Post on 25-Feb-2023
Form 990-PF Department of the Treasury Internal Revenue Service
Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation
| Do not enter social security numbers on this form as it may be made public. | Go to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0052
2017 For calendar year 2017 or tax year MAY Name of foundation
JEROME FOUNDATION, INC. Number and street (or P.O. box number if mail is not delivered to street address)
400 SIBLEY STREET City or town, state or province, country, and ZIP or foreign postal code SAINT PAUL, MN 55101
and en APR 30, 2018 A Employer identification number
**-***5163 Room/suite B Telephone number 125 651 224 9431
C If exemption application is pending, check here ... |
G Check all that apply: Initial return Initial return of a former public charity Final return Amended return
H Check type of organization: X Section 501(c)(3) exempt private foundation
OddiiiAiREtttursg
seaee
veearp
nsaenpnn
xn
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I Fair market value of all assets at end of year J Accounting method: Cash (from Part II, col. (c), line 16) Other (specify) |$ 104, 390, 635. (Part I, column (d) must beon cash basis.)
Part I Analysis of Revenue and Expenses (a) Revenue and (The total of amounts in columns (b), (c), and ( d ) may not necessarily equal the amounts in column (a).) expenses per books
1 Contributions, gifts, grants, etc., received ......... 15, 00 0. 2 Check| if the foundation is not required to attach Sch. B
Interest on savings and temporary 3 cash investments .......................................... 4 Dividends and interest from securities............... 2, 12 6, 644. 5a Gross rents ................................................
b Net rental income or (loss)
6a Net gain o r (loss) from sale of assets not on line 10 ...... 6, 7 0 1, 5 1 8. Gross sales price for all
b assets on line 6a ...... 12, 0 2 1, 904. 7 Capital gain net income (from Part IV, line 2) ............... 8 Net short-term capital gain ........................... 9 Income modifications ....................................
Gross sales less returns 1 0a and allowances ............ b Less: Cost of goods sold ... c Gross profit or (loss) ....................................
11 Other income ............................................. 12 Total. Add lines 1 through 11 �������� 8, 843, 162. 13 Compensation of officers, directors, trustees, etc. ......... 280, 000. 14 Other employee salaries and wages .................. 264, 406. 15 Pension plans, employee benefits .................. 10 2, 40 7. 16a Legal fees.................................S...T...M...T......
2 ... 9,123.
b Accounting fees ........................S...T...M...T......3 ... 19, 256.
c Other professional fees ...............S...T...M...T ......4 ... 252,592.
17 Interest ...................................................... 18 Taxes.......................................S...T...M...T......
5 ... 209,442.
19 Depreciation and depletion ........................... 8, 75 0. 20 Occupancy ................................................ 63, 076. 21 Travel, conferences, and meetings .................. 4 7, 521. 22 Printing and publications .............................. 1, 715. 23 Otherexpenses ........................S...T...M...T......
6 ... 104, 841.
24 Total operating and administrative
expenses. Add lines 13 through 23 ............... 1, 363,129. 25 Contributions, gifts, grants paid ... ... ... ... ... ... ... 5, 161, 845.
-
26 Total expenses and disbursements.
- Add lines 24 and 25 � � � � � � � � � � � � 6,524, 974. -
27 Subtract line 26 from line 12: a Excess of revenue over expenses and disbursements ... 2, 3 1 8, 1 8 8.
-
b Net investment income (if negative, enter -0-) ... ... ... .______________________ -
- c Adjusted net income (if negative, enter -0-) � � � � ________________________ -
723501 01-03-18 LHA For Paperwork Reduction Act Notice, see instructions.
D 1. Foreign organizations, check here......|
2. Foreign organizations meeting the 85% test, check here and attach computation ... ... ... ... |
E If private foundation status was terminated under section 507(b)(1)(A), check here ... |
F If the foundation is in a 60-month termination under section 507(b)(1)(B), check here ... |
(d) Disbursements for charitable purposes
(cash basis only)
STATEMENT 1
2 5 2 , 0 0 0 . 265, 608. 99,530. 9,123.
11,554. 163, 381.
30, 015.
59, 922. 47,521. 1,715.
111, 000.
1, 051, 369. 3,593, 671.
4, 645, 040.
Form 990-PF (2017)
Accrual
(b) Net investment (c) Adjusted net income income
N/A
2,126, 644.
6,701,518.
8, 828,162. 28, 000.
0. 2, 877.
0. 7,702.
89, 211.
2,161. 0.
3,154. 0. 0.
3, 651.
136,756. _______
136,756. _______
8, 691,406. _______
N/A
1 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
if the foundation is not required to attach Sch. B
OMB No. 1545-0052
Department of the TreasuryInternal Revenue Service Open to Public Inspection
Number and street (or P.O. box number if mail is not delivered to street address) Room/suite
If exemption application is pending, check here
Foreign organizations meeting the 85% test,check here and attach computation
(The total of amounts in columns (b), (c), and (d) may notnecessarily equal the amounts in column (a).)
Disbursementsfor charitable purposes
(cash basis only)
Check
Interest on savings and temporarycash investments
Net rental income or (loss)
Net gain or (loss) from sale of assets not on line 10Gross sales price for allassets on line 6a
Capital gain net income (from Part IV, line 2)
Gross sales less returnsand allowances
Less: Cost of goods sold
Compensation of officers, directors, trustees, etc.
Excess of revenue over expenses and disbursements
(if negative, enter -0-)
(if negative, enter -0-)
723501 01-03-18
or Section 4947(a)(1) Trust Treated as Private Foundation| Do not enter social security numbers on this form as it may be made public.| Go to www.irs.gov/Form990PF for instructions and the latest information.
For calendar year 2017 or tax year beginning , and ending
A
B
C
Employer identification number
G D 1.
2.
H E
I J F
Analysis of Revenue and Expenses (d)(a) (b) (c)
1
2
3
4
5
7
8
9
11
a
b
6a
b
10a
b
c
12 Total.
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
a
b
c
Total operating and administrative
expenses.
Total expenses and disbursements.
a
b
c
Net investment income
Adjusted net income
For Paperwork Reduction Act Notice, see instructions.
Re
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Op
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Ad
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ati
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sForm
Name of foundation
Telephone number
City or town, state or province, country, and ZIP or foreign postal code ~ |
|
|
|
|
Check all that apply: Initial return Initial return of a former public charity Foreign organizations, check here ~~
Final return Amended return
Address change Name change ~~~~
Check type of organization: Section 501(c)(3) exempt private foundation If private foundation status was terminatedunder section 507(b)(1)(A), check hereSection 4947(a)(1) nonexempt charitable trust Other taxable private foundation ~
Fair market value of all assets at end of year Accounting method: Cash Accrual If the foundation is in a 60-month terminationunder section 507(b)(1)(B), check here(from Part II, col. (c), line 16) Other (specify) ~
(Part I, column (d) must be on cash basis.)$| Revenue and
expenses per books Net investment
income Adjusted net
income
Contributions, gifts, grants, etc., received ~~~
|
~~~~~~~~~~~~~~
Dividends and interest from securities
Gross rents
~~~~~
~~~~~~~~~~~~~~~~
~~
~~
~~~~~
Net short-term capital gain
Income modifications
~~~~~~~~~
~~~~~~~~~~~~
~~~~
~
Gross profit or (loss)
Other income
~~~~~~~~~~~~
~~~~~~~~~~~~~~~
Add lines 1 through 11 ��������
~~~
Other employee salaries and wages
Pension plans, employee benefits
~~~~~~
~~~~~~
Legal fees
Accounting fees
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
Other professional fees ~~~~~~~~~~~
Interest
Taxes
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~
Depreciation and depletion ~~~~~~~~~
Occupancy
Travel, conferences, and meetings
Printing and publications
Other expenses
~~~~~~~~~~~~~~~~
~~~~~~
~~~~~~~~~~
~~~~~~~~~~~~~~
Add lines 13 through 23 ~~~~~
Contributions, gifts, grants paid ~~~~~~~
Add lines 24 and 25 ������������
Subtract line 26 from line 12:
~
~~~
����
Form (2017)LHA
Part I
990-PF
Return of Private Foundation990-PF 2017
STATEMENT 1
STMT 2STMT 3STMT 4
STMT 5
STMT 6
**-***5163
400 SIBLEY STREET
X
X
104,390,635.
15,000.
2,126,644. 2,126,644.
6,701,518.
6,701,518.
8,843,162. 8,828,162.280,000. 28,000. 252,000.264,406. 0. 265,608.102,407. 2,877. 99,530.9,123. 0. 9,123.19,256. 7,702. 11,554.252,592. 89,211. 163,381.
209,442. 2,161. 30,015.8,750. 0.63,076. 3,154. 59,922.47,521. 0. 47,521.1,715. 0. 1,715.
104,841. 3,651. 111,000.
1,363,129. 136,756. 1,051,369.5,161,845. 3,593,671.
6,524,974. 136,756. 4,645,040.
2,318,188.8,691,406.
125
JEROME FOUNDATION, INC.
N/A
N/A
651 224 9431
MAY 1, 2017 APR 30, 2018
12,021,904.
SAINT PAUL, MN 55101
1 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
F
Ats ses
orm 990-PF (2017) JEROME FOUNDATION, INC.
Bala Attached schedules and amounts in the description Part n II ce Sheets
column should be for end-of-year amounts only.
1 Cash - non-interest-bearing ~~~~~~~~~~~~~~~~~~ 2 Savings and temporary cash investments ~~~~~~~~~~~~ 3 Accounts receivable 2, 184.
Less: allowance for doubtful accounts 9 4 Pledges receivable
Less: allowance for doubtful accounts 5 Grants receivable ~~~~~~~~~~~~~~~~~~~~~~~ 6 Receivables due from officers, directors, trustees, and other
disqualified persons ~~~~~~~~~~~~~~~~~~~~~~ 7 Other notes and loans receivable ~~~~~~~~9
Less: allowance for doubtful accounts 8 Inventories for sale or use ~~~~~~~~~~~~~~~~~~~ 9 Prepaid expenses and deferred charges ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
10a Investments - U.S. and state government obligations ~S~T~M~T~~9
~
b Investments - corporate stock ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~S~T~M~T ~ ~1~0
c Investments - corporate bonds ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~S~T~M~T ~ ~1~1
11 Investments - land, buildings, and equipment: basis ~ ~ _____________________________
Less: accumulated depreciation ~ ~ ~ ~ ~ ~ ~ ~ 12 Investments - mortgage loans ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 13 Investments - other ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~S~T~M~T ~ ~
1~2
14 Land, buildings, and equipment: basis 159, 070 . Less:accumulated depreciation ~ ~ S ~T ~M ~T ~ ~1 ~ 3 145, 86 0 .
15 Other assets (describe BENEFICIAL INTEREST ) 16 Total assets (to be completed by all filers - see the
Beginningofyear
(a) Book Value
215, 394.
1,558.
**-***5163 Page 2
Endof year
Book Value (c) FairMarket Value
436,116. 436,116.
2,184. 2,184.
9, 213. 35,740. 35, 740. 3, 323,444. 3, 384, 335. 3, 384, 335.
71, 375, 879. 72, 004,723. 72, 004,723. 17,514, 840. 20, 975, 369. 20, 975, 369.
3,133,496. 3,238,792. 3,238,792.
21, 959. 13,210. 13,210. 3,788,131. 4, 300,166. 4, 300,166.
iiiLilbtsea
17 Accounts payable and accrued expenses ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 18 Grants payable ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 19 Deferred revenue ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 20 Loans from officers, directors, trustees, and other disqualified persons ~ ~ ~ ~ 21 Mortgages and other notes payable ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 22 Other liabilities (describe DEFERRED EXCISE TA )
99, 383, 914. 57,245.
2, 355,290.
535, 628.
104, 390, 635. 65,467.
3, 923,464.
469,161.
104, 390, 635.
2, 948,163. 4,458, 092.
dBFAlNttanueasessersocn
Foundations that follow SFAS 117, check here ~~~~ X and complete lines 24 through 26, and lines 30 and 31.
24 Unrestricted ~~~~~~~~~~~~~~~~~~~~~~~~~ 25 Temporarily restricted ~~~~~~~~~~~~~~~~~~~~~ 26 Permanently restricted ~~~~~~~~~~~~~~~~~~~~~
Foundations that do not follow SFAS 117, check here ~ 9 and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds ~~~~~~~~~~~ 28 Paid-in or capital surplus, or land, bldg., and equipment fund ~ ~ ~ ~ 29 Retained earnings, accumulated income, endowment, or other funds ~ 30 Total net assets or fund balances ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
92, 647, 620. 95, 632, 377. 3,788,131. 4, 300,166.
96,435,751. 99, 932,543.
31 Totalliabilitiesandnetassets/fundbalances ______________________________ 99, 383, 914. 104, 390, 635.
PartIII Analysis of Changes in Net Assets or Fund Balances
1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30
(must agree with end-of-year figure reported on prior year's return) ~ ~ ~ ~ ~ 2 Enter amount from Part I, line 27a ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 3 Other increases not included in line 2 (itemize) __________________________ 4 Add lines 1,2, and 3 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 5 Decreases not included in line 2 (itemize) 9
723511 01-03-18
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ SEE STATEMENT 7
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ SEE STATEMENT 8
96,435,751. 2, 318,188. 1,191, 923.
99, 945, 862. 13, 319.
99, 932,543. Form 990-PF (2017)
2 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Attached schedules and amounts in the descriptioncolumn should be for end-of-year amounts only.
Other notes and loans receivable
Investments - land, buildings, and equipment: basis
Less: accumulated depreciation
Less: accumulated depreciation
Loans from officers, directors, trustees, and other disqualified persons
723511 01-03-18
2
(a) (b) (c)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
a
b
c
Total assets
17
18
19
20
21
22
23 Total liabilities
Foundations that follow SFAS 117, check here
and complete lines 24 through 26, and lines 30 and 31.
24
25
26
27
28
29
30
31
Foundations that do not follow SFAS 117, check here
and complete lines 27 through 31.
Total net assets or fund balances
Total liabilities and net assets/fund balances
1
2
3
4
5
1
2
3
4
5
66
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es
Form 990-PF (2017) Page
Beginning of year End of year
Book Value Book Value Fair Market Value
Cash - non-interest-bearing
Savings and temporary cash investments
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~
Accounts receivable
Less: allowance for doubtful accounts
Pledges receivable
Less: allowance for doubtful accounts
Grants receivable
Receivables due from officers, directors, trustees, and other
disqualified persons
~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~
Less: allowance for doubtful accounts
Inventories for sale or use
Prepaid expenses and deferred charges
~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Investments - U.S. and state government obligations ~~~~~~~
Investments - corporate stock
Investments - corporate bonds
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~
~~
~~~~~~~~
Investments - mortgage loans
Investments - other
Land, buildings, and equipment: basis
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~
Other assets (describe )
(to be completed by all filers - see the
instructions. Also, see page 1, item I) ��������������
Accounts payable and accrued expenses ~~~~~~~~~~~~~
Grants payable
Deferred revenue
~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~
~~~~
Mortgages and other notes payable
Other liabilities (describe
~~~~~~~~~~~~~~~
)
(add lines 17 through 22) ������������
~~~~
Unrestricted
Temporarily restricted
Permanently restricted
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
~
Capital stock, trust principal, or current funds ~~~~~~~~~~~
Paid-in or capital surplus, or land, bldg., and equipment fund
Retained earnings, accumulated income, endowment, or other funds
~~~~
~
~~~~~~~~~~~~~~~~
����������
Total net assets or fund balances at beginning of year - Part II, column (a), line 30
(must agree with end-of-year figure reported on prior year's return) ~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter amount from Part I, line 27a
Other increases not included in line 2 (itemize)
Add lines 1, 2, and 3
Decreases not included in line 2 (itemize)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Total net assets or fund balances at end of year (line 4 minus line 5) - Part II, column (b), line 30 ���������������
Form (2017)
Balance SheetsPart II
Analysis of Changes in Net Assets or Fund BalancesPart III
990-PF
9 99 9
99
99999
99
9
99
SEE STATEMENT 7
SEE STATEMENT 8
STMT 9STMT 10STMT 11
STMT 12
STMT 13
215,394. 436,116. 436,116.
1,558. 2,184. 2,184.
9,213. 35,740. 35,740.3,323,444. 3,384,335. 3,384,335.71,375,879. 72,004,723. 72,004,723.17,514,840. 20,975,369. 20,975,369.
3,133,496. 3,238,792. 3,238,792.
21,959. 13,210. 13,210.3,788,131. 4,300,166. 4,300,166.
99,383,914. 104,390,635. 104,390,635.57,245. 65,467.
2,948,163.
2,355,290. 3,923,464.
4,458,092.
92,647,620. 95,632,377.
535,628. 469,161.
3,788,131. 4,300,166.
96,435,751. 99,932,543.
99,383,914. 104,390,635.
96,435,751.2,318,188.1,191,923.99,945,862.
13,319.99,932,543.
2,184.
159,070.145,860.
BENEFICIAL INTEREST
DEFERRED EXCISE TA
X
**-***5163JEROME FOUNDATION, INC.
2 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
**-***5163 Page 3
How acquired ( c ) D a t e acquired - Purchase (d) Date sold - Donation (mo.,day, yr.) (mo., day, yr.) I
P
Form 990-PF (2017) JEROME FOUNDATION, INC. Part IV I Capital Gains and Losses for Tax on Investment In
(a) List and describe the kind(s) of property sold (for example, real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co.)
1a CLASS ACTION LAWSUIT SETTLEMENT INCOME b PUBLICLY TRADED SECURITIES c CAPITAL GAINS DIVIDENDS
e
(e) Gross sales price
a 7, 898. b 12, 010, 997. c 3, 009. d
(f) Depreciation allowed (g) Cost or other basis (or allowable) plus expense of sale
5, 320, 386.
(h) Gain or (loss) ((e) plus (f) minus (g))
7, 898. 6, 690, 611.
3, 009.
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69.
(j) Adjusted basis I (k) Excess of col. (i) (i) FMV as of 12/31/69 as of 12/31/69 over col. (j), if any
b
d
r 2 a ) q
If gain, also enter in Part I, line 7
in net income or (net capital loss s p
Capital g If (loss), enter -0- in Part I, line 7 .................. o m 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). p If (loss), enter -0- in Part I, line 8� � � � � � � � � � � � � � � � � � � � � � � � � � � � o m � � 3
(l) Gains (Col. (h) gain minus col. (k), but not less than -0-) or
Losses (from col. (h))
7, 898. 6, 690, 611.
3, 009.
6,701,518.
N/A Part V Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Yes X No If Yes, the foundation doesn't qualify under section 4940(e). Do not complete this part. 1 Enter the appropriate amount in each column for each year; see the instructions before making any entries.
(a) ( b) (c) (d) Base p eriod y ears Distribution ratio
Calendar year (or tax year beginning in) Adjusted qualifying distributions Net value of noncharitable-use assets (col. (b) divided by col. (c)) 2016 4, 334, 351. 90, 371,445. . 047962 2015 4,542,558. 86, 851,548. . 052303 2014 4,709,735. 92, 337, 367. . 051006 2013 4,401,113. 86,780,538. . 050715 2012 3, 942,192. 77,443,169. . 050904
. 252890
. 050578
98,593, 390.
4, 986, 656.
86, 914.
5, 073,570.
4, 645, 040.
2 Total of line 1, column (d) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2
3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5.0, or by the number of years the foundation has been in existence if less than 5 years ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3
4 Enter the net value of noncharitable-use assets for 2017 from Part X, line 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4
5 Multiply line 4 by line 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5
6 Enter 1% of net investment income (1% of Part I, line 27b) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6
7 Add lines 5 and 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7
8 Enter qualifying distributions from Part XII, line 4 ................................................................................................... 8
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.
723521 01-03-18 Form 990-PF (2017) 3
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
723521 01-03-18
3
(b)(a) (c) (d)
1a
b
c
d
e
(f) (g) (h)(e)
a
b
c
d
e
(l)or(j) (k)
(i)
a
b
c
d
e
2 2
3
3
1
(a) (d)(b) (c)
2
3
4
5
6
7
8
Total 2
3
4
5
6
7
8
Form 990-PF (2017) Page
How acquiredP - PurchaseD - Donation
List and describe the kind(s) of property sold (for example, real estate,2-story brick warehouse; or common stock, 200 shs. MLC Co.)
Date acquired(mo., day, yr.)
Date sold(mo., day, yr.)
Depreciation allowed(or allowable)
Cost or other basisplus expense of sale
Gain or (loss)((e) plus (f) minus (g))
Gross sales price
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69. Gains (Col. (h) gain minuscol. (k), but not less than -0-)
Losses (from col. (h)) Adjusted basis
as of 12/31/69 Excess of col. (i)
over col. (j), if any FMV as of 12/31/69
If gain, also enter in Part I, line 7If (loss), enter -0- in Part I, line 7Capital gain net income or (net capital loss) ~~~~~~
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):If gain, also enter in Part I, line 8, column (c).If (loss), enter -0- in Part I, line 8������������������������������
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If "Yes," the foundation doesn't qualify under section 4940(e). Do not complete this part.
~~~~~~~~~~~~~~~~ Yes No
Enter the appropriate amount in each column for each year; see the instructions before making any entries.
Base period yearsCalendar year (or tax year beginning in)
Distribution ratio(col. (b) divided by col. (c))Adjusted qualifying distributions Net value of noncharitable-use assets
2016
2015
2014
2013
2012
of line 1, column (d)
Average distribution ratio for the 5-year base period - divide the total on line 2 by 5.0, or by the number of years
the foundation has been in existence if less than 5 years
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the net value of noncharitable-use assets for 2017 from Part X, line 5
Multiply line 4 by line 3
~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter 1% of net investment income (1% of Part I, line 27b) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines 5 and 6 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter qualifying distributions from Part XII, line 4~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate.See the Part VI instructions.
Form (2017)
Capital Gains and Losses for Tax on Investment IncomePart IV
Qualification Under Section 4940(e) for Reduced Tax on Net Investment IncomePart V
990-PF
pmorqspmo
CLASS ACTION LAWSUIT SETTLEMENT INCOMEPUBLICLY TRADED SECURITIESCAPITAL GAINS DIVIDENDS
P
7,898.12,010,997.
3,009.5,320,386.
7,898.6,690,611.
3,009.
7,898.6,690,611.
3,009.
6,701,518.
X
4,334,351. 90,371,445. .0479624,542,558. 86,851,548. .0523034,709,735. 92,337,367. .0510064,401,113. 86,780,538. .0507153,942,192. 77,443,169. .050904
.252890
.050578
98,593,390.
4,986,656.
86,914.
5,073,570.
4,645,040.
**-***5163JEROME FOUNDATION, INC.
N/A
3 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Form 990-PF (2017) JEROME FOUNDATION, INC. **-***5163 Page 4 Part VI I Excise Tax Based on Investment Income (Secti or 4948- see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here | and enter N/A on line 1.
Date of ruling or determination letter: ______________________ (attach copy of letter if necessary-see instructions)
b Domestic foundations that meet the section 4940(e) requirements in Part V, check here | and enter 1% 1 173, 828. of Part I, line 27b ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations, enter 4% of Part I, line 12, col. (b). 2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only; others, enter -0-) ~ ~ ~ ~ ~ ~ 2 0. 3 Add lines 1 and 2 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 3 173, 828. 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- ~~~~~~~~~~~~~~ ~ ~ ~ 5 173, 828. 6 Credits/Payments:
a 2017 estimated tax payments and 2016 overpayment credited to 2017 ~ ~ ~ ~ ~ ~ ~ ~ 6a 18 2 , 151. b Exempt foreign organizations - tax withheld at source ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 6b 0. c Tax paid with application for extension of time to file (Form 8868) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 6c 0. d Backup withholding erroneously withheld ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 6d 0.
7 Total credits and payments. Add lines 6a through 6d ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 7 182,151. 8 Enter any penalty for underpayment of estimated tax. Check here X if Form 2220 is attached 189. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 9 Tax due . If the total of lines 5 and 8 is more than line 7 , enter amount owed ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ | 9
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid � � � � � � � � � � � � � � | 8,134. 11 Enter the amount of line 10 to be: Credited to 2018 estimated tax | 8, 134. I Refunded | 11 0.
1a During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in
any political campaign? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
b Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions for the definition ~
If the answer is Yes to 1a or 1b, attach a detailed description of the activities and copies of any materials published or
distributed by the foundation in connection with the activities.
c Did the foundation file Form 1 120-POL for this year? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. | $ 0. (2) On foundation managers. | $ 0 . e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed on foundation
managers. | $ 0 . 2 Has the foundation engaged in any activities that have not previously been reported to the IRS? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
If Yes, attach a detailed description of the activities. 3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or
bylaws, or other similar instruments? If Yes, attach a conformed copy of the changes ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 4a Did the foundation have unrelated business gross income of $1,000 or more during the year? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
b If Yes, has it filed a tax return on Form 990-T for this year? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
If Yes, attach the statement required by General Instruction T. 6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
• By language in the governing instrument, or
• By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law
remain in the governing instrument? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 7 Did the foundation have at least $5,000 in assets at any time during the year? If Yes, complete Part II, col. (c), and Part XV ~ ~ ~ ~ ~
1 a X 1 b X
1c X
~ ~ ~ 2 X
~ ~ ~ 3 X ~ ~ ~ 4a X ~ ~ ~ 4b X ~ ~ ~ 5 X
~ ~ ~ 6 X 7 X
8a Enter the states to which the foundation reports or with which it is registered. See instructions. 9 ______________________________________
MN,OR b If the answer is Yes to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate)
of each state as required by General Instruction G? If No, attach explanation ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 8 b X 9 Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendar
year 2017 or the tax year beginning in 2017? See the instructions for Part XIV. If Yes, complete Part XIV ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 9 X 10 Did any persons become substantial contributors during the tax year? If " Yes , " attach a schedule listing their names and addresses � � � � � � � � 10 - X
Form 990-PF (2017)
723531 01-03-18
4 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
If "Yes," attach a schedule listing their names and addresses
723531 01-03-18
4
1
2
3
4
5
6
7
8
9
10
a
b
c
(attach copy of letter if necessary-see instructions)
1
2
3
4
5Tax based on investment income.
a
b
c
d
6a
6b
6c
6d
7
penalty 8
Tax due. amount owed 9
Overpayment. amount overpaid 10
11 Credited to 2018 estimated tax Refunded 11
1
2
3
4
a
b
c
d
e
1a
1b
1c
1a 1b
Form 1120-POL
(1) (2)
2
3
4a
4b
5
a
b Form 990-T
5
6
7
8
6
7
a
b
8b
9
10
9
10
General Instruction T.
General Instruction G?
Form 990-PF (2017) Page
Exempt operating foundations described in section 4940(d)(2), check here | and enter "N/A" on line 1.
Date of ruling or determination letter:
Domestic foundations that meet the section 4940(e) requirements in Part V, check here
of Part I, line 27b
| and enter 1%
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations, enter 4% of Part I, line 12, col. (b).
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only; others, enter -0-)
Add lines 1 and 2
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only; others, enter -0-) ~~~~~~~~
Subtract line 4 from line 3. If zero or less, enter -0- ~~~~~~~~~~~~~~~~~
Credits/Payments:
2017 estimated tax payments and 2016 overpayment credited to 2017 ~~~~~~~~
Exempt foreign organizations - tax withheld at source
Tax paid with application for extension of time to file (Form 8868)
Backup withholding erroneously withheld
~~~~~~~~~~~~~~~~
~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
Total credits and payments. Add lines 6a through 6d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter any for underpayment of estimated tax. Check here if Form 2220 is attached ~~~~~~~~~~~~~
If the total of lines 5 and 8 is more than line 7, enter ~~~~~~~~~~~~~~~~~~~~ |
|
|
If line 7 is more than the total of lines 5 and 8, enter the ��������������
Enter the amount of line 10 to be: |
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in
any political campaign? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions for the definition ~~~~
If the answer is "Yes" to or , attach a detailed description of the activities and copies of any materials published or
distributed by the foundation in connection with the activities.
