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(1) There may be legitimate reasons why Judge Adelman chose not to disclose various interests and events in these statements. No claim is made that any laws have been violated. (2) There is also a possibility that the data is incorrect or outdated, which is why the reader should not rely on it and should independently verify this information for themselves.(3) Why are the amounts of the investments and transactions omitted from the disclosures?(4) Who are the donors to the Adelman Family Foundation? (5) See $12,240,000 STATE OF CONNECTICUTHEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, CONNECTICUT COLLEGE ISSUE, SERIES Ihttp://www.fpr.net/fulfillment/pdf/post_os_chefa_connecticut_college_2012i.pdf(6) Draw your own conclusions.
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3/17/13 11:20 AMGerard Adelman | LinkedIn
Page 1 of 2http://www.linkedin.com/pub/gerard-adelman/5/113/3
consulting offers expertise requests business deals reference requests getting back in touch
Gerard Adelman's OverviewAttorney at Weigand, Mahon & AdelmanGovernor at Connecticut Bar AssociationThe University of Connecticut School of LawSouthern Connecticut State UniversityThe Ohio State University10 connectionsCompany Website
Gerard Adelman's Experience
AttorneyWeigand, Mahon & AdelmanNovember 1982 – Present (30 years 5 months)Since 1974, we have provided the full range of legal services to the greater Meriden area. I personnally limit my practice to family law with an emphasison alternative dispute resolution modes such as collaborative divorce and divorce mediation. I also assist disabled invviduals obtain Social Securitydisability benefits.
GovernorConnecticut Bar AssociationNonprofit; 11-50 employees; Nonprofit Organization Management industry2004 – 2009 (5 years)
Gerard Adelman's Education
The University of Connecticut School of LawJD1978 – 1982
Southern Connecticut State UniversityMA in History, American history1970 – 1977
The Ohio State UniversityBA, History1967 – 1970
Gerard Adelman's Additional Information
Company Website
Divorce mediation, Collaborative divorce and other alternative dispute resolution methods in family law.
IACP. ABA, CBA, New Haven County Bar Association, The Rotary Club of Meriden, CT., Divorce Solutions of CT, TheCollaborative Divorce Team of CT.
Phi Beta Kappa (Epsilon of Ohio@Ohio State University)
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Gerard AdelmanAttorney at Weigand, Mahon & AdelmanGreater New York City Area Law Practice
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3/17/13 11:25 AMMeriden Rotary Club Essay/Speaking Contest Video
Page 1 of 1http://www.meridenrotary.org/news/newsView.asp?NewsId=4096836
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Meriden Rotary Club Essay/Speaking Contest Video
12/14/2009
MERIDEN - The Meriden Rotary Club's Four Way Test Essay and Speaking Contest took place Dec. 2. Advertisement Kate Mordarski, a junior at Platt High School, won first
place in the speaking and essay contest while Jose Brocero, also a Platt junior, took second place in both categories. Jordan Adams, a Platt junior, placed third in the speaking
contest while Kaitlyn Dyrek, a Maloney High School junior, took third place in the essay contest. Judges for the essay contest were Marcia Trotta, a professor at Albertus
Magnus College; Peter Melien, attorney at law; Jim Ieronimo, Executive Director for United Way of Meriden-Wallingford; Frank Ridley, Commissioner of Higher Education;
Mary Cortright, Meriden Superintendent of Schools. Judges for the speaking contest were Cliff Carlson, President of the Meriden Rotary Club; Gerard Adelman, Superior Court
Judge; Kevin Curry, Past President of the Meriden Rotary Club; Joanne Bugai, Interim Director of Middlesex Community College's Meriden campus; Liz White, Record-
Journal's Associate Publisher for New Media. Courtesy of Record Journal © www.MyRecordJournal.com 2009
© 2010-2013 All rights reserved. Rotary Club of Meriden, CT.
MERIDEN ROTARY CLUB “GOOD SPOKE” Meriden, Connecticut, USA
President Rob Tarlov Pres Elect
Tari Marshall-Day Vice President Ty Bongiovanni
Secretary Rob Tarlov Treasurer Dave Lake
Ass't Secretary Kieren Moore
Ass't Treasurer Yvonne de Angeli -
Fontanez Sergeant at Arms
Gloria Griffiths Assist. Sergeant at Arms:
Angela LaMoria IPP : Pam Craig-White
Newsletter Editor Tari Marshall –Day
Service Above Self MAR 3, 2012 VOL 11-12 ISSUE 36
NEWS!
What we cover!
Presidents News
This Past Week
Looking Forward
Reflections
Remember
SEE PAGE 4 for UPCOMING
EVENTS AND SPEAKERS!
ABOVE—CELEBRATING PAST-PRESIDENTS’ DAY AT
ROTARY LUNCH James Clarke 1985 Sam Carr 1986 Mike Barker 1987
Gerard Adelman 1990 Dan Roman 1992 Sandra Schede 1994
Pat Sawicki 1995 Lynn Faria 1998 Kevin Curry 1999
Marcia Trotta 2000 Marlene McGann 2002
Thomas Barton 2005 Craig Nielsen 2006
In Memoriam Dan Hunter 2007
Adam Mosher 2008 Cliff Carlson 2009
Pam White 2010
REMINDER! Check the Calendar on Page 4 for upcoming events!
India removed from polio-endemic list
The World Health Organization has removed India from the list of polio-endemic countries. The news was announced at the Polio Summit 2012 in New Delhi, India. Read "India is no longer polio endemic" Read more from Rotarians who took part in National Immu-nization Days in Rotary Voices
Page 2
“Rotary’s influence on the heart of the world will be in direct
proportion to the number of communities that are exposed to the Rotary ideal. So let us help to found new clubs wherever the soil is
at all fertile.” — Five Goals for Friendly Men, THE ROTARIAN, July 1950
LAW AND ORDER ... ROTARY STYLE …
Thank you!
Judge Gerard Adelman (Past President of Meriden Rotary)
We all, at some point, get caught
up in CSI, MI-5..James Bond...Law and Order… but it is captivating,
for sure, to understand the day to day process of being a Judge. To
hear about how decisions are made and how heart-wrenching
some decisions can be, really focuses on the
“Service Above Self” of a Judge.
June 16 at Jennifer's House of Hair on
Broad St. To benefit Girls Inc.
SAVE THE DATE for AMBER ALERT
*** TIMES TO FOLLOW
Page 4 MERIDEN ROTARY
“Merely selling things is boredom;; selling services is the stuff of which self-respect
and dignifying one’s vocation are made.” — Rotary in a Progressing World, THE ROTARIAN, July 1934
TUESDAY, FEBRUARY 21 (SPEAKER)
FELLOWSHIP
TUESDAY, FEBRUARY 28 (SPEAKER)
Judge Gerard Adelman (Past President of Meriden Rotary)
WEDNESDAY, FEBRUARY 29 (ROUND-TABLE MAKE UP MEETING)
Four Points by Sheraton at 5:30 P (Check reader-board for room location)
MY CITY KITCHEN FUNDRAISER - MARCH 31 at the MARC TWAIN HOUSE
See the link for details
http://www.mycitykitchen.org/wp-content/uploads/2012/01/Extravaganza-Flyer1.pdf
***SAVE THE DATE!***
SATURDAY - APRIL 14th… QUINNIPIAC RIVER CLEANUP!
Please e-mail Tari at
[email protected] for any calendar additions, changes or updates!
3/17/13 11:03 AMCommercial Recording Division
Page 1 of 1http://www.concord-sots.ct.gov/CONCORD/PublicInquiry?eid=9744&businessID=0611431
Business InquiryBusiness Inquiry Details
Business Name: THE ADELMAN FAMILYFOUNDATION, INC. Business Id: 0611431
Business Address: 562 BALDWIN AVENUE, UNIT#2, MERIDEN, CT, 06450 Mailing Address: 562 BALDWIN AVENUE, UNIT #2,
MERIDEN, CT, 06450
Citizenship/State Inc: Domestic/CT Last Report Year: 2013
Business Type: Non-Stock Business Status: Active
Date Inc/Register: Jan 15, 1999
Principals
Name/Title: Business Address: Residence Address:
GEORGIA B. ADELMAN PRESIDENT
GAYLORD HOSPITAL, GAYLORDFARM ROAD, POB 400,WALLINGFORD, CT, 06492
562 BALDWIN AVE, UNIT #2, MERIDEN, CT, 06450
JESSICA A. KOGUT VICE PRESIDENT
234 LYDALE PLACE, MERIDEN,CT, 06450 234 LYDALE PLACE, MERIDEN, CT, 06450
GERARD I. ADELMAN SECRETARY
54 W. MAIN ST., (SUPERIORCOURT - JUDGE'S SECTY),MERIDEN, CT, 06451
562 BALDWIN AVE, UNIT #2, MERIDEN, CT, 06450
Business Summary
Agent Name: GERARD I. ADELMAN
Agent BusinessAddress: 54 WEST MAIN ST, MERIDEN, CT, 06451
Agent ResidenceAddress: 562 BALDWIN AVENUE #2, MERIDEN, CT, 06450
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3/17/13 11:00 AMAdelman Family Foundation - About | Facebook
Page 1 of 1https://www.facebook.com/AdelmanFamilyFoundation/info
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Adelman Family Foundation About Like
About
The Adelman Family Foundation was organized in1999 to assist Meridenresidents interested in a nursing career.
Description
The Foundation was begun in honor of Georgia B. Adelman, R.N., B.S.N.on the occasion of her 50th birthday. Having a scholarship program foraspiring nurses had been a long time ambition of Mrs. Adelman and herfamily. Nineteen $500 scholarships have been awarded by theFoundation through the academic year 2010-2011.
The Foundation is a tax-exempt non- profit organization and is fundedtotally by the donations of private citizens.
General Information
Eligibility:Must be a resident of Meriden, CT at the time of graduation from highschool or a graduate from a high school located in Meriden, CT
Must be planning to pursue a career in nursing through either a BSNprogram or any program that would make the student eligible to sit forthe Connecticut Registered Nurse Examination.
Must be able to demonstrate a history of civic or communityinvolvement.
Must be able to demonstrate a financial need for the scholarshipassistance.
