TY 2021 Form 990PF

- TIN:

Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation

or Section 4947(a)(1) Trust Treated as Private Foundation

Do not enter social security numbers on this form as it may be made public.
bullet

Go to www.irs.gov/Form990PF for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

For calendar year 2021, or tax year beginning 07-01-2021 , and ending 06-30-2022

Name of foundation
LAS VEGAS JAYCEES SENIOR CITIZENS M
HOME COMMUNITY FOUNDATION

Number and street (or P.O. box number if mail is not delivered to street address)5805 W HARMON
Room/suite

City or town, state or province, country, and ZIP or foreign postal code
LAS VEGAS, NV89103

A Employer identification number

94-2553808

B Telephone number (see instructions)

C If exemption application is pending, check here bullet

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

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

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

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

H Check type of organization: Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation

F If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here ....... bullet

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

$916,570J Accounting method: Cash Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)

	Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)	(a) Revenue and expenses per books		(b) Net investment income	(c) Adjusted net income	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)	7,000
2	Check .............
3	Interest on savings and temporary cash investments	656		656
4	Dividends and interest from securities...
5a	Gross rents............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10
b	Gross sales price for all assets on line 6a
7	Capital gain net income (from Part IV, line 2)...
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).......		1,390,443		1,390,443
12	Total. Add lines 1 through 11........	1,398,099		656	1,390,443
13	Compensation of officers, directors, trustees, etc.
14	Other employee salaries and wages......	116,866
15	Pension plans, employee benefits.......	10,645
16a	Legal fees (attach schedule).........		61,481		61,481
b	Accounting fees (attach schedule).......		11,915		11,915
c	Other professional fees (attach schedule)....
17	Interest...............	146,181			146,181
18	Taxes (attach schedule) (see instructions)...		9,937		9,937
19	Depreciation (attach schedule) and depletion...		177,772		177,772
20	Occupancy..............
21	Travel, conferences, and meetings.......
22	Printing and publications..........
23	Other expenses (attach schedule).......		886,144		886,144
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	1,420,941		0	1,293,430	0
25	Contributions, gifts, grants paid.......	0				0
26	Total expenses and disbursements. Add lines 24 and 25	1,420,941		0	1,293,430	0
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	-22,842
b	Net investment income (if negative, enter -0-)			656
c	Adjusted net income (if negative, enter -0-)...				97,013

For Paperwork Reduction Act Notice, see instructions.

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

Form 990-PF (2021)

Page 2

Part II		Balance Sheets	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing.............	152,985	71,913	71,913
	2	Savings and temporary cash investments.........	756,775	822,813	822,813
	3	Accounts receivable 21,844
		Less: allowance for doubtful accounts	4,180	21,844	21,844
	4	Pledges receivable
		Less: allowance for doubtful accounts
	5	Grants receivable.................	35,000
	6	Receivables due from officers, directors, trustees, and other
		disqualified persons (attach schedule) (see instructions).....
	7	Other notes and loans receivable (attach schedule)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use..............
	9	Prepaid expenses and deferred charges..........	15,343	14,492
	10a	Investments—U.S. and state government obligations (attach schedule)
	b	Investments—corporate stock (attach schedule).......
	c	Investments—corporate bonds (attach schedule).......
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans.............
	13	Investments—other (attach schedule)..........
	14	Land, buildings, and equipment: basis 7,173,661
		Less: accumulated depreciation (attach schedule) 5,062,989	2,214,199	2,110,672
	15	Other assets (describe )	15,550	12,845
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	3,194,032	3,054,579	916,570
	17	Accounts payable and accrued expenses..........	90,681	91,804
	18	Grants payable.................
	19	Deferred revenue.................	10,881	21,155
	20	Loans from officers, directors, trustees, and other disqualified persons
	21	Mortgages and other notes payable (attach schedule)......	2,898,764	2,770,756
	22	Other liabilities (describe )
	23	Total liabilities (add lines 17 through 22).........	3,000,326	2,883,715
		Foundations that follow FASB ASC 958, check here
		and complete lines 24, 25, 29 and 30.
	24	Net assets without donor restrictions...........	-563,069	-651,949
	25	Net assets with donor restrictions............	756,775	822,813
		Foundations that do not follow FASB ASC 958, check here
		and complete lines 26 through 30.
	26	Capital stock, trust principal, or current funds........
	27	Paid-in or capital surplus, or land, bldg., and equipment fund
	28	Retained earnings, accumulated income, endowment, or other funds
	29	Total net assets or fund balances (see instructions).....	193,706	170,864
	30	Total liabilities and net assets/fund balances (see instructions).	3,194,032	3,054,579

