form treated as a private...

Form 990'P� Return of Private Foundation OMB No 1545-0052

or Section 4947(a)(1) Nonexempt Charitable Trust 004Treated as a Private Foundation

Department of the TreasuryInternal Revenue Service Note : The organization may be able to use a copy of this return to satisfy state reporting requirements.

For calendar year 2004 , or tax year beginning October 1 , 2004, and ending September 30 , 20 05

G Check all that apply: ❑ Initial return ❑ Final return ❑ Amended return ❑ Address change ❑ Name change

z

0U)

Use the IRS Name of organization A Employer identification number

label. KELLY FOUNDATION 68 ; 0175739Otherwise , Number and street (or P.O box number it mail is not delivered to street address ) Room/sui te B Telephone number (see page 10 of the instruction

pri nt 3610 AMERICAN RIVER DRIVE 190 ( 916 ) 978-4892or type.See Specific City or town, state , and ZIP code C If exemption application is pending, check here . ❑Instructions . SACRAMENTO , CA 95864-5999 D 1. Foreign organizations , check here . . ► ❑H Check type of organization: J Section 501(c)(3) exempt private foundation 2. Foreign organizations meeting the 85% test,❑ Section 4947(a)(1) nonexempt charitable trust ❑ Other taxable private foundation check here and attach computation . ► ❑

I Fair market value of all assets at end J Accounting method. El Cash W1 Accrual E if private foundation status was terminatedunder section 507(b)(1)(A), check here . ► ❑

of year (from Part ll, col. (c), ❑ Other (specify) ............................ F If the foundation is in a 60-month terminationline 16) ► $ 6427174 (Part 1, column (d) must be on cash basis.) under section 507(b)( 1)(B). check here . ► ❑

Analysis of Revenue and Expenses (The total of ( a) Revenue and (d) Disbursementsamounts in columns (b), (c), and (d) may not necessarily equal expenses per (b) Net investment (c) Adjusted net for charitable

the amounts in column (a) (see page 11 of the instructions)) books income income purposes(cash basis only)

I Contributions gifts grants etc received (attach schedule) ='7`}•` �`i-``' `�`"r'+='= k=, `�, q,'�'=`` �',`� •',,, , ,2 Check 10- ® if the foundation is not required to attach Sch B F

a'! 'H }? l�',_. J.1 :{7..,f.,. f - S'�" T}`+'•. _4'{� ��"�'rv •-"N k� �,i:K .t� •iC..J:

3 Interest on savings and temporary cash investments 179800 179800 `r=�I1. rmV+m...."r'' h;3 •, a4? g �,il �ti

4 Dividends and interest from securities . .5a Gross rents . . . . . . . . . . .b Net rental income or (loss) °''

(6a Net gain or (loss) from sale of assets not on line 10 -22452 •. i e5rr�' s �`'g`'• 1'54 :.F�•" (��'"`' •��• ---� h,"�„',_°-4 h..17J�: f�SP.'- "`y b Gross sales p rice for all assets on Iln 1953100

_`�`'�r,�-r' t; �.:

=

- _��y:;_ _;�. �=h,..•�.�

' =��Y,. F=�`

,;r2},'�,;;. ��.,��••�_�A,.,l ta° SS_ da',i7

•

P,�w� z,,,, ,`•-�I •HtF Yx

0 Part IV ��7 Capital gain net income (from 0 't.�3�:f��-A�`NaiN

,t�4.f�

MT

8 Net short-term capital gain,

+'i ! h_Vi•S

�•-k' ''kY-fRiw-L'ti~•'�! ,]LlI�'LT

�Wx'x-��"z::'�.'•yrPi}h P.%y1F

''4``'t`-°°��"f9 Income modifications

�',:4•axa tn. f •{r!j,�J.�Yi'k�n �•�.h;M1h{ �:'J'✓jy�.'"i- kl (a;•'C �'�'ii 'f: �l.�-•'-.

. .10a Gross sales less returns and allowan FEB r' ,,ti'te `"

b Less: Cost of goods sold ,±r � :k;" - n 1 ti., d. •.d`-.^' !.711+�

;, y f4m� ,emu;S4- `-`v�-.�w�%,ir {Sf.;K'r8.:-�'

�'� ...?��S'�Yi.L�'..,a��,C`n .N�

rs ks r�[''�:��`= , i� ,: f.'�,.t'�i.

c Gross profit or (loss) (attach s hedu@GDEN"'ybklr may,k ^' r ,`riµfr`S:s - s, +,-A';-='r_-r�9w' �nr:• '=-.__' :'�•'

,11 Other income (attach schedul . . . .12 Total. Add lines 1 through 11 157348 179800

to etc.13 Compensation of officers directors trustees None0)

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

employee benefits15 Pension plansQ , . . . . .W 16a Legal fees (attach schedule) . . . .

b Accounting fees (attach schedule) .51TWT I 1500 1500

c Other professional fees (attach schedule)17 Interest .18 Taxes (attach schedule) (seepage 14 of the i tf'u�ctti ons)'L 2278 147819 Depreciation (attach schedule) and depletion •�• ��^.20 Occupancy . . . . . . . . . . . .

conferences and meetings21 Travel , , . . . . .22 Printing and publications . . .

5i1v.r 323 Other expenses (attach schedule) 2310 2310c .24 Total operating and administrative expenses.

Add lines 13 through 23 6088 1478 3810

E.

25 Contributions gifts grants paid 276340 276340. . . .,,26 Total expenses and disbursements. Add lines 24 and 25 282428 1478 28015027 Subtract line 26 from line 12:

„r1":',.; v'��,.� ry `�' ., �.?F.aw i��.{y'v =,�,+M`Y hw.`-,. •.t' . • k' " ,µa y ��+,�*.«`.,•',rr ;,�•i. '•`:-` a#�=' x •=-"•• y ` rzy +, ` YA 'a Excess of revenue over expenses and disbursements -125080 p'� ,-}',i7�v'a, �";� Stz." l e 3 , {,l-�r : r,�r . ,:,y,

�c. i;' ; + aM , a, r•3p_ a :.k, s ,F;ai'S•7�;, ara �: t;.,�;d , _ •,� A z

b Net investment income (if negative, enter -0-) k t,' :r:�".Ye, �?':''MLt 178322 Pi q `, 1• m °' k a�`t,*' =� ':' ti -i+ i'�i'° :�-1�':�� _1-, ,_,�,•.

c Adjusted net income (if negative, enter -0-) •"-,,W-r WS"ry��n:=�-`+tifli��i*1:1��tF�-t

For P ri vacy Act and Paperwork Reduction Act Notice , see the instructions . Cat No 11289X Form 990-PF (2004)

13

Kelly Foundation 68-0175739

Form 990-PF (2004)

Attached schedules and amounts in the description columnSh

Beginning of year End of yearBalance eets should be for end-01-year amounts only (See instructions ). ( a) Book Value (b) Book Value ( c) Fair Market Value

1 Cash-non-interest-bearing . . . . . . . . . 5577 5396 53962 Savings and temporary cash investments . . . . . 0 0 0.3 Accounts receivable ►

yil'F`._-`T�,

T-Y.17] :;

f z=',rv_

{y'`'' " '�'Less : allowance for doubtful accounts ► . ....................

4 Pledges receivable ►.. r;i+_v

X: •S._4s wi�4��l:� . §tt

:L•�.b.._m̀ow.: _'w'riu'� �•1i .v5.. ', F^_ti,47u',. r. ,1

Less : allowance for doubtful accounts ► .................. ...5 Grants receivable . . . . . . . . . . . . .

6 Receivables due from officers, directors , trustees , and otherdisqualified persons (attach schedule) (see page 15 of theinstructions) . . . .

7 Other notes and loans receivable (attach schedule)) ► _________________Ary'

01 Less: allowance for doubtful accounts ► . . ........ .4

ai. ........ .. .......

8 Inventories for sale or use. . . . . . . . . . . .9 Prepaid expenses and defe rred charges . .. . . . .

10a Investments-U.S. and state government obligations (attach schedule)b Investments-corporate stock (attach schedule) . . . .c Investments-corporate bonds (attach schedule) . . . .

