990 return of organization exempt from income tax m9n o uw...

1

Form 990 Return of Organization Exempt From Income Tax M9N o 1545-0047

Under section 501(c), 527, or 4947(a)(7) of the Internal Revenue Code (except black lung LS00 1 benefit trust or private foundation)

Depr'Imenl of the Treasury ~ internal Revenue Seance " The organization may have to use a cop 1 i i a r r PA. A Fog the 2007 calendar ear or tax ear be mrn 1 , a n` W7'10 /2002 B c~xY .�de` ple a. C Name of organization POLY PREP COUNTRY DAY SCHOOL (FORMERLY D Employer Identification number

same uw IRS wro . lead . , POLYTECHNIC PREPARATORY COUNTRY DAY SCHOOL 11-1630821

X wm" =~~ p��, Number and street (or P O box if mail is not delivered to street address) Room/suite E Telephone number mtwrwwn type

Fw~~^~^ ,. Sd~~ 9216 SEVENTH AVENUE (718 ) 836-9800 "°'° memo- City or town slate or country, and ZIP + 4 F � c�countliq ~ c., 51 -,

~ ~pp... don . LJ ..Mb, 11228- 3698 F Ome(sP-fY) ii~

Hand 1 are not applicable (o sec(wn 527 pganrzalrons

H(a) Is this a group return for affiliates? Flyer; Ili] No H(b) If'Ves'enter number ofaffiliates 1

H(c) Are all affiliates included? QYes ~ No (if 'NO' attach a 115L See insliucuons )

Hid) Is this a siyanate rewm flea by an ~~ ~~ aaanmaixn moerad by a omie rulno'+I I Yes I X I No

J Organization type (Check only me) flax sot c) 3 1 " (Insert no) a947(a)(1 ) or 1 527

K Check here 1 A the organizations gross receipts aye normally not more than 325000 The

arganvaUOn need not file a return with the IRS but R the organization received a Form 990 package in tie mail, n should file e return vnNwt financial data Some states require a complete return GEN I Enter 4-digi

M Check J if the organization Is not required B (Form 990 9902 a 990 PF) 6b BD, Bb, and 10b to line 12 111"

Revenue, Expenses, and Changes in Net Assets or Fund Balances See Specific Instructions 1 Contributions, gifts, grants, and similar amounts received a Direct public support 1 1a l 2 , 667 , 425 b Indirect public support , , 1 1b c Government contributions (grants) 1 c 103- 255 d ratailaaainastathrough tcl (msnf 2,497 .726 . non~asns 270,954 )

2 Program service revenue including government tees and contracts (from Part VII line 93) 3 Membership dues and assessments

4 Interest on Savings and temporary rash investments 5 Dividends and interest from securities 6 a Gross rents _ 6a . b Less rental expenses 16b l c Net rental income or (loss) (subtract line 66 from line 6a)

7 Other investment income (describe 8 a Gross amount from sales of assets other (A) securities JB) Other

than inventory Slkff 1]} _ 15 . 340 , 320 . 8a 5 , 000 b Less cost or other basis and sales expenses 15 , 726, 546 . 8b c Gain or (loss)(attathsrhedule) , , -386 , 226 Bc 5 , 000 d Net gain or (loss) (combine line 8c, columns (A) and (B))

9 Special events and activities (attach schedule) a Gross revenue (not including $ of

contributions reported online 1a), , 9a b Less direct expenses other than fundraising expenses , 9b C Net income or (loss) from special events (subtract line 9b from line 9a)

10a Gross sales of Inventory, less returns and allowances 0a b Less cost of goads sold , on c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line t0a)

71 Other revenue (from Part VII, line 103) 12 Total revenue add lines 1d 2 3 4 5 6c 7 8d 9c 10c 13 Program services (from line 44, column (B)) , , , T_ F D . 14 Management and general (from line 44, column (C))

L12)~- L~

7 MAY

' ̀ ^ (~ a 15 Fundraising (from line 44, column (D)) s'nM i; ,y 16 Payments to affllales (attach schedule)

GtiFfd '-

17 Total ex penses add lines 16 and 44 column A --.-.--. 18 Excess or (deficit) for the year (subtract line 17 from line ~ 19 Net assets or fund balances at beginning of year (from line 73, column (A)) 20 Other changes in net assets or fund balances (attach explanation) , gTiQT } m 21 Net assets or fund balances at end of Ye ar (combine hoes 18 19 and 20

For Paperwork Reduction Act Notice, sea the separate Instructions JSA tE10102000

FTX4KB L161 05/05/2003 10 38 .44 V01-7 300985

F«.,. 990 (200,)

0 Section 501(c)(3) organizations and 1947(s)(1) nonexempt charitable trusts must attach a completed Schedule A (Form 990 or 990-EZ)

Farm 990 2001) 11-1630821

Statement of All organizations must complete column (A) Columns (B) (C) and (0) are required for section 501(c)(3) and (4) organizations functional Exaenses and section 4947(a)(1) nonexempt chanlable (rusts but optional brothers (Sea Specific instructions on page 21 )

~~ Do not include amounts reported on line 66, 86, 96, 706 or 16 of Part/

22 Grants and allocations (attach schedule; ICdSh S , OOOGSIIS 3,217,745

23 Specific assistance to indmduals (attach schedule) 24 Benefits pain to or for members (attach schedule) 25 Compensation of officers, directors, etc 26 Other salaries and wages 27 Pension plan contributions 28 Other employee benefits 29 Payroll taxes 30 Professional fundraising fees 31 Accounting fees 32 Legal fees 33 Supplies 34 Telephone 35 Postage and shipping 36 Occupancy 37 Equipment rental and maintenance 38 Printing and publications 39 Travel_ 40 Conferences, conventions, and meetings 41 Interest ` 7__ _ 42 Depreciation devI(_ ~n ~ anac s dole) 43 Oiner expenses na cmered acme (itemize) STMT 2

b c d e

44 Total functional expanses lava lines 22 through 43) grUm,zabons completing columns (9)-(D), carry

TVT 2Z

What is the organization's primary exempt purposes " EDUCATION Program Service Expenses

All organizations must describe their exempt purpose achievements in a clear and concise manner Stale the number (Required for501(c)(3)ana of clients served, publications issued, etc Discuss achievements that are not measurable Section 501 (c)(3) and 4 (4) or9s , and a9a7(a)(7)

( ~ trusts but optional for organizations and 4947(x)(1) nonexempt charitable trusts must also enter the amount of grants and allocations to others ) others )

a THE - SCHOOL - PROVIDES -ACADEMIC- AND- OTHER RELATED ACTIVITIES -----------------TO - STUDENTS - IN -VARIOUS -CLASSES- FROM PRE-KINDERGARTEN THROUGH GRADE TWELVE

Grants and allocations $ 3 , 217 , 745 ) 19 , 307 , 937 b

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Grants and allocations $ c

------------------------------------------------------------------------------------------------------------------------------------------------------

Grants and allocations $ d

------------------------------------------------------------------------------------------------------------------------------------------------------

Grants and allocations $ e Other prog ram services attach schedule Grants and allocations $ f Total of Program Service Expenses (should equal line 44, column (B) Program services) . ~ 19,307,937 .

iEioxozooo Form990 (2001) FTX4KB L161 05/05/2003 09 54 24 V01-7 300985

(A) Total I (8) Program (C) Management (D~Fund2ising services and general

Joint Costs Check " U it you are following SOP 98-2 Are any point costs from a combined educational campaign and fundraising soliatahon reported in (B) Program services? " 0 Yes aX N o If "Yes; enter (i) the aggregate amount of these joint costs $ . (it) the amount allocated to Program services E

Form 990 (2001) 11-1630821

Balance Sheets (See Specific Instructions on page 24 )

(A) (B) Beginning of year End of year

40 , 121. 45 82 , 988 3 , 341 , 705 46 4 , 023 , 353

123 . 877 47c 137 , 246

1 , 226 , 737 48c 1 , 541 , 404 49

50

51c 52

629 , 719 53 361 , 045 11 , 786 , 814 54 9 , 203 , 6.71 .

