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
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 ...... 3 0 . 347725
4 Enter the net value of noncharitable-use assets for 2003 from Part X, line 5 4
5 Multiply line 4 by line 3 5
6 Enter 1% of net investment income (1% of Part 1, line 27b) 6 5 .
7 Add lines 5 and 6 7 5 .
8 Enter qualifying distributions from Part Xll, line 4 8 l4 , 465 .
If line 8 Is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part usmg a 1% tax rate. See the Part VI instructions. BAA Form 990-PF (2003) TEEA0303 08/15/03 Form 990-PF (2003) THE SHLOMO BARUCH & BRINA CHARITABLE TRUST 11 -6446279 Page 4 {Part Vt I Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see instructions) 1a Exempt operating foundations described in section 4940(d)(2), check here > I] 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, 1 5 . check here ’ and enter 1% of Part I, line 27b c All other domestic organizations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, column (b) 2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 O . 3 Addlinesland2...... 3 5. 4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) . . 4 0 . 5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- 5 5 . ‘ 6 Credits/Payments. a 2003 estimated tax pmts and 2002 overpayment credited to 2003 . . . 6a b Exempt foreign organizations - tax Withheld at source 6b c Tax paid With application for exten5ion of time to file (Form 8868) SC 0 . d Backup Withholding erroneously Withheld 6d 7 Total credits and payments. Add lines 6a through 6d 7 0 . 8 Enter any penalty for underpayment of estimated tax. Check here [j if Form 2220 is attached 8 9 Tax due. If the total of lines Sand 8 is more than line 7, enter amount owed ...... > 9 5 . 10 Overpayment. If line7 is more than the total of lines Sand 8, enter the amount overpaid . . ’ 10 11 Enter the amount on line l0 to be Credited to 2004 estimated tax > Refunded > 11 [Part Vii-A IStatements Regarding Activities
1a During the tax year, did the organization 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 instructions for definition)? 1 b X If the answer is 'Yes' to Ia or 11:, attach a detailed description of the actiwties and copies of any materials published or distributed by the organization in connection With the act/Vities. c Did the organization file Form 1120-POL for this year? ...... 1c X d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year. (1) On the organization > $ (2) On organization managers > 5 e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed on organization managers ’ $ 2 Has the organization engaged in any actIVities that have not prewously been reported to the IRS? . 2 X If 'Yes,‘ attach a detailed description of the act/Vities.
3 Has the organization made any changes, not prewously reported to the IRS, in its governing instrument, articles of incorporation, or bylaws, or other Similar instruments? If 'Yes,’attach a conformed copy of the changes . . . 3 X 4a Did the organization have unrelated business gross income of $1,000 or more during the year? 4a X b If 'Yes,’ has it filed a tax return on Form 990-T for this year? . . . . 4b 5 Was there a liqUidation, termination, dissolution, or substantial contraction during the year? 5 X If 'Yes,’ attach the statement reqmred by General Instruction T. 6 Are the requuements of section 508(e) (relating to sections 4941 through 4945) satisfied either. 0 By language in the governing instrument or
0 By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict With the state law remain in the governing instrument? 6 X 7 Did the organization have at least $5,000 in assets at any time during the year? If 'Yes,'camplete Part II, column (0), and Pan‘ XV . . . . 7 X 8a Enter the states to which the foundation reports or With which it is registered (see instructions) . . . _ _
b It the answer is 'Yes' to line 7, has the organization furnished a copy of Form 990-PF to the Attorney General (or deSIgnate) of each state as requued by General Instruction 6" If 'No, 'attach explanation . . 8b X 9 Is the organization claiming status as a private operating foundation Within the meaning of section 4942(i)(3) or 4942(i)(5) for calendar year 2003 or the taxable year beginning in 2003 (see instructions for Part XIV)? If Wes/complete PartX/V . . . 9 X 10 Did any persons become substantial contributors during the tax year? . 10 X If 'Yes, ' attach a schedule listing their names and addresses. 11 Did the organization comply With the public inspection reqwrements for its annual returns and exemption application? 11 X Web Site address . ______12 The books are in care of > _BAliB_A_RA _P_E EK_A_L ______Telephone no. > _(Z 1_8_) _9_6_1_- §4_5§_ _ Located at > _6§-_4_6_1_6_7]’l-_l _SIL _F_LL_lS_H_IflG_ _th ______ZIP +4 > _ll§6_5______13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 — Check here . > U and enter the amount of tax-exempt interest received or accrued during the year ...... >I 13 l BAA Form 990-PF (2003) TEEA0304 08/15/03 Form 990—PF(2003) THE SHLOMO BARUCH & BRINA CHARITABLE TRUST 11-6446279 Page5 {Part Vlt-B lStatements Regarding Activities for Which Form 4720 May Be Required File Form 4720 if any item is checked in the 'Yes' column, unless an exception applies. Yes No la During the year did the organization (either directly or indirectly). (1) Engage in the sale or exchange, or leasmg of property With a disqualified person? . . . . D Yes No
(2) Borrow money from, lend money to, or otherWise extend credit to (or accept it from) a disqualified person? . . . Yes (3) Furnish goods, serVices, or faCiIities to (or accept them from) a disqualified person? . Yes (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? Yes
(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)? . . . . E] Yes No
(6) Agree to pay money or property to a government offimal? (Exception. Check 'No' if the organization agreed to make a grant to or to employ the offICIal for a period after termination of government serVIce, if terminating Within 90 days.) . . . DYes
b If any answer is 'Yes' to 1a(l)-(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 instructions)? 1b Organizations relying on a current notice regarding disaster a55istance check here . . . ’ E]
c Did the organization engage in a prior year in any of the acts described in 1a, other than excepted acts, that were not corrected before the first day of the tax year beginning in 2003? ...... 1c X
2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization was a private operating foundation defined in section 49420)(3) or 4942(1)(5)):
a At the end of tax year 2003, did the organization have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning before 2003? ...... E] Yes No If 'Yes,‘ list the years ’ 20 , 20 , 20 , 19
