Fo~m.990-PF Return of Private...

Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust

Treated as a Private Foundation Note The oryanaeuon may be able to use a copy of this return to satisfy state raFron

or tax Year oeoinnino . and enAlno

OMB No 731y0052

LOOL oaperm+n o1 a. Tmeun IntrrW fyrM . Sw,o

the the IRS Name of organization

label Otherwise, I INTERSCHOLASTIC INJURY FUND

print NurMI and 8hsl (a P O DDa AU~DY II X11 a Wt 0"n>eE b "VM bORY) RmM~ult~

or typo 83 ROSEGARDEN STREET Sea Specific Instructions City or town, stale, and ZIP code

WICK RI 02888 H Check type of organization M Section 501(c)(3) exempt private foundation 0 Section 4947(a)(1)nonexempt chantabletrust [::] Other taxable private foundation

I Fair market value al all assets al end of year J Accounting method OX Cash E] Accrual (/turn Pert II, cot (c), line 76) ED Other (specify) " E 2 3 0 4 4 9 0 . (Pert 1, coximn (0 must be on cash basis ) art { Analysis of Revenue and Expenses (a) Revenue and (b) Net investment crn~. mfw

N of .~de. ~~ w.d.~. m), (q, add (m R+r dot books income e4uY me vrwnbm mwmn W expenses per

- 244 . STATEMENT 2 67 , 833- STATEMENT 3

"' STATEMENT 1

43433 .

40,370-STATEMENT 4 151 880 .

8 , 158 . 0 .

95 . 0 . 2 , 094 . 0 .

0 .

624 . 0 .

3 , 240 . 0 .

12 486 . 0 .

B . 26 , 697 . 0 . 3-8 , 85-4 .

8 . 2-6 , 697, 3-8 , 85-4 .

9 . V

125 183 ., - T _ ̂ T-^ _-----_- . - Form 990-PF(2002)

27 Subtract We 26 from line 12 i Ear al rnriua me, aapnsm nu anounmianb

0 NB1 Investment Income pf --PWw edW -0-)

~.~ <7 :17i .~- ~ . ..

LFLA For Paperwork Reduction Act Notice, see the Instructions 2

Fo~m .990-PF

1 Contributions, gifts, grants, etc , received Gnu 111' ml 'Ihbuwilm smIRamA m amCi SCE B

2 Distributions from split-interest gusts t on uvmw via Wnpo~ry

3 ingot inn u,.emWu

4 Dividends and interest from securities Sa Gross rents b (Not rentai ... ot Q.)

6a Net sped or Pipe .) td~dd "* oT~ not od nn* 10 Groom, ". pd. for an 8-98,530 . _`de

Od pd* 6@ r cc 7 Cep,w gn net id~ tMon, Pm W. one 2)

8 Net short-term capital gain 9 Income modifications

lei Gives sales less MUma .m rio.rca b Lee, coat of woMm sad

C Gross profft or (loss) 11 Other income

Q 12 Total Add lines I throu g h 11 '~ 13 Conqnuhonalolfiwa dirclm trustee Nc

11 Other employee salaries and wages

y � 15 Pension plans, employee benefits 16a Legal fees S

b Accounting fees c Other professional le ~ T 70 .E

17 interest (1

m 18 Taxes .~;}vl 8

19 Depreciation and deple~io

E 20 Occupancy a 21 Travel, conferences. and meet p5 m 22 Printing and publications ~ 23 Other expenses STMT 9 m 21 Total operating and administrative n expenses Ado lines 13 through 23 0 25 Contnbubons, pals, grants gab

26 Total expenses and disbursements

61,806

100 .660

Employer Identification number

OS-0374155 B Telephone number

(401)461-6270 C u usrwoun wolkroon a wwln cneC* here NO. ED D 1 Foreign organizations, check here pf~ E] j Fore orpanin4oro nee4np Me 95% t<L ,

fJ1K111n NE 7LIYl1 Wd~pYt14011

E If private foundation status was terminated under section 507(b)(1)(A), check here 10,

F It tie foundation is m a 60-month termination ~ne. .e.a- cmiwvnio, ..w . . . .~ w...

(c) Adjusted net income

17 Accounts payable and accrued expenses t8 Grants payable

d 19 Detained revenue 20 lnn . ho.olno»,a,ncton Mtwa ~naameralw.d1nppwaom

m 21 Mortgages and other notes payable 22 Other liabilities (describe " 1

23 Total liabilities add lines 17 throw A 22 0 . 0 .

Organizations that follow SFAS 117, check here and complete lines 24 through 25 and lines 30 and 31

24 Unrestricted 25 Temponny restricted

m 26 Permanency restricted °c Organizations that do not follow SFAS 117, check dare 1 D 0

and complete lines 27 through 31 27 Capital stock . trust principal . or current funds 0 . 0 .

28 Paid-in or capital surplus, or land, bldg and equipment fund 0 . 0 .

29 Retained earnings, accumulated income, endowment, or other funds 0 . -0 .

30 Total netassets orfund balances 2 , 550 , 923a 2 , 582 , 570 ..

1 31 Total liabilities ananetassets /fu nd oaunces 2 , 550 , 923 . 2 , 58-2 , 570 .

partjp Analysis of Changes in Net Assets or Fund Balances

1 Total net assets of fund balances at beginning of year - Part 11, column (a), line 30 (mustagree with en0-of-yearfigure reported on Dnoryeafsretum) t 2,550, 923 .

2 Enter amount tram Part I, line 27a Z <7 , 17 -1-.>

3 Other increases notincluded inline 2(dem¢e) 1 BASIS ADJUSTMENT 3 39 , 477 .

4 nddlines i,2,and3 e 2 , 583 , 229 .

5 Decreases not included m line 2 (itemize) " FED EXC TAX 5 659 .

6 Total net assets or lurid balances at end of ear brie 4 minus brie 5 - Put II, column (b ) , line 30 8 2 5 82 570 . F. 990-PF a=

223511 01 z3-m 3

TTTTODP~ll/ITTCTT1

Form s90-PP~2002) RI INTERSCHOLASTIC INJURY FUND OS-0374155 Pagex

~~ Balance Sheets ~�'m°`°�,d�~�°�̀�~,b�~pr,~a�E~��~~ Beginning ofyear EnAOlyear

Book Value (G) Book Value (c) Fair Market Value

t Cash -non,nterest-beannq 15 , 929 . 13 , 407 . 13 , 407 . 2 savings anGtemporary cash investments 16 , 198 . 21 , 345 . 21 , 345 . 3 Accounts receivable 0 -

Less allowance for doubtful accounts d Pledges receivable

Less anowance for doubtful accounts 5 Gams rewrvaLie 6 Recervables due from officers directors trustees, and other

disqualified persons 7 aeroesma~uis~e 1 k . , , . �

Less allowance for doubtful accounts 8 inventories for sale of use 9 Prepaid expenses an0deferred charges 7 , 973 . 8 , 370 . 8 , 370 .

N

a 10a investments - U S and state government obligations

b Investments -corporate stock STMT 10 2 , 375 , 282 .. 2 , 151 , 006t 1 872 926 . a Investments-corporate bonds

11 �~e imaeuwm,raep.p~o~ L1511, amm"Llimaro~ 1

12 Investments - mortgage loans 13 investments-other STMT 11 135 541 . 388 442 . 388 442 . 14 Land, buildings, and equipment basis 10'

L=mmumam~ 15 Other assets (describe

,9 *., .,1 ...etr/1nFnnnmntafeAhvellfilertl 2 .550,923 . 2 .582,570 . 2 .304490 .

