return ofprivate foundation 2009990s.foundationcenter.org/990pf_pdf_archive/237/... ·...

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Return of Private FoundationFonn990-PF or Section 4947(a)(1) Nonexempt Charitable TrustDepartment or me Treasury Treated as a Private Foundation

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Internal ee+renue service Note : The foundation may be able to use a copy of this return to satisfy state rrtinc

Fnr calandar wear 2009 - or_ta^r vAa^ 4 ese +r^ ._ ---20

0MB No. 1545-0052

2009G Check all that apply.

H

Initial return Initial return of a former public charity Final return

Amended return Address change Name changeName of foundation A Employer Identification number

Use the IRS ROSS J. BORN FAMILY CHARITABLE TRUST

label C/0 ROSS J. BORN 23-7653033Otherwise, Number and Street (or P.O. box number if mail is not delivered to street address) Room/suite S Teleptmne murO,u (see pop 10 of er5eth om)

printor type.

ecificSee S3571 CATHERINE AVENUE (610) 867-7568

pInstructions . City or town, state, and ZIP code C If emmption apWi^lon is

►pending,.heck here

D 1. Foreign organizations , check here • ►ALLENTOWN, PA 18103 2. Foreign organizations meeting the

H Check a of organization: X Section 501 c 3 exempt private foundationtype ( computation85% test check here and attachcomputation ►

Section 4947 (a)( 1 ) nonexempt charitable trust Other taxable private foundationdf i f d ti t t i t

I Fair market value of all assets at end Accounting method: X Cash AccrualE I napr vate oun a on s atus was erm e

under section 607(b)(1)(A), check here . ►of year (from Part ll, col. (c), line q Other (specify) _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ - F If the foundation Is In e m.month termination16) ► $ 2,528,668 • (Part 1, column (d) must be on cash basis.) under section 507(b)(1)(B), check hem . ►

EM.Analysis of Revenue and Expenses (The (d) Disbursementstotal of amounts In columns (b), (c), and (49 (a) Revenue and (b) Net Investment (c) Adjusted net for charitablemay not necessarily equal the amounts In expenses per Income income purposescolumn (a) (see page 11 of the instructions). books (cash basis only)

I Contributions fRB, grants

,

etc,. received (attach schedule)•

3+".ra R -t r, a^.rsa,N ., i.x+

-. ^rLT'^.' e.•.: s=.. `-l^.I . t rh+.'.'t,'L'^fi•R^.^.Yry^1+.,-^^:.•.^

If the foundation is not req uired to2 (ihedC 1111'. schattach B

:4'_x n Y^ "^ `R*i_ :.dt + Inc ti? y«. ^ -

4 c^ r` t;T e -i. ,,•+

,^« .r + 7 r`r r, ^»>^twt `â^'1•c 4

. .

3 Interest on savings and temporary cash Investments 19,462 . 19,462 .

A D ividends and rinte e".* f,'^..^) JGMÎI.wYW__ndde 4 3 , 310 4 3 , 310. ssq`2 ±r^'>`^`,'` i

zS a Gross rents . . ...... ... .. .. •

b Net rental income or (loss)G; ..J •?1Sd,;Fal i.?^^•, i^':`.`^ ^^f<_=r ?pib=3

?.', f°a;, s. •,^? : Y.• '`

3s r x7w :F Kj 'w`^^ " _ c

•I}4s'?rZ1"f''illr. a,f )sa i

m S a Net gain or (loss ) from sale of assets not on line 10 51, 430 ,:^= i+u e.,= . x. ,- i .,r

s • h b^; •.a xSs,7 b Gross sales price for all 437 391 ^:',7-r;

e :dot tip-.; ::- -a. 4.. R•,. .^

w''C, .

assets on line 6ap a . • . ^ _ _ K 1Y^ 5 ; _. a r' . L G - ,... , a •. • .• r

m 7 Capital gain net income (from Part N, line 2) .

:r`_'„--tsT t 51, 430. ^'Y'.e=, '.'4ti='>' ,, î ms` s .h' i•,1'+ r'^"t

y

Net short-term capital gain • • • • • • • •'.^'°^,' f.w w î t^

.:._:r-, •'^ ak L,, •^F r,.^ 4î `-'.a ^r f'y •'^ ,° S+: .. ^=:: -z.^_r.^_:IVI /Al Id • î,_9^ • n_'l•.r

,_,3 - ' , u

9 Income modifications ... ^R"'^ r. ;;:

Ri i "},i- :`G t.a ^+S kSih`, r« : -.„ •-- • `-^`5v';S^•.I .S„^r 1'i•`•A^^}k+•L,:•i

^_xGJ`1"S'C J'IV

10a Gross sales less 7 ^ f k^ ' w;, 01d ll

•

tK^=^3vti^ se+ ^ c y .n_-^^ r c. irc , sYk ,t4ân a owances

b Less: Cost of goods soldJ-!^r F ?fa^:k' 7`j

:*ra,• t,'t'naTf F-^",S `}^ ^^ r, ^y.•-,-

â"' T "x'`3k i k".^ + il,^-^` *4 *' ]Lv {ry , '^,

^^•.5frt'^-

: r ^?

c Gross profit or (loss) (attach schedule) N _

11 Other income (attach schedule) 586. 586. 2yZ'^;y• • • • • • •

12 Total. Add lines 1 throw h 11 114,788 . 114,788.

13 Compensation of officers, directors. trustees, etc. • •

14 Other employee salaries and wages ....e

16 Pension plans, employee benefits

a

. • . • ,

16a Legal fees (attach schedule) • •

b Accounting fees (attach schedule) ATCH 4 • 3,100 . 3,100. 0. 0.

c Other professional fees (attach schedule).* 20,908 . 20,908.

17 Interest .. . .. .. . . .. . . .•

• • •1k

IS T s d d d l ^ ^1 75-9- 1, 7-59;axe (alta s w ua^ ^

19 Depreciation (attach schedule) and depletion. = F______•` =__ _

. . ... . . . . . . . . .20 Occupancy . .

s 21 Travel, conferences, and meetings

10

. ,

22 Printing and publications . . . .. .

23 Other expenses (attach schedule) ATCH• 7 • 1, 4 95 1, 4 95 .

bw 24 Total operating and administrative expenses.

a Add lines 13 through 23 .......... 27/262 27,262. 0. 0.

gifts, grants paid26 Contributions 373, 275 ;; -i"`y 373, 275.,

537400 27 262. 0. 275.37326 ToW expenses and dlsbursementLAdd lines 24end25 , , ,

27 Subtract line 28 from line 12:_ ,^ -rj nth :`J7 V.-fir a1. :

"`" y^`^lt.aF`•.ir' t"s3; 'i`•'

T. ,y^

I. r u %r...S ^G'f'-` ^= r'is

V•f•.^c ,y, ..s`ti'r'^{..^-.. ~ h ^^F^F.:^ '

7 49- 2 85.'[^n?» ^ - ^^Ct'x'; ft^ :3.

•^"^ ° ^.,t r•.;t1 ^_^ r ^'

},u:^; ' ^^ -a Excess of revenue over expertm and disbursements , ;. c. • C4 - r_ 4• ^- .x a s . +_ ^ : : ^. • •^r

b Net Investment Income (If negative, enter -0-) 8 7 , 52 6 . ',;,rs^_RV

c Adj usted net Income ( if negative , enter -0-).•Y}. •} L^'r`Wi 1L.,^p'^ •

n,. '• s ' =„ r?à f +lrtr'-^y.. LY'Y .x:1 1-•.-

^=r^^ , ^'a ' - :^ r - 0-`nf^l^^c• s}r^.w. 1,1

INFor Privacy Act and Paperwork Reduction Act Notice , see page 30 of the Instructions .* ATCH 5 ,ISA * * ATCH 6 Form 990-PF (2009) \

9E14101000488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 1

rFd 990-PF (2009 ) 23-7653033

Attached schedules and amounts in the Beginning of year End of yearBalance Sheets description column should be for end-of-year

amounts only. (See instructions.) (a) Book Value (b) Book Value (c) Fair Market Value

• I Cash - non-Interest-bearing ........... ...... .

-2--Saing , and temparry s r ` wetments; ........ - 8 87 0: -1144,9-9'3. 14-4,993.

