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.