efile Public Visual Render
ObjectId: 201743179349102559 - Submission: 2017-11-13
TIN: 95-4280605
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
16
Open to Public Inspection
For calendar year 2016, or tax year beginning
01-01-2016
, and ending
12-31-2016
Name of foundation
MOSS FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)
421 N BEVERLY DRIVE NO 260
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
BEVERLY HILLS
,
CA
90210
A Employer identification number
95-4280605
B
Telephone number (see instructions)
(818) 716-1120
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)
$
5,729,059
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
287
287
4
Dividends and interest from securities
...
125,725
125,725
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
-167,535
b
Gross sales price for all assets on line 6a
3,754,280
7
Capital gain net income (from Part IV, line 2)
...
0
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
........
-41,523
126,012
13
Compensation of officers, directors, trustees, etc.
0
0
0
14
Other employee salaries and wages
......
83,000
83,000
0
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
6,238
6,238
0
b
Accounting fees (attach schedule)
.......
12,480
12,480
0
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
9,723
9,723
0
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
50,769
50,769
0
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
162,210
162,210
0
25
Contributions, gifts, grants paid
.......
1,900,706
1,900,706
26
Total expenses and disbursements.
Add lines 24 and 25
2,062,916
162,210
1,900,706
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-2,104,439
b
Net investment income
(if negative, enter -0-)
0
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2016)
Page 2
Form 990-PF (2016)
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
.............
323,198
142,510
142,510
2
Savings and temporary cash investments
.........
127,920
88,673
88,673
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)
.......
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)
..........
7,017,385
5,132,881
5,497,876
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)
7,468,503
5,364,064
5,729,059
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
..................
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
........
-4,774,509
-6,878,948
28
Paid-in or capital surplus, or land, bldg., and equipment fund
0
0
29
Retained earnings, accumulated income, endowment, or other funds
12,243,012
12,243,012
30
Total net assets or fund balances
(see instructions)
.....
7,468,503
5,364,064
31
Total liabilities and net assets/fund balances
(see instructions)
.
7,468,503
5,364,064
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
7,468,503
2
Enter amount from Part I, line 27a
.....................
2
-2,104,439
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
5,364,064
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30
.
6
5,364,064
Form
990-PF
(2016)
Page 3
Form 990-PF (2016)
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
GOLDMAN SACHS #9137
P
b
GOLDMAN SACHS #9137
P
c
GOLDMAN SACHS #1438
P
d
GOLDMAN SACHS #1438
P
e
GOLDMAN SACHS #8667
P
GOLDMAN SACHS #8667
P
GOLDMAN SACHS #1304
P
GOLDMAN SACHS #1304
P
DISALLOWED WASH SALE (GOLDMAN SACHS #9137)
P
DISALLOWED WASH SALE (GOLDMAN SACHS #1438)
P
DISALLOWED WASH SALE (GOLDMAN SACHS #1438)
P
DISALLOWED WASH SALE (GOLDMAN SACHS #1304)
P
DISALLOWED WASH SALE (GOLDMAN SACHS #1304)
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
568,375
573,034
-4,659
b
1,919,986
2,092,224
-172,238
c
614,867
631,296
-16,429
d
119,535
139,508
-19,973
e
36,378
39,220
-2,842
87,249
69,258
17,991
81,266
105,810
-24,544
296,673
271,465
25,208
7,644
7,644
6,609
6,609
2,777
2,777
11,694
11,694
1,227
1,227
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
-4,659
b
-172,238
c
-16,429
d
-19,973
e
-2,842
17,991
-24,544
25,208
7,644
6,609
2,777
11,694
1,227
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
-167,535
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))
2015
2,133,403
8,841,448
0.241296
2014
2,421,447
9,588,088
0.252547
2013
2,259,202
11,787,974
0.191653
2012
1,778,708
12,001,708
0.148205
2011
2,365,705
12,721,950
0.185955
2
Total
of line 1, column (d)
.....................
2
1.019656
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
0.203931
4
Enter the net value of noncharitable-use assets for 2016 from Part X, line 5
......
