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 10-01-2021 , and ending 09-30-2022
Name of foundation
Washington Square Health Foundation
 
Number and street (or P.O. box number if mail is not delivered to street address)875 North Michigan Ave 3516
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Chicago, IL60611
A Employer identification number

36-1210140
B Telephone number (see instructions)

(312) 664-6488
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$16,811,906J 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) 5,875
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 306,327 306,327  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 1,165,103
b Gross sales price for all assets on line 6a 2,616,779
7 Capital gain net income (from Part IV, line 2)... 1,165,103
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances 0
b Less: Cost of goods sold.... 0
c Gross profit or (loss) (attach schedule)..... 0  
11 Other income (attach schedule)....... 0 0 0
12 Total. Add lines 1 through 11........ 1,477,305 1,471,430 0
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 420,804 42,080   378,724
14 Other employee salaries and wages...... 8,094 809   7,285
15 Pension plans, employee benefits....... 147,934 14,793   133,140
16a Legal fees (attach schedule)......... Click to see attachment 824 82 0 742
b Accounting fees (attach schedule)....... Click to see attachment 34,087 3,409 0 30,678
c Other professional fees (attach schedule).... Click to see attachment 4,540 454 0 4,086
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 47,557 2,496 0 22,461
19 Depreciation (attach schedule) and depletion... Click to see attachment 7,805 781 0
20 Occupancy.............. 71,401 7,140   64,261
21 Travel, conferences, and meetings....... 7,002 700   6,302
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 95,786 9,580 0 86,208
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 845,834 82,324 0 733,887
25 Contributions, gifts, grants paid....... 549,236 534,236
26 Total expenses and disbursements. Add lines 24 and 25 1,395,070 82,324 0 1,268,123
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 82,235
b Net investment income (if negative, enter -0-) 1,389,106
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2021)
Form 990-PF (2021)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............. 998,121 838,511 838,511
2 Savings and temporary cash investments......... 1,473,167 1,506,951 1,506,951
3 Accounts receivable bullet3,015
Less: allowance for doubtful accounts bullet   8,020 3,015 3,015
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet   0 0 0
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)..... 0 0 0
7 Other notes and loans receivable (attach schedule) bullet0
Less: allowance for doubtful accounts bullet0 0 0 0
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges.......... 35,628 34,119 34,119
10a Investments—U.S. and state government obligations (attach schedule) 0 0 0
b Investments—corporate stock (attach schedule)....... 17,703,341 Click to see attachment13,336,242 13,336,242
c Investments—corporate bonds (attach schedule)....... 296,520 Click to see attachment336,172 336,172
11 Investments—land, buildings, and equipment: basis bullet0
Less: accumulated depreciation (attach schedule) bullet0 0   0
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 664,216 Click to see attachment424,306 424,306
14 Land, buildings, and equipment: basis bullet87,975
Less: accumulated depreciation (attach schedule) bullet64,324 24,883 Click to see attachment23,651 23,651
15 Other assets (describe bullet) Click to see attachment365,905 Click to see attachment308,939 Click to see attachment308,939
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 21,569,801 16,811,906 16,811,906
Liabilities 17 Accounts payable and accrued expenses.......... 52,932 53,591
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons 0 0
21 Mortgages and other notes payable (attach schedule)...... 0 0
22 Other liabilities (describe bullet) Click to see attachment621,952 Click to see attachment676,557
23 Total liabilities (add lines 17 through 22)......... 674,884 730,148
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........... 20,894,917 16,081,758
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 20,894,917 16,081,758
30 Total liabilities and net assets/fund balances (see instructions). 21,569,801 16,811,906
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
20,894,917
2
Enter amount from Part I, line 27a .....................
2
82,235
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
20,977,152
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
4,895,394
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
16,081,758
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 SECURITIES      
b
c
d
e
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a 2,616,779   1,451,676 1,165,103
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a     0 1,165,103
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 1,165,103
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 0
Form 990-PF (2021)
Form 990-PF (2021)
Page 4
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2  
3 Add lines 1 and 2........................... 3 19,309
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 19,309
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 22,110
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 22,110
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 2,801
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet2,801 RefundedBullet 11 0
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XIV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletIL
    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 addressbulletWWW.WSHF.ORG
    14
    The books are in care ofbulletHOWARD NOCHUMSON Telephone no.bullet (312) 664-6488

