Form 990-PF ~ 'Returri of Private Foundatidrr990s.foundationcenter.org › 990pf_pdf_archive › 382 › ... · " a,.Z4_02 F r rwor B dueti n At U otice, see the Imtruetions. Form

T-553 P 002 F-880

OMB Na 1545.02

200 1

6167740702 Jul-27-04 07:53am

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Form 990-PF

From-PLANTE & MORAN, PLLC - GR

~__'Returri of Private Foundatidrr or Section 494;~7(a)(1) Nonexempt Charitable Trust

Treated as a Private Foundation eflan maV be able io use a coat' of this return to satisfy stets rector

Department of Ne Tr¢a:ury internal Nevenue 56r' 101 Note ; The

For calendar year 2001, or tax year bi and end

G Check all [nat a i initial return u rmai rumm 1 . . I nme~

Use the IRS Name of organization

18De1 . Otherwise, ME P. 5UBAR FOUNDATI7N

print Number s,d sheet (a P.O. box numDCr M mail in not eeGveed t ~ ~ secret address)

Or We- p BOX 8037 See Speclfie Instructions . City or town, state, and ZIP code

BAND RAPIDS MI 4951$ H Check type of organization: D Section 501(c)(3) exempt umrate foundation 0 Section 4947(a)(1) nonexempt charitable trust [-] Othert izable private foundation

I Fair market value of all assets at end of year J AcCOUnting met iod: M Cash

(from Part 11, co!- (c), line 16) 0 Other (specify) 11104 1,754 , 042 . (Part t, column (et) must be on cash bas!

;R" ~ a} Analysis of Revenue and Expenses (The total of amounts in columns (b), l~~) Revenue and

(c), and (~ may not r~cessarily equal expenses per

the amounts in column (q) .)

1 Contributions, gifts, grants, etc ., received �� , . .� 5 , 9 3 2 . M 7Y~JS> .~c:e ~~aT7LY7~f~A ~'.YCo.i

Ched~10 Hmcloun~BmGnvtre0~adtoilG~Sd~B ~...>°«~:`~.t:,~ .f.°~,:d=� o d" . ~~?~+~r ncawwray~wr:xr

2 Distri butions from split-interest trusts . . . . .. . � , � y on and lempoear Interest

3 0 :h imestr�anm . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . .. . . . . . . 1933 . . d Dividends and Interest from securities . . . . . . . . . . . . ., 26,389

5a Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x`otiNa.e,~Qu 7+,~iio~

b (Nee renml income or Posa) Net pain W (b&4) from =a of a=ab not on 2 5 31 line 10 .."'. .. . . . . . .

. . .

. . . . . . . . . . . . . . . . . . . . .__.. . ."".. .. . . ~ .e~w

Gro^ :aIC p(k1B (01811 39

0-sets

sv~i~

0-sets o nhn e8 a . A,~, ~uav Asr>rH,a r .HC.

w ~c 7 C~plt vyyv nnot inaDrtW(from Port N, line 2) . . . . . . . . . . . . . . .

8 Net short-term capital gain . �� . . . ., . . . . . . . . . . . . ~"'~~'.' 9 Income modtricatlons

Gross ial4sl~eewms $voa~raiM:'~'hd"~' ~Y`r7"xKe'k .~a e 1 oa and el~owenc~ :. °. .. . . .y a.:;~;~~,..

o . . b I.a-- Crt o1 goods edd

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . R» :': t Gross profit or (loss) 11 Other income �� . . . . . . . . . . .

. . . . . . . .�� . . . . . . 12 Total. Add lines 1 through 11 36 , 785 .

18 Campenasnan or oHlara, dlrec~or., trustees, eta .�.� , . . O

14 Other employee salaries and wages . . .. . . . . . . . . . . . . . .

15 Pension plans . employee benefits , . . . . . .. . . . . . . . . . H H 16a Legal fees . . .--- . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. a b Accountinpfees . .. . . . . . . . . . . . , .STMT .�3._ ._ 1,096 --e Other professional fees � . � , . . . . . . . . . . . . . . . .. . . . . . . . .

} 17 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . .. . . . . . . . . cr w. c= 120 18 Taxes . . . . . . ., . . . . . . . . . . . . . . . .. . STMT 4. . . . Z , 0 4 7 . C~ ro

19 Depreciation and depletion . . . . . . . . . . . . .' . . . . . . . . . . . . . .

~E 20 Occupancy' . . . . . . . . . . .. . . . . . . . . . . . . . 21 Travel, conferences, and meetings , .�� , . . . . . . Q .

.. . . .

m 22 Printing and publications . . . ct cn 23 other expenses STMT 5 , . . 17 8 .

~` 24 7otal operating and administrative expenses- Add lines 13 through 23 . ; ; ; : : : :, . . . 3 , 321 .

25 Contributions, gifts, grants paid . . . . . . . . 1 0 6 , 8 8 7 . ~:

28 Total expenses and disbursements . Add lines 24 and 25 . . . �� . . . . . . . . . . . . . . . . . . . . . . . . 110,208 .

1i1 27 Subtract fine 26 from line 12 : <73 423 .

8 fi~ of rtTrEnue over owensc sic dkDUrae'nMts . .. <73 ..a.+

A Nct investment income p+--9.L6.-. -.1-e-)� 1"i."f°r`3~NY:~^x s:K'~.'x^~~s~ ~;y~.a~a ee w t~raa

c Adjusted netIncome ~rnecsuv..entw-a) ., . .� , . . . Wl~.~.a~

" a, .Z4_02 F r rwor B dueti n At otice, see the Imtruetions . U Form 990-PF (2001)

26561-1 18480514 099771 26561 2001 .05030 JEROME P . SUBAR FOUNDATION

Employer Identification numner

38-2445793 B Telephone number

( 616 ) 241-6491 C If exemption application is pmdnp, check here . ..

D 1 . Foreign organizations, check here � , .�10 2. Forapn oManizetlons meetlnp the 85% waC W.

Check hem 7rW attach mrtlpuChon . . . . . . . . . . . .

E If private foundation status was terminated []Accrual under section 507(b)(1)(A),check here ,.1~

F If the foundation is m a 60-month lermlnallon s.) under section 507( b )( 1 ) B ) . check here 1

(d) Disbursements (b) Net investment I (e) Adjusted net I for charitable

income income purposes N/A (cash basis only)

26,3

N".~a "n ~`O~flo ~ ~'rS+ ' k~aw~ ~%« xi x a+~ '. ̀t ~ . . ~~xpa :i

0,853 . 0 . 0 .

1 , 096 . 0 .

0 . 0 .

150 . 28 .

1,246 . 28 . 7~ E :~ _i LI: 106 , 887 .

1 .246 .1 1 106,915 .

Jut-27-04 OT:55am From-PLANTS & MORAN, PLLC - GR

38-2445793 Page 2 nning of year End of year Book Value (b) Book Value (e) Fair Market Value

19 685 . <47 4 686 . > <47 9 686 .> ~w~e~+sw~.~.waw .L~ w R "̂C dam' i~`^T"~: i.nmw ~.am wp.w.. VWSinW'~ .Y,s1 eww~Hrw~

11~ ~'M wwjw

:Y'iw7s.aua.,.wax~RaavY a~wo.o1#.~w' S~oS~..oraa~ o~FX %i fi;rASa 5

. ...'.wa.e~Cy~~ i~~i <a f s s s ~ ~~ . . .

7-7

881,463 . 875 411 . 1 769 067 . 12,870 . 12,870 . 32,661 .

:i,~awq'riw::a4w~tiwa.' ~ .rr~ :a~~7^'~ : ar »r+WC >«ni"nom iw ' e a~ "awa~i~rx~i iFa":w i :aoia- ii8:.~nw~ .w. ww~. .~~ ~ A .IxW N:iM~wA "i ~k~H wJn p4 (Ns ~"h~p ufrYG'Yi'q ,M Yr r~G;~ v ) ~~ f . ~ . v~

. .~~.w a. .o . ., x< : �. y~0o WM,~',+~ Q~',rtJ~'~tK'I$ O~ ~W1JtyW~af*'~bblViR~ 7 i a

pj~, rf~9~~fYJyf{,Y~4 :k .{,Rq)'.F.h~~~ Wi A<tMYlAww.t9 MNWI.IWMJIH%

914 018 . 840 595 . 1 9 754 , 042 .

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9iauJO < wi> tin~x9i M ̂ i ,~% ~ w"f ~'* * v

0 . D . . . ,,~ .._ . =_.,.~.. :w:~,: :

Zj IDI8111a011I11851dVP~~~~ds 1i uuvuyuccl . . . . . . . . . . . ~- .. ~~ . """"" . " "°" . "

Organizations that follow SFAS 117, check here . and complete lines 24 through 25 and lines 30 and 81 -

24 Unrestricted .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Temporarily restricted . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . . .---- . 26 Permanently restricted . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .. . . . .. . . . . . .--- . . . . .

