2012-11-14T17:01:57-06:00 2011-12-31 680289709 DAL POGGETTO & CO LLP 149 STONY CIRCLE FIRST FLOOR SANTA ROSA CA 95401 990PF 2011-01-01 237062014 FURTH FAMILY FOUNDATION FURT 7075261389 5610 SKYLANE BLVD SUITE A SANTA ROSA CA 95403 FREDERICK P FURTH 7075261389 2012-11-13 1 JULIE M SCHOEPP P00845483 7075453311 2011 2016-02-24 21:20:13Z X 1573915 X X 18828 18828 81252 81252 100080 100080 0 0 0 4118 0 0 19350 0 0 35 0 0 175 175 0 23678 175 0 149379 149379 173057 175 149379 -72977 99905 272983 160324 160324 8117 8117 144066 1001288 1176881 1269525 5004028 0 0 6286416 1345322 1573915 155371 150617 155371 150617 X 6131045 1194705 6131045 1194705 6286416 1345322 6131045 -72977 140911 6198979 5004274 1194705 UBS CARLYLE FUND, LLC - SERIES A P 2004-07-01 2011-12-31 81252 81252 81252 0 45588 6114340 0.007456 8960 6036969 0.001484 406796 7553319 0.053857 779648 12401328 0.062868 3971695 9784310 0.405925 0.531590 0.106318 1350357 143567 999 144566 149379 X 999 0 999 0 999 3601 3601 2602 2602 0 0 0 0 0 0 0 0 0 0 0 1 1 CA 1 0 0 0 0 1 N/A FREDERICK P FURTH 7075261389 5610 SKYLANE BLVD SUITE A SANTA ROSA CA 95403 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FREDERICK P FURTH 5610 SKYLANE BLVD SUITE A SANTA ROSA CA 95403 5.00 0 0 0 PEGGY J FURTH 5610 SKYLANE BLVD SUITE A SANTA ROSA CA 95403 5.00 0 0 0 DARBY FURTH BONOMI 5610 SKYLANE BLVD SUITE A SANTA ROSA CA 95403 5.00 0 0 0 DONNA W FURTH 5610 SKYLANE BLVD SUITE A SANTA ROSA CA 95403 5.00 0 0 0 NONE 0 NONE 0 0 1159927 210994 0 1370921 0 0 1370921 20564 1350357 67518 67518 999 999 66519 0 66519 0 66519 149379 0 149379 999 148380 66519 0 0 3526565 779648 406796 8960 45588 4767557 149379 0 0 149379 0 0 66519 66519 4850417 0 0 0 0 0 0 3460046 1390371 779648 406796 8960 45588 149379 FREDERICK P FURTH FREDERICK P FURTH 5610 SKYLANE BLVD SUITE A SANTA ROSA CA 95403 7075261389 NO SPECIFIC FORM NONE NONE 181 MISSIONARY OBLATES 9480 N DE NAZEBID DR BELLVILLE IL 92223 UNRELATED VARIOUS CHARITABLE PURPOSES 250 ADVOKIDS 5643 PARADISE DR SUITE 12 CORTA MADERA CA 94925 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 ALOIS SOCIETY PO BOX 96011 WASHINGTON DC 20090 UNRELATED VARIOUS CHARITABLE PURPOSES 500 AMERICAN CANCER ASSOCIATION 250 WILLIAM ST ATLANTA GA 30303 UNRELATED VARIOUS CHARITABLE PURPOSES 100 AOPA FOUNDATION 421 AVIATION WAY FREDERICK MD 21701 UNRELATED VARIOUS CHARITABLE PURPOSES 250 ARCHDIOCESE FOR MILITARY PO BOX 96168 WASHINGTON DC 20090 UNRELATED VARIOUS CHARITABLE PURPOSES 250 CAL GOLF (UNIVERSITY OF CALIFORNIA GOLF TEAM) 12 TOTTERDELL COURT ORINDA CA 94563 UNRELATED VARIOUS CHARITABLE PURPOSES 2500 CARMEL MISSION FOUNDATION 200 CLOCK TOWER PLACE 206E CARMEL CA 93922 UNRELATED VARIOUS CHARITABLE PURPOSES 500 CATHOLIC CHARITIES CYO 180 HOWARD ST SUITE 100 SAN FRANCISCO CA 94105 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 CATHOLICS FOR THE COMMON GOOD