b Are there any years listed in 2a for which the organization is not applying the prowsions 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 instructions.) . . 2b c If the prowsmns of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here. > 20__ ,20__ ,20__ ,19__ 3a Did the organization hold more than a 2% direct or indirect interest in any busmess enterprise at any time during the year? ...... E] Yes No
b If 'Yes,‘ did it have excess busmess holdings in 2003 as a result of (1) any purchase by the organization or disqualified persons after May 26, 1969, (2) the lapse of the 5-year period (or longer period approved a) the Commissmner under section 4943(c)(7)) to dispose of holdings acguired by gift or bequest, or the lapse of the 10-, 15-, or 20-year first phase holding period? (Use chedule , Form 4720, to determine if the organization had excess busmess holdings in 2003 ) 3b 4a Did the organization invest during the year any amount in a manner that would Jeopardize its charitable purposes? . 4a X b Did the organization make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that had not been removed from Jeopardy before the first day of the tax year beginning in 2003? . 4b X 5a During the year did the organization pay or incur any amount to. (1) Carry on propaganda, or otherWIse attempt to influence legislation (section 4945(e))? D Yes No
(2) Influence the outcome of any speCific public election (see section 4955), or to carry on, directly or indirectly, any voter registration drive? Yes No (3) Provide a grant to an individual for travel, study, or other Similar purposes? B Yes No
(4) Prowde 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)? . . [:I Yes No
(5) Prowde for any purpose other than religious, charitable, smentific, literary, or educational purposes, or for the prevention of cruelty to children or animals? [:I 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 instructions)? . . . . 5b Organizations relying on a current notice regarding disaster assistance check here > D
c If the answer is 'Yes' to question 5a(4), does the organization claim exemption from the tax because it maintained expenditure respon5ibility for the grant? [3 Yes [:I No If 'Yes,’ attach the statement reqmred by Regulations section 53.4945-5(d). 6a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? E] Yes No b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? 6b X Ifyou answered 'Yes' to 6b, also file Form 8870.
BAA TEEA0305 08/l5/03 Form 990-PF (2003) Form 990~PF(2003) THE SHLOMO BARUCH 8r BRINA CHARITABLE TRUST 11-6446279 Page 6 [Part Vlfl [Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors 1 List all officers, directors, trustees, foundation managers and their compensation (see instructions): (b) Trtle and average (c) Compensation (d) Contributions to (e) Expense account, hours per week (If not paid, enter -0-) employee benefit other allowances (a) Name and address devoted to posrtron plans and deferred compensation _§AREABA_PERKAL ______TRUSTEE 64-46 167TH ST FLUSHING NY AS NEEDED 0. 0. 0. fiARI}N_SAfl§QN______TRUSTEE OLD ROUTE 17, FERNDALE NY AS NEEDED 0. 0. 0.
2 Compensation of five highest-paid employees (other than those included on line 1— see instructions). If none, enter 'NONE.‘ (a) Name and address of each employee (b) Trtle and average (c) Compensation (d) Contributions to (e) Expense account, pard more than $50,000 hours per week employee benefit other allowances devoted to posmon plans and deferred compensation
Total number of other employees paid Over $50,000 None 3 Five highest-paid independent contractors for professional services — (see instructions). If none, enter 'NONE.‘ (a) Name and address of each person paid more than $50,000 (b) Type of servrce (c) Compensation
Total number of others recervrng over $50,000 for professronal servrces None
{Part lX-A I Summary of Direct Charitable Activities
List the foundation‘s four largest direct charitable actrvrtres during the tax year Include relevant statistical Information such as the number of Expenses organizations and other bene ICIarIes served, conferences convened, research papers produced, etc
______.______.______.______.______..
TEEAO306 08“ 5/03 Form 990-PF (2003) Form 990-PF(2003) THE SHLOMO BARUCH 8: BRINA CHARITABLE TRUST 11-6446279 Page7
[Part 1X43 [Summary of Program-Related Investments (see Instructions)
Describe the two largest program-related investments made by the foundation during the taxyear on lines 1 and 2. Amount 1
2
Total. Add lines 1 through 3
EPart X a Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see 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 b Average of monthly cash balances 1b c Fair market value of all other assets (see instructions) . 1c d Total (add lines 1a, b and c) . ... 1d e Reduction claimed for blockage or other factors reported on lines 1a and 1c (attach detailed explanation) I 1ei 2 AcquiSition indebtedness applicable to line 1 assets 2 3 Subtract line 2 from line 1d . . . 3 4 Cash deemed held for charitable activmes. Enter 1-1/2% of line 3 (for greater amount, see instructions) 4 5 Net value of noncharitable-use assets. Subtract line 4 from line 3 Enter here and on Part V, line 4 5 6 Minimum investment return. Enter 5% of line 5 . 6 EPart )(l iDistributable Amount (see instructions) (Section 49420)(3) and (0(5) private operating foundations and certain foreign organizations check here > H and do not complete this part.) 1 Minimum investment return from Part X, line 6 1 2a Tax on investment income for 2003 from Part VI, line 5 2a 5 . b Income tax for 2003. (This does not include the tax from Part VI.) 2b c Add lines 2a and 2b ...... 2c 5 . 3 Distributable amount before adiustments. Subtract line 2c from line 1 3 0 . 4a Recoveries of amounts treated as qualifying distributions . 4a b Income distributions from section 4947(a)(2) trusts 4b c Add lines 4a and 4b 4c 5 Addline53and4c 5 0. 6 Deduction from distributable amount (see instructions) 6 7 Distributable amount as adjusted. Subtract line 6 from line 5 Enter here and on Part Xlll, line 1 7 0 . m Qualifying Distributions (see 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 1a 14, 465 . b Program-related investments — Total from Part lX-B , . . 1b 2 Amounts paid to acqmre assets used (or held for use) directly in carrying out charitable, etc, purposes 2
3 Amounts set aSIde for sspecmc charitable proiects that satisfy the. a Suitability test (prior IR approval reqwred) . 33 b Cash distribution test (attach the reqwred schedule) . . . 3b 4 Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part Xlll, line 4 4 144 465 .
