Form 990-PF , Return of Private Foundation or Section 4947 ...990s.foundationcenter.org/990pf_pdf_archive/341/341667193/...2 Fae~~ npanixationa mail the e5% test Uadi use and attxn

Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust

Treated as a Private Foundation

0MB No 1545-0052 Form 990-PF , Department al the Thai Internal Revenue Serv,"

Note

Far calendar veer 2002 . or taxv

LOOL

end

Employer identification number Use the IRS Name of organization label HE ALEXANDER SHASHATY FAMILY FOUNDATION

Otherwise, INC . print Number and strwi (a P O box numbs If maul is not Gelrvaed to street address) RoohVWLtG

or type 0 MILDRED SHASHATY 41562 LODGE RD See Specific Instructions City or town, state, and ZIP code

EETONIA OH 44431 H Check type of organization X Section 501(c)(3) exempt private foundation

JY-100/17J

B Telephone number (330)482-3017

II exemption mli a pending, cheCx has ,

D t Foreign organizations, check here 1 2 Fae~~ npanixationa mail the e5% test

Uadi use and attxn Computation 1

E If private foundation status was terminated under section 501(b)(1)(A), check here

F If the foundation is in a 60-monih termination under section 507 b t B check here

(c) Adjusted net (d) tolsou . .d�al income for <euA4tlao^mou (b) Net investment

income

1 Contributions, gifts, grants, etc ,received Ch" 100 ]( AOIetaunGiCOnISnotRamreEN7t7th 5[A B

2 distributions from split-interest trusts Iniseet an aavinW ~a tpnowary 3 cash Investments

4 Dividends and interest from securities 5a Gross rents b(Netrenulinmmea(loaa)

y Nat Ran a boa) fan sale of ovals not on 7 68 line 10

b Grow wee ono, ra an waste on line file 3 .

L Q ] Cspn net Income (bam Pert IV one 2)

8 Net horFte///111sin

9 In om IO2 ~qep

&d.

layis

~i b bar ~oi «" C Gf0 11t or (IOSSJ ~ I

17 Othe r ~ ~ 6 , 027 . 6 , 027 . O . STATEMENT 3 12 To 1 OU R Q 11 , 703 . 11 , 703 . 0 .

~'r~:.~S~,l ~ em 0 . 0 . 0 . 0 . 13 Compensation oro i m wsc 14 Other employee salaries and_-Wages 15 Pension plans, employee benefits

U1 °y' 16a Legal fees bAccounting fees STMT 4 1 , 750 . 250 . 0 . 1 , 500 .

w c Other professional fees > 17 Interest b 18 Taxes

19 Depreciation and depletion E 20 Occupancy a 21 Travel, conferences, and meetings v

22 Printing and publications 23 Other expenses STMT 5 200 . 50 . 0 . 150 .

'6 24 Total operating and administrative n expenses nddlines i3through 23 1 950 . 300 . 0 . 1 650 . 0 25 Contrihutions,gitts,grants paid 12 000 . 12 000 .

26 Total expenses and disbursements ndd~ines24 ane25 13 950 . 300 . 0 . 13 650 .

27 Subtract line 26 from line 12 2 4 7 . i Exma olrevenue avxezpmasaenddisbursements GZ

b Netinvestment income (irnegative e,r. a-) 11 . 403 . e Ad justed net income (if neeai an. -0 ~ Q ,

YI7501 o, zoos LHA For Paperwork Reduction Act Notice, see the instructions Form 990-PF (2002) ~,

~~_ i 10571111 759239 SHASHATYFAMI 2002 .06030 THE ALEXANDER SHASHATY FAMI SHASHA01

I Fair market value of all assets at end of year J Accounting method X Cash (from Part 11, col (c), line 76) Other (specity)

1 5 6 6 9 . Part 1column d must be on case Part I Analysis of Revenue end Expenses (a) Revenue and

(The total of amounts in columns ft (ca aria (C) may not nenurtiN aqua the amount, in column iai I expenses per books

Accrual

THE ALEXANDER SHASHATY FAMILY FOUNDATION Form 990-PF

of End Book

Organizations that tollow SFAS 117, cheek here and complete lines 24 through 28 and lines 30 and 31

