-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0047
20
21
Open to Public Inspection
For calendar year 2021, or tax year beginning
01-01-2021
, and ending
12-31-2021
Name of foundation
SSIR CARES INC
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 2370
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
PARK CITY
,
UT
84060
A Employer identification number
81-1351995
B
Telephone number (see instructions)
(435) 729-9500
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
87,393
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
232,205
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
b
Gross sales price for all assets on line 6a
7
Capital gain net income (from Part IV, line 2)
...
0
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)
.......
12
Total.
Add lines 1 through 11
........
232,205
0
13
Compensation of officers, directors, trustees, etc.
0
0
0
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
430
0
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
430
0
0
25
Contributions, gifts, grants paid
.......
312,350
312,350
26
Total expenses and disbursements.
Add lines 24 and 25
312,780
0
312,350
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-80,575
b
Net investment income
(if negative, enter -0-)
0
c
Adjusted net income
(if negative, enter -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
1
Cash—non-interest-bearing
.............
167,968
87,393
87,393
2
Savings and temporary cash investments
.........
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
c
Investments—corporate bonds (attach schedule)
.......
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
167,968
87,393
87,393
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
)
23
Total liabilities
(add lines 17 through 22)
.........
0
0
Foundations that follow FASB ASC 958, check here
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
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
0
0
27
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
28
Retained earnings, accumulated income, endowment, or other funds
167,968
87,393
29
Total net assets or fund balances
(see instructions)
.....
167,968
87,393
30
Total liabilities and net assets/fund balances
(see instructions)
.
167,968
87,393
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
167,968
2
Enter amount from Part I, line 27a
.....................
2
-80,575
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
87,393
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
87,393
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.)
1a
b
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
b
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
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
and enter “N/A" on line 1.
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
0
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
0
6
Credits/Payments:
a
2021 estimated tax payments and 2020 overpayment credited to 2021
6a
0
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
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
0
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
0
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2022 estimated tax
Refunded
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.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
.........
4a
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)
UT
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 address
N/A
14
The books are in care of
THE FOUNDATION
Telephone no.
(435) 649-1884
Located at
PO BOX 2370
PARK CITY
UT
ZIP+4
84060
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part 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)
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
c
Organizations relying on a current notice regarding disaster assistance check here
........
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
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
..............................
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)
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
c
Organizations relying on a current notice regarding disaster assistance check here
.........
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
WHITNEY OLCH
DIRECTOR
1.00
0
0
0
1750 PARK AVENUE PO BOX 2370
PARK CITY
,
UT
84060
KATHLEEN MEARS
DIRECTOR
1.00
0
0
0
1750 PARK AVENUE PO BOX 2370
PARK CITY
,
UT
84060
HENRY MASTAIN
DIRECTOR
1.00
0
0
0
1750 PARK AVENUE PO BOX 2370
PARK CITY
,
UT
84060
RYAN KIRKHAM
DIRECTOR
1.00
0
0
0
1750 PARK AVENUE PO BOX 2370
PARK CITY
,
UT
84060
JEFF JUSTICE
DIRECTOR
1.00
0
0
0
1750 PARK AVENUE PO BOX 2370
PARK CITY
,
UT
84060
LAUREL SIMMONS
DIRECTOR
1.00
0
0
0
1750 PARK AVENUE PO BOX 2370
PARK CITY
,
UT
84060
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
...................
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
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
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
.........................
0
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
0
b
Average of monthly cash balances
.......................
1b
128,734
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
128,734
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
128,734
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions)
.............................
4
1,931
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3.
.......
5
126,803
6
Minimum investment return.
Enter 5% (0.05) of line 5
................
6
6,340
Part X
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part IX, line 6
..................
1
6,340
2a
Tax on investment income for 2021 from Part V, line 5
.......
2a
b
Income tax for 2021. (This does not include the tax from Part V.)
...
2b
c
Add lines 2a and 2b
............................
2c
0
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
6,340
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
6,340
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
6,340
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
6,340
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
......
b
From 2017
......
113,026
c
From 2018
......
156,134
d
From 2019
......
230,937
e
From 2020
......
241,617
f
Total
of lines 3a through e
........
