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3/17/13 11:20 AM
Gerard Adelman
Attorney at Weigand, Mahon & Adelman
Greater New York City Area Law Practice
Connections Websites
Since 1974, we have provided the full range of legal services to the greater Meriden area. I personnally limit my practice to family law with an emphasis on alternative dispute resolution modes such as collaborative divorce and divorce mediation. I also assist disabled invviduals obtain Social Security disability benefits.
Governor
Connecticut Bar Association
Nonprofit; 11-50 employees; Nonprofit Organization Management industry
http://www.linkedin.com/pub/gerard-adelman/5/113/3
Page 1 of 2
3/17/13 11:25 AM
Meriden
12/14/2009
MERIDEN - The Meriden Rotary Club's Four Way Test Essay and Speaking Contest took place Dec. 2. Advertisement Kate Mordarski, a junior at Platt High School, won first place in the speaking and essay contest while Jose Brocero, also a Platt junior, took second place in both categories. Jordan Adams, a Platt junior, placed third in the speaking contest while Kaitlyn Dyrek, a Maloney High School junior, took third place in the essay contest. Judges for the essay contest were Marcia Trotta, a professor at Albertus Magnus College; Peter Melien, attorney at law; Jim Ieronimo, Executive Director for United Way of Meriden-Wallingford; Frank Ridley, Commissioner of Higher Education; Mary Cortright, Meriden Superintendent of Schools. Judges for the speaking contest were Cliff Carlson, President of the Meriden Rotary Club; Gerard Adelman, Superior Court Judge; Kevin Curry, Past President of the Meriden Rotary Club; Joanne Bugai, Interim Director of Middlesex Community College's Meriden campus; Liz White, RecordJournal's Associate Publisher for New Media. Courtesy of Record Journal www.MyRecordJournal.com 2009
http://www.meridenrotary.org/news/newsView.asp?NewsId=4096836
Page 1 of 1
Read "India is no longer polio endemic" Read more from Rotarians who took part in National Immunization Days in Rotary Voices
NEWS!
What we cover! Presidents News This Past Week Looking Forward Reflections Remember
Page 2
Rotarys influence on the heart of the world will be in direct proportion to the number of communities that are exposed to the Rotary ideal. So let us help to found new clubs wherever the soil is at all fertile. Five Goals for Friendly Men, THE ROTARIAN, July 1950
MERIDEN ROTARY
Page 4
Merely selling things is boredom; selling services is the stuff of which selfrespect and dignifying ones vocation are made. Rotary in a Progressing World, THE ROTARIAN, July 1934
TUESDAY, FEBRUARY 21 (SPEAKER) FELLOWSHIP TUESDAY, FEBRUARY 28 (SPEAKER) Judge Gerard Adelman (Past President of Meriden Rotary) WEDNESDAY, FEBRUARY 29 (ROUND-TABLE MAKE UP MEETING) Four Points by Sheraton at 5:30 P (Check reader-board for room location)
MY CITY KITCHEN FUNDRAISER - MARCH 31 at the MARC TWAIN HOUSE See the link for details http://www.mycitykitchen.org/wp-content/uploads/2012/01/Extravaganza-Flyer1.pdf
***SAVE THE DATE!*** SATURDAY - APRIL 14th QUINNIPIAC RIVER CLEANUP! Please e-mail Tari at nzinternational1@yahoo.com for any calendar additions, changes or updates!
3/17/13 11:03 AM
Business Inquiry
Business Inquiry Details Business Name: Business Address: THE ADELMAN FAMILY FOUNDATION, INC. 562 BALDWIN AVENUE, UNIT #2, MERIDEN, CT, 06450 Business Id: 0611431 Mailing Address: 562 BALDWIN AVENUE, UNIT #2, MERIDEN, CT, 06450
Citizenship/State Inc: Domestic/CT Business Type: Non-Stock Date Inc/Register: Jan 15, 1999 Principals Name/Title: Business Address:
Residence Address: 562 BALDWIN AVE, UNIT #2, MERIDEN, CT, 06450
GAYLORD HOSPITAL, GAYLORD GEORGIA B. ADELMAN FARM ROAD, POB 400, PRESIDENT WALLINGFORD, CT, 06492 JESSICA A. KOGUT VICE PRESIDENT GERARD I. ADELMAN SECRETARY 234 LYDALE PLACE, MERIDEN, CT, 06450 54 W. MAIN ST., (SUPERIOR COURT - JUDGE'S SECTY), MERIDEN, CT, 06451
Business Summary Agent Name: GERARD I. ADELMAN Agent Business 54 WEST MAIN ST, MERIDEN, CT, 06451 Address: Agent Residence 562 BALDWIN AVENUE #2, MERIDEN, CT, 06450 Address:
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http://www.concord-sots.ct.gov/CONCORD/PublicInquiry?eid=9744&businessID=0611431
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3/17/13 11:00 AM
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The Adelman Family Foundation was organized in1999 to assist Meriden residents interested in a nursing career. Description The Foundation was begun in honor of Georgia B. Adelman, R.N., B.S.N. on the occasion of her 50th birthday. Having a scholarship program for aspiring nurses had been a long time ambition of Mrs. Adelman and her family. Nineteen $500 scholarships have been awarded by the Foundation through the academic year 2010-2011. The Foundation is a tax-exempt non- profit organization and is funded totally by the donations of private citizens. General Information Eligibility: Must be a resident of Meriden, CT at the time of graduation from high school or a graduate from a high school located in Meriden, CT Must be planning to pursue a career in nursing through either a BSN program or any program that would make the student eligible to sit for the Connecticut Registered Nurse Examination. Must be able to demonstrate a history of civic or community involvement. Must be able to demonstrate a financial need for the scholarship assistance.
