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 11-01-2021 , and ending 10-31-2022
Name of foundation
POTOMAC HEALTH FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)2296 OPITZ BLVD 200
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WOODBRIDGE, VA22191
A Employer identification number

52-1340920
B Telephone number (see instructions)

(703) 523-0620
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$104,353,678J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet.............
3 Interest on savings and temporary cash investments 154 154  
4 Dividends and interest from securities... 1,962,730 2,207,740  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 4,046,306
b Gross sales price for all assets on line 6a 26,839,833
7 Capital gain net income (from Part IV, line 2)... 4,572,977
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)....... Click to see attachment 0 79,576  
12 Total. Add lines 1 through 11........ 6,009,190 6,860,447  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 149,694 22,454   115,317
14 Other employee salaries and wages...... 162,329 0   92,952
15 Pension plans, employee benefits....... 71,765 5,165   47,901
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 25,324 0   25,324
c Other professional fees (attach schedule).... Click to see attachment 710,829 652,479   58,350
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 80,833 381   0
19 Depreciation (attach schedule) and depletion... 1,679 0  
20 Occupancy.............. 36,607 0   0
21 Travel, conferences, and meetings....... 6,203 0   6,203
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 74,482 155,807   54,344
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 1,319,745 836,286   400,391
25 Contributions, gifts, grants paid....... 5,072,118 6,744,287
26 Total expenses and disbursements. Add lines 24 and 25 6,391,863 836,286   7,144,678
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -382,673
b Net investment income (if negative, enter -0-) 6,024,161
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2021)
Form 990-PF (2021)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing.............      
2 Savings and temporary cash investments......... 432,671 70,630 70,630
3 Accounts receivable bullet80,873
Less: allowance for doubtful accounts bullet   48,590 80,873 80,873
4 Pledges receivable bullet252,258
Less: allowance for doubtful accounts bullet   364,238 252,258 252,258
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges.......... 34,516 42,907 42,907
10a Investments—U.S. and state government obligations (attach schedule) 65 Click to see attachment65 65
b Investments—corporate stock (attach schedule)....... 61,678,651 Click to see attachment46,174,205 46,174,205
c Investments—corporate bonds (attach schedule)....... 38,980,572 Click to see attachment29,585,290 29,585,290
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 23,247,679 Click to see attachment28,136,645 28,136,645
14 Land, buildings, and equipment: basis bullet61,243
Less: accumulated depreciation (attach schedule) bullet50,438 2,454 Click to see attachment10,805 10,805
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 124,789,436 104,353,678 104,353,678
Liabilities 17 Accounts payable and accrued expenses.......... 214,711 463,290
18 Grants payable................. 5,749,825 4,077,656
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet) Click to see attachment376,702 Click to see attachment127,587
23 Total liabilities (add lines 17 through 22)......... 6,341,238 4,668,533
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........... 118,448,198 99,685,145
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)..... 118,448,198 99,685,145
30 Total liabilities and net assets/fund balances (see instructions). 124,789,436 104,353,678
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
118,448,198
2
Enter amount from Part I, line 27a .....................
2
-382,673
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
118,065,525
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
18,380,380
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
99,685,145
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 PUBLICLY TRADED SECURITIES      
b SEI GLOBAL PRIVATE ASSETS V LP P    
c SEI GLOBAL PRIVATE ASSETS IV,LP P    
d SEI CORE PROPERTY FUND LP P    
e CAPITAL GAINS DIVIDENDS P    
(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 22,519,052   22,793,527 -274,475
b       21,739
c       187,720
d       317,212
e 4,320,781     4,320,781
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       -274,475
b       21,739
c       187,720
d       317,212
e       4,320,781
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 4,572,977
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Form 990-PF (2021)
Form 990-PF (2021)
Page 4
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 83,736
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 83,736
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 115,048
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 115,048
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 31,312
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet31,312 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$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XIV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletVA
    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.POTOMACHEALTHFOUNDATION.ORG
    14
    The books are in care ofbulletERIN MATTHEWS THOMAS Telephone no.bullet (703) 523-0620

