990-pf' return of private...

1

Form 990-PF' Return of Private Foundation OMB No.1545-0052

or Section 4947(a)(1) Nonexempt Charitable Trust 2002 Department of the Treasury Treated as a Private Foundation

Internal Revenue Service Note : The organization may be able to use a copy of this return to satisfy state reporting requirements. For calendar year 2002, or tax year beginning DEC 1, 2002 , and ending NOV 3 0, 2003 G Check all that a I 0 Initial return ~ Final return 0 Amended return 0 Address chan g e 0 Name chan e

Use the IRS Name of organization A Employer identification number

label . Otherwise, PGAR-BLACK FOUNDATION 23-3024321

print Number and street (or P O box number it malt Is not delivered to street address) Room/suite B Telephone number ortype . 42 RIVER ROAD 215-567-6565

See Specific Instructions . City or town, state, and ZIP code C If exemption application is pending, check here

T PLEASANT PA 18950 D 1 . Foreign organizations, check here " 0 H Check e of organization 2 . Foreign organizations meeting the es% test. type 0 Section 501(c)(3rexempt private foundation check here and attach computation 1 D

Section 4947(a)(1) nonexempt charitable trust ~X Other taxable private foundation E If private foundation status was terminated I Fair market value of all assets at end of year J Accounting method 0 Cash ~X Accrual under section 507(b)(1)(A), check here 101, (from Part ll, co/ (c), line 16) 0 Other (specify) F If the foundation is in a 60-month termination 101. $ 368 , 874 . 1 (Part l, column (d) must be on cash basis.) under section 507( b )( 1 B ) , check here lop- Part I Analysis of Revenue and Expenses (a) Revenue and (b) Net investment (c) Adjusted net (d) Disbursements Rne total or amounts In columns (b), (o), and (d) may got expenses per books income income roe charitable purposes

necessarily equal the amounts in column (a) ) p (cash basis only)

. ~T Contributions, gifts, grants, etc, received 35 , 000 Check 1 O il the loundadOn 15 riot required to attach Sch B

2 Distributions from split-interest trusts 3 cash ~invoenvtmentss

and temporary 5 , 337 . 5 337 . STATEMENT ~ 4 Dividends and interest from securities 2 , 753 . 2 11` 753 . TATEMENT 3 5a Gross rents b (Net rental Income or (loss)

I 5a Net gain or (loss) horn sale of assets not on -5 1 276 . STATEMENT ~. 7 line 10 b Gross sales pnce for ell 141 , 590 . assets on line 6a

d 7 Capital pain net Income (from Part IV, line 2) 0 .

8 Net short-term capital gain 9 Income modifications 0a Gross sales less returns

and allowances

b Less Cost of goods sold

c Gross profit or (loss) 1 Other income 26 , 427 . 0 . STATEMENT 4

13 Compensation of officers, directors, trustees, etc

14 Other employee salaries and wages 15 Pension plans, employee benefits

,~ 16a Legal fees . . . . . b Accounting fees � STMT 5 1 , 375 . 0 . 0 .

u, c Other professional fees . STMT 6 6 , 610 . 6 , 610 . 0 . Lal 17 Interest

18 Takes ~' ~, Z'~- 1 0 0 4 *STMT 7 9 . 0 . 0 . 19 Depreciation and depletion ' 20 Occupancy ' , 21 Travel, conferences, and meetings

M 22 Printing and publications ~ 23 Other expenses + STMT 8 32 . 0 . 0 .

24 Total operating and administrative n expenses . Add lines 13 through 23 8 , 026 . 6 610 . X 25 Contributions, gifts, grants paid 25 , 000 . 25 , 000 .

26 Total expenses and disbursements . Add lines 24 and 25 3 3 026 . 6 610 . 25 9 000 .

27 Subtract line 26 from line 12 8 Excess of revenue over expenses and disbursements 31 , 21 5 .

b Net Investment Income Or negative, enter -o-) 1 4 8 0 . 1 N/A C Adjusted net Income (if negative, enter -0-)

223501 3 LHA For Paperwork Reduction Act Notice, see the instructions . Form 990-PF (2002) 2

2002 .08000 APGAR-BLACK FOUNDATION 9998_1~ 13370726 798008 9998

23-3024321 End of year

Book Value (c) Fair Market Value 22 586 . 22 , 586 . 3,770 . 3,770 .

368,874 .

0 .

337,659 .

0 .

874 .

1 31 Total liabilities and not assells/fund balances

p7a7r7tj~fJ Analysis of Changes in Net Assets or Fund

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

2 Enter amount from Part I, line 27a 3 Other increases not included in line 2 (itemize) 110, 4 Add lines 1, 2, and 3 5 Decreases not included in line 2 (itemize) 01 6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II, ci

13370726 798008 9998 2002 .08000

f

Form 990-P6 (2002) ` APGAR-BLACK FOUNDATION

P+~~ J~ Balance Sheets Attacheduhedulesandamounts lnthe0e5crIDGon column should be for end-of-year amounts only

1 Cash - non-interest-bearing

2 Savings and temporary cash investments 3 Accounts receivable 10,

Less allowance for doubtful accounts 1 4 Pledges receivable 101,

Less allowance for doubtful accounts 5 Grants receivable 6 Recewables due from officers, directors, trustees, and other

disqualified persons 7 Other notes and loans receivable 10.