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Founded 1999
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Email adelmanfamilyfoundation@gmail.com
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3/17/13 10:59 AM
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2012
2011
Kimberly Crawford Kimberly Cornell Kaitlyn Dyrek 2010 Kayla McQuade Jaboa Davis Heather Vicenty 2009 2008 Roshni Patel No winner
2007 Shannon Jones 2006 Shari Stanely 2005 Samantha Wilson Yalitzia Garcia 2004 Catherine M. Smock Brandon T. Brady
2003
Evan A. Landry Binal A. Salsani Kristin E. Jones Priscilla L. Crespo 2002 Vanessa Chaparro Stanio 2001 Juliana Baez
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3/17/13 11:36 AM
Business Inquiry
Business Inquiry Details Business Name: J. P. FACILITIES, LLC Business Address: 1007 MIDDLETOWN AVENUE, NORTH BRANFORD, CT, 06471 Business Id: 0880357 Mailing Address: PO BOX 819, DEER PARK, NY, 11729
Date Inc/Register: Nov 29, 2006 Principals Name/Title: JOSEPH PELOSI TRUST MEMBER Business Summary Agent Name: GERARD I. ADELMAN Agent Business 636 BROAD STREET, MERIDEN, CT, 06450 Address: Agent Residence 50 WILLIAM AVENUE, MERIDEN, CT, 06451 Address:
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Residence Address: C/O ROBERT PELOSI, AS TRUSTEE, PO BOX 819, 377 CARLL'S PATH, DEER PARK, NY, 11729
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http://www.concord-sots.ct.gov/CONCORD/PublicInquiry?eid=9744&businessID=0880357
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3/17/13 11:37 AM
Business Inquiry
Business Inquiry Details Business Name: Business Address: SENTINEL SPECIAL SERVICES, LLC 19 LITTLE CITY RD., HIGGANUM, CT, 06441 Business Id: 0692969 Mailing Address: NONE Last Report Year: Business Status: Active
Date Inc/Register: Oct 11, 2001 Principals Name/Title: JAMES R. SAUCIER MEMBER Business Summary Agent Name: GERARD I. ADELMAN, ESQ. Agent Business 636 BROAD ST., P. O. BOX 2420, MERIDEN, CT, 06450 Address: Agent Residence 50 WILLIAM AVE., MERIDEN, CT, 06451 Address:
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http://www.concord-sots.ct.gov/CONCORD/PublicInquiry?eid=9744&businessID=0692969
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3/17/13 11:38 AM
Business Inquiry
Business Inquiry Details Business Name: RNSC, LLC Business Address: 523 NORTH COLONY STREET, MERIDEN, CT, 06450 Business Id: 0897154 Mailing Address: 523 NORTH COLONY STREET, MERIDEN, CT, 06450
Date Inc/Register: Apr 23, 2007 Principals Name/Title: ROGER R. NEMEC MEMBER STEVE CHASSE MEMBER Business Summary Agent Name: GERARD I. ADELMAN Agent Business 636 BROAD ST, MERIDEN, CT, 06450 Address: Agent Residence 50 WILLIAM AVE, MERIDEN, CT, 06451 Address:
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Business Address: 523 NORTH COLONY STREET, MERIDEN, CT, 06450 523 NORTH COLONY STREET, MERIDEN, CT, 06450
Residence Address: 523 NORTH COLONY STREET, MERIDEN, CT, 06450 104 MILLER AVE, MERIDEN, CT, 06450
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http://www.concord-sots.ct.gov/CONCORD/PublicInquiry?eid=9744&businessID=0897154
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Meriden Court To Begin Special Masters Program - Mahon, Quinn & Mahand, Mahon & Adelman - Attorneys at Law, Meriden, Connecticut (CT)
3/17/13 11:33 AM
2008-2013 All rights reserved. Mahon, Quinn & Mahon P.C. Attorneys at Law - Formerly Weigand, Mahon & Adelman. | Privacy Policy | Site Map Mahon, Quinn & Mahon. P.C. Attorneys at Law specialize in Social Security Disability, Personal Injury, DUI Defense and Workers' Compensation. Located at 636 Broad Street, Meriden, CT 06450.
http://www.mqmlawyer.com/news/newsView.asp?NewsId=4096823
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3/17/13 10:58 AM
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Scholarship Application Deadline All applications for the nursing scholarship for the academic year Notes 3 2011-2012 mu
Highlights
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Both of our 2012 scholarship winners have checked in with the Foundation to report their successful start in their studies. Both are doing quite well and we have great confidence in their futures as active RNs. Keep up the good work, ladies.
Like Comment 2
Here is the current application for the Foundation sch February 15 at 9:33am Gerard Adelman The applications for the 2012-2013 academic year ar February 15 at 9:30am Gerard Adelman The AFF received a very significant donation from the August 29, 2012 at 8:46am Gerard Adelman
We recently received a very generous donation by our 5 2 July 25, 2012 at 10:05am More Posts
2012 was a very good year for The Adelman Family Foundation! We received $3,160.00 in donations which is double our donations for the previous year. We want to thank our many supporters and thank them once again for their ongoing support year after year. The applications for this year's scholarships will be going out to the schools in just a few weeks and we look forward to awarding college scholarships to assist future nurses with their education.
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Likes H.C. Wilcox Technical High School School Francis T Maloney High School School Orville H. Platt High School School
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3/17/13 10:58 AM
Adelman Family Foundation April 30, 2012 near Portland, CT via mobile
The scholarships for academic year 2011-2012 have been awarded. This year's scholars are Ms Envy Stone and Ms Danielle Harriott. Envy will graduate Platt High School next month ranked 3rd out of a class of 220. She will be attending St. Joseph College in Hartford this fall. Many of her courses at Platt have been advanced placement or honors level classes. We are quite proud to be supporting he...See More
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Tomorrow is the filing deadline for this year's scholarships. We are excited to see them.
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2011
The Meriden Record-Journal published a story announcing that our scholarship applications for the current academic year were available. They can be obtained at any of the three Meriden high schools, the public library or the Board of Education.
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Adelman Family Foundation created an event. February 11, 2012 Open Application Period February 10, 2012 at 12:00am Adelman Family Foundation went
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Form
990 -PF
Note . The foundation may be able to use a co py of this return to satisfy state re p ortin g re q uirements. Internal Revenue service For calendar Year 2011 or tax year beainnina . and endino
OMB No 1545-0052
2011
INC
Room/sulte
06-1537647
B Telephone number
4 -2 , #2
203-631-5255
C If exemption application is pending , check here
MERIDEN , CT
G Check all that apply.
06450-3596
D 1. Foreign organizations, check here 2. check har=zat d the 85% test, comps
0 Initial return 0 Initial return of a former public charity 0 Final return 0 Amended return 0 Address chan g e E] Name chan g e Section 501(c)(3) exempt private foundation H Check type of organization: Section 4947(a)( 1 ) nonexem pt charitable trust 0 Other taxable p rivate foundation Cash Accrual I Fair market value of all assets at end of year J Accounting method:
E If private foundation status was terminated under section 507(b)(1)(A), check here F If the foundation is in a 60-month termination
0 Other (specify)
8 8 5 9 . (Part 1, column (d) must be on cash basis.) 111114 Part I Analysis of Revenue and Expenses (a) Revenue and (b) Net investment (The total of amounts in columns (b), (c), and (d) may not
necessarily equal the amounts in column (4) e xpenses per books income
( d) Disbursements
1575
3 ^fnvestments
22.
22.
22. S tatement 1
_O_ C UUVED
. . ^
c0 v
, t r
9 Income modifications
b Less . Cost of goods sold
rY
L_U
1597.
0.
E
0.
22.
0.
22.
0.
$tmt
315. 1.
0. 0.
0. 0.
315. 1.
Stmt 3
55
Depreciation and depletion Occupancy Travel, conferences, and meetings Printing and publications
i 23 Other expenses
$ tmt 4
50.
366. 1500.
0.
0 .
0.
0
50.
24 Total operating and administrative a expenses . Add lines 13 through 23 0 25 Contributions, gifts, grants paid 26 Total expenses and disbursements. Add lines 24 and 25 27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements
3 6 6.
1500.
1866.
- 2 6 9 .
0.
22. 1
0.
1866.
