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Form~ 990-PF Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust
DepartmerZ,oftheTreawry Treated as a Private Foundation Internal Revenue Service Note : The organization may be able to use a copy of this return to satisfy state reporting requirements.
OMB No 1545-0052
2003
Use the IRS Name of organization
label . Otherwise, JAMES M . COLLINS FOUNDATION
print Number and street (or P O box number if mail is not delivered to street address) Room/suite
or type : 8115 PRESTON ROAD ~680 See Specific City or town, state, and ZIP code Instructions .
y 1 a L gal fees e~ co~f6~;te4s 8 2004 1; r MT 4 2 , 580 .
u,, c 0 er professional fees MT 5 28 , 998 . 147 . ;8 Inter ~s G,~ EK9-=U~'
MT 6 2 , 801 . 19 Depreciation and depletion 20 Occupancy
a 21 Travel, conferences, and meetings v ~ 22 Printing and publications X 23 Other expenses STMT 7 29 , 948 .
24 Total operating and administrative a expenses . Add lines 13 through 23 64 , 474 . X 25 Contributions, gifts, grants paid 1 , 011 , 288 .
26 Total expenses and disbursements . Add lines 24 and 25 1 , 075 , 762 .
27 Subtract line 26 from line 12 : a Excess of revenue over expenses and disbursements -1 , 011 , 928 .
b Net investment income at negative, enter -o-> c Adjusted net income (if negative, enter -o-)
323501 ,z-os-oa LHA for Paperwork Reduction Act Notice, see the instructions. Form 990-PF (2003) 1
14370803 759901 2687 2003 .05040 JAMES M. COLLINS FOUNDATION 2687 1
For calendar year 2003, or tax year beginning , and
H Check type of organization : LXJ Section 501(c)(3) exempt private foundation 0 Section 4947(a)(1) nonexempt charitable trust 0 Other taxable private foundation
I Fair market value of all assets at end of year J Accounting method : [K] Cash 0 Accrual (from Part 11, Col. (c), line 16) 0 Other (specify)
$ 19 , 796 , 787 . (Part l, column (d) must be on cash bass) Part I Analysis of Revenue and Expenses (a) Revenue and (b) Net investment (The total of amounts in columns (b), (c), and (d) may not ex penses per books income necessarily equal the amounts in column (a) ) P
1 Contributions, gifts, grants, etc ., received Cnecko'.1f] Itthetoundahonisnotreqwredtoattach Sch B
2 Distributions from split-interest trusts Interest on sarongs and temporary 2 , 592 . 2 , 59 a ~ ~ 3 cash investments Dividends and interest from securities 26 , 646 . 26 , 64
5a Gross rents b (Net rental income w (doss) 1
7 6a hoe 10in or (loss) from sale of assets not on 34 , 779 . C b Gross sales price for all assets on line ea 1-J-9 41, 9 6 3 .
Capital gain net income (from Part IV, line 2) 34 , 77 8 Net short-term capital gain 9 Income modifications
108 Gross saes less returns and allowances
b Less Cost of goods sold
c Gross profit or (loss) 11 Other income -183 . -18 12 Total . Add lines 1 through 11 63 , 834 . 6 3 8 3 13 Compensation of officers, directors, trustees, etc
6 .
z . 0 .
A Employer identification number
/7-OU'&V /'3J
B Telephone number
(214) 691-2032 If exemption application is pending, check here
D 1. Foreign organizations, check here Q, Foreign organizations meeting the 85% test, , O
check here and attach computation
E If private foundation status was terminated under section 507(b)(1)(A), check here 111-0
F If the foundation is in a 60-month termination under section 507( b )( 1 ) B), check here
(C) Adjusted net (d) Disbursements income
for charitable purposes (cash basis only)
N/A
STATEMENT 1 STATEMENT 2 -
STATEMENT 3
2,580 . 0 . 0 . 0 .
0. 1 O
6 . 12 .763,198 .
Part III Analysis of Changes in Net Assets or Fund Bal
1 Total net assets or fund balances at beginning of year - Part II, column (a), line (must agree with end-of-year figure reported on prior year's return)
2 Enter amount from Part I, line 27a 3 Other increases not included in line 2 (itemize) 4 Add lines 1, 2, and 3 5 Decreases not included in line 2 (itemize) 6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II, ci
14370803 759901 2687 2003 .05040
Form 99o-PF (2003) JAMES M . COLLINS FOl
Part II Balance Sheets Aachedschedules andamounts inNedescnphon column should be for end -01-year amounts only
1 Cash - non-interest-bearing 2 Sarongs and temporary cash investments 3 Accounts receivable 10,
Less : allowance for doubtful accounts 00, 4 Pledges receivable 1110*
Less : allowance for doubtful accounts 5 Grants receivable 6 Receivables due from officers, directors, trustees, and other
disqualified persons 7 Other notes and loans receivable
Less : allowance far doubtful accounts 8 Inventories for sale or use
y 9 Prepaid expenses and deferred charges a 10a Investments - U .S . and state government obligations
b Investments - corporate stock STMT 8 c Investments - corporate bonds
11 investments -land, buildings, and equipment basis 11111.
Less accumulated depreciabon 111111
12 Investments - mortgage loans
13 Investments - other STMT 9 14 Land, buildings, and equipment : basis 00,
Less accumulated depreciation 00.
15 Other assets (describe " MISC RECEIVABLES )
17 Accounts payable and accrued expenses 18 Grants payable 19 Deferred revenue
-= 20 Loans from officers, directors, trustees, and other disqualified persons
0 21 Mortgages and other notes payable
J 22 Other liabilities (describe
23 Total liabilities add lines 17 throw h 22 Organizations that follow SFAS 117, check here " 0 and complete lines 24 through 26 and lines 30 and 31
N °' 24 Unrestricted G
25 Temporarily restricted m m 26 Permanently restricted v
Organizations that do not follow SFAS 117, check here and complete lines 27 through 31 .
y 27 Capital stock, trust principal, or current funds Y
m 28 Paid-in or capital surplus, or land, bldg., and equipment fund N a 29 Retained earnings, accumulated income, endowment, or other funds .. °' 30 Total net assets or fund balances z
ON 75-6040743 Page 2 Beginning of year End of year (a) Book Value (b) Book Value (c) Fair Market Value
247 296 . 151 652 . 151 652 .
1 , 600 . 2 , 470 . 2 , 470 .
14 925 663 . 13 860 050 . 19 282 688 .
323511 12-05-03
Form 990-PF (2003) JAMES M . COLLINS FOUNDATION Part IV Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e .g ., real estate, 2-story brick warehouse ; or common s tock, 200 shs . MLC Co .)
1a b SEE ATTACHED STATEMENTS c d e
(e) Gross sales pace (f) Depreciation allowed (p) Cost or other basis (or allowable) plus expense of sale
a
in column (h) and owned by the foundation on 12/31/69
(j) Adjusted basis (k) Excess of Col. (Q as of 12/31/69 over Col. (j), if any (i) F.M.V. as of 12/31/69
2 Capital am net income or net capital loss) . If gain, also enter in Part I line 7 1 ~ If (loss), enter -0- in PartI, line 7 1
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 Part 1, line 8
Part V I Qualification Under Section 4940(e) for Reduced Tax on Net Inve (For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income .)
A
2 Total of line 1, column (d) 2 3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by the number of years
the foundation has been in existence if less than 5 years 3
7 Add lines 5 and 6
3 14370803 759901 2687 2003 .05040 JAMES M. COLLINS FOUNDATION 2687 1
Complete onlv for assets
d e
If section 4940(4)(2) applies, leave this part blank .
Was the organization liable for the section 4942 tax on the distnbutable amount of any year in the base period? ~ Yes FXI No If 'Yes," the organization does not quality under section 4940(e). Do not complete this part. 1 Enter the appropriate amount in each column for each year; see instructions before making any entries.
ratio Base peraod years Adjusted (distributions Net value of nonchalntable-use assets Distribution ratio Calendar ear or tax ear be g innin g in qualifying (Col . (b) divided by Col . (c))
2002 956 937 . 20 123 707 . .0475527 2001 1,237,000 . 19,713,187 . .0627499
1998 1 841 .092 .1 20 .526 .440 .1
4 Enter the net value of noncharitable-use assets for 2003 from Part X, line 5
5 Multiply line 4 by line 3
6 Enter 1% of net investment income (1% of Part I, line 27b)
8 Enter qualifying distributions from Part XII, line 4 1 8 I 1 , U 16 , 13 ti . If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate . See the Part VI instructions .
323521/12-OS-03 Form 990-PF (2003)
(c) Date acquired I (d) Date sold (mo., day, yr.) (mo., day, yr .)
(h) Gain or (loss) (e) plus (t) minus (g)
(I) Gains (Col . (h) gain minus Col . (k), but not less than -0-) or
Losses (from Col . (h))
Form 990-PF (2003) JAMES M . COLLINS FOUNDATION Part VI Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or
1a Exempt operating foundations described in section 4940(d)(2), check here " 0 and enter °N/A" on line 1 . Date of ruling letter : (attach copy of ruling letter if necessary-see instructions)
b Domestic organizations that meet the section 4940(e) requirements m Part V, check here 1 [j] and enter 1% of Part I, line 27b
c 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-) 3 Add lines 1 and 2 4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only . Others enter -0-) 5 Tax based on investment income . Subtract line 4 from line 3 . If zero or less, enter -0- 6 Credits/Payments: a 2003 estimated tax payments and 2002 overpayment credited to 2003 6a 2 , 000 b Exempt foreign organizations - tax withheld at source 6b c Tax paid with application for extension of time to file (Form 8868) 6c d Backup withholding erroneously withheld ~ 6d
7 Total credits and payments. Add lines 6a through 6d 8 Enter any penalty for underpayment of estimated tax. Check here [:1 if Form 2220 is attached 9 Tax due . If the total of lines 5 and 8 is more than line 7, enter amount owed 1
10 Overpayment . If line 7 is more than the total of lines 5 and 8, enter the amount overpaid 11 Enter the amount of line 10 to be: Credited to 2004 estimated tax Ill. 10 0 . ~ Refunded piio, Part VII-A Statements Regarding Activities
-vv.* t - see
42 .