Did the foundation file for this year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
On the foundation. | $ On foundation managers. | $
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed on foundation
managers. | $
Has the foundation engaged in any activities that have not previously been reported to the IRS? ~~~~~~~~~~~~~~~~~~~~
If "Yes," attach a detailed description of the activities.
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or
bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes ~~~~~~~~~~~~~~~~~~~~~~~~
Did the foundation have unrelated business gross income of $1,000 or more during the year?
If "Yes," has it filed a tax return on for this year?
~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was there a liquidation, termination, dissolution, or substantial contraction during the year? ~~~~~~~~~~~~~~~~~~~~~~
If "Yes," attach the statement required by
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
¥ By language in the governing instrument, or
¥ By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law
remain in the governing instrument? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c), and Part XV ~~~~~~~~
Enter the states to which the foundation reports or with which it is registered. See instructions.
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate)
of each state as required by If "No," attach explanation ~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendar
year 2017 or the tax year beginning in 2017? See the instructions for Part XIV. If "Yes," complete Part XIV ~~~~~~~~~~~~~~~~
Did any persons become substantial contributors during the tax year? ��������
Form (2017)
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see instructions)Part VI
Statements Regarding ActivitiesPart VII-AYes No
990-PF
pnnnmnnno
9
X
8,134.
MN,OR
173,828.
0.173,828.
0.173,828.
182,151.0.0.0.
182,151.189.
8,134.0.
X
XX
XX
X
X
X
X
X
X
XX
**-***5163JEROME FOUNDATION, INC.
0. 0.
0.
4 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Form 990-PF (2017) JEROME FOUNDATION, INC. **-***5163 Page 5
No 11 At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of
section 512(b)(13)? If "Yes, "attach schedule. See instructions ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ X 12 Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges?
If "Yes, "attach statement. See instructions ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ X 13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Website address | WWW. JEROMEFDN. ORG 14 Thebooksareincareof | LORI LAWONN Telephone no.|651-224-9431
Locatedat|400 SIBLEY STREET, SUITE 125 , SAINT PAUL, MN ZIP+4 | 55101 15 Section 4947(a)(1) nonexempt charitable 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 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ | 15 I N/A 16 At any time during calendar year 2017, did the foundation have an interest in or a signature or other authority over a bank, Yes No
securities, or other financial account in a foreign country? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 16 X See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes, "enter the name of the
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies. Yes No 1a During the year, did the foundation (either directly or indirectly):
(1) Engage in the sale or exchange, or leasing of property with a disqualified person? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Yes X No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified 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? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ X Yes No
(5) Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Yes X No
(6) Agree to pay money or property to a government official? ( Exception. Check "No "
if the foundation agreed to make a grant to or to employ the official for a period after
termination of government service, if terminating within 90 days.) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Yes X No
b If any answer is "Yes "to 1a(1)-(6), did any of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ X Organizations relying on a current notice regarding disaster assistance, check here ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ |
c Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts, that were not corrected
before the first day of the tax year beginning in 2017? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 1c X 2 Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private operating foundation
defined in section 4942(j)(3) or 4942(j)(5)):
a At the end of tax year 2017, did the foundation have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning
before 2017? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Yes X No If "Yes, "list the years |____________________ , ____________________ , ____________________ , ____________________
b Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2) (relating to incorrect
valuation of assets) to the year's undistributed income? (If applying section 4942(a)(2) to all years listed, answer "No "and attach
statement - see instructions.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~N~/~A ~ 2b
c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
| _______________________________________________ , _______________________________________________ , _______________________________________________ , _______________________________________________
3a Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any time during the year? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Yes X No
b If "Yes, "did it have excess business holdings in 2017 as a result of (1) any purchase by the foundation or disqualified persons after
May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose
of holdings acquired by gift or bequest; or (3) the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C,
Form 4720, to determine if the foundation had excess business holdings in 2017.) ~~~~~~~~~~~~~~~~~~~~~~N~~/A ~ ~ 3b 4a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ X
b Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2017? . I 4b I I X
Form 990-PF (2017)
723541 01-03-18
5 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
723541 01-03-18
5
11
12
13
14
15
16
11
12
13
Form 1041 -
15
16
1a
(1)
(2)
(3)
(4)
(5)
(6)
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Exception.
b
c
any
1b
1c
2
a
b
c
Yes No
not
all
2b
any
3a
b
Yes No
(1)
(2)
(3)
3b
4a
4b
4a
b
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
(continued)Form 990-PF (2017) Page
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of
section 512(b)(13)? If "Yes," attach schedule. See instructions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges?
If "Yes," attach statement. See instructions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the foundation comply with the public inspection requirements for its annual returns and exemption application? ~~~~~~~~~~~
Website address |
The books are in care of |
Located at |
Telephone no. |
ZIP+4 |
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of check here ~~~~~~~~~~~~~~~~~~~~~~~ |
and enter the amount of tax-exempt interest received or accrued during the year ~~~~~~~~~~~~~~~~~~~ |
At any time during calendar year 2017, did the foundation have an interest in or a signature or other authority over a bank,
securities, or other financial account in a foreign country?
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes," enter the name of the
foreign country
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
|
During the year, did the foundation (either directly or indirectly):
Engage in the sale or exchange, or leasing of property with a disqualified person?
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
~~~~~~~~~~~~~
~~~~~~~~~~~~~~
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Agree to pay money or property to a government official? ( Check "No"
if the foundation agreed to make a grant to or to employ the official for a period after
termination of government service, if terminating within 90 days.) ~~~~~~~~~~~~~~~~~~~~~
If any answer is "Yes" to 1a(1)-(6), did of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ~~~~~~~~~~~~~~~~~~~~~~
|Organizations relying on a current notice regarding disaster assistance, check here ~~~~~~~~~~~~~~~~~~~~~
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts, that were not corrected
before the first day of the tax year beginning in 2017?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private operating foundation
defined in section 4942(j)(3) or 4942(j)(5)):
At the end of tax year 2017, did the foundation have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning
before 2017? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," list the years | , , ,
Are there any years listed in 2a for which the foundation is 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 years listed, answer "No" and attach
statement - see instructions.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If the provisions of section 4942(a)(2) are being applied to of the years listed in 2a, list the years here.
| , , ,
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any time
during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did it have excess business holdings in 2017 as a result of any purchase by the foundation or disqualified persons after
May 26, 1969; the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose
of holdings acquired by gift or bequest; or the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C,
Form 4720, to determine if the foundation had excess business holdings in 2017.) ~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes? ~~~~~~~~~~~~~
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that
had not been removed from jeopardy before the first day of the tax year beginning in 2017? ����������������������
Form (2017)
Part VII-A Statements Regarding Activities
Yes No
Yes No
Part VII-B Statements Regarding Activities for Which Form 4720 May Be Required
Yes No
990-PF
X
X
XX
X
X
X
X
X
X
X
X
N/A
N/A
**-***5163JEROME FOUNDATION, INC.
X
XX
WWW.JEROMEFDN.ORGLORI LAWONN
400 SIBLEY STREET, SUITE 125, SAINT PAUL, MN651-224-9431
55101
N/A
X
5 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Form 990-PF (2017) JEROME FOUNDATION, INC. **-***5163 Page 6
5a During the year, did the foundation pay or incur any amount to:
(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Yes X No
(2) Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly,
any voter registration drive? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Yes X No
(3) Provide a grant to an individual for travel, study, or other similar purposes? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ X Yes No
(4) Provide a grant to an organization other than a charitable, etc., organization described in section 4945(d)(4)(A)? See instructions ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Yes X No
(5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for
the prevention of cruelty to children or animals? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Yes X No
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 instructions ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ X Organizations relying on a current notice regarding disaster assistance, check here ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ |
c If the answer is Yes to question 5a(4), does the foundation claim exemption from the tax because it maintained
expenditure responsibility for the grant?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~N~/~A ~ ~ ~ Yes No If Yes, attach the statement required by Regulations section 53.4945-5(d).
6a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Yes X No
b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ X If Yes to 6b, file Form 8870.
7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? ~ ~ ~ ~ ~ ~ ~ ~ ~ Yes X No b I f Y d i d t h f d t i i
---
d h ti ttibtblttht ti ? N/A Part VIII I Information About Officers, Directors, Trustees, Foundation Managers, Highly
Paid Employees, and Contractors 1 List all officers, directors, trustees, and foundation managers and their compensation.
(a) Name and address
EE STATEMENT 16
(b) Title, and average (c) Compens hours per week devoted (If not pai
to position enter -0-
to I (e) Expenseans account, other
allowances
280, 000. 25, 889. 2, 884.
2 Compensation of five highest-paid employees (other than those included on line 1). If none, enter "NONE." ___________ ___________ (b) Title, and average (d ) Contributionsto (e) Expense
Name and mp ore than $50,000 emp loyee benef i t plans (a) address of each e loyee paid m hours per week (c) Compensation anddeferred account, other ______________________________________________________________________________ devoted to position __________________ compensation allowances ELEANOR SAVAGE - 400 SIBLEY STREET PROGRAM DIREC T OR SUITE 125 , ST PAUL, MN 55101 40. 00 110, 000. 23,276. 0. ANDREA BROWN - 400 SIBLEY STREET G RANTS ADMINI S TRATOR SUITE 125 , ST PAUL, MN 55101 40. 00 60, 680. 10, 853. 0. VENESSA FUENTES - 400 SIBLEY STREET PROGRAM OFFIC E R SUITE 125 , ST PAUL, MN 55101 40. 00 51,405. 18,233. 0.
Total number of other over | 0 Form 990-PF (2017)
723551 01-03-18
6 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Contributions toemployee benefit plans
and deferredcompensation
Contributions toemployee benefit plans
and deferredcompensation
723551 01-03-18
5a
(1)
(2)
(3)
(4)
(5)
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
b
c
any
5b
6b
7b
Yes No
6
7
a
Yes No
b
a
b
Yes No
(If not paid,enter -0-)
6
1 List all officers, directors, trustees, and foundation managers and their compensation.(d)(c) (e)(b)
(a)
2 Compensation of five highest-paid employees (other than those included on line 1). If none, enter "NONE."(d) (e)(b)
(a) (c)
Total
(continued)Form 990-PF (2017) Page
During the year, did the foundation pay or incur any amount to:
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly,
any voter registration drive?
~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Provide a grant to an individual for travel, study, or other similar purposes?
Provide a grant to an organization other than a charitable, etc., organization described in section
4945(d)(4)(A)? See instructions
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for
the prevention of cruelty to children or animals? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If any answer is "Yes" to 5a(1)-(5), did of the transactions fail to qualify under the exceptions described in Regulations
section 53.4945 or in a current notice regarding disaster assistance? See instructions ~~~~~~~~~~~~~~~~~~~~~~~~
|Organizations relying on a current notice regarding disaster assistance, check here ~~~~~~~~~~~~~~~~~~~~~
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the tax because it maintained
expenditure responsibility for the grant?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," attach the statement required by Regulations section 53.4945-5(d).
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ~~~~~~~~~~~~~~~~
If "Yes" to 6b, file Form 8870.
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? ~~~~~~~~~
If "Yes," did the foundation receive any proceeds or have any net income attributable to the transaction?
Compensation Expenseaccount, other
allowances
Title, and averagehours per week devoted
to position Name and address
Expenseaccount, other
allowances
Title, and averagehours per week
devoted to position Name and address of each employee paid more than $50,000 Compensation
number of other employees paid over $50,000 ��������������������������������������� |
Form (2017)
�����������������
Part VII-B Statements Regarding Activities for Which Form 4720 May Be Required Yes NoYes No
Part VIII Information About Officers, Directors, Trustees, Foundation Managers, HighlyPaid Employees, and Contractors
990-PF
SEE STATEMENT 16
110,000. 23,276. 0.PROGRAM DIRECTOR
40.00ELEANOR SAVAGE - 400 SIBLEY STREETSUITE 125, ST PAUL, MN 55101ANDREA BROWN - 400 SIBLEY STREETSUITE 125, ST PAUL, MN 55101VENESSA FUENTES - 400 SIBLEY STREETSUITE 125, ST PAUL, MN 55101
GRANTS ADMINISTRATOR40.00
PROGRAM OFFICER40.00
10,853.
18,233.
0.
0.
60,680.
51,405.
0
**-***5163JEROME FOUNDATION, INC.
280,000. 25,889. 2,884.
X
XX
X
X
X
N/A
XX
XN/A
6 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Form 990-PF(2017) JEROME FOUNDATION, INC. **-***5163 Page 7
Part VIII I Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors (continued)
3 Five highest-paid independent contractors for professional services. If none, enter "NONE."
(a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation CLIFTON LARSON ALLEN I 220 S SIXTH STREET, MINNEAPOLIS, MN 55402 ACCOUNTING SERVICES 55, 885.
9 0
List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
1 N/A Expenses
2
3
4
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
1 N/A
2
All other program-related investments. See instructions. 3
Total. Add lines 1 th 3 0. Form 990-PF (2017)
723561 01-03-18
7 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
723561 01-03-18
7
1
2
3
3 Five highest-paid independent contractors for professional services. If none, enter "NONE."
(a) (c)(b)
Total
1
2
3
4
Total.
(continued)
Form 990-PF (2017) Page
Name and address of each person paid more than $50,000 Compensation Type of service
number of others receiving over $50,000 for professional services ��������������������������������
List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as thenumber of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
All other program-related investments. See instructions.
Form (2017)
Add lines 1 through 3 ��������������������������������������������
Part VIII Information About Officers, Directors, Trustees, Foundation Managers, HighlyPaid Employees, and Contractors
Summary of Direct Charitable ActivitiesPart IX-A
Part IX-B Summary of Program-Related Investments
990-PFJ
9
N/A
0.
CLIFTON LARSON ALLENACCOUNTING SERVICES 55,885.220 S SIXTH STREET, MINNEAPOLIS, MN 55402
0
N/A
**-***5163JEROME FOUNDATION, INC.
7 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Form 990-PF(2017) JEROME FOUNDATION, INC. **-***5163 Page 8
Part X Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes:
a Average monthly fair market value of securities ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
b Average of monthly cash balances ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
c Fair market value of all other assets ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
d Total (add lines 1a, b, and c) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
e Reduction claimed for blockage or other factors reported on lines 1a and 1c (attach detailed explanation) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 1e 0 .
2 Acquisition indebtedness applicable to line 1 assets ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 3 Subtract line 2 from line 1d ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 4 Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see instructions) ~ ~ ~ ~ ~ ~ ~ ~ 5 Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 6 Minimum investment return. Enter 5% of line 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations, check here 9 and do not complete this part.)
1 Minimum investment return from Part X, line 6 ............................................. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2a Tax on investment income for 2017 from Part VI, line 5 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 2a I 173, 828.
b Income tax for 2017. (This does not include the tax from Part VI.) ~ ~ ~ ~ ~ ~ ~
c Add lines 2a and 2b ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 3 Distributable amount before adjustments. Subtract line 2c from line 1 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 4 Recoveries of amounts treated as qualifying distributions ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 5 Add lines 3 and 4 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 6 Deduction from distributable amount (see instructions) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Part XII I Qualifying Distributions (see instructions)
99,587, 638. 507,174.
00, 094, 812.
0. 00, 094, 812. 1,501,422.
98,593, 390. 4, 929, 670.
4, 929, 670.
173, 954. 755, 716.
0. 755, 716.
0. 755,716.
1 Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a Expenses, contributions, gifts, etc. - total from Part I, column (d), line 26 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 1a 4, 645, 04 0 . b Program-related investments - total from Part IX-B ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 1b 0 .
2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes ~ ~ ~ ~ ~ ~ ~ ~ ~ 2 3 Amounts set aside for specific charitable projects that satisfy the:
a Suitability test (prior IRS approval required) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ .__________________________ 3 a
b Cash distribution test (attach the required schedule) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 3b ____________________________ 4 Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8; and Part XIII, line 4 ~ ~ ~ ~ ~ ~ ~ ~ ~ 4 4, 645, 040 . 5 Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 5 0 . 6 Adjusted qualifying distributions. Subtract line 5 from line 4 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 6 4, 645, 040 .
Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the section 4940(e ) reduction of tax in those years.
Form 990-PF (2017)
723571 01-03-18
8 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
723571 01-03-18
8
1
a
b
c
d
e
1a
1b
1c
1d
2
3
4
5
6
Total
1e
2
3
4
5 Net value of noncharitable-use assets.
6 Minimum investment return.
1
2
3
4
5
6
1
2c
3
4
5
6
7
a
b
c
2a
2b
7 Distributable amount
1
2
3
4
5
6
a
b
1a
1b
2
3a
3b
4
5
6
a
b
Qualifying distributions.
Adjusted qualifying distributions.
Note:
Form 990-PF (2017) Page
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes:
Average monthly fair market value of securities
Average of monthly cash balances
Fair market value of all other assets
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
(add lines 1a, b, and c)
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
Acquisition indebtedness applicable to line 1 assets
Subtract line 2 from line 1d
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see instructions) ~~~~~~~~
Subtract line 4 from line 3. Enter here and on Part V, line 4 ~~~~~~~~~~
Enter 5% of line 5 ��������������������������������
(Section 4942(j)(3) and (j)(5) private operating foundations and certain
foreign organizations, check here and do not complete this part.)
Minimum investment return from Part X, line 6
Tax on investment income for 2017 from Part VI, line 5
Income tax for 2017. (This does not include the tax from Part VI.)
Add lines 2a and 2b
���������������������������������
~~~~~~~~~~~
~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Distributable amount before adjustments. Subtract line 2c from line 1
Recoveries of amounts treated as qualifying distributions
~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines 3 and 4
Deduction from distributable amount (see instructions)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ������������
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
Expenses, contributions, gifts, etc. - total from Part I, column (d), line 26
Program-related investments - total from Part IX-B
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~
Amounts set aside for specific charitable projects that satisfy the:
Suitability test (prior IRS approval required)
Cash distribution test (attach the required schedule)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines 1a through 3b. Enter here and on Part V, line 8; and Part XIII, line 4 ~~~~~~~~~
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Subtract line 5 from line 4 ~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 (2017)
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
(see instructions)
(see instructions)
Minimum Investment ReturnPart X
Part XI Distributable Amount
Qualifying Distributions Part XII
990-PF
9
4,645,040.
0.
99,587,638.507,174.
100,094,812.
0.100,094,812.1,501,422.98,593,390.4,929,670.
4,929,670.173,828.
126.173,954.
4,755,716.0.
4,755,716.0.
4,755,716.
**-***5163JEROME FOUNDATION, INC.
0.
4,645,040.
0.4,645,040.
8 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Form 990-PF(2017) JEROME FOUNDATION, INC. **-***5163 Page 9
Part XIII I Undistributed Income (see instructions)
(a) (b) (c) (d) Corpus Yearspriorto 2016 2016 2017
1 Distributable amount for 2017 from Part XI,
line 7 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 2 Undistributed income, if any, as of the end of 2017:
a Enter amount for 2016 only ~ ~ ~ ~ ~ ~
b Total for prior years:
, , 3 Excess distributions carryover, if any, to 2017:
a From 2012 ~ ~ ~
b From 2013 ~ ~ ~
c From 2014 ~ ~ ~
d From 2015 ~ ~ ~ 177,701. e From 2016 ~ ~ ~
f Total of lines 3a through e ~ ~ ~ ~ ~ ~ ~ ~ 4 Qualifying distributions for 2017 from
PartXII, line 4: 9 $ 4, 645, 040. a Applied to 2016, 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 2017 distributable amount ~ ~ ~
e Remaining amount distributed out of corpus 5 Excess distributions carryover applied to 2017 ~ ~
(If an amount appears in column ( d ) , the same amount must be shown in column (a).)
6 Enter the net total of each column as indicated below:
a Corpus. Add lines 3f , 4c, and 4e. Subtract line 5 ~ ~
b Prior years ' undistributed income. Subtract
line 4b from line 2b ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
c Enter the amount of prior years ' undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
d Subtract line 6c from line 6b. Taxable
amount - see instructions ~ ~ ~ ~ ~ ~ ~ ~
e Undistributed income for 2016. Subtract line 4a from line 2a. Taxable amount - see instr. ~
f Undistributed income for 2017. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2018 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 7 Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election
may be required - see instructions) ~ ~ ~ ~ 8 Excess distributions carryover from 2012
not applied on line 5 or line 7 ~ ~ ~ ~ ~ ~ ~ 9 Excess distributions carryover to 2018.
Subtract lines 7 and 8 from line 6a ~ ~ ~ ~ 10 Analysis of line 9:
a Excess from 2013 ~ ____________________
b Excess from 2014 ~ ____________________
c Excessfrom 2015 ~ 67, 025. d Excess from 2016 ~ ____________________
e Excess from 2017 � 723581 01-03-18
4, 755, 716.
0.
0.
177,701.
0.
0.
0. 110, 676.
0.
4, 645, 040.
110 , 676.
67, 025.
0.
0.
0.
0.
0.
0.
0.
67, 025.
Form 990-PF (2017) 9
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Undistributed income, if any, as of the end of 2017:
Excess distributions carryover applied to 2017(If an amount appears in column (d), the same amountmust be shown in column (a).)
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
723581 01-03-18
9
(a) (b) (c) (d)
1
2
3
a
b
a
b
c
d
e
f Total
4
a
b
c
d
e
5
6 Enter the net total of each column asindicated below:
a
b
c
d
e
f
7
8
9
10
Excess distributions carryover to 2018.
a
b
c
d
e
Form 990-PF (2017) Page
Corpus Years prior to 2016 2016 2017
Distributable amount for 2017 from Part XI,
line 7 ~~~~~~~~~~~~~~~~~
Enter amount for 2016 only ~~~~~~~
Total for prior years:
, ,
Excess distributions carryover, if any, to 2017:
From 2012
From 2013
From 2014
From 2015
From 2016
~~~
~~~
~~~
~~~
~~~
of lines 3a through e ~~~~~~~~
Qualifying distributions for 2017 from
$Part XII, line 4:
Applied to 2016, but not more than line 2a
Applied to undistributed income of prior
years (Election required - see instructions)
~
~
Treated as distributions out of corpus
(Election required - see instructions)
Applied to 2017 distributable amount
~~~
~~~
Remaining amount distributed out of corpus
~~
~~
Prior years' undistributed income. Subtract
line 4b from line 2b ~~~~~~~~~~~
Enter the amount of prior years'undistributed income for which a notice ofdeficiency has been issued, or on whichthe section 4942(a) tax has been previouslyassessed ~~~~~~~~~~~~~~~
Subtract line 6c from line 6b. Taxable
amount - see instructions ~~~~~~~~
Undistributed income for 2016. Subtract line
4a from line 2a. Taxable amount - see instr.~
Undistributed income for 2017. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2018 ~~~~~~~~~~
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election
may be required - see instructions) ~~~~
Excess distributions carryover from 2012
not applied on line 5 or line 7 ~~~~~~~
Subtract lines 7 and 8 from line 6a ~~~~
Analysis of line 9:
Excess from 2013
Excess from 2014
Excess from 2015
Excess from 2016
Excess from 2017
~
~
~
~
�
Form (2017)
(see instructions)Undistributed IncomePart XIII
990-PF
9 4,645,040.
67,025.
4,755,716.
0.
0.
177,701.
0.4,645,040.
0.110,676. 110,676.
67,025.
0.
0.
0.
0.
0.
67,025.
0.
177,701.
0.
0.
**-***5163JEROME FOUNDATION, INC.
0.
9 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Form 990-PF (2017) JEROME FOUNDATION, INC. Part XIV Private Operating Foundations (see instructions and Part VII-A, question 9) 1 a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2017, enter the date of the ruling ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 9 b Check box to indicate whether the foundation is a private operating foundation described in section ~ ~ ~
2 a Enter the lesser of the adjusted net Tax year ____________________ Prior 3 years
income from Part I or the minimum (a) 2017 (b) 2016 (c) 2015
investment return from Part X for
each year listed ~ ~ ~ ~ ~ ~ ~ ~ ~ .____________________ ____________________ _______________
b 85% of line 2a ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ________________ ________________ ____________
c Qualifying distributions from Part XII,
line 4 for each year listed ~ ~ ~ ~ ~ .___________________ ___________________ ______________
d Amounts included in line 2c not
used directly for active conduct of
exempt activities ~ ~ ~ ~ ~ ~ ~ ~ ~ .____________________ ____________________ _______________
e Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c ~ ~ ~ ~ .___________________ ___________________ ______________ 3 Complete 3a, b, or c for the
alternative test relied upon: a Assets alternative test - enter:
(1) Valueofallassets ~ ~ ~ ~ ~ ~ ._________________ _________________ _____________
(2) Value of assets qualifying under section 4942(j)(3)(B)(i) ~ ___________________ ___________________ ______________
b Endowment alternative test - enter 2/3 of minimum 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, payments on securities loans (section 512(a)(5)), or royalties) ~ ~ ~ ~ .___________________ ___________________ ______________
(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii) ~ ~ ~ ___________________ ___________________ ______________
(3) Largest amount of support from
an exempt organization ~ ~ ~ ~ .___________________ ___________________ ______________
(4) Gross investment income ......... ____________________ _______________
Part XV I Supplementary Information (Complete this part only if the foundat
**-***5163 Page 10 N/A
942(j)(3 ) or 4942(j)(5 )
(d) 2014 (e)Total
or more at any time during the year-see instructions.)
1 Information Regarding Foundation Managers:
a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
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 of a 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 9 if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. If the foundation makes gifts, grants, etc., to individuals or organizations under other conditions, complete items 2a, b, c, and d.
a The name, address, and telephone number or email address of the person to whom applications should be addressed:
SEE STATEMENT 17 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:
723601 01-03-18 Form 990-PF (2017)
10 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
723601 01-03-18
10
1 a
b
a
b
c
d
e
2(a) (b) (c) (d) (e) Total
3
a(1)
(2)
b
c
(1)
(2)
(3)
(4)
1
a
b
2
a
b
c
d
Information Regarding Foundation Managers:
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Form 990-PF (2017) Page
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2017, enter the date of the ruling ~~~~~~~~~~~~~~Check box to indicate whether the foundation is a private operating foundation described in section 4942(j)(3) or 4942(j)(5)
Prior 3 yearsTax yearEnter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for
each year listed
2017 2016 2015 2014
~~~~~~~~~
85% of line 2a ~~~~~~~~~~
Qualifying distributions from Part XII,
line 4 for each year listed ~~~~~
Amounts included in line 2c not
used directly for active conduct of
exempt activities ~~~~~~~~~
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c~~~~Complete 3a, b, or c for thealternative test relied upon:"Assets" alternative test - enter:
Value of all assets ~~~~~~
Value of assets qualifyingunder section 4942(j)(3)(B)(i) ~
"Endowment" alternative test - enter2/3 of minimum investment returnshown in Part X, line 6 for each yearlisted ~~~~~~~~~~~~~~
"Support" alternative test - enter:
Total support other than grossinvestment income (interest,dividends, rents, payments onsecurities loans (section512(a)(5)), or royalties) ~~~~
Support from general publicand 5 or more exemptorganizations as provided insection 4942(j)(3)(B)(iii) ~~~
Largest amount of support from
an exempt organization
Gross investment income
~~~~
���
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation before the close of any taxyear (but only if they have contributed more than $5,000). (See section 507(d)(2).)
