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
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 10-01-2015 , and ending 09-30-2016
Name of foundation
THE ALON AND ROSANA MILLER FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)550 S HILL STREET
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LOS ANGELES, CA90013
A Employer identification number

20-0515170
B Telephone number (see instructions)

(213) 628-8619
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$2,503,659J 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)  
2 Check bullet Sch. B .............
3 Interest on savings and temporary cash investments 3,349 3,349 3,349
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)...  
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........ 3,349 3,349 3,349
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc.        
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule)......... Click to see attachment 530      
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 24 4 4  
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 list of attachments 150 150 150  
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 704 154 154 0
25 Contributions, gifts, grants paid....... 559,930 559,930
26 Total expenses and disbursements. Add lines 24 and 25 560,634 154 154 559,930
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -557,285
b Net investment income (if negative, enter -0-) 3,195
c Adjusted net income (if negative, enter -0-)... 3,195
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......... 163,097 2,503,546 2,503,546
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.......... 117 113 113
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).......... 2,897,730    
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) 3,060,944 2,503,659 2,503,659
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 3,060,944 2,503,659
30 Total net assets or fund balances (see instructions)..... 3,060,944 2,503,659
31 Total liabilities and net assets/fund balances (see instructions). 3,060,944 2,503,659
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
3,060,944
2
Enter amount from Part I, line 27a .....................
2
-557,285
3
Other increases not included in line 2 (itemize) bullet
3
 
4
Add lines 1, 2, and 3 ..........................
4
2,503,659
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
2,503,659
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 451,145    
2013 469,900 3,040,873 0.15453
2012 498,570 2,945,408 0.16927
2011 440,300 2,568,473 0.17143
2010 409,700 2,127,698 0.19256
2
Total of line 1, column (d) .....................
20.687779
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years . . .
3
0.137556
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
 
5
Multiply line 4 by line 3......................
5
 
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
32
7
Add lines 5 and 6........................
7
32
8
Enter qualifying distributions from Part XII, line 4.............
8
559,930
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 32
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 32
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 32
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a 113
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.............. 7 113
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  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 81
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet81 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
 
No
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
     
    No
    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)
    bulletCA
    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 addressbulletN/A
    14
    The books are in care ofbulletALON AND ROSANA MILLER FOUNDN Telephone no.bullet (213) 628-8619

    Located atbullet550 S HILL STREETLOS ANGELESCA ZIP+4bullet900132401
    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
     
    No
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 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
     
    No
    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
     
    No
    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
     
    No
    .........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
     
    No
    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
    ALON MILLER President
    1.00     		0    
    5145 AMESTOY AVENUE
    ENCINO,CA91316
    ROSANA MILLER Secretary
    1.00     		0    
    5145 AMESTOY AVENUE
    ENCINO,CA91316
    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...................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
    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
     
    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
    0
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    0
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
     
    3
    Subtract line 2 from line 1d.........................
    3
    0
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    0
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    0
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    0
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
     
