View
2
Download
0
Category
Preview:
Citation preview
OMB No 1545 0052 Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust
Treated as a Private Foundation Note The organization may be able to use a copy of this return to satisfy state
reporting requirements
202 Department of the Treasury Internal Revenue service
13 Compensation of officers directors trustees etc 14 Oilier employee salaries and wages
_ 3as, emp oyee benefits
4,400
750
1,080
18,730 596,511
615,241 763
a Excess of revenue over expenses and disbursements -660,236
b Net investment Income (I negative enter 0 ) 224
C Adjusted net income (d negative enter 0 )
anerwork Reduction Act Notice . see the instructions TEEA0301 10122/02
.,
Fo;m 99O'PF
For calendar ear 2002, or tax ear be innm F2b 1 , 2002, and endin Jan 31 , 2003 G Check all that apply Initial return Final Final return Amended return Address change Name change Use the
Name of organization A Employer identification number
IRS label Thomas Wilson Sanitarium for Children of Baltimore City 52-6044885 Otherwise, Number and street (or P O boa number if mail is not delivered to street address) RooMSUae B Telephone number (see instructions)
print or type P 0 Box 2766 (410) 360-9510
See Specific city « gown slam ZIP code C If exemption application is pending, check here Instructions B a 1 t 1 mO f 2 MD 21225 D 1 Foreign organizations, check here H Check type of organization X Section 501(c)(3 exempt private foundation 2Foreign organizations meeting the 85% test, clink
Section 4947 a 1) nonexem t charitable trust Other taxable private foundation here and attach computation Fair market va ue o a assets ai en o year J Accounting method X Cash Accrual E If private foundation status was terminated (tram Part ll, column c, line 16) under section 507(b)(1XA), check here
0 Other (specify) F If the foundation is m a 60 month termination ~ $ 9,836,563 (Part l, column d must be on cash basis ) under section 501(h)(1 x8), check here lir L1
Part I Analysis of Revenue and (a) Revenue and (b) Net investment (c) Adjusted net (d) Disbursements Expenses (The total of amounts m expenses per books income income for charitable columns b, c, and d may not neces purposes sanly equal the amounts in column a ) (cash basis only) (see instructions) 1 Contributions QiHS grants etc received (off sch)
Ck . F1 d the ipuidn is not req to aft Sch B 2 Distributions from split interest trusts 3 Interest on savings and temporary - - ' -- -
cash investments 186 186 186 4 Dividends andinterest from securities 278,665 278,655 278,655 ~- J Sa Gross rents b (Net rental Income or 005s) 7,
6a Net pains(loss) from safe or assets not on line io -75-9, ~083 b Grass sales pares for all 2 10 15 , 535 assets m line 6a - - - -
V 7 Capital gain net income (from Part IV line 2) E 8 Net short-term capital gain
9 Income modifications - g 10a Gross sales less I - I . i, - _- - , I '~
L return, an, 5 Cost of a
ances JIM
b Les! goods sold ''
c Gross profit/(loss) (att sch) 11 Other income (attach schedule)
c Other prof tees (ana'I`~ ) 54,763
"TBNTaes~att2TiacT~edu W
ee Line 18 Stint 750 i ~ on a scFred le) and depletion
E '~ - 1-~revdrcontefences, and meetings E 22 Printing and publications
o P 23 Other expenses (attach schedule) See Line 23 Stmt 1,080
24 Total operating and administrative s expenses Add lines 13 through 23 73,493
25 Contributions, gifts, grants paid 96 , 1 1 26 Total expenses and disbursements
7
9,804,638 9,144,402
9 .804 .638 9 .144 .402 ~ -- .
Part III Analysis of Changes in Net Assets or Fund Balances
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 1, 2, and 3 5 Decreases not included in line 2 (itemize) 6 Total nee assets or fund balances at end of year (line 4 minus line 5) - Part II, column (b) line 30
BAA TEEA0302 1023/02
.804,638 -660 .236
9,144,402 Form 990-PF (2002)
Porm 99d-PF (2002) Thomas Nelson Sanitarium for Children of Balti Attached Schedules and amounts m the descnpUOn BB
Part II Balance Sheets column should be for end of yea amounts only (See mstmchons )
1 Cash - non-interest bearing
2 Savings and temporary cash investments 3 Accounts receivable
Less allowance for doubtful accounts 4 Pledges receivable
Less allowance for doubtful accounts 5 Grants receivable 6 Recervahles due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions) 7 Other notes and loans receivable (attach sch)
Less allowance for doubtful accounts ~_ _-_ -------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) c Investments - corporate bonds (attach schedule)
11 Investments - land, buildings, and equipment basis Less accumulated deprecation (attach schedule)
12 Investments - mortgage loans 73 investments - other (attach schedule) 14 Land, buildings, and equipment basis ~ _
Less accumulated depreciation (attach schedule)
75 other assets (described Income tax overpayment ) 16 Total assets (to be completedby all filers -
see instructions Also, see page 1, item I) 17 Accounts payable and accrued expenses
A 18 Grants payable 19 Deferred revenue 20 Loans from officers, directors, trustees, 8 other disqualified persons L 21 Mortgages and other notes payable (attach schedule) 22 Other liabilities (describes )
E
Organizations that follow SFAS 117, check here 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
Organizations that do not follow SFAS 117, check here S B 5 A and complete lines 27 through 31 E L T A 27 Capital stock, trust principal, or current funds S N Zg Paid m 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 assets/fund balances
more Cit y 52-6044885 Page 2 ginning of year End of year a) Book Value (b) Book Value (c) Fair Market Value
25,747 14,292 14,292 1,474,706 1,296,718 1,296,718
310,170 310,170 341,470 5,117,785 5,387,240 5,884,717 2,865,417 2,130,682 2,294,066
144,402 9,836,563
~'- li V- OI~K
524,722
119,680 J Ar ° U,
'_,~i
'2002) Thomas Wilson Sanitarium i
(a) List and describe the kind(s) of property. sold (e g ,real estate, (b)HOwacpwre 2 story brick warehouse, or common stock, 20 shares MLC Company) p- Purchase
D - Donation
