Form' 990'PF Department of the Treasury Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation Note- The oraanizolion may be able to use o coov of this return to satisfy state reoortino re 4 ror caiondar oar zooa or tax oar do Innin and onCin G Check all that a pp ly Initial return Final return Amended return UsothoIRS Name of organization label FUND FOR LIFE FOUNDATION INC . Otherwise . pint Number and street Spr P .O . box number If moll 10 not delivered to street address) Room/uulio or typo . 1428 36TH STREET 200 Soo Specific City or town . state . and ZIP code Instructions . BROOKLYN NY 11218 H Chock typo of organization : X Soction 501(c)(3 exempt private foundation Soctfon 494 % 0 1 nonexem t charltoble trust Other taxable rivato foundation I Address change ~ ~ Name Ch A Employer Identification number 11-3239215 B Telephone number (800 page 10 of the Instructions) C If exemption application to pending . chock hero D 1 . Foreign org(1niYollonp, Chock hero 2 . Foreign orgnnlxnflonn mooting olio 85% lost, chock hero and allach computation E if private foundation status was terminated under section 507(b)( 1)(A) . chock horn I Fair market value of all assets at end J Accounting method Cash X Accrual F u the foundation is in n do-morns iorminnUon of year (from Part II, coy (c), 1 :1 Other (seedy) under section so7(b)(i)(a), mock here t line 16 111 $ 12 0 0 8 7 8 4 Part 1column d must be on cash bass `P6rt I Analysis of Revenue and Expenses (The (a) Revenue and total of amounts In columns (b), (c), & (d) may not necessarily expenses per (b) Net investment books Income eq ual the amounts In column a see pag e 11 of the Instr 1 Contributions . gifts, grants. etc., received (attach schedule) 3 , 265 , 796 2 Check 1 F] If the foundation Is not required to attach Sch B 3 Interest on savings and temporary cash Investments 166 , 318 166 , 318 4 Dividends and interest from securities 302 302 5a Gross rents 14 750 14 750 R b (Net rental income or (loss) -24,508 e 6a Not galN(loss) from sale of assets not on In 10 o b Gross sales price for ell assets on line 8a n 7 Capital gain net Income (from Part IV, line 2) ' " 8 Net short-term ca p ital g ain : ,,, . . . . . . . . . . . ¬; £'3 .' " '' e 9 Income modifications 10a Gross soles loss returns and ollowancos IM t, "' A b Less . COST OF goods 601d c Gross profit or (loss) (attach schedule) `_I :>~~~~~I "o v :Swel % 11 Other income (attach schedule) 12 Total . Add pines I throu g h 11 . , . . . , , , , 3 , 447 , 166 181 , 370 A 13 Compensation of officers, directors, trustees, etc . d m 14 Other employee salaries and wages I 15 Pension plans, employee benefits " 1sa Legal tees (attach schedule) SEE STMT 1 5 , 405 5 , 405 Accounting tees (attach schedule) STMT 2 1 500 s t c Other professional fees (att . schedule) r r 17 Interest . . Imm on 14 n t the Instr > STMT 3 7 543 I ( tile) 8 epletion STMT 4 18 , 540 18 , 540 t 9 DR~ ~ Y 1.. V n v 0 ~' U 15 , 313 15 , 313 Tr I erences, and ~ n s ~a E Pr a bl' s Qn z 3 ~ STMT 5 1 , 627 , QM 0d Q 4 o a I In s ratlve expenses . n 49 928 39 , 258 Q 25 Contributions, gifts, grants paid 551 , 840 s 26 Total ex penses and disbursements Add lines 24 and 25 601 768 3 9 258 (d) Disbursements (c) Adjusted net for charitable Income purposes cash basis on fi . h k +~ ,~ 166 318 ~''~ '2 r17 s 14 750 s r ~a,'a F~, \w : ZJ ~t'S ~ 2?s x ~. <. 181, 3 7 0 T . ffi 1, 500 7, 543 1,627 10,670 551,840 562,510 Form 990-PF (zoom 39 27 Subtract line 26 horn line 12 a Excess of revenue over expenses and disbursements 2 , 845 , 3 98 UJI Z b Net Investment Income (if negative, enter -0-) 142 112 c Ad j usted net income if negative, enter -0- 142 , 112 Q U For Privacy Act and Paperwork Reduction Act Notice, see the instructions . DAA 5020A 11/11 /2005 2 35 PM y 5,40 0 18,54 15,313 9
Transcript
Form' 990'PF
Department of the Treasury
Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust
Treated as a Private Foundation Note- The oraanizolion may be able to use o coov of this return to satisfy state reoortino re
4
ror caiondar oar zooa or tax oar do Innin and onCin G Check all that app ly Initial return Final return Amended return
UsothoIRS Name of organization
label FUND FOR LIFE FOUNDATION INC . Otherwise .
pint Number and street Spr P.O . box number If moll 10 not delivered to street address) Room/uulio
or typo . 1428 36TH STREET 200
Soo Specific City or town . state . and ZIP code
Instructions . BROOKLYN NY 11218
H Chock typo of organization : X Soction 501(c)(3 exempt private foundation Soctfon 494 % 0 1 nonexem t charltoble trust Other taxable rivato foundation
I Address change ~ ~ Name Ch A Employer Identification number
11-3239215
B Telephone number (800 page 10 of the Instructions)
C If exemption application to pending . chock hero
D 1 . Foreign org(1niYollonp, Chock hero
2 . Foreign orgnnlxnflonn mooting olio
85% lost, chock hero and allach computation
E if private foundation status was terminated
under section 507(b)( 1)(A) . chock horn I Fair market value of all assets at end J Accounting method Cash X Accrual F u the foundation is in n do-morns iorminnUon
of year (from Part II, coy (c), 1:1 Other (seedy) under section so7(b)(i)(a), mock here t line 16 111 $ 12 0 0 8 7 8 4 Part 1column d must be on cash bass `P6rt I Analysis of Revenue and Expenses (The (a) Revenue and
total of amounts In columns (b), (c), & (d) may not necessarily expenses per (b) Net investment books Income
eq ual the amounts In column a see pa ge 11 of the Instr
1 Contributions . gifts, grants. etc., received (attach schedule) 3 , 265 , 796 2 Check 1 F] If the foundation Is not required to attach Sch B 3 Interest on savings and temporary cash Investments 166 , 318 166 , 318 4 Dividends and interest from securities 302 302 5a Gross rents 14 750 14 750
R b (Net rental income or (loss) -24,508 e 6a Not galN(loss) from sale of assets not on In 10 o b Gross sales price for ell assets on line 8a n 7 Capital gain net Income (from Part IV, line 2) ' "
8 Net short-term cap ital g ain : ,,, . . . . . . . . . . . ¬; £'3 .' " '' e 9 Income modifications 10a Gross soles loss returns and ollowancos IM t, "'A b Less . COST OF goods 601d
c Gross profit or (loss) (attach schedule) `_I:>~~~~~I "o v:Swel % 11 Other income (attach schedule) 12 Total . Add pines I through 11 . , . . . , , , , 3 , 447 , 166 181 , 370
A 13 Compensation of officers, directors, trustees, etc . d m 14 Other employee salaries and wages I 15 Pension plans, employee benefits " 1sa Legal tees (attach schedule) SEE STMT 1 5 , 405 5 , 405
Accounting tees (attach schedule) STMT 2 1 500 s t c Other professional fees (att . schedule)
r r 17 Interest . .