24 Unrestricted u 25 Temporarily restricted

A 28 Permanently restricted

Organizations that do not follow SFAS 717, check here " X and complete lines 27 through 31

21 Capital stock, trust principal, or current funds H 28 Paid-in or capital surplus, or land, bldg , and equipment fund N

29 Retained earnings, accumulated income, endowment, or other funds 0 Z 30 Total net assets or fund balances

Analysis of Changes in Net Assets or Fund Balances

1 Total net assets or fund balances at beginning of year - Part 11, column (a), line 30 (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) " YEAR END TAX ADJUSTMENT 4 Add lines 1, 2, and 3 5 Decreases not included in line 2 (itemize) 6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II, column (b), line 30

223511 01 23-03

2

10571111 759239 SHASHATYFAMI 2002 .06030 THE ALEXANDER SHASHATY FAMI SHASHA01

Part II Balance Sh00t5 " schedules anaamountsmtneaesrnonan column should 6e for end tlyeai amounts on y

t Cash-non-interest-bearing 2 Savings and temporary cash investments 3 Accounts receivable

Less allowance for doubtful accounts 4 Pledges receivable IIII

Less allowance for doubtful accounts 5 Grants receivable 6 Receivables due from officers, directors, trustees, and other

disqualified persons 1 omernausanaioansrtceinoie 10.

Less allowance for doubtful accounts r

III 8 Inventories far sale or use 9 Prepaid expenses and deferred charges 10e Investments - U S and state government obligations

b Investments corporate stock STMT 6 c Investments-corporate bonds

11 investments lane buildings and erfulumentbasis

Less accumulated de;rlsuton

12 Investments mortgage loans 73 Investments-other $TMT 7 14 Land, buildings, and equipment basis bI

Less a¢umuhledaeoireaoon 1

15 Other assets (describe III

11 Accounts payable and accrued expenses 18 Grants payable

d 19 Deferred revenue - 20 Loans to. ofACaa duectom, wneea end om> a~ .c .Wniea P>eom

n 21 Mortgages and other notes payable

J 22 Other liabilities (describe fg, 1

From 990-PF (zoox)

IV I Capital Gams and Losses for Tax on Investment Income

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

;ERE SYSTEMS INC DEL A - CASH IN LIEU SERE SYSTEMS INC CL H - CASH IN LIEU

(e) Gross sales price (f) Depreciation allowed (p) Cost or other basis (or allowable) plus expense of sale

in column (h) and owned by the foundation on 12/31/69 (j) Adjusted basis (k) Excess of col (i) as of 12/31/69 aver col (1), if any

(I) Gains (Col (h) pain minus col (k), but not less than -0-) or

Losses (from cal (h)) (i) F M V as of 1?l31/69

3 10571111 759239 SHASHATYFAMI 2002 .06030 THE ALEXANDER SHASHATY FAMI SHASHA01

THE ALEXANDER SHASHATY FAMILY FOUNDATION

for assets

V Date acquired (d) Date sold 0 , I (me, day, yr ) ,

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

2 Capital gain net income or net capital loss) If Qain, also enter in Part I, line 7

A ( 1 ~ If (loss), enter -0- in Part I, line 7

3 Net short-term capital pain or (loss) as defined in sections 1222(5) and (6) II gain, also enter in Part I, line B, column (c) II (loss), enter -0- in Part I, line B

I Part y I yuauncation under Section 494u(e) for Reduced r ax on Net mve (For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income

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

Was the organization liable for the section 4942 lax on the distributable amount of any year in the base period? Yes X No If 'Yes .'the organization does not Qualify under section 4940(e) Do not complete this pan 1 Enter the appropriate amount in each column tar each year, see instructions before making any entries

Base period years Adjusted 1(~) Distribution ratio Calendar vear for tax vear heainninn in) qualifying distributions Net value of noncharitable-use assets (COI (b) divided 6v cot fell

2 Total of line 1, column (d) 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

4 Enter the net value of noncharita6le-use assets for 2002 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)

7 Add lines 5 and 6

8 Enter qualifying distributions from Part XII, line 4 I 8 I 13 , ()!)U .

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 Seethe Part VI instructions

223521/01 33-07 Farm 990-PF (2002)


or 4948 - see Part VI j Excise Tax, Based on Investment Income (Section 4940(a), 4940(b), 49