Less allowance for doubtful accounts 1

8 Inventories for sale or use N 9 Prepaid expenses and deferred charges

10a Investments - U S and state government obligations STMT 9 b Investments-corporate stock STMT 10 c Investments-corporate bonds

11 Investments -Iand,buildinps.andequipment basis 1

Less accumulated depreciation

12 Investments - mortgage loans 13 Investments - other STMT 11 14 Land, buildings, and equipment basis 1

Less accumulated deprada8on 1

15 Other assets (describe 1 )

16 Total assets to be comp leted b all filers 17 Accounts payable and accrued expenses 18 Grants payable 19 Deferred revenue 20 Loans from officers, directors, trustees, and other disqualified persons

m 21 Mortgages and other notes payable

J 22 Other liabilities (describe

23 Total liabilities add lines 17 throu g h 22 Organizations that tallow SFAS 117, check here 1 and complete lines 24 through 26 and lines 30 and 31 .

°' 24 Unrestricted v 25 Temporarily restricted

m m 26 Permanently restricted M

Organizations that do not follow SFAS 117, check here 1 and complete lines 27 through 31 .

,°~ 27 Capital stock, trust principal, or current funds ~+ y 28 Paid-in or capital surplus, or land, bldg , and equipment fund

29 Retained earnings, accumulated income, endowment, or other funds °' 30 Total net assets or fund balances z

ginning of year a) Book Value

14,320 . 3,865 .

858 .

964 . 85,997 . 20,168 .

12,812 .

338,984 . 1,325 .

1,325 .

84,237 . 239,082 .

19,199 .

368,874 .

0 .

84 , 237 . 239 082 .

19 , 199 .

223511 01-23-03

r

Form 990-PF~ 2002 ' APGAR-BLACK FOUNDATION P'artIV Capital Gains and Losses for Tax on Investment Income

(a) List and describe the kind(s) of property sold (e g , real estate, (b How acqi 2-story back warehouse, or common stock, 200 shs MLC Co ) ~' - Purcha

D - Donate 1a SEE ATTACHED SCHEDULE P h

d e

(e) Gross sales pace

a 141,590 . b c d e

Complete only for assets shown

(I) F .M .V as of 12/31/69

a

(t) Depreciation allowed (g) Cost or other basis (or allowable) plus expense of sale

146,866 .

m in column (h) and owned by the foundation on 12/31/69

(1) Adjusted basis (k) Excess of col (i) as of 12/31/69 over col (1), if any

N/A J .P~rt V ,I Qualification Under Section 4940(e) for Reduced Tax on Net Investment (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

8 Enter qualifying distributions from Part XII, line 4 1 8 ~ 2 5 , 0 0 0 .

If line 8 is equal to or greater than line 7, check the box m Part VI, line 1b, and complete that part using a t % tax rate See the Part VI instructions .

223521/01-23-03 Form 990-PF (2002) 4

2002 .08000 APGAR-BLACK FOUNDATION 9998 1 13370726 798008 9998

2 Capital gain net income or (net capital loss) { If ain, also enter m Part I, line 7 l If loss), enter-0- in Part I, line 7 1

3 Net short-term capital gam or (loss) as defined in sections 1222(5) and (6) Ii gain, also enter in Part I, line 8, column (c) If (loss), enter -0- in Part 1, line 8

23-3024321 Paae3

(c Date acquired (d) Date sold ~mo , day, yr.) I (mo , day, yr )

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

-5,276 .

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

Losses (from col (h))

-5,276 .

-5,276 .

Was the organization liable for the section 4942 tax on the distnbutable amount of any year in the base periods ~ Yes EX-1 No If 'Yes," the organization does not qualify under section 4940(e) Do not complete this part 1 Enter the appropriate amount in each column for each year, see instructions before making any entries

Base peraod years Adjusted (distributions Net value of noncharitable-use assets Distribution ratio Calendar ear or tax ear be g innin g in qualifying (col (b) divided by col (c))

2001 25,000 . 359 111 . .0696164 2000 90 , 000 . 436 061 . .2063931 1999 310 , 929 . 479 261 . .6487676 1998

2 Total of line 1, column (d) 2 .9247771 3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by the number of years

the foundation has been m existence if less than 5 years 3 . 3082590

4 Enter the net value of noncharitable-use assets for 2002 from Part X, line 5 1 4 1 331,768 .

5 Multiply line 4 by line 3 1 5 1 102,270 .

6 Enter 1% of net investment income (1% of Part I, line 27b) 1 6 1 15 .

7 Add lines 5 and 6 1 7 1 102,285 .

b If the answer is "Yes" to line 7, has the organization furnished a copy of Form 990-PF to the Attorney General (or designate) of each state as required by General Instruction G? 1/ "No," attach explanation 8b X