    Located atbullet2296 OPITZ BOULEVARD SUITE 200WOODBRIDGEVA ZIP+4bullet22191
    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
    STEVEN LIGA EXECUTIVE DIRECTOR AS OF AUG 2022
    40.00     		35,769 8,226 150
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    SUSIE LEE EXECUTIVE DIRECTOR TO JUL 2022
    40.00     		113,925 26,203 400
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    MARION M WALL CHAIR
    4.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    CAROL S SHAPIRO MD MBA VICE-CHAIR
    4.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    R MICHAEL SORENSEN TREASURER
    3.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    WAYNE MALLARD SECRETARY
    2.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    PAUL GADEN DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    HOWARD L GREENHOUSE DIRECTOR EMERITUS TO AUG 2022
    1.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    SAM HILL EDD DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    KATHIE JOHNSON DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    PHYLLIS MORGAN PHD DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    ALA S MORTAZAVI MD DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    WILLIAM M MOSS DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    SARAH PITKIN PHD DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    CLARICE TORAN MED DIRECTOR
    1.00     		0 0 0
    2296 OPITZ BOULEVARD SUITE 200
    WOODBRIDGE,VA22191
    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
    ERIN MATTHEWS THOMAS SENIOR PROGRAM OFFIC
    40.00     		101,050 23,241 600
    2296 OPITZ BLVD SUITE 200
    WOODBRIDGE,VA22191
    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
    SEI GLOBAL INSTITUTIONAL GROUP INVESTMENT MANAGEMENT 652,479
    1 FREEDOM VALLEY DRIVE
    OAKS,PA19456
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part VIII-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1  
    2  
    3  
    4  
    Part VIII-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    112,390,475
    b
    Average of monthly cash balances.......................
    1b
    233,150
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    112,623,625
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    112,623,625
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    1,689,354
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    110,934,271
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    5,546,714
    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
    5,546,714
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    83,736
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    83,736
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    5,462,978
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    5,462,978
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
    7
    5,462,978
    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 5,462,978
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 3,425,432
    b Total for prior years:20, 20, 20 0
    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 ........ 0
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 7,144,678
    a Applied to 2020, but not more than line 2a 3,425,432
    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..... 3,719,246
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2021. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2021. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2022 ..........     		1,743,732
