-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0047
20
23
Open to Public Inspection
For calendar year 2023, or tax year beginning
01-01-2023
, and ending
12-31-2023
Name of foundation
INTEGRA FOUNDATION INC
% Glen Coleman
Number and street (or P.O. box number if mail is not delivered to street address)
1100 CAMPUS RD
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
PRINCETON
,
NJ
085406650
A Employer identification number
52-2388679
B
Telephone number (see instructions)
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
699,443
J
Accounting method:
Cash
Accrual
Other (specify)
(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)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
0
0
0
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
0
b
Gross sales price for all assets on line 6a
0
7
Capital gain net income (from Part IV, line 2)
...
0
8
Net short-term capital gain
.........
9
Income modifications
...........
0
10a
Gross sales less returns and allowances
0
b
Less: Cost of goods sold
....
0
c
Gross profit or (loss) (attach schedule)
.....
0
0
11
Other income (attach schedule)
.......
0
0
0
12
Total.
Add lines 1 through 11
........
0
0
0
13
Compensation of officers, directors, trustees, etc.
0
0
0
0
14
Other employee salaries and wages
......
0
0
0
0
15
Pension plans, employee benefits
.......
0
0
0
0
16a
Legal fees (attach schedule)
.........
0
0
0
0
b
Accounting fees (attach schedule)
.......
0
0
0
0
c
Other professional fees (attach schedule)
....
0
0
0
0
17
Interest
...............
0
0
0
0
18
Taxes (attach schedule) (see instructions)
...
0
0
0
0
19
Depreciation (attach schedule) and depletion
...
0
0
0
20
Occupancy
..............
0
0
0
0
21
Travel, conferences, and meetings
.......
0
0
0
0
22
Printing and publications
..........
0
0
0
0
23
Other expenses (attach schedule)
.......
0
0
0
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
0
0
0
0
25
Contributions, gifts, grants paid
.......
417,800
417,800
26
Total expenses and disbursements.
Add lines 24 and 25
417,800
0
0
417,800
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-417,800
b
Net investment income
(if negative, enter -0-)
0
c
Adjusted net income
(if negative, enter -0-)
...
0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2023)
Form 990-PF (2023)
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
1
Cash—non-interest-bearing
.............
1,127,243
699,443
699,443
2
Savings and temporary cash investments
.........
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
0
0
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
0
0
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
0
b
Investments—corporate stock (attach schedule)
.......
0
c
Investments—corporate bonds (attach schedule)
.......
0
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
0
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
0
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
0
15
Other assets (describe
)
0
0
0
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
1,127,243
699,443
699,443
17
Accounts payable and accrued expenses
..........
0
0
18
Grants payable
.................
10,000
0
19
Deferred revenue
.................
0
0
20
Loans from officers, directors, trustees, and other disqualified persons
0
0
21
Mortgages and other notes payable (attach schedule)
......
0
22
Other liabilities (describe
)
List of Attached Documents:
// Content
0
List of Attached Documents:
// Content
0
23
Total liabilities
(add lines 17 through 22)
.........
10,000
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
1,117,243
699,443
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances
(see instructions)
.....
1,117,243
699,443
30
Total liabilities and net assets/fund balances
(see instructions)
.
1,127,243
699,443
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
1,117,243
2
Enter amount from Part I, line 27a
.....................
2
-417,800
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
699,443
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
699,443
Form
990-PF
(2023)
Form 990-PF (2023)
Page
3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a)
List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1a
b
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(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
b
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a
Exempt operating foundations described in section 4940(d)(2), check here
and enter “N/A" on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
1
0
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
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
6
Credits/Payments:
a
2023 estimated tax payments and 2022 overpayment credited to 2023
6a
0
b
Exempt foreign organizations—tax withheld at source
......
6b
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
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
0
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2024 estimated tax
0
Refunded
11
0
Form
990-PF
(2023)
Form 990-PF (2023)
Page
4
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.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
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)
NJ
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 2023 or the taxable year beginning in 2023? 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
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 address
www.integra-foundation.org
14
The books are in care of
Integra LifeSciences Corporation
Telephone no.