9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendar year 2002 or the taxable year beginning in 2002 (see instructions for Part XIV)? If "Yes," complete Part XIV 9 K

10 Did any persons become substantial contributors during the tax years If 'Yes,' attach a schedule Ilstlng their names end addresses STMT 12 10 X

11 Did the organization comply with the public inspection requirements for its annual returns and exemption applications ~ 11 ~ X Web site address " N/A

12 7hebooksaremcareof " APGA.R-BLACK FOUNDATION Telephone no "215-567-6565 Located at " 42 RIVER ROAD PT PLEASANT, PA ZIP+4 .18950

13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF m lieu of Form 1041 - Check here " 0 and enter the amount of tax-exempt interest received or accrued during the year 10- 1 13 ~ N/A

0 23-0.3 Form 990-PF (2002) 5


,Form 990-PF(2002) ' APGAR-BLACK FOUNDATION 23-3024321 Page a

Pert 1/t Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see instructions) 1 a Exempt operating foundations described in section 4940(d)(2), check here " 0 and enter "N/A" on line 1 .

Date of ruling letter (attach copy of ruling letter if necessary-see Instructions) 6 Domestic organizations that meet the section 4940(e) requirements in Part V, check here " = and enter 1% 1 30 .

of Part I, line 27b c All other domestic organizations enter 2% of line 27b . Exempt foreign organizations enter 4% of Part I, line 12, col (b)

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

3 Add lines 1 and 2 3 30 . 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 30 . 6 Credits/Payments a 2002 estimated tax payments and 2001 overpayment credited to 2002 6a b Exempt foreign organizations - tax withheld at source 6b c Tax paid with application for extension of time to file (Form 8868) 6c 200 . d Backup withholding erroneously withheld 6d

7 Total credits and payments Add lines 6a through 6d 7 200 . 8 Enter any penalty for underpayment of estimated tax Check here [_ 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 " 10 170 . 11 Enter the amount of line 10 to be Credited to 2003 estimated tax " 17 0 . Refunded " 11 0 . Nar`t VttyA Statements Regarding Activities 1 a During the tax year, did the organization attempt to influence any national, state, or local legislation or did it participate or intervene in Yes No

1a X any political campaign b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)? 1 b K

If the answer is "Yes" to 1 a or 1 h, attach a detailed description of the activities and copies of any materials published or distributed by the organization in connection with the activities.

c Did the organization file Form 1120-POL for this years 1 c X d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year

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

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

If "Yes, " attach s detailed description of the activities . 3 Has the organization made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or

bylaws, or other similar instruments N "Yes," attach a conformed copy of the changes 3 4a Did the organization have unrelated business gross income of $1,000 or more during the years 4a X b If "Yes," has it filed a tax return on Form 990-T for this years N/A 4b

5 Was there a liquidation, termination, dissolution, or substantial contraction during the years 5 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 X 7 Did the organization have at least $5,000 in assets at any time during the years 7 X

If "Yes, " complete Part 11, cot. (c), and Part XV. 8a Enter the states to which the foundation reports or with which it is registered (see instructions) " NONE

23-3024321 Page s

Yes No

0 Yes OX No

0 Yes M No 0 Yes OX No D Yes ~X No

0 Yes OX No

0 Yes ~X No

(3) Furnish goods, services, or facilities to (or accept them from) ad isqualified person (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person (5) Transfer any income or assets to a disqualified person (or make any of either available

for the benefit or use of a disqualified person) (6) Agree to pay money or property to a government officials (Exception . Check "No'

if the organization agreed to make a grant to or to employ the official for a period otter termination of government service, if terminating within 90 days

b If any answer is 'Yes' to 1 a(1)-(6), did any of the acts fail to qualify under the exceptions described in Regulations section 53 4941(d)-3 or in a current notice regarding disaster assistance (see page 19 of the instructions)? N/A Organizations relying on a current notice regarding disaster assistance check here ~ 0

c Did the organization engage m a prior year in any of the acts described in 1 a, other than excepted acts, that were not corrected before the first day of the tax year beginning in 2002

2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization was a private operating foundation defined in section 4942(j)(3) or 49420)(5))

a At the end of tax year 2002, did the organization have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning 0 Yes OX No before 2002

If 'Yes,' list the years b Are there any years listed m 2a for which the organization is not applying the provisions of section 4942(a)(2) (relating to incorrect

valuation of assets) to the year's undistributed incomes (If applying section 4942(a)(2) to all years listed, answer "No" and attach statement-see instructions ) N/A

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

3a Did the organization hold more than a 2% direct or indirect interest m any business enterprise at any time during the year? ~ Yes M No

b If "Yes ; did it have excess business holdings in 2002 as a result of (1) any purchase by the organization or disqualified persons after May 26, 1969, (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest, or (3) the lapse of the 10-,15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if the organization had excess business holdings m 2002 .) N/A

4a Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes b Did the organization make any investment m 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 m 2002?

