OMB No 1545-0052 Form 990 -PF Return of Private Foundation or Section 4947(aXl) Trust Treated as Private Foundation ' Do not enter Social 201 3 Department of the Treasury Security numbers on this form as it may be made public. Internal Revenue Service Information about Form 990 - PF and its separate instructions is at www. irs.gov/form990pf. For calendar year 2013, or tax year beginning 3/01 , 2013, and ending 2/28 , 2014 Employer Identification number ZICHRON SIMCHA D'SASSOV 45-0673679 86 ROUTE 59 Telephone number (see the instructions) SPRING VALLEY, NY 10977

r~ IT exemption application is penaing, cnecK nere G Check all that apply Initial return Initial return of a former public charity Final return Amended return D 1 Foreign organizations, check here Address change Name change 2 Foreign organizations meetin g the 85% test, check q H Check type of org an iza ion X t S ec t ion 501 (c)(3) exempt priva te foun d ation here and attac h computation ► Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation 0 11 E If private foundation status was terminated I Fair market value of all assets at end of year J Accounting method- }{ Cash Accrual under section 507(b)(1)(A), check here [ (from Part Il, column (c), line 16) Other (specify) F If the foundation is in a 60-month termination under section 507(b)(1)(B), check here ► $ (Part column (d) must be on cash basis.) Part I ]Analysis o R evenue an d Revenue and (b) Net Investment (c) Adjusted net (d) Disbursements Expenses (The total of amounts in per columns (b), (c), and (d) may not neces- expenses books income income for charitable purposes (cash sanly equal the amounts In column (a) onlyly) (see instructions).) basisb only) Contributions, gifts, grants, etc, received (aft sch) 162 , 360. 2 Ck ' if the foundn is not req to att Sch B 3 Interes on savings and temporary cash investments 4 Dividends and interest from securities 5a Gross rents b Net rental income or (loss) R 6a Net gain /(loss) from sale of assets not on line 10 E b Gross sales price for all V assets on line 6a - - - - • ------E 7 Capital gain net income (from Part IV, line 2) - N 8 Net short-term capital gain U 9 Income modifications E Gross sale less 10a returns an^ allowances b Less Cost of goods sold c Gross profit/(loss) (attsch) 11 Other income (attach scheduled

12 Total. Add Ines th roug h 162 360. 0. 0. 1-5 Compensation of officers, directors, trustees, etc 14 Other employee salaries and wages 15 Pension plans, employee benefits A 16a Legal fees (attach schedule) - _ =-n= - M b Accounting fees (attach sch) '16-1 IC Y V N c Other prof fees (attach sch) 1I 17 Interest A (7 u P S 1 E TT 18 Taxes (attach schedulexsee instrs) 19 Depreciationsch) T T dep l e ton h ( N I 20 Occupancy i" c G E 21 Travel, conferences, and meetings A E 22 Printing and publications N P 23 Other expenses (attach schedule) D NE See Statement 1 1 , 132. S 24 E Total operatin g and administrative expenses . Add lines 13 through 23 1 , 132. 25 Contributions, gifts, grants paid Part XV 165 905. 165 , 905. 26 Total expenses and disbursements. Add lines 24 and 25 167 037. 0. 0. 165 , 905. 27 Subtract line 26 from lne : a Excess of revenue over expenses and disbursements -4,677. 1 b Net investment income (f negative, enter -0-) 0. 1 1 C Adj usted net Income ( if negative, enter -0-) 0. umm rur ropwrwurR rceuuc: uun race riusice, see Insiruclons . TEEAU504L 10/18/13 form y9U-F'h (LU13) Form 990-PF (2013) ZICHRON SIMCHA D' SAS 45-0673679 Page 2 Attached schedules and amounts in the description 3eginning of year End of year Part 11 Balance Sheets column should be for end-of-year amounts only (See instructions ) (a) Book Value (b) Book Value (c) Fair Market Value 1 Cash - non-interest-bearing 5,392. 872. 2 Savings and temporary cash investments 3 Accounts receivable ► ------j Less: allowance for doubtful accounts 11 - 4 Pledges receivable ► ------Less. allowance for doubtful accounts ------5 Grants receivable 6 Receivables due from officers, directors, trustees, and other disqualified persons (attach schedule) (see instructions) 7 Other notes and loans receivable (attach sch) 210. ► ------^ S Less- allowance for doubtful accounts 1, 210.------210. S 8 Inventories for sale or use E 9 Prepaid expenses and deferred charges T S 10a Investments - U S and state government obligations (attach schedule) b Investments - corporate stock (attach schedule) c Investments - corporate bonds (attach schedule) 11 Investments - land, buildings, and equipment: basis ► ------Less accumulated depreciation (attach schedule) ------12 Investments - mortgage loans 13 Investments - other (attach schedule) 14 Land, buildings, and equipment- basis ► ------Less: accumulated depreciation (attach schedule) ► Other 15 assets (describe ► See Statement_ _2______2,091. 1,934. 16 Total assets (to be comprtec1b -all1lf rs- see the instructions. Also, see page 1, item I) 7,693. 3,016. 0. L 17 Accounts payable and accrued expenses A 18 Grants payable B 19 Deferred revenue L 20 Loans from officers, directors, trustees, & other disqualified persons I 21 Mortgages and other notes payable (attach schedule) 22 Other liabilities (describe, ) E S 23 Total liabilities (add lines 17 through 22) 0 . 0 . Foundations that follow SFAS 117, check here and complete lines 24 through 26 and lines 30 and 31. N F 24 Unrestricted E U Temporarily T N 25 restricted D 26 Permanently restricted AS B Foundations that do not follow SFAS 117, check here }{ S A and complete lines 27 through 31. E L T A 27 Capital stock, trust principal, or current funds S N 28 Paid-in or capital surplus, or land, building, and equipment fund Retained earnings, O CE 29 accumulated income, endowment, or other funds 7,693. 3 , 016. R S 30 Total net assets or fund balances (see instructions) 7,693. 3,016. 31 Total liabilities and net assets/fund balances (see instructions) 7,693. 3,016. Part Ana lysis of Changes in Net Assets or un a ances 1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year's return) 1 7 , 693. Part 2 Enter amount from I, line 27a 2 --4,677. 3 Other increases not included in line 2 (itemize) ' 3 ------4 Add lines 1, 2, and 3 4 3, 016. 5 Decreases not included in line 2 (itemize) ► ______5 6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II, column (b), line 3Q 6 3,016. BAA TEEA0302L 07/09/13 Form 990-PF (2013) Form 990-PF (2013) ZICHRON SIMCHA D'SASSOV 45-0673679 Page 3 Party C apita lMain an losses for Tax on I nvestment I ncome (a) List and describe the kind (s) of proper sold (e . g., real estate, How acquired (C) Date acquired Date sold 2-story brick warehouse ; or common stock , (00 shares Company) P - Purchase (month, day, year) (month , day, year) MLC D - Donation 1 a N/A b c d e (e) Gross sales price (f) Depreciation allowed (g) Cost or other basis (h) Gain or (loss) (or allowable) plus expense of sale (e) plus (f) minus (g) a b c d e Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Gains (Column (h) (i) Fair Market Value (j) Adjusted basis (k) Excess of column (i) gain minus column (k), but not less as of 12/31/69 as of 12/31 /69 over column 0), if any than -0- ) or Losses (from column (h)) a b c d e

