Form 990-PF Return of Private Foundation ' Treated as a...

990-PF Return of Private Foundation Form or Section 4947(ax1) Nonexempt Charitable Trust

' Treated as a Private Foundation

Department of the Treasury Note : The organization may be able to use a copy of this return to saftsfy state Inlamal Revenue Service reporting requirements

OMB No 15450052

2003 For calendar car 2003 or tax ear beginning 11/01 2003 and end G Check all that app ly - Initial return Final return Amended return Use the IRS label THE RON AND DEBRA HARRIS CHARITABLE Otherwise, FOUNDATION INC print ortyUe390 FARMS ROAD .

See Specific STAMFORD, CT 06903 Instructions .

10/31 .2004 ess change I I Name cha

Employor VdanlHVcet{on number

13-3793221 IbIUpNOllU "W"'bUr (7;0Q 111JUuC6011v)

C II exemption application is pondmp, check hero 11 I I D 1 Foreign orgnnuoUOns, check pore

2Foreign organizations meeting the 85% test, check a here and attach computation

E I( private foundation status was terminated under section 501(b)(1)(A), check here

F I( the foundation is in a 60-month termination under section 507(b)(1)(B), check here

H Check type of organization : U Section 501(c)(3 exompl pi vate foundation

[] Section 4947 a 1 nonexom t charitable trust Other taxable private foundatioll mr market value o a assets u en o year J Accounting method [J Cash U Accrual

(hour Pat f ll, column c, lino !G) [_~ Other (specify) I. $ 4 , 882 , 343 . Part l, column d must be on cash bass

pAW -J Anal sic of Revenue and (d) Disbursements (or charitable purposes

(cash bass only)

EX total of amounts in (a) Revenue and I (b) Net investment (c) Adjusted net

Expenses (1'he expenses per books income income columns b, c, and d may not neces~ sarily equal the amounts in column a ) see instructions)

1 Contiibutions, pelts, grants, etc, received (alt sch)

Ck " Nd the found i5 not rBq l0 ill SCh B

2 Distributions from split-interest trusts . . 3 Interest on savings and temporary

cash investments . . 54 , 194 . 4 Dividends and interest from securities 83 , 684 . 5a Gross rents . . . . . . . . . . . b (Net rental

income or (1055) ) 6 a Not pain/(loss) from solo of assets not on line IQ 1 0 9 , 736 . b cross sales Prices for nn 868 094 . E assets on line 60

V 7 Capital gain not income Groin Part IV . line 2) 8 Net short-term capital gain, . . . 9 Income modifications . l0a Gross sales less . , , .

t1j E returns and allowances . . . . .

b Less : Cost of goods sold. .

Z c Gross profit/(loss) (att sch) 11 Other income (attach schedule) .

V SEE STATEMENT 1 21 , 856 . (n 12 Total. Add lines 1 through 11. . . . 269 , 470 .

13 Compensation of officers, directors . trustees . etc 14 Other employee salaries and wages 15 Pennon plans, employee benefits

m 16a Legal fees (attach schedule) b Accounting fees (attach sch) $ZE ST 2. 200 . c Other pros fees (attach sch) SEE ST 3 31 000 .

E T 17 Interest if R 18 Taxes (attach schedule) . SEE .STMT 4 11 . A A T T 19 Deprecation (attach schedule) and depletion N v 20 Occupancy c E 21 Travel, conferences, and meetings

22 Priming and publications 90 . P o 23 Other expenses (attach schedule)

SEE STATEMENT 5 4 , 863 . 24 Total operating and administrative

0 . 4

expenses. Add lines 13 through 23 36 , 164 . 31 , 301, 25 Contributions, gifts, grants paid PART XV 510 , 000 . 26 Total expenses and disbursements .

Add lines 24 and 25 546,164 . 31,301 . 27 Subtract line 26 from line 12 :

a Excess of revenue over expenses and disbursements -276 694 .

b Nat investment income (if negative, enter 0 ) 21 6,313 .

C Adjusted net income (if negative, enter -0 )

BAA For Paperwork Reduction Act Notice, see the instructions . TEEA0503L 08/18103 Form 99U-PF (2003)

~vv

59,194 .

510 000 .

0 . 510,000 .

t a 27 Capital stock, trust principal, or current funds s n 28 Paid-in or capital surplus, or land, building, and equipment fund

29 Retained earnings, accumulated income, endowment, or other funds o e r s 30 Total net assets or fund balances (see instructions)

31 Total liabilities and net assetslfund balances see instructions

Part III Analysis of Changes in Net Assets or Fund Balances 4,554, 681 4,277, 987 .

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 1, line 27a 3 Other increases not included in line 2 (itemize) 4 Add lines l, 2, and 3 5 Decreases not included in line 2 (itemize) 6 Total net assets or fund balances al end of year (line 4 minus line 5) - Part II, column (b), line 30

BAA TEEA0302L 08/15/03

4,554,681 . -276,694 .

4,277, 987 . Form 990-PF (2003)

nning of year Book Value

141, 597 .

16,538

2,383,860 1,762,736

250,000

9, 554, 681

0 .

4,554,681 4,554,681

13-3793221 End of year

(b) Book Value (c) Fair Market Value 151 998 . 151 998 .

- -- -

--- - ----

8,_019 . 8 , 019 .

1 , 469 , 950 . 1 , 821 , 735 . 861 813 . 916 , 792 .

1 , 786 , 207 . 1 983 799 .

--

4,277,987 . 9,882,393 .

0 .

4,277, 987 . 4,277, 987 .

4,277, 987 .

Form 990-PF 2003 THE RON AND DEBRA HARRIS CHARITABLE Attached schedules end amounts ~n the dUSGipliOn

Part fl Balance Sheets column should be for end-of year amounts only (S 'n truction ) Is- ~ s s.

1 Cash - non -interest -bearing

2 Sarongs and temporary cash investments

3 Accounts receivable . . . . . . . . . Less allowance (or doubtful accounts I -

4 Pledges receivable . . . . . . .

. . .

I -_

Less' allowance for doubtful accounts'

5 Giants receivable . ., . . . . . . . . . . . . . . . . . . . .

6 Receivnbles due from officers, directors, trustees, and other disqualified persons (attach schedula) (sae instructions)

7 Other notes and loans rocoivoblo (attach sch) .

Less allowance for doubtful accounts 'I'

s 8 Inventories for sale or use . . . . . . . . . . . . . . . . 9 Prepaid expenses and deferred charges . t

s 10a Investments - U.S . and slate government obligations (attach schedule) . . . . . . .

b Investments - corporate stock (attach schedule) STATEMENT 6

c Investments - corporate bonds (attach schedule) STATEMENT 7

11 Investments - land, buildings, and equipment : basis . . . .

Less accumulated depreciation (attach schedule) . . . . . . . .

