Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletInformation about Form 990-PF and its instructions is at www.irs.gov/form990pf.
OMB No. 1545-0052
2015
Open to Public Inspection
For calendar year 2015, or tax year beginning 01-01-2015 , and ending 12-31-2015
Name of foundation
WR Berkley Corporation Charitable
Foundation
% Foundation Source
Number and street (or P.O. box number if mail is not delivered to street address)Foundation Source 501 Silverside Rd
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Wilmington, DE198091377
A Employer identification number

36-4516560
B Telephone number (see instructions)

(800) 839-1754
C bullet
G Check all that apply:

D 1. bullet
2. bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$400,660J Accounting method:
 
(Part I, column (d) must be on cash basis.)
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 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) 615,156
2 Check bullet Sch. B .............
3 Interest on savings and temporary cash investments 45 45  
4 Dividends and interest from securities...      
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)... 0
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........ 615,201 45  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0      
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 instructions)...        
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 3,787     3,787
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 3,787 0   3,787
25 Contributions, gifts, grants paid....... 623,630 623,630
26 Total expenses and disbursements. Add lines 24 and 25 627,417 0   627,417
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -12,216
b Net investment income (if negative, enter -0-) 45
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2015)
Form 990-PF (2015)
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.............      
2 Savings and temporary cash investments......... 412,876 400,660 400,660
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 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).......      
c Investments—corporate bonds (attach schedule).......      
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) 412,876 400,660 400,660
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
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........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds 412,876 400,660
30 Total net assets or fund balances (see instructions)..... 412,876 400,660
31 Total liabilities and net assets/fund balances (see instructions). 412,876 400,660
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
412,876
2
Enter amount from Part I, line 27a .....................
2
-12,216
3
Other increases not included in line 2 (itemize) bullet
3
 
4
Add lines 1, 2, and 3 ..........................
4
400,660
5
Decreases not included in line 2 (itemize) bullet
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
400,660
Form 990-PF (2015)
Form 990-PF (2015)
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.)
1a
b
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
b
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
b
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  
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in 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 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))
2014 523,751 341,065 1.535634
2013 463,930 259,178 1.790005
2012 382,508 265,030 1.443263
2011 368,618 235,355 1.566221
2010 387,635 334,383 1.159255
2
Total of line 1, column (d) .....................
27.494378
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
1.498876
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
386,405
5
Multiply line 4 by line 3......................
5
579,173
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
 
7
Add lines 5 and 6........................
7
579,173
8
Enter qualifying distributions from Part XII, line 4.............
8
627,417
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 990-PF (2015)
Form 990-PF (2015)
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 Bullet and enter “N/A" on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 0
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  
3 Add lines 1 and 2........................... 3 0
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 0
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 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 0
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 2015 estimated taxBullet   RefundedBullet 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 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$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
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
Yes
 
If "Yes," attach the statement required by General Instruction T.Click to see attachment
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 instructions)
    bulletDE
    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 2015 or the taxable year beginning in 2015 (see instructions for Part XIV)?
    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
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    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) .............
    11
     
    No
    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).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbullet  
    14
    The books are in care ofbulletFoundation Source Telephone no.bullet (800) 839-1754

    Located atbullet501 Silverside Road Suite 123WilmingtonDE ZIP+4bullet198091377
    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 2015, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country?
    16   No
    See instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country bullet  
    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 instructions)? ........
    1b
     
     
    ........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 2015?.............
    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 2015, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2015?.............
    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 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 2015 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 2015.)..................
    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 2015?
    4b
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (Continued)
    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 4945(d)(4)(A)? (see 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 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 (2015)
    Form 990-PF (2015)
    Page 7
    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 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
    William R Berkley Pres / Dir
    1.0     		0 0 0
    Foundation Source 501 Silverside Rd
    Wilmington,DE198091377
    William R Berkley Jr VP / Dir / Treas
    1.0     		0 0 0
    Foundation Source 501 Silverside Rd
    Wilmington,DE198091377
    Josephine A Raimondi VP / Dir / Sec
    1.0     		0 0 0
    Foundation Source 501 Silverside Rd
    Wilmington,DE198091377
    2 Compensation of five highest-paid employees (other than those included on line 1—see 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
     
    Total number of other employees paid over $50,000...................bullet  
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
     
    Total number of others receiving over $50,000 for professional services.............bullet  
    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  
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 8
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    0
    b
    Average of monthly cash balances.......................
    1b
    392,289
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    392,289
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
     
