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Form 990-PF

Department of the Treasuryinternal Revenue Service

Return of Private Foundationor Section 4947(aXl) Nonexempt Charitable Trust

Treated as a Private FoundationNote : The organization may be able to use a copy of this return to satisfy state

OMB No 1545 0052

2004For calendar year 2004, or tax year beginning 12/01 , 2004, and ending 11/30 , 2005G Check all that apply. Initial return Final return Amended return Address than a Name thanUse the

.-.

cation number

IRS label . THE ROTHMAN FAMILY FOUNDATION 23Otherwise ,pt t C/O KANE & HOCKING

-

r (see instructions)ypor type. 197 W. SPRING VALLEY AVE. 2ND FLOOR 1414

See SpecificInstructions..

MAYWOOD, NJ 07607 ication Is pend in g, check here ►D 1 Foreign organization s, check here ►

H Check typeof organization. Section 501 (c)(3) exempt private foundation 2 Foreign organizations meeting the 85% test, checkSection 4947(a)(1) nonexempt charitable trust Other taxable private foundation

❑here and attach computation ►

I Fair market value of all assets at end of year J Accounting method: X Cash Accrual E If private foundation status was terminatedd ►(from Part ll, column (c), line 16) Other (specify)

❑un er section 507(b)(1 )(A), check here

► $ 174, 002._ _ _ _ _ _ _ _ _ _ _ _ _

(Part 1, column (d) must be on cash basis.)F If the foundation is in a 60-month termination

under section 507(b)(1)(B), check here ►p Analysis of Revenue and

Expenses (The total of amounts ina Revenue and( (b) Net investment (c) Ad)usted net (d) Disbursements

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

incomecome for charitable

sadly equal the amounts in column (a)(see instructions).)

purposescash basisis only)(

1 Contributions, gifts, grants , etc, received (att sch ) 7,068.2 Ck ► if the ioundn is not req to att Sch B3 Interes on savings and temporary

cash investments 62. 62. 62*4 Dividends and interest from securities 5, 022. 5, 022. 5/022.

J 5a Gross rentsb Net rental income

or (loss)

R6a Net gain/ (loss) from sale of assets not on line 10 -18,555. STATEMENT I

Eb Gross sales price for all 28,675.assets on line 6a

V 7 Capital gain net income (from Part IV, line 2)

' E 8 Net short-term capital gainu 9 Income modifications

E10a Gross sales less

returns andallowances

b Less. Cost ofgoods sold 0.00

c Gross profit/(loss) (att sch)11 Other income (attach schedule)

12 Total. Add lines 1 through 11 -6,403. 5,084. 51084.13 Compensation of officers , directors, trustees, etc14 Other employee salaries and wages

A 15 Pension plans, employee benefitsD 16a Legal fees (attach schedule)M

I b Accounting fees (attach sch) SEE ST 2 1,425. 1,425.o N

Sc Other prof fees (attach sch)

EE T 17 InterestR R 18 Taxes (attach schedule ) SEE STMT 3 162. 162.T T 19 Depreciation (attach schedule) and depletionN vG E

20 Occupancy21 Travel, conferences, and meetings

A E 22 Printing and publicationsNxD 23 Other expenses (attach schedule)E SEE STATEMENT 4 50. 50.E 24 Total operating and administratives expenses. Add lines 13 through 23 . 1,637. 162. 1,475.

25 Contributions, gifts, grants paid PART XV 6,400. 6,400.26 Total expenses and disbursements.

Add lines 24 and 25 . 8 037. 162. 0. 7,875.27 Subtract line 26 from line 12:

a Excess of revenue over expenses -and disbursements -14,440.

b Net investment income (f negative , enter 0 -} 4 922 ,C Adjusted net income (if negative , enter -0) 5,084.1

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Fnrm 99nkPF (9nn41 THE ROTHMAN FAMTT.Y POTTNDATTON 13-i92nn2i P- ,*Attached schedules and amounts in the description

l lh b ftShB lBeginning of year End of year

umn s ys co e or end-of-year amounts onouldeeancefl a(See instructions ) (a) Book Value (b) Book Value (c) Fair Market Value

1 Cash - non-interest-bearing 11,675. 2,096. 2,096.2 Savings and temporary cash investments . .. .3 Accounts receivable . ----------

Less. allowance for doubtful accounts 0- _ _ _ _ _ _ _ _ _4 Pledges receivable 0- - - - _ _ _ _ _ -

Less. allowance for doubtful accounts ---------5 Grants receivable

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

7 Other notes and loans receivable (attach sch)

5

----------Less. allowance for doubtful accounts ii- ----------

s 8 Inventories for sale or useet 9 Prepaid expenses and deferred charges .s 10a Investments - U.S. and state government

obligations (attach schedule)b Investments - corporate stock (attach schedule) 121, 037. 110, 113. 171,906.c Investments - corporate bonds (attach schedule) ...

