Return of Organization Exempt From Income Tax...

Return of Organization Exempt From Income Tax OMB NO 1545-OQ

Form 990

, Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) Open to Public

2003 Department of the Treasury 1 Internal Revenue Service The or ga ni zatio n may h ave t o use a copy of this return to satisfy state reporting requirements 14spgctipn A For the 2003 calendar year, or tax year beginning and ending

B Check if P ~~e C Name of organization applicable

use IRS RNA JORGENSEN CHARITABLE TRUST Ochanges print

label or Y or ,~o_

1,O_

't ~2 O_0862500

Name, type Number and street (or P 0 box if mad is not delivered to street address) Initial Spesee cific /O KEYBANK 800 SUPERIOR, TRUST TAX

e~ ~nswc- ret~um ~0~5 City or town, state or country, and ZIP + 4 end- etum _ LEVELAND, OH 44114

91-6369099 Room/suite E Telephone number

( 216 ) 828-9535 F Accounting method a Cash a Accrual

Other , s ea

pen p,. .l BLon 0 Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts H and I are not applicable to section 527 organizations . must attach a completed Schedule A (Form 990 or 990-EZ) .

H I h f ff I 7 0 Y OX N No-N/A

J Organization type (dhxka~N«~e) " ~X 501c)`~X ) 1 " GnS~no) 04947(a)(t)or0 52

K Check here " 0 if the organization's gross r ipts are normally not more than $25,000 The organization need not file a return with the IRS, but if the organization received a Form 990 Package m the mad, it should file a return without financial data Some slates require a complete return . 101

M Check 10, L Gross receipts Add lines 6b, 8b, 9b, and 10b to line 12 . 716 , 455 . 62 ~ Sch B (Fi

park 1 Revenue Expenses, and Changes in Net Assets or Fund Balances 1 Contributions, gifts, grants, and similar amounts received

a Direct public support 1 a b Indirect public support 1b c Government contributions (grants) 1c d Total (add lines 1a through 1c) (cash $ noncash $

XJ if the organization is not required to attach rm 990,990-EZ,or990-PF)

0 .00

1z-»-a3 LHA For Paperwork Reduction Act Notice, see the separate Instructions . V Form 990 (2003) 1

10170506 758519 916369099 2003 .05040 ERNA JORGENSEN CHARITABLE T 91636901

D Employer identification number

(a) s t is a group return or a i sates es o H(b) If 'Yes," enter number of affiliates H(c) Are all affiliates included? N/A Yes No

(it 'No,* attach a list ) H(d) Is this a separate return filed by an or-

2 Program service revenue including government fees and contracts (from Part VII, line 93) 2 3 Membership dues and assessments 3 4 Interest on savings and temporary cash investments . . . 4 5 Dividends and interest from securities 5 250,788 .43

6 a Gross rents SEE STATEMENT 1 6a 263 , 538 .65 b Less' rental expenses SEE STATEMENT 2 6b 171,939 .29 c Net rental income or (joss) (subtract line 6b from pine 6a) 6c 91,599 .36

7 Other investment income (describe " 7 8 a Gross amount from sales of assets other A Securities B Other

d than inventory 152,491 .94 8a b Less cost or other basis and sales expenses 8b c Gain ~ 152 , 491 .94 8c

n ~c inn (A) and (B)) STMT 3 . . ed 152,491 .94 d Net m or =S 1 9 Spec al e nts and activities (attach sc ) If any amount is from gaming, check here " D

a Gros nu~~inc~di~g ~~04 of contributions repo A n line ia) ~ 9a

b Less dire a ~y aiSIR expenses 9b c Net i come ecl3~v nts (s tract line 9b from line 9a) 9c

10 a Gross sates of inventory, less returns and allowances 10a b Less cost of goods sold 10b c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) 10c

11 Other revenue (from Part VII, line 103) 11 49 , 636 .60 12 Total revenue add lines 1d 2 3 4 5 6c 7 8d 9c 10c and 11 12 544, 516 . 3 3

13 Program services (from line 44, column (B)) _ 13 599, 877 .72 N y 14 Management and general (from line 44, column (C)) _ 14 89,269 .04

a 15 Fundraising (from line 44, column (D)) _ 15 W 16 Payments to affiliates (attach schedule) _ 16

17 Total ex penses add lines 16 and 44 column A 17 689 , 146 .76 18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 -144 , 630 .43

N ~ d 19 Net assets or fund balances at beginning of year (from line 73, column (A)) _ 19 9 , 997, 470 .23 N ZQ 20 Other changes in net assets or fund balances (attach explanation) SEE STATEMENT 4 20 -6 902 .00

21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) 21 9 845 937 .80 323001

' ERNA JORGENSEN CHARITABLE TRUST 40-10-420-0862500 91-6369099

~~ Statement of All organizations must complete column (A) Columns (B), (C), and (D) are required for section 501(c)(3) 0 Functional expenses and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others

Do not include amounts reported on line p Total (B) Program (C) Management (D) Fundraising Rh Rh Qh 1 Oh nr 1R of Part 1 ( ) ~ services and general

22 Grants and allocations (attach schedule) cash E 599 877,72 noncashS 22

23 Specific assistance to individuals (attach schedule) 23 24 Benefits paid to or for members (attach schedule) 24 25 Compensation of officers, directors, etc 25 26 Other salaries and wages 26 27 Pension plan contributions 27 28 Other employee benefits 28 29 Payroll taxes _ 29 30 Professional fundraising fees 30 31 Accounting fees 31 32 Legal fees 32 33 Supplies 33 34 Telephone 34 35 Postage and shipping 35 36 Occupancy 36 37 Equipment rental and maintenance 37 38 Printing and publications . _ 38 39 Travel 39 40 Conferences, conventions, and meetings 40 41 Interest 41 42 Depreciation, depletion, etc (attach schedule) . 42 43 Other expenses not covered above (itemize) :

a STATE FILING FEE 43 . b ESTIMATES PAID WITH 431 c 990PF 431 d 431 e 431

599,877 .721 599,877 .7

0 .00 0 .0

1,960 .0

44 boa'~e«`~~"o~o~o~a~~s~~~`vm~ioa~'lines 13-1s1441 689,146 .76 599,877 .72 89,269 .04 0 . Joint Costs. Check " 1:1 if you are following SOP 98-2 Are any point costs from a combined educational campaign and fundraising solicitation reported in (B) Program services No- 0 Yes D No If 'Yes," enter (i) the aggregate amount of these joint costs $ , (ii) the amount allocated to Program services $ Gill the amount allocated to Management and general $ , and (iv) the amount allocated to Fundraising $

Statement of Program Service Accomplishments What is the organization's primary exempt purposes t SEE STATEMENT 5

Program Service

All organizations must describe their exempt purpose achievements In a clear and concise manner State the number of clients served, publications Issued, etc Discuss expenses

(Required for 501(c)p) and achievements that are not measurable (Section 501 (c)(3) and (4) organizations and 4947(a)(1) nonexempt charitable trusts must also enter we amount of grants and (4) orgs , and 4947(a)(1) allocations to others) ousts, but optional for others

a TRUST DISTRIBUTES ITS INCOME TO CHILDREN'S HOSP ; - FRED

UNIVERSITY OF WASHINGTON 599,877 .721 1 599,877 .72

b

(Grants and allocations $ ) C

(Grants and allocations $ ) d

(Grants and allocations $ ) e Other program services (attach schedule) (Grants and allocations $

2 10170506 758519 916369099 2003 .05040 ERNA JORGENSEN CHARITABLE T 91636901

7,044 .45

25 .0

80,239 .5

7,044 .4

25 .0

HUTCHINSON CANCER RESEARCH CTR ; PACIFIC LUTHERAN UNIV ; AND

f Total of Program Service Expenses (should equal line 44, column (B), Program services) t !) 99 , U-/ - / . -1 2 0~ 1 03 Form 990 (2003)

ERNA JORGENSEN CHARITABLE TRUST Form 99o(2003) 40-10-420-0862500 91-6369099

P~'E IV Balance Sheets

(A) (B) Beginning of year End of year

45 46

47c

48c 49

50

51c 52

48 a Pledges receivable 48a

b Less allowance for doubtful accounts 48b

49 Grants receivable

50 Receivables from officers, directors, trustees,

and key employees N

51 a Other notes and loans receivable 51 a

b Less . allowance for doubtful accounts 51b

52 Inventories for sate or use

53 Prepaid expenses and deferred charges . . .


Note: Where required, attached schedules and amounts within the descnphon column should be for end-of-year amounts only.