5a During the year did the organization pay or incur any amount to (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))9 0 Yes OX No (2) Influence the outcome of any specific public election (see section 4955), or to carry on, directly or indirectly,

any voter registration dnve7 ~ Yes OX No (3) Provide a grant to an individual for travel, study, or other similar purposes 0 Yes OX 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)? E__1 Yes ~X No (5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for

the prevention of cruelty to children or ammals9 = Yes X No

X 4b

h If any answer is 'Yes' to 5a(1)-(5), did any of the transactions fad to qualify under the exceptions described m Regulations section 53 4945 or m a current notice regarding disaster assistance (see instructions)? Organizations relying on a current notice regarding disaster assistance check here

c If the answer is 'Yes'to question Sa(4), does the organization claim exemption from the tax because it maintained

N/A [_§b "a

6b X

Fay 990-PF (2002)

9998 1

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

6 13370726 798008 9998 2002 .08000 APGAR-BLACK FOUNDATION

Form 990-PF(2002) ' APGAR-BLACK FOUNDATION Part 1111 8. . Statements Regarding Activities for Which Form 4720 May Be

File Form 4720 if any item is checked in the "Yes" column, unless an exception applies. 1 a During the year did the organization (either directly or indirectly)

(1) Engage in the sale or exchange, or leasing of property with a disqualified person (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person?

1b

X

X

expenditure responsibility for the grants N/A 0 Yes 0 No If "Yes, " attach the statement required by Regulations section 53.4945-5(o)

6a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contracts ~ Yes 0 No

223541 01-23-03

APGAR-BLACK FOUNDATION 23-3024321

E ~ In%irmation About Officers, Directors, Trustees, Foundation Managers, Highly Page s

Paid Employees, and Contractors 1 List all officers, directors, trustees, foundation managers and their compensation :

(b) Title, and average (c) Compensation (dconmoueonsto (e) Expense (a) Name and address hours per week devoted (If not paid, employee ~h~i~uns account, other

to position enter -0- comp ensation allowances ALLEN D . BLACK 42 RIVER ROAD PT PLEASANT PA 18950 ART 0 . 0 . 0 . RANDY APGAR 42 RIVER ROAD PT PLEASANT PA 18950 ART 0 . 0 . 0 .

ad on line 1) . If none, enter "NONE." (b) Title and average

hours p er week (c) Compensation devoted to position

2 Compensation of five highest-paid employees (other than t

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

NONE

s I (e) Ex pense account, other allowances

0 1110.

4

Form 990-PF (2002)

9998 1 7

2002 .08000 APGAR-BLACK FOUNDATION 13370726 798008 9998

Total number of other employees paid over $50,000 3 Five highest-paid independent contractors for professional services . If none, enter "NONE."

(a) Name and address of each person paid more than $50,000 (b) Type of service NONE

Total number of others receivin g over $50,000 for professional services pad J7!C A 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 of organizations and other beneficiaries served, conferences convened, research papers produced, etc

N/A

2

3

100.

(c) Co

Expenses

0

Form 990-PF(2002) ' APGAR-BLACK FOUNDATION 23-3024321 Page?

Palm iX-~ Summary of Program-Related Investments

Describe the two largest program-related investments made by the foundation during the tax Amount on lines 1 and 2 N/A

2

All other program-related investments See instructions 3

Total . Add lines 1 through 3

"E X Mlnlmcm Investment Return (All domestic foundations must complete this part . Foreign foundations, see instructions .)

1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc , purposes a Average monthly fair market value of securities b Average of monthly cash balances c Fair market value of all other assets d Total (add lines 1a, b, and c)

323,637 . 13,183 .

336,820 .

223561 01-23-03

8


e Reduction claimed for blockage or other factors reported on lines is and 1c (attach detailed explanation) 1e 0

2 Acquisition indebtedness applicable to line 1 assets _ 2 0 . 3 Subtract line 2 from line 1d 3 336 , 820 . 4 Cash deemed held for charitable activities Enter 1 1/2% of line 3 (for greater amount, see instructions) 4 5 , 052 . 5 Net value of noncharitable-use assets . Subtract line 4 from line 3 . Enter here and on Part V, line 4 5 331 , 768 . 6 Minimum Investment return . Enter 5% of line 5 ~6 ~ 16 , 588 .

x-7Dlstrlbutable Amount (see instructions) (Section 4942(j)(3) and (1)(5) private operating foundations and certain foreign organizations check here " EJ and do not complete this part )

1 Minimum investment return from Part X, line 6 1 16 , 588 .

2a Tax on investment income for 2002 from Part VI, line 5 2a -30 .

b Income tax for 2002 (This does not include the tax from Part VI ) 2b c Add lines 2a and 2b 2c 3 0 .