(609) 936-2465
Located at
1100 CAMPUS RD
PRINCETON
NJ
ZIP+4
085406650
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2023, did the foundation have an interest in or a signature or other authority over
Yes
No
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
Form
990-PF
(2023)
Form 990-PF (2023)
Page
5
Part VI-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
...........
1a(1)
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
..............................
1a(2)
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
...........
1a(3)
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
............
1a(4)
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
......................
1a(5)
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
...............
1a(6)
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
..........
1b
c
Organizations relying on a current notice regarding disaster assistance check here
........
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 2023?
.............
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 2023, did the foundation have any undistributed income (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2023?
....................
2a
Yes
If "Yes," list the years
2019
,
2020
,
2021
,
2022
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
No
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
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 2023 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 2023.)
.....................
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 2023?
..
4b
No
Form
990-PF
(2023)
Form 990-PF (2023)
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
Organizations relying on a current notice regarding disaster assistance check
.........
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
Simon Archibald
List of Attached Documents:
// Content
Trustee & President
0.00
0
0
0
1100 Campus Road
Princeton
,
NJ
08540
Stuart Essig
List of Attached Documents:
// Content
Trustee
0.00
0
0
0
1100 Campus Road
Princeton
,
NJ
08540
Stuart Hart
List of Attached Documents:
// Content
Trustee
0.00
0
0
0
1100 Campus Road
Princeton
,
NJ
08540
Jessica Smith
List of Attached Documents:
// Content
Trustee
0.00
0
0
0
1100 Campus Road
Princeton
,
NJ
08540
Jeffery Mosebrook
List of Attached Documents:
// Content
Treasurer
0.00
0
0
0
1100 Campus Road
Princeton
,
NJ
08540
Gianna Sabella
List of Attached Documents:
// Content
Executive Director & Corporate Secretary
15.00
0
0
0
1100 Campus Road
Princeton
,
NJ
08540
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
Total
number of other employees paid over $50,000
...................
Form
990-PF
(2023)
Form 990-PF (2023)
Page
7
Part VII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
Total
number of others receiving over $50,000 for professional services
.............
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
.........................
Form
990-PF
(2023)
Form 990-PF (2023)
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
0
b
Average of monthly cash balances
.......................
1b
895,847
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
895,847
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
List of Attached Documents:
// Content
.............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
0
3
Subtract line 2 from line 1d
.........................
3
895,847
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions)
.............................
4
13,438
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3.
............
5
882,409
6
Minimum investment return.
Enter 5% (0.05) of line 5
................
6
44,120
Part X
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part IX, line 6
..................
1
44,120
2a
Tax on investment income for 2022 from Part V, line 5
.......
2a
0
b
Income tax for 2022. (This does not include the tax from Part V.)
...
2b
0
c
Add lines 2a and 2b
............................
2c
0
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
44,120
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
44,120
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
44,120
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
417,800
b
Program-related investments—total from Part VIII-B
..................
1b
0
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)
List of Attached Documents:
// Content
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part XII, line 4.
.......
4
417,800
Form
990-PF
(2023)
Form 990-PF (2023)
Page
9
Part XII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2022
(c)
2022
(d)
2023
1
Distributable amount for 2023 from Part X, line 7
44,120
2
Undistributed income, if any, as of the end of 2022:
a
Enter amount for 2022 only
.......
b
Total for prior years:
2021
,
2020
,
2019
1,174,206
3
Excess distributions carryover, if any, to 2022:
a
From 2018
......
407,832
b
From 2019
......
405,253
c
From 2020
......
421,757
d
From 2021
......
347,196
e
From 2022
......
349,680
f
Total
of lines 3a through e
........
1,931,718
4
Qualifying distributions for 2023 from Part
XI, line 4:
$
417,800
a
Applied to 2022, but not more than line 2a
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
d
Applied to 2023 distributable amount
.....
44,120
e
Remaining amount distributed out of corpus
373,680
5
Excess distributions carryover applied to 2023.
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
2,305,398
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
1,174,206
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
...........
