Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
right arrowDo not enter social security numbers on this form as it may be made public.
right arrowGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
For calendar year 2022, or tax year beginning 01-01-2022 , and ending 12-31-2022
Name of foundation
David & Janet Polak Foundation
 
% Foundation Source
Number and street (or P.O. box number if mail is not delivered to street address)Foundation Source 501 Silverside Rd
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Wilmington, DE198091377
A Employer identification number

45-4797578
B Telephone number (see instructions)

(800) 839-1754
C right arrow
G Check all that apply:

D 1. Foreign organizations, check here............. right arrow
2. Foreign organizations meeting the 85%
test, check here and attach computation ... right arrow
E right arrow
H Check type of organization:
F right arrow
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)right arrow$80,733,214J 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) 0
2 Check right arrow.............
3 Interest on savings and temporary cash investments 87,745 87,745  
4 Dividends and interest from securities... 810,321 810,321  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 3,459,673
b Gross sales price for all assets on line 6a 49,486,786
7 Capital gain net income (from Part IV, line 2)... 3,376,604
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
List of Attached Documents:
// Content
883,610 951,901  
12 Total. Add lines 1 through 11........ 5,241,349 5,226,571  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 247,768     247,768
14 Other employee salaries and wages...... 74,000     74,000
15 Pension plans, employee benefits....... 44,042     44,042
16a Legal fees (attach schedule)......... Click to see attachment
List of Attached Documents:
// Content
17,923 0 0 17,923
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... Click to see attachment
List of Attached Documents:
// Content
561,570 409,834   151,736
17 Interest............... 1,006 1,006    
18 Taxes (attach schedule) (see instructions)... Click to see attachment
List of Attached Documents:
// Content
161,872 17,659    
19 Depreciation (attach schedule) and depletion...      
20 Occupancy.............. 71,319     71,319
21 Travel, conferences, and meetings....... 205,881     205,881
22 Printing and publications.......... 9,483     9,483
23 Other expenses (attach schedule)....... Click to see attachment
List of Attached Documents:
// Content
809,768 678,386   105,556
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 2,204,632 1,106,885 0 927,708
25 Contributions, gifts, grants paid....... 2,654,600 2,654,600
26 Total expenses and disbursements. Add lines 24 and 25 4,859,232 1,106,885 0 3,582,308
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 382,117
b Net investment income (if negative, enter -0-) 4,119,686
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2022)
Form 990-PF (2022)
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......... 5,727,416 4,714,004 4,714,004
3 Accounts receivable right arrow  
Less: allowance for doubtful accounts right arrow        
4 Pledges receivable right arrow  
Less: allowance for doubtful accounts right arrow        
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) right arrow  
Less: allowance for doubtful accounts right arrow        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule) 25,956,247 Click to see attachment
List of Attached Documents:
// Content
26,201,842 		26,302,681
b Investments—corporate stock (attach schedule)....... 11,487,851 Click to see attachment
List of Attached Documents:
// Content
12,232,803 		14,336,017
c Investments—corporate bonds (attach schedule)....... 1,000,149 Click to see attachment
List of Attached Documents:
// Content
1,000,149 		818,390
11 Investments—land, buildings, and equipment: basis right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 22,141,023 Click to see attachment
List of Attached Documents:
// Content
22,047,005 		30,033,861
14 Land, buildings, and equipment: basis right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
15 Other assets (describe right arrow) Click to see attachment
List of Attached Documents:
// Content
4,150,100 		Click to see attachment
List of Attached Documents:
// Content
4,650,100 		Click to see attachment
List of Attached Documents:
// Content
4,528,261
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 70,462,786 70,845,903 80,733,214
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe right arrow)    
23 Total liabilities (add lines 17 through 22)......... 0 0
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here right arrow
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions...........    
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here right arrow
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 70,462,786 70,845,903
29 Total net assets or fund balances (see instructions)..... 70,462,786 70,845,903
30 Total liabilities and net assets/fund balances (see instructions). 70,462,786 70,845,903
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
70,462,786
2
Enter amount from Part I, line 27a .....................
2
382,117
3
Other increases not included in line 2 (itemize) right arrowClick to see attachment
List of Attached Documents:
// Content
3
1,000
4
Add lines 1, 2, and 3 ..........................
4
70,845,903
5
Decreases not included in line 2 (itemize) right arrow
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
70,845,903
Form 990-PF (2022)
Form 990-PF (2022)
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 Passthrough K1 Capital Gain/(Loss)      
c DISTRIBUTIONS IN EXCESS OF BASIS      
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 49,486,786   47,470,162 2,016,624
b       1,304,675
c       55,305
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a       2,016,624
b        
c        
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 3,376,604
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 (2022)
Form 990-PF (2022)
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 right arrow 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) 1 57,264
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 57,264
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 57,264
6 Credits/Payments:
a 2022 estimated tax payments and 2021 overpayment credited to 2022 6a 56,430
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 13,100
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 69,530
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2221 is attached. Click to see attachment
List of Attached Documents:
// Content
8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......right arrow 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...right arrow 10 12,266
11 Enter the amount of line 10 to be: Credited to 2023 estimated taxright arrow12,266 Refundedright arrow 11  
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? Click to see list of attachments
List of Attached Documents:
// Content
....................
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. right arrow$   (2) On foundation managers.right arrow$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.right arrow$  
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 changesClick to see list of attachments
List of Attached Documents:
// Content
....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
Yes
 
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
Yes
 
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.Click to see list of attachments
List of Attached Documents:
// Content
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
round bullet By language in the governing instrument, or
round bullet 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)
right arrowCA, DE
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 2022 or the taxable year beginning in 2022? 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 (2022)
Form 990-PF (2022)
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 addressright arrow  
14
The books are in care ofright arrowFoundation Source Telephone no.right arrow (800) 839-1754

Located atright arrow501 Silverside Road Suite 123WilmingtonDE ZIP+4right arrow198091377
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........right arrow
and enter the amount of tax-exempt interest received or accrued during the year ........right arrow
15
 
16 At any time during calendar year 2022, 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 right arrow
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)
Yes
 
(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
Organizations relying on a current notice regarding disaster assistance check here ........right arrow
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 2022? .............
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 2022, did the foundation have any undistributed income (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2022?....................
2a
 
No
If "Yes," list the years right arrow20, 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.
right arrow20, 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 2022 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 2022.) .....................
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 2022? ..
4b
 
No
Form 990-PF (2022)
Form 990-PF (2022)
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)
Yes
 
(5) Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals? .............
5a(5)
 
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
 
No
c
Organizations relying on a current notice regarding disaster assistance check .........right arrow
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
Yes
 
