2004 Carl & Ruth Shapiro Family Foundation 990

t

Return of Private Foundation

990-PF

Form

or Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation

Department of the Treasury

Internal Revenue Service

I

and

Name of organization

A Employer identification number

Otherwise, CARL & RUTH SHAPIRO FAMILY FOUNDATION print

Number and street (or P O box number If mad Is not delivered to street address)

or type- 399 BOYLSTON STREET See Specific City or town, state, and ZIP code Instructions . OSTON MA 02116

Roorn'suice

04-6135027

I B Telephone number

617-778-7999

C If exemption application is pending, check here D 1 . Foreign organizations, check here

I Fair market value of all assets at end of year (from Part ll, Col. (c), line 16)

J

Accounting method' D Cash = Other (specify)

Q 4

Contributions, gifts, grants, etc., received

Check lOHlMfoundation lsnotrequlradtoattach SchB Interest on savings and temporary .cash Investments Dividends and interest from securities .

5a Gross rents .

W

. . .

. .. .

.

_

.

..

'e d

7

Capital gain net Income (from Part IV, line 2) , , 

°~

8

Net short-term capital gain

9

Income modifications Gross sales less returns and allowances

F If the foundation is m a 60-month termination under section 507 b 1 B , check here . .

I

(a) Revenue and expenses P8f books

(b) Net investment income

(c) Adjusted net income

6865142 .1

06610 .E 09518 .

306610 . 1209518 .

18204331 .E 54166 .

11339189 . 0.

(d) Disbursements forcharitable purposes (cash basis only)

.. . .

..

.. .. ...

b Less* Cost of goods sold .

U

c Gross profit or (loss) 11

Other income

12

Total. Add lines 1 throw h 1 i

1$

Compensation of officers, directors, trustees, etc. 

14

Other employee salaries and wages .

15

Pension plans, employee benefits

y 16a Legal fees d

. .. . . . .. .

. .. . . .. . .

Stmt

b Accounting fees . . . .

.z 17

Interest . . . dti~and t de letion

. .. .. . .

. . . Stmt . . 3. . . . 4

StICit . .5 . ._ .

c Other professional fees

c°'o

.

b Net rental income or (lass) Net galn or (loss) from sale of asset not on . . .. sa line 10 . ... Gross safes price for ell " 215915195 . h assets on line Be . . .. .

,Z

E If private foundation status was terminated under section 507(b)(1)(A), check here 01 =

0 Accrual

16 5 7 9 4 9 7 8 . (Part l, column (c) must be on cash basis)

I loan I Analysis of Revenue and Expenses (The total of amount in columns (b) (c), and (d) may not necessarily equal the amounts m column (~ ~

101 "

Z . Foreign organizations meadng the 85% test, check here and attach computation

H Check type of organization O Section 501(c)(3) exempt private foundation Section 4947(a)(1) nonexempt charitable trust = Other taxable private foundation

111104

2004

ration may be able to use a copy of this return to satisfy state nspor

Note : The

For calendar year 2004, or tax year bE

Use the IRS label .

OMB No 1 5 45- 0052

._ .

. ..

.. .

Stmt ,

6

, ,

1 ~Tr~yels~qq ~ ~ ran ~ rid meetings . . . 'Prihting an~d'pu ip~t ns . ... . . .. Stmt 7 O~ 4 ~o~op~ti ig and . dmlnlstrative .. . 3through 23 . X 25 Contributions, gifts, grants paid ., .. 26 Total expenses and disbursements . Add lines 24 and 25 27 Subtract line 26 from line 12 : 8 Excess of revenue over expenses and disbursements b Net Investment Income (if negative, enter -0-) . . . . . . c Adjusted net income (if negative, enter -o-> 423501 01-03-OS

LHA

7067 12642 0 6107

. . . .

25284 . 13000 . 6107 .

12642 . 13000 . 0.

245460 . 6373 . 37200 .

0. 0. 0. 0. 0. 0.

407375 . 3 2 05 4 00 .

25642 .

134144 . 3205400 .

3612775 .

25642 .

3339544 .

3946 . 198 . 8574 .

14591556 .

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions .

13120608 788779 fnd

54166 .

135471 . --

I

4792 . 37200 3946 198 8026

. . . .

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1 2004 .05002 CARL & RUTH SHAPIRO FAMILY

Form 990-PF (2004) FND

1

2-1-L

k Z

`

Form 990-PF(2004) Balance

SFleetS column should betaendof-yearartwunlsonly.

8 9 10a b c 11

6238104 .

364 . 22145467 .

364 . 22145467 .

11800 . 134211471 . 2129470 .

11800 . 132812211 . 2212930 .

11800 . 133503471 . 10132836 .

1733 .

1040 .

1040 .

Other noles and loans receivable

Less . allowance for doubtful accounts Inventories for sale or use . . . . . . . . . . Prepaid expenses and deferred charges _ ... Investments - U .S . and state government obligations

15

Stltlt 8 . . . . . . . . . . .StTCIt 9 .. . ... .. ... . .... .. . . . .. ... .. .. . ..

Investments-corporate stock _ Investments - corporate bonds .

Imestrronts-Wnd,bulldnps,andequipment basis L .esS :accumulated depreciation

12 13 14

.. .

.. .....

..

1

Investments - mortgage loans . .. .. ... . .. Investments - other . . . . . . . . . . . . . . . . ._ . . . . Land, buildings, and equipment : basis 1 Lm: accumulated depreciation Stmt 10 00. Other assets (describe "

17 Accounts payable and accrued expenses . . 18 Grants payable _ ..... .. ..... . . . .. . . . . . . . .

... , ... ...

.. ..

... . ..

..... ..... .. 95606 . 94566 . )

... .

Deferred revenue

20

Loans from officers, directors, trustee, and other diequalifled persons

c0

Mortgages and other notes payable .

..

Other liabilities (describe 11101 ula . naul . ..U.

- uuw . i uuvu

142592578 .1

..... . . ..

1571

. . . . .. . . . . . .. . . . . . . . . . .

19

20 21 J 22

Page 2

End of year (c) Fair Market Value

b) Book Value

(a)Book Value

1 Cash - non-interest-bearing 2 Savings and temporary cash investments .. 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

04-6135027

CARL & RUTH SHAPIRO FAMILY FOUNDATION Beginning of year edschedules andamounts inthedescription

. ...

. ..

. . ., . . .. .,

.. ..

1300 .

78 .

29046392 . 0. 113544886 . 142591278 .

29046392 . 0. 128136442 . 157182834 .

142592578 .1

157183812 .1

Statement . . . 11

n cc

.. ..

. ..

. .. . . .

.. . . . .. . . . ..

N

Organizations that follow SFAS 117, check here and complete lines 24 through 26 and lines 30 and 31 .

~ D

,~° 27 28 a 29 Z 30

Organizations that do not follow SFAS 117, check here " D and complete lines 27 through 81 . Capital stock, trust principal, or current funds . .. ... ... . . . . . Paid-in or capital surplus, or land, bldg ., and equipment fund Retained earnings, accumulated income, endowment, or other funds .. . Total net assets or fund balances ... . ... .... .. . .. . . ..... ..... .