3 Accounts receivable ► ------ ------^Y3Kti' _,^^r'F .•{x,'. ^`'._T}s ^}"i`4

-- -- -------- .+a ML11 11Less : allowance for doubtful accounts ►

4 Pledges receivable 10 ......................... ^ ^,ri+y,^Fc t; `'s^,;^^.,'^•, -,^ c«wid^^.^^ .x,*^ i=G.ar.:. ^.',^`.,•q ^..; ii,-?.i:, ^•'?,^.^.'tr•.^"=^:^- , i

Less : allowance for doubtful accounts ►

5 Grants receivable .. . . . . . ... .... . . . . . . .

6 Receivables due from officers , directors , trustees , and other

disqualified persons (attach schedule) (see page 16 of the Instructions)_•.. ^s ^- ;a+a^ a •r:^^•...«. ^±

7 Other notes and loans receivable (attach schedule) ► _ ^` -'j+';` " '`

Less : allowance for doubtful accounts ► _ _ _ _ _ _ _

8 Inventories for sale or use ,

9 Prepaid expenses and deferred charges ...... . .... .

Q 10 a Investments - U.S. and state government obligations (attach schedule)

b Investments - corporate stock (attach schedule) ATCH 8 1, 482, 195. 1, 219, 600. 1, 603, 775.

c Investments - corporate bonds (attach schedule) ATCH , 9 , 2 99 , 418. 316 , 141. 32 7 , 98 0 .

z ^`^ ;" Erna 6 - °_r 4}^ ra; ^ ^ _agm=w=

11 Investments - land, buildin gs, 101andequlpmentbsis ---------------- -.4,^d=.a,: ;t;,.;>, 5 :j°M ^rt`":w'.; ,'

Less : accumulated depreciation ►(attach schedule) -------------------

12 Investments - mortgage loans . .

13 Investments - other (attach schedule) ,ATCH. 10, 451, 920. 451, 920. 451, 920.,: ` :^txis_1^v^^ raT, = :: = s_^ r > t fCt ,.r14 Land, building s, and

1equipment basis;t.^' <r'^ ,+ - . r? °+st ^^ t aw ti,^s

Less : accumulated depredation ►(attach schedule) --------------------

15 Other assets (describe ► ____________________ )

16 Total assets (to be completed by all filers - see the

instructions . Aiso, see pay 1 rn 1) 2, 4188, 403. 2,132,654. 1 2,528,668.

17 Accounts payable and accrued expenses , , , , , , , , , , ;ttiy-"1

47 3-{:=

18 Grants payable . . . . . . . . . . . ... . . . . . .. .. '+^ ;rsr19 Deferred revenue

20 Loans from officers , directors, trustees , and other disqualified persons .

A 21 Mortgages and other notes payable (attach schedule)^'ay

22 Other liabilities (describe __ -_--____)

23 Total liabilities (add lines 17 through 22) .. .. . . . .. . .

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

0 24 Unrestricted . .. .... . .. . . . .. .. . . . . . .. .

26 Temporarily restricted .. . . . . . . .. . .. . . . . .. .

M 26 Permanently restricted .. . .. . . . .. .. . . . . . .. .W Foundations that do not follow SFAS 117,

i check here and complete lines 27 through 31. ►Q0 27 Capital stock, trust principal, or current funds ........ .

«15 28 Paid- In or capital surplus , or land , bldg., and equipment fund ,

29 Retained earnings , accumulated Income, endowment, or other funds 2,418,403. 2,132,654.

30 Total net assets or fund balances (see page 17 of the

2 , 41:8 , 403. i ,

31 Total liabilities and net assetslfund balances (see page 17

of the instructions 2,418,403. 2,132,654.

Analysis of Changes in Net Assets or Fund BalancesI Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree with

end-of-year figure reported on prior years return) , , , , , , , , , , , , , , , , ,,,,,,,,

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

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

5 Decreases not included in line 2 (itemize) ►------------------------------------

s Total net assets or fund balances at and of year ( line 4 min-us line 5) - Part II. column (b). line 30 . . .. .

,sA

9E 1420 1.000488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039

1 2,418,403.

2 -285,749.

34 2,132,654.

56 2,132,654.

Form 990-PF (2009)

PAGE 2

r

Form 990-PF (2009) 23-7653033

OM^ Ca ital Gains and Losses for Tax on Investment Income(a) List and describe the kind (s) of property sold (e. g., real estate, e^ (c) Date_ _(d).Date.sad-- -- -

-- - -2- brick'warreouse;orcommon s o c, 00 shs. MLC Co. (m a"day, dyr.) mo., day, yr.)

4. SEE PART IV SCHEDULE

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

Com plete only for assets showing gain in column ( h) and owned by the foundation on 12/31 (q Gains (Col. (h) gain minus

0) Adjusted basis (k) Excess of col . (i) col. (k). but not less than -0-) or(0 F.M.V. as of 12/31/69

as of 12/31/69 over col. 0). If any

/69

Losses (from col. (h))

If gain ,Capital gain net income or (net capital loss) f , also enter in Part I, line 7

( If (loss), enter -0- in Part I , line 7 } 2 51,430.

3 Not sha term capitai gain or (ioss) as defined in sections 1222(5) and (6):

If gain , also enter in Part I , line 8, column (c) (see pages 13 and 17 of the instructions).

If (loss), enter -0- in Part I , line 8. 3Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income

(For optional use by domestic private foundations subject to the section 4940 (a) tax on net investment income.)

If section 4940(d)(2) applies , leave this part blank.

Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period? .... F-I Yes Q NoIf "Yes," the foundation does not qualify under section 4940(e). Do not complete this park

I Enter the a propriate amount in each column for -arm see page 18 of the instructions before making env entries(a)

Base period yearsCalendar year (or tea year beginning I

. ---..

butlons(c)

Net value of nonchariteble-use assets

(d)Distribution ratio

( col. (b) d ivided by col. (c))

2008 306,555. 3,156,210. 0.097128

2007 316,214. 3,459,944. 0.091393

2006 741,277. 3,486,576. 0.212609

2005 495,569. 3,961,020. 0.125111

2004 504,482. 4,480,988. 0.112583

2 Total of line 1 , column (d) . .....................S-Average-dis perio - ivi e the total on line 2 by 5, or by the

number of years the foundation has been in existence if less than 5 years

2

3

0.638824

0.127765

4 Enter the net value of noncharitable -use assets for 2009 from Part X, line 5 4 2,439,845.

6 Multiply line 4 by line 3 , , , , , , , , , , , ,, , , , , , , , , , , 6 311,727., , , , , , , , , , , , , , ,

6 Enter 1 % of net investment income ( 1 % of Part I, line 27b) , ............... .. 6 875.. .

7 Add lines 5 and 6 7 312,602.

B Enter qualifying distributions from Part XII, line 4'

8 373,275.

Part Vi. line lb. and complete tIf line 8 is equal to or greater than line 7 . check the *box in hat fart usina a 1% tax rate . See thePart VI instructions on page 18.

.isn9E1430 1 000

488841 N232 5/11/2010 3:42:40 PM V 09-6.1

Form 990-PF (2009)

52039 PAGE 3

Form 990-12F (2009) 23-7653033 1jaMIJUL Excise Tax Based on Investment Income (Section 4940 ( a), 4940 ( b), 4940(e), or 4948 - see page 18 of the Instructions)

I a Exempt operating foundations desrnbed In section 4940 (d)(2), check here ► and enter "N/A" on line 1 . 7 _•^s

, , js^ =^ sw ,.^+_. . .£

Date of ruling or determination letter . _ .(attach copy of ruling letter If necessary • am Instructions). .M

b-61cme;tic-fcurdatIc,-.s-t at-meet-the-sect9cn-4940(e)-raru1rem, u.is-1n-PamV-check 1- 875

here 110- [] and enter 1% of Part I , line 27b

, • . .c All other domestic foundations enter 2% of line 27b . Exempt foreign organizations enter 4%

of Part I, line 12 , col. (b)

2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) . . 2

3 Add lines 1 and 2 . ....... . . . . . . .. . .. . . . . . . .. ... . ... .. . .. . . . . . . 3 875.

4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) . . , 4 0.

5 Tax based on Investment Income. Subtract line 4 from line 3. If zero or less, enter -0- , . , , , , , , , , , , 5 875.

6 Credits/Payments :4 S. n.',^ -r `i_xj:;L' a%yrr A= •.^

-0W?a 2009 estimated tax payments and 2008 overpayment credited to 2009 6a 2,400.

6 b 0.b Exempt foreign organizations-tax withheld at source

x

, , , • , ,0 .c Tax paid with application for extension of time to file (Form 8868) 6c

d Backup withholding erroneously withheld , , , , , , , , , , , , 6d i{

7 Total credits and payments . Add lines 6a through 6d ... . ..

.

