Form990-PF

Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Nonexempt Charitable Trust
Treated as a Private Foundation
Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0052
2011
For calendar year 2011, or tax year beginning 01-01-2011 , and ending 12-31-2011
G
Check all that apply:
Name of foundation
ROSE & LOUIS KLOSK FUND UW R KLOSK TRUST R51742006
 

Number and street (or P.O. box number if mail is not delivered to street address)JPMORGAN CHASE BANKNAPOBOX3038   Room/suite
City or town, state, and ZIP code
MILWAUKEE, WI53201
A Employer identification number

13-6334348
B Telephone number (see page 10 of the instructions)

(414) 977-1210
C bullet
D 1. bullet
H Check type of organization:
2. bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$783,141J Accounting method:
 
(Part I, column (d) must be on cash basis.)
E bullet
F bullet
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see page 11 of the instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet
3 Interest on savings and temporary cash investments 32 32  
4 Dividends and interest from securities...... 22,185 21,697  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 620
b Gross sales price for all assets on line 6a 620
7 Capital gain net income (from Part IV, line 2)... 620
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 22,837 22,349  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 9,610 7,207   2,403
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see page 14 of the instructions) Click to see attachment 264 120   0
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 100 0   100
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 9,974 7,327   2,503
25 Contributions, gifts, grants paid........ 42,650 42,650
26 Total expenses and disbursements. Add lines 24 and 25 52,624 7,327   45,153
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -29,787
b Net investment income (if negative, enter -0-) 15,022
c Adjusted net income (if negative, enter -0-)...  
For Privacy Act and Paperwork Reduction Act Notice, see page 30 of the instructions.
Cat. No. 11289X Form 990-PF (2011)
Form 990-PF (2011)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)		 Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............... 148 81 81
2 Savings and temporary cash investments.......... 61,909 37,729 37,729
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 378,810 Click to see attachment378,810 521,819
c Investments—corporate bonds (attach schedule)........ 213,245 Click to see attachment213,246 223,512
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 654,112 629,866 783,141
Liabilities 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 (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22).......... 0 0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted....................    
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds......... 654,112 629,866
28 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
29 Retained earnings, accumulated income, endowment, or other funds 0 0
30 Total net assets or fund balances (see page 17 of the
instructions).................... 654,112 629,866
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 654,112 629,866
Part III Analysis of Changes in Net Assets or Fund Balances
1 Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree
with end-of-year figure reported on prior year’s return)............... 1 654,112
2 Enter amount from Part I, line 27a..................... 2 -29,787
3 Other increases not included in line 2 (itemize) bulletClick to see attachment 3 5,541
4 Add lines 1, 2, and 3.......................... 4 629,866
5 Decreases not included in line 2 (itemize) bullet 5 0
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 629,866
Form 990-PF (2011)
Form 990-PF (2011)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.) 		(b) How acquired
P—Purchase
D—Donation 		(c) Date acquired
(mo., day, yr.) 		(d) Date sold
(mo., day, yr.)
1 a CLASS ACTIONS PROCEEDS- QWEST INC P   2012-06-10
b CAPITAL GAINS DIVIDENDS P    
c
d
e
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 52     52
b 568     568
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a       52
b       568
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 620
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see pages 13 and 17 of the instructions).
If (loss), enter -0- in Part I, line 8 . . . . . . . . . . . . . 		Bracket 3  
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?
If “Yes,” the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2010 54,286 779,216 0.069667
2009 40,059 722,338 0.055457
2008 45,018 837,184 0.053773
2007 43,182 949,767 0.045466
2006 70,447 875,370 0.080477
2 Total of line 1, column (d) ...................... 2 0.304840
3 Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years. . . 		3 0.060968
4 Enter the net value of noncharitable-use assets for 2011 from Part X, line 5..... 4 810,510
5 Multiply line 4 by line 3....................... 5 49,415
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 150
7 Add lines 5 and 6......................... 7 49,565
8 Enter qualifying distributions from Part XII, line 4.............. 8 45,153
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 on page 18.
Form 990-PF (2011)
Form 990-PF (2011)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a Bulletand enter “N/A” on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 300
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2............................ 3 300
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- ..... 5 300
6 Credits/Payments:
a 2011 estimated tax payments and 2010 overpayment credited to 2011 6a  
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 0
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 300
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2012 estimated taxBullet   Refunded Bullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?............................
1b
 
