0169d9fd - 990s.foundationcenter.org990s.foundationcenter.org/990pf_pdf_archive/311/...15480112 805528 AVERY 2003.03000-JOHN E. & CARON G. AVERY FO AVERY-1. JOHN E . & CARON G. AVERY

Form 990-P FDepartment of the TreasuryInternal Revenue Service

For calendar year 200:

or Section 4947 (a)( 1 ) Nonexempt Charitable TrustTrea ted as a Pr i vate Founda t ion

N ote : The organization maybe able to use a copy of this return to satisfy state reporting requirements.or tax year beginnIng OCT 1, 2003 ,and ending SEP 30, 200 4

Initial retu rn ~ Final return E:1 Amended re turn Address Chan e CI

31-148150 6

Use the IRS N ame of organization A Emp l oyer i dentif i cat i on numb e

label . JOHN E . & CARON G . AVERY

Otherwise, FOUNDATION, INC .print Number and street (or P O box number i f mai l is no t del iv ered to street address)

or type . 2 /0 R .E . INGRAM, 410 GEORGE STREETS e e Spec

ific City or town, state, and ZIP cod eInstructions EWBRUNSWICK, NJ 0890 1

H Check type of organization ~X Section 501(c)(3) exempt private foundationSection 4947(a)(1) nonexempt charitable trust = Other taxable private foundation

I Fair market value of all assets at end of year J Accounting method 1XI Cash [

(from Part ll, co!. (c), line 16) = Other (specify )► $ 3,072,362 . (Part 1, column (d) must be on cash bass

2003

Room/suite IB Telephone numbe r

732-524-106 0

Accrua l

pan I Analys i s of Revenue and Expenses ( a) Revenue and ( b ) Net investment(The total of amounts in columns ( b), (c), an d (d) may no tnecessarily equa l th e amounts in column (a)) expenses per boo ks in come

interes t

1 Contributions, gifts, grants, etc ,received 0 .

Ch eck lo- a it th e loun da bOn is not required to a ttach Sch B

2 Distributions from split-interest trustson savin gs and te mporary

3 cash investments

4 Dividends and interest from securities

.-

5a Gross rents

b ( Net rental income or (loss) 1Nel ga in or (l oss) from sale of assets not on

L l ine 1 0b G ro ss sales pnce for all 107,838 .> assets on line 6 a

dnl~ W 7 Capital gain n et i ncome (fro m Part IV, line 2)

8 Net short-term capital gai n

9 Income modification sJ 10a Gro ss sales less returns

and allo wances

b Less Cost of goods sold

c Gross profit or (loss)

11 Other income

1 2 Total . Add lines 1 throw h 11 113,401 .1 3 Compensation of officers, d irecto rs, trus tees , etc 0 .

C~) 14 Other employee sala ri es and wages

15 Pension plans, employee benefits

16a Legal fee s

a b Accounting fees STMT 3 3,000 .

W c Other professional fee s> 17 Interest

18 Taxes STMT 4 1,806 .• ~ 1 9 Depreciation and depletio n

20 Occupancy

a 21 Travel, conferences, and meetings

m 22 Printing and publication sc

S0 23 Other expenses STMT 5 29 .

M 24 T ot a l o p er atin g and ad ministrati ve

a expenses . A d d lines 13 through 23 4,835 .0

25 Contributions, gifts, grants paid 171,540 .

26 Tot al e xp enses a n d d is b ursem e nt sAdd lines 24 and 25 17 6 3 7 5 .

2 7 Subtract line 26 from line 1 2

a Excess of revenue over expenses and d i sbu rs ements <62,974 .>b Net In v estment in co me (it negative, enter -0- )

c Ad just ed net inc ome (if negative, enter -0-)

j3p5 2p3 LHA For Pap e rwork Re duction Act Not i ce , see the instructions .

56,771 .

106,208 .

C If exemption application is pendin g , chec k here No. u

0 1 Foreign organizations, check here ►2 . Foreign organizations meeting the 85% test, ►

check h ere and attach computation

E If private foundation status was terminatedunder section 507(b)(1)(A), check her e

F If the foundation is in a 60-month terminationunder section 507(b)(1) B), check here ►

(c) Adjusted net (d) Disbursementsincome for chartable purposes

(cash b asis only)

NIA

TATEMENT

TA

162 979 . n •-

1 000 .

0 .

9 .

1,009 .

1,009 .

161,970 .N/A

IT 0 .

2,000 .

0 .

20 .

2,020 .171,540 .

173,560 .

Form 990 -PF (2003 )1

15480112 805528 AVERY 2003 .03000 -JOHN E . & CARON G . AVERY FO AVERY-1

JOHN E . & CARON G . AVERYForm 990-PF (2003) FOUNDATION, INC .