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership orother entity) of which the foundation has a 10% or greater interest.
Check here if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. Ifthe foundation makes gifts, grants, etc., to individuals or organizations under other conditions, complete items 2a, b, c, and d.
The name, address, and telephone number or email address of the person to whom applications should be addressed:
The form in which applications should be submitted and information and materials they should include:
Any submission deadlines:
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:
Form (2017)
(see instructions and Part VII-A, question 9)Part XIV Private Operating Foundations
Part XV Supplementary Information (Complete this part only if the foundation had $5,000 or more in assetsat any time during the year-see instructions.)
990-PF
9
9
SEE STATEMENT 17
NONE
NONE
N/A**-***5163JEROME FOUNDATION, INC.
10 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Form 990-PF (2017) JEROME FOUNDATION, INC. Part X V Supplementary Information (continued) 3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation
Name and address (home or business) any foundation manager status of or substantial contributor recipient
a Paid during the year
ABU-SHAHEEN, MANAL N ONE I
**-***5163 Page 11
Purpose of grant or contribution I Amount
AND STUDY
4,500.
AKRE, JOHN FILM/VIDEO/DIGITAL
8,000.
ALVES, FLAVIO FILM/VIDEO/DIGITAL
20,000.
AMERICAN COMPOSERS FORUM
75 5TH ST W, STE 522
ST. PAUL, MN 55102
AMERICANS FOR THE ARTS
1000 VERMONT AVE NW, 6TH FLOOR
WASHINGTON, DC 20005
Total ....................................... ... S b Approved for future payment
ADILI, GOLNAR
PORT FOR PROGRAMS
EMERGING COMPOSERS
PORT FOR A NATIONAL
FERENCE
9 3
a
AND STUDY
160,000.
6,500.
3,593,671.
1,350.
ALBERTI, MIKE AND STUDY
4,844.
ALLAN, HAWA
Total ... ... ... ... ... ... ... ... ... ... ... ...
723611 01-03-18
10070813 144198 64692
I TRAVEL AND STUDY
PROJECT
5,000.
N... ... S ... H ... E ... E ... T ... ... ( S ... ... ) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 3b 3,923,464.
Form 990-PF (2017)
11 2017.04010 JEROME FOUNDATION, INC. 64692__1
723611 01-03-18
11
3
a
Total 3a
b
Total 3b
Grants and Contributions Paid During the Year or Approved for Future Payment
(continued)
Paid during the year
Approved for future payment
Page Form 990-PF (2017)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
������������������������������������������������������
������������������������������������������������������
Form (2017)
Part XV Supplementary Information
990-PF
9
9
ABU-SHAHEEN, MANAL
AKRE, JOHN
4,500.
NONE I TRAVEL AND STUDYPROJECT
3,593,671.
1,350.
ADILI, GOLNAR NONE I TRAVEL AND STUDYPROJECT
3,923,464.
ALVES, FLAVIO
AMERICAN COMPOSERS FORUM75 5TH ST W, STE 522
AMERICANS FOR THE ARTS1000 VERMONT AVE NW, 6TH FLOOR
NONE
NONE I MN FILM/VIDEO/DIGITALPROJECT
8,000.
6,500.
20,000.
4,844.
ALBERTI, MIKE NONE I TRAVEL AND STUDY
NONE
PROJECT
5,000.
ALLAN, HAWA NONE I TRAVEL AND STUDYPROJECT
NONE
I
PC
PC
ST. PAUL, MN 55102
NY FILM/VIDEO/DIGITALPROJECT
SUPPORT FOR PROGRAMSFOR EMERGING COMPOSERS
WASHINGTON, DC 20005
SUPPORT FOR A NATIONALCONFERENCE
160,000.
SEE CONTINUATION SHEET(S)
SEE CONTINUATION SHEET(S)
**-***5163JEROME FOUNDATION, INC.
11 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Form 990-PF(2017) JEROME FOUNDATION, INC. **-***5163 Page 12
Part XVI-A Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e) (a) (b) ( c)
E x c l u- (d) Related or exempt Bu s i n e ss s i o n
1 Program service revenue: c o d e Amountcode Amount function income
a _______________________________________________________ ____________ __________________________ ____________________________ _____________________________
b ____________________________________________________________ _____________ ____________________________ _______________________________ _______________________________
c ____________________________________________________________ _____________ ____________________________ _______________________________ _______________________________
d ____________________________________________________________ _____________ ____________________________ _______________________________ _______________________________
e ____________________________________________________________ _____________ ____________________________ _______________________________ _______________________________
f
g Fees and contracts from government agencies ~ ~ ~ __________ ______________________ ________________________ _________________________ 2 Membership dues and assessments ~ ~ ~ ~ ~ ~ ~ ~ ~ .__________ ______________________ ________________________ _________________________ 3 Interest on savings and temporary cash
investments ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ___________ ________________________ __________________________ ___________________________ 4 Dividends and interest from securities ~ ~ ~ ~ ~ ~ ~ ~ .__________ ______________________ 14 2, 12 6, 644 . _________________________ 5 Net rental income or (loss) from real estate: __________ ______________________ ________________________ _________________________
a Debt-financed property ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ._________ _____________________ _______________________ ________________________
b Not debt-financed property ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ._________ _____________________ _______________________ ________________________ 6 Net rental income or (loss) from personal
property ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ._________ _____________________ _______________________ ________________________ 7 Other investment income ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ __________ ______________________ ________________________ _________________________ 8 Gain or (loss) from sales of assets other
than inventory ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ .________ _________________ 18 6,701,518. ___________________ 9 Net income or (loss) from special events ~ ~ ~ ~ ~ ~ ~ .__________ ______________________ ________________________ _________________________
10 Gross profit or (loss) from sales of inventory ~ ~ ~ ~ ~ .__________ ______________________ ________________________ _________________________ 11 Other revenue:
a _______________________________________________________ ____________ __________________________ ____________________________ _____________________________
b ____________________________________________________________ _____________ ____________________________ _______________________________ _______________________________
c ____________________________________________________________ _____________ ____________________________ _______________________________ _______________________________
d ____________________________________________________________ _____________ ____________________________ _______________________________ _______________________________
e ____________________________________________________________ _____________ ____________________________ _______________________________ _______________________________ 12 Subtotal.Add columns(b),(d),and(e) ~ ~ ~ ~ ~ ~ ~ ~ .________ 0 . - 8, 828,162. 0. 13 Total. Add line 12, columns (b), (d), and (e) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13 8, 828, 162 . (See worksheet in line 13 instructions to verify calculations.)
Part XVI-B Relationship of Activities to the Accomplishment of Exempt Purposes
12 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Excluded by section 512, 513, or 514
Exclu-sioncode
723621 01-03-18
12
(e)(c)(a) (b) (d)
1
a
b
c
d
e
f
g
2
3
4
5
6
7
8
9
10
a
b
11
12
13
a
b
c
d
e
Total. 13
Line No.
Form 990-PF (2017) Page
Unrelated business incomeEnter gross amounts unless otherwise indicated.Related or exemptfunction income
Businesscode Amount AmountProgram service revenue:
Fees and contracts from government agencies ~~~
Membership dues and assessments
Interest on savings and temporary cash
investments
~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
Dividends and interest from securities
Net rental income or (loss) from real estate:
~~~~~~~~
Debt-financed property
Not debt-financed property
~~~~~~~~~~~~~
~~~~~~~~~~~~
Net rental income or (loss) from personal
property ~~~~~~~~~~~~~~~~~~~~~
Other investment income
Gain or (loss) from sales of assets other
than inventory
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~
Net income or (loss) from special events
Gross profit or (loss) from sales of inventory
Other revenue:
~~~~~~~
~~~~~
Subtotal. Add columns (b), (d), and (e)
Add line 12, columns (b), (d), and (e)
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
(See worksheet in line 13 instructions to verify calculations.)
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the accomplishment ofthe foundation's exempt purposes (other than by providing funds for such purposes).
Form (2017)
Part XVI-A Analysis of Income-Producing Activities
Part XVI-B Relationship of Activities to the Accomplishment of Exempt Purposes
990-PF
<
8,828,162.0.
14
18
2,126,644.
6,701,518.
8,828,162. 0.
**-***5163JEROME FOUNDATION, INC.
12 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________ _______________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager unt Name and address (home or status o o
business) f contribution Am
or substantial contributor recipient ____________________________ ___________________
ANDERSON CENTER N ONE P C SUPPORT FOR RESEARCH
163 TOWER VIEW DRIVE R ESIDENCIES FOR
RED WING, MN 55066 E MERGING ARTISTS 21,250.
ANDERSON NOEL W. N ONE I TRAVEL AND STUDY
VEL AND STUDY
JECT
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS
PORT FOR PROGRAMS
EMERGING WRITERS
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE
FILM/VIDEO/DIGITAL
JECT
FILM/VIDEO/DIGITAL
JECT
VEL AND STUDY
JECT
VEL AND STUDY
ARNOLD, LIANNE
ART IN GENERAL
20 JAY STREET, SUITE 201A
BROOKLYN, NY 11201
ASIAN AMERICAN WRITERS ' WORKSHOP
110-112 W. 27TH STREET SUITE 600
NEW YORK, NY 10001
BAAD! /BRONX ACADEMY OF ARTS AND DANCE
2474 WESTCHESTER AVENUE
BRONX, NY 10461
BAILEY, E. G.
BAKRY, OMAR
BECKEY, JACKIE
BENDER, KATIE
3,223.
1,000.
20,000.
24,000.
30,000.
15,000.
30,000.
5,000.
4,200.
3,394,671.
723631 04-01-17
14
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
ANDERSON CENTER 163 TOWER VIEW DRIVE
21,250.
NONE PC SUPPORT FOR RESEARCHRESIDENCIES FOR
3,394,671.
ANDERSON, NOEL W.
ARNOLD, LIANNE
ART IN GENERAL
ASIAN AMERICAN WRITERS' WORKSHOP
BAAD!/BRONX ACADEMY OF ARTS AND DANCE
20 JAY STREET, SUITE 201A
110-112 W. 27TH STREET SUITE 600
2474 WESTCHESTER AVENUE
NONE
NONE
NONE
NONE
NONE
I
I
PC
PC
PC
TRAVEL AND STUDY
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PROJECT
PROJECT
3,223.
FOR EMERGING VISUAL
FOR EMERGING WRITERS
FOR EMERGING ARTISTS
24,000.
1,000.
4,200.
BENDER, KATIE
BAILEY, E. G.
BAKRY, OMAR
BECKEY, JACKIE
NONE I TRAVEL AND STUDYPROJECT
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
I
I
20,000.
30,000.
MN FILM/VIDEO/DIGITAL
NY FILM/VIDEO/DIGITAL
TRAVEL AND STUDY
PROJECT
PROJECT
PROJECT
15,000.
30,000.
5,000.
RED WING, MN 55066 EMERGING ARTISTS
BROOKLYN, NY 11201 ARTISTS
NEW YORK, NY 10001
BRONX, NY 10461 IN DANCE
14 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163 Information
3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________ ______________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager unt Name and address (home or status o o
business) f contribution Am
or substantial contributor recipient ____________________________ __________________
BENNETT, JEFF N ONE I TRAVEL AND STUDY
P ROJECT
____________________ ______________ _____________________ 5,000.
BHATIA RAFIQ N ONE I C OMPOSER/SOUND ARTIST
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE
PORT FOR CREATION
A NEW DANCE WORK
BROOKLYN ARTS EXCHANGE
421 FIFTH AVENUE
BROOKLYN, NY 11215
BROOKLYN ARTS EXCHANGE/MARJANI FORT &
WORKS
421 FIFTH AVENUE
BROOKLYN, NY 11215
BROOKLYN ARTS EXCHANGE/NI'JA WHITSON
421 FIFTH AVENUE
BROOKLYN, NY 11215
BURSTEIN, NIRA
CAMARGO FOUNDATION
1 AVENUE MAURICE JERMINI
CASSIS, FRANCE
CAMARGO FOUNDATION
1 AVENUE MAURICE JERMINI
CASSIS, FRANCE
CAMARGO FOUNDATION
1 AVENUE MAURICE JERMINI
CASSIS, FRANCE
CAMERA CLUB OF NEW YORK
126 BAXTER ST
NEW YORK, NY 10013
20,000.
22,000.
24,000.
12,000.
30,000.
9,000.
115,000.
21,500.
20,000.
PORT FOR CREATION
A NEW DANCE WORK
FILM/VIDEO/DIGITAL
JECT
PORT FOR RESIDENCY
GRAM
POF ERAL PROGRAM
PORT
POF PORT FOR A PROGRAM
AFRICAN AMERICAN
YWRIGHTS
PORT FOR PROGRAMS
EMERGING VISUAL
723631 04-01-17
15 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
BENNETT, JEFF
5,000.
NONE I TRAVEL AND STUDYPROJECT
BROOKLYN ARTS EXCHANGE/MARJANI FORT &
BHATIA, RAFIQ
BROOKLYN ARTS EXCHANGE
WORKS
BROOKLYN ARTS EXCHANGE/NI'JA WHITSON
BURSTEIN, NIRA
421 FIFTH AVENUE
421 FIFTH AVENUE
421 FIFTH AVENUE
NONE
NONE
NONE
NONE
NONE
PC
I
PC
PC
I
SUPPORT FOR CREATION
COMPOSER/SOUND ARTIST
SUPPORT FOR PROGRAMS
OF A NEW DANCE WORK
SUPPORT FOR CREATION
NY FILM/VIDEO/DIGITAL
FELLOWSHIP
FOR EMERGING ARTISTS
20,000.
OF A NEW DANCE WORK
PROJECT
12,000.
22,000.
20,000.
CAMERA CLUB OF NEW YORK126 BAXTER ST
CAMARGO FOUNDATION
CAMARGO FOUNDATION
CAMARGO FOUNDATION
NEW YORK, NY 10013
NONE
1 AVENUE MAURICE JERMINI
1 AVENUE MAURICE JERMINI
1 AVENUE MAURICE JERMINI
PC SUPPORT FOR PROGRAMSFOR EMERGING VISUALARTISTS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
POF
POF
POF
24,000.
30,000.
SUPPORT FOR RESIDENCY
GENERAL PROGRAM
SUPPORT FOR A PROGRAM
PROGRAM
SUPPORT
FOR AFRICAN AMERICAN
9,000.
115,000.
21,500.
BROOKLYN, NY 11215 IN DANCE
BROOKLYN, NY 11215
BROOKLYN, NY 11215
CASSIS, FRANCE
CASSIS, FRANCE
CASSIS, FRANCE PLAYWRIGHTS
15 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________ _______________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager unt Name and address (home or status o o
business) f contribution Am
or substantial contributor recipient ____________________________ ___________________
CAVE CANEM FOUNDATON INC. N ONE P C S UP PORT FOR PROGRAMS
20 JAY STREET, SUITE 310-A F OR EMERGING WRITERS
BROOKLYN, NY 11201 __________________ ____________ ___________________ 22,000.
CEDAR CULTURAL CENTER N ONE P C SUPPORT FOR PROGRAMS
416 CEDAR AVE S F OR EMERGING COMPOSERS
MINNEAPOLIS, MN 55454 ______________________ _______________ ________________________ 38,000.
CHANDLER, TODD N ONE I N Y FILM/VIDEO/DIGITAL
CHEUNG, WINNIE
CHOCOLATE FACTORY
5-49 49TH AVENUE
LONG ISLAND CITY, NY 11101
CHOE, CHRISTINA
CHOMET, SUN MEE
COFFEE HOUSE PRESS
79 13TH AVE. N.E. SUITE 110
MINNEAPOLIS, MN 55413
COFFEE HOUSE PRESS
79 13TH AVE. N.E. SUITE 110
MINNEAPOLIS, MN 55413
COMMUNITY OF LITERARY MAGAZINES AND
PRESSES
154 CHRISTOPHER ST. SUITE 3C
NEW YORK, NY 12534
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE
FILM/VIDEO/DIGITAL
AND STUDY
PORT FOR PROGRAMS
EMERGING WRITERS
PORT FOR PROGRAMS
EMERGING WRITERS
PORT FOR PROGRAMS
EMERGING WRITERS
32,000.
30,000.
4,830.
23,000.
1,000.
46,000.
723631 04-01-17
16
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
30,000.
FILM/VIDEO/DIGITAL
7,000.
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
CAVE CANEM FOUNDATON INC.20 JAY STREET, SUITE 310-A
22,000.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING WRITERS
CEDAR CULTURAL CENTER
CHANDLER, TODD
CHEUNG, WINNIE
CHOCOLATE FACTORY
CHOE, CHRISTINA
416 CEDAR AVE S
5-49 49TH AVENUE
NONE
NONE
NONE
NONE
NONE
PC
I
I
PC
I
SUPPORT FOR PROGRAMS
NY FILM/VIDEO/DIGITAL
NY FILM/VIDEO/DIGITAL
SUPPORT FOR PROGRAMS
NY FILM/VIDEO/DIGITAL
FOR EMERGING COMPOSERS
PROJECT
38,000.
PROJECT
FOR EMERGING ARTISTS
PROJECT
32,000.
30,000.
46,000.
COMMUNITY OF LITERARY MAGAZINES ANDPRESSES154 CHRISTOPHER ST. SUITE 3C
CHOMET, SUN MEE
COFFEE HOUSE PRESS
COFFEE HOUSE PRESS
NEW YORK, NY 12534
NONE
79 13TH AVE. N.E. SUITE 110
79 13TH AVE. N.E. SUITE 110
PC SUPPORT FOR PROGRAMSFOR EMERGING WRITERS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
PC
PC
7,000.
30,000.
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PROJECT
FOR EMERGING WRITERS
FOR EMERGING WRITERS
4,830.
23,000.
1,000.
BROOKLYN, NY 11201
MINNEAPOLIS, MN 55454
LONG ISLAND CITY, NY 11101 IN DANCE
MINNEAPOLIS, MN 55413
MINNEAPOLIS, MN 55413
16 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
VEL AND STUDY
30,000.
20,000.
2,259.
PORT FOR PROGRAMS
EMERGING
MMAKERS
PORT FOR PROGRAMS
EMERGING
MMAKERS
FILM/VIDEO/DIGITAL
35,000.
22,000.
30,000.
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ ____________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient _________________________
DANSPACE PROJECT N ONE P C SUPPORT FOR PROGRAMS
131 EAST 10TH STREET F OR EMERGING ARTISTS
NEW YORK, NY 10003 IN DANCE
DEL AMO, YOLANDA N ONE I TRAVEL AND STUDY
P ROJECT
Amount
34,500.
5,000.
DIXON PLACE/OPEN CHANNELS
161A CHRYSTIE STREET
NEW YORK, NY 10002
ENSEMBLE STUDIO THEATRE
545-549 WEST 52ND STREET
NEW YORK, NY 10019
EVANS, AYANA
FILMNORTH (FORMERLY IFP MN)
550 VANDALIA ST SUITE 120
SAINT PAUL, MN 55114
FILMNORTH (FORMERLY IFP MN)
550 VANDALIA ST SUITE 120
SAINT PAUL, MN 55114
FORBES, STEFAN
FORD, T'AI FREEDOM
FORECAST PUBLIC ARTWORKS
2300 MYRTLE AVENUE SUITE 160
ST. PAUL, MN 55114
PPORT FOR ARTIST
SEARCH RESIDENCY
OJECT
PPORT FOR PROGRAMS
R EMERGING VISUAL
5,300.
40,000.
723631 04-01-17
17
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
DANSPACE PROJECT131 EAST 10TH STREET
34,500.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING ARTISTS
DEL AMO, YOLANDA
DIXON PLACE/OPEN CHANNELS
ENSEMBLE STUDIO THEATRE
EVANS, AYANA
FILMNORTH (FORMERLY IFP MN)
161A CHRYSTIE STREET
545-549 WEST 52ND STREET
550 VANDALIA ST SUITE 120
NONE
NONE
NONE
NONE
NONE
I
PC
PC
I
PC
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
PROJECT
FOR EMERGING THEATER
5,000.
FOR EMERGING THEATER
PROJECT
FOR EMERGING
2,259.
30,000.
40,000.
FORECAST PUBLIC ARTWORKS2300 MYRTLE AVENUE SUITE 160
FILMNORTH (FORMERLY IFP MN)
FORBES, STEFAN
FORD, T'AI FREEDOM
ST. PAUL, MN 55114
NONE
550 VANDALIA ST SUITE 120
PC SUPPORT FOR PROGRAMSFOR EMERGING VISUALARTISTS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
PC
I
PC
20,000.
35,000.
SUPPORT FOR PROGRAMS
NY FILM/VIDEO/DIGITAL
SUPPORT FOR ARTIST
FOR EMERGING
PROJECT
RESEARCH RESIDENCY
22,000.
30,000.
5,300.
NEW YORK, NY 10003 IN DANCE
NEW YORK, NY 10002 ARTISTS
NEW YORK, NY 10019 ARTISTS
SAINT PAUL, MN 55114 FILMMAKERS
SAINT PAUL, MN 55114 FILMMAKERS
PROJECT
17 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163 Information
3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________ ________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager Amo Name and address (home or business) status of contribution
or substantial contributor recipient ____________________________ __________
FOUR WAY BOOKS N ONE P C SUPPORT FOR PROGRAMS
11 JAY STREET 4TH FL F OR EMERGING WRITERS
NEW YORK, NY 10013
FRANCONIA SCULPTURE PARK N ONE P C SUPPORT FOR PROGRAMS
29836 ST. CROIX TRAIL F OR EMERGING VISUAL
SHAFER, MN 55074 A RTISTS
FRANKLIN FURNACE ARCHIVE N ONE P C SUPPORT FOR PROGRAMS
PRATT INSTITUTE, 200 WILLOUGHBY AVENUE F OR EMERGING VISUAL
BROOKLYN, NY 11205 A RTISTS
GHISELINE JOSETTE N ONE I TRAVEL AND STUDY
GRANTMAKERS IN THE ARTS PORT FOR SERVICES
4055 21ST AVE W, STE 100 GRANTMAKERS
SEATTLE, WA 98199
GRIFFIN, STEPHANIE POSER/SOUND ARTIST
HAAS, NOAH SOMMERS AND STUDY
HART, HEATHER AND STUDY
HASS, EMILY
HENRY ST SETTLEMENT/ABRONS ART CENTER
265 HENRY ST
NEW YORK, NY 10002
VEL AND STUDY
JECT
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE
23,000.
39,000.
42,000.
5,000.
11,000.
20,000.
5,000.
5,000.
5,000.
21,000.
723631 04-01-17
18 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
FOUR WAY BOOKS11 JAY STREET 4TH FL
23,000.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING WRITERS
FRANCONIA SCULPTURE PARK
FRANKLIN FURNACE ARCHIVE
GHISELINE, JOSETTE
GRANTMAKERS IN THE ARTS
GRIFFIN, STEPHANIE
29836 ST. CROIX TRAIL
PRATT INSTITUTE, 200 WILLOUGHBY AVENUE
4055 21ST AVE W, STE 100
NONE
NONE
NONE
NONE
NONE
PC
PC
I
PC
I
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
SUPPORT FOR SERVICES
COMPOSER/SOUND ARTIST
FOR EMERGING VISUAL
FOR EMERGING VISUAL
39,000.
PROJECT
FOR GRANTMAKERS
FELLOWSHIP
11,000.
42,000.
21,000.
HENRY ST SETTLEMENT/ABRONS ART CENTER265 HENRY ST
HAAS, NOAH SOMMERS
HART, HEATHER
HASS, EMILY
NEW YORK, NY 10002
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING ARTISTSIN DANCE
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
I
I
5,000.
20,000.
TRAVEL AND STUDY
TRAVEL AND STUDY
TRAVEL AND STUDY
PROJECT
PROJECT
PROJECT
5,000.
5,000.
5,000.
NEW YORK, NY 10013
SHAFER, MN 55074 ARTISTS
BROOKLYN, NY 11205 ARTISTS
SEATTLE, WA 98199
18 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163 Information
3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________ ______________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager unt Name and address (home or status o o
business) f contribution Am
or substantial contributor recipient ____________________________ __________________
HERNNDEZ, ELIZABETH MCWILLIAMS N ONE I TRAVEL AND STUDY
P ROJECT
_____________ 5,000.
HEURING, TRICIA
AND STUDY
4,460.
HIGHPOINT CENTER FOR PRINTMAKING
912 W. LAKE STREET
MINNEAPOLIS, MN 55408
HOLNES, DARREL ALEJANDRO
IBRAHIM, FADUMO
IN THE HEART OF THE BEAST PUPPET AND
MASK THEATRE (HOBT)
1500 EAST LAKE ST
MINNEAPOLIS, MN 55407
IN THE HEART OF THE BEAST PUPPET AND
MASK THEATRE (HOBT)
1500 EAST LAKE ST
MINNEAPOLIS, MN 55407
INTERMEDIA ARTS
2822 LYNDALE AVENUE SOUTH
MINNEAPOLIS, MN 55408
IYER, SANGAMITHRA
JAMES SEWELL BALLET
528 HENNEPIN AVENUE SUITE 125
MINNEAPOLIS, MN 55403
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS
VEL AND STUDY
VEL AND STUDY
JECT
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
PORT FOR PROGRAMS
EMERGING THEATER
PPORT FOR PROGRAMS
R EMERGING ARTISTS
PPORT FOR ARTIST
SEARCH RESIDENCY
OJECT
PPORT FOR PROGRAMS
R EMERGING ARTISTS
DANCE
20,000.
5,000.
4,898.
24,000.
25,000.
72,500.
5,300.
17,000.
723631 04-01-17
19 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
HERNNDEZ, ELIZABETH MCWILLIAMS
5,000.
NONE I TRAVEL AND STUDYPROJECT
IN THE HEART OF THE BEAST PUPPET AND
HEURING, TRICIA
HIGHPOINT CENTER FOR PRINTMAKING
HOLNES, DARREL ALEJANDRO
IBRAHIM, FADUMO
MASK THEATRE (HOBT)
912 W. LAKE STREET
1500 EAST LAKE ST
NONE
NONE
NONE
NONE
NONE
PC
I
PC
I
I
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
TRAVEL AND STUDY
FOR EMERGING THEATER
PROJECT
FOR EMERGING VISUAL
4,460.
PROJECT
PROJECT
ARTISTS
4,898.
20,000.
IN THE HEART OF THE BEAST PUPPET AND
17,000.
JAMES SEWELL BALLET528 HENNEPIN AVENUE SUITE 125
MASK THEATRE (HOBT)
INTERMEDIA ARTS
IYER, SANGAMITHRA
MINNEAPOLIS, MN 55403
NONE
1500 EAST LAKE ST
2822 LYNDALE AVENUE SOUTH
PC SUPPORT FOR PROGRAMSFOR EMERGING ARTISTS
NONE
IN DANCE
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
PC
PC
PC
5,000.
24,000.
SUPPORT FOR PROGRAMSFOR EMERGING THEATER
SUPPORT FOR PROGRAMS
SUPPORT FOR ARTIST
ARTISTS
FOR EMERGING ARTISTS
RESEARCH RESIDENCY
25,000.
72,500.
5,300.
MINNEAPOLIS, MN 55408 ARTISTS
MINNEAPOLIS, MN 55407
MINNEAPOLIS, MN 55407
MINNEAPOLIS, MN 55408
PROJECT
19 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________ _______________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager unt Name and address (home or status o o
business) f contribution Am
or substantial contributor recipient ____________________________ ___________________
JAZZ GALLERY N ONE P C SUPPORT FOR PROGRAMS
PO BOX 153, LENOX HILL STATION F OR EMERGING COMPOSERS
NEW YORK, NY 10021 __________________ ____________ ___________________ 25,000.