Fo~msso-PF(2oo2 RI INTERSCHOLASTIC INJURY FUND Part N Capital Gams and Losses for Tax on Investment Income

(a) List m0 describe the kind(s) of property sold (e q , reel estate, 2-story brick warehouse, or common stork, 200 shs MLC Co )

12 o SEE ATTACHED STATEMENTS c a 8

(e) Grass sales price (1) Depreciation allowed (p) Cost or other bash (or allowable) opus expense of sale

m column (A) and owned by the foundation on 12!l1/69 (1) Adjusted basis (q Excess of coi (i) as of 12/31/69 overcol(j),rtany (I) FMV as o112/31/69

<16,691 . >

<16,691 . >

43,433 .

N/A J Fit V I Qualification Under Section 494U(el for Reduced Tax on Net Inve(For optional use by domestic private foundations subbed to the section 4940(a) to on net investment income )

8 Enter qualifying distributions from Part %1I, line 4 ~ B I It line 8 is equal to or greater than line 7, check tie box in Part VI, line 1b, and complete that part using a 1% tax rate Seethe Part VI instructions

inWlAl 7J-07 Form 990-PF (2002) 4

mFOCrvn,rcT*~ .,* ., .., . . .. .,-- .~~~ .

for assets

2 Capital pain net income or (net capital loss) ( It ain, also enter in Part 1, line 7 1

If loss), enter -0-m Part l, line 7

3 Net short-term capital pain or (loss) as defined in sections 1222(5) and (6) If gain, also enter in Part I, line 8, column (c) It floss). enter -0-in Part I line B

It section 4940(0)2) applies, leave this part blank

Was the organization table for the section 4942 tax on the distributaGle amount of any year in the base penod9 0 Yes 0 No It-Yes.' Ine organization does not quality under section 49401e) Do not completathis part 1 Enter the appropriate amount in each column for each year, sea instructions before making any entries

ratio Base Dente years Adjusted qualifying distributions Net value of nonchalnlahtewse assets Distn6uGOn ratio Calenaarvearlortaxvearbeainninainl (cot (b)divided DVCOI (c11

2 Total of line 1, column (D) 3 Average distribution ratio for the 5-year base period -divide tie total on line 2 by 5, or by tie number o1 years

tie foundation has been in existence A less than 5 years

d Enter the net value at nonchafiable-use assets tai 2002 tom Part X, tine 5

5 Multiply line 4 by line 3

6 Enter 1 °A, of net investment income (1% of Part I, line 276)

7 /10d lines 5 and fi

OS-0374155

(e) Date acquired I (d) Date sold (m( , day, yr ) (mo day, yr )

(n) Gam or (loss) (e) plus (1) minus (p)

(1) Gams (Col (h) pain minus col (k), but not less than -0-) or

Losses (from col (A))

c Tax paid with application for extension of time to file (Forth 8868) 6C O Backup withholding erroneously withhek! 7 Total credits and payments Add lines 6a through 6d 8 Enter any penalty for underpayment of estimated tax. Check here E~) d Form 2220 is attached 9 Tax due II the total of lines 5 and 8 n more than line 7, enter amount owed 10 Overpayment I1 tine 7 is more than the total of lines 5 and 8, enter the amount overpaid 11 Enter the amount of lin e 70 to be Credited to 2003 estimated tai " 7 , 711 .I Refunded

370 .

X

11 Did tie organization comply with the public inspection requirements for R5 annual returns and exemption application? Web site address 10- N/A

12 7heDOOksaremwreol " RAYMOND T . DWYER Telephone no "4U1-461-6170 Locateuat " 83 ROSEGARDEN STREET, WARWICK, RI ZIPa X02888

13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF to lieu of Farm 1031 " Check here " D

v~ 990-PF Roan

RI I

to Exempt operating foundations described m section 4940(d)(2) check here " LJ and enter N/A' on fine t Dale o1 ruling lever (attach copy of ruling lever If necessary-see Instructions)

b Domestic organizations that meet the section 4940(e) requirements in Part V, check here 1 ID and enter t%

ot Part 1, line 27b c All other domestic organizations enter 2% 01 line 270 Exempt foreign orpanQations enter 4% of Part 1, line 12, col (b)

2 Tax under section 511 (domestic section 4947(a)(1 ) trusts and taxable foundations only Others enter -0-) 3 Add tines 7 and 2 e Subtitle A (income) tax (domestic section 4947(a)(1 ) trusts and taxable foundations only Others enter 4) 5 Tax based an investment income Subtract line 4 from line 3 It zero or less, enter -0- 6 CreEdSRayments a 2002 eestimated tax payments and 2001 overpayment credited to 2002 6a 8

b Exempt foreign organizations - tax withheld at source 60

5-03741

59 .

1 a During the tax year, did tie organization attempt to influence any national, state, or local legislation or did R participate or intervene in any political campaign7

b Did it spend more than $700 during the year (either directly or indirectly) for political purposes (see instructions for Oefindion)? If the answer a 'Yes' l0 1 t or 1 h, attach a detailed description of the ectmbes end copies of any materials published or distributed by the organization in connection with the activities

c Did tie organization file Form 1120-POL for this year A Enter the amount (d any) of taa on political expenditures (section 4955) imposed during the year

(t) On the organization " $ 0 " (2) On organization managers " t 0 e Enter tie reimbursement (A any) Dab 6y the organization during tie year for political expenditure tax imposed on organization

managers " S 0 .- 2 Has tie organization engaged in any activities that have not previously been reported to the IRS 9

I! 'Yes,' attach a detailed description of the actnaties 3 Has the organization made any changes, not previously reported to tie IRS, in its governing Instrument, articles o1 incorporation, or

bylaws, or other similar instruments? If 'Yes,' attach a conformed copy of the changes <s Did the organization have unrelated business gross income of $7,000 or more during the year 0 If Yes' his R filed a tax retain on Farm 990-T for this years N/A

5 Was there a liquidation . termination dissolution . or substantial contraction during the yeah 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 m the governing instrument or " By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the stale law

remain in the governing instrument 7 Did the organization have al least 15.000 in assets al any time during the yeah M 'Yes,' complete Part 11, cot (c), end Part XV

B7 Enter the states to which the foundation reports or with which 9 is registered (see instructions) 10' RHODE ISLAND

0 II the answer is 'Yes' to line 7, has the orpan¢ation furnished a copy of Forth 990-PF to the Attorney General (or designate) of each state as required by General Instruction G7 If 'No,' attach explanation

9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(p(5) for calendar year 2002 or the taxable year beginning in 2002 (see instructions for Part )(IV)? If 'Yes,' compote Part XIV

10 Did any persons become substantial contributors during the tax yeah a ~a., " @idrti . rJ~~pN* IIsWp Ner n~n~a ~M ~EUrme

55

X

1l 'Yes,' attach the statement required by Regulations section 53 4945-5(dJ 6a Did the organization, during tie year, receive any funds, directly or indirectly . to pay premiums on

a personal benefit contnct7 0 Yes 0 No 6 Did the orpan¢abon, during tie year, pay premiums, directly or indirectly, on a personal benefit contract?