11 Investments-land, buildings , and equipment . basis 10 ...............'7!� f'i,:''A!: �.S.C4r%ak�.-

`- t '°- -"-i5e{'t7 �fA'' `°; 1,

_: i °;3�s-"v,..N';, .,-s,wr;:h'7aiy'�''4�•� =�•'- -"r • ' 'F ,

Less accumulated depreciation (a ttach schedule ) ► ..................12 Investments-mortgage loans . . .13 Investments-other (attach schedule) 5 (tb! r. 4 5751699 6421778 642177814 Land , buildings , and equipment basis ►---------------------------

,:�,'.W rt¢ r -r,

[F4r d A, 1. t Ys,^al.•t�

tJ

.,.��Ld , iLr'

Less accumulated depreciation ( attach schedule ) ►______________ __ __15 Other assets (describe ►- --------- - - ----- -- )- - - ------- - ----------16 Total assets (to be completed by all filers-see page 16 of

the instructions . Also, see page 1, item I) 5757276 6427174 6427174

17 Accounts payable and accrued expenses M r,u`t. . . . .18 Grants payable �u

U) 19 Deferred revenue . . . . . . . . . . . . . . 3G73,4320 Loans from officers , directors , trustees , and other disqua lified persons '464'\at lu hk�i ;{.'�.4' t ; r s�M

21 Mo rtgages and other notes payable (attach schedule)5 ,x'�'"J 22 Other liabilities (describe ► ...................... see STMT 5) 800 ' °'yryFs;

` f23 Total liabilities (add lines 17 through 22). 0 800 ? f`tE.1 � t t,r" 7.1 1

Organizations that follow SFAS 117, check here ► ❑ :,,0C1

and complete lines 24 through 26 and lines 30 and 31 . FFt P ri`vr •a3rT,

c 24 Unrestricted . . . . . . . . . . . . . . r�.�� '

m25 Temporarily restricted26 Permanently restncted .

gs:1*� �'=I 11,37 fjd-•- 1

= Organizations that do not follow SFAS 117, check here ►and complete lines 27 through 31.

L0 27 Capital stock , trust principal , or current funds .28 Paid -in or capital surplus , or land , bldg., and equipment fund

N:�ry1-,' "G;TFSjnvhM1�i

y 29 Retained eamings accumulated income endowment or other funds 5757276 6426374, , ,` '

+r30 Total net assets or fund balances (see page 17 of the

instructions ) . . 5757276 6426374,?,° 14= to^-a sr4�ra=a

Z 31 Total liabilities and net assets/fund balances (see a e 17 of x`°=sgpthe instructions 5757276 6427174 �t

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 with5757276end-of-year figure reported on prior year's return). . . . . . . . . . . . . . . . . 1

2 Enter amount from Part I, line 27a. . . . . . . . . . . . . . . . 2 -125080

3 Other increases not included in line 2 (itemize) ► STMT 6A 3 795203

4 Add lines 1, 2, and 3 . . . . . . . • . . . 4 6427399

5 Decreases not included in line 2 (itemize) No VFW 6B . _ _ _ _ _ _ 5 10256 Total net assets or fund balances at end of year (line 4 minus line 5)-Part II, column (b), line 30. . 6 6426374

Form 990-PF (2004)


Form 990-PF (2004)

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)ry )

(b) How acquired

D-Donation(c) Date acquired(mo, day, yr)

(d) Date sold(mo, day, yr)

is STATEMENT 7bcde

(e) Gross sales price (1) Depreciation allowed(or allowable)

(g) Cost or other basisplus expense of sale

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

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

I G l hC

(i) F M V as of 12/31/69 U) Adjusted basisas of 12/31/69

(k) Excess of col (I)over col (I), If any

ains (( ) o ( ) gain minuscol (k), but not less than -0-) or

Losses (from col (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 -22452

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 pages 13 and 17 of the instructions). tIf (loss), enter -0- in Part I, line 8 J 3

JiM 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'? ❑ Yes ® NoIf "Yes," the organization does not qualify under section 4940(e). Do not complete this part.

1 Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.

(a)Base peri od years

Calend ar year (or tax year beginning in) Adjusted qualifying distributions Net value of nonchantable - use assets(d)

Distribution ratio(col (b) divided by col (c))

2003 288490 5931295 .048638619392002 244597 5123164 .047743347672001 294480 5420069 .054331411652000 275710 6077645 . 045364610801999 171205 5855595 . 02923784859

2 Total of line 1, column (d) . . . . . . . . . . . . . . . . . . . . . 2 .22531583809

3 Average distribution ratio for the 5-year base period-divide the total on line 2 by 5, or bythe number of years the foundation has been in existence if less than 5 years . . 3 .045063168. .

4 Enter the net value of noncharitable- use assets for 2004 from Part X line 5. . . . . . 4 6141396,

5 Multiply line 4 by line 3 . . . . . . . . . . . 5 276751. . . .. . . . . . .

6 Enter 1 % of net investment income (1 % of Part I, line 27b) . . . . . . . . . . . 6 1783

7 Add lines 5 and 6 . . . . . . . . . . . . . . . . . .. 7 278534. . . . .

8 Enter cluallfvlnq distributions from Part Xli . line 4 . . . . . . . . . . . . 8 280150If line 8 is equal to or greater than line 7, check the box in Part VI, line 1 b, and complete that part using a 1 % tax rate. See thePart VI instructions on page 18.

Form 990-PF (2004)


Form 990-PF (2004) Excise Tax Based on Investment Income (Section 4940 (a), 4940 (b), 4940 (e), or 4948-see page 1 8 of the instructions)

1a Exempt operating foundations descri bed in section 4940 (d)(2), check here Op- El and enter " N/A" on line 1. ± _XDate of ruling letter_ __________ _______ (attach copy of ruling letter if necessa ry-see instructions )

b Domestic organizations that meet the section 4940(e) requirements in Part V check 1 1783,here ► m and enter 1 /o of Part I , line 27b . .

c All other domestic organizations enter 2% of li ne 27b Exempt foreign organizations enter 4% of Part I, li ne 12, col (b )2 Tax under section 511 (domestic section 4947 (a)(1) trusts and taxable foundations only. Others enter -0-) 2 03 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1783

4 Subtitle A (i ncome) tax (domestic section 4947 (a)(1) trusts and taxable foundations only. Others enter -0-). 4 05 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- - . - 5 17836 Credits/Payments : �t(h'� 4!� u P F�,.a.63i.JZSh1� �'�. 5

a 2004 estimated tax payments and 2003 overpayment credited to 2004 6a 1300

b Exempt foreign organizations-tax withheld at source 6bc Tax with application forpaid extension of time to file (Form 8868) 6cd Backup withholding erroneously withheld i ° ru s h.

7 Total credits and payments . Add lines 6a through 6d (. . err cu£� . crf _��

1300•

8 Enter any penalty for underpayment of estimated tax. Check here ❑ if Form 2220 is attached. 89 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed . . . . 9 483

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 2005 estimated tax ► Refunded ► 11FLOTITM Statements Regarding Activities

1a During the tax year did the organization attempt to influence any national state or local legislation or did Yes No, , ,it participate or intervene in any political campaign ? . . . . . . . . . . . . . . . 1a ✓

b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page ✓19 of the instructions for definition)? . . . . . . . . . . . . . . . . . . . . . . . lb

If the answer is "Yes " to 1a or 1b, attach a detailed description of the activities and copies of any materialspublished or distributed b the organization in connection with the activities . `W

c Did the organization file Form 1120-POL for this year? . . . . . . . . . . . . . . 1cd Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the organization. ► $ (2) On organization managers . ► $e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed

on organization managers . ► $ `; �2 Has the organization engaged in any activities that have not previously been repo rted to the IRS? . . 2 ✓

If "Yes," attach a detailed description of the activities . T, �;+u,�� '• ' , _ -3 Has the organization made any changes , not previously reported to the IRS , in its governing instrument, art icles

of incorporation , or bylaws , or other sim il ar instruments ? If "Yes ," attach a conformed copy of the changes 3 ✓4a Did the organization have unrelated business gross income of $1 000 or more during the year? 4a ✓, .b If "Yes ," has it filed a tax return on Form 990 -T for this year? . . . . . . . . .