Basic Info
Founded 1999
Contact Info
Email [email protected]
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3/17/13 10:59 AMPast winners of the Adelman Family Foundation Scholarship | Facebook
Page 1 of 1https://www.facebook.com/notes/adelman-family-foundation/past-winners-of-the-adelman-family-foundation-scholarship/134254166697227
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by Adelman Family Foundation (Notes) on Monday, February 20, 2012 at 4:53pmPast winners of the Adelman Family Foundation Scholarship
2012 Envy Stone Danielle Harriott 2011 Kimberly Crawford Kimberly Cornell Kaitlyn Dyrek2010 Kayla McQuade Jaboa Davis Heather Vicenty 2009 Roshni Patel 2008 No winner 2007 Shannon Jones 2006 Shari Stanely2005 Samantha Wilson Yalitzia Garcia 2004 Catherine M. Smock Brandon T. Brady 2003 Evan A. Landry Binal A. Salsani Kristin E. Jones Priscilla L. Crespo 2002 Vanessa Chaparro Stanio2001 Juliana Baez
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3/17/13 11:36 AMCommercial Recording Division
Page 1 of 1http://www.concord-sots.ct.gov/CONCORD/PublicInquiry?eid=9744&businessID=0880357
Business InquiryBusiness Inquiry Details
Business Name: J. P. FACILITIES, LLC Business Id: 0880357
Business Address: 1007 MIDDLETOWN AVENUE,NORTH BRANFORD, CT, 06471 Mailing Address: PO BOX 819, DEER PARK, NY,
11729
Citizenship/State Inc: Domestic/CT Last Report Year: 2011
Business Type: Domestic Limited LiabilityCompany Business Status: Active
Date Inc/Register: Nov 29, 2006
Principals
Name/Title: Business Address: Residence Address:
JOSEPH PELOSITRUST MEMBER
1007 MIDDLETOWN AVENUE,NORTH BRANFORD, CT, 06471
C/O ROBERT PELOSI, AS TRUSTEE, PO BOX 819,377 CARLL'S PATH, DEER PARK, NY, 11729
Business Summary
Agent Name: GERARD I. ADELMAN
Agent BusinessAddress: 636 BROAD STREET, MERIDEN, CT, 06450
Agent ResidenceAddress: 50 WILLIAM AVENUE, MERIDEN, CT, 06451
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3/17/13 11:37 AMCommercial Recording Division
Page 1 of 1http://www.concord-sots.ct.gov/CONCORD/PublicInquiry?eid=9744&businessID=0692969
Business InquiryBusiness Inquiry Details
Business Name: SENTINEL SPECIAL SERVICES,LLC Business Id: 0692969
Business Address: 19 LITTLE CITY RD.,HIGGANUM, CT, 06441 Mailing Address: NONE
Citizenship/State Inc: Domestic/CT Last Report Year:
Business Type: Domestic Limited LiabilityCompany Business Status: Active
Date Inc/Register: Oct 11, 2001
Principals
Name/Title: Business Address: Residence Address:
JAMES R. SAUCIER MEMBER
19 LITTLE CITY RD., HIGGANUM,CT, 06441 19 LITTLE CITY RD., HIGGANUM, CT, 06441
Business Summary
Agent Name: GERARD I. ADELMAN, ESQ.
Agent BusinessAddress: 636 BROAD ST., P. O. BOX 2420, MERIDEN, CT, 06450
Agent ResidenceAddress: 50 WILLIAM AVE., MERIDEN, CT, 06451
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3/17/13 11:38 AMCommercial Recording Division
Page 1 of 1http://www.concord-sots.ct.gov/CONCORD/PublicInquiry?eid=9744&businessID=0897154
Business InquiryBusiness Inquiry Details
Business Name: RNSC, LLC Business Id: 0897154
Business Address: 523 NORTH COLONY STREET,MERIDEN, CT, 06450 Mailing Address: 523 NORTH COLONY STREET,
MERIDEN, CT, 06450
Citizenship/State Inc: Domestic/CT Last Report Year: 2008
Business Type: Domestic Limited LiabilityCompany Business Status: Active
Date Inc/Register: Apr 23, 2007
Principals
Name/Title: Business Address: Residence Address:
ROGER R. NEMEC MEMBER
523 NORTH COLONY STREET,MERIDEN, CT, 06450 523 NORTH COLONY STREET, MERIDEN, CT, 06450
STEVE CHASSE MEMBER
523 NORTH COLONY STREET,MERIDEN, CT, 06450 104 MILLER AVE, MERIDEN, CT, 06450
Business Summary
Agent Name: GERARD I. ADELMAN
Agent BusinessAddress: 636 BROAD ST, MERIDEN, CT, 06450
Agent ResidenceAddress: 50 WILLIAM AVE, MERIDEN, CT, 06451
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3/17/13 11:33 AMMeriden Court To Begin Special Masters Program - Mahon, Quinn & Mah…and, Mahon & Adelman - Attorneys at Law, Meriden, Connecticut (CT)
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Meriden Court To Begin Special Masters Program
1/22/2004
The Judges sitting in the Superior Court, Judicial District of New Haven at Meriden voted to initiate a "special masters" pretrial program
for dissolution cases yesterday. Attorney Gerard I. Adelman of Weigand, Mahon & Adelman, Attorneys at Law, P.C. of Meriden,
Connecticut initiated the idea and has recruited an initial group of about thirty attorney volunteers.
A special masters program uses experienced family law practitioners to pretry dissolution cases with the hope of developing a
satisfactory resolution short of a full trial. A two person team consisting of a male and female volunteer meet with the attorneys
representing the parties and hear the essential facts of the case. As objective and knowledgeable third parties, such pretrials frequently
result in settlements being reached. Such special master programs are currently being used in the New Haven and Middlesex courts
with good success.
Attorney Adelman first suggested the idea of such a program in Meriden to Judges Wiese and Fischer last spring, but the implantation
was delayed when the composition of the sitting judges changed in September 2003. After allowing the new judges to be acclimated to
Meriden, Adelman brought the idea up again and was allowed to begin recruiting volunteers. Judges Wiese, Frazzine and Tanzer voted
to start the program. The first special master pretrials are expected to begin sometime in March 2004.
© 2008-2013 All rights reserved. Mahon, Quinn & Mahon P.C. Attorneys at Law - Formerly Weigand, Mahon & Adelman. | Privacy Policy | SiteMapMahon, Quinn & Mahon. P.C. Attorneys at Law specialize in Social Security Disability, Personal Injury, DUI Defense and Workers' Compensation.Located at 636 Broad Street, Meriden, CT 06450.
3/17/13 10:58 AMAdelman Family Foundation | Facebook
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Non-Profit OrganizationThe Adelman Family Foundation was organized in1999 toassist Meriden residents interested in a nursing career.
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ScholarshipApplication DeadlineAll applications for thenursing scholarship forthe academic year2011-2012 muNotes 3
Highlights
Adelman Family FoundationFebruary 8
Both of our 2012 scholarship winners have checked in withthe Foundation to report their successful start in theirstudies. Both are doing quite well and we have great confidence intheir futures as active RNs. Keep up the good work, ladies.
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Gerard AdelmanHere is the current application for the Foundation sch…February 15 at 9:33am
Gerard AdelmanThe applications for the 2012-2013 academic year ar…February 15 at 9:30am
Gerard AdelmanThe AFF received a very significant donation from the …August 29, 2012 at 8:46am
Gerard AdelmanWe recently received a very generous donation by our…
5 2 · July 25, 2012 at 10:05amAdelman Family FoundationJanuary 19
2012 was a very good year for The Adelman FamilyFoundation! We received $3,160.00 in donations which isdouble our donations for the previous year.
We want to thank our many supporters and thank themonce again for their ongoing support year after year.
The applications for this year's scholarships will be goingout to the schools in just a few weeks and we look forwardto awarding college scholarships to assist future nurseswith their education.
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Adelman Family FoundationMay 16, 2012
The scholarships for academic year 2011-2012 have beenawarded. This year's scholars are Ms Envy Stone and MsDanielle Harriott.Envy will graduate Platt High School next month ranked 3rdout of a class of 220. She will be attending St. JosephCollege in Hartford this fall. Many of her courses at Platthave been advanced placement or honors level classes. Weare quite proud to be supporting he...See More
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Adelman Family FoundationApril 30, 2012 near Portland, CT via mobile
Tomorrow is the filing deadline for this year's scholarships.We are excited to see them.
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Adelman Family FoundationMarch 22, 2012
Scholarship Application DeadlineAll applications for the nursing scholarship for the academic year2011-2012 must be submitted my the announced deadline which isTuesday, May 1, 2012.
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Adelman Family FoundationFebruary 20, 2012
Past winners of the Adelman Family FoundationScholarship2012 Envy Stone Danielle Harriott 2011 Kimberly Crawford Kimberly Cornell Kaitlyn Dyrek...
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Adelman Family FoundationFebruary 20, 2012
The Meriden Record-Journal published a story announcingthat our scholarship applications for the current academicyear were available. They can be obtained at any of thethree Meriden high schools, the public library or the Boardof Education.
Like · Comment 1Adelman Family FoundationFebruary 15, 2012
Adelman Family Foundation ApplicationThe Adelman Family Foundation, Inc.Once application is completed please email:[email protected] for the mailing address tosubmit the application and supporting documentation. Nursing Career Scholarship Application ...
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55c 22 Printing and publications
Return of Private Foundation OMB No 1545-0052Form 990-PF or Section 4947(a)(1) Nonexempt Charitable Trust
2011Department of the Treasury Treated as a Private FoundationInternal Revenue service Note . The foundation may be able to use a copy of this return to satisfy state re p ortin g re q uirements.For calendar Year 2011 or tax year beainnina . and endino
Name of foundation A Employer identification number
THE ADELMAN FAMILY FOUNDATION , INC 06-1537647Number and street (or P O box number if mail is not delivered to street address) Room/sulte B Telephone number562 BALDWIN AVENUE 4-2 , #2 203-631-5255
City or town, state, and ZIP code C If exemption application is pending , check here
MERIDEN , CT 06450-3596G Check all that apply. 0 Initial return 0 Initial return of a former public charity D 1. Foreign organizations, check here
0 Final return 0 Amended return
0 Address chan g e E] Name chang e 2. check har=zatd compsthe 85% test,
H Check type of organization: ® Section 501(c)(3) exempt private foundation E If private foundation status was terminatedSection 4947(a)( 1 ) nonexem pt charitable trust 0 Other taxable p rivate foundation under section 507(b)(1)(A), check here
I Fair market value of all assets at end of year J Accounting method: ® Cash Accrual F If the foundation is in a 60-month termination(from Part fl, col. (c), line 16) 0 Other (specify) under section 507(b)(1)(B), check here111114 8 8 5 9 . (Part 1, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (a) Revenue and (b) Net investment (c) Adjusted net ( d) Disbursements(The total of amounts in columns (b), (c), and (d) may notnecessarily equal the amounts in column (4) expenses per books income income
for charitable purposes(cash basis only)
1 Contributions, gifts, grants, etc., received 15752 Check^® B the foundation Is not required to attach Sch B
Interest on savings and temporary3 ^f„nvestments 22. 22. 22. Statement 14 Dividends and interest from securities5a Gross rentsb Net rental income or Qoss)
6a Net gain or (loss) from sale of assets not on line 10Gross sales price for all
b assets on line Ba
d 7 Capital gain net income (from Part IV, line 2) 0
8 Net short-term capital gain _O_ CUUVED9 Income modifications . . ^ U
Gross sales lass returns10a and allowances c0 v
b Less . Cost of goods sold , t r
c Gross profit or (loss) rY
11 Other income L_U E12 Total . Add lines 1 throu g h 11 1597. 22. 22.13 Compensation of officers , directors , trustees , etc. 0. 0. 0. 0.