......... ..... . .. .. 7 2, 400 .

8 Enter any penalty for underpayment of estimated tax Check here q If Form 2220 is attached , , . . . . . 8

9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed , , , , , , , ► 9, , , , , , , ,

►10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid 10 1,525.• , , , , , ,11 Enter the amount of line 10 to be: Credited to 2010 estimated tax ► 1, 525. Refunded 11

IMNITMi Statements Regarding Activities

1a During the tax year, did the foundation attempt to influence any national , state, or local legislation or did it k_<<

participate or intervene in any political campaign? • , , , , , , , , , , , , , , , , , , , • , , , , , , , , , , • , , la

b Did it spend more than $ 100 during the year (either directly or indirectly) for political purposes (see page 19

of the instructions for definition)?

.

1 b

if the answer is "Yes" to 4a or la, attach a detailed description of the activities and copies of any materials °=

published or distributed by the foundation in connection with the activities.

c Did the foundation file Form 1120-POL for this year? , , • , , , , , , , , , , , , , , , , , • , , , , , , , , , , I c

d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the foundation . (2) On foundation managers . ► $

e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers . ► $

2 Has the foundation engaged In any activities that have not previously been reported to the IRS? , , , , , , • , , , , , , , 2

If "Yes,' attach a detailed description of the activities .

3 Has the foundation made any changes , not previously reported to the IRS, in its governing instrument , articles of u =`^

Incorporation , or bylaws, or other similar instruments? If "Yes,"attach a conformed copy of the changes , , , , , , . . , . 3

4a Did the foundation have unrelated business gross Income of $1 ,000 or more during the year? , , , , , , , , , , • , , 4a

b If "Yes," has it filed a tax return on Form 990-T for this year? , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 4 b

5 Was there a liquidation , termination , dissolution, or substantial contraction during the year? , , , , , , , , , , , , , , 5

If 'Yes,' attach the statement required by General Instruction T.

6 Are the requirements of section 508(e) ( relating to sections 4941 through 4945) satisfied either:

• By language in the governing Instrument, or• By state legislation that effectively amends the governing instrument so that no mandatory directions that

conflict with the state law remain In the governing Instrument? . . . . . . . . .. ... ... . . . . . .. . .. .. . . . 6

7 Did the foundation have at least $5 ,000 In assets at any time during the year? Mies, I complete Part ll, col. (c), and PartXV. . 7

instructions) ► PA'_______________________ _ _ __ _ _ __ _ ___

b If the answer Is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General

(or designate) of each state as required by General Instruction G? If 'No,' attach explanation , , , , , , , , , , , , , , , , , ,

9 Is the foundation claiming status as a private operating foundation within the meaning of section 49420)(3) or

49420)(5) for calendar year 2009 or the taxable year beginning In 2009 (see Instructions for Part XIV on page

27)? If "Yes' complete PartXIV ... . . . . . . .. . . . . . . . . ... ... .. .. .. . . . . . . . . .. .. .. . .

10 Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their

names and addresses ..... .... . .. .... .. . . .......... .. ...... . . ... ..... .. .

JSA9E1440 1.000

X

X

X

gI

X

^,1P

X

X

v

^ZW-4

X

X

X

X

. 1101 1 XForm 990-PF (2009)

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 4

990-PF 23-7653033

11 At any time during the year, did the foundation , directly or indirectly , own a controlled entity within the

meaning of section 512(b)(13)? If "Yes," attach schedule (see page 20 of the instructions ) ... . . . .. .... ... . . .

Did-theloundaton -acqulre'a-dIrect-orndirectiriterest in any aPPlicab a c

August 17 , 2008? . . .. ..... .. . . . . .. . . . . . .... . .. . . .. .. ... . . . .. .. .. ... .. .

13 Did the foundation comply with the public Inspection requirements for Its annual returns and exemption application? .. . . .

we Re address ► N/A

X

14 The books are in care of ► ROSS _J__BORN----- - ----------------- Telephone no ► ----_ i800) 44!3_------___

Located at LEN V , PA --------------- ZIP+4 ► 18103 ------------------------------------

15 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF In lieu of Form 1041 - Check here • • . • . • . • . • • • • - - - • •

and enter the amount of tax-exempt interest received or accrued during the year . . .. ... ..... ...... ► 15

Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the "Yes" column, unless an exception applies. Yes Nc

1a During the year did the foundation (either directly or indirectly): w

(1) Engage In the sale or exchange, or leasing of property with a disqualified person? , , ° , , ° ° , q Yes q No u{ ^gAZ

(2) Borrow money from , lend money to, or otherwise extend credit to (or accept it from) a +k,z

disqualified person? ... .. . .. . . . ... . . . . .. .. . . . . . ..... ... .. Yes X No ' j- ?,'t;

(3) Furnish goods, services , or facilities to (or accept them from) a disqualified person? . . . ° .. . Yes X No

(4 ) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? . , . , , .. . Yes X No 0

(5) Transfer any Income or assets to a disqualified person (or make any of either available for 'N

the benefit or use of a disqualified person)?.... ................. ... ... Yes No %4 NN,

f.,^.m ' 's•s3=Y

(6) Agree to pay money or property to a government official? (Exception. Check "No" if

the foundation agreed to make a grant to or to employ the official for a period after

^..:^termination of government service , if terminating within 90 days .) . . . .. ... .. ... .. . El Yes q No

b If any answer is "Yes" to la( 1)-(6), did any of the acts fall to qualify under the exceptions described in Regulations

section 53 .4941 (d)-3 or In a current notice regarding disaster assistance (see page 20 of the instructions)? • • • •. • • • . lb

Organizations relying on a current notice regarding disaster assistance check here ... ... ° ...... ► u ;3: ;}

c Did the foundation engage in a prior year In any of the acts described In 1a, other than excepted acts , that L :5%

were not corrected before the first day of the tax year beginning in 2009? ° .. .. . .. ... .. . .. . . .. . .. . . .. 1c X>i4 • *c :,

2 Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private ORoperating foundation defined in section 4942(1')(3) or 4942(j)(5)):

a At the end of tax year 2009 , did the foundation have any undistributed Income ines 6d and `"rl51

6e, Part XIII ) for tax year(s) beginning before 2009? . . . . . . . . . . .. . . ... .. ... .. . q Yes q No

If "Yes; list the years .--------- .-------- ' --------

b Are there any years listed in 2a for which the foundation Is not applying the provisions of section 4942(a)(2)

(relating to incorrect valuation of assets) to the year's undistributed income? (If applying section 4942(a)(2)

to all years listed , answer "No" and attach statement - see page 20 of the instructions .) . ............ ... .... 2b

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

---------,--------,--------

3a Did the foundation hold more than a 2% direct or indirect Interest in any business N't

enterprise at any time during the year?

.

, , , , , , , , , , , , , , , , ,, , ,,, , , , El Yes q No 5

b If "Yes," did it have excess business holdings In 2009 as a result of (1) any purchase by the foundation or

disqualified persons after May 26 , 1969 ; (2) the lapse of the 5-year period (or longer period approved by the

Commissioner under section 4943 (c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse

of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C Form 4720, to determine if the

foundation had excess business holdings in 2009.) . . . . . . . ... . . .. .. . . . . . . . . . . . . .. . . .. .... 3b

b Did the foundation make any Investment In a prior year (but after December 31, 1969) that could jeopardize its

charitable purpose that had not been removed from Jeopardy before the first day of the tax year beginning in 2009? X

Form 990-PF (2009)

JSA

9E1450 1 000

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 5

Form 990-PF(2009) 23-7653033

Statements Regarding Activities for Which Form 4720 May Be Required continuedlig5a During the year did the foundation pay or Incur any amount to: ^ ^,

(1) Carry on propaganda , or otherwise attempt to Influence legislation (section 4945(e))? , q Yes q No E;

-(2) -In^uence1he-outcome-otany'speanc pu e e on see section 4955); or to carry on.&URdirectly or indirectly, any voter registration drive? Yes X No

(3) Provide a grant to an Individual for travel , study, or other similar purposes?, Yes X No

(4) Provide a grant to an organization other than a charitable , etc., organization described in

section 509 (a)(1), (2), or (3), or section 4940(d)(2)? (see page 22 of the instructions) , , . . . , . q Yes q No tw

(5) Provide for any purpose other than religious , charitable, scientific , literary, or educational^F.l.

purposes , or for the prevention of cruelly to children or animals? . . . . . ... . .. ... .. . q Yes a No l l

b If any answer Is "Yes' to 5a(1)-(5), did any of the transactions fall to qualify under the exceptions described In

Regulations section 53 .4945 or in a current notice regarding disaster assistance (see page 22 of the Instructions)? ... 5b

Organizations relying on a current notice regarding disaster assistance check here . . .. . . . . . . . . . . . ►Q ; #

c If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the tax (4

because It maintained expenditure responsibility for the grant? . q Yes q No

if 'Yes," attach the statement required by Regulations section 53.4945-5(d).. .... .. . .

