Instrumentl eFile Render
Object ID: 202231049349100718 - Rendered 2024-09-08
TIN: 84-1721846
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0047
20
21
Open to Public Inspection
For calendar year 2021, or tax year beginning
01-01-2021
, and ending
12-31-2021
Name of foundation
THE SALON FAMILY FOUNDATION INC
Number and street (or P.O. box number if mail is not delivered to street address)
C/O JOEL SALON 15 FARAWAY ROAD
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
ARMONK
,
NY
10504
A Employer identification number
84-1721846
B
Telephone number (see instructions)
(347) 589-8551
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
2,129,937
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
.............
3
Interest on savings and temporary cash investments
16,008
16,008
16,008
4
Dividends and interest from securities
...
14,925
14,925
14,925
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
117,498
b
Gross sales price for all assets on line 6a
685,487
7
Capital gain net income (from Part IV, line 2)
...
117,498
8
Net short-term capital gain
.........
30,339
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
Total.
Add lines 1 through 11
........
148,431
148,431
61,272
13
Compensation of officers, directors, trustees, etc.
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
2,400
2,400
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
590
590
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
13,517
13,517
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
16,507
16,507
0
25
Contributions, gifts, grants paid
.......
91,490
91,490
26
Total expenses and disbursements.
Add lines 24 and 25
107,997
16,507
91,490
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
40,434
b
Net investment income
(if negative, enter -0-)
131,924
c
Adjusted net income
(if negative, enter -0-)
...
61,272
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
1
Cash—non-interest-bearing
.............
33,652
22,801
22,801
2
Savings and temporary cash investments
.........
137,492
109,621
109,621
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
611,951
542,719
1,421,877
c
Investments—corporate bonds (attach schedule)
.......
325,136
160,857
160,645
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
93,289
405,956
414,993
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
1,201,520
1,241,954
2,129,937
17
Accounts payable and accrued expenses
..........
18
Grants payable
.................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
1,201,520
1,241,954
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances
(see instructions)
.....
1,201,520
1,241,954
30
Total liabilities and net assets/fund balances
(see instructions)
.
1,201,520
1,241,954
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return)
...............
1
1,201,520
2
Enter amount from Part I, line 27a
.....................
2
40,434
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
1,241,954
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
1,241,954
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
30 adobe systems incorporated
P
2021-03-11
2021-12-15
b
1150 AMERICAN RLTY TR
P
2020-03-25
2021-03-15
c
20 BOOKING HOLDINGS INC
P
2021-08-23
2021-12-15
d
400 BOSTON SCIRNTIFIC
P
2021-02-01
2021-08-04
e
25 COINBASE GLOBAL
P
2021-04-14
2021-06-24
20000 CROWN AMERICANS LLC
P
2021-08-18
2021-10-14
150 DRAFTKINGS INC
P
2020-01-21
2021-01-19
20000 EQUINIX INC
P
2020-11-12
2021-06-02
725 GENERAL MTRS
P
2021-01-12
2021-08-23
800 KRATOS DEFENSE AND SECUIRTY
P
2020-09-04
2021-05-14
400 LEGALZOOM COM INC
P
2021-08-16
2021-11-11
75 SPDR GOLD TR GOLD SHS
P
2020-04-08
2021-02-22
550 SPDR SER TR S&P REGLBKG
P
2021-03-18
2021-07-08
20000 TARGA RES PARTNERS
P
2020-10-30
2021-05-17
750 VIRGIN GALACTIC HOLDINGS INC
P
2020-06-03
2021-05-11
20000 ARES CAPITAL CORP
P
2020-11-10
2021-12-23
20000 BALL CORP NOTE
P
2019-04-15
2021-10-28
250 BLACKSTONE INC
P
2020-04-17
2021-10-21
50 CHEINIERE ENERGY INC
P
2018-11-14
2021-10-20
200 DRAFTKINGS INC
P
2020-01-17
2021-01-19
55 FACEBOOK INC
P
2016-11-07
2021-02-23
200 FIDELITY NATL INFO
P
2019-09-12
2021-06-03
10000 FIDELITY NATL INFO
P
2017-06-21
2021-03-03
150 INTERCONTINENTAL EXCHANGE INC
P
2019-04-16
2021-10-21
245 ISHARES RUSSELL
P
2020-11-10
2021-12-15
275 JOHNSON AND JOHNSON
P
2019-09-06
2021-07-06
20000 SBA COMMUNICATIONS CORP
P
2019-09-26
2021-02-11
250 SERVICE CORPORATION INTERNATIONAL
P
2018-05-03
2021-11-10
220 SPDR GOLD TR GOLD SHS
P
2019-09-12
2021-02-22
10000 VERIZON COMMUNICATIONS INC
P
2017-06-13
2021-11-12
15000 ZIMMER BIOMET HOLDINGS INC
P
2018-03-08
2021-12-31
Capital Gain Dividends
(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
18,374
13,586
4,788
b
42,007
36,607
5,400
c
42,660
