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Return of Private Foundation PF Or Section 4947(Ax1) Nonexempt Charitable Trust Treated As a Private Foundation 2002 Department of the Treasury Note

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Return of Private Foundation PF Or Section 4947(Ax1) Nonexempt Charitable Trust Treated As a Private Foundation 2002 Department of the Treasury Note OMB No 1545 0052 .Form .7 .70' Return of Private Foundation PF or Section 4947(ax1) Nonexempt Charitable Trust Treated as a Private Foundation 2002 Department of the Treasury Note. The organization may be able to use a copy of this return to satisfy state Infernal Revenue Service Ca Check all that anniv I Ilnihal rahrrn I I Final rohnn I IAmnndcd roll m I I Use the . " . ALL FOR ADC 970 IRS SAMUE94-6062478 sf 7HE J3 NON FOUNDATION oPtYPe PO BOX 056 g (541) 598-8109 see Specil REDMOND OR97756-0079 S217 P2 C It exemption application is pending, check here Instructor D 1 Foreign organizations, check here H Check type of organization U Section 501 (c)(32 exempt private foundation 2Foreign organizations meeting the 85'Y test, check O here and attach computation ng method E If private foundation status was terminated (/mm Part ll, column c, line 16) under section 507(b)(1)(A), check here (specify) F If the foundation is in a 60-month termination ndo. -1- 417/h1/11/Al AwL hors . n (a) Revenue and (b) Net investment (c) Adjusted net (d) Disbursements Expenses (The total of amounts in expenses per books income I income for charitable columns b, c, and d may not neces purposes sandy equal the amounts in column a ) (cash basis only) l ContribNions gifts prams etc received (aft scn) . rep Ck nx d the found is not to an sfh e 2 Distributions from split interest trusts 3 Interest on savings and temporary cash investments 12 1 N 4 Dividends and interest from securities so Gross rents b (Net rental income or (loss) ) 63 Net gain/(lou) from sale of assets not on line 1D R b Gross sales paces for all E assets on line so 666,191 V 7 Capital gain net income (hom Part IV, line 2) E 8 Net short term capital gain N 9 Income modifications U E l0 a Gross sales less returns and allowances b Less Cost of goods sold O c Gross profiV(loss) (att sch) N 11 Other income (attach schedule) N 12 Total Add lines 1 through 11 73 Comcenwbon of officers directors trustees etc 14 Other employee salaries and wage A 15 Pension la benefits r] M ule) E2 $C z N b MhM O fee St, 3 o i 5 r pro f (attach sch) CO E S 0 A R A A i sttalhihl'e~ g_ Stint 4 3 , 269 4 682 1 , 687 i T T i i 7 Depreciation attic depletion 373 149 N y G 21 4 , 145 1 , 658 2 , 487 A E x 786 999 292 D p 23 Other expenses (attach schedule) E N See Statement 5 9 .115 3 .646 5 .469 5 E 24 Total operatin g and administrative s expenses Add lines 13 through 23 808 I 24 .676 I I 31 25 Contributions, gifts, grants paid Part XV 26 Total expenses and disbursements 989,319 I 24 .676 I I 962,519 . a Excess of revenue over expenses and disbursements b Net Invesbnmt Income (f negative enter 0 ) see TEEA0503L 1022/03 T\ Form s40-PF 2002 The Samuel ",S " Johnson Foundation 99-6062478 Page 2 nrcxcnea sNeauies and amounts m vie aesuip~on Beginning of year End of year Pal't ~~ Balance Sheets wlumn should be for end of year amounLS only see instructions > (a) Book Value (b) Book Value (c) Fair Market Value 1 Cash - non interest bearing 52 , 118 5-1 , 14-5 51,145 2 Savings and temporary cash investments 970, 373 . 929 929 . 929,924 3 Accounts receivable Less allowance for doubtful accounts ~ 4 Pledges receivable Less allowance for doubtful accounts 5 Grants receivable 6 Recervables due from officers, directors, trustees, and other disqualified persons (attach schedule) (see instructions) 7 Other note and loans receivable (attach sch) ~ 32,928 Less allowance for doubtful accounts W 27 , 503 . 32 , 928 32 , 928 . 5 8 Inventories for sale or use T 9 Prepaid expenses and deferred charges S 10a Investments - U S and state government obligations (attach schedule) 390 409 . 204 , 635 204 , 841 bInvestments -corporate stock (attachschmWe) 4,128 357 3 , 744 , 596 7 422 , 355 c Investments - corporate bonds (attach schedule) 147,675 150 , 010 156,376 11 Investments - land, buildings, and equipment basis Lass accumulated deprenaGOn (attach schedule) 12 Investments - mortgage loans 13 Investments - other (attach schedule) 14 Land, buildings, and equipment basis w 3, 386 . Las accumulated depreciaUOn (attach schedule) See Stmt 6 w 3,082 677 304 304 15 Other assets describe 16 Total assets (lo be completed by filers - see instructions Also, see a e 1,al ife m I 5,667,112 5 113, 542 . 8, 797, 873 . 