S a Did the foundation , during the year , receive any funds, directly or Indirectly, to pay premiums

on a personal benefit contract? . ... .. . .. . . . .. ..... . . . .. ..... .. . . . . q Yes q No

b Did the foundation , during the year , pay premiums , directly or indirectly , on a personal benefit contract? . .. .. 6b

if 'Yes* to 6b, file Farm 8870.

7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? q Yes q No :emu

b If yes , did the foundation receive any proceeds or have any net income attributable to the transaction? .. . 71b

Information About Officers , Directors, Trustees, Foundation Managers, Highly Paid Employees,

6

X

X

t Lar au nrnco rc_ nirPernna_ rrucraa_c_ reunnarlen manners ann rnaIr cmmnan_caTInn rsae nacre rt er ma lnsaucnonsr_

a Name and address()(b) Title and average

hours per weekdevoted to oosItion

(e) Compensation

#not paid, enter0-)

(d) Contrfbutmns toemployee benefit plans

and deferred wmaensason

(e) Expense account,other allowances

ROSS J,- BORN------------------------------------

RUSTEE-0- -0- -0-

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

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

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

2 Compensation of five hiahest-paid emolovees (other than those included on line I - see oaae 23 of the instructions).If none. enter "NONE."

a Name and address of each employee aid more than $50,000(b) Title, and average

a) Compensation employee benefit (e) Expense account,() P hours per week ( plans and defer ed other allowances

devoted to position compensation

-------------------------------------NONE

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

Total number of other employees paid over $50,000 .Form 990-PF (2009)

JSA

9E1460 1 000

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 6

Form990-PF(2009) 23-7653033

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,and Contractors (continued)

3-Fiva-Y: Or A co rac rs or profess ional services see page 23 of the Instructions) . If none, enter "NONE."(a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation

Total number of others receiving over $50 , 000 for professional services ........................... ► NONE

Summary of Direct Charitable Activities

List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical Information such as the number I usesof organizations and other beneficiaries served, conferences convened, research papers produced, etc

j NOT APPLICABLE---------------------------------------------------------------------------

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

2

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

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

f 'a:7 Summary of Pronram -Related Investments (see nacre 23 of the instructionalDescribe the two largest program-related investments made by the foundation during the tax year on lines I and 2 . Amount

1 NOT APPLICABLE---------------------------------------------------------------------------

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

2 ---------------------------------------------------------------------------

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

All other program-related Investments See page 24 of the Instructions.

3 NONE- ----------------------------------------------------------------------

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

Total. Add lines 1 throug h 3 . . ►Form 990-PF

JSA

9E1465 1 000488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 7

Form 990-PF(2009) 23-7653033 Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see page 24 of the instructions)

purposes: ;aE .-a Average monthly fair market value of securities , , , , , , , , , , , , , , , , , , , , , , , , , , , I a 1,877,403.

b, ,

, , , , , , , , , , , , , , , , , , .Average of monthly cash balances . . . , , , , . . . . . . , , . 1 b 147,677.

c,

Fair market value of all other assets (see page 24 of the instructions ) , , , , , , , , , , , , , , , Ic 451, 920.

d Total (add lines 1 a , b, and c) d 2 , 4 7 7 , 0 0 0 .

e Reduction claimed for blockage or other factors reported on lines 1a and

.

1 c (attach detailed explanation) 1 e aj^2 Acquisition indebtedness applicable to line I assets 2 0.

3............................

Subtract line 2 from line Id 3 2,477,000.

4................................

Cash deemed held for charitable activities . Enter 1 1 /2 % of line 3 (for greater amount, see page 25

of the instructions ) 4 37, 155.

5

........ ............ ......... . . . ........ .Net value of noncharitable -use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4 5 2, 439, 845 .

6 Minimum Investment return . Enter 5% of line 5 , 6 121,992.

Distributable Amount (see page 25 of the instructions) (Section 4942(j)(3) and 0 )( 5) private operatingfoundations and certain foreign organizations check here ► n and do not complete this part.)

carrying out charitable, etc.,

1. Minimum investment return from Part X, line 6 ................ ............ . 1 121,992.

2a Tax on investment income for 2009 from Part VI, line 5 2a 875.

b Income tax for 2009. (This does not include the tax from Part 2b

c Add lines 2a and 2b ...... 2c 875.

3.......................................

Distributable amount before adjustments. Subtract line 2c from line 1 ................. 3 121,117.

4 Recoveries of amounts treated as qualifying distributions , , , , , , , , , , , , , , , , , , , 4

5 Add lines 3 and 4 5 121,117.

G Deduction from distributabie amount (see page 25 of the instructions) , , , , , 17 Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,

. ..

linel 7 121,117.

Qualifying Distributions (see page 25 of the instructions)

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

a Expenses, contributions, gifts, etc. - total from Part I, column (d), line 26 , , , , , , ,, , , , , Ia 373,275.

b Program-related investments - total from Part IX-B _ ............ .. ........* *

.

lb 0

2 tc.,Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc .,

purposes . .. .....................

.

2 0.

3 Amounts set aside for specific charitable projects that satisfy the:

a , , , , , , , , , , , , , , , ,Suitability test (prior IRS approval required) 3a 0.

b

,,,,, , ,

Cash distribution test (attach the required schedule) , , , , , , , , , , , , , , , , , 3b 0.

4 Qualifying dIstributons. Add lines la through 3b. Enter here and on Part V, line 8, and Part All, line 4 , , , , 4 373,275.

5 Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income.

Enter 1 % of Part I, line 27b (see page 26 of the instructions) , , , , , , , , , , , , , , ,,,,,,, 5 875.

6 ,Adjusted qualifying distributions. Subtract line 5 from line 4 , , , , , 6 372, 400.

uent years when calculating wNote : The amount on line 6 will be used in Part V, column (b), in subseq hether the foundationqualifies for the section 4940(e) reduction of tax in those years.

Form 990-PF (2009>

JSA

9E1470 1.000

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 8

Form 990-PF 23-7653033

OMEW Undistributed Income see page 26 of the instructions)

(a) (b)I Distributable amount for 2009 from Part XI Corpus Years prior to 2008

line 7

2 Undistributed Income, If an as of the end of 2009 : ^^-+ ^ £`' -• }+r xc

a Enter amount for 2008 only , xo- 1"'fi

b Total for prtor years: 20 07 20 06 20 05 'ran _

3 Excess distributions carryover , if any, to 2009:

From 2004 282 , 641 ,^;g,',

b From 2005 .. , , . 303,312.;

c From 2006 }

d From 2007 '400. X-5`^ F . ^^' ^ • ,^• 't°..;^^

e From 2008

. . . .. 146

,rd^ z^rs::f .149 906.'

f Total of lines 3a through e ,

.::Ld^ •ti•^-^:^:^^-,, -h-.:M;^: 3r^^^F4 Quali fying distributions for 2009 fromrom Part XII

'line 4: ► $ 373,275.

a Applied to 2008, but not more than line 2a , ,

b Applied to undistributed income of prior years (Election ?^" ``°''4^'•required - see page 26 of the instructions ) . , . , t wro ^°`^ w14 ',

c Treated as distributions out of corpus ( Election "~^^,^srequired - see page 26 of the Instructions) , , .

Y,'`Jrrx^d Applied to 2009 distributable amount

e Remaining amount distributed out of corpus 252,158.

5 Excess distributions carryover applied to 2009(,° an amount appears in column (a), the same r^' r. ^s ^; '_ •,^ ,,)Y ^.^~aamount must be shown in column ` ' yr A°• }' ''

6 Enter the net total of each column asIndicated below:'

a Corpus. Add lines 3f, 4c , and 4e. Subtract line 5

b Prior years' undistributed income. Subtract aline 4b from line 2b

c Enter the amount of prior years' undistributedIncome for which a notice of deficien cy has beenIssued , or on which the section 4942 (a) tax hasbeen previously assessed ........ . .. .. t_" - LLt„:v ,

d Subtract line 6c from line 6b . Taxableamount - see page 27 of the Instructions

e Undistributed Income for 2008 . Subtract line4a from line 2a Taxable amount see page "E^'^,Ms27 of the Instructions ... . . . . . . . . .. Nr^3,-.;F`.rs

f Undistributed Income for 2009. Subtract lines4d and 5 from line 1. This amount must bedistributed in 2010 .............

