o Return of Private Foundation OMB No ' ► -P` 1545-0052 Forth 990 or Section 4947( a)(1) Nonexempt Charitable Trust Department of the Treasury Treated as a Private Foundation Internal Revenue Samoa Note : The organization may be able to use a copy of this return to satisfy state reporting requirements 2 005 For caletS'dar y ear 2005 , or tax y ear beginning 07 / 01 , 2005 , and ending 06 / 30 / 2006 G Check all that aDDIv: Initial return Final return x Amended return Address chance Name nhnnnP Name of organization A Employer Identification number Use the IRS label. FANNIE AND JOHN HERTZ FOUNDATION 36-2411723 Otherwise, Number and street (or P.O. box number if mail is not delivered to street address) Room/suite B Telephone number (see page 10 of print the instructions) or type. See Specific 2456 RESEARCH DRIVE ( 925 ) 373-1642 City or town, state, and ZIP code C If exemption application is Instructions . pending, check here • • . . . . . ►
D 1. Foreign organizations. check here , ► LIVERMORE CA 9 4550 2. Foreign organizations meeting the H Check type of organization: X Section 501(c 3 exempt private foundation 85% test, check here and attach computation ...... ► Section 4947( l )( 1 ) nonexem pt charitable trust Other taxable p rivate foundation E If private foundation status was terminated 1 Fair market value of all assets at end J Accounting method: Cash Accrual q under section 507(b)(1)(A) , check here . ► of year (from Part 11, col. (c) , line Other (s p ecify) MODIFIED _ CASH______F If the foundation is In a 60-month termination 16) (Part column (d) must be on cash basis) ► $ 26 , 334 , 549. under section 507(b)(1)(B), check here . ► x Analysis of Revenue and Expenses (d) Disbursements (a) (The total of amounts in columns (b), (c), and Revenue and (b) Net investment (c) Adjusted net for charitable not necessarily equal the amounts in expenses per income income (d) may books purposes column (a) (see page 11 of the instructions (cash basis only) 1 Contnbuuon^sg.d_ts, grants, etc, reserved (attach schedule) 2 , 693 , 875. - - - -,;, I I If the foundation is not required to 2 Check LJ attach Sch B - } ` 3 Interest on savings and temporary cash investments 977. 977. STMT 1 4 Dividends and interest from securities . . 467 538. 467 , 538. 'STMT 2 S a Gross rents ...... b Net rental income or (loss) o 6a Net gain or (loss) from sale of assets not on line 10 2 , 688 , 523 . - , , b Gross sales price for all y assets on line 6a 25 , 592 131 . d 7 Capital gain net income (from Part IV, line 2) , 2 , 688 , 523. -'{c ' 8 Net short-term capital gain . . . . . z 9 Income modifications . . . . . • . . . • 10a Gross sales less returns and allowances • • - - b Less Cost of goods sold , t c Gross profit or (loss) (attach schedule) 11 Other income (attach schedule) • • • • ^• • 12 Total. Add lines 1 through 11 5 , 850 , 913. 3 157 038. =^•}w• - "'•' 13 Compensation of officers, directors, trustees, etc 312 , 859. 312 , 859. 14 Other employee salaries and wages . . , , 206 184. in 206 , 184. y 15 Pension plans, employee benefits . . , . . 99 , 964. 99 , 964. 16a Legal (attach CL fees schedule) , . ,STMT 3 • 74 , 658. NONE NONE 74 , 658 . 1j b Accounting fees (attach schedule)STMT, 4 • 25 , 449. 7 , 635. NONE 17 , 814 . c Other professional fees (attach scl, 5 . 276 638. 182 123. 94 , 515. 17 Interest • , , , , . . • . , • • . , , . , . , 18 Taxes (attach schedule) (see page 14 of the mstructionst 79 , 873. 39 , 438.
19 Depreciation (attach schedule) and depletion ? _: - • `: ;;" -74 20 Occupancy . . , . . . , . , . . . • . „ 44 192. 44 , 192. 21 153 430. 153 430. 01 22 Prt eet"I , , , , , 41 787. 41 787 c 23 O6 attach sch IM TXT, 7 245 294. 245 295 . sm 24 01ging d Is a expenses. d 7g Na , , , , , 1 560 328. 189 758. NONE 1 , 330 , 136. 25 Co t gr 2 230 458. 2 719 , 635. 26 otatex a Add li s 24 and 25 3 790 786. 189 758. NONE 4 , 049 , 771. 27 Subtract line 26 from line 12 -- r a
a Excess of revenue over expenses and disbursements 2 , 060 , 127 . b Net Investment Income (if negative, enter -0-) 2 967 , 280 .1 -_ - c Adj usted net income ( if negative , enter -G- ) . 71 - - - 0 - - - For Privacy Act and Paperwork Reduction Act Notice , see the instructions . **STMT 6 Form 990-PF (2005) JSA 5E14102000 4WS052 M261 V05-8.1 4 roan v u - rr ^uv^ . -L-211 / L.7 r e-L Attadhed schedules and amounts in the Be innin of year End of year B a l ance Sh eets descript ion column shou ld be for end-of-year amounts only (See instructions (a ) Book Value (b ) Book Value c Fair Market Value 1 Cash - non-interest-bearing , , , , , , , , , , , , , , , , , 29 929 . 176 563 . 176 563 . 2 Savings and temporary cash investments . , . , , . . , , , 239 685 . 3 Accounts receivable ►------= . allowance for doubtful accounts Less . ► ------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 page 15 of the instructions) 7 Other notes and loans receivable (attach schedule) ► ______^__^ ^_,`_-_ _ ^^ __ ;_ ; __ Less : allowance for doubtful accounts ► _ _ _ _ 8 Inventories for sale or use , , , , , , , , , , , , , , , , , y 9 Prepaid expenses and deferred charges , , , , , , , , , , . , Q 10 a Investments - U S and state government obligations (attach schedule)* 5 , 73.7 . 980 . 9 , 159 , 092 . 9 , 159 , 092 . b Investments - corporate stock (attach schedule) . $TKT 9. 17 819 458 . 16 998 894. 16 , 998 , 894. c Investments - corporate bonds (attach schedule) , . , . , , I I Investments - land, buildings, - r ,, n and equipment basis ------_ _ _>. ------`" = r ! Less accumulated depredation (attach schedule ) ►------12 Investments - mortgage loans , , , , , , , , , , , , , , , , 13 Investments - other (attach schedule) , . , , , , , . , , , , 55 , 286 . NONE NONE 14 Land, buildings, and ► - - equipment basis ------__L.^ _^•r__-- Less accumulated depreciation ► (attach schedule) ------15 Other assets (describe 01 ______) 16 Total assets (to be completed by all filers - see page 16 of the instructions Also see page 1 item I - 23 862 338. 26 , 334 , 549 . 26 , 334 , 549. 17 Accounts payable and accrued expenses . , , . , - , 18 Grants payable , , , , , , , , , , , , , , , , , , , , , , 2 , 865 . 316 . 2 , 376 , 140. 19 Deferred revenue ...... 20 Loans from officers , directors, trustees , and other disqualified persons 0 21 Mortgages and other notes payable (attach schedule) 22 Other liabilities (describe 01 ______STMT 10) 764 , 650. .1 23 Total liabilities (add lines 17 through 22 ) - 2 , 865 , 316 . 3 , 140 . 790. Organizations that follow SFAS 117, check here ► X and complete lines 24 through 26 and lines 30 and 31. - 24 Unrestricted ...... 20 997 022. 23 , 193 , 759. m 25 Temporarily restricted ...... 26 Permanently restricted . • . • • • • • • . • • • . • • • . • c Organizations that do not follow SFAS 117, ILL check here and complete lines 27 through 31. ► 0 27 Capital stock , trust principal, or current funds ...... f =_ m 28 Paid -in or capital surplus , or land , bldg , and equipment fund . , , , y y 29 Retained earnings , accumulated income, endowment, or other funds 30 Total net assets or fund balances (see page 17 of the - - instructions) ,,,,,,,,,,,,,,,,,,,, 20 997 022. 23 193 759. z 31 Total liabilities and net assets/fund balances (see page 17 of ' the instructions 23 , 862 . 338 . 26 , 334 , 549. Analysis of Changes in Net Assets or Fund Balances
I 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 20 , 997 , 022 . 2 Enter amount from Part I, line 27a , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 2 2 , 060 , 127. 3 Other increases not included in line 2 (itemize) SEE STATEMENT 3 ►------11 ------136 , 610 . 4 Add lines 1 , 2, and 3 4 23 193 759. 5 Decreases not included in line 2 ( 5 6 Total net assets or fund balances at end of year line 4 minus line 5 - Part II column (b ), line 30 .. . 6 23 193 759. **STMT 8 Form 990-PF (2005)
JSA 5E 1420 1 000 4WS052 M261 V05-8 8 Fdrm 996-PP (2005) 36 - 241 17 23 Page 3 Caoital Gains and Losses for Tax on Investment Income How (c) Date (a) List and describe the kind(s) of property sold (e g , real estate , acquired acquired (d) Date sold P-Purch (mo., day, yr ) 2-story brick warehouse; or common stock, 200 shs MLC Co.) D-Donatioasen (mo , day, yr la SEE PART IV SCHEDULE b 0 d e (e) Gross sales puce (f) Depreciation allowed (g) Cost or other basis (h) Gain or (loss) (or allowable) plus expense of sale (e) plus (f) minus (g) a b 6 d e Com p lete only for assets showing gain in column ( h) and owned by the foundation on 12/31/69 (I) Gains (Col. (h) gain minus Adjusted basis (k) Excess of col (i) col. (k), but less than -0-) or (I) F.M.V. as of 12/31/69 U) as of 12/31/69 over col U), if any not(from s (h)) a b c d e If gain, also enter in Part I, line 7 2 Capital gain net income or (net capital loss) 1 If (loss), enter -0- in Part I, line 7 } 2 2 , 688 , 523. 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 pages 13 and 17 of the instructions). If ( loss ) , enter -0- in Part I, line 8 ...... 3 FOMMM 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 organization liable for the section 4942 tax on the distributable amount of any year in the base period ?. . . . F-I Yes FX No If "Yes ," the organization does not qualify under section 4940(e). Do not complete this part.
I Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.
(a) (d) Base period years Calendar year Distribution ratio Adjusted qualifying distributions Net value of nonchantable-use assets (or tax year beginning in ) (col ( b ) divided by col c 2004 4 , 206 , 722. 25 510 790. 0.16489971498 2003 4 , 373 , 056. 26 858 380. 0.16281905312 2002 4 , 642 , 503. 28 504 082. 0.16287151433 2001 4 , 419 , 803. 34 412 309. 0.12843668816 2000 4 , 062 , 087. 38 598 530. 0.10523942233
2 Total of line 1, column (d) ...... 2 0.72426639292 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 0.14485327858
4 Enter the net value of noncharitable-use assets for 2005 from Part X, line 5 4 25 , 755 , 904.
5 Multiply line 4 by line 3 ...... 5 3 , 730 , 827.
6 Enter 1% of net investment income (1% of Part I, line 27b) • , , • , • • • , • , .. , • • , • • 6 29 , 673.
7 Add lines 5 and 6 7 3 , 760 , 500.
8 Enter qualifying distributions from Part XII, line 4 ...... 8 4 , 049 , 771. 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 on page 18 Form 5EA5E1430 1 000 990-PF (2005) 4WS052 M261 V05-8 9 Form 36-2411723 • Excise Tax Based on Investment Income ( Section 4940 (a ) , 4940 ( b) , 4940 (e ) , or 4948 - see pa g e 18 of the instructions )
I a Exempt operating foundations described in section 4940 (d)(2), check here ► and enter ' N/A" on line 1 , . . Date of ruling letter: ______(attach copy of ruling letter If necessary - see Instructions) b Domestic organizations that meet the section 4940 (e) requirements in Part V, check 1 1 29 , 673. q here ► X and enter 1 % of Part I, line 27b ...... c All other domestic organizations enter 2% of line 27b Exempt foreign organizations enter 4% of Part I , line 12 , col (b) 2 Tax under section 511 (domestic section 4947( a)(1) trusts and taxable foundations only Others enter -0-) . , , 2 3 Add lines 1 and 2 ...... 3 29 , 673. 4 Subtitle A ( income ) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) . , . 4 NONE 5 Tax based on Investment Income. Subtract line 4 from line 3. If zero or less, enter -0...... 5 29 , 673 . 6 Credits /Payments . ; •^ a 2005 estimated tax payments and 2004 overpayment credited to 2005 , , , 6a 36 , 088. b Exempt foreign organizations - tax withheld at source ...... 6b NONE -, r c Tax paid with application for extension of time to file (Form 8868 ) , 6c NONE •_ ,'_. _ • ` I d Backup withholding erroneously withheld ...... 6d 7 Total credits and payments . Add lines 6a through 6d ...... 7 36 , 088 . 8 Enter any penalty for underpayment of estimated tax. Check here . q 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 6 , 415. 1 1 Enter the amount of line 10 to be, Credited to 2006 estimated tax ► 6 , 415 . Refunded ► 11 Statements Re 1 a During the tax year , did the organization attempt to influence any national , state, or local legislation or did Yes No it participate or intervene in any political campaign? ...... j a X b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of the instructions for definition )? ...... 1 b X If the answer is "Yes " to la or 1b, attach a detailed description of the activities and copies of any materials . published or distributed by the organization in connection with the activities.
