TY 2015 Form 990PF

- TIN:

Form990-PF
Click to see attachment

Department of the Treasury
Internal Revenue Service

Return of Private Foundation

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

Do not enter social security numbers on this form as it may be made public.
bullet

Information 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 12-01-2015 , and ending 11-30-2016

Name of foundation
ADRIAN FAMILY FOUNDATION

Number and street (or P.O. box number if mail is not delivered to street address)1610 Las Canoas Rd
Room/suite

City or town, state or province, country, and ZIP or foreign postal code
Santa Barbara, CA931052345

A Employer identification number

33-0783199

B Telephone number (see instructions)

(805) 898-1969

C If exemption application is pending, check here bullet

G Check all that apply: Initial returnInitial return of a former public charity
Final returnAmended return
Address changeName change

D 1. Foreign organizations, check here ............. bullet

2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet

E If private foundation status was terminated
under section 507(b)(1)(A), check here ....... bullet

H Check type of organization: Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trustOther taxable private foundation

F If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here ....... bullet

I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16) bullet

$3,794,450J Accounting method: Cash Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)

	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	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)
2	Check Sch. B .............
3	Interest on savings and temporary cash investments	12,682		12,682
4	Dividends and interest from securities...	99,872		99,872
5a	Gross rents............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10		7,537
b	Gross sales price for all assets on line 6a 288,485
7	Capital gain net income (from Part IV, line 2)...			7,537
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).......		1,183	1,183
12	Total. Add lines 1 through 11........	121,274		121,274
13	Compensation of officers, directors, trustees, etc.	0		0	0
14	Other employee salaries and wages......
15	Pension plans, employee benefits.......
16a	Legal fees (attach schedule).........
b	Accounting fees (attach schedule).......		5,800	1,000	4,800
c	Other professional fees (attach schedule)....		3,791	0	3,791
17	Interest...............
18	Taxes (attach schedule) (see instructions)...		204	119	85
19	Depreciation (attach schedule) and depletion...
20	Occupancy..............
21	Travel, conferences, and meetings.......
22	Printing and publications..........
23	Other expenses (attach schedule).......		50,003	16,091	33,912
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	59,798		17,210	42,588
25	Contributions, gifts, grants paid.......	309,022			309,022
26	Total expenses and disbursements. Add lines 24 and 25	368,820		17,210	351,610
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	-247,546
b	Net investment income (if negative, enter -0-)			104,064
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	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing.............
	2	Savings and temporary cash investments.........	126,522	141,832	141,832
	3	Accounts receivable
		Less: allowance for doubtful accounts
	4	Pledges receivable
		Less: allowance for doubtful accounts
	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)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use..............
	9	Prepaid expenses and deferred charges..........
	10a	Investments—U.S. and state government obligations (attach schedule)	0	135,000	135,000
	b	Investments—corporate stock (attach schedule).......	1,624,794	2,029,740	2,029,740
	c	Investments—corporate bonds (attach schedule).......	170,496	0	0
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans.............
	13	Investments—other (attach schedule)..........	1,684,266	1,487,878	1,487,878
	14	Land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	15	Other assets (describe )
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	3,606,078	3,794,450	3,794,450
	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 )
	23	Total liabilities (add lines 17 through 22).........	0	0
		Foundations that follow SFAS 117, check here
		and complete lines 24 through 26 and lines 30 and 31.
	24	Unrestricted..................	3,606,078	3,794,450
	25	Temporarily restricted...............
	26	Permanently restricted...............
		Foundations that do not follow SFAS 117, check here
		and complete lines 27 through 31.
	27	Capital stock, trust principal, or current funds........
	28	Paid-in or capital surplus, or land, bldg., and equipment fund
	29	Retained earnings, accumulated income, endowment, or other funds
	30	Total net assets or fund balances (see instructions).....	3,606,078	3,794,450
	31	Total liabilities and net assets/fund balances (see instructions).	3,606,078	3,794,450

Part III

Analysis of Changes in Net Assets or Fund Balances

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) ...............

3,606,078

Enter amount from Part I, line 27a .....................

-247,546

Other increases not included in line 2 (itemize) bullet

435,918

Add lines 1, 2, and 3 ..........................

3,794,450

Decreases not included in line 2 (itemize) bullet

Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .

