Form990-PF


Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
For calendar year 2021, or tax year beginning 01-01-2021 , and ending 12-31-2021
Name of foundation
LIFEWORKS FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)P O BOX 50276
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
NASHVILLE, TN372050276
A Employer identification number

62-1428468
B Telephone number (see instructions)

(615) 269-6663
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ...
bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$4,149,625
J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books
(b) Net investment
income
(c) Adjusted net
income
(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet.............
3 Interest on savings and temporary cash investments 2 2  
4 Dividends and interest from securities... 73,349 73,349  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 249,735
b Gross sales price for all assets on line 6a 1,857,142
7 Capital gain net income (from Part IV, line 2)... 249,735
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)....... 30 0  
12 Total. Add lines 1 through 11........ 323,116 323,086  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 81,250 20,313   0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits....... 1,316 329   0
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... 29,950 7,488   0
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... 9,653 2,413   0
19 Depreciation (attach schedule) and depletion... 440 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... 55,690 45,036   0
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 178,299 75,579   0
25 Contributions, gifts, grants paid....... 172,030 172,030
26 Total expenses and disbursements. Add lines 24 and 25 350,329 75,579   172,030
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -27,213
b Net investment income (if negative, enter -0-) 247,507
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
Assets 1 Cash—non-interest-bearing............. 14,925 36,204 36,204
2 Savings and temporary cash investments......... 50,536 359,187 359,187
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)....... 2,773,812 Click to see attachment2,413,741 3,748,310
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis bullet103,973
Less: accumulated depreciation (attach schedule) bullet101,822 1,045 Click to see attachment2,151 2,151
15 Other assets (describe bullet) Click to see attachment2,922 Click to see attachment3,773 Click to see attachment3,773
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 2,843,240 2,815,056 4,149,625
Liabilities 17 Accounts payable and accrued expenses.......... 1,375  
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22)......... 1,375 0
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions...........    
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........ 2,841,865 2,815,056
27 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
28 Retained earnings, accumulated income, endowment, or other funds 0 0
29 Total net assets or fund balances (see instructions)..... 2,841,865 2,815,056
30 Total liabilities and net assets/fund balances (see instructions). 2,843,240 2,815,056
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
2,841,865
2
Enter amount from Part I, line 27a .....................
2
-27,213
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
404
4
Add lines 1, 2, and 3 ..........................
4
2,815,056
5
Decreases not included in line 2 (itemize) bullet
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
2,815,056
Form 990-PF (2021)
Form 990-PF (2021)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1 a CVS HEALTH CORP P 2018-09-14 2020-12-30
b MARATHON PETROLEUM CORP P 2016-11-28 2020-12-30
c MARATHON PETROLEUM CORP P 2016-12-01 2020-12-30
d MARATHON PETROLEUM CORP P 2017-02-02 2020-12-30
e ILLUMINA INC P 2020-08-07 2021-01-04
REVERSAL - BROADRIDGE P 2019-01-01 2021-01-04
REVERSAL - ADJUSTMENT P 2019-01-01 2021-01-04
REVERSAL - DELL P 2019-01-01 2021-01-04
MICRON TECHNOLOGY P 2020-12-23 2021-01-04
SONY CORP ADR P 2019-06-04 2021-01-04
MICRON TECHNOLOGY P 2020-11-25 2021-01-04
MICRON TECHNOLOGY P 2020-11-19 2021-01-05
PAYPAL HOLDINGS INC P 2020-11-03 2021-01-08
PAYPAL HOLDINGS INC P 2020-11-09 2021-01-08
WALT DISNEY CO P 2019-09-23 2021-01-11
HCA HEALTHCARE INC P 2020-04-23 2021-01-14
QUALCOMM CORP P 2016-03-01 2021-01-19
WALT DISNEY CO P 2019-09-23 2021-01-20
QUALCOMM CORP P 2016-03-01 2021-01-20
ILLUMINA INC P 2020-08-07 2021-01-25
ILLUMINA INC P 2020-08-07 2021-01-27
PARAMOUNT GLOBAL CL B P 2019-11-07 2021-01-27
ILLUMINA INC P 2020-08-07 2021-01-27
BROADRIDGE FINANCIAL SOLUTIONS INC P 2020-10-27 2021-01-29
NATIONAL INSTRUMENTS CORP P 2020-12-01 2021-01-29
DANAHER CORP P 2019-08-28 2021-01-29
QUALCOMM CORP P 2016-03-01 2021-01-29
LIBERTY SIRIUS GROUP C P 2020-10-21 2021-02-01
APPLE COMPUTER P 2013-04-22 2021-02-01
NATIONAL INSTRUMENTS CORP P 2020-12-01 2021-02-01
LIBERTY SIRIUS GROUP C P 2020-07-28 2021-02-01
INTL FLAVORS & FRAGRANCES INC P 2020-12-22 2021-02-01
UBER TECHNOLOGIES INC P 2020-01-03 2021-02-02
QUALCOMM CORP P 2016-03-01 2021-02-03
PAYPAL HOLDINGS INC P 2020-01-30 2021-02-08
SOFTBANK GROUP CORP ADR P 2020-01-22 2021-02-08
WALT DISNEY CO P 2015-08-27 2021-02-08
WALT DISNEY CO P 2018-09-21 2021-02-08
WALT DISNEY CO P 2019-01-04 2021-02-08
UBER TECHNOLOGIES INC P 2020-01-03 2021-02-10
HCA HEALTHCARE INC P 2020-04-23 2021-02-11
ILLUMINA INC P 2020-08-07 2021-02-11
PAYPAL HOLDINGS INC P 2020-11-03 2021-02-11
BLACKBERRY LIMITED P 2021-02-03 2021-02-11
MICRON TECHNOLOGY P 2020-11-19 2021-02-11
MICROSOFT CORP P 2016-07-12 2021-02-11
BLACKBERRY LIMITED P 2021-02-03 2021-02-11
PAYPAL HOLDINGS INC P 2020-01-30 2021-02-11
SOFTBANK GROUP CORP ADR P 2020-01-22 2021-02-11
WALT DISNEY CO P 2015-08-27 2021-02-11
ILLUMINA INC P 2020-08-11 2021-02-12
ILLUMINA INC P 2020-11-09 2021-02-12
ILLUMINA INC P 2020-08-07 2021-02-12
ILLUMINA INC P 2020-08-07 2021-02-12
LOWE'S COMPANIES INC P 2018-12-17 2021-02-19
LOWE'S COMPANIES INC P 2019-05-30 2021-02-19
DELL TECHNOLOGIES INC CLASS C P 2019-09-11 2021-02-19
MGM RESORTS INTERNATIONAL P 2019-02-06 2021-02-23
MGM RESORTS INTERNATIONAL P 2019-09-05 2021-02-23