7a Premier Parks Notes P b Bl th Inc 3600 SH P c Frontier Corp Notes P d Bl th Inc 2000 SH P e See Attached Part IV, Line 1 Stmt
(e) Gross sales price (9 Depredation allowed I (g) Cost or other basis (or allowable) plus expense of sale
a 104 .730 101 .750
c a 4
(k) Excess of column (( over column 0), if any
0) Adjusted basis as of 12/31/69 as of 12/31/69
d e
2 Capital gain net income or (net capital loss) ~If gain, also enter in Part I, line 7 It (loss), enter 0 in Part I, line 7
3 Net short term capital gain or (loss) as defined in sections 1222(5) and (6)
If gain, also enter in Part I, line 8, column (c) (see instructions) N Qoss), enter 0 in Part I line 8 T 3
8 Enter qualifying distributions from Part XII, line 4 1 8 1 615,241
If line 8 is equal to or greater than line 7, check the box in Part VI, line It, and complete that part using a 1% tax rate See the Part VI instructions
BAA Form 990-PF (2002) TEEA0303 10/23102
5
acquired I kU) Date sole day year) (month day year)
various 02/21/02 various 03/05/02 various 03/06/02
(h) Gain or (loss) (e) plus (Q minus (g)
2 .980
10 .1
(I) Gains (Column (h) gain minus rnlumn (k), but not less
than 0) or Losses (from column (h))
2 980 -20,253
-120,206 -10,168
_i')i nzc
(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 distributable amount of any year in the base periods F Yes Fx~ No If 'Yes .' the organization does not quality under section 4940(e) Do not complete this part
1 Enter the appropriate amount in each column for each yeas, see instructions before making any entries
a d Base period years Adjusted qualifying distributions Net va l uho value of Distribution ratio
Calendar year (or tax year noncharilable use assets (column (b) divided by column (c)) beginning in)
2001 629 .439 11 .748 .647 0 053575
X999 582,892 12901,540 0 045180 t998 498,637 12
,.765,303 0 039062
1997 415 .896 10 .970 .084 0 037912
2 Total of line 1, column (d) 2 0 222641
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 044528
4 Enter the net value of noncharilable use assets for 2002 from Part X, line 5 4 10, 715, 043
5 Multiply line 4 by line 3 1 5 1 477, 11
6 Enter 7 % of net investment income (I% of Part I, line 27b)
7 Add lines 5 and 6 1 7 1 479,360
TEEA0307 10/23/02
'orm99U-PF(2002) Thomas Wilson Sanitarium for Children of Baltimore Cit y 52-6044885 ~ Page 4 pert VI Excise Tax Based OA Investment Income (Section 4940 a), 4940(b), 4940 (e ) , or 4948 - see instructions
1 a Exempt operating foundations described in section 4940(d)(2), check here ~ and enter N/A' on line 1 Date of ruling letter -- _ -- _- (attach copy of ruling letter if necessary - see instructions)
b Domestic organizations that meet the section 4940(e) requirements in Part V, 1 2,241 check here ~ X and enter 1 % of Part I, line 27b
c All other domestic organizations enter 2% of line 27h Exempt foreign organizations enter 4% of Part I, line 12, column (h) 2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0 ) 2 0 3 Add lines 1 and 2 3 2 , 241 4 Subtitle A (income) lax (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0 ) 4 0 5 Tax based on investment income Subtract line 4 from line 3 If zero or less, enter -0- 5 2,241 6 Credits/Payments a 2002 estimated tax pmts and 2001 overpayment credited to 2002 6a 4,500 b Exempt foreign organizations - tax withheld at source 6b c Tax paid with application for extension of lime to file (Form 8868) 6c d Backup withholding erroneously withheld 6d
7 Total credits and payments Add lines 6a through 6d 7 4,500 8 Enter any penalty for underpayment of estimated tax Check here a if Form 2220 is attached 8 9 Tax due If the total of lines 5 and 8 is more than line 7, enter amount owed ~ 9 10 Overpayment If line 7 is more than the foul of lines 5 and 8, enter the amount overpaid ~ 10 2 , 259- 11 Enter the amount on line 10 to he Credited to 2003 estimated tax ~ 2,259 Refunded ~ 11 lart'VII;AeStatements Regarding Activities
1 a During the tax year, did the organization attempt to influence any national, state, or local legislation or did it -- Yes No participate or intervene in any political campaigns 1 a X
b Did it spend more than $10) during the year (either directly or indirectly) for politrzal purposes (see instructions tar definitian)7 1 b X
I( the answer is Yes' to 1a or 76, attach a detailed description of the activities and copies of any materials published - ;r . -`y~ or distributed by the organization in connection with !he activities
c Did the organization file Form 7120-POL for this years 1c: X J d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year (1) On the organization ~ $ (2) On organization managers ~ $
e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed on organization managers ~ $ y
2 Has the organization engaged in any activities that have not previously been reported to the IRS 2 r X If 'Yes,' attach a detailed description of the activities :all S
3 Has the organization made any changes, not previously reported to the IRS, in its governing instrument, articles ~-e=---=-' of incorporation, or bylaws, or other similar instruments If 'Yes,' attach a conformed copy o/ the changes 3 X
4a Did the organization have unrelated business gross income of $1,000 or more during the years 4a X b If 'Yes,' has it filed a tax return on Form 990-T for this years 4b X
5 Was there a liqwdation, termination, dissolution, or substantial contraction during the years 5 X II 'Yes,' attach the statement required by General Instruction T
6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either -'--! " By language in the governing instrument or
" By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law remain in the governing instrument? 6 X
7 Did the organization have at least $5,000 in assets at any lime during the years If 'Yes,'romplefe Part fl, column (c), and Part XV 7 X 8a Enter the states to which the foundation reports or with which it is registered (see instructions) ~ May land ---------------
