585
30 Total liabilities and net assets/fund balances (see instructions). 72,413,245 71,098,585
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
72,413,245
2
Enter amount from Part I, line 27a .....................
2
-1,323,545
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
8,885
4
Add lines 1, 2, and 3 ..........................
4
71,098,585
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
71,098,585
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.)
1 a Publicly-traded Securities      
b Passthrough K1 Capital Gain/(Loss)      
c 1150 UNION INVESTORS LLC P 2016-05-31 2020-06-25
d LATITUDE MGMT RE CAPITAL III INC P 2013-05-23 2020-06-01
e LATITUDE MGMT RE CAPITAL III INC P 2013-05-23 2020-07-21
LATITUDE MGMT RE CAPITAL III INC P   2020-09-15
LATITUDE MGMT RE CAPITAL III INC P 2013-10-15 2020-10-15
LATITUDE MGMT RE CAPITAL III INC P   2020-11-16
LATITUDE MGMT RE CAPITAL III INC P 2014-05-14 2020-12-16
TRINITY CAPITAL FUND III, L.P P 2017-12-13 2020-01-16
DISTRIBUTIONS IN EXCESS OF BASIS      
(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 24,661,274   23,456,233 1,205,041
b       222,117
c 7,593   7,593  
d 125,000   125,000  
e 100,000   100,000  
75,000   75,000  
50,000   50,000  
75,000   75,000  
25,000   25,000  
3,530,781   3,530,775 6
      41,090
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       1,205,041
b        
c        
d        
e        
       
       
       
       
      6
       
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 1,468,254
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 28,384
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 28,384
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 28,384
6 Credits/Payments:
a 2020 estimated tax payments and 2019 overpayment credited to 2020 6a 85,336
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 85,336
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. Click to see attachment 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 56,952
11 Enter the amount of line 10 to be: Credited to 2021 estimated taxBullet28,400 RefundedBullet 11 28,552
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$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changesClick to see attachment....
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.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)
    bulletCA, DE
    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 addressbullet  
    14
    The books are in care ofbulletJeff Polak Telephone no.bullet (310) 601-4296

