efile Public Visual Render
ObjectId: 201601809349100310 - Submission: 2016-06-28
TIN: 36-4134174
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.
Information about Form 990-PF and its instructions is at
www.irs.gov/form990pf
.
OMB No. 1545-0052
20
15
Open to Public Inspection
For calendar year 2015, or tax year beginning
01-01-2015
, and ending
12-31-2015
Name of foundation
CAROL BERNICK FAMILY FOUNDATION
c/o Polished Nickel Capital Mgmt
Number and street (or P.O. box number if mail is not delivered to street address)
155 N Wacker No 1680
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
chicago
,
IL
60606
A Employer identification number
36-4134174
B
Telephone number (see instructions)
(312) 477-7603
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
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year
(from Part II, col. (c),
line 16)
$
7,335,164
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
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
Sch. B
.............
3
Interest on savings and temporary cash investments
356
356
4
Dividends and interest from securities
...
185,484
185,484
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
257,617
b
Gross sales price for all assets on line 6a
1,944,563
7
Capital gain net income (from Part IV, line 2)
...
257,617
8
Net short-term capital gain
.........
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
........
443,457
443,457
13
Compensation of officers, directors, trustees, etc.
0
0
0
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
7,180
0
0
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
2,899
2,899
0
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
45,459
45,459
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
55,538
48,358
0
25
Contributions, gifts, grants paid
.......
923,450
923,450
26
Total expenses and disbursements.
Add lines 24 and 25
978,988
48,358
923,450
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-535,531
b
Net investment income
(if negative, enter -0-)
395,099
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2015)
Page 2
Form 990-PF (2015)
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
.........
686,711
466,021
466,021
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
..........
10a
Investments—U.S. and state government obligations (attach schedule)
b
Investments—corporate stock (attach schedule)
.......
6,793,086
6,278,245
6,869,143
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)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
7,479,797
6,744,266
7,335,164
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
0
Foundations that follow SFAS 117, check here
and complete lines 24 through 26 and lines 30 and 31.
24
Unrestricted
..................
7,479,797
6,744,266
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
30
Total net assets or fund balances
(see instructions)
.....
7,479,797
6,744,266
31
Total liabilities and net assets/fund balances
(see instructions)
.
7,479,797
6,744,266
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
7,479,797
2
Enter amount from Part I, line 27a
.....................
2
-535,531
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
6,944,266
5
Decreases not included in line 2 (itemize)
5
200,000
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30
.
6
6,744,266
Form
990-PF
(2015)
Page 3
Form 990-PF (2015)
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.)
1 a
MERRILL LYNCH 02226
P
2015-01-01
2015-12-31
b
MERRILL LYNCH 02226
P
2014-01-01
2015-12-31
c
MERRILL LYNCH 02227
P
2015-01-01
2015-12-31
d
MERRILL LYNCH 02227
P
2014-01-01
2015-12-31
e
MERRILL LYNCH 02228
P
2015-01-01
2015-12-31
MERRILL LYNCH 02228
P
2014-01-01
2015-12-31
MERRILL LYNCH 02231
P
2015-01-01
2015-12-31
MERRILL LYNCH 02231
P
2014-01-01
2015-12-31
MERRILL LYNCH 02480
P
2015-01-01
2015-12-31
MERRILL LYNCH 02480
P
2014-01-01
2015-12-31
MERRILL LYNCH 02497
P
2015-01-01
2015-12-31
MERRILL LYNCH 02497
P
2014-01-01
2015-12-31
MERRILL LYNCH 02498
P
2015-01-01
2015-12-31
MERRILL LYNCH 02498
P
2014-01-01
2015-12-31
MERRILL LYNCH 02499
P
2015-01-01
2015-12-31
MERRILL LYNCH 02499
P
2014-01-01
2015-12-31
MERRILL LYNCH 02500
P
2015-01-01
2015-12-31
MERRILL LYNCH 02500
P
2014-01-01
2015-12-31
MERRILL LYNCH 04203
P
2014-01-01
2015-12-31
Capital Gains Dividends
P
(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
76,962
88,531
-11,569
b
331,331
273,685
57,646
c
3,929
3,704
225
d
62,823
45,150
17,673
e
4,914
5,062
-148
46,938
24,865
22,073
20,888
22,039
-1,151
88,117
77,874
10,243
16,082
17,093
-1,011
124,101
124,590
-489
128,097
132,025
-3,928
373,616
319,403
54,213
9,169
6,554
2,615
91,323
77,265
14,058
9,741
10,216
-475
208,324
161,993
46,331
21,589
17,729
3,860
144,281
104,182
40,099
180,014
174,986
5,028
2,324
2,324
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
-11,569
b
57,646
c
225
d
