TY 2021 Form 990PF

- TIN:

Form990-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.
bullet

Go 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
CASSIOPEIA FOUNDATION INC

Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 5246
Room/suite

City or town, state or province, country, and ZIP or foreign postal code
CHARLOTTESVILLE, VA22905

A Employer identification number

13-6034219

B Telephone number (see instructions)

(434) 296-2156

C If exemption application is pending, check here bullet

G Check all that apply: Initial returnInitial return of a former public charity
Final returnAmended return
Address change Name change

D 1. Foreign organizations, check here............. bullet

2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet

E If private foundation status was terminated
under section 507(b)(1)(A), check here ....... bullet

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 ....... bullet

I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16) bullet

$51,360,049J Accounting method: Cash Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)

	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)	20,000
2	Check .............
3	Interest on savings and temporary cash investments
4	Dividends and interest from securities...	827,508		827,508
5a	Gross rents............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10		-4,095,160
b	Gross sales price for all assets on line 6a 6,099,706
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).......		173,355	103,355	70,000
12	Total. Add lines 1 through 11........	-3,074,297		930,863	70,000
13	Compensation of officers, directors, trustees, etc.	275,000		27,500	0	247,500
14	Other employee salaries and wages......	130,000		13,000	0	117,000
15	Pension plans, employee benefits.......	20,619		2,062	0	18,557
16a	Legal fees (attach schedule).........		29,754	0	1,305	28,449
b	Accounting fees (attach schedule).......		149,922	74,961	0	72,961
c	Other professional fees (attach schedule)....		1,582,877	1,531,113	0	51,764
17	Interest...............
18	Taxes (attach schedule) (see instructions)...		36,487	2,217	0	19,830
19	Depreciation (attach schedule) and depletion...		89,167	15,550	0
20	Occupancy..............	29,924		0	0	29,924
21	Travel, conferences, and meetings.......	1,827		0	0	1,827
22	Printing and publications..........	55,000		5,500	0	49,500
23	Other expenses (attach schedule).......		245,845	1,722	0	207,166
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	2,646,422		1,673,625	1,305	844,478
25	Contributions, gifts, grants paid.......	714,303				714,503
26	Total expenses and disbursements. Add lines 24 and 25	3,360,725		1,673,625	1,305	1,558,981
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	-6,435,022
b	Net investment income (if negative, enter -0-)			0
c	Adjusted net income (if negative, enter -0-)...				68,695

For Paperwork Reduction Act Notice, see instructions.

Cat. No. 11289X Form 990-PF (2021)

Form 990-PF (2021)

Page 2

Part II		Balance Sheets	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing.............	85,835	115,691	115,691
	2	Savings and temporary cash investments.........	3,697,659	2,511,315	2,511,315
	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..........	29,473	2,765	2,765
	10a	Investments—U.S. and state government obligations (attach schedule)	12,563,961	11,786,988	11,786,988
	b	Investments—corporate stock (attach schedule).......	157,723	117,798	117,798
	c	Investments—corporate bonds (attach schedule).......	9,768,957	10,103,514	10,103,514
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans.............
	13	Investments—other (attach schedule)..........	26,454,796	20,891,430	20,891,430
	14	Land, buildings, and equipment: basis 2,776,591
		Less: accumulated depreciation (attach schedule) 1,317,369	1,541,657	1,459,222	1,459,222
	15	Other assets (describe )	4,299,402	4,371,326	4,371,326
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	58,599,463	51,360,049	51,360,049
	17	Accounts payable and accrued expenses..........	14,638	47,932
	18	Grants payable.................	1,270,948	1,148,310
	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 )	30,831	35,470
	23	Total liabilities (add lines 17 through 22).........	1,316,417	1,231,712
		Foundations that follow FASB ASC 958, check here
		and complete lines 24, 25, 29 and 30.
	24	Net assets without donor restrictions...........	57,283,046	50,128,337
	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........
	27	Paid-in or capital surplus, or land, bldg., and equipment fund
	28	Retained earnings, accumulated income, endowment, or other funds
	29	Total net assets or fund balances (see instructions).....	57,283,046	50,128,337
	30	Total liabilities and net assets/fund balances (see instructions).	58,599,463	51,360,049

Part III

Analysis of Changes in Net Assets or Fund Balances

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) ...............

57,283,046

Enter amount from Part I, line 27a .....................

-6,435,022

Other increases not included in line 2 (itemize) bullet

Add lines 1, 2, and 3 ..........................

50,848,024

Decreases not included in line 2 (itemize) bullet

719,687

Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .

