Form990-PF
Click to see attachment
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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 01-01-2021 , and ending 12-31-2021
Name of foundation
A to Z Impact Foundation
 
% Foundation Source
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

47-1982106
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$14,975,106J 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) 3,133,750
2 Check bullet.............
3 Interest on savings and temporary cash investments 625 625  
4 Dividends and interest from securities... 13,663 13,663  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 1,074,773
b Gross sales price for all assets on line 6a 1,092,843
7 Capital gain net income (from Part IV, line 2)... 1,810,617
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 144,229 145,004 36,493
12 Total. Add lines 1 through 11........ 4,367,040 1,969,909 36,493
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0      
14 Other employee salaries and wages...... 211,923 10,788   201,135
15 Pension plans, employee benefits....... 47,785 1,895   45,890
16a Legal fees (attach schedule)......... Click to see attachment 13,841 0 0 13,841
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... Click to see attachment 788 300   488
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 21,010      
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings....... 2,567 199   2,368
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 125,993 76,043   49,934
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 423,907 89,225 0 313,656
25 Contributions, gifts, grants paid....... 313,240 313,240
26 Total expenses and disbursements. Add lines 24 and 25 737,147 89,225 0 626,896
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 3,629,893
b Net investment income (if negative, enter -0-) 1,880,684
c Adjusted net income (if negative, enter -0-)... 36,493
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......... 1,419,785 3,101,005 3,101,005
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)....... 417,717 Click to see attachment417,717 415,712
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).......... 7,279,480 Click to see attachment8,518,094 9,660,439
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment1,128,000 Click to see attachment1,838,059 Click to see attachment1,797,950
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 10,244,982 13,874,875 14,975,106
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 10,244,982 13,874,875
29 Total net assets or fund balances (see instructions)..... 10,244,982 13,874,875
30 Total liabilities and net assets/fund balances (see instructions). 10,244,982 13,874,875
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
10,244,982
2
Enter amount from Part I, line 27a .....................
2
3,629,893
3
Other increases not included in line 2 (itemize) bullet
3
 
4
Add lines 1, 2, and 3 ..........................
4
13,874,875
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
13,874,875
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 Publicly-traded Securities      
b Passthrough K1 Capital Gain/(Loss)      
c DEERFIELD - DEERFIELD SPECIAL SITUATIONS FUND L.P P 2015-01-01 2021-11-19
d
e
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a 1,088,889   397,905 690,984
b       1,138,130
c 3,954   22,451 -18,497
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a       690,984
b        
c       -18,497
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 1,810,617
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  
3 Add lines 1 and 2........................... 3 26,142
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 26,142
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 21,800
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 5,400
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 27,200
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. Click to see attachment 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 1,058
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet1,058 RefundedBullet 11  
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)
    bulletDE
    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 addressbullet  
    14
    The books are in care ofbulletFoundation Source Telephone no.bullet (800) 839-1754

    Located atbullet501 Silverside Road Suite 123WilmingtonDE ZIP+4bullet198091377
    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)
    Yes
     
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
    Yes
     
    (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)
     
    No
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.) ...............
    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
     
    No
    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)
    Yes
     
    (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)
     
    No
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........
    5b
     
    No
    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
    Yes
     
    If "Yes," attach the statement required by Regulations section 53.4945–5(d). Click to see attachment
    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
    Andrea Kaplan Dir, VP
    1.0     		0 0 0
    Foundation Source 501 Silverside Rd
    Wilmington,DE198091377
    Jeffrey Kaplan Pres, Dir, Sec, Treas
    20.0     		0 0 0
    Foundation Source 501 Silverside Rd
    Wilmington,DE198091377
    Michael Kaplan Dir
    40.0     		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
    ALEXANDER JOHN EVANGELIDES Foundation Person
    40.0     		71,923 6,269  
    1354 GRASSY BROOK RD
    BROOKLINE,VT05345
    MICHAEL KAPLAN EXECUTIVE DIR
    40.0     		140,000 23,780  
    117 MAIN ST
    SEYMOUR,CT06483
    Total number of other employees paid over $50,000...................bullet  
    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
     
