2022-11-15T15:05:07-06:00 2021-12-31 Foundation Source 3333 New Hyde Park Rd Ste 406 New Hyde Park NY 11042 990PF 2021-01-01 471982106 A to Z Impact Foundation % Foundation Source ATOZ 8008391754 Foundation Source 501 Silverside Rd Wilmington DE 198091377 Jeffrey Kaplan Founder and Chairman 8008391754 2022-11-14 true Jeffrey Kaplan 999009999 Jeffrey D Haskell P01345770 8008391754 2021 2022-09-23 18:48:47Z X 14975106 X 3133750 625 625 13663 13663 1074773 1092843 1810617 144229 145004 36493 4367040 1969909 36493 0 211923 10788 201135 47785 1895 45890 13841 0 0 13841 788 300 488 21010 2567 199 2368 125993 76043 49934 423907 89225 0 313656 313240 313240 737147 89225 0 626896 3629893 1880684 36493 1419785 3101005 3101005 417717 417717 415712 7279480 8518094 9660439 1128000 1838059 1797950 10244982 13874875 14975106 0 0 X 10244982 13874875 10244982 13874875 10244982 13874875 10244982 3629893 13874875 13874875 Publicly-traded Securities 1088889 397905 690984 690984 Passthrough K1 Capital Gain/(Loss) 1138130 DEERFIELD - DEERFIELD SPECIAL SITUATIONS FUND L.P P 2015-01-01 2021-11-19 3954 22451 -18497 -18497 1810617 26142 26142 26142 21800 0 5400 27200 X 0 1058 1058 false false false false false false false true true DE true false false false false true Foundation Source 8008391754 501 Silverside Road Suite 123 Wilmington DE 198091377 false false false true true false false false false false false false false false false false true false false true false false false false Andrea Kaplan Foundation Source 501 Silverside Rd Wilmington DE 198091377 Dir, VP 1.0 0 0 0 Jeffrey Kaplan Foundation Source 501 Silverside Rd Wilmington DE 198091377 Pres, Dir, Sec, Treas 20.0 0 0 0 Michael Kaplan Foundation Source 501 Silverside Rd Wilmington DE 198091377 Dir 40.0 0 0 0 ALEXANDER JOHN EVANGELIDES 1354 GRASSY BROOK RD BROOKLINE VT 05345 Foundation Person 40.0 71923 6269 MICHAEL KAPLAN 117 MAIN ST SEYMOUR CT 06483 EXECUTIVE DIR 40.0 140000 23780 MY AGRO PRI- TO FUND EXPENSES DIRECTLY RELATED TO RELIEVING POVERTY BY TRANSFORMING THE LIVES OF SMALL-SCALE FARMERS 625000 MY AGRO PRI - TO FUND EXPENSES DIRECTLY RELATED TO RELIEVING POVERTY BY TRANSFORMING THE LIVES OF SMALL-SCALE FARMERS; ORIGINAL AMOUNT OF $500,000 WAS RECOVERED DURING YEAR 1 0 851500 1476500 416282 1850586 8016594 10283462 0 10283462 154252 10129210 506461 506461 26142 26142 480319 766441 1246760 1246760 626896 1476500 0 0 0 2103396 1246760 2019 2018 2017 25973 1299754 680570 2006297 2103396 1246760 856636 2862933 0 2862933 25973 1299754 680570 856636 Jeffrey Kaplan X C Dieu- Nalio 463 West Street Apt A628 New York NY 10014 NONE I Short-term Emergency Assistance Grant 3000 COMMUNITY ANIMAL RESCUE EFFORT INC PO BOX 691 SKOKIE IL 60076 N/A PC General & Unrestricted 1875 CONSERVATIVE SYNAGOGUE OF FIFTH AVENUE FIFTH AVE 11 EAST 11TH STREET NEW YORK NY 10003 N/A PC Sam Swartz Wheelchair Fund 1180 DASRA ONE RIVERWAY STE 1900 HOUSTON TX 77056 N/A PC General & Unrestricted 50000 DECORAH COVENANT CHURCH DECORAH IA 115 WASHINGTON ST DECORAH IA 52101 N/A PC Nan Akou Cumberland Presbyterian Church in Haiti for Earthquake Relief run by Pastor Sheslaire 5000 DENVER RESCUE MISSION PO BOX 5206 DENVER CO 80217 N/A PC General & Unrestricted 1176 FRIENDS OF SIVANANDA ASHRAM YOGA IN THE CARIBBEAN 555 THEODORE FREMD AVE RYE NY 10580 N/A PC Help the Ashram Reopen Initiative 1000 J Beeks 413 W 16th Street 2D New York NY 10011 NONE I Short-term Emergency Assistance Grant 2500 KING BAUDOUIN FOUNDATION UNITED STATES INC 10 ROCKEFELLER PL 16TH FL NEW YORK NY 10020 N/A PC American Friends of the Rachel Swart Fund 10530 LIFE HOUSE FOUNDATION FOR CHILDREN PO BOX 1005 GLENDORA CA 91740 N/A PC Little Dreamers Academy, Uganda. 