45 Cash - non-interest-bearing 46 Savings and temporary cash investments

47 a Accounts receivable 47a b Less allowance for doubtful accounts 47b

54 Investments-securities . _ 1 D Cost = FMV 54 55 a Investments - land, buildings, and

equipment basis 55a

b Less accumulated depreciation 55b 55c

56 investments-other SZE STATEMENT 7 9,997,470 .23 56 9,845,937 .80 57 a Land, buildings, and equipment basis . 57a

b Less accumulated depreciation 57b 57c 58 Other assets (describe 100, 58

59 Total assess add lines 45 throu g h 58 must e q ual line 74 9 , 997 , 470 . 23 59 9 , 845 , 937 . 80

60 Accounts payable and accrued expenses 60 61 Grants payable _ _ 61

62 Deferred revenue . . 62 N d 63 Loans from officers, directors, trustees, and key employees 63

64 a Tax-exempt bond liabilities 64a b Mortgages and other notes payable 64b

65 Other liabilities (describe 01 ) 65

66 Total liabilities add lines 60 through 65 0 .00 66 0 .00 Organizations that follow SFAS 117, check here ~ D and complete lines 67 through

69 and lines 73 and 74 N

67 Unrestricted 67 68 Temporarily restricted 68

m 69 Permanently restricted 69 Organizations that do not tallow SFAS 117, check here 1 D and complete lines

70 through 74 70 Capital stock, trust principal, or current funds . _ 9,997,470 .23 70 9,845,937 .80 71 Paid-in or capital surplus, or land, budding, and equipment fund 0 .00 71 0 .00 72 Retained earnings, endowment, accumulated income, or other funds _ 0 .00 72 0 .00

Y

z 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72, column (A) must equal pine 19, column (B) must equal line 21) 9 , 997 , 470 .23 73 9 , 845 , 937 .80

74 Total liabilities and net assets / fund balances (add lines 66 and 73) 1 9 , 997 , 470 .23 74 9 , 845 , 937 .80 Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization How the public

perceives an organization m such cases may be determined by the information presented on its return Therefore, please make sure the return is complete and accurate and fully describes, m Part III, the organization's programs and accomplishments

323021 12-17-03

ERNA JORGENSEN CHARITABLE TRUST Form 990 2003 40-10-420-0862500 91-6369099 Page a ParE IV-A Reconciliation of Revenue per Audited Part IV-8 Reconciliation of Expenses per Audited

Financial Statements with Revenue per Financial Statements with Expenses per Return Return

a Total revenue, gams, and other support a Total expenses and losses per per audited financial statements 1 a N/A audited financial statements " a N/A

b Amounts included on line a but not on b Amounts included on line a but not on line 17, Form 990

line 12, Form 990 (1) Donated services (1) Net unrealized gains and use of facilities $

on investments $ (2) Prior year adjustments (2) Donated services reported on line 20,

and use of facilities $ Form 990 $ (3) Recoveries of prior (3) Losses reported on

year grants $ line 20, Form 990 $ (4) Other (specify) (4) Other (specify)

S S Add amounts on lines (1) through (4) " b Add amounts on lines (1) through (4) " b

c Line a minus line b " c c Line a minus line b " c d Amounts included on line 12, Form d Amounts included on line 17, Form

990 but not on line a: 990 but not on line a

(1) Investment expenses (1) Investment expenses not included on not included on line 6b, Form 990 $ line 6b, Form 990 $

(2) Other (specify) (2) Other (specify) : S S

Add amounts on lines (1) and (2) " d Add amounts on lines (1) and (2) 110- d e Total revenue per line 12, Form 990 e Total expenses per line 17, Form 990

(line c plus line d) " e (line c plus line d) 10- e PY List of Officers, Directors, Trustees, and Key Employees (gist each one even it not compensated)

(B) Title and average hours (C) Compensation (D~Contnbu4ons ~ (E) Expense (A) Name and address per week devoted to (II not enter P"~p,l58 e"�~ account and

position -0- . coin ensatlon other allowances KEYBANK N A TRUSTEE 800 SUPERIOR AVE CLEVELAND OHIO 44114 0o 80 239 .59 0o00 0 .00

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75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related orgamzations7 If 'Yes,' attach schedule " [::] Yes OX No

323031 12-17-03 Form 990 (2003) 4


ERNA JORGENSEN CHARITABLE TRUST Form 99o(2003) . 40-10-420-0862500 91-6369099 Pages

81 a Enter direct or indirect political expenditures See line 81 instructions 81a 0 . 0 0

b Did the organization file Form 1120-POL for this year? 81 b X

82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value? 82a X

b If 'Yes,* you may indicate the value of these items here Do not include this amount as revenue m Part I or as an expense m Part II (See instructions in Part III ) 82b N/A

83 a Did the organization comply with the public inspection requirements for returns and exemption applications NBA 83a b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 83b X

84 a Did the organization solicit any contributions or gifts that were not tax deductibles 84a

b It 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible'? N/A 84b

85 501(c)(4), (5), or (6) organizations. a Were substantially all dues nondeductible by members? NBA 85a b Did the organization make only in-house lobbying expenditures of $2,000 or less N/A 85b

It "Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year .

c Dues, assessments, and similar amounts from members 85c N / A

d Section 162(e) lobbying and political expenditures 85d N/A

e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e N/A

f Taxable amount of lobbying and political expenditures (line 85d less 85e) 85f N/A

g Does the organization elect to pay the section 6033(e) tax on the amount on line 85fl N/A _ 85 h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of dues

allocable to nondeductible lobbying and political expenditures for the following tax years N/A 85h 86 501(c)(7) organizations. Enter a Initiation fees and capital contributions included on line 12 85a N/A

b Gross receipts, included on line 12, for public use of club facilities 86b N/A

87 501(c)(12) organizations. Enter a Gross income from members or shareholders 87a N/A

b Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them ) 87b N/A

88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 3017701-2 and 3017701-39 If "Yes," complete Part IX _ . 88

89 a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under section 4911 10, N/A , section 4912 " N/A , section 4955 " N/A

b 501(c)(3) end 501(c)(4) organizations Did the organization engage m any section 4958 excess benefit transaction during the year or did d become aware of an excess benefit transaction from a prior year? If °Yes ; attach a statement explaining each transaction _ N/A 89b

c Enter Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 . . . " N/A

d Enter Amount of tax on line 89c, above, reimbursed by the organization . . . " N/A

90 a fist the states with which a copy of this return is tiled t WASHINGTON b Number of employees employed m the pay period that includes March 12, 2003 ~ 90b ~ 0

91 The books are in care of " KEYBANK, N A Telephone no " 216-828-9535

ziP+4 110,- 44114

10. 0 " 1 92~ N/A

Form 990 (2003)

92 Section 49470(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041- Check here

5 2003 .05040 ERNA JORGENSEN CHARITABLE T 91636901 10170506 758519 916369099

pad y1 Other Information Yes No 76 Did the organization engage m any activity not previously reported to the IRS If "Yes ; attach a detailed description of each activity 76 K 77 Were any changes made in the organizing or governing documents but not reported to the IRS 77 X

If 'Yes,* attach a conformed copy of the changes 78 a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this returns 78a

b If'Yes ; has it filed a tax return on Form 990-T for this year? N/A 78b 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? 79 K

If'Yes ; attach a statement 80 a Is the organization related (other than by association with a statewide or nationwide organization) through common membership,

governing bodies, trustees, officers, etc , to any other exempt or nonexempt organization? 80a K b If 'Yes,' enter the name of the organization

and check whether it is 0 exempt or 0 nonexempt

Locatedat " 800 SUPERIOR AVE, 4TH FLR, CLEVELAND,- OHIO

ERNA JORGENSEN CHARITABLE TRUST Form 99o(2003) 40-10-420-0862500 91-6369099 pad V[E Analysis of Income-Producing Activities (See page 33 of the instructions) Note : Enter gross amounts unless otherwise Unrelated business income Fxciuaea b section sit, sia, orsia

indicated. (A) (B) ~~~ _ (D) Related or exempt Business Amount S,o� Amount 93 Program service revenue code code function income

a b C d e t Medicare/Medicaid payments g Fees and contracts from government agencies

94 Membership dues and assessments 95 Interest on savings and temporary cash investments 96 Dividends and interest from securities 14 250,788 .43 97 Net rental income or (loss) from real estate a debt-financed property 16 91 ,599 .36

b not debt-financed property 98 Net rental income or (loss) from personal property 99 Other investment income 100 Gain or (loss) from sales of assets

other than inventory 18 152,491 .94 101 Net income or (loss) from special events 102 Gross profit or (loss) from sales of inventory 103 Other revenue

a IRS REFUND 14 32,651 .60 b SECURITY DEPOSITS 16 16,985 .00 c d e

104 Subtotal (add columns (B), (D), and (E)) 0 .00 544,516 .33 1 0 .00 105 Total (add pine 104, columns (e), (o), and (E)) " 544,516 .33 Note : Line 105 plus line 1d, Part l, should equal the amount on line 12, Part L p~ V ~~I Relationship of Activities to the Accomplishment of Exempt Purposes (see page 34 of the instructions) Line No . Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's

exempt purposes (other than by providing funds for such purposes)

Name, address, aod~EIN of corporation, I Percentage of I Nature of activities I Total income

N/A

10170506 758519 916369099 2003 .05040

Subsidiaries and Disregarded Entities (see page 34 of the instructions)

Pan X I Information Regarding Transfers Associated (a) Did the organization, during the year, receive any funds, directly or indirectly, (b) Did the organization, during the year, pay premiums, directly or indirectly, on Note : I/ "Yes" to ( b ) , file Form 8870 and Form 4720 see instructions) .