12 Investments - mortgage loans .

13 Investments - other (attach schedule) STATEMENT. 8

14 Land, buildings, and equipment. basis

Less accumulated depreciation (attach schedule) . . . . . . . . . . .

15 Other assets (describe 01 ) 16 Total assets (to be completed by all filers -

see instructions . Also see page 1, item I

17 Accounts payable and accrued expenses . . .

18 Grants payable . . . . . . . b 19 Deferred revenue . . . . . . . . . . . . . . .

20 Loans from officers, directors, trustees, 8 other disqualified persons I i 21 Mortgages and other notes payable (attach schedule). .

22 Other liabilities (describe. 01 - _ _ _ _ ) e

23 Total liabilities add lines 17 through 22 Organizations that follow SFAS 117, check here -;T and complete lines 24 through 26 and lines 30 and 31 .

N F 24 Unrestricted . . . e u t n 25 Temporarily restricted .

d 26 Permanently restricted

s B Organizations that do not follow SFAS 117, check here s a and complete lines 27 through 31 . e I

Form 990~PF 2003 THE RON AND DEBRA HARRIS CHARITABLE 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 back warehouse, or common stock, 2(O0 shares MLC Company)

1a SEE SCHEDULE ATTACHED

J How acquired C Date acquired (d) Dote sold P - Purchase (month. day, year) (month, day, yeas) D - Do nation

P VARIOUS VARIOUS P VARIOUS VARIOUS P 9/07/97 VARIOUS

(g) Cost or other bisis plus Elxpeii50 0l salp

283, 643 . 474, 715 .

(Q De reciation allowed r allowable)

179 . 1,309 . 590 .

(I) Gams (Column (h) gain minus column (k), but not less than ~0 ) or Losses (from column (n))

in column h and owned b the foundation on 12/31/69 Q) Adjusted bass (k) Excess of column (i) as of 12/31/69 over column Q), if any

94,772 . 179 .

1,309 . 590 .

09,736 .

c d

2 Capital gain net income or (net capital loss) .-F If gain, also enter in Part I, line 7 If loss), enter -0- in Part I, line 7

3 Net short-term capital gam or (loss) as defined in sections 1222(5) and (6)

If am also enter in Part I, line 8, column (c) (see instructions) If (loss) enter ~0-

TEEA0303L 08/15/03

13-3793221

c BOEING CO COM d LEGATO SYS INC COM o BANK AMER CORP

(e) Gross sales pace

a 296, 529 . b 569,987 . c 179 .

c 590 .I Complete only for assets showi

(i) Fair Market Value as of 12/31/69

a

P .0/01/98 1 VARIOU (h) Gain or (loss)

(e) plus (1) minus (g)

in Part I, line 8 . . . . . . . . . . . . . . . . . . . . . . 3 0 . Part V 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 organization liable for the section 4942 tax on the distnbutable amount of any year in the base period? 1-1 Yes Xa No If 'Yes,' the organization does not qualify under section 4940(e) Do not complete this part

1 Enter the appropriate amount m each column for each year ; see instructions before making any entries

a b c) d Base period years Adjusted qualifying distributions Net value of Distribution ratio

Calendar year (or tax year noncharitable-use assets (column (b) divided by column (c)) beginning in)

2002 268 , 857 . 5 , 056 , 124 . 0 .053168 2001 308 987 . 5 , 227 , 840 . 0 .059109 2000 279 000 . 6 178 999 . 0 .095157

9 335 500 . 6 , 671 , 003 . 0 .050292 1998 373 790 . 6 175 132 . 0 .060523

2 Total of line 1, column (d) 2 0 .268249

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 3 0 .053649

4 Enter the net value of noncharitable-use assets for 2003 from Part X, line 5 4 4, 882 915 .

5 Multiply line 4 by line 3 5 261 , 964 .

6 Enter 1 % of net investment income (1 % of Part I, line 27b) 6 2 , 163 .

7 Add lines 5 and 6 7 ~ 264,127 .

8 Enter qualifying distributions from Part XII, line 4 1 8 1 510, 000 .

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

BAA Form 99U-PF (2003)

13-3793221 Paae 4 Form iARRIS CHi 'art VI Excise Tax Based on Investment Income section 4940 (a), 4940 (b), 4940(e), or 4948 - sec 1 a Exempt operating foundations described in section 4940(d)(2), check here ' Hand enter 'N/A' on line I

Date of ruling letter _ - _ _ _ - _ .(attach copy of ruling letter it necessary - see instructions) b Domestic organizations that meet the section 4940(e) requirements in Part V, check here 11, X and enter 1 % of Part I, line 27b .

c All other domestic organizations enter 2% of line 21b. Exempt foreign organizations color A% of Part I, line 12, column (b) 2 Tax under section 511 (domestic section 4947(x)(1) trusts and taxable foundations only Others enter ~0~) 3 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Subtitle A (income) tax (domestic section 4947(x)(1) trusts end taxable foundations only Others onte~ ~0~) 5 Tax based on Investment Income . Subtract line 4 from line 3 . II zero or loss, enter ~0~. . . . 6 Credits/Payments . a 2003 estimated tax pmts and 1002 overpayment credited to 2003 . . . . . . . . . . . . 6 a S 019 .

2,163 . 0 .

2 , 163 .

8,019 .

5,856 .

2

b Exempt foreign organizations - tax withheld at source 6 b c Tax paid with application for extension of time to file (Form 8868) 6c d Backup withholding erroneously withheld . . . 6d

7 Total credits and payments . Add lines 6a through 6d . . 8 Enter any penalty for underpayment of estimated tax Check here 1-1 if Foam 2220 is attached 9 Tax due If the total of lines 5 and 8 is more than line 1, enter amount owed 10 Overpayment If line 1 is more than the total of lines 5 and 8, enter the amount overpaid 11 Enter the amount on line 10 to be: Credited to 2009 estimated tax . ~ 5,856 .1 Refunded 'art VII-A Statements ReqardinQ Activities

7 8 g

10 11

TEE-A03041 08115I03

2,163 .

