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
2023
Open to Public Inspection
For calendar year 2023, or tax year beginning 04-01-2023 , and ending 03-31-2024
Name of foundation
Omron Foundation Inc
 
Number and street (or P.O. box number if mail is not delivered to street address)2895 GREENSPOINT PARKWAY No 100
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
HOFFMAN ESTATES, IL60169
A Employer identification number

36-3644055
B Telephone number (see instructions)

(847) 843-7900
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$2,266,161J 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) 478,156
2 Check right arrow.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 39,506 39,506  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 4,414
b Gross sales price for all assets on line 6a 4,414
7 Capital gain net income (from Part IV, line 2)... 4,414
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances 0
b Less: Cost of goods sold.... 0
c Gross profit or (loss) (attach schedule)..... 0  
11 Other income (attach schedule)....... Click to see attachment
List of Attached Documents:
// Content
3,201 0 0
12 Total. Add lines 1 through 11........ 525,277 43,920 0
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc.        
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
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...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment
List of Attached Documents:
// Content
2,000 0 0 0
19 Depreciation (attach schedule) and depletion... 0 0 0
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment
List of Attached Documents:
// Content
7,627 7,627 0 0
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 9,627 7,627 0 0
25 Contributions, gifts, grants paid....... 591,461 591,461
26 Total expenses and disbursements. Add lines 24 and 25 601,088 7,627 0 591,461
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -75,811
b Net investment income (if negative, enter -0-) 36,293
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
Assets 1 Cash—non-interest-bearing............. 563,831 393,887 393,887
2 Savings and temporary cash investments.........      
3 Accounts receivable right arrow  
Less: allowance for doubtful accounts right arrow   0 0 0
4 Pledges receivable right arrow  
Less: allowance for doubtful accounts right arrow   0 0 0
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)..... 0 0 0
7 Other notes and loans receivable (attach schedule) right arrow0
Less: allowance for doubtful accounts right arrow0 0 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 0 0
b Investments—corporate stock (attach schedule)....... 0 Click to see attachment
List of Attached Documents:
// Content
0 		0
c Investments—corporate bonds (attach schedule)....... 0   0
11 Investments—land, buildings, and equipment: basis right arrow0
Less: accumulated depreciation (attach schedule) right arrow0 0   0
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 1,621,178 Click to see attachment
List of Attached Documents:
// Content
1,715,311 		1,872,274
14 Land, buildings, and equipment: basis right arrow0
Less: accumulated depreciation (attach schedule) right arrow0 0   0
15 Other assets (describe right arrow) 0 0 0
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 2,185,009 2,109,198 2,266,161
Liabilities 17 Accounts payable and accrued expenses.......... 0  
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons 0 0
21 Mortgages and other notes payable (attach schedule)...... 0 0
22 Other liabilities (describe 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........ 2,185,009 2,109,198
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)..... 2,185,009 2,109,198
30 Total liabilities and net assets/fund balances (see instructions). 2,185,009 2,109,198
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
2,185,009
2
Enter amount from Part I, line 27a .....................
2
-75,811
3
Other increases not included in line 2 (itemize) right arrow
3
0
4
Add lines 1, 2, and 3 ..........................
4
2,109,198
5
Decreases not included in line 2 (itemize) right arrow
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
2,109,198
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.)
1 a SECURITIES P   2024-02-02
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 100,000   95,586 4,414
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a     0 4,414
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 4,414
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3 0
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) 1 504
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........................... 3 504
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- ..... 5 504
6 Credits/Payments:
a 2023 estimated tax payments and 2022 overpayment credited to 2023 6a 1,000
b Exempt foreign organizations—tax withheld at source...... 6b  
c Tax paid with application for extension of time to file (Form 8868)... 6c  
d Backup withholding erroneously withheld .......... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 1,000
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. Click to see attachment
List of Attached Documents:
// Content
8 5
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 10 491
11 Enter the amount of line 10 to be: Credited to 2024 estimated taxright arrow491 Refundedright arrow 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. 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 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:
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 arrow
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 addressright arrowHTTPS://WWW.OMRONFOUNDATION.OMRON.COM/
14
The books are in care ofright arrowJAMES P EBERHART Telephone no.right arrow (224) 520-7665

Located atright arrow2895 GREENSPOINT PARKWAY NO 100HOFFMAN ESTATESIL ZIP+4right arrow60169
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 2023, 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
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)
Yes
 
