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Form 990-PF Return of Private Foundation

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Form 990-PF Return of Private Foundation d I EXTENSION ATTACHED Return of Private Foundation OMB No 1545-0052 Form 990-PF or Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation Department of the Treasury 2010 Internal Revenue Service Note . The foundation may be able to use a copy of this return to satisfy state reporting requirements. For calendar year 2010 , or tax year beginning DEC 1, 2010 and ending NOV 3 0, 2011 G Check all that apply. Initial return Initial return of a former public charity Ej Final return 0 Amended return ® Address chanae Name change Name of foundation A Employer identification number JACK ADJMI FAMILY FOUNDATION INC 13-3202295 Number and street (or P O box number if mail is not delivered to street address) Room/swte B Telephone number 463 SEVENTH AVENUE , 4TH FLOOR 212-629-960 0 City or town, state, and ZIP code C If exemption application is pending, check here NEW YORK , NY 10 018 D 1- Foreign organizations, check here 2. Foreign organizations meeting the 85% test, H Check type of organization: Section 501(c)(3) exempt private foundation check here and attach computation charitable Other taxable foundation Section 4947(a )( 1 ) nonexem pt trust 0 private E If p rivate foundation status was terminated I Fair market value of all assets at end of year J Accounting method: ® Cash 0 Accrual under section 507(b)(1)(A), check here (from Part ll, col. (c), line 16) = Other (specify) F If the foundation is in a 60-month termination 111114 218 5 2 4 . (Part 1, column (d) must be on cash basis.) under section 507 b 1 B , check here Part I Analysis of Revenue and Expenses (a) Revenue and (b) Net investment (c) Adjusted net ( d) Disbursements (The total of amounts in columns (b) (c), and (d) may not for charitable purposes necessarily equal the amounts in column (a)) expenses per books income income (cash basis only) 1 Contributions, gifts, grants, etc., received 2 , 178 , 450. N / A 2 Check ► O If the foundation is not required to attach Sob B 3 Interest on savings and temporary cash investments 4 Dividends and interest from securities 5a Gross rents b Net rental income or Qoss) 6a Net gain or (loss) from sale of assets not on line 10 Gross sales puce for all b assets on tine 6a 7 Capital gain net income (from Part IV, line 2) 0. 8 Net short-term capital gain 9 Income modifications Gross sales less returns 10a and allowances b Less Cost of goods sold c Gross profit or (loss) 11 Other income r 12- 2 178 450. 0. 13 V 4r^PRlq;e ,Mffjn. erectors, rustees, etc 0. 0. 0. 44 Other emp oyee sa anes a d ges 115 Ja7n 01 el ee 101 is c 6a Legal fees a 6 c S rs^^r)ale sf > 17^teres 2 18 Taxes 19 Depreciation and depletion E 20 Occupancy < 21 Travel, conferences, and meetings J c 22 Printing and publications N 0 23 Other expenses STMT 1 204. 204. 0. M 24 Total operating and administrative expenses . Add lines 13 through 23 204. 204. 0. 0 25 Contributions, gifts, grants paid 2 , 115 , 709. 2 115 , 709. 26 Total expenses and disbursements. Add lines 24 and 25 2 , 115 , 913. 204. 2 , 115 , 709. 0 27 Subtract line 26 from line 12: LU a Excess of revenue over expenses and disbursements 62 , 537. b Net investment income of negative, enter -0-) 0. c Adjusted net income (if negative, enter -0-) N / A 023501 12-07-1 1-ini;il , V, + It I Fnrm qqn-PF t2Rin1 . T7u('V /1Tl.TMT P11MTT.V 'nTTATfATTn7Q TAT(' 1 '2 _'t x!1') 7 a rz Pnno 9 Attached schedules and amounts in description Beginning of year End of year r r Part II Balance Sheets the column should betorend-ot-year amounts only (a) Book Value (b) Book Value (c) Fair Market Value 1 Cash - non-Interest-bearing 141 , 092. 204 , 524. 204 , 524. 2 Savings and temporary cash investments 895. 