2 Capital gain net income or (net capital loss) If ain , also enter in Part I, line 7 { lf ?loss), enter -0- in Part I, Ilne 7 } 2 3 Net short - term capital gain or (loss) as defined in sections 1222(5 ) and (6): If gain, also enter in Part I , line 8, column (c) (see instructions ) If (loss), enter -0- IF in Part I , line 8 3 a " ' Q ua l i fication U nder Section 4940(e) for Red uced Tax on Net I nvestm -e-n-115come (For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income) N/A If section 4940(d)(2) applies, leave this part blank

Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period? [Yes [ No If 'Yes,' the foundation does not qualify under section 4940 (e) Do not complete this part 1 Enter the appropriate amount in each column for each year , see the instructions before making any entries

Base periiod years Adjusted qualifying distributions Net value of Distributtiion ratio Calendar year (or tax year beginning in) noncharitable-use assets (column (b) divided by column (c)) 2012 2011 2010 2009 2008

2 Total of line 1, column (d) 2 3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by the number of years the foundation has been in existence if less than 5 years 3

4 Enter the net value of noncharitable-use assets for 2013 from Part X, line 5 4

5 Multiply line 4 by line 3 5

6 Enter 1 % of net investment income (1 % of Part I, line 27b) 6

7 Add lines 5 and 6 7

8 Enter qualifying distributions from Part XII, line 4 L8 If line 8 is equal to or greater than line 7, check the box in Part VI, line 1 b, and complete that part using a 1 % tax rate See the Part VI Instructions. BAA Form 990-PF (2013)

TEEA0303L 07/09/13 Form 990-PF (2013) ZICHRON SIMCHA D'SASSOV 45-0673679 Page 4 Part V1 I E xcise Tax Based on I nvestment I ncome (Section 4940(a), 4940(b), 4940(e), or 4948 - see instructions) 1 a Exempt operating foundations described in section 4940(d)(2), check here and enter 'N/A' on line 1. Date of ruling or determination letter: _ _ _ (attach copy of letter if necessary - see instrs) Domestic foundations that meet b the section-494o(e) requirements in Part V, 1 01 check here- ' Fland enter 1 % of Part I, line 27b c All other domestic foundations enter 2% of line 27b Exempt foreign organizations enter 4% of Part I, line 12, column (b) 2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0. 3 Add lines 1 and 2 3 0. 4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) 4 0. 5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- 5 0. 6 Credits/Payments: a 2013 estimated tax pmts and 2012 overpayment credited to 2013 6a b Exempt foreign organizations - tax withheld at source 6b c Tax paid with application for extension of time to file (Form 8868) 6c d Backup withholding erroneously withheld 6d 7 Total credits and payments Add lines 6a through 6d 7 0. 8 Enter any penalty for underpayment of estimated tax Check here if Form 2220 is attached 8 11 9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed 9 0. 10 Overpayment If line 7 is more than the total of lines 5 and 8, enter the amount overpaid 10 11 Enter the amount of line 10 to be. Credited to 2014 estimated tax ' Refunded 11

1 a During the tax year , did the foundation attempt to influence any national , state , or local legislation or did it Yes No participate or intervene in any political campaign? 1 a X b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see the instructions for definition) 1 b X If the answer is 'Yes' to 1a or 1b, attach a detailed description of the activities and copies of any materials published or distributed by the foundation in connection with the activities c Did the foundation file Form 1120-POL for this year? 1 c X d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year (1) On the foundation ' $ 0. (2) On foundation managers 0-$ 0. e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax impose on foundation managers. $ 0. 2 Has the foundation engaged in any activities that have not previously been reported to the IRS' . 2 X If 'Yes,' attach a detailed description of the activities.

3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles - - - of incorporation, or bylaws, or other similar instruments? If 'Yes,' attach a conformed copy of the changes 3 X 4a Did the foundation have unrelated business gross income of $1,000 or more during the year? 4a X b If 'Yes,' has it filed a tax return on Form 990-T for this year? 4b N A 5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? 5 X If 'Yes,' attach the statement required by General Instruction T. 6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either • By language in the governing instrument, or • By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict - - - with the state law remain in the governing instrument' 6 X 7 Did the foundation have at least $5,000 in assets at any time during the year? If 'Yes,' complete Part II, column (c), and PartXV 7 X Enter 8a the states to which the foundation reports or with which it is registered (see instructions) ► 1 N/A b If the answer is 'Yes' to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General - (or designate) of each state as required by General Instruction G7 If 'No, 'attach explanation 8 b X 9 Is the foundation claiming status as a private operating foundation within the meaning of section 49420)(3) or 49420)(5) - --7 for calendar year 2013 or the taxable year beginning in 2013 (see instructions for Part XIV)7 If 'Yes,' complete Part XIV 9 X

10 Did any persons become substantial contributors during the tax year? If 'Yes,' attach a schedule listing their names and addresses 10 X BAA Form 990-PF (2013)

TEEA0304L 07/10/13 Form 990-PF (2013) ZICHRON SIMCHA D'SASSOV 45-0673679 Page 5

11 At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of section 512(b)(13)7 If 'Yes', attach schedule (see instructions) 11 X 12 Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges? If 'Yes,' attach statement (see instructions) . 12 X 13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? 13 X Website address ' N/A ------14 The books are in care of SCHMUEL HOROWITZ Telephone no 845-356-7773 ► ------Located at 86 ROUTE 59 SPRING VALLEY NY ZIP + 4 10977 ► ------• ► ------15 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 - Check here and enter the amount of tax-exempt interest received or accrued during the year - 1 15 N/A Yes No 16 At any time during calendar year 2013, did the foundation have an interest in or a signature or other authority over a bank, securities, or other financial account in a foreign country? 16 X See the instructions for exceptions and filing requirements for Form TD F 90-22 1. If 'Yes,' enter the name of the foreign country Part VII-B R egard ing Activities for Wh ic h Form M ay B e equire File Form 4720 if any item is checked in the 'Yes' column , unless an exception applies. Yes No 1 a During the year did the foundation (either directly or indirectly): (1) Engage in the sale or exchange, or leasing of property with a disqualified person? Yes No 11 (Z) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person? Yes X No (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? Yes X No (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? Yes X No (5) Transfer any income or assets to a disqualified person (or make any of either available for the bene fi t or use of a d isqua l ified person) ? EYes No

(6) Agree to pay money or property to a government official? (Exception . Check ' No' if the foundation agreed to make a grant to or to employ the official for a period after termination of government service, if terminating within 90 days. ) Yes JNo 11 b If any answer is 'Yes' to la(1)-(6), did any of the acts fail to qualify under the exceptions described in Regulations section 53.4941 (d)-3 or in a current notice regarding disaster assistance (see instructions)? 1 b N A Organizations relying on a current notice regarding disaster assistance check here

c Did the foundation engage in a p rior year in any of the acts described in 1a, other than excepted acts, that were not corrected before the first day of the tax year beginning in 20137 1 c X 2 Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private operating foundation defined in section 49420)(3) or 49420)(5)):

a At the end of tax year 2013, did the foundation have anyy undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning before 2013? DYes No If 'Yes,' list the years 20 , 20 , 20 , 20

b Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets) to the year's undistributed income? (If applying section 4942(a)(2) to _- - - -J all years listed, answer 'No' and attach statement - see instructions.) 2 b N A c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here. 20 20 , 20 , 20