No
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 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
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....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If “Yes,” has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
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?................
    6
    Yes
     
    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.
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see page 19 of the
    instructions)bulletNY
    b
    If the answer is “Yes” to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If “No,” attach explanation .
    8b
    Yes
     
    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 2011 or the taxable year beginning in 2011 (see instructions for Part XIV on
    page 27)? If “Yes,” complete Part XIV..........................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If “Yes,” attach a schedule listing their names and addresses.
    10
     
    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 page 20 of the instructions) .......
    11
     
    No
    12
    Did the foundation acquire a direct or indirect interest in any applicable insurance contract before August 17, 2008?
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletJPMORGAN CHASE BANK NA Telephone no.bullet (212) 464-1020
    Located atbullet270 PARK AVENUE 16TH FLNEW YORKNY ZIP+4bullet10017
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16
    At any time during calendar year 2011, 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? .................
    16
     
    No
    See page 20 of the instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes", enter the name of the foreign country bullet  
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 5
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the “Yes” column, unless an exception applies.
    Yes
    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?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?.........................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (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)?.................
    (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.).........
    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 page 20 of the instructions)?...
    1b
     
    No
    .........bullet
    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 2011?.............
    1c
     
    No
    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 2011, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2011?...............
    If “Yes,” list the years bullet20, 20, 20, 20
    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 page 20 of the instructions.) .........
    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.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business
    enterprise at any time during the year?.....................
    b
    If “Yes,” did it have excess business holdings in 2011 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 2011.)....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    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 2011?
    4b
     
    No
    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))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?...............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see page 22 of the instructions)...
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?........
    b
    If any answer is “Yes” to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see page 22 of the instructions)?
    5b
     
     
    .........bullet
    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?............
    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?....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    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?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 6
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see page 22 of the instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to
    employee benefit plans
    and deferred compensation     		(e) Expense account,
    other allowances
    JPMORGAN CHASE BANK NA CO-TRUSTEE
    3.00     		8,326 0 0
    PO BOX 3038
    MILWAUKEE,WI53201
    MICHAEL KLOSK CO-TRUSTEE
    2.00     		1,284 0 0
    JPMORGAN CHASE BANKNA 270 PARK
    AVENUE 16 FL
    NEW YORK,NY10017
    2 Compensation of five highest-paid employees (other than those included on line 1—see page 23 of the instructions).
    If none, enter “NONE.”
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    3 Five highest-paid independent contractors for professional services (see page 23 of the instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 7
    Part IX-B
    Summary of Program-Related Investments (see page 23 of the instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See page 24 of the instructions.
    3  
    Total. Add lines 1 through 3..........................bullet0
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
    see page 24 of the 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...................
    1a
    757,137
    b
    Average of monthly cash balances.......................
    1b
    65,716
    c
    Fair market value of all other assets (see page 24 of the instructions)............
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    822,853
    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..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    822,853
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ...........................
    4
    12,343
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    810,510
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    40,526
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    40,526
    2a
    Tax on investment income for 2011 from Part VI, line 5......
    2a
    300
    b
    Income tax for 2011. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    300
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    40,226
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    5,500
    5
    Add lines 3 and 4............................
    5
    45,726
    6
    Deduction from distributable amount (see page 25 of the instructions)...........
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1................................
    7
    45,726
    Part XII
    Qualifying Distributions (see page 25 of the instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    45,153
    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)....................
    3a
     
