efile Public Visual Render
ObjectId: 201403109349100225 - Submission: 2014-11-06
TIN: 04-3254361
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter Social Security numbers on this form as it may be made public. By law, the IRS cannot redact the information on the form.
Information about Form 990-PF and its instructions is at
www.irs.gov/form990pf
.
OMB No. 1545-0052
20
13
Open to Public Inspection
For calendar year 2013, or tax year beginning
01-01-2013
, and ending
12-31-2013
Name of foundation
THEODORE L CROSS
FAMILY CHARITABLE FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
100 MERRICK ROAD
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
ROCKVILLE CENTRE
,
NY
11570
A Employer identification number
04-3254361
B
Telephone number (see instructions)
(516) 478-6000
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here .............
2.
Foreign organizations meeting the 85% test,
check here and attach computation ...........
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .........
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
I
Fair market value of all assets at end
of year
(from Part II, col. (c),
line 16)
$
18,976,472
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .........
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
3
Interest on savings and temporary cash investments
78
78
78
4
Dividends and interest from securities
......
233,047
233,047
233,047
5a
Gross rents
..............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
1,075,095
b
Gross sales price for all assets on line 6a
7,836,265
7
Capital gain net income (from Part IV, line 2)
....
1,075,095
8
Net short-term capital gain
.........
8,879
9
Income modifications
...........
10a
Gross sales less returns and allowances
.......
b
Less: Cost of goods sold
...
c
Gross profit or (loss) (attach schedule)
......
11
Other income (attach schedule)
........
12
Total.
Add lines 1 through 11
.........
1,308,220
1,308,220
242,004
13
Compensation of officers, directors, trustees, etc.
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
69
b
Accounting fees (attach schedule)
.......
1,552
c
Other professional fees (attach schedule)
....
79,178
79,178
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
15,006
2,749
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
2,807
99
2,708
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
98,612
82,026
2,708
25
Contributions, gifts, grants paid
........
883,000
883,000
26
Total expenses and disbursements.
Add lines 24 and 25
981,612
82,026
885,708
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
326,608
b
Net investment income
(if negative, enter -0-)
1,226,194
c
Adjusted net income
(if negative, enter -0-)
...
242,004
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2013)
Page 2
Form 990-PF (2013)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
...............
2
Savings and temporary cash investments
..........
925,967
592,302
592,302
3
Accounts receivable
Less: allowance for doubtful accounts
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 schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
...............
9
Prepaid expenses and deferred charges
...........
13,336
1,079
1,079
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
........
13,144,839
11,417,369
12,381,751
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)
...........
3,100,000
5,500,000
6,001,340
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
17,184,142
17,510,750
18,976,472
17
Accounts payable and accrued expenses
..........
18
Grants payable
..................
19
Deferred revenue
..................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
..........
0
Foundations that follow SFAS 117, check here
and complete lines 24 through 26 and lines 30 and 31.
24
Unrestricted
...................
25
Temporarily restricted
................
26
Permanently restricted
................
Foundations that do not follow SFAS 117, check here
and complete lines 27 through 31.
27
Capital stock, trust principal, or current funds
.........
28
Paid-in or capital surplus, or land, bldg., and equipment fund
29
Retained earnings, accumulated income, endowment, or other funds
17,184,142
17,510,750
30
Total net assets or fund balances
(see page 17 of the
instructions)
....................
17,184,142
17,510,750
31
Total liabilities and net assets/fund balances
(see page 17 of
the instructions)
..................
17,184,142
17,510,750
Part III
Analysis of Changes in Net Assets or Fund Balances
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
17,184,142
2
Enter amount from Part I, line 27a
.....................
2
326,608
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
17,510,750
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 30
.
6
17,510,750
Form
990-PF
(2013)
Page 3
Form 990-PF (2013)
Page
3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a)
List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1a
b
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(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
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
b
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
1,075,095
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-
in Part I, line 8
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
3
8,879
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
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 page 18 of the instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2012
880,004
17,854,248
0.04929
2011
794,929
17,611,530
0.04514
2010
7,500
13,407,399
0.00056
2009
7,976
131,247
0.06077
2008
151,004
2
Total
of line 1, column (d)
......................