CISCO SYSTEMS P 2019-08-20 2021-02-24
ISHARES US REAL ESTATE ETF P 2019-04-26 2021-02-24
NESTLE SA ADR P 2017-07-28 2021-02-24
STARBUCKS CORP P 2018-08-07 2021-02-25
ISHARES US REAL ESTATE ETF P 2019-01-08 2021-02-25
ISHARES US REAL ESTATE ETF P 2019-03-25 2021-02-25
STARBUCKS CORP P 2018-08-07 2021-02-26
ISHARES US REAL ESTATE ETF P 2018-12-21 2021-02-26
GSK PLC ADR P 2014-05-07 2021-02-26
ISHARES US REAL ESTATE ETF P 2019-01-08 2021-02-26
BERKSHIRE HATHAWAY INC CL B P 2019-07-24 2021-03-01
DELL TECHNOLOGIES INC CLASS C P 2019-09-11 2021-03-03
SOFTBANK GROUP CORP ADR P 2020-02-18 2021-03-03
ALPHABET INC CL A P 2017-06-28 2021-03-03
ALPHABET INC CL A P 2020-03-02 2021-03-03
DOLLAR TREE INC P 2020-09-04 2021-03-04
BROADRIDGE FINANCIAL SOLUTIONS INC P 2020-10-06 2021-03-04
BROADRIDGE FINANCIAL SOLUTIONS INC P 2020-10-06 2021-03-04
DOLLAR TREE INC P 2020-09-09 2021-03-04
DOLLAR TREE INC P 2021-03-03 2021-03-04
LIBERTY SIRIUS GROUP C P 2020-07-21 2021-03-04
SONY CORP ADR P 2019-06-04 2021-03-04
SONY CORP ADR P 2020-02-28 2021-03-04
DELL TECHNOLOGIES INC CLASS C P 2019-11-05 2021-03-11
LOWE'S COMPANIES INC P 2018-12-17 2021-03-11
EMERSON ELEC CO P 2020-08-10 2021-03-11
CIGNA CORP P 2018-03-27 2021-03-17
DELL TECHNOLOGIES INC CLASS C P 2019-11-05 2021-03-17
FEDEX CORP P 2020-02-06 2021-03-19
AMERICAN EXPRESS P 2021-01-26 2021-03-24
LIBERTY SIRIUS GROUP C P 2020-07-21 2021-03-24
DELL TECHNOLOGIES INC CLASS C P 2019-11-06 2021-03-24
LOWE'S COMPANIES INC P 2018-12-17 2021-03-25
DANA HOLDING CORP P 2021-02-25 2021-04-01
GENTEX CORP P 2020-08-10 2021-04-01
LIBERTY SIRIUS GROUP C P 2020-07-21 2021-04-01
DANA HOLDING CORP P 2021-02-24 2021-04-01
LIBERTY SIRIUS GROUP C P 2020-07-21 2021-04-01
GENTEX CORP P 2020-07-27 2021-04-01
FEDEX CORP P 2020-02-06 2021-04-01
MGM RESORTS INTERNATIONAL P 2019-02-06 2021-04-01
PFIZER INC P 2017-03-02 2021-04-01
LOWE'S COMPANIES INC P 2018-12-17 2021-04-01
MGM RESORTS INTERNATIONAL P 2019-02-06 2021-04-01
DANA HOLDING CORP P 2021-02-08 2021-04-09
DANA HOLDING CORP P 2021-02-25 2021-04-09
DANA HOLDING CORP P 2021-02-25 2021-04-09
ISHARES US REAL ESTATE ETF P 2018-12-21 2021-04-14
PFIZER INC P 2017-03-02 2021-04-14
ALPHABET INC CL A P 2020-03-06 2021-04-14
UBER TECHNOLOGIES INC P 2020-01-03 2021-04-20
LOWE'S COMPANIES INC P 2018-12-17 2021-04-20
PAYPAL HOLDINGS INC P 2021-02-19 2021-04-20
GENTEX CORP P 2020-08-03 2021-04-20
GENTEX CORP P 2020-07-24 2021-04-20
GENTEX CORP P 2020-09-08 2021-04-20
GENTEX CORP P 2020-07-27 2021-04-20
DANA HOLDING CORP P 2021-02-05 2021-04-26
DANA HOLDING CORP P 2021-02-18 2021-04-26
DANA HOLDING CORP P 2021-02-08 2021-04-26
DANA HOLDING CORP P 2021-02-19 2021-04-26
DANA HOLDING CORP P 2021-02-05 2021-04-26
AGILENT TECHNOLOGIES INC P 2019-06-07 2021-04-29
FEDEX CORP P 2020-02-06 2021-04-29
HCA HEALTHCARE INC P 2020-04-23 2021-04-30
COMCAST CORP CL A P 2020-07-07 2021-05-05
BERKSHIRE HATHAWAY INC CL B P 2019-07-24 2021-05-05
JP MORGAN CHASE & CO P 2020-09-04 2021-05-06
SOFTBANK GROUP CORP ADR P 2020-02-18 2021-05-06
INTL FLAVORS & FRAGRANCES INC P 2021-03-04 2021-05-06
HCA HEALTHCARE INC P 2020-04-23 2021-05-06
ADIENT PLC P 2021-04-22 2021-05-06
ADIENT PLC P 2021-04-09 2021-05-06
ADIENT PLC P 2021-04-26 2021-05-06
BERKSHIRE HATHAWAY INC CL B P 2019-07-24 2021-05-10
FEDEX CORP P 2020-02-06 2021-05-10
GENTEX CORP P 2020-07-24 2021-05-12
ISHARES US REAL ESTATE ETF P 2020-05-18 2021-05-12
ISHARES US REAL ESTATE ETF P 2018-12-21 2021-05-12
RAYTHEON TECHNOLOGIES CORP P 2020-04-23 2021-05-12
MICRON TECHNOLOGY P 2020-11-19 2021-05-13
PAYPAL HOLDINGS INC P 2021-02-23 2021-05-13
VMWARE, INC P 2021-01-13 2021-05-13
VMWARE, INC P 2021-01-14 2021-05-13
MICRON TECHNOLOGY P 2020-11-16 2021-05-13
STARBUCKS CORP P 2020-03-04 2021-05-13
MGM RESORTS INTERNATIONAL P 2019-02-06 2021-05-13
AGILENT TECHNOLOGIES INC P 2019-06-07 2021-05-13
ALPHABET INC CL A P 2017-06-28 2021-05-13
ALPHABET INC CL A P 2015-04-22 2021-05-13
STARBUCKS CORP P 2020-03-24 2021-05-13
CIGNA CORP P 2018-06-28 2021-05-19
CIGNA CORP P 2018-03-27 2021-05-19
APPLE COMPUTER P 2013-04-22 2021-05-19
APPLE COMPUTER P 2020-02-28 2021-05-19
BOEING CO P 2019-12-11 2021-05-27
SALESFORCE INC P 2020-12-22 2021-05-28
AIR PRODUCTS & CHEMICALS INC P 2020-11-11 2021-06-04
BERKSHIRE HATHAWAY INC CL B P 2019-07-24 2021-06-04
ELI LILLY & CO P 2021-03-15 2021-06-07
ELI LILLY & CO P 2021-03-15 2021-06-07
ELI LILLY & CO P 2021-03-15 2021-06-07
ELI LILLY & CO P 2021-03-15 2021-06-07
ILLUMINA INC P 2021-02-16 2021-06-07
HILTON WORLDWIDE HOLDINGS INC P 2020-05-29 2021-06-07
ELI LILLY & CO P 2021-03-17 2021-06-07
MICROSOFT CORP P 2020-03-16 2021-06-08
WELLS FARGO & CO P 2018-02-09 2021-06-09
STARBUCKS CORP P 2020-03-24 2021-06-09
RAYTHEON TECHNOLOGIES CORP P 2020-05-08 2021-06-09
RAYTHEON TECHNOLOGIES CORP P 2020-04-06 2021-06-09
DELL TECHNOLOGIES INC CLASS C P 2019-11-08 2021-06-09
DELL TECHNOLOGIES INC CLASS C P 2019-11-06 2021-06-09
ILLUMINA INC P 2021-02-18 2021-06-09
MGM RESORTS INTERNATIONAL P 2019-02-06 2021-06-09
MICRON TECHNOLOGY P 2020-11-16 2021-06-10
MICRON TECHNOLOGY P 2021-05-20 2021-06-10
ILLUMINA INC P 2021-02-23 2021-06-11
ILLUMINA INC P 2021-02-18 2021-06-11
PAYPAL HOLDINGS INC P 2020-03-02 2021-06-14
MGM RESORTS INTERNATIONAL P 2019-01-30 2021-06-14
MGM RESORTS INTERNATIONAL P 2019-02-06 2021-06-14
INFOSYS TECHNOLOGIES P 2021-04-21 2021-06-17
MICRON TECHNOLOGY P 2020-11-16 2021-06-17
MGM RESORTS INTERNATIONAL P 2019-01-30 2021-06-17
PROSSHARES ULTRA VIX SHORT-TERM FUTURES ETF P 2021-06-08 2021-06-18
AGILENT TECHNOLOGIES INC P 2019-06-12 2021-06-18
RAYTHEON TECHNOLOGIES CORP P 2020-04-03 2021-06-21
RAYTHEON TECHNOLOGIES CORP P 2020-04-06 2021-06-21
MICRON TECHNOLOGY P 2020-11-16 2021-06-23
MICRON TECHNOLOGY P 2020-11-17 2021-06-23
MICROSOFT CORP P 2020-03-16 2021-06-24
FEDEX CORP P 2020-02-06 2021-06-24
ELI LILLY & CO P 2021-04-29 2021-06-24
ELI LILLY & CO P 2021-04-27 2021-06-24
ELI LILLY & CO P 2021-04-27 2021-06-24
ELI LILLY & CO P 2021-03-17 2021-06-24
BIOGEN INC P 2021-06-24 2021-06-24
GENERAL ELECTRIC CO P 2015-05-12 2021-06-29
BERKSHIRE HATHAWAY INC CL B P 2019-07-23 2021-06-29
NETFLIX INC P 2021-06-29 2021-07-07
NETFLIX INC P 2021-06-29 2021-07-07
GENERAL ELECTRIC CO P 2015-05-12 2021-07-07
GENERAL ELECTRIC CO P 2015-05-12 2021-07-08
