Form'990-PF Return of Private Foundation or Section 4847(a)(1) Nonexempt Charitable Trust

o,o.tin. t a m . rrixem,. Treated as a Privets Foundation I""p ""'"°" Ser"° Note The organization may bill, able to use a copy o1 this MUM to setaly stets ispor

Foredenbuyear 20of,orhxyear beginning DEC 1 . 2 001 , and ending NON

2001

Name o1 orpanmhon We the IRS label

Otherwise, print

or type Sao specific Instructions City or town, state, and ZIP code

H Check type of organization L}LJ Section 501(c)(3) exempt private foundation 0 Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation

I Fair market value o1 all assets at end o1 year J Accounting method W Cash LIJ Accrual (from Pert 11, col (c), line 16) = Other (specify) hx~C 2 2 0 f, f, 'i 5 7 _ !Pert l. column !dl must be on cash basm )

Analysis of Revenue end Expenses (a) Revenue and (11re tote! of amounts in columns (b), (b) Net investment azpensos por (c), end (d) may not nacesseny equal Income _ __------ ._ 11 . 6oakc (e) Adjusted net - -for charitable

Income purposes N / A I (cash base and

1 Contributions, gifts, grants, etc , received ci�(yMs. ~ ~ dAe bunAnonumlMunlmtests &A B

2 Distributions from split-interest trusts Inlmst on wnnpf end brtpawy cash in.aNenb

4 Dividends and interest from securities 826

5m Gross rents

b Met and income a Pose) 1

e et "~:~n oo.) m~w. ~.n~et ~

296 b Gross mIesPMe lvall m eb 592.70 . o eb on line 6a

p 7 Cwital own not .. ri.nn Pert IV h. 2)

0 Net short-term capital gain

D Income modifications log GvaaileflavnNma ND WIO JfIClf

b Less Cost a Dome sole

e Gross profit or (loss)

11 Other income 12 Total Add lines t through 11

13 CoMennuen of off ¢na Ersctero, warcaa, st 167 11 Other employee salaries and wages 15 Pension plans, employee beneifts

w - fare Legal fees

m b Aecoun6ngfees

u~ c Other professional fees $TMT 2 54

> 17 Interest

m 1e TABS STMT 3 10

fY Deprecation and depletion

E 20 Occupancy

21 Travel, conferences, and meetings v m 22 Priming and publications

Y.( cm 23 Other expenses $TMT 4 6

t m 21 Total operating and administrative

a expenses Add lines 13 through 23 238 O O 25 Contributions, gift, pram paid 1 013

26 Told expenses and disbursements

Add lines 24 and 25 1 . 251

27 Subtract line 26 from line 12

1Erseaqn.nu. o. ~span.aWEnitvaertrnb -128 b Not investment income (it neoxitiw, anise -0-)

e Adjusted not income (d negatnee enter -o-)

o? z5i-oz LHA Far Paperwork Reduction Act Notice, too the instructions Form 000-PF (2001) 1

We NO iu~

Employer Identification number

NunOV W asset (a P O boy nunEr n MI a rat dGLVew ~d m sbwt ixOAnsn) I NeorNosb Telephone number 19r -A2d-

n . ..mom cv~~ e w~a~~q, uurk n. . t Foreign organizations, check here 1 2 Fa. o,QanOema In.eno m. esx test

Nswvns. .na .mcnm~mUmoen 1

It private founda0on status was terminated under section 507(b)(1)(A), check here

11 the foundation s in a 80-month termination-

z

Value 1 Cash - non-Interest-bearing 2 Savings and temporary cash Investments 3 Accounts receivable 110,

Less allowance for doubtful accounts 1 Pledges receivable 1111,

Less allowance for doubtful account 1110-5 Grants recervable 0 ReceNables due from officers, directors, trustees, end otter

disqualified persona ONerroWmlbms nanlY

Less allowance for doubtful accounts 6 Inventories for sale or use

A 0 Prepaid expenses and deterred charges 10a Investments - U S and sate government obligations

b Investments -corporate stock STMT S e Investments -corporate bonds STMT 6

11 in,amr .~m kind emwnn and souomMCe .m Lass; mumutisaaepncinon

12 Investments - mortgage loans 13 Investments - other 14 Land, buildings, end equipment buts

Lm saumuYYa eeo~ba

15 Other assets (describe 110-

Organizations that fallow SFAS 717, check here ON. andcomplets lines 24 through 26 and lines 30 and 31 s

00 24 Unrestricted

mm 25 Temporarily restricted

m 2E Permanently restricted Orpaniza4ons that do not follow WAS 111, check her@ P. F-1 and complete lines 27 through 31

27 Capital stock, trust principal, or current funds m 20 Paid-in or capital surplus, or land, bldg , and equipment fund

29 Retained earnings, accumulated income, endowment, or other funds 20 Total not assets or fund balances Z

2

Paltll Balance Sheets Us leg'! meo+ee.rrer~id~r.moa~eNr ta)BootValue

17 Accounts payable and accrued expenses 10 Grants payable

m 19 Deferred revenue r 20 Lw,e nom onioen. a..cev .. wae.n ma ome aiaoumni .d n.noro a 21 Mortgages and other notes payable

22 Other liabilities (describe

part 111Analysis of Changes in Net Assets or Fund Balances

1 Total net assets or fund balances at beginning o1 year - Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year's return) 1 27,

2 Enter amount from Part I, line 27a 3 Other Increases not Included In Ilne 2 (Itemize) " S I Add lines 1, 2, and 3 1 2 7 5 Decreases notincluded inline 2(itemize) " UNREALIZED LOSS ON SECURITIES S 4 0 Total net asset or fund balances at end of year (line 4 minus line 5) - Part II, column (b), line 30 a 22 .

