Return of Private Foundation

Transcription

1 F rm 990PF Return of Privte Foundtion or Section 4947()(1) Trust Treted s Privte Foundtion Do not enter Socil Security numbers on this form s it my be mde public. Deprtment of the Tresury Internl Revenue Service Informtion bout Form 990PF nd its seprte instructions is t For clendr yer 2013, or tx yer beginning, 2013, nd ending, 26oyridenUfictionnumber THE SPINE INSTITUTE FOUNDATION LINDERO CYN RD #235 Telephone number ( see the instructions) WESTLAKE VILLAGE, CA (818) OM B No UZI G Check ll tht pply Initil return Initil return of former public chrity Finl return Amended return D 1 Foreign orgniztions, check here Address chnge Nme chnge e 2 Foreign orgniztions meeting the 85% test, check q H Check type of orgniztion : Section 561(c)(3) exempt privte foundtion here nd ttch computtion _ 11 v n cciipuvn ppnuuuii pwiny, uncl.n licit I LJ O Section 4947( )(1) nonexempt chritble trust X Other txble privte foundtion E If privte foundtion sttus ws terminted Fir mrket vlue of ll ssets t end of yer J Accounting method Csh }{ Accrul under section 507 ( b)(1)(a), check here (from Prt ll, column (c), line 16) Other ( specify ) F If the foundtion is in 60month termintion under section 507(b)(1)(B ) check here $ 246, 738. (Prt, column (d) must be on csh bs is, P rt A n l ysis o R evenue n d Expenses (The totl of mounts m () Revenue nd (b ) Net investment (c) Adjusted net (d) Disbursements expenses per books income income c h ri tble columns (b), (c), nd (d) my not neces p urposes (csh srily equl the mounts in column () bsis only) (see instructions) ) Contributions, g i fts, grnts, etc, received ( lt sch ) 389, Ck ' if the foundn is not req to tt Sch B 3 Interes on svings nd temporry csh investments 4 Dividends nd interest from securities 5 Gross rents b Net rentl income or (loss) R 6 Net gin /( loss) from sle of ssets not on line 10 RECiz E b Gross sles price for ll V ssets on line 6 U E 7 Cp i tl gin net income (from Prt IV, line 2) N 8 Net short term cpitl gin O U 9 Income modifictions cq E 10 Gross sle S less returns nd I llownces b Less Cost of goods sold c Gross profit /( loss) (tt sch) 11 Other income (ttch schedule),, I.. l 12 ot. Ines 1 t h roug h Compenstion of officers directors trustees, etc. 2b, UUU Other employee slries nd wges 73, , Pension plns, employee benefits A 16 Legl fees ( ttch schedule) D b Accounting fees (ttch sch) SEE ST 1 7, c Other prof fees (ttch sch) IN 1 17 Interest P 5 ER T 18 Txes ( ttch schedulexsee inslrs ) SEE STM 2 8, , 624. R A 19 Deprecition ( ttch T T sch ) nd depletion SEE STMT 3 3, 669. v 20 Occupncy N G E 21 Trvel, conferences, nd meetings A E 22 Printing nd publictions N D p 23 Other expenses ( ttch schedule) E SEE STATEMENT 4 31, , 832. s s 24 Totl opertin g nd dministrtive expenses. Add lines 13 through Contributions, gifts, grnts pid Totl expenses nd disbursements. Add lines 24 nd Subtrct ine 2 6 from line 12: Excess of revenue over expenses nd disbursements , 875. tbaa b Net investment income ( if negtive, enter 0.) 0. C Ad justed net income ( if ne g tive, enter 0 0. ror YperworK Keuction Act Notice, see instructions. TEEA0504L 10/18/13 corm uuurr (1U i. ) ^ 0

2 l ' Form 990PF (2013) THF. SPINE INSTITUTE FOUNDAT ION Pe 2 Attched schedules nd mounts in the description Beginning of yer End of yer P rt 1 B l nce Sh ee ts co umn shou ld b e for en d o f yer moun ts on ly (See instructions () Book Vlue (b) Book Vlue (c) Fir Mrket Vlue S E T S 1 Csh noninterestbering , Svings nd temporry csh investments... 3 Accounts receivble Less: llownce for doubtful ccounts 4 Pledges receivble Less: llownce for doubtful ccounts 5 Grnts receivble. 6 Receivbles due from officers, directors, trustees, nd other disqulified persons (ttch schedule ) ( see instructions) 7 Other notes nd lons receivble (ttch sch) 11 Less: llownce for doubtful ccounts' 8 Inventories for sle or use 9 Prepid expenses nd deferred chrges 10 Investments U.S. nd stte government obligtions (ttch schedule) b Investments corporte stock (ttch schedule) c Investments corporte bonds (ttch schedule). 11 Investments lnd, buildings, nd equipment: bsis Less ccumulted deprecition (ttch schedule). 12 Investments mortgge lons. 13 Investments other (ttch schedule).. 14 Lnd, buildings, nd equipment: bsis', _ 18 _,_ 7_ 88 Less: ccumulted deprec (ttch schedule) Z STMT 5 12,126. 9,460. 6,662. 6, Other ssets (describe Totl ssets (to be completedby Zlilerssee the instructions. Also, see pge 1, item I) 11, , 738. L 17 Accounts pyble nd ccrued expenses 3, I 18 Grnts pyble B 19 Deferred revenue IL 20 Lons from officers, directors, trustees, & other disqulified persons I 21 Mortgges nd other notes pyble (ttch schedule) T 22 Other libilities (describe S 23 Totl libilities (dd lines 17 through 22) 3,778. 1, 331. Foundtions tht follow SFAS 117, check here nd complete lines 24 through 26 nd lines 30 nd 31. LX N F 24 Unrestricted 7, ,252. E U T N 25 Temporrily restricted 141,818. D 26 Permnently restricted A S B Foundtions tht do not follow SFAS 117, check here S A nd complete lines 27 through 31. E L T A 27 Cpitl stock, trust principl, or current funds S N 28 Pidin or cpitl surplus, or lnd, building, nd equipment fund 0 E 29 Retined ernings, ccumulted income, endowment or other funds R S 30 Totl net ssets or fund blnces (see instructions) 7, , Totl libilities nd net ssets/fund blnces (see instructions) 11, , 401. rre Hniysis or t nnges in net Assets or run rsiinces 1 Totl net ssets or fund blnces t beginning of yer Prt II, column (), line 30 (must gree with endofyer figure reported on prior yer's return) 1 7, Enter mount from Prt I, line , Other increses not included in line 2 ( itemize) 3 4 Add lines 1, 2, nd , Decreses not included in line 2 ( itemize) 5 6 Totl net ssets or fund blnces t end of yer (line 4 minus line 5) Prt II, column (b) line ,070. BAA TEEA0302L 07/09/13 Form 990PF (2013)