    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
    45,153
    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 (see page 26 of the instructions)............
    5
    0
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    45,153
    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 (2011)
    Form 990-PF (2011)
    Page 8
    Part XIII
    Undistributed Income (see page 26 of the instructions)
    (a)
    Corpus     		(b)
    Years prior to 2010     		(c)
    2010     		(d)
    2011
    1 Distributable amount for 2011 from Part XI, line 7 45,726
    2 Undistributed income, if any, as of the end of 2011:
    a Enter amount for 2010 only....... 36,383
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2011:
    a From 2006.......  
    b From 2007.......  
    c From 2008.......  
    d From 2009.......  
    e From 2010.......  
    fTotal of lines 3a through e......... 0
    4Qualifying distributions for 2011 from Part
    XII, line 4: bullet$ 45,153
    a Applied to 2010, but not more than line 2a 36,383
    b Applied to undistributed income of prior years
    (Election required—see page 26 of the instructions)    		 0
    c Treated as distributions out of corpus (Election
    required—see page 26 of the instructions)...     		0
    d Applied to 2011 distributable amount..... 8,770
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2011. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		0
    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......     		0
    d Subtract line 6c from line 6b. Taxable
    amount—see page 27 of the instructions ...     		0
    e Undistributed income for 2010. Subtract line
    4a from line 2a. Taxable amount—see page 27
    of the instructions ...........     		0
    f Undistributed income for 2011. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2011 ..........     		36,956
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see page 27
    of the instructions) ...........     		0
    8Excess distributions carryover from 2006 not
    applied on line 5 or line 7 (see page 27 of the
    instructions) .............     		0
    9Excess distributions carryover to 2012.
    Subtract lines 7 and 8 from line 6a ......     		0
    10 Analysis of line 9:
    a Excess from 2007....  
    b Excess from 2008....  
    c Excess from 2009....  
    d Excess from 2010....  
    e Excess from 2011....  
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 9
    Part XIV
    Private Operating Foundations (see page 27 of the instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2011, enter the date of the ruling.......bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2011 (b) 2010 (c) 2009 (d) 2008
             