4
6,305,653
5
Multiply line 4 by line 3
......................
5
1,285,918
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
0
7
Add lines 5 and 6
........................
7
1,285,918
8
Enter qualifying distributions from Part XII, line 4
,.............
8
1,900,706
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
(2016)
Page 4
Form 990-PF (2016)
Page
4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see 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
0
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
0
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
0
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
0
6
Credits/Payments:
a
2016 estimated tax payments and 2015 overpayment credited to 2016
6a
449
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
449
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
449
11
Enter the amount of line 10 to be:
Credited to 2017 estimated tax
449
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)
CA
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 2016 or the taxable year beginning in 2016 (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
(2016)
Page 5
Form 990-PF (2016)
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
NONE
14
The books are in care of
THE FOUNDATION
Telephone no.
(818) 716-1120
Located at
421 N BEVERLY DRIVE NO 260
BEVERLY HILLS
CA
ZIP+4
90210
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 2016, 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 2016?
.............
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 2016, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2016?
.............
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 2016 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 2016.)
..................
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 2016?
4b
No
Form
990-PF
(2016)
Page 6
Form 990-PF (2016)
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
(2016)
Page 7
Form 990-PF (2016)
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
JEROME S MOSS
PRESIDENT
0.00
0
0
0
421 N BEVERLY DRIVE
BEVERLY HILLS
,
CA
90210
ANN HOLBROOK MOSS
VICE PRESIDENT
0.00
0
0
0
421 N BEVERLY DRIVE
BEVERLY HILLS
,
CA
90210
LAWRENCE S KARTIGANER
CHIEF FINANCIAL OFFICER
0.00
0
0
0
421 N BEVERLY DRIVE
BEVERLY HILLS
,
CA
90210
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
(2016)
Page 8
Form 990-PF (2016)
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
6,298,185
b
Average of monthly cash balances
.......................
1b
103,493
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
6,401,678
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
6,401,678
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
96,025
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
6,305,653
6
Minimum investment return.
Enter 5% of line 5
..................
6
315,283
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
315,283
2a
Tax on investment income for 2016 from Part VI, line 5
......
2a
b
Income tax for 2016. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
0
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
315,283
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
315,283
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
315,283
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
1,900,706
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
1,900,706
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
0
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
1,900,706
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
(2016)
Page 9
Form 990-PF (2016)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2015
(c)
2015
(d)
2016
1
Distributable amount for 2016 from Part XI, line 7
315,283
2
Undistributed income, if any, as of the end of 2016:
a
Enter amount for 2015 only
.......
0
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2016:
a
From 2011
......
1,740,963
b
From 2012
......
1,277,863
c
From 2013
......
1,682,819
d
From 2014
......
1,966,585
e
From 2015
......
1,694,807
f
Total
of lines 3a through e
........
8,363,037
4
Qualifying distributions for 2016 from Part
XII, line 4:
$
1,900,706
a
Applied to 2015, 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 2016 distributable amount
.....
315,283
e
Remaining amount distributed out of corpus
1,585,423
5
Excess distributions carryover applied to 2016.
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
9,948,460
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 2015. 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 2017
..........
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 2011 not
applied on line 5 or line 7 (see instructions)
...
1,740,963
9
Excess distributions carryover to 2017.
Subtract lines 7 and 8 from line 6a
......
8,207,497
10
Analysis of line 9:
a
Excess from 2012
....
1,277,863
b
Excess from 2013
....
1,682,819
c
Excess from 2014
....
1,966,585
d
Excess from 2015
....
1,694,807
e
Excess from 2016
....
1,585,423
Form
990-PF
(2016)
Page 10
Form 990-PF (2016)
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 2016, 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)
2016
(b)
2015
(c)
2014
(d)
2013
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).)