17,673
e
-148
22,073
-1,151
10,243
-1,011
-489
-3,928
54,213
2,615
14,058
-475
46,331
3,860
40,099
5,028
2,324
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
257,617
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
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 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))
2014
49,500
8,383,866
0.005904
2013
723,550
8,432,415
0.085806
2012
782,148
8,305,711
0.094170
2011
1,045,172
8,456,297
0.123597
2010
365,798
8,703,488
0.042029
2
Total
of line 1, column (d)
.....................
2
0.351506
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
0.070301
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5
.....
4
7,853,343
5
Multiply line 4 by line 3
......................
5
552,098
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
3,951
7
Add lines 5 and 6
........................
7
556,049
8
Enter qualifying distributions from Part XII, line 4
.............
8
923,450
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
(2015)
Page 4
Form 990-PF (2015)
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
3,951
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
0
3
Add lines 1 and 2
...........................
3
3,951
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
3,951
6
Credits/Payments:
a
2015 estimated tax payments and 2014 overpayment credited to 2015
6a
6,854
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
6,854
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
2,903
11
Enter the amount of line 10 to be:
Credited to 2015 estimated tax
2,903
Refunded
11
0
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 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.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
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
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
Yes
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)
IL
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 2015 or the taxable year beginning in 2015 (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
Form
990-PF
(2015)
Page 5
Form 990-PF (2015)
Page
5
Part VII-A
Statements Regarding Activities (continued)
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
TOM EBERHARDT
Telephone no.
(312) 477-7603
Located at
155 N WACKER DRIVE SUITE 1680
CHICAGO
IL
ZIP+4
60606
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 2015, 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 FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country
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 instructions)?
........
1b
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 2015?
.............
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 2015, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2015?
.............
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
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 2015 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 2015.)
..................
3b
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 2015?
4b
No
Form
990-PF
(2015)
Page 6
Form 990-PF (2015)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(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
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 4945(d)(4)(A)? (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
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
Form
990-PF
(2015)
Page 7
Form 990-PF (2015)
Page
7
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
CAROL BERNICK
PRES/TREAS
0.10
0
0
0
155 N WACKER STE 1680
CHICAGO
,
IL
60606
CRAIG BERNICK
DIRECTOR
0.10
0
0
0
155 N WACKER STE 1680
CHICAGO
,
IL
60606
PETER BERNICK
DIRECTOR
0.10
0
0
0
155 N WACKER STE 1680
CHICAGO
,
IL
60606
ELIZABETH BERNICK HUBER
VICE PRESIDENT/SECRETARY/D
0.10
0
0
0
155 N WACKER STE 1680
CHICAGO
,
IL
60606
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
...................
0
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
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
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 instructions.
3
Total.
Add lines 1 through 3
.........................
0
Form
990-PF
(2015)
Page 8
Form 990-PF (2015)
Page
8
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
7,402,088
b
Average of monthly cash balances
.......................
1b
570,849
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
7,972,937
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
0
3
Subtract line 2 from line 1d
.........................
3
7,972,937
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
119,594
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
7,853,343
6
Minimum investment return.
Enter 5% of line 5
..................
6
392,667
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
392,667
2a
Tax on investment income for 2015 from Part VI, line 5
......