3 Distributable amount before adjustments Subtract line 2c from line 1 3 16 , 558 . 4 a Recoveries of amounts treated as qualifying distributions 4a 0 . h Income distributions from section 4947(a)(2) trusts 4b 0 c Add lines 4a and 4b 4c 0

5 Add lines 3 and 4c 5 16 , 558 . g Deduction from distnbutable amount (see instructions) 6 0 . 7 Dlstrihutable amount as adjusted Subtract line 6 from line 5 Enter here and on Part XIII, line 1 ~7 ~ 16 , 558 .

Pact Xil Qualifying Distributions (see instructions)

1 Amounts paid (including administrative expenses) to accomplish charitable, etc , purposes a Expenses, contributions, gifts, etc - total from Part I, column (d), line 26 1 a 25 , 000 . b Program-relatedinvestments -Total from Part IX-El lb 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 satisfy the a Suitability test (prior IRS approval required) 3a b Cash distribution test (attach the required schedule) 3b

4 Qualifying distributions . Add lines 1a through 3b Enter here and on Part V, line 8, and Part XIII, line 4 4 25 , 000 . 5 Organizations that quality under section 4940(e) for the reduced rate of tax on net investment

income Enter 1% of Part 1, line 27b 5 0 . 6 Adjusted qualifying distributions . Subtract line 5 from line 4 ~ 6 ~ 25,000 .

Note : The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax in those years.

Fort� 990-PF (zoo2)

Form 990-PF .(2002) APGAR-BLACK FOUNDATION 23-3024321

Part 7f111 Undistributed Income (see instructions)

M 2001

0 .

371,544 .

9 2002 .08000 APGAR-BLACK FOUNDATION 9998 1 13370726 798008 9998

1 Distnbutable amount for 2002 from Part XI, line 7

2 Undistributed Income, If any, as of the end of 2001

a Enter amount for 2001 only

b Total for prior years

3 Excess distributions carryover, if any, to 2002

a From 1997 b From 1998 c From 1999 287,842 . d From 2000 68 , 215 . e From 2001 7 , 045 . f Total of lines 3a through e

4 Qualifying distributions for 2002 from Part Xll,line a " g 25,000 .

a Applied to 2001, but not more than line 2a b Applied to undistributed income of prior years (Election required - see instructions)

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

d Applied to 2002 distributable amount e Remaining amount distributed out of corpus

5 Excess distributions carryover applied to 2002 (If en amount appears In column (d), the same amount must be shown in column (a)

6 Enter the net total of each column as indicated below:

2 Corpus Add lines 3f, 4c, end 4e Subtract line 5

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

c Enter the amount of prior years' undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed

d Subtract line 6c from line 6b . Taxable amount-see instructions

e Undistributed income for 2001 Subtract line 4a from line 2a Taxable amount - see instr

1 Undistributed income for 2002 . Subtract lines 4d and 5 from line 1 This amount must be distributed in 2003

7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(E) or 4942(g)(3)

8 Excess distributions carryover from 1997 not applied on line 5 or line 7

9 Excess distributions carryover to 2003 . Subtract lines 7 and 8 from line 6a

10 Analysis of line 9 a Excess from 1998 b Excess from 1999 287 , 842 . c Excess from 2000 68 , 215 . d Excess from 2001 7 , 045 . w FYracc frnm 91711719 8 , 442 .

223571 01-23-03

(a) (b) Corpus Years prior to 2001

363,102 .

0 .

8,442 . 0 .

371,544 .

0 .

0 .

0 .

0 .

0 .

0 .

(d) 2002

16 r 558 .

0 .

16 558 .

0 .

0 .

0 .

Form 990-PF (2002

23-3024321 N/A

142(l)(3) or 0 4942(1)(5)

(d) 1999 (e) Total

Form 990-PF42002) ' APGAR-BLACK FOUNDATION Private Ons (see instructions and Part VII-A,

foundation, and the ruling is effective for 2002, enter the date of the ruling b Check box to indicate whether the organization is a nvat

2 a Enter the lesser of the adjusted net Tax ear income from Part I or the minimum (a) 2002

investment return from Part X for each year listed

b 85% of line 2a c Qualifying distributions from Part XII,

line 4 for each year listed d Amounts included m line 2c not

used directly for active conduct of exempt activities

e Qualifying distributions made directly for active conduct of exempt activities Subtract line 2d from line 2c

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

a 'Assets' alternative test - enter (1) Value of all assets

(2) Value of assets qualifying under section 4942(1)(3)(8)(i)

b "Endowment' alternative fast - Enter 2/3 of minimum investment return shown in Part X, line 6 for each year listed

c 'Support' alternative test - enter (1) Total support other than gross

investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties)

(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(8)(ui)

(3) Largest amount of support from an exempt organization

Prior 3 years (b) 2001 (C) 2000

10 13370726 798008 9998 2002 .08000 APGAR-BLACK FOUNDATION 9998

1 a If the foundation has received a ruling or determination letter that it is a private operating

Part XV Supplementary Information (Complete this part only if the organization had $5,000 or more in assets at any time during the year-see page 25 of the instructions .)

