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11-6446279 990PF 200312.Pdf I Return of Private Foundation OMB No 1545 0052 Form or Section 4947(a)(‘l) Nonexempt Charitable Trust Treated as a Private Foundation 2003 Department of the Treasury Note: The organization may be able to use a copy of this return to satisfy state Internal Revenue Semce reporting requirements. For calendar year 2003, or tax year beginning , 2003, and ending G Check all that apply. I I Initial return I IFinal return I IAmended return I I Address change I I Name change Use the Name of organization A Employer identitication number IRS label. THE SHLOMO BARUCH & BRINA CHARITABLE TRUST 11- 6446279 Othemtlsel Number and street (or P 0 box number if mail IS not delivered to street address) Room/swte B Telephone number (see instructions) (718) 961-5455 ol’ll'le. 65-46 167TH STREET 533 SPeF'llc CW °' ‘°‘”" Slam Z'P °°d° C It exemption application is pending, check here > lnSlrucmns' F L U S H I N G NY 1 13 6 5 D 1 Foreign organizations, check here > H Check type of organization. LX_I Section 501(c)(3) exempt private foundation 2Foreign organizations meeting the 85% test, check here and attach computation I—I Section 4947(a)(l) nonexempt charitable trust I—I Other taxable private foundation E It private foundation status was terminated 1 Fair market value of all assets at end of year J Accounting method. IMOash I_I Accrual (from Part II, column c, line 16) under section 507(b)(l)(A), check here >D I:I Other (specny) F If the foundation is in a 60-month termination ’$ 26,018. (Part I, column d must be on cash basrs.) under section 507(b)(l)(B) check here *D [Evil lAnalysis of Revenue and (a) Revenue and (b) Net investment (c) Adjusted net (d) Disbursements Expenses (The total of amounts in expenses per books income income for charitable columns b, c, and d may not neces- purposes sarily equal the amounts in column a.) (cash baSIS only) (see instructions) 1 Contributions, gifts, grants, etc, received (att sch) Ck ’ it the toundn is not req to an Sch B 2 Distributions from split-interest trusts 3 Interest on savmgs and temporary cash investments 4 DiVidends and Interest lrorn securities 125: 125. 5a Gross rents . b (Net rental Income or (loss) ) W 6a Net gain/(loss) lrom sale of assets not on line 10 l tau b Gross sales prices for all assets on line 6a 7 Capital gain net income (lrom Part IV, line 2) ESL“) 8 Net short-term capital gain 634 9 Income modifications ITICZM<ITIN 10a Gross sales less returns and 06m allowances b Less: Cost of goods sold c Gross profit/(loss) (att sch) Other income (attach schedule) MISC 407. 407. 407. Total. Add lines 1 through ll 537. 538. 538. Compensation ol officers, directors, trustees, etc GENNVOS Other employee salaries and wages Pensmn plans, employee benefits 16a Legal tees (attach schedule) b Accounting fees (attach sch) 500. 500. c Other prot fees (attach sch) Interest Taxes (attach schedule) See Line .18 Stmt 109. 109. ’5‘... Mt:0Eto. Depremation (attach schedule) and depletion Occupancy Travel, conferences, and meetings Printing and publications [Dz—41>:va02> Other expenses (attach schedule) See Line 23 Stmt 509. 509. Total operating and administrative m<—-i>:u—iin—z—SU>mmwzm-oxm expenses. Add lines 13 through 23 1,118. 1,118. Contributions, gifts, grants paid 14,465. 14,465. 26 Total expenses and disbursements. Add lines 24 and 25 15,583. 1,118. 14,465. 27 Subtract line 26 from line 12: a Excess of revenue over expenses and disbursements -15,046. b Net investment income (il negative, enter 0 ) . 529. C Adjusted net income (if negative, enter 0) BAA For Paperwork Reduction Act Notice, see the instructions. TEEAOSOl 08/1 8/03 Form 990-PF (2003) Form 990-PF (2003) THE SHLOMO BARUCH 8f BRINA CHARITABLE TRUST 1 1 -6446279 Page 2 Attached schedules and amounts In the description Beginning of year End of year [Part it 1 Balance Sheets 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 1,877. 1,514. 1,514. 2 SaVings and temporary cash investments 14,033. 