If "Yes," attach the statement required by Regulations section 53.4945–5(d). Click to see attachment
List of Attached Documents:
// Content
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
David PolakClick to see attachment
List of Attached Documents:
// Content
Dir
1.0 		0 0 0
Foundation Source 501 Silverside Rd
Wilmington,DE198091377
Janet PolakClick to see attachment
List of Attached Documents:
// Content
Dir
1.0 		0 0 0
Foundation Source 501 Silverside Rd
Wilmington,DE198091377
Jeff PolakClick to see attachment
List of Attached Documents:
// Content
Dir, Pres, Executive Dir
40.0 		247,768 11,000 0
Foundation Source 501 Silverside Rd
Wilmington,DE198091377
Robert PolakClick to see attachment
List of Attached Documents:
// Content
Dir
1.0 		0 0 0
Foundation Source 501 Silverside Rd
Wilmington,DE198091377
Jonathan SeltzerClick to see attachment
List of Attached Documents:
// Content
Dir
1.0 		0 0 0
Foundation Source 501 Silverside Rd
Wilmington,DE198091377
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
Noreen L Rubio ADMINISTRATIVE ASST
40.0 		74,000    
3850 N WILKE RD
ARLINGTON HEIGHTS,IL60004
Total number of other employees paid over $50,000...................right arrow  
Form 990-PF (2022)
Form 990-PF (2022)
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
Polak Investors LLC Investment Mgmt 394,893
1880 Century Park East Suite 811
Los Angeles,CA90067
POP 403 Productions LLC Philanthropic 115,873
15057 Greenleaf Street
Sherman Oaks,CA91403
Foundation Source Administrative 93,698
55 Walls Drive 3rd Fl
Fairfield,CT06824
Total number of others receiving over $50,000 for professional services.............right arrow  
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 AKLA PROGRAM - WILL INTRODUCE PARTICIPANTS TO EXCITING & INSPIRING NEW WAYS OF LOOKING AT THEIR JEWISH VALUES & CONNECT THEM WITHIN THEIR OWN LIVES & LA JEWISH COMMUNITY 321,880
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 YAMO PHARMACEUTICALS LLC - TO PROMOTE HEALTH BY FINDING AN EFFECTIVE CURE FOR AUTISM 250,000
2 NEUROVISION IMAGING INC - TO PROMOTE HEALTH AND REDUCE SUFFERING OF THOSE AFFECTED WITH NEUROGENERATIVE CONDITIONS INCLUDING ALZHEIMERS 250,000
All other program-related investments. See instructions.
3  
Total. Add lines 1 through 3.........................right arrow500,000
Form 990-PF (2022)
Form 990-PF (2022)
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
42,432,240
b
Average of monthly cash balances.......................
1b
6,405,475
c
Fair market value of all other assets (see instructions)................
1c
30,067,976
d
Total (add lines 1a, b, and c).........................
1d
78,905,691
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation) .............
1e
 
2
Acquisition indebtedness applicable to line 1 assets..................
2
0
3
Subtract line 2 from line 1d.........................
3
78,905,691
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
1,183,585
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
77,722,106
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
3,886,105
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
3,886,105
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
57,264
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
4,150
c
Add lines 2a and 2b............................
2c
61,414
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
3,824,691
4
Recoveries of amounts treated as qualifying distributions................
4
1,000
5
Add lines 3 and 4............................
5
3,825,691
6
Deduction from distributable amount (see instructions).................
6
 
7
Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
7
3,825,691
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
3,582,308
b
Program-related investments—total from Part VIII-B..................
1b
500,000
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes...............................
2
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)....................
3a
0
b
Cash distribution test (attach the required schedule) .................
3b
0
4
Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4. .......
4
4,082,308
Form 990-PF (2022)
Form 990-PF (2022)
Page 9
Part XII
Undistributed Income (see instructions)
(a)
Corpus 		(b)
Years prior to 2021 		(c)
2021 		(d)
2022
1 Distributable amount for 2022 from Part X, line 7 3,825,691
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2021 only....... 3,858,101
b Total for prior years:2020, 2019, 2018  
3 Excess distributions carryover, if any, to 2022:
a From 2017......  
b From 2018......  
c From 2019......  
d From 2020......  
e From 2021......  
f Total of lines 3a through e ........  
4Qualifying distributions for 2022 from Part
XI, line 4: right arrow$ 4,082,308
a Applied to 2021, but not more than line 2a 3,858,101
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 2022 distributable amount..... 224,207
e Remaining amount distributed out of corpus 0
5 Excess distributions carryover applied to 2022.    
(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 .......... 		 
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 2021. Subtract line
4a from line 2a. Taxable amount—see
instructions ............. 		 
f Undistributed income for 2022. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2023 .......... 		3,601,484
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 2017 not
applied on line 5 or line 7 (see instructions) ... 		 
9 Excess distributions carryover to 2023.
Subtract lines 7 and 8 from line 6a ...... 		0
10 Analysis of line 9:
a Excess from 2018....  
b Excess from 2019....  
c Excess from 2020....  
d Excess from 2021....  
e Excess from 2022.... 0
Form 990-PF (2022)
Form 990-PF (2022)
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 2022, enter the date of the ruling ...... right arrow
 
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 IX for each
year listed .......... 		Tax year Prior 3 years (e) Total
(a) 2022 (b) 2021 (c) 2020 (d) 2019
         
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).)
NONE
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 right arrow
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 (2022)
Form 990-PF (2022)
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

AMCHA INITIATIVE

517 BETHANY CURVE
SANTA CRUZ,CA95060 		N/A PC General & Unrestricted 20,000

AMERICAN FRIENDS OF ISRAELI NAVY SEALS INC

138 W 133RD ST
NEW YORK,NY10030 		N/A PC funds for Three scholarships each be "repaid" with 120 hours of community service to impactful partner organizations;(800 NIS) Passover gift vouchers for Israel Navy SEAL unit soldiers in financial need 15,100

AMERICAN FRIENDS OF SHEBA MEDICAL CENTER INC

6505 WILSHIRE BLVD STE 615
LOS ANGELES,CA90048 		N/A PC General & Unrestricted 10,000

AMERICAN FRIENDS OF THE ISRAEL MUSEUM

545 5TH AVE RM 920
NEW YORK,NY10017 		N/A PC General & Unrestricted 5,000

AMERICAN FRIENDS OF THE ISRAEL PHILHARMONIC ORCHES

555 W 5TH ST 35TH FL
LOS ANGELES,CA90013 		N/A PC General & Unrestricted 10,000

AMERICAN SOCIETY FOR TECHNION- ISRAEL INSTITUTE OF

55 EAST 59TH ST 14TH FLOOR
NEW YORK,NY10022 		N/A PC General & Unrestricted 10,000

AMERICAN YOUTH SYMPHONY INC

841 APOLLO ST STE 344
EL SEGUNDO,CA90245 		N/A PC General & Unrestricted 5,000

AMERICANS FOR BEN-GURION UNIVERSITY INC

1001 AVE OF THE AMERICAS FL 19
NEW YORK,NY10018 		N/A PC Israel's National Artificial Intelligence Resilience Laboratory 800,000