Imm on 14 n t the Instr > STMT 3 7 543 I ( tile) 8 epletion STMT 4 18 , 540 18 , 540 t 9
DR~ ~ Y 1.. V n v 0 ~' U 15 , 313 15 , 313 Tr I erences, and ~ n s
~a E Pr a bl' s Qn z 3 ~ STMT 5 1 , 627
, QM 0d Q 4 o a I In s ratlve expenses . n 49 928 39 , 258 Q 25 Contributions, gifts, grants paid 551 , 840 s 26 Total expenses and disbursements Add lines 24 and 25 601 768 3 9 258
(d) Disbursements (c) Adjusted net for charitable
Income purposes cash basis on
fi . h k +~ ,~
166 318 ~''~ '2 r17 s
14 750 s r ~a,'a F~,
\w : ZJ
~t'S ~ 2?s
x ~. <.
181, 3 7 0 T. ffi
1, 500
7, 543
1,627
10,670 551,840 562,510
Form 990-PF (zoom
39 27 Subtract line 26 horn line 12
a Excess of revenue over expenses and disbursements 2 , 8 4 5 , 3 98 UJI Z b Net Investment Income (if negative, enter -0-) 142 112
c Adjusted net income if negative, enter -0- 142 , 112 Q U For Privacy Act and Paperwork Reduction Act Notice, see the instructions .
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5020A 11/1112005 2 35 PM _, Paae 2 11-3239215
:amnma of vear Farm 990-PF (2004) FUND FOR LIFE FOUNDATION INC .
Part ft Balance Sheets Attached schedules and amounts in the description column should be for end-of-year amounts only (See instructions )
1 Cash-non-interest-bearing
2 Savings and temporary cash investments 3 Accounts receivable 1
Less allowance for doubtful accounts 1 4 Pledges receivable 1
Less allowance for doubtful accounts 1 5 Grants receivable 6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the instructions)
A 7 Other notes and loans receivable 1 SEE WRK 2,420,827 Less : allowance for doubtful accounts 1
s 8 Inventories for sale or use
t 9 Prepaid expenses and deferred charges 10a Investments-U S and state government obligations (attach schedule)
b Investments-corporate stock (attach schedule) SEE STMT 6
c Investments-corporate bonds (attach schedule) 11 Investments-land, buildings, and equipment basis 1
13 Investments-other (attach schedule) SEE STATEMENT 7 14 Land, buildings, and equipment basis 1 622,816
Less accumulated depreciation 1 STMT 8 36,324 15 Other assets (describe 1 ) 16 Total assets (to be completed by all filers-see page 16 of
the instructions Also, see page 1, item I 17 Accounts payable and accrued expenses 18 Grants payable
b 19 Deferred revenue 20 Loans from officers, directors, trustees, and other disqualified persons 21 Mortgages and other notes payable (aft schedule) i 22 Other liabilities (describe 1 SEE STATEMENT 9
e s 23 Total liabilities add lines 17 throug h 22 N Organizations that follow SFAS 117, check here 1111 H i and complete lines 24 through 26 and lines 30 and 31 .
A 24 Unrestricted s 25 Temporarily restricted
i 26 Permanently restricted
Organizations that do not follow SFAS 117, check here 1 X ° and complete lines 27 through 31 .
F 27 Capital stock, trust principal, or current funds n 28 Paid-in or capital surplus, or land, bldg , and equipment fund d
29 Retained earnings, accumulated income, endowment, or other funds a 30 Total net assets or fund balances (see page 17 of the I a instructions)
c 31 Total liabilities and net assets/fund balances (see page 17 of e s the instructions
Part [it 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)
2 Enter amount from Part 1, line 27a 3 Other increases not included in line 2 (itemize) 1 SEE STATEMENT 10 4 Add lines 1, 2, and 3 5 Decreases not included in line 2 (itemize) 1 6 Total net assets or fund balances at end of year (line 4 minus lin e 5)-Part II, column (b), line 30
8,820,864 2,845,398
16,052 1,682,314
Form 990-PF (2004) DAA
"' Fair Market Value
4,207,5931 3,965,1731 3,965,173
539 , 567 2 420 827 2- 1 3-8-3- 1 759
2 292
126 , 625 144 174 144 , 174
3 , 646 , 603 4 , 845 , 678 4 , 845 , 678
605 , 032 586 , 492 670 , 000
9 127 712 11 962 344 12 008 784 250 1,107
306,5981 278,923
306,8481 280,030
8,820,8641 11,682,31
4111,682,31
9,127,7121 11,962,34
-PF (?A04) FUND FOR LIFE FOUNDATION INC . 11-3239215 1I.,< Capital Gains and Losses for Tax on Investment Income
,-(a) List aid describe the kinds) of property sold (e g , real estate (b) Now acquired 2-story brick warehouse, or common stock. 200 shs MLC Co ) P-Purchase
D-Donation
/A
o) Croao aobo price (n Depreciation allowed I (g) Coat or othor basis
(or olbwOblo) ~ plun oxponco of anb (
b
c
d
Com loco only for assets showln gain In column h and owno
(I) F, M V as of 12/31/89 U1A o1,72/3d1/89gig
(I) Gains (Col (h) gain minus Cal (k), but not loss then "0-) or
Losses (from coi (n)) (k) Excess of col (I) over Col (J), If any
b c d e
2 Capital gain net income or net capital loss) If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7 ~ 2
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6) If gain, also enter in Part I, line 8, column (c) (see pages 13 and 17 of the instructions) ~ If loss enter -0- in Part I line 8 -J 3
Part V; Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income (For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income )
If section 4940(d)(2) applies, leave this part blank .
