990-PF - Jerome Foundation

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

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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.

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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


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

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)


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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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


Grants receivable

Receivables due from officers, directors, trustees, and other

disqualified persons

~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~


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.


**-***5163

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


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.


N/A


Form 990-PF (2017) JEROME FOUNDATION, INC. **-***5163 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


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?


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


0. 0.

0.


Form 990-PF (2017) JEROME FOUNDATION, INC. **-***5163

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


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


X

XX

WWW.JEROMEFDN.ORGLORI LAWONN

400 SIBLEY STREET, SUITE 125, SAINT PAUL, MN651-224-9431

55101

N/A

X


Form 990-PF (2017) JEROME FOUNDATION, INC. **-***5163

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


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


280,000. 25,889. 2,884.

X

XX

X

X

X

N/A

XX

XN/A


Form 990-PF(2017) JEROME FOUNDATION, INC. **-***5163

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


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)


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




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


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:


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.


0.

4,645,040.

0.4,645,040.



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


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


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.


0.


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 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)


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:


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.


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

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)




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


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.


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.



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


72363104-01-17

3

Total from continuation sheets

Grants and Contributions Paid During the Year (Continuation)


RecipientFoundation

status ofrecipient



��


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


2474 WESTCHESTER AVENUE

NONE

NONE

NONE

NONE

NONE

I

I

PC

PC

PC

TRAVEL AND STUDY

TRAVEL AND STUDY

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

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


JEROME FOUNDATION, INC. **-***5163 Information

3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________ ______________




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


CASSIS, FRANCE

CAMARGO FOUNDATION


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


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


BENNETT, JEFF

5,000.


BROOKLYN ARTS EXCHANGE/MARJANI FORT &

BHATIA, RAFIQ


WORKS


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


OF A NEW DANCE WORK



FELLOWSHIP


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




PC SUPPORT FOR PROGRAMSFOR EMERGING VISUALARTISTS


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








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



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


30,000.

FILM/VIDEO/DIGITAL

7,000.

72363104-01-17

3




RecipientFoundation

status ofrecipient



��


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






FOR EMERGING COMPOSERS

PROJECT

38,000.

PROJECT


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



PC SUPPORT FOR PROGRAMSFOR EMERGING WRITERS


NONE

NONE

NONE

I

PC

PC

7,000.

30,000.

TRAVEL AND STUDY



PROJECT



4,830.

23,000.

1,000.

BROOKLYN, NY 11201


LONG ISLAND CITY, NY 11101 IN DANCE




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.


Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ ____________________


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





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


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


DANSPACE PROJECT131 EAST 10TH STREET

34,500.

NONE PC SUPPORT FOR PROGRAMSFOR EMERGING ARTISTS

DEL AMO, YOLANDA



EVANS, AYANA





NONE

NONE

NONE

NONE

NONE

I

PC

PC

I

PC

TRAVEL AND STUDY



TRAVEL AND STUDY


PROJECT

FOR EMERGING THEATER

5,000.


PROJECT

FOR EMERGING

2,259.

30,000.

40,000.

FORECAST PUBLIC ARTWORKS2300 MYRTLE AVENUE SUITE 160


FORBES, STEFAN

FORD, T'AI FREEDOM

ST. PAUL, MN 55114

NONE




NONE

NONE

NONE

PC

I

PC

20,000.

35,000.



SUPPORT FOR ARTIST

FOR EMERGING

PROJECT

RESEARCH RESIDENCY

22,000.

30,000.

5,300.


NEW YORK, NY 10002 ARTISTS


SAINT PAUL, MN 55114 FILMMAKERS


PROJECT



3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________ ________


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


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


FOUR WAY BOOKS11 JAY STREET 4TH FL

23,000.