AMERICANS FOR BEN-GURION UNIVERSITY INC

1001 AVE OF THE AMERICAS FL 19
NEW YORK,NY10018 		N/A PC General & Unrestricted 2,500

AYN RAND INSTITUTE THE CENTER FOR THE ADVANCEMENT

6 HUTTON CENTRE DR STE 600
SANTA ANA,CA92707 		N/A PC General & Unrestricted 30,000

AYN RAND INSTITUTE THE CENTER FOR THE ADVANCEMENT

6 HUTTON CENTRE DR STE 600
SANTA ANA,CA92707 		N/A PC Free Books Program for Teachers in Los Angeles County 25,000

BAYIT SHELANU SYNAGOGUE

10825 ASHBY AVE
LOS ANGELES,CA90064 		N/A PC General & Unrestricted 1,800

BEIT TSHUVAH

8831 VENICE BLVD
LOS ANGELES,CA90034 		N/A PC General & Unrestricted 5,000

BUCKLEY SCHOOL

3900 STANSBURY AVE
SHERMAN OAKS,CA91423 		N/A PC General & Unrestricted 10,000

CEDARS-SINAI MEDICAL CENTER

8700 BEVERLY BLVD
W HOLLYWOOD,CA90048 		N/A PC Board of Governors Innovation Center 100,000

CEDARS-SINAI MEDICAL CENTER

8700 BEVERLY BLVD
W HOLLYWOOD,CA90048 		N/A PC General & Unrestricted 25,000

CENTRAL FUND OF ISRAEL

461 CENTRAL AVE
CEDARHURST,NY11516 		N/A PC General & Unrestricted 35,000

COMMITTEE FOR ACCURACY IN MIDDLE EAST REPORTING IN

PO BOX 35040
BOSTON,MA02135 		N/A PC General & Unrestricted 20,000

CONCERN FOUNDATION

11111 W OLYMPIC BLVD STE 214
LOS ANGELES,CA90064 		N/A PC General & Unrestricted 6,000

CROHN'S & COLITIS FOUNDATION OF AMERICA - THE GREA

10350 SANTA MONICA BLVD STE 120
LOS ANGELES,CA90025 		N/A PC General & Unrestricted 10,000

CUFI CHURCH ASSOCIATION

PO BOX 1307
SAN ANTONIO,TX78295 		N/A PC General & Unrestricted 10,000

DAVID HOROWITZ FREEDOM CENTER

28494 WESTINGHOUSE PL STE 212
VALENCIA,CA91355 		N/A PC General & Unrestricted 15,000

ENDOWMENT FOR MIDDLE EAST TRUTH

700 STONINGTON RD
SILVER SPRING,MD20902 		N/A PC General & Unrestricted 20,000

FOUNDATION FOR ECONOMIC EDUCATION INC

1819 PEACHTREE RD NE STE 300
ATLANTA,GA30309 		N/A PC General & Unrestricted 5,000

FOUNDATION FOR INDIVIDUAL RIGHTS AND EXPRESSION IN

510 WALNUT ST STE 1250
PHILADELPHIA,PA19106 		N/A PC General & Unrestricted 5,000

FRIENDS OF ELNET

5215 OLD ORCHARD RD STE 880
SKOKIE,IL60077 		N/A PC General & Unrestricted 100,000

FRIENDS OF ISRAEL SCI-TECH SCHOOLS INC

477 MADISON AVE 6TH FL
NEW YORK,NY10022 		N/A PC General & Unrestricted 5,000

FRIENDS OF THE ISRAEL DEFENSE FORCES - LOS ANGELES

6505 WILSHIRE BLVD STE 625
LOS ANGELES,CA90048 		N/A PC sponsor 13 additional IMPACT! Scholarship students 52,000

HAROLD GRINSPOON FOUNDATION

67 HUNT ST STE 100
AGAWAM,MA01001 		N/A SO I PJ Library fund 15,000

HILLSDALE COLLEGE

33 E COLLEGE ST
HILLSDALE,MI49242 		N/A PC General & Unrestricted 10,000

HONEST REPORTING COM INC

165 E 56TH ST 2ND FL
NEW YORK,NY10022 		N/A PC General & Unrestricted 10,000

IMAGINATION PRODUCTIONS INC

11110 W OAKLAND PARK BLVD STE 288
SUNRISE,FL33351 		N/A PC Initial research phase for film project 25,000

IMAGINATION PRODUCTIONS INC

11110 W OAKLAND PARK BLVD STE 288
SUNRISE,FL33351 		N/A PC General & Unrestricted 10,000

IMERMAN ANGELS

2001 N HALSTED ST STE 302
CHICAGO,IL60614 		N/A PC General & Unrestricted 5,000

ISRAEL CANCER RESEARCH FUND INC

52 VANDERBILT AVE S1510
NEW YORK,NY10017 		N/A PC Research Career Development Program 49,500

ISRAEL EMERGENCY ALLIANCE - STANDWITHUS

PO BOX 341069
LOS ANGELES,CA90034 		N/A PC General & Unrestricted 200,000

ISRAEL TENNIS CENTERS FOUNDATION INC

165 E 56TH ST 2ND FL
NEW YORK,NY10022 		N/A PC General & Unrestricted 5,000

JEWBELONG INC

45 AFTERGLOW WAY
VERONA,NJ07044 		N/A PC General & Unrestricted 5,000

JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES

6505 WILSHIRE BLVD STE 800
LOS ANGELES,CA90048 		N/A PC PJ Library fund in Los Angeles 18,000

JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES

6505 WILSHIRE BLVD STE 800
LOS ANGELES,CA90048 		N/A PC expanding the Community Security Initiative (CSI) through the new CSI Public Outreach Program 75,000

JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES

6505 WILSHIRE BLVD STE 800
LOS ANGELES,CA90048 		N/A PC General & Unrestricted 140,000

JEWISH FUNDERS NETWORK

150 W 30TH ST RM 900
NEW YORK,NY10001 		N/A PC General & Unrestricted 3,600

JEWISH NEWS SERVICE INC

40 NONANTUM ST
NEWTON,MA02458 		N/A PC General & Unrestricted 10,000

JEWISH WOMENS THEATRE

3435 OCEAN PARK BLVD STE 107 PMB 85
SANTA MONICA,CA90405 		N/A PC General & Unrestricted 2,500

LAWFARE PROJECT INC

633 THIRD AVE 21ST FLOOR
NEW YORK,NY10017 		N/A PC General & Unrestricted 25,000

LOS ANGELES JEWISH HOME FOR THE AGING

7150 TAMPA AVE
RESEDA,CA91335 		N/A PC General & Unrestricted 25,000

LOS ANGELES PHILHARMONIC ASSOCIATION

151 S GRAND AVE
LOS ANGELES,CA90012 		N/A PC General & Unrestricted 5,000

LOS ANGELES SHERIFFS FOUNDATION

10960 WILSHIRE BLVD 5TH FL
LOS ANGELES,CA90024 		N/A PC General & Unrestricted 5,000

MANHATTAN INSTITUTE FOR POLICY RESEARCH INC

52 VANDERBILT AVE
NEW YORK,NY10017 		N/A PC General & Unrestricted 5,000

MASSACHUSETTS INSTITUTE OF TECHNOLOGY

600 MEMORIAL DR BLDG W98-300
CAMBRIDGE,MA02139 		N/A PC MISTI MIT-Israel fund to support student internships 40,000

MIDDLE EAST FORUM

1650 MARKET ST STE 3600
PHILADELPHIA,PA19103 		N/A PC to fund approximately 10 percent of annual Israel Victory Project 40,000