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		0
    8 Excess distributions carryover from 2016 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		0
    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)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2021, enter the date of the ruling ....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part IX, line 6 for each year listed ..     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XIV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    ACTION IN COMMUNITY THROUGH SERVICE INC
    PO BOX 74
    DUMFRIES,VA22026     		  PC RENT & UTILITY ASSISTANCE PROGRAM 15,000
    ACTION IN COMMUNITY THROUGH SERVICE INC
    PO BOX 74
    DUMFRIES,VA22026     		  PC OPERATING SUPPORT 250,000
    AMERICAN KIDNEY FUND
    11921 ROCKVILLE PIKE SUITE 300
    ROCKVILLE,MD20852     		  PC SAFETYNET FINANCIAL ASSISTANCE FOR PRINCE WILLIAM COUNTY 17,500
    BOYS & GIRLS CLUB OF GREATER WASHINGTON
    4103 BENNING RD NE
    WASHINGTON,DC20019     		  PC REFURBISH GYM AT BGCGWS HYLTON CLUB IN DALE CITY 44,230
    BRINGING RESOURCES TO AID WOMEN'S SHELTERS (BRAWS)
    133 PARK STREET NE SUITE 3B
    VIENNA,VA22180     		  PC SUPPLYING MENSTRUAL SUPPLIES & UNDERGARMENTS TO RESIDENTS OF PRINCE WILLIAM COUNTY 37,785
    BRINGING RESOURCES TO AID WOMEN'S SHELTERS (BRAWS)
    133 PARK STREET NE SUITE 3B
    VIENNA,VA22180     		  PC SUPPLYING MENSTRUAL SUPPLIES & UNDERGARMENTS TO EPWC & SFFXCO 15,323
    CAPITAL AREA FOOD BANK
    4900 PUERTO RICO AVENUE NE
    WASHINGTON,DC20017     		  PC TACKLING FOOD INSECURITY IN PRINCE WILLIAM COUNTY BOTH DURING AND POST-PANDEMIC 35,000
    CAPITAL AREA FOOD BANK
    4900 PUERTO RICO AVENUE NE
    WASHINGTON,DC20017     		  PC YOU ARE WHAT YOU EAT 48,000
    CAPITAL CARING HEALTH
    3180 FAIRVIEW PARK DRIVE SUITE 600
    FALLS CHURCH,VA22042     		  PC EXPANDING STAY AT HOME SERVICES 38,820
    CATCHAFIRE
    2000 P ST NW 240
    WASHINGTON,DC20036     		  PC CAPACITY BUILDING - FOUNDATION PLATFORM FEES 77,500
    CATHOLIC CHARITIES ARLINGTON DIOCESE MOTHER OF MERCY FREE MEDICAL CLINIC
    9380 FORESTWOOD LANE UNIT B
    MANASSAS,VA20110     		  PC OPERATING SUPPORT 150,000
    COMMUNITY FOUNDATION OF NORTHERN VIRGINIA
    3201 JERMANTOWN ROAD SUITE 660
    FAIRFAX,VA22030     		  PC FINDING YOUR WAY BACK TO MENTAL HEALTH 5,000
    EDU-FUTURO
    2110 WASHINGTON BLVD THIRD FLOOR
    ARLINGTON,VA22204     		  PC COVID-19 IMMIGRANT FAMILY SERVICES 15,000
    FOODS & FRIENDS INC
    219 RIGGS ROAD NE
    WASHINGTON,DC20011     		  PC SPECIALIZED NUTRITION SERVICES FOR SERIOUSLY ILL VIRGINIANS 28,000
    FOODS & FRIENDS INC
    219 RIGGS ROAD NE
    WASHINGTON,DC20011     		  PC SPECIALIZED NUTRITION SERVICES FOR SERIOUSLY ILL VIRGINIANS 7,500
    FORMED FAMILIES FORWARD
    4031 UNIVERSITY DRIVE SECOND FLOOR
    FAIRFAX,VA22030     		  PC TRAUMA-INFORMED CARE FOR CHILDREN WITH DISABILITIES: EMPOWERING FAMILIES TO PARTNER FOR SAFETY 20,667
    GEORGE MASON UNIVERSITY OFFICE OF SPONSORED PROGRAMS
    4400 UNIVERSITY DRIVE MSN 4C6
    FAIRFAX,VA220304422     		  PC OPERATING SUPPORT 125,000
    GOOD SHEPHERD HOUSING AND FAMILY SERVICES
    PO BOX 15096
    ALEXANDRIA,VA22309     		  PC HALO FOR HEALTH IMPROVEMENTS 40,600
    GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
    4379 RIDGEWOOD CENTER DRIVE SUITE
    102