Organizations that 4o not follow SFAS 117, cheek here IN- FX and complete lines 27 through 31 .

27 Capital stock, trust principal, or currentiunds . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .

28 Paid-in or capital surplus, or land, bldg ., and equipment fund . . . . . . . . . . . . 29 Retained earnings, accumulated Income, endowment, or otnerfunds . . .

N

v C l7 A m

0

N d N

O

0 . 0 . 8 . 840,595 .

y 3o Total net assets or fund balances . . . . . . . . . . . . .. . . . .. . . . ., . . . ., , . . . ., . . . . . . . . . 914 , 018 . 840,595 .

91 Total liabilities and net assets undbalances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 914,018 . 840 , 595 .

Analysis of Changes in Net Assets +)r Fund Balances

Total net assets or fund balances at beginning otyear- Part II, cilumn (a), line 80 (must agree with end-of-year figure reported nn prior year's re[wn) _ . . . .__, . . . . 1

. . . . . . . . . . . . . .. . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . ., . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . 2 z Enter amount from Part I, line 27a �� , . . .

3 Other increases not included In line 2 (itemize) 1 a Add fines 1 . 2 . and 3 . . . . . . . . . . . . . . . . .. . . . . .---- . .- .------ . .--- . . . . . . . . . . . . . . . . .--- . . . .---. . . . . . . . .---- . . . . . . . . . . . . . . . . . . . . . . 5 Decreases not included in line x (Iiemiu) .10, _ 6 Total net assets or 1unG DdWnCgs at end of year (line 4 minus line 5 - Part II, column (D) One 80 , � , �� , . . . . . . . . . . . . . . . . . . . . e

914,018 . <73,423 .>

0 . 840 595 .

0 . 840,595 .

From 990-PF 2001

tzasn 01-24-0¢

18480514 099771 26561 2

2001 .05030 JEROME P . SUBAR FOUNDATION 265611

Fort

m N a

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n 990-PF (2001) JEROME P ., UBAR FOUNDATION

Balance Sheets Z'~"~''"°°"'°""~'"°~°~"~"° caturtnshouldbetorb+do}"rrounls Wyc

1 Cash-non-interest-bearing, . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . ..

2 Savings and temporary cash investments ., . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .

8 Accounts receivable

Less . allowance for doubtful accounts 1

4 Pledges receivdDle 1

Less : allowance for doubtful accounts 00,

5 Grants receivable . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .

6 Receivables due from officers, directors, trustees, and other

disqualified persons . . . . . . . . . . . . . . . . . . . . . . . ., . ., . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . ..~n . .tee . . . . . . . . . , w.~, .. ..~ f rwl~ NO Wefi6 ~h¢h a xr~v. ... 7 00~ . . . . . . . . . . . . . .

Less . allowance for doubtful accounts 1

8 Inventories torsale oruse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � , � , . . . . . . .

9 Prepaid expenses and deferred charges �., . . . . . . . . . . . . . . . , .�� . �

10a Investments -U .S . and state government obligations �� , ��

h Investments-corporate stock . . . . . . . . . . . . . ., ST KT 6�,

e Investments-corporate bonds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ST!ZT . 7. . ,

11 f+~ro~s-hna. owimrosanaevulDmentWz . . . . . .

L= uan+wukedaptecuuon . . . . . . . . . . . . . . . . .

12 Investments -mortgage loans . . . , . �� , .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19 Investments - other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14 Land, buildings, and equipment: basis 1

Low YLImIIYIOwd dsvmd""C11 . . . . .r . . . . . . . . . . . . . .

15 Other assets (describe 01

17 Accounts payable and accrued expenses . . . . . . . . . . . . . . . . . . . . . . � . �� . � 18 Grants payable . . . . . ., , . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 19 Deferred revenue �� , . �� , .�� , . . . . . . . . . . . . . . . 20 Loans from ofPocr; director. tux-lee:, and othel AIBQuWIflQO pcrom: . . . . . . . . . . .

21 Mortgages and other notes payable . . . . �� . . . . . . . . . . . . . . . . . . . .. . . . . . . 22 Other liabilities (describe 00,

6167140702 T-553 P 003/022 F-880

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k'iH~4 ~~KR

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2 capital aln net Income or (net capital loss ). If ain, also -inter in Part I, tine 7 9 t moss), ert1or-0- to Part I, fine 7 . . . . . . . . . . . . . . . . . . . . . 2 2,531 .

S 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 f, line 8 . . . , . . . . . . � . . . . . . . . . ., . ., . . . ., . . . , . . � ., . . . . . . . . . . . . . . . . . . ) 3 NBA

FTW. -;V,l Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income (For optional use by domestic private foundations subject to tie secllon 4940(a) tax on net Investment income.)

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

Was the organization liable for the section 4942 tax on the distdbut, ale amount of any year in the base period? . , .�� , � .�� , , ., F-1 Yes EKI No If "Yes .' the organization does not qualify unQer section 4940(e). Do iotcomDtete this part. 1 Enter the appropriate amount in each column for each year, see instructions before making any entries .

Base penod years (n) (~1 Adjusted qualityin~i distributions Net value of noncharlmble-use assets

Distribution ratio Calendar ear ortax ear6e innin in ) (col_ (h) divided by col . (c))

2000 101, 736 . 1, 981, 974 . .0513306 1sss 77 , 073 . 1 , 952 , 213 . .0394798 1sse 88 , 193 . 1 , 707 , 699 . .0516443 1997 12 343 . 1 , 339 , 733 . .0092130 teas 14 .500 . 935 , 612 . T .0154979

2 Total of line 1, column (d) �� ., ., . . . . . . ._ _ . . . . . . . ._ . . . . . ._ . . . 2 .1671656

9 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 it less than 5 years �� . , � , . ., . ., . . . ., . . .�� e .0334331

b Enter the net value of nonchadtable-use easels for 2001 from Pat X, line 5 ._. . . . .. . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1 771 , 782 .

5 MuftiDly line 4 6y line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .� . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 5 59,236 .

6 Enter 1% of net investment income (1% of Part I, line 27b) . . . . . . . . . . . . . . . . . . . . . . . . . � ., . . .�� . .�� , .� . . . . . . . . . . . . , � . , , . � fi 296 .

7 add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . 7 5 9, 532 .

8 Enter qualifying distributions from Part XII, line 4 . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . ., . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . .. . . . .. . . . .. . . . . [8 106, 915 .

If line S Is equal to or greaterthan line 7, check the box (n Part Vi line 1b, and complete that part using a 1 % tax rate . See the Part VI instructions .

F~,*, 990 "PF pooi) i~~~ 01-24-02

3 18480514 099771 26561 2001 .05030 JEROME P . SUBAR FOUNDATION 265611

Jul-2T-04 OT :56am From-PLANTE & MORAN, PLLC - GR 6167740702 T-553 P 004/022 F-880

Form 990-PF (2001) JEROME P . 'BAR FOUNDATION ~ 38-24 4 5793 Page 3 Capital Gains and Losses or Tax on Investment Income

(a) List and describe the kind(s) of properly solo (9 .g , real estate, (h, How acquired (c) Date acquired (d) Date sold 2-sto ry prick warehouse ; or common stock, 20~) shs . MLC Co,) P- Purchase (mo., day, yr .) (mo ., day, yr,) D - Donation

to p SEE ATTACHED STATEMENT e d e

(e) Gross saes pro (1) Depreciation allowed (g) Cost of oVler basis (h) Gain or (loss) (or allowable) plus expense of sale (e) plus (fl minus (9)

a b c d e 39 989 . 37 4 458 . 2,531 .

Complete only far assets showing gain in column (h) and owned 6y the foundation on 12J31/69 (I) Gains (Col . (h) gain minus (1) Adjusted basis (k) Excess 0} col. (i) col . (k), but not less than -0-) or

(1) F.M .V, as of 12J31/69 as of 12/3t/69 over col_ (j), H any Losses (from col. (h))

c

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? !f %_%" attach a cor.brffRd copy of the changes , . . . . . . . . , � ., , . � � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4a Did the organization have unrelated business gross income at!' )1,000 or more during me year? . . . . . . �� . � .�� , .�� . � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4a X b If Yes; has it filed a tax return on Form 990 "T for this yea( .. . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . ., N/A. ., 4D

5 Was there a liquidation, termination . dissolution, or SuDSIdntlaf contraction during the year? . . . . . ., .� .�� , .�� ., .�� .� , .�� , 5 X If "Yes," attach the statement required by General fnsfi. cdon T.