1 a During the tax year, did the organization attempt to influence any national, stale, or local legislation or did it Yes No participate or intervene in any political campaign7 1 a X

b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for de(inition)7 1 b X

If the answer is 'Yes' to 1a or 1b, attach a detailed description o/ the activities and copes 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 (i( any) of tax on political expenditures (section 4955) imposed during the year

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

2 Has the organization engaged in any activities that have not previously been reported to the IRS 2 X 11 'Yes,' attach a 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? 11 'Yes,' attach a conformed copy of the changes 3 X

4a Did the organization have unrelated business gross income o1 $1,000 or more during the year? 4a X b If 'Yes,' has it filed a tax return on Form 990-T for this years 4b N VA

5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? 5 X 11 'Yes,' attach the statement required by General Instruction T

6 Are the requirements of section 508(e) (relating to sections 4947 Through 4945) satisfied ether " By language m 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 11 'Yes,' complete Part fl, column (c), and Part XV 7 X 8a Enter the slates to which the foundation reports or with which it is registered (see instructions) _--

N/A

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 stale as required by General Instruction G7 ll'No,'attachexplanation 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 2003 or ---the taxable year beginning in 2003 (see instructions (or Part Xlh? If 'Yes,' complete Part XlV 9 X

10 Did any persons become substantial contributors during the tax years 10 X 1/ 'Yes,' attach a schedule listing their names and addresses

11 Did the organization comply with the public inspection requirements for its annual returns and exemption application? 11 X Web site address 01 N/A

12 The books are in care of - MICHAEL I THALERI-CPA Telephone no - 516 938-5219 located at ' 100 JERICHO QUADRANGLE JERICHO NY ZIP + 4 ~ 11753

13 Section 4947(x)(1) nonexempt charitable trusts tiling Form 990-PF in lieu of Form 1041 - Check here NBA 01 and enter the amount of tax-exempt interest received or accrued during the year -1 13 ~ N/A

BAA Form 990-PF (2003)

5

b If 'Yes,' did it have excess business holdings in 2003 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 loner 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 periods Use Schedule C, Form 4720, to -- determine i/ the organization had excess business holdings in 2003.) 3b N A

4a Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes?, . . . . . , , . . . . . . . , 4a X

b Did the organization make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2003?. . . . . 4b ~ X

Sa 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))7 ~ Yes ~ No

(2) Influence the outcome of any specific public election (see section 4955), or to carry on, directly or indirectly, any voter registration drives 8 Yes B No

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

(4) Provide a grant to an organization other than a charitable, etc, organization described in section 509(a)(1), (2), or (3), or section 4940(d)(2)7 ~ Yes Z No

(5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals7 a Yes X No

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 mstructions)7 5b N IA Organizations relying on a current notice regarding disaster assistance check here

c If the answer is 'Yes' to question 5a(4), does the organization clam exemption from the lax because it maintained expenditure responsibility for the granf7 N/A a Yes [] No If 'Yes,' attach the statement required by Regulations section 534945-5(d)

6a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contracts 1:1 Yes X No

b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contracts 6b X 11 you answered 'Yes' to 6b, also file Form &470

BAA rEEa,oso5L osnsio3 Form 990-PF (2003)

Form 990-PF 2003 THE RON AND DEBRA HARRIS CHARITABLE 13-3793221 Page Part V11-B -1 Statements Regarding Activities for Which Form 4720 Ma Be Required

File Form 4720 if any item is checked in the 'Yes' column, unless an exception applies . Yes No 1 a During the year did the organization (ether directly or indirectly)

(1) Engage in the sale or exchange, or leasing of properly with a disqualified persons ~ Yes Xa No

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person?. . . . . . . . . . . . . . . . Yes X No

(3) Furnish goods, services, or facilities to (or accept Uhern frorn) a U1squAlihed persons Yes X No (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified poison? Yes X No

(5) Transfer any income or assets to a disqualified person (or mako any of oilhor available fog the benefit or use of a disqualified person) . . . . . . . . . . . . . . . . . . . L Yes X~ No

(6) Agree to pay money or property to a government official7 (Exception . ChCCk 'No' it llie or ganixation agreed to make a grant to or to employ the official for a period after taminalion of government service, if terminating within 90 days ) . . L Yes ~ No

b I( 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 nonce regarding disaster assistance (see instructions)? 1 b N A Organizations relying on a current notice regarding disaster assistance check here

c Did the organization engage in a prior year in any of the acts described in 7a, other than excepted acts, - that were not corrected before the first day of the tax year beginning in 2003 1 c ~ X

2 Taxes on failure to distribute income (section 4942) (does riot appl (or years the organization was a private operating foundation defined m section 4942Q)(3) or 4942~~(5))

a At the end of tax year 2003, did the organization have any undistributed income (Dries 6d and 6e, Part XI11) for tax year(s) beginning before 2003? Yes X No If 'Yes,' list the years " 20_ _ , 20_ _ , 20_ - , 19_

b Are there any years listed in 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 income? (I( applying section 4942(a)(2) to -all years listed, answer 'No' and attach statement - see instructions ) 2b N IA

c If the provisions of section 4942(a)(2) are bung applied to any of the years listed m 2a, list the years here 1" 20 , 20 , 20 , 19

3a Did the organization hold more than a 2% direct or indirect interest in any business enterprise at any time during the year? . . . . . . a yes Z No

Form 990-PF 2003 THE RON AND DEBRA HARRIS CHARITABLE 13-3793221 Part VIII Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,

and Contractors 1 List all officers , directors trustees foundation managers and their com ensation see instructions

(b) Tale and average (c) Compensation (d) Contributions to (e) Expense account, (a) Name and address hours per week (If not paid, enter -0-) employee benefit other allowances

devoted to position I plans and deterred comoensalion

0 .

lruclions . I( none entcr'NONE .' (d) Contributions to (e) Expense account, employee benefit other allowances plans and deferred

comoensation

other than those included on line 1- see (b) Title and average (c) Compensation

hours per week devoted to position

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

lion

Total number of others receiving over $50,000 for professional services

Part IX-A Summary of Direct Charitable Activities

List the foundation's tour largest direct charitable activities during the tax year Include relevant statistical information such as the number of I Expenses organizations and other beneficiaries served, conferenc es convened, resea r ch papers pr oduced, etc 1 N/A

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

2

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

3

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

4

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

BAA Form 990-PF (2003) TEEA0306L 08/1503

SEE STATEMENT 9 ---- ------------------- ------------------------

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

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

2 Compensation of five highest-bald em Q (a) Name and address of each employee

paid more than $50,000

NONE

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

Total number of other employees paid over $50,000 3 Five hi hest- aid inde endent contractors for professional services - see instructions ) . II none enter'NONE .'