11 Investments - land, buildings, andequipment: basis ----------Less: accumulated depreciation(attach schedule) . ----------

12 Investments - mortgage loans13 Investments - other (attach schedule)14 Land, buildings, and equipment. basis ----------

Less- accumulated depreciation(attach schedule)

15 Other assets (describe --------------- --16 Total assets (to be completed by all filers -see instructions. Also, see page 1, item I) 132, 712. 112, 209. 174,002.

L 17 Accounts payable and accrued expenses

a 18 Grants payableb 19 Deferred revenue . .

20 Loans from officers, directors, trustees, & other disqualified persons21 Mortgages and other notes payable (attach schedule) •

It 22 Other liabilities (describe 0 )es 23 Total liabilities (add lines 17 through 22) ... 0. 0.

Organizations that follow SFAS 117 , check here Xand complete lines 24 through 26 and lines 30 and 31.

N F 24 Unrestricted . . 132, 712. 112, 209.e ut n 25 Temporarily restricted •••

d 26 Permanently restricted . . .A Bs Organizations that do not follow SFAS 117 , check heres

aa and complete lines 27 through 31.

e 1t a 27 Capital stock, trust principal, or current fundss n 28 Paid-in or capital surplus, or land, building, and equipment fund .

co e 29 Retained earnings, accumulated income, endowment, or other funds,r s 30 Total net assets or fund balances (see instructions) 132, 712. 112, 209.

31 Total liabilities and net assetsifund balances(see instructions) 132, 712. 112, 209.

F*4 Jill Analysis of Changes in Net Assets or Fund Balances

1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree withend-of-year figure reported on prior year's return) . . .. 1 132, 712.

2 Enter amount from Part I, line 27a .. . . 2 -14,440.3 Other increases not included in line 2 (itemize) . '--------------------------- --- 34 Add lines 1, 2, and 3 . . 4 118 272.5 Decreases not included in line 2 (itemize) . "SEE_ STATEMENT-5 _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5 6,063.6

_Total net assets or fund balances at end of year (line 4 minus line 5) - Part II, column b line 30 6 112,209.

BAA TEEA0302L 07129(04 Form 990-PF (2004)

Form 990-PF 2004 THE ROTHMAN FAMILY FOUNDATION 13-392002`3 Page 3Part Wk I 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 shares MLC Company)

(b) How acquiredP - PurchaseD - Donation

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

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

1a N/Abcde

(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)

abcdeComplete only for assets showin gain in column (h) and owned by the foundation on 12/31/69 (I) Gains (Column (h)

(1) Fair Market Valueas of 12/31/69

(I') Adjusted basisas of 12/31/69

(k) Excess of column (i)over column 0), if any

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

abcde

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

3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):

If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-in Pa rt I, line 8 3

f 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 organization liable for the section 4942 tax on the distributable amount of any year in the base period? 1-1 Yes X NoIf 'Yes,' the organization does not qualify under section 4940 (e). Do not complete this pa rt .

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

(a)Base period years

Calendar year (or tax yearbeginning in)

Adjusted qualifying distributions Net value ofnonchantable - use assets Distribution ratio

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

2003 8,125. 163, 292. 0.0497572002 9,815. 142, 385. 0.0689332001 6,328. 160 136. 0.0395162000 6,325. 170,785. 0.0370351999 11,750. 196, 087. 0.059922

2 Total of line 1 , column (d) .. 2 0.255163

3 Average distribution ratio for the 5 -year base period - divide the total on line 2 by 5, or by thenumber of years the foundation has been in existence if less than 5 years 3 0.051033

4 Enter the net value of nonchantable - use assets for 2004 from Part X, line 5 4 168,211.

5 Multiply line 4 by line 3 .. 5 8,584.

6 Enter 11% of net investment income (I% of Part I, line 27b) ... . . 6 49.

7 Add lines 5 and 6 . . 7 8,633.

8 Enter qualifying distributions from Part XII, line 4 .. 8 7,875.If line 8 is equal to or greater than line 7, check the box in Part VI, line 1 b, and complete that pa rt using a 11% tax rate . See thePart VI instructions.

BAA Form 990-PF (2004)TEEA0303L 07/29/04

F THE ROTHMAN FAMILY FOUNDATION 13-3920023 Page 4Part V Excise Tax Based on Investment Income section 4940(a), 4940(b), 4940(e), or 4948 - see instructions

1 a Exempt operating foundations described in section 4940(d)(2), check here. .. ' and enter 'N/A' on line 1.Date of ruling letter: _ _ _ _ _ _ _ (attach copy of ruling letter if necessary - see instructions)

b Domestic organizations that meet the section 4940(e) requirements in Part V, 1 98.check here 01 D 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, column (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 98.4 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 98.6 Credits/Payments:a 2004 estimated tax pmts and 2003 overpayment credited to 2004 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 E 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 98.