. -

. . 4b5 Was there a liquidation , termination , dissolution , or substantial contraction during the year? . . . . . 5 ✓

ff 'Yes," attach the statement required by General Instruction T. �,=1

• °' �,;ar y�rF'��6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either : r+rKr k� ;pr=w

• 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? 6 ✓. . . . . . . . . . . .7 Did the organization have at least $5,000 in assets at any time during the year? If "Yes," complete Part 11, col. (c), and Part XV. 7 ✓8a Enter the states to which the foundation repo rt s or with which it is registered (see page 19 of the r2ri�::..° 5

instructions) No -- CALIFORNIA ............................................................................. .........b If the answer is "Yes " to line 7 , has the organization furnished a copy of Form 990-PF to the Attorney 6N -74

General (or designate) of each state as required by General Instruction G? If "No," attach explanation 8b ✓

9 Is the organization claiming status as a private operating foundation within the meaning of section 49426)(3) 'N' ` �;or 49420)(5) for calendar year 2004 or the taxable year beginning in 2004 (see instructions for Part XIV on }�page 25)? If "Yes," complete Part XIV . . . . . . . . . . . . . . . . . . . . . . . 9 ✓

10 Did any persons become substantial contributors during the tax year? If "Yes, "attach a schedule listing their names and addresses. 10 ✓11 Did the organization comply with the public inspection requirements for its annual returns and exemption application? 11 ✓

Web site address ► .....................Barbee..............................12 Th e books are in care of ► ..........................................ea 916=9 )8-4$9Z

-••----•--------------.. Telephone no. ► ...........-----------Located at ► 3610 AMERICAN RIVER DRIVE #190 - ........... ZIP+4 ► ......- 95864-5999

13 Section 4947(a)(1) nonexempt chartable trusts filing Form 990-PF in lieu of Form 1041-Check here . . . . . ► ❑and enter the amount of tax -exempt interest received or accrued during the year . . . . ► 1 13 1 NIA

Form 990-PF (2004)


Form 990-PF (2004) Statements Regarding Activities for Which Form 4720 May Be Reauired

File Form 4720 if any item is checked in the "Yes" column , unless an exception applies. Yes Nois During the year did the organization (either directly or indirectly). 3';iFr' ; 5Y' *h7 '-�,

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

T 3 a ,'a disqualified person?. ❑ Yes 21 Nom,

•3,LV

iv .,v

S�l(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? El Yes 21 No(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ❑ Yes ® No(5) Transfer any income or assets to a disqualified person (or make any of either available s �, ryy A�L -r,

for the benefit or use of a disqualified person)? ❑Yes ® No ..• ��i�(6) Agree to pay money or property to a government official? (Exception . Check "No"

if the organization agreed to make a grant to or to employ the official for a period`after termination of government service, if terminating within 90 days.) . . . . ❑ Yes No � `r> + +ra° j,

b If any answer is "Yes" to 1 a(l)-(6), did any of the acts fail to qualify under the exceptions described in Regulations r=~ r r .-'�✓section 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions)? , ib /

Organizations relying on a current notice regarding disaster assistance check here. ► ❑ . %4" M1F. t --

c Did the organization engage in a prior year in any of the acts described in 1 a other than excepted acts '°-n� .T"

": I,

�, ,that were not corrected before the first day of the tax year beginning in 2004 . . . . . . . . 1c ✓

2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization was a private" 4

operating foundation defined in section 4942U)(3) or 49420)(5)):;rear s� : j r

a At the end of tax year 2004, did the organization have any undistributed income (lines 6d F =-aand 6e, Part XIII for tax year(s) beginning before 2004? . . . . . . . . . . El Yes ® No t:�, rnl;

YIf "Yes," list the ears ► 20..... , 20.... , 20 .... , 20 .....

T. :r r.,

b Are there any years listed in 2a for which the organization is not applying the provisions of section 4942(a)(2)(relating to incorrect valuation of assets) to the year's undistributed income? (If applying section 4942(a)(2)to all years listed, answer "No" and attach statement-see page 20 of the 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? . . . . . . . . . . . . . . . . ❑ Yes ® No

b If "Yes ," did it have excess business holdings in 2004 as a result of (1) any purchase by the organization ; ''`or disqualified persons after May 26 , 1969; (2) the lapse of the 5-year period (or longer peri od approved

,jy5711 'W17i ;Ta,"4 4 Jby 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 organization had excess business holdings in 2004 ) . . . . . . . . . . . . . . . 3b /✓ !E

4a Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes 4a ✓b Did the organization make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable �`sr a

purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2004? . . 4b ✓. .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))? El Yes ® No xh h t t,(2) Influence the outcome of any specific pub li c election (see section 4955); or to carry

on, directly or indirectly, any voter registration drive? . . . . . . . . . . ❑ Yes 0 No a.A�(3) Provide a grant to an individual for travel , study, or other similar purposes?. . . ❑ Yes 0 No r1(4) Provide a grant to an organization other than a charitable , etc., organization described

in section 509 (a)(1) (2) or r3) ti n 4940 ? ❑ Yd 2D

,A, , ( , o sec o ( )( ) es No'

oAN i(5) Provide for any g() purpose other than religious, charitable, scientific, lliterary, or

ti l fd th ti lt t hild lf i ? ❑ W1" '

uca ona purposes , or or e prevene on o crue y ren or an mao c s Yes No „ A-b If any answer is "Yes" to 5a( 1)-(5), did any of the transactions fail to qualify under the exceptions described in

Regulations section 53 .4945 or in a current notice regarding disaster assistance (see page 20 of the instructions)? 5bOrganizations relying on a current notice regarding disaster assistance check here. , . . . ► ❑ si4

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? El Yes El NoIf "Yes," attach the statement required by Regulations section 53.4945-5 d.

r.-

6a Did the organization, during the year, receive any funds, directly or indirectly, to paypremiums on 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

Form 990-PF (2004)


Form 990-PF (2004) Information About Officers, Directors , Trustees, Foundation Managers , Highly Paid Employees,and Contractors

1 List all officers, directors, trustees, foundation managers and their compensation (see page 20 of the instructions).(a) Name and address(1

(b) Title, and averagehours per week

devoted to position

(c) Compensation( If not paid , enter

-0-)

(d) Contributions toemployee benefit plans

and deferred compensation(e) Expense account,

other allowances

STATEMENT80 None None

2 Compensation of five highest-paid employees (other than those included on line 1-see page 21 of the instructions).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(d) Contributions toemployee benefitplans and deferred

compensation

(e) Expense account,other allowances

NONE

-------•-- ------•-••----•------------•--------•------------------

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

iotai numoer or otner employees pals over sbu,uuu. ► 1 None3 Five highest-paid independent contractors for professional services-(see page 21 of the instructions). 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 receiving over $50,000 for professional services . ► None

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 I Expensesof organizations and other beneficiaries served, conferences convened, research papers produced, etc.

1 N/A

2

3

4

Form 990-PF (2004)


Form 990-PF (2004)

= Summary of Prociram- Related Investments (see pane 22 of the instructions)Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2 Amount

1 NONE._._....••-• ...............................................................................................................

2...............................................................•-••--•-••-.........••.....................................

All other program-related investments See page 22 of the instructions

3 ••• ..........................•-••-•.............__...............•----•...................................................

Total. Add lines 1 through 3 . . ► NoneMinimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see page 22 of the instructions.)

1 Fair market value of assets not used (or held for use) directly in carry ing out charitable, etc., (purposes:

a Average monthly fair market value of securities . . . . . . . . . . la 6228240

b Average of monthly cash balances . . . . . . . . . . . . . . . . . . . 1b 6680c Fair market value of all other assets (see page 22 of the instructions) . . . . . . . 1c Noned Total (add lines 1a, b, and c) . . . . . . . . . . . . . . . . . . . . . id 6234920

e Reduction claimed for blockage or other factors reported on lines 1a and1c (attach detailed explanation) . . . . . . . . . . . . 1e

2 Acquisition indebtedness applicable to line'1 assets . . . . . . . . . . . . 2 None3 Subtract line 2 from line 1 d . . . . . . . . . . . . . . . . . . . . 3 6234920

4 Cash deemed held for charitable activities. Enter 11/2% of line 3 (for greater amount, see page 23of the instructions) . . . . . . . . . . . . 4 93524

5 Net value of noncharitable -use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4 5 61413966 Minimum investment return . Enter 5% of line 5 6 307070

Distributable Amount (see page 23 of the instructions) (Section 49420)(3) and 0)(5) private operatingfoundations and certain foreign organizations check here ► ❑ and do not complete this part.)