741,714
4
Qualifying distributions for 2021 from Part
XI, line 4:
$
312,350
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
.....
6,340
e
Remaining amount distributed out of corpus
306,010
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).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
1,047,724
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)
...
0
9
Excess distributions carryover to 2022.
Subtract lines 7 and 8 from line 6a
......
1,047,724
10
Analysis of line 9:
a
Excess from 2017
....
113,026
b
Excess from 2018
....
156,134
c
Excess from 2019
....
230,937
d
Excess from 2020
....
241,617
e
Excess from 2021
....
306,010
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
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
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.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
WHITNEY OLCH
PO BOX 2370 1750 PARK AVENUE
PARK CITY
,
UT
84060
(435) 640-4147
WHITNEY.OLCH@SOTHEBYSREALTY.COM
b
The form in which applications should be submitted and information and materials they should include:
FILL OUT THE SSIR CARES, INC CHARITABLE CONTRIBUTION REQUEST FORM. INCLUDE: - CHARITY NAME AND CONTACT INFORMATION - COMPLETED FORM W-9 - RELATIONSHIP OF REQUESTOR TO THE ORGANIZATION - PURPORSE OF DONATION - WHAT KIND OF ADVERTISING/SIGNAGE/RECOGNISTION WILL SSIR CARES, INC RECEIVE - WILL AN EVENT SPONSORSHIP INCLUDE TICKETS? IF YES, HOW MANY - AMOUNT REQUESTED - DATE CONTRIBUTION IS NEEDED BY AND TO WHOM IT IS PAYABLE
c
Any submission deadlines:
MINIMUM OF 45 DAYS PRIOR TO THE GRANT DISTRIBUTION DEADLINE
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
- IN UTAH, A CHARITABLE ORGANIZATION IS REQUIRED TO BE REGISTERED WITH THE UTAH DIVISION OF CONSUMER PROTECTION BEFORE SOLICITING CHARITABLE CONTRIBUTIONS. - THE ORGANIZATION REQUESTING THE CONTRIBUTION MUST BE QUALIFIED AS A 501(C)(3) NON-PROFIT ORGANIZATION. - THE RECIPIENT IS A LOCAL COMMUNITY ORGANIZATION IN THE STATE OF UTAH. - MONEY DONATED WILL BE SPENT IN UTAH. - MONEY DONATED WILL DIRECTLY BENEFIT RESIDENTS OF UTAH. - MONEY DONATED WILL BENEFIT A LARGE NUMBER OF PEOPLE. - SSIR CARES, INC. RECEIVES RECOGNITION FOR ITS DONATIONS.
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)
a
Paid during the year
ALZHEIMER'S ASSOCIATION
222 N MICHIGAN AVE FL 17
CHICAGO
,
IL
60601
PUBLIC CHARITY
RESEARCH IN CURING ALZHEIMER'S
5,000
BACKPACKS FOR KIDS INC
3178 CANYON VIEW DR
SANTA CLARA
,
UT
84765
PUBLIC CHARITY
SUPPORT PROGRAM FOR CHILDREN
1,000
BALLET WEST
52 W 200 S
SALT LAKE CITY
,
UT
84101
PUBLIC CHARITY
PROMOTE BALLET
15,000
BIG BROTHERS BIG SISTERS OF UTAH
151 EAST 5600 SOUTH 200
MURRAY
,
UT
84107
PUBLIC CHARITY
SUPPORT MENTORING RELATIONSHIPS FOR YOUTH
3,000
BLUE ANGELS FOUNDATION
PO BOX 1945
PENSACOLA
,
FL
32591
PUBLIC CHARITY
SUPPORT WOUNDED VETERAN INITIATIVES
3,000
BONNEVILLE CYCLING CLUB
PO BOX 9241
SALT LAKE CITY
,
UT
84109
PUBLIC CHARITY
PROVIDE OPPORTUNITIES FOR RECREATION, FITNESS, ETC
5,000
BOOT - INDIAN HILLS ELEMENTARY
440 EAST 100 SOUTH
SALT LAKE CITY
,
UT
84111
PUBLIC CHARITY
EDUCATIONAL
500
CAMP HOBE' INC
PO BOX 520755
SALT LAKE CITY
,
UT
841520755
PUBLIC CHARITY
SUPPORT PROGRAM FOR CHILDREN BEING TREATED FOR CANCER
2,000
CARS 4 KIDS FOUNDATION INC
49 E 3300 S
SALT LAKE CITY
,
UT
84115
PUBLIC CHARITY
PROVIDE COMFORT HAPPINIESS AND MONETARY SUPPORT TO CRITICALLY ILL OR INJURED CHILDREN
2,000
CHOICE HUMANITARIAN
7879 S 1530 W 200
WEST JORDAN
,
UT
84088
PUBLIC CHARITY
ENDING EXTREME POVERTY
2,000
CHRISTIAN CENTER
1283 DEER VALLEY DRIVE
PARK CITY
,
UT
84068
PUBLIC CHARITY
PROVIDING A VARIETY OF SOCIAL SERVICES THAT SUPORT BASIC NEEDS.