Was the organization liable for the section 4942 tax on the distribulable amount of any year in the base period? ~ Yes X No If "Yes ." the org a ni za UOn does not quality unde r section 4940(e). Do not complete this pan .
1 Enter the appropriate amount in each column for each year ; see page 18 of the instructions before making any entries .
a b '
' Base Period years Adjusted qualifying distributions Not value of nOncha'rilOblo-us erilOblo-use assets Distribution ratio
Calendar ear or tax Dar Innin In Col b divided b c01 c
2 Total of line 1, column (d) 2 0 .748874 3 Average distribution ratio for the 5-year base period-divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years 3 0 .149775
4 Enter the net value of nonchantable-use assets for 2004 from Part X, line 5 4 7 523 , 598
5 Multiply line 4 by line 3 5 1 126 , 847
6 Enter 1% of net investment income (1% of Part I, line 27b) 6 1 , 421
Add lines s and s 7 1 12 8 268
8 Enter qualifying distnbubons from Part XII, line 4 8 562 , 510 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 on page 18
Form 990-PF (zooa) DAA
1a
b
c
5020A 11/11
(c) Date acquired (d) Date sob (mo . day, yr ) I (mo. . day, y<
Fart VI Excise Tax Based on Investment Income Section 4940(a), x940 b 4940(e), or 4948-see page 15 of the instruct Ins)
1a Exempt operating foundations described in section 4940(d)(2), check here 1 U and enter "NIA" online 1 x pate 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 1 2 1 842
here 1 Q and enter 1% of Part I, line 27b
C All other domestic organizations enter 2% of line 27b Exempt foreign organizations enter 4°l of Part I, line 12, cot (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) 2 0
3 Add lines 1 and 2 3 2 , 842
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 2 , 842
6 Credits/Payments
a 2004 estimated tax payments and 2003 overpayment credited to 2004 6a 1 , 896
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 6d
7 Total credits and payments Add lines 6a through 6d 7 1 , 896
8 Enter any penalty for underpayment of estimated tax Check here N if Form 2220 is attached 8 3
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed 1 9 949
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid 1 10
11 Enter the amount of line 10 to be Credited to 2005 estimated tax 1 Refunded 1 11
Part VIE"h Statements Regarding Activities
1a During the tax year, did the organization attempt to influence any national, state, or local legislation or did Yes No
it participate or intervene in any political campaigns 1a X
b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page
19 of the instructions for definition) 1 b X
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed 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 1 $ (2) On organization managers 1 $
e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed
on organization managers 1 $ 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 years N/A 4b
5 Was there a liquidation, termination, dissolution, or substantial contraction during the years 5 X
If "Yes," attach the statement required by General Instruction T 6 Are the requirements of section 508(e) (relating to secUons 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 instruments 6 X
7 Did the organization have at least $5,000 in assets at any time during the yeah If "Yes," complete Part II, cot (c), and Part XV 7
8a Enter we states to which the foundation reports or with which it is registered (see page 19 of the
instructions) 1 NY 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) of each state as required by General Instruction G? If "No," att explanation 8b X
9 Is the organization claiming status as a private operating foundation within the meaning of section 4942Q)(3)
or 49420(5) for calendar year 2004 or the taxable year beginning in 2004 (see instructions for Part XIV on
page 25)? If "Yes," complete Part XIV 9 X
10 Did any persons become substantial contributors during the tax yea( If "Yes," attach a schedule listing their names & addresses 10
11 Did the organization comply with the public inspection requirements for its annual returns and exemption applications 11 X
Web site address t N/A 12 The books are in care of 1 Telephone no 1
Located at 1 ZIP+4 10-
13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 -Check here I Ill- El and enter the amount of tax-exempt interest received or accrued during the year . . . . . . . . . . , . . . . , , . . . . . . . . . . 1 ~ 13
Form 990-PF (zooa)
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'orm s9o-PF (200a) FUND FOR LIFE FOUNDATION INC . 11-3239215 Pane 5
~Part~bII~B~~ Statements Regarding Activities for Which Form 4720 Ma Be Required
File dorm 4720 if any Item is chockod In tho "Yos" column, unless an exception applies. Yes No
1a During the year did the organization (either directly or Indirectly) : ,rte .~y ,+f' ~ ~~ (1) Engage in the sale or exchange, or leasing of property with a disqualified person? , a Yes ~X No ~~~? ;̂;~x,~ { .~K;
y (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) . ;~ �M= ~. �;" s5' ; 2ge`
a disqualified person? Yes X No ~
(3) Furnish goods, services, or facilities to (or accept them from) e disqualified person? Yes X No (4) Pay compensation to, or pay or reimburse the expenses of, o disqualified person? Yes X No
(5) Transfer any income or assets to a disqualified person (or make any of either ovoiloblp
for the benefit or use of o disqualiflod person)? . . . . . . . . . . . . . . . . . . . . . . . . ~ Yes OX No ~~~~` ̀ ~` ̀~ ```~"` . . . . . . . . - ,a:. ~- (8) Agree to pay money or property t0 0 government official? (Exception . Chock "No"
If the organization agreed to make a grant to or to employ the official for o period
after termination of government BOrviCO. If terminating within 90 days Yes X~ No b If any answer Is "Yes" to 10(1)-(8), did any of the acts fall t0 qualify under the exceptions doscrlbed in Rogulollons
section 53.4941(d)-3 or In a current notice regarding disaster assistance (sea pogo 20 0( the Instructions)? N/A 1b Organizations relying on e current notice regarding disaster assistance check hero " ~ "£ " ̀ t. ;A y~"