JEROME S MOSS
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
(2016)
Page 11
Form 990-PF (2016)
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
ACLU
1313 W 8 TH STREET
LOS ANGELES
,
CA
90017
NONE
PUBLIC
CHARITABLE
25,000
AMERICAN HOSPITAL OF PARIS
150 EAST 58TH STREET 24TH FLOOR
NEW YORK
,
NY
10155
NONE
PUBLIC
CHARITABLE
1,000
AMFAR
PO BOX 96635
WASHINGTON
,
DC
20090
NONE
PUBLIC
CHARITABLE
25,000
ANGELS AT RISK
115 BARRINGTON WALK
LOS ANGELES
,
CA
90049
NONE
PUBLIC
CHARITABLE
5,000
ANTI-DEFAMATION LEAGUE
10495 SANTA MONICA BLVD
LOS ANGELES
,
CA
90025
NONE
PUBLIC
CHARITABLE
2,500
BRADY CENTER TO PREVENT GUN VIOLENCE
840 FIRST STREET NE SUITE 400
WASHINGTON
,
DC
20002
NONE
PUBLIC
CHARITABLE
2,000
BREAD & ROSES
233 TAMALPAIS DRIVE
CORTE MADERA
,
CA
94925
NONE
PUBLIC
CHARITABLE
1,000
CALIFORNIA THOROUGHBRED FOUNDATION
PO BOX 60018
ARCADIA
,
CA
91066
NONE
PUBLIC
CHARITABLE
2,000
CARTER CENTER
453 FREEDOM PARKWAY
ATLANTA
,
GA
30307
NONE
PUBLIC
CHARITABLE
1,000
CHABAD TELETHON
741 GAYLEY AVENUE
LOS ANGELES
,
CA
90024
NONE
PUBLIC
CHARITABLE
2,500
CHILDREN OF THE NIGHT
14530 SYLVAN STREET
VAN NUYS
,
CA
91411
NONE
PUBLIC
CHARITABLE
10,000
CHRISTOPHER & DANA REEVE FOUNDATION
636 MORRIS TURNPIKE STE 3A
SHORT HILLS
,
NJ
07078
NONE
PUBLIC
CHARITABLE
1,000
COALITION FOR ENGAGED EDUCATION
3131 OLYMPIC BOULEVARD
SANTA MONICA
,
CA
90404
NONE
PUBLIC
CHARITABLE
50,000
COVENANT HOUSE
1325 N WESTERN AVENUE
HOLLYWOOD
,
CA
90027
NONE
PUBLIC
CHARITABLE
1,000
DOLPHIN CONNECTION
421 N BEVERLY DRIVE
BEVERLY HILLS
,
CA
90210
NONE
PUBLIC
CHARITABLE
20,000
DOLPHIN RESEARCH CENTER
58901 OVERSEAS HIGHWAY
GRASSY KEY
,
FL
33050
NONE
PUBLIC
CHARITABLE
15,000
EARTH ISLAND INSTITUTE
2150 ALLSTON WAY SUITE 460
BERKELEY
,
CA
94704
NONE
PUBLIC
CHARITABLE
15,000
EDWIN J GREGSON FOUNDATION
285 W HUNTINGTON DRIVE
ARCADIA
,
CA
91007
NONE
PUBLIC
CHARITABLE
3,000
ELIZABETH GLASER PEDIATRIC AIDS FOUNDATION
PO BOX 418649
BOSTON
,
MA
02241
NONE
PUBLIC
CHARITABLE
10,000
EXCEPTIONAL CHILDREN'S FOUNDATION
8740 WASHINGTON BLVD
CULVER CITY
,
CA
90232
NONE
PUBLIC
CHARITABLE
15,000
EXPLORING THE ARTS
162 WEST 56TH STREET SUITE 405
NEW YORK
,
NY
10019
NONE
PUBLIC
CHARITABLE
2,500
FRIENDS OF THE SABAN FREE CLINIC
8405 BEVERLY BLVD
LOS ANGELES
,
CA
90048
NONE
PUBLIC
CHARITABLE
5,000
GEFFEN PLAYHOUSE
10886 LE CONTE AVENUE
LOS ANGELES
,
CA
90024
NONE