Balance Sheets Attached schedules and amounts in the descriptioncolumn shou ld be for end-of-year amounts onl y

1 Cash - non-in terest-beann g2 Savings and temporary cash inves tments

3 Acco u n t s receivable 01

Less allowance for doubtful accounts

4 P ledges receivable 10 ,

Less allowance f or doubtful accounts 11110-

5 Grants receivable

6 R eceivables due from officers, directors, trustees, and other

d is qu ali fied person s

7 Other notes and loans receivabl e

Less allowance for doubtful accountsto 8 Inventories for sale or us eY

9 Prepaid expenses and deferred charge sa 10a Investments - U S and state government obligation s

b Investments - corporate st oc k STMT 6

c Investment s - corporate bond s

11 Investments - land, bu ildings, and equipment bas is

um accumulated depreciatoon

12 Invest m ent s - mortgage loans

13 Investments - othe r

14 Lan d , buildings, and equipment basi sLess accumulated depreciation 110.

15 Other assets (describe 10'

17 Accoun t s payable an d accrued expenses

1 8 Grants payabl e

2 m19 Deferred revenu e

20 Loans from officers, di rectors, trustees, and other di squalifi ed person s

~ 21 Mortgages an d other notes payable

'.1 22 Other liabilit ies (describe ►

Organizations that follow SFAS 117 , check her e

a n d compl e te l ines 24 through 26 and lin e s 30 a n d 31 .

24 Unrestricte d

a 25 Temporarily res t ric te d

m 26 Permanen t ly restricte d

Organizat i ons that do not fo llow SFAS 117 , check here 10"LL and c om p let e lines 27 throu g h 3 1 .

y 27 Ca p ital stock, trust p rincipal, or current fund s

28 P ai d -in or capital surplus, or land, bldg ,and equipment fun d

a 29 R e t ained earnings, accumulated income, endowment, or other f unds

30 Total net assets or fund ba l ance sz

ginning of year

a) Book Value

465 .323 .

31-1481506 PagetEnd of y ea r

B oo k Va lue (c) Fa ir market valu e

<10,978 . <10,978 . >

2,091,359 .1 2,040,151 .1 3,083,340 .

2,092,147 . 1 2,029,173 . 1 3,072,362 .

0 .

2,092,147 .0 .

2,092,147 .

2,029,173 .0 .0 ..

2,029,173 .

2,092,147 . 1 2,029,173 .

p~ 7 Analysis of Changes in Net Assets or Fund Balance s

1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30

(must agree with end-of-year figure reported on prior year's return )

2 Enter amount from Part I, line 27 a

3 Other increases not included in line 2 (itemize) 10,

4 Add lines 1, 2, and 3

5 Decreases not included in line 2 (itemize )6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II, column (b), line 3 0

32351112- 05- 03

15480112 805528 AVERY

0 .

2,092,147 .<62,974 . >

0 .2,029,173 .

0 .

2,029,173 .Form 990 -PF (2003 )

22003 .03000 JOHN E . & CARON G . AVERY FO AVERY 1

JOHN E . & CARON G . AVERYForm 990-PF (2003 FOUNDATION INC .Past IV Capital Gains and Losses for Tax on Investment

(a) List and describe the kind(s) of property sold (e g , real estate,2-story brick warehouse, or common stock, 200 shs MLC C o

1a

SEE ATTACHED STATEMENT

d

(e) Gross sales price I (f) Depreciation allowed ( g ) Cost or oth er basis(or allowable) plus expense of sale

a

b

31-1481506 P age 3

H ow acquired (c ) Date acquired (d) D ate sol dP - Purchase (mo , day, yr) (mo , day, yr )D - D onatio n

e 107,838 . 1 1,630 .Complete only for assets show in g gain in column (h) and owned by the foundation on 12/31/6 9

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

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

106,208 .(q Gains (Col (h) gain minu s

col ( k ), but not less than -0- ) ordosses (from col (h))

106,208 .

2 Capital gain net income or (net capital loss) ~ If ?loss), am,Iso enter in Part I, line 7 2

106,208 .If 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 )If (loss), enter -0- in Pa rtI, line 8 3 N/A

Part V Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income

If section 4940(d)(2) applies, leave this part blan k

Was the organization liable for the section 4942 tax on the distributable amount of any year in the base period? Yes 0 No

If Yes, the organization does not qualify under section 4940(e) Do not complete this part1 Enter the approp riate amount in each column for each year, see instructions before making any entrie s

Base peraiod years ha)ntable-use assets Distribution ratioCalendar year or tax year beginning in) Adjusted qualifying distributions Net value of nonc (col (b) divided by col (c))

2002 158,089 . 2,965,023 . .05331802001 131,765 . 3,141 725 . .04194032000 103,477 . 2,679,255 . .03862161 sss 62,71 . 2,100,610 . .02985661 ss8 54,996 . 1,272,233 . .043227 9

2 Total of line 1 , column (d )

3 Average d ist ribution ratio for the 5-year base period - divide the tot al on line 2 by 5, or b y th e number of years

t he f o u n d at ion has been in existence if less than 5 years

4 Enter the net valu e of nonchantable - use assets fo r 2003 from Pa rt X , line 5

5 Multiply line 4 by line 3

6 Enter 1% of net investmen t income ( 1 % of Par t I, line 27b )

7 Add lines 5 and 6

2 .2069644

3 .0413929

a 2,861,744 .

5 118,456 .

6 1,620 .

7 120,076 .