7 Amounts treated as distributions out of corpusto satisfy requirements Imposed by section170(b)(1)(F) or 4942(g)(3) (see page 27 of theInstructions) . . .. .. . . . .

8 Excess distributions carryover from 2004 not

Instructions) ........... , .. 2 8 2 , 641.

9 Excess distributions carryover to 2010.Subtract lines 7 and 8 from line 6a

. . ..

1,421,462.

10 Analysis of line 9 : -'.,^°T^r-ec

a Excess from 2005 , , 3 0 3 , 312. t

b Excess from 2006 . . 569, 616.

c Excess from 2007 146,400.

149 906 ^d Excess from 2008 , . z=j

e Excess from 2009 2 5 2 , 15 8 . e^'''^

JSA

9E1480 1 000

488841 N232 5/11/2010 3: 42:40 PM V 09-6.1 52039

(c) (d)2008 2009

le 9

7.

Form 990-PF (2009)

PAGE 9

Form 990-PF (2009) 23-7653033

Private Operating Foundations (see page 27 of the instructions and Part VII-A, q uestion 9) NOI a If the foundation has received a ruling or determination letter that It Is a private operating

foundation , and the ruling is effective for 2009, enter the date of the ruling _ . ... .. . .. ► - -Ib--C ec oxto-indicate whether the foundation Is a private operating foundation described in section 49420)(3) or

2 a Enter the lesser of the ad- Tax year Prior 3 years

justed net Income from Part (a) 2009 (b) 2008 (c) 2007 (d) 2006or the minimum investment

return from Part X for eachyearlisted . . . . . . .

b 85% of line 2a . . . . .

LICABLE

(e) Total

C Qualifying distributions from Part

XII, 11ne 4 far each yearlisted ,

d Amounts Included In line 2c notused directly for active conductof exempt activities . . . . .

e Qualifying distributions madedirectly for active conduct ofexempt activities Subbad line2d from line 2c , . , ,

3 Complete 34 b, or c for thealternative test railed upon

a 'Assets" altemaWe test - enter.

(1) Value of all assets

(2) Value of assets qualifyingunder section

49M)(3)(0)C). . . . .b "Endowment" alternative test-

enter 2/3 of minimum Invest-

ment return shown In Part X

line 6 for each year listed . .

C "Support' alternative test - enter

(1) Total support other thangross Investment '"conic

(trdmast, dividends, rents,payments on securitiesloans (section 512(e)(5)),or royalties) . . . .

(2) Support from generalpublic and 5 or moreexempt organizations asprovided in section 4942

UK3(e)(o) .. . . . .

(3) Largest amount of sup-part from an exemptorganization . . . . ,

4 Gross investment Income ,

Supplementary Information (Complete this part only if the foundation had $5,000 or more in assetsat any time during the year - see page 28 of the instructions.)

I Information Regarding Foundation Managers:a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation

before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)

ROSS J. BORN

b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of theownership of a partnership or other entity) of which the foundation has a 10% or greater interest

N/A

2 Information Regarding

e ere if the foundation only makes contributions to preselected charitable organizations and does not acceptunsolicited requests for funds. If the foundation makes gifts, grants, etc. (see page 28 of the instructions) to individuals ororganizations under other conditions, complete items 2a, b, c, and d.

a The name, address, and telephone number of the person to whom applications should be addressed:

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

c Any submission deadlines:

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

JSA9E14901 000 Form 990-PF (2009)

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 10

Form 990-PF (2009)

Supplementary Information3 Grants and Contributions Paid D

-- Recipierd

Name and address (home or business)

a Paid during the year

ATTACHMENT 11

23-7653033 11

the Year orf reelplent Is an lndtshow any relatlonslany foundation mei

• I Foundationstatus of

Payment-

Purposentributioo!g rant or F Amountcon

Total . ► 3a 373, 275.

b Approved for future payment

Total.................................................. ► 3bForm 990-PF (2009)

JSA9E1491 1 000

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 11

Form 990-PF (2009)

Analyst:

Enter gross amounts unless

23-7653033 12

(a) (b) (y (d) Tunaion incomeBathess code Amount Edusron code Amount the

jSeI page 28 of1 Program service revenue : Instructions.)

a

b

C

d

e

f

g Fees and contracts from government agencies

2 Membership dues and assessments , , , ,

3 Interest on savings and temporary cash Investments 14 19, 462.

4 Dividends and Interest from securities 14 43,310.i^jl i^ ^r.' ^->1'^ y 7j'' Y`i."`^^\;4•uM1:p, r.,:Y+^>la^ y:.,^_^'?s.t,^•:^;, „^ .';,.. ,.G

y/' ~R x.i^." r-

?:r^.-4' l r' t6E'6 Net rental income or (loss) from real estate : . ^xr^., ,,^•• , : t,•,:;'--::^ •- 'n.! . :i'• ^S r er,+ :^^ :t?^Y^': „G^^Y ^ ^F3'•_^a^_cs,ts^J-

a Debt-financed property .. , . , . , ,

b Not debt-financed property . , , , , ,

6 Net rental income or (loss) from personal property

7 Other investment Income ... , . , , . 16 586.

8 Gain or pass) from sales of assets other than Inventory 18 51,430.

9 Net Income or (loss) from special events , ,

10 Gross profit or (loss) from sales of Inventory.

11 Other revenue: a

b

e

d

e

12 Subtotal. Add columns (b), (d), and (e) 114 , 7 8 8 .

13 Total. Add line 12, columns (b), (d), and (e) . . , . 13 114,788.

(See worksheet In line 13 Instructions on page 28 to verify calculations.)

Relationship of Activities to the Accomplishment of Exempt Purposes

Line No. Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to. the accomplishment of the foundation's exempt purposes (other than by providing funds for such purposes). (See

page 29 of the instructions.)

NOT APPLICABLE

Form 990-PF (2009)JSA9E1492 1.000

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 12

Form 990-PF(2009 ) 23-7653033 JIMEM Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations1 Did the organization directly or indirectlyengage inanyof_the-following-with-any-other-orgenlzatlen-dascribad- Yes- -ua-

In s on 501 (c) of the Code (other than section 501(c)(3) organizations) or In section 527, relating to politicaloraanilzahons? ^^^'u: q> t

a Trans ers from the reporting foundation to a noncharitable exempt organization of. -;L

(1) Cash ........................................................ 1a1 X

(2) Other assets . ..... .. . . .. . .. . . . .. . . . . . . ... . .. ... . .. .. ... . .. ... . ... la (2) X

b Other transactions : c ;ZT(1) Sales of assets to a noncharitable exempt organization . . . . . . ... . .. ... . .. . . .. . . . .... . .. 1 b ( l ) X

(2) Purchases of assets from a noncharitable exempt organization . . . .. . .. . .. . .. . . .. . . . ... . . .. 1 b (2) X

(3) Rental of facilities , equipment, or other assets . . . . . . . . . . . .. . .. ... . .. .. . .. . .. ... . .. 1 b (3 1 X

(4) Reimbursement arrangements . . . . .. . . . ... . . .. . . ... . .. ... . .. .. ... . .. .. . . . .. 1 b 4 X

(5) Loans or loan guarantees . . . . .. . .. . . ... . . . . . . ... . . . ... . .. .. .. . . . ... . . ... 1 b (5) X

(6) Performance of services or membership or fundraising solicitations ... . . . ... . .. . . .. . . . ... . . .. 1 b 6 X

c Sharing of facilities , equipment , mailing lists, other assets , or paid employees . .. . .. . .. . . . . . . . ... . . .... 1 c X

d If the answer to any of the above Is 'Yes," complete the following schedule . Column (b) should always show the fair market

value of the goods, other assets , or services given by the reporting foundation. If the foundation 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.