1a Exempt operating foundations described in section 4940(0)(2), check here " and enter'N/A' on line 1 Date of ruling letter (attach copy of ruling letter it nece§3&ry-see instruction

b Domestic organizations that meet the section 4940(e) requirements in Part V, check here " X 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 2 Tax under section 511 (domestic section 4947(a)(7) 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 beset on investment income Subtract line 41rom line 3 If zero or less, enter -0- 6 Credits/Payments a 2002 estimated tax payments and 2001 overpayment credited to 2002 6a h Exempt foreign organizations -tax withheld at source 6b c Tax paid with application far extension of time to file (Form 8868) 6c d Backup withholding erroneously withheld 6d

7 Total credits and payments Add lines 6a through 6d B Enter any penalty for underpayment of estimated tax Check here d Farm 2220 is attached 9 Tax due It the total of lines 5 and 8 is more than line 7, enter amount awed 10 Overpayment If line 7 is more than the total of lines 5 and 8, enter the amount overpaid

(b)

72 The books are in care of " MI LDRED SHASHATY Telephone no " ( 3 3 0 ) 482-3017 Locatedat " 41562 LODGE ROAD, LEETONIA, OH ZIP+4 144431

13 Section 4947(a)(1) nonexempt charitable trusts tiling Farm 990-PF in lieu of Farm 1041 - Check here 11111. and enter the amount of tax-exempt interest received or accrued durinu the year 11. 1 73 1 N/A

22353 1 01 03 Fam 990-PF (2032)


Form 990 PF

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) far political purposes (see instructions for definition)9 11 the answerrs 'Yes" to 1a or 1b, attach a detailed descnpuon of the activities and copies o(anymaterials published or

distributed by the organization in connection with the activities e Did the organization file Farm 1120-POL for this year? d Enter the amount (d any) of tax on political expenditures (section 4955) imposed during the year

(1) An the organization " $ 0 . (2) On organization managers 111- $ 0 . e Enter the reimbursement (d any) paid by the organization during the year for political expenditure tax imposed on organization

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

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? If 'Yes,' attach a conformed copy of the changes 4a Did the organization have unrelated business gross income of $1,000 or more during the yeah b If "Yes ; has it filed a tax return on Form 990-T for this year? N/A

5 Was there a liquidation, termination, dissolution, or substantial contraction during the year 11 '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? 1 Did the organization have at least $5,000 in assets at any time during the year

If "Yes, ' complete Part I/, co/ (c), and Part XV Be Enter the stales to which the foundation reports or with which it is registered (see instructions) 1111.

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

9 Is the organization claiming status as a private operating foundation within the meaning of section 49a2(j)(3) or 4942(1)(5) for calendar year 2002 or the taxable year beginning in 2002 (see instructions for Part XIV)9 If -yes, ' complete part x1v

10 Did any persons become substantial contributors during the tax yeah Ii "v� " attach . ~sauie listing their ham� wd addresses 11 Did the organization comply with the public inspection requirements for its annual returns and exemption application?

Website address " N/A

THE ALEXANDER SHASHATY FAMILY FOUNDATION Form 990-PF(2002) INC . 34-1667193 Page 5

File Form 4720 ii any item is checked in the "Yes" column, unless an exception applies 1e During the year did the organization (either directly or indirectly)

(1) Engage in the sale or exchange, or leasing of property with a disqualified persons Yes X No (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified persons Yes X No (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? Yes X No (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified persons Yes X 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) Yea X Na (6) Agree to pay money or property to a government official? (Exception Check'No'

d the organization agreed to make a grant to or to employ the official for a period after termination of government service, d terminating within 90 days ) Yes X No

b If any answer is 'Yes'to 1a(7) (6), did any of the acts fail to quaky under the exceptions described in Regulations section 53 4947(d)-3 or in a current nonce regarding disaster assistance (see gape 79 of the instructions)? N/A Organizations relying on a current notice regarding disaster assistance check here

c Did the organization engage in a prior year in any of the acts described in 1a, other than excepted acts, that were not corrected before the lust day of the tax year beginning in 2002