    Total number of others receiving over $50,000 for professional services.............bullet  
    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 MY AGRO PRI- TO FUND EXPENSES DIRECTLY RELATED TO RELIEVING POVERTY BY TRANSFORMING THE LIVES OF SMALL-SCALE FARMERS 625,000
    2 MY AGRO PRI - TO FUND EXPENSES DIRECTLY RELATED TO RELIEVING POVERTY BY TRANSFORMING THE LIVES OF SMALL-SCALE FARMERS; ORIGINAL AMOUNT OF $500,000 WAS RECOVERED DURING YEAR 1 0
    All other program-related investments. See instructions.
    3 Click to see attachment 851,500
    Total. Add lines 1 through 3.........................bullet1,476,500
    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
    416,282
    b
    Average of monthly cash balances.......................
    1b
    1,850,586
    c
    Fair market value of all other assets (see instructions)................
    1c
    8,016,594
    d
    Total (add lines 1a, b, and c).........................
    1d
    10,283,462
    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
    10,283,462
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    154,252
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    10,129,210
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    506,461
    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
    506,461
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    26,142
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    26,142
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    480,319
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    766,441
    5
    Add lines 3 and 4............................
    5
    1,246,760
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
    7
    1,246,760
    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 1,246,760
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only.......  
    b Total for prior years:2019, 2018, 2017  
    3 Excess distributions carryover, if any, to 2021:
    a From 2016......  
    b From 2017...... 25,973
    c From 2018...... 1,299,754
    d From 2019......  
    e From 2020...... 680,570
    f Total of lines 3a through e ........ 2,006,297
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 2,103,396
    a Applied to 2020, but not more than line 2a  
    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 2021 distributable amount..... 1,246,760
    e Remaining amount distributed out of corpus 856,636
    5 Excess distributions carryover applied to 2021.    
    (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 2,862,933
    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 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) .......     		 
    8 Excess distributions carryover from 2016 not
    applied on line 5 or line 7 (see instructions) ...     		 
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		2,862,933
    10 Analysis of line 9:
    a Excess from 2017.... 25,973
    b Excess from 2018.... 1,299,754
    c Excess from 2019....  
    d Excess from 2020.... 680,570
    e Excess from 2021.... 856,636
    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).)
    Jeffrey Kaplan
    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
    C Dieu- Nalio
    463 West Street Apt A628
    New York,NY10014     		NONE I Short-term Emergency Assistance Grant 3,000
    COMMUNITY ANIMAL RESCUE EFFORT INC
    PO BOX 691
    SKOKIE,IL60076     		N/A PC General & Unrestricted 1,875
    CONSERVATIVE SYNAGOGUE OF FIFTH AVENUE
    FIFTH AVE 11 EAST 11TH STREET
    NEW YORK,NY10003     		N/A PC Sam Swartz Wheelchair Fund 1,180
    DASRA
    ONE RIVERWAY STE 1900
    HOUSTON,TX77056     		N/A PC General & Unrestricted 50,000
    DECORAH COVENANT CHURCH DECORAH IA
    115 WASHINGTON ST