    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) Value of all assets ......          
    (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
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see page 27 of the instructions.)
    1Information Regarding Foundation Managers:
    aList 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).)
    bList 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.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 10
    Part XV
    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
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    AARP FOUNDATION
    601 E STREET NW
    WASHINGTON,DC20049     		NONE PUBLIC CHARITY CONTRIBUTION 150
    ALUMNI ASSOCIATION OF THE BRONX HIGH SCHOOL OF SCIENCE
    PO BOX 145
    BRONX,NY10468     		NONE PUBLIC CHARITY CONTRIBUTION 500
    ALZHEIMERS DISEASE AND RELATED DISORDERS FOUNDATION
    225 N MICHIGAN AVE 17TH FL
    CHICAGO,IL60601     		NONE PUBLIC CHARITY OPERATING FUNDS 500
    AMERICAN HEART ASSOCIATION INC
    7272 GREENVILLE AVE
    DALLAS,TX75231     		NONE PUBLIC CHARITY CONTRIBUTION 500
    AUTISM SPEAKS
    1 EAST 33RD ST 4TH FL
    NEW YORK,NY10016     		NONE PUBLIC CHARITY CONTRIBUTION 250
    CHILDREN'S HOSPITAL OF LOS ANGELES
    4650 SUNSET BLVD MS29
    LOS ANGELES,CA97027     		NONE PUBLIC CHARITY OPERATING FUNDS 500
    CITY OF HOPE MEDICAL CENTER
    1500 EAST DUARTE ROAD
    DUARTE,CA91010     		NONE PUBLIC CHARITY OPERATING FUNDS 500
    CONGREGATION TIKVAT JACOB
    1829 NORTH SEPULVEDA BLVD
    MANHATTAN BEACH,CA90266     		NONE PUBLIC CHARITY CONTRIBUTION 3,250
    CROHN'S & COLITIS FDN OF AMERICA
    386 PARK AVENUE SOUTH 17TH FL
    NEW YORK,NY10032     		NONE PUBLIC CHARITY OPERATING FUNDS 250
    DR SUSAN LOVE RESEARCH FOUNDATION
    2811 WILSHIRE BLVD STE 500
    SANTA MONICA,CA90403     		NONE PUBLIC CHARITY CONTRIBUTION 500
    ELIZABETH GLASER PEDIATRIC AIDS FOUNDATION
    1140 CONNECTICUT AVENUE NW S200
    WASHINGTON,DC20036     		NONE PUBLIC CHARITY OPERATING FUNDS 250
    HEBREW HOME FOR THE AGED AT RIVERDALE
    5901 PALISADE AVENUE
    BRONX,NY10471     		NONE PUBLIC CHARITY OPERATING FUNDS 18,500
    HEBREW HOSPITAL HOMEINC
    61 GRASSLANDS AVE
    VALHALLA,NY10595     		NONE PUBLIC CHARITY OPERATING FUNDS 500
    HOLY NAME MEDICAL CENTER INC
    718 TEANECK ROAD
    TEANECK,NJ07666     		NONE PUBLIC CHARITY OPERATING FUND 1,000
    HUC- SKIRBALL CULTURAL CENTER
    2701 N SEPULVEDA BLVD
    LOS ANGELES,CA90049     		NONE PUBLIC CHARITY CONTRIBUTION 250
    JEWISH FEDERATION COUNCIL OF GREATER LOS ANGELES
    6505 WILSHIRE BLVD
    LOS ANGELES,CA90048     		NONE PUBLIC CHARITY CONTRIBUTION 500
    LITTLE COMPANY OF MARY HOSPITAL
    4101 TORRANCE BLVD
    TORRANCE,CA90503     		NONE PUBLIC CHARITY OPERATING FUNDS 1,000
    LOS ANGELES JEWISH HOME FOR THE AGING
    7150 TAMPA AVENUE
    RESADA,CA91335     		NONE PUBLIC CHARITY GRANT: IN-SCHOOL ACTIVITIES FUND 1,000
    LOS ANGELES MUSEUM OF THE HOLOCAUST MARTYRS MEMORIAL
    100 S THE GROVE DR
    LOS ANGELES,CA90036     		NONE PUBLIC CHARITY CONTRIBUTION 500
    MUSCULAR DISTROPHY ASSOCIATION
    3300 E SUNRISE DRIVE
    TUCSON,AZ85718     		NONE PUBLIC CHARITY CONTRIBUTION 500
    NEW YORK UNIVERSITY
    726 BROADWAY
    NEW YORK,NY10026     		NONE PUBLIC CHARITY C 2,500
    PROSTATE CANCER FOUNDATION
    1250 FOURTH STREET
    SANTA MONICA,CA90401     		NONE PUBLIC CHARITY OPERATING FUNDS 750
    SAVE THE CHILDREN FEDERATION INC
    54 WILTON ROAD
    WESTPORT,CT06880     		NONE PUBLIC CHARITY OPERATING FUNDS 250
    SIMON WEISENTHAL CENTER
    1399 S ROXBURY 2ND FL
    LOS ANGELES,CA90035     		NONE PUBLIC CHARITY GRANT; MUSEUM OF TOLERANCE 250
    ST JUDE CHILDREN'S RESEARCH HOSPITAL
    501 ST JUDES PLACE
    MEMPHIS,TX38105     		NONE PUBLIC CHARITY OPERATING FUNDS 1,000
    TORRANCE MEMORIAL MEDICAL CENTER
    3330 LOMITA BOULEVARD
    TORRANCE,CA90555     		NONE PUBLIC CHARITY OPERATING FUNDS 1,000
    TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
    3451 WALNUT STREET
    PHILADELPHIA,PA19104     		NONE PUBLIC CHARITY CONTRIBUTION 1,500
    UCLA MEDICAL CENTER AUXILIARY
    10833 LECONTE AVE
    LOS ANGELES,CA90095     		NONE PUBLIC CHARITY GRANT: MATTEL CHILDRENS HOSPITAL 500
    US HOLOCAUST MEMORIAL COUNCIL
    100 RAOUL WALLENBERG PLACE SW
    WASHINGTON,DC20024     		NONE PUBLIC CHARITY GRANT: HOLOCAUST MUSEUM 500
    WOMEN'S LEAGUE FOR ISRAEL INC
    521 FIFTH AVENUE
    NEW YORK,NY10175     		NONE PUBLIC CHARITY CONTRIBUTION 3,500
    Total .................................bullet 3a 42,650
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 11
    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)
    Related or exempt
    function income
    (See page 28 of
    the instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3Interest on savings and temporary cash investments     14 32  
    4 Dividends and interest from securities....     14 22,185  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory     18 620  
    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 22,837 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    1322,837
    (See worksheet in line 13 instructions on page 28 to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the organization’s exempt purposes (other than by providing funds for such purposes). (See
    page 28 of the instructions.)
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 12
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section
    Yes
    No
    501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is “Yes,” complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If “Yes,” complete the following schedule.
    (a) Name of organization (b) Type of organization (c) Description of relationship
    SignHere
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    Signature of officer or trustee Date Title
    PaidPreparersUseOnly Preparer's SignatureBullet Date PTIN
    Firm's namebullet



