-4 EXTENSION ATTACHED
^^ Return of Private Foundation OMB No 1545-0052 Form 990 -P F or Section 4947(a)(1) Nonexempt Charitable Trust Department of the Treasury Treated as a Private Foundation Internal Revenue Service Note The foundation may be able to use a copy of this return to satisfy state re 2010 For calendar year 2010. or tax year beainnina .2010. and ending .20 G Check all that apply Initial return initial return of a former public chars Final return Amended return Address change Name change Name of foundation A Employer identification number
KANFEI NESHARIM FOUNDATION 20-6609618
Number and street (or P 0 box number if mail is not delivered to street address ) Room/suite B Telephone number ( see page 10 of the instructions)
156 WEST 56TH STREET 1701 (212) 419-2730
City or town, state, and ZIP code C If exemption application is ► pending , check here
D 1 Foreign organizations , check here , ► NEW YORK, NY 10019 2 Foreign organizations meeti ng the comtua check here and attach H Check type of organization X Section 501 c 3 exem t private foundation ( P computation ...... ► Section 4947 ( a )( 1 ) nonexem pt charitable trust Other taxable p rivate foundation E If private foundation status was terminated I Fair market value of all assets at end J Accounting method X Cash Accrual q under section 507(b)( 1 )(A), check here ► of year (from Part fl, col (c), line E] Other (specify) ______- F If the foundation is i n a 60-month termination 16) (Part 1, column (d) must be on cash basis) under section 507(b)( 1)(B), check here . ► $ 1,676,357. ► Analysis of Revenue and Expenses (The (d) Disbursements Revenue and total of amounts in columns (b), (c), and (d) (a) (b) Net investment (c) Adjusted net for chartable expenses per may not necessarily equal the amounts in income income purposes books column (a) (see page 11 of the instructions)) (cash basis onl y)
1 contributions dts, grants , etc , received ( attach schedule ) 1,818 ,661. if the foundation is not required to 2 Check ► attach Sch B ...... 3 Interest on savings and temporary cash investments 5,090. 5,090. AT C H 1 4 Dividends and interest from securities 5a Gross rents ...... O b Net rental income or (loss) as 6a Net gain or (loss) from sale of assets not on line 10 150. b Gross sales rice for all 305,250. assets onlme6a NO V 1, 4 Z011 I y > 7 Capital gain net income (from Part IV, line 2) 150. 8 Net short-term capital gain ...... t 9 Income modifications • • • • • • • • • ' 10 a Gross sales less returns and allowances • • b Less Cost of goods sold , c Gross profit or (loss) (attach schedule) . 11 Other income (attach schedule) • • . • 367. 20. ATCH 2 12 Total . Add lines 1 throuh11 1,824,268. 5,260. 13 Compensation of officers, directors, trustees, etc • . 0
14 Other employee salaries and wages , . . . . 22,667. 0 . 0. 2 2 , 6 67 U) 15 Pension plans, employee benefits 7,403. 0. 0. 7, 4 0 3 16 a Legal fees (attach schedule) ATCIi 3 9, 335. 0 . 0. 9, 335 L b Accounting fees (attach schedule) ATCH 4 1, 196. 0 . 0. 1,196 c Other professional fees (attach schedule) 31,498. 0. 0. 31, 4 9 8 17 Interest , , , , , , , , , , , , , , , , , , , 18 Taxes (attach schedule ) ( see page 14 of the instructions) 19 Depreciation (attach schedule) and depletion 0 20 Occupancy ...... ¢Q1 0 21 Travel, conferences, and meetings , , , , , , 19, 646. 0. 0. 19,646 ,tee 22 Printing and publications , ...... 9 23 Other expenses (attach schedule) ATCH• 6 4, 118. 148. 0. 3 , 9 7 0 2 24 Total operating and administrative expenses. a Add lines 13 through 23 ...... 95,863. 148 . 0. 95,715 25 Contributions, gifts, grants paid ...... 1,845, 169. 1, 845 , 169 26 Total expenses and disbursements Add lines 24 and 25 1,941,032. 148 . 0. 1, 9 4 0 , 8 8 4 27 Subtract line 26 from line 12
a Excess of revenue over expenses and disbursements -116,764 . b Net investment income (if negative, enter -0-) 5,112. 1 c Adjusted net income ( if negative , enter -0- . . For Paperwork Reduction Act Notice , see page 30 of the instructions * ATCH 5 JSA Form 990-PF (2010) 0614101000 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 M Form 990-PF (2010) 20-6609618 Page2 Attached schedules and amounts in the Beginning of year End of year Balance Sheets description column should be for end-of-year amounts only ( See instructions ) (a) Book Value ( b) Book Value (c) Fair Market Value 1 Cash - non-interest-bearing ...... 89 ,850. 79,767. 79,767. 2 Savings and temporary cash investments ...... 992,888. 887,548. 887,548. Accounts receivable 10,619, 3 ------0. 10, 619. 10,619. Less allowance for doubtful accounts ► 4 Pledges receivable ------
Less allowance for doubtful accounts ► ______5 Grants receivable ...... 6 Receivables due from officers , directors, trustees, and other disqualified persons ( attach schedule) (see page 15 of the instructions)
7 Other notes and loans receivable ( attach schedule) ► _ _ _ _ _ Less allowance for doubtful accounts ► 8 Inventories for sale or use 9 Prepaid expenses and deferred charges ...... Q 10 a investments - U S and state government obligations (attach schedule) , b Investments - corporate stock (attach schedule ) , ...... c Investments - corporate bonds (attach schedule ) , ...... 11 Investments - land, buildings, ► and equipment basis ______Less accumulated depreciation ► (attach sch ed u le) ------12 Investments - mortgage loans ...... 13 Investments - other ( attach schedule) , , , , , , , , , , , , , 14 Land , buildings, and ► equipment basis ______Less accumulated depreciation ► (attach schedule) ------698, 423. 698, 423. 698, 423. 15 Other assets (describe ► ------KT_Cjj _ 7 --- ) 16 Total assets (to be completed by all filers - see the instructions Also, see page 1, item I) 1, 781, 161. 1, 676, 357. 1, 676, 357. 17 Accounts payable and accrued expenses . , , . . , , . . . , 18 Grants payable , , , , , , , , , , , , , , , , , , , , , , , y 19 Deferred revenue ...... 20 Loans from officers, directors , trustees , and other disqualified persons 62 5,000. 625,000. ATCH 8 r_a 21 Mortgages and other notes payable (attach schedule) , , , , , 22 Other liabilities (describe )
23 Total liabilities ( add lines 17 through 22 ) 625, 000. 625,000e
Foundations that follow SFAS 117, check here ► and complete lines 24 through 26 and lines 30 and 31.
(D 24 Unrestricted ...... u 0 25 Temporarily restricted ...... m 26 Permanently restricted , Foundations that do not follow SFAS 117, through 31. LL check here and complete lines 27 Po. 0 27 Capital stock , trust principal , or current funds , , , , , , , , , 28 Paid-in or capital surplus , or land, bldg , and equipment fund 29 Retained earnings, accumulated income, endowment , or other funds , 1, 156, 161. 1,051,357. 30 Total net assets or fund balances (see page 17 of the Z instructions) , , 1,156,161. 1,051,357. 31 Total liabilities and net assets/fund balances ( see page 17 of the instructions) ...... 1, 781, 161. 1,676,357. 1 Analysis of Chan ges in Net Assets or Fund Balances 1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year's return ) , , , , ,,, , , , , , , , , , , , , , , , , , , 1 1,156,161 -116,764 2 Enter amount from Part I, line 27a ...... 2 3 Other increases not included in line 2 ( itemize ) ATTACHMENT 9 3 11, 960 ►------4 Add lines 1 , 2, and 3 4 1,051,357 5 Decreases not included in line 2 ( itemize) ► _ _ 5 6 Total net assets or fund balances at end of year line 4 minus Ilne 5 - Part II , column b line 30 6 1,051,357 Form 990-PF (2010)
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0E1420 1 000 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 .t
Form 990-PF(2010) 20-6609618 Page3 Capital Gains and Losses for Tax on Investment Income (c) Date /d) (a) List and describe the kind(s) of property sold (e g real estate, acquired acquired Date sold P-Purchase (mo , day, yr ) day, yr ) 2-story brick warehouse, or common stock, 200 shs MLC Co) D- Donatio n (mo is SEE PART IV SCHEDULE b c d e Depreciation allowed (g) Cost or other basis (h) Gain or (loss) (e) Gross sales price (f) (or allowable) plus expense of sale (e) plus (f) minus (g) a b c d e Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Gains (Col (h) gain minus Adjusted basis (k) Excess of col (I) col (k), but not less than -0-) or (i) F M V as of 12/31/69 U) as of 12/31/69 over col ()), if any Losses (from col (h)) a b c d e If gain,, also enter in Part I, line 7 Capital gain net income or (net capital loss) { If (loss), enter -0- in Part I, line 7 } 2 150. 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 Ur&M Qualification Under Section 4940 (e) for Reduced Tax on Net Investment Income (For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income )
If section 4940(d)(2) applies, leave this part blank
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period'? q Yes 7X No If "Yes," the foundation 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
Base period years Adjusted q ualifying (col ( b) divided by col (c)) 2009 2,234,147. 928,457. 2.406301 2008 2,583,978. 1,411,789. 1.830286 2007 1,620,323. 1,901,510. 0.852124 2006 634,137. 1,292,932. 0.490464 2005 217,500. 1,219,923. 0.178290
