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Form 990-PF Return of Private Foundation OMB No 1 5 45- 0052

or Section 4947(a)(1) Nonexempt Charitable Trust


Department of the Treasury
Internal Revenue Service
I Note : The
Treated as a Private Foundation
ration may be able to use a copy of this return to satisfy state nspor 2004
For calendar year 2004, or tax year bE and

Name of organization A Employer identification number


Use the IRS
label .
Otherwise, CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027
print Number and street (or P O box number If mad Is not delivered to street address) Roorn'suice I B Telephone number
or type- 399 BOYLSTON STREET 617-778-7999
See Specific
City or town, state, and ZIP code C If exemption application is pending, check here 101 "
Instructions .
OSTON MA 02116 D 1 . Foreign organizations, check here
Z . Foreign organizations meadng the 85% test,
H Check type of organization O Section 501(c)(3) exempt private foundation check here and attach computation
Section 4947(a)(1) nonexempt charitable trust = Other taxable private foundation
E If private foundation status was terminated
I Fair market value of all assets at end of year J Accounting method' D Cash 0 Accrual under section 507(b)(1)(A), check here 01 =
(from Part ll, Col. (c), line 16) = Other (specify) F If the foundation is m a 60-month termination
111104 16 5 7 9 4 9 7 8 . (Part l, column (c) must be on cash basis) under section 507 b 1 B , check here . .
I loan I Analysis of Revenue and Expenses (a) Revenue and (b) Net investment (c) Adjusted net (d) Disbursements
(The total of amount in columns (b) (c), and (d) may not forcharitable purposes
necessarily equal the amounts m column (~ ~ expenses P8f books income income (cash basis only)

Contributions, gifts, grants, etc., received I 6865142 .1


Q Check lOHlMfoundation lsnotrequlradtoattach SchB
Interest on savings and temporary
cash Investments
- - .-
06610 .E 306610 .
4 Dividends and interest from securities . . _ 09518 . 1209518 .
5a Gross rents . . . . . .. . . . ..
b Net rental income or (lass)
Net galn or (loss) from sale of asset not on . . ..
sa line 10 . ...
Gross safes price for ell "
'e
d h assets on line Be . . .. . 215915195 .
7 Capital gain net Income (from Part IV, line 2) , , 
W °~ 8 Net short-term capital gain ..
,Z 9 Income modifications . . .. .. .. ...
Gross sales less returns
and allowances
b Less* Cost of goods sold .
U
c Gross profit or (loss)
11 Other income
12 Total. Add lines 1 throw h 1 i . .. . . .. . . 18204331 .E 11339189 .
1$ Compensation of officers, directors, trustees, etc.  54166 . 0. 54166 .
14 Other employee salaries and wages .
15 Pension plans, employee benefits . .. .. . . 7067 .
y 16a Legal fees . .. . . . .. . . . . Stmt . . 3. . . . 25284 . 12642 . 12642 .
d b Accounting fees . . . . Stmt 4 13000 . 13000 . 0 .
c Other professional fees StICit . .5 . ._ . 6107 . 0. 6107 .
.z 17 Interest . . . ._ . . .. .. .
Stmt 6 245460 . 0. 4792 .
dti~and
t de letion , , , 6373 . 0.
37200 . 0. 37200 .
1 ~Tr~yels~qq ~ ~ ran ~ rid meetings . . . 3946 . 0. 3946 .
c°'o 'Prihting an~d'pu ip~t ns . ... . . .. 198 . 0. 198 .
Stmt 7 8574 . 0. 8026 .
O~ 4 ~o~op~ti ig and . dmlnlstrative .. .
3through 23 . 407375 . 25642 . 134144 .
X 25 Contributions, gifts, grants paid ., .. 3 2 05 4 00 . 3205400 .
26 Total expenses and disbursements .
Add lines 24 and 25 3612775 . 25642 . 3339544 .
27 Subtract line 26 from line 12 :
8 Excess of revenue over expenses and disbursements 14591556 .
b Net Investment Income (if negative, enter -0-) . . . . . . 135471
. -- ---
c Adjusted net income (if negative, enter -o-> I
LHA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions . Form 990-PF (2004)
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13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
k

Z `

Form 990-PF(2004) CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Page 2
edschedules andamounts inthedescription Beginning of year End of year
Balance SFleetS column should betaendof-yearartwunlsonly.
(a)Book Value b) Book Value (c) Fair Market Value
1 Cash - non-interest-bearing 364 . 364 .
2 Savings and temporary cash investments .. 6238104 . 22145467 . 22145467 .
3 Accounts receivable
Less allowance for doubtful accounts
4 Pledges receivable
Less' allowance for doubtful accounts 1
5 Grants receivable .. .
6 Receivables due from officers, directors, trustees, and other
disqualified persons .... .
7 Other noles and loans receivable

Less . allowance for doubtful accounts


8 Inventories for sale or use . . . . . . . . . .
9 Prepaid expenses and deferred charges _ ... 11800 . 11800 . 11800 .
10a Investments - U .S . and state government obligations Stltlt 8 134211471 . 132812211 . 133503471 .
b Investments-corporate stock _ . . . . . . . . . . .StTCIt 9 2129470 . 2212930 . 10132836 .
c Investments - corporate bonds . .. . ... .. ... . .... .. . . . .. ... .. .. . ..
11 Imestrronts-Wnd,bulldnps,andequipment basis .. .

L .esS :accumulated depreciation .. ..... .. 1

12 Investments - mortgage loans . .. .. ... . .. ... ..... ..... ..


13 Investments - other . . . . . . . . . . . . . . . . ._ . . . . . ..
14 Land, buildings, and equipment : basis 1 95606 .
Lm: accumulated depreciation Stmt 10 00. 94566 . 1733 . 1040 . 1040 .
15 Other assets (describe " )

142592578 .1 1571
17 Accounts payable and accrued expenses . . ... , ... ... . ..... . . ..
18 Grants payable _ ..... .. ..... ...
19 Deferred revenue . . . .. . . . . . . . . .. .. . . . . .. . . . . . .. . . . . . . . . . .
20 Loans from officers, directors, trustee, and other diequalifled persons . . ., . . .. .,

20 21 Mortgages and other notes payable . .. . ... . .. .. ..


J 22 Other liabilities (describe 1110- Statement . . . 11 1300 . 78 .

c0 1 ula . naul . ..U. - uuw . i uuvu n cc .. .. . .. . .. . . . .. . . . .. . . . ..

Organizations that follow SFAS 117, check here ~ D


and complete lines 24 through 26 and lines 30 and 31 .
N
24 Unrestricted . . ..... . . . . --- . . . . . . . . . . . . . . . . . . . . . . . . .
a 25 Temporally restricted . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
m 26 Permanently restricted . .. . . .. .. ., . .... ... ..... . .... .
Organizations that do not follow SFAS 117, check here " D
and complete lines 27 through 81 .
,~° 27 Capital stock, trust principal, or current funds . .. ... ... . . . . . 29046392 . 29046392 .
28 Paid-in or capital surplus, or land, bldg ., and equipment fund 0. 0.
a 29 Retained earnings, accumulated income, endowment, or other funds .. . 113544886 . 128136442 .
Z 30 Total net assets or fund balances ... . ... .... .. . .. . . ..... ..... . 142591278 . 157182834 .

X 31 Total liabilities and net assets/tund balances . . 1 142592578 .1 157183812 .1


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 142591278 .
2 Enter amount from Part I, line 27a . . . . . .... . 2 14591556 .
3 Other increases not included in line 2 (itemize) " 8 0
4 Add lines 1, 2, and 3 . .. ... 4 157182834 .
5 Decreases not included in line 2 (itemize) " 5 0
8 Total net assets or fund balances at end of ear line 4 minus line 5 - Part II, column ( b ) , line 30 . . .. ... . . .. .. ... .. g 157182834 .
Form 990-PF (2004)
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13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
" Form 990-PF 2004 CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027
ftt 1V Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e .g ., real estate, (b, How acqw (c Date acquired (d) Date sold
2-story back warehouse ; or common stock, 200 shs . MLC Co .) ~mo ., day, yr.) I (mo ., day, yr .)
D - Donatioi
1a
e See Attached Statements

(f) Depreciation allowed I (p) Cost or other basis (h) Gam or (loss)
(e) Gross sales price
(or allowable) plus expense of sale (e) plus (f) minus (g)

215915195 .
omplete only for assets show! in column (h) and owned by the foundation on 12/31/69 (I) Gains (Col . (h) gain minus
(k) Excess of col . (i) col . (k), but not less than -0-) or
(J) Adjusted basis
(i) F.M .V as of 12/31169 as of 12/31/69 over col. (j), If any Losses (from col . (h))

9823061 .
If gain, also enter in Part I, line 7
2 Capital gain
9 net income or (net capital loss) . ~ If (loss), enter-0-in Part I, line 7 9823061 .
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 _____
[~V ~ Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
.. .. ..... . ..... . , . .. ... J N/A

(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? . . .. 0 Yes [XI No
If 'Yes,'the organization does not aualiiv under section 4940(e). Do not complete this part .
1 Enter the appropriate amount in each column for each year ; sae instructions before making any entries .
(b) Distribution ratio
Base period years Adjusted qualifying distributions Net value of noncharitable-use assets (col. (b) divided by col. (c))
Calendar ear or tax ear bem,nin in
2003 6809240 . 148563393 . .0458339
2002 7700592 . 139233371 . .0553071
2001 7929251 . 133023383 . .0596079
2000 I 8268194 .E 131336054 .E .0629545
,oaa 11687976 . 149443178 . .0782102

2 Total of line t, column (d) .. .. 2 .3019136


3 Average distribution ratio for the 5-year base period -divide the total online 2 by 5, or by the number of years
the foundation has been in existence if less than 5 years .... ... ...., . . ... .. . .... . .. ... . 8 .0603827

4 Enter the net value of noncharitable-use assets for 2004 from Part X, line 5 . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. . . . . 1 4 1 155208719 .

5 Multiply line 4 by line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... . .. ..... ... ..... ..... . . . .. .. ... . ..... . .. ... . ... .. .. .... 1 5 I 9371922 .

