FormC990-PF Return of Private Foundation ...990s.foundationcenter.org/990pf_pdf_archive/233/233024321/233024321... · b (Net~anullncomsor0ossl I fia Net py norposs)komsaleotusetsnoton

FormC990-PF Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust

DepertmmlolNOTreuury Treated as a Private Foundation i"i""da°"`""° S""i`° Note The organization may be able to use a copy of this return to satisfy state 2por

Forcatender year 2001,ortazyear bell inning DEC 1, 2001 ,andending NO\

OMB No 1 5 45 0052

LOOI

Use tie IRS Name of organization

label Otherwise, PGAR-BLACK FOUNDATION

print NumbmanEabeet(orPO oaxnumbvilmaillanoidelivered bsVeet Address)

or type 42 RIVER ROAD See Specific City or town, stale, and ZIP code Instructions

T PLEASANT PA 18950 H Check type of organization = Section 501(c)(3) exempt private foundation OSection 4947(a)(1)nonexempt charitable trust ~X Other taxable private foum:

I Fair market value of all assets al end of year J Accounting method 0 Cash (from Part fl, cot (c), line 16) = Other (specify) " $ 3 3 8 9 8 4 . (Part 1, column (off must be on cash

rl I Analysis of Revenue and Expenses (a) Revenue and (The total of amounts in columns (b), expenses per (c), end (a) may not necessanly equal books the amounts in column (a)1 Conlribu6ons,pifts,grants,etc,received 25 , 000 .

cnxk " 0 u me iwnmem s not mouthed a &crn srn e

2 Distributions from split-interest trusts Interest on savings end temporary 6 , 456 . 3 msn invsvnent~

4 Dividends and interest from securities 2,405 . 5a Gross rents b (Net~anullncomsor0ossl I

fia Net py norposs)komsaleotusetsnoton -45 , 608 . p line 10

h Gross same price for .11 79 , 832 . V assets on line 6e

y 7 CepIWpunnallncome(homPart N,line 7)

8 Net short-term capital gain

9 Income modifications 1Da Gross s Nes less returns

and ellowancn

b Less Cost of goods sold

c Gross profit or (loss) 2 . 11 Other income Z1

, 958 19 rhtni Add enee I m.riinnii -~"4 .705 .

(h) Net investment (c) Adjusted net for charitable income income purposes

NBA (wshbasis on ly)

3 27 Subtract line 26 from line 12 cn A~'I

d E+~cma of revenue over eapanaas ono alsbunemenb -~7 7 ~ ~ Y

D Net Investment Income 0f nepanve,entr o-)

c Adjusted net Income of nagauve enter o-)

- 1 02 LHA Far Paperwork Reduction Act Notice, see the Instructions 2

2001 .08010 APGAR-BLACK FOUNDATION 9998-1 \u 12070707 798008 9998

Employer Identification number 23-3024321 ^~~~~c^ B Telephone number II exemption appllutlan is pandlnp Oak hem D I Foreign organizations, check here Is= , 2 Forelpnorganizations meeW9ineB5%Last check hem and ettmn mmouGLOn E If private foundation status was terminated Accrual under section 507(b)(1)(A) check here F If the foundation is in a 60 " month termination,-,

13 compensation olalficas alrei wnees em (/, 14 Other employee salaries and wages 15 Pension plans, employee benefits N 16a Legalities 00 h accounting fees STMT 5 0 �", c Other professional fees STMT 6 i 17 Interest 78 Taxes STMT 7 19 Depreciation and depletion r " E 20 Occupancy t-, ~,N t=l~~i16E~Iti~' 1 a 21 Travel conference a a 22 Printing and DuDli do ~ 5 0 23 Other expenses ~ 'JUl- n 24 Total operating an a~ Inisirative n expenses Add line 13 hr~c h~E~ u" 25 Contributions gifts, rants ~ 26 Total expenses and disbursements 25 .000 .

Form 990-PF(2001)

4321 Page 2

Fair Market Value 14,320 . 3,865 .

858 .

Book Value ~ (h) Book Value

984 . 40

1 .325 23 Total liabilities add lines 17 through 22 ) Organizations that follow SFAS 117, check here and complete lines 24 through 26 and lines 30 and 31

N 24 Unrestricted

ad 25 Temporarily restricted m 26 Permanently restricted

Organizations that do not follow SFAS 117, check here 1 and complete lines 27 through 31

27 Capital stock, trust principal, or current funds 28 Paid-in or capital surplus, or land, bldg , and equipment fund 29 Retained earnings, accumulated income, endowment or other funds

0 Z 30 Total net assets or fund balances

0 .

123511 01 24-OZ

3 12070707 798008 9998 2001 .08010 APGAR-BLACK FOUNDATION 9998 1

Balance Sheets "'°`"`°q"`d'i°'"a+mwnsmmeaoneeon column Would be lot en"! pi! amounts any

1 Cash - non-interest-bearing 2 Savings and temporary cash investments 3 Accounts receivable 1 858

Less allowance for doubtful accounts 1 4 Pledges receivable 10'

Less allowance for doubtful accounts 10. 5 Grams receivable 6 Recervablas due from officers, directors, trustees, and other

disqualified persons 7 DOW noM and 10103 M=4010 11o.