(a) Name of organization (b) Type of organization (c) Description of relationship

Under penalties of pe ury, I I I have examined this return , Including accompanying schedules and statements and to the best of myJmnwftuIga_arA^ gt of hi h h k l fVPf nr Ilf` aN C G en A n ,rm nn w c nrwoamr as anV new At nA

`Signature office crtru

etres /iaO C 1N s gn

a m Firm's name (or yours If GAN LEVIN BLOSSself-employed), address , , 1620 POND ROAD, SOand ZIP code ALLENTOWN, PA

JSA9E 14931 000

488841 N232 5/11/2010 3:42:40 PM V 09

2a Is the foundation 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? . . .. ... . .. .. . .. . . . . .. . .. . q Yes © No

IN If Was " emmnlafa fha fnllnwmn crherli da

ROSS J. BORN FAMILY CHARITABLE TRUST 23-7653033FORM 990-PF - PART IV

CAPITAL GAINS AND LOSSES FOR TAX ON INVESTMENT INCOME!C!rd-cf-Prc;zriy escnption - ate sold

D acquiredGross sale Depreciation Cost or FMV Adj. basis nprice less allowed/ other

7as of

^as of FMV over or

e e es of sale allowable hasin 2131/69 12/31/69 ad basis Voss)

LT GAIN VAR VAR

387,391. 335,572. 51,819.

ST GAIN 04/24/2008 03/05/2009

50,000. 50,389. -389.

TOTAL GAIN(LOSS) ...... ....................................... 51,430.

,SA9E1730 1 000

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 14

ROSS J. BORN FAMILY CHARITABLE TRUST

FORM 990PF, PART I - INTEREST ON TEMPORARY CASH INVE:

DESCRIPTION

SOVEREIGN BANKNATIONAL PENNSOVEREIGN BANK TAX EXEMFSOVEREIGN BANK US TREAS.

TOTAL

488841 N232 5/11/2010 1 3:42:40 PM V 09-6.1

Trs

23-7653033.

REVENUEAND NET

EXPENSES INVESTMENTPER BOOKS INCOME

].2,114. 12,114.4,508. 4,508.2,100. 2,100.

740. 740.

19,462. 19,462.

52039 PAGE 15ATTACHMENT 1


FORM 990PF, PART I - DIVIDENDS AND INTEREST FROM SECURITIES

DESCRIPTION

SOVEREIGN BANKNATIONAL PENN

TOTAL

23-7653033

ATTACHMENT 2

REVENUEAND NET

EXPENSES INVESTMENTPER BOOKS INCOME

35,040. 35,040.8,270. 8,270.

43,310. 43,310.

488841 N232 5/11/2010 1 3:42:40 PM V 09-6.1 52039 PAGE 16ATTACHMENT 2


990PF, PART I - OTH8R INCOME

DESCRIPTIONMISCELLANEOUS

TOTALS

REVENUEAND

EXPENSESPER BOOKS

586.

NETINVESTMENT

INCOME5^3E

586. 586.

488841 N232 5/11/20101 3:42:40 PM V 09-6.1 52039 PAGE 17ATTACHME T 3


FORM 990PF, PART I - ACCOUNTING FEES

DESCRIPTION

ACCOUNTING FEES

REVENUEAND

EXPENSESPER BOOKS

3,100.

NETINVESTMENT

INCOME

3,100.

ATTACHMENT 4

I23-7653033

ADJUSTEDNET CHARITABLINCOME PURPOSES

TOTALS 3,100. 3,100. 0.

488841 N232 5/11/201 3:42:40 PM V 09-6.1 52039 PAGE 18ATT ENT 4

ROSS J. BORN FAMILY CHARTABLE TRUST

FORM 990PF, PART I - OTHBR PROFESSIONAL FEES

DESCRIPTION

NATIONAL PENN MANAGEMENTIFEESSOVEREIGN MANAGEMENT FEE

488841 N232 5 /11/2010

REVENUEAND

EXPENSESPER BOOKS

4,106.16,802.

4,106.16,802.

ALS 20 ,908. 20,908.

3:42:40 PM V 09-6.1 52039

NETINVESTMENT

I NCOME

23-76530f3

ATTACHMENT 5

PAGE 19ATTACHM NT 5

ROSS J. BORN FAMILY CHAR: TABLE TRUST 23-7653013 •

ATTACHMENT 6

FORM 990PF, PART I - TAX} S

DESCRIPTION

FOREIGN TAX PAIDTAXES 990

488841 N232 5/11/201

REVENUEAND

EXPENSESPER BOOKS

1,397.362.

NETINVESTMENT

INCOME

1,397.362.

'OTALS 1,759. 1,759.

3:42:40 PM V 09-6.1 52039 PAGE 20

ATT NT 6

ROSS J. BORN FAMILY CHARTABLE TRUST 23-7653053

ATTACHMENT 7

FORM 990PF, PART I - OTH1R EXPENSES

DESCRIPTIONFILING FEESMISCELLANEOUS EXPENSE

REVENUEAND

EXPENSESPER BOOKS

15.1,480.

NETINVESTMENT

INCOME15.

1,480.

488841 N232 5/11/2010

TOTALS 1,495. 1,495.

3:42:40 PM V 09-6.1 52039 PAGE 21ATTACHMENT 7


FORM 990PF, PART II - COR PORATE STOCK

DESCRIPTION

SOVEREIGN BANK

BEGINNINGBOOK VALUE

1,482,195.

ALS 1, 482,195.

23-76530 I3

ATTACHMENT 8

ENDING ENDINGBOOK VALUE FMV

1,219,600.

1,219,600.

488841 N232 5/11/20101 3:42:40 PM V 09-6.1 52039

1,603,775.

1,603,775.

PAGE 22ATTACHMENT 8

ROSS J. BORN FAMILY CHARI ABLE TRUST

FORM 990PF, PART II - COR ORATE BONDS

^ DESCRIPTION

I SOVEREIGN BANK

BEGINNINGBOOK VALUE

299,418.

ALS 299,418.

ATTACHMENT 9

ENDING ENDINGBOOK VALUE FMV

316,141.

316,141.

488841 N232 5/11/2010 13:42:40 PM V 09-6.1 52039

23-7653013

327,980.

327, 980.

PAGE 23ATTACHMENT 9

ROSS J. BORN FAMILY CHA ITABLE TRUST

FORM 990PF, PART II - 0 HER INVESTMENT

DESCRIPTION

CSV LIFE INSURANCE

488841 N232 5/11/201(

23-7653033

ATTACHMENT 10

BEGINNING ENDING ENDINGBOOK VALUE BOOK VALUE FMV

451,920. 451,920. 451,920.

TOTALS 451,920. 451, 920. 451,920.

3:42:40 PM V 09-6.1 52039 PAGE 24ATTACHMENT 10

2OSS J. BORN FAMILY CHARITABLE TRUST

RECIPIENT NAME AND ADDRESS

JEWISH FEDERATION OF LEHIGH VALLEY

ALLENTOWN, PA 18104

BRYN MAWR

BRYN MAWR, PA 18104

HILLEL FOUNDATION

ALLENTOWN, PA 18104

THIRD STREET ALLIANCE

ALLENTOWN, PA 18104

SECOND HARVEST FOOD BANK

ALLENTOWN, PA 16104

PROJECT OF EASTON INC

ALLENTOWN, PA 18104

23-7653033

RELATIONSHIP TO SUBSTANTIAL CONTRIBUTOR

AND

FOUNDATION STATUS OF RECIPIENT PURPOSE OF GRANT OR CONTRIBUTION

UNRESTRICTED USE BY DONEE

UNRESTRICTED USE BY DONEE 1(} 0.

UNRESTRICTED USE BY DONEE 0.

UNRESTRICTED USE BY DONEE 1,4 0.

UNRESTRICTED USE BY DONEE 1,0 1 0.

UNRESTRICTED USE BY DONEE 1,8 0.

ATTACHMENT 11

PAGE 25N232 5/11/2010 3:42:10 PM V 09-6.1 52039 5


vnou GOnDC DADR VU - tPAM'rc nun MIS


PROGRAM FOR WOMEN & FAMILIES

ALLENTOWN, PA 18104

PLANNED PARENTHOOD OF NORTH EAST

ALLENTOWN, PA 18104

PERFECT FIT FOR WORKING WOMEN

ALLENTOWN, PA 18104

PENNSYLVANIA YOUTH THEATRE

ALLENTOWN, PA 18104

VICTORY HOUSE OF THE LEHIGH VALLEY

ALLENTOWN, PA 18104

VALLEY YOUTH HOUSE

ALLENTOWN, PA 18104


AND





UNRESRICTED USE BY DONEE



ATTACHMENT 11

488841 N232 5/11/2010 3:42: 0 PM V 09-6.1 52039 PAGE 26

23-7653033

300.

1,0 0.

2,090.