10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid ' 1011 Enter the amount on line 10 to be: Credited to 2005 estimated tax. ► Refunded ► 11

1 a During the tax year, did the organization attempt to influence any national, state, or local legislation or did itparticipate 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 publishedor distributed by the organization in connection with the activities.

c Did the organization 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 organization P. $ 0. (2) On organization managers ► $e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed onorganization managers W-$ 0.

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

5 Was there a liquidation, termination, dissolution, or substantial contraction during the year'If 'Yes,' attach the statement required by General Instruction T.

6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:• By language in the governing instrument, or

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

7 Did the organization have at least $5,000 in assets at any time during the year? If 'Yes, 'completePart/l, column (c), and PartXV8a Enter the states to which the foundation reports or with which it is registered (see instructions) ►_ _ _ _ -

NEW YORK ------------------------------------------------b If the answer is 'Yes' to line 7, has the organization furnished a copy of Form 990-PF to the Attorney General

(or designate) of each state as required by General Instruction G? If 'No, 'attach explanation .

Yes Nola X1b X

1c X

0.

2 X

3 X4a X4b N IA5 X

6 X7 X

8b X

9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendar year 2004 orthe taxable year beginning in 2004 ( see instructions for Pa rt XIV)? lf'Yes,' complete PartXIV 9 X

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

11 Did the organization comply with the public inspection requirements for its annual returns and exemption application? 11 XWeb site address N/A---

Located at ►12 The books are i n care of KANE & HOCKING CPAS PC _ _ _ Telephone no. 201 _712 _1414

-SP-R------------YW-197WESTINGVALLEYAVEMA 0D0NJ

_ _ _ _ _ _ _ZIP+4► 07607___

13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 - Check here N/Aand enter the amount of tax-exempt interest received or accrued during the year 13 � N/A

BAA Form 990-PF (2004)TEEA0304L 01/03105

Form 990-PF (2004) THE ROTHMAN FAMILY FOUNDATION 13-3920023 Page 5Part Vt.8 Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the'Yes' column , unless an exception applies. Yes No1 a During the year did the organization (either directly or indirectly).

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? 11 Yes Z No

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) adisqualified person? .. .. 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 person? Yes X 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)? Yes X] No

(6) Agree to pay money or property to a government official? ( Exception . Check 'No' if theorganization agreed to make a grant to or to employ the official for a period after terminationof government service, if terminating within 90 days.) .. []Yes Z No

b If any answer is 'Yes' to 1a(1)-(6), did any of the acts fail to qualify under the exceptions described inRegulations section 53.4941 (d)-3 or in a current notice regarding disaster assistance (see instructions)?Organizations relying on a current notice regarding disaster assistance check here ► U

c Did the organization 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 2004? . .

2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization was aprivate operating foundation defined in section 49420)(3) or 49420)(5)):

a At the end of tax year 2004, did the organization have any undistributed income (lines 6dand 6e, Part XI II) for tax year(s) beginning before 2004? E Yes X❑ NoIf 'Yes,' list the years ► 20 , 20 , 20 , 20

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) toall years listed, answer ' No' and attach statement - see instructions.)

c If the provisions of section 4942 (a)(2) are being applied to any of the years listed in 2a, list the years here.► 20 20 20 20--.

3a Did the organization hold more than a 2% direct or indirect interest in any businessenterprise at any time during the year? U Yes No

b If 'Yes ,' did i t have excess business holdings in 2004 as a result of (1) any purchase by the organizationor disqualified persons after May 26 , 1969; (2) the lapse of the 5-year period (or longer period approvedby the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or

l3 th f th 10 15 20( ) e apse o e -, -, or -year first phase holding period ? (Use Schedule C, Form 4720, todetermine if the organization had excess business holdings in 2004.)

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

b Did the organization make any investment in a prior year (but after December 31, 1969) that couldjeopardize its charitable purpose that had not been removed from jeopardy before the first day ofthe tax year beginning in 2004?.