2a
3,951
b
Income tax for 2015. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
3,951
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
388,716
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
388,716
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
388,716
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
923,450
b
Program-related investments—total from Part IX-B
..................
1b
0
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
923,450
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
3,951
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
919,499
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
(2015)
Page 9
Form 990-PF (2015)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2014
(c)
2014
(d)
2015
1
Distributable amount for 2015 from Part XI, line 7
388,716
2
Undistributed income, if any, as of the end of 2015:
a
Enter amount for 2014 only
.......
0
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2015:
a
From 2010
......
b
From 2011
......
340,354
c
From 2012
......
383,766
d
From 2013
......
305,032
e
From 2014
......
14,917
f
Total
of lines 3a through e
........
1,044,069
4
Qualifying distributions for 2015 from Part
XII, line 4:
$
923,450
a
Applied to 2014, 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 2015 distributable amount
.....
388,716
e
Remaining amount distributed out of corpus
534,734
5
Excess distributions carryover applied to 2015.
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
1,578,803
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
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
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2014. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2016. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2015
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2010 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2016.
Subtract lines 7 and 8 from line 6a
......
1,578,803
10
Analysis of line 9:
a
Excess from 2011
....
340,354
b
Excess from 2012
....
383,766
c
Excess from 2013
....
305,032
d
Excess from 2014
....
14,917
e
Excess from 2015
....
534,734
Form
990-PF
(2015)
Page 10
Form 990-PF (2015)
Page
10
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 2015, 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)
2015
(b)
2014
(c)
2013
(d)
2012
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 or email address 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
(2015)
Page 11
Form 990-PF (2015)
Page
11
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
Access Living
115 W Chicago Avenue
Chicago
,
IL
60654
PC
GENERAL FUND
5,000
ALS TDI
300 Technology Sq Suite 400
Cambridge
,
MA
02139
PC
GENERAL FUND
1,000
ALS TDI
300 Technology Sq Suite 400
Cambridge
,
MA
02139
PC
GENERAL FUND
5,000
Alzheimer's Association
225 N Michigan Avenue Fl 17
Chicago
,
IL
60601
PC
GENERAL FUND
250
Alzheimer's Association
225 N Michigan Avenue Fl 17
Chicago
,
IL
60601
PC
GENERAL FUND
500
American Cancer Society
225 N Michigan Avenue 1210
Chicago
,
IL
60601
PC
GENERAL FUND
3,000
BCCA Scholarship Fund