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



TRAVEL AND STUDY

SUPPORT FOR SERVICES


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


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


SEATTLE, WA 98199








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


HOLNES, DARREL ALEJANDRO

IBRAHIM, FADUMO

IN THE HEART OF THE BEAST PUPPET AND

MASK THEATRE (HOBT)

1500 EAST LAKE ST



MASK THEATRE (HOBT)

1500 EAST LAKE ST


INTERMEDIA ARTS

2822 LYNDALE AVENUE SOUTH


IYER, SANGAMITHRA

JAMES SEWELL BALLET

528 HENNEPIN AVENUE SUITE 125


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


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


HERNNDEZ, ELIZABETH MCWILLIAMS

5,000.



HEURING, TRICIA


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


TRAVEL AND STUDY


TRAVEL AND STUDY

TRAVEL AND STUDY


PROJECT

FOR EMERGING VISUAL

4,460.

PROJECT

PROJECT

ARTISTS

4,898.

20,000.


17,000.

JAMES SEWELL BALLET528 HENNEPIN AVENUE SUITE 125

MASK THEATRE (HOBT)

INTERMEDIA ARTS

IYER, SANGAMITHRA


NONE

1500 EAST LAKE ST

2822 LYNDALE AVENUE SOUTH

PC SUPPORT FOR PROGRAMSFOR EMERGING ARTISTS

NONE

IN DANCE


NONE

NONE

PC

PC

PC

5,000.

24,000.

SUPPORT FOR PROGRAMSFOR EMERGING THEATER


SUPPORT FOR ARTIST

ARTISTS


RESEARCH RESIDENCY

25,000.

72,500.

5,300.

MINNEAPOLIS, MN 55408 ARTISTS




PROJECT








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


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


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



TRAVEL AND STUDY


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


NONE

NONE

NONE

I

I

PC

20,000.

13,000.

TRAVEL AND STUDY


SUPPORT FOR RESEARCH

PROJECT

PROJECT

RESIDENCIES FOR

5,000.

11,500.

18,000.

NEW YORK, NY 10021

LANESBORO, MN 55949 EMERGING ARTISTS



Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ ____________________



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


LOFT LITERARY CENTER N ONE P C SUPPORT FOR PROGRAMS



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


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


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


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


306 WEST 37TH STREET, 6TH FLOOR

125 MAIDEN LANE, 2ND FLOOR

NONE

NONE

NONE

NONE

NONE

PC

PC

PC

PC

I





TRAVEL AND STUDY



50,000.

FOR EMERGING VISUAL

FOR EMERGING VISUAL

PROJECT

28,000.

100,000.

5,000.

MEISTER, KELLEY

MARTINSON, ZOEY

MAY, BENJAMIN


NONE


I TRAVEL AND STUDYPROJECT


NONE

NONE

NONE

I

I

PC

15,000.

1,000.

TRAVEL AND STUDY



PROJECT

PROJECT


1,000.

30,000.

22,000.

NEW YORK, NY 10027-3723 ARTISTS







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.


Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________ __________




or substantial contributor recipient ____________________________ _____________

MILGROM, ALBERT N ONE I M N FILM/VIDEO/DIGITAL

MILKWEED EDITIONS



MINNEAPOLIS COLLEGE OF ART AND DESIGN

2501 STEVENS AVENUE



2501 STEVENS AVENUE


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


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


MILGROM, ALBERT

2,650.


MILKWEED EDITIONS



MOVEMENT RESEARCH

MOVEMENT RESEARCH


2501 STEVENS AVENUE

2501 STEVENS AVENUE

140 SECOND AVE #501

140 SECOND AVE #501

NONE

NONE

NONE

NONE

NONE

PC

PC

PC

PC

PC







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



NONE

NONE

NONE

PC

PC

I

170,000.

30,000.






PROJECT

30,000.

20,000.

29,764.




NEW YORK, NY 10003

NEW YORK, NY 10003


SAINT PAUL, MN 55101 AND LIBRETTISTS



Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ ______________________


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 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


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


PELOFF, BETH

PORT FOR PROGRAMS

EMERGING THEATER

ISTS

FILM/VIDEO/DIGITAL

20,000.