2
0.15576
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
0.03115
4
Enter the net value of noncharitable-use assets for 2013 from Part X, line 5
.....
4
18,502,691
5
Multiply line 4 by line 3
.......................
5
576,377
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
12,262
7
Add lines 5 and 6
.........................
7
588,639
8
Enter qualifying distributions from Part XII, line 4
..............
8
885,708
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See
the Part VI instructions.
Form
990-PF
(2013)
Page 4
Form 990-PF (2013)
Page
4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a
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 instructions)
b
Domestic foundations that meet the section 4940(e) requirements in Part V, check
1
12,262
here
and 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, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
3
Add lines 1 and 2
............................
3
12,262
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-).
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
12,262
6
Credits/Payments:
a
2013 estimated tax payments and 2012 overpayment credited to 2013
6a
13,341
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
13,341
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
1,079
11
Enter the amount of line 10 to be:
Credited to 2014 estimated tax
1,079
Refunded
11
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?
............................
1b
No
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?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
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
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
No
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
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
No
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c), and Part XV.
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
NJ
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 G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2013 or the taxable year beginning in 2013 (see instructions for Part XIV)?
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names and addresses.
10
No
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)? If "Yes," attach schedule. (see instructions)
.............
11
No
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
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
N/A
14
The books are in care of
JOHN W HALLORAN CPA
Telephone no.
(516) 478-6000
Located at
100 MERRICK ROAD SUITE 304W
ROCKVILLE CENTRE
NY
ZIP+4
11570
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
......
15
16
At any time during calendar year 2013, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
16
No
See instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes", enter the name of the
foreign country
Form
990-PF
(2013)
Page 5
Form 990-PF (2013)
Page
5
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
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
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
.........................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
.................
Yes
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
No
b
If any answer is "Yes" to 1a(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 page 20 of the instructions)?
...
1b
No
Organizations relying on a current notice regarding disaster assistance check here
.........
c
Did the foundation engage in a prior 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 2013?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2013, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2013?
...............
Yes
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
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
No
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 enterprise at
any time during the year?
.........................
Yes
No
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;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) 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 2013.)
....................
3b
No
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
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 the tax year beginning in 2013?
4b
No
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
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
(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 section 4940(d)(2)? (see instructions)
........
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
........
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
No
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 responsibility for the grant?
............
Yes
No
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
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
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?
....
7b
No
Form
990-PF
(2013)
Page 6
Form 990-PF (2013)
Page
6
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation (see instructions).
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to
employee benefit plans
and deferred compensation
(e)
Expense account,
other allowances
MARY CROSS
Trustee
5.00
0
ONE CAMPBELTON CIRCLE
PRINCETON
,
NJ
08540
AMANDA B CROSS
Trustee
5.00
0
C/O FOUNDATION ADDRESS
ROCKVILLE CENTRE
,
NY
11570
LISA W POWNALL-GRAY
Trustee
5.00
0
42 LORDS HIGHWAY
WESTON
,
CT
06883
ADRIENNE CANNELLA
Trustee
5.00
0
83-04 267TH STREET
FLORAL PARK
,
NY
11004
JOHN W HALLORAN
TRUSTEE
0.00
0
11 FIELD DAISY LANE
EAST NORTHPORT
,
NY
11731
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 paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
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
.............
Part IX-A
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 organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Form
990-PF
(2013)
Page 7
Form 990-PF (2013)
Page
7
Part 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
2
All other program-related investments. See page 24 of the instructions.
3
Total.
Add lines 1 through 3
.........................
Part X
Minimum Investment 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
...................
1a
13,980,361
b
Average of monthly cash balances
.......................
1b
801,313
c
Fair market value of all other assets (see instructions)
................
1c
4,002,784
d
Total
(add lines 1a, b, and c)
.........................
1d
18,784,458
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
3
Subtract line 2 from line 1d
.........................
3
18,784,458
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
281,767
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
18,502,691
6
Minimum investment return.
Enter 5% of line 5
..................
6
925,135
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
925,135
2a
Tax on investment income for 2013 from Part VI, line 5
......
2a
12,262
b
Income tax for 2013. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
12,262
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
912,873
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
912,873
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
912,873
Part XII
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
..........