2 Total of line 1, column (d) 2 5.757465 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 1.151493
4 Enter the net value of nonchantable-use assets for 2010 from Part X, line 5 4 852,742.
5 Multiply line 4 by line 3 ...... 5 981, 926.
6 Enter 1% of net investment income ( 1% of Part I , line 27b ) ...... 6 51.
7 Add lines 5 and 6 7 981,977.
8 Enter qualifying distributions from Part XII , line 4 8 1, 940,884. If line 8 is eaual to or areater than line 7. check the box in Part VI. line 1b . and complete that Dart usina a 1% tax rate See the Part VI instructions on page 18 iSA Form 990-PF (2010) 0E1430 1 000 4929C0 L161 11/3/2011 3:41:45 PM V 10-8.2 Form 990-PF 20 -6609618 4 FUMFiM Excise Tax Based on Investment Income ( Section 4940(a), 4940( b), 4940( e), or 4948 - see page 18 of the instructions)
1 a Exempt operating foundations described in section 4940(d)(2), check here ► and enter "N/A" on line 1 . . , Date of ruling or determination letter ------(attach copy of ruling letter if necessary - see instructions) b Domestic foundations that meet the section 4940(e) requirements in Part V, check 1 51. q here ► and enter 1% of Part I, line 27b , c All other domestic foundations enter 2% of line 27b Exempt foreign organizations enter 4% of Part I, line 12, col (b) 2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) . . 2 3 Add lines 1 and 2 3 51. 4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) , . 4 0. 5 51. 5 Tax based on investment income. Subtract line 4 from line 3 If zero or less, enter -0, , , , , , , , , , , , , , 6 Credits/Payments a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a 50. b Exempt foreign organizations-tax withheld at source 6b 0. c Tax paid with application for extension of time to file (Form 8868) , , , , , , , 6c 0. d Backup withholding erroneously withheld ...... 6d 7 Total credits and payments Add lines 6a through 6d ...... 7 50. 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 1 10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid , , , , , , , ► 10 11 Enter the amount of line 10 to be Credited to 2011 estimated tax ► 0 . Refunded 10- 11 Statements Regarding Activities 1a During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it Yes No participate or intervene in any political campaign? ...... 1a 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)? ...... lb X If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials published or distnbuted by the foundation in connection with the activities c Did the foundation file Form 1120-POL for this years , , , , , , , , 1c X d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year
(1) On the foundation 0. (2) On foundation managers ► $ 0 e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers ► $ 0. 2 Has the foundation engaged in any activities that have not previously been reported to the IRS? , , , , , , , , , , , , , , 2 X If "Yes,"attach a detailed description of the activities 3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or bylaws, or other similar instruments' If "Yes,"attach a conformed copy of the changes , , , , , ...... , 3 X 4a Did the foundation 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? ...... 4b 5 Was there a liquidation , termination , dissolution , or substantial contraction during the year? , , , , , , , , , , , , , , , , , 5 X If "Yes,"attach the statement required by General Instruction T 6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either • By language in the governing instrument, or • By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law remain in the governing instrument? ...... 6 X 7 Did the foundation have at least $5 , 000 in assets at any time during the year? If "Yes, " complete Part 11, 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 instructions) ► NY% ------b If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate) of each state as required by General Instruction G?If "No," attach explanation ...... 8b X 9 Is the foundation claiming status as a private operating foundation within the meaning of section 49420)(3) or 49420)(5) for calendar year 2010 or the taxable year beginning in 2010 (see instructions for Part XIV on page 27)' If "Yes, "complete Part XIV ...... 9 10 Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names and addresses ...... 10 X Form 990-PF (2010)
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Form 990-PF (2010) 20-6609618 Page 5 I'MiTTRY Statements Regardin g Activities (continued) 11 At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of section 512(b)(13)7 If "Yes," attach schedule (see page 20 of the instructions) ...... 11 X 12 Did the foundation acquire a direct or indirect interest in any applicable insurance contract before August 17, 2008 ...... 12 X 13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? . . . . . 13 X
Website address 10,------N/A------PERILUNE GROUP ------212-419-2730 14 The books are in care of ► Telephone no ► ------Locatedat - WEST - 56TH _ STREET, _SUITE _1_701NEWYORK,__N_Y_ ------Z1P+4 01 10019--- __ __ _ 15 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 Check here • • • • • • • • ►^ 15 and enter the amount of tax-exempt interest received or accrued during the year ...... ► 16 At any time during calendar year 2010, did the foundation have an interest in or a signature or other authority Yes No over a bank, securities, or other financial account in a foreign country'? ...... 16 X See page 20 of the instructions for exceptions and filing requirements for Form TD F 90-22 1 If "Yes," enter
the name of the forei g n country ► Statements Reg ardin g Activities for Which Form 4720 May Be Re q uired File Form 4720 if any item is checked in the "Yes" column , unless an exception applies. Yes No 1 a During the year did the foundation (either directly or indirectly) q (1) Engage in the sale or exchange , or leasing of property with a disqualified person? • , , , . , . El Yes X 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? ...... Yes X 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 X No (6) Agree to pay money or property to a government official? ( Exception Check " No" if the foundation agreed to make a grant to or to employ the official for a period after termination of government service , if terminating within 90 days ) ...... 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 22 of the instructions)' • • • • • • • • 1b here ...... Organizations relying on a current notice regarding disaster assistance check . ► c Did the foundation engage in a pnor 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 2010? ...... 1c X 2 Taxes on failure to distribute income ( section 4942 ) (does not apply for years the foundation was a private operating foundation defined in section 49420 )( 3) or 49420)(5)) a At the end of tax year 2010 , did the foundation have any undistributed income ( lines 6d and 6e, Part XIII) for tax year(s) beginning before 2010 ...... q Yes No If"Yes," list the years b Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets ) to the year's undistributed income '? (If applying section 4942(a)(2) to all years listed , answer "No" and attach statement - see page 22 of the instructions) ...... 2b c If the provisions of section 4942 (a)(2) are being applied to any of the years listed in 2a, list the years here
3 a Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any time during the year? . . . . . , . . • . • . , . . . • , , , • . . . , . . • . . , . , , • , q Yes No b If "Yes," did it have excess business holdings in 2010 as a result of (1) any purchase by the foundation or disqualified persons after May 26, 1969 , (2) the lapse of the 5-year period ( or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest, or (3) the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if the foundation had excess business holdings in 2010 ) ...... 3 4a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes' ...... 4a b Did the foundation make any investment in a prior year ( but after December 31, 1969) that could j eopardize its chnritnhle niirnnae that hart not been removers from iennarrly before the first day of the tax year beninnina in 2010 . . 4b X Form 990-PF (2010)
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0E1450 1 000 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 Form 990-PF 20-6609618 Page 6 Statements Regarding Activities for Which Form 4720 May Be Required (continued) 5a During the year did the foundation pay or incur any amount to (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945 (e)) ? , , , , , , q Yes N o (2) Influence the outcome of any specific public election (see section 4955), or to carry on, directly or indirectly, any voter registration drives Yes X No (3) Provide a grant to an individual for travel, study, or other similar purposes? ...... X Yes 8 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)? (see page 22 of the instructions) ...... q Yes q 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 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 22 of the in structions )? . . . 5b X Organizations relying on a current notice regarding disaster assistance check here ...... 111111- q c If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the tax q q because it maintained expenditure responsibility for the grant ? ...... Yes No If "Yes,"attach the statement required by Regulations section 53 4945-5(d) 6a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums q q on a personal benefit contract? ...... Yes No b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? , , , , , , , , , 6b X If "Yes" to 6b, file Form 8870 7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? q Yes No b If "Yes," did the foundation receive any proceeds or have any net income attributable to the transactions . 7b Information About Officers , Directors , Trustees , Foundation Managers, Highly Pa id Employees, and Contractors 1 List all officers, directors , trustees , foundation mana gers and their compensation ( see pa ge 22 of the instructions). (b) Title, and average (c) Compensation (d) Contributions to (e) Expense account, ()a Name and address hours per week (lf not paid, enter employee benefit plans other allowances devoted to P osition -0 - ) and deferred com pensation
------ATTACHMENT 10 0. 0. 0 ------
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2 Compensation of five highest-paid employees (other than those included on line 1 - see page 23 of the Instructions). If none. enter "NONE" (d) Contributions to b Title, and average employee et (e) Expenoe account, (a) Name and address of each employee paid more than $50,000 (c) Compensation () hours Pper week plans and deferred other allowances devoted to position com pensation
------NONE
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Total number of other employees paid over $50,000 . ► Form 990-PF (2010)
JSA 0E1460 1 000 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 Form 990-PF (2010) 20-6609618 Page 7 Information About Officers, Directors , Trustees , Foundation Managers, Highly Paid Employees, and Contractors (continued) 3 rive nlgnest- ala Inaepenaent contractors or protessionat services tsee pag e zs or the instructions ). IT none, enter nvnm. (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
------NONE
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Total number of others receivin g over $50,000 for p rofessional services . ► NONE Summary of Direct Charitable Activities
List the foundation' s four largest direct charitable activities during the tax year Include relevant statistical information such as the number of Expenses organizations and other beneficiaries served , conferences convened , research papers produced, etc
1 N/A ------
2 ------
3 ------
4
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Summary of Program -Related Investments (see page 24 of the instructions) Descnbe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2 Amount NONE ------
2 ------
All other program -related investments See page 24 of the instructions
3 NONE ------
Total . Add lines 1 throug h 3 ► Form 990-PF (2010)
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OE1465 1 000 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 Form 990-PF (2010) 20-6609618 Page 8 Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see page 24 of the instructions ) 1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc , purposes a Average,monthly fair market value of securities 1a 0. b Average of monthly cash balances . . . , , . , , ...... lb 865,728. c Fair market value of all other assets (see page 25 of the instructions ) ...... 1c 0. d Total (add lines 1a , b, and c) . , ...... Id 865,728. e Reduction claimed for blockage or other factors reported on lines 1 a and 1c (attach detailed explanation) 1e 2 Acquisition indebtedness applicable to line 1 assets ...... 2 0. 3 Subtract line 2 from line 1d ...... 3 865,728. 4 Cash deemed held for charitable activities Enter 1 1/2 % of line 3 (for greater amount, see page 25 of the instructions ) ...... 4 12, 986. 5 Net value of noncharitabie -use assets . Subtract line 4 from line 3 Enter here and on Part V, line 4 5 852,742. 6 Minimum investment return . Enter 5% of line 5 6 42,637. Distributable Amount (see page 25 of the instructions ) (Section 49420)( 3) and 0)(5) private operating foundations and certain foreign organizations check here ► E and do not complete this part ) 1 Minimum investment return from Part X, line 6 ...... 1 42 , 637 . 2 a Tax on investment income for 2010 from Part VI, line 5 2a 51. b Income tax for 2010 (This does not include the tax from Part VI) . 2b c Add lines 2a and 2b ...... 2c 51. 3 Distributable amount before adjustments Subtract line 2c from line 1 ...... 3 42,586. 4 Recoveries of amounts treated as qualifying distributions ,,,,,, , , , , , , , , , , , , , ,, , 4 9,460. 5 Add lines 3 and 4 ...... 5 52,046. 6 Deduction from distributable amount (see page 25 of the instructions) 6 7 Distributable amount as adjusted Subtract line 6 from line 5 Enter here and on Part XIII, line 1 7 52,046. Qualifying Distributions(see page 25 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 1, 940, 884. b Program-related investments - total from Part IX-B ...... 1b 0. 2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc , purposes ...... 2 0. 3 Amounts set aside for specific charitable projects that satisfy the a Suitability test (prior IRS approval required ) ...... 3a 0. b Cash distribution test (attach the required schedule) ...... 3b 0. 4 Qualifying distributions . Add lines la through 3b Enter here and on PartV , line 8, and Part XIII, line 4 . . . 4 1, 940, 884. 5 Foundations that qualify under section 4940 (e) for the reduced rate of tax on net investment income Enter 1 % of Part I, line 27b (see page 26 of the instructions ) ...... 5 51. 6 Adjusted qualifying distributions . Subtract line 5 from line 4 ...... 6 1, 940,833. Note : The amount on line 6 will be used in Part V, column (b), in subsequent years when cal culati ng whether the foundation qualifies for the section 4940 (e) reduction of tax in those years Form 990-PF (2010)
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0E1470 1 000 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 Form 990-PF (2010) 20-6609618 Page 9 Undistributed Income (see page 26 of the instructions) (a) (b) (c) (d) 1 Distributable amount for 2010 from Part XI, Corpus Years prior to 2009 2009 2010 line? ...... 52,046. 2 Undistributed income, if any, as of the end of 2010 a Enter amount for 2009 only ...... b Total for prior years 20 0 8 , 20 07 20 06 3 Excess distributions carryover, if any, to 2010 a From 2005 156,737. b From 2006 570,264. c From2007 1,526,479. d From 2008 21514,099. e From2009 2, 187, 730. 955, 309 f Total of lines 3a through e , , , , , , , , , , , . 6, . 4 Qualifying distributions for 2010 from Part XII, 1, 940,884. line4 ► $ a Applied to 2009, but not more than line 2a , , ,
b Applied to undistributed income of prior years (Election required - see page 26 of the instructions) . . . . ,
c Treated as distributions out of corpus (Election required - see page 26 of the instructions) . , , d Applied to 2010 distributable amount . . . . 52,046. e Remaining amount distributed out of corpus . . 1, 888, 838. 5 Excess distributions carryover applied to 2010 (If an amount appears in column (d), the same amount must be shown in column (a) ) 6 Enter the net total of each column as indicated below: a Corpus Add lines 3f, 4c, and 4e Subtract line 5 8, 844, 147 . b Prior years' undistributed income Subtract line 4b from line 2b 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 ...... d Subtract line 6c from line 6b Taxable amount - see page 27 of the instructions e Undistributed income for 2009 Subtract line 4a from line 2a Taxable amount - see page 27 of the instructions ......