    WOODBRIDGE,VA22192     		  PC ADDRESSING PATIENT SOCIAL DETERMINANTS OF HEALTH 30,000
    GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
    4379 RIDGEWOOD CENTER DRIVE SUITE
    102
    WOODBRIDGE,VA22192     		  PC OPERATING SUPPORT 150,000
    HOUSE OF MERCY
    8170 FLANNERY COURT
    MANASSAS,VA20109     		  PC COVID-19 FOOD INSECURITY RELIEF & ASSISTANCE 15,000
    INOVA HEALTH CARE SERVICES
    2740 PROSPERITY AVENUE SUITE 200
    FAIRFAX,VA22031     		  PC EXPANDING BEHAVIORAL HEALTH SERVICE CAPACITY IN PRINCE WILLIAM COUNTY 145,853
    INSTITUTE OF PUBLIC HEALTH INNOVATION
    1301 CONNECTICUT AVENUE NW SUITE
    200
    WASHINGTON,DC20036     		  PC STRENGTHENING THE INFRASTRUCTURE OF THE COMMUNITY HEALTH COALITION OF GREATHER PRINCE WILLIAM COUNTY 33,600
    LEGAL AID JUSTICE CENTER
    1000 PRESTON AVENUE
    CHARLOTTESVILLE,VA22903     		  PC PROTECTING THE LIVES AND LIVELIHOODS OF LOW-INCOME IMMIGRANTS 105,000
    LLOYD F MOSS FREE CLINIC
    1301 SAM PERRY BOULEVARD
    FREDERICKSBURG,VA22401     		  PC OPERATING SUPPORT 155,000
    LORTON COMMUNITY ACTION CENTER
    9518 RICHMOND HWY
    LORTON,VA22079     		  PC CONTINUED COVID-19 RESPONSE 15,000
    MEDICAL CARE FOR CHILDREN PARTNERSHIP (MCCP) FOUNDATION
    6699 SPRINGFIELD CENTER DRIVE SUITE
    303
    SPRINGFIELD,VA22150     		  PC EXPANDING HEALTH SERVCIES TO LORTON CHILDREN 10,500
    NATIONAL COALITION OF 100 BLACK WOMEN
    PO BOX 1166
    DUMFRIES,VA22026     		  PC OPERATING SUPPORT 4,500
    NATIONAL COALITION OF 100 BLACK WOMEN INC PRINCE WILLIAM COUNTY CHAPTER
    PO BOX 1166
    DUMFRIES,VA22026     		  PC OPERATING SUPPORT 10,500
    NATIONAL KOREAN AMERICAN SERVICE & EDUCATION CONSORTIUM (NAKASEC)
    4304 EVERGREEN LANE SUITE 104
    ANNANDALE,VA22003     		  PC STRENGTHENING COMMUNITY HEALTH CARE THROUGH SERVICE & ADVOCACY 72,664
    NATIONAL KOREAN AMERICAN SERVICE & EDUCATION CONSORTIUM (NAKASEC)
    4304 EVERGREEN LANE SUITE 104
    ANNANDALE,VA22003     		  PC STRENGTHENING COMMUNITY HEALTH CARE THROUGH SERVICE & ADVOCACY 35,329
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		  PC AGENCY-WIDE EQUITY, DIVERSITY & INCLUSION TRAINING 25,385
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		  PC OPERATING SUPPORT 259,600
    NORTHERN VIRGINIA FAMILY SERVICE (KIDS CONNECT)
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		  PC OPERATING SUPPORT 38,400
    NORTHERN VIRGINIA FOOD RESCUE
    PO BOX 74
    DUMFRIES,VA22026     		  PC FOOD RESCUE EXPANSION 122,500
    NORTHERN VIRGINIA FOOD RESCUE
    PO BOX 74
    DUMFRIES,VA22026     		  PC FOOD RESCUE EXPANSION 52,500
    NOVA SCRIPTSCENTRAL INC
    6400 ARLINGTON BOULEVARD SUITE 120
    FALLS CHURCH,VA22042     		  PC OPERATING SUPPORT 230,000
    NUEVA VIDA INC
    206 N WASHINGTON STREET SUITE 300
    ALEXANDRIA,VA22314     		  PC ACCESS & CONTINUITY OF CARE FOR MEDICALLY UNDERSERVED LATINAS 105,000
    PATHWAY HOMES
    10201 FAIRFAX BOULEVARD
    FAIRFAX,VA22030     		  PC PERMANENT SUPPORTIVE HOUSING 175,000
    PRINCE WILLIAM COUNTY COMMUNITY FOUNDATION INC
    PO BOX 5148
    WOODBRIDGE,VA22194     		  PC COMBATING HUNGER ON WHEELS WAGON INITIATIVE 38,696
    PRINCE WILLIAM COUNTY COMMUNITY FOUNDATION INC
    PO BOX 5148
    WOODBRIDGE,VA22194     		  PC COMBATING HUNGER ON WHEELS WAGON INITIATIVE 15,000
    PRINCE WILLIAM COUNTY COMMUNITY SERVICES
    7969 ASHTON AVENUE
    MANASSAS,VA20109     		  GOV CRISIS RECEIVING AND STABILIZATION CENTER 1,000,000
    PRINCE WILLIAM DROP-IN CENTER
