FJ ii- F990s.foundationcenter.org/990pf_pdf_archive/597/... · Form 990-PF Return of Private Foundation OMB No 1545-0052 orSection 4947(ax1) NonexemptCharitable Trust Treated asa

Form 990-PF Return of Private FoundationOMB No 1545-0052

or Section 4947(ax1) Nonexempt Charitable TrustTreated as a Private Foundation 2009

Department r- Trea3ryInternal Revet

heService Note : The foundation may be able to use a copy of this return to satisfy state reporting requirements

For calendar year 2009 . or tax year beainnina 2009 a nd onrlinn

G Check all that apply.

R

Initial return 11 Initial Return of a former public charity Final return

Amended return Address change Name change

Use the A Employer Identification number

IRS label . THE NASIRDIN & ZEENAT MADHANY FAMILY 59-72 03653Otherwise ,

printFOUNDATION B Telephone number (see the instructions)

or type . 8967 SAVANNAH PARKOR

( 407 ) 876-4098See Specific LANDO, FL 32819Instructions.

C If exemption application is pending, check here

D 1 Foreign organizations , check hereH Check type of organization. Section 501(c)(3 exempt private foundation 2 Foreign organizations meeting the 85% test check

Section 4947 (a)( 1 ) nonexem p t charitable trust Other taxable private foundation_FJ, q

here and attach computation ►Fair market value of all assets at end of year J Accounting method: X Cash Accrual E If private foundation status was terminated q

under section 507(b)(1)(A) check here(from Part 11, column (c), line 16) Othe (s f ),

r peci y _ _ _ _ _ _ _ _ _ _ _ _ F If the foundation is in a 60-month termination$ 989 807. (Part 1 column (d) must be on cash basis under section 507 b 1 B check here ii- F

is Ana ysis of Revenue an dExpenses a total of amounts in^

a Revenue and()

(b) Net Investment() (c) An net (d) Disbursements

columns (b), (c), and (d) may not neces-expenses per books income incomeome for charitable

sarily equal the amounts in column (a)purposes

(cash basis only)(see the instructions )1 Contributions , gifts, grants , etc, received (attsch) 302 681 . „';;#s#%r,{##,##'s:6s{## #;##:' s'ss ;s`s, ##s#:l#ss ##s ` #» s# s#, s#,is'#',:###'

2 Ck I- if the foundn is not req to att Sch B9

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3 Interest on savings and temporary :sr#s;s»s;;;;zs.;;;#"'•.,;ssss»ssz:cash investments ------------

4 Dividends and interest from securities 30 , 252. 30 , 252. '30 , 252. `#±##'-#####%%%######N#'r%#r######5 a Gross rents s###ii# #"%%%% ####'r##;:r%irr`b Ne(rental income

or oss)sssff#:#####'s#t#s;###s## s`s# ss##{###t s`# #s:',f sss'sN## ` f't######s:#### ss sss s{fi##s#######s#is s # ss'^#3

R 6a Net gam/Qoss ) from sale of assets not on line 10 .-2 , 680 sss^ ^s; 'sss.,#„`ss .' s, »s^s''..ss^' s »s.`ss s#'. »# '##, # sss### ##f ,''tsE b Gross sales price for all 39 279 # s # f##% 5#5;#{' "##; l+#{',##f#s# s!' `" #`% #` #' $% ' f f #' ##"7{### ###` # ## #'# ' '#'## ''###"^ »v , .assets on line 6a , ,

+s s

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E 7 Capital gain net income (from Part IV, line 2) sNx # ###%%%## #sx s„` #^'sss, s» ':##' >#s0 ##s#'rrss` , »» ss s

s si%% 'si#ss „» s' »s'fa'»yssss"s, '/.'.#ss#::;#sss#: s,s»;s ss»»s:;

' `N 8 Net sh o rt-te rm capital gain #Nv'ss#`.:##'s#s# `sf#frs<####### :x##### #??############ #:##:#%##:%#!;{##':#f##xi O.s„:;.;ssi%sss:;; >s,ss;;%fis s;`ssss:s:;;;sss.z';ss»»,s»,s;, s„rssss';U

E 9 Income modifications ##;s######,^,##^##r`###„':sz;;,ss's's,»i 's #N##»", s#,,"s»: ,,,s^,{,s;,s", s###;;'#^# % :,10 a Gross sales less

r turns andl

s <isssssss:sss»ssss`s, ,s:s."## sssssssss `s"ssss':ss'sss ! `s#sf`,,,i' ##' #'

ssss»sNsss'sss'„sssssssss',{ssssssss,i,'ssss,sssss# ssssss;ss ss/'sssss'sss's,•,' ' ' ' ##'''' #

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b Less Cost ofDodsg sold

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^ ' s ",,,s ,,,. »„»»» ssss#sssss # s ## ##;st

c Gross profit /( loss) (att sch ) {

11 Other income (attach schedule

See Statement 1 548. 548.12 Total . Add Imes 1 through 11 330 801. 30 800. 30 252.13 Compensation of officers , directors , trustees, etc

14 Other employee salaries and wages

15 Pension plans, employee benefits

A 16a Legal fees (attach schedule)

M b Accounting fees (attach sch ) See St 2 500.N c Other prof fees ( attach sch)

_

P S 17 Interest an p

E TR R

18 Taxes (attach schedulexsee mstr ) See Stm 3 2 , 680. 5 Cl)A A 19 Depreciation (attach

'T T sch) and depletion s's###s###;s:ss##,N####s'#3

N v 20 OccupancyG E 21 Travel , conferences, and meetings

E 22 Printing and publicationsD P 23 Other expenses (attach schedule)

E See Statement 4 1964 1964N ., , .E 24 Total operating and administratives expenses . Add lines 13 through 23 7 , 376. 505. 4 196.

25 Contributions , gifts, grants paid Part XV 12 , 102. ######s##s##s######';#'#####%:!i::### ' #s#N{'`:;"rrrr- r#if.##s# 12 , 102.26 Total expenses and disbursements.