3 Form 190PF (2013) THE SPINE INSTITUTE FOUNDATION Pge 3 rt ' Cpit l G ins n osses for Tx on I nvestment I ncome () List nd describe the kind(s ) of property sold (e.g., rel estte, ( C ) Dte cquired Dte sold 2story brick wrehouse ; or common stock, 200 shres MLC Compny ) ( month, dy, yer) ( month, dy, yer) 1N/A b c d e b c d e (e) Gross sles price ( f) Deprecition llowed (or llowble ) ( g) Cost or other bsis plus expense of sle How cquired P Purchse 0 Dont i on (h) Gin or (loss) (e) plus ( f) minus (g) Complete only for ssets showi ng gin in column (h) nd owned by the foundtion on 12/31/69 (I) Gins (Column (h) (i) Fir Mrket Vlue ( j) Adjusted bsis (k) Excess of column ( i) gin minus column ( k), but not less s of 12 / 31 /69 s of 12/31 /69 over column 0 ), if ny thn 0 ) or Losses (from column (h)) b c d e 2 Cpitl gin net income or (net cpitl loss ). 3 Net short term cpitl gin or (loss ) s defined in sections 1222(5) nd (6): If gin, lso enter in Prt I, line 7 LIf (loss), enter 0 in Prt I, line 7 2 If gin, lso enter in Prt I, line 8, column (c) (see instructions ). If (loss), enter 0 in Prt I, line 8 3 '1 tylv I Qulifiction Under Section 4940 (e) for Reduced Tx on Net Investment Income (For optionl use by domestic privte foundtions subject to the section 4940() tx on net investment income.) N/A If section 4940( d)(2) pplies, leve this prt blnk. Ws the foundtion lible for the section 4942 tx on the distributble mount of ny yer in the bse period? If 'Yes,' the foundtion does not qulify under section 4940 (e). Do not complete this prt. 1 Enter the pproprite mount in ech column for ech yer ; see the instructions before mking ny entries Bse erod Clendr period yers yer (orretx y er beginning in) (b) Adjusted qulifying distributions (c) Net vlue of nonchritbleuse ssets E Yes F1 No (d) Distribution rtio (column (b) divided by column (c)) 2 Totl of line 1, column (d) 2 3 Averge distribution rtio for the 5yer bse period divide the totl on line 2 by 5, or by the number of yers the foundtion hs been in existence if less thn 5 yers 3 4 Enter the net vlue of nonchritbleuse ssets for 2013 from Prt X, line Multiply line 4 by line Enter 11% of net investment income (1 % of Prt I, line 27b) 6 7 Add lines 5 nd Enter qulifying distributions from Prt XII, line 4 8 If line 8 is equl to or greter thn line 7, check the box in Prt VI, line 1 b, nd complete tht prt using 1 % tx rte See the Prt VI Instructions. BAA Form 990PF (2013) TEEA0303L 07/09/13

4 Form 990PF (2013) THE SPINE INSTITUTE FOUNDATION Pge 4 Prt VIg' Excise Tx B se d on I nvestment I ncome (Section 4940(), 4940(b), 4940(e), or 4948 see instructions) 1 Exempt operting foundtions described in section 4940(d)(2), check here ' nd enter 'N/A' on line 1. Dte of ruling or determintion letter (ttch copy of letter if necessry see instrs) b Domestic foundtions tht meet the section 4940(e) requirements in Prt V, 1 0. check here. ' Snd enter 1% of Prt I, line 27b c All other domestic foundtions enter 2% of line 27b Exempt foreign orgniztions enter 4% of Prt I, line 12, column (b) 2 Tx under section 511 (domestic section 4947()(1) trusts nd txble foundtions only. Others enter 0) Add lines 1 nd Subtitle A (income) tx (domestic section 4947()(1) trusts nd txble foundtions only Others enter 0) Tx bsed on investment incomesubtrct line 4 from line 3. If zero or less, enter Credits/Pyments: 2013 estimted tx pmts nd 2012 overpyment credited to 2013 b Exempt foreign orgniztions tx withheld t source c Tx pid with ppliction for extension of time to file (Form 8868) 6c d Bckup withholding erroneously withheld... 6 d 7 Totl credits nd pyments. Add lines 6 through 6d Enter ny penlty for underpyment of estimted tx. Check here n if Form 2220 is ttched 8 9 Tx due. If the totl of lines 5 nd 8 is more thn line 7, entermount owed Overpyment. If line 7 is more thn the totl of lines 5 nd 8, enter themount overpid Enter the mount of line 10 to be Credited to 2014 estimted tx Refunded ' 11 rt_ St temen ts R egrd ing Activities 1 During the tx yer, did the foundtion ttempt to influence ny ntionl, stte, or locl legisltion or did it prticipte or intervene in ny politicl cmpign? b Did it spend more thn $100 during the yer (either directly or indirectly) for politicl purposes (see the instructions for definition)?... If the nswer is 'Yes' to l or 1b, ttch detiled description of the ctivities nd copies of ny mterils published or distributed by the foundtion in connection with the ctivities c Did the foundtion fileform 1120POL for this yer? d Enter the mount (if ny) of tx on politicl expenditures (section 4955) imposed during the yer: (1) On the foundtion. $ 0. (2) On foundtion mngers 0$ 0. e Enter the reimbursement (if ny) pid by the foundtion during the yer for politicl expenditure tx imposed on foundtion mngers. $ 0. 2 Hs the foundtion engged in ny ctivities tht hve not previously been reported to the IRS? If 'Yes,' ttch detiled description of the ctivities 6 6 b 1 lb is Yes No X X X 2 X 3 Hs the foundtion mde ny chnges, not previously reported to the IRS, in its governing instrument, rticles of incorportion, or bylws, or other similr instruments? If 'Yes,' ttch conformed copy of the chnges 4 Did the foundtion hve unrelted business gross income of $1,000 or more during the yer? b If 'Yes,' hs it filed tx return onform 990T for this yer? 5 Ws there liquidtion, termintion, dissolution, or substntil contrction during the yer? If 'Yes,' ttch the sttement required by Generl Instruction T 6 Are the requirements of section 508(e) (relting to sections 4941 through 4945) stisfied either: By lnguge in the governing instrument, or 3 X 4 X 4b N/A 5 X By stte legisltion tht effectively mends the governing instrument so tht no mndtory directions tht conflict with the stte lw remin in the governing instrument? 6 X 7 Did the foundtion hve t lest $5,000 in ssets t ny time during the yer?lf 'Yes,' complete Prt 11, column (c), nd Prt XV 7 X 8 Enter the sttes to which the foundtion reports or with which it is registered (see instructions) CA b If the nswer is 'Yes' to line 7, hs the foundtion furnished copy of Form 990PF to the Attorney Generl (or designte) of ech stte s required by Generl Instruction G? If 'Vo,' ttch explntion I Bbl XI 9 Is the foundtion climing sttus s privte operting foundtion within the menin g of section 49420)(3) or 4942(^) (5) ^ X for clendr yer 2013 or the txble yer beginning in 2013 (see instructions for Prt XIV)3f 'Yes,' complete Prt XIV 9 X 10 Did ny persons become substntil contributors during the tx yer?lf 'Yes,' ttch schedule listing their nmes nd ddresses X Form 990PF (2013) TEEA0304L 07/10/13

