Form990-PF


Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
For calendar year 2021, or tax year beginning 01-01-2021 , and ending 12-31-2021
Name of foundation
THE PLYMOUTH ROCK ASSURANCE FOUNDATION
 
% Paula Gold
Number and street (or P.O. box number if mail is not delivered to street address)695 ATLANTIC AVENUE
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
BOSTON, MA021112623
A Employer identification number

04-6739902
B Telephone number (see instructions)

C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$563,394J 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) 1,324,618
2 Check bullet.............
3 Interest on savings and temporary cash investments     0
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 Click to see attachment 1,324,618
b Gross sales price for all assets on line 6a 1,324,618
7 Capital gain net income (from Part IV, line 2)... 1,324,618
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........ 2,649,236 1,324,618 0
Operating and Administrative Expenses 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)... Click to see attachment 35 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)....... Click to see list of attachments 883 0 0 0
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 918 0 0 0
25 Contributions, gifts, grants paid....... 1,612,889 1,612,889
26 Total expenses and disbursements. Add lines 24 and 25 1,613,807 0 0 1,612,889
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 1,035,429
b Net investment income (if negative, enter -0-) 1,324,618
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2021)
Form 990-PF (2021)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............. 852,582 563,394 563,394
2 Savings and temporary cash investments.........      
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
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) bullet  
Less: allowance for doubtful accounts bullet   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 bullet  
Less: accumulated depreciation (attach schedule) bullet     0  
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........   0  
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet     0  
15 Other assets (describe bullet) 0 0 0
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 852,582 563,394 563,394
Liabilities 17 Accounts payable and accrued expenses.......... 0 0
18 Grants payable................. 0 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 bullet) Click to see attachment0 Click to see attachment0
23 Total liabilities (add lines 17 through 22)......... 0 0
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions........... 852,582 563,394
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 852,582 563,394
30 Total liabilities and net assets/fund balances (see instructions). 852,582 563,394
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
852,582
2
Enter amount from Part I, line 27a .....................
2
1,035,429
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
1
4
Add lines 1, 2, and 3 ..........................
4
1,888,012
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
1,324,618
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
563,394
Form 990-PF (2021)
Form 990-PF (2021)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)		 (b)
How acquired
P—Purchase
D—Donation 		(c)
Date acquired
(mo., day, yr.) 		(d)
Date sold
(mo., day, yr.)
1 a Public Traded Securities      
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 1,324,618 0 0 1,324,618
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       1,324,618
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 1,324,618
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Form 990-PF (2021)
Form 990-PF (2021)
Page 4
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2  
3 Add lines 1 and 2........................... 3 18,412
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 18,412
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 23,916
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 23,916
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.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 5,504
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet5,504 RefundedBullet 11 0
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XIV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletMA
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
    If "Yes," complete Part XIII .............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 5
    Part VI-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
    Yes
     
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletNone
    14
    The books are in care ofbulletPaula Gold Telephone no.bullet (617) 720-1620

    Located atbullet695 ATLANTIC AVENUEBOSTONMA ZIP+4bullet021112623
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country? .................
    16   No
    See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........
    1a(1)
     
    No
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person? ..............................
    1a(2)
     
    No
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
    1a(3)
     
    No
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
     
    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
    ........bullet
    d
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2021? .............
    1d
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2021.) .....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    No
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals? .............
    5a(5)
     
    No
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........
    5b
     
     
    c
    .........bullet
    d
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant? .................
    5d
     
     
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract? .............................
    6a
     
    No
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    7a
     
    No
    b
    If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .........................
    8
     
    No
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    Sonja PlessetClick to see attachment Trustee and Executive Director
    1.00     		0 0 0
    695 Atlantic Avenue
    Boston,MA02111
    Paula GoldClick to see attachment Trustee
    1.00     		0 0 0
    695 Atlantic Avenue
    Boston,MA02111
    Lee EnglertClick to see attachment Trustee
    1.00     		0 0 0
    695 Atlantic Avenue
    Boston,MA02111
    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...................bullet  
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 7
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
     
    Total number of others receiving over $50,000 for professional services.............bullet  
    Part VIII-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 None 0
    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 NONE 0
    2  
    All other program-related investments. See instructions.
    3 Click to see attachment 0
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    0
    b
    Average of monthly cash balances.......................
    1b
    1,342,798
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    1,342,798
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) Click to see attachment.............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    1,342,798
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    20,142
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    1,322,656
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    66,133
    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
    66,133
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    18,412
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
    0
    c
    Add lines 2a and 2b............................
    2c
    18,412
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    47,721
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    47,721
    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
    47,721
    Part XI
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
     
    b
    Program-related investments—total from Part VIII-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4.
    4
     