24 Unrestricted . . ..... . . . . --- . . . . . . . . . . . . . . . . . . . . . . . . . a 25 Temporally restricted . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m 26 Permanently restricted . .. . . .. .. ., . .... ... ..... . .... .

X 31 Total liabilities and net assets/tund balances

. 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) 2 Enter amount from Part I, line 27a . . . . .

, ... ..... . .. ... . ..

._, , . .

..

.

..

3 Other increases not included in line 2 (itemize) " 4 Add lines 1, 2, and 3

5 Decreases not included in line 2 (itemize) " 8 Total net assets or fund balances at end of ear line 4 minus line 5 - Part II, column ( b ) , line 30 423511 01-03-05

13120608 788779 fnd

... .. ... .. .... .

. .. ... . . .. ... . .

..

.. ...

..

1 2

142591278 . 14591556 .

5 g

0 157182834 .

8 4

2 2004 .05002 CARL & RUTH SHAPIRO FAMILY

0 157182834 .

Form 990-PF (2004)

FND

1

"

04-6135027

Form 990-PF 2004 CARL & RUTH SHAPIRO FAMILY FOUNDATION ftt 1V Capital Gains and Losses for Tax on Investment Income

(b, How acqw

(a) List and describe the kind(s) of property sold (e .g ., real estate, 2-story back warehouse ; or common stock, 200 shs . MLC Co .)

1a

e

(c Date acquired ~mo ., day, yr.)

D - Donatioi

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

I

See Attached Statements

(f) Depreciation allowed (or allowable)

(e) Gross sales price

215915195 . omplete only for assets show! (i) F.M .V as of 12/31169

I

(p) Cost or other basis plus expense of sale

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

in column (h) and owned by the foundation on 12/31/69 (k) Excess of col . (i) (J) Adjusted basis

as of 12/31/69

(I) Gains (Col . (h) gain minus col . (k), but not less than -0-) or Losses (from col . (h))

over col. (j), If any

9823061 . If gain, also enter in Part I, line 7 ~ If (loss), enter-0-in Part I, line 7

2

Capital gain net income or (net capital loss) . 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 _____

.. .. ..... . ..... .

9823061 . , .

J

.. ...

N/A

[~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 distributable amount of any year In the base period? . 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) Adjusted qualifying distributions

Base period years ,nin in Calendar ear or tax ear bem

2003 2002 2001 2000 ,oaa

6809240 . 7700592 . 7929251 . 8268194 .E 11687976 .

I

. ..

0 Yes [XI No

148563393 . 139233371 . 133023383 . 131336054 .E 149443178 . ..

2 Total of line t, column (d) .. 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 .... ... ...., . . 4 Enter the net value of noncharitable-use assets for 2004 from Part X, line 5 . . . . . . . . . . . . . . . . . . . . . . . . 5

Multiply line 4 by line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6

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

7 Add lines 5 and 6

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... .

. . .. .. ... . ..... .

.. . .. ..... ..... .... .

..

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... ..

. .

.. ... . ...

..

. ..

.... ... .

.... ....

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

Distribution ratio (col. (b) divided by col. (c))

Net value of noncharitable-use assets

.. . ... .. .

... . .. .

.0458339 .0553071 .0596079 .0629545 .0782102

2

.3019136

8

.0603827

1

4

1

155208719 .

.... 1

5

I

9371922 .

.

.. . ...

8

113135 .

..

7

9485057 .

... . ~

8

~

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

13120608 788779

fnd

3 2004 .05002 CARL & RUTH SHAPIRO FAMILY

3345224 .

Form 990-PF (2004) 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-) 0. _ 2 8 Add lines 1 and 2 226271 . a 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_ .... . . _ _ 226271 . 5 6 Credits/Payments : a 2004 estimated tax payments and 2003 overpayment credited to 2004 229917 . . . . .__ 6a 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  ., . ..... ..... .. .. ... . ... .. . . .. 9 1 10 Overpayment . If line 7 is more than the total of lines 5 and 8, enter the amour overpaid . . . . . . . . . . . . . . . . . . 3646 . _. . . . , i0 11 Enter the amount of line 10 to be : Credited to 2005 estimated tax " 3 6 4 6 . .Refunded 0 . 11 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 any political campaign? .... . ... .... .. .. . ... .. .. ... . .. ... b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)? .... .. 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? . ... . ..... ..... ..... .. . , _ ., .... , , . d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year. .. .. .. ..

0 . (2) On organization managers . " $ (1) On the organization . " $ 0. e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed on organization 0. managers . " $

2

Has the organization engaged in any activities that have not previously been reported to the IRS? If "Yes," attach a detailed description of the activities .

...

. . .,

. . ._

.

1c

X

2

X

3 4a 4b 5

X X

. ....

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 _ . . , . . . . . . . . . . . . . . . . . . . ._ . . 4a Did the organization have unrelated business gross income of $1,000 or more during the year? , .,_ , _, b If "Yes," has it filed a tax return on form 990-T for this year? . . . . . .. ..... .. .. . ... _ . . . . N/A 5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? . . . . . . . . . ... .. ... . 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? . . . . . . ..... .... .. . .. .. . . .. .. . ..

7 Did the organization have at least $5,000 in assets at anytime during the yeas? , . ,._ . __ 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 . .. ..... ..... . .... .. .... .... . .. ... .. .. . ... . 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 10 11

Yes No X X

1a 1b

year 2004 or the taxable year beginning in 2004 (see instructions for Part XIV)? If "Yes," complete Part XIV . . . . . . . . . . . . . . . . .. Did any persons become substantial contributors during the tax year? it 'Yes,' attach a schedule listing their names and addresses Stmt .12 Did the organization comply with the public inspection requirements for its annual retains and exemption application? .. .. .. N/A .. .. .. Web site address "

X

6 7

X X

8b

X

9 lo 11

X X

X

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 and enter the amount of tax-exempt interest received or accrued durinfl the veer . . . ...

423531 01-03-05

13120608 788779

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_. ,

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.. . ..... 10- 1 is I

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4 2004 .05002 CARL & RUTH SHAPIRO FAMILY

_ . . 00. ED N/A

Form 990-PF (2004) FND

1

Form 990-PF(2004)

CARL & RUTH SHAPIRO FAMILY FOUNDATION

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. 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 ... ... .. ... (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person? (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? , ___ _. ,. . (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)? __ .. .

b

c 2 a

04-6135027

Pages No

0 Yes OX No

.. .

. . . = Yes ~X No . =Yes ~ No . . _ ~ Yes D No

~ 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 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 "0 Organizations relying on a current notice regarding disaster assistance check here . . . . 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? . .. .. , .. . ..... ... .... . 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)) : 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,

1

X

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? . . . . . . . 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? 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? . . b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . . If you answered "Yes" to 6b, also file Form 8870.

423541 01-03-05

13120608 788779 fnd

...

X X

. . . 0 Yes 0 No

X

... ..