7,000.

723631 04-01-17

23


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


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


NONE

NONE

NONE

NONE

NONE

PC

PC

PC

PC

PC






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


NONE


I MN FILM/VIDEO/DIGITALPROJECT


NONE

NONE

NONE

I

I

PC

27,100.

13,000.




FELLOWSHIP

PROJECT


20,000.

30,000.

20,000.


NEW YORK, NY 10011

NEW YORK, NY 10011


MINNEAPOLIS, MN 55408 NEW MEDIA





3 Grants and Contributions Paid During the Year (Continuation) ______________ _____________________


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








PLAYWRIGHTS ' CENTER N ONE P C SUPPORT FOR PROGRAMS

2301 E FRANKLIN AVE F OR EMERGING THEATER


PLAYWRIGHTS HORIZONS N ONE P C SUPPORT FOR PROGRAMS

416 WEST 42ND STREET F OR EMERGING THEATER


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


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


PENTACLE/FAYE DRISCOLL75 BROAD STREET SUITE 304

16,000.

NONE PC SUPPORT FOR CREATIONOF A NEW DANCE WORK

PILLSBURY HOUSE THEATRE



PLAYWRIGHTS' CENTER

PLAYWRIGHTS HORIZONS

3501 CHICAGO AVENUE SOUTH



2301 E FRANKLIN AVE

416 WEST 42ND STREET

NONE

NONE

NONE

NONE

NONE

PC

PC

PC

PC

PC








15,000.




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



NONE

NONE

NONE

I

PC

PC

37,500.

25,000.




PROJECT



30,000.

25,000.

34,000.

NEW YORK, NY 10004






NEW YORK, NY 10003

NEW YORK, NY 10282-1240



Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ _____________________



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


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


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


RADIVOJEVIC, IVA

20,800.

NONE I NY FILM/VIDEO/DIGITALPROJECT

RASHIED-WALKER, RASHANNA

RED EYE THEATER


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 ARTIST

PROJECT


4,750.


PROJECT

RESEARCH RESIDENCY

10,424.

33,000.

30,000.

SEED, RACHEL ELIZABETH


RYNEARSON, ANNE


NONE



I NY FILM/VIDEO/DIGITALPROJECT


NONE

NONE

NONE

PC

I

PC

20,000.

750.


TRAVEL AND STUDY



PROJECT

FOR EMERGING VISUAL

70,000.

2,780.

25,750.


NEW YORK, NY 10002 NEW MEDIA

PROJECT

BROOKLYN, NY 11217

COLLEGEVILLE, MN 56321 ARTISTS



Information 3 Grants and Contributions Paid During the Year (Continuation) ______________ _____________________



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


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






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


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


SERU, DAVU

20,000.

NONE I COMPOSER/SOUND ARTISTFELLOWSHIP

SHYU, JENNIFER

SINHA, SONEJUHI



STREB LAB FOR ACTION MECHANICS



51 NORTH 1ST STREET

NONE

NONE

NONE

NONE

NONE

I

I

PC

PC

PC

TRAVEL AND STUDY





PROJECT

PROJECT

3,667.

FOR EMERGING VISUAL



20,000.

15,000.

12,000.

THE TEAM138 SOUTH OXFORD ST. SUITE 1C




BROOKLYN, NY 11217

NONE




PC GENERAL PROGRAM


NONE

NONE

NONE

PC

PC

PC

25,000.

23,000.




FOR EMERGING VISUAL



19,000.

61,000.

62,000.

LONG ISLAND CITY, NY 11106 ARTISTS













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


72363104-01-17

3




RecipientFoundation

status ofrecipient



��


THEATER MU/MU PERFORMING ARTS275 EAST FOURTH ST.

50,000.


