2022-05-05T09:42:42-05:00 2021-06-30 366055558 GRANT THORNTON LLP 757 THIRD AVENUE 3RD FLOOR NEW YORK NY 100172013 990PF 2020-07-01 472836360 NICK SIMONS FOUNDATION INTERNATIONAL NICK 6469681888 149 5TH AVE 5TH FL NEW YORK NY 10010 MARILYN SIMONS SECRETARY/TREASURER 6463620039 2022-05-05 1 MARILYN SIMONS XXX-XX-XXXX SCOTT THOMPSETT P00741490 2125990100 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z X X 641474 X 5025000 0 5025000 0 0 0 0 0 0 408 0 0 408 956 0 0 956 12712 0 0 0 1500 0 0 1500 1729 0 0 1729 2055 0 0 2055 254 0 0 978 19614 0 0 7626 5020000 4395000 5039614 0 0 4402626 -14614 0 0 19001 641474 641474 19001 641474 641474 2224 14311 625000 2224 639311 X 16777 2163 16777 2163 19001 641474 16777 -14614 0 2163 0 2163 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 NY 1 0 0 0 0 1 N/A FANG HAN 6469681888 149 5TH AVE 5TH FL NEW YORK NY 10010 1 NP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 JAMES SIMONS 149 5TH AVE 5TH FL NEW YORK NY 10010 PRESIDENT 1.00 0 0 0 MARILYN SIMONS 149 5TH AVE 5TH FL NEW YORK NY 10010 SECRETARY/TREASURER 1.00 0 0 0 AUDREY CAPPELL 149 5TH AVE 5TH FL NEW YORK NY 10010 DIRECTOR 1.00 0 0 0 NATHANIEL SIMONS 149 5TH AVE 5TH FL NEW YORK NY 10010 DIRECTOR 1.00 0 0 0 LAURA-BAXTER SIMONS 149 5TH AVE 5TH FL NEW YORK NY 10010 DIRECTOR 1.00 0 0 0 ELIZABETH SIMONS 149 5TH AVE 5TH FL NEW YORK NY 10010 DIRECTOR 1.00 0 0 0 MARK HEISING 149 5TH AVE 5TH FL NEW YORK NY 10010 DIRECTOR 1.00 0 0 0 CAITLIN HEISING 149 5TH AVE 5TH FL NEW YORK NY 10010 DIRECTOR 1.00 0 0 0 JACOB CAPPELL 149 5TH AVE 5TH FL NEW YORK NY 10010 DIRECTOR 1.00 0 0 0 NONE 0 NONE 0 0 0 169287 0 169287 0 0 169287 2539 166748 8337 8337 0 8337 0 8337 0 8337 4402626 0 4402626 0 4402626 8337 0 0 1000300 3356486 3626660 57973 6763 8048182 4402626 0 0 4402626 0 0 8337 8337 12442471 0 0 0 0 0 4402626 991963 7047882 3356486 3626660 57973 6763 JAMES SIMONS X NICK SIMONS INSTITUTE BOX 8975 EPC 1813 SANEPA LALITPUR NP NONE NC TO TRAIN AND SUPPORT SKILLED HEALTHCARE WORKERS IN THE RURAL REGIONS OF NEPAL. 4395000 4395000 NICK SIMONS INSTITUTE BOX 8975 EPC 1813 SANEPA LALITPUR NP NONE NC TO TRAIN AND SUPPORT SKILLED HEALTHCARE WORKERS IN THE RURAL REGIONS OF NEPAL. 625000 625000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X X 1 NICK SIMONS FOUNDATION 149 5TH AVE 5TH FL NEW YORK NY 10010 5025000 X J.B. RAJBHANDARY & DIBINS 956 0 0 956 SEE STATEMENT 8 NICK SIMONS INSTITUTE BOX 8975 EPC 1813 SANEPA LALITPUR NP 2019-07-01 3670000 TO TRAIN AND SUPPORT SKILLED HEALTHCARE WORKERS IN THE RURAL REGIONS OF NEPAL. 3670000 NO 7/31/20 THE FUNDS WERE EXPENDED TO SUPPORT THE GRANTEE'S HEALTHCARE MISSION AS DESCRIBED UNDER "GRANT PURPOSE," WITHIN THE MEANING OF SECTION 170(C)(2)(B) OF THE INTERNAL REVENUE CODE. THE AMOUNT EXPENDED BY THE GRANTEE TOWARDS ACCOMPLISHMENT OF THESE PURPOSES IS $3,670,000 (BASED ON THE MOST RECENT REPORT RECEIVED FROM THE GRANTEE).TO THE BEST OF THE FOUNDATION'S KNOWLEDGE, THE GRANTEE HAS NOT DIVERTED ANY PORTION OF THE FUNDS (OR ANY INCOME THEREFROM) FROM THE PURPOSE OF THE GRANT. THE GRANTEE HAS CERTIFIED TO THE FOUNDATION THAT IT HAS EXPENDED, FOR CHARITABLE AND EDUCATIONAL PURPOSES, AN AMOUNT EQUAL TO THE VALUE OF THE GRANT NOT LATER THAN THE END OF THE GRANTEE'S FIRST TAXABLE YEAR AFTER THE TAXABLE YEAR IN WHICH THE GRANT WAS RECEIVED, IN ACCORDANCE WITH THE OUT-OF-CORPUS RULES OF SECTION 4942(G)(3) OF THE CODE. NICK SIMONS INSTITUTE BOX 8975 EPC 1813 SANEPA LALITPUR NP 2020-07-01 5020000 TO TRAIN AND SUPPORT SKILLED HEALTHCARE WORKERS IN THE RURAL REGIONS OF NEPAL. 