8700 Bay Colony Drive
Naples
,
FL
34108
PC
GENERAL FUND
1,000
Bear Necessities
55 W Wacker Drive
Chicago
,
IL
60601
PC
GENERAL FUND
1,300
Bear Necessities Pediatric Cancer Foundation
55 W Wacker Drive
Chicago
,
IL
60601
PC
GENERAL FUND
1,500
Benedictine Sisters Of Chicago
7430 N Ridge Blvd
Chicago
,
IL
60645
PC
GENERAL FUND
2,500
Benet Academy
220 Maple Avenue
Lisle
,
IL
60532
PC
GENERAL FUND
2,500
Big Shoulders Fund
212 West Van Buren Suite 900
Chicago
,
IL
60607
PC
GENERAL FUND
10,000
Big Shoulders Fund
212 West Van Buren Suite 900
Chicago
,
IL
60607
PC
GENERAL FUND
5,000
Boys & Girls Club Of Chicago
550 W Van Buren Street Suite 350
Chicago
,
IL
60607
PC
GENERAL FUND
7,000
Boys & Girls Club Of Chicago
550 W Van Buren Street Suite 350
Chicago
,
IL
60607
PC
GENERAL FUND
25,000
Boys & Girls Club Of Chicago
550 W Van Buren Street Suite 350
Chicago
,
IL
60607
PC
GENERAL FUND
1,000
Brother Rice High School
10001 South Pulaski Road
Chicago
,
IL
60655
PC
GENERAL FUND
20,000
C200 Foundation
980 N Michigan Ave Ste 1575
Chicago
,
IL
60611
PC
GENERAL FUND
8,000
C200 Foundation
980 N Michigan Ave Ste 1575
Chicago
,
IL
60611
PC
GENERAL FUND
10,000
CAAEL
611 Thomas
Forest Park
,
IL
60130
PC
GENERAL FUND
10,000
Casa Central
1343 N California Ave
Chicago
,
IL
60622
PC
GENERAL FUND
5,000
Catholic Theological Union
5401 S Cornell Ave
Chicago
,
IL
60615
PC
GENERAL FUND
3,000
Center Stage
400 E Illinois Road
Lake Forest
,
IL
60045
PC
GENERAL FUND
5,000
Chicago Blackhawks Charities
1901 W Madison St
Chicago
,
IL
60612
PC
GENERAL FUND
5,000
Chicago Foundation For Women
1 E Upper Wacker Dr
Chicago
,
IL
60601
PC
GENERAL FUND
5,000
Cystic Fibrosis Foundation
150 N Michigan Ave Ste 400
Chicago
,
IL
60601
PC
GENERAL FUND
5,000
Don't Be a Monster
1550 Larimer St Room 277
Denver
,
CO
80202
PC
GENERAL FUND
1,000
DownLine Ministries
PO Box 770296
Memphis
,
TN
38177
PC
GENERAL FUND
5,000
DuPage P A D S Inc
705 W Liberty Dr
Wheaton
,
IL
60187
PC
GENERAL FUND
500
EMG Fund
3060 North Shore Drive
Wayzata
,
MN
55391
PC
GENERAL FUND
500
Fenwick High School
705 W Liberty Dr
Wheaton
,
IL
60187
PC
GENERAL FUND
5,000
Fold Of Honor Foundation
5800 N Patriot Dr
Owasso
,
OK
74055
PC
GENERAL FUND
1,000
Friends Of Prentice
251 E Huron Street Suite 3-200
Chicago
,
IL
60611
PC
GENERAL FUND
10,000
Friends Of Prentice
251 E Huron Street Suite 3-200
Chicago
,
IL
60611
PC
GENERAL FUND
37,000
Geneva Lake Association Inc
PO Box 412
Lake Geneva
,
WI
53147
PC
GENERAL FUND
250
Geneva Lake Conservancy
398 Mill Street PO Box 388
Fontana
,
WI
53125
PC
GENERAL FUND
5,000
Geneva Lake Water Safety Committee Inc
PO Box 412
Lake Geneva
,
WI
53147
PC
GENERAL FUND
5,000
George Williams College Of Aurora University
347 S Gladstone Ave
Aurora
,
IL
60506
PC
GENERAL FUND
10,000
Girl Scouts GCNWI
205 W Wacker Dr Suite 1400
Chicago
,
IL
60606
PC
GENERAL FUND
5,000
Greater Chicago Food Depository
4100 West Ann Lurie Place
Chicago
,
IL
60632
PC
GENERAL FUND
5,000
Guerin Prep High School
8001 W Belmont Ave
River Grove
,
IL
60034
PC
GENERAL FUND
1,000
Harvest Church
PO Box 381855
Germantown