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    32
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    32
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    32
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    32
    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
    0
    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
    559,930
    b
    Program-related investments—total from Part IX-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    559,930
    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
    32
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    559,898
    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 0
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2015:
    a From 2010...... 303,587
    b From 2011...... 312,140
    c From 2012...... 351,363
    d From 2013...... 317,936
    e From 2014...... 381,200
    fTotal of lines 3a through e........ 1,666,226
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 559,930
    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)........     		0
    d Applied to 2015 distributable amount.....  
    e Remaining amount distributed out of corpus 559,930
    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 2,226,156
    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) ...     		303,587
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......     		1,922,569
    10 Analysis of line 9:
    a Excess from 2011.... 312,140
    b Excess from 2012.... 351,363
    c Excess from 2013.... 317,936
    d Excess from 2014.... 381,200
    e Excess from 2015.... 559,930
    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).)
    ALON MILLER
    ROSANA MILLER
    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 e-mail address of the person to whom applications should be addressed:
    THE ALON AND ROSANA MILLER FOUNDATI
    550 S HILL STREET 770
    LOS ANGELES,CA900132401
    (213) 628-8619
    bThe form in which applications should be submitted and information and materials they should include:
    SUBMIT APPLICATION IN THE FORM OF A LETTER ON THE LETTERHEAD OF THE CHARITABLE ORGANIZATION. WE WANT TO KNOW WHEN THE ORGANIZATION WAS FOUNDED, WHAT IS THE PURPOSE OF THIS ORGANIZATION, AND WHAT GOALS ARE THEY STRIVING TO ACHIEVE. WHY DO THEY WANT THIS SPECIFIC AMOUNT OF FUNDS FROM OUR FOUNDATION AND WHAT SPECIFIC USE ARE THEY PLANNING FOR THE CONTRIBUTION.
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    THE AMOUNT OF ANY CONTRIBUTION MADE FROM THE FOUNDATION MUST BE UTILIZED FOR THE SPECIFIC PURPOSE THAT THE CHARITABLE ORGANIZATION STATED IT WAS TO BE USED FOR.
    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
    YESHIVA OHR ELCHONON CHABAD
    7215 WARING AVENUE
    LOS ANGELES,CA90046     		  PUBLIC CONSTRUCTION OF NEW SCHOOL DORMITORY 11,400
    MESIVTA OF GREATER LOS ANGELES
    25115 MUREAU ROAD
    CALABASAS,CA91302     		  PUBLIC SCHOOL BUILDINGS CONSTRUCTION 14,100
    VALLEY TORAH HIGH SCHOOL
    12517 CHANDLER BLVD