It you answered 'Yes' to 66, also fib Form 8870 Foam 980-PF Rov11

217511 O7-T}07

Form 990-PF(2002) RI

Fib Form 4720 A any item is checked in the 'Yes' column, unless an exception applies . 1a During the year did the organization (either directly or indirectly)

(1) Engage in the sale or exchange. or leasing of property with a disqualified persons 0 Yes D No (2) Borrow money from, lend money to, or otherwise extend credit to (or accept rt from)

a disqualified persons 0 Yet o NO (3) Furnish goods, services, or facilities to (or accept them from) a disqualified penon7 ~ Yes D No (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? Yes EKI No (5) Transfer any income or assets to a disqualified person (or make any of either available

for the benefit or use of a disqualified personp Yes M1 No (6) Agree to pay money or property to a government officLaI9 (Exception Check 'No'

d the organization agreed to make a grant to or to employ the official for a period after termination of government service A terminating within 90 days ) D Yes D No

D If any answer is -Yes' to 1a(1)-(6), did any of the acts tail to quality under the exceptions described in Regulations section 53 4941(d)-3 or in a current notice regarding disaster assistance (see page 19 of the Instructions)-) NBA Organizations retying on a current notice regarding disaster assistance check here

c Did the organization engage in a poor 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 2002 Taxes on failure to distribute income (section 4942) (does not apply for years the organization was a private operating foundation defined in section 4942(j)(3) or 4942(j)(5))

a At the end of tax year 2002, did the organization have any undistributed income (lines 60 and tie, Part %11I) for fax year(s) beginning before 2002 =Yes o Na It Yes,' list the years

b Are there any years listed in 2a for which tie organization is pat applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets) to tie years undistributed incomes (If applying section 4942(a)(2) to all years listed, answer No' and attach statement - see instructions ) N /A

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

3a Did the organization fold more than a 2% direct or indirect interest in any business enterprise at any time during tie yeaf9 0 Yet M No

h It Yes' did it have excess business holdings in 2002 as a result of (1) any purchase by the organization or disqualified persons after May 26, 1969,12) 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 70-, 15-, or 20-year first phase holding period) (Use Schedule C, Form 4720, to determine if the organization had access business holdings in 2002) N/A

Ia Did the organization invest during the year any amount in a manner that would jeopardize Its charitable purposes'P h Did the organization make any investment in a prior year (bud after December 31, 1969) that could jeopardize its charitable purpose that had not been removed from jeopardy baton the first day of the lax year beginning in 2002

Sa During tie year did the organization pay or incur any amount to (1 ) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? 0 Yes EKI No (2) Influence the outcome of any Specific politic election (see section 4955), or to carry on, directly or indirectly,

any voter registration d me? ~ Yes 0 No (3) Provide a grant to an individual for travel, study, or athersimiWr Durposes7 ~ Yes D No (6) Provide a grant to an organization other than a charitable, etc , organization described m section

509(a)(1), (2) or (3), or section 4940(d)(2)7 ~ Yes [~ No (S) Provide for any purpose other than religious, charitable . scientific, literary, or educational purposes, or far

the prevention of cruelty to children or animals ~ Yet D No b If any answer is Yes' to Sa(1)-(5), did and of the transactions fail to quality under the exceptions described in Regulations

section 53 4945 or in a current notice regarding disaster assistance (see instruclions)9 N/A Organizations raying on a cogent notice regarding disaster assistance check here

a If the answer is Yes'to question Sa(4), does the organization claim exemption from the lax because it maintained expenditure responsibility for the grant7 N/A Yes No

X

I INTERSCHOLASTIC IN s

independent contractors for professional semces. Name and address o1 each person paid more than 550.000

enter 'NONE

10.

3DICK REYNOLDS AWARDS

RI a

Form 990-PF (2po2) 7

Information About Officers, Directors, Paid Employees, and Contractors

1 List all ofGurs, directors, trustees, foundation managers an

(a) Name and address

(a) Name and address of each employee paid more than 150,000

Total number

VJ~

Foundation Managers, Hiphty

(b)TNe,and hours per wee

16,317

on une Title and

(c) Compensation

Total number of others retemn over 550,000 for professional services Part IX-A Summary of Direct Charitable Activities List tie foundation's four largest direct charitable activities during tie tax year Include relevant statistical information such as the number of orpanmlions and other be n eficia ries served, con fe re n ces conven ed, resea rch pa p ers p roduced etc tBOYS HIGH SCHOOL ATHLETIC INJURIES

2 SC

Expenses

1 Minimum investment return from Part X, line 6 1 2a 7a: on investment income for 2002 tram Part VI, line 5 2a 0 Income tax for 2002 (This does hat include the tax from Part VI ) 2h c Add lines 2a and 2b 2c

3 Oistnbutable amount before adjustments Subtract line 2c from line 1 3 0 a Retouches of amounts treated as qualifying distributions 4a 6 Income distributions from section 4947(a)(2) trusts CG e Add lines 4a and 4b as

5 Add lines 3 and 4c 5 5 Deduction from dislnbutable amount (see instructions) g 7 OIttrICutaEle amount as adjusted Subtract line 6 from line 5 Enter here and on Pad XIII, line 1 7

Part XN Qualifying Distributions (see instructions)

8

Form 990-PF(2002) RI INTERSCHOLASTIC INJURY FUND OS-0374155 Part (X-B Summary of Program-Related Investments

Describe tie two Largest DroqramrelateA investments made by the foundation during the tax year on lines 1 and 2 1 Amount 1

2

All other program-related investments See Instructions 3

Total Add lines 1 through 3

Pd1't X minimum investment Return (All domestic foundations must complete this part Foreign foundations, see instructions )

1 Fair market value of assets not used (or hold for use) Ouecty m carrying out charitable, etc , purposes a Average monthly fair market value of securities 2,561 265 b Average olmonthly cash balances 1E 33 439 . c Fair market value otaiiother assets tc 8 172 . a Total (aaalines ia,e and c) is 2 , 602 , 876 . e Reduction claimed for blockage or other factors reported on lines to and

tc (attach detailed explanation) to 0 . 2 Acquisition indebtedness applicable to line 1 assets 2 0 . 3 Subtract line 2from line ia 3 2 , 602 , 876 . 4 Cash deemed held for charitable activities Enter 1 1R% of line 3 (for greater amount, see instructions) d 39 043 . 5 Net value of noncherltahle-use assets Subtract line 4 from line 3 enter here and on Part v, line 4 ( 5 2,563, 833 . 6 Minimum Investment return Enter 5% 01 line 5 6 128, 192 .

~ DIStIlbutable Amount (see instructions) (Section ..494Y(j)(3)~nG (1)(5) private operating foundations and certain

', ..e., . . . , . .,. ., . . ... . . . . . ,. ... .' w_ ._ , 11 .

1 Amounts paid (including administrative expenses) to accomplish charitable, etc , purposes a Expenses, contributions, grits, etc -toUl from Part I, column (d), line 26 12 38 , 854 . D Program-related investments -Total from Part IX-B 10 0 .

2 Amounts paid to acquire assets used (or held for use) directly in carrying out charrtaDle, etc , purposes 2 2-5- , 815 . 3 Amounts set aside for specific charitable projects that satisfy the

a SurUbility test (prior IRS approval required) 3a b Cash distribution test (attach the required schedule) 3b

d Qualifying distribution: Add lines to through 3b Enter here and on Pad V, line 8, and Part XIII, line 4 t 64 , 6 6 9 . 5 Organizations that quality under section 4940(e) for the reduced rate of tax on net investment

income Enter 116 0l Part I, line 27b 5 0 . 6 Adjusted qualifying distributions Subtract tine S from line 4 ~ 6 64, 669 .