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 9
    Part XII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2020     		(c)
    2020     		(d)
    2021
    1 Distributable amount for 2021 from Part X, line 7 47,721
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2021:
    a From 2016......  
    b From 2017......  
    c From 2018......  
    d From 2019......  
    e From 2020......  
    f Total of lines 3a through e ........ 0
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 1,612,889
    a Applied to 2020, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		 
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		 
    d Applied to 2021 distributable amount..... 47,721
    e Remaining amount distributed out of corpus 1,565,168
    5 Excess distributions carryover applied to 2021.    
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 1,565,168
    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 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2021. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2022 ..........     		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 2016 not
    applied on line 5 or line 7 (see instructions) ...     		 
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		1,565,168
    10 Analysis of line 9:
    a Excess from 2017....  
    b Excess from 2018....  
    c Excess from 2019....  
    d Excess from 2020....  
    e Excess from 2021.... 1,565,168
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2021, enter the date of the ruling ....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part IX, line 6 for each year listed ..     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XIV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    NONE
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    NONE
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    180 Turning Lives Around
    1 Bethany Road
    Building 3 Suite 42
    Hazlet,NJ07730     		None PC Employee Matching 3,000
    A Better City
    33 Broad Street
    3rd Floor
    Boston,MA02109     		None PC Employee Matching 5,000
    A SHOT FOR LIFE INCORPORATED
    80 Poplar St
    Watertown,MA02472     		None PC Employee Matching 600
    ACLU FOUNDATION
    211 Congress St
    Boston,MA02110     		None PC Employee Matching 1,000
    ACLU FOUNDATION OF TEXAS INC
    PO Box 8306
    Houston,TX77288     		None PC Employee Matching 200
    AFRICAN WILDLIFE FOUNDATION
    1100 New Jersey Ave SE
    Suite 900
    Washington,DC20003     		None PC Employee Matching 100
    AHED INTERNATIONAL INC
    2300 Valley View Lane
    370
    IRVING,TX75062     		None PC Employee Matching 100
    AIDS Foundation Chicago
    200 W Monroe St
    Suite 1150
    Chicago,IL60606     		None PC Employee Matching 400
    Alexs Lemonade Stand Foundation
    333 E Lancaster Ave
    Suite 414
    Wynnewood,PA19096     		None PC Employee Matching 300
    ALZHEIMERS NEW JERSEY INC
    425 Eagle Rock Ave
    Suite 203
    Roseland,NJ07068     		None PC Employee Matching 400
    AMERICAN BRAIN TUMOR ASSOCIATION
    8550 W Bryn Mawr Ave
    Chicago,IL60631     		None PC Employee Matching 200
    American Cancer Society
    250 Williams Street NW
    Atlanta,GA30303     		None PC Employee Matching 1,242
    American Foundation for Suicide Prevention
    120 Wall Street
    29th Floor
    New York,NY10005     		None PC Employee Matching 300
    American Heart Association
    7272 Greenville Ave
    Dallas,TX752314596     		None PC Employee Matching 1,284
    AMERICAN INSTITUTE FOR CANCER RESEARCH
    PO Box 97167
    Washington,DC20090     		None PC Employee Matching 40
    AMERICAN LUNG ASSOCIATION
    55 W Wacker Dr
    Suite 1150
    Chicago,IL60601     		None PC Employee Matching 100
    AMHERST COLLEGE TRUSTEES
    220 South Pleasant
    AMHERST,MA10025     		None PC Employee Matching 1,500
    ANDREW MCDONOUGH B POSITIVE FOUNDATION
    101 Rockland Cir
    Wilmington,DE19803     		None PC Employee Matching 50
    ARTISTS FOR HUMANITY INC
    100 W 2nd St
    Boston,MA02127     		None PC Employee Matching 15,000
    ASSOCIATED HUMANE SOCIETIES INC
    124 Evergreen Ave
    Newark,NJ071142133     		None PC Employee Matching 80
    ATHLETES UNLIMITED NEWTON MA INC
    PO Box 66163
    Auburndale,MA02466     		None PC Employee Matching 100
    AURICLE COMMUNICATIONS
    43 Montgomery St
    Jersey City,NJ073032011     		None PC Employee Matching 976
    Ayiti Demen
    28 Bethune Street
    New York,NY10019     		None PC Employee Matching 50
    BARKANN FAMILY HEALING HEARTS FOUNDATION
    PO Box 118
    Newtown Square,PA19073     		None PC Employee Matching 200
    BARNARD COLLEGE
    3009 Broadway
    New York,NY10027     		None PC Employee Matching 1,500
    Beagle Freedom Project
    4804 Laurel Canyon Blvd
    534
    Valley Village,CA91607     		None PC Employee Matching 50
    BERKSHIRE HUMANE SOCIETY INC
    214 Barker Rd
    Pittsfield,MA01201     		None PC Employee Matching 52
    Best Buddies - Palm Beach
    100 SE 2ND ST STE 2200
    Suite 2200
    MIAMI,FL331312151     		None PC Employee Matching 100
    Beth Isreal Deaconess Medical Center
    330 Brookline Ave
    Boston,MA02215     		None PC Employee Matching 1,500
    BIG BROTHERS BIG SISTERS
    2502 N Rocky Point Drive
    Suite 550
    Tampa,FL33607     		None PC Employee Matching 30,000
    Blackbaud Giving Fund
    65 Fairchild Street
    Charleston,SC29492     		None PC Employee Matching 67,455
    Blackbaud Giving Fund
    66 Fairchild Street
    Charleston,SC29493     		None PC Support for programmimg in the areas of education youth services health care human services environment and arts and culture 540,500
    BOSTON AFTER SCHOOL BEYOND INC
    89 South St 601
    Boston,MA02111     		None PC Employee Matching 50,000
    Boston College Law School
    885 Centre St
    Newton Centre,MA02459     		None PC Employee Matching 1,500
    BOSTON COLLEGE TRUSTEES
    140 Commonwealth Ave
    Cadigan Alumni Center