1,174,206
e
Undistributed income for 2022. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2023. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2024
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
8
Excess distributions carryover from 2018 not
applied on line 5 or line 7 (see instructions)
...
407,832
9
Excess distributions carryover to 2024.
Subtract lines 7 and 8 from line 6a
......
1,897,566
10
Analysis of line 9:
a
Excess from 2019
....
405,253
b
Excess from 2020
....
421,757
c
Excess from 2021
....
347,196
d
Excess from 2022
....
349,680
e
Excess from 2023
....
373,680
Form
990-PF
(2023)
Form 990-PF (2023)
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 2023, enter the date of the ruling
......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
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)
2023
(b)
2022
(c)
2021
(d)
2020
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.)
1
Information Regarding Foundation Managers:
a
List 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).)
b
List 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.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2023)
Form 990-PF (2023)
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)
a
Paid during the year
Direct Relief
6100 Wallace Becknell Rd
N/A
Santa Barbara
,
CA
93117
None
PC
Contribution provided
25,000
Americares Foundation
88 Hamilton Avenue
N/A
Stamford
,
CT
06903
None
PC
Contribution provided
25,000
Princess Nora's Warrior Foundation
2728 Malvern Ave
N/A
Hot Springs
,
AR
71901
None
PC
Contribution provided
1,000
Neurosurgery Research and Education Foundation
5550 Meadowbrook Dr
N/A
Rolling Meadows
,
IL
60008
None
PC
Contribution provided
2,500
Americares Foundation
88 Hamilton Avenue
N/A
Stamford
,
CT
06903
None
PC
Contribution provided
10,000
Direct Relief
6100 Wallace Becknell Rd
N/A
Santa Barbara
,
CA
93117
None
PC
Contribution provided
10,000
American Society for Neural Therapy and Repair
30446 USF Holly Drive
N/A
Tampa
,
FL
33620
None
PC
Contribution provided
5,000
Future Neurosurgeons Foundation Inc
3745 W Chipmunk Road
N/A
Prescot
,
AZ
86305
None
PC
Contribution provided
5,000
ThinkFirst Foundation
1801 N Mill Street Suite F
N/A
Naperville
,
IL
60563
None
PC
Contribution provided
6,000
Sisters Network
9668 Westheimer Rd
N/A
Houston
,
TX
77063
None
PC
Contribution provided
5,000
Case Western Reserve University
2109 Adelbert Road
N/A
Cleveland
,
OH
44106
None
PC
Contribution provided
7,000
Emmanuel Cancer Foundation
77 Brant Ave Suite 304
N/A
Clark
,
NJ
07066
None
PC
Contribution provided
1,000
Burn Prevention Foundation
236 N 17th Street
N/A
Allentown
,
PA
18104
None
PC
Contribution provided
1,000
National Children's Cancer Society
500 N Broadway Ste 1850
N/A
St Louis
,
MO
63102
None
PC
Contribution provided
1,000
Dental Lifeline Network
1800 15th Street Suite 100
N/A
Denver
,
CO
80202
None
PC
Contribution provided
10,000
Neurocritical Care Society
330 N Wabash 2000
N/A
Chicago
,
IL
60611
None
PC
Contribution provided
20,000
Ohana One International Surgical Aid
555 W 5th St 35th Floor
N/A
Los Angeles
,
CA
90013
None
PC
Contribution provided
2,000
Center for Excellence in Education
8201 Greensboro Dr 215
N/A
McLean
,
VA
22102
None
PC
Contribution provided
3,500
Emory University School of Medicine
201 Dowman Drive
N/A
Atlanta
,
GA
30322
None
PC
Contribution provided
2,500
Solidarity Bridge
1703 Darrow Avenue Unit 1
N/A
Evanston
,
IL
60202
None
PC
Contribution provided
2,000