Less allowance to rdoub[ful accounts 1

8 Inventories for sale or use N

y 9 Prepaid expenses and deferred charges too investments-US and state government obligations STMT 8 b Investments -corporate stock STMT 9 s Investments-corporate bonds

11 ~mavrms land. euunnpsanaewicmntoask 10,

LeammftMOeomdanem 1

12 Investments - mortgage loans

13 Investments-other STMT 10 14 Land, buildings, and equipment basis

Ls~awu~rsaeomwem

15 Other assets (describe ~

17 Accounts payable and accrued expenses 18 Grants payable

y 19 Deferred revenue 20 Loan . from alficen Olrocton trusties end other ElsquaIIfieC persona

n 21 Mortgages and other noes payable 22 Other liabilities (descnbe

0

131 Total liabilities andnetassetsAunEbalances 1 406,706 . 338,984 .

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" ot-year pure reported on prior year's return) i 406 , 706 .

2 Enter amount tram Part I, line 27a 2 -69 , 047 .

3 Other increases not included in line 2 (itemize) " 3 0 .

e nd0lines i,2,and3 a 337 , 659 .

5 Decreases nod 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 6 337 , 6-59 .

From 990-PF Rood

3 IV I Capital Gains and Losses for Tax on Investment Income

(a) List and descnbe the kind(s) of property sold (a 9 , real estate, 2- story brick warehouse or common stock, 200 shs MLC Co )

3E ATTACHED SCHEDULE

(e) Grass sales price (f) Depreciation allowed (p) Cost or other basis (or allowable) plus expense of sale

(d) Date sold (mo , day, yr )

(h) Gain or (loss) (e) plus (f) minus (g)

the foundation on 12/37/69 (k) Excess of cot (p over col (1), if any

(p Adjusted basis as of 72/37/69 (I) F M V as 0112/31/69

II section 4940(d)(2) applies, leave this part blank

8 Enter qualifying distributions from Part XII, line 4 2 5,000 .

It line B is equal to or greater than line 7, check the box in Part VI line 1 b, and complete that part using a 1% tax rate See the Part VI instructions

Fo,m 990-PF Roam ,zasz, o1-za-as


in column IN and owned

(t) Date acquired (mo , day, yr )

2 Capital gain net income or net capital lass If ain, also enter in Part I, line 7

B ( ) (

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) It pain, also enter in Part I, line 8, column (c) If floss). enter-0-in Part I line 8 ~ 3

Part V I Qualification under secyon aa4yte) for r+eaucea i ax on nei inye

(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income )

(I) Gains (Col (h) pain minus cot (k), but not less than -0-) or

Losses (from cot (h))

Was the organization liable for the section 4942 Paz on the distribulable amount of any year in the base penod? 0 Yes ~ No If Yes' the organization does not quality under section 4940(e) Do not complete this part 1 Enter the appropnate amount in each column far each year, sae instructions before making any entries

a (d

Base peno e)

0 years Adjusted distnbulions Net value of nonchantable-use assets Distribution ratio

falnMarvxarlnrta :vearhnmnn mnm) quali fy ing (c01 (b) divided byC01 (C))

2 Total of line 1, column (d) 2 . o » i o v i

3 Average distribution ratio for tie 5-year base penad -OiviOe the total on line 2 by 5, or by the number of years the foundation has been in existence it lass than 5 years 3 . 4 275804

4 Enter the net value of noncharitable-use assets for 2001 from Part X, line 5 4 3 5 9 , 111 .

5 Multiply line 4 by line 3

6 Enter 1% al net investment income (1% of Part I line 27b)

7 AOd lines 5 and 6

23-3024321 or 4948 - see instn

FOUNDATION se on

160 .

7 Total credits and payments Add hoes 6a through 6d 8 Enter any penalty for underpayment of estimated tax Check here E:1 d Farm 2220 is attached 9 Tax due it the total of lines 5 and 8 is more than line 7, enter amount owed 10 Overpayment II line 7 is more than the total of lines 5 and 8, enter the amount overpaid 11 Enter the amount of line 10 to be Credited to 2002 estimated tax No.