X
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 G9 If "No," attach explanation
9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendar year 2003 or the taxable year beginning in 2003 (see instructions for Part XIV)? If "Yes," complete Part XIV
10 Did any persons become substantial contributors during the tax years If "Yes," attach a schedule listing their names and addresses 11 Did the organization comply with the public inspection requirements for its annual returns and exemption applications I 1 1 I X I
Web site address 1 N/A 12 The books are m care of " BOBBY CHALMERS Telephone no. No- ( 214 ) 6 91-2032
Located at " 8115 PRESTON ROAD, SUITE 686, DALLAS, TEXAS ZAP+x 17 5 2 2 5 13 Section 4947(x)(1) nonexempt charitable trusts filing Form 990-PF m lieu of Form 1041 - Check here
and enter the amount of tax-exempt interest received or accrued during the year 00- 1 13 ~ N/A 323531 12-05-03 Form 990-PF (2003)
4 2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1 14370803 759901 2687
1a During the tax year, did the organization attempt to influence any national, state, or local legislation or did it participate or intervene in any political campaign
b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions far definition) If the answer is "Yes" to 1 a or 1b, attach a detailed description of the activities and copies o/ any materials published or distributed by the organization in connection with the activities . Did the organization file Form 1120-POL for this year Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year: (1) On the organization . " $ 0 . (2) On organization managers. " $ 0 . Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed on organization managers . " $ 0 .
Has the organization 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 organization made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or bylaws, or other similar instruments? I/ "Yes," attach a conformed copy of the changes
4a Did the organization 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 far this year? N/A 5 Was there a liquidation, termination, dissolution, or substantial contraction during the year
I/ "Yes, " attach the statement required by General Instruction T. 6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either :
~ By language in the governing instrument or ~ By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law
remain in the governing instrument? 7 Did the organization have at least $5,000 in assets at any time during the year
1( "Yes, " complete Part 1l, col. (c), and Part XV 8a Enter the states to which the foundation reports or with which it is registered (see instructions)
No
Bbl IX
5 14370803 759901 2687 2003 .05040 JAMES M. COLLINS FOUNDATION 2687 1
Form 990-PF(2003) JAMES M . COLLINS FOUNDATION 75-6040743 Pages
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies. 1a During the year did the organization (either directly or indirectly) :
(1) Engage m the sale or exchange, or leasing of property with a disqualified persons 0 Yes [X No (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person? 0 Yes ~ No (3) Furnish goods, services, or facilities to (or accept them from) a disqualified persons ~ Yes ~ No (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified persons 0 Yes ~ No (5) Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)? 0 Yes ~ No (6) Agree to pay money or property to a government officials (Exception . Check 'No"
if the organization agreed to make a grant to or to employ the official for a period after termination of government service, if terminating within 90 days .) ~ Yes ~ No
b If any answer is 'Yes' to 1a(1)-(6), did any of the acts fail to quality under the exceptions described in Regulations section 53.4941(4)-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 " 0
c Did the organization engage in a prior year in any of the acts described m 1a, 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 m 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) beginning before 2003 0 Yes ~ No If "Yes,* list the years 1
b Are there any years listed in 2a for which the organization is not applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets) to the year's undistributed income? (If applying section 4942(a)(2) to all years listed, answer "No' and attach 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 here .
3a Did the organization hold more than a 2% direct or indirect interest in any business enterprise at any time during the years 0 Yes FXI 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 after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse of the 10-, 15-, or 20-year first phase holding periods (Use Schedule C, Form 4720, to determine d 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 purposes? b Did the organization make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning m 2003?
5a During the year did the organization pay or incur any amount to : (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? 0 Yes ~ No (2) Influence the outcome of any specific public election (see section 4955) ; or to carry on, directly or indirectly,
any voter registration drives ~ Yes ~ No (3) Provide a grant to an individual for travel, study, or other similar purposes 0 Yes ~ No (4) Provide a grant to an organization other than a charitable, etc ., organization described in section
509(a)(1), (2), or (3), or section 4940(d)(2)? 0 Yes ~ No (5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for
the prevention of cruelty to children or animals ~ Yes ~ No b If any answer is 'Yes' to 5a(1)-(5), did any of the transactions fad to qualify under the exceptions described in Regulations
section 53.4945 or in a current notice regarding disaster assistance (see mstructions)9 N/A 5b Organizations relying on a current notice regarding disaster assistance check here " 0
c If the answer is 'Yes" to question 5a(4), does the organization claim exemption from the tax because it maintained expenditure responsibility for the granfl N/A ~ Yes ~ No If "Yes, " attach the statement required by Regulations section 53.4945-5(d).
6a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contracfl 0 Yes ~ No
b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contracts 6b X If you answered "Yes" to 6b, also file Form 8870
Form 990-PF (2003)
323541 12-OS-03
13643 DEERING BAY
Expenses
4
Form 990-PF (2003) 6
2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1
12-OS-03
14370803 759901 2687
JAMES M . COLLINS FOUNDATION 75-6040743 Part VIII Information About Officers, Directors, Trustees, Foundation Managers, Highly Page s 0 Paid Employees, and Contractors 1 List all otfic6rs, directors, trustees, foundation managers and their compensation :
(b) Title, and average (c) Compensation (dconmnuuonsio (e) Ex~ense (a) Name and address hours per week devoted (If not paid, employee
ueie~ecP~ans account, other to position enter -0- compensation allowances
DOROTHY DAMN COLLINS TORBETT RESIDENT
MICHAEL COLLINS (VICE PRES
ECRETARY
2 Compensation of five highest-paid employees (other than those included on line 1) . If none, enter "NONE." (b) Title and average
(a) Name and address of each employee paid more than $50,000 hours per week (c) Compensation devoted to position
Total number of other employees paid over $50,000 3 Five highest-paid independent contractors for professional services. If none, enter "NONE."
(a) Name and address of each person paid more than $50,000 (b) Type of service
Total number of others receiving over $50,000 for professional services Part IX-A Summary of Direct Charitable Activities
List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
t N/A
2
3
(e) Expense account, other allowances
(c) Compensation
Farm 99o-PF (2003) JAMES M . COLLINS FOUNDATION 75-6040743 _Page 7
Part IX-B Summary of Program-Related Investments
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
2
All other program-related investments . See instructions. 3
Total . Add lines 1 through 3 1
Part X Minimum Investment Return (All domestic foundations must complete this part . Foreign foundations, see instructions .)
1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes: a Average monthly fair market value of securities b Average of monthly cash balances c Fair market value of all other assets d Total (add lines 1a, b, and c) e Reduction claimed for blockage or other factors reported on lines 1a and
is (attach detailed explanation) 1e 2 Acquisition indebtedness applicable to line 1 assets 3 Subtract line 2 from line 1d 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
0 .
Pa~'t XI Dlstributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here 1 = and do not complete this part .)
1 Minimum investment return from Part X, line 6 2a Tax on investment income for 2003 from Part VI, line 5 2a 42 . b Income tax for 2003 . (This does not include the tax from Part VI .) 2b c Add lines 2a and 2b
3 Distributable amount before adjustments . Subtract line 2c from line 1 4a Recoveries of amounts treated as qualifying distributions 4a 0 . b Income distributions from section 4947(a)(2) trusts 4b 0 . c Add lines 4a and 4b
5 Add lines 3 and 4c g Deduction from distnbutable amount (see instructions) 7 Distributable amount as adjusted . Subtract line 6 from line 5 . Enter here and on Part XIII, line 1
Part XII Qualifying Distributions see instructions)
42,082 .
323561 12-OS-03
7
2003 .05040 JAMES M. COLLINS FOUNDATION 2687 1 14370803 759901 2687
1 Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes: a Expenses, contributions, gifts, etc. -total from Part I, column (d), line 26 1a 1 , 016 , 138 . 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 the: a Suitability test (prior IRS approval required) 3a b Cash distribution test (attach the required schedule) 3b
4 Qualifying distributions . Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4 4 1 , 016 , 138 . 5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b 5 42 . 6 Adjusted qualifying distributions Subtract line 5 from line 4 6 1 , 016 , 0 9 6 .
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 section 4940(e) reduction of tax m those years
Form 990-PF (2003)
Form 990-PF (2003) JAMES M . COLLINS FOUNDATION 75-6040743 Page 8
Part XIII Undistributed Income (see instructions)
(a) (b) (c) (d) Corpus Years prior to 2002 2002 2003
1 Distnbutable amount for 2003 from Part XI, line 7 942 , 082 .
2 Undistributed income, it any, as of the end of 2002 a Enter amount for 2002 only 962 , 015 . b Total for prior years:
0 . 3 Excess distributions carryover, if any, ~to 2003 :
a From 1998 b From 1999 c From 2000 d From 2001 e From 2002 f Total of lines 3a through e 0 .
4 Qualifying distributions for 2003 from Part xll, line 4 : t $ 1 , 016 , 138 .
a Applied to 2002, but not more than line 2a 962 , 015 . b Applied to undistributed income of prior years (Election required - see instructions) 0 .
c Treated as distributions out of corpus (Election required - see instructions) 0 .
d Applied to 2003 distnbutable amount 54 , 123 . e Remaining amount distributed out of corpus 0 .
5 Excess distributions carryover applied to 2003 0 . 0 . Q1 an amount appears m column (d), the same amount must be shown in column (a) )
6 Enter the net total of each column as indicated below :
8 Corpus Add lines 3f, 4c, and 4e Subtract line 5 0 . b Prior years' undistributed income . Subtract
line 4b from line 2b 0 . c Enter the amount of prior years' undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed 0 .
d Subtract line 6c from line 6b . Taxable amount - see instructions 0 .
e Undistributed income for 2002. Subtract line 4a from line 2a . Taxable amount - see mstr. 0 .
f Undistributed income for 2003. Subtract lines 4d and 5 from line 1 . This amount must be distributed in 2004 887 , 959 .
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(E) or 4942(8)(3) 0 .