5 Form990 PF (2013) THE SPINE INSTITUTE FOUNDATION Pge 5 11 At ny time during the yer, did the foundtion, directly or indirectly, own controlled entity within the mening of section 512(b)(13)? If 'Yes', ttch schedule (see instructions) 11 X 12 Did the foundtion mke distribution to donor dvised fund over which the foundtion or disqulified person hd dvisory privileges? If 'Yes,' ttch sttement (see instructions) 12 X 13 Did the foundtion comply with the public inspection requirements for its nnul returns nd exemption ppliction? 13 X Website ddress N/A 14 The books re in cre of HOWARD ABRAMS Telephone no (818) Locted t LINDERO CYN RD 235 WESTLAKE VILLAGE CA ZIP Section 4947()(1) nonexempt chritble trusts filing Form 990PF in lieu oform 1041 Check here N1/ nd enter the mount of txexempt interest received or ccrued during the yer 1 15 N/A 16 At ny time during clendr yer 2013, did the foundtion hve n interest in or signture or other uthority over bnk, securities, or other finncil ccount in foreign country? Se e the instructions for exceptions nd filing requirements for Form TD F If 'Yes,' enter the nme of the foreign country N =t3 Sttements Regrding Activities for Which form 4izu my tte Requires File Form 4720 if ny item is checked in the 'es' column, unless n exception pplies. Wg^^k Yes No 1 During the yer did the foundtion (either directly or indirectly): r= = ' ' ' (1) Engge in the sle or exchnge, or lesing of property with disqulified person? EjYes No (2) Borrow money from, lend money to, or otherwise extend credit to (or ccept it from) R disqulified person? Yes X No (3) Furnish goods, services, or fcilities to (or ccept them from) disqulified person? Yes X No (4) Py compenstion to, or py or reimburse the expenses of, disqulified person? Yes X No (5) Trnsfer ny income or ssets to disqulified person (or mke ny of either vilble for the benefit or use of dis q ulified p erson)?.. JYes No (6) Agree to py money or property to government officil? exception. Check 'No' if the, ^ r,`" ; "'1 foundtion greed tmke co grnt to or to employ the officil for period fter termintion of government service, if terminting within 90 dys. ) Yes X No b If ny nswer is 'Yes' to l (1)(6), didny of the cts fil to q ulify under the exce p tions described in Regultions section (d)3 or In current notice regrding disster ssistnce (see instructions)? 1 b N A Orgniztions relying on current notice regrding disster ssistnce check here e,; _ c Did the foundtion engge in prior yer in ny of the cts described in 1, other thn excepted cts, tht were not corrected before the first dy of the tx yer beginning in 2013? 1 c X F^! Yes No X A jys.. 2 Txes on filure to distribute income (section 4942) (does not pply for yers the foundtion ws privte operting foundtion defined in section 49420)(3) or 4942(j)(5)). y lyy4.rif. P A V At the end of tx yer 2013, did the foundtion hve ny undistributed income (lines 6d nd 6e, Prt XIII) for tx yer(s) beginning before 2013? If 'Yes,' list the yers 0" 20, 20, 20, 20. Yes No, 11 b Are there ny yers listed in 2 for which the foundtion snot pplying the provisions of section 4942()(2) (relting to incorrect vlution of ssets) to the yer ' s undistributed income? (If pplying section 4942( )(2) to ll yers listed, nswer ' No' nd ttch sttement see instructions.) c If the provisions of section 4942 ( )(2) re being pplied tcny of the yers listed in 2, list the yers here 0' 20,20,20,20. 2b N A 3 Did the foundtion hold more thn 2% direct or indirect interest in ny business enterprise t ny time during the yer? Des Fx] No b If 'Yes,' did it hve excess business holdings in 2013 s result o ( 1) ny purchse by the foundtion or disqulified persons fter My 26, 1969;(2) the lpse of the 5 yer period (or longer period pproved by the Commissioner under section 4943 (c)(7)) to dispose of ho[dings cquired by gift or bequest, or (3) the lpse of the 10, 15, or 20yer first phse holding period?(use Schedule C, Form 4720, to determine if the foundtion hd excess business holdings in 2013 ) 4 Did the foundtion invest during the yer ny mount in mnner tht would jeoprdize its chritble purposes? 3b 4 N VA X b Did the foundtion mke ny investment in prior yer (but fter December 31, 1969) tht could jeoprdize its chritble purpose tht hd not been removed from jeoprdy before the first dy of the tx yer beginning in 2013?.... I4bl IX Form 990PF (2013) TEEA0305L 12/07/12