JOACHIM, NATHALIE N ONE I TRAVEL AND STUDY
P ROJECT
__________________ ____________ ___________________ 5,000.
JOHNSON, WILLIAM N ONE I C OMPOSER/SOUND ARTIST
F ELLOWSHIP
______________________ _______________ ________________________ 20,000.
KAISER, JOHN N ONE I M N FILM/VIDEO/DIGITAL
______________________ _______________ ________________________ 20,000.
KATZ, JONATHAN N ONE I TRAVEL AND STUDY
P ROJECT
______________________ _______________ ________________________ 4,305.
KESSLER, GABRIELLA N ONE I N Y FILM/VIDEO/DIGITAL
P ROJECT
__________________ ____________ ___________________ 13,000.
KEY, CAROLINE N ONE I TRAVEL AND STUDY
P ROJECT
__________________ ____________ ___________________ 5,000.
KNOLL, RACHEL N ONE I M N FILM/VIDEO/DIGITAL
P ROJECT
______________________ _______________ ________________________ 11,500.
LANESBORO ARTS N ONE P C SUPPORT FOR RESEARCH
103 PARKWAY AVE N R ESIDENCIES FOR
LANESBORO, MN 55949 E MERGING ARTISTS 18,000.
LARK PLAY DEVELOPMENT CENTER N ONE P C SUPPORT FOR PROGRAMS
311 WEST 43RD STREET SUITE 406 F OR EMERGING THEATER
723631 04-01-17
20
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
JAZZ GALLERYPO BOX 153, LENOX HILL STATION
25,000.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING COMPOSERS
JOACHIM, NATHALIE
JOHNSON, WILLIAM
KAISER, JOHN
KATZ, JONATHAN
KESSLER, GABRIELLA
NONE
NONE
NONE
NONE
NONE
I
I
I
I
I
TRAVEL AND STUDY
COMPOSER/SOUND ARTIST
MN FILM/VIDEO/DIGITAL
TRAVEL AND STUDY
NY FILM/VIDEO/DIGITAL
PROJECT
FELLOWSHIP
5,000.
PROJECT
PROJECT
4,305.
20,000.
22,000.
LARK PLAY DEVELOPMENT CENTER311 WEST 43RD STREET SUITE 406
KEY, CAROLINE
KNOLL, RACHEL
LANESBORO ARTS
NEW YORK, NY 10036
NONE
103 PARKWAY AVE N
PC SUPPORT FOR PROGRAMSFOR EMERGING THEATERARTISTS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
I
PC
20,000.
13,000.
TRAVEL AND STUDY
MN FILM/VIDEO/DIGITAL
SUPPORT FOR RESEARCH
PROJECT
PROJECT
RESIDENCIES FOR
5,000.
11,500.
18,000.
NEW YORK, NY 10021
LANESBORO, MN 55949 EMERGING ARTISTS
20 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ ____________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient _________________________
LAUNDROMAT PROJECT N ONE P C SUPPORT FOR PROGRAMS
127 WEST 127TH STREET SUITE 434 F OR EMERGING VISUAL
NEW YORK, NY 10027-3723 A RTISTS
LOFT LITERARY CENTER N ONE P C SUPPORT FOR PROGRAMS
1011 WASHINGTON AVENUE SOUTH SUITE 200 F OR EMERGING WRITERS
MINNEAPOLIS, MN 55415
LOFT LITERARY CENTER N ONE P C SUPPORT FOR PROGRAMS
1011 WASHINGTON AVENUE SOUTH SUITE 200 F OR EMERGING WRITERS
MINNEAPOLIS, MN 55415
LOWER EAST SIDE PRINTSHOP N ONE P C SUPPORT FOR PROGRAMS
306 WEST 37TH STREET, 6TH FLOOR F OR EMERGING VISUAL
NEW YORK, NY 10018 A RTISTS
LOWER MANHATTAN CULTURAL COUNCIL N ONE P C SUPPORT FOR PROGRAMS
125 MAIDEN LANE, 2ND FLOOR F OR EMERGING VISUAL
NEW YORK, NY 10038 A RTISTS
MARTIN, JONATHAN DAVID N ONE I TRAVEL AND STUDY
P ROJECT
Amount
17,250.
50,000.
100, 000.
15,000.
28,000.
1,000.
MARTINSON, ZOEY
MAY, BENJAMIN
MA-YI THEATER COMPANY
520 8TH AVE, STE 309
NEW YORK, NY 10018
MEISTER, KELLEY
AND STUDY
FILM/VIDEO/DIGITAL
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
VEL AND STUDY
1,000.
30,000.
22,000.
5,000.
723631 04-01-17
21
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
LAUNDROMAT PROJECT127 WEST 127TH STREET SUITE 434
17,250.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING VISUAL
LOFT LITERARY CENTER
LOFT LITERARY CENTER
LOWER EAST SIDE PRINTSHOP
LOWER MANHATTAN CULTURAL COUNCIL
MARTIN, JONATHAN DAVID
1011 WASHINGTON AVENUE SOUTH SUITE 200
1011 WASHINGTON AVENUE SOUTH SUITE 200
306 WEST 37TH STREET, 6TH FLOOR
125 MAIDEN LANE, 2ND FLOOR
NONE
NONE
NONE
NONE
NONE
PC
PC
PC
PC
I
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
FOR EMERGING WRITERS
FOR EMERGING WRITERS
50,000.
FOR EMERGING VISUAL
FOR EMERGING VISUAL
PROJECT
28,000.
100,000.
5,000.
MEISTER, KELLEY
MARTINSON, ZOEY
MAY, BENJAMIN
MA-YI THEATER COMPANY
NONE
520 8TH AVE, STE 309
I TRAVEL AND STUDYPROJECT
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
I
PC
15,000.
1,000.
TRAVEL AND STUDY
MN FILM/VIDEO/DIGITAL
SUPPORT FOR PROGRAMS
PROJECT
PROJECT
FOR EMERGING THEATER
1,000.
30,000.
22,000.
NEW YORK, NY 10027-3723 ARTISTS
MINNEAPOLIS, MN 55415
MINNEAPOLIS, MN 55415
NEW YORK, NY 10018 ARTISTS
NEW YORK, NY 10038 ARTISTS
NEW YORK, NY 10018 ARTISTS
21 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
2,650.
PORT FOR PROGRAMS
EMERGING WRITERS
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS
PORT FOR RESIDENCY
23,000.
110, 000.
170,000.
21,750.
PORT FOR RESIDENCY
30,000.
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________ __________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager unt Name and address (home or status o o
business) f contribution Am
or substantial contributor recipient ____________________________ _____________
MILGROM, ALBERT N ONE I M N FILM/VIDEO/DIGITAL
MILKWEED EDITIONS
1011 WASHINGTON AVENUE SOUTH SUITE 300
MINNEAPOLIS, MN 55415
MINNEAPOLIS COLLEGE OF ART AND DESIGN
2501 STEVENS AVENUE
MINNEAPOLIS, MN 55404
MINNEAPOLIS COLLEGE OF ART AND DESIGN
2501 STEVENS AVENUE
MINNEAPOLIS, MN 55404
MOVEMENT RESEARCH
140 SECOND AVE #501
NEW YORK, NY 10003
MOVEMENT RESEARCH
140 SECOND AVE #501
NEW YORK, NY 10003
NATIONAL BLACK THEATRE PORT FOR PROGRAMS
213 WEST 127TH ST EMERGING THEATER
NEW YORK, NY 10030 ISTS 30,000.
NAUTILUS MUSIC-THEATER PORT FOR PROGRAMS
308 PRINCE STREET #190 EMERGING COMPOSERS
SAINT PAUL, MN 55101 LIBRETTISTS 20,000.
NERBURN, NICHOLAS FILM/VIDEO/DIGITAL
29,764.
NEW DRAMATISTS PORT FOR PROGRAMS
424 WEST 44TH STREET EMERGING THEATER
NEW YORK, NY 10036 ISTS 42,000.
723631 04-01-17
22
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
MILGROM, ALBERT
2,650.
NONE I MN FILM/VIDEO/DIGITALPROJECT
MILKWEED EDITIONS
MINNEAPOLIS COLLEGE OF ART AND DESIGN
MINNEAPOLIS COLLEGE OF ART AND DESIGN
MOVEMENT RESEARCH
MOVEMENT RESEARCH
1011 WASHINGTON AVENUE SOUTH SUITE 300
2501 STEVENS AVENUE
2501 STEVENS AVENUE
140 SECOND AVE #501
140 SECOND AVE #501
NONE
NONE
NONE
NONE
NONE
PC
PC
PC
PC
PC
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR RESIDENCY
SUPPORT FOR RESIDENCY
FOR EMERGING WRITERS
FOR EMERGING VISUAL
23,000.
FOR EMERGING VISUAL
PROGRAM
PROGRAM
21,750.
110,000.
42,000.
NEW DRAMATISTS424 WEST 44TH STREET
NATIONAL BLACK THEATRE
NAUTILUS MUSIC-THEATER
NERBURN, NICHOLAS
NEW YORK, NY 10036
NONE
213 WEST 127TH ST
308 PRINCE STREET #190
PC SUPPORT FOR PROGRAMSFOR EMERGING THEATERARTISTS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
PC
PC
I
170,000.
30,000.
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
MN FILM/VIDEO/DIGITAL
FOR EMERGING THEATER
FOR EMERGING COMPOSERS
PROJECT
30,000.
20,000.
29,764.
MINNEAPOLIS, MN 55415
MINNEAPOLIS, MN 55404 ARTISTS
MINNEAPOLIS, MN 55404 ARTISTS
NEW YORK, NY 10003
NEW YORK, NY 10003
NEW YORK, NY 10030 ARTISTS
SAINT PAUL, MN 55101 AND LIBRETTISTS
22 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient ____________________________
NEW DRAMATISTS N ONE P C SUPPORT FOR PROGRAMS
424 WEST 44TH STREET F OR EMERGING THEATER
NEW YORK, NY 10036 A RTISTS
NEW YORK LIVE ARTS/JOANNA KOTZE N ONE P C SUPPORT FOR CREATION
219 W, 19TH STREET O F A NEW DANCE WORK
NEW YORK, NY 10011
NEW YORK LIVE ARTS/SIBYL KEMPSON N ONE P C SUPPORT FOR CREATION
219 W. 19TH STREET O F A NEW DANCE WORK
NEW YORK, NY 10011
NORTHERN CLAY CENTER N ONE P C SUPPORT FOR PROGRAMS
2424 FRANKLIN AVENUE EAST F OR EMERGING VISUAL
MINNEAPOLIS, MN 55406 A RTISTS
NORTHERN LIGHTS.MN N ONE P C SUPPORT FOR PROGRAMS
2751 HENNEPIN AVE. S. #231 F OR ARTISTS WORKING IN
MINNEAPOLIS, MN 55408 N EW MEDIA
NORTHERN LIGHTS.MN/ANICCHA ARTS N ONE P C SUPPORT FOR CREATION
2751 HENNEPIN AVE. S. #231 O F A NEW DANCE WORK
MINNEAPOLIS, MN 55408
ORTMAN, LAURA N ONE I C OMPOSER/SOUND ARTIST
PALLAORO, ANDREA
FILM/VIDEO/DIGITAL
Amount
42,500.
12,000.
10 ,000.
27,100.
65,000.
13,000.
20,000.
30,000.
PANGEA WORLD THEATER
711 WEST LAKE STREET SUITE 101
MINNEAPOLIS, MN 55408
PELOFF, BETH
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
FILM/VIDEO/DIGITAL
20,000.
7,000.
723631 04-01-17
23
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
NEW DRAMATISTS424 WEST 44TH STREET
42,500.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING THEATER
NEW YORK LIVE ARTS/JOANNA KOTZE
NEW YORK LIVE ARTS/SIBYL KEMPSON
NORTHERN CLAY CENTER
NORTHERN LIGHTS.MN
NORTHERN LIGHTS.MN/ANICCHA ARTS
219 W, 19TH STREET
219 W. 19TH STREET
2424 FRANKLIN AVENUE EAST
2751 HENNEPIN AVE. S. #231
2751 HENNEPIN AVE. S. #231
NONE
NONE
NONE
NONE
NONE
PC
PC
PC
PC
PC
SUPPORT FOR CREATION
SUPPORT FOR CREATION
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR CREATION
OF A NEW DANCE WORK
OF A NEW DANCE WORK
12,000.
FOR EMERGING VISUAL
FOR ARTISTS WORKING IN
OF A NEW DANCE WORK
65,000.
10,000.
7,000.
PELOFF, BETH
ORTMAN, LAURA
PALLAORO, ANDREA
PANGEA WORLD THEATER
NONE
711 WEST LAKE STREET SUITE 101
I MN FILM/VIDEO/DIGITALPROJECT
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
I
PC
27,100.
13,000.
COMPOSER/SOUND ARTIST
NY FILM/VIDEO/DIGITAL
SUPPORT FOR PROGRAMS
FELLOWSHIP
PROJECT
FOR EMERGING THEATER
20,000.
30,000.
20,000.
NEW YORK, NY 10036 ARTISTS
NEW YORK, NY 10011
NEW YORK, NY 10011
MINNEAPOLIS, MN 55406 ARTISTS
MINNEAPOLIS, MN 55408 NEW MEDIA
MINNEAPOLIS, MN 55408
MINNEAPOLIS, MN 55408 ARTISTS
23 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163 Information
3 Grants and Contributions Paid During the Year (Continuation) ______________ _____________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient ___________________________
PENTACLE/FAYE DRISCOLL N ONE P C SUPPORT FOR CREATION
75 BROAD STREET SUITE 304 O F A NEW DANCE WORK
NEW YORK, NY 10004
PILLSBURY HOUSE THEATRE N ONE P C SUPPORT FOR PROGRAMS
3501 CHICAGO AVENUE SOUTH F OR EMERGING THEATER
MINNEAPOLIS, MN 55407 A RTISTS
PILLSBURY HOUSE THEATRE N ONE P C SUPPORT FOR PROGRAMS
3501 CHICAGO AVENUE SOUTH F OR EMERGING THEATER
MINNEAPOLIS, MN 55407 A RTISTS
PILLSBURY HOUSE THEATRE N ONE P C SUPPORT FOR PROGRAMS
3501 CHICAGO AVENUE SOUTH F OR EMERGING THEATER
MINNEAPOLIS, MN 55407 A RTISTS
PLAYWRIGHTS ' CENTER N ONE P C SUPPORT FOR PROGRAMS
2301 E FRANKLIN AVE F OR EMERGING THEATER
MINNEAPOLIS, MN 55406 A RTISTS
PLAYWRIGHTS HORIZONS N ONE P C SUPPORT FOR PROGRAMS
416 WEST 42ND STREET F OR EMERGING THEATER
NEW YORK, NY 10036 A RTISTS
PLAZINSKA, KATARZYNA N ONE I N Y FILM/VIDEO/DIGITAL
P ROJECT
POETRY PROJECT
131 E. 10TH ST
NEW YORK, NY 10003
POETS HOUSE
10 RIVER TERRACE
NEW YORK, NY 10282-1240
POETS HOUSE
10 RIVER TERRACE
NEW YORK, NY 10282-1240
PORT FOR PROGRAMS
EMERGING WRITERS
PORT FOR PROGRAMS
EMERGING WRITERS
PORT FOR PROGRAMS
EMERGING WRITERS
Amount
16,000.
15,000.
36,500.
37,500.
120,000.
25,000.
30,000.
25,000.
34,000.
35,000.
723631 04-01-17
24 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
PENTACLE/FAYE DRISCOLL75 BROAD STREET SUITE 304
16,000.
NONE PC SUPPORT FOR CREATIONOF A NEW DANCE WORK
PILLSBURY HOUSE THEATRE
PILLSBURY HOUSE THEATRE
PILLSBURY HOUSE THEATRE
PLAYWRIGHTS' CENTER
PLAYWRIGHTS HORIZONS
3501 CHICAGO AVENUE SOUTH
3501 CHICAGO AVENUE SOUTH
3501 CHICAGO AVENUE SOUTH
2301 E FRANKLIN AVE
416 WEST 42ND STREET
NONE
NONE
NONE
NONE
NONE
PC
PC
PC
PC
PC
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
FOR EMERGING THEATER
FOR EMERGING THEATER
15,000.
FOR EMERGING THEATER
FOR EMERGING THEATER
FOR EMERGING THEATER
120,000.
36,500.
35,000.
POETS HOUSE10 RIVER TERRACE
PLAZINSKA, KATARZYNA
POETRY PROJECT
POETS HOUSE
NEW YORK, NY 10282-1240
NONE
131 E. 10TH ST
10 RIVER TERRACE
PC SUPPORT FOR PROGRAMSFOR EMERGING WRITERS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
PC
PC
37,500.
25,000.
NY FILM/VIDEO/DIGITAL
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PROJECT
FOR EMERGING WRITERS
FOR EMERGING WRITERS
30,000.
25,000.
34,000.
NEW YORK, NY 10004
MINNEAPOLIS, MN 55407 ARTISTS
MINNEAPOLIS, MN 55407 ARTISTS
MINNEAPOLIS, MN 55407 ARTISTS
MINNEAPOLIS, MN 55406 ARTISTS
NEW YORK, NY 10036 ARTISTS
NEW YORK, NY 10003
NEW YORK, NY 10282-1240
24 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ _____________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient ___________________________
RADIVOJEVIC, IVA N ONE I N Y FILM/VIDEO/DIGITAL
P ROJECT
RASHIED-WALKER, RASHANNA
AND STUDY
Amount
20,800.
4,750.
RED EYE THEATER
15 W 14TH STREET
MINNEAPOLIS, MN 55403
RHIZOME COMMUNICATIONS, INC
235 BOWERY
NEW YORK, NY 10002
RICE, DEMPSEY
ROBERTS, MATANA
ROULETTE INTERMEDIUM
30 THIRD AVENUE SUITE 208
BROOKLYN, NY 11217
RYNEARSON, ANNE
PORT FOR PROGRAMS
EMERGING THEATER
ISTS 33,000.
PORT FOR PROGRAMS
ARTISTS WORKING IN
MEDIA 20,000.
FILM/VIDEO/DIGITAL
10,424.
PPORT FOR ARTIST
SEARCH RESIDENCY
OJECT 750.
PPORT FOR PROGRAMS
R EMERGING COMPOSERS
70,000.
AVEL AND STUDY
2,780.
SAINT JOHN'S UNIVERSITY
2810 ABBEY PLAZA, PO BOX 6377
COLLEGEVILLE, MN 56321
SEED, RACHEL ELIZABETH
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS
FILM/VIDEO/DIGITAL
25,750.
30,000.
723631 04-01-17
25
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
RADIVOJEVIC, IVA
20,800.
NONE I NY FILM/VIDEO/DIGITALPROJECT
RASHIED-WALKER, RASHANNA
RED EYE THEATER
RHIZOME COMMUNICATIONS, INC
RICE, DEMPSEY
ROBERTS, MATANA
15 W 14TH STREET
235 BOWERY
NONE
NONE
NONE
NONE
NONE
I
PC
PC
I
I
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
NY FILM/VIDEO/DIGITAL
SUPPORT FOR ARTIST
PROJECT
FOR EMERGING THEATER
4,750.
FOR ARTISTS WORKING IN
PROJECT
RESEARCH RESIDENCY
10,424.
33,000.
30,000.
SEED, RACHEL ELIZABETH
ROULETTE INTERMEDIUM
RYNEARSON, ANNE
SAINT JOHN'S UNIVERSITY
NONE
30 THIRD AVENUE SUITE 208
2810 ABBEY PLAZA, PO BOX 6377
I NY FILM/VIDEO/DIGITALPROJECT
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
PC
I
PC
20,000.
750.
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
FOR EMERGING COMPOSERS
PROJECT
FOR EMERGING VISUAL
70,000.
2,780.
25,750.
MINNEAPOLIS, MN 55403 ARTISTS
NEW YORK, NY 10002 NEW MEDIA
PROJECT
BROOKLYN, NY 11217
COLLEGEVILLE, MN 56321 ARTISTS
25 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ _____________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient ___________________________
SERU, DAVU N ONE I C OMPOSER/SOUND ARTIST
SHYU, JENNIFER
Amount
20,000.
3,667.
AND STUDY
FILM/VIDEO/DIGITAL
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS
PORT FOR PROGRAMS
EMERGING WRITERS
PORT FOR PROGRAMS
EMERGING WRITERS
ERAL PROGRAM
SINHA, SONEJUHI
SOCRATES SCULPTURE PARK
PO BOX 6259, 32-01 VERNON BOULEVARD
LONG ISLAND CITY, NY 11106
SOHO REPERTORY THEATRE
401 BROADWAY, SUITE 300
NEW YORK, NY 10013
STREB LAB FOR ACTION MECHANICS
51 NORTH 1ST STREET
BROOKLYN, NY 11249
STUDIO MUSEUM IN HARLEM
144 WEST 125TH STREET
NEW YORK, NY 10027
THE LOFT LITERARY CENTER
1011 WASHINGTON AVENUE SOUTH SUITE 200
MINNEAPOLIS, MN 55415
THE LOFT LITERARY CENTER
1011 WASHINGTON AVENUE SOUTH SUITE 200
MINNEAPOLIS, MN 55415
THE TEAM
138 SOUTH OXFORD ST. SUITE 1C
BROOKLYN, NY 11217
15, 000.
25,000.
20,000.
23,000.
19,000.
61,000.
62,000.
12,000.
723631 04-01-17
26
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
SERU, DAVU
20,000.
NONE I COMPOSER/SOUND ARTISTFELLOWSHIP
SHYU, JENNIFER
SINHA, SONEJUHI
SOCRATES SCULPTURE PARK
SOHO REPERTORY THEATRE
STREB LAB FOR ACTION MECHANICS
PO BOX 6259, 32-01 VERNON BOULEVARD
401 BROADWAY, SUITE 300
51 NORTH 1ST STREET
NONE
NONE
NONE
NONE
NONE
I
I
PC
PC
PC
TRAVEL AND STUDY
NY FILM/VIDEO/DIGITAL
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PROJECT
PROJECT
3,667.
FOR EMERGING VISUAL
FOR EMERGING THEATER
FOR EMERGING ARTISTS
20,000.
15,000.
12,000.
THE TEAM138 SOUTH OXFORD ST. SUITE 1C
STUDIO MUSEUM IN HARLEM
THE LOFT LITERARY CENTER
THE LOFT LITERARY CENTER
BROOKLYN, NY 11217
NONE
144 WEST 125TH STREET
1011 WASHINGTON AVENUE SOUTH SUITE 200
1011 WASHINGTON AVENUE SOUTH SUITE 200
PC GENERAL PROGRAM
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
PC
PC
PC
25,000.
23,000.
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
FOR EMERGING VISUAL
FOR EMERGING WRITERS
FOR EMERGING WRITERS
19,000.
61,000.
62,000.
LONG ISLAND CITY, NY 11106 ARTISTS
NEW YORK, NY 10013 ARTISTS
BROOKLYN, NY 11249 IN DANCE
NEW YORK, NY 10027 ARTISTS
MINNEAPOLIS, MN 55415
MINNEAPOLIS, MN 55415
26 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163 Information
3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________ ______________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager unt Name and address (home or status o o
business) f contribution Am
or substantial contributor recipient ____________________________ __________________
THEATER MU/MU PERFORMING ARTS N ONE P C SUPPORT FOR PROGRAMS
275 EAST FOURTH ST. F OR EMERGING THEATER
SAINT PAUL, MN 55101 A RTISTS 50,000.
THOMPSON, LAURA MARIE N ONE I TRAVEL AND STUDY
P ROJECT
2,500.
TOFTE LAKE CENTER
2209 FERNBERG ROAD
ELY, MN 55731
TUBERGEN, ELIZABETH
PPORT FOR RESEARCH
SIDENCIES FOR
ERGING ARTISTS
AVEL AND STUDY
31,000.
5,000.
VOCALESSENCE PORT FOR PROGRAMS
1900 NICOLLET AVENUE EMERGING COMPOSERS
MINNEAPOLIS, MN 55403 _____________________ 30,000.
VSA MINNESOTA PORT FOR PROGRAMS
528 HENNEPIN AVENUE SUITE 305 EMERGING VISUAL
MINNEAPOLIS, MN 55403 ISTS 21,000.
WANDURAGALA, CHAMINDIKA VEL AND STUDY
5,000.
WEE, HONG-LING AND STUDY
5,000.
WESTFALL, KIM
ZONDON, WAZINA
AND STUDY
AND STUDY
1,711.
2,500.
723631 04-01-17
27 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363104-01-17
3
Total from continuation sheets
Grants and Contributions Paid During the Year (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
THEATER MU/MU PERFORMING ARTS275 EAST FOURTH ST.
50,000.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING THEATER
THOMPSON, LAURA MARIE
TOFTE LAKE CENTER
TUBERGEN, ELIZABETH
VOCALESSENCE
VSA MINNESOTA
2209 FERNBERG ROAD
1900 NICOLLET AVENUE
528 HENNEPIN AVENUE SUITE 305
NONE
NONE
NONE
NONE
NONE
I
PC
I
PC
PC
TRAVEL AND STUDY
SUPPORT FOR RESEARCH
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PROJECT
RESIDENCIES FOR
2,500.
PROJECT
FOR EMERGING COMPOSERS
FOR EMERGING VISUAL
30,000.
31,000.
2,500.
ZONDON, WAZINA
WANDURAGALA, CHAMINDIKA
WEE, HONG-LING
WESTFALL, KIM
NONE I TRAVEL AND STUDYPROJECT
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
I
I
5,000.
21,000.
TRAVEL AND STUDY
TRAVEL AND STUDY
TRAVEL AND STUDY
PROJECT
PROJECT
PROJECT
5,000.
5,000.
1,711.
SAINT PAUL, MN 55101 ARTISTS
ELY, MN 55731 EMERGING ARTISTS
MINNEAPOLIS, MN 55403
MINNEAPOLIS, MN 55403 ARTISTS
27 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
PORT FOR PROGRAMS
EMERGING WRITERS
VEL AND STUDY
35,000.
4,341.
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ____________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient _________________________
ANDERSON CENTER N ONE P C SUPPORT FOR RESEARCH
163 TOWER VIEW DRIVE R ESIDENCIES FOR
RED WING, MN 55066 E MERGING ARTISTS
ARNOLD, BRIAN N ONE I TRAVEL AND STUDY
P ROJECT
Amount
21,250.
5,000.
ASIAN AMERICAN WRITERS WORKSHOP
110-112 W. 27TH STREET SUITE 600
NEW YORK, NY 10001
AWADALLAH, LEILA
BAAD! /BRONX ACADEMY OF ARTS AND DANCE
PO BOX 86
BRONX, NY 10451
BRONX DOCUMENTARY CENTER
614 COURTLANDT AVE
BRONX, NY 10451
BRONX MUSEUM OF THE ARTS
1040 GRAND CONCOURSE
BRONX, NY 10456
BROOKLYN ARTS EXCHANGE
421 FIFTH AVENUE
BROOKLYN, NY 11215
BROOKLYN ARTS EXCHANGE/600 HIGHWAYMEN
421 FIFTH AVENUE
BROOKLYN, NY 11215
BROOKLYN ARTS EXCHANGE/NI'JA WHITSON
421 FIFTH AVENUE
BROOKLYN, NY 11215
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE 30,000.