42,723
-63
d
18,172
14,562
3,610
e
5,700
9,525
-3,825
20,962
20,804
158
7,685
2,056
5,629
21,451
21,711
-260
34,916
33,215
1,701
21,994
15,507
6,487
8,305
13,913
-5,608
12,719
11,644
1,075
34,056
39,387
-5,331
20,000
20,052
-52
28,712
12,082
16,630
20,016
20,058
-42
20,338
20,126
212
33,070
11,739
21,331
5,211
2,951
2,260
10,246
2,683
7,563
14,445
4,941
9,504
29,373
25,585
3,788
10,640
10,155
485
19,451
11,908
7,543
39,008
28,923
10,085
46,031
35,381
10,650
20,200
20,317
-117
16,631
8,948
7,683
37,308
31,681
5,627
10,777
10,219
558
15,000
15,000
29
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
4,788
b
5,400
c
-63
d
3,610
e
-3,825
158
5,629
-260
1,701
6,487
-5,608
1,075
-5,331
-52
16,630
-42
212
21,331
2,260
7,563
9,504
3,788
485
7,543
10,085
10,650
-117
7,683
5,627
558
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
117,498
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
30,339
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
and enter “N/A" on line 1.
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
1,834
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
1,834
6
Credits/Payments:
a
2021 estimated tax payments and 2020 overpayment credited to 2021
6a
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
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
50
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
1,884
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2022 estimated tax
0
Refunded
11
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
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.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
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
No
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)
DE
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
If "Yes," complete Part XIII
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2021)
Form 990-PF (2021)
Page
5
Part VI-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
HEATHER SALON
Telephone no.
(347) 589-8551
Located at
369 BRAGG HILL ROAD
NORWICH
VT
ZIP+4
05055
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
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
No
c
Organizations relying on a current notice regarding disaster assistance check here
........
d
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 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 (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2021?
....................
2a
No
If "Yes," list the years
20
,
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.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
..............................
3a
No
b
If "Yes," did it have excess business holdings in 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
Organizations relying on a current notice regarding disaster assistance check
.........
d
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
.................
5d
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.............................
6a
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
7a
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
.....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.........................
8
No
Part VII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
JOEL SALON
President
0.25
0
15 FARAWAY ROAD
ARMONK
,
NY
10504
CAROLYN SALON
Vice President
0.25
0
15 FARAWAY ROAD
ARMONK
,
NY
10504
HEATHER SALON
Vice President
0.25
0
369 BRAGG HILL ROAD
NORWICH
,
VT
05055
DEBORAH SALON
Vice President
0.25
0
208 EAST 14TH STREET
TEMPE
,
AZ
85281
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
NONE
Total
number of other employees paid over $50,000
...................
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
NONE
Total
number of others receiving over $50,000 for professional services
.............
Part VIII-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part VIII-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(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
1,870,379
b
Average of monthly cash balances
.......................
1b
41,736
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
1,912,115
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
1,912,115
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions)
.............................
4
28,682
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3.
............
5
1,883,433
6
Minimum investment return.
Enter 5% (0.05) of line 5
................
6
94,172
Part X
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part IX, line 6
..................
1
94,172
2a
Tax on investment income for 2021 from Part V, line 5
.......
2a
1,834
b
Income tax for 2021. (This does not include the tax from Part V.)