Under penal~es of perjury, I declare that I have examined this retain, including axoi Please correct, and comple D ra on of prep r (other then offices is based on all m

Sign

Here ' Signature of Awy8R . to ~oav11

Paid Preparer's, signature

Preparer~s Rrm's name (or Use Only yours If '

self-employed),

323161 address, and »_17_m ZIP +4

SCHEDULE A . Organization Exempt Under Section 501(c)(3) (Form 990 or 990-EZ) (Except Private Foundation) and Section 501(e), 501(f), 501(k),

501(n), or Section 4947(a)(1) Nonexempt Charitable Trust

Department oftheTreasury Supplementary Information-(See separate instructions.) Internal Revenue Service 1 MUST be completed by the above organizations and attached to their Form 990 or 990-EZ

2003 Name of the organization ERNA JORGENSEN CHARITABLE TRUST

40-10-420-0862500 Employer identification number

91 6369099

Total number of other employees paid over $50,000 101 0

Part 11 Compensation of the Five Highest Paid Independent Contractors for Professional Services (See page 2 of the instructions List each one (whether individuals or firms) If there are none, enter "None ')

(b) Type of service I (c) Compensation

NONE

Total number of others receiving over $50,000 for professional services " I 0

323101/12-05-03 LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ . Schedule A (Form 990 or 990-EZ) 2003 7


OMB No 15450047

Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions List each one If there are none, enter 'None') (a) Name and address of each employee paid (b) Title and average hours (dempol yebeube efito (e) Expense

more than $50,000 per week devoted to (c) Compensation plans 8 deterred account and other

uosition compensation allowances

NONE

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

13 M An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in (1) lines 5 through 12 above, or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2) (See section 509(a)(3) )

Provide the following information about the supported organizations (See page 5 of the instructions ) (b) Line number

from above (a) Name(s) of supported organization(s)

CHILDREN'S HOSP / FRED HUTCHINSON CANCER RESEARCH CTR

PACIFIC LUTHERAN UNIV / UNIVERSITY OF WASHINGTON

14 E:1 An organization organized and operated to test for public safety Section 509(a)(4) (See page 6 of the instructions

323111 12-OS03

7

6

Schedule A (Form 990 or 990-EZ) 2003

8


ERNA JORGENSEN CHARITABLE TRUST Schedule A(Formssoors9o-EZ)2oo3 40-10-420-0862500 91-6369099 Page 2

p~ 1I1 Statements About Activities (see page 2 of the instructions) Yes No

1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendums It 'Yes," enter the total expenses paid or incurred in connection with the lobbying activities " $ $ (Must equal amounts on line 38, Part VI-A, or line i of Part VI-B ) 1 X Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A Other organizations checking

'Yes,' must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities 2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors,

trustees, directors, officers, creators, key employees, or members of then families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary'? (if the answer to any question is "Yes," attach a detailed statement explaining the transactions.)

a Sale, exchange, or leasing of property 2a K

b Lending of money or other extension of credits ~ 2b

I 2c X c Furnishing of goods, services, or facilities? . .

d Payment of compensation (or payment or reimbursement of expenses if more than $1,000) 1 2d

e Transfer of any part of its income or assets 2e K

3 a Do you make grants for scholarships, fellowships, student loans, etc 9 (If "Yes,' attach an explanation of how 3a X you determine that recipients qualify to receive payments ) b Do you have a section 403(b) annuity plan for your employees . . . 3b K

4 Did you maintain any separate account for participating donors where donors have the right to provide advice on the use or distribution of funds 4 X

~ partAV I Reason for Non-Private Foundation Status (see pages 3 through 6 of the instructions .)

The organization is not a private foundation because it is (Please check only ONE applicable box ) 5 [:] A church, convention of churches, or association of churches Section 170(b)(1)(A)(i) 6 D A school section 170(b)(1)(A)(n) (Also Complete Part V ) 7 ~ A hospital or a cooperative hospital service organization . Section 170(b)(1)(A)(ui) 8 D A Federal, state, or local government or governmental unit Section 170(b)(1)(A)(v) 9 0 A medical research organization operated m conjunction with a hospital Section 170(b)(1)(A)(ui) Enter the hospital's name, city,

and state 10 ~ An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(rv)

(Also complete the Support Schedule m Part IV-A ) 11a 0 An organization that normally receives a substantial part of its support from a governmental unit or from the general public

Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A ) 11b ~ A community trust Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A ) 12 ~ An organization that normally receives (1) more than 331% of its support from contributions, membership fees, and gross

receipts from activities related to its charitable, etc , functions - subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975 See section 509(a)(2) (Also complete the Support Schedule m Part IV-A )

d Add : Lore 27a total and line 27b total I 27d 1v / R

e Public support (line 27c total minus line 27d total) . 1 27e N/A

f Total support for section 509(a)(2) test Enter amount on line 23, column (e) 1 271 N/A

g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) 1 27 N/A h Investment income percentage line 18 column e numerator divided b line 27f denominator 1 27h N/A

28 Unusual Grants : For an organization described in line 10, 11, or 12 that received any unusual grants during 1999 through 2002, prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant Do not the this list with your return . Do not include these grants in line 15

323121 12-05-03 Schedule A (Form 990 or 990-EA 2003


ERNA JORGENSEN CHARITABLE TRUST Schedule A(Form990or990-EZ)2o03 40-10-420-0862500 91-6369099 Page 3

pgq jV~A Support Schedule (Complete only if you checked a box on line 10, 11, or 12 .) Use cash method of accounting. N/A Note: You ma use the worksheet m the instructions for converting from the accrual to the cash method of accountm .

Calendar year (or fiscal year Winnin g in " (a) 2002 (b) 2001 (c) 2000 (d) 1999 (e) Total 15 Gifts, grants, and contributions

received (Do not include unusual rants See line 28

16 Membership fees received 17 Gross receipts from admissions,

merchandise sold or services performed, or furnishing of facilities m any activity that is related to the organization's charitable, etc , purpose

18 Gross income from interest, dividends, amounts received from payments on securities loans (section 512(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organization after June 30, 1975

19 Net income from unrelated business activities not included in line 18

pp Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf

21 The value of services or facilities furnished to the organization by a governmental unit without charge Do not include the value of services or facilities generally tarnished to the public without charge

22 Other income Attach a schedule Do not include gain or (loss) from sale of capital assets

23 Total oflines t5through 22 0 .00 0 .00 0 .00 0 .00 0 .00 24 Line 23 minus line 17 25 Enter 1% of line 23 26 Organizations described on lines 10 or 11 : a Enter 2% of amount m column (e), line 24 1 26a N/A

b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental amt or publicly supported organization) whose total gifts for 1999 through 2002 exceeded the amount shown m line 26a . Do not file this list with your return . Enter the total of all these excess amounts 1 26b N/A

c Total support for section 509(a)(1) test Enter line 24, column (e) 1 26c N/A

d Add Amounts from column (e) for lines 18 19 22 26b 1 26d N/A

e Public support (line 26c minus line 26d total) . 1 26e N/A f Public support percentage (line 26e (numerator) divided by line 26c (denominator)) 1 26f N/A

27 Organizations described on line 12 . a For amounts included m lines 15, 16, and 17 that were received from a 'disqualified person; prepare a list for your records to show the name of, and total amounts received m each year from, each 'disqualified person' Do not ills this list with your return . Enter the sum of such amounts for each year

(2000) (1999) (2002) (2001) b For any amount included m line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records to show the name of,

and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000 (Include in the list organizations described in lines 5 through 11, as well as individuals ) Do not file this list with your return . After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year

