2025-11-17T10:28:31-06:00 2024-12-31 Foundation Source 3333 New Hyde Park Rd Ste 406 New Hyde Park NY 11042 990PF 2024-01-01 454797578 David & Janet Polak Foundation % Foundation Source DAVI 8008391754 Foundation Source 501 Silverside Rd Wilmington DE 198091377 JEFFREY POLAK PRESIDENT 8008391754 2025-11-14 true true Jeffrey D Haskell P01345770 8008391754 2024 2025-03-06 01:10:19Z X 81278194 X 7800 136837 136837 1793981 1793981 1642733 33743486 1554530 1233708 1167235 -31590 4815059 4652583 -31590 278167 278167 89500 89500 48257 48257 18401 2775 0 15626 583448 405628 177820 163932 15096 69767 69767 151171 151171 9874 9874 913261 745383 2520 134517 2325778 1168882 2520 974699 2334600 2334600 4660378 1168882 2520 3309299 154681 3483701 0 5287003 4819298 4819298 23488275 24996762 25309163 12039652 11491674 14293871 1000149 1000149 986078 24001746 23322758 31391444 4442972 4783837 4478340 70259797 70414478 81278194 0 0 X 70259797 70414478 70259797 70414478 70259797 70414478 70259797 154681 70414478 70414478 Publicly-traded Securities 33742952 32705776 1037176 1037176 Passthrough K1 Capital Gain/(Loss) 535520 LATITUDE MGMT REAL ESTATE CAPITAL III INC P 2024-01-02 2024-05-09 534 18700 -18166 -18166 1554530 48423 48423 48423 58778 0 58778 X 0 10355 10355 false false false false false true true false true true CA 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 David Polak Foundation Source 501 Silverside Rd Wilmington DE 198091377 Dir 1.0 0 0 0 Janet Polak Foundation Source 501 Silverside Rd Wilmington DE 198091377 Dir 1.0 0 0 0 Jeff Polak Foundation Source 501 Silverside Rd Wilmington DE 198091377 Dir, Pres 40.0 278167 26509 0 Robert Polak Foundation Source 501 Silverside Rd Wilmington DE 198091377 Dir 1.0 0 0 0 Jonathan Seltzer Foundation Source 501 Silverside Rd Wilmington DE 198091377 Dir 1.0 0 0 0 Noreen L Rubio 4301 Mandalay Drive Los Angeles CA 90063 ADMINISTRATIVE ASST 40.0 89500 940 polak investors llc 1880 Century Park East Ste 811 Los Angeles CA 90067 Investment Mgmt 388686 POP 403 Productions LLC 15057 Greenleaf Street Sherman Oaks CA 91403 Philanthropic 120000 Foundation Source 55 Walls Drive Suite 302 Fairfield CT 06824 Administrative 105688 AKLA PROGRAM - WILL INTRODUCE PARTICIPANTS TO EXCITING & INSPIRING NEW WAYS OF LOOKING AT THEIR JEWISH VALUES & CONNECT THEM WITHIN THEIR OWN LIVES & LA JEWISH COMMUNITY 315029 PRI TO BRIGHT URO, INC TO FUND RESEARCH AND DEVELOPMENT OF THE GLEAN URODYNAMICS SYSTEM AND RELATED SOFTWARE TO FIND A EFFECTIVE DIAGNOSTIC UROLOGY TOOL 250000 PRI - OCT HEALTH, LLC TO PROMOTE THE HEALTH AND REDUCE THE SUFFERING OF THOSE AFFECTED BY AGE-RELATED MUSCULAR DEGENERATION AND TO ADVANCE RESEARCH IN PUBLIC INTEREST 125000 375000 42709914 3335530 31739621 77785065 0 77785065 1166776 76618289 3830914 3830914 48423 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Future 50000 WASHINGTON INSTITUTE FOR NEAR EAST