3,794,450

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.)
1 a	Publicly Traded Stock
b	Publicly Traded Stock
c	Capital Gain Distribution
d	Publicly Traded Stock
e	PUblicly Traded Stock

(e) Gross sales price		(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a	159,096	152,834	6,262
b	128,169	128,114	55
c	190		190
d	783		783
e	247		247

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			6,262
b			55
c			190
d			783
e			247

2	Capital gain net income or (net capital loss)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	2	7,537
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 ...................		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? Yes No

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	273,300	4,036,883	0.067701
2013	238,813	4,362,387	0.054744
2012	184,263	4,107,582	0.044859
2011	94,436	3,902,093	0.024201
2010	93,786	3,757,585	0.024959

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

20.216464

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 . . .

0.043293

Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....

3,411,704

Multiply line 4 by line 3......................

147,703

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

1,041

Add lines 5 and 6........................

148,744

Enter qualifying distributions from Part XII, line 4.............

351,610

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)

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	Exempt operating foundations described in section 4940(d)(2), check here and enter “N/A" on line 1.
	Date of ruling or determination letter: (attach copy of letter if necessary–see instructions)
b	Domestic foundations that meet the section 4940(e) requirements in Part V, check	1	1,041
	hereand 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	1,041
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	1,041
6	Credits/Payments:

a	2015 estimated tax payments and 2014 overpayment credited to 2015	6a	8,680
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	8,680
8	Enter any penalty for underpayment of estimated tax. Check hereif Form 2220 is attached.		8
9	Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......		9
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...		10	7,639
11	Enter the amount of line 10 to be: Credited to 2015 estimated tax7,639	Refunded	11	0

Part VII-A

Statements Regarding Activities

During the tax year, did the foundation attempt to influence any national, state, or local legislation or did

Yes

it participate or intervene in any political campaign? ....................

Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see Instructions

for definition)?.................................

If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials

published or distributed by the foundation in connection with the activities.

Did the foundation file Form 1120-POL for this year?.....................

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

Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. bullet

$ 0

Has the foundation engaged in any activities that have not previously been reported to the IRS?.......

If "Yes," attach a detailed description of the activities.

Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles

of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....

Did the foundation have unrelated business gross income of $1,000 or more during the year?........

If "Yes," has it filed a tax return on Form 990-T for this year?...................

Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........

If "Yes," attach the statement required by General Instruction T.

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?................

Yes

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..................................

Yes

Enter the states to which the foundation reports or with which it is registered (see instructions)

If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney

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

Yes

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.............................

Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names

and addresses. ...............................

Form 990-PF (2015)

Page 5

Part VII-A

Statements Regarding Activities (continued)

At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the

meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............

Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had

advisory privileges? If "Yes," attach statement (see instructions).................

Did the foundation comply with the public inspection requirements for its annual returns and exemption application?

Yes

Website address bullet

N/A

The books are in care of bullet

Gina Adrian-Giannetto Telephone no. bullet

(805) 898-1969

Located at bullet

1610 Las Canoas RdSanta BarbaraCA ZIP+4 bullet

931052345

Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —Check here....... bullet

and enter the amount of tax-exempt interest received or accrued during the year ...... bullet

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

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? YesNo

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person?......................YesNo

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? YesNo

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? YesNo

(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)?...............YesNo

(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.).......YesNo

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)? ........

Yes

Organizations relying on a current notice regarding disaster assistance check here........ bullet

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?.............

Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private

operating foundation defined in section 4942(j)(3) or 4942(j)(5)):

At the end of tax year 2015, did the foundation have any undistributed income (lines 6d

and 6e, Part XIII) for tax year(s) beginning before 2015?.............YesNo

If "Yes," list the years bullet

20, 20, 20, 20

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.) ..............

If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.

20, 20, 20, 20

Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at

any time during the year?......................YesNo

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.)..................

Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?

Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its

charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2015?

Form 990-PF (2015)

Page 6

Part VII-B

Statements Regarding Activities for Which Form 4720 May Be Required (Continued)

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))? YesNo

(2) Influence the outcome of any specific public election (see section 4955); or to carry

on, directly or indirectly, any voter registration drive?.............YesNo

(3) Provide a grant to an individual for travel, study, or other similar purposes? YesNo

(4) Provide a grant to an organization other than a charitable, etc., organization described

in section 4945(d)(4)(A)? (see instructions)................YesNo

(5) Provide for any purpose other than religious, charitable, scientific, literary, or

educational purposes, or for the prevention of cruelty to children or animals?.....YesNo

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)? ......