2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization eras a private operating foundation defined in section 4942(j)(3) or 4942(j)(5))

a At the end of lax year 2002, did the organization have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning before 2002? Yes X No If Yes; list the years

b Are there any years listed in 2a for which the organization is not applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets) to the year's undistributed 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 year? Yea X Na

6 If Yes; did it have excess business holdings in 2002 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 70-, 15-, or 20-year first phase holding periods Use Schedule C, Form 4720, to determine d the organization had excess business holdings in 2002) N/A

Ie Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes? b Did the organization make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that

had not been removed from jeopardy before the first day of the tax year beginning in 2002'+ Sa during the year did the organization pay or incur any amount to

(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))9 Yea X No (2) Influence the outcome of any specific public election (see section 4955), or to carry on, directly or indirectly,

any voter registration drive? Yes X No (3) Provide a grant to an individual for travel, study, or other similar purposes Yes X No (4) Provide a grant to an organization other than a charitable, etc , organization described in section

509(a)(1), (2), or (3), or section 4940(d)(2)? Yea X No (5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or tar

the prevention of cruelty to children or animals? Yea X Na 6 If any answer is 'Yes' to Sa(1)-(5), did any of the transactions hit to qualify under the exceptions described in Regulations

section 53 4945 or in a current nonce regarding disaster assistance (see instructions)? N/A Organizations relying on a current nonce regarding disaster assistance check here

c If the answer is 'Yes'to question Sa(4), does the organization claim exemption from the tax because it maintained expenditure responsibility forthepranC9 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 contracl9 Yes X No

b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract

223541 Ol 27-03


F~ 990-PF (zaoz)


Part Information About Officers, Directors, Trustees, Foundation Managers, Highly Page s 0VIII Paid Employees, and Contractors

3 Five highest-paid independent contractors for professional services If none, enter "NONE " (al Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation

"" 07 23A7 Fog 990-PF (2002)


services

List the loundation's four largest direct charitable activities during the tax year Include relevant statistical information such as the Expenses number of organizations and other beneficiaries served, conferences convened, research papers produced, etc

t N/A

2

3

4

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 l a __ b Average of monthly cash balances 16 c Fair market value of all other assets 1c d Total (add tines 1a, b, and c) 1d

e Reduction claimed for blockage or other factors reported on lines to and 1c (attach detailed explanation) to 0 .

2 Acquisition indebtedness applicable to line 1 assets 2 3 Subtract line 2 from line 1d 3 4 , Cash deemed held for charitable activities Enter 1 1/2% of line 3 (for greater amount, see instructions) 5 Net value of noncheritable-use assets Subtract line 4 from line 3 Enter here and on Part V, line 4 5 6 Minimum investment return Enter 5% of line 5 8

P01t XI DIStnbUtable Amount (see instructions) (Section 4942(j)(3) and (1)(5) private operating foundations and certain foreign aroanizations check here 1 and do not complete this part)


THE ALEXANDER SHASHATY FAMILY FOUNDATION Form 990-PF(20o2) INC . 34-1667193 Page 7

Part IX-B Summary'of Program-Related Investments

Describe the two largest oroaram-related investments made by the foundation during the tax year an lines 1 and

1

2

All other program-related investments See instructions 3

Total Add lines 1 through 3

1 Minimum investment return from Part X, line 6 2a Tax on investment income for 2002 from Part VI, line 5 b Income tax for 2002 (This does not include the tax tram Part VI ) s Add lines 2a and 2b

3 Distributahle amount before adjustments Subtract line 2c from line 1 4a Recoveries of amounts treated as qualifying distributions b Income distributions from section 4947(a)(2) trusts c Add lines 4a and 4b

5 Add lines 3 and 4c Deduction from distributable amount (see instructions)

7 Distnbutable amount as adjusted Subtract line 61rom line 5 Enter here and on Part XIII, line 1 I 7 I 9 , 897 .

Part XII Qualifying Distributions (see instructions)

1 Amounts paid (including administrative expenses) to accomplish charitable, etc, purposes a Expenses, contributions, gifts, etc -total tram Part I, column (d), line 26 1a 13 , 650 .

b Program-related investments-Total from Part IX-8 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 lest (attach the required schedule) 36

4 Qualifying distributions Add lines 1a through 3b Enter here and on Part V, line 8, and Part XIII, line 4 4 13 650 . 5 Organizations that quality under section 4940(e) far the reduced rate of tax on net investment

income Enter 1% of Part I, line 27b 5 114 . 6 Adjusted qualifying distributions Subtract line 5 from line 4 ~ 6 ~ 13, 536 .