5 Or anizations that quali under section 4940(e) for the reduced rate of tax on net investment income. En er 1% of Part I, line 7b (see instructions) . . . 5 5 . 6 Adjusted qualifying distributions. Subtract line 5 from line 4 6 14 , 460 . Note: The amount on line 6 WI// be used In Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax in those years. BAA Form 990-PF (2003)
TEEAOSO7 08/15/02 Form 990~PF (2003) THE SHLOMO BARUCH 8r BRINA CHARITABLE TRUST 11-6446279 PageB
1P3“ Xttl Undistributed Income (see instructions)
(a) (b) (c) ((0 Corpus Years prior to 2002 2002 2003
1 Distributable amount for 2003 from Part XI, line 7 . 0 . 2 Undistributed Income, it any, as of the end oi 2002: a Enter amount for 2002 only . . . 1 , 685 . b Total for prior years. 20_, 20 _, 19 _ 3 Excess distributions carryover if any, to 2003‘ aFrom1998 109,811. bFrom 1999. 11,080. cFrom 2000 27,447. dFrom 2001 15,990. 9 From 2002 10,994. f Total of lines 3a through e 175 , 322 . 4 Qualifying distributions for 2003 from Part Xll,line 4: > 5 14,465. a Applied to 2002, but not more than line 2a
b AEpplied to undistributed income of prior years ( lection requrred — see instructions)
c Treated as distributions out of corpus (Election required — see instructions) d Applied to 2003 distributable amount e Remaining amount distributed out of corpus 14, 465 . 5 Excess distributions carryover applied to 2003 (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 at, 4c, and 4e. Subtract line 5 189, 787 .
b Prior ears' undistributed income. Subtract line 4 from line 2b ...... 0. c Enter the amount of prior years' undistribut- ed income for which a notice of defrcrency has been issued, or on which the section 4942(a) tax has been prevrously assessed
d Subtract line 6c from line 6b. Taxable amount — see instructions . . .
e Undistributed income for 2002. Subtract line 4a from line 2a. Taxable amount — see instructions 1 , 685 .
t Undistributed income for 2003. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2004 0 . 7 Amounts treated as distributions out of corpus to satist requirements imposed by section 170( )(1)(E) or 4942(g)(3) (see instructions) .
8 Excess distributions car over from 1998 not applied on line 5 or line (see instructions) 109, 811 . 9 Excess distributions carryover to 2004. Subtract lines 7 and 8 from line 6a 79, 976 . 10 Analysrs of line 9. a Excess from 1999 1 1,080. b Excess from 2000 27 , 447 . c Excess from 2001 1 5 , 990. d Excess from 2002 10, 994 . e Excess from 2003 14 , 465 . BAA Form 990-PF (2003)
TEEAO308 08/I 5/03 \
Form 990-PF (2003) THE SHLOMO BARUCH 8r BRINA CHARITABLE TRUST 11-6446279 Page9 {Part XIV 1 Private Operating Foundations (see Instructions and Part VII-A, questIon 9) N/A 1a If the foundatIon has recered a rullng or determInatIon letter that It Is a prIvate operatIng foundatIon, and the rulIng is effectIve for 2003, enter the date of the rulIng . . . . b Check box to IndIcate whether the organIzatIon Is a prIvate operatIng foundatIon descrIbed In sectIon fl 4942(1)(3) or 4942(1)(5) 2a Enter the lesser of the adjusted net Tax year PrIor 3 years Emefjrfi 'frg'rrthga’r‘g'g'fim (a) 2003 (b) 2002 (c) 2001 (d) 2000 (e) Total each year lIsted b 85% of lIne 2a c QualIfyIng dIstrIbutIons from Part XII, Me 4 for each year lIsted d Amounts Included In Me 20 not used dIrectly for actIve conduct of exempt actIVItIes e QualItyIng dIstrIbutIons made dIrectIy for actIve conduct of exem t actIVItIes. Subtract lIne 2d from lIne c 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 Investment return shown In Part X, Me 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 prowded In sectlon 4942(])(3)(B)(lll) (3) Largest amount of support from an exempt organIzatIon (4) Gross Investment Income {Part XV 1 Supplementary Information (Complete this part only if the organIzation had $5,000 or more in assets at any time during the year.) 1 lniormation 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).) NON E
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 mm the foundatIon has a 10% or greater Interest. NONE
2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc, Programs: Check here ’ [I If the organIzatIon only makes contrIbutIons to preselected charItable organIzatIons and does not accept unsoIiCIted requests for funds. If the organizatIon makes ngts, grants, etc, (see 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 appIIcatIons should be addressed. BARBARA PERKAL 65 -46 167TH STREET FLUSHING NY 11365 (718) 961-6455 bThe form In thch appIIcatIons should be sumetted and InformatIon and materIals they should Include. NAME, ADDRESS, PHONE, CHARITABLE FUNCTION TAX EXEMPT ID# c Any sumeSSIon deadlInes: NONE
d Any restrIctIons or lImItatIons on awards, such as by geographIcal areas, charItable erlds, kInds of InstItutIons, or other factors. NONE
BAA TEEA0309 08/15/03 Form 990-PF (2003) Form 990rPF(200‘3) THE SHLOMO BARUCH 8: BRINA CHARITABLE TRUST 11-6446279 Page 10 E Part XV | Supplementary Information (contlnued) 3 Grants and Contributions Paid During the Year or Approved for Future Payment R t If rfiuplent ISlaiti IndLVIdual, Foundahon ecuplen s ow any re a Ions ID to P f i any foundation manager or Status of “flaw,” {5: or Amour“ Name and address (home or busmess) Substantlal contrlbutor rec'p'ent 3 Paid during the year SEE SCHEDULE ATTACHED CHARITABLE DONATION 1 4 . 46 5 .