MIDDLE EAST MEDIA AND RESEARCH INSTITUTE INC

PO BOX 27837
WASHINGTON,DC20038 		N/A PC General & Unrestricted 5,000

MOISHE HOUSE

441 SAXONY RD BARN 2
ENCINITAS,CA92024 		N/A PC funds for Sherman Oaks and the other LA Moishe Houses 50,000

MUSEUM ASSOCIATES

5905 WILSHIRE BLVD
LOS ANGELES,CA90036 		N/A PC General & Unrestricted 5,000

PACIFIC LEGAL FOUNDATION

555 CAPITOL MALL STE 1290
SACRAMENTO,CA95814 		N/A PC General & Unrestricted 5,000

PARDES INSTITUTE OF JEWISH STUDIES NORTH AMERICA I

54 W 40TH ST
NEW YORK,NY10018 		N/A PC General & Unrestricted 5,000

PRAGER UNIVERSITY FOUNDATION

15021 VENTURA BLVD 552
SHERMAN OAKS,CA91403 		N/A PC General & Unrestricted 50,000

PROCLAIMING JUSTICE TO THE NATIONS INC

PO BOX 682711
FRANKLIN,TN37068 		N/A PC General & Unrestricted 20,000

REMEMBER US THE HOLOCAUST BNAI MITZVAH PROJECT

1112 MONTANA AVE 182
SANTA MONICA,CA90403 		N/A PC General & Unrestricted 3,600

REPORT INC - RESEARCH EVALUATION PROMOTING OR

PMB 225 1121 N BETHLEHEM PIKE STE 6
SPRING HOUSE,PA19477 		N/A PC General & Unrestricted 50,000

ROAD RUNNERS CLUB OF AMERICA

9854 NATIONAL BLVD 534
LOS ANGELES,CA90034 		N/A PC Track Permits program 5,000

SIMON WIESENTHAL CENTER INC

1399 S ROXBURY 2ND FL
LOS ANGELES,CA90035 		N/A PC Moriah Films' comprehensive documentary about the life and legacy of David Ben-Gurion 70,000

STUDENTS RUN AMERICA

5252 CREBS AVE
TARZANA,CA91356 		N/A PC General & Unrestricted 5,000

THE JEWISH INSTITUTE FOR NATIONAL SECURITY OF AMER

1101 14TH ST NW STE 1030
WASHINGTON,DC20005 		N/A PC General & Unrestricted 100,000

THE MAPLE COUNSELING CENTER

439 N CANON DR STE 209
BEVERLY HILLS,CA90210 		N/A PC General & Unrestricted 5,000

THE OPEN TEMPLE

1422 ELECTRIC AVE
VENICE,CA90291 		N/A PC General & Unrestricted 5,000

TRIBE MEDIA CORP

1800 CENTURY PARK E STE 200
LOS ANGELES,CA90067 		N/A PC General & Unrestricted 75,000

TURNING POINT USA INC

4940 EAST BEVERLY RD
PHOENIX,AZ85044 		N/A PC Jewish Programs in the 2022-2023 academic year 25,000

UNITED STATES HOLOCAUST MEMORIAL MUSEUM

100 RAOUL WALLENBERG PL SW
WASHINGTON,DC20024 		N/A PC General & Unrestricted 5,000

UNIVERSITY OF SOUTHERN CALIFORNIA

3551 TROUSDALE PKWY ADM 160
LOS ANGELES,CA90089 		N/A PC Furthering the mission of the "USC Center for the Political Future" 50,000

WASHINGTON INSTITUTE FOR NEAR EAST POLICY

1111 19TH ST NW STE 500
WASHINGTON,DC20036 		N/A PC General & Unrestricted 5,000

YOUNG AMERICA'S FOUNDATION

11480 COMMERCE PARK DR STE 600
RESTON,VA20191 		N/A PC to sponsor 10 students to our 2023 High School conferences at the Reagan Ranch 25,000
Total .................................right arrow 3a 2,654,600
bApproved for future payment
Total ................................. right arrow 3b  
Form 990-PF (2022)
Form 990-PF (2022)
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 87,745  
4 Dividends and interest from securities ....     14 810,321  
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 ............ 		525990 278,967 18 3,180,706  
9 Net income or (loss) from special events:          
10 Gross profit or (loss) from sales of inventory          
11 Other revenue:
aK-1 Inc/Loss 		525990 -223,920 14 953,155  
bFederal Tax Refund     01 117,578  
cSTATE TAX REFUND     01 38,051  
dFOREIGN CURRENCY LOSS     01 -1,254  
e
12 Subtotal. Add columns (b), (d), and (e) .. 55,047 5,186,302  
13Total. Add line 12, columns (b), (d), and (e)..................
13
5,241,349
(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 (2022)
Form 990-PF (2022)
Page 13
Part XVI
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
1
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Yes
No
a
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1) Cash...................................
1a(1)
 
No
(2) Other assets.................................
1a(2)
 
No
b
Other transactions:
(1) Sales of assets to a noncharitable exempt organization....................
1b(1)
 
No
(2) Purchases of assets from a noncharitable exempt organization..................
1b(2)
 
No
(3) Rental of facilities, equipment, or other assets.......................
1b(3)
 
No
(4) Reimbursement arrangements...........................
1b(4)
 
No
(5) Loans or loan guarantees.............................
1b(5)
 
No
(6) Performance of services or membership or fundraising solicitations................
1b(6)
 
No
c
Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
1c
 
No
d
If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
(a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
2a
Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
b
If "Yes," complete the following schedule.

(a) Name of organization (b) Type of organization (c) Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
right arrow right arrow
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 Check if self-
employed right arrow		 PTIN
Firm's name SmallBullet
 Firm's EIN SmallBullet
Firm's address SmallBullet


 Phone no.
Form 990-PF (2022)
Additional Data


Software ID:  
Software Version:  


Form 990PF - Special Condition Description:
Special Condition Description

TY 2022 CompensationExplanation
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Person Name Explanation
Jeff Polak * DAVID POLAK (DIRECTOR), JANET POLAK (DIRECTOR) AND JEFF POLAK PRESIDENT/DIRECTOR/EXECUTIVE DIRECTOR), OF DAVID & JANET POLAK FOUNDATION (THE "FOUNDATION"), ARE PRINCIPALS AT THE INVESTMENT MANAGEMENT FIRM POLAK INVESTORS, LLC, A DISQUALIFIED PERSON WHICH PROVIDES INVESTMENT MANAGEMENT SERVICES TO THE FOUNDATION. IN THE TAXABLE YEAR ENDING DECEMBER 31, 2022, THE FOUNDATION PAID $394,893 FOR INVESTMENT MANAGEMENT SERVICES RENDERED BY SUCH DISQUALIFIED PERSON, AS REPORTED IN PART I, LINE 16C. THE REASONABLENESS OF THE PROFESSIONAL FEES WAS ESTABLISHED BY AN OUTSIDE COMPENSATION COMMITTEE, WHICH REVIEWED THE RATES CHARGED BY COMPARABLE INVESTMENT MANAGEMENT FIRMS.