    Located atbullet1725 Green AcresBeverly HillsCA ZIP+4bullet90210
    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
    David PolakClick to see attachment Dir
    1.0     		0 0 0
    Foundation Source 501 Silverside Rd
    Wilmington,DE198091377
    Janet PolakClick to see attachment Dir
    1.0     		0 0 0
    Foundation Source 501 Silverside Rd
    Wilmington,DE198091377
    Jeff PolakClick to see attachment Dir, Pres, executive dir
    40.0     		222,800 11,000 0
    Foundation Source 501 Silverside Rd
    Wilmington,DE198091377
    Robert PolakClick to see attachment Dir
    1.0     		0 0 0
    Foundation Source 501 Silverside Rd
    Wilmington,DE198091377
    Jonathan SeltzerClick to see attachment Dir
    1.0     		0 0 0
    Foundation Source 501 Silverside Rd
    Wilmington,DE198091377
    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
    Noreen L Rubio ADMINISTRATIVE ASST
    40.0     		60,000    
    4301 MANDALAY DRIVE
    LOS ANGELES,CA90063
    Karen Springer PROGRAM ADVISOR
    40.0     		150,000 0  
    PO BOX 574
    PALO ALTO,CA94302
    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
    Polak Investors LLC Investment Mgmt 374,402
    1880 Century Park East Suite 811
    Los Angeles,CA90067
    Foundation Source Administrative 86,452
    55 Walls Drive 3rd Fl
    Fairfield,CT06824
    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
    42,953,189
    b
    Average of monthly cash balances.......................
    1b
    8,850,476
    c
    Fair market value of all other assets (see instructions)................
    1c
    24,578,787
    d
    Total (add lines 1a, b, and c).........................
    1d
    76,382,452
    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
    76,382,452
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    1,145,737
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    75,236,715
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    3,761,836
    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
    3,761,836
    2a
    Tax on investment income for 2020 from Part VI, line 5......
    2a
    28,384
    b
    Income tax for 2020. (This does not include the tax from Part VI.)...
    2b
    34,963
    c
    Add lines 2a and 2b............................
    2c
    63,347
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    3,698,489
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    8,885
    5
    Add lines 3 and 4............................
    5
    3,707,374
    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
    3,707,374
    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
    3,400,295
    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
    3,400,295
    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
    3,400,295
    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 3,707,374
    2 Undistributed income, if any, as of the end of 2020:
    a Enter amount for 2019 only....... 3,339,727
    b Total for prior years:2018, 2017, 2016  
    3 Excess distributions carryover, if any, to 2020:
    a From 2015......  
    b From 2016......  
    c From 2017......  
    d From 2018......  
    e From 2019......  
    fTotal of lines 3a through e........  
    4Qualifying distributions for 2020 from Part
    XII, line 4: bullet$ 3,400,295
    a Applied to 2019, but not more than line 2a 3,339,727
    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..... 60,568
    e Remaining amount distributed out of corpus 0
    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 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		 
    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 ...........     		 
    e Undistributed income for 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		 
    f Undistributed income for 2020. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2021 ..........     		3,646,806
    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) ...     		 
    9Excess distributions carryover to 2021.
    Subtract lines 7 and 8 from line 6a ......     		0
    10 Analysis of line 9:
    a Excess from 2016....  
    b Excess from 2017....  
    c Excess from 2018....  
    d Excess from 2019....  
    e Excess from 2020.... 0
    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).)
    NONE
    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 email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    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
    AMCHA INITIATIVE
    517 BETHANY CURVE
    SANTA CRUZ,CA95060     		N/A PC General & Unrestricted 30,000
    AMERICAN FRIENDS OF ISRAELI NAVY SEALS INC
    138 W 133RD ST
    NEW YORK,NY10030     		N/A PC scholarship fund to four candidates 21,000
    AMERICAN SOCIETY FOR TECHNION- ISRAEL INSTITUTE OF
    55 EAST 59TH ST
    NEW YORK,NY10022     		N/A PC the David & Janet Polak Family Distance learning studio fund 1,000,000
    AMERICAN SOCIETY FOR TECHNION- ISRAEL INSTITUTE OF
    55 EAST 59TH ST
    NEW YORK,NY10022     		N/A PC General & Unrestricted 5,000
    AMERICANS FOR BEN-GURION UNIVERSITY INC
    1001 AVE OF THE AMERICAS FL 19
    NEW YORK,NY10018     		N/A PC General & Unrestricted 20,000
    ASSOCIATION FOR THE STUDY OF THE MIDDLE EAST AND A
    PO BOX 2241
    BALA CYNWYD,PA19004     		N/A PC General & Unrestricted 5,000
    AYN RAND INSTITUTE THE CENTER FOR THE ADVANCEMENT
    6 HUTTON CENTRE DR STE 600
    SANTA ANA,CA92707     		N/A PC the Free Books to Teacher program: distribution of books throughout the Los Angeles area 25,000
    AYN RAND INSTITUTE THE CENTER FOR THE ADVANCEMENT
    6 HUTTON CENTRE DR STE 600
    SANTA ANA,CA92707     		N/A PC ARC Israel fund 10,000
    BEIT TSHUVAH
    8831 VENICE BLVD
    LOS ANGELES,CA90034     		N/A PC General & Unrestricted 1,500
    BUCKLEY SCHOOL
    3900 STANSBURY AVE
    SHERMAN OAKS,CA91423     		N/A PC General & Unrestricted 7,500
    CEDARS-SINAI MEDICAL CENTER
    8700 BEVERLY BLVD
    W HOLLYWOOD,CA90048     		N/A PC the Polak Family Fellowship fund in Precision Healthcare, board of governors innovation center 100,000
    CEDARS-SINAI MEDICAL CENTER
    8700 BEVERLY BLVD
    W HOLLYWOOD,CA90048     		N/A PC General & Unrestricted 25,000
    CENTRAL FUND OF ISRAEL
    461 CENTRAL AVE
    CEDARHURST,NY11516     		N/A PC Palestinian Media Watch fund 25,000
    COMMITTEE FOR ACCURACY IN MIDDLE EAST REPORTING IN
    PO BOX 35040
    BOSTON,MA02135     		N/A PC General & Unrestricted 10,000
    CONCERN FOUNDATION
    11111 W OLYMPIC BLVD STE 214
    LOS ANGELES,CA90064     		N/A PC General & Unrestricted 6,000
    CUFI CHURCH ASSOCIATION
    PO BOX 1307
    SAN ANTONIO,TX78295     		N/A PC General & Unrestricted 10,000