c Did the organization file Form 1120-POL for this year? , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . Ic X d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year. On organization managers $ (1) On the organization. ► $ (2) ► e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed on organization managers . ► $ 2 Has the organization engaged in any activities that have not previously been reported to the IRS? , , , , , , , , , , , , 2 X If 'Yes,' attach a detailed description of the activities. 3 Has the organization 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 X 4a Did the organization have unrelated business gross income of $1,000 or more during the year? ...... 4a X b If "Yes ," has it filed a tax return on Form 990-T for this year? ...... 4 b A 5 Was there a liquidation , termination, dissolution , or substantial contraction during the year? , , , , , , , , , , , , , , , , , 5 X B '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 X 7 Did the organization have at least $ 5,000 in assets at any time during the year? if "Yes," complete Part II, col. (c), and Part XV. 7 X 8a Enter the states to which the foundation reports or with which it is registered (see page 19 of the SEE STATEMENT 12 • instructions) ► b If the answer is "Yes" to line 7, has the organization 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 ...... 8 b X 9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(j)(3) - - or 49420 )(5) for calendar year 2005 or the taxable year beginning in 2005 (see instructions for Part XIV on page 26)? If "Yes, " complete Part XIV ...... 9 X 10 Did any persons become substantial contributors during the tax year? If 'Yes,* attach a schedule listing their names and addresses. , . 10 X 1 1 Did the organization comply with the public inspection requirements for its annual returns and exemption application ? , , , , 11 X Web site address _---- WWW _HERTZFOUNDATION.ORG ► ------12 The books are in care of ► _ LINDA KUBIAK ------Telephone no 925-373 -1642 Located at _RBSEARCH _DRIVEL_LIVERMORE,_ CA ZIP+4 ► 94550_- - -__ -- ______13 Section 4947 (a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of------Form 1041 - Check here . . . . . N/A . . . . . q enter the tax-exempt received or and amount of interest accrued during the year . ► 1 13 Form 990-PF (2005) JSA 5E1440 1 000 4WS052 M261 V05-8 10 Form 990-PF FUMIN"t Statemerfts 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 la During the year did the organization (either directly or indirectly): (1) Eraage in the sale or exchange , or leasing of property with a disqualified person? ...... q Yes No (2) Borrow money from , lend money to, or otherwise extend credit to (or accept it from) a disqualified person? ...... Yes X No (3) Furnish goods , services , or facilities to (or accept them from) a disqualified person? ...... Yes X No (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ...... X 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 )? ...... q Yes No (6) Agree to pay money or property to a government official? (Exception. Check "No" if the organization agreed to make a grant to or to employ the official for a period after termination of government service , if terminating within 90 days.) ...... q Yes q No b If any answer is 'Yes' to la( 1)-(6), did any of the acts fail to qualify under the exceptions described in Regulations section 53 .4941 (d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions)? ...... 1 b X Organizations relying on a current notice regarding disaster assistance check here • , , , , , , , , , ► c Did the organization engage in a prior year in any of the acts described in la, other than excepted acts, that were not corrected before the first day of the tax year beginning in 2005? ...... I c X 2 Taxes on failure to distribute income (section 4942 ) (does not apply for years the organization was a private operating foundation defined in section 4942 (j)(3) or 4942(j)(5)): a At the end of tax year 2005 , did the organization have any undistributed income (lines 6d - ; and 6e, Part XI II) for tax year(s) beginning before 2005 ? qX No If "Yes ,"' list the years ------I------b Are there any years listed in 2a for which the organization is not applying the provisions of section 4942(a)(2) ri (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 page 20 of the instructions.) ...... 2b N1 P, c If the provisions of section 4942 (a)(2) are being applied to any of the years listed in 2a, list the years here.
------'------r 3a Did the organization hold more than a 2% direct or indirect interest in any business enterprise at any time during the year? ...... F-1 Yes No - "j b If "Yes ," did it have excess business holdings in 2005 as a result of ( 1) any purchase by the organization 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 organization had excess business holdings in 2005.) ...... • 3 b N 4a Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes ? ...... 4a X b Did the organization 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 2005? ...... 4b X 5a During the year did the organization pay or incur any amount to: (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ...... q Yes qX No (2) Influence the outcome of any specific public election (see section 4955 ); or to carry :;•.. ' on, directly or indirectly, any voter registration drive? q Yes q No (3) Provide a grant to an individual for travel , study, or other similar purposes ? X Yes No (4) Provide a grant to an organization other than a charitable , etc., organization described in section 509(a )( 1), (2), or (3), or section 4940(d)(2)? , , , , , , • ...... q 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? q Yes q 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 page 20 of the instructions)? . . 5b X Organizations relying on a current notice regarding disaster q assistance check here ...... ► c If the answer is "Yes" to question 5a(4), does the organization claim exemption from the tax because it maintained expenditure responsibility for the grant? ...... N/A q Yes q No If 'Yes,' attach the statement required by Regulations section 53.4945-5(d). 6a Did the organization , during the year, receive any funds , directly or indirectly, to pay premiums on a personal benefit contract? , , , , , , , , , , , , , , • . . . . _ . . . . . , . . , q Yes q No b Did the organization , during the year, pay premiums, directly or indirectly, on a personal benefit contract? ...... 6b X If you answered "Yes" to 6b. also file Form 8870 . , F Form 990-PF (2005)
JSA 5E1450 1 000 4WS052 M261 V05-8 11 36-2411723 d Foam 990-PF42005) Page S Information About Officers, Directors, Trustees, Foundation Managers , Highly Paid Employees, and Contractors I list all nffir_ers- dirartnrs - trustees- foundation managers and their romnensation (see nano 21 of the instructinnsl- (b) Title, and average (c Compensation (d) Contributions to (e) Expense account, (a) Name and address hours per week notnot paid, enter employee benere plans other allowances devoted to position -0- and deferred compensation SEE STATEMENT 11A VARIOUS C / O THE FOUNDATION 312 859. 46 , 671. 5 , 046. ------
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2 Comeensation of five highest-paid emolovees (other than those included on line I - see oaae 21 of the instructions). If none. enter "NONE." (d) Contributions to (b) Title and average (e) account, (a) Name and address of each employee paid more than $50,000 Compensation employee benefit Expense hours perweek (c) plans and deferred other allowances devoted to position com p ensation SUSAN OVERMAN DEV & FUNDRAISING VP C / O THE FOUNDATION 40 HRS /WK 129 450. 19 , 496. NOW ------
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Total number of other employees paid over $50,000 . t I NONE 3 Five highest-paid independent contractors for professional services - (see page 21 of the instructions). If none, enter "NONE." (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation NEUBERGER AND BERMAN ------605 THIRD AVENUE , NEW YORK , NY 10158 INVESTMENT MGMT. 182 123. ADLER & COLVIN SILK,------235 MONTGOMERY ST , SAN FRAN. , CA 94104 LEGAL SERVICES 61 , 500. ------
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Total nu m be r of otne rs receiving over :5 bu,uuu tor protesslonal services . . ► I NONE Summary of Direct Charitable Activities
List the foundation 's four largest direct chartable activities during the tax year include relevant statistical information such as the number organizations and other beneficiaries served , conferences convened , research papers produced, etc. Expensess
1 NONE
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Form 990-PF (2005)
JSA 5E1460 1 000 4WS052 M261 V05-8 12 Form 990-PF (2005) 36-2411723 Page 7 - - Summary of Proaram -Related Investments (see Daae 22 of the instructions) Describe the two largest program -related investments made by the foundation during the tax year on lines 1 and 2 Amount
I NOT APPLICABLE ------
2 ------
All other program -related investments See page 22 of the instructions
3 NONE ------
Total. Add lines 1 throu g h 3 ► L;i Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see page 22 of the instructions.) I 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 ...... Ia 25 766 587 . b Average of monthly cash balances 1 b 381 539. c Fair market value of all other assets (see page 23 of the instructions) NONE d Total (add lines la, b, and c) 1 d 26 148 126 . e Reduction claimed for blockage or other factors reported on lines la and 1 c (attach detailed explanation) 1 e 2 Acquisition indebtedness applicable to line 1 assets ...... 2 NONE 3 Subtract line 2 from line ld ...... 3 26 148 126. 4 Cash deemed held for charitable activities. Enter 1 1/2 % of line 3 (for greater amount, see page 23 of the instructions) . . 4 392 222. 5 Net value of noncharitable -use assets. ^Subtract ^line 4 from line 3. Enter here and on Part V, Tine 4 5 25 , 755 , 904. 6 Minimum investment return. Enter 5% of line 5 . 6 1 , 287 , 795. Distributable Amount (see page 23 of the instructions) (Section 4942(j)(3) and 0)(5) private operating foundations and certain foreign organizations check here ► and do not complete this part.) I Minimum investment return from Part X, line 6 ...... 1 1 , 287 , 795. 2a Tax on investment income for 2005 from Part VI, line 5 . . .. 2a 29 , 673. . b Income tax for 2005. (This does not include the tax from Part VI.), 2b c Add lines 2a and 2b ...... , ...... 2c 29 , 673. 3 Distributable amount before adjustments. Subtract line 2c from line 1 ...... 3 1 , 258 , 122. 4 Recoveries of amounts treated as qualifying distributions , , , , , , , , , ,, , , , , , , , , , , , . NONE 5 Add lines 3 and 4 122 . 6 Deduction from distributable amount (see page 24 of the instructions) 7 Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 Qualifying Distributions (see page 24 of the 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 ...... Ia 4 , 049 , 771.
b Program-related investments - total from Part IX-B ...... lb NONE 2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes ...... 2 NONE 3 Amounts set aside for specific charitable projects that satisfy the: ; _. a Suitability test (prior IRS approval required) ... _ .. 3a NONE b Cash distribution test (attach the required schedule) ...... 3b NONE 4 Qualifying distributions. Add lines 1 a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4 , , . . 4 4 , 049 , 771. 5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment income. Enter 1 % of Part I, line 27b (see page 24 of the instructions) .. .. 5 29 , 673. 6 Adjusted qualifying distributions. Subtract line 5 from line 4 . . 6 4 , 020 , 098. 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 (2005)
JSA 6E1470 1 000 4WS052 M261 V05-8 13 Fdrm 990-PF (2005) 36-2411723 Page 8 Undistributed Income (see page 24 of the instructions)
(a) (b) (c) (d) prior to 2004 2004 2005 1 Distributable amount for 2005 from Part XI, Corpus Years line ? 1 1 258 , 122. 2 2 0 0 4 - a Enter amount for 2004 only ...... - - NONE b Total for prior years. NONE 3 Excess distributions carryover, if any, to 2005 a From 2000 2 , 159 824 . b From 2001 ...... 2 , 755 , 848 . c From 2002 . . . • . . 3 , 238 , 328. d From 2003 .. , , 3 , 048 , 139. -:- e From 2004 , , , , , , 2 995 530. f Total of lines 3a through e 14 , 197 , 66 9. - 4 Qualifying distributions for 2005 from Part t -_ _ ._ 7 XII, line 4:00- $ 4,049,771. a Applied to 2004 , but not more than line 2a , . , NONE b Applied to undistributed income of prior years (Election required • see page 25 of the instructions) , NONE c Treated as distributions out of corpus (Election required - see page 25 of the instructions) NO -' V + - d Applied to 2005 distributable amount . . . 1 , 258 , 122. e Remaining amount distributed out of corpus 2 , 791 649. 5 Excess distributions carryover applied to 2005 +' r (ff an amount appears in column (d), the same amount must be shown in column (a).) -1 , 6 Enter the net total of each column as I• indicated below : a Corpus . Add lines 3f , 4c, and 4e . Subtract line 5 16 , 989 . 318. ,- b Prior years' undistributed income. Subtract line 4b from line 2b NONE 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 , NONE d Subtract line 6c from line 6b. Taxable amount - see page 25 of the instructions NONE e Undistributed income for 2004 Subtract line 4a from line 2a. Taxable amount - see page 25 of the Instructions , , , , , , , , , , , , , , NONE {
f Undistributed income for 2005. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2006 - 7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(E) or 4942(g)(3) (see page r 25 of the instructions) , . . 8 Excess distributions carryover from 2000 not applied on line 5 or line 7 (see page 25 of - - ' the instructions) ...... 2 , 159 , 824. 9 Excess distributions carryover to 2006. Subtract lines 7 and 8 from line 6a , . . . , . 14 829 494 . - 10 Analysis of line 9: a Excess from 2001 . . . 2 , 755 , 848. ry b Excess from 2002 , . . 3 , 238 , 328. _ c Excess from 2003 , , , 3 , 048 , 139. d Excess from 2004 2 , 995 , 530 , e Excess from 2005 . . 2,791,649. Form 990-PF (2005)
JSA 5121480 1 000
4WS052 M261 V05-8 14 Form 990-PF (2006) 36-2411723 Private Operating Foundations (see page 26 of the instructions and Part VII-A, question 9) NOT APPLI 1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2005, enter the date of the ruling ► b Check box to indicate whether the is a private operating foundation described in section 49420)(3) or 49420)(5) year Prior 3 years 2a Tax I Enter the lesser of the (e) Total adjusted net income from (a) 2005 (b) 2004 (c) 2003 (d) 2002 Part I or the minimum investment return from Part X for each year listed . _ .
b 85% of line 2a . . . . .