,
TN
38183
PC
GENERAL FUND
5,000
Harvest Church
PO Box 381855
Germantown
,
TN
38183
PC
GENERAL FUND
2,500
Hephzibath Children's Association
1144 Lake Street 5th Floor
Oak Park
,
IL
60301
PC
GENERAL FUND
1,000
Holiday Home Camp
361 N Lake Shore Dr PO Box 10
Williams Bay
,
WI
53191
PC
GENERAL FUND
5,000
Holy Family Villa
12220 Will Cook Road
Palos Park
,
IL
60464
PC
GENERAL FUND
300
Holy Family Villa
12220 Will Cook Road
Palos Park
,
IL
60464
PC
GENERAL FUND
1,000
Hope & Friendship Foundation
721 Hickory St
Lemont
,
IL
60439
PC
GENERAL FUND
1,500
Hospice Of Marion County
3231 SW 34th Avenue
Ocala
,
FL
34474
PC
GENERAL FUND
500
Howard Brown Health Center
3837 N Broadway Ave 2nd Floor
Chicago
,
IL
60613
PC
GENERAL FUND
2,500
Illinithon
PO Box 2097
Champaign
,
IL
62825
PC
GENERAL FUND
500
Invest For Kids
875 N Michigan Ave Suite 3400
Chicago
,
IL
60611
PC
GENERAL FUND
3,000
Jackson Chance Foundation
230 N Michigan Avenue 37th Floor
Chicago
,
IL
60601
PC
GENERAL FUND
1,000
Kellogg School Of Management
1201 Davis Street
Evanston
,
IL
60208
PC
GENERAL FUND
25,000
Kellogg School Of Management
1201 Davis Street
Evanston
,
IL
60208
PC
GENERAL FUND
500
Lake Geneva Garden Club Foundation Inc
326 Center St
Lake Geneva
,
WI
53147
PC
GENERAL FUND
500
Lambs Farm
14245 W Rockland Road
Libertyville
,
IL
60048
PC
GENERAL FUND
5,000
Legal Momentum
5 Hanover Square Ste 1502
New York
,
NY
10004
PC
GENERAL FUND
5,000
Lemont Park District Foundation
16028 127th St
Lemont
,
IL
60439
PC
GENERAL FUND
500
Lewis University
5 Hanover Square Ste 1502
New York
,
NY
10004
PC
GENERAL FUND
5,000
Luther College
700 College Dr
Decorah
,
IA
52101
PC
GENERAL FUND
1,000
Metropolitan Planning Council
140 S Dearborn St Suite 1400
Chicago
,
IL
60603
PC
GENERAL FUND
3,000
Metropolitan Planning Council
140 S Dearborn St Suite 1400
Chicago
,
IL
60603
PC
GENERAL FUND
15,000
Milestone Inc
4060 McFarland Road
Rockford
,
IL
61111
PC
GENERAL FUND
1,000
Milestone Inc
4060 McFarland Road
Rockford
,
IL
61111
PC
GENERAL FUND
500
Misericordia
6300 North Ridge
Chicago
,
IL
60660
PC
GENERAL FUND
10,000
Mundelein High School Band Boosters
1350 W Hawley St
Mundelein
,
IL
60060
PC
GENERAL FUND
1,000
Naperville Responds For Our Veterans
1111 S Washington St
Naperville
,
IL
60540
PC
GENERAL FUND
500
National Hurricane Museum & Science Center
1205 N Lakeshore Dr
Lake Charles
,
LA
70601
PC
GENERAL FUND
5,000
National Parkinson's Foundation
200 SE 1st St Suite 800
Miami
,
FL
33131
PC
GENERAL FUND
500
NCH Healthcare Foundation
PO Box 234
Naples
,
FL
34106
PC
GENERAL FUND
10,000
Network For Teaching Entrepreneurship
205 West Wacker Drive Suite 1400
Chicago
,
IL
60606
PC
GENERAL FUND
5,000
Noble Network Of Charter Schools
1 N State Street 7-L
Chicago
,
IL
60602
PC
GENERAL FUND
4,000
Northwestern Brain Tumor Institute
Galter Pavilion 251 E Huron St Ste
3-200
Chicago
,
IL
60611
PC
GENERAL FUND
10,000
Northwestern Memorial Hospital
251 E Huron Street Suite 3-200
Chicago
,
IL
60611
PC
GENERAL FUND
20,000
Northwestern University
420 E Superior St Rubloff Bldg 9th
Floor
Chicago
,
IL
60611
PC