1 Minimum investment return from Part X, line 6 . . . . . . . . . 1 3070702a Tax on investment income for 2004 from Part VI, line 5 . . . . 2a 1783

0 sb Income tax for 2004. (This does not include the tax from Part VI.) . 2bc Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . 2c 1783

3 Distributable amount before adjustments. Subtract line 2c from line 1 . . . . . . . 3 3052874 Recoveries of amounts treated as qualifying distributions . . . . . . . . . . . . 4 None5 Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . 5 3052876 Deduction from distributable amount (see page 23 of the instructions) . . . . . . . . . 6 None

7 Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,line 1 7 305287

Qualifying Distributions (see page 23 of the 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 . . . . . . la 280150

b Program-related investments-total from Part IX- B . . . . . . . . . . . . . . . 1b None

2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 None

3 Amounts set aside for specific charitable projects that satisfy the: sa Suitability test (prior IRS approval required) . . . . . . . . . . . . . . . . . . 3a None

b Cash distribution test (attach the required schedule) . . . . . . . . . . . . . . . 3b None4 Qualifying distributions . Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4 4 280150

5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investmentincome. Enter 1 % of Part I, line 27b (see page 24 of the instructions) . . . . . . . . . 5 1783

6 Adjusted qualifying distributions. Subtract line 5 from line 4 . . . . . . . . . . . 6 278367Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation

qualifies for the section 4940(e) reduction of tax in those years.Form 990-PF (2004)


Form 990-PF (2004)

Undistributed Income (see page 24 of the instructions)

(a) (b) (c) (d)

1 Distributable amount for 2004 from Part XI , corpus Years prior to 2003 2003 2004",§=.�Lr�N�„, ',",,. ;k•!,x rr ,' ;.p"r.,-.} ',' r+,iii L ,,; R , "xfy,,, " 305287line 7 . . . . . . ° . , , . . :,;_,., �„ ,, tt;,;�,.,, ,�. �y U U,.,� 1'; n�,r.,•'+:••,. y VS. .� . =dk•';8"` h?M.h, r,'J . L,G^ "' �C7 t°�`Y.

t .^d,•.. �+rw J.+!°_�- Yi ��,,. } ,:•„cc .'rv

tr,,'*�,' - ;air rR �'rZ^` •r gt• '�� ','3" ,'„ '"d`'tSr'Ar „�1, , A P "k• i

= �' E t',7' • 3�r�rs,Nr:',{ ., (P "'i' ::rn FpW,�, r. s �t, dty�'�r 'r' sl7a a'_, ,y u .u'a` r42 Undist ributed income, if any, as of the end of 2003 : + h'" I,.. + s ,•[ ,.r �,•^,'•s,.y r ;wry',Pa.^M r r � -a 's„12r w r�,+�';a:x� 9 v^�•.' r�;:�1t' •r,p�i�l:��rfi;�'9 •Eh". G'NF ",L�Y 1 P LcF S S�� Ap . A JF r'�P: �` y J I�;rFl t

a Enter amount for 2003 only "3. "r:�-, X'�,. mr ;1;,i ','°'trl;�.f,, s �a "" A • 4 ,' w.,,:,, 279647 ,u^;"%.;', �,r[f,

b Total for p ri or years: 20 20_ , 20 Jay yE '"y �7 yC }3 S•� P y F .rk u� ��:i'Nw,i•?�M,k,'r Jd" m5 -o:" ti FY�S h?, _�, ym-!u;F 'C -i!'3°'

i'`:` -Y&TT "S's; ey"p,

"';ty i ;+ Y tif, 3, ,�,� .,r�'S% -i ;a =�'�' R':4••r'.�,�' �^ [ `k k'1'Er ks''`3 Excess distributions carryover, if any, to 2004 ,' ;b .3 a,""� s� ' l` = �1.'' w •�; ,�-; r+' a ht�i• [+,r , à k ._i,c, ru a� ,: d. I,u r`hrb.LL';r .s, r sr:` ls; ;fir v e> N '% h,°I w,'

a From 1999 °r r" u' #+`'� •.n C"'t .r, fa i,=� 41a•' S , a 'r,�,+ ws,' _s ra: s'r . i^.. r •E• ,.% 5 `� v w,, , `, �r s� 1'� u

k'�`J; P. [ �,'at✓"�F po. C,•,%J.�t ,{'h

From 2000 'd" sM� ZZO," eb :tis', t_, 61q U�a`j A,1rI'4 1u',a F't h y r°` :+a„� +''. af'?:4

,.n .J V. y'' 1JF t5 fi °L_ 1, rv, ti�,tr-3, v4 i1.,, [''!t"+_ x'r i%i+, t i,. „ d, ,}t ,S�,aiN4w • s'. qtr $•,c From 2001

f�:w,�;',.i'''̀'t;°,i�,•;1P'�'}�,s`�r"'n.

`;;�' `. 4'wa,:f1'+.*,';

d�V`T�_L-is y�

-•-6t.

'F5=�"

,.v+•r,.,fhr",`,;i r, � �an�a Ktiwy�',,.';"�'aw 1+1 ?;'CG''r�„:rX' "} F,A uv "

�'9^,,ti•�.1.a1y^1 r`�°

^ ;a�y�ftacy,,;̀ ir\;r_ �,;, i�r+. • ,';•.;,a' r"cr, t._t z ..1. �° h�+� w •L-,�,'L 9•"r� y"`', r�fa�"� 'S 1 rp"!�,Csi^n,2,�1,,,' c, ,,, W f: ,.s• y '" r w' , .t ��)r's}`,, ,�l�r.,d From 2002 7 ctsrom "e}v ; ";, ,� �1. °- r ;o, t ikd ;, Fy + xt n,� rt,� r,.� .��r,S�k 7L{1,i' F� 4.v�,�. rr.;.$..�'�',� �L''8{'. F•�.yr.1�..g. . -'4�"�Y x�.c a'� $'��+�"'4�•a : J'w,r �r.;•,u Ze�'a Ne,c; s -t,

";f,4 �, ,1�dFi.:.✓'/".'„a,lA.fl'.r+N h..rv:�i t.Fko-tì�"�f'.rmJ{ Tda'fns;i"-F`'�.'A`*`.'rn: �',�A.5'4��a},3�f Total of lines 3a through e . . . , .'r^="�'F -A'r,'2ai'; ,\'-C (•,FLti7?s 'e'r, -asi�+.il!}r-bJ+' F'i„•.Ly�l/: �i4t „�J �}(_§1Jà•,Jr' �À /W i�;h� ,•1` ?r''S4:'.u�d^�r̀ s

T. s!

+t',�'

`̀=rr

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v̂rr,'r̀'

`'^'°z" 'k";"�`,'

f"?v

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t dTr

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fsc„i

•'x

.r:*t r̀,''x„

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a��'4 Qualifying distributions for 2004 from Part "V">ria c�.;�; k;3,✓'ikaat;�� f', (rT'4'Aky%' 4,�.','n 1,'f°._'iuA4 dL ,W,.r, ,,, ,",rn; e fir' ,�;r` n 1•s280150 ,, �+ x �,.F wn r a� SN ,r�a�•, �#� 1 L, t"�.;n_"�° �'� x^' ,';?^ t. r,�XII, line 4: ► r �¢, 4 :p �R r, 7sriL R .E :z-. ;1�,,•;?!cl; js�, .,;icy' rig `• „�Lti�e+�l 1'+'♦''a;1" .:- .;•} ,'; •, ,a •.+?"r a3

279647a Applied to 2003, but not more than line 2a �`'"�^b Applied to undist ri buted income of prior years jrw„ -

a •,+ " k,"F,t

r, '[ :�hFrarIc:sF:::�(Election required-see page 24 of the instructions ) �` q�';�L;r+i��'k r:'rw .�..� •ir�;ft.�l w-:Jl-: T-'?µ,3�!'�rrtiy'�, ?tr.�r„1fkt'• -'fib E FP=i r.,

, !' rh"°ì , t'' Ji y., i,5 d �Lc Treated as distributions out of corpus (Electi on 'p '•ie'yPI•

