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. 1545-0047
2021
Open to Public Inspection
For calendar year 2021, or tax year beginning 07-01-2021 , and ending 06-30-2022
Name of foundation
AHS FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)90 S 7TH STREET 11TH FLOOR N 9305
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MINNEAPOLIS, MN55402
A Employer identification number

41-0944654
B Telephone number (see instructions)

(888) 730-4933
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$9,465,485J 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)  
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 191,401 191,401  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 258,297
b Gross sales price for all assets on line 6a 1,611,966
7 Capital gain net income (from Part IV, line 2)... 258,297
8 Net short-term capital gain......... 0
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 66,803 44,323  
12 Total. Add lines 1 through 11........ 516,501 494,021  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0   0
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule).........       0
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... Click to see attachment 92,343 92,343   0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... Click to see attachment 35,079 1,847   0
19 Depreciation (attach schedule) and depletion... 0 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......   0 0  
22 Printing and publications..........   0 0  
23 Other expenses (attach schedule)....... Click to see attachment 14,602 14,529   25
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 142,024 108,719 0 25
25 Contributions, gifts, grants paid....... 550,000 550,000
26 Total expenses and disbursements. Add lines 24 and 25 692,024 108,719 0 550,025
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -175,523
b Net investment income (if negative, enter -0-) 385,302
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2021)
Form 990-PF (2021)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing.............      
2 Savings and temporary cash investments......... 562,568 69,215 69,215
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
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 bullet0      
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)   Click to see attachment1,264,286 1,227,652
b Investments—corporate stock (attach schedule).......   Click to see attachment3,714,244 5,251,120
c Investments—corporate bonds (attach schedule).......   Click to see attachment2,157,869 1,929,605
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 7,695,551 Click to see attachment997,620 987,893
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) 8,258,119 8,203,234 9,465,485
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
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........ 8,258,119 8,203,234
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 8,258,119 8,203,234
30 Total liabilities and net assets/fund balances (see instructions). 8,258,119 8,203,234
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
8,258,119
2
Enter amount from Part I, line 27a .....................
2
-175,523
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
122,780
4
Add lines 1, 2, and 3 ..........................
4
8,205,376
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
2,142
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
8,203,234
Form 990-PF (2021)
Form 990-PF (2021)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)		 (b)
How acquired
P—Purchase
D—Donation 		(c)
Date acquired
(mo., day, yr.) 		(d)
Date sold
(mo., day, yr.)
1 a 317. AARON'S CO INC/THE     2021-07-15
b 239. AARON'S CO INC/THE     2021-07-15
c 18. VANGUARD SHORT-TERM TREASURY     2021-07-15
d 234. ALLISON TRANSMISSION HOLDINGS     2021-07-22
e 56. WNS HOLDINGS LTD ADR   2017-01-05 2021-07-22
112. MAXLINEAR INC   2015-03-11 2021-07-30
8. WNS HOLDINGS LTD ADR   2017-01-05 2021-07-30
73. COLLIERS INTERNATIONAL GROUP     2021-08-26
6241. ISHARES CORE MSCI EAFE ETF     2021-09-14
719. SAP SE     2021-09-14
230.121 WF ULTR SHORT-TRMINCOME-I#3104   2021-03-31 2021-10-18
135. MAXLINEAR INC   2015-03-11 2021-11-12
160. INTERDIGITAL INC     2022-01-18
86. MAXLINEAR INC   2015-03-11 2022-01-18
81. NV5 GLOBAL INC     2022-01-18
75000. ENTERPRISE PRODUCTS 3.500% 2/01/22   2020-08-27 2022-02-01
81. VANGUARD SHORT-TERM TREASURY     2022-03-08
3. VANGUARD SHORT-TERM TREASURY   2020-07-08 2022-03-08
.358 S&P GLOBAL INC   2016-07-13 2022-03-10
336. META PLATFORMS INC     2022-04-06
75000. HCP INC 3.400% 2/01/25   2019-07-30 2022-04-07
46. ISHARES MBS ETF   2021-10-18 2022-04-07
2143. ISHARES MBS ETF     2022-04-07
50000. VERIZON COMMUNICATIO 3.500% 11/01/24   2018-01-11 2022-04-07
100000. DR PEPPER SNAPPLE GR 3.430% 6/15/27     2022-04-13
1318. ISHARES CMBS ETF   2022-04-07 2022-04-13
898. AVAYA HLDGS CORP     2022-04-27
100000. US TREASURY NOTE 0.125% 4/30/22   2020-05-07 2022-04-30
99. BRIGHT HORIZONS FAMILY SOLUTIO     2022-05-04
241. VANGUARD SHORT-TERM TREASURY     2022-05-04
50000. GLAXOSMITHKLINE CAPI 2.850% 5/08/22   2018-03-19 2022-05-08
909.221 WF ULTR SHORT-TRMINCOME-I#3104   2021-03-31 2022-05-09
230. MAXIMUS INC   2018-05-18 2022-05-16
48. WNS HOLDINGS LTD ADR   2017-01-05 2022-05-16
125. LCI INDUSTRIES     2022-05-24
196. MASTEC INC COM   2014-11-17 2022-06-16
11. VANGUARD SHORT-TERM TREASURY   2022-01-18 2022-06-16
298. MAXLINEAR INC     2022-06-30
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
CAPITAL GAIN DIVIDENDS P    
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a 8,893   6,615 2,278
b 6,704   1,752 4,952
c 1,106   1,120 -14
d 9,218   4,792 4,426
e 4,562   1,525 3,037
5,396   920 4,476
657   218 439
9,763   4,598 5,165
485,677   370,675 115,002
104,262   40,731 63,531
1,977   1,979 -2
9,290   1,109 8,181
10,985   9,523 1,462
5,459   706 4,753
9,233   4,471 4,762
75,000   78,210 -3,210
4,857   4,980 -123
180   187 -7
142   41 101
74,971   40,597 34,374
75,084   77,133 -2,049
4,604   4,962 -358
214,481   235,824 -21,343
50,784   50,714 70
99,254   101,849 -2,595
64,950   65,019 -69
9,169   17,245 -8,076
100,000   99,965 35
9,541   10,057 -516
14,170   14,692 -522
50,000   49,599 401
7,665   7,819 -154
14,905   14,333 572
3,426   1,307 2,119
13,266   17,802 -4,536
13,744   4,912 8,832
643   666 -23
9,965   5,022 4,943
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
      27,983
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a       2,278
b       4,952
c       -14
d       4,426
e       3,037
      4,476
      439
      5,165
      115,002
      63,531
      -2
      8,181
      1,462
      4,753
      4,762
      -3,210
      -123
      -7
      101
      34,374
      -2,049
      -358
      -21,343
      70
      -2,595
      -69
      -8,076
      35
      -516
      -522
      401
      -154
      572
      2,119
      -4,536
      8,832
      -23
      4,943
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
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 2 258,297
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  
Form 990-PF (2021)
Form 990-PF (2021)
Page 4
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here 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 All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 5,356
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 5,356
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 5,384
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 5,384
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 28
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet28 RefundedBullet 11 0
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XIV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletMN
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
    If "Yes," complete Part XIII .............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 5
    Part VI-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletWELLS FARGO BANK Telephone no.bullet (888) 730-4933