Organizations relying on a current notice regarding disaster assistance check here......... bullet

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?..........YesNo

If "Yes," attach the statement required by Regulations section 53.4945–5(d). Click to see attachment

Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on

a personal benefit contract?.....................YesNo

Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....

If "Yes" to 6b, file Form 8870.

At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? YesNo

If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....

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
Donald J Adrian through 912016	President 20.00	0	0	0
287 La Costa Avenue Encinitas,CA92024	President 20.00	0	0	0
Mark Anderson through 912016	Secretary/Treasurer 5.00	0	0	0
287 La Costa Avenue Encinitas,CA92024	Secretary/Treasurer 5.00	0	0	0
Duncan McColl	Board Member 1.00	0	0	0
287 La Costa Avenue Encinitas,CA92024	Board Member 1.00	0	0	0
Craig Racine through 812016	Board Member 1.00	0	0	0
287 La Costa Avenue Encinitas,CA92024	Board Member 1.00	0	0	0
David Adrian through 912016	Vice President 1.00	0	0	0
287 La Costa Avenue Encinitas,CA92024	Vice President 1.00	0	0	0
Armando Osario	Board Member 1.00	0	0	0
287 La Costa Avenue Encinitas,CA92024	Board Member 1.00	0	0	0
Jean Smith through 812016	Board Member 1.00	0	0	0
287 La Costa Avenue Encinitas,CA92024	Board Member 1.00	0	0	0

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
NONE









Total number of other employees paid over $50,000...................				0

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
NONE

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	REVOLVING LOAN FUND (RLF) PROGRAM: SEE STATEMENT A	30,400
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)

Page 8

Part X

Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see instructions.)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,

purposes:

Average monthly fair market value of securities...................

3,346,460

Average of monthly cash balances.......................

117,199

Fair market value of all other assets (see instructions)................

Total (add lines 1a, b, and c).........................

3,463,659

Reduction claimed for blockage or other factors reported on lines 1a and

1c (attach detailed explanation) .............

Acquisition indebtedness applicable to line 1 assets..................

Subtract line 2 from line 1d.........................

3,463,659

Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see

instructions) .............................

51,955

Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4

3,411,704

Minimum investment return. Enter 5% of line 5..................

170,585

Part XI

Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here bullet

and do not complete this part.)

Minimum investment return from Part X, line 6....................

170,585

Tax on investment income for 2015 from Part VI, line 5......

1,041

Income tax for 2015. (This does not include the tax from Part VI.)...

Add lines 2a and 2b............................

1,041

Distributable amount before adjustments. Subtract line 2c from line 1............

169,544

Recoveries of amounts treated as qualifying distributions................

Add lines 3 and 4............................

169,544

Deduction from distributable amount (see instructions).................

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

169,544

Part XII

Qualifying Distributions (see instructions)

Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:

Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........

351,610

Program-related investments—total from Part IX-B..................

Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,

purposes...............................

Amounts set aside for specific charitable projects that satisfy the:

Suitability test (prior IRS approval required)....................

Cash distribution test (attach the required schedule) .................

Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4

351,610

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).................

1,041

Adjusted qualifying distributions. Subtract line 5 from line 4..............

350,569

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)

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					169,544
2 Undistributed income, if any, as of the end of 2015:
a Enter amount for 2014 only.......				15,337
b Total for prior years:20, 20, 20			0
3 Excess distributions carryover, if any, to 2015:
a From 2010......
b From 2011......
c From 2012......
d From 2013......
e From 2014......
fTotal of lines 3a through e........		0
4Qualifying distributions for 2015 from Part
XII, line 4: $ 351,610
a Applied to 2014, but not more than line 2a				15,337
b Applied to undistributed income of prior years (Election required—see instructions).....			0
c Treated as distributions out of corpus (Election required—see instructions)........		0
d Applied to 2015 distributable amount.....					169,544
e Remaining amount distributed out of corpus		166,729
5 Excess distributions carryover applied to 2015.		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		166,729
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 instructions ...........			0
e Undistributed income for 2014. Subtract line 4a from line 2a. Taxable amount—see instructions .............				0
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) .......		0
8Excess distributions carryover from 2010 not applied on line 5 or line 7 (see instructions) ...		0
9Excess distributions carryover to 2016. Subtract lines 7 and 8 from line 6a ......		166,729
10 Analysis of line 9:
a Excess from 2011....
b Excess from 2012....
c Excess from 2013....
d Excess from 2014....
e Excess from 2015....	166,729

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 section4942(j)(3) or4942(j)(5)

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	(e) Total

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).)