6 Form990PF (2013) THE SPINE INSTITUTE FOUNDATION Pge 6 V'B Sttements R egrd ing Activit i es for Wh ich Form 4720 My Be Require d continued) 5 During the yer did the foundtion py or incur ny mount to, (1) Crry on propgnd, or otherwise ttempt to influence legisltion (section 4945(e))? Yes No (2) Influence the outcome of ny specific public election (see section 4955), or to crry on, directly or indirectly, ny voter registrtion drive? Yes X No (3) Provide grnt to n individul for trvel, study, or other similr purposes? Yes X No (4) Provide grnt to n orgniztion other thn chritble, etc, orgniztion described in sec tion 509 ()( 1 ), ( 2), or ( 3 ), or sec tion 4940 ( d)( 2 )? (see ins truc t ions) Yes No (5) Provide for ny purpose other thn religious, chritble, scientific, literry, or e d uc tion l purpo s es, or for th e prev e n t ion o f c r ue lty to c hildren or nimls? Y es N o b If ny nswer is 'Yes' to 5(1)(5) didny of the trnsctions fil to qulify under the exceptions described in Regultions section X or in current notice regrding disster ssistnce (see instructions)? b N A Orgniztions relying on current notice regrding disster ssistnce check here 0 c If the nswer is 'Yes' to question 5(4), does the foundtion clim exemption from the tx becuse it mintined expenditure responsibility for the grnt? N/A Yes [] No If 'Yes, 'ttch the sttement required by Regultions section (d) 6 Did the foundtion, during the yer, receive ny funds, directly or indirectly, to py premiums on personl benefit contrct? 11 Yes N No b Did the foundtion, during the yer, py premiums, directly or indirectly, on personl benefit contrc t? 6 b X If 'Yes' to 6b, file Form At ny time during the tx yer, ws the foundtion prty to prohibited tx shelter trnsction? Yes N No b If 'Yes,' did the foundtion receive ny proceeds or hve ny net income ttributble to the trnsction? N/A 7b i n form tion Abou t Officers, D ire ctors, Trus tees, Foun d tion M ngers,mgtil y P i d E mp l oyees, nd Contrctors 1 List ll officers. directors, trustees. foundtion mngers nd their compenstion (see instructions). (b)title, nd verge (c) Compenstion (d) Contributions to (e) Expense ccount, () Nme nd ddress hours per week (If not pid, employee benefit other llownces devoted to position enter 0) plns nd deferred compenstion J PATRICK JOHNSON PRESIDENT SAN VICENTEBL_#800 0 LOS ANGELES CA MARKO MIJAT SECRETARY 25, WEST 3RD ST #1080W LOS ANGELES, CA RICHARD LAREW _ TREASURER WEST 3RD ST # 1080W 0 LOS ANGELES CA Compenstion of five highest pid employees (other thn those included on line4 see instructions ). If none, enter 'NONE.' () Nme nd ddress of ech employee pid more thn $50,000 (b)title, nd verge (c) Compenstion JULIAN A MATTIELO _ 109 1/2 HARPER AVE _ T,OS 'A9GET,9S C^ 96048_ BRIDGET L COOPER 5905 BARTON RD IGM 9 ;CK ` hours per week devoted to position PHYSICIAN MANAGER (d)contributions to employee benefit plns nd deferred compenstion (e) Expense ccount, other llownces 40 69, , i Totl number of other employees pid over $50,000 0 t$aa TEEAD306L 07/10/13 rorm yyurr (LU J)

7 Form'990PF (2013) THE SPINE INSTITUTE FOUNDATION Pge 7 P i n formtion out Officers, Directors, T rustees, Foun d tion M ngers, H ig hl y Pi d Emp l oyees, nd Contrctors (continued) 3 Five highestpid independent contrctors for professionl services (see instructions ). If none, enter 'NONE.' () Nme nd ddress of ech person pid more thn $50,000 (b) Type of service (c) Compenstion NONE Totl number of others receiving over $50,000 for professionl services 0 Summry of Direct Chritble Activities List the foundtion ' s four lrgest direct chritble ctivities during the tx yer. Include relevnt sttisticl informtion such s the number of orgniztions nd other beneficiries served, conferences convened, reserch ppers produced, etc. 1 N/A Expenses Summry of Progrm Relted Investments (see instructions) Describe the two lrgest progrmrelted investments mde by the foundtion during the tx yer on lines 1 nd 2. Amount 1 Ni N/A 2 All other progrmrelted investments. See instructions. 3 Totl. Add lines 1 through 3 0. BAA Form 990PF (2013) TEEA0307L 07/10/13

8 Form990PF (2013) THE SPINE INSTITUTE FOUNDATION Pge 8 inlmum Investment Return (All domestic foundtions must complete this prt. Foreign foundtions, see instructions.) 1 Fir mrket vlue of ssets not used (or held for use) directly in crrying out chritble, etc, purposes: Averge monthly fir mrket vlue of securities, b Averge of monthly csh blnces c Fir mrket vlue of ll other ssets (see instructions) d Totl (dd lines 1, b, nd c) e Reduction climed for blockge or other fctors reported on lines l nd lc (ttch detiled explntion) I 1 e 2 Acquisition indebtedness pplicble to line I ssets 3 Subtrct line 2 from line ld 4 Csh deemed held for chritble ctivities. Enter 1.1/2% of line 3 (for greter mount, see instructions) 5 Net vlue of nonchritble use ssetssubtrct line 4 from line 3. Enter here nd on Prt V, line 4 6 Minimum investment return.enter 5% of line 5.. nd certin foreign orgniztions check here 1 Minimum investment return from Prt X, fine 6,, N/A 2 Tx on investment income for 2013 from Prt VI, line 5 2 b Income tx for (This does not include the tx from Prt VI.) c Add lines 2 nd 2b 3 Distributble mount before djustments. Subtrct line 2c from line 1 4 Recoveries of mounts treted s qulifying distributions 5 Add lines 3 nd 4 6 Deduction from distributble mount (see instructions) 7 Distributble mounts djusted. Subtrct line 6 from line 5. Enter here nd on Prt XIII, line I l lb lc Id ing foundtions 1 2c rti Qulifying Distributions (see instructions) 1 Amounts pid (including dministrtive expenses) to ccomplish chritble, etc, purposes Expenses,, gifts, etc totl from Prt I, column (d), line 26 b Progrmrelted investments totl from Prt IXB 2 Amounts pid to cquire ssets used (or held for use) directly in crrying out chritble, etc, purposes 3 Amounts set side for specific chritble projects tht stisfy the: Suitbility test (prior IRS pprovl required) b Csh distribution test (ttch the required schedule) 4 Qulifying distributionsadd lines l through 3b. Enter here nd on Prt V, line 8, nd Prt XIII, line 4 5 Foundtions tht qulify under section 4940(e) for the reduced rte of tx on net investment income. Enter 1% of Prt I, line 27b (see instructions) 6 Adjusted qulifying distributionssubtrct line 5 from line 4 l lb 2 3 3b ,875. Note. The mount on line 6 will be used in Prt V, column (b), in subsequent yers when clculting whether the foundtion qulifies for the section 4940(e) reduction of tx in those yers. BAA Form 990PF (2013) TEEA0308L 07/10/13