50,128,337

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
1 a	3.85622 HAROT 0.74% 11/15/22	P
b	5.33769 NAROT 0.47% 10/17/22	P
c	3.80227 HAROT 0.74% 11/15/22	P
d	5.07351 NAROT 0.47% 10/17/22	P
e	88 AIR PROD & CHEM 3% 11/03/21	P
	87 HOME DEPOT 3.25% 03/01/22	P
	3.63622 HAROT 0.74% 11/15/22	P
	102 KROGER CO 2.8% 08/01/22	P
	112 MICROSOFT CORP 2.375% 02/12/22	P
	4.66640 NAROT 0.47% 10/17/22	P
	94 SPG 2.625% 06/15/22	P
	4.15653 HAROT 0.74% 11/15/22	P
	5.84795 NAROT 0.47% 10/17/22	P
	134 BAC 3.499% 05/17/22	P
	3.87658 HAROT 0.74% 11/15/22	P
	5.32542 NAROT 0.47% 10/17/22	P
	124 PRAXAIR INC 2.45% 02/15/22	P
	84 VERIZON COMM 5.15% 09/15/23	P
	3.53903 HAROT 0.74% 11/15/22	P
	4.83465 NAROT 0.47% 10/17/22	P
	478 US TREASURY N/B 1.5% 09/15/22	P
	87 CISCO SYSTEMS 3% 06/15/22	P
	94 WALT DISNEY CO 2.45% 03/04/22	P
	3.72891 HAROT 0.74% 11/15/22	P
	92 NVR INC CORP 3.95% 09/15/22	P
	5.02832 NAROT 0.47% 10/17/22	P
	3.39751 HAROT 0.74% 11/15/22	P
	4.62318 NAROT 0.47% 10/17/22	P
	2.38738 NISSAN AUTO REC 1.45% 12/15/22	P
	94 VISA 2.15% 09/15/22	P
	91 ECOLAB INC 3.25% 01/14/23	P
	3.33494 HAROT 0.74% 11/15/22	P
	4.47289 NAROT 0.47% 10/17/22	P
	2.28713 NISSAN AUTO REC 1.45% 12/15/22	P
	3.18872 HAROT 0.74% 11/15/22	P
	65 IA ST FIN AUTH 2.85% 07/01/23	P
	4.10235 NAROT 0.47% 10/17/22	P
	2.05557 NISSAN AUTO REC 1.45% 12/15/22	P
	3.13561 HAROT 0.74% 11/15/22	P
	0.80992 NAROT 0.47% 10/17/22	P
	0.61922 NISSAN AUTO REC 1.45% 12/15/22	P
	90 SO POWER CO 2.5% 12/15/21	P
	0.57832 HAROT 0.74% 11/15/22	P
	90 NY METRO TRANS 5% 11/15/22	P
	ABBVIE INC	P
	COMCAST CORP	P
	ESCONDIDO CA	P
	JEA FL	P
	JPMORGAN CHASE	P
	MERCK AND CO	P
	MIDAMERICAN ENERGY	P
	MORGAN STANLEY	P
	ORACLE CORP	P
	GOLDMAN SACHS	P
	THERMO FISHER	P
	UNIV UT	P
	US TREASURY 1.875%	P
	US TREASURY 2.375%	P
	US TREASURY 2.375%	P
	US TREASURY 2%	P
	US TREASURY 2%	P
	US TREASURY 2%	P
	US TREASURY 2%	P
	US TREASURY 1.75%	P
	US TREASURY 2.25%	P
	GS MEZZANINE PARTNERS V OFFSHORE LP	P
	GS DISTRESSED OPPORTNITIES FUND IV OFFSHORE LP	P
	GS VINTAGE FUND V OFFSHORE LP	P
	MOSAICO EVERGREEN FUND LP	P

(e) Gross sales price		(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a	3,856	3,867	-11
b	5,338	5,338	0
c	3,802	3,813	-11
d	5,074	5,073	1
e	89,469	87,850	1,619
	89,571	88,939	632
	3,636	3,647	-11
	105,253	103,940	1,313
	113,924	112,086	1,838
	4,666	4,666	0
	95,999	95,617	382
	4,157	4,168	-11
	5,848	5,848	0
	134,000	135,956	-1,956
	3,877	3,888	-11
	5,325	5,325	0
	125,394	124,745	649
	92,665	95,595	-2,930
	3,539	3,549	-10
	4,835	4,835	0
	485,936	477,567	8,369
	89,273	89,162	111
	95,316	94,482	834
	3,729	3,740	-11
	94,923	95,512	-589
	5,028	5,028	0
	3,398	3,407	-9
	4,623	4,623	0
	2,387	2,392	-5
	95,823	94,938	885
	94,588	96,695	-2,107
	3,335	3,344	-9
	4,473	4,473	0
	2,287	2,292	-5
	3,189	3,198	-9
	65,000	67,995	-2,995
	4,102	4,102	0
	2,056	2,060	-4
	3,136	3,145	-9
	810	810	0
	619	621	-2
	90,000	89,190	810
	578	580	-2
	93,869	94,868	-999
	129,554	121,658	7,896
	306,601	285,000	21,601
	230,000	230,000	0
	155,435	150,000	5,435
	332,780	300,000	32,780
	201,751	200,000	1,751
	213,729	199,961	13,768
	178,125	169,920	8,205
	279,790	270,000	9,790
	167,702	166,346	1,356
	168,756	174,626	-5,870
	265,000	265,025	-25
	251,938	250,425	1,513
	52,923	50,132	2,791
	68,800	73,249	-4,449
	177,687	176,556	1,131
	101,535	97,580	3,955
	76,151	76,730	-579
	228,025	226,756	1,269
	151,077	144,335	6,742
	210,124	207,043	3,081
		32,258	-32,258
	3,517		3,517
		135,849	-135,849
		4,048,448	-4,048,448