^7
THE ADELMAN FAMILY FOLTN DATI ON INC Beginning of year Ati"hedschedules and amounts in me description
(a) Book Value (b) Book Value
U15-15371547
End of year
Pa ne 2
9128.
8859.
8859.
3 Accounts receivable ^
Less: allowance for doubtful accounts ^ 4 Pledges receivable ^ Less: allowance for doubtful accounts ^
5 Grants receivable 6 Receivables due from officers, directors, trustees, and other
disqualified persons
7 Other notes and loans receivable ^
12
13 Investments - other 14 Land, buildings, and equipment basis ^ Less accumulated depredation Stmt 5 ^ 15 Other assets (describe ^
180. 180.
9128.
8859 .
8859 .
,20 21 Mortgages and other notes payable '' 22 Other liabilities (describe ^ 23 Total liabilities (add lines 17 thro u g h 22 ) Foundations that follow SFAS 117, check here and complete lines 24 through 26 and lines 30 and 31. 24 Unrestricted
a 25 Temporarily restricted
0. ^ 0
0.
m 26 Permanently restricted Foundations that do not follow SFAS 117, check here ^ Eil r_ LL and complete lines 27 through 31. 27 Capital stock, trust principal, or current funds 28 Paid-in or capital surplus, or land, bldg., and equipment fund 29 Retained earnings, accumulated income, endowment, or other funds
0. 0.
0 0
9128.
9128.
9128. 1
8859 .
8859 .
8859 .
Part iiI
1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year's return) 2 Enter amount from Part I, line 27a 3 Other increases not included in line 2 (itemize) ^ 4 Add lines 1, 2, and 3 5 Decreases not included in line 2 (itemize) ^ 6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II. column (b), line 30
123511 12-02-11
9128 .
-269 . 0 . 8859. 0 . 8859 .
Form 990-PF (2011THE ADELMAN FAMILY FOUNDATION , INC Part IV Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co. is (b How acquired Purchase D Donation
06-1537647
acquired (c)mo., day, yr.)
Page 3
b
C
d
NONE
e
(e) Gross sales price (f) Depreciation allowed (or allowable) (g) Cost or other basis plus expense of sale (h) Gain or (loss) (e) plus (f) minus (g)
a b c d e Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i) F.M.V. as of 12/31/69 (j) Adjusted basis as of 12/31/69 (k) Excess of cal. (i) over cal. (1), if any
a b c d e 2 Capital gain net income or (net capital loss) If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7 2
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6): If gain, also enter in Part I, line 8, column (c). If ( loss), enter -0- in Part I line 8
[Part V I Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income (For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period? If 'Yes,' the foundation 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 period years Calendar year or tax year be g innin g ( b) Adjusted qualifying distributions (c) Net value of nonchantable- use assets
LI Yes No
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 in existence if less than 5 years 4 Enter the net value of nonchantable-use assets for 2011 from Part X, line 5 5 Multiply line 4 by line 3 6 Enter 1% of net investment income (1% of Part I, line 27b) 7 Add lines 5 and 6 L 8 Enter qualifying distributions from Part XII, line 4
If line 8 is equal to or greater than line 7, check the box in PartVI, line 1b, and complete that part using a 1% tax rate. See the Part VI in structions.
123521 12-02.11
.131151 6994 .
917. 0. 917.
4
5
..
. .. .
6 7 8
1866.
Form 990-PF (2011)
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Part VI
Excise Tax Based on Investment Income (Section 4940(a). 4940(b), 4940(e), or 4948 - see instructions)
la Exempt operating foundations described in section 4940(d)(2), check here ^ U and enter' WA' on line 1.
Date of ruling or determination letter. ( attach copy of letter if necessary-see instructions) b Domestic foundations that meet the section 4940(e) requirements in Part V, check here ^ 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-)
0.
6 Credits/Payments: a 2011 estimated tax payments and 2010 overpayment credited to 2011 6a b Exempt foreign organizations - tax withheld at source 6b c Tax paid with application for extension of time to file (Form 8868) 6c ... 6d d Backup withholding erroneously withheld 7 Total credits and payments. Add lines 6a through 6d 8 Enter any penalty for underpayment of estimated tax. Check here 0 if Form 2220 is attached 9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed 10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid 11 Enter the amount of line 10 to be: Credited to 2012 estimated tax No, Part VII-A Statements Regarding Activities
^ ^ Refunded
7 8 9 10 11
0. 0.
la During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in any political campaign? _ Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)? b If the answer is 'Yes' to la or 1b, attach a detailed description of the activities and copies of any materials published or distributed by the foundation in connection with the activities.
Is
c Did the foundation file Form 1120-POL for this year? d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year. $ (1) On the foundation. ^ $ 0 0 . (2) On foundation e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed on foundation managers. ^ $ 0.
2 _ Has the foundation engaged in any activities that have not previously been reported to the IRS? 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 incorporation, or bylaws, or other similar instruments? If 'Yes,' attach a conformed copy of the changes
4a Did the foundation have unrelated business gross income of $1,000 or more during the year? b If 'Yes,' has it filed a tax return on Form 990-T for this year? 5 Was there a liquidation, termination, dissolution, or substantial contraction during the year?
If 'Yes,' attach the statement required by General Instruction T.
_ N/A
I4aI
IX
6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either. By language in the governing instrument, or By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law remain in the governing instrument? .
7 Did the foundation have at least $5,000 in assets at any time during the year? If 'Yes,' complete Part Ii, col. (c), and Part XV. .. .
8a Enter the states to which the foundation reports or with which it is registered (see instructions) ^
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
8b I X
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendar year 2011 or the taxable year beginning in 2011 (see instructions for Part XIV)? If 'Yes,' complete Part XIV
Did any persons become substantial contributors during the tax year? It -Y . " attach a schedule hstma their names and addresses
123531 12-02-11
Activities
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 instructions) 12 Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges? If 'Yes, attach statement (see instructions) 13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
Website address ^
N/A
14 The books are in care of ^ GERARD ADELMAN Located at ^ 562 BALDWIN AVENUE , MERIDEN ,
CT
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
16 At any time during calendar year 2011, did the foundation have an interest in or a signature or other authority over a bank, securities, or other financial account in a foreign country? See the instructions for exceptions and filing requirements for Form TD F 90-22.1. If 'Yes; enter the name of the foreign
Part VII - B Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes " column , unless an exception applies. 1a During the year did the foundation (either directly or indirectly): Yes No
(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)
(3) (4) (5) (6) a disqualified person? Furnish goods, services, or facilities to ( or accept them from) a disqualified person? Pay compensation to, or pay or reimburse the expenses of, a disqualified person? Transfer any income or assets to a disqualified person ( or make any of either available for the benefit or use of a disqualified person )? . 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
0 Yes No
Yes M No ED Yes No L1 Yes No 0 Yes No
0 Yes No termination of government service, if terminating within 90 days.) in Regulations exceptions described qualify under the of the acts to fail b If any answer is'Yes'to la( 1)-(6), did any N/A section 53.4941(d )-3 or in a current notice regarding disaster assistance ( see instructions )? here 0 assistance check ... ^ Organizations relying on a current notice regarding disaster not corrected acts, that were other than excepted c Did the foundation engage in a prior year in any of the acts described in 1a,
before the first day of the tax year beginning in 2011? 2 Taxes on failure to distribute income (section 4942 ) ( does not apply for years the foundation was a private operating foundation
lb
1c
c 3a b
0 Yes No .. . before 2011? If 'Yes,' list the years ^ , 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 N/A statement - see instructions.) If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here. ^ , Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any time =1 Yes No during the year? .. If 'Yes; did it have excess business holdings in 2011 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 2011 .) . , . N/A.