Kessler Foundation
120 Eagle Rock Ave 100
N/A
East Hanover
,
NJ
07936
None
PC
Contribution provided
2,500
American Foundation for Surgery of the Hand
822 W Washington Blvd 2nd Fl
N/A
Chicago
,
IL
60607
None
PC
Contribution provided
6,700
Orphan Grain Train
621 East West Blvd
N/A
Millersville
,
MD
21108
None
PC
Contribution provided
1,000
The College of New Jersey Foundation
2000 Pennington Road
N/A
Ewing
,
NJ
08628
None
PC
Contribution provided
7,850
Childrens Home Society of New Jersey
635 South Clinton Avenue
N/A
Trenton
,
NJ
08611
None
PC
Contribution provided
2,000
All Star Code
276 5th Avenue Suite 704 734
N/A
New York
,
NY
10001
None
PC
Contribution provided
5,000
National Military Family Association
3601 Eisenhower Ave 425
N/A
Alexandria
,
VA
22304
None
PC
Contribution provided
5,000
University of Alberta
3rd Floor Administration Building
Edmonton
,
Alberta
T6G 2M7
CA
None
PC
Contribution provided
5,000
Acoustic Neuroma Association
600 Peachtree Parkway 108
N/A
Cumming
,
GA
30041
None
PC
Contribution provided
2,500
Special Olympics of NJ
1 Eunice Kennedy Shriver Way
N/A
Lawrenceville
,
NJ
08648
None
PC
Contribution provided
2,500
Firefighters for Healing
PO Box 374
N/A
Champlin
,
MN
55316
None
PC
Contribution provided
3,000
Fighting Childrens Cancer Foundation
55 Lane Road Suite 300
N/A
Fairfield
,
NJ
07004
None
PC
Contribution provided
5,000
National Brain Tumor Society
55 Chapel Street 200
N/A
Newton
,
MA
02458
None
PC
Contribution provided
5,000
Physicians for Peace
521 West 21st St G2103
N/A
Norfolk
,
VA
23517
None
PC
Contribution provided
5,000
Plastic Surgery Foundation
444 E Algonquin Rd
N/A
Arlington Heights
,
IL
60005
None
PC
Contribution provided
10,000
AORN Foundation
2170 S Parker Road 400
N/A
Denver
,
CO
80231
None
PC
Contribution provided
10,000
Push to Walk
100 Bauer Drive
N/A
Oakland
,
NJ
07436
None
PC
Contribution provided
1,000
Kaserem Futures
2146 Brown Pelican Ln
N/A
Charleston
,
SC
29412
None
PC
Contribution provided
500
Burn Institute
8825 Aero Drive 200
N/A
San Diego
,
CA
92123
None
PC
Contribution provided
4,000
MedTech and BioTech Veterans Program Inc
10 Villa Rd
N/A
South Hamilton
,
MA
01982
None
PC
Contribution provided
5,000
World Pediatric Project
7201 Glen Forest Dr Ste 304
N/A
Richmond
,
VA
23226
None
PC
Contribution provided
3,000
Grossman Burn Foundation
23679 Calabasas Rd Suite 270
N/A
Calabasas
,
CA
91302
None
PC
Contribution provided
5,000
Neurosurgery Foundation at Goodman Campbell
13345 N Illinois St
N/A
Carmel
,
IN
46032
None
PC
Contribution provided
1,000
University of Maryland Medical System Foundation
110 South Paca Street 9th Floor
N/A
Baltimore
,
MD
21201
None
PC
Contribution provided
5,000
Brain Injury Alliance of NJ
825 Georges Road 2nd Fl
N/A
New Brunswick
,
NJ
08902
None
PC
Contribution provided
2,000
Princeton Community Housing
One Monument Drive Lower Level
N/A
Princeton
,
NJ
08540
None
PC
Contribution provided
2,500
Direct Relief
6100 Wallace Becknell Rd
N/A
Santa Barbara
,
CA
93117
None
PC
Contribution provided
15,000
Americares Foundation
88 Hamilton Avenue
N/A
Stamford
,
CT
06903
None
PC
Contribution provided
15,000
Princeton Committee of UNCF
60 Park Place Suite 406
N/A
Newark
,
NJ
07102
None
PC
Contribution provided
17,250
Children's Burn Foundation
5000 Van Nuys Blvd 210
N/A
Sherman Oaks
,
CA
91403
None
PC
Contribution provided
10,000
Children's Brain Tumor Foundation
1460 Broadway 8th Floor
N/A
New York
,
NY
10036
None
PC
Contribution provided