3a Did the foundation hold more than a 2% direct or indirect interest in any business e nterprise at any time d u r i n g the year? Yes N o b If 'Yes,' did it have excess business holdings in 2013 as a result of (1) any purchase by the foundation or disqualified persons after May 26, 1969, the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)^^)) to dispose of holdings acquired by gift or bequest, or (3) the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if the foundation had excess business holdings in 2073) 3 b N A 4a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes' 4a X

b Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that had not been removed from jeopardy before the first day of ------i the tax year beginning in 2013? 4b X BAA Form 990-PF (2013)

TEEA0305L 12/07112 Form 990-PF (2013) ZICHRON SIMCHA D' 45-0673679 Page 6 an vii- 13 aiaiemenis Kegaraing Activities Tor Wlhicn 1•orm 47ZU may 13e Kequired (continued) 5a During the year did the foundation pay or incur any amount to: (1) Carry on propaganda , or otherwise attempt to influence legislation (section 4945 (e))? [ Yes a No (2) Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly, any voter registration drive? Yes No X (3) Provide a grant to an individual for travel , study, or other similar purposes ? Yes }{ No (4) Provide a grant to an organization other than a charitable, etc, organization described in section 509 (a)( 1 ), (2), or (3), or sect ion 4940 (d)(2) ? (see instructions) [ Yes No (5) Provide for any purpose other than religious , charitable, scientific, literary, or ed uca t iona l purposes , or for th e preven tion of crue lty to c h i ld ren or anima l s ? [ Yes No b If any answer is 'Yes' to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions described in Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? 5b N A Organizations relying on a current notice regarding disaster assistance check here

c If the answer is 'Yes' to question 5a (4), does the foundation claim exemption from the tax because it maintained expenditure responsibi l ity for the grant ? N /A Yes No 11 11 If 'Yes,' attach the statement required by Regulations section 53.4945-5(d).

6a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract Yes No 11 b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? 6b X If 'Yes' to 6b, file Form 8870 7 a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? [ Yes No b If 'Yes,' did the foundation receive any proceeds or have any net income attributable to the transaction? N/A 7b art I n formation out Officers, D irectors, T rustees , Foun dation M anagers , H ig hly Pai d E mp loyees, and Contractors 1 List all officers. directors. trustees. foundation manaaers and their compensation (see instructions). (b) Title, and average (c) Compensation (d) Contributions to (e) Expense account, (a) Name and address hours per week (If not paid , employee benefit other allowances devoted to position enter -0-) plans and deferred compensation SCHMUEL HOROWITZ ______Trustee 0. 0. 0. _86ROUTE_ 59______3.00 SPRING VALLEY NY 10977 RACHEL_HOROWITZ ______Trustee 0. 0. 0. 86_ROUTE_ 59______0 SPRING VALLEY NY 10977 ------

------

2 Compensation of five highest-paid employees (other than those included on line 1 - see instructions). If none , enter'NONE.' (a) Name and address of each employee (b) Title, and average (c) Compensation (d)Contributions to (e) Expense account, paid more than $50,000 hours per week employee benefit other allowances devoted to position plans and deferred compensation None ------

------

------

------

------

Total number of other employees paid over $50,000 0

O flJ_ ICC4U3UVL U / l I U I I . I VI III 7.7V-rr \cV IJ) Form 990-PF (2013) ZICHRON SIMCHA D'SASSOV 45-0673679 Page 7 artx i nformation out Officers, D irectors , Trustees , Foundation Managers, H ig hly Pai d Employees, and Contractors (continued) 3 Five highest-paid independent contractors for professional services (see instructions). If none , enter ' NONE.' (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation None

Total number of others receiving over $50,000 for professional services 0 PartJ! !& Summary of Direct Charitable Activities

List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of Expenses organizations and other beneficiaries served, conferences convened, research papers produced, etc 1 N/A ------

2 ------

3 ------

4 ------

R,art IX .B: Summary of Program - Related Investments (see instructions)

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2 Amount 1 N7------N/A ------

2 ------

All other program-related investments. See instructions. 3 ------

Total. Add lines 1 through 3 ' 0. BAA Form 990-PF (2013)

TEEA0307L 07/10/13 Form 990-PF (2013) ZICHRON SIMCHA D'SASSOV 45-0673679 Page 8 art Minimum I nvestment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)

1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc, purposes: a Average monthly fair market value of securities b Average of monthly cash balances lbi 10,677. c Fair market value of all other assets (see instructions) d Total (add lines 1 a, b, and c) 1dl 10,677. e Reduction claimed for blockage or other factors reported on lines 1a and 1c (attach detailed explanation) I 1 e 0. 2 Acquisition indebtedness applicable to line 1 assets 3 Subtract line 2 from line Id 3 1 10,677. 4 Cash deemed held for charitable activities Enter 1-1/2% of line 3 (for greater amount, see instructions) 4 160. 5 Net value of noncharitable-use assets . Subtract line 4 from line 3 Enter here and on Part V, line 4 5 10,517. 6 Minimum investment return . Enter 5% of line 5 6 526. ;ai ,, Distrib uta ble mount (see instructions (Section an private operating oun a Ions and certain foreign organizations check here ' and do not complete this part.) 1 Minimum investment return from Part X, line 6 1 526. 2 a Tax on investment income for 2013 from Part VI, line 5 2a b Income tax for 2013 (This does not include the tax from Part VI.) 2b 8g; c Add lines 2a and 2b 2c 3 Distributable amount before adjustments Subtract line 2c from line 1 3 526. 4 Recoveries of amounts treated as qualifying distributions 4 5 Add lines 3 and 4 5 526. 6 Deduction from distributable amount (see instructions) 6 7 Distributable amount as adjusted Subtract line 6 from line 5 Enter here and on Part XIII, line 1 7 526. Part Xll Qualifying Distributions (see instructions)

1 Amounts paid (including administrative expenses) to accomplish charitable, etc, purposes: a Expenses, contributions, gifts, etc - total from Part I, column (d), line 26 1 a 165,905. b Program-related investments - total from Part IX-B 1 b 2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc, purposes 2 3 Amounts set aside for specific charitable projects that satisfy the: 1 a Suitability test (prior IRS approval required) 3a b Cash distribution test (attach the required schedule) 3b 4 Qualifying distributions . Add lines 1a through 3b Enter here and on Part V, line 8, and Part XIII, line 4 4 165,905. 5 Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income. Enter I% of Part I, line 27b (see instructions} 5 6 Adjusted qualifying distributions . Subtract line 5 from line 4 6 165,905. Note. The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax in those years BAA Form 990-PF (2013)

TEEA0308L 07/10/13 For 990-PF (2013) ZICHRON SIMCHA D'SASSOV 45-0673679 Page 9 Part XIII Undistributed Income (see instructions)

(a) (b) (c) (d) Corpus Years prior to 2012 2012 2013

1 Distributable amount for 2013 from Part XI, line 7 526. 2 Undistributed income, if any, as of the end of 2013. a Enter amount for 2012 only 0. b Total for prior years. 20 _, 20 _,20 _ 0. 3 Excess distributions carryover, if any, to 2013. a From 2008 b From 2009 c From 201Q d From 2011 122,535. eFrom 2012 143,674. f Total of lines 3a through e 266, 209. 4 Qualifying distributions for 2013 from Part XII, line 4 " $ 165,905. a Applied to 2012, but not more than line 2a 0. b Applied to undistributed income of prior years (Election required - see instructions) 0. c Treated as distributions out of corpus (Election required - see instructions) 0. d Applied to 2013 distributable amount 526. e Remaining amount distributed out of corpus 165 , 379. 5 Excess distributions carryover applied to 2013 0. 0. (If an amount appears in column (d), the same amount must be shown in column (a).)