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    392,289
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    5,884
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    386,405
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    19,320
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
    19,320
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    0
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    0
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    19,320
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    19,320
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    19,320
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    627,417
    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
    0
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
    0
    b
    Cash distribution test (attach the required schedule) .................
    3b
    0
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    627,417
    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 instructions).................
    5
     
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    627,417
    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 (2015)
    Form 990-PF (2015)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2014     		(c)
    2014     		(d)
    2015
    1 Distributable amount for 2015 from Part XI, line 7 19,320
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only.......  
    b Total for prior years:2013, 2012, 2011  
    3 Excess distributions carryover, if any, to 2015:
    a From 2010...... 370,917
    b From 2011...... 356,851
    c From 2012...... 369,257
    d From 2013...... 439,471
    e From 2014...... 506,198
    fTotal of lines 3a through e........ 2,042,694
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 627,417
    a Applied to 2014, 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 2015 distributable amount..... 19,320
    e Remaining amount distributed out of corpus 608,097
    5 Excess distributions carryover applied to 2015.    
    (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 2,650,791
    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 2014. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		 
    f Undistributed income for 2016. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2015 ..........     		0
    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) .......     		 
    8Excess distributions carryover from 2010 not
    applied on line 5 or line 7 (see instructions) ...     		370,917
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......     		2,279,874
    10 Analysis of line 9:
    a Excess from 2011.... 356,851
    b Excess from 2012.... 369,257
    c Excess from 2013.... 439,471
    d Excess from 2014.... 506,198
    e Excess from 2015.... 608,097
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 10
    Part XIV
    Private Operating Foundations (see 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 2015, 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) 2015 (b) 2014 (c) 2013 (d) 2012
             