9 For 990PF (2013) THE SPINE INSTITUTE FOUNDATION Pge 9 Prt XIII Undistributed Income (see instructions) N/A ( ) b (c ) (d ) Corpus Yers prior to Distributble mount for 2013 from Prt XI, line 7 2 Undistributed income, if ny, s of the end of Enter mount for 2012 only b Totl for prior yers: 20, 20, 20 3 Excess distributions crryover, if ny, to 2013: From 2008 b From 2009 c From 2010 d From 2011 e From f Totl of lines 3 through e.. 4 Qulifying distributions for 2013 from Prt XII, line 4: " $ Applied to 2012, but not more thn line 2 b Applied to undistributed income of prior yers (Election required see instructions) c Treted s distributions out of corpus (Election required see instructions) d Applied to 2013 distributble mount e Remining mount distributed out of corpus 5 Excess distributions crryover pplied to 2013 (If n mount ppers in column (d), the sme mount must be shown in column () ) 6 Enter the net totl of ech column s indicted below: Corpus. Add lines 3f, 4c, nd 4e. Subtrct line 5 b Prior yers ' undistributed income. Subtrct line 4b from line 2b.. c Enter the mount of prior yers ' undistributed income for which notice of deficiency hs been issued, or on which the section 4942( ) tx hs been previously ssessed d Subtrct line 6c from line 6b. Txble mount see instructions e Undistributed income for Subtrct line 4 from line 2 Txble mount see instructions f Undistributed income for Subtrct lines 4d nd 5 from line 1. This mount must be distributed in Amounts treted s distributions out of corpus to stisfy requirements imposed by section 170 ( b)(1)(f) or 4942(g)(3) (see instructions) 8 Excess distributions crryover from 2008 not pplied on line 5 or line 7 (see instructions) 9 Excess distributions crryover to Subtrct lines 7 nd 8 from line Anlysis of line 9: Excess from 2009 b Excess from 2010 c Excess from 2011 d Excess from 2012 e Excess from 2013 BAA Form 990PF (2013) TEEA0309L 07/10/13

10 Form990PF (2013) THE SPINE INSTITUTE FOUNDATION Pge 10 r.rgffl, VAl P rivte O perting Foun d tions (see instructions n d rt VIIA, question 9 ) 1 If the foundtion hs received ruling or determintion letter tht it is privte operting foundtion, nd the ruling is effective for 2013, enter the dte of the ruling 8/20/09 b Check box to indicte whether the foundtion is privte operting foundtion described in section n 4942(1) (3) or 49420)(5) 2 Enter the lesser of the djusted net Tx yer Prior 3 yers income from Prt I or the minimum investment return from Prt X for () 2013 (b) 2012 (c) 2011 (d ) 2010 (e) Totl ech yer listed b 85% of line 2 c Qulifying distributions from Prt XI I, line 4 for ech yer listed d Amounts included in line 2c not used directly for ctive conduct of exempt ctivities e Qulifying distributions mde directly for ctive conduct of exempt ctivities. Subtrct line 2d from line 2c Complete 3, b, or c for the lterntive test relied upon: 'Assets' lterntive test enter: (1) Vlue of ll ssets (2) Vlue of ssets qulifying under section 49420)(3)(8)(1) b'endowment ' lterntive test enter 2/3 of minimum investment return shown in Prt X, line 6 for ech yer listed c 'Support' lterntive test enter: (1) Totl support other thn gross investment income ( interest, dividends, rents, pyments on securities lons (section 512()(5)), or roylties) , 195. (2) Support from generl public nd 5 or more exempt orgniztions s provided in section 4942(j)(3)(B)(iii).. (3) Lrgest mount of support from n exempt orgniztion (4) Gross investment income Supplement ry Informtion (Complete this prt only if the foundtion hd $5,000 or more in ssets t ny time during the yer see instructions.) 1 Informtion Regrding Foundtion Mngers: List ny mngers of the foundtion who hve contributed more thn 2% of the totl received by the foundtion before the close of ny tx yer (but only if they hve contributed more thn $5,000). (See section 507(d)(2).) J PATRICK JOHNSON b List ny mngers of the foundtion who own 10% or more of the stock of corportion (or n eqully lrge portion of the ownership of prtnership or other entity) of which the foundtion hs 10% or greter interest. SEE STATEMENT 6 2 Informtion Regrding Contribution, Grnt, Gift, Lon, Scholrship, etc, Progrms: Check here 0' FR if the foundtion only mkes to preselected chritble orgniztions nd does not ccept unsolicited requests for funds. If the foundtion mkes gifts, grnts, etc (see instructions) to individuls or orgniztions under other conditions, complete items 2, b, c, nd d. The nme, ddress, nd telephone number or emil of the person to whom pplictions should be ddressed. b The form in which pplictions should be submitted nd informtion nd mterils they should include: c Any submission dedlines: d Any restrictions or limittions on wrds, such s by geogrphicl res, chritble fields, kinds of institutions, or other fctors BAA TEEA0310L 07/10/13 Form 990PF (2013)