Part III

Analysis of Changes in Net Assets or Fund Balances

Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............

193,706

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

-22,842

Other increases not included in line 2 (itemize) bullet

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

170,864

Decreases not included in line 2 (itemize) bullet

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

170,864

Form 990-PF (2021)

Page 3

Part IV

Capital Gains and Losses for Tax on Investment Income

(a) List and describe the kind(s) of property sold (e.g., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co.)		(b) How acquired P—Purchase D—Donation	(c) Date acquired (mo., day, yr.)	(d) Date sold (mo., day, yr.)
1a
b
c
d
e

(e) Gross sales price		(f) Depreciation allowed (or allowable)	(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a
b
c
d
e

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i) F.M.V. as of 12/31/69	(j) Adjusted basis as of 12/31/69	(k) Excess of col. (i) over col. (j), if any
a
b
c
d
e

2	Capital gain net income or (net capital loss)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	2
3	Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
	If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0- in Part I, line 8 ...................		3

Form 990-PF (2021)

Page 4

Part V

Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)

1a	Exempt operating foundations described in section 4940(d)(2), check here and enter “N/A" on line 1.
	Date of ruling or determination letter: 1980-05-31(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	9
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	9
6	Credits/Payments:

a	2021 estimated tax payments and 2020 overpayment credited to 2021	6a
b	Exempt foreign organizations—tax withheld at source......	6b
c	Tax paid with application for extension of time to file (Form 8868)...	6c
d	Backup withholding erroneously withheld ...........	6d

7	Total credits and payments. Add lines 6a through 6d..............		7
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.......		9	9
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...		10
11	Enter the amount of line 10 to be: Credited to 2022 estimated tax	Refunded	11

Part VI-A

Statements Regarding Activities

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

Yes

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

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

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

If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials

published or distributed by the foundation in connection with the activities.

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

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

(1) On the foundation. bullet

$ (2) On foundation managers. bullet

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

on foundation managers. bullet

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

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

Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles

of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....

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

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

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

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

Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:

By language in the governing instrument, or

By state legislation that effectively amends the governing instrument so that no mandatory directions

that conflict with the state law remain in the governing instrument?................

Yes

Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),

and Part XIV..................................

Yes

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

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 . Click to see attachment

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

Yes

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

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

Form 990-PF (2021)

Page 5

Part VI-A

Statements Regarding Activities (continued)

At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the

meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............

Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had

advisory privileges? If "Yes," attach statement. See instructions.................

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

Yes

Website address bullet

N/A

The books are in care of bullet

GATSKI COMMERCIAL REAL ESTATE SERVI Telephone no. bullet

(702) 789-6343

Located at bullet

4755 DEAN MARTIN DRLAS VEGASNV ZIP+4 bullet

89103

Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here ......... bullet

and enter the amount of tax-exempt interest received or accrued during the year ........ bullet

16 At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over YesNo

a bank, securities, or other financial account in a foreign country? .................

16 No

See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country bullet

Part VI-B

Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.

Yes

During the year did the foundation (either directly or indirectly):

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........

1a(1)

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

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

1a(2)

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

1a(3)

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............

1a(4)

(5) Transfer any income or assets to a disqualified person (or make any of either available

for the benefit or use of a disqualified person)? ......................