    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 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).)
    NONE
    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 or email address 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 (2015)
    Form 990-PF (2015)
    Page 11
    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
    A COMPANY OF GIRLS
    PO BOX 7527
    PORTLAND,ME04112     		N/A PC Family Traditions Program 2,000
    AAMGA EDUCATION FOUNDATION
    150 S WARNER RD STE 156
    KING OF PRUSSIA,PA19406     		N/A PC General & Unrestricted 5,000
    ABBY KELLEY FOSTER HOUSE INC
    52 HIGH ST
    WORCESTER,MA01609     		N/A PC General & Unrestricted 1,300
    ALBANY HOUSING COALITION INC
    278 CLINTON AVE
    ALBANY,NY12210     		N/A PC General & Unrestricted 1,000
    AMANDA CARES INC
    1821 GRAND AVE
    W Des Moines,IA50265     		N/A PC Amanda the Panda Program 2,500
    AMERICAN CANCER SOCIETY
    8364 HICKMAN RD STE D
    DES MOINES,IA50325     		N/A PC Relay for Life Campaign 2,500
    AM ENTERPRISE INSTITUTE FOR PUBLIC POLICY RESEARCH
    1150 17TH ST NW
    WASHINGTON,DC20036     		N/A PC General & Unrestricted 5,000
    AMERICAN HEART ASSOCIATION
    444 LIBERTY AVE STE 130
    PITTSBURGH,PA15222     		N/A PC General & Unrestricted 1,500
    AMERICAN HEART ASSOCIATION
    210 MALABU DR STE 125
    LEXINGTON,KY40503     		N/A PC General & Unrestricted 1,500
    AMERICAN HEART ASSOCIATION INC
    1449 MEDICAL PARK DR
    BIRMINGHAM,AL35213     		N/A PC General & Unrestricted 4,500
    ANDREW JACKSON POLICE YOUTH CAMP
    440 WELSHWOOD DR
    NASHVILLE,TN37211     		N/A PC General & Unrestricted 750
    APPALACHIAN STATE UNIVERSITY
    THELMA C RALEY HALL ASU BOX 32058
    BOONE,NC28608     		N/A PC General & Unrestricted 5,000
    ASSISTANCE LEAGUE OF BOISE IDAHO INC
    PO BOX 140104
    GARDEN CITY,ID83714     		N/A PC Operation School Bell Fund 2,000
    ATLAS OF ROCK COUNTY
    PO BOX 922
    LUVERNE,MN56156     		N/A PC General & Unrestricted 27,500
    AUTISM SOCIETY OF AMERICA
    4465 E GENESEE ST PMB 252
    DEWITT,NY13214     		N/A PC Central NY Chapter 2,000
    AVON THEATRE FILM CENTER INC
    8 SOUND SHORE DR
    GREENWICH,CT06830     		N/A PC General & Unrestricted 500
    BIG BROTHERS BIG SISTERS OF THE CAPITAL REGION INC
    1698 CENTRAL AVE
    ALBANY,NY12205     		N/A PC School Based Program 1,175
    BILLINGS FORGE COMMUNITY WORKS INC
    140 RUSS ST
    HARTFORD,CT06106     		N/A PC Job Training Program 1,000
    BOY SCOUTS OF AMERICA
    3120 RAINIER AVE S
    SEATTLE,WA98144     		N/A PC ScoutReach Initiative 2,500
    BOYS & GIRLS CLUB OF GREENWICH INC
    4 HORSENECK LN
    GREENWICH,CT06830     		N/A PC General & Unrestricted 10,000
    BOYS AND GIRLS CLUB OF BURLINGTON INC
    62 OAK ST
    BURLINGTON,VT05401     		N/A PC Career Readiness & Life Skills Program 2,000
    BOYS CLUB OF MT VERNON N Y INC
    350 S 6TH AVE
    MOUNT VERNON,NY10550     		N/A PC General & Unrestricted 350
    BOYS CLUB OF NEW YORK INC
    287 E 10TH ST
    NEW YORK,NY10009     		N/A PC General & Unrestricted 5,000
    BROADLAWNS MEDICAL CENTER
    1801 HICKMAN RD
    DES MOINES,IA50314     		N/A PC General & Unrestricted 3,000
    CANCER COMMUNITY CENTER
    778 MAIN ST
    SOUTH PORTLAND,ME04106     		N/A PC Creative Expressions Program 3,000
    CARNEGIE HALL SOCIETY INC
    881 7TH AVE
    NEW YORK,NY10019     		N/A PC General & Unrestricted 5,000
    CHARITABLE ASSISTANCE TO COMMUNITY'S HOMELESS
    503 S AMERICANA BLVD
    BOISE,ID83702     		N/A PC General & Unrestricted 3,000
    CHAVES COUNTY CANCER FUND INC
    PO BOX 193
    ROSWELL,NM88202     		N/A PC General & Unrestricted 500
    CHILD CRISIS ARIZONA
    2334 E POLK ST
    PHOENIX,AZ85006     		N/A PC General & Unrestricted 7,500
    CHILDREN AND FAMILY URBAN MINISTRIES
    1548 8TH ST
    DES MOINES,IA50314     		N/A PC Whyld Girls Program 1,500
    CHILDREN'S DEFENSE FUND - NEW YORK
    15 MAIDEN LN STE 1200
    NEW YORK,NY10038     		N/A PC General & Unrestricted 25,000
    CHILDRENS MIRACLE NETWORK
    205 W 700 S