5 2004 .05002 CARL & RUTH SHAPIRO FAMILY

Form 990-PF (200x)

FND

1

' 1

CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors

List all officers, directors, trustees, foundation managers and their compensation . (b) Title, and average hours per week devoted (a) Name and address to aosition

See Statement 13

(c) Compensation (If not paid, enter -0-1

(d~CoMnbu6onsto (e)Ex pense °"'°'a~account, other como=uon allowances

54166 .1

2

Title and average lours per week

(a) Name and address of each employee paid more than $50,000

7067 .1

0.

to I

(e) Expense account, other allowances

I (c) Compensation

None

Total number of other employees paid over $50,000 _ .. _ . _ ..... ..... . 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

None

Page s

0

"~ of service

(c) Compensation

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 number of organizations and other beneficiaries served, conferences convened, research papers produced, etc .

Expenses

N/A

2

3

4

oi3oa-'os

13120608 788779 fnd

6

2004 .05002 CARL & RUTH SHAPIRO FAMILY

Form 990-PF (2004)

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. 1 N/A

Amount

2

All other program-related investments . See instructions .

8

Total. Add lines 1 through 3 ~ 1~ 1 a b c d e 2 3 4 5 8

..

. 11110. 1

Q ,

Minimum investment Return (All domestic foundations must complete this part . Foreign foundations, see instructions .)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes : Average monthly fair market value of securities . . . . . . . . . ..... . . ..... . . ... Average of monthly cash balances . .. Fair market value of all other assets . . . . . .. Total (add lines 1a, b, and c) ... .. Reduction claimed for blockage or other factors reported on lines 1a and 1c (attach detailed explanation) .. .. ._ . . . , . . . , . . . . . , ,  ,  , . . .  . . .,  1a Acquisition indebtedness applicable to line 1 assets . . . . . . . ., . . . . . . . . . . . . . . . ., . . . . . . ., . . ., .  , . . . . . . . . . , . . ., . . . . . Subtract line 2 from line 1 d . . . . . . . . . . . Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see instructions) .... Net value of noncharitable-use assets . Subtract line 4 from line 3 . Enter here and on Part V, line 4 . . . . . . . . . . . Minimum Investment return . Enter 5% of line 5 . . . . . . . . . . . . . ..... ..... .. . ... . . .. .. =)a

1 2a b c 8 4 5 8 7

, .__

..

.

. . . ... . . ... .. _ . .

la 1b 1c 1d

0 . ... . . .. . , . .. .. , .. . .... .. , .. _

._ .

2 3 4 5 6 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.)

Minimum investment return from Part X, line 6 . . . . . . . .. ~ Tax on investment income for 2004 from Part VI, line 5 . . . . . . . . . . . . . . . .. . ... 2a 226271* . Income tax for 2004 . (This does not include the tax from Part VI .) . .   .  2b Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . ., . 2c Distributable amount before adjustments. Subtract line 2c from line 1 ., . . . . . . ., . . ., . . . .  . . . . . . . . . . . . . .  . . . ., .,  . .  . 3 Recoveries of amounts treated as qualifying distributions . . . . . . . . ..... ..... .. .. ... ... . .. .. . ..... .. ..... .. .. 4 Add lines 3 and 4 . . . , ., . . 5 Deduction from distributable amount (see instructions) . .. ... ..... .... . ... ..... ..... . . . . . . . . . . . . . . . ._ 8 Distributable amount as adjusted . Subtract line 6 from line 5 . Enter here and on Part XIII, line 1 .... . .. .. ., 7

141009501 16492803 70000 157572304

. . . .

0 157572304 2363585 155208719 7760436

. . . . .

7760436 .

226271 7534165 0 7534165 0 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 . . . . . . . .,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h Program-related investments-total from Part IX-8 , . . . . . ., . . . ., . . . 2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc ., purposes . . . . . . . . . . . . . . . . . . 3 Amounts set aside for specific charitable projects that satisfy the : a Suitability test (prior IRS approval required) . . . . .. .. ... . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . , . . . ., . . . . . b Cash distribution test (attach the required schedule) . . . . . . . . .. .. ..... . . . . . . . . . . . . . . ., ., . . , . , . . . _ . . . 4 Qualifying distributions . Add lines is through 3b . Enter here and on Part V, line 8, and Part XIII, line 4 . . . . . . .. . Organizations qualify under section 4940(e) for 5 that the reduced rate of tax on net investment income . Enter 1% of Part I, line 27b . . .... .. 6 Adjusted qualifying distributions . Subtract line 5 from line 4 . . ., . . . . . . . . . . . . ., . .  . ., .  , ., . . ., . . ., . . . . . . . . . . . . . . . . . . . . . . .

18 1111 2 8a 36 4

3339544 . 5680 .

3345224 .

0 . 5 3345224 . 8 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

7

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) Years prior to 2003

Corpus 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 6 Total for prior years :

.

...

. .

.

0.

5624189 1793675 1514910 1054439

. . . . 9987h3 .

....

. . .

3345224 . Part Xll,line 4: " $ a Applied to 2003, but not more than line 2a

0. 0.

8 Enter the net total of each column as Indicated below:

4188941 .

5798272 .

8 Corpus Add lines 3f, 4o, and 4e Subtract line 5

c Excess from 2002 d Excess from 2003

3345224 .

0. 8941 .

Excess distributions carryover applied to 2004 Of an amount appears in column (d), the same artiounf must be shown in column (e) )

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 tine 6c from line 6b . Taxable amount -ses instructions . . . . . . . . . . . ... . e Undistributed income for 2003 . Subtract line 4a from line 2a Taxable amount - see instr . t 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(g)(3) 8 Excess distributions carryover from 1999 not applied on line 5 or line 7 9 Excess distributions carryover to 2005 . Subtract lines 7 and 8 from line 6a . .... 10 Analysis of line 9

{,

0.

b Applied to undistributed income of prior years (Election required -see instructions) c Treated as distributions out of corpus (Election required - see instructions) .. d Applied to 2004 distributable amount . . . . . e Remaining amount distributed out of corpus

a Excess from 2000 b Excess from 2001

2004

..

f Total of lines 3a through e . . 4 Qualifying distributions for 2004 from

5

W 2003

7534165 .

3 Excess distributions carryover, If any, to 2004:

a From 1999 b From 2000 c From 2001 d From 2002 e From 2003

I

0 .1 `

1" ;

. ... .` "

0. 0. 0. 0. 0.

+

f

1435248 . 4363024 .

1793675 . 1514910 .

1054439 . . '

Form 990-PF (2004)

423571 01-03-OS

13120608 788779 fnd

8

2004 .05002 CARL & RUTH SHAPIRO FAMILY

FND

1

' .

.

Form 990-PF 2004 CARL & RUTH SHAPIRO FAMILY FOUNDATION Private Operating Foundations (see instructions and Part VII-A, question 9) 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 . 2 a Enter the lesser of the adjusted net Tax ear Prior 3 years (a) 2004 (b) 2003 (c) 2002 income from Part I or the minimum

b c d

e 3 a

investment return from Part X for each year listed 85% of line 2a Qualifying distributions from Part XI I, line 4 for each year listed Amounts included in line 2c not used directly for active conduct of exempt activities ._ Qualifying distributions made directly for active conduct of exempt activities . Subtract line 2d from line 2c . . . . . . Complete 3a, b, or c for the alternative test relied upon : 'Assets' alternative test - enter : (1) Value of all assets ... ..