(2001) � (2000) (1999) (2002) c Add' Amounts from column (e) for lines 15 16

17 20 21 " 1 27c ~ N/A

34 a Does the organization receive any financial aid or assistance from a governmental agency . . . b Has the organization's right to such aid ever been revoked or suspended

If you answered 'Yes' to either 34a or b, please explain using an attached statement 35 Does the organization certify that it has complied with the applicable requirements of sections 4 01 through 4 05 of Rev Proc 75-50,

1975-2 C 8 587, covering racial nondiscrimination) If 'No,' attach an explanation

323131 12-OS03

10


ERNA JORGENSEN CHARITABLE TRUST Schedule A(Form99oor99o-EZ)2003 40-10-420-0862500 91-6369099 Page a pWti y Private School Questionnaire (See page 7 of the instructions) N/A

(To be completed ONLY by schools that checked the box on line 6 in Part IV)

Yesl No 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing

instrument, or in a resolution of its governing body 29 30 Does the organization include a statement of its racially nondiscriminatory policy toward students m all its brochures, catalogues,

and other written communications with the public dealing with student admissions, programs, and scholarships 30 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of

solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known

to all parts of the general community it serves 31 If 'Yes ; please describe, if 'No," please explain (If you need more space, attach a separate statement )

32 Does the organization maintain the following a Records indicating the racial composition of the student body, faculty, and administrative staffs 32a b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis 32b

c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student

admissions, programs, and scholarships 32c

d Copies of all material used by the organization or on its behalf to solicit contnbutionsl 32d If you answered "No' to any of the above, please explain (If you need more space, attach a separate statement )

33 Does the organization discriminate by race m any way with respect to a Students' rights or privileges? 33a b Admissions policies 33b c Employment of faculty or administrative staffs 33c d Scholarships or other financial assistance 33d e Educational policies . . 33e f Use of facilities 33f g Athletic programs _L 3j

Other extracurricular activities . . 33h If you answered 'Yes'to any of the above, please explain (If you need more space, attach a separate statement )

Schedule A (Form 990 or 990-EZ) 2003

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns

below See the instructions for lines 45 through 50 on page 11 of the instructions .)

Lobbying Expenditures During 4-Year Averaging Period N/A

Calendar year (or (a) (b) (c) (d) (e) fiscal year beginning fn) 1 2003 2002 2001 2000 Total

45 Lobbying nontaxable amount 0 .00

46 Lobbying ceding amount 150% of line 45 (e )) 0 . 00

47 Total lobbying exp enditures 0 .00

48 Grassroots nontaxable amount 0 .00

49 Grassroots ceiling amount 150% of line 48 (e )) 0 .00

50 Grassroots lobbying expenditures 0

Part V1.8 Lobbying Activity by Nonelecting Public Charities (For reporting only by organizations that did not complete Part VI-A) (See page 12 of the instructions ) N/A

During the year, did the organization attempt to influence national, state or local legislation, including any attempt to Yes No Amount

influence public opinion on a legislative matter or referendum, through the use of. a Volunteers b Paid staff or management (Include compensation in expenses reported on lines c through h .) c Media advertisements d Mailings to members, legislators, or the public e Publications, or published or broadcast statements 1 Grants to other organizations for lobbying purposes g Direct contact with legislators, their staffs, government officials, or a legislative body h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means I Total lobbying expenditures (Add lines c through h .) ~ ~ 0 .00

If 'Yes'to any of the above, also attach a statement giving a detailed description of the lobbying activities 323145

-1

1 2 -003 Schedule A (Form 990 or 990-EZ) 2003 11


ERNA JORGENSEN CHARITABLE TRUST Schedule A(Form98oor99o ;EZ)2oo3 40-10-420-0862500 91-6369099 Page 5 Part VI-A Lobbying Expenditures by Electing Public Charities (see page 9 of the instructions) N/A

(To be completed ONLY by an eligible organization that fled Form 5768) " a n if the oraamzation belongs to an affiliated arouo Check 1 b

Limits on Lobbying Expenditures (a)

Affiliated group To be completed for ALL (The term expenditures' means amounts paid or incurred ) totals electing organizations

N/A 36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36

37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37

38 Total lobbying expenditures (add lines 36 and 37) 38

39 Other exempt purpose expenditures 39

40 Total exempt purpose expenditures (add lines 38 and 39) 40

41 Lobbying nontaxable amount Enter the amount from the following table

If the amount on line 40 Is - The lobbying nontaxable amount is -

Not over $500,000 _ 20% of the amount on line 40

Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000

Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000 41

Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over E7,500,000

Over $17,000,000 _ $7,000,000 _

42 Grassroots nontaxable amount (enter 25% of line 41) 42

43 Subtract line 42 from fine 36 Enter-0- if line 42 is more than line 36 43

44 Subtract line 41 from line 38 Enter-0- if line 41 is more than line 38 . . ~44

Caution : If there Is an amount on either Ime 43 or line 44, you must file Form 4720.

(1) Cash 51 a(!) X

(11) Otherassets a(!!) X

Other transactions

(1) Sales or exchanges of assets with a nonchantable exempt organization b(l) X

(I I) Purchases of assets from a nonchantable exempt organization b(II) X

(Ili) Rental of facilities, equipment, or other assets b(lil) X

(iv) Reimbursement arrangements b(iv) X

(v) Loans or loan guarantees b(v) X

(vi) Performance of services or membership or fundraising solicitations b(VI) X

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

It the answer to any of the above is 'Yes," complete the following schedule Column (b) should always show the fair market value of the

goods, other assets, or services given by the reporting organization If the organization received less than fair market value in any

transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received N/A

(a) (b) M (d) Line no Amount involved Name of nonchantable exempt organization Description of transfers, transactions, and sharing arrangements

52 a 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? IN- 0 Yes No


ERNA JORGENSEN CHARITABLE TRUST Schedule A (Form 990 or 990-~Z) 2003 40-10-420-0862500 91-6369099 Page 6 F P_,:;_ti V11] Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations (See page 12 of the instructions 51 Did the reporting 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 nonchantable exempt organization of

13 STATEMENT(S) 1, 2, 3 10170506 758519 916369099 2003 .05040 ERNA JORGENSEN CHARITABLE T 91636901

ERNA JORGENSEN CHARITABLE TRUST 40-10-42 91-6369099

FORM 990 RENTAL INCOME STATEMENT 1

ACTIVITY GROSS KIND AND LOCATION OF PROPERTY NUMBER RENTAL INCOME

KING COUNTY PROPERTIES 1 263,538 .65

TOTAL TO FORM 990, PART I, LINE 6A 263,538 .65

FORM 990 RENTAL EXPENSES STATEMENT 2

ACTIVITY DESCRIPTION NUMBER AMOUNT TOTAL

PROPERTY TAXES 18,023 .73 0 .00

UTILITIES 1,377 .11 0 .00

MISC EXP 116,862 .56 LEGAL FEES 35,675 .89

- SUBTOTAL - 1 171,939 .29

TOTAL TO FORM 990, PART I, LINE 6B 171,939 .29

FORM 990 GAIN (LOSS) FROM PUBLICLY TRADED SECURITIES STATEMENT 3

GROSS COST OR EXPENSE NET GAIN DESCRIPTION SALES PRICE OTHER BASIS OF SALE OR (LOSS)

UNDISTRIBUTED CTF G/L -1,366 .42 0 .00 0 .00 -1,366 .42 SEE ATTACHED 153,839 .59 0 .00 0 .00 153,839 .59 CAP GN DIV 18 .77 0 .00 0 .00 18 .77

TO FORM 990, PART I, LINE 8 152,491 .94 0 .00 0 .00 152,491 .94

91-6369099 . ERNA JORGENSEN CHARITABLE TRUST 40-10-42

FORM 990 OTHER CHANGES IN NET ASSETS OR FUND BALANCES STATEMENT 4

TOTAL TO FORM 990, PART I, LINE 20 -6,902 .00

14 STATEMENT(S) 4, 5, 6 10170506 758519 916369099 2003 .05040 ERNA JORGENSEN CHARITABLE T 91636901

DESCRIPTION

COST BASIS ADJUSTMENT

AMOUNT

-6,902 .00

FORM 990 STATEMENT OF ORGANIZATION'S PRIMARY EXEMPT PURPOSE STATEMENT 5 PART III

EXPLANATION

FUND CARE FOR CHILDREN 0 FGAMILIES WHO CANNOT AFFORD CARE AT HOSP ADDED TO GENERAL OPERATING FUND FUND SCHOLARSHIP FUND PROVIDES FWLLOWSHIPS FOR MEDICAL STUDENTS