    DAVID HOROWITZ FREEDOM CENTER
    14724 VENTURA BLVD STE 820
    SHERMAN OAKS,CA91403     		N/A PC General & Unrestricted 10,000
    ENDOWMENT FOR MIDDLE EAST TRUTH
    700 STONINGTON RD
    SILVER SPRING,MD20902     		N/A PC General & Unrestricted 10,000
    FOUNDATION FOR INDIVIDUAL RIGHTS IN EDUCATION INC
    510 WALNUT ST STE 1250
    PHILADELPHIA,PA19106     		N/A PC General & Unrestricted 5,000
    FRIENDS OF ELNET
    5215 OLD ORCHARD RD STE 880
    SKOKIE,IL60077     		N/A PC General & Unrestricted 30,000
    FRIENDS OF SHEBA MEDICAL CENTER INC
    6505 WILSHIRE BLVD NO 615
    LOS ANGELES,CA90048     		N/A PC General & Unrestricted 5,000
    FRIENDS OF THE ISRAEL DEFENSE FORCES
    60 E 42ND ST
    NEW YORK,NY10165     		N/A PC IMPACT! Scholarship fund 48,000
    FRIENDS OF THE ISRAEL DEFENSE FORCES - LOS ANGELES
    6505 WILSHIRE BLVD STE 625
    LOS ANGELES,CA90048     		N/A PC IMPACT! Scholarship fund 52,000
    HAROLD GRINSPOON FOUNDATION
    67 HUNT ST STE 100
    AGAWAM,MA01001     		N/A SO I pj library program book fund in domestic and international communities 91,112
    HILLCREST COUNTRY CLUB CHARITABLE FUND
    10000 W PICO BLVD
    LOS ANGELES,CA90064     		N/A PC General & Unrestricted 5,000
    HONEST REPORTING COM INC
    165 E 56TH ST 2ND FL
    NEW YORK,NY10022     		N/A PC General & Unrestricted 3,000
    IMERMAN ANGELS
    205 W RANDOLPH ST 19TH FL
    CHICAGO,IL60606     		N/A PC General & Unrestricted 5,000
    INVEST FOR KIDS INC
    875 N MICHIGAN AVE STE 3400
    CHICAGO,IL60611     		N/A PC General & Unrestricted 5,000
    ISRAEL CANCER RESEARCH FUND INC
    52 VANDERBILT AVE S1510
    NEW YORK,NY10017     		N/A PC General & Unrestricted 5,000
    ISRAEL CHRISTIAN NEXUS
    11039 MCCORMICK ST
    N HOLLYWOOD,CA91601     		N/A PC General & Unrestricted 1,000
    ISRAEL EMERGENCY ALLIANCE - STANDWITHUS
    PO BOX 341069
    LOS ANGELES,CA90034     		N/A PC General & Unrestricted 200,000
    ISRAEL TENNIS CENTERS FOUNDATION INC
    57 W 38TH ST STE 605
    NEW YORK,NY10018     		N/A PC General & Unrestricted 3,600
    JEWBELONG INC
    PO BOX 3013
    UPR MONTCLAIR,NJ07043     		N/A PC General & Unrestricted 5,000
    JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES
    6505 WILSHIRE BLVD STE 800
    LOS ANGELES,CA90048     		N/A PC General & Unrestricted 45,000
    JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES
    6505 WILSHIRE BLVD STE 800
    LOS ANGELES,CA90048     		N/A PC the Guard Force program to expand current Community security efforts, development and launch of a computer-based training program of advanced situational awareness 75,000
    JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES
    6505 WILSHIRE BLVD STE 800
    LOS ANGELES,CA90048     		N/A PC PJ Library Program books fund 18,000
    LAWFARE PROJECT INC
    633 3RD AVE FL 21
    NEW YORK,NY10017     		N/A PC General & Unrestricted 30,000
    LOS ANGELES JEWISH HOME FOR THE AGING
    7150 TAMPA AVE
    RESEDA,CA91335     		N/A PC General & Unrestricted 25,000
    MAKE A WISH FOUNDATION OF GREATER LOS ANGELES
    11390 W OLYMPIC BLVD STE 300
    LOS ANGELES,CA90064     		N/A PC General & Unrestricted 10,000
    MANHATTAN INSTITUTE FOR POLICY RESEARCH INC
    52 VANDERBILT AVE
    NEW YORK,NY10017     		N/A PC General & Unrestricted 5,000
    MASSACHUSETTS INSTITUTE OF TECHNOLOGY
    600 MEMORIAL DR BLDG W98-300
    CAMBRIDGE,MA02139     		N/A PC General & Unrestricted 10,000
    MIDDLE EAST FORUM
    1650 MARKET ST STE 3600
    PHILADELPHIA,PA19103     		N/A PC annual Israel victory project 40,000
    MIDDLE EAST MEDIA AND RESEARCH INSTITUTE INC
    PO BOX 27837
    WASHINGTON,DC20038     		N/A PC General & Unrestricted 20,000
    MOISHE HOUSE
    441 SAXONY RD NO BARN 2
    ENCINITAS,CA92024     		N/A PC community building fund in Los Angeles 45,000
    PACIFIC LEGAL FOUNDATION
    555 CAPITOL MALL STE 1290
    SACRAMENTO,CA95814     		N/A PC General & Unrestricted 5,000
    PRAGER UNIVERSITY FOUNDATION
    15021 VENTURA BLVD 552
    SHERMAN OAKS,CA91403     		N/A PC General & Unrestricted 100,000
    PROCLAIMING JUSTICE TO THE NATIONS INC
    PO BOX 682711
    FRANKLIN,TN37068     		N/A PC General & Unrestricted 30,000
    REPORT INC - RESEARCH EVALUATION PROMOTING OR
    PMB 225 1121 N BETHLEHEM PIKE STE 6
    SPRING HOUSE,PA19477     		N/A PC General & Unrestricted 30,000
    SIMON WIESENTHAL CENTER INC
    1399 S ROXBURY 2ND FL
    LOS ANGELES,CA90035     		N/A PC Moriah Films' comprehensive documentary about the life and legacy of david ben-gurion project 70,000
    STUDENTS RUN AMERICA
    5252 CREBS AVE
    TARZANA,CA91356     		N/A PC General & Unrestricted 5,000
    THE JEWISH HOME AND SENIOR LIVING FOUNDATION
    302 SILVER AVE
    SAN FRANCISCO,CA94112     		N/A PC the Emergency Covid19 Response Program 10,000
    THE JEWISH INSTITUTE FOR NATIONAL SECURITY OF AMER
    1101 14TH ST NW STE 1030
    WASHINGTON,DC20005     		N/A PC The Fight Against the Conditioning of Military Aid to israel project 134,820
    THE JEWISH INSTITUTE FOR NATIONAL SECURITY OF AMER
    1101 14TH ST NW STE 1030
    WASHINGTON,DC20005     		N/A PC General & Unrestricted 10,000
    THE MAPLE COUNSELING CENTER
    439 N CANON DR STE 209
    BEVERLY HILLS,CA90210     		N/A PC General & Unrestricted 2,500
    TRIBE MEDIA CORP
    3250 WILSHIRE BLVD STE 1250
    LOS ANGELES,CA90010     		N/A PC General & Unrestricted 65,000
    TURNING POINT USA INC
    4940 EAST BEVERLY RD
    PHOENIX,AZ85044     		N/A PC General & Unrestricted 50,000
    UNIVERSITY OF SOUTHERN CALIFORNIA
    1150 S OLIVE ST 25TH FL
    LOS ANGELES,CA90015     		N/A PC Technion|USC Postdoctoral Fellowship fund 80,000
    WASHINGTON INSTITUTE FOR NEAR EAST POLICY
    1111 19TH ST NW STE 500
    WASHINGTON,DC20036     		N/A PC General & Unrestricted 5,000
    YOUNG AMERICA'S FOUNDATION
    11480 COMMERCE PARK DR STE 600
    RESTON,VA20191     		N/A PC to reach broader youth audiences through the campaign to drive up and maximize views for ben shapiro's top lectures on youtube 50,000
    Total .................................bullet 3a 2,755,032
    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 66,750  
    4 Dividends and interest from securities....     14 887,181  
    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 ............     		525990 240,117 18 1,407,770  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aK-1 Inc/Loss     		525990 38,427 14 559,221  
    bFederal Tax Refund     01 37,273  
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e).. 278,544 2,958,195  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    3,236,739
    (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