1a(5)

(6) Agree to pay money or property to a government official? (Exception. Check "No"

if the foundation agreed to make a grant to or to employ the official for a period

after termination of government service, if terminating within 90 days.) ...............

1a(6)

If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations

section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........

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

Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,

that were not corrected before the first day of the tax year beginning in 2021? .............

Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private

operating foundation defined in section 4942(j)(3) or 4942(j)(5)):

At the end of tax year 2021, did the foundation have any undistributed income (lines 6d

and 6e, Part XII) for tax year(s) beginning before 2021?....................

If "Yes," list the years bullet

20, 20, 20, 20

Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)

(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)

to all years listed, answer "No" and attach statement—see instructions.) ..............

If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.

20, 20, 20, 20

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

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

If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation

or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved

by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)

the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine

if the foundation had excess business holdings in 2021.) .....................

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

Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its

charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..

Form 990-PF (2021)

Page 6

Part VI-B

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

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

Yes

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

5a(1)

(2) Influence the outcome of any specific public election (see section 4955); or to carry

on, directly or indirectly, any voter registration drive? ....................

5a(2)

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

5a(3)

(4) Provide a grant to an organization other than a charitable, etc., organization described

in section 4945(d)(4)(A)? See instructions ........................

5a(4)

(5) Provide for any purpose other than religious, charitable, scientific, literary, or

educational purposes, or for the prevention of cruelty to children or animals? .............

5a(5)

If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in

Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........

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

If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the

tax because it maintained expenditure responsibility for the grant? .................

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

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

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

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

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

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

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

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

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

Part VII

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors

1 List all officers, directors, trustees, foundation managers and their compensation. See instructions

(a) Name and address	(b) Title, and average hours per week devoted to position	(c) Compensation (If not paid, enter -0-)	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances
BETTY RODRIQUEZ	TREASURER 000.00	0	0	0
5805 WEST HARMON AVE LAS VEGAS,NV89103	TREASURER 000.00	0	0	0
MIKE BAJOREK	PRESIDENT 000.00	0	0	0
5805 WEST HARMON LAS VEGAS,NV89103	PRESIDENT 000.00	0	0	0
DARBY JOHNSON	DIRECTOR 000.00	0	0	0
5805 WEST HARMON LAS VEGAS,NV89103	DIRECTOR 000.00	0	0	0
SUSAN RHODES	VISE PRESIDE 000.00	0	0	0
5805 WEST HARMON LAS VEGAS,NV89103	VISE PRESIDE 000.00	0	0	0
SIGRID MONDA	DIRECTOR 000.00	0	0	0
5805 W HARMON AVE SPC 206 LAS VEGAS,NV89103	DIRECTOR 000.00	0	0	0
RICHARD RICK MORAN	DIRECTOR 000.00	0	0	0
5805 WEST HARMON LAS VEGAS,NV89103	DIRECTOR 000.00	0	0	0
STEPHANIE JEPSON	ADMIN SECRET 000.00	0	0	0
5805 WEST HARMON AVE LAS VEGAS,NV89103	ADMIN SECRET 000.00	0	0	0

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

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............. 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	THE ORGANIZATION PROVIDES LOW COST SPACE RENTALS FOR MOBILE HOMES TO LOW INCOME SENIOR CITIZENS.	1,420,940
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	N/A
2


All other program-related investments. See instructions.
3

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

Form 990-PF (2021)

Page 8

Part IX

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

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

purposes:

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

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

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

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

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

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

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

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

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

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

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

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

Part X

Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow

and do not complete this part.)