8 Enter qualifying distributions from Part XII, line 4 1 8 173,560 .

If line 8 is equal to or greater than line 7, check the box in Part VI, line 1 b, and complete that part using a 1 % tax rat eSee the Part VI instruction s

323521/12-05-03 Form 990-PF (2003 )3

15480112 805528 AVERY 2003 .03000 JOHN E . & CARON G . AVERY FO AVERY-1

JOHN E . & CARON G . AVERYForm 990-PF (2003) FOUNDATION, INC . 31-1481506 Page 4Part YI Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see instructions)

la Exempt operating foundations described in section 4940(d)(2), check here ► [::] and enter "N/A" on line 1Date 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, check here ► OX and enter 1% 1 1,620 .

of Part 1, line 27 bc All other domestic organizations enter 2% of line 27b Exempt foreign organizations enter 4% of Part I, line 12, col (b )

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

3 Add lines 1 and 2 3 1,620 .

4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) 4 0

5 Tax based on investment Income . Subtract line 4 from line 3 If zero or less, enter -0- 5 1,620 .

6 Credits/Payment s

a 2003 estimated tax payments and 2002 overpayment credited to 2003 6a 1,806 .

b Exempt foreign organizations -tax withheld at source 6 b

c Tax paid with application for extension of time to file (Form 8868) 6c

d Backup withholding erroneously withheld 6 d

7 Total credits and payments Add lines 6a through 6d 7 1,806 .

8 Enter any penalty for underpayment of estimated tax Check here 0 if Form 2220 is attached 8-

9 Tax due . If the total of lines 5 and 8 is more than line 7, enter amount owed ► 9

10 Overpayment . If line 7 is more than the total of lines 5 and 8, enter the amount overpaid ► 10 186 .

11 Enter the amount of line 10 to be Credited to 2004 estimated tax ► 18 6 . Refunded ► 11 0 .

Part VIfyA Statements Regarding Activities

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

any political campaigns la X

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

If the answer is "Yes" to 1 a or l b, attach a detailed description of the activities and copies of any materials published o r

distnbuted by the organization in connec tion with the activities .c Did the organization file Form 1120-POL for this years 1c X

d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the yea r

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

managers ►$ 0.2 Has the organization engaged in any activities that have not previously been reported to the IRS 2 X

If "Yes," attach a detailed description of the activities .

3 Has the organization made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, o r

bylaws, or other similar instruments If "Yes," attach a conformed copy of thechanges 3 X

4a Did the organization have unrelated business gross income of $1,000 or more during the year? 4a X

b If "Yes; has it filed a tax return on Form 990-T for this years N/A 4b

5 Was there a liquidation, termination, dissolution, or substantial contraction during the years 5 X

If "Yes, " attach the statement required by General Instruction T

6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either

• By language in the governing instrument o r

• By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state la w

remain in the governing instrument? 5 X

7 Did the organization have at least $5,000 in assets at any time during the years 7 X

If "Yes, " complete Part ll, coL (c), and Part XV.

Sa Enter the states to which the foundation reports or with which it is registered (see instructions)NEW JERSEY

b If the answer is "Yes" to line 7, has the organization furnished a copy of Form 990-PF to the Attorney General (or designate )

of each state as required by General Instruction G 9 If "No," attach explanation 8b X

9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(l)(5) for calenda r

year 2003 or the taxable year beginning in 2003 (see instructions for PaR XIV)? If "Yes," complete Part XIV 9 X

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

11 Did the organization comply with the public inspection requirements for its annual returns and exemption applications 11 X

Web site address ► N/A

12 The books are in care of ► RICHARD E . INGRAM Telephone no ►732-524-1060

Located at ► 410 GEORGE STREET, NEW BRUNSWICK, NJ ZIP+4 ►0890 1

13 Section 4947(a)(1) nonexempt charitable trusts fling Form 990-PF in lieu of Form 1041 - Check here 1

and enter the amount of tax-exempt interest received or accrued during the year ► 1 13 I N/A32353 112-05-03 Form 990-PF (2003)

415480112 805528 AVERY 2003 .03000 JOHN E . & CARON G . AVERY FO AVERY -1

Form 990-PF (2003 )

Part UII -B Statements Regarding Activities for Which Form 4720 May B eFile Form 4720 if any item is checked in the "Yes " column , unless an exception applies .

1 a During the year did the organization (either directly or indirectly )

(1) Engage in the sale or exchange, or leasing of property with a disqualified person?

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from )

a disqualified person ?

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person(5) Transfer any income or assets to a disqualified person (or make any of either availabl e

f or t h e benefit or use of a disqualified person) ?

( 6) Agree to pay money or property to a government officials (E x ception . Check 'No*if the organization agreed to make a grant to or to employ the official for a period after

termination of government service, if terminating within 90 days )

31-1481506 Page s

Yes No

Yes No

Yes ~ No

Yes EXI No

Yes 0 No

0 Yes EX--1 No

Yes EX-1 No

b If any answer is'Yes'to l a(l)-(6), did any of the acts fail to qualify under the exceptions described in Regulation s

section 53 4941(d)-3 or in a current notice regarding disaster assistance (see page 19 of the instructions)? N/A

Organizations relying on a current notice regarding disaster assistance check here

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 2003 ?