Note The amount online 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualities for the section 4940(e) reduction of tar in those years

Fog 990-PF Roan

223561 o, 23-M

Form 990-yF(2002) RI INTERSCHOLASTIC INJURY FUND OS-0374155 page e Aart XIII Undistnbuted Income (see unsiructans)

121 Ibl W (a) Corpus Years prior to 2007 2001 2002

1 DisinbufaGle amount for 2002 from Part Xl, line 7 0 .

2 waumoutao mmrr. a My n of w era of 2001 .. ,. ~ ' . ,

a Enter amount tar 2001 only ~ Q , b Total for prior years

3 Excess distributions carryover rtany,to 2002 7 From 1997 D From 1998 c From 1999 d From 2000 e From Y001 1 Total of lines 3a through 9

4 Qualifying distributions for 2002 from Part %II,line 41S N/A

a Applied to 2001, Gut not more than line 2a D Applied to undistributed income at poor years (Election required -see instructions)

c Treated as distributions out of corpus (Election required -see instructions)

d Applied to 2002 distnbuU0le amount e Remaining amount distributed out of corpus

5 E.. abtinuuon. wyws roou.a W 2002 of en enqunt al in column (E) Me unr amount moat a snow, in wune, (.))

6 Enter the net total of each column as Indicated below

7 Corpus Add lines 31, ~ Ana N Subbcl line S

0 Prior years' undistributed income Subtract line 4b from line 2b

c Enter the amount o1 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 6t from line 6b Taxable amount-see instructions

e Undistributed income far 2001 Subtract line 9a from line 2a Taxable amount " see insir

1 Undistributed income for 2002 SSubtract lines 4d and S from line 1 This amount must ' be distributed in 2003

7 Amounts treated as distributions out of corpus to sassy requirements imposed by section 170(b)(1)(E) or 4942(g)(3)

8 Excess distributions carryover from 1997

., ., 0 .

0 .

0 .

O .

0 .

Fon,, B90-PF Rmz)

d Excess from 2001 e Excess from 2002

127577 01 2103

9 amts ann')oo orrniac ono, ..~ . . ..~ *,r

V ~ 0 .1

not applied on line 5 or line 7 0 . 9 Excess distributions cunovar to 2003

Subtract tines 7 and 8 from fine 6a 0 .1 10 Analysis of line 9

a Excess from 1998 ~ ' b Excess from 1999 c Excess from 2000

0 .

c Any submission deadlines N/A

d My restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions . or other factors HIGH SCHOOLS, COLLEGES, HOSPITALS, TEACHING, PREVENTION, MEDICINE

F.990-PF R= M5111,01 23-M

10 t

ortn99o-PF Y0o2 RI INTERSCHOLASTIC INJURY FUND OS-0374155 XIV Private Operating Foundations (see instructions end Part VII q question s)

1 a II the foundation has received a ruling or determination letter that it is a private operabng foundation, and the ruling is effective toy 2002 enter the date at the ruling lo. I

D Check box to Indicate whether the orpanixahon a a mate Operatin g foundation described in section OX 4942 (j)( 3 ) or 4942 (1)(5 ) 2 a Enter the lesser of the adjusted net Tax ear Prior 3 years

income from Part I or the minimum 012002 (b) 2001 (c) 2000 (0)1999 (e) Total

investment retain from Part X for each year listed 125 183 . 96 , 170 . 113 214 . 138 926 . 473 493 .

G &5%afline 2o 106 406 . 81 , 745 . 96- , 2-3-2-, 118 087 . 402 469 . c 4ualAyinq distributions from Part XII,

line 4foreach year listed 64 , 669 . 63 , 863 . 69 , 114 . 79,554 . 277 200 . G Amounts included in line 2C not used directly for acme conduct of exempt actrvdies 0 . 0 . 0 . 0 . 0 .

e Qualifying distributions made Avecty for active conduct of exempt activities Subtract line YOfrom line 2c 64 , 669 . 63 1 863 . 69 , 114 . 79 , 554 . 277 200 .

3 Complete 3a, b, or c for the attematrve test relied upon

a 'Assets' attematrve test-enter (1) Value of all assets 0 . (2) Value of assets qualifying

under section 4942(j)(3)(8)(Q 0 . D 'EnCOwmenY atternatrve test - Enter

2/3 0l minimum investment retain

V~slaeninPart x,line 6toreach year year

85 , 461 . 92,557 . 94,771 . 92,617 . 365 406 . c 'SuDDOrC alternative test - enter

(1) Total support other than gross investment income (interest dividends rents, payments an securities loans (section 512(a)(5)), or royalties) 0

(2) SuDDOAfrom peneralpublic and 5 or more exempt organizations as provided m section 4902(j)(3)(8)(ni) 0 .

(3) largest amount of support from r an exempt organization 1 0 .

PI artXV 1 Supplementary Information (complete this part only if the organization had $5,000 or more in assets at any time during the year-see page 25 of the instructions.)

1 Information Regarding Foundation Managers a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation before the close of any tax

year (but any d they nave contributed more than $5,000) (See section 507(4)(2) )

NONE e List nay managers of the foundation who awe 10°/. or more of the stock al a corporation (or an equally large portion of the ownership of a partnership of

other entity) of which the foundation has a 10% or greater interest

2 Information Regarding Contribution, Grant, Grit, Loan, scholarship, ate, Programs: Check here 10 LD d the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds it the organization makes grits, grants, etc (sea instructions) to Individuals or organizations under other conditions, complete items 2a, b, C . and d

It The name address, and telephone number of the person to whom applications should be addressed RAYMOND T . DWYER, C/O RI INTERSCHOLASTIC INJURY FUND, 83 ROSEGARDEN ST ., WARWICK, RI 02888 401-461-6270

D The form in which applications should be submitted and information and matenals they should include N/A

Total " 3D ~ 0 . xnsoiAi-2a03 Foam 990-PF Roozl

11 crun,n'ZTTr *r�TTn .. ~ N .Mex « ,

Form 990-PF(2002) RI INTERSCHOLASTIC INJURY FUND OS-0374155 Pa el0 Pmt 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 Foundation Purpose o1 grant or

Name and address (dome or business) any foundation manager status of coninbution Amount orsubstantial contnDutar recipient

a Pad during the year

DICK REYNOLDS REYNOLDS AWARDS WARDS 916 .

INJURY HIGH SCHOOL BOYS REATMENT 25,207 .

INJURY HIGH SCHOOL GIRLS REATMENT 11,297 .

UTSTANDING THLETE AND

NELSON SCHOLARSHIP TUDENT 500 .

UTSTANDING THLETE AND

PARISEAU SCHOLARSHIP TUDENT 514 .

RI COLLEGE ATHLETICS ONATION 320 .

RI CANCER SOCIETY ONATION 100 .

Tota l 0, 3a 38 , 854 . 6 Approved lorfuture peyment

NONE

12 T

Form 99o-PF(20o2) RI INTERSCHOLASTIC INJURY FUND OS-0374155

Part XYI-A I Analysis of Income-Producing Activities unreia~eo ousmess i~~wma r..auan ..coop siz su or su Enter gross amounts unless otherwise indicated (e) (1) (h) ° � (A) Related Orexempt

1 Program service revenue Busines s Amount ~~� Amount function income

a 0 c a e t q Fees and contracts from government agencies

2 Membership dues and assessments 3 Interest on savings and temporary cash

investments 244 . e Dividends and interest from securities 6 7 833 . 5 Net rental income or (loss) from real estate

a Debt-financed property D Not debt-financed property

6 Net rental income or (loss) from personal property

7 Other investment income 8 Gain or (loss) tram sales of assets other

than inventory <16 , 691 .> 9 Net income or (doss) from special events 40 , 3 7 0 .