5a During the year did the organization pay or incur any amount to:(1) Carry on propaganda , or otherwise attempt to influence legislation (section 4945 (e))? U Yes X❑ No

(2) Influence the outcome of any specific public election (see section 4955); or to carryon, directly or indirectly , any voter registration drive? . . .. .. H Yes X No

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

(4) Provide a grant to an organization other than a charitable , etc, organization describedi n section 509 (a)(1) (2 3 t 4940 d 2 ?, ), or ( ), or sec ion ( )( ) fl Yes X] No

(5) Provide for any purpose other than religious , charitable , scientific , litera ry , ored c lt f th ftu a iona purposes , or or e preven ion o cruelty to children or animals? R Yes Xa No

b If any answer is 'Yes' to 5a(1)-(5), did any of the transactions fail to qualify under the exceptionsdescribed in Regulations section 53 . 4945 or i n a current notice regarding disaster assistance(see instructions )? .. .. . . . . .Organizations relying on a current notice regarding disaster assistance check here . . ► U

c If the answer is 'Yes' to question 5a (4), does the organization claim exemption from thetax because it maintained expenditure responsibility for the grant? N/A U Yes U NoIf '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 premiumson a personal benefit contract ? . . . . Yes No

b Did the organization , during the year , pay premiums, directly or indirectly , on a personal benefit contract?If you answered 'Yes' to 6b, also file Form 8870.

1b N A

1c X

2bl NVA

3b NA

4a X

4b X

46b X

BAA TEEA0305L 07/29/04 Form 990-PF (2004)

Form 990-PF (2004 THE ROTHMAN FAMILY FOUNDATION 13-3920023 Page 6!{f Information About Officers, Directors, Trustees, Foundation Managers , Highly Paid Employees,

and Contractors1 List all officers. directors . trustees . foundation managers and their comnensation (see instruc tions).

(a) Name and address(b) Title and average

hours per weekdevoted to position

(c) Compensation(If not paid, enter -0-)

(d) Contributions toemployee benefitplans and deferred

compensation

(e) Expense account,other allowances

- -----------------------SEE STATEMENT 6 0. 0. 0.------------------------

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

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

2 Comnensation of five highest-paid emolovees (other than those included on line 1- see instructions. If none enter'NnNF'

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

(b) Title and averagehours per week

devoted to position

(c) Compensation (d) Contributions toemployee benefitplans and deferred

compensation

(e) Expense account,other allowances

NONE------------------------

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

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

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

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

Total number of other employees paid over $50,0003 Five hinhect-paid indenendent contractors for nrofessionai cervices -(sae instruetionsl_ If none - enter'NONF'

(a) Name and address of each person paid more than $50,000 Type of service c CompensationNONE--------------------------------------

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

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

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

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

Total number of others receiving over $50,000 for professional services

Pa# A Summary of Direct Charitable Activities

List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of 1 Expensesorganizations and other beneficiaries served, conferences convened, research papers produced, etc.

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

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

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

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

BAA TEEA0306L 01/03/05 Form 990-PF (2004)

Form 990-PF (2004) THE ROTHMAN FAMILY FOUNDATION 13-3920023 Page 7

rt, - Summary of Program-Related Investments (see instructions)

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount1 N/A------------------------------------------------------------------------------------------------------------

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

All other program-related investments. See instructions.3 ------------------------------------------------------------------------------------------------------------

Total. Add lines 1 through 3 0.

.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 .. 1 a 168,542.b Average of monthly cash balances .. .. 1 b 2,231.c Fair market value of all other assets (see instructions) .. 1 cd Total (add lines 1a, b and c) ... 1 d 170,773.e Reduction claimed for blockage or other factors reported on lines la and 1c

(attach detailed explanation) . 1 e 0.2 Acquisition indebtedness applicable to line 1 assets ... 2 0.3 Subtract line 2 from line ld . . 3 170,773.4 Cash deemed held for charitable activities. Enter 1-1/2% of line 3 (for greater amount, see instructions) 4 2,562.5 Net value of noncharitable-use assets . Subtract line 4 from line 3. Enter here and on Part V, line 4 5 168,211.6 Minimum investment return . Enter 5% of line 5 6 8,411.

Distributable Amount (see instructions) (Section 49420)(3) and (I)(5) private operating foundations and certainforeign organizations check here and do not complete this part.)

1 Minimum investment return from Part X, line 6 1 8,411.2a Tax on investment income for 2004 from Part VI, line 5 .. 2a 98Jb Income tax for 2004. (This does not include the tax from Part VI.) 2bc Add lines 2a and 2b. 2c 98.

3 Distributable amount before adjustments. Subtract line 2c from line 1 .. 3 8,313.4 Recoveries of amounts treated as qualifying distributions .. 45 Add lines 3 and 4 .. .. . . .. 5 8,313.6 Deduction from distributable amount (see instructions) . .. .. .. 67 Distributable amount as ad usted. ubtract line 6 from line 5. Enter here and on Part Xlll, line. 1. _7

Part XJi I 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 .. 1 a 7,875.b Program-related investments - total from Part IX-B 1 b

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

3 Amounts set aside for specific charitable projects that satisfy the.a Suitability test (prior IRS approval required) 3ab 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 7,875.5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment income.