04-6135027

N/A 142(o)(3) or

9

El 4942(i)(5)

(d) 2001

(e) Total

(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

13120608 788779 fnd

9 2004 .05002 CARL & RUTH SHAPIRO FAMILY

Form 990-PF (2004)

FND

1

a2aso1ro1-oa-o5

13120608 788779 fnd

10 2004 .05002 CARL & RUTH SHAPIRO FAMILY

Form 990-PF (2004)

FND

' . Form 990-PF(2004)

CARL & RUTH SHAPIRO FAMILY FOUNDATION

04-6135027

Analysis of Income-Producing Activities unreiatea ousmess income (a) (b) Business Amount code

Enter gross amounts unless otherwise indicated . 1 Program service revenue : a b c d e f g Fees and contracts from government agencies . 2 Membership dues and assessments . . . . . . . . .

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

..

..

. .

14 14

306610 . 1209518 .

18

9823061 .

..

. .. ... .. . ._ . .. ... .. ._

10 Gross profit or (loss) from sales of inventory . . 11 Other revenue :

Related or exempt function income

.. .

3 Interest on savings and temporary cash investments a Dividends and interest from securities 5 Net rental income or (loss) from real estate.

a Debt-financed property .. .... ... b Not debt-financed property ... ... ... .. 6 Net rental income or (loss) from personal property 7 Other investment income 8 Gain or (loss) from sales of assets other

Excluded b section 512 513 ors1a ~~~_ (d) i°" Amount 9code

Page 11

..

a

b c d e

12 Subtotal. Add columns (b), (d), and (e) ...

. .. . ...

13 Total . Add line 12, columns (b), (d), and (e) . . . . . . . . . . . . . . . . . . (See worksheet in line 13 instructions to verify calculations .)

..... ..... .

___,_ _

0 . ,_, . ._

.... .. .

11339189 .

.. . . ..

.. .

..

13

0.

11339189 .

Relationship of Activities to the Accomplishment of Exempt Purposes

01303-05

13120608 788779 fnd

11

2004 .05002 CARL & RUTH SHAPIRO FAMILY

Form 990-PF (2004) FND

1

Form 990-PF (2004)

CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Pag e 12 Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations 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? Transfers from the reporting organization to a noncharitable exempt organization of: (1) Cash ., , . . . X .. 11a ( l ) (2) Otherassets X .. . . . . .. . ..... ... . .. Other transactions . X (1) Sales of assets to a noncharitable exempt organization _ . ., . . _ . . . . . ._ . . 1b (i ) X (2) Purchases of assets from a noncharitable exempt organization 1b 2 .. . . . . (3) Rental of facilities, equipment, or other assets ._ . . . .. . .__ . ' .. . . . 1b 13 ) X (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 Sharing of facilities, equipment, mailing lists, other assets, or paid employees . , . . . . . . . . . . . . . . . . . . ... . .. .. . .. . _. 11 C 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 t1

1 a

b

c d

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?

Name of

Under penalties of per~y8y(~pe~laro ~t I have er and complete DeGar~tlqfi a~reparer other than

of

oluding is bas

.

. .... ....

.... .. ...

..

..

..

. ..

.. .

.

of

mpanying schedules end statements, and to the best of my knowledge and ballet, it is true, correct, on all Information of whictrpreparer has any knowledge , N(sCtR1

m , Signature of office or trustee °'

Preparer's' :-' signature 2-

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

423621 01-0 .3-05

13120608 788779 fnd

=Yes

2004 .05002

[XI No

' .

Schedule B

Schedule of Contributors

(Form 990, 990-EZ, or 990-PF) Department of the Treasury Internal Revenue Service

OMB No 1545-0047

2004

Supplementary Information for line 1 of Form 990, 990-EZ, and 990-PF (see instructions)

Name of organization

Employer identification number

-6135027

CARL & RUTH SHAPIRO FAMILY FOUNDATION

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 RuleFor 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 RulesFor 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 for Form 990, Form 990-EZ, and Form 990-PF.

423451 11-24-04

13120608 788779 fnd

Schedule B (Form 990, 990-EZ, or 990-PF) (2004)

13 2004 .05002 CARL & RUTH SHAPIRO FAMILY

FND

1

S Scheou ched le B (Forth 990, 990-EZ, or 990-PFD (2004)

Page

Name of organization

CARL & RUTH SHAPIRO FAMILY FOUNDATION 1 (a) No. 1

ONE

WASHINGTON

STE .

202

$

3267884 .

MA

STREET,

ONE

WASHINGTON

WELLESLEY, (a) No.

MA

STE .

(c) Aggregate contributions

202

$

2083491 .

Person Payroll Noncash

0 0

(c) Type of contribution Person Payroll Noncash

FT 0

(Complete Part II if there is a noncash contribution .)

02481

(b) Name, address, and ZIP + 4 SHAPIRO FAMILY FIFTEEN YEAR LEAD TRUST C/O

(cQ Type of contribution

(Complete Part II if there is a noncash contribution .)

MA 02481

WASHINGTON

WELLESLEY,

3

STREET,

(c) Aggregate contributions

(b) Name, address, and ZIP + 4 SHAPIRO FAMILY TEN YEAR CHARITABLE LEAD STRUST C/0 ONE

(a) No.

04-6135027

(b) Name, address, and ZIP + 4 SHAPIRO FAMILY FIVE YEAR CHARITABLE LEAD TRUST

WELLESLEY,

2

1 of Part I

liOf1vIDUiOfS (see speclTlc instructions .)

C/O

(a) No .

1 of

Employer Identification number

STREET,

CHARITABLE

STE .

202

(c) Aggregate contributions

$

1513767 .

(cn Type of contribution Person Payroll Noncash

FT Q 0

(Complete Part II if there is a noncash contribution .)

02481

(b) Name, address, and ZIP + 4

(c) Aggregate contributions

(d) Type of contribution Person Payroll Noncash

0

(Complete Part II if there is a noncash contribution .) (a) No .

(b) Name, address, and ZIP + 4

(c) Aggre ate contributions

(d) Type of contribution Person Payroll Noncash

Q

(Complete Part II if there is a noncash contribution .) (a) No.

(b) Name, address, and ZIP + 4

(c) Aggregate contributions

(CO Type of contribution Person Payroll Noncash

$

0 0 0

(Complete Part II if there is a noncash contribution .) 423452 11-24-04 13120608

788779

fnd

2004 .05002

14 CARL

Schedule B (Form 990, 990-EZ, or 990-PF) (2004) &

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 (b How acquired (c Date acquired (d) Date sold (a) List and describe the kind(s) of property sold, e.g , real estate, se ~" 2-story brick warehouse, or common stock, 200 shs. MLC Co ~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 P 01/05/0402/09/04 e 80 000 SHS AMR CORP . 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 50 000 SHS XEROX P 01/05/0402/12/04 n o25 , 000 SHS XEROX P 01/05/0402/12/04 other (h) (f) Depreciation allowed (p) Cost or basis Gain or (loss) (e) Gross sales price plus expense of sale (e) plus (f) minus (g) (or allowable) 7780855 . 7780345 . 510 . a 86711127 . 86695219 . 15908 . b 1826650 . 1508150 . 318500 . c 2348550 . 1925100 . 423450 . d . 1284000 . 1044000 240000 . e 159900 . 130500 . 29400 . t 1199250 . 975000 . 224250 . n 1829250 . 1426500 . 402750 . 609750 . 474750 . 135000 . 854550 . 261450 . 1116000 . 711000 . k 5902500 . 5191500 . . 393500 . 342600 50900 . 1 506000 . m 3932000 . 3426000 . 74500 . n 763000 . 688500 . 39000 . 0 381500 . 342500 . Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Losses (from col. (h)) Gains (excess of col. (h) gain over col. (k), (k) Excess of col. (i) (1) Adjusted basis but not less than '-0-') (i) F.M.V as of 12/31/69 as of 12/31/69 over col . (1), if any 510 . 15908 . b 318500 . 423450 . 240000 . 29400 . f 224250 . n 402750 . 135000 . 261450 . 711000 . i 50900 . 506000 . 74500 . n 0 39000 . If gain, also enter in Part I, line 7 1 .. ..... .. . ""' ' ~ (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 . . .. .. . . .. .... ,. . . .... ..... ..... ....  2 Capital gam net income or S net capital loss)