10 Gross profit or (loss) from sales of inventory 11 Other revenue

a b c a e

12 Subtotal Ado columns (b), (d), and (e) 0 . . 0 .1 91,756 . 73 Total A00 line 12, columns (b), (d), and (a) 13 91,756 . (See worksheet in line 13 instructions to vertN calculations 1

Pmt XVI-B Relationship of Activities to the Accomplishment of Exempt Purposes

Line No Explain below how each act" for which income is reported in column (e) of Part XVI-A contributed importantly to the accomplishment of V I the oraanlution's exempt Purposes (other than by providing funds for such purposes)

F.990-VF Row)

Form 99o-PF(2002) RI INTERSCHOLASTIC INJURY OS-0374155 and

1 Did the organization directly or indirectly engage m any of the following with any other organization described m section 501(c) of YE the Code (other than section 501(c)(3) organizations) or m section 527, relating to political organizations?

a Transfers from the reporting organization to a nonchantable exempt organization of (1) Cash to 1 (2) Other assets 18 12 1

b Other Transactions (t) Sales of assets to a nonchantable exempt organization lIb Il l (2) Purchases al assets from a nonchantable exempt organization lb ( 2 ) (3) Rental of facilities . equipment, or older assets 11:10) ((4) Reimbursement arrangements 1 b ( 4 ) (5) Loans or loan guarantees 1b ( 5) (6) Performance of services or membership or tunOraisinp solicitations I b ( 6)

c Sharing of facilities equipment, mailing lists, other asses, or gab employees 1 C 0 II the answer to any of the above is Yes; complete the following schedule Column (b) should always show tie fair market value at tie goods, other assets,

or services given 6y the reporting organization 11 the orpaniubon received less than fair market value in any transaction or sharing arrangement, show in column (it) the value of the goods, other assets . or services received

X

and

D Yes M NO

of

223621 01 zero

X~~

Amount involved I (c) Name of nonchantable

21 Is the organization 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 507 (c)(3)) or in section 5279

h It Yes ; complete lie followin g schedule 1a1 Name of oraanirahon 161 Tvoe o1 oraanaation

umsPwwj~ oI pnu7 1 ~ " l nwe 4-a" Nb nbm IrciuElrq WroM rp cao61M bC~OOn o1 onouv Io0at.Y~w a Mutawl n Ea0 on III

i - .iv o ' Siqn officer or nistee

PraD r5 m a o b signature

�� ~Q �� KIELISZAK, EGGERT AN a~ acdwoi�aKo '161 WATERMAN STREET

PROVIDENCE, RI 02906

P

(h) Gain or (lass) (e) plus (1) minus (q)

n

the foundation on 12/31/69

(q Excess o1 col (i) over col Q), d any

in column (h) and o (1) Adjusted basis as of 12/31169 (I) FMV as of12131169

2 Capital gain net income or (net capital loss) l If (losi)a'enter enter i n

Part 1, line 7 3 Net Short-term capital pain or (loss) as defined in sections 1222(5) and (6)

It gain, also enter in Part I, line 8, column (c) It (loss), enter *-0-' in Pan I, line 8

223591 oso,-0z

14 ** (SHORT-TERM)

"

RI RSCHOLASTIC INJURY FUND ;apttal Gains end Losses fog Tea on Investment Income

(a) Lut and describe the land(s) of property sob, e p real estate, 2-story brick warehouse, or common stock, 200 shs MLC Co

SHS GLOBAL SANTA FE SHS ASTORIA FINANCIAL SHS ASTORIA FINANCIAL SHS JP MORGAN CHASE SHS JOHNSON b JOHNSON

CONTINUATION FOR 990-PF, PART IV 05-0374155 PAGE 1 OF 3

I lb How ill(cgoatedacquIredl (d) Date sold ~ - PuracZusee

ay . yr ) (mo , day, yr n - nnn2tinn

je) Gross sales price

INDUSTRIES LNTA FE IER (Q Depreciation allowed

(or allowable) (p) Cost or other basis plus expense of sale

<335 .>

<20,Z96 . > 1,600 . 1,483 .

<11,885 . > (I) Losses (from caI (h))

Gains (excess o1 col (h) gain over cot (k), but not less than W)

"" <335 . > ** 6,324 . ** 9,389 . ** 619 . ** 13,508 . ** 4,820 . +* 2,719 . ** 5,558 . ** 6,439 . ** 6,589 . ** 6,499 .

** 1,600 . 1,483 .

<11,885 .>

111111 and Losses for Tax on Investment Income (a) List and describe the kind(s) of property sob, e p , real estate, 2-story beck warehouse, or common stock, 200 shs MLC Co

S

P

(9 Depreciation allowed (or allowable)

(p) Cost or other basis plus expense of sale

m column (h) and owned by the foundation on 12/31/69 (p Adjusted basis (k) Excess of col (q aso112/i1/69 overcol (j),Aany (I) FMV as of 12131/69

l p 1 2 Capital gain net income or (net capital loss) It ain, also enter in Part I, line 7

l It,loss), enter '-0-' in Part I, hoe 7 1 3 Net short-term capital gain or (loss) as defined in sections 1422(5) and (6)

If pain, also enter m Part I, line 8, column (c) It (loss), solar'-0' m Part I hoe B

771581 oso,-M 15

Oll'71 A 011A700 nrTA 1 Cc ~nn~ moon .,~

** (SHORT-TERM)

RI I

(e) Gross sales pots

n


(G1 How acawred (~, Date acawred (d) Date sold V-PurcAase (mo,day.yr) (mo,day D - Donation . Yr 1

P

P

(n) Gain or (loss) (e) plus (1) minus (p)

<17 , 940 .> 1 , 599 .

<19 686 .> <44 531 .> <11 , 010 .> 26 , 259 . 10 , 959 . <307 .>

<1 .> 31 , 638 . <338 .>

<158 .> (I) Losses (from col (n))

Gains (excess of col (h)gain over col (w), but not less than'-0-')

<17,940 . > 1,599 .

<19,686 . > <44,531 . > <11,010 . > 26,259 . 10,959 . <307 . >

<1 . > 31,638 . <338 .>

<158 .>

OLASTIC INJURY FUND iIns and Losses for Tax on Investment Income (a) List and describe the Wills) of property sold, e q , real estate, 2-story beck warehouse, of common stock . 200 5h5 MLC CO

P

(n) Gam or (loss) (e) plus (I) minus (q)

k

*i (SHORT-TERM)

nr remTr TW+7T+nl 16

n


(y ow Purchase

d «~ pate acawred (o) Date sob P

n-nn~innn mo,0ay,yr) (mo,Gay,yr~

(e) Gross sales price (Q Depredation allowed (p) Cost or other basis (or allowable) I plus expense al sale

omplete only for assets showing gain in column (A) and owned by tie IounOaGOn on 17/d1/69

(i) F M V as of 12/dl/69 (1) Adlusled basis (k) Excess of col (i) as of 12/31169 over col (1) . d any

2 Capital gain net income or (net capital bass) { If p din, also enter in Part I, line 7 1 II (loss), enter '-0-' in Part I, line 7 1

3 Net sort-term capital gain or (loss) as defined in sections 1222(5) and (6) It pain, also enter in PAR I, line 8, column (c) It (loss), enter W m Part 1, dne 8

zneei oso, of

169 . ,163 . > ,948 .> <424 .>

(I) Losses (from coi (n)) Gains (excess of col (n) pain over col (k),

but not less than '-0-1

<15,163 . > <14,948 .>

<424 .>

<16,691 .>

43

RI INTERSCHOLASTIC INJURY FUND OS-0379155

FORM 990-PF GAIN OR (LOSS) FROM SALE OF ASSETS STATEMENT 1

(A) MANNER DATE DESCRIPTION OF PROPERTY ACQUIRED ACQUIRED DATE SOLD

1000 SHS GLOBAL SANTA FE PURCHASED 02/15/02 12/03/02

9,011 . 8,676

MANNER DATE ACQUIRED ACQUIRED DATE SOLD

PURCHASED 08/28/01 05/28/02

(D) (E) (F) EXPENSE OF

SALE DEPREC . GAIN OR LOSS

(A) DESCRIPTION OF PROPERTY

1000 SHS ASTORIA FINANCIAL

(C) COST OR

OTHER BASIS

28,175 . 0 . 0 . 6,324 .