f Undistributed income for 2010 Subtract lines 4d and 5 from line 1 This amount must be distributed in 2011 7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (see page 27 of the instructions) ...... 8 Excess distributions carryover from 2005 not applied on line 5 or line 7 (see page 27 of the instructions) ...... 156,737. 9 Excess distributions carryover to 2011. Subtract lines 7 and 8 from line 6a 8, 687,410. 10 Analysis of line 9 a Excess from 2006 , 570,264. b Excess from 2007 , 1,526,4 7 9. c Excess from 2008 2,514,099. d Excess from 2009 , 2,187,730. e Excess from 2010. 1,888,838. Form 990-PF (2010)
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0E1480 1 000 4929C0 L161 11/3/2011 3:41:45 PM V 10-8.2 Form 990-PF (2010) 20-6609618 Page 10 Offflfflr Private O peratin g Foundations ( see pa g e 27 of the instructions and Part VII-A, q uestio 9 ) NOT APPLICABLE la If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2010, enter the date of the ruling ► b Check box to indicate whether the foundation is a private operatlnp foundation described in section 4942(1)(3) or 49420)(5) Tax year Prior 3 years 2 a Enter the lesser of the ad- (e) Total justed net income from Part ( a)2010 ( b)2009 (c)2008 (d)2007 I or the minimum investment return from Part X for each year listed ......
b 85% of line 2a , , . , .
C Qualifying distributions from Part XI I, line 4 for each year listed
d Amounts included in line 2c not used directly for active conduct of exempt activities . . . . . e Qualifying distributions made directly for active conduct of exempt activities Subtract line 2d from line 2c . . , . . . 3 Complete 3a , b, or c for the alternative test relied upon a "Assets " alternative test - enter
(1) Value of all assets . . . (2) value of assets qualifying under section 49420)(3)(B)(i) . . . . . 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(a)(5)), or royalties) . . (2) Support from general public and 5 or more exempt organizations as provided in section 4942 U)(3)(B)(vi ) . . . . . (3) Largest amount of sup- port from an exempt organization , , , , , (4) Gross investment income , Supplementary Information (Complete this part only if the foundation had $5, 000 or more in assets at any time during the year - see page 28 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) )
N/A 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
N/A 2 Information Regarding Contribution , Grant, Gift, Loan, Scholarship , etc., Programs: q preselected charitable organizations and does not accept Check here ► if the foundation only makes contributions to unsolicited requests for funds If the foundation makes gifts, grants, etc (see page 28 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
b The form in which applications should be submitted and information and materials they should include
c Any submission deadlines
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors
990-PF (2010) 0E1490JSA1 000 Form 4929CO L161 11/3/2011 3 :41:45 PM V 10-8.2 Form 990-PF (2010) 20-6609618 Page 11 Supplementary Information (continued) 3 Grants and Contributions Paid During the Year or Approved for Future Payment If recipient is an individual , Foundation Recipient any Purpose of grant or show relati onsh i p to status of Amount any foundation manager contribution Name and address ( home or business ) or substantial contributor recipient a Paid during the year SEE SCHEDULE ATTACHED NONE 1,845,169.
1,845,169. Total ...... ► 3a b Approved for future payment
NONE Total ► 3b Form 990-PF (2010)
JSA 0E1491 1 000 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 Form 990-PF (2010) 20-6609618 Page 12 MOM!WT, Analysis of Income -Producing Activities Unrelated section 512 , 513 , or 514 e Enter gross amounts unless otherwise indicated business income Excluded b Related or exem pt (a) (b) (c) (d) function rincome Business code Amount Exclusion code Amount of Program service revenue fhe Instructions a b c d e f 9 Fees and contracts from government agencies 2 Membership dues and assessments , , , 3 Inte rest on savings and temporary cash investments 14 5,090. 4 Div idends and interest from securities 5 Ne t rental income or (loss) from real estate a Debt-financed property , , , , , , , , , b Not debt-financed property , , , , , , , 6 Net rental income or (loss) from personal property 7 Oth er investment income 8 Galn or (loss ) from sales of assets other than inventory 18 150. 9 Net income or ( loss) from special events . , 10 Gross profit or ( loss) from sales of inventory . 11 Oth errevenue a b MISC INCOME 01 20. c EXCISE TAX REFUND 01 347. d e 12 Su )total Add columns ( b), (d), and (e) . . . 5, 607 . 13 Total . Add line 12, columns ( b), (d), and (e) ...... 13 5,607. (See worksheet in line 13 instructions on page 29 to verify calculations ) wrawn .3 Relationship of Activities to the Accomplishment of Exempt Purposes Line No. Explain below how each activity for which income is reported in column (e) of Part XVI -A contributed importantly to the . accomplishment of the foundation 's exempt purposes (other than by providing funds for such purposes) (See page 29 of the Instructions )
Form 990-PF (2010) JSA 0E1492 1 000 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 Form 990-PF (2010) 20-6609618 Page 13 giCalgo Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Orcianizations Did the organization directly or indirectly engage in any of the following with any other organization described No in section 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 foundation to a noncharltable exempt organization of (1) Cash ...... 1a1 X (2) Other assets ...... 1a ( 2 X b Other transactions (1) Sales of assets to a noncharltable exempt organization , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1b0 X (2) Purchases of assets from a noncharltable exempt organization , , , , , , , , , , , , , , , , , , , , , , , , , , , , lb (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(5 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. 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 foundation If the foundation received less than fair market
2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 5277 ...... q Yes © No h If "Vne " rmm^lctn thn fnlln.uinn erhnrii ilo (a) Name of organization (b) Type of organization (c) Description of relationship
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements , and to the best of my knowledge and belief, it is true, correct , and complete D laration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge Sign Here ' Signature of officer or trustee Prlnt/Type preparer's name Preparer' s slgnatu
Paid m Q(^^ C
0E1493 1 000 Schedule B Schedule of Contributors OMB No 1545-0047 (Form 990, 990-EZ, or 990-PF) ► Attach to Form 990 , 990-EZ, or 990-PF. Department of the Treasury 2010
Name of the organization Employer identification number KANFEI NESHARIM FOUNDATION 20-6609618 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
q For an organization 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 990-EZ that met the 33 1/3 % support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1 h or (n) Form 990-EZ, line 1 Complete Parts IandII
q For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, aggregate contributions 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
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, 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 ...... ► $ Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or 990-PF), but it must answer "No" on Part IV, line 2 of its Form 990, or check the box on line H of its Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF)
For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF. Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
JSA
0E1251 1 000 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 Schedule B ( Form 990, 990-EZ , or 990-PF ) ( 2010) Page of of Part I Name of organization KANFEI NESHARIM FOUNDATION Employer Identification number 1 20-6609618 Contributors (see instructions)
(a) (b) (c) (d) No. Name, address , and ZIP + 4 Aggregate contributions Type of contribution
1 CHARITABLE LEAD TRUST ------FO----ARK Person Payroll 142 OLD RIDGEFIELD ROAD, SUITE 202 $ ------1,818,661 _ Noncash (Complete Part II if there is WILTON, CT 06897 ------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 )
(a) (b) (c) (d) No. Name, address , and ZIP + 4 Aggregate contributions Type of contribution
------Person Payroll
(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 )
SSA Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
0E1253 1 000 4929CO L161 11/7/2011 5:36:50 PM V 10-8.2 KANFEI NESHARIM FOUNDATION 20-6609618
ATTACHMENT 1
FORM 990PF, PART I - INTEREST ON TEMPORARY CASH INVESTMENTS
REVENUE AND NET EXPENSES INVESTMENT DESCRIPTION PER BOOKS INCOME
FIRST REPUBLIC BANK 1,528. 1,528. FIRST REPUBLIC TRUST COMPANY 3,562. 3,562.