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

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

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

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

Form 990-PF (2003) THE RON AND DEBRA HARRIS CHARITABLE 13-3793221

Parfi IX-B Summary of Program-Related Investments (see instructions)

i the foundation during the tax year on lines 1 Describe the two largest progr

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

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

All other prograrn~i elated investments . See instructions . 3

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

Total . Add lines 1 through 3 . . . . . . . . . . . . . . . . . . . . 'I 0 .

PBPt X Minimum 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 m 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 (see instructions) d Total (add lines 1a, b and c) e Reduction claimed for blockage or other factors reported on lines 11a and Ic

(attach detailed explanation) I 1 e 2 Acquisition indebtedness applicable to line 1 assets 3 Subtract line 2 from line ld 4 Cash deemed held for charitable activities Enter 1 .1/2% of line 3 (for greater amount, see instructions) 5 Net value of noncharitable-use assets . Subtract line 4 from line 3 Enter here and on Part V, line 4 6 Minimum investment return. Enter 5% of line 5 a XI Distributable Amount (see instructions) (Section a9a20)(3) and 0)(5) private opi

foretan oraanizations check here "' n

11a 4 , 810 , 501 . 1b 146 773 . 1c 1d 4 957 274 .

0 . 2 0 . 3 4 957 274 . 4 74 359 . 5 4 882 915 . 6 249 196 .

gating foundations and certain and do not complete this part )

244, 146 . 1 Minimum investment return from Part X, line 6 2a Tax on investment income for 2003 from Part VI, line 5 b Income tax for 2003 . (This does not include the tax from Part VI ) c Add lines 2a and 2b . . . . . . . . . . . . . . .

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

5 Add lines 3 and 4c . . . . . . . . . 6 Deduction from distributable amount (see instructions) 7 Distributable amount as adjusted Subtract line 6 from line 5 Enter h 241,983 . on Part XIII, line 1

TEEA0307L 0&1502

N/A

2

gal 2, 163 .

4a

2c 2 , 163 . s 241 983 .

4c 5 241,983 .

Part XII 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 510 , 000 . b Program-related investments - Total from Part IX-B 1 b

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 chat satisfy the a Suitability test (prior IRS approval required) 3a b Cash distribution test (attach the required schedule) 3b

4 Qualifying distributions Add lines 7a through 3b Enter here and on Part V, fine 8, and Part XIII, line 4 4 510,000 .

5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment income Enter 1 % of Part I, line 27b (see instructions) 5 2 , 163 .

6 Adjusted qualifying distributions . Subtract line 5 from line 4 6 507 , 837 .

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


Form 990-PF (2003) THE RON AND DEBRA HARRIS CHARITABLE 13-3793221

Part XIII Undistributed Income (see instructions)

corpus Years pno~ to 2002 20c02 20403

0 .

0 .

0 .

67 , 503 .

337 824 .

TEEA0308L 08115/03


1 Distribulable amount for 2003 from Part XI, line 7 . . . . . . . . . . . . . . . ,

2 Undistributed income, if any, as of the end of 2002: a Enter amount for 2002 only . . . . . . . . . . . . . . . . b Total for prior years- 20-, 20 _ 1 19 -

3 Excess distributions carryover, if any, to 2003: a Frorn 1998 . . . . . . 67 , 503 . b From 1999 . . . . . . . . 20 , 193 . c From 2000 . . . . . . . dFiom2001 . . . . . . . . . 99 614 . e From 2002 . . 1 Total of lines 3a through e . . . . . .

4 Qualifying distributions for 2003 from Part X11, line 4 11 $ 510,000 .

a Applied to 2002, 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 l0 2003 dislribulable amount . e Remaining amount distributed out of corpus

5 Excess distributions carryover applied to 1003 . . . . (If an 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 :

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

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

c Enter the amount of prior years' undistribut-ed income for which a nonce 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 2002 Subtract line 4a from line 2a Taxable amount - see instructions .

f Undistributed income for 2003 Subtract lines 4d and 5 from line 1 . This amount must be distributed m 2004

7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(6)(1)(E) or 4942(8)(3) (see instructions)

8 Excess distributions carryover from 1998 not applied on line 5 or line 7 (see instructions)

9 Excess distributions carryover to 2004. Subtract lines 7 and 8 from line 6a

10 Analysis of line 9 a Excess from 1999 20 , 193 . b Excess from 2000 c Excess from 2001 49, 614* d Excess from 2002 e Excess from 2003 268,017 .

137 .310 .

268,017 . 0 .

905 .327 .

0 .

0 .

0 .

0 .

291 .983 .

241, 983 .

0 .

0 .

Form 990-PF 2003 THE RON E 13-3793221 Paae 9

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

BAA TEEA0309L 08/15/03 Form 990-PF (2003)

Part XIV Private Operating Foundations see instructions and Part VII-A , q uestion 9 N/A 1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling

is effective (or 2003, enter the date of the ruling . . . . . b Check box to indicate whether the organization is a private o eratin foundation described in section 49420)(3 ) or 4942 5

2a Enter the lesser of the adjusted net Tax ear Prior 3 ears income from Part I or the minimum 2003 ~) 2002 c 2001 d 2000 e Total investment retain from Part X (or a each year listed . . . . . . . . . . . . .

b 8590 of line 2a . . . . . . . . . . . . . t Qualifying distributions from Part XII,

line 4 for each year listed . . . . . . . . . d Amounts included in line 2t not used directly

for octavo conduct of exempt activities . . . . . . . . . 0 Quah(ying distributions made directly

for ac livo conduct of exempt activities Subtract line 2d from line 2c . . . . . . .

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

a 'Assets' alternative test - enter' (1) Value of all assets . . . . (2) Value of assets qualifying under

section 49420)(3)(B)(i) . . . . b 'Endowment' alternative test - Enter 2/3 of minimum investment return shown m Part X, line 6 for each year listed . . . . . .

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

investment income (interest, dividends, rents,

Pa ymenls

on securities loans (section 512(a)(5)), or royalties) . . . . . .

(2) Support from general public and S or more exempt organizations as provided in section 4942(j)(3)(B)(iii) . . . . .

(3) Largest amount of support from an exempt organization . . . . . . .