    Chestnut Hill,MA02467     		None PC Employee Matching 50
    BOSTON COMMUNITY PEDIATRICS
    527 Albany St 200
    Boston,MA02118     		None PC Employee Matching 25,000
    BOSTON GLOBE FOUNDATION INC
    1 Exchange Place
    Suite 201
    Boston,MA02109     		None PC Employee Matching 200
    BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM INC
    780 Albany St
    Boston,MA02118     		None PC Employee Matching 2,500
    BOSTON LANDMARKS ORCHESTRA INC
    PO Box 441160
    Somerville,MA02144     		None PC Employee Matching 5,000
    BOSTON MEDICAL CENTER
    801 Massachusetts Avenue
    First Floor
    Boston,MA021182393     		None PC Employee Matching 1,550
    Boston Rescue Mission
    P O Box 120069
    Boston,MA021120069     		None PC Employee Matching 103
    Boston Schools Fund
    7 Caldwell Ave
    Somerville,MA02143     		None PC Employee Matching 60,000
    BOSTON UNIVERSITY
    595 Commonwealth Ave
    Ste 700
    Boston,MA02215     		None PC Employee Matching 200
    BOYS & GIRLS CLUBS OF MERCER COUNTY INC
    212 Centre Street
    Trenton,NJ08611     		None PC Employee Matching 50
    BREAKTIME CAFE INC
    170 Portland Street
    Boston,MA02114     		None PC Employee Matching 10,000
    BRIDGE BOSTON CHARTER SCHOOL
    435 Warren St
    Boston,MA02119     		None PC Employee Matching 40,000
    BRIDGE OVER TROUBLED WATERS
    47 West St
    Boston,MA02111     		None PC Employee Matching 20,000
    BRIDGE STEPS
    1818 Corsicana St
    Dallas,TX75201     		None PC Employee Matching 22
    BROTHER LETS TALK LLC
    137 6th Ave
    Birmingham,AL35209     		None PC Employee Matching 100
    BROTHERHOOD RIDE INC
    PO Box 110862
    Naples,FL34108     		None PC Employee Matching 100
    Brown University
    Box 1893
    Providence,RI02912     		None PC Employee Matching 700
    Bunker Hill Community College Foundation
    250 New Rutherford Ave
    Suite H150
    Boston,MA021292925     		None PC Employee Matching 5,000
    BURLINGTON COUNTY LIBRARY SYSTEM FOUNDATION
    5 Pioneer Blvd
    Westampton,NJ08060     		None PC Employee Matching 702
    CAMP KESEM NATIONAL
    10586 W Pico Blvd
    Los Angeles,CA90064     		None PC Employee Matching 800
    Cancer Research Institute
    29 Broadway
    Floor 4
    New York,NY100063111     		None PC Employee Matching 150
    CAPE MAY COUNTY ZOOLOGICAL SOCIETY INC
    707 North Route 9
    P O Box 864
    Cape May Court House,NJ08210     		None PC Employee Matching 50
    CASA ESPERANZA INC
    302 Eustis St
    Boston,MA02119     		None PC Employee Matching 20,000
    CENTRAL TEXAS FOOD BANK INC
    6500 Metropolis Dr
    Austin,TX78744     		None PC Employee Matching 22
    CHAI LIFELINE
    151 W 30th St
    New York,NY10001     		None PC Employee Matching 2,000
    Childrens Hospital of Philadelphia
    3401 CIVIC CENTER BLVD
    PHILADELPHIA,PA191044319     		None PC Employee Matching 144
    CHILDRENS ROOM - CENTER FOR GREIVING CHILDREN & TEENAGERS INC
    1210 Massachusetts Avenue
    Arlington,MA02476     		None PC Employee Matching 300
    Chinese Progressive Association
    28 Ash St
    Boston,MA02111     		None PC Employee Matching 2,500
    Colby College
    4000 Mayflower Hill
    Waterville,ME04901     		None PC Employee Matching 1,500
    COLLIER YOUTH SERVICES
    160 Conover Road
    Wickatunk,NJ07765     		None PC Employee Matching 20,000
    Community Food Bank of New Jersey
    31 Evans Terminal
    Hillside,NJ07205     		None PC Employee Matching 400
    Compassionate Care ALS
    P O Box 1052
    West Falmouth,MA02574     		None PC Employee Matching 50
    Connecticut Food Bank
    2 Research Parkway
    Wallingford,CT06492     		None PC Employee Matching 40
    CONSCIOUS KID
    9226 Regents Rd
    Apt L
    La Jolla,CA920371434     		None PC Employee Matching 200
    Conservation Law Foundation
    62 Summer St
    Boston,MA02110     		None PC Employee Matching 1,200
    CORAZON MINISTRIES INC
    230 E Travis St
    San Antonio,TX782051702     		None PC Employee Matching 22
    CORNERSTONE CREATIVE INC
    146 MAIN ST APT 2
    GLOUCESTER,MA019305761     		None PC Employee Matching 200
    CRADLES TO CRAYONS
    281 Newtonville Ave
    Newton,MA02460     		None PC Employee Matching 1,000
    CRISTO REY BOSTON HIGH SCHOOL
    00 Savin Hill Ave
    Dorchester,MA02125     		None PC Employee Matching 1,500
    Crohns and Colitis Foundation
    733 3rd Ave
    New York,NY10017     		None PC Employee Matching 200
    CRYSTAL LAKE CONSERVANCY
    P O Box 610038
    Newton Highlands,MA02461     		None PC Employee Matching 200
    CYSTIC FIBROSIS FOUNDATION
    4550 Montgomery Avenue
    Suite 1100N
    Bethesda,MD20814     		None PC Employee Matching 300
    DANA-FARBER CANCER INSTITUTE
    450 Brookline Ave
    Brookline,MA02445     		None PC Employee Matching 1,530
    DOC WAYNE YOUTH SERVICES INC
    418 Commonwealth Ave
    Boston,MA02215     		None PC Employee Matching 20,000
    EAGLES AUTISM CHALLENGE INC
    1 NOVACARE WAY
    PHILADELPHIA,PA191455900     		None PC Employee Matching 200
    East Catholic High School
    115 New State Road
    Manchester,CT06042     		None PC Employee Matching 440
    East Waterford Fire Department
    9607 Route 75 South
    East Waterford,PA17021     		None PC Employee Matching 100
    ECLC FOUNDATION A NEW JERSEY NON PROFIT CORPORATION
    21 Lum Ave
    Chatham Township,NJ07928     		None PC Employee Matching 250
    ECLC OF NJ A NEW JERSEY NON PROFIT CORPORATION
    100 Passaic Ave Ste 1
    Chatham,NJ079282848     		None PC Employee Matching 500
    EDWARD CHARLES FOUNDATION
    269 S Beverly Dr
    Beverly Hills,CA90212     		None PC Employee Matching 103
    ELIOT SCHOOL TRUSTEES
    24 Eliot Street
    Jamaica Plain,MA02130     		None PC Employee Matching 200
    Elizabeth Avenue Fire Company
    2 Wiley Dr
    Somerset,NJ08873     		None PC Employee Matching 50
    Employment Horizons
    10 Ridgedale Avenue
    Cedar Knolls,NJ07927     		None PC Employee Matching 969