TOTAL 5,090. 5,090.
ATTACHMENT 1 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 KANFEI NESHARIM FOUNDATION 20-6609618
ATTACHMENT 2
FORM 990PF, PART I - OTHER INCOME
REVENUE AND NET EXPENSES INVESTMENT DESCRIPTION PER BOOKS INCOME MISC. INCOME - ONLINE STATEMENT REWARDS 20. 20. EXCISE TAX REFUND 347. 0.
TOTALS 367. 20.
ATTACHMENT 2 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 KANFEI NESHARIM FOUNDATION 20-6609618
ATTACHMENT 3
FORM 990PF, PART I - LEGAL FEES
REVENUE AND NET ADJUSTED EXPENSES INVESTMENT NET CHARITABLE DESCRIPTION PER BOOKS INCOME INCOME PURPOSES
JACKIE EWENSTEIN 1,125. 0. 0. 1,125. WEIL, GOTSHAL & MANGES LLP 8,210. 0. 0. 8,210.
TOTALS 9,335. 0. 9,335.
ATTACHMENT 3 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 KANFEI NESHARIM FOUNDATION 20-6609618
ATTACHMENT 4
FORM 990PF, PART I - ACCOUNTING FEES
REVENUE AND NET ADJUSTED EXPENSES INVESTMENT NET CHARITABLE DESCRIPTION PER BOOKS INCOME INCOME PURPOSES
SPIELMAN KOENIGSBERG & PARKER 1,196. 0. 0. 1,196.
TOTALS 1,196. 0. 0. 1,196.
ATTACHMENT 4 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 KANFEI NESHARIM FOUNDATION 20-6609618
ATTACHMENT 5
FORM 990PF, PART I - OTHER PROFESSIONAL FEES
REVENUE AND NET ADJUSTED EXPENSES INVESTMENT NET CHARITABLE DESCRIPTION PER BOOKS INCOME INCOME PURPOSES
CONSULTING FEES 12,002. 0. 0. 12,002. FOUNDATION ADMINISTRATION 19,496. 0. 0. 19,496.
TOTALS 31,498. 0. 0. 31,498.
ATTACHMENT 5 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 KANFEI NESHARIM FOUNDATION 20-6609618
ATTACHMENT 6
FORM 990PF, PART I - OTHER EXPENSES
REVENUE AND NET ADJUSTED EXPENSES INVESTMENT NET CHARITABLE DESCRIPTION PER BOOKS INCOME INCOME PURPOSES BANK CHARGES 5. 0. 0. 5. INSURANCE 202. 0. 0. 202. INVESTMENT FEES 148. 148. 0. 0. OFFICE EXPENSE 2,657. 0. 0. 2,657. PAYROLL ADMIN FEES 1,106. 0. 0. 1,106.
TOTALS 4,118. 148. 0. 3,970.
ATTACHMENT 6 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 KANFEI NESHARIM FOUNDATION 20-6609618
ATTACHMENT 7
FORM 990PF, PART II - OTHER ASSETS
BEGINNING ENDING ENDING DESCRIPTION BOOK VALUE BOOK VALUE FMV
INTEREST IN REAL ESTATE FOR CHARITABLE USE 591,315. 591,315. 591,315. SEFER TORAH FOR CHARITABLE USE 107, 108. 107, 108. 107, 108.
TOTALS 698,423. 698,423. 698,423.
ATTACHMENT 7 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 KANFEI NESHARIM FOUNDATION 20-6609618
ATTACHMENT 8
FORM 990PF, PART II - LOANS FROM OFFICERS, DIRECTORS, ETC.
LENDER: NETANYA ENDEAVORS LLC ORIGINAL AMOUNT: 625,000. INTEREST RATE: 0.000000 DATE OF NOTE: 05/04/2009 REPAYMENT TERMS: NO INTEREST, DUE ON DEMAND SECURITY PROVIDED: NONE PURPOSE OF LOAN: FOR CHARITABLE USE
BEGINNING BALANCE DUE ...... 625,000.
ENDING BALANCE DUE ...... 625,000.
TOTAL BEGINNING LOANS FROM OFFICERS, DIRECTORS, ETC. 625,000.
TOTAL ENDING LOANS FROM OFFICERS, DIRECTORS, ETC. 625,000.
ATTACHMENT 8 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 KANFEI NESHARIM FOUNDATION 20-6609618
ATTACHMENT 9
FORM 990PF, PART III - OTHER INCREASES IN NET WORTH OR FUND BALANCES
DESCRIPTION AMOUNT
PRIOR PERIOD ADJUSTMENT (VOIDED CHECKS) 11,960.
TOTAL 11,960.
ATTACHMENT 9 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 KANFEI NESHARIM FOUNDATION 20-6609618
FORM 990PF, PART VIII - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES ATTACHMENT 10
CONTRIBUTIONS EXPENSE ACCT TITLE AND AVERAGE HOURS PER TO EMPLOYEE AND OTHER NAME AND ADDRESS WEEK DEVOTED TO POSITION COMPENSATION BENEFIT PLANS ALLOWANCES
B.S.D. TRUST COMPANY TRUSTEE 0. 0. 0. (RESIGNED SEPTEMBER 2010) 5.00 142 OLD RIDGEFIELD ROAD, SUITE 202 WILTON, CT 06897
CAREY WOLCHOCK TRUSTEE 0. 0. 0. 156 WEST 56TH STREET 2.00 1701 NEW YORK, NY 10019
DAVID CAMHI TREASURER 0. 0. 0. 156 WEST 56TH STREET 2.00 1701 NEW YORK, NY 10019
LYUDMILA KOYENOVA SECRETARY 0. 0. 0. 156 WEST 56TH STREET 2.00 1701 NEW YORK, NY 10019
GRAND TOTALS 0. 0.
ATTACHMENT 10 4929CO L161 11/7/2011 5:36:50 PM V 10-8.2 THIRD AMENDMENT OF THE KANFE1 NESHARIM FOUNDATION
WHEREAS, by trust agreement known as the "WOLCHOCK FAMILY 2005
CHARITABLE TRUST AGREEMENT" dated July 21. 2005 between TAMAR
ABRAHAM WOLCHOK . as settlor (the "Scttlor"). and B .S.D. TRUST COMPANY,
INC. ("BSD"), as trustee (the ''Trust Agreement"), the WOLCHOK FAMILY 2005
CHARITABLE TRUST (the "Trust") was created; and
WHEREAS, Article 11 of the Trust Agreement provides that the Protectors may, in their sole discretion. amend the Trust Agreement, subject to certain limitations, by an instrument in writing, duly acknowledged and delivered to the Trustees: and
WI IERE-AS. on August 31, 2005 the Trust Agreement was amended and the name of the Trust was changed to the KANFEI NESHARIM FOUNDATION; and
Wl II RE-AS. on July 15. 2009 the Trust Agreement was amended with respect to permissible grantees; and
WHEREAS, BSD currently is the sole trustee and sole Independent Trustee (as defined in the Trust Agreement ) under the Trust Agreement, and the Settlor and the
Settlor's spouse. CAREY ROBINSON WOLCHOCK ("CAREY"). currently are the sole
Protectors under the Trust Avreement; and
WHEREAS. the Protectors now desire to amend the Trust Agreement in certain respects; and
WIII;REAS. the desired amendments to the Trust Agreement arc not prohibited by Article II of the Trust Agreement.
I i5 ACTIVF \4347530;t01\57( 9.0004 NOW. THEREFORE, the Protectors hereby amend the Trust Agreement as follows:
1. Article IV shall be deleted and replaced with the following:
PROPERTY RECEIVED FROM THE FOUR ARK
CHARITABLE LEAD TRUST
The Trust may receive property From time to time from the FOUR
ARK Cl IARI"I'AI3LE LEAD TRUST or from other charitable lead trusts
established by the Settlor. The Trustees shall establish a separate fund
(the "Restricted Fund") to receive and hold such property. During the
Settlor's life, the Trustees shall hold such assets. together with any and all
earnings generated by such assets, in the Restricted Fund, and shall
administer such fund as separate and distinct from every other fund of the
1'rust. Notwithstandins) anything to the contrary in this Trust Agreement.
CAREY shall make all decisions relating to distributions from the
Restricted Fund while lie is competent . After CARLY's death or
disability, no Protector other than an Independent Protector and no Trustee
other than an Independent Trustee, as the case may be. shall participate in
any decision relating to distributions from the Restricted Fund. The Trust
Agreement shall not he amended pursuant to Article II in such manner as
to permit a Protector other than an Independent Protector or a Trustee
other than an Independent Trustee to participate in any decision relating to
distributions from such Restricted Fund. Upon the death of the Settlor, the
Restricted Fund shall terminate and its assets shall he combined with the
US- .ACIIVLw34753o \u1\5761Q.0no4 2 Trust Fund or any separate fund of the Trust Fund as the Protectors
direct."
2. Subsection ( 3) of section (A) of Article viii of the Trust Agreement shall he deleted and replaced with the following:
"(3) The Protectors and the Trustees shall exercise their power
to designate Trustees in such a manner as to assure that either CAREY or
an Independent Trustee is always serving while there is a Restricted
Fund...
3. Subsection (12) ol'section (A) of Article XI of the Trust Agreement shall be deleted and the remaining subsections of section (A) of Article Xl shall he renumbered accordingly.
4. The following shall be added as subsection (17) of section (A) of Article
Xl of the Trust Agreement:
'`(17) ' FOUR ARK CI-IARITAI3LL LLAD '1'RUS I- ; the trust
created under article 11 of the trust agreement dated July 30. 2004 between
the Settlor. as settlor. and the Senior. CARRY and RICHARD A. SAUER.
as trustees, as amended August 30. 2005. known as the `TAMAR
ABRAI TAM WOLCHOK CI-IARITABI.1; TRUST AGREEMENT.-
Ii5 Ac rlv^;. w74?5 .O5\nfls;(^I4nao^J 3 The above amendments shall be effective on the date on which receipt is acknowledged by the Trustee below.