3,000
CIRCLES SALT LAKE
150 SOUTH STATE STREET STE 160
SALT LAKE CITY
,
UT
84111
PUBLIC CHARITY
REDUCE POVERTY BY SUPPORTING FAMILIES ON THEIR JOURNEY
2,000
COMMUNITY FOR CHILDRENS JUSTICE
PO BOX 683564
PARK CITY
,
UT
84068
PUBLIC CHARITY
SUPPORT CHILD ABUSE VICTIMS & FAMILIES
3,000
CONNECT SUMMIT COUNTY
7120 CANYON DRIVE
PARK CITY
,
UT
84098
PUBLIC CHARITY
MENTAL HEALTH
3,000
CROSSROADS URBAN CENTER
1385 WEST INDIANA AVE
SALT LAKE CITY
,
UT
84104
PUBLIC CHARITY
ASSIST LOW INCOME FAMILIES
1,000
CURESEARCH FOR CHILDREN'S CANCER
PO BOX 45781
BALTIMORE
,
MD
21297
PUBLIC CHARITY
RESEARCH
2,500
DANIELLE BYRON HENRY MIGRAINE FOUNDATION
2936 E BENCHMARK DR
SALT LAKE CITY
,
UT
84109
PUBLIC CHARITY
RAISE AWARENESS & PROVIDE SUPPORT & ACCESS TO TREATMENT
1,000
DONORCONNECT
6065 S FASHION BLVD STE 125
MURRAY
,
UT
84107
PUBLIC CHARITY
CONNECTING DONORS WITH RECIPIENTS
1,000
EATS PARK CITY
PO BOX 682896
PARK CITY
,
UT
84068
PUBLIC CHARITY
PROVIDE HEALTHY MEALS FOR SCHOOLS
3,000
EGYPTIAN THEATRE
PO BOX 3119
PARK CITY
,
UT
84060
PUBLIC CHARITY
COMMUNITY ASSETT DEDICATED TO ENRICHING LIVES THRU ARTS
3,000
FHF MEXICO INC
1744 SOUTH VAL VISTA DRIVE SUITE
217
MESA
,
AZ
85204
PUBLIC CHARITY
PROVIDES FOOD COMMODITIES TO LOCAL FAMILIES
1,000
FRIENDS OF SUMMIT COUNTY SEARCH & RESCUE FUND
PO BOX 682800
PARK CITY
,
UT
84068
PUBLIC CHARITY
RESCUE & SERVICE OF RESIDENTS OR VISITORS THAT FIND THEMSELVES IN DISTRESS
3,000
FRIENDS OF SWITCHPOINT INC
948 N 1300W
ST GEORGE
,
UT
84770
PUBLIC CHARITY
ASSISTING THE HOMELESS THROUGH EDUCATION AND PLAN
1,000
FRIENDS OF THE UTAH AVALANCHE FORECAST CENTER INC
PO BOX 521353
SALT LAKE CITY
,
UT
84152
PUBLIC CHARITY
PROVIDE AVALANCHE SAFETY AND EDUCATION TO THE PUBLIC
3,000
GREAT BASIN K-9 SAR INC
2577 N HWY 162 1051
EDEN
,
UT
84310
PUBLIC CHARITY
TRAIN K-9 TEAMS TO PROVIDE K9 SERVICES TO PUBLIC SAFETY ORGANIZATIONS
3,000
HABITAT FOR HUMANITY OF SUMMIT & WASATCH COUNTIES
PO BOX 68274
PARK CITY
,
UT
84068
PUBLIC CHARITY
PROVIDE HOUSING FOR UNDER-SERVED
3,000
HOLY CROSS MINISTRIES
860 E 4500 S
SALT LAKE CITY
,
UT
84107
PUBLIC CHARITY
HELPING THE UNDERSERVED COMMUNITY'S NEED FOR HEALTH AND WELL-BEING
5,500
HUNTSMAN CANCER FOUNDATION
500 HUNTSMAN WAY
SALT LAKE CITY
,
UT
84108
SO III FI