PUBLIC
CHARITABLE
25,000
GRAYSON-JOCKEY CLUB RESEARCH
821 CORPORATE AVENUE
LEXINGTON
,
KY
40503
NONE
PUBLIC
CHARITABLE
2,500
HAMMER MUSEUM
10899 WILSHIRE BLVD
LOS ANGELES
,
CA
90024
NONE
PUBLIC
CHARITABLE
25,000
INTERNATIONAL SOCIETY FOR THE MUSTANGS & BURROS
PO BOX 55
LANTRY
,
SD
57636
NONE
PUBLIC
CHARITABLE
2,000
INTERNATIONAL SOCIETY FOR THE PRESERV OF THE TROPICAL RAIN FOREST
3302 N BURTON AVE
ROSEMEAD
,
CA
91770
NONE
PUBLIC
CHARITABLE
10,000
JOHN BURTON FOUNDATION FOR CHILDREN WITHOUT HOMES
235 MONTGOMERY STREET STE 1142
SAN FRANCISCO
,
CA
94104
NONE
PUBLIC
CHARITABLE
1,000
JOHN F KENNEDY LIBRARY FOUNDATION
COLUMBIA POINT
BOSTON
,
MA
02125
NONE
PUBLIC
CHARITABLE
1,000
JOYFUL HEART FOUNDATION
32 W 22ND STREET 4TH FLOOR
NEW YORK
,
NY
10010
NONE
PUBLIC
CHARITABLE
5,000
KCET
2900 WEST ALAMEDA AVENUE
BURBANK
,
CA
91505
NONE
PUBLIC
CHARITABLE
2,500
KCRW
1900 PICO BLVD
SANTA MONICA
,
CA
90405
NONE
PUBLIC
CHARITABLE
15,000
KENTUCKY DERBY MUSEUM
704 CENTRAL AVENUE
LOUISVILLE
,
KY
40208
NONE
PUBLIC
CHARITABLE
1,000
LACMA
5905 WILSHIRE BLVD
LOS ANGELES
,
CA
90036
NONE
PUBLIC
CHARITABLE
10,000
LEADERCOMM
1615 DUKE STREET THIRD FLOOR
ALEXANDRIA
,
VA
22314
NONE
PUBLIC
CHARITABLE
75,000
LOS ANGELES MISSION
13356 ELDRIDGE AVENUE
SYLMAR
,
CA
91342
NONE
PUBLIC
CHARITABLE
10,000
LOS ANGELES REGIONAL FOODBANK
1734 EAST 41ST STREET
LOS ANGELES
,
CA
90058
NONE
PUBLIC
CHARITABLE
5,000
LUPUS LA
8383 WILSHIRE BLVD SUITE 232
BEVERLY HILLS
,
CA
90211
NONE
PUBLIC
CHARITABLE
10,000
MAUI FOOD BANK
760 KOLU STREET
WAILUKU
,
HI
96793
NONE
PUBLIC
CHARITABLE
10,000
MEMORIAL SLOAN KETTERING
1275 YORK AVENUE
NEW YORK
,
NY
10065
NONE
PUBLIC
CHARITABLE
50,000
METROPOLITITAN MUSEUM OF ART
1000 FIFTH AVENUE
NEW YORK
,
NY
10028
NONE
PUBLIC
CHARITABLE
600
MOCA
250 SOUTH GRAND AVENUE
LOS ANGELES
,
CA
90012
NONE
PUBLIC
CHARITABLE
10,000
MUSIC CENTER
135 NORTH GRAND AVENUE
LOS ANGELES
,
CA
90012
NONE
PUBLIC
CHARITABLE
25,000
NATIONAL MUSEUM OF RACING
191 UNION AVENUE
SARATOGA SPRINGS
,
NY
12866
NONE
PUBLIC
CHARITABLE
1,500
NEW DIRECTIONS FOR VETERANS
11303 WILSHIRE BLVD VA BLDG 116
LOS ANGELES
,
CA
90073
NONE
PUBLIC
CHARITABLE
50,000
OAKLAND SCHOOL FOR THE ARTS
2269 CHESTNUT STREET SUITE 500
SAN FRANCISCO
,
CA
94123
NONE
PUBLIC
CHARITABLE
25,000
OCEANA
1350 CONNECTICUT AVE NW 5TH FLOOR
WASHINGTON
,
DC
20036
NONE
PUBLIC
CHARITABLE
10,000