b If the answer is 'Yes' to line 7, has the organization furnished a co py of Form 990 PF to the Attorney General -- ---(or designate) of each stale as required by General Instruction G~ I/'No,' attach explanation 8b X
9 Is the organization claiming status as a private operating foundation within the meaning of section 4942Q)(3) or 494YU)(5) for calendar year 2002 or - -- - - the taxable year beginning in 2002 (see instructions (or Part Xlh7 If 'Yes,'tomplete Part XIV 9 X
10 Did any persons become substantial contributors during the tax years 10 X If 'Yes,' attach a schedule listing then names and addresses
17 Did the organization comply with the public inspection requirements for its annual returns and exemption applitalion7 11 X Web site address
12 The books are in care of - Mil l le Campon-----_------_ _ _ _ _ _ Telephone no - (410) 360-9510 Located at " P 0 Box 2766 Baltimore, MAryland ZIP +a~ 21225-2766
13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 PF in lieu of Form 1041 - Check here - - - - - - - - - - - - -and enter the amount of tax-exempt interest received or accrued during the year ~j 13
BAA Form 990-PF (2002)
s art VII-8 I Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the 'Yes' column, unless an exception applies 1 a During the year did the organization (either directly or indirectly)
(1) Engage in the sale or exchange, or leasing of property with a disqualified persons ~ Yes X No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified persons Yes X No
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified persons ~ Yes X No (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified persons Yes X No
(5) fT~rai~seebenefitno~ se of asdisqualified
t~disqualified jd person (or make any of either available F1 Yes X No
(6) Agree to pay money or property to a government officials (Exception Check 'No' if the organization agreed to make a grant to or to employ the official for a period after termination of government service, it terminating within 90 days ) El Yes X No
b If any answer is 'Yes' to 1 a(1) (6), did any of the acts fail to quality under the exceptions described in Regulations section 53 4941 (d) 3 or m a current notice regarding disaster assistance (see instructions) 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 1 a, other than excepted acts, that were not corrected before the first day of the tax year beginning in 2002
2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization was a private operating foundation defined in section 49420(3) or 49420(5))
_-
a At the end of lax year 2002, did the organization have any undistributed income (lines 6d and 6e, Part Xllq for tax year(s) beginning before 2002 DYes 21 No If 'Yes,' list the years ~ 20 , 20 , 19 , 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 incomes (If applying section 4942(a)(2) to - all years listed, answer 'No' and attach statement - see instructions ) 21
c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here X20 ,20 ,19 ,19
3a Did the organization hold more than a 2% direct or indirect interest in any business enterprise at any time during the years 11 Yes Xa No -
(5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelly to children or animals ~ Yes X No
b If any answer is 'Yes' to Sa(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 instrudions)7 Organizations relying on a current notice regarding disaster assistance check here
c If the answer is 'Yes' to question Sa(4), does the organization claim exemption from the tax because it maintained expenditure responsibility for the granl7 EJYes [] No I/ 'Yes,' a(tach the statement required by Regulations section 53 494,5 5(d)
6a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit tonlracl7 F~ Yes LMXJ No
b Did the organization during the year, pay premiums, directly or indirectly, on a personal benefit contract' X
BAA Form 990-PF (2002) TEEno3o5 10/231o2
Yes No
b If 'Yes,' did it have excess business holdings in 2002 as a result of (I) any purchase by the organization or disqualified persons after May 26, 1969, (2) the lapse of the 5-year period (or longer period approved _ by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest, or (3) the lapse of the 10 , 15 or 20 year first phase holding periods (Use Schedule C, Form 4720, to determine if the organization had excess business holdings in 2002)
4a Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes
b Did the organization make any investment 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 2002
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))? ~ Yes El No
(2) Influence the outcome of any specific public election (see section 4955), or to carry on, directly or indirectly, any voter registration drrve7 e Yes Xe No
(3) Provide a grant to an individual (or 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)? Yes X~ No
l
X
i ti I
` .
.' J
6 Form 990-PF (2002) Thomas Wilson Sanitarium for Children of Baltimore City Part VII Information About Officers, Directors, Trustees, Foundation Manai
and Contractors
1 List all officers, directors, trustees, toundatuon mana ers and their com ensaUon see lost (b) Title and average (c) Compensation
(a) Name and address hours per week Q( not paid, enter -0-)
devoted to position
Dr_ Kenneth SchuberthPresident Baltimore, Mar y land 2 0
0 0
------------------------
over Total number 'None'
0
--------------------------------------
Total number of others receiving over $50, 000 for professional services
Part IX=Ar-Summary of Direct Charitable Activities
List the foundation's four largest direct charitable activities during the tax year Include relevant statistical information such as the number of organizations and other beneficiaries served, confe rences conv en ed, rese arch papers produced, etc
1 The Foundation funded-XX applications-totaling $596511_
duringlthe year ened_January-31,_2003_ These grants-were dirertv for the cadre and development of the children of Bal timore City
Expenses
96
---------------------------- -------------------------------------------------------------------------------
4 ________________________ .