FORM 990 CASH GRANTS AND ALLOCATIONS STATEMENT 6

DONEE'S CLASSIFICATION DONEE'S NAME DONEE'S ADDRESS RELATIONSHIP AMOUNT

CHILDREN'S DEBRA PALMER NONE HOSPITAL FDN SELLER, P 0 BOX

5371, SEATTLE, WA 150,419 .43

FRED HUTCHINSON DAVID LITTLE, PO NONE CANCER RESEARCH BOX19024, SEATTLE, CTR WA 149,819 .43

PACIFIC LUTHERAN SHERRI TONN, NONE UNIV TACOMA, WA 149,819 .43

UNIVERSITY OF ANN SAMA, 280 NONE WASHINGTON GERBERDING HALL,

SEATTLE WA 149,819 .43

TOTAL INCLUDED ON FORM 990, PART II, LINE 22 599,877 .72

ERNA JORGENSEN CHARITABLE TRUST 40-10-42 91-6369099

15 STATEMENT(S) 7 10170506 758519 916369099 2003 .05040 ERNA JORGENSEN CHARITABLE T 91636901

FORM 990 OTHER INVESTMENTS STATEMENT 7

VALUATION DESCRIPTION METHOD AMOUNT

SEE ATTACHED COST 9,845,937 .80

TOTAL TO FORM 990, PART IV, LINE 56, COLUMN B 9,845,937 .80

RUN 05/0312004

TRUST YEAR ENDING 12131/2003

LEGEND F - FEDERAL S - STATE I - INHERITED E - EXEMPT FROM STATE U - ACO COST UNKNOWN

SHARES DATE SALES PRICE COST BASIS GAIN/LOSS TERM ------ ---- ----------- ---------- --------- ----

PROPERTY DESCRIPTION --------------------

150 0000 AMERICAN EXPRESS CO COM - 025816109 SOLD 01103/2003 5497 33 ACQ 150 0000 12103/2002 5497,33 5706 00 -208 67 PRE-ST

50 0000 AMERICAN EXPRESS CO COM - 025816109 SOLD 01103/2003 1832 44 ACQ 50 0000 07/09/2002 1832 44 1856 44 -24 00 PRE-ST

55 0000 DELL COMPUTER CORP COM - 247025109 SOLD 01/03/2003 1512 45 ACO 55 0000 07/24/2001 1512 45 1498 20 14 25 LT20

100 0000 MERCK & CO INC COM 589331107 SOLD 01/03/2003 5916 82 ACQ 100 0000 08/16/1999 5916 82 6456 00 -539 18 LT20

50 0000 MERCK & CO INC COM 589331107 SOLD 01/0312003 2958 41 ACQ so 0000 12/03/2002 2958 41 2777 50 180 91 PRE-ST

100 0000 MERCK & CO INC COM 589331107 SOLD 01/0312003 5916 82 ACQ 100 0000 07/31/2002 5916 82 4848 00 1068 82 PRE-ST

800 0000 MERCK & CO INC COM 589331107 SOLD 01103/2003 47334 .57 ACQ 800 0000 06/02/1997 47334 57 35890 00 11444 57 LTQ5

10 0000 INTERNATIONAL PAPER CO COM - 460146103 SOLD 01/06/2003 358 81 ACO 10 0000 07/31/2002 358 .81 397 .60 -38 .79 PRE-ST

1000 0000 INTERNATIONAL PAPER CO COM - 460146103 SOLD 01/0612003 35880 71 ACO 1000 0000 07/24/2001 35880 71 38510 00 -2629 29 LT20

30 .0000 INTERNATIONAL PAPER CO COM - 460146103 SOLD 01106/2003 1076 42 ACQ 30 0000 12/03/2002 1076 42 1141 80 -65 38 PRE-ST

300 0000 INTERNATIONAL PAPER CO COM - 460146103 SOLD 01/06/2003 10764 22 ACO. 300 0000 11/0712001 10764 22 11367 .99 -603 77 LT20

300 0000 ABBOTT LABS COM - 002824100 SOLD 0111312003 11910 24 ACQ 300 0000 04/18/2002 11910 24 16359 00 -4448 76 PRE-ST

200 0000 ABBOTT LABS COM - 002824100 SOLD 01/13/2003 7940 .16 ACQ 200 0000 11/07/2001 7940 16 10792 00 -2851 84 LT20

120 .0000 ABBOTT LABS COM - 002824100 SOLD 01/13/2003 4764 10 ACQ 120 0000 07124/2001 4764 10 6136 80 -1372 70 LT20

11270 4300 GNMA POOL 442039 7 5% 10/15/26 36207UB02 SOLO 01/15/2003 11270 43 ACCI 11270 4300 10/02/1996 11270 43 11270 43 0 00 LT20

8934 7000 FANNIE MAE POOL FN254378 - 31371KQ79 SOLD 01/25/2003 8934 70 ACQ 8934 7000 05/15/2002 8934 70 8934 70 0 .00 LT20

4533 9900 FANNIE MAE POOL 313757 - 31374GQJ9 SOLD 01/25/2003 4533 .99 ACQ 4533 9900 03104/1999 4533 .99 4533 99 0 .00 LT20

250000 0000 AMERICAN EXPRESS MASTER TR ABS 98-1 A SFT BLT EXP 05/15103 025928AJ1 SOLD 02/03/2003 253076 17 ACQ 250000 0000 03/11/1999 253076 .17 251904 30 1171 87 LT20

92 4800 GNMA POOL 442039 7 5% 10/15/26 36207UBG2 SOLD 02/15/2003 92 48 ACO 92 4800 10/02/1996 92 48 92 48 0 00 LT20

7710 9400 FANNIE MAE POOL FN254378 - 31371KQ79 SOLD 02/25/2003 7710 94 ACQ 7710 9400 0511512002 7710 94 7710 94 0 00 LT20

4131 5300 FANNIE MAE POOL 313757 - 31374GQJ9 SOLD 02/25/2003 4131 53 ACQ 4131 5300 03/0411999 4131 53 4131 .53 0 00 LT20

750 0000 DUKE ENERGY CORP COM - 264399106 SOLD 02/26/2003 10184 69 ACQ 750 0000 11114/2001 10184 .69 28537 50 -18352 81 LT20

175 0000 DUKE ENERGY CORP COM 264399106 SOLD 02/26/2003 2376 43 ACQ 175 0000 12/11/2001 2376 43 6053 25 -3676 82 LT20

500 0000 DUKE ENERGY CORP COM 264399106 SOLD 02/2612003 6789 .80 ACQ 500 0000 07/09/2002 6789 80 15121 90 -8332 .10 PRE-ST

160 0000 DUKE ENERGY CORP COM 264399106 SOLD 02/26/2003 2172 73 ACQ 160 0000 07/31/2002 2172 73 4014 40 -1841 67 PRE-ST

345 0000 EMERSON ELEC CO COM 291011104 SOLD 03/12/2003 15248 54 ACQ 345 0000 12/11/2001 15248 54 19551 67 -4303 13 LT20

1600 8400 GNMA POOL 442039 7 5% 10115/26 36207UBG2 SOLD 03/15/2003 1600 84 ACQ. 1600 8400 10/02/1996 1600 84 1600 84 0 00 LT20

8481 2000 FANNIE MAE POOL FN254378 - 91371KQ79 SOLD 0312512003 8481 20 ACO 8481 2000 05/15/2002 8481 20 8481 20 0 00 LT20

ACCT 9095 104200862500 FROM 01/01/2003 TO 12/31/2003

TAX PREPARER 586 TRUST ADMINISTRATOR 764 INVESTMENT OFFICER 305

KEYBANK NATIONAL ASSOCIATION, STATEMENT OF CAPITAL GAINS AND LOSSES ERNA jORGESEN CHARIT TRST T/W

PAGE 85

990 5300 FANNIE MAE POOL 254637 - 31371KZA2 SOLD 03/25/2003 990 53 ACQ 990 5300 01131/2003 990 53 990 53 0 00 LT20

3635 8700 FANNIE MAE POOL 313757 - 313746QJ9 SOLD 03/25/2003 3635 87 ACQ 3635 8700 03/0411999 3635 87 3635 87 0 00 LT20

150 0000 ENSCO INTL INC COM - 26874QlOO SOLD 04/1412003 3845 28 ACO 150 0000 01/03/2003 3845 28 4528 50 -683 22 PRE-ST

80 0000 ENSCO INTL INC COM 268740100 SOLD 04/14/2003 2050 82 ACO 80 0000 12/03/2002 2050 82 2385 60 -334 78 PRE-ST

1630 0000 ENSCO INTL INC COM 26874(2100 SOLD 04/14/2003 41785 37 ACQ 1630 0000 10/11/2002 41785 37 42935 34 -1149 97 PRE-ST