    TY 2020 CompensationExplanation
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Person Name Explanation
    Jeff Polak * david polak (director), Janet polak (director) and jeff POLAK PRESIDENT/DIRECTOR/EXECUTIVE DIRECTOR), OF DAVID & JANET POLAK FOUNDATION (THE "FOUNDATION"), ARE PRINCIPALS AT THE INVESTMENT MANAGEMENT FIRM POLAK INVESTORS, LLC, A DISQUALIFIED PERSON WHICH PROVIDES INVESTMENT MANAGEMENT SERVICES TO THE FOUNDATION. IN THE TAXABLE YEAR ENDING DECEMBER 31, 2020, THE FOUNDATION PAID $374,402 FOR INVESTMENT MANAGEMENT SERVICES RENDERED BY SUCH DISQUALIFIED PERSON, AS REPORTED IN PART I, Line 16c. THE REASONABLENESS OF THE PROFESSIONAL FEES WAS ESTABLISHED BY AN OUTSIDE COMPENSATION COMMITTEE, WHICH REVIEWED THE RATES CHARGED BY COMPARABLE INVESTMENT MANAGEMENT FIRMS.

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

    TY 2020 DepreciationSchedule
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    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

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    TY 2020 ExpenditureResponsibilityStmt
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Grantee's Name Grantee's Address Grant Date Grant Amount Grant Purpose Amount Expended By Grantee Any Diversion By Grantee? Dates of Reports By Grantee Date of Verification Results of Verification
    NeuroVision Imaging LLC
          		1395 Garden Highway Suite 250
    Sacramento,CA95833     		2014-12-17 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR ADDITIONAL INFORMATION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the reports from the grantee; therefore, no independent verification of the reports were made.
    Bruin Biometrics LLC
          		10960 Wilshire Blvd Suite 950
    Los Angeles,CA90024     		2015-05-13 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the reports from the grantee; therefore, no independent verification of the reports were made.
    Biop Medical LTD
          		10 Haeliav St
    Ramat Gan   5252263
    IS     		2017-04-21 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the reports from the grantee; therefore, no independent verification of the reports were made.
    Online Disruptive Technologies Inc
          		MATAM Adv Tech Pk bld 23 pobx 15050
    haifa   3190501
    IS     		2017-04-21 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the reports from the grantee; therefore, no independent verification of the reports were made.
    Orgenesis Ltd
          		Arad Street 9
    Tel Aviv    
    IS     		2017-04-21 305,498 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the reports from the grantee; therefore, no independent verification of the reports were made.
    Bryn Pharma LLC fka EPI-Now LLC
          		518 North Hillcrest Road
    Beverly Hills,CA90210     		2018-07-13 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the reports from the grantee; therefore, no independent verification of the reports were made.
    CyWat Technologies Ltd
          		168 Jabotinsky St
    Bnei Brak    
    IS     		2018-11-26 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the reports from the grantee; therefore, no independent verification of the reports were made.
    Y&B Mothers Choice Ltd
          		HiTech Vil 4/9 givat ram POB 39231
    jerusalem   9129102
    IS     		2018-04-20 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the reports from the grantee; therefore, no independent verification of the reports were made.
    Y&B Mothers Choice Ltd
          		HiTech Vil 4/9 givat ram POB 39231
    Jerusalem   9129102
    IS     		2018-07-19 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the reports from the grantee; therefore, no independent verification of the reports were made.
    MaxQ AI Ltd
          		96 Yigal Alon Street Entrance A
    Tel Aviv   6789140
    IS     		2019-03-19 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO     The grantor has no reason to doubt the accuracy or reliability of the reports from the grantee; therefore, no independent verification of the reports were made.
    ExThera Medical Corporation
          		757 Arnold Drive Suite B
    Martinez,CA94553     		2019-12-19 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the report from the grantee; therefore, no independent verification of the report was made.
    YonaLink Ltd
          		Hadassah Ein Kerem Hosp POB 12000
    Jerusalem   9112001
    IS     		2019-11-12 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the report from the grantee; therefore, no independent verification of the report was made.
    Amicrobe Inc
          		3142 Tiger Run Court 103
    Carlsbad,CA92010     		2019-10-31 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   The grantor has no reason to doubt the accuracy or reliability of the report from the grantee; therefore, no independent verification of the report was made.