Enter 1% of Part I, line 27b (see instructions) . . .. . . 56 Adjusted qualifying distri butions . Subtract line 5 from line 4 . 6 7,875.

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

BAA Form 990-PF (2004)

TEF-AG307L 01/14105

Form 990-PF (2004) THE ROTHMAN FAMILY FOUNDATION 13-3920023 Page 8[.PWtX[111 Undistributed Income (see instructions)

1 Distributable amount for 2004 from Part XI,line 7

2 Undistributed income, if any, as of the end of 2003:a Enter amount for 2003 onlyb Total for prior years: 20_, 20 _, 20

3 Excess distributions carryover, if any, to 2004:a From 1999b From 2000c From 2001d From 2002 1,697.e From 2003 8,125.f Total of lines 3a through e

4 Qualifying distributions for 2004 from PartXII, line 4: $ 7,875.

a Applied to 2003, 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 2004 distributable amounte Remaining amount distributed out of corpus

5 Excess distributions carryover applied to 2004(If an amount appears in column (d), thesame amount must be shown in column (a).)

6 Enter the net total of each column asindicated below:

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

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

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

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

e Undistributed income for 2003. Subtract line 4a fromline 2a Taxable amount - see instructions

f Undistributed income for 2004. Subtract lines4d and 5 from line 1. This amount must bedistributed in 2005

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

8 Excess distributions carryover from 1999 notapplied on line 5 or line 7 (see instructions)

9 Excess distributions carryover to 2005.Subtract lines 7 and 8 from line 6a

10 Analysis of line 9:a Excess from 2000b Excess from 2001c Excess from 2002 1,2599d Excess from 2003 8,125.e Excess from 2004

BAA

(a)(b)Corpus Years prior to 2003 2003

9,822.

0.

438.

9.384.

0.

0.

0.

2040d

8,313.

0.

0.

7(875.

438.

0.

0.

Form 990-PF (2004)

TEEA0308L 07/29/04

Form 990-PF 023 Page 9rt XTV Private Operating Foundations (see instructions and Part VII -A, question 9 N/A

1 a If the foundation has received a ruling or determination letter that it is a private operating foundation , and the rulingP.

-1is effective for 2004 , enter the date of the ruling .. ...

b Check box to indicate whether the organization is a private o eratin foundation described in section 04942G) 3 or 49422a Enter the lesser of the adjusted net Tax year Prior 3 years

income from Part I or the minimum (a) 2004 (b) 2003 (c) 2002 (d) 2001 (e) Totalinvestment 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 of exempt activitiese Qualifying distributions made directly

for active conduct of exempt activities.Subtract line 2d from line 2c

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

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

section 49420)(3)(8)(1) .b 'Endowment ' alternative test - Enter 2/3 ofminimum investment return shown in Part X,line 6 for each year listed

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

investment income (interest,dividends , rents , paymentson securities loans (section512(a)(5)), or royalties)

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

(3) Largest amount of support froman exempt organization

4) Gross investment income[Part X/ Supplementary Information (Complete this part only if the organization had $5,000 or more in assets at any time during the year.)

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 theclose of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)NONE

b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership ofa partnership or other entity) of which the foundation has a 10% or greater interest.NONE

2 Information Regarding Contribution , Grant, Gift, Loan, Scholarship , etc, Programs:Check here 11 ❑X if the organization only makes contributions to preselected charitable organizations and does not accept unsolicitedrequests for funds. If the organization makes gifts, grants, etc, (see instructions) to individuals or organizations under other conditions,complete items 2a, b, c, and d.

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

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

c Any submission deadlines:

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

BAA TEEA0309L 07129/04 Form 990-PF (2004)

Form 990-PF 004 THE ROTHMAN FAMILY FOUNDATION 13-3920023 Page 10t Supplementa ry Information (continued)

3 Grants and Contributions Paid During the Year or ADDroved for Future Payment

RecipientIf recipient is an individual ,show any relationship to

any foundation manager orFoundationstatus of Purpose of grant or

contribution AmountName and address (home or business) substantial contributor recipient

a Paid during the yearSEE STATEMENT 7

Total ► 3a 6,400.b Approved for future payment

Total ' 3biBAA TEEA031OL 07/29104 Form 990-PF (2004)

Form 990-PF (2004). THE ROTHMAN FAMILY FOUNDATION 13-3920023 Page 11

P AXOA Analysis of Income-Producing Activities

Ente

c2345

6789

1011

cde

1213 Total . Add line 12, columns (b), (d), and (e) 13 -13,471.(See worksheet in the instructions for line 13 to verify calculations.)