11 Form 990PF (203) THE SPINE INSTITUTE FOUNDATION Pge 11 IfffflMl S upp lementry n ormtion (continued) 3 Grnts nd Contributions Pid During the Yer or Approved for Future Pyment N/A If recipient is n individul, Recipient show ny reltionship to ny Foundtion foundtion mnger or sttus of Purpose of grnt or Amount contribution Nme nd ddress (home or business ) substntil contributor recipient Pid during the yer Totl b Approved for future pyment 3 Totl P" 3bi BAA TEEA0501L 07/11/13 Form 990PF (2013)

12 Form 990PF (2013) THE SPINE INSTITUTE FOUNDATION Pge 12 '! Anlysis of Income Producing Activities Ente 1 gross mounts unless otherwise indicted. Unrelte d business income Excluded by section 512, 513, or 514 (e) Progrm service revenue: () Business code (b) Amount (c) Exclucode (d ) Amount Relted or exempt function income (See instructions.) b c d e Fees nd contrcts from government gencies Membership dues nd ssessments Interest on svings nd temporry csh investments Dividends nd interest from securities N e t rentl income or (loss) from rel estte: Debtfinnced property Not debtfinnced property Net rentl income or (loss) from personl property Other investment income Gin or ( loss) from sles of ssets other thn inventory Net income or (loss) from specil events... Gross profit or (loss) from sles of inventory Other revenue: Subtotl. Add columns (b), (d), nd (e) Totl. Add line 12, columns (b), (d), nd (e) (See worksheet in line 13 instructions to verify clcultions.) '!B Reltionship of Activities to the Accomplishment of Exempt Purposes 13 U. BAA TEEA0502L Form 990PF (2013)

13 Form 990PF (2013) THE SPINE INSTITUTE FOUNDATION Pge 13 Prb ' XVIJi' I n formtion Regrd ing T rns fers T o n d T rnsctions n d Re l tions h ips Wit h one ntbl e Exempt Orgniztions 1 Did the orgniztion directly or indirectly engge in ny of the following with ny other orgniztion described in section 501(c) of the Code (other thn section 501(c)(3) orgniztions) or in section 527, relting to politicl orgniztions? Trnsfers from the reporting foundtion to nonchritble exempt orgniztion of: (1) Csh.,. 1(1) X (2) Other ssets.. 1 (2) X b Other trnsctions: (1) Sles of ssets to nonchritble exempt orgniztion 1 b(1) X (2) Purchses of ssets from nonchrltble exempt orgniztion 1 b (2) X (3) Rentl of fcilities, equipment, or other ssets 1 b (3) X (4) Reimbursement rrngements.. 1 b (4) X (5) Lons or lon gurntees 1 b (5) X (6) Performnce of services or membership or fundrising solicittions 1 b (6) X c Shring of fcilities, equipment, miling lists, other ssets, or pid employees 1 c X d If the nswer to ny of the bove is 'Yes,' complete the following schedule. Column(b) should lwys show the fir m rket vlu the goods, other ssets, or services given by the reporting foundtion. If the foundtion received less thn fir mrke t vlue in e of ny trnsction or shring rrngement, show in column(d) the vlue of the goods, other ssets, or services received () Line no. (b) Amount involved (c) Nme of nonchritble exempt orgniztion (d) Description of trnsfers, trnsctions, nd shring rrngements N/A Yes No 2 Is the foundtion directl y or indirectly ffilited with, or relted to, one or more txexempt orgniztions described in section 501(c) of the Code ( other thn section 501(c)(3 )) or in section 527? F ]Yes b If 'Yes,' complete the following schedule. () Nme of orgniztion (b) Type of orgniztion (c) Description of reltionship N/A No Sign Here y( Under penlties of perjury, I declre tht I hve exmined this return, including ccompnyin correct, nd complete Declrtion of preprer (other thn txpyer ) is bsed on ll inl Signtureer orrttrustee Print/Type preprer ' s nme Preprer ' s signture Pid HOWARD J. ABRAMS HOWARD J. Preprer Firm's nme " HOWARD J ABRAMS AN ACCOUN Use Only Firm's ddress LINDERO CANYON RD WESTLAKE VILLAGE, CA 9136 BAA Dt TEEA0503L

14 Schedule B (Form 990, 990EZ, or 990 PF) Schedule of Contributors Deprtment of the Tresury Attch to Form 990, Form 990 EZ, or Form 990PF Internl Revenue Service Info rtntlon bout Schedule B (Form 990, 990EZ, 990PF) nd Its Instructions Is fiww. irs.gov/form990. OMB No ^O^ Nme of the orgniztion Employer Identifiction number THE SPINE INSTITUTE FOUNDATION Orgniztion type (check one): Filers of: Section: Form 990 or 990EZ LI 501(c)( ) (enter number) orgniztion LI 4947()(1) nonexempt chritble trustnot treted s privte foundtion n 527 politicl orgniztion Form 990PF [ 501 (c)(3) exempt privte foundtion 4947()(1) nonexempt chritble trust treted s privte foundtion 501(c)(3) txble privte foundtion Check if your orgniztion is covered by the Generl Rule or Specil Rule. Note. Only section 501(c)(7), (8), or (10) orgniztion cn check boxes for both the Generl Rule nd Specil Rule See instructions Generl Rule FvI For n orgniztion filing Form 990, 990EZ, or 990PF tht received, during the yer, $5,000 or more (in money or property) from ny one L^J contributor. (Complete Prts I nd II.) Specil Rules For section 501(c)(3) orgniztion filing Form 990 or 990EZ tht met the 331/3% support test of the regultions under sections 509()(1) nd 170(b)(1)(A)(vl) nd received from ny one contributor, during the yer, contribution of the greter ofi) $5,000 or (2) 2% of the mount on (I) Form 990, Prt VIII, line 1h, or (ii) Form 990EZ line 1. Complete Prts I nd II. For section 501 (c)(7), (8), or (10) orgniztion filing Form 990 or 990EZ tht received from ny one contributor, during the yer, totl of more thn $1,000 for useexclusively for religious, chritble, scientific, literry, or eductionl purposes, or the prevention of cruelty to children or nimls. Complete Prts I, II, nd Ill. For section 501 (c)(7), (8), or (10) orgniztion filing Form 990 or 990EZ tht received from ny one contributor, during the yer, for use exclusively for religious, chritble, etc, purposes, but these did not totl to more thn $1,000 If this box is checked, enter here the totl tht were received during the yer for rexclusively religious, chritble, etc, purpose. Do not complete ny of the prts unless thegenerl Rule pplies to this orgniztion becuse it received nonexclusively religious, chritble, etc, of $5,000 or more during the yer 0$ Cution :An orgniztion tht is not covered by the Generl Rule nd/or the Specil Rules does not file Schedule B (Form 990, 990EZ, or 990PF) but itmust nswer 'No' on Prt IV, line 2, of its Form 990; or check the box on line H of Its Form 990EZ or on its Form 990PF, Prt I, line 2, to certify tht it does not meet the filing requirements of Schedule B (Form 990, 990EZ, or 990PF) BAA For Pperwork Reduction Act Notice, see the Instructions for Form 990, 990EZ, Schedule B (Form 990, 990EZ, or 990PF) (2013) or 990PF. TEEA070IL