Note The amount online 6 will be used m Part V, column (b), m subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax in those years

Form 990-PF (zooz)

zzasai Ol 23 07

8


THE ALEXANDER SHASHATY FAMILY FOUNDATION Form 9so-PF(2002) INC . 34-16671 9 3 Page 9

Part XIII Undistributed Income uses instructions)

(a) (b) (c) (d) Corpus Years prior to 2001 2001 2002

1 Distributable amount for 2002 from Part X1, line 7 9 , 897 . Undistributed income deny as Of the and of 2001

a Enter amount tar 2001 only 4 , 7 48 . y Total far prior years

0 . 3 Excess distributions carryover, d any, to 2002 e From 1997 6 From 1998 c From 1999 d From 2000 e From 2001 f Total of lines 3a through e 0 . 1

4 Qualifying distributions for 2002 from Pan XII, pine a t $ 13 , 650 .

a Applied to 2001, but not more than line 2a 4 , 748 . D 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 2002 disVibuta6le amount 8- , -902 . e Remaining amount distributed out of corpus 0 .

5 Evcess disvibutions carryover mplled to 7002 Q , Of m amount V0eva in column (d) the vme amount must be lIITVn in column (aw

6 Enter the net total of each column of indicated below Corpus Add lines Jf ac fund ae Subtract line 5 0 .

b Prior years' undistributed income Subtract line 4b tram line 2h 0 .

e Enter the amount of prior years' undistributed income for which a nonce of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed Q ,

d Subtract line 6c from line 6b Taxable amount - see instructions 0 .

e Undistributed income for 2001 Subtract line 4a from line 2a Taxable amount - see instr 0 .

f Undistributed income for 2002 Subtract lines 4d and 5 from line 1 This amount must be distributed in 2003 9 9 5 ,

7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(6)(1)(E) or 4942(p)(3) 0 .

B Excess distributions carryover tram 1997 not applied on line 5 or line 7 0 .

9 Excess distributions carryover to 2003 Subtract lines 7 and 8 from line 6a 0 .

10 Analysis of line 9 e Excess from 1998 b Excess from 1999 e Excess ham 2000 d Excess from 2001 e Excess from 2002 .

~ 72757 Fmn 990-PF (zooz) O1-23-03

Total

(1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 572(a)(5)), or royalties)

(2) Support ham general public and 5 or more exempt organizations as provided in section 4942(l)(3)(B)(m)

(3) Largest amount of support from an exempt organization

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

c~990-13F (2002) 73758tN1-27-03



instructions and Part VII A

1 a It the foundation has received a ruling or determination letter that it is a prorate operating foundation, and the ruling is effective for 2002, enter the date of the ruling

b Check box to indicate whether the orA 2 a Enter tie lesser of the adjusted net

income from Part I or the minimum investment return from Part X for each year listed

6 85%, of line 2a c Qualifying distributions from Part %1I,

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

o Qualifying distributions made directly for active conduct of exempt activities Subtract line 20 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(l)(3)(B)(i)

6 'Endowment alternative best - Enter 213 of minimum investment return shown in Part X, line 6 for each year fisted

e 'Support' alternative test - enter

Pal rt XV I Supplementary information (Complete this part only it the organization had X5,000 or more in assets at any time during the year-see page 25 of the instructions.)

1 Information Regarding Foundation Managers a List any managers of the foundation who have contributed more than 2°/, of the total contributions received by tie foundation before the close of any tax

year (Out only d they have contributed more than $5,000) (See section 507(d)(2) )

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%a or greater interest.