...
2b
c
Add lines 2a and 2b
............................
2c
1,834
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
92,338
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
92,338
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
92,338
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
91,490
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
91,490
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
92,338
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
......
3,836
d
From 2019
......
e
From 2020
......
8,599
f
Total
of lines 3a through e
........
12,435
4
Qualifying distributions for 2021 from Part
XI, line 4:
$
91,490
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)
........
0
d
Applied to 2021 distributable amount
.....
91,490
e
Remaining amount distributed out of corpus
5
Excess distributions carryover applied to 2021.
848
848
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
11,587
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
e
Undistributed income for 2019. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
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
......
11,587
10
Analysis of line 9:
a
Excess from 2017
....
b
Excess from 2018
....
2,988
c
Excess from 2019
....
d
Excess from 2020
....
8,599
e
Excess from 2021
....
Form
990-PF
(2021)
Form 990-PF (2021)
Page
10
Part XIII
Private Operating Foundations
(see instructions and Part VI-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2021, enter the date of the ruling
......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part IX for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
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.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(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)
a
Paid during the year
NEW YORK MEDICAL COLLEGE
40 SUNSHINE COTTAGE ROAD
VALHALLA
,
NY
10595
NONE
PF
EDUCATION
2,000
WOMEN FOR WOMEN INTERNATIONAL
PO BOX 9224
CENTRAL ISLIP
,
NY
11722
NONE
PF
CHARITABLE
2,000
UNITED WAY OF WESTCHESTER AND PUTNAM INC
PO BOX 8000 DEPARTMENT 952
BUFFALO
,
NY
14267
NONE
PF
CHARITABLE
3,000
UNION OF CONCERNED SCIENTISTS
PO BOX 4123
WOBURN
,
MA
01888
NONE
PF
CHARITABLE
1,600
SOLAR COOKERS INTERNATIONAL
2400 22ND ST SUITE 210
SACRAMENTO
,
CA
95818
NONE
PF
CHARITABLE
1,600
REED COLLEGE
3203 SOUTHEAST WOODSTOCK BOULEVARD
PORTLAND
,
OR
97202
NONE
PF
CHARITABLE
3,500
THE NATURE CONSERVANCY
PO BOX 1561
MERRIFIELD
,
VA
22116
NONE
PF
CHARITABLE
750
NATIONAL KIDNEY FOUNDATION
30 EAST 33RD STREET
NEW YORK
,
NY
10016
NONE
PF
CHARITABLE
1,000
FINCA
PO BOX 98048
WASHINGTON
,
DC
20090
NONE
PF
CHARITABLE
3,000
AJC
165 EAST 56TH STREET
NEW YORK
,
NY
10022
NONE
PF
CHARITABLE
1,580
ACCION
PO BOX 265
ALLENWOOD
,
NJ
08720
NONE
PF
CHARITABLE
2,000
THE FAMILY PLACE
319 US RTE 5 SOUTH
NORWICH
,
VT
05055
NONE
PF
CHARITABLE
6,000
REVELS NORTH
PO BOX 415
HANOVER
,
NH
03755
NONE
PF
CHARITABLE
1,500
VPIRGVPIREF
141 MAIN STREET