985 0000 UNOCAL CORP COM - 915289102 SOLD 04114/2003 26052 22 ACG 985 0000 07/24/2001 26052 22 33174 80 -7122 58 LT20

2221 0000 GNMA POOL 442039 7 5% 10/15/26 36207UBG2 SOLD 04115/2003 2221 00 ACQ 2221 0000 10/02/1996 2221 00 2221 00 0 00 LT20

9157 8600 FANNIE MAE POOL FN254378 - 31371KG79 SOLD 04/25/2003 9157 86 ACO. 915'7 8600 05115/2002 9157 86 9157 86 0 00 LT20

1912 4200 FANNIE MAE POOL 254637 - 31371KZA2 SOLD 04/2512003 1912 42 ACO 1912 4200 01/31/2003 1912 42 1912 42 0 00 LT20

4467 3200 FANNIE MAE POOL 313757 - 31374GQJ9 SOLD 04125/2003 4467 32 ACO 4467 3200 03/04/1999 4467 32 4467 32 0 .00 LT20

115 0000 WENDYS INTL INC COM - 950590109 SOLD 05/07/2003 3341 74 ACQ 115 0000 12103/2002 3341 74 3188 95 152 79 POST-ST

250 0000 WENDYS INTL INC COM - 950590109 SOLD 05107/2003 7264 66 ACQ 250 0000 01/03/2003 7264 66 6735 00 529 66 POST-ST

635 .0000 WENDYS INTL INC COM - 950590109 SOLD 05/0712003 18452 24 ACO. 635 0000 08103/2000 18452 24 12079 22 6373 02 LT15

9584 2700 GNMA POOL 442039 7 5% 10115/26 36207UBG2 SOLD 05/15/2003 9584 27 ACO. 9584 2700 10/02/1996 9584 27 9584 27 0 00 LT15

615 0000 WENDYS INTL INC COM - 950590109 SOLD 05121/2003 17363 03 ACCI 615 0000 08/0312000 17363 03 11698 78 5664 25 LT15

1250 0000 WENDYS INTL INC COM - 950590109 SOLD 05/2112003 35290 72 ACQ 1250 0000 08121/2

000 35290 72 22887 50 12403 22 LT15

11411 6700 FANNIE MAE POOL FN254378 - 3 1 371KC179

SOLD 05125/2003 11411 67 ACQ 11411 6700 05/15/2002 11411 67 11411 67 0 00 LT15

3894 .9300 FANNIE MAE POOL 254637 - 31371KZA2 SOLD 05/25/2003 3894 93 ACQ 3894 9300 01/31/2003 3894 93 3894 93 0 00 LT15

3856 8800 FANNIE MAE POOL 313757 - 313746QJ9 SOLD 05/25/2003 3856 88 ACO 3856 8800 0310411999 3856 88 3856 88 0 00 LT15

150 .0000 FANNIE MAE COM - 313586109 SOLD 06112/2003 9982 03 ACO. 150 0000 0713112002 9982 03 11161 50 -1179 47 POST-ST

125 0000 FANNIE MAE COM - 313586109 SOLO 06/12/2003 8318 36 ACO 125 0000 01/03/2003 8318 36 8432 50 -114 14 POST-ST

50 0000 FANNIE MAE COM - 313586109 SOLO 06/12/2003 3327 35 ACQ 50 0000 12/03/2002 3327 35 3189 00 138 35 POST-ST

250 0000 FANNIE MAE COM - 313586109 SOLD 06/12/2003 16636 72 ACO 250 0000 06/01/1998 16636 .72 14861 25 1775 47 LT15

390 0000 ST PAUL COS INC COM - 792860108 SOLD 06/12/2003 14754 26 ACQ 390 0000 01/13/2003 14754 26 13935 13 819 13 POST-ST

1100 0000 ST PAUL COS INC COM - 792860108 SOLD 06/1212003 41614 57 ACO 1100 0000 10/11/2002 41614 57 34627 89 6986 68 POST-ST

2412 7200 GNMA POOL 442039 7 5% 10/15126 36207UBG2 SOLD 06115/2003 2412 72 ACO. 2412 7200 10102/1996 2412 72 2412 72 0 00 LT15

1000 0000 SOUTHWESTERN BELL TEL CO PFD 6 875% 845335108 SOLO 06/15/2003 25000 00 ACCI 1000 0000 01/30/2003 25000 00 25250 00 -250 00 POST-ST

0000 GAME N' PLAY - $5880 00 SECURITY DEPOSIT - 999008717 SOLD 06/2012003 0 00 ACQ 0000 06/20/2003 0 00 0 00 0 00 LT15

ACCT 9095 104200862500 KEYBANK NATIONAL ASSOCIATION PAGE 86 FROM 01101/2003 STATEMENT OF CAPITAL GAINS AND LOSSES TO 12/31/2003 ERNA JORGESEN CHARIT TRST T/W RUN 05/03/2004

TRUST YEAR ENDING 12131/2003

TAX PREPARER 586 TRUST ADMINISTRATOR 764 LEGEND F - FEDERAL S - STATE I - INHERITED INVESTMENT OFFICER 305 E - EXEMPT FROM STATE U - ACQ COST UNKNOWN

PROPERTY DESCRIPTION SHARES DATE SALES PRICE COST BASIS GAIN/LOSS TERM -------------------- ------ ---- ----------- ---------- --------- ----

0000 FIVE CORNERS RV INC $4,200 SECURITY DEPOSIT - 999010044 SOLD 06/20/2003 0 00 ACQ 0000 06/20/2003 0 00 0 00 0 00 LT15

0000 SOCIETY OF ST VINCENT D'PAUL $6,905 SECURITY DEPOSIT - 999011984 SOLD 06/20/2003 0 00 ACO. 0000 06/2012003 0 00 0 00 0 00 LT15

10480 5900 FANNIE MAE POOL FN254378 - 31371KG79 SOLD 06/25/2003 10480 59 ACO 10480 5900 05/15/2002 10480 59 10480 59 0 00 LT15

3832 .4400 FANNIE MAE POOL 254637 - 31371KZA2 SOLD 06/25/2003 3832 44 ACQ 3832 4400 01/31/2003 3832 44 3832 44 0 00 LT15

3511 4200 FANNIE MAE POOL 313757 - 313746CIJ9 SOLD 06/25/2003 3511 42 ACCI 3511 4200 03/04/1999 3511 42 3511 42 0 00 LT15

425 0000 CINERGY CORP COM - 172474108 SOLD 0612712003 15783 75 ACCI 425 0000 01103/2003 15783 75 14603 00 1180 75 POST-ST

1150 .0000 ORACLE CORP COM - 68389X105 SOLD 07/10/2003 14385 83 ACO. 1150 0000 01/03/2003 14385 83 12995 00 1390 83 POST-ST

310 .0000 EMERSON ELEC CO COM - 291011104 SOLD 07/11/2003 16413 73 ACO. 310 0000 12/1112001 16413 73 17568 16 -1154 43 LT15

225 0000 INTERNATIONAL BUSINESS MACHS COM - 459200101 SOLD 07111/2003 19110 60 ACO. 225 0000 07/24/2001 19110 60 23555 25 -4444 65 LT15

4455 8000 GNMA POOL 442039 7 5% 10/15/26 - 36207UBG2 SOLD 07115/2003 4455 80 ACQ 4455 8000 10/02/1996 4455 80 4455 80 0 00 LT15

320 0000 EMERSON ELEC CO COM - 291011104 SOLD 07/16/2003 16447 10 ACO. 320 0000 12/1112001 16447 10 18134 88 -1687 78 LT15

15 0000 EMERSON ELEC CO COM - 291011104 SOLD 07/16/2003 770 96 ACO. 15 0000 07/24/2001 770 96 824 55 -53 59 LT15

985 0000 EMERSON ELEC CO COM - 291011104 SOLD 07/16/2003 50574 03 ACO 985 0000 07/24/2001 50574 03 54145 45 -3571 42 LT15

50 0000 EMERSON ELEC CO COM - 291011104 SOLD 07/1612003 2567 21 ACQ 50 0000 07/09/2002 2567~21 2679 .00 -111 79 LT15

280 0000 EMERSON ELEC CO COM - 291011104 SOLD 0711612003 14376 38 ACO. 280 0000 07/31/2002 14376 38 14173 .60 202 78 POST-ST

1400 0000 BRUNSWICK CORP COM - 117043109 SOLD 0712412003 36118 30 ACQ 1400 0000 04/1412003 36118 30 27791 54 8326 76 POST-ST