B Are the requirements of section 508(e) (relating to sections 4911 through 4945) satisfied either : . :ak' ;rvi 0 By language in tie governing instrument or ~' ~; F:~r ;< <'>'x>

" By state Iegfsledon that effectively amends the governing foci rument so that no mandatory directions that confine with the state law ' .,~;.; remain in the governing instrument? . . . . . . . . . . . . .. . . . . . .. . . . .. . . . . . . . .. . .. . .. .. . .. .. . . . .. . . . . . . .--~-- . . . . . . . . . . .. . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .---~~ ~ 6 X I

7 Did the organization have at least $5,000 in assets at any time during the year? �� .�� , ., . . . . ., . . . . . . . ., � . . . . , ., . .�� .� . , . . . . ., . . . . � . 7 X

!f 'Yes, ° complete Part If. col. (c), and Pert XV. 8a Enter the states to which the foundation reports or with which II Is registered (see Instructions) 1

MICHIGAN ~ ~cs'y K i> ~o , .S°.., ow ~

ew%CJY C DIY' ~'~ : :r~

h If the answer is'Yes' to line 7, has the organization famished a copy of Form 990-PF to the Attorney General (or designate) ~:rM ,fiM . . r~ .; .......

of each state as required 6y General Instruction G7 If "No,"eYsch explanation . . .. . . . . . . . . . . . � . . . . . . . . . . ., . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8b . X 9 is the organtraUon claiming status as a private operating foundation within the meaning of section 4942(1)(3) or4942(j)(5) for calendar

year 2001 or the taxable year beginning In 2001 (see Instructions fir Part XN)? If "Yes,' complete Part XV.. . . . . . . . . . . . . . . . . . . . . . . .�� . . . . . . . . 9 X 10 Did any persons become substantial contributors during the t2 (year? . . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . EE , . STATEMENT. . . . . . . 1o X

If 'Yes, " attach a schedule fisting their names and addresses. 'It Did the organization comply with the public inspection requlrertents for Its annual returns and exemption application? . . . . . . . . . . . . . . . . . . . . . . ._ _� i~ X

web site address 1111- N/A 12 The books are In wre of t JEROME P . SUBP R Telephone no . " ( 6 16 ) 241-6491

LocateGat X 100 - 28TH ST, S .E ., GRAND RAPYDS, MY Z1P.Fa X49508 13 Section 4947(a)(1) nonexempt charitable trusts filing Form 99Q-PF in lieu of Form 1041 - Check here . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . 1

and enter the amount of tax-exempt interest received or accruNO during the near ��., �� , . . . . �� , .�� , . .�� . . ., ., 1 1 13 ~ N/A 123631 M .24-02 Fay� 990-PF poo,>

4 18480514 099771 26561 2001 .05030 JEROME P . SUBAR FOUNDATION 26561 1

Jul-1T-04 OT :5Tam From-PLANTE & MORAN, PLLC - GR 61 67740 702 T-553 P 005/022 F-980

Form 990-PF (2001) JEROME P . U ;OUNDATION ~--~ 38-2445793 Page 4 ~,ia1t1; Excise Tax Based on In

`vestrnent In come (Section 4940(a), 4940(b), 4940(e), or 4948 -see instructions)

1a Exempt operating foundations described in section 4940(d)(2; check here t [] and enter *N/A* on line 1. Date of ruling letter. (anaeh copy of ruling leer if necessary-see instructions)

h Domestic organizations that meet the section 4940(e) requlrerr cots In Part V, check here " FX-land enter 190 ~ 296 . ~ ~~MMw

Mat?

Of Part 1, line 274, . . . . . . . . . . . . . . . . . . . .r . .r . . . . . . . . . . . . . .n . . . . . . . r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . 'VVW N ~~ mot( '~ ~C :o:VY.~wai7"aww'oya i P.~ w ~%

e All outer domestic organizations enter 270 of line 27b . Exempt 'oreign organizations enter 4% of Part I, line 12, col_ (h) "° "° ... ..s; :: . . . . .b~w . ~ ., . ...,u.v~! ,... .. ... ~...... . . ., . .. 2 Tax under section 511 (domestic section 4947(a)(1) trusts any taxable toundations only . Others enter -0-) . . . _, � , . . . . . . . . . . . . . . . 2 0 . 3 Add lines 1 and 2 . . . . . . ., . . . . . . . . . . . . . . . . .. . . . . . . . �� a 296 . 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- ., .. .� ..� . ..� , ., . . .. . . . .., . . . . . . . . . . . . .. . . . .. . . 5 296 . 8 Crtdlts/Payments . , VA kkAi � y~ ;Nis ~s s'~T~

[""

a 2001 estimated tax payments and 2000 overpayment credited' a 2001 .�� , fia 1,400 . . . ., . . . . .. . . . .

.+7i hAr>T~a~ "wn . v >~xxA>a~~r r~ ~x tf ; p Exempt foreignorganlzatfons-taxwdhheldatsource � . . . . . . ., . . p~,p.p,~k'~yyt�y~yptjy~r~qpa~u w """""""" "

. . . . . . 6b "."""

. . ."

. f:Ta'3> "f CveiY>ifC~~~ T :i>~eZR~~~iS.~R'~ Yx,

c Tax paid with application for extension of time to file (Form 881:8). � , , .� � , . �� , 6C d Backup withholding erroneously withheld � , . . . . . . . . . . 6d 7 Total credits and payments . Add lines 6a through fid � . . . , . . . �� , . .�� .�� . . . ., . . . . . . . . . . . . . . . . , � ., ., . .�� ., 7 1 4 400 . 8 Enter any penalty for underpayment of estimated tax. Check ht re D it Form 2220 Is attaches . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. .. e 9 Tai sue . if the total of lines 5 and B is more than line 7, enter e mount owed . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . ., . . .� 1 9 10 Overpayment. If line 7 is more than the total of lines 5 and B, elter the amount overpaid �� , �� 1 1 .~ �� , 1 10 1 , 10 4 . 11 Enter the amount of line 10 to be : Credited to 2002 estimated I~ ~ ~ , 10 4 . efunded 1 71 0 . ;p47't_ ,yjt.;,q,= Statements Regarding Activities

Voa.. 1a During the tax year. did the organization attempt to influence any national, slate, or loyal legislation or did It paNcipate or intervene in Yes NO

any political campaign? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s, b Did it spend mare than $100 during the year (either directly or ndiredly) for political purposes (sea instructions for definition)? . . . . . . . . . . . . . . . . I D X

!f the answer is "Yes" to 1 a or 1 h, aRach a detailed description of the activities and copies o1 arty materials published or ^w ̀pip , ~ Y;.� ;; distributed by the organization in connection with the activities.

c Did the organization file Form 1120-POL for this yeah . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 p . ?C . . d Enter the amount frf any) of tax on political expenditures (Section 4955) imposed du ring the year.

ae~ w V`w 7a ~ nywji~ww (1) On the organization . " $ 0 " 12) On organization managers . 1111i- $ 0 . e Enter the relmbursement (if any) paid by the organization during the year for political expenditure tax imposed on organization

managers . " $ 0 " 2 Has the organization engaged in any activities that have not previously been reported to the IRS? . . . . . . . . . . ~ 2 VX

if "Yes, ' attach a detailed description of the activities. A , ~ ~r ~

izasat 01-24-02

5 18480514 099771 26561 2001 .05030 JEROME P . SUHAR FOUNDATION 26561^-1

Jul-2T-04 08 :0tam From-PLANTE & KORAN, PLLC - GR 6167740702 T-553 P 006/022 F-880

Form 990-PF (2001) JEROME P .-'SUBAR FOUNDATION 38-2445793 Page s

I1-~34 Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item Is checked in the °Yes" autumn, unless an exception applies. Yes No

; a rK.wo n .....r I l a During me year did the organization (either directly or indirect-r): fA .s,> e~ . (1) Engage fn the sale or exchange, or leasing of property wit[ i a disqualified person? Yes MI No %=~~

~~ ;~~ -VrF

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

a disqualified person? . . 0 Yes ~ Na �~,~r~`, vG . " ~ ̀ o'ti Wt a ewww ; (3) Furnish goods, services, orfacilliles to (of acceptttiem from) a disqualified person? . . . . . , . . . . . � ., . ., ., . . . . . . . . . . . . . 0 Yes [M No M,w

. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . , . . (4) Pay compensation to, or pay or reimburse the expenses (if, a disqualified person? 0 Yes fl No

(5) Transfer any income or assets to a disqualified person (or make any of either available "Y°,

for the benefit or use of a disqualified person)? . . . . . . . . .=Yes M No

(6) Agree to pay money or property to a government otflcial" (E7cception..Check ."No". . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... .., if the organization agreed to make a pant to orto employ the official for a period after v . . .. .. . .o~~ "

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . .. . . . . . . . . . . . . . .. . . . Yes ".o.~ .r ... . . . .. . . . ., termination of government service, if terminating within 5~) days .) 0 D No ..f . b If any answer Is'Yes'to Sa(1)-(6), did any of the acts fail to QL alffy upper the exceptions described in Regulations

section 53.4941(d)-3 or in a cogent notice regarding disaster assistance (seepage 19 of the instructions)? . . . . .. . . . .. . . . . . . . . . . . . . . .. . . . . . WA. . . .16 . .~. .. . ..~< .. Organizations relying on a current notice regarding disaster assistance check here

.