    ENDING COMMUNITY HOMELESSNESS COALITION INC
    PO Box 150249
    Austin,TX78752     		None PC Employee Matching 22
    English For New Bostonians
    105 Chauncy St
    4th Floor
    Boston,MA02111     		None PC Employee Matching 10,000
    EPIPHANY SCHOOL
    154 Centre Street
    Dorchester,MA02124     		None PC Employee Matching 10,000
    FAIRFIELD UNIVERSITY
    1073 N Benson Rd
    Fairfield,CT06824     		None PC Employee Matching 100
    FAMILY ELDERCARE INC
    1700 Rutherford Lane
    Austin,TX78754     		None PC Employee Matching 22
    FAMILY PROMISE NORTH SHORE BOSTON INC
    8 Rantoul
    Beverly,MA01915     		None PC Employee Matching 200
    FATHERS UPLIFT INC
    12 Southern Ave
    Dorchester,MA02124     		None PC Employee Matching 20,000
    FEEDING TEXAS
    1524 S Frontage Rd
    Austin,TX78704     		None PC Employee Matching 22
    Fenn School
    516 Monument St
    Concord,MA01742     		None PC Employee Matching 450
    FISH HOSPITALITY PROGRAM INC
    PO Box 170
    Dunellen,NJ088120170     		None PC Employee Matching 400
    Fisherman's Mark
    37 S Main St
    Lambertville,NJ08530     		None PC Employee Matching 100
    FOODBANK OF MONMOUTH AND OCEAN COUNTIES INC
    3300 State Route 66
    Neptune City,NJ07753     		None PC Employee Matching 100
    FOWA RESCUE INC
    PO 3701
    Wayne,NJ07470     		None PC Employee Matching 50
    FRANCIS OUIMET SCHOLARSHIP FUND
    300 Arnold Palmer Boulevard
    Norton,MA02766     		None PC Employee Matching 200
    FRANCISCAN CHARITIES INC
    355 S 6TH ST
    NEWARK,NJ071032301     		None PC Employee Matching 100
    Franklin Food Bank
    P O Box 333
    Somerset,NJ08875     		None PC Employee Matching 200
    Freshman Fresh Start
    P O Box 81126
    Wellesley Hills,MA024810001     		None PC Employee Matching 200
    GEORGETOWN UNIVERSITY
    3700 O St NW
    Washington,DC20007     		None PC Employee Matching 200
    GERMANTOWN FRIENDS SCHOOL
    31 West Coulter Street
    Philadelphia,PA19144     		None PC Employee Matching 200
    GIVE FOUNDATION INC
    396 Washington St
    Wellesley,MA02481     		None PC Employee Matching 292
    Golf Fights Cancer
    300 Arnold Palmer Boulevard
    Norton,MA02766     		None PC Employee Matching 300
    GORDON COLLEGE
    255 Grapevine Rd
    Wenham,MA01984     		None PC Employee Matching 300
    GREATER BOSTON LEGAL SERVICES
    197 Friend Street
    Boston,MA02114     		None PC Employee Matching 400
    Greater Boston Legal Services
    197 Friend Street
    Boston,MA02114     		None PC Employee Matching 10,000
    Greater Boston Stage Company
    395 Main Street
    Stoneham,MA02180     		None PC Employee Matching 1,500
    GREATER PLYMOUTH PERFORMING ARTS CENTER INC
    110 Fairview Lane
    PLYMOUTH,MA023608208     		None PC Employee Matching 90
    HABITAT FOR HUMANITY INTERNATIONAL INC
    P O Box 3111
    Manassas,VA20108     		None PC Employee Matching 44
    HALE RESERVATION INC
    80 Carby St
    Westwood,MA02090     		None PC Employee Matching 200
    Health Law Advocates
    One Federal Street
    5th Floor
    Boston,MA02110     		None PC Employee Matching 1,500
    Heart and Hooves Rescue and Sanctuary Inc
    330 Auburn St
    Cherry Valley,MA01611     		None PC Employee Matching 60
    HEATH BROOK-TRAHAN ELEMENTARY SCHOOLS PARENT ADVISORY COUNCIL
    1 Shawsheen St
    TEWKSBURY,MA018763200     		None PC Employee Matching 60
    Hebrew SeniorLife
    1200 Centre Street
    Boston,MA02131     		None PC Employee Matching 1,500
    HINGHAM HIGH SCHOOL ROWING ASSOCIATION
    187 Main Street
    HINGHAM,MA020430453     		None PC Employee Matching 520
    HOPE FOR NEW YORK
    57 W 57th St 4th Floor
    New York,NY10019     		None PC Employee Matching 1,050
    HOUSTON FOOD BANK
    535 Portwall Street
    Houston,TX77029     		None PC Employee Matching 23
    HUMANE SOCIETY FOR GREATER NASHUA CORPORATION
    24 Ferry Rd
    Nashua,NH03064     		None PC Employee Matching 40
    HUNTER COLLEGE FOUNDATION INC
    695 Park Ave
    New York,NY100655024     		None PC Employee Matching 1,000
    INDIA SOCIETY OF WORCESTER MASS
    152 Main St
    SHREWSBURY,MA015450136     		None PC Employee Matching 400
    Inspire Arts and Music
    47 Fairmount Ave
    Boston,MA02136     		None PC Employee Matching 5,000
    Institute For Nonprofit Practice
    89 South Street
    Suite LL02
    Boston,MA02111     		None PC Employee Matching 1,500
    INSURANCE LIBRARY ASSOCIATION OF BOSTON
    156 Slate St 2
    Boston,MA02109     		None PC Employee Matching 300
    INTERFAITH NEIGHBORS INC
    810 4th Ave
    Asbury Park,NJ07712     		None PC Employee Matching 18,000
    INTERNATIONAL F O P ASSOCIATION INC
    1520 Clay Street
    Suite H2
    North Kansas City,MO64116     		None PC Employee Matching 2,200
    INTERNATIONAL INSTITUTE OF NEW ENGLAND
    2 Boylston St
    Boston,MA02116     		None PC Employee Matching 20,000
    JARED ALLENS HOMES FOR WOUNDED WARRIORS
    7890 E McClain Dr
    2
    Scottsdale,AZ85260     		None PC Employee Matching 400
    JDRF
    200 Vesey St
    28th Floor
    New York,NY10281     		None PC Employee Matching 1,580
    JESPY HOUSE
    102 Prospect St
    South Orange,NJ07079     		None PC Employee Matching 1,030
    Joseph Middlemiss Big Heart Foundation
    PO Box 428
    Dracut,MA01826     		None PC Employee Matching 700
    Kelly Brush Foundation
    3 Main St
    Suite 105
    Burlington,VT05401     		None PC Employee Matching 70
    LACEY TOWNSHIP HIGH SCHOOL BOOSTER ASSOCIATION INC
    PO Box 20
    Forked River,NJ08731     		None PC Employee Matching 200
    LACK-TUSCARORA EMS
    9320 PA 75
    East Waterford,PA17021     		None PC Employee Matching 200
    Leukemia Lymphoma Society
    3 International Drive
    Suite 200
    Rye Brook,NY10573     		None PC Employee Matching 400
    LINCROFT FIRE COMPANY
    601 Newman Springs Rd
    Lincroft,NJ07738     		None PC Employee Matching 100
    LIVING WITH RSDS INC
    421 Courtyard Dr