50 0000 PFIZER INC COM - 717081103 SOLD 07/24/2003 1662 42 ACQ 50 0000 01121/2000 1662 42 1812 37 -149 95 LT15

545 0000 PFIZER INC COM - 717081103 SOLD 07/24/2003 18120 40 ACQ 545 0000 01125/2

000 18120 40 19272 56 -1152 16 LT15

12064 8900 FANNIE MAE POOL FN254378 - 3 1 371KQ79

SOLD 07/25/2003 12064 89 ACC 12064 8900 05/15/2002 12064 89 12064 89 0 00 LT15

11799 5000 FANNIE MAE POOL 254637 - 31371KZA2 SOLD 07/25/2003 11799 50 ACCI 11799 5000 01/31/2003 11799 50 11799 50 0 00 LT15

3209 9800 FANNIE MAE POOL 313757 - 3137460,19 SOLD 07125/2003 3209 98 ACQ 3209 9800 03/0411999 3209 98 3209 98 0 00 LT15

2136 .0350 FRANKLIN BALANCE SHEET INV OPEN-END FUND CL A - 355148107 SOLD 07/2512003 88239 61 ACQ 2136 0350 03/01/2002 88239 61 88218 23 21 38 LT15

1248 1280 FRANKLIN BALANCE SHEET INV OPEN-END FUND CL A - 355148107 SOLD 07/25/2003 51560 17 ACQ 1248 1280 12/11/2001 51560 17 50000 00 1560 17 LT15

7 3975 FRANKLIN BALANCE SHEET INV OPEN-END FUND CL A - 355148107 SOLD 07/25/2003 305 59 ACO 7 3975 12118/2001 305 59 287 69 17 90 LT15

3 2993 FRANKLIN BALANCE SHEET INV OPEN-END FUND CL A - 355148107 SOLO 07125/2003 136 29 ACQ 3 2993 12/18/2001 136 29 128 31 7 98 LT15

30 3062 FRANKLIN BALANCE SHEET INV OPEN-END FUND CL A - 355148107 SOLD 07/25/2003 1251 95 ACO. 30 3062 12/18/2001 1251 95 1178 61 73 34 LT15

2461 8410 SCUDDER MICRO CAP FUND OPEN-END FUND INSTL CL - 81116P592 SOLD 07/25/2003 44534 70 ACQ 2461 8410 05/1512002 44534 70 50000 .00 -5465 30 LT15

1000 0000 MSDW CAPITAL TRUST I PFD 7 10% - 553538208 SOLD 08111/2003 25000 00 ACQ 1000 0000 01/30/2003 25000 00 25440 00 -440 00 POST-ST

ACCT 9095 104200862500 KEYBANK NATIONAL ASSOCIATION, PAGE 87 FROM 01/01/2003 STATEMENT OF CAPITAL GAINS AND LOSSES TO 12/31/2003 - ERNA JORGESEN CHARIT TRST T/W RUN 05/03/2004

TRUST YEAR ENDING 12/31/2003

TAX PREPARER 586 TRUST ADMINISTRATOR 764 LEGEND F - FEDERAL S - STATE I - INHERITED INVESTMENT OFFICER 305 E - EXEMPT FROM STATE U - ACQ COST UNKNOWN


1000 0000 MSOW CAPITAL TRUST I PFO 7 10% - 553538208 SOLD 08/11/2003 25000 00 ACQ 1000 0000 06116/2003 25000 00 25228 70 -228 70 POST-ST

110 0000 AMERICAN EXPRESS CO COM - 025816109 SOLD 08/12/2003 4911 26 ACG 110 0000 07/09/2002 4911 26 4084 17 827 09 LT15

1000 0000 SOUTHTRUST CORP COM - 844730101 SOLD 08/12/2003 28638 66 ACO 1000 0000 08/16/2002 28638 66 26649 00 1989 66 POST-ST

6333 .7600 GNMA POOL 442039 7 5% 10/15126 36207UBG2 SOLD 08/15/2003 6333 76 ACQ 6333 7600 10/02/1996 6333 76 6333 76 0 00 LT15

13529 8300 FANNIE MAE POOL FN254378 - 31371KQ79 SOLO 0812512003 13529 83 ACQ 13529 8300 05115/2002 13529 83 13529 83 0 00 LT15

16350 8200 FANNIE MAE POOL 254637 - 31371KZA2 SOLD 0812512003 16350 82 ACQ 16350 8200 01/31/2003 16350 82 16350 82 0 00 LT15

3691 6900 FANNIE MAE POOL 313757 - 31374GGJ9 SOLD 08/25/2003 3691 69 ACO 3691 6900 03/04/1999 3691 69 3691 69 0 00 LT15

700 0000 HEWLETT PACKARD CO COM - 428236103 SOLD 08125/2003 13663 36 ACQ 700 0000 07124/2001 13663 36 18312 00 -4648 64 LT15

200 0000 HEWLETT PACKARD CO COM - 428236103 SOLD 08125/2003 3903 82 ACQ 200,0000 01/28/2002 3903 82 4398 00 -494 18 LT15

1250 0000 HEWLETT PACKARD CO COM - 428236103 SOLD 08/25/2003 24398 85 ACQ 1250 0000 06/12/2002 24398 85 22481 25 1917 60 LT15

655 0000 HEWLETT PACKARD CO COM - 428236103 SOLD 08/25/2003 12785 00 ACQ 655 .0000 07131/2002 12785 00 8700 30 4084 70 LT15

120 0000 FPL GROUP INC COM 302571104 SOLD 08/2712003 7454 34 ACQ 120 0000 06/27/2003 7454 34 8084 40 -630 06 POST-ST

120 .0000 FPL GROUP INC COM 302571104 SOLO 08127/2003 7454 34 ACO 120 0000 12/03/2002 7454 34 6974 40 479 94 POST-ST

500 0000 FPL GROUP INC COM 302571104 SOLD 0812712003 31059 74 ACO 500 0000 07109/2002 31059 74 28625 00 2434 74 LT15

410 0000 ALLTEL CORP COM - 020039103 SOLD 08/28/2003 18514 73 ACQ 410 0000 07/24/2001 18514 -73 25169 90 -6655 17 LT15

1 0000 COMM - 130 SIN 152ND - 997004692 SOLD 09/0212003 493824 74 ACCI 1 0000 01/28/1993 493824 74 342000 00 151824 74 LT15

135 .0000 ALCOA INC COM - 013817101 SOLD 09/09/2003 3921 57 ACQ 135 0000 07/31/2002 3921 57 3577 50 344 07 LT15

40 0000 ALCOA INC COM - 013817101 SOLD 09/09/2003 1161 94 ACQ 40 0000 12/03/2002 1161 94 990 80 171 14 POST-ST

170 0000 ALCOA INC COM - 013817101 SOLD 09/0912003 4938 27 ACQ 170 0000 01/06/2003 4938 27 4107 20 831 07 POST-ST

100 0000 CATERPILLAR INC DEL COM - 149123101 SOLD 09/09/2003 6956 67 ACQ 100 0000 01103/2003 6956 67 4714 00 2242 67 POST-ST

255 0000 CATERPILLAR INC DEL COM - 149123101 SOLD 09/09/2003 17739 52 ACO. 255 0000 11/15/2002 17739 52 11270 77 6468 .75 POST-ST

45 0000 EATON CORP COM - 278058102 SOLD 09109/2003 4203 70 ACQ 45 0000 01/03/2003 4203 70 3589 20 614 50 POST-ST

15 0000 EATON CORP COM - 278058102 SOLD 0910912003 1401 23 ACQ 15 0000 12/03/2002 1401 23 1120 .80 280 43 POST-ST

150000 0000 FREDDIE MAC NOTE - 3134A4RA4 SOLD 09109/2003 152466 00 ACQ 150000 0000 10101/2002 152466 00 151882 50 583 50 POST-ST

20 0000 GANNETT INC COM - 364730101 SOLD 09/09/2003 1564 52 ACQ 20 0000 08/20/2002 1564 52 1506 67 57 85 LT15

1000 0000 GENERAL MOTORS CORP PFO 7 25% - 370442758 SOLD 09109/2003 24642 84 ACQ 1000 0000 06/16/2003 24642 84 25040 00 -397 .16 POST-ST

545 0000 HCA INC COM - 404119109 SOLD 09/0912003 20376 59 ACQ 545 0000 04118/2002 20376 59 25342 50 -4965 91 LT15

686 0000 PFIZER INC COM - 717081103 SOLD 0910912003 21690 30 ACQ 686 0000 01/25/2000 21690 .30 24258 68 -2568 38 LT15

ACCT 9095 104200862500 KEYeANK NATIONAL ASSOCIATION, PAGE 88 FROM 01/0112003 STATEMENT OF CAPITAL GAINS AND LOSSES TO 12/31/2003 ERNA JORGESEN CHARIT TRST T/W RUN 05/03/2004