Donald J Adrian through 912016

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

if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under
other conditions, complete items 2a, b, c, and d.

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)

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)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year
Accion Medica Intergral San Luca 07 AV 2-07 Zona 1 San Juan La Laguna Solola GT	None	NC	To train leaders to address community health issues to prevent diseases. To establish medical clinicThe Foundation supports strengthening rural community health in Solona, Guatemala. The grant is designated for training Pastors and lay leaders to address community health issues to prevent diseases and decrease their severity. A medical clinic has been established along with environmental innovations such as latrines and rural stoves. The grant funds are to be expended over the period January 31, 2015 through December 31, 2017. Total grant amount: $87,134.47	29,022
Seven Sisters International PO Box 3069 Breckenridge,CO804243069	None	PC	Provides rehabilitative care to minor girls rescued from trafficking and abuse.	30,000
Plant with Purpose 4747 Morena Blvd San Diego,CA92117	None	PC	Provide a platform for agricultural land environmental projects as well as sharing God's love.	250,000
Total ................................. 3a				309,022

bApproved for future payment

Total ................................. 3b				0

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	(e) Related or exempt function income (See instructions.)
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	12,682
4 Dividends and interest from securities....			14	99,872
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.....			14	1,183
8 Gain or (loss) from sales of assets other than inventory ............			18	7,537
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		121,274	0

13Total. Add line 12, columns (b), (d), and (e)..................

13121,274

(See worksheet in line 13 instructions to verify calculations.)

Part XVI-B

Relationship of Activities to the Accomplishment of Exempt Purposes

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

Form 990-PF (2015)

Page 13

Part XVII

Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations

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

Transfers from the reporting foundation to a noncharitable exempt organization of:

(1) Cash...................................

1a(1)

(2) Other assets.................................

1a(2)

Other transactions:

(1) Sales of assets to a noncharitable exempt organization....................

1b(1)

(2) Purchases of assets from a noncharitable exempt organization..................

1b(2)

(3) Rental of facilities, equipment, or other assets.......................

1b(3)

(4) Reimbursement arrangements...........................

1b(4)

(5) Loans or loan guarantees.............................

1b(5)

(6) Performance of services or membership or fundraising solicitations................

1b(6)

Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............

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

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?...........YesNo

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.
				May the IRS discuss this return with the preparer shown below (see instr.)? Yes No
	Signature of officer or trustee	Date	Title

Paid Preparer Use Only	Print/Type preparer's name	Preparer's Signature	Date	Check if self- employed	PTIN
	Firm's name				Firm's EIN
	Firm's address				Phone no.

Form 990-PF (2015)

Additional Data

Software ID:
Software Version:

Form 990PF - Special Condition Description:

Special Condition Description

- TIN:

TY 2015 AccountingFeesSchedule

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Accounting Fees	5,800	1,000		4,800