    HILLSBOROUGH,NJ088444254     		None PC Employee Matching 600
    LUNA FOUNDATION ARUBA INC
    19 Standish St
    North Weymouth,MA02191     		None PC Employee Matching 100
    LUNCH BREAK
    121 Drs James Parker Boulevard
    Red Bank,NJ07701     		None PC Employee Matching 4,000
    MAHAIWE PERFORMING ARTS CENTER
    14 Castle Street
    Great Barrington,MA01230     		None PC Employee Matching 1,500
    MARBLEHEAD BOOSTERS CLUB INCORPORATED
    PO Box 244
    MARBLEHEAD,MA19450     		None PC Employee Matching 100
    MARKET STREET MISSION INC
    9 Market St
    Morristown,NJ07960     		None PC Employee Matching 200
    MARYS PLACE BY THE SEA INC
    PO Box 86
    Ocean Grove,NJ07756     		None PC Employee Matching 400
    MASS GENERAL BRIGHAM INCORPORATED
    800 Boylston St
    11th Floor
    Boston,MA02114     		None PC Employee Matching 100
    MASS GENERAL HOSPITAL ASPIRE
    1 Maguire Rd
    Lexington,MA02421     		None PC Employee Matching 1,500
    MEDECINS SANS FRONTIERS USA INC
    PO Box 5030
    Hagerstown,MD21741     		None PC Employee Matching 200
    MEMORIAL SLOAN-KETTERING CANCER CENTER
    1275 York Ave
    New York,NY10065     		None PC Employee Matching 100
    MICHAEL J FOX FOUNDATION FOR PARKINSONS RESEARCH
    PO BOX 4777
    Grand Central Station
    NEW YORK,NY101634777     		None PC Employee Matching 132
    MILTON ACADEMY
    170 Centre St
    Milton,MA02186     		None PC Employee Matching 1,500
    MISSION OF OUR LADY OF MERCY
    1140 West Jackson Blvd
    Chicago,IL60607     		None PC Employee Matching 200
    Museum of African American History
    31 Milk Street
    Suite 705
    Boston,MA02109     		None PC Employee Matching 5,000
    MY BROTHERS TABLE INC
    98 Willow St
    Lynn,MA01901     		None PC Employee Matching 200
    NATIONAL BRAIN TUMOR SOCIETY INC
    55 Chapel Street
    Newton,MA02458     		None PC Employee Matching 400
    NATIONAL MULTIPLE SCLEROSIS SOCIETY
    733 Third Avenue
    3rd Floor
    New York,NY10017     		None PC Employee Matching 700
    NATIONAL OVARIAN CANCER COALITION INC
    3800 Maple Avenue
    Suite 435
    Dallas,TX75219     		None PC Employee Matching 2,215
    NATURAL AREAS CONSERVANCY INC
    1234 5th Ave
    New York,NY10029     		None PC Employee Matching 1,500
    NEEDHAM EDUCATION FOUNDATION INC
    PO Box 920145
    Needham,MA02492     		None PC Employee Matching 100
    NEW ENGLAND BAPTIST HOSPITAL
    125 Parker Hill Ave
    Boston,MA02120     		None PC Employee Matching 1,500
    NEW ENGLAND COLLEGIATE BASEBALL LEAGUE INC
    38 Roberts Street
    SANFORD,ME040730026     		None PC Employee Matching 600
    NEW ENGLAND MALAYALEE ASSOCIATION
    22 Hatikva Way
    North Chelmsford,MA01863     		None PC Employee Matching 520
    NEW ENGLAND WILDLIFE CENTER
    500 Columbian Street
    South Weymouth,MA02190     		None PC Employee Matching 5,000
    NEW HAMPSHIRE PUBLIC RADIO INC
    2 Pillsbury Street
    6th Floor
    Concord,NH03301     		None PC Employee Matching 230
    New Jersey Gay Men's Chorus
    P O Box 21
    PRINCETON,NJ085420021     		None PC Employee Matching 1,000
    NEWTON FOOD PANTRY
    100 Commonwealth Ave
    Newton,MA02459     		None PC Employee Matching 200
    NEWTON GIRLS SOFTBALL INC
    36 Jasset St
    NEWTON,MA024581003     		None PC Employee Matching 600
    NORTH TEXAS FOOD BANK
    3677 Mapleshade Lane
    Plano,TX75075     		None PC Employee Matching 22
    OHIO STATE UNIVERSITY FOUNDATION
    PO Box 710811
    COLUMBUS,OH43221     		None PC Employee Matching 170
    OKLAHOMA STATE UNIVERSITY FOUNDATION
    400 S Monroe St
    Stillwater,OK74076     		None PC Employee Matching 300
    OLIVER AND ANNIE INC
    6 DANTES WAY
    MIDDLETOWN,NJ077482869     		None PC Employee Matching 80
    OPERATION SAVE THE CHILDREN
    6 DANTES WAY
    MIDDLETOWN,NJ077482869     		None PC Employee Matching 150
    ORANGE WEST ORANGE UNICO FOUNDATION
    29 NORTHFIELD AVENUE
    WEST ORANGE,NJ070525358     		None PC Employee Matching 200
    ORGANIZATION FOR AUTISM RESEARCH INC
    2111 Wilson Blvd
    Suite 401
    Arlington,VA22201     		None PC Employee Matching 400
    OXFAM-AMERICA INC
    226 Causeway St
    Boston,MA02114     		None PC Employee Matching 100
    Pan Massachusetts Challenge
    77 4th Ave
    Needham,MA02494     		None PC Employee Matching 3,760
    PARKINSONS FOUNDATION INC
    1359 Broadway
    1509
    New York,NY10018     		None PC Employee Matching 200
    PHOENIX CHARTER ACADEMY NETWORK
    60 Canal St 4th Floor
    Boston,MA02114     		None PC Employee Matching 20,000
    PINE STREET INN
    444 Harrison Avenue
    Boston,MA02118     		None PC Employee Matching 5,000
    PITCH HER PRODUCTIONS INC
    25 62 42nd Street
    Astoria,NY11103     		None PC Employee Matching 300
    Planned Parenthood League of Massachusetts
    1055 Commonwealth Avenue
    Boston,MA022151001     		None PC Employee Matching 400
    PREPARATORY FOUNDATION INC
    885 River St
    Boston,MA02136     		None PC Employee Matching 15,000
    PRESIDENT AND FELLOWS OF HARVARD COLLEGE
    1563 Mass Ave
    CAMBRIDGE,MA021385366     		None PC Employee Matching 400
    PRINCETON SYMPHONY ORCHESTRA INC
    PO Box 250
    Princeton,NJ08542     		None PC Employee Matching 200
    Project 351
    50 Congress St
    351
    Boston,MA02109     		None PC Employee Matching 950
    Project Bread
    145 Border Street
    East Boston,MA021281903     		None PC Employee Matching 70
    PROJECT CITIZENSHIP
    4 Faneuil South Market Building
    3rd Floor
    Boston,MA02109     		None PC Employee Matching 600
    PROJECT HOPE THE PEOPLE TO PEOPLE HEALTH FOUNDATION INC
    7500 Old Georgetown Rd
    Suite 600
    Bethesda,MD20814     		None PC Employee Matching 50
    PROSTATE CANCER FOUNDATION
    1250 4th St
    Santa Monica,CA90401     		None PC Employee Matching 100
    PTA MASSACHUETTS PARENT-TEACHER ASSOCIATION INC
    101 Lothrop St
    NORTH EASTON,MA023562001     		None PC Employee Matching 50