    SALT LAKE CTY,UT84101     		N/A PC Ann & Robert H. Luri Children's Hospital Fdn Fund 500
    CHILDRENS MIRACLE NETWORK
    205 W 700 S
    SALT LAKE CTY,UT84101     		N/A PC Boston Children's Hospital Trust Fund 500
    CHILDRENS MIRACLE NETWORK
    205 W 700 S
    SALT LAKE CTY,UT84101     		N/A PC Children's Healthcare of Atlanta Foundation Fund 1,500
    CHILDRENS MIRACLE NETWORK
    205 W 700 S
    SALT LAKE CTY,UT84101     		N/A PC Children's Medical Center Fund 1,000
    CHILDRENS MIRACLE NETWORK
    205 W 700 S
    SALT LAKE CTY,UT84101     		N/A PC Children's Specialized Hospital Fund 1,000
    CHILDRENS MIRACLE NETWORK
    205 W 700 S
    SALT LAKE CTY,UT84101     		N/A PC The Children's Hospital of Philadelphia Fund 500
    CITY OF HOPE
    1500 E DUARTE RD
    DUARTE,CA91010     		N/A PC General & Unrestricted 250
    CLEAR PATH FOR VETERANS INC
    1223 SALT SPRINGS RD
    CHITTENANGO,NY13037     		N/A PC The Wellness Program 1,000
    CMC FOUNDATION OF CENTRAL TEXAS
    4900 MUELLER BLVD
    AUSTIN,TX78723     		N/A PC Give Hope 2015 for the Dell Children's Blood & Cancer Center Program 1,000
    COMBAT MARINE OUTDOORS INC
    6610 MALIBU DR
    HOUSTON,TX77092     		N/A PC General & Unrestricted 2,539
    COMMUNITY CHEST OF ENGLEWOOD
    310 ENGLE ST
    ENGLEWOOD,NJ07631     		N/A PC General & Unrestricted 500
    CONCERNED CITIZENS FOR COMMUNITY HEALTH
    7700 E ROOSEVELT ST
    SCOTTSDALE,AZ85257     		N/A PC General & Unrestricted 2,500
    COUNCIL OF DES MOINES
    1426 6TH AVE
    DES MOINES,IA50314     		N/A PC General & Unrestricted 3,500
    COURAGE LEAGUE SPORTS
    4405 121ST ST
    URBANDALE,IA50323     		N/A PC General & Unrestricted 5,000
    CRIPPLED CHILDRENS FOUNDATION
    2019 4TH AVE N
    BIRMINGHAM,AL35203     		N/A PC General & Unrestricted 2,500
    CYSTIC FIBROSIS FOUNDATION
    2302 PARKLAKE DR NE STE 210
    ATLANTA,GA30345     		N/A PC General & Unrestricted 2,000
    DES MOINES PASTORAL COUNSELING CENTER
    8553 URBANDALE AVE
    URBANDALE,IA50322     		N/A PC General & Unrestricted 3,500
    DOVER CHILDRENS HOME
    207 LOCUST ST
    DOVER,NH03820     		N/A PC Residential Treatment Program 3,200
    EASTER SEALS NEW HAMPSHIRE INC
    555 AUBURN ST
    MANCHESTER,NH03103     		N/A PC Veterans Count Program 5,000
    EMPLOYMENT OPTIONS INC
    82 BRIGHAM ST
    MARLBOROUGH,MA01752     		N/A PC General & Unrestricted 1,300
    FAMILY CENTERS INC
    40 ARCH ST
    GREENWICH,CT06830     		N/A PC General & Unrestricted 25,000
    FAMILY PLACE INC
    1420 W MOCKINGBIRD LN
    DALLAS,TX75247     		N/A PC General & Unrestricted 2,414
    FAMILY PROMISE OF GREATER NASHUA INC
    180 LOWELL RD
    HUDSON,NH03051     		N/A PC Anne-Marie House Program 3,200
    FARMER VETERAN COALITION
    4614 2ND ST STE 4
    DAVIS,CA95618     		N/A PC Homegrown by Heroes Program in Bowdoinham, ME 3,000
    FEED MY STARVING CHILDREN
    401 93RD AVE NW
    COON RAPIDS,MN55433     		N/A PC General & Unrestricted 500
    FOOD BANK OF LINCOLN INC
    PO BOX 29228
    LINCOLN,NE68529     		N/A PC General & Unrestricted 5,000
    FOUNDATION FOR TEACHING ECONOMICS
    260 RUSSELL BLVD STE B
    DAVIS,CA95616     		N/A PC General & Unrestricted 1,000
    FRESH START INC
    6433 HAVELOCK AVE
    LINCOLN,NE68507     		N/A PC General & Unrestricted 2,000
    FRIENDSHIP SERVICE CENTER INC
    PO BOX 1896
    NEW BRITAIN,CT06051     		N/A PC Transitional Living Center Program 1,100
    GIRLS INCORPORATED OF THE GREATER CAPITAL REGION
    962 ALBANY ST
    SCHENECTADY,NY12307     		N/A PC Project Bold 2,000
    GOOD SAMARITAN LEAGUE INC
    590 W WASHINGTON ST
    BOISE,ID83702     		N/A PC General & Unrestricted 2,500
    GOOD SHEPHERD FOOD-BANK
    PO BOX 1807
    AUBURN,ME04211     		N/A PC Cooking Matters Program in Maine 1,000
    GREATER MARLBORO PROGRAMS INCORPORATED
    65 BOSTON POST RD W STE 220
    MARLBORO,MA01752     		N/A PC Community Living Arrangements Program 2,425
    GREENWICH EMERGENCY MEDICAL SERVICE INCORPORATED
    1111 E PUTNAM AVE
    RIVERSIDE,CT06878     		N/A PC General & Unrestricted 5,000