    Firm's addressbullet







         		Firm's EINbullet
    Phone no.
    Form 990-PF (2011)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2011 InvestmentsCorpBondsSchedule
    Name:
    ROSE & LOUIS KLOSK FUND UW R KLOSK TRUST R51742006
    EIN: 13-6334348
    Name of Bond End of Year Book Value End of Year Fair Market Value
    JPM CORE BOND FD - SEL - 14193.064 SHS 157,841 167,904
    JPM HIGH YIELD FD - SEL - 2359.14 SHS 20,270 17,977
    JPM TR I TAX AWARE REAL RTRN FD -SEL - 1456.816 SHS 14,000 14,947
    JPM STR INC OPP FD - 2002.092 SHS 21,135 22,684

    TY 2011 InvestmentsCorpStockSchedule
    Name:
    ROSE & LOUIS KLOSK FUND UW R KLOSK TRUST R51742006
    EIN: 13-6334348
    Name of Stock End of Year Book Value End of Year Fair Market Value
    CORNING INC - 200 SHS 3,210 2,596
    EDISON INTERNATIONAL - 400 SHS 15,804 16,560
    HEWLETT-PACKARD CO - 200 SHS 4,640 5,152
    INTERNATIONAL BUSINESS MACHINES CORP - 200 SHS 16,772 36,776
    JOHNSON & JOHNSON - 200 SHS 9,266 13,116
    PEPSICO INC - 400 SHS 1,088 26,540
    PFIZER INC - 300 SHS 11,991 6,492
    QUALCOMM INC - 200 SHS 7,243 10,940
    SPDR S&P 500 ETF TRUST - 340 SHS 42,853 42,670
    SCHLUMBERGER LTD - 600 SHS 35,036 40,986
    TEXAS INSTRUMENTS INC - 100 SHS 2,890 2,911
    WELLS FARGO & CO - 500 SHS 12,912 13,780
    ALCOA INC - 300 SHS 10,260 2,595
    VERIZON COMMUNICATIONS INC - 300 SHS 1,967 12,036
    EXELON CORP - 200 SHS 17,567 8,674
    DODGE & COX INTL STOCK - 399.346 SHS 18,127 11,677
    ISHARES RUSSELL MIDCAP GROWTH INDEX FUND - 160 SHS 9,042 8,808
    CAUSEWAY INTL VALUE FUND - 1377.067 SHS 26,783 14,859
    3M CO - 200 SHS 1,679 16,346
    MEDCO HEALTH SOLUTIONS INC - 300 SHS 7,921 16,770
    JPM INTREPID AMERICA FD - SEL - 1614.001 SHS 36,139 36,654
    JPM MULTI-CAP MARKET NEUTRAL FD -SEL- 1238.309 SHS 13,597 11,962
    JPM EM MKTS EQU FD - SEL- 304.723 SHS 6,000 6,162
    JPM ASIA EQU FD - SEL - 78.34 SHS 1,890 2,253
    AT&T INC - 700 SHS 2,342 21,168
    JPM TR I HIGHBRIDGE STATISTICAL -SEL - 532.248 SHS 8,500 7,883
    IVY GLOBAL NATURAL RESOURCE-I - 597.443 SHS 19,820 10,372
    PHILIP MORRIS INTL - 400 SHS 9,362 31,392
    FRONTIER COMMUNICATIONS CORP - 72 SHS 133 371
    SPDR GOLD TRUST - 100 SHS 9,028 15,199
    MERCK AND CO INC - 200 SHS 8,810 7,540
    COVIDIEN PLC NEW - 50 SHS 1,163 2,251
    EXXON MOBIL CORP - 600 SHS 1,743 50,856
    KRAFT FOODS INC CLASS A - 200 SHS 3,232 7,472

    TY 2011 OtherExpensesSchedule
    Name:
    ROSE & LOUIS KLOSK FUND UW R KLOSK TRUST R51742006
    EIN: 13-6334348
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    NY STATE ATTORNEY GENERAL FILING FEES 100 0   100


    TY 2011 OtherIncreasesSchedule
    Name:
    ROSE & LOUIS KLOSK FUND UW R KLOSK TRUST R51742006
    EIN: 13-6334348
    Description Amount
    ADJUSTMENT RETURN OF CAPITAL DISTRIBUTIONS 41
    RETURNED DISTRIBUTIONS 5,500


    TY 2011 TaxesSchedule
    Name:
    ROSE & LOUIS KLOSK FUND UW R KLOSK TRUST R51742006
    EIN: 13-6334348
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL EXCISE TAX - PRIOR YEAR 144 0   0
    FOREIGN INCOME TAX WITHHELD 120 120   0