Add lines 24 and 25 19,478. 505. 0. 16f298.27 Subtract line 26 from line 12: sssssxsssss::sssssssssss,s'ssssss,ss'ss ',s„s'sssss»s;;xsssssss,sssssss,Ns,sss sfs;;sxssNsss ss'sssss:s 'sssss»ssss,s

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%-a, BAA For Privacy Act and Paperwork Reduction Act Notice, see the instructions . TEEA0504L 02/02/10 Form 990-PF (2009)

.- j ...I

Form 990-PF (2009 THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Page 2Attached schedules and amounts in the description

B l ShBeginning of year End of year

eets column should be for end-of - year amounts onlya ance(See instructions ) (a) Book Value (b) Book Value (c) Fair Market Value

1, Cash ' non-interest-bearing 231. 13 599. 13 . 599.2 Savings and temporary cash investments

►3 Accounts receivable ss s`rir######### #{iii##»»r.+r s##N#yss`ssss{sssss##:#: #s## ss##r. rfr#; ^ s ##i:::##:##!###:.# #ss####### s- - - - - - - - - - r»rsrrr»rr srr, sf,rsrrrrrrrr»»»»rrr rrrrr.r rr f... .;»rrrr.,s ssssss a !sr• rrrrrr # ssss ; ss x.` ssss`H s;sssssLess. allowance for doubtful accounts ►

4 Pled es receivable sssssssr ssssssss s#f##` # / r, rrsss+rr ssssrssssxrs### s/ ##########'#tf##,`` 'f "''- --- - - -- - -g rrrrr rr r»+siifi`lil+ffrfF+fffL{s{f%l%l%ffffrry irrr rrr

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Less: allowance for doubtful accounts ►---------

5 Grants receivable

6 Receivables due from officers , directors, trustees, and otherdisqualified persons (attach schedule) ( see the instructions)

7 Other notes and loans receivable ( attach sch) ► - - - - - - - - - -ss's###%s#'r}r##ss##s ''s# » .rrf;`;:sss`sss "rs»r

„r,^,ssss»»r,rs`ss^.rassiss}r+r»rsrrrrf »r» « r »rr» r»rfs ssssssus#sr»sssss ;rrr ' ssssss,»»#', :########s#rrrr,sssrrrrrr»sr»f,,»s r»rssssssssssrrrrr,«rssssssssrsrr .,» »rrr » rrr s`rr ss rs r s rssr rrrrr i ```ss s;ri #sr r#, srr ss ;sss###`###r r rrrs:

r f#,sss#rs'ssss#sssssrx :sass#sxsssrsssss:,A Less: allowance for doubtful accounts ►S ----------S 8 Inventories for sale or use . .. .

E 9 Pre aid ex enses and deferred char esT p gp .

S 10a Investments - U.S. and state governmentobligations (attach schedule) ...

b Investments - corporate stock ( attach schedule ) Statement 5 684 , 062. 736 , 088. 976 , 208.c Investments - corporate bonds ( attach schedule)

11 Investments -land buildings ands`fssssss#3## #r:..s..'r s###^### ###

ss## ##+#s s sssssssss sssssssssssss ` ss`sssss ....

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Less, accumulated depreciation(attach schedule) ►

---------12 Investments - mortgage loans

13 Investments - other (attach schedule)►buildings and equipment: basis14 Land sssss »ssssss##s# r»r######sss############ s»rr»»"

ss s ` 3 `rsr s#### rss########## #s##s;#s ###rss`##s

s;<sssssss s'ss###'s.ss# :%###s# ###N#### »r»»r».` % `, , _ _ _ _ _ _ _ - - - rssrs.^:ssssHssss^sssxszsssrsfrssssssss ss^sssss»r»^»rrr»`r„»»»sssss^„^srs^;sss^ rs !^,;. rrrrrss,rr»r `»»sr : + ` `sr » srssss:sssssssss,:Less: accumulated depreciation(attach schedule ) ..... ►

----------15 Other assets (describe ►

----------- ----- -16 Total assets (to be completed by all filers -

see instructions. Also , see pag e 1, item I 684 293. 749 687. 989 807.L 17 Accounts payable and accrued expenses #s##$########<ss##``ss%##s#s: ###s#s?ssssr..s.rrsr#s#### #%s#` #sxsI

18 Grants payables s sss s;###r rr rrrrr ,r , #s , s<#sss'#s#s`:ssfss ####"ss>## sss#{rssr»rr»r rs.sss:£ii ^s %A ##•»ss#••ss###ssv%•# ;s##s###rs#: ir sa s s###` zg#" ##swB 19 Deferred revenue s ss s ,########ss:# ;#s's#ss###;#####;s#;###;##s#rr##r,r;##

'L 20 Loans from officers, directors, trustees , & other disqualified persons

#.........{ssss s?sss'ss#s`sss;ss;,

ss##f#s##z?s.s#,#:,i######s;####'ss :# ' s s

21 Mortgages and other notes payable ( attach schedule )s>ssr"r;<g s^, ^`ssrrrssssrr# r `r <;Ns,`ssssssssss`#s ssss'#ssss•ss#sff.#sss, `ssssr ` r «r rrr

T22 Other liabilities (describe

0,001, 45's .;#k$##f; ##<s% '?# #s^####,sE _ _ _ _ _ _ _ _ _ _ _ _ _ _ rr » ### ssssssr s sr..s%ss;...

S 23 Total liabilities (add lines 17 through 22) 0. 0. s..sZOO%s ` `►Foundations that follow SFAS 117 , check here s `•'ss"%`s #ss`s ssssr##sxs"s#•`s#### 's`ss s»,.#..^;r#s srssssssss`sissssssNss`

and complete lines 24 through 26 and lines 30 and 31 ..rs sss"s'sssss# rf#:;s„s`:"s+:ssssss'

'''#s sr> , rrssssN FE U

24 Unrestricted ssr`rrr`rs,.», r+rsr f## #%s##''s# s#` s`;`sssss `ss<;%#Y''s''sss#s# s;,,;#"## s: # ss##%ssiss##i3#vs#sscss+

NT

25 Temporarily restricted

`D 26 Permanently restricted fsf{#}%`sr'?$$;N'#À

S B Foundations that do not follow SFAS 117, check here ► Xrrsssssssss ,ss:ss`ssss Misr,+sssssssrs

ssr`'s<; #;#'#"N#s###sf##'s

S A and complete lines 27 through 31. 's#sss##ss':ssssss#s#s;#r##'sss%###;:s

E L 27 Capital stock trust principal or current funds 684 293 749 687. '''' ` '' 'T A , , . , `s 's#s ##s#s#•s ;#####ss`s^##s#:##`# ss`'s 's;#;# •.S N 28 Paid-in or capital surplus or land and equipment fundbuilding ###s;########:#%;;#;#s,##'s##%#;;s;ss;.;y`,, , ;ss;ass :s ;sssssssrrs s r s ##' ss ` #"'

''C

0 E 29 Retained earnings, accumulated income, endowment, or other fundsssss#„ ssFS#;# s,#sss#i#####s#s#; > `s+s `s s ss#

## %` ##

s

i z si sR S 30 Total net assets or fund balances (see the instructions) 684 293. 749 , 687. s'S"ss% 'rr##,'r#?

+31 Total liabilities and net assetsifund balances s;sss' ss#';s``s##ss#;;s; ssr#s;see the instructions 684 293. 749 687. ss;#`'s

l`"" - 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 withend-of-year figure reported on prior year's return) 1 684 293.