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			-11
b			0
c			-11
d			1
e			1,619
			632
			-11
			1,313
			1,838
			0
			382
			-11
			0
			-1,956
			-11
			0
			649
			-2,930
			-10
			0
			8,369
			111
			834
			-11
			-589
			0
			-9
			0
			-5
			885
			-2,107
			-9
			0
			-5
			-9
			-2,995
			0
			-4
			-9
			0
			-2
			810
			-2
			-999
			7,896
			21,601
			0
			5,435
			32,780
			1,751
			13,768
			8,205
			9,790
			1,356
			-5,870
			-25
			1,513
			2,791
			-4,449
			1,131
			3,955
			-579
			1,269
			6,742
			3,081
			-32,258
			3,517
			-135,849
			-4,048,448

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	-4,095,160
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)

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
b	Exempt foreign organizations—tax withheld at source......	6b
c	Tax paid with application for extension of time to file (Form 8868)...	6c
d	Backup withholding erroneously withheld ...........	6d

7	Total credits and payments. Add lines 6a through 6d..............		7	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

During the tax year, did the foundation attempt to influence any national, state, or local legislation or did

Yes

it participate or intervene in any political campaign? ....................

Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions

for the definition.................................

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.

Did the foundation file Form 1120-POL for this year?.....................

Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the foundation. bullet

$ 0(2) On foundation managers. bullet

$ 0

Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. bullet

$ 0

Has the foundation engaged in any activities that have not previously been reported to the IRS?.......

If "Yes," attach a detailed description of the activities.

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....

Did the foundation have unrelated business gross income of $1,000 or more during the year?.........

Yes

If "Yes," has it filed a tax return on Form 990-T for this year?...................

Yes

Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........

If "Yes," attach the statement required by General Instruction T.

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?................

Yes

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..................................

Yes

Enter the states to which the foundation reports or with which it is registered (see instructions)

NY, VA

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 .

Yes

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 .............................

Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names

and addresses. ...............................

Form 990-PF (2021)

Page 5

Part VI-A

Statements Regarding Activities (continued)

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 .............

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.................

Did the foundation comply with the public inspection requirements for its annual returns and exemption application?

Yes

Website address bullet

WWW.BLUEMOONFUND.ORG

The books are in care of bullet

THE ORGANIZATION Telephone no. bullet

(434) 295-5160

Located at bullet

PO BOX 5246CHARLOTTESVILLEVA ZIP+4 bullet

22905

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

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

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)

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person? ..............................

1a(2)

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........

1a(3)

(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)

(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)

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 ..........

Organizations relying on a current notice regarding disaster assistance check here........ bullet

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? .............

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)):

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?....................

If "Yes," list the years bullet

20, 20, 20, 20

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.) ..............

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

Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at

any time during the year? ..............................

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.) .....................

Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?

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? ..

Form 990-PF (2021)

Page 6

Part VI-B

Statements Regarding Activities for Which Form 4720 May Be Required (continued)

During the year did the foundation pay or incur any amount to:

Yes

(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........

5a(1)

(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)

(3) Provide a grant to an individual for travel, study, or other similar purposes? .............

5a(3)

Yes

(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)

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 ........

Organizations relying on a current notice regarding disaster assistance check here ......... bullet

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? .................

Yes

If "Yes," attach the statement required by Regulations section 53.4945–5(d). Click to see attachment

Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on

a personal benefit contract? .............................

Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....

If "Yes" to 6b, file Form 8870.

At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?

If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....

Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or

excess parachute payment during the year? .........................

Part 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-)	(e) Expense account, other allowances
ZACHARY MILLER	TRUSTEE 1.00	0	0
PO BOX 5246 CHARLOTTESVILLE,VA229055246	TRUSTEE 1.00	0	0
ETHAN A MILLER	SECRETARY/TRUSTEE 1.00	0	0
PO BOX 5246 CHARLOTTESVILLE,VA229055246	SECRETARY/TRUSTEE 1.00	0	0
DIANE E MILLER	PRESIDENT/CEO/TRUSTEE 30.00	275,000	10,876
PO BOX 5246 CHARLOTTESVILLE,VA229055246	PRESIDENT/CEO/TRUSTEE 30.00	275,000	10,876

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
STEPHANIE RANDOLPH	PGM/GRANTS OFFICER 37.50	130,000	0	6,841
PO BOX 5246 CHARLOTTESVILLE,VA229055246	PGM/GRANTS OFFICER 37.50	130,000	0	6,841








Total number of other employees paid over $50,000...................				0

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
MOSAICO LP	INVESTMENT MANAGEMENT	635,795
119 EAST COLUMBIA STREET FALLS CHURCH,VA22046	INVESTMENT MANAGEMENT	635,795
HANTZMON WIEBEL LLP	ACCOUNTING/TAX SERVICES	118,128
701 E WATER ST STE 300 CHARLOTTESVILLE,VA22902	ACCOUNTING/TAX SERVICES	118,128
SARA MILLER	PROPERTY MANAGEMENT	89,898
2245 GARTH RD CHARLOTTESVILLE,VA22901	PROPERTY MANAGEMENT	89,898