55c 56

19 , 561 , 134 57c 20 , 795 , 705 929 , 026 58 873 , 7. 32

37 , 639 , 133 59 37 , 019 , 144 568 , 288 60 994 , 393

61 62

63 64a

5 , 674 , 167 64b 3 , 640 , 000 3 , 397 , 904 65 3 , 342 , 691

9 , 640 , 359 66 7 , 977 , 084

21 643 556 . 67 22 281 102 2 434337 . 68 2 , 336 , 772 3 , 920 , 881 69 4 , 424 , 186

70 71 72

Organizations that follow SFAS 117, check here " L xJ and complete lines 67 through 69 and lines 73 and 74

m 67 Unrestricted c 68 Temporarily restricted m 69 Permanently restricted . . m

Organizations that do not follow SFAS 177, check here t D and complete lines 70 through 74

0 70 Capital stock, trust principal, or current funds m 71 Paid-in or capital surplus, or land, building, and equipment fund _ m 72 Retained earnings, endowment, accumulated income, or other funds

73 Total net assets or fund balances (add lines 67 through 69 OR lines m 70 through 72, z

column (A) must equal line 19, and column (B) must equal line 21)

Forth 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization How the public perceives an organization in such cases may be determined by the information presented on its return Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments

JsA 1E1070 Z 000

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NPte VYhere required, attached schedules and amounts within the description

45 Cash - norrinterest-bearing 46 Savings and temporary cash investments

47a Accounts receivable b Less allowance for doubtful accounts

48a Pledges receivable 48a 1 , 615 , 404 b Less allowance for doubtful accounts , , 48b 74 , 000

49 Grants receivable 50 Recervables from officers, directors, trustees, and key employees

(attach schedule) 51a Other notes and loans receivable (attach

schedule) 57a b Less allowance for doubtful accounts _ 51 b

Q 52 Inventories for sale or use 53 Prepaid expenses and deferred charges STMT 3 54 Investments -securities (attach schedule) $Tk1T 4 " oCost Q FMV 55a Investments - land, buildings, and

equipment basis _ _ 55a b Less accumulated depreciation (attach

schedule) , SSb 56 Investments - other (attach schedule) 57a Land, buildings, and equipment basis-,$:I-MT 4 57a 30 , 566 , 733

b Less accumulated depreciation (attach schedule) _ 57b 9 771 028

58 Other assets (describe " STMT 5 )

60 Accounts payable and accrued expenses 61 Grants payable 62 Deferred revenue . . . . 63 Loans from officers, directors, trustees, and key employees (attach

- schedule) A 64a Tax-exempt bond liabilities (attach schedule)

b Mortgages and other notes payable (attach schedule) $T14T 6 65 Other liabilities (describe " STMT 7 )

Reconciliation of Revenue per Audited Financial Statements with Revenue per Return (See Soeafic Instructions . oaae 26

Reconciliation of Expenses per Audited Financial Statements with Expenses per

a Total expenses and losses per audited financial statements

b Amounts included on line a but not on line 17, Form 990

(1) Donated services and use of facilities $

(2) Prior year adjustments reported on line 20 Form 990 $

(3) Losses reported on line 20, Form 990 f

(4) Other (specify)

Add amounts on lines (7) through (4) Add amounts on lines (1) through (4)

c 19 063 039 c Line a minus line b 10 d Amounts included on line 17

Form 990 but not on line a (1) Investment expenses

not included on line 6b, Form 990 $

(z) other(speay)

c Line a minus line b d Amounts included on line 12,

Form 990 but not on line a (1) Investment expenses

not included on line 6b, Form 990 $

(2) Olher(speafy)

S1TTP 9 $ 3,217,745 Add amounts on lines (1) and (2)

e Total expenses per line 17, Form 990

STMT 8 $ 3 .217,745 Add amounts on lines (1) and (2)

e Total revenue per line 12, Form 990

List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated, see Specific

(B)Title andaverage I (C) COmpansabon I (D) ca~vieuwnsb I (E) F~ense noun O~~k (II not paid, enter employee Eenafnplans8 account and aNer

J5A 1 E 100 Z 000

FTX4FB L161 05/05/2003 09 54 24 V01-7 300985

a Total revenNe, gains, and other support per audited financial statements

b Amounts included on line a but not on line 12, Form 990

(1) Net unrealized gains

on investments $ -4 92, 047 (]) Donated services

and use of facilities $ (7) Recoveries of poor

year grants $ (4) Other (specify)

(A) Name and address

75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than E100 000 from your organization and all related organizations, of which more than $10,000 was Provided by the related organizations? " 0 Yes EANo I( "Yes,' attach schedule - see Specific Instructions on page 27

Form aau X2007)

N

b Did the organization file Form 1120-POL for this year? B2 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge

or al substantially less than fair rental value? ,

b If 'Yes 'you may indicate the value of these items here Do not include this amount

d Section 162(e) lobbying and political expenditures e Aggregate nondeductible amount of section 6033(ex1)(A) dues notices f Taxable amount of lobbying and political expenditures (line BSd less 85e)

sources against amounts due or received from them )

NONE NONE d Enter Amount of tax on line 89c, above, reimbursed by we organization

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Instructions on 76 Did the organization engage in any activity not previously reported to the IRS If "Yes," attach a detailed description of each activity 77 W erg any changes made in the organizing or governing documents but not reported to the IRS $TtQ'P 1 5

If "Yes," attach a conformed copy of the changes 78 a Did the organization have unrelated business gross income of $t 000 or mare during the year covered by this return?

b I I 'Yes; has it filed a tax return on Form 990-7 for this years 79 Was there a liquidation dissolution termination or substantial contraction during the years If 'Yes' attach a statement 80a Is the organization related (other than by association with a statewide or nationwide organization) through common

membership, governing bodies trustees, officers, etc , to any other exempt or nonexempt organization? 6 If 'Yes; enter the name of the organization

and check whether it is " exempt OR 81 a Enter direct or indirect political expenditure See line 81 instructions

as revenue in Part I or as an expense in Part II (See insWCUOns m Part III ) . 1 8 : 83a Did the organization comply with the public inspection requirements for returns and exemption applications?

b Did the organization comply with the disclosure requirements relating to quid pro quo contribubons? 84a Did the organization solicit any contributions or gifts that were not tax deductible? _

b If "Yes 'did the organization include with every solicitation an egress statement that suds contributions or gifts were not tax deductible?