THOMPSON, LAURA MARIE

TOFTE LAKE CENTER

TUBERGEN, ELIZABETH

VOCALESSENCE

VSA MINNESOTA

2209 FERNBERG ROAD

1900 NICOLLET AVENUE


NONE

NONE

NONE

NONE

NONE

I

PC

I

PC

PC

TRAVEL AND STUDY


TRAVEL AND STUDY



PROJECT

RESIDENCIES FOR

2,500.

PROJECT


FOR EMERGING VISUAL

30,000.

31,000.

2,500.

ZONDON, WAZINA

WANDURAGALA, CHAMINDIKA

WEE, HONG-LING

WESTFALL, KIM



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




PORT FOR PROGRAMS

EMERGING WRITERS

VEL AND STUDY

35,000.

4,341.


Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ____________________



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


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


421 FIFTH AVENUE

BROOKLYN, NY 11215

BROOKLYN ARTS EXCHANGE/600 HIGHWAYMEN

421 FIFTH AVENUE

BROOKLYN, NY 11215


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


72363504-01-17

3


Grants and Contributions Approved for Future Payment (Continuation)


RecipientFoundation

status ofrecipient



��


ANDERSON CENTER163 TOWER VIEW DRIVE

21,250.


3,912,270.

ARNOLD, BRIAN

ASIAN AMERICAN WRITERS WORKSHOP

AWADALLAH, LEILA

BAAD!/BRONX ACADEMY OF ARTS AND DANCE

BRONX DOCUMENTARY CENTER


PO BOX 86

614 COURTLANDT AVE

NONE

NONE

NONE

NONE

NONE

I

PC

I

PC

PC

TRAVEL AND STUDY


TRAVEL AND STUDY



PROJECT


5,000.

PROJECT


FOR EMERGING

30,000.

35,000.

12,000.

BROOKLYN ARTS EXCHANGE/NI'JA WHITSON421 FIFTH AVENUE

BRONX MUSEUM OF THE ARTS


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


NONE

NONE

NONE

PC

PC

PC

4,341.

80,000.



SUPPORT TO CREATE A

FOR EMERGING VISUAL


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



Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ______________________ ______________





BRUNO, SHIRLEY N ONE I TRAVEL AND STUDY

P ROJECT

________ 5,000.

CAMARGO FOUNDATION


CASSIS, FRANCE

PORT FOR RESIDENCY

3,000.


126 BAXTER ST

NEW YORK, NY 10013

CAVE CANEM FOUNDATON INC.

20 JAY STREET, SUITE 310-A

BROOKLYN, NY 11201


416 CEDAR AVE S


CENTER FOR FICTION

80 FIFTH AVENUE, SUITE 1201

NEW YORK, NY 10011

CHOCOLATE FACTORY

5-49 49TH AVENUE


CODJOE, AMA

COFFEE HOUSE PRESS



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


72363504-01-17

3




RecipientFoundation

status ofrecipient



��


BRUNO, SHIRLEY

5,000.


CAMARGO FOUNDATION


CAVE CANEM FOUNDATON INC.


CENTER FOR FICTION


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






PROGRAM

FOR EMERGING VISUAL

3,000.




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




NONE

NONE

NONE

PC

I

PC

25,000.

42,500.


TRAVEL AND STUDY



PROJECT


32,000.

5,000.

24,000.

CASSIS, FRANCE


BROOKLYN, NY 11201


NEW YORK, NY 10011

LONG ISLAND CITY, NY 11101 IN DANCE




Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ __________________


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



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.



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



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


72363504-01-17

3




RecipientFoundation

status ofrecipient



��


CZERWIEC, HEIDI

1,250.


DANSPACE PROJECT


EDUARDOVNA, IRA


ETHELS FOUNDATION FOR THE ARTS

131 EAST 10TH STREET



132 E 43RD ST #213

NONE

NONE

NONE

NONE

NONE

PC

PC

I

PC

PC



TRAVEL AND STUDY





34,500.

PROJECT



20,000.

25,000.

5,000.