    TY 2020 GeneralExplanationAttachment
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Identifier Return Reference Explanation
    FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: NeuroVision Imaging, LLC DATES AND AMOUNTS OF PRI: 12/17/2014 $250,000 5/17/2018 $37,502 PURPOSE OF PRI: Research and development of diagnostic tools for early-stage detection of Alzheimer's disease and other degenerative neurological disorders. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED FULL AND COMPLETE FINANCIAL REPORTS OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 3/25/2015 FOR FYE 12/31/2014 DATE OF REPORT: 5/18/2016 FOR FYE 12/31/2015 DATE OF REPORT: 6/7/2017 FOR FYE 12/31/2016 DATE OF REPORT: 5/11/2018 FOR FYE 12/31/2017 DATE OF REPORT: 11/1/2019 FOR FYE 12/31/2018 DATE OF REPORT: 6/2/2020 FOR FYE 12/31/2019 DATE OF REPORT: 6/28/2021 FOR FYE 12/31/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
    FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: BRUIN BIOMETRICS, LLC DATE AND AMOUNT OF PRI: 5/13/2015 $250,000 PURPOSE OF PRI: TO PROMOTE THE HEALTH AND REDUCE THE SUFFERING OF THOSE AFFECTED BY EARLY-STAGE PRESSURE ULCERS DURING THEIR HOSPITAL STAYS AND TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH IN THE PUBLIC INTEREST. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORTS OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 5/24/2016 FOR FYE 12/31/2015 DATE OF REPORT: 6/29/2017 FOR FYE 12/31/2016 DATE OF REPORT: 5/15/2018 FOR FYE 12/31/2017 DATE OF REPORT: 6/14/2019 FOR FYE 12/31/2018 DATE OF REPORT: 4/22/2020 FOR FYE 12/31/2019 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
    FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: BIOP MEDICAL LTD DATES AND AMOUNTS OF PRI: 4/21/2017 $250,000 PURPOSE OF PRI: TO PROMOTE THE HEALTH AND REDUCE THE SUFFERING OF THOSE AFFECTED BY DISEASE AND TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH IN THE PUBLIC INTEREST. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 6/4/2018 FOR FYE 12/31/2017 DATE OF REPORT: 2/12/2019 FOR FYE 12/31/2018 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. IN CONNECTION WITH THIS PROGRAM RELATED INVESTMENT ("PRI"), THE FOUNDATION HAS MADE NUMEROUS GOOD FAITH ATTEMPTS TO CONTACT THE INVESTEE AND REQUEST THE OVERDUE ANNUAL REPORTS FROM THE INVESTEE WITH RESPECT TO THE PRI, WHICH ATTEMPTS HAVE BEEN DOCUMENTED BY THE FOUNDATION, BUT HAS NOT BEEN ABLE TO OBTAIN SUCH REPORTS. PER SECTION 53.4945-5(E)(2) OF THE TREASURY REGULATIONS, THE FAILURE OF THE INVESTEE TO SUBMIT SUCH REPORTS WILL NOT RESULT IN A TAXABLE EXPENDITURE FOR THE FOUNDATION BECAUSE THE FOUNDATION (I) MADE THE PRI IN ACCORDANCE WITH PARAGRAPH (B) OF SAID SECTION OF THE REGULATIONS, (II) HAS COMPLIED WITH THE REPORTING REQUIREMENTS CONTAINED IN PARAGRAPH (D) OF SAID SECTION OF THE REGULATIONS, (III) MADE A REASONABLE EFFORT TO OBTAIN THE REQUIRED REPORTS, AND (IV) WILL WITHHOLD ALL FUTURE PRI PAYMENTS TO THE INVESTEE UNTIL SUCH REPORT IS FURNISHED. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
    FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: ONLINE DISRUPTIVE TECHNOLOGIES, INC. DATE AND AMOUNT OF PRI: 4/21/2017 $250,000 PURPOSE OF PRI: TO PROMOTE THE HEALTH AND REDUCE THE SUFFERING OF THOSE AFFECTED BY CANCER AND TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH IN THE PUBLIC INTEREST. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 6/6/2018 FOR FYE 12/31/2017 DATE OF REPORT: 2/12/2019 FOR FYE 12/31/2018 DATE OF REPORT: 6/1/2020 FOR FYE 12/31/2019 DATE OF REPORT: 8/18/2021 FOR FYE 12/31/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
    FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: Bryn Pharma LLC f/k/a EPI-Now LLC DATE AND AMOUNT OF PRI: 7/13/2018 $250,000 PURPOSE OF PRI: To promote the health of those who require epinephrine and to advance scientific understanding through research in the public interest. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 8/23/2019 FOR FYE 12/31/2018 DATE OF REPORT: 10/24/2020 FOR FYE 12/31/2019 DATE OF REPORT: 8/2/2021 FOR FYE 12/21/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. appreciation of property.
    FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: Orgenesis Ltd. DATE AND AMOUNT OF PRI: 4/21/2017 $305,498 PURPOSE OF PRI: To promote the health and reduce the suffering of those affected by diabetes by way of researching and bringing to clinical trial the Company technology solution. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED FULL AND COMPLETE FINANCIAL REPORTS OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 9/9/2018 FOR FYE 12/31/2017 DATE OF REPORT: 10/20/2020 FOR FYE 12/31/2018 DATE OF REPORT: 10/20/2020 FOR FYE 12/31/2019 DATE OF REPORT: 5/20/2021 FOR FYE 12/31/2020 THE FOUNDATION EXERCISED AN OPTION TO EXCHANGE ITS INTEREST IN THE INVESTEE FOR THE STOCK IN THE PARENT COMPANY OF THE INVESTED. THIS WAS DONE TO PRESERVE THE PRI AND NOT TO GENERATE INCOME OR FOR THE APPRECIATION OF PROPERTY. THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
    FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: CyWat Technologies Ltd DATE AND AMOUNT OF PRI: 11/26/2018 $250,000 PURPOSE OF PRI: To promote the health of people who are affected by polluted drinking water by funding the development of a water monitoring system that is distributed throughout the entire water grid and which can immediately detect potential dangers. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 6/18/2019 FOR FYE 12/31/2018 DATE OF REPORT: 1/13/2020 FOR FYE 12/31/2019 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
    FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VII-B, LINE 5C - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: Y&B MOTHERS CHOICE LTD. DATE AND AMOUNT OF PRI: 4/20/2018 $250,000 PURPOSE OF PRI: TO PROMOTE HEALTH BY FUNDING RESEARCH INTO DEVELOPING NON HAZARDOUS, NATURAL PRODUCTS THAT DO NOT ENDANGER HUMAN HEALTH. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2018 DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2019 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. PRI RECIPIENT: Y&B MOTHERS CHOICE LTD. DATE AND AMOUNT OF PRI: 7/19/2018 $250,000 PURPOSE OF PRI: TO PROMOTE HEALTH BY FUNDING RESEARCH INTO DEVELOPING NON HAZARDOUS, NATURAL PRODUCTS THAT DO NOT ENDANGER HUMAN HEALTH. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2018 DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2019 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. PRI RECIPIENT: MAXQ AI, LTD DATE OF PRI: 3/19/2019 $250,000 PURPOSE OF PRI: TO PROMOTE THE DEVELOPMENT OF A PRODUCT THAT WILL SUBSTANTIALLY BENEFIT THE PUBLIC BY INCORPORATING SOPHISTICATED ARTIFICIAL INTELLIGENCE INTO DIAGNOSTIC RADIOLOGY. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 10/13/2020 FOR FYE 12/31/2019 DATE OF REPORT: 7/20/2021 FOR FYE 12/31/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. PRI RECIPIENT: EXTHERA MEDICAL CORPORATION DATE AND AMOUNT OF PRI: 12/19/2019 $250,000 PURPOSE OF PRI: TO FUND THE DEVELOPMENT AND/OR DISTRIBUTION OF CURRENT AND FUTURE MEDICAL TECHNOLOGY, INCLUDING WITHOUT LIMITATION THE SERAPH BLOOD FILTER DEVICE, THAT HAVE A DEMONSTRABLE DEMAND FOR HUMANITARIAN USE IN DEVELOPING COUNTRIES AND THAT OFFER BREAK-THROUGH TECHNOLOGY FOR USE IN THE TREATMENT OF INTRACTABLE OR EMERGING PUBLIC-HEALTH THREATS. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 2/2/2021 FOR FYE 12/31/2019 DATE OF REPORT: 6/30/2021 FOR FYE 12/31/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. PRI RECIPIENT: YonaLink Ltd. DATE AND AMOUNT OF PRI: 11/12/2019 $250,000 PURPOSE OF PRI: To finance provision of the YonaLink Automated Study Manager Technology to nonprofit academic hospitals for free or at substantially below cost. The Technology has the potential to significantly improve the quality and efficiency of processing data for clinical research studies in the public interest. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 4/6/2021 FOR FYE 12/31/2019 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. PRI RECIPIENT: AMICROBE, INC. DATE AND AMOUNT OF PRI: 10/31/2019 $250,000 PURPOSE OF PRI: TO FUND THE DEVELOPMENT AND COMMERCIALIZATION OF AMICIDIN-ALPHA SURGICAL GEL AND ITS AMICIDIN-BETA SOLUTION, TOGETHER WITH RELATED WORK AND MEDICAL PRODUCTS HAVING SIMILAR PURPOSES. THIS HAS THE POTENTIAL TO PROVIDE BREAKTHROUGH TECHNOLOGICAL SOLUTIONS TO THE GROWING THREAT OF ANTIBIOTIC RESISTANCE AROUND THE WORLD. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED FULL AND COMPLETE FINANCIAL REPORTS OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 12/28/2020 FOR FYE 12/31/2019 DATE OF REPORT: 8/4/2021 FOR FYE 12/31/2020 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2020. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
    Forms 8865 Forms 8865 The Foundation has prepared these forms to the best of its ability based on the limited information provided to it by the investment on which the Foundation is reporting and on the basis of having received no information to the contrary. Any missing or incomplete information is due to the Foundation's inability to obtain such information and is not a willful attempt to withhold such information.
    Part I line 6a PART I LINE 6A (990-PF) RECONCILIATION OF NET GAIN/(LOSS) FROM SALES OF ASSETS NOT INCLUDED IN PART IV TOTAL INCLUDED IN PART IV: (DETAILS BELOW) NET GAIN/(LOSS): $1,407,770 TOTAL NOT INCLUDED IN PART IV: PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - UBI NET GAIN/(LOSS): $240,117 TOTAL PART I, LINE 6A: $1,647,887 DETAILS OF ASSETS INCLUDED IN PART IV: PUBLICLY-TRAIDED SECURITIES GROSS SALES PRICE: $24,661,274 BOOK BASIS: $23,516,717 NET GAIN/(LOSS): $1,144,557 PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - NON UBI NET GAIN/(LOSS): $222,117 SALES OF OTHER ITEMIZED ASSETS GROSS SALES PRICE: $3,988,374 BOOK BASIS: $3,988,368 NET GAIN/(LOSS): $6 DISTRIBUTIONS IN EXCESS OF BASIS NET GAIN/(LOSS): $41,090