    DECORAH,IA52101     		N/A PC Nan Akou Cumberland Presbyterian Church in Haiti for Earthquake Relief run by Pastor Sheslaire 5,000
    DENVER RESCUE MISSION
    PO BOX 5206
    DENVER,CO80217     		N/A PC General & Unrestricted 1,176
    FRIENDS OF SIVANANDA ASHRAM YOGA IN THE CARIBBEAN
    555 THEODORE FREMD AVE
    RYE,NY10580     		N/A PC Help the Ashram Reopen Initiative 1,000
    J Beeks
    413 W 16th Street 2D
    New York,NY10011     		NONE I Short-term Emergency Assistance Grant 2,500
    KING BAUDOUIN FOUNDATION UNITED STATES INC
    10 ROCKEFELLER PL 16TH FL
    NEW YORK,NY10020     		N/A PC American Friends of the Rachel Swart Fund 10,530
    LIFE HOUSE FOUNDATION FOR CHILDREN
    PO BOX 1005
    GLENDORA,CA91740     		N/A PC Little Dreamers Academy, Uganda. 3,570
    LONG ISLAND COUNCIL OF CHURCHES
    1644 DENTON GREEN
    HEMPSTEAD,NY11550     		N/A PC The Freeport Food Pantry February Food Drive 750
    LTP FOUNDATION INC
    360 MADISON AVE
    NEW YORK,NY10017     		N/A PC General & Unrestricted 150,000
    M Solomon
    515 W 42ND ST NYNY
    Bronx,NY10453     		NONE I Short-term Emergency Assistance Grant 2,500
    NYAYA HEALTH A NONPROFIT CORPORATION - POSSIBLE
    99 WALL ST 4100
    NEW YORK,NY10005     		N/A PC COVID Relief Fund 10,000
    QUEENS COMMUNITY HOUSE INC
    10825 62ND DR
    FOREST HILLS,NY11375     		N/A PC General & Unrestricted 1,000
    RED DOOR COMMUNITY INC
    195 W HOUSTON ST
    NEW YORK,NY10014     		N/A PC Charitable Event 29,204
    SPREAD THE LOVE
    25797 CONIFER RD
    CONIFER,CO80433     		N/A PC General & Unrestricted 1,080
    THE WATER TRUST INC
    PO BOX 4668 75942
    NEW YORK,NY10163     		N/A PC General & Unrestricted 25,000
    THE WATER TRUST INC
    PO BOX 4668 75942
    NEW YORK,NY10163     		N/A PC Charitable Event 5,000
    WOMEN FOR AFGHAN WOMEN INC
    15824 73RD AVE
    FRESH MEADOWS,NY11366     		N/A PC General & Unrestricted 1,875
    ZANMI BENI FOUNDATION INC
    6201 RIVIERA DR
    CORAL GABLES,FL33146     		N/A PC General & Unrestricted 2,000
    ZANMI BENI FOUNDATION INC
    6201 RIVIERA DR
    CORAL GABLES,FL33146     		N/A PC Charitable Event 5,000
    Total .................................bullet 3a 313,240
    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 ...........     		    14 625  
    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 ............     		525990 1 18 1,074,772  
    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 -775 14 108,511  
    bINTEREST INCOME FROM PRIS         36,493
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. -774 1,197,571 36,493
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    1,233,290
    (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.)
    11 Interest income from Program Related Investment, COMMUNITY INVESTMENT PRI 5YR - TO ADDRESS THE SOCIAL AND ECONOMIC HEALTH NEEDS OF THE DISADVANTAGED
    11 Interest income from program related investment, ONE ACRE FUND PRI - TO PROVIDE FARM FAMILES WITH TOOLS AND FINANCING TO GROW THEIR WAY OUT OF HUNGER AND POVERTY BY OFFERING BASIC AGRICULTURAL TRAINING IN SUB-SAHARAN AFRICA
    11 Interest Income from program related investment, Community investment PRI 1y- TO ADDRESS THE SOCIAL AND ECONOMIC NEEDS OF THE DISADVANTAGED IN COMMUNITY DEVELOPMENT
    11 Interest income from program related investment, community housing capital Inc- TO FUND LOANS TO ANY ORGANIZATIONS DEVELOPING AFFORDABLE HOUSING & PROTECTING THE ENVIRONMENT.
    11 Interest income from Program Related Investment MyAgro Farms, See Part IX-B for a description of this program-related investment
    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
    Schedule B
    (Form 990)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors

    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
    OMB No. 1545-0047
    2021
    Name of the organization
    A to Z Impact Foundation
     
    Employer identification number

    47-1982106
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ






    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
    or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990) (2021)
    Schedule B (Form 990) (2021) Page 2
    Name of organization
    A to Z Impact Foundation
          		Employer identification number
    47-1982106
    Part I
    Contributors
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
    Kaplan Jeffrey
    117 Main St
     
    Seymour, CT06483

    		$ 3,133,750


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

    		$  


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

    		$  


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

    		$  


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

    		$  


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

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 3
    Name of organization
    A to Z Impact Foundation
          		Employer identification number

    47-1982106
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
    1
    		 DEERFIELD PARTNERS, L.P $ 1,000,000 2021-07-01
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
    1
    		 MANKIND CORP. MNKD, 250000 sh. $ 1,133,750 2021-12-28
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 4
    Name of organization
    A to Z Impact Foundation
          		Employer identification number

    47-1982106
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990) (2021)
    Additional Data


    Software ID:  
    Software Version:  

    TY 2021 AllOthProgRltdInvestmentsSch
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    Category Amount
    OPEN ROAD IMPACT FUND 4% PRI- TO PROVIDE FINANCIAL P&S TO ESTABLISHED SOCIAL ENT AND NON-PROFIT, DOM&INT, WHO REQUIRE SHORT-TERM BRIDGE FINANCING WHILE WAITING FOR COMMITED FUND 350,000
    RH CAPITAL FUND II PRI-TO ACCELERATE INNOVATION&AVAILABILITY OF REPRODUCTIVE HEALTH SOLUTIONS FOR WOMEN IN UNDERSERVED COMMUNITIES, WOMEN OF COLOR, MEDICAID PATIENTS & LOW INCOME 175,000
    COLLAB FUND PRI- TO PROVIDE ACCESS TO CAPITAL TO UNDERRESSOURCED & UNDERNETWORKED BLACK BUSINESS OWNERS WITH RESPECT TO VENTURE CAPITAL & GROWTH OPPORTUNITIES IN USA 166,500
    GLOBAL PTN/ELEOS SOCAL VENTURE PRI- TO EXPAND OPPORTUNITY FOR PEOPLE LIVING IN POVERTY 10,000
    OPEN ROAD IMPACT FUND 2% PRI- TO PROVIDE FINANCIAL PRODUCTS & SVCS TO SOCIAL ENTERPRISES AND NON-PROFITS WHO REQUIRE SHORT-TERM BRIDGE FINANCING WHILE WAITING FOR COMMITED FUNDS 150,000

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

    TY 2021 DepreciationSchedule
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    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 2021 ExpenditureResponsibilityStmt
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    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
    RH CAPITAL FUND II LP
          		47 Kearny Street
    San Francisco,CA94108     		2021-02-09 175,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   None necessary
    Collab Fund I LLC
          		384 Northyards Blvd NW
    Atlanta,GA30313     		2021-03-25 166,500 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   None necessary
    Open Road Impact Fund LLC
          		301 Commerce Street Suite 301
    Fort Worth,TX76102     		2021-11-09 150,000 PRI LOAN-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   None necessary
    Open Road Impact Fund LLC
          		301 Commerce Street Fort
    Fort Worth,TX76102     		2021-11-09 350,000 PRI LOAN-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   None necessary

    TY 2021 GeneralExplanationAttachment
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    Identifier Return Reference Explanation
    FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: RH CAPITAL FUND II, L.P. TOTAL AMOUNT OF PRI FUNDS DISBURSED: $175,000 DATES OF PRI: This PRI was made in multiple installments on the following dates: 2/9/2021 - $50,000 3/9/2021 - $75,000 11/3/2021 - $50,000 PURPOSE OF PRI: To accelerate innovation and increase the availability of reproductive health solutions for all women, and in particular for women in underserved communities, women of color, Medicaid patients and low-income women. REPORTS OF AMOUNTS EXPENDED: Recipient 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:10/13/2022 FOR FYE 12/31/2021 This investment remained on the foundation's books as of 12/31/2021. 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 VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: Collab Fund I, LLC DATE OF PRI: 3/25/2021 TOTAL AMOUNT OF PRI FUNDS DISBURSED: $166,500 PURPOSE OF PRI: To provide access to capital to black business owners who have historically been under-resourced and under-networked with respect to venture capital funding and growth opportunities in the United States REPORTS OF AMOUNTS EXPENDED: Recipient 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:10/12/2022 FOR FYE 12/31/2021 This investment remained on the foundation's books as of 12/31/2021. 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.
    PART I LINE 6A (990-PF) PART I LINE 6A (990-PF) 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): $1,074,771 TOTAL NOT INCLUDED IN PART IV: PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - UBI NET GAIN/(LOSS): $1 TOTAL PART I, LINE 6A: $1,074,772 DETAILS OF ASSETS INCLUDED IN PART IV: PUBLICLY-TRAIDED SECURITIES GROSS SALES PRICE: $1,088,889 BOOK BASIS: $1,133,750 NET GAIN/(LOSS): $(40,861) PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - NON UBI NET GAIN/(LOSS): $1,138,130 SALES OF OTHER ITEMIZED ASSETS GROSS SALES PRICE: $3,954 BOOK BASIS: $22,452 NET GAIN/(LOSS): $(18,498)
    FORM 990-PF FORM 990-PF One or more partnerships in which the foundation was invested in 2021 have provided a Schedule K-1 indicating that a Schedule K-3 would be provided, but it was not provided. As a result, there is insufficient information to allow Foundation Source, as tax preparer, to ascertain whether there is missing information about direct or indirect foreign investments that might have affected any item on this return or required additional forms to be filed. The Foundation has prepared this return to the best of its ability and without any foreign filings for such partnerships based on the information provided to it by these partnerships 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.
    FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: Open Road Impact Fund LLC DATE OF PRI: 11/9/2021 TOTAL AMOUNT OF PRI FUNDS DISBURSED: $150,000 PURPOSE OF PRI: To provide financial products and services to established social enterprises and non-profits, domestically and internationally, who require short-term bridge financing while waiting for committed funding. REPORTS OF AMOUNTS EXPENDED: Recipient is expected to submit 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 in 2022. This investment remained on the foundation's books as of 12/31/2021. 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 VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: Open Road Impact Fund LLC DATE OF PRI: 11/9/2021 TOTAL AMOUNT OF PRI FUNDS DISBURSED: $350,000 PURPOSE OF PRI: To provide financial products and services to established social enterprises and non-profits, domestically and internationally, who require short-term bridge financing while waiting for committed funding. REPORTS OF AMOUNTS EXPENDED: Recipient is expected to submit 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 in 2022. This investment remained on the foundation's books as of 12/31/2021. 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.