FOUNDATION CENTER32 OLD SLIP, 24TH FL

EYEBEAM ARTS AND TECHNOLOGY


FORSTEIN, MICHAEL

NEW YORK, NY 10005

NONE

34 35TH ST. UNIT 26/5TH FLOOR


PC SUPPORT FOR SERVICESFOR GRANTMAKERS


NONE

NONE

NONE

PC

PC

I

5,000.

20,000.





FOR EMERGING VISUAL

PROJECT

15,000.

80,000.

30,000.




NEW YORK, NY 10017

BROOKLYN, NY 11232 NEW MEDIA

ST. PAUL, MN 55114 ARTISTS






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


GIBNEY DANCE N ONE P C SUPPORT FOR PROGRAMS

890 BROADWAY, 5TH FL F OR EMERGING ARTISTS


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


HARLEM STAGE/AARON DAVIS HALL N ONE P C SUPPORT FOR PROGRAMS

150 CONVENT AVENUE F OR EMERGING ARTISTS


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


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


72363504-01-17

3




RecipientFoundation

status ofrecipient



��


FOUR WAY BOOKS11 JAY STREET 4TH FL

23,000.


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 SERVICES


FOR EMERGING VISUAL

FOR EMERGING VISUAL

39,000.


FOR GRANTMAKERS


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



NONE

NONE

NONE

PC

PC

PC

50,000.

23,000.





FOR EMERGING


25,000.

17,000.

60,000.

NEW YORK, NY 10013

SHAFER, MN 55074 ARTISTS



SEATTLE, WA 98199



NEW YORK, NY 10012 FILMMAKERS



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.


3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ____________________



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.


912 W. LAKE STREET


HUANG, JESSICA


MASK THEATRE (HOBT)

1500 EAST LAKE ST


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



JAZZ GALLERY

PO BOX 153, LENOX HILL STATION

NEW YORK, NY 10021

JINDAL, ANU

723635 04-01-17


72363504-01-17

3




RecipientFoundation

status ofrecipient



��



28,000.



INTERNATIONAL CONTEMPORARY ENSEMBLE



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



TRAVEL AND STUDY


TRAVEL AND STUDY



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


PO BOX 153, LENOX HILL STATION

I TRAVEL AND STUDYPROJECT

NONE


NONE

NONE

PC

PC

PC

5,000.

40,000.

SUPPORT FOR PROGRAMSFOR EMERGING VISUAL



ARTISTS



60,000.

17,000.

80,000.

ARTISTS



BROOKLYN, NY 11232

JAMAICA, NY 11432

MINNEAPOLIS, MN 55403 IN DANCE

NEW YORK, NY 10021



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


72363504-01-17

3




RecipientFoundation

status ofrecipient



��


JOHNSON III, HERBERT

4,200.


JOSHI, AMITABH

JURANIC, MARIA

KAMPS, JEREMY

KESSLER, GABRIELLA

KHALIL, ADAM

NONE

NONE

NONE

NONE

NONE

I

I

I

I

I

TRAVEL AND STUDY


TRAVEL AND STUDY


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

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.



Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ______________________ _______________





LANESBORO ARTS N ONE P C SUPPORT FOR RESEARCH

103 PARKWAY AVE N R ESIDENCIES FOR

LANESBORO, MN 55949 E MERGING ARTISTS 36,000.



NEW YORK, NY 10036 A RTISTS 22,000.



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



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


30,000.

AND STUDY

5,000.

72363504-01-17

3




RecipientFoundation

status ofrecipient



��


LANESBORO ARTS103 PARKWAY AVE N

36,000.


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





TRAVEL AND STUDY



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



NONE

NONE

NONE

I

PC

I

70,000.

5,000.

TRAVEL AND STUDY


TRAVEL AND STUDY

PROJECT


PROJECT

5,000.

30,000.

5,000.