    Located atbullet875 NORTH MICHIGAN AVE STE 3516CHICAGOIL ZIP+4bullet60611
    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)
    Yes
     
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)? ......................
    1a(5)
     
    No
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.) ...............
    1a(6)
     
    No
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........
    1b
     
    No
    c
    ........bullet
    d
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2021? .............
    1d
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2021.) .....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    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
    Barbara Berendt Director
    2.000     		11,500 0 0
    875 North Michigan Ave
    Chicago,IL60611
    Catherine M Creticos MD Director
    2.000     		12,500 0 0
    875 North Michigan Ave
    Chicago,IL60611
    Sandy Goldberg PhD Director
    2.000     		10,750 0 0
    875 North Michigan Ave
    Chicago,IL60611
    William N Werner MD MPH Board Chair / Director
    2.000     		28,250 0 0
    875 North Michigan Ave
    Chicago,IL60611
    William B Friedeman Secretary / Director
    2.000     		17,000 0 0
    875 North Michigan Ave
    Chicago,IL60611
    James M Snyder Treasurer / Director (thru 12/31/21)
    2.000     		6,750 0 0
    875 North Michigan Ave
    Chicago,IL60611
    Howard Nochumson Executive Director & President
    40.000     		220,800 79,382 0
    875 North Michigan Ave
    Chicago,IL60611
    Catherine Kapella MPH Associate Director & Vice President
    40.000     		156,641 61,368 0
    875 North Michigan Ave
    Chicago,IL60611
    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
     
    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
     
    Total number of others receiving over $50,000 for professional services.............bullet  
    Part VIII-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1  
    2  
    3  
    4  
    Part VIII-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1 None  
    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
    18,906,442
    b
    Average of monthly cash balances.......................
    1b
    1,212,453
    c
    Fair market value of all other assets (see instructions)................
    1c
    80,740
    d
    Total (add lines 1a, b, and c).........................
    1d
    20,199,635
    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
     