15 Schedule B (Form 990, 990EZ, or 990PF) (2013) Pge 1 of 3 of Prt 1 of orgniztion THE SPINE INSTITUTE FOUNDATION Contributors (see instructions). Use duplicte copies of Prt I if dditionl spce is needed. (b) c (d ) Num ber Nme, ddress, nd ZIP + 4 T o t l Type of contribution 1 THE HEARST FOUNDATION Pyroll 300 WEST 57STREET Ti $ 250L000_ Noncsh LI NEW YORK 1 _NY (Complete Prt II for noncsh.) (b) c (d ) Num ber Nme, ddress, nd ZIP + 4 Totl Type of contribution 2 HENRY MARVIN _ Pyroll 2725 SCHMILY CT $ 1OL000_ Noncsh F1 LANCASTERi (Complete Prt II for.) () (b) (c) (d) Number Nme, ddress, nd ZIP + 4 Totl Type of contribution I I 3 BERT JOHNSON Pyroll LEDRIVE $ 15L000_ Noncsh A (Complete n Prt for b d Num ber Nme, ddress, nd ZIP +4 Type of contribution 4 HAM Pyroll CA Noncsh Li I I (Complete t for (Compl b c d Num ber Nme, ddress, nd ZIP +4 Totl Type of contribution 5 RICKMAN Pyroll 9713 MOORGATE_RD Noncsh BEVERLY HILLS CA ( Complete Prt 11 for noncsh () (b) (d) Number Nme, ddress, nd ZIP +4 Type of contribution 6 DR. MICHAEL MOTAMED Pyroll 10751WILSHIREBLVD, #1406 Noncsh Li (Complete Prt II for LOS ANGELES, CA noncsh ) I BAA TEEA0702L 12127/13 Schedule B (Form 990, 990EZ, or 990 PF) (2013) X

16 Schedule B (Form 990, 990EZ, or 990 PF) (2013) of Orgniztion THE SPINE INSTITUTE FOUNDATION Contributors (see instructions). Use duplicte copies of Prt I if dditionl spce is needed. Pge 2 of 3 of Prt 1 () (b) (c) (d) Number Nme, ddress, nd ZIP + 4 Totl Type of contribution 7 CHERYL EISER Pyroll TH STREET, APT 1 C_03 Noncsh OX (CornptePrtfl for oncsh.) (b) d Num ber Nme, ddress, nd ZIP+4 Type of contribution 8 ROBERTPIKE OTONDLAKE Noncsh LAKE FOREST, IL Complete Prt 11 for ) () (b) (d) Number Nme, ddress, nd ZIP +4 Type of contribution F1 9 HELEN JONAH 6317 WARNER DRIVE Noncsh LOS ANGELES, CA Cormete Prt II for b d Num ber Nme, ddress, nd ZIP + 4 Type of contribution 10 MR. ORRIN SAGE _ Pyroll OAD $ 5L000_ Noncsh 11 CA_93108 _ (Complete Prt 1I n for () (b) (c) (d) Number Nme, ddress, nd ZIP +4 Totl Type of contribution 11 LUM, M. D. Pyroll 710 N. PALM DRIVE $ 8, 000. Non csh El BEVERLY HILLS CA _ i (Complete Prt ll for () (b) (d) Number Nme, ddress, nd ZIP + 4 Type of contribution 12 MR. RICHARD BUTKUS Pyroll 3930 VILLACOSTERA Noncsh (Complete Prt 11 for MALIBU CA _ ^ noncsh ) BAA TEEA0702L 12/27/13 Schedule B (Form 990, 990 EZ, or 990 PF) (2013)

17 Schedule B (Form 990, 990EZ, or 990PF) (2013) Pge 3 of 3 of Prt 1 Nme of orgniztion Employer Identifiction number THE SPINE INSTITUTE FOUNDATION Contributors (see instructions). Use duplicte copies of Prt I if dditionl spce is needed. (b) (c ) (d ) Num ber Nme, ddress, nd ZIP + 4 Totl Type of contribution 13 RICHARD WALDRON Pyroll 10601WILSHIREBLVD, UNIT1104 $ 20L000_ Noncsh (Complete Prt II for LOS ANGELES, CA ioncsh ) d Num ber Nme, ddress, nd ZIP +4 Type of contribution 14 RONALD VINCENT Pyroll 1230 E. ROCKWOOD PINESRD $10L000_ Noncsh Li 11 SPOKANE WA 9930 ^ (Complete Prt II for noncsh ) () (b) (c) (d) Number Nme, ddress, nd ZIP +4 Totl Type of contribution Li Pyroll Noncsh Li (Complete Prt II for noncsh.) ( ) Number Nme, ddr es s, nd ZIP + 4 c Totl (d) Type of contribution Pyroll Li $ _ Noncsh El (Complete Prt II for noncsh ) () (b) (c) (d) Number Nme, ddress, nd ZIP +4 Totl Type of contribution $ Li Pyroll Noncsh 11 (Complete Prt II for noncsh.) ) Nu mber b Nme, ddres s, nd ZIP + 4 To t l d Type of co ntribution Li Pyroll Noncsh n (Complete Prt II for noncsh ) 13AA TEEA0702L 12/27113 Schedule B (Form 990, 990EZ, or 990PF) (2013)