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

TY 2015 ExpenditureResponsibilityStmt

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

Grantee's Name	Grantee's Address	Grant Date	Grant Amount	Grant Purpose	Amount Expended By Grantee	Any Diversion By Grantee?	Dates of Reports By Grantee	Date of Verification	Results of Verification
Accion Medica Integral San Lucas	07 AV 2-07 Zona 1 San Juan La Laguna Solola GT	2016-06-06	29,022	TO TRAIN PASTORS AND LAY LEADERS TO ADDRESS COMMUNITY HEALTH ISSUES TO PREVENT DISEASES AND DECREASE THEIR SEVERITY. A MEDICAL CLINIC WILL BE ESTABLISHED ALONG WITH ENVIRONMENTAL INNOVATIONS SUCH AS LATRINES AND RURAL STOVES.	29,022	N/A	1/31/2017		In accordance with IRS regulations section 53 4945-5(d), the following information is provided regarding the grants made or approved by the Adrian Family Foundation to organizations that are not exempt under sections 509(a)(l), (2) or (3) or section 4940(d)(2). The Foundation will exercise expenditure responsibility over these grants. The information provided includes the name and address of the grantee, the date and amount of the grant and the purpose of the grant. For grants approved or paid in the current tax year, information regarding the nature and amount of expenditures incurred by the grantees will be provided upon receipt of the grantees' annual reports which are generally due one year after payment of the grant. To the best of our knowledge no grantee has diverted any portion of the funds from the purpose of the grant.
Accion Medica Integral San Lucas	07 AV 2-07 Zona 1 San Juan La Laguna solola GT	2015-03-31	27,640	TO TRAIN PASTORS AND LAY LEADERS TO ADDRESS COMMUNITY HEALTH ISSUES TO PREVENT DISEASES AND DECREASE THEIR SEVERITY. A MEDICAL CLINIC WILL BE ESTABLISHED ALONG WITH ENVIRONMENTAL INNOVATIONS SUCH AS LATRINES AND RURAL STOVES.	27,640	N/A	2/15/2016		In accordance with IRS regulations section 53 4945-5(d), the following information is provided regarding the grants made or approved by the Adrian Family Foundation to organizations that are not exempt under sections 509(a)(l), (2) or (3) or section 4940(d)(2). The Foundation will exercise expenditure responsibility over these grants. The information provided includes the name and address of the grantee, the date and amount of the grant and the purpose of the grant. For grants approved or paid in the current tax year, information regarding the nature and amount of expenditures incurred by the grantees will be provided upon receipt of the grantees' annual reports which are generally due one year after payment of the grant. To the best of our knowledge no grantee has diverted any portion of the funds from the purpose of the grant.

- TIN:

TY 2015 GeneralExplanationAttachment

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

Identifier	Return Reference	Explanation
Summary of Direct Charitable Activities	Part IX A	1. REVOLOVING LOAN FUND (RLF) PROGRAMA revolving loan program has been established in the Dominican Republic. The general program includes agroforestry training and loans to impoverished farmers for agroforestry farm development to enable them to become self-sufficient. Long term loans (6 to 10 years) are made for establishing timber and fruit trees and short term loans (about 1 -3 years) for intercrops. The farmers use the loan proceeds to purchase plants, seeds, fertilizer and other agroforestry supplies as well as for their living expenses while they are working on the farms and the crops are maturing. The loans will be repaid as the crops are harvested and sold. Some of these farmers have begun to harvest their trees and are selling their wood and beginning to repay their loans. The farmers who are interested in the program generally live on their farm land and the soil quality is generally suitable. Eight farmers, all below the poverty level, were selected in 2001 using specific criteria and have received training in agroforestry by an agroforestry technician. The loan procedures are established and part time personnel have been contracted to operate the program. Except for two drought periods, additional farmers have been added each year. The work load per farmer is heaviest in the first couple of years, and then decreases allowing time for new farmers to be trained. A total of 66 farmers have benefited from the program. Twelve of the farmers have repaid their loans and one has defaulted. Farmer's plant eucalyptus, acacia, and mahogany due to the high local demand in addition to various other trees including: bananas, coffee, orange and cacao. The farmers generally grow a large portion of their seedlings in community nurseries established by the foundation. This significantly reduces the cost of establishing their farms. Plans are being made for community nurseries.2. BRAIN RESEARCHThis activity covers research directed towards non-pharmaceutical treatment of currently incurable diseases such as Alzheimer's and Parkinson's disease.Part of the study involves medical library research to find low cost symptomatic treatments such as physical and speech therapy, value of exercise and avoidance of obesity. The next level of the research for possible relief of symptoms is by reprogramming the neural system. For example, implanted deep brain stimulators in the sub thalamus neurons. These devices are very expensive and we are investigating non-invasive methods such as bio-feedback and extremely low frequency electrical stimulation.Finally we plan to investigate the stimulation of brain cells to produce natural chemicals which may be neuroprotective. Stimulus possibilities include heat and electromagnetic radiation. Experiments with rats show that exercise stimulates the production of neurotropic factors which slow degeneration and cause the growth of new neurons in the hippocampus, an area in the brain important for Alzheimer's disease. It remains to be determined if this will occur in humans. However exercise can be recommended at this time since it has been shown effective in treating depression which often accompanies neurodegenerative diseases.Biofeedback using EEG and accelerometer signals has been experimented with to reduce tremors associated with Parkinson's disease. In cooperation with a consortium of researchers, new signal processing and display techniques have been investigated for studying tremor. The possible use of tremor data as an indicator of disease progression is also being studied. Preliminary analysis indicates that tremor frequency decreases as Parkinson's disease progresses. We have found that massage has an effect on tremor similar to biofeedback. Both biofeedback and massage seem to produce an "alpha state" in EEG. This state is the opposite of stress or excited state which is known to promote tremor. Experiments with a massage machine have shown little effect on tremor. This is disappointing since available machines would be much more economical than a massage therapist. The study is still continuing and other methods of obtaining the benefits of human touch will be examined. We have found that a combination of heavy exercises (a stationary bicycle and treadmill) and biofeedback allows for the reduction of medication (and resulting side effects) for symptomatic treatment of Parkinson's disease. In one case this reduction has lasted several years but we have not yet isolated the relative contribution of exercise and biofeedback.The individual mentioned in the last paragraph has had other ailments for the last couple of years which led to severe reduction of his exercise. His medication has had to be increased to 400 mg of levo dopa per day from an earlier 200 to 250 mg per day. Massage therapy has continued during this time. This result hints that exercise may be more important than massage (or biofeedback) in slowing symptoms. In cooperation with another foundation, the electrical stimulation of the peripheral nervous system is being studied for reducing tremor and muscle stiffness and pain associated with neurological disorders. Long range plans include using electrical stimulation to mimic part of the effects (e.g. contracting of muscles) of exercise. This is important since persons with more advanced disease have difficulty in exercising. 3. ACCION MEDICA INTEGRAL SAN LUCAS (AMI)The Foundation supports strengthening rural community health in Solona, Guatemala. The grant is designated for training Pastors and lay leaders to address community health issues to prevent diseases and decrease their severity. A medical clinic has been established along with environmental innovations such as latrines and rural stoves. The grant funds are to be expended over the period January 31, 2015 through December 31, 2017. Total grant amount: $87,134.47