SUPPORTING THE EDUCATIONAL, RESEARCH, AND HEALTH PROMOTION ACTIVITIES OF THE HEALTH SCIENCES CENTER OF THE UNIVERSITY OF UTAH
8,000
JDRF INTERNATIONAL
26 BROADWAY 15TH FL
NEW YORK
,
NY
10004
PUBLIC CHARITY
RESEARCH TO CURE, PREVENT AND TREAT TYPE 1 DIABETES
7,500
JEWISH FAMILY SERVICE
3201 S TAMARAC DR
DENVER
,
CO
80231
PUBLIC CHARITY
IMPROVING THE LIVES OF INDIVIDUALS & FAMILIES WITH SUPPORING SERVICES
3,000
JOURNEY OF HOPE INC
PO BOX 160
LIBERTY MILLS
,
IN
46946
PUBLIC CHARITY
EDUCATION
2,500
JUNIOR LEAGUE OF SALT LAKE CITY
526 E 300 S
SALT LAKE CITY
,
UT
84102
PUBLIC CHARITY
DEVELOPING THE POTENTIAL OF WOMEN & IMPROVING COMMUNITIES
500
KIMBALL ART CENTER
PO BOX 1478
PARK CITY
,
UT
84060
PUBLIC CHARITY
PROMOTE ARTS
3,000
KOSTOPULOS DREAM FOUNDATION
4180 EMIGRATION CANYON RD
SALT LAKE CITY
,
UT
84108
PUBLIC CHARITY
DEDICATED TO IMPROVING THE QUALITY OF LIFE THRU EDUCATION & GROWTH
2,000
KPCW
PO BOX 1372
PARK CITY
,
UT
84060
PUBLIC CHARITY
PROMOTE PUBLIC RADIO
3,000
MAKE-A-WISH FOUNDATION
771 E WINCHESTER
MURRAY
,
UT
84107
PUBLIC CHARITY
CREATE LIFE-CHANGING WISHES FOR CHILDREN WITH CRITICAL ILLNESSES
5,000
MEMORY MATTERS UTAH
168 N 100 E 104
ST GEORGE
,
UT
84770
PUBLIC CHARITY
INCREASE WELLNESS FOR INDIVIDUALS WITH DEMENTIA AND THEIR CAREGIVERS
1,500
MOUNTAIN LANDS COMMUNITY HOUSING TRUST
1960 SIDEWINDER DR STE 107
PARK CITY
,
UT
84060
PUBLIC CHARITY
PROVIDE AFFORDABLE HOUSING
3,000
MOUNTAIN MEDIATION CENTER INC
PO BOX 681552
PARK CITY
,
UT
84068
PUBLIC CHARITY
PROVIDES MEDIATION AND FACILITATION SERVICES
3,000
MOUNTAIN TOWN STAGES
PO BOX 680896
PARK CITY
,
UT
84068
PUBLIC CHARITY
PRODUCE, FOSTER AND SUPPORT LIVE MUSIC
3,000
MOUNTAIN TRAILS FOUNDATION
PO BOX 754
PARK CITY
,
UT
84060
PUBLIC CHARITY
BUILD, MAINTAIN AND ADVOCATE FOR NON-MOTORIZED TRAILS IN PARK CITY AND AROUND UTAH
5,000
NATIONAL ABILITY CENTER
PO BOX 682799
PARK CITY
,
UT
84068
PUBLIC CHARITY
PROMOTE ADAPTIVE RECREATION
2,000
NATIONAL MULTIPLE SCLEROSIS SOCIETY
733 THIRD AVENUE
NEW YORK
,
NY
10017
PUBLIC CHARITY
RESEARCH TO CURE, PREVENT AND TREAT MULTIPLE SCLEROSIS
2,000
NEEDS BEYOND MEDICINE
PO BOX 712043
SALT LAKE CITY
,
UT
84171
PUBLIC CHARITY
HELP CANCER PATIENTS WITH NON-MEDICAL EXPENSES AND EDUCATIONAL OUTREACH ON SIGNS AND SYMPTOMS OF CANCER.