    3
    Subtract line 2 from line 1d.........................
    3
    20,199,635
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    302,995
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    19,896,640
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    994,832
    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
    994,832
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    19,309
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    19,309
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    975,523
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    4,506
    5
    Add lines 3 and 4............................
    5
    980,029
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
    7
    980,029
    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 7 980,029
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 0
    b Total for prior years:2019, 2018, 2017 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016...... 522,795
    b From 2017...... 319,254
    c From 2018...... 430,743
    d From 2019...... 672,248
    e From 2020...... 200,622
    f Total of lines 3a through e ........ 2,145,662
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 1,268,123
    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..... 980,029
    e Remaining amount distributed out of corpus 288,094
    5 Excess distributions carryover applied to 2021.   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 2,433,756
    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......     		 
    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) ...     		522,795
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		1,910,961
    10 Analysis of line 9:
    a Excess from 2017.... 319,254
    b Excess from 2018.... 430,743
    c Excess from 2019.... 672,248
    d Excess from 2020.... 200,622
    e Excess from 2021.... 288,094
    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 e-mail address of the person to whom applications should be addressed:
    HOWARD NOCHUMSON
    875 NORTH MICHIGAN AVE SUITE 3516
    CHICAGO,IL60611
    (312) 664-6488
    bThe form in which applications should be submitted and information and materials they should include:
    Visit the website for the organization's grant guidelines & application: http://wshf.org/general-guidelines/
    cAny submission deadlines:
    GRANT SUBMISSIONS WERE ACCEPTED ON A CONTINUOUS ROLLING BASIS FOR EITHER THE 12/1 OR 6/1 DEADLINES.
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    NONE
    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
    A Silver Lining Foundation
    134 N LaSalle Street Suite 2050
    Chicago,IL60602     		NONE PC Tasting Stars Matching Grant to be used to support the Mammogram Program 15,000
    A Silver Lining Foundation
    134 N LaSalle Street Suite 2050
    Chicago,IL60602     		NONE PC Breast Health Testing for those affected by the Pandemic 35,000
    A Silver Lining Foundation
    134 N LaSalle Street Suite 2050
    Chicago,IL60602     		NONE PC Dr. Sandy Goldberg's Board of Director Grant to A Silver Lining Foundation for Mammography 7,500
    A Silver Lining Foundation
    134 N LaSalle Street Suite 2050
    Chicago,IL60602     		NONE PC Special Designated Grant to A Silver lining Foundation for Mammography Services 4,000
    A Silver Lining Foundation
    134 N LaSalle Street Suite 2050
    Chicago,IL60602     		NONE PC Dr. Catherine M. Creticos' Board of Director Grant to A Silver Lining Foundation for Mammography 1,750
    A Silver Lining Foundation
    134 N LaSalle Street Suite 2050
    Chicago,IL60602     		NONE PC Barbara Berendt's Board of Director Grant to A Silver Lining Foundation 2,000
    Advocate Charitable Foundation
    3075 Highland Pkwy 600
    Downers Grove,IL60515     		NONE PC Dr. William N. Werner's Board of Director Grant to the Angelo P. Creticos, MD Cancer Center at Advocate Illinois Masonic Medical Center 2,000
    Advocate Charitable Foundation
    3075 Highland Pkwy 600
    Downers Grove,IL60515     		NONE PC Dr. Catherine M. Creticos' Board of Director Grant to the Angelo P. Creticos, MD Lectureship Fund at Advocate Illinois Masonic Medical Center 1,000
    Advocate Charitable Foundation
    3075 Highland Pkwy 600
    Downers Grove,IL60515     		NONE PC Dr. Catherine M. Creticos' Board of Director Grant to the Anastasia and Angelo P. Creticos, MD Medical Innovation Endowment at Advocate Illinois Masonic Medical Center. 500
    Advocate Charitable Foundation
    3075 Highland Pkwy 600
    Downers Grove,IL60515     		NONE PC Dr. Catherine M. Creticos' Board of Director Grant to the Angelo P. Creticos, MD Lectureship Fund at Advocate Illinois Masonic Medical Center 500
    Advocate Charitable Foundation
    3075 Highland Pkwy 600
    Downers Grove,IL60515     		NONE PC Howard Nochumson's Board of Director Grant to the Eye Center 500