10,000
Society of Neurological Surgeons
10 N Martingale Rd
N/A
Schaumburg
,
IL
60173
None
PC
Contribution provided
5,000
Tigerlily Foundation
42020 Village Center Plaza
N/A
Stoneridge
,
VA
20105
None
PC
Contribution provided
3,000
Pediatric Brain Tumor Foundation
6065 Roswell Rd NE Ste 505
N/A
Atlanta
,
GA
30328
None
PC
Contribution provided
5,000
Americares Foundation
88 Hamilton Avenue
N/A
Stamford
,
CT
06903
None
PC
Contribution provided
20,000
American Diabetes Association
2451 Crystal Drive
N/A
Arlington
,
VA
22202
None
PC
Contribution provided
5,000
Alisa Ann Ruch Burn Foundation
50 N Hill Ave Suite 305
N/A
Pasadena
,
CA
91106
None
PC
Contribution provided
2,500
Agnes Marshall Walker Foundation
8735 West Higgins Rd 300
N/A
Chicago
,
IL
60631
None
PC
Contribution provided
20,000
Drexel University
3141 Chestnut Street
N/A
Philadelphia
,
PA
19104
None
PC
Contribution provided
2,500
Students 2 Science
66 Deforest Avenue
N/A
East Hanover
,
NJ
07963
None
PC
Contribution provided
1,000
ICAN International Cancer Advocacy Network
27 West Morten Avenue
N/A
Phoenix
,
AZ
85021
None
PC
Contribution provided
2,500
Corporate Angels Network
1 Loop Road
N/A
White Plains
,
NY
10604
None
PC
Contribution provided
2,500
Chapel York US Foundation
1350 6th Ave Floor 2 Suite 266
N/A
New York
,
NY
10019
None
PC
Contribution provided
9,000
University of Texas Foundation
9011 Mountain Ridge Dr Suite 150
N/A
Austin
,
TX
78759
None
PC
Contribution provided
2,000
Brain and Spine Group
1579 N Altadena Dr
N/A
Pasadena
,
CA
91107
None
PC
Contribution provided
15,000
The Latin American Legal Defense and Education Fund
714 716 S Clinton Avenue
N/A
Trenton
,
NJ
08611
None
PC
Contribution provided
1,000
Neurosurgery Outreach Foundation
3545 St Johns Bluff Rd South
Suite 118
Jacksonville
,
FL
32224
No Relationship
PC
Contribution provided
3,000
Total
.................................
3a
417,800
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2023)
Form 990-PF (2023)
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.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
0
0
0
b
0
0
0
c
0
0
0
d
0
0
0
e
0
0
0
f
0
0
0
0
0
0
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
0
0
0
3
Interest on savings and temporary cash
investments
...........
0
0
0
4
Dividends and interest from securities
....
0
0
0
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
0
0
0
b
Not debt-financed property
.....
0
0
0
6
Net rental income or (loss) from personal property
0
0
0
7
Other investment income
.....
0
0
0
8
Gain or (loss) from sales of assets other than
inventory
............
0
0
0
9
Net income or (loss) from special events:
0
0
0
10
Gross profit or (loss) from sales of inventory
0
0
0
11
Other revenue:
a
0
0
0
b
0
0
0
c
0
0
0
d
0
0
0
e
0
0
0
12
Subtotal. Add columns (b), (d), and (e)
..
0
0
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
0
(See worksheet in line 13 instructions to verify calculations.)
Part XV-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
Form
990-PF
(2023)
Form 990-PF (2023)
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?
...........
Yes
No
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.
May the IRS discuss this return
with the preparer shown below?
See instructions.
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's EIN
Firm's address
Phone no.
Form
990-PF
(2023)
Additional Data
Software ID:
23017649
Software Version:
V2.0
Form 990PF - Special Condition Description:
Special Condition Description