1,000
NEIGHBORHOOD HOUSE ASSOCIATION
1050 WEST 500 SOUTH
SALT LAKE CITY
,
UT
84104
PUBLIC CHARITY
CULTIVATING A SAFE NEIGHBORHOOD THRU EDUCATION OUTREACH & ADVOCACY
1,000
NUZZLES & CO
PO BOX 682155
PARK CITY
,
UT
84068
PUBLIC CHARITY
PROTECT AND PROVIDE FOR ANIMALS
3,250
OPERATION UNDERGROUND RAILROAD
700 N VALLEY ST STE B
ANAHEIM
,
CA
92801
PUBLIC CHARITY
FIGHT SEX TRAFFICKING
7,500
PARK CITY COMMUNITY FOUNDATION
PO BOX 681499
PARK CITY
,
UT
84068
PUBLIC CHARITY
SUPPORT THE COMMUNITY
8,000
PARK CITY EDUCATION FOUNDATION
PO BOX 681422
PARK CITY
,
UT
84068
PUBLIC CHARITY
SUPPORT HIGH-IMPACT PROGRAMS THAT ADVANCE STUDENT ACHIEVEMENT
17,100
PARK CITY FILM SERIES AND PARK CITY FILM
PO BOX 683058
PARK CITY
,
UT
84060
PUBLIC CHARITY
TO CREATE COMMUNITY THRU FILM
3,000
PARK CITY HISTORICAL SOCIETY & MUSEUM
PO BOX 555
PARK CITY
,
UT
84060
PUBLIC CHARITY
PRESERVE HISTORY
3,000
PARK CITY READS
1109 FOXCREST DR
PARK CITY
,
UT
84098
PUBLIC CHARITY
RECOGNIZING, EDUCATING & ADVOCATING FOR DYSLEXIC STUDENTS
3,000
PARK CITY TOTS INC
1850 SIDEWINDER DR 410
PARK CITY
,
UT
84060
PUBLIC CHARITY
PROVIDING HIGH QUALITY, AFFORDABLE AND SAFE CHILDCARE
3,000
PAWS FOR LIFE
PO BOX 70
HEBER CITY
,
UT
84032
PUBLIC CHARITY
ANIMAL RESCUE
1,500
PEACE HOUSE INC
1960 SIDEWINDER DRIVE SUITE 208
PARK CITY
,
UT
84060
PUBLIC CHARITY
SUPPORT & DEDICATION TO END FAMILY VIOLENCE & ABUSE
5,500
PEOPLE'S HEALTH CLINIC
PO BOX 681558 650 ROUND VALLEY DR
PARK CITY
,
UT
80468
PUBLIC CHARITY
PROVIDE AFFORDABLE HEALTHCARE
5,000
PLAYING FOR LIFE FOUNDATION
PO BOX 681332
PARK CITY
,
UT
84068
PUBLIC CHARITY
TO RAISE FUNDS TO BENEFIT BREAST CANCER RESEARCH
1,500
PROJECT HOPE 4 KIDS
1220 19TH ST NW SUITE 800
WASHINGTON
,
DC
20036
PUBLIC CHARITY
HELPING REFUGEE CHILDREN AND THEIR FAMILIES
1,000
PURE MIDWAY
1526 W UTE BLVD STE 203
PARK CITY
,
UT
84098
PUBLIC CHARITY
DEDICATED TO PRESERVING THE RURAL OPEN SPACE HERITAGE
2,500
RECYCLE UTAH
PO BOX 682998 1951 WOODBINE WAY
PARK CITY
,
UT
84068
PUBLIC CHARITY
PROMOT RECYCLING
1,500
RESCUE MISSION OF SALT LAKE
463 S 400 W
SALT LAKE CITY
,
UT
84101
PUBLIC CHARITY
PROVIDE SHELTER FOR HOMELESS
3,000
RISE INC
725 MAIN ST 228
WOODLAND
,
CA
95695
PUBLIC CHARITY
PROVIDES SOCIAL SERVICES
1,000
SAINT GEORGE BICYCLE COLLECTIVE
2312 S WEST TEMPLE
SALT LAKE CITY
,
UT
84115
PUBLIC CHARITY
REFURBISHES DONATED BICYCLES AND PROVIDES TO NEEDY CHILDREN.