Dated: e..,10S ^f 2) 010
TAMAR ABRAHAM WOLC'I10K. Protector
LZA RE1 ROBINS()N W l10K. Protector
RECEIPT ACKNOWI.I:DUE D this ')r ` 1 day of ^ i - b , 2010
B.S.D. TRUST COMPANY. INC.. Trustee
AVID F. ILI KOF ' resident
IIS-ACTIVE \4.i47{1O5\1 I\576IQ 0004 4 STATE OF ^j -(,w t- )
) 'ss.: COUNTY OF N JL," 7m1' )
On the '' day of 2010. before me. the undersigned. a Notary
Public in and for said State. personally appeared TAMAR AIBRAI-IAM WOLCHOK.
personally Known to me or proved to me on the basis of satisfactory evidence to he the
individual whose name is subscribed to the within instrument and acknowledged to me
that she executed the scone in her capacity. and that by her signature on the instrument.
the individual, or the person upon behalf of'tihich the individual acted, executed the
instrument.
Notary Public
STATE OF l1 V. - scar `- ) LAUREN GLEITMAN NOTARY PUBLIC-STATE OF NEW YORK ) ss.: No. 01 GL6210223 COUN'T'Y OF Lit 1U4- . ) Qualified to New York County My Commission Expires August 10, 2013
On the 'S day of 4_'A2 ,.,ty:+-2010. before me. the undersigned , a Notary
Public in and for said State. personally appeared CAREY ROBINSON WOLCIIOK.
personally known to me or proved to me on the basis of satisfactory evidence to he the
individual ^\hose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity. and that by his signature on the instrument. the
individual, or the person upon behalf of which the individual acted, executed the instrument.
Notary Public
LAUREN GLEITMAN NOTARY PUBLIC - STATE OF NEW YORK No. 01GL6210223 IIS_ACTIVIi.ua4r;3OS\0IU"6t9 llluw 5 Qualified In New York County My Commission Expires August 10, 2013 KANFEI NESHARIM FOUNDATION 20-6609618 FORM 990-PF - PART IV CAPITAL GAINS AND LOSSES FOR TAX ON INVESTMENT INCOME P Kind of Property Description Date Date sold acquired Gross sale Depreciation Cost or FMV Add basis Excess of Gain price less allowed/ other as of as of FMV over or -ex penses of sale allowable ad i basis ( loss )
300,000 DELTA AIRLINES 7.920% 5/18/2012 P 02/02/2010 03/29/2010 PROPERTY TYPE: SECURITIES 305,250. 305,100. 150.
TOTAL GAIN (LOSS) ...... 150.
JSA 0E1730 1 000 4929CO L161 11/3/2011 3:41:45 PM V 10-8.2 KANFEI NESHARIM FOUNDATION EIN: 20-6609618 2010 Grants Paid
Purpose and Status of Name EIN Address Grant or Contribution Total Proof of Exemption 24 Engleberg Terrace, Lakewood, NJ 509[c][3] A F of Yeshiva Amaleh Shel Torah 22-3758699 08701 Educational Institution 1,80000 509[a][1] 318 Ewenston Drive, East Windsor, NJ 509[c][3] A F of Yeshivas Bircas HaTorah 13-3667854 08520 Educational Institution 10,000 00 509[a][1] Adam Kabins n/a 9615 Lowell Skokie, IL 60076 Abraham Scholarship 3,250 00 Information on File 42 Broadway, 14th Floor New York, NY 509[c][3] Agudath Israel of America 13-5604164 10005 Charitable Institution 18,000 00 509[a][1] 313 West 83rd Street New York, NY 509[c][3] Aish Center 26-3698290 10024 Chartable Institution 3,600 00 509[a][1] Go Rabbi Simcha Tolwin 25725 Coolidge Exempt as Religious Aish HaTorah Huntington Woods Highway Oak Park, MI 48237 Charitable Institution 4,000 00 Organization 150 w 46th Street, Suite 3, New York, NY 509[c][3] Aish Hatorah New York 13-3548993 10036 Chantable Institution 2,10000 509[a][1] 509[c][3] Aish Hatorah, Inc 52-2277693 408 S Lake Drive, Lakewood, NJ 08701 Charitable Institution 9,470 00 509[a][1] 125800 Northwestern Highway Southfield, Exempt as Religious Aish Huntington Woods M148075 Charitable Institution 5,000 00 Organization 509[c][3] American Friend of Beis Moaz 11-3465390 4612 12th Ave, Brooklyn, NY 11219 Charitable Institution 55000 509[a][1] 509[c][31 American Friend of Kollel Toras Zeraim 11-3051057 960-46 Street Brooklyn, NY 11219 Educational Institution 10,000 00 509[a][1] 509[c][3] American Friends of Amshinover Yeshiva 11-2575133 5417 18th Ave, Brooklyn, NY 11204 Charitable Institution 5,400 00 509[a][1] 455 N Formosa Avenue Los Angeles, CA 509[c][3] American Friends of Ayelet Hashachar 20-1180744 90036 Charitable Institution 18,000 00 509[a][1] 509[c][3] American Friends of Darche Noam 11-2823551 1551 E 7th Street, Brooklyn, NY 11230 Educational Institution 18,400 00 509[a][1] American nen s of rat - (committe for the Resucue of Israeli 509[c][3] Babies) 22-3431457 1612 57th Street, Brooklyn, NY 11204 Charitable Institution 3,200 00 509[a][1] 509[c][3] American Friends of Kesher, Inc 14-1903655 919 East 24th Street Brooklyn, NY 11210 Chartable Institution 1,000 00 509[a][1] American Friends of Kiryat Chinuch 111 Broadways, Suite 704, New York, NY 509[c][3] Lebani 11-2637224 10006 Educational Institution 20,000 00 509[a][1] American Friends of Mesilat Hatorah aka 509[c][3] Keren Hayeshivot Trust 13-3702251 1954 E 5th Street, Brooklyn, NY 11223 Educational Institution 10,000 00 509[a][1] 1560 Broadway Suite 510 New York, NY 509[c](3] American Friends of Migdal Ohr 13-3389558 10036 Chartable Institution 18,000 00 509[a][1] 509[c][3] American Friends of Mosdos Beis Dovid 68-0528334 4709 11th Avenue Brooklyn, NY 11219 Chantable Institution 7,000 00 509[a][1] 1133 Broadway, Suite 823 New York, NY 509[c][3] American Friends of Ponevez Yeshiva 13-5600414 10010 Educational Institution 5,00000 509[a)[1)
Page 1 of 11 KANFEI NESHARIM FOUNDATION EIN: 20-6609618 2010 Grants Paid
Purpose and Status of Name EIN Address Grant or Contribution Total Proof of Exemption 190 Glen Avenue South Lakewood, NJ 509[c][3] American Friends of the Jerusalem Kollel 20-1320557 08701 Educational Institution 5,00000 509[a][1] 509[c](3] American Friends of Yad Eliezer 11-3459952 1102 East 26th Street Brooklyn, NY 11210 Chartable Institution 10,000 00 509[a][1) 509[c][3] American Friends of Yad Naftali 20-4988389 1268 48th Street, Brooklyn, NY 11219 Charitable Institution 10,000 00 509[a][1] American Friends of Yeshiva D'Mir Inc 5227 New Utrecht Ave, Brooklyn, NY 509[c][3] (A F of Mir Yerushlam) 13-2946608 11219 Educational Institution 25,100 00 509[a][1] 1842 Coney Island Avenue, Brooklyn, NY 509[c][3] American Friends of Zichron Kelem 20-1848849 11230 Charitable Institution 3,600 00 509[a)[1] 15 West 16th Street New York, NY 509[c][3] American Jewish Historical Society 13-1764804 10011 Charitable Institution 10,000 00 509[a][1] 24861 South Woodland Road Beachwood, Andrew Weiner n/a OH 44122 Abraham Scholarship 1,00000 Information on File 509[c][3] Anshei Chayil Inc dba Nahal Haredi 13-4069565 127 RT 59, Monsey, NY 10952 Charitable Institution 10,000 00 509[a][1] Association for Advancement of 555 Madison Avenue Lakewood, NJ 509[c][3] Education 22-3347995 08701 Educational Institution 1,000 00 509[a]I1] Bais Hamedrash & Mesivta of Baltimore 6823 Old Pimlico Road Baltimore, MD 509[c][3] Inc 52-1980774 21209 Educational Institution 500 00 5091a](1] 235 PARK AVENUE S NEW YORK, NY 509[c][3] BAR-ILAN UNIVERSITY 13-6192275 10003 Educational Institution 5,000 00 509[a][1] 300 E51st Street, Suite 8G, New York, NY 509[c][3] Batya - Friends of United Hatzalah 11-3533002 10022 Charitable Institution 1,800 00 509[a][1] 509[c)[3] Bayith Lepleitot, Inc 11-2213686 1362 East 21st Street Brooklyn, NY 11210 Chartable Institution 29,767 00 509[a][1] 17 Ft George Hill, Apt 7J, New York, NY 509(c][3] Beis Midrash of Queens 11-2509831 10040 Educational Institution 925 00 509(a)(11 17 Copperbeach Lane, Lawrence, NY Beitar Illit Advanced Talmud Project 11-3618915 11559 Charitable Institution 180 00 501(c][3] 509[c][3] Beth Medrash Govoha of Lakewood 22-3839462 601 Private Way, Lakewood, NJ 08701 Educational Institution 76,550 00 509[a][1] 180 Riverside drive, #3B, New York, NY 509[c][3] Bikur Cholim of Manhattan 13-3208366 10024 Charitable Institution 1,00000 509[a][1] 1755 46th Street Brooklyn, New York 509[c][3] Bonei Olam 11-3473757 11204 Charitable Institution 18,000 00 509[a][1] 305 West 79th Street New York, NY 509[c][31 Carlebach Shul 13-1985569 10024 Charitable Institution 1,80000 509[a][1] 980 6th Avenue, 3rd Floor New York, NY 509[c][3] Central Fund of Israel 13-2992985 10018 Charitable Institution 2,50000 509[a](1] 821 HAWKINS AVENUE LAKE GROVE, 509[c][3] CHABAD AT STONY BROOK 11-2958801 NY 11755 Charitable Institution 1,00000 509[a][1] Ahavas Tzedek Chaim Mendelson n/a 960 46th Street, Brooklyn, NY 11219 Scholarship 36,000 00 information on File Page 2 of 11 KANFEI NESHARIM FOUNDATION EIN: 20-6609618 2010 Grants Paid
Purpose and Status of Name EIN Address Grant or Contribution Total Proof of Exemption 1217 East 32nd Street Brooklyn, NY 509[c][3] Chaim Shel Tikvah 27-0346824 11210 Charitable Institution 5,00000 509[a][1] 445 Central Avenue, Cedarhurst, NY 509[c][3] Chasdei Yisroel 56-2627256 11516 Chartable Institution 18,000 00 509[a](1)