X

X

If 'Yes,' attach e schedule listing their names end addresses 11 Did lie organization comply with the public inspection requirements for its annual returns and exemption aDPlicalion9

Web site address " N/A 12 The books era in care of " APGAR-BLACK FOUNDATION Telephone m:

Located at " 42 RIVER ROAD PT PLEASANT, PA 13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 - Check here

ziF+41 " 18950

13 ~ N/A Fo.m 990-PF Roots

5 2001 .08010 APGAR-BLACK FOUNDATION 9998 1 12070707 798008 9998

1 a Exempt operating foundations described in section 4940(4)(2), check here " U and enter 'N/A' on line 1 ~Date of ruling letter (attach copy of ruling letter II necessary-see instructions)

h Domestic organizations that meet the section 4940(e) requirements in Part V, check here " E] and enter 1% of Part I, line 27D

s All other domestic organizations enter 2% of line 27b Exempt foreign organizations enter 4% of Part I, line 12, cot (b) 2 Tax under section 511 (domestic section 4947(a)(1) gusts and taxable foundations only Others enter-0 ") 3 Add lines 1 and 2 4 Subtitle A (income) tax (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 It zero or less, enter-0- 6 Credds/Payments a 2001 estimated tax payments and 2000 overpayment credited to 2001 6a b Exempt foreign organizations -tax withheld al source s Tax paid with application for extension of time to file (Form 8868) d Backup withholding erroneously withheld

1 a During the tax year, did the organization attempt to influence any national, stale, or local legislation or did A participate or intervene in any political campaign

b Did it spend more than E700 during the year (either directly or indirectly) for political purposes (see instructions for definition) I/ the answer is 'Yes' to 1 a or 7 6, attach a detailed description of the activities and copies o! any matenals published or distributed by the organization in connection with the activities

c Did the organization file Form 1120-POL for this year d Enter the amount (it any) at tax on political expenditures (section 4955) imposed during the year

(7) On the organization " $ 0 . (2) On organization managers " a 0 . e Enter the reimbursement (it any) paid by the organization during the year for political expenditure tax imposed on organization

managers " a 0 . 2 Has the organization engaged in any activities that have not previously been reported to the IRS9

If 'Yes,' attach e detailed description of the activities 3 Has the organization made any changes, not previously reported to the IRS, in ids governing instrument, articles of incorporation, or

bylaws,orother similar instruments9 I!'Yes,"attach econlormedcopy o(thechanges 4a Did the organization have unrelated business gross income of $1,000 or mare during the year b If 'Yes .' has it tiled a tax return on Form 990-T for this years N/A

5 Was there a liquidation, termination, dissolution, or substantial contraction during the year 11 'Yes,' attach the statement required by General Instruction T

6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either " By language in the governing instrument or " By state legislation that effectively amends tie governing instrument so that no mandatory directions that conflict with the slate law

remain in the governing instrument? 7 Did the organization have al least E5,000 in assets at anytime during the year

If 'Yes," complete Pert fl, cot (c), end Part XV Be Enter the states to which the foundation reports or with which it is registered (see instructions) 1 NONE

b If the answer is 'Yes' to line 7, has the organization furnished a copy of Form 990-PF to the Attorney General (or designate) at each state as required by General Instruction G? II'No,"attach explanation

9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(1)(5) far calendar year 2001 or the taxable year beginning in 2001 (see instructions for Part XIV)? I/ "Yes," complete Pert XIV

10 Did any parsons become substantial contributors during ihetaxyear9 SEE STATEMENT 11

X

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))') ~ Yes 0 No (2) Influence the outcome of any specific public election (see section 4955), or to carry on, directly or indirectly,

any voter registration drrva9 ~ Yes ~ No (3) Provide a grant to an individual for travel, study, or other similar purposes 0 Yes 0 No (4) Provide a gram to an organization other than a chanlable, etc , organization described in section

509(a)(t), (2), or (3), or section 4940(d)(2)? ~ Yes 0 No (5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for

the prevention of cruelty to children or animals ~ Yes M No h It any answer is 'Yes'to Sa(1)-(5) did any of the transactions fail to quality under the exceptions described in Regulations

section 53 4945 or in a current notice regarding disaster assistance (see instructions)? N/A SD Organizations retying on a current notice regarding disaster assistance check here ~

c If the answer is 'Yes'to question Sa(4), does the organization claim exemption from the tax because it maintained expenditure responsibility for the grant? N/A = Yes No If "Yes," attach the statement required by Regulations section 53 4945-5(d)

8a Did the organization during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contracts = Yes 0 No

6 Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contracts 6D X I! you answered "Yes" to 66, also file Form 8870

corm 890-PF (tool)

123541 01 74 07 6

12070707 798008 9998 2001 .08010 APGAR-BLACK FOUNDATION 9998 1

Form 990-PF(2007) APGAR-BLACK FOUNDATION 23-3024321 Page 5

Part VII-B, Statements Regarding Activities for Which Forth 4720 Ma Be Required File Form 4720 ii any item is checked in the "Yes" column, unless en exception applies Yes NO

1 a During the year did the organization (either directly or indirectly) (7 ) Engage in the sale or exchange, or leasing of property with a disqualified person? 0 Yes [K] No (2) Borrow money from lend money lo, or otherwise extend credit to (or accept it from)

a disqualified persons 0 Yes EKI No (3) Furnish goods, services or facilities to (or accept them from) a disqualified Derson7 0 Yes 0 No (4) Pay compensation to, or pay or reimburse tie expenses of, a disqualified persons 0 Yes ~ No (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) ~ Yes 0 No (6) Agree to pay money or property to a government official? (Exception Check 'No'

if the organization agreed to make a grant to or to employ the official for a period attar termination of government service, if terminating within 90 days ) E] Yes M No