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

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

ALLEN D . BLACK b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or

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

NONE 2 Information Regarding Contribution, Grant, Gin, Loan, Scholarship, etc., Programs :

Check here 1 0 if the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds If the organization makes gifts, grants, etc (see instructions) to individuals or organizations under other conditions, complete items 2a, b, c, and d

a The name, address, and telephone number of the person to whom applications should be addressed ALLEN D BLACK 42 RIVER ROAD PT PLEASANT PA 18950

b The form in which applications should be submitted and information and materials they should include LETTER REQUESTING AMOUNT AND PROPOSED USES OF FUNDS

c Any submission deadlines NONE

d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors . NONE

zzasairoi-2a-a3 Form 990-PF (2oo2)

NONE

" 3b~ 0 . Form 990-PF (2002)

9998 1

Tota I 223601/01-23-03

13370726 798008 9998 11

2002 .08000 APGAR-BLACK FOUNDATION

Form 990-PR(2002) ' APGAR-BLACK FOUNDATION 23-3024321 Pert XV Supplementary Information (continued) 3 Grants and Contributions Paid During the Year or Approved for Future Payment

Recipient If recipient is an individual, show any relationship to Foundation Purpose of grant or

Name and address (home or business) any foundation manager status of contribution Amount or substantial contributor recipient

a Paid dunng the year

JAMES A MICHENER ART PUBLIC SATELLITE SITE MUSEUM 138 PINE STREET CHARITY T UNION SQUARE DOYLESTOWN, PA 18901 ONE 5,000 .

AMERICAN FOUNDATION FOR UBLIC AIDS RESEARCH 120 WALL RARITY STREET 13TH FL NEW YORK, NY ONE GENERAL SUPPORT 15,000 .

PRINCE MUSIC THEATRE 100 UHLIC BUILDUP CAPITAL SOUTH BROAD ST SUITE 650 RARITY CAMPAIGN PHILADELPHIA, PA M19110 ONE 5,000 .

Total 1110- 3a 25 , 000 . b Approved for future payment

Enter gross amounts unless otherwise indicated un1marou uuanicaa incunio rxcwaea o secnon oiz oijoroin

(a) (b) ~~L (d) Related or exempt Business Amount ode Amount function income 1 Program service revenue code a b c d e i g Fees and contracts from government agencies

2 Membership dues and assessments 3 Interest on savings and temporary cash

investments 14 47 . a Dividends and interest from securities 14 8 , 043 . 5 Net rental income or (loss) from real estate

a Debt-financed property b Not debt-financed property

6 Net rental income or (loss) from personal property

7 Other investment income Oi l 26 , 427 . 8 Gain or (loss) from sales of assets other

than inventory 18 -5 , 276 . 9 Met income or (loss) from special events

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

a b C d e

12 Subtotal Add columns (b), (d), and (e) � , 0 . 29,241 . 1 0 .

13 Total . Add line 12, columns (b), (d), and (e) 13 29,241 .

(See worksheet in line 13 instructions to verity calculations )

Park XVf48 Relationship of Activities to the Accomplishment of Exempt Purposes

12 13370726 798008 9998 2002 .08000 APGAR-BLACK FOUNDATION 9998 1

Form 990-PF(2002) ' APGAR-BLACK FOUNDATION 23-3024321 Part XYI~A Analysis of Income-Producing Activities

Form 990-PF(2002) ' APGAR-BLACK FOUNDATION 23-3024321 Pag e 12 Pad 011 Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of YE the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations

a Transfers from the reporting organization to a noncharitable exempt organization of (1) Cash 1a ( 1 ) (2) Other assets 1a ( 2 )

b Other Transactions* (1) Sales of assets to a nonchantable exempt organization 1 b ( 1 ) (2) Purchases of assets from a nonchantable exempt organization 1 b ( 2 ) (3) Rental of facilities, equipment, or other assets 1b ( 3 ) (4) Reimbursement arrangements 1b 4 (5) Loans or loan guarantees 1b (5 ) (6) Performance of services or membership or fundraising solicitations 1b ( 6 )

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees 1 c d If the answer to any of the above is 'Yes,' complete the following schedule Column (b) should always show the fair market value of the goods, other assets,

or services given by the reporting organization If the organization received less than fair market value in any transaction or sharing arrangement, show m

X

2a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described m section 501(c) of the Code (other than section 501(c)(3)) or in section 5279 Yes [I] No

b If "Yes," complete the following schedule (a) Name of organization (b) Type of organization (c) Description of relationship