MICROSOFT CORP P 2016-07-12 2021-07-14
MICROSOFT CORP P 2020-03-16 2021-07-14
L3HARRIS TECHNOLOGIES INC P 2019-10-18 2021-07-16
HILTON WORLDWIDE HOLDINGS INC P 2020-05-29 2021-07-16
HILTON WORLDWIDE HOLDINGS INC P 2020-05-29 2021-07-16
ORGANON & CO P 2021-05-12 2021-07-16
ORGANON & CO P 2021-05-19 2021-07-16
ILLUMINA INC P 2020-09-24 2021-07-19
ILLUMINA INC P 2020-10-01 2021-07-19
PROSSHARES ULTRA VIX SHORT-TERM FUTURES ETF P 2021-06-08 2021-07-19
ILLUMINA INC P 2020-10-28 2021-07-19
ILLUMINA INC P 2021-02-23 2021-07-19
ILLUMINA INC P 2020-11-16 2021-07-19
PROSSHARES ULTRA VIX SHORT-TERM FUTURES ETF P 2021-06-08 2021-07-19
ILLUMINA INC P 2021-03-02 2021-07-19
3M CO P 2021-03-11 2021-07-19
PROSSHARES ULTRA VIX SHORT-TERM FUTURES ETF P 2021-06-08 2021-07-19
PROSSHARES ULTRA VIX SHORT-TERM FUTURES ETF P 2021-06-09 2021-07-19
3M CO P 2021-03-19 2021-07-19
PROSSHARES ULTRA VIX SHORT-TERM FUTURES ETF P 2021-06-08 2021-07-19
HONEYWELL INTL INC P 2021-04-26 2021-07-22
ALPHABET INC CL A P 2015-04-22 2021-07-23
HILTON WORLDWIDE HOLDINGS INC P 2020-05-29 2021-07-23
BIOGEN INC P 2021-07-14 2021-07-23
HCA HEALTHCARE INC P 2020-04-23 2021-07-23
UBER TECHNOLOGIES INC P 2020-07-17 2021-07-23
SOFTBANK GROUP CORP ADR P 2020-03-04 2021-07-23
SOFTBANK GROUP CORP ADR P 2020-02-18 2021-07-23
HILTON WORLDWIDE HOLDINGS INC P 2020-04-17 2021-07-23
3M CO P 2021-03-11 2021-07-26
PFIZER INC P 2017-03-02 2021-07-30
PFIZER INC P 2016-09-12 2021-07-30
APPLE COMPUTER P 2013-04-22 2021-07-30
CISCO SYSTEMS P 2019-08-20 2021-07-30
CSX CORP P 2009-05-12 2021-08-03
SONY CORP ADR P 2020-03-10 2021-08-04
SONY CORP ADR P 2020-03-09 2021-08-04
APTIV PLC P 2021-03-01 2021-08-04
ALTERYX INC CLASS A P 2021-02-16 2021-08-04
CYRUSONE INC P 2021-07-20 2021-08-09
SONY CORP ADR P 2021-04-30 2021-08-19
AGILENT TECHNOLOGIES INC P 2019-06-12 2021-08-19
SONY CORP ADR P 2020-03-10 2021-08-19
AT&T INC P 2021-05-24 2021-08-23
LOWE'S COMPANIES INC P 2018-12-17 2021-08-23
MICROSOFT CORP P 2016-07-12 2021-08-23
L3HARRIS TECHNOLOGIES INC P 2019-10-18 2021-08-23
CISCO SYSTEMS P 2019-08-20 2021-08-23
SALESFORCE INC P 2020-12-22 2021-08-25
SALESFORCE INC P 2020-12-02 2021-08-25
AGILENT TECHNOLOGIES INC P 2019-06-12 2021-08-26
ALPHABET INC CL A P 2015-04-22 2021-08-27
HCA HEALTHCARE INC P 2020-04-23 2021-08-31
CANADIAN NATIONAL RAILWAY P 2021-05-28 2021-09-01
PFIZER INC P 2016-09-12 2021-09-09
BERKSHIRE HATHAWAY INC CL B P 2019-07-23 2021-09-09
HCA HEALTHCARE INC P 2020-04-23 2021-09-09
HILTON WORLDWIDE HOLDINGS INC P 2020-09-09 2021-09-14
AGILENT TECHNOLOGIES INC P 2019-06-12 2021-09-14
ABB LTD ADR P 2020-08-06 2021-09-14
FOX CORP CLASS B P 2019-03-19 2021-09-14
ALIBABA GROUP HOLDING SPONSORED ADR P 2021-02-19 2021-09-14
ALIBABA GROUP HOLDING SPONSORED ADR P 2020-11-23 2021-09-14
FOX CORP CLASS B P 2021-03-26 2021-09-14
FOX CORP CLASS B P 2019-03-19 2021-09-17
PROSSHARES ULTRA VIX SHORT-TERM FUTURES ETF P 2021-06-09 2021-09-20
GENERAL ELECTRIC CO NEW P 2019-03-06 2021-09-21
FOX CORP CLASS B P 2019-03-19 2021-09-21
FOX CORP CLASS B P 2019-04-04 2021-09-21
GENERAL ELECTRIC CO NEW P 2015-05-12 2021-09-21
GENERAL ELECTRIC CO NEW P 2020-11-25 2021-09-21
FOX CORP CLASS B P 2019-03-19 2021-09-21
LOWE'S COMPANIES INC P 2018-12-17 2021-09-21
UBER TECHNOLOGIES INC P 2020-07-15 2021-09-21
UBER TECHNOLOGIES INC P 2020-07-17 2021-09-21
GENERAL ELECTRIC CO NEW P 2020-12-28 2021-09-21
GENERAL ELECTRIC CO NEW P 2020-02-26 2021-09-21
CYRUSONE INC P 2021-07-20 2021-09-28
MGM RESORTS INTERNATIONAL P 2019-01-30 2021-09-28
FOX CORP CLASS B P 2019-04-04 2021-09-30
SALESFORCE INC P 2020-12-02 2021-09-30
CYRUSONE INC P 2021-07-23 2021-09-30
CYRUSONE INC P 2021-07-20 2021-09-30
ALIBABA GROUP HOLDING SPONSORED ADR P 2020-11-16 2021-09-30
ALIBABA GROUP HOLDING SPONSORED ADR P 2021-02-19 2021-09-30
MERCK & CO INC P 2021-05-19 2021-10-01
INTL FLAVORS & FRAGRANCES INC P 2021-02-09 2021-10-01
INTL FLAVORS & FRAGRANCES INC P 2020-12-22 2021-10-01
BIOGEN INC P 2021-07-14 2021-10-04
BIOGEN INC P 2021-07-14 2021-10-04
GENERAL MOTORS CO P 2021-02-09 2021-10-04
WALT DISNEY CO P 2020-04-07 2021-10-07
HILTON WORLDWIDE HOLDINGS INC P 2020-09-09 2021-10-07
AT&T INC P 2021-05-24 2021-10-11
AT&T INC P 2017-02-03 2021-10-11
MGM RESORTS INTERNATIONAL P 2019-01-25 2021-10-13
MGM RESORTS INTERNATIONAL P 2019-01-30 2021-10-13
MACQUARIE INFRASTRUCTURE CO P 2020-12-23 2021-10-20
MACQUARIE INFRASTRUCTURE CO P 2020-12-30 2021-10-20
MACQUARIE INFRASTRUCTURE CO - C.G. DISTRIBUTIONS P 2020-12-23 2021-10-20
SPLUNK INC. P 2021-10-20 2021-10-26
ALIBABA GROUP HOLDING SPONSORED ADR P 2020-11-16 2021-11-05
ALTERYX INC CLASS A P 2021-03-11 2021-11-05
ALTERYX INC CLASS A P 2021-02-24 2021-11-05
ALTERYX INC CLASS A P 2021-02-19 2021-11-05
ALIBABA GROUP HOLDING SPONSORED ADR P 2020-11-19 2021-11-05
ALIBABA GROUP HOLDING SPONSORED ADR P 2021-06-24 2021-11-05
ALIBABA GROUP HOLDING SPONSORED ADR P 2021-03-11 2021-11-05
ALIBABA GROUP HOLDING SPONSORED ADR P 2020-12-30 2021-11-05
INTERNATIONAL BUSINESS MACHINES P 2020-12-23 2021-11-05
ALTERYX INC CLASS A P 2021-02-16 2021-11-05
AT&T INC P 2017-08-25 2021-11-05
PARAMOUNT GLOBAL CL B P 2021-04-14 2021-11-05
PARAMOUNT GLOBAL CL B P 2021-03-29 2021-11-05
PARAMOUNT GLOBAL CL B P 2021-03-30 2021-11-05
PARAMOUNT GLOBAL CL B P 2021-03-31 2021-11-05
PARAMOUNT GLOBAL CL B P 2021-04-30 2021-11-05
PROSSHARES ULTRA VIX SHORT-TERM FUTURES ETF P 2021-06-09 2021-11-05
SOFTBANK GROUP CORP ADR P 2021-09-22 2021-11-05
UNILEVER PLC ADR P 2021-08-11 2021-11-05
UNILEVER PLC ADR P 2021-09-14 2021-11-05
AT&T INC P 2016-10-24 2021-11-05
KYNDRYL HLDGS INC P 2021-03-03 2021-11-05
INTERNATIONAL BUSINESS MACHINES P 2021-03-03 2021-11-05
AT&T INC P 2017-02-03 2021-11-05
GSK PLC ADR P 2021-05-10 2021-11-05
AT&T INC P 2018-04-16 2021-11-05
SOFTBANK GROUP CORP ADR P 2020-03-04 2021-11-05
AT&T INC P 2019-09-18 2021-11-05
AT&T INC P 2020-01-29 2021-11-05
AT&T INC P 2020-02-28 2021-11-05
AT&T INC P 2020-06-02 2021-11-05
AT&T INC P 2020-06-03 2021-11-05
AT&T INC P 2020-09-04 2021-11-05
GSK PLC ADR P 2014-05-07 2021-11-05
GSK PLC ADR P 2015-12-01 2021-11-05
INTERNATIONAL BUSINESS MACHINES P 2015-02-04 2021-11-05
INTERNATIONAL BUSINESS MACHINES P 2017-09-13 2021-11-05