4 Gross investment income . . . . . . . . . XV Su lementa Information (Complete this art onl y if the or g anization had $5 , 000 or more in assets at an y time during the 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 i( they have contributed more than $5,000) (See section 507(d)(2) ) SEE STATEMENT 10

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 1, X if the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests (or funds It 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

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

c Any submission deadlines

Form 990-PF 2003 THE RON AND DEBRA HARRIS CHARITABLE 13-3793221 Part XV Supplementary Information (continued) 3 Grants and Contributions Paid During the Year or Approved for Fut re Payment

II recipient is an individual, Foundation Recipient show any relationship to status of Purpose of grant or Amount any foundation manager or recipient conlnbut~on Name and address home or business substantial contributor recap

a Paid during the year DARTMOUTH COLLEGE ALUMNI FUND UNRESTRICTED 300,000 . RHODE ISLAND CONTRIBUTION

CYSTIC FIBROSIS FOUNDATION UNRESTRICTED 10,000 . CONTRIBUTION

STAMF'ORD HOSPITAL FOUNDATION UNRESTRICTED 200,000 . STAMFORD CT CONTRIBUTION

Total ~ 3a 510 000 . b Approved for future payment

Total 111- 3b Form 990-PF (2003) BAA rEEn0310L 12110103

Form 990-PF (2003) THE RON AND DEBRA HARRIS CHARITABLE 13-3793221 Page 71

Part XVI-A Analysis of Income-Producing Activities

Enter gross amounts unless otherwise indicated Unrelated business income Excluded b section 512 513 or 514

(a) (b) (C) (d) M Business Amount Exclu Amount Related or exempt code soon function income

1 Program service revenue* code see instructions a b c d e t g Fees and contracts from government agencies

2 Membership dues and assessments . . . . . 3 Interest on savings and temporary cash investments 14 54,194 . a Dividends and interest from securities . . . . . . 19 83 , 684 . 5 Net rental income or (loss) from real estate a Debt-financed property . . . . . . . . . . . b Not debt-financed properly. , . .

6 Net rental income or (loss) tram personal property 7 Other investment income . . . 8 Gain or (loss) from sales of assets other than inventory 18 109 , 736 . 9 Net income or (loss) from special events 10 Gross profit or (loss) from sales of inventory 11 Other revenue

a -FEDERAL TAX REFUND 21 , 856 . b c d e

12 Subtotal Add columns (b), (d), and (e) . . . 21,856 . r -~ 297, 619 13 Total . Add line 12, columns (b), (d), and (e) . . . . . . . . . . . 13 269,470 . (See worksheet in the instructions for line 13 to verify calculations .)

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

BAA TEEAOSOII 08115/03 Form 990-PF (2003)

Form 990-PF 2003 THE RON AND DEBRA HARRIS CHARITABLE 13-3793221 'Part XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations

Paae 12

Yes No 1 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 organization to a noncharitable exempt uigarnzalion of Cash . . . . . . . . . . . . . . . . . . . . . . . . _ 10 - 1 ) X

(2) Other assets . . . . . . . . . . . . . . . . . . . . . . . . la (2) X b Other transactions : - -

(1) Sales of assets to a noncharilable exempt organization , . , , . . . . . . . . . . . 1 b 1 X (2) Purchases of assets from a noncharilpble exempt ofganixation . . . . 1 b (2I X

(3) Rental of facilities, equipment, or other assets . . . . . . . . . . . . . . . 1 b 3 X (4) Reimbursement arrangements . . . . . . . . . . . . . 1 b 4 X (5) Loans or loan guarantees . . . . . . . . . . . . . . . . . . . . . 1 b L5) X (6) Performance of services or membership or fundraising solicitations 1 b 6 X

c Shaiing of facilities, equipment, mailing lists, other assets, or paid employees ~ 1 c ~ ~ X

d Ii 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 an transaction or sharing arrangement , show in column d the value of the goods, other assets, or services received

a Line no b Amount involved c Name of noncharitable exem pt organization d Descri ption of transfers , transactions , and sharing arrangements N/A

2a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501 (c) of the Code (other than section 501(c)(3)) or in section 527 0Yes Xa No

b I( 'Yes .' complete the followma schedule

s c N

H E R E

FEDERAL STATEMENTS THE RON AND DEBRA HARRIS CHARITABLE

FOUNDATION INC

FEDERAL TAX REFUND . . $ 2,~1 856 . TOTAL $ 21,84-

.: 56 .

STATEMENT 5 FORM 990-PF, PART I, LINE 23 OTHER EXPENSES

(A) (B) NET (C) (D) EXPENSES INVESTMENT ADJUSTED CHARITABLE PER BOOKS INCOME NET INCOME PURPOSES

TOTAL $ 0 . $ 0 . $ 0 . $ 0 .

2003

STATEMENTI FORM 990-PF, PART 1, LINE 11 OTHER INCOME

PAGE 1

13-3793221

STATEMENT 2 FORM 990-PF, PART I, LINE 16B ACCOUNTING FEES

STATEMENT 3 FORM 990-PF, PART I, LINE 16C OTHER PROFESSIONAL FEES

CUSTODIAL FEES . . .

STATEMENT 4 FORM 990-PF, PART I, LINE 18 TAXES

FOREIGN TAX PAID


$ 200 . $ 200 . TOTAL 200 . $ 200 . $ 0 . $ 0 .


31 000 . $ 31,000 . TOTAL 31,000 . $ 31,000 . $ 0 . $ 0 .


$ 11 . $ 11 . TOTAL $ 11 . $ 11 . $ 0 . $ 0 .

FEDERAL STATEMENTS PAGE 2 THE RON AND DEBRA HARRIS CHARITABLE

FOUNDATION INC 13-3793221

2003

HOWARD PRESANT DIRECTOR 0 . 0 . 0 . 685 THIRD AVE NONE NEW YORK, NY 10017

TOTAL $ 0 . $ 0 . $ 0 .

STATEMENT 6 FORM 990-PF, PART 11, LINE l OB INVESTMENTS - CORPORATE STOCKS

VALUATION BOOK FAIR MARKET QQ$2ORATE STOCKS METHOD VAI,J~ VAT,SjF

COST 1, 469, 950 . 1 821 , 735 . TOTAL , 49, 950 . 1, 821, 735 .

STATEMENT 7 FORM 990-PF, PART II, LINE lOC INVESTMENTS - CORPORATE BONDS

VALUATION BOOK FAIR MARKET CORPORATE BONDS METHOD VALUE VALUE

COST $ 861,813 . $ 916,792 . TOTAL $ 861,813 . $ 916,792 .

STATEMENT 8 FORM 990-PF, PART II, LINE 13 INVESTMENTS-OTHER

VALUATION FAIR MARKET METHOD VALUE VALUE

OTHER INVESTMENTS COST $ 1,786,207 . $ 1,983,799 .