17 Accounts payable and accrued expenses 18 Grants payable B 19 Deferred revenue L 20 Loans from officers, directors, trustees, 8 other disqualified persons 21 Mortgages and other notes payable (attach schedule) 22 Other liabilities (describe w ) 288 g 23 Total liabilities add lines 17 through 22) 288 0 0 anizations that follow SFAS 117, check hem complete lines 24 through 26 and lines 30 and 31 . LX N F 24 Unrestricted 5 , 666 , 824 5 , 113 , 542 . E U y T N Temporarily restricted 26 Permanently restricted Organizations that do not follow SFAS 117, check here S5 AB and complete lines 27lhrou h 31 E L T A 27 Capital stock, trust principal, or current funds 5 N pg Paid in or capital surplus, or land, building, and equipment fund O E 29 Retained earnings, accumulated income, endowment, or other funds R 5 30 Total net assets or fund balances (see instructions) 5 , 666,824 51113,542 . 31 Total liabilities and net assets!(und balances (see instructions) 5,667,112 5,113,542 . Part III Analysis of Changes in Net Assets or Fund Balances t 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 5,666 , 824 2 Enter amount from Part I, line 27a 2 -553 , 282 3 Other increases not included in line 2 (itemize) ~ 3 4 Add lines 1, 2, and 3 4 5,113 , 542 5 Decreases not included in line 2 (itemize) ~ 5 6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II column (b), line 30 6 5,113,542 BAA TEeao30a 10123102 Form 990.PF (2002) 3 (a) List and describe the kind(s) of property sold (e g , real estate, 3) Mw aCqwrCA acaui«a (a) Date wm P - Purchase OY Yom') I (monN. day year) 2 story brick warehouse, or common stock, 100 shares MLC Company) D - Donation 7 e (e) Gross sales price (0 Depreciation allowed (g) Cost or other basis (h) Gain or (loss) (or allowable) plus expense of sale (e) plus (f) minus (g) b c mnaanon on i uo iio7 (I) Gains (Column (h) Fair Market Value Q) Adjusted basis (k) Excess of column (i) gain minus column (k), but not less as of 12/31/69 as of 12/31/69 over column 0), if any than 0-) or Losses (from column (h)) e 2 Capital gain net income or (net capital loss) ~f gain, also enter in Part I, line 7 {If (loss), enter 0 in Part I, line 7 } 2 -354 , 121 . 3 Net short-term capital gain or (loss) as defined in sections 7222(5) and (6) If gain,vin, also enter in Part I, line 8, column (c) (see instructions) If (loss), enter 0 in I, line 8 3 -4,270 . i Y8R V I VU811i1G8i10n Uf10Ef JeCSIOfI 4`J4U(2) TOE FffOUC2O 1 al( OA Net IfIVBStrtlBfli I~ILOTO (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 periods 1-1 Yes NNo If 'Yes,' the organization does not quaky under section 4940(e) Do not complete this part 1 Enter the appropriate amount in each column for each year, see instructions before making any entries b ) Base periaod years Adjusted qualiying distributions Net value of Distribution ratio Calendar year (or lax year I noncharilable-use assets I (column (b) divided by column (c)) beginning in) 2001 562 .982 . 10 .291 .190 0 05965 . 038 2 Total of line 1, column (d) 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 khan 5 years 4 Enter the net value of nonchantable use assets for 2002 from Part X, tine 5 1 4 1 - 8,449,857 5 Multiply line 4 by line 3 6 Enter 1% of net investment income (1% of Part I, line 27b) 1 6 1 2,605 . 7 Add lines 5 and 6 8 Enter qualifying distributions from Part XII, line 4 1 8 1 462,514 If line 8 is equal to or greater than line 7, check the box in Part VI, line lb, and complete that part using a 1% tax rate See the Part VI instructions BAA Form 990-PF(2002) TEen0303L 10/23102 Form 910-aF (2002) The Samuel S Johnson 1 a Exempt operating foundations described in section 49a0(d)(2), check here ~ U 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 here 11` Nand enter 1% of Part 1, line 27b c All other domestic organizations enter 2% of line 27h Exempt foreign organizations enter 4% of Part I, line 12, column (6) 2 Tax under section 511 (domestic section 4947(a)(7) trusts and taxable foundations only Others enter -0-) 3 Add lines 1 and 2 4 Subtitle A (income) lax (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0 ) 5 Tax based on investment income Subtract line 4 from line 3 If zero or less, enter 0 6 Credits/Payments a 2002 estimated tax pmts and 2001 Overpayment trailed to 2002 b Exempt foreign organizations - tax withheld al source 6b c Tax paid with application for extension of time to file (Form 8868) 6c d Backup withholding erroneously withheld 6d 7 Total credits and payments Add lines 6a through 6d 8 Enter any penalty for underpayment of estimated tax Check here XO if Form 2220 is attached 9 Tax clue If the total of lines 5 and 8 is more than line 7, enter amount owed 10 Overpayment I( line
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