6 Enter the net total of each column as indicated below: a Corpus Add lines 3f, 4c, and 4e Subtract line 5 431,588. b Prior years' undistributed income Subtract line 4b from line 2b 0. c Enter the amount of prior years' undistribut- ed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed 0. d Subtract line 6c from line 6b Taxable amount - see instructions 0. e Undistributed income for 2012. Subtract line 4a from line 2a Taxable amount - see instructions 0.

f Undistributed income for 2013 Subtract lines 4d and 5 from line 1. This amount must be distributed in 2014 0. 7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170()(1)(F) or 4942(g)(3) (see instructions) 0. 8 Excess distributions carryover from 2008 not applied on line 5 or line 7 (see instructions) 0. 9 Excess distributions carryover to 2014. Subtract lines 7 and 8 from line 6a 431,588. 10 Analysis of line 9 a Excess from 2009 b Excess from 2010 c Excess from 2011 122, 535. d Excess from 2012 143,674. e Excess from 2013 165,379. BAA Form 990-PF (2013)

TEEA0309L 07/10/13 Form 990-PF (2013) ZICHRON SIMCHA D'SASSOV 45-0673679 Page 10 art. ' ' #' P rivate O perating Foun d ations (see instructions an d art VII-A , question N/A 1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling it effective for 2013, enter the date of the ruling ► b Check box to indicate whether the foundation is a private operating foundation described in section 49420)(3) or 4942(1)(5) 2 a Enter the lesser of the adjusted net Tax year Prior 3 years income from Part I or the minimum investment return from Part X for (a) 2013 (b) 2012 (c) 2011 (d) 2010 (e) Total each year listed b 85% of line 2a c Qualifying distributions from Part XII, line 4 for each year listed d Amounts included in line 2c not used directly for active conduct of exempt activities e Qualifying distributions made directly for active conduct of exempt activities Subtract line 2d from line 2c 3 Complete 3a, b, or c for the alternative test relied upon a Assets' alternative test - enter (1) Value of all assets (2) Value of assets qualifying under section 49420)(3)(B)(i) b Endowment' alternative test - enter 2/3 of minimum investment return shown in Part X, line 6 for each year listed c Support' alternative test - enter (1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties)

(2) Support from general public and 5 or more exempt organizations as provided in section 4942(I)(3)(B)(ui) (3) Largest amount of support from an exempt organization (4) Gross investment income art ,^_,,, Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets at any time during the year - see instructions.) 1 Information Regarding Foundation Managers: a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2) See Statement 3

b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or other entity) of which the foundation has a 10% or greater interest None

2 Information Regarding Contribution , Grant, Gift, Loan , Scholarship , etc, Programs: Check here I FR if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds If the foundation makes gifts, grants, etc (see instructions) to individuals or organizations under other conditions, complete items 2a, b, c, and d a The name, address, and telephone number or e-mail of the person to whom applications should be addressed

b The form in which applications should be submitted and information and materials they should include:

c Any submission deadlines

d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors*

BAA TEEA031OL 07/10/13 Form 990-PF (2013) Form 990-PF (20 13) ZICHRON S IMCHA D' SASSOV 45-0673679 Page 11

3 Grants and Contributions Paid During the Year or Approved for Future Payment If recipient is an individual, Recipient show any relationship to any Foundation status of Purpose of grant or Amount foundation manager or contri b ut ion Name and address (home or business) substantial contributor recipient a Paid during the year See Statement 4

Total 3a 165, 905. b Approved for future payment

Total ► 3 bj BAA TEEA0501 L 07/11/13 Form 990-PF (2013) Form 990-PF (2013) ZICHRON SIMCHA D'SASSOV 45-0673679 Page 12 Part XVI-A Analysis of Income- Producing Activities

Entei gross amounts unless otherwise indicated Unrelated business income Excluded by section 512, 513, or 514 (e) (a) (b) (c) (d) Related or exempt Business Amount Exclu- Amount function income code sion (See instructions rogram service revenue- code a 4 C d e f c Fees and contracts from government agencies 2 Membership dues and assessments 3 Interest on savings and temporary cash investments 4 Dividends and interest from securities 5 Net rental income or (loss) from real estate, Debt-financed property Not debt-financed property 6 Net rental income or (loss) from personal property 7 Other investment income 8 Gain or (loss) from sales of assets other than inventory 9 Net income or (loss) from special events 10 Gross profit or (loss) from sales of inventory 11 Other revenue-

12 Subtotal Add columns (b),, (d), and (e) Total. Add line 12, columns (b), (d), and (e) 13 0. (See worksheet in line 13 instructions to verify calculations.) Part XVI-B Relationship of Activities to the Accomplishment of Exempt Purposes Form 990-PF (2013) ZICHRON SIMCHA D'SASSOV 45-0673679 Page 13 Part XVII I nformation Regard ing Transfers To and Transactions an d Relations h ips With one arita e Exempt O rganizations Yes No 1 Did the organization directly or indirectly engage in any of the following with any other organization described in section 501 (c) of the Code (other than section 501 (c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting foundation to a noncharitable exempt organization of: (1) Cash 1 a (1) X (2) Other assets 1 a (2) 1 1 X b Other transactions: (1) Sales of assets to a noncharitable exempt organization 1 b(1) (2) Purchases of assets from a noncharltable exempt organization 1 b (2) X (3) Rental of facilities, equipment , or other assets 1 b (3) X (4) Reimbursement arrangements 1 b (4) X (5) Loans or loan guarantees 1 b (5) X (6) Performance of services or membership or fundraising solicitations 1 b (6) X c Sharing of facilities, equipment, mailing lists, other assets , or paid employees 1 C X

d If the answer to any of the above is 'Yes,' complete the following schedule. Column (b) should always show the fair market value of the goods, other assets, or services given by the reporting foundation If the foundation received less than fair market value in any transaction or sharing arrangement , show in column (d) the value of the goods, other assets, or services received (a) Line no (b) Amount Involved (c) Name of noncharitable exempt organization (d) Description of transfers , transactions , and sharing arrangements N/A

2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax - exempt organizations described in section 501 (c) of the Code (other than section 501 (c)(3)) or in section 527 ? F]Yes Fx] No b If 'Yes,' complete the following schedule (a) Name of organization (b) Type of organization (c) Description of relationship N/A