TOTAL $ 1,786,2 07 . $ 1, 983, 799 .

STATEMENT 9 FORM 990-PF, PART VIII, LINE 1 LIST OF OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES

TITLE AND CONTRI- EXPENSE AVERAGE HOURS COMPEN- BUTION TO ACCOUNT/

NAME AND ADDRESS PER WEEK DEVOTED SATION EBP & DC OTHER

RONALD HARRIS PRESIDENT $ 0 . $ 0 . $ 0 . 340 FARMS ROAD NONE STAMFORD, CT 06903

DEBRA HARRIS VICE PRESIDENT 0 . 0 . 0 . 340 FARMS ROAD NONE STAMFORD, CT 06903

ACCOUNT ft 9525800571 TAX ID 323-40-0831 FROM 11/01/03 TO LO/ 3L/04 FISCAL YEAR : L2/31

CUSIP V DATE SOLD/ PROPERTY DESCRIPTION ACQUIRED -------------------- ----------

SHORT TER14 CAPITAL CAIN (LOSS) - POST 5/5/2001 ----------------------------------------------

300 SHARES OF LL/12/03 AIdERISOURCEBBRGEN CORD COM 07/23/07

100 SHARES OF 11/12/03 Ab1ERLS0URCE8£RGBN CORP COM 08/05/03

200 SHARES OF 11/12/03 RMBRISOURCB9BRGEPf CORD COM 08/L4/03

30 .000000 SHARES OE 01/12/09 ORACLE CORP COhi 43/25/03

300 SHARES OF 02/12/04 11 W G[2r1iNGER INC COM 10/07/07

250 SElAR13S of 02/19/04 INTUIT COM 09/22/03

30D S'HAIitSJ VC WEATHERPORD INTERNATIONAL LTD 09/22/0] COm

200 SHARES OF OS/LO/04 Pt\N'bSiE H1AE COM 05/14/03

204 SHARES OF 05/10/04 P.4iVNIE MAE COM LL/12/03

400 SHARES OE 05/10/04 iCRSSPY KRS14H DOUGHNUTS INC COPT 44/15/U4

300 SHARES OF 05/LD/04 K,RCSPY KRBN6 DOUGHNUTS INC COM 04/22/04

300 SHARES OP 06/24/04 Fu~IAzou corn INC core oz/a5/oa

240 SHARES OF 06/24/04 Ab1AZON COi4 [VC COM 02/20/04

700 SHARES OF 06/24/09 ('_OMCAST FlI,DGS INC CL A 0'7/03/03

an

m

N

a a 0 s CJ

E

E 0

0

N

0 1

N

12,489 .58

13,856 .00

13,290 .56

10,419 .00

13,E09 .00

9,065 .48

21,647 .15

2),650 .55

13,650,54

8,391 .99

6,293 .61

15,288 39

10,192 26

19,593 .24

L, L60 97

(205 .61

(4,899 07)

(4 ,125 .39)

1, 479 .39

1,126.78

(2,053 .91)

N O O

a

N

m

N

m N M

N

9fACHOVfA BANK, N .A . Gain and Loss Report RON ANA DEBORAH HARRIS WACHOVLA SANK, N,A .

CHARITABLE POL13dDATCON AGE`ICY ACCOUNT

GAIN AND LOSS DETAIL

PROCEEDS OP SALE

18,857_45

6,285 82

12,571 .63

4,42 .08

14,449 .72

11, 356 97

11 .140_17

COST

20,003 .52

6,058 .00

12,273 .70

3,402 .00

14,901 .09

12, 483 .45

11, 205 . 72

PAGE 1 AS 0? 09/01/05 RUN S8p OL 0

1

GAIN OR CUSS

(L, 146 .07)

227 .82

247 .91

940 .08

(451 .17)

(!,126 .=8)

1,934 .45

ACCOUNT # 9525800571 TAX ID 323-40-0831

CID FROM 11/01/03 TO 10/31/04

,i FISCAL YEAR . 12/31

WACHOV CA BAdX, N . A Gain and Loss Report

RON AND DEBORAH HARRIS WACNOVIA BANK, Pl .A .

CFARiTAHLE FOUNDATION AGENCY ACCOUNT


CUSLP a/ DATE SOLD/ PROCEEDS PROPERTY DESCRIPTION ACQUIRED OP SALE -------------------- ---------- -------- --------

SHORT TERM CAPITAL GAIN (LOSS) - POST 5/5/20Q3 - CONTINUSO ---------------------------------------------- 300 SHARES OF OE/24/04

COMCAST HLDGS LP1C CL A 07/25/03

800 SHARES OF X6/24/04 DEERE & CO COhI 07/02/03

LOGO SHARES OF 06/24f04 r4ETL3FE IfIC COhi 07/25/03

600 SHARES OE 07/28/44 DISNEY (HALT) COMPANY HOLDING 02/19/09 COMPANY COM

800 SHARBS OF 09/17/04 ALTSRA CORP CONi 02/26/44

TOTAL SHORT TER1Q CAPITAL CALM (LOSS) - POST 5/5/2003

8,786 .70 (389 .60)

36,880 .00 18,526 .70

28,740 .00 6,569 17

16,110 .00 (2,454 .32)

8,397 .!0

55,406 .7U

35,309 .17

13,655 .66

15,696 .83 18,222 .15 (2,525 .3))

296,529 .40 283,543 .11 12,886 29

co m

N Q tD

M O N

Q

0 S U

E

E cn 0 v

0 0 N

O 1

N

0 0

a

N

m N

PAGB 2 AS OP 09/01/05 RUN SEP 0 L 05

t

COST CAC[I OR LASS ------------

ACCOUNT # 9525840571 t4ACHOVLA BANK, N .A . PACE'3 TAX ]D 323-40-0831 Gain and Loss Report AS OF 09/01/05 FROM 1!/01/03 RON AND DEBORAH HARRIS RUN SEp 01 OS TO 10/31 /04 'rIr1C}(O'! I A BANK, N . A . FISCAL YEAR : 12/31 CHll1RC'!'I+BLB FOLWDATION AGENCY

ACCOUNT

GAIN AND LOSS DETAIL v 0

CUSIP ~/ DATE SOLD/ PROCEEDS PROPERTY DESCRIPTION ACQUIRED OF SALE COST GAIN OR LOSS -------------------- ---------- -------- ------------ N

LONG TERM CAPITAL GAIN (LOSS) - POST 5/5/2003 --------------------------------------------- ---------------------------------------------