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

TY 2022 DepreciationSchedule
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
Life (# of years)		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included

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TY 2022 ExpenditureResponsibilityStmt
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Grantee's Name Grantee's Address Grant Date Grant Amount Grant Purpose Amount Expended By Grantee Any Diversion By Grantee? Dates of Reports By Grantee Date of Verification Results of Verification
NEUROVISION IMAGING INC
  		1395 GARDEN HIGHWAY SUITE 250
SACRAMENTO,CA95833 		2014-12-17 250,000 PRI INVEST-SEE GEN EXPLAN FOR PURPOSE & ADDTL DETAILS RE AMT, AMT EXPENDED, & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
BRUIN BIOMETRICS LLC
  		10960 WILSHIRE BLVD SUITE 950
LOS ANGELES,CA90024 		2015-05-13 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
BIOP MEDICAL LTD
  		10 Ohaliav St
RAMAT GAN   5252263
IS 		2017-04-21 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
ONLINE DISRUPTIVE TECHNOLOGIES INC
  		MATAM ADV TECH PK BLD 23 POBX 15050
HAIFA   3190501
IS 		2017-04-21 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
ORGENESIS LTD
  		ARAD STREET 9
TEL AVIV    
IS 		2017-04-21 305,498 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
BRYN PHARMA LLC FKA EPI-NOW LLC
  		518 NORTH HILLCREST ROAD
BEVERLY HILLS,CA90210 		2018-07-13 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
CYWAT TECHNOLOGIES LTD
  		168 JABOTINSKY ST
BNEI BRAK    
IS 		2018-11-26 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
BIO-ACTIVES SYNERYGIO LTD FKA YB MO CHO
  		HITECH VIL 4/9 GIVAT RAM POB 39231
JERUSALEM   9129102
IS 		2018-04-20 250,000 PRI LOAN-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
BIO-ACTIVES SYNERYGIO LTD FKA YB MO CHO
  		HITECH VIL 4/9 GIVAT RAM POB 39231
JERUSALEM   9129102
IS 		2018-07-19 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
MAXQ AI LTD
  		96 YIGAL ALON STREET ENTRANCE A
TEL AVIV   6789140
IS 		2019-03-19 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO     THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
EXTHERA MEDICAL CORPORATION
  		757 ARNOLD DRIVE SUITE B
MARTINEZ,CA94553 		2019-12-19 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
YONALINK LTD
  		HADASSAH EIN KEREM HOSP POB 12000
JERUSALEM   9112001
IS 		2019-11-12 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
AMICROBE INC
  		3142 TIGER RUN COURT 103
CARLSBAD,CA92010 		2019-10-31 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
OCTHEALTH LLC
  		1395 GARDEN HIGHWAY SUITE 250
SACRAMENTO,CA95833 		2021-06-08 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORT WAS MADE.
BIO-ACTIVES SYNERGIO LTD
  		HI-TECH VILLAGE UNIT 4/9 POB39231
GIVAT RAM   9129102
IS 		2021-10-12 100,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORT WAS MADE.
CYWAT TECHNOLOGIES LTD
  		168 JABOTINSKY ST
BNEI BRAK    
IS 		2021-06-15 100,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WERE MADE.
NEUROVISION IMAGING INC
  		1395 Garden Highway Suite 250
sacramento,CA95833 		2022-06-17 250,000 PRI LOAN-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORT WAS MADE.
YAMO PHARMACEUTICALS LLC
  		400 Madison Ave Ste 11A
NEW YORK,NY10017 		2022-07-13 250,000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION   NO See General Explanation for Report Dates   THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORT FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORT WAS MADE.