D If any answer is 'Yes'to ta(1)-(6), did any of the acts fail to quality under the exceptions described in Regulations section 53 4941(d)-3 or in a current notice regarding disaster assistance (see page 19 of the instructions) N/A 1h Organizations retying on a current notice regarding disaster assistance check here 10.

c did the organization engage in a pnor 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 20019 1 c

I Taxes on failure to distribute income (section 4942) (does not apply for years the organization was a private operating foundation defined in section 4942(j)(3) or 4942(j)(5))

e At the end of tax year 2001, did the organization have any undistributed income (lines 6d and 6e, Part 7(111) for tax year(s) beginning before 2001 D Yes M No If 'Yes' list the years

h Are there any years listed in 2a for which the organization is not applying tie provisions of section 4942(x)(2) (relating to incorrect valuation of assets) to the year's undistributed incomes (It applying section 4942(x)(2) to all years listed, answer 'No' and attach statement - see instructions ) N / A

c It the provisions of section 4942(x)(2) are being applied to any of the years listed in 2a, list the years here

3a did the organization hold more than a 2°/, direct or indirect interest in any business enterprise at any time during the years 0 Yes 0 No

b It'Yes ; did it have excess business holdings in 2001 as a result of (1) any purchase by the organization or OisQualife0 persons after May 26, 7969, (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest, or (3) the lapse of the t0-, 75-, or 20-year first phase holding penod? (Use Schedule C, Form 4720, to determine if the organization had excess business holdings in 2001) N / A

Oa Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes h 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 fax year beginning in 20019

ahly Paid Employees,

[ion (d~c~~ onnowasro (e) Ex dense °AQp~~ 2CCOUni,Othef

can aeon allowances

0 . 0 . 0 .

0 . 0 . 0 .

Tile and

Total number of other employees paid over $50,000 3 Five highest-paid independent contractors for professional services If none, enter "NONE "

lal Name and address of each person paid mare than $50.000 of service

Total number of others receivin g over $50,000 for professional services Part IX-A Summary of Direct Charitable Activities

List the foundation s four largest direct charitable activities during the tax year Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc

N/A

2

3

4

Fo .m 9B0-PF Roots

99981 7

2001 .08010 APGAR-BLACK FOUNDATION 12070707 798008 9998

Form 990-PF(2001) APGAlt-riLAC:K t'UUNllA'1'lUN

Information About Officers, Directors, Trustees, Foundation Managers, and Contractors

1 List all officers, directors, trustees, foundation managers and their compensation

(a) Name and address (b) Title, and avers g e (c) Comp

hours perweekdevotea (if not to p osition enter

ALLEN D . BLACK 42 RIVER ROAD PT PLEASANT PA 18950 ART RANDY APGAR

e

(a) Name and address of each employee paid more than $50,000 (c) Compensation (e) Ex ense

accoun P other allowances

Compensation

Expenses

Form 990-PF(2001) APGAR-BLACK FOUNDATION 23-3024321 Page?

Part IX-B Summary of Program-Related Investments

Amount 1 Describe the two investments made by the

PaYt X 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 D Average of monthly cash balances s Fair market value of all other assets 0 Total (add lines 1 a, b, and c) e Reduction claimed tar blockage or other factors reported on lines 1a and

1c (attach detailed explanation) 1e 2 Acquisition indebtedness applicable to line 1 assets 3 Subtract line 2 from line 1 d 0 Cash deemed held for charitable activities Enter 1 1/2°/, of line 3 (for greater amount, see instructions) 5 Net value of noncharltahle "use assets Subtract line 4 from line 3 Enter here and on Part V, line 4 6 Minimum Investment return Enter S I of line 5

0 .

1 Minimum investment return from Pad X, line 6 2a Tax on investment income for 2001 from Part VI, line 5 ~ 2a I 1

b Income tax for 2001 (This does not include the lax from Part VI 2b c Add lines 2a and 21b

3 Distributable amount before adjustments Subtract line 2c from line 1 4a Recoveries of amounts treated as qualifying distributions ~ 4a ~

06 Income distnbutions tram section 4947(a)(2) trusts 4h 0 .

c Add lines 4a and 4b 5 Add lines 3 and 4c 5 Deduction from dislnbutable amount (see instructions) 7 Olsiri6utaGle amount as adjusted Subtract line 6 tram line 5 Enter here and on Part XIII, line 1

Part Xll Qualifying Dlstnbutions (see instructions)

B 12070707 798008 9998 2001 .08010 APGAR-BLACK FOUNDATION 9998 1

2

All other program-related investments See instructions 3

~ X~ Dlstflbutable Amount (see instructions) (Section 49420)(3) and (1)(5) Drrvate operating foundations and certain foreign organizations check here 1 n and do not complete this part 1