    Located atbullet100 N MAIN STWINSTON SALEMNC ZIP+4bullet27101
    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 2021, 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 VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........
    1a(1)
     
    No
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person? ..............................
    1a(2)
     
    No
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
    1a(3)
     
    No
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
     
    No
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)? ......................
    1a(5)
    Yes
     
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.) ...............
    1a(6)
     
    No
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........
    1b
    Yes
     
    c
    ........bullet
    d
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2021? .............
    1d
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    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? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2021.) .....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    No
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals? .............
    5a(5)
    Yes
     
    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
    Yes
     
    c
    .........bullet
    d
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant? .................
    5d
     
     
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract? .............................
    6a
     
    No
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    7a
     
    No
    b
    If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .........................
    8
     
    No
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    LEE SCHUBERT PRESIDENT
    1     		0    
    PO BOX 339 WHITE OAK GROVE
    FAR HILLS,NJ07931
    CHRISTOPHER SCHUBERT VICE PRESIDENT
    1     		0    
    4125 ASHWORTH AVE NORTH
    SEATTLE,WA98103
    DAVID A SCHUBERT VICE PRESIDENT
    1     		0    
    PO BOX 1486
    CONCORD,MA01742
    THOMAS WRIGHT SECRETARY TREASURER
    1     		0    
    907 WEST MINNEHAHA PKWY
    MINNEAPOLIS,MN55419
    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
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 7
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    ABBOT DOWNING AGENT 92,343
    6325 S RAINBOW BLVD STE 300
    LAS VEGAS,NV89118
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part VIII-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1  
    2  
    3  
    4  
    Part VIII-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    10,649,836
    b
    Average of monthly cash balances.......................
    1b
    535,852
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    11,185,688
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    11,185,688
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    167,785
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    11,017,903
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    550,895
    Part X
    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 IX, line 6..................
    1
    550,895
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    5,356
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    5,356
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    545,539
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    2,750
    5
    Add lines 3 and 4............................
    5
    548,289
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
    7
    548,289
    Part XI
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
     
    b
    Program-related investments—total from Part VIII-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4.
    4
     