TY 2022 GeneralExplanationAttachment
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Identifier Return Reference Explanation
FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: NEUROVISION IMAGING, INC. DATES AND AMOUNTS OF PRI: 12/17/2014 $250,000 5/17/2018 $37,502 PURPOSE OF PRI: RESEARCH AND DEVELOPMENT OF DIAGNOSTIC TOOLS FOR EARLY-STAGE DETECTION OF ALZHEIMER'S DISEASE AND OTHER DEGENERATIVE NEUROLOGICAL DISORDERS. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED FULL AND COMPLETE FINANCIAL REPORTS OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 3/25/2015 FOR FYE 12/31/2014 DATE OF REPORT: 5/18/2016 FOR FYE 12/31/2015 DATE OF REPORT: 6/7/2017 FOR FYE 12/31/2016 DATE OF REPORT: 5/11/2018 FOR FYE 12/31/2017 DATE OF REPORT: 11/1/2019 FOR FYE 12/31/2018 DATE OF REPORT: 6/2/2020 FOR FYE 12/31/2019 DATE OF REPORT: 6/28/2021 FOR FYE 12/31/2020 DATE OF REPORT: 8/25/2023 FOR FYE 12/31/2021 DATE OF REPORT: 8/25/2023 FOR FYE 12/31/2022 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2022. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: BRUIN BIOMETRICS, LLC DATE AND AMOUNT OF PRI: 5/13/2015 $250,000 PURPOSE OF PRI: TO PROMOTE THE HEALTH AND REDUCE THE SUFFERING OF THOSE AFFECTED BY EARLY-STAGE PRESSURE ULCERS DURING THEIR HOSPITAL STAYS AND TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH IN THE PUBLIC INTEREST. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORTS OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 5/24/2016 FOR FYE 12/31/2015 DATE OF REPORT: 6/29/2017 FOR FYE 12/31/2016 DATE OF REPORT: 5/15/2018 FOR FYE 12/31/2017 DATE OF REPORT: 6/14/2019 FOR FYE 12/31/2018 DATE OF REPORT: 4/22/2020 FOR FYE 12/31/2019 DATE OF REPORT: 8/25/2022 FOR FYE 12/31/2020 DATE OF REPORT: 8/11/2022 FOR FYE 12/31/2021 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2022. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: BIOP MEDICAL LTD DATES AND AMOUNTS OF PRI: 4/21/2017 $250,000 PURPOSE OF PRI: TO PROMOTE THE HEALTH AND REDUCE THE SUFFERING OF THOSE AFFECTED BY DISEASE AND TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH IN THE PUBLIC INTEREST. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 6/4/2018 FOR FYE 12/31/2017 DATE OF REPORT: 2/12/2019 FOR FYE 12/31/2018 DATE OF REPORT: 11/13/2021 FOR FYE 12/31/2019 DATE OF REPORT: 11/13/2021 FOR FYE 12/31/2020 Although the foundation has made multiple attempts to obtain formal reports for 2021 and 2022, it has been unable to do so. However, BIOP has informally indicated that it has neither funds available nor working staff, and that its activities have been reduced to the bare minimum from the onset of the pandemic and have not since recovered. Per Section 53.4945-5(e)(2) of the Treasury Regulations, the failure of PRI Recipient to submit an annual report will not result in a taxable expenditure for the Foundation because the Foundation (i) made the grant in accordance with paragraph (b) of said section of the Regulations, (ii) has complied with the reporting requirements contained in paragraph (d) of said section of the Regulations, (iii) made a reasonable effort to obtain the required report, and (iv) will withhold all future payments on any grant to this grantee until such report is furnished. THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2022. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: ONLINE DISRUPTIVE TECHNOLOGIES, INC. DATE AND AMOUNT OF PRI: 4/21/2017 $250,000 PURPOSE OF PRI: TO PROMOTE THE HEALTH AND REDUCE THE SUFFERING OF THOSE AFFECTED BY CANCER AND TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH IN THE PUBLIC INTEREST. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 6/6/2018 FOR FYE 12/31/2017 DATE OF REPORT: 2/12/2019 FOR FYE 12/31/2018 DATE OF REPORT: 6/1/2020 FOR FYE 12/31/2019 DATE OF REPORT: 8/18/2021 FOR FYE 12/31/2020 DATE OF REPORT: 3/20/2023 FOR FYE 12/31/2021 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2022. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: BRYN PHARMA LLC F/K/A EPI-NOW LLC DATE AND AMOUNT OF PRI: 7/13/2018 $250,000 PURPOSE OF PRI: TO PROMOTE THE HEALTH OF THOSE WHO REQUIRE EPINEPHRINE AND TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH IN THE PUBLIC INTEREST. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 8/23/2019 FOR FYE 12/31/2018 DATE OF REPORT: 10/24/2020 FOR FYE 12/31/2019 DATE OF REPORT: 8/2/2021 FOR FYE 12/21/2020 DATE OF REPORT: 5/16/2023 FOR FYE 12/21/2021 DATE OF REPORT: 4/25/2023 FOR FYE 12/21/2022 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2022. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. APPRECIATION OF PROPERTY.
FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: ORGENESIS LTD. DATE AND AMOUNT OF PRI: 4/21/2017 $305,498 PURPOSE OF PRI: TO PROMOTE THE HEALTH AND REDUCE THE SUFFERING OF THOSE AFFECTED BY DIABETES BY WAY OF RESEARCHING AND BRINGING TO CLINICAL TRIAL THE COMPANY TECHNOLOGY SOLUTION. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED FULL AND COMPLETE FINANCIAL REPORTS OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 9/9/2018 FOR FYE 12/31/2017 DATE OF REPORT: 10/20/2020 FOR FYE 12/31/2018 DATE OF REPORT: 10/20/2020 FOR FYE 12/31/2019 DATE OF REPORT: 5/20/2021 FOR FYE 12/31/2020 DATE OF REPORT: 5/14/2023 FOR FYE 12/31/2021 DATE OF REPORT: 5/14/2023 FOR FYE 12/31/2022 THE FOUNDATION EXERCISED AN OPTION TO EXCHANGE ITS INTEREST IN THE INVESTEE FOR THE STOCK IN THE PARENT COMPANY OF THE INVESTED. THIS WAS DONE TO PRESERVE THE PRI AND NOT TO GENERATE INCOME OR FOR THE APPRECIATION OF PROPERTY. THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2022. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: CYWAT TECHNOLOGIES LTD DATES AND AMOUNTS OF PRI: 11/26/2018 $250,000 3/3/2021 $7,101 PURPOSE OF PRI: TO PROMOTE THE HEALTH OF PEOPLE WHO ARE AFFECTED BY POLLUTED DRINKING WATER BY FUNDING THE DEVELOPMENT OF A WATER MONITORING SYSTEM THAT IS DISTRIBUTED THROUGHOUT THE ENTIRE WATER GRID AND WHICH CAN IMMEDIATELY DETECT POTENTIAL DANGERS. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 6/18/2019 FOR FYE 12/31/2018 DATE OF REPORT: 1/13/2020 FOR FYE 12/31/2019 DATE OF REPORT: 1/20/2022 FOR FYE 12/31/2020 DATE OF REPORT: 1/16/2022 FOR FYE 12/31/2021 DATE OF REPORT: 6/13/2023 FOR FYE 12/31/2022 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2022. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: BIO-ACTIVES SYNERGIO LTD. F/K/A Y&B MOTHERS CHOICE LTD. DATE AND AMOUNT OF PRI: 4/20/2018 $250,000 PURPOSE OF PRI: TO PROMOTE HEALTH BY FUNDING RESEARCH INTO DEVELOPING NON HAZARDOUS, NATURAL PRODUCTS THAT DO NOT ENDANGER HUMAN HEALTH. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2018 DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2019 DATE OF REPORT: 11/13/2022 FOR FYE 12/31/2020 DATE OF REPORT: 9/18/2023 FOR FYE 12/31/2021 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2022. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: BIO-ACTIVES SYNERGIO LTD. F/K/A Y&B MOTHERS CHOICE LTD. DATE AND AMOUNT OF PRI: 7/19/2018 $250,000 PURPOSE OF PRI: TO PROMOTE HEALTH BY FUNDING RESEARCH INTO DEVELOPING NON HAZARDOUS, NATURAL PRODUCTS THAT DO NOT ENDANGER HUMAN HEALTH. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2018 DATE OF REPORT: 10/29/2020 FOR FYE 12/31/2019 DATE OF REPORT: 11/13/2022 FOR FYE 12/31/2020 DATE OF REPORT: 9/18/2023 FOR FYE 12/31/2021 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2022. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.
FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: MAXQ AI, LTD DATE OF PRI: 3/19/2019 $250,000 PURPOSE OF PRI: TO PROMOTE THE DEVELOPMENT OF A PRODUCT THAT WILL SUBSTANTIALLY BENEFIT THE PUBLIC BY INCORPORATING SOPHISTICATED ARTIFICIAL INTELLIGENCE INTO DIAGNOSTIC RADIOLOGY. REPORTS OF AMOUNTS EXPENDED: RECIPIENT HAS SUBMITTED A FULL AND COMPLETE FINANCIAL REPORT OF THE TYPE ORDINARILY REQUIRED BY COMMERCIAL INVESTORS UNDER SIMILAR CIRCUMSTANCES AND A STATEMENT THAT IT HAS COMPLIED WITH THE TERMS OF THE INVESTMENT FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT: 10/13/2020 FOR FYE 12/31/2019 DATE OF REPORT: 7/20/2021 FOR FYE 12/31/2020 DATE OF REPORT: 3/24/2023 FOR FYE 12/31/2021 DATE OF REPORT: 7/7/2023 FOR FYE 12/31/2022 THIS INVESTMENT REMAINED ON THE FOUNDATION'S BOOKS AS OF 12/31/2022. DIVERSIONS: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE.