85 501(c)(4), (5), a (6) organrzahons a Were substantially all dues nondeductible by members b Did the organization make only in-house lobbying expenditures of $2,000 or less

If 'Yes" was answered to ether 85a or 85b, do not complete BSc through 85h below unless the organization received a waiver for proxy tax owed for the prior year

c Dues, assessments, and similar amounts from members

g Does the organization elect to pay the section 6033(e) fax on the amount in 85f? h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount in 85f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year?

86 507(c)(7) orgs Enter a Initiation fees and capital contributions included on line 12 86a h Gross receipts included on line 12, for public use of dub facilities

87 507(c)(12) crgs Enter a Gross income from members or shareholders , , b Gross income from other sources (Do not net amounts due or paid to other

BB At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301 7701-2 and 301 7701-3? If 'Yes; complete Part IX _

89a 507(c)(3) organizations Enter Amount of tax imposed on the organization during the year under section 4911 " NONE . section 4912 " NONE , section 4955

b 507(c)(3) and 501(c)(4) orgs Did the organization engage in any section 4958 excess benefit Vansachon during the year or did it become aware of an excess benefit transaction from a prior years If 'Yes," attach a statement explaining each transaction

c Enter Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958

90a List the states with which a copy of this return is fled fl~ NONE b Number of employees employed in the pay period that includes March 12, 2001 (See instructions) . ~ 906 1183

97 The books are in care of " POLY PREP COUNTRY DAY SCHOOL Telephone no " (718 ) 836-9800 Located at tl~ 9216 SEVENTH AVENUE, BROOKLYN, NY Z1P+q tl~ 11228-3698

92 Section 4947(a)(1) nonexempt charitable trusts riling Form 990 in lieu of Form 1041-Check here , and enter the amount of tax-exempt interest received or accrued during the tax year " ~ 92 " ~ NONE

Fmri990 (2001)

JSA 1E1041 2000

512 513 or 514 (E) p Related or

Amount exempt (unction

Note Enter gross amounts unless otherwise Unrelated business inc

ind7Fated (A) (B) Business Amount 93 Program service revenue code

a TUITION INCOME

b STUDENT FEES

c AUXILIARY ACTIVITY

d OTHER SCHOOL

e PROGRAMS

f Medicare/Medicaid payments

g Fees and contracts from government agencies

94 Membership dues and assessments

95 Interest on sawngs and tanpaary cash n~Menls

96 Dividends and interest from securities

97 Net rental income or (loss) from real estate

a debt-financed property

b not debt-financed property

98 Nelrental incameullnsohanpersmai0roperty

99 Other investment income 100 Gem or(lc¢5)hpnsales olassets OViarNaninventory

101 Net income or (loss) from specaal events

102 Gross profit or (loss) from sales of inventory

103 Other revenue a b

c

d

e

104 Subtotal (add columns (B) (D), and (E))

105 Total (add line 104, columns (B), (D) and (E)) . . Note Line 105 plus line 1d, Part l, should equal the amount on line 12, Part I

. . ll~ 19,512,104 .

Line No I Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment

B I lnaer~er~cea I Nature of acUHties Total income Name

on 33 No No

Transfers Associated with Personal Benefit Contracts Yes Yes

JSA 7 E 1050 2 000

FTX4KB L161 05/05/2003 09 54 24 V01-7

(a) 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

Under enalties of per7u I declar that I have examined this and be Pet it is Irue, 1 n0 mplet Declaration of pr

Please Sign I Sign is ololfl& Here ' BST ~BE~G/~

Type or print name and title

Preparef5

Paid signature v

Preparer's F,msname (wors EI NE L Use Only it scll~makyyed), ' 750 THIRD AVENUE

address and ZIP w 4

SCHEDULER Organization Exempt Under Section 501(c)(3) OMB NO 1545-1

(Form 990 or 990-EZ) (Except Private Foundation) and Section 501(e), 50'1(n, 507(k), 501(n), or Section 4947(a)(1) Nonexempt Charitable Trust

Supplementary Information-(See separate instructions.) 200 1 Department olNeTreasury incemal Raeenue"Samca " MUST be completed b the above organizations and attached to their Form 990 or 990.E2 Name of the organization Employer IEentlflcatlan num

POLY PREP COUNTRY DAY SCHOOL 11-1630821 Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions List each one If there are none, enter "None ")

(e) Name and address o! each employee paid more (b) Title and average (d) Contributions to (e) Expense than $50,000 A hours per week ̂ (c) Compensation employee benefit plans 8 account and other

TO

Paid Independent Contractors for Profess ch one (whether individuals or firms) If were are

Compensation of the Five (See Dace 2 of the instruchor

(a) Name and address a! each independent contractor paid more than $50,000 1 (b) Type o! service (c) Compensation

NONE

Schedule A (Form 990 or 990FZ) 2001

JSA t E1370 3 000

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STEVE -ANDERSON C/O POLY PREP COUNTRY DAY SCH .

ROHERT ABERLIN C/O POLY PREP COUNTRY DAY SCH

MAUREEN 47AL3H C/O POLY PREP COUNTRY DAY SCH .

TOM O'HANDLEY C/O POLY PREP COUNTRY DAY 3CH .

kaL7.TZM Q3C__ C/O POLY PREP COUNTRY DAY SCH

Total number of other employees paid over

OF

_ LOWER

OP DSVEL

D - UDPFI2 SCHTSI.

NONE

Services enter "None

------------------------------------------------

------------------------------------------------

------------------------------------------------

---------------------------------------------

Talal number of others receiving over $50,000 for I` professional services , " NONE I For Paperwork Reduction Act Notice, sea the Instructions fu Form 990 and Form 990-EZ

3 Does the organization make grants for scholarships, fellowships student loans, etc 7 (See Note below )

4 Do you have a section 403(b) annuity plan for your employees?

Note Attach a statement [o explain how the organization determines that individuals a organizations receiving grants STMT 17

The or anizelion is not a private foundation because it is (Please check only ONE applicable box)

5 A church, convention of churches, or association of churches Section 170(b)(1 xAxi)

6 X A school Section 170(bx1xA)(u) (Also complete Part V )

7 I I A hospital or a cooperative hospital service organization Section 170(bxlHAxm)

8 e A Federal, stale, or local government or governmental unit Section 170(bXlXAXv)

9 A medical research organization operated in conjunction with a hospital Section 170(bxlxAxni) Enter the hospital's name, city,

and state je~

10 a An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(7 )(Axrv)

(Also complete the Support Schedule n Pail IV-A ) 71 a O M organization that normally receives a substantial part of its support from a governmental unit or (mm the general public.