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 9
    Part XII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2020     		(c)
    2020     		(d)
    2021
    1 Distributable amount for 2021 from Part X, line 7 548,289
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016...... 16,801
    b From 2017...... 18,621
    c From 2018...... 8,130
    d From 2019...... 11,055
    e From 2020...... 19,871
    f Total of lines 3a through e ........ 74,478
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 550,025
    a Applied to 2020, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		0
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2021 distributable amount..... 548,289
    e Remaining amount distributed out of corpus 1,736
    5 Excess distributions carryover applied to 2021. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 76,214
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2021. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2022 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		0
    8 Excess distributions carryover from 2016 not
    applied on line 5 or line 7 (see instructions) ...     		16,801
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		59,413
    10 Analysis of line 9:
    a Excess from 2017.... 18,621
    b Excess from 2018.... 8,130
    c Excess from 2019.... 11,055
    d Excess from 2020.... 19,871
    e Excess from 2021.... 1,736
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2021, enter the date of the ruling ....... 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) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part IX, line 6 for each year listed ..     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XIV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    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 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 (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    EBB & FLOW ARTS
    PO BOX 1081
    KULA,HI96790     		NONE PC GENERAL SUPPORT 15,000
    BIRTHING BEAUTIFUL COMMUNITIES
    5000 EUCLID AVENUE 400
    CLEVELAND,OH44103     		NONE PC GENERAL SUPPORT 20,000
    CDLS FOUNDATION INC
    30 TOWER LANE SUITE 400
    CLEVELAND HEIGHTS,CT06001     		NONE PC GENERAL SUPPORT 5,000
    FAMILY TREE CLINIC
    1619 DAYTON AVENUE SUITE 205
    ST PAUL,MN55104     		NONE PC GENERAL SUPPORT 5,000
    LAKE ERIE INK
    2843 WASHINGTON BOULEVARD
    CLEVELAND HEIGHTS,OH44118     		NONE PC GENERAL SUPPORT 10,000
    HEIGHTS ARTS
    2175 LEE ROAD
    CLEVELAND HEIGHTS,OH44118     		NONE PC GENERAL SUPPORT 5,000
    FRESNO FREE COLLEGE FOUNDATION
    PO BOX 4364
    FRESNO,CA93744     		NONE PC GENERAL SUPPORT 2,500
    ROOTT
    2533 SUMMIT STREET
    COLUMBUS,OH43202     		NONE PC GENERAL SUPPORT 10,000
    SOUL FIRE FARM INSTITUTE INC
    1972 RT 2
    PETERSBURGH,NY12138     		NONE PC GENERAL SUPPORT 2,500
    INTERFAITH WORKING GROUP
    6757 GREENE STREET SUITE 200
    PHILADELPHIA,PA19119     		NONE PC GENERAL SUPPORT 40,000
    GIANT STEPS THERAPEUTIC EQUESTRIAN
    1320 COMMERCE ST SUTIE A
    PETALUMA,CA94954     		NONE PC GENERAL SUPPORT 11,000