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
TEEn0306 10123102 BAA
Kinloch N_ Yellott_ III-_---- Vice Pres Baltimore . Maryland ------------------------
------------------------
2 Compensation of five highest-paid employee s other than those mi
(a) Name and address of each employee (b) Title and average paid more than $50,000 hours per week
devoted to position
None N/A
None
------------------------
------------------------
------------------------
services -
a) Name and address of each person aid mare than $50,000
None u� ~A N/A
--------------------------------------
-------------------------------------
-------------------------------------
52-6' 1y Paid
(d) Contributions to (e) Expense account, employee benefit other allowances plans and deterred
0
ed on line 1- see instructions If none, enter 'None .
(c) Compensation (d) Contributions to (e) Expense account, employee benefit other allowances plans and deferred
ne
------------------------------------------------------
Form 990-PF (2002) Thomas Wilson Sanitarium for Children of Baltimore City 52-6 044885 Page 7
Pan IX-B Summary of Program-Related Investments (see instructions)
ear on fines 1 and 2
------------------------------------------------------
------------------------------------------------------
Ali other program related investments See instructions 3
------------------------------------------------------
Total Add lines 7 through 3 ~ N o ne
Part 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 in carrying out charitable, etc, purposes a Average monthly fair market value of securities 1 a 10,877 , 716
b Average of monthly cash balances l b 500
c Fair market value of all other assets (see instructions) 1 c
d Total (add lines la, b and c) 1 d 10,878, 216
e Reduction claimed for blockage or other factors reported on lines la and lc (attach detailed explanation) l e i 0
2 Acquisition indebtedness applicable to line 1 assets 2
3 Subtract line 2 from line ld 3 10, 878, 216 4 Cash deemed held for charitable activities Enter 1-112% of line 3 (for greater amount, see instructions) 4 163 173
5 Net value of nonchantable-use assets Subtract line 4 from line 3 Enter here and on Part V, line 4 5 10, 715,043 6 Minimum investment return Enter 5% of line 5 6 535 . 752
Part XI Distnbutable Amount (see instructions) (Section 4942Q)(3) and Q)(5) private operating foundations and certain foreign organizations check here i" and do not complete this art )
1 Minimum investment return from Part X, line 6 1 535,752 2a Tax on investment income (or 2002 from Part VI, line 5 2a 2, 241 b Income tax for 2002 (this does not include the tax from Part VI ) 2b c Add lines 2a and 2b 2c 2, 241
3 Distributable amount before adjustments Subtract line 2c from line 1 3 533, 511 4a Recoveries of amounts treated as qualifying distributions 4, 1 b Income distributions from section 4947(a)(2) trusts 46 c Add lines 4a and 4b
5 Add lines 3 and 4c 5 533, 511 6 Deduction from distributable amount (see instructions) 6 7 Distnbutable amount as adjusted Subtract line 6 from line 5 Enter here and on Part XIII, line 1 7 533 , 5 11
Pan XII Qualifying Distributions (see instructions)
TEEA0307 10123/02
7 N/A
2
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 615,241 b Program-related investments - Total from Part IX-B 1 b 0
2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc, purposes 2
3 Amounts set aside for specific charitable projects that satisfy the a Suitability lest (prior IRS approval required) 3a b Cash distribution test (attach the required schedule) 3b
4 Qualifying distributions Add lines 1 a through 3b Enter here and on Part V, line 8, and Part XIII, line 4 4 615,241
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 , 241
6 Adjusted qualifying distributions Subtract line 5 from line 4 6 613, 000
Note The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies far the section 4940(e) reduction of tax m those years
gqp Form 990-PF (2002)
.,
Form99d-PF(2002) Thomas Wilson Sanitarium for Children of Baltimore City 52-6044885 Page B
Pan XIII Undistributed Income (see instructions)
(a) (b) (c) (d) Corpus Years prior l0 2001 2001 2002
l Distributable amount for 2002 from Part XI, dine 7 533,511
2 Undistributed income, d any, as of the end of 2001 a Enter amount (or 2001 only 583,245 b Total for prior years 20_, 19 , 19
3 Excess distributions carryover, d any, to 2002 a From 1997 0 b From 1998 0 c From 1999 0 d From 2000 8 , 6 5 3 e From 2001 633 , 626 _ _ f Total of lines 3a through e 642,279
4 Qualifying distributions for 2002 from Part X11, line 4 ~ $ 615,241
a Applied to 2001, but not more than line 2a
b Applied to undistributed income of prior years ' - ', - (Election required - see instructions) 'I
c Treated as distributions out of corpus f_ri (Election required - see instructions) - d Applied to 2002 distnbutable amount e Remaining amount distributed out of corpus 1 615, 241
5 Excess distributions carryover applied l0 2002 (if an amount appears m column (d), !he 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 1 257, 520
b Prior years' undistributed income Subtract line 4b from line 2b 0
c Enter the amount of prior years undistribut ' ed income for which a notice of deficiency has been issued, or on which the section 4942(a) lax has been previously assessed _ 1T" ~ `' - I
d Subtract line Fx from line 6b Taxable amount - see instructions 0 - - -
e Undistributed income for 2001 Subtract line 4a from line 2a Taxable amount - see instructions
f Undistributed income for 2002 Subtract lines 4d and 5 from line 1 This amount must be ` distributed in 2003 533, 511
7 Amounts treated as distributions out of corpus to salisfy requirements imposed by section 170(6)(1)(E) or 4942(8)(3) (see instructions) - -
8 Excess distributions carryover from 1997 not applied on line 5 or line 7 (see instructions) 0