From 900-PF Roo+l

123511 of x4-oz

Forth r -M.

(d) Date sold (mg, day, YT )

(a) List end describe the kind(s) of property sad (e.g , real estate, 2-story brick warehouse, o r common stock, 200 airs MLC Co

3E ATTACHED

(a) Gross ales price (Q Depreciation allowed (p) Cost or other bass (or allowable) plus expense of sale

(A) Gain or (loss) (a) plus (Q minus (q)

m column (h) and owned by the foundation on 1213 1M9 (1) Adjusted basis (k) Excess of cal (i) as of 17/d1iH8 over coL (), N any

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

Losses (ham cal (n)) (i) F M V u o1 12/d1/B9

Was the organization liable for the secLOn 4942 tax on the disVibuta6le amount o1 any year in the base period? Yes ETC] No If Yes,' the organization does not qualify under section 4940(e) Do not complete this part. 1 Enter the appropruta amount in each column for each year, see Instructions before making any entries

Ibl I (c) Adjusted qualifying distributions Net value of noncharlGble-use assets

3

for assets

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

2 Capital pain not Income or (net capital loss) ~ II gain, also enter in Part I, tine 7 If (loss), enter -0- In Pal I, line 7

3 Net short-term capital pain or (loss) as defined in sections 1222(5) and (B) 11 gain, also enter to Part I, line 8, column (c) II floss) . enter -0- in Part l . line 8

I Pa" V I Vu911ncailOn under JeCIIOn aV4U(e) iof Fi6duceG lax on Net Inye

(For optional use by domestic private foundations subject to the section 4940(a) tax on not investment income )

11 section 4940(0)(2) applies, leave this part blank

2 Total of line 1, column (d) 3 Average distribution ratio for the 5-year base period - drviAe the total on line 2 by 5, or by me number of years

the foundation has been in existence if less than 5 years

I Enter the net value o1 nonshanlable-use assets for 2001 from Part X, line 6

S MuIUDN line 4 by line 3

0 Enter 1% of not investment income (1°.6 of Part l, line 27b)

7 Add lines 5 and B

6 Enter qualifying distributions from Part XII, line 4 J 6 I 1 , 10 3 . 3 6 5 . If line 8 is equal to or greater than line 7, check the box in Part VI, line 1h, and complete that part using a 1% tax rate See the Part VI instructions

Fm., 900-PF Room uWz, a, xa-ov

1 Sublide A (Income) tax (domestic section 4947(x)(1) trusts and taxable foundations only Others enter -0-) S Tax based on investment income Subtract line 4 from line 3 If zero or less, enter -0- E Credits/Payments a 2001 estimated to payments and 2000 overpayment credited to 2001 Es 32 . 991 b Exempt foreign organizations -tuwithhold alsource d6 o Tax paid with application for extension of time to file (Farm 8888) de d Backup withholding erroneously withheld Oil

7 Total credits and payments Add lines So through ad 0 Enter any penalty for underpayment of estimated fu Check here M M Form 7220 s attached 0 Tax dug II the total of lines 5 and 8 B more than line 7, enter amount owed 1

10 Overpayment If line 7 i5 more than the total of lines 5 and B, enter the amount overpaid 17 Enter the amount of line 10 to be Credited to 2002 estimated tax 1 - 13 43~2 . wndsdp~

70 Did any persons become substantial contributors during the tax yeah 11 'Yes,' attach a schedule listing their names and addresses

11 Did the organization comply "^th the public inspection requirements for its annual returns and exemption application? Web site address I s-

12 The booksaieineareot 1 RICHARD EDELMAN Telephone no "336-824-4413 locateaat " 277 GLENDALE DRIVE CATHAGE . NC ZtP,4 .28327

13 Section 4941(x)(1) nonexempt charitable trusts filing Form 990-PF In lieu of Form 1011 " Check here 10 and enter the amount of tax-exempt interest received or accrued during the veer . . . . . . . . . . . . . . . 0.1 13 I N/A

iz=i a,-z"z r,m, 000-PF Roil

to Exempt operating foundations described in aeeCon 4940(d)(2), check hen 1 U end enbr'N/A' on Ilne 1

Date of ruling letter (attach copy of ruling letter N neassuyy~~ Imtruehon~)

p Dortlesuc organizations that meet the section 4940(e) requirements m Put V, check here 1 [::] end enter 1% of Part I, line 27b

o All other domestic organizations enter 2% of line 21b. Exempt foreign organizations enter 4% 2 Tax under section 511 (domestic section 4947(a)(1) trusts and gable foundations only Others enter -0-) 3 Add lines 1 and 2

1s During the tax year, did the organization attempt to influence any na6onal, state, or local IepISIaOOn or did R participate or intervene in any political campaign?

b Did it spend more than $100 during the year (enter directly or Indirectly) for political purposes (sae instructions for definition)? 11 the cower rs 'Yes' to 1 s or 1b, attach a detailed description of the activities end mpiss of any materials published or dWnbuted by the orgarrizieficin in connection with the activities

o Did the organization file Form 1120-POL for this year! d Enter tie amount (it any) of tax on political expenditures (section 4855) imposed during the year

(1) On the organization " $ 0 . (2) On organization managers 13 0 . o Enter the reimbursement (d any) paid 6y the organization during the year for political expenditure tax Imposed on organization

managers " $ 0 . 2 Has the organization engaged in any actrvNes that have not previously been reported to the IRS?