6 Enter 1% of net investment income (1% of Part I, line 27b) ... . .. . .. ..... ..... .... . .... ... . .. . ... 8 113135 .

7 Add lines 5 and 6 .... .... .. 7 9485057 .

8 Enter qualifying distributions from Part XII, line 4 . . . .  . ., . . . . . . . . . . . . . . . . . . . . .. . ... .. . ... . .. . ... . ~ 8 ~ 3345224 .

If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1 % tax rate .
See the Part VI instructions .
a2asziro1-a3-os Form 990-PF (2004)
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13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
Form 990-PF(2004) CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Pa9e4
fwk wt Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see instructions)
1 a Exempt operating foundations described in section 4940(d)(2), check here " 0 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, check here " E::] and enter 1 226271 .
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, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only . Others enter -0-) _ 2 0.
8 Add lines 1 and 2 a 226271 .
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 226271 .
6 Credits/Payments :
a 2004 estimated tax payments and 2003 overpayment credited to 2004 . . . .__ 6a 229917 .
b Exempt foreign organizations - tax withheld at source _ . . . . . . . . . . . . . . . . ,. .... , , 6b
c Tax paid with application for extension of time to file (Form 8868) . . . . . . . . . . ., ., . . . . . . . 6c
d Backup withholding erroneously withheld . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . ... . 8d
7 Total credits and payments . Add lines 6a through 6d . .... ..... ..... ..... .... , .. ..... ..... .. , . , . .. ... ... .. . . .. 229917 .
8 Enter any penalty for underpayment of estimated tax . Check here 0 if Form 2220 is attached . . .. _ . . . . __ 8
9 Tax due . If the total of lines 5 and 8 is more than line 7, enter amount owed  ., . ..... ..... .. .. ... . ... .. . . .. 1 9
10 Overpayment . If line 7 is more than the total of lines 5 and 8, enter the amour overpaid . . . . . . . . . . . . . . . . . . _. . . . , i0 3646 .
11 Enter the amount of line 10 to be : Credited to 2005 estimated tax " 3 6 4 6 . .Refunded 11 0 .

1 a During the tax year, did the organization attempt to Influence any national, state, or local legislation or did it participate or intervene in Yes No
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)? .... .. . . ._ 1b X
If the answer is "Yes" to 1 a or 1 b, attach a detailed description of the activities and copies of any materials published or
distnbuted by the organization in connection with the activities.
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 . " $ 0 . (2) On organization managers . " $ 0.
e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed on organization
managers . " $ 0.
2 Has the organization engaged in any activities that have not previously been reported to the IRS? ... . . ., . .... 2 X
If "Yes," attach a detailed description of the activities .
3 Has the organization made any changes, not previously 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? . . . . . .. ..... .. .. . ... _ . . . . N/A 4b
5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? . . . . . . . . . .. ... . ... 5 X
If "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 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 anytime during the yeas? , . ,._ . __ 7 X
If "Yes," complete Part ll, col. (c), and Part XV.
8a Enter the states to which the foundation reports or with which it is registered (see instructions)
DELAWARE, MASSACHUSETTS
b If the answer is "Yes" to line 7, has the organization famished a copy of Form 990-PF to the Attorney General (or designate)
of each state as required by General Instruction G? If "No," attach explanation . .. ..... ..... . .... .. .... .... . .. ... .. .. . ... . 8b X
9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendar
year 2004 or the taxable year beginning in 2004 (see instructions for Part XIV)? If "Yes," complete Part XIV . . . . . . . . . . . . . . . . .. 9 X
10 Did any persons become substantial contributors during the tax year? it 'Yes,' attach a schedule listing their names and addresses Stmt .12 lo X
11 Did the organization comply with the public inspection requirements for its annual retains and exemption application? .. .. .. 11 X
Web site address " N/A .. .. ..
12 The books are in care of " WELLESLEY CAPITAL MANAGEMENT, INC . Telephone no. " 7 81-2 35-610 7
Locatedat No- ONE WASHINGTON ST . SUITE 202, WELLESLEY, MA . ZIP+4 .02481
13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of form 1041 - Check here .. .. .... _. , . .. . ..... .. ..... .. _ . . 00. ED
and enter the amount of tax-exempt interest received or accrued durinfl the veer . . . ... . .. . 10- 1 is I N/A
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01-03-05 Form 990-PF (2004)
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13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
Form 990-PF(2004) CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Pages
Pill Vt1.B Statements 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. No
1 a During the year did the organization (either directly or indirectly):
~(1) Engage in the sale or exchange, or leasing of property with a disqualified persons ... ... .. ... 0 Yes OX No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person? . . . = Yes ~X No
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? . =Yes ~ No
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? , ___ _. ,. . .. . . . _ ~ Yes D 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 D 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 after
termination of government service, if terminating within 90 days .) . . . ., . ., . . . . . ., . . . . . . . . .. .... . . . . . _ . 0 Yes M No
b If any answer is 'Yes'to 1 a(1)-(6), did airy 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 page 20 of the instructions)? . . . . . . . . . . . . _ . . N/A 1
Organizations relying on a current notice regarding disaster assistance check here . . . . "0
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 thefirst dayofthetaxyear beginning in2004? . .. .. , .. . ..... ... .... . 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 4942(j)(3) or 4942(j)(5)) :
a At the end of tax year 2004, did the organization have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning
before 2004 .. . .. .... .. . . E-1 Yes OX No
If "Yes," list the years 100,
b Are there any years listed in 2a for which the organization is not applying the provisions 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 .) ... . ... . ... ... . .... ..... . .... ..... .., .. . .. . ... .. .N/A
c If the provisions of section 4942(a)(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 year? . . 0 Yes D No
b If 'Yes ; did it have excess business holdings in 2004 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 by the Commissioner under section 4943(c)(7)) to dispose
of holdings acquired by gift or bequest ; or (8) the lapse of the 10-,15-, or 20-year first phase holding period? (Use Schedule C,
Form 4720, to determine if the organization had excess business holdings in 2004 .) . . . ., . . . . . . . . . . . . . . . . . , N/A
4a Did the organization Invest during the year any amount in a manner that would jeopardize its charitable purposes? . . . . . . . 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 2004? 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))? . ., , . . .  , . . . . . . . ED Yes D No
(2) Influence the outcome of any specific public election (see section 4955) ; or to carry on, directly or indirectly,
any voter registration drive? , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  , , .  , . ., D Yes D No
(3) Provide a grant to an individual for travel, study, or other similar purposes? , ., . . . . . . ., . . . . , . ., . . . . . . . . . . . . . . EJ Yes EXI No
(4) Provide a grant to an organization other than a charitable, etc ., organization described in section
509(x)(1), (2) . or (3) . or section 4940(d)(2)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D Yes D 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? .. . ... , . ,. ... .. ...  ..... .. , ..... . .. . . . . . . . 0 Yes 0 No
b If any answer is 'Yes'to Sa(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)? . . . . . . . . ., ._ . . . . . . . . . . . . . . . . .N/A
Organizations relying on a current notice regarding disaster assistance check here . . . . . ., . . , . . . . . . .  . . . . , . . . . . . . . . . . . . . . . . ,1
c If the answer is 'Yes'to question 5x(4), does the organization claim exemption from the tax because it maintained
expenditure responsibility forthegrant? . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . , . . . . . . . . . . . . . . . . . . . . . . . . .N/A, _ 0 Yes = No
If "Yes, " attach the statement required by Regulations section 53.4945-5(~. .
6a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract? . . . . . 0 Yes 0 No
b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . . ... ... .. X
If you answered "Yes" to 6b, also file Form 8870.
Form 990-PF (200x)
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13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
' CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027
Information About Officers, Directors, Trustees, Foundation Managers, Highly Page s
Paid Employees, and Contractors
1 List all officers, directors, trustees, foundation managers and their compensation .
(b) Title, and average (c) Compensation (d~CoMnbu6onsto (e)Ex pense
(a) Name and address hours per week devoted (If not paid, °"'°'a~account, other
to aosition enter -0-1 como=uon allowances

See Statement 13 54166 .1 7067 .1 0.

2
Title and average (e) Expense
(a) Name and address of each employee paid more than $50,000 lours per week I (c) Compensation to I account, other
allowances
None

Total number of other employees paid over $50,000 _ .. _ . _ ..... ..... . "~ 0
3 Five highest-paid independent contractors for professional services . If none, enter "NONE ."
(a) Name and address of each person paid more than $50,000 of service (c) Compensation
None

Total number of others receiving over $50.000 for

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

oi3oa-'os Form 990-PF (2004)


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13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
Form 990-PF(2004) CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Page?
P,~1~~$ Summary of Program-Related Investments
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
1 N/A

All other program-related investments . See instructions .


8

Total. Add lines 1 through 3 , .__ .. . 11110. 1 Q ,

~ 1~ 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 . . . . . . . . . ..... . . ..... . . ... .. . . la 141009501 .
b Average of monthly cash balances . .. . ... . . 1b 16492803 .
c Fair market value of all other assets . . . . . .. ... .. 1c 70000 .
d Total (add lines 1a, b, and c) ... .. . _ . . 1d 157572304 .
e Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation) .. .. ._ . . . , . . . , . . . . . , ,  ,  , . . .  . . .,  1a 0 .
2 Acquisition indebtedness applicable to line 1 assets . . . . . . . ., . . . . . . . . . . . . . . . ., . . . . . . ., . . ., .  , . . . . . . . . . , . . ., . . . . .
2 ._ . ... . . 0 .
3 Subtract line 2 from line 1 d . . . . . . . . . . . 3 .. . , 157572304 .
4 Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see instructions) 4 .... . .. .. , 2363585 .
5 Net value of noncharitable-use assets . Subtract line 4 from line 3 . Enter here and on Part V, line 4 . . . . . . . . . . .
5 .. . .... .. , 155208719 .
8 Minimum Investment return . Enter 5% of line 5 . . . . . . . . . . . . . ..... ..... .. 6 . ... . . .. .. .. _ 7760436 .
=)a Dlstr'Ibutable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain
foreign organizations check here " = and do not complete this part.)
1 Minimum investment return from Part X, line 6 . . . . . . . .. ~ 7760436 .
2a Tax on investment income for 2004 from Part VI, line 5 . . . . . . . . . . . . . . . .. . ... 2a 226271* . -
b Income tax for 2004 . (This does not include the tax from Part VI .) . .   .  2b
c Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . ., . 2c 226271 .
8 Distributable amount before adjustments. Subtract line 2c from line 1 ., . . . . . . ., . . ., . . . .  . . . . . . . . . . . . . .  . . . ., .,  . .  . 3 7534165 .
4 Recoveries of amounts treated as qualifying distributions . . . . . . . . ..... ..... .. .. ... ... . .. .. . ..... .. ..... .. .. 4 0 .
5 Add lines 3 and 4 . . . , ., . . 5 7534165 .
8 Deduction from distributable amount (see instructions) . .. ... ..... .... . ... ..... ..... . . . . . . . . . . . . . . . ._ 8 0 .
7 Distributable amount as adjusted . Subtract line 6 from line 5 . Enter here and on Part XIII, line 1 .... . .. .. ., 7 7534165 .