9 Excess distributions carryover to 2003 Subtract lines 7 and 8 from line 6a 1,257,520 I
10 Analysis of line 9 a Excess from 1998 0 b Excess from 1999 0 c Excess from 2000 8, 653 d Excess from 2001 633 , 626 e Excess from 2002 G15,241
BAA Form 990-PF (2002)
reeno30e 11n2102
re City 52-
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors Grants must benefit the children of Baltimore City, Maryland
BAA reeao3os ionyoz Form 990-PF (2002)
and Part VII 1 a If the foundation has received a ruling or determination leper that d is a private operating foundation, and the ruling
is effective for 2002, enter the date of the ruling b Check box to indicate whether the organization is a private o eratin foundation described in 5c
2a Enter the lesser of the adjusted net Tax ear Prior 3 ee income from Part I or the minimum a 2002 b 2001 c 2000 investment return from Part X for each year listed
b 85% of line 2a c Qualifying distributions from Part XII,
line 4 for each year listed d Amounts included in line 1c not used directly
for active conduct of exempt activities e Qualifying distributions made directly
for active conduct of ezempt activities Subtract line 2d from line 2c Complete 3a, b, or c for the alternative test relied upon
a Assets' alternative test - enter (7) Value of all assets (2) Value of assets qualifying under
section 4942Q)(3)(B)(p to 'Endowment' alternative test - Enter 2/3 of minimum investment return shown in Part X, line 6 for each year listed
c 'Support' alternative test - enter (1) Total support other than gross
investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties)
(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(Bxup
(3) Largest amount of support from an exempt organization
(4) Gross investment income
7 Information Regarding Foundation Managers,
a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation before the close of any tax year (but only if they have contributed more than $5,000) (See section 507(d)(2) ) None
b List any managers of the foundation who own 10°h 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 " O if the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds I( the organization makes gifts, grants, ett, (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 Dr Kenneth S Schuberth p,0, (;on z7blo Baltimore, Maryland Z12Z5 ealc,more MD 2_t z7-5 (aio) 3(p0-951C
b The form in which applications should be submitted and information and materials they should include Letter form stating the entity to be benefited and services to be rendered
c Any submission deadlines None
3b BAN TEEA0310 1023102 Form 990-PF (2002)
Form 990-PF(2002) Thomas Wilson Sanitarium for Children of Baltimore Cit y 52-6044885 Page 10 'Part XV Su lementary Information (continued) 3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient If recipient is an individual, show any relationship to any Foundation Purpose of grant or Amount foundation mana ger or status of contribution
Name and address home or business substantial contributor recipient a Paid during the year
Schedule attached Attached Attached N/A 596 .511
3al 596 .511 b Approved for future payment
Form 990 PF (2002) Thomas Wilson Sanitarium for Children of Baltimore City 52-6044885 Page 77
Part XVI"A Analysis of Income-Producing Activities
d e f g Fees and contracts from government agencies
2 Membership dues and assessments 3 Interest on savings and temporary cash imestmenis 4 Dividends and interest from securities 5 Net rental income or (loss) from real estate a Debt financed property b Not debt-financed property
6 Net rental income or (loss) from personal property 7 Other investment income 8 Gain or (loss) from sales of assets other than inventory 9 Net income or (loss) from special events 10 Gross profit or (loss) from sales of inventory 11 Other revenue
186 278 .665
- . ._ _ I _
Line No I Explain below how each activity for which income is reported in column (e) of Part XVI A contributed importantly to the ~ accomplishment of the organization's exempt purposes (other than by providing funds for such purposes) (See instructions )
Form 990-PF (2002) BAA TEeno5o1 o1rz3io3
Enter gross amounts unless otherwise indicated Unrelated business inc(
Bu( a)
Amount code
1 Program service revenue a
Excluded b section 512, 513, or 514 (c) (d)
Exclu Amount (e )
exempt function income
b c d e
12 Subtotal Add columns (b), (d), and (e) I ^~ ~ = ~ 9,768 13 Total Add line 12, columns (b), (d), and (e) 13 9,768
(See worksheet in the instructions for line 13 to verify calculations )
Part XVI-B;, Relationship of Activities to the Accomplishment of Exempt Purposes
Information Regarding Transfers To and Transactions and Relationships With Nonchantable Exempt Organizations
Ye~ I 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 nonchantable exempt organization of - - (1) Cash 1 a (1) (2) Other assets 1 a (2)
la Other Transactions (1) Sales of assets to a noncharitable exempt organization 1 If (1) (2) Purchases of assets from a noncharitable exempt organization I b (2) (3) Rental of facilities, equipment, or other assets 1 lo (3) (4) Reimbursement arrangements I b (4) (5) Loans or loan guarantees 1 b (5) (6) Performance of services or membership or fundraising solicitations I b (6)
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees I C
d If the answer to any of the above is 'Yes,' complete the following schedule Column (b) should always show the fair market value of (he goods, other assets, or services
given by the ing oroanization If the organization received less than fair market value in
an,_I~mgcl~onoofftLhan~ aTangemen I, show in =n (d) the value of the goods, other assets, or services received
(a) Line no b Am 'n miol, d
(c) Name of nonchantable exeMDt omanization I (d) Descritition of transfers . transactions. and shanno arratmenniff
X
F]Yes El No
TEEA0502
I .