a2assl 05-01-04 13120608 788779 fnd

g

15 2004 .05002 CARL & RUTH SHAPIRO FAMILY

FND

1

Continuation for 990-PF, Part IV

CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 2 of 4 Page PIVCapital Gains and Losses for Tax on Investment Income (bLHow acqwred (c? Date acquired (d) Date sold (a) List and describe the kind(s) of property sold, e g., real estate, ~' - Purchase 2-story back warehouse ; or common stock, 200 shs . MLC Co. I o ,day, yr) (mo., day, yr ) D - Donation 1a 35 , 000 SH5 XEROX P 0 1/05/04 0 2/13/04 INC b 70 000 SH5 YAHOO 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 P e 60,000 SH5 QLOGIC CORP . 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 P 01/05/0402/25/04 k 80 000 SHS ABERCROMBIE & FITCH 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 P 01/05/0402/27/04 n 40 000 SHS ELECTRONIC DATA SYS CORP 020 , 000 SHS ELECTRONCI DATA SYS CORP P 01/05/0402/27/04 Depreciation allowed (p) Cost or other basis (h) Gain or (loss) (0 (e) Gross sales price (or allowable) plus expense of sale (e) plus (f) minus (g) 535500 . 479500 . 56000 . a 3336200 . 3189200 . 147000 . b 4343500 . 4804200 . -460700 . c d 14268207 . 14268254 . -47 . 2566200 . 3119400 . -553200 . e 2220480 . 1871280 . 349200 . t 2572170 . 2159660 . 412510 . 4022850 . 3496350 . 526500 . n 1 3225040 . 2799680 . 425360 . 2739600 . 2094300 . 645300 . 2440000 . . 575200 . k 1864800 . 2589106 . 2589106 0 . 1 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)) Gains (excess of col . (h) gain over col . (k), (k) Excess of col. (i) (1) pAdjusted basis but not less than '-0=) (~)i F.M.V. as of 12/31/69 as of 12/31/69 over col. (j), if any a 56000 . 147000 . b -460700 . c -47 . d a -553200 . 349200 . t 412510 . n 526500 . i 425360 . 645300 . k 575200 . i 0. -293000 . m -232800 . n -115600 . o 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 .. .. ..

423591 05-01-04

13120608 788779 fnd

.. 

.. .. ,

g

16 2004 .05002 CARL & RUTH SHAPIRO FAMILY

FND

1

J

'

r Continuation for 990-PF, Part IV CARL & RUTH SHAPIRO FAMILY FOUNDATION 04-6135027 Page 3 of 4 1VCapital Gains and Losses for Tax on Investment Income (b How acquired (c Date acquired (d) Date sold (a) List and describe the kind(s) of property sold, e.g., real estate, ~ - Purchase 2-story brick warehouse ; or common stock, 200 shs . MLC Co. lmo., day, yr.) (mo., day, yr.) D - Donation 1a 80,000 SHS SPX CORP . P 01/05/04 0 2/27/0 ;f tT92,000 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 P 01/05/0403/02/04 f 90,000 SHS TRANSOCEAN SEDCO 75,000 SHS TR.ANSOCEAN SEDCO P 01/05/0403/02/04 P 01/05/0403/02/04 n 60 000 SHS AETNA INC . 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 INC . P 01/05/0403/03/04 n 40 000 SHS DELTA AIRLINES P 01/05/0403/03/04 0 85 , 000 SHS JP MORGAN CHASE Depreciation allowed (p) Cost or other basis (h) Gam or (loss) (0 (e) Gross sales price (or allowable) plus expense of sale (e) plus (f) minus (g) 3364000 . 4660000 . -1296000 . a 3867680 . 3307400 . 560280 . b 2706000 . 457500 . 3163500 . c 1326390 . 8190 . 1334580 . d 2931750 . 495750 . 3427500 . e 2106000 . 702000 . t 2808000 . 1748250 . 588000 . 2336250 . 3949800 . 885000 . n 4834800 . 4942500 . 1132500 . i 6075000 . 1592500 . 515450 . 2107950 . 1353000 . 421850 . k 1774850 . 1221000 . 392500 . 1613500 . 1 597500 . -148000 . m 449500 . 476400 . -116800 . n 359600 . 3550450 . 3106750 . 443700 . 0 Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Losses (from col. (h)) Gains (excess of col. (h) gain over col. (k), (1) Adjusted basis (k) Excess of col. (i) (I) F.M V as of 12/31/69 but not less than ~-O--) as of 12/31/69 over col. (j), if any -1296000 560280 457500 8190 495750 702000 588000 885000 1132500 515450 421850 392500 -148000 -116800 443700

b e t n i k t m n o 2 Capital 9am net income or C net capital loss))

If gain, also enter ~n Part I, line 7 1 -- ~ 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

13120608 788779 fnd

17

2004 .05002 CARL & RUTH SHAPIRO FAMILY

FND

1

. . . . . . . . . . . . . . .

`

Continuation for 990-PF, 04-6135027 Page

CARL & RUTH SHAPIRO FAMILY FOUNDATION PIV_ Capttal Gains and Losses for Tax on Investment Income (a) List and describe the kind(s) of property sold, e g , real estate, 2-story brick warehouse ; or common stock, 200 shs. MLC Co .

(b, How acquired (C 1 Date acquired P - Purchase (mo ., day, yr .) D - Donation

Part IV 4 of 4 (d) Date sold (mo, day, yr.)

P 01/05/0403/04/04 P 01/05/0403/09/04 P 01/05/0403/09/04 P 01/05/0403/09/04 X1/05/0403/09/04 P 01/05/0403/09/04

to 95,000 SHS APPLE COMPUTERS b5,000 SHS ALTERA CORP . c 90,000 SHS ALTERA CORP . d 65,000 SHS ALTERA CORP . e95,000 SHS EMULUX CORP . f 50,000 SHS NIKE INC .

I

n (f) Depreciation allowed (or allowable)

(e) Gross sales price 2288550 105450 1898100 1375400 2155550 3843000

a b c d e t

(g) Cost or other basis plus expense of sale

2068150 115600 2077200 1502800 2660000 3375500

. . . . . .

. . . . . .