Section 170(b)(1)(A)(h) (Also complete the Support Schedule m Part IV-A ) 11 b 8 A community trust Section 170(b)(1)(AxH) (Also complete the Support Schedule in Part IV-A )

12 M organization that normally receives (1) more than 33 1/3'4 of its support from contributions, membership lees, and gross

receipts tram actihties related to its charitable, etc , functions - subject to certain exceptions, and (2) no more than 33 1/3°,G of

its support from grass investment income and unrelated business [arable income (less section 511 lax) from businesses acquired

by the organization after June 30, 1975 See section 509(ax2) (Also complete the Support Schedule in Part IV-A )

7 3 F_1

M organization that is not controlled by any disqualified persons (other than foundation managers) and supports organvahons described in (1) lines 5 through 12 above, or (2) section 501(c)(4), (5), or (6), d they meet the lest of section 509(a)(2) (See

section 509(a)(3) )

(b) Line number (a) Name(s) of supported organization(s) from above

14 I I An organ i zation organized and operated to test for publ i c safety Section 509(a)(4) (See page 6 of the instructions I Schedule A (Form 990 or B90-EZ) 2001

JSA 1E1220 2 000

FTX4[B L161 05/05/2003 09 .54 :24 V01-7 300985

1-

Statements About Activities (See page 2 of the instructions) I Yes I No

7 ` During the year has the organization attempted to influence national, stale, or local legislation, including any

attempt to, influence public opinion on legislative matter or referendums If Yes' enter the total expenses paid

or incurred in connection with the lobbying activities " $ (Must equal amount on line 38,

Part VI-A, or line i a Part VI-B )

Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A Other

organizations checking Yes; must complete Pail VI-8 AND attach a statement giving a detailed description of the lobbying activities

2 During the year, has the organization either directly or indirectly, engaged in any of the following acts with any

substantial contributors, trustees, directors, officers, creators key employees or members of (heir families, or

with any taxable organization with which any such person is affiliated as an officer, director, trustee majority

owner, or principal beneficiary? (H the answer to any question is "Yes," attach a detailed statement explaining

the transactions)

a Sale, exchange, a leasing o! property

b Lending of money or other extension of credit?

c Furnishing of goods, services, or facilities?

d Payment of compensation (or payment or reimbursement of expenses if more than $1 000)

e Transfer of any pan of its income or assets

Reason for Non-Private Foundation Status (See pages 3 through 6 of the instructions )

SthedUle A Form 990 or 990-EZ 2001 11-1630821 P ~o 3 iaffiSuPpOrt Schedule (Complete only if you checked a box on line 10, 11 or 12 ) Use cash methodofaccounting NOT APPLICABLE

7 5 Gifts, grants, aid contributions received (Do

19 Net income from unrelated business

activities not included in line 18

20 Tax revenues levied for the organizations benefit and either paid to it or expended on

21 me value of services or facilities furnished to

the organization by a governmental unit

without charge Do not include the value of

services or facilities generally furnished to the

22 Other income Attach a schedule Do not

include gain or (loss) from sale of capital assets

26 Organizations described on fines 70 or 11 a Enter 2% of amount in column (e), line 24 NQT Xp$"CjiP7.$ b Prepare a list for your records to show the name of and amount contributed by each person (other than a

governmental unit or publicly supported organization) whose total gifts for 1997 through 2000 exceeded the amount shown in line 26a Do not file this list with your return Enter the total of all these excess amounts

c Total support for section 509(a)(1) lest Enter line 24, column (e) d Add Amounts from column (e) (or lines 18 19

22 26b

e Public support (line 26c minus line 26d total) 1

(2000) -----__-_-------(1999) _______-__------- (1998) ___NOT APPLICABLE__ (1997) -_------------b For any amount included in line 17 that was received from each person (other than 'disqualified persons"), prepare a list for your records to

show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000 (Include in the list organizations described in lines 5 through 11, as well as individuals ) Do not file this list with your return After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year (2000) ________________1999) ___________________ (1998) ___________________1997)______________

c Add Amounts from column (e) for lines 15 16 17 20 21

d Add Line 27a total and line 27b total , e Public support (line 27c total minus line 27d total) 1 Total support for section 509(a)(2) test Enter amount on line 23, column (e) g Public support percentage (line 27e (numerator) divided by line 27f idenominator))

28 Unusual Grants For an organization described in line 10, 11, or 12 that received any unusual grants during 1997 through 2000, prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant Do not file this Ilst with your realm Do not include these grants in line 15

Schedule A (Farm 990 or 990-EZ)1001 JSA 1 E 1721 3 000

FfX4KH L161 05/05/2003 09 54 24 V01-7 300985

17 Grass receipts from admissions, merchandise

sold or services performed, or furnishing of

facilities in any activity that is related to the

18 Gross income from interest, dividends

amounts received from payments on securities loans (section 512(ax5)), rents royalties and

unrelated business taxable income (less

section 511 taxes) from businesses acquired

27 Organizations described on line 12 a For amounts included in lines 15, 16, and 17 that were received from a 'disqualified person; prepare a list (or your records to show the name of, and total amounts received in each year from, each 'disqualified person " Do not file this list with your return Enter the sum of such amounts for each year

Schedule p(FOrm 990 or 990-EZ)7001 Page 4

Private School Questionnaire (See page 7 of the instructions ) (To be completed ONLY by schools that checked the box on line 6 m Part IV)

a Students' rights or privileges?

X

Ii you answered "Yes" to any of the above, please explain (If you need more space, attach a separate statement -------------------------------------------------------------------------- --------------------------------------------------------------------------------

------------------------------- --------------------------------

34a Does the organization receive any financial aid or assistance from a governmental agency . STMT 1

b Has the organizations right to such aid ever been revoked or suspended I( you answered "Yes" to either 34a or b, please explain using an attached statement

35 Does the organization certify that it has complied with the applicable requirements of sections 4 01 through 4 OS

Schedule A (Form 990 or 990-EZ)1001 JSA tE1Z702000

FTX4KB L161 05/05/2003 10 .51 50 V01-7 300985

11-1630821

29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, Yes No other governing instrument, or in a resolution of its governing body 29 x

30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships 30 X

31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves 31 X If "Yes," please describe, d "NO," please explain (If you need more space, attach a separate statement )

STMT 1 ----------------------------------------------------------------------- ------------------------------------- --------------------------------------- ----------------------------------------------------------------------------- ----------------------------------------------------------------------------- 32 Does the organization maintain the following

a Records indicating the racial composition of the student body, faculty, and administrative staff? b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory

basis? c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing

with student admissions, programs, and scholarships d Copies of all material used by the organization or on its behalf to solicit contributions?

If you answered "No" to any of the above, please explain (If you need more space, attach a separate statement ) ----------------------------------------------------------------------------- --------------------------------------------------------------------------

33 Does the organization discriminate by race in any way with respect to

b Admissions policies?

c Employment of faculty or administrative staff?

d Scholarships or other financial assistance

e Educational policies?

f Use of facilities?

g Athletic programs

h Other extracurricular activities?