X
2 a Is the organization directly or indirecti affiliated with, or related to, one or more tax exempt organizations described in section 501 (c) of the CoYe (other than section 501 (c)(3)) or in section 5277
b If 'Yes .' comolete the followino schedule
under whailies of perjury I declare hat I have examined this return including ac( correct and complete Declaration of preparer (other than taxpayer or fiduciary) is
0-
cc ~ dufl~-
Sign e of officer or must" A
Sign Prepaier s 1~ F%N Here Paid signature Pre- Michael D Sisk, Sr p.arer's Michael D SisF& use Firm s name (or yours
if self empi 575 S Charles St Only i Zi code address anon%
BAA
OMB No 1545 OD47
2002 Employer identification number
Sbhedu!ge, (Form 990, ~ FEZ, Schedule of Contributors or 990-PF)
Department of the Treasury Supplementary infortriation for Internal Re~enue service line I of Form 990, 990-EZ and 990-PF (see inst
Name of organi~ation
hildren of Baltimore Ci
Special Rules - For a section 501 (c)(3) organization filing Form 990, or Form 990 EZ, that met the 33 1/3% support test of the regulations under sections 509(a)(1 )II 70(b)(1 )(A)(vi) and received from any one contributor, during the year, a contribution of the greater of $5,000 or 2% of the amount on line I of these forms (Complete Parts I and 11 )
For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990 EZ, that received from any one contributor, during the year, aggregate contributions or bequests of more than $1 000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals (Complete Parts 1, 11, and III )
For a section 501 (c)(7), (8), or (10) organization filing Form 990, or Form 990 EZ, that received from any one contributor, during the year, some contributions for use exclusively for religious, charitable, etc, purposes, but these contributions did not aggregate to more than $1,000 (if this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc, purpose Do not complete any of the Parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc, contributions of $5,000 or more during the year ) ii~ S
Caution Organizations that are not covered by the General Rule andlor the S cial Rules do not file Schedule 8 (Form 990, 990-EZ, or 990 PF) but must check the box in the heading of their Form 990, Form 990 9 or on line I of their Form 990 PF, to certify that they do not meet the filing requirements of Schedule 8 (Form 990, 990 EZ, or 990 PF)
Schedule B (Form 990, 990 EZ, or 990 PF) (2002)
TEEA0701 01/23103
Organization type (check one) Filers of Section Form 990 or 990 EZ 501 (c)(_) (enter number) organization
4947(a)(1) nonexempt charitable trust not treated as a private foundation 527 political organization
Form 990 PF 501 (c)(3) exempt private foundation 4947(a)(1) nonexempt charitable trust treated as a private foundation 501 (c)(3) taxable private foundation
Check if your organization is covered by the General Rule or a Special Rule (Note Only a section 501(c)(7) . (8), or (10) organization can check box(es) for both the General Rule and a Special Rule - see instructions )
General Rule - FX] For organizations filing Form 990, 990 EZ, or 99D PF that received, during the year, $5,000 or more (in money or property) from any one
contributor (Complete Parts I and I )
BAA For Paperwork Reduction Act Notice, see the instructions for Form 990 and Form 990-EZ
I I I . I I . I
Form 990-PF Capital Gains and Losses for Tax 2002 Part IV, Line 1 on Investment Income Statement Attach to return
Name Employer ID No Thomas Wilson Sanitarium for Children of Baltimor 52-6044885
Copy Number I of 4
(b) How (c) Date (d) Date acquired acquired sold
P Purchase (month, (month, D Donation day, year) day, year)
(a) List and describe the kind(s) of property sold (e g , real estate, 2-story brick warehouse, or common stock, 200 shares MLC Company)
1 aBlyth Inc 1900 SH P various 03/07/02 bArnerican Express 3300 SH P various 03/14/02 Jallpine Corp 3600 SH P various 03/22/02 dGeneral Motors 900 SH P various 03/27/02 eGeneral Motors 1100 SH P various 03/27/02 fGeneral Motors 200 SH P various 04/01/02 qWells Fargo 1200 SH P various 04/01/02 hGeneral Motors 600 SH P various 04/02/02 iGeneral Motors 400 SH P various 04/03/02 jFirst Data 1200 SH P various 04/11/02
1 1 (e) Gross sales price (f) Depreciation allowed (g) Cost or other basis (h) Gain or (loss)
(or allowable) plus expense of sale I (e) plus (f) minus (g)
-11,004 106,335 -10,302 -11,689 -14,141 -2, 562 37,990 -7,679 -5,181 72,576
51,758 29,070 60,571 26,311 32, 158 5,847
20,804 17,541 11,694 32,393
a 40,754 b- 135,405 C 50,269 d- 14,622 e 18,017 f- 3, 285 9 58,794 h- 9,862 1 6, 513 J 104,969
(1) Gains (column (h) gain minus column (k), but not less than -0-)
or losses (from column (h))
(i) Fair Market Value 0) Adjusted basis (k) Excess of column (i) as of 12/31/69 as of 12/31/69 1 over column 0), if any
-11,004 106,335 -10,302 -11,689 -14,141 -2, 562 37,990 -7,679 -5, 181 72,576