N /A

223621 01-23-03

13 2002 .08000 APGAR-BLACK FOUNDATION 9998 1 13370726 798008 9998

X

X X

Under penalties of ury, I lace that I have examl this return, Including accompanying schedules and statements, end to the best of my knowledge end belief, It Is true, correct, and complete reparer than ayer duct Is based on all information of which preparer has any knowled e 1 8/)

Z ~ ~~ IY~JI~ d v ' Sign of officer or trustee Dad 1 Title

Date Check If Prep erels SSN or PTIN Preparer's self- o signature 1 C. ~(,f,~T ,1 ~J 0 em to ed " 0 y Frm'snama(oryours ~`~`PH~T WILLIS & NERI ' ~ EIN ~ Ifselfbmploye~, '318 OUTH BURNT MILL ROAD

address,anCZIPcoda VOORHEES, NJ 08043 Phone no 856)354-7666 Form 990-PF (2002)

Schedule B (Form 990, 990-EZ, or

990-PFD Department of the Treasury Internal Revenue Service

Schedule of Contributors OMB No 1545-0047

LOOL Supplementary Information for

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

Name of organization

23-3024321 APGAR-BLACK FOUNDATION

LHA For Paperwork Reduction Act Notice, see the Instructions Schedule B (Form 990, 990-EZ, or 990-PF) (2002) for Form 990 and Form 990-EZ

223451 01-23-03

14 13370726 798008 9998 2002 .08000 APGAR-BLACK FOUNDATION 9998 1

Employer identification number

Organization type (check one) :

Filers of: Section :

Form 990 or 990~EZ = 501(c)( ) (enter number) organization

D 4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990~PF = 501(c)(3) exempt private foundation

0 4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule . (Note : Only a section 501(c)(7), (8), or (10) organization can check boxes) for both the General Rule and a Special Rule-see instructions)

General Rule-

For organizations fling Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (m money or property) from anyone contributor . (Complete Parts I and II .)

Special Rules-

For a section 501(c)(3) organization filing Form 990, or Form 990~EZ, that met the 33 1/3% support test of the regulations under sections 509(a)(1)/170(b)(1)(A)(w) and received from any one contributor, during the year, a contribution of the greater of $5,000 or 2% of the amount on line 1 of these forms . (Complete Parts 1 and II .)

D For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990~EZ, that received from anyone contributor, during the year, aggregate contributions or bequests of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. (Complete Parts I, II, and III .)

D For a section 501(c)(7), (8), or (10) organization fling Form 990, or Form 990-EZ, that received from any one contributor, during the year, some contributions for use exclusively for religious, charitable, etc ., purposes, but these contributions did not aggregate to more than $1,000 . (If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, efc ., purpose. Do not complete any of the Parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc ., contributions of $5,000 or more during the year .) " $

Caution : Organizations that ere not covered by the General Rule and/or the Special Rules do not file Schedule B (Form 990, 990-EZ, or 990-PF), but they must check the box m the heading of their Form 990, Form 990-EZ, or on line 1 of their Form 990-PF, to certify that they do not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).

Schedule B (Forth 990, 990-EZ, or 990-PFD (2002)

Name of organization

APGAR-BLACK FOUNDATION

1 to 1 of Pert I

Employer Identification number

23-3024321 I

Part 1 Contributors (See Specific Instructions .)

(a) (b) (c) No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution

1 ALLEN D . BLACK Person OX Payroll 0

g 35,000 . Noncash 0

(Complete Part II if there 42 RIVER ROAD PT PLEASANT PA 18950 is anoncashcontnbution .)

(a) (b) (c) (c) No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution

Person 0 Payroll 0 Noncash 0

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

(a) (b) (c) (c) No . Name, address, and ZIP + 4 Aggregate contributions Type of contribution

Person 0 Payroll 0 Noncash 0


(a) (b) (c) (c) No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution

Person Payroll 0 Noncash 0


(a) (b) (c) No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution

Person Payroll Noncash


(a) (b) (c) (c) No . Name, address, and ZIP + 4 Aggregate contributions Type of contribution

Person 0 Payroll

g Noncash


223452 Ot-23-03 Schedule B (Form 990, 990-EZ, or 990-PF) (2002) 15

13370726 798008 9998 2002 .08000 APGAR-BLACK FOUNDATION 9998 1

23-3024321 APGAR-BLACK FOUNDATION

FORM 990-PF GAIN OR (LOSS) FROM SALE OF ASSETS STATEMENT 1

MANNER DATE ACQUIRED ACQUIRED DATE SOLD

PURCHASED SEE ATTACHED SCHEDULE

16 STATEMENT S) 1 13370726 798008 9998 2002 .08000 APGAR-BLACK FOUNDATION 9998 1

(A) DESCRIPTION OF PROPERTY

(B) (C) (D) (E) (F) GROSS VALUE AT EXPENSE OF

SALES PRICE TIME OF ACQ . SALE DEPREC . GAIN OR LOSS

141,590 . 146,866 . 0 . 0 . -5,276 .