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

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

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

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

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

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

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

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

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

Part XI

Qualifying Distributions (see instructions)

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

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

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

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

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

Amounts set aside for specific charitable projects that satisfy the:

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

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

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

Form 990-PF (2021)

Page 9

Part XII

Undistributed Income (see instructions)

		(a) Corpus	(b) Years prior to 2020	(c) 2020	(d) 2021
1 Distributable amount for 2021 from Part X, line 7
2 Undistributed income, if any, as of the end of 2021:
a Enter amount for 2020 only.......
b Total for prior years:20, 20, 20
3 Excess distributions carryover, if any, to 2021:
a From 2016......
b From 2017......
c From 2018......
d From 2019......
e From 2020......
f Total of lines 3a through e ........
4Qualifying distributions for 2021 from Part
XI, line 4: $
a Applied to 2020, but not more than line 2a
b Applied to undistributed income of prior years (Election required—see instructions).....
c Treated as distributions out of corpus (Election required—see instructions)........
d Applied to 2021 distributable amount.....
e Remaining amount distributed out of corpus
5 Excess distributions carryover applied to 2021.
(If an amount appears in column (d), the same amount must be shown in column (a).)
6Enter the net total of each column as indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
b Prior years’ undistributed income. Subtract line 4b from line 2b ..........
c Enter the amount of prior years’ undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed......
d Subtract line 6c from line 6b. Taxable amount —see instructions ...........
e Undistributed income for 2019. Subtract line 4a from line 2a. Taxable amount—see instructions .............
f Undistributed income for 2021. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2022 ..........
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (Election may be required - see instructions) .......
8 Excess distributions carryover from 2016 not applied on line 5 or line 7 (see instructions) ...
9 Excess distributions carryover to 2022. Subtract lines 7 and 8 from line 6a ......
10 Analysis of line 9:
a Excess from 2017....
b Excess from 2018....
c Excess from 2019....
d Excess from 2020....
e Excess from 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

1980-05-31

b Check box to indicate whether the organization is a private operating foundation described in section 4942(j)(3) or4942(j)(5)

2a Enter the lesser of the adjusted net income from Part I or the minimum investment return from Part X for each year listed ..........	Tax year	Prior 3 years			(e) Total
	(a) 2021	(b) 2020	(c) 2019	(d) 2018	(e) Total
	0				0
b 85% (0.85) of line 2a .........
c Qualifying distributions from Part XI, line 4 for each year listed .....					0
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 ..				17,921	17,921
c “Support" alternative test—enter:
(1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) ....
(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii)....
(3) Largest amount of support from an exempt organization
(4) Gross investment income

Part XIV

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

1Information Regarding Foundation Managers:

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

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

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

Check here bullet

if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions

aThe name, address, and telephone number or email address of the person to whom applications should be addressed:

bThe form in which applications should be submitted and information and materials they should include:

cAny submission deadlines:

dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:

Form 990-PF (2021)

Page 11

Part XIV

Supplementary Information (continued)

3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient	If recipient is an individual, show any relationship to any foundation manager or substantial contributor	Foundation status of recipient	Purpose of grant or contribution	Amount
Name and address (home or business)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year

Total ................................. 3a

bApproved for future payment

Total ................................. 3b

Form 990-PF (2021)

Page 12

Part XV-A

Analysis of Income-Producing Activities

Enter gross amounts unless otherwise indicated.	Unrelated business income		Excluded by section 512, 513, or 514		(e) Related or exempt function income (See instructions.)
1Program service revenue:	(a) Business code	(b) Amount	(c) Exclusion code	(d) Amount	(e) Related or exempt function income (See instructions.)
a
b
c
d
e
f
gFees and contracts from government agencies
2 Membership dues and assessments ....
3 Interest on savings and temporary cash investments ...........			14	656
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 ............
9 Net income or (loss) from special events:
10 Gross profit or (loss) from sales of inventory
11 Other revenue: aMISC OTHER INCOME			41	12,664
bLATE CHARGE FEES			41	1,029
c
d
e
12 Subtotal. Add columns (b), (d), and (e) ..				1,391,099

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

1,391,099

(See worksheet in line 13 instructions to verify calculations.)