PORT FOR PROGRAMS
EMERGING
MMAKERS 80,000.
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS 54,000.
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE 80,000.
PORT TO CREATE A
CIFIC THEATER PIECE
10 ,000.
PORT FOR CREATION
A NEW DANCE WORK
12,000.
3,912,270.
723635 04-01-17
28
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
ANDERSON CENTER163 TOWER VIEW DRIVE
21,250.
NONE PC SUPPORT FOR RESEARCHRESIDENCIES FOR
3,912,270.
ARNOLD, BRIAN
ASIAN AMERICAN WRITERS WORKSHOP
AWADALLAH, LEILA
BAAD!/BRONX ACADEMY OF ARTS AND DANCE
BRONX DOCUMENTARY CENTER
110-112 W. 27TH STREET SUITE 600
PO BOX 86
614 COURTLANDT AVE
NONE
NONE
NONE
NONE
NONE
I
PC
I
PC
PC
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PROJECT
FOR EMERGING WRITERS
5,000.
PROJECT
FOR EMERGING ARTISTS
FOR EMERGING
30,000.
35,000.
12,000.
BROOKLYN ARTS EXCHANGE/NI'JA WHITSON421 FIFTH AVENUE
BRONX MUSEUM OF THE ARTS
BROOKLYN ARTS EXCHANGE
BROOKLYN ARTS EXCHANGE/600 HIGHWAYMEN
BROOKLYN, NY 11215
NONE
1040 GRAND CONCOURSE
421 FIFTH AVENUE
421 FIFTH AVENUE
PC SUPPORT FOR CREATIONOF A NEW DANCE WORK
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
PC
PC
PC
4,341.
80,000.
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT TO CREATE A
FOR EMERGING VISUAL
FOR EMERGING ARTISTS
SPECIFIC THEATER PIECE
54,000.
80,000.
10,000.
RED WING, MN 55066 EMERGING ARTISTS
NEW YORK, NY 10001
BRONX, NY 10451 IN DANCE
BRONX, NY 10451 FILMMAKERS
BRONX, NY 10456 ARTISTS
BROOKLYN, NY 11215 IN DANCE
BROOKLYN, NY 11215
28 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ______________________ ______________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager unt Name and address (home or status o o
business) f contribution Am
or substantial contributor recipient ____________________________ __________________
BRUNO, SHIRLEY N ONE I TRAVEL AND STUDY
P ROJECT
________ 5,000.
CAMARGO FOUNDATION
1 AVENUE MAURICE JERMINI
CASSIS, FRANCE
PORT FOR RESIDENCY
3,000.
CAMERA CLUB OF NEW YORK
126 BAXTER ST
NEW YORK, NY 10013
CAVE CANEM FOUNDATON INC.
20 JAY STREET, SUITE 310-A
BROOKLYN, NY 11201
CEDAR CULTURAL CENTER
416 CEDAR AVE S
MINNEAPOLIS, MN 55454
CENTER FOR FICTION
80 FIFTH AVENUE, SUITE 1201
NEW YORK, NY 10011
CHOCOLATE FACTORY
5-49 49TH AVENUE
LONG ISLAND CITY, NY 11101
CODJOE, AMA
COFFEE HOUSE PRESS
79 13TH AVE. N.E. SUITE 110
MINNEAPOLIS, MN 55413
COMMUNITY OF LITERARY MAGAZINES AND
PRESSES
154 CHRISTOPHER ST. SUITE 3C
NEW YORK, NY 12534
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS 20,000.
PORT FOR PROGRAMS
EMERGING WRITERS
_____________________ 25,000.
PORT FOR PROGRAMS
EMERGING COMPOSERS
_____________________ 80,000.
PORT FOR PROGRAMS
EMERGING WRITERS
_____________________ 42,500.
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE 32,000.
VEL AND STUDY
5,000.
PORT FOR PROGRAMS
EMERGING WRITERS
_____________________ 24,000.
PORT FOR PROGRAMS
EMERGING WRITERS
_____________________ 46,000.
� � � � � � � � � � � �
723635 04-01-17
29
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
BRUNO, SHIRLEY
5,000.
NONE I TRAVEL AND STUDYPROJECT
CAMARGO FOUNDATION
CAMERA CLUB OF NEW YORK
CAVE CANEM FOUNDATON INC.
CEDAR CULTURAL CENTER
CENTER FOR FICTION
1 AVENUE MAURICE JERMINI
126 BAXTER ST
20 JAY STREET, SUITE 310-A
416 CEDAR AVE S
80 FIFTH AVENUE, SUITE 1201
NONE
NONE
NONE
NONE
NONE
POF
PC
PC
PC
PC
SUPPORT FOR RESIDENCY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PROGRAM
FOR EMERGING VISUAL
3,000.
FOR EMERGING WRITERS
FOR EMERGING COMPOSERS
FOR EMERGING WRITERS
80,000.
20,000.
46,000.
COMMUNITY OF LITERARY MAGAZINES ANDPRESSES154 CHRISTOPHER ST. SUITE 3C
CHOCOLATE FACTORY
CODJOE, AMA
COFFEE HOUSE PRESS
NEW YORK, NY 12534
NONE
5-49 49TH AVENUE
79 13TH AVE. N.E. SUITE 110
PC SUPPORT FOR PROGRAMSFOR EMERGING WRITERS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
PC
I
PC
25,000.
42,500.
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
FOR EMERGING ARTISTS
PROJECT
FOR EMERGING WRITERS
32,000.
5,000.
24,000.
CASSIS, FRANCE
NEW YORK, NY 10013 ARTISTS
BROOKLYN, NY 11201
MINNEAPOLIS, MN 55454
NEW YORK, NY 10011
LONG ISLAND CITY, NY 11101 IN DANCE
MINNEAPOLIS, MN 55413
29 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ __________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient _______________________
CZERWIEC, HEIDI N ONE I TRAVEL AND STUDY
DANSPACE PROJECT
131 EAST 10TH STREET
NEW YORK, NY 10003
DIXON PLACE/OPEN CHANNELS
161A CHRYSTIE STREET
NEW YORK, NY 10002
EDUARDOVNA, IRA
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
VEL AND STUDY
Amount
1,250.
34,500.
25,000.
5,000.
ENSEMBLE STUDIO THEATRE
545-549 WEST 52ND STREET
NEW YORK, NY 10019
ETHELS FOUNDATION FOR THE ARTS
132 E 43RD ST #213
NEW YORK, NY 10017
EYEBEAM ARTS AND TECHNOLOGY
34 35TH ST. UNIT 26/5TH FLOOR
BROOKLYN, NY 11232
FORECAST PUBLIC ARTWORKS
2300 MYRTLE AVENUE SUITE 160
ST. PAUL, MN 55114
FORSTEIN, MICHAEL
FOUNDATION CENTER
32 OLD SLIP, 24TH FL
NEW YORK, NY 10005
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
PORT FOR PROGRAMS
EMERGING COMPOSERS
PORT FOR PROGRAMS
ARTISTS WORKING IN
MEDIA
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS
FILM/VIDEO/DIGITAL
PORT FOR SERVICES
GRANTMAKERS
20,000.
20,000.
15, 000.
80,000.
30,000.
5,000.
723635 04-01-17
30
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
CZERWIEC, HEIDI
1,250.
NONE I TRAVEL AND STUDYPROJECT
DANSPACE PROJECT
DIXON PLACE/OPEN CHANNELS
EDUARDOVNA, IRA
ENSEMBLE STUDIO THEATRE
ETHELS FOUNDATION FOR THE ARTS
131 EAST 10TH STREET
161A CHRYSTIE STREET
545-549 WEST 52ND STREET
132 E 43RD ST #213
NONE
NONE
NONE
NONE
NONE
PC
PC
I
PC
PC
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
FOR EMERGING ARTISTS
FOR EMERGING THEATER
34,500.
PROJECT
FOR EMERGING THEATER
FOR EMERGING COMPOSERS
20,000.
25,000.
5,000.
FOUNDATION CENTER32 OLD SLIP, 24TH FL
EYEBEAM ARTS AND TECHNOLOGY
FORECAST PUBLIC ARTWORKS
FORSTEIN, MICHAEL
NEW YORK, NY 10005
NONE
34 35TH ST. UNIT 26/5TH FLOOR
2300 MYRTLE AVENUE SUITE 160
PC SUPPORT FOR SERVICESFOR GRANTMAKERS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
PC
PC
I
5,000.
20,000.
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
MN FILM/VIDEO/DIGITAL
FOR ARTISTS WORKING IN
FOR EMERGING VISUAL
PROJECT
15,000.
80,000.
30,000.
NEW YORK, NY 10003 IN DANCE
NEW YORK, NY 10002 ARTISTS
NEW YORK, NY 10019 ARTISTS
NEW YORK, NY 10017
BROOKLYN, NY 11232 NEW MEDIA
ST. PAUL, MN 55114 ARTISTS
30 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ____________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient _________________________
FOUR WAY BOOKS N ONE P C SUPPORT FOR PROGRAMS
11 JAY STREET 4TH FL F OR EMERGING WRITERS
NEW YORK, NY 10013
FRANCONIA SCULPTURE PARK N ONE P C SUPPORT FOR PROGRAMS
29836 ST. CROIX TRAIL F OR EMERGING VISUAL
SHAFER, MN 55074 A RTISTS
FRANKLIN FURNACE ARCHIVE N ONE P C SUPPORT FOR PROGRAMS
PRATT INSTITUTE, 200 WILLOUGHBY AVENUE F OR EMERGING VISUAL
BROOKLYN, NY 11205 A RTISTS
GIBNEY DANCE N ONE P C SUPPORT FOR PROGRAMS
890 BROADWAY, 5TH FL F OR EMERGING ARTISTS
NEW YORK, NY 10023 IN DANCE
GRANTMAKERS IN THE ARTS N ONE P C SUPPORT FOR SERVICES
4055 21ST AVE W, STE 100 F OR GRANTMAKERS
SEATTLE, WA 98199
GRAYWOLF PRESS N ONE P C SUPPORT FOR PROGRAMS
250 3RD AVE N, STE 600 F OR EMERGING WRITERS
MINNEAPOLIS, MN 55401
HARLEM STAGE/AARON DAVIS HALL N ONE P C SUPPORT FOR PROGRAMS
150 CONVENT AVENUE F OR EMERGING ARTISTS
NEW YORK, NY 10031 IN DANCE
HARVESTWORKS N ONE P C SUPPORT FOR PROGRAMS
596 BROADWAY SUITE 602 F OR EMERGING
NEW YORK, NY 10012 F ILMMAKERS
HENRY ST SETTLEMENT/ABRONS ART CENTER N ONE P C SUPPORT FOR PROGRAMS
265 HENRY ST F OR EMERGING ARTISTS
NEW YORK, NY 10002 IN DANCE
HERE N ONE P C SUPPORT FOR PROGRAMS
145 6TH AVE F OR EMERGING THEATER
Amount
23,000.
39,000.
60,000.
50,000.
11, 000.
23,000.
25,000.
17,000.
60,000.
22,000.
723635 04-01-17
31
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
FOUR WAY BOOKS11 JAY STREET 4TH FL
23,000.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING WRITERS
FRANCONIA SCULPTURE PARK
FRANKLIN FURNACE ARCHIVE
GIBNEY DANCE
GRANTMAKERS IN THE ARTS
GRAYWOLF PRESS
29836 ST. CROIX TRAIL
PRATT INSTITUTE, 200 WILLOUGHBY AVENUE
890 BROADWAY, 5TH FL
4055 21ST AVE W, STE 100
250 3RD AVE N, STE 600
NONE
NONE
NONE
NONE
NONE
PC
PC
PC
PC
PC
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR SERVICES
SUPPORT FOR PROGRAMS
FOR EMERGING VISUAL
FOR EMERGING VISUAL
39,000.
FOR EMERGING ARTISTS
FOR GRANTMAKERS
FOR EMERGING WRITERS
11,000.
60,000.
22,000.
HERE145 6TH AVE
HARLEM STAGE/AARON DAVIS HALL
HARVESTWORKS
HENRY ST SETTLEMENT/ABRONS ART CENTER
NEW YORK, NY 10013
NONE
150 CONVENT AVENUE
596 BROADWAY SUITE 602
265 HENRY ST
PC SUPPORT FOR PROGRAMSFOR EMERGING THEATERARTISTS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
PC
PC
PC
50,000.
23,000.
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
FOR EMERGING ARTISTS
FOR EMERGING
FOR EMERGING ARTISTS
25,000.
17,000.
60,000.
NEW YORK, NY 10013
SHAFER, MN 55074 ARTISTS
BROOKLYN, NY 11205 ARTISTS
NEW YORK, NY 10023 IN DANCE
SEATTLE, WA 98199
MINNEAPOLIS, MN 55401
NEW YORK, NY 10031 IN DANCE
NEW YORK, NY 10012 FILMMAKERS
NEW YORK, NY 10002 IN DANCE
31 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS
VEL AND STUDY
JECT
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
PORT FOR PROGRAMS
EMERGING COMPOSERS
PORT FOR PROGRAMS
EMERGING VISUAL
40,000.
5,000.
25,000.
40,000.
60,000.
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE
PORT FOR PROGRAMS
EMERGING COMPOSERS
VEL AND STUDY
17,000.
80,000.
5,000.
JEROME FOUNDATION, INC. **-***5163 Information
3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ____________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient _________________________
HERNNDEZ, ELIZABETH MCWILLIAMS N ONE P C SUPPORT FOR PROGRAMS
F OR EMERGING VISUAL
A RTISTS
HERNNDEZ, ELIZABETH MCWILLIAMS N ONE I TRAVEL AND STUDY
P ROJECT
Amount
28,000.
5,000.
HIGHPOINT CENTER FOR PRINTMAKING
912 W. LAKE STREET
MINNEAPOLIS, MN 55408
HUANG, JESSICA
IN THE HEART OF THE BEAST PUPPET AND
MASK THEATRE (HOBT)
1500 EAST LAKE ST
MINNEAPOLIS, MN 55407
INTERNATIONAL CONTEMPORARY ENSEMBLE
(ICE)
4306 3RD AVE, 4TH FL
BROOKLYN, NY 11232
JAMAICA CENTER FOR ARTS & LEARNING
( JCAL)
161-04 JAMAICA AVE
JAMES SEWELL BALLET
528 HENNEPIN AVENUE SUITE 125
MINNEAPOLIS, MN 55403
JAZZ GALLERY
PO BOX 153, LENOX HILL STATION
NEW YORK, NY 10021
JINDAL, ANU
723635 04-01-17
32 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
HERNNDEZ, ELIZABETH MCWILLIAMS
28,000.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING VISUAL
IN THE HEART OF THE BEAST PUPPET AND
INTERNATIONAL CONTEMPORARY ENSEMBLE
HERNNDEZ, ELIZABETH MCWILLIAMS
HIGHPOINT CENTER FOR PRINTMAKING
HUANG, JESSICA
MASK THEATRE (HOBT)
(ICE)
912 W. LAKE STREET
1500 EAST LAKE ST
4306 3RD AVE, 4TH FL
NONE
NONE
NONE
NONE
NONE
PC
PC
I
PC
I
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
FOR EMERGING THEATER
FOR EMERGING COMPOSERS
PROJECT
FOR EMERGING VISUAL
5,000.
PROJECT
ARTISTS25,000.
40,000.
JAMAICA CENTER FOR ARTS & LEARNING
5,000.
JINDAL, ANU
(JCAL)
JAMES SEWELL BALLET
JAZZ GALLERY
NONE
161-04 JAMAICA AVE
528 HENNEPIN AVENUE SUITE 125
PO BOX 153, LENOX HILL STATION
I TRAVEL AND STUDYPROJECT
NONE
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
PC
PC
PC
5,000.
40,000.
SUPPORT FOR PROGRAMSFOR EMERGING VISUAL
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
ARTISTS
FOR EMERGING ARTISTS
FOR EMERGING COMPOSERS
60,000.
17,000.
80,000.
ARTISTS
MINNEAPOLIS, MN 55408 ARTISTS
MINNEAPOLIS, MN 55407
BROOKLYN, NY 11232
JAMAICA, NY 11432
MINNEAPOLIS, MN 55403 IN DANCE
NEW YORK, NY 10021
32 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC.
Part X V Supplementary Information 3 Grants and Contributions Approved for Future Payment (Continuation) ___________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation
Name and address (home or business) any foundation manager status of or substantial contributor recipient
JOHNSON III, HERBERT N ONE I
JOSHI, AMITABH N ONE I
JURANIC, MARIA N ONE I
KAMPS, JEREMY N ONE I
KESSLER, GABRIELLA N ONE I
KHALIL, ADAM N ONE I
KHALIL, ZACK N ONE I
KLEBER-DIGGS, MICHAEL N ONE P C
KRISCHE, AMANDA N ONE I
KUNDIMAN N ONE P C
113 WEST 60TH STREET, ROOM 924
NEW YORK, NY 10023
**-***5163
Purpose of grant or contribution Amount
L AND STUDY
4,200.
AND STUDY
5,000.
FILM/VIDEO/DIGITAL
16,000.
AND STUDY
5,000.
FILM/VIDEO/DIGITAL
17,000.
AND STUDY
2,500.
AND STUDY
2,500.
AND STUDY
1,500.
AND STUDY
3,500.
PORT FOR PROGRAMS
EMERGING WRITERS
60,000.
723635 04-01-17
33
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
JOHNSON III, HERBERT
4,200.
NONE I TRAVEL AND STUDYPROJECT
JOSHI, AMITABH
JURANIC, MARIA
KAMPS, JEREMY
KESSLER, GABRIELLA
KHALIL, ADAM
NONE
NONE
NONE
NONE
NONE
I
I
I
I
I
TRAVEL AND STUDY
MN FILM/VIDEO/DIGITAL
TRAVEL AND STUDY
NY FILM/VIDEO/DIGITAL
TRAVEL AND STUDY
PROJECT5,000.
PROJECT
PROJECT
PROJECT
17,000.
16,000.
60,000.
KUNDIMAN113 WEST 60TH STREET, ROOM 924
KHALIL, ZACK
KLEBER-DIGGS, MICHAEL
KRISCHE, AMANDA
NEW YORK, NY 10023
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING WRITERS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
PC
I
5,000.
2,500.
TRAVEL AND STUDY
TRAVEL AND STUDY
TRAVEL AND STUDY
PROJECT
PROJECT
PROJECT
2,500.
1,500.
3,500.
33 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ______________________ _______________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager unt Name and address (home or status o o
business) f contribution Am
or substantial contributor recipient ____________________________ ___________________
LANESBORO ARTS N ONE P C SUPPORT FOR RESEARCH
103 PARKWAY AVE N R ESIDENCIES FOR
LANESBORO, MN 55949 E MERGING ARTISTS 36,000.
LARK PLAY DEVELOPMENT CENTER N ONE P C SUPPORT FOR PROGRAMS
311 WEST 43RD STREET SUITE 406 F OR EMERGING THEATER
NEW YORK, NY 10036 A RTISTS 22,000.
LARK PLAY DEVELOPMENT CENTER N ONE P C SUPPORT FOR PROGRAMS
311 WEST 43RD STREET SUITE 406 F OR EMERGING THEATER
NEW YORK, NY 10036 A RTISTS 30,000.
LAUNDROMAT PROJECT N ONE P C SUPPORT FOR PROGRAMS
127 WEST 127TH STREET SUITE 434 F OR EMERGING VISUAL
NEW YORK, NY 10027-3723 A RTISTS 70,000.
LAVORE, KYLE N ONE I N Y FILM/VIDEO/DIGITAL
LUE, JEN
LY, OSKAR
MABOU MINES
PO BOX 777
NEW YORK, NY 10009
MAO, WENWEN
MA-YI THEATER COMPANY
520 8TH AVE, STE 309
NEW YORK, NY 10018
AND STUDY
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
VEL AND STUDY
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
5,000.
30,000.
5,000.
60,000.
723635 04-01-17
34
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
30,000.
AND STUDY
5,000.
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
LANESBORO ARTS103 PARKWAY AVE N
36,000.
NONE PC SUPPORT FOR RESEARCHRESIDENCIES FOR
LARK PLAY DEVELOPMENT CENTER
LARK PLAY DEVELOPMENT CENTER
LAUNDROMAT PROJECT
LAVORE, KYLE
LUE, JEN
311 WEST 43RD STREET SUITE 406
311 WEST 43RD STREET SUITE 406
127 WEST 127TH STREET SUITE 434
NONE
NONE
NONE
NONE
NONE
PC
PC
PC
I
I
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
NY FILM/VIDEO/DIGITAL
TRAVEL AND STUDY
FOR EMERGING THEATER
FOR EMERGING THEATER
22,000.
FOR EMERGING VISUAL
PROJECT
PROJECT
30,000.
30,000.
60,000.
MA-YI THEATER COMPANY520 8TH AVE, STE 309
LY, OSKAR
MABOU MINES
MAO, WENWEN
NEW YORK, NY 10018
NONE
PO BOX 777
PC SUPPORT FOR PROGRAMSFOR EMERGING THEATERARTISTS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
PC
I
70,000.
5,000.
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
PROJECT
FOR EMERGING THEATER
PROJECT
5,000.
30,000.
5,000.
LANESBORO, MN 55949 EMERGING ARTISTS
NEW YORK, NY 10036 ARTISTS
NEW YORK, NY 10036 ARTISTS
NEW YORK, NY 10027-3723 ARTISTS
NEW YORK, NY 10009 ARTISTS
34 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163 Information
3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ______________________ ________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager Amo Name and address (home or business) status of contribution
or substantial contributor recipient ____________________________ __________
MILGROM, ALBERT N ONE I M N FILM/VIDEO/DIGITAL
P ROJECT
MILKWEED EDITIONS N ONE P C SUPPORT FOR PROGRAMS
1011 WASHINGTON AVENUE SOUTH SUITE 300 F OR EMERGING WRITERS
MINNEAPOLIS, MN 55415
MINNESOTA CENTER FOR BOOK ARTS N ONE P C SUPPORT FOR PROGRAMS
1011 WASHINGTON AVENUE SOUTH SUITE 100 F OR EMERGING VISUAL
MINNEAPOLIS, MN 55415 A RTISTS
MIXED BLOOD THEATRE COMPANY N ONE P C SUPPORT FOR PROGRAMS
1501 SOUTH FOURTH STREET F OR EMERGING THEATER
MINNEAPOLIS, MN 55454 A RTISTS
MOLSON, RICHARD N ONE I N Y FILM/VIDEO/DIGITAL
P ROJECT
MONTILUS MAXINE N ONE I TRAVEL AND STUDY
MORGAN, SARETTA VEL AND STUDY
JECT
MOVEMENT RESEARCH PORT FOR PROGRAMS
140 SECOND AVE #501 EMERGING ARTISTS
NEW YORK, NY 10003 DANCE
MSANGI, EKWA FILM/VIDEO/DIGITAL
JECT
NATIONAL BLACK THEATRE PORT FOR PROGRAMS
213 WEST 127TH ST EMERGING THEATER
NEW YORK, NY 10030
22,350.
23,000.
48,000.
8,000.
30,000.
2,900.
4,295.
80,000.
30,000.
30,000.
723635 04-01-17
35 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
MILGROM, ALBERT
22,350.
NONE I MN FILM/VIDEO/DIGITALPROJECT
MILKWEED EDITIONS
MINNESOTA CENTER FOR BOOK ARTS
MIXED BLOOD THEATRE COMPANY
MOLSON, RICHARD
MONTILUS, MAXINE
1011 WASHINGTON AVENUE SOUTH SUITE 300
1011 WASHINGTON AVENUE SOUTH SUITE 100
1501 SOUTH FOURTH STREET
NONE
NONE
NONE
NONE
NONE
PC
PC
PC
I
I
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
NY FILM/VIDEO/DIGITAL
TRAVEL AND STUDY
FOR EMERGING WRITERS
FOR EMERGING VISUAL
23,000.
FOR EMERGING THEATER
PROJECT
PROJECT
30,000.
48,000.
30,000.
NATIONAL BLACK THEATRE213 WEST 127TH ST
MORGAN, SARETTA
MOVEMENT RESEARCH
MSANGI, EKWA
NEW YORK, NY 10030
NONE
140 SECOND AVE #501
PC SUPPORT FOR PROGRAMSFOR EMERGING THEATERARTISTS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
PC
I
8,000.
2,900.
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
NY FILM/VIDEO/DIGITAL
PROJECT
FOR EMERGING ARTISTS
PROJECT
4,295.
80,000.
30,000.
MINNEAPOLIS, MN 55415
MINNEAPOLIS, MN 55415 ARTISTS
MINNEAPOLIS, MN 55454 ARTISTS
NEW YORK, NY 10003 IN DANCE
35 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163 Information
3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ______________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient ____________________________
NAUTILUS MUSIC-THEATER N ONE P C SUPPORT FOR PROGRAMS
308 PRINCE STREET #190 F OR EMERGING COMPOSERS
SAINT PAUL, MN 55101 AND LIBRETTISTS
NEO PHILANTHROPY/ARTCHANGEUS N ONE P C SUPPORT FOR ARTIST
45 W 36TH ST, 6TH FL P ARTICIPATION AT
NEW YORK, NY 10018 C ONFERENCE
NEW DRAMATISTS N ONE P C SUPPORT FOR PROGRAMS
424 WEST 44TH STREET F OR EMERGING THEATER
NEW YORK, NY 10036 A RTISTS
NEW YORK THEATRE WORKSHOP N ONE P C SUPPORT FOR PROGRAMS
79 EAST 4TH ST. F OR EMERGING THEATER
NEW YORK, NY 10003 A RTISTS
NORTHERN CLAY CENTER N ONE P C SUPPORT FOR PROGRAMS
2424 FRANKLIN AVENUE EAST F OR EMERGING VISUAL
MINNEAPOLIS, MN 55406 A RTISTS
NORTHERN LIGHTS.MN N ONE P C SUPPORT FOR PROGRAMS
2751 HENNEPIN AVE. S. #231 F OR ARTISTS WORKING IN
MINNEAPOLIS, MN 55408 N EW MEDIA
OBSATZ, KEVIN N ONE I M N FILM/VIDEO/DIGITAL
P ROJECT
PANGEA WORLD THEATER
711 WEST LAKE STREET SUITE 101
MINNEAPOLIS, MN 55408
PARTICIPANT INC
253 EAST HOUSTON STREET, # 1
NEW YORK, NY 10002
PELOFF, BETH
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS
FILM/VIDEO/DIGITAL
Amount
20,000.
9,000.
42,500.
20,000.
25,000.
65,000.
25,000.
50,000.
44,000.
1,500.
723635 04-01-17
36 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
NAUTILUS MUSIC-THEATER308 PRINCE STREET #190
20,000.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING COMPOSERS
NEO PHILANTHROPY/ARTCHANGEUS
NEW DRAMATISTS
NEW YORK THEATRE WORKSHOP
NORTHERN CLAY CENTER
NORTHERN LIGHTS.MN
45 W 36TH ST, 6TH FL
424 WEST 44TH STREET
79 EAST 4TH ST.
2424 FRANKLIN AVENUE EAST
2751 HENNEPIN AVE. S. #231
NONE
NONE
NONE
NONE
NONE
PC
PC
PC
PC
PC
SUPPORT FOR ARTIST
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PARTICIPATION AT
FOR EMERGING THEATER
9,000.
FOR EMERGING THEATER
FOR EMERGING VISUAL
FOR ARTISTS WORKING IN
25,000.
42,500.
1,500.