e I
TEEW1601 SCR 10121102
Complete only for assets showing gain in column (h) and owned by the foundation on 12131/69
b C
Capital Gains and Losses for Tax 2002 on Investment Income
Attach to return
~ Employer ID No inore City 52-6044885
Copy Number 2 of 4
(b) How (c) Date (d) Date acquired acquired sold
P Purchase (month, (month, D-Donation day, year) day, year)
Name Thon
(a) List and describe the kind(s) of property sold (e g , real estate, 2-story brick warehouse, or common stock, 200 shares MLC Company)
1 aMillipore Corp Notes P various 04/24/02 bConvergys 2100 SH P various 07/09/02 Jrudential Financial 2000 SH P various 07/25/02 dWellpoint 700 SH P various 07/26/02 eWells Fargo 1200 SH p various 07/26/02 fGreen Tree Notes p various 07/08/02 gAmericredit 2400 SH p various 08/13/02 hAgilent 4500 SH p various 08/27/02 iAOL 5100 SH P various 08/27/02 j Agre 2697 SH P various 08/28/02
(h) Gain or (loss) (e) plus (0 minus (g)
250 -40, 114
1 , 128 28, 138 32,026 1,894
-36,727 -79,914 46,978 4,411
(1) Gains (column (h) gain minus column (k), but not less than -0-)
or losses (from column (h))
250 -40,114
1, 128 28, 138 32,026 1,894
-36,727 -79,914 46,978 4,411
TEEW1601 SCR 10121102
Form 990-PF Part IV, Line 1 Statement
(e) Gross sales price (f) Depreciation allowed (g) Cost or other basis I (or allowable) I plus expense of sale
a 100,000 99,750 b 22,139 62, 253 C 62,354 61,226 d- 49,257 21,119 e 52,830 20,804 f- 151,500 149,606 9 24,995 61,722 h- 74,238 154,152 1 71,390 24,412 J 4,411 0
Complete only for assets showing gain in column (h) and owned by the foundation on 12131/69
(i) Fair Market Value 0) Adjusted basis (k) Excess of column (i) as of 12/31/69 as of 12/31/69 over column 0), if any
a b C of e
h I J
laAvaya 316 SH p various 08/28/02 bLucent 9800 SH P various 08/28/02 ciraverlers Propert 457 SH P various 09/09/02 dTraverlers Property 940 SH P various 09/09/02 eWellpoint Health 600 SH P various 10/11/02 fSolutia Notes P various 10/15/02 qMBIA 500 SH P various 11/18/02 hXL Capital 900 SH ? various 11/19/02 i6tigroup 1700 SH ? various 11/22/02 jAmericredit 6800 SH P various 01/22/03
1 1 i (h) Gain or (loss)
(e) plus (f) minus (g)
-269,298 6,348
13,286 27,921
321 2,017
41,609 48,823 -92 .737
(1) Gains (column (h) gain minus column (k), but not less than -0-)
or losses (from column (h))
574 -269,298
6,348 13,286 27,921
321 2, 017
41,609 48,823 -92,737
h_ I-J-
TEEW1601 SCR 10/21/02
Form 990-PF Capital Gains and Losses for Tax 2002 Part IV, Line I on Investment Income Statement Attach to return
Name Empioyer ID No Thomas Wilson Sanitarium for Children of Baltimore City 52-6044885
Copy Number 3 of 4
(a) List and describe the kind(s) of property sold (b) How (c) Date (d) Date (e g , real estate, 2-story brick warehouse, or acquired acquired sold common stock, 200 shares MLC Company) P-Purchase (month, (month,
D-Donation day, year) day, year)
(e) Gross sales price (f) Depreciation allowed (g) Cost or other basis I (or allowable) I plus expense of sale
a 574 0 b 14,937 284,235 C 6,348 0 d- 13 .286 0 e 46,023 18, 102 f- 100, 000 99,679 9 19,400 17,383 h- 70,387 28,778 1 62,255 13,432 i 27,575 120,312
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i) Fair Market Value 0) Adjusted basis (k) Excess of column (i) as of 12/31/69 as of 12131/69 over column 0), if any
a b
e f
Form 990-PF Capital Gains and Losses for Tax 2002 Part IV, Line I on Investment Income Statement Attach to return
Name Employer ID No Thomas Wilson Sanitarium for Children of Baltimo e Citv 52-6044885
1 -
Copy Number 4 of 4
id so (b) How (c) Date (d) Date acquired acquire
31d
P-Purchase (month (month, D-Donation day, year) day, year)
(a) List and describe the kind(s) of property sold (e g , real estate, 2 story brick warehouse, or common stock, 200 shares MLC Company)
h
J .
(h) Gain or (loss) (e) plus (f) minus (9)
(e) Gross sales price (f) Depreciation allowed (g) Cost or other basis I (or allowable) I plus expense of sale
-21,957 9,244
28,309 199,656 150,000
f
(1) Gains (column (h) gain minus column (k), but not less than 0
or losses (from column (h))
(i) Fair Market Value 0) Adjusted basis (k) Excess of column (i) as of 12/31/69 as of 12/31/69 1 over column 0), if any
-21,957 9,244
0
h i
TEEW1601 SCR 10121/02
laAmericredit 1600 SH p various 01/23/03 b-cendant Notes P various 01/28/03 cCountrywide Notes P various 10/08/02 CF
f
a 6,352 b 208,900 c 150,000 d
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
I I
b
e If
Form 990-PF, Page 1, Part 1, Line 23 Line 23 Stmt
Other expenses Rev/Exp Book Net Inv Inc Adl Net Inc Charity Disto Miscellaneous Telephone
Total 1,080 1,080
Thomas Wilson Sanitarium for Children of Baltimore City 526044885
Form 990 PF, Page 1, Part 1, Line IS Line 18 Strnt
Taxes (see instructions) Rev/Exp Book Net Inv Inc Adl Net Inc Charity Disb Payroll taxes Foreign taxes paid 750 750 Excise taxes
Total 750 750
4 . . .