2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization was a private operating foundation

defined in section 4942(j)(3) or 4942(j)(5) )

a At the end of tax year 2003, did the organization have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginnin g

before 2003 Q Yes ~ No

If *Yes,* list the years ►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 attac h

statement - see instructions ) N/A

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

3a Did the organization hold more than a 2% direct or indirect interest in any business enterprise at any tim e

during the year? 0 Yes 0 No

b If 'Yes,* did it have excess business holdings in 2003 as a result of (1) any purchase by the organization or disqualified persons afte r

May 26, 1969, (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose

of holdings acquired by gift or bequest, or (3) the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C,

Form 4720, to determine if the organization had excess business holdings in 2003.) N/A

4a Did the organization invest during the year any amount in a manner that would jeopardize its charitable purpose s

b Did the organization make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that

had not been removed from jeopardy before the first day of the tax year beginning in 2003 ?

5a During the year did the organization pay or incur any amount t o

(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? Q Yes EXI No

(2) Influence the outcome of any specific public election (see section 4955), or to carry on, directly or indirectly ,

any voter registration drive? 0 Yes 0 No

(3) Provide a grant to an individual for travel, study, or other similar purposes? ~ Yes 0 No

(4) Provide a grant to an organization other than a charitable, etc , organization described in sectio n

509(a)(1), (2), or (3), or section 4940(d)(2)? 0 Yes ~ No

(5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or fo r

the prevention of cruelty to children or animals? 0 Yes 0 No

b If any answer is 'Yes' to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions described in Regulation s

section 53 4945 or in a current notice regarding disaster assistance (see instructions)? N/A

Organizations relying on a current notice regarding disaster assistance check her e

c If the answer is Yes to question 5a(4), does the organization claim exemption from the tax because it maintaine d

expenditure responsibility for the grant? N/A Yes No

If "Yes, " attach the statement required by Regulations sec ti on 53.4945-5(d) .

3b

X

X

X

6a Did the o r gani zation , du ri ng the year , receiv e an y fund s, dir e ct ly or in d irec tl y, to pay premiums o n

a perso n a l benefit contract? 0 Yes ~ No

b Did the o r gani zat i on , du ri ng the year , pa y premiums , dir e ctly o r indirectl y, on a pers on a l benefit contract? 6b XIfyou an swered "Yes" to 6b, also file Form 8870.

Form 990 -PF (2003 )

32 35411 2 -05 -03

15480112 805528 AVERY

JOHN E . & CARON G . AVERYFOUNDATION, INC .

52003 .03000 JOHN E . & CARON G . AVERY FO AVERY

JOHN E . & CARON G . AVERYFOUNDATION, INC. 31-1481506

~arE Vt!! Information About Officers , Directors, Trustees, Foundation Managers , Highly Page 6Paid Employees, and Contractor s

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

(b) Title, and average (c) Compensation (d~ conmouuonsco (e) Expensehours per week devoted (II not a f d, empoyeebenefi t cans account, ot her(a) Name and address to

position enter p 0- com e~sau allowances

JOHN E . AVERY PRESIDENT/TRUSTEE

330 COCONUT ROW, APT . 4C ,PALM BEACH, FL 33480 0. 0 . 0 . 0 .CARON G . AVERY SECRETARY/TRE SURER/TT E330 COCONUT ROW, APT . 4C ,PALM BEACH, FL 33480 0. 0 . 0 . 0 .RICHARD E. INGRAM TRUSTEE410 GEORGE STREE TNEW BRUNSWICK, NJ 08901 0. 0 . 0 . 0 .

2 Compensation of five highest-paid employees (other than those included on line 1) . If none, enter " NONE . "

( b) Title and average (d~Contribubonsto (e ) Expense( a) Name and address of each employee paid more than $50,000 hours per week (c) Compensation emp y d̂~yj~~~~'"~ account, other

devoted to position compensa tion allowances

NONE

Total number of other e m ployees p aid over $50,000

3 Five highest - paid independent contractors for professional serv ices . If none , enter " NONE ."

(a) N ame an d address o f eac h person paid more than $ 50,00 0

NONE

► I 0

of service I (c) Compensatio n

Total number of others receiving over $50,000 f or p rofessional servicespast 1X-q Summa ry of Direct Charitable Activitie s

List t he f oundation's four larges t d irect charitable act ivit ies during the tax year Includ e relevan t s t at is tical information such as th enumber of organizations and o ther beneficiaries served, con f erences convened, research papers produced, e tc

~ N/A

2

3

4

1110.

Expenses

Form 990-PF (2003 )6


JOHN E . & CARON G . AVERYForm 990-PF (2003) FOUNDATION, INC . 31-1481506 Page 7

P2I~ !X»B Summary of Program -Related Investments

Describe the two largest program-related investments made b y the fo un dation during the tax year on lines 1 and 2 Amou n t1 N/A

2 N/A

A ll other p rog ram-related investmen t s See ins t ruc t ions3 N/A

Total . Add lines 1 through 3 1111l. 1 0 .