Qualifying Distributions (see instructions)

1 Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes :


a Expenses, contributions, gifts, etc. -total from Part t, column (d), line 26 . . . . . . . .,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 3339544 .
h Program-related investments-total from Part IX-8 , . . . . . ., . . . ., . . . 1111
2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc ., purposes . . . . . . . . . . . . . . . . . . 2 5680 .
3 Amounts set aside for specific charitable projects that satisfy the :
a Suitability test (prior IRS approval required) . . . . .. .. ... . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . , . . . ., . . . . . 8a
b Cash distribution test (attach the required schedule) . . . . . . . . .. .. ..... . . . . . . . . . . . . . . ., ., . . , . , . . . _ . . . 36
4 Qualifying distributions . Add lines is through 3b . Enter here and on Part V, line 8, and Part XIII, line 4 . . . . . . .. . 4 3345224 .
5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment
income . Enter 1% of Part I, line 27b . . .... 5 0 . ..
6 Adjusted qualifying distributions . Subtract line 5 from line 4 . . ., . . . . . . . . . . . . ., . .  . ., .  , ., . . ., . . ., . . . . . . . . . . . . . . . . . . . . . . .
8 3345224 .
Note: The amount on line 6 will 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.
Form 990-PF (2004)

423561
01-03-05

13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
Form 990-PF(2004) CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Page B
Undistributed Income (see instructions)

(b) I W
Corpus Years prior to 2003 2003 2004
1 Distributable amount
for 2004 from Part XI, line 7 7534165 .
2 Undistributed Income, if any, as of the end of 2003-

a Enter amount for 2003 only . ... ..


6 Total for prior years :
0.
3 Excess distributions carryover, If any, to 2004:
a From 1999 . . 5624189 .
b From 2000 . 1793675 .
c From 2001 1514910 .
d From 2002 1054439 .
e From 2003
f Total of lines 3a through e . . .... 9987h3 .
4 Qualifying distributions for 2004 from . . . {,
Part Xll,line 4: " $ 3345224 .
a Applied to 2003, but not more than line 2a 0.
b Applied to undistributed income of prior
years (Election required -see instructions) 0.
c Treated as distributions out of corpus
(Election required - see instructions) .. 0.
d Applied to 2004 distributable amount . . . . . 3345224 .
e Remaining amount distributed out of corpus 0.
5 Excess distributions carryover applied to 2004 8941 . 4188941 .
Of an amount appears in column (d), the same artiounf
must be shown in column (e) )

8 Enter the net total of each column as


Indicated below:
8 Corpus Add lines 3f, 4o, and 4e Subtract line 5 5798272 .
b Prior years' undistributed income . Subtract
line 4b from line 2b . ... .. .... 0 .1
1" ;
c Enter the amount of prior years
undistributed income for which a notice of ` . ... .` "
deficiency has been issued, or on which
the section 4942(a) tax has been previously
assessed 0.
d Subtract tine 6c from line 6b . Taxable
amount -ses instructions . . . . . . . . . . . ... . 0.
e Undistributed income for 2003 . Subtract line
4a from line 2a Taxable amount - see instr . 0.
t Undistributed income for 2004 . Subtract
lines 4d and 5 from line 1 . This amount must
be distributed in 2005 0.
7 Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(E) or 4942(g)(3) 0. + f
8 Excess distributions carryover from 1999
not applied on line 5 or line 7 1435248 .
9 Excess distributions carryover to 2005 .
Subtract lines 7 and 8 from line 6a . .... 4363024 .
10 Analysis of line 9
a Excess from 2000 1793675 .
b Excess from 2001 1514910 .
c Excess from 2002 1054439 . . '
d Excess from 2003

Form 990-PF (2004)


423571
01-03-OS

13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
. ' .

Form 990-PF 2004 CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 9
Private Operating Foundations (see instructions and Part VII-A, question 9) N/A
1 a If the foundation has received a puling or determination letter that it is a private operating
foundation, and the ruling is effective for 2004, enter the date of the ruling . . . . . . . . . . . . . ._ _ o. L
b Check box to indicate whether the organization is a p rivate o eratin foundation described in section . 142(o)(3) or El 4942(i)(5)
2 a Enter the lesser of the adjusted net Tax ear Prior 3 years
income from Part I or the minimum (a) 2004 (b) 2003 (c) 2002 (d) 2001 (e) Total
investment return from Part X for
each year listed
b 85% of line 2a
c Qualifying distributions from Part XI I,
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
for 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)
b "Endowment" alternative test - enter
2/3 of minimum investment return
shown m Part X, line 6 for each year
listed . .
c "SupporPalternative 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 provided in
section 4942(j)(3)(B)(iii) . . . .
(8) Largest amount of support from
an exempt organization . ....

~~ 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 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) .)
See Statement 14
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 which the foundation has a 10% or greater interest .
None
2 Information Regarding Contribution, Grant, Gin, Loan, Scholarship, etc., Programs :
Check here " X if the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds 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:

b The form in which applications should be submitted and Information and materials they should include :

c Any submission deadlines :

d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors :

azass1/oi-a3-os Form 990-PF (2004)


9
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
a2aso1ro1-oa-o5 Form 990-PF (2004)
10
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND
' .
Form 990-PF(2004) CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Page 11
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated . unreiatea ousmess income Excluded b section 512 513 ors1a
(a) (b) ~~~_ (d) Related or exempt
Business
1 Program service revenue : code Amount i°"
9code Amount function income
a
b
c
d
e
f
g Fees and contracts from government agencies . .. .
2 Membership dues and assessments . . . . . . . . .
3 Interest on savings and temporary cash ..
investments 14 306610 .
a Dividends and interest from securities 14 1209518 .
5 Net rental income or (loss) from real estate.
a Debt-financed property .. .... ...
b Not debt-financed property ... ... ... .. .. ..
6 Net rental income or (loss) from personal
property
7 Other investment income
8 Gain or (loss) from sales of assets other
than inventory ... ..... ..... .. .... . .. ... .. . 18 9823061 .
9 Net income or (loss) from special events ._ . .. ... .. ._
10 Gross profit or (loss) from sales of inventory . . . . ..
11 Other revenue :
a
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e) ... . .. . ... 0 . ,_, 11339189 . 0.
13 Total . Add line 12, columns (b), (d), and (e) . . . . . . . . . . . . . . . . . . ..... ..... . ___,_ _ . ._ .... .. . .. . . .. .. . .. 13 11339189 .
(See worksheet in line 13 instructions to verify calculations .)

Relationship of Activities to the Accomplishment of Exempt Purposes

01303-05 Form 990-PF (2004)


11

13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
Form 990-PF (2004) CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Pag e 12
t1 Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations
1 Did the organization directly or indirectly engage in any of the following with any other organization described m section 501(c) of Yes NO
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 .. ., , . . . 11a ( l ) X
(2) Otherassets .. . . . . .. . ..... ... . .. X
b Other transactions .
(1) Sales of assets to a noncharitable exempt organization _ . ., . . _ . . . . . ._ . . 1b (i ) X
(2) Purchases of assets from a noncharitable exempt organization .. . . . . 1b 2 X
(3) Rental of facilities, equipment, or other assets ._ . . . .. . .__ . ' .. . . . 1b 13 )
(4) Reimbursement arrangements .. . . .. .. .. ... .. . .. 1b 4 X
(3) loans or loan guarantees . ..... .. .. . ... .. .. .. ... . .. ..... .... . . .... . 1b 5 X
(6) Performance of services or membership orfund raising solicitations . . . . , . , . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . .. .. . . 1b 6 X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees . , . . . . . . . . . . . . . . . . . . ... . .. .. . .. . _. 11 C X
d If the answer to any of the above is 'Yes," complete the following schedule . Column (b) should always show the fair market value of the goods, other assets,
or services given by the reporting organization . If the organization received less than fair market value in any transaction or sharing arrangement, show in

2a Is the organization directly or indirectly affiliated 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? . . .... .... .... .. ... .. .. .. . .. .. . . =Yes [XI No

Name of of of

Under penalties of per~y8y(~pe~laro ~t I have er oluding mpanying schedules end statements, and to the best of my knowledge and ballet, it is true, correct,
and complete DeGar~tlqfi a~reparer other than is bas on all Information of whictrpreparer has any knowledge ,

N(sCtR1

m , Signature of office or trustee


Preparer's'
°' :-' signature
2-
y ao,m Rnn'snamecoryours KONIGS OL CO .,
a ~ itsair-empioyeul, 6440 PARK AVENUE SOUTH
aad~ss, mdz~coao NEW YORK . N .Y . 10016

423621
01-0
.3-05

13120608 788779 fnd 2004 .05002


' .
Schedule B Schedule of Contributors OMB No 1545-0047
(Form 990, 990-EZ, or

2004
990-PF) Supplementary Information for
Department of the Treasury line 1 of Form 990, 990-EZ, and 990-PF (see instructions)
Internal Revenue Service
Name of organization Employer identification number

CARL & RUTH SHAPIRO FAMILY FOUNDATION -6135027


Organization type (check one):

Filers of: Section :

Form 990 or 990-EZ 0 501(c)( ) (enter number) organization

0 4947(a)(1) nonexempt charitable trust not treated as a private foundation

0 527 political organization

Form 990~PF OX 501(c)(3) exempt private foundation

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

D 501(c)(3) taxable private foundation

Check If your organization is covered by the General Rule or a Special Rule. (Note: Only e section 501(c)(1), (8), or (10) organization can check boxes
for both the General Rule and a Special Rule-see instructions.)