Total ’ 33 14,465. b Approved for future payment
Total ’ 3b TEEA03I 0 12/10/03 Form 990-PF (2003) Form 990-PF (2003) THE SHLOMO BARUCH & BRINA CHARITABLE TRUST 11-6446279 Page 11
{Part XVF-A [Analysis of Income-Producing Activities
Enter gross amounts unless otheMise Indicated. Unrelated busmess Income Excluded by section 512, 5l3, or 514 (a) (W (c) (fl (a Busmess Amount Exclu- Amount Related or exempt code sron function income 1 Program sewice revenue: code (see Instructions)
“MQOU'DD 9 Fees and contracts from government agenCIes Membership dues and assessments Interest on saVIngs and temporary cash investments DiVIdends and Interest from securities WW 125. onpr Net rental income or (loss) from real estate: a Debt-financed property b Not debt-financed property Net rental income or (loss) from personal property Other investment Income Gain or (loss) from sales of assets other than Inventory OQNG‘I Net income or (loss) from speCIal events 10 Gross profit or (loss) from sales of inventory 11 Other revenue:
09.00” 12 Subtotal. Add columns (b), (d), and (e) 130. 13 Total. Add line 12, columns (b), (d), and (e) 13 130. (See worksheet in the Instructions for line 13 to verify calculations.)
Part XVFB 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 V accomplishment of the organization's exempt purposes (other than by prOVIdIng funds for such purposes). (See Instructions.)
BAA TEEA0501 OBI1 5/03 Form 990-PF (2003) Form 990-PF(2003) THE SHLOMO BARUCH & BRINA CHARITABLE TRUST 11-6446279 Page 12 [Part Xth [Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
1 Did the organization directly or indirectly engage in any of the followmg With any other organization yes No described 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 organization to a noncharitable exempt organization of. (1) Cash .. 1a (1) X (2) Other assets la (2) X b Other transactions: (1) Sales of assets to a noncharitable exempt organization . . . . 1b(1) X (2) Purchases of assets from a noncharitable exempt organization . . 1b(2) X (3) Rental of faCIlities, equipment, or other assets 1b(3) X (4) Reimbursement arrangements . 1b (4) X (5) Loans or loan guarantees 1b(5) X (6) Performance of servuces or membership or fundraismg soliCitations 1b (6) X c Sharing of faCIlities, equment, mailing lists, other assets, or paid employees . 1c X
d If the answer to any of the above is 'Yes,’ complete the followmg schedule. Column (b) should always show the fair market value of the goods, other assets, or serVices given by the organization. If the received less than fair market value in transaction or show in the value of the other assets or serVices received. Line no Amount involved Name of noncharitable ization of and
2a Is the organization directly or indirectl affiliated With, or related to, one or more tax-exempt organizations described in section 501(c) of the Co e (other than section 501(c)(3)) or in section 527? . ' El Yes No b If 'Yes,‘ complete the followmg schedule. (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 Declaration of preparer (other than taxpayer or fidumary) is based on all information of which preparer has any knowledge
> musrgg .5 *0. M 59W awe/mm G Signature of officer or trustee
TEEAOSOZ i2/i0/o3 Form 990-PF (2003) THE SHLOMO BARUCH & BRINA CHARITABLE TRUST 1 1 -6446279
Form 990-PF, Page 1, Part I, Line 18 Line 18 Stmt
Taxes: (see Instructions) Rev/Exp Book Net Inv Inc Adj Net Inc ChanIy Dle FOREIGN TAXES 9. 9. 9. 2002 TAXES 100. 100.
Total 109. 9. 109 .
Form 990-PF, Page I, Part I, Line 23 Line 23 Stmt
Other expenses: Rev/Exp Book Net Inv Inc I Ad] Net Inc I Charity DISb CHARITY BUREAU FEES 25. 25. BANK CHARGES 180. 180. INVESTMENT FEES 304. 304.
Total 509. 509. . 2:21 PM Charitable Trust EIN: 11-6446279 10/11/04 Cash Basis - 2003 Contributions Paid January through December 2003