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

220400 -10150 -179100 -127400 -504450 467500

. . . . . .

m omplete only for assets (I) F.M .V . as of 12/31/69

in column (h) and owned by the foundation on 12/31/69 (k) Excess of Col. (i) (1) Adjusted basis over Col. (j), if any as of 12/31/69

(1) Losses (from Col. (h))

Gains (excess of Col . (h) gain over Col . (k), but not less than '-0-")

220400 . -10150 . -179100 . -127400 . -504450 . 467500 .

a

1 k

n

Capital gain net income or (net capital loss)

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 . .

-

(

2

If loss),~entert 0 'nin art I~ line 7 )

.. . . . . . .. . .

. . . . . .. . . .. . . . .. . .

"'

., . . . . .. . . .

9823061 .

""'

N/A

423591

05-Ot-04

13120608 788779 fnd

18

2004 .05002 CARL & RUTH 3HAPIRO FAMILY

FND

1

2004 DEPRECIATION AND AMORTIZATION REPORT

Form 990-PF Page 1

Asewt

Descri ption

Date

Acquired

Method

1 FURNITURE AND FIXTURE 121502 OOD

Life

No

Unadjusted

Cost Or Basis

Bus %

Excl

w

Reduction In

Basis

Basis For

Depreciation

Accumulated

Depreciation

Current

Sec 179

Amount Of

Depreciation

.00 17

8228 .

8228 .

0.

8 02-.20GDB5 .00 17 11 3 FURNITURE AND FIXTURE 121502 OOD .00 17

1290 .

1290 .

04

13944 .

13944 .

0.

2. DPT ICE EQUIPMMT

A.FURNITURE AND -FIXTURES 1215 2.200D:. 5 FFICE RENOVATION W"ICE -EQUXPMW

0 11203 2 00D '200

.00, 17

4882

.00 17

31637 .

31637 .

.00 17

-60 36,

6036

1841 .

.304141

1308*

693,. 0.

7 FURNITURE AND FIXTURE

41703 OOD

.00 17

9000 .

9000 .

0 .

9 FURNITURE AND FIXTURE

80403 OOD

.00 17

7464 .

7464 .

0.

5680*:.

5680 .

95606 .

92565 .

10 FUMITURE rIXTURES 6:6 19 04 2000 .5 .00 19M Total 990-PF Pg 1 ear

iaosoa

,

990-PF

(D) -Asset disposed

19

5680*: 3041 .

1308 . 5680 .

5680 6373 .

" ITC, Section 179, Salvage, Bonus, Commercial Revitalization Deduction

" , CARS & RUTH SHAPIRO FAMILY FOUNDATION Form 990-PF

04-6135027

Interest on Savings and Temporary Cash Investments

Source

1

Amount

BANK - INTEREST ON SAVINGS BANK - TEMPORARY CASH INVESTMENT Total to Form 990-PF,

Form 990-PF

Part I,

12 . 306598 .

line 3,

Column A

306610 .

Dividends and Interest from Securities

77500 137 1956 133040 996885

GOVT BONDS & T-BILLS MMKT ACCTS MMKT ACCTS - CORP DIVIDENDS - GOVT BONDS & T-BILLS

Total to Fm 990-PF, Part I,

Form 990-PF

In 4

Statement

Capital Gains Dividends

Gross Amount

Source BANK BANK BANK BROKER BROKER

Statement

. . . . .

1209518 .

0 0 0 0 0

Description

Column (A) Amount

. . . . .

133040 . 996885 .

0.

1209518 .

Legal Fees (a) Expenses Per Books

2

77500 . 137 . 1956 .

Statement

(b) Net Investment Income

(c) Adjusted

Net Income

3

(d) Charitable Purposes

LEGAL FEES

25284 .

12642 .

12642 .

To Fm 990-PF, Pg 1, In 16a

25284 .

12642 .

12642 .

Form 990-PF

Accounting Fees (a) Expenses Per Books

Description ACCOUNTING FEES To Form 990-PF,

Pg 1,

13120608 788779 fnd

In

16b

Statement

(b) Net Investment Income

(c) Adjusted Net Income

4

(d) Charitable Purposes

13000 .

13000 .

0 .

13000 .

13000 .

0 .

20 Statement s) 1, 2, 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND

3, 4 1

`CARL & RUTH SHAPIRO FAMILY FOUNDATION Form 99Q-PF

Other Professional Fees (a) Expenses Per Books

Description PROFESSIONAL CONSULTANTS To Form 990-PF,

04-6135027

Pg 1,

In 16c

Form 990-PF

Statement

(b) Net Investment Income

(c) Adjusted Net Income

(d) Charitable Purposes

6107 .

0 .

6107 .

6107 .

0 .

6107 .

Taxes (a) Expenses Per Books

Description

5

Statement

(b) Net Investment Income

(c) Adjusted Net Income

6

(d) Charitable Purposes

ANNUAL FRANCHISE TAX PAYROLL TAXES FEDERAL INCOME TAX STATE UNEMPLOYMENT TAXES IRS PENALTIES

25 . 4482 . 240456 . 309 . 188 .

0. 0. 0. 0. 0.

0. 4483 . 0. 309 . 0.

To Form 990-PF, Pg 1,

245460 .

0.

4792 .

In 18

Form 990-PF

Description

Other Expenses (a) Expenses Per Books

Statement

(b) Net Investment Income

(c) Adjusted Net Income

7

(d) Charitable Purposes

ANNUAL FEES TELEPHONE/INTERNET BUSINESS INSURANCE MISCELLANEOUS EXPENSES COMPUTER SOFTWARE CHARGES OFFICE SUPPLIES

548 . 2884 . 2410 . 107 . 1139 . 1486 .

0. 0. 0. 0. 0. 0.

0. 2884 . 2410 . 107 . 1139 . 1486 .

To Form 990-PF, Pg 1, In 23

8574 .

0.

8026 .

13120608 788779 fnd

21 Statement s) 5, 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND

6,

1

7

CARS & RUTH SHAPIRO FAMILY FOUNDATION Form 990-PF

U .S .

04-6135027

and State/City Government Obligations U .S . Govt

Description US TREASURY BILLS FEDERAL HOME LOAN BANK NOTES

Other Govt

X X

Total U .S . Government Obligations

Book Value

Statement

8

Fair Market Value

128812211 . 4000000 .

129523471 . 3980000 .

132812211 .

133503471 .

132812211 .

133503471 .

Total State and Municipal Government Obligations Total to Form 990-PF, Part II, line 10a

Form 990-PF

Corporate Stock

Description

Book Value

COMMON & PREFERRED STOCKS Total to Form 990-PF,

Form 990-PF

Statement

Part II,

line lOb

Cost or Other Basis

Fair Market Value

2212930 .

10132836 .

2212930 .

10132836 .

Depreciation of Assets Not Held for Investment

Description

9

Accumulated Depreciation

Statement

10

Book value

FURNITURE AND FIXTURES OFFICE EQUIPMENT FURNITURE AND FIXTURES FURNITURE AND FIXTURES OFFICE RENOVATION OFFICE EQUIPMENT FURNITURE AND FIXTURES FURNITURE AND FIXTURES FURNITURE AND FIXTURES FURNITURE AND FIXTURES

8228 . 1290 . 13944 . 4882 . 31637 . 6036 . 9000 . 7445 . 7464 . 5680 .