    Alexian Brothers Bonaventure House
    825 West Wellington
    Chicago,IL60657     		NONE PC Dr. Catherine M. Creticos' Board of Director Grant to Alexian Brothers Bonaventure House 1,250
    Alzheimer's Association
    225 North Michigan Avenue Suite 17
    Chicago,IL60601     		NONE PC Special Designated Grant in Memory of Kathleen Pietschmann, RN, ND 250
    Ann & Robert H Lurie Children's Hospital of Chicago
    225 E Chicago Ave Box 4
    Chicago,IL60611     		NONE PC Hematology, Oncology and Stem Cell Transplantation Fellowship Program 60,000
    Bensenville Wood Dale Food Pantry
    192 S Center S
    Bensenville,IL60106     		NONE PC Barbara Berendt's Board of Director Grant to the Bensenville-Wood Dale Food Pantry 1,000
    Boulder Community Health Foundation
    PO Box 19320
    Boulder,CO80308     		NONE PC William B. Friedeman's Board of Director Grant to Boulder Community Health Foundation for Program Support 1,000
    Chicago Chesed Fund
    7045 Ridgeway
    Lincolnwood,IL60712     		NONE PC Howard Nochumson's Board of Director Grant to the Chicago Chesed Fund for Program Support 1,000
    Chicago Chesed Fund
    7045 Ridgeway
    Lincolnwood,IL60712     		NONE PC Howard Nochumson's Board of Director Grant to the Chicago Chesed Fund for Program Support 1,000
    Chicago Diabetes Project
    1074 W Taylor Street 233
    Chicago,IL60607     		NONE PC Special Designated Grant to Sponsor the CDP Donor Update Dinner on October 6, 2022 5,000
    Chicago Hearing Society
    6610 N Clark St
    Chicago,IL60626     		NONE PC CHS Hearing Health Clinic Audiology Testing Equipment 14,470
    City Of Hope
    1500 East Duarte Road
    Duarte,CA91010     		NONE PC Special Designated Grant to the City of Hope for Program Support 10,000
    Community Health NFP
    2611 W Chicago Ave
    Chicago,IL60622     		NONE PC Patient Advisory Committee and Health Education Program 12,470
    Congregation KINS of West Rogers Park
    2800 West North Shore Avenue
    Chicago,IL60645     		NONE PC Howard Nochumson's Board of Director Grant to Congregation KINS of West Rogers Park for Covid Prevention 1,000
    Congregation KINS of West Rogers Park
    2800 West North Shore Avenue
    Chicago,IL60645     		NONE PC Howard Nochumson's Board of Director Grant to Congregation KINS of West Rogers Park for Covid Prevention 1,000
    Council on Foundations
    1828 L Street NW Suite 300
    Washington,DC20036     		NONE PC Foundation Designated Grant 3,000
    Covenant World Relief
    8303 W Higgins Rd
    Chicago,IL60631     		NONE PC Dr. William N. Werner's Board of Director Grant to Covenant World Relief and Development 2,000
    Erie Family Health Center
    1701 West Superior Street 3rd Floo
    Chicago,IL60622     		NONE PC Reshaping Diabetes Prevention and Management in the Context of COVID-19 12,500
    Forefront
    208 South LaSalle Street Suite 1540
    Chicago,IL60604     		NONE PC Foundation Designated Grant 645
    Gilda's Club Chicago
    537 N Wells St
    Chicago,IL60654     		NONE PC One to One Counseling Services 25,250
    Grantmakers In Health
    1100 Connecticut Avenue NW Suite
    Washington,DC20036     		NONE PC Special Designated Grant 3,250
    Harvest House
    175 Jefferson Ave
    Buffalo,NY14210     		NONE PC William B. Friedeman's Board of Director Grant in honor of Jessica R. Friedeman to Harvest House for the Good Neighbors Health Care Program 1,000
    Howard Brown Health Center
    4025 N Sheridan Rd
    Chicago,IL60640     		NONE PC Special Designated Grant to Howard Brown Health for Program Support 5,000
    Howard Brown Health Center
    4025 N Sheridan Rd
    Chicago,IL60640     		NONE PC Dr. Catherine M. Creticos' Board of Director Grant to Howard Brown Health Center for Clinical Research 1,500
    ILLini Chabad
    209 E Armory Ave
    Champaigne,IL61820     		NONE PC Howard Nochumson's Board of Director Grant to ILLini Chabad for Program Support 1,000
    Institute of Medicine of Chicago
    332 South Michigan Avenue Suite 525
    Chicago,IL60604     		NONE PC Special Designated Grant to Institute of Medicine of Chicago for Program Support 3,000
    Mount Sinai Hospital and Medical Center
    1500 S Fairfield Ave F-125 Develop
    Chicago,IL60608     		NONE PC Ogden Commons Health Village 25,000
    MPN Research Foundation
    180 N Michigan Ave Ste 1870
    Chicago,IL60601     		NONE PC Ms. Barbara Berendt's Board of Director Grant to the MPN Research Foundation 2,000
    Near North Health Service Corporation
    1276 N Clybourn Avenue
    Chicago,IL60610     		NONE PC Integrated Mobile Healthcare and Outreach 12,500
    New York Road Runners
    320 W 57th Street
    New York,NY10019     		NONE PC Catherine Kapella, MPH's Board Officer Grant to the NYRR Team for Kids Program. 1,000
    North Park University
    3225 W Foster Ave
    Chicago,IL60091     		NONE PC Direct-Entry Master of Science in Nursing (DEMSN) Program 10,000