2b
3b
, 4a Did the foundation invest during the year any amount in a manner that would jeopard ize its charitable purposes? purpose that charitable that could jeopardize its after December 31, 1969) in prior year (but make any investment a the foundation Did b
4a
123541 12-02-11
Part VII- B I Statements Reaardina Activities for Which Form 4720 May Be Recuired (continued)
5a During the year did the foundation pay or incur any amount to:
El Yes No
Yes No Yes LI No
0 Yes No
Yes No
(5) Provide for any purpose other than religious, charitable , scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals? b If any answer is Yes to 5a(1)-(5 ), did any of the transactions fail to qualify under the exceptions described in Regulations
section 53.4945 or in a current notice regarding disaster assistance (see instructions)? Organizations relying on a current notice regarding disaster assistance check here c If the answer is 'Yes' to question 5a( 4), does the foundation claim exemption from the tax because it maintained
expenditure responsibility for the grant? If 'Yes,' attach the statement required by Regulations section 53.4945-5(d). 6a Did the foundation, during the year, receive any funds, directly or indirectly , to pay premiums on N/A.
5b ^0
O Yes 0 No
Yes No
_ 0 Yes No 6b X
Information About Officers, Directors, Trustees, Foundation Managers , Highly Part VIII 0 Paid Employees, and Contractors
1 List all officers, directors, trustees, foundation managers and their compensation. (b) Title, and average hours per week devoted (a) Name and address to position
(c) Compensation (If not paid , enter- 0(I ConMbutlonsto e p ON BedeneetdpIns compensabon
GEORGIA B. ADELMAN 562 BALDWIN AVENUE , A-2 , MERIDEN , CT 06450 GERARD I. ADELMAN 562 BALDWIN AVENUE , A-2 ,
RESIDENT #2
0.50
SECRETARY/TRE ASURER #2
0. 0. 0.
0. 0. 0.
0. 0. 0.
MERIDEN , CT 06450
JESSICA A. KOGUT 234 LYDALE PLACE
0.10
ICE-PRESIDE
MERIDEN , CT 06450
0.10
2 Compensati on of five highest-paid employees (other than those included on line 1). If none, enter "NONE."
(a) Name and address of each employee paid more than $50,000
(c) Compensation
NONE
123551 12-02-11
Form 990-PF (2011) THE ADELMAN FAMILY FOUNDATION, INC 06-1537647 Information About Officers , Directors , Trustees , Foundation Managers, Highly Part VIII
Page 7
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
(c) Compensation
NONE
^
I Expenses
N/A
0.
123581 12-02-11
INC
06 -1537647
Page 8
Minimum Investment Return (All domestic foundations must complete this part . Foreign foundations , see instructions.)
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes: a Average monthly fair market value of securities b Average of monthly cash balances c Fair market value of all other assets
_
le
e Reduction claimed for blockage or other factors reported on lines 1a and 1c (attach detailed explanation) 2 Acquisition indebtedness applicable to line 1 assets
3
4 5
1 3 1 $tmt 6
8994. 4.
Distributable Amount (see instructions) (Section 4942(j)(3) and (1)(5) private operating foundations and certain foreign organizations check here ^ J and do not complete this part) 1 2a
Minimum investment return from Part X, line 6 1 2a Tax on investment income for 2011 from Part VI, line 5
b Income tax for 2011. (This does not include the tax from Part VI.)
2b
2c 3 4 5 6 7
c Add lines 2a and 2b 3 Distributable amount before adjustments. Subtract line 2c from line 1 4 Recoveries of amounts treated as qualifying distributions 5 Add lines 3 and 4 6 Deduction from distributable amount (see instructions) 7 Distributable amount as ad justed. Subtract line 6 from line 5. Enter here and on Part XIII , line 1 Part XII Qualifying Distributions (see instructions)
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes: a Expenses, contributions, gifts, etc. - total from Part I, column (d), line 26 b Program-related investments - total from Part IX-B 2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes 3 Amounts set aside for specific charitable projects that satisfy the: 1
a Suitability test (prior IRS approval required) . b Cash distribution test (attach the required schedule)
, . .
1a 1b 2
3a 3b
1866. 0.
. ..
4 5
6
Qualifying distributions . Add lines la through 3b. Enter here and on Part V, line 8, and Part XIII, line 4. Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
1866.
0. 1866.
5 income. Enter 1% of Part I, line 27b 6 Adjusted qualifying distributions . Subtract line 5 from line 4 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
123571 12-02-11
. Form 990-PF (2011) Part XIII Undistributed Income (see instructions) (a) Corpus
1
2
(c) 2010
(d) 2011
c Treated as distributions out of corpus (Election required - see instructions) d Applied to 2011 distributable amount e Remaining amount distributed out of corpus
5 Excess distributions carryover applied to 2011 of an amount appears in column (4 the same amount must be shown in column (a4)
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 2010. Subtract line 4a from line 2a. Taxable amount - see instr. f Undistributed income for 2011. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2012 7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) 8 Excess distributions carryover from 2006 not applied on line 5 or line 7 . _ 9 Excess distributions carryover to 2012. Subtract lines 7 and 8 from line 6a 10 Analysis of line 9: a Excess from 2007 b Excess from 2008 c Excess from 2009 d Excess from 2010
123581 12-02-11
.Form
10
[t XIV ] Private Operating Foundations (see instructions and Part VII-A, question 9)
1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2011, enter the date of the ruling ^ b Check box to indicate whether the foundation is a p rivate op eratin g foundation described in section Prior 3 2 a Enter the lesser of the adjusted net Tax year income from Part I or the minimum 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 in line 2c not used directly for active conduct of exempt activities
3 ) or (d) 2008
(a) 2011
(b ) 2010
(c) 2
22. 19.
60. 51.
98 . 83.
69. 59. 4
249. 212.
e Qualifying distributions made directly for active conduct of exempt activities. Subtract line 2d from line 2c Complete 3a, b, or c for the alternative test relied upon: a 'Assets' alternative test - enter. (1) Value of all assets
(2) Value of assets qualifying under section 4942( I)(3)(B)(i) b 'Endowment' alternative test - enter 2/3 of minimum investment return shown in Part X, line 6 for each year listed c 'Supporr alternative test - enter. (1) Total support other than gross investment income ( interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties)
452.1 452.1
1 1
27438. 27438.