PO BOX 320038 SAN FRANCISCO CA 94132 UNRELATED VARIOUS CHARITABLE PURPOSES 500 COUNCIL ON AGING 30 KAWANA SPRINGS RD SANTA ROSA CA 95404 UNRELATED VARIOUS CHARITABLE PURPOSES 250 DISABILITY RIGHTS ADVOCATES 2001 CENTER ST FOURTH FLOOR BERKLEY CA 94704 UNRELATED VARIOUS CHARITABLE PURPOSES 2500 DISABILITY SERVICE & LEGAL 5210 MENDOCINO AVE SANTA ROSA CA 95401 UNRELATED VARIOUS CHARITABLE PURPOSES 200 DISCALCED CARMELITE FRIARS PO BOX 2178 REDLANDS CA 92373 UNRELATED VARIOUS CHARITABLE PURPOSES 250 EAST BAY CHILDREN'S LAW OFFICES 1404 FRNAKLIN ST SUITE 400 OAKLAND CA 94612 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 ED2 INTERNATIONAL 945 BRYANT ST SUITE 300 SAN FRANCISCO CA 94103 UNRELATED VARIOUS CHARITABLE PURPOSES 68941 EXPLORATORIUM 3601 LYON STREET SAN FRANCISCO CA 94123 UNRELATED VARIOUS CHARITABLE PURPOSES 100 FRIENDS HOUSE 684 BENICIA DR SANTA ROSA CA 95409 UNRELATED VARIOUS CHARITABLE PURPOSES 100 GRACE CATHEDRAL 1100 CALIFORNIA ST SAN FRANCISCO CA 94108 UNRELATED VARIOUS CHARITABLE PURPOSES 250 GREAT DANE RESCUE OF NORTHERN CALIFORNIA 15255 CLYDELLE AVE SAN JOSE CA 95124 UNRELATED VARIOUS CHARITABLE PURPOSES 250 HEALTHCARE FOUNDATION PO BOX 1025 HEALDSBURG CA 95448 UNRELATED VARIOUS CHARITABLE PURPOSES 250 HELP HOSPITALIZED VETERANS 36585 PENFIELD LANE WINCHESTER CA 92596 UNRELATED VARIOUS CHARITABLE PURPOSES 100 HOLY FAMILY DAY HOME 299 DOLORES ST SAN FRANCISCO CA 94103 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 HORSES IN THE HOOD PO BOX 583249 TARZANA CA 91357 UNRELATED VARIOUS CHARITABLE PURPOSES 500 JUVENILE LAW SOCIETY 250 HUMBOLDT ST DENVER CO 80109 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 KID STREET LEARNING CENTER PO BOX 6784 SANTA ROSA CA 95406 UNRELATED VARIOUS CHARITABLE PURPOSES 500 KID'S TURN 55 MONTGOMERY SUITE 500 SAN FRANCISCO CA 94105 UNRELATED VARIOUS CHARITABLE PURPOSES 1988 KIDS SCOOP FOUNDATION 181 ANDRIEUXX ST SUITE 200 SONOMA CA 95476 UNRELATED VARIOUS CHARITABLE PURPOSES 250 KQED PUBLIC RADIO PO BOX 7618 SAN FRANCISCO CA 94120 UNRELATED VARIOUS CHARITABLE PURPOSES 2000 LEGAL AID OF SONOMA COUNTY 1105 N DUTTON AVE SUITE B SANTA ROSA CA 95401 UNRELATED VARIOUS CHARITABLE PURPOSES 250 LEGAL AID SOCIETY - EMPLOYMENT LAW CENTER 180 MONTGOMERY ST SUITE 600 SAN FRANCISCO CA 94104 UNRELATED VARIOUS CHARITABLE PURPOSES 500 LEGAL SERVICES FOR CHILDREN 1254 MARKET ST THIRD FLOOR SAN FRANCISCO CA 94103 UNRELATED VARIOUS CHARITABLE PURPOSES 25000 MARIN COUNTY DAY SCHOOL 5221 PARADISE DR CORTE MADERA CA 94925 UNRELATED VARIOUS CHARITABLE PURPOSES 7750 MARY AGATHA FURTH CENTER 8400 OLD REDWOOD HWY WINDSOR CA 95492 UNRELATED VARIOUS CHARITABLE PURPOSES 6000 MULTI-CULTURAL CHILD DEVELOPMENT 1650 W 3RD ST SANTA ROSA CA 95401 UNRELATED VARIOUS CHARITABLE PURPOSES 500 NATIONAL FOSTER YOUTH ACTION NETWORK PO BOX 26690 SAN FRANCISCO CA 94126 UNRELATED VARIOUS