c Did the organization engage in a prior year In any of the acts described in 1 a, other than excepted acts, rY ~ 4 that were not corrected before the (first day of the tax year beginning in 2004? N/A 1c
2 Taxes on failure to distribute Income (section 4942) (does not apply (or years the organization was a private
operating foundation defined in section 4942Q)(3) or 49420)(5))- V
* 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 20041 a Yes X No 'y ; 3
If "Yes ." list the years 1 20 . , 20 . . , 20 , 20 `;~`.̀,~; .~ '`Y~a
b Are there any years listed In 2a for which the organization is not applying the provisions of section 4942(a)(2) ,, i,4 2k
(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 page 20 of the instructions ) N/A 2b
c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here
20 20 20 GO
~ ",2` y S
,,yy ,y ii,' ,
3a Did the organization hold more than a 2 /o direct or indirect interest in any business
enterprise at any time during the year? Yes ~X No ~`"~,'` k°~V~
b I( "Yes," did it have excess business holdings In 2004 as a result of aany " '° ~~ (1 ) y 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 (3) � ;?~~+
the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine �r{ <,~� ~ a% , if the organization had excess business holdings in 2004 .) N/A 3b
4a Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes? 4a X b Did the organization make any Investment in a prior year (but after December 31, 1969) that could jeopardize its charitable ' :R; 'y ;;, ;
purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2004? 4b X
,4j ,,�}, ~ Frr 5a During the year did the organization pay or incur any amount to . fr f ;' (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))7 ~ Yes ~X No (2) Influence the outcome of any specific public election (see section 4955), or to carry ` : .,fs F � ,"̀ :
on, directly or indirectly, any voter registration drive? Yes X No ,
(3) Provide a grant to an individual (or travel, study, or other similar purposes 8 Yes eX No ,
(4) Provide a grant to an organization other than a charitable, etc., organization described
in section 509(a)(1), (2), or (3), or section 4940(d)(2)7 ~ Yes ~ 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 a Yes X No b If any answer is "Yes" to 5a(1 }(5), did any of the transactions fail to qualify under the exceptions described in
Regulations section 53 4945 or in a current notice regarding disaster assistance (see page 20 of the instructions)? N/A 5b Organizations relying on a current notice regarding disaster assistance check here
c If the answer is "Yes" to question 5a(4), does the organization clam exemption from the
tax because d maintained expenditure responsibility for the grants N/A a Yes E] No If "Yes," attach the statement required by Regulations section 53 4945-5(d)
6a Did the organization, during the year, receive any funds, directly or indirectly, to pay
premiums on a personal benefit contracts ~ Yes X No
b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contracts 6b X
If you answered "Yes" to 6b, also file Form 8870 I 1 Form 990-PF (2ooa)
)tal number of other employees paid over $50,000 1 3 Five highest-paid independent contractors for professional services-(see page 21 of the instructions) . If none, enter
"NONE." a Name and address of each pe rson aid more than $50,000 b Typ e of service c Co
NONE
otal number of others receiving over $50,000 for professional services 1
Part IXA Summary of Direct Charitable Activities
List the foundations 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 Expenses
N/A
z
3
4
DAA
Form 990-PF (2004)
Form 990-PF 2004 FUND FOR LIFE FOUNDATION INC . 11-3239215 5020A 11/1 t/20o~5 2 ess M
Park Vtil Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, . and Contractors
1 List all officers, directors, trustees, foundation managers and their compensation (see page 20 of the Instructions ) . (b) Tale, and average (c) Compensation (d) Contnb to EExpense account,
(a) Name and address hours per week (If not paid, enter plans and d {~rerted (e~ oher allowances
devoted to osition -0- com ensa ion
HARRY REICHMAN PRESIDENT 1552-53 ST . BROOKLYN NY 0 0 0 CHAYA REICHMAN TREASURER I
I 0 1552-53 ST . BROOKLYN NY OI ~
2 Compensation of five highest-paid employees (other than those included on line 1-see page 21 of the instructions) . If none, enter "NONE."
(b) Title and average I I (d) Contributions to (a) Name and address of each employee paid more than $50,000
hours devoted to
per week position (c) Compensation employee
plans and benefit
deferred (e)
other Expense
allowances account,
compensation
NONE
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Form 99U-PF (2004) FUND FOR LI FE FOUNDATION INC . 11-3239215 Page 7 'PaftqIX=B ~ Summa of Program-Related Investments (see page 22 of the instructions Describe the two largest ram-related investments made b the foundation durl the lax year on fines 1 and 2 Amount ~ N/A
2
All othor prpqrcim "rUlpt0tl InvpatmonlD . Soo page 22 of the Instructions 3
Total . Add lines 1 through 3 y`,Part;X;~ Minimum Investment Return (All domestic foundations must complete this part Foreign foundations,
see page 22 of the instructions . 1 Fair market vogue of assets not used (or held for use) directly fn carrying out charitable, etc , � ; }`'~< t
purposes- a Average monthly fair market value of securities 1a 0 b Average of monthly cash balances . , , , 1 b 3 , 617 , 171 c Fair market value of all other assets (see page 22 of the Instructions) 1c 4 , 021 , 000 d Total (add lines la, b . and c) Ild 7 , 638 , 171 e Reduction claimed for blockage or other factors reported on lines 1a and . . ,< ..
1c (attach detailed explanation) 1e 0"' ~' 2 Acquisition Indebtedness applicable to line 1 assets . . 2 0 3 Subtract line 2 from line 1 d 3 7 , 638 , 171 4 Cash deemed held for charitable activities Enter 1,1/2% of line 3 (for greater amount, see page 23
of the instructions) 4 114 , 573 5 Net value of noncharltable-use assets . Subtract line 4 from line 3 . Enter here and on Part V, line 4 5 7 523 , 598 6 Minimum Investment return . Enter 5°Ao of line 5 , I b ~ 3 7 6 , 18
.Part"Xl : Distributable Amount (see page 23 of the instructions) (Section 4942(j)(3) and 0)(5) private operating foundations and certain foreign organizations check here " and do not com plete this art .