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    Name of Stock End of Year Book Value End of Year Fair Market Value
    MAINSTAY SHORT DURATION HIGH Y 416,088 411,193
    UNITEDHEALTH GROUP INC 1,629 4,519

    TY 2021 InvestmentsOtherSchedule2
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    CONTEXT PARTNERS OFFSHORE, L.P   1,000,000 1,495,728
    DEERFIELD PARTNERS, L.P   6,784,930 6,367,404
    ELEVAR EQUITY IV, L.P   349,023 1,289,668
    ILLUMEN CAPITAL LP   212,173 318,014
    IMPACT VENTURES IV, LP   171,968 189,625

    TY 2021 LegalFeesSchedule
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Document Review/Drafting 12,978     12,978
    General Consultations 863     863


    TY 2021 OtherAssetsSchedule
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    COMMUNITY INVESTMENT NOTE, 5 Y   250,000 250,000
    GLOBAL PTN/ELEOS SOCIAL VENTUR   61,559 61,559
    PRI - COLLAB FUND I, LLC - 0%   166,500 147,214
    PRI - MYAGRO FARMS - 5% - 09/3   625,000 625,000
    PRI - ONE ACRE FUND - 2%   60,000 60,000
    PRI - OPEN ROAD IMPACT FUND LL   150,000 150,000
    PRI - OPEN ROAD IMPACT FUND SU   350,000 350,000
    PRI - RH CAPITAL FUND II, L.P.   175,000 154,177


    TY 2021 OtherExpensesSchedule
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Administrative Fees 35,613     35,613
    Bank Charges 90 90    
    Cell Phone Expense 1,743 57   1,686
    Computers/Electronic Devices 1,976     1,976
    Equipment/Furniture Purchase 321     321
    Foundation Dues & Memberships 7,299     7,299
    K-1 Exp DEERFIELD PARTNERS, L. 33,004 32,992    
    K-1 Exp DEERFIELD SPECIAL SITU 259 259    
    K-1 Exp ELEVAR EQUITY IV, L.P 9,952 9,951    
    K-1 Exp ILLUMEN CAPITAL LP 16,962 16,959    
    K-1 Exp IMPACT VENTURES IV, LP 15,725 15,725    
    OFFICE SUPPLIES 484     484
    EQUIPMENT MAINTENANCE 137     137
    DIGITAL SUBSCRIPTIONS 221 10   211
    Payroll Processing Fees 982     982
    State or Local Filing Fees 25     25
    Training & Professional Develo 1,200     1,200


    TY 2021 OtherIncomeSchedule2
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    K-1 Inc/Loss DEERFIELD PARTNERS, L.P 105,126 105,901  
    K-1 Inc/Loss DEERFIELD SPECIAL SITUATIONS FUND L.P 781 781  
    K-1 Inc/Loss ELEVAR EQUITY IV, L.P 1,436 1,436  
    K-1 Inc/Loss ILLUMEN CAPITAL LP 287 287  
    K-1 Inc/Loss IMPACT VENTURES IV, LP 106 106  
    Interest Income from PRIs 36,493 36,493 36,493


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Investment Management Services 300 300    
    Website Development 488     488


    TY 2021 TaxesSchedule
    Name:
    A to Z Impact Foundation
    EIN:
    47-1982106
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    990-PF Estimated Tax for 2021 4,500      
    990-PF Extension for 2020 16,510