2 Enter amount from Part 1, line 27a . . 2 311 , 323.

3 Other increases not included in line 2 ( itemize) . . ► See Statement 6---- ---- ---------------- 3 2 452 .-- -- --4 Add lines 1, 2, and 3 4 998 , 068.5 Decreases not included in line 2 ( Itemize ) .. ► See Statement 7 _ _ _

[14

248 381._ _ _ _ _ _ _ _ -6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II column (b), line 30 1 749 , 687.

BAA TEEA0302L 07106/09 Form 990-PF (2009)

. , r

Form 990-PF (2009) THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Page 3Capital Gains and Losses for Tax on Investment Income

(a) List and describe the kind(s) of property sold (e g., real estate,2-story brick warehouse; or common stock, 200 shares MLC Company)

( b) How acquiredP - PurchaseD - Donation

(c) Date acquired(month, day, year)

(d) Date sold(month, day, year)

la See, Statement 8b

c

d

e

(e) Gross sales price (f) Depreciation allowed(or allowable)

(g) Cost or other basisplus expense of sale

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

a

b

c

d

e

Comp lete onl y for assets showing gain in column (h) and owned by the foundation on 12/31169 (I) Gains (Column (h)(I) Fair Market Value

as of 12/31/69(j) Adjusted basisas of 12/31 /69

(k) Excess of column ( I)over column (I), if any

gain minus column (k), but not lessthan -0-) or Losses (from column (h))

a

b

c

d

e

2 Capital gain net income or (net capital loss). If gain, also enter in Part I, line 7If (loss), enter -0- in Part I, line 7 } 2 -2 , 680.

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 the instructions). If (loss), enter -0-in Part I, line 8 3 -4.

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

If section 4940(d)(2) applies, leave this part blank.

Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period ? F]Yes a No

If 'Yes,' the foundation does not qualify under section 4940 (e). Do not complete this part.

1 Enter the appropriate amount in each column for each year; see the instructions before maklno any entries.

Base periodCalendar (or tax

years

begmeaar (ot year(b)Adjusted qualifying distributions

(c)Net value of

noncharitable-use assets

(d)Distribution ratio

(column (b) divided by column (c))

2008 29 , 549. 529 541. 0.0558012007 54 , 696. 636 764. 0.0858972006 3 , 472. 410 346. 0.0084612005 17 , 351. 319 806. 0.0542552004 28 , 064, 330 696. 0.084863

2 Total of line 1, column (d) 2 0.289277

3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by thenumber of years the foundation has been in existence if less than 5 years 3 0 . 057855

4 Enter the net value of noncharitable-use assets for 2009 from Part X, line 5 4 711 , 710.

5 Multiply line 4 by line 3 .. 5 41 , 176.

6 Enter 1 % of net investment income (1 % of Part I, line 27b) 6 303.

7 Add lines 5 and 6 7 41 , 479.

8 Enter qualifying distributions from Part XII, line 4 8 16 , 298.

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 rate See thePart VI Instructions

BAA Form 990-PF (2009)

TEEA0303L 07/06/09

Form 990-PF 2009 THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Page 4i#sf Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see the instructions

1 a Exempt operating foundations described in section 4940(d)(2), check here and enter 'NIA' on line I ;zs####'ss;;;;;;ssss r,/•."s's'ss##s###;`s## s

Date pf ruling o/ determination letter _ - - _ _ _ _ (attach copy of letter if necessary - see instr.)

b Domestic foundations that meet the section 4940(e) requirements in Part V, 1 606.

check here " Fland enter 1% of Part I, line 27b

c All other domestic foundations enter 2% of line 27b Exempt foreign organizations enter 4% of Part I, line 12, column (b)

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

3 Add lines 1 and 2 3 606.4 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- 5 606.

6 Credits/Payments: ;#-.•;.,.,,i,,.,,,## ,.rrr$ssss^;s{'ss:si;

a 2009 estimated tax pmts and 2008 overpayment credited to 2009 6a 1 , 540.

r

b Exempt foreign organizations - tax withheld at source 6b. . .............

c Tax paid with application for extension of time to file (Form 8868) 6c f iss#H # ' :# #±#" '%

d Backup withholding erroneously withheld .... . 6d

7 Total credits and payments. Add lines 6a through 6d . . .... 7 1 , 540.8 Enter any penalty for underpayment of estimated tax. Check here r] 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 P 9 0.

10 Overpayment . If line 7 is more than the total of lines 5 and 8, enter the amount overpaid 10 934.11 Enter the amount of line 10 to be: Credited to 2010 estimated tax ► 608. Refunded ► 11 326.

M Statements Regardin g Activities

the tax did the foundation attem1 a Durin ear t to influence an or local lenational tat slati n or did it Yes Nog py , y , s gie, oparticipate or intervene in any political campaign? 1 a X

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

If the answer is 'Yes' to la or 1b, attach a detailed description of the activities and copies of any materials publishedor distributed by the foundation in connection with the activities

c Did the foundation file Form 1120-POL for this year?d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

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

2 Has the foundation engaged in any activities that have not previously been reported to the IRS?

If 'Yes, 'attach a detailed description of the activities

3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articlesof incorporation, or bylaws, or other similar instruments? If 'Yes, ' attach a conformed copy of the changes

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

b If 'Yes,' has it filed a tax return on Form 990-T for this year?

5 Was there a liquidation, termination, dissolution, or substantial contraction during the year?

If 'Yes, ' attach the statement required by General Instruction T

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

• By language in the governing instrument, or

• By state legislation that effectively amends the governing instrument so that no mandatory directions that conflictwith the state law remain in the governing instrument?

7 Did the foundation have at least $5,000 in assets at any time during the year? If Yes,' complete Part II, column (c), and Part XV

8a Enter the states to which the foundation reports or with which it is registered (see the instructions)

b If the answer is 'Yes' to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General(or designate) of each state as required by General Instruction G? If 'No, 'attach explanation

1cl I X

0. .s# ss### # x:#s#

2 X

f`# svs:

3 X

4a X

4b N /A

Ie

X

XMX

i fr{ii iiSi$

ii{ ffX INIt

XX7 X

9 Is the foundation claiming status as a private operating foundation within the meaning of section 4942)(3) or 49420)(5)for calendar year 2009 or the taxable year beginning in 2009 (see instructions for Part XIV) ' If 'Yes,' complete Part XIV

10 Did any persons become substantial contributors during the tax year ? If 'Yes,' attach a schedule listing their names

BAA

9 1 I X

Form 990-PF (2009)

TEEA0304L 07/06/09

Form 990-PF 2009 THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Page 5Statements Reg arding Activities Continued

11 At any time during the year, did the foundation, directly or indirectly, own a controlled entitywith,in the mbaning of section 512(b)(13)' If 'Yes', attach schedule (see instructions) 11 X

12 Did the foundation acquire a direct or indirect interest in any applicable insurance contract beforeAugust 17, 2008? 12 X

13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? 13 X

Website address ► N/A---------------------------- ---- ---------

14 The books are in care of ► ZEENAT MADHANY Telephone no. ► (407 ) 876-409 8_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _96 7Located at ► 8 SAVANNAH PARK, ORL NDO , FLORIDAA ZIP +4 ► 32819

.__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _

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

_ _ _

. N/A ► ffand enter the amount of tax-exem p t interest received or accrued during the year 15 N/A

u Statements Regardin g Activities for Which Form 4720 May Be Req uiredFile Form 4720 if any item is checked in the 'Yes' column , unless an exception applies . Yes No

1 a During the year did the foundation (either directly or indirectly): ./..s^%%%k^'•••r%%%%%%'%rs'si

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? []Yes No +{#i lrrs ; ss• sssssss;

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a x ;;"% %%%%%``%disqualified person? Yes X No goo/ìsr

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? Yes X No jg f^/ S{!