Date Num Name Split Paid Amount — Jan - Dec 03 01/03/2003 898 Adas Yerelm Dime Savmgs Bank 100 00 10/10/2003 961 Ahavas Chesed Dime Savmgs Bank 25 00 03/05/2003 903 NA Terror Victims Fund DIme Savmgs Bank 120 00 1 1/18/2003 974 AlSh Corn DIme Savmgs Bank 150 00 10/10/2003 964 All 4 Israel DIme Savnngs Bank 36 00 03/05/2003 901 AmIt Dime Savmgs Bank 87 00 1 1/03/2003 967 Amlt DIme Savmgs Bank 18 00 1 1/02/2003 965 Assomation of Former Resrdents of Rozan Dime Savmgs Bank 250 00 01/03/2003 893 Bais Yaakov of Queens DIme Savmgs Bank 40 00 10/10/2003 959 BAMBI DIme Savmgs Bank 25 00 01/03/2003 878 Beth Jacob Teachers Seminary DIme Savmgs Bank 18 00 11/08/2003 970 Beth Jacob Teachers Seminary Dime Savnngs Bank 18 00 05/09/2003 919 Beth Shlfra DIme Savmgs Bank 10 00 06/05/2003 311 Bnel Aklva Merrill Lynch 500 00 10/10/2003 962 Chesed L'Avrohom Dime Savungs Bank 25 00 01/03/2003 877 Cong Ohr YItzchak Dime Savmgs Bank 100 00 03/05/2003 902 Cong Ohr Yltzchak Dime Savmgs Bank 180 00 11/03/2003 966 Congregation Kehllath Moshe DIme Savmgs Bank 100 00 06/15/2003 936 Congregation Ohr Yltzchak DIme Savmgs Bank 150 00 06/27/2003 937 Congregation Ohr Yltzchak Dime Savmgs Bank 200 00 09/10/2003 955 Congregatlon Ohr Yltzchak Dime Savings Bank 190 00 10/10/2003 956 Congregation Ohr Yltzchak DIme Savmgs Bank 100 00 05/05/2003 915 DOROT Dime Savings Bank 72 00 05/09/2003 920 EIS Laasous DIme Savmgs Bank 36 00 05/26/2003 935 Em Vayeled DIme Savmgs Bank 36 00 07/22/2003 944 Ezer MIZIon DIme Savmgs Bank 36 00 05/09/2003 921 Ezras Torah Dime Savmgs Bank 25 00 01/03/2003 890 Friends of Yeshivat Sha‘alvrm DIme Savmgs Bank 36 00 01/03/2003 887 General Israel Orphans Home for Girls DIme Savmgs Bank 25 00 05/10/2003 927 HASC DIme Savmgs Bank 54 00 09/09/2003 950 HASC DIme Savmgs Bank 50 00 01/03/2003 882 Hatzolah Of Queens DIme Savmgs Bank 50 00 12/25/2003 979 Hatzolah Of Queens DIme Savmgs Bank 100 00 05/05/2003 912 HIDEC DIme Savmgs Bank 40 00 01/03/2003 880 Jaffa Institute Dime Savmgs Bank 50 00 05/04/2003 909 J00 of Hillcrest Inc Dime Savnngs Bank 54.00 03/17/2003 905 JEP DIme Savmgs Bank 300.00 01/03/2003 881 JeWIsh Heritage Center DIme Savmgs Bank 50 00 08/27/2003 947 Jewrsh Heritage Center DIme Savmgs Bank 50 00 11/25/2003 975 Jewush Heritage Center DIme Savmgs Bank 135 00 05/09/2003 922 Kayama DIme Savings Bank 36 00 01/03/2003 879 Keren Hayeled DIme Savmgs Bank 100 00 02/28/2003 900 Klbbutz Mlgdal Oz Dime Savmgs Bank 180.00 03/20/2003 906 Kollel Ner Dowd DIme Savmgs Bank 115 00 05/16/2003 933 Lighthouse lnt'l DIme Savings Bank 64 00 06/30/2003 939 Machon Daniel DIme Savmgs Bank 50 00 01/03/2003 896 Mesuvta TIfereth Jerusalem DIme Savmgs Bank 1.470 00 03/22/2003 907 MOSDOS SKOLYA DIme Savungs Bank 180 00 01/03/2003 899 National Councnl of Young Israel Dime Savmgs Bank 40 00 05/15/2003 929 Neve Kodesh Synagogue Dime Savmgs Bank 50 00 07/22/2003 940 Noam Shabbos DIme Savmgs Bank 18 00 12/14/2003 978 N'shel 0hr Moshe DIme Savmgs Bank 140 00 12/05/2003 977 Oorah DIme Savmgs Bank 100 00 05/09/2003 923 Orthodox Union DIme Savmgs Bank 18 00 10/10/2003 960 Partners In Torah DIme Savmgs Bank 36 00
Page 1 of 2 . 2:21 PM Charitable Trust EIN: 11-6446279 10I11l04 Cash Basis - 2003 Contributions Paid January through December 2003
Date Num Name Split Paid Amount — 01/03/2003 892 P'eylim Lev L'achlm Dime Savrngs Bank 50 00 05/08/2003 917 P'eylim Lev L'achlm Dime Savrngs Bank 50 00 10/10/2003 957 P'eylim Lev L'achlm DIme Savrngs Bank 20 00 01/03/2003 897 Rabbinlcal Seminary of America Dime Savmgs Bank 2,500 00 05/09/2003 918 Rabbinical Seminary of America DIme Savrngs Bank 1.000 00 11/03/2003 969 Rabbinical Seminary of America Dime Savrngs Bank 2,000 00 12/02/2003 976 Rabblnlcal Seminary of America Dlme Savrngs Bank 100 00 09/09/2003 953 Religious Zionists of Amerlca DIme Savmgs Bank 54 00 05/04/2003 910 Rofeh Chollm Cancer Soc1ety Dime Savmgs Bank 75 00 01/03/2003 884 Sanz Medlcal Center DIme Savrngs Bank 100 00 10/10/2003 963 Shalom Chesed Fund Dime Savrngs Bank 18.00 01/03/2003 885 Share Dime Savrngs Bank 25 00 O1l03/2003 8B8 Sh'or Yoshuv Dime Savmgs Bank 18 00 05/09/2003 924 Sh'or Yoshuv DIme Savrngs Bank 10 00 08/27/2003 948 Sh'or Yoshuv Dime Savrngs Bank 18 00 05/10/2003 925 Shuvu/Return Dime Savrngs Bank 36 00 08/30/2003 949 Temlma H S for Girls Dime Savmgs Bank 500 00 03l17/2003 904 The Chofetz Charm Heritage Foundailon Dime Savrngs Bank 70 00 01/03/2003 886 The Jewrsh Braille Inst. of America Dime Savrngs Bank 36 00 07/22/2003 943 TIkvah Layeled Dime Savrngs Bank 18 00 05/05/2003 916 Tomche Shabbos Boro Park Dime Savmgs Bank 10 00 1 1/03/2003 968 Tomche Shabbos of Queens Dime Savrngs Bank 100 00 10/10/2003 958 Torah Center of Hlllcrest Dime Savrngs Bank 36 00 05l12/2003 930 Utopla Jewrsh Center Dime Savmgs Bank 60 00 05/05/2003 913 Y T M l Dov Revel Center Dlme Savrngs Bank 50 00 05/18/2003 934 Yad Eliezer DIme Savrngs Bank 36 00 01/03/2003 891 Yad L'achlm Dime Savrngs Bank 100.00 05/05/2003 914 Yad L‘achlm Dime Savrngs Bank 54 00 07/22/2003 942 Yaldemu Dime Savrngs Bank 36.00 09/09/2003 951 Yaldemu Dime