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	RURAL DEVELOPMENT INITIATIVE:AN INITIATIVE TO BETTER UNDERSTAND THE CHALLENGES FACING RURAL COMMUNITIES IN ADDRESSING POVERTY IN A CULTURALLY AND ENVIRONMENTALLY SUSTAINABLE MANNER. INCLUDES RESEARCH, CONVENING, AND PRACTICAL COMPONENTS, WITH THE EXPECTED OUTCOME BEING AN ACTION PLAN TO BE MADE AVAILABLE TO THE GENERAL PUBLIC AND VARIOUS STAKEHOLDERS INCLUDING FUNDERS, AND GOVERNMENT AGENCIES	8,085
2	COVID RESPONSE:CASSIOPEIA EXPANDED ITS GRANTMAKING STRATEGY IN MARCH 2020 TO SUPPORT THE IMMINENT AND EMERGING NEEDS OF CHARLOTTESVILLE, VIRGINIA AS A RESULT OF THE COVID-19 PANDEMIC. THIS STRATEGY PROVIDED LOCAL NONPROFITS WITH THE RESOURCES THEY NEEDED TO RESPOND TO THE UNPRECEDENTED NEEDS OF A COMMUNITY IN THE MIDST OF A PUBLIC HEALTH CRISIS WITH CATASTROPHIC EFFECTS ON THE LOCAL ECONOMY. GRANTS WERE MADE TO A RANGE OF SOCIAL SAFETY NET ORGANIZATIONS TO DEVELOP NEW PATHWAYS FOR SERVICE DELIVERY TO ENSURE AND EXPAND ACCESS TO PHYSICAL AND MENTAL HEALTH SERVICES, TO COMBAT RISING FOOD INSECURITY THROUGH INCREASED COORDINATION AMONG SERVICE PROVIDERS AND INCREASE THE AVAILABILITY OF LOCALLY GROWN PRODUCE FOR FAMILIES IN NEED, TO AUGMENT THE LOCAL HEALTH DEPARTMENT'S BILINGUAL EDUCATIONAL & OUTREACH TEAM, TO FACILITATE FREE MOBILE COVID TESTING AND THE DISTRIBUTION OF MASKS IN HIGH RISK COMMUNITIES, AND TO DEVELOP A SERIES OF MULTI-MEDIA COMMUNICATION STRATEGIES TO INCREASE AWARENESS	9,927
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	ASIA PACIFIC FUEL CELL TECHNOLOGIES LTD:TO SUPPORT A DEMONSTRATION PROGRAM OF FUEL CELL-BASED ZERO EMISSIONS SCOOTERS WHICH INCLUDES DEVELOPMENT AND IMPLEMENTATION OF MASS PRODUCTION TECHNOLOGIES TO PROVIDE ACCESS TO THE FUEL CELL-BASED ZERO EMISSIONS SCOOTERS TO THE GENERAL PUBLIC, CONDUCT FURTHER RESEARCH AND DEVELOPMENT ACTIVITIES ON TECHNOLOGIES ASSOCIATED WITH THE PRODUCTION OF FUEL CELL-BASED ZERO EMISSIONS SCOOTERS AND TO CARRY OUT VARIOUS EXHIBITIONS AND EDUCATIONAL PROGRAMS AIMED AT EDUCATING THE GENERAL PUBLIC AND POLICYMAKERS ON THE BENEFITS OF FUEL CELL-BASED ZERO EMISSIONS SCOOTERS AND ASSOCIATED TECHNOLOGIES.	3,500,000
2


All other program-related investments. See instructions.
3

Total. Add lines 1 through 3......................... bullet

3,500,000

Form 990-PF (2021)

Page 8

Part IX

Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,

purposes:

Average monthly fair market value of securities...................

55,552,902

Average of monthly cash balances.......................

2,875,672

Fair market value of all other assets (see instructions)................

1,459,221

Total (add lines 1a, b, and c).........................

59,887,795

Reduction claimed for blockage or other factors reported on lines 1a and

1c (attach detailed explanation) .............

Acquisition indebtedness applicable to line 1 assets..................

Subtract line 2 from line 1d.........................

59,887,795

Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see

instructions) .............................

898,317

Net value of noncharitable-use assets. Subtract line 4 from line 3. .......

58,989,478

Minimum investment return. Enter 5% (0.05) of line 5................

2,949,474

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.)

Minimum investment return from Part IX, line 6..................

2,949,474

Tax on investment income for 2021 from Part V, line 5.......

Income tax for 2021. (This does not include the tax from Part V.) ...

6,732

Add lines 2a and 2b............................

6,732

Distributable amount before adjustments. Subtract line 2c from line 1............

2,942,742

Recoveries of amounts treated as qualifying distributions................

Add lines 3 and 4............................

2,942,742

Deduction from distributable amount (see instructions).................

Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...

2,942,742

Part XI

Qualifying Distributions (see instructions)

Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:

Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........