General Rule-

For organizations filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from anyone
contributor . (Complete Parts I and II .)

Special Rules-

For a section 501(c)(3) organization filing Form 990, or Form 990~EZ, that met the 331/3% support test of the regulations under
sections 509(a)(1)/170(b)(1)(f)(v) and received from any one contributor, during the year, a contribution of the greater of $5,000 or 2°r6
of the amount on line 1 of these forms . (Complete Parts I and II .)

D For a section 501(c)(7),(8), or (10) organization filing Form 990, or Form 990~EZ, that received from anyone 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 anyone contributor, during the year,
some contributions for use exclusively for religious, charitable, etc ., purposes, but these contributions did not aggregate to more than
$1,000 . (If 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
nonexclusively 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 8 (Form 990, 990-EZ, or 990-PF), but
they must check the box in the heading of their Form 990, Form 990-EZ, or on line 2 of their Form 990-PF, to certify that they do not meet the filing
requirements of Schedule 8 (Form 990, 990-EZ, or 990-PF).

LHA For Paperwork Reduction Act Notice, see the Instructions Schedule B (Form 990, 990-EZ, or 990-PF) (2004)
for Form 990, Form 990-EZ, and Form 990-PF.

423451 11-24-04

13
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
Sched le B (Forth 990, 990-EZ, or 990-PFD (2004)
Scheou Page 1 of 1 of Part I
Name of organization Employer Identification number

CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027


1 liOf1vIDUiOfS (see speclTlc instructions .)

(a) (b) (c) (cQ


No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution
SHAPIRO FAMILY FIVE YEAR CHARITABLE
1 LEAD TRUST Person
Payroll 0
C/O ONE WASHINGTON STREET, STE . 202 $ 3267884 . Noncash 0
(Complete Part II if there
WELLESLEY, MA 02481 is a noncash contribution .)

(a) (b) (c) (c)


No . Name, address, and ZIP + 4 Aggregate contributions Type of contribution
SHAPIRO FAMILY TEN YEAR CHARITABLE
2 LEAD STRUST Person FT
Payroll 0
C/0 ONE WASHINGTON STREET, STE . 202 $ 2083491 . Noncash
(Complete Part II if there
WELLESLEY, MA 02481 is a noncash contribution .)

(a) (b) (c) (cn


No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution
SHAPIRO FAMILY FIFTEEN YEAR CHARITABLE
3 LEAD TRUST Person FT
Payroll Q
C/O ONE WASHINGTON STREET, STE . 202 $ 1513767 . Noncash 0
(Complete Part II if there
WELLESLEY, MA 02481 is a noncash contribution .)

(a) (b) (c) (d)


No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution

Person
Payroll
Noncash 0
(Complete Part II if there
is a noncash contribution .)

(a) (b) (c) (d)


No . Name, address, and ZIP + 4 Aggre ate contributions Type of contribution

Person
Payroll Q
Noncash
(Complete Part II if there
is a noncash contribution .)

(a) (b) (c) (CO


No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution

Person 0
Payroll 0
$ Noncash 0
(Complete Part II if there
is a noncash contribution .)
423452 11-24-04 Schedule B (Form 990, 990-EZ, or 990-PF) (2004)
14
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
Continuation for 990-PF, Part IV
" CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Page 1 of 4
JN Cap ital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold, e.g , real estate, (b How acquired (c Date acquired (d) Date sold
" 2-story brick warehouse, or common stock, 200 shs. MLC Co ~- se ~mo , day, yr ) (mo , day, yr )
D - DPurchaonation
U7,795 000 US T-BILL DUE 2/19/04 P 12/04/0301/08/04
b 87,060,000 U5 T-BILL DUE 2/19/04 P 09/18/0301/08/04
c 35,000'SHS MILLIPORE CORP . P 01/05/0402/02/04
d45,000 SHS MILLIPORE CORP . P 01/06/0402/02/04
e 80 000 SHS AMR CORP . P 01/05/0402/09/04
f10 , 000 5HS AMR CORP . P 01/05/0402/09/04
75 , 000 SHS AMR CORP . P 01/06/0402/09/04
h75 , 000 SHS PRICELINE .COM INC P 01/06/0402/11/04
125,000 SHS PRICELINE .COM INC P 01/05/0402/11/04
i45 , 000 SHS PRICELINE .COM, INC P 01/05/0402/11/04
k75,000 SHS ZIMMER HOLDINGS P 01/05/0402/11/04
1 5 , 000 SHS ZIMMER HOLDINGS P 01/06/0402/11/04
m50,000 SHS ZIMMER HOLDINGS P 01/06/0402/11/04
n 50 000 SHS XEROX P 01/05/0402/12/04
o25 , 000 SHS XEROX P 01/05/0402/12/04
(f) Depreciation allowed (p) Cost or other basis (h) Gain or (loss)
(e) Gross sales price (or allowable) plus expense of sale (e) plus (f) minus (g)
a 7780855 . 7780345 . 510 .
b 86711127 . 86695219 . 15908 .
c 1826650 . 1508150 . 318500 .
d 2348550 . 1925100 . 423450 .
e 1284000 . 1044000 . 240000 .
t 159900 . 130500 . 29400 .
1199250 . 975000 . 224250 .
n 1829250 . 1426500 . 402750 .
609750 . 474750 . 135000 .
1116000 . 854550 . 261450 .
k 5902500 . 5191500 . 711000 .
1 393500 . 342600 . 50900 .
m 3932000 . 3426000 . 506000 .
n 763000 . 688500 . 74500 .
0 381500 . 342500 . 39000 .
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Losses (from col. (h))
(1) Adjusted basis (k) Excess of col. (i) Gains (excess of col. (h) gain over col. (k),
(i) F.M.V as of 12/31/69 as of 12/31/69 over col . (1), if any but not less than '-0-')
510 .
b 15908 .
318500 .
423450 .
240000 .
f 29400 .
224250 .
n 402750 .
135000 .
261450 .
711000 .
i 50900 .
506000 .
n 74500 .
0 39000 .
If gain, also enter in Part I, line 7 1 .. ..... .. .
2 Capital gam net income or S net capital loss) ' ~ (floss), enter'-Vin Part f, line 7 1 ""'
S Net short-term capital gain or (loss) as defined in sections 1222(5) and (6) :
If gain, also enter m Part I, line 8, column (c) .
If (loss), enter'-0= in Part I, line 8 . . .. .. . . .. .... ,. . . .... ..... ..... ....  g

a2assl
05-01-04
15
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
Continuation for 990-PF, Part IV
CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Page 2 of 4
PIVCapital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold, e g., real estate, (bLHow acqwred (c? Date acquired (d) Date sold
2-story back warehouse ; or common stock, 200 shs . MLC Co. ~' - Purchase
D - Donation I o ,day, yr) (mo., day, yr )
1a 35 , 000 SH5 XEROX P 0 1/05/04 0 2/13/04
b 70 000 SH5 YAHOO INC P 01/05/0402/13/04
c85 , 000 SH5 CHIRON CORP P 01/05/0402/18/04
d14 , 300 , 000 US T-BILL DUE 3/111/04 P 12/11/0302/18/04
e 60,000 SH5 QLOGIC CORP . P 01/05/0402/23/04
f72 , 000 SHS HALIBURTON CO . P 01/05/0402/24/04
0 83 , 000 SHS HALIBURTON CO . P 01/05/0402/24/04
h65,000 SH5 QUALCOMM INC . P 01/05/0402/24/04
152,000 SHS QUALCOMM INC P 01/05/0402/24/05
1 90 , 000 SHS ABERCROMBIE & FITCH P 01/05/0402/25/04
k 80 000 SHS ABERCROMBIE & FITCH P 01/05/0402/25/04
12,600,000 US T-BILL DUE 2/26/04 P 09/25/0302/26/04
M50,000 SHS ELECTRONIC DATA SYS CORP P 01/05/0402/27/04
n 40 000 SHS ELECTRONIC DATA SYS CORP P 01/05/0402/27/04
020 , 000 SHS ELECTRONCI DATA SYS CORP P 01/05/0402/27/04
(e) Gross sales price (0 Depreciation allowed (p) Cost or other basis (h) Gain or (loss)
(or allowable) plus expense of sale (e) plus (f) minus (g)
a 535500 . 479500 . 56000 .
b 3336200 . 3189200 . 147000 .
c 4343500 . 4804200 . -460700 .
d 14268207 . 14268254 . -47 .
e 2566200 . 3119400 . -553200 .
t 2220480 . 1871280 . 349200 .
2572170 . 2159660 . 412510 .
n 4022850 . 3496350 . 526500 .
1 3225040 . 2799680 . 425360 .
2739600 . 2094300 . 645300 .
k 2440000 . 1864800 . 575200 .
1 2589106 . 2589106 . 0 .
m 947500 . 1240500 . -293000 .
n 758000 . 990800 . -232800 .
0 379800 . 495400 . -115600 .
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Losses (from col. (h))
(1) pAdjusted basis (k) Excess of col. (i) Gains (excess of col . (h) gain over col . (k),
(~)i F.M.V. as of 12/31/69 as of 12/31/69 over col. (j), if any but not less than '-0=)
a 56000 .
b 147000 .
c -460700 .
d -47 .
a -553200 .
t 349200 .
412510 .
n 526500 .
i 425360 .
645300 .
k 575200 .
i 0.
m -293000 .
n -232800 .
o -115600 .
If gain, also enter in Part I, line 7 1
g ain net income or ( net ca p ital loss ) ~~ ~~~ { If (loss), enter'-0= in Part I, line 7
2 Capital 9