POLICY 1111 19TH ST NW STE 500 WASHINGTON DC 20036 N/A PC General & Unrestricted 5000 YOUNG AMERICA'S FOUNDATION 11480 COMMERCE PARK DR STE 600 RESTON VA 20191 N/A PC General & Unrestricted 10000 2334600 14 136837 14 1793981 525990 199530 18 1443203 K-1 Inc/Loss 525990 -92531 14 1204901 Federal Tax Refund 01 152157 K-1 INC/LOSS PRI - OCTHEALTH LLC -10408 K-1 INC/LOSS PRI - BBI MEDICAL SOLUTIONS -14605 K-1 INC/LOSS PRI - BRYN PHARMA LLC -2 K-1 INC/LOSS PRI - YAMO PHARMACEUTICALS LLC -6575 FOREIGN CURRENCY LOSS 01 -5860 CLASS ACTION LAWSUIT PROCEEDS 01 16 STATE TAX REFUND 01 6615 106999 4731850 -31590 4807259 11 BBI Medical - loss from program related investment to promote health & reduce suffering of those affected by early state pressure ulcers DURING THE HOSPITAL STAYS and TO ADVANCE SCIENTIFIC UNDERSTANDING THROUGH RESEARCH. Octhealth LLC - loss from program related investment TO PROMOTE THE HEALTH OF PEOPLE WHO ARE AFFECTED BY POLLUTED DRINKING WATER BY FUNDING THE DEVELOPMENT OF A WATER MONITORING SYSTEM. BRYN PHARMA LLC FKA EPI-NOW LLC - loss from program related investment TO FUND TASK 4(A)-STUDY 5 OF THE MRI STATEMENT OF WORK WHICH WILL ASSIST THE COMPANY IN ITS DEVELOPMENT OF AN EPINEPHRINE DELIVERY SYSTEM YAMO PHARMACEUTICALS LLC - loss from program related investment to PROMOTE HEALTH BY FINDING AN EFFECTIVE CURE FOR AUTISM false false false false false false false false false false X X 1 The Sandra Lawrence Post Family F 3275 Old Conejo Rd Thousand Oaks CA 91320 5000 X Jeff Polak * DAVID POLAK (DIRECTOR), JANET POLAK (DIRECTOR) AND JEFF POLAK PRESIDENT/DIRECTOR/EXECUTIVE DIRECTOR), OF DAVID & JANET POLAK FOUNDATION (THE "FOUNDATION"), ARE PRINCIPALS AT THE INVESTMENT MANAGEMENT FIRM POLAK INVESTORS, LLC, A DISQUALIFIED PERSON WHICH PROVIDES INVESTMENT MANAGEMENT SERVICES TO THE FOUNDATION. IN THE TAXABLE YEAR ENDING DECEMBER 31, 2024, THE FOUNDATION PAID $388,686 FOR INVESTMENT MANAGEMENT SERVICES RENDERED BY SUCH DISQUALIFIED PERSON, AS REPORTED IN PART I, LINE 16C. THE REASONABLENESS OF THE PROFESSIONAL FEES WAS ESTABLISHED BY AN OUTSIDE COMPENSATION COMMITTEE, WHICH REVIEWED THE RATES CHARGED BY COMPARABLE INVESTMENT MANAGEMENT FIRMS. NEUROVISION IMAGING INC 1395 GARDEN HIGHWAY SUITE 250 SACRAMENTO CA 95833 2014-12-17 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BBI MEDICAL FKA BRUIN BIOMETRICS LLC 10960 WILSHIRE BLVD SUITE 950 LOS ANGELES CA 90024 2015-05-13 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BIOP MEDICAL LTD 10 OHALIAV ST RAMAT GAN IS 5252263 2017-04-21 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. SIVACEL FKA ONLINE DISRUPTIVE TECH MATAM ADV TECH PK BLD 23 POBX 15050 HAIFA IS 3190501 2017-04-21 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. ORGENESIS LTD ARAD STREET 9 TEL AVIV IS 2017-04-21 305498 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BRYN PHARMA LLC FKA EPI-NOW LLC 