1 Minimum investment return from Pert X, line 6 . . . . . 1 376 , 180 2a Tax on investment income for 2004 from Part VI, line 5 2, 2 , 842 b Income tax for 2004 . (This does not Include the tax from Part VI .) , , 2b ;Nc Add lines 2a and 2b 2c 2 , 842 3 Distributable amount before adjustments Subtract line 2c from line 1 3 373 , 338 4 Recoveries of amounts treated as qualifying distributions 4 5 Add lines 3 and 4 5 373 , 338 6 Deduction from distributable amount (see page 23 of the Instructions) 6 7 Dlstrlbutable amount as adjusted . Subtract line 6 from line 5 . Enter here and on Part XIII,
line 1 . . , . . . , ., ., . , , . ., 7 373 , 338
Part Xtl' Qualifying Distributions (see page 23 of the instructions)
1 Amounts paid (including administrative expenses) to accomplish charitable, etc , purposes . a Expenses, contributions, gifts, etc -total from Part I, column (d), line 26 1aJ 562 , 510 b Program-related investments-total from Part IX-B 1b 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 charitable projects that satisfy the a Suitability test (prior IRS approval required) 3a b Cash distribution test (attach the required schedule) 3b 4 Qualifying distributions . Add lines 1 a through 3b Enter here and on Part V, line 8, and Part XI II, line 4 4 562 , 510 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 (see page 24 of the msVuchons) 5 0 6 Adjusted qualifying distributions . Subtract line 5 from line 4 r 6 T 562, 510
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 (2ooa)
5020A 11/11/2005 2 35 PM Form 99o-PF 2004 FUND FOR LIFE FOUNDATION INC . 11-3239215 - Page 8
Part Xtll Undistributed Income (see page 24 of the instructions)
Form 990-PF (2004) DAA
1 Distributable amount for 2004 from Part XI, line 7
2 Undistributed income, if any, as of the end of 2003 a Enter amount for 2003 only b Total for prior years 20 ,20 , 20
3 Excess distributions carryover, if any, to 2004 a From 1999 300 , 544 b From 2000 254 , 131 c From 200 179 , 850 d From 2002 e From 2003 62 , 590 f Total of lines 3a through e
4 Qualifying distributions for 2004 from Part xIl, line 4 t $ 562,510
a Applied to 2003, but not more than line 2a b Applied to undistributed income of prior years
(Election required-see page 24 of the instructions) c Treated as distributions out of corpus (Election
required-see page 24 of the instructions) d Applied to 2004 distnbutable amount e Remaining amount distributed out of corpus
5 Excess distributions carryover applied to 2004 (If an amount appears in column (d), the same amount must be shown in column (a) .)
6 Enter the net total of each column as indicated below :
a Corpus Add lines 3f, 4c, and 4e Subtract line 5 b Prior years' undistributed income Subtract
line 4b from line 2b 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
d Subtract line 6c from line 6b Taxable amount-see page 25 of the instructions
e Undistributed income for 2003 Subtract line 4a from line 2a . Taxable amount-see page 25 of the instructions
f Undistributed income for 2004 Subtract lines 4d and 5 from line 1 This amount must be distributed in 2005
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(E) or 4942(8)(3) (see page 25 of we instructions)
8 Excess distributions carryover from 1999 not applied on line 5 or line 7 (see page 25 of the instructions)
9 Excess distributions carryover to 2005 . Subtract lines 7 and 8 from line 6a
10 Analysis of line 9 a Excess from 2000 254,131 b Excess from 2001 179 , 850 c Excess from 2002 d Excess from 2003 62 , 590 e Excess from 2004 18 9,172
------ (a) (b) (c) (d)
Corpus Years pnor to 2003 2003 2004
373,338
797,115
373,338 189,172
6,287
0
300,544
685
5020A 11/11 Form 99o-PF (2004 ) FUND FOR LIFE FOUNDATION INC . 11-323921!
'APart`Xf1/I Private Operating Foundations see page 25 of the instructions and Part V
1a It the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2004, enter the date of the ruling 1
b Check box to indicate whether the organization is a private o eratin foundation described in section 49
2a Enter the lesser of the adjusted net Tax ear Prior 3 years
income from Part 1 or the minimum a 2004 b 2003 c 2002
investment return from Part X for each
year listed
b 85% of line 2a
c Qualifying distributions from Part XII,
line 4 for ouch year listed
'' . . . . . . . . . .
d Amounts Included In line 2c not used
directly
for ncllvo COnquct of exempt octivitloo
o Qualifying distributions made directly, .
for octivo 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 49420)(3)(B)(i)
b "Endowment" alternative test-enter 2/3
of minimum Investment return shown in
Part X, line 6 !or each year listed
c 'Support' alternative test-enter
(1) Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
(2) Support from general public
and 5 or more exempt
organizations as provided in
section 4942Q)(3)(B)(lii)
(3) Largest amount of support from
an exempt organization
(o) Total
b The form in which applications should be submitted and information and materials they should include N/A
c Any submission deadlines N/A
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors N/A
oaA Form 990-PF (2004)
'' Part.XV~-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) ) HARRY REICHMAN
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 N/A
2 Information Re arding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs : Check here 1 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 page 26 of the 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 N/A
Total 1 3a 551 , 840
b Approved for future payment N/A
Total 1 3b Form 990-PF (2004)
DAA
Form 99o-PF 2004 FUND FOR LIFE FOUNDATION ANC, 11-3239215 so2oAIi/i~i2o~oaz Bonn
Part XV Supplementary Information continued 3 Grants and Contributions Paid Durina the Year or Approved for Future Payment
If recipient is an individual, Foundation Recipient show any relationship to status of Purpose of grant or Amount
any foundation manages recipient contnbution
Name and address (home or business) or substantial contributor
a Paid during the year SEE STATEMENT 11
551,840
Form 990-PF (2004) FUND FOR LIFE FOUNDATION INC . 11-323 "ParV,XVI=XM Analysis of Income-Producing Activities
Enter gross,amounls unless otherwise indicated . Unrelated business Income E
b Busal~ess Amount code
512 513, or 514 (0) Related or exempt function Income
Amount (Soo page 28 of 1 Program service revenue
a b
c
d
0 f
g Fees and contracts from government agencies
2 Membership duos and assessments 3 interest on savings and temporary cash Investments 14 166 , 318 4 Dividends and Interest from securities 14 302 $ Not rental Income or (1035) from f081 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 9 Net income or (loss) from special events 10 Gross profit or (loss) from sales of inventory 11 Other revenue a
b c d f
-24,508
DAA
5020A 1111
12 Subtotal Add columns (b) . (d), and (e) , . . ;,< t 0 k~- 166, 620 1 -24,508 13 Total . Add line 12, columns (b), (d), and (e) 13 142, 112 (See worksheet in line 13 Instructions on page 26 to verify calculations .) Part>XVI»g Relationship of Activities to the Accomplishment of Exempt Purposes
Llno No Explain below how each activity (or which income Is reported In column (e) of Part XVI-A contributed importantly to
. the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes) (See
Form 990-PF (zooa)
Form 990-pF (2004 ) FUND FOR LIFE FOUNDATION INC . 11-3239215 Page 12 part XVfI Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Oraanitations 1 Did the organization directly or indirectly engage in any of the following with any other organization described m section Yes Nc
501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
a Transfers from the reporting organization to a nonchantable exempt organization of (1) Cash 130 ) X
(2) Other assets 1a 2 X
b Other transactions (1) Sales of assets to a nonchardable exempt organization 1b 1 X
(2) Purchases of assets from a noncharitable exempt organization R(2) X
(3) Rental of facilities, equipment, or other assets X
(4) Reimbursement arrangements X
(5) Loans or loan guarantees X
(6) Performance of services or membership or fundraising solicitations X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees 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 column (d) the value of the goods, other assets, or services
received . and Amount invoNed
N/A
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 aX No
b If "Yes :" complete the following schedule
5020A 111111205 2 35 PM
5020A 11/112005 2:35 PM
OMB No . 1545-0047
2004
Employer Identification number
11-3239215
Schedule B~ (Form 990, 990-EZr or 890-PF)' Oeoanment of the Trea .