1,000
SUMMIT COMMUNITY GARDENS
PO BOX 683984
PARK CITY
,
UT
84068
PUBLIC CHARITY
TO BOND OVER PLANTING SEEDS TO NOURISH OUR BODIES WITH FRESH GROWN FRUITS & VEGETABLES
3,000
SUMMIT COUNTY CLUBHOUSE
PO BOX 680861
PARK CITY
,
UT
84068
PUBLIC CHARITY
AN INCLUSINVE COMMUNITY IN WHICH ALL ADULTS LIVING WITH A MENTAL HEALTH DIAGNOSIS ACHIEVE POTENTIAL
3,000
SUMMIT LAND CONSERVANCY
PO BOX 1775
PARK CITY
,
UT
84060
PUBLIC CHARITY
PROTECT AND PRESERVE LAND AND WATER FOR THE BENEFIT OF PEOPLE AND NATURE
3,000
SWANER NATURE PRESERVE
1445 OLD MAIN HILL
LOGAN
,
UT
84322
PUBLIC CHARITY
PRESERVE NATURE
3,000
TAYLOR HAGEN MEMORIAL INC
6376 S CRESTMOUNT CIRCLE
SALT LAKE CITY
,
UT
84121
PUBLIC CHARITY
SUICIDE PREVENTION
2,500
TEE IT UP FOUNDATION
7364 TALL OAKS CIRCLE
PARK CITY
,
UT
84098
PUBLIC CHARITY
CANCER RESEARCH
5,000
THE CANYONS SCHOOL DISTRICT EDUCATION FOUNDATION
9361 S 300 E
SANDY
,
UT
84070
PUBLIC CHARITY
EDUCATION
2,500
THE CHILDREN'S CENTER
6800 NW 39TH EXPRESSWAY
BETHANY
,
OK
73008
PUBLIC CHARITY
24-HR MEDICAL AND RESPIRATORY CARE FOR CHILDREN
2,000
THE CHRISTMAS BOX INTERNATIONAL
3660 SOUTH WEST TEMPLE
SALT LAKE CITY
,
UT
84115
PUBLIC CHARITY
WORKS TO PREVENT CHILD ABUSE AND DEFEND CHILDREN.