518 NORTH HILLCREST ROAD BEVERLY HILLS CA 90210 2018-07-13 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. CYWAT TECHNOLOGIES LTD 168 JABOTINSKY ST BNEI BRAK IS 2018-11-26 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BIO-ACTIVES SYNERYGIO LTD FKA YB MO CHO HITECH VIL 4/9 GIVAT RAM POB 39231 JERUSALEM IS 9129102 2018-04-20 250000 PRI LOAN-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BIO-ACTIVES SYNERYGIO LTD FKA YB MO CHO HITECH VIL 4/9 GIVAT RAM POB 39231 JERUSALEM IS 9129102 2018-07-19 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. MAXQ AI LTD 96 YIGAL ALON STREET ENTRANCE A TEL AVIV IS 6789140 2019-03-19 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. EXTHERA MEDICAL CORPORATION 757 ARNOLD DRIVE SUITE B MARTINEZ CA 94553 2019-12-19 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. YONALINK LTD HADASSAH EIN KEREM HOSP POB 12000 JERUSALEM IS 9112001 2019-11-12 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. AMICROBE INC 3142 TIGER RUN COURT 103 CARLSBAD CA 92010 2019-10-31 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. OCTHEALTH LLC 1395 GARDEN HIGHWAY SUITE 250 SACRAMENTO CA 95833 2021-06-08 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BIO-ACTIVES SYNERGIO LTD HI-TECH VILLAGE UNIT 4/9 POB39231 GIVAT RAM IS 9129102 2021-10-12 100000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. CYWAT TECHNOLOGIES LTD 168 JABOTINSKY ST BNEI BRAK IS 2021-06-15 100000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. NEUROVISION IMAGING INC 1395 GARDEN HIGHWAY SUITE 250 SACRAMENTO CA 95833 2022-06-17 250000 PRI LOAN-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. YAMO PHARMACEUTICALS LLC 400 MADISON AVE STE 11A NEW YORK NY 10017 2022-07-13 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES THE GRANTOR HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE REPORTS FROM THE GRANTEE; THEREFORE, NO INDEPENDENT VERIFICATION OF THE REPORTS WAS MADE. BRIGHT URO INC 1209 Orange St Wilmington DE 19801 2024-01-11 250000 PRI INVEST-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES NONE NECESSARY OCT Health LLC 1395 Garden Hwy Sacramento CA 95833 2024-07-26 125000 PRI LOAN-SEE GENERAL EXPLANATION FOR PURPOSE & ADDTL DETAILS RE AMT EXPENDED & LACK OF DIVERSION NO SEE GENERAL EXPLANATION FOR REPORT DATES NONE NECESSARY Forms 8865 Form 8865 The Foundation has prepared this form to the best of its ability based on the limited information provided to it by the investment on which the Foundation is reporting 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. 