14 Other employee salaries and wages15 Pension plans, employee benefits
Ny 16a Legal feesQ b Accounting fees $tmt 2 315. 0. 0. 315.il^ c Other professional fees
9 17 Interest
18 Taxes Stmt 3 1. 0. 0. 1.19 Depreciation and depletion
E 20 Occupancya 21 Travel, conferences, and meetings
i 23 Other expenses $ tmt 4 50. 0. 0. 50.24 Total operating and administrative
a expenses . Add lines 13 through 23 366. 0 . 0 . 3 6 6.0 25 Contributions, gifts, grants paid 1500. 1500.
26 Total expenses and disbursements.Add lines 24 and 25 1866. 0. 0. 1866.
27 Subtract line 26 from line 12:a Excess of revenue over expenses and disbursements - 2 6 9 .
b Net investment income (if negative, enter -0-) 22. 1c Adiusted net income o f negative , enter -0-) 22.
12-02^1 LHA For Paperwork Reduction Act Notice, see instructions. Form 99U-PF (2011)
^7
Form 990-PF 2011 THE ADELMAN FAMILY FOLTNDATION INC U15-15371547 Pan e 2
Balance Sheets Ati"hedschedules and amounts in me description Beginning of year End of yearPart II column should be for end-ol-yearamountsonry (a) Book Value (b) Book Value (c) Fair Market Value
1 Cash - non-interest-bearing
2 Savings and temporary cash investments 9128. 8859. 8859.3 Accounts receivable ^
Less: allowance for doubtful accounts ^4 Pledges receivable ^
Less: allowance for doubtful accounts ^5 Grants receivable6 Receivables due from officers, directors, trustees, and other
disqualified persons
7 Other notes and loans receivable ^
Less: allowance for doubtful accounts ^8 Inventories for sale or use
9 Prepaid expenses and deferred charges10a Investments - U.S. and state government obligations
b Investments - corporate stockc Investments - corporate bonds
11 Investments - land, buildings , and equipment basis ^
Less accumulated depredaboo ^
12 Investments - mortgage loans
13 Investments - other14 Land, buildings, and equipment basis ^ 180.
Less accumulated depredation Stmt 5 ^ 180.15 Other assets (describe ^
16 Total assets to be completed by all filers 9128. 8 8 5 9 . 8 8 5 9 .17 Accounts payable and accrued expenses
18 Grants payablea) 19 Deferred revenue
20 Loans from of icas, directors , trustees , and other disqualified persons
,20 21 Mortgages and other notes payable'' 22 Other liabilities (describe ^
23 Total liabilities (add lines 17 thro u g h 22 ) 0. 0.Foundations that follow SFAS 117, check here ^ 0and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricteda 25 Temporarily restricted
m 26 Permanently restrictedr_ Foundations that do not follow SFAS 117, check here ^ EilLL and complete lines 27 through 31.° 27 Capital stock, trust principal, or current funds 0. 0
28 Paid-in or capital surplus, or land, bldg., and equipment fund 0. 029 Retained earnings, accumulated income, endowment, or other funds 9128. 8 8 5 9 .
Z 30 Total net assets or fund balances 9128. 8 8 5 9 .
31 Total liabilities and net assets/fund balances 9128. 1 8 8 5 9 .
Part iiI Analysis of Changes in Net Assets or Fund Balances
1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30(must agree with end-of-year figure reported on prior year's return) 1 9128 .
2 Enter amount from Part I, line 27a 2 -269 .3 Other increases not included in line 2 (itemize) ^ 3 0 .4 Add lines 1, 2, and 3 4 8859.5 Decreases not included in line 2 (itemize) ^ 5 0 .6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II. column (b), line 30 6 8859 .
Form 990-PF (2011)12351112-02-11
Form 990-PF (2011THE ADELMAN FAMILY FOUNDATION , INC 06-1537647 Page 3Part IV Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,2-story brick warehouse; or common stock, 200 shs. MLC Co.
(b How acquiredPurchase
D Donation(c)mo.,
acquiredday, yr.)
(d) Date sold(mo., day, yr.)
is
b NONECde
(e) Gross sales price (f) Depreciation allowed(or allowable)
(g) Cost or other basisplus expense of sale
(h) Gain or (loss)(e) plus (f) minus (g)
abcde
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Gains (Col. (h) gain minus
(i) F.M.V. as of 12/31/69(j) Adjusted basisas of 12/31/69
(k) Excess of cal. (i)over cal. (1), if any
cal. (k), but not less than -0-) orLosses (from cal. (h))
abcde
2If gain, also enter in Part I, line 7
Capital gain net income or (net capital loss) If (loss), enter -0- in Part I, line 7 2
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):If gain, also enter in Part I, line 8, column (c).If ( loss), enter -0- in Part I line 8 3
[Part V I Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period? LI Yes ® NoIf 'Yes,' the foundation does not qualify under section 4940 (e). Do not complete this part.1 Enter the appropriate amount in each column for each year; see instructions before making any entries.
L
Base period yearsCalendar year or tax year be g innin g
( b)Adjusted qualifying distributions (c)Net value of nonchantable - use assetsDistribution ratio
(col. (b ) divided by cal. (c))
2010 2076. 7335. .2830272009 895. 7475. .1197322008 0. 6340. .0000002007 500. 4089. .1222792006 500. 3825. .130719
2 Total of line 1 , column (d) 2 .655757
3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by the number of yearsthe foundation has been in existence if less than 5 years 3 .131151
4 Enter the net value of nonchantable-use assets for 2011 from Part X, line 5 4 6 9 9 4 .
5 Multiply line 4 by line 3 5 917.
6 Enter 1% of net investment income (1% of Part I, line 27b) .. . 6 0.
7
.
Add lines 5 and 6 .. . 7 917.
8 Enter qualifying distributions from Part XII, line 4 8 1866.If line 8 is equal to or greater than line 7, check the box in PartVI, line 1b, and complete that part using a 1% tax rate.See the Part VI in structions.
123521 12-02.11 Form 990-PF (2011)
rujiiiyyu-rr cuiu -1-nC' t UZLJI1ltlly rLtLLiLi rVUMj1ft. .LVMV LX4%_ Vo-I).7Io ^ rd e4
Part VI Excise Tax Based on Investment Income (Section 4940(a). 4940(b), 4940(e), or 4948 - see instructions)la Exempt operating foundations described in section 4940(d)(2), check here ^U and enter'WA' on line 1.
Date of ruling or determination letter. ( attach copy of letter if necessary-see instructions)b Domestic foundations that meet the section 4940(e) requirements in Part V, check here ^® and enter 1%
of Part I, line 27b
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b).
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
3 Add lines 1 and 24 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
5 Tax based on investment income . Subtract line 4 from line 3. If zero or less, enter -0-
6 Credits/Payments:
0.
a 2011 estimated tax payments and 2010 overpayment credited to 2011 6ab Exempt foreign organizations - tax withheld at source 6bc Tax paid with application for extension of time to file (Form 8868) 6cd Backup withholding erroneously withheld ... 6d
7 Total credits and payments. Add lines 6a through 6d 7 0.8 Enter any penalty for underpayment of estimated tax. Check here 0 if Form 2220 is attached 89 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed ^ 9 0.10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid ^ 1011 Enter the amount of line 10 to be: Credited to 2012 estimated tax No, Refunded 11Part VII-A Statements Regarding Activities
la During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in
any political campaign? _
b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)?
If the answer is 'Yes' to la or 1b, attach a detailed description of the activities and copies of any materials published or
distributed by the foundation in connection with the activities.
c Did the foundation file Form 1120-POL for this year?d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year.
(1) On the foundation. ^ $ 0 . (2) On foundation $ 0e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed on foundation
managers.^ $ 0.2 Has the foundation engaged in any activities that have not previously been reported to the IRS? _
If 'Yes,' attach a detailed description of the activities.
3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or
bylaws, or other similar instruments? If 'Yes,' attach a conformed copy of the changes
4a Did the foundation have unrelated business gross income of $1,000 or more during the year? _b If 'Yes,' has it filed a tax return on Form 990-T for this year? N/A
5 Was there a liquidation, termination, dissolution, or substantial contraction during the year?If 'Yes,' attach the statement required by General Instruction T.
6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either.• By language in the governing instrument, or• By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law
remain in the governing instrument? .7 Did the foundation have at least $5,000 in assets at any time during the year? .. .
If 'Yes,' complete Part Ii, col. (c), and Part XV.
8a Enter the states to which the foundation reports or with which it is registered (see instructions) ^
b If the answer is Yes' to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate)
of each state as required by General Instruction G? If 'No,' attach explanation
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendaryear 2011 or the taxable year beginning in 2011 (see instructions for Part XIV)? If 'Yes,' complete Part XIVDid any persons become substantial contributors during the tax year? It -Y." attach a schedule hstma their names and addresses
Is
X
I4aI IX
8b I X
Form 990-PF (2011)
12353112-02-11
Activities11 At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of
section 512(b)(13)? If 'Yes; attach schedule (see instructions)12 Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges?