(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 ........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 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
 
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 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 .........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
 
 
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
Nigel Blakeway President/Director
2.000 		0 0 0
2895 Greenspoint Parkway
Hoffman Estates,IL60169
K Blake Tatcher Secretary/Director
1.000 		0 0 0
2895 Greenspoint Parkway
Hoffman Estates,IL60169
James P Eberhart Treasurer/V.P./Director
1.000 		0 0 0
2895 Greenspoint Parkway
Hoffman Estates,IL60169
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...................right arrow 0
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.............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  
2  
3  
4  
Part VIII-B
Summary of Program-Related Investments (see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
1 N/A  
2  
All other program-related investments. See instructions.
3  
Total. Add lines 1 through 3.........................right arrow0
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
1,833,080
b
Average of monthly cash balances.......................
1b
282,623
c
Fair market value of all other assets (see instructions)................
1c
0
d
Total (add lines 1a, b, and c).........................
1d
2,115,703
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation) .............
1e
0
2
Acquisition indebtedness applicable to line 1 assets..................
2
 
3
Subtract line 2 from line 1d.........................
3
2,115,703
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
31,736
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
2,083,967
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
104,198
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
104,198
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
504
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
 
c
Add lines 2a and 2b............................
2c
504
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
103,694
4
Recoveries of amounts treated as qualifying distributions................
4
3,201
5
Add lines 3 and 4............................
5
106,895
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
106,895
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
591,461
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
 
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)....................
3a
 
b
Cash distribution test (attach the required schedule) .................
3b
0
4
Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4. .......
4
591,461
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 7 106,895
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2022 only....... 0
b Total for prior years:20 , 20, 2019 0
3 Excess distributions carryover, if any, to 2022:
a From 2018...... 601,544
b From 2019...... 725,901
c From 2020...... 661,230
d From 2021...... 444,852
e From 2022...... 1,057,004
f Total of lines 3a through e ........ 3,490,531
4Qualifying distributions for 2023 from Part
XI, line 4: right arrow$ 591,461
a Applied to 2022, but not more than line 2a 0
b Applied to undistributed income of prior years
(Election required—see instructions)..... 		0
c Treated as distributions out of corpus (Election
required—see instructions)........ 		0
d Applied to 2023 distributable amount..... 106,895
e Remaining amount distributed out of corpus 484,566
5 Excess distributions carryover applied to 2023.   0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6Enter the net total of each column as
indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 3,975,097
b Prior years’ undistributed income. Subtract
line 4b from line 2b .......... 		0
c Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed...... 		 
d Subtract line 6c from line 6b. Taxable amount
—see instructions ........... 		0
e Undistributed income for 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) ....... 		0
8 Excess distributions carryover from 2018 not
applied on line 5 or line 7 (see instructions) ... 		601,544
9 Excess distributions carryover to 2024.
Subtract lines 7 and 8 from line 6a ...... 		3,373,553
10 Analysis of line 9:
a Excess from 2019.... 725,901
b Excess from 2020.... 661,230
c Excess from 2021.... 444,852
d Excess from 2022.... 1,057,004
e Excess from 2023.... 484,566
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 ...... 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) 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.)
1Information Regarding Foundation Managers:
aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here right arrow
aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
Kevin Butalek
2895 GREENSPOINT PARKWAY NO 100
HOFFMAN ESTATES,IL60169
(224) 520-7660
ofi@omron.com
bThe form in which applications should be submitted and information and materials they should include:
SEE APPLICATION GUIDELINES AT: https://www.omronfoundation.omron.com/guidelines.php SEE THE FORM AT: https://www.omronfoundation.omron.com/files/OFI%20Grant%20Application%20for%20Omron%20Foundation%20Inc%208-29-13.pdf
cAny submission deadlines:
APPLICATIONS ARE CONSIDERED THROUGHOUT THE YEAR.
dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
SEE FUNDING EXCLUSIONS ON "GUIDELINES" WEBPAGE: https://www.omronfoundation.omron.com/guidelines.php
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)
aPaid during the year