Under penalties of perjury, I declare that a examen this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete Decl Lion of r (other t n taxpayer) is based on all infor Sign

Here d oz Signature of officer or trustee Date Print/Type preparer's name Preparer's signature

Paid Aharon Friedman , EA Aharon Frie Preparer Firms name " Aharon Friedman Use Only Firm's address " 5 Remsen Avenue, Suite 1 Monsey, NY 10952 BAA

TEEA0503L Schedule B OMB No 1545-0047 (Form 990, 990-EZ, or 990-PF) Schedule of Contributors 2^^ 3 Department of the Treasury ► Attach to Form 990, Form 990-EZ, or Form 990-PF Internal Revenue Service ► Information about Schedule B (Form 990, 990-EZ , 990-PF ) and its instructi ons is at www. irs.gov/form990. Name of the organization Employer identification number ZICHRON SIMCHA D'SASSOV 45-0673679 Organization type (check one) Filers of: Section: Form 990 or 990-EZ 501 (c)( ) (enter number) organization 4947(a)(1) nonexempt charitable trust not treated as a private foundation 527 political organization

Form 990 -PF 501 (c)(3) exempt private foundation 4947(a)(1) nonexempt charitable trust treated as a private foundation 501 (c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule

Note . Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions General Rule For an organization filing Form 990 , 990-EZ , or 990 -PF that received , during the year , $5,000 or more (in money or property) from any one LAJ contributor (Complete Parts I and II )

Special Rules section organization filing met under sections F]For a 501(c)(3) Form 990 or 990-EZ that the 33-1/3% support test of the regulations 509(a)(1) and 170(b)(1)(A)(vl) and received from any one contributor, during the year, a contribution of the greater of (1) $5,000 or (2) 2% of the amount on (I) Form 990, Part VIII, line 1h, or (if) Form 990-EZ, line 1 Complete Parts I and II For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, total contributions of more than $1 ,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals Complete Parts I, II, and III. 0 For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, contributions for use exclusively for religious, charitable, etc, purposes, but these contributions did not total to more than $1000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc, purpose Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc, contributions of $5,000 or more during the year I. $

Caution : An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or 990-PF) but it must answer 'No' on Part IV, line 2, of its Form 990, or check the box on line H of its Form 990-EZ or on its Form 990-PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF) BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990EZ, Schedule B (Form 990, 990-EZ , or 990 -PF) (2013) or 990-PF.

TEEA0701L 12/27113 Schedule B (Form 990, 990-EZ, or 990-PF) (2013) Page 1 of 1 of Part 1 Name of organization Emolover Identification number ZICHRON SIMCHA D'SASSOV 145-0673679 '-Par•,t^.;,^y' ,' ` ^^^` Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.

(a) b Number Name, addres and ZIP + 4 Total Type of contribution s, contributions

1 SCHMUEL HOROWITZ Person ------Payroll 86-ROUTE 59 ------$ _ _ _ _ _162L360_ Noncash El ------(Complete Part II for SPRING VALLEY%______NY 10977 noncashcontributions )

(a) (b) (c) (d) Number Name , address, and ZIP + 4 Total Type of contribution contributions

Person F] ------Payroll Noncash ------1-1 (Complete Part II for ------noncash contributions.)

(a) (b) (c) (d) Number Name, address, and ZIP + 4 Total Type of contribution contributions

Person ------Payroll Noncash ------$------1-1 (Complete Part II for ------noncash contributions

(a) (b) (c) (d) Number Name , address, and ZIP + 4 Total Type of contribution contributions

Person F1 ------Payroll F1 Noncash ------$------El (Complete Part II for ______noncash contributions

(a) (b) (c) (d) Number Name, address, and ZIP + 4 Total Type of contribution contributions

Person ------Payroll Noncash 1-1 (Complete Part II for ______noncash contributions

(a) (b) (c) (d) Number Name , address, and ZIP + 4 Total Type of contribution contributions

Person ------Payroll Noncash ------11 (Complete Part II for ______noncash contributions

BAA TEEA0702L 12/27/13 Schedule B (Form 990, 990-EZ, or 990-PF) (2013) Schedule B (Form 990, 990-EZ, or 990-PF) (2013) Page 1 to 1 of Part II Name of organization Employer identification number ZICHRON SIMCHA D'SASSOV 45-0673679

Part II Noncash Property (see instructions). Use duplicate copies of Part II If additional space is needed.

(a) No. (b) (c) (d) from Description of noncash property given FMV (or estimate) Date received Part I (see instructions) N/A ------

(a) No. (b) (c) (d) from Description of noncash property given FMV (or estimate) Date received Part I (see instructions)

------

(a) No. (b) (c) (d) from Description of noncash property given FMV (or estimate) Date received Part I (see instructions)

------

(a) No, (b) c from Description of noncash property given FMV (or estimate ) Date received Part I (see instructions)

------

(a) No. (b) (c) (d) from Description of noncash property given FMV (or estimate) Date received Part I (see instructions)

------

(a) No. (b) (c) (d) from Description of noncash property given FMV (or estimate) Date received Part I (see instructions)

------$

BAA Schedule B (Form 990 , 990-EZ , or 990 -PF) (2013)

TEEA0703L 12/27/13 Schedule B (Form 990 , 990-EZ, or 990-PF) to 1 of Part III fame of organization Employer identification number ZICHRON S-IMCHA D'SASSOV 45-0673679 Part-Ell i Exclusively religious, charitable , etc., individual contributions to section 501(c)(7),(8) or (10) organizations that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter total of exclusively religious, charitable, etc , contributions of $1,000 or less for the year (Enter this information once See Instructions ) $ N/A Use duplicate copies of Part III if additional space is needed. ------(a) (b) (c) (d) No. from Purpose of gift Use of gift Description of how gift is held Part I N/A ------

(e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee

------

(a) (b) (c) (d) No. from Purpose of gift Use of gift Description of how gift is held Part I

------

(e) Transfer of gift Transferee's name , address, and ZIP + 4 Relationship of transferor to transferee

------

(a) (b) (c) (d) No. from Purpose of gift Use of gift Description of how gift is held Part I ------

------

(e) Transfer of gift Transferee's name, address , and ZIP + 4 Relationship of transferor to transferee

------

(a) (b) (c) (d) No. from Purpose of gift Use of gift Description of how gift is held Part ------

------

(e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee

------

BAA Schedule B (Form 990, 990-EZ, or 990-PF) (2013) TEEA0704L 12/27/13 2013 Federal Statements Page 1

ZICHRON SIMCHA D'SASSOV 45-0673679

Statement 1 Form 990- PF, Part I , Line 23 Other Expenses

(a) (b) Net (C) (d) Expenses Investment Adjusted Charitable per Books Inc ome Net Income Purposes Amortization $ 157. N/A Bank Charges 950. NYS Filing Fees 25. Total 1,132. 0. 0. 0.

Statement 2 Form 990- PF, Part II , Line 15 Other Assets

Fair Market Book Value Value Net Intangible Assets $ 1 , 934. To t a l 1 , 934 . 0 .