6506 N Saint Louis Avenue Lincolnwood, 509[c][3] Chicago Center for Torah & Chesed, Inc 20-1041063 IL 60712 Charitable Institution 0 00 509[a][1]
509[c][3] Chicago Community Kollel 36-3247340 6506 N California Chicago, IL 60645 Chartable Institution 5,000 00 509[a][1]
509[c][31 Children's Aid Fund 13-4068150 15 Dunhill Lane Monsey, NY 10952 Chantable Institution 10,000 00 509[a][1]
509[c](3] Chofetz Chaim Heritage Foundation 11-2642559 361 Spook Roch Road, Suffern, NY 10901 Charitable Institution 2,500 00 509[a][1]
509[c][3] Collegiate Learning Exchange 02-0637274 4900 Pinetree Drive Miami, FL 33140 Educational Institution 3,000 00 509[a][1]
7 Fairway Oval New Hampstead, NY 509[c][3] Community Legacy Foundation Inc 30-6027053 10977 Charitable Institution 1,00000 509[a][2]
509[c][3] Congregation Ahavas Tzdokah 11-2558749 5323 12th Ave, Brooklyn NY 11219 Charitable Institution 1,00000 509[a][1]
45 Broadway, Floor 25, New York, NY 509[c][3] Congregation Bais Medrash Avreichim 11-3463631 10006 Charitable Institution 10,000 00 509[a][1]
Congregation Beth Chaim/Kahilas 7211 Beverly Blvd, Los Angeles, CA 509[c][3] Yaakov 95-4063165 90036 Charitable Institution 1,000 00 509[a][1]
509[c][3] Congregation Beth Medrash Govoha 51-0137088 5113 16th Ave, Brookly, NY 11204 Charitable Institution 5,00000 509[a][1]
509[c][3] Congregation Bi rkat Asher 52-1653157 8908 Lancroft Rd, Baltimore, MD 21215 Charitable Institution 360 00 509[a][1]
353 West 84th Street New York, NY Congregation B'Nai Israel Chaim 10024 Charitable Institution 15,000 00 Exempt as a Church
509[c][3] Congregation B'nei Torah Of Clifton 16-1743309 12 Edgewood Ave, Clifton, NJ 07012 Charitable Institution 613 00 509[a][1]
Page 3 of 11 KANFEI NESHARIM FOUNDATION EIN: 20-6609618 2010 Grants Paid
Purpose and Status of Name EIN Address Grant or Contribution Total Proof of Exemption
509[c][31 Congregation Bnei Yerushalayim 13-4015883 6 Elaine Place, Spring Valley, NY 10977 Chartable Institution 500 00 509[a][1]
509[c)[3] Congregation Ezras Yisroel of Boyar 11-3460508 4415 14th Avenue Brooklyn, NY 11219 Charitable Institution 500 00 509[a][1]
509[c][3] Congregation Kehilas Yaakov 11-3498666 459 Argyle Rd, Brooklyn NY 11218 Chantable Institution 1,80000 509[a][1]
509[c][3] Congregation Minchas Chinuch 13-4179739 276 Riverside Drive, New York, NY 10025 Chartable Institution 2,0000011 509[a][1]
509[c][3] Congregation Ohel Yaakov 13-3316056 4 Yale Drive, Monsey, NY 10952 Charitable Institution 1,000 00 509[a][1]
do Rabbi Twersky 1223 45th Street 509[c][3) Congregation Rachmistnvka 11-2604058 Brooklyn, NY 11219 Charitable Institution 600 00 509[a][1]
509[c][31 Congregation Tiferes Israel 11-2906454 1271 E 35th Street, Brooklyn NY 11210 Chartable Institution 500 00 509[a][1]
1271 6th Avenue, 48th Floor New York, 509[c][3] Congregation Yad Shaul 13-4147735 NY 10020 Charitable Institution 76,000 00 509[a][1]
509[c][31 Congregation Zichrone Binyamin 22-3684722 701 Princeton Ave, Lakewood, NJ 08701 Chantable Institution 1,226 00 509[a][1]
David Glaser n/a 18 Kilmer Drive Hillsborough, NJ 08844 Abraham Scholarship 834 00 Information on File
1505 Coney Island Ave Brooklyn, NY 509[c][3] Eitz Chaim Foundation 23-7009045 11230 Charitable Institution 5,00000 509[a][1]
Go Sarah & Scott Bryce 2038 Englewood Elena Bryce n/a Avenue Durham, NC 27705 Abraham Scholarship 3,250 00 Information on File
149-05 79th Ave, Suite 2, Flushing, NY 509[c][3] Emet Outreach 27-0559746 11367 Chartable Institution 500 00 509[a][1]
EOM (Em Od Milvado dba Congregation 509[c][3] Zichrone Binyamin) 22-3684722 701 Princeton Ave, Lakewood, NJ 08701 Chantable Institution 500 00 509[a][1]
Page 4 of 11 KANFEI NESHARIM FOUNDATION EIN: 20-6609618 2010 Grants Paid
Purpose and Status of Name EIN Address Grant or Contribution Total Proof of Exemption
509[c][3] Ezer Mzion Inc 13-3660421 1281 49th Street Brooklyn, NY 11219 Chartable Institution 500 00 509[a][1]
15871 Asilomar Blvd, Pacific Palisades, 509[c][3] FAMILY OF ISRAEL FUND 91-2150577 CA 90272 Chartable Institution 1,80000 509[a][1]
509[c][31 Friends of Mosdot Goor 13-3065542 1310 48th Street, Brooklyn NY 11219 Chantable Institution 2,62600 509[a][2]
509[c][3] Friends of Yad Naftali 20-4988389 1268 48th Street, Brooklyn, NY 11219 Chantable Institution 300 00 509[a][1]
509[c][3] Friends of Yemin Orde, Inc 22-3090463 12230 Wilkins Ave, Rockville, MD 20852 Chartable Institution 1,00000 509[a][1]
6651 Berquist Avenue West Hills, CA Gary Schwartz n/a 91307 Abraham Scholarship 1,75000 Information on File
509[c][3] Gateways Organization, Inc 13-3984085 11 Wallenberg Circle Monsey, NY 10952 Charitable Institution 18,000 00 509[a][1]
800 Yamato Road, Suite 101 Boca Raton, 509[c][3] Gift of Life Bone Marrow Foundation 22-3131232 NY 33431 Charitable Institution 1,80000 509[a][1]
1431 Coney Island Ave, Brooklyn, NY 509[c][3] Girls Town Or Chodosh 11-6156180 11230 Chantable Institution 1,80000 509[a][11
509[c][3] Hatzalah of Baltimore 20-4603471 5906 Key Ave, Baltimore, MD 21215 Chartable Institution 85,000 00 509[a][1]
509[c][3] Heritage Retreats 95-4892649 557 Fenlon Blvd, Clifton, NJ 07014 Chartable Institution 20,250 00 509[a][1]
509[c][3] Hillel Foundation for Jewish Campus Life 52-1844823 800 Eighth Street, Washington, DC 20001 Chartable Institution 50,000 00 509[a][1]
509[c][3] HINENI, INC 11-427999 232 West End Ave, New York, NY 10023 Charitable Institution 5,000 00 509[a][1]
509[c][31 In His Image Charitable Trust 13-7120573 1158 6th Ave, New York, NY 10036 Chantable Institution 6,00000 509[a][1]
Page 5 of 11 KANFEI NESHARIM FOUNDATION EIN: 20-6609618 2010 Grants Paid
Purpose and Status of Name EIN Address Grant or Contribution Total Proof of Exemption
509[c][3] Isralight South Florida 65-0915662 6866 Elianto Way Lake Worth, FL 33467 Chartable Institution 5,000 00 509[a](1)
Go Daniel Cohen 62 Memson Street Jeffrey Cohen n/a Teaneck, NJ 07666 Abraham Scholarship 3,250 00 Information on File
135 W50th Street, 6th Floor, New York, 509[c][3] Jewish Board of Family & Children's Svcs 13-5564937 NY 10020 Charitable Institution 11,100 00 509[a][1]
575 Madison Avenue, Suite 703 New 509[c][3] Jewish Communal Fund 23-7174183 York, NY 10022 Charitable Institution 18,000 00 509[a][1]
509[c][3] Jewish Enrichment Center 13-3959885 38 West 13th Street New York, NY 10011 Chartable Institution 20,000 00 509[a][1]
382 Central Park West, Suite 4A New 509[c][3] Jewish International Connection NY Inc 54-2102372 York, ny 10025 Charitable Institution 5,000 00 509[a][1]
441 West End Avenue New York, NY 509[c][3] Jewish Renaissance Center 13-3370708 10023 Charitable Institution 12,670 00 509[a][1]
234 West 74th Street New York, NY 509[c][3] Jewish Women's Club 13-6177764 10023 Charitable Institution 1,00000 509[a][2]
Go Norman Erlich 63 Linden Avenue Jonathan Erlich n/a Swampscott, MA 01907 Abraham Scholarship 3,25000 Information on File
do Gen Schnitzer-Newson 545 Rainier Joshua Newson n/a Boulevard N #2 Issaquah, WA 98027 Abraham Scholarship 3,250 00 Information on File
587 Fifth Avenue, Suite 702 New York, 509[c][3] Just One Life 13-3033863 NY 10017 Charitable Institution 1,800 00 509[a][1]
509[c][3] Keren Nesivos Moshe 13-4003987 80 Broad St 29th FI New York, NY 10004 Charitable Institution 18,000 00 509[a][1]
509[c][3] Keren Yehoshua V'Yisrael Inc 22-3209160 125 Carey Street, Lakewood, NJ 08701 Chantable Institution 3,60000 509[a][1]
509[c][3] Keren Zichron Moishe 64-6230222 1031 E 26th Street, Brooklyn, NY 11210 Charitable Institution 7,50000 1 1 509[a][1}
Page 6 of 11 KANFEI NESHARIM FOUNDATION EIN: 20-6609618 2010 Grants Paid
Purpose and Status of Name EIN Address Grant or Contribution Total Proof of Exemption
1830 Keystone Blvd, North Miami, FL 509[c][3) Keystone Jewish Center 65-1013786 33181 Charitable Institution 1,00000 509[a][1]
509[c][3] Kupat Eizer Nisuin Bais Yisroel 11-3472664 5110 18th Ave, Brooklyn, NY 11204 Charitable Institution 2,46200 509[a][1]
174 Broadways, Suite 504, Brooklyn, NY 509[c][3] Lechem Lasova 20-0780379 11211 Chartable Institution 2,00000 509[a][1]
509[c][3] Lezion B'nna Institute 11-3062761 1436 42nd Street, Brooklyn, NY 11219 Charitable Institution 500 00 509[a][1]
Go Laurie Howell 36619 Grand Island Mackenzie Howell n/a Oaks Circle Grand Island, FL 32735 Abraham Scholarship 3,250 00 Information available on file
509[c][3] MAOR, Inc 52-1606782 3407 Pinkney Road, Baltimore, MD 21215 Charitable Institution 1,00000 509[a][1]