INTERNATIONAL BUSINESS MACHINES P 2017-11-20 2021-11-05
AT&T INC P 2019-09-09 2021-11-05
INTERNATIONAL BUSINESS MACHINES P 2019-08-21 2021-11-05
KYNDRYL HLDGS INC P 2015-02-04 2021-11-05
SOFTBANK GROUP CORP ADR P 2020-05-27 2021-11-05
KYNDRYL HLDGS INC P 2017-09-13 2021-11-05
KYNDRYL HLDGS INC P 2017-11-20 2021-11-05
KYNDRYL HLDGS INC P 2019-08-21 2021-11-05
SOFTBANK GROUP CORP ADR P 2020-01-22 2021-11-05
SOFTBANK GROUP CORP ADR P 2020-03-03 2021-11-05
SOFTBANK GROUP CORP ADR P 2020-03-03 2021-11-05
SOFTBANK GROUP CORP ADR P 2020-03-10 2021-11-05
KYNDRYL HLDGS INC P 2020-12-23 2021-11-05
VMWARE, INC P 2019-11-08 2021-11-09
(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 6,765   7,757 -992
b 10,375   12,057 -1,682
c 6,225   7,244 -1,019
d 8,300   9,592 -1,292
e 3,672   3,490 182
10,500   11,404 -904
4,496   4,496 0
10,985   14,577 -3,592
3,858   3,528 330
5,025   2,394 2,631
1,929   1,580 349
1,928   1,537 391
1,205   882 323
1,205   965 240
4,465   3,309 1,156
8,515   5,284 3,231
4,066   1,238 2,828
8,717   6,619 2,098
3,307   990 2,317
4,232   3,490 742
2,141   1,745 396
31,943   22,478 9,465
4,282   3,490 792
7,116   7,047 69
6,246   5,729 517
5,859   3,464 2,395
3,140   990 2,150
2,045   1,795 250
2,641   283 2,358
14,819   13,367 1,452
2,045   1,762 283
3,287   2,897 390
2,825   1,558 1,267
4,081   1,238 2,843
6,992   2,855 4,137
4,681   2,207 2,474
3,940   2,138 1,802
440   259 181
330   194 136
3,431   1,714 1,717
2,635   1,585 1,050
4,494   3,490 1,004
5,893   3,529 2,364
620   585 35
3,418   2,458 960
6,065   1,334 4,731
3,100   2,926 174
2,947   1,142 1,805
7,077   3,310 3,767
9,409   5,112 4,297
13,534   8,719 4,815
8,121   4,753 3,368
8,121   5,235 2,886
8,121   5,235 2,886
1,783   921 862
2,675   1,411 1,264
2,019   1,382 637
979   742 237
1,957   1,561 396
2,277   2,416 -139
9,029   8,673 356
5,333   4,214 1,119
7,767   3,911 3,856
8,839   7,662 1,177
4,419   4,301 118
5,435   2,607 2,828
4,417   3,795 622
5,880   9,700 -3,820
8,834   7,662 1,172
6,171   5,186 985
2,075   1,382 693
6,127   3,018 3,109
4,060   1,893 2,167
6,090   4,065 2,025
20,368   18,242 2,126
3,458   3,448 10
24,204   24,139 65
5,092   4,602 490
5,092   5,009 83
4,407   3,516 891
4,570   2,154 2,416
2,539   1,511 1,028
4,451   2,742 1,709
5,175   2,764 2,411
27,542   20,292 7,250
2,430   1,689 741
4,485   2,742 1,743
4,225   2,244 1,981
20,856   17,602 3,254
4,416   3,516 900
3,469   2,186 1,283
9,966   5,068 4,898
1,221   1,221 0
3,587   2,744 843
17,736   14,065 3,671
1,221   1,238 -17
4,434   3,516 918
3,587   2,700 887
2,835   1,496 1,339
3,823   2,969 854
3,628   3,469 159
3,824   1,843 1,981
3,823   2,969 854
3,832   3,387 445
3,832   3,662 170
1,277   1,221 56
4,763   3,795 968
3,711   3,469 242
11,290   6,421 4,869
1,449   779 670
5,045   2,304 2,741
5,392   5,809 -417
3,581   2,695 886
3,581   2,583 998
3,581   2,691 890
3,581   2,700 881
2,765   2,222 543
2,765   2,121 644
1,383   1,129 254
11,061   8,800 2,261
5,530   4,444 1,086
6,730   3,502 3,228
4,371   2,244 2,127
3,048   1,585 1,463
5,670   4,023 1,647
1,414   1,037 377
3,952   2,560 1,392
3,416   1,811 1,605
7,218   6,511 707
4,164   2,114 2,050
2,351   2,307 44
9,405   8,553 852
3,527   3,640 -113
1,471   1,037 434
4,725   2,244 2,481
13,762   10,332 3,430
14,475   10,866 3,609
9,650   7,589 2,061
4,191   3,201 990
2,726   2,151 575
4,819   5,179 -360
20,077   17,112 2,965
12,046   10,135 1,911
389   306 83
4,634   3,320 1,314
3,746   2,969 777
3,244   1,751 1,493
2,222   947 1,275
8,889   2,178 6,711
883   502 381
1,302   834 468
2,603   1,689 914
9,933   1,133 8,800
9,933   5,263 4,670
4,995   6,822 -1,827
3,621   3,434 187
3,048   2,886 162
2,917   2,074 843
7,595   6,651 944
5,425   4,751 674
10,850   9,501 1,349
3,255   2,850 405
4,274   5,053 -779
2,509   1,599 910
3,255   2,817 438
6,367   3,553 2,814
2,767   3,366 -599
2,792   1,568 1,224
4,456   2,896 1,560
1,782   1,077 705
5,173   2,728 2,445
1,035   547 488
5,633   6,371 -738
5,481   3,711 1,770
3,158   2,452 706
4,736   4,792 -56
2,254   2,300 -46
901   980 -79
6,803   2,771 4,032
2,136   1,441 695
2,136   1,484 652
4,114   3,604 510
6,409   4,904 1,505
4,257   2,882 1,375
1,706   1,727 -21
3,649   1,744 1,905
1,735   1,034 701
2,602   1,615 987
13,883   10,727 3,156
1,983   1,523 460
2,667   1,421 1,246
1,810   898 912
5,927   4,545 1,382
5,927   4,565 1,362
5,927   4,565 1,362
2,371   1,878 493
14,079   13,625 454
1,945   4,053 -2,108
4,153   3,085 1,068
5,382   5,336 46
10,764   10,672 92
2,582   5,404 -2,822
5,082   10,808 -5,726
1,413   267 1,146
4,238   2,132 2,106
2,251   1,962 289
1,801   1,199 602
6,002   3,997 2,005
715   920 -205
286   373 -87
6,984   4,103 2,881
4,656   3,128 1,528
1,693   1,731 -38
4,656   3,156 1,500
2,328   2,300 28
2,328   1,514 814
3,387   3,455 -68
6,984   6,639 345
6,914   6,468 446
847   864 -17
847   855 -8
3,951   3,788 163
4,233   4,318 -85
2,325   2,220 105
5,243   1,089 4,154
1,863   1,199 664
4,830   5,342 -512
3,713   1,585 2,128
1,878   1,279 599
3,260   2,374 886
1,630   1,207 423
1,242   741 501
23,147   21,252 1,895
2,144   1,734 410
429   346 83
10,853   1,062 9,791
2,767   2,416 351
2,092   201 1,891
513   302 211
7,691   4,528 3,163
8,308   7,669 639
3,367   5,924 -2,557
3,727   3,683 44
1,933   2,042 -109
4,139   1,744 2,395
2,900   1,811 1,089
2,762   3,009 -247
6,212   2,764 3,448
7,600   1,334 6,266
3,478   2,943 535
2,920   2,416 504
3,890   3,434 456
1,297   1,119 178
2,594   1,046 1,548
14,325   2,722 11,603
3,814   1,585 2,229
12,351   11,307 1,044
2,301   1,731 570
4,190   3,085 1,105
2,612   1,057 1,555
6,498   4,549 1,949
3,446   1,395 2,051
3,497   2,464 1,033
2,938   3,603 -665
1,614   2,661 -1,047
2,422   4,059 -1,637
1,650   1,790 -140
2,107   2,429 -322
711   855 -144
2,423   1,898 525
5,177   6,074 -897
3,415   3,549 -134
606   1,351 -745
2,423   2,088 335
33   35 -2
3,084   1,382 1,702
1,732   1,275 457
433   320 113
1,817   1,614 203
2,423   2,302 121
3,878   3,683 195
2,250   1,441 809
3,758   3,585 173
4,067   3,358 709
3,921   3,650 271
7,841   7,314 527
1,472   2,617 -1,145
2,208   3,992 -1,784
6,090   5,670 420
3,485   3,209 276
3,485   2,897 588
2,808   3,749 -941
1,404   1,781 -377
2,769   2,810 -41
3,560   2,098 1,462