(4) Pay compensation to or pay or reimburse the expenses of, a disqualified person? ....... Yes X No

.. . .(5) Transfer any income or assets to a disqualified person (or make any of either available ?ss .. .. ....?for the benefit or use of a disqualified person)? Yes .••

(6) Agree to pay money or p ro p erty to a government official? (Exce ption. Check 'No' if thef

'$%rs% %%%{s%ssss'soundation agreed to make a grant to or to employ the official for a period after termination lf;;#„of government service, if terminating within 90 days.) Yes No

b If any answer is 'Yes' to 1 a(1)-(6) did any of the acts fail to qualify under the exceptions described in ss ^r^f,s:,Regulations section 53.4941(d)-3 or in a current notice regarding disaster assistance (see the instructions)? lb N AOrganizations relying on a current notice regarding disaster assistance check here

s" ` `s,,s ssrsc Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,

•that were not corrected before the first day of the tax year beginning in 2009' 1 c X

2 Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a MWprivate operating foundation defined in section 4942(1)(3) or 4942(j)(5)):

a At the end of tax year 2009, did the foundation have any undistributed income (lines 6dand 6e, Part XIII) for tax year(s) beginning before 2009? Yes No ,•••; 's';'s,;;;s;:;v;

If 'Yes,' list the years 20 _ 120_ 20_ 20_,

b Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)Y Y

4^ 10 00,

s%s,<X%s ;^%:::%^• #:< ?%(relating to incorrect valuation of assets) to the year's undistributed income? (If applying section 4942(a)(2) to

s ss>wN$% ^!{<€€^ r^.<#

all years listed, answer 'No' and attach statement - see the instructions.) .. 2b N VA

c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here. „frrjsss;;;

- 20 20 20 20NOW

3a Did the foundation hold more than a 2% direct or indirect interest in any businessenterprise at any time during the year? Yes No `:;; `'z:;:.:;•„#

b If 'Yes,' did it have excess business holdings in 2009 as a result of (1) any purchase by the foundation ##r ;#;i'# <<s##sor disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved s#%;'by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or

the la se of the 10- r first n15- 20 hase h ld eriod? (U 47203 S h d l F tCg pp , , or -yea p i( ) o se c e u orm , oe ,determine if the foundation had excess business holdings in 2009) 3b N VA

4a Did the foundation invest during the year any amount in a manner that would jeopardize itscharitable purposes? 4a X

b Did the foundation make any investment in a prior year (but after December 31, 1969) that could • j;;;; ;ss,`s;#;s, ?%%%``%%;;%^jeopardize its charitable purpose that had not been removed from jeopardy before the first day ofthe tax year beg innin g in 2009? 4b X


TEEA0305L 07/06/09

Form 990-PF 2009 THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Pag e 6Statements Regardin g Activities for Which Form 4720 May Be Req uired (continued)

5a During the year did the foundation pay or incur any amount to:

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

'`(2) Influence the outcome of any specific public election (see section 4955); or to carry "s`s%%%% "`r:'s 's{%;•on, directly or indirectly, any voter registration drive? a Yes XX No

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

(4) Provide a grant to an organization other than a charitable, etc, organization described?

W Ogg'' , ;;;off #ff #;.

in section 509 (a)( 1 ), (2), or (3), or section 4940 (d)(2) (see instructions ) q Yes No

(5) Provide for any purpose other than religious, charitable, scientific, literary, or

ZZ^

èducational purposes, or for the prevention of cruelty to children or animals? q Yes q No r{; ''%'f%% `•.,'si's`s`s`s's ,"",

b If any answer is 'Yes' to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions %s "' ; %%`'%'``s%""described in Regulations section 53.4945 or in a current notice regarding disaster assistance """'`'

(see instructions)? 5b N AOrganizations relying on a current notice regarding disaster assistance check here ► %%%%s MMV; M;;;;;

c If the answer is 'Yes' to question 5a(4), does the foundation claim exemption from thetax because it maintained expenditure responsibility for the grant? N/A. q Yes q No

If 'Yes , ' attach the statement required by Regulations section 53 4945-5(d)

6a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums ;fir;Jon a personal benefit contract? Yes X No .........................

b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? 6b XIf 'Yes' to 6b, file Form 8870

7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?

b If es, did the foundation receive any proceeds or have any net income attributable to the transaction? 7b N Ai n formation About Officers, Dire ctors , Trustees , Foundation Managers , H ig hly Pai d Emp l oyees,and Contractors

1 List all officers, directors . trustees . foundation managers and their compensation (see instructionsl_

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

devoted to position plans and deferredcom pensation

_NASIRDIN M.MADHANY M.D_ Trustee 0. 0. 0.8967 SAVANNAH PARK 0ORLANDO , FL 32819

-ZEENAT N. MADHANY - - - - - - - - - -------------- Trustee 0. 0. 0.8967 SAVANNAH PARK 0ORLANDO , FL 32819

-AL-HUSEIN MADHANY - - - - - - - - - -------------- Trustee 0. 0. 0.8967 SAVANNAH PARK 0ORLANDO , FL 32819

-NUREZ MADHANY - - - - - - - - - - - - ----------- Trustee 0. 0. 0.8967 SAVANNAH PARK 0ORLANDO . FL 328 1 9z GomDensatlon of Live highest-paid emDlovees (other than those included on line 1- cap inetrurtinnel If nnna antar 'NfNF '

(a) Name and address of each employeepaid more than $50,000

(b) Title and averagehours per week

devoted to position

(c) Compensation (d) Contributions toemployee benefitplans and deferredcom pensation

(e) Expense account,other allowances

None------------------------

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

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

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

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

Total number of other emp loyees paid over $50 , 000 ► 0

BAA TEEA03061- 07/06/09 Norm 99U-PF (2009)

Form 990-PF (2009) THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Page 7, ; Information About Officers , Directors , Trustees , Foundation Managers , Highly Paid Employees,

and Contractors (continued)

3 Five highest-paid independent contractors for professional services - (see instructions). If none,enter 'NONE.'

(a) Name and address of each person paid more than $50 , 000 (b) Type of service (c) Com pensation

None--------------------------------------

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

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

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

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

Total number of others receivin g over $50 , 000 for professional services 0

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 oforganizations and other beneficiaries served, conferences convened, research papers produced, etc

Expenses

1 N/A ---------------------------------------------------------------------------------------------------

2------------------------------------------------------

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

3 ------------------------------------------------------

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

4

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

Summary of Program -Related Investments (see instructions)

Describe the two lar gest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount

1 N/A------------------------------------------------------------------------------------------------------------

2 ------------------------------------------------------

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

All other program-related investments. See instructions.