C Qualifying distributions from Part )it, line 4 for each year listed . d Amounts included in line 2c not used directly for acme conduct of exempt activities . . . . . 0 Qualifying distributions made directly for acme 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 4942OX3XBXi). . . . . b Endowment alternative test- enter 2/3 of minimum invest- ment 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(aX5)). or royalties) (2) Support from general public and 5 or more exempt organizations as provided in section 4942 (IX3XBXm) ...... (3) Largest amount of sup- port from an exempt organization . , , . . (4) Gross investment income , Supplementary Information (Complete this part only if the organization had $5,000 or more In assets at any time during the year - see page 26 of the 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. NONE
2 Information Regarding Contribution , Grant, Gift, Loan, Scholarship , etc., Programs:
Check here ► 0 if the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. If the organization makes gifts, grants, etc. (see page 26 of the instructions) to individuals or organizations under other conditions, complete items 2a, b, c, and d. a The name, address, and telephone number of the person to whom applications should be addressed: SEE STATEMENT 13 b The form in which applications should be submitted and information and materials they should include:
SEE STATEMENT 13 c Any submission deadlines:
SEE STATEMENT 13 d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:
SEE STATEMENT 13 JSA 5E1490 1 000 Form 990-PF (2005) 4WS052 M261 V05-8 15 Form 990 -PF.(2005) 36-2411723 Page 10 FUNM Supplementary Information (continued) 3 Grants and Contributions Paid During the Year or Approved for Future Payment Recip ient If recipient is an mdrndual, Foundation show any relationship to Purpose of grant or A any foundation manager contnbution mount Name and address (home or business) or substan tial contributor ciup ent a Paid during the year
SEE STATEMENT 14
Total ...... lo. 3a 2 , 719 , 635. b Approved for future payment
SE STATEMENT 15
Total 2,376,141. Form 990-PF (2005)
JSA 5E1491 1 000 4WS052 M261 V05-8 16 Fdrm 990-PF'(2005) 36-2411723 Page 1 1 Analysis of Income-Producing Activities Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 Related or exempt (a) (b) (c) (d) function income Business Exclu ion (See page 26 of I Program service revenue, code Amount code Amount the instructions. 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 14 977. 4 Dividends and interest from securities , , , , 14 467 , 538. 5 Net rental income or (loss) from real estate: ^^Y i' 1'` s'w''•' z ^' ,T' i = :+ '' ' S. ' Y { 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 2 , 688 , 523. 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) , , ' 3 , 157 , 038. 13 Total. Add line 12 , columns (b), (d), and (e) ...... 13 3 , 157,038. (See worksheet in line 13 instructions on page 27 to verify calculations ) Relationship of Activities to the Accomplishment of Exempt Purposes Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to Line No. the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes). (See V page 27 of the instructions.)
Form 990 -PF (2005) JSA 5E1492 1 000 4WS052 M261 V05-8 17 Form 990 -PF 005 36-2411723 • Page 12 Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations Did the organization directly or indirectly engage in any of the following with any other organization described in section Yes No 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a nonchantable exempt organization of (1) Cash ...... 1a1 X (2) Other assets ...... la ( 2 ) X b Other transactions (1) Sales of assets to a noncharitable exempt organization ...... lb ( l ) X (2) Purchases of assets from a nonchantable exempt organization ...... 1 b ( 2 ) X (3) Rental of facilities, equipment, or other assets ...... 1 b ( 3 ) X (4) Reimbursement arrangements ...... 1 b ( 4 ) X (5) Loans or loan guarantees ...... 1 b ( S ) X (6) Performance of services or membership or fundraising solicitations ...... 1 b 6 X c Sharing of facilities, equipment, mailing lists, other assets, or paid employees ...... 1 c X 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 organization If the organization 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
2 a Is the organization 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? ...... E Yes 7X No h If "Vac " rm-lntc thn fnllnwinn erhpriida (a) Name of organization (b) Type of organization (c) Description of relationship
Under pe hies per)ury, th t I have examined this return , including accompanying schedul and statements , and to the best of my knowledge and belief, it i e, and I of preparer (other than taxpayer or fiduciary) is bed fall nfbrma .n of which preparer s any owledge f l 6 claration
Signat a of officer or trustee
Z. Preparer's y a signature a- o in Firm 's name (or yours If ' CONDON O' MEARA MCGI self-employed), address , 3 NEW YORK PLAZA and code ZIP NEW YORK , NY
JSA 5E11493 1 000 4WS052 M261 V05-8 Schedule B Schedule of Contributors OMB No 1545-0047 (Form 990, 990-EZ , pp ry 005 or 990 PF) - Su lementa Information for Department :he Treasury Internal Revenue Service line I of Form 990, 990 -EZ, and 990-PF ( see instructions) Name of organization Employer Identification number FANNIE AND JOHN HERTZ FOUNDATION 36-2411723 Organization type (check one):
Filers of: Section:
Form 990 or 990-EZ q 501 (c)( ) (enter number) organization
q 4947 (a)(1) nonexempt charitable trust not treated as a private foundation
q 527 political organization
Form 990-PF 501(c)(3) exempt private foundation
q 4947(a)(1) nonexempt charitable trust treated as a private foundation
q 501(c)(3) taxable private foundation
Check if your organization is covered by the General Rule or a Special Rule. (Note : Only a section 501 (c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule - see instructions.)
General Rule -
0 For organizations filing Form 990 , 990-EZ, or 990-PF that received , during the year, $5,000 or more (in money or property ) from any one contributor . (Complete Parts I and II.)
Special Rules -
q For a section 501 (c)(3) organization filing Form 990, or Form 990-EZ, that met the 33 1 /3% support test under Regulations sections 1.509 (a)-3/1.170A- 9(e) and received from any one contributor , during the year, a contribution of the greater of $5,000 or 2% of the amount on line 1 of these forms. (Complete Parts I and II.)
q For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from any one contributor, during the year, aggregate contributions or bequests of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. (Complete Parts I, II, and III.)
q For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from anyone contributor, during the year, some contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not aggregate to more than $1,000. (If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the Parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more during the year.) ...... No- $
Caution: Organizations that are not covered by the General Rule and/or the Special Rules do not file Schedule B (Form 990, 990-EZ, or 990-PF), but they must check the box in the heading of their Form 990, Form 990-EZ, or on line 2 of their Form 990-PF, to certify that they do not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions Schedule B (Form 990, 990-EZ, or 990.PF) (2005) for Form 990, Form 990.EZ, and Form 990.PF.
JSA 5E1251 1 000 4WS052 M261 V05-8 20 Shedule b (Form 090, 990-EZ, or Page of of Part 1 Name of organization FANNIE AND JOHN HERTZ FOUNDATION Employer Identification number
Contributors (See Specific Instructions.)
(a) (b) (c) (d) No. Name , address , and ZIP + 4 Aggregate contributions Type of contribution
1 RAY SIDNEY Person Payroll PO BOX 6767 2,400, 000. Noncash (Complete Part II if there is STATELINE, NV 89449 a noncash contribution.)
(a) (b) (c) (d) No. Name , address , and ZIP + 4 Aggregate contributions Type of contribution
2 ERIC WEPSIC Person X Payroll 255 W 84TH ST, #7C 150 ,000. Noncash (Complete Part II if there is NEW YORK, NY 10024 a noncash contribution.)
(a) (b) (c) (d) No. Name, address , and ZIP + 4 Aggregate contributions Type of contribution
3 J. DOYNE FARMER Person X Payroll 1239 MADRID RD 50, 000. Noncash (Complete Part II if there is SANTA FE, NM 87505 a noncash contribution.)
(a) (b) (c) (d) No. Name, address , and ZIP + 4 Aggregate contributions Type of contribution
4 CONTRIBUTIONS < 296 Person Payroll 93,875. Noncash (Complete Part II if there is a noncash contribution.)
(a) (b) (c) (d) No. Name , address , and ZIP + 4 Aggregate contributions Type of contribution
Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) (b) (c) (d) No. Name, address , and ZIP + 4 Aggregate contributions Type of contribution
Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990 , 990-q or 690-PF) (2005) JSA
5E1253 1 000 4WS052 M261 V05-8 21 FORM 990-PF - PART IV CAPITAL GAINS AND LOSSES FOR TAX O N INVESTMENT INC[)MF
Kind of Property Description Date Date sold acquired Gross sale Depreciation Cost or FMV Adj . basis Excess of Gain price less allowed/ other as of as of FMV over or expense. of sale allowable hnql-q 1 12131/69 12111169 ad' basis loss
SEE ATTACHED SCHEDULE
25592131. 22903608 . 2,688,523.
TOTAL GAIN(LOSS) ...... 2,688,523.
JJA 5E 1730 1 000 4WS052 M261 V05-8 19 FANNIE AND JOHN HERTZ FOUNDATION
Schedule of Realized Cain or (Loss) on the Disposition of Investments
For Year Ended June 30, 2006
Shares/ Realized Face Gain or Description Value Cost Net Proceeds (Loss) Stocks 3M Company 5,000 $ 124,080 $ 422,404 $ 298,324 American International Group, Inc. 10,000 106,585 .598,058 491,473 Analog Devices Inc 280 - 10,349 10,349 Anteon International Corp 150 4,590 6,630 2,040 Apache Corp 5,000 322,656 360,289 37,633 Arch Coal 7,000 199,364 306,483 107,119 Avon Products 10,000 291,264 321,114 29,850 BP P L C Sponsored Adr 7,000 387,437 470,722 83,285 Burlington Resources Inc 5,500 305,739 475,079 169,340 Chicago Bridge & Iron Co 15,000 196,721 353,550 156,829 China Mobile Hong Kong Ltd 5,000 127,765 130,867 3,102 Denbury Resources Inc New 5,400 135,103 170,810 35,707 Dentsply International Inc 8,000 298,213 406,237 108,024 Dover Corp 5,000 123,809 235,032 111,223 Ebay Inc 10,000 461,700 393,788 (67,912) Gazprorn 5,500 162,305 200,369 38,064 Google Inc CL A 700 - 292,836 292,836 Hewlett Packard Co 5,000 150,280 154,987 4,707 India Fund Inc 10,000 268,894 413,204 144,310 Intel Corp 20,000 380,944 388,988 8,044 Ishares Inc FTSE Sinhau HK China 25 Index 2,500 142,889 183,424 40,535 Ishares Inc MSCI Japan Index Fd 10,000 109,838 144,896 35,058 Johnson and Johnson 5,000 60,079 291,283 231,204 Manpower Inc-Wisc 10,000 343,761 461,387 117,626 Microsoft Corp 15,000 484,989 363,004 (121.985) Mirant Corp 16,000 439,795 401,953 (37,842) NU Skin Enterprises Inc 15,000 338,739 371,087 32,348 Orbital Science Corp 500 - 5,597 5,597 Quicksilver Resources 2,000 123,604 72,646 (50,958) SLM Corporation 5,000 194,623 263,222 68,599 Stryker Corp 7,500 355,224 373,776 18,552 Sunrise Senior Living Inc 60 - 3,520 3,520 Templeton Russia and East 1,900 77.666 118.276 40.610 Total stock $ 6,718,656 $ 9,165,867 $ 2,447,211 FANNIE AND JOHN HERTZ FOUNDATION
Schedule of Realized Gain or (Loss) on the Disposition of Investments
For Year Ended June 30, 2006
Shares/ Realized Face Gain or Description Value Cost Net Proceeds (Loss) Bonds, Notes and Other U.S. Treasury Bill, due 9/22/2005 4,775,000 $ 4,701,627 $ 4,775,000 $ 73,373 U S Treasury Bill, due 12/01/2005 990,000 974,600 986,973 12,373 U.S. Treasury Bill, due 3/23/2006 5,275,000 5,175,943 5,271,380 95,437 U.S. Treasury Bill, due 4/06/2006 1,200,000 1,183,031 1,199,750 16,719 U S. Treasury Bill, due 4/20/2006 500,000 489,879 500,000 10,121 U.S. Treasury Bill, due 2/09/2006 1,200,000 1,188,276 1,194,430 6,154 U.S. Treasury Bill, due 6/29/2006 2,500,000 2,471,596 2,498,731 27,135 Total Bonds, Notes and Other 16.184.952 16.426.264 241.312 Grand Total $ 22,903,608 $ 25 ,592,131 $ 2,688,523 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART I - INTEREST ON TEMPORARY CASH INVESTMENTS ------
REVENUE AND NET EXPENSES INVESTMENT DESCRIPTION PER BOOKS INCOME ------
INTEREST - CHECKING ACCOUNT 977. 977.