2,111   1,365 746
2,611   3,009 -398
2,611   4,149 -1,538
1,213   710 503
4,851   2,882 1,969
1,855   15,540 -13,685
371   6,618 -6,247
21,358     21,358
16,849   16,577 272
14,371   23,557 -9,186
4,023   4,427 -404
4,023   5,041 -1,018
4,023   5,547 -1,524
3,992   6,483 -2,491
2,395   3,248 -853
3,992   6,011 -2,019
3,194   4,790 -1,596
12,224   11,876 348
16,093   23,695 -7,602
10,054   15,175 -5,121
3,620   4,197 -577
10,860   14,106 -3,246
3,620   4,747 -1,127
3,620   4,524 -904
3,620   4,163 -543
1,502   3,420 -1,918
4,093   4,472 -379
7,898   8,605 -707
2,633   2,791 -158
12,575   18,523 -5,948
250   288 -38
6,112   5,779 333
7,545   12,447 -4,902
4,302   3,872 430
9,035   11,683 -2,648
10,916   9,496 1,420
3,773   5,522 -1,749
1,258   1,865 -607
2,515   3,572 -1,057
2,515   3,109 -594
5,030   6,290 -1,260
2,515   2,948 -433
30,117   38,800 -8,683
43,024   40,813 2,211
39,728   49,004 -9,276
12,224   13,867 -1,643
12,224   14,427 -2,203
3,546   5,263 -1,717
9,168   9,619 -451
1,626   2,441 -815
2,729   2,187 542
500   691 -191
500   719 -219
375   479 -104
13,645   11,033 2,612
2,729   2,347 382
5,458   4,695 763
2,729   2,065 664
500   591 -91
48   28 20
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       -992
b       -1,682
c       -1,019
d       -1,292
e       182
      -904
      0
      -3,592
      330
      2,631
      349
      391
      323
      240
      1,156
      3,231
      2,828
      2,098
      2,317
      742
      396
      9,465
      792
      69
      517
      2,395
      2,150
      250
      2,358
      1,452
      283
      390
      1,267
      2,843
      4,137
      2,474
      1,802
      181
      136
      1,717
      1,050
      1,004
      2,364
      35
      960
      4,731
      174
      1,805
      3,767
      4,297
      4,815
      3,368
      2,886
      2,886
      862
      1,264
      637
      237
      396
      -139
      356
      1,119
      3,856
      1,177
      118
      2,828
      622
      -3,820
      1,172
      985
      693
      3,109
      2,167
      2,025
      2,126
      10
      65
      490
      83
      891
      2,416
      1,028
      1,709
      2,411
      7,250
      741
      1,743
      1,981
      3,254
      900
      1,283
      4,898
      0
      843
      3,671
      -17
      918
      887
      1,339
      854
      159
      1,981
      854
      445
      170
      56
      968
      242
      4,869
      670
      2,741
      -417
      886
      998
      890
      881
      543
      644
      254
      2,261
      1,086
      3,228
      2,127
      1,463
      1,647
      377
      1,392
      1,605
      707
      2,050
      44
      852
      -113
      434
      2,481
      3,430
      3,609
      2,061
      990
      575
      -360
      2,965
      1,911
      83
      1,314
      777
      1,493
      1,275
      6,711
      381
      468
      914
      8,800
      4,670
      -1,827
      187
      162
      843
      944
      674
      1,349
      405
      -779
      910
      438
      2,814
      -599
      1,224
      1,560
      705
      2,445
      488
      -738
      1,770
      706
      -56
      -46
      -79
      4,032
      695
      652
      510
      1,505
      1,375
      -21
      1,905
      701
      987
      3,156
      460
      1,246
      912
      1,382
      1,362
      1,362
      493
      454
      -2,108
      1,068
      46
      92
      -2,822
      -5,726
      1,146
      2,106
      289
      602
      2,005
      -205
      -87
      2,881
      1,528
      -38
      1,500
      28
      814
      -68
      345
      446
      -17
      -8
      163
      -85
      105
      4,154
      664
      -512
      2,128
      599
      886
      423
      501
      1,895
      410
      83
      9,791
      351
      1,891
      211
      3,163
      639
      -2,557
      44
      -109
      2,395
      1,089
      -247
      3,448
      6,266
      535
      504
      456
      178
      1,548
      11,603
      2,229
      1,044
      570
      1,105
      1,555
      1,949
      2,051
      1,033
      -665
      -1,047
      -1,637
      -140
      -322
      -144
      525
      -897
      -134
      -745
      335
      -2
      1,702
      457
      113
      203
      121
      195
      809
      173
      709
      271
      527
      -1,145
      -1,784
      420
      276
      588
      -941
      -377
      -41
      1,462
      746
      -398
      -1,538
      503
      1,969
      -13,685
      -6,247
      21,358
      272
      -9,186
      -404
      -1,018
      -1,524
      -2,491
      -853
      -2,019
      -1,596
      348
      -7,602
      -5,121
      -577
      -3,246
      -1,127
      -904
      -543
      -1,918
      -379
      -707
      -158
      -5,948
      -38
      333
      -4,902
      430
      -2,648
      1,420
      -1,749
      -607
      -1,057
      -594
      -1,260
      -433
      -8,683
      2,211
      -9,276
      -1,643
      -2,203
      -1,717
      -451
      -815
      542
      -191
      -219
      -104
      2,612
      382
      763
      664
      -91
      20
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
Bracket 2 249,735
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ...................
Bracket 3  
Form 990-PF (2021)
Form 990-PF (2021)
Page 4
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 3,440
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 3,440
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 1,600
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 1,600
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 15
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 1,855
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet   RefundedBullet 11  
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 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)
    bulletTN
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
    If "Yes," complete Part XIII .............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 5
    Part VI-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletBAKER SULLIVAN HOOVER PLC Telephone no.bullet (615) 255-6143