Supplomontary Information for line 1 of Forth 990, 990-EZ, and 990-PF (soo Instructions)
ON INC .
Fllors of : Section:
Caution: Organizations that are not covered by the General Rule andlor the Special Rules do not file Schedule B (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 B (Form 990, 990-EZ, or 990-PF )
Schedule B (Form 990, 990-EZ, or 990-PF) (2004)
DAA
Schedule of Contributors
Name of organization
FUND FOR LIFE POUN Organization typo (check one)
Form 990 or 990-EZ 11 501(c)( ) (ontor nurribor) organization
D 4fla%(n)(1) nonoxompt charftnblo truer not trcotod os a privato foundation
11 527 political organization
Form 990-PF X 501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
11 501(c)(3) taxable private foundation
Check if your organization is covered by the General Rule or a Special Rule . (Note : Only a section 501(c)(7),(8), or (10) organization can check boxes (or 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 any one contributor . (Complete Parts I and II )
Special Rulos-
For a section 501(c)(3) organization filing Form 990, or Form 990-EZ, that met the 33 1/3% support test of the regulations under sections 509(8)(1 u170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the greater of $5,000 or 2% 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 (or 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 (or religious, charitable, etc , purposes, but these contributions did not aggregate to more than $1,000 . (I( 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 apples to this organization because it received nonexUusively religious, charitable, etc , contributions of $5,000 or more during the year ) 1 $
For Paperwork Reduction Act Notice, see the Instructions for Form 990, Form 990-EZ, and Form 990-PF .
5020A 11/11/2005 2 35 PM
Page 1 of 1 of part I
Employer identificatidn number Name of organization
FUND FOR LIFE FOUNDATION INC .
Part I Contributors (See Specific Instructions .)
(a) (b) No . Name address, and ZIP + 4
1 HARRY REICHMAN
(c) (d) Aggregate contributions Type of contribution
Person X Payroll
3,265,796 Noncash (Complete Part II if there is a noncash contribution )
(c) (d) Aggregate contributions Type of contribution
Person Payroll
$ Noncash (Complete Part 1l if there is a noncash contnbuUOn )
(c) (d) Aggregate contributions Type of contribution
Person Payroll
$ Noncash (Complete Part II if there is a noncash contribution )
(c) (d) Aggregate contributions Type of contribution
Person Payroll
$ Noncash (Complete Part II if there is a noncash contribution )
(c) (d) Aggregate contributions Type of contribution
Person Payroll
$ Noncash (Complete Part II if there is a noncash contribution )
(c) (d) Aggregate contributions Type of contribution
Person Payroll
$ Noncash (Complete Part II if there is a noncash contribution )
Schedule B (Form 990, 990-EZ, or 990-PF) (2004)
(b) ss, and ZIP +
(b) address, and ZIP + 4
(b) is . and ZIP + 4
DAA
(a)
(a)
(a) No .
(a)
(a) No .
FL
(b) is . and ZIP + 4
(b) address . and ZIP +
5020A 11/71/2005 2:35 PM
and Loans Receivable 2004
i and endin Employer Identification Number
1 'I _ '2 ')'7 Q 7 l S
Forms vtner 990 / 990,,PF
For calendar ear 2004 or tax i Name
FUND FOR LIFE FOUNDATION INC .
FORM 990-PF, PART II,
Rolotionship to disqualified person
Original amount Maturity Interest borrowed Date of loan date Repayment terms rate
Purpose of loan
Totals 2,383,759 39 .567 420 .827
1
"SS
Security provided by borrower
(11
5
Consideration furnished by lender Balance due at
beginning of year
159,567 350,000 30 .000
Balance due at end of year
981,810 350,000
700,000 389 .017
Fair market value (990-PF only)
944,742 350,000
700,000 389,017
9 Installment duo dates. Enter In columns (o) through (d) Ih
75th day of the 4th (Form B80"PF fllors : Use 5th month), 6th, 9th, and 12th months of the corporation's tux year 9 5/17 /04 6/15/04 9/15/04 12 / 15/04
Exception. If ono of your Installment duo dates Is
September 15, 2004, soo oho Instructions ' . . ""
10 Required Installments . If the box on line 1 and/or line 2
above Is chocked. enter the amounts from Schedule A . line ry;{#s~ 38 II the box on line 3 (but not 1 or 2) IS chOCkOd, s00
Instructions for the amounts to enter . II none of these bozos
ere chucked, enter 2596 of line e above in each column 10 510 510 510 508 0 11 Estimated tax paid or credited for each period (see
instructions) For column (o) only, enter the amount
from line 11 on line 15 11 1 , 896
Complete lines 12 through 18 of one column before '
going to the next column .