TOTAL ------977. 977. ------
4WS052 M261 V05-8 22 STATEMENT 1 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART I - DIVIDENDS AND INTEREST FROM SECURITIES ------
REVENUE AND NET EXPENSES INVESTMENT DESCRIPTION PER BOOKS INCOME
DIVIDENDS - COMMON STOCKS 467,538. 467,538. ------TOTAL 467,538. 467,538. ------
4WS052 M261 V05-8 23 STATEMENT 2 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART I - LEGAL FEES ------
REVENUE AND NET ADJUSTED EXPENSES INVESTMENT NET CHARITABLE DESCRIPTION PER BOOKS INCOME INCOME PURPOSES ------
LEGAL FEES 74,658. 74,658. ------TOTALS 74,658. NONE NONE 74,658. ------
4WS052 M261 V05-8 24 STATEMENT 3 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART I - ACCOUNTING FEES ------
REVENUE AND NET ADJUSTED EXPENSES INVESTMENT NET CHARITABLE DESCRIPTION PER BOOKS INCOME INCOME PURPOSES ------
ACCOUNTING FEES 25,449. 7,635. 17,814. ------TOTALS 25,449. 7,635. NONE 17,814.
4WS052 M261 V05-8 25 STATEMENT 4 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART I - OTHER PROFESSIONAL FEES ------
REVENUE AND NET EXPENSES INVESTMENT CHARITABLE DESCRIPTION PER BOOKS INCOME PURPOSES ------
INVEST. MGM'T & CUSTODIAL FEES 182,123. 182,123. COMPUTER CONSULTANTS 56,769. 56,769. OTHER CONSULTANTS 37,746. 37,746. ------TOTALS 276,638. 182,123. 94,515. ------
4WS052 M261 V05-8 26 STATEMENT 5 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART I - TAXES ------
REVENUE AND EXPENSES CHARITABLE DESCRIPTION PER BOOKS PURPOSES ------
PAYROLL TAXES 39,438. 39,438. EXCISE TAX 40,435. ------TOTALS 79,873. 39,438. ------
4WS052 M261 V05-8 27 STATEMENT 6 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART I - OTHER EXPENSES ------
REVENUE AND EXPENSES CHARITABLE DESCRIPTION PER BOOKS PURPOSES ------
FUNDRAISING EXPENDITURES 78,789. 78,789.
OFFICE SUPPLIES & EQUIPMENT 56,346. 56,346.
INSURANCE 13,717. 13,717.
UTILITIES 16,617. 16,617.
POSTAGE 22,960. 22,960.
ELECTRONIC MEDIA 2,823. 2,823.
REPAIRS AND MAINTENANCE 9,627. 9,628.
TARGETED COMMUNICATIONS 22,234. 22,234.
SYMPOSIUM & OTHER 22,181 . 22,181. ------TOTALS 245,294. 245,295. ------
4WS052 M261 V05-8 28 STATEMENT 7 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART II - U.S. AND STATE OBLIGATIONS ------
ENDING ENDING DESCRIPTION BOOK VALUE FMV ------
U.S. OBLIGATIONS 9,159,092. 9,159,092. SEE ATTACHED SCHEDULE ------US OBLIGATIONS TOTAL 9,159,092. 9,159,092. ------
4WS052 M261 V05-8 29 STATEMENT 8 FANNIE AND JOHN HERTZ FOUNDATION
Schedule of Investments
June 30, 2006
Market Description Shares Cost Value
Bonds, notes and other investments US Treasury Bill 7/06/06 700,000 $ 684,907 $ 699,760 US Treasury Bill 12/14/2006 1,500,000 1,462,652 1,465,697 US Treasury Bill 9/28/06 2,215,000 2,280,698 2,307,547 US Treasury Bill 7/27/06 4,700,000 4.682.581 4.686.088 Total $ 9,110,838 $ 9,159,092 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART II - CORPORATE STOCK ------
ENDING ENDING DESCRIPTION BOOK VALUE FMV ------
STOCKS 16,998,894. 16,998,894. SEE ATTACHED SCHEDULE ------TOTALS 16,998,894. 16,998,894. ------
4WS052 M261 V05-8 30 STATEMENT 9 FANNIE AND JOHN HERTZ FOUNDATION
Schedule of Investments
June 30, 2006
Market Description Shares Cost Value Stocks 3M Company 15,000 $ 372,298 $ 1,147,895 Alltell Corp 5,000 284,828 319,150 American International Group Inc. 30,000 319,756 1,771,500 Anadarko Petroleum Corp 5,000 286,942 476,900 Arch Coal Inc 5,000 142,403 211,850 Canadian Natural Resources 12,400 519,466 686,712 Cemento Andino Co 1,001 1,001 - Chicago Bridge & Iron Co 15,000 196,721 362,250 China Mobile Hong Kong Ltd. 10,000 255,531 286,100 CITIGROUP INC 10,000 94,053 482,400 Dover Corp 10,000 247,619 494,300 Emerson Electric Co. 9,000 235,066 754,290 Gazprom 12,000 354,120 504,600 General Electric 20,000 563,417 659,200 Google Inc CL A 2,000 - 838,600 Hewlett Packard Co. 20,000 601,118 633,600 Home Depot Inc 8,000 306,909 286,320 Illinois Tool Works Inc. 13,000 141,149 617,500 India Fund Inc. 5,000 134,447 230,950 Inversiones Andino 95,512 1,041 95,512 Ishares Inc. FTSE Sinhau I-IK China 25 Index 4,500 257,200 345,600 Ishares Inc MSCI Japan Index Fd 20,000 219,676 272,800 Johnson and Johnson 10,000 120,159 599,200 Medtronic Inc 10,000 483,625 469,200 NI Holdings Inc. 9,000 524,901 507,480 Nomura Hldgs Inc 20,000 480,618 376,000 Pepsico Inc 10,000 431,722 600,400 Questar Corp 7,000 558,747 563,430 Quicksilver Resources, Inc. 7,000 247,207 257,670 Schlumberger Ltd 14,000 332,748 911,540 SLM Corporation 7,000 272,472 370,440 Suncor 8,000 609,284 649,870 Templeton Russia and East 3,100 126,718 215,635
Total $ 9,722,962 $16,998,894 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART II - OTHER LIABILITIES
ENDING DESCRIPTION BOOK VALUE
DUE TO INVESTMENT ADVISORS 764,650.
------TOTALS 764,650. ------
STATEMENT 10
4WS052 M261 V05-8 31 FANNIE AND JOHN HERTZ FOUNDATION 36-24117,23 ,
FORM 990PF, PART III - OTHER INCREASES IN NET WORTH OR FUND BALANCES
DESCRIPTION AMOUNT ------
UNREALIZED GAIN DUE TO CHANGE IN MARKET 136,610. VALUE OF INVESTMENTS ------TOTAL 136,610. ------
STATEMENT 11
4WS052 M261 V05-8 32 Hrs/ Wk Contribution Expense Name Title Compensation devoted to Employee Account, to SEP Plan Other position Allowances Gregory H . Chairman of the Board/ $ 16,780.01 4 hrs /wk $2,890 .00 $1,096.29 Canavan Director John F . Holzrichter President/ Di rector $ 111,132.00 1 Shrs/wk $16,512 . 15 $1,730.91 Thomas McCann Treasurer/Director 0 0.5hrs/wk 0 $331.91 Tom Silk Secretary/Director 0 0.5hrs/wk 0 $588.41 Barbara G . Nichols Sr. Asst . Secretary $ 65,561 . 84 25hrs /wk $9,818.07 Linda Kubiak Asst. Secretary $ 60,317 .08 30hrs/wk $8,288.59 0 Lowell L Wood Senior Fellowship $10,250 . 04 3.5hrs/wk $1,650.00 0 Interviewer/Director Thomas A. Senior Fellowship $48 , 817.64 5hrs/wk $7,512.50 0 Weaver Interviewer/Director John Browne Director 0 0.5hrs/wk 0 0 Ilene Busch- Director 0 0.5hrs/wk 0 $166.90 Vishniac Ruth A. David Director 0 0.5hrs/wk 0 0 Jay C. Davis Director 0 0.5hrs/wk 0 0 Gilbert F. Decker Director 0 0.5hrs/wk 0 0 David J . Galas Director 0 0.5hrs/wk 0 $667.00 W. Danny Hillis Director 0 0.5hrs/wk 0 0 Arthur Kantrowitz Director 0 0.5hrs/wk 0 0 Hans Mark Director 0 0.5hrs/wk 0 0 Richard B . Miles Director 0 0.5hrs/wk 0 0 Harold Newman Director 0 0.5hrs/wk 0 0 Paul D. Nielsen Director 0 0.5hrs/wk 0 0 Sidney Singer Director 0 0.5hrs/wk 0 0 Peter Strauss Director 0 0.Shrs/wk 0 0 Wilson K. Talley President Emeritus 0 0.5hrs/wk 0 $464.80 /Director Daniel Weise Director 0 0.5hrs/wk 0 TOTALS - $ 312,858 . 61 $46,671.31 $5,046.22
STATEMENT 11A FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART VII-A, LINE 8A - STATES
AL,AK,AZ,AR,CA,CT,GA,IL, KS, KY,ME,MD,MA,MI,MS,NH,NJ,NY, NC,ND,OH,OK,OR,PA,RI,SC,TN,UT,VA,WA,WV,WI
STATEMENT 12
4WS052 M261 V05-8 33 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 9 9 0 PF , PART XV - 2a-2d
SEE ATTACHED
STATEMENT 13
4WS052 M261 V05-8 34 Application Fee: $0 Next Deadline : See Instructions HERTZ -FOUNDATION This Application has NOT been submitted
Step 1: I astruct:o s
Here are the application instructions for Hertz Foundation. Please review these instructions before you proceed.
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Hertz Foundation Obiectives • Special Instructions • Eligibility Requirements • Airport Codes • Typical Fields of Study • Tenable Schools
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To view and print these pages you must have Adobe Acrobat Reader installed. This product Is free to download here. Users with visual disabilities can access Information in Adobe 0 PDF by also Adobe downloading the Acrobat Access plug-in. Coovnght Notice HERTZ -•FQL VDATION
FANNIE AND JOHN HERTZ FOUNDATION ...devoted to applications of the physical sciences
Objectives
The late John and Fannie Hertz, in establishing the Fannie and John Hertz Foundation, had as principal objectives the promotion of education and the democratic principles of our nation . This is in support of the economic well being, the security and the enhancement of the technical stature of the United States. The Foundation's specific role is to aid in the education of the most capable students , particularly with respect to the applied physical sciences.
The Directors of the Foundation implement these objectives according to their judgment of how the Foundation's resources may best be deployed at any given time.
GRADUATE FELLOWSHIP PROGRAM
The current principal activity of the Foundation is support of the graduate education of students of outstanding potential in the applied physical sciences. The Directors believe that the intent of the Founders is most effectively accomplished by fostering the postgraduate studies of excellent young men and women who seem likely to become leaders in scientific and technological advances, exemplars of teaching skills in the applied physical sciences, and key contributors to the technological capability on which the well-being of the United States depends ever more crucially. It is the Foundation's hope that the stipend will allow Hertz Fellows to exercise intellectual independence early in their graduate careers, rather than having to accept immediate assignment to research tasks which may not always correspond to their primary interests.
Approximately 20 new Fellowships are awarded each year, renewable for up to four additional years.
ELIGIBILITY
The Foundation's resources are overmatched by the large number of outstanding applicants for Fellowships. As a result, the Foundation has established a rigorous screening procedure which attempts to insure that only the most able applicants become Fellows. The Fellowship is highly competitive, with only one out of forty well- qualified applicants receiving an award.