    VALLEY VILLAGE,CA91607     		  PUBLIC SCHOOL SCHOLARSHIP FUND 15,000
    AMERICAN FRIENDS OF ORA
    36 RODNEY ST
    BROOKLYN,NY11219     		  PUBLIC EDUCATION SCHOLARSHIP FUND 3,000
    AM FRNDS OF BEIT ISSIE SHAPIRO
    5870 OLYMPIC BLVD STE 107
    LOS ANGELES,CA90036     		  PUBLIC SUPPORT INNOVATIVE PROGRAMS FOR CHILDREN WITH DEVELOPMENTAL DISABILITIES 1,000
    HATZOLAH OF LOS ANGELES
    P O BOX 360559
    LOS ANGELES,CA90036     		  PUBLIC TO PROVIDE A LIFESAVING BRIDGE DURING THE CRITICAL MOMENTS IT TAKES THE MANDATED EMS PROVIDER TO ARRIVE, BY PROVIDING LIFESAVING INTERVENTION, PREVENTING ADDITIONAL INJURY AND/OR FURTHER DETERIORATION OF THE PATIENT'S HEALTH AND WELLBEING, STABILIZING THE PATIENT/S AND PROVIDING COMFORT 2,500
    OHR ELIYAHU ACADEMY
    241 S DETROIT STREET
    LOS ANGELES,CA90036     		  PUBLIC SUPPORT TORAH AND GENERAL STUDIES EDUCATION 3,600
    EMEK HEBREW ACADEMY
    15365 MAGNOLIA BLVD
    SHERMAN OAKS,CA91403     		  PUBLIC SCHOLARSHIP FUND 18,000
    MERKAZ HATORAH COMMUNITY KOLLEL
    1441 SOUTH CARDIFF AVENUE
    LOS ANGELES,CA90035     		  PUBLIC EDUCATIONAL SCHOLARSHIP FUND 8,500
    ISRAELI LEADERSHIP COUNCIL
    5900 CANOGA AVE STE 390
    WOODLAND HILLS,CA91367     		  PUBLIC TO SUPPORT EDUCATION AND ECONOMICAL GOALS FOR ORGANIZATIONS SUPPORTING ISRAEL 17,000
    ISRAEL EMERGENCY ALLIANCESTAND WITH
    PO BOX 341069
    LOS ANGELES,CA90034     		  PUBLIC DEDICATED TO EDUCATING PEOPLE SO THAT THEY CAN MORE EFFECTIVELY ADVOCATE FOR ISRAEL AND PEACE LOVING PEOPLE OF ALL FAITHS. 46,000
    THE SOURCE OF LIFE INC
    17815 VENTURA BLVD 213-215
    ENCINO,CA91316     		  PUBLIC TO SUPPORT A RELIGIOUS CENTER TO EDUCATE JEWISH FAMILIES IN THE LEARNING OF TORAH AND OTHER RELIGIOUS STUDIES. 130,000
    LARGER THAN LIFE
    P O BOX 480835
    LOS ANGELES,CA90048     		  PUBLIC SUPPORT THE BUILDING OF TWO NEW APPLIED RESEARCH LABORATORIES AT TEL-HASHOMER HOSPITAL IN ISRAEL. AT THE FOREFRONT OF IMPROVING THE QUALITY OF LIFE OF KIDS WITH CANCER, REGARDLESS OF RELIGION, RACE OR ETHNICITY. 15,000
    BNOS DEVORAH HIGH SCHOOL
    7659 BEVERLY BLVD
    LOS ANGELES,CA90036     		  PUBLIC SCHOOL SCHOLARSHIP FUND 25,000
    LOS ANGELES CHEDER
    801 N LA BREA AVENUE
    LOS ANGELES,CA90038     		  PUBLIC EDUCATIONAL INSTITUTION IMPROVEMENTS FOR THE BENEFIT OF THE CHILDREN 22,600
    WEST VALLEY ERUV SOCIETY
    18625 WELLS DRIVE
    TARZANA,CA91356     		  PUBLIC TO SUPPORT THE CONSTRUCTION OF AN ERUV FOR THE WEST SAN FERNANDO VALLEY 66,000
    BAIS YAAKOV SCHOOL FOR GIRLS
    7353 BEVERLY BLVD
    LOS ANGELES,CA90036     		  PUBLIC SCHOLARSHIP FUND 3,600
    NAHAL HAREDI
    586 SUNDERLAND ROAD
    TEANECK,NJ07666     		  PUBLIC TO PROVIDE THE IDF SOLDIERS WITH VITAL SERVICES SUCH AS EDUCATIONAL AND VOCATIONAL TRAINING; RABBINIC MENTORING AND RELIGIOUS ENRICHMENT PROGRAMS. 5,000
    AISH
    1417 S DOHENY DRIVE
    LOS ANGELES,CA90035     		    SCHOLARSHIP FUND 3,000
    AMERICAN FRIENDS OF ORCHOS CHAIM
    17402 CITRONIA STREET
    NORTHRIDGE,CA91325     		    SCHOLARSHIP FUND 4,000