MONTPELIER
,
VT
05602
NONE
PF
CHARITABLE
3,000
UPPER VALLEY HAVEN
713 HARTFORD AVE
WHITE RIVER JUNCTION
,
VT
05001
NONE
PF
CHARITABLE
6,000
PLANNED PARENTHOOD OF AMERICA
PO BOX 97166
WASHINGTON
,
DC
20090
NONE
PF
CHARITABLE
2,100
VALLEY OF THE SUN UNITED WAY
3200 E CAMELBACK ROAD
PHOENIX
,
AZ
85018
NONE
PF
CHARITABLE
2,500
THE NEW YORK TIMES NEEDIEST CASES FUND
PO BOX 5193
NEW YORK
,
NY
10087
NONE
PF
CHARITABLE
2,000
INTERNALTIONAL RESCUE COMMITTEE
PO BOX 6068
ALBERT LEA
,
MN
56007
NONE
PF
CHARITABLE
2,000
350ORG
20 JAY STREET SUITE 732
BROOKLYN
,
NY
11201
NONE
EOF
EDUCATIONAL
2,100
THE ALEX MORROW CHILDRENS FUND
56 RYE ROAD
RYE
,
NY
10580
NONE
EOF
EDUCATIONAL
500
THE BRIDGE FUND OF NEW YORK INC
271 MADISON AVENUE SUITE 907
NEW YORK
,
NY
10016
NONE
EOF
EDUCATIONAL
10,000
ENVIROMENTAL DEFENSE FUND
PO BOX 98051
WASHINGTON
,
DC
20077
NONE
EOF
EDUCATIONAL
2,500
GRAMEEN FOUNDATION USA
1101 15TH STREET NW FLOOR 3
WASHINGTON
,
DC
20005
NONE
EOF
EDUCATIONAL
1,000
OXFARM AMERICA
226 CAUSEWAY STREET FLOOR 5
BOSTON
,
MA
02114
NONE
EOF
EDUCATIONAL
2,600
TECHNOSERVE
PO BOX 96828
WASHINGTON
,
DC
20077
NONE
EOF
EDUCATIONAL
1,500
UMOM NEW DAY CENTERS
3333 EAST VAN BUREN ST
PHOENIX
,
AZ
85008
NONE
EOF
EDUCATIONAL
3,000
NYPIRG
BSMT B1 9 MURRAY STREET
NEW YORK
,
NY
10277
NONE
EOF
EDUCATIONAL
100
PBA OF THE TOWN OF NORTH CASTLE
PO BOX 659
ARMONK
,
NY
10504
NONE
GOV
CHARITABLE
100
NATIONAL PARKS CONSERVATION ASSOCIATION
PO BOX 97202
WASHINGTON
,
DC
20090
NONE
POF
ENVIROMENTAL
200
NORTHERN WESTCHESTER HOSPITAL
400 EAST MAIN STREET
MOUNT KISCO
,
NY
10549
NONE
EOF
MEDICAL
300
FRIENDS OF NORTH CASTLE PUBLIC LIBRARY
PO BOX 767
ARMONK
,
NY
10504
NONE
POF
ENVIROMENTAL
200
THE FRESH AIR FUND
PO BOX 4535
NEW YORK
,
NY
10164
NONE
POF
CHILDREN
210
CYSTIC FIBROSIS FOUNDATION
PO BOX 5004
HAGERSTOWN
,
MD
21741
NONE
POF
MEDICAL
200
COMMUNITY CENTER OF NORTHERN WESTCHESTER
84 BEDFORD ROAD
KATONAH
,
NY
10536
NONE
POF
CHARITABLE
2,000
BOYS&GIRLS CLUB OF NORTHERN WESTCHESTER
351 EAST MAIN STREET
MT KISCO
,
NY
10549
NONE
POF
CHILDREN
200
ARMONK FIRE DEPARTMENT
PO BOX 116
ARMONK
,
NY
10504
NONE
POF
CHARITABLE
200
AMNESTY INTERNATIONAL
PO BOX 98233
WASHINGTON
,
DC
20077
NONE
POF
ENVIROMENTAL
300
AMERICAN INDIAN COLLEGE FUND
PO BOX 172449
DENVER
,
CO
80217
NONE
POF
EDUCATIONAL
250
AFS-USA INC
120 WALL STREET 4TH FL
NEW YORK
,
NY
10269
NONE
POF
CHARITABLE
200
AMERICAN CIVIL LIBERTIES UNION
PO BOX 96259
WASHINGTON
,
DC
20077
NONE
POF
CHARITABLE
200
BRAIN & BEHAVIOR RESEARCH FOUNDATION
747 THIRD AVENUE
NEW YORK
,
NY
10017
NONE
PF
MEDICAL
1,000
CAMFED
466 GREARY STREET SUITE 400
SAN FRANSISCO
,
CA
94102
NONE
PF
ENVIROMENTAL
2,000
GIVEDIRECTLY
PO BOX 3221
NEW YORK
,
NY
10008
NONE
PF
CHARITABLE
2,000
READING IS FUNDAMENTAL
PO BOX 96897
WASHINGTON
,
DC
20090
NONE
PF
EDUCATION
500
ST MARYS FOOD BANK ALLIANCE
2831 NORTH 31ST AVENUE
PHOENIX
,
AZ
85009
NONE
PF
CHARITABLE
2,500
SOCIETY IF ST VINCENT DE PAUL - PHOENIX