Part '-'o Relationship of Activities to the Accomplishment of Exempt Purposes

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

rogram service revenue:

(a)Businesscode

(b)Amount

(c)Exclu•sioncode

(d)Amount

(e)Related or exemptfunction income(see instructions)

Fees and contracts from government agenciesMembership dues and assessmentsInterest on savings and temporary cash investments 62.Dividends and interest from securities 14 5,022.Net rental income or (loss) from real estate:Debt-financed propertyNot debt-financed propertyNet rental income or (loss) from personal propertyOther investment incomeGain or (loss) from sales of assets other than inventory -18,555.Net income or (loss) from special events. .Gross profit or (loss) from sales of inventoryOther revenue:

Subtotal. Add columns (b), (d), and (e) -13,471.

BAA TEEA0501L 07129/04 Form 990-PF (2004)

Form 990-PF (2004 THE ROTHMAN FAMILY FOUNDATION 13-3920023 Page 12,xvii Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations

1 Did the organization directly or indirectly engage in any of the following with any other organizationdescribed in section 501(c) of the Code (other than section 501 (c)(3) organizations) or in section 527,relating to political organizations?

a Transfers from the reporting organization to a noncharltable exempt organization of:(1) Cash la(2) Other assets . 1 a

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

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees 1 c

Yes No

X2) X

X2) X

X4 X

X

d If the answer to any of the above is 'Yes,' complete the following schedule. Column (b) should always show the fair market value ofthe goods, other assets, or services given by the reporting organization. If the organization received less than fair market value inany transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

(a) Line no. (b) Amount involved (c) Name of nonchantable exempt organization Description of transfers, transactions , and sharing arrangementsN/A

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

b If 'Yes.' complete the following schedule.(a) Name of organization (b) Type of organization (c) Description of relationship

N/A

Under penalties of perjury, I declare that I have examined this return , including accompanying schedules and statements , and to the best of my knowledge and belief , it is true , co rrect, andcomplete Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge

- M&S ► .,a,

6 Signature of officer or trusteeN

NPaid

Preparer'ssignatureR

R Pre- $R CE R. HOCKINGE parer's Firm's name (or KANE & HOCKING CPA' S PCUse

Onlyyours ► 197 W. SPRING VALLEY AVENUE 2ddra ess, and

ZIP code MAYWOOD, NJ 0 7 6 0 7BAA

TEEA0502L

Schedule B(Form 990, 990-EZ,

or 990-PF)

Department of the TreasuryInternal Revenue Service

Schedule of ContributorsOMB .No 1545.0047

Supplementary Information for I 2004line 1 of Fonn 990, 990-EZ and 990-PF (see instructions)

Name of organization THE ROTHMAN FAMILY FOUNDATION Employer identifi cation number

C/O KANE & HOCKING 13-392002 3Organization type (check one):Filers of: Section:Form 990 or 990-EZ 501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation527 political organization

Form 990-PF X 501 (c)(3) exempt private foundation4947(a)(1) nonexempt charitable trust treated as a private foundation501 (c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule. (Note : Only a section 501(c)(), (8), or (10) organization can checkboxes for both the General Rule and a Special Rule - see instructions.)

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

Special Rules -

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

For a section 501(c)(7), (8), or (10) organization filing Form 990 , or Form 990-EZ, that received from any one contributor, during the year,aggregate contributions or bequests of more than $ 1,000 for use exclusively for religious, charitable , scientific , litera ry , or educationalpurposes , or the prevention of cruelty to children or animals . (Complete Parts I, II, and III.)

R For a section 501 (c)(7), (8), or ( 10) organization filing Form 990 , or Form 990 -EZ, that received from any one contributor, during the year,some contributions for use exclusively for reli gious, charitable , etc, purposes, but these contributions did not aggregate to more than$1,000. (If this box is checked , enter here the total contributions that were received during the year for an exclusively religious , charitable,etc, purpose . Do not complete any of the Parts unless the General Rule applies to this organization because it received nonexclus ivelyreligious, charitable , etc, contributions of $5,000 or more during the year .) . . ► $

Caution : Organizations that are not covered by the General Rule and/or the Special Rules do not file Schedule B (Form 990, 990-EZ, or990-PF) but they must check the box in the heading of their Form 990, Form 990-EZ, or on line 2 of their Form 990-PF, to certify that they donot meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).

BAA For Paperwork Reduction Act Notice , see the Instructions Schedule B (Form 990, 990-EZ, or 990-PF) (2004)for Form 990 , Form 990-EZ, and Form 990-PF.

TEEA0701L 11/24/04

Schedule B'Name of oraanu

FAMILY FOUNDATION

1 of 1 of Part

13-392002number

P Contributors (See Specific Instructions.)