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 .. .. .. ..  .. .. , g

423591
05-01-04
16
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
r Continuation for 990-PF, Part IV
J ' CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Page 3 of 4
1VCapital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold, e.g., real estate, (b How acquired (c Date acquired (d) Date sold
2-story brick warehouse ; or common stock, 200 shs . MLC Co. ~ - Purchase lmo., day, yr.) (mo., day, yr.)
D - Donation
1a 80,000 SHS SPX CORP . P 01/05/04 0 2/27/0 ;f
tT-92,000 SHS BOSTON SCIENTIFIC P 01/05/0403/01/04
c75,000 SHS BOSTON SCIENTIFIC P 01/05/0403/01/04
d19 , 500 SHS FEDERAL EXPRESS P 01/05/0403/01/04
e75,000 SHS NCR CORP . P 01/05/0403/01/04
f 90,000 SHS TRANSOCEAN SEDCO P 01/05/0403/02/04
75,000 SHS TR.ANSOCEAN SEDCO P 01/05/0403/02/04
n 60 000 SHS AETNA INC . P 01/05/0403/02/04
75,000 SHS AETNA INC . P 01/05/0403/02/04
65 000 SHS CAREMARK RX INC . P 01/05/0403/02/04
k55,000 SHS CAREM.ARK RX INC P 01/05/0403/02/04
1 50 , 000 SHS CAREMARK RX INC P 01/05/0403/02/04
m50 000 SHS DELTA AIRLINES INC P 01/05/0403/03/04
n 40 000 SHS DELTA AIRLINES INC . P 01/05/0403/03/04
0 85 , 000 SHS JP MORGAN CHASE P 01/05/0403/03/04
(0 Depreciation allowed (p) Cost or other basis (h) Gam or (loss)
(e) Gross sales price (or allowable) plus expense of sale (e) plus (f) minus (g)
a 3364000 . 4660000 . -1296000 .
b 3867680 . 3307400 . 560280 .
c 3163500 . 2706000 . 457500 .
d 1334580 . 1326390 . 8190 .
e 3427500 . 2931750 . 495750 .
t 2808000 . 2106000 . 702000 .
2336250 . 1748250 . 588000 .
n 4834800 . 3949800 . 885000 .
i 6075000 . 4942500 . 1132500 .
2107950 . 1592500 . 515450 .
k 1774850 . 1353000 . 421850 .
1 1613500 . 1221000 . 392500 .
m 449500 . 597500 . -148000 .
n 359600 . 476400 . -116800 .
0 3550450 . 3106750 . 443700 .
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Losses (from col. (h))
(1) Adjusted basis (k) Excess of col. (i) Gains (excess of col. (h) gain over col. (k),
(I) F.M V as of 12/31/69 as of 12/31/69 over col. (j), if any but not less than ~-O--)
-1296000 .
b 560280 .
457500 .
8190 .
e 495750 .
t 702000 .
588000 .
n 885000 .
i 1132500 .
515450 .
k 421850 .
t 392500 .
m -148000 .
n -116800 .
o 443700 .
If gain, also enter ~n Part I, line 7 1
2 Capital 9am net income or C net capital loss)) -- ~ Ifloss), 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 gam, also enter in Part I, line 8, column (c) .
If (loss), enter'-O-" in Part I, line 8 . . . .  , ., . . . . . . . . .

423591
05-01-04
17

13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
Continuation for 990-PF, Part IV
CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Page 4 of 4
` PIV_ Capttal Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold, e g , real estate, (b, How acquired (C 1 Date acquired (d) Date sold
P - Purchase
2-story brick warehouse ; or common stock, 200 shs. MLC Co . D - Donation (mo ., day, yr .) (mo, day, yr.)

to 95,000 SHS APPLE COMPUTERS P 01/05/0403/04/04


b5,000 SHS ALTERA CORP . P 01/05/0403/09/04
c 90,000 SHS ALTERA CORP . P 01/05/0403/09/04
d 65,000 SHS ALTERA CORP . P 01/05/0403/09/04
e95,000 SHS EMULUX CORP . X1/05/0403/09/04
f 50,000 SHS NIKE INC . P 01/05/0403/09/04

(f) Depreciation allowed (g) Cost or other basis (h) Gain or (loss)
(e) Gross sales price (or allowable) plus expense of sale (e) plus (~ minus (g)

a 2288550 . 2068150 . 220400 .


b 105450 . 115600 . -10150 .
c 1898100 . 2077200 . -179100 .
d 1375400 . 1502800 . -127400 .
e 2155550 . 2660000 . -504450 .
t 3843000 . 3375500 . 467500 .

omplete only for assets in column (h) and owned by the foundation on 12/31/69 (1) Losses (from Col. (h))
(k) Excess of Col. (i) Gains (excess of Col . (h) gain over Col . (k),
(1) Adjusted basis
(I) F.M .V . as of 12/31/69 but not less than '-0-")
as of 12/31/69 over Col. (j), if any
a 220400 .
-10150 .
-179100 .
-127400 .
-504450 .
467500 .

1
k

(
2 Capital gain net income or (net capital loss) - If loss),~entert 0 'nin art I~ line 7 ) "' ""' 9823061 .
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6) :
If gain, also enter m Part I, line 8, column (c) .
If (loss), enter %02 in Part I, line 8 . . .. . . . . . .. . . . . . . . .. . . .. . . . .. . . ., . . . . .. . . . N/A

423591
05-Ot-04
18

13120608 788779 fnd 2004 .05002 CARL & RUTH 3HAPIRO FAMILY FND 1
2004 DEPRECIATION AND AMORTIZATION REPORT ,
Form 990-PF Page 1 990-PF

w
Asewt Date Unadjusted Bus % Reduction In Basis For Accumulated Current Amount Of
Descri ption Acquired Method Life No Cost Or Basis Excl Basis Depreciation Depreciation Sec 179 Depreciation

1 FURNITURE AND FIXTURE 121502 OOD .00 17 8228 . 8228 . 0.

2. DPT ICE EQUIPMMT 8 02-.20GDB5 .00 17 1290 . 1290 . 04


11
3 FURNITURE AND FIXTURE 121502 OOD .00 17 13944 . 13944 . 0.

A.FURNITURE AND -FIXTURES 1215 2.200D:. .00, 17 4882 1841 . .304141 1308* 693,.

5 FFICE RENOVATION 0 11203 2 00D .00 17 31637 . 31637 . 0.

W"ICE -EQUXPMW '200 .00 17 -60 36, 6036

7 FURNITURE AND FIXTURE 41703 OOD .00 17 9000 . 9000 . 0 .

9 FURNITURE AND FIXTURE 80403 OOD .00 17 7464 . 7464 . 0.

10 FUMITURE rIXTURES 6:6 19 04 2000 .5 .00 19M 5680*:. 5680 . 5680*: 5680
Total 990-PF Pg 1
ear 95606 . 92565 . 3041 . 1308 . 5680 . 6373 .

iaosoa (D) -Asset disposed " ITC, Section 179, Salvage, Bonus, Commercial Revitalization Deduction

19
" , CARS & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027

Form 990-PF Interest on Savings and Temporary Cash Investments Statement 1

Source Amount

BANK - INTEREST ON SAVINGS 12 .


BANK - TEMPORARY CASH INVESTMENT 306598 .

Total to Form 990-PF, Part I, line 3, Column A 306610 .

Form 990-PF Dividends and Interest from Securities Statement 2

Capital Gains Column (A)


Source Gross Amount Dividends Amount

BANK - GOVT BONDS & T-BILLS 77500 . 0 . 77500 .


BANK - MMKT ACCTS 137 . 0 . 137 .
BANK - MMKT ACCTS 1956 . 0 . 1956 .
BROKER - CORP DIVIDENDS 133040 . 0 . 133040 .
BROKER - GOVT BONDS & T-BILLS 996885 . 0 . 996885 .

Total to Fm 990-PF, Part I, In 4 1209518 . 0. 1209518 .

Form 990-PF Legal Fees Statement 3

(a) (b) (c) (d)


Expenses Net Invest- Adjusted Charitable
Description Per Books ment Income Net Income Purposes

LEGAL FEES 25284 . 12642 . 12642 .

To Fm 990-PF, Pg 1, In 16a 25284 . 12642 . 12642 .

Form 990-PF Accounting Fees Statement 4

(a) (b) (c) (d)


Expenses Net Invest- Adjusted Charitable
Description Per Books ment Income Net Income Purposes

ACCOUNTING FEES 13000 . 13000 . 0 .

To Form 990-PF, Pg 1, In 16b 13000 . 13000 . 0 .

20 Statement s) 1, 2, 3, 4
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
`CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027

Form 99Q-PF Other Professional Fees Statement 5

(a) (b) (c) (d)


Expenses Net Invest- Adjusted Charitable
Description Per Books ment Income Net Income Purposes

PROFESSIONAL CONSULTANTS 6107 . 0 . 6107 .

To Form 990-PF, Pg 1, In 16c 6107 . 0 . 6107 .

Form 990-PF Taxes Statement 6

(a) (b) (c) (d)


Expenses Net Invest- Adjusted Charitable
Description Per Books ment Income Net Income Purposes

ANNUAL FRANCHISE TAX 25 . 0. 0.


PAYROLL TAXES 4482 . 0. 4483 .
FEDERAL INCOME TAX 240456 . 0. 0.
STATE UNEMPLOYMENT TAXES 309 . 0. 309 .
IRS PENALTIES 188 . 0. 0.

To Form 990-PF, Pg 1, In 18 245460 . 0. 4792 .

Form 990-PF Other Expenses Statement 7

(a) (b) (c) (d)


Expenses Net Invest- Adjusted Charitable
Description Per Books ment Income Net Income Purposes

ANNUAL FEES 548 . 0. 0.


TELEPHONE/INTERNET 2884 . 0. 2884 .
BUSINESS INSURANCE 2410 . 0. 2410 .
MISCELLANEOUS EXPENSES 107 . 0. 107 .
COMPUTER SOFTWARE CHARGES 1139 . 0. 1139 .
OFFICE SUPPLIES 1486 . 0. 1486 .