PELOFF, BETH
OBSATZ, KEVIN
PANGEA WORLD THEATER
PARTICIPANT INC
NONE
711 WEST LAKE STREET SUITE 101
253 EAST HOUSTON STREET, # 1
I MN FILM/VIDEO/DIGITALPROJECT
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
PC
PC
20,000.
65,000.
MN FILM/VIDEO/DIGITAL
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PROJECT
FOR EMERGING THEATER
FOR EMERGING VISUAL
25,000.
50,000.
44,000.
SAINT PAUL, MN 55101 AND LIBRETTISTS
NEW YORK, NY 10018 CONFERENCE
NEW YORK, NY 10036 ARTISTS
NEW YORK, NY 10003 ARTISTS
MINNEAPOLIS, MN 55406 ARTISTS
MINNEAPOLIS, MN 55408 NEW MEDIA
MINNEAPOLIS, MN 55408 ARTISTS
NEW YORK, NY 10002 ARTISTS
36 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ____________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient _________________________
PENUMBRA THEATRE N ONE P C S UP PORT FOR PROGRAMS
270 N KENT ST F OR EMERGING THEATER
SAINT PAUL, MN 55102 A RTISTS
PERFORMANCE SPACE NEW YORK N ONE P C SUPPORT FOR PROGRAMS
150 FIRST AVENUE F OR EMERGING ARTISTS
NEW YORK, NY 10009 IN DANCE
PETRUS, JUNAUDA N ONE I TRAVEL AND STUDY
PILLSBURY HOUSE THEATRE
3501 CHICAGO AVENUE SOUTH
MINNEAPOLIS, MN 55407
PLAYWRIGHTS ' CENTER
2301 E FRANKLIN AVE
MINNEAPOLIS, MN 55406
POETRY PROJECT
131 E. 10TH ST
NEW YORK, NY 10003
PRINTED MATTER
231 ELEVENTH AVENUE
NEW YORK, NY 10001
PUBLIC THEATER, THE
425 LAFAYETTE STREET
NEW YORK, NY 10003
QUEENS MUSEUM
NEW YORK CITY BUILDING, FLUSHING
MEADOWS CORONA PARK QUEENS , NY
11368
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
PORT FOR PROGRAMS
EMERGING WRITERS
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS
PORT FOR PROGRAMS
EMERGING THEATER
ISTS
PORT FOR PROGRAMS
EMERGING VISUAL
Amount
70,000.
50,000.
4,335.
50,000.
45,000.
25,000.
24,000.
60,000.
140,000.
RADIVOJEVIC, IVA FILM/VIDEO/DIGITAL
9,200.
723635 04-01-17
37
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
PENUMBRA THEATRE270 N KENT ST
70,000.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING THEATER
PERFORMANCE SPACE NEW YORK
PETRUS, JUNAUDA
PILLSBURY HOUSE THEATRE
PLAYWRIGHTS' CENTER
POETRY PROJECT
150 FIRST AVENUE
3501 CHICAGO AVENUE SOUTH
2301 E FRANKLIN AVE
131 E. 10TH ST
NONE
NONE
NONE
NONE
NONE
PC
I
PC
PC
PC
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
FOR EMERGING ARTISTS
PROJECT
50,000.
FOR EMERGING THEATER
FOR EMERGING THEATER
FOR EMERGING WRITERS
45,000.
4,335.
9,200.
QUEENS MUSEUM
RADIVOJEVIC, IVA
PRINTED MATTER
PUBLIC THEATER, THE
NEW YORK CITY BUILDING, FLUSHING
NONE
231 ELEVENTH AVENUE
425 LAFAYETTE STREET
MEADOWS CORONA PARK QUEENS , NY
I NY FILM/VIDEO/DIGITALPROJECT
NONE
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
PC
PC
PC
50,000.
25,000.
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
FOR EMERGING VISUAL
FOR EMERGING VISUAL
FOR EMERGING THEATER
ARTISTS
24,000.
60,000.
140,000.
SAINT PAUL, MN 55102 ARTISTS
NEW YORK, NY 10009 IN DANCE
MINNEAPOLIS, MN 55407 ARTISTS
MINNEAPOLIS, MN 55406 ARTISTS
NEW YORK, NY 10003
NEW YORK, NY 10001 ARTISTS
NEW YORK, NY 10003 ARTISTS
11368
37 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ______________________ ______________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
any foundation manager unt Name and address (home or status o o
business) f contribution Am
or substantial contributor recipient ____________________________ __________________
RAMASWAMY, ASHWINI N ONE I TRAVEL AND STUDY
P ROJECT
5 , 000.
REED, GLENDA
AND STUDY
4,856.
RHIZOME COMMUNICATIONS, INC
235 BOWERY
NEW YORK, NY 10002
ROCKMORE, RYAN
ROULETTE INTERMEDIUM
30 THIRD AVENUE SUITE 208
BROOKLYN, NY 11217
SAINT JOHN'S UNIVERSITY
2810 ABBEY PLAZA, PO BOX 6377
COLLEGEVILLE, MN 56321
SAINTONGE, STEFANI
SEALEY, NICOLE
PORT FOR PROGRAMS
ARTISTS WORKING IN
MEDIA 50,000.
VEL AND STUDY
3,100.
PORT FOR PROGRAMS
EMERGING COMPOSERS
_____________________ 140,000.
PORT FOR PROGRAMS
EMERGING VISUAL
ISTS 25,750.
VEL AND STUDY
4,520.
AND STUDY
3,660.
SHAH, KAVITA AND STUDY
5,000.
SHARKEY, ERIN AND STUDY
3,027.
� � � � � � � � �
723635 04-01-17
38
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
RAMASWAMY, ASHWINI
5,000.
NONE I TRAVEL AND STUDYPROJECT
REED, GLENDA
RHIZOME COMMUNICATIONS, INC
ROCKMORE, RYAN
ROULETTE INTERMEDIUM
SAINT JOHN'S UNIVERSITY
235 BOWERY
30 THIRD AVENUE SUITE 208
2810 ABBEY PLAZA, PO BOX 6377
NONE
NONE
NONE
NONE
NONE
I
PC
I
PC
PC
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PROJECT
FOR ARTISTS WORKING IN
4,856.
PROJECT
FOR EMERGING COMPOSERS
FOR EMERGING VISUAL
140,000.
50,000.
3,027.
SHARKEY, ERIN
SAINTONGE, STEFANI
SEALEY, NICOLE
SHAH, KAVITA
NONE I TRAVEL AND STUDYPROJECT
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
I
I
I
3,100.
25,750.
TRAVEL AND STUDY
TRAVEL AND STUDY
TRAVEL AND STUDY
PROJECT
PROJECT
PROJECT
4,520.
3,660.
5,000.
NEW YORK, NY 10002 NEW MEDIA
BROOKLYN, NY 11217
COLLEGEVILLE, MN 56321 ARTISTS
38 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ____________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient _________________________
SMACK MELLON STUDIOS N ONE P C SUPPORT FOR PROGRAMS
92 PLYMOUTH STREET F OR EMERGING VISUAL
BROOKLYN, NY 11201 A RTISTS
SMACK MELLON STUDIOS N ONE P C SUPPORT FOR PROGRAMS
92 PLYMOUTH STREET F OR EMERGING VISUAL
BROOKLYN, NY 11201 A RTISTS
SOCRATES SCULPTURE PARK N ONE P C SUPPORT FOR PROGRAMS
PO BOX 6259, 32-01 VERNON BOULEVARD F OR EMERGING VISUAL
LONG ISLAND CITY, NY 11106 A RTISTS
SOHO REPERTORY THEATRE N ONE P C SUPPORT FOR PROGRAMS
401 BROADWAY, SUITE 300 F OR EMERGING THEATER
NEW YORK, NY 10013 A RTISTS
SPRINGBOARD FOR THE ARTS N ONE P C GENERAL PROGRAM
308 PRINCE STREET, SUITE 270
SAINT PAUL, MN 55101
SPRINGBOARD FOR THE ARTS/MONKEYBEAR'S N ONE P C SUPPORT FOR PROGRAMS
HARMOLODIC WORKSHOP F OR EMERGING THEATER
308 E. PRINCE ST., STE. 270 A RTISTS
ST. PAUL, MN 55101
Amount
22,000.
25,000.
25,000.
70,000.
34,000.
30,000.
ST. CATHERINE UNIVERSITY/MOMENTUM
2004 RANDOLPH AVE
ST. PAUL, MN 55105
ST. PAUL NEIGHBORHOOD NETWORK
550 VANDALIA ST SUITE 170
SAINT PAUL, MN 55114
STREB INC.
51 NORTH 1ST STREET
BROOKLYN, NY 11249
STUDIO MUSEUM IN HARLEM
144 WEST 125TH STREET
NEW YORK, NY 10027
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE
PORT FOR PROGRAMS
EMERGING
MMAKERS
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE
PORT FOR PROGRAMS
EMERGING VISUAL
80,000.
60,000.
23,000.
19,000.
723635 04-01-17
39
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
SMACK MELLON STUDIOS92 PLYMOUTH STREET
22,000.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING VISUAL
SPRINGBOARD FOR THE ARTS/MONKEYBEAR'S
SMACK MELLON STUDIOS
SOCRATES SCULPTURE PARK
SOHO REPERTORY THEATRE
SPRINGBOARD FOR THE ARTS
HARMOLODIC WORKSHOP
92 PLYMOUTH STREET
PO BOX 6259, 32-01 VERNON BOULEVARD
401 BROADWAY, SUITE 300
308 PRINCE STREET, SUITE 270
308 E. PRINCE ST., STE. 270
NONE
NONE
NONE
NONE
NONE
PC
PC
PC
PC
PC
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
GENERAL PROGRAM
FOR EMERGING THEATER
FOR EMERGING VISUAL
FOR EMERGING VISUAL
25,000.
FOR EMERGING THEATER
ARTISTS
34,000.
25,000.
19,000.
STUDIO MUSEUM IN HARLEM144 WEST 125TH STREET
ST. CATHERINE UNIVERSITY/MOMENTUM
ST. PAUL NEIGHBORHOOD NETWORK
STREB INC.
NEW YORK, NY 10027
NONE
2004 RANDOLPH AVE
550 VANDALIA ST SUITE 170
51 NORTH 1ST STREET
PC SUPPORT FOR PROGRAMSFOR EMERGING VISUALARTISTS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
PC
PC
PC
70,000.
30,000.
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
FOR EMERGING ARTISTS
FOR EMERGING
FOR EMERGING ARTISTS
80,000.
60,000.
23,000.
BROOKLYN, NY 11201 ARTISTS
BROOKLYN, NY 11201 ARTISTS
LONG ISLAND CITY, NY 11106 ARTISTS
NEW YORK, NY 10013 ARTISTS
SAINT PAUL, MN 55101
ST. PAUL, MN 55101
ST. PAUL, MN 55105 IN DANCE
SAINT PAUL, MN 55114 FILMMAKERS
BROOKLYN, NY 11249 IN DANCE
39 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ _____________________
Recipient If recipient is an individual, ___________________________________________________ show any relationship to Foundation Purpose of grant or
Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient ___________________________
STUDIO MUSEUM IN HARLEM N ONE P C SUPPORT FOR PROGRAMS
144 WEST 125TH STREET F OR EMERGING VISUAL
NEW YORK, NY 10027 A RTISTS
STYLES, ALISI N ONE I M N FILM/VIDEO/DIGITAL
P ROJECT
Amount
25,000.
24,236.
TAVERA CASTRO, XAVIER
TEXTILE CENTER
3000 UNIVERSITY AVENUE
MINNEAPOLIS, MN 55414
THE KITCHEN/HALEAKALA, INC
512 WEST 19 STREET
NEW YORK, NY 10011
THEATER MU/MU PERFORMING ARTS
275 EAST FOURTH ST., SUITE 496
SAINT PAUL, MN 55101
TOFTE LAKE CENTER
2209 FERNBERG ROAD
ELY, MN 55731
VOCALESSENCE
1900 NICOLLET AVENUE
MINNEAPOLIS, MN 55403
VONGSAY, SAYMOUKDA
VSA MINNESOTA
528 HENNEPIN AVENUE SUITE 305
MINNEAPOLIS, MN 55403
AND STUDY
5,000.
PPORT FOR PROGRAMS
R EMERGING VISUAL
TISTS 54,000.
PPORT FOR PROGRAMS
R EMERGING ARTISTS
DANCE 26,000.
PPORT FOR PROGRAMS
R EMERGING THEATER
TISTS 27,000.
PPORT FOR RESEARCH
SIDENCIES FOR
ERGING ARTISTS 31,000.
PPORT FOR PROGRAMS
R EMERGING COMPOSERS
30,000.
AVEL AND STUDY
5,000.
PORT FOR PROGRAMS
EMERGING VISUAL
21,000.
723635 04-01-17
40
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
STUDIO MUSEUM IN HARLEM144 WEST 125TH STREET
25,000.
NONE PC SUPPORT FOR PROGRAMSFOR EMERGING VISUAL
STYLES, ALISI
TAVERA CASTRO, XAVIER
TEXTILE CENTER
THE KITCHEN/HALEAKALA, INC
THEATER MU/MU PERFORMING ARTS
3000 UNIVERSITY AVENUE
512 WEST 19 STREET
275 EAST FOURTH ST., SUITE 496
NONE
NONE
NONE
NONE
NONE
I
I
PC
PC
PC
MN FILM/VIDEO/DIGITAL
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PROJECT
PROJECT
24,236.
FOR EMERGING VISUAL
FOR EMERGING ARTISTS
FOR EMERGING THEATER
26,000.
5,000.
21,000.
VSA MINNESOTA528 HENNEPIN AVENUE SUITE 305
TOFTE LAKE CENTER
VOCALESSENCE
VONGSAY, SAYMOUKDA
MINNEAPOLIS, MN 55403
NONE
2209 FERNBERG ROAD
1900 NICOLLET AVENUE
PC SUPPORT FOR PROGRAMSFOR EMERGING VISUALARTISTS
JEROME FOUNDATION, INC. **-***5163
NONE
NONE
NONE
PC
PC
I
54,000.
27,000.
SUPPORT FOR RESEARCH
SUPPORT FOR PROGRAMS
TRAVEL AND STUDY
RESIDENCIES FOR
FOR EMERGING COMPOSERS
PROJECT
31,000.
30,000.
5,000.
NEW YORK, NY 10027 ARTISTS
MINNEAPOLIS, MN 55414 ARTISTS
NEW YORK, NY 10011 IN DANCE
SAINT PAUL, MN 55101 ARTISTS
ELY, MN 55731 EMERGING ARTISTS
MINNEAPOLIS, MN 55403
40 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC.
Part X V Supplementary Information 3 Grants and Contributions Approved for Future Payment (Continuation)
Recipient I If recipient is an individual, I ___________________________________________________ show any relationship to I Foundation
Name and address (home or business) any foundation manager I status of or substantial contributor I recipient
WILLIAMS, ROSEMARY
YANG, KAYVA
ZEITGEIST
275 EAST FOURTH STREET, STE 200
SAINT PAUL, MN 55101
ZEITGEIST
275 EAST FOURTH STREET, STE 200
SAINT PAUL, MN 55101
ZENON DANCE COMPANY
528 HENNEPIN AVENUE, #400
MINNEAPOLIS, MN 55403
**-***5163
Purpose of grant or contribution Amount
FILM/VIDEO/DIGITAL
JECT
_____________________ 13,000.
VEL AND STUDY
JECT
_____________________ 4,000.
PORT FOR PROGRAMS
EMERGING COMPOSERS
_____________________ 16,500.
PORT FOR PROGRAMS
EMERGING COMPOSERS
16,500.
PORT FOR PROGRAMS
EMERGING ARTISTS
DANCE 28,000.
723635 04-01-17
41
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
72363504-01-17
3
Total from continuation sheets
Grants and Contributions Approved for Future Payment (Continuation)
If recipient is an individual,show any relationship toany foundation manageror substantial contributor
RecipientFoundation
status ofrecipient
Purpose of grant orcontribution Amount
Name and address (home or business)
�����������������������������������������������
Part XV Supplementary Information
WILLIAMS, ROSEMARY
13,000.
NONE I MN FILM/VIDEO/DIGITALPROJECT
YANG, KAYVA
ZEITGEIST
ZEITGEIST
ZENON DANCE COMPANY
275 EAST FOURTH STREET, STE 200
275 EAST FOURTH STREET, STE 200
528 HENNEPIN AVENUE, #400
NONE
NONE
NONE
NONE
I
PC
PC
PC
TRAVEL AND STUDY
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
SUPPORT FOR PROGRAMS
PROJECT
FOR EMERGING COMPOSERS
4,000.
FOR EMERGING COMPOSERS
FOR EMERGING ARTISTS28,000.
16,500.
JEROME FOUNDATION, INC. **-***5163
16,500.
SAINT PAUL, MN 55101
SAINT PAUL, MN 55101
MINNEAPOLIS, MN 55403 IN DANCE
41 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Schedule B (Form 990, 990-EZ, or 990-PF) Department of the Treasury Internal Revenue Service
Schedule of Contributors | Attach to Form 990, Form 990-EZ, or Form 990-PF.
| Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2017 Name of the organization Employer identification number
JEROME FOUNDATION, INC. **-***5163 Organization type (check one):
Filers of: Section:
Form 990 or 990-EZ
Form 990-PF
501 (c)( ) (enter number) organization
4947(a)(1) nonexempt charitable trust not treated as a private foundation
527 political organization
X 501 (c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501 (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)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
X For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.
Special Rules
For an organization described in section 501 (c)(3) filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under
sections 509(a)(1) and 1 70(b)(1 )(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 1 6a, or 1 6b, and that received from
any one contributor, during the year, total contributions of the greater of (1) $5,000; or (2) 2% of the amount on (i) Form 990, Part VIII, line 1 h;
or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For an organization described in section 501 (c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the
year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for
the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For an organization described in section 501 (c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the
year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled 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. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively
religious, charitable, etc., contributions totaling $5,000 or more during the year ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ | $ _______________
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990, 990-EZ, or 990-PF),
but it must answer No on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on its Form 990-PF, Part I, line 2, to
certify that it doesn't meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
LHA For Paperwork Reduction Act Notice, see the instructions for Form 990, 990-EZ, or 990-PF. Schedule B (Form 990, 990-EZ, or 990-PF) (2017)
723451 11-01-17
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
723451 11-01-17
Schedule B (Form 990, 990-EZ, or 990-PF) (2017)
(Form 990, 990-EZ,or 990-PF)
| Attach to Form 990, Form 990-EZ, or Form 990-PF.| Go to www.irs.gov/Form990 for the latest information.
Name of the organization Employer identification number
Organization type
Filers of: Section:
not
General Rule Special Rule.
Note:
General Rule
Special Rules
(1) (2)
General Rule
Caution:
must
For Paperwork Reduction Act Notice, see the instructions for Form 990, 990-EZ, or 990-PF.
exclusively
exclusively
exclusively
nonexclusively
(check one):
Form 990 or 990-EZ 501(c)( ) (enter number) organization
4947(a)(1) nonexempt charitable trust treated as a private foundation
527 political organization
Form 990-PF 501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501(c)(3) taxable private foundation
Check if your organization is covered by the or a
Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.
For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under
sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from
any one contributor, during the year, total contributions of the greater of $5,000; or 2% of the amount on (i) Form 990, Part VIII, line 1h;
or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the
year, total contributions of more than $1,000 for religious, charitable, scientific, literary, or educational purposes, or for
the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the
year, contributions for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box
is checked, enter here the total contributions that were received during the year for an religious, charitable, etc.,
purpose. Don't complete any of the parts unless the applies to this organization because it received
religious, charitable, etc., contributions totaling $5,000 or more during the year ~~~~~~~~~~~~~~~ | $
An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990, 990-EZ, or 990-PF),
but it answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on its Form 990-PF, Part I, line 2, to
certify that it doesn't meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
LHA
Schedule B Schedule of Contributors
2017
JEROME FOUNDATION, INC. **-***5163
X
X
Schedule B (Form 990, 990-EZ, or 990-PF) (2017) Page 2 Name of organization Employer identification number
JEROME FOUNDATION, INC. **-***5163
(a) (b) (c) (d) No. Name, address, and ZIP + 4 Total contributions Type of contribution
1 HRK FOUNDATION Person X 1200 LANDMARK TOWER, 345 ST PETER Payroll STREET $ 15, 000. Noncash
(Complete Part II for ST. PAUL, MN 55102 noncash contributions.)
(a) (b) (c) (d) No. Name, address, and ZIP + 4 Total contributions Type of contribution
Person Payroll
$ Noncash
(Complete Part II for noncash contributions.)
(c) Total contributions
$
(c) Total contributions
$
(c) Total contributions
$
(d) p e of contribution
Person Payroll Noncash
(Complete Part II for noncash contributions.)
(d) p e of contribution
Person Payroll Noncash
(Complete Part II for noncash contributions.)
(d) p e of contribution
Person Payroll Noncash
(Complete Part II for noncash contributions.)
(a) (b) No. e ss, and ZIP + 4
(a) (b) No. e ss, and ZIP + 4
(a) (b) No. e ss, and ZIP + 4
(a) No.
723452 11-01-17
10070813 144198 64692
(b) (c) (d) e ss, and ZIP + 4 Total contributions Type of contribution
_______________________________ Person Payroll
______________________________ $ ____________________ Noncash
(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2017) 43
2017.04010 JEROME FOUNDATION, INC. 64692__1
723452 11-01-17
Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2017)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
Schedule B (Form 990, 990-EZ, or 990-PF) (2017) Page
(see instructions). Use duplicate copies of Part I if additional space is needed.
$
(Complete Part II fornoncash contributions.)
$
(Complete Part II fornoncash contributions.)
$
(Complete Part II fornoncash contributions.)
$
(Complete Part II fornoncash contributions.)
$
(Complete Part II fornoncash contributions.)
$
(Complete Part II fornoncash contributions.)
2
Part I Contributors
1 X
15,000.
HRK FOUNDATION
STREET1200 LANDMARK TOWER, 345 ST PETER
ST. PAUL, MN 55102
JEROME FOUNDATION, INC. **-***5163
43 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Schedule B (Form 990, 990-EZ, or 990-PF) (2017) Page 3 Name of organization Employer identification number
JEROME FOUNDATION, INC. **-***5163
(a) I I ( c )
No. (b) I (d) I FMV (or estimate) I from I Description of noncash property given Date received
(See instructions.) Part I
(a) No.
from Part I
(b) Description of noncash property given
$ _______________________ _______________
(c) (d)
FMV (or estimate) Date received
(See instructions.)
(a) No.
from Part I
(b) Description of noncash property given
$ _______________________ _______________
(c) (d)
FMV (or estimate) Date received
(See instructions.)
(a) No.
from Part I
(b) Description of noncash property given
$ _______________________ _______________
(c) (d)
FMV (or estimate) Date received
(See instructions.)
(a) No.
from Part I
(b) Description of noncash property given
$ _______________________ _______________
(c) (d)
FMV (or estimate) Date received
(See instructions.)
(a) No.
from Part I
(b) Description of noncash property given
$ _______________________ _______________
(c) (d)
FMV (or estimate) Date received
(See instructions.)
I $ I 723453 11-01-17 Schedule B (Form 990, 990-EZ, or 990-PF) (2017)
44 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
723453 11-01-17
Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2017)
(a)
No.
from
Part I
(c)
FMV (or estimate)
(See instructions.)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(See instructions.)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(See instructions.)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(See instructions.)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(See instructions.)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(See instructions.)
(b)
Description of noncash property given
(d)
Date received
Schedule B (Form 990, 990-EZ, or 990-PF) (2017) Page
(see instructions). Use duplicate copies of Part II if additional space is needed.
$
$
$
$
$
$
3
Part II Noncash Property
JEROME FOUNDATION, INC. **-***5163
44 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Schedule B (Form 990, 990-EZ, or 990-PF) (2017) 4
Name of organization Employer identification number
JEROME FOUNDATION, INC. **-***5163 Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for
the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enterthis info. once.) |$
Use duplicate copies of Part III if additional space is needed. (a) No. f rom (b) Purpose of gift (c) Use of gift (d) Description of how gift is held P t I
(e) Transfer of gift
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 of transferor to transferee
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 of transferor to transferee
723454 11-01-17 Schedule B (Form 990, 990-EZ, or 990-PF) (2017) 45
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
(Enter this info. once.)
For organizations
completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year.
723454 11-01-17
Name of organization Employer identification number
religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 forthe year from any one contributor. (a) (e) and
Schedule B (Form 990, 990-EZ, or 990-PF) (2017)
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(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 (d) Description of how gift is held
(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 (d) Description of how gift is held
(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 (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
Complete columns through the following line entry.
Schedule B (Form 990, 990-EZ, or 990-PF) (2017) Page
| $
Use duplicate copies of Part III if additional space is needed.
Exclusively
4
Part IIIJEROME FOUNDATION, INC. **-***5163
45 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
Form 2220 I Underpayment of Estimated Tax by Corporations Department of the Treasury I | Attach to the corporation's tax return. FORM 99 0- PF Internal Revenue Service | Go to www.irs.gov/Form2220 for instructions and the latest information. Name
JEROME FOUNDATION, INC.
OMB No. 1545-0123
2017
Employer identification number **-***5163
Note: Generally, the corporation isn't required to file Form 2220 (see Part II below for exceptions) because the IRS will figure any penalty owed and bill the corporation. However, the corporation may still use Form 2220 to figure the penalty. If so, enter the amount from page 2, line 38 on the estimated tax penalty line of the corporation's income tax return, but do not attach Form 2220.
Part I I Required Annual Payment
173, 828.
173, 828.
126, 351.
126, 351.
1 Total tax (see instructions) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 1
2 a Personal holding company tax (Schedule PH (Form 1120), line 26) included on line 1 ~ ~ ~ ~ ~ ~ 2 a
b Look-back interest included on line 1 under section 460(b)(2) for completed long-term contracts or section 167(g) for depreciation under the income forecast method ~ ~ ~ ~ ~ ~ ~ ~ ~ 2 b
c Credit for federal tax paid on fuels (see instructions) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 2 c
d Total. Add lines 2a through 2c 2d 3 Subtract line 2d from line 1. If the result is less than $500, do not complete or file this form. The corporation
doesn't owe the penalty ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 3
4 Enter the tax shown on the corporation's 2016 income tax return. See instructions. Caution: If the tax is zero
or the tax year was for less than 12 months, skip this line and enter the amount from line 3 on line 5 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 4
5 Required annual payment. Enter the smaller of line 3 or line 4. If the corporation is required to skip line 4, enter the amount from line 3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5
Part II I Reasons for Filing - Check the boxes below that apply. If any boxes are checked, the corporation must file Form 2220
even if it doesn't owe a penalty. See instructions. 6 The corporation is using the adjusted seasonal installment method. 7 X The corporation is using the annualized income installment method. 8 X The corporation is a large corporation figuring its first required installment based on the prior year's tax. Part III I Figuring the Underpayment
9 Installment due dates. Enter in columns (a) through (d) the 15th day of the 4th (Form 990-PF filers: U s e 5 t h m o n t h ) , 6 t h , 9 t h , a n d 1 2 t h m o n t h s o f t h e c o r p o r a t i o n ' s t a x y e a r ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 9 09/15/17 10/15/17 01/15/18 04/15/18
10 Required installments. If the box on line 6 and/or line 7
above is checked, enter the amounts from Sch A, line 38. If the box on line 8 (but not 6 or 7) is checked, see instructions for the amounts to enter. If none of these boxes are checked, enter 25% (0.25) of line 5 above in each column ~ ~ ~ ~ 10 29, 271 .