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

contributions

1 PETER M ROTHMAN PersonPayroll

6509 GLEN LAKE COURT $ 5, 038 . Noncash X

s(Complete Part 11 if there

FORT WAYNE, IN 46804 - - - - - - - - - - - - - - - - - - - - - ---------------- i


contributions

------------------------------------- PersonPayroll

-------------------------------------- $----------- Noncash

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


contributions

------------------------------------- PersonPayroll

$ Noncash

(Complete Part II if there------------------------------------- is a noncash contribution.)


contributions

------------------------------------- PersonPayroll

$ Noncash

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


contributions

------------------------------------- PersonPayroll

$ Noncash

(Complete Part II if there

------------------------------------- is a noncash contribution.)

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

contributions

------------------------------------ PersonPayroll

$ Noncash

(Complete Part II if thereis a noncash contribution.)

BAA TF-E,oo702L 09/13/04 Schedule B (Form 990 , 990-EZ, or 990-PF) (2004)

(a)No. fromPart I

(b)Description of noncash property given

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

(d)Date received

1 -325 SHARES-NOKIA CORP------------------------------------------ -- ------------------------ ---- --- --- ---

-------------------------------------------------------------------------------- $------ 5L038_ _ 12/10/04

(a)No. fromPart I


(c)FMV (or estimate(see instructions)

(d)Date received

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

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

(a)No. fromPart I

. (b)Description of noncash property given


(d)Date received

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

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

(a)No. fromPart I


(c)FMV (or estimate(see instructions)

(d)Date received

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

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

(a)No. fromPart I



(d)Date received

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

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

(a)No. fromPart I



(d)Date received

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

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

BAA Schedule B (Form 990 , 990-EZ, or 990-PF) (2004)

TEEA0703L 09/13/04

Pad 1 Noncash Property (See Specific Instructions.)

Schedule B' (Form 990, 990-EZ, or 990-PF) (2004) Page 1 of 1 of Part IIIName of organization Employer identification number

THE ROTHMAN FAMILY FOUNDATION 13-3920023Ens ��i Exclusively religious, charitable , etc, individual contributions to section 501(c)(7), (8), or (10)

organizations aggregating more than $1,000 for the year (Complete cols (a) through (e) and the following line entry.)

For organizations completing Part III, enter total of exclusively religious, charitable, etc,contributions of $1,000 or less for the year. (Enter this information once - see instructions.) $ N/A

(a)No. fromPart I

(b)Purpose of gift

(c)Use of gift

(d)Description of how gift is held

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

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

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

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

--------------------(e)

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

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

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

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

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

(a)No. fromPart I

(b)Purpose of gift

(c)Use of gift


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

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

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

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

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

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

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

-

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

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

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

(e)Transfer of gift

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

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

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

(a)No. fromPart I

(b)Purpose of gift

(c)Use of gift


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

----- ----

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

--- -- -- --

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

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

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

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

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

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

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

(e)Transfer of gift

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

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

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

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

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

(a)No. fromPart I

(b)Purpose of gift

(c)Use of gift


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

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

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

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

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

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

(e)Transfer of gift

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

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

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

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

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

BAA Schedule B (Form 990, 990-EZ , or 990-PF) (2004)TEEAO7O& 09/13/04

2004 FEDERAL STATEMENTS PAGE 1THE ROTHMAN FAMILY FOUNDATION

C/O KANE & HOCKING 13-3920023

STATEMENT 1FORM 990-PF , PART I, LINE 6NET GAIN (LOSS) FROM NONINVENTORY SALES

DESCRIPTION: 8000 WORLDCOM INC GA NEWDATE ACQUIRED: 6/13/2001HOW ACQUIRED: PURCHASEDATE SOLD: 12/29/2004TO WHOM SOLD:GROSS SALES PRICE: 0.COST OR OTHER BASIS: 0.

GAIN (LOSS)

DESCRIPTION:DATE ACQUIRED:HOW ACQUIRED:DATE SOLD:TO WHOM SOLD:GROSS SALES PRICE:COST OR OTHER BASIS:

625 FLEXTRONICS INTL10/17/2003PURCHASE2/28/2005

8,269.9,953.

GAIN (LOSS)


111 CORNING3/06/2000

PURCHASE2/28/2005

1,223.7,448.

GAIN (LOSS)


100 EMC CORP7/20/2000

PURCHASE2/28/2005

1,220.8,223.

GAIN (LOSS)


200 MICOSOFT7/20/2000

PURCHASE2/28/2005

4,936.7,936.

GAIN (LOSS)


100 MICROSOFT10/24/2000PURCHASE2/28/2005

2,468.3,011.

0.

-1,684.

-6,225.

-7,003.

-3,000.

GAIN (LOSS) -543.