300 .000000 SHARES OF OL/12/D9 8,078 .15 4,902 .00 3,176 .35 CLSCO SYS INC CODS 02/20/02

200 .OOOODO SHARES OED 01/19/04 10,58U_99 10,937 .26 (356 .27) 'r1AL 14ART STORES INC CObI 06/30/00

LOOU SHARES OF 02/i2/04 68,145 .21 51,948 .00 16,197 .21 .4V0`1 PRODS INC CODl 11/1S/02

m

300 SHARES OP 02/19/04 17,522 .18 16,405 .89 1, 116 .29 cli

P1AL MART STORES INC COM 06/3Q/00

200 SHARES OF 02/25/04 9,786 40 8,939 .67 896 .73 AFFILIATED COMPUTER SVGS INC CV 10/23/02 A

200 SFiARBS OF 02/25/44 9,786 .44 9,072 .00 714 .40 AFFiLIATBD COMPUTER SVCS INC CL 10/21/02 A

722 000000 SHARES OP 03/19/04 22,655 .09 21,370 .26 1,284 76 COVOCOPF{CLLIPS COPt 03/12/41

2000 SHARES OF 04/06/04 75,798 .22 56,079 .00 19,719 .22 ti PRAXAIR INC COM 11/19/02 cn 0 "' La5 .22 SHARES OF 09/05/09 10,113 .42 9,037 .86 475 .56

CONOCOPHLLLLPS COM 03/L2/OL 0

654 .78 SHARES OP 04/06/04 45,600 29 41,554 .78 3,645 .46 COPIOCOPHLLLIPS CON O4/2b/O1

E O

1000 SHARES OP 04/06/04 12,628 80 9,178 .50 3,250 30 ORACLE CORP C0:! GB/19/02

5DI SHARES OF 04/06/04 6,314 40 5,676 .00 644 40 °v ORACLE CORD CaDt 03/25/03

100 SHARES OP 04/06/04 3,713 91 3,856 .00 (142 .09) o IiOhtg DEPOT INC C0M 06/19/02 0 N

O 1

H

ACCOUNT # 9525800571 WACHOVCA BANK, N .A . PAGE 4 'PAX ID 323-40-0831 Gain and Loss Report AS OF 09/01/05 FROM 11/D1/03 ROft AND DEBORAH HARRIS RUN SEP OL 05 'CO 10/31/04 91ACHOVZA BANK, N .A . PCSCAL YEAR : 12/3! CHARITABLE FO MATEON AGENCY

ACCOIlVT

GAIN AND [ASS DETAIL 0 ° CUSIP #/ DATE SOLD/ PROCEEDS

PROPERTY DESCRIPTIOPf A(`Q(lCRBD OF SALE COST CAIN OR LOSS

(V -------------------- ---------- -------- ---- ------------

LONG TERt9 CAPITAL GAIN (LOSS) - POST 5/5/2003 - CONTINUED LONG ---------------------------------------------

30D SHARES OF 04/D6/OQ 11,L41 .74 11,343 .0 (2x1 .26) f{OME DEPOT INC COM U6/25/02

500 SHARES OF 04/06/04 12,414 .71 21,850 .00 (9,435 29) SEC COP114UNICATIONS INC COI"I 07/17/OL

500 SHARES OF 44/06/04 12,914 .71 22,05E .30 (9,643 .59) SBC COMMUNICATIONS INC COM 47/18/01

0 150 SHARES OF 04/06/04 13,315 .07 8,986 .50 4,328 .57 `" UN27gD TECHNOLOGIES CORD COM 08/14/02

300 SHARES OF Q5/09/04 13,L40 .18 11,934 .00 1,206 .18 WBATHERPORD INTERNATIONAL LTD 03/24/07 cort

200 SHARES OF 06/24/04 13,851 .68 8,216 .34 5,635 .34 DEERE & CO COt9 04/1D/O]

30 SHARES OF 06f24/04 818 .68 979 .03 tivv »i HOSPIRA INC-W/I 03/21/02 COM

m

3) SHARES OF 06/29/04 818 .68 865 75 (47 07) HOSPCRA INC-(J/I D6/03/02

o COhi N

Q 90 SHARES OF 06/29/04 1,091 .58 949 .53 147 05 o HOSPIRA INC-W/[ 03/2x/03

c~ COhS

0 1500 SHARES OF 06/24/04 73,157 .29 56,565 .62 16,687 .67 t49D7FtONIC iNC C014 04/29/L999

800 SHARES OF 06/24/04 38,247 .10 16,157 .74 22,089 36 MERCK & CO INC COhi 03/15/1995 co

0 v

200 SHARES OF 06/24/04 9,561 .76 12,595 .46 (2,981 .68) MERCK & co INC com 07/13/1958

o° 200 SHARES OF 06/24/04 9 .561_ .78 10,384 .56 (822 78) `i MERCK & CO INC COW x5/20/03 0

fn

ACCOUNT # 952580D57L TAX ID 323-40-0831 FROM 11/01/03 TO 10/31/04 FISCAL YEAR ; 12/3L

(JACNOVIA BAtIK, N.A . Gain and Loss Report RON AND DEBORAH HARRIS FIACEEOVZA BANK, N.R .

CHARITABLE FOUNDATION AGENCY ACCOUNT


CUSIP 1#/ DATE SOLD/ PROCEEDS PROPERTY DESCREPTrom ACQUIRED OF SALE -------------------- ---------- -------- --------

COST

LONG TERM CAPITAL GAIN {LOSS) - POST 5/5/2003 - CONTINUED --------------------------------------------- 225 SHARES OF 09/09/04

NIKE INC CL B COM 81/07/03

225 SHARES OF 09/09/04 NIKE INC CL B COM 01/10/03

500 SHARES OP 09/17,/04 'CEXAS fP75TRS INC COM 05/08/03

100 SHARES OE 10/14/04 DEVON &N ERGY CORP NEW COM 06/07/01

100 SHARES OED 10/14/04 DEVON ENERGY CORP MEW COM 06/08/01

TOTAL LONG TERM CAPCTAL GAIN (LOSS) - POST 5/5/2003

16,877 .80 10,327 .07

16,877 .80 10,908 .00

10,864 .75 9,410 .0

7,305.23 5,631 .00

7,306 .22 5,557 .00

569,487 .39 474,715 .15

6,550.73

5,9E9 .80

1,959 .75

C, 675 .23

1,749 .22

94,772 .20

N

m 0 (V

Q

S U Q

1 E 0

E ca 0

u7 0 0 N

O 1

a a

a

N

r'-

9.0

N

PAGEr5 . AS OF 09/01/05 R(R1 SE? 0t OS

GAIN OR LOSS ------------

Form 8868 Application for Extension of Time to File an (Decemper 2000) Exempt Organization Return OMB No 1545-»09 Department of the Treasury Internal Revenue Service ~ File a separate application for each return

If you are filing (or an Automatic 3-Month Extension, complete only Part I and check this box . . . . II you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 0l this form)

Note : Do not complete Part 11 unless you have already been granted nn automatic 3-month extension on a previously tiled Form 8868.