Academy for Science and Design

486 Amherst St
Nashua,NH030631282 		none PC CHARITABLE AND EDUCATION 5,000

Agape Service Project

710 9th Ave
Seattle,WA98104 		none PC CHARITABLE AND EDUCATION 1,000

Alameda County Community Food Bank

7900 Edgewater Dr
Oakland,CA94621 		none PC CHARITABLE AND EDUCATION 250

Alpha Omega Miracle Home Inc

2860 Collins Ave
St Augustine,FL32084 		none PC CHARITABLE AND EDUCATION 50

Alzheimer's Association

225 N Michigan Ave 17th Fl
Chicago,IL60601 		none PC CHARITABLE AND EDUCATION 288

Alzheimers Greater Los Angeles

4221 Wilshire Blvd Suite 400
Los Angeles,CA90010 		none PC CHARITABLE AND EDUCATION 3,000

American Cancer Society

PO Box 6704
Hagerstown,MD21741 		none PC CHARITABLE AND EDUCATION 211

American Heart Association

300 South Riverside Plaza Suite 100
Chicago,IL60606 		none PC CHARITABLE AND EDUCATION 14,768

American Red Cross

431 18th Street NW
Washington,DC20006 		none PC CHARITABLE AND EDUCATION 356

Americares

88 Hamilton Avenue
Stamford,CT06902 		none PC CHARITABLE AND EDUCATION 131

Angiosarcoma Awareness Inc

PO Box 4919
Portland,ME04101 		none PC CHARITABLE AND EDUCATION 250

ARCO A Community Resource

901 North 4th Street
Monroe,LA71201 		none PC CHARITABLE AND EDUCATION 2,000

Ashley Academy

2615 S Roan St
Johnson City,TN37601 		none PC CHARITABLE AND EDUCATION 500

Aspca

424 Est 92nd St
New York,NY10128 		none PC CHARITABLE AND EDUCATION 450

Avoca

235 Beech Dr
Glenview,IL60025 		none PC CHARITABLE AND EDUCATION 200

BACKBONES

PO Box 7334
Prospect Heights,IL60070 		none PC CHARITABLE AND EDUCATION 100

Bartlett High School

701 W Schick Rd
Bartlett,IL60103 		none PC CHARITABLE AND EDUCATION 1,750

Beaver Brook Association

117 Ridge Rd
Hollis,NH03049 		none PC CHARITABLE AND EDUCATION 1,113

Becky Furnish Foundation

1050 Division St
Geneva,IL60134 		none PC CHARITABLE AND EDUCATION 200

Beloit College

700 College Street
Beloit,WI53511 		none PC CHARITABLE AND EDUCATION 100

Black Cat Animal Rescue

100 Trey Lane
Berea,KY40403 		none PC CHARITABLE AND EDUCATION 300

Brothers Rise Up - Midwest Sports Academy

PO Box 631
Huntley,IL60142 		none PC CHARITABLE AND EDUCATION 700

Cals Angels

2422 W Main St Unit 3B
St Charles,IL60175 		none PC CHARITABLE AND EDUCATION 12,250

Cambridge Lakes Charter School

900 Wester Boulevard
Pingree Grove,IL60140 		none PC CHARITABLE AND EDUCATION 750

Canyon Heights Academy

775 Waldo Rd
Campbell,CA95008 		none PC CHARITABLE AND EDUCATION 53

Care Org

151 Ellis Street NE
Atlanta,GA30303 		none PC CHARITABLE AND EDUCATION 100

CARE USA

PO Box 1870
Merrifield,VA22116 		none PC CHARITABLE AND EDUCATION 273

Caregivers

1765 Goodyear Avenue Suite 205
Ventura,CA93003 		none PC CHARITABLE AND EDUCATION 2,000

CARES of Farmington Hills Inc

27835 Shiawassee Rd
Farmington Hills,MI48336 		none PC CHARITABLE AND EDUCATION 10,800

Center for Developmental Services

29 N Academy Street
Greenville,SC29601 		none PC CHARITABLE AND EDUCATION 2,950

Charleston Symphony Orchestra

480 East Bay Street Ste F
Charleston,SC29403 		none PC CHARITABLE AND EDUCATION 600

Charlotte Rescue Mission

PO Box 33000
Charlotte,NC28233 		none PC CHARITABLE AND EDUCATION 1,000

Childrens Cancer Research Fund

7301 Ohms Lane Suite 355
Minneapolis,MN55439 		none PC CHARITABLE AND EDUCATION 36

Childrens Hospital Los Angeles

4650 Sunset Blvd
Los Angeles,CA90027 		none PC CHARITABLE AND EDUCATION 4,000

Childrens Hunger Fund

13931 Balboa Blvd
Sylmar,CA91342 		none PC CHARITABLE AND EDUCATION 1,700

Christopher Reeve Foundation

Christopher and Dana Reeve Foundati
Short Hills,NJ07078 		none PC CHARITABLE AND EDUCATION 52