3------------------------------------------------------------------------------------------------------------

Total. Add lines 1 throu gh 3 ► 0.


TEEA0307L 07/06/09

Form 990-PF (2009) THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Pace 8N- r'••î J 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: r, ,a Average monthly fair market value of securities 1 a 720 , 003.b Average of monthly cash balances 1 b 2 , 545.c Fair market value of all other assets (see instructions) 1 c

d Total (add lines la, b, and c) 1 d 722 , 548.e Reduction claimed for blockage or other factors reported on lines la and lc

(attach detailed explanation) 1 e 0.

2 Acquisition indebtedness applicable to line 1 assets 2 0.3 Subtract line 2 from line Id 3 722 , 548.

4 Cash deemed held for charitable activities. Enter 1-1/2% of line 3(for greater amount, see instructions) 4 10 , 838.

5 Net value of noncharitable -use assets . Subtract line 4 from line 3. Enter here and on Part V, line 4 5 711 710.

6 Minimum investment return . Enter 5% of line 5 6 35, 586.

Distributable Amount (see instructions) (Section 49420)(3) and (j)(5) private operating foundationsand certain forei g n org anizations check here ► and do not com p lete this art.

1 Minimum investment return from Part X, line 6 1 35 , 586.2a Tax on investment income for 2009 from Part VI, line 5 2a 606 . %"s#ss$#

b Income tax for 2009. (This does not include the tax from Part VI.) 215 1

c Add lines 2a and 2b 2c 606.

3 Distributable amount before adjustments. Subtract line 2c from line 1 3 34 , 980.4 Recoveries of amounts treated as qualifying distributions 4

5 Add lines 3 and 4 5 34 , 980.6 Deduction from distributable amount (see instructions) 6

7 Distributable amount as ad j usted. Subtract line 6 from line 5. Enter here and on Part XIII , line 1 7 34 , 980.

Qualifying Distributions (see instructions)

'H1 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 16 , 298.

b Program-related investments - total from Part IX-B 1 b

2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc, purposes 2

3 Amounts set aside for specific charitable projects that satisfy the:a Suitability test (prior IRS approval required) 3a

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

4 Qualifying distributions . Add lines la through 3b. Enter here and on Part V, line 8, and Part XIII, line 4 4 16 , 298.

5 Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment incomeEnter 1% of Part I, line 27b (see instructions) 5

6 Adjusted qualifying distributions . Subtract line 5 from line 4 6 16,298.

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


TEEA0308L 07/06/09

Form 990-PF (2009) THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Page 9

Undistributed Income (see instructions)

1 Distributable amount for 2009 from Part XI,line 7

2 Undistributed income, if any, as of the end of 2009-

a Enter amount for 2008 only

b Total for prior years: 20_, 20 _, 20_

3 Excess distributions carryover if any, to 2009:

a From 2004 1 , 154.

b From 2005 17 , 447.

c From 2006

d From 2007 24 , 666.e From 2008 4 , 611.f Total of lines 3a through e

4 Qualifying distributions for 2009 from Part

XII, line 4. 11 $ 16,298.

a Applied to 2008, but not more than line 2a

b Applied to undistributed income of prior years(Election required - see instructions)

c Treated as distributions out of corpus(Election required - see instructions)

d Applied to 2009 distributable amount

e Remaining amount distributed out of corpus

5 Excess distributions carryover applied to 2009(If an amount appears in column (d), thesame amount must be shown in column (a) )

6 Enter the net total of each column asindicated below:

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

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

c Enter the amount of prior years' undistribut-ed income for which a notice of deficiencyhas been issued, or on which the section4942(a) tax has been previously assessed

d Subtract line 6c from line 6b. Taxableamount - see instructions

e Undistributed income for 2008. Subtract line 4a fromline 2a Taxable amount - see instructions

f Undistributed income for 2009. Subtract lines4d and 5 from line 1. This amount must bedistributed in 2010

7 Amounts treated as distributions out ofcorpus to satisfy requirements imposedby section 170()(1)(F) or 4942(g)(3)(see instructions)

8 Excess distributions carryover from 2004 notapplied on line 5 or line 7 (see instructions)

9 Excess distributions carryover to 2010.Subtract lines 7 and 8 from line 6a . . .

10 Analysis of line 9:

a Excess from 2005

b Excess from 2006

c Excess from 2007 24 , 585.

d Excess from 2008 4 , 611.

e Excess from 2009

(a) b (Corpus Years prior to 2008 2008

47,878.

0.

0.18,682.

29.1

(d)2009

34 6 980.

fSS :sss's's?'s'ss%sssss"s s's#'s{ {+;,,+„;, ,::

0.

16,298.

18,682.

-11 MR,

0.

29,196.


TEEA0309L 07/06/09

0.

0.

0.

Form 990-PF 2009 THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Page 10Private Operating Foundations (see instructions and Part VII-A q uestion 9) N/A

1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the rulingis effective for 2009, enter the date of the ruling ►

b Check box to indicate whether the foundation is a p rivate operatin g foundation described in section 4942 3 or 7 49420)(5)2a Enter the lesser of the adjusted net Tax year Prior 3 years

income from Part I or the minimum(a) 2009 (b) 2008 c 2007 (d) 2006 (e) Totalinvestment return from Part X for

each year listed

b 85% of line 2a

c Qualifying distributions from Part XII,line 4 for each year listed

d Amounts included in line 2c not used directlyfor active conduct of exempt activities

e Qualifying distributions made directlyfor active conduct of exempt activities.Subtract line 2d from line 2c

3 Complete 3a, b, or c for thealternative test relied upon:

a 'Assets' alternative test - enter

(1) Value of all assets

(2) Value of assets quali ing undersection 4942(j)(3)(B)(

b 'Endowment' alternative test - enter 2/3 ofminimum investment return shown in Part X,line 6 for each year listed

c 'Support' alternative test - enter:

(1) Total support other than grossinvestment income (interest,dividends, rents, paymentson securities loans (section512(a)(5)), or royalties)

(2) Support from general public and 5 ormore exempt organizations as providedin section 4942(I)(3)(B)(ui)

(3) Largest amount of support froman exempt organization

4 caross investment income

MAMMON Supplementary Information (Complete this part only if the organization had $5,000 or more inassets at any time during the year - see instructions.)