"""~° "<

e Did the organization engage In a prior year in any of the acts e :scribed in 1 a, other than excepted acts, that were not corrected "'":' ~

before the flrstday of the tax year beginning In 2001?. . . . . . . . .. . . . . . . ., . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ry 1e . X

oFa.. waii,wwr .a°''"x.Z 2 Taxes on failure to distribute income (section 4942) (does nor apply for years the organisation was a private operating foundation '1.x '

~�, .', y~ �M ` defined in section 4942(1)(3) or 4942(i)(5)): < .i.s~a t a At the end of tazyear 2001, did the organization have any undistributed income (lines 6d and 6e, Part XIII ) fortoxYear(s) beginning

Yes ~ No ,�., ' ~4 < before 2001? . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . .. . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . "' . ~<

yJ ~<~ ~ ~~ x If Yes; IISI the years 1111o

b Are there any years listed in 2a for which the organization is nat a00lying the provisions of section 4942(a)(2) (relating to incorrect

valuation of assets) to the years undistributed income? (n applying section 49a2(d)(2) to all years fated, answer 'No' and attach N~A �, 2b statement-see instructions .) . . . . . . . .. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. .. . . . .. . . . . . . .. . . . . . . . . . . . . .. . . . .. . . . . .

c It the provisions of section 4942(a)(2) are being applied to an fofthe years listed In 2a, list the years here. Z."'~('< T > i t ;,1 w wk ,'~' ~ V y,,s ~i~.t�'. . MM ., . 3a Did Me organization hold more than a 2% direct or Indirect int3rest in any business enterprise at any time ;y . :-

during the year? . � ,

.

. . . . . . . . . . . . . . . . . . . . . ~

. . ~ Yes X~ No

b If 'Yes ;did itha

.,.

ve excess business holdings in 2001 as aresidt of (1) any purchase by the organization or Clsquallfled persons after

May 26, 1969 ; (2) the lapse ofthe 5-year period (or longer pi sod approved 6y 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-yearfirst phase holding period? (Use Schedule C,

Form 4720, to determine if the organizatlon had excess business holdings in 2007 .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N.l. A. . . 3b

da Did the organization invest during the year any amount In a m inner that would jeopardize its charitable purposes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4a X

b Did the organization make any investment In a poor year (hut after December 31, 1969) that could jeopardize Its charitable purpose that

had not heap removed from jeopardy before rite first tidy of the taxyear beginning in 2001? �. � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . ., , . �� , 4b . . X

;~ . �.. 5a During the year did the organization pay or Inalr any amount ;o : ~"~, roe na G~ e > 1 . (1) Carry on propaganda, or otherwise attempt to Influence legislation (section 4945(e))1 . . . . . . . . . . .� ., . . . . . . . . . . . . . . . . . . .. [~ Yes MI No

(2) Influence the outcome of any specific public election (see section 4955); or to warty on, directly or indirectly . ~`~~

any voter registration drive? . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o Yes ~ No ~E iY Y %z

. . . . . . . . . . . . . . . . . .. . . . .. . . . .. . . . . . . . . . . . . . . . . . . ~ Yes ~ No .,< .. . . x

:

(3) Provide a grant to an individual for travel, study, or other similar purposes?

(4) Provide a grant to an organization other Man d charitable, ate., organisation described in section nirwN'H, ~

. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .""""""' . . . . . . Yes No i."~.a"~°" . rr ..x 509(a)(1),(2),ar(3)arsection 4940(d)(2)9 . . . . . . . . . . . D IAI "~'

(5) ProvICe for any purpose oUlerthan religious, charitable, ~ieientific, literary, ar edueadonal purposes, or for

the prevention of cruelly to children or animals? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ Yes D No

b If any answer Is 'Yes'to 5a(1){5), d !d any of the transach ons fall to Qualify under the exceptions described in Regulations x .

section 53.4945 or in a current notice regarding disaster assi :mnce (see instructions)? , . . .. . . . .. . . . .. . . . .. . . . . . . . . . . . . . . . . . , . �� . . . . .. . . . .. N/A.. . 5D

organizations relying on a current notice regarding disasters ;slstanee check here . .�, .�� , .� , . . . . . . . . . . . . . . . .. . . . .. . . .. . . . ..!

.< . c if the answer is'Yes' to question 5a(4), does the organization claim exemption from the tax because it maintained

expend llure responsibTrtytorthegtant? ' ." . NIA . . ._ 0 Yes D No

'~ i»r s 1'4iww,: .r.a .: .n.r.x If 'Yes,' attach !he statement required by Regulations section 53.x945-5(ap. t

the year, feeeNe arty tends, directly or indirectly, to pay premmms on 6a Did the organization, during the year. receive any funds. directly or indirectly, to pay premiums an

a personal benefit contract? �� .. . . . .. . .. . . =Yes ~ No .~.,~,~" -<,~,;Y

D Did the organization, during the year . pay premiums, directly 3r indirectly, on a personal benefit contract? . . . ., . . . . . . . . . . . . . . . �� ., . . . . . . . . . . . . . . . . . . . 6b

If you answsied 'Yes' Lo 60, also file Form 8870. Form 990-PF ¢=)

Jul-27-04 08 :02am From-PLANTE & KORAN, PLLC - GR 6167740702 7-553 P 007/022 F-880

Farm 990-PF (2001) JERQME P . JBAR FOUNDATION ~ 38-2445793 Page e

r~,ul~rw Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors

1 l.st all officers, directors, trustees, foundation rnanac ers and their compensation :

(a) Name and address (b) Title, and average (c) Campensadon (oiamonsro (e ) Ex ense

nouns p er week devoted (It not paid, ~ ~,d °~,~°'~ account, other toposition enter-0- canxnuean allowances

JEROME P . SUBAR RESIDENT 100 - 28TH ST S .E . GRAND RAPIDS . MI 49508 1 0 . 0 . 0 . JUDITH H . SUBAR ].00 - 28TH ST S .E . GRAND RAPIDS, MI 49508 0 0 . 0 . 0 . JONATAON E . SUBAR 100 - 28TH ST S .E . GRAND RAPIDS, MI 49508 0 .~ 0 . 0 .

pensation of five highest-paid employees (ether :non Lnose induaea on une i . R none, enter -nunc.-

(b~ TiGe and average (a) Name and address of each employee paid more than 9150,000 'hourspe r week (c) Compensation

devoted to osftlon NONE

t

of service

-r-f.1 numhor nt others rarAIVIBO over ISO-000 for orofessional services

Expenses

4

Form 990-PF 9001) 6

18480514 099771 26561 2041 .05030 JEROME P . SUBAR FOUNDATION 26561-1

Total number of other employees paid over $50,00 , , . . . . . . I,=- 3

., . . �� , 3 Five highest-paid independent contractors for prole&sional services, If none, enter "NONE."

(a) Name and address of each person paid m[ re than $50,000

NONE

1.151 the foundation's four largest dined charttable activities during the tazyear. Include relevant statistical information such as [he number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.

N/A

2

3

(e) Expense accounL other allowances

(c) Compensation

6167740702 T-553 P-008/022 F-980 Jul-27-04 08 :02am From-PLANTE & MORAN, PLLC - GR

Form 990-PF (2001) JEROME P.tUBAR ]FOUNDATION 38-2445793 Page 7

~~ Summary of Program-Related Invastments

Describe the two largest program-related investments made by the foundation during the tax year an lines I and 2. Amount 1 N/A I

2

All other program-related investments. See Instructions. 3

Total . Add lines 1 through 3 . . . . . . . . . . ..... . . . .

~ Minimum Investment Return (All dorrm~tie foundations must complete this part- Foreign foundations . see instructions .)

1 Fair market value of assets not used (or held foruse) directly Ird carrying out charitable . etc., purposes: a Average monthly fair market value of securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Average Of Monthly cash balances . . .. . . . . . . . . . . .. . . . . . .. . . . .. . . . .. . . . . . . . .. . . . . . . . . .. . . . . . . . . .. . . . .. . . . .. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * .. . . . 1 b

c Fair market value of all other assets . . .. . . . . . . . . . . .. . . . . . . . . . . .. . . . .. . . . . . . .. . . . . . . . . .. . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 C d Total (add lines 1 a, b . and c) . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . . . . . . . .. . . . . . .. . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I d e Reduction cialmed lot blockage or other factors foportoo on lin-is la and

1 c (attach detailed explanation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 10 U

2 Acquisition Indebtedness applicable to line I assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Subtract line 2 f ram line 1 d . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . . .. . . . . .. . . . .. . . . .. . . . . . . . . . . . . .. . . . .. . . . . . . . .. . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Cash deemed held for charitable activities . Enter 1 1/2% of line 3 (for greater amount, see Instructions) .. . . . .. . . . .. . . . . . . . . . . . . 4 5 Net value of noncharitablo-use assets . Subtract line 4 from Or e 3 . Enter here and on Part V, line 4 . .. . . . .. .. . .. . . . .. . . . . . . . . . . 6 Minimum Investment return . Enter 5% of line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H6 +

Distributable Amount (see Instructions) (Section 49426)(3) and (1)(5) private operating foundations and certain foreign organizations check here Oo. [= and do n ot complete this part.)