Part XV-B

Relationship of Activities to the Accomplishment of Exempt Purposes

Line No.	Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See instructions.)
1A	ORGANIZATION DERIVES ITS RENTAL REVENUE FROM SPACE RENT COLLECTED FROM LOW INCOME SENIOR CITIZENS WITH MOBILE HOMES LOCATED IN THE PARK IN LAS VEGAS, NEVADA

Form 990-PF (2021)

Page 13

Part XVI

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

Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

Yes

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

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

1a(1)

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

1a(2)

Other transactions:

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

1b(1)

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

1b(2)

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

1b(3)

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

1b(4)

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

1b(5)

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

1b(6)

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

If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

(a) Line No.	(b) Amount involved	(c) Name of noncharitable exempt organization	(d) Description of transfers, transactions, and sharing arrangements

Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........Yes No

If "Yes," complete the following schedule.

(a) Name of organization	(b) Type of organization	(c) Description of relationship

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
				May the IRS discuss this return with the preparer shown below? See instructions. Yes No
	Signature of officer or trustee	Date	Title

Paid Preparer Use Only	Print/Type preparer's name	Preparer's Signature	Date	Check if self- employed	PTIN
	Firm's name				Firm's EIN
	Firm's address				Phone no.

Form 990-PF (2021)

Additional Data

Software ID:
Software Version:

Form 990PF - Special Condition Description:

Special Condition Description

- TIN:

TY 2021 AccountingFeesSchedule

Name:

LAS VEGAS JAYCEES SENIOR CITIZENS M

HOME COMMUNITY FOUNDATION

EIN:

94-2553808

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
SPACE RENTAL	11,915		11,915

- TIN:

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

TY 2021 AmortizationSchedule

Name:

LAS VEGAS JAYCEES SENIOR CITIZENS M

HOME COMMUNITY FOUNDATION

EIN:

94-2553808

Description of Amortized Expenses	Date Acquired, Completed, or Expended	Amount Amortized	Deduction for Prior Years	Amortization Method	Current Year Amortization	Net Investment Income	Adjusted Net Income	Total Amount of Amortization
LOAN FEES AND RE-FI COSTS - BANK OF	2011-05-20	37,698	37,698	10.0000				37,698

- TIN:

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

TY 2021 DepreciationSchedule

Name:

LAS VEGAS JAYCEES SENIOR CITIZENS M

HOME COMMUNITY FOUNDATION

EIN:

94-2553808

Description of Property	Date Acquired	Cost or Other Basis	Prior Years' Depreciation	Computation Method	Rate / Life (# of years)	Current Year's Depreciation Expense	Adjusted Net Income
NSPECIFIED L/I	1995-01-01	47,910	32,554	S/L	39.0000	1,229	1,229
DUMPSTERS (2)	1999-06-30	4,200	4,200	S/L	7.0000
CLUBHOUSE	1993-09-01	501,964	358,239	S/L	39.0000	12,871	12,871
SITE IMPROVEMENTS	1993-09-01	5,147,979	3,582,136	S/L	40.0000	128,699	128,699
SWIMMING POOL	1993-09-01	46,000	46,000	S/L	27.5000
SITE IMPROVEMENTS	1994-07-01	7,175	7,045	S/L	27.5000	130	130
SITE IMPROVEMENTS-JCMP	1995-07-12	1,050	993	S/L	27.5000	38	38
SITE IMPROVEMENT-JCMP	1995-07-12	2,175	2,056	S/L	27.5000	79	79
SITE IMPROVEMENTS	1995-08-22	1,305	1,226	S/L	27.5000	47	47
SITE IMPROVEMENTS-JCMP	1995-09-25	870	815	S/L	27.5000	31	31
SITE IMPROVMENTS=JCMP	1995-12-21	675	626	S/L	27.5000	25	25
SITE IMPROVMENTS-LCMP	1996-01-22	205	189	S/L	27.5000	8	8
SITE IMPROVEMENTS-JCMP	1996-04-11	76	70	S/L	27.5000	2	2
SITE IMPROVEMENT	1996-05-09	200	183	S/L	27.5000	7	7
SITE IMPROVMENTS	1995-10-05	2,643	2,475	S/L	27.5000	96	96
SITE IMPROVEMENT	1997-01-01	221	197	S/L	27.5000	8	8
LANDSCAPING	1993-09-01	92,527	92,527	S/L	27.5000
BLOCK WALL	1999-08-12	2,785	2,785	S/L	10.0000
STREET IMPROVEMENTS	2001-04-03	38,377	38,377	S/L	20.0000
MANAGERS COACH HOME	2006-02-01	138,143	56,827	S/L	27.5000	3,454	3,454
PARKING LOT LIGHTING	2006-04-01	2,833	2,833	S/L	15.0000
LANDSCAPE	2005-10-01	765	765	S/L	15.0000
LANDSCAPE	2005-11-01	1,607	1,607	S/L	15.0000
LANDSCAPE	2005-12-01	9,000	9,000	S/L	15.0000
LANDSCAPE	2006-01-01	947	947	S/L	15.0000
LANDSCAPE	2006-04-01	1,870	1,870	S/L	15.0000
LANDSCAPE	2006-05-01	4,890	4,890	S/L	15.0000
WATER ISOLATION VALVE	2006-02-15	112,767	112,767	S/L	15.0000
SPA AREA AWNING	2006-04-01	2,800	2,800	S/L	15.0000
SPA AREA AWNING	2006-05-01	12,343	12,343	S/L	15.0000
SPA AREA AWNING	2006-06-01	11,800	11,800	S/L	15.0000
MAINTENANCE SHOP DOORS	2006-06-01	1,715	685	S/L	27.5000	43	43
SPEED BUMPS	2006-06-01	5,699	5,699	S/L	15.0000
DRIVWAY TO MANAGERS HOME	2006-03-01	5,224	5,224	S/L	15.0000
AUTOMATIC GATE - ELITE RECEIVER	2006-07-01	11,293	11,293	S/L	7.0000
CLUBHOUSE LANDSCAPTING	2007-06-15	58,340	57,052	S/L	15.0000	1,288	1,288
ROADS & PARKING - SEAL & REPAVE	2007-05-31	51,880	50,734	S/L	15.0000	1,146	1,146
POOL DECK RESURFACE	2008-03-01	26,040	22,796	S/L	15.0000	1,736	1,736
HANDICAP DOOR OPER SYS	2008-12-29	5,092	5,092	S/L	7.0000
HANDICAP DOOR OPER POOL AREA	2009-01-13	2,380	2,380	S/L	7.0000
HEATING & AIR COND UNIT	2009-01-22	8,990	8,990	S/L	7.0000
12 LARGE ROUND TABLES	2009-03-09	2,389	2,389	S/L	7.0000
400 GALLON WATER HEATER	2009-04-16	5,800	5,800	S/L	7.0000
1 ROUND TABLE	2009-04-30	558	558	S/L	7.0000
OFFICE EXPANSION	2008-09-02	4,731	2,100	S/L	27.5000	172	172
WALL CABINETS	2008-09-02	710	710	S/L	7.0000
GATE - SW RV STORAGE	2008-10-28	3,843	3,843	S/L	7.0000
CEILING FANS	2008-11-14	379	379	S/L	7.0000
HANDICAP LIFT CHAIR - POOL	2009-03-09	3,633	3,633	S/L	7.0000