Schedule A Form 990 or 990-EZ 2001 11-1630821 Page 5 Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions ) To be completed ONLY b an eligible organization that filed Form 5768 NOT APPLICABLE

Chick " a N d the organization belongs to an affiliated group Cherk t b if you checked "a" and "limited control" orowsions aoolv

aled group To be completed totals for ALL electing

Not over $500,000 20% of the amount on line 40

Over $500,000 but not over E7 000 000 $100 000 plus 15% of the excess over $500 000

Over $1 000 000 but not over $1 500,000 . $175 000 plus 10% of tie excess over $1,000 000

Over $1 500 000 but not over $17,000 000 $225 000 plus 5 : of the excess over $1,500,000

Over $17,000 000 $1 000 000

42 Grassroots nontaxable amount (enter 25% of line 41) . 43 Subtract line 42 from line 36 Enter -0- if line 42 is more than line 36 44 Subtract line 41 from line 38 Enter -0- if line 41 is more than line 38

Lobbying Expenditures During 4-Year Averaging Period

(6)

Grassroots lobbying

Lobbying Activity by Nonelecting Public Charities NOT APPLICABLE

FTX4KB L161 05/05/2003 09 54 24 VO1-7 300985

Limits on Lobbying Expenditures

(The term "expenditures" means amounts paid or incurred )

36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 38 Total lobbying expenditures (add lines 36 and 37) 39 Other exempt purpose expenditures 40 Total exempt purpose expenditures (add lines 38 and 39) 41 Lobbying nontaxable amount Enter the amount from the following table -

If the amount on line 40 is - The lobbying nontaxable amount is

4-Year Averaging Period Under Section 507(h) (Same organizations that made a section 501(h) election do not have to complete all of the five columns below

See the instructions (or lines 45 through 50 on oaae 11 of the instructions )

Calendar year (or fiscal (a)

ear beginning in " 2001

Lobbying nontaxable

Lobbying ceiling amount

Grassroots nontaxotble

Grassroots ceiling amount

During the year, did the organization attempt to influence national, state or local legislation, including any Yes No to influence public opinion on a legislative matter or referendum, through the use of o Amount

a Volunteers g b Paid staff or management (Include compensation in expenses reported on lines c through h ) , X c Media advertisements d Mailings to members, legislators, or the public . , , , . . . . , X e Publications, or published or broadcast statements , _ X ( Grants to other organizations for lobbying purposes , , X g Direct contact with legislators, their staffs, government officials, or a legislative body . . X h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means x i Total lobbying expenditures (add lines c through h ) , , , , ,

If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities Schedule A (Form 890 or B90EZ) 1001

JSA 1E77<03000

With Nonchanlable Information Regarding Transfers To and Transactions Exempt Organizations (See page 12 of the instructions )

51, Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 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 noncharitable exempt organization of (I) ~ Cash _ , (u) Other assets

b Other transactions (I) Sales or exchanges of assets with a noncharitable exempt organization (u) Purchases of assets from a noncharitable exempt organization

(iii) Rental of facilities . equipment, or other assets (Iv) Reimbursement arrangements (v) Loans or loan guarantees

(vi) Performance of services or membership or fundraising solicitations c Sharing o! facilities, equipment, mailing lists, other assets, or paid employees

52a 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 " 0 Yes EZNo

b If "Yes ," com plete the following schedule (a) Ibl Icl

Name of organization Type of organization Description of relationship

Schedule A (Form 990 or 990.EZ) 2007

FTX4KH L161 05/05/2003 09 .54 24 v01-7 300985

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 organimhon 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

lal I (b) I Ic1 (d) Line no Amount involved Name of nonchanlable rxempt or9anvatim Descnption of transfers, transactions, and shanng arrangements

JSA 1 E1250 Z 000

Mr Byron G George 6/12/2002 $10,000()0 2282 Harbour Court Drive Longboat Key, FL 34228

Mr and Mrs John R Gordon 3/6/2002 $5,00000 635 Park Avenue #10 New York, NY 10021

Lewes and Dianne Goverman 3/5/2002 S7,00000 115 -96th Street, Apt 3B Brooklyn, NY 11209

Richard Grand-Jean & 6/232002 S5,00000 Christine Doudna 32 Grove Street New York, NY 10014

Mr Richard A Greenberg 6/17/2002 $5,00000 146 Central Park West, Apt 9F New York, NY 10023

Stephen and Ameba Grosberg 7/31/2001 $29,01000 601 East 20th Street, 8-C New York, NY 10010

Donald and Meryl Gummer 7!202002 $20,00000 511 Avenue of the Americas, #300 New York, NY 10011

Mr Andrew F Gurley 6/19/2002 $10,00000 1 Park Road Irnngton, NY 10533

George and Cheryl Haywood 11/23/2001 $35,00000 642 Second Street Brooklyn, NY 112 15

John Herbert & Patricia 10/25/2001 $46,42500 Gauvey 593 4th Street Brooklyn, NY 11215

Mrs J Victor Herd 12/25/2001 $5,00000 Cons7ans Culver Foundation Two Montague Terrace Brooklyn, NY 11201

Bans and Betsy Humes 12/1112001 $5,23200 684 Cartoll Street Brooklyn, NY 11215

::r

SCHEDULE B 3/6

POLY PREP COUNTRY DAY SCHOOL .rureE 30, zooz EtN 11-1630821

Nameotdonors Date Amount

TOTAL

STATEMENT 1

FTX4RB L161 05/05/2003 09 :54 :29 V01-7 300985

POLY PREP COUNTRY DAY SCHOOL

FORM-990=-PART-I- =OTHER DECREASES IN FUND BALANCES

DESCRIPTION

NET UNREALIZED LOSS ON INVESTMENTS

11-1630821

AMOUNT

492,047 . ------------

492,047 .

STATEMENT 1 A

POLY PREP COUNTRY DAY SCHOOL EIN# 11-1630821 JUNE 30, 2002

SALE OF ASSETS OTHER THAN INVENTORY LINE 8a, b and c

(A) SECURITIES Sales pnce Cost Gam (Loss)

EQUITY SECURITIES AND BONDS $ 15,340,320 $ 15,726,546 $ (386,226)

(B) OTHER

SALE OF EQUIPMENT $ 5,000 4 - $ 5,000

ANCILLARY PROGRAMS 1,539,560 . 1,539,560 . FUEL, LIGHT AND WATER 250,280 . 212,738 . 37,542 . ATHLETIC EQUIPMENT 223,738 223,738 INSURANCE 109,272 98,344 . 5,464 . 5,464 . PROFESSIONAL FEES 114,784 97,567 . 11,478 . 5,739 . SECURITY EXPENSES 132,021 . 118,819 . 6,601 . 6,601 .

PROFESSIONAL STAFF EXPENSES FACULTY DEVELOPMENT AND FUNDRAISING EXPENSES 569,280 . 250,641 . 318,639 . COMMUNITY RELATED EXPENSES 48,551 . 48,551 . OTHER REPAIRS b MAINTENANCE 17,086 . 17,086 . STUDENT ACTIVITY EXPENSES 42,814 . 42,814 . STUDENT PUBLICATIONS 44,035 . 44,035 . I EMPLOYMENT FEES 64,036 . 69,036 . ADMISSIONS 46,131 . 46,131 . DRAMA RELATED EXPENSES 39,034 . 39,034 . TECHNOLOGY 107,800 . 97,020 . 5,390 . 5,390 . AMORTIZATION EXPENSE' 18,484 . 10,655 . 7,829 . MISCELLANEOUS EXPENSES 451,917 . 435,406 . 11,187 . 5,324 .