1 Minimum investment return from Part X, line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . ia .] . . . .. . . . .. . . . . . . . .. . . . . . . . . .. . . . 2a Tax on investment income for 2001 from Part VI, line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 9 6 -b income tax for 2001 . (This does not include the tax from PartVI .) . . . . . . . . . . . . . . . . . .. . . 2b c Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . .. . 2C

3 Distributable amount before adjustments . Subtract line 2c from line 1 . . . . . . .. . . . . . . . . . . . . . . .. . . .. . . . .. . . . . . . . . . . .. . . . . 3

4a Recoveries of amounts treated as qualifying distributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Income dIstributions from secton 4947(a)(2) tnists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4b 0

c Add lines 4a and 4b . . . . .. .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4c 5 Add lines 3 and 4c 5 6 Deduction from distributable amount (see Instructions) . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Distributable amount as adjubted . Subtract line 6 from line 5, I~ titer here and on Part XIII, line I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,748,864 . 49,899 .

1,798,763 .

0 . 1,798,763 .

26,981 . 1,771,782 .

$8,589 -

88,589 .

296 . 88,293 .

0 . 88,293 .

0 . 88 .293 .

Qualifying Distributions (see instructions)

7 18480514 099771 26561 20C1 .05030 JEROME P . SUBAR FOUNDATION 265611

1 Amounts paid (including administrative expenses) to accomplit.1i criaritable. etc., purposes : a Expenses, contributions, gifts . etc . - total from Part 1 . column (c.), line 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I a 106,915 .

b Program-relatea investments - Total from Part IX-B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1 b 0 .

Z Amounts paid to acquire assets used (or held for use) directly , i 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -Lb- 4 Qualifying distributions . Add fines la through 3b . Enter here a id on Part V, Ong 8, and Part gill, line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 106,915 .

5 Organizations that qua% under section 4940(a) forth@ reduced rate ottax an net investment income . Enter 1 % of Part [, line 27D . . . . . . .. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 296 .

6 Adjusted qualifying distributions . Subtract line 5 from One 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6 1 106,619 .

Note : The amount on line 6 will be used in Pivt V colUm-7 (b), in subsequentyean; when carcu4WIng whether the foundation quartfies for the section 4940(e) reauction of tax in triose year--

F~ 990-PF (20al)

123561 01-24-02

Jul-27-04 08 :02am From-PLANTE & MORAN, PLLC - GR 6167740702 T-553 P 009/022 F-980

1235711 011-24-02

18480514 099771 26561 2001 .05030 JEROME P . SUBAR FOUNDATION 265611

Farm 990~-PF (2001) JEROME P . JBAR I-'OUNDATION 38-2445793 Page a

Undistriblurted Income (5m inirtructior s)

(III (b) (c) (d) Corpus Years prior to 20DO 2000 2001

1 Distributable amount 4tk

M,

for 2001 from Part A line 7 . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 88,293 . 2 Uneistnbuted iritmerimik If any, = of the enci of 2000. MX 'I

0 . . . . . . . . . a Enter amountfor 2DOO only . . . . . . . . . . . . . . . . . 97,632 . bT0&brPl1VrYGGMK 1191919 . . . . . . . . . . .

95.0-0 3 F,~- dL-bibutions carryQor, If miny . to 2001 :

- --------- a From 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b From 1997

- ------- -- ---- c From 1998 . . . d From 1999 . . . . . . . . . .. . . Is From 2000 f Total of lines 3a through a 0

No= 4 Qualifying distributions for 2001 from V *L Part XII, line 4. 101 $ 106,91- 1 1P

a Applied to 20DO . but not more man line 2a 97,639

h Applied to undistributed income of prior A M ~-*,: ~F~`g. 0 .

years (Election required - see instructions) ~A .Iz:

c Treated as distributions out of corpus - - - - - - - - - - - - - - - EIR.3", nil . *.1 A! =3 - see (Election required instructions) . . . . . . . 0 _4

d Applied to 2001 distributable amount . . . . . . . 9,283 . z

e Remaining amount distributed out of corPus

5 CxcL-_- aminbunanz, awryover applied to 2001 QF-IntappaMInccAun,,nld), 1hemm6arr;i6Wi

0 .

rnuat be shci~ In w1urnn (zV

6 Enterliho nettotal ofeach column as h 0. :'.

Indicated below:

a Corpvs, Add I- W. 4a, and 4e.!3jwbtrr_z line 5 0 .

. .. . . . .. . . . .

b Prioryears' undistributed income. Subtract 4

. . . . . . . . . . . . . . . line 4b from line 2b

. . . . . . . .

. . c Enter the amount of pdor years' ------------- -----

undistributed income for wrijon a notli-e of IAIP A,

deficiency has been issued, or on which

the section 4942(a) tax has boon previously ~_A

0 . assessed

d Subtract lint 6c from line 6b . Taxable ! : :it~Eo

amount - see instructions 0

Mild .

It Undistributed Income for 2000 . Subtract line . . . . . . . . . . . .. .

4a from line 2a Taxable amount - see instr . . 4s

I Undistributed income for 2001 - Subtract

lines 4d and 5 from line 1 This amount miust

be distributed -in 2002 . . . . . . . . . . . .. . . .. . . . . 79,010 . 7 Amounts treated as distributions out of

....... ----- . . . . . . . . . . III k

corDus to satisfy requirements imposed by RAM

0 . .. . . . . . . . . . ._-___.__ .________ - _-s . . . =

- - --------- -- section 170(b)(1)(E) or 4942(g)(3) NO

- ----------------- 8 Excess distributions carryover from 1996

- ------ SWIR."Mm .. . . . . . . . . . . .. .

not applied on line S or line 7 . . . . . . . . . . . . . . . . 0 "WAR, A-k

9 Excess distributions cirryover to 2002 .

Subtract lines 7 and 8 from fine 6a 0

10 Analysis of line 9 : "A.

a Excess from 1997

b Excess from 1998 . . . ...... . . . . .. . . . . . . . . . . . . .. ... . .

I; Excess from 1999 . . .

III Excess from 2DOO

o Excess from 2001 4

Forrn 990-PF amij

38-2445793 Page 9 N/A

42(o)(3) or = 4 4211)(51

(d) 1998 (e) Tota I

I a If the foundation has received a ruling or determination letter that it is a private operating found2tiOn, and the ruling Is effective for 2001, enter the date )f ine ruling . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . 10~

b Check box to indicat8 whether the organization Is a private 20rating foundation described in section Tax year _ I Prior 3 yea (a) 2001 1 (b) 2000 W 1999

2 a Enter the lesser of the adjusted not income from Part I or the minimum investment return from Part X for each year listed . . . . . . . . . . . . . . . . . . . . . . .. .

b 85% of line 2a . . . . . . . . . . . . . . . . . . . . . . ... . c QualifyIng distributions from Part XII,

line 4 for each year listed . . . . . . . . . . . . . . . d Amounts included in line 2c not used directly for active conduct of exempt activities . . . . . . . . . . . . . . . . . . . . . .

a Qualifying distributions made directly for active conduct of exempt activities . Subtract line 2d from line 20 . . . . . . . . . . .

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

a "Assets' alternative test - enter (1) Value of an assets . . . . . . . . . . . . . . . . . . (2) Value of assets qualifying

under section 49420)(3)(8)(1) . . . b 'Endowmenr alternative test -

Enter 2/3 of minimum investment return snown in Part X, line 6 for each year listed . . . . . . . . . . . . . . . . . . . . . . . . .

c 'Supporr alternative test - enter : (1) Total support other than gross

investment income (Interest. dividends, rentS, payments on securities loans (section 51 2(a)(5)), or royalties) . . . . . . .

(2) Support from general public and 5 or more exempt organizations as provided in section 49420)(3)(13)(iff) . . . . . . . .

(3) Largest amount of support from an exempt organization . . . . . . . . . . .

d Any restrictions or limitations on awards, such as by geograpnical areas, charitable fields, kinds of institutions, or otherfactors :

1235811/01-24-W 9 rarfn 990-PF (2ool)

18480514 099771 26561 2001 .05030 JEROME P- SUBAR FOUNDATION 265611

Jul-27-04 08 :05am From-PLANTE & MORAN, PLLC - GR 6167740702

P , UBAR FOUNDATION WMB'i~t_ions ee Instructions and Part VII-A, cuestion 9)

T-553 P 010/022 F-980

Supplementary Information (Complete this part only it the organization had $5,000 or more in assets at any time during the year-see poge 26 of the instructions.)

1 information Rogarding Foundation Managem:

a List any managers of the foundation who nave contributed more than 2% of the total contributions received Dy the foundation before the close of any tax year (but only if they have contributed more than $5,000) . IS ; e section 507(d)(2) .)