PURCHASED 12/06/01 05/28/02


1000 SHS ASTORIA FINANCIAL

17 STATEMENT S) 1 '`

(B) GROSS

SALES PRICE

(C) COST OR

OTHER BASIS

(H) GROSS

SALES PRICE

34,499 .



0 . 0 . <335 .>

(B) (C) (D) (E) (F) GROSS COST OR EXPENSE OF

SALES PRICE OTHER BASIS SALE DEPREC . GAIN OR LOSS

34,499 . 25,110 . 0 . 0 . 9,389 .


1000 SHS NORTEK


PURCHASED 11/14/01 02/15/02

(H) (C) (D) (E) (F) GROSS COST OR EXPENSE OF


25,500 . 20,680 . 0 . 0 . 4,820 .


2000 SHS TRAVELERS PROPRTY CASUALTY

(B) (C) GROSS COST OR

SALES PRICE OTHER BASIS

39,719 . 37,000 .

18 STATEMENT S) 1

RI INTERSCHOLASTIC INJURY FUND


1000 SHS JP MORGAN CHASE



24,799 . 24,180 .


1000 SHS JOHNSON & JOHNSON



56,208 . 42,700 .

OS-0374155


PURCHASED 07/25/02 12/03/02



0 . 0 . 619 .


PURCHASED 07/22/02 12/03/02



0 . 0 . 13,508 .


PURCHASED 03/21/02 04/23/02



0 . 0 . 2,719 .

OS-0374155

DATE SOLD

04/16/02

MANNER DATE ACQUIRED ACQUIRED

PURCHASED 02/15/02


2000 SHS TYCO



5,558 . 0 . 0 .


PURCHASED 04/26/02 05/24/02

0 . 0 . 6,439 .

19,150 .


1000 SHS UNITED NATURAL FOODS

GROSS SALES PRICE

25,599 .

(C) COST OR

OTHER BASIS

19,100 . 0 . 0 . 6,499 .

19 STATEMENT S) 1 '


(B) GROSS

SALES PRICE

60,058 .

DESCRIPTION OF PROPERTY

1000 SHS TYCO INT'L

(B) GROSS

SALES PRICE

25,739 .


1000 SHS TYCO INT'L

(B) GROSS

SALES PRICE

25,739 .

(C) COST OR

OTHER BASIS

54,500 .

(C) COST OR

OTHER BASIS

19,300 .

(C) COST OR

OTHER BASIS

(D) (E) EXPENSE OF

SALE DEPREC .

(F)

GAIN OR LOSS


PURCHASED 05/01/02 05/24/02



0 . 0 . 6,589 .


PURCHASED 09/05/02 12/03/02




PURCHASED VARIOUS 05/30/02 1500 SHS WILLIAMS CO INC

(C) COST OR

OTHER BASIS

42,630 .

(B) GROSS

SALES PRICE

22,334 0 . <20,296 .> 0 .


500 AOL TIME-WARNER



6,640 . 18,525 .


PURCHASED 12/21/00 12/20/02

STATEMENT S) 1 20




1000 WORTHINGTON INDUSTRIES

(H) (C) GROSS COST OR


17,600 . 16,000 .


665 SHS GLOBAL SANTA FE

GROSS COST OR SALES PRICE OTHER BASIS

17,223 . 15,740 .

05-0374155

(D) (E) EXPENSE OF

SALE DEPREC

(F)

GAIN OR LOSS


PURCHASED 06/20/02 12/03/02

EXPENSE OF SALE DEPREC . GAIN OR LOSS

0 . 0 . 1,600 .


PURCHASED 08/28/01 12/03/02



0 . 0 . 1,483 .

(D) (E) EXPENSE OF

SALE DEPREC .

0 .

(F)

GAIN OR LOSS

0 . <11,885 .>


500 SHS AOL TIME-WARNER

(B) GROSS

SALES PRICE

6,640 . 24,580 .


1000 APPLE COMPUTER


PURCHASED 06/02/97 09/27/02



0 . 0 . <44,531 .>


2000 SHS CALLAWAY GOLF

(B) GROSS

SALES PRICE

20,719 .

(C) COST OR

OTHER BASIS

65,250 .

21 STATEMENT S) 1


(C) COST OR

OTHER BASIS


8000 SHS AMERICAN POWER CONVERSION CORP

(e) (C) GROSS COST OR


127,996 . 126,397 .

(B) GROSS

SALES PRICE

14,330 .

(C) COST OR

OTHER BASIS

34,016 .

OS-0374155


PURCHASED 04/27/01 12/20/02



0 . 0 . <17,940 .>


PURCHASED VARIOUS 12/03/02



0 . 0 . 1,599 .





0 . 0 . <19,686 .>

22 STATEMENT(S) 1



1500 SHS FORD MOTOR PURCHASED 09/28/01 12/20/02

(H) (C) (D) (E) (F) GROSS COST OR EXPENSE OF


14,745 . 25,755 . 0 . 0 . <11,010 .>


1000 GTECH HOLDINGS PURCHASED 02/06/01 02/15/02



50,259 . 24,000 . 0 . 0 . 26,259 .


2000 HUGHES SUPPLY PURCHASED VARIOUS 02/15/02



61,559 . 50,600 . 0 . 0 . 10,959 .


50 SHS ZNTERSIL PURCHASED 02/24/00 12/03/02



943 . 1,250 . 0 . 0 . <307 .>


2000 PEPSI BOTTLING PURCHASED VARIOUS 09/03/02



54,038 . 22,400 . 0 . 0 . 31,638 .


155 SHS SCHOOL SPECIALTY INC



1,672 . 2,010 .


1000 SHS TEXTRON

GROSS SALES PRICE

49,179 .

(C) COST OR

OTHER BASIS

45,050 .

23 STATEMENT S) 1

RI INTERSCHOLASTIC INJURY FUND 05-0374155


.5621 SHS MONSANTO PURCHASED VARIOUS 08/21/02



9 . 10 . 0 . 0 . <1 .>


PURCHASED 11/11/97 12/20/02



0 . 0 . <338 .>


PURCHASED 09/28/00 05/14/02



0 . 0 . 4,129 .

.5544 SHS TRAVELERS PRPTY

(B) GROSS

SALES PRICE

(C) COST OR

OTHER BASIS

6 . 9 .





0 . 0 . 4 .


800 SHS TYCO


PURCHASED OB/11/00 12/03/02

(H) GROSS

SALES PRICE

41,399 .

(C) COST OR

OTHER BASIS

41,375 .

24 STATEMENT S) 1




1 .5831 SHS TRAVELRS PRPTY

(H) (C) GROSS COST OR


14 . 10 .

(B) GROSS

SALES PRICE

28,480 .


1000 SHS VERIZON

(C) COST OR

OTHER BASIS

28,638 .