1a
885,708
b
Program-related investments—total from Part IX-B
..................
1b
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:
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
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b (see instructions)
.................
5
12,262
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
873,446
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.
Form
990-PF
(2013)
Page 8
Form 990-PF (2013)
Page
8
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2012
(c)
2012
(d)
2013
1
Distributable amount for 2013 from Part XI, line 7
912,873
2
Undistributed income, if any, as of the end of 2013:
a
Enter amount for 2012 only
.......
742,626
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2013:
a
From 2008
......
b
From 2009
......
c
From 2010
......
d
From 2011
......
e
From 2012
......
f
Total
of lines 3a through e
........
4
Qualifying distributions for 2013 from Part
XII, line 4:
$
885,708
a
Applied to 2012, but not more than line 2a
742,626
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2013 distributable amount
.....
143,082
e
Remaining amount distributed out of corpus
5
Excess distributions carryover applied to 2013.
(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
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
e
Undistributed income for 2012. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
f
Undistributed income for 2013. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2014
..........
769,791
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (see
instructions)
.............
8
Excess distributions carryover from 2008 not
applied on line 5 or line 7 (see instructions)
...
9
Excess distributions carryover to 2014.
Subtract lines 7 and 8 from line 6a
......
10
Analysis of line 9:
a
Excess from 2009
....
b
Excess from 2010
....
c
Excess from 2011
....
d
Excess from 2012
....
e
Excess from 2013
....
Form
990-PF
(2013)
Page 9
Form 990-PF (2013)
Page
9
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2013, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2013
(b)
2012
(c)
2011
(d)
2010
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 4942(j)(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(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the organization 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).)
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.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
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 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:
Form
990-PF
(2013)
Page 10
Form 990-PF (2013)
Page
10
Part XV
Supplementary Information
(continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
AMERICAN HEART ASSOCIATION
7272 GREENVILLE AVENUE
DALLAS
,
TX
75231
NONE
N/A
GENERAl
5,000
AMFAR
120 WALL STREET 13TH FLOOR
NEW YORK
,
NY
10005
NONE
N/A
GENERAL PURPOSES
7,500
ANGELO J MELLILO CENTER FR MENTAL H
113 GLEN COVE AVENUE
GLEN COVE
,
NY