8 Excess distributions carryover from 1998 not applied on line 5 or line 7 0 .
9 Excess distributions carryover to 2004 Subtract lines 7 and 8 from line 6a 0 .
10 Analysis of line 9 : a Excess from 1999 b Excess from 2000 c Excess from 2001 d Excess from 2002 e Excess from 2003
Form 990-PF (2003) 323571 12-OS-03
8 14370803 759901 2687 2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1
-6040743 Page 9 Form 990-PF Part XIV (see instructions and Part VII-A, question 9) N/A 1 a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2003, enter the date of the ruling lo. ~ b Check box to indicate whether the organization is a private opera tin foundation described in section
2 a Enter the lesser of the adjusted net Tax year Prior 3 yea
income from Part I or the minimum (a) 2003 (b) 2002 (c) 2001
investment return from Part X for each year listed
b 85% of line 2a
(d) 2000 I (e) Total
supplementary inrormation (c:ompiete tnis part only It the organization naa,1io,uuu or more in at any time during the year-see page 25 of the instructions.)
SEE STATEMENT 13 3zasevo,-zo-oa Form 990-PF (2003)
9 2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1 14370803 759901 2687
c qualifying distributions from Part XII, line 4 for each year listed
d Amounts included m line 2c not used directly for active conduct of exempt activities
e qualifying distributions made directly for active conduct of exempt activities . Subtract line 2d from line 2c
3 Complete 3a, b, or c for the alternative test relied upon :
a 'Assets' alternative test - enter: (1) Value of all assets
(2) Value of assets qualifying under section 4942(j)(3)(B)(i)
b 'EndowmenC alternative test - Enter Z3 of minimum investment return shown in Part X, line 6 for each year listed
c 'Support' alternative test - enter : (1) Total support other than gross
investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties)
(2) Support from general public and 5 or mare exempt organizations as provided m section 4942(j)(3)(B)(ui)
(3) Largest amount of support from an exempt organization
141 Gross investment income
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).)
NONE b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or
other entity) of which the foundation has a 10% or greater interest.
SEE STATEMENT 10 2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs :
Check here " 0 if the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. If the organization makes gifts, grants, etc . (see instructions) to individuals or organizations under other conditions, complete items 2a, b, c, and d .
a The name, address, and telephone number of the person to whom applications should be addressed: JAMES M. COLLINS FOUNDATION 8115 PRESTON ROAD, SUITE 680, DALLAS, TEXAS 75225 b The form in which applications should be submitted and information and materials they should include :
SEE STATEMENT 11 c Any submission deadlines :
SEE STATEMENT 12 d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:
323801/12-OS-03 Form 990-PF (2003) 10
14370803 759901 2687 2003 .05040 JAMES M . COLLINS FOUNDATION 2687
Enter grass amounts unless otherwise indicated. unreiatea ousiness income Excluded b section 512 , s,s or 514 (a) (b) E~~ r� _ (d) Related or exempt
Business Amount ode Amount function income t Program service revenue : code a b c d e f p Fees and contracts from government agencies
2 Membership dues and assessments 3 Interest on savings and temporary cash
investments 14 2 , 592 . 4 Dividends and interest from securities 14 26 , 646 . 5 Net rental income or (loss) from real estate : a Debt-financed property b Not debt-financed property
6 Net rental income or (loss) from personal property
7 Other investment income 14 -183 . 8 Gam or (loss) from sales of assets other
than inventory 18 34 , 779 . 9 Net income or (loss) from special events
10 Gross profit or (loss) from sales of inventory 11 Other revenue :
a b c d
12 Subtotal . Add columns (b), (d), and (e) ~ 0 . 63,834 . 0 . 13 Total . Add line 12, columns (b), (d), and (e) 13 63,834 . (See worksheet in line 13 instructions to verify calculations .)
Part XVI-B Relationship of Activities to the Accomplishment of Exempt Purposes
iz os os Form 990-PF (2003) 11
14370803 759901 2687 2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1
Form 990-PF (2003) JAMES M . COLLINS FOUNDATION 75-6040743 Page 11
Part XVI-A Analysis of Income-Producing Activities
Form 990-PF (2003) JAMES M . COLLINS FOUNDATION 75-6040743 Page 12 Part XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of YQS NO the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations
a Transfers from the reporting organization to a noncharitable exempt organization of (1) Cash 1101 ) X (2) Other assets 1a 2 X
b Other transactions : (1) Sales of assets to a nonchantable exempt organization 1b (j X (2) Purchases of assets from a noncharitable exempt organization M211 X (3) Rental of facilities, equipment, or other assets 1b 3 X (4) Reimbursement arrangements M411 X (5) Loans or loan guarantees 1b 5 X (6) Performance of services or membership or fundraising solicitations 1b 6 X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees 1c 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 m any transaction or sharing arrangement, show m
2a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described m section 501(c) of the Code (other than section 501(c)(3)) or in section 527 0 Yes 0 No
b If 'Yes ° comp lete the followin g schedule . (a) Name of organization (b) Type of organization (c) Description of relationship
Under penalties of per ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete Dec lion o1 preparer ( rf than taxpayer or fiduciary) is based on all information of which preparer has any knowledge
~G-off Signature of officer or trustee Date 1 Title d
Date Check if Preparer's ssN or PTIN y Preparer's self- signature' wgp g-y- em to ed " 0
o, y Frm'sname (oryours HOWARD & C0~, P . C . EIN G )w Iserc~emoloyed), ' 8350 MEADOW ROAD, SUITE 286
address and ZIPcoOe DALLAS TX 7 5 2 31 Phone no. ( 214 ) 346-0750 Form 990-PF (2003)
323821 12-OS-03
12
14370803 759901 2687 2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1
CONTINUATION FOR 990-PF, PART IV JAMES M . COLLINS FOUNDATION 75-6040743 PAGE 1 OF 2 Pelt IV Capital Gams and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold, e.g ., real estate, (b How acquired (c) Date acquired (d) Date sold 2-story back warehouse ; or common stock, 200 shs . MLC Co. ~ - Purchase
D - Donation (mo ., day, yr.) (mo ., day, yr .)
I 1a CLIPPER INTERNATIONAL CL A BONDS P 10 / 01 / 0210 / 01 / 03 b STCG THRU ENDOWMENT VENTURE PARTNERS c LTCL THRU ENDOWMENT VENTURE PARTNERS d STCG THRU CONMONFUND CAPITAL VENTURE e LTCL THRU COMMONFUND CAPITAL VENTURE f HERMAN MILLER INC - 1300 SH P 03 / 15 / 9902 / 04 / 03 COGNOS INC - 1400 SH P 10 / 02 / 9804 / 17 / 03
h MARLIN OFFSHORE FUND P 10 / 01 / 0102 / 10 / 03 TYSON FOODS INC - 2500 SH P 01 / 27 / 0305 / 16 / 03 COGNOS INC - 600 SH P 10 / 02 / 9806 / 04 / 03
k CHITTENDEN CORP - 1952 SH P 04 / 16 / 96.06 / 10 / 03 i BANK HAWAII CORP - 1400 SH P 03 / 13 / 00106 / 27 / 03 m SCIENTIFIC ATLANTA INC - 300 SH P 09 / 21 / 0107 / 07 / 03 n INTERNATIONAL GAME TECH - 1000 SH P 09 / 21 / 0 107 / 07 / 03 o SCIENTIFIC ATLANTA INC - 400 SH P 09 / 21 / 0109 / 03 / 03
(e) Gross sales pace (f) Depreciation allowed (p) Cost or other basis (h) Gain or (loss) (or allowable) plus expense of sale (e) plus (f) minus (g)
a 589 398 . 539 982 . 49 , 416 . 697 .
c -7 , 245 . d 30 . e -254 . t 21 , 798 . 20 , 863 . 935 .
36 , 005 . 11 , 438 . 24 , 567 . n 804 345 . 1 , 006 , 551 . -202 , 206 .
23 , 312 . 26 , 808 . -3 , 496 . 16 , 781 . 4 , 902 . 11 , 879 .
k 54 , 290 . 26 , 815 . 27 , 475 . 1 46 , 656 . 22 , 581 . 24 , 075 . m 7 , 716 . 4 , 955 . 2 , 761 . n 24 , 621 . 6 , 530 . 18 , 091 . 0 13 , 975 . 6 , 607 . 7 , 368 .
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Losses (from col. (h))
F.M.V. as of 12/31/69 (1) Adjusted basis (k) Excess of col. (i) Gains (excess of col. (h) gain over col . (k), i as of 12/31/69 over col . (j), if any but not less than "-0-')
a 49 , 416 . 697 .
c -7 , 245 . d 30 . e -254 . t 935 .
24 , 567 . n -202 , 206 .
-3 , 496 . 11 , 879 .
k 27 , 475 . i 24 , 075 . m 2 , 761 . n 18 , 091 . 0 7 , 368 .