    RAILS TO TRAILS CONSERVANCY
    2121 Ward Court NW
    5th Floor
    Washington,DC20037     		None PC Employee Matching 70
    RAMAPO-BERGEN ANIMAL REFUGE INC
    2 Shelter Ln
    Oakland,NJ07436     		None PC Employee Matching 50
    RANDOM ACTS INC
    1009 Oakwood Lane
    Los Angeles,CA90027     		None PC Employee Matching 100
    RAPE ABUSE AND INCEST NATIONAL NETWORK INC
    1220 L St NW
    WASHINGTON,DC200054018     		None PC Employee Matching 100
    RHODE ISLAND COMMUNITY FOOD BANK ASSOCIATION
    200 Niantic Ave
    Providence,RI02907     		None PC Employee Matching 500
    ROCHESTER EDUCATION FOUNDATION INC
    250 Mill St
    Rochester,NY14614     		None PC Employee Matching 1,000
    Rose Fitzgerald Kennedy Greenway Conservancy
    185 Kneeland St
    Boston,MA02110     		None PC Employee Matching 300
    Rose Fitzgerald Kennedy Greenway Conservancy
    185 Kneeland St
    Boston,MA02110     		None PC Employee Matching 5,000
    Rowan University
    201 Mullica Hill Road
    c/o Tedd Importico Scholarship Fund
    Glassboro,NJ080281700     		None PC Employee Matching 200
    Roxbury Latin School
    101 Saint Theresa Ave
    West Roxbury,MA02132     		None PC Employee Matching 1,500
    RUTGERS UNIVERSITY FOUNDATION -
    335 George Street Suite 4000
    C/o Rutgers University Foundation
    New Brunswick,NJ08901     		None PC Employee Matching 100
    SALEM MISSION INC
    56 Margin St
    Salem,MA01970     		None PC Employee Matching 100
    SALEM MISSION INC
    56 Margin St
    Salem,MA01970     		None PC Employee Matching 25,000
    SALVATION ARMY NATIONAL CORP
    615 Slaters Ln
    Alexandria,VA22314     		None PC Employee Matching 200
    SAVE THE CHILDREN FEDERATION INC
    501 Kings Hwy E 400
    Fairfield,CT06825     		None PC Employee Matching 100
    Semper Fi Americas Fund
    Wounded Warrior Center
    Bldg H49
    Camp Pendleton North,CA92055     		None PC Employee Matching 1,000
    SESAME WORKSHOP
    1900 Broadway
    New York,NY10023     		None PC Employee Matching 200
    Several Sources Shelters
    300 AIRMOUNT AVE
    RAMSEY,NJ074461289     		None PC Employee Matching 100
    Shriners Hospital For Children
    2900 N ROCKY POINT DR
    TAMPA,FL336071435     		None PC Employee Matching 294
    SIENA COLLEGE
    515 Loudon Rd
    Loudonville,NY12211     		None PC Employee Matching 1,000
    SIGNAL TECHNOLOGY FOUNDATION
    650 CASTRO ST
    STE 120 223
    MOUNTAIN VIEW,CA940412093     		None PC Employee Matching 20
    SILVER LINING MENTORING
    727 Atlantic Ave 3
    Boston,MA02111     		None PC Employee Matching 25,000
    Smile Train
    P O Box 96231
    Washington,DC200906231     		None PC Employee Matching 50
    Smithsonian Institution
    P O Box 37012
    Suite 3150 MRC 712
    Washington,DC200137012     		None PC Employee Matching 250
    SOCIAL GOOD FUND
    P O Box 5473
    Richmond,CA94805     		None PC Employee Matching 400
    SOCIEDAD LATINA INC
    1530 Termont St
    Roxbury,MA02120     		None PC Employee Matching 25,000
    Southern Vermont Therapeutic Riding Center
    3 Cross Country Circle
    Wilmington,VT05363     		None PC Employee Matching 40
    Special Olympics New Jersey
    1 Eunice Kennedy Shriver Way
    Lawrence Township,NJ08648     		None PC Employee Matching 320
    Sportsmens Tennis & Enrichment Center
    950 Blue Hill Avenue
    Dorchester,MA02124     		None PC Employee Matching 1,900
    SquashBusters
    795 Columbus Avenue
    Roxbury Crossing,MA02120     		None PC Employee Matching 700
    SquashBusters
    795 Columbus Avenue
    Roxbury Crossing,MA02120     		None PC Employee Matching 10,000
    St Stephens Youth Programs
    419 Shawmut Avenue
    Boston,MA02118     		None PC Employee Matching 50,000
    St Jude Childrens Research Hospital
    501 St Jude Place
    Memphis,TN38105     		None PC Employee Matching 6,093
    Stanford University
    450 Serra Mall
    Stanford,CA94305     		None PC Employee Matching 2,000
    STEPHEN SILLER TUNNEL TO TOWERS FOUNDATION
    2361 Hylan Blvd
    Staten Island,NY10306     		None PC Employee Matching 900
    STORY SCHOOL
    12 A Street
    Burlington,MA01803     		None PC Employee Matching 50
    SUNSHINE APPROACH FOUNDATION COMPANY INC
    16192 Coastal Hwy
    LEWES,DE199583608     		None PC Employee Matching 800
    Susan G Komen Breast Cancer Foundation
    13770 Noel Rd
    Ste 801889
    Dallas,TX75380     		None PC Employee Matching 402
    Susan G Komen Breast Cancer Foundation
    13770 Noel Rd
    Ste 801889
    Dallas,TX75380     		None PC Employee Matching 370
    SWIM ACROSS AMERICA
    508 Park Road 389
    Charlotte,NC28210     		None PC Employee Matching 500
    SYRACUSE UNIVERSITY
    400 Ostrom Ave
    Syracuse,NY13244     		None PC Employee Matching 200
    Teach For America - Massachusetts
    60 Canal St
    5th Floor
    Boston,MA02114     		None PC Employee Matching 10,000
    Team Eagle Foundation
    198 Kings Rd
    Madison,NJ079402238     		None PC Employee Matching 200
    TEMPLE UNIVERSITY
    P O Box 827651
    Philadelphia,PA191827651     		None PC Employee Matching 200
    The Association for Frontotemporal Degeneration
    2700 Horizon Dr
    Suite 120
    King of Prussia,PA19406     		None PC Employee Matching 1,500
    The Boston Foundation
    75 Arlington St
    300
    Boston,MA02116     		None PC Employee Matching 25,000
    THE CORNERSTONE CREATIVE INC
    27 Commercial St
    Gloucester,MA01930     		None PC Employee Matching 400
    THE EMMANUEL CANCER FOUNDATION INC
    1710 NJ 71
    Wall Township,NJ07719     		None PC Employee Matching 2,500
    The Greater Boston Food Bank
    70 South Bay Avenue
    Boston,MA02118     		None PC Employee Matching 200
    The Home for Little Wanderers
    10 Guest Street
    Boston,MA02135     		None PC Employee Matching 204
    THE INSTITUTE FOR MIDDLE EAST UNDERSTANDING
    2913 El Camino Real
    Suite 436
    Tustin,CA92782     		None PC Employee Matching 100