If 'Yes,' ettecA a detailed description of the activities 3 Has the orpanizaUOn made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or

bylaws, or other similar instruments? It 'Yes,' attach a mn(ormed copy of the changes Ia Did the organ anon have unrelated business gross Income of x1,000 or more during the yeah b II Yes; has It filed a tax return on Form 0Y0-7 for this year! N/A 6 Was there a liquidation, termination, dissolution, or substantial contraction during the yeah

II 'Yes,' attach the statement raquned by General Instruction T 0 Are the requirements of section 508(x) (relating to sections 4941 through 4945) satisfied either

" By language in the governing instrument or " By state IegaWhon 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 any time during the yeah

If 'Yes," complete Part 1l, col (c), and Pert XV Ea Enter the states to which the foundation reports or with which R is registered (sae instructions) 10,

b If the answer is 'Yes' to line 7, has the organization furnished a copy of Form 990-PF to the Attorney General (or designate) of each state as required by General Instruction G7 If 'NO,' attach explanation

0 Is the organization claiming status as a private operating foundation wMin the meaning of section 4842(l)(3) or 4842(1)(5) for calendar year 2001 or the taxable year beginning in 2001 (see instructions for Part XIh7 If 'Yes,' complete Pert XIV

5

Form 9W-PF

File Form 47?D h any Him b chacksd in the '11a" column, unless an oxceprincin applies. Is During the year did the organization (either directly or indirectly)

(1) Engage In the sale or exchange, or leasing of property with a disqualified person? ED Yet CE No (2) Borrow money from, lend moray to, or otherwise extend credit to (or accept it from)

a disqualified person? yet No (8) Furnish pooch, services, or facilities W (or accept them ham) a disqualified person? ~ Yes ~ No (1) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ~ Yes ~ No (5) Transfer any Income or assets to a disqualified person (or make airy of either available

for the benefit or use of a disqualified person)? Yes CE No (0) Agree to pay money or property to a government officlaV (Exception Check 'No'

A the organization agreed to make a grant to or to employ the official for a period after termination of government service, K terminating with in BO days ) 0 Yes M No

b If any answer is 'Yes* to 1a(1)-(6), did any of me acts till to quality under the exceptions described in Regulations section 53 4941(d)-3 or m e current notice regarding disaster assistance (see page 19 of the Instructions)? N/A Organizations raying on a current notice regarding disaster assistance check here 10

e Did the organization engage in a prior year in any of the acts described In Is, other than excepted act, that were not corrected before the first day of the fax year beginning in 20017 Taxes on failure to distribute Income (section 4942) (does not apply for years me organization was a private operating foundation defined In section 4942(j)(3) or 4942(j)(5))

a At the end of to year 2001, did the organization have any undistributed Income (lines Bd and Be, Part XIII) for fax year(s) beginning before 20017 Yet M No If Yes; tlst the yeas ".

b Are there any years listed m 2a for which the organization o not applying me provisions of section 4842(a)(2) (totaling to Incorrect valuation o1 assets) to the years undistributed Income? (II applying section 4842(a)(2) to dl years listed, answer 'No' and attach statement - see instructions ) N/A

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

3& Did the organization hold mare than a 2% direct or Indirect Interest in any business enterprise et any time during the yeah ~ Yes FXI No

b II Yes; did It have excess business holdings in 2001 as a result 01 (t) any purchase by the organization or disqualified persons otter May 26 . 1969, (2) the lapse of me 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest or (3) the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine d the orgen¢etion tied excess business holdings in 2007 ) N/A

Ia Did the organization invest during the year any amount in a manner mat would jeopardize its charitable purposes? 6 Did the organization make any mvestrnent m a prior year (but otter December 31, 1969) Nat could jeopardize its charitable purpose that had not been removed from jeopardy before the first day o1 the fax year beginning in 20017

5a During the year did the organization pay or incur any amount to 17) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))7 ~ Yes ~ No (2) Influence the outcome of any specific public election (see section 4955), or to carry on, directly or indirectly,

any voter registration drive? 0 Yes ~ No (3) Provide a grant to an individual for travel, study, or other similar purposes? ~ Yes ~ No (I) Provide a grant to an organization other than a charitable, ate , organization described in section

509(a)(1), (2), or (3), or section 4940(d)(2)9 0 Yes ~ No (S) Provide for any purpose other than religious, charitable, scientifi c, literary, or educational purposes, or tar

the prevention of cruelty to children or animals? Yes EK) No b If any answer is Yes'to Sa(1){5), did any of the transactions fail to quality under the exceptions described in Regulations

section 53 4945 or in a current notice regarding disaster assistance (see instructions)? N/A Organizations raying on a current notice regarding disaster assistance check here 10.