3570 LONG ISLAND COUNCIL OF CHURCHES 1644 DENTON GREEN HEMPSTEAD NY 11550 N/A PC The Freeport Food Pantry February Food Drive 750 LTP FOUNDATION INC 360 MADISON AVE NEW YORK NY 10017 N/A PC General & Unrestricted 150000 M Solomon 515 W 42ND ST NYNY Bronx NY 10453 NONE I Short-term Emergency Assistance Grant 2500 NYAYA HEALTH A NONPROFIT CORPORATION - POSSIBLE 99 WALL ST 4100 NEW YORK NY 10005 N/A PC COVID Relief Fund 10000 QUEENS COMMUNITY HOUSE INC 10825 62ND DR FOREST HILLS NY 11375 N/A PC General & Unrestricted 1000 RED DOOR COMMUNITY INC 195 W HOUSTON ST NEW YORK NY 10014 N/A PC Charitable Event 29204 SPREAD THE LOVE 25797 CONIFER RD CONIFER CO 80433 N/A PC General & Unrestricted 1080 THE WATER TRUST INC PO BOX 4668 75942 NEW YORK NY 10163 N/A PC General & Unrestricted 25000 THE WATER TRUST INC PO BOX 4668 75942 NEW YORK NY 10163 N/A PC Charitable Event 5000 WOMEN FOR AFGHAN WOMEN INC 15824 73RD AVE FRESH MEADOWS NY 11366 N/A PC General & Unrestricted 1875 ZANMI BENI FOUNDATION INC 6201 RIVIERA DR CORAL GABLES FL 33146 N/A PC General & Unrestricted 2000 ZANMI BENI FOUNDATION INC 6201 RIVIERA DR CORAL GABLES FL 33146 N/A PC Charitable Event 5000 313240 14 625 14 13663 525990 1 18 1074772 K-1 Inc/Loss 525990 -775 14 108511 INTEREST INCOME FROM PRIS 36493 -774 1197571 36493 1233290 11 Interest income from Program Related Investment, COMMUNITY INVESTMENT PRI 5YR - TO ADDRESS THE SOCIAL AND ECONOMIC HEALTH NEEDS OF THE DISADVANTAGED 11 Interest income from program related investment, ONE ACRE FUND PRI - TO PROVIDE FARM FAMILES WITH TOOLS AND FINANCING TO GROW THEIR WAY OUT OF HUNGER AND POVERTY BY OFFERING BASIC AGRICULTURAL TRAINING IN SUB-SAHARAN AFRICA 11 Interest Income from program related investment, Community investment PRI 1y- TO ADDRESS THE SOCIAL AND ECONOMIC NEEDS OF THE DISADVANTAGED IN COMMUNITY DEVELOPMENT 11 Interest income from program related investment, community housing capital Inc- TO FUND LOANS TO ANY ORGANIZATIONS DEVELOPING AFFORDABLE HOUSING & PROTECTING THE ENVIRONMENT. 11 Interest income from Program Related Investment MyAgro Farms, See Part IX-B for a description of this program-related investment false false false false false false false false false false X X 1 Kaplan Jeffrey 117 Main St Seymour CT 06483 3133750 X X 1 DEERFIELD PARTNERS, L.P 1000000 2021-07-01 1 MANKIND CORP. MNKD, 250000 sh. 1133750 2021-12-28 OPEN ROAD IMPACT FUND 4% PRI- TO PROVIDE FINANCIAL P&S TO ESTABLISHED SOCIAL ENT AND NON-PROFIT, DOM&INT, WHO REQUIRE SHORT-TERM BRIDGE FINANCING WHILE WAITING FOR COMMITED FUND 350000 RH CAPITAL FUND II PRI-TO ACCELERATE INNOVATION&AVAILABILITY OF REPRODUCTIVE HEALTH SOLUTIONS FOR WOMEN IN UNDERSERVED COMMUNITIES, WOMEN OF COLOR, MEDICAID PATIENTS & LOW INCOME 175000 COLLAB FUND PRI- TO PROVIDE ACCESS TO CAPITAL TO UNDERRESSOURCED & UNDERNETWORKED BLACK BUSINESS OWNERS WITH RESPECT TO VENTURE CAPITAL & GROWTH OPPORTUNITIES IN USA 166500 GLOBAL PTN/ELEOS SOCAL VENTURE PRI- TO EXPAND OPPORTUNITY FOR PEOPLE LIVING IN POVERTY 10000 OPEN ROAD IMPACT FUND 2% PRI- TO PROVIDE FINANCIAL PRODUCTS & SVCS TO SOCIAL ENTERPRISES AND NON-PROFITS WHO REQUIRE SHORT-TERM BRIDGE FINANCING WHILE WAITING FOR COMMITED FUNDS 150000 RH CAPITAL FUND II LP 47 Kearny Street San Francisco CA 94108 2021-02-09 175000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO See General Explanation for Report Dates None necessary Collab Fund I LLC 384 Northyards Blvd NW Atlanta GA 30313 2021-03-25 166500 