JEROME P . SUBAR 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 IN ,resL

NONE 2 Information Ragarding Corytribution, Grant, Gift, Leon, Scholarship, etr-, Programs:

Check here 111111 rX7 if the organization only makes contnbut ons to preselected charitable organizations and does not accept unsolicited requests for funds . It the organization makes gifts, grants, etc. (see Instructions) to individuals or organizations under other conditions, complete items 22, b, 0, and d .

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

b The form in which applications should be submitted and info i mation and materials they should include :

c Any submission deadlines,.

Jul-27-04 08 :06am From-PLANTE & MORAN, PLLC - GR

ION %'_~ 38-2445793 Page 1 o Form 990-PF (2001) JEROME F .

iZ3=j0l .24-C2 F9nn990-PF aooi)

10


6167740702 T-553 P-011/022 F-980

Enter gross amounts unless otherwise indicated, unreigieu ousiness income EXWuded bw 5~ctjot) 512, 513, oe 51 4 W 1 (9, W (b) EX (a) Related or exempt

Eusinoss Amount sion Amount function income I Program service revenue: code Wde

a b

C

d e f

g Fees and contracts from government agencies

2 Membership dues and assessments . . .. . . . . . . . . . . . . .

3 interest on savings and temporary cash investments . . . . . . . . 14 1,933 .

4 Dividends and interest from securities . . . . . . . . . . . . . . . . . 14 26,389 . .M 5 Not rental Income or (loss) from real estate:

a Debt-financed property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b Not debt4lnancea property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 Not rental income or (loss) from personal

property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 Other investment income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8 Galn or (loss) from sales of assets other

than Inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2,531 .

9 Net Income or (loss) from special events . . . . . . . . . . . . . . . .

10 Gross profit or (loss) from sales of inventory . . . . . . . . . . . . . . . . .

11 Other revenue.

a

b V d

e

12 Subtotal . Add columns (b), (d), and (e) 0 . 30,853 ., 0 . 13 Total . Add line 12, columns (b), (d), and (e) . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-13 301853 . (See w rksheet In line 13 Instructions to verify calculations .1

~~ Relationship of Activities to the AccomplishMent of Exempt Purposes

Line No . Explain aelow how each activity tor which Income ~; reported in column (a) of PartXVI-A contdbuted importantly to the accomplishment of v the organization's exempt purposes (otherthan by providing funds for such purposes).

123611 F~mggO-PF Caoal) 01 '24-02 26,5651 1 18480514 099771 26561 2001 .05030 JEROME P . SUBAR FOUNDATION -


Form 990-PF (2001) JEROME P-__ UBARf'OUNDATION 38-2445793 Page 11

F-7- __Q p Analysis of Income-Producinri Activities

Form 99D-PF (2001) JEROME P_ "BAR L~~"',XYI~P information Regarding-Transf

Exempt Organizations

38-2445793 ons and Relationships With Noricharitable

. . . . . . . Ye 1 Dia the organization directly or Indirectly engage In any ofthe following with any other organization described in section 601(c) of

the Code (other than section 501 (c)(3) organizations) or in sai;tlon 527, relating to political argankations?

a TransferS from the reporting organization to a noncharitable exempt orgarilzation of., A-V

(1) Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210)

(2) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .

b Other Transactions, (1) Sales of assets to a noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .. . . . .. . . .. lb(i) (2) Purchases of assets from a noncharitable exempt orgadation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . lb(2) (8) Rental ottacilities, equipment, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . itip) (6) Reimbursement arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . ... . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b 4 (5) Loans orloan guarantees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 .1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b 5

(6) Performance at services or membership or fundralsing s 311citations . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . lb 6

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . , . . . i 9C d It the answer to any of the above is "Yes,'complete the follow ng schedule . Column (b) should always show the fair market value of the goods, other assets,

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

X X X X

X X

2a Is the organization directly or indirectly affiliated with, or relal W to, one or more lu-exempt organizations describsO in section 501 (c) at the Coda (other than section 501 (c)(3)) .r In section 527? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1:1 Yes FX1 No

b tfYes,' omplete the following schedule . (a) Name of organization (b) Type Of Orgllnlzatlon:::~ (c) Description of relationship

N/A I

Undcr penaides of periury. I dedwe tnwt I Nwe eicamined 013 raturn . Ind . ding Doewnpainymg =chedulea and staternan tEN and la Inc b--t of my Wwwled ge nnd belier, it is im 9, coract,

and marnplate Dedmtlon at preparer (other than tWgWerorlicluclafy) is based an aJI Infonmtlon 01'Which PrtPW"h= any knowledge.

g! Signature of officer or trustee Preparer's signature Pr 0 C coo

CL CL C, F1ffd5nmM(arVMM PLANTE & MORAN, LLP a! "WA'amwirzi, 333 BRIDGE STREET, NW 0.

2dCk=WAZTCWXRAWD RAPIDS . M1 49504

123621 01-2&M

18480514 099771 26561 20


X X

T-553 P 014/022 F-980

GMB No . 1545-0047

2001 Employer identification number

38-2445793

6167740702

Schedule B (Form 990, 990-EZ, or

990-PF) Depwtnwt of the Tromry Inhurud Re~enue Seml,=

Supplementary Information for line I of Forrit 990, 990-EZ and 990-PF (see instnictions)

JEROME P . SUBAR FOUNDATION Organization type (check one) ;

Filers ot Section .

Form 990 or 990-EZ = 501 (c)( (enter number) organization

1134SI 12-29-M

13 18480514 099771 26561 2001 .05030 JEROME P . SUBAR FOUNDATION 265611

Jul-27-04 08 :07am From-PLANTE & MORAN, PLLC - GR

Schedule of Contributors

Name of organization

= 4947(a)(1) none-empt charitable trust not treated as a private foundation

= 627 political organization

Form 990-PF MI 501 (c)(3) eXeMpt privatet foundation

M 4947(a)(1) nonexempt charitable trust treated as a private foundation

= 501(c)(3) taxable prival6foundaffon

Check if your organization is covered by theGeneral rule or a Special nile. (Note : Only a section 501(c)(7), (8), or(70) organization can check boxiets) for both the General rule and a Special tule-see instructions)

General Rule-

For organizations filing Form 990, 990-EZ, or 990-F F that received, during the year, $5,000 or more (in money or property) from anyone

contributor. (Complete Parts I and 11 .)

Special Rules-

For asectlon 501(c)(3) organization filing Form 99C . or Form 990-CZ, that met the 33 1/3% support test of the regulations under sections 609(a)(1)11 70(b)(1)A)(vi) and received froin any one contributor, during the year, a contribution of the greater of $5.000 or 2% of the amount on line I of these forms . (Complete Parts I ancl 11 .)

For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ that received from anyone contributor, during the year,

aggregate contributions or bequests of more than $1 .000 for use exclushvlY for religious, charitable, scientific, literary, or educational

purposes, orthe prevention of cruelty to children or animals. (Complete Parts 1, 11, and 111 .)

For a section 501 (c)(7), (8), or (1 0) organization fifir g Form 990, or Form 990-EZ, that received from any one contributor . during the year.

some contributions for use exclusively for raliglow ., charitable, etc., purposes . but these contributions did not aggregate to more than

$1,000 . (if this box is checked, enter here the tortal contributions that were received during the yearfor an exclusively religious,

charitable, etc. . purpose. Do not complete any of [he Parts unless the General rule applies to this organization because it received

nonexclusively religious, charitable, etc., contnbut ons of $5,000 or more during the year.) . . . . . . . . . . . . . . . . . . . . . . . . . . . 0- $

Caution: Organizations that are not covered by the Genem'wle andlor the SpaciaJ rules do not file Schedule B (Form 990, 990-FZ or 990-Pa but they must check the box in the heading of thele FarrrY 990, .7orm 990-EZ or on line I of TheirForm 990-PF to certify that they do not rineet the filing

requirements of Schedule 19 (Fon77 990, 990-F7, or 990-PFI .

Schedule 8 (Form 990, 990-EZ, or IaQO-FF) (2001)

payroll

(Complete Part I I if there is a noncash contributlon-)

(a) (b) (0) (d) No . Name, address and ZIP + 4 Aggregate contributions Type of contribution

Person Payroll

$ Noncash

(Complete Part )) if there ir. a noncash contribution .)

(b) W (d) No. Name, address and ZIP + 4 Aggregate contribtitions Type of contribution

Person payroll

$ Noneash

(Complete Part 11 if there is a noncash contribution .)

(a) (b) (c) (d) No. Narne, address and 7 IP + 4 Aggregate contributions Type of contribution

Person Payroll Noncash

(Complete Part I I if th are is a noncash contribution .)

(b) W (d) No. Name, address andZIP + 4 9 re ate contributions Type of contribution

Person Payroll

(Complete Part It if there is a noncesh contribution .)