    CENTER FOR PUPPETRY ARTS
    1404 SPRING STREET NW
    ATLANTA,GA30309     		NONE PC GENERAL SUPPORT 2,500
    SLIDE RANCH
    2025 SHORELINE HWY
    MUIR BEACH,CA94965     		NONE PC GENERAL SUPPORT 10,000
    THE FRIENDS OF THE BANCROFT LIBRARY
    UC BERKELEY C/O THE BANCROFT LIBRAR
    BERKELEY,CA94720     		NONE PC GENERAL SUPPORT 2,000
    LAKE COUNTRY HISTORICAL SOCIETY
    PO BOX 128
    TWO HARBORS,MN55616     		NONE PC GENERAL SUPPORT 1,300
    MAUI POPS ORCHESTRA
    PO BOX 532357
    KIHEI,HI96753     		NONE PC GENERAL SUPPORT 7,500
    JONES HARRISON FOUNDATION
    3700 CEDAR LAKE AVENUE
    MINNEAPOLIS,MN55416     		NONE PC GENERAL SUPPORT 2,000
    OAKLAND CHILDREN'S FAIRYLAND INC
    669 BELLEVUE AVENUE
    OAKLAND,CA94610     		NONE PC GENERAL SUPPORT 4,000
    RAILS-TO-TRAILS CONSERVANCY
    2121 WARD COURT NW FIFTH FLOOR
    WASHINGTON,DC20037     		NONE PC GENERAL SUPPORT 5,500
    MILL VALLEY PUBLIC LIBRARY FDN
    375 THROCKMORTON AVENUE
    MILL VALLEY,CA94941     		NONE PC GENERAL SUPPORT 1,500
    CITY YEAR
    287 COLUMBUS AVENUE
    BOSTON,MA02116     		NONE PC GENERAL SUPPORT 3,000
    REGIONAL ARTS & CULTURE COUNCIL
    411 NW PARK AVE
    PORTLAND,OR97209     		NONE PC GENERAL SUPPORT 2,500
    NEW YORK COMMON PANTRY
    8 EAST 109TH STREET
    NEW YORK,NY10029     		NONE PC GENERAL SUPPORT 3,000
    PINE STREET INN
    444 HARRISON AVENUE
    BOSTON,MA02118     		NONE PC GENERAL SUPPORT 12,000
    KIDDO
    409 SYCAMORE AVENUE
    MILL VALLEY,CA94941     		NONE PC GENERAL SUPPORT 6,000
    CITIZEN SCHOOLS
    308 CONGRESS STREET 5TH FLOOR
    BOSTON,MA02210     		NONE PC GENERAL SUPPORT 3,000
    C&S PATIENT EDUCATION FOUNDATION
    320 OSPREY COURT
    WEXFORD,PA15090     		NONE PC GENERAL SUPPORT 1,000
    OAKLAND PARKS & RECREATION FDN
    PO BOX 13267
    OAKLAND,CA94661     		NONE PC GENERAL SUPPORT 3,000
    CAMP SUNSHINE AT SEBAGO LAKE
    35 ACADIA ROAD
    CASCO,ME04015     		NONE PC GENERAL SUPPORT 3,000
    AMAZON CONSERVATION ASSOCIATION
    1012 14TH ST NW SUITE 625
    WASHINGTON,DC20005     		NONE PC GENERAL SUPPORT 1,750
    FEEDING THE GULF COAST
    5248 MOBILE SOUTH STREET
    THEODORE,AL36582     		NONE PC GENERAL SUPPORT 3,000
    COMMUNITY FOOD BANK INC
    PO BOX 26727
    TUCSON,AZ85726     		NONE PC GENERAL SUPPORT 3,750
    SUNSHINE DIVISION INC
    687 NORTH THOMPSON
    PORTLAND,OR97229     		NONE PC GENERAL SUPPORT 2,000
    DIPSEA RACE FOUNDATION
    PO BOX 10
    MILL VALLEY,CA94942     		NONE PC GENERAL SUPPORT 2,500
    ST THERESE FOUNDATION INC
    1660 S HWY 100 SUITE 103
    ST LOUIS PARK,MN55416     		NONE PC GENERAL SUPPORT 3,500
    MERCY CORPS
    PO BOX 2669
    PORTLAND,OR97208     		NONE PC GENERAL SUPPORT 2,500
    CLEVELAND SOCIETY FOR THE BLIND
    1909 EAST 101ST ST PO BOX 1988
    CLEVELAND,OH44106     		NONE PC GENERAL SUPPORT 2,500
    THE TREVOR PROJECT
    PO BOX 69232
    WEST HOLLYWOOD,CA90069     		NONE PC GENERAL SUPPORT 8,000
    SIDE BY SIDE
    300 SUNNY HILLS DRIVE
    SAN ANSELMO,CA94960     		NONE PC GENERAL SUPPORT 6,500
    STEP UP FOR STUDENTS
    PO BOX 54367
    JACKSONVILLE,FL33245     		NONE PC GENERAL SUPPORT 3,000