LANESBORO, MN 55949 EMERGING ARTISTS



NEW YORK, NY 10027-3723 ARTISTS




3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ______________________ ________


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



MINNESOTA CENTER FOR BOOK ARTS N ONE P C SUPPORT FOR PROGRAMS

1011 WASHINGTON AVENUE SOUTH SUITE 100 F OR EMERGING VISUAL


MIXED BLOOD THEATRE COMPANY N ONE P C SUPPORT FOR PROGRAMS

1501 SOUTH FOURTH STREET F OR EMERGING THEATER


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


72363504-01-17

3




RecipientFoundation

status ofrecipient



��


MILGROM, ALBERT

22,350.


MILKWEED EDITIONS

MINNESOTA CENTER FOR BOOK ARTS

MIXED BLOOD THEATRE COMPANY

MOLSON, RICHARD

MONTILUS, MAXINE



1501 SOUTH FOURTH STREET

NONE

NONE

NONE

NONE

NONE

PC

PC

PC

I

I





TRAVEL AND STUDY


FOR EMERGING VISUAL

23,000.


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



NONE

NONE

NONE

I

PC

I

8,000.

2,900.

TRAVEL AND STUDY



PROJECT


PROJECT

4,295.

80,000.

30,000.







3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ______________________


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


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 THEATRE WORKSHOP N ONE P C SUPPORT FOR PROGRAMS

79 EAST 4TH ST. F OR EMERGING THEATER


NORTHERN CLAY CENTER N ONE P C SUPPORT FOR PROGRAMS

2424 FRANKLIN AVENUE EAST F OR EMERGING VISUAL


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




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


72363504-01-17

3




RecipientFoundation

status ofrecipient



��


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


79 EAST 4TH ST.

2424 FRANKLIN AVENUE EAST


NONE

NONE

NONE

NONE

NONE

PC

PC

PC

PC

PC

SUPPORT FOR ARTIST





PARTICIPATION AT


9,000.


FOR EMERGING VISUAL


25,000.

42,500.

1,500.

PELOFF, BETH

OBSATZ, KEVIN


PARTICIPANT INC

NONE


253 EAST HOUSTON STREET, # 1

I MN FILM/VIDEO/DIGITALPROJECT


NONE

NONE

NONE

I

PC

PC

20,000.

65,000.




PROJECT


FOR EMERGING VISUAL

25,000.

50,000.

44,000.


NEW YORK, NY 10018 CONFERENCE




MINNEAPOLIS, MN 55408 NEW MEDIA








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


PETRUS, JUNAUDA N ONE I TRAVEL AND STUDY




PLAYWRIGHTS ' CENTER

2301 E FRANKLIN AVE


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


72363504-01-17

3




RecipientFoundation

status ofrecipient



��


PENUMBRA THEATRE270 N KENT ST

70,000.


PERFORMANCE SPACE NEW YORK

PETRUS, JUNAUDA


PLAYWRIGHTS' CENTER

POETRY PROJECT

150 FIRST AVENUE


2301 E FRANKLIN AVE

131 E. 10TH ST

NONE

NONE

NONE

NONE

NONE

PC

I

PC

PC

PC


TRAVEL AND STUDY





PROJECT

50,000.




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


NONE

NONE

PC

PC

PC

50,000.

25,000.




FOR EMERGING VISUAL

FOR EMERGING VISUAL


ARTISTS

24,000.

60,000.

140,000.





NEW YORK, NY 10003



11368



Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ ______________________ ______________





RAMASWAMY, ASHWINI N ONE I TRAVEL AND STUDY

P ROJECT

5 , 000.

REED, GLENDA

AND STUDY

4,856.


235 BOWERY

NEW YORK, NY 10002

ROCKMORE, RYAN



BROOKLYN, NY 11217



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


72363504-01-17

3




RecipientFoundation

status ofrecipient



��


RAMASWAMY, ASHWINI

5,000.


REED, GLENDA


ROCKMORE, RYAN



235 BOWERY



NONE

NONE

NONE

NONE

NONE

I

PC

I

PC

PC

TRAVEL AND STUDY


TRAVEL AND STUDY



PROJECT


4,856.