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

Ea Did the organizaLOn, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? Yes EENo

b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? If you answered 'Yes' to 615, also file Form 8870

Pam 9B0-PF (2ooi)

123541 of-z.-o:

Form e9o-PF(2o01) HENRY NIAS FOUNDATION . INC . 13-6075785 Pages

Part VIII Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors

1 List all ofGwh, dvecton, trustew, foundaLOn managers and their comipensation :

other

(e) Compensation

for

6

nouns (a) Name end address

(bl TrGe end (e) Name and address of each employee paid more than $50,000 I .Tiours_per

Total number of omen employees paid over $50,000 3 Five highest-paid independent contractwa fair professional services It none, enter -NONF-l'

lal Name and address of each Derson paid more than 550.000

List the foundation's lour largest direct charitable acWNes during the lax year Include relevant statistical Information such as the number o1 organizations and other benefcianes served, conferences convened, research papers produced, efc Expenses

2

3

4

roe� Oe0-PF (2oo,)

Part XII Qualifying Distributions see instructions)

Form 99o-PF(2o01) HENRY NIAS FOUNDATION . INC . 13-6075785 Page 1

. Part I - Summery of Program-Related Investments

Investments made by me foundation Eurino the hx veu on hoes

1

2

All other program-related investments See Instructions 8

Total Add lines 1 through 3 . . � . .� ,

Part X Minimum Investment Return WI dortnestk foundations must complete this pert Foreign foundations, see Instructions )

1 Fair market value o1 assets not used (or held for use) directly In carrying out charitable, eh ,purposes a Average monthly fair market value of securities Is 24 , 543 b Average of mouthy cash balances 16 616 e Fair market value of all other assets 10 e Total (add hoes Is, n, and e) is 25 159

Reduction clamed for blockage or other factors reported on lines 1a end 1c (attach detailed explana6on) Is 0 .

2 Acquisition indebtedness applicable to line 1 assets 2 3 Subtract line z nom line id a 25 , 159 1 Cash deemed bald for charitable activities Enter 11/2% of line 3 (for greater amount, see Instructions) 1 377 5 Hit value of nonchmtabl"u assets Subtract line 4 from line 3 Enter here and on Part V, line 4 S 2 4 , 78 2 d Minimum investment return Enter s°koiline 5 0 1 .239 p;rt w DIStI1bUt8bl9 Amount (see instructions) (Section 4842(p(3) and (p(5) private oDeraOnp foundations and certain

foreign organizations check here fj~ and do not template this part) t Minimum investment return from Pan x, line e f 1 , 23 9 2a Tax on investment income toy 20011rom Part VI, line 5 2, 19 , 559 . b Income tax for 2001 (This does not include the tax from Part VI 2b e Add lines 2a and 2b 2e 1

3 Distrihutahle amount before adNstrnents Subtract line 2c from line 1 2 1 , 219 1a Recoveries of amounts treated as qualifying distributions 4a 0 . D Income distributions from section 4947(a)(2) trusts Ib 0 . e Add lines 4a and 46 Ie

s sad lines a and 4c 5 1 , 219 D Deduction ham distributable amount (sea instructions) Q

1 Amounts paid (including administraUve expenses) to accomplish charitable, etc , purposes e Expenses, contributions, gifts, etc -total from Pan 1, column (d), line 26 is 1 , 103 , 365 . E Program-related investments " Total from Part IX-B 16 0 .

2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc , purposes 2 3 Amounts set aside for specific charitable projects that sat" the

Suitability test (prior IRS approval required) 34 b Cash distrihubon test (attach the required schedule) 3b

I Qualifying dutribu6ons Add lines 1a through 3b Enter here and on Part V, line B, and Part XIII, line 4 _ 4 1 10 3 3 6 5 . S Organizations that gushy under section 4940(x) for the reduced rate of tax on not investment

income Enter 1°h o1 Part I, line 276 5 0 Adjusted qualifying 4ittrlDuhons Subtract line 5from line a e 1,103,365 .

Note The amount on line 6 wig be used in Pert V, column (6), m subsequent years when calculating whether the loundefan queldles for the section 4940(e) reduction o/ tax in those years

F. 000-PF (2oo,)

1235 6 1 za-ox

Ibl to 2000

J 1c)000

I la) orpus Years prior 0 2 2pp1

1 Distributable amount for 2001 from Part XI, line 7

2 watweuda incanr n .iy ., a m. .~e a xooo a Enter amount for 2000 only biorrw pnarv, 18-,19-,18-

8 E+cm meeumn aryew, a ary ro »o7

From Hess 159 , 795 b From 1997 13 , 384 e From 1988 it From 1988 a From 2000 49 3 f Total of tines 3a through a

I Qualifying distribuhons for 2001 from Part Xll,line e ~ $ 1,103, 365

a Applied to 2000, but not more than line Z b Applied to undistributed Income of prior years (Election required-see Instructions)

e Treated as distributions out of corpus (Election required - see instructions)

d Applied to 2001 d¢tributable amount a Remaining amount distributed out of corpus

S F~ almeueonac+naw oouadmzoot of m mount Qpe"m cdwm (dj me vir ~nt mush be mown m colurm y))

6 Enter the not total of each column as indicated below

8 comu" nee uoe m 4c and 4. s~eo-act en. s b Prior years' undistributed income Subtract tine 4b from line 2b

a Enter the amount of poor years' undistributed income for which a notice of deficiency has been issued, or an which the section 4942(a) fax has been previously assessed

d Subtract line Bc from line Bb Taxable amount - see instructions

a Undistributed income for 2000 Subtract tine 4a from line 2a Taxable amount -sae instr