Pat'f X7 Minimum Investment Return (A ll domest i c foun dations must complete th is pa rt . Foreign foundat ions , see instruct i ons . )

1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc ,purposes

a Average monthly fair market value of securities

b Average of monthly cash balances

c Fair market value of all other assets

d Total (add lines la, b, and c )

e Reduction claimed for blockage or other factors reported on lines la an d

1c (attach detailed explanation) le

2 Acquisition indebtedness applicable to line 1 assets

3 Subtract line 2 from line 1 d

4 Cash deemed held for charitable activities Enter 1 1/2% of line 3 (for greater amount, see instructions)

5 Net value of noncharitable-use assets . Subtract line 4 from line 3 Enter here and on Part V, line 4

6 Minimum investment return . Enter 5% of line 5

1,620 .

P~ x, Distributable Amount (see instructions) (Section 4942(j)(3) and (1)(5) private operating foundations and certainforeign organizations check here ► 0 and do not complete this part )

1 M inimum invest ment ret urn f rom Part X , line 6

2a Tax on investment income for 2003 from Par t VI, line 5 2a

b Income tax f or 2003 (This does no t include the tax from Part VI) 2b

c Add lines 2a an d 2b

3 Distributable amount before adjust ment s Sub t ract line 2c from line 1

4a Recoveries of amounts treated as qualifying distributions 4a

b Income distributions from section 4 9 4 7(a)(2) trusts 4b

c Add lines 4 a and 4 b5 Add lines 3 and 4c

6 De d uct ion from distributable amount (see instructions )

7 Distributab l e amount as adjusted Subtract line 6 from line 5 E nter here and on P art X III, line 1

0 .

0 .2,905,324 .

43,580 .2,861,744 .

143,087 .

143,087 .

1,620 .141,467 .

0 .141 467 .

0 .467 .14 1

F_ __W Qualifying Distributions (see instructions)

1 Amounts paid (including administrative expenses) to accomplish charitable, etc , purposes

a Expenses, contributions, gifts, etc - total from Part I, column (d), line 26 1 a 173,560 .

b Program-related investments -Total from Part IX-B 1b 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 th e

a Suitability test (prior IRS approval required) 3a

b Cash distribution test (attach the required schedule) 3 b

4 Qualifying distributions . Add lines la through 3b Enter here and on Part V, line 8, and Part XIII, line 4 4 173,560 .

5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investmen t

income Enter 1% of Part I, line 27b 5 1,620 .

6 Adjusted qualifying distributions . Subtract line 5 from line 4 6 171,940 .

Note : The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the sec ti on4940(e) reduction of tax in those years .

Form 990-PF (2003 )

32356112-05-03

la 2,899,284 .1 b 6,040 .1 c

l d 2,905,324 .

0 .

7

15480112 805528 AVERY 2003 .03000 JOHN E . & CARON G . AVERY FO AVERY 1


paft X11 Undistributed Income (see instructions)

1 D istributable amountfor 2003 from Part XI, line 7

2 Undistri buted I ncome , if any, as of the end of 200 2

a E nter amount f or 2002 onlyb T otal for prior year s

3 Excess distributions carryover, if any, to 2003

a From 1998

b From 1999

c From 2000

d From 2001

e From 200 2

I Total of lines 3a through e4 Qualifying distributions for 2003 fro m

Part Xll,line 4 ►$ 173,560 .a Applied to 2002, but not more than line 2 ab Applied to undistributed income of prior

years (Election required - see instructions)

c Treated as distributions out of corpu s

(Election required - see instructions)

d Applied to 2003 distributable amoun t

e Remaining amount distributed out of corpus

5 Excess distributions carryove r applied to 200 3(If an amount appears in column (d), th e same amountmust be shown in column (a) )

6 Enter the net total of each column asIndicated below :

a Corpus Add lin es 3f, 4c, and 4e Subtract line 5

b Prior years' undistributed income Subtract

line 4b from line 2 b

c Enter the amount of prior years'undistributed income for which a notice ofdeficiency has been issued, or on whichthe section 4942(a) tax has been previouslyassesse d

d Subtract line 6c from line 6b Taxable

amount - see instruction s

e Undistributed income for 2002 Subtract line

4a from line 2a Taxable amount - see inst r

f Undistributed income for 2003 Subtract

lines 4d and 5 from line 1 This amount must

be distributed in 200 4

7 Amounts treated as distributions out of

corpus to satisfy requirements imposed by

section 170(b)(1)(E) or 4942(g)(3 )

8 Excess distributions carryover from 1998

not applied on line 5 or line 7

9 E x cess distributions carryover to 2004 .

Subtract lines 7 and 8 from line 6 a1 0 Analysis of line 9

a Excess from 1999

b Excess from 2000

c Excess from 2001

d Excess from 200 2

32357112-05 .03

15480112 805528 AVERY

C orpus Years prior to 2002 2002

0 .

141,467 .

0 .

0 .

0 .0 .

0 .

0 .

(d)2003

32,206 .

0 .

0 .

0 .

0 .

0 .

109,261 .

0 .

0 .

0 .

Form 990 -PF (2003 )

8

2003 .03000 JOHN E . & CARON G . AVERY FO AVERY- 1

141,354 .

141,354 .