Go Deborah Alpert 2526 W Dunwood Mara Alpert n/a Road Glendale, WI 53209 Abraham Scholarship 3,250 00 Information available on File
509[c][3] Matan Bseter Bambi Inc (Bambi) 11-2967060 1728 53rd St, Brooklyn, NY 11204 Chantable Institution 5,00000 509[a][1]
1340 NE 171st Street, North Miami Beach, 509[c][3] Matanah B'sesser of South Florida 65-0705354 FL 33162 Charitable Institution 8,000 00 509[a][1]
1205 Manor Drive, South Weston, FL Matthew Sorkin n/a 33326 Abraham Scholarship 3,250 00 Information Available on File
2921 West Farwell Avenue Chicago, IL 509[c][3] Meor Northwestern 45-0545167 60645 Charitable Institution 31,285 50 509[a][1]
509[c][3] Meor-Heritage Retreats Foundation 51-0430002 2 Glenbrook Road Monsey, NY 10952 Charitable Institution 166,555 38 509[a][1]
205 West Beech Street Long Beach, NY 509[c)[3] Mesivta of Long Beach 11-2818825 11561 Educational Institution 500 00 509[a][1]
MESIVTA YESHIVA RABBI CHAIM 1585 CONEY ISLAND AVE BROOKLYN, 509[c][3] BERLIN 11-2225154 NY 11230 Educational Institution 18,000 00 5091a]I1]
Page 7 of 11 KANFEI NESHARIM FOUNDATION EIN: 20-6609618 2010 Grants Paid
Purpose and Status of Name EIN Address Grant or Contribution Total Proof of Exemption
80 Maiden Lane, 21st Floor, New York, 509[c][3] Met Council 13-2738818 NY 10038 Charitable Institution 3,600 00 509[a][1]
509[c][3J Mishmeres HaSholom Inc 26-0543979 8 Elyon Road Monsey, NY 10952 Charitable Institution 5,00000 509[a][1]
Ahavas Tzedek Nachum Hymowitz n/a 25 Divrei Chaim, Jerusalem, Israel 94479 Scholarship 1,000 00 Information available on File
509[c][3) National Council of Young Israel 13-3617102 111 John Street #450 New York,NY 10038 Charitable Institution 500 00 509[a][1]
1090 Coney Island Avenue 3rd floor 509[c][3] National Society for Hebrew Day Schools 13-3554128 Brooklyn, NY 11230 Charitable Institution 5,00000 509[a][1]
509[c][3] Nefesh Yehudie, Inc 20-5202955 1274 49th Street, Brooklyn, NY 11219 Educational Institution 10,000 00 509[a][1]
509[c][3] Netivot Israel 11-2943633 1617 Ocean Parkway Brooklyn, NY 11223 Charitable Institution 2,50000 509[a][1]
25 Broadway, Rm 403, New York, NY 509[c][3] Neve Yerushalayim 13-3163148 10004 Educational Institution 5,000 00 509[a][1]
14 Elie Court Staten Island, New York 509[c][3] New Springville Jewish Center 13-3317092 10314 Charitable Institution 128,000 00 509[a][1]
1340 Wynnstone Drive Ann Arbor, MI Nunt Weizman n/a 48105 Abraham Scholarship 1,750 00 Information available on file
509[c][3] Ohel Avraham 36-3352340 8624 Hamlin Ave, Skokie, IL 60076 Charitable Institution 1,000 00 509[a][1] 509[c][3] Ohel Childrens Home & Family Svcs 11-6078704 4510 16th Avenue Brooklyn, NY 11204 Charitable Institution 1,00000 509[a][1] 551 W 181st Street, St 123, New York, NY 509[c][3] Org for the Resolution of Agunot Inc 81-0582070 10033 Charitable Institution 1,00000 509[a][1] 11 Broadway, 14th Floor, New York, NY 509[c][3] OU 13-5623717 10004 Charitable Institution 500 00 509[a][1] 509[c][3] Partners Charity Fund for Israel 20-5550560 1301 47th Street Brooklyn, NY 11219 Charitable Institution 500 00 509[a][1] 6516 N 7th Str, Ste #104 Phoenix, AZ 509[c][3] Phoenix Community Kollel 86-0964706 85014 Charitable Institution 1,00000 1 1 509[a][1]
Page 8 of 11 KANFEI NESHARIM FOUNDATION EIN: 20-6609618 2010 Grants Paid
Purpose and Status of Name EIN Address Grant or Contribution Total Proof of Exemption 509[c][3] Project Extreme 36-4428246 335 Central Avenue Lawrence, NY 11559 Chartable Institution 500 00 509[a][1) 509[c][3] Rabbi Jacob Joseph School 13-5562257 1 Plainfield Ave, Edison, NJ 08817 Educational Institution 7,200 00 509[a][1] Rechov Etzion Gaver 3/16, Jerusalem, Ahavas Tzedek Rabbi Yehoshua Styne n/a Israel Scholarship 40,604 78 Information available on file Judaic Studies Rabbi Yoel Aneh n/a 136-43 71 Rd Flushing, NY 11367 Scholarship 14,400 00 Information available on file 509[c][3] Rabinowitz Institute, Inc 30-0264885 P 0 Box 1024 Clifton, NJ 07104 Charitable Institution 7,22500 509[a][1] 509[c][3] RCCS-Rofeh Cholim Cancer Society 11-3355081 768 Bedford Ave, Brooklyn, NY 11205 Charitable Institution 1,000 00 509[a][1] 509[c][3] Sar Shalom Inc 11-2809413 4107 16th Ave, Brooklyn, NY 11204 Charitable Institution 1,000 00 509[a][1] 509[c][3] Seattle Kollel 91-1473080 6003 51st Ave S, Seattle, WA 98118 Charitable Institution 3,60000 509[a][1] 18512 Union TPK, Fresh Meadows, NY 509[c][3] Sephardic Torah and Return Ctr Inc 11-3541417 11366 Charitable Institution 500 00 509[a][1] 509[c][3] Shor Yoshuv 11-2145464 1 Cedarlawn Avenue Lawrence, NY 11559 Chantable Institution 3,50000 509[a][1] 509[c][3] Sinai Retreats 20-2082285 3587 Severn Road Cleveland, OH 44118 Charitable Institution 5,00000 509[a][1] c/o Martin Mandelbaum 21 Frost Valley Spencer Mandlebaum n/a Road Mount Sinai, NY 11766 Abraham Scholarship 1,00000 Information available on file 509[c][3] Stam Gemilas Chessed Fund 22-2371278 615 Forest Ave, Lakewood, NJ 08701 Chartable Institution 750 00 509[a][21 30 S Adelaide Ave #3K Highland Park, 509(c](3] STEP 20-3836410 NJ 08904 Charitable Institution 4,300 00 509[a][1] 509[c](3] Talmudic College of Florida 59-1571122 4000 Alton Rd Miami Beach, FL 33140 Educational Institution 1,000 00 509[a][1] Talmudic Research Center of Northern 35 Ascension Street, Passaic Park, NJ 509[c][3] New Jersey 22-2041389 07055 Educational Institution 260 00 509[a][1] 4445 Old Court Road Baltimore, MD 509[c][3] Talmudical Academy of Baltimore 52-0591676 21208 Educational Institution 3,60000 509[a][1] C/o Lon Saland 55 Joyce Road Plainview, Tamir Saland n/a NY 11803 Flight Scholarship 1,00000 Information Available on File 509[c][3] Tehillat Naava Shlach Lachmecha, Inc 26-0233818 1415 59th Street, Brooklyn, NY 11219 Chartable Institution 1,00000 509[a][1] 825 NE 205th Terrace, North Miami 509[c][3] Temple Beis Moshiaj 14-1844564 Beach, FL 33179 Charitable Institution 500 00 509[a][1] North Modus Road, Box R, Modus, CT 509[c][31 The Torah Institute Inc 22-2394502 06469 Charitable Institution 5,360 00 509[a][1]
Page 9 of 11 KANFEI NESHARIM FOUNDATION EIN: 20-6609618 2010 Grants Paid
Purpose and Status of Name EIN Address Grant or Contribution Total Proof of Exemption 509[c][3] Tiferet Moshe Inc 22-3428577 818 Forest Ave Lakewood, NJ 08701 Charitable Institution 1,800 00 509[a][1] 509[c][3] Torah Academy High School of Brooklyn 11-2582944 2066 E 9th Street, Brooklyn, NY 11223 Educational Institution 500 00 509[a][1] 10167 San Jose Blvd Jacksonville, FL 509[c][3] Torah Academy of Jacksonville 26-0067800 32257 Educational Institution 8,750 00 509[a](1] Torah Umesorah (National Society for 1090 Coney Island Ave, Ste 3, Brooklyn, 509[c][3] Hebrew Day Schools) 13-5564128 NY 11230 Charitable Institution 1,80000 509[a][1] 509[c][3] United Fund Education (Shuvu - Return) 11-3064893 5417 18th Avenue Brooklyn, NY 11230 Charitable Institution 15,000 00 509[a][1] 1566 Coney Island Ave, Brooklyn, NY 509[c][3) Vaad L Hatzolas Nidchei Yisroel Inc 11-3245314 11230 Charitable Institution 180 00 509[a][1] 131 West 86th Street New York, NY 509[c][3] West Side Hatzoloh 13-3666149 10024 Charitable Institution 1,76700 509[a][1] West Side Kollel Inc aka Los Angeles 10523 Santa Monica Blvd Los Angeles, 509[c][3] Intercommunity Kollel (LINK) 42-1548771 CA 90025 Educational Institution 10,000 00 509[a][1] 646 West End Avenue New York, NY 509[c][3] West Side Kollel Torah Ctr 31-1751967 10025 Charitable Institution 64,250 00 509[a][1] 43 Montgomery Street, Jersey City, NJ 509[c][3] WFMU Auncle Communications 13-3649722 07302 Charitable Institution 2,70000 509[a][1] 1271 Ave of the Americas, 47th Floor, 509[c][3] Yad Avraham of New York, Inc 13-4087567 New York, NY 10020 Charitable Institution 200,000 00 509[a][1] 48 Scotland Hill Road Chestnut Ridge, NY 509[c][3] Yedei Chesed Inc 13-3728771 10977 Charitable Institution 500 00 509[a][1] Yeshiva Achei Temimim Lubavitz aka 77 Mount Pleasant Drive Trumbull, CT 509[c][3] Mishkan Israel Day Camp (MIDC) 06-1011201 06611-3424 Charitable Institution 50000 509[a][1] 509[c][3] Yeshiva Gedolah of Bayonne 22-3067176 735 Ave C, Bayonne, NJ 07002 Charitable Institution 1,00000 509[a][1] 509[c][3] Yeshiva Gedolah of Paterson 22-3415952 555 15th Ave, Paterson, NJ 07504 Chantable Institution 1,00000 509[a][1] 199 Lee Ave PMB 357, Brooklyn, NY 509[c][3] Yeshiva Keren HaTorah 16-1631453 11211 Educational Institution 1,00000 509[a][1] 509[c][3] Yeshiva Keren Orah 23-7098648 1339 52nd Street, Brooklyn, NY 11219 Educational Institution 31,300 00 509[a][1] 346 WEST 89TH STREET NEW YORK, 509[c][3] YESHIVA KETANA OF MANHATTAN 13-3423229 NY 10024 Educational Institution 24,531001 1 509[a][1] 101 West Forest Avenue Engelwood, NJ 509[c][3] Yeshiva Ohr Simcha of Englewood 22-3677646 07631 Educational Institution 2,000 00 509[a][1] 509[c][31 Yeshiva Orchos Chaim 01-0844614 46 Briarcliff Drive, Monsey, NY 10952 Educational Institution 18,000 00 509[a][1] 509[c][3] Yeshiva Rabbi Samson Raphael Hirsch 13-1624224 100 Bennett Ave, New York, NY 10033 Educational Institution 1,50000 509[a][1]