    HAWTHORN HILL
    3001 GRAND AVE
    DES MOINES,IA50312     		N/A PC General & Unrestricted 4,000
    HEBREW HOME FOR THE AGED AT RIVERDALE FOUNDATION
    5901 PALISADE AVE
    BRONX,NY10471     		N/A PC General & Unrestricted 1,000
    HEPHZIBAH CHILDRENS ASSOCIATION
    1144 LAKE ST
    OAK PARK,IL60301     		N/A PC General & Unrestricted 5,000
    HOPE MINISTRIES
    PO BOX 862
    DES MOINES,IA50304     		N/A PC General & Unrestricted 3,500
    HORACE MANN EDUCATIONAL ASSOCIATES INC
    8 FORGE PARK E
    FRANKLIN,MA02038     		N/A PC Autism Resource Center of Central Massachusetts Program 1,300
    HORACE MANN EDUCATIONAL ASSOCIATES INC
    8 FORGE PARK E
    FRANKLIN,MA02038     		N/A PC Educational Training for Disabled Program 2,425
    HUDSON LINK FOR HIGHER EDUCATION IN PRISON INC
    PO BOX 862
    OSSINING,NY10562     		N/A PC General & Unrestricted 5,000
    HUSSON UNIVERSITY
    1 COLLEGE CIR
    BANGOR,ME04401     		N/A PC Brent Cross Scholarship Fund 10,000
    IDAHO FOODBANK WAREHOUSE
    3562 S TK AVE
    BOISE,ID83705     		N/A PC General & Unrestricted 3,000
    INTERCULTURAL COMMUNITY CENTER
    36 PATRICK DR
    WESTBROOK,ME04092     		N/A PC Women's Health & Wellness Program 2,800
    INTREPID MUSEUM FOUNDATION INC
    W 46TH ST 12TH AVE
    NEW YORK,NY10036     		N/A PC General & Unrestricted 5,000
    IOWA COLLEGE FOUNDATION
    505 5TH AVE STE 1034
    DES MOINES,IA50309     		N/A PC General & Unrestricted 2,750
    JA WORLDWIDE
    200 CONNECTICUT AVE
    NORWALK,CT06854     		N/A PC General & Unrestricted 2,500
    JDRF INTERNATIONAL
    26 BROADWAY 14TH FL
    NEW YORK,NY10004     		N/A PC Northern New Jersey & Rockland County Chapter 10,000
    JEFF GORDON CHILDRENS FOUNDATION
    7575 W WINDS BLVD NW STE C
    CONCORD,NC28027     		N/A PF Texas Promise Circle Program for the Children's Blood & Cancer Center Campaign 1,500
    JOHN BROCKINGTON FOUNDATION
    1835 FORT STOCKTON DR
    SAN DIEGO,CA92103     		N/A PC General & Unrestricted 5,000
    JUNIOR ACHIEVEMENT OF LINCOLN INC
    285 S 68TH ST PL STE 580
    LINCOLN,NE68510     		N/A PC General & Unrestricted 1,000
    JUNIOR LEAGUE OF GREENWICH CONN INC
    231 E PUTNAM AVE
    GREENWICH,CT06830     		N/A PC General & Unrestricted 2,500
    KIDS CHANCE INC
    PO BOX 13756
    GREENSBORO,NC27415     		N/A PC General & Unrestricted 25,000
    KIDS CHANCE INC OF PENNSYLVANIA
    PO BOX 543
    POTTSTOWN,PA19464     		N/A PC General & Unrestricted 1,163
    KIDS CHANCE OF ARIZONA
    PO BOX 36753
    PHOENIX,AZ85067     		N/A PC General & Unrestricted 1,500
    KIDS CHANCE OF GEORGIA INC
    2024 POWERS FERRY RD STE 225
    ATLANTA,GA30339     		N/A PC General & Unrestricted 6,000
    KIDS CHANCE OF MARYLAND INC
    PO BOX 20262
    BALTIMORE,MD21284     		N/A PC General & Unrestricted 15,000
    KIDS CHANCE OF SOUTH CAROLINA INC
    PO BOX 2957
    GEORGETOWN,SC29442     		N/A PC General & Unrestricted 1,500
    KIDS CHANCE OF VIRGINIA INC
    12701 MARBLESTONE DR STE 250
    WOODBRIDGE,VA22192     		N/A PC General & Unrestricted 11,000
    KIDS IN CRISIS INC
    1 SALEM ST
    COS COB,CT06807     		N/A PC General & Unrestricted 10,000
    LITERACY VOLUNTEERS OF MID-COAST MAINE
    28 LINCOLN ST
    ROCKLAND,ME04841     		N/A PC GED Preparation Program 3,500
    LUVERNE AREA COMMUNITY FOUNDATION
    PO BOX 623
    LUVERNE,MN56156     		N/A PC Child Guide Program - Luverne Elementary School Fund 5,000
    LUVERNE AREA COMMUNITY FOUNDATION
    PO BOX 623
    LUVERNE,MN56156     		N/A PC Various funds on behalf of employees 46,000
    LUVERNE INITIATIVES FOR TOMORROW
    213 E LUVERNE ST
    LUVERNE,MN56156     		N/A PC Beyond the Yellow Ribbon Program 1,000
    LUVERNE STREET MUSIC INC
    303 N KNISS AVE
    LUVERNE,MN56156     		N/A PC General & Unrestricted 2,000
    LYMPHOMA RESEARCH FOUNDATION
    115 BROADWAY 13TH FL
    NEW YORK,NY10006     		N/A PC General & Unrestricted 2,500
    MAINE GUIDES EDUCATION FUND
    PO BOX 603
    PATTEN,ME04765     		N/A PC 4-H Camp Program 3,400
    MAINE MEDICAL CENTER
    22 BRAMHALL ST