Statement 3 Form 990-PF, Part XV, Line 1 a Foundation Managers - 2% or More Contributors

SCHMUEL HOROWITZ RACHEL HOROWITZ

Statement 4 Form 990- PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationship Status Grant Amount AHAVAS YISROEL None Exempt General $ 910. 1470 EAST 19TH STREET Contribution BROOKLYN, NY 11230

BNEI YECHIEL None Exempt General 180. 8 TRUMAN AVENUE Contribution SPRING VALLEY, NY 10977

CHABAD CENTER AT UNIV. OF None Exempt General 36. COLORADO, INC Contribution 909 14TH STREET, STE 104 BOULDER, CO 80302 2013 , Federal Statements Page 21

ZICHRON SIMCHA D'SASSOV 45-0673679

Statement 4 (continued) Form 990-PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationship Status Grant Amount CONG AHAVAS YISROEL None Exempt General $ 180. 4 MORRIS ROAD Contribution SPRING VALLEY, NY 10977

CONGREGATION ADAS YEREIM None Exempt General 101. 33 UNION ROAD Contribution MONSEY, NY 10952

CONGREGATION AHAVAS TZDOKAH None Exempt General 500. VCHESED INC Contribution 1347 42ND STREET BROOKLYN, NY 11219

CONGREGATION CHAIM None Exempt General 18. V'CHESED, INC Contribution 11B EDWIN LANE MONSEY, NY 10952

CONGREGATION KHAL AVREICHIM None Exempt General 3,490. 31 DOVER TERRACE Contribution MONSEY, NY 10952

CONGREGATION KOLEL CHASIDEI None Exempt General 430. RACHMISTRIVK Contribution 6 HORIZON CT. MONSEY, NY 10952

CONGREGATION MACHZIKEI None Exempt General 101. HADAS OF Contribution 3 NORTH COLE AVE SPRING VALLEY, NY 10977

CONGREGATION TIFERES None Exempt General 5,430. YISROEL Contribution 55 WEST MAPLE AVENUE MONSEY, NY 10952

KEREN HACHESED OF MONSEY None Exempt General 180. 6 BLAUVELT ROAD Contribution MONSEY, NY 10952

KEREN YAD VEIZER None Exempt General 281. 51 BLAUVELT ROAD Contribution MONSEY, NY 10952

KUPATH EZRAH None Exempt General 1,510. PO BOX 3 Contribution MONSEY, NY 10952 2013 Federal Statements Page 3

ZICHRON SIMCHA D'SASSOV 45-0673679

Statement 4 (continued) Form 990-PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationship Status Grant Amount OHR HAGANUZ INC None Exempt General $ 180. C/O BAUMRIND 201 CLINTON Contribution STREET BROOKLYN, NY 11201

PROJECT INSPIRE None Exempt General 750. 520 8TH AVENUE, 20TH FLOOR Contribution NEW YORK, NY 10018

BAIS MEDROSH ELYON ASSN None Exempt General 360. INC. Contribution 73 MAIN STREET MONSEY, NY 10952

SMACH ZEVILIN OF NY, INC None Exempt General 601. 18 STONEHOUSE DRIVE Contribution SPRING VALLEY, NY 10977

TOLDOS AVROHOM YITZCHOK None Exempt General 3,800. 1276 46TH STREET Contribution BROOKLYN, NY 11219

YESHIVA TALPIOT None Exempt General 500. 100 LAWRENCE STREET Contribution NANUET, NY 10954

YESHIVATH BETH MOSHE None Exempt General 250. PO BOX 1411 Contribution SCRANTON, PA 18501

ZICHRON MENACHEM, INC None Exempt General 1,991. 10 MAPLE TERRACE Contribution MONSEY, NY 10952

AHAVAS CHAVEIRIM GEMILAS None Exempt GENERAL 3,110. CHESED, INC. CONTRIBUTION 4 RIBIER COURT MONSEY, NY 10952

AMERICAN FRIENDS OF None Exempt GENERAL 250. SUNDERLAND CONTRIBUTION 34 NINTH STREET LAKEWOOD, NJ 08701

BINYAN YERUSHALAYIM None Exempt GENERAL 250. 1274 49TH STREET CONTRIBUTION BROOKLYN, NY 11219

CHOFETZ CHAIM KALLAH FUND None Exempt GENERAL 550. 18 MOUNTAIN AVENUE CONTRIBUTION MONSEY, NY 10952 2013 Federal Statements Page 41

ZICHRON SIMCHA D'SASSOV 45-0673679

Statement 4 (continued) Form 990-PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationship Status Grant Amount CONGREGATION DKHAL DERECH None Exempt GENERAL $ 120. EMES CONTRIBUTION 24 CRESTVIEW TERRACE MONSEY, NY 10952

CONGREGATION EZER LYEHUDA None Exempt GENERAL 360. 45 YALE DRIVE CONTRIBUTION MONSEY, NY 10952 CONGREGATION OHEL MORDECHAI None Exempt GENERAL 180. 51 FOREST ROAD UNIT 203 CONTRIBUTION MONROE, NY 10950

CONREGATION KHAL YEREIM None Exempt GENERAL 360. 52 CARLTON ROAD CONTRIBUTION MONSEY, NY 10952 CONGREGATION SAR SHALOM None Exempt GENERAL 180. INC. CONTRIBUTION 4107 16TH AVENUE BROOKLYN, NY 11204

CONGREGATION ZICHRON YAKOV None Exempt GENERAL 200. DMELITZ CONTRIBUTION 263 CLASSON AVE SUITE 4F BROOKLYN, NY 11205 CONGREGATION OHR MOSHE None Exempt GENERAL 120. 1 MONSEY BLVD CONTRIBUTION MONSEY, NY 10952

CONGREGATION DIVREI EMUNA None Exempt GENERAL 1,120. INC. CONTRIBUTION PO BOX 826 MONSEY, NY 10952 HACHNOSAS ORCHIM OF MONSEY None Exempt GENERAL 1,250. 2 DR FRANK ROAD CONTRIBUTION MONSEY, NY 10952 HATZOLOH None Exempt GENERAL 1,125. 19 GROVE STREET CONTRIBUTION MONSEY, NY 10952

KEREN MUGEIN IMOISHEYA None Exempt GENERAL 240. 69 PENN STREET CONTRIBUTION BROOKLYN, NY 11249

CONGREGATION ORCHOS CHAIM None Exempt GENERAL 720. CONTRIBUTION 31 LENORE AVE MONSEY, NY 10952 2013 . Federal Statements Page 51

ZICHRON SIMCHA D'SASSOV 45-0673679

Statement 4 (continued) Form 990-PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationship Status Grant Amount YAD YEHUDA None Exempt GENERAL $ 500. 1451 52 ST UNIT B5 CONTRIBUTION BROOKLYN, NY 11204