Clearbrook

1835 W Central Road
Arlington Heights,IL60005 		none PC CHARITABLE AND EDUCATION 4,500

Coastal Carolina Council BSA

9297 Medical Plaza Dr
North Charleston,SC29406 		none PC CHARITABLE AND EDUCATION 1,200

Concordia Language Villages

901 9th St S
Moorhead,MN56562 		none PC CHARITABLE AND EDUCATION 15,000

Cradles to Crayons

4141 W George Street
Chicago,IL60641 		none PC CHARITABLE AND EDUCATION 10,000

CRPS Warriors Foundation

29910 Murrieta Hot Springs Rd G143
Murrieta,CA92563 		none PC CHARITABLE AND EDUCATION 250

Currier Museum of Art

150 Ash Street
Manchester,NH03104 		none PC CHARITABLE AND EDUCATION 213

Dana-Farber Cancer Institute and the Jimmy Fund

10 Brookline Place West 6th Floor
Brookline,MA024457226 		none PC CHARITABLE AND EDUCATION 50

Doctors Without Borders

40 Rector St 16 Fl
New York,NY10006 		none PC CHARITABLE AND EDUCATION 450

Donors Choose Org

PO Box 7247
Philadelphia,PA191706656 		none PC CHARITABLE AND EDUCATION 50

Dress for Success Worldwide

32 East 31st Street
New York,NY10016 		none PC CHARITABLE AND EDUCATION 1,000

EduCare Foundation

16134 Wyandotte Street
Van Nuys,CA91406 		none PC CHARITABLE AND EDUCATION 5,000

Embrace Relief Foundation

18 PA SSAIC Ave Unit 1
Fairfield,NJ07004 		none PC CHARITABLE AND EDUCATION 250

Esteem Women's Center

27 Sevilla St
Saint Augustine,FL32084 		none PC CHARITABLE AND EDUCATION 250

Feed My Starving Children

401 93rd Avenue NW
Minneapolis,MN55433 		none PC CHARITABLE AND EDUCATION 9,110

FIRST

Sir Frederick Banting Secondary Sch
Boston,MA022845446 		none PC CHARITABLE AND EDUCATION 875