    MOUNTAIN PLAY ASSOCIATION
    1556 4TH STREET SUITE B
    SAN RAFAEL,CA94901     		NONE PC GENERAL SUPPORT 10,000
    SAGE
    305 SEVENTH AVENUE
    NEW YORK,NY10001     		NONE PC GENERAL SUPPORT 2,700
    MAUI NUI BOTANICAL GARDENS
    PO BOX 6040
    KAHULUI,HI96733     		NONE PC GENERAL SUPPORT 8,500
    EDWINS LEADERSHIP AND RESTAURANT IST
    13101 SHAKER SQUARE
    CLEVELAND,OH44120     		NONE PC GENERAL SUPPORT 2,500
    OPEN ARMS
    2524 16TH AVENUE SOUTH
    SEATTLE,WA98144     		NONE PC GENERAL SUPPORT 2,500
    BASTYR UNIVERSITY
    14500 JUANITA DRIVE NE
    KENMORE,WA98028     		NONE PC GENERAL SUPPORT 2,500
    SARVVEY WILDLIFE CARE CENTER
    13106 148TH ST NE PO BOX 3590
    ARLINGTON,WA98223     		NONE PC GENERAL SUPPORT 2,500
    EARSHOT JAZZ
    3429 FREMONT PLACE N
    SEATTLE,WA98103     		NONE PC GENERAL SUPPORT 5,000
    SEATTLE REPERTORY THEATER
    155 MERCER STREET
    SEATTLE,WA98109     		NONE PC GENERAL SUPPORT 7,500
    SOUJOURNS COMMUNITY HEALTH CLINIC
    4923 US ROUTE 5
    WESTMINSTER,VT05158     		NONE PC GENERAL SUPPORT 2,500
    FRIENDS OF THE AUBERRY LIBRARY
    PO BOX 157
    AUBERRY,CA93602     		NONE PC GENERAL SUPPORT 5,000
    YOUNG MUSICIANS AND ARTISTS
    220 NW 8TH AVENUE
    PORTLAND,OR97209     		NONE PC GENERAL SUPPORT 2,000
    WASHBURN UNIVERSITY
    1729 SW MACVICAR AVENUE
    TOPEKA,KS66604     		NONE PC GENERAL SUPPORT 25,000
    OREGON SHAKESPEARE FESTIVAL
    15 S PIONEER ST
    ROCHESTER,NY14619     		NONE PC GENERAL SUPPORT 5,000
    RECLAIM
    771 RAYMOND AVENUE
    ST PAUL,MN55114     		NONE PC GENERAL SUPPORT 50,000
    INDIAN LAND TENURE FOUNDATION
    151 COUNTY ROAD B2 EAST
    ST PAUL,MN55117     		NONE PC GENERAL SUPPORT 5,000
    DIAN FOSSEY GORILLA FUND INTL
    800 CHEROKEE AVE SE
    ATLANTA,GA30315     		NONE PC GENERAL SUPPORT 2,500
    HOPEWELL
    147 BELL STREET SUITE 303
    CHAGRIN FALLS,OH44022     		NONE PC GENERAL SUPPORT 2,500
    INNOCENCE PROJECT INC
    40 WORTH STREET SUITE 701
    NEW YORK,NY10013     		NONE PC GENERAL SUPPORT 2,500
    RUFFING MONTESSORI SCHOOL
    3380 FAIRMOUNT BLVD
    CLEVELAND HEIGHTS,OH44118     		NONE PC GENERAL SUPPORT 2,500
    THE NATURE CENTER AT SHAKER LAKES
    2600 SOUTH PARK BLVD
    CLEVELAND,OH44120     		NONE PC GENERAL SUPPORT 2,500
    MIDDLE EAST CHILDREN'S ALLIANCE
    1101 8TH STREET SUITE 100
    BERKELEY,CA94710     		NONE PC GENERAL SUPPORT 5,000
    EQUAL JUSTICE INITIATIVE
    122 COMMERCE STREET
    MONTGOMERY,AL36104     		NONE PC GENERAL SUPPORT 8,000
    SIERRA FOOTHILLS CONSERVANCY
    PO BOX 529
    PRATHER,CA93651     		NONE PC GENERAL SUPPORT 10,000
    WEECYCLE
    20 S HAVANA STREET
    AURORA,CO80012     		NONE PC GENERAL SUPPORT 40,000
    GIRLS ON THE RUN ROCKIES
    7000 E BELLEVIEW AVE
    GREENWOOD VILLAGE,CO80111     		NONE PC GENERAL SUPPORT 25,000
    ORION
    187 MAIN STREET
    GREAT BARRINGTON,MA01230     		NONE PC GENERAL SUPPORT 5,000
    SOMA AQUATICS FOUNDATION
    1528 SARKESIAN DRIVE
    PETALUMA,CA94954     		NONE PC GENERAL SUPPORT 2,500
    BLACK MAMAS MATTER ALLIANCE
    1237 RALPH DAVID ABERNATHY BLVD