    PORTLAND,ME04102     		N/A PC Maine Children's Cancer Program 2,000
    MAINE YOUTH LEADERSHIP INC
    PO BOX 11483
    PORTLAND,ME04104     		N/A PC Leadership Seminar Program 1,000
    MANHATTAN INSTITUTE FOR POLICY RESEARCH INC
    52 VANDERBILT AVE
    NEW YORK,NY10017     		N/A PC General & Unrestricted 12,500
    MASSACHUSETTS CHILDRENS FUND INC
    63 LAMPLIGHTER DR
    SHREWSBURY,MA01545     		N/A PC Nutritional Education Program 2,425
    MEALS FROM THE HEARTLAND
    357 LINCOLN ST
    W Des Moines,IA50265     		N/A PC General & Unrestricted 3,500
    MERIDIAN COMMUNITY COLLEGE FDN
    910 HWY 19 N
    MERIDIAN,MS39307     		N/A PC General & Unrestricted 1,000
    METROPORT MEALS ON WHEELS INC
    PO BOX 204
    ROANOKE,TX76262     		N/A PC General & Unrestricted 2,341
    MUSCULAR DYSTROPHY ASSOCIATION
    3925 FOUNTAINS BLVD 100
    CEDAR RAPIDS,IA52411     		N/A PC General & Unrestricted 2,500
    MY PLACE TEEN CENTER INC
    755 MAIN ST
    WESTBROOK,ME04092     		N/A PC After School Program 1,400
    NATIONAL CENTER FOR LEARNING DISABILITIES INC
    32 LAIGHT ST 2ND FL
    NEW YORK,NY10013     		N/A PC General & Unrestricted 5,000
    NAVY SEAL FOUNDATION INC
    PO BOX 5965
    VIRGINIA BEACH,VA23471     		N/A PC General & Unrestricted 10,000
    NEBRASKA CHILDRENS HOME SOCIETY INC
    4939 S 118TH ST
    OMAHA,NE68137     		N/A PC General & Unrestricted 2,000
    NEW HAMPSHIRE FOOD BANK
    DEPT F PO BOX 9510
    MANCHESTER,NH03108     		N/A PC Recipe for Success - Culinary Job Training Program 1,400
    NEWBORNS IN NEED
    PO BOX 340
    PFAFFTOWN,NC27040     		N/A PC General & Unrestricted 11,358
    NYU LANGONE MEDICAL CENTER
    1 PARK AVE 17TH FL
    NEW YORK,NY10016     		N/A PC Medical Ethics Division 1,000
    OCEANS HARBOR HOUSE INC
    808 CONIFER ST
    TOMS RIVER,NJ08753     		N/A PC General & Unrestricted 500
    OPEN HEARTH ASSOCIATION
    150 CHARTER OAK AVE
    HARTFORD,CT06106     		N/A PC General & Unrestricted 1,000
    OVERLAKE SERVICE LEAGUE
    13122 NE 20TH ST 100
    BELLEVUE,WA98005     		N/A PC General & Unrestricted 3,000
    PACKAGES FROM HOME
    5643 W MOUNTAIN VIEW RD
    GLENDALE,AZ85308     		N/A PC General & Unrestricted 2,500
    PEDIATRIC BRAIN TUMOR FOUNDATION OF THE US INC
    302 RIDGEFIELD CT
    ASHEVILLE,NC28806     		N/A PC General & Unrestricted 1,500
    PENOBSCOT THEATRE COMPANY
    115 MAIN ST FL 4
    BANGOR,ME04401     		N/A PC Dramatic Academy Program 5,000
    PINE TREE SOCIETY FOR HANDICAPPED CHILDREN & ADULT
    149 FRONT ST
    BATH,ME04530     		N/A PC Pine Tree Campers Fund 5,700
    PLUS FOUNDATION
    5353 WAYZATA BLVD STE 600
    MINNEAPOLIS,MN55416     		N/A SO I General & Unrestricted 500
    REGENTS OF THE UNIVERSITY OF MINNESOTA
    PO BOX 898
    LUVERNE,MN56156     		N/A PC General & Unrestricted 3,000
    RIVERS OF RECOVERY INC - CONNECTICUT CHAPTER
    PO BOX 752
    SOUTHPORT,CT06890     		N/A PC General & Unrestricted 2,000
    ROBBIE FOUNDATION
    PO BOX 1534
    SCARBOROUGH,ME04070     		N/A PC Arts Adventure Program 2,000
    ROCK COUNTY OPPORTUNITIES INC
    PO BOX 626
    LUVERNE,MN56156     		N/A PC General & Unrestricted 4,000
    ROCK COUNTY RED ARROW INC
    PO BOX 895
    LUVERNE,MN56156     		N/A PC General & Unrestricted 3,000
    SPECIAL OLYMPICS TEXAS INC
    1804 RUTHERFORD LN
    AUSTIN,TX78752     		N/A PC General & Unrestricted 540
    SPIERINGS CANCER FOUNDATION
    700 HARVEST TRL
    APPLETON,WI54913     		N/A PC General & Unrestricted 2,500
    ST JOHNS UNIVERSITY - SCHOOL OF RISK MANAGEMENT
    101 MURRAY ST
    NEW YORK,NY10007     		N/A PC General & Unrestricted 25,000
    ST MARYS FOOD BANK ALLIANCE
    2831 N 31ST AVE
    PHOENIX,AZ85009     		N/A PC General & Unrestricted 7,000
    THE ALFRED E SMITH MEMORIAL FOUNDATION
    1011 1ST AVE STE 1400
    New YORK,NY10022     		N/A PC General & Unrestricted 1,000
    THE BRIDGE-A VISION FOR SHARED DOWNTOWN MINISTRY
    600 6TH AVE
    DES MOINES,IA50309     		N/A PC The Connection Cafe Program 5,000
    THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
    110 S WALNUT AVE