2 Capital gain net income or (net capital loss) ~ If If g ain , also Part 1 , line 7
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6) : If gam, also enter in Part I, line 8, column (c) . D If (loss), enter °-0-° in Part I, line 8 ~ 3
323581 OS-01-03
13 14370803 759901 2687 2003 .05040 JAMES M. COLLINS FOUNDATION 2687 1
CONTINUATION FOR 990-PF, PART IV JAMES M. COLLINS FOUNDATION 75-6040743 PAGE 2 OF 2 Part IV Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold, e .g ., real estate, (b How acquired (c) Date acquired (d) Date sold 2-story brick warehouse; or common stock, 200 shs. MLC Co . D - Donation (mo ., day, yr.) (mo ., day, yr .)
la JANUS CAPITAL GROUP - 1400 SH P 06 28 / 0109 / 04 / 03 b JANUS CAPITAL GROUP - 1400 SH P 09 / 26 / 0109 / 04 / 03 c INTERNATIONAL GAME TECH - 600 SH P 04 / 02 / 9709 / 24 / 03 d INTERNATIONAL GAME TECH - 700 SH P 07 / 17 / 9709 / 24 / 03 e INTERNATIONAL GAME TECH - 1000 SH P 07 / 17 / 9709 / 26 / 03 t DOW JONES & CO - 600 SH P 11 / 12 / 0210 / 09 / 03 INTERNATIONAL GAME TECH - 400 SH P 07 / 17 / 97.10 / 31 / 03
n UALCONIIM INC - 1100 SH P 05 / 07 / 02110 / 31 / 03 i CIGNA CORP - 400 SH P 02 / 06 / 0211 / 03 / 03 MARCUS CORP - 900 SH P 01 / 20 / 0011 / 11 / 03
k MIDAS INC - 1200 SH P 06 / 21 / 0011 / 11 / 03 I SOUTHEBYS HOLDINGS CL A - 45 P 11 / 20 / 0311 / 25 / 03 m INTERNATIONAL GAME TECH - 300 SH P 07 / 17 / 97.12 / 18 / 03 n INTERNATIONAL GAME TECH - 900 SH P 09 / 21 / 01 11 12 / 18 / 03 0
(e) Gross sales price (f) Depreciation allowed (p) Cost or other basis (h) Gam or (loss) (or allowable) plus expense of sale (e) plus (f) minus (g)
a 22 , 122 . 46 , 141 . 24 , 019 . 22 , 122 . 28 , 136 . -6 , 014 .
c 17 , 384 . 3 , 918 . 13 , 466 . d 20 , 281 . 4 , 571 . 15 , 710 . e 28 , 556 . 6 , 530 . 22 , 026 . t 30 , 900 . 22 , 177 . 8 , 723 .
12 , 993 . 2 , 612 . 10 , 381 . n 52 , 084 . 29 , 001 . 23 , 083 .
22 , 402 . 35 , 830 . -13 , 428 . 13 , 085 . 10 , 872 . 2 , 213 .
k 16 , 575 . 24 , 756 . -8 , 181 . i 487 . 487 . m 11 , 019 . 1 , 959 . 9 , 060 . n 33 , 056 . 5 , 877 . 27 , 179 . 0
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Losses (from Col . (h))
F.M.V . as of 12/31/69 (1) Adjusted basis (k) Excess of Col. (Q Gains (ex but not less than
gain ~O over Col. (k), i as of 12/31/69 over Col. (j), if any
a -24 , 019 . -6 , 014 .
c 13 , 466 . d 15 , 710 . e 22 , 026 . r 8 , 723 .
10 , 381 . n 23 , 083 .
-13 , 428 . 2 , 213 .
k -8 , 181 . i 487 . m 9 , 060 . n 27 , 179 . 0
r If gain, also enter m Part I, line 7 1 2 Capital gain net income or (net capital loss) ` If (loss), enter'-Vin Part I, line 7 1 2 34 , 779 .
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) . D If (loss), enter "-0=' m Part I, line 8 ~ 3 N/A
32358 OS-01-03
14 14370803 759901 2687 2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1
Ju1 .21 04 11 :09a Collies/Torbert 214-691-7886 p .2
OMB No ~1s4s~o7a 71 Information Return of U.S. Persons With
Respect To Certain Foreign Corporations File in vip5oaee (Rev. January Yuc3) r See separate instructions. (soo When end 11l
h+forrnadon fumisned for the foreign ration' annual Accounting eri00 Itax r To Fib «, page I of Deoanmcm of aye TrcAw~ ~~ ,~ g p yes required by the insvuct ons) uurn,~ a,wnue s~wee section 898y (see In .tnrctbns) oeginning ai/p t , 20 0J and ending i.~/,0 . 20od Harm of paisoil Or" LlIa return A tdertUyy,q mutnWr
10 ure,i acmasS7 a r. .nlwy m 0 . (So0 pa(JO 7 of the inppW4en7. CIUGK oppl4dGlc ooxce~~ . , C z [3 3 O a C] s D C Enter the cold pe+tcNaigv of me 1asV corporation's vouri; sioch
you Owned at vie trio of in annual eeceunung parbo . . . . . . . . . . . . . 76
a Person(S) on whose behalf 0S
(7I Nemt (21 ACCrtss
must be in English. AM amounts mast be stated
D EmC~~toyw lCOiroficeoior Rumba, if arty J~ 'D tae
c Cavtry under whose laws tr+caporatoa dPITxr11 rJrtW./rJ l; GA.~,rs
p PrlnnlPyl bucinau mhrRy w Fu,+aronal wTCrcy `~.~yr~JE"
d Dew W Y+COrpophon a PfhdD3l Place a business t PfinCp alwee al buslne~.t+~ettvlry code Plumber
°9I~~/g 9 To~eral.a B!/r I .5,~r9 9o ! IhvrIJr ~,e rtaiaw+ny inronnaaon ror a+~ ~aiec ~n cor Don's account iod staood aeo
01 nuTeer of snares Issued one mrMa" (a) OasviWion W w-h ease of stock 6) Begnnng of e-nual GJ Ella W aluwil
Coru .*a.a SyWAj cccountuy period xcarnenq panda
~~ 9 37 9 6b -P-40.P 9~ 1B
Pan D--Additional Information for Preferred Stock (To be completed very by ~Cete arr i trace for foreign personal holding tom anise.
(al Description d escf+ lass a Aretrrrt:a amk iNota Tnrs desa~an sAa~m msrch me torrrspondlng (b) Par
hYtCd011B! value ~r' currency W Wye of O~dend smut i ~cum~ e~ r t~ve o
0ltGNptiOM MKrCd in P,7't i . calurnn W) ronnnn%IK"
Far Paperwork Reduedon Act Notice, see page 13 of the instruetiorm Cat No tgg58Y Farm 6471 (lieu 1-2003y
Number . sCeec . ane room a subs no. (or P .O . D= numDpr tf enai is not
town. state, and ZIP wde
Important: fill fn all applicable hoes and schedules . AU in 11 S, dollars umloss otherwise indicated.
1s Name end address d fxe~gn corporaUon C/.J 7NjZf~J~J7VQd/~ f4.~/J', .LTA
,C.p~wr~7t4 e'/a ^~e,a f7wsRe.,..fL 11_04dXclf it wd Ge c..C t ~ O. .~OJI' .Py6 .'O e ~,~. Tom. .B
(3) iae"ing number (4) Gheck applicobta bwclasl
51+meholdr Officzr Qreetor
Nerve, eddNass . and KU lying number of branch office a agent 4f any) h 6 N a U.S. !name ma rewm was filed . enrer: tie Urmd Sates
C.ll.i,vS 00 u s i.~wmc tax polo !'YSo r~r7il~o ~~ rpde.~ea6~ Su ~Te' '/'60
rl ~exeao a~come a Qassl (after at erodas i
42a,044 C'Al1.lty, j~ ."11014
e No .rc and aaarass of foreign caporatbn's statutnry or residw¢ agent In a Name ono address Nncixlu+g eorparete etepartrnent, d appAuWe) of mu" of rotorperation pariah for persons) With custody elf the eoaxs end records of era cadge
LOtDOratCrl !n0 the 19 qltldl M eirJ+MM4a %,A1 rerVA9 R eIRc+Ont
~rto.~ Ccy.tT, /, o. .dor ..~r'Go Cott~.ur C~1~rAL r9~Gidrra.~, ~~c,
/C~e.OATci~:~ Ta.e1e~~! ~1~ /srSo ~1"~4~oCr~ ~v .~l/yGS~dTd A/0o
C~ Q~l C CiY9IC~~ i~
cam 6471 Rzy. , .2003)
Ju1,21 04 11 :09a CollinsfTorbert 214-691-7886 p .3
Form 3471 (Raw. 140" Pag e 2 U.S. Shareholders of Fore! 9n oration See page 4 of the instructions .
~ vR 1b) DesvlpUa+ d Wen etass d stxk held by k1 Numewr d I (d) NuffIeer of (4 Name, snotps, ono ioerGtying snorenoioer preb: rnLs ee,criptlan snoura m+een ms 8f N'W I .IJ Ol ilVRJi 14914 of of sApart P bca~lnn~n~ of and of armual ~1llrnbfr of shareholder eor~eapon0~ny d@terlpdon ertferod ib 5crl~d~Ie A, emwl accounting I
a p~ eenteo1 S Part f, COWmn (dJ .J accounting pLTbd D~O~ .T~9wqtJ .~l. Cnt /.r ..r rr..st1T~ ~'orr..r.wa f .~a~ . ~-f
X ~S'-~a yo ry.~
Important: Report all irrformedon in functional currency In accordance with U.S. GAAP. Also, report each airroUnf m U.S . dollars translated Irom Rrnctional currency (using GAAP translation 'rules) . However, if the functional currency is the L1.5. dollar. cornploto only the U.S. poll3rs column. Sop ft-buffoons for special rules fcr OASTM caaoradorts. - -
Fueeoon- LUrrer" I VAIN 00tWIr% 1e Gross receipts or sales . . . . . . . . . . . . , . . . . . b Returns and allowances . . . , . , . . , . , , , e Subtract line 1b from line 1a , . . . ,
2 Cost of goods sold . . . . . . . . . . . . . . . . . . 3 Gross profit (subtract line 2 bum line lc) , 4 Dividends , . . . . . . . . . . . 5 IntwtSt . . . . . . . . . . . . 6 Gross routs, royalties, and license fees . . , . . . , . , , , z Net gain or (loss) an sale of capital assets . . . , . . . . . _ 8 Other ilCOme (attach schedule) . . . . 9 Total income (odd lines 3 thrcwah el , . .