Program-related investments—total from Part VIII-B..................

Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,

purposes...............................

Amounts set aside for specific charitable projects that satisfy the:

Suitability test (prior IRS approval required)....................

Cash distribution test (attach the required schedule) .................

Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4.

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					2,942,742
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......	9,978,931
b From 2017......	11,020,219
c From 2018......	7,843,451
d From 2019......	2,480,261
e From 2020......	8,659,632
f Total of lines 3a through e ........		39,982,494
4Qualifying distributions for 2021 from Part
XI, line 4: $ 5,058,981
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.....					2,942,742
e Remaining amount distributed out of corpus		2,116,239
5 Excess distributions carryover applied to 2021.		0			0
(If an amount appears in column (d), the same amount must be shown in column (a).)
6Enter the net total of each column as indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5		42,098,733
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) ...		9,978,931
9 Excess distributions carryover to 2022. Subtract lines 7 and 8 from line 6a ......		32,119,802
10 Analysis of line 9:
a Excess from 2017....	11,020,219
b Excess from 2018....	7,843,451
c Excess from 2019....	2,480,261
d Excess from 2020....	8,659,632
e Excess from 2021....	2,116,239

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 4942(j)(3) or4942(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	(e) Total

b 85% (0.85) of line 2a .........
c Qualifying distributions from Part XI, line 4 for each year listed .....
d Amounts included in line 2c not used directly for active conduct of exempt activities ..........
e Qualifying distributions made directly for active conduct of exempt activities. Subtract line 2d from line 2c ....
3 Complete 3a, b, or c for the alternative test relied upon:
a “Assets" alternative test—enter:
(1) Value of all assets ......
(2) Value of assets qualifying under section 4942(j)(3)(B)(i)
b “Endowment" alternative test— enter 2/3 of minimum investment return shown in Part IX, line 6 for each year listed ..
c “Support" alternative test—enter:
(1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) ....
(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii)....
(3) Largest amount of support from an exempt organization
(4) Gross investment income

Part XIV

Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)

1Information Regarding Foundation Managers:

aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)

bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.

2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:

Check here bullet

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

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)

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)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year
ALBEMARLE COUNTY PUBLIC SCHOOLS 401 MCINTIRE ROAD CHARLOTTESVILLE,VA22902		OTHER	FOR GENERAL OPERATING SUPPORT	250,000
APPALACHIAN VOICES 812 EAST HIGH STREET CHARLOTTESVILLE,VA22902		PC	FOR GENERAL OPERATING SUPPORT	125
BECKLEY AREA FOUNDATION INC 1210 S KANAWHA ST BECKLEY,WV25801		PC	FOR GENERAL OPERATING SUPPORT	100
BEVERLY STREET STUDIO SCHOOL 217 W BEVERLEY ST STAUNTON,VA24401		PC	FOR GENERAL OPERATING SUPPORT	20,000
BLUE MORNING INC 222 W SOUTH ST CHARLOTTESVILLE,VA22902		PC	FOR GENERAL OPERATING SUPPORT	7,553
BLUE RIDGE ABORTION FUND PO BOX 5082 CHARLOTTESVILLE,VA22905		PC	FOR GENERAL OPERATING SUPPORT	200
CHARLOTTESVILLE HIGH SCHOOL BAND BOOSTERS 1400 MELBOURNE RD CHARLOTTESVILLE,VA229013148		PC	FOR GENERAL OPERATING SUPPORT	500
CROZET ARTS 1408 CROZET AVE 102 CROZET,VA22932		PC	FOR GENERAL OPERATING SUPPORT	20,000
DANCING RABBIT INC 1 DANCING RABBIT LN RUTLEDGE,MO63563		PC	FOR GENERAL OPERATING SUPPORT	225
FOXFIELD RACING LLC 2215 FOXFIELD TRACK CHARLOTTESVILLE,VA22901		PC	FOR GENERAL OPERATING SUPPORT	100,000
INTERNATIONAL NEIGHBORS 224-A 9TH STREET SW CHARLOTTESVILLE,VA22903		PC	FOR GENERAL OPERATING SUPPORT	150
INVEST APPALACHIA 1456 PATTON AVE STE D ASHEVILLE,NC288061760		PC	FOR GENERAL OPERATING SUPPORT	200,000
LITERACY VOLUNTEERS OF CHARLOTTESVILLE 233 4TH ST NW CHARLOTTESVILLE,VA22903		PC	FOR GENERAL OPERATING SUPPORT	200
LIVE ARTS 123 EAST WATER STREET CHARLOTTESVILLE,VA22902		PC	FOR GENERAL OPERATING SUPPORT	125
MCGUFFEY ART CENTER 201 2ND ST NW CHARLOTTESVILLE,VA22902		PC	FOR GENERAL OPERATING SUPPORT	20,000
ON OUR OWN OF CHARLOTTESVILLE 123 4TH ST NW CHARLOTTESVILLE,VA22902		PC	FOR GENERAL OPERATING SUPPORT	125
SHENANDOAH VALLEY ART CENTER 126 S WAYNE AVE WAYNESBORO,VA22980		PC	FOR GENERAL OPERATING SUPPORT	20,000
STAUNTON-AUGUSTA ART CENTER 20 S NEW ST STAUNTON,VA24401		PC	FOR GENERAL OPERATING SUPPORT	20,000
THE ARTS CENTER IN ORANGE 129 E MAIN ST ORANGE,VA22960		PC	FOR GENERAL OPERATING SUPPORT	20,000
THE BRIDGE PROGRESSIVE ARTS INITIATIVE 209 MONTICELLO RD CHARLOTTESVILLE,VA22902		PC	FOR GENERAL OPERATING SUPPORT	20,000
THE FOUNTAIN FUND 233 4TH ST NW BOX Z CHARLOTTESVILLE,VA22903		PC	FOR GENERAL OPERATING SUPPORT	200
THE HAVEN 112 WEST MARKET STREET CHARLOTTESVILLE,VA22902		PC	FOR GENERAL OPERATING SUPPORT	5,000
WEST VIRGINIA RIVERS COALITION 3501 MACCORKLE AVE SE 129 CHARLESTON,WV25304		PC	FOR GENERAL OPERATING SUPPORT	10,000
Total ................................. 3a				714,503