ROSS J. BORN FAMILY CHARITABLE TRUST 23-7653033

ATTACHMENT 11 (CONT'D)


UNITED WAY OF THE GREATER LEHIGH

ALLENTOWN, PA 18104

NEW BETHANY

ALLENTOWN, PA 18104

NCSJ

ALLENTOWN, PA 18104

MERCY SPECIAL LEARNING CENTER

ALLENTOWN, PA 18104

MEALS ON WHEELS

ALLENTOWN, PA 18104

LEHIGH VALLEY HOSPITAL

ALLENTOWN, PA 18104


AND








AMOUNT

55,0 0.

1,0 0.

10 0.

1,500.

Il^1,500.

1,00 .

ATTACHMENT 11

488841 N232 5/11/2010 3: 42:40 PM V 09 -6.1 52039 PAGE 27


i.,,o.. nonec onDr va, _ noamM a aan rnN


AND




LEHIGH COUNTY CONFERENCE

ALLENTOWN, PA 18104

JEWISH FEDERATION OF THE LEHIGH VALLEY

ALLENTOWN, PA 18104

JAFFA INSTITUTE

ALLENTOWN, PA 18104

INSTITUTE FOR JEWISH-CHRISTIAN

ALLENTOWN, PA 18104

HILLSIDE SCHOOL

ALLENTOWN, PA 18104

GOOD SHEPHERD

ALLENTOWN, PA 18104

23-7653033



UNRESTRCITED USE BY DONEE




AMOUNT

1,C

100,(

1, 00.

1, 00.

1,000.

ATTACHMENT 11

488841 N232 5 /11/2010 3 :4 :40 PM V 09 -6.1 52039 PAGE 28


FORM QQOPF PART XV - GRANTS AND CON'


EQUI-LIBRIUM

ALLENTOWN, PA 18104

EASTER SEALS

ALLENTOWN, PA 18104

CRIME VICTIMS

ALLENTOWN, PA 18104

CONGREGATION KENESETH ISRAEL SECOND CENTURY

ALLENTOWN, PA 18104

COMMUNITY ACTION COMMITTEE

ALLENTOWN, PA 18104

CIVIC THEATRE

ALLENTOWN, PA 18104

488841 N232 5/11/2010 3: 42J40 PM


AND

FOUNDATION STATUS OF RECIPIENT

V 09-6.1 52039

23-7653033

PURPOSE OF GRANT OR CONTRIBUTION







ATTACHMENT 11 ( C D)

AMODUT

1000.

1 000.

1,1000.

5,1 000.

2,'500.

ATTACHMENT 11

PAGE 29


cnou oonoc ono, xv - r_ona'rc nan rnm

23-7653033



CHILD CARE INFORMATION SERVICES

ALLENTOWN, PA 18104

CHILD ADVOCACY

ALLENTOWN, PA 18104

BOYS & GIRLS CLUB

EASTON, PA 18104

ALLENTOWN JEWISH CAPITOL STEPS

ALLENTOWN, PA 18104

ASSOCIATION FOR THE BLIND

ALLENTOWN, PA 18104

BOY SCOUTS OF AMERICA

ALLENTOWN, PA 18104

488841 N232 5/11/2010 3 :42:41 PM


AND









ATTACHMENT 11

V 09-6.1 52039 PAGE 30

AMOUNT'

I1,0 0.

1,0 0.

4,0 .

5 0.

3,5 ,0.

1,000.

20SS J. BORN FAMILY CHARITABLE TRUST 23-7653033

cno.. oonoc ono' Vv - rnn)re nNn PnNTPTQIITTfNC DnRTN[: THE YEAR

ATTACHMENT 11 (CONT' D)l


AND

RECIPIENT NAME AND ADDRESS FOUNDATION STATUS OF RECIPIENT PURPOSE OF GRANT OR CONTRIBUTION AMOUNT

ALLENTOWN JEWISH LEGAL SERVICES UNRESTRICTED USE BY DONEE 5,00 .

ALLENTOWN, PA 18104

0

AMERICAN RED CROSS OF THE GREATER LEHIGH VALLEY UNRESTRICTED USE BY DONEE 1,000.

ALLENTOWN, PA 18104

1ALLENTOWN JEWISH PUBLIC SUPPORT UNRESTRICTED USE BY DONEE 1,01

ALLENTOWN, PA 18104

ALLENTOWN PUBLIC LIBRARY READING PROGRAM UNRESTRICTED USE BY DONEE 2,00

ALLENTOWN, PA 18104

CONGREGATION KENESETH ISRAEL DIRECTORY UNRESTRICTED USE BY DONEE 15

ALLENTOWN, PA 18104

CASA GUADALUPE CENTER CAPITOL COMPAIGN UNRESTRICTED USE BY DONEE 7,50 1 .

ALLENTOWN, PA 18104

ATTACHMENT 11

488841 N232 5/11/2010 3:42:4 0 PM V 09-6.1 52039 PAGE 31


RORM QQOPP _ PART XV - (;RANTS AND CON


CHILDRENS HOME OF EASTON SPECIAL ACTIVITIES

ALLENTOWN, PA 18104

JEWISH FEDERATION OF THE AMY BORN FUND

ALLENTOWN, PA 18104

HILLEL INTERNATIONAL ANNUAL

ALLENTOWN, PA 18104

COMMUNITY MUSIC SCHOOL

ALLENTOWN, PA 18104

JEWISH DAY SCHOOL

ALLENTOWN, PA 18104

JEWISH FEDERATION OF THE JCC

ALLENTOWN, PA 18104


AND


23-7653033





UNRESTRCITED USE BY DONEE



ATTACHMENT 11 (C ONT' D)

AMOUNT

T

1,00.

6 0.

3,000.

1,200.

5,000.

23,00 1 .

ATTACHMENT 11

488841 N232 5/11/2010 3 :42:40 PM V 09-6.1 52039 PAGE 32



JEWISH VALLEY ENDOWMENT

ALLENTOWN, PA 18104

NORTHEAST MINISTRY SUMMER CAMP

ALLENTOWN, PA 18104

RISING TIDE COMMUNITY LOAN FUND

ALLENTOWN, PA 18104

SARASOTA-MANATEE 2009

ALLENTOWN, PA 18104

ST LUKES DRIVE FOR HEALTHY KIDS

ALLENTOWN, PA 18104

THIRD STREET ALLIANCE

ALLENTOWN, PA 18104

488841 N232 5/11/2010 3:42:40 PM


AND


V 09-6.1 52039

23-7653033





UNRESTRICTED BY USE OF DONEE



1,00 0.

10,000.

360.

1

ATTACHMENT 11

PAGE 33

(OSS J. BORN FAMILY CHARITABLE TRUST

mom donor onor vu - r_nnume nun rnM

23-7653033

ATTACHMENT 11 (CONT' D I

1ECIPIENT NAME AND ADDRESS

ODD NATHAN: MEMORY OF RALPH LUNDAUER

ILLENTOWN, PA 18104

JNITED STATES HOLICOST

LLLENTOWN, PA 18104

JNITED WAY OF THE COMPASS

4LLENTOWN, PA 18104

JNITED WAY OF THE GREATER BRIGHT FUTURE

4LLENTOWN, PA 18104

#DIY COMMUNITY PUBLIC RADIO

4LLENTOWN, PA 18104

lILDLANDS CONSERVATORY

ALLENTOWN, PA 18104


AND








AMOUNT

1 11 0 .

2,5 0.

5,0(0.

7,5Q0.

TOTAL CONTRIBUTIONS PAID

0.

1

ATTACHMENT 11

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 34

SCHEDULE D'(Form 1041)

Internal Revenue Service

C -OMB No. 1545-0092

apita Gains and LossesAttach to-Eosm 1041, Fgrrn 5227, cr FVTm'JJi/-I.-Ssa L':a Ir^trzLt,'arN for- - _2009-Schedule D (Form 1041) (also for Form 5227 or Form 990-T, if applicable).

AName of estate or trust ROSS J. BORN FAMILY CHARITABLE TRUST Employer Identification number

C/O ROSS J. BORN 23-7653033

Note : Form 5227 filers need to complete onlyParts / and ll.

ff^ Short-Term Caaital Gains and Losses -Assets Held One Year or Less(a) Description of property

(Example : 100 shares 7% preferred of T Co.)(b) Date acquired(mo., day, yr)

(c) Date sold(mo., day, yr.) (d) Sates pots

(e) Cost or other basis(see

Instructions)the

(f) Gain or (loss) for

Sbthe entire year

tract (e) from (d)

1a

b Enter the short-term gain or (loss), if any, from Schedule D-1, line lb . .............. ...... . 1b -389.