GENERAL FUND
5,000
Old St Patrick's Church
700 W Adams St
Chicago
,
IL
60661
PC
GENERAL FUND
2,500
Opportunity Knocks
8020 Madison St
River Forest
,
IL
60305
PC
GENERAL FUND
25,000
Ounce Of Prevention Fund
33 W Monroe St Suite 2400
Chicago
,
IL
60603
PC
GENERAL FUND
5,000
Pathways Foundation
150 N Michigan Avenue Suite 2100
Chicago
,
IL
60601
PC
GENERAL FUND
5,000
PAWS
1997 N Clybourn Avenue
Chicago
,
IL
60614
PC
GENERAL FUND
1,500
Permanently Disabled Jockey Fund
PO Box 803
Elmhurst
,
IL
60126
PC
GENERAL FUND
2,500
Receptions For Research
315 N Racine Ave Suite 501
Chicago
,
IL
60607
PC
GENERAL FUND
250
Rehabilitation Institute of Chicago
345 E Superior
Chicago
,
IL
60611
PC
GENERAL FUND
6,000
River Grove Lions Club
8420 W Fullerton Ave
River Grove
,
IL
60171
PC
GENERAL FUND
500
Roots Of Renewal
1000 N Broad St
New Orleans
,
LA
70019
PC
GENERAL FUND
1,000
Sarah's Inn
311 Harrison St
Oak Park
,
IL
60304
PC
GENERAL FUND
1,000
Sarah's Inn
311 Harrison St
Oak Park
,
IL
60304
PC
GENERAL FUND
5,000
Senior Services Associates
101 S Grove Ave
Elgin
,
IL
60120
PC
GENERAL FUND
2,500
Spectrum Progressive School Of Rockford
2909 N Main St
Rockford
,
IL
61103
PC
GENERAL FUND
2,000
St Alphonsus
1429 Wellington Ave
Chicago
,
IL
60657
PC
GENERAL FUND
1,000
St Cyprian School
2561 Clinton Street
River Grove
,
IL
60171
PC
GENERAL FUND
1,500
St Cyprian School
2561 Clinton Street
River Grove
,
IL
60171
PC
GENERAL FUND
1,500
St Cyril & Methodius Parish
608 Sobieski St
Lemont
,
IL
60439
PC
GENERAL FUND
750
St Edward Central Catholic High School
3211 4th St NE
Washington
,
DC
20017
PC
GENERAL FUND
2,500
St Francis De Sales Catholic Church
11 S Buesching Road
Lake Zurich
,
IL
60047
PC
GENERAL FUND
1,000
St Francis High School
2130 W Roosevelt Road
Wheaton
,
IL
60187
PC
GENERAL FUND
1,500
St Ignatius College Prep
1076 W Roosevelt Road
Chicago
,
IL
60608
PC
GENERAL FUND
5,000
St Luke Development
519 Ashland Ave
River Forest
,
IL
60305
PC
GENERAL FUND
2,000
St Luke's
519 Ashland Ave
River Forest
,
IL
60305
PC
GENERAL FUND
5,000
St Mary Appalachia
5400 Walnut Ave 402
Downers Grove
,
IL
60515
PC
GENERAL FUND
300
Success Preparatory Academy
2011 Bienville St
New Orleans
,
LA
70112
PC
GENERAL FUND
12,000
Success Preparatory Academy
2011 Bienville St
New Orleans
,
LA
70112
PC
GENERAL FUND
25,000
Teach For America
2450 N Lakeview
Chicago
,
IL
60614
PC
GENERAL FUND
20,000
Teaching Tolerance
9603 Woods Drive
Skokie
,
IL
60077
PC
GENERAL FUND
12,500
Teaching Tolerance
9603 Woods Drive
Skokie
,
IL
60077
PC
GENERAL FUND
20,000
The Auxilary Of NorthShore
1033 University Place Suite 450
Evanston
,
IL
60201
PC
GENERAL FUND
1,000
The Chicago Community Foundation
205 W Wacker Dr Suite 1400
Chicago
,
IL
60606
PC
GENERAL FUND
5,000
The Chicago Network
737 N Michigan Ave Ste 1900
Chicago
,
IL
60611
PC
GENERAL FUND
10,000
The Leukemia And Lymphoma Society
651 W Washington Blvd 400
Chicago
,
IL
60661
PC
GENERAL FUND
3,000
The Leukemia And Lymphoma Society
651 W Washington Blvd 400
Chicago
,
IL
60661
PC
GENERAL FUND
10,000
The Leukemia And Lymphoma Society