If 'Yes, attach statement (see instructions)13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
Website address ^ N/A14 The books are in care of ^ GERARD ADELMAN Telephone no.^ 2 0 3 - 6 31- 5 2 5 5
Located at ^ 562 BALDWIN AVENUE , MERIDEN , CT ZIP+4 ^0 6 4 5 015 Section 4947(a)(1) nonexempt charitable trusts filing Form 990- PF in lieu of Form 1041 - Check here ^0
and enter the amount of tax-exempt interest received or accrued during the year ^ 15 N /A16 At any time during calendar year 2011, did the foundation have an interest in or a signature or other authority over a bank, Yes No
securities, or other financial account in a foreign country? 16 XSee the instructions for exceptions and filing requirements for Form TD F 90-22.1. If 'Yes; enter the name of the foreign
Part VII-B Statements Regarding Activities for Which Form 4720 May Be RequiredFile Form 4720 if any item is checked in the "Yes " column, unless an exception applies. Yes No
1a During the year did the foundation (either directly or indirectly):(1) Engage in the sale or exchange , or leasing of property with a disqualified person? 0 Yes ® No(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person? Yes M No(3) Furnish goods, services, or facilities to ( or accept them from) a disqualified person? ED Yes ® No(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? L1 Yes ® No(5) Transfer any income or assets to a disqualified person ( or make any of either available
for the benefit or use of a disqualified person )? . 0 Yes ® No(6) Agree to pay money or property to a government official? (Exception . Check 'No'
if the foundation agreed to make a grant to or to employ the official for a period aftertermination of government service, if terminating within 90 days .) 0 Yes ® No
b If any answer is'Yes'to la( 1)-(6), did any of the acts fail to qualify under the exceptions described in Regulationssection 53 .4941(d )-3 or in a current notice regarding disaster assistance ( see instructions )? N/A lbOrganizations relying on a current notice regarding disaster assistance check here ... ^0
c Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts, that were not correctedbefore the first day of the tax year beginning in 2011? 1c X
2 Taxes on failure to distribute income (section 4942 ) ( does not apply for years the foundation was a private operating foundationdefined in section 4942(j )(3) or 4942 ( j)(5)):
a At the end of tax year 2011 , did the foundation have any undistributed income ( lines 6d and 6e, Part XIII ) for tax year ( s) beginningbefore 2011? .. . 0 Yes ® NoIf 'Yes,' list the years^ ,
b Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2) (relating to incorrectvaluation of assets ) to the year ' s undistributed income? ( If applying section 4942(a)(2) to all years listed , answer 'No' and attachstatement - see instructions.) N/A 2b
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 foundation hold more than a 2% direct or indirect interest in any business enterprise at any timeduring the year? .. =1 Yes ® No
b If 'Yes; did it have excess business holdings in 2011 as a result of ( 1) any purchase by the foundation or disqualified persons afterMay 26, 1969; (2) the lapse of the 5-year period ( or longer period approved by the Commissioner under section 4943 ( c)(7)) to disposeof holdings acquired by gift or bequest; or (3) the lapse of the 10-, 15-, or 20 -year first phase holding period? (Use Schedule C,Form 4720, to determine if the foundation had excess business holdings in 2011 .) . , . N/A. 3b
4a Did the foundation invest during the year any amount in a manner that would jeopard iz e its charitable purposes? , . . 4a Xb Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that
Form 990-PF (2011)
12354112-02-11
Part VII-B I Statements Reaardina Activities for Which Form 4720 May Be Recuired (continued)5a During the year did the foundation pay or incur any amount to:
(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? El Yes ® 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 ® No(3) Provide a grant to an individual for travel, study, or other similar purposes? ® Yes LI No(4) Provide a grant to an organization other than a charitable , etc., organization described in section
509(a )( 1), (2), or (3 ), or section 4940(d)(2)? 0 Yes ® No(5) Provide for any purpose other than religious, charitable , scientific , literary, or educational purposes, or for
the prevention of cruelty to children or animals? Yes ® No
b If any answer is Yes to 5a(1)-(5 ), did any of the transactions fail to qualify under the exceptions described in Regulationssection 53.4945 or in a current notice regarding disaster assistance (see instructions)? 5b XOrganizations relying on a current notice regarding disaster assistance check here ^0
c If the answer is 'Yes' to question 5a ( 4), does the foundation claim exemption from the tax because it maintainedexpenditure responsibility for the grant? N/A. O Yes 0 NoIf 'Yes,' attach the statement required by Regulations section 53.4945-5(d).
6a Did the foundation, during the year, receive any funds, directly or indirectly , to pay premiums on
a personal benefit contract? Yes ® Nob Did the foundation, during the year , pay premiums, directly or indirectly, on a personal benefit contract? _ 6b X
If 'Yes' to 6b, file Form 8870.
7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? 0 Yes ® No
Part VIII Information About Officers, Directors, Trustees, Foundation Managers , Highly0 Paid Employees, and Contractors1 List all officers, directors, trustees, foundation managers and their compensation.
(a) Name and address(b) Title, and average
hours per week devotedto position
(c) Compensation(If not paid ,enter-0-
(I ConMbutlonsto
e p ONBedeneetdpInscompensabon
(e)Expenseaccounotherallowances
GEORGIA B. ADELMAN RESIDENT562 BALDWIN AVENUE , A-2 , #2MERIDEN , CT 06450 0.50 0. 0. 0.GERARD I. ADELMAN SECRETARY/TRE ASURER562 BALDWIN AVENUE , A-2 , #2MERIDEN , CT 06450 0.10 0. 0. 0.JESSICA A. KOGUT ICE-PRESIDE234 LYDALE PLACEMERIDEN , CT 06450 0.10 0. 0. 0.
2 Compensati on of five highest-paid employees (other than those included on line 1). If none, enter "NONE."
(a) Name and address of each employee paid more than $50,000(b) Title, and average
hours per weekdevoted to position
(c) Compensation(ed) Contributlonsto
e p anddefeedppnscompensation
(e) Expenseaccount, otherallowances
NONE
Total number of other employees paid over $50,000 ^ 1 0Form 990-PF (2011)
12355112-02-11
Form 990-PF (2011) THE ADELMAN FAMILY FOUNDATION, INC 06-1537647 Page 7
Part VIII Information About Officers , Directors , Trustees , Foundation Managers, HighlyPaid Employees, and Contractors (continued)
3 Five highest-paid independent contractors for professional services . If none, enter ° NONE.°
(a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
NONE
Total number of others receivin g over $50 ,000 forprofessional services ^ 0Part IX-A I Summary of Direct Charitable ActivitiesList the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as the I Expensesnumber of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
1ACCUMULATION OF FUNDS FOR SCHOLARSHIP
Part (X-B I Summary of Proaram-Related InvestmentsDescribe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
1 N /A
2
All other program-related investments. See instructions.3
Total. Add lines 1 through 3 ^ 0.
Form 990-PF (2011)
12358112-02-11
. Form 990-PF (2011) THE ADELMAN FAMILY FOUNDATION, INC 06 -1537647 Page 8
Part X Minimum Investment Return (All domestic foundations must complete this part . Foreign foundations , see instructions.)
1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes:a Average monthly fair market value of securitiesb Average of monthly cash balancesc Fair market value of all other assetsd Total (add lines la, b, and c) _e Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation) le
2 Acquisition indebtedness applicable to line 1 assets
3 Subtract line 2 from line 1d4 Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see instructions)
5 Net value of noncharitable-use assets . Subtract line 4 from line 3. Enter here and on Part V, line 4$tmt 6
1 3 1 8994.
4.
Part XIDistributable Amount (see instructions) (Section 4942(j)(3) and (1)(5) private operating foundations and certainforeign organizations check here ^ J and do not complete this part)
1 Minimum investment return from Part X, line 6 1
2a Tax on investment income for 2011 from Part VI, line 5 2a
b Income tax for 2011. (This does not include the tax from Part VI.) 2bc Add lines 2a and 2b 2c
3 Distributable amount before adjustments. Subtract line 2c from line 1 3
4 Recoveries of amounts treated as qualifying distributions 4
5 Add lines 3 and 4 5
6 Deduction from distributable amount (see instructions) 6
7 Distributable amount as ad justed. Subtract line 6 from line 5. Enter here and on Part XIII , line 1 7
Part XII Qualifying Distributions (see instructions)
1 Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:a Expenses, contributions, gifts, etc. - total from Part I, column (d), line 26 1a 1866.b Program-related investments - total from Part IX-B , . . 1b 0.
2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes 23 Amounts set aside for specific charitable projects that satisfy the:a Suitability test (prior IRS approval required) . . .. 3a
b Cash distribution test (attach the required schedule) 3b
4 Qualifying distributions . Add lines la through 3b. Enter here and on Part V, line 8, and Part XIII, line 4. 4 1866.5 Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b 5 0.
6 Adjusted qualifying distributions . Subtract line 5 from line 4 6 1866.
Note . The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the section4940(e) reduction of tax in those years.
Form 990-PF (2011)
12357112-02-11
. Form 990-PF (2011) Pane 9
Part XIII Undistributed Income (see instructions)N/A
1 Distributable amount for 2011 from Part XI,
line 7
2 Undistributed Income , if any , as of the end of 2011
a Enter amount for 2010 only
b Total for prior years:
3 Excess distributions carryover, if any, to 2011:
a From 2006
b From 2007
c From 2008
d From 2009
e From 2010
f Total of lines 3a through e
4 Qualifying distributions for 2011 from
Part XII, line 4: ^ $
a Applied to 2010, but not more than line 2a
b Applied to undistributed income of prior
years (Election required - see instructions)
c Treated as distributions out of corpus
(Election required - see instructions)
d Applied to 2011 distributable amount
e Remaining amount distributed out of corpus
5 Excess distributions carryover applied to 2011of an amount appears in column (4 the same amountmust be shown in column (a4)
6 Enter the net total of each column asindicated below:
a Corpus. Add lines 3f , 4c, and 4e Subtract line 5
b Prior years' undistributed income. Subtract
line 4b from line 2b
c Enter the amount of prior years'undistributed income for which a notice ofdeficiency has been issued, or on whichthe section 4942(a) tax has been previouslyassessed _
d Subtract line 6c from line 6b. Taxable
amount - see instructions
e Undistributed income for 2010. Subtract line
4a from line 2a. Taxable amount - see instr.
f Undistributed income for 2011. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2012
7 Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3)
8 Excess distributions carryover from 2006
not applied on line 5 or line 7 . _
9 Excess distributions carryover to 2012.
Subtract lines 7 and 8 from line 6a
10 Analysis of line 9:
a Excess from 2007
b Excess from 2008
c Excess from 2009
d Excess from 2010
12358112-02-11
(a)Corpus
(b)Years prior to 2010
(c)2010
(d)2011
Form 990-PF (2011)
.Form 10[t XIV ] Private Operating Foundations (see instructions and Part VII-A, question 9)
1 a If the foundation has received a ruling or determination letter that it is a private operatingfoundation, and the ruling is effective for 2011, enter the date of the ruling ^
b Check box to indicate whether the foundation is a p rivate op eratin g foundation described in section2 a Enter the lesser of the adjusted net
income from Part I or the minimuminvestment return from Part X foreach year listed
b 85% of line 2ac Qualifying distributions from Part XII,
line 4 for each year listedd Amounts included in line 2c not
used directly for active conduct ofexempt activities
e Qualifying distributions made directlyfor active conduct of exempt activities.Subtract line 2d from line 2cComplete 3a , b, or c for thealternative test relied upon:
a 'Assets ' alternative test - enter.(1) Value of all assets(2) Value of assets qualifying
under section 4942( I)(3)(B)(i)b 'Endowment' alternative test - enter
2/3 of minimum investment returnshown in Part X, line 6 for each yearlisted
c 'Supporr alternative test - enter.(1) Total support other than gross
investment income ( interest,dividends, rents, payments onsecurities loans (section512(a)(5)), or royalties)
(2) Support from general publicand 5 or more exemptorganizations as provided insection 4942 ( I)(3)(B)(iii)
(3) Largest amount of support froman exempt organization .