Page 10 of 11 KANFEI NESHARIM FOUNDATION EIN: 20-6609618 2010 Grants Paid
Purpose and Status of Name EIN Address Grant or Contribution Total Proof of Exemption 509[c][3] Yeshiva Shaar Hatalmud 13-4034360 1746 53rd Street, Brookyn, NY 11204 Educational Institution 1,80000 509[a][1] 509[c][3] Yeshiva Torah Vodaath 11-3091709 425 East 9th Street Brooklyn, NY 11218 Educational Institution 2,000 00 509[a][1] 509(c][3] Yeshiva Toras Chaim 51-0159234 489 West End Ave, New York, NY 10024 Educational Institution 1,000 00 509[a][1] 509[c][31 Yeshivas Ohr HaChaim 11-2808947 27 W 23rd Street, New York, NY 10010 Educational Institution 500 00 509[a][1] Yeshivas Wolozin Bnei Brak Israel Inc 1778 East 15th Street Brooklyn, NY 509[c][3] (Yeshivas Volozhin) 13-6222762 11229 Educational Institution 6,00000 509[a][1] 708 3rd Ave, Rm 1610, New York, NY 509[c][3] Yeshivat Nachlat Halevi'im 13-7131323 10017 Educational Institution 1,00000 509[a][1] 1144 East 29th Street Brooklyn, NY 509[c][3] Yeshivat Shaalvim Inc 11-3221587 11210 Educational Institution 6,667 00 509[a)[1) 509[c][3] Young Israel Bal Harbor 65-0905878 PO Box 545985 Surfside, FL 33154 Charitable Institution 6,000 00 509[a][1] 509[c][3] Zichron Menachem 51-0201844 6 Lane Street, Monsey, NY 10952 Chantable Institution 10,000 00 509[a][1]
TOTAL 1,845,168.66
"Grants to individuals for travel, study or other similar purposes IRS approved individual grant-making procedures under section 4945(g)(1) of the Code Detailed records maintained by the Foundation on all of these grants.
Page 11 of 11 Application for Extension of Time To File an Fonn 8868 (Rev January 2011) Exempt Organization Return OMB No. 1545-1709 Department of the Treas ry Internal Revenue Service ► File a separate application for each return. • If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box ...... ► I X • If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part li (on page 2 of this form). Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form 8868. Electronic filing (e-file). You can electronically file Form 8868 if you need a 3-month automatic extension of time to file (6 months for a corporation required to file Form 990-T), or an additional (not automatic) 3-month extension of time. You can electronically file Form 8868 to request an extension of time to file any of the forms listed in Part I or Part II with the exception of Form 8870, Information Return for Transfers Associated With Certain Personal Benefit Contracts, which must be sent to the IRS in paper format (see instructions). For more details on the electronic filing of this form, visit www.us.gov/efile and click on a-file for Charities & Nonprofits. • Automatic 3-Month Extension of Time. Only submit original (no copies needed). A corporation required to file Form 990-T and requesting an automatic 6-month extension-check this box and complete Part I only ...... q ► All other corporations (including 1120-C filers), partnerships, REMICs, and trusts must use Form 7004 to request an extension of time to file income tax returns. Type or Name of exempt organization Employer identification number print KANFEI NESHARIM FOUNDATION 2 0 6 6 0 9 6 1 8 File by the Number, street, and room or suite no. If a P.O. box, see instructions. due date for WEST 56TH STREET, SUITE 1701 filing your 156 return. See City, town or post office, state, and ZIP code. For a foreign address, see instructions. instructions NEW YORK NY 10019
Enter the Return code for the return that this application is for (file a separate application for each return) . . . O .
Application Return Application Return Is For Code Is For Code Form 990 01 Form 990-T (corporation) 07 Form 990-BL 02 Form 1041-A 08 Form 990-EZ 03 Form 4720 09 Form 990-PF 04 Form 5227 10 Form 990-T (sec. 401(a) or 408(a) trust) 05 Form 6069 11 Form 990-T (trust other than above) 06 Form 8870 12
• The books are in the care of ► KANFEI NESHARIM FOUNDATION
Telephone No. ► FAX No. ► • If the organization does not have an office or place of business in the United States, check this box ...... '. q • If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) . If this is q check this box . . . . q and attach for the whole group, check this box . . . ► . If it Is for part of the group, ► a list with the names and EINs of all members the extension is for. 1 I request an automatic 3-month (6 months for a corporation required to file Form 990-T) extension of time until 08 / 15/2011 to file the exempt organization return for the organization named above. The extension is ------for the organization 's return for: year n0 10 or year beginning 20--, and ending
2 If the tax year entered in line 1 is for less than 12 months, check reason: q Initial return q Final return q Change in accounting period
3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069 , enter the tentative tax, less any nonrefundable credits. See instructions. $ 50 b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit. $ 50 c Balance due. Subtract line 3b from line 3a Include your pE if required , by using EFTPS (Electronic Federal Tax Payment System). See i nstructions. Caution . If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO for payment instructions. For Paperwork Reduction Act Notice, see Instructions. Cat No 27916D Form 8868 (Rev. 1-2011) Form 8868 (Rev. 1 -2011) Page 2 • If you are filing for an Additional (Not Automatic) 3-Month Extension , complete only Part II and check this box . . . . ► Fx1 Note . Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868. • If you are filing for an Automatic 3-Month Extension , complete only Part I (on page 1). Additional (Not Automatic) 3-Month Extension of Time. Only file the Type or Name of exempt organization Employer identification number print KANFEI NESHARIM FOUNDATION 2 0 6 6 0 9 6 1 8 File by the Number, street, and room or suite no. If a P.O. box, see instructions. extended due date for 156 WEST 56TH STREET, SUITE 1701 filing your City, town or post ottice, state, and LIP code. For a foreign address, see return. See instructions. NEW YORK NY 10019
Enter the Return code for the return that this application is for (file a separate application for each return) . . . . 0 41
Application Return Application Return Is For q Code Is For Code Form 990 01 Form 990-BL 02 Form 1041-A 08 Form 990-EZ 03 Form 4720 09 Form 990-PF 04 Form 5227 10 Form 990-T (sec. 401(a) or 408(a) trust) 05 Form 6069 11 Form 990-T (trust other than above) 06 Form 8870 12 STOP! Do not complete Part If if you were not already granted an automatic 3-month extension on a previously filed Form 8868. • The books are in the care of ► KANF Et (y ESHAR- FO ^J NDAT^Q[y-____------Telephone No. ► FAX No . ► __ _ q • If the organization does not have an office or place of business in the United States, check this box . . . . . ► • If this is for a Group Return , enter the organization's four digit Group Exemption Number (GEN) . If this is q q for the whole group, check this box . . . ► . If it is for part of the group , check this box . . . . ► and attach a list with the names and EINs of all members the extension is for. 4 I request an additional 3-month extension of time until _ 11/15/2011 5 For calendar year 2010 , or other tax year beginning 20 , and ending /20 6 If the tax year entered in line 5 is for less than 12 months , check reason: q Initial return q Final return q Change in accounting period 7 State in detail why you need the extension _AwaitingthirdQart^ information necessary_for filing a_complete and accurate return _
8a If this application is for Form 990-BL, 990-PF , 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits . See instructions. $ 50 b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit and any amount paid previously with Form 8868. c Balance due. Subtract line 8b from line 8a. Include your payment with this form, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions. $ 0
Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete, and that I am authorized to prepare this form.
Signature ► Trtle ► Date ► Form 8868 (Rev. 1-2011)