1 Undistributed Income for 2001 Subtract lines 4d and 5 from line 1 This amount must he distributed in 2002

7 Amounts treated as distributions out al corpus to sausy requirements imposed by section 170(b)(7)(E) or 4942(9)(3)

0 Excess distributions carryover from 1996 not applied on line 5 or line 1

Y Exeut dutribubana auryowrto 2002 Subtract lines 7 and 8 from line 6a

10 Analysis of line 9 a Excess from 1B97 13 384 . b Excess from 1998 e Excess from 1989 d Excess from 2000 4 9 , 3 5 6 .

r~ 990-PF Rooi>

123571 o, zo oz

8

Forme90-PF(20o1) HENRY NIAS FOUNDATION . INC . 13-6075785 Page e Part XIII Undistributed Income (am wtnccnru)

sea wauctwns and sere V11-A. c

Total

(1) Total support other than gross Investment Income (Interest, dividends, rents, payments an securities loans (section 512(a)(5)), or royalties)

(2) Support tram general public and 5 or more exempt organizations as provided in section 4942(i)(3)(13)(m)

(d) Largest amount of support from an exempt organization

izaseiAi-z"-a: 9 Fm� 900-PF (2oo+)

1 a 11 the foundation has received a ruling or determination letter that It Is a private operating foundation, end the ruling k effective for 2001, enter the dab of The ruling

b Check box to Indicate whether me organization is a Private alienating foundation described In section 2 a Enter the lesser of the adjusted not

income from Put I or the minimum investment realm from Part X far each year listed

6 85% of line 2a e OualAylnp dlsfibuCOns from Part XII,

line 41or each year listed d Amounts included in line 2c not used directly for scale conduct of exempt activities

a OualAyinq distributions made directly for active conduct of exempt ac4inhes Subtract line 2d from line 2c

8 Complete 3a, b, or c for the alternative test reified upon

a 'Assets' anernaWe test - enter It) Value of all assets (2) Value of assets qualifying

under section 4942(1)(3)(11)(1) b "Endowmenf alternative test-

Enter ?/d of minimum investment return shown in Put x line B for each year fisted

e Supporfalternative test -enter

Pal rt XV I Supplementary Information (GOmplete this part only if the organization had 55,000 or more in assets at any time during the year-see page 28 of the instructions .)

t Information Regarding Foundation Manapxs : a List any managers of be foundation who have contributed more than 2% of me total contributions received by the foundation before the close of any tax

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

NONE b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion al the ownership of a partnership or

other entity) al which the foundation has a 10% or greater interest.

NONE 2 Intwmetion Regarding Contribution, Grant, GM, Loan, Scholarship, etc, Programs

Check here " 0 if the organization any makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds If the organization makes gills, grand, etc (see insVuehons) to Individuals or organizations under other conditions, complete acme 2a, b, e, and d

a The name, address, and telephone number of the person to whom applications should be addressed RICHARD SDELMAN 277 GLENDALB DRIVE CATHAGE, N.C . 28327 336-824-4413

b The form in which applications should be submitted and information and materials may should include NO SPECIAL REOUIRMENTS OTHER THAN NATURE OF ACTIVITY

c Any submission deadlines AUGUST ANNUALLY

d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other lectors N .Y .C . - MEDICAL ARTS, CULTURAL AND GENERAL PHILANTHROPIC

Foundation I Purpose of pram or shNS of contribution

an Fm � BBO-PF Room

10

Form B90-PF

Grants; end Contributions Peed Dualnp tha Yiner or Approved for Furtuera Recipient tt recipient Is an IndrAdual,

show any relationship to Name and address (home or busmen) any foundation manager

or substantial contributor a Pad dunr?g the year

Total b Approved /or /utwa payment

NONE

rout 120601101 2402

a.

Amount

Form 9BO-PF(2oot) HENRY NIAS FOUNDATION . INC . 13-6075785 page it Part XVhA Analysis of Income-Producing Activities

csmeome eenn.a ..cemeustoaau 1 (0) (b) &(d) Related or exempt

Amount SIM , Amount function Income

a Debt-financed property b Not debt-financed property

0 Nat rental income or (loss) from personal property

7 Other investment income 0 Gain or (loss) from sales of assets other

than inventory 0 Net income or (loss) from special events 10 Gross profit or (loss) from sales of inventory 11 Other revenue

F~BBO-PF Room

Enter gross amounts unless otherwise Indicated

1 Program service revenue

p Fees and contracts tram government agencies 2 Membership dues and assessments 3 Interest on savings and temporary cash

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

12 Subtotal Add columns (b), (d), and (e) t-- J U .I I 1 , 1 L .i , U U L .I U . 13 Total nod line iz, columns (o), (d), aid (e) 10.13 1,123 , 002 . (See worksheet in line 13 instructions to verify calculations I

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

Line Ho Explain below how each activity for which income IS reported in column (e) of Part %VI-A contributed importantly to the accomplishment o1 the organization's exempt purposes (other than by providing funds for such purposes)

21s Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described Yst ETLI No in section 501(c) of me Code (other man section 501(c)(3)) or in section 5277

of of Name of

Unde" panalY of pn I Oeclaa Met 1 have ~umned Mp roMn inclu0inp a[conpary~np schedules end statemanb arid b tea beat d ny kmWSOps end belief it is M.is ~t and conp of Pr as ~othr N 7i9 r a IiEUCiay) ,a based on all inlancGOn N ~+hich VrW ar ha a^Y knoweCpe