    North Park Friendship Center
    3448 W Foster
    Chicago,IL60625     		NONE PC Dr. William N. Werner's Board of Director Grant to the North Park Friendship Center 2,500
    NorthShore University HealthSystem Research Institute
    1001 University Place
    Evanston,IL60201     		NONE PC Advanced Diffusion Tensor MRI for Breast Cancer 83,981
    Northwestern Memorial Foundation
    541 N Fairbanks Court Suite 800
    Chicago,IL60611     		NONE PC Barbara Berendt's Board of Director Grant to Northwestern Memorial Foundation 1,000
    Northwestern University Feinberg School of Medicine
    710 N Lake Shore Drive
    Chicago,IL60611     		NONE PC Catherine Kapella, MPH's Board Officer Grant to Northwestern University to advance the research of Dr. Amani Fawzi 5,000
    Ocean First Institute
    3015 Bluff Street
    Boulder,CO80301     		NONE PC Mr. William B. Friedeman's Board of Director Grant to Ocean First Institute for Programs with Aquatic Therapy in Treating Autism. 1,000
    Orchard Village
    7660 Gross Point Rd
    Skokie,IL60077     		NONE PC StationMD Residential Implementation for Adults with Intellectual and Developmental Disabilities 23,220
    Planned ParenthoodChicago Area
    18 S Michigan Ave 6th Floor
    Chicago,IL60603     		NONE PC Telehealth Program 10,000
    Polish American Association
    3834 N Cicero Ave
    Chicago,IL60641     		NONE PC Polish American Association Food Pantry. 37,500
    Polish American Association
    3834 N Cicero Ave
    Chicago,IL60641     		NONE PC Catherine Kapella's Board Officer Grant to Polish American Association for Program Support 1,500
    Project CURE
    10377 E Geddes Ave
    Centennial,CO80112     		NONE PC Mr. William B. Friedeman's Board of Director Grant to Project C.U.R.E. for Program Support 500
    Project Seed of Suburban Chicago Inc
    6045 N Monticello Avenue
    Chicago,IL60659     		NONE PC Howard Nochumson's Board of Director Grant to Project Seed of Suburban Chicago for Program Support 1,000
    Ray Graham Association for People with Disabilities
    901 Warrenville Rd Suite 500
    Lisle,IL60532     		NONE PC Dr. Catherine M. Creticos' Board of Director Grant to the Hanson Center Therapeutic Riding Program at Ray Graham Association for People with Disabilities. 750
    Rosalind Franklin University of Medicine and Science
    3333 Green Bay Road
    Chicago,IL60064     		NONE PC The WSHF Nursing Scholarship Program 12,500
    Rush University Medical Center
    1700 W Van Buren St Suite 250
    Chicago,IL60612     		NONE PC William B. Friedeman's Board of Director Grant to The Woman's Board of Rush University Medical Center in honor of Laurie S. Friedeman and all past Woman's Board Presidents 3,000
    Second Sense
    65 E Wacker Place Suite 101
    Chicago,IL60601     		NONE PC Orientation and Mobility 14,500
    St Anthony Hospital
    2875 W 19TH ST
    Chicago,IL60623     		NONE PC PRI Foregiveness 40,000
    St John's Episcopal Church
    PO Box 1690
    Jackson,WY83001     		NONE PC Mr. William B. Friedeman's Board of Director Grant to St. John's Episcopal Church for the Whittier Food Pantry 1,000
    The American Committee for the Weizmann Institute of Science
    180 N LaSalle Street Suite 3110
    Chicago,IL60601     		NONE PC Scholarship: Women in Science and Gender Equality Program 20,000
    The Kedzie CenterExpanded Mental Health Services Of Chicago
    4141 N Kedzie Ave Suite 2
    Chicago,IL60618     		NONE PC Dr. William N. Werner's Board of Director Grant to The Kedzie Center 1,000
    Torah Academy of Buffalo Grove
    720 Armstrong Drive
    Buffalo Grove,IL60089     		NONE PC Howard Nochumson's Board of Director Grant to Torah Academy of Buffalo Grove for CPR & Defibrillator Use Training 1,000
    University Of Illinois at Chicago College of Nursing
    845 S Damen
    Chicago,IL60612     		NONE PC Community Based Wound Care for Persons Experiencing Opioid Use Disorder 4,000
    Vision For Chicago
    1319 Wenonah ave
    Berwyn,IL60402     		NONE PC Vision for Chicago - Eye Care for ReEntry Population 9,950
    Wood Dale Community United Methodist Church
    206 N Wood Dale Rd PO Box 250
    Wood Dale,IL60191     		NONE PC Barbara Berendt's Board of Director Grant to the Bensenville-Wood Dale Food Pantry 1,500
    Zacharias Sexual Abuse Center
    4275 Old Grand Avenue
    Gurnee,IL60031     		NONE PC Digital Prevention Education Development 10,000
    Total .................................bullet 3a 574,236
    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 ...........     		         
    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 1,165,103  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 0 1,471,430 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    1,471,430
    (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: 21014044
    Software Version: 2021v4.2


