OM B No 1545-0052 Form 990-PF . Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust Depart ment of thS Treasu ry Treated as a Private Foundation nterna IRavenue service Note: The organization may be able to use a copy of this return to satisfy state reporting requirements. 2nn4 For calendar year 2004 , or tax year beginning DEC^ 1, 2004 , and ending NOV 3 0, 2005 R r.hpek all that annlu [1 Initial rabirn I I F in al return Amended return F__-1 Addrn nhnn F__I fJnm rhon Name of organization Use the IRS A Employer identification number label. Otherwise , ROSSMAN FAMILY FOUNDATION 11-2994863 print Number and street (or P O box number if mail is not delivered to street address) Room/style B Telephone number ortype. 1461 53RD STREET 718 -369-2200 See Specific Ci or town, state, and ZIP code C If exemption application Is pending , check here ►O Instructions . ty BROOKLYN, NY 11219 D 1. Foreign organizations, check here ►0 2. Foreign organizations meeting the 85% test, ►O H Check typea of organization: Section 501(c)(3) exempt private foundation check here and attach computation 0 Section 4947(a)(1) nonexempt charitable trust 0 Other taxable private foundation E If private foun dation status was terminate d I Fair market value of all assets at end of year J Accounting method: ® Cash Accrual under section 507(b)(1)(A), check here ►� (from Part ll, col. (c), line 16) 0 Other (specify) F It the foundation is in a 60-month termination 111104 2 19 0 6 91 . (Part 1, column (d) must be on cash basis.) under section 507(b)(1) B check here jo� Part I Analysis of Revenue and Expenses (a) Revenue and (b Net investment Adjusted net (d) Disbursements ( Th e total of amounts in columns (b), (c), and (d) may not ) (c) for ch ar itable purposes necess ar ily equal the amounts in column (a)) expenses per books income income (cash basis only) 1 Contributions, gifts, grants, etc., received 540,000 . N/A 2 Check ii Q If the foundaflon is not required to attach Sch B Interest on savings and temporary 3 cash investments 4 Dividends and interest from securities 15 412 . 15 412. Statement 1 5a Gross rents b Net rental income or (loss) Net gain or (loss) from sale of assets not on 6a line 10 7 Gross sales price for all y b assets on line as y 7 Capital gain net income (from Part IV, line 2) 0. 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 12 Total. Add lines 1 through 11 555,412. 15,412. 13 Compensation of officers , directors, trustees, etc 0. 0. 0. 14 Other employee salaries and wages 15 Pension plans, employee benefits N 16a Legal fees s b Accounting fees W c Other professional fees 17 Interest b 18 Taxes Stmt 2 99. 0. 99. 2 19 Depreciation and depletion E 20 Occupancy < 21 Travel, con ces _5 pe�- ® 22 Printing an public I NE IF Other expe &,s - ml, 3 250. 0. 250. RG m 24 Total opera ing andAni ve UUb a expenses . r�d nes 13 through 23_ 349. 0 . 349. 0 , gi 229,148. 229,148. 25 Contribution I npalc9=t N1 U 26 Total expens sand Add lines 24 and 25 229 497. 0. 229 497. 27 Subtract line 26 from line 12: a Excess of revenue over expenses and disbursements 325,915. b Net investment income (if negative, enter -0-) 15,412.1 c Adjusted net income (if negative, enter -0-) N/A LHA For Privacy Act and Paperwork Reduction Act Notice , see the instructions . Form 990-PF (2004) 423501 01-03-05 1 11200321 807829 arossmanfdtn 2004.08000 GROSSMAN FAMILY FOUNDATION GROSSM21 Form 990-PF (2004) C_RnGGMAN FAMTT.V F()TTNnATTnN 11-2994863 Page2 �ched schedules and amounts Inthe description Beginning of year End of year rt II B a l ance Sheets A Pa column should be for end of yearamounts only (a) Book Value (b) Book Value (c) Fair Market Value 1 Cash - non-interest-bearing 24,485. 13, 388. 13,388. 2 Savings and temporary cash investments 352,520. 247, 932. 2471932. 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 ► 50,000. Less: allowance for doubtful accounts ► 50, 000. 501000. (4 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 4 1,487,771. 1, 487, 771. 1,487,771. c Investments - corporate bonds 11 investments •land, buildings, and equipment basis ► Less accumulated depredation ► 12 Investments - mortgage loans 13 Investments - other Stmt 5 0. 391, 600. 3911600. 14 Land, buildings, and equipment: basis ► Less accumulated depreclabon ► 15 Other assets (describe ► 16 Total assets to be completed by all filers 1,864,776. 21 190, 691. 211-9-0,691. 17 Accounts payable and accrued expenses 18 Grants payable 19 Deferred revenue 20 Loans from officers, directors, trustees , and other disqualified persons m 21 Mortgages and other notes payable J 22 Other liabilities (describe ► 23 Total liabilities (add lines 17 through 22) 0. 0. Organizations that follow SFAS 117, check here ► and complete lines 24 through 26 and lines 30 and 31. 24 Unrestricted 25 Temporarily restricted ca 26 Permanently restricted Organizations that do not follow SFAS 117, check here 0, If] C LL and complete lines 27 through 31. y 27 Capital stock, trust principal, or current funds 1,864,776. 2, 190, 691. 28 Paid-in or capital surplus, or land, bldg., and equipment fund 0. 0. < 29 Retained earnings, accumulated income, endowment, or other funds 0. 0. Z 30 Total net assets or fund balances 1,864,776. 2, 190, 691. 31 Total liabilities and net assets/fund balances 1,864,776. 2, 190, 691. 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 1,864, 776 . 2 Enter amount from Part I, line 27a 2 325, 915 . 3 Other increases not included in line 2 (itemize) ► 3 0 . 4 Add lines 1, 2, and 3 4 2 190, 691. 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 (b), line 30 6 2 , 190, 691 . Form 990-PF (2004) 423511 01-03-05 2 11200321 807829 arossmanfdtn 2004.08000 GROSSMAN FAMILY FOUNDATION GROSSM21 Form 990-PF (2004) GROSSMAN FAMILY FOUNDATION 11-2994863 Page 3 Pa rt IV Capital Gains and Losses for Tax on Investment Income List and describe the kind(s) of property sold (e.g., real estate, (b How acquired (c) Date acquired (d) Date sold (a) Purchase 2-storyY brick warehouse; or common stock, 200 shs. MLC Co.) D - Donation (mo., day, yr.) (mo., day, yr.) 18 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 not less than -0-) (j) Adjusted basis (k) Excess of col. (i) col. (k), but 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 1 2 2 Capital gain net income or (net capital loss). If (loss), enter -0- in Part I , line 7 1 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 Part V I 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 organization liable for the section 4942 tax on the distributable amount of any year in the base period? Yes ® No If'Yes' the organization does not qualify under section 4940(e). Do not complete this pa rt. I Enter the aooroonate amount in each column for each year: see instructions before making any entries. Distribution Base period years value of use assets (b) Calendar year (or tax year beginning in Adjusted qualifying distributions Net nonchantable (col. ) divided by col. (c)) 2003 425 292. 1, 694, 436. .2509933 2002 458 028. 1, 511, 036. .3031218 2001 427 083. 1, 527, 205. .2796501 2000 606 231. 376 888. 1.6085176 1999 175 497. 404 954. .4333751 2 Total of line 1, column (d) 2 2.8756579 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 .5751316 4 Enter the net value of noncharitable-use assets for 2004 from Part X, line 5 4 1 761,177.