'- ~ Z a3 a ' Signature of officer or trustse

Preparer's ~/~'~

EB E 'PROPER 5 THIRD AVENUE

123621 0 f-z. 02

Did the organization directly or Indirectly engage m any o1 the following with any other orpan¢a4on described in secLOn 501(e) of the Code (other than section 501(c)(3) organizations) or m section 527, relaling to political organizations? Transfers from the reporting orqanvaton to a nonehuihbk exempt organization at, (1) Cash (2) Other assets

b Otter TransacLOns t) Sales o1 assets to a noneharitable exempt organization (2) Purchases of assets from a noncharrtable exempt organlraNon (3) Rental 01 facilities, equipment, or other assets J4) Reimbursement arrangements (5) Loans or loan guarantees (E) Performance of services or membership or fundraising solicitations

e Sharing of facilities, equipment mailing lists, other assets, or paid employees If the answer to any of the above is "Yes: complete the following schedule Column (b) should always show the fair market value of me goods, other asset, of services given by the reporting organization If the organization received less man fair market value in any transaction or sharing arrangement, show In column Idl Cue value of the aooda, other assets . or services received

transactions,

°~O

Fd

ae Frm~mme Ior pun

~WA~mObhA)

Saar.. ~.a nv ait.

FORM 990-PF TAXES STATEMENT 3

(A) (s) EXPENSES NET INVEST-PER BOORS MSNT INCOME

10,000 . 0 .

10,000 . 0 .

(C) ADJUSTED NET INCOME

(D) CHARITABLE PURPOSES

0 .

0 .

EXCISE TAX

TO FORM 990-PF, PG 1, IN 18

FORM 990-PF OTHER EXPENSES STATEMENT 4

(c) ADJUSTED NET INCOME

(D) CHARITABLE PURPOSES

6,427 .

6,427 .

MISCELLANEOUS

TO FORM 990-PF, PG 1, IN 23

13 STATEMENT S) 1, 2, 3, 4

HSNjtY NIAS FOUNDATION, INC . 13-6075785

FORM 990-PF DIVIDENDS AND INTEREST FROM SECURITIES STATEMENT 1

CAPITAL GAINS COLUMN (A) SOURCE GROSS AMOUNT DIVIDENDS AMOUNT

PAINE WBBBER 826,652 . 0 . 826,652 .

TOTAL TO FM 990-PF, PART I, IN 4 826,652 . 0 . 826,652 .

FORM 990-PF OTHER PROFESSIONAL FEES STATEMENT 2

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

DESCRIPTION PER BOORS MENT INCOME NET INCOME PURPOSES

PROFESSIONAL FEES - CONSULTING 54,673 . 54,673 . 0 .

TO FORM 990-PF, PG 1, IN 16C 54,673 . 54,673 . 0 .

DESCRIPTION

DESCRIPTION

(a) (s) EXPENSES NET INVEST-PER BOORS MENT INCOME

6,427 . 6,427 .

6,427 . 6,427 .

HW Y NIAS FOUNDATION, INC . 13-6075785

FORM 990-PF CORPORATE BONDS STATEMENT 6

FAIR MARKET VALUE

5,316,861 .

5,316,861 .

DESCRIPTION

SECURITIES

TOTAL TO FORM 990-PF, PART II, LINE lOC

BOOR VALUE

5,316,861 .

5,316,861 .

STATEMENT 7 PART VIII - LIST OF OFFICERS, DIRECTORS TRUSTEES AND FOUNDATION MANAGERS

COMPEN-SATION

5~, Soo 3£~0

44,000 .

34,625 .

NAME AND ADDRESS

DR . STANBLY BDELMAN 60 BAST END AVENUE NEW YORK, NY 10028

CHARLES D . FLEISFIMAN 200 PLATT ROAD MILFORD, CT 06460

WILLIAM F . ROSENBERG 9 PLEASANT VALLEY LANE WESTPORT, CT 06880

RICHARD J . FE;i=a&N sdEImAn/ 277 GLENDALE DRIVE CATHAGE, NC 28327

ALBERT ROSENBERG 9 PLEASANT VALLEY LANE WESTPORT, CT 06880

SECRETARY 10 0 . 0 .

0 . 0 . TREASURER 36,7-5-0 15 3 .

PRESIDENT EMERITUS 0 0 . 0 . 0 .

TOTALS INCLUDED ON 990-PF, PAGE 6, PART VIII

6

14 STATEMENT S) 5, 6, 7

FORM 990-PF CORPORATE STOCK STATEMENT 5

FAIR MARKET DESCRIPTION HOOK VALUE VALUE

SECURITIES 16,649,110 . 16,649,110 .

TOTAL TO FORM 990-PF, PART II, LINE lOB 16,649,110 . 16,649,110 .

FORM 990-PF

TITLE AND AVRG HRS/WR

CHAIRMAN 20

PRESIDENT 20

EMPLOYEE BEN PLAN EXPENSE CONTRIS ACCOUNT

0 . 0 .

0 . 0 .

167,875 . 0 . 0 .