bApproved for future payment
AFRICAN AMERICAN TEACHING FELLOWS OF CHARLOTTESVILLE-ALBEMARLE INC PO BOX 5064 CHARLOTTESVILLE,VA22905	PC	FOR GENERAL OPERATING SUPPORT	50,000
CALVERT IMPACT CAPITAL INC 7315 WISCONSIN AVE 1000W BETHESDA,MD20814	PC	FOR GENERAL OPERATING SUPPORT.	848,510
Total ................................. 3b			898,510

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	(e) Related or exempt function income (See instructions.)
a
b
c
d
e
f
gFees and contracts from government agencies
2 Membership dues and assessments ....
3 Interest on savings and temporary cash investments ...........
4 Dividends and interest from securities ....
5 Net rental income or (loss) from real estate:
aDebt-financed property......
bNot debt-financed property.....
6 Net rental income or (loss) from personal property
7 Other investment income .....
8 Gain or (loss) from sales of assets other than inventory ............			18	-4,095,160
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) ..		38,679		-3,202,976	70,000

13Total. Add line 12, columns (b), (d), and (e)..................

-3,094,297

(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.)
1A	INTEREST EARNED DURING 2021 ON PROGRAM RELATED INVESTMENTS

Form 990-PF (2021)

Page 13

Part XVI

Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations

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

Transfers from the reporting foundation to a noncharitable exempt organization of:

(1) Cash...................................

1a(1)

(2) Other assets.................................

1a(2)

Other transactions:

(1) Sales of assets to a noncharitable exempt organization....................

1b(1)

(2) Purchases of assets from a noncharitable exempt organization..................

1b(2)

(3) Rental of facilities, equipment, or other assets.......................

1b(3)

(4) Reimbursement arrangements...........................

1b(4)

(5) Loans or loan guarantees.............................

1b(5)

(6) Performance of services or membership or fundraising solicitations................

1b(6)

Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............

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

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

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

2021

Name of the organization

CASSIOPEIA FOUNDATION INC

Employer identification number

13-6034219

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 33¹/3% 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 ......... 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 CASSIOPEIA FOUNDATION INC

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	ROBERT WOOD JOHNSON FOUNDATION 1634 I STREET NW SUITE 810 WASHINGTON, DC200064015	$ 20,000	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	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 CASSIOPEIA FOUNDATION INC		Employer identification number 13-6034219

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 CASSIOPEIA FOUNDATION INC			Employer identification number 13-6034219
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

(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

(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

(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

(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 AccountingFeesSchedule

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
ANNUAL ACCOUNTING & RELATED EXPENSES	149,922	74,961	0	72,961

- TIN:

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

TY 2021 ExpenditureResponsibilityStmt

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

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
ASIA PACIFIC FUEL CELL TECHNOLOGIES LTD	4F NO 22 KEDONG 3 RD ZHUNAN,MIAOLI35053 TW	2002-12-20	3,500,000	TO SUPPORT A DEMONSTRATION PROGRAM OF FUEL CELL-BASED ZERO EMISSIONS SCOOTERS WHICH INCLUDES DEVELOPMENT AND IMPLEMENTATION OF MASS PRODUCTION TECHNOLOGIES TO PROVIDE ACCESS TO THE FUEL CELL-BASED ZERO EMISSIONS SCOOTERS TO THE GENERAL PUBLIC, CONDUCT FURTHER RESEARCH AND DEVELOPMENT ACTIVITIES ON TECHNOLOGIES ASSOCIATED WITH THE PRODUCTION OF FUEL CELL-BASED ZERO EMISSIONS SCOOTERS AND TO CARRY OUT VARIOUS EXHIBITIONS AND EDUCATIONAL PROGRAMS AIMED AT EDUCATING THE GENERAL PUBLIC AND POLICYMAKERS ON THE BENEFITS OF FUEL CELL-BASED ZERO EMISSIONS SCOOTERS AND ASSOCIATED TECHNOLOGIES.	3,500,000	NONE	FINANCIAL AND NARRATIVE REPORTS FYE 12/31/2002 -12/31/2021 - DETAIL ON FILE		THE CASSIOPEIA FOUNDATION REVIEWED THE GRANT REPORT(S) NOTED IN #7 ABOVE, BUT DID NOT UNDERTAKE ANY VERIFICATION OF THE GRANTEE'S REPORTS AS THERE HAS NOT BEEN ANY REASON TO DOUBT THEIR ACCURACY OR RELIABILITY