��-•z '�'`�*'- J �"�'' ��'�'�' ''}� '�r3n,4s eMi

required-see page 24 of the instructions) 1' �' a'• k_' �L�� • "`'' " t ,� ° `+=g �.'„��'` psiIT,I.�",w'�tF 1'tr,rrivaGa 1:.;i.lhkh.�t'll' �s•0.,i•k'r Wtt�.^f'4�+ r5,.l,r t;r.

x° �, r �' �ur�'r�"rp�, 4 'w',c;�•, f• �a a••-,F ..' a;� r: -,'t;��.d Applied to 2004 distributable amount �ky=°a-} 503e Remaining amount distributed out of corpus

�,'� �4�sA. 'ter. ��A . �;��r. " a•t `J �.�.,, None5 Excess distributions carryover applied to 2004�Ra9k°K-`"'"s_ i�r;�-'�,ybi,;r .1• �.iapse

a,"`rir�i":ias: ' �,'^ �r}6 +""r �„b' y.,. Tr•. 9� ... �, �-..g.. ..,.,;e °�(If an amount appears in column (d), the _3`',• ,E .i; -, }`RPti J. 4t

'ri..,,j r. .''✓ r;wt.,'�.•,

M

1` ,1'{ Y,Sf,t'f`1. ur4 ><f.'. tir,+',•+h1e5".`v'i'r M1 3", Y-i..`5*`�d5^ t�i

i+N'` 6'*i`n J' aC f +,; 1Y",.,same amount must be shown in column (a).) �"'' ',rx .fit r✓ "u- ` S a Jcl' .c , k'�,,,y�s.a,.x. 3-'� `v,� a 5

�•iT''•+rs+iay�•�,sv,•"Si6 'm'_'.i•indicated below

yt-16J'i RF+(dd ,F - N„3: w14 ' te �'-

a Corpus . Add lines 3f, 4c, and 4e. Subtract line 5 �^ -. 4i H'°:� {,%i�'P ,r ,51�•''t",a' �. �'+Lt^,r"b Pri or years ' undistributed income . Subtract y a��="y -̀ �; , �)".

line 4b from line 2b T ',i�.ta•".ir ro'; a w:�r==�"=ti�+' •f3`',s" ;r ,',�, mow.r a, -:�'

Tf±ic Enter the amount of prior years' undistributed � MAI-I-f. e.�i,�, � i[", N."•5 �a ,-'�iJ 'g!"``�{7'•'C�-n�•'4n . a,aF •.�-s"'r'�r' ,j�Yn aincome for which a notice of deficiency hasy

"��`{v_'r,��i�.4'��T ��•� �,u"�Ft•"�'^viriti 1s� F „�''*�,��'?'�--h".r�tti�+•�,�been issued , or on which the section 4942(a)-�`*r

��fg° v� i;7 ly�s;�r1 ' eyy+ k:ka rf ,..5+"# F,^;r;tax has been previously assessed . . . kx�- �±` ` {1 , w=.$°u• ; , S`'� �K�='-' -1•

,'�'-� ,,v„ r" '•`, ®r•--�sd Subtract li ne 6c from line 6b. Taxable a ' + F "�r ra �•'a(�Ax�>?'`•'4`�'' �,�F+:�''v-r»�7"'a�'}'`'t;u,�i.,a.� ':��'a�=Sa"t�•c::s.� :�",. f;1.,�amount-see page 25 of the instructions .

:Y,T a s''! r'-new' ' _ -; o- 't+1y�'•v:k�i .F's•: 'ir "'.�"+°,i �Frl�,�k,�sT, r :y,( s!',y�., y.�i a f err � a s t, "tk'rle Undistri buted income for 2003 . Subtract line 'a' "�', �;. v 3 � �... � ,s d � 1,`_t�. „+ar.ak` �"'r y.r`- �y°`t•.�'''a

•,,�`` 31,E zr.'� M1 ,�°,"'�;' ,�•, ,�` x,F�+ sjr�' .Y�°�. ,.� .;,j "cwad r 2a ,, sr, �+;sr k F °� T :�; • 1l�- a w s�' y�" y�'4a from line 2a. Taxable amount-see page

25 of the instructions �wP. t�ra„'�,.�• t' 0 w} t�~;�;'.xsry�;_,d �t f4 dl.- -N:�=i��•}`.1'{ +>r" L".^..a�`�' NCrc+f4R'r+ �).

-^ vi`'isi [� '°P �,".�̀A,,:r+x r+''�,µ�y -"y��,Y�°`,ÎAsL'ir>ti?3=N`y4'-'r'�+p4J"�5 �''ti.�:..'�,.i,z� ,n��%�rilL•ir•.L Ki�r+t' rb`^-Ti(' '�-• v'` }�yitsroi�yd4^ 'RJ

8,aKL "Y tY'm7,P'pj"4f Undistributed income for 2004 . Subtract "lines 4d and 5 from li ne 1 . This amount mustbe distributed in 2005 . . . . .�4�`�' 304784

7 Amounts treated as distributions out of rcorpus to satisfy requirements imposed by Yr,�' , �•*�, 4, - h1section 1 70 b 1 or 4942(g)(3) (see page Y25 of the instructions) . . . . . .{"��"

s,�, ''��tr">vtiti,i •f Z e� aKr r �:..>d', 1:.�'��,8 Excess distributions carryover from 1999 not r f -', �° ' r '+- t +r �wLF OP ,H P W-111,applied on line 5 or line 7 (see page 25of 6-i� k r �

.. `tea,.the instructions) *L�j fi; ì+�

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

a 4 =i k i FI "tr r'"7-f;�r 7 zti a2

tiy ? {" ;�,� x i ;a=b •�, � nI ^

Om,"s -41 ^10 Analysis of line 9 ' MN �, �,hr7uw r vcS° 0-a Excess from 2000.

s?� fax..' tE e. „r q,1 l y, f L ¢:'3r i 2 .r.+ta - w yYrk 7 'fS�z.r: , ,tR�•'yf�?�, .a+,�lr��•I• ;, '-f-U;.` �,` n�P•:

'nb Excess from 2001 . to d ',a ✓V 1 y A 'J'17t ' 2'r L' J4L vsy„x r ' a. Jî.A J� iaa5 !�}i�� 4¢ K r!,q'41� a'a�= Mr, r,,•-,.�"r.: a. �r,Y' man .,,,' f= + +�,;,, ,c "•'+� l'�; `, � �>. J7��:� l9 ,`:T�, �� r�S era',';; r aF�,,�,, � ,�',3'.4v`j 3�,+� d�a' n *,rM�t xln�• s'. C

c Excess from 2002 W' "'Am 'Y.` ^'"+i +�e ,:a:•x ;��' 3}`'i'e'' n ?e"'s'L"' .. v7:•�,'1�+W✓LV y i�d ?^ "'A,;vsS,ok, . °- ��.,;•' '+�;r� ,�''� �,- ,r s'r,� y�, r.''� �,�� • r�� r.d Excess from 2003. �,�! �'`. ��=�° •,� ;;r , `S �.',

�i$ f(M, •t'i, ,v�.4^.,.,r.F r ';k r'< ,n'r -c,�',,,, £ • • :Y' �^'u,'',t's,�`{r

e Excess from 2004. i n',r" � �;'=LLF,; � , �; 'r ;'?�'t a' �+�""'" }`9+"-�'A� r�i� �°•A:• :-�''�."; �. •��,r�i;,, �i'�"�`, a t'; ,• . -.diva !•.E.,y+reN:.•a's;1�,-.,, ^,•r;,.r ,Fi.+c'�•;.�. 4.�..r.., ��:a

Form 990-PF (2004)


Form 990-PF (2004)

1 9.1-a0:4 Private Operating Foundations (see page 25 of the instructions and Part VII-A, question 9)la

b2a

b

c

d

If the foundation has received a ruling or determination letter that it is a private operatingfoundation, and the ruling is effective for 2004, enter the date of the ruling. . . . . ► N/ACheck box to indicate whether the organization is a private operating foundation desc ribed in section ❑ 49420)(3) orEnter the lesser of the adincome from Part I or theinvestment return from Partyear listed . .85% of line 2a . . .