NONE 2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, atc, Programs

Check here " X d the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests tar funds II the organization makes gifts, grants, etc (see instructions) to individuals or organizations under other conditions, complete items 2a, b, c, and d

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

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

c My submission deadlines


723EOtiDi-27-03 Form Q0-PF ROOD

10


p Fees and contracts ham government agencies 2 Membership dues and assessments 3 Interest on savings and temporary cash

investments 14 837 . 4 Dividends one interest from securities 14 4 , 8-36 . 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

7Other investment income 15 6 , 0 27 . 8 Gain or (loss) from sales of assets other

than inventory 1 8 3 . 9 Net income or (loss) from special events

10 Gross profit or (loss) from sales of inventory 11 Other revenue

e b e d 0

12 Subtotal Add columns (b), (d), and (e) 0 . 11,703 . 1 0 . 13 Total Add line 12, columns (b), (d), and (e) 13 11,703 . (See worksheet in line 73 instructions to verily calculations 1

Part XVI-B Relationship of Activities to the Accomplishment of Exempt Purposes


THE ALEXANDER SHASHATY FAMILY FOUNDATION Form 990-PF(20o2) INC . 34-1667193 Pace i t Part XVI-A Analysis of Income-Producing Activities

Enter gross amounts unless otherwise indicated unreiarea ousiness income e+cwesa e neon 512 , 51 3 , 514 (a) (b) E!cu- (d) Related or exempt

Business Amount mod; Amount function income 1 Program service revenue code

a b c d ~~ e I I f

THE ALEXANDER SHASHATY FAMILY FOUNDATION 34-1667193 Farm 990-PF

Regarding Transfers

Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of Yf the Code (other than section 507(c)(3) organizations) or in section 527, relating to political orpan¢auons9

a Transfers from the reporting organization to a noncharitable exempt organization of (1) Cash 1110 1 (2) Other assets 1a 2

b Other Transactions (1) Sales of assets to a noncharitable exempt organization 1b 1 (2) Purchases of assets from a noncharitahle exempt organization 1b 2 (3) Rental of facilities, equipment, or other assets UP) (4) Reimbursement arrangements lb ( 4 ) (5) Loans or loan guarantees 1b 5 (6) Performance of services or membership or fundraising solicitations 1b 8

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees 1e d If the answer to any of tie 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 orpanizallon If the organization received less than lair market value in any transaction or sharing arrangement, show in

X

2a Is the organization duecty or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 5217 Yes X No

6 If 'Yes! complete the lollowina schedule

and statement and to the beat of my knowledge mC belief it is Vua caract,

10571111 759239 SHASHATYFAMI 2002 .06030

N/A

Under pylalhu of pa N7 I declare the I nave examined Ihl ntum IneluOinp accompanying end mq(oy ~ D vnion of ~va ( en tav ~iduei o ba~ e on elf infmm

d ' U

ure of officer or trusW H reparer's'

signature y y`c

a~ Armsnime(oiyours PACKER THOMAS aj nsm<moiayw) '1000 BANK ONE BUILDING

~aaless~~aziecoae vnrrur_emnwra nu aaSn'A

113021 01-13-07

of

Form $868 (December 2000)'

Department of the Treasury Inlemnl Revenue Service

Application for Extension of Time To File an Exempt Organization Return

" File a separate application for each return

OMB No 1545 1709

Note Form 990-T corporations requesting an automatic 6-month extension - check this box and complete Part 1 only All other corporations Including Form 990-C tilers) must use Form 7004 to request an extension of time to file income tax returns Partnerships, REMICs end trusts must use Form 8736 to request an extension of trine to No Form 1065, 1066, or 7041

Name of Exempt Organization THE ALEXANDER SHASHATY FAMILY FOUNDATION INC . Number, street, and room or suite no If a P O box, see instructions C/O MILDRED SHASHATY, 41562 LODGE RD

34-1667193 File by the due dale ho Ailnp your rvium see in avudlom City, town or post office, state, and ZIP code For a foreign address see Instructions

LEETONIA, OH 44431

15420514 759239 SHASHATYFAMI 2002 .05040 THE ALEXANDER SHASHATY F11MI SHASHA01

If you are tiling for an Automatic 3-Month Extension, complete only Part I and check this box " ~X I( you are tiling for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this loan)

Note Do not complete Part II unless you have already been granted an automatic 3-month extension on e previously tiled Form 8868

Part I Automatic 3-Month Extension of Time - Only submit original ono copies needed

Type or print

Employer Identification number

Check type o1 return to be flled(Ille a separate application (or each return)