1 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).)

See Statement 9

b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership ofa 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 if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicitedrequests for funds. If the foundation makes gifts, grants, etc, (see instructions) to individuals or organizations under other conditions,complete items 2a, b, c, and d.

a The name, address, and telephone number of the person to whom applications should be addressed:

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

c Any submission deadlines:

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

BAA TEEA0310L 07/06/09 Form 990-PF (2009)

Form 990-PF 2009 THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Pag e 11Supplementary Information (continued)

3 Grants and Contributions Paid Durinci the Year or Approved for Future Payment

RecipientIf recipient is an individual ,show an y relationship to Foundation

Purpose of grant orany foundation mana er or status ofstatus Amountg

reci pientName and address (home or business) substantial contributor

a Paid during the year

AGA KHAN FOUNDATION U.S.A. PUBLIC GENERAL 11,087.1825 K STREET NW, SUITE 901WASHINGTON, DC 20006

FOCUS HUMANITARIAN ASSISTANCE PUBLIC GENERAL 565.1700 FIRST COLONY BLVD #300SUGAR LAND, TX 77479

BC WOMEN'S HOSPITAL & HEALTH PUBLIC GENERAL 100.CENTRE FDN4500 OAK STREETVANCOUVER, BC, CANADA VBH 3N1

VIBHA PUBLIC GENERAL 100.1030 EAST EL CAMINO REAL #424SUNNYVALE, CA 94087

JUBILEE MONUMENTS CORP PUBLIC GENERAL 250.1700 FIRST COLONY BLVD, #100SUGAR LAND, TX 77479

Total ► 3a 12 , 102.b Approved for future payment

Total . ► 3biBAA TEEA0501L 07/06/09 Form 990-PF (2009)

Form 990-PF (2009) THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Page 12

Analysis of Income -Producing Activities

Enter

a

b

c

d

e

f

92

3

4

5

a

b

6

7

8

9

10

11

a

b

c

d

e

12 Subtotal.Total. Add line 12, columns (b), (d), and (e) .. . 13 28,120.

(See worksheet in the instructions for line 13 to verify calculations.)

, < , { # Relationship of Activities to the Accomplishment of Exempt Purposes

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

rogram service revenue:

(a)Businesscode

(b)Amount

(c)Exclu-sioncode

(d)Amount

(e)Related or exemptfunction income

(see the instructions

Fees and contracts from government agencies

Membership dues and assessments

Interest on savings and temporary cash investments

Dividends and interest from securities

Net rental income or ( loss) from real estate:

Debt-financed property

'' s{fir### ##### !#`##`1,11, :#:%#####%##i#'#### Yt#,

14

`• %%##### ##:

30 252.

' + +{'';###

# 'r' + #+„":;s:::::{ ,s;,ts .ss:s't v,vs ss'si

Not debt-financed property .

Net rental income or (loss ) from personal property

Other investment income

Gain or ( loss) from sales of assets other than inventory -2 , 680.Net income or ( loss) from special events

Gross profit or (loss) from sales of inventory

Other revenue :

PENGROWTH K-1

„»,»»^{ : :%sss's';';;;'• „

548.,,•.,•:,#``s ss:{;,,,,,,:H

. Add columns (b), (d), and (e) <''' `{z# :s #; 30 800. -2 680 .

BAA TEEA0502L 07/06/09 Form 990-PF (2009)

Form 990-PF 2009 THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653 Page 13` ` Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations

:•;Ms;s;: es NoDid the organization directly or indirectly engage in any of the following with any other organization s zs#s#:#:;;#;; ;#:::::described in section 501 (c) of the Code (other than section 501(c)(3) organizations) or in section 527, rrrZf'WZ f^1 I rrrr rrrelating to political organizations ? {%

a Transfers from the reporting foundation to a noncharitable exempt organization of r`.#;?:sss̀s's(1) Cash

(2) Other assets

b Other transactions:

X

(1) Sales of assets to a noncharitable exempt organization 1 b (1 ) X(2) Purchases of assets from a noncharitable exempt organization 1 b (2) X

(3) Rental of facilities, equipment, or other assets 1 b X(4) Reimbursement arrangements .. 1 b (4) X

(5) Loans or loan guarantees 1 b (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

Under penalties of perjury, Ideclare

f' ' 'complete Declaration of

S

G signature of officer or trusteeN

E PaidPsignaturereparer's

R Pre- J Russell Hamlin, CPAE parer's Firm's

Use yours self-

Only enad ress, andZIP code Maitland, FL 32751

BAA

2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizationsdescribed in section 501 (c) of the Code (other than section 501(c)(3)) or in section 527? E Yes No

Schedule B(Formor990PF)

990-EZ, Schedule of ContributorsDepartment of the Treasury ► Attach to Form 990, 990-EZ, or 990-PFInternal Revenue Service

OMB No 1545-0047

2009Name of the organization THE NASIRDIN & ZEENAT MADHANY FAMILY Employer Identification number

FOUNDATION 1 59-7203653Organization 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 X 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 boxes for both the General Rule and a Special Rule. See instructions.

General Rule -For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any onecontributor. (Complete Parts I and II.)

Special Rules -

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33-1/3% support test of the regulations under sections509(a)(1)/170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the greater of (1) $5,000 or (2) 2% of theamount on (I) Form 990, Part VIII, line 1h or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ, that received from any one contributor, during the year,aggregate contributions of more than $1,000 for use exclusively for rellgsous, charitable, scientific, literary, or educational purposes, or theprevention of cruelty to children or animals. Complete Parts I, 11, and III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ, that received from any one contributor, during the year,contributions for use exclusively for religious, charitable, etc, purposes, but these contributions did not aggregate to more than $1,000. Ifthis 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. ► $

Caution : An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or990-PF) but it must answer 'No' on Part IV, line 2 of their Form 990, or check the box on line H of Its Form 990-EZ, or on line 2 of its Form990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).

BAA For Privacy Act and Paperwork Reduction Act Notice, see the Instructionsfor Form 990, 990EZ, or 990-PF.

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

TEEA0701L 01/30/10

Schedule B (Form 990 , 990-EZ , or 990-PF) (2009) Pac e 1 of 1 of Part IName of organization Employer Identification number

THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653

Contributors (see instructions.)

(a) (b) (c) (d)Number Name, address, and ZIP + 4 Aggregate Type of contribution

contributions

1 NASIRDIN &-ZEENAT-MADHANY------------------- Person XPers

8967 SAVANNAH- PARK---------------------- 71-390_ Noncash

(Co m p lete Part 11 if thereORLANDFL 32819_________________________ is


contributions

2 NASIRDIN &-ZEENAT-MADHANY--------------------------------- _ _ PersonPayroll

8967 SAVANNAH- PARK- - - - - - - - - - - - - - - - - - - - - - - - $- - - - - 93L114. Noncash X

(Complete Part II if thereORLANDFL 32819_________________________ is a noncash contribution.)

