Return of Private Foundation

Transcription

1 Form 990-PF Dprtmnt of th Trsury Intrnl Rvnu Srvi Rturn of Privt Fountion or Stion 97()() nxmpt Chritl Trust Trt s Privt Fountion t: Th orgniztion my l to us opy of this rturn to stisfy stt rporting rquirmnts. OMB. -00 For lnr yr 00, or tx yr ginning, 00, n ning, 0 G Chk ll tht pply: Initil rturn Finl rturn Amn rturn Arss hng Nm hng Us th IRS ll. Othrwis, print or typ. S Spifi Instrutions. Nm of orgniztion Numr n strt (or P.O. ox numr if mil is not livr to strt rss) City or town, stt, n ZIP o H Chk typ of orgniztion: Stion 0()() xmpt privt fountion Stion 97()() nonxmpt hritl trust Othr txl privt fountion I Fir mrkt vlu of ll ssts t n J Aounting mtho: Csh Arul of yr (from Prt II, ol. (), Othr (spify) lin ) $ (Prt I, olumn () must on sh sis.) Prt I Rvnu Oprting n Aministrtiv Expnss Anlysis of Rvnu n Expnss (Th totl of mounts in olumns (), (), n () my not nssrily qul th mounts in olumn () (s pg 0 of th instrutions).) Contriutions, gifts, grnts, t., riv (tth shul) Chk if th fountion is not rquir to tth Sh. B Distriutions from split-intrst trusts Intrst on svings n tmporry sh invstmnts Divins n intrst from suritis Gross rnts (Nt rntl inom or (loss) ) Nt gin or (loss) from sl of ssts not on lin 0 Gross sls pri for ll ssts on lin 7 Cpitl gin nt inom (from Prt IV, lin ) 8 Nt short-trm pitl gin 9 Inom moifitions 0 Gross sls lss rturns n llowns Lss: Cost of goos sol Gross profit or (loss) (tth shul) Othr inom (tth shul) Totl. A lins through Compnstion of offirs, irtors, trusts, t. Othr mploy slris n wgs Pnsion plns, mploy nfits Lgl fs (tth shul) Aounting fs (tth shul) Othr profssionl fs (tth shul) 7 Intrst 8 Txs (tth shul) (s pg of th instrutions) 9 Dprition (tth shul) n pltion 0 Oupny Trvl, onfrns, n mtings Printing n pulitions Othr xpnss (tth shul) Totl oprting n ministrtiv xpnss. A lins through Contriutions, gifts, grnts pi Totl xpnss n isursmnts. A lins n 7 Sutrt lin from lin : Exss of rvnu ovr xpnss n isursmnts Nt invstmnt inom (if ngtiv, ntr -0-) Ajust nt inom (if ngtiv, ntr -0-) For Pprwork Rution At ti, s th instrutions. () Rvnu n xpnss pr ooks Room/suit () Nt invstmnt inom Ct.. 89X A Employr intifition numr B Tlphon numr (s pg 0 of th instrutions) ( ) C If xmption pplition is pning, hk hr D. Forign orgniztions, hk hr. Forign orgniztions mting th 8% tst, hk hr n tth omputtion E If privt fountion sttus ws trmint unr stion 07()()(A), hk hr F If th fountion is in 0-month trmintion unr stion 07()()(B), hk hr () Ajust nt inom 00 () Disursmnts for hritl purposs (sh sis only)

2 Assts Liilitis Prt II Atth shuls n mounts in th sription olumn Bln Shts shoul for n-of-yr mounts only. (S instrutions.) Csh non-intrst-ring Svings n tmporry sh invstmnts Aounts rivl Lss: llown for outful ounts Plgs rivl Lss: llown for outful ounts Grnts rivl Rivls u from offirs, irtors, trusts, n othr isqulifi prsons (tth shul) (s pg of th instrutions) 7 Othr nots n lons rivl (tth shul) Lss: llown for outful ounts 8 Invntoris for sl or us 9 Prpi xpnss n frr hrgs 0 Invstmnts U.S. n stt govrnmnt oligtions (tth shul) Invstmnts orport stok (tth shul) Invstmnts orport ons (tth shul) Invstmnts ln, uilings, n quipmnt: sis Lss: umult prition (tth shul) Invstmnts mortgg lons Invstmnts othr (tth shul) Ln, uilings, n quipmnt: sis Lss: umult prition (tth shul) Othr ssts (sri ) Totl ssts (to omplt y ll filrs s pg of th instrutions. Also, s pg, itm I) 7 Aounts pyl n ru xpnss 8 Grnts pyl 9 Dfrr rvnu 0 Lons from offirs, irtors, trusts, n othr isqulifi prsons Mortggs n othr nots pyl (tth shul) Othr liilitis (sri ) Bginning of yr () Book Vlu Pg En of yr () Book Vlu () Fir Mrkt Vlu Nt Assts or Fun Blns Totl liilitis ( lins 7 through ) Orgniztions tht follow SFAS 7, hk hr n omplt lins through n lins 0 n. Unrstrit Tmporrily rstrit Prmnntly rstrit Orgniztions tht o not follow SFAS 7, hk hr n omplt lins 7 through. Cpitl stok, trust prinipl, or urrnt funs 7 8 Pi-in or pitl surplus, or ln, lg., n quipmnt fun 9 Rtin rnings, umult inom, nowmnt, or othr funs 0 Totl nt ssts or fun lns (s pg 7 of th instrutions) Totl liilitis n nt ssts/fun lns (s pg 7 of th instrutions) Prt III Anlysis of Chngs in Nt Assts or Fun Blns Totl nt ssts or fun lns t ginning of yr Prt II, olumn (), lin 0 (must gr with n-of-yr figur rport on prior yr s rturn) Entr mount from Prt I, lin 7 Othr inrss not inlu in lin (itmiz) A lins,, n Drss not inlu in lin (itmiz) Totl nt ssts or fun lns t n of yr (lin minus lin ) Prt II, olumn (), lin 0

3 Prt IV Cpitl Gins n Losss for