11542
NONE
N/A
GENERAL PURPOSES
10,000
BLESSINGS IN A BACKPACK
1839 BROWNSBORO ROAD
LOUISVILLE
,
KY
40206
NONE
N/A
GENERAL PURPOSES
5,000
BRENNAN CENTER FOR JUSTICE AT NYU
161 AVENUE OF THE AMERICAS 12TH FL
NEW YORK
,
NY
10013
NONE
N/A
GENERAL PURPOSES
10,000
CITY HARVEST
DONOR SYSTEMS 575 8TH AVE 4TH FL
NEW YORK
,
NY
10018
NONE
N/A
GENERAL PURPOSES
10,000
DING DARLING SOCIETY
PO BOX 565
SANIBEL
,
FL
33957
NONE
N/A
GENERAL PURPOSES
7,500
FISH FRIENDS IN SERVICE HERE
1630 PERIWINKLE WAY UNIT B
SANIBEL
,
FL
33957
NONE
N/A
GENERAL PURPOSES
7,500
FRIENDS IN DEED
594 BROADWAY SUITE 706
NEW YORK
,
NY
10012
NONE
N/A
GENERAL PURPOSES
2,500
FRIENDS OF LAUREL HOUSE
1616 WASHINGTON BLVD
STAMFORD
,
CT
06902
NONE
N/A
GENERAL PURPOSES
15,000
GIVE WELL AKA 'THE CLEAR FUND'
320 7TH AVE 232
BROOKLYN
,
NY
11215
NONE
N/A
GENERAL PURPOSES
2,500
GLOBAL GIVING
1023 15TH ST NW 12TH FLOOR
WASHINGTON
,
DC
20005
NONE
N/A
GENERAL PURPOSES
2,500
HARRIS CENTER AT MASS GENERAL HOSPI
165 CAMBRIDGE ST SUITE 600
BOSTON
,
MA
02114
NONE
N/A
GENERAL PURPOSES
15,000
HARRY CHAPIN FOOD BANK
3760 FOWLER ST
FORT MYERS
,
FL
33901
NONE
N/A
GENERAL PURPOSES
7,500
HEIFER INTERNATIONAL
1 WORLD AVE
LITTLE ROCK
,
AR
72202
NONE
N/A
GENERAL PURPOSES
5,000
HUMAN RIGHTS CAMPAIGN FOUNDATION
1640 RHODE ISLAND AVE NW
WASHINGTON
,
DC
20036
NONE
N/A
GENERAL PURPOSES
7,500
HUMAN RIGHTS WATCH
350 FIFTH AVE 34TH FLOOR
NEW YORK
,
NY
10118
NONE
N/A
GENERAL PURPOSES
50,000
JOE TORRE SAFE AT HOME FOUNDATION
PO BOX 1037 MIDTOWN STATION
NEW YORK
,
NY
10018
NONE
N/A
GENERAL PURPOSES
5,000
KANZIUS CANCER RESEARCH FOUNDATION
130 WEST 8TH ST SUITE 216
ERIE
,
PA
16501
NONE
N/A
GENERAL PURPOSES
10,000
LONG ISLAND CARES
10 DAVIDS DRIVE
HAUPPAUGE
,
NY
11788
NONE
N/A
General Purpose
10,000
MS FOUNDATION FOR WOMEN
12 METRO TECH CENTER 26TH FLOOR
BROOKLYN
,
NY
11201
NONE
N/A
General Purpose
40,000
NATIONAL COALITION FOR HOMELESS VET
333 1/2 PENNSYLVANIA AVE SE
WASHINGTON
,
DC
20003
NONE
N/A
General Purpose
2,500
NATIONAL DOMESTIC WORKERS ALLIANCE
330 7TH AVE 19TH FLOOR
NEW YORK
,
NY
10001
NONE
N/A
General Purpose
5,000
NEW YORK CARES
214 W 29TH ST 5TH FL
NEW YORK
,
NY
10001
NONE
N/A
General Purpose
5,000
OPEN DOOR SHELTER NORWALK
4 MERRITT ST
SOUTH NORWALK
,
CT
06854
NONE
N/A
General Purpose
7,500
PACE CENTER FOR GIRLS
3760 SCHOOLHOUSE RD W
FT MYERS
,
FL
33916
NONE
N/A
General Purpose
5,000
PARTNERS IN HEALTH
888 COMMONWEALTH AVE 3RD FL
BOSTON
,
MA
02215
NONE
N/A
General Purpose
10,000
PERKINS SCHOOL FOR THE BLIND
175 NORTH BEACON ST
WATERTOWN
,
MA
02472
NONE
N/A
General Purpose
25,000
PLAN USA
155 PLAN WAY
WARWICK
,
RI
02886
NONE
N/A
General Purpose
5,000
PLANNED PARENTHOOD
434 WEST 33RD ST
NEW YORK
,
NY
10001
NONE
N/A
General Purpose
54,000
POSSE FOUNDATION
14 WALL ST SUITE 8A-60
NEW YORK
,
NY
10005
NONE
N/A
General Purpose
5,000
PREP FOR PREP
328 WEST 71ST ST
NEW YORK
,
NY
10023
NONE
N/A
General Purpose
25,000
PROJECT ALS
3960 BROADWAY SUITE 420
NEW YORK
,
NY
10032
NONE
N/A
General Purpose