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): $1,443,203 TOTAL NOT INCLUDED IN PART IV: PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - UBI NET GAIN/(LOSS): $199,530 TOTAL PART I, LINE 6A: $1,642,733 DETAILS OF ASSETS INCLUDED IN PART IV: PUBLICLY-TRAIDED SECURITIES GROSS SALES PRICE: $33,742,952 BOOK BASIS: $32,817,103 NET GAIN/(LOSS): $925,849 PASSTHROUGH K-1 CAPITAL GAIN/(LOSS) - NON UBI NET GAIN/(LOSS): $535,520 SALES OF OTHER ITEMIZED ASSETS GROSS SALES PRICE: $534 BOOK BASIS: $18,700 NET GAIN/(LOSS): $(18,166) EDISON INTL BOND PERPETUAL - 5 1000149 986078 AGNICO EAGLE MINES LTD 735251 1228288 ALGOMA STL GROUP INC 76925 97800 ALLIED GOLD CORP 34816 35565 AMERICAN AXLE & MFG HOLDINGS I 165846 105523 ARCH COAL, INC 25424 42366 ARDAGH METAL PACKAGING SA 117421 60200 B2 GOLD CORP COM NPV 150587 102968 BARRICK GOLD CORPORATION 757500 387500 BAYER A G SPONSORED ADR 198370 39040 BERRY PLASTICS GROUP INC 215823 323350 BLACKSTONE SEC LENDING 315803 420030 BLOOM ENERGY CORP 19368 22210 CAMECO CORPORATION 19784 51390 CENTERRA GOLD INC 88332 56900 CENTURY ALUMINUM COMPANY 15721 18220 CHENIERE ENERGY INC 201025 537175 CITIGROUP INC 248049 351950 CLIFFS NATURAL RESOURCES INC. 69635 37600 COMPASS MINERALS INTERNATIONAL 160778 45000 COMSTOCK RES INC 130453 346180 CONSOL ENERGY, INC 53977 160020 CONSTELLIUM NV 136767 61620 COPA HOLDINGS S.A 99309 87880 COTERRA ENERGY INC 425563 613318 CVS CAREMARK CORP 233000 224450 DANA HOLDING CP 18142 11560 ELDORADO GOLD CORP COM NPV 308509 416360 ENDEAVOUR MINING CORP 206264 181115 FIDELITY CONSERV INC BD FD 9664 9700 FIRST MAJESTIC SILVER CORP 142415 82350 FLUTTER ENTERTAINMENT ORD SHS 90356 180915 G MINING VENTURES CORP 49888 118273 GENERAL MOTORS 329075 479430 GOLD FIELDS LTD ADS 125508 290400 GRAFTECH INTERNATIONAL LTD 427360 83040 GRAPHIC PACKAGING CORP COM STK 41828 81480 HALLIBURTON COMPANY 226736 163140 HESS CORP 190621 266020 HOLCIM N 442464 855000 HUDBAY MINERALS INC 224452 497988 IVANHOE MINES LTD 43852 260480 JAPAN SMALLER CAPITALIZATION F 403984 389636 JET2 PLC 47621 99127 JOHNSON & JOHNSON 48846 77516 KAZATOMPROM JSC NAC GDR 147503 377500 LIBERTY OILFIELD SVCS INC COM 151164 238680 MAGNERA CORP 17793 25093 MARKET VECTORS VIETNAM ETF 40705 22960 MERCK & CO INC 68053 149220 MICRON TECHNOLOGY 300822 925760 MONTAGE GOLD CORP 77026 111000 NEWMONT GOLDCORP CORPORATION 683100 734574 NEXGEN ENERGY LTD 115963 231000 NOVAGOLD RESOURCES 108485 66600 NUVEEN MLT STR I&G 9760 7860 OCEANAGOLD CORPORATION COM 142250 165660 ORGANON & CO 18170 11936 PFIZER INC 294452 318360 PHILIP MORRIS INTL 8916 12035 SHELL ADR EACH REPRESENTING 2 155120 187950 TEVA PHARMACEUTICAL INDUSTRIES 36513 22040 THE MOSAIC CO 306123 196640 TOREX GOLD RESOURCES 181332 295370 TPG RE FINANCE TRUST INC 2013 850 TRUIST FINANCIAL CORPORATION 30848 43380 UNITED STATES STEEL CORP 50123 67980 VALARIS LTD WTS EXP 04/29/2028 220170 662 VALARIS PLC COM CL A 161969 VIATRIS ORD SHS 90189 80688 23280042 23590170 1716720 1718993 ACHIEVE PARTNERS EDTECH BUYOUT 236446 192417 AIR U.S. LIFE FUND III, LP 2205878 2173614 AIR US LIFE FUND IV, LP 1926638 2153897 ALPHA WAVE (F/K/A FALCON EDGE) 546775 1278748 ALTAIR - 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