    13184 CENTERPOINTE WAY
    WOODBRIDGE,VA22192     		  PC OPERATING SUPPORT 51,500
    PRINCE WILLIAM HEALTH DISTRICT
    9301 LEE AVENUE
    MANASSAS,VA20110     		  GOV PLATFORM LICENSE FEE FOR "BE HEALTHY BE HAPPY PWHD" 4,800
    PROJECT MEND-A-HOUSE INC
    9500 TECHNOLOGY DRIVE SUITE 101
    MANASSAS,VA20110     		  PC REPAIRING FOR SAFE & HEALTHY HOMES 60,000
    RX PARTNERSHIP
    2924 EMERYWOOD PARKWAY SUITE 300
    RICHMOND,VA23294     		  PC OPERATING SUPPORT 50,000
    RX PARTNERSHIP
    2924 EMERYWOOD PARKWAY SUITE 300
    RICHMOND,VA23294     		  PC VIRTUAL AUDIT IMPROVEMENTS 7,500
    SCAN OF NOVA
    205 S WHITING STREET SUITE 205
    ALEXANDRIA,VA22304     		  PC CHILDHOOD TRAUMA & HEALTH PROGRAMMATIC & OPERATIONS SUPPORT 125,000
    SENTARA NORTHERN VIRGINIA MEDICAL CENTER
    2300 OPITZ BOULEVARD
    WOODBRIDGE,VA22191     		  PC OPERATING SUPPORT 175,000
    STAFFORD SCHOOL HEAD START
    610 GAYLE STREET
    FALMOUTH,VA22405     		  PC CHILDREN'S HEALTH INSURANCE OUTREACH 4,348
    STAFFORD SCHOOLS HEAD START
    610 GAYLE STREET
    FALMOUTH,VA22405     		  PC CHILDREN'S HEALTH INSURANCE OUTREACH 10,144
    STREETLIGHT COMMUNITY OUTREACH MINISTRIES
    14806 BLACKBURN ROAD
    WOODBRIDGE,VA22191     		  PC REGISTERED NURSE POSITION FOR STREETLIGHT MEDICALLY FRAGILE SUPPORTIVE HOUSING AND SHELTER CLIENTS 46,071
    TAHIRIH JUSTICE CENTER
    6400 ARLINGTON BLVD SUITE 400
    FALLS CHURCH,VA22042     		  PC ADDRESSING SOCIAL DETERMINANTS OF HEALTH OF IMMIGRANT SURVIVORS OF GENDER-BASED VIOLENCE 35,000
    TENANTS AND WORKERS UNITED
    3801 MOUNT VERNON AVE 215
    ALEXANDRIA,VA22305     		  PC WOODBRIDGE EVICTION PREVENTION, HEALTH & HOUSING INFORMATION SHARING, AND COMMUNITY DEVELOPMENT 37,198
    TENANTS AND WORKERS UNITED
    3801 MOUNT VERNON AVE 215
    ALEXANDRIA,VA22305     		  PC WOODBRIDGE EVICTION PREVENTION, HEALTH & HOUSING INFORMATION SHARING, AND COMMUNITY DEVELOPMENT 15,942
    THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
    13505 HILLENDALE DRIVE
    DALE CITY,VA22193     		  PC BUILDING & IMPROVING CAPACITY 52,500
    THE ARC OF GREATER PRINCE WILLIAMINSIGHT INC
    13505 HILLENDALE DRIVE
    DALE CITY,VA22193     		  PC SUPPORTING INDIVIDUALS W/ DEVELOPMENTAL DISABILITIES & THEIR FAMILIES 250,000
    THE CHRIS ATWOOD FOUNDATION
    PO BOX 9282
    RESTON,VA20195     		  PC REVIVE TO THRIVE 75,985
    THE FENWICK FOUNDATION
    23 N FENWICK STREET
    ARLINGTON,VA22201     		  PC PROJECT ADAPT - DENTAL CARE FOR PRINCE WILLIAM COUNTY LOW-RESOURCE OLDER ADULTS 21,000
    THE GOOD NEWS COMMUNITY KITCHEN
    308 POPLAR ALLEY B
    OCCOQUAN,VA22125     		  PC MOBILE MEALS 52,500
    THE GOOD NEWS COMMUNITY KITCHEN
    308 POPLAR ALLEY B
    OCCOQUAN,VA22125     		  PC MOBILE MEALS 15,000
    THE HOUSE STUDENT LEADERSHIP CENTER
    1400 CROWN COURT SUITE 105
    WOODBRIDGE,VA22193     		  PC OPERATING SUPPORT 250,000
    THE VOLUNTARY ACTION CENTER OF PRINCE WILLIAM AREA INC
    9248 CENTER STREET
    MANASSAS,VA20110     		  PC VETS - VETERANS ENHANCED TRANSPORTATION SERVICES 35,000
    THE WOMEN'S CENTER
    133 PARK STREET NE
    VIENNA,VA22180     		  PC ENHANCED ACCESS TO MENTAL HEALTH PROGRAM 52,500
    TRILLIUM DROP-IN CENTER
    13184 CENTERPOINTE WAY
    WOODBRIDGE,VA22193     		  PC BOOK SPONSORHIP 4,000
    VIRGINIA COMMUNITY FOOD CONNECTIONS
    406 PRINCESS ANNE STREET
    FREDERICKSBURG,VA22401     		  PC OPERATING SUPPORT 60,000