To Form 990-PF, Pg 1, In 23 8574 . 0. 8026 .

21 Statement s) 5, 6, 7
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
CARS & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027

Form 990-PF U .S . and State/City Government Obligations Statement 8

U .S . Other Fair Market


Description Govt Govt Book Value Value

US TREASURY BILLS X 128812211 . 129523471 .


FEDERAL HOME LOAN BANK NOTES X 4000000 . 3980000 .

Total U .S . Government Obligations 132812211 . 133503471 .

Total State and Municipal Government Obligations

Total to Form 990-PF, Part II, line 10a 132812211 . 133503471 .

Form 990-PF Corporate Stock Statement 9

Fair Market
Description Book Value Value

COMMON & PREFERRED STOCKS 2212930 . 10132836 .

Total to Form 990-PF, Part II, line lOb 2212930 . 10132836 .

Form 990-PF Depreciation of Assets Not Held for Investment Statement 10

Cost or Accumulated
Description Other Basis Depreciation Book value

FURNITURE AND FIXTURES 8228 . 8228 . 0.


OFFICE EQUIPMENT 1290 . 1290 . 0.
FURNITURE AND FIXTURES 13944 . 13944 . 0.
FURNITURE AND FIXTURES 4882 . 3842 . 1040 .
OFFICE RENOVATION 31637 . 31637 . 0.
OFFICE EQUIPMENT 6036 . 6036 . 0.
FURNITURE AND FIXTURES 9000 . 9000 . 0.
FURNITURE AND FIXTURES 7445 . 7445 . 0.
FURNITURE AND FIXTURES 7464 . 7464 . 0.
FURNITURE AND FIXTURES 5680 . 5680 . 0.

Total To Fm 990-PF, Part II, In 14 95606 . 94566 . 1040 .

22 Statement s) 8, 9, 10
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
',CARh & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027

Form 990-PF Other Liabilities Statement 11

Description Amount

PAYROLL TAXES - WITHHELD 978 .

Total to Form 990-PF, Part II, line 22, Column B 978 .

Form 990-PF List of Substantial Contributors Statement 12


Part VII-A, Line 10

Name of Contributor Address

CARL SHAPIRO 2 NORTH BREAKERS ROW #45, PALM BEACH, FL


33480
RUTH SHAPIRO 2 NORTH BREAKERS ROW #45, PALM BEACH, FL
33480
SHAPIRO FAMILY FIVE YEAR CHARITABLE C/0 ONE WASHINGTON ST, STE 202, WELLESLEY,
LEAD TRUST MA 02481
SHAPIRO FAMILY TEN YEAR CHARITABLE C/O ONE WASHINGTON ST, STE 202, WELLESLEY,
LEAD TRUST MA 02481
SHAPIRO FAMILY FIFTEEN YEAR C/O ONE WASHINGTON ST, STE 202, WELLESLEY,
CHARITABLE LEAD TRUST MA 02481

23 Statement s) 11, 12
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
r
CAkB & RUTH SHAPIRII -FAM-ILK FOUNDATION 04-6135027

Form 990-PF Part VIII - List of Officers, Directors Statement 13


Trustees and Foundation Managers

Employee
Title and Compen- Ben Plan Expense
Name and Address Avrg Hrs/Wk sation Contrib Account

CARL SHAPIRO CHAIRMAN


2 N . BREAKERS ROW 20 0 . 0. 0 .
PALM BEACH, FL 33480

RUTH SHAPIRO SECRETARY & TREAS . & TRSTE


2 N . BREAKERS ROW 4 0 . 0 . 0 .
PALM BEACH, FL 33480

RHONDA ZINNER PRESIDENT


C/o 399 BOYLSTON STREET 20 0. 0 . 0 .
BOSTON, MA 02116

ELLEN JAFFE TRUSTEE


c/o 399 BOYLSTON STREET 4 0. 0 . 0.
BOSTON, MA 02116

LINDA WAINTRUP TRUSTEE


C/o 399 BOYLSTON STREET 4 0 . 0 . 0.
BOSTON, MA 02116

JEAN S . WHITNEY PROGRAM DIRECTOR


112 WOODRIDGE ROAD 32 54166 . 7067 . 0 .
WAYLAND, MA 01778

Totals included on 990-PF, Page 6, Part VIII 54166 . 7067 . 0.

Form 990-PF Part XV - Line la Statement 14


List of Foundation Managers

Name of Manager

CARL SHAPIRO
RUTH SHAPIRO

24 Statement s) 13, 14
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
The Carl and Ruth Shapiro Family Foundation - 2004 Grants and Contributions

o~-6i3s oar s~, .,m~~- #~s


Recipient Name Status Relationship Program Area Pur pose of Grant Amount

Amer. Friends of Israel Phil. Orchestra Public Charity None Arts & Culture Operating Support I $5,000

Amer. Friends of Livnot U'lehibanot Public Charity None Jewish Interests Operating Support $1,000

American Cancer Society Public Charity None Health Operating Support $20,000

American Friends of Hebrew U. Public Charity None Education Operating Support $10,000

American Friends of Israel Museum Public Charity None Arts & Culture Operating Support $10,500

American Jewish Committee Public Charity None Jewish Interests Operating Support $10,000

American Society for Technion Public Charity None Education Operating Support $10,000

Anti-Defamation League Public Charity None Education Operating Support $110,000

ARMDI - Magen David Public Charity None Health Operating Support $10,000

Arthritis Foundation Public Charity None Health Operating Support $2,500

Artists for Humanity Public Charity None Arts & Culture Youth Development $20,000

Associated Grant Makers Public Charity None Membership $8,900

Association of Small Foundations Public Charity None Membership $400

BaIletRox --Public Charity None Arts & Culture Youth Development $12,000

Barry Price Rehabilitation Center Public Charity None Human Services Operating Support ' $4,000

Beth Israel Deaconess Medical Ctr. Public Charity None Health Research/Education $50,000

Bethel AME Church Public Charity None Arts & Culture Youth Development $20,000

Boston Medical Center Public Charity None Health Project Support $25,000

Boston Symphony Orchestra Public Charity None Arts & Culture Operating Support $25,000

Brain Tumor Society Public Charity None Health Operating Support $10,000

Brandeis University Public Charity None Education Scholarships $52,000

Breast Cancer Research Fdn . Public Charity None Health Operating Support $5,000

Brigham & Women's Hospital Public Charity None Health Capital $300,000

Brigham 8 Women's Hospital Public Charity None Health Research/Education $51,500

Grimmer and May School Public Charity None Education Operating Support $50,000
The Carl and Ruth Shapiro Family Foundation - 2004 Grants and Contributions

0
Recipient Name Status Relationship Program Area Pur ose of Grant Amount

Cambridge Arts Council P ublic Charity None Arts & Culture Operating Support I $2,500

Center for Creative Education Public Charity None Arts & Culture Youth Development $15,000

Center for Family Services Public Charity None Human Services Operating Support $5,000

Center for Information and Crisis Public Charity None Human Services Operating Support $2,200

Children's M useum Public Charity None Arts & Culture Operating Support $2,500

Children's Place at Home Safe Public Charity None Human Services Project Support $20,000

City Stage Public Charity None Arts & Culture Youth Development $10,000

Coalition for Ind . Living Options Public Charity None Human Services Disability Services $20,000

Com bined Jewish Philanthropies Public Charity None Jewish Interests Operatin g Support $204,000

Community Art Center Public Charity None Arts & Culture Youth Development $15,000

Community Music Center Public Charity None Arts & Culture Youth Development $20,000

Crohn's & Colitis Fdn. of America Public Charity None Health Operating Support $5,000

Cystic Fibro sis Public Charity None Health Research/Education $20,000

Dana Farber Cancer Institute Public Charity None Health Research/Educat ion $50,000

Facing History and Ourselves Public Charity None Education Ope rating Support $10,000

Hadassah Public Charity None Jewish Interests Operating Support $5,000

Harvard Grad. School of Education Public Charity None Education Operating Support $2,500

Hebrew Rehab Center for the Aged Public Charity None Jewish Interests Project Support $12,500

Hospice of Palm Beach County Public Charity None Human Services Operating Support $25,000

Jewish Adoption & Foster Care Public Charity None Jewish Interests I Operating Support $5,000

Jewish Community Center Public Charity None Jewish Interests Operating Support $100

Jewish Fam ily 8 Children's Service Public Charity None Jewish Interests Project Support $1,800

Jewish Fed . of Palm Beach Public Charity None Jewish Interests Operating Support $ 100,000

Jewish Guild for the Blind Public Charity None Jewish Interests Operating Support $5,000

Jewish Home for Aged of PBC Fdn. Public Charity None Jewish Interests Project Support $20,000
`- The Carl and Ruth Shapiro Family Foundation - 2004 Grants and Contributions

o - 6135_O a Sno
Recipient Name Status Relationship Program Area Purpose of Grant Amount

Jewish Theological Seminary Public Charity None Jewish Interests Operating Support $12,350

Joslin Clinic Public Charity None Health Project Support $50,000

Kennedy Cntr . For the Pert. Arts Public Charity None Arts & Culture I Operating Support $10,000

Kravis Performing Arts Public Charity None Arts & Culture Capital $200,000

Kravis Performing Arts Public Charity None Arts & Culture Operating Support $45,750

Lafayette College Public Charity None Ed ucation Operating Support $1,000

Leukemia and Lymphoma Society Public Charity None Health Research/Education $110,000

Mass . Eye and Ear Foundation Public Charity None Health Operating Support $2,000

Mela noma Foundation Public Charity None Health Operating Support $10,000

Muse um of Fine Arts Public Charity None Arts & Culture Capita! $690,000
~-

Museum of Fi ne Arts Public Charity None Arts & Culture Operating Support $20,000
T
National Council on Spinal Cord Injury Public Charity None Health Operating Support $5,000