- TIN:

TY 2015 InvestmentsCorpBondsSchedule

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

Name of Bond	End of Year Book Value	End of Year Fair Market Value
Corporate Bonds	0	0

- TIN:

TY 2015 InvestmentsCorpStockSchedule

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

Name of Stock	End of Year Book Value	End of Year Fair Market Value
760 Shares Centurylink	17,875	17,875
2,481 Shares Communications Sales & Leasing	61,851	61,851
1,000 Shares Countrywide	25,470	25,470
500 Shares Jacobs Engineering Group	31,005	31,005
5,500 Shares Medtronic	401,555	401,555
400 Shares Perkinelmer Inc.	20,288	20,288
18,500 Shares Qualcomm Inc.	1,260,405	1,260,405
11,100 Shares Sprint Corp	87,024	87,024
1,000 Shares Walgreens Boots Alliance Inc.	84,730	84,730
2,067 Shares Winstream Holdings Inc.	15,317	15,317
2,000 Shares America Movil	24,220	24,220

- TIN:

TY 2015 InvestmentsGovtObligationsSch

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

US Government Securities - End of Year Book Value:

US Government Securities - End of Year Fair Market Value:

State & Local Government Securities - End of Year Book Value:

135,000

State & Local Government Securities - End of Year Fair Market Value:

135,000

- TIN:

TY 2015 InvestmentsOtherSchedule2

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

Category/ Item	Listed at Cost or FMV	Book Value	End of Year Fair Market Value
Mutual Funds	FMV	1,487,834	1,487,834
Rights and Warrants	FMV	44	44

- TIN:

TY 2015 OtherExpensesSchedule

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

Description	Revenue and Expenses per Books	Net Investment Income	Disbursements for Charitable Purposes
Insurance	2,217	0	2,217
Miscellaneous Expense	1,295	0	1,295
Fees	16,091	16,091	0
RLF - Progrm Expense	30,400	0	30,400

- TIN:

TY 2015 OtherIncomeSchedule2

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

Description	Revenue And Expenses Per Books	Net Investment Income	Adjusted Net Income
Fee Reimbursement	1,183	1,183	1,183

- TIN:

TY 2015 OtherIncreasesSchedule

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

Description	Amount
Unrealized Gain/Loss	435,918

- TIN:

TY 2015 OtherProfessionalFeesSchedule

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Bookkeeping	1,775	0		1,775
Consulting	2,016	0		2,016

- TIN:

TY 2015 TaxesSchedule

Name:

ADRIAN FAMILY FOUNDATION

EIN:

33-0783199

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Filing Fees	85	0		85
Foreign Tax	119	119		0