House of Mercy Literacy Program 20,000 901 Hollins Street Baltimore, MD 21223
THOMAS WILSON SANITARrUM FOR CHILDREN OF BALTIMORE CITY
Names and Addresses of 2002 Grant Requests
Advocates for Children & Youth Improving Health Care Access for Foster Children 25,000 8 Market Place - 5' Floor Baltimore, MD 21202
Baltimore Christian School K-5 Reading and Writing Curriculum 25,000 505 East 4Td Street Baltimore, MD 21218
Bryn Mawr School Baltimore Reader's Camp 10,000, 109 West Melrose Avenue Baltimore,MD 21210
Camp Believe, Inc Camp Believe Summer Program 10,000 2453 Maryland Avenue Baltimore, MD 21218
Enoch Pratt Free Library Roland Park Middle School After-School Program 10,000 400 Cathedral Street Baltimore, MD 21201
Father Charles A Hall Middle School Fresh Air for Asthmatic Students 5,000 2848 W Lafayette Avenue Baltimore, MD 21216
Franciscan Youth Center Summer Program Changing Hearts, Changing Minds 30,000 2209 Greemmount Avenue Baltimore, MD 21218
Gilman School Baltimore Independent School Learning Camp 25,000 5407 Roland Avenue Baltimore,MD 21210
Grace and St Peter's School School Restoration and Expansion Project 5,000 707 Park Avenue Baltimore, MD 21201
Greater Homewood Community Corporation Youth Development Initiative 5,000 3503 North Charles Street Baltimore, MD 21218
Hampden Family Center After-School Enrichment Program 10,000 1 104 West 361b Streeet Baltimore, MI) 21211
19,800 j
20,000/
15,000
10,000
5,000
25,000
35,000
15,000
19,656
19,691
19,800
13,754
19,112 Johns Hopkins School of Mechcme General Pediatrics & Adolescent Medicine 600 North Wolfe Street - CMSC 149 Baltimore, MD 21287
Language Delays Among Young Children in Baltimore City Prevalence and Determinants of Early Identification
V : ' . ..
M~ryland'Farents of Blind Children 1800 Johnson Street Baltimore, MD 21230
Maryland Society for Sight 13 13 West Old Cold Spring Lane Baltimore, MD 21209
Mother Seton Academy 724 South Ann Street Baltimore, MD 21231
St Paul's School P 0 Box 8 100 Falls Road Brooklandville, MD 21032
St Vincent de Paul Society J20 Cathedral Street Baltimore, MD 21201
Teach Balumore/JHU Interfaith Center 3400 North Charles Street Baltimore, MD 21218
Jemicy School Community Outreach I I Celadon Road Ovnngs MiIls, MD 21117
American Lung Association of Maryland 1840 York Road, Suite M Timonium, MD 21093
Johns Hopkins Children's Center Division of Pediatric Endocrinology 600 North Wolfe Street - Park 211 Baltimore, MD 21287
Johns .HopkLns Hospital 600 North Wolfe Street - Park 307 Baltimore, MD 21287-2530
Johns Hopkins School of Medicine 600 North Wolfe Street - CMSC 145 Baltimore, NO 21287
Johns Hopkins Hospital Department of Pediatrics 600 North Wolfe Street - CMSC 144 Baltimore, MD 21287
KIDS Camp and Teen Restreat
Pediatric Vision Screening in Baltimore City
Holistic Approach to Catholic Middle School Education
Bridges An Academic Eninchment Program for City Youth
Camp St Vincent
Summer Reading Initiative Expansion
Community Outreach Partnership with Archdiocese Schools
Camp Superkids 2002
Extensive Evaluation/Adolescents with Growth Disorders
Improving Pediatricians' Recogration/Management of Depression in Primary Care
Parental Attitudes and Satisfaction with Services and Medication Treatment for ADHD in Baltimore City
Current Counseling Practices Regarding Booster Seats in Primary Care Pediatric Practice
Total 596,511
Johns Hoftms Children's Center Ufthzation of New Technological Advances for the 19,926 Divi~ion of Pe(hatric Endocrinology Treatment of Baltimore Children with Diabetes 600 North Wolfe Street - Park 21 1 Baltimore, MD 21287
Johns Hopkins University Comparison of Low Fat v Low Glycemic Index Diets 15,000 Pediatric Gastroenterology in the Treatment of Obesity in School-Aged Children 720 Rutland Avenue - Room 129 Baltimore, MD 21205
Johns Hopkins University Combined Use of G-NM and Push Enteroscopy to 15,000 Pediatric Gastroenterology Sub-stratify Peduttric 1131) 720 Rutland Avenue - Room 129 Baltimore, MD 21205
Johns Hopkins University Evaluating the Effects of Probiotic Therapy on the 15,000 Pediatric Gastroenterology & Nutrition Gastrointestinal Symptoms Association with Autism 720 Rutland Avenue - Room 129 Baltimore, NO 21205 Ic- Johns Hopkins University Medical Adherence and Health Care Utilization in 15,000 Pediatric Gastroenterology & Nutrition Children with Crohn's Disease 720 Rutland Avenue - Room 129 Baltimore, MD 21205
Johns Hopkins School of Mecheme Cerebral Impact of Childhood Sleep Apnea 15,000 600 North Wolfe Street - Park 316 Baltimore, MD 21287
Kennedy Krieger Institute Jmtial Chrucal Vatidation of an Auditory Continuous 25,000 707 North Broadway Performance Test for Preschoolers Baltimore, MD 21205
Kennedy Kneger Research Institute, Inc Motion Analysis in Cerebral Palsy Quantification of 24,864 707 North Broadway Distinct Motor Disorders in the Upper Extremity Baltimore, MD 21205
University of Maryland School of Medicine Obesity Prevention Among Baltimore Teens 34908 Department of Pediatrics 655 West Lombad Street - Suite 3 11 Baltimore, MD 21201
Recommended