1 Amounts paid (including administrative expenses) to accomplish charitable, etc , purposes a Expenses, contributions, gifts, etc -total from Part I column (d), line 26 1 a 25 f 000 .

b Program-relatedinvestments -Total from Part l%-B 1h 0 . 2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc , purposes 2 3 Amounts set aside for specific chantable protects that satisfy the a Suitability test (prior IRS approval required) 3a 6 Cash distribution test (attach the required schedule) 3b

4 Qualifying distributions Add lines 1a through 3b Enter here and on Part V, line B, and Part %11I, line 4 d 25 , 000 . 5 Organizations that quality under section 4940(e) for the reduced rate of tax on not investment

income Enter 1 °/, of Pa it I, line 27b 5 0 . 6 Adjusted qualifying distributions Subtract line 5 from line 4 ~ 6 ~ 25,5-00 .

Note The amount on line 6 will be used in Pert V, column (b), in subsequent years when calculating whether the foundation quay/yes for the section 4940(e) reduction of tax in those years

Fo~ 990-PF Roop

177581 of 24 OP

Farm990-PF(2001) APGAR-BLACK FOUNDATION 23-3024321 Page e

PePt XIII Undistributed Income (see instructions)

1a) (b) (c) (d) Corpus Years pnorto 2000 2000 2007

1 Distributable amount for2001from Part xl,line 7 17 955 .

2 unaiameuted inmme If My, m al tit. ma 012000 a Enter amount for 2000 only 0

" b7oWbrpoor Yinin, 19 ,79 ,1J 0

3 E. a,awn.oomfrnvo~e*.uMy mzroi a From 1996 " , h From 1997 c From 1998 eFrom i999 287 842 . e From 2000 68 , 215 . ITotal otlines 3athrough e 356 057 .

4 Qualifying distributions tar 2007 from ~ ' Part %Il,line 415 25 000 .

a Applied to 2000, but not more than line 2a ' ~ 0h Applied to undistributed income of prior

years (Election required -see instructions) 0c Treated as distributions out of corpus

(Election required - see instructions) 00 Applied is 2001 distnbutaDle amount 17 , 955 .

e Remaining amount distributed out of corpus 7 , 045 . S E,,cesaCIatnDutlonarerrymcepplledto7007 0 . 0 .

of NYIIOUf1IGPpdYlIACOIYlM(E),OIOfY1VmMU0I mush ot, .Mw,, in .1u.

6 Enter the net total of each column as Indicated below

2 Corpus Add dries 3I 4c and 4e Suottect Ilne 5 363 , 102 .

h Prior years' undistributed income Subtract line 4D from line 2b

0c Enter the amount of prior years' undistributed income for which a notice of deficiency has been issued, or on which ~ ' the section 4942(a) fax has been previously ` assessed 0 .

d Subtract line 6c from line 6b Taxable amount-see instructions 0

e Undistributed income for 2000 Subtract line 4a tram line 2a Taxable amount - see instr 0

1 Undistributed income tar 2001 Subtract lines 40 and 51ram line 1 This amount must be distributes in 2002 0

7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(7)(E)or4942(p)(3) 0

8 Excess distributions carryover from 1996 not applied on line 5 or line 7 0 .

9 Excess distributions carryover to 2002 Subtract lines 7 and 8 from line 6a 363 , 102 .

10 Analysis at line 9 ~ , a Excess from 1997 b Excess from 1998 cExcess from 1999 287 842 . 0 Excess from 2000 68 , 215 . eExcess from 200i 7,045 .

Form 990-PF Root)

123571 Ot 24 02


1998 I (a) Tote I

each year listed c 'Support' allamatrve test-enter

(1) Total support other than gross investment income (interest, dividends, rends, payments on securities loans (section 512(a)(5)), or royalties)

(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(11)(in)

(3) Largest amount of support from an exempt organization

i2358i10i 24-02 10 Fo~980-PF (2oo+) 12070707 798008 9998 2001 .08010 APGAR-BLACK FOUNDATION 99981

Form 990-PF120011 APGAR-BLACK

1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2001, enter the date of the ruling 1

b Check box to indicate whether tie organization is a ovate opera tin foundation described in section 2 a Enter the lesser of the adjusted not Tax year Prior 3 yea

income from Pan I or lha minimum (a) 2001 (b) 2000 (x)1999

investment return Iram PaA K tar each year listed

h 85% of line 2a s Qualifying distributions from Part XII

line 4 for each year listed d Amounts included in line 2c not used directly for active conduct of exempt activities

e Qualifying distributions made directly far active conduct of exempt activities Subtract line 2d from line 2c

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 4942(j)(3)(B)(i) h 'EnOOwmenY altemative test-

Enter 2/3 of minimum investment return shown in Part X, line 6 for

P~ art XY J Supplementary Information (Complete this part only if the organization had $5,000 or more in assets at any time during the year-see page 26 of the instructions.)