18 Schedule B (Form 990, 990EZ, or 990PF) (2013) Pge 1 to 1 of Prt II Nme of orgniztion Employer Identifiction number THE SPINE INSTITUTE FOUNDATION P 'll Noncsh Property (see instructions). Use duplicte copies of Prt II if dditionl spce is needed. () No. (b ) ( c) (d) from Description of noncsh property given FMV (or estimte ) Dte received Prt I (see instructions) N/A $ () No. (b) (c) (d) from Description of noncsh property given FMV (or estimte) Dte received Prt I (see instructions) () No. b c d frm Description of noncsh property given FMV (or estimte ) Dte received Prt I (see instructions) $ No. (b) c (d ) ( from Description of noncsh property given FMV (or estimte) Dte received Prt I (see instructions) $ ( No. (b) c d from Description of noncsh property given FMV (or estimte) Dte received Prt I (see instructions) () No. (b ) (c) (d) from Prt I Description of noncsh property given FMV (or estimte ) (see instructions) Dte received BAA Schedule B (Form EZ. or 990 PF) (2013) TEEA0703L 12/27/13

19 Schedule B (Form 990, 990EZ, or 990PF) (2013) Pge 1 to 1 of Prt III Nme of orgniztion Employer identifiction number THE SPINE INSTITUTE FOUNDATION MEMO Exclusively religious, chritble, etc., individul to section 501 (c)(7), (8) or (10) orgniztions tht totl more thn $1,000 for the yer. Complete columns ( ) through (e) nd the following line entry. For orgniztions completing Prt III, enter totl ofexclusively religious, chritble, etc., of $1,000 or less for the yer. (Enter this informtion once. See instructions.) $ N/A Use duplicte copies of Prt III if dditionl spce is needed. ( ) No. from Prt I (b) Purpose of gift N/A (c) Use (of gift (d) Description of how gift is held e Trnsfer of gift Trnsferee 's nme, ddress, nd ZIP + 4 Reltionship of trnsferor to trnsferee No. from Prt I (b) c Purpose of gift Use(of gift (d ) Description of how gift is held I (e) Trnsfer of gift Trnsferee 's nme, ddress, nd ZIP + 4 Reltionship of trnsferor to trnsferee No. from Prt I (b) c Purpose of gift Use(of gift Description oid ) how gift is held (e) Trnsfer of gift Trnsferee 's nme, ddress, nd ZIP + 4 Reltionship of trnsferor to trnsferee () No. from Prt I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Trnsfer of gift Trnsferee 's nme, ddress, nd ZIP + 4 Reltionship of trnsferor to trnsferee BAA Schedule B (Form 990, 990EZ, or 9904PF) (2013) TEEA0704L 12/27/13

20 2013 FED ERAL STATEMENTS PAGE 1 CLIENT SPINEFDN THE SPINE INSTITUTE FOUNDATION / PM STATEMENT1 FORM 990PF, PART I, LINE 16B ACCOUNTING FEES (A) (B) NET (C) (D) EXPENSES INVESTMENT ADJUSTED CHARITABLE PER BOOKS INCOME NET INCOME PURPOSES ACCOUNTIING $ 7,731. TOTAL 7, $ 7, ,731. STATEMENT 2 FORM 990PF, PART I, LINE 18 TAXES (A) (B) NET (C) (D) EXPENSES INVESTMENT ADJUSTED CHARITABLE PER BOOKS INCOME NET INCOME PURPOSES FTB $ 35. $ 35. PAYROLL TAXES TOTAL 8, STATEMENT 3 FORM 990 PF, PART I, LINE 19 ALLOCATED DEPRECIATION DATE COST PRIOR YR CURRENT NET INVEST ADJUSTED ACQUIRED BASIS DEPR METHOD RATE LIFE YR DEPR INCOME NET INCOME COMPUTER EQUIPMENT 8/01/09 2,308 1,848 S/L COMPUTER EQUIP 7/05/10 3,137 1,568 S/L COMPUTER EQUIP 7/15/10 3,767 1,883 S/L COMPUTER EQUIP 9/01/10 2,493 1,247 S/L COMPUTER EQUIPMENT 5/12/11 3,969 1,191 S/L COMPUTER EQUIPMENT 4/26/11 2, S/L COMPUTER EQUIPMENT 8/15/ S/L

21 2013 FEDERAL STATEMENTS PAGE 2 CLIENT SPINEFDN THE SPINE INSTITUTE FOUNDATION /14/14 02' 12PM STATEMENT 4 FORM 990PF, PART I, LINE 23 OTHER EXPENSES (A) (B) NET (C) (D) EXPENSES INVESTMENT ADJUSTED CHARITABLE PER BOOKS INCOME NET INCOME PURPOSES ADVERTISING..... $ 1,210. $ 1,210. COMPUTER EXP CREDIT CARD DISCOUNT FEES 1,530. 1,530. DELIVERY HEALTH INSURANCE 7,162. 7,162. MEALS AND ENTERTAINMENT 4,038. 4,038. MISCELLANEOUS OFFICE EXPENSES PARKING POSTAGE RENTAL EXPENSES 5,500. 5,500. TELEPHONE TRAVEL TOTAL 31, , ,832. STATEMENT 5 FORM 990PF, PART II, LINE 14 LAND, BUILDINGS, AND EQUIPMENT ACCUM. BOOK FAIR MARKET CATEGORY BASIS DEPREC. VALUE VALUE FURNITURE AND FIXTURES $ 0. $ 0. $ 0. $ 6,000. MACHINERY AND EQUIPMENT 18, , , TOTAL 18, ,126. 6,662.,000. STATEMENT 6 FORM 990 PF, PART XV, LINE 1 B FOUNDATION MANAGERS 10% OR MORE STOCKHOLDERS J PATRICK JOHNSON RICHARD LAREW