651 W Washington Blvd 400
Chicago
,
IL
60661
PC
GENERAL FUND
15,000
The Rock School
1101 S Broad St
Philadelphia
,
PA
19147
PC
GENERAL FUND
5,000
The Shelter
PO Box 10102
Naples
,
FL
34101
PC
GENERAL FUND
1,000
The Shrine Of Our Lady Of Pompeii
1224 W Lexington St
Chicago
,
IL
60607
PC
GENERAL FUND
250
The St Philip The Deacon Foundation
17205 County Road Six
Plymouth
,
MN
55447
PC
GENERAL FUND
1,000
The University Of Chicago
5801 S Ellis Ave Chicago IL 60637
Chicago
,
IL
60637
PC
GENERAL FUND
1,000
The University Of Iowa Foundation
PO Box 4550
Iowa City
,
IA
52244
PC
GENERAL FUND
500
Thurgood Marshall College Fund
901 F Street NW Ste 300
Washington
,
DC
20004
PC
GENERAL FUND
5,000
Town Of Linn Police Department DARE Program
W3728 FRANKLIN WALSH ST
ZENDA
,
WI
53195
PC
GENERAL FUND
5,000
Trinity Catholic High School
7574 West Division Street
River Forest
,
IL
60305
PC
GENERAL FUND
25,000
Trinity Catholic High School
7574 West Division Street
River Forest
,
IL
60305
PC
GENERAL FUND
1,500
Trinity High School
7574 West Division Street
River Forest
,
IL
60305
PC
GENERAL FUND
15,000
Trinity High School
7574 West Division Street
River Forest
,
IL
60305
PC
GENERAL FUND
5,000
Tulane Educational Brick Fund
1555 Poydras St Ste 1000
New Orleans
,
LA
70112
PC
GENERAL FUND
15,000
Tulane University
6823 St Charles Avenue
New Orleans
,
LA
70118
PC
GENERAL FUND
200,000
United Jewish Appeal
4600 Bathurst St
Toronto
,
ONTARIO
M2R 3V2
CA
PC
GENERAL FUND
5,000
WINGSSweet Home Chicago
Three First National Plaza Ste 4600
Chicago
,
IL
60602
PC
GENERAL FUND
15,000
Wittenburg Village
3150 Salt Creek Lane
Arlington Heights
,
IL
60005
PC
GENERAL FUND
5,000
YMCA Of Metropolitan Chicago
205 W Wacker Drive Suite 1400
Chicago
,
IL
60606
PC
GENERAL FUND
5,000
Young At Heart Pet Rescue
PO Box 1293
Palatine
,
IL
60078
PC
GENERAL FUND
1,000
Young At Heart Pet Rescue
PO Box 1293
Palatine
,
IL
60078
PC
GENERAL FUND
300
Young Life North Shore
PO Box 415
Wilmette
,
IL
60091
PC
GENERAL FUND
1,000
Total
.................................
3a
923,450
b
Approved for future payment
Total
.................................
3b
0
Form
990-PF
(2015)
Page 12
Form 990-PF (2015)
Page
12
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
356
4
Dividends and interest from securities
....
14
185,484
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
............
18
257,617
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)
..
0
443,457
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
443,457
(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
(2015)
Page 13
Form 990-PF (2015)
Page
13
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) is based on all information of which preparer has any knowledge.
2016-06-27
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 F Barsella
Preparer's Signature
Date
2016-06-22
Check if self-
employed
PTIN
P00083925
Firm's name
PLANTE & MORAN PLLC
Firm's EIN
38-1357951
Firm's address
10 S Riverside Plaza 9th Floor
Chicago
,
IL
60606
Phone no.
(312) 207-1040
Form
990-PF
(2015)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description