    VIRGINIA DENTAL ASSOCIATION FOUNDATION
    3460 MARYLAND COURT SUITE 110
    RICHMOND,VA23233     		  SO-DP DONATED DENTAL SERVICES (DDS) PROGRAM 17,500
    VIRGINIA FOUNDATION FOR COMMUNITY COLLEGE EDUCATION
    300 ARBORETUM PLACE SUITE 200
    RICHMOND,VA23219     		  PC PHF FELLOWS PROGRAM 125,000
    VIRGINIA INTERFAITH CENTER FOR PUBLIC POLICY
    1716 E FRANKLIN STREET
    RICHMOND,VA23223     		  PC DEEPENING HEALTH ADVOCACY CAPACITY 52,500
    VIRGINIA POVERTY LAW CENTER
    919 E MAIN STREET SUITE 610
    RICHMOND,VA23219     		  PC ENROLL VIRGINIA - POTOMAC 198,806
    VIRGINIANS ORGANIZED FOR INTERFAITH COMMUNITY ENGAGEMENT (VOICE)
    4444 ARLINGTON BLVD
    ARLINGTON,VA22204     		  PC PRINCE WILLIAM COUNTY CRISIS STABILIZATION UNIT 59,500
    VOICES FOR VIRGINIA'S CHILDREN
    701 E FRANKLIN STREET SUITE 807
    RICHMOND,VA23219     		  PC EQUITABLE ACCESS TO TRAUMA-INFORMED CHILDREN'S MENTAL HEALTH SERVICES 60,000
    WORKHOUSE ARTS FOUNDATION INC
    9518 WORKHOUSE WAY BUILDING 16
    LORTON,VA22079     		  PC WORKHOUSE TESSITURA DATABASE IMPLEMENTATION 31,500
    WORKHOUSE ARTS FOUNDATION INC
    9518 WORKHOUSE WAY BUILDING 16
    LORTON,VA22079     		  PC WORKHOUSE MILITARY IN THE ARTS INITIATIVES 77,050
    YOUNG INVINCIBLES
    1411 K STREET NW SUITE 400
    WASHINGTON,DC20005     		  PC HEALTHY YOUNG AMERICA - NOVA CAMPAIGN 125,000
    YOUTH FOR TOMORROW
    11835 HAZEL CIRCLE DRIVE
    BRISTOW,VA20136     		  PC COORDINATED BEHAVIORAL HEALTH SERVICES -DUMFRIES 363,445
    YOUTH FOR TOMORROW
    11835 HAZEL CIRCLE DRIVE
    BRISTOW,VA20136     		  PC YFT BEHAVIORAL MENTAL HEALTH SERVICES FOR THE UNDERSERVED 58,500
    YOUTH FOR TOMORROW
    11835 HAZEL CIRCLE DRIVE
    BRISTOW,VA20136     		  PC YFT BEHAVIORAL MENTAL HEALTH SERVICES FOR THE UNDERSERVED 136,500
    YOUTH FOR TOMORROW
    11835 HAZEL CIRCLE DRIVE
    BRISTOW,VA20136     		  PC BEHAVIORAL HEALTH SERVICES 132,046
    Total .................................bullet 3a 6,744,287
    bApproved for future payment
    AMERICAN KIDNEY FUND
    11921 ROCKVILLE PIKE SUITE 300
    ROCKVILLE,MD20852     		  PC SAFETYNET FINANCIAL ASSISTANCE FOR PRINCE WILLIAM COUNTY 7,500
    BOYS & GIRLS CLUB OF GREATER WASHINGTON
    4103 BENNING RD NE
    WASHINGTON,DC20019     		  PC REFURBISH GYM AT BGCGWS HYLTON CLUB IN DALE CITY 18,955
    BRINGING RESOURCES TO AID WOMEN'S SHELTERS (BRAWS)
    133 PARK STREET NE SUITE 3B
    VIENNA,VA22180     		  PC SUPPLYING MENSTRUAL SUPPLIES & UNDERGARMENTS TO RESIDENTS OF PRINCE WILLIAM COUNTY 16,194
    CAPITAL AREA FOOD BANK
    4900 PUERTO RICO AVENUE NE
    WASHINGTON,DC20017     		  PC TACKLING FOOD INSECURITY IN PRINCE WILLIAM COUNTY BOTH DURING AND POST-PANDEMIC 15,000
    FOODS & FRIENDS INC
    219 RIGGS ROAD NE
    WASHINGTON,DC20011     		  PC SPECIALIZED NUTRITION SERVICES FOR SERIOUSLY ILL VIRGINIANS 12,000
    FORMED FAMILIES FORWARD
    4031 UNIVERSITY DRIVE SECOND FLOOR
    FAIRFAX,VA22030     		  PC TRAUMA-INFORMED CARE FOR CHILDREN WITH DISABILITIES: EMPOWERING FAMILIES TO PARTNER FOR SAFETY 8,858
    GOOD SHEPHERD HOUSING AND FAMILY SERVICES
    PO BOX 15096
    ALEXANDRIA,VA22309     		  PC HALO FOR HEALTH IMPROVEMENTS 17,400
    LEGAL AID JUSTICE CENTER
    1000 PRESTON AVENUE
    CHARLOTTESVILLE,VA22903     		  PC PROTECTING THE LIVES AND LIVELIHOODS OF LOW-INCOME IMMIGRANTS 45,000
    NATIONAL COALITION OF 100 BLACK WOMEN INC PRINCE WILLIAM COUNTY CHAPTER
    PO BOX 1166
    DUMFRIES,VA22026     		  PC OPERATING SUPPORT 4,500