5,000
ROBIN HOOD FOUNDATION
826 BROADWAY 9TH FLOOR
NEW YORK
,
NY
10003
NONE
N/A
General Purpose
5,000
ROOT CAUSE
ONE CANAL PLACE 3RD FLOOR
CAMBRIDGE
,
MA
02141
NONE
N/A
General Purpose
2,500
SPIRIT OF GOODWILL BAND
C/O GOODWILL INDUSTRIES OF SOUTH FL
MIAMI
,
FL
33142
NONE
N/A
General Purpose
2,500
STUDIO IN A SCHOOL
410 WEST 59TH ST
NEW YORK
,
NY
10019
NONE
N/A
General Purpose
5,000
ARNOLD P GOLD FOUNDATION THE
619 PALISADE AVE
ENGLEWOOD CLIFFS
,
NJ
07632
NONE
N/A
General Purpose
5,000
CLIMATE REALITY PROJECT THE
901 E STREET NW SUITE 610
WASHINGTON
,
DC
20004
NONE
N/A
General Purpose
7,500
COUNCIL OF FASHION DESIGNERS OF AME
1412 BROADWAY SUITE 2006
NEW YORK
,
NY
10018
NONE
N/A
General Purpose
5,000
IMMOKALEE FOUNDATION THE
3960 RADIO ROAD SUITE 207
NAPLES
,
FL
34104
NONE
N/A
General Purpose
2,500
THERE WITH CARE
2825 WILDERNESS PLACE SUITE 100
BOULDER
,
CO
80301
NONE
N/A
General Purpose
10,000
UNICEF SCHOOLS FOR AFRICA
125 MAIDEN LANE
NEW YORK
,
NY
10038
NONE
N/A
General Purpose
2,500
WELLNESS IN THE SCHOOLS
PO BOX 250832
NEW YORK
,
NY
10025
NONE
N/A
General Purpose
10,000
WOMEN'S FUNDING NETWORK
505 SANSOME ST
SAN FRANCISCO
,
CA
94111
NONE
N/A
General Purpose
7,500
YOUNG SURVIVAL COALITION YSC
61 BROADWAY SUITE 2235
NEW YORK
,
NY
10006
NONE
N/A
General Purpose
2,500
AMERICAN UNIVERSITY IN CAIRO SCHOLA
420 FIFTH AVE 3RD FLOOR
NEW YORK
,
NY
10018
NONE
N/A
General Purpose
5,000
AMERICAN UNIVERSITY IN CAIRO
420 FIFTH AVE 3RD FLOOR
NEW YORK
,
NY
10018
NONE
N/A
General Purpose
10,000
AMNESTY INTERNATIONAL
5 PENN PLAZA 16TH FLOOR
NEW YORK
,
NY
10001
NONE
N/A
General Purpose
5,000
ARTS COUNCIL OF PRINCETON
102 WITHERSPOON ST
PRINCETON
,
NJ
08542
NONE
N/A
General Purpose
5,000
CRISIS MINISTRY OF PRINCETON AND TR
123 E HANOVER ST
TRENTON
,
NJ
08608
NONE
N/A
General Purpose
5,000
DEPT OF COMPARATIVE LIT - PRINCETON
133 B EAST PYNE
PRINCETON
,
NJ
08542
NONE
N/A
General Purpose
20,000
DOCTORS WITHOUT BOARDERS
333 SEVENTH AVE 2ND FLOOR
NEW YORK
,
NY
10001
NONE
N/A
General Purpose
5,000
HOLLINS UNIVERSITY
PO BOX 9658
ROANOKE
,
VA
24020
NONE
N/A
General Purpose
6,000
HOSPICE CARE OF NANTUCKET
57 PROSPECT ST
NANTUCKET
,
MA
02554
NONE
N/A
General Purpose
7,500
HOSPICE CARE OF PRINCETON
253 WITHERSPOON ST
PRINCETON
,
NJ
08540
NONE
N/A
General Purpose
5,000
HUMAN RIGHTS WATCH
350 5TH AVE
NEW YORK
,
NY
10118
NONE
N/A
General Purpose
5,000
MCCARTER THEATER COMPANY
91 UNIVERSITY PLAZA
PRINCETON
,
NJ
08540
NONE
N/A
General Purpose
8,000
METROPOLITAN OPERA
LINCOLN PLAZA
NEW YORK
,
NY
10023
NONE
N/A
General Purpose
5,000
NAACP LEGAL DEFENSE AND EDUCATION F
99 HUDSON STREET SUITE 1600
NEW YORK
,
NY
10013
NONE
N/A
General Purpose
5,000
NANTUCKET ATHENEUM
1 INDIA ST
NANTUCKET
,
MA
02554
NONE
N/A
General Purpose
5,000
NANTUCKET CONSERVATION FOUNDATION
118 CLIFF ROAD
NANTUCKET
,
MA
02554
NONE
N/A
General Purpose
10,000
NANTUCKET COTTAGE HOSPITAL
57 PROSPECT ST
NANTUCKET
,
MA
02554
NONE
N/A
General Purpose
10,000
NANTUCKET HISTORICAL ASSOCIATION