YESHIVATH VIZNITZ D'KHAL None Exempt GENERAL 750. TORATH CHAIM CONTRIBUTION PO BOX 446 MONSEY, NY 10952

CONGREGATION CHASDEI None Exempt GENERAL 108. OF MONSEY CONTRIBUTION 18 JILL LANE MONSEY, NY 10952

KOLLEL METZUYONIM OF None Exempt GENERAL 120. ROCKLAND COUNTRY CONTRIBUTION 16 JEFFREY PLACE MONSEY, NY 10952

KOLLOL OR YECHIEL None Exempt GENERAL 180. 17 KASSUTO ST. CONTRIBUTION JERUSALEM, BAYIT VEGAN JERUSALEM Israel

AMERICAN FRIENDS OF KUPAT None Exempt GENERAL 202. HAIR CONTRIBUTION 4415 14TH AVENUE BROOKLYN, NY 11219

LEV YISRAEL INC None Exempt GENERAL 500. PO BOX 816 CONTRIBUTION MONSEY, NY 10952

MERKAZ HABRITH FOR RUSSIAN None Exempt GENERAL 101. JEWRY CONTRIBUTION 2054 BEDFORD AVE BROOKLYN, NY 11210

SHEKEL HAKODESH None Exempt GENERAL 72. 3054 BEDFORD AVENUE CONTRIBUTION BROOKLYN, NY 11210

CONGREGATION OHEL None Exempt GENERAL 461. 8 JOSHUA COURT CONTRIBUTION MONSEY, NY 10952

CONGREGATION TIFERES None Exempt GENERAL 1,120. GEDALIA CONTRIBUTION 9 SADDLE RIVER ROAD MONSEY, NY 10952 2013 Federal Statements Page 6

ZICHRON SIMCHA D'SASSOV 45-0673679

Statement 4 (continued) Form 990 -PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationship Status Grant Amount VAAD HARABANIM LINYUNEI None Exempt GENERAL $ 250. TZEDUKAH CONTRIBUTION 221 REGENT DRIVEE LAKEWOOD, NJ 08701 TORAS CHAIM None Exempt GENERAL 120. PO BOX 1000 CONTRIBUTION LAKEWOOD, NJ 08701

YESHIVAT LELLUV OF None Exempt GENERAL 1,800. JERUSALEM CONTRIBUTION 3311 OLD FOREST ROAD BALTIMORE, MD 21208

CHASDEI YAKOV None Exempt GENERAL 1,150. 56 MAIN STREET CONTRIBUTION MONSEY, NY 10952

OHEL AVROHOM ELIMELECH None Exempt GENERAL 250. 222 PEN STREET CONTRIBUTION BROOKLYN, NY 11211

YESHIVATH VIZNITZ DKALH None Exempt GENERAL 400. TORATH CHAIM CONTRIBUTION PO BOX 446 MONSEY, NY 10952 VARIOUS None Exempt GENERAL 791. VARIOUS CONTRIBUTION MONSEY, NY 10952 CONGREGATION KOLEL BAIS None Exempt GENERAL 1,000. AVROHOM YAKOV IN CONTRIBUTION 57 FRANCIS PL MONSEY, NY 10952

YESHIVA BETH DAVID None Exempt GENERAL 15,290. 22 W MAPLE AVE CONTRIBUTION MONSEY, NY 10952

BETH HOROAH INC None Exempt GENERAL 360. 3 NANCY LANE CONTRIBUTION MONSEY, NY 10952

CONGREGATION BETH MEDRASH None Exempt GENERAL 72. GOVOHA CONTRIBUTION 5113 16TH AVE BROOKLYN, NY 11204

CONGREGATION BETH ROCHEL None Exempt GENERAL 6,000. 145 SADDLE RIVER RD CONTRIBUTION MONSEY, NY 10952 12013 Federal Statements Page 71

ZICHRON SIMCHA D'SASSOV 45-0673679

Statement 4 (continued) Form 990-PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationshi p Status Grant Amount CONGREGATION BARUCH YISROEL None Exempt GENERAL $ 180. 1717 58TH STREET #1721 CONTRIBUTION BROOKLYN, NY 11204

CONGREGATION BIRCHAS YOSEF None Exempt GENERAL 650. NIKOLSBURG CONTRIBUTION 6 MILTON PL SPRING VALLEY, NY 10977

FRIENDS OF THE BRISKER None Exempt GENERAL 180. YESHIVA INC CONTRIBUTION 38 SADDLE RIVER RD MONSEY, NY 10952

CONGREGATION CHAIM V-CHESED None Exempt GENERAL 3,290. INC CONTRIBUTION 11B EDWIN LANE MONSEY, NY 10952

CHESED OF NEW SQUARE None Exempt GENERAL 100. 27 JACKSON AVE CONTRIBUTION SPRING VALLEY, NY 10977

CONGREGATION OHEL MORDECHE None Exempt GENERAL 180. DTOSH CONTRIBUTION 34 DR STE 201 MONROE, NY 10950

CONGREGATION SDEI YAAKOV None Exempt GENERAL 101. DSHIKON SQUARE CONTRIBUTION 766 N MAIN ST SPRING VALLEY, NY 10977

CONG SHEARITH HAPLETA None Exempt GENERAL 101. 204 KEAP ST CONTRIBUTION BROOKLYN, NY 11211

BAIS YISROEL None Exempt GENERAL 234. 95 DIVISION AVE CONTRIBUTION BROOKLYN, NY 11211

CONGREGATION None Exempt GENERAL 250. YITZCHOK CONTRIBUTION 3 ELAINE PL SPRING VALLEY, NY 10977

YESHIVA INSTITUTE DIVREI None Exempt GENERAL 800. SHMUEL INC CONTRIBUTION 2 PHYLLIS TERRACE MONSEY, NY 10952 2013 Federal Statements Page 81

ZICHRON SIMCHA D'SASSOV 45-0673679

Statement 4 (continued) Form 990-PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationship Status Grant Amount KAHAL MEKOR CHAIM None Exempt GENERAL $ 120. 7 VALENCIA DR CONTRIBUTION MONSEY, NY 10952 CONGREGATION NACHLEI EMUNAH None Exempt GENERAL 1,000. 252 KEAP ST CONTRIBUTION BROOKLYN, NY 11211 CONGREGATION OHR SHOLOM None Exempt GENERAL 101. ZLOCHOV CONTRIBUTION 531 FLUSHING AVE BROOKLYN, NY 11205

CONG 3PRI HOORETZ None Exempt GENERAL 500. 1332 50TH STREET CONTRIBUTION BROOKLYN, NY 11219

CONGREGATION TIFERETH None Exempt GENERAL 4,856. ISRAEL CONTRIBUTION 55 WEST MAPLE AVE MONSEY, NY 10952

CONG TORAH VACHESSED None Exempt GENERAL 1,000. 12 YALE DRIVE CONTRIBUTION MONSEY, NY 10952 CONGREGATION TORAH V AVODA None Exempt GENERAL 250. 54 DECATUR AVE CONTRIBUTION SPRING VALLEY, NY 10977

CONG KHAL TZEMACH TZADIK None Exempt GENERAL 2,870. WIZNITZ 16TH AV CONTRIBUTION 4501 14 AVE BROOKLYN, NY 11219 CONGREGATION SHEMEN LMINCHA None Exempt GENERAL 3,000. INC CONTRIBUTION 11 ENGLEBERG TER LAKEWOOD, NJ 08701

CONGREGATION TOLDOS AVRUHOM None Exempt GENERAL 46,700. YIPZCHOK CONTRIBUTION 1219 56TH STREET BROOKLYN, NY 11219

GEMILAS CHESED EZRAS TORAH None Exempt GENERAL 50. 299 BROADWAY CONTRIBUTION NEW YORK, NY 10007 CONGREGATION EZRAS YISROEL None Exempt GENERAL 500. 4415 14TH AVE CONTRIBUTION BROOKLYN, NY 11219 2013 , Federal Statements Page 91