CHARITABLE PURPOSES 2500 NATIONAL SHRINE 400 MICHIGAN AVE NE WASHINGTON DC 20017 UNRELATED VARIOUS CHARITABLE PURPOSES 300 OLD ST MARY'S CATHEDRAL 660 CALIFORNIA ST SAN FRANCISCO CA 94108 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 OUR LADY OF GUADALUPE 8460 ALDEN LANE WINDSOR CA 95492 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 OUR LADY OF THE SNOWS PO BOX 1650 SUN VALLEY ID 83353 UNRELATED VARIOUS CHARITABLE PURPOSES 250 PROSTATE CANCER FOUNDATION 1250 FOURTH ST SANTA MONICA CA 90401 UNRELATED VARIOUS CHARITABLE PURPOSES 100 REDWOOD EMPIRE FOODBANK 3320 INDUSTRIAL DR SANTA ROSA CA 95403 UNRELATED VARIOUS CHARITABLE PURPOSES 5000 ROOSEVELT INSTITUTE 570 LEXINGTON AVE 18TH FLOOR NEW YORK NY 10022 UNRELATED VARIOUS CHARITABLE PURPOSES 500 SAN FRANCISCO FALL ANTIQUE SHOW 200 PINE ST FLOOR 6 SAN FRANCISCO CA 94104 UNRELATED VARIOUS CHARITABLE PURPOSES 1500 SANTA ROSA COMMUNITY HEALTH CENTERS 3569 ROUND BARN CIRCLE SANTA ROSA CA 95403 UNRELATED VARIOUS CHARITABLE PURPOSES 500 SISTERS OF NOTRE DAME 1520 RALSTON AVE BELMONT CA 94002 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 SONOMA ACADEMY 50 MARK WEST SPRINGS RD SANTA ROSA CA 95403 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 ST JOHN'S SEMINARY 5012 SEMINARY DR CAMARILLO CA 93012 UNRELATED VARIOUS CHARITABLE PURPOSES 1600 ST JOSEPH'S CHURCH 632 008 VLRDT TAMIL NADU IN UNRELATED VARIOUS CHARITABLE PURPOSES 100 ST MARY'S STUDENT PARISH 331 THOMPSON ANN HARBOR MI 48104 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 ST PATRICK PARISH 114 KING ST LARKSPUR CA 94939 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 ST PIUS SCHOOL 1100 WOODSIDE RD REDWOOD CITY CA 94061 UNRELATED VARIOUS CHARITABLE PURPOSES 250 SUPREME COURT HISTORICAL SOCIETY 224 EAST CAPITOL ST NE WASHINGTON DC 20003 UNRELATED VARIOUS CHARITABLE PURPOSES 250 THE SPIRIT OF COMMUNITY 63 NORTH 24TH STREET BATTLE CREEK MI 49015 UNRELATED VARIOUS CHARITABLE PURPOSES 1000 TRACK TWO - INSTITUTE FOR CITIZEN DIPLOMACY 2670 LEABONWORTH ST SAN FRANCISCO CA 94133 UNRELATED VARIOUS CHARITABLE PURPOSES 250 VINE VILLAGE 4059 OLD SONOMA RD NAPA CA 94559 UNRELATED VARIOUS CHARITABLE PURPOSES 500 VOLUNTEER CENTER OF SONOMA 153 STONY CIRCLE SUITE 100 SANTA ROSA CA 95401 UNRELATED VARIOUS CHARITABLE PURPOSES 500 149379 0 14 18828 18 81252 0 100080 0 100080 0 0 0 0 0 0 0 0 0 0 ACCOUNTING FEES 19350 0 0 ELECTION STATEMENT UNDER REGS. SECTION 53.4942(A)-3(D)(2)THE FOUNDATION HEREBY ELECTS TO DESIGNATE THE QUALIFYING DISTRIBUTIONS OF $146,379 MADE DURING 2011 AS DISTRIBUTIONS OUT OF CORPUS. ROBERT HALF 2217 45536 BF ENTERPRISES 5900 98530 UBS CARLYLE FUND LLC AT COST 988019 1080663 UBS INVESTMENT AT COST 188862 188862 LEGAL FEES 4118 0 0 BOOK TO TAX DIFFERENCES 246 BOOKS ONLY ADJUSTMENT 5004028 INVESTMENT EXPENSE 175 175 0 UNREALIZED GAIN IN UBS CARLYLE FUND, LLC 140911 TAXES 35 0 0