Qualifying distributions fromline 4 for each year listed

Amounts included in line 2c notfor active conduct of exempt ac

e Qualifying distributions mafor active conduct of exempSubtract line 2d from line 2

3 Complete 3a, b, or calternative test relied up

a "Assets" alternative test(1) Value of all assets(2) Value of assets

under section 49420b "Endowment ' alte rn ative test

of minimum investment returPart X , line 6 for each year list

c "Suppo rt" alternative tes

(1) Total support other tinvestment incomedividends, rents, pon secu rities loans512(a)( 5)), or royaltie

(2) Support from geneand 5 or more exeorganizations as p rsection 49420)(3)(B)(

(3) Largest amount offrom an exempt or

(4) Gross investment in

Supplements ry

4942(i)(5)lusted net Tax year Prior 3 years (e) Totarminimum

mumf h(a) 2004 (b) 2003 (c) 2002 (d) 2001

orX eac

Part XII,

used directlytivities . .

de directlyt activitiescC. . .

for then:

-enter,

qualifying)(3)(B)(i)-enter %n shown inedt-enter:han gross(interest,

ayments(section

s) . .al publicptovided inm) . .support

anizationcomeInformation (Complete

o

rm

g

this part only if the organization had $5,000 or more inassets at any time during the year-see page 26 of the instructions.)

1 Information Regarding Foundation Managers:a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation

before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2) )Jon S. Kelly & Gregory G. Kelly, Members of J.S. Kelly, LLC & G.G. Kelly, LLC

b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of theownership of a partnership or other entity) of which the foundation has a 10% or greater interest.

N/A2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:

Check here ► ❑ if the organization only makes contributions to preselected charitable organizations and does not acceptunsolicited requests for funds. If the organization makes gifts, grants, etc. (see page 26 of the instructions) to individuals ororganizations 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:

STATEMENT 9-10

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

STATEMENT 9-10

c Any submission deadlines:

STATEMENT 9-10

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

STATEMENT 9-10Form 990-PF (2004)


Form 990-PF (2004) Mrs"At Supplementary Information (continued)3 Grants and Contributions Paid During the Year or Approved for Future Payment

Recipient If recipient is an individual Foundationshow and relationship ft t Purpose of grant orany foundation managerr s a us o contribution Amount

Name and address (home or business) or substantial contnbutor recipient

a Paid during the year

STATEMENT11

Total ► 3a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b Approved for future payment

Total . . ► 3blForm 990-PF (2004)


Form 990-PF (2004)

Analysis of Income-Producing ActivitiesEnter

1 Proabcdef9

2 Me3 Inte4 Div5 Net

ab

6 Net7 Ot8 Gain9 Net

10 Gr11 Ot

bcde

12 Subtotal. Add columns (b), (d), and (e) 15734813 Total . Add line 12, columns (b), (d), and (e) . . . . . . . . . . . . . . . . . 13 157348(See worksheet in line 13 instructions on page 26 to verify calculations.)

Relationshi of Activities to the Accomplishment of Exempt Purposes

Line No. Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to. the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes). (See

page 27 of the instructions.)N/A

ross amounts unless otherwise indicated . Unrelated business income Excluded by secti on 512, 513 , or 514 (e)

ram service revenue :

(a)Business code

(b)Amount

(C)Exclusion code

(d)Amount

Related or exemptfunction income(See page 26 ofthe instructions.)

Fees and contracts from government agenciesmbership dues and assessments . . . .rest on savings and temporary cash investments 14 179800

dends and interest from securities .. .rental income or (loss) from real estate : `xs T _ " '- ^Debt-financed prope rty . . . . . .Not debt-financed property . . . .rental income or doss) from personal propertyer investment income . . . . . . . .or (loss ) from sales of assets other than invento ry 18 -22452

income or (loss) from special events . . .ss profit or (loss) from sales of inventoryerrevenue: a

`3-�•^� ` - `''"�^`�` -

g

i

h

oh

Form 990-PF (2004)


Form 990-PF (2004)

Information Regarding Transfers To and Transactions and Relationships With NoncharitableExempt Organizations

1 Did the organization directly or indirectly engage in any of the following with any other organization described in section x 2, Yes No501 (c) of the Code (other than section 501 (c)(3) organizations) or in section 527, relating to political organizations?

a Transfers from the repo rting organization to a noncharitable exempt organization of.(1) Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a 1) ✓(2) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . la(2) ✓

b Other transactions : H " y"..(1) Sales of assets to a noncharitable exempt organization . . . . . . . . . . . . . . . . 1b 1) ✓(2) Purchases of assets from a noncharitable exempt organization . . . . . . . . . . 1b(2) ✓(3) Rental of facilities , equipment , or other assets . . . . . . . . . . . . . . . . . . . lb(3) ✓(4) Reimbursement arrangements . . . . . . . . . . . . . . . . . . . . . ib 4) ✓(5) Loans or loan guarantees . . . . . . . . . . . . . . . . . . . . . . . . . . I 5) ✓(6) Pe rformance of services or membership or fundraising solicitations. . . . . . . . . . . . lb(6)1 I ✓

c Sharing of facilities, equipment , mailing lists , other assets , or paid employees . . . . . . . . . is ✓d If the answer to any of the above is "Yes," complete the following schedule . Column (b) should always show the fair market

value of the goods, other assets , or services given by the repo rting organization . If the organization received less than fairmarket value in any transaction or sharing arrangement , show in column (d) the value of the goods , other assets, or servicesreceived.

(a) Name of organization (b) Type of organization (c) Desc ri ption of relationship

Under penalties of perju ry, I declare that I have examined this return, mcludmg accompanying schedules and statements, and to the best of my knowledge andbelief, it is true correct and comp) to Dec aratio of preparer (other than ta

offd Signature of officer or trust

IC y �

CO Preparer's

o signature r)4, c y

Firm's name (o y rs ifself-employed), dress,and ZIP code

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? . . . . . . ❑ Yes ® No

b If "Yes." complete the following schedule.

2004 , Federal Statements


Statement 1Form 990-PF, Part I, Line 16bAccounting Fees

PricewaterhouseCoopers LLP

(a) (b) Net (c) (d)Expenses Investment Adjusted Charitableper Books Income Net Income Purposes

$ 1,500 $ 1,500

Total $ 1,500 $ - $ - $ 1,500

Statement 2Form 990-PF, Part I, Line 18Taxes

Excise TaxForeign Tax


$ 8001,478 1478

Total $ 2,278 $ 1,478 $ - $ -

Statement 3Form 990-PF, Part I, Line 23Other Expenses

Association DuesInsurance-Liability/D&OOffice Expense


$ 400 $ 4001,605 1,605305 305

Total $ 2,310 $ - $ - $ 2,310

2004 Federal Statements


Statement 4Form 990-PF, Part II, Line 13Investments-Other

Valuation Book Fair MarketMethod Value Value

Investment-Dodge & CoxInvestment-DFA

Mkt Value $ 3,072,679 $ 3,072,679Mkt Value 3,349,099 3,349,099

Total $ 6,421,778 $ 6,421,778

Statement 5Form 990-PF, Part II, Line 22Other Liabilities

Deferred Excise Tax $ 800

Total $ 800

Statement 6aForm 990-PF, Part III, Line 3Other Increases

FMV Adjustment of InvestmentsExcise Tax refund

$ 792,0363,167

Total $ 795,203

Statement 6bForm 990-PF, Part III, Line 5Other Decreases

Excise Tax payment $ 1,025

Total $ 1,025

11/2/2005

Cl)H

H

03zH

2004 KELLY FOUNDATION Capital Gains10/1/2004 Through 9/30/2005

Account Security

Dodge & Cox Income ... Dodge & Cox Income FundT. Rowe Price (PRFEX) T. Rowe Price PRFEX

-- - --------------- ------- - --- ----------------T. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEX

-- - - --------- ---- -- - - ------ - ----- -- - - -T. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price P-RFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEXT. Rowe Price (PRFEX) T. Rowe Price PRFEX

TOTAL LONG TERM

Shares Bought Sold Gross Proce...