OS-0374155





0 . 0 . 3 .





0 . 0 . <158 .>

(D) (E) EXPENSE OF

SALE DEPREC .

0 .

(F)

GAIN OR LOSS

0 . 24 .


23 SHS VISTEON CORP

367 . 198 .


PURCHASED 03/14/01 04/16/02

CAPITAL GAINS DIVIDENDS FROM PART IV

TOTAL TO FORM 990-PF, PART I, LINE 6A

25 STATEMENT S) 1


GROSS SALES PRICE

(C) COST OR

OTHER BASIS


1000 SHS WILLIAMS COMMUNICATIONS

CBI (C) GROSS COST OR


150 . 15,313 .


1000 SHS WORLDCOM

GROSS COST OR SALES PRICE OTHER BASIS

970 . 15,918 .


40 SHS WORLDCOM



220 . 644 .

OS-0374155





0 . 0 . 169 .


PURCHASED 11/20/00 04/16/02



0 . 0 . <15,163 .>


PURCHASED 03/14/01 06/24/02



0 . 0 . <14,948 .>

(D) (E) EXPENSE OF

SALE DEPREC .

0 .

(F)

GAIN OR LOSS

0 . <424 .>

0 .

<16,691 .>


SOURCE AMOUNT

244 .

244 . TOTAL TO FORM 990-PF, PART I, LINE 3, COLUMN A

FORM 990-PF DIVIDENDS AND INTEREST FROM SECURITIES STATEMENT 3

CAPITAL GAINS COLUMN (A) GROSS AMOUNT DIVIDENDS AMOUNT

67,833 . 0 . 67,833 .

67,833 . 0 . 67,833 .

OTHER INCOME

DESCRIPTION

GROSS INCOME FROM SPECIAL FUNDRAISING EVENTS

TOTAL TO FORM 990-PF, PART I, LINE 11, COLUMN A 40,370 .

26 STATEMENT S) 2, 3, 4, 5

FORM 990-PF INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT 2

CITIZENS BANK OF RI

SOURCE

SMITH BARNEY 188-11054-13 205

TOTAL TO FM 990-PF, PART I, IN 4

FORM 990-PF STATEMENT 4

AMOUNT

40,370 .

FORM 990-PF LEGAL FEES STATEMENT 5

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE

DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES

FILING FEES 95 . 0 . 95 . 0 .

TO FM 990-PF, PG 1, LN 16A 95 . 0 . 95 . 0 .


FORM 990-PF ACCOUNTING FEES STATEMENT 6

(A) (B) EXPENSES NET INVEST-PER BOOKS MENT INCOME

2,094 . 0 .

2,094 . 0 .

AUDIT FEE

TO FORM 990-PF, PG 1, LN 16B 0 . 2,094 .

FORM 990-PF TAXES STATEMENT 8

STATEMENT 9 OTHER EXPENSES

DESCRIPTION

INSURANCE TELEPHONE OFFICE SUPPLIES CONTRACT SERVICES POSTAGE 6 MAILING

TO FORM 990-PF, PG 1, LN 23

27 STATEMENT S) 6, 7, 8, 9 ~ .

DESCRIPTION

(c) ADJUSTED NET INCOME

2,094 .

(D) CHARITABLE PURPOSES

0 .

FORM 990-PF OTHER PROFESSIONAL FEES STATEMENT 7

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE

DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES

INVESTMENT SERVICES 25,815 . 25,815 . 0 . 0 .

TO FORM 990-PF, PG 1, LN 16C 25,815 . 25,815 . 0 . 0 .

DESCRIPTION

FICA MEDICARE FOREIGN TAXES PAID

TO FORM 990-PF, PG 1, LN 18

FORM 990-PF

(A) (B) EXPENSES NET INVEST-PER HOOKS MENT INCOME

1,012 . 506 . 236 . 118 . 511 . 511 .

1,759 . 1,135 .

(C) (D) ADJUSTED CHARITABLE NET INCOME PURPOSES

506 . 0 . 118 . 0 .

0 . 0 .

624 . 0 .

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE PER BOOKS MENT INCOME NET INCOME PURPOSES

2,675 . 0 . 2,675 . 0 . 1,514 . 0 . 1,514 . 0 .

78 . 0 . 78 . 0 . 7,950 . 0 . 7,950 . 0 .

269 . 0 . 269 . 0 .

12,486 . 0 . 12,486 . 0 .


FORM 990-PF OTHER INVESTMENTS STATEMENT 11

FAIR MARKET HOOK VALUE VALUE

388,442 . 388,442 .

388,442 . 388,442 .

SMITH HARVEY 188-11054-13

TOTAL TO FORM 990-PF, PART II, LINE 13

FORM 990-PF PART VIII - LIST OF OFFICERS, DIRECTORS STATEMENT 12 TRUSTEES AND FOUNDATION MANAGERS

RAYMOND T . DWYER 83 ROSEGARDEN ST WARWICK, RI 02888

KATHLEEN M . LAQUALE 1290 WAMPANOAG TRAIL EAST PROVIDENCE, RI 02915

HOWARD CATLEY, JR 6 F SOUTH, 196 OLD RIVER RD LINCOLN, RI 02876

27 STATEMENT S) 10, 11, 12 `

FORM 990-PF CORPORATE STOCK STATEMENT 10

FAIR MARKET DESCRIPTION BOOK VALUE VALUE

SMITH HARVEY 188-11054-13 205 2,151,006 . 1,872,926 .

TOTAL TO FORM 990-PF, PART II, LINE lOB 2,151,006 . 1,872,926 .

DESCRIPTION

NAME AND ADDRESS

TED STEHBINS 236 RIVERSIDE AVE WARWICK, RI 02889

MICHAEL NAPPA 207 RICHMOND DRIVE WARWICK, RI 02888

EMPLOYEE TITLE AND COMPEN- BEN PLAN EXPENSE

AVRG HRS/WK SATION CONTRIH ACCOUNT

PRESIDENT 0 0 . 0 . 0 .

VICE PRESIDENT 0 0 . 0 . 0 .

TREASURER 24-30 16,317 . 0 . 0 .

SECRETARY 0 0 . 0 . 0 .

BOARD MEMBER 0 0 . 0 . 0 .

28 STATEMENT S) 12 `'


ROBERT CAVANAGH BOARD MEMBER 5 PEGUBSIKA RD 0 0 . 0 . 0 . WAKEFIELD, RI 02879

AUDREY CROZIER BOARD MEMBER 14 CHAMBERLAIN CT 0 0 . 0 . 0 . NORTH SMITHFIELD, RI 02896

JOYCE FREEMAN BOARD MEMBER 165 ANNAQUATUCRET RD 0 0 . 0 . 0 . NORTH KINGSTON, RI 02852

RAYMOND MCGEE HOARD MEMBER 16 LORING PARKWAY 0 0 . 0 . 0 . PAWTUCKET, RI 02861

FRED MCNULTEY BOARD MEMBER 85 YATES AVENUE 0 0 . 0 . 0 . WARWICK, RI 02886

ROLAND PARISEAU HOARD MEMBER 49 WINTHROP DR 0 0 . 0 . 0 . ATTLEBORO, MA 02703

RUTH PLANTE BOARD MEMBER 6 NANCY COURT 0 0 . 0 . 0 . BLACKSTONE, MA 01504

TONY RAINONE BOARD MEMBER 348 OLNEY ARNOLD RD 0 0 . 0 . 0 . CRANSTON, RI 02921

THOMAS SHOLA BOARD MEMBER 86 SWEETFERN AVE 0 0 . 0 . 0 . CRANSTON, RI 02921

WILLIAM STRINGFELLOW BOARD MEMBER 122 GROSVENOR AVE 0 0 . 0 . 0 . EAST PROVIDENCE, RI 02914

TOTALS INCLUDED ON 990-PF, PAGE 6, PART VIII 16,317 . 0 . 0 .