TY 2022 InvestmentsCorpBondsSchedule
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Name of Bond End of Year Book Value End of Year Fair Market Value
EDISON INTL BOND PERPETUAL - 5 1,000,149 818,390

TY 2022 InvestmentsCorpStockSchedule
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Name of Stock End of Year Book Value End of Year Fair Market Value
AGNICO EAGLE MINES LTD 735,250 816,503
AMERICAN AXLE & MFG HOLDINGS I 263,446 204,102
ARCH COAL, INC 84,323 142,790
ARDAGH METAL PACKAGING SA 76,117 48,100
B2 GOLD CORP COM NPV 150,587 150,654
BARRICK GOLD CORPORATION 757,500 429,500
BAYER A G SPONSORED ADR 198,370 102,880
BERRY PLASTICS GROUP INC 274,208 362,580
BLOOM ENERGY CORP 19,368 19,120
BP PLC SPONSORED ADR 102,249 104,790
CAMECO CORPORATION 19,784 22,670
CENTERRA GOLD INC 88,332 51,800
CENTURY ALUMINUM COMPANY 134,168 81,800
CHENIERE ENERGY INC 262,699 524,860
CITIGROUP INC 248,049 226,150
CLIFFS NATURAL RESOURCES INC. 94,101 96,660
COMPASS MINERALS INTERNATIONAL 82,086 82,000
COMSTOCK RES INC 139,670 287,910
CONSOL ENERGY, INC 177,409 390,000
CONSTELLIUM NV 136,767 70,980
COPPER MOUNTAIN MINI NG CORP 66,822 151,200
COTERRA ENERGY INC 425,563 590,024
CVS CAREMARK CORP 466,000 931,900
DANA HOLDING CP 137,340 121,040
ELDORADO GOLD CORP COM NPV 308,509 234,080
ENDEAVOUR MINING CORP 206,264 213,907
FIDELITY CONSERV INC BD FD 8,731 8,694
FIRST MAJESTIC SILVER CORP 109,720 83,400
FIRST QUANTUM MINERALS LTD 17,953 41,720
FLUTTER ENTERTAINMENT ORD SHS 90,356 94,325
GENERAL MOTORS 361,740 336,400
GOLD FIELDS LTD ADS 140,581 269,100
GRAFTECH INTERNATIONAL LTD 391,515 166,600
GRAPHIC PACKAGING CORP COM STK 41,828 66,750
HALLIBURTON COMPANY 226,736 236,100
HESS CORP 190,621 283,640
HOLCIM LTD SPON ADS 57,245 102,900
HOLCIM N 491,587 517,510
HUDBAY MINERALS INC 186,121 152,100
IVANHOE MINES LTD 60,260 237,000
JAPAN SMALLER CAPITALIZATION F 403,984 329,184
JET2 PLC 78,926 115,286
JOHNSON & JOHNSON 231,728 441,625
KAZATOMPROM JSC NAC GDR 147,503 281,400
MARKET VECTORS VIETNAM ETF 40,705 23,680
MERCK & CO INC 226,844 554,750
MICRON TECHNOLOGY 300,822 549,780
NEWCREST MINING LTD 109,012 134,830
NEWMONT GOLDCORP CORPORATION 574,088 748,403
NEXGEN ENERGY LTD 115,963 155,050
NOVAGOLD RESOURCES 108,485 119,600
NUVEEN MLT STR I&G 9,760 7,280
OCEANAGOLD CORPORATION COM 142,250 114,000
ORGANON & CO 18,170 22,344
PEABODY ENERGY CORP 111,551 132,100
PFIZER INC 294,452 614,880
PHILIP MORRIS INTL 8,916 10,121
SHELL ADR EACH REPRESENTING 2 202,042 227,800
TEVA PHARMACEUTICAL INDUSTRIES 36,513 9,120
THE MOSAIC CO 306,123 350,960
TOREX GOLD RESOURCES 181,332 172,500
TPG RE FINANCE TRUST INC 2,013 679
TRUIST FINANCIAL CORPORATION 30,848 43,030
UNITED STATES STEEL CORP 48,470 50,100
VALARIS LTD WTS EXP 04/29/2028 220,170 1,142
VALARIS PLC COM CL A 161,969  
VIATRIS ORD SHS 90,189 72,134

TY 2022 InvestmentsGovtObligationsSch
Name:
David & Janet Polak Foundation
EIN:
45-4797578
US Government Securities - End of Year Book Value:

23,699,318
US Government Securities - End of Year Fair Market Value:

23,846,633
State & Local Government Securities - End of Year Book Value:


2,502,524
State & Local Government Securities - End of Year Fair Market Value:


2,456,048


TY 2022 InvestmentsOtherSchedule2
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
AIR U.S. LIFE FUND III, LP   2,091,530 2,156,858
AIR US LIFE FUND IV, LP   1,996,407 2,149,384
ALPHA WAVE (F/K/A FALCON EDGE)   551,806 1,332,337
ALTAIR - PACIFIC COAST CPTL PT   467,684 365,083
ALTAIR DIRECT LENDING FUND, LL   166,151 149,222
ALTAIR EUROPEAN R E OPPORTUNIT   659,098 226,593
ALTAIR SENIOR HOUSING FUND (AE   49,830 451,866
ANAGENESIS CAPITAL PARTNERS SB   1,247,114 2,139,296
ASM CONNAUGHT HOUSE FUND III L   1,000,000 1,278,344
AVANTE CAPITAL PARTNERS SBIC I   229,509 234,765
BROAD ST REAL ESTATE CREDIT PT     139,481
BW GAS & CONVENIENCE ONSHORE F   1 3,040,428
DORCHESTER CAPITAL SECONDARIES   810,630 1,063,452
ENLIGHTENMENT CAP SOLUTION III   1,385,602 3,163,935
ENLIGHTENMENT CAP SOLUTION IV   440,192 449,928
FIRST EAGLE CLO EQUITY FUND I,   280,004 176,406
FOURTHSTONE SMALL-CAP FINANCIA   353,864 414,152
GOLDMAN SACHS VINTAGE FUND V L   302,066 82,615
GRANITE CREEK FLEXCAP II, L.P   1,030,020 1,113,908
GS DISTRESSED OPPORTUNITIES FU   133,187 135,718
GSO CAPITAL SOLUTIONS FD II 1   6,008 2,678
GSO CAPITAL SOLUTIONS FD II 2   77,804 26,952
GSO CAPITAL SOLUTIONS FD II LP   266,762 118,905
GSO ENERGY SELECT OPP FD AIV-2   74,433 86,351
GSO ENERGY SELECT OPP FD AIV-3   57,108 53,389
GSO ENERGY SELECT OPP FD AIV-5   1,287 1,203
GSO ENERGY SELECT OPP FUND   14,932 13,400
LATITUDE MGMT RE CAP III   40,000 22,479
LATITUDE MGMT RE CAP IV   2,000,000 2,022,277
PCCP EQUITY VII, LP   1,818,674 2,812,522
PCCP EQUITY VIII, LP   685,393 933,217
QS CAPITAL STRATEGIES II, L.P   686,664 713,701
SILVERVIEW CREDIT OPP FUND LP   55,573 90,230
SILVERVIEW CREDIT OPP OFFSHORE   1,300,213 1,300,213
THE EDGBASTON ASIAN EQUITY TRU   1,421,237 1,226,351
BERNIE L MADOFF - CLAIM RECEIV   346,222 346,222

TY 2022 LegalFeesSchedule
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
Document Review/Drafting 12,453     12,453
General Consultations 5,470     5,470