Norton Museum Public Charity None Arts & Culture Capital $140,000

Norton Muse um Public Charity None Arts & Culture Operating Support $ 120,000

NYU_ Hospitals Center Public Charity ~ None Health Project Support $28,500

Palm Beach Opera Public Charity None Arts & Culture Operating Support $25,000

Palm Beach Public Schools Public Charity None Education Operating Support $500

Palm He althcare Fdn.l H.O .W. Public Charity None Health Proj ect Support $20,000

Park School Public Charity None Education Operating Support r $35,000

PB Community Chest United Way Public Charity None Human Services Operating/Program Support $105,000

PB_C ounty PBAI Cops for Kids Public Charity None Human Services Operating Support $15

PB Friends of M uscular Dystrophy Assoc Public Charity None Health I Operating Support I $10,000

Planned Parenthood Public Charity None Health Operating Support $2,500

Preservation Foundation Public Charity None Arts & Culture Operating Support $7,000

Project STEP Public Charity None Arts & Culture Youth Development $7,500
It

The Carl and Ruth Shapiro Family Foundation - 2004 Grants and Contributions

b ~3So a7 S ~r #i~
Recipient Name Status Relationshi p Program Area Purpose of Grant Amount

Reha b Cntr . for Children/Adults Public Charity None Health Operating Support $10,000

Sarah Lawrence College Public Charity None Education Operating Support $2,500

Scenarios USA Public Charity None Human Services Operating Support $5,000

So ciety of Four Arts Public Charity None Arts & Culture Operating Support $2,500
I
Spaulding Rehabilitation Hospital Public Charity None Health Operating Support $11,000

Temple Emmanu-El Public Charity None Jewish Interests Operating Supp ort $785

Te mple Israel Public Charity None Jewish Interests Operating Supp ort $3,600

Topf Center for Dance Education Public Charity None Arts & Culture Youth Development $20,00 0

Trin ity College Public Charity None Education Operating Support $3,000

U .S . Holocaust Memorial Museum Public Charity None Arts & Culture Operating Support $5,000

United Way of MA Bay Public Charity None Human Services Project Support $10,000

Un iversity of Pennsylvania Public Charity None Education Operating Support $1,000

Urban Improv Public Charity None Human Services Operating Support $15,000

Wang Center Public Charity None Arts & Culture Operating Support $5,000

Washington Institute - Public Charity None Education Operating Supp ort $10,000
--

Wellesley College Public Charity None Education Project Support $5,000

Wellness Community Public Charity None Health Operating Support $10,000

WGBH Public Charity None Education Operating Supp ort $6,000

Winsor School Public Charity None Education Operating support $2,000

ZUMIX Public Charity None Arts & Culture Youth Development ' $20,000

TOTAL CHARITABLE GIVING : I $3,205,400


'.

4562
OMB No 1545-0172

" ' Forth Depreciation and Amortization 99o-pF


DepsrtmentoftheTreasury (Including Information on Listed Property) z
Attachment
Internal Revenue Service 1 See separate instructions . 1 Attach t0 your tax return . Sequence No 67
Name(s) shown on realm Business or activity to which this forth relates Identifying number

CARL & RUTH SHAPIRO FAMILY FOUNDATION orm 990-PF Pa ge 1 04-6135027


fPWt I Election To Ex p ense Certain Pro p erty Under Section 179 Note: If you have an listed property, complete Part V before you complete Part I .
1 Maximum amount . See instructions for a higher limit for certain businesses .. . .. 7 10200F.
2 Total cost of section 179 property placed in service (see instructions) 2 5680 .
3 Threshold cost of section 179 property before reduction in limitation 3 410000 .
4 Reduction in limitation . Subtract line 3 from line 2 . If zero or less, enter -0- . . . . 4 0 .
5 Dollar Ilmitabon for [ax year. Subtract line 4 horn line 1 . If zero or less, enter -0-. If married filing separately, see Instructions 5 102000 .
(a) Description of property (b) Coat (business use only) (c) Elected coat
FURNITURE AND FIXTURES 5680 . 5680 .

7 Listed property. Enter the amount from line 29 . . . .


8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 . . . . . . . . . . . . _ . . . _ . . 8 5680 .
9 Tentative deduction . Enter the smaller of line 5 or line 8 . ., . . . . . . . . . . . . . . ., , . . ._ . . . . . . . . . . ., ., . . . . . . . _ . 9 5680 .
10 Carryover of disallowed deduction from line 13 of your 2003 Form 4562 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Business income limitation . Enter the smaller of business income (not less than zero) or line 5 . . . . . . . . . . . 11 102000 .
12 Section 179 expense deduction . Add lines 9 and 10, but do not enter more than line 11 12 5680 .
13 Carryover of disallowed deduction to 2005 . Add lines 9 and 10, less line 12 . . . " 13
Note : Do not use Part 11 or Part 111 below for listed property. Instead, use Part V.

14 Special depreciation allowance for qualified property (other than listed property) placed In service during the tax year (see Instructions) . , . ,
15 Property subject to section 168(fl(7) election (see instructions) . . . . , , . . .. . . . .. . . . , . . . . . . .. .. , .. .. ...
18 tether depreciation (including ACRS) (sae instructions) .. . . .. . .. . . . .. . . . . ... . .. ..

17 MACRS deductions for assets placed in service in tax years beginning before 2004 . . . . . . . . . . . ... 3.
18 If you are electing under section 168(1)(4) to group any assets placed in service during the tax
year into one or more general asset accounts, check here . . . . . . . . .. . . . . . ... . .. .. ..
Cae-finn R . Accnic Dlsb~~rl in Carvfns Aurinn 9flflA Twr V^Ar I lcinn fNa nanarnl no
(b) Month and (c) Beak for depreciation (d) Recovery
(a) Classification of properly year placed (business/investment use (e) Convention I (q Method (g) Degradation deduction
period
In service only - see Instructions)

.. rY. .

25 vrs. I I S/L

h Residential rental property


27 .5 vrs. I MM I S/L

i Nonresidential real property


I MM I s/L I
Section C - Assets Placed in Service 2004 Tax Year the Alternative Depreciation System
~a Class life
b 12~vear ` ° f 12
40
Summary (See instructions .)
21 Listed property . Enter amount from line 28 ._ ... ... . . ., .. . .. . .. 21
22 Total . Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21 .
Enter here and on the appropriate lines of your return . Partnerships and S corporations ~ see instr . 22 6373 .
23 For assets shown above and placed in service during the current year, enter the
rtion of the basis attributable to section 283A costs . . . . . .. . . .. . . . . . . . .. . .. . . . . F23T
416251
4
LHA For Paperwork Reduction Act Notice, see separate instructions. Form 4582 (2004)
25
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
H
Form 4562 (2004) Page 2
~ Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used for entertainment,
recreation, or amusement .)
Note : For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b, columns (a)
through (c) of Section A, ell of Section B, and Section C if applicable.
Section A - Depreciation and Other Information (Caution: See instnictlons for limits for passenner automobdes.l

(a) ~~~ (cn X81 (fl (9) (h) G)


Type of property Date Business/ Basis roe depreciation Elected
placed in investment Cost or (business/investment Recovery Method/ Depreciation
section 179
(list vehicles first ) (b)
service use percentage other basis 9, only) period Convention deduction
cost
25 Special depreciation allowance for qualified listed property placed in service during the tax

27 Property used 50% or less in a qualified business use :


11

28 Add amounts in column (h), lines 25 through 27 . Enter here and on line 21, page 1 _ _ . .. . 28
29 Add amounts in column 01 , line 26 . Enter here and on line 7, page 1  . . . . ., . . . . . . . . .  ._, . , . ., . . . , . .... __ . .
Section B - Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other 'more than 5% owner,' or related person .
If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for
those vehicles.

(e) I (b) I (C) I 41111 I (e) I lfl


30 Total busmesslinvestment miles driven during the
year (do not include commuting miles) . . . . . . . .
31 Total commuting miles driven during the year . . .
32 Total other personal (noncommuting) miles
driven
33 Total miles driven during the year.
Add lines 30 through 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34 Was the vehicle available for personal use
during off-duty hours? .. . .. .. ..
35 Was the vehicle used primarily by a more
than 5% owner or related person? .. . .. ..
38 Is another vehicle available for personal
use? - - ---- ~ - - -- --
Section C - questions for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5%
owners or related arsons.
37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your Yes N
employees? . . . .... .
38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See instructions for vehicles used by corporate officers, directors, or 1 % or more owners , . . . . . . . . ._
39 Do you treat all use of vehicles by employees as personal use? .. .. . .. . . . . ... . ... _ . .. ..
40 Do you provide more than five vehicles to your employees, obtain information from your employees about
the use of the vehicles, and retain the information received? , ... ... , ... , . ., . .. ... .. .. _ .. ..... ..
41 Do you meet the requirements concerning qualified automobile demonstration use? .  . ., . . . , . . .  . . . . , . . . . . . . , . . . ., ., . . . . ,
Note: Ifyour answer to 37, 38, 39, 40, or 41 is "Yes, " do not complete Section B for the covered vehicles.
Amortization
cap
Description of cosb
(b)
DaSOamorlhaban
I c~~
Amortlzable
I Code
c~ I ce>
MaNzaGon
I ~fl
Amortization
Mains amount section period pr paCentaae for this year

Amortization of costs that begins during your 2004 tax near :

43 Amortization of costs that began before your 2004 tax year


as Total . Add amounts in column (fl . See instructions for where to . . . . . I 44
476252/11-15-04 Form 4582 (2004)
26
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
1

4562
0MB No . 1545-0172

2004
A ,` ,

Depreciation and Amortization


DepartmentottheTreasury (Including Information on listed Property) Attachment
Internal Revenue Service 1 See separate instructions . 1 Attach to your tax return . Sequence No. 87
Name(s) shown on return Business or activity to which this forth relates Identifying number

X04-6135027
Pon I Election To Expense Certain Property Under Section 179 Note : If you have an listed property, complete Part V before you coi Part I.
1 Maximum amount . See instructions for a higher limit for certain businesses .. _ ._ . .. .. ..
2 Total cost of section 179 property placed in service (see instructions) .. ,. ..
3 Threshold cost of section 179 property before reduction in limitation
4 Reduction in limitation . Subtract line 3 from line 2. If zero or less, enter -0- _
5 Dollar limitation for tax year Subtract line 4 from line 1 If zero or less, enter -0-, If martied filing separately, see Instructions .. rJ
(a) Description of property (b) Cost (business use only) (c) Elected cost

7 Listed property. Enter the amount from line 29 . ..... .. . .. . . .... . . . ... .. , . .. I 7 I
8 Total elected cost of section 179 property . Add amounts in column (c), lines 6 and 7 . . . . . . . . . . . . . . . .. . . ...
9 Tentative deduction . Enter the smaller of line 5 or line 8 . . . . .... ..... ..... .... ... , .. .. . ..
10 Carryover of disallowed deduction from line 13 of your 2003 Form 4562 ..... .... ... ... . .. . .. . ...
11 Business income limitation . Enter the smaller of business income (not less than zero) or line 5 . . .. . . . .. .
12 Section 179 expense deduction . Add lines 9 and 10, but do not enter more than line 11 . . . . . . . . . . . ., . .
13 Carryover of disallowed deduction to 2005. Add lines 9 and 10, less line 12 . . " 13
Note: Do not use Part 11 or Part 111 below for listed croQertv. Instead. use Part V.