JOHN E . & CARON G . AVERY

Form 990-PF 2002 2003) FOUNDATION INC .

part XJV Private Operating Foundations (see instruct ions and Part vii•a, question 9)

1 a If the foundation has received a ruling or determination letter that it is a private operatin gfoundation, and the ruling is effective for 2003, enter the date of the ruling io. L

b Check box to indicate whether the organization is a private opera infoundation described in sectio n

2 a Enter the lesser of the adjusted net Tax year Prior 3 years

income from Part I or the minimum (a) 2003 (b) 2002 (c) 2001

investment return from Part X fo r

each year listedb 85% of line 2 ac Qualifying distributions from Part XII,

line 4 for each year listed

d Amounts included in line 2c not

used directly for active conduct of

exempt activitie s

e Qualifying distributions made directly

for active conduct of exempt activities

Subtract line 2d from line 2 c3 Complete 3a, b, or c for the

alternative test relied upo na 'Assets' alternative test - enter

(1) Value of all assets

(2) Value of assets qualifyingunder section 4942( j )(3)(B)(Q

b 'Endowment alternative test - Ente r2/3 of minimum investment returnshown in Part X, line 6 for each yearliste d

c 'Support' alternative test - enter

(1) Total support other than grossinvestment income (interest,dividends, rents, payments onsecurities loans (section51 2(a)(5)), or royalties)

(2) Support from general publicand 5 or more exemptorganizations as provided insection 4942(1)(3)(B)(ui )

(3) Largest amount of support from

an exempt organization

Part XV ~ Supplementa ry Information (Complete this pa rt only if the organization had $5 , 000 or more in assetsat any time during the year-see page 25 of the instructions . )

1 Information Regarding Foundation Managers :

a List any managers of t he founda t ion w h o have con t ributed more than 2% o f the total con t ri b u tions receive d b y t he foundation be fore t he close of any t axyear (but only if th ey have cont ribu ted more t han $5,000) (See sec tion 507(d)(2 )

JOHN E . AVERYb List any ma n agers o f t he foundation who own 10% or more of the s toc k of a corporat ion (or an equally large portio n o f the ownership of a par t ners h ip or

other ent ity) o f which the foundation has a 10% or greater interes t

NONE2 Information Regarding Contribution , Grant , Gift , Loan , Scholarship, etc ., Programs:

C h ec k h ere 10' M1 if the organization only makes contribu tions t o preselec ted ch aritabl e organizations and d oes no t accept unsolicited reques ts for f unds I fth e organization makes gifts, grants, etc (see instructions) to individuals or organizations under other conditions, co m plete items 2a, b , c, a nd d

a The name, address, and telephone number of the person to whom applications s h ould be addressedN/A

b The form in which applications should be submi tted and inform at i on and mate ri a ls t h ey should in cludeN/A

c A n y submission dead li nesN/A

d Any rest ric ti ons or limit a t ion s on awa rds , s uch as by ge o graphical a reas, ch a rit a b l e fields , k in ds of in stitutions , o r ot h e r factorsN/A

32 35 81/1 2 -05-03

31-1481506 Page 9N/A

4 9 42(1)(3) or 0 4 9 4 26l(5 )

(d) 2000 I (e) Tota l

Form 990 -PF (2003 )9


JOHN E . & CARON G . AVERY

1 0

15480112 805528 AVERY 2003 .03000 JOHN E . & CARON G . AVERY FO AVERY - 1

323601/12-05-03 Form 990-PF (2003)


Part XVI ~A Analysis of Income -Producing Activities

Enter gross amounts unless otherwise indicated unreiatea ousiness income Excluded by s ection 512, 513, or 51 4 (e )

( a) (b) ~~„_ ( d) Related or exemptBusiness Amount Sion Amount function income1 Program service revenue code cod e

a

b

c

d

e

f

g Fees and contracts from government agencies

2 Membership dues and assessments

3 Interest on savings and temporary cash

investment s

4 Dividends and interest from securities 14 56,771 .

5 Net rental income or (loss) from real estate

a Debt-financed property

b Not debt-financed propert y6 Net rental income or (loss) from personal

property

7 Other investment income

8 Gain or (loss) from sales of assets othe r

than inventory 18 56,630 .9 Net income or (loss) from special event s

10 Gross profit or (loss) from sales of inventory

11 Other revenu e

abcde

12 Subtotal Add columns (b), (d), and (e) 011 113, 4 O 1 . 0 .13 Total. Add line 12, columns (b), (d), and (e) 1 3 113 ;401 .

(See worksheet in line 13 in structions to verify calculation s

P~rE XV1 48 Relationship o f Activities to the Accomplishment of Exempt Purposes

Line No . E xplain below how each activity for which income is reported in column (e) o f Part XVI-A con t ribut ed importantly t o t he accomplish ment of

11 t he organization's exempt purposes (other than by providing funds for suc h purposes)

Form 990 -PF (2003 )11


JOHN E . & CARON G . AVERYF orm 990- PF (2003) FOUNDATION, INC . 31-1481506 Page 12

R;Wl XVII Information Regarding Transfers To and Transactions and Relationships With NoncharitableExempt Organization s

Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of Yes Nc

the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organization s

a Transfers from the reporting organization to a nonchantable exempt organization o f