(2) Support from general public and 5 or more exempt organizations as provided in section 4942 ( I)(3)(B)(iii)
(3) Largest amount of support from an exempt organization .
0.
Part XV
1
Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets at any time during the year- see instructions.)
a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
See Statement 7
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, Gift, Loan, Scholarship , etc., Programs: Check here ^ 0 if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. If the foundation 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:
See Statement 8
b The form in which applications should be submitted and information and materials they should include: c Any submission deadlines: d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:
123801 12-02-11
-1537647
a uranzs ana onviouuons raia uunn me rear or roves ror ruture ra If recipient is an individual, Recipient show any relationship to any foundation manager Name and address (home or business) or substantial contributor enz Foundation status of recipient Purpose of grant or contribution
Pape II
Amount
ONE
SSIST IN HIGHER
E DUCATION STUDIES
00 ,
ONE
500
ONE
Total
3a
1500 ,
None
Total
123811 12-02-11
INC
06-153 7647
Pane 12
Part XVI -A
EN.yO" code
(d) Amount
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 4 Dividends and interest from securities
5 Net rental income or (loss ) from real estate: a Debt-financed property
22.
e
12 Subtotal . Add columns ( b), (d), and ( e) 13 Total. Add line 12, columns ( b), (d), and ( e)
(See worksheet in line 13 instructions to verify calculations.)
0.
0. 13
22.
22.
PartXVI-B
Line No . V
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).
I NTEREST INCOME , TOGETHER WITH CONTRIBUTIONS AND GIFTS RECEIVED , WILL E USED TO FUND RE QUIRED & PRIMARILY CHARITABLE ACTIVITIES
1Y:7O
12-02-11
Form
(2011)
.Form990-PF 2011 06-15376 47 THE ADELMAN FAMILY FOUNDATION , INC Part XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organ izations
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? Transfers from the reporting foundation to a noncharitable exempt organization of (1) Cash (2) Other assets Other transactions: (1) Sales of assets to a noncharltable exempt organization (2) Purchases of assets from a noncharitable exempt organization 1a 1 la( 2 ) _ lb ( l ) lb ( 2 )
Pa a13
Yes Nc
X X X X
(3) Rental of facilities, equipment, or other assets (4) Reimbursement arrangements (5) Loans or loan guarantees (6) Performance of services or membership or fundraising solicitations Sharing of facilities, equipment, mailing lists, other assets, or paid employees
_ ..
lb ( 3 ) 1b 4 lb ( 5 ) lb 6 1c
X X X X X
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
2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described LI Yes in section 501 (c) of the Code ( other than section 501(c)(3 )) or in section 527? b If 'Yes.' complete the following schedule. (c) Description of relationship (b ) Type of organization (a) Name of organization
No
N/A
Here
use Signature of office Print/Type preparer's name Date Preparer's signatur
Sign
declare that I have examined this return, including accompanylnn Under penalties of per act, plate Declaration of preparer (other than taxpayer) is and belief, it is true,
Paid HOWARD M. LEVINE Preparer Firm's name ^ Howard M. Levine, Use Only
Firm's address ^
CPA
26 N. Main St.
Southin
123822 12-02-11
INC
06-1537647
Form 990-PF
Statement
Source
NAUGATUCK SAVINGS BANK
Amount
22. 22.
Form 990-PF
Accounting Fees
Statement
Description
TAX PREPARATION
(c) Adjusted
Net Income
(d) Charitable
Purposes
315. 315.
0. 0.
0. 0.
315. 315.
Taxes (b)
Net Investment Income 0.
Statement (c)
Adjusted Net Income 0.
(d)
Charitable Purposes 1.
To Form 990-PF, Pg 1, In 18
1.
0.
0.
1.
Form 990-PF
Statement (c)
Adjusted Net Income 0.
(d)
Charitable Purposes 50.
To Form 990-PF, Pg 1, In 23
50.
0.
0.
50.
Statement(s) 1,
2,
3,
INC
06-1537647
Form 990-PF
Statement
Book Value 0.
In 14
180.
180.
0.
Statement(s) 5
INC
06-1537647
Statement 6
Form 990 - PF
ANTICIPATED ADMINISTRATIVE EXPENSES OF $500 AND A SCHOLARSHIP DISTRIBUTION(S) OF $1500; DUE TO THE SMALL BALANCE OF ASSETS, 1 1/2% OF ASSETS IS TOO SMALL TO REASONABLY COVER DISBURSEMENTS.
Statement(s) 6
INC
06-1537647 Statement 7
Form 990-PF
Statement(s)
INC
06-1537647 Statement 8
Form 990-PF
Name and Address of Person to Whom Applications Should be Submitted GERARD ADELMAN 562 BALDWIN AVENUE, MERIDEN, CT 06450 Telephone Number 203-237- 9856
A-2,
#2
Form and Content of Applications SUBMISSION ON AN OFFICIAL APPLICATION FORM, TOGETHER WITH A HIGH SCHOOL TRANSCRIPT, PROOF OF ACCEPTANCE INTO A NURSING PROGRAM AND 3 REFERENCE LETTERS
Restrictions and Limitations on Awards RECIPIENT NEEDS TO: 1)BE A RESIDENT OF MERIDEN, CT OR 2) ATTENDING OR GRADUATED FROM ONE OF THE THREE HIGH SCHOOLS LOCATED IN MERIDEN, CT. AND 3)PURSUING THE STUDY OF REGISTERED NURSING.
Statement(s)
m Form
'^90-PF
OMB No 1545-0052
For calendaryear 20i0, or tax year beginning G Check all that apply. Name of foundation
INC
Room/suite
06-1537647
B Telephone number
-2 #2
203-631-5255
C If exemption application is pending , check here
MERIDEN ,
CT
06450-3596
Section 50 1(c)(3) exempt private foundation H Check type of organization: Section 4947( a )( 1 ) nonexem p t charitable trust Other taxable p rivate foundation I Fair market value of all assets at end of year J Accounting method: Cash E] Accrual (from Part ll, col (c), line 16) F-1 Other (specify) 11104 912 8 . (Part 1, column (d) must be on cash basis.) Part I Analysis of Revenue and Expenses (a) Revenue and (b) Net investment (The tool of amounts in columns (b), (c), and (d) may not expenses per books income necessarily equal the amounts in column (a))
E If priva t e f oun d a t ion s t a t us was t ermina t e d under section 507(b)(1)(A), check here F If the foundation is in a 60-month termination under section 507(b)(1 B ), check here (d) Disbursements (c) Adjusted net for chantable purposes income (cash basis only)
Check
5a Gross rents
6a Net gain or (loss) from sale of assets not on line 10
cc
8 9
0. i1 ].
t e
1663.
0.
60.
0.
60.
0. 0.
Other employee salaries and wages 15 Pension plans, employee benefits to 16a Legal fees 14
b Accounting fees
Stmt 2
525. 2.
0. 0.
0. 0.
525. 2.