Tax year Prior 3(a) 2011 (b ) 2010 (c) 2
3 ) or 0 4942(j)( 5 )
(d) 2008 (e) Total
22. 60. 98 . 69. 249.19. 51. 83. 59. 212.
4
0.
Part XV Supplementary Information (Complete this part only if the foundation had $5,000 or more in assetsat any time during the year-see instructions.)
1 Information Regarding Foundation Managers:a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation before the close of any tax
year (but only if they have contributed more than $5,000). (See section 507(d)(2).)See Statement 7
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 orother entity) of which the foundation has a 10% or greater interest
None2 Information Regarding Contribution , Grant, Gift, Loan, Scholarship , etc., Programs:
Check here ^0 if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. Ifthe foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under other conditions, complete items 2a, b, c, and d.
a The name, address, and telephone number of the person to whom applications should be addressed:
See Statement 8b The form in which applications should be submitted and information and materials they should include:
c Any submission deadlines:
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:
452.1 1 27438.
452.1 1 27438.
123801 12-02-11 Form 990-PF (2011)
-1537647 Pape II
a uranzs ana onviouuons raia uunn me rear or roves ror ruture ra enzRecipient If recipient is an individual,
show any relationship to Foundation Purpose of grant orName and address (home or business) any foundation manager
or substantial contributorstatus ofrecipient
contribution Amount
a Paid during the year
KAITLYN DYREK
189 MILLER AVENUE
MERIDEN CT 06451
ONE SSIST IN HIGHER
EDUCATION STUDIES
00 ,
KIMBERLY CORNELL
138 FAIRWAY DRIVE
MERIDEN CT 06450
ONE SSIST IN HIGHER
EDUCATION STUDIES
500 ,
KIMBERLY CRAWFORD
645 BEE STREET
MERIDEN CT 06450
ONE SSIST IN HIGHER
EDUCATION STUDIES
500 ,
Total 3a 1500 ,
b Approved for future payment
None
Total ^ 3b 1 0.Form 990-PF (2011)
123811 12-02-11
.Form 990-PF (2011) THE ADELMAN FAMILY FOUNDATION, INC 06-153 7647 Pane 12
Part XVI -A Analysis of Income -Producing Activities
Enter gross amounts unless otherwise indicated Unrelate d business income Exduded by section 512 , 513, «514 (e).
I Program service revenue :
(a)Businesscode
(b)Amount
EN.-yO"code
(d)Amount
Related or exemptfunction income
abcdef
g Fees and contracts from government agencies2 Membership dues and assessments3 Interest on savings and temporary cash
investments 22.4 Dividends and interest from securities5 Net rental income or (loss ) from real estate:
a Debt-financed property
b Not debt-financed property6 Net rental income or (loss) from personal
property
7 Other investment income
8 Gain or ( loss) from sales of assets otherthan inventory
9 Net income or (loss ) from special events
10 Gross profit or (loss ) from sales of inventory11 Other revenue:
abcde
12 Subtotal . Add columns ( b), (d), and ( e) 0. 0. 22.13 Total. Add line 12, columns ( b), (d), and ( e) 13 22.(See worksheet in line 13 instructions to verify calculations.)
PartXVI-B Relationship of Activities to the Accomplishment of Exempt Purposes
Line No .V
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the accomplishment ofthe foundation's exempt purposes (other than by providing funds for such purposes).
3 INTEREST INCOME , TOGETHER WITH CONTRIBUTIONS AND GIFTS RECEIVED , WILLE USED TO FUND REQUIRED & PRIMARILY CHARITABLE ACTIVITIES
1Y:7O 712-02-11 Form (2011)
.Form990-PF 2011 THE ADELMAN FAMILY FOUNDATION , INC 06-15376 47 Pa a13Part XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of Yes Nc
the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Transfers from the reporting foundation to a noncharitable exempt organization of
(1) Cash 1a 1 X
(2) Other assets la ( 2 ) X
Other transactions:
(1) Sales of assets to a noncharltable exempt organization _ lb ( l ) X
(2) Purchases of assets from a noncharitable exempt organization lb ( 2 ) X
(3) Rental of facilities, equipment, or other assets _ lb ( 3 ) X(4) Reimbursement arrangements .. 1b 4 X
(5) Loans or loan guarantees lb ( 5 ) X(6) Performance of services or membership or fundraising solicitations lb 6 XSharing of facilities, equipment, mailing lists, other assets, or paid employees 1c XIf the answer to any of the above is'Yes; complete the following schedule. Column (b) should always show the fair market value of the goods, other assets,
or services given by the reporting foundation. If the foundation received less than fair market value in any transaction or sharing arrangement, show in
(a) Name of organization (b ) Type of organization (c) Description of relationship
N /A
Under penalties of per declare that I have examined this return, including accompanylnn ^+ ^aa en + ^^+^++^te and fn the best of my knewledae
Signand belief, it is true , act, plate Declaration of preparer (other than taxpayer) is
HereSignature of office use Date
Print/Type preparer's name Preparer's signatur
Paid HOWARD M. LEVINEPreparer Firm's name ^ Howard M. Levine, CPAUse Only
Firm's address ^26 N. Main St. Southin
12382212-02-11
2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described
in section 501 (c) of the Code ( other than section 501(c)(3 )) or in section 527? LI Yes ® No
b If 'Yes.' complete the following schedule.
THE ADELMAN FAMILY FOUNDATION, INC 06-1537647
Form 990-PF Interest on Savings and Temporary Cash Investments Statement 1
Source
NAUGATUCK SAVINGS BANK
Total to Form 990-PF, Part I, line 3, Column A
(a) (b)Expenses Net Invest-Per Books ment Income
Form 990-PF Accounting Fees Statement 2
Description
TAX PREPARATION 315.
Amount
22.
22.
(c)Adjusted
Net Income
0. 0.
To Form 990-PF, Pg 1, In 16b 315. 0. 0.
(d)CharitablePurposes
315.
315.
Form 990-PF Taxes Statement 3
(a) (b) (c) (d)Expenses Net Invest- Adjusted Charitable
Description Per Books ment Income Net Income Purposes
FEDERAL EXCISE TAX 1. 0. 0. 1.
To Form 990-PF, Pg 1, In 18 1. 0. 0. 1.
Form 990-PF Other Expenses Statement 4
(a) (b) (c) (d)Expenses Net Invest- Adjusted Charitable
Description Per Books ment Income Net Income Purposes
STATE FILING FEES 50. 0. 0. 50.
To Form 990-PF, Pg 1, In 23 50. 0. 0. 50.
Statement(s) 1, 2, 3, 4
THE ADELMAN FAMILY FOUNDATION, INC 06-1537647
Form 990-PF Depreciation of Assets Not Held for Investment Statement 5
Cost or AccumulatedDescription Other Basis Depreciation Book Value
ORGANIZATION COSTS 180. 180. 0.
Total To Fm 990-PF, Part II, In 14 180. 180. 0.
Statement(s) 5
THE 4DELMAN FAMILY FOUNDATION, INC 06-1537647
Form 990 - PF Cash Deemed Charitable Explanation Statement Statement 6Part X, Line 4
ANTICIPATED ADMINISTRATIVE EXPENSES OF $500 AND A SCHOLARSHIPDISTRIBUTION(S) OF $1500; DUE TO THE SMALL BALANCE OF ASSETS, 1 1/2%OF ASSETS IS TOO SMALL TO REASONABLY COVER DISBURSEMENTS.
Statement(s) 6
THE ADELMAN FAMILY FOUNDATION, INC
Form 990-PF Part XV - Line laList of Foundation Managers
06-1537647
Statement 7
Name of Manager
GEORGIA B. ADELMANGERARD I. ADELMAN
Statement(s) 7
THE ADELMAN FAMILY FOUNDATION, INC 06-1537647
Form 990-PF Grant Application Submission Information Statement 8Part XV, Lines 2a through 2d
Name and Address of Person to Whom Applications Should be Submitted
GERARD ADELMAN562 BALDWIN AVENUE, A-2, #2MERIDEN, CT 06450
Telephone Number Name of Grant Program
203-237- 9856 ADELMAN FAMILY FOUNDATION SCHOLARSHIP
Form and Content of Applications
SUBMISSION ON AN OFFICIAL APPLICATION FORM, TOGETHER WITH A HIGH SCHOOLTRANSCRIPT, PROOF OF ACCEPTANCE INTO A NURSING PROGRAM AND 3 REFERENCELETTERS
Any Submission Deadlines
FIRST BUSINESS DAY OF MAY
Restrictions and Limitations on Awards
RECIPIENT NEEDS TO: 1)BE A RESIDENT OF MERIDEN, CT OR 2) ATTENDING ORGRADUATED FROM ONE OF THE THREE HIGH SCHOOLS LOCATED IN MERIDEN, CT. AND3)PURSUING THE STUDY OF REGISTERED NURSING.
Statement(s) 8
a
'^90-PF Return of Private Foundation OMB No 1545-0052mForm
or Section 4947(a)(1) Nonexempt Charitable Trust 2 - ODepartm6kt of the Treasury Treated as a Private FoundationInternal Revenue Service Note . The foundation may be able to use a copy of this return to satisfy state reporting requirements.