Form 990 0 Form 990 T (corporation) EDForm 4720 Form 990 BL ~ Form 990 T (sec 401(x) or 406(x) trust) 0 Form 5227

0 Form 990 EZ ~ Form 990 T (trust other than above) ~ Form 6069 Form 990 PF 0 Form 1047 A ~ Form 8870

" II the orponlzotlon does not have an office or place of business In the United Stales check this box " 0 " II this Is for D Group Retina, enter the organization's lour digit Group Exemption Number (GEN) 11 this Is for the whole group, check this box " [1 If II Is for part of the prow, chock tlil9 box " 1= and attach n let with the names and EINs of ell members the extension will cover

t I request an automatic 3 month (B month, for 990-T corporation) extension of time until AUGUST 15r 2003 to file the exempt organization return for the organization named above The extension is for the organization's return for " [Vw] calendar year 2 0 0 2 or " 0 tax year beginning' and ending

2 II this tax year Is for less than 12 months, check reason ~ Initial return ~ Final return ~ Change In accounting period

9a I1 this application is for Form 990 BL . 990 PF, 990T . 4720, or 6069, enter the tentative tax, less any nonrefundable credits Sea instructions $ 68 .

b 11 this application Is for Form 990 PF or 990 T, enter any refundable credits end estimated tax payments made Include any Prior year overpayment allowed as a credit $ 66 .

c Balance Due Subtract line 3b from line 3a Include your payment with this form or. I1 required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See Instructions 5

Signature and Verification

Under penalties of perjury 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 loam

Signature " r Title " AGENT (OHIO CPA) pate " fly LHA For aperwork Reduction Act Notice, see instruction Form 8868 (12-2000)

223931 OS 01 07

City or [own, province or state and country (incluo~ng postal or ZIP code) 6232 823'12 I YOUNGSTOWN, OH 44503

Form 8868 (12-2000)

16220811 759239 SHASHATYFAYII 2002 .06010 THE ALEXANDER SHASHATY FAMI SHASHA01

Form 8868 112-2000) Paae 2

Ii you are fling for an Auditional (not automatic) 3-Month Extension, complete only Part II and check this box " ~X Note Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868

It you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1) Part 11 1 Additional (not automatic) 3-Month Extension of Time - Must file Original and One Copy

Name of Exempt Organization Employer identification number Type or HE ALEXANDER SHASHATY FAMILY FOUNDATION

INC . 34-1667193 Fne by Me e� e�aed Number, street, and room or suite no If a P O box, see instructions For IRS use only aueaatemr/O MILDRED SHASHATY, 41562 LODGE RD Rlinq Ine reNm sK Qty, town or post office, state and ZIP code For a foreign address see instructions '"'`"'"°"` EETONIA, OH 44431 Check type of return to be filed (File a separate application for each return)

Form 990 = Form 990-EZ ~ Form 990 T (sec 401(a) or 408(a) trust) ~ Form 1041 A ~ Form 5227 ~ Form 8870 D Form 990 BL =X Form 990 PF ~ Form 990 T (trust other than above) ~ Form 4720 ~ Form 6069

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

If the organization does not have an office or place of business in the United States, check this box If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) I` this is for the whole group, check :his

box " 0 If it 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 is for

4 I request an additional 3 month extension of time until NOVEMBER 12, 2003 5 For calendar year 2 0 0 2 , or other tax year beginning ~- ~ and ending 6 If this tax year is for less than 12 months, check reason ~ Initial return ~ Final return ~ Change in accounting period 7 State in detail why you need the extension

ADDITIONAL INFORMATION IS NEEDED FROM INDEPENDENT THIRD PARTIES IN ORDER TO FILE A COMPLETE AND ACCURATE RETURN .

