2023-11-14T14:41:15-06:00 2022-12-31 920460586 PWC US TAX LLP 1420 5TH AVE STE 2800 SEATTLE WA 981011344 990PF 2022-01-01 320660398 THE BASZUCKI FAMILY FOUNDATION BASZ 6502418740 204 2ND AVENUE 522 SAN MATEO CA 944013904 JAN BASZUCKI SECRETARY/TREASURER 6502418740 2023-11-14 1 JAN BASZUCKI 999009999 0 KYLE TALLEY P01239408 2063983000 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z X 25858896 X 3167500 109313 109313 100894 100894 7417303 7417323 7417303 10795010 7627510 0 0 0 0 0 58788 29394 0 29394 718519 0 0 718519 44847 364 0 0 108341 245 0 108096 930495 30003 0 856009 31694969 3880954 32625464 30003 0 4736963 -21830454 7597507 0 23406896 116680 116680 0 25292220 25292220 10316000 499996 449996 33722896 25908896 25858896 0 49647 0 27814015 468745 94872 468745 27958534 X 0 0 0 0 33254151 -2049638 33254151 -2049638 33722896 25908896 33254151 -21830454 0 11423697 13473335 -2049638 PUBLICLY TRADED SECURITIES - ROBLOX CORP (RBLX) CLASS A, 100,000 SHARES 2004-04-06 2022-08-23 4137969 10 4137959 4137959 PUBLICLY TRADED SECURITIES - ROBLOX CORP (RBLX) CLASS A, 100,000 SHARES 2004-04-06 2022-11-23 3182251 10 3182241 3182241 CAPITAL GAIN DISTRIBUTION FROM FIDELITY 2021-01-01 2022-12-13 97103 97103 97103 7417303 0 105605 0 105605 0 105605 93000 0 15000 0 108000 0 2395 2395 0 0 0 0 0 0 0 1 0 0 0 1 1 CA 1 0 0 1 0 1 N/A JIM CONLEY CO THE BASZUCKI FAMILY 6502418740 204 2ND AVE 522 SAN MATEO CA 944013904 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DAVID BASZUCKI 204 2ND AVENUE 522 SAN MATEO CA 944013904 PRESIDENT 1.00 0 0 0 JAN BASZUCKI 204 2ND AVENUE 522 SAN MATEO CA 944013904 SECRETARY/TREASURER 10.00 0 0 0 NONE 0 HUNGRY HEART MEDIA INC 5450 W WASHINGTON BLVD LOS ANGELES CA 90016 COMMUNICATIONS 252235 GMMB 1200 WESTLAKE AVE N SEATTLE WA 98109 COMMUNICATIONS 168303 FARELLA BRAUN MARTEL LLP ONE BUSH STREET 9TH FLOOR SAN FRANCISCO CA 94104 LEGAL SERVICES 150808 ARNOLD & PORTER KAYE SCHOLER LLP 601 MASSACHUSETTS AVE NW WASHINGTON DC 20001 LEGAL SERVICES 89404 VALERIE CONN CONSULTING LLC 2023 32ND AVE S SEATTLE WA 981444949 CONSULTING SERVICES 72000 0 NONE 0 NONE 0 0 0 14861584 11793265 6582 26661431 0 0 26661431 399921 26261510 1313076 1313076 105605 105605 1207471 0 1207471 0 1207471 4736963 0 4736963 1207471 688512 0 0 4736963 688512 0 2840980 1207471 0 0 0 2840980 0 0 0 0 0 3167500 0 0 DAVID BASZUCKI JAN BASZUCKI X THE RESEARCH FOUNDATION FOR THE STATE UNIVERSITY OF NEW YORK PO BOX 9 ALBANY NY 12201 PC A RESEARCH PROJECT TO DEVELOP A DATA-DRIVEN SOFTWARE PLATFORM FOR MODELING COMPUTATIONAL PSYCHIATRY KNOWN AS NEUROBLOX UNDER THE DIRECT SUPERVISION OF L. R. MUJICA-PARODI, PH.D. 1154772 THE MILKEN INSTITUTE 1250 FOURTH STREET 2ND FLOOR SANTA MONICA CA 90401 PC LAUNCH AND FOSTER A NEW SCIENTIFIC COMMUNITY IN METABOLIC PSYCHIATRY. 2641413 UNIVERSITY OF PITTSBURGH 213 PARK PLAZA 128 NORTH CRAIG STREE PITTSBURGH PA 15260 PC TO SUPPORT BIPOLAR DISORDER AND RELATED RESEARCH IN THE MOOD AND BRAIN LAB IN THE DEPARTMENT OF PSYCHIATRY, WHICH IS CURRENTLY BEING CONDUCTED BY MARY PHILIPS, MD. 84769 3880954 THE RESEARCH FOUNDATION FOR THE STATE UNIVERSITY OF NEW YORK PO BOX 9 ALBANY NY 12201 PC A RESEARCH PROJECT TO DEVELOP A DATA-DRIVEN SOFTWARE PLATFORM FOR MODELING COMPUTATIONAL PSYCHIATRY KNOWN AS NEUROBLOX UNDER THE DIRECT SUPERVISION OF L. R. MUJICA-PARODI, PH.D. 1998454 THE MILKEN INSTITUTE 1250 FOURTH STREET 2ND FLOOR SANTA MONICA CA 90401 PC LAUNCH AND FOSTER A NEW SCIENTIFIC COMMUNITY IN METABOLIC PSYCHIATRY. 