The following conditions apply: (1) Only applicants who will have received a bachelor's degree by the time they propose to commence tenure of their Fellowships, and who propose to complete a program of graduate study leading to an advanced degree are eligible. Applications are accepted from students who have already commenced graduate study. (2) The proposed field of graduate study must be directed toward the understanding and solving of problems associated with contemporary human concern, using applications of knowledge from the physical and engineering sciences. This is in contrast to work whose primary purpose is to extend the frontier of knowledge in the physical sciences for the sake of new knowledge alone. (3) Evidence of exceptional creativity, broad understanding of physical principles, and outstanding potential for innovative research is expected. (4) Citizenship or Permanent Residency in the United States. P^:L..a.^ .w •.'.61} l1 .. R}.'. C is,•_ ^1^1t'« ..• ,{.l .tt - F'['..a,^ --1}' t I M.III t +}:L'' i^
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Special Instructions
1. In addition to your application, you must submit two sets of official transcripts of all your college academic records, undergraduate and (if applicable) graduate. Official transcripts are those submitted directly from the school to the Hertz Foundation. (You may collect these and submit them, but be sure they are still in the sealed, signed envelopes from the Registrar).
2. Reference Reports from four different individuals, who know well your academic and professional experience and ability, must be received by the Foundation by November 1, 2004, or else your Application cannot be assured of receiving full consideration. Reference Report forms can be filled out using Embark.com's online recommendation system (See the "To Do" list by clicking on the button in the navbar).
3. Every Fellowship applicant is now REQUIRED to take at least the aptitude portion of the Graduate Record Examination and to have the results (Verbal, Quantitative and Writing scores) sent to the Foundation. This can be done by adding the Hertz Foundation ID Number, 4366, to those of the schools requiring the GRE for admission as a graduate student on your GRE form. If you have already taken the GRE, you can enter your scores in the boxes provided. If you enter your scores, you must also send documented verification of these GRE scores to the Foundation.
4. The Phone Information Sheet ( page 12 of the application) should be as detailed as possible . Please review the form for specific instructions.
5. For purposes of submitting documents by US Postal Service or express delivery services, you should use the following address:
Fannie and John Hertz Foundation 2456 Research Drive Livermore, CA 94550-3850
6. To contact us:
Fannie and John Hertz Foundation E-Mail: [email protected] Telephone: 925/373-1642 Internet site: www.hertzfoundation.org L' :i. '00.7^CA ..u-L .h.!"; `..^1'c .4 •f .-J^t.l ^t 'A G'^^ . - { . .:1:^ H
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Eligibility Requirements
Evidence of exceptional creativity, broad understanding of physical principles, and outstanding potential for innovative research is expected.
Eligible applicants must be students of the applied physical sciences who are U.S. citizens or permanent residents, and who will morally commit to make their skills available to the United States in times of national emergency.
College seniors wishing to pursue the PhD degree in any of the appropriate fields, as well as graduate students already in the process of doing so, may apply.
We screen our applicants for qualities we believe are essential ingredients of future professional accomplishment and/or leading indicators of future professional success. These include:
• Exceptional Intelligence and Creativity with particular emphasis on those aspects pertinent to technical endeavors • Excellent Technical Education evidenced not only by transcripts and reference reports from senior technical professionals, but also by the results of a personal, technical interview • Orientation and Commitment to the aaolications of the physical sciences as is typical of most applicants • Extraordinary Accomplishment in technical or related professional studies which may offset slightly lower academic records, or add luster to outstanding ones • Features of Temperament and Character conducive to high attainment as a technical professional the assessment of which is difficult, albeit important to the Foundation • Appropriate moral and ethical values of considerable interest to the Foundation in the furthering of our basic goals • Leverage what difference the award of the Hertz Fellowship is likely to make in the kind, quality, and/or personal creativity of the student's graduate research v _ - . _ 3g ' 3. •Ltl^' Q3R^i.^{'R'ti - {LIY,.^i:r ^,S"LL• L•. '#k d/ ^ r.'' FIB =' 'T• ' - !- r t- ^ j:;i• '3:v ^• 3' -J&±^ r• .w-'^',^^'7,' •'_,• -^^^.,_.^^ - ^r ^ia^Y ^`F4 •• C'^,{1-`-y`n^Htis'. yi:.7Nit^ : ^.^,= ^•T- 'Jdy.n.e 1HERTZ v . 12FOU ^f-^^,•7^- .^t- l^^-3^'^ ^ y a^!. {,^ a-`r^'i',- r^• is :r1^ 'a :qT;.^ iy 4s' ^A Y' rte. ^'^. ^'_ :s,^ 5t Y;,; x3:&^,:t . •x._ ri - ^ ` y^5`t^„-y^^^8' ^;ii^^f;'^:;,d; ^[ i±. µi=1:•- F^ v7k^ p __ CA^^^i%^ e i ..5 ='=`PY.^.! xtC.^fii ' >D^^N 1-• _ ^ ,_ a-.w ^ -.., ...•^ ::'fa :?3)c'a; =`_itJ.::,. E^1•a`^'r:=!^'^F.3".^`..dLs+'a..a
Three-Letter Airport Identifiers, Listed by City and State I BHM Birmingham~ 1AL JMLI Moline _- ^ ,III, CVG ']Cincinnati - --` OH HSV Huntsville AL PIA Peoria IL CLE Cleveland_ _ - OH MOB Mobile AL SPI Springfield IL CMH Columbus OH MGM Montgomery AL EVV j Evansville IN DAY Dayton OH LIT Little Rock AR FWA Ft Wayne IN TOL Toledo ' OH TXK Texarkana AR IND Indianapolis IN YNG Youngstown ' OH PINY Phoenix AZ LAF Lafayette IN OKC Oklahoma City OK TUS Tucson AZ SBN South Bend IN TUL ; Tulsa OK YUM Yuma AZ TOP ! Topeka XS EUG Eugene OR BFL Bakersfield CA ICT Wichita KS PDX Portland OR BUR Burbank CA LEX Lexington KY ABE Allentown PA ACV Eureka/Arcata CA SDF Louisville KY ERI Erie PA FAT Fresno CA IBTR Baton Rouge ' LA HAR Harrisburg PA LGB Long Beach CA MSY New Orleans LA PHL Philadelphia PA LAX Los Angeles CA SHV Shreveport LA PIT Pittsburgh PA MRY Monterey CA BOS Boston MA RDG Reading PA OAK Oakland CA BWI Baltimore MD SCE ; State College 1 PA ONT Ontario CA BGR Bangor ME AVP ' Wilkes-Barre PA SNA Orange County CA PWM Portland ME . PVD Providence RI PSP Palm Springs CA AZO Kalamazoo MI CHS ; Charleston S C RDD Redding CA UIT Detroit MI CAE Columbia S C SMF Sacramento CA GRR Grand Rapids MI GSP Greenville SC SAN San Diego CA LAN Lansing MI ABR Aberdeen SD SFO San Francisco CA MBS Saginaw MI RAP Rapid City SD SJC San Jose CA MSP Minneapolis/StP MN FSD ' Sioux Falls SD San Luis CA RST Rochester MN CHA Chattanooga JTN SBP Obispo MKC , Kansas City MO TYS Knoxville TN SBA Santa Barbara CA SGF Springfield MO MEM Memphis TN SCK Stockton CA St Louis MO BNA Nashville Colorado JAN ' Jackson TRI Airport TN COS CO ; Tri-C- ity Springs BIL Billings ABI - Abilene TX IDEN Denver CO OMA ; Omaha AMA Amaiillo TX PUB Pueblo CO AVL Asheville HNC AUS Austin BDL Hartford CT CLT ' Charlotte NC CILL ': College Station TX HVN New Haven CT GSO Greensboro NC DFW ' Dallas/Ft Worth TX GON New London CT OAJ Jacksonville ' NC ELP El Paso TX DAB Daytona Beach FL RDU Raleigh/Durham NC HOU j Houston TX Ft Walton VPS FL ELM Wilmington N C LBB Lubbock Beach BIS Bismarck ND, MAF Midland/Odessa TX FLL Ft Lauderdale FL FAR Fargo ND SAT San Antonio TX FMY Ft Myers FL EWR Newark NJ SLC Salt Lake City UT JAX Jacksonville FL ABQ Albuquerque NM LYH Lynchburg ; VA MIA Miami FL LAS Las Vegas NV RIC Richmond VA ORL Orlando FL RNO ! Reno ' NV: ROA Roanoke VA PNS Pensacola FL ALB ! Albany NY IAD Washington/Dulles . VA SRQ Sarasota FL BGM Binghamton NY DCA I Washington/Nat'l - VA TLH Tallahassee FL BUF Buffalo NY ORF Williamsburg : VA TPA Tampa/St. Pete FL TTH Ithaca NY BLI Bellingham WA AHN Athens GA JFK NYC/Kennedy NY PSC I Pasco WA ATL Atlanta GA NYC/La SEA Seattle WA AGS ' Augusta GA LGA NY; Guardia GEG ! Spokane WA SAV Savannah GA POU Poughkeepsie NY ATW ] Appleton WI HNL Honolulu HI ROC 31 Rochester NY GRB , Green Bay WI CID Cedar Rapids IA SYR Syracuse NY MSN Madison WI DSM Des Moines IA UCA Utica NY MKE Milwaukee WI MCW Mason City IA HPN White Plains NY CRW lCharleston ' WV SUX Sioux City IA CAK Akron OH MGW` Morgantown WV BMI Bloomington IL CMI Champaign IL ORD Chicago IL - S- 4
HERTZ FOUNDATIC
Typical Fields of Study
The Foundation supports graduate students working towards the Ph.D. degree in applications of the physical sciences ranging from electrical engineering to molecular biomedicine. These are the fields - applied physics, applied chemistry, applied mathematics, applied modern biology and all areas of engineering - which apply results from the basic physical sciences to generate solutions to problems of comparatively near-term, widespread human interest. The Foundation's efforts complement the applied physical sciences portion of the NSF's graduate fellowship program (and the Foundation coordinates with the NSF periodically). The Foundation doesn't support study in pursuit of the M.D. degree, although it will support the Ph.D. portion of a joint M.D./Ph.D. study program.
Again, the Foundation's interests extend from applied math through applied physics and chemistry, encompassing all of the engineering disciplines, and include those aspects of modern biology which apply the physical sciences intensively. While the following is an illustrative (but not exclusive) list of the fields in which we have recently supported Hertz Fellows, it is up to each Fellowship applicant to advocate to us his or her specific field of interest as an " applied physical science."
Typical Fields of Study
• Aeronautics/Astronautics • Electrical Engineering • Applied Mathematics • Industrial Engineering • Applied Physics • Materials Science • Applied Science • Mechanical Engineering • Astronomy • Nuclear Engineering • Biotechnology • Operations Research • Chemical Engineering • Physics • Chemistry • Quantitative Biology • Civil Engineering • Statistics • Computer Science • Earth Sciences x-.c^t4uc x.a:_,^. t +;l _ fl f.,3Ut'. ;Yt- &Y-Y-a"S^.TT^ {
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The Foundation carefully evaluates, on a continuing basis, the quality of the environment for education in the applications of the physical sciences provided by leading schools in the United States. At present, the Foundation permits its Fellows to hold tenure of their Fellowships only* at the following schools:
Tenable Schools
California Institute of University of California, Technology Davis / Livermore Pasadena, California Department of Applied Carnegie-Mellon University Science Pittsburgh, Livermore, California Pennsylvania University of California, Columbia University Irvine New York, New York Irvine, California Cornell Univers!tj University of California, Los Ithaca, New York Angeles Georgia Institute of Los Angeles, California Technology University of California, Atlanta, Georgia Riverside Harvard University Riverside, California Cambridge, University of California, Massachusetts San Diego ]ohns Hopkins University La Jolla, California Baltimore, Maryland University of California, Massachusetts Institute of Santa Barbara Technology Santa Barbara, Cambridge, California Massachusetts University of California, New York University Santa Cruz New York, New York Santa Cruz, California Northwestern University University of Chicago Evanston, Illinois Chicago, Illinois Ohio State University University of Colorado, Columbus, Ohio Boulder Polytechnic University Boulder, Colorado Brooklyn, New York University of Illinois Urbana-Champaign, University of California, Illinois San Francisco San Francisco, California Princeton University University of Maryland Princeton, New Jersey College Park, Maryland Purdue University University of Michigan West Lafayette, Indiana Ann Arbor, Michigan Rensselaer Polytechnic University of Minnesota Institute Minneapolis/St. Paul, Troy, New York Minnesota Rice University University of Rochester Houston, Texas Rochester, New York Stanford University University of Southern Stanford, California California Texas A & M University Los Angeles, California College Station, Texas University of Texas at The Pennsylvania State Austin University Austin, Texas State College, University of Washington Pennsylvania Seattle, Washington The Scripps Research University of Wisconsin Institute Madison, Wisconsin La Jolla, California Vanderbilt University University of California , Nashville, Tennessee Berkeley Yale University Berkeley, California New Haven, Connecticut University of California, Davis Davis, California
We are aware, however, that other schools may offer unique study and research opportunities, and we will seriously consider making such schools tenable at the request of successful applicants. The criteria for doing this include whether: 1) the quality and breadth of education provided at the school meets our standards of excellence in the field, and related fields, of the applicant's interest, 2) the Foundation is able to come to timely and satisfactory administrative arrangements with the school, and 3) the school is located in the United States.