123462 12-29-01 14 Scheaule 0 (Form 990, 990-EZ, or 990-PF) (2001) 18480514 099771 26561 2001 .05030 JEROME P . SUBAR FOUNDATION 265611


Schedule 5 (Foffn NO. 890-E4 or 990-Pn (2001) pagc to 1 Fpwtl

Name of organization Employer 10entilication number

JEROME P . SUBAR FOUNDATION 38-2445793

Contributors (See Specific instructions.) . . . _4 .

(a) (b) W (CQ No. Name, address and ZIP + 4 ontributions Type of contribution

1 MODEL COVERALL, INC . Person Payroll

100 28TH STREET SE, PO 130X 8037 $ 5,932 . Noncash (Complete Part I I If there

GRAND RAPIDS, MI 49548 is a noncash contribution .)

(b) W (d) No . Name, a0drass and ZI P + 4 A9,!9regate contributions Type of contribution

Person

Jul-27-04 08 :08am From-PLANTE MORAN, PLLC - GR

JEROME P . SUBAR FOUNDAT N Capital Gains and Losses for Tax nninirestment Income

(a) List and describe the kind(s) of property sold, e .g ., real estate, 2-story brick warehouse ; or common st~ick, 200 shs . MLC Go

1,000 SHS MCN ENERGY b 114 SHS CITIGROUP, INC . c 377 SRS UNISYS CORPORATION d39 SHS VISTFON CORPORATION DELAWARE e 116 SHS CITIGROUP, INC . f 3-9 SHS VISTEON CORPORATION DELAWARE 11FIFTH THIRD BANK - CIL h CAPITAL GAINS DIVIDENDS

How ac . red (c) Date acquired (a) Date sold Pur a e (mo ., day, yr.) (mo ., day, yr .) - Donat! P 24/9704/30/01 P 08/09/96 01 P 07/27/9910/04/01 P 08/09/9010/04/01 P 12/05/OOTO-/04/01 P 07/06/0010/04/01 P VARIOUS 12/31/01

(f) Depreciation allowed (g) Cost or other basis (or allowable) I plus expense at sale

5

I

(1) Losses (from Col. (h)) Gains (excess at col . (h) gain over col. (k),

but not less than '-0-*)

<1,673 .> 1,005 .

<2,540 .> 183 .

5,035 . 488 . 32 . 1 .

ain in column (h) and ownid by the foundation on 12/31/69_ (11 Adjusted basis (k) Excess of col, (I) as of 12/31/69 1 over col . (1), if any

omplete onry for assets ,

(I) F.M. as of 12/31/69

( if In, 2% D enter In Part 1 . line 7 p Capital gain not income or (net capital loss) . . . . . . if ?13.lss), e ite r '-0-* In Pa rt 1, lin e 7 ) . . . . . . . . . . . . . . . . . .

3 Not snort-rerm cavitaluain or (loss) as defined in sections 112222(s) and (6): It gain, also enter in Part 1, line 8, column (c) . If (loss), enter'-O-" In Part 1, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -- -- -

123591 U7-17-91

2 .531 .

15 18480514 099771 26561 2001 .05030 JEROME P . SU13AR FOUNDATION 265611

6167740702 T-553 P-016/022 F-9B0

CONTINUT~ION FOR 990-PF, PART IV 38-2445,,3 PAGE 1 OF I

h I

(e) Gross sales price

25,818 . 4,948 .

035-488 . 32 .

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

<1, 673 .> 1,005 .

<2,540 .> 183 .

5,035 . 488 . 32& 1 -

FORM 990-PF TAXES STATEMENT 4

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

2,047 . 0 .

2,047 . 0 .

(C) (D) ADJUSTED CHARITABLE NET INCOME PURPOSES

0 .

0 .

16 STATEMENT(S) 1, 2, 3, 4 2001 .05030 JEROME P . SUBAR FOUNDATION 265611 18480514 099771 26561


JEROME P . SUBAR FOUNDAI N 38-2445793 I-

FORM 990-PF INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT 1

SOURCE AMOUNT

MERRILL LYNCH 1,933 .

TOTAL TO FORM 990-PF, PART 1, LINE 3, COLUMN A 1,933 .

FORM 990-PF DIVIDENDS A14D INTEREST FROM SECURITIES STATEMENT 2

CAPITAL GAINS COLUMN (A) SOURCE GROSS AMOUNT DIVIDENDS AMOUNT

MERRILL LYNCH 26,390 . 1 . 26,389-

TOTAL TO FM. 990-PF, PART 1, IN 4 26,390 . 1 . 26,389 .

FORM 990-PF ACCOUNTING FEES STATEMENT 3

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE

DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES

PLANTE & MORAN, LLP 1,096 . 11096 . 0 .

TO FORM 990-PF, PG 1, IN 16B lr096 . 1,096 . 0 .

DESCRIPTION

INTERNAL REVENUE SERVICE

TO FORM 990-PF, PC 1, IN IS

FORM 990-PF OTHER EXPENSES STATEMENT 5

18 . 0 . 18 .

178 . 150 . 28 . TO FORM 990-PF, PG 1, IN 23

FORM 990-PF CORPORATE STOCK STATEMENT 6

FAIR MARKET BOOK VALUE VALUE

37,430 . 123,768 . 1 . 9,432 .

9,416 . 251,600 . 34,444 . 117,600 .

0 . 0 . 30,001 . 14,473 . 28,313 . 41,120 . 26,552 . 32,280 .

0 . 0 . 49,645 . 64,940 .

0 . 0 . 73,500 . 34,160 .

0 . 0 . 21,125 . 56,440 . 76,775 . 99,268 . 51,940 . 88,350 . 21,242 . 20,184 . 58,009 . 54,500 . 22,191 . 9,056 . 79,903 . 56,000 . 71,994 . 46,350 .

0 . 0 . 182,930 . 649,546 .

875,411 . 1,769,067 . TOTAL TO FORM 990-PF, PART 11, LINE 10B

17 STATZMENT(S) 5, 6

18480514 099771 26561 2001 .05030 JEROME P . SUBAR FOU14DATION 26561 - 1

Jul-27-04 08 :09am From-PLANTE & MORAN . PLLC - GR 6167740702 T-553 P-018/022 F-980

JEROME P . SUBAR FOUNDAT )7 38-2445793

DESCRIPTION

ANNUAL INVESTMENT FEE MICHIGAN ANNUAL REPORT CHURCH AND STATE MEMBERSHIP FEE

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE PER BOOKS MENT INCOME NET INCOME PURPOSES

150 . 150 . 0 . 10 . 0 . 10 .

DESCRIPTION

2,160 COMERICA BANK 600 FORD MOTOR CO 8,000 INTEL CORP 2,000 MERCK & CO . 377 UNISYS 3 .75 SER A 7,538 FRANKLIN AGE HIGH INCOME F,-) 1,000 HEINZ 800 INTL PAPER 14,313 OLD KENT FINANCIAL 2,000 RAYTHEON CO . 1,000 MCN ENGY GP 3,500 COMPAQ COMPUTER CORP 230 CITIGROUP 1,000 AMGEN INC COM CORP CLA 1,660 KIMBERLY CLARK CORP 1,500 TYCO INTL LTD NEW 842 .772 MUNDER INDEX 500 1,000 UNITED PARCEL SVC 503 .643 MUNDER NETNET FUND 2,000 TEXAS INSTRUMENTS 1,000 MEDIMMUNE, INC . 78 VISTEON 10,591 FIFTH THIRD BANCORP

JEROME P . SUBAR FOUNDAT : 38-2445793

FORM 990-PF CORPORATE BONDS STATEMENT 7

FAIR MARKET BOOK VALUE VALUE

12,870 . 32,661 .

12,870 . 32,661 .

DESCRIPTION

33,000 ARCHER DANIELS MIDLAND

TOTAL TO FORM 990-PF, PART 11, LINE 10C

FORM 990-PF LIST OF SU13STANTIAL CONTRIBUTORS STATEMENT 8 PART VII-A, LINE 10

ADDRESS

100 28TH ST, GRAND RAPIDS, MI 49508

NAME OF CONTRIBUTOR

JEROME SUBAR

FORM 990-PF GRANTS AND CONTRIBUTIONS STATEMENT 9 PAID DURING THE YEAR

RECIPIENT RELATIONSEP AMOUNT

NONE 7,787 .

RECIPIENT RECIPIENT NAME AND ADDRESS STNTUS PURPOSE OF GRANT

AHAVAS ISRAEL PUBLIC COMMUNITY CHAIRTTY

AMERICA'S SECOND HARVEST PUBLIC COMMUNITY CHARITY

AMERICAN CIVIL LIBERTIES PUBLIC COMMUNITY UNION FOUNDATION CHM:ITY

AMERICAN FRIENDS OF TEL PUBLIC EDUCATION AVIV UNIVERSITY CHABITY

AMERICAN RED CROSS PUBLIC COMMUNITY CHAPITY

ARTS COUNCIL OF GREATER PUBLIC COMMUNITY GRAND RAPIDS CHAIRITY

BROADWAY THEATER GUILD PUBLIC COMMUNITY CHM.ITY

CLOSE UP FOUNDATION PUBLIC EDUCATION CHAI;.ITY

NONE

NONE

NONE

NONE

NONE

NONE

NONE

1,500 .