0. O. 3 Accounts receivable . P Less allowance for doubtful accounts P 4 Pledges receivable . P Less. allowance for doubtful accounts P 5 Grants receivable 6 Receivables due from officers, directors, trustees, and other disqualified persons (attach schedule) (see instructions) 7 Other notes and loans receivable (attach sch) P Less. allowance for doubtful accounts P 8 Inventories for sale or use 9 Prepaid expenses and deferred charges mnomm> 10a Investments — US. and state government obligations (attach schedule) b Investments — corporate stock (attach schedule) 26,265. 26,265. 24,504. c Investments — corporate bonds (attach schedule) 11 Investments — land, bUildings, and equipment. baSIS Less accumulated depreCiation (attach schedule) . P 12 Investments — mortgage loans 13 Investments — other (attach schedule) 14 Land, bUIIdlngS, and equipment. has P Less: accumulated depreciation (attach schedule) P 15 Other assets (describe P _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __) 16 Total assets (to be completed by all filerS— see instructions. Also, see page 1, item ') 42,175. 27,779. 26,018. Accounts payable and accrued expenses Grants payable Deferred revenue Loans from officers, directors, trustees, & other disqualified persons 650. Mortgages and other notes payable (attach schedule) . Other liabilities (describe P _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __) inm_.,+_.__.um_.|- Total liabilities (add lines 17 through 22) 650. Or anizations that follow SFAS 117, check here P an complete lines 24 through 26 and lines 30 and 31. Unrestricted Temporarily restricted Permanently restricted . Or anizations that do not follow SFAS 1 17, check here P X an complete lines 27 through 31. Capital stock, trust prinCipaI, or current funds 42,175. 27,129. mnrbmrn)nmz Paid-in or capital surplus, or land, budding, and eqUipment fund Retained earnings, accumulated income, endowment, or other funds "O wmflflm—NW9.5:“ Total net assets or fund balances (see instructions) 42,175. 27,129. 388§8 Total liabilities and net assets/fund balances (see instructions) 42,175. 27,779. EPart iAnalysis 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) . 42,175. Enter amount from Part I, line 27a -15,046. Other increases not included in line 2 (itemize) P Add lines I, 2, and 3 . .. 27,129. Decreases not included in line 2 (itemize) P @01th Total net assets or fund balances at end of year (line 4 minus line 5) — Part II, column (b), line 30 mthN‘ 27.129. BAA TEEA0302 08/I 5/03 Form 990-PF (2003) \ Form 990-PF(2003) THE SHLOMO BARUCH & BRINA CHARITABLE TRUST 11-6446279 Page 3 lPat‘t 1V viCapital Gains and Losses for Tax on Investment Income (a) List and describe the kind(s) of property sold (e.g., real estate, (b) How acquned (c) Date acquued (d) Date sold P — Purchase (month, day, year) (month, day, year) 2-story brick warehouse; or common stock, 200 shares MLC Company) D — Donation 1 a b c d e (e) Gross sales price (f) DepreCIation allowed (9) Cost or other ba5is (h) Gain or (loss) (or allowable) plus expense of sale (e) plus (f) minus (9) a b c d e Complete only for assets showmg gain in column (h) and owned by the foundation on 12/31/69 (I) cams (column (h) (i) Fair Market Value (j) Adjusted ba5is (k) Excess of column (i) galn manS column 00, but not less as of 12/31/69 as of 12/31/69 over column 0), If any man -0-) 0f LOSSES ("0m comm" (11)) 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 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 instructions). If (loss), enter -0- 7'. in Part I, line 8 3 [Part V iQualification Under Section 4940(e) for Reduced Tax on Net Investment Income (For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.) If section 4940(d)(2) applies, leave this part blank. Was the organization liable for the section 4942 tax on the distributable amount of any year in the base period? . DYes DNO If 'Yes,‘ the organization does notgualify under section 4940(6). Do not complete this part. 1 Enter the appropriate amount in each column for each year; see instructions before making any entries. (a) (b) (c) (d) Base period years Adjusted qualifying distributions Net value of Distribution ratio Calendar year (or tax year noncharitable-use assets (column (b) diVided by column (c)) beginning in) 2002 10,992. 33,739. 0.325795 2001 18,894. 58,263. 0.324288 2000 32,796. 116,917. 0.280507 1999 17,230. 130, 770. 0.131758 1998 118,408. 175,088. 0.676277 2 Total of line 1, column (d) 2 1 .738625 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 .
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