15 BROAD ST
NANTUCKET
,
MA
02554
NONE
N/A
General Purpose
5,000
PLANNED PARENTHOOD OF MERCER COUNTY
437 E STATE ST
TRENTON
,
NJ
08608
NONE
N/A
General Purpose
14,000
PRINCETON HOSPITAL
253 WITHERSPOON ST
PRINCETON
,
NJ
08540
NONE
N/A
General Purpose
15,000
PRINCETON PUBLIC LIBRARY
65 WITHERSPOON ST
PRINCETON
,
NJ
08542
NONE
N/A
General Purpose
5,000
PRINCETON SYMPHONY ORCHESTRA
PO BOX 250
PRINCETON
,
NJ
08542
NONE
N/A
General Purpose
5,000
SAVE - A FRIEND TO HOMELESS ANIMALS
900 HERRINGTOWN RD
PRINCETON
,
NJ
08542
NONE
N/A
General Purpose
1,500
SEEING EYE FOUNDATION
PO BOX 375
MORRISTOWN
,
NJ
07963
NONE
N/A
General Purpose
3,000
SWEET BRIAR COLLEGE
PO BOX 1051
SWEET BRIAR
,
VA
24595
NONE
N/A
General Purpose
3,500
TRENTON AREA SOUP KITCHEN TASK
72 1/2 ESCHER ST
TRENTON
,
NJ
08609
NONE
N/A
General Purpose
3,000
YMCA OF PRINCETON
59 PAUL ROBESON PLACE
PRINCETON
,
NJ
08540
NONE
N/A
General Purpose
2,500
YWCA OF PRINCETON
59 ROBESON PLACE
PRINCETON
,
NJ
08540
NONE
N/A
General Purpose
2,500
OUR LADY OF THE SNOWS RC CHURCH
258-15 80TH AVE
FLORAL PARK
,
NY
11004
NONE
N/A
General Purpose
2,500
MASSACHUSETTS INSTITUTE OF TECHNOLO
120 VASSAR ST BUILDING W35-276
CAMBRIDGE
,
MA
02139
NONE
N/A
GENERAL
5,000
BIG BROTHERS BIG SISTERS - LI
145 SYCAMORE AVE
ISLANDIA
,
NY
11749
NONE
N/A
GENERAL
5,000
HABITAT FOR HUMANITY OF LI
643 MIDDLE COUNTRY ROAD
MIDDLE ISLAND
,
NY
11953
NONE
N/A
GENERAL
5,000
ACCESS YOUTH ACADEMY
9370 WAPLES STREET SUITE 101
SAN DIEGO
,
CA
92121
NONE
N/A
GENERAL
15,000
ACLU FOUNDATION
125 BROAD STREET 18TH FLOOR
NEW YORK
,
NY
10005
NONE
N/A
GENERAL
7,500
BOB WOODRUFF FOUNDATION
PO BOX 955
BRISTOW
,
VA
20136
NONE
N/A
GENERAL
5,000
CARDINAL MCCLOSKY COMMUNITY SERVICE
115 E STEVENS AVE SUITE LL5
VALHALLA
,
NY
10595
NONE
N/A
GENERAL
5,000
CHILD FIRST
267 GRANT STREET
BRIDGEPORT
,
CT
06610
NONE
N/A
GENERAL
15,000
COMMACK VOLUNTEER AMBULANCE CORPS
200 BURR ROAD
COMMACK
,
NY
11725
NONE
N/A
GENERAL
5,000
DISABILITY OPPORTUNITY FUND
201 IU WILLETS ROAD
ALBERTSON
,
NY
11507
NONE
N/A
GENERAL
2,500
HUMAN TRAFFICKING AWARENESS PARTNER
PO BOX 1113
SANIBEL
,
FL
33957
NONE
N/A
GENERAL
2,500
INNOVATIONS OF POVERTY ACTION
101 WHITNEY AVE
NEW HAVEN
,
CT
06510
NONE
N/A
GENERAL
2,500
LEE MEMORIAL HEALTH SYSTEM FOUNDATI
9800 S HEALTH PARK DRIVE 210
FORT MYERS
,
FL
33908
NONE
N/A
GENERAL
50,000
MEMORIAL SLOAN KETTERING CANCER CEN
PO BOX 27106
NEW YORK
,
NY
10087
NONE
N/A
GENERAL
20,000
PROJECT HORSESHOE FARM
745 HORSHOE BEND
GREENSBORO
,
AL
36744
NONE
N/A
GENERAL
30,000
SERVICE WOMAN'S ACTION NETWORK
220 E 23 STREET SUITE 509
NEW YORK
,
NY
10010
NONE
N/A
GENERAL
2,500
RADCLIFF INSTITUTE
10 GARDEN ST
CAMBRIDGE
,
MA
02138
NONE
N/A
GENERAL
5,000
THE ALI FORNEY CENTER
224 W 35TH STREET 15TH FLOOR
NEW YORK
,
NY
10001
NONE
N/A
GENERAL
5,000
THE DOE FUND
232 EAST 84TH STREET
NEW YORK
,
NY
10028
NONE
N/A
GENERAL
2,500
THE LOWER EAST SIDE GIRLS CLUB
56 E 1ST STREET
NEW YORK
,
NY
10003
NONE
N/A
GENERAL
5,000
YALE UNIVERSITY OFFICE OF DEVELOPME