For calendaryear 20i0, or tax year beginning , and ending
G Check all that apply. 0 Initial return 0 Initial return of a former public charity Final return0 Amended return 0 Address chance n Name chance
Name of foundation A Employer identification number
THE ADELMAN FAMILY FOUNDATION , INC 06-1537647Number and street (or P O box number if mail is not delivered to street address ) Room/suite B Telephone number
562 BALDWIN AVENUE -2 #2 203-631-5255City or town, state, and ZIP code C If exemption application is pending , check here
MERIDEN , CT 06450-3596 D 1. Foreign organizations, check hereH Check type of organization: ®Section 50 1(c)(3) exempt private foundation 2. Foreign
erre and atach computathe85%
tiontest,
Section 4947( a )( 1 ) nonexem p t charitable trust Other taxable p rivate foundation E If t f t td t t t dI Fair market value of all assets at end of year J Accounting method: ® Cash E] Accrual
priva oun ion s us was erminae a a eunder section 507(b)(1)(A), check here
(from Part ll, col (c), line 16) F-1 Other (specify) F If the foundation is in a 60-month termination11104 912 8 . (Part 1, column (d) must be on cash basis.) under section 507(b)(1 B ) , check herePart I Analysis of Revenue and Expenses (a) Revenue and (b) Net investment (c) Adjusted net (d) Disbursements
(The tool of amounts in columns (b), (c), and (d) may notnecessarily equal the amounts in column (a)) expenses per books income income for chantable purposes
(cash basis only)
I Contributions, gifts, grants, etc., received 16032 Check If the toundahon is not requited to attach Sch B
Interest on savings and temporary3 cash investments 60. 60. 60. t atement 14 Dividends and interest from securities
5a Gross rentsb Net rental income or (loss)
6a Net gain or (loss ) from sale of assets not on line 10Gross sales price for all
b assets on line ea7 Capital gain net income (from Part IV, line 2) ._ (r 0.
cc 8 Net short-term capital gain 0.9 Income modifications i1 ]. d
Gross sales less returns10a and allowances P
b Less Cost of goods sold o t e
c Gross profit or (loss)
11 Other income
12 Total. Add lines 1 throu g h 11 1663. 60. 60.13 Compensation of officers, directors, trustees, etc 0. 0. 0. 0.
14 Other employee salaries and wages
15 Pension plans, employee benefitsto
16a Legal fees
a b Accounting fees Stmt 2 525. 0. 0. 525.6 c Other professional fees
> 17 Interest
18 Taxes $ tmt 3 2. 0. 0. 2.19 Depreciation and depletion
E 20 OccupancyE
< 21 Travel, conferences, and meetings
t c 22 Printing and publications
0 23 Other expenses $ tmt 4 50. 0. 0. 50.cc 24 Total operating and administrative
C . expenses . Add lines 13 through 23 577. 0. 0. 577.- 0 25 Contributions, gifts, grants paid 1500. 1500..U 26 Total expenses and disbursements.
Add lines 24 and 25 2077. 0. 0. 2077.27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements - 414.
CD b Net investment income ff negative, enter -0-) 60.
c Adjusted net income (if negative. enter -0- 60.
cC,
Q
12of-10 LHA For Paperwork Reduction Act Notice , see the instructions . Form 990-PF (2010).`In ve2
dFnrm QQn- PF (9n1n1 muT: ATb T.MA KT T.' ?MTT_V WnTTKT M rntT TWTO fl L - 1 . 1'7 G A '7 Pane 9
I Balance Sheets chedschedules and amounts in the descriptionP
Beginning of year End of yearartI column should be for endol -yearamountsonly (a) Book Value (b) Book Value (c) Fair Market Value1 Cash - non-interest-bearing2 Savings and temporary cash investments 9 5 4 2 . 9128. 9128.3 Accounts receivable ^
Less: allowance for doubtful accounts ^4 Pledges receivable ^
Less: allowance for doubtful accounts ^5 Grants receivable6 Receivables due from officers, directors, trustees, and other
disqualified persons7 Other notes and loans receivable ^
Less: allowance for doubtful accounts ^to 8 Inventories for sale or usey 9 Prepaid expenses and deferred chargesa 10a Investments - U.S. and state government obligations
b Investments - corporate stockc Investments - corporate bonds
11 Investments - land, buildings , and equipment basis 10.Less accumulated depredation ^
12 Investments - mortgage loans13 Investments - other14 Land, buildings, and equipment basis ^ 180.
Less accumulated depreciation Stmt 5 ^ 180.15 Other assets (describe ^
16 Total assets to be comp leted by all filers 9 5 4 2 . 9128. 9128.17 Accounts payable and accrued expenses18 Grants payable
ta 19 Deferred revenue20 Loans from officers, directors , trustees, and other disqualified persons
,20 21 Mortgages and other notes payableJ 22 Other liabilities (describe ^
23 Total liabilities ( add lines 17 throu g h 22 ) 0. 0.Foundations that follow SFAS 117, check here ^ 0and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted25 Temporarily restricted
co 26 Permanently restrictedC Foundations that do not follow SFAS 117, check here ^ E^jLL and complete lines 27 through 31.° 27 Capital stock, trust principal, or current funds 0. 0.
28 Paid-in or capital surplus, or land, bldg., and equipment fund 0. 0.4 29 Retained earnings, accumulated income, endowment, or other funds 9 5 4 2 . 9128.Z 30 Total net assets or fund balances 9 5 4 2 . 9128.
31 Total liabilities and net assets/fund balances 9 5 4 2 . 912 8 .Part III Analysis of Changes in Net Assets or Fund Balances
I Total net assets or fund balances at beginning of year - Part II, column (a), line 30(must agree with end-of-year figure reported on prior year's return)
2 Enter amount from Part I, line 27a3 Other increases not included in line 2 (itemize) ^4 Add lines 1, 2, and 35 Decreases not included in line 2 (itemize) ^
- Part II. column
121 -414.
2
Form 990-PF (2010)02351112-07-10
Form 990-PF (2010) THE ADELMAN FAMILY FOUNDATION , INC 06-1537647 Page 3Part IV Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,` 2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b How acquired^ - PurchaseD - Donation
(C) Date acquired(mo., day, yr.)
(d) Date sold(mo., day, yr.)
la
b NONECde
(e) Gross sales price (f) Depreciation allowed(or allowable)
(g) Cost or other basisplus expense of sale
(h) Gain or (loss)(e) plus (f) minus (g)
ab
cde
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Gains (Col. (h) gain minus
(i) F.M.V. as of 12/31/69(j) Adjusted basisas of 12/31/69
(k) Excess of col. (i)over col. (1), if any
col. (k), but not less than -0-) orLosses (from col. (h))
ab
cde
2If gain, also enter in Part I, line 7
Capital gain net income or (net capital loss) If (loss), enter -0- in Part I, line 7 2
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):If gain, also enter in Part I, line 8, column (c).If ( loss ), enter -0- in Part I line 8 3
Part V Qualification Under Section 494U(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period? 0 Yes ® No
If 'Yes,' the foundation does not qualify under section 4940 ( e). Do not complete this part.1 Enter the appropriate amount in each column for each year ; see instructions before making any entries.
Base periiod yearsCalendar year ( or tax year beginning m (b distributionsAdjusted q uali fyi n g Net value of noncharitable - use assets
Distribution ratio(col. (b) divided by col. (c))
2009 895. 7475. .1197322008 0. 6340. .0000002007 500. 4089. .1222792006 500. 3825. .1307192005 1000. 3940. .253807
2 Total of line 1, column (d) 2 . 6 2 6 5 3 7
3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by the number of years
the foundation has been in existence if less than 5 years 3 . 125307
4 Enter the net value of noncharitable-use assets for 2010 from Part X, line 5 4 7 3 3 5 .
5 Multiply line 4 by line 3 5 919.
6 Enter 1% of net investment income (1% of Part I, line 27b) 6 1 .
7 Add lines 5 and 6 7 920.
8 Enter qualifying distributions from Part XII, line 4 8 2077.
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate.See the Part VI instructions.
023521 12-07-10 Form 990-PF (2010)
Form 990-PF (2010) THE ADELMAN FAMILY FOUNDATION , INC 06-1537647 Page 4Part VI Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see instructions)la Exempt operating foundations described in section 4940(d)(2), check here ^ L^j and enter 'N/A' on line 1.
Date of ruling or determination letter. (attach copy of letter if necessary - see instructions)b Domestic foundations that meet the section 4940(e) requirements in Part V, check here ^® and enter 1% 1 1 .
of Part I, line 27b
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b).
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0.3 Add lines 1 and 2 3 1.4 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 16 Credits/Payments:
a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a
b Exempt foreign organizations - tax withheld at source 6b
c Tax paid with application for extension of time to file (Form 8868) 6c
d Backup withholding erroneously withheld 6d
7 Total credits and payments. Add lines 6a through 6d 7 0.
8 Enter any penalty for underpayment of estimated tax Check here LI if Form 2220 is attached 8
9 Tax due . If the total of lines 5 and 8 is more than line 7, enter amount owed ^ 9 1
10 Overpayment . If line 7 is more than the total of lines 5 and 8, enter the amount overpaid ^ 10
11 Enter the amount of line 10 to be : Credited to 2011 estimated tax Refunded 00- 11Part VII-A Statements Regarding ActivitiesIs During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in Yes No
any political campaign? 1a X
b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)? lb X
If the answer is 'Yes' to 1 a or 1b, attach a detailed description of the activities and copies of any materials published or
distributed by the foundation in connection with the activities.
c Did the foundation file Form 1120-POL for this year? tc X
d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. ^ $ 0. (2) On foundation managers. ^ $ 0.
e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed on foundation
managers. ^ $ 0.
2 Has the foundation engaged in any activities that have not previously been reported to the IRS? 2 X
If 'Yes,' attach a detailed descnption of the activities.
3 Has the foundation 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 foundation have unrelated business gross income of $1,000 or more during the year?
b If "Yes,' has it filed a tax return on Form 990-T for this year?
5 Was there a liquidation, termination, dissolution, or substantial contraction during the year?
If 'Yes,' attach the statement required by General Instruction T.
6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
• By language in the governing instrument, or
• By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law
remain in the governing instrument?