30000000 31998454 14 109313 14 100894 18 7417303 0 7627510 0 7627510 0 0 0 0 0 0 0 0 0 0 X X 1 DAVID AND JAN BASZUCKI 204 2ND AVENUE 522 SAN MATEO CA 944013904 3167500 X X 1 SECURITY (ROBLOX CORP CL A) 100,000 SHARES 3167500 2022-11-23 ACCOUNTING SERVICES 58788 29394 0 29394 IN ADDITION TO ITS GRANTMAKING ACTIVITIES, IN 2022 THE FOUNDATION LAUNCHED METABOLIC MIND LLC, A NONPROFIT INITIATIVE WITH A MISSION TO PROVIDE EDUCATION AND RESOURCES IN THE EMERGING FIELD OF METABOLIC PSYCHIATRY, INCLUDING KETOGENIC THERAPIES FOR MENTAL DISORDERS. NONE 0 SEE STATEMENT 16 PART XII, LINE 4(C) CONDUIT ELECTION STATEMENT STATEMENT REGARDING STATUS AS A CONDUIT PRIVATE FOUNDATIONTREASURY REGULATION 53.4942(A)-3(C)(2)(IV) ELECTIONTHE BASZUCKI FAMILY FOUNDATION; EIN: 32-0660398TAX YEAR ENDING: 12/31/2022ATTACHMENT TO FORM 990-PF, PART XII UNDISTRIBUTED INCOMETHE FOUNDATION HAD NO REMAINING UNDISTRIBUTED INCOME FOR THE CURRENT (2022) OR PRIOR TAX YEAR (2021) AS REQUIRED BY TREASURY REGULATION 53.4942(A)-3(C)(2)(I). THE FOLLOWING AMOUNTS REPRESENT THE CONTRIBUTIONS MADE TO THE FOUNDATION DURING 2022 AND THE SUBSEQUENT OUT OF CORPUS ELECTION TO DISTRIBUTE AN AMOUNT EQUAL TO ALL CONTRIBUTIONS IN SATISFACTION OF THE REQUIREMENTS OF TREASURY REGULATION 53.4942(A)-3(C)(2) ALLOWING THE FOUNDATION TO QUALIFY AS A CONDUIT FOUNDATION FOR THE 2022 TAX YEAR. AMOUNTS RECEIVED IN 2022 $3,167,500 PART XII, LINE 7AMOUNTS DISTRIBUTED BY 03/15/2023 ($3,167,500) (SEE DETAIL BELOW)REMAINING AMOUNT TO BE DISTRIBUTED $ 0 LINE 7 AMOUNT TREATED AS DISTRIBUTION OUT OF CORPUS TO SATISFY REQUIREMENTS IMPOSED BY IRC SECTION 170(B)(1)(F)(II). THE FOUNDATION MEETS THE REQUIREMENTS OF IRC 170(B)(1)(A)(VII), 170(B)(1)(F)(II) AND 4942(H) SUCH THAT QUALIFYING DISTRIBUTIONS OUT OF CORPUS WERE MADE WITHIN 2.5 MONTHS FOLLOWING THE CLOSE OF THE 2022 TAX YEAR IN AN AMOUNT EQUAL TO 100% OF ALL CONTRIBUTIONS RECEIVED DURING THE 2022 TAX YEAR. THERE IS NO REMAINING UNDISTRIBUTED INCOME FOR THE 2022 AND 2021 TAX YEARS. THEREFORE, THE FOUNDATION QUALIFIES AS A CONDUIT PRIVATE FOUNDATION AND THE 50% CHARITABLE CONTRIBUTION TAX BASE APPLIES UNDER IRC 170(B)(1)(A). _______________________________________________________________________ SIGNATURE AND TITLE DATE OWNERSHIP OF CONTROLLED ENTITIES FORM 990-PF, PART VI-A, LINE 11 METABOLIC MIND, LLC204 2ND AVE STE 522SAN MATEO, CA 94401THE BASZUCKI FAMILY FOUNDATION TRANSFERRED $100,000 OF INITIAL FUNDING TO LAUNCH METABOLIC MIND, LLC. DOMESTIC EQUITY SECURITIES (KNOW LABS & KETOSWISS) 499996 449996 25292220 25292220 0 0 UNREALIZED LOSS 13473335 GENERAL AND ADMINISTRATIVE 108096 0 0 108096 INVESTMENT EXPENSES 245 245 0 0 FEDERAL EXCISE TAX PAYABLE 325353 94872 DEFERRED FEDERAL EXCISE TAX PAYABLE 143392 0 PROFESSIONAL FEES 718519 0 0 718519 FOREIGN TAX PAID 364 364 0 0 EXCISE TAX EXPENSE 44483 0 0 0 METABOLIC MINDS LLC 204 2ND AVE STE 522 SAN MATEO CA 94401 920573910 THE BASZUCKI FAMILY FOUNDATION TRANSFERRED $100,000 OF INITIAL FUNDING TO LAUNCH METABOLIC MIND LLC. 100000 100000