8228 . 1290 . 13944 . 3842 . 31637 . 6036 . 9000 . 7445 . 7464 . 5680 .

0. 0. 0. 1040 . 0. 0. 0. 0. 0. 0.

Total To Fm 990-PF, Part II, In 14

95606 .

94566 .

1040 .

13120608 788779 fnd

22 Statement s) 8, 9, 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND

10 1

',CARh & RUTH SHAPIRO FAMILY FOUNDATION Form 990-PF

Other Liabilities

Description

04-6135027 Statement Amount

PAYROLL TAXES - WITHHELD

978 .

Total to Form 990-PF,

Part II,

Form 990-PF

List of Substantial Contributors Part VII-A, Line 10

Name of Contributor

11

line 22, Column B

978 .

Statement

12

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

13120608 788779 fnd

23 Statement s) 11, 12 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1

r

CAkB & RUTH SHAPIRII -FAM-ILK FOUNDATION Form 990-PF

04-6135027

Part VIII - List of Officers, Directors Trustees and Foundation Managers

Name and Address

Title and Avrg Hrs/Wk

Statement

Employee Ben Plan Expense Contrib Account

Compensation

CARL SHAPIRO 2 N . BREAKERS ROW PALM BEACH, FL 33480

CHAIRMAN 20

RUTH SHAPIRO 2 N . BREAKERS ROW PALM BEACH, FL 33480

SECRETARY & TREAS . 4

RHONDA ZINNER C/o 399 BOYLSTON STREET BOSTON, MA 02116

PRESIDENT 20

ELLEN JAFFE c/o 399 BOYLSTON STREET BOSTON, MA 02116

13

0.

0 .

0 .

0 .

0.

0 .

0 .

TRUSTEE 4

0.

0 .

0.

LINDA WAINTRUP C/o 399 BOYLSTON STREET BOSTON, MA 02116

TRUSTEE 4

0 .

0 .

0.

JEAN S . WHITNEY 112 WOODRIDGE ROAD WAYLAND, MA 01778

PROGRAM DIRECTOR 32

54166 .

7067 .

0 .

54166 .

7067 .

0.

Totals included on 990-PF, Page 6, Part VIII

Form 990-PF

Part XV - Line la List of Foundation Managers

0 . & TRSTE 0 .

Statement

14

Name of Manager CARL SHAPIRO RUTH SHAPIRO

13120608 788779 fnd

24 Statement s) 13, 14 2004 .05002 CARL & RUTH SHAPIRO FAMILY FND 1

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

Relationship

Program Area

s~, .,m~~- #~s Pur pose of Grant Amount

Amer. Friends of Israel Phil. Orchestra

Public Charity

None

Arts & Culture

Operating Support

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

Barry Price Rehabilitation Center

Public Charity

None

Human Services

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

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

Recipient Name

o~-6i3s oar

Youth Development

I

Operating Support '

$5,000

$12,000 $4,000

$5,000

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

0

Status

Relationship

Program Area

Pur ose of Grant

Cambridge Arts Council

P ublic Charity

None

Arts & Culture

Operating Support

Center for Creative Education

Public Charity

None

Arts & Culture

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

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

Amount I

$2,500

Youth Development $15,000

$1,800

$20,000

`-

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

- 6135_O a

Status

Relationship

Program Area

Sno Purpose of Grant

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

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!

Museum of Fi ne Arts

Public Charity

None

Arts & Culture

Operating Support

National Council on Spinal Cord Injury

Public Charity

None

Health

Operating Support

Norton Museum

Public Charity

None

Arts & Culture

Capital

Norton Muse um

Public Charity

None

Arts & Culture

Operating Support

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

Park School

Public Charity

None

Education

PB Community Chest United Way

Public Charity

None

Human Services Operating/Program Support

PB_C ounty PBAI Cops for Kids

Public Charity

None

Human Services

PB Friends of M uscular Dystrophy Assoc Public Charity

None

Health

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

Recipient Name

Amount

$200,000

$690,000

~-

$20,000 T

$140,000 $ 120,000

Operating Support r

Operating Support I

Operating Support I

$5,000

$20,000 $35,000 $105,000 $15 $10,000

It The Carl and Ruth Shapiro Family Foundation - 2004 Grants and Contributions b ~3So a7

Status

Relationshi p

Program Area

S Purpose of Grant

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

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

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

Recipient Name

Washington Institute

TOTAL CHARITABLE GIVING :

-

I

~r #i~ Amount

Youth Development '

$20,000

I $3,205,400

'. "

' Forth

4562

Depreciation and Amortization 99o-pF

z

(Including Information on Listed Property)

DepsrtmentoftheTreasury Internal Revenue Service

Attachment Sequence No 67

1 Attach t0 your tax return . Business or activity to which this forth relates

1 See separate instructions .

Name(s) shown on realm

Identifying number

CARL & RUTH SHAPIRO FAMILY FOUNDATION orm 990-PF Pa ge 1 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 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 Ilmitabon for [ax year. Subtract line 4 horn line 1 . If zero or less, enter -0-. If married filing separately, see Instructions (b) Coat (business use only) (c) Elected coat (a) Description of property FURNITURE

OMB No 1545-0172

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 . . . . . . . . . . . . _ . . . _ . . 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 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) .. . . .. . .. . . . .. . .

.

, . . .. . . . .. . . . , . . . . . . .. . ...

.

.. ..

04-6135027 complete Part I . 7 10200F. 2 5680 . 410000 . 3 4 0 . 5 102000 .

..

17 MACRS deductions for assets placed in service in tax years beginning before 2004 . . . . . . . . . . . 18 If you are electing under section 168(1)(4) to group any assets placed in service during the tax

,

, ..

5680 . 5680 .

8 9 10 11 12

102000 . 5680 .

. , ..

...

3.

...

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 year placed In service

(a) Classification of properly

..

h

Residential rental property

i

Nonresidential real property

~a

Class life

b

(d) Recovery period

` °

2004 Tax Year

f

25 vrs.

I

27 .5 vrs.

I

rtion of the basis attributable to section 283A costs

MM

I

S/L

I

S/L

MM I I s/L I the Alternative Depreciation System

21 Listed property . Enter amount from line 28 ._ ... ... . . ., .. . .. . 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 . 23 For assets shown above and placed in service during the current year, enter the

4

(g) Degradation deduction

12 40

Summary (See instructions .)

416251

(e) Convention I (q Method

rY. .

Section C - Assets Placed in Service

12~vear

(c) Beak for depreciation (business/investment use only - see Instructions)

. . . . . .. . . .. . . . . . . .

..

. .. . . . . F23T

..

21

6373 .