7 Did the foundation have at least $5,000 in assets at any time during the year?
If 'Yes,' complete Part 11, col (c), and Part XV
8a Enter the states to which the foundation reports or with which it is registered (see instructions) ^
b If the answer is 'Yes' to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate)
of each state as required by General Instruction G? If 'No,' attach explanation 8b X
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(I)(3) or 4942(1)(5) for calendar
year 2010 or the taxable year beginning in 2010 (see instructions for Part XIV)? If 'Yes,' complete Part XIV 9 X
Form 990-PF (2010)
N/A4a
02353112-07-10
Form 990-PF (20 10) THE ADELMAN FAMILY FOUNDATION , INC 06-1537647 Page 5Part VII -A• Statements Regarding Activities (continued)11 At,any time during the year, did the foundation , directly or indirectly, own a controlled entity within the meaning of
section 512( b)(13)? It'Yes; attach schedule (see instructions) 11 X12 Did the foundation acquire a direct or indirect interest in any applicable insurance contract before
August 17, 2008? 12 X13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? 13 X
Website address ^ N/A
14 The books are in care of ^ GERARD ADELMAN Telephone no. ^ 2 0 3 - 6 31- 5255Located at ^ 5 6 2 BALDWIN AVENUE, MERIDEN , CT ZIP+4 ^0 6 4 5 0
15 Section 4947 ( a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 - Check here ^0and enter the amount of tax-exempt interest received or accrued during the year ^ 15
16 At any time during calendar year 2010, did the foundation have an interest in or a signature or other authority over a bank, Yes Nosecurities, or other financial account in a foreign country? 16 XSee page 20 of the instructions for exceptions and filing requirements for Form TO F 90-22.1. If 'Yes,* enter the name of
Part VII -B Statements Regarding Activities for Which Form 4720 May Be RequiredFile Form 4720 if any item is checked in the "Yes" column , unless an exception applies. Yes No
la During the year did the foundation ( either directly or indirectly):
(1) Engage in the sale or exchange, or leasing of property with a disqualified person? 0 Yes III No(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person? 0 Yes ® No
(3) Furnish goods , services , or facilities to ( or accept them from) a disqualified person? 0 Yes ® No(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? 0 Yes ® No
(5) Transfer any income or assets to a disqualified person ( or make any of either availablefor the benefit or use of a disqualified person )? 0 Yes ® No
(6) Agree to pay money or property to a government official? ( Exception . Check 'No'if the foundation agreed to make a grant to or to employ the official for a period after
termination of government service, if terminating within 90 days .) 0 Yes ® Nob If any answer is 'Yes' to la(1)-(6), did any of the acts fail to qualify under the exceptions described in Regulations
section 53 .4941(d )-3 or in a current notice regarding disaster assistance ( see page 22 of the instructions)? N/AOrganizations relying on a current notice regarding disaster assistance check here ^0
c Did the foundation engage in a prior year in any of the acts described in la, other than excepted acts, that were not corrected
before the first day of the tax year beginning in 20109
Taxes on failure to distribute income ( section 4942 ) ( does not apply for years the foundation was a private operating foundation
defined in section 4942( l)(3) or 4942 ( j)(5)):
a At the end of tax year 2010 , did the foundation have any undistributed income ( lines 6d and 6e, Part XIII ) for tax year(s) beginning
before 2010? 0 Yes ® NoIf 'Yes, list the years ^
b Are there any years listed in 2a for which the foundation 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/Ac 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 foundation hold more than a 2% direct or indirect interest in any business enterprise at any timeduring the year? Yes ® No
b If 'Yes, did it have excess business holdings in 2010 as a result of ( 1) any purchase by the foundation or disqualified persons after
May 26, 1969; (2 ) the lapse of the 5-year period ( or longer period approved by the Commissioner under section 4943 ( c)(7)) to dispose
of holdings acquired by gift or bequest; or (3) the lapse of the 10 -, 15-, or 20 -year first phase holding period? (Use Schedule C,
Form 4720, to determine if the foundation had excess business holdings in 2010) N/A
4a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
b Did the foundation make any investment in a prior year ( but after December 31, 1969 ) that could jeopardize its charitable purpose thatfirst day of the tax year beainnina in
Form 990-PF (2010)
02354112-07-10
Form 990-PF 2010 THE ADELMAN FAMILY FOUNDATION , INC 06-1537647 Pag e 6Part VII -B Statements Regarding Activities for Which Form 4720 May Be Required (continued)5a During the year did the foundation pay or incur any amount to:
(1) Carry on propaganda, or otherwise attempt to influence legislation ( section 4945 (e))? 0 Yes ® No
(2) Influence the outcome of any specific public election ( see section 4955 ); or to carry on , directly or indirectly,
any voter registration dnve2 0 Yes ® No(3) Provide a grant to an individual for travel, study, or other similar purposes? ® Yes 0 No(4) Provide a grant to an organization other than a charitable , etc., organization described in section
509(a )( 1), (2), or (3 ), or section 4940(d)(2)2 E__1 Yes ® No(5) Provide for any purpose other than religious , charitable , scientific , literary, or educational purposes, or for
the prevention of cruelty to children or animals? Yes ® No
b If any answer is 'Yes' to 5a(1)-(5 ), did any of the transactions fail to qualify under the exceptions described in Regulationssection 53 . 4945 or in a current notice regarding disaster assistance (see instructions)? 5b XOrganizations relying on a current notice regarding disaster assistance check here ^0
c If the answer is 'Yes' to question 5a ( 4), does the foundation claim exemption from the tax because it maintained
expenditure responsibility for the grant? N/A 0 Yes =NoIf 'Yes,' attach the statement required by Regulations section 53.4945-5(d).
6a Did the foundation , during the year , receive any funds , directly or indirectly, to pay premiums on
a personal benefit contract? 1 Yes ® No
b Did the foundation , during the year , pay premiums, directly or indirectly, on a personal benefit contract? 6b XIf 'Yes " to 6b, File Form 8870
7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction ? L Yes ® No
b If 'Yes , " did the foundation receive any p roceeds or have any net income attributable to the transaction? N /A 7b
Part VIII Information About Officers , Directors , Trustees, Foundation Managers , HighlyPaid Employees, and Contractors
1 List all officers. directors. trustees. foundation managers and their compensation.
(a) Name and address(b) Title, and average
hours per week devotedto position
(c) Compensation
(If not p aidenter -0
(dContnbutionstoemployee benefit plans
conpensation
(e) Expenseaccount, otherallowances
GEORGIA B. ADELMAN RESIDENT562 BALDWIN AVENUE , A-2 , #2MERIDEN , CT 06450 0.50 0. 0. 0.GERARD I. ADELMAN SECRETARY/TRE ASURER562 BALDWIN AVENUE , A-2 , #2MERIDEN , CT 06450 0.10 0. 0. 0.JESSICA A. KOGUT ICE-PRESIDE234 LYDALE PLACEMERIDEN , CT 06450 0.10 0. 0. 0.
7 rmmnpnQAtinn nf iuP hinhect-n,i(d PmntnvPPC rnthPr thin thnCP inf_Iiid rI nn IInP 11 If nnnp_ PntPr ,NnNE_"
(a) Name and address of each employee paid more than $50,000(b) Title, and average
hours per weekdevoted to position
(c) Compensation(d)ConmDubonsto
benefita p andsd eferred
plans
compensation
(e) Expenseaccount, otherallowances
NONE
Total number of other employees paid over $50,000 ^ I 0Form 990-PF (2010)
02355112-07-10
Form 990-PF (20 10) THE ADELMAN FAMILY FOUNDATION, INC 06-1537647 Page 7
Part VIII Information About Officers, Directors , Trustees, Foundation Managers , HighlyPaid Employees, and Contractors (continued)
3 Five highest-paid independent contractors for professional services. If none, enter "NONE."
(a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
NONE
Total number of others receivin g over $50 ,000 for p rofessional services ^ 0Part IX-A Summary of Direct Charitable Activities
List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as thenumber of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
1ACCUMULATION OF FUNDS FOR SCHOLARSHIP TO QUALIFIED STUDENTS
2077.2
3
4
Part IX-B I Summary of Program - Related InvestmentsDescribe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
I N /A
2
All other program-related investments. See instructions.
3
Total . Add lines 1 through 3 ^ 0.Form 990-PF (2010)
02350112-07-10
Form 990-PF (2010) THE ADELMAN FAMILY FOUNDATION, INC 06-1537647 Page 8
Part X Minimum Investment Return (All domestic foundations must complete this part . Foreign foundations, see instructions)
1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes:a Average monthly fair market value of securities
b Average of monthly cash balances
c Fair market value of all other assets
d Total (add lines la, b, and c)
e Reduction claimed for blockage or other factors reported on lines 1a and1c (attach detailed explanation) le
2 Acquisition indebtedness applicable to line 1 assets
3 Subtract line 2 from line ld
4 Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see instructions)
5 Net value of noncharitable - use assets . Subtract line 4 from line 3. Enter here and on Part V, line 4Stmt 6
0.9335.
9335.
0.9335.2000.7335.367.
Part XIDistributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certainforeign organizations check here ^ j and do not complete this part.)
I Minimum investment return from Part X, line 6 12a Tax on investment income for 2010 from Part VI, line 5 2a
b Income tax for 2010. (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 34 Recoveries of amounts treated as qualifying distributions 4
5 Add lines 3 and 4 5
6 Deduction from distributable amount (see instructions) 67 Distributable amount as ad j usted. Subtract line 6 from line 5. Enter here and on Part XIII , line 1 7
Part XII Qualifying Distributions (see instructions)
1 Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a Expenses, contributions, gifts, etc. - total from Part I, column (d), line 26 1a 2 0 7 7 .
b Program-related investments - total from Part IX-B lb 0.2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes 2
3 Amounts set aside for specific charitable projects that satisfy the:
a Suitability test (prior IRS approval required) 3a
b Cash distribution test (attach the required schedule) 3b
4 Qualifying distributions . Add lines la through 3b. Enter here and on Part V, line 8, and Part XIII, line 4 4 2 0 7 7 .
5 Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b 5 1
6 Adjusted qualifying distributions . Subtract line 5 from line 4 6 2076.Note. The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the fo undation qualifies for the section
4940(e) reduction of tax in those years.