    CHAI LIFELINE
    151 W 30TH STREET
    NEW YORK,NY10001     		    SUPPORT PROGRAMS FOR ASSISTING FAMILIES THROUGH BOTH THE CRISES AND EVERYDAY TRIALS OF SERIOUS PEDIATRIC ILLNESS 5,000
    HILLEL HEBREW ACADEMY
    9120 W OLYMPIC BLVD
    BEVERLY HILLS,CA90212     		    SCHOLARSHIP FUND 1,000
    MACHOM BETH MEIR
    1339 48TH STREET
    BROOKLYN,NY11219     		    SCHOLARSHIP FUND 5,000
    FRIENDS OF PITTSBURGH INSTITUTIONS
    411 N CITRUS AVENUE
    LOS ANGELES,CA90036     		    SCHOLARSHIP FUND 2,000
    YESHIVA HANEGEV INC
    860 W 181 STREET
    NEW YORK,NY10033     		    TO PROVIDE OPPORTUNITIES FOR THE YOUTH OF THE NEGEV 2,500
    ZION ORPHANAGE
    69-27 181 STREET
    FRESH MEADOWS,NY11365     		    ZION EDUCATION SCHOLARSHIP FOR ORPHANS AND DISADVANTAGED CHILDREN 2,000
    CHEDER LUBAVITCH HEBREW DAY SCHOOL
    5201 WEST HOWARD
    SKOKIE,IL60077     		    SCHOOL SCHOLARSHIP FUND 1,000
    AMERICAN FRIENDS OF SHEBA MEDICAL C
    9465 WILSHIRE BLVD 300
    BEVERLY HILLS,CA90212     		    HELPING THOSE IN NEED OF MEDICAL ATTENTION 1,900
    AM FRIENDS OF THE ISRAEL PHILHARMON
    9911 W PICO BLVD 505
    LOS ANGELES,CA90035     		    TO SUPPORT THE ISRAEL PHILHARMONIC ORCHESTRA AND ITS MUSIC EDUCATION PROGRAM FOR ISRAELI YOUTH 1,000
    AM FRIENDS OF MAGEN DAVID ADOM
    6505 WILSHIRE BLVD 650
    LOS ANGELES,CA90048     		    TO SUPPORT THE PARAMEDICS ABLE TO HELP IN MEDICAL EMERGENCIES 12,500
    STAND BY ME
    15910 VENTURA BLVD 812
    ENCINO,CA91436     		    TO PROVIDE FINANCIAL AND MORAL SUPPORT NEEDED TO CONTINUE OUR WORTHY MISSION, PROVIDING NECESSARY SERVICES TO THE CANCER PATIENTS IN OUR COMMUNITY 1,800
    ZICHRON SHLOMO REFUAH FUND
    1319 51st ST
    BROOKLYN,NY11219     		    TO SUPPORT THE FINANCIAL, EMOTIONAL AND PRACTICAL NEEDS OF THE CANCER PATIENTS AND THEIR FAMILIES 1,000
    AMERICAN FRIENDS OF BIRCHAS MORDECH
    15 HERSCHEL TERRACE
    MONSEY,NY10952     		    SCHOLARSHIP 1,000
    AMERICAN FRIENDS OF IDF-LA
    6505 WILSHIRE BLVD STE 625
    LOS ANGELES,CA90048     		    TO SUPPORT THE MEN AND WOMEN IN HARMS WAY 22,000
    BEIT MIDRASH HACHIDA
    44 Bayit Vagan Street
    Jerusalem,Jerusalem16096
    IS     		    SCHOLARSHIP 1,000
    CONGREGATION KEHILAS YAAKOV
    7211 BEVERLY BOULEVARD
    LOS ANGELES,CA90036     		    SCHOLARSHIP 1,500
    FRIENDS OH OHR ELCHONON
    27 OHOLIAC STREET
    JERUSALEM,JERUSALEM36200
    IS     		    SCHOLARSHIP 3,000
    HOMAT ZION
    PO BOX 5017
    JERUSALEM,JERUSALEM91050
    IS     		    SCHOLARSHIP 1,000
    JEWISH AWARENESS MOVEMENT JAM
    369 N FAIRFAX AVE 4
    LOS ANGELES,CA90036     		    CAMPUS OUTREACH AND EDUCATION PROGRAM 12,000
    KOSHER INFORMATION BUREAU
    12753 CHANDLER BOULEVARD
    NORTH HOLLYWOOD,CA91607     		    KASHRUS INFORMATION INFORMATION FOR ISRAEL AND MANY OTHER COUNTRIES. 7,200
    LCBY INC
    8 SHARON COURT
    LAKEWOOD,NJ08701     		    SCHOLARSHIPS 12,500
    YESHIVA LEV AVRAHAM
    1331 EAST 34TH STREET
    BROOKLYN,NY11210     		    SCHOLARSHIP 4,500