To aid in this process, it is important that applicants notify us as early as possible -- preferably on their initial application -- if their unconstrained first choice of graduate schools is (or has become) a school not on our tenable list. They must also give a detailed rationale for their choice and also indicate as well their top choice among currently tenable schools. Note that even if a non-tenable school is indicated as an "unconstrained choice" on an application, a tenable school MUST be used as the "first choice", or else the application will not be considered. 0
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.II 4] 1 Step 2: Application Farm
Hertz Foundation : Page 1 of 14 The Fannie and John Hertz Foundation Application for Graduate Fell owship
To apply for a Hertz Foundation Graduate Fellowship, you must provide us with all of the information requested. Doing so will likely require at least 15 but no more than 30 minutes. Please read the Instructions carefully before filling in each box. It Is important that you format your answers according to the Instructions.
PERSONAL INFORMATION Title (Mr./Ms./Mrs.)
First Name L Middle name
Last name -_ Name Adjunct Social Security number Date of birth rJvC ( Use the format mm/dd/yyyy, e.g. June 10, 1978 would be 06/10/1978) Country of birth Citizenship If you are neith er a US citizen nor a Permanent Resident of the US, you are not eligible to apply for a Hertz Fellowship. (If you are not a US citizen, we will ask to see proof of Application for Citizenship or your Permanent Resident Card when you are interviewed).
CURRENT SCHOOL /WORK INFORMATION If you are currently attending school, enter that school's name in the "Present school" box. If you are currently out of school, put your current occupation in the " Currently out of school" box and leave the "Present school" box blank . In the City and State boxes, enter the city and state of your current location. Present school Currently out of school City State '
What is your current status? L Undergraduate >' '
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UNDERGRADUATE INSTITUTION If you are currently a Graduate student, name the school that awarded your undergraduate degree. If you are currently an Undergraduate, enter your current school. Undergraduate School 2005-2006 will be your Lorst., year as a graduate student. Undergraduate Academic Major 1 - • -•.._ _ _._. __ _. (field of study) (Academic major means physics, chemistry, mathematics, mechanical engineenng, etc.) Overall Undergraduate GPA (4.0 [ ' max) (When computing your GPA, "A" and 'A+" are both 4.0) Undergraduate Major GPA If your undergraduate university does not assign grades, please enter "N/A." Your scores in the GRE Aptitude and Advanced Subject Tests will be especially important to the Foundation in evaluating your application. If graduate you are currently a student, what Is your overall graduate GPA? 17
GRADUATE INSTITUTION Name the educational institution at which you currently propose to hold your Fellowship. This must be one of the schools Included in our list of Tenable Institutions (page 6 of the Instructions).
It is = necessary for you to have been accepted at this Institution at the time you submit your application. You may change your selected school provided you choose another school from the list of Tenable Institutions. Changes In your selected school must be reported to the Foundation in writing, prior to Fellowship award, or permission requested of the Foundation in writing after Fellowship award.
Tenable School Choice
In the next box, please indicate what your proposed General Field of Study will be at the school selected above. The General Field of Study should be one of the Applied Physical Sciences included on the list of fields in the instructions.
General Field
Please note that the Foundation does not support students seeking professional degrees other than PhD.(e.g. MD, LLB, MBA, etc. are not supported). In the Specialty Area box, please Indicate what specialty area you Intend to study, (e.g. condensed matter physics, molecular biology-DNA analysis, electrical engineering). If you do not know what Specialty Area you'll be studying, enter "Unknown."
Specialty • • ® R ack Next
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GRADUATE INSTITUTION ( continued) If your first choice of graduate school is not presently a Hertz tenable school, enter the name of your first choice school in the "Unconstrained school choice" box below. You will be expected to concisely defend this unconstrained choice later In the application, indicating what this school offers that is not offered by any of the tenable schools. Indicate the General Field and Specialty Area you intend to study at this Institution In the next two boxes (should you receive a fellowship, we will consider adding your choice to our list of tenable schools). Unconstrained school choice General field i I Specialty area _ I] Toward what ultimate degree will you be working while in Graduate School?
During what calendar year do you expect to complete your Ph.D. studies? 77
PREPARATION FOR GRADUATE WORK IN THC APPLIED PHYSICAL SCIENCES You should have had university-level courses in physics, mathematics and chemistry beyond the introductory level. Please Indicate below the number of upper division courses in each category that you have taken already or plan to take as an undergraduate. Enter the numbers as decimals, with a year-long course counting as 1.0, a semester course as 0.5, and a quarter course as 0.33. Please count research courses as upper division courses. Upper-Division Course Years Physics Chemistry f-- Engineering (ME, ChE, EE, CE) Mathematics Computer Science Earth Science Modern Biology
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YOUR LOCATION During the application process, it is important for us to be able to reach you on short notice. We may need to arrange a technical Interview, or we may have a question about your application. Please give careful thought to this information. Further along on this form you will have the opportunity to give several alternate telephone numbers and addresses where you might be reached during the next 6 months. If any of this information changes between the time you submit this application and April 30, 2005, please Inform us promptly of the changes, by e-mail to AskHertz(a^aol.com
What is your present mailing address? Street i City State ( abbr only) Zip (first five digits only) In which state do you currently hold residency? If your location is not listed, please enter it here
What are your present home and work phone numbers? ( Be sure to include area codes.) Home phones ( (Area Code/ Number) j
Work phones (()4 (Area Code/Number) (^I
Current e-mail address Second or alternate e-mail address We have found e-mail to be an especially good way to reach Fellowship applicants. We will be using e-mail to correspond with you regarding the status of your application, and to let you know when your application arrives at our office. We may also be using e-mail to alert you to the possibility of a technical interview.
Until what date do you expect this contact information to be valid? Use the same format, mm/dd /yyyy, as was used to enter your day of birth (e. g. June 10, 2005 would be 06 / 10/2005). Contact information valid until
In order to plan the technical interviewing process, we need to know what airport is nearest to your location. Find and enter the most appropriate airport abbreviation (from the list included in the Instruction section) into the "Closest airport'. field. Closest airport Please enter the address where we should mail the final selection announcement letter on/before April 1, 2005. Street city State ( abbr only) Zip (first five digits only) ^-i
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ALTERNATE LOCATIONS/TRAVEL PLANS If you plan to be at a different location during vacation and holiday periods, or at any other time between the present and April 1, 2005, please enter here the dates you will be away and the locations where we might reach you during the corresponding Interval. Please Include complete address and telephone Information. In addition to holiday periods, if you know you will be traveling to a professional meeting or to another university campus (i.e., to visit a possible graduate school), please include those travel dates and locations.
Travel Period 1 begins (mm/dd/yyyy) 71 Travel Period 1 ends ( mm/dd/yyyy) Travel Location 1
Area Code/ Number (-) 7
Travel Period 2 begins (mm/dd/yyyy) L/r/ri
Travel Period 2 ends (mm/dd/yyyy) 77 Travel Location 2
Area Code/ Number
begins Travel Period 3 (mm/dd/yyyy) 7/7/F71 Travel Period 3 ends (mm/dd/yyyy)-
Travel Location 3 I
Area Code/Number (f )^
Travel Period 4 begins (mm/dd/yyyy) Travel Period 4 ends ( mm/dd/yyyy) Travel Location 4
Area Code/ Number
Travel Period 5 begins (mm/dd/yyyy)
Travel Period 5 ends ( mm/dd/yyyy) 77/11,711-7 Travel Location 5 Area Code/Number (^^
Travel Period 6 begins (mm/dd/yyyy) _y1 Travel Period 6 ends (mm/dd/yyyy) Travel Location 6
Area Code/Number
If you have entered information into any of the Travel boxes above, please CHECK box M Yes, I expect to be traveling If any of your travels listed above will be taking you to the San Francisco Bay area, please CHECK this box L- Bay area travel anticipated
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INTERVIEW AVAILABILITY We may want to arrange a personal, technical interview with you while you are at one of the travel locations listed on Application Page 5 (e.g., while you are home for the holidays, or visiting another campus), so giving us as much Information as possible about your locations and travel plans is to your advantage.
This interview generally requires 30 to 60 minutes. It may be held In one of a variety of locations, Including hotel rooms or lobbies, restaurants, airports or on a university campus. You may not be given much advance notice, and you may have to arrange transportation to your interview. (Your reasonable-and-ordinary travel expenses will be fully reimbursed by the Foundation If, at our request, you must travel over 5 miles.) The interview is patterned after the PhD oral exam, and you may be required to perform calculations or discuss your previous technical work.
In the first box, please indicate your preference for interview availability/scheduling . (e.g., Weekends, anytime; Weekdays, mornings preferred.) Availability preferences L- I In the second box, please indicate any constraints or limitations to your availability for interviews. (e.g., Not available Tuesday mornings.) Availability constraints We will do our best to honor your preferences and constraints, but this may not be possible.
FOUR VERY BRIEF ESSAYS In the spaces below (I.e., in approximately 300 words), please provide concise responses to each of the following questions.
Question 1: Choice of Field and Future Expectations
How did you choose your field and what are your primary expectations of your future career? If you are currently in your second or later year of graduate school , please indicate what difference the award of the Hertz Fellowship is likely to make in the kind and quality of your graduate work, including your ability to pursue promising new ideas. You may use more than the allotted space for your response, and any additional text will be included in your application. However, when you print this page, only the text that appears in the text box will print. Question 2: Proposed Field of Study
How do your proposed field of study and career constitute an aoolication of the physical sciences? You may use more than the allotted space for your response, and any additional text will be included in your application. However, when you print this page, only the text that appears in the text box will print.
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FOUR VERY BRIEF ESSAYS ( continued) Question 3 : Choice of Graduate School
What are the considerations involved In your choice of graduate school? If you have listed an "unconstrained choice," explain clearly, completely and concisely why it Is preferable to any of the tenable schools. You may use more than the allotted space for your response, and any additional text will be included in your application. However, when you print this we rexr mac appears in me cexr oox will pnnr.
Question 4: Chronological Resume
Provide a concise resume, in chronological order, with dates, recapitulating significant periods of technical and other creative activity since high school graduation. Omit activities only distantly related to your professional development. Include workshops, summer schools, a general description of all courses of study pursued (e.g. "3 quarters of Differential Equations") and degrees expected or awarded (dates, institutions, fields). Separate your undergraduate activities from your graduate activities (if/as applicable) with a single dashed line. You may use more than the allotted space for your response, and any additional text will be included in your application. However, when you print this page, only the text that appears in the text box will print. ACADEMIC HONORS In the space provided below, list, in chronological order, academic honors and distinctions which you have received and the time or time-interval of receipt. Separate your undergraduate from your graduate awards (if/as applicable) with a single dashed line. (Include title, reason for award, and where/when received). Use no more than one line per award whenever possible (what, where/when received). You may use more than the allotted space for your response, and any additional text will be included in your application. However, when you print this page, only the text that appears in the text box will print.
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Coovnaht Notice Application Fee: $0 Fv+!T?' ^1' s tii Next Deadline : See Instructions EIERTZ- 0lJ7 DATION, This Appitcabon has NOT been submitted
page : 1 1 2. 1 3 1 4_ I s_ I 6_ I ? 1 6 1 2 1 101 U 12I 131 14 ® _
Step 2: Application form
Hertz Foundation: Page 8 of 14
FELLOWSHIPS, SCHOLARSHIPS, ETC. List here, in chronological order, any fellowships, scholarships, teaching or other appointments held since entering college or university. Separate your undergraduate and graduate education intervals (if/as applicable) with a single dashed line. Put an asterisk (*) at the beginning of all lines indicating a national-level award (e.g., award of a National Merit Scholarship, NSF or NASA Fellowship, election to Phi Beta Kappa, Tau Beta Pi, Sigma Xi, etc. Use one line per item whenever feasible (provide basic what, where, when data). You may use more than the allotted space for your response, and any additional text will be included in your application. However, when you print this page, only the text that appears in the text box will print.
Fellowships, Scholarships, etc.
PREVIOUS RESEARCH Please list any research topics that you have previously pursued, in chronological order, with the calendar time-interval of the work indicated (e.g., "May-August 2002"). Use a single asterisk (*) for the title of any document that you wrote, which was not formally recorded in a library system. Put a double asterisk (**) at the beginning (i.e., in the left- hand margin) of any entry which resulted in an internal document, or a non-peer reviewed conference paper, or a non-refereed publication of a research topic you pursued. Put a triple asterisk (***) at the beginning of any entry which has been submitted to, or published In, a refereed journal or given at a peer-reviewed conference. [You should bring a rnnv of om,-F, ,.f be Invited.]