14 Special depreciation allowance for qualified properly (other than listed prop") placed In service during the tax year (see Instructions) , . _ 14
15 Property subject to section 168(fl(1) election (see instructions) . . . . . . . . . . . . . . . . . . . , . . . . . . ., . . . . . . . . . . . . . . . . . . . . . _ . 15
18 Other dep reciation ncludin ACRS see instructions . . . . . . . . . . . . . . 18
MACRS Depreciation (Do not include listed property .) (See instructions.)
Section A
17 MACRS deductions for in
assets placed service in tax years beginning before 2004 . . . . . . . . . . . . . . . . . . . . . . . 17
18 If you are electing under section 168()(4) to group any assets placed in service during the tax

(b) Month end (c) Basis fir depreciation (d) Recovery


(s) Classification of properly year pieced (buslness/InvssUnentuae (a) Convention I (n Method I (g) Depreciation deduction
period
In service only - sea Instructions)

19a

1 . "t.
' if~ h ~'lni.
r f

27 .5 vrs . I MM I S/L
h Residential rental property

MM I S/L
i Nonresidential real property

Section C - Assets Placed in Service 2004 Tax Year Using the Alternative
,a Class life
b 12-year `
c 40-veer / s 40 vrs. I MM I S/L
Summary (See instructions .)
21 fisted property. Enter amount from line 28 . . . . ., . . ., . ., . . . . . . . . . . . . . . .. .. , . ... , . ... . .. ... . 21
22 Total . Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21 .
Enter here and on the appropriate lines of your return . Partnerships and S corporations - see instr . . .. .. . ... 22
23 For assets shown above and placed in service during the current year, enter the
ortion of the basis attributable to section 263A costs . ... . .. . . . .. . . . .. . . . .. ... 23
41625 4
LHA For Paperwork Reduction Act Notice, see separate instructions . Form 4562 (2004)
27
13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1
f r
h
Form 4562 (2004) Page 2
Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used for entertainment,
recreation, or amusement .)
` Note: For any vehicle for which you are using the standard mileage cafe or deducting lease expense, complete only 24a, 24b, columns (a)
through (c) of Section A, all of Section 8, and Section C if applicable.
Section A - Depreciation and Other Information (Caution : See instructions for limits for passenger automobiles.)
24a Do you have evidence to su ort the businesslnvestment use claimed? Yes 0 No 24b If 'Yes ' is the evidence written? ~ Yes 0 No
(a) ~b~ (c) (c) (e) (~1 (9) (h)
Date Business! Basis fordeproclatlon Elected
Type of property Cost or Recovery Method/ Depreciation
(list vehicles fast ) p laced in investment
other basis (buslnesa/lnvestment
period Convention deduction section 179
service use percentage use only) COSH
25 Special depreciation allowance for qualified listed property placed in service during the tax

business use:

27 Prooertv used 50% or less in a

28 Add amounts in column (h), lines 25 through 27 . Enter here and on line 21, page 1 ..... .. .. . 28
29 Add amounts in column (), line 26 . Enter here and on line 7, page 1 , . . . . . . . . . .. . . __ . . . . .__ . . , ,. .. .. ,... 2g
Section B - Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other 'more than 5% owner,' or related person .
If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for
those vehicles .

I (b) I (c) I (d) I (e) I (fl


30 Total business/investment miles driven during the
year (do not include commuting miles) . . . . . . . . .
31 Total commuting miles driven during the year . . .
32 Total other personal (noncommuting) miles
driven . . . . . . . . . . . . . . . ....
33 Total miles driven during the year.
Add lines 30 through 32 . . . . . . . . . . . . . . . . . . . . . . .
34 Was the vehicle available for personal use
during off-duty hours? , ...  .. ..
35 Was the vehicle used primarily by a more
than 5% owner or related person?  . . , ., . . . .
38 Is another vehicle available for personal

Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5%

37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your
employees?  , . . . . . ,  ., .
38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See instructions for vehicles used by corporate officers, directors, or 1 % or more owners . . . . . . . ., .
39 Do you treat all use of vehicles by employees as personal use? . . . . . . . . . . . . . . . .
40 Do you provide more than five vehicles to your employees, obtain information from your employees about
the use of the vehicles, and retain the information received? . . . . . ., . ., . . . . , . , . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . .
41 Do you meet the requirements concerning qualified automobile demonstration use? , , .  . . , ,
Note: If your answer to 37, 38, 39, 40, or 41 is "Yes, " do not complete Section B for the covered vehicles.
Amortization
(e) (b) I (C) I (CQ I (e)
Description ofcosts Damortarbadm Amortizable Code Amailvb Amortization
heolns amount section oellodorcem for this veer

42 Amortization of

43 Amortization of costs that began before your 2004 tax year . . . . . . . . . . . . . . . . . . . ... . .. .. .. .... . .. . . . . . ..
44 Total. Add amounts in column ft See instructions for where to report . ._ . . . . . .. .. .. . .
416252/11-15-04 Form 4582 (2004)
as
13120608 788779 fnd 2004 .05002 CARL & RUTH 5HAPIRO FAMILY FND 1
Form $8S$ Application for Extension of Time To File an
(Rev. December 2004)
Exempt Organization Return OMB No. 1545-1709
Departrwt of the Treasury
Internal Revenue Service 00, File a for each return .

" If you are filing for an Automatic 3-Month Extension, complete only Part t and check this box . . . . . .. . . . . . . . . . . . .  , . . . . . ., . ., . . . . . . . . . . . . . . ., ., . . . . . " D
" If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part Fl (on page 2 of this form).
Do not complete Part 11 unless you have already been granted an automatic 3-month extension on a previously filed Form 8868 .

LV `t:~J Automatic 3-Month Extension of Time - only submit original (no copies needed

Form 990-T corporations requesting an automatic 6-month extension " check this box and complete Part I only .. .. ,... . . . ... ... _ . .. " D

All other corporations Including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax
returns . Partnerships, REMICs, and busts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041 .
Electronic Filing (e-fife) . Form 8868 can be filed electronically if you want a 3-month automatic extension of time to file one of the returns noted
below (6 months for corporate Form 990-T filers) . However, you cannot file it electronically ff you want the additional (not automatic) 3-month
extension, instead you must submit the fully completed signed page 2 (Part II) of Form 8868. For more details on the electronic filing of this form,
visit www.irs .gov/efile.
Type or Name of Exempt Organization Employer identification number
print
CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027
Rio by Cro
due date for Number, street, and room or suite no . If a P.O . box, see instructions .
flling your 399 BOYLSTON STREET
return. See
Instructions. City, town or post office, state, and ZIP code . For a foreign address, see Instructions .
BOSTON . MA 02116

Check type of return to be filed (file a separate application for each return) :

Form 990 1--] Form 990-T (corporation) D Form 4720


0 Forth 990-BL 0 Form 990 "T (sec . 401(a) or 408(a) trust) E::] Form 5227
0 Form 990-EZ 0 Form 990-T (trust other than above) Q Form 6069
~X Form 990-PF [::] Form 1041-A 0 Form 8870

" The books are in the care of " WELLESLEY CAPITAL MANAGEMENT, INC .
Telephone No. " 781-235-6107 FAX No.
If the organization does not have an office or place of business in the United States, check this box . ..... ..... .. .. ..... .. .. . ..... .. . .. .. . ... ... " D
If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN . If this is for the whole group, check this
box " ID . If it is for part of the group, check this box 1110E::1 and attach a list with the names and EINs of all members the extension will cover.

1 I request an automatic 3-month (6-months for a Form 990-T corporation) extension of time until August 15, 2005
to file the exempt organization return for the organization named above . The extension is for the organization's return for:
" ~X calendar year 2 0 0 4 or
tax year beginning , and ending

2 If this tax year is for less than 12 months, check reason : 0 Initial return D Final return D Change in accounting period

3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6089, enter the tentative tax, less any
nonrefundable credits . See instructions ... ... . .. .. . . ... . .. ..... ..... ........ .. ..... .. ....... ..... . . ..... .. .... ....... ..... .. .. ..... .... . $ 226271 .

b If this application is for Form 990-PF or 990"T, enter any refundable credits and estimated
tax payments made . Include any prior year overpayment allowed as a credit . . . . . . . . . . . . . . . . . . ., . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . $ 229917 .

c Balance Due. Subtract line 3b from line 3a . Include your payment with this form, or, if required, deposit with FTD
coupon or, if required, by using EF7P5 (Electronic Federal Tax Payment System). See instructions ...... .. .. .... . ..... $ 0

Caution. If you are going to make an electronic fund withdraws! with this Form 8888, see Form 8453-EO and Form 8879~E0 for payment instructions .

LHA For Privacy Act and Paperwork Reduction Act Notice, see instructions. Form 8888 (Rev. 12-2004)

423831
01-10-05
29
15470510 788779 fnd 2004 .05002 CARL & RjJTH GHApTR(1 FAM7T .v FMTn 1

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