    The Justice George Lewis Ruffin Society
    58 Adams Way
    Amherst,NH03031     		None PC Employee Matching 20,000
    THE MASSACHUSETTS INSTITUTE FOR A NEW COMMONWEALTH INC
    11 Beacon Street
    Suite 500
    Boston,MA02108     		None PC Employee Matching 400
    THE STEPPINGSTONE FOUNDATION
    One Appleton Street
    4th Floor
    Boston,MA02116     		None PC Employee Matching 1,800
    THE STEPPINGSTONE FOUNDATION
    One Appleton Street
    4th Floor
    Boston,MA02116     		None PC Employee Matching 50,000
    THE TREVOR PROJECT INC
    8704 Santa Monica Blvd
    Suite 200
    West Hollywood,CA90069     		None PC Employee Matching 50
    The University of Rhode Island Foundation & Alumni Engagement
    7 Upper College Rd
    KINGSTON,RI028812023     		None PC Employee Matching 100
    Thompson Island Outward Bound
    P O Box 127
    Boston,MA02127     		None PC Employee Matching 50,000
    TIDES FOUNDATION
    PO Box 399389
    San Francisco,CA941399389     		None PC Employee Matching 100
    Tough Warrior Princesses
    80 MONROE ST
    AMESBURY,MA019133215     		None PC Employee Matching 800
    TRINITY BOSTON CONNECTS
    206 Clarendon Street
    Boston,MA02116     		None PC Employee Matching 5,000
    Trustees of Boston Univ-Wbur
    595 Commonwealth Avenue
    Suite 700West Entrance
    Boston,MA02215     		None PC Employee Matching 1,700
    TRUSTEES OF DARTMOUTH COLLEGE
    6066 Development Office
    Gift Recording Office
    HANOVER,NH037554400     		None PC Employee Matching 680
    TRUSTEES OF THE LAWRENCE ACADEMY AT GROTON
    26 Powerhouse Rd
    Groton,MA01450     		None PC Employee Matching 1,500
    TRUSTEES OF THE NEWTON FREE LIBRARY
    330 Homer St
    Newton,MA02459     		None PC Employee Matching 100
    TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
    2929 Walnut Street
    Suite 300
    Philadelphia,PA191045099     		None PC Employee Matching 400
    UNICEF USA
    125 Maiden Lane
    New York,NY10038     		None PC Employee Matching 500
    UNICEF USA
    125 Maiden Lane
    New York,NY10038     		None PC Employee Matching 25,000
    UNITED ANIMAL NATIONS
    PO Box 188890
    Sacramento,CA95818     		None PC Employee Matching 100
    United Way of Central Jersey
    32 Ford Avenue
    Milltown,NJ08850     		None PC Employee Matching 350
    United Way of Massachusetts Bay and Merrimack Valley
    51 Sleeper Street
    Boston,MA02210     		None PC Employee Matching 500
    UNIVERSITY OF MASSACHUSETTS AMHERST FOUNDATION INC
    134 Hicks WayMemorial Hall
    Amherst,MA01003     		None PC Employee Matching 200
    VIETNAM VETERANS WORKSHOP INC
    27 Beacon St
    Boston,MA02108     		None PC Employee Matching 50
    VILLANOVA UNIVERSITY
    800 LANCASTER AVENUE
    OFFICE OF UNIVERSITY ADVANCEMENT
    VILLANOVA,PA19085     		None PC Employee Matching 50
    Volunteers in Medicine Berkshires
    777 S Main 4
    Great Barrington,MA01230     		None PC Employee Matching 1,500
    WALKBOSTON
    405 Waltham Street Suite 309
    Lexington,MA02421     		None PC Employee Matching 1,500
    WBUR
    890 Commonwealth Ave
    Brookline,MA02445     		None PC Employee Matching 15,000
    WESTERN IOWA JOURNALISM FOUNDATION
    15302 140th St
    Breda,IA51436     		None PC Employee Matching 100
    WGBH EDUCATIONAL FOUNDATION
    1 Guest St
    Boston,MA02135     		None PC Employee Matching 200
    WHYY
    150 N 6th Street
    Philadelphia,PA19106     		None PC Employee Matching 290
    Wikimedia Foundation
    P O Box 98204
    Washington,DC200908204     		None PC Employee Matching 304
    WOODLAND GOLF CLUB SCHOLARSHIP FOUNDATION
    1897 Washington Street
    Auburndale,MA02466     		None PC Employee Matching 400
    Woodland Golf Club Scholarship Foundation
    1897 Washington Street
    Auburndale,MA02466     		None PC Employee Matching 1,000
    Wounded Warrior Project
    P O Box 758516
    Topeka,KS66675     		None PC Employee Matching 380
    ZUMIX
    260 Sumner St
    East Boston,MA02128     		None PC Employee Matching 10,000
    The St Pauls Schools for Grils
    P O Box 8000
    Brooklandville,MD21022     		None PC Employee Matching 600
    St John Regional School
    61 S State St
    Concord,NH03301     		None PC Employee Matching 1,000
    St Baldricks Foundation
    1333 S Mayflower Ave
    Suite 400
    Monrovia,CA91016     		None PC Employee Matching 300
    Joseph R Dawe JR Elementary
    131 Pine St
    Stoughton,MA02072     		None PC Employee Matching 200
    GIRLS INC OF LYNN
    50 High St
    Lynn,MA01902     		None PC Employee Matching 50,000
    Foundation Pierre Smith Mondelus Inc
    117 Pinehurst Pointe Dr
    St Augustine,FL32092     		None PC Employee Matching 1,100
    Food Bank of the Rio Grande Valley inc
    724 N Cage Blvd
    McAllen,TX78502     		None PC Employee Matching 22
    Childrens Miracle Network Hospitals
    205 West 700 South
    Salt Lake City,UT84101     		None PC Employee Matching 200
    BARRINGTON STAGE COMPANY INC
    30 Union St
    Pittsfield,MA01201     		None PC Employee Matching 1,500
    Total .................................bullet 3a 1,612,889
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 12
    Part XV-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments ....   0   0 0
    3 Interest on savings and temporary cash
    investments ...........     		  0   0 0
    4 Dividends and interest from securities ....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......   0   0 0
    bNot debt-financed property.....   0   0 0
    6 Net rental income or (loss) from personal property   0   0 0
    7 Other investment income .....          
    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
    13Total. 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.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    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.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below?
    See instructions.
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