698.357 3/29/2004 5/20/2005 8,911.044,380.054 12/29/1999 11/24/2004 65,000.00

26,991.356 2/17/1997 1/12/2005 407,029.60481.140 12/29/1997 1/12/2005 7,255.5922.910 12/29/1997 1/12/2005 345.48

1,076.840 12/29/1997 1/12/2005 16,238.75602.100 12/16/1998 1/12/2005 9,079.67207.620 12/16/1998 1/12/2005 3,130.91

- - ---- -- ----- --- --- - --62.290 12/16/1998 1/12/2005 939.33

294.490 12/15/1999 1/12/2005 4,440.912,321.277 12/15/1999 1/12/2005 35,004.85

- -- ----- ---- -- --------- - - - ---- -- - - -19,643.296 12/29/1999 1/12/2005 296,220.87

391.117 12/13/2000 1/12/2005 5,898.04142.224 12/13/2000 1/12/2005 2,144.74

--- -------- ------ - - --- - -------------- --- --- -4,800.077 12/13/2000 1/12/2005 72,385.151,984.235 12/12/2001 1/12/2005 29,922.26

25,258.964 1/23/2002 1/12/2005 380,905.141,271.415 12/18/2002 1/12/2005 19,172.94169.522 12/18/2002 1/12/2005 2,556.39

1,716.862 12/17/2003 1/12/2005 25,890.28137.349 12/17/2003 1/12/2005 2,071.22

1,849,976.23

OVERALL TOTAL

68-0175739

Cost Basis Realized Gain...9,078.64

97,543.80435,910.40

7,606.81362.23

17,024.7710,368.163,575.221,072.636,031.16

47,539.75437,456.20

6,832.812,484.65

83,857.3525,795.06

317,000.0013,299.001,773.20

22,525.231,802.02

1,871 ,092.76

-167.60-32,543.80-28,880.80

-351.22-16.75

-786.02-1,288.49-444.31-133.30

-1,590.25-12,534.90

-141,235.33-934.77-339.91

-11,472.204,127.20

63,905.145,873.94783.19

3,365.05269.20

-21,116.53

,953,099.67 1,975,551.83 -22,452.16

Page 2

V

11/2/2005

68-0175739

Account Security Shares Bought Sold Gross Proce... Cost Basis Realized Gain...

y HORT TERM -DFA-US Micro DFA-US Micro Cap 42.814 9/8/2004 1/12/2005 610.96 562.15 48.81DFA-US Micro DFA-US Micro Cap 1,956.821 12/2012004 1/1212005 27,923.84 28,684.92 -761.08DFA-US Micro DFA-US Micro Cap 1,388.359 12/20/2004 1/12/2005 19,811.88 20,408.88 -597.00Dodge & Cox Income ... Dodge & Cox Income Fund 2,492.887 1/19/2005 5/20/2005 31,809.24 32,033.60 -224.36T. Rowe Price (PRFEX) T. Rowe Price PRFEX 1,523.045 12/16/2004 1/12/2005 22,967.52 22,769.52 198.00

TOTAL SHORT TERM 103,123 .44 104,459.07 -1,335.63

DFA-Five Yr Gov DFA-Five Yr Government 3,225.806 1/25/1993 2/23/2005 34,000.00 33,790.32 209.68DFA-US Large DFA-US Large Company 2,914.160 1/25/1993 1/12/2005 101,383.62 38,729.19 62,654.43DFA-US Large

----- - - - -DFA-US Large Company

- ----- ----- --- ------ - ---- ------- - -18.110

- - --- -3/9/1993

-- ---- ------ ------ -1/12/2005

-630.05

-- ---- -----248.29

- - - -- -- - - - -381.76

- - -- - --- -- - --- - -DFA-US Large DFA-US Large Company 31.040 6/9/1993 1/12/2005 1,079.88 415.63 664.25DFA-US Large DFA-US Large Company 27.430 9/8/1993 1/12/2005 954.29 376.89 577.40DFA-US Large DFA-US Large Company

--- ---- - ------- --21.010

- ------11/16/1993------- -- - --

1/12/2005- --- - --- ---- -

730.94- ---- -------- - - -

294.98- - - ----- - ---- -

435.96--- -- - -- --- ------- - - ---

DFA-US Large--- ------ -

DFA-US Large Company- - -

12.300-12/16/1993

-1/12/2005 427.92 169.44 258.48

DFA-US Large DFA-US Large Company 31.360 12/16/1993 1/12/2005 1,091.01 432.08 658.93DFA-US Large DFA-US Large Company 776.840 1/24/1994 1/1212005 27,026.26 11,000.05 16,026.21DFA-US Large DFA-US Large Company 18.160 3/8/1994 1/12/2005 631.79 252.79 379.00DFA-US Large DFA-US Large Company 29.660 6/8/1994 1/12/2005 1,031.87 406.05 625.82DFA-US Large DFA-US Large Company 32.420 9/8/1994 1/12/2005 1,127.89 459.39 668.50- -- -- - - - -DFA-US Large

-- - - - ------ - -DFA-US Large Company

- - --41.200

- - - -11/28/1994

--- - -1/12/2005

-1,433.35

--559.91

- -873.44

DFA-US Large DFA-US Large Company 1.890 11/28/1994 1/12/2005 65.75 25.69 40.06DFA-US Large

------- - --DFA-US Large Company-- - -- ----- - - -- --- -

12.400- - -

12/28/1994- --- - -- -

1/12/2005-

431.40- -

171.00- - -- -

260.40- ---- - --- ------

DFA-US Large DFA-US Large Company 1,741.290 1/17/1995 1/12/2005 60,579.48 24,499.95 36,079.53DFA-US Large DFA-US Large Company 29.250 3/8/1995 1/12/2005 1,017.61 422.96 594.65DFA-US Large DFA-US Large Company 34.920 6/8/1995 1/12/2005 1,214.87 556.97 657.90DFA-US Large DFA-US Large Company 40.780 9/8/1995 1/12/2005 1,418.74 699.78 718.96DFA-US Large DFA-US Large Company 408.833 9/11/1995 1/12/2005 14,223.30 7,027.84 7,195.46to

to DFA-US Large DFA-US Large Company 2,085.964 12/29/1999 9/23/2005 74,322.91 89,613.03 -15,290.12DFA-US Large DFA-US Large Company 19.003 6/8/2000 9/23/2005 677.09 815.44 -138.35DFA-US Micro DFA-US Micro Cap 1,681.850 12/20/1999 1/12/2005 24,000.00 19,812.19 4,187.81DFA-US Micro DFA-US Micro Cap 2,989.021 12/20/1999 1/12/2005 42,653.33 35,210.66 7,442.67DFA-US Micro DFA-US Micro Cap 2,364.395 5/26/1999 2/23/2005 34,000.00 26,481.22 7,518.78Dodge & Cox Income ... Dodge & Cox Income Fund 830.486 6/26/2003 5/20/2005 10,597.00 10,788.01 -191.01Dodge & Cox Income ... Dodge & Cox Income Fund 769.014 9/26/2003 5/20/2005 9,812.62 9,912.59 -99.97Dodge & Cox Income ... Dodge & Cox Income Fund 695.149 12129/2003 5/20/2005 8,870.10 8,981.33 -111.23

2004 KELLY FOUNDATION Capital Gains10/1/2004 Through 9/30/2005

Page 1

2004 Federal Statements


Statement 8Form 990-PF, Part VII, Line 5List of Officers, Directors and Trustees

Name and Address Title CompensationContrib toEBP & DC

ExpenseAccount

Jon S. Kelly Director NONE NONE NONE3610 American River Drive, #190Sacramento, CA 95864

Gregory G. Kelly Director/ NONE NONE NONE3610 American River Drive, #190 PresidentSacramento, CA 95864

Scott G. Nichols Treasurer NONE NONE NONE3610 American River Drive, #190Sacramento, CA 95864

Keiko Jean Kashiwada Secretary NONE NONE NONE3610 American River Drive, #190Sacramento, CA 95864

Jeanne Reeves Director NONE NONE NONE2485 Natomas Park DriveSacramento, CA 95833

Bob Woods Director NONE NONE NONE1220 Brickyard Cove Road, #200Pt. Richmond, CA 94801

KELLY FOUNDATION 68-0175739

FORM 990PF, PART XV, SUPPLEMENTARY INFORMATIONLINE 2a, b, c, and d.

LINE 2a

Kelly FoundationP0 Box 255868Sacramento, CA 95865-868

LINE 2b

gem"attaciiec7-Application Form

LINE 2c

Quarterly deadlines as follows:October 15January 15April 15July 15

An organizationmay apply only once a year, regardless ofwhat action is taken.

LINE 2d

Kelly Foundation considers grant requests in the following categories:• Health and human services

• Education andCulture and civic improvement

The Kelly Foundation will not consider grants to the following types of organizations orfor the following purposes:

Religious organizations for explicit religious activities , 'as distinguished fromsocial or educational activities

Political organizations or political campaignsFraternal organizations , labor, societi es or ordersTelephone solicitationsNational fundraising efforts.