~ 10 Compensation riot deducted elsewhere . , I t Rents. rayarcies. and uterus tees . .11 12 Interest . . . . . . . . . . . . . . . . . . . . . . . 12
-rq-, 13 Depreciation trot Oeouctea elsewhere . . , 14 DepteUan . . . . . . . . . . . . . . . . . . . . 14
m 15 Taxes lexdude provision for income . war profim, and excess profits cause) . 16 Other deductions (attach schedule-exclude prwcsion for income, war profits,
and excess profits taxes) . . . . . . . . , , . . . , 16 17 Total deducUOtis (add lutes 10 U r"; 16) ~ . 17 s Net Inwme or pees) bervre extraordinary Items . prior pertoo aajustmenEs, aria
the provision for income, war profits, and excess profits lazes (subtract fine i 17 ftOm line 9) . . . . . . . . . . . . . . . . . . . . 18
L= 19 Extraordinary items and prior period adjustments (see instructions) IV 20 Provision for Iruame war pnofns, and excess protlts taxes see instructions)
21 Current veer net income or Ik)ss1 per hooks (combine fines 18 Ihrouah 201 . 2s
Ju1 .21 04 11 :10a Collies/Torbert 214-691-7886 p .4
IrreportaM~ Report a(! amounts in U S. dolA3rs preporcd and translated in accordance with U. S. GAAP. See pyge s of the JliStfUCUdn3 for an PalCBAtf011 for DASTM corporations.
I I dd DI xnv]I i-0 of I nnwl
re Total Fom+ 5477 oh.. t ~2oo3f
Assets
') Cash . . . . . . . . . . . . . . . . . . . . . . . . . ~ 1
2a Tre4Q notes and accounts r6Celv3ble . , , . . . . . . , . . , 2a
Ib Less allowance for bad debts . . . . . . . . . . . . . . . . 21) 3 Invemwms . . . . . . . . . . . . .
other current assets (aaach schedule) . . S Loans to shareNotders and other related persons . 6 Investment In suhxuiiariF-q (Arrarh sd+PClule) . . 7 Other investments (anaCh schedule) . , . . 8a Buildings and other depreciable asels , . . . . . . . . , . , , Ba b Less accumulated CepreclaUOn . . . . . . . _ . . , , , , , Sb
9a D6pletable assets . . . . . . . . . , . . . . . . . . . . 9a b Less accumulated deletion . . . . . .
10 Land (net of arty amortizeCwn) . . . . . . . . . . . . , , , , , 10 11 Intangible assets:
ate a GoodwIA . . . . . . . . . . . . . . b Organization costs . . . . . , . . . , . . . . . . . . . . itt
c Patents, trademarks. acid otter '.mangible assets . . . . . . . . . . d Less accumulated amortization fog lines 11 a, b, and c
12 Orw assets (attach schedule) . . . . . . . . . . . . . . . . 72
13 Total assets LiaDitities and Shareholders' Equity
14 accounts peyab;e . . . . , . . . . . . . . . . . . . . 4!' 'Is C1tFwr f.11RPf1T IIAIIIIRipS (Att,erh 5rheCkde) . . . . . . . . . . . . . ~. 16 Loam from shareholders and o4her related persons . . . . , , , , t6
17' Other liabilities (attach schedule) ill Capital Stock: a Prelerr+ed stock . . . . . . . . . . . . . . . . . . . . . lea
b Common stack . . . . . . . . . . . . . . . let 1s Paid-In a capital surplus (attach rEConciIraUon) , . , . . . , . , , , 19
20 Retained earnings . . . . . . . . . 21 less cost of treasury stuck . . . . 1
Jul 21 04 11 :10a Collies/Torbert 214-691-7886 p .5
Factoring income . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total of Urtes 1 through 5 . Enter here and on your income tax return . See page 6 of instructions
7 Div+denOS received (tranalatpG ac spa rate nn riaymanrterra tinrlar s2ttinn 9~(b)(1~ .
9 Exchan4e gain ar poi on a distribution of previously taxed income - Yes No
" Was any income of me foreign corporation olacked7 . , . . . . . . . . . ~
. . . O O Did any such income become unblocked during the tax year (see setbon 963(b)J''> . _ . . . . . . . . . D D
I( the answer to either auespon is 'Ye s." attach an explanation, r
0 -- Form 5471 lste. . t .2oos7
rw"n 571 (RCV, 7-llWA P*yc Q " - Other Inforr»atlon
Yes No 1 Oaring the tax year, did the foreign corporation own at lest a t09'o interest d+recqy or indirectly. .n any foreign
paRnership'li . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O D n "Yes ." see page 5 of the instructions for required attachment .
2 During the tax year, did the foreign corporation own an interest in any trust? , . . . , . , . . , . , 0 El 3 Miring the tax year, did the to4gn corpwaGon own any foreign entaie5 that were diaregarcW ba erilGlieb arNeraie
morn their ownePS under Regulations sections 301,7701-2 and 30i .770t-3? . . . If "Yes," attach a Statement listing the name, Goarntry under whose laws we entity was organized. and EIN (if and of each entit .
Camera Esmings and Profits (See page 5 of the instructions) IaiportanC Enter the amounts on lutes f thnpuqh Sc in functional current . 1 Current year net income or Qoss) per foreign books of account , . . . , , , , . , . , ~ ,~���
2 Net adjuSLmentS mAda to trop 'i rn cieWmine current earnings and profits according to U-5. financial and tax Net Nat accounting standards (see instructions) : Adcfitians 5ubtnctiarts
e Gepual gains or losses . b Depredation arid amortization , , , , , , , , , c Depletion . . . . . . . . . . . d Investment or incentive allowance . e Charges to steWiwy reserves . . . . . . . . . f Inventory adjustments g Taxes . . . . . . . . . . . , . . . . . ' h ewer (mach schodude) ,
:I Total net additions . . . U TOtAI f12'( SUbV8tti0f15 , . . . . . . , fps Current earnings ana profits (line 1 Plus one 3 minus dine 4) b DASTM gain or (bas) for foreign corporations that use DASTM (see instructions) . , , , c Combine braes Sa and Sb . . . . , , , , . e Current earnings and profits in U.S donors pine Sc transloted at the appropriate exchange rate as
defmed in section 989(b) and the related regulations (see instructions)) Enter oxehanoe rate used for lint Sd ),-
1 Subpart F income (line 40b, Woftheet A in the Instructions) .
8 Earnings Invested in U.S . Property Oine 17 . Worksheet B Iii me iilst(mliuim) . 7 Previously excluded subvert F income w+thdrawn from qualified investments (line r2b. Worksheet
C m the instructions) . . . . . . . . . . . . . . . . ,! Previously excluded export trade income withdrawn from investment in export trade assets (line
7b . Worksheet 0 m ire instructions) . . . . . . . . .
Ju1 .21 04 ll :lla Collies/Torbert 214-691-7886 p .6
SCHEDULE N Returns of Officers, Directors, and 1096 or Mode (Dorm 5471) cRbv.Januar, 2M Shareholders of a Foreign Personal Holding Company OMB No ,s"s.o,o" -1t-0 0.1 m
Mhr " Attach to Form $.71. S!! InstrucNpnS for Forte 501.
Name a person mug Form $u1 Idaudymq mamesr ~n ,M <._~ AL
Nprne of faeign tappr*lpn C w ydT<-<~v7r~ow.~c ~~4.v~, ~c r~J
trt" rtant: an amounts Mist be stated 1n U.S. dolilars translated from functional cwrenty See page 70 0l the Mstructhms /a the relevant e+rcliange tale. Enter rhA rQlqvgnt furmional currency and :he eKOhangc rotcM uxd throughout this sc,ieUUlr r ¢s . Ovp('64-f-
vaWe
9 Gross income 85 OBfineC in section 555 (attach schedule) , Deductions allowable uncW section 161 (aRach schedule .
3 Taxable income or (loss) (subtract line 2 from line 1) . , , , I Adjustments to taxable income a (lass) (see page 12 of instructions); s Taxes (see inz&uetioe+:) . . . . . . . . . . . . . . . . . . . b Charitable contributions . . . . . . . , . . . , e Special deductions disallav+ed . . . . . . . . . _ d Net operating lass . . . . . . . . . . . . . . . . . . . . . . . . e Expenses end depreciation appica ble to property of the taxpayer f TaxPe artrf cantr,hrrtions to persion ousts . , , , , _ , , , , , , , , , g 7atal adjustments (combine lines ~a8 through 40 , , , $ Combine line 3 and line 4g , . . , , . , . . , , , , , . , , , . 6 ueouction ror dividends paid during tax year, Enter the amount from Section 3, line 12, belay 7 Subtract line 6 from line 5 . . . . . , , , _ , , , , , , . F Deduction allowed under section 500 for dividends Rald after niece of my yp ;ir (see
instructions). Attach designation required by Rev. Pros. 94-26, 1990 .7 C.B . 512 . 9 Undistributed foreign persona! holding company income (subtract line 8 from line n . _
10 Taxable dividends paid dicing tax yam: oW~ f a Cash . . . . . . . . . . . . . . . . . . . . . b Property other than cash or the corporeUOn's overt securities
(indicate nature of property} , C Oh0!latinnc of the cs+rpnrntinn (Mnrfc rmt~, step, Pte.)