18 Taxes
19 Depreciation and depletion E 20 Occupancy
c C, Q
$ tmt 3
< 21 t c 22
0 23 Other expenses
$ tmt 4
50.
577.
0.
0.
0.
0.
50.
577.
C . expenses . Add lines 13 through 23 - 0 25 Contributions, gifts, grants paid .U 26 Total expenses and disbursements.
1500. 2077.
- 414. 60.
1500. 0. 0. 2077.
c Adjusted net income (if negative. enter -0LHA For Paperwork Reduction Act Notice , see the instructions . 12 of-10
.`In
ve2
muT:
ATb
T.MA KT
T.' ?MTT_V
WnTTKT
M rntT
TWTO
fl L - 1
. 1'7 G A '7
Pane 9
P artI I 1 2 3 4 5 6
7
chedschedules and amounts in the description Balance Sheets column should be for endol -yearamountsonly
Cash - non-interest-bearing Savings and temporary cash investments Accounts receivable ^ Less: allowance for doubtful accounts ^ Pledges receivable ^ Less: allowance for doubtful accounts ^ Grants receivable Receivables due from officers, directors, trustees, and other disqualified persons
Other notes and loans receivable ^
9542 .
9128.
9128.
Inventories for sale or use Prepaid expenses and deferred charges Investments - U.S. and state government obligations Investments - corporate stock Investments - corporate bonds
Investments - land, buildings , and equipment basis Less accumulated depredation 10. ^
12 13
180.
180.
9542 .
9128.
9128.
18 Grants payable
ta 19
20
Deferred revenue
Loans from officers, directors , trustees, and other disqualified persons
,20 21 J 22
23 Total liabilities ( add lines 17 throu g h 22 ) Foundations that follow SFAS 117, check here and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted
25 Temporarily restricted co 26 Permanently restricted Foundations that do not follow SFAS 117, check here ^ E^j C LL through 31. and complete lines 27 27 Capital stock, trust principal, or current funds 28 Paid-in or capital surplus, or land, bldg., and equipment fund
0. 0.
0. 0.
4 29 Retained earnings, accumulated income, endowment, or other funds Z 30 Total net assets or fund balances
31 Total liabilities and net assets/fund balances
Part III
I Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year's return) 2 Enter amount from Part I, line 27a
121
-414. 2
3 Other increases not included in line 2 (itemize) ^ 4 Add lines 1, 2, and 3 5 Decreases not included in line 2 (itemize) ^
- Part II. column
Form 990-PF (2010) THE ADELMAN FAMILY FOUNDATION , INC Part IV Capital Gains and Losses for Tax on Investment Income
` la (a) List and describe the kind(s) of property sold (e.g., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co.) (b How acquired ^ - Purchase D - Donation
06-1537647
(C) Date acquired (mo., day, yr.)
Page 3
b
C d e
(e) Gross sales price
NONE
a
b
c d e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (i) F.M.V. as of 12/31/69 (j) Adjusted basis as of 12/31/69 (k) Excess of col. (i) over col. (1), if any (I) Gains (Col. (h) gain minus col. (k), but not less than -0-) or Losses (from col. (h))
a
b
c d e
2 Capital gain net income or (net capital loss) If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7 2
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6): If gain, also enter in Part I, line 8, column (c). If ( loss ), enter -0- in Part I line 8 3 Qualification Under Section 494U (e) for Reduced Tax on Net Investment Income Part V (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? If 'Yes,' the foundation 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 periiod years Calendar year ( or tax year beginning m (b n g distributions Adj usted q uali fyi Net value of noncharitable - use assets 0 Yes No
2 Total of line 1, column (d) 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 in existence if less than 5 years 4 Enter the net value of noncharitable-use assets for 2010 from Part X, line 5
4 5
6
7
8
920.
2077.
023521 12-07-10
Form 990-PF (2010) Page 4 THE ADELMAN FAMILY FOUNDATION , INC 06-1537647 Part VI Excise Tax Based on Investment Income (Section 4940 (a), 4940(b), 4940 (e), or 4948 - see instructions)
la Exempt operating foundations described in section 4940(d)(2), check here ^ L^j and enter 'N/A' on line 1. Date of ruling or determination letter. (attach copy of letter if necessary - see instructions) b Domestic foundations that meet the section 4940(e) requirements in Part V, check here ^ 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-) 3 Add lines 1 and 2 4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
1 .
2 3 4
0. 1. 0.
5 Tax based on investment income . Subtract line 4 from line 3. If zero or less, enter -06 Credits/Payments: a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a b Exempt foreign organizations - tax withheld at source 6b 6c c Tax paid with application for extension of time to file (Form 8868) 6d d Backup withholding erroneously withheld 7 Total credits and payments. Add lines 6a through 6d 8 Enter any penalty for underpayment of estimated tax Check here LI if Form 2220 is attached 9 Tax due . If the total of lines 5 and 8 is more than line 7, enter amount owed 10 11 Overpayment . If line 7 is more than the total of lines 5 and 8, enter the amount overpaid Enter the amount of line 10 to be : Credited to 2011 estimated tax
7 ^ ^ Refunded 008 9 10 11
0. 1
Part VII-A
Is During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in any political campaign? b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)? If the answer is 'Yes' to 1 a or 1b, 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? d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year: 0. (2) On foundation managers. ^ $ 0. (1) On the foundation. ^ $ (if foundation during the year for political expenditure tax imposed on foundation Enter the reimbursement any) paid by the e managers. ^ $ 0. 2 Has the foundation engaged in any activities that have not previously been reported to the IRS? If 'Yes,' attach a detailed descnption of the activities. 3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or bylaws, or other similar instruments? If 'Yes," attach a conformed copy of the changes 4a Did the foundation have unrelated business gross income of $1,000 or more during the year? b If "Yes,' has it filed a tax return on Form 990-T for this year? 5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? If 'Yes,' attach the statement required by General Instruction T. 6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either: By language in the governing instrument, or By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law remain in the governing instrument? 7 Did the foundation have at least $5,000 in assets at any time during the year? If 'Yes,' complete Part 11, col (c), and Part XV 8a Enter the states to which the foundation reports or with which it is registered (see instructions) ^ 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 Is the foundation claiming status as a private operating foundation within the meaning of section 4942(I)(3) or 4942(1)(5) for calendar year 2010 or the taxable year beginning in 2010 (see instructions for Part XIV)? If 'Yes,' complete Part XIV
tc
4a
N/A
8b 9
X X
023531 12-07-10
Form 990-PF (20 10) THE ADELMAN FAMILY FOUNDATION , Part VII -A Statements Regarding Activities (continued)
11 12 13
INC
06-1537647
P age 5
At,any time during the year, did the foundation , directly or indirectly, own a controlled entity within the meaning of section 512( b)(13)? It'Yes; attach schedule (see instructions) Did the foundation acquire a direct or indirect interest in any applicable insurance contract before August 17, 2008? Did the foundation comply with the public inspection requirements for its annual returns and exemption application? Website address ^ N/A
11 12 13
X X X
14 The books are in care of ^ GERARD ADELMAN Located at ^ 5 6 2 BALDWIN AVENUE, MERI DEN ,
15 16
CT
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 At any time during calendar year 2010, did the foundation have an interest in or a signature or other authority over a bank, securities, or other financial account in a foreign country? See page 20 of the instructions for exceptions and filing requirements for Form TO F 90-22.1. If 'Yes,* enter the name of
Part VII - B Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column , unless an exception applies. la During the year did the foundation ( 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? (3) Furnish goods , services , or facilities to ( or accept them from) a disqualified person? (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? (5) Transfer any income or assets to a disqualified person ( or make any of either available for the benefit or use of a disqualified person )? Yes 0 Yes III No 0 Yes No 0 Yes No 0 Yes No No
0 Yes No (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 .) 0 Yes No b If any answer is 'Yes' to la(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 22 of the instructions)? N/A Organizations relying on a current notice regarding disaster assistance check here ^0 c Did the foundation engage in a prior year in any of the acts described in la, other than excepted acts, that were not corrected before the first day of the tax year beginning in 20109 Taxes on failure to distribute income ( section 4942 ) ( does not apply for years the foundation was a private operating foundation defined in section 4942( l)(3) or 4942 ( j)(5)): a At the end of tax year 2010, did the foundation have any undistributed income ( lines 6d and 6e, Part XIII ) for tax year(s) beginning
before 2010?