OLD FRIENDS INC
1841 PAYNES DEPOT ROAD
GEORGETOWN
,
KY
40324
NONE
PUBLIC
CHARITABLE
5,000
PS ARTS
6701 CENTER DRIVE W SUITE 550
LOS ANGELES
,
CA
90045
NONE
PUBLIC
CHARITABLE
75,000
PAINTED TURTLE CAMP
1300 4TH STREET SUITE 300
SANTA MONICA
,
CA
90401
NONE
PUBLIC
CHARITABLE
25,000
PARALYZED VETERANS
801 18TH STREET
NW WASHINGTON
,
DC
20006
NONE
PUBLIC
CHARITABLE
2,000
PEOPLE FOR THE AMERICAN WAY
1101 15TH STREET NW STE 600
WASHINGTON
,
DC
20005
NONE
PUBLIC
CHARITABLE
50,000
RAPE FOUNDATION
1223 WILSHIRE BLVD NO 410
SANTA MONICA
,
CA
90403
NONE
PUBLIC
CHARITABLE
5,000
REDCAT
631 WEST 2ND STREET
LOS ANGELES
,
CA
90012
NONE
PUBLIC
CHARITABLE
10,000
SALVATION ARMY
PO BOX 866014
LOS ANGELES
,
CA
90086
NONE
PUBLIC
CHARITABLE
1,000
SAN JUAN COMMUNITY THEATRE
PO BOX 1063
FRIDAY HARBOR
,
WA
98250
NONE
PUBLIC
CHARITABLE
5,000
SAN JUAN PRESERVATION TRUST
PO BOX 327
LOPEZ ISLAND
,
WA
98261
NONE
PUBLIC
CHARITABLE
1,000
SIMON WIESENTHAL CENTER
1399 SOUTH ROXBURY DRIVE
LOS ANGELES
,
CA
90035
NONE
PUBLIC
CHARITABLE
3,500
SOUTHERN CALIFORNIA PUBLIC RADIO
474 SOUTH RAYMOND AVENUE
PASADENA
,
CA
91105
NONE
PUBLIC
CHARITABLE
10,000
SOUTHERN POVERTY LAW CENTER
400 WASHINGTON AVENUE
MONTGOMERY
,
AL
36104
NONE
PUBLIC
CHARITABLE
15,000
STANLEY M ISAACS NEIGBORHOOD CENTER INC
PO BOX 507
ETNA
,
NH
03750
NONE
PUBLIC
CHARITABLE
1,000
TJ MARTELL FOUNDATION
40 WORTH STR 10TH FLOOR
NEW YORK
,
NY
10013
NONE
PUBLIC
CHARITABLE
15,000
THE TIBET FUND
241 EAST 32 STREET
NEW YORK
,
NY
10016
NONE
PUBLIC
CHARITABLE
15,000
THELONIOUS MONK INSTITUTE OF JAZZ
445 CHARLES E YOUNG DRIVE EAST
LOS ANGELES
,
CA
90095
NONE
PUBLIC
CHARITABLE
25,000
THOROUGHBRED RETIREMENT FOUNDATION
PO BOX 834
SARATOGA SPRINGS
,
NY
12866
NONE
PUBLIC
CHARITABLE
1,000
TREEPEOPLE
PO BOX 512205
LOS ANGELES
,
CA
90051
NONE
PUBLIC
CHARITABLE
4,000
UC REGENTS NEUROSURGERY
BOX 956901
LOS ANGELES
,
CA
90095
NONE
PUBLIC
CHARITABLE
200,000
UCLA FOUNDATION (FILM & TV ARCHIVES)
12400 WILSHIRE BLVD SUITE 1000
LOS ANGELES
,
CA
90025
NONE
PUBLIC
CHARITABLE
29,760
UCLA FOUNDATION ATHLETICS
PO BOX 24044
LOS ANGELES
,
CA
90024
NONE
PUBLIC
CHARITABLE
1,000
UCLA FOUNDATION VISIONARY BALL
5670 WILSHIRE BLVD STE 830
LOS ANGELES
,
CA
90036
NONE
PUBLIC
CHARITABLE
25,000
UCLA FOUNDATION VOICE CENTER FOR MEDICINE
200 UCLA MEDICAL PLAZA SUITE 550
LOS ANGELES
,
CA
90095
NONE
PUBLIC
CHARITABLE
100,000