TY 2022 OtherAssetsSchedule
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
PRI - AMICROBE, INC   250,000 250,000
PRI - BARAK BALLET   200,000 200,000
PRI - BIOP MEDICAL   250,000 250,000
PRI - BRUIN_BIOMETRICS   250,000 250,000
PRI - BRYN PHARMA LLC F/K/A EP   250,000 250,000
PRI - CYWAT TECH   507,100 507,101
PRI - EXTHERA MEDICAL CORP   250,000 250,000
PRI - MAXQ AI, LTD   250,000 250,000
PRI - MOTHERS CHOICE   250,000 250,000
PRI - MOTHERS CHOICE (2)   250,000 250,000
PRI - NEUROVISION IMAGING, INC   250,000 250,000
PRI - OCTHEALTH LLC - 15,000 U   250,000 250,000
PRI - ONLINE DISRUPTIVE   250,000 250,000
PRI - ORGENESIS - 32,052 SHARE   294,398 183,658
PRI - ORGENESIS WTS - 32,052 U   11,100  
PRI - SER A1 PFD (82,175 UNITS   250,000 250,000
PRI - SER A2 PFD (15,408 UNITS   37,502 37,502
PRI - SYNERGIO BIO ACTIVES LTD   100,000 100,000
PRI - YAMO PHARMACEUTICALS LLC   250,000 250,000
PRI - YONALINK LTD   250,000 250,000


TY 2022 OtherExpensesSchedule
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
Administrative Fees 93,698     93,698
Bank Charges 1,091 1,091    
Cell Phone Expense 822     822
Insurance Premiums 1,129     1,129
K-1 Exp AIR U.S. LIFE FUND III 131,124 131,124    
K-1 Exp AIR US LIFE FUND IV, L 84,930 84,930    
K-1 Exp ALPHA WAVE (F/K/A FALC 7,931 7,931    
K-1 Exp ALTAIR - PACIFIC COAST 12,873 12,871    
K-1 Exp ALTAIR DIRECT LENDING 1,057 1,047    
K-1 Exp ALTAIR SENIOR HOUSING 3,259 3,209    
K-1 Exp ANAGENESIS CAPITAL PAR 152,411 151,900    
K-1 Exp AVANTE CAPITAL PARTNER 56,039 50,467    
K-1 Exp BW GAS & CONVENIENCE O 434 172    
K-1 Exp ENLIGHTENMENT CAPITAL 50,232 50,145    
K-1 Exp ENLIGHTENMENT CAPITAL 37,316 37,216    
K-1 Exp FIRST EAGLE CLO EQUITY 8,607 8,607    
K-1 Exp FOURTHSTONE SMALL-CAP 6,117 6,117    
K-1 Exp GRANITE CREEK FLEXCAP 8,190 8,070    
K-1 Exp GSO CAPITAL SOLUTIONS 2,540 -14    
K-1 Exp GSO CAPITAL SOLUTIONS 2,050 2,050    
K-1 Exp GSO ENERGY SELECT OPPO 17,700 1,643    
K-1 Exp GSO ENERGY SELECT OPPO 955 854    
K-1 Exp GSO ENERGY SELECT OPPO 122 122    
K-1 Exp GSO ENERGY SELECT OPPO 646 646    
K-1 Exp PCCP EQUITY VII, LP 34,364 34,283    
K-1 Exp PCCP EQUITY VIII, LP 5,671 5,663    
K-1 Exp QS CAPITAL STRATEGIES 71,205 71,175    
K-1 Exp SILVERVIEW CREDIT OPPO 2,147 2,147    
K-1 Exp THE EDGBASTON ASIAN EQ 5,201 4,920    
PARKING FEES 3,180     3,180
OFFICE SUPPLIES 5,708     5,708
Postage/Delivery Service 68     68
Registered Agent Fee 125     125
State or Local Filing Fees 250     250
Website Hosting/Support 576     576


TY 2022 OtherIncomeSchedule2
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
K-1 Inc/Loss AIR U.S. LIFE FUND III, LP 51 51  
K-1 Inc/Loss AIR US LIFE FUND IV, LP 71 71  
K-1 Inc/Loss ALTAIR - PACIFIC COAST CPTL PTNRS EQ -9,724 -6,856  
K-1 Inc/Loss ALTAIR DIRECT LENDING FUND, LLC 461 461  
K-1 Inc/Loss ALTAIR SENIOR HOUSING FUND (AEW), LL -24,794 -549  
K-1 Inc/Loss ANAGENESIS CAPITAL PARTNERS SBIC FUN 227,787 281,248  
K-1 Inc/Loss AVANTE CAPITAL PARTNERS SBIC III, LP 47,540 44,641  
K-1 Inc/Loss BW GAS & CONVENIENCE ONSHORE FUND, L -248,550    
K-1 Inc/Loss ENLIGHTENMENT CAPITAL SOLUTIONS FUND 157,552 130,810  
K-1 Inc/Loss ENLIGHTENMENT CAPITAL SOLUTIONS FUND 18,743 10,286  
K-1 Inc/Loss FIRST EAGLE CLO EQUITY FUND I, LP 42,210 42,210  
K-1 Inc/Loss FOURTHSTONE SMALL-CAP FINANCIALS FD 6,573 5,939  
K-1 Inc/Loss GRANITE CREEK FLEXCAP II, L.P 60,368 60,368  
K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II AIV-1 -19 -19  
K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II AIV-2 -10,435 8  
K-1 Inc/Loss GSO CAPITAL SOLUTIONS FUND II LP 26,906 26,857  
K-1 Inc/Loss GSO ENERGY SELECT OPPORTUNITIES FUND 26,282 81  
K-1 Inc/Loss GSO ENERGY SELECT OPPORTUNITIES FUND 9 8  
K-1 Inc/Loss PCCP EQUITY VII, LP 132,484 38,657  
K-1 Inc/Loss PCCP EQUITY VIII, LP -11,146 1,706  
K-1 Inc/Loss QS CAPITAL STRATEGIES II, L.P 81,245 111,556  
K-1 Inc/Loss SILVERVIEW CREDIT OPPORTUNITES OFFSH 138,430 138,430  
K-1 Inc/Loss THE EDGBASTON ASIAN EQUITY TRUST 67,191 67,191  
Federal Tax Refund 117,578    
Foreign Currency Loss -1,254 -1,254  
State Tax Refund 38,051    


TY 2022 OtherIncreasesSchedule
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Description Amount
RETURNED GRANT 1,000


TY 2022 OtherProfessionalFeesSchedule
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
PROGRAMMER SERVICES 1,000     1,000
EMPLOYEE RECRUITING SERVICES 32,500     32,500
Investment Management Services 409,834 409,834    
DESIGNER SERVICES 3,000     3,000
Philanthropic Consulting Srvcs 101,600     101,600
PROJECT MANAGEMENT SERVICES 1,000     1,000
PHOTO SERVICES 500     500
VIDEO PRODUCTION 12,136     12,136


TY 2022 TaxesSchedule
Name:
David & Janet Polak Foundation
EIN:
45-4797578
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
990-PF Estimated Tax for 2022 41,900      
990-T Extension for 2021 70,100      
990-T Income Tax for 2021 1,104      
Foreign Tax Paid 17,659 17,659    
IRS MISCELLANEOUS FEE 9      
STATE INCOME TAX 2021 31,100