PROJECT


FOR EMERGING VISUAL

140,000.

50,000.

3,027.

SHARKEY, ERIN

SAINTONGE, STEFANI

SEALEY, NICOLE

SHAH, KAVITA



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






SMACK MELLON STUDIOS N ONE P C SUPPORT FOR PROGRAMS

92 PLYMOUTH STREET F OR EMERGING VISUAL


SMACK MELLON STUDIOS N ONE P C SUPPORT FOR PROGRAMS

92 PLYMOUTH STREET F OR EMERGING VISUAL


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


SPRINGBOARD FOR THE ARTS N ONE P C GENERAL PROGRAM

308 PRINCE STREET, SUITE 270


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



STREB INC.

51 NORTH 1ST STREET

BROOKLYN, NY 11249



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


72363504-01-17

3




RecipientFoundation

status ofrecipient



��


SMACK MELLON STUDIOS92 PLYMOUTH STREET

22,000.


SPRINGBOARD FOR THE ARTS/MONKEYBEAR'S

SMACK MELLON STUDIOS



SPRINGBOARD FOR THE ARTS

HARMOLODIC WORKSHOP

92 PLYMOUTH STREET



308 PRINCE STREET, SUITE 270

308 E. PRINCE ST., STE. 270

NONE

NONE

NONE

NONE

NONE

PC

PC

PC

PC

PC





GENERAL PROGRAM


FOR EMERGING VISUAL

FOR EMERGING VISUAL

25,000.


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


51 NORTH 1ST STREET



NONE

NONE

NONE

PC

PC

PC

70,000.

30,000.





FOR EMERGING


80,000.

60,000.

23,000.



LONG ISLAND CITY, NY 11106 ARTISTS



ST. PAUL, MN 55101

ST. PAUL, MN 55105 IN DANCE





Information 3 Grants and Contributions Approved for Future Payment (Continuation) ______________ _____________________



STUDIO MUSEUM IN HARLEM N ONE P C SUPPORT FOR PROGRAMS

144 WEST 125TH STREET F OR EMERGING VISUAL


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


THE KITCHEN/HALEAKALA, INC

512 WEST 19 STREET

NEW YORK, NY 10011

THEATER MU/MU PERFORMING ARTS

275 EAST FOURTH ST., SUITE 496


TOFTE LAKE CENTER

2209 FERNBERG ROAD

ELY, MN 55731

VOCALESSENCE



VONGSAY, SAYMOUKDA

VSA MINNESOTA



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


72363504-01-17

3




RecipientFoundation

status ofrecipient



��


STUDIO MUSEUM IN HARLEM144 WEST 125TH STREET

25,000.


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


TRAVEL AND STUDY




PROJECT

PROJECT

24,236.

FOR EMERGING VISUAL



26,000.

5,000.

21,000.

VSA MINNESOTA528 HENNEPIN AVENUE SUITE 305

TOFTE LAKE CENTER

VOCALESSENCE

VONGSAY, SAYMOUKDA


NONE

2209 FERNBERG ROAD




NONE

NONE

NONE

PC

PC

I

54,000.

27,000.



TRAVEL AND STUDY

RESIDENCIES FOR


PROJECT

31,000.

30,000.

5,000.





ELY, MN 55731 EMERGING ARTISTS




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


ZEITGEIST



ZENON DANCE COMPANY

528 HENNEPIN AVENUE, #400


**-***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


72363504-01-17

3




RecipientFoundation

status ofrecipient



��


WILLIAMS, ROSEMARY

13,000.


YANG, KAYVA

ZEITGEIST

ZEITGEIST

ZENON DANCE COMPANY



528 HENNEPIN AVENUE, #400

NONE

NONE

NONE

NONE

I

PC

PC

PC

TRAVEL AND STUDY




PROJECT


4,000.


FOR EMERGING ARTISTS28,000.

16,500.


16,500.



