2022-09-09T11:21:29-05:00 2021-12-31 440160260 FORVIS LLP 245 RIVERSIDE AVENUE SUITE 410 JACKSONVILLE FL 32202 990PF 2021-01-01 592742007 SELEVAN FAMILY FOUNDATION INC SELE 9047339311 12901 FLAGLER CENTER BLVD JACKSONVILLE FL 32258 JACK SELEVAN PRESIDENT 9047339311 2022-09-09 1 JACK SELEVAN 999009999 JAMES L SMITH JR P00473981 9042969333 2022-09-09 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z X X 627979 X 1052447 869 869 5098 5098 498074 1028084 498074 1556488 504041 0 0 0 142 0 0 39 39 0 181 39 0 562410 562410 562591 39 562410 993897 504002 164080 208915 208915 0 426049 419064 164080 634964 627979 0 0 X 164080 634964 164080 634964 164080 634964 164080 993897 0 1157977 523013 634964 DIMENSIONAL FUND ADVISORS - TAX-MGD 2020-03-12 2021-03-29 440025 225000 215025 215025 DIMENSIONAL FUND ADVISORS US SM CAP 2012-01-17 2021-03-29 155992 88206 67786 67786 DIMENSIONAL FUND ADVISORS - TAX-MGD 2010-05-03 2021-03-29 128391 60517 67874 67874 DIMENSIONAL FUND ADVISORS US SM CAP 2011-09-09 2021-03-29 302149 156287 145862 145862 CAPITAL GAINS DIVIDENDS P 1527 1527 1527 498074 7006 0 7006 0 7006 924 0 0 0 924 0 6082 0 0 0 0 0 0 0 0 0 0 1 1 FL 1 0 0 0 0 1 N/A RUSSELL SELEVAN 9047339311 12901 FLAGLER CENTER BLVD JACKSONVILLE FL 32258 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 JACK SELEVAN 12901 FLAGLER CENTER BLVD JACKSONVILLE FL 32258 PRESIDENT/TREASURER 1.00 0 0 0 RUSSELL SELEVAN 12901 FLAGLER CENTER BLVD JACKSONVILLE FL 32258 VP/SECRETARY 1.00 0 0 0 MARC SELEVAN 12901 FLAGLER CENTER BLVD JACKSONVILLE FL 32258 TRUSTEE 1.00 0 0 0 ANDREW SELEVAN 12901 FLAGLER CENTER BLVD JACKSONVILLE FL 32258 TRUSTEE 1.00 0 0 0 NONE 0 NONE 0 0 302888 593044 0 895932 0 0 895932 13439 882493 44125 44125 7006 7006 37119 0 37119 0 37119 562410 0 562410 37119 0 0 190797 109810 219514 214976 498671 1233768 562410 0 0 0 37119 525291 0 0 1759059 0 0 0 0 0 0 190797 1568262 109810 219514 214976 498671 525291 RUSSELL SELEVAN 12901 FLAGLER CENTER BLVD JACKSONVILLE FL 32258 9047339311 ALL PERTINENT INFORMATION N/A N/A AMERICAN CANCER SOCIETY 8464 BEACH BOULEVARD JACKSONVILLE FL 32207 NONE PUBLIC CHARITY CHARITABLE 10000 DREAMS COME TRUE 6803 SOUTHPOINT PKWY JACKSONVILLE FL 32216 NONE PUBLIC CHARITY CHARITABLE 8500 ETZ CHAIM SYNAGOGUE 10167 SAN JOSE BOULEVARD JACKSONVILLE FL 322575955 NONE PUBLIC CHARITY RELIGIOUS 4500 JACKSONVILLE JEWISH CENTER 3662 CROWN POINT ROAD JACKSONVILLE FL 322575955 NONE PUBLIC CHARITY RELIGIOUS 115000 JEWISH COMMUNITY