1 Information Regarding Foundation Managers a List any managers of the foundation who have contributed more than 2% of the foul contributions received by tie foundation before the close of any tax

year (but only if they have contributed more than $5,000) (See section 507(d)(2)

ALLEN D . BLACK h List any managers of the foundation who own 10°h or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or

other entity) of which the foundation has a 10°b or greater interest

2 Information Regarding Contnbution, Grant, Gill, Loan, Scholarship, etc, Programs Check here 10- El ii the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests for lands If the organization makes gifts, 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 applications should be addressed ALLEN D BLACK 42 RIVER ROAD PT PLEASANT PA 18950

b The torte in which applications should be submitted and information and materials they should include LETTER REQUESTING AMOUNT AND PROPOSED USES OF FUNDS

c Any submission deadlines NONE

d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors NONE

io Form 890-PF(200tj APGAR-BLACK Pert XV Supplementary lnformati

2

3 Grants and Contributions Paid During the Year or Approved for Future Payment Recipient If recipient is an individual,

show any relationship to Foundation Name and address (home or business) any foundation manager status of

or substantial contributor recipient

a Pad during the year

UNIVERSITY OF TEXAS LAW PUBLIC SCHOOL BOX 149090 AUSTIN C HARITY TX 78714

UBLIC RARITY

UBLIC RARITY

3a

123601/07 24 07

12070707 798008 9998

Form 990-PF Rood

99981 11

2001 .08010 APGAR-BLACK FOUNDATION

JAMES A MICHENER ART MUSEUM 138 PINE STREET DOYLESTOWN, PA 18901

UNIVERSITY OF PENNSYLVM 433 FRANKLIN BLDG PHILA, PA 19104

h Approved /or future payment

NONE

Purpose of pram or contribution

HARLES KIPPLE EMORIAL ENDOW RES . CHOLARSHIP IN AW

ATELLITE SITE T UNION SQUAB:

.G .B .T . ARRIAGE HOUSE

Amount

10,000 .

5,000 .

10,000 .

Form 99o-PF(200i) APGAR-BLACK FOUNDATION 23-3024321 Page 11 ParE XVI-A Analysis of Income-Producing Activities

a b t a e I p Fees and contracts from government agencies

2 Membership dues and assessments 3 Interest on savings and temporary cash

investments 4 Dividends and interest from securities 5 Net rental income or (loss) from real estate

a Debt-financed property b Not debt-financed property

6 Net rental income or (lass) from personal property

7 Other investment income 8 Gain or (loss) from sales of assets other

than inventory 9 Net income or (loss) from special events

10 Grass profit or (loss) from sales of inventory 11 Other revenue

a h

181 -45,608

Line No I Explain below how each activity for which income is reported in column (e) of Part 7NI-A contributed importantly to the accomplishment of ~ the oraanizahon's exempt Purposes (other than by orovi0inu funds far such purposes)

12 Form 990-PF Root) 2001 .08010 APGAR-BLACK FOUNDATION 9998 1 12070707 798008 9998

Enter gross amounts unless otherwise indicated

1 Program service revenue

ss income s.omaea e . s«uon512 517 or 514

(b) F 19u- (d) Related or exempt Amount ode Amount function income

14i 42 . 14 8,819 .

e a e

12 Subtotal Add columns (b), (d), and (e) 0 .1 -58,705 .1 0 . 13 Total Add line 12, columns (b), (d), and (a) " 13 -58,705 . (See worksheet in line 13 instructions to verity calculations )

Part XVI-B Relationship of Activities to the Accomplishment of Exempt Purposes

Form 990-PF(200i) APGAR-BLACK FOU ION Regarding and Transactions

Exempt bid the organization directly or indirectly engage in any of tie following with any other organization descnbed in section 501(c) of Ye the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizalions7

a Transfers from the reporting organization to a nonchantable exempt organization of (1) Cash (2) Other assets la(2)

b Other Transactions (7) Sales of assets to a nonchantable exempt organization 1130 ) (2) Purchases of assets from a noncharitable exempt organization 1D 2 (3) Rental of facilities, equipment, or other assets 1D 3 (A) Reimbursement arrangements 164 (5) Loans or loan guarantees 1D 5 (6) Performance of services or membership or fundraising solicitations 10 6

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees 1c d If the answer to any of the above is 'Yes,' complete the following schedule Column (6) should always show the fair market value of the goads, other assets,

or services given 6y the reporting organization It the organization received less than fair market value in any transaction or sharing arrangement, show in

X

2a Is the organization directly or indirectly actuated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527 ED Yes [K] No

h If 'Yes,' complete the tollowmg schedule 01

I derJere Met I nme uemin la nNm Inpu0ln e~mpenYL^0 xneGUlea and statements WO to Me beat of My knvMadpa and belief II la we correct 'I psrer dot n cup a or fiOu fiery) Is m on all inbrtrallon of which pnpsnr has any Ynowl pe

r or trustee

under penalties of and complete pai

Preparer's' signature

Fimsurt(a KO1 LLE & NERI LLP i~w'oimm '2008 CHESTNUT STREET

PHILADELPHIA . PA 19103

m 2a ax 12W21

2001 .08010 12070707 798008 9998

X

Name of N/A

~O I ~ =r

Schedule B Schedule of Contributors (Form 990,980-EZ,or

9B0-PF) Supplementary Information for Dn~t of ft 7~uN line 1 of Form 880, 990-EZ and 890-PF (See instructions) Inhmel Revenue Serviw