FIRST New Hampshire Souhegan High School

PO Box 940
Bloomington,CT06002 		none PC CHARITABLE AND EDUCATION 1,750

FIRST Washington

21238 68th Ave S
Kent,WA98032 		none PC CHARITABLE AND EDUCATION 5,000

Food for the Poor

6401 Lyons Road
Coconut Creek,FL33073 		none PC CHARITABLE AND EDUCATION 250

Food Foward

7412 Fulton Ave Ste 3
North Hollywood,CA91605 		none PC CHARITABLE AND EDUCATION 5,000

Food Lifeline

815 S 96th St
Seattle,WA98108 		none PC CHARITABLE AND EDUCATION 200

Friends & Family of South Loop School

1212 S Plymouth St
Chicago,IL60605 		none PC CHARITABLE AND EDUCATION 100

Gigi's Playhouse

2350 W Higgins Rd
Hoffman Estates,IL60169 		none PC CHARITABLE AND EDUCATION 19,403

Glenmary Sisters

PO Box 22264
Owensboro,KY42304 		none PC CHARITABLE AND EDUCATION 2,000

Grant Community Baseball and Softball

PO Box 103
Fox Lake,IL60020 		none PC CHARITABLE AND EDUCATION 200

Guadalupe Community Services Center

21600 Hart Street
Canoga Park,CA91303 		none PC CHARITABLE AND EDUCATION 1,500

Habitat for Humanity of Northe

56 South Grove Avenue
Elgin,IL60120 		none PC CHARITABLE AND EDUCATION 5,105

Hawaii Community Foundation

827 Fort Street Mall
Honolulu,HI96813 		none PC CHARITABLE AND EDUCATION 300

HealthCorps Inc

33 Irving Place 3rd Floor
New York,NY10003 		none PC CHARITABLE AND EDUCATION 30,000

Help Hope Live

100 Matsonford Road
Radnor,PA19087 		none PC CHARITABLE AND EDUCATION 110

Help Us Adopt

PO Box 787
New York,NY10150 		none PC CHARITABLE AND EDUCATION 100

Hilton Head Symphony Orchestra

PO Drawer 5757
Hilton Head Island,SC29938 		none PC CHARITABLE AND EDUCATION 200

Hines Fischer VA House

5000 S 5th Ave
Hines,IL60141 		none PC CHARITABLE AND EDUCATION 1,400

Hockomock YMCA

45 ForgeHill Road
Franklin,MA02038 		none PC CHARITABLE AND EDUCATION 1,000

Homeless Coalition of St Johns County

62 Chapin Street
Saint Augustine,FL32084 		none PC CHARITABLE AND EDUCATION 750

House of Ruth

PO Box 459
Claremont,CA91711 		none PC CHARITABLE AND EDUCATION 253

Human Development Foundation

2625 Butterfield Rd Ste 101
Oak Brook,IL60523 		none PC CHARITABLE AND EDUCATION 1,400

Hungry Heroes Hawaii Emergency Fire Response

262 Anuhea Pl
Makawai,HI96768 		none PC CHARITABLE AND EDUCATION 30

ICAN Positive Programs for Youth

650 E Morelos St
Chandler,AZ85225 		none PC CHARITABLE AND EDUCATION 5,000

IMSA Fund

1500 Sullivan Road
Aurora,IL60506 		none PC CHARITABLE AND EDUCATION 750

International Fellowhip of Christians and Jews

30 North LaSalle St Ste 4300
Chicago,IL606022584 		none PC CHARITABLE AND EDUCATION 200

Japan America Society of Chicago

1 N LaSalle St Ste 2475
Chicago,IL60602 		none PC CHARITABLE AND EDUCATION 958

Japan Chamber of Commerce and Industry Chicago

8600 W Bryn Mawr Ave Ste 700N
Chicago,IL60631 		none PC CHARITABLE AND EDUCATION 1,000

JCCC Foundation

8600 W Bryn Mawr Ave Ste 700N
Chicago,IL60631 		none PC CHARITABLE AND EDUCATION 5,000

Kenneth Young Center

1001 Rohlwing Road
Elk Grove Village,IL60007 		none PC CHARITABLE AND EDUCATION 1,030

Kent Schools Foundation

12033 SE 256th St
Kent,WA980306503 		none PC CHARITABLE AND EDUCATION 5,000

KUOW

4518 University Way NE Suite 310
Seattle,WA981054535 		none PC CHARITABLE AND EDUCATION 300

LA Family Housing

7843 Lankershim Blvd
North Hollywood,CA91605 		none PC CHARITABLE AND EDUCATION 2,000

Lambs Farm Inc

14245 W Rockland Road
Libertyville,IL60048 		none PC CHARITABLE AND EDUCATION 500

Lemons of Love

433 E Golf Rd
Des Plaines,IL60016 		none PC CHARITABLE AND EDUCATION 25

Leukemia and Lymphoma Society Inc

Office of Donor Services
Rye Brrok,NY10573 		none PC CHARITABLE AND EDUCATION 100

Love Without Boundaries

7901 4th St N Ste 8144
Saint Petersburg,FL33702 		none PC CHARITABLE AND EDUCATION 2,000