Savmgs Bank 36 00 01/03/2003 889 Yeshiva Kesser Torah Dlme Savings Bank 50 00 05/12/2003 928 Yeshiva Kesser Torah Dime Savrngs Bank 54 00 05/05/2003 911 Yeshiva Madrelgas HaAdam Dime Savrngs Bank 25 00 05/10/2003 926 Yeshiva Trferes Ylsroel Dime Savrngs Bank 36 00 11/08/2003 971 Yeshiva TIferes YIsroel Dime Savungs Bank 18 00 09/09/2003 952 Yeshivat Sha‘alvrm DIme Savmgs Bank 36 00 07/22/2003 945 Young Israel of Hlllcrest DIme Savings Bank 525.00 04/13/2003 908 Young IsraeI of Queens Valley Dime Savmgs Bank 56 00 06/30/2003 938 Young Israel of Queens Valley Dime Savmgs Bank 150 00 09/09/2003 954 ZAKA Rescue & Recovery DIme Savrngs Bank 25 00 07/22/2003 941 Zlchron MeIr Ler Dlme Savrngs Bank 36 00 Jan - Dec 03 14,465.00
Page 2 of 2 - 10’12/04 Charitable Trust EIN: 11-6446279 2003 Vendor Contact List ' October 12, 2004
Vendor Address Adas Yereim Adas Yereim 173-19 73 Ave HilIcrest, N Y 11366 Agudath Israel of Amenca Agudath Israel of Amenca 42 Broadway NYC, N Y 10275 Ahavas Chesed Ahavas Chesed 720 Lefferts Ave Brooklyn, N Y 11203 AIA Terror Victims Fund AIA Terror Victims Fund Aish Hatorah Aish Hatorah 313 West 83 St NYC, NY 10024 Aish Corn ' Aish Com Lakewood, N J All 4 Israel All 4 Israel 98 CuttenniII Road Great Neck, N Y 11203 Amit Amit 817 Broadway NYC, NY 10003 Amshinov Amshinov 4408 15th Ave Brooklyn, N Y 11219 Association of Former Residents of Rozan Association of Former ReSIdents of Rozan Ateres Ateres Ayelet Hashachar Ayelet Hashachar 806 Dorian Ct Far Rockaway, NY 18691 B'nei Akiva of N Y B'ner Akiva of N Y 25 W 26th St N Y ,N Y Bais Shifra Minam Bais Shifra Miriam 1928 E 9 St Brooklyn, NY 11223 Bais Yaakov of Queens Bars Yaakov of Queens 124—50 Metropolitan Ave Kew Gardens NY 11415 BAMBI BAMBI CIO Cookie Garrin 424 West End Ave NYC, N Y 10024 Bayit LepIetot Bayit Lepletot 1 Beharan Street PO Box 5115 Jerusalem Israel Be'er Hagolah Institute Be'er Hagolah Institute 671 LOUISIana Ave B'klyn, NY 11239 Beth Hamedrash Chasrdei Amshinov Beth Hamedrash Chasrdei Amshinov Beth Jacob Teachers Seminary Beth Jacob Teachers Seminary 44-21 15 Ave Brooklyn NY 11219 Beth Shifra Beth Shifra 1719 Ave P Brooklyn, N Y 11229 Bikur Cholrm of Queens Bikur Cholim of Queens Birkas Rifka Birkas Rifka do Kitay 1340 Princeton Ave Lakewood, NJ 08701-9888 Bnei Akiva New York Bnei Akiva New York Bnos Malka Bnos Malka Bnos Malka Academy Bnos Malka Academy 65-15 164 Street Flushing, NY 11365 Chabad JCC Chabad JCC Chabad of Great Neck Chabad of Great Neck 400 East Shore Road Great Neck, NY11024 Chai Lifeline/ Camp Simcha Chai Lifeline/ Camp Simcha 48 W 25 St NYC, NY 10010 Chai Lifeline Chai Lifeline 151 W 30th St NYC,NY 10001 Charities Bureau Charities Bureau CHEMED CHEMED 17 Olympia Lane Monsey, N Y 10952 Chesed L'Avrohom Chesed L'Avrohom 1320 53 St Brooklyn, N Y 11219 Children's Torah Foundation Children's Torah Foundation 1212 Ave of the Amerrcas SUite2301 NYC, NY 10036 Chmol Chmol 1469 42 St B'klyn, NY 11219 Chofetz Chaim Heritage Foundation Chofetz Chaim Heritage Foundation 6 Melnick Drive Monsey, N Y 10952 Chofetz Chaim Heritage Center Chofetz Chaim Heritage Center 6 MeInik Dnve Monsey, NY 10952 Cong Bais Moshe Samson Cong Bais Moshe Samson 843 Old Route 17 POB 556 Ferndale NY 12734 Cong Mikveh Israel Cong Mikveh Israel 71-11 Vleigh Place Flushig NY 11367 Cong 0hr Yitzchak Cong 0hr Yitzchak 165-14 69th Ave Flushing, NY 11365 Cong Vehechzakto Bo Cong Vehechzakto Bo Cong Vyoal Moshe Cong VyoaI Moshe 1323 51st St Brooklyn, N Y 11219 Cong Kahal Adas Yereim Cong Kahal Adas Yereim Cong 0hr Yitzchak Cong 0hr Yitzchak 165-14 69 Ave Flushing, NY 11365 Cong ChaSidei Amshinov Cong ChaSldel Amshinov 4408 15 Ave B'klyn, NY 11219 Cong Hope of Israel Cong Hope of Israel Cong Kehilath Moshe Cong Kehilath Moshe Cong 0hr Moshe Cong Ohr Moshe Cong 0hr Yitzchak Cong 0hr Yitzchak 165-14 69th Ave Flushing, NY 11365 Cong 0hr Yitzchok Cong 0hr Yitzchok Cong Khal Adas Yereim Cong Khal Adas Yereim 173-20 73 Ave HilIcrest, NY 11366 Cong Ohr Yitzchok Cong 0hr Yitzchok Congregaation ChaSIdel Skolya Congregaation Chasrdei Skolya Congregation Kehilath Moshe Congregation Kehilath Moshe Congregation 0hr Yitzchak Congregation 0hr Yitzchak 165—14 69 Ave Flushing, NY 11365 Count Me In Count Me In 555 Bedford Ave #2G Brooklyn, NY 11211 Current Inc Current Inc DOROT DOROT 171 W85 St N Y , N Y 10024 Eis LaaSOIS Eis Laasms do Mayer Furst 1626 43rd St B'klyn, NY 11204 Em VayeIed Em VayeIed 1348 47 St Brooklyn, N Y 11219 Ezer MIZIOn Ezer Mizion 1281 49th St Brooklyn, NY11219 Ezra Academy Ezra Academy 119—45 Union Tpke Forest Hills NY 11375 Ezra V'Chesed Ezra V‘Chesed 20 W 22 St NYC, NY 10010