---------- ---------- ---------- ----------

TOTALS 3,818,823 . 3,386,175 . 85,491 . 347,157 .

STATEMENT 2 FTX4KB L161 05/05/2003 09 :54 :24 V01-7 300985

POLY PREP COUNTRY DAY SCHOOL 11-1630821

FORM 990, PART II - OTHER EXPENSES

PROGRAM MANAGEMENT DESCRIPTION TOTAL SERVICES AND GENERAL FUNDRAISING ----------- ----- -------- --- ------- -----------

STATEMENT 2A

POLY PREP COUNTRY DAY SCHOOL EIN # 11-1630821 SCHEDULE OF FIXED ASSETS JUNE 30, 2002

Cost

Land $ 409,742

Building 8 improvements 23,932,472

Equipment 6,224,519

Total $ 30,566,733

Accumulated deprecation 7/1/01 $ 8,729,272

Deprecation 1,181,553

Wnte-off (139,797)

Accumulated depreciation 6/30/02 9,771,028

STATEMENT Z,a

POLY PREP COUNTRY DAY SCHOOL SCHEDULE OF SCHOLARSHIPS

6/30/02

Tax 1D# 11-1630821

Form 990 Part II Line 22

Grants are given by the School in the form of scholarships to eligible students in

the school grades Pre K -12 Details of students who received scholarship grants

are in the possession of the School .


FORM 990, PART IV - PREPAID EXPENSES AND DEFERRED CHARGES

ENDING BOOR VALUE

11,187 . 465,985 . 152,547 .

--------------- TOTALS 629,719 .

BOORS AND SUPPLIES DEFERRED EXPENSE OTHER PREPAIDS

STATII4ENT 3

FTX4IC8 L161 05/05/2003 09 :54 :24 V01-7 300985

11-1630821

DESCRIPTION BEGINNING BOOR VALUE

9,471 . 199,893 . 151,681 .

---------------361,045 .

EQUITY SECURITIES 3,158,870 . CORPORATE BONDS 2,908,368 . U. S . GOVERNMENT AND AGENCY OBLIGATIONS 5,719,576 .

---------------

TOTALS 11,786,814 .

STATEMENT 4

FTX4RB L161 05/05/2003 09 :59 :24 V01-7 300985


FO$M~S90, PART IV - INVESTMENTS - SECURITIES ------------

BEGINNING DESCRIPTION BOOR VALUE ----------- ----------

11-1630821

ENDING BOOR VALUE

2,961,297 . 3,021,346 .

3,221,078 .

9,203,671 .

219,256 362,270 . 99,412 .

209,401 . 38,687 .

------------929,026 . TOTALS

STATEMENT 5

FTX4R8 L161 05/05/2003 09 :54 :24 V01-7 300985


FOf}M~$90, PART IV - OTHER ASSETS

DESCRIPTION

DEFERRED LOAN ORIGINATION COST GOODWILL INTEREST 6 DIVIDEND RECEIVABLE SPLIT DOLLAR LIFE INSURANCE OTHER

BEGINNING BOOR VALUE

11-1630821

ENDING BOOR VALUE

211,427 . 351,615 . 69,704 .

209,401 . 31,585 .

--------------- 873,732 .

LENDER : NEW YORK CITY INDUSTRIAL DEV'L AGENCY ORIGINAL AMOUNT : 5,745,000 . INTEREST RATE : 4 .250000-v',3iZ 'h DATE OF NOTE : 06/01/1999 MATURITY DATE : 05/01/2029 REPAYMENT TERMS : ANNUAL BOND PRINCIPAL PAYMENTS EVERY MAY 1 . PURPOSE OF LOAN : FIN .COST OF CONS 6 EQUIP FOR THE NEW SCIENCE BLDG

TOTAL ENDING MORTGAGES AND OTHER NOTES PAYABLE

STATEMENT 6

FTX4R8 L161 05/05/2003 09 :54 :24 V01-7 300985


FORM ̀990, PART IV - MORTGAGES AND OTHER NOTES PAYABLE

BEGINNING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ENDING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TOTAL BEGINNING MORTGAGES AND OTHER NOTES PAYABLE

5,679,167 . 3,640,000 .

5,674,167 .

3,640,000 .

3,397,904 .

3,397,904 TOTALS

STATEL4ENT 7

FTX4RB L161 05/05/2003 09 :54 :24 V01-7 300985


FORM'990, PART IV - OTHER LIABILITIES

DESCRIPTION

TUITION RECEIVED IN ADVANCE

BEGINNING BOOR VALUE

11-1630821

ENDING BOOR VALUE

3,342,691 . ---------------

3,342,691 .


FINANCIAL AID NETTED AGAINST REVENUE PER AUDITED FINANCIAL STATEb1ENTS, INCLUDED IN EXPENSES PER RETURN . 3,217,745 .

--------------- 3,217,745 .

B

ETX4RB L161 05/05/2003 09 :54 :24 V01-7 300985

FOFtM'~~90, PART IV-A - OTHER REVENUE ON RETURN BUT NOT ON BOORS -- - -------- ------------

DESCRIPTION AMOUNT ----------- ------

TOTAL

11-1630821 POLY PREP COUNTRY DAY SCHOOL

FOF;M `q90, PART IV-B - OTHER EXPENSES ON RETURN BUT NOT ON BOOKS

DESCRIPTION AMOUNT ----------- ------

STATEMENT 9

FTX4RB L161 05/05/2003 09 :54 :24 VO1-7 300985

FINANCIAL AID NETTED AGAINST REVENUE PER AUDITED FINANCIAL STATEMENTS, INCLUDED IN EXPENSES PER RETURN .

TOTAL

3,217,745 . ---------------

3,217,745 .


FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

CONTRIBUTIONS EXPANSE ACCT TO EMPLOYEE AND OTHER

BENEFIT PLANS ALLOWANCES TITLE AND TIME

DEVOTED TO POSITION COMPENSATION ------------------- ------------

DAVID HARMAN C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

DON CARSWELL C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

ALEX ARAPOGLOU C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

CLIFFORD BARK, ESQ . C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

RITA CHARRABARTI C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

CYNTHIA CHESWICR C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

MICHAEL CORRERA TRUSTEE AS NEEDED

STATEMENT 10 FTX4RB L161 05/05/2003 09 :54 :24 V01-7 300985

NAME AND ADDRESS

HEADMASTER FULL-TIME

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

187,000 . 21,137 . 2,784 .