MINNEAPOLIS, MN 55403 IN DANCE


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


527 political organization

Form 990-PF 501(c)(3) exempt 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


X

X

Schedule B (Form 990, 990-EZ, or 990-PF) (2017) Page 2 Name of organization Employer identification number


(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

$


$


$

(d) p e of contribution

Person Payroll Noncash








(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


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


(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Total contributions

(d)

Type of contribution

Person

Payroll

Noncash

(a)

No.

(b)


(c)

Total contributions

(d)


Person

Payroll

Noncash

(a)

No.

(b)


(c)

Total contributions

(d)


Person

Payroll

Noncash

(a)

No.

(b)


(c)

Total contributions

(d)


Person

Payroll

Noncash

(a)

No.

(b)


(c)

Total contributions

(d)


Person

Payroll

Noncash

(a)

No.

(b)


(c)

Total contributions

(d)


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.)

$


$


$


$


$


2

Part I Contributors

1 X

15,000.

HRK FOUNDATION

STREET1200 LANDMARK TOWER, 345 ST PETER

ST. PAUL, MN 55102



Schedule B (Form 990, 990-EZ, or 990-PF) (2017) Page 3 Name of organization Employer identification number


(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


$ _______________________ _______________

(c) (d)


(See instructions.)

(a) No.

from Part I


$ _______________________ _______________

(c) (d)


(See instructions.)

(a) No.

from Part I


$ _______________________ _______________

(c) (d)


(See instructions.)

(a) No.

from Part I


$ _______________________ _______________

(c) (d)


(See instructions.)

I $ I 723453 11-01-17 Schedule B (Form 990, 990-EZ, or 990-PF) (2017)


723453 11-01-17



(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)


(d)

Date received

(a)

No.

from

Part I

(c)

FMV (or estimate)

(See instructions.)

(b)


(d)

Date received

(a)

No.

from

Part I

(c)

FMV (or estimate)

(See instructions.)

(b)


(d)

Date received

(a)

No.

from

Part I

(c)

FMV (or estimate)

(See instructions.)

(b)


(d)

Date received

(a)

No.

from

Part I

(c)

FMV (or estimate)

(See instructions.)

(b)


(d)

Date received


(see instructions). Use duplicate copies of Part II if additional space is needed.

$

$

$

$

$

$

3

Part II Noncash Property



Schedule B (Form 990, 990-EZ, or 990-PF) (2017) 4


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


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





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


(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


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


(a) No.fromPart I



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

(a) No.fromPart I




(a) No.fromPart I




(a) No.fromPart I




Complete columns through the following line entry.


| $

Use duplicate copies of Part III if additional space is needed.

Exclusively

4

Part IIIJEROME FOUNDATION, INC. **-***5163


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


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


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.


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


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


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





30 Underpayment on line 17 x Number of days on line 29 x *% 365


32 Underpayment on line 17 x Number of days on line 31 x *% 365


34 Underpayment on line 17 x Number of days on line 33 x *% ~ 365


~ 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


Underpayment on line 17 x Number of days on line 23 x 4% (0.04)

365



365



365


Underpayment on line 17 x Number of days on line 29 x *%

365



365



365



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


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



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.




~~~~~~~~~~~~

~~~~~~~~~~~~

~~~~~~~~~~~~

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.


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


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 ��


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.


** 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.


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


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.


FORM 990-PF


SOURCE } } } } } } CUT TIMBER PROCEEDS DIVIDEND AND INTEREST INCOME

TO PART I, LINE 4

GROSS AMOUNT

13.

2,129,640. } } } } } } } } } } 2,129,653.


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.


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


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


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


1 ,361. 26 ,749. 6 ,187.

17 ,751. 404.

0 . 58 ,548.

} } } } } } } } } } 111 ,000 .



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~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. ~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~


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.



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~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. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~



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


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~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. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~


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


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~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. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~


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


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~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. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~


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}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}



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.



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~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.

}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}



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.



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~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.


990-PF - Jerome Foundation

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