___________________ ____________ ___________________
11 Estimated tax paid or credited for each period. For column (a) only, enter the amount from line 11 on line 15. See instructions ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 11 32, 500 .
____________________ _____________ _____________________
Complete lines 12 through 18 of one column
before going to the next column. 12 Enter amount, if any, from line 18 of the preceding column 12 ____________________ ____________________ _____________ _____________________
13 Addlines 11and 12 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 13 _______________ _______________ __________ ________________
14 Add amounts on lines 16 and 17 of the preceding column 14 ___________________ ___________________ ____________ ___________________
15 Subtract line 14 from line 13. If zero or less, enter -0- ~ ~ 15 32, 500 .___________________ ____________ ___________________
16 If the amount on line 15 is zero, subtract line 13 from line 14. Otherwise, enter-0- ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 16 ____________________ ____________________ _____________ _____________________
17 Underpayment. If line 15 is less than or equal to line 10, subtract line 15 from line 10. Then go to line 12 of the next column. Otherwise, go to line 18 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 17 ____________________ ____________________ _____________ _____________________
18 Overpayment. If line 10 is less than line 15, subtract line 10
from line 15. Then go to line 12 of the next column � � � 18 3, 229 .___________________ ____________ ___________________
Go to Part IV on page 2 to figure the penalty. Do not g o to Part IV if there are no entries on line 17- no ____________________________________
LHA For Paperwork Reduction Act Notice, see separate instructions.
712801 02-07-18
46 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
31, 928. -
18,474. 94,155.
10, 000. -
60, 000. 79, 651.
3,229. - ________
22, 827. 13,229.
- 60, 000. 102,478. 18, 699.
____________
13,229. 41, 301. 102,478.
0. 0. ____________
18, 699. -
22, 827. ____________
penalty is owed. Form 2220 (2017)
OMB No. 1545-0123
Department of the TreasuryInternal Revenue Service
712801 02-07-18
| Attach to the corporation's tax return.
| Go to www.irs.gov/Form2220 for instructions and the latest information.
Employer identification number
1
2
3
4
5
1
2d
3
4
5
a
b
c
d
2a
2b
2c
Total.
do not
Caution: If the tax is zero
or the tax year was for less than 12 months, skip this line and enter the amount from line 3 on line 5
Required annual payment. smaller
must
6
7
8
(a) (b) (c) (d)
9
10
11
12
13
14
15
16
17
18
Installment due dates. (Form 990-PF filers:
9
10
11
12
13
14
15
16
17
18
Required installments.
Complete lines 12 through 18 of one column
before going to the next column.
Underpayment.
Overpayment.
Go to Part IV on page 2 to figure the penalty. Do not go to Part IV if there are no entries on line 17 - no penalty is owed.
For Paperwork Reduction Act Notice, see separate instructions. 2220
Note:
do not
Form
Name
Total tax (see instructions)
Personal holding company tax (Schedule PH (Form 1120), line 26) included on line 1
Look-back interest included on line 1 under section 460(b)(2) for completed long-term
contracts or section 167(g) for depreciation under the income forecast method
Credit for federal tax paid on fuels (see instructions)
Add lines 2a through 2c
Subtract line 2d from line 1. If the result is less than $500, complete or file this form. The corporation
doesn't owe the penalty
Enter the tax shown on the corporation's 2016 income tax return. See instructions.
Enter the of line 3 or line 4. If the corporation is required to skip line 4,
enter the amount from line 3 ���������������������������������������������
Check the boxes below that apply. If any boxes are checked, the corporation file Form 2220even if it doesn't owe a penalty. See instructions.
The corporation is using the adjusted seasonal installment method.
The corporation is using the annualized income installment method.
The corporation is a "large corporation" figuring its first required installment based on the prior year's tax.
Enter in columns (a) through(d) the 15th day of the 4th Use 5th month), 6th, 9th, and 12th months of thecorporation's tax year ~~~~~~~~~~~~~~~~
If the box on line 6 and/or line 7
above is checked, enter the amounts from Sch A, line 38. If
the box on line 8 (but not 6 or 7) is checked, see instructions
for the amounts to enter. If none of these boxes are checked,
enter 25% (0.25) of line 5 above in each column
Estimated tax paid or credited for each period. For
column (a) only, enter the amount from line 11 on line 15.
See instructions
Enter amount, if any, from line 18 of the preceding column
Add lines 11 and 12
Add amounts on lines 16 and 17 of the preceding column
Subtract line 14 from line 13. If zero or less, enter -0-
If the amount on line 15 is zero, subtract line 13 from line
14. Otherwise, enter -0-
If line 15 is less than or equal to line 10,
subtract line 15 from line 10. Then go to line 12 of the next
column. Otherwise, go to line 18
If line 10 is less than line 15, subtract line 10
from line 15. Then go to line 12 of the next column ���
Form (2017)
Generally, the corporation isn't required to file Form 2220 (see Part II below for exceptions) because the IRS will figure any penalty owed andbill the corporation. However, the corporation may still use Form 2220 to figure the penalty. If so, enter the amount from page 2, line 38 on theestimated tax penalty line of the corporation's income tax return, but attach Form 2220.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~
~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~
~~~~
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~
~~
~~~~~~~~~~~~~~~
~~~~~~~~~~~
LHA
Part I Required Annual Payment
Reasons for Filing - Part II
Part III Figuring the Underpayment
Underpayment of Estimated Tax by Corporations2220
2017
JEROME FOUNDATION, INC. **-***5163
173,828.
173,828.
29,271. 94,155.18,474.31,928.
32,500. 10,000. 60,000. 79,651.
3,229. 22,827.13,229. 60,000. 102,478.
18,699.32,500. 13,229. 41,301. 102,478.
0. 0.
18,699.
3,229. 22,827.
126,351.
126,351.
FORM 990-PF
XX
09/15/17 10/15/17 01/15/18 04/15/18
46 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
FORM 990-PF Form2220(2017) JEROME FOUNDATION, INC. **-***5163 Page 2
I Part IV I Figuring the Penalty
19 Enter the date of payment or the 15th day of the 4th month after the close of the tax year, whichever is earlier. (C Corporations with tax years ending June 30
and S corporations: Use 3rd month instead of 4th month. Form 990-PF and Form 990-T filers: Use 5th month instead of 4th month.) See instructions ~ ~ ~ ~ ~ ~ ~ ~ 19
20 Number of days from due date of installment on line 9 to the
date shown on line 19 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 20
21 Number of days on line 20 after 4/15/2017 and before 7/1/2017 ~ ~ 21
22 Underpayment on line 17 x Number of days on line 21 x 4% (0.04) ~ 22 365
23 Number of days on line 20 after 06/30/2017 and before 10/1/2017 ~ 23
24 Underpayment on line 17 x Number of days on line 23 x 4% (0.04) 365
25 Number of days on line 20 after 9/30/2017 and before 1/1/2018
26 Underpayment on line 17 x Number of days on line 25 x 4% (0.04) 365
27 Number of days on line 20 after 12/31/2017 and before 4/1/2018
28 Underpayment on line 17 x Number of days on line 27 x 4% (0.04) 365
29 Number of days on line 20 after 3/31/2018 and before 7/1/2018
30 Underpayment on line 17 x Number of days on line 29 x *% 365
31 Number of days on line 20 after 6/30/2018 and before 10/1/2018
32 Underpayment on line 17 x Number of days on line 31 x *% 365
33 Number of days on line 20 after 9/30/2018 and before 1/1/2019
34 Underpayment on line 17 x Number of days on line 33 x *% ~ 365
35 Number of days on line 20 after 12/31/2018 and before 3/16/2019
~ 24
~ ~ 25
~ 26
~ 27
~ 28
~ ~ 29
~ ~ 30
~ 31
~ ~ 32
~ ~ 33
~ ~ 34
35
SEE ATTACHED WORKSHEET
36 Underpayment on line 17 x Number of days on line 35 x *% ~ ~ ~ 36 $ $ $ 365
37 Add lines 22, 24, 26, 28, 30, 32, 34, and 36 ~ ~ ~ ~ ~ ~ ~ ~ ~ 37 $ $ $
38 Penalty. Add columns (a) through (d) of line 37. Enter the total here and on Form 1120, line 33;
or the comparable line for other income tax returns � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � * Use the penalty interest rate for each calendar quarter, which the IRS will determine during the first month in the preceding quarter. These rates are published quarterly in an IRS News Release and in a revenue ruling in the Internal Revenue Bulletin. To obtain this information on the Internet, access the IRS website at www.irs.gov. You can also call 1-800-829-4933 to get interest rate information.
189.
Form 2220 (2017)
712802 02-07-18
47 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692 _ _1
Number of days from due date of installment on line 9 to the
date shown on line 19
Number of days on line 20 after 4/15/2017 and before 7/1/2017
Underpayment on line 17 x Number of days on line 21 x 4% (0.04)365
Number of days on line 20 after 06/30/2017 and before 10/1/2017
Underpayment on line 17 x Number of days on line 23 x 4% (0.04)
365
Number of days on line 20 after 9/30/2017 and before 1/1/2018
Underpayment on line 17 x Number of days on line 25 x 4% (0.04)
365
Number of days on line 20 after 12/31/2017 and before 4/1/2018
Underpayment on line 17 x Number of days on line 27 x 4% (0.04)
365
Number of days on line 20 after 3/31/2018 and before 7/1/2018
Underpayment on line 17 x Number of days on line 29 x *%
365
Number of days on line 20 after 6/30/2018 and before 10/1/2018
Underpayment on line 17 x Number of days on line 31 x *%
365
Number of days on line 20 after 9/30/2018 and before 1/1/2019
Underpayment on line 17 x Number of days on line 33 x *%
365
Number of days on line 20 after 12/31/2018 and before 3/16/2019
Underpayment on line 17 x Number of days on line 35 x *%
365
Add lines 22, 24, 26, 28, 30, 32, 34, and 36
712802 02-07-18
(a) (b) (c) (d)
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
(C Corporations with tax years ending June 30and S corporations: Form 990-PF and Form 990-T filers:
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
Penalty.
38
www.irs.gov.
2220
Form 2220 (2017) Page
Enter the date of payment or the 15th day of the 4th monthafter the close of the tax year, whichever is earlier.
Use 3rd month instead of 4th month.Use 5th month
instead of 4th month.) See instructions
~~~~~~~~~~~~~~~~~
~~
~ $
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
~
~
~~
~
~
~
~~
~~~
~
~~~
~~
~~~
~
~~~
~~~~~~~~~
Add columns (a) through (d) of line 37. Enter the total here and on Form 1120, line 33;
or the comparable line for other income tax returns ������������������������������������
* Use the penalty interest rate for each calendar quarter, which the IRS will determine during the first month in the preceding quarter.These rates are published quarterly in an IRS News Release and in a revenue ruling in the Internal Revenue Bulletin. To obtain thisinformation on the Internet, access the IRS website at You can also call 1-800-829-4933 to get interest rate information.
Form (2017)
~~~~~~~~
2
Part IV Figuring the Penalty
SEE ATTACHED WORKSHEET
189.
**-***5163JEROME FOUNDATION, INC.FORM 990-PF
47 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163 Form 2220(2017) FORM 990- PF Page 3
Schedule A Adjusted Seasonal Installment Method and Annualized Income Installment Method See instructions.
Form 1 120S filers: For lines 1, 2, 3, and 21, below, taxable income refers to excess net passive income or the amount on which tax is imposed under section 1374 (a), whichever applies.
Part I Adjusted Seasonal Installment Method Caution: Use this method only if the base period percentage for any 6 consecutive months is at least 70%. See instructions.
Enter taxable income for the following periods.
a Taxyear beginning in 2014 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 1 a
b Taxyear beginning in 2015 ~~~~~~~~~~~~ 1 b
c Tax year beginning in 2016 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 2 Enter taxable income for each period for the tax year beginning in
2017. See the instructions for the treatment of extraordinary items
3 Enter taxable income for the following periods.
a Tax year beginning in 2014 ~ ~ ~ ~ ~ ~ ~ ~ ~
b Tax year beginning in 2015 ~ ~ ~ ~ ~ ~ ~ ~ ~
c Tax year beginning in 2016 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 4 Divide the amount in each column on line 1a by the
amount in column (d) on line 3a ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 5 Divide the amount in each column on line 1b by the
amount in column (d) on line 3b ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 6 Divide the amount in each column on line 1c by the
amount in column (d) on line 3c ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
7 Add lines 4 through 6 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
8 Divide line 7 by 3.0 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 9a Divide line 2 by line 8 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 9a
b Extraordinary items (see instructions) ~ ~ ~ ~ ~ ~ ~ ~ 9b
c Add lines 9a and 9b ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 9c 10 Figure the tax on the amt on ln 9c using the instr for Form
1120, Sch J, line 2 or comparable line of corp's return ~ 10 11 a Divide the amount in columns (a) through (c) on line 3a
by the amount in column (d) on line 3a ~ ~ ~ ~ ~ ~ ~ 11a
b Divide the amount in columns (a) through (c) on line 3b
by the amount in column (d) on line 3b ~ ~ ~ ~ ~ ~ ~ 11b
c Divide the amount in columns (a) through (c) on line 3c
by the amount in column (d) on line 3c ~ ~ ~ ~ ~ ~ ~ 11c 12 Add lines 11a though 11c ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 12 13 Divide line 12 by 3.0 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 13 14 Multiply the amount in columns (a) through (c) of line 10
by columns (a) through (c) of line 13. In column (d), enter
the amount from line 10, column (d) ~ ~ ~ ~ ~ ~ ~ ~ 15 Enter any alternative minimum tax for each payment
period. See instructions ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
16 Enter any other taxes for each payment period. See instr. 17 Add lines 14 through 16 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 18 For each period, enter the same type of credits as allowed
on Form 2220, lines 1 and 2c. See instructions ~ ~ ~ ~ 19 Total tax after credits. Subtract line 18 from line 17. If
zero or less, enter -0- ............................................. 712821 02-07-18
First 4 months First 6 months First 9 months Entire year
17
18
19
Form 2220 (2017) 48
10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692 _ _1
Enter taxable income for each period for the tax year beginning in
2017. See the instructions for the treatment of extraordinary items
712821 02-07-18
3
Form 1120S filers:
(a) (b) (c) (d)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
a
b
c
a
b
c
a
b
c
a
b
c
1a
1b
1c
2
3a
3b
3c
4
5
6
7
8
9a
9b
9c
10
11a
11b
11c
12
13
14
15
16
17
18
19
2220
For lines 1, 2, 3, and 21, below, "taxable income" refers to excess net passive income or the amount on which tax isimposed under section 1374(a), whichever applies.
Form 2220 (2017) Page
See instructions.
Enter taxable income for the following periods.
Tax year beginning in 2014
Tax year beginning in 2015
Tax year beginning in 2016
First 3 months First 5 months First 8 months First 11 months
~~~~~~~~~~~~
~~~~~~~~~~~~
~~~~~~~~~~~~
First 4 months First 6 months First 9 months Entire yearEnter taxable income for the following periods.
Tax year beginning in 2014
Tax year beginning in 2015
Tax year beginning in 2016
~~~~~~~~~~~~
~~~~~~~~~~~~
~~~~~~~~~~~~
Divide the amount in each column on line 1a by the
amount in column (d) on line 3a
Divide the amount in each column on line 1b by the
amount in column (d) on line 3b
Divide the amount in each column on line 1c by the
amount in column (d) on line 3c
~~~~~~~~~~
~~~~~~~~~~
~~~~~~~~~~
Add lines 4 through 6
Divide line 7 by 3.0
Divide line 2 by line 8
Extraordinary items (see instructions)
Add lines 9a and 9b
Figure the tax on the amt on ln 9c using the instr for Form
1120, Sch J, line 2 or comparable line of corp's return
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~
~~~~~~~~
~~~~~~~~~~~~~~~
~
Divide the amount in columns (a) through (c) on line 3a
by the amount in column (d) on line 3a
Divide the amount in columns (a) through (c) on line 3b
by the amount in column (d) on line 3b
Divide the amount in columns (a) through (c) on line 3c
by the amount in column (d) on line 3c
Add lines 11a though 11c
~~~~~~~
~~~~~~~
~~~~~~~
~~~~~~~~~~~~~
Divide line 12 by 3.0
Multiply the amount in columns (a) through (c) of line 10
by columns (a) through (c) of line 13. In column (d), enter
the amount from line 10, column (d)
Enter any alternative minimum tax for each payment
period. See instructions
Enter any other taxes for each payment period. See instr.
Add lines 14 through 16
~~~~~~~~~~~~~~~
~~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
For each period, enter the same type of credits as allowed
on Form 2220, lines 1 and 2c. See instructions
Total tax after credits. Subtract line 18 from line 17. If
zero or less, enter -0-
~~~~
���������������
Form (2017)
Use this method only if the base period percentage for any 6 consecutive months is at least 70%.See instructions.
Schedule A Adjusted Seasonal Installment Method and Annualized Income Installment Method
Part I Adjusted Seasonal Installment MethodCaution:
FORM 990-PF**-***5163JEROME FOUNDATION, INC.
48 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
25%
29,271.
1st
installment
29,271.
29,271.
31,588.
31,588.
50%
61,199.
2nd
installment
61,199.
29,271.
31, 928.
55, 326.
2, 317.
57, 643.
75%
79, 673.
3rd
installment
79, 673.
61,199.
18,474.
43,457.
25,715.
69,172.
100%
222, 628.
4th
installment
222, 628.
79, 673.
142, 955.
43,457.
50, 698.
94,155.
JEROME FOUNDATION, INC. **-***5163 Form 2220(2017) FORM 990- PF Page 4
** I Part II I Annualized Income Installment Method
(a) (b) (c) (d)
First 2 First 3 First 6 First 9 20 Annualization periods (see instructions) ~ ~ ~ ~ ~ ~ ~ 21 Enter taxable income for each annualization period. See
instructions for the treatment of extraordinary items ~ ~
22 Annualization amounts (see instructions) ~ ~ ~ ~ ~ ~ 22
23a Annualized taxable income. Multiply line 21 by line 22 ~ 23a
b Extraordinary items (see instructions) ~ ~ ~ ~ ~ ~ ~ ~ 23b
c Add lines 23a and 23b ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 23c 24 Figure the tax on the amount on line 23c using the
instructions for Form 1120, Schedule J, line 2,
or comparable line of corporation's return ~ ~ ~ ~ ~ ~ 24
25 Enter any alternative minimum tax for each payment
period (see instructions) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 25
26 Enter any other taxes for each payment period. See instr. 26
27 Total tax. Add lines 24 through 26 ~ ~ ~ ~ ~ ~ ~ ~ ~ 27
28 For each period, enter the same type of credits as allowed
on Form 2220, lines 1 and 2c. See instructions ~ ~ ~ ~ 28
29 Total tax after credits. Subtract line 28 from line 27. If
zero or less, enter -0- ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 29
975,710. 1,529, 975. 2, 655,776. 8, 348,571.
6. 000000 4. 000000 2. 000000 1. 333330
5, 854,260. 6,119, 900. 5, 311,552. 11,131,400.
5, 854,260. 6,119, 900. 5, 311,552. 11,131,400.
117, 085. 122, 398. 106,231. 222, 628.
117, 085. 122, 398. 106,231. 222, 628.
117, 085. 122, 398. 106,231. 222, 628.
30 Applicable percentage ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 30
31 Multiply line 29 by line 30 � � � � � � � � � � � � � 31
I Part III Required Installments
Note: Complete lines 32 through 38 of one column
before completing the next column. 32 If only Part I or Part II is completed, enter the amount in
each column from line 19 or line 31. If both parts are
completed, enter the smaller of the amounts in each
column from line 19 or line 31 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 32
33 Add the amounts in all preceding columns of line 38.
See instructions ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 33
34 Adjusted seasonal or annualized income installments. Subtract line 33 from line 32. If zero or less, enter -0- ~ 34
35 Enter 25% (0.25) of line 5 on page 1 of Form 2220 in
each column. Note: "Large corporations, " see the
instructions for line 10 for the amounts to enter ~ ~ ~ ~ 35
36 Subtract line 38 of the preceding column from line 37 of
the preceding column ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 36
37 Add lines 35 and 36 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 37
38 Required installments. Enter the smaller of line 34 or
line 37 here and on page 1 of Form 2220, line 10.
Seeinstructions � � � � � � � � � � � � � � � � � 38 I 29,271. 31, 928. 18,474. 94,155. Form 2220 (2017)
** ANNUALIZED INCOME INSTALLMENT METHOD USING STANDARD OPTION
712822 02-07-18
49 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
712822 02-07-18
4
(a) (b) (c) (d)
20
21
22
23
24
25
26
27
28
29
30
31
20
21
22
23a
23b
23c
24
25
26
27
28
29
30
31
a
b
c
Note:
32
33
34
35
36
37
38
smaller
Adjusted seasonal or annualized income installments.
32
33
34
35
36
37
38
Note:
Required installments. smaller
2220
Form 2220 (2017) Page
First
months
First
months
First
months
First
monthsAnnualization periods (see instructions)
Enter taxable income for each annualization period. See
instructions for the treatment of extraordinary items
Annualization amounts (see instructions)
Annualized taxable income. Multiply line 21 by line 22
Extraordinary items (see instructions)
Add lines 23a and 23b
~~~~~~~
~~
~~~~~~
~
~~~~~~~~
~~~~~~~~~~~~~~
Figure the tax on the amount on line 23c using the
instructions for Form 1120, Schedule J, line 2,
or comparable line of corporation's return
Enter any alternative minimum tax for each payment
period (see instructions)
Enter any other taxes for each payment period. See instr.
Total tax. Add lines 24 through 26
~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~
For each period, enter the same type of credits as allowed
on Form 2220, lines 1 and 2c. See instructions
Total tax after credits. Subtract line 28 from line 27. If
zero or less, enter -0-
Applicable percentage
~~~~
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~ 25% 50% 75% 100%
Multiply line 29 by line 30 �������������
Complete lines 32 through 38 of one column
before completing the next column.
1st
installment
2nd
installment
3rd
installment
4th
installment
If only Part I or Part II is completed, enter the amount in
each column from line 19 or line 31. If both parts are
completed, enter the of the amounts in each
column from line 19 or line 31
Add the amounts in all preceding columns of line 38.
See instructions
Subtract line 33 from line 32. If zero or less, enter -0-
~~~~~~~~~~~
~~~~~~~~~~~~~~~~~
~
Enter 25% (0.25) of line 5 on page 1 of Form 2220 in
each column. "Large corporations," see the
instructions for line 10 for the amounts to enter ~~~~
Subtract line 38 of the preceding column from line 37 of
the preceding column
Add lines 35 and 36
Enter the of line 34 or
line 37 here and on page 1 of Form 2220, line 10.
See instructions
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~
�����������������
Form (2017)
Part II Annualized Income Installment Method
Part III Required Installments
1,529,975. 2,655,776. 8,348,571.
6.000000 4.000000 2.000000
117,085. 122,398. 106,231. 222,628.
5,854,260.
61,199. 79,673. 222,628.
6,119,900.
29,271. 61,199. 79,673.
5,311,552.11,131,400.
31,928. 18,474. 142,955.
29,271. 61,199.
**
79,673.
FORM 990-PF
222,628.
117,085. 122,398. 106,231.
1.333330
117,085. 122,398. 106,231.
222,628.
222,628.
29,271.
29,271.
31,588. 55,326. 43,457. 43,457.
2,317. 25,715. 50,698.
31,588. 57,643. 69,172. 94,155.
29,271. 31,928. 18,474. 94,155.
**-***5163JEROME FOUNDATION, INC.
** ANNUALIZED INCOME INSTALLMENT METHOD USING STANDARD OPTION
975,710.
2 3 6 9
5,854,260. 6,119,900. 5,311,552.11,131,400.
49 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
FORM 990-PF UNDERPAYMENT OF ESTIMATED TAX WORKSHEET
Name(s) Identifying Number
JEROME FOUNDATION, INC. ____________ **-***5163 (A) (B) (C) (D) (E) (F)
Adjusted Number Days Daily *Date Amount Balance Due Balance Due Penalty Rate Penalty
__________________________________________ -0- ________________________ ________________________ ________________________
09/15/17 29,271. 29,271. _____________ ______________ ______________
09/15/17 -32,500. -3,229. _____________ _____________ _____________
10/15/17 31, 928. 28, 699. _____________ _____________ _____________
10/15/17 -10, 000. 18, 699. 92 .000109589 189.
01/15/18 18,474. 37,173. ______________ ______________ ______________
01/15/18 -60, 000. -22, 827. _____________ _____________ _____________
03/31/18 0. -22, 827. 15 .000136986 _____________
04/15/18 94,155. 71, 328. _____________ _____________ _____________
04/15/18 -79, 651. -8, 323. _____________ _____________ _____________
Penalty Due (Sum of Column F). ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 189 .
* Date of estimated tax payment, withholding credit date or installment due date.
712511 04-01-17
50 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
71251104-01-17
Name(s) Identifying Number
(A) (B) (C) (D) (E) (F)
Adjusted Number Days Daily*Date Amount Balance Due Balance Due Penalty Rate Penalty
-0-
Penalty Due (Sum of Column F). ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
* Date of estimated tax payment, withholdingcredit date or installment due date.
UNDERPAYMENT OF ESTIMATED TAX WORKSHEET
09/15/17 29,271. 29,271.
09/15/17 -32,500. -3,229.
10/15/17 31,928. 28,699.
10/15/17 -10,000. 18,699. 92 .000109589 189.
01/15/18 18,474. 37,173.
01/15/18 -60,000. -22,827.
03/31/18 0. -22,827. 15 .000136986
04/15/18 94,155. 71,328.
04/15/18 -79,651. -8,323.
189.
JEROME FOUNDATION, INC. **-***5163
FORM 990-PF
50 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
SOURCE } } } } } } CUT TIMBER PROCEEDS DIVIDEND AND INTEREST INCOME
TO PART I, LINE 4
GROSS AMOUNT
13.
2,129,640. } } } } } } } } } } 2,129,653.
JEROME FOUNDATION, INC. **-***5163
FORM 990-PF DIVIDENDS AND INTEREST FROM SECURITIES STATEMENT 1
CAPITAL (A) (B) (C) GAINS REVENUE NET INVEST- ADJUSTED
DIVIDENDS PER BOOKS MENT INCOME NET INCOME
0 . 13. 13.
3 ,009. 2,126, 631. 2,126,631. } } } } } } } } } } } } } } } } } } } } } } } } } } } } 3 ,009. 2,126, 644. 2,126,644.
FORM 990-PF LEGAL FEES STATEMENT 2
DESCRI PTION } } } } } } } } } } } LEGAL FEES
TO FM 990-PF, PG 1 , LN 16A
(A) (B) (C) EXPENSES NET INVEST- ADJUSTED PER BOOKS MENT INCOME NET INCOME } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } }
9,123. 0. } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } }
9,123. 0.
(D) CHARITABLE PURPOSES } } } } } } } } } }
9 ,123. } } } } } } } } } }
9 ,123.
FORM 990-PF ACCOUNTING FEES STATEMENT 3
DESCRI PTION } } } } } } } } } } } AUDIT FEES
TO FORM 990-PF, PG 1, LN 16B
(A) (B) (C) EXPENSES NET INVEST- ADJUSTED PER BOOKS MENT INCOME NET INCOME } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } }
19,256. 7,702. } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } }
19,256. 7,702.
(D) CHARITABLE PURPOSES } } } } } } } } } }
11 ,554. } } } } } } } } } }
11 ,554.