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors

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

    36-1210140
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ






    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
    or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990) (2021)
    Schedule B (Form 990) (2021) Page 2
    Name of organization
    Washington Square Health Foundation
          		Employer identification number
    36-1210140
    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
    ZENDT TRUST
     
    C/O BANK OF AMERICA 100 WESTMINSTER
    STREET
    PROVIDENCE, RI02903

    		$ 5,875


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

    		$  


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

    		$  


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

    		$  


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

    		$  


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

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 3
    Name of organization
    Washington Square Health Foundation
          		Employer identification number

    36-1210140
    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
    Washington Square Health Foundation
          		Employer identification number

    36-1210140
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990) (2021)
    Additional Data


    Software ID: 21014044
    Software Version: 2021v4.2

    TY 2021 AccountingFeesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Accounting Fees 34,087 3,409   30,678

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

    TY 2021 DepreciationSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    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           7,805 781    

    TY 2021 InvestmentsCorpBondsSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Name of Bond End of Year Book Value End of Year Fair Market Value
    CORPORATE BONDS 0 0
    Mutual Funds 336,172 336,172

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Name of Stock End of Year Book Value End of Year Fair Market Value
    DOM. SMALL CAP MUTUAL FUNDS 2,025,159 2,025,159
    DOM. LARGE CAP MUTUAL FUNDS 3,372,785 3,372,785
    DOMESTIC EQUITY FUNDS 0 0
    INTERNATIONAL EQUITY FUNDS 1,677,928 1,677,928
    DOM. MIDDLE CAP MUTUAL FUNDS 2,207,469 2,207,469
    COMMINGLED EQUITY FUNDS 0 0
    Equities 4,052,901 4,052,901

    TY 2021 InvestmentsOtherSchedule2
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    LONG-TERM GROWTH EQUITY FUND FMV 0 0
    DIVIDEND APPRECIATION INDEX FMV 424,306 424,306

    TY 2021 LandEtcSchedule2
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    EQUIPMENT 87,975 64,324 23,651 23,651


    TY 2021 LegalFeesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES 824 82   742


    TY 2021 OtherAssetsSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    RENT SECURITY DEPOSIT 6,971 6,971 6,971
    PROGRAM RELATED INVESTMENTS 358,934 301,968 301,968


    TY 2021 OtherDecreasesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Description Amount
    Unrealized loss 4,895,394


    TY 2021 OtherExpensesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INSURANCE 5,141 514   4,627
    OFFICE SUPPLIES 20,887 2,089   18,798
    BOARD DIRECTED PROGRAMS 3,740 374   3,366
    DUES & SUBSCRIPTIONS 8,705 871   7,835
    SERVICE CONTRACTS 15,584 1,558   14,026
    BANK CHARGES 12,527 1,253   11,274
    EXECUTIVE DIRECTOR EXPENSE 865 87   779
    BOARD MEETINGS 27,629 2,763   24,866
    ASSOCIATE DIRECTOR EXPENSE 708 71   637


    TY 2021 OtherLiabilitiesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Description Beginning of Year - Book Value End of Year - Book Value
    EMPLOYEE BENEFIT PLAN 621,952 676,557


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    CONSULTING FEES 4,540 454   4,086


    TY 2021 TaxesSchedule
    Name:
    Washington Square Health Foundation
    EIN:
    36-1210140
    Software ID:
    21014044
    Software Version:
    2021v4.2
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL EXCISE TAX 22,600      
    Payroll Tax 24,957 2,496   22,461