    TY 2020 InvestmentsCorpStockSchedule
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Name of Stock End of Year Book Value End of Year Fair Market Value
    AMERICAN AXLE & MFG HOLDINGS I 251,018 183,480
    B2 GOLD CORP COM NPV 150,587 236,320
    BANK OF AMERICA CORP 113,640 363,720
    BARRICK GOLD CORPORATION 768,039 569,500
    BAYER A G SPONSORED ADR 198,370 118,720
    BERRY PLASTICS GROUP INC 118,805 168,570
    BP PLC SPONSORED ADR 102,249 61,560
    CABOT OIL & GAS CORP 32,348 32,560
    CAMECO CORPORATION 19,784 13,400
    CHENIERE ENERGY INC 120,095 120,060
    CITIGROUP INC 248,049 308,300
    CLIFFS NATURAL RESOURCES INC. 50,603 58,240
    COMPASS MINERALS INTERNATIONAL 253,526 308,600
    COMSTOCK RES INC 18,674 17,480
    CONSTELLIUM NV 136,767 83,940
    COPPER MOUNTAIN MINI NG CORP 78,225 198,800
    COVANTA HOLDING CORP 83,405 65,650
    CROWN HOLDINGS INC 185,100 501,000
    CVS CAREMARK CORP 466,000 683,000
    DANA HOLDING CP 68,217 97,600
    DELTA AIR LINES INC 24,396 80,420
    ELDORADO GOLD CORP COM NPV 218,701 238,860
    ENDEAVOUR MINING CORP 141,284 162,425
    FIDELITY CONSERV INC BD FD 8,564 8,587
    FIRST QUANTUM MINERALS LTD 17,953 35,940
    FLUTTER ENTERTAINMENT ORD SHS 59,804 91,895
    FTS INTERNATIONAL INC 321,080 276,826
    GENERAL MOTORS 361,740 416,400
    GOLD FIELDS LTD ADS 140,581 241,020
    GOLDEN STAR RESOURCES LTD 13,940 14,840
    GRAPHIC PACKAGING CORP COM STK 41,828 50,820
    HALLIBURTON COMPANY 226,736 113,400
    HOLCIM N 256,612 283,350
    HUDBAY MINERALS INC 133,864 175,000
    IVANHOE MINES LTD 60,260 162,000
    JAPAN SMALLER CAPITALIZATION F 365,092 414,032
    JET2 PLC 78,926 195,470
    JOHNSON & JOHNSON 231,728 393,450
    KAZATOMPROM JSC NAC GDR 147,503 180,000
    KBR INC 91,500 92,790
    KIRKLAND LAKE GOLD LTD 268,643 338,868
    LAFARGEHOLCIM LTD ADR 67,245 108,400
    MARKET VECTORS VIETNAM ETF 40,705 34,980
    MERCK & CO INC 381,120 654,400
    MICRON TECHNOLOGY 325,144 902,159
    MICROSOFT CORP 28,785 222,420
    NEWMONT GOLDCORP CORPORATION 574,088 949,615
    NOVAGOLD RESOURCES 69,977 174,060
    NUVEEN MLT STR I&G 9,760 9,500
    OCEANAGOLD CORPORATION COM 103,358 78,400
    PFIZER INC 490,753 736,200
    PHILIP MORRIS INTL 8,916 8,279
    PRETIUM RESOURCES INC 86,644 114,800
    TEVA PHARMACEUTICAL INDUSTRIES 36,513 9,650
    THE MOSAIC CO 169,858 92,040
    TOREX GOLD RESOURCES 181,332 225,600
    TPG RE FINANCE TRUST INC 2,013 1,062
    TRUIST FINANCIAL CORPORATION 30,848 47,930
    TURQUOISE HILL RESOURCES LTD 85,140 62,100
    VALARIS PLC 382,692 175
    VIATRIS ORD SHS 26,941 46,494