    Located atbullet35 PEABODY STREET SUITE 310NASHVILLETN ZIP+4bullet37210
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country? .................
    16   No
    See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........
    1a(1)
     
    No
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person? ..............................
    1a(2)
     
    No
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
    1a(3)
     
    No
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
     
    No
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)? ......................
    1a(5)
     
    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
    ........bullet
    d
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2021? .............
    1d
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2021.) .....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    No
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals? .............
    5a(5)
     
    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
    .........bullet
    d
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant? .................
    5d
     
     
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract? .............................
    6a
     
    No
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    7a
     
    No
    b
    If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .........................
    8
     
    No
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position
    (c) Compensation
    (If not paid, enter
    -0-)
    (d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    GEORGE N BULLARD DIRECTOR
    10.00
    0 0 0
    PO BOX 50276
    NASHVILLE,TN37205
    PATRICIA BULLARD TRUSTEE
    25.00
    0 0 0
    PO BOX 50276
    NASHVILLE,TN37205
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position
    (c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation
    (e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 7
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part VIII-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 LIFEWORKS IS PRIMARILY A GRANT MAKING FOUNDATION ENABLING OTHER CHARITABLE ORGANIZATIONS TO FURTHER THEIR CHARITABLE ACTIVITIES. EXPENSES LISTED HERE ARE ACTUAL GRANTS MADE DURING YEAR. 0
    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.........................bullet0
    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
    3,914,886
    b
    Average of monthly cash balances.......................
    1b
    105,014
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    4,019,900
    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
    4,019,900
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    60,299
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    3,959,601
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    197,980
    Part X
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
    1
    Minimum investment return from Part IX, line 6..................
    1
    197,980
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    3,440
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    3,440
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    194,540
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    194,540
    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
    194,540
    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 7 194,540
    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...... 30,806
    b From 2017...... 17,635
    c From 2018...... 24,243
    d From 2019......  
    e From 2020......  
    f Total of lines 3a through e ........ 72,684
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 172,030
    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..... 172,030
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2021. 22,510 22,510
    (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 50,174
    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) ...
    8,296
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......
    41,878
    10 Analysis of line 9:
    a Excess from 2017.... 17,635
    b Excess from 2018.... 24,243
    c Excess from 2019....  
    d Excess from 2020....  
    e Excess from 2021....  
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2021, enter the date of the ruling ....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........
    Tax year Prior 3 years (e) Total
    (a) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    line 4 for each year listed .....
             
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........
             
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....
             
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)
             
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part IX, line 6 for each year listed ..
             
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....
             
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....
             