Page 1 of 4 . 10I1 2104 Charitable Trust EIN: 11-6446279 2003 Vendor Contact List October 12, 2004
Vendor Address Ezras Torah Ezras Torah 235 East Broadway NYC,NY10002 Ezras Yisroel Ezras Yisroel cJo Rabbi Tuwa Goldstein 1718 59 Street Brooklyn,NY 11204 Friends for Long Island Heritage Friends for Long Island Heritage Friends of Yeshivat Sha'alwm Friends of Yeshivat Sha'aIVIm 1144 E29 St Brooklyn, N Y 11210 G'mach Chasdei Shimon V'TZIpporah G'mach Chasdei Shimon V'TZipporah do Rabbi Reuven Feinstein 191 \fictory Blv'd Staten Island, NY10301 General Israel Orphans Home for Girls General Israel Orphans Home for Girls P O Box3147 N Y , N Y 10277 Girl's Town Or Chadash Girf's Town Or Chadash 1431 Coney Island Ave Brooklyn, NY 11230 Hachnosas Kallah Fund Hachnosas Kallah Fund 150-05 70th Rd Kew Gardens Hills, N Y 11367 HANC HANC HASC HASC 6220 14 Ave Brooklyn. N Y 11219 HASC Summer Program HASC Summer Program 1311 55 St Brooklyn, N Y 11219 Hashevaynu Hashevaynu 144-02 Jewel Ave Flushing, NY 11367 Hatzolah Of Queens Hatzolah Of Queens 114 Mowbray Dnve Kew Gardens, N Y 11415 Hatzolas Nefesh Fund Hatzolas Nefesh F,und clo Rabbi Shmuel Felder 800 Clifton Ave Lakewood, N J 08701 Hebrew Academy of Suffolk County Hebrew Academy of Suffolk County Hebrew Academy of West Queens Hebrew Academy of West Queens 88-01 102 Street Richmond Hill NY 11418 Hebrew Institute for the Deaf Hebrew Institute for the Deaf 5014 16 Ave B'klyn, NY 11204 HIDEC HIDEC 5014 16 Ave Brooklyn, N Y 11204 Israel Cancer Research Fund Israel Cancer Research Fund 1290 Ave of the Americas swte 550 NYC, NY 10104 Israel Emergency Solidarity Fund Israel Emergency Solidarity Fund 98 Cutten'nill Rd Ste 201 Great Neck N Y 11021 Jaffa Institute Jaffa Institute Clo Hartman 171—06 76 Ave Flushing.N Y 11366 JCC of HiIIcrest Inc JCC oinllcrest Inc 70-06172 St HiIIcrest, N Y 11365 JEP JEP JeWish Braille Institute of America JeWISh Braille Institute of America 110 E 30 St NYC Page 2 of 4 . 10/1 2104 Charitable Trust EIN: 11-6446279 2003 Vendor Contact List October 12, 2004 Vendor Address Otsar Family SerVIces Otsar Family Sewices 2324 West 13 Street Brooklyn NY 11223 0U Proiect Reunite OU Proiect Reunite 11 Broadway NYC,NY 10001 OUINCSY Summer Scholarship Program OUINCSY Summer Scholorship Program 333 7th Ave NYC,NY 10001 P'eylim Lev L'achim P'eyIim Lev L'achim 1034 E 12th St B'klyn, N Y 11230 P'eylim/Lev L,Achim P'eylim/Lev L'achim 1034 East 12 Street Brooklyn NY 11230 P E F Israel Endowment Fund P E F Israel Endowment Fund cdo Matti Friedman 75-32 170 St Hillcrest,NY 11366 Partners in Torah Partners in Torah 160 Broadway N Y .N Y 10273 Police Conference of N Y Police Conference of N Y Prionty One Priority One 26 Columbia Ave Cedarhurst, NY 11516 Queens JeWish Education Program Queens JeWIsh Education Program 92-15 69th Ave Forest Hills,11375 Rabbinical Seminary of America Rabbinical Seminary of America 92-15 69 Ave Forest Hills, NY 11375 Reb Meir Baal Haness Reb Meir Baal Haness Refuah/ Yeshuah Refuah/ Yeshuah POB 191212 Brooklyn NY 11219 Refuah/Yeshuah Refuah/Yeshuah P O Box 191212 B'klyn, NY 11219 Religious Zionists of America Religious Zionists of America 7 Penn Plaza Ste 205 NY,NY 10001 Retum/ Shuvu Return! Shuvu 39 Broadway sUite 3300 NYC,NY 10006 Rika Breuer Teachers Seminary Rika Breuer Teachers Seminary 9-103 Bennett Ave NYC,NY10033 Rivkah Laufer Bikur Cholim Rivkah Laufer Bikur Cholim 167 E 61 St #29 D/E NYC< NY 10021 Rofeh Cholim Cancer Seeiety Rofeh Cholim Cancer Somety 768 Bedford Ave Brooklyn, N Y 11205 Roslyn Torah Foundation Roslyn Torah Foundation 2 Shelter Rock Rd Roslyn. N Y 11576 San Diego Torah Center San Diego Torah Center Sanz Medical Center Sanz Medical Center 18 W45th St swte 307 N Y ,N Y 10109 Sh'or Yoshuv Sh'or Yoshuv One Cedar Lawn Ave Lawrenc'e, NY11559 Sh‘or Yoshuv Institute Sh'or Yoshuv Institute 15-25 Central Ave Far Rockaway, NY Shalom Chesed Fund Shalom Chesed Fund do Rabbi Reuvain Feinstein 20 Yeshiva Lane Staten Island, N Y 10309 Share Share 1501 Broadway suite1720 N Y , N Y 10036 Shevach High School Shevach High School Shomrei Hachomoiseb Meir Baal Haness Shomrei Hachomos/Reb Meir Baal Haness Shomrei Hadas Shomrei Hadas Shuvu/Retum Shuvu/Retum 80 Broad St 29th Fl NYC,NY 10275 Talmudic Commentaries Foundation Talmudic Commentaries