12 Enter amount, d any, from line 18 of the preceding column 12 1 , 386 876 366
13 Addlines t1 and 12 13 1,386 876 366
14 Add amounts on lines 16 and 17 of the preceding column 14 15 Subtract line 14 from pine 13 If zero or less, enter -0- 15 1,896 1,386 876 366 0
16 If the amount on One 15 is zero, subtract line 13 from line
14 Otherwise, enter-0- 16 0 0 0
17 Underpayment. If line 15 is less than or equal to line 10 .
subtract line 75 from line 10 Then go to tine 12 of the next
column Otherwise go to line 18 17 0 0 0 142
18 Overpayment . I( line 10 is less than line 15, subtract line
10 from line 15 Then o to line 12 of the next column 18 1,386, 876, 366 , Go to Part III on page 2 to figure the penalty Do not go to Part III If there are no entries on line 17-no penalty is owed .
For Paperwork Reduction Act Notice, see separate Instructions . Form 2220 (2ooa) DAA
FORM 9 9 0 - PF 5020A 11/11/2005 2 .35 PM
Form 2220 Underpayment of Estimated Tax by Corporations OMB NO 154S0142
100 soa separate Instructions . 2004 D~ema~ Revenue
the Treasury ~ 1 Attach to the corporation's tax return .
Name Employer Idontificatlon number
FUND FOR LIFE FOUNDATION INC . 11-3239215 Note : In most cases, the corporation is not required to file Form 2220 (see Part I below for exceptions) because the IRS will figure any penalty owed and bill the corporation. Even if Form 2220 is not required, the corporation may still use it to figure the penalty. In such a
rose, enter the amount from page 2, line 38 on the estimated lax penalty line of the corporation's income lax return, but do not attach Form 2220 .
; ;Pi~rt;l~a Roasons for Filing- Check the boxes below that apply . If any boxes are chucked, and line 6, below, is $500 or more the corporation must file Form 2220 even if it does not owe a penalty .
1 The corporation is using the adjusted seasonal Instnllmonl mothod, 2 The corporation Is using the annualized Incomo inatnllmont mothod . 3 ~ 1 The corporation Is n "IarAO corporation" (Igurlnp Its first roquirod installment based on the prior year's tax ~part~llr ̀ Flourlna the Underpayment
4 Total lax (sue instructions) 4 2 842
5a Personal holding company tax (Schedule PH (Form 1120), line 26) included on line 4 5a b Look-back interest included on line 4 under section 460(b)(2) for completed long-term
contracts or section 167(8) for depreciation under the income forecast method Sb
2v c Credit for Federal tax paid on fuels (see instructions) Sc ~: d Total. Add lines Sa through Sc 5d
6 Subtract line Sd from line 4 If the result is less than $500, do not complete or file this form The corporation
does not owe the penalty 6 2 , 84 2
7 Enter the tax shown on the corporation's 2003 Income tax return (sea instructions) Caution. If the tax Is zero or the tax year was for loss than 12 months, skip this line and enter the amount from line B on line B 7- ~ 2 , 038
8 Enter the smaller of line 6 or line 7 If the corporation is required to skip hne 7, enter the amount from line 6 ( 8 L- 2 , 0 3 8
Part III Figuring the Penalty
24 Underpayment on line 17 x Number of days on line 23 x 4% 24 $ 366
25 Number of days on line 20 after 9/30/2004 and before 1/1/2005 25
26 Underpayment on line 17 x Number of days on line 25 x 5% 26 $ 366
27 Number of days on line 20 after 12/3112004 and before 4/1/2005 27
28 Underpayment on line 17 x Number of days on line 27 x 5% 28 $ 365
29 Number of days on line 20 after 3/31/2005 and before 7/1/2005 29
30 Underpayment on line 17 x Number of days on line 29 x '% 30 $ 365
31 Number of days on line 20 after 6130/2005 and before 10/1/2005 31
32 Underpayment on line 17 x Number of days on line 31 x '% 32 $ 365
33 Number of days on line 20 after 9/30/2005 and before 1/1/2006 33
34 Underpayment on line 17 x Number of days on line 33 x '% 34 $ 365
35 Number of days on line 20 after 12131/2005 and before 2/16/2006 35
36 Underpayment on line 17 x Number of days on line 35 x '% 36 $ 365
38 Penalty . Add columns (a) through (e) of line 37 Enter the total here and on Form 1120, line 33, Form 1120-A, line 29,
or the comparable line for other income tax returns sa 1$ 3
DAA
5020A 11/1112005 2 35 PM
Form 2220 2004 FUND FOR LIFE FOUNDATION INC . 11-3239215 Pa e 2
19 Enter the date of payment or the 15th day of the 3rd month after the close of the tax year, whichever is earlier (see instructions) (Form 990-PF and Form 990-Y filers : Use 5th month instead of 3rd month ) 19 SEE WO KSHEET
20 Number of days from due date of installment on line 9 to the date shown on line 19 24
21 Number of days on line 20 after 4/15/2004 and before 7/1/2004 L 21
22 Underpayment on line 17 x Number of days on line 21 x 5% 22 366
23 Number of days on line 20 after 6/30/2004 and before 1011/2004 23
*For underpayments paid after March 31, 2005 : For lines 30, 32, 34, and 36, use the penalty interest rate for each calendar
quarter, which the IRS will determine during the first month in the preceding quarter These rates are published quarterly m an IRS
News Release and in a revenue ruling in the Internal Revenue Bulletin To obtain this information on the Internet, access the IRS
website at www irs gov You can also call 1-800-829-1040 to get interest rate information . Form 222 (2004)
5020A 1111 1/2005 2.35 PM
2004
Employer Identification Number
Form 2220 i I For calendar year 2004, or tax year beginning
1st Quarter 2nd quarter 3rd Quarter 4th Quarter Due date of estimated payment 5/17/04 6/15/04 9/15/04 12/15/04 Amount of underpayment 142
Prior year overpayment applied 1,896
1st Poymont 2nd Paymont 3rd Payment 4th Poymont 5111 Perymont Doto of payment Amount of payment
Business Or activity l0 which 1h10 form relates
PROPERTIES `'Part~l Election To Expense Certain Property Under Section 179
Note: If you have an listed property, complete Part V before you complete Part I . Maximum amour, . Soo page 2 of use instructions for o signer limit for certain businesses 1 102 , 000
2 Total cost of eoctlon 179 property placed In sorvlce (see page 3 of the Instructions) 2 3 Threshold cost of section 179 property before roduttfon In limitation 3 410 , 000
4 Reduction In limitation . Subtract line 3 from line 2. II zoro or less, enter -0- 4
5 Dolor ihnltnllon for inx vonr. Subtract line n from line 1 II zero or loan. enter " 0" . II married Illlno nounmtolv. noo'nnno 3 of the Instructions 5 102 . 000
Coat
7 Listed property Enter the amount from line 29 7 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 (see instructions) 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 1 13 3 I :. ', . , Note : Do not use Part II or Part 111 below for listed property Instead, use Part V . ~Pat~t~ltSpecial Depreciation Allowance and Other Depreciation Do not include listed prop e
14 Special depreciation albwanco for qualified prop (other than listed prop ) placed in service during the lax year (see pg 3 of the instructions) 14
15 Property subject to section 168(f)(1) election (see page 4 of the instructions) 15
16 Other depreciation (including ACRS) (see papa 4 of the instructions) 16
Pait t!!~ MACRS Depreciation (Do not include listed property.) (See page 5 of the instructions .) Section A
17 MACRS deductions for assets placed In service in tax years beginning before 2004 17 18 , 540 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 . . . ~ I I :a .