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO See General Explanation for Report Dates None necessary Open Road Impact Fund LLC 301 Commerce Street Suite 301 Fort Worth TX 76102 2021-11-09 150000 PRI LOAN-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO See General Explanation for Report Dates None necessary Open Road Impact Fund LLC 301 Commerce Street Fort Fort Worth TX 76102 2021-11-09 350000 PRI LOAN-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO See General Explanation for Report Dates None necessary FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: RH CAPITAL FUND II, L.P. TOTAL AMOUNT OF PRI FUNDS DISBURSED: $175,000 DATES OF PRI: This PRI was made in multiple installments on the following dates: 2/9/2021 - $50,000 3/9/2021 - $75,000 11/3/2021 - $50,000 PURPOSE OF PRI: To accelerate innovation and increase the availability of reproductive health solutions for all women, and in particular for women in underserved communities, women of color, Medicaid patients and low-income women. REPORTS OF AMOUNTS EXPENDED: Recipient submitted a full and complete financial report of the type ordinarily required by commercial investors under similar circumstances and a statement that it has complied with the terms of the investment FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT:10/13/2022 FOR FYE 12/31/2021 This investment remained on the foundation's books as of 12/31/2021. Diversions: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: Collab Fund I, LLC DATE OF PRI: 3/25/2021 TOTAL AMOUNT OF PRI FUNDS DISBURSED: $166,500 PURPOSE OF PRI: To provide access to capital to black business owners who have historically been under-resourced and under-networked with respect to venture capital funding and growth opportunities in the United States REPORTS OF AMOUNTS EXPENDED: Recipient submitted a full and complete financial report of the type ordinarily required by commercial investors under similar circumstances and a statement that it has complied with the terms of the investment FOR ITS FISCAL YEARS INDICATED BELOW: DATE OF REPORT:10/12/2022 FOR FYE 12/31/2021 This investment remained on the foundation's books as of 12/31/2021. Diversions: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. PART I LINE 6A (990-PF) PART I LINE 6A (990-PF) PART I LINE 6A (990-PF) - RECONCILIATION OF NET GAIN/(LOSS) FROM SALES OF ASSETS NOT INCLUDED IN PART IV TOTAL INCLUDED IN PART IV: (DETAILS BELOW) NET GAIN/(LOSS): $1,074,771 TOTAL NOT INCLUDED IN PART IV: PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - UBI NET GAIN/(LOSS): $1 TOTAL PART I, LINE 6A: $1,074,772 DETAILS OF ASSETS INCLUDED IN PART IV: PUBLICLY-TRAIDED SECURITIES GROSS SALES PRICE: $1,088,889 BOOK BASIS: $1,133,750 NET GAIN/(LOSS): $(40,861) PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - NON UBI NET GAIN/(LOSS): $1,138,130 SALES OF OTHER ITEMIZED ASSETS GROSS SALES PRICE: $3,954 BOOK BASIS: $22,452 NET GAIN/(LOSS): $(18,498) FORM 990-PF FORM 990-PF One or more partnerships in which the foundation was invested in 2021 have provided a Schedule K-1 indicating that a Schedule K-3 would be provided, but it was not provided. As a result, there is insufficient information to allow Foundation Source, as tax preparer, to ascertain whether there is missing information about direct or indirect foreign investments that might have affected any item on this return or required additional forms to be filed. The Foundation has prepared this return to the best of its ability and without any foreign filings for such partnerships based on the information provided to it by these