PO BOX 2038
NEW HAVEN
,
CT
06521
NONE
N/A
GENERAL
10,000
SPECIAL OLYMPICS - CT CHAPTER
2666 STATE STREET SUITE 1
HAMDEN
,
CT
06517
NONE
N/A
GENERAL
5,000
AMERICAN RED CROSS
PO BOX 4002018
DES MOINES
,
IA
50340
NONE
N/A
GENERAL
25,000
WISER WOMEN'S INSTITUTION FOR A SEC
1140 19TH STREET NW SUITE 550
WASHINGTON
,
DC
20036
NONE
N/A
GENERAL
5,000
VITAL VOICES GLOBAL PARTNERSHIP - C
1625 MASSACHUSETTS AVENUE NW
WASHINGTON
,
DC
20036
NONE
N/A
GENERAL
2,500
Total
.................................
3a
883,000
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2013)
Page 11
Form 990-PF (2013)
Page
11
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
14
78
4
Dividends and interest from securities
....
14
233,047
5
Net rental income or (loss) from real estate:
a
Debt-financed property
........
b
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
.............
1,075,095
9
Net income or (loss) from special events:
...
10
Gross profit or (loss) from sales of inventory
..
11
Other revenue:
a
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
233,125
1,075,095
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
1,308,220
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
Form
990-PF
(2013)
Page 12
Form 990-PF (2013)
Page
12
Part XVII
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
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?
Yes
No
a
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1)
Cash
...................................
1a(1)
No
(2)
Other assets
.................................
1a(2)
No
b
Other transactions:
(1)
Sales of assets to a noncharitable exempt organization
....................
1b(1)
No
(2)
Purchases of assets from a noncharitable exempt organization
..................
1b(2)
No
(3)
Rental of facilities, equipment, or other assets
.......................
1b(3)
No
(4)
Reimbursement arrangements
...........................
1b(4)
No
(5)
Loans or loan guarantees
.............................
1b(5)
No
(6)
Performance of services or membership or fundraising solicitations
................
1b(6)
No
c
Sharing of facilities, equipment, mailing lists, other assets, or paid employees
..............
1c
No
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
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?
...........
Yes
No
b
If "Yes," complete the following schedule.
(a)
Name of organization
(b)
Type of organization
(c)
Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
2014-11-06
May the IRS discuss this return
with the preparer shown below
(see instr.)?
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
John W Halloran CPA
Preparer's Signature
Date
Check if self-
employed
PTIN
P00367498
Firm's name
Firm's address
John W Halloran CPA PC
100 Merrick Road Suite 304W
Rockville Centre
,
NY
11570
Firm's EIN
Phone no.
(516) 478-6000
Form
990-PF
(2013)
Additional Data
Software ID:
13000170
Software Version:
2013v3.1
Form 990PF - Special Condition Description:
Special Condition Description