    NATIONAL KOREAN AMERICAN SERVICE & EDUCATION CONSORTIUM (NAKASEC)
    4304 EVERGREEN LANE SUITE 104
    ANNANDALE,VA22003     		  PC STRENGTHENING COMMUNITY HEALTH CARE THROUGH SERVICE & ADVOCACY 31,142
    NORTHERN VIRGINIA FAMILY SERVICE (KIDS CONNECT)
    10455 WHITE GRANITE DRIVE SUITE 100
    OAKTON,VA22124     		  PC OPERATING SUPPORT 9,600
    NORTHERN VIRGINIA FOOD RESCUE
    PO BOX 74
    DUMFRIES,VA22026     		  PC FOOD RESCUE EXPANSION 52,500
    PRINCE WILLIAM COUNTY COMMUNITY FOUNDATION INC
    PO BOX 5148
    WOODBRIDGE,VA22194     		  PC COMBATING HUNGER ON WHEELS WAGON INITIATIVE 16,584
    PRINCE WILLIAM COUNTY COMMUNITY SERVICES
    7969 ASHTON AVENUE
    MANASSAS,VA20109     		  GOV CRISIS RECEIVING AND STABILIZATION CENTER 1,000,000
    STREETLIGHT COMMUNITY OUTREACH MINISTRIES
    14806 BLACKBURN ROAD
    WOODBRIDGE,VA22191     		  PC REGISTERED NURSE POSITION FOR STREETLIGHT MEDICALLY FRAGILE SUPPORTIVE HOUSING AND SHELTER CLIENTS 19,745
    TAHIRIH JUSTICE CENTER
    6400 ARLINGTON BLVD SUITE 400
    FALLS CHURCH,VA22042     		  PC ADDRESSING SOCIAL DETERMINANTS OF HEALTH OF IMMIGRANT SURVIVORS OF GENDER-BASED VIOLENCE 15,000
    THE CHRIS ATWOOD FOUNDATION
    PO BOX 9282
    RESTON,VA20195     		  PC REVIVE TO THRIVE 32,565
    THE FENWICK FOUNDATION
    23 N FENWICK STREET
    ARLINGTON,VA22201     		  PC PROJECT ADAPT - DENTAL CARE FOR PRINCE WILLIAM COUNTY LOW-RESOURCE OLDER ADULTS 9,000
    THE GOOD NEWS COMMUNITY KITCHEN
    308 POPLAR ALLEY B
    OCCOQUAN,VA22125     		  PC MOBILE MEALS 22,500
    THE VOLUNTARY ACTION CENTER OF PRINCE WILLIAM AREA INC
    9248 CENTER STREET
    MANASSAS,VA20110     		  PC VETS - VETERANS ENHANCED TRANSPORTATION SERVICES 15,000
    THE WOMEN'S CENTER
    133 PARK STREET NE
    VIENNA,VA22180     		  PC ENHANCED ACCESS TO MENTAL HEALTH PROGRAM 22,500
    VIRGINIA DENTAL ASSOCIATION FOUNDATION
    3460 MARYLAND COURT SUITE 110
    RICHMOND,VA23233     		  SO-DP DONATED DENTAL SERVICES (DDS) PROGRAM 7,500
    VIRGINIA INTERFAITH CENTER FOR PUBLIC POLICY
    1716 E FRANKLIN STREET
    RICHMOND,VA23223     		  PC DEEPENING HEALTH ADVOCACY CAPACITY 22,500
    VIRGINIANS ORGANIZED FOR INTERFAITH COMMUNITY ENGAGEMENT (VOICE)
    4444 ARLINGTON BLVD
    ARLINGTON,VA22204     		  PC PRINCE WILLIAM COUNTY CRISIS STABILIZATION UNIT 25,500
    WORKHOUSE ARTS FOUNDATION INC
    9518 WORKHOUSE WAY BUILDING 16
    LORTON,VA22079     		  PC WORKHOUSE TESSITURA DATABASE IMPLEMENTATION 13,500
    YOUTH FOR TOMORROW
    11835 HAZEL CIRCLE DRIVE
    BRISTOW,VA20136     		  PC YFT BEHAVIORAL MENTAL HEALTH SERVICES FOR THE UNDERSERVED 58,500
    Total .................................bullet 3b 1,519,043
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 12
    Part XV-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments ....          
    3 Interest on savings and temporary cash
    investments ...........     		    14 154  
    4 Dividends and interest from securities ....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6 Net rental income or (loss) from personal property          
    7 Other investment income .....          
    8 Gain or (loss) from sales of assets other than
    inventory ............     		    18 4,046,306  
    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 6,009,190 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    6,009,190
    (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)
    Yes
     