- TIN:

TY 2021 InvestmentsCorpBondsSchedule

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Name of Bond	End of Year Book Value	End of Year Fair Market Value
ABBOTT LABORATORY 2.950% DUE 3/15/25	173,257	173,257
AFRICAN DEV BK 0.750 DUE 4/3/23	170,350	170,350
ALEXANDRIA REAL ESTSTE 4.900% DUE 12/15/30	83,866	83,866
AMERICAN EXPRESS 2.500% DUE 07/30/24	165,079	165,079
ANHEUSER BUSCH 3.650% DUE 2/1/26	177,701	177,701
ANTHEM, INC 3.650% DUE 12/01/27	169,667	169,667
AON CORP 2.800% DUE 5/15/30	169,960	169,960
APPLE INC 2.850% 02/23/2023 DD 02/23/16	286,483	286,483
AT & T INC 4.125% 02/17/2026 DD 02/09/16	190,593	190,593
BANK OF AMERICA CORP DUE 7/23/31	253,254	253,254
BOSTON PROPERTIES 3.800% DUE 2/1/24	83,689	83,689
CITIGROUP INC DUE 7/24/28	253,232	253,232
CVS CAREMARK CORP 2.750% DUE 12/01/22	116,597	116,597
EQUINOR ASA 2.65% 1/15/24	211,509	211,509
HOME DEPOT INC 2.800% DD 9/14/27	264,323	264,323
KFW 2.000% DUE 9/29/22	131,499	131,499
LINCOLN NATIONALCORP 3.050% DUE 1/15/30	88,489	88,489
LOWES COMPANIES 3.100% DUE 5/3/27	154,667	154,667
MASTERCARD INC 3.350% DUE 3/26/30	252,833	252,833
MICROSOFT CORP 2.700% DD 2/12/25	339,523	339,523
NEXTERA ENERGY 3.550% DUE 5/1/27	178,618	178,618
SCHLUMBERGER INVESTMENT SA 3.650% 12/1/23 DD 12/3/16	302,891	302,891
SIMON PPTY GROUP LP 3.375% DUE 10/1/24	142,046	142,046
STARBUCKS CORP 2.450% 6/15/26 DD 5/16/16	263,620	263,620
STATE STREET CORP DUE 11/1/25	257,055	257,055
TARGET CORP 2.250% DUE 4/15/25	149,485	149,485
TOTAL CAPITAL 3.455% DUE 2/19/29	173,831	173,831
UNION PACIFIC CORP 3.700% DUE 3/1/29	127,092	127,092
UNITEDHEALTH GROUP INC 3.750% DUE 7/15/25	249,098	249,098
ABBVIE INC 3.200% DUE 11/21/29	175,830	175,830
AMAZON.COM INC 0.450% DUE 05/12/24	128,750	128,750
AMERICAN TOWER 3.125% DUE 01/15/27	94,220	94,220
AMGEN INC 2.200% DUE 02/21/26	173,976	173,976
AT&T INC 0.900% DUE 03/25/24	99,566	99,566
BANK OF AMERICA CORP 1.486% DUE 05/19/23	144,048	144,048
BANK OF AMERICA CORP DUE 04/22/32	15,199	15,199
BRUNSWICK CORP 0.850% DUE 08/18/24	98,591	98,591
COMCAST CORP 3.300% DUE 02/01/27	263,305	263,305
CVS HEALTH CORP 4.300% DUE 03/25/28	151,124	151,124
ENBRIDGE INC 2.500% DUE 01/15/25	87,365	87,365
EVERSOURCE ENERG 1.650% DUE 08/15/30	177,486	177,486
GOLDMAN SACHS INT VAR DUE 04/23/29	174,011	174,011
HOME DEPOT INC 3.750% DUE 02/15/24	89,607	89,607
JPMORGAN CHASE & CO DUE 04/22/32	260,407	260,407
MICROSOFT CORP 2.750% DUE 02/06//2024	113,466	113,466
MITSUBISHI UFJ 3.455% DUE 03/02/23	252,176	252,176
MORGAN STANLEY DUE 05/04/27	177,916	177,916
NIKE INC CORP 2.250% DUE 05/01/23	94,710	94,710
ORACLE CORP 3.400% DUE 07/08/24	95,152	95,152
SALESFORCE.COM 1.950% DUE 07/15/31	178,224	178,224
SEMPRA 3.400% DUE 02/01/28	175,662	175,662
SHELL INTERNTN 3.875% DUE 11/13/28	211,698	211,698
SIMON PPTY GROUP LP 3.750% DUE 02/01/24	94,241	94,241
THE WALT DISNEY CO 2.000% DUE 09/01/29	258,438	258,438
TORONTO DOMINIO 3.250% DUE 03/11/24	261,596	261,596
VERIZON COMMUNICATION 1.500% DUE 09/18/30	178,230	178,230
VERIZON COMMUNICATIONS INC 0.750% DUE 03/22/24	99,608	99,608
WALT DISNEY COMP 1.750% DUE 08/30/24	95,509	95,509
KROGER COMPANY 4.00% DUE 02/01/24	103,096	103,096