(a) (b) (c) (d)Number Name , address , and ZIP + 4 Aggregate Type of contribution

contributions

3 NASIRDIN &_ZEENAT_MADHANY __________________ PersonPayroll

8967 SAVANNAH- PARK- - - - - - - - - - - - - - - - - - - - - - - - $- - - - - 46L834 . Noncash X

oORLANDO, FL 32819_________________________ oncashcntributon)isa


contributions

4 NASIRDIN & ZEENAT MADHANY------------------------------------- Person

Payroll

8967 SAVANNAH- PARK- - - - - - - - - - - - - - - - - - - - - - - - $- - - - -123494. Noncash X

(Complete Part II if thereORLANDO, FL 32819 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ is a noncash contribution.)

(a) (b) (c) (d)Number Name , address , and ZIP + 4 Aggregate Type of contribution

contributions

5 NASIRDIN &-ZEENAT-MADHANY - - - - - - - - - - - - - _ _ _ _ _----------------- PersonPayroll

8967 SAVANNAH-PARK________________________ $_____ 31L _-850. Noncash X

plete Part 11 if thereoORLANDO,_FL 32819_________________________ noisa


contributions

--------------------------------- Person

Payroll

__ $ Noncash

(Complete Part II if there_ _ is a noncash contribution.)

BAA TEEA0702L 06123 /09 Schedule B (Form 990 , 990-EZ, or 990-PF) (2009)

(a)No. fromPart I

(b)Description of noncash property given

(C)FMV (or estimate(see instructions)

(d)Date received

1 , 400 shares Amen AMGN2

$ 93 , 114. 8/20/09

(a)No. fromPart I


(C)FMV (or estimate(see instructions)

(d)Date received

1 , 035 shares GlaxoSmithKline (GSK)3

$ 46 , 834. 8/20/09

(a)No. fromPart I


(c)FMV (or estimate)(see instructions)

(d)Date received

2 , 359 shares Philip Morris ( PM )4

$ 123 494. 12/07/09

(a)No. fromPart I



(d)Date received

1% ownership share Nural LLC5

$ 31 , 850. 12/31/09

(a)No. fromPart I



(d)Date received

(a)No. fromPart I


(c)FMV (or estimate(see instructions)

(d)Date received

BAA Schedule B (Form 990 , 990-EZ, or 990-PF) (2009)

TEEA0703L 06/23/09

Noncash Property (see instructions.)

Schedule B (Form 990 , 990-EZ , or 990-PF) (2009) Page 1 of 1 of Part IIIName of organization Employer Identification number

THE NASIRDIN & ZEENAT MADHANY FAMILY 59-7203653Exclusively religious , charitable , etc, individual contributions to section 501 (c)(7), (8), or (10)organizations aggregating more than $1,000 for the year.(Complete cols (a) through (e) and the following line entry.)

For organizations completing Part III, enter total of exclusively religious, charitable, etc,contributions of $1.000 or less for the year. (Enter this information once - see instructions) M /A

(a)

No. fromPart

(b)

Purpose of gift

(c)

Use of gift

(d)

Description of how gift is held

N/A

(e)Transfer of gift

Transferee 's name , address, and ZIP + 4 Relationship of transferor to transferee

(a)

No. fromPart I

(b)

Purpose of gift(C)

Use of gift

(d)


(e)Transfer of gift

Transferee 's name, address , and ZIP + 4 Relationship of transferor to transferee

(a)

No. fromPart I

(b)

Purpose of gift

(c)

Use of gift

(d)


(e)Transfer of gift

Transferee 's name, address, and ZIP + 4 Relationship of transferor to transferee

(a)

No. fromPart I

(b)

Purpose of gift

(c)

Use of gift

(d)


(e)Transfer of gift

Transferee 's name , address, and ZIP + 4 Relationship of transferor to transferee

BAA Schedule B (Form 990 , 990-EZ, or 990-PF) (2009)TEEA07041 06/23/09

2009 Federal Statements Page 1THE NASIRDIN & ZEENAT MADHANY FAMILY

Client .MA4368 FOUNDATION 59-7203653

9/09/10 12.31 PM

Statement 1Form 990 -PF, Part I , Line 11Other Income

(a) (b) Net (c)Revenue Investment Adjusted

per Books Income Net Income

PENGROWTH K-1 $ 548.$ 548.Total 548.$ 548.$ 0.

Statement 2Form 990-PF, Part I, Line 16bAccounting Fees

(a) (b) Net (c) (d)Expenses Investmentper Books Income

AdjustedNet Income

CharitablePur oses

ACCOUNTING FEES $ 500.

p

Total $ 500. $ 0. $ 0. $ 0.

Statement 3Form 990 -PF, Part I , Line 18Taxes

(a) (b) Net (C) (d)Expenses Investment Adjusted Charitableper Books Income Net Income Purposes

EXCISE TAX $ 2,175.FOREIGN TAXES 505. $ 505.

Total X2,680. $ 505. $ 0. $ 0.

Statement 4Form 990-PF , Part I, Line 23Other Expenses

(a) (b) Net (c) (d)Expenses Investmentper Books Income

AdjustedNet Income

CharitablePurposes

MISCELLANEOUS $ 4,196. $ 4,196.Total $ 4,196. $ 0. 0. $ 4,196.


Client .MA4368 FOUNDATION 59-7203653

9/09/10 12 31 PM

Statement 5Form 990 -PF, Part II , Line 10bInvestments - Corporate Stocks

Valuation Book Fair MarketCorporate Stocks Method Value Value

SEE SCHEDULE Cost 736 088. $ 976,208.Total 736,088. $ 976,208.

Statement 6Form 990-PF, Part III, Line 3Other Increases

PRIOR PERIOD ADJUSTMENTS $ 2 452.,Total 2,452.

Statement 7Form 990-PF, Part III, Line 5Other Decreases

ADJUST FMV OF NON-CASH CONTRIBUTIONS TO COST BASIS $ 248,381.Total $ 248,381.

Statement 8Form 990-PF, Part IV, Line 1Capital Gains and Losses for Tax on Investment Income

(b) How (c) Date (d) DateI tem (a) Description Acquired Acquired Sold1 Advantage Energy Purchased Various 7/14/20092 Allergan Purchased Various 11/09/20093 Lab Corp of America Purchased Various 12/15/20094 Medarex Purchased 1/14/2005 9/04/20095 AOL Purchased Various 12/09/20096 Cigna Corp Purchased Various 11/25/20097 Cash in Lieu Purchased Various Various

(e) (f) (g) (h) (i) ( j) (k) (1)Gross Deprec. Cost Gain FMV Adj. Bas. Excess Gain

I tem Sales Allowed Basis (Loss) 12/31/69 12/31/69 (i)-(j) (Loss)1 10,726. 28,356. -17,630. $ -17,630.2 18,130. 7,034. 11,096. 11,096.3 4,226. 2,695. 1,531. 1,531.4 4,000. 2,295. 1,705. 1,705.5 21. 25. -4. -4.6 2,156. 1,530. 626. 626.7 20. 24. -4. -4.