Foundation 3499 Harold St OceanSide. NY11572 Talmudic Institute of Upstate N Y Talmudic Institute of Upstate N Y 769 Park Ave Rochester. NY 14607 Talmudical Institute of Upstate New York Talmudical Institute of Upstate New York 769 Park Ave Rochester, NY 14607 Taryag Int'I, Inc Taryag Int'I, Inc Tashbar Tashbar 8210 21 Ave Brooklyn,NY 11214 Temima H S for Girls Temima H S for Girls 1810-B Briarcliff Atlanta, Georgia 30329 The Chofetz Chaim Heritage Foundation The Chofetz Chaim Hentage Foundation 6 Melnick Drive Monsey, NY 10952 The JeWIsh Braille Inst of Amenca The JeWish Braille Inst of America 110 E 30 St NY,NY 10016 The Monah School of Englewood The Monah School of Englewood 53 S Woodland St Engelwood, N J 07631 The Utopia JeWIsh Center The Utopia JeWIsh Center 64-41 Utopia Parkway Fresh Meadows, N Y Tiferes Bnei Elige Inc Tileres Bnei Elige Inc Tikva Benevolent Fund Tikva Benevolent Fund Radio City Station P O Box 1220 NYC,NY10102-1220 Tikvah Layeled Tikvah Layeled 322 W 52 St N Y , N Y 10019 Tomche Shabbos Boro Park Tomche Shabbos Boro Park 4712 Fort Hamilton Parkway Brooklyn, N Y 11219 Tomche Shabbos of Queens Tomche Shabbos of Queens 67-07 Austin St Forest Hills, N Y 11375 Tomchei Shabbos of Queens Tomchei Shabbos of Queens 67-07 Austin Street Forest Hills NY 11375 Torah Center of Hillcrest Torah Center of Hillcrest Jewel Ave Hillcrest,N Y 11365 Torah Umesorah Torah Umesorah 160 Broadway 4th floor NYC,NY 10038 Torah Umesorah Camp Scholarship Fund Torah Umesorah Camp Scholarship Fund 160 Broadway NYC, NY 10038 Tzedokah V‘Chesed Tzedokah V'Chesed do Rabbi Nisson Wolpin 305 Ave F Brooklyn NY 11218 Tzedokah V‘Chesed Fund Tzedokah V'Chesed Fund 521 5th St Lakewood, NY 08701 United Talmudical Academy United Talmudical Academy Utopia JeWIsh Center Utopia JeWish Center 64-41 Utopia P'kway Flushing NY 11365 v0id v0id Vtfisconsm Institute for Torah Study Wisconsm Institute for Torah Study 3288 North Lake Drive Milwaukee, WI 33211 Y T M / Dov Revel Center Y T M l Dov Revel Center 83-06 Abingdon Rd Kew Gardens N Y 11415 Yachad Yachad 11 Broadway NYC,NY10004 Yad Eliezer Yad Eliezer 1102 E 26 St Brooklyn, N Y 11210 Yad L'achim Yad L'achim 579 5th Ave ste 1420 N Y , N Y 10164 Yaldeinu Yaldeinu 1320 53 ST Brooklyn NY 11219 Yeshiva Education for SpeCial Students Yeshiva Education for SpeCIal Students Yeshiva Chofetz Chaim Yeshiva Chofetz Chaim 92-15 69 Ave Forest Hills, N Y 11375 Yeshiva Education For SpeCial Students Yeshiva Education For SpeCial Students 150-05 70 rd Kew Gardens Hills NY 11367 Page 3 of 4 . 10/12/04 Charitable Trust EIN: 11-6446279 2003 Vendor Contact List October 12, 2004 Vendor Address Yeshiva Farm Settlement Yeshiva Farm Settlement admln office 194 DIVlSlon Ave Brooklyn, NY11211 Yeshiva Har Torah Yeshiva Har Torah 254-04 Unlon Tumplke Floral Park, NY Yeshiva Kesser Torah Yeshiva Kesser Torah 72-11 Vlelgh PI Kew Gardens Hulls, NY11367 Yeshiva Ketana Yeshiva Ketana 78-15 Parsons Blvd Fresh Meadows, NY Yeshiva Madrelgas HaAdam Yeshlva Madrelgas HaAdam 69-13 172 St HIIlcrest, NY 11365 Yeshiva of NItra Yeshiva of NItra Mount KISCO, NY admin office 194 DIVISIOI‘I Ave Brooklyn, NY 11211 Yeshiva Tlferes Ylsroel Yeshiva Tlferes Ylsroel 1271 E 35 Street Brooklyn, N Y 11210 Yeshiva Tlfereth Moshe Yeshiva Tlfereth Moshe 83-06 Abrngdon Rd Kew Gardens NY 11415 Yeshiva Torah Ore Yeshiva Torah Ore 1314 Ave J Brooklyn, N Y 11230 Yeshiva Unrversrty H S for GII'IS Yeshiva UnIverSIty H S for GII'IS 86-86 Palo Alto St HoIIIswood, NY11423 YESHIVAS TORAH ORE YESHIVAS TORAH ORE 1314 Ave J Brooklyn, NY11230 Yeshwat Sha'alvrm Yeshrvat Sha'alvnm 1144 E 29 St Brooklyn, N Y 11210 Yonah Vogel Machon Daniel 200 W 79th St Apt 9D N Y ,N Y 10024 Young Israel of Lawrence Cedarhurst Young Israel of Lawrence Cedarhurst Young Israel of HIIIcrest Young Israel of HIIlcrest 169-07 Jewel Ave Flushing, NY 11365 Young Israel of Jamaica Estates Young Israel of Jamaica Estates 83-10 188 St Jamarca Estates, NY Young Israel of Kew Gardens Hulls Young Israel of Kew Gardens HIHS Young Israel of Queens Valley Young Israel of Queens Valley 141-55 77th Ave Kew Gardens Hulls, N Y 11367 Young Israel Torah Fund Young Israel Torah Fund 169-07 Jewel Ave Flushing, NY 11365 ZAKA Rescue 8. Recovery ZAKA Rescue 8. Recovery 622 E 'th St Brooklyn, N Y 11218 ZIchron Merr Lelb Zlchron Melr Lelb 1840 52 St Brooklyn, N Y 11204 Zlchron Shlome—Refuah Fund ZIchron Shlome—Refuah Fund 1319 51 Street Brooklyn, NY 11219 Page 4 of 4