KIELISZAK, EGGERT AND COMPANY, LTD. Certified Public Accountants

FINANCIAL STATEMENTS

RHODE ISLAND INTERSCHOLASTIC INJURY FUND

DECEMBER 31, 2002

PREPARED BY :

Statement of Cash Flows Schedule 1--Statement of Management and General Expenses

4

FINANCIAL STATEMENTS


DECEMBER 31, 2002

Accountant's Compilation Report Statement of Financial Position Statement of Activities

Management has elected to omit substantially all of the disclosures required by generally accepted accounting principles If the omitted disclosures were included m the financial statements, they might influence the user's conclusions about the Organization's financial position, results of operations and cash flows Accordingly, these financial statements are not designed for those who are not informed about such matters

July 15, 2003

l1 i~ ~~~6"/~

L lECO. Mvaeec OF Dmsior+ MR CPA Fiant4AICPA

KIELISZAK, EGGERT AND COMPANY, LTD . CERTIFIED PUBLIC ACCOUNTANTS

161 WATERMAN STREET PROVIDENCE RI 02906 TELEPHONE (401) 351-1020 pqx(401) 351-5067 WWW KE-CPA COM

ACCOUNTANT'S COMPILATION REPORT

To the Board of Directors Rhode Island Interscholastic Injury Fund Warwick, Rhode Island

We have compiled the accompanying statement of financial position of Rhode Island Interscholastic Injury Fund (a nonprofit organization) as of December 31, 2002 and the related statements of activities and cash flows for the year then ended and the accompanying supplementary information contained in Schedule 1 which is presented only for supplementary analysis purposes, in accordance with Statements on Standards for Accounting and Review Services issued by the American Institute of Certified Public Accountants

A compilation is limited to presenting m the form of financial statements information that is the representation of management We have not audited or reviewed the accompanying financial statements and supplementary information schedule, and accordingly, do not express an opinion or any other form of assurance on them

-1-

DECEMBER 31, 2002

34,752

388,442 1,872,926

8,370

2 304 490

$2,304,490

2 44

-2-

STATEMENT OF FINANCIAL POSITION


ASSETS Cash Investments Smith Barney Account cash 188-11054-13 Account stocks 188-11054-13 (at fair value) Prepaid tax on investment income

TOTAL ASSETS

LIABILITIES

NET ASSETS Unrestncted Undesignated

TOTAL LIABILITIES AND NET ASSETS

See accountant's compilation report

YEAR ENDED DECEMBER 31, 2002

(7,171)

(6591 (7,830)

2,818,040 (505,720 )

-3-

STATEMENT OF ACTIVITIES


REVENUE AND GAINS Program fees Other Interest income Memonams Investment income Net realized gam/(loss)

TOTAL REVENUE AND GAINS

EXPENSES Injury claims Gifts and grants Investment fees Management and general--Schedule l

TOTAL EXPENSES

Increase/(decrease) m net assets before income tax

Federal income tax INCREASE IN NET ASSETS

Net assets at beginning of year Unrealized holding loss at end of year

NET ASSETS AT END OF YEAR


$ 40,370

244 1,733

67,833 (16,6911 93,489

36,503 2,349

25,815 35 .993 100.660

DECEMBER 31, 2002

$ (513,551)

516,573 (397)

2,625

32,127

$ 34.752

-4-

STATEMENT OF CASH FLOWS


CASH FLOWS FROM OPERATING ACTIVITIES Decrease in net assets Adjustments to reconcile increase m net assets to net cash provided by operating activities Decrease in investments (Increase) m prepaid tax on investment income

NET CASH USED BY OPERATING ACTIVITIES

Beginning cash

ENDING CASH


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SCHEDULE 1-STATEMENT OF MANAGEMENT AND GENERAL EXPENSES


DECEMBER 31, 2002

Payroll $16,317 Payroll taxes 1,248 Foreign taxes paid 512 Contract services 7,950 Insurance 2,675 Accounting 2,094 Postage and mailing 270 Office supplies 78 Legal and filing fees 95 Telephone 1,514 Meetings 3 .240

TOTAL MANAGEMENT AND GENERAL, EXPENSES $~


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Application for Extension of Time To File an Exempt Organization Return I OMB No ,mss-,7os

0- File a for each return

27

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" H you are filing for an Automatic 3-Month Extension, complete only Pen I end check this box " If you we filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on papa 2 of the forth) Note Do not complete Part II unless you have already bean granted an automatic 3-month extension on a prenousy filed Form BBBB

Part 1 Automatic 3-Month Extension of Time - Only submit original (no copes needed)

Note Form 99o-7 corporations requesting en automatic 6-month extension - check this box end complete Part I ony 1 All other corporations (ncNding Form 990-C Mans) must use Form 7000 to request en extension o/ time to file income tax returns Partnerships, REMICs end vests must use Form 8736 to request en extension of nine to ale Form 7065, 1066, or 1041

Type or Name of Exempt Organization Employer identification number print

RI INTERSCHOLASTIC INJURY FUND OS-0374155 Y °'e due ante br Number, street, and room or suite no II a P O box, see instructions

filin your 83 ROSEGARDEN STREET return See , ..~on. City . town or post office, state, and ZIP code For a foreign address, see instructions

WARWICK RI 02888

Check type of return to a filed (file a separate application for each return)

0 Form 990 D Form 990~T (corporation) 0 Form 4720 Form 990 BL ~ Form 99o-7 (sec 401(a) or 408(a) trust) ~ Form 5227 Form 99o-EZ o Form 99a7 (trust other than above) ~ Forth 6069

OX Forth 990 PF O Form 1041 A ~ Forth 8870

0 N the organization does not have an office or place o1 business in the United States, check this box 0 If this is for a Group Return . enter the organization's four dpn Group Exemption Number (GEM H this is for the whole group, check this box " = If n is for part of the group, check this box 1 = and attach a list with the names and EINs of all members the extension will rover

t I request an automatic 3-month (6 month, for B90-T corporation) extension of time until AUGUST 15 ., 2-0-0-3-to file tie exempt organization return for the organization named above The extension is for the organization's return for " OX calendar year 2 0 0 2 or N O'= tax year beginning , and ending

2 If this tax year is for less than 72 months, check reason ~ InnW return ~ Final return 0 Change m accounting period

9a If this application is for Form 990-BL . 99PPF, 990-7, 4720, a 6069, enter the tentative tax . less any nonrefundable credos See insiructans S 659 .

b If this application is for Form 990-PF or 990 T, enter any refundable credos and estimated tax payments made Include any poor year overpayment allowed as a credit $ 8 ,370 .

e Balance Due Subtract line 3b from tine 3a Include your payment with this loan, a, A required, depose with FTD coupon or, d required . by using EFTPS (Electronic Federal Tan Payment System) See instructions ; 0 .

Signature and Verification

Under penalties a1 Gerlury I declare that rm, including accompanying schedules and statements, and to the best of my knowledge and belief, A is true, ton , late and t t I am authorized to Drepa is forth

Si nature ) Data Form . 8868 (72-2000) LFIA For Paperwork Reduction An Notice, see instru n ~~y

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Fo~m.990-PF Return of Private...

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