    LUVERNE,MN65156     		N/A PC General & Unrestricted 2,500
    THE PRESBYTERIAN CHURCH IN LEONIA
    181 FORT LEE RD BOX 448
    LEONIA,NJ07605     		N/A PC General & Unrestricted 100
    TREASURE VALLEY FAMILY YMCA
    1177 W STATE ST
    BOISE,ID83702     		N/A PC Strong Kids Campaign 3,000
    UNITED CARE USA
    613 COLTS NECK CT
    COLLEYVILLE,TX76034     		N/A PC General & Unrestricted 500
    UNITED JEWISH APPEAL FED OF JEWISH PHILANTHROPIES
    130 E 59TH ST
    NEW YORK,NY10022     		N/A PC General & Unrestricted 100
    UNITED WAY INC
    PO BOX 15200
    PORTLAND,ME04112     		N/A PC Westbrook Bookmobile Program 500
    UNITED WAY OF GREENWICH INC
    1 LAFAYETTE COURT
    GREENWICH,CT06830     		N/A PC Greenwich Campership Program 2,500
    UNIVERSITY OF COLORADO FOUNDATION-DENVER CAMPUS
    PO BOX 17126
    DENVER,CO80217     		N/A PC Business School Risk Managment & Insurance Program 5,000
    URBANDALE COMMUNITY ACTION NETWORK INC
    PO BOX 7615
    URBANDALE,IA50323     		N/A PC General & Unrestricted 1,000
    URBANDALE FOOD PANTRY
    7611 DOUGLAS AVE STE 34/35
    URBANDALE,IA50322     		N/A PC General & Unrestricted 2,000
    VALLEY HOME CARE INC
    15 ESSEX RD
    PARAMUS,NJ07652     		N/A PC General & Unrestricted 100
    VETERANS INC
    69 GROVE ST
    WORCESTER,MA01605     		N/A PC Employment and Training Program 2,425
    VETERANS PLACE INC
    220 VINE ST
    NORTHFIELD,VT05663     		N/A PC General & Unrestricted 1,300
    VISITING NURSE ASSN OF CHITTENDEN AND GRAND ISLE
    1110 PRIM RD
    COLCHESTER,VT05446     		N/A PC VNA Family Room Fund 2,000
    VISITING NURSE SERVICES OF IOWA
    1111 9TH ST
    DES MOINES,IA50314     		N/A PC General & Unrestricted 1,500
    VOLUNTEER CENTER OF SONOMA COUNTY INC
    153 STONY CIR STE 100
    SANTA ROSA,CA95401     		N/A PC General & Unrestricted 2,500
    WASHINGTON LEGAL FOUNDATION
    2009 MASSACHUSETTS AVE NW
    WASHINGTON,DC20036     		N/A PC General & Unrestricted 15,000
    WAYSIDE FOOD PROGRAMS
    PO BOX 1278
    PORTLAND,ME04104     		N/A PC Food Rescue Program 3,000
    WEBSTER HOUSE
    135 WEBSTER ST
    MANCHESTER,NH03104     		N/A PC General & Unrestricted 2,500
    WESLEYAN UNIVERSITY
    237 HIGH ST
    MIDDLETOWN,CT06459     		N/A PC Green Street Teaching and Learning Ctr Discovery After School Program 1,000
    WWP INC - WOUNDED WARRIOR PROJECT INC
    4899 BELFORT RD STE 300
    JACKSONVILLE,FL32256     		N/A PC General & Unrestricted 100
    YMCA OF LINCOLN
    570 FALLBROOK BLVD STE 210
    LINCOLN,NE68521     		N/A PC Southeast YMCA Construction Project 2,000
    YORK COUNTY SHELTER PROGRAMS INC
    3 GEORGE RD
    ALFRED,ME04002     		N/A PC Community Farm Program 1,000
    YOUTH HOMES OF MID-AMERICA
    7225 NW 58TH ST
    JOHNSTON,IA50131     		N/A PC General & Unrestricted 5,000
    Total .................................bullet 3a 623,630
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See 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....          
    3
    Interest on savings and temporary cash investments ...........     		    14 45  
    4 Dividends and interest from securities....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot 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 ............     		         
    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)..   45  
    13Total. Add line 12, columns (b), (d), and (e)..................
    1345
    (See worksheet in line 13 instructions 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 foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 13
    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 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    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
    Sign Here
    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) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2015)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
    OMB No. 1545-0047
    2015
    Name of the organization
    WR Berkley Corporation Charitable
    Foundation
    Employer identification number