partnerships and on the basis of having received no information to the contrary. Any missing or incomplete information is due to the Foundation's inability to obtain such information and is not a willful attempt to withhold such information. FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: Open Road Impact Fund LLC DATE OF PRI: 11/9/2021 TOTAL AMOUNT OF PRI FUNDS DISBURSED: $150,000 PURPOSE OF PRI: To provide financial products and services to established social enterprises and non-profits, domestically and internationally, who require short-term bridge financing while waiting for committed funding. REPORTS OF AMOUNTS EXPENDED: Recipient is expected to submit a full and complete financial report of the type ordinarily required by commercial investors under similar circumstances and a statement that it has complied with the terms of the investment in 2022. This investment remained on the foundation's books as of 12/31/2021. Diversions: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY FORM 990-PF, PART VI-B, LINE 5D - EXPENDITURE RESPONSIBILITY PRI RECIPIENT: Open Road Impact Fund LLC DATE OF PRI: 11/9/2021 TOTAL AMOUNT OF PRI FUNDS DISBURSED: $350,000 PURPOSE OF PRI: To provide financial products and services to established social enterprises and non-profits, domestically and internationally, who require short-term bridge financing while waiting for committed funding. REPORTS OF AMOUNTS EXPENDED: Recipient is expected to submit a full and complete financial report of the type ordinarily required by commercial investors under similar circumstances and a statement that it has complied with the terms of the investment in 2022. This investment remained on the foundation's books as of 12/31/2021. Diversions: TO THE KNOWLEDGE OF THE GRANTOR, NO FUNDS HAVE BEEN DIVERTED TO ANY ACTIVITY OTHER THAN THE ACTIVITY FOR WHICH THE INVESTMENT WAS ORIGINALLY MADE. MAINSTAY SHORT DURATION HIGH Y 416088 411193 UNITEDHEALTH GROUP INC 1629 4519 CONTEXT PARTNERS OFFSHORE, L.P 1000000 1495728 DEERFIELD PARTNERS, L.P 6784930 6367404 ELEVAR EQUITY IV, L.P 349023 1289668 ILLUMEN CAPITAL LP 212173 318014 IMPACT VENTURES IV, LP 171968 189625 Document Review/Drafting 12978 12978 General Consultations 863 863 COMMUNITY INVESTMENT NOTE, 5 Y 250000 250000 GLOBAL PTN/ELEOS SOCIAL VENTUR 61559 61559 PRI - COLLAB FUND I, LLC - 0% 166500 147214 PRI - MYAGRO FARMS - 5% - 09/3 625000 625000 PRI - ONE ACRE FUND - 2% 60000 60000 PRI - OPEN ROAD IMPACT FUND LL 150000 150000 PRI - OPEN ROAD IMPACT FUND SU 350000 350000 PRI - RH CAPITAL FUND II, L.P. 175000 154177 Administrative Fees 35613 35613 Bank Charges 90 90 Cell Phone Expense 1743 57 1686 Computers/Electronic Devices 1976 1976 Equipment/Furniture Purchase 321 321 Foundation Dues & Memberships 7299 7299 K-1 Exp DEERFIELD PARTNERS, L. 33004 32992 K-1 Exp DEERFIELD SPECIAL SITU 259 259 K-1 Exp ELEVAR EQUITY IV, L.P 9952 9951 K-1 Exp ILLUMEN CAPITAL LP 16962 16959 K-1 Exp IMPACT VENTURES IV, LP 15725 15725 OFFICE SUPPLIES 484 484 EQUIPMENT MAINTENANCE 137 137 DIGITAL SUBSCRIPTIONS 221 10 211 Payroll Processing Fees 982 982 State or Local Filing Fees 25 25 Training & Professional Develo 1200 1200 K-1 Inc/Loss DEERFIELD PARTNERS, L.P 105126 105901 K-1 Inc/Loss DEERFIELD SPECIAL SITUATIONS FUND L.P 781 781 K-1 Inc/Loss ELEVAR EQUITY IV, L.P 1436 1436 K-1 Inc/Loss ILLUMEN CAPITAL LP 287 287 K-1 Inc/Loss IMPACT VENTURES IV, LP 106 106 Interest Income from PRIs 36493 36493 36493 Investment Management Services 300 300 Website Development 488 488 990-PF Estimated Tax for 2021 4500 990-PF Extension for 2020 16510