    LANIADO HOSPITAL
    9025 WILSHIRE BLVD 301
    BEVERLY HILLS,CA90211     		    TO HELP PROVIDE QUALITY CARE TO THE PATIENTS. AN INVESTMENT IN THE LIVES OF THE 350,000 RESIDENTS OF NETANYA AND ENVIRONS. THE ONLY HOSPITAL AVAILABLE. 1,800
    MATEH AHARON
    C/O S GREENBERG 1511 ALLSTON WAY
    BERKELEY,CA94703     		    EDUCATION 1,000
    METZAD CONGREGATION
    1371 S BEVERLY GLEN BLVD 206
    LOS ANGELES,CA90024     		    SCHOLARSHIP 1,500
    BET MEDRASH MEVASER TOV
    17915 Ventura Blvd Ste 212
    Encino,CA91316     		    EDUCATION 1,800
    NACHLAS HATORAH INC
    3917 W STRATHMORE AVE
    BALTIMORE,MD21215     		    SCHOLARSHIP 1,000
    NAGEL JEWISH ACADEMY
    18648 CLARK STREET
    TARZANA,CA91356     		    SCHOLARSHIP 3,000
    VALLEY COMMUNITY KOLLEL
    5552 RESEDA BLVD
    TARZANA,CA91356     		    SCHOLARSHIP 1,000
    WIZO INT'L ZIONIST ORG
    9461 CHARLEVILLE BLVD 207
    BEVERLY HILLS,CA90212     		    DAY CARE CENTERS AND ABUSED WOMEN'S SHELTERS IN ISRAEL 1,000
    NCSY
    9831 WEST PICO BLVD STE 101
    LOS ANGELES,CA90035     		    EDUCATIONAL PROGRAMMING 1,800
    WORLD OF BELZ
    4303 15TH AVE
    BROOKLYN,NY11219     		    EDUCATIONAL PROGRAMS 1,800
    YESHIVA BEIT RAFAEL
    7520 VLEIGH PLACE
    FLUSHING,NY11367     		    SCHOLARSHIPS 1,000
    YESHIVA GEDOLAH OF LOS ANGELES
    5444 WEST OLYMPIC BLVD
    LOS ANGELECA,CA90036     		    SCHOLARSHIPS 13,500
    YESHIVA KETANA OF LOS ANGELES
    12131 BURBANK BLVD
    VALLEY VILLAGE,CA91607     		    SCHOLARSHIPS 1,000
    SAMUEL A FRYER YAVNEH HEBREW ACADEM
    5353 WEST THIRD STREET
    LOS ANGELES,CA90020     		    SCHOLARSHIPS 10,000
    YOUNG ISRAEL NORTH BEVERLY HILLS
    9261 ALDEN DRIVE
    BEVERLY HILLS,CA90210     		    SCHOLARSHIP 2,030
    Total .................................bullet 3a 559,930
    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 ...........     		        3,349
    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)..     3,349
    13Total. Add line 12, columns (b), (d), and (e)..................
    133,349
    (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: 15000324
    Software Version: 2015v3.0


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2015 LegalFeesSchedule
    Name:
    THE ALON AND ROSANA MILLER FOUNDATION
    EIN:
    20-0515170
    Software ID:
    15000324
    Software Version:
    2015v3.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Legal Fees 530 0 0 0


    TY 2015 OtherExpensesSchedule
    Name:
    THE ALON AND ROSANA MILLER FOUNDATION
    EIN:
    20-0515170
    Software ID:
    15000324
    Software Version:
    2015v3.0
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EMA FILING FEE 150 150 150  


    TY 2015 TaxesSchedule
    Name:
    THE ALON AND ROSANA MILLER FOUNDATION
    EIN:
    20-0515170
    Software ID:
    15000324
    Software Version:
    2015v3.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Excise Tax on Investment Income 4 4 4  
    Secretary of State Filing Fees 20