17 Consent dividends (aaaUh schedule) ~ , 12 Deduction for divlder+ds paid during tot year ladd lines 7pa through 1?y. Enter here and on POr Pdp~k ReOucclm Au Notice, see the! MSVUCtWrlSlor ii-orn1 SST, Cat N0 . 6'1925Q
A+r+ouM
? 6 above
Schedule N (Fcrnf 6471) (Rev 1 .2003)
Description of soewi6es (attach e complete, Detailed swtement of ccrivarslon privileges)
Section B-List of Holders of convertible Securities or Options Nwno and aaanss of eo0h holder Clnso of convertible securrties or Options 'If Be inning of ear End of (dQSignato flowesidwtt epees) _ seeurtdes Number Face venue Nurnber , F
Int2rest rats ('K)
Face value of year Erul
Explanation acrd date b! any change In holdings of s9cuHt'e5 dut'ang the year
Jul-21 04 11 :12a Collies/Torbert 214--691-7886 p .7
i u i i I r- ~ e`~- ~// // -/ L her strccL and room m whc na !of PO bex mmact a man b na adncrc0 so smc aoarrsd a Category d Rlw Me papa I of ft imvaalona Check oprdKrtLk
5~ ! j S r,e sIo n P, ~l bolesu~ 10 2C] ; 0 4C) s O or town. ststt', and 21P Code C Enter the total pemMtsge of Ins forage cwporaGOn's vodrg stock
11-c'_LL . t -! X 7 <12 -:;-, -~~ ya+ o%ned stu+e eno or its annual eccoundng aercod . . . . . . . . . . .46
rnporunt : Fill in all in U. S. t
i0 Name and address of ra
G W T/l,~.O.r~< . [fig/yB~~1Se~ Ftv~1 I~ yYA/ C.Y'U"/ /
.~.~o aa.a, rov d Date of incorpwason
Itianiiiication nuirnow, if any - -- - I ~"
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I
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IF WmeFpW WiAmce arnyny code number
"srs99a
e Name and address Gncti0lrp eorpaate department. V appUcab+'e) of person fog parsons) wRh a+stody of Ore books and racorosof Use fora~gn cnrpnrAflnn . MA rho V~rminn nr v~ hOOks and records. R ekkvanc
Ce lC,r.,,d GfA,,,.4L I0vJ,C4oigi: 1..>t , /ticro "~rsrJ.Psc~I Ar/b~se~, J'G.r~~ Sao
F'L .~"s`/lrY. t'oi2lz G'ATler
n ersonai naam companies.) 011 Par value In i Rae of dividend funotioroi curaney (d
GaL No. 09958V Form 5471 ~;tev t-20071 For PapelYYOfk Reduction RGt Notice, see page 13 of the rt13VUCtiOnS~
Form 5471 Information Return of U.S , Persons With °""B "° 1545-070-0 Respect To Certain Foreign Corporations File In Duplicate
(New January 2003! W sae separate instructions. isoe ~ Awe Whore To File an F age t pr p"~.,~,~ ~ ~ T ,u~, IrKOrmatfOn furnished For the for0lgn COrpOretron's annual acarn8utng period (tax year reqinred D the fr~~n~e~Dy~b 1~+a~ s.~w. s~+~. aecuon ese) (see in:arucoons) beQcming o iii . z0 oaT , ano endmg . 20Z
Ndib a peraws Nuy tlJa astum - A IapnCfyB1Q 11wnCel
Filer's MR yew Miming D PeraOrIs ) on whDSQ behaM
(t) Nen+e
and
` "̀w w.~~,~ (21 Address (71 CMIMyin9 no me t~ -
Shareholder'
- -L-- T 1
'e5. All information must 62 in English. AM amounts must Lie stated
c Cow" under Who" Was wcwppate0
a Provide vw laro" mrQmatwn for vie roroqin coro«oyon's oavunun0 t Norm, a00rQfe. and iaMU"numOv o1 branch ofte ar agent Q1 arrfim the UnRoE States
Ca CL +w..t CrJI~rr+lC ./iOLRl'~f1'
/s<fo APOstrur 1 ̀q ~~t` ~YOo
c6'4"*t sqel.~r, e Name and eaaress of Welgn corporatbn~s sWOKCry a resident agent In
oouncy of trrsrporoGen
~~JON CJ~~~AG jE"el~l~3 ~Jir�jles~4
.~~tso .~ ~o' 4.~r /~a. Col' .
/~.~s/lrac.,r~ Tog~
Pert 1--AU
w oea«loaton of each teas m snck
Part 11--Additional Information tou Preferred Stock (To be cornpWted onhr by Category 1 Rats f
(i) CexrIpGOn of cash ela:s of Preferred swck limos : This diesanpnon VntuV mM:h the conirsponaln9
dv:c4pNan amnd M Pqn L coMnn !U!
o 1f a us tnoOma taR raarnwir, mea . ewtv . M Taxable LICOnK Or Qotsl
9D N .S . income W+ i+e+l (nta t11 asd4a)
(0) Number of shipra Issued arta
({l 0ey-in9 d erv+wt acwrttlnA period
r.! era Ur y,'1~. .a xcountlng peArd
(a) indicate MT10fNQf Iht stock b curtulstlve x
nOrouTUutlvn
(a Rn rarer crvw of w0ptrti
incam e leery a. a pq,cenuge)
~.r..V3f~ zq"nCS Af, co-MA-4 jp/.T A*,.tToJ ..M, A.th' e.0 D1M~,4t, Tt" 1W-LA-r'
7s = Lo 4'e 7y~
to Gross receipts or saes . . . . . . . . b Fte :urns and allowances . . . . . . . . c Subtract line 1b from line to . . . . .
E 2 Cost of goods sold . . . . . . . . . . g 3 Gross profit (subtract line 2 from line 1c) . , C 4 Dividends . . . . . . . . . . . .
3 Interest . . . . . . . . 6 Gross rents, royalties, end ucanse fees . . . 7 Net gain or (1065) OA S81! 0f capital assets 8 Other income (attach schedule) . . , .
TWaI mLAXrRe (acid hfict; 7 Lh~ uuyri 8)
10 Compensation not deducted elsewhere . . 11 RanTC rnyaRins, Anti lirortao favc
X 72 Interest . . . . . . . . . . . . . ° 77 Depreciation not deducted elsewhere .
Ye Depletion . . . . . . . . . . . . . ~, 15 Taxes (exclude provision 1a Retains, wee profits. and excess protcs taxes) 0 16 Other deductions (attach sdtedule--exc!ude prav6ion fa income, war profiEs.
and excess profits taxes) . ~ 17 Total deducUoris (add lines 10 through 16)
~iis Net income a )loss) wore i;xtraordinary sterns, prior period aGjusvnenm and the prooston for income, way praFrts, and excess qrofta taxes (subtrace ore 17 from tens 9)
~ ~ x119 Extraordinary items end pri3r pertoc Oustments(see instruccionsi m 20 Provision for income, war profits, and excess profits mixes (see instructions) z
21 Currerx near net income or (loss) per books KOmbirw Imes 18 truough 20~ Form 5471 ,'RQV t-2003
Ju1,21 04 11 :13a Collies/Torbert 214-691-7886
ru2n 3471 haw 1 "2V0J1
U.S. Shareholders of Forei n Corporation See page 4 of the instructions .
W) Name. 9uaress and iaonutymg s1~a ~A ~ (Nose T~Aeis~tda ss~ r nrn au I (al nM+om M
oeglmueig of ena fl(JfTS~BI 0~ $~18fP.I1GIQl7 ~f!!lQOndl7lg OQfVvlOA CAfQ11~Q H $C1TlC1d! /Q, ~~.
el site,
1 Pert C cdumn !~d) aecaunww aarwd ~
p .8
z
EYMMUM9 income Stateme+n (See page 5 of the instructions .) Important: Report all information in (unuiona! currency m accordance write U S. GAAP. Also, report each t1mount in
US. dollars trenslared from functional currency (usog GAAP transWon rates). However, if rtes o"unrtional currency is rtes U.S . dollar, complete only the U.S . Dovuas column . See instructions for specie!' rules for DASTM aorporadons.
Funcam,g curraitmv I us . ca.rs
- Yes NO Was any Income of the foreign Corporation blocked? . . . . . . . . . . . . . . . . . . . . (]
" Did any such income become unClotket] dunng the tax year (see Section 96a(b))? , , . . , . , _ It the answer to either question !s 'Ycrs." coach an explanactan
Form 5471 Rev i-zwsi
Jul, 21 04 11 :14a Co1linslTorbert 214-691-7886 p,y
.Wm $471 (Roy. 1 d1JUA page a Ocher Information
Yea No 1 During the tax year, did the foreign corporation own at least a 10°r6 interest, directly a Indirectly, in any foreign
partnenrop? . . . . . . . . . . . . . . . . . . . . . . o a it 'Yes.' See page 5 of the insUuctions far required attachment .
2 During the tax year, did the foreign corporation own an interest in any oust? , , . , , 3 niKirvj !ha tax year. did the foreign corporation Our any for9ign entities that were disrCg3rdcd as cnutlCS sep0rote
from their owners under Regulations sections 301 .7701-2 and 301 .7701-3Z . . IF 'Yes," attach s statement listing the name, country under whose taws the entity was organized, and EIN ff any) of each crit(!X.
Current Earnings and Profits (See page 5 of the instructions .) tmpoftartt : Frrfer Me arnourns an lines 1 throu_qh 5c in tunctiarrall curr~encsr. __ .
Bo 3s ) Current year net income or ss r per foreign hooks of account , ,
2 Net adjustments made to line 1 to determine torrent ' eammgs and profits according to U.S . financial end tax Net Net accounting standards (968 instructions): Additions Subtractions
a Capital gains or losses . D Deprecation and amortization , . , . , , , . , ' c DcpICUon
. d Investment or inceriUve allowance . e Chzrges to stauxary reserves . f Inventory 8dustments . g Taxies . . . . . . . h Other (settkch Schedule) . 3 Total net addtlpns 4 Total net sublCaclion5 . . . . . . . . . . . 5a Current earnings and profits Dine 1 plus Me s minus tine 4) . . . b OAS7M gain or Qoss) for foray corporations that use DASTM (see instructions) . c Combine tines 5e end 5b . . . . . . . , , 5c
' d Current earnings and profits in U.S . dollars (forte 5c translated! at die epproprista exchange rate as defined m Section 989(b) and the: related regulations tsft inStruGUons)) . . . . . , , , . 5d Erttar Qxchanao rate used for One Sd t
1 Subpart F income One 40b, Wo+ksheet A in the instructions) . . .
2 Eemn99 inve3ted in U.£ . ptvpaty Dine 17, Wbrkaheet n in the irsavuCUona) , ,
3 Preciously excluded SuOpart F income withdrawn from qualified investments (fine 6t). Worksheet C in the instructions) . . . . . . . . . . . . . . . .
4 Previously excluded export trade income wlV+drawn Trorn Investment In export trade assets pine 7b . 1A+orksheet D in the Instructions) . . . . . . . . . . .