22

LHA For Paperwork Reduction Act Notice, see separate instructions. 25 13120608 788779 fnd 2004 .05002 CARL & RUTH SHAPIRO FAMILY

Form 4582 (2004)

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)

Date

Type of property (list vehicles first )

placed in

(b) service

~~~

X81

(cn

Business/

investment

use percentage

(fl

(h)

(9)

Basis roe depreciation (business/investment Recovery period 9, only)

Cost or other basis

G)

Elected

Depreciation deduction

Method/

Convention

section 179 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 29 Add amounts in column 01 , line 26 . Enter here and on line 7, page 1  . . . . ., . . . . . . . . .



_ ._, .

_ . .. . , . ., . . . ,

28 . ....

__ . .

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)

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?

- -

----

~ - -

--

(b)

I

(C)

I

I

41111

(e)

I

lfl

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 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 Mains

I

c~~

Amortlzable amount

I

c~

Code section

I

ce>

MaNzaGon period pr paCentaae

I

~fl

Amortization 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 476252/11-15-04

13120608 788779 fnd

. . . . . I 44

26 2004 .05002 CARL & RUTH SHAPIRO FAMILY

Form 4582 (2004)

FND

1

1

A

4562

,` ,

0MB No . 1545-0172

2004

Depreciation and Amortization (Including Information on listed Property)

DepartmentottheTreasury Internal Revenue Service

1 See separate instructions .

Name(s) shown on return

Attachment Sequence No. 87 Identifying number

1 Attach to your tax return .

Business or activity to which this forth relates

X04-6135027 Part I.

Pon I Election To Expense Certain Property Under Section 179 Note : If you have an listed property, complete Part V before you coi 1

Maximum amount . See instructions for a higher limit for certain businesses

._ .

..

5 Dollar limitation for tax year Subtract line 4 from line 1 If zero or less, enter -0-, If martied filing separately, see Instructions

..

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(a) Description of property

(b) Cost (business use only)

7 Listed property. Enter the amount from line 29

. ..... .. . .. . . .... . . .

8 9 10 11

... .. , . ..

_ (c) Elected cost

rJ

I 7 I

Total elected cost of section 179 property . Add amounts in column (c), lines 6 and 7 . . . . . . . . . . . . . . . .. . . ... Tentative deduction . Enter the smaller of line 5 or line 8 . . . . .... ..... ..... .... ... , .. .. . .. Carryover of disallowed deduction from line 13 of your 2003 Form 4562 ..... .... ... ... . .. . .. . ... . . .. . . . Business income limitation . Enter the smaller of business income (not less than zero) or line 5 .. . Section 179 expense deduction . Add lines 9 and 10, but do not enter more than line 11 . . . . . . . . . . . ., . . 12 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) , . _ 15 Property subject to section 168(fl(1) election (see instructions) . . . . . . . . . . . . . . . . . . . , . . . . . . ., . . . . . . . . . . . . . . . . . . . . . _ . 18 Other dep reciation ncludin ACRS see instructions . . . . . . . . . . . . . . MACRS Depreciation (Do not include listed property .) (See instructions.) Section A for in tax beginning 17 MACRS deductions assets placed service in years before 2004 . . . . . . . . . . . . . . . . . . . . . . . 18 If you are electing under section 168()(4) to group any assets placed in service during the tax

(s) Classification of properly

(b) Month end year pieced

(c) Basis fir depreciation (buslness/InvssUnentuae

In service

only - sea Instructions)

(d) Recovery period

14 15 18

17

(a) Convention I (n Method I

(g) Depreciation deduction

19a

c . "t.

1

'

h

Residential rental property

i

Nonresidential real property

if~ h ~'lni. r f

27 .5 vrs .

Class life 12-year 40-veer

Summary (See instructions .)

`

/

40 vrs.

s

21 fisted property. Enter amount from line 28 . . . . ., . . ., . ., . . . . . . . . . . . . . . .. .. , . ... , . ... 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 . 23 For assets shown above and placed in service during the current year, enter the ortion of the basis attributable to section 263A costs 41625 4

. ...

. .. . . . .. . . . .. . . . ..

LHA For Paperwork Reduction Act Notice, see separate instructions .

13120608 788779 fnd

MM

I

S/L

MM

I

S/L

MM

I

S/L

2004 Tax Year Using the Alternative

Section C - Assets Placed in Service ,a b c

I

...

I . .. . ..

... .. .

...

.

21 22

23

27 2004 .05002 CARL & RUTH SHAPIRO FAMILY

Form 4562 (2004)

FND

1

h

f r 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~

Date p laced in

Type of property

(list vehicles fast )

service

(c)

(c)

Business! investment

use percentage

(e)

Basis fordeproclatlon (buslnesa/lnvestment

Cost or

other basis

use only)

(~1

(9)

Recovery

(h)

Method/

period

Elected

Depreciation

Convention

section 179 COSH

deduction

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 ..... .. .. . 29 Add amounts in column (), line 26 . Enter here and on line 7, page 1 , . . . . . . . . . .. . . __ . . . . .__ Section B - Information on Use of Vehicles

. . , ,.

..

28

..

,...

2g

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

30 Total business/investment miles driven during the year (do not include commuting miles) . . . . . . . . .

(b)

I

(c)

I

(d)

I

(e)

I

(fl

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)

Description ofcosts

(b)

Damortarbadm heolns

I

(C)

Amortizable amount

I

(CQ

Code section

I

(e)

Amailvb oellodorcem

Amortization 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

13120608 788779 fnd

as

... .

.. .. .. .... . .. . . . . . . . .. ..

. .. .. .

.

2004 .05002 CARL & RUTH 5HAPIRO FAMILY

Form 4582 (2004)

FND

1

Form

$8S$ (Rev. December 2004) Departrwt of the Treasury Internal Revenue Service

Application for Extension of Time To File an Exempt Organization Return 00, File a

OMB No. 1545-1709

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.

Name of Exempt Organization

Type or print Rio by Cro due date for flling your return. See Instructions.

Employer identification number

04-6135027

CARL & RUTH SHAPIRO FAMILY FOUNDATION Number, street, and room or suite no . If a P.O . box, see instructions .

399 BOYLSTON STREET

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 0 Forth 990-BL 0 Form 990-EZ ~X Form 990-PF

1--] Form 990-T (corporation) 0 Form 990 "T (sec . 401(a) or 408(a) trust) 0 Form 990-T (trust other than above) [::] Form 1041-A

D E::] Q 0

" The books are in the care of " WELLESLEY CAPITAL MANAGEMENT, Telephone No. " 781-235-6107 FAX No.

Form Form Form Form

4720 5227 6069 8870

INC .

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. August 15, I request an automatic 3-month (6-months for a Form 990-T corporation) extension of time until to file the exempt organization return for the organization named above . The extension is for the organization's return for:

1

" ~X calendar year 2 0 0 4 or tax year beginning

2 3a

b

c

2005

, and ending

If this tax year is for less than 12 months, check reason :

0 Initial return

D Final return

D Change in accounting period

If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6089, enter the tentative tax, less any

226271 .

nonrefundable credits . See instructions ... ... . .. .. . . ... . .. ..... ..... ........ .. ..... .. ....... ..... . . ..... .. .... ....... ..... .. .. ..... .... . $ 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 .

$

Balance Due. Subtract line 3b from line 3a . Include your payment with this form, or, if required, deposit with FTD

0

coupon or, if required, by using EF7P5 (Electronic Federal Tax Payment System). See instructions ...... .. .. .... . ..... $

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

Form 8888 (Rev. 12-2004)

For Privacy Act and Paperwork Reduction Act Notice, see instructions.

423831

01-10-05

15470510 788779 fnd

2004

.05002

29

CARL

&

RjJTH GHApTR(1

FAM7T .v

FMTn

1