- TIN:

TY 2021 InvestmentsCorpStockSchedule

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Name of Stock	End of Year Book Value	End of Year Fair Market Value
GS INVESTMENT PARTNERS OFFSHORE LP	117,798	117,798

- TIN:

TY 2021 InvestmentsGovtObligationsSch

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

US Government Securities - End of Year Book Value:

7,235,301

US Government Securities - End of Year Fair Market Value:

7,235,301

State & Local Government Securities - End of Year Book Value:

4,551,687

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

4,551,687

- TIN:

TY 2021 InvestmentsOtherSchedule2

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Category/ Item	Listed at Cost or FMV	Book Value	End of Year Fair Market Value
GS DISTRESSED MANAGERS FUND IV OFFSHORE LP	FMV	305,934	305,934
MOSAICO EVERGREEN FUND LP	FMV	20,585,496	20,585,496

- TIN:

TY 2021 LegalFeesSchedule

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
INCURRED IN THE GENERAL COURSE OF BUSINESS	28,449	0	0	28,449
LEGAL FEES FOR MRI	1,305	0	1,305	0

- TIN:

TY 2021 OtherAssetsSchedule

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Description	Beginning of Year - Book Value	End of Year - Book Value	End of Year - Fair Market Value
INTEREST AND DIVDEND INCOME RECEIVABLE	920,273	989,343	989,343
PRI-INVESTMENTS	3,500,000	3,500,000	3,500,000
PROVISION FOR LOSS ON PRI	-214,210	-214,210	-214,210
PREPAID EXCISE/INCOME TAX	93,339	96,193	96,193

- TIN:

TY 2021 OtherDecreasesSchedule

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Description	Amount
UNREALIZED GAIN/LOSS ON INVESTMENTS	719,687

- TIN:

TY 2021 OtherExpensesSchedule

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Description	Revenue and Expenses per Books	Net Investment Income	Disbursements for Charitable Purposes
BANK SERVICE FEES	1,558	0	1,558
DIRECTOR & OFFICER LIABILITY INSURANCE	20,253	0	20,253
GENERAL LIABILITY INSURANCE	3,244	0	3,244
MAINTENANCE AGREEMENTS	98,816	0	98,816
OFFICE EXPENSE	11,036	1,722	11,036
REPAIRS AND MAINTENANCE EXPENSE	1,443	0	1,443
ONLINE SUBSCRIPTIONS	13,662	0	13,662
DIRECT CHARITABLE ACTIVITIES	8,085	0	8,085
BLUE MOON RISING EXPENSES	37,358	0	37,358
ART AUCTION FUNDRAISER	9,927	0	9,927
INCOME FROM PARTNERSHIP INVESTMENTS	38,679	0	0
COMPUTER SOFTWARE EXPENSED	1,736	0	1,736
MISCELLANEOUS EXPENSE	1	0	1
ABANDONED ASSET LOSS	47	0	47

- TIN:

TY 2021 OtherIncomeSchedule2

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Description	Revenue And Expenses Per Books	Net Investment Income	Adjusted Net Income
UBIT INCOME/LOSS	38,679	38,679
OTHER INCOME	1,663	1,663
INCOME FROM PARTNERSHIP INVESTMENTS	63,013	63,013
INTEREST EARNED ON PRI'S	70,000		70,000

- TIN:

TY 2021 OtherLiabilitiesSchedule

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Description	Beginning of Year - Book Value	End of Year - Book Value
DEFERRED TAXES PAYABLE	20,000	20,000
ACCRUED EXPENSES	1,500	1,500
PAYROLL TAXES - FED	7,543	0
PAYROLL TAXES - VIRGINIA	1,788	0
UBIT PAYABLE	0	13,970

- TIN:

TY 2021 OtherProfessionalFeesSchedule

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Category	Amount	Net Investment Income	Disbursements for Charitable Purposes
CONSULTING FEES - GENERAL	41,825	0	41,825
CONSULTING FEES - INFORMATION TECHNOLOGY	9,939	0	9,939
INVESTMENT MANAGEMENT FEES	1,531,113	1,531,113	0

- TIN:

TY 2021 TaxesSchedule

Name:

CASSIOPEIA FOUNDATION INC

EIN:

13-6034219

Category	Amount	Net Investment Income	Disbursements for Charitable Purposes
FEDERAL EXCISE TAXES	11,116	0	0
OTHER TAXES AND LICENSES	1,706	0	1,706
PAYROLL TAXES	22,165	2,217	16,624
STATE REGISTRATION FEES	1,500	0	1,500