    ATLANTA,GA30310     		NONE PC GENERAL SUPPORT 5,000
    POLICY MATTERS OHIO
    3641 PERKINS AVE
    CLEVELAND,OH44114     		NONE PC GENERAL SUPPORT 5,000
    NAACP LEGAL DEFENSE FUND
    40 RECTOR ST
    NEW YORK,NJ10006     		NONE PC GENERAL SUPPORT 8,500
    CLEVELAND FOOD BANK
    15500 SOUTH WATERLOO ROAD
    CLEVELAND,OH44110     		NONE PC GENERAL SUPPORT 2,500
    RED CLOUD INDIAN SCHOOL
    100 MISSION DRIVE
    PINE RIDGE,SD57770     		NONE PC GENERAL SUPPORT 2,500
    WYOMING OUTDOOR COUNCIL
    262 LINCOLN STREET
    LANDER,WY82520     		NONE PC GENERAL SUPPORT 2,500
    THIRD WAVE FUND
    228 PARK AVE
    NEW YORK,NY10003     		NONE PC GENERAL SUPPORT 5,000
    BOYS AND GIRLS CLUB OF NE OHIO
    6114 BROADWAY AVENUE
    CLEVELAND,OH44127     		NONE PC GENERAL SUPPORT 2,500
    SOUTHERN POVERTY LAW CENTER
    400 WASHINGTON AVE
    MONTGOMERY,AL36104     		NONE PC GENERAL SUPPORT 5,000
    CENTER FOR BIOLOGICAL DIVERSITY
    PO BOX 710
    TUSCON,AZ85702     		NONE PC GENERAL SUPPORT 5,000
    POVERELLO HOUSE
    PO BOX 12225
    FRESNO,CA93777     		NONE PC GENERAL SUPPORT 5,000
    HESPERIAN HEALTH GUIDES
    1919 ADDISON ST
    BERKELEY,CA94704     		NONE PC GENERAL SUPPORT 5,000
    CHICAGO WOMENS HEALTH CENTER
    1025 W SUNNYSIDE AVE
    CHICAGO,IL60640     		NONE PC GENERAL SUPPORT 2,500
    STRATFORD SHAKESPEARE FEST AMERICA
    34 GEORGE STREET EAST
    STRATFORD,CT48226     		NONE PC GENERAL OPERATING 5,000
    URBAN COMMUNITY SCHOOL
    4909 LORAIN AVENUE
    CLEVELAND,OH44102     		NONE PC GENERAL OPERATING 2,500
    GREATER CLEVELAND CONGREGATIONS
    6114 FRANCIS AVE
    CLEVELAND,OH44127     		NONE PC GENERAL OPERATING 2,500
    Total .................................bullet 3a 550,000
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 12
    Part XV-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments ....          
    3 Interest on savings and temporary cash
    investments ...........     		         
    4 Dividends and interest from securities ....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6 Net rental income or (loss) from personal property          
    7 Other investment income .....          
    8 Gain or (loss) from sales of assets other than
    inventory ............     		    18 258,297  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aFROM PARTNERSHIP/S     		    1 42,875  
    bCLASS ACTION     1 1,448  
    cPARTNERSHIP UBIT 900099 22,480      
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 22,480 494,021  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    516,501
    (See worksheet in line 13 instructions to verify calculations.)
    Part XV-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 XV-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 (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    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 (2021)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2021 InvestmentsCorpBondsSchedule
    Name:
    AHS FOUNDATION
    EIN:
    41-0944654
    Name of Bond End of Year Book Value End of Year Fair Market Value
    SEE ATTACHED 2,157,869 1,929,605

