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Form 990-PF Return of Private Foundation

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Form 990-PF Return of Private Foundation EXTENSION GRANTED UNTIL OCTOBER 15,2011 Return of Private Foundation OMB No 1545-0052 Form 990-PF a or Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation Department of the Treasury 2009 Internal Revenue Service Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements. For calendar year 2009, or tax year beginning DEC 1, 200 9 , and ending NOV 30, 2010 G Check all that apply: Initial return 0 Initial return of a former public charity LJ Final return n Amended return n Address chance n Name chance of foundation A Employer identification number Use the IRS Name label Otherwise , ROSSMAN FAMILY FOUNDATION 11-2994863 print Number and street (or P O box number if mad is not delivered to street address) Room/suite B Telephone number ortype. 1461 53RD STREET ( 718 ) -369-2200 See Specific City or town, state, and ZIP code C If exem p tion app lication is p endin g , check here 10-E] Instructions 0 1 BROOKLYN , NY 11219 Foreign organizations, check here ► 2. Foreign aanizations meeting % test, H Check type of organization. ®Section 501(c)(3) exempt private foundation chec here nd att ch comp t atiooe5 Section 4947(a )( nonexem pt charitable trust 0 Other taxable private foundation 1 ) 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 Il, co! (c), line 16) 0 Other (specify) F If the foundation is in a 60-month terminatio n $ 3 , 333 , 88 0 . (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)) ex penses p er books income income (cash basis only) I Contributions, gifts, grants, etc., received N / A 2 Check ► ® If the foundation is not required to aflach Sch B Interest on savings and temporary 3 cash investments 4 Dividends and interest from securities 1 , 836. 1 , 836. S tatement 1 5a Gross rents b Net rental income or (loss) J 6a Net gain or (loss ) from sale of assets not on line 10 Gross sales price for all C b assets on line 8a y 7 Capital gain net income (from Part IV, line 2) 0. cc 8 Net short-term capital gain 9 Income modifications Gross sales less returns 1oa and allowances b Less Cost of goods sold c Gross profit or (loss) 11 Other income VI) 12 Total. Add lines 1 throu g h 11 1 , 836. 1 , 836. 13 Compensa tion of officeryd irectorstrusteesetc 0. 0. 0. 14 0 i em ei 15 P nsi n p ens, emp oyee enJ U) fees 16a L oaF a b Ac;6^'WAUB 2 W c Other rofesslonalfees 17 Inrest ®G® N V 18 Taxes 19 Depreciation and depletion 20 Occupancy a 21 Travel, conferences, and meetings r- 22 Printing and publications 0 23 Other expenses Stmt 2 389. 0. 389. 24 Total operating and administrative expenses Add lines 13 through 23 389. 0 . 389. 0 25 Contributions, gifts, grants paid 457 , 348. 457 , 348. 26 Total expenses and disbursements Add lines 24 and 25 457 737. 0. 457 737. 27 Subtract line 26 from line 12: a Excess of revenue over expenses and disbursements -455 , 901. b Net investment income (if negative, enter -0-) 1 , 836. c Adjusted net income (if negative, enter -0-) N / A 1^ 02-02-'1o LHA For Privacy Act and Paperwork Reduction Act Notice, see the instructions Form 990-PF (2009) 1 '® 12340801 807829 grossmanfdtn 2009.05020 GROSSMAN FAMILY FOUNDATION GROSSM21 'Form 990:PF (26091 nV nCCMAN t+ AMTT.V FnTTNT1ATTON 11-2994R93 Paoe2 andamounts Inthedescriphon Beginning of year End of year Part ll Balance Sheets A..chedschedules column should be for end-0I-year amounts only (a) Book Value (b) Book Value (c) Fair Market Value 1 Cash - non-Interest-bearing 561 , 313. 373 , 576. 373 , 576. 2 Savings and temporary cash investments 3 , 116 , 468. 2 , 018 , 304. 2 , 018 , 304. 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 10a Investments - U.S. and state government obligations b Investments - corporate stock c Investments - corporate bonds 11 Investments • land. buildings. and equipment basis ► Less accumulated depreciation ► 12 Investments - mortgage loans 13 Investments - other $tmt 3 112 000. 442 000. 442 000. 14 Land, buildings, and equipment: basis ► Less accumulated depreciation ► 15 Other assets (describe 0- Statement 4 ) 0. 500 000. 500 000. 16 Total assets to be com p leted by all filers 3 , 789 , 781. 3 333 , 880. 3 333 , 880. 17 Accounts payable and accrued expenses 18 Grants payable 19 Deferred revenue 20 Loans from officers, directors , trustees , and other disqualified persons ro 21 Mortgages and other notes payable _' 22 Other liabilities (describe ► 23 Total liabilities ( add lines 17 throw h 22 ) 0. 0. Foundations that follow SFAS 117, check here ► 0 and complete lines 24 through 26 and lines 30 and 31. 24 Unrestricted m 25 Temporarily restricted co 26 Permanently restricted C Foundations that do not follow SFAS 117, check here ► and complete lines 27 through 31. 27 Capital stock, trust principal, or current funds 3 , 789 , 781. 3 , 333 , 880. 28 Paid-in or capital surplus, or land, bldg., and equipment fund 0. 0. a 29 Retained earnings, accumulated income, endowment, or other funds 0. 0. 30 Total net assets or fund balances 3 , 789 , 781. 3 , 33-3 , 880. 31 Total liabilities and net assets/fund balances 3 , 789 , 781. 3 , 333 , 880. PartIII 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 3,789, 781 2 Enter amount from Part I, line 27a 2 -455 , 901 . 3 Other increases not included in line 2 (itemize) ► 3 0 4 Add lines 1, 2, and 3 4 3 333 , 880 . 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 3 , 3 3 3, 8 8 0 Form 990-PF (2009) 923511 02-02-10 2 12340801 807829 grossmanfdtn 2009.05020 GROSSMAN FAMILY FOUNDATION GROSSM21 'Form 990•PF (2009) GROS SMAN FAMILY FOUNDATION 11-2994863 Page 3 Part,IV Capital Gains and Losses for Tax on I nvestment Income (b How acquired ()a List and describe the kinds() of P roP ertY sold (e.g., real estate, ()c Date ac q (d) Date sold Purchase (mo., yr.) 2-story brick warehouse; or common stock, 200 shs. MLC Co.) D - Donation Imo., day, yr.) day, la b NONE c d e Depreciation allowed (g) Cost or other basis (h) Gain or (loss) (e) Gross sales price (f) (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 (j), 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 I 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? El 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 co lumn for each year; see instructions before making any entries. Base periiod years Distnbutdion ratio Calendar ear or tax year be g inning m Ad justed qualify( in g distributions Net value of noncha)ntable use assets (col ( b) divided by col (c)) 2008 325 390. 3 , 838 , 423. .084772 2007 335 292. 3 , 598 , 344. .093180 2006 857 602. 3 , 161 , 088. .271300 2005 297 624. 2 , 176 , 306. .136757 2004 229 497. 1 , 761 , 177. .130309 2 Total of line 1, column (d) 2 .716318 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 .
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