    TY 2020 InvestmentsGovtObligationsSch
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    US Government Securities - End of Year Book Value:

    30,238,616
    US Government Securities - End of Year Fair Market Value:

    30,426,972
    State & Local Government Securities - End of Year Book Value:


    3,545,065
    State & Local Government Securities - End of Year Fair Market Value:


    3,724,010


    TY 2020 InvestmentsOtherSchedule2
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    AIR U.S. LIFE FUND III, LP   2,020,814 2,011,592
    AIR US LIFE FUND IV, LP   2,033,480 2,029,825
    ALTAIR - PACIFIC COAST CPTL PT   496,156 592,192
    ALTAIR DIRECT LENDING FUND, LL   212,783 173,946
    ALTAIR EUROPEAN R E OPPORTUNIT   659,098 311,089
    ALTAIR SENIOR HOUSING FUND (AE   182,992 740,403
    ANAGENESIS CAPITAL PARTNERS SB   897,667 1,037,522
    ASM CONNAUGHT HOUSE FUND III L   1,000,000 1,172,884
    BROAD ST REAL ESTATE CREDIT PT     181,145
    BW GAS & CONVENIENCE ONSHORE F   424,573 2,379,072
    DORCHESTER CAPITAL SECONDARIES   188,581 212,717
    ENLIGHTENMENT CAPITAL SOLUTION   984,325 1,624,449
    FALCON EDGE INDIA I LP   556,167 701,113
    FIRST EAGLE CLO EQUITY FUND I,   834,921 823,393
    FOURTHSTONE SMALL-CAP FINANCIA   251,807 263,874
    GOLDMAN SACHS VINTAGE FUND V L   302,066 142,137
    GRANITE CREEK FLEXCAP II, L.P   402,725 480,818
    GS DISTRESSED OPPORTUNITIES FU   133,187 157,249
    GSO CAPITAL SOLUTIONS FUND II   6,463 6,463
    GSO CAPITAL SOLUTIONS FUND II   79,926 63,937
    GSO CAPITAL SOLUTIONS FUND II   287,336 124,603
    GSO ENERGY SELECT OPPORTUNITIE   272,291 294,771
    GSO ENERGY SELECT OPPORTUNITIE   59,065 59,065
    GSO ENERGY SELECT OPPORTUNITIE   1,434 1,434
    GSO ENERGY SELECT OPPORTUNITIE   66,759 40,366
    LATITUDE MGMT REAL ESTATE CAPI   500,000 496,683
    LATITUDE MGMT REAL ESTATE CAPI   1,500,000 1,502,157
    PCCP EQUITY VII, LP   2,533,796 3,065,724
    PCCP EQUITY VIII, LP   556,154 638,614
    SILVERPEAK CREDIT OPPORTUNITIE   263,639 274,117
    SILVERPEAK CREDIT OPPORTUNITIE   1,670,998 1,684,065
    THE EDGBASTON ASIAN EQUITY TRU   1,249,841 1,104,920
    BERNIE L MADOFF - CLAIM RECEIV   530,622 530,622

    TY 2020 LegalFeesSchedule
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    General Consultations 16,907     16,907


    TY 2020 OtherAssetsSchedule
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    PRI - AMICROBE, INC   250,000 250,000
    PRI - BIOP MEDICAL   250,000 250,000
    PRI - BRUIN_BIOMETRICS   250,000 250,000
    PRI - BRYN PHARMA LLC F/K/A EP   250,000 250,000
    PRI - CYWAT TECH   250,000 250,000
    PRI - EXTHERA MEDICAL CORP   250,000 250,000
    PRI - MAXQ AI, LTD   250,000 250,000
    PRI - MOTHERS CHOICE   250,000 250,000
    PRI - MOTHERS CHOICE (2)   250,000 250,000
    PRI - ONLINE DISRUPTIVE   250,000 250,000
    PRI - ORGENESIS - 32,052 SHARE   294,397 144,234
    PRI - ORGENESIS WTS - 32,052 U   11,100  
    PRI - SER A1 PFD (82,175 UNITS   250,000 250,000
    PRI - SER A2 PFD (15,408 UNITS   37,502 37,502
    PRI - YONALINK LTD   250,000 250,000