CAPITAL GAINS DIVIDENDS FROM PART IV 0 .

TOTAL TO FORM 990-PF, PART I, LINE 6A -5,276 .


TOTAL TO FORM 990-PF, PART I, LINE 3, COLUMN A 5,337 .

17 STATEMENT S) 2 2002 .08000 APGAR-BLACK FOUNDATION 9998 1 13370726 798008 9998

FORM 990-PF INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT 2

SOURCE AMOUNT

HUDSON BANK 47 . MERRILL LYNCH 5,290 .

APGARJBLACK FOUNDATION

STATEMENT 3 DIVIDENDS AND INTEREST FROM SECURITIES

CAPITAL GAINS COLUMN (A) GROSS AMOUNT DIVIDENDS AMOUNT

2,753 . 0 . 2,753 .

2,753 . 0 . 2,753 .

SOURCE

MERRILL LYNCH

TOTAL TO FM 990-PF, PART I, LN 4


FORM 990-PF

23-3024321


APGARTBLACK FOUNDATION 23-3024321

FORM 990-PF OTHER INCOME STATEMENT 4

DESCRIPTION AMOUNT

UNREALIZED GAINS 26,427 .

TOTAL TO FORM 990-PF, PART I, LINE 11, COLUMN A 26,427 .


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

DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES

ACCOUNTING 1,375 . 0 . 0 .

TO FORM 990-PF, PG 1, LN 16B 1,375 . 0 . 0 .

2 0 STATEMENT S) 5 2002 .08000 APGAR-BLACK FOUNDATION 9998 1 13370726 798008 9998

FORM 990-PF ACCOUNTING FEES STATEMENT 5

APGAR-'BLACK FOUNDATION 23-3024321

FORM 990-PF OTHER PROFESSIONAL FEES STATEMENT 6

(C) (D) ADJUSTED CHARITABLE

NET INCOME PURPOSES

(B) NET INVEST-MENT INCOME

6,610 .

6,610 . 6,610 . 0 .


DESCRIPTION

INVESTMENT FEES

TO FORM 990-PF, PG 1, LN 16C

(A) EXPENSES PER BOOKS

6,610 . 0 .


FORM 990-PF TAXES STATEMENT 7

(C) (D) ADJUSTED CHARITABLE NET INCOME PURPOSES

8 . 1 .

0 . 0 .

MSCL EXCISE

0 . 0 .

TO FORM 990-PF, PG 1, LN 18 9 . 0 . 0 .


DESCRIPTION

(A) EXPENSES PER BOOKS

NET INVEST-MENT INCOME

23-3024321 APOAR--BLACK FOUNDATION

FORM 990-PF OTHER EXPENSES STATEMENT 8

(C) ADJUSTED

NET INCOME EXPENSES NET INVEST-PER BOOKS MENT INCOME

32 . 0 .

32 . 0 .

(D) CHARITABLE PURPOSES

0 .

0 .


DESCRIPTION

BANK CHARGES

TO FORM 990-PF, PG 1, LN 23

2 4 STATEMENT S) 9 13370726 798008 9998 2002 .08000 APGAR-BLACK FOUNDATION 9998 1


FORM 990-PF U .S . AND STATE/CITY GOVERNMENT OBLIGATIONS STATEMENT 9

U .S . OTHER FAIR MARKET DESCRIPTION GOVT GOVT BOOK VALUE VALUE

MERRILL LYNCH X 83,307 . 83,307 . MERRILL LYNCH X 930 . 930 .

TOTAL U .S . GOVERNMENT OBLIGATIONS 84,237 . 84,237 .

TOTAL STATE AND MUNICIPAL GOVERNMENT OBLIGATIONS

TOTAL TO FORM 990-PF, PART II, LINE 10A 84,237 . 84,237 .

CORPORATE STOCK

FAIR MARKET VALUE BOOK VALUE

239,082 . 239,082 .

239,082 . 239,082 .

MERRILL LYNCH

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


APGARwBLACK FOUNDATION

FORM 990-PF

DESCRIPTION

23-3024321

STATEMENT 10


FORM 990-PF OTHER INVESTMENTS STATEMENT 11

FAIR MARKET BOOK VALUE VALUE

19,199 . 19,199 .

19,199 . 19,199 . TOTAL TO FORM 990-PF, PART II, LINE 13


DESCRIPTION

MERRILL LYNCH

APaAR}BLACK FOUNDATION

STATEMENT 12

ADDRESS


FORM 990-PF

NAME OF CONTRIBUTOR

ALLEN D BLACK

LIST OF SUBSTANTIAL CONTRIBUTORS PART VII-A, LINE 10

23-3024321

42 RIVER ROAD PT PLEASANT PA 18950

990-pf' return of private...

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