Mansfield Ind School District

609 E Broad Street
Mansfield,TX76063 		none PC CHARITABLE AND EDUCATION 5,000

March of Dimes Greater Charlot

4833 E Berewick Town Ctr Dr E177
Charlotte,NC28278 		none PC CHARITABLE AND EDUCATION 3,815

Marklund

1 South 450 Wyatt Drive
Geneva,IL60134 		none PC CHARITABLE AND EDUCATION 7,700

Marquette University

PO Box 1881
Milwaukee,WI53201 		none PC CHARITABLE AND EDUCATION 30

Maui Humane Society

PO Box 1047
Puuene,HI96784 		none PC CHARITABLE AND EDUCATION 100

McHenry County PADS

1805 South Illinois Rte 31
McHenry,IL60050 		none PC CHARITABLE AND EDUCATION 400

Meadow Glens Home and School

1150 Muirgead Avenue
Naperville,IL60565 		none PC CHARITABLE AND EDUCATION 500

MEND-Meet Each Need with Digni

10641 N San Francisco Road
Pacoima,CA91331 		none PC CHARITABLE AND EDUCATION 5,000

Momentous Institute

106 East 10th Street
Dallas,TX752032236 		none PC CHARITABLE AND EDUCATION 200

Monadnock Humane Society

101 W Swanzey Road
Swanzey,NH03446 		none PC CHARITABLE AND EDUCATION 103

NAF

218 West 40th Street 5th Floor
New York,NY10018 		none PC CHARITABLE AND EDUCATION 5,000

National Merit Scholarship Cor

1560 Sherman Ave Ste 200
Evanston,IL602014897 		none PC CHARITABLE AND EDUCATION 32,960

National MS Society

733 Third Ave 3rd Floor
New York,NY10017 		none PC CHARITABLE AND EDUCATION 75

NEDA Ed Foundation dba ECIA Foundation

310 Maxwell Rd Ste 200
Alpharetta,GA30009 		none PC CHARITABLE AND EDUCATION 10,000

New Hampshire Public Radio

PO Box 9645
Manchester,NH03108 		none PC CHARITABLE AND EDUCATION 330

North Central College

30 N Brainard St
Naperville,IL60540 		none PC CHARITABLE AND EDUCATION 5,000

Northern Illinois Food Bank

273 Dearborn Court
Geneva,IL60134 		none PC CHARITABLE AND EDUCATION 4,458

Northwest Harvest

PO Box 12272
Seattle,WA98102 		none PC CHARITABLE AND EDUCATION 5,000

Oakland Parks and Recreation Foundation

666 Bellevue Ave
Oakland,CA94610 		none PC CHARITABLE AND EDUCATION 500

Okemos Outreach

Okemos MI 48864
Okemos,MI48864 		none PC CHARITABLE AND EDUCATION 1,000

Oklahoma State University

400 S Monroe
Stillwater,OK74074 		none PC CHARITABLE AND EDUCATION 150

Olive Branch Mission

6310 S Claremont Ave
Chicago,IL60636 		none PC CHARITABLE AND EDUCATION 200

Open Heart Kitchen

1141 Catalina Dr Mailbox 137
Livermore,CA94550 		none PC CHARITABLE AND EDUCATION 5,000

Operation Gratitude

PO Box 260257
Encino,CA914260257 		none PC CHARITABLE AND EDUCATION 6,000

Operation Smile

3641 Faculty Blvd
Virginia Beach,VA23453 		none PC CHARITABLE AND EDUCATION 515

Opportunity Networks

11 Caldwell Drive
Amherst,NH03063 		none PC CHARITABLE AND EDUCATION 5,000

Paws Chicago

1997 North Clybourne Ave
Chicago,IL60614 		none PC CHARITABLE AND EDUCATION 26

Pleasanton Unified School District

4665 Bernal Ave
Pleasanton,CA94566 		none PC CHARITABLE AND EDUCATION 100

Portal School Community Organization

1188 Wunderlich Drive
San Jose,CA95129 		none PC CHARITABLE AND EDUCATION 425

Respiratory Health Assc of Met

1440 W Washington Blvd
Chicago,IL606071878 		none PC CHARITABLE AND EDUCATION 20,053

Restoring The Path DBA Crushers Club

1406 West 64th St
Chicago,IL60636 		none PC CHARITABLE AND EDUCATION 5,000

Robolabs

3203 Madden Way
Dublin,CA94568 		none PC CHARITABLE AND EDUCATION 5,000

Ruth Bancroft Garden and Nursery

1552 Bancroft Rd
Walnut Creek,CA94598 		none PC CHARITABLE AND EDUCATION 150

Safe Families for Children Nat

4300 W Irving Park Road
Chicago,IL60641 		none PC CHARITABLE AND EDUCATION 5,250

Saint Joseph School

43222 Mission Blvd
Fremont,CA94539 		none PC CHARITABLE AND EDUCATION 220

San Fernando Valley Rescue Mis

PO Box 8073
Van Nuys,CA914098073 		none PC CHARITABLE AND EDUCATION 5,000

Save the Children

Attn Gift Processing
Fairfield,CT06825 		none PC CHARITABLE AND EDUCATION 5,000

Schaumburg Oyanokai School

PO Box 68104
Schaumburg,IL60168 		none PC CHARITABLE AND EDUCATION 500

Shriners Hospital for Children

2900 N Rocky Point Drive
Tampa,FL33607 		none PC CHARITABLE AND EDUCATION 208

SME Education Foundation

1000 Town Center
Southfield,MI48075 		none PC CHARITABLE AND EDUCATION 42,500

Somebody Cares St Augustine

PO Box 840081
St Augustine Beach,FL32080 		none PC CHARITABLE AND EDUCATION 500

Spartanburg Community College Foundation

C/O John Jaraczewski
Spartanburg,SC29303 		none PC CHARITABLE AND EDUCATION 25,000