(b) Month and (c) Basis for depreciation year Placed In I (buslnoss/Invostmont use (a) Classification of properly
19a 3-Year property
b 5-year property
c 7-year property
d 10-year property
0 15-year property f 20-year property
g 25-year property
h Residential rental property
I Nonresidenhal real property
Sectlc
20a Class life
b 12-year
c 40-vear
,~ .
12 s S/L
40 vrs MM S/L
Part IV Summa see page 8 of the 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 18 , 54 0 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 For Paperwork Reduction Act Notice, see separate instructions Form 4562 (2ooa) DAA THERE ARE NO AMOUNTS FOR PAGE 2
5020A 11/172005 2.35 PM
Depreciation and Amortization OMB No ,sAso,7z Form 4562
' (Including Information on Listed Property) 2004 Department of the Treasury
1 Soo separate Instructions. 1 Attach to our tax return . Attachment
internal Revenue Service o 67
Nome(s) shown on return Identifying number
FUND FOR LIFE FOUNDATI ON INC . 11-3239215
8 ,. s
B 9
11 I 0
C-Assets Placed In Service Durlna 2004 Tax Year U
Recovery (a) Convention I (n Method I (g) Depreciation deduction
period I
25 s S/L
?7 5 rs MM S/L
>7 5 rs MM S/L
39 r5 MM S/L
MM S/L
ia the Alternative Deoreclatlon Svs
5020A 11/71/2005 2 35 PM
FUND FOR LIFE FOUNDATION INC . 11-323921.5
Pert V Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, ana 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, tab, columns (a) through (c) of Section A, all of Section B, and Section C if applicable
Section A-De reciation and Other Information Caution : See a e 9 of the instructions for limits for passenger automobiles
24a Do you have evidence to su ort the business/investment use claimed) Yes No 24b If "Yes," is the evidence written Yes No f~l lal (b) (c) (d) lel M Isl (h)
Type of prop Date placed in Business) investment Cost or other Basis for depreciation Recovery Method/ Deprecation Elected
(list vehicles service use bass (business/investment penod Convention deduction section 179 first) ercenta e use only) cost
25 Special depreciation allowance for qualified listed property placed in service during the tax year and used more than 50% in a qualified business use (see page 8 of the instructions) T 25
26 Property used more than 50% in a qualified business use (see page 8 of the instructions)
ness use (see oaae S of the 27 Proaertv used 50% or
oho S/L-
28 Add amounts in column (h), lines 25 through 27 Enter here and on line 21, page 1 28
29 Add amounts m column i , line 26 Enter here and on line 7, p age 1 29 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
30 Total business/investment miles driven (a) (b) (c) (d) (e) (fl during the year (do not include commuting Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6
miles-See page 2 of the instructions) 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 Yes No Yes No Yes No Yes No Yes No Yes No
use during off-duty hours 35 Was we vehicle used primarily by a
more than 5% owner or related person 36 Is another vehicle available for personal uses ~ I
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 persons (see page 10 of the instructions)
Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees See page 10 of the instructions for vehicles used by corporate officers, directors, or 1 °/a or more owners Do you treat all use of vehicles by employees as personal use? 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 Do you meet the requirements concerning qualified automobile demonstration uses (See page 10 of the instructions ) Note : If vour answer to 37, 38, 39, 40, or 41 is "Yes ;" do not complete Section B for the covered vehicles .
41
(d) Amortization M Code period or Amortization for section oercentaae this year
43 Amortization of costs that began before your 2004 tax year
44 Total. Add amounts in column (f) See page 12 of the instri DAA
for where to Form 4562 (2004)
S/L-
37 38
39 40
Date amortization Description of costs I begins
on of costs that begins during vour 2004 tax year (see
Amortczable amount
11 of the instructions
0
11/11/2005 2 :34 PM
Statement 1 - Form 990-PF, Part I, Line 16a - Legal Fees
Net Description Total Investment
PROPERTIES $ 5,405 $ 5,905
TOTAL $ 5,405 $ 5,405
Adjusted Net
$ 5,405 $ 5,405
Charitable Purpose
$ 0
Statement 2 - Form 990-PF, Part I, Line 16b - Accounting Fees
Net Adjusted Description Total Investment Net
FEDERAL TAXES $ 7,293 $ $ STATE TAXES 250
TOTAL $ 7,543 $ 0 $ 0
1-3
5020A Fund For Life Foundation Inc . 11-323921,5 Federal Statements FYE :' 12/31/2004
Net Adjusted Description Total Investment Net
INDIRECT ACCOUNTING FEES $ 1,500 $ $
TOTAL $ 1,500 $ 0 $ 0
Statement 3 - Form 990-PF. Part I, Line 18 - Taxes
Charitable Purpose
$ 1,500
$ 1,500
Charitable Purpose
$ 7,293 250
$ 7,543
5-9
5020A Fund For Life Foundation Inc . 11/11/2005 2:34 PM 11-3239215 Federal Statements FY E .' 12/31/2004
Statement 5 - Form 990-PF, Part I, Line 23 - Other Expenses
Net Adjusted Charitable Description Total Investment Net Purpose
S S S S EXPENSES
BANK CHARGES 984 98'1 OFFICE EXPENSE 643 613
TOTAL $ 1,627 $ 0 $ 0 $ 1,627
Statement 6 - Form 990-PF, Part II, Line 10b - Corporate Stock Investments
Beg inning End of Basis of Fair Market Description of Year Year Valuation Value