0 Yes 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 instructions.) 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 enterprise at any time
N/A
Yes No b If 'Yes , did it have excess business holdings in 2010 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 2010) N/A 4a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
b Did the foundation make any investment in a prior year ( but after December 31, 1969 ) that could jeopardize its charitable purpose that
first day of the tax year beainnina in
023541 12-07-10
Form 990-PF 2010 THE ADELMAN FAMILY FOUNDATION , INC 06-1537647 Part VII - B Statements Regarding Activities for Which Form 4720 May Be Required (continued)
5a 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))? ( 2) Influence the outcome of any specific public election ( see section 4955 ); or to carry on , directly or indirectly, any voter registration dnve2 (3) Provide a grant to an individual for travel, study, or other similar purposes? ( 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)2 ( 5) Provide for any purpose other than religious , charitable , scientific , literary, or educational purposes, or for the prevention of cruelty to children or animals? 0 Yes No 0 Yes No Yes 0 No E__1 Yes No Yes No 5b ^0
Page 6
b If any answer is 'Yes' to 5a(1)-(5 ), did any of the transactions fail to qualify under the exceptions described in Regulations section 53 . 4945 or in a current notice regarding disaster assistance (see instructions)? Organizations relying on a current notice regarding disaster assistance check here c If the answer is 'Yes' to question 5a ( 4), does the foundation claim exemption from the tax because it maintained expenditure responsibility for the grant? N/A If 'Yes,' attach the statement required by Regulations section 53.4945-5(d). 6a Did the foundation, during the year , receive any funds , directly or indirectly, to pay premiums on a personal benefit contract? b Did the foundation, during the year , pay premiums, directly or indirectly, on a personal benefit contract? If 'Yes " to 6b, File Form 8870 7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction ? b If 'Yes ," did the foundation receive any p roceeds or have any net income attributable to the transaction?
0 Yes =No
1 Yes No 6b L Yes No N /A X
7b
Part VIII
Information About Officers, Directors , Trustees, Foundation Managers , Highly Paid Employees , and Contractors
(c) Compensation If not p aid ( enter -0
(dContnbutionsto employee benefit plans conpensation
1 List all officers. directors. trustees. foundation managers and their compensation. (b) Title, and average hours per week devoted (a) Name and address to position
RESIDENT #2
MERIDEN , CT 06450
GERARD I. ADELMAN 562 BALDWIN AVENUE , A-2 , #2
0.50
SECRETARY/TRE ASURER
0. 0. 0.
0. 0. 0.
0. 0. 0.
MERIDEN , CT 06450
JESSICA A. KOGUT 234 LYDALE PLACE
0.10
ICE-PRESIDE
MERIDEN , CT 06450
0.10
rI nn IInP 11
If nnnp_ PntPr
,NnNE_"
(a) Name and address of each employee paid more than $50,000
(c) Compensation
NONE
023551 12-07-10
Form 990-PF (20 10) THE ADELMAN FAMILY FOUNDATION, INC 06-1537647 About Officers, Directors , Trustees, Foundation Managers , Highly Information Part VIII Paid Employees, and Contractors (continued)
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
Page 7
(c) Compensation
NONE
Total number of others receivin g over $50 ,000 for p rofessional services
Part IX-A
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.
2077.
2
N/A
0.
023501 12-07-10
INC
06-1537647
Page 8
Minimum Investment Return (All domestic foundations must complete this part . Foreign foundations, see instructions)
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes: Average monthly fair market value of securities Average of monthly cash balances Fair market value of all other assets Total (add lines la, b, and c) Reduction claimed for blockage or other factors reported on lines 1a and 1c (attach detailed explanation) le Acquisition indebtedness applicable to line 1 assets Subtract line 2 from line ld Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see instructions) Net value of noncharitable - use assets . Subtract line 4 from line 3. Enter here and on Part V, line 4
Stmt 6
Part XI
Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here ^ j and do not complete this part.) 2a 2b 2c 3 4 5 6 7
Minimum investment return from Part X, line 6 I 2a Tax on investment income for 2010 from Part VI, line 5 b Income tax for 2010. (This does not include the tax from PartVI.) c Add lines 2a and 2b 3 4 5 6 7 Distributable amount before adjustments. Subtract line 2c from line 1 Recoveries of amounts treated as qualifying distributions Add lines 3 and 4 Deduction from distributable amount (see instructions)
Distributable amount as ad j usted. Subtract line 6 from line 5. Enter here and on Part XIII , line 1
2077 . 1 2076.
5 Adjusted qualifying distributions . Subtract line 5 from line 4 6 Note. The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the fo undation qualifies for the section 4940(e) reduction of tax in those years.