Boys Club of Amen" Pomona, CA 91769 Public Technical support 6,000 None Catholic Charities Archdix New York. NY Public Technical support 10,000 None Central Park Conservancy New York, NV Public Technical support 70,000 None City Harvest New Ywk, NY Public Technical support 70,000 None Colpa4 University Hamilton, NY ti]4G Public Technical support 70,000 None Columbia Unrv Col of P85 New York, NY Public Educational 40,000 None Columbia University New York, NY Public Educational 10,000 None Ellen Fleitdaiman Lrtaky New York, NY Public Technical support ],000 None Fadcap Rehabilitation Sam New York, NY 70071 Public Technical support 10,000 None Federation UJA General Cont New York, NY 10072 Public Technical support 16,000 None Film Sa of Lincoln Center New York, NY 10023 Public Technical support 30,000 None Hair Inc New York, NY 70001 Public Charitable 10,000 None Hebrew Free Loan Sx New York, NY 10077 Public Charitable 70,000 None Helen Keller Serv for the B Birmingham, AL 76205 Public Charitable 16,000 None Horizon Concerts New York, NY Public Arts instruction 6,000 None ICD Ezn K Llka Inst far C New York, NY Public Vocational training 70,000 None In Touch Foundation Las Vegas, NV 98727 Public Vocational training 2.000 None Jewish Assn for Blind New York, NY 10001 Public Physical instruction 76,000 None Jewish Bd of Family Service New Haven, CT 06676 Public Vocational training 6,000 None Jewish Community Center of Harrison, NY 70268 Public Vocational training 70,000 None Jewish Home 6 Hosp for the New York, NY 70026 Public Vocational training 40.000 None Kings Bay YM 6 YVJHA Brooklyn, NY 17778 Public Physical instruction 20,000 None Lenoa Hill Hospital New York, NY 10021 Public Medical Instruction 76,000 None Manhattan Sch of Music Bronx, NY 10453 Public Arts Instruction 18,000 None Mare After School Program New York, NY Public Educational 16,000 None Metropolitan Museum of Art New York, NY 10021 Public Arty instruction 20,000 None Metropolitan NY Coordinating New York, NV 10026 Public /W instruction 18,000 None Metropolitan Opera Assoc New York, NY 70077 Public Arts instruction 70,000 None Mt Sinai Mad Gntr Dept Surq New York, NV 10079 Public Medical instruction 75,000 None Museum of the City of New York New York, NV 70028 Public Arts instruction 5,000 None National Actor Theatre New York, NY 70029 Public Arts instruction 70,000 None New York City Opera New York, NY 70076 Public Arts instruction 26,000 None NY Ballet New York, NY 70046 Public Arts instruction 6,000 None NY Committee for Young Audi New Yolk, NY Public Physical instruction 14,000 None NY Hemophic New York, NY 10148 Public Physical instruction 70,000 None NV League for Hard of Hearing New York, NY 10126 Public Physical instruction 30,000 None NY Philharmonic New York, NY 10021 Public Musical instruction 26,000 None NY Road Runners New York, NY 10148 Public Sports 6,000 None NY Youth Symphony New York, NY 70019 Public Arts instruction 6,000 None OISGr New York, NY 10021 Public Technical support 10,000 None Planned Parenthood o1 NY City New York, NY 10012 Public Technical support 16,000 None Princess Grace Foundation New York, NY 10766 Public Technical support 60,000 None Rrverdale YM b YMCA Wverdale, NY Public Educational 70,000 None Roundabout Theatre New York, NY 10018 Public Arts instruction 10,000 None Sheltenng Arms Children Service New York, NV 10016 Public Technical support 10,000 None St Joseph High School SL Joseph, MO 66607 Public Educational 10,000 None Stanley laaacc Neighborhood New York, NY 70728 Public Charitable 10,000 None Symphony Space New York, NY 10026 Public Arts instruction 26,000 None The Doe Fund Ready Willing New York, NY 10028 Public Charitable 10,000 None Theater Development Fund New York, NY 10279 Public Arts instruction 6,000 None Theaters at Lincoln Center New York, NY 10279 Public Arts instruction 26,000 None Third Street Music Settlement New York, NY 7000 Public Arts instruction 6,000 None Town Hall New York, NY 10078 Public Arts instruction 76,000 None Townsend Horns Alumni Assn Inc Flushing, NY 11367 Public Educational 36,000 None University of New Haven West Haven, CT 06616 Public Educational 70,000 None Whitney Museum New York, NY 10071 Public Educational 20,000 None WHET Channel 13 New York, NY 10007 public Broadcasting 6,000 None WNYC Fndm New York, NY 10007 Public Broadcasting 8,000 None Young MenNWOmens Xebnw 1lssxlauon New York, NY 10028 Public Arcs instruction 60,000 None

Total Contributions 1,01 ,000

Henry Nlas Foundation Inc List of Grants Paid

December 2001 through November 2002

Name Address Foundation Status Purpose Amount Relationship American Jewish Comm New York, NY Public Art Instruction 70,000 None American Museum of Natural New York, NY Public Art Instruction 26,000 None Anti Defamation League BNAI New York, NY Public Charitable 50,000 None Bk St School of Ed New York, NY Public Educational 2000 None

Realized GaiN(Loss) Report From 12lDi/20D1 To 11130/2002

ibis sport provlda a summery o1 both shall-term end bnq-twm nslped pslndpopa) of the selected mccourd(@~.

Iisporl Date : July le, 2003 Account Nsne. HENRY NIAS FOUNDATION DR STANLEY EDELI+IAN, CHAIRMAN Account Numbsr(s) : TI1000f! 60 EAST END AVENUE NEW YORK, NY 100?&7Y07

Financial Adviser ISDALEWANNINa FA NumW: TlBB

7M end of to IePort oorelrw lmparWddiWasu,es reqaed8og IM rRwnxlbn aM rdAM4om peeenbd In lb1+ repa[ Plmea rodew Met Inkvve6on earehdly eM catdac7 your Flnardal AAftor VA any quest".