2001 Name of organization

-302432 APGAR-BLACK FOUNDATION


OMB No 151100

Employer identification number

Organization type (check one)

Filers or Section

Form 990 or 990 EZ [-I 501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

0 527 political organization

Form 990 PF 0 501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check i1 your organization is covered by the General rule or a Special rule (Note Only e section 501(c)(/), (8), or (10) organization can check box(es) /or both the General rule end a Spade! rule-see instructions)

General Rule-

0 For organizations fling Form 990, 990 EZ, or 990-PF that received, during the year, E5,000 or more (n money or property) from anyone contributor (Complete Pans I and II )

Special Rules-

For a section 501(c)(3) organization filing Form 990, or Form 990~EZ, that met the 33 1!3% support test of the reputations under sections 509(a)(1)/170(b)(1)(P)(v) and received from any one contributor, during the year, a contribution of the greater 0155,000 or 2% of the amount on line 1 of these forms (Complete Pans I and 11 )

0 For a section 501(c)(7), (B), or (10) organization flung Form 990, or Form 990 EZ, that received from any one contributor, during the year, aggregate contributions or bequests of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals (Complete Parts I, II, and III )

For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990 EZ, that received from any one contributor, during the year, some contributions for use exclusively for religious, charitable, etc , purposes, but these contributions did not aggregate to more than E1,000 (It this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc , purpose Do not complete any of the Parts unless the General rule applies to this organization because it received nonexclusrvely religious, charitable, etc , contributions of $5 .000 or more during the year ) " $

Caution Organizations that are not covered by the General rule and/or the Special rules do not file Schedule B (Form 990, 990-EZ, or 990-PF), but they must check the box in the heading o! they Form 990, Form 990-EZ, or online 1 0/ their Form 990-PF, to certify that they do not meet the filing requirements o/ Schedule B (Form 990, 990-EZ, or 990-PFD

Schedule B (Form 990, 990-EZ, or 990-PF) (2001)

173451 12 29 01

Peg. 1 to 1 of Pert I

Employer Identification number

23-3024321

Schedule B (Form 990 99o-E2 or 990-7F) (20011

Name of organization

APGAR-BLACK FOUNDATION

Part l Contributors (see Specific Instructions )

(a) (b) No Name, address end ZIP r 4

1 ALLEN D . BLACK

42 RIVER ROAD PT PLEASANT PA 18950

(a) (b) No Name, address and ZIP + 4

2 ALLEN D . BLACK

a

42 RIVER ROAD PT PLEASANT PA 18950

(a) (b) No Name, address and ZIP + 4

1d1 ie of contribution

(c)

Person Payroll Noneash

(Complete Part II if there is a noncash contribution )

ie of contribution (c)

Person M Payroll Noneash 0


(e) (d) contributions Type of contribution

Person Payroll 0

E Noncash 0

(Complete Pail II if there is a noncash contribution )

(a) Ibl (c) (d) No Name, address and ZIP + 4 Aggregate contributions Type o1 contribution

Person 0 Payroll 0 Noneash 0


(a) (b) (c) (d) No Name, address and ZIP +d Aggregate contributions Type of contribution

Person 0 Payroll Noncash

(Complete PaA II if there is a noncash contribution )

(a) (b) (c) (d) No Name, address and ZIP + 4 Aggregate contributions Type of contribution

Person 0 Payroll 0

E Noneash 0

(Complete Part II it there is a noncash contribution )

isaasz ,z-zs-o, 1 5 Schedule B (Form 990,990-EZ,or990-PF) (2001) 12070707 798008 9998 2001 .08010 APGAR-BLACK FOUNDATION 9998 1

E

(e) (c) No (b) FMV (or estimate) from Description of noncash property given Date received Part 1

(see instructions)

IS 1 6 Schedule B(FOrm 990,990-EZ,or990-PF) (2001)

2001 .08010 APGAR-BLACK FOUNDATION 9998 1 12aesa 12-29-0,

12070707 798008 9998

ScheduieB(FO/m990B90-E7, or990-PF) (2001) Peg. 1 to 1 ofGenll Name at organization Employer identification number

APGAR-BLACK FOUNDATION 23-3024321

Part II, Noncash Property (see Specific instructions )

(e) No (b) FMV (or estimate) from Description of noncash property given (see instructions)

Date received Part I

1

3

(a) No (b) FMV (or estimate) from Description of noncash property given (see instructions) Date received Part I

8

(a) (c) No (b) FMV (or estimate) from Description of noncash property given (see instructions)

Dale received Part I

E

(c1 No from Description of noncash property given

FMV (or estimate) Data received

Part I (see instructions)

E

(a) (e) No from Description of noncash properly given

FMV (or estimate) (see instructions) Date received

Part I


FORM 990-PF GAIN OR (LOSS) FROM SALE OF ASSETS STATEMENT 1

(A) DESCRIPTION OF PROPERTY

SEE ATTACHED SCHEDULE

GROSS VALUE AT SALES PRICE TIME OF ACQ .