500 .

500 .

1,000 .

500 .

5,000 .

500 .

18 STATEMENT(S) 7, 8, 9 18480514 099771 26561 2001 .05030 JEROME P . SUBAR FOUNDATION 265611


19 STATEMENT(S) 9 18480514 099771 26561 2001 .05030 JEROME P . SUBAR FOUNDATION 265611

Jul-27-04 08 :09am From-PLANTE & MORAN, PLLC - GR 6167740702 T-553 P-020/022 F-980

JEROME P . SUBAR POUNDATI--, 38-2445793

COMMUNITY CIRCLE THEATER PUBLIC COMMUNITY NONE CHARITY 10f250 .

DAVENPORT UNIVERSITY PUBLIC EDUCATION NONE FOUNDATION CHAR':TY 1,000 .

FREDERICK MEIJER GARDENS PUBL::C COMMUNITY NONE CHAR':TY 250 .

GERALD R . FORD FOUNDATION PUBLIC COMMUNITY NONE CHARITY 250 .

GRAND RAPIDS COMMUNITY PUBLIC COMMUNITY NONE FOUNDATION CHARITY 1,500 .

GRAND RAPIDS STUDENT PUBL'ICC EDUCATION NONE ADVANCEMENT CHARITY 500 .

GRAND RAPIDS SYMPHONY PUBLTC COMMUNITY NONE CHARETY 350 .

GRAND VALLY STATE PUBLEC EDUCATION NONE UNIVERSITY SCHOLARSHIP FUND CMARETY 2,500 .

INTERNATIONAL ASSOC OF FIRE PUBLIC COMMUNITY NONE FIGHTERS CHARrTY 1,000 .

INTERNATIONAL RESCUE PUBLIC COMMUNITY NONE COMMITTEE CHARITY 500 .

JEWISH CULTURAL COUNCIL PUBLIC COMMUNITY NONE CHARITY 500 .

JEWISH FEDERATION OF GRAND PUBLIC COMMUNITY NONE RAPIDS CHARITY 30,000 .

JEWISH NATIONAL FUND PUBLIC COMMUNITY NONE CHARITY 500 .

JUNIOR ACHIEVEMENT PU13LIC EDUCATION NONE CHARITY 400 .

MEMORIAL SLOAN-KETTERING PUBLIC COMMUNITY NONE CANCER CENTER CHARITY 500 .

OXFAM AMERICA PUBLIC COMMUNITY NONE CHARITY 500 .

UNITED WAY PUBLIC COMMUNITY NONE CHAPITY 7,000 .

UNIVERSITY OF MICHIGAN PUBLIC EDUCATION NONE ANN ARBOR, MI CHAPITY 2,000 .

20 STATEMENT(S) 9 19490514 099771 26561 2c,ol .OS030 JEROME P . SUBAR POUNDATION 26561 -1


JEROME P . SUBAR FOUNDAT2 38-2445793

LAKESIDE HERITAGE MUSEUM PUBL :.-C COMMUNITY NONE CHAR-_--TY 3,000 .

AMERICAN ASSOC OF BEN PUBL__C COMMUNITY NONE GURION CHAR'.CTY 500 .

AMERICANS UNITED PUBLIC COMMUNITY NONE GUARDIANS OF FREEDOM CHARITY 300 .

BAR ILIAN UNIVERSITY PUBLIC EDUCATION NONE CHARITY 500 .

CELEBRATION ON THE GRAND PUBLIC COMMUNITY NONE CHARITY 500 .

FRIENDS OF THE JEWISH PUBLEC COk2fUNITY NONE DANISH CHARITY 500 .

GRAND RAPIDS YOUTH PUBLIC C014MUNITY NONE COMMONWEALTH CHARETY 500 .

GRAND RAPIDS CIVIC THEATRE PUBLIC COMMUNITY NONE CHARITY 250 .

GRAND VALLEY STATE PUBLIC COMMUNITY NONE UNIVERSITY OFFICE OF CHARITY MINORITY AFFAIRS 1,000 .

GRAND RAPIDS JEWISH PUBLIC COMMUNITY NONE COMMUNITY ENDOWMENT FUND CHA-PITY 10,000 .

MICHIGAN BLOOD CENTERS PUBLIC COMMUNITY NONE CHARITY 500 .

MICHIGAN MILITARY MUSEUM PUBLIC COMMUNITY NONE CHARITY 3,000 .

NEW YORK FRATERNAL ORDER OF PUBLIC COMMUNITY NONE POLICE CHARITY 1,000 .

SEPTEMBER 11 FUND PUBLIC COMMUNITY NONE CHM:ITY 3,000 .

SOUTHERN POVERTY LAW CENTER PUBlIC EDUCATION NONE CHARITY 250 .

ST . CECILIA MUSIC SOCIETY PUBIIC COMMUNITY NONE CHAIiITY 300 .

WORLD AFFAIRS COUNCIL PUBLIC COMMUNITY NONE CHARITY 5,000 .

TOTAL TO FORM 990-PF, PART XV, LINE 3A 106,887 .


Appbi;ation for Extension of Timet-6 File an Exempt Organization Return

Form 8868 (December 20DO) Depwtrant of Uw T--Y InQMW Pman= SOW=

OmB No. 1545-1709

0- F for each return.

Under penalties of pedury, I declare that I have examined this lorm, Including accompanying schedules and statements . and to the best of my knovAei3ge and belief, it Is true, correct, ai~d complete, ana that I am authorized to pK-pare this form-

C10 2~1_16 Form 88118 (12-2090)

12W31 07-16W


" if you are; filing for an Automatic 3-Morrth ExtanrJon, complete only Part 1 and check this box . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. FX1

" If you are filing for an Additional (not automatic) 3-hionth Extension, complqte only Part 11 (on page 2 of this form). Note: Do not complete Part 11 unless you have alreadil been granted an automatic 3-month extension on a previcuslY filed Form 8868.

=f"j Automatic 3-Month Fxtension of Time - Only submit original (no copies needecQ Note: Farm 990-T corporations requasting an automaC.- 6-month extension - check this box and complete Part I only . . .. . . . .. . . . . . . . . . . . . . . . . . jo, All other corpom tfons rin cluding Form 990-C Rem) must i ise Poirn 7004 to request an adension of time to rile income &W retums. Partnemhfps~ REMICs and trusta twst use Form 8736 to request an exlensi6n of time to file Form 1065, 1066, or 1041 .

Type or Name of Exempt Organi:zation Employer identification number print

JEROME P . SUBAR FOUNDArION 38-2445793 F119 cy in' dued ;..,,r Number, street, and room or suite no . If a P.0 . box, see instructions. filingyaur PO BOX 8037 retum. s= Imw=dwm City. town or post office, state, and ZIP cod . ;-. For a foreign addres;s, see instructions.

IGRAND RAPIDS, MI 49518

Check type of return to be filed pi e a separate applicaflon for each retum) ;

Form 990 Form 990-T (c .)rporatlon) Form 4720 Form 990-BL Form 990-T (s,)c . 401 (a) or 408(a) trust) Form 52.27 Form 990-EZ Form 990-T 4 rust other than above) Form 6.0669 F.rM 990-PF Form 1041-A Form 8870

" If the organization does not have an office or place ol business In the United States, check this box . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )0.

" If this is for a Group Return, enter the orVanization's I our digit Group Exemption Number (GEN - If this Is for the whole group . check this box 1111- = . If It is for pad of the group . check this boc 10- ED and aftwh a list with the names and EINs of all members the extension will cover.

I I request an automatic 3-month (6-month, for 090- T corporation) extension of time until-AUGUST 15, 2002 to file the exempt organization return for,the orgarkation named above. The waansion is for the organization's retunn for P. calendar year 2 0 0 1 or 10, tax yew beginning and ending

2 If this tax year is for less than 12 months, check rimson : =initiaireturn, Final return Change in accounting period

39 If this application Is for Form 990-BL, 990-PF, 990 T . 4720, or 60612, enter the tentatlye tax, lass any nonrefundable credits . See Instructions . . . . . . . . . . . . . . . . . . . .. . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . $ 296 .

b If this application is for Form 990-PFor990-T, eni-ar any refundable credits and estimated tax payments made . Include any prior year overpayment allowed as a credit . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 1,400 .

c Balance Due. Subtract line 3b from line U Inclule your payment with this form . or, If mquired, deposit with FTD coupon or, if required . by using EFTPS (Electranir Federal Tax Payment Symem) . See Instructions . . . . . . . . . . . . . . . . . . . .. . . . S 0 .

Signature and Verification

LHA For Paperwork Reduction Act Notice, see initruction

Documents

Form 990-PF ~ 'Returri of Private Foundatidrr990s.foundationcenter.org › 990pf_pdf_archive › 382 › ... · " a,.Z4_02 F r rwor B dueti n At U otice, see the Imtruetions. Form