(1) Cash la(l) X

(2) Other assets 1a(2), X

b Other transaction s

(1) Sales of assets to a nonchantable exempt organization 1 b(l) X

(2) Purchases of assets from a nonchantable exempt organization 1 b(2) X

(3) Rental of facilities, equipment, or other assets 1 b(3) X

(4) Reimbursement arrangements 1b(4) X

(5) Loans or loan guarantees 1b(5) X

( 6) Performance of services or membership or fundraising solicitations 1 b(6) X

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

d If the answer to any of the above is "Yes," complete the following schedule Column (b) should always show the fair market value of the goods, other assets ,

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

Name of organization (b) Ty pe o f o rganization (c) D escription ofN/ A

Under pe nalti es of perjury, I declare th at I have examined this return, inclu din g accompanying schedules and statements, and to the best of my k nowledge a nd be lie f, it is tru e, correct,and comp lete Declaration o f prepare they thqrrfaVayer or fid uciary) is based on all Information of which pre parer has any knowledg e

Si atu of officer or trustee

= eparer' ssignature

CL 4, Arm's name (or yours RICHARD E . ING ESQif self-emvioWd), '410 GEORGE STR

I a0dras,andZlPcode NEW BRUNSWICK, NJ 089 0

32362112-05-Q3

15480112 805528 AVERY 2003 .030 0

2a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described

in section 501(c) of the Code (other than section 501 (c)(3)) or in section 527 Yes [11 No

JOHN E . & CARON G . AVERYFQUNDATION, INC .

CONTINUATION FOR 990-PF, PART IV31-1481506 PAGE 1 OF 1

Pad IV I Capital G ains an d Losses for Tax on Investment Incom e

( a ) List and describe the kind(s) of property sold, e g , real estate,2-story brick warehouse, or common stock, 200 shs MLC C o

la 151 SHARES JOHNSON & JOHNSON COMMON STOCKb 350 SHARES JOHNSON & JOHNSON COMMON STOCKc 100 SHARES JOHNSON & JOHNSON COMMON STOCKd 100 SHARES JOHNSON & JOHNSON COMMON STOCKe 469 SHARES JOHNSON & JOHNSON COMMON STOCK1535 SHARES JOHNSON & JOHNSON COMMON STOCKa 300 SHRES JOHNSON 7 JOHNSON COMMON STOC K

k

0

(e) Gross sales pric e

a 7,524 .b 17,295 .c 5,168 .d 4,982 .e 25,406 .t 30,582 .q 16,881 .

h

(t) Depreciation allowed(or allowable)

(g) Cost or other basisplus expense o f s al e

123 .284 .81 .81 .

382 .435 .I AA

(b How acquired (c~ Date acquired (d) Date sold- Purchase mo ,day, yr) (mo , day, yr )D - Donatio nD 12/12/9610/21/03D 12/12/9612/16/03D 12/12/9603/15/04D 12/12/9604/06/04D 12/12/9605/07/04D 12/12/9609/14/04D 12/12/9609/23/0 4

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

7,401 .17,011 .5,087 .4,901 .

25,024 .30,147 .16,637 .

0

a

b

c

d

e

f

h

1k

m

n

omplete only for assets showing gain in column (h) and owned by the foundation on 12/31/69

(i) F M V as of 12/31/69(j) Adjusted basis (k) Excess of col (i )as of 12/31/69 over col ( 1 ), if an y

2 Capital am net income or net capital loss) If ain, also enter in Part I, line 79 ( ~ If 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 Pad I, line 8, column (c)If (loss), enter'-0= in Part 1, line 8

32359105-01-03

(1) Losses (from col (h) )Gains (excess of col (h) gain over col (k),

but not less than'-0= )

/ r Z V 1

17,011 .5,087 .4,901 .

25,024 .30,147 .16,637 .

2

3 N/A

106,208 .


2003 CONTRIBUTIONSJOHN E AND CARON G . AVERY FOUNDATION IN C

Alzheimer's AssocAmerican Inst For Cancer ResearchAmerican Museum of Nat HistAmericas Societ yAmerica's SocietyBoy Scout sBoys Hope Girls HopeBrooks Schoo lCasita MariaCasita MarieChannel 13ChicagoTheatre Grou pChildrens Aid societycouncil on Foreign Relationscouncil on Foreign RelationsCSC Repertory LtdDalton Schools, Inc .Eden Institute Fdn IncFamilies w/ Children fir ChinaFoundation for Fighting BlindnessGods Love We DeliverGoodspeed Opera House FndHands Togethe rHands Togethe rKravis Center for Perfoming ArtsLenox Hill Hospita lLeukemia & Lymphoma SocMarble Collegiate ChurchMaumee Valley Country DayMetropolitan Museum of ArtNational Multiple Sclerosis Soc .Norton Museum of ArtNY Landmarks ConservancyNY Landmarks ConservancyOpportunity, In cPalm Beach CommunityParents Television CouncilPrinceton Day SchoolRiverside Park FundSacred Heart UniversitySearch & CareSearch & CareShoreline Soup KitchensSmithsonian InstitutionSociety of the Four ArtsSt Michael's Churc hSt Michael's ChurchSynergos InstituteThe Dalton SchoolThe Kew Forest SchoolThe Madeira SchoolThe Madison Foundatio nThe Patrons of the Vatican MuseumsWomen & Family Life Cente rWoods Hole OceanographicYale University