*** IMPORTANT***
Finally, choose one or two projects that best illustrate your own creativity and discuss in more detail what you personally contributed to them. Example: * "Controlled Fusion in the Shadow of the French Alps: My Summer Internship at Grenoble"; June-August 2002. ** "Peculiarities in Gene Transcription Regulation In wingless Drosophila Mutants", prepared/presented as part of the Student Research Seminar Series; U of Calif. Report, UCRL Report 1029-04, Sept 01-May 02. *** "Deficiencies in Stereospecific Iodination of Thyroxine Precursors Isolated From Chernobyl-Region Voles", J. Exotic Endocrine Chem. 239, 3365 (June 2003), K. Early, M. Y. Name, L. Late, and M. Middle.
Number of: B.S. Researches Pursued B.S. Researches Documented r B.S. Researches Submitted to _j Refereed Publications Grad . Researches Pursued j Grad . Researches Documented 7-11 Grad . Researches Submitted fl to Refereed Publications Previous Research
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Coovrfaht Notice 0
• J{ ` = r = Application Fee: $0 Next Deadline : See Instructions HERTZ FOUNDAnON . This Application has NOT been submitted
age : 1 I 2 I 3 I ^1 I S I 6 I 2 I 8 1 9 10 I 111 12 1 13 1L4
Step 2: Application Form
Hertz Foundation : Page 9 of 14
GRE SCORES Every Fellowship applicant Is now REQUIRED to take at least the aptitude portion of the Graduate Record Examination and to have the results (Verbal, Quantitative and Analytical scores ) sent to the Foundation . This can be done by adding the Hertz Foundation ID Number, 4366, to those of the schools requiring the GRE for admission as a graduate student on your GRE form . If you have already taken the GRE, you can enter your scores in the boxes provided . If you enter your scores , you must also send documented verification of these GRE scores to the Foundation. Verbal Score/%ile I 1^% Date of Exam (mm/yyyy) Quantitative Score/%ile Date of Exam (mm/yyyy) AWA/Writing Score/% ile %
Date of Exam (mm/yyyy) 7777 Analytical Score/%ile/^% Date of Exam (mm/yyyy) 7-7/;^^
GRE Subject 1 Subject 1 Score/%ile Date of Exam (mm/yyyy)
GRE Subject 2
Subject 2 Score/%ile E1 Date of Exam (mm/yyyy)
TRANSCRIPTS You must send 2 sets of official transcripts of all your college academic records, undergraduate and (if applicable) graduate. Official transcripts are those sent directly from the school to the Hertz Foundation. (You may collect these and send them, but be sure they are still in the sealed, signed envelopes, prepared by the school's Registrar.)
Please list here the schools you have attended, the dates you were enrolled, your GPA while attending each school, and any degrees earned. We will expect you to send two official transcripts from each of these schools. (If you briefly attended an Institution, e.g., for a summer course, or for a class that Is unrelated to your major, e.g., a foreign language session, you do not need to furnish a transcript of this schooling.) Please Indicate which of the schools in your list below will be providing transcripts by placing a "CHECK" in the "Transcript?" box on the right. Transcripts 1 Enrollment dates (mm/yyyy) % GPA Degree earned Transcript ?
Transcripts 2 Enrollment dates (mm/yyyy) !/f GPA Degree earned 1-! Transcript ?
Transcripts 3 Enrollment dates (mm/yyyy)
GPA Degree earned ;-^ Transcript ?
Transcripts 4 Enrollment dates (mm/yyyy) f/I GPA F711 Degree earned r Transcript ?
Transcripts 5
Enrollment dates (mm/yyyy) f /. GPA Degree earned T anscrlpt ? PW
Transcripts 6 Enrollment dates (mm/yyyy) 'Jj GPA Degree earned ("1 Transcript ?
Transcripts 7 Enroll ment dates (mm/yyyy) [ l( GPA Degree earned Transcript ?
Transcripts 8 Enrollment dates (mm/yyyy) GPA Degree earned Transcript ?
® Bac k Ne xt ^ ^ p ® To view and punt these pages you must have Adobe Acrobat Reader installed . This product is free to download here . Users R^^er with visual disabilities can access information in Adobe O PDF by also downloading the Acrobat Access plug-in.
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Coovnaht Notice E]
Application Fee: $0 Next Deadline : See Instructions IERTZ f?OLi DATION This Application has NOT been submitted
s I M 11111 .a i F P^ . ' Y _
MMMM Page: 1{ 2 1 21 A I 5_ I t?I eI9110IIiI i213Q114 BE= EM
Step 2: Application Form
Hertz Foundation : Page 10 of 14
OTHER OPPORTUNITIES The Foundation Is often approached by other institutions, including industrial organizations, universities and national laboratories, who are interested in considering our Applicants or Fellows for part-time or summer employment or in offering other types of opportunities. The Foundation also receives requests for information concerning Applicants from other funding organizations, both governmental and private charities, who are seeking well-qualified applicants to consider for fellowships. The Foundation will normally share information on a Fellowship application with potential employers and other funding organizations that the Foundation considers to be responsible, disinterested and acting in the public interest, provided that the Applicant has not asked that such information be withheld. If you would prefer that we NOT share the information in this application with these other organizations, please check the "Do NOT make other opportunities available" box below. (Your chances for selection as a Hertz Fellow are not influenced by this choice.)
Do NOT make other opportunities available to me: W
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Application Fee: $0 Next Deadline : See Instructions $TO*A11O This Application has NOT been submitted
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{ Step 2: Application Form
Hertz Foundation : Page 11 of 14
REFERENCE REPORTS Please list here the names , addresses, telephone numbers and e- mail addresses of the four persons who best know your academic and professional ability and whom you are requesting to provide Reference Reports on your behalf. Note that these Reports must be received by the Foundation by Monday, November 1, 2004 or your application Is not assured of full consideration by the Foundation . IT IS YOUR RESPONSIBILITY TO ASSURE TIMELY RECEIPT OF ALL FOUR OF THESE REFERENCE REPORTS BY THE FOUNDATION. In addition to listing your four Referees here, you must also register them using Step 4 of the Home page . Once your referees are registered , they will receive an email from Embark/ Princeton Review explaining how to submit the Reference Report. This email will Include the necessary access Information and password. Reference Report 1 Title (-1 First name Last name Title/position School or business Address Street City - -- - i State (-j Zip ^_-- i Country
Phone (Area Code/Number) (r ] 777 Email
Reference Report 2 Title First name Last name L Title/position School or business Address Street City State 77 Zip Country Phone ( Area Code/ Number) (i )F
Email Reference Report 3 Title First name Last name Title/position School or business Address Street City State i .+ Zip Country Phone (Area Code/Number) (E i Email
Reference Report 4 Title First name Last name Title/position School or business Address Street City State Li Zip Country Phone (Area Code/Number) Email
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Coovrlaht Notice -'tea ,,, f nag= 1n Application Fee: $0 Next Deadline : See I nstructions IERTZ FQUNDATIO:h This Application has NOTT been submitted
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Step 2: Application Farm
Hertz Foundation: Page 12 of 14
CONTACT INFORMATION After examination of all applications for the Fannie and John Hertz Foundation Graduate Fellowships, approximately 20% of the applicants will be offered Interviews in 2004-2005. These interviews are technical In nature, covering topics in physics, chemistry, mathematics, engineering, etc.
The interviewers are volunteers, fitting the meetings into their work or travel schedules. Interviews may take place at schools, hotels, airports, restaurants, or other convenient locations. If we request that you travel more than five miles to meet with a Foundation Interviewer, we will fully reimburse your reasonable-and-ordinary travel expenses to attend the interview. However, we do not support travel from outside of the contiguous United States.
Because the volunteers sandwich interviews into their other activities, there may be only two or three days notice of your interview. We must know how to let you know of a possible interview from November 1, 2004 through April 1, 2005.
In the boxes below, please enter telephone numbers where we can reach you, or an answering machine, or a friend, or a relative, during this time, so that you will be able to contact the Hertz Foundation within 24 hours of our attempt to reach you. Please identify each number, e.g., "my work #," "my parent's #," "my dad's # at work," "my advisor's #." We will try the numbers in the order you give them, but the more options you give us, the more likely it is that we will be able to reach you when we need to. Please also include your email addresses, as we will be using email as our first line of communication In most cases. Name Relationship Area Code/Number Email
Name I j Relationship Area Code/Number (fT) - Email
Name Relationship Area Code/Number (I )I Email
Name Relationship Area Code/Number Email Name Relationship
I Area Code/Number Email
Name 1 Relationship Area Code/Number
Email f 1
Name Relationship Area Code/Number (') Email
Name Relationship
Area Code/Number Email f- - -1
Name Relationship
Area Code/Number
Name Relationship Area Code/Number Email
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Coovrlaht Notice Application Fee: $0 `ink! 14lri ' - - s ;=- Next Deadline : See Instructions + - +- -r1ERTZ FOUNDATION This Application has NOT been submitted
ME Mr! - b - _- L=t r u1 age : MINE IN P 1 I 2 I 3 I 4 1 5 I 6 I 2 I 8 I 11 1 114 am=
2: Application Form
Hertz Foundation : Page 13 of 14
ADDITIONAL INFORMATION Before completing page 13 and/or page 14, please review the Instructions for both pages. We have provided various ways for you to submit essays, supplemental documents and other information pertinent to your application.
Page 13 is to be used for submitting a personal essay or for pasting in an essay that is TEXT only. Include here information about your favored extracurricular and leisure time activities since your graduation from high school.
If you have other supplemental documents you would like to have included as part of your application , use the upload capability on Page 14 . If your document contains illustrations or Images, use Page 14 to submit the document. To help ensure successful processing of your application, please include a file extension (e.g. essay . doc) and limit the size of uploaded files to 1MB.
If you have documents that exceed the 1MB limit, you are welcome to mail two printed copies of those documents to:
Fannie and John Hertz Foundation 2456 Research Drive Livermore, CA
Be sure that any supplemental documents you mail to the Hertz Foundation are appropriately Identified with your name and Social Security Number.
You may use more than the allotted space for your response, and any additional text will be included in your application. However, when you print this page, only the text that appears in the text box will print. j,-
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Coovnaht Notice - Application Fee: $0 ,{rerican.l^di - ; Next Deadline : See Instructions HERTZ OLiNDATION This Application has NOT been submitted
- -`a 'far c _ . -
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Step 3: Essays
Hertz Foundation: Page 14 of 14
SUPPLEMENTAL & OTHER INFORMATION Before completing page 13 and/or page 14, please review the instructions for both pages. We have provided various ways for you to submit essays, supplemental documents and other information pertinent to your application.
Page 13 Is to be used for submitting a personal essay or for pasting In an essay that is TEXT only. Include here information about your favored extracurricular and leisure time activities since your graduation from high school.
If you have other supplemental documents you would like to have included as part of your application , use the upload capability on Page 14. If your document contains illustrations or Images, use Page 14 to submit the document. To help ensure successful processing of your application , please Include a file extension ( e.g. essay.doc) and limit the size of uploaded files to 1MB.
If you have documents that exceed the 1MB limit, you are welcome to mail two printed copies of those documents to:
Fannie and John Hertz Foundation 2456 Research Drive Livermore, CA
Be sure that any supplemental documents you mail to the Hertz Foundation are appropriately identified with your name and Social Security Number.
Transcripts for your Fannie and John Hertz Foundation Graduate Fellowship Application may NOT be uploaded here. They MUST be sent directly from the registrar's office at each university.
To upload a new document, simply click on the "Browse" button to select your document. Then, click on the "Upload" button to complete your upload.
If you would like to save this document for use in other applications , please enter a name for your document before uploading it. Otherwise, feel free to upload your document and leave the name field blank. To help ensure successful processing , please include a file extension (e.g. essay . doc) and limit the size of uploaded flies to 1MB.
Name: ^Choos_e.Fllp.,r no file selected
OR
You currently do not have any saved documents. Click "Manage Documents" to upload and save new documents, or simply upload your new document on this page.
Quick Tip: Need to upload a paper document (e.g. transcripts)? Click on the "?" button for more info. ® Back Continue to Recommendations 13
To view and print these pages you must have Adobe Acrobat Reader installed. This product is free to download. Users visual disabilities can access information in Adobe POF by also downloading the Acrobat Access plug-in. Adubt with 8 8 I 10I 11 1 13 1 13 Page * I ? 1 3 I a l 5 1 b I Z i 2 1 1 14 ®® Coovnoht Notice FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART XV - GRANTS AND CONTRIBUTIONS PAID DURING TEE YEAR
RELATIONSHIP TO SUBSTANTIAL CONTRIBUTOR AND RECIPIENT NAME AND ADDRESS FOUNDATION STATUS OF RECIPIENT PURPOSE OF GRANT OR CONTRIBUTION AMOUNT ------
SEE STATEMENT ATTACHED NO RELATION TO SUBSTANTIAL CONTRIBUTOR EDUCATIONAL 2,719,635. (AFTER STATEMENT 15) INDIVIDUALS
------TOTAL CONTRIBUTIONS PAID 2,719,635.