    (3) Largest amount of support
    from an exempt organization
             
    (4) Gross investment income          
    Part XIV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    Foundation
    status of
    recipient
    Purpose of grant or
    contribution
    Amount
    Name and address (home or business)
    aPaid during the year
    AMERICAN MALTESE ASSOCIATION
    2240 SOUTH 308TH ST
    FEDERAL WAY,WA98003
      PUBLIC FURTHER CHARITY PURPOSE 2,030
    CROSSROADS CAMPUS
    707 MONROE STREET
    NASHVILLE,TN37208
      PUBLIC FURTHER CHARITY PURPOSE 1,000
    DOC OWSLEY
    33 W 3RD ST
    COOKVILLE,TN38501
      PUBLIC FURTHER CHARITY PURPOSE 1,500
    HEALING STONES FOUNDATION
    PO BOX 50276
    NASHVILLE,TN37205
      PUBLIC FURTHER CHARITY PURPOSE 144,000
    NASHVILLE BALLET
    3630 REDMON STREET
    NASHVILLE,TN37209
      PUBLIC FURTHER CHARITY PURPOSE 5,000
    NASHVILLE DOLPHINS
    95 WHITE BRIDGE ROAD
    NASHVILLE,TN37205
      PUBLIC FURTHER CHARITY PURPOSE 500
    NASHVILLE TREE FOUNDATION
    95 WHITE BRIDGE ROAD
    NASHVILLE,TN37205
      PUBLIC FURTHER CHARITY PURPOSE 500
    SILOM HEALTH
    820 GALE LANE
    NASHVILLE,TN37204
      PUBLIC FURTHER CHARITY PURPOSE 7,500
    TENNGREEN LAND CONSERVANCY
    1213A 16TH STREET
    NASHVILLE,TN37212
      PUBLIC FURTHER CHARITY PURPOSE 5,000
    VCU COMMUNITY GRANT
    907 FLOYD AVENUE
    RICHMOND,VA23284
      PUBLIC FURTHER CHARITY PURPOSE 2,500
    WE HELP ANIMALSNET
    PO BOX 1007
    FRANKLIN,TN37065
      PUBLIC FURTHER CHARITY PURPOSE 2,500
    Total .................................bullet 3a 172,030
    bApproved for future payment
    Total .................................bullet 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.)
    1Program service revenue: (a)
    Business code
    (b)
    Amount
    (c)
    Exclusion code
    (d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments ....          
    3 Interest on savings and temporary cash
    investments ...........
        14 2  
    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 ............
        18 249,735  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aLITIGATION SETTLEMENT
        14 30  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 0 323,116 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    323,116
    (See worksheet in line 13 instructions to verify calculations.)
    Part XV-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow
    Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below?
    See instructions.
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    Firm's EIN SmallBullet
    Firm's address SmallBullet


    Phone no.
    Form 990-PF (2021)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2021 AccountingFeesSchedule
    Name:
    LIFEWORKS FOUNDATION
    EIN:
    62-1428468
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BAKER, SULLIVAN & HOOVER, PLC 17,600 4,400   0
    MARIE SWINFORD, CPA 12,350 3,088   0

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

    TY 2021 DepreciationSchedule
    Name:
    LIFEWORKS FOUNDATION
    EIN:
    62-1428468
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)
    Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    EQUIPMENT 1992-12-01 2,975 2,975 200DB 5.000000000000 0 0    
    EQUIPMENT 1994-07-01 1,766 1,766 200DB 5.000000000000 0 0    
    EQUIPMENT 1995-07-01 723 723 200DB 5.000000000000 0 0    
    COMPUTER 1996-07-01 4,262 4,262 200DB 5.000000000000 0 0    
    SCANNER 1997-04-11 342 342 200DB 7.000000000000 0 0    
    EQUIPMENT 1998-11-04 4,558 4,558 200DB 5.000000000000 0 0    
    COMPUTER 2000-12-02 1,774 1,774 200DB 5.000000000000 0 0    
    FURNITURE 1992-07-01 1,252 1,252 200DB 5.000000000000 0 0    
    FURNITURE 1996-07-01 38,744 38,744 200DB 7.000000000000 0 0    
    DESKS, CRENDENZA 2000-03-18 563 563 200DB 7.000000000000 0 0    
    SHELVES 2000-03-18 345 345 200DB 7.000000000000 0 0    
    WINDOWS XP SOFTWARE 2002-10-30 543 380 200DB 3.000000000000 0 0    
    CSPG-ARTWORK 2003-02-14 320 224 200DB 7.000000000000 0 0    
    FORD EXCURSION 2003-04-28 21,000 14,700 200DB 5.000000000000 0 0    
    FORD EXCURSION-REGISTRATION 2003-05-08 109 55 200DB 5.000000000000 0 0    
    PRINTER 2003-09-18 426 213 200DB 7.000000000000 0 0    
    FILE CABINET 2003-09-18 404 202 200DB 7.000000000000 0 0    
    SAFE 2004-03-04 526 263 200DB 7.000000000000 0 0    
    COMPUTER MONITOR 2004-04-03 503 252 200DB 5.000000000000 0 0    
    EQUIPMENT 2004-04-15 175 87 200DB 7.000000000000 0 0    
    FIRE PROOF FILE DRAWER CABINET 2004-10-21 841 420 200DB 5.000000000000 0 0    
    COMPUTER 2004-11-05 1,725 863 200DB 5.000000000000 0 0    
    COMPUTER HARDWARE-DVDRW PLAYER 2006-04-19 238 238 200DB 5.000000000000 0 0    
    COMPUTER 2006-07-10 1,621 1,621 200DB 5.000000000000 0 0    
    PHONE 2006-10-18 164 164 200DB 7.000000000000 0 0    
    SHELVES 2006-11-09 261 261 200DB 7.000000000000 0 0    
    SHREDDER 2007-01-10 152 152 200DB 7.000000000000 0 0    
    SHREDDER 2007-02-28 164 164 200DB 7.000000000000 0 0    
    COMPUTER 2007-08-30 703 703 200DB 5.000000000000 0 0    
    HP LASERJET COLOR PRINTER 2007-10-16 552 552 200DB 5.000000000000 0 0    
    9-1 FILE CABINETS 2007-10-09 1,049 1,049 200DB 7.000000000000 0 0    
    PRINTER 2007-12-05 203 203 200DB 5.000000000000 0 0    
    COPIER 2009-02-09 441 220 200DB 5.000000000000 0 0    
    TABLES 2008-07-10 326 163 200DB 7.000000000000 0 0    
    CELL PHONE 2009-02-09 227 113 200DB 7.000000000000 0 0    
    FURNITURE 2009-08-27 4,370 2,185 200DB 7.000000000000 0 0    
    VIDEO CARD AND FAX 2009-10-22 248 124 200DB 5.000000000000 0 0    
    I PHONE 2010-07-08 347 173 200DB 5.000000000000 0 0    
    AIR CONDITIONER 2010-08-09 257 128 200DB 7.000000000000 0 0    
    CABLE MODEM-BASE STATION 2010-08-25 343 172 200DB 5.000000000000 0 0    
    NETWORK CARD, SURGE PROTECTOR ETHERNET CARD 2010-08-27 227 114 200DB 5.000000000000 0 0    
    SOFTWARE 2010-09-10 1,377   200DB 3.000000000000 0 0    
    PRINTER 2011-10-13 245   200DB 5.000000000000 0 0    
    HARD DRIVE 2012-04-04 175 88 200DB 5.000000000000 0 0    
    TELEPHONE 2012-09-10 435 218 200DB 5.000000000000 0 0    
    AC UNIT FOR OFFICE 2013-08-08 202 101 200DB 7.000000000000 0 0    
    APPLE COMPUTER 2015-11-17 2,455 2,455 200DB 5.000000000000 0 0    
    SAFES 2017-01-07 679 233 200DB 7.000000000000 30 0    
    FIRE SAFE 2020-10-10 1,092   200DB 7.000000000000 269 0    
    FIRE SAFE FILING DRAWERS 2021-10-03 944   200DB 7.000000000000 34 0    
    NEW PHONES 2021-06-08 600   200DB 7.000000000000 107 0    