    (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
    1a(1) 1,500 ROTARY CLUB OF LAKE RIDGE SPONSORSHIP OF 2022 CELEBRITY WAITER LUNCHEON
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

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


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


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2021 AccountingFeesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 25,324 0   25,324

    TY 2021 InvestmentsCorpBondsSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Name of Bond End of Year Book Value End of Year Fair Market Value
    SEI CORE FIXED INCOME FUND #285 22,424,046 22,424,046
    SEI SIIT REAL RETURN A 1,821,283 1,821,283
    SIIT ULTRA SHORT DURATION BOND FUND 5,339,961 5,339,961

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Name of Stock End of Year Book Value End of Year Fair Market Value
    SEI ISHARES MSCI USA MIN VOL FACTOR ETF 8,575,903 8,575,903
    SEI LARGE CAP FUND 19,031,626 19,031,626
    SEI EXTENDED MKT INDEX-A 2,719,614 2,719,614
    SEI WORLD EQUITY EX-US FUND 7,176,354 7,176,354
    SEI STATE ST EMG MKT EQTY INDX-K 2,494,925 2,494,925
    SEI STATE STREET GLB ALL CAP EQ X US IN 6,175,783 6,175,783

    TY 2021 InvestmentsGovtObligationsSch
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    US Government Securities - End of Year Book Value:

    65
    US Government Securities - End of Year Fair Market Value:

    65
    State & Local Government Securities - End of Year Book Value:


    0
    State & Local Government Securities - End of Year Fair Market Value:


    0


    TY 2021 InvestmentsOtherSchedule2
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    SEI GLOBAL PRIVATE ASSETS V LP FMV 1,186,726 1,186,726
    SEI GLOBAL PRIVATE ASSETS IV LP FMV 4,210,237 4,210,237
    SEI SPECIAL SITUATIONS FUND LTD FMV 5,788,778 5,788,778
    SEI CORE PROPERTY FUND LP FMV 16,950,904 16,950,904

    TY 2021 LandEtcSchedule2
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    FURNITURE, EQUIPMENT AND TECHNOLOGY 61,243 50,438 10,805 10,805


    TY 2021 OtherDecreasesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Description Amount
    UNREALIZED LOSS ON INVESTMENTS 18,380,380


    TY 2021 OtherExpensesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PROFESSIONAL DEVELOPMENT 33,655 0   35,655
    TECHNOLOGY EXPENSE 19,415 0   13,915
    INSURANCE 2,207 0   2,207
    BANK FEES 50 50   0
    OTHER EXPENSES 3,155 0   2,567
    SPONSORSHIPS 16,000 0   0
    SEI GLOBAL PRIVATE ASSETS IV LP DEDUCTIONS - ROYALTY INCOME 0 354   0
    SEI GLOBAL PRIVATE ASSETS V LP OTHER DEDUCTIONS 0 15,341   0
    SEI GLOBAL PRIVATE ASSETS IV LP OTHER DEDUCTIONS 0 92,972   0
    SEI CORE PROPERTY FUND LP OTHER DEDUCTIONS 0 41,077   0
    SEI GLOBAL PRIVATE ASSETS V LP INVESTMENT INTEREST EXPENSE 0 1,009   0
    SEI GLOBAL PRIVATE ASSETS IV LP INVESTMENT INTEREST EXPENSE 0 5,004   0


    TY 2021 OtherIncomeSchedule2
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    SEI GLOBAL PRIVATE ASSETS V LP ORDINARY LOSS 0 -1,357 0
    SEI GLOBAL PRIVATE ASSETS IV LP ORDINARY INCOME 0 9,712 0
    SEI GLOBAL PRIVATE ASSETS V LP RENTAL INCOME 0 1 0
    SEI GLOBAL PRIVATE ASSETS IV LP RENTAL LOSS 0 -2,981 0
    SEI GLOBAL PRIVATE ASSETS IV LP ROYALTY INCOME 0 2,304 0
    SEI GLOBAL PRIVATE ASSETS V LP OTHER LOSS 0 -41 0
    SEI GLOBAL PRIVATE ASSETS IV LP OTHER INCOME 0 29,782 0
    SEI CORE PROPERTY FUND LP OTHER INCOME 0 42,156 0


    TY 2021 OtherLiabilitiesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Description Beginning of Year - Book Value End of Year - Book Value
    DUE TO RELATED PARTY 18,254 24,626
    DEFERRED TAX LIABILITY 358,448 102,961


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    CONSULTANT FEES 58,350 0   58,350
    INVESTMENT MANAGEMENT FEES 652,479 652,479   0


    TY 2021 TaxesSchedule
    Name:
    POTOMAC HEALTH FOUNDATION
    EIN:
    52-1340920
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXCISE TAX 80,833 0   0
    SEI GLOBAL PRIVATE ASSETS V LP FOREIGN TAXES 0 50   0
    SEI GLOBAL PRIVATE ASSETS IV LP FOREIGN TAXES 0 331   0