79,832 . 125,440 .

CAPITAL GAINS DIVIDENDS FROM PART IV

TOTAL TO FORM 990-PF, PART I, LINE 6A

0 .

-45,608 .

17 STATEMENT S) 1 2001 .08010 APGAR-BLACK FOUNDATION 99981 12070707 798008 9998

MANNER DATE ACQUIRED ACQUIRED DATE SOLD

PURCHASED

(D) (E) (F) EXPENSE OF

SALE DEPREC . GAIN OR LOSS

0 . 0 . -45,608 .


TOTAL TO FORM 990-PF, PART I, LINE 3, COLUMN A 6,456 .

18 STATEMENT S) 2 2001 .08010 APGAR-BLACK FOUNDATION 9998 1 12070707 798008 9998

FORM 590-PF INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT 2

SOURCE AMOUNT

HUDSON BANK 42 . MERRILL LYNCH 6,414 .


FORM 990-PF DIVIDENDS AND INTEREST FROM SECURITIES STATEMENT 3

COLUMN (A) AMOUNT

2,405 .

2,405 .

CAPITAL GAINS DIVIDENDS

0 .

0 .

GROSS AMOUNT

2,405 .

2,405 .

SOURCE

MERRILL LYNCH

TOTAL TO FM 990-PF, PART I, LN 4



TOTAL TO FORM 990-PF, PART I, LINE 11, COLUMN A -21,958 .


FORM 990-PF OTHER INCOME STATEMENT 4

DESCRIPTION AMOUNT

UNREALIZED GAINS -22,010 . MSCL 52 "


21 STATEMENT S) 5 12070707 798008 9998 2001 .08010 APGAR-BLACK FOUNDATION 9998 1

FORM X90-PF ACCOUNTING FEES STATEMENT 5

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE

DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES

ACCOUNTING 1,325 . 0 . 0 .

TO FORM 990-PF, PG 1, LN 16B 1,325 . 0 . 0 .


FORM 990-PF OTHER PROFESSIONAL FEES STATEMENT 6

EXPENSES NET INVEST-PER BOOKS MENT INCOME

8,833 . 8,833 .

8,833 . 8,833 .

(C) (D) ADJUSTED CHARITABLE NET INCOME PURPOSES

0 .


DESCRIPTION

INVESTMENT FEES

TO FORM 990-PF, PG 1, LN 16C

0 .


FORM X90-PF TAXES STATEMENT 7

(C) ADJUSTED

NET INCOME EXPENSES NET INVEST-PER BOOKS MENT INCOME

6 . 0 . 178 . 0 .

184 . 0 .

(D) CHARITABLE PURPOSES

0 . 0 .

0 .


DESCRIPTION

MSCL EXCISE

TO FORM 990-PF, PG 1, LN 18


FORM 990-PF U .S . AND STATE/CITY GOVERNMENT OBLIGATIONS STATEMENT 8

FAIR MARKET VALUE

85,997 .

85,997 .

U .S . OTHER DESCRIPTION GOVT GOV T

MERRILL LYNCH X

TOTAL U .S . GOVERNMENT OBLIGATIONS

TOTAL STATE AND MUNICIPAL GOVERNMENT OBLIGATIONS

TOTAL TO FORM 990-PF, PART II, LINE 10A

BOOK VALUE

85,997 .

85,997 .

85,997 . 85,997 .



FORM 990-PF CORPORATE STOCK STATEMENT 9

220,168 . TOTAL TO FORM 990-PF, PART II, LINE lOB 220,168 .


DESCRIPTION

MERRILL LYNCH

BOOK VALUE

220,168

FAIR MARKET VALUE

220,168 .


FORM 990-PF OTHER INVESTMENTS STATEMENT 10

TOTAL TO FORM 990-PF, PART II, LINE 13 12,812 . 12,812 .


DESCRIPTION

MERRILL LYNCH

BOOK VALUE

12,812 .

FAIR MARKET VALUE

12,812 .


27 STATEMENT S) 11 12070707 798008 9998 2001 .08010 APGAR-BLACK FOUNDATION 9998 1

FORM 990-Pfi LIST OF SUBSTANTIAL CONTRIBUTORS STATEMENT 11 PART VII-A, LINE 10

NAME OF CONTRIBUTOR ADDRESS

ALLEN D BLACK 42 RIVER ROAD PT PLEASANT PA 18950

Documents

FormC990-PF Return of Private Foundation ...990s.foundationcenter.org/990pf_pdf_archive/233/233024321/233024321... · b (Net~anullncomsor0ossl I fia Net py norposs)komsaleotusetsnoton