POOL & SPA DRAINS & PUMPS RETRO-FIT	2009-01-22	4,805	4,805	S/L	7.0000
FREEZER	2008-07-23	599	599	S/L	7.0000
COMPUTER	2009-03-03	1,100	1,100	S/L	3.0000
COMPUTER MON & SCAN	2009-08-21	1,405	1,405	S/L	5.0000
CLUBHOUSE REMODEL	2009-07-06	19,573	8,076	S/L	27.5000	712	712
KITCHEN APPLIANCES	2009-08-20	4,562	4,562	S/L	7.0000
CLUBHOUSE REMODEL	2009-08-20	745	306	S/L	27.5000	27	27
CLUBHOUSE DOORS	2009-09-10	1,530	1,530	S/L	7.0000
CLUBHOUSE REMODEL	2009-09-11	19,146	7,820	S/L	27.5000	696	696
OFFICE FILE	2009-09-15	211	211	S/L	7.0000
OFFICE DEPOT - REMODEL	2009-09-15	978	978	200DB	7.0000
KITCHEN APPLIANCES	2009-10-30	1,820	1,820	S/L	7.0000
CLUBHOUSE REMODEL	2009-10-30	7,659	3,112	S/L	27.5000	278	278
FILE CABINET	2009-11-11	211	211	S/L	7.0000
REWIRE	2009-11-11	479	194	S/L	27.5000	17	17
BATHROOM LIGHTING	2009-12-07	1,924	807	S/L	27.5000	70	70
HANDICAP DOORS	2009-12-14	2,060	2,060	200DB	7.0000
BATHROOM REWIRE	2010-01-07	1,369	548	S/L	27.5000	50	50
CLUBHOUSE REMODEL	2010-01-12	1,800	720	S/L	27.5000	66	66
KITCHEN APPLIANCES	2010-02-09	1,602	1,602	S/L	7.0000
CLUBHOUSE REMODEL	2010-02-17	935	372	S/L	27.5000	34	34
CLUBHOUSE REMODEL	2010-03-16	1,207	478	S/L	27.5000	44	44
CLUBHOUSE REMODEL	2010-04-02	1,200	473	S/L	27.5000	43	43
CLUBHOUSE REMODEL	2010-04-21	375	148	S/L	27.5000	13	13
CLUBHOUSE REMODEL	2010-05-13	175	69	S/L	27.5000	6	6
CLUBHOUSE REMODEL	2010-05-13	1,915	750	S/L	27.5000	70	70
POOL FURN	2009-11-18	978	978	S/L	7.0000
SECURITY SYSTEM	2009-08-19	3,869	3,869	S/L	7.0000
FIRE CERTIFICATION	2009-08-19	1,190	488	S/L	27.5000	44	44
LANDSCAPE - CLUBHOUSE	2010-05-04	4,660	4,660	S/L	15.0000
PIANO	2009-11-16	1,724	1,724	S/L	7.0000
BOARDROOM IMPROVEMENTS (POUND GR)	2009-12-21	6,957	2,798	S/L	27.5000	253	253
BOARDROOM (CHRIESTENSON BUILDERS)	2009-12-09	1,156	465	S/L	27.5000	42	42
HOME DEPOT	2009-12-04	653	263	S/L	27.5000	23	23
BOARDROOM (JAY HINER)	2009-12-14	4,155	1,671	S/L	27.5000	151	151
FURNITURE - BOARDROOM	2009-12-28	1,492	1,492	S/L	7.0000
BOARDROOM TILE - (J VANDR LINDE)	2009-12-21	1,050	422	S/L	27.5000	38	38
COMPUTERS	2011-04-20	2,448	2,448	S/L	5.0000
CLUBHOUSE REMODEL IN PROGRESS	2011-06-30				39.0000
GOLF CART	2011-07-15	2,703	2,703	200DB	5.0000
GOLF CART	2011-07-15	2,703	2,703	200DB	5.0000
CLUB HOUSE REMODEL	2011-07-29	534,269	192,661	S/L	27.5000	19,428	19,428
POOL PUMP & FILTER	2014-01-22	3,643	3,643	200DB	7.0000
RESURFACE POOL & SEAL DECK	2013-11-23	32,640	30,761	150DB	15.0000	1,879	1,879
ICE MAKER CLUBHOUSE	2013-08-06	1,844	1,844	200DB	7.0000
TRASH ENCLOSURE	2014-06-13	2,100	538	S/L	27.5000	76	76
FREEZER	2018-07-27	817	817	200DB	5.0000
2-BBQ'S FOR POOL AREA	2018-08-21	868	868	200DB	5.0000
2 NEW DRIVEWAYS 343&165	2019-01-17	4,980	314	S/L	39.0000	128	128
BLOCK WALL AND 8 BOLLARDS	2019-01-17	4,800	303	S/L	39.0000	123	123
WATER HEATER INSTALLATION	2018-07-27	1,532	1,532	200DB	7.0000
HVAC	2021-08-24	14,500		S/L	7.0000	1,726	1,726
SPLAR PANELS	2022-04-06	9,750		S/L	7.0000	348	348
IRON FENCE	2022-06-07	50,000		S/L	15.0000	278	278