ALLIANCE 8505 SAN JOSE BOULEVARD JACKSONVILLE FL 32217 NONE PUBLIC CHARITY RELIGIOUS 7500 JEWISH FAMILY & COMMUNITY SERV 8540 BAYCENTER ROAD JACKSONVILLE FL 32256 NONE PUBLIC CHARITY RELIGIOUS 30000 JEWISH FEDERATION OF JACKSONVILLE 8505 SAN JOSE BOULEVARD JACKSONVILLE FL 32217 NONE PUBLIC CHARITY RELIGIOUS 210000 RIVER GARDEN FOUNDATION 11401 OLD ST AUGUSTINE ROAD JACKSONVILLE FL 32258 NONE PUBLIC CHARITY CHARITABLE 20000 TOM COUGHLIN JAY FUND PO BOX 50798 JACKSONVILLE BEACH FL 32240 NONE PUBLIC CHARITY CHARITABLE 2500 UNITED WAY OF NE FLORIDA 1301 RIVERPLACE BLVD SUITE 400 JACKSONVILLE FL 32207 NONE PUBLIC CHARITY CHARITABLE 30000 AMERICAN FRIENDS OF CARMEL SCHOOL 31 W 34TH ST FL 9 NEW YORK NY 10001 NONE PUBLIC CHARITY CHARITABLE 6410 THE BOLLES SCHOOL 7400 SAN JOSE BLVD JACKSONVILLE FL 32217 NONE PUBLIC CHARITY CHARITABLE 10000 ONEJAX 1 UNF DRIVE- HICKS HALL BUILDING 53 SUITE 2750 JACKSONVILLE FL 32224 NONE PUBLIC CHARITY CHARITABLE 3000 WILSHIRE BLVD TEMPLE CAMPS 3663 WILSHIRE BLVD LOS ANGELES CA 90010 NONE PUBLIC CHARITY CHARITABLE 5000 JEWISH NATIONAL FUND 78 RANDALL AVE ROCKVILLE CENTER NY 11570 NONE PUBLIC CHARITY CHARITABLE 100000 562410 0 14 869 14 5098 18 498074 0 504041 0 504041 0 0 0 0 0 0 0 0 0 0 X X 1 RUSSELL SELEVAN 2734 ESTATES LANE JACKSONVILLE FL 32257 1052447 X 1 STOCK CONTRIBUTION - DFA TAX - MGD US TARGETED VALUE PORTFOLIO & DFA US SMALL CAP VALUE PORTFOLIO 1052447 2021-03-26 AMENDED RETURN CHANGES FORM 990-PF THE TAXPAYER IS AMENDING THE RETURN TO PROPERLY REPOT THE INCOME FROM THE TD AMERITRADE INVESTMENT ACCOUNT. THE REPORTING OF THE TD INVESTMENT ACCOUNT CHANGES ITEMS ON PART I, PART II, PART II, PART III, PART IV, AND PART V. THE FOLLOWING LINE ITEMS HAVE CHANGED FROM THE ORIGINALLY FILED RETURN:PART I - ANALYSIS OF REVENUE AND EXPENSESLINE 1 - CONTRIBUTIONSLINE 3 - INTEREST LINE 4 - DIVIDENDSLINE 6A - CAPITAL GAINSLINE 27A - EXCESS REVENUE OVER EXPENSESLINE 27B - NET INVESTMENT INCOMEPART II, BALANCE SHEETLINE 2 - SAVINGS AND TEMPORARY CASH INVESTMENTSLINE 13 - INVESTMENTS, OTHERLINE 16 - TOTAL ASSETSLINE 24 - NET ASSETSLINE 30 - TOTAL LIABILITIES AND NET ASSETSPART III, ANALYSIS OF CHANGES IN NET ASSETSLINE 2LINE 3LINE 4LINE 6, TOTAL NET ASSETSPART IV, CAPITAL GAINSLINE 2 - CAPITAL GAIN NET INCOMEPART V, EXCISE TAXLINE 1A - TAXLINE 9 - TAX DUE TD AMERITRADE #6277 AT COST 426049 419064 LEGAL FEES 142 0 0 ADJUSTMENT TO DONATED STOCK BASIS TO ADJ. FOR DONOR'S BASIS 523013 BANK CHARGES 39 39 0