2004 FEDERAL STATEMENTSTHE ROTHMAN FAMILY FOUNDATION

CIO KANE & HOCKING

PAGE 21

13-39200231

STATEMENT 1 (CONTINUED)FORM 990-PF, PART I, LINE 6NET GAIN (LOSS) FROM NONINVENTORY SALES


110 WAL-MART4/26/1999

PURCHASE3/04/2005

5,699.5,370.

GAIN (LOSS)


62.500 TIME WARNER12/16/1999PURCHASE8/02/2005

1,023.922.

GAIN (LOSS)


37.500 TIME WARNER7/20/2000

PURCHASE8/02/2005

614.2,332.

GAIN (LOSS)


128 BELLSOUTH12/19/2001PURCHASE9/21/2005

3,223.2,035.

329.

101.

-1,718.

GAIN (LOSS)

STATEMENT 2FORM 990-PF, PART I, LINE 16BACCOUNTING FEES

ACCOUNTING

1,188.

TOTAL NET GAIN (LOSS) FROM NONINVENTORY SALES $ -18,555.

(A) (B) NET (C) (D)EXPENSES INVESTMENT ADJUSTED CHARITABLEPER BOOKS INCOME NET INCOME PURPOSES

$ 1,425. 1,425.TOTAL $ 1,425. 0. 0. $1,425.


CIO KANE & HOCKING 13-3920023

STATEMENT 3FORM 990-PF , PART I, LINE 18TAXES

(A) (B) NET (C) (D)EXPENSES INVESTMENT ADJUSTED CHARITABLEPER BOOKS INCOME NET INCOME PURPOSES

EXCISE TAX $ 133. $ 133.FOREIGN INCOME TAX 29. 29.

TOTAL 62. 2. 0. 0.

STATEMENT 4FORM 990-PF , PART I,, LINE 23OTHER EXPENSES

(A) (B) NET (C) (D)EXPENSES INVESTMENT ADJUSTED CHARITABLEPER BOOKS INCOME- NET INCOME PURPOSES

STATE FILING FEES $ 50. $ 50.TOTAL $ 50. 0. 0.

STATEMENT 5FORM 990-PF , PART III, LINE 5OTHER DECREASES

EXCESS OF FMV OVER BASIS OF DONATIONS RECEIVED $ 6,063.TOTAL $ 6,063.

STATEMENT 6FORM 990-PF , PART VIII, LINE 1LIST OF OFFICERS , DIRECTORS , TRUSTEES , AND KEY EMPLOYEES

TITLE AND CONTRI- EXPENSEAVERAGE HOURS COMPEN- BUTION TO ACCOUNT/

NAME AND ADDRESS PER WEEK DEVOTED SATION EBP & DC OTHERLESTER D. ROTHMAN TRUSTEE $ 0. $ 0. $ 0.100 WEST 57 STREET NONENEW YORK, NY 10016

PETER M. ROTHMAN TRUSTEE 0. 0. 0.6509 GLEN LAKE COURT NONEFORT WAYNE, IN 46804

WILSON J. ROTHMAN TRUSTEE 0. 0. 0.6509 GLEN LAKE COURT NONEFORT WORTH, IN 46804

TOTAL 0. $� 0.

M


C/O KANE & HOCKING 13-3920023

STATEMENT 7FORM 990-PF, PART XV, LINE 3ARECIPIENT PAID DURING THE YEAR

FOUND-DONEE ATION PURPOSE OF

NAME AND ADDRESS RELATIONSHIP STATUS GRANT AMOUNTWBNI NE INDIANA PUBLIC RADIO N/A 501C3 UNRESTRICTED $ 450.3204 CLAIRMONT COURTFT WAYNE , IN 46804

CANTERBURY SCHOOL N/A 501C3 UNRESTRICTED 3,000.3610 SMITH ROADFT WAYNE, IN 46804

FT. WAYNE PHILHARMONIC N/A 501C3 UNRESTRICTED 750.2340 FAIRFIELD AVENUEFT WAYNE , IN 46807

WBNI NE INDIANA PUBLIC RADIO N/A 501C3 UNRESTRICTED 250.3204 CLAIRMONT COURTFT WAYNE, IN 46805

SSEJ N/A 501C3 UNRESTRICTED 800.2444 BROADWAY SUITE 316NEW YORK NY 10028

HOPE FOR THE CHILDREN OF HAIT N/A 501C3 UNRESTRICTED 800.21 CUMMINGS PARKWOBURN, MA 01801

ALLEN CITY SPCA N/A 501C3 UNRESTRICTED 250.491 S HANNA STFT WAYNE, IN 46806

IU MEDICAL SCHOLL FOUNDATION N/A 501C3 UNRESTRICTED 100.2101 E COLISEUM BLVDFT WAYNE, IN 46805

TOTAL 6,400.1

b l sh t l h b f l -...

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