- TIN:

TY 2021 ExplnOfNonFilingWithAGStmt

Name:

LAS VEGAS JAYCEES SENIOR CITIZENS M

HOME COMMUNITY FOUNDATION

EIN:

94-2553808

Statement:

NEVADA DOES NOT REQUIRE COPY OF FORM 990

- TIN:

TY 2021 LandEtcSchedule2

Name:

LAS VEGAS JAYCEES SENIOR CITIZENS M

HOME COMMUNITY FOUNDATION

EIN:

94-2553808

Category / Item	Cost / Other Basis	Accumulated Depreciation	Book Value	End of Year Fair Market Value
BUILDLINGS	7,173,661	5,062,989	2,110,672

- TIN:

TY 2021 LegalFeesSchedule

Name:

LAS VEGAS JAYCEES SENIOR CITIZENS M

HOME COMMUNITY FOUNDATION

EIN:

94-2553808

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
SPACE RENTAL	61,481		61,481

- TIN:

TY 2021 MortgagesAndNotesPayableSch

Name:

LAS VEGAS JAYCEES SENIOR CITIZENS M

HOME COMMUNITY FOUNDATION

EIN:

94-2553808

Total Mortgage Amount: 2,770,756

- TIN:

TY 2021 OtherAssetsSchedule

Name:

LAS VEGAS JAYCEES SENIOR CITIZENS M

HOME COMMUNITY FOUNDATION

EIN:

94-2553808

Description	Beginning of Year - Book Value	End of Year - Book Value	End of Year - Fair Market Value
LOAN FEES - NET OF AMORT	15,550	12,845
OTHER ASSETS

- TIN:

TY 2021 OtherExpensesSchedule

Name:

LAS VEGAS JAYCEES SENIOR CITIZENS M

HOME COMMUNITY FOUNDATION

EIN:

94-2553808

Description	Revenue and Expenses per Books	Adjusted Net Income
SPACE RENTAL
AUTO MILEAGE	1,521	1,521
BANK CHARGES	1,290	1,290
BOARD OF DIRECTORS	7,740	7,740
EDUCATION	695	695
MISCELLANEOUS	3,130	3,130
EQUIPMENT LEASE	571	571
EMPLOYEE BENEFITS	17,828	17,828
SECURITY	82,744	82,744
UTILITIES	473,271	473,271
POSTAGE	860	860
REPAIRS & MAINTENANCE	129,352	129,352
LANDSCAPE	48,480	48,480
INSURANCE	19,575	19,575
MANAGEMENT FEE	53,287	53,287
GRANT PROGRAM EXPENSE	40,536	40,536
ROUNDING DIFF	2	2
ADVERTISING AND PROM	809	809
EQUIPMENT RENT	1,748	1,748

- TIN:

TY 2021 OtherIncomeSchedule2

Name:

LAS VEGAS JAYCEES SENIOR CITIZENS M

HOME COMMUNITY FOUNDATION

EIN:

94-2553808

Description	Revenue And Expenses Per Books	Adjusted Net Income
SPACE RENTAL	1,376,750	1,376,750
MISC OTHER INCOME	12,664	12,664
LATE CHARGE FEES	1,029	1,029

- TIN:

TY 2021 TaxesSchedule

Name:

LAS VEGAS JAYCEES SENIOR CITIZENS M

HOME COMMUNITY FOUNDATION

EIN:

94-2553808

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
SPACE RENTAL	9,937		9,937