NONE NONE NONE

NONE NONE NONE

NONE NONE NONE

NONE NONE NONE

NONE NONE NONE

NONE NONE NONE


GEORGE W. HAYWOOD TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE

STATEMENT 11 FTX4ICB L161 05/05/2003 09 :54 :24 V01-7 300985

FORM 990, PART V - LIST OE OFFICERS, DIRECTORS, AND TRUSTEES ., ------------ -- -- - ------- --

CONTRIBUTIONS EXPENSE ACCT TITLE AND TIME TO EMPLOYEE AND OTHER

NAME AND ADDRESS DEVOTED TO POSITION COMPENSATION BENEFIT PLANS ALLOWANCES ---------------- ------------------- ------------ ------------- ----------

C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN , NY 11228

CHARLES B . DORF TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE BROOKLYN, NY 11228

JEFFREY S . FERRARO TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE BROOKLYN, NY 11228

STEVEN G . GOLDBERG TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE BROOKLYN, NY 11228

RICHARD L . GRAND-JEAN TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE BROOKLYN, NY 11228

SUSAN GREIG TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE BROOKLYN, NY 11228


FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES ----------------

TITLE AND TIME NAME AND ADDRESS DEVOTED TO POSITION COMPENSATION ---------------- ------------------- ------------

BROOKLYN, NY 11228

NONE NONE TRUSTEE AS NEEDED

NONE RICHARD MIZRACR, ESQ . C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

STATEMENT 12 FTX4R8 L161 05/05/2003 09 :54 :24 VO1-7 300985

ALAN M. RANTROW C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

PETER S . LIEBERT, M .D . C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

FREEMAN D . LOVE , M. D . C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

JOHN H . MADDEN, JR ., ESQ. C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

JACQUELINE MERHIGE C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

NONE

NONE

NONE I

NONE

NONE

TO EMPLOYEE BENEFIT PLANS -------------

NONE

NONE

NONE

NONE

NONE

EXPENSE ACCT AND OTHER ALLOWANCES ----------

NONE

NONE

NONE

NONE

NONE


FTX4RB L161 05/05/2003 09 :54 :24 V01-7 300985 STATEMENT 13

FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

.S CONTRIBUTIONS EXP$NSE ACCT

TITLE AND TIME TO EMPLOYEE AND OTHER NAME AND ADDRESS DEVOTED TO POSITION COMPENSATION BENEFIT PLANS ALLOWANCES ---------------- ------------------- ------------ ------------- ----------

THOMAS H . PARKER TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE BROOKLYN, NY 11228

HARRY PETCHESRY, ESQ . TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE BROOKLYN, NY 11228

STEPHEN M. RAPHAEL, ESQ . TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE BROOKLYN, NY 11228

RICHARD B . SALTZbD,N TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE BROOKLYN, NEW YORK 11228

VICTOR M . SANg2A, JR . TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE BROOKLYN, NY 11228

GRACE M. SAWYER TRUSTEE NONE NONE NONE C/O POLY PREP COUNTRY DAY SCHOOL AS NEEDED 9216 SEVENTH AVENUE BROOKLYN, NY 11228

SCOTT M. SMITH TRUSTEE NONE NONE NONE AS NEEDED

11-1630821

FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES - - --------- -

CONTRIBUTIONS EXPENSE ACCT TO EMPLOYEE AND OTHER BENEFIT PLANS ALLOWANCES

TITLE AND TIME DEVOTED TO POSITION COMPENSATION ------------------- ------------

PEG TYRE C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

VINCENT J. VZGORITA, M.D . C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

DAVID WObB,CR C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

GRAND TOTALS

FTX4RB L161 05/05/2003 09 :54 :24 V01-7 300985 STATEMENT 14


NAME AND ADDRESS ----------------

C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

ALAN C . STEP9ENSON, ESQ . C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

NATHAN R . TRYNIN, ESQ . C/O POLY PREP COUNTRY DAY SCHOOL 9216 SEVENTH AVENUE BROOKLYN, NY 11228

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

TRUSTEE AS NEEDED

NONE NONE NONE

NONE NONE NONE

NONE NONE NONE

NONE NONE NONE

NONE NONE NONE

---------- ---------- -----

187,000 21,137 . 2,784 .

FTX4RB L161 05/05/2003 10 :31 :49 V01-7 300985

POLY PREP COUNTRY DAY SCHOOL 11-1630821 y

FORM 990, PART VI - CHANGES TO ORGANIZING OR GOVERNING DOCUMENT

DURING FISCAL YEAR 202, THE SCHOOL CHANGED ITS NAME FROM POLYTECHNIC PREPARATORY COUNTRY DAY SCHOOL TO POLY PREP COUNTRY DAY SCHOOL . SEE ATTACHED AMENDMENT OF CHARTER GRANTED ON JULY 18, 2002, BY THE BOARD OF REGENTS OF THE UNIVERISTY OF TAE STATE OF NEW YORK .

STATEMENT 15

Vot that the absolute charter of Polytechnic Preparatory Country Day School, located in Brooklyn, county of Kings, state of New York, which was granted by action of the Board of Regents on July 1,1916; which provisional cater was made absolute by Regents action on May 27, 1920; which absolute chatter was amended by Regents action on October 23, 1980 and March 11, 1997 be, and the same hereby is, amended to change the corporate name in "Poly Prep Country Day School"

Granted, July 18, 2002, by the Board of Regents of The University of the State of New York, for and on behalf of the State Education Department, and executed under the seal of said University and recorded as Number 23,401 .

Chancellor President of the University and Commissioner of Education

_QT"T KITA

£Darattaa $r~+artttarttt


AMENDMENT OF CHARTER

This Instrument Wimesseth That the Board of Regents for and on behalf of the Education Department of the State of New York at their meeting of July 18, 2002,

M application having been made by and on behalf of the trustees of Polytechnic Preparatory Country Day School, for its absolute charter to be amended, it was

11-1630821

EXPLANATION OF HOW EACH ACTIVITY FOR WHICH INCOME LINE ZS REPORTED IN COLUMN (E) OF PART VII CONTRIBUTED NO . IMPORTANTLY TO THE ACCOMPLISHMENT OF EXEMPT PURPOSES

----------------------------------------------------

FTX4RB L161 05/05/2003 09 :54 :24 VO1-7 300985

POLY PREP COUNTRY DAY SCHOOL r �

FORM 990, PART VIII - ACCOMPLISHMENT OF EXEMPT PURPOSES

93 POLY PREP COUNTRY DAY SCHOOL IS AN EDUCATIONAL FACILITY FOR GRADE LEVEL PRE-KINDERGARTEN THROUGH TWELFTH GRADE . ALL INCOME PRODUCING ACTIVITIES CONTRIBUTE TO THE EDUCATIONAL FUNCTION OF THE SCHOOL AS WELL AS THE OPERATION AND MAINTENANCE OF THE SCHOOL'S FACILITIES .

STATEMENT 16

FTX4RB L161 05/05/2003 09 :54 :24 V01-7 300985


SCHEDULE A, PART III - EXPLANATION FOR LINE 4

FAMILIES SEEKING FINANCIAL AID PROVIDE CERTAIN PERSONAL FINACIAL DATA TO AN INDEPENDENT REVIEW ORGANIZATION . BASED ON THE RESULTS OF THAT REVIEW, THE SCHOOL'S OFFICE OF FINANCIAL AID AWARDS FINANCIAL AID TO APPLICANTS WHO QUALIFY UNDER GUIDELINES ESTABLISHED BY THE TRUSTEES OF THE SCHOOL .