Report created an JWy 16 . 2000 Pays t d 2

1 UBS UBS Financial Services Inc.

Realized Gain/(Loss) Report Account MonMr(s).7NO032B

Coo basis b zero Coupon tewnerda has not been aubmaCW 1y adjusted br accrued Mlplnd ime drsemnA and Iharsbm QadnNf~ccas) aye not t*Ualad.

O 20Q2,Zau9 UBS Frcwal 6srwes 6r N Pophb Reserved. Member SIPC .

aeon created = My III, 20M Pop 2d4

This report u (a mtomintlorml purposes; only and should not be Felted open m Me based en irneetneM m IlqLddafon dectian AD hlamiallm Presented h auqect Node e1 ur/ rms rid b pwqsd MV n o1 Cue dale fndmmd U&S FnancIW Services accounts statements and aIIIrbl tax docunsm0 are the arty alfdW moord d ydr eooaub and an not rsped~ amended or syemadsa by " at the InformaYan ProseiEod In these reports

no report Includes d hddnpe held In to eoearnqa) selecEad Alan Ns report vu yanarate0 Those aaamts may a mar not irctude s8 d yin accounts with U9S Rrrctd BerAcw. The saaWe Nchdad n lids ieparl are GYed wrier the 'Aassd 1Juro6ar(p' section m on cover d this report

1 Accounts Nrtwh held array and transferred b UBS Financial Seivfoas WE reflect polN(taee) ealaletana arty far the period al Cme from wtiN it" were Yarolert~d b we Fpm. Non Msbrld mieffnawn can m added a the Financial ao-nsa. N this Tepon aanialm podllam wih unaraIFaNe cog basis (+Iwwn 0s zao ow*. the radaed poiN(bul log fims podlbn may be dspl6Yed as,' WA' In Kddfiu411row Positions era excluded ht to calautallmi M the TM RsdIneA pa4Y(Wss).

is If you are filing for an Additional (not automatic) 3-Month EiQenslon, complete only Part II and check this box Note : Only complete Part 11 H you have already been granted an automatic 3-month extension on a previously filed Form ! 9 If you are filing for an Automatic 3-Month Extension. complete only Part I (on pace 1) rare 11 '+uuu~~ua~ Suva auwmnuc rmunu~ u~anawn v~ ~ unu-mwa r11o W11"11 Type a HENRY NIAS FOUNDATION, INC , c/o FLEISHMAN print ZO CARMEN ROAD ~; . y-File by dw MILFORD CT 06460 t~

^due ate for filing the EIN 13075785 YEAREND 11/d0/02 EXT7 7/15/03 °sWCUms s return See FORMS 990.PF497 instructions EXT2 10/15/03 Check type of return to be filed (File e separate application for each return)

Form 990 ~ Forth 99QEZ 0 Form 990-T (sec 40f(a)or408(a)hust) 0 Forth 1041-A /~ Form 990-BL Form 990.PF n Form 990-T (trust other than above) I-I Form 4720

5 -

Form 5227 [] Forth 8870 Forth 6069

is If the organization does not have an office or place of business in the United States, check this box No. n o If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) IT this is for the whole group, check this box li~ 0 If it is for part of the group, check this box is, Fj 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 October 1.1) 20 07 5 For calendar year-, or other tax year beginning December 1 , Zp 01 and ending 6 If this tax year is for less than 12 months, check reason ~ Initial return 0 Final return 0 7 State m detail why yon peed the extension Certain information necessarx to file a c

accurate return is no yet available, It is anticipated that all data will t e exten e ue date.

8a If this application is for Form 990-BL, 99aPF, 990.T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions 5

By- Director Data

Loeb 6 Troper --- Frederick H. Rothman Number end street (include suits, room, or apt. no ) Or a P O bo: number 655 Third Avenue City or town, province or state, New York . New York

postal or

FoRn 8868 b12-2ooo> STF FED9DS6F 2

use

STOP: Do not complete Part II If you were not already granted an automatic 3-month extension on a previously filed Form 8868.

per 30 , 20 in accounting period

b If this application is for Form 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 Form 8868 $

c Balance Due. Subtract line Bb from line Ba Include your payment with this form, or, if required, deposit with FTD coupon or, d required, by using EFTPS (Electronic Federal Tax Payment System) See instructions $

Signature and Verification Under penalties of r u tare Ciat I have exam this fo ncludinp accompanying schedules end statement and to the best of my knowledge and belie! It Is true, correct, and complete an at I avU b re Ni

Signature Is. rued CPA oacell~ July 8, 2003 Notice to Applicant-To Be Completed by the IRS

0 We have approved this application Please attach this form to the organization's return We have not approved this apphwhon However, we have granted a 70-day grace penal from the later of the data shown below a the due date a the organization's return (including any prior extensions) This grace period u considered to he a valid wdension a time for elections otherwise required to be made on a limey return Please attach this form to the organization's return

0 We have not approved this application After considering the realms stated m Rein 7, we cannot grant your request for an extension of time to file We aye not granting a 10.day grace period

0 We cannot consider this application because R was filed after the due data d we return for which an a¢ension was requested other

Alternate Mailing Address-Enter the address if you want the copy of this application for an additional 3-month extension returned to an address different than the one entered above

Type or print