Total $ -2,680.


Client MA4368 FOUNDATION 59-7203653

9/09/10 12:31 PM

Statement 9Form 990-PF, Part XV, Line 1aFoundation Managers - 2% or More Contributors

NASIRDIN M. MADHANY, M.D.ZEENAT N. MADHANY

Form 8868 Application for Extension of Time To File an(Rev April 2009)

Exempt Organization Return OMB No 1545 1709

Department of the TreaturyIn ternal Revenue Service File a separate application for each return.

• If you are filing for an Automatic 3-Month Extension , complete only Part I and check this box

• If you are filing for an Additional (Not Automatic) 3-Month Extension , complete only Part II (on page 2 of this form).

Do not complete Part // unless you have already been granted an automatic 3-month extension on a previously filed Form 8868.

Pad I Automatic 3-Month Extension of Time. Only submit original (no copies needed).

A corporation required to file Form 990 -T and requesting an automatic 6-month extension - check this box and complete Part I only P.11

All other corporations (including 1120-C filers), partnerships, REM/CS, and trusts must use Form 7004 to request an extension of time to fileincome tax returns.

Electronic Filing (&r/el. Generally, you can electronically file Form 8868 if you want a 3-month automatic extension of time to file one of thereturns noted below (6 months for a corporation required to file Form 990-T) However, you cannot file Form 8868 electronically if (1) you wantthe additional (not automatic) 3-month extension or (2) you file Forms 990-BL, 6069, or 8870, group returns, or a composite or consolidatedForm 990-T. Instead, you must submit the fully completed and signed page 2 (Part II) of Form 8868. For more details on the electronic filing ofthis form, visit www.irs.gov/efile and click on e-file for Charities & Nonprofits.

Type or

print

File b thedue date forfling yourreturn. Seeinstructions

Name of Exempt Organization Employer identification number

THE NASIRDIN & ZEENAT MADHANY FAMILYFOUNDATION 59-7203653Number, street , and room or suite number If a P 0 box , see instructions

8967 SAVANNAH PARKCity, town or post office , state, and ZIP code For a foreign address , see instructions

ORLANDO, FL 32819Check type of return to be filed (file a separate application for each return).

Form 990 Form 990-T (corporation) Form 4720

Form 990-BL Form 990-T (section 401(a) or 408(a) trust) Form 5227

Form 990-EZ Form 990-T (trust other than above) Form 6069

X Form 990-PF Form 1041-A Form 8870

• The books are in the care of 01 ZEENAT MADHANY

Tele phoneNo . 0( 407)876-4098 FAX No.• If the organization does not have an office or place of business in the United States , check this box L

• If this is for a Group Return , enter the organization ' s four digit Group Exemption Number (GEN) If this is for the whole group,

check this box 0' F] . If it is for part of the group, check this box " and attach a list with the names and EINs of all members

the extension will cover.

1 I request an automatic 3-month (6 months for a corporation required to file Form 990-T) extension of time

until _ 8/1 5-_

_ , 20 1 0-, to file the exempt organization return for the organization named above

The extension is for the organization ' s return for:

XX calendar year 20 0_9_ or

tax year beginning _ _ _ _ 20 and ending , 20

2 If this tax year is for less than 12 months, check reason : 11 Initial return ElFinal return Change in accounting period

3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less anynonrefundable credits. See instructions.

b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax paymentsmade. Include any prior year overpayment allowed as a credit

c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required,

deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System).

See instructions . .

0.

0.

0.

Caution . If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO forpayment instructions.

BAA For Privacy Act and Paperwork Reduction Act Notice, see instructions. Form 8868 (Rev. 4-2009)

FIFZ0501L 03/11/09

7009 2250 00041481 8922

Form 8868 (Rev 4-2009) Pa e 2

• If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II and check this box ► FNote . Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868

• If you are filing for an Automatic 3-Month Extension , complete only Part I (on page 1 ) .

1'att11 Additional (Not Automatic) 3-Month Extension of Time. Only file the original (no copies needed).Name of Exempt Organization Employer identification number

Type or THE NASIRDIN & ZEENAT MADHANY FAMILYprint FOUNDATION 59-7203653

Number, street , and room or suite number If a P 0 box, see instructions For IRS use only

File by theextended , GLICKSTEIN LAVAL CARRIS, P.A., CPAS

Check type of return to be filed (File a separate application for each return).

Form 990 X Form 990-PF Form 1041-A Form 6069

Form 990-BL Form 990-T (section 401(a) or 408(a) trust) Form 4720 Form 8870

Form 990-EZ Form 990-T (trust other than above) Form 5227

STOP! Do not complete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868.

• The books are in care of ► ZEENAT MADHANY-

-4--------------------------------

Telephone No. 0_(_40_7_)_8_7_609_8FAX No.

• If the organization does not have an office or place of business in the United States, check this box ► U• If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) . If this is for the

whole group, check this box ► . If it is for part of the group, check this box ► and attach a list with the names and EINs of all

members the extension is for.

4 I request an additional 3-month extension of time until 11/15_____ , 20 10.

5 For calendar year 2009 , or other tax year beginning - , 20 and ending_ 20______ ,____

6 If this tax year is for less than 12 months, check reason . Initial return flFinal return JChange in accounting period

7 State in detail why you need the extension TAXPAYER RESPECTFULLY REQUESTS ADDITIONAL TIME TO--------------------------_-----------

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

8a If this application is for Form 990-BL , 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any

b If this application is for Form 990-PF, 990-T, 4720, or 6069 , enter any refundable credits and estimated taxpayments made . Include any prior year overpayment allowed as a credit and any amount paid previouslywith Form 8868 8bj$ 0.

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

Signature and VerificationUnder penalties of er ury , I declare that I have examined this form, including accompanying schedules and statements , and to the best of my knowledge and belief, it is true,correct and com nd that I am aut onz to prepare t form

Signature ► la itle ► yr A Data ► 8/t4 / ` ^`^ 1

BAA FIFZ0502L 03/11/09

r^Ôp^7

Form 8868 (Rev 4-2009)

Cert. # 7010 0290 0003 6197 1039

Documents

FJ ii- F990s.foundationcenter.org/990pf_pdf_archive/597/... · Form 990-PF Return of Private Foundation OMB No 1545-0052 orSection 4947(ax1) NonexemptCharitable Trust Treated asa