5 Factoring income . . . . . . . . . . . . . . . .
6 Total of tines T through 5. Enter here aro0 on your income tax return. See page 5 of instructions . --6
7 Dividends received (translated at spot rate an payment date under section 989(bxtl . . . 7 _
8 Exchange gain or (loss) on a di stribution of previously taxed Income
Jul 21 04 11 :15a Collies/Torbert c14-691-7886 p.10
SCHEDULE N Return of Officers, Directors, and 101`u or More o3) Shareholders of a Foreign Personal Holding Company OMB No 154,'-0704
1Y,,.R�.", d B,. �....",, Wem~~ ae"Awe S.mce 110 Atcaal+ to fom 5471 . See Instructions for Form 3<71 . !k'i'M% Of Person Sing Form 5171 number
IdjrRB of foreign corwawn
C6J T.~'.q~,~rG 4..+~o, A.' r,0. hnportant : AU amour+ts muse be mared in U.S. ddrprs translated from funcuonal currency. See page 70 d bye inscrucGvns for the relevant exchange race EntPr the rrsRVA nt functional cwroney-ano the exchange ratelzl uaed throughout u-.a sdiie;luir f L!s .ObL47y,
t Gross income as defined in section 555 (attach schedule)i , 2 Deductions allowable under section 761 (attach schedule) . s taxable income a posh (subtract one 2 from ilea 1) . . . 4 Adjustments to taxable income or (loss) (see page 12 of instructions) : a Taxes (scam instructions) . . . . . . . . . . . . . . . . . . . . . . b Charitable Contribuflons . . , , , . . , , . , . , . , , , , , , c Special reductions dlsellwed . . . . . . . . . . . . . . . . . , . a Net operal.rng loss . . . _ . . . . . . . . . e Expenses and deprecation applicable to property of the taxpayer f Taxes and contributions to pan%&m enmrc . . . , _ , , , , , , . , , , g Total adjustments (combine lines 4a through 40 . .
ti Combine line 3 end line 4g . . . , . . . , . . , . , , , e : DeauaWn for dividends paiC Gunny tax year . Enter the amount from Section B, line 12, below 'J Subtract Ire 6 from line 5 . . . . . . , . . 11 Deduction mowed wrier setqpn 563(c) for dividends paid after dose of tax year (aRa
instructions) . Attach designation required by Rev . Proc . 9x26. 1990-t C.B, $12 !1 Undistributed fore°qn Dersonal holding company income (subtract lire 8 from line 71
10 Taxable dividends paid during tai year Date Pave a Cash . . . . . . ' . b Property other than cash or the corporation's own securities
(Indicate nature of properly) . . . e Obligations of the corporation (bands . moms . seep, ate.)
11 Consent dividends (meth sCheciule) iS ! Deduct= for dividends paid during me year (add lines 10B throuGh 1 1) . Enter here ant online 6 t
Fur dapsrworK ReduCtloef ACS Notice, SEC Me (11sWC[rons la Form 3471 . Cal lye, 69250
Amaum
Schedule N (Forte 5471) (R~~v 7-2003)
Description of Securities (attach a complete, detailed statement of conversion privileges) Interest rate (96)
Section B-Ust of Holders of Cortversfble Securities or Options Grante4 Nartq and address d oaeh holder rl.7,p Sa[uririnc hoW
or cortvertib~e seeurtiQS or option of Be Inning of year End of yew ~deaignate noruvsldvnt alters) sEturities NurnbCr Face value Number Face value
Face value or year [nC of
Expianaqon enq da t o1 any change in holdGiss of securities during Me, year
Income
JAMES M. COLLINS FOUNDATION FORM 990PF RETURN OF PRIVATE FOUNDATION SCHEDULE OF CONTRIBUTIONS AND AWARDS
PART XV 75-6040743 121-03
Atzheimers Association 7610 N. Stemmons, Ste 600, Dallas, TX 75247 300 American Heart Association 1615 N Stemmons, Dallas, TX 75207 15,000 American Lung Assoc 7616 LBJ Freeway , Dallas, TX 75251 150 Arthritis Foundation 2824 Swiss Ave, Dalls, TX 75204 15,150 Athena Foundation 11203 Bushire Dr. 75229 200 Arts Magnet Building Fund 900 Jackson #150, Dallas, TX 75202 1,000 Barbara Bush Foundation for Family 1201 15th St NW #420, Washington DC 20005 4,400 Ba for Health Care System Foundation 3600 Gaston Ave #100, Dallas, TX 6,000 Cam Fire for Boys & Girls 4417 Skillman Dallas TX 75206 1,500 Christ Church Islesboro, ME 04848 1,000 Colorado College 945 Pennsylvania St, Denver, CO 80203 500 Connemara Conservancy P . O Box 793808, Dallas, TX 75279 150 Crystal Charity Ball 30 Highland Park Village #206, Dallas, TX 10,000 Dallas Arboretum 8525 Garland Rd Dallas, Tx 75218 300 Dallas Baptist University 300 Mountain Dallas Pkwy , Dallas Tx 1,500 Dallas Blue Foundation 5646 MiRon St, Dallas, TX 75206 150 Dallas Historical Society POBox 150038, Dallas TX 250 Dallas Museum of Art 1717 N . Harwood Dallas, Tx 75201 20,800 Dallas Museum of Natural History P . O . Box 150349, Dallas TX 75201 3,000 Dallas Symphony 2301 Flora Street, Ste 300 Dallas, Tx 75201 10,000 Earthwatch 3 Clock Tower PI . #100, Ma nerd, MA 01754 3 ,943 Educational Opportunities 8117 Preston Rd #500, Dallas, TX 3,000 Fairchild Tropical Gardens 10901 Old Cutler Rd., Miami, n 33156 1,000 Family Gateway 711 S St Paul, Dallas, TX 750 Family Place 5477 Glen Lakes, Dallas, TX 100 Florida Chamber of Commerce P.O Box 11309, Tallahassee, Florida 5,000 Friends of Alice Pendleton Libra Islesboro, ME 04848 250 Friends of Florence 4409 Dexter St NW, Washington D.C . 58,700 Friends of KERA 3000 Harry Hines Blvd., Dallas, Tx 75201 500 Friends of the Center for Human Nutrition P . O . Box 910888, Dallas, Tx 75391 1,000 Friends of the Dallas Police 3232 McKinne #855, Dallas, TX 75204 750 Goodwill Industries 2800 n. Hampton Rd . Dallas, TX 75212 25,000 Habitat for Humanity 121 Habitat St, Amencle, GA 500 Harvard University Soldiers Field, Boston, Ma 02139 39,500 Highland Park Presbyterian Church 3821 Univers ity Blvd . Dallas, TX 75205 1,000 Hockada School 11600 Welch Dallas, Tx 75229 100 Institute of the Americas 10111 N Torre Pines Rd . La Jolla Ca 92037 10,000 Island Institute 410 Main St, Richland, MA 1,000 Islesboro Central School P . O Box 166 Islesboro Me 04848 4,000 Islesboro Community Fund P . O. Box 166 Islesboro Me 04848 500 Isleboro Island Trust P.O.Box 182, Islesboro, ME 04848 1,000 Jesuit Foundation 12345 Irnvood Rd., Dallas, TX 75244 150 Junior League of Dallas 8003 Inwood Rd, Dallas, TX 75209 2,500 Leadership Foundation Endowment 1621 Connecticut Ave NW X300, Washington, DC 1,000 Macular Degeneration 22512 Gateway Center, Clarksbur MD 20871 150 Meals on Wheels 1440 W. Mockingbird LN Ste 500, Dallas, TX 75247 150 Methodist Health System Foundation 1441 N . Beckle , Dallas, TX 75203 500 Miami Business Forum 150 W. Fla ue St, Miami FL 13,000 MOCA 770 NE 125 Street, Miami, FL 33161 4,230 North Texas Food Bank 4306 Shilling Way , Dallas, TX 1,000 Old Red Museum 100 S . Houston St, Dallas, TX 75202 100,000 Parkland Foundation 2777 Stemmons # 1700, Dallas, TX 75207 3,000 Presbyterian Heafthcare Foundation 8440 Walnut Hill LN # 800, Dallas, TX 75231 6,000 Rassias Foundation 6071 Wentworth Hall, Hanover NH 03755 ~ 5,000 IRectorv School 528 Pomfret St, Pomfret, CN 1,000
JAMES M . COLLINS FOUNDATION 75-6040743
FORM 990-PF DIVIDENDS AND INTEREST FROM SECURITIES STATEMENT 2
26,646 . 0 . 26,646 . TOTAL TO FM 990-PF, PART I, LN 4
TOTAL TO FORM 990-PF, PART I, LINE 11, COLUMN A -183 .
15 STATEMENT S) 1, 2, 3 2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1 14370803 759901 2687
FORM 990-Pt INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT 1
SOURCE AMOUNT
BANK ONE 1,107 . BEAR STEARNS SECURITIES (CARNES) 1 . COMMONFUND CAPITAL PRIVATE EQUITY PARTNERS V, LP 42 . COMMONFUND CAPITAL VENTURE PARTNER VI, LP 54 . ENDOWMENT VENTURE PARTNERS V LP 988 . MARLIN OFFSHORE FUND 400 .
TOTAL TO FORM 990-PF, PART I, LINE 3, COLUMN A 2,592 .
SOURCE
BEAR, STEARNS SECURITIES CORP -CARNES CAPITAL COMMONFUND PRIVATE EQUITY PARTNERS ENDOWMENT VENTURE PARTNERS V LP
CAPITAL GAINS COLUMN (A) GROSS AMOUNT DIVIDENDS AMOUNT
26,621 . 0 . 26,621 .
1 . 0 . 1 . 24 . 0 . 24 .
FORM 990-PF OTHER INCOME STATEMENT 3
DESCRIPTION AMOUNT
ENDOWMENT VENTURE PARTNERS V -484 . PARTNERSHIP LOSS - ENDOWMENT VENTURE PARTNERS -720 . MISCELLANEOUS DEPOSIT 1,021 .
(C) (D) ADJUSTED CHARITABLE NET INCOME PURPOSES
2,580 .
2,580 .
(A) (B) EXPENSES NET INVEST-
DESCRIPTION PER BOOKS MENT INCOME
ACCOUNTING FEES 2,580 . 0 .
TO FORM 990-PF, PG 1, LN 16B 2,580 . 0 .