    36-4516560
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




    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
    Special Rules
    ......... Arrow Bullet $  
    Caution. An organization that is not covered by the General Rule and/or the Special Rules does not 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 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
    Name of organization
    WR Berkley Corporation Charitable
    Foundation         		Employer identification number
    36-4516560
    Part I
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
     
     

    Berkley Insurance Co  
    475 Steamboat Rd
     
    Greenwich, CT06830

    		$ 357,156


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
     
     

    WR Berkley Corporation  
    475 Steamboat Road
     
    Greenwich, CT06830

    		$ 250,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 3
    Name of organization
    WR Berkley Corporation Charitable
    Foundation         		Employer identification number

    36-4516560
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 4
    Name of organization
    WR Berkley Corporation Charitable
    Foundation         		Employer identification number

    36-4516560
    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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

    Additional Data


    Software ID:  
    Software Version:  

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    TY 2015 DepreciationSchedule
    Name:
    WR Berkley Corporation Charitable
     
    Foundation
    EIN:
    36-4516560
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included

    TY 2015 LiquidationExplanationStmt
    Name:
    WR Berkley Corporation Charitable
     
    Foundation
    EIN:
    36-4516560
    Statement:
    This statement is submitted to report the distribution of certain assets during the above referenced year. The distributions resulted in a substantial contraction of assets. The following information is submitted in accordance with Treasury Regulation Section 1.6043-3(a)(1) and the Form 990-PF instructions: During the taxable year ending December 31, 2015, the Foundation made distributions from assets from sources other than current income. Collectively, the distributions in excess of current income totaled $623,630. This amount represents over 25% of the Foundation's net assets of $412,876 (as measured by fair market value) at the beginning of the Foundation's taxable year ending December 31, 2015. Although the Foundation technically experienced a substantial contraction, it will continue in existence and has no plans for dissolution. The Foundation made distributions of cash to the grantees listed in the attachment to Part XV, Line 3a; each such grant was made solely for the charitable purpose specified therein.


    TY 2015 OtherExpensesSchedule
    Name:
    WR Berkley Corporation Charitable
     
    Foundation
    EIN:
    36-4516560
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Administrative Fees 3,762     3,762
    State or Local Filing Fees 25     25