4395000 NO 7/31/21 THE FUNDS WILL BE EXPENDED TO SUPPORT THE GRANTEE'S HEALTHCARE MISSION AS DESCRIBED UNDER "GRANT PURPOSE," WITHIN THE MEANING OF SECTION 170(C)(2)(B) OF THE INTERNAL REVENUE CODE. THE AMOUNT EXPENDED BY THE GRANTEE TOWARDS ACCOMPLISHMENT OF THESE PURPOSES IS $4,395,000 (BASED ON THE MOST RECENT REPORT RECEIVED FROM THE GRANTEE).TO THE BEST OF THE FOUNDATION'S KNOWLEDGE, THE GRANTEE HAS NOT DIVERTED ANY PORTION OF THE FUNDS (OR ANY INCOME THEREFROM) FROM THE PURPOSE OF THE GRANT. THE GRANTEE HAS CERTIFIED TO THE FOUNDATION THAT IT HAS EXPENDED, FOR CHARITABLE AND EDUCATIONAL PURPOSES, AN AMOUNT EQUAL TO THE VALUE OF THE GRANT NOT LATER THAN THE END OF THE GRANTEE'S FIRST TAXABLE YEAR AFTER THE TAXABLE YEAR IN WHICH THE GRANT WAS RECEIVED, IN ACCORDANCE WITH THE OUT-OF-CORPUS RULES OF SECTION 4942(G)(3) OF THE CODE. PART XIII, LINE 4(C) CONDUIT ELECTION STATEMENT STATEMENT REGARDING NICK SIMONS FOUNDATIONAL INT'L ELECTION TO BE TREATED AS A CONDUIT PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE SECTION 4942(H)(2) PURSUANT TO INTERNAL REVENUE CODE SECTION 4942(H)(2) AND TREASURY REGULATION SECTION 53.4942(A)-3(D)(2), NICK SIMONS FOUNDATION INTERNATIONAL HEREBY ELECTS TO TREAT CERTAIN QUALIFYING DISTRIBUTIONS MADE DURING THE 2020 TAX YEAR AS DISTRIBUTIONS MADE OUT OF CORPUS. ELECTION AMOUNT TREATED AS MADE OUT OF CORPUS: TOTAL QUALIFYING DISTRIBUTIONS FOR 2020: $4,402,626CURRENT YEAR DISBURSEMENTS APPLIED AGAINST 2020 DISTRIBUTABLE AMOUNT: $(0)TREATED AS DISTRIBUTIONS OUT-OF-CORPUS: $4,402,626TOTAL QUALIFYING DISTRIBUTIONS ATTRIBUTABLE TO NICK SIMONS FOUNDATION'S GIVING TREATED AS MADE OUT OF CORPUS TO SATISFY REQUIREMENTS IMPOSED BY SECTION 170(B)(1)(F) OR 4942(G)(3): $(4,402,626) EXCESS DISTRIBUTIONS CARRYOVER FROM 2020: $0 THE FOUNDATION MEETS THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTIONS 170(B)(1)(A)(VII), 170(B)(1)(F)(II) AND 4942(H)(2). THE FOUNDATION NOTES THAT: - NICK SIMONS FOUNDATION AND NICK SIMONS FOUNDATION INTERNATIONAL ARE RELATED ORGANIZATIONS. THE ELECTION REPRESENTS CONDUIT GRANTS NICK SIMONS FOUNDATION GAVE TO NICK SIMONS FOUNDATION INTERNATIONAL, WHICH NICK SIMONS FOUNDATION WILL BE RECOGNIZING AS QUALIFYING DISTRIBUTIONS ON ITS OWN TAX RETURN. - NOT LATER THAN ONE YEAR AFTER THE END OF THE TAX YEAR IN WHICH NICK SIMONS FOUNDATION INTERNATIONAL RECEIVED FUNDING FROM NICK SIMONS FOUNDATION, IT MADE A DISTRIBUTION EQUAL TO THE FULL AMOUNT OF THE CONTRIBUTION.- THE FOUNDATION HAS NO REMAINING UNDISTRIBUTABLE INCOME FOR THE 2019 AND 2020 TAX YEARS THAT WOULD PREVENT THE FOUNDATION FROM UTILIZING THE ELECTION. - THE FOUNDATION HAS MET ITS MINIMUM DISTRIBUTION REQUIREMENTS WITHOUT TAKING INTO ACCOUNT ANY OF THE AMOUNTS INTENDED TO BE USED AS A CONDUIT GRANT. LOEB, BLOCK & PARTNERS, LLP 408 0 0 408 BANK SERVICE FEES 175 0 0 175 NYS FILING FEES 25 0 0 25 GENERAL ADMINISTRATIVE EXPENSE 54 0 0 778 PROGRAM CONSULTING 12712 0 0 0