FORM 990-PF OTHER PROFESSIONAL FEES STATEMENT 5
(A) (B) (C) EXPENSES NET INVEST- ADJUSTED
DESCRIPTION PER BOOKS MENT INCOME NET INCOME
BROKER FEES 28,998 . 28,998 .
TO FORM 990-PF, PG 1, LN 16C 28,998 . 28,998 .
(D) CHARITABLE PURPOSES
0 .
0 .
(A) (B) EXPENSES NET INVEST-PER BOOKS MENT INCOME
(C) (D) ADJUSTED CHARITABLE NET INCOME PURPOSES
0 .
0 .
0 .
76 .
2,725 .
2,801 .
76 .
2,725 .
2,801 .
16 STATEMENT S) 4, 5, 6 2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1 14370803 759901 2687
JAMES M . COLLINS FOUNDATION
FORM 990-PP ACCOUNTING FEES
75-6040743
STATEMENT 4
FORM 990-PF
DESCRIPTION
FOREIGN TAX WITHHELD ON INVEST . INCOME EXCISE TAXES ON INVESTMENT INCOME
TO FORM 990-PF, PG 1, LN 18
TAXES STATEMENT 6
JAMES M . COLLINS FOUNDATION 75-6040743
17 STATEMENT S) 7, 8 14370803 759901 2687 2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1
FORM 990-Pt OTHER EXPENSES STATEMENT 7
(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE
DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES
BANK CHARGES 320 . 320 . 0 . PASS THROUGH INVESTMENT EXPENSES 27,293 . 27,293 . 0 . DUES & SUBSCRIPTIONS 2,270 . 0 . 2,270 . PENALTIES 65 . 65 . 0 .
TO FORM 990-PF, PG 1, LN 23 29,948 . 27,678 . 2,270 .
FORM 990-PF CORPORATE STOCK STATEMENT 8
FAIR MARKET DESCRIPTION BOOK VALUE VALUE
WHITNEY HOLDING CORP 32,197 . 61,485 . INTERNATIONAL GAME TECHNOLOGY 15,019 . 82,110 . SKYLINE CORP . 49,792 . 62,766 . FOREST CITY ENTERPRISES CL A 48,851 . 156,783 . PENN ENGINEERING & MFG CORP 53,433 . 98,956 . AEHR TEST SYSTEMS 33,810 . 22,940 . BEAR STEARNS CO 66,870 . 125,921 . INDEPENDENCE COMMUNITY BANK 43,000 . 125,895 . TRIUMPH GROUP 41,728 . 58,240 . CW INTERNATIONAL FUND 7,656,840 . 11,971,804 . ALLTEL CORP 136,184 . 116,450 . ELECTRO RENT CORP 24,792 . 32,016 . HARRAHS ENTERTAINMENT 33,378 . 94,563 . KNIGHT RIDER INC 40,292 . 61,896 . MCCLATGCHY CO CL A 45,222 . 75,680 . COMPUTER ASSOCIATES 179,128 . 215,986 . DUNDEE BANCORP 40,888 . 65,816 . APPLE COMPUTER 47,744 . 64,110 . GANNETT 41,653 . 62,412 . NCR CORP NEW 27,706 . 31,040 . NEW YORK TIMES 41,096 . 47,790 . QUANTUM CORP 68,696 . 18,096 . SCIENTIFIC ATLANTA 49,571 . 81,900 . TEKTRONIX INC 27,795 . 44,240 . CW TR.ANDING FUND 3,950,000 . 4,113,964 . BANK NORTH GROUP INC 24,581 . 35,783 . COUNTRYWIDE FINANCIAL CORP 36,362 . 60,680 . ELECTRO SCIENTIFIC INDUSTRIES 37,354 . 40,460 . FOREST CITY ENTERPRISES CV CL B 31,330 . 217,350 . MGM MIRAGE 87,456 . 101,547 .
19,282,688 . TOTAL TO FORM 990-PF, PART II, LINE 10B 13,860,050 .
18 STATEMENT S) 8, 9, 10, 11 14370803 759901 2687 2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1
JAMES M . COLLINS FOUNDATION
UNIVERSAL HEALTH SERVICES CLASS B CLIPPER INTERNATIONAL BELO CORP BOYD GAMING EASTMAN KODAK HCA INC IMATION CORP OPPENHEIMER HOLDINGS INC PEOPLE SOFT
51,294 . 589,398 . 33,022 . 35,586 . 29,179 . 27,816 . 34,330 . 22,512 . 24,145 .
75-6040743
64,464 . 606,754 . 45,344 . 35,508 . 30,804 . 34,368 . 35,150 . 47,432 . 34,185 .
FORM 990-PF OTHER INVESTMENTS STATEMENT 9
FAIR MARKET DESCRIPTION BOOK VALUE VALUE
ENDOWMENT VENTURE PARTNERS V LP 355,780 . 285,735 . COMMONFUND CAPITAL PRIVATE EQUITY PARTNERS V LP 27,401 . 30,459 . COMMONFUND CAPITAL VENTURE PARTNERS VI LP 44,324 . 43,409 .
TOTAL TO FORM 990-PF, PART II, LINE 13 427,505 . 359,603 .
FORM 990-PF PART XV - LINE 1B STATEMENT 10 LIST OF FOUNDATION MANAGERS
NAME OF MANAGER
DOROTHY DAMN COLLINS TORBETT MICHAEL COLLINS DOROTHY COLLINS WEAVER
FORM 990-PF PART XV, LINE 2B STATEMENT 11 APPLICATION REQUIREMENTS
DESCRIPTION
THERE IS NO SPECIAL FORM FOR REQUESTS OF CONTRIBUTIONS OR GIFTS FOR PUBLIC CHARITABLE PURPOSES, WHICH INCLUDES CHARITABLE, SCIENTIFIC, LITERARY, RELIGIOUS AND EDUCATIONAL PUBLIC PURPOSES . A SIMPLE LETTER SETTING FORTH PUBLIC PURPOSE IS SUFFICIENT . THERE IS NO RESTRICTION ON GEOGRAPHICAL AREAS . THERE ARE DOLLAR LIMITATIONS DEPENDING ON AVAILABILITY OF FUNDS AND THE CHOICE OF THE TRUSTEES OF THE PROJECT THAT MOST BENEFITS THE PUBLIC CHARITABLE PURPOSE .
JAMES M . COLLINS FOUNDATION 75-6040743
19 STATEMENT S) 12, 13 14370803 759901 2687 2003 .05040 JAMES M. COLLINS FOUNDATION 2687 1
FORM 990-PP PART XV, LINE 2C STATEMENT 12 SUBMISSION DEADLINES
DESCRIPTION
REQUESTS ARE RECEIVED ANYTIME . NOTICE OF APPROVAL, REJECTION, AND REQUEST FOR ADDITIONAL INFORMATION IS MADE WITHIN A REASONABLE TIME .
FORM 990-PF PART XV, LINE 2D STATEMENT 13 AWARD RESTRICTIONS AND LIMITATIONS
DESCRIPTION
THERE IS NO RESTRICTION ON GEOGRAPHICAL AREAS . CONTRIBUTIONS, GIFTS, AND AWARDS ARE MADE EXCLUSIVELY IN AID OF PUBLIC CHARITABLE PURPOSES . THIS INCLUDES SUCH CHARITABLE, SCIENTIFIC, LITERARY, RELIGIOUS, AND EDUCATIONAL PUBLIC PURPOSES AS THE TRUSTEES SELECT FROM TIME TO TIME AND NOT FOR ANY OTHER PURPOSES . NO SCHOLARSHIPS OR LOANS OR GRANTS FOR FURTHER STUDIES AND RESEARCH ARE MADE TO INDIVIDUALS . THE FOUNDATION MAKES CONTRIBUTIONS TO SOME PRE-SELECTED ORGANIZATIONS . AWARD PROGRAMS WOULD BE PRE-SELECTED DEPENDING ON THE PUBLIC NEED .
Application for Extension of Time To File an Exempt Organization Return I OMB No . 1545-1709
Form 8868 (December 2000) Department of the Treasury Internal Revenue Service for each return File a
Note : Form 990-T corporations requesting an automatic 6-month extension - check this box and complete Part I only All other corporations (including Form 990-C /dens) must use Form 7004 to request an extension of time to (de income tax returns . Partnerships, REMICs and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041
Employer identification number Type or I Name of Exempt Organization print
File by the due date for filing your return See instructions
Number, street, and room or suite no . If a P.O . box, see instructions 8115 PRESTON ROAD, N0 . 680 City, town or post office, state, and ZIP code For a foreign address, see instructions
323831 OS-01-03
18260428 759901 2687 2003 .05040 JAMES M . COLLINS FOUNDATION 2687 1
" 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) Note : Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously tiled Form 888.
Part I Automatic 3-Month Extension of Time - Only submit original (no copies needed)
Check type of return to be filed (file a separate application for each return)
Form 990 ~ Form 990-T (corporation) 0 Form 4720 Form 990-BL 0 Form 990-T (sec. 401(a) or 408(a) trust) ~ Form 5227
0 Form 990-EZ ~ Form 990-T (trust other than above) 0 Form 6069 Form 990-PF ~ Form 1041-A ~ Form 8870
" If the organization does not have an office or place of business in the Untied States, check this box . " 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 1 [] If d is for part of the group, check this box 1 0 and attach a list with the names and EINs of all members the extension will cover.
I request an automatic 3-month (6-month, for 990-T corporation) extension of time until AUGUST 16, 2004 to file the exempt organization return for the organization named above me extension is for the organization's return for " ~ calendar year 2 0 0 3 or 10 tax year beginning , and ending
2 If this tax year is for less than 12 months, check reason 0 Initial return 0 Final return 0 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 any nonrefundable credits . See instructions $ 43 .
b If this application is for Form 990~PF or 990-T, enter any refundable credits and estimated tax payments made . Include any prior year overpayment allowed as a credit $ 3,170 .
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 .
Signature and Verification
Under penalties of penury, 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 complete, and that I am authorized to prepare this form .
Signature it ~ n oe Title " CPA Date " .~ LHA For Paperwork Reduction Act Notice, see instruction Form 888 (12-2000)