9,500
THE INTERNATIONAL RESCUE COMMITTEE INC
PO BOX 6068
ALBERT LEA
,
MN
56007
PUBLIC CHARITY
PROVIDES FOOD, MEDICAL CARE, AND EMERGENCY SUPPLIES TO REFUGEE FAMILIES
3,000
THE LEUKEMIA & LYMPHOMA SOCIETY
PO BOX 22324
NEW YORK
,
NY
10087
PUBLIC CHARITY
WORK TO CURE LEUKEMIA, LYMPHOMA, HODGKIN'S DISEASE AND MYELOMA, AND IMPROVE THE QUALITY OF LIFE OF PATIENTS AND THEIR FAMILIES
2,500
THE ROAD HOME
PO BOX 2788
SALT LAKE CITY
,
UT
84110
PUBLIC CHARITY
TO INVIDIDUALLY ASSESS & SERVE THE HOMELESS & NEAR HOMELESS
2,500
UNIVERSITY OF UTAH
101 S WASATCH DR
SALT LAKE CITY
,
UT
84112
PUBLIC CHARITY
SUPPORT LOCAL PBS AFFILIATE
1,000
UTAH CLEAN AIR PARTNERSHIP INC
195 N 1950 W
SALT LAKE CITY
,
UT
84116
PUBLIC CHARITY
SUPPORT CLEAN AIR FOR UTAH
3,000
UTAH OLYMPIC LEGACY FOUNDATION
PO BOX 980337 3419 OLYMPIC PKWY
PARK CITY
,
UT
84098
PUBLIC CHARITY
SUPPORT ACTIVE LIFESTYLES
8,000
UTAH OPEN LANDS CONSERVATION ASSOCIATION
1488 S MAIN STREET
SALT LAKE CITY
,
UT
84115
PUBLIC CHARITY
PRESERVE & PROTECT LAND FOR COMMUNITIES & TOMORROW'S GENERATION
3,000
UTAH SYMPHONY & OPERA
123 WEST SOUTH TEMPLE
SALT LAKE CITY
,
UT
84101
PUBLIC CHARITY
CONNECT THE COMMUNITY THROUGH LIVE MUSIC
3,000
UTAH VETERANS ALLIANCE
230 W 200 S 2607
SALT LAKE CITY
,
UT
84101
PUBLIC CHARITY
SUPPORT VETERANS
5,000
WASATCH COMMUNITY FOUNDATION
PO BOX 399
HEBER CITY
,
UT
84032
PUBLIC CHARITY
SCHOLARSHIP PROGRAM
8,000
WEILENMANN SCHOOL OF DISCOVERY
4237 KILBY RD
PARK CITY
,
UT
84098
PUBLIC CHARITY
SUPPORT ACADEMIC EXCELLENCE
13,000
WILD UTAH PROJECT
824 SOUTH 400 WEST SUITE B119
SALT LAKE CITY
,
UT
84101
PUBLIC CHARITY
PROVIDES SCIENCE BASED STRATEGIES FOR WILDLIFE & LAND CONSERVATION
3,000
WILDLAND FIREFIGHTER FOUNDATION
2393 W AIRPORT WAY
BOISE
,
ID
83705
PUBLIC CHARITY
HELP THE FAMILIES OF FIREFIGHTERS KILLED IN THE LINE OF DUTY AND TO ASSIST INJURED FIREFIGHTERS AND THEIR FAMILIES
2,000
YOUTH SPORTS ALLIANCE
PO BOX 381698
PARK CITY
,
UT
84060
PUBLIC CHARITY
SUPPORT YOUTH SPORTS
7,000
PARK CITY SUMMIT COUNTY ARTS COUNCIL
PO BOX 4455
PARK CITY
,
UT
84060
PUBLIC CHARITY
TO SERVE OUR ARTS & CULTURE COMMUNITY BY DRIVING CREATIVE PROGRAMMING, PROVIDING VALUABLE RESOURCES, AND CULTIVATING CONNECTIONS.
3,000
KINDNESSORG INC
1350 AVENUE OF THE AMERICAS FL 2
NEW YORK
,
NY
10019
PUBLIC CHARITY
EDUCATE AND INSPIRE PEOPLE TO CHOOSE KINDNESS
2,500
TALL MOUNTAIN WELLNESS
950 WILLIAMSTOWN CT
PARK CITY
,
UT
84098
PUBLIC CHARITY
PUBLIC HEALTH
1,500
Total
.................................
3a
312,350
b
Approved for future payment
Total
.................................
3b
0
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.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
4
Dividends and interest from securities
....
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than
inventory
............
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
0
0
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
0
(See worksheet in line 13 instructions to verify calculations.)
Part XV-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part 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?
...........
Yes
No
b
If "Yes," complete the following schedule.
(a)
Name of organization
(b)
Type of organization
(c)
Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
May the IRS discuss this return
with the preparer shown below?
See instructions.
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's EIN
Firm's address
Phone no.
Form
990-PF
(2021)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description
-
TIN:
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Attach to Form 990, 990-EZ, or 990-PF.
Go to
www.irs.gov/Form990
for the latest information.