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 7 Other notes and loans receivable ► Less. allowance for doubtful accounts ► 8 Inventories for sale or use 9 Prepaid expenses and deferred charges a 10a Investments - U.S. and state government obligations b Investments - corporate stock c Investments - corporate bonds 11 Investments - land,buddings , and equipment basis ► Less accumulated depreciation ► 12 Investments - mortgage loans 13 Investments - other 14 Land, buildings, and equipment basis ► Less accumulated depreciation ► 15 Other assets (describe ► ADVANCE TO CHARITY ) 14 , 000. 14 , 000. 14 , 000. 16 Total assets (to be completed by all filers ) 155 , 987. 218 , 524. 218 , 524. 17 Accounts payable and accrued expenses 18 Grants payable w 19 Deferred revenue 20 Loans from officers, directors, trustees, and other disqualified persons 21 Mortgages and other notes payable 16 , 500. 16 , 500. J 22 Other liabilities (describe ► 23 Total liabilities ( add lines 17 throu g h 22 ) 16,50 0. 16,50 0. Foundations that follow SFAS 117, check here ► 0 and complete lines 24 through 26 and lines 30 and 31. 24 Unrestricted 25 Temporarily restricted co 26 Permanently restricted Foundations that do not follow SFAS 117, check here Eil C ► LL and complete lines 27 through 31 N° 27 Capital stock, trust principal, or current funds 0. 0. N 28 Paid-in or capital surplus, or land, bldg., and equipment fund 0. in 0. 29 Retained earnings, accumulated income, endowment, or other funds 139 , 487. 202 , 024. Z 30 Total net assets or fund balances 139 , 487. 202 , 024. 31 Total liabilities and net assets/fund balances 155 , 987 . 218 , 524. 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) 1 139 , 487 2 Enter amount from Part I, line 27a 2 62 , 537 3 Other increases not included in line 2 (itemize) ► 3 0 4 Add lines 1, 2, and 3 4 202 , 024. 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 N. line 30 6 2 0 2 . 0 2 4 . Form 990-PF (2010) 023511 12-07-10 2 13061011 797 696 4CKJAF 2010.O F020 ,TAOK A fl ,TMT 'AMT T.V VnTMMA m Tn A( Tr -rA VI Form 1990-PF (2010) JACK ADJMI FAMILY FOUNDATION , INC 13-3202295 Page 3 Part IV Capital Gains and Losses for Tax on Investment Income How acquired (c) (a) List and describe the kind(s) of property sold (e.g.,., real estate, (P Date acquired (d) Date sold - Purchase yr.) 2-story brick warehouse; or common stock, 200 shs. MLC Co.) D - Donation (mo., day, (mo., day, yr.) is b NONE C d e Depreciation allowed or (e) Gross sales price (f) (g) Cost or other basis (h) Gain (loss) (or allowable) plus expense of sale (e) plus (f) minus (g) a b c d e Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Gains (Col. (h) gain minus (j) Adjusted basis (k) Excess of col. (i) col. (k), but not less than -0-) or Losses (from col. (h)) (i) F.M.V. as of 12/31/69 as of 12/31/69 over col. (I), if any a b c d e If gain, also enter in Part I, line 7 2 Capital gain net income or (net capital loss) If (loss), enter -0- in Part I, line 7 2 3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6): If gain, also enter in Part I, line 8, column (c). If loss enter -0- in Part I line 8 3 Part V UualiTicatlon under Jectlon 45l4U(e) Tor Heaucea I ax 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 periods Yes ® No If 'Yes, the foundation does not quality under section 4940(e). Do not complete this part. 1 Enter the aooroonate amount in each column for each year: see instructions before makma any entries. Base per iod years ) Distribution ratio Calendar year or tax year beginnin g m Adjusted qualifying(b) distributions Net value of noncharitable -use assets (col. (b) divided by col. (c)) 2009 1 , 888 , 162. 172 826. 10.925220 2008 1 , 894 , 454. 97 , 633. 19.403829 2007 2 , 716 , 315. 181 015. 15.006022 2006 3 , 935 , 442. 3 , 068 , 400. 1.282571 2005 3 , 650 , 653. 87 , 701. 41.626127 2 Total of line 1, column (d) 2 88.243769 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 17 .648754 4 Enter the net value of noncharitable -use assets for 2010 from Part X, line 5 4 272 , 430. 5 Multiply line 4 by line 3 5 4 , 808 , 050.
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