TAX PREPARER 586 TRUST ADMINISTRATOR 764 LEGEND F FEDERAL S - STATE I - INHERITED INVESTMENT OFFICER 305 E EXEMPT FROM STATE U - ACQ COST UNKNOWN


RUN 05/03/2004


LEGEND F - FEDERAL S - STATE I - INHERITED E - EXEMPT FROM STATE U - ACQ COST UNKNOWN

SHARES DATE SALES PRICE COST BASIS GAIN/LOSS TERM ------ ---- ----------- ---------- --------- ----

PROPERTY DESCRIPTION --------------------

1405,0000 SOUTHTRUST CORP COM 844730101 SOLD 09/09/2003 41824 89 ACQ 1405 0000 08/16/2002 41824 89 37441 85 4383 04 LT15

290 0000 SOUTHTRUST CORP COM 844730101 SOLD 09/09/2003 8632 89 ACQ 290 0000 08130/2002 8632 89 7648 23 984 66 LT15

40 0000 TARGET CORP COM - 87612E106 SOLD 09109/2003 1565 13 ACO 40 0000 12/03/2002 1565 13 1378 00 187 13 POST-ST

250 0000 TARGET CORP COM - 87612E106 SOLD 0910912003 9782 04 ACQ 250 0000 11/0712001 9782 04 8575 00 1207 04 LT15

175 0000 TARGET CORP COM - 87612E106 SOLD 09/09/2003 6847 42 ACQ 175 0000 01/0312003 6847 42 5286 75 1560 67 POST-ST

150000 0000 UNITED STATES TREAS NTS DTD 05/15/96 6 875% DUE 05/15106 912827X80 SOLD 09/0912003 168140 63 ACO 150000 0000 05/13/1996 168140 63 151734 38 16406 25 LT15

5828 8600 GNMA POOL 442039 7 5% 10/15126 - 36207UBG2 SOLD 09/15/2003 5828 86 ACQ 5828 8600 10102/1996 5828 86 5828 86 0 .00 LT15

10410 6500 FANNIE MAE POOL FN254378 - 31371KQ79 SOLD 09/25/2003 10410 65 ACQ 10410 .6500 05/15/2002 10410 65 10410 65 0 00 LT15

9415 7700 FANNIE MAE POOL 254637 - 31371KZA2 SOLD 09125/2003 9415 77 ACQ 9415 7700 01/31/2003 9415 77 9415 77 0 00 LT15

3595 9400 FANNIE MAE POOL 313757 - 31374GQJ9 SOLD 09/2512003 3595 94 ACQ 3595 9400 03/0411999 3595 94 3595 94 0 00 LT15

380 0000 GANNETT INC COM - 364730101 SOLD 10/01/2003 29733 80 ACQ 380 0000 08120/2002 29733 80 28626 81 1106 99 LT15

65 0000 GANNETT INC COM - 364730101 SOLD 10/01/2003 5086 04 ACQ 65 0000 09/26/2002 5086 04 4853 55 232 .49 LT15

55 0000 GANNETT INC COM - 364730101 SOLD 10/01/2003 4303 58 ACO 55 0000 01/0312003 4303 58 4013 90 289 68 POST-ST

57 0700 GNMA POOL 442039 7 5% 10/15/26 36207UBG2 SOLD 10/15/2003 57 07 ACQ 57 0700 10102/1996 57 07 57 07 0 00 LT15

6729 0400 FANNIE MAE POOL FN254378 - 31371KG79 SOLD 10125/2003 6729 04 ACQ 6729 0400 05/15/2002 6729 04 6729 04 0 00 LT15

3716 4700 FANNIE MAE POOL 254637 - 31371KZA2 SOLD 10/25/2003 3716 47 ACQ 3716 4700 01/31/2003 3716 47 3716 47 0 00 LT15

2616 8500 FANNIE MAE P06L 313757 - 31374GCIJ9 SOLD 10/25/2003 2616 85 ACQ 2616 8500 03/04/1999 2616 85 2616 85 0 00 LT15

600 0000 FLEETBOSTON FINANCIAL CORP COM - 339030108 SOLD 11/06/2003 24274 86 ACQ 600 0000 08128/2001 24274 86 22836 00 1438 .86 LT15

1375 0000 FLEETBOSTON FINANCIAL CORP COM - 339030108 SOLD 11/06/2003 55629 89 ACO 1375,0000 07/24/2001 55629 89 51411 25 4218 64 LT15

2608 6400 GNMA POOL 442039 7 5% 10115/26 - 36207UB62 SOLD 11/15/2003 2608 64 ACQ 2608 6400 10/0211996 2608 64 2608 64 0 00 LT15

4802 6700 FANNIE MAE POOL FN254378 - 31371KQ79 SOLD 11/25/2003 4802 67 ACQ 4802 .6700 05/15/2002 4802 67 4802 67 0 .00 LT15

3205 9400 FANNIE MAE POOL 254637 - 31371KZA2 SOLD 11125/2003 3205 94 ACO 3205 9400 01/31/2003 3205 94 3205 94 0 .00 LT15

2389 2200 FANNIE MAE POOL 313757 - 31374GCIJ9 SOLD 11/2512003 2389 22 ACO 2389 .2200 03/04/1999 2389 22 2389 22 0 00 LT15

3827 0500 GNMA POOL 442039 7 5% 10/15/26 36207UBG2 SOLD 12/15/2003 3827 05 ACQ 3827 0500 10/02/1996 3827 05 3827 05 0 00 LT15

2200 0000 BEARINGPOINT INC COM - 074002106 SOLD 12/22/2003 21230 54 ACO 2200 0000 01128/2002 21230 54 37686 00 -16455 46 LT15

300 0000 BEARINGPOINT INC COM - 074002106 SOLD 12/22/2003 2895 08 ACO 300 0000 12/03/2002 2895 08 2643 00 252 08 LT15

125 0000 BEARINGPOINT INC COM - 074002106 SOLO 12/22/2003 1206 28 ACQ 125 0000 01103/2003 1206 28 893 75 312 53 POST-ST

3698 8500 FANNIE MAE POOL FN254378 - 31371KO79 SOLD 12/25/2003 3698 85 ACO 3698 8500 05/15/2002 3698 85 3698 85 0 00 LT15

ACCT 9095 104200862500 FROM 01/01/2003 TO 12/31/2003

TAX PREPARER 586 TRUST ADMINISTRATOR 764 INVESTMENT OFFICER 305

KEYBANK NATIONAL ASSOCIATION, STATEMENT OF CAPITAL GAINS AND LOSSES ERNA JORGESEN CHARIT TRST T/W

FEDERAL LONG TERM LONG TERM 28% LONG TERM 20% LONG TERM Q5(GAIN) LONG TERM 05(LOSS) LONG TERM 15% ------------- ------------- ------------------ ------------------ -------------

SUBTOTAL FROM ABOVE 0 00 -40266 00 11444 57 0 00 166038 76

LONG TERM

0 00

N/A

CAPITAL LOSS CARRYOVER SHORT TERM ---------------------- ----------FEDERAL 0 00

WASHINGTON N/A

ACCT 9095 104200862500 KEYBANK NATIONAL ASSOCIATION . PAGE 90 FROM 01/01/2003 STATEMENT OF CAPITAL GAINS AND LOSSES TO 12/31/2003 ERNA JORGESEN CHARIT TRST T/W RUN 05/03/2004


TAX PREPAREIR 586 TRUST ADMINISTRATOR 764 LEGEND F - FEDERAL S - STATE I - INHERITED INVESTMENT OFFICER 305 E - EXEMPT FROM STATE U ACQ COST UNKNOWN

PROPERTY DESCRIPTION SHARES DATE SALES PRICE COST BASIS GAINILOSS TERM -------------------- ------ ---- ----------- ---------- --------- ----

2570 5500 FANNIE MAE POOL 25463~ - 31371KZA2 SOLD 12/25/2003 2570 55 ACQ 2570 5500 01/3112003 2570 55 2570 55 0 00 LT15

1191 3900 FANNIE MAE POOL 313357 - 313746QJ9 SOLD 12/25/2003 1197 39 ACO 1193 3900 03/04/1999 1197 39 1197 39 0 00 LT15

--------------- --------------- TOTALS 2696008 57 2542168 98

SUMMARY OF CAPITAL GAINS/LOSSES -------------------------------

FEDERAL SHORT TERM PRE-SHORT TERM POST-SHORT TERM -------------- ---------------

SUBTOTAL FROM ABOVE -15877 61 32499 87

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