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Q B Accounting Feesc^C, V 2 4 2016 NO EXTENDED TO NOVEMBER 15, 2016 Return of Private Foundation Form 990 - P FFor Section 4947(a}(1) Trust Treated as Private Foundation Do not enter social security numbers on this form as it may be_made public. Department of_theTreasury, ► 2015, - Internal Revenue Service ► Information about Form 990-PF and its separate instructions is at wwwJrs.gov/form For calendar year 2015 or tax year beainnina . and endina Name of foundation A Employer identification number THE SHOLOM & PESSY JACOBS FOUNDATION INC 20-5782495 Number and street (or P C box number if mail is not delivered to street address ) Room/suite B Telephone number 351 PACIFIC AVENUE 212-868-1234 City or town, state or province, country, and ZIP or foreign postal code C If exemption application is pending , check here CEDARHURST NY 11516 G Check all that apply: Initial return El Initial return of a former public charity D 1 Foreign organizations, check here 0 Final return 0 Amended return 2 Foreign organizations meeting the 85% test, 0 Address chap e D Name chan g e check here and attach computation H Check type of organization: ® Section 501(c)(3) exempt private foundation E If private foundation status was terminated 0 Section 4947(a)(1) nonexempt charitab le trust 0 Other taxable p rivate foun dation under section 507(b)(1)(A), check here I Fair market value of all assets at end of year J Accounting method. ® Cash [] Accrual F If the foundation is in a 60-month termination (from Part ll, col (c), line 16) 1 0 Other (specify) under section 507(b)(1)(B), check here $ 7 $ 3 8 8 , (Part 1, column (d) must be on cash basis) Part I Analysis of Revenue and Expenses (a) Revenue and (b) Net investment (c) Adjusted net (d) Disbursements (The total of amounts in columns (b), (c), and (d) may not for charitable purposes necessarily equal the amounts in column (a)) expenses per books income income (cash basis only) 1 Contributions, gifts, grants, etc , received 110 213. N / A 2 Check ► a it the foundation is not required to attach Sch B 3 Interest on savings and temporary cash investments 4 Dividends and interest from securities 5a Gross rents b Net rental income or (loss) 6a Net gain or (loss) from sale of assets not on line 10 Gross sales price for all b assets on line 6a 7 Capital gain net income (from Part IV, line 2) 0 dl cc 8 Net short-term capital gain 9 Income modifications Gross sales less returns 10a and allowances b Less Cost of goods sold c Gross profit or (loss) 11 Other income 2 , 630. 2 , 630. S TATEMENT 1 12, Total Add lines 1 throu g h 11 112 , 843. 2 , 630. 1^) Compensation of officers , directors, trustees , etc 0. 0. 0. Pension plans emplo,ePy neftt 3a Legal fees Q b Accounting feesc^c, NO V 2 4 2016 r' c Other professldrial ees 17 Interest 107. 107. 0. 8 Taxes it OG D EN 19 TaxesDepreciation and depletion 274. 274. 20 Occupancy 21 Travel, conferences, and meetings r- 22 Printing and publications 23 Other expenses STMT 2 2 079. 2 074. 0. 0 24 Total operating and administrative Q, expenses Add lines 13 through 23 2 460. 2 455. 0. 0 25 Contributions, gifts, grants paid 111 , 088. 111 , 088. 26 Total expenses and disbursements Add lines 24 and 25 113 , 548. 2 455. 111 , 088. 27 Subtract line 26 from line 12: a Excess of revenue over expenses and disbursements <705. b Net investment income (it negative, enter -0-) 175. c Adjusted net income if negat ive, enter -0-) N / A 11-24 15 BHA For Paperwork Reduction Act Notice , see instructions Fo 9 PF (2015) 1 15471114 800467 JACOBSFOUND 2015.04030 THE SHOLOM & PESSY JA S F JACOBSF1 Fnrm QQfh-PF (9(1151 TRR .S'9171TflM & PR 9SY TA('OR..q nATTfN TN(` 2O-7R2 49 5 Pana 9 ^chedschedulesandamounts in the description Beginning of year End of year A CPart II Balance Sheets column should betofand •of year amounts onty - (a) B6ok Va lue (b) Book Value (c) Fair Market Value 1 Cash - non-interest-bearing 2 Savings and temporary cash investments 257. 105. 105. 3 Accounts receivable ► Less: allowance for doubtful accounts ► 4 Pledges receivable ► Less: allowance for doubtful accounts ► 5 Grants receivable 6 Receivables due from officers, directors, trustees, and other disqualified persons 7 Other notes and loans receivable ► 2 , 000. Less, allowance for doubtful accounts ► 0. 