STATEMENT w9

The Foundation directors may also, from time to time, identify areas for special emphasiswhen emerging needs require extraordinary attention.

Grants are generally made up for one (1) year only, through a limited number of multi-year grants may be made available.

STATEMENT /0

68-0175739

KELLY FOUNDATION

APPLICATION FORM

KELLY FOUNDATION APPLICATION FORM '

Please read carefully:

We would like to give your organization every opportunity to "shine" which is part of thereason for this somewhat lengthy application procedure. Unfortunately, our funds are muchmore limited than are the needs in the community, so we have to ask detailed questions todistinguish carefully among the projects and organizations. Please be assured that the timeand effort you spend on this application is very much appreciated.

Before filling out this form, please review the "Grant Distribution Guidelines" for the KellyFoundation to be sure your proposal-qualifies for consideration. You are stronglyencouraged to.send a preliminary letter of inquiry, though a binding determination will not bemade until the full application is submitted.

Please type your answer to each question as concisely as possible, using "not applicable" asyour response to those questions you feel are not germane to your proposal. You arewelcome to use extra sheets if necessary. Submit original and (1) copy of the applicationform prior to the quarterly deadline. r

All applications must be accompanied by one (1) copy of an IRS 501 (c) (3) Tax ExemptionLetter. A detailed project budget must also be attached, as well as a current annual budgetand audited financial statement of the organization, if available. Finally, one (1) copy of theroster of the Board of Directors should also be included. A- checklist is at the end of this formfor your convenience.

I. ORGANIZATION

Name

Address

ContactName Title Telephone

rev: 3/98

CHECKLIST

Please attach one (1) copy of each of the following documents to each of the two (2)Application forms you submit:

A. Total agency budget

B. Detailed project budget

C. Descri ptive b rochures, if available

• Please submit one (1 ) copy of each of the following documents with you applicationpackage:

D. Audited fi nancial statement, if available

E. List of officers and board members, including addressesand occupations

F. Copy of IRS 501 (c) (3) Tax Exemption Determination -Letter

When your application packet is complete, please send it according to the scheduledescribes on the information sheet to: -

'KELLY FOUNDATIONPO Box 255868Sacramento , CA 95865-5868

rev: 3/98

KELLY FOUNDATION APPLICATION FORM

1. What are the major goals of your organization?

2. When was it founded? -

3. What were the major accomplishments of the organization last year?

4. Describe the characteristics and geographical area of the population you serve.

b Annual income:

Sources of income:

- a. Ticket sales or other fees (specify):

b. Membership and individualcontributions:

c. United Way or other public charities:

d. Corporate donations (specify):

e. Government (specify):

f. -Foundations:

g. Other

rev 3/98

Percent to total

S. Please list previous grant applications to the Kelly Foundation:

Amount Amount KellyDate Purpose Requested Approved Contact'

7. Does or will your organization engage in activities intending to influencelegislation or intervene in any. way in political campaigns?

Yes No

PROJECT -

8. Amount requested from the Kelly Foundation?

9. When is the funding needed from us?

10. Indicate whether request is for.

Special Program

One-time capital expenditure

Operating support

Other

11. List the primary objectives of the project

12. List the primary methods by which you intend to achieve these objectives:

rev: 3/98

I

13. Briefly describe what you intend to do with the money requested, includingstarting date, benchmarks or milestones, completion date, and public or privateorganizations you will work with in carrying out your plan. (If this is a capitalrequest, please describe b ri efly the item(s) needed and the itemized costs. If itis a campaign, describe the components of the drive and the separate dollargoals.)

14. How did you determine that this project would fill an important need in thecommunity?

15. What evidence do you have of community suppo rt for your proposal?

16. List other organizations involved in similar projects and indicate the extent ofcoordination-with each, if applicable. (To the-extent that your programduplicates others in the area, what distinguishes it from the others?)

17. How will the project be monitored and the results evaluated?

18. Total proposal budget:

Percent requested from Kelly Foundation:

rev: 3/98

19. Amount requested from other sources:

Name Amount Present Status

20. is there anything else you would like to tell us?

The preceding information is correct to the best of my knowledge and belief.

Signature-

Title

Date

Please have the Chairman of the Board sign below:

Name

Date

rev. 3/98

Kelly Foundation #68-01757392004 Form 990-PF

Statement 11

Part XV Line 3a Supplementary Information/Grants and Contributions Paid During the Year

Reciaient/Address Status Purpose Amount

Families First / 2100 Fifth Street, Davis, CA 95616 Non-profit Crisis nursery $ 25,000

PEACE for Families / PO Box 5462, Auburn, CA 95603 Non-profot Shelter for battered women & children $ 10,000

Guide Dogs of America/13445 Glenoaks Blvd,Sylmar, CA 91342 Non-profit Sponsor a puppy for training $ 4,000

Sierra Adoption Services, 8928 Volunteer Lane, #240Sacramento, CA 95826 Non-profit Therapuetic Support - tests & sessions $ 5,000

Family Service Agency Non-profit Child abuse prevention program $ 2,0008912 Volunteer Lane, #100, Sacramento, CA 95826

Fairytale Town, 3901 Land Park DriveSacramento, CA 95822 Non-profit Help build the Mother Goose Stage $ 5,000

Asian Community Center, 7375 Park City Drive,Sacramento, CA 95831 Non-profit Lifelong Learning & Wellness Program $ 3,000

transportation services for all elderly

Sacramento Tree Foundation, 201 Lathrop Way, Ste FSacramento, CA 95815 Non-profit

Center for Equine HealthOne Shields Avenue, Davis, CA 95616 Non-profit

Discovery Museum, 101 I Street,Old Sacramento, CA 95814 Non-profit

Operating support - urban forest for Sacto $ 10,000

Edwin Gregson Fellowship - year 4 of 5for Stephanie Bell $ 45,000

"Space Quest" program $ 5,000

Sacramento Theatre Co.1419 H Street, Sacramento, CA 95814 Non-profit

Stanford Home3628 Madison Avenue, #7, No Highlands, CA 95660 Non-profit

Short Term Emergency Aid Committee (STEAC) Non-profitBox 1047, Davis, CA 95616

Asian Pacific Rim Foundation Non-profitPO Box 22973, Sacramento, CA 95822

Jr. Achievement Non-profitPO Box 2767, Sacramento, CA 95670

Developmental Disabilities Service Org. (DDSO) Non-profit1250 Sutterville Road, #200, Sacramento, CA 95822

Special Olympics of No. California Non-profit3841 N. Freeway Blvd., #280, Sacramento, CA 95834

The First Tee of Greater Sacramento Non-profit4427 Freeport Blvd., Sacramento, CA 95822

WIND Youth Services Non-profitPO Box 13856, Sacramento, CA 95853

"Kids Write Plays" $ 5,000

Foster care mental health program $ 10,000

New education program (for homeless) $ 3,640

Scholarships $ 5,000

Program for Wm Brooks Elementary $ 3,500School in El Dorado Hills

Acting & film making for actors withdisabilities + mural project $ 5,000

Expenses for the golf athletes $ 10,000

Golf & life skills for underprivileged youth $ 5,000

Case worker for at-risk youth $ 25,000

1 of 2

Statement 11Kelly Foundation #68-01757392004 Form 990-PFPart XV Line 3a Supplementary Information/Grants and Contributions Paid During the Year

Recipient/Address Status Purpose Amount

Boys & Girls Clubs Non-profit Lemon Hill "Garden Science Program" $ 10,0005212 Lemon Hill Avenue, Sacramento, CA 95824

Salvation Army Non-profit Beds at the Women's Homeless Shelter $ 5,0003755 N. Freeway Blvd., Sacramento, CA 95834

American Red Cross8928 Volunteer Lane, #100, Sacramento, CA 95826 Non-Profit Katrina relief / Sacramento local $ 50,000

UC Davis Medical Center2315 Stockton Boulevard, Sacramento, CA 95817 Non-profit New medical facility $ 25,000

Association of Small Foundations Non-profit Regional recruiting & seminars $ 200Bethesda, MD

Total 1011/04 to 9/30/05 $ 276,340

2of2

form treated as a private...

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