UNCF
1441 BROADWAY STE 5001
NEW YORK
,
NY
10018
NONE
PUBLIC
CHARITABLE
1,000
UNITED FRIENDS OF THE CHILDREN
1055 WILSHIRE BLVD SUITE 1955
LOS ANGELES
,
CA
90017
NONE
PUBLIC
CHARITABLE
2,500
VENICE FAMILY CLINIC
604 ROSE AVENUE
VENICE
,
CA
90291
NONE
PUBLIC
CHARITABLE
2,500
WILLIAM HOLDEN WILDLIFE FOUNDATION
PO BOX 16637
BEVERLY HILLS
,
CA
90209
NONE
PUBLIC
CHARITABLE
25,000
WOLF HOLLOW WILDLIFE REHABILITATION CENTER
PO BOX 391
FRIDAY HARBOR
,
WA
98250
NONE
PUBLIC
CHARITABLE
5,000
YES
110 SHAW DRIVE
SAN ANSELMO
,
CA
94979
NONE
PUBLIC
CHARITABLE
40,000
ALZHEIMER'S GREATER LOS ANGELES
4221 WILSHIRE BLVD SUITE 400
LOS ANGELES
,
CA
90010
NONE
PUBLIC
CHARITABLE
10,000
ARCADIA HISTORICAL SOCIETY
PO BOX 661332
ARCADIA
,
CA
91066
NONE
PUBLIC
CHARITABLE
4,000
BREAK THE CYCLE
PO BOX 811334
LOS ANGELES
,
CA
90081
NONE
PUBLIC
CHARITABLE
15,000
CALIFORNIA CAREFORCE
950 RESERVE DRIVE SUITE 120
ROSEVILLE
,
CA
95678
NONE
PUBLIC
CHARITABLE
75,000
CEDARS-SINAI MEDICAL CENTER
8700 BEVERLY BLVD STE 2416
LOS ANGELES
,
CA
90048
NONE
PUBLIC
CHARITABLE
3,000
CHILDREN'S DIABETES FOUNDATION
4380 S SYRACUSE STREET STE 430
DENVER
,
CO
80237
NONE
PUBLIC
CHARITABLE
20,000
CONCERN FOUNDATION
11111 WEST OLYMPIC BLVD STE 214
LOS ANGELES
,
CA
90064
NONE
PUBLIC
CHARITABLE
6,000
CONSERVATION COUNCIL FOR HAWAII
250 WARD AVENUE SUITE 220
HONOLULU
,
HI
96814
NONE
PUBLIC
CHARITABLE
1,000
DOCTORS WITHOUT BORDERS
333 7TH AVENUE 2ND FLOOR
NEW YORK
,
NY
10001
NONE
PUBLIC
CHARITABLE
2,000
THE EXCELLER FUND
PO BOX 4237
LEXINGTON
,
KY
40544
NONE
PUBLIC
CHARITABLE
100
FIRST STAR
10401 WYTON DRIVE
LOS ANGELES
,
CA
90024
NONE
PUBLIC
CHARITABLE
25,000
INNER-CITY ARTS
720 KOHLER STREET
LOS ANGELES
,
CA
90021
NONE
PUBLIC
CHARITABLE
25,000
INNER CITY LAW CENTER
1309 E SEVENTH STREET
LOS ANGELES
,
CA
90021
NONE
PUBLIC
CHARITABLE
25,000
LA OPERA
135 NORTH GRAND AVENUE
LOS ANGELES
,
CA
90012
NONE
PUBLIC
CHARITABLE
10,000
LOS ANGELES COUNTY ARTS COMMISSION (ARTS FOR ALL)
1055 WILSHIRE BLVD SUITE 800
LOS ANGELES
,
CA
90017
NONE
PUBLIC
CHARITABLE
25,000
MUSEUM OF THE MOVING IMAGE
36-01 35 AVENUE
ASTORIA
,
NY
11106
NONE
PUBLIC
CHARITABLE
5,000
MUSICARES FOUNDATION
3030 OLYMPIC BLVD
SANTA MONICA
,
CA
90404
NONE
PUBLIC
CHARITABLE
10,000
NATURAL RESOURCES DEFENSE COUNCIL
40 WEST 20TH STREET 11TH FLOOR
NEW YORK
,
NY
10011
NONE
PUBLIC
CHARITABLE
25,000
RAINFOREST FUND