2 , 000. 2 , 000. 2 , 000. y) 8 Inventories for sale or use 9 Prepaid expenses and deferred charges < 10a Investments - U.S. and state government obligations b Investments - corporate stock STMT 3 19 , 603. 15 , 712. 11 , 937. c Investments - corporate bonds 11 investments - land buildings and equipment basis ► Less accumulated depreciation ► 12 Investments - mortgage loans 13 Investments - other STMT 4 61 , 008. 64 , 346. 64 , 346. 14 Land, buildings, and equipment: basis ► Less accumulated depreciation ► 15 Other assets (describe ► 16 Total assets (to be completed by all filers - see the instructions. Also, see p a Q e 1 , item I 82 , 868. 82 , 163. 78 , 388. 17 Accounts payable and accrued expenses 18 Grants payable u) 19 Deferred revenue == 20 Loans from officers , directors , trustees , and other disqualified persons coo 21 Mortgages and other notes payable 22 Other liabilities (describe ► 23 Total liabilities ( add lines 17 throu g h 22 ) 0. 0. Foundations that follow SFAS 117, check here ► 0 and complete lines 24 through 26 and lines 30 and 31 24 Unrestricted m 25 Temporarily restricted m 26 Permanently restricted r_ Foundations that do not follow SFAS 117, check here Pi. it and complete lines 27 through 31 N 27 Capital stock, trust principal, or current funds 0. 0. 28 Paid-in or capital surplus, or land, bldg., and equipment fund 0. 0. < 29 Retained earnings, accumulated income, endowment, or other funds 82 , 868. 82 , 163 Z 30 Total net assets or fund balances 82 , 868. 82 , 163. 31 Total liabilities and net assets/fund balances 82 , 868. 82 . - -3 Part III Analysis of Changes in Net Assets or Fund Balances 1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year's return) 1 82 , 868 2 Enter amount from Part I, line 27a 2 <705 . > 3 Other increases not included in line 2 (itemize) ► 3 0 4 Add lines 1, 2, and 3 4 82 163 5 Decreases not included in line 2 (itemize) ► 5 0 6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II. column N. line 30 6 82 .163 Form 990-PF (2015) 523511 11-24-15 2 15471114 800467 JACOBSFOUND 2015.04030 THE SHOLOM & PESSY JACOBS F JACOBSF1 Form 990-PF (2015) THE SHOLOM & P E S SY JACOBS FOUNDATION INC 20-5782495 Page 3 Part IV Capital Gains and Losses for Tax on Investment Income (a) List and describe the kind(s) of property sold (e.g., real estate, (b How acquired (c Date acquired (d) Date sold Purchase day, yr.) (mo., day, 2-storyy brick warehouse; or common stock, 200 shs. MLC Co ) D - Donation No., yr.) la b NONE C d e Depreciation allowed (g) Cost or other basis (h) Gain or (loss) (e) Gross sales price (f) (or allowable) plus expense of sale (e) plus (f) minus (g) a b c d e Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Gains (Col. (h) gain minus (j) Adjusted basis (k) Excess of col. (i) col. (k), but not less than -0-) or (from col. (h)) (i) F.M.V. as of 12/31/69 as of 12/31/69 over col. (I), if any Losses a b c d e If gain, also enter in Part I, line 7 2 Capital gain net income or (net capital loss) If (loss), enter -0- in Part I, line 7 2 3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6): If gain, also enter in Part I, line 8, column (c). If loss enter -0- in Part I line 8 3 1 i'art v I yuaiitication unaer section gw4ute) Tor rreaucea i ax on Net investment income (For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.) If section 4940(d)(2) applies, leave this part blank. Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base periods [l Yes ® No If "Yes; the foundation does not qualify under section 4940(e). Do not complete this part 1 Enter the anorooriate amount in each column for each year: see the instructions before makino any entries. Base periiod years (c) Distribuhon ratio Calendar ear or tax year be innin in Adjusted qualifying(b distributions Net value of noncharitable-use assets (col. (b) divided by col. (c)) 2014 104 124. 76 , 464. 1.361739 2013 114 879. 75 , 352. 1.524565 2012 118 108. 63 , 842. 1.850005 2011 126 848. 76 , 159. 1.665568 2010 28 167. 103 464. .272240 2 Total of line 1, column (d) 2 6 . 6 7 4117 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 .
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