420 WEST WATKINS ROAD
PHOENIX
,
AZ
85002
NONE
PF
CHARITABLE
2,500
ST JUDE CHILDRENS RESEARCH HOSPITAL
PO BOX 1000 DEPT 495
MEMPHIS
,
TN
38101
NONE
PF
MEDICAL
500
FRIENDS OF UNFPA
PO BOX 387
ALLENWOOD
,
NJ
08720
NONE
PF
CHARITABLE
2,000
WESTCHESTER LAND TRUST
403 HARRIS ROAD
BEDFORD HILLS
,
NY
10507
NONE
PF
ENVIROMENTAL
125
BYRAM HILLS EDUCATION FOUNDATION
PO BOX 872
ARMONK
,
NY
10504
NONE
PF
EDUCATION
50
DOCTORS WITHOUT BORDERS
PO BOX 5023
HAGERSTOWN
,
MD
21741
NONE
PF
MEDICAL
500
FEEDING WESTCHESTER
200 CLEARBROOK ROAD
ELMSFORD
,
NY
10523
NONE
POF
CHARITABLE
400
GUIDING EYES FOR THE BLIND
PO BOX 97007
WASHINGTON
,
DC
20090
NONE
POF
CHARITABLE
50
HEIFER INTERNATIONAL
PO BOX 6021
ALBERT LEA
,
MN
56007
NONE
POF
CHARITABLE
300
I HAVE A DREAM FOUNDATION
330 SEVENTH AVENUE FLOOR 2
NEW YORK
,
NY
10001
NONE
POF
CHARITABLE
500
IPPFWHR
PO BOX 55960
BOSTON
,
MA
02205
NONE
POF
CHARITABLE
100
NAMI DONOR SERVICES
PO BOX 62596
BALTIMORE
,
MD
21264
NONE
POF
MEDICAL
100
NATURAL RESOURCES DEFENSE COUNSEL
PO BOX 1830
MERRIFIELD
,
VA
22116
NONE
POF
ENVIROMENTAL
50
NAACP EMPOWERMENT PROGRAMS
PO BOX 6483
BALTIMORE
,
MD
21298
NONE
POF
CHARITABLE
100
POPULATION CONNECTION
PO BOX 97129
WASHINGTON
,
DC
20077
NONE
POF
CHARITABLE
300
RAILS TO RAILS CONSERVANCY
2121 WARD COURT NW
WASHINGTON
,
DC
20077
NONE
POF
CHARITABLE
55
RONALD MCDONALD HOUSE
PO BOX 2489
NEW YORK
,
NY
10131
NONE
POF
CHARITABLE
70
STAYIN ALIVE CHARITY
15 WINDMILL PLACE
ARMONK
,
NY
10504
NONE
POF
CHARITABLE
300
WORLD WILDLIFE FUND
PO BOX 96555
WASHINGTON
,
DC
20077
NONE
POF
CHARITABLE
200
WOUNDED WARRIOR PROJECT
PO BOX 758540
TOPEKA
,
KS
66675
NONE
POF
CHARITABLE
300
Total
.................................
3a
91,490
b
Approved for future payment
Total
.................................
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.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
14
14,925
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
14
16,008
4
Dividends and interest from securities
....
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not 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
............
29
117,469
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
29
30,933
117,469
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
148,431
(See worksheet in line 13 instructions to verify calculations.)
Part XV-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
Form
990-PF
(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?
...........
Yes
No
b
If "Yes," complete the following schedule.
(a)
Name of organization
(b)
Type of organization
(c)
Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
May the IRS discuss this return
with the preparer shown below?
See instructions.
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's EIN
Firm's address
Phone no.
Form
990-PF
(2021)
Additional Data
Software ID:
21013475
Software Version:
2021v4.0
Form 990PF - Special Condition Description:
Special Condition Description