    TY 2020 OtherExpensesSchedule
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Administrative Fees 86,452     86,452
    Bank Charges 8,879 8,879    
    K-1 Exp 1150 UNION INVESTORS L 4,554 4,554    
    K-1 Exp AIR U.S. LIFE FUND III 91,232 91,232    
    K-1 Exp AIR US LIFE FUND IV, L 30,250 30,250    
    K-1 Exp ALTAIR - PACIFIC COAST 19,138 19,017    
    K-1 Exp ALTAIR DIRECT LENDING 489 489    
    K-1 Exp ALTAIR SENIOR HOUSING 4,125 2,721    
    K-1 Exp ANAGENESIS CAPITAL PAR 132,910 131,625    
    K-1 Exp BW GAS & CONVENIENCE O 809 492    
    K-1 Exp ENLIGHTENMENT CAPITAL 34,886 34,886    
    K-1 Exp FALCON EDGE INDIA I LP 9,168 9,168    
    K-1 Exp FIRST EAGLE CLO EQUITY 22,404 12,436    
    K-1 Exp FOURTHSTONE SMALL-CAP 256 256    
    K-1 Exp GRANITE CREEK FLEXCAP 75,426 75,318    
    K-1 Exp GSO CAPITAL SOLUTIONS 7,606 2,264    
    K-1 Exp GSO CAPITAL SOLUTIONS 6,899 6,861    
    K-1 Exp GSO ENERGY SELECT OPPO 40,973 4,422    
    K-1 Exp GSO ENERGY SELECT OPPO 1,326 926    
    K-1 Exp GSO ENERGY SELECT OPPO 173 173    
    K-1 Exp GSO ENERGY SELECT OPPO 3,281 2,026    
    K-1 Exp PCCP EQUITY VII, LP 22,725 22,718    
    K-1 Exp PCCP EQUITY VIII, LP 5,652 5,649    
    K-1 Exp SILVERPEAK CREDIT OPPO 2,274 2,274    
    K-1 Exp THE EDGBASTON ASIAN EQ 3,100 2,974    
    Office & Supplies 30     30
    Postage/Delivery Service 107     107
    Registered Agent Fee 125     125
    State or Local Filing Fees 235     235
    Website Hosting/Support 480     480
    PARKING FEES 10,735     10,735


    TY 2020 OtherIncomeSchedule2
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    K-1 Inc/Loss 1150 UNION INVESTORS LLC -634 -634  
    K-1 Inc/Loss AIR U.S. LIFE FUND III, LP 77,177 77,177  
    K-1 Inc/Loss AIR US LIFE FUND IV, LP 1,162 1,162  
    K-1 Inc/Loss ALTAIR - PACIFIC COAST CPTL PTNRS EQU 26,431 29,704  
    K-1 Inc/Loss ALTAIR DIRECT LENDING FUND, LLC 85 85  
    K-1 Inc/Loss ALTAIR SENIOR HOUSING FUND (AEW), LLC -53,339 -3,834  
    K-1 Inc/Loss ANAGENESIS CAPITAL PARTNERS SBIC FUND 58,817 110,745  
    K-1 Inc/Loss BW GAS & CONVENIENCE ONSHORE FUND, LP -42,126 -42,126  
    K-1 Inc/Loss ENLIGHTENMENT CAPITAL SOLUTIONS FUND 64,777 64,777  
    K-1 Inc/Loss FIRST EAGLE CLO EQUITY FUND I, LP 74,756 57,584  
    K-1 Inc/Loss FOURTHSTONE SMALL-CAP FINANCIALS FD L 270 270  
    K-1 Inc/Loss GRANITE CREEK FLEXCAP II, L.P 84,052 84,052  
    K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II AIV-1 L -135 -40  
    K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II AIV-2 L 102,302 1,300  
    K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II LP 1,189 1,108  
    K-1 Inc/Loss GSO ENERGY SELECT OPPORTUNITIES FUND 46,917 -391  
    K-1 Inc/Loss GSO ENERGY SELECT OPPORTUNITIES FUND 10,185 6,289  
    K-1 Inc/Loss PCCP EQUITY VII, LP -9,522 972  
    K-1 Inc/Loss PCCP EQUITY VIII, LP -11,451 394  
    K-1 Inc/Loss SILVERPEAK CREDIT OPPORTUNITIES OFFSH 163,608 163,608  
    K-1 Inc/Loss THE EDGBASTON ASIAN EQUITY TRUST 49,168 49,168  
    K-1 Inc/Loss TRINITY CAPITAL FUND III, L.P -47,679 -47,679  
    Federal Tax Refund 37,273    
    Foreign Currency Gain 1,638 1,638  


    TY 2020 OtherIncreasesSchedule
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Description Amount
    RETURNED GRANT NEXT FISCAL YEAR 8,885


    TY 2020 OtherProfessionalFeesSchedule
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Administration of Foundation 29,721     29,721
    Investment Management Services 386,250 386,250    
    Website Development 2,058     2,058


    TY 2020 TaxesSchedule
    Name:
    David & Janet Polak Foundation
    EIN:
    45-4797578
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    990-PF Estimated Tax for 2020 32,700      
    990-T Extension for 2019 1,800      
    990-T Income Tax for 2019 91,871      
    Foreign Tax Paid 28,110 28,110    
    STATE TAXES WITHHELD BY PTSHP 2,984      
    STATE UBTI TAX 2019 38,209