2 Short-term capital gain or (loss) from Forms 4684, 6252, 6781, and 8824 , , , , , , , , , ,, , , , , , , , 2

3 Net short-term gain or (loss) from partnerships, S corporations, and other estates or trusts ... ..... S4 Short-term capital loss carryover. Enter the amount, if any, from line 9 of the 2008 Capital Loss

Carryover Worksheet ......................................... ...... 4 ( )5 Net short-term gain or (loss). Combine lines 1a through 4 in column (f). Enter here and on line 13,

column (3 ) on the back . ► 5 -389 .Long-Term Capital Gains and Losses - Assets Held More Than One Year

(a) Description of property (b) Date acquired (c) Date sold (e) Cost or other basis (f) Gain or pose) for

(Example: 100 shares 7% preferred of -Z' Co.) (mo., day, yr.) (mo., day, yr.) (d) Sales price (see aee 4 of the Subthe entire artract (e) fom (d)

6a

b Enter the long -term gain or ( loss), if any, from Schedule D-1, line 6b . . . . . . . . . . . ........... . 6b

7 Long-term capital gain or (loss) from Forms 2439, 4684, 6252, 6781, and 8824 , , , , , ,, , , , , , , , , L

8 Net long-term gain or (loss) from partnerships, S corporations, and other estates or trusts ........... [ 8

9 Capital gain distributions , , , , , , , , , , , , , , ,, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , L9

51,819.

10 Gain from Form 4797, Part I , , , , , , , , , , , , , , , , , , . , , , , , , . , , , , , , , . , , , , , , 10

11 Long-term capital loss carryover. Enter the amount, if any, from line 14 of the 2008 Capital Loss

Carryover Worksheet .... .......................................... 11 ( )

12 Net long-term gain or (loss). Combine lines 6a through 11 in column (f). Enter here and on line 14a,

column (3) on the back ............................................. ► 12 51,819.

For Paperwork Reduction Act Notice, see the Instructions for Form 1041. Schedule D (Form 1041) 2009

JSA9F12102000

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 35

Schedule D (Form 1041 ) 2009 Page 2

Summary of Parts I and II (1) Beneficiaries ' ( 2) Estate'sCaution : Read the instructions before completing this part. (see page 5) or trust's (3) Total

13 Net short-term gain or ( loss) .. ... .. ............ 13 - 3 8 9 .

14 Net long -term gain or (loss):a Total for year , , , , , , , 14a 51,819.

b Unrecaptured section 1250 gain (see line 18 of the w,rkshk), 14b

c 28% rate gain . . ... . ..................... 14c

15 Total net gain or (loss). Combine lines 13 and 14a .... . ► 15 51,430.

Note : If line 15, column (3), is a net gain, enter the gain on Form 1041, line 4 (or Form 990-T, Part 1, line 4a). If lines 14a and 15, column (2), are net gains, goto Part V, and db not complete Part IV. 11 line 15, column (3), is a net loss, complete Part N and the Capital Loss Canyover Wbrkshee1, as necessary.

Loss Limitation

16 Enter here and enter as a (loss) on Form 1041, line 4 (or Form 990-T, Part I, line 4c, If a trust), the smaller of I

a The loss on line 15, column (3) or b $3,000 16 ( )Note: If the loss on line 15, column (3), Is more than $3,000, or if Fonn 1041, page 1, line 22 (or Form 990-T, line 34), is a loss, complete the Capital LossCanyover Worksheet on page 7 of the instructions to figure your capital loss carryover.

Tax Computation Using Maximum Capital Gains RatesForm 1041 filers. Complete this part only if both lines 14a and 15 in column (2) are gains, or an amount is entered in Part I or Part II andthere is an entry on Form 1041, line 2b(2), and Form 1041, line 22, is more than zero.Caution: Skip this part and complete the worksheet on page 8 of the instructions if.• Either line 14b, col. (2) or line 14c, col. (2) is more than zero, or• Both Form 1041, line 2b(1), and Form 4952, line 4g are more than zero.

Form 990-T trusts. Complete this part only if both lines 14a and 15 are gains, or qualified dividends are included in income in Partof Form 990-T, and Form 990-T, line 34, is more than zero. Skip this part and complete the worksheet on page 8 of the instructions if

I

either line 14b, col. (2) or line 14c, col. (2) is more than zero.

17 Enter taxable income from Form 1041, line 22 (or Form 990-T, line 34) 17

18 Enter the smaller of line 14a or 15 in column (2) I z

but not less than zero . 18 r:`=

19 Enter the estate's or trust's qualified dividends ^;from Form 1041, line 2b(2) (or enter the qualified

4r

dividends included in income in Part I of Form 990-T) 19

20 Add lines 18 and 19 20 L"

21 If the estate or trust is filing Form 4952, enter the

amount from line 4g; otherwise, enter -0- ► 21

22 Subtract line 21 from line 20. If zero or less, enter -0- ............. 22

23 Subtract line 22 from line 17. If zero or less, enter -0- 2233

24 Enter the smaller of the amount on line 17 or $2,300 ............. 24

25 Is the amount on line 23 equal to or more than the amount on line 24?

8 Yes. Skip lines 25 and 26; go to line 27 and check the "No" box

No. Enter the amount from line 23 25

26 Subtract line 25 from line 24 , ,,,,,,,,,,, 26

27 Are the amounts on lines 22 and 26 the same?

ElYes. Skip lines 27 thru X go to line 31 ED No. Enter the smatier or line l7 or Nne 22 27

28 Enter the amount from line 26 (If line 26 is blank, enter -)-) , , ....... .

29 Subtract line 28 from line 27 . . ........................ 1 29 1

30 Multiply line 29 by 15% (.15) , , , , , ........... , . . „ ........ . ... .

31 Figure the tax on the amount on line 23. Use the 2009 Tax Rate Schedule for Estates and Trusts

(see the Schedule G instructions in the instructions for Form 1041) . . ...... ............ .

32 Add lines 30 and 31 ....... .......... . . . . . .... . . . ....... .. ,

33 Figure the tax on the amount on line 17. Use the 2009 Tax Rate Schedule for Estates and Trusts

(see the Schedule G instructions in the instructions for Form 1041) . . ...... ............ .

34 Tax on all taxable income. Enter the smaller of line 32 or line 33 here and on Form 1041, Schedule

G. line la (or Form 990-T. line 36) . .... . . . . . . . . . . . . . . . .. .... . .... ... . .. . .

32

33

Schedule D (Form 1041) 2009

JSA

sF12202000

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 36

SCHEDULE D-1 Continuation Sheet for Schedule D'(Form 1041 ) ( Form 1041)-Depestmeat oitheTre ,ry-- - -^See-Instructions -torStedu!e-D-(Form-l04-1}:

Internal Revenue Service ► Attach to Schedule D to list additional transactions for lines Is and 6a.

Name of estate or trust Employer Identification number

ROSS J. BORN FAMILY CHARITABLE TRUST 23- 7 653033

ShortTerm Capital Gains and Losses - Assets Held One Year or Less

(a) Description of property (E emple: (b) Data (c) Data sold (d) Sales price (e) Cost or other basis (y Gain or (loss)100 sh. 7% preferred ofT Co.) acquired (mo., day, yr.) (see page 4 of the (see page 4 of the Subtract (e) from (d)

(mo. , day. Instructions) Instructions)

1aST GAIN 04/24/2008 03/05/2009 50,000. 50,389. -389.

lb Total. Combine the amounts in column (f). Enter here and on Schedule D, line lb .................. I -389 .

For Paperwork Reduction Act Notice , see the Instructions for Form 1041 . Schedule D-1 (Form 1041) 2009JSA9F12213000

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 37

OMB No. 1545-0092

Schedule D-1 (Form 1041 ) 2009 Page 2

Name of estate or trust as shown on Form 1041 . Do not enter name and employer identification number if shown on the other side Employer Identification number

ffWM Long-Term Capital Gains and Losses - Assets Held More Than One Year

(a) Description of property (Example: (b) Date (c) Data sold (d) Sales price (a) Cost or other basis (1) Gain or (loss)100 sh . 7% preferred of 2° Co.) acquired (mo. day, yr.) (see page 4 of the (see page 4 of the Subtract (e) from (d)

mo., day, instructions) Instructions)

6aLT GAIN VAR VAR 387,391. 335,572. 51,819.

6b Total. Combine the amounts in column . Enter here and on Schedule D, line 6b .................. 51, 819.

Schedule D-1 (Form 1041) 2009

JSA

9F1222 3 000

488841 N232 5/11/2010 3:42:40 PM V 09-6.1 52039 PAGE 38

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