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    AHS FOUNDATION
    EIN:
    41-0944654
    Name of Stock End of Year Book Value End of Year Fair Market Value
    SEE ATTACHED 3,714,244 5,251,120

    TY 2021 InvestmentsGovtObligationsSch
    Name:
    AHS FOUNDATION
    EIN:
    41-0944654
    US Government Securities - End of Year Book Value:

    1,264,286
    US Government Securities - End of Year Fair Market Value:

    1,227,652
    State & Local Government Securities - End of Year Book Value:


     
    State & Local Government Securities - End of Year Fair Market Value:


     


    TY 2021 InvestmentsOtherSchedule2
    Name:
    AHS FOUNDATION
    EIN:
    41-0944654
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    SEE ATTACHED AT COST 313,534 303,807
    LYME FOREST FUND V FB TAX-EXEM AT COST 305,488 305,488
    RRG SUSTAINABLE WATER IMPACT F AT COST 138,973 138,973
    FUNDAMTNEAL PARTNERS III LP AT COST 239,625 239,625

    TY 2021 OtherDecreasesSchedule
    Name:
    AHS FOUNDATION
    EIN:
    41-0944654
    Description Amount
    COST BASIS ADJ 926
    CY POAI C/O 1,216


    TY 2021 OtherExpensesSchedule
    Name:
    AHS FOUNDATION
    EIN:
    41-0944654
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    STATE FILING FEE 25 0   25
    ADR FEES 341 341   0
    PARTNERSHIP EXPENSES 14,236 14,188   0


    TY 2021 OtherIncomeSchedule2
    Name:
    AHS FOUNDATION
    EIN:
    41-0944654
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    FROM PARTNERSHIP/S-CORP 65,355 42,875  
    CLASS ACTION 1,448 1,448  


    TY 2021 OtherIncreasesSchedule
    Name:
    AHS FOUNDATION
    EIN:
    41-0944654
    Description Amount
    GRANT RECOVERY 2,750
    PARTNERSHIP ADJ 112,093
    PY POAI C/O 1,539
    WASH SALE ADJ 3,998
    RECOVERY OF PY ATTORNEY FEES 2,400


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    AHS FOUNDATION
    EIN:
    41-0944654
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT MNGT FEES 92,343 92,343    


    TY 2021 TaxesSchedule
    Name:
    AHS FOUNDATION
    EIN:
    41-0944654
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL TAX PAYMENT PRIOR YEAR 22,000 0   0
    FOREIGN TAXES 1,847 1,847   0
    ESTIMATED EXCISE PAYMENTS 11,232 0   0