OMB No. 1545-0047
20
21
Name of the organization
SSIR CARES INC
Employer identification number
81-1351995
Organization type
(check one):
Filers of:
Section:
Form 990 or 990-EZ
501(c)(
) (enter number) organization
4947(a)(1) nonexempt charitable trust
not
treated as a private foundation
527 political organization
Form 990-PF
501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501(c)(3) taxable private foundation
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
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.
Special Rules
For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33
1
/3
% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of
(1)
$5,000 or
(2)
2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000
exclusively
for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions
exclusively
for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an
exclusively
religious, charitable, etc., purpose. Don't complete any of the parts unless the
General Rule
applies to this organization because it received
nonexclusively
religious, charitable, etc., contributions totaling $5,000 or more during the year
.........
$
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. 30613X
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page
2
Name of organization
SSIR CARES INC
Employer identification number
81-1351995
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
SLAGER LIZ
1260 STRINGHAM AVENUE
SALT LAKE CITY
,
UT
84106
$
14,000
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
2
WILSON BRIAN
PO BOX 2370
PARK CITY
,
UT
84060
$
6,038
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
3
ORMAN KERRY
13693 S 200 W SUITE 100
DRAPER
,
UT
84020
$
6,369
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
4
SWAN MICHAEL
PO BOX 2370
PARK CITY
,
UT
84060
$
7,680
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
5
WRIGHT THOM
362 N MAIN STREET
HEBER CITY
,
UT
84032
$
6,924
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
6
EASTMAN MICHELLE
PO BOX 2370
PARK CITY
,
UT
84060
$
5,108
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)
Name of organization
SSIR CARES INC
Employer identification number
81-1351995
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
7
MAIZLISH SCOTT
PO BOX 2370
PARK CITY
,
UT
84060
$
5,727
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
8
BOLDUC ONIE
PO BOX 2370
PARK CITY
,
UT
84020
$
9,115
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
9
CAHILL JILLINE
PO BOX 2370
PARK CITY
,
UT
84020
$
5,485
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
10
CHRISTIANSON BYRON
PO BOX 2370
PARK CITY
,
UT
84020
$
5,902
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
11
FISHER BENJAMIN
PO BOX 2370
PARK CITY
,
UT
84020
$
7,721
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
12
FISHER STAN
PO BOX 2370
PARK CITY
,
UT
84020
$
6,542
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)
Name of organization
SSIR CARES INC
Employer identification number
81-1351995
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
13
FROST JAMISON
PO BOX 2370
PARK CITY
,
UT
84020
$
7,796
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
14
HALL SHEILA
PO BOX 2370
PARK CITY
,
UT
84020
$
5,000
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
15
HORN KELLY
PO BOX 2370
PARK CITY
,
UT
84020
$
22,346
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
16
LINDNER VALEN
PO BOX 2370
PARK CITY
,
UT
84020
$
7,708
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
17
MCCLELLAND CAREN
PO BOX 2370
PARK CITY
,
UT
84020
$
6,297
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
18
NOEL GARRETT
PO BOX 2370
PARK CITY
,
UT
84020
$
6,928
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)
Name of organization
SSIR CARES INC
Employer identification number
81-1351995
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
19
OLCH WHITNEY
PO BOX 2370
PARK CITY
,
UT
84020
$
9,160
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
20
OTT WILL
PO BOX 2370
PARK CITY
,
UT
84020
$
7,704
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page
3
Name of organization
SSIR CARES INC
Employer identification number
81-1351995
Part II
Noncash Property
(see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
$
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page
4
Name of organization
SSIR CARES INC
Employer identification number
81-1351995
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.)
$
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:
-
TIN:
TY 2021 CashDeemedCharitableExplnStmt
Name:
SSIR CARES INC
EIN:
81-1351995
Explanation:
ALL CASH HELD AT THIS TIME IS TO BE DISTRIBUTED IN THE NEXT YEAR TO SELECTED CHARITIES
-
TIN:
TY 2021 OtherExpensesSchedule
Name:
SSIR CARES INC
EIN:
81-1351995
Description
Revenue and Expenses per Books
Net Investment Income
Adjusted Net Income
Disbursements for Charitable Purposes
BANK FEES
430
0
0