Part I Automatic 3-Month Extension of Time - Only submit original (no copes needed) Note : Form 990-T corporations requesting on automatic 6-month extension - check this box end complete Part I only . . . .

All other Corporations (including Form 990 "C tilers) must use Form 7001 to request nn extension of tune to file income fnx returns . Partnerships, REMICS and trusts must use Form 8736 to request an extension of lime to ldo Form 1065, 1066, or 1041

I Name of Exempt Oipandxnli0n I Employer Identification number

Typo or prlnt FIIe by the due date for tiling your return See instructions

13-3793221

340 FARMS ROAD state ZIP code City . town or post office For a foreign address, see instructions

STAMFORD, CT 06903 Check type of return to be filed (file a separate application for each return)'

Form 990 Form 990~T (corporation) Form 4720 Form 990-BL Form 990-T (Section 401(a) or 408(a) trust) Form 5227 Form 990-EZ Form 990~T (trust other than above) Form 6069

X Form 990-PF Form 1041-A Form 8870 If the organization does not have an office or place of business in the United States, check this box I-. U If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) If this is for the whole group, check this box 01 F] . If it is for part of the group, check this box It, Fland attach a list with the names and EINs of all members the extension will cover .

1 I request an automatic 3-month (6-month, for 990-T corporation) extension of time until 9/15 , 20 05 , to file the exempt organization return for the organization named above The extension is (or the organization's return for

X R

calendar year 20 or tax year beginning 11/O1 , 20 03 , and ending 10/31 , 20 09

2 I( this tax year is (or less than 12 months, check reason : a Initial return Final return ~ Change in accounting period

3a I( this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions . . . . . . $ 2,163 .

FIFZ0501L 01105/04

THE RON AND DEBRA HARRIS CHARITABLE FOUNDATION INC Number, street, and room or suite number . II 0 P 0 box see instructions

b I( this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit $ 8,019 .

c Balance Due . Subtract line 3b from line 3a . Include your payment with this form,; r, if required, deposit with FTD coupon or, if required, by using EF7PS (Electronic Federal Tax Payment System) See instructions $ 0 .

Signature and Verification Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the bast of my knowledge and beret, it is true, correct, and complete and that I im authorized t0 prepare this loan

Signature "' Title ~ Date

BAA For Paperwork Reduction Act Notice, see instructions . Form 6868 (122000)

Form 8868 12.2000 Page 2 111~ N " I( you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box . . .

Note : Only complete Part 11 11 you have already been granted an automatic 3-month extension on a previously filed Form 8868.

" If you are filing for an Automatic 3-Month Extension , complete only Part I (on page 1 ) Part II Additional (not automatic) 3-Month Extension of Time - Must File Original and One

Name of Exempt Organization

Employer`

Id

Type or THE RON AND DEBRA HARRIS CHARITABLE print FOUNDATION INC 13-379

Numbs . SbUUI, arid room or suite number . II n P 0 box. 800 instructions Fog IRS}

uric

File by tire uMlonclod

hlnp'thu ~"` 340 FARMS ROAD ~uluin SOO city. lows or inwliuCtiOnA p0a1 office . state, and ZIP code, For D foreign address, 50o mAliucUOns .

.

STAMFORD CT 06903 Check type of return to be filed (file a separate application for each retut I))

R Form 990 Form 990~EZ R Form 990~T (Section 401(a) or 408(a) trust) A Form 1041 ~A A For in 5227 Form 990-BL X Form 990~PF Form 990-T (trust other than above) Form 4720 Form 6069

a Form 8870

By Director Dale

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

Name

LAZAR SANDERS, LLP Number and street (include suite, room, or apartment number) or a P 0 box number Type or

print

BAA

100 JERICHO QUADRANGLE STE 127 City or town, province or slate, end country (including postal or ZIP code)

JERICHO, NY 11753-2702 Form 8868 (Rev 12-2000) fIFZ0502L 01/05104

number

Stop : Do not complete Part II if you were not already ranted an automatic 3-month extension on a previousl y tiled Form 8868 . " If the organization does not have an office or place of business in the United States, check this box ll~

17 " If this is (or a Group Return, enter the organizations four digit Group Exemption Number (GEN) . If this is (or the

whole group, check this box . . 1" 7 If it is part of the group, check this box 01 [_~ and attach a list with the names and EINs of all members the extension is for . 4 I request an additional 3-month extension of time until 9/15 , 20 05 5 For calendar year , or other tax year beginning 11/O1 , 20 03 and ending 10/31 , 20 04 6 If this tax year is for less than 12 months, check reason : ~ Initial return ~Final return Change in accounting period 7 State in detail why you need the extension . TAXPAYER RESPECTFULLY _REQUESTS ADDITIONAL TIME TO

GATHER INFORMATION NECESSARY TO FILE A COMPLETE AND ACCURATE TAX RETURN . --- - - - - - -- - - - - - - - - -----------------------------------------------------------------

8a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions . . . . . . . . . $ 2,163 .

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

. $ 8,019 .

c Balance due. Subtract line 8b from line 8a . Include your paymenl with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) . See instructions $ 0 .

Signature and Verification under penalties of Poquiy. I declare that I have examined this form, including accompanying schadulos and statements, and to the best of my knowiodgo and belief . d is true . correct, and complete . and that I um authorized to prepare this form

signature ~ Title 11. Date

Notice to Applicant - To be Completed by the IRS We have approved this application Please attach this form to the organization's return We have not approved this application . However, we have granted a 10-day grace period from the later of the date shown below or the due date of the organization's return (including any prior extensions) This grace period is considered to be a valid extension of time for elections otherwise required to be made on a timely filed return Please attach this form to the organization's return We have not approved this application After considering the reasons stated in item 7, we cannot grant your request for an extension of time to file We are not granting a 10-day grace period .

We cannot consider this application because it was filed after the due date of the return for which an extension was requested - - - - -F1 Other

Form 990-PF Return of Private Foundation ' Treated as a...

Documents

Transcript of Form 990-PF Return of Private Foundation ' Treated as a...