023571 12-07-10
Form 990-PF (2010) 1 1 ' Undistributed Income (see instructions) Part X11(a) Corpus 1
2
Page 9
N/A (b) Years prior to 2009
(c) 2009
(d) 2010
b Total for prior years: 3 Excess distributions carryover, if any, to 2010: a From 2005
f Total of lines 3a through e 4 Qualifying distributions for 2010 from Part X11, line 4: 111110- $ a Applied to 2009, 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 2010 distributable amount
e Remaining amount distributed out of corpus 5 Excess distributions carryover applied to 2010
Of an amount appears in column (d), the same amount must be shown in column (a) )
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 2009. Subtract line 4a from line 2a. Taxable amount - see instr. f Undistributed income for 2010. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2011 7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or4942(g)(3) 8 9 Excess distributions carryover from 2005 not applied on line 5 or line 7 Excess distributions carryover to 2011. Subtract lines 7 and 8 from line 6a
10 Analysis of line 9: a Excess from 2006 b Excess from 2007 c Excess from 2008 d Excess from 2009 e Excess from 2010
023581 12-07-10
Form 990-PF 2010 THE ADELMAN FAMILY FOUNDATION , INC Part XIV Pri vate Operating Foundations (see instructions and Part VII-A, question 9)
1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2010, enter the date of the ruling _ ^ b Check box to indicate whether the foundation is a p rivate op eratin g foundation described in section Tax year Prior 3 y 2 a Enter the lesser of the adjusted net (a) 2010 (b) 2009 (c) 20 income from Part I or the minimum 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 in line 2c not used directly for active conduct of exempt act vities e Qualifying distributions made directly for active conduct of exempt activities. Subtract line 2d from line 2c Complete 3a, b, or c for the alternative test relied upon: a 'Assets' alternative test - enter: (1) Value of all assets (2) Value of assets qualifying under section 4942(I)(3)(B)(i) b 'Endowment' alternative test - 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(l)(3)(B)(ui) (3) Largest amount of support from an exempt organization
06-1537647
Page 10
1
or
(d) 2007 1 (e) Total
69. 59. 0. 0. 0.
0.
Part XV
1
Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets at any time during the year-see the instructions.)
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).) 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
See Statement 7
None 2 Information Regarding Contribution , Grant, Gift, Loan, Scholarship , etc., Programs:
Check here ^ LI if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. If the foundation 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:
See Statement 8
b The form in which applications should be submitted and information and materials they should include: c Any submission deadlines: d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:
023801
12-07-10
Form 990 -PF (2010) THE ADELMAN FAMILY FOUNDATION , Part XV - Supplementary Information (continued)
a
INC
06-1537647
Page 11
ura nts ano %,onuuounons rasa uurnn the re ar or roves Tor future Paym ent If recipient is an individual, Recipient Foundation show any relationship to status of any foundation manager Name and address ( home or business ) recipient or substantial contributor a Paid dung the year
Amount
ONE
SSIST
IN HIGHER
500.
EDUCATION STUDIES
ONE
SSIST IN
HIGHER
500.
EDUCATION STUDIES
ONE #13
SSIST
IN HIGHER
500.
EDUCATION STUDIES
Total
b Approved for future payment
^ 3a
1500.
None
INC
06-1537647
Page 12
(e)
( d) Amount
a b c d e f
p Fees and contracts from government agencies
2 Membership dues and assessments 3 Interest on savings and temporary cash investments
4 Dividends and interest from securities 5 Net rental income or (loss ) from real estate: a Debt-financed property b Not debt-financed property 6 Net rental income or (loss ) from personal property 7 Other investment income 8 Gain or ( loss) from sales of assets other than inventory 9 Net income or (loss ) from special events 10 Gross profit or (loss ) from sales of inventory 11 Other revenue: a
60.
b c d e
12 Subtotal. Add columns ( b), (d), and ( e) 13 Total . Add line 12, columns ( b), (d), and ( e) (See worksheet in line 13 instructions to verify calculations.) 0. 0. 13 60. 60.
PartXVI - B
Line No . y
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).
INTEREST INCOME , TOGETHER WITH CONTRIBUTIONS AND GIFTS RECEIVED , WILL E USED TO FUND RE QUIRED & PRIMARILY CHARITABLE ACTIVITIES
12-0i1o
Form 990 -PF 2010 THE ADELMAN FAMILY FOUNDATION , INC 06-1537647 Part XVII 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 the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting foundation to a noncharitable exempt organization of. (1) Cash (2) Other assets b Other transactions: (1) Sales of assets to a noncharitable exempt organization (2) Purchases of assets from a noncharitable exempt organization
Pa a 13
Yes No
la ( l ) la ( 2 ) 1b 1 lb ( 2 )1
X X X X X X X X X
(3) Rental of facilities, equipment, or other assets lb ( 3 ) (4) Reimbursement arrangements lb ( 4 ) (5) Loans or loan guarantees lb ( 5 ) (6) Performance of services or membership or fundraising solicitations lb ( 6 ) Sharing of facilities, equipment, mailing lists, other assets, or paid employees tc 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
2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax - exempt organizations described E] Yes in section 501 ( c) of the Code ( other than section 501(c)(3 )) or in section 5279 b If "Yes, complete the following schedule. (c) Description of relationship (b) Type of organization (a) Name of organization
No
N/A
of pre
a that I have examined this return , including accompan in schedules and statements and to the best of m knowled a and belief it is true correct er (other than taxpayer or fiduciary) is based on all mt
Here
r
Slgna ure of o
Prm
r or tru
Preparer's signature
a prepar is name
CPA
023622 03-04-11
INC
06-1537647
Form 990-PF
Statement
Source NAUGATUCK SAVINGS BANK Total to Form 990-PF, Part I, line 3, Column A
Amount
60. 60.
Form 990-PF
Accounting Fees
Statement
(a)
Description TAX PREPARATION Expenses Per Books 525.
(b)
Net Investment Income 0.
(c)
Adjusted Net Income
(d)
Charitable Purposes
0. 0.
525. 525.
To Form 990-PF, Pg 1,
In 16b
525.
0.
Taxes (b)
Net Investment Income 0.
Statement (c)
Adjusted Net Income 0.
(d)
Charitable Purposes 2.
To Form 990-PF, Pg 1,
In 18
2.
0.
0.
2.
Form 990-PF
Other Expenses
Statement
(c) Adjusted
Net Income
50. 50.
0. 0.
0. 0.
To Form 990-PF, Pg 1, In 23
Statement(s) 1, 2,
3,
INC
06-1537647 Statement 5
Form 990-PF
Other Basis
Book Value
180. 180.
180. 180.
0. 0.
Statement(s)
INC
06-1537647
Statement 6
Form 990 - PF
ANTICIPATED ADMINISTRATIVE EXPENSES OF $500 AND A SCHOLARSHIP DISTRIBUTION(S) OF $1500; DUE TO THE SMALL BALANCE OF ASSETS, 1 1/2% OF ASSETS IS TOO SMALL TO REASONABLY COVER DISBURSEMENTS.
Statement(s)
INC
06-1537647
Statement 7
Statement(s)
INC
06-1537647 Statement 8
Name and Address of Person to Whom Applications Should be Submitted GERARD ADELMAN 562 BALDWIN AVENUE, MERIDEN , CT 06450
A-2,
#2
Form and Content of Applications SUBMISSION ON AN OFFICIAL APPLICATION FORM, TOGETHER WITH A HIGH SCHOOL TRANSCRIPT, PROOF OF ACCEPTANCE INTO A NURSING PROGRAM AND 3 REFERENCE LETTERS
Restrictions and Limitations on Awards RECIPIENT NEEDS TO: 1)BE A RESIDENT OF MERIDEN, CT OR 2) ATTENDING OR GRADUATED FROM ONE OF THE THREE HIGH SCHOOLS LOCATED IN MERIDEN, CT. AND 3)PURSUING THE STUDY OF REGISTERED NURSING.
Statement(s)