Form 990-PF (2010)
02357112-07-10
Form 990-PF (2010) Page 9Part X11-1 1 ' Undistributed Income (see instructions)
N /A(a) (b) (c) (d)
Corpus Years prior to 2009 2009 20101 Distributable amount for 2010 from Part XI,
line 72 Undistributed income, if any, as of the end of 2010a Enter amount for 2009 onlyb Total for prior years:
3 Excess distributions carryover, if any, to 2010:a From 2005b From 2006c From 2007d From 2008e From 2009f Total of lines 3a through e
4 Qualifying distributions for 2010 fromPart X11, line 4: 111110- $
a Applied to 2009, but not more than line 2ab Applied to undistributed income of prioryears (Election required - see instructions)
c Treated as distributions out of corpus(Election required - see instructions)
d Applied to 2010 distributable amounte Remaining amount distributed out of corpus
5 Excess distributions carryover applied to 2010Of an amount appears in column (d), the same amountmust be shown in column (a) )
6 Enter the net total of each column asindicated below:
a Corpus Add lines 3f, 4c, and 4e Subtract line 5
b Prior years' undistributed income. Subtractline 4b from line 2b
c Enter the amount of prior years'undistributed income for which a notice ofdeficiency has been issued, or on whichthe section 4942(a) tax has been previouslyassessed
d Subtract line 6c from line 6b. Taxableamount - see instructions
e Undistributed income for 2009. Subtract line4a from line 2a. Taxable amount - see instr.
f Undistributed income for 2010. Subtractlines 4d and 5 from line 1. This amount mustbe distributed in 2011
7 Amounts treated as distributions out ofcorpus to satisfy requirements imposed bysection 170(b)(1)(F) or4942(g)(3)
8 Excess distributions carryover from 2005not applied on line 5 or line 7
9 Excess distributions carryover to 2011.Subtract lines 7 and 8 from line 6a
10 Analysis of line 9:a Excess from 2006b Excess from 2007c Excess from 2008d Excess from 2009e Excess from 2010
Form 990-PF (2010)02358112-07-10
Form 990-PF 2010 THE ADELMAN FAMILY FOUNDATION , INC 06-1537647 Page 10Part XIV Private Operating Foundations (see instructions and Part VII-A, question 9)1 a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2010, enter the date of the ruling _ ^b Check box to indicate whether the foundation is a p rivate op eratin g foundation described in section
2 a Enter the lesser of the adjusted net Tax year Prior 3 y
income from Part I or the minimum (a) 2010 (b) 2009 (c) 20
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 act vities
e Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2cComplete 3a, b, or c for thealternative test relied upon:
a 'Assets' alternative test - enter:(1) Value of all assets
(2) Value of assets qualifyingunder section 4942(I)(3)(B)(i)
b 'Endowment' alternative test - enter2/3 of minimum investment returnshown in Part X, line 6 for each yearlisted
c 'Support' alternative test - enter:
(1) Total support other than grossinvestment income (interest,dividends, rents, payments onsecurities loans (section512(a)(5)), or royalties)
(2) Support from general publicand 5 or more exemptorganizations as provided insection 4942(l)(3)(B)(ui)
(3) Largest amount of support from
an exempt organization
Part XV Supplementary Information (Complete this part only if the foundation had $5,000 or more in assetsat any time during the year-see 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 the foundation before the close of any taxyear (but only if they have contributed more than $5,000). (See section 507(d)(2).)
See Statement 7b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or
other entity) of which the foundation has a 10% or greater interest
None2 Information Regarding Contribution , Grant, Gift, Loan, Scholarship , etc., Programs:
Check here ^ LI if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. Ifthe foundation makes gifts, grants , etc. (see instructions ) to individuals or organizations under other conditions , complete items 2a, b , c, and d.
a The name, address, and telephone number of the person to whom applications should be addressed:
See Statement 8b The form in which applications should be submitted and information and materials they should include:
c Any submission deadlines:
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:
98.1 69.
1or
(d) 2007 1 (e) Total
51. 83. 59. 38. 231.
2077 . 895. 0. 500. 3472.
0. 0. 0. 0. 0.
2077. 895. 0. 500. 3472.
9127. 9452. 6016. 24595.
9127. 9452. 6016. 24595.
0.
023801 12 -07-10 Form 990-PF (2010)
Form 990-PF (2010) THE ADELMAN FAMILY FOUNDATION , INC 06-1537647 Page 11Part XV - Supplementary Information (continued)a ura nts ano %,onuuounons rasa uurnn the rear or roves Tor future Payment
Recipient If recipient is an individual,show any relationship to Foundation Purpose of grant or
Name and address (home or business ) any foundation manager status of contribution Amountor substantial contributor recipient
a Paid dung the year
HEATHER VICENTY ONE SSIST IN HIGHER 500.216 CATHERINE DRIVE EDUCATION STUDIESMERIDEN , CT 06450
JACOBA DAVIS ONE SSIST IN HIGHER 500.75 NOOKS HILL ROAD EDUCATION STUDIES
CROMWELL, CT 06416
KAYLA MCQUADE ONE SSIST IN HIGHER 500.36 HUBBARD STREET, #13 EDUCATION STUDIES
MERIDEN , CT 06451
Total ^ 3a 1500.b Approved for future payment
None
Total ^ 3b 1 0.023011 12 -07-10 Form 990-PF (2010)
Form 990-PF (2010) THE ADELMAN FAMILY FOUNDATION, INC 06-1537647 Page 12Part XVI -A Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated. Unrelated business income Exclu ded by section 512 , 513, or 514 (e)
1 Program service revenue :
(a)Businesscode
(b)Amount
Exc?„_Sioncode
( d)Amount
Related or exemptfunction income
abcdefp Fees and contracts from government agencies
2 Membership dues and assessments3 Interest on savings and temporary cash
investments 60.4 Dividends and interest from securities
5 Net rental income or (loss ) from real estate:
a Debt-financed property
b Not debt-financed property
6 Net rental income or (loss ) from personal
property
7 Other investment income
8 Gain or ( loss) from sales of assets other
than inventory
9 Net income or (loss ) from special events
10 Gross profit or (loss ) from sales of inventory
11 Other revenue:
a
bcde
12 Subtotal. Add columns ( b), (d), and ( e) 0. 0. 60.13 Total . Add line 12 , columns ( b), (d), and ( e) 13 60.(See worksheet in line 13 instructions to verify calculations.)
PartXVI -B Relationship of Activities to the Accomplishment of Exempt Purposes
Line No .y
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the accomplishment ofthe foundation's exempt purposes (other than by providing funds for such purposes).
3 INTEREST INCOME , TOGETHER WITH CONTRIBUTIONS AND GIFTS RECEIVED , WILLE USED TO FUND REQUIRED & PRIMARILY CHARITABLE ACTIVITIES
12-0i1o Form 990-PF (2010)
Form 990-PF 2010 THE ADELMAN FAMILY FOUNDATION , INC 06-1537647 Pa a 13Part XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt OrganizationsDid the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of Yes No
the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
a Transfers from the reporting foundation to a noncharitable exempt organization of.(1) Cash la ( l ) X(2) Other assets la ( 2 ) X
b Other transactions:
(1) Sales of assets to a noncharitable exempt organization 1b 1 X(2) Purchases of assets from a noncharitable exempt organization lb ( 2 )1 X(3) Rental of facilities, equipment, or other assets lb ( 3 ) X(4) Reimbursement arrangements lb ( 4 ) X(5) Loans or loan guarantees lb ( 5 ) X
(6) Performance of services or membership or fundraising solicitations lb ( 6 ) XSharing of facilities, equipment, mailing lists, other assets, or paid employees tc XIf the answer to any of the above is 'Yes,' complete the following schedule. Column (b) should always show the fair market value of the goods, other assets,or services given by the reporting foundation. If the foundation received less than fair market value in any transaction or sharing arrangement, show in
(a) Name of organization (b) Type of organization (c) Description of relationship
N/A
Under penalties of perlu a that I have examined this return , including accompan in schedules and statements and to the best of m knowled a and belief it is true correct
Signand complete Dad i of pre er (other than taxpayer or fiduciary) is based on all mt
Here rSlgna ure of o r or truPrm a prepar is name Preparer's signature
Paid HOWARD M. LEVINEPreparer Firm's name ^ Howard M. Levine, CPAUse Only
Flrm'saddress ^ 26 N. Main St. Southin
02362203-04-11
2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax - exempt organizations described
in section 501 ( c) of the Code ( other than section 501(c)(3 )) or in section 5279 E] Yes ® No
b If "Yes, complete the following schedule.
,THE ADELMAN FAMILY FOUNDATION, INC 06-1537647
Form 990-PF Interest on Savings and Temporary Cash Investments Statement 1
Source
NAUGATUCK SAVINGS BANK
Total to Form 990-PF, Part I, line 3, Column A
Amount
60.
60.
Form 990-PF Accounting Fees Statement 2
(a) (b) (c) (d)Expenses Net Invest- Adjusted Charitable
Description Per Books ment Income Net Income Purposes
TAX PREPARATION 525. 0. 0. 525.
To Form 990-PF, Pg 1, In 16b 525. 0. 0. 525.
Form 990-PF Taxes Statement 3
(a) (b) (c) (d)Expenses Net Invest- Adjusted Charitable
Description Per Books ment Income Net Income Purposes
FEDERAL EXCISE TAX 2. 0. 0. 2.
To Form 990-PF, Pg 1, In 18 2. 0. 0. 2.
Form 990-PF Other Expenses Statement 4
Description
STATE FILING FEES
To Form 990-PF, Pg 1, In 23
(a) (b)Expenses Net Invest-Per Books ment Income
50. 0. 0. 50.
50. 0. 0. 50.
(c)Adjusted
Net Income
(d)CharitablePurposes
Statement(s) 1, 2, 3, 4
.THE ADELMAN FAMILY FOUNDATION, INC 06-1537647
Form 990-PF Depreciation of Assets Not Held for Investment Statement 5
Description
ORGANIZATION COSTS
Total To Fm 990-PF, Part II, In 14
Cost or AccumulatedOther Basis Depreciation Book Value
180.
180.
180. 0.
180. 0.
Statement(s) 5
.THE ADELMAN FAMILY FOUNDATION, INC 06-1537647
Form 990 - PF Cash Deemed Charitable Explanation Statement Statement 6Part X, Line 4
ANTICIPATED ADMINISTRATIVE EXPENSES OF $500 AND A SCHOLARSHIPDISTRIBUTION(S) OF $1500; DUE TO THE SMALL BALANCE OF ASSETS, 1 1/2%OF ASSETS IS TOO SMALL TO REASONABLY COVER DISBURSEMENTS.
Statement(s) 6
.THE ADELMAN FAMILY FOUNDATION, INC 06-1537647
Form 990 -PF Part XV - Line la Statement 7List of Foundation Managers
Name of Manager
GEORGIA B. ADELMANGERARD I. ADELMAN
Statement(s) 7
.THE ADELMAN FAMILY FOUNDATION, INC 06-1537647
Form 990 -PF Grant Application Submission Information Statement 8Part XV, Lines 2a through 2d
Name and Address of Person to Whom Applications Should be Submitted
GERARD ADELMAN562 BALDWIN AVENUE, A-2, #2MERIDEN , CT 06450
Telephone Number
203-237-9856
Name of Grant Program
ADELMAN FAMILY FOUNDATION SCHOLARSHIP
Form and Content of Applications
SUBMISSION ON AN OFFICIAL APPLICATION FORM, TOGETHER WITH A HIGH SCHOOLTRANSCRIPT, PROOF OF ACCEPTANCE INTO A NURSING PROGRAM AND 3 REFERENCELETTERS
Any Submission Deadlines
FIRST BUSINESS DAY OF MAY
Restrictions and Limitations on Awards
RECIPIENT NEEDS TO: 1)BE A RESIDENT OF MERIDEN, CT OR 2) ATTENDING ORGRADUATED FROM ONE OF THE THREE HIGH SCHOOLS LOCATED IN MERIDEN, CT. AND3)PURSUING THE STUDY OF REGISTERED NURSING.
Statement(s) 8