ZICHRON SIMCHA D'SASSOV 45-06736791

Statement 4 (continued) Form 990-PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationship Status Grant Amount HATZOLOH EMS INC None Exempt GENERAL $ 500. 19 GROVE ST CONTRIBUTION MONSEY, NY 10952

AMERICAN FRIENDS OF IMREI None Exempt GENERAL 120. NOAM CONTRIBUTION 1160 E 9TH STREET BROOKLYN, NY 11230

KARAN ELUZAR INC None Exempt GENERAL 680. 255 PENN ST CONTRIBUTION BROOKLYN, NY 11211

CHASDEI YEHUDA None Exempt GENERAL 500. 264 PENN ST CONTRIBUTION BROOKLYN, NY 11211

CONGREGATION KEREN ECRAH None Exempt GENERAL 120. INC CONTRIBUTION 11 GWEN LANE MONSEY, NY 10952

KEREN HACHESED OF MONSEY None Exempt GENERAL 10,000. 6 BLAUVELT RD CONTRIBUTION MONSEY, NY 10952

CONG KEREN ZICHRON CHAIM None Exempt GENERAL 2,500. INC CONTRIBUTION PO BOX 1597 LAKEWOOD, NJ 08701

CONGREGATION KHAL AVREICHIM None Exempt GENERAL 4,239. 31 DOVER TERRACE CONTRIBUTION MONSEY, NY 10952

KOLEL AVREICHIM D'CHASIDI None Exempt GENERAL 180. BELZ CONTRIBUTION 12 MAPLE TERRACE MONSEY, NY 10952

KOLEL METZEYONIM OF None Exempt GENERAL 250. ROCKLAND COUNTY CONTRIBUTION 16 JEFFREY PL MONSEY, NY 10952

KOLLEL ZICHRON SHNEUR INC None Exempt GENERAL 720. 55 W MAPLE AVE CONTRIBUTION MONSEY, NY 10952

KUPATH CHASANIM None Exempt GENERAL 101. 14 TAFT LANE CONTRIBUTION SPRING VALLEY, NY 10977 12013 Federal Statements Page 101

ZICHRON SIMCHA D'SASSOV 45-06736791

Statement 4 (continued) Form 990-PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationship Status Grant Amount JERUSALEM OPEN HOUSE None Exempt GENERAL $ 1,018. 3014 AVENUE CONTRIBUTION BROOKLYN, NY 11210

MECHON LHOROA None Exempt GENERAL 250. 168 MAPLE AVE CONTRIBUTION MONSEY, NY 10952

MESAMCHE LEV - VIYOEL MOSHE None Exempt GENERAL 101. 51 ROSS ST CONTRIBUTION BROOKLYN, NY 11211

MA'AYNEI HAYESHUA TRUST None Exempt GENERAL 120. 5417 18TH AVE CONTRIBUTION BROOKLYN, NY 11204

CONGREGATION MISHMERES None Exempt GENERAL 360. SHULEM CONTRIBUTION 4 MERRICK DR SPRING VALLEY, NY 10977

CONG NACHLAS MOSHE MAKAVA None Exempt GENERAL 870. 25 DANA ROAD CONTRIBUTION MONSEY, NY 10952

BAIS HAMEDRISH NETZACH None Exempt GENERAL 265. YISROEL CONTRIBUTION 1315 54TH STREET BROOKLYN, NY 11219

SATMER BIKUR CHOLIM None Exempt GENERAL 75. 152 RODNEY STREET CONTRIBUTION BROOKLYN, NY 11211

CONG SHAREI CHESED None Exempt GENERAL 30. 3054 BEDFORD AVE CONTRIBUTION BROOKLYN, NY 11210

CONG SHVES ACHIM None Exempt GENERAL 250. 3054 BEDFORD AVE CONTRIBUTION BROOKLYN, NY 11210

CONGREGATION SDEI YAAKOV None Exempt GENERAL 360. DSHIKON SQUARE CONTRIBUTION 766 N MAIN ST SPRING VALLEY, NY 10977

CONGREGATION THILOS ARYE None Exempt GENERAL 250. 2515 12 AVE #C-5 CONTRIBUTION BROOKLYN , NY 11219 2013 Federal Statements Page 11

ZICHRON SIMCHA D'SASSOV 45-0673679

Statement 4 (continued) Form 990-PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationship Status Grant Amount CONG TORAH DCHASIDEI None Exempt GENERAL $ 1,000. BOBOV MONSEY CONTRIBUTION 49 S MAIN ST SPRING VALLEY, NY 10977

TALMUD TORAH HABEEIN YAKIR None Exempt GENERAL 180. INC CONTRIBUTION 2 VAN BUREN DR MONROE, NY 10950 THE JEWISH CENTER FOR None Exempt GENERAL 101. SPECIAL EDUCATION CONTRIBUTION 1760 53RD ST BROOKLYN, NY 11204 CONGREGATION TOLDOS ODOM None Exempt GENERAL 180. 1511 50TH STREET CONTRIBUTION BROOKLYN, NY 11219

CONG VYOEL MOSHE None Exempt GENERAL 101. 1 MONSEY BLVD CONTRIBUTION MONSEY, NY 10952

YESHIVA OF BROOKLYN None Exempt GENERAL 50. TALMUDICAL SCHOOL CONTRIBUTION 1470 OCEAN PKWY # 74 BROOKLYN, NY 11230

CONG MESIFTA BETH SHRAGA None Exempt GENERAL 250. PO BOX 412 CONTRIBUTION MONSEY, NY 10952

ZICHRON AVROHOM VESTHER None Exempt GENERAL 180. FUND CONTRIBUTION PO BOX 724 TALLMAN, NY 10982 ZICHRON AVROHOM BINYOMIN None Exempt GENERAL 250. INC CONTRIBUTION 26 CHARLES LN SPRING VALLEY, NY 10977 CONGREGATION ZICHRON YAAKOV None Exempt GENERAL 500. 1 CHALLENGER CT CONTRIBUTION MONSEY, NY 10952

RAV CHESED None Exempt GENERAL 430. 1511 50TH ST CONTRIBUTION BROOKLYN, NY 11219 2013 Federal Statements Page 12

ZICHRON SIMCHA D'SASSOV 45-0673679

Statement 4 (continued) Form 990-PF, Part XV, Line 3a Recipient Paid During the Year

Found- Donee ation Purpose of Name and Address Relationship Status Grant Amount ROFEH CHOLIM CANCER SOCIETY None Exempt GENERAL $ 1,800. 762 BEDFORD AVE CONTRIBUTION BROOKLYN, NY 11205

CHEVRA OSAI TZDOKOH VCHESED None Exempt GENERAL 6,250. DSATMAR INC CONTRIBUTION 44 ADAR CT MONSEY, NY 10952

UNITED INSTITUTIONS OF None Exempt GENERAL 250. KARLIN STOLIN CONTRIBUTION 1436 42 STREET BROOKLYN, NY 11219

Total