STATEMENT 17

18

FTX4RB L161 05/05/2003 10 :51 :50 V01-7 300985

POLY PREP COUNTRY DAY SCHOOL 11-1630821 ,.

w r

SCHEDULE A, PART V - EXPLANATION FOR LINE 31

THE SCHOOL'S POLICY IS ADEQUATELY DESCRIBED IN VARIOUS PUBLICATIONS DISTRIBUTED BY THE SCHOOL AND AVAILABLE TO THE GENERAL PUBLIC .

19

FTX4R8 L161 05/05/2003 10 :51 :50 V01-7 300985


1

SCHEDULE A, PART V - EXPLANATION FOR LINE 39A

THE SCHOOL RECEIVED FINANCIAL ASSISTANCE FROM THE NEW YORK STATE EDUCATION DEPARTMENT .

" D1 " n e11 ~YYwrv1lO. .1V" aYwAlSuuY J-nwuw LAlG11JW11 VI I IIIIC- IIIWI f11C W1191111 41 OIIU wile VUpy.

Type or Name of Exempt Orgamza6m Employer identification number print POLYTECHNIC PREPARATORY COUNTRY DAY SCHOOL 11-1630821 File by the Number, street, and room a suite no If a PO box, see msWchons For IRS use only ebended due ease for 9216 SEVENTH AVENUE filing the City, town a post ice, state, and ZIP code. For a foreign address, see instructions return See instructions BROOKLY, NEW YORK 11228 Check type of return to be filed (File a separate application for each return) ~X Forth 990 EJ Forth 990-EZ [:J Forth 990.T (sec 401(a)or40B(a) trust) ~ Form 1041-A E] Form 5227 [:] Forth 8870

Form 990-BL [] Form 990-PF 0 Form 990-T (trust other than above) 0 Form 4720 n Form 6069

Signature w` ~" Title " CPA Data ji~ Z I ` I e Notice to Applicant-To Be Completed by the IRS

We have approved this application Please attach this form to the organization's return We have not approved this application However, we halve granted a 10-day grace period from the late d the dale shown below a the due date d the organia6ori s return (inducting any prior extensions) This grace period is considered to be a vela extension of time for elections otherwise required to be made m a timely return Please attach this form to the organization's return ---1-iI- .r We have not approved this application After considering the realms stated m darn 7, we cannot gran your re~a~~d 6m to file We are not granhrg a 10-day grace period W e cannot consider this application because d will filed after the due date of the rim far which ~, ested U

Q Other ~al ~ 2003 °I

I ~GDE Direct" Alternate Mailing Address - Enter the address if you want the copy of this application for an add Y returned to an address different than the one entered above

suits, room, or apt. no I Or a P O box JE ate, and county (including postal a . YORK 10017-2703

a town, province or

- SIR" ,, .,

Forth {

0 If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box 0. [R Note Only complete Part 11 if you have already been grapted an automatic 3-month extension on a previously filed Form 8868 0 If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1)

STOP Do not complete Part II if you were not already granted an automatic 3-month extension on a previouslyfiled Forth 8868.

" If the organization does not have an office or place of business in the United States, check this box . 0. F1 0 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 jo . [:] If it is for part of the group, check this box li~ n and attach a list with the names and EINs of all members the extension is for 4 I request an additional 3-month extension of time until MAY 15 , Zp 03 5 For calendar year-, or other lax year beginning J ~ and ending JUNE 30 , 20 02 6 If this tax year is for less than 12 months, check reason 0 Initial return " Q Final return 0 Change m accounting penod 7 State in detail why you need the extension INFORMATION NECESSARY TO FILE A COMPLETE

AND ACCURATE RETURN IS NOT YET AVAILABLE

8a If this application is for Forth 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions . . . .

b If this application is for Forth 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit and any amount paid previously with Forth 8868

c Balance Due. Subtract line 8b from line Sa Include your payment with this forth, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See instructions

Signature and Venfication Under penalties of penury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete, and that lam authorized to prepare this forth

EISNER LLP Type a Number and street (in pant 7SOI THIRD A

onth extension

" If the organization does not have an office or place of business in we United States, check this box " If this is for a Group Return, enter the orgamza6on's four digit Group Exemption Number (GEN) If this is for we whole group, check this box ji~ 0 If it is for part of the group, check this box li~ 0 and attach a list with we names and EINs of all members the extension will cover

1 I request an automatic 3-month (6-month, for 990-T corporation) extension of time until 02 / 17 , 20 -a-3, to file the exempt organization velum for the organization named above The extension is for the organization's velum for

p. ~ calendar year 20 - or 1 Ox tax year beginning - ,20LL, and ending 06/30 ,20 02

sA sTF FEosossF i

Fo�r $$6$ Application for Extension of Time To File an (o"mber 2000) Exempt Organization Return OMB No 15aS1709 RpeNnml d IM TmesW 1 File a separate application for each velum

" If you are filing for an Automatic 3-Month Extension, complete only Part 1 and check this box " If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part 11 (on page 2 of this forth) Note : Do not complete Part 11 unless you have already been granted an automatic 3-month extension on a previously fled Form 8868. Part I Automatic 3-Month Extension of Time - Only submit onginal (no copies needed) Note . Form 990.T corporations requesting an automatic 6-month extension - check this box and complete Part 1 only t AO other corporations (including Form 99aC filers) must use Form 7004 to request an extension of time to ale income tax returns Partnershos. REMICs and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041

Type or Name d Exempt Organization Employer Identification number

print POLYTECHNIC PREPARATORY COUNTRY DAY SCHOOL 11-1630821 Fie by the Number, stream, and room or suite no If a P O box, see instructions d"edate r°` 9216 SEVENTH AVENUE filing your return see Qty, Win v post office, state, and ZIP coda For a foreign address, see Instructions

°m BROOKLYN NY 11228 Check type of velum to be filed (file a separate application for each velum). 0 Form 990 E] Form 99aT (corporation) E] Forth 4720

Forth 990-BL ~ Forth 990-T (sec 401(a) or 408(a) trust) [] Forth 5227 Forth 990-EZ ~ Forth 99aT (trust other than above) 0 Form 6069 Forth 99aPF E] Form 1041-A 0 Forth 8870

2 If this tax year is for less than 12 months, check reason 0 Initial velum E] Final velum 0 Change in accounting penod

3a If this application is for Forth 990-BL, 99aPF, 990.T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions $

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

c Balance Due Subtract line 3b from line 3a Include your payment wrath this forth, or, if required, deposit with F"fD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See Instructions $

Signature and Verification Under penalties of penury I declare that I have examined t Ns loan, Including aaomparcylng sdiedWes and statements, and to the best of my knowledge end billet, it Is true, correct, and complete, end that I am auttiorized to prepare this form

Sipirahce 1 Title 1 CPA Dale

Far Paperwork Reduction Act Notice, see Instruction Form 8868 (t2-2000)

990 return of organization exempt from income tax m9n o uw...

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