St Jude Childrens Reasearch Hospital

201 E Sandpointe Ave Ste 300
Santa Ana,CA92707 		none PC CHARITABLE AND EDUCATION 500

St Jude Childrens Research Hospital

32121 Woodward Ave Ste 350
Royal Oak,MI48073 		none PC CHARITABLE AND EDUCATION 300

St Jude Childrens Research Hospital

501 St Jude Place
Memphis,TN38105 		none PC CHARITABLE AND EDUCATION 355

St Jude Childrens Research Hospital

262 Danny Thomas Place
Memphis,TN38105 		none PC CHARITABLE AND EDUCATION 200

St Baldrick's Foundation

1333 South Mayflower Avenue Suite
Monrova,CA91016 		none PC CHARITABLE AND EDUCATION 50

Steel Magnolia Sanctuary

PO Box 15203
Albany,NY12212 		none PC CHARITABLE AND EDUCATION 1,000

Steele Magnolia Sanctuary

3441 Kinneys Road
Cedar Hill,TN37032 		none PC CHARITABLE AND EDUCATION 2,000

Susan G Komen Dallas

PO Box 660843
Dallas,TX75266 		none PC CHARITABLE AND EDUCATION 145

Techo

425 Lexington Avenue
New York,NY10017 		none PC CHARITABLE AND EDUCATION 7,160

The Harbour

1440 Renaissance Dr Ste 240
Park Ridge,IL60068 		none PC CHARITABLE AND EDUCATION 3,155

The Moving Company dba MoCo Arts

40 Roxbury St
Keene,NH03431 		none PC CHARITABLE AND EDUCATION 350

The Nashua Center

18 Simon Street
Nashua,NH03060 		none PC CHARITABLE AND EDUCATION 5,250

The Salvation Army

615 Slaters Lane PO Box 269
Alexandria,VA22314 		none PC CHARITABLE AND EDUCATION 104

The Wash Project

2201 W 50th St
Westwood Hills,KS66205 		none PC CHARITABLE AND EDUCATION 103

Thurston County Food Bank

220 Thurston Ave NE
Olympia,WA98501 		none PC CHARITABLE AND EDUCATION 106

Tunnel to Towers Foundation

2361 Hylan Blvd
Staten Island,NY10306 		none PC CHARITABLE AND EDUCATION 2,500

Unicef USA

125 Maiden Lane
New York,NY10038 		none PC CHARITABLE AND EDUCATION 2,298

United Way of Greater Atlanta

40 Courtland St NE
Atlanta,GA30303 		none PC CHARITABLE AND EDUCATION 311

Unity Academy

485 S Bartlett Rd
Streamwood,IL60107 		none PC CHARITABLE AND EDUCATION 578

University of Michigan

3003 South State Street Suite 9000
Ann Arbor,MI481091288 		none PC CHARITABLE AND EDUCATION 100

University of Puget Sound

1500 N Warner St
Tacoma,WA98416 		none PC CHARITABLE AND EDUCATION 104

University of Texas Arlington

701 S Nedderman Dr
Arlington,TX76019 		none PC CHARITABLE AND EDUCATION 45,000

UNRWA USA National Committee

1725 ST NW Ste 510
Washington,DC20006 		none PC CHARITABLE AND EDUCATION 900

Valley Cities Behavioral Health

325 West Gowe Street
Kent,WA98032 		none PC CHARITABLE AND EDUCATION 2,226

Vision House

PO Box 2951
Renton,WA98056 		none PC CHARITABLE AND EDUCATION 220

Walnut Grove Elementary PTA

1999 Harvest Rd
Pleasanton,CA94566 		none PC CHARITABLE AND EDUCATION 200

Warm Up America

3740 N Josey Lane Suite 126
Carrollton,TX75007 		none PC CHARITABLE AND EDUCATION 100

Washington Trails Association

705 Second Ave Suite 300
Seattle,WA98104 		none PC CHARITABLE AND EDUCATION 105

WBUR 909 FM Boston University

890 Commonwealth Ave 3rd Floor
Boston,MA02215 		none PC CHARITABLE AND EDUCATION 50

WestSide Baby

10002 14th Ave SW
Seattle,WA98146 		none PC CHARITABLE AND EDUCATION 5,104

Wikimedia Foundation Inc

PO Box 98204
Washington,DC20090 		none PC CHARITABLE AND EDUCATION 130

Wine to Water

PO Box 2567
Boone,NC28607 		none PC CHARITABLE AND EDUCATION 50,000

World Child Cancer

1301 Arapahoe St Ste 105
Golden,CO80401 		none PC CHARITABLE AND EDUCATION 24,150

World Food Program USA

PO Box 96316
Washington,DC20090 		none PC CHARITABLE AND EDUCATION 250
Total .................................right arrow 3a 591,465
bApproved for future payment
Total ................................. right arrow 3b 0
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.)
1Program service revenue: (a)