420 LEXINGTON AVE SUITE 1710
NEW YORK
,
NY
10170
NONE
PUBLIC
CHARITABLE
25,000
RYMAN CARROLL FOUNDATION
1933 S BROADWAY SUITE 1138
LOS ANGELES
,
CA
90007
NONE
PUBLIC
CHARITABLE
10,000
SOCIETY OF SINGERS
26500 AGOURA ROAD SUITE 102 554
CALABASAS
,
CA
91302
NONE
PUBLIC
CHARITABLE
5,000
TREE ACADEMY
5555 W OLYMPIC BLVD
LOS ANGELES
,
CA
90036
NONE
PUBLIC
CHARITABLE
25,000
UNIVERSITY OF CALIFORNIA PRESS FOUNDATION
155 GRAND AVENUE SUITE 400
OAKLAND
,
CA
94612
NONE
PUBLIC
CHARITABLE
1,000
UCLA FOUNDATION (MOSS PERSONALIZED SURGERY)
10920 WILSHIRE BLVD SUITE 900
LOS ANGELES
,
CA
90024
NONE
PUBLIC
CHARITABLE
228,246
UCLA FOUNDATION HERB ALPERT SCHOOL OF MUSIC
445 CHARLES E YOUNG DRIVE EAST
LOS ANGELES
,
CA
90095
NONE
PUBLIC
CHARITABLE
10,000
UJA-FEDERATION OF NY
6900 JERICHO TURNPIKE 302
SYOSSET
,
NY
11791
NONE
PUBLIC
CHARITABLE
5,000
UNITED CEREBRAL PALSY
1825 K STREET NW SUITE 600
WASHINGTON
,
DC
20006
NONE
PUBLIC
CHARITABLE
2,500
VISION TO LEARN
11611 SAN VICENTE BLVD SUITE 500
LOS ANGELES
,
CA
90049
NONE
PUBLIC
CHARITABLE
1,000
WORLD ELEPHANT SOCIETY
PO BOX 132
AGOURA HILLS
,
CA
91376
NONE
PUBLIC
CHARITABLE
5,000
Total
.................................
3a
1,900,706
b
Approved for future payment
Total
.................................
3b
0
Form
990-PF
(2016)
Page 12
Form 990-PF (2016)
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
287
4
Dividends and interest from securities
....
14
125,725
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
-216,141
48,606
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
-90,129
48,606
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
-41,523
(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.)
1
IN 2016, THE FOUNDATION EARNED INTEREST INCOME AND DIVIDEND INCOME
2
FROM BANK AND INVESTMENT ACCOUNTS. IN ADDITION,SECURITIES WERE SOLD
3
IN 2016 THAT GENERATED CAPITAL LOSS.
Form
990-PF
(2016)
Page 13
Form 990-PF (2016)
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.
2017-10-31
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
RICHARD FINNSTROM
Preparer's Signature
Date
Check if self-
employed
PTIN
P00958881
Firm's name
EDWARD WHITE & CO LLP
Firm's EIN
95-3121227
Firm's address
21700 OXNARD STREET SUITE 400
WOODLAND HILLS
,
CA
91367
Phone no.
(818) 716-1120
Form
990-PF
(2016)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description