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


    Software ID: 21013404
    Software Version: V1.0


    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
    2021
    Name of the organization
    THE PLYMOUTH ROCK ASSURANCE FOUNDATION
     
    Employer identification number

    04-6739902
    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) (2021)
    Schedule B (Form 990) (2021) Page 2
    Name of organization
    THE PLYMOUTH ROCK ASSURANCE FOUNDATION
          		Employer identification number
    04-6739902
    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
    Plymouth Rock Assurance Corporation
     
    695 Atlantic Avenue
     
    Boston, MA02111

    		$ 1,324,618


    (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.)
    (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.)
    (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) (2021)
    Schedule B (Form 990) (2021)
    Page 3
    Name of organization
    THE PLYMOUTH ROCK ASSURANCE FOUNDATION
          		Employer identification number

    04-6739902
    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
    1
    		 7,700 Shares of Verisk Analytics Inc $ 1,324,618 2021-03-12
    (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) (2021)
    Schedule B (Form 990) (2021)
    Page 4
    Name of organization
    THE PLYMOUTH ROCK ASSURANCE FOUNDATION
          		Employer identification number

    04-6739902
    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) (2021)
    Additional Data


    Software ID:  
    Software Version:  

    TY 2021 OtherDecreasesSchedule
    Name:
    THE PLYMOUTH ROCK ASSURANCE FOUNDATION
    EIN:
    04-6739902
    Software ID:
    21013404
    Software Version:
    V1.0
    Description Amount
    Cap Gain on Contributed Stock 1,324,618


    TY 2021 OtherExpensesSchedule
    Name:
    THE PLYMOUTH ROCK ASSURANCE FOUNDATION
    EIN:
    04-6739902
    Software ID:
    21013404
    Software Version:
    V1.0
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Bank Fees 883 0 0 0


    TY 2021 OtherIncreasesSchedule
    Name:
    THE PLYMOUTH ROCK ASSURANCE FOUNDATION
    EIN:
    04-6739902
    Software ID:
    21013404
    Software Version:
    V1.0
    Description Amount
    Rounding 1


    TY 2021 TaxesSchedule
    Name:
    THE PLYMOUTH ROCK ASSURANCE FOUNDATION
    EIN:
    04-6739902
    Software ID:
    21013404
    Software Version:
    V1.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    MA Excise Tax 35 0 0 0