4WS052 M261 V05-8 35 STATEMENT 14 FANNIE AND JOHN HERTZ FOUNDATION 36-2411723
FORM 990PF, PART XV - CONTRIBUTIONS APPROVED FOR FUTURE PAYMENT
RELATIONSHIP TO SUBSTANTIAL CONTRIBUTOR AND RECIPIENT NAME AND ADDRESS FOUNDATION STATUS OF RECIPIENT PURPOSE OF GRANT OR CONTRIBUTION AMOUNT ------
SEE STATEMENT ATTACHED NO RELATION TO SUBSTANTIAL CONTRIBUTOR EDUCATIONAL 2,376,141. INDIVIDUALS
------TOTAL CONTRIBUTIONS APPROVED 2,376,141.
CCCOO^OO0000
4WS052 M261 V05-8 36 STATEMENT 15 • 4
Fannie and John Hertz Foundation Fellowship Expenditures 3B Total 3A Approved Part XV, Line 3A+3B, Grants Accrued Total Paid for Future Paid and Accrued 6/30/2005 2005-06 Payment 2006-07
California Institute of Technology Xiaoyan Robert Bao 40,000.00 40,000.00 14,333.00 Kimberly Beatty 40,000.00 40,000.00 43,000.00 Douglas Behenna 40,000.00 40,000.00 0.00 Michael Henry 43,000.00 43,000.00 43,000.00 John McKeen 45,000.00 45,000.00 3,000.00 Anthony Miller 40,000.00 40,000.00 43,000.00 Kartik Srinivasan 40,000.00 40,000.00 0.00 David Van Valen 43,000.00 43,000.00 43,000.00 Stephen Waydo 40,000.00 40,000.00 43,000.00 David Zhang 0.00 0.00 43,000.00 Subtotal 371,000 00 371,000.00 275,333.00
California , Berkeley, University of Daniel Adkins 36,439.90 36,439.90 0.00 Alexander Fabrikant 36,439.90 36,439.90 39,867.50 Radu Mihaescu 41,439.90 36,896.90 14,867.50 Bradley Olsen 36,439.90 36,439.90 39,867.50 Rahul Satija 0.00 0.00 0.00 Had Shroff 36,439.90 36,439.90 39,867.50 Daniel Slichter 0.00 0.00 39,867.50 Simon Sponberg 36,439.90 36,439.90 39,867.50 Joseph Subotnik 36,439.90 36,439.90 0.00 Subtotal 260,079.30 255,536.30 214,205.00
California , Davis, University of Stuart Davis Herring 36,959.50 36,959.50 40,142.16 Subtotal 36,959.50 36,959.50 40,142.16
California , Los Angeles , University of David Hwang Refund 2004-05 0.00 (17,391.92) 0.00 Subtotal 0.00 (17,391.92) 0.00
California , San Francisco , University of David Breslow 44,899.00 44,899.00 45,075.00 Subtotal 44,899.00 44,899.00 45,075.00
California, Santa Barbara , University of Brian Camley 0.00 0.00 40,122.64 Brian Kinlan 37,122.64 37,122.64 0.00 Nathaniel Stem 37,122.64 37,122.64 40,122.64 Credit 0.00 (20.48 ) 0.00 Subtotal 74,245.28 74,224.80 80,245.28 Fannie and John Hertz Foundation Fellowship Expenditures 3B Total 3A Approved Part XV, Line 3A+3B, Grants Accrued Total Paid for Future Paid and Accrued 6/30/2005 2005-06 Payment 2006-07
Carnegie-Mellon University Jeremy Kubica 40,000.00 40,000.00 (18,611.12) Subtotal 40 ,000.00 40,000.00 (18,611.12)
Colorado -Boulder, University of Laurel Griggs Larsen 3,000.00 3,000.00 3,000.00 Cindy Regal 34,078.00 36,407.52 0.00 Subtotal 37,078.00 39,407.52 3,000.00
Cornell University James Wray 0.00 0.00 48,000.00 Subtotal 0.00 0.00 48,000.00
Harvard University Lillian Childress 38,200.00 32,430.00 41,200.00 Paul Choi 38,200.00 38,002.00 41,200.00 Kevin Esvelt 45,000.00 45,000.00 48,000.00 Michael Fischbach 40,000.00 38,002.00 43,000.00 Elizabeth Hong 38,200.00 38,002.00 41,200.00 Jared Kaplan 48,000.00 48,000.00 48,000.00 Jacob Krich 38,200.00 38,002.00 41,200.00 Julius Lucks 38,200.00 38,002.00 41,200.00 Lars Nielsen 38,200.00 38,002.00 41,200.00 Lucas Nivon 32,430.00 32,430.00 0.00 Adam Pivonka 48,000.00 48,000.00 48,000.00 Matthew Schiffler 38,200.00 38,002.00 41,200.00 Alexander Wissner-Gross 38,200.00 38,002.00 41,200.00 Yi Zhou 3,000.00 3,000.00 3,000.00 Subtotal 522,030.00 512,876.00 519,600.00
Illinois, University of Matthew Meitl 37,498.00 37,578.00 40,498.00 Kenneth Dean Mitchell 15,000.00 12,552.00 15,000.00 Robert Shimmin 17,500.00 17,500.00 19,000.00 - Subtotal 69,998.00 67,630.00 74,498.00
Johns Hopkins University Noah Smith 40,000.00 40,000.00 0.00 Subtotal 40,000.00 40,000.00 0.00
Kansas, University of (transfer from Univ. of Michigan) o, I. 4
Fannie and John Hertz Foun dation Fellowship Expenditures 3B Total 3A Approved Part XV, Line 3A+3B, Grants Accrued Total Paid for Future Paid and Accrued 6/30/2005 2005-06 Payment 2006-07 Katie Mitchell-Koch 3,000.00 3,000.00 3,000.00 Subtotal 3,000.00 3,000.00 3,000.00
Maryland , University of Kyle Gustafson 43,000.00 43,000.00 43,000.00 Subtotal 43 ,000.00 43,000.00 43,000.00
Massachusetts Institute of Technology Luis Alvarez 0.00 0.00 32,300.00 Dmitriy Aronov 0.00 0.00 43,000.00 Michael Baym 3,000.00 3,000.00 3,000.00 Anna Bershteyn 0.00 0.00 48,000.00 Brett Bethke 3,000.00 3,000.00 3,000.00 Russell Cox 40,000.00 40,000.00 0.00 John Frank 40,000.00 40,000.00 43,000.00 Anastasios Hart 40,000.00 40,000.00 0.00 William Kaminsky 20,000.00 20,000.00 0.00 Christopher Loose 40,000.00 40,000.00 43,000.00 Joshua Mueller 0.00 0.00 0.00 David Oertel 40,000.00 40,000.00 0.00 Jane Rempel 40,000.00 40,000.00 43,000.00 Jennifer Roberts 3,000.00 3,000.00 48,000.00 Joel Rosenthal 40,000.00 40,000.00 0.00 Stephen Samouhos 43,000.00 43,000.00 43,000.00 Samuel Schaevitz 0.00 0.00 0.00 Monika Schleier-Smith 48,000.00 48,000.00 48,000.00 Michael Schnall-Levin 0.00 0.00 3,000.00 Mikhail Shapiro 40,000.00 40,000.00 43,000.00 E. Courtnay Wilson 40,000.00 40,000.00 43,000.00 Subtotal 480,000.00 480,000.00 486,300.00
Michigan , University of Paul Podsiadlo 0 0 57,333.33 Subtotal 0 0 57,333.33
Princeton University Philip Eckhoff 45,000.00 45,000.00 3,000.00 Yedidya Hilewitz 26,500.00 26,500.00 3,000.00 Po-Shen Loh 45,000.00 45,000.00 3,000.00 Joseph Morrone 40,000.00 40,000.00 43,000.00 Jeremiah Zartman 23,500.00 23,500.00 24,800.00 Subtotal 180,000.00 180,000.00 76,800.00
Purdue University Stephen Pieper 2,462.00 2,738.00 0.00 Tyler Robarge 0.00 1,942.35 0.00 Fannie and John Hertz Foundation Fellowship Expenditures 3B Total 3A Approved Part XV, Line 3A+3B, Grants Accrued Total Paid for Future Paid and Accrued 6/30/2005 2005-06 Payment 2006-07 Subtotal 2,462.00 4,680.35 0.00
Rice University Gwendolyn Hoben 43,000.00 43,000.00 43,000.00 Elizabeth Stephens 0.00 0.00 43,000.00 Subtotal 43,000.00 43,000.00 86,000.00
Scripps , The Research Institute David Horning 0.00 0.00 3,000.00 Chang Liu 48,000.00 46,100.00 48,000.00 Daniel O'Malley 3,000.00 3,000.00 3,000.00 Subtotal 51,000.00 49,100.00 54,000.00
Southern California , University of Matthew Behrend 3,000.00 3,000.00 3,000.00 Thomas Space 16,200.00 16,158.00 0.00 Subtotal 19,200.00 19,158.00 3,000.00
Stanford University Jessica Chuang 37,000.00 32,257.00 0.00 Nicholas Cizek 40,000.00 40,000.00 40,000.00 Adam Cohen 52,680.00 52,680.00 2,610.00 Jeremy England 42,555.56 42,556.00 40,000.00 Elena Fabrikant Koslover 0.00 0.00 0.00 Keith Fife 37,000.00 37,000.00 40,000.00 Kenneth Franko 37,000.00 37,000.00 40,000.00 Eric Hoke 0.00 0.00 0.00 Valentin Spitkovsky 37,000.00 37,000.00 40,000.00 Neal Tanner 37,000.00 32,830.00 2,610.00 Kathryn Todd 37,000.00 37,000.00 40,000.00 John Waterston 0.00 0.00 0.00 Jesse Zalatan 37,000.00 37,000.00 40,000.00 Subtotal 394,235.56 385,323.00 285,220.00
Texas-Austin , University of William Pritchett 0.00 0.00 0.00 Subtotal 0.00 0.00 0.00
Wisconsin-Madison , University of Jordan Schmidt 37,000.00 28,282.28 0.00 Subtotal 37,000.00 28,282.28 0.00 I.
Fannie and John Hertz Foundation Fellowship Expenditures 3B Total 3A Approved Part XV, Line 3A+3B, Grants Accrued Total Paid for Future Paid and Accrued 6/30/2005 2005-06 Payment 2006-07
SUBTOTAL 2,749,186.64 2,700,684.83 2,376,140.65
Other Awards
Thesis Awards 0.00 5,000.00 0.00
Other Awards 0.00 13,950.00 0.00
Total Awards 2,749,186.64 2,719,634.83 2,376,140.65
Reversal of Fellowship Award (489,176 00)
Reversal of Other Awards (29,552.00)
Total 2,230,458.64 Apr 20 05 12:05p I. tz Foundation 510 ----5 3509 I p•2 1
Consent Fixing Period of Limitation Upon F orm 872-(, OMB No 1545-0055 Assessment of Tax Under Section 4940 of the
(Rev September 1900) Internal Revenue Code To be used with Form 1023. Submit D[parencnl of 1no Trouajy in duplicate IrtaneI rirrewe Service (See instructions.)
Under section 6501 (c)(4) of the Internal Revenue Code, and as part of a request filed with Form 1023 that the organization named below be treated as a publicly supported organization under section 170(b)(1)(A)(vi) or section 509( a)(2) during an advance ruling period,
Fannie and John Hertz Foundation (Exact/egarname of organization as anoanrnorganizing documrnq District Director Internal Revenue,nue,, or and the Assistant 2456 Livermore, Research Drive, California 94550 Come lsPlaner (Numbe( Streol. citie or town S tate. andZPCCde) (Em¢loye Plans and Exempt Organizations)
consent and agree that the period for assessing tax (imposed under section 4940 of the Code) for any of the 5 tax years in the advance ruling period will extend 8 years, 4 months, and 15 days beyond the end of the first tax year. However, if a notice of deficiency in tax for any of these years is sent to the organization before the period expires, the time for making an assessment will be further extended by the number of days the assessment is prohibited, plus 60 days.
Ending date of first tax year June 30, 2006 (t,t-nlh, day, and year)
Name of organization as shown in organizing document) Date
Fannie and John Hertz Foun `ation 4 - - , - D Officer or trustee having authority 6 I n Type or print name and title John Holzrichter Signahrep L^ `r - 21 2-0r'v., President For IRS use o,dy District Director or Assistant Commissioner (Employee Plans and Exempt Organizations) Date
By For Paperwork Reduction Act Notice , see page 7 of the Form 1023 instructions. ISA 5TFFED1505F