8a 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 5 - 68 .

b If this application is (or Form 990 PF, 990 T, 4720 or 6069, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit and any amount paid previously with Form 8868 S 68 .

c Balance Due Subtract line 8b from line 8a Include your payment with this form, nr, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See instructions S 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 tNe correct, and complete, and that I am authorized to prepare this form

Signature " ~ki7 title " AGENT OHIO CPA Date " Q1" No ice to Applicant - To Be Completed by the IRS

We have approved this application Please attach this form to the organization's return We have not approved this application However, we have granted a 10 day grace period from the later of the date shown below or the due date of the organization's return (including any prior extensions) This grace period is considered to be a valid extension of time for elections otherwise required to be made on a timely return Please attach this form to the organization's return _ We have not approved this application After considering the reasons stated in item 7 we cannot grant your request for an extension of time tn

file We are not granting the I 0-day grace period

We cannot consider this application because it was filed after the due date of the return for which an extension was reqyested j

Other

Director Date

Alternate Mailing Address - enter the address if you want the copy of tots application for an addiLOnal3 month extension returned to an address different than the one entered above

Name SS JR ., CPA, C/0 PACKER THO

Type Number and street (include sure room, or apt no) Or a P O box number or print I 1000 BANK ONE BUILDING

THE ALEXANDER SHASHATY FAMILY FOUNDATION 34-1667193

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

AMOUNT

TOTAL TO FORM 990-PF, PART I, LINE 3, COLUMN A 837 .

FORM 990-PF DIVIDENDS AND INTEREST FROM SECURITIES STATEMENT 2

2,337 . 2,499 .

MERRILL LYNCH - DIVIDEND INCOME MERRILL LYNCH - INTEREST INCOME

I TOTAL TO FM 990-PF, PART I, LN 4 4,836 . 0 . 4,836 .

FORM 990-PF OTHER INCOME STATEMENT 3

TOTAL TO FORM 990-PF, PART I, LINE 11, COLUMN A 6,027 .

FORM 990-PF ACCOUNTING FEES STATEMENT 4

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

DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES

1,750 . 250 . 0 . 1,500 .

1,750 . 250 . 0 . 1,500 . TO FORM 990-PF, PG 1, LN 16B

13 STATEMENT S) 1, 2, 3, 4 10571111 759239 SHASHATYFAMI 2002 .06030 THE ALEXANDER SHASHATY FAMI SHASHA01

SOURCE

ML RANKING ADVANTAGE 837 .

SOURCE GROSS AMOUNT CAPITAL GAINS COLUMN (A) DIVIDENDS AMOUNT

0 . 2,337 . 0 . 2,499 .

DESCRIPTION

MERRILL LYNCH - ROYALTY TRUST DISTRIBUTION

AMOUNT

6,027 .

PACKER THOMAS

THE ALEXANDER SHASHATY FAMILY FOUNDATION 34-1667193

FORM 990-PF OTHER INVESTMENTS STATEMENT 7

140,876 117,800 . TOTAL TO FORM 990-PF, PART II, LINE 13

14 STATEMENT S) 5, 6, 7 10571111 759239 SHASHATYFAMI 2002 .06030 THE ALEXANDER SHASHATY FAMI SHASHA01

FORM 990-PF OTHER EXPENSES STATEMENT 5

(A) (H) (c) (n) EXPENSES NET INVEST- ADJUSTED CHARITABLE

DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES

ACCOUNT FEE 100 . 50 . 0 . 50 . STATE FILING FEE 100 . 0 . 0 . 100 .

TO FORM 990-PF, PG 1, LN 23 200 . 50 . 0 . 150 .

FORM 990-PF CORPORATE STOCK STATEMENT 6

FAIR MARKET DESCRIPTION BOOK VALUE VALUE

SIERRA PACIFIC RES NEW 23,424 . 6,500 . LUCENT TECHNOLOGIES, INC . 58,414 . 1,890 . AVAYA, INC . 4,139 . 306 . XCEL ENERGY INC 21,884 . 11,000 . AGERE SYSTEMS INC DEL A 509 . 23 . AGERE SYSTEMS INC CL B 12,535 . 554 .

TOTAL TO FORM 990-PF, PART II, LINE lOB 120,905 . 20,273 .

DESCRIPTION

BP PRUDHOE HAY CLNL INTR HI INCM FD SBI DN WESTERNHK OF PR CALLABLE CD 6$ 2/1/12

HOOK VALUE

69,277 . 21,599 . 50,000 .

FAIR MARKET VALUE

59,040 . 8,760 .

50,000 .

Documents

Form 990-PF , Return of Private Foundation or Section 4947 ...990s.foundationcenter.org/990pf_pdf_archive/341/341667193/...2 Fae~~ npanixationa mail the e5% test Uadi use and attxn