$1,000 001,000 .00

750 005,000 00

15,000 00500 .00

1,000005,000 002,000 .00

12,500 001,000 .001,000005,000 002,500 .00

640 001,000005,000 00

500 00300 00

2,000 005,000 001,000005,000 003,000 004,000 00

10,000 002,000.002,000 005,000 008,000 001,000006,000.002,000.002,000 001,500001,000001,000005,000.001,000 .001,000002,000.002,000 00

500 00350 00

5,000 001,00000

500 003,000 .005,000 005,000 001,000 .005,000 001,000005,000 .001,000005,000 .0 0

Ending Balance - Charitable Distributions $171,540 .00

JOAN E .. & CARON G. AVERY FOUNDATION, INC 31-1481506

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

(A) MANNER DATEDESCRIPTION OF PROPERTY ACQUIRED ACQUIRED DATE SOLD

151 SHARES JOHNSON & JOHNSON COMMON STOCK DONATED 12/12/96 10/21/0 3

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

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

7,524 . 3,857. 0. 0. 3,667 .




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

17,295 . 8,939. 0. 0. 8,356 .




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

5,168. 2,554. 0. 0. 2,614 .

14 STATEMENT(S) 115480112 805528 AVERY 2003 .03000 JOHN E . & CARON G . AVERY FO AVERY -1

JOHN E . , & CARON G . AVERY FOUNDATION, INC 31-148150 6



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


4,982 . 2,554. 0. 0. 2,428 .





25,406 . 11,978. 0. 0. 13,428 .

(A)DESCRIPTION OF PROPERTY

535 SHARES JOHNSON & JOHNSON COMMON STOCK

(B)GROS S

SALES PRICE

30,582 .

(C)VALUE AT

TIME OF ACQ .

13,664 .

(D)EXPENSE OF

SALE

(A)DESCRIPTION OF PROPERTY

300 SHRES JOHNSON 7 JOHNSON COMMON STOC K

(B)GROS S

SALES PRICE

16,881 .

(C)VALUE AT

TIME OF ACQ .

7,662 .

CAPITAL GAINS DIVIDENDS FROM PART IV

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

MANNER DATEACQUIRED ACQUIRED DATE SOLD

DONATED 12/12/96 09/14/0 4

(E) (F)

DEPREC . GAIN OR LOS S

0 . 0 . 16,918 .

MANNER DATEACQUIRED ACQUIRED DATE SOLD

DONATED 12/12/96 09/23/0 4

(D)EXPENSE O F

SALE

0 .

(E) (F)

DEPREC . GAIN OR LOSS

0 .

56,630 .

0 . 9,219 .

15 STATEMENT(S) 115480112 805528 AVERY 2003 .03000 JOHN E . & CARON G . AVERY FO AVERY-1

JOAN E . , & CARON G . AVERY FOUNDATION, INC 31-148150 6

FORM 990-PF DIVIDENDS AND INTEREST FROM SECURITIES STATEMENT 2

SOURCE

JOHNSON & JOHNSON COMMON STOCKUBS FINANCIAL SERVICES

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

GROSS AMOUNT

56,738 .33 .

56,771 . 0 .

COLUMN (A)AMOUNT

56,738 .33 .

56,771 .

FORM 990-PF ACCOUNTING FEES STATEMENT 3

DESCRIPTION

RICHARD E . INGRAM, ESQ .

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

3,000 . 1,000 .

3,000 . 1,000 .

(C)ADJUSTEDNET INCOME

(D)CHARITABLEPURPOSES

2,000 .

2,000 .

FORM 990-PF TAXES STATEMENT 4

DESCRIPTION

UNITED STATES TREASURY

TO FORM 990-PF, PG 1, LN 18

(A) (B)EXPENSES NET INVEST-PER BOOKS MENT INCOME


1,806. 0.

1,806. 0.

(C)ADJUSTEDNET INCOME

(D)CHARITABLEPURPOSES

0 .

0 .

FORM 990-PF OTHER EXPENSES STATEMENT 5

DESCRIPTION

TREASURER, STATE OF NEWJERSEYBANK FE E

TO FORM 990-PF, PG 1, LN 23


25. 8.4. 1.

29. 9.

CAPITAL GAINSDIVIDENDS

0 .0 .

(C) (D)ADJUSTED CHARITABLENET INCOME PURPOSES

17 .3 .

20 .

16 STATEMENT(S) 2, 3, 4, 515480112 805528 AVERY 2003 .03000 JOHN E . & CARON G . AVERY FO AVERY-1

JOAN E . , & CARON G . AVERY FOUNDATION, INC 31-148150 6

FORM 990-PF CORPORATE STOCK STATEMENT 6

DESCRIPTION

52,815 SHARES JOHNSON & JOHNSON COMMON STOCK

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

BOOK VALUE

2,040,151 .

2,040,151 .

FAIR MARKETVALUE

3,083,340 .

3,083,340 .

17 STATEMENT(S) 615480112 805528 AVERY 2003 .03000 JOHN E . & CARON G . AVERY FO AVERY-1

Documents

0169d9fd - 990s.foundationcenter.org990s.foundationcenter.org/990pf_pdf_archive/311/...15480112 805528 AVERY 2003.03000-JOHN E. & CARON G. AVERY FO AVERY-1. JOHN E . & CARON G. AVERY