Business code 		(b)
Amount 		(c)
Exclusion code 		(d)
Amount
a
b
c
d
e
f
gFees and contracts from government agencies          
2 Membership dues and assessments ....          
3 Interest on savings and temporary cash
investments ........... 		         
4 Dividends and interest from securities ....     14 39,506  
5 Net rental income or (loss) from real estate:
aDebt-financed property......          
bNot debt-financed property.....          
6 Net rental income or (loss) from personal property          
7 Other investment income .....          
8 Gain or (loss) from sales of assets other than
inventory ............ 		    18 4,414  
9 Net income or (loss) from special events:          
10 Gross profit or (loss) from sales of inventory          
11 Other revenue:
agrant recoveries 		    1 3,201  
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e) .. 0 47,121 0
13Total. Add line 12, columns (b), (d), and (e)..................
13
47,121
(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 (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? ...........
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.
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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 (2023)
Additional Data


Software ID: 23017437
Software Version: 2023v5.1


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

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Name of the organization
Omron Foundation Inc
 
Employer identification number

36-3644055
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990) (2023)
Schedule B (Form 990) (2023) Page 2
Name of organization
Omron Foundation Inc
  		Employer identification number
36-3644055
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
1
OMRON ELECTRONICS LLC
 
2895 GREENSPOINT PARKWAY
 
Hoffman Estates, IL60169

$ 100,599


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
2
Omron Electronics LLC
 
2895 Greenspoint Parkway
 
Hoffman Estates, IL60169

$ 247,487


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
3
Omron Healthcare Inc
 
1925 W Field Ct
 
Lake Forest, IL60045

$ 106,364


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
4
Omron Canada Inc
 
802 100 Consilium Place
 
Scarborough, OntarioM1H3E3CA

$ 23,659


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

$  


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

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)
Schedule B (Form 990) (2023)
Page 3
Name of organization
Omron Foundation Inc
  		Employer identification number

36-3644055
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
Schedule B (Form 990) (2023)
Schedule B (Form 990) (2023)
Page 4
Name of organization
Omron Foundation Inc
  		Employer identification number

36-3644055
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990) (2023)
Additional Data


Software ID: 23017437
Software Version: 2023v5.1

TY 2023 InvestmentsOtherSchedule2
Name:
Omron Foundation Inc
EIN:
36-3644055
Software ID:
23017437
Software Version:
2023v5.1
Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
FIDELITY ASSET MANAGER AT COST 1,715,311 1,872,274

TY 2023 OtherExpensesSchedule
Name:
Omron Foundation Inc
EIN:
36-3644055
Software ID:
23017437
Software Version:
2023v5.1
Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
BANK FEES 7,627 7,627    


TY 2023 OtherIncomeSchedule2
Name:
Omron Foundation Inc
EIN:
36-3644055
Software ID:
23017437
Software Version:
2023v5.1
Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
grant recoveries 3,201    


TY 2023 TaxesSchedule
Name:
Omron Foundation Inc
EIN:
36-3644055
Software ID:
23017437
Software Version:
2023v5.1
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
OTHER TAXES 2,000