51 STATEMENT(S) 1, 2 , 3 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}JEROME FOUNDATION, INC. **-***5163
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 1FORM 990-PF DIVIDENDS AND INTEREST FROM SECURITIES
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}
CAPITAL (A) (B) (C) GROSS GAINS REVENUE NET INVEST- ADJUSTEDSOURCE AMOUNT DIVIDENDS PER BOOKS MENT INCOME NET INCOME}}}}}} }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}}CUT TIMBERPROCEEDS 13. 0. 13. 13.DIVIDEND ANDINTEREST INCOME 2,129,640. 3,009. 2,126,631. 2,126,631.
}}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}}TO PART I, LINE 4 2,129,653. 3,009. 2,126,644. 2,126,644. ~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 2FORM 990-PF LEGAL FEES
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLEDESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}LEGAL FEES 9,123. 0. 9,123.
}}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}TO FM 990-PF, PG 1, LN 16A 9,123. 0. 9,123. ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 3FORM 990-PF ACCOUNTING FEES
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLEDESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}AUDIT FEES 19,256. 7,702. 11,554.
}}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}TO FORM 990-PF, PG 1, LN 16B 19,256. 7,702. 11,554. ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~
STATEMENT(S) 1, 2, 351 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
FORM 990-PF OTHER PROFESSIONAL FEES STATEMENT 4
(C) ADJUSTED NET INCOME DESCRI PTION
} } } } } } } } } } } INVESTMENT AND MANAGEMENT FEES HONORARIUMS CONSULTING FEES OTHER PROFESSIONAL FEES
TO FORM 990-PF, PG 1, LN 16C
(A) (B) EXPENSES NET INVEST-PER BOOKS MENT INCOME
83,622. 83, 622. 75,400. 0. 37,685. 0. 55,885. 5,589.
} } } } } } } } } } } } } } } 252,592. 89,211.
(D) CHARITABLE PURPOSES
0 . 75 ,400 . 37 ,685. 50 ,296.
} } } } } } } } 163 ,381.
FORM 990-PF TAXES STATEMENT 5
DESCRI PTION } } } } } } } } } } } PAYROLL TAXES FEDERAL EXCISE TAX FRINGE BENEFIT TAX
TO FORM 990-PF, PG 1, LN 18
(A) (B) EXPENSES NET INVEST-PER BOOKS MENT INCOME } } } } } } } } } } } } } } } } } } } } } }
32,176. 2,161. 176,930. 0.
336. 0. } } } } } } } } } } } } } } } } } } } } } }
209,442. 2,161.
(C) ADJUSTED NET INCOME
(D) CHARITABLE PURPOSES } } } } } } } } } }
30 ,015. 0 . 0 .
} } } } } } } } } } 30 ,015.
FORM 990-PF OTHER EXPENSES STATEMENT 6
DESCRI PTION } } } } } } } } } } } POSTAGE INSURANCE TELEPHONE OFFICE OPERATIONS EDUCATION PROGRAM BANK FEES COMPUTER EXPENSES
TO FORM 990-PF, PG 1, LN 23
(A) (B) EXPENSES NET INVEST-PER BOOKS MENT INCOME } } } } } } } } } } } } } } } } } } } } } }
1,361. 0. 7,515. 0. 6,513. 326. 28,605. 1,430.
404. 0. 1,895. 1, 895.
58,548. 0. } } } } } } } } } } } } } } } } } } } } } }
104,841. 3, 651.
(C) ADJUSTED NET INCOME
(D) CHARITABLE PURPOSES } } } } } } } } } }
1 ,361. 26 ,749. 6 ,187.
17 ,751. 404.
0 . 58 ,548.
} } } } } } } } } } 111 ,000 .
52 STATEMENT(S) 4, 5 , 6 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}JEROME FOUNDATION, INC. **-***5163
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 4FORM 990-PF OTHER PROFESSIONAL FEES
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}
(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLEDESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}INVESTMENT AND MANAGEMENTFEES 83,622. 83,622. 0.HONORARIUMS 75,400. 0. 75,400.CONSULTING FEES 37,685. 0. 37,685.OTHER PROFESSIONAL FEES 55,885. 5,589. 50,296.
}}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}TO FORM 990-PF, PG 1, LN 16C 252,592. 89,211. 163,381. ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 5FORM 990-PF TAXES
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLEDESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}PAYROLL TAXES 32,176. 2,161. 30,015.FEDERAL EXCISE TAX 176,930. 0. 0.FRINGE BENEFIT TAX 336. 0. 0.
}}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}TO FORM 990-PF, PG 1, LN 18 209,442. 2,161. 30,015. ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 6FORM 990-PF OTHER EXPENSES
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLEDESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES}}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}POSTAGE 1,361. 0. 1,361.INSURANCE 7,515. 0. 26,749.TELEPHONE 6,513. 326. 6,187.OFFICE OPERATIONS 28,605. 1,430. 17,751.EDUCATION PROGRAM 404. 0. 404.BANK FEES 1,895. 1,895. 0.COMPUTER EXPENSES 58,548. 0. 58,548.
}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}TO FORM 990-PF, PG 1, LN 23 104,841. 3,651. 111,000. ~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~
STATEMENT(S) 4, 5, 652 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. } } } } } } } } } } } } } } } } } } } } } } } ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ FORM 990-PF OTHER INCREASES IN NET ASSETS OR FUND BALANCES
DESCRI PTION } } } } } } } } } } } CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST UNREALIZED LOSS ON INVESTMENTS
TOTAL TO FORM 990-PF, PART III, LINE 3
**-***5163 } } } } } } } } } }
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ STATEMENT 7
AMOUNT
512, 035. 679, 888.
1,191, 923.
FORM 990-PF OTHER DECREASES IN NET ASSETS OR FUND BALANCES STATEMENT 8 } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } }
DESCRIPTION AMOUNT } } } } } } } } } } } } } } } } } } } } } } } } } CHANGE IN FEDERAL EXCISE TAX BENEFIT (PROVISION) 13, 319.
} } } } } } } } } } } } } } TOTAL TO FORM 990-PF, PART III, LINE 5 13, 319.
FORM 990-PF U.S. AND STATE/CITY GOVERNMENT OBLIGATIONS } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } }
U.S. OTHER DESCRIPTION GOV'T GOV'T BOOK VALUE } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } US GOVERNMENT OBLIGATIONS X 3,384,335.
STATEMENT 9 } } } } } } } } } } } } }
FAIR MARKET VALUE
} } } } } } } } } } } } } 3, 384, 335.
TOTAL U.S. GOVERNMENT OBLIGATIONS 3,384,335. 3, 384, 335.
TOTAL STATE AND MUNICIPAL GOVERNMENT OBLIGATIONS
TOTAL TO FORM 990-PF, PART II, LINE 10A 3,384,335. 3, 384, 335.
53 STATEMENT(S) 7, 8 , 9 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}JEROME FOUNDATION, INC. **-***5163
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 7FORM 990-PF OTHER INCREASES IN NET ASSETS OR FUND BALANCES
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}
DESCRIPTION AMOUNT}}}}}}}}}}} }}}}}}}}}}}}}}CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLEREMAINDER TRUST 512,035.UNREALIZED LOSS ON INVESTMENTS 679,888.
}}}}}}}}}}}}}}TOTAL TO FORM 990-PF, PART III, LINE 3 1,191,923. ~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 8FORM 990-PF OTHER DECREASES IN NET ASSETS OR FUND BALANCES
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} DESCRIPTION AMOUNT}}}}}}}}}}} }}}}}}}}}}}}}}CHANGE IN FEDERAL EXCISE TAX BENEFIT (PROVISION) 13,319.
}}}}}}}}}}}}}}TOTAL TO FORM 990-PF, PART III, LINE 5 13,319. ~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 9FORM 990-PF U.S. AND STATE/CITY GOVERNMENT OBLIGATIONS
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} U.S. OTHER FAIR MARKETDESCRIPTION GOV'T GOV'T BOOK VALUE VALUE}}}}}}}}}}} }}}}} }}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}}US GOVERNMENT OBLIGATIONS X 3,384,335. 3,384,335.
}}}}}}}}}}}}}} }}}}}}}}}}}}}}TOTAL U.S. GOVERNMENT OBLIGATIONS 3,384,335. 3,384,335. }}}}}}}}}}}}}} }}}}}}}}}}}}}}TOTAL STATE AND MUNICIPAL GOVERNMENT OBLIGATIONS }}}}}}}}}}}}}} }}}}}}}}}}}}}}TOTAL TO FORM 990-PF, PART II, LINE 10A 3,384,335. 3,384,335. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~
STATEMENT(S) 7, 8, 953 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
FORM 990-PF CORPORATE STOCK STATEMENT 10
DESCRI PTION } } } } } } } } } } } VANGUARD VALUE INDEX FUND VANGUARD TOTAL STOCK MARKET INDEX FUND INST VANGUARD REIT INDEX FUND INST VANGUARD MID-CAP GROWTH FUND VANGUARD INTERNATIONAL VALUE FUND VANGUARD INTERNATIONAL GROWTH FUND ADMIRAL VANGUARD FTSE ALL-WORLD EX-US INDEX FND INST VANGUARD GROWTH INDEX FUND INST VANGUARD MID-CAP VALUE FUND
TOTAL TO FORM 990-PF, PART II, LINE 10B
BOOK VALUE } } } } } } } } } } } }
6,453,397. 20 ,972,895. 5,879,289. 2,798,958. 6,287,513. 6,250 ,116. 14,127,969. 6,379,940. 2,854,646.
} } } } } } } } } } } } 72,004,723.
FAIR MARKET VALUE
} } } } } } } } } } } } } 6,453, 397.
20 , 972, 895. 5, 879,289. 2,798, 958. 6,287,513. 6,250 ,116.
14,127, 969. 6, 379, 940. 2, 854, 646.
} } } } } } } } } } } } } 72, 004,723.
FORM 990-PF CORPORATE BONDS STATEMENT 11
DESCRI PTION } } } } } } } } } } } VANGUARD TOTAL BOND MARKET INDEX FUND INST - NON-USGO PORTION VANGUARD INTERMEDIATE-TERM INV GRADE ADMIRAL - NON-USGO PORTION VANGUARD SHORT-TERM INV GRADE ADMIRAL - NON-USGO PORTION
TOTAL TO FORM 990-PF, PART II, LINE 10C
BOOK VALUE
10 ,203,632.
6,936,135.
3,835,602. } } } } } } } } } } } 20 ,975,369.
FAIR MARKET VALUE
10 ,203, 632.
6, 936,135.
3, 835, 602. } } } } } } } } } } } 20 , 975, 369.
FORM 990-PF OTHER INVESTMENTS STATEMENT 12
BOOK VALUE } } } } } } } } } } } }
2,467,000.
6,926. 764,866.
} } } } } } } } } } } } 3,238,792.
VALUATION DESCRIPTION METHOD } } } } } } } } } } } } } } } } } } } } TIMBER AND TIMBERLAND FMV CASH EQUIVALENTS - SECURITIES FMV LENDING VANGUARD SPECIAL FUND - ANNUITY FMV
TOTAL TO FORM 990-PF, PART II, LINE 13
FAIR MARKET VALUE
} } } } } } } } } } } } } 2,467, 000.
6, 926. 764, 866.
} } } } } } } } } } } } } 3,238,792.
54 STATEMENT(S) 10 , 11, 12 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}JEROME FOUNDATION, INC. **-***5163
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 10FORM 990-PF CORPORATE STOCK
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}
FAIR MARKETDESCRIPTION BOOK VALUE VALUE}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}}VANGUARD VALUE INDEX FUND 6,453,397. 6,453,397.VANGUARD TOTAL STOCK MARKET INDEX FUND INST 20,972,895. 20,972,895.VANGUARD REIT INDEX FUND INST 5,879,289. 5,879,289.VANGUARD MID-CAP GROWTH FUND 2,798,958. 2,798,958.VANGUARD INTERNATIONAL VALUE FUND 6,287,513. 6,287,513.VANGUARD INTERNATIONAL GROWTH FUND ADMIRAL 6,250,116. 6,250,116.VANGUARD FTSE ALL-WORLD EX-US INDEX FND INST 14,127,969. 14,127,969.VANGUARD GROWTH INDEX FUND INST 6,379,940. 6,379,940.VANGUARD MID-CAP VALUE FUND 2,854,646. 2,854,646.
}}}}}}}}}}}}}} }}}}}}}}}}}}}}TOTAL TO FORM 990-PF, PART II, LINE 10B 72,004,723. 72,004,723. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 11FORM 990-PF CORPORATE BONDS
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} FAIR MARKETDESCRIPTION BOOK VALUE VALUE}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}}VANGUARD TOTAL BOND MARKET INDEX FUND INST -NON-USGO PORTION 10,203,632. 10,203,632.VANGUARD INTERMEDIATE-TERM INV GRADE ADMIRAL -NON-USGO PORTION 6,936,135. 6,936,135.VANGUARD SHORT-TERM INV GRADE ADMIRAL - NON-USGOPORTION 3,835,602. 3,835,602.
}}}}}}}}}}}}}} }}}}}}}}}}}}}}TOTAL TO FORM 990-PF, PART II, LINE 10C 20,975,369. 20,975,369. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 12FORM 990-PF OTHER INVESTMENTS
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} VALUATION FAIR MARKETDESCRIPTION METHOD BOOK VALUE VALUE}}}}}}}}}}} }}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}}TIMBER AND TIMBERLAND FMV 2,467,000. 2,467,000.CASH EQUIVALENTS - SECURITIESLENDING
FMV6,926. 6,926.
VANGUARD SPECIAL FUND - ANNUITY FMV 764,866. 764,866.}}}}}}}}}}}}}} }}}}}}}}}}}}}}
TOTAL TO FORM 990-PF, PART II, LINE 13 3,238,792. 3,238,792. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~
STATEMENT(S) 10, 11, 1254 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. } } } } } } } } } } } } } } } } } } } } } } } ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ FORM 990-PF DEPRECIATION OF ASSETS NOT HELD FOR INVESTMENT
**-***5163 } } } } } } } } } }
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ STATEMENT 13
DESCRI PTION } } } } } } } } } } } AUTOMOBILE EQUI PMENT LEASEHOLD IMPROVEMENTS
TOTAL TO FM 990-PF, PART II, LN 14
COST OR OTHER BASIS } } } } } } } } } } } } }
28,821. 63,725. 66,524.
} } } } } } } } } } } } } 159,070.
ACCUMULATED DEPRECIATION } } } } } } } } } } } } }
15,611. 63,725. 66,524.
} } } } } } } } } } } } } 145,860.
BOOK VALUE } } } } } } } } } } } }
13,210. 0. 0.
} } } } } } } } } } } } 13,210.
FORM 990-PF OTHER ASSETS STATEMENT 14
BEGINNING OF END OF YEAR DESCRIPTION YR BOOK VALUE BOOK VALUE } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 3,788,131. 4,300 ,166.
} } } } } } } } } } } } } } } } } } } } } } } } } } } } TO FORM 990-PF, PART II, LINE 15 3,788,131. 4,300 ,166.
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ FORM 990-PF OTHER LIABILITIES
FAIR MARKET VALUE
4, 300 ,166. } } } } } } } } } } 4, 300 ,166.
STATEMENT 15
DESCRI PTION } } } } } } } } } } } DEFERRED EXCISE TAX PAYABLE
TOTAL TO FORM 990-PF, PART II, LINE 22
BOY AMOUNT } } } } } } } } } } } }
535,628. } } } } } } } } } } } }
535,628.
EOY AMOUNT } } } } } } } } } } } } }
469,161. } } } } } } } } } } } } }
469,161.
55 STATEMENT(S) 13, 14, 15 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}JEROME FOUNDATION, INC. **-***5163
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 13FORM 990-PF DEPRECIATION OF ASSETS NOT HELD FOR INVESTMENT
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}
COST OR ACCUMULATEDDESCRIPTION OTHER BASIS DEPRECIATION BOOK VALUE}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}}AUTOMOBILE 28,821. 15,611. 13,210.EQUIPMENT 63,725. 63,725. 0.LEASEHOLD IMPROVEMENTS 66,524. 66,524. 0.
}}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}}TOTAL TO FM 990-PF, PART II, LN 14 159,070. 145,860. 13,210. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 14FORM 990-PF OTHER ASSETS
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} BEGINNING OF END OF YEAR FAIR MARKETDESCRIPTION YR BOOK VALUE BOOK VALUE VALUE}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}}BENEFICIAL INTEREST IN CHARITABLEREMAINDER TRUST 3,788,131. 4,300,166. 4,300,166.
}}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}}TO FORM 990-PF, PART II, LINE 15 3,788,131. 4,300,166. 4,300,166. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 15FORM 990-PF OTHER LIABILITIES
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} DESCRIPTION BOY AMOUNT EOY AMOUNT}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}}DEFERRED EXCISE TAX PAYABLE 535,628. 469,161.
}}}}}}}}}}}}}} }}}}}}}}}}}}}}TOTAL TO FORM 990-PF, PART II, LINE 22 535,628. 469,161. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~
STATEMENT(S) 13, 14, 1555 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163 } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ FORM 990-PF PART VIII - LIST OF OFFICERS, DIRECTORS STATEMENT 16
TRUSTEES AND FOUNDATION MANAGERS } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } }
EMPLOYEE TITLE AND COMPEN- BEN PLAN EXPENSE
NAME AND ADDRESS AVRG HRS/WK SATION CONTRIB ACCOUNT } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } CHARLES ZELLE DIRECTOR 400 SIBLEY STREET, SUITE 125 1.00 0. 0. 0. ST. PAUL, MN 55101
PHILIP BITHER DIRECTOR, CHAIR 400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0. ST. PAUL, MN 55101
LINDA EARLE DIRECTOR, VICE CHAIR 400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0. ST. PAUL, MN 55101
GARY NAN TIE DIRECTOR 400 SIBLEY STREET, SUITE 125 1.00 0. 0. 0. ST. PAUL, MN 55101
KATE BARR SECRETARY AND TREASURER 400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0. ST. PAUL, MN 55101
CARLYLE BROWN DIRECTOR 400 SIBLEY STREET, SUITE 125 1.00 0. 0. 0. ST. PAUL, MN 55101
PATRICIA HAMPL DIRECTOR 400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0. ST. PAUL, MN 55101
DANIEL ALEXANDER JONES DIRECTOR 400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0. ST. PAUL, MN 55101
ELIZABETH STREB DIRECTOR 400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0. ST. PAUL, MN 55101
BEN CAMERON PRESIDENT 400 SIBLEY STREET, SUITE 125 45.00 280 ,000. 25,889. 2,884. ST. PAUL, MN 55101
56 STATEMENT(S) 16 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}JEROME FOUNDATION, INC. **-***5163
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 16FORM 990-PF PART VIII - LIST OF OFFICERS, DIRECTORS
TRUSTEES AND FOUNDATION MANAGERS}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}
EMPLOYEE TITLE AND COMPEN- BEN PLAN EXPENSENAME AND ADDRESS AVRG HRS/WK SATION CONTRIB ACCOUNT}}}}}}}}}}}}}}}} }}}}}}}}}}}}} }}}}}}}}}}} }}}}}}}} }}}}}}}}CHARLES ZELLE DIRECTOR400 SIBLEY STREET, SUITE 125 1.00 0. 0. 0.ST. PAUL, MN 55101
PHILIP BITHER DIRECTOR, CHAIR400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0.ST. PAUL, MN 55101
LINDA EARLE DIRECTOR, VICE CHAIR400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0.ST. PAUL, MN 55101
GARY NAN TIE DIRECTOR400 SIBLEY STREET, SUITE 125 1.00 0. 0. 0.ST. PAUL, MN 55101
KATE BARR SECRETARY AND TREASURER400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0.ST. PAUL, MN 55101
CARLYLE BROWN DIRECTOR400 SIBLEY STREET, SUITE 125 1.00 0. 0. 0.ST. PAUL, MN 55101
PATRICIA HAMPL DIRECTOR400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0.ST. PAUL, MN 55101
DANIEL ALEXANDER JONES DIRECTOR400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0.ST. PAUL, MN 55101
ELIZABETH STREB DIRECTOR400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0.ST. PAUL, MN 55101
BEN CAMERON PRESIDENT400 SIBLEY STREET, SUITE 125 45.00 280,000. 25,889. 2,884.ST. PAUL, MN 55101
STATEMENT(S) 1656 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. } } } } } } } } } } } } } } } } } } } } } } } CALOGERO SALVO 400 SIBLEY STREET, SUITE 125 ST. PAUL, MN 55101
MARK TRIBE 400 SIBLEY STREET, SUITE 125 ST. PAUL, MN 55101
DIRECTOR 1.00
DIRECTOR 2.00
**-***5163 } } } } } } } } } }
0. 0. 0.
0. 0. 0.
TOTALS INCLUDED ON 990-PF, PAGE 6, PART VIII 280 ,000. 25,889. 2,884. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
57 STATEMENT(S) 16 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
CALOGERO SALVO DIRECTOR400 SIBLEY STREET, SUITE 125 1.00 0. 0. 0.ST. PAUL, MN 55101
MARK TRIBE DIRECTOR400 SIBLEY STREET, SUITE 125 2.00 0. 0. 0.ST. PAUL, MN 55101
}}}}}}}}}}} }}}}}}}} }}}}}}}}TOTALS INCLUDED ON 990-PF, PAGE 6, PART VIII 280,000. 25,889. 2,884. ~~~~~~~~~~~ ~~~~~~~~ ~~~~~~~~
JEROME FOUNDATION, INC. **-***5163}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}
STATEMENT(S) 1657 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
FORM 990-PF GRANT APPLICATION SUBMISSION INFORMATION STATEMENT 17 PART XV, LINES 2A THROUGH 2D
} } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } }
NAME AND ADDRESS OF PERSON TO WHOM APPLICATIONS SHOULD BE SUBMITTED
BEN CAMERON 400 SIBLEY STREET, SUITE 125 SAINT PAUL, MN 55101
TELEPHONE NUMBER NAME OF GRANT PROGRAM
651-224-9431 ALL GRANT PROGRAMS
FORM AND CONTENT OF APPLICATIONS
ONLINE THROUGH THE FOUNDATION'S WEBSITE AT WWW.JEROMEFDN.ORG; APPLICATIONS SHOULD INCLUDE PROGRAM DESCRIPTION, PROGRAM BUDGET, RESUMES OF KEY CREATIVE ARTISTS, FINANCIAL AND ORGANIZATIONAL INFORMATION AND WORK SAMPLES.
ANY SUBMISSION DEADLINES } } } } } } } } } } } } } } } } } } } } } } } } APPLICATIONS ARE ACCEPTED AT ANYTIME. PLEASE SEE OUR WEBSITE FOR INFORMATION.
RESTRICTIONS AND LIMITATIONS ON AWARDS } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } } NEW YORK CITY AND MINNESOTA NOT-FOR-PROFIT ARTS/CULTURAL ORGANIZATIONS AND ARTISTS.
58 STATEMENT(S) 17 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}JEROME FOUNDATION, INC. **-***5163
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 17FORM 990-PF GRANT APPLICATION SUBMISSION INFORMATION
PART XV, LINES 2A THROUGH 2D }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}
NAME AND ADDRESS OF PERSON TO WHOM APPLICATIONS SHOULD BE SUBMITTED}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}BEN CAMERON400 SIBLEY STREET, SUITE 125SAINT PAUL, MN 55101
TELEPHONE NUMBER NAME OF GRANT PROGRAM}}}}}}}}}}}}}}}} }}}}}}}}}}}}}}}}}}}}}651-224-9431 ALL GRANT PROGRAMS
FORM AND CONTENT OF APPLICATIONS}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}ONLINE THROUGH THE FOUNDATION'S WEBSITE AT WWW.JEROMEFDN.ORG; APPLICATIONSSHOULD INCLUDE PROGRAM DESCRIPTION, PROGRAM BUDGET, RESUMES OF KEY CREATIVEARTISTS, FINANCIAL AND ORGANIZATIONAL INFORMATION AND WORK SAMPLES.
ANY SUBMISSION DEADLINES}}}}}}}}}}}}}}}}}}}}}}}}APPLICATIONS ARE ACCEPTED AT ANYTIME. PLEASE SEE OUR WEBSITE FORINFORMATION.
RESTRICTIONS AND LIMITATIONS ON AWARDS}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}NEW YORK CITY AND MINNESOTA NOT-FOR-PROFIT ARTS/CULTURAL ORGANIZATIONS ANDARTISTS.
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}
STATEMENT(S) 1758 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
JEROME FOUNDATION, INC. **-***5163
GENERAL EXPLANATION STATEMENT 18
FORM/LINE IDENTIFIER AND DESCRIPTION/RETURN REFERENCE
FORM 990-PF, PART I, LINE 25 : - GRANT TO A PREVIOUSLY CONROLLED ORGANIZAT
EXPLANATION:
AT THE BEGINNING OF THE TAX YEAR, THE CAMARGO FOUNDATION, A PRIVATE OPERATING FOUNDATION, WAS CONTROLLED BY JEROME FOUNDATION. DURING THE COURSE OF THE YEAR, BOTH THE BOARD AND THE STAFF OF JEROME FOUNDATION DIVERGED FROM CAMARGO FOUNDATION SUCH THAT, BY THE END OF THE YEAR, JEROME FOUNDATION AND CAMARGO FOUNDATION WERE SEPARATE, INDEPENDENT ENTITIES.
DURING THE TAX YEAR, JEROME FOUNDATION MADE GRANTS IN THE AMOUNT OF $145 ,500 TO CAMARGO FOUNDATION. THESE GRANTS WERE APPROVED BY JEROME FOUNDATION'S BOARD AFTER THE TWO FOUNDATIONS HAD BECOME INDEPENDENT AND DISTINCT ENTITIES.
THERE IS NO EXPECTATION THAT JEROME FOUNDATION WILL CONTROL THE CAMARGO FOUNDATION OR ANY OTHER EXEMPT ORGANIZATION GOING FORWARD.
59 STATEMENT(S) 18 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1
}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}JEROME FOUNDATION, INC. **-***5163
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~STATEMENT 18 GENERAL EXPLANATION
}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}
FORM/LINE IDENTIFIER AND DESCRIPTION/RETURN REFERENCE}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}FORM 990-PF, PART I, LINE 25: - GRANT TO A PREVIOUSLY CONROLLED ORGANIZAT
EXPLANATION:
AT THE BEGINNING OF THE TAX YEAR, THE CAMARGO FOUNDATION, A PRIVATEOPERATING FOUNDATION, WAS CONTROLLED BY JEROME FOUNDATION. DURING THECOURSE OF THE YEAR, BOTH THE BOARD AND THE STAFF OF JEROME FOUNDATIONDIVERGED FROM CAMARGO FOUNDATION SUCH THAT, BY THE END OF THE YEAR,JEROME FOUNDATION AND CAMARGO FOUNDATION WERE SEPARATE, INDEPENDENTENTITIES.
DURING THE TAX YEAR, JEROME FOUNDATION MADE GRANTS IN THE AMOUNT OF$145,500 TO CAMARGO FOUNDATION. THESE GRANTS WERE APPROVED BY JEROMEFOUNDATION'S BOARD AFTER THE TWO FOUNDATIONS HAD BECOME INDEPENDENT ANDDISTINCT ENTITIES.
THERE IS NO EXPECTATION THAT JEROME FOUNDATION WILL CONTROL THE CAMARGOFOUNDATION OR ANY OTHER EXEMPT ORGANIZATION GOING FORWARD.
STATEMENT(S) 1859 10070813 144198 64692 2017.04010 JEROME FOUNDATION, INC. 64692__1