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    LIFEWORKS FOUNDATION
    EIN:
    62-1428468
    Name of Stock End of Year Book Value End of Year Fair Market Value
    ABB LTD ADR 45,097 72,714
    ABBVIE INC 51,921 101,550
    AGILENT TECHNOLOGIES INC 19,658 46,299
    AIR PRODUCTS & CHEMICALS INC 60,854 68,459
    ALPHABET INC CL A 44,282 217,278
    APPLE COMPUTER 13,101 164,252
    BAXTER INTL 68,417 85,840
    BERKSHIRE HATHAWAY INC CL B 35,190 52,325
    BOEING CO 62,106 49,323
    BRISTOL MYERS SQUIBB 75,116 90,408
    CATERPILLAR INC 30,643 41,348
    CIGNA CORP NEW 37,149 49,370
    CISCO SYSTEMS 46,635 82,381
    COCA COLA CO 55,416 75,789
    COMCAST CORP NEW CL A 47,574 60,396
    CSX CORP 22,098 48,880
    CVS HEALTH CORP 46,327 64,475
    DANAHER CORP 24,012 57,577
    DELL TECHNOLOGIES INC CLASS C 11,917 33,702
    FEDEX CORP 39,034 55,608
    FOX CORP CLASS B 45,903 47,978
    HCA HEALTHCARE INC 21,892 53,953
    HILTON WORLDWIDE HOLDINGS INC 24,257 46,797
    INTEL CORP 71,541 92,700
    INTL FLAVORS & FRAGRANCES INC 51,104 67,793
    JP MORGAN CHASE & CO 12,596 19,794
    L3HARRIS TECHNOLOGIES INC 47,018 66,104
    LOWE'S COMPANIES INC 37,226 72,374
    MEDTRONIC PLC 67,284 75,519
    MGM RESORTS INTERNATIONAL 39,318 68,442
    MICROSOFT CORP 22,410 141,254
    NESTLE SA ADR 42,142 69,934
    PAYPAL HOLDINGS INC 25,146 37,716
    PFIZER INC 15,229 25,982
    QUALCOMM CORP 28,779 85,949
    RAYTHEON TECHNOLOGIES CORP 33,893 67,127
    SALESFORCE INC 32,043 36,849
    SONY CORP ADR 25,834 59,408
    STARBUCKS CORP 20,442 38,015
    SYSCO CORP 41,612 53,021
    UBER TECHNOLOGIES INC 28,879 38,995
    VERIZON COMMUNICATIONS CORP 75,606 75,342
    WALMART INC 44,714 79,580
    WALT DISNEY CO 56,778 80,543
    WELLS FARGO & CO 58,580 60,215
    WESTERN DIGITAL CORP 33,558 52,168
    APTIV PLC 36,740 41,238
    BIOGEN INC 26,662 17,994
    CANADIAN NATIONAL RAILWAY 47,601 52,216
    CLOROX CO 48,452 47,077
    GENERAL MOTORS CO 59,905 64,493
    HONEYWELL INTL INC 63,781 61,510
    JOHNSON & JOHNSON 41,983 42,768
    MERCK & CO INC 31,820 32,572
    NEXTERA ENERGY INC 48,308 60,684
    NIKE INC CL B 37,322 41,668
    ROCHE HLDG LTD ADR 29,487 32,505
    ROYAL DUTCH SHELL PLC ADR A 28,641 30,380
    UNITED PARCEL SERVICE CL B 54,214 61,087
    VMWARE, INC 18,494 30,592

    TY 2021 LandEtcSchedule2
    Name:
    LIFEWORKS FOUNDATION
    EIN:
    62-1428468
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    EQUIPMENT 2,975 2,975 0  
    EQUIPMENT 1,766 1,766 0  
    EQUIPMENT 723 723 0  
    COMPUTER 4,262 4,262 0  
    SCANNER 342 342 0  
    EQUIPMENT 4,558 4,558 0  
    COMPUTER 1,774 1,774 0  
    FURNITURE 1,252 1,252 0  
    FURNITURE 38,744 38,744 0  
    DESKS, CRENDENZA 563 563 0  
    SHELVES 345 345 0  
    WINDOWS XP SOFTWARE 543 543 0  
    CSPG-ARTWORK 320 320 0  
    FORD EXCURSION 21,000 21,000 0  
    FORD EXCURSION-REGISTRATION 109 109 0  
    PRINTER 426 426 0  
    FILE CABINET 404 404 0  
    SAFE 526 526 0  
    COMPUTER MONITOR 503 503 0  
    EQUIPMENT 175 175 0  
    FIRE PROOF FILE DRAWER CABINET 841 841 0  
    COMPUTER 1,725 1,725 0  
    COMPUTER HARDWARE-DVDRW PLAYER 238 238 0  
    COMPUTER 1,621 1,621 0  
    PHONE 164 164 0  
    SHELVES 261 261 0  
    SHREDDER 152 152 0  
    SHREDDER 164 164 0  
    COMPUTER 703 703 0  
    HP LASERJET COLOR PRINTER 552 552 0  
    9-1 FILE CABINETS 1,049 1,049 0  
    PRINTER 203 203 0  
    COPIER 441 441 0  
    TABLES 326 326 0  
    CELL PHONE 227 227 0  
    FURNITURE 4,370 4,370 0  
    VIDEO CARD AND FAX 248 248 0  
    I PHONE 347 347 0  
    AIR CONDITIONER 257 257 0  
    CABLE MODEM-BASE STATION 343 343 0  
    NETWORK CARD, SURGE PROTECTOR ETHERNET CARD 227 227 0  
    SOFTWARE 1,377 1,377 0  
    PRINTER 245 245 0  
    HARD DRIVE 175 175 0  
    TELEPHONE 435 435 0  
    AC UNIT FOR OFFICE 202 202 0  
    APPLE COMPUTER 2,455 2,455 0  
    SAFES 679 603 76  
    FIRE SAFE 1,092 420 672  
    FIRE SAFE FILING DRAWERS 944 34 910  
    NEW PHONES 600 107 493  


    TY 2021 OtherAssetsSchedule
    Name:
    LIFEWORKS FOUNDATION
    EIN:
    62-1428468
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    DEPOSITS AND CREDITS 2,157 2,157 2,157
    DUE FROM G. BULLARD 199 107 107
    DUE FROM AFFILIATE 566 566 566
    CREDIT ON REVOLVING LINE   943 943


    TY 2021 OtherExpensesSchedule
    Name:
    LIFEWORKS FOUNDATION
    EIN:
    62-1428468
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    AUTOMOBILE EXPENSE 220 0   0
    ALARM 429 0   0
    BANK CHARGES 308 0   0
    OTHER LABOR COSTS 86 0   0
    DUES, SUBSCRIPTIONS, & MEMBERSHIPS 276 69   0
    INSURANCE EXPENSE 3,661 915   0
    INVESTMENT MGT FEE 41,833 41,833   0
    LEGAL FEES 2,310 578   0
    OFFICE SUPPLIES 785 196   0
    POSTAGE 350 88   0
    ROUNDING 3 0   0
    TELEPHONE/COMMUNICATIONS 5,429 1,357   0


    TY 2021 OtherIncomeSchedule2
    Name:
    LIFEWORKS FOUNDATION
    EIN:
    62-1428468
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    LITIGATION SETTLEMENT 30   30


    TY 2021 OtherIncreasesSchedule
    Name:
    LIFEWORKS FOUNDATION
    EIN:
    62-1428468
    Description Amount
    COST ADJUSTMENT ON UNREALIZED GAINS/LOSSES 403
    ROUNDING 1


    TY 2021 TaxesSchedule
    Name:
    LIFEWORKS FOUNDATION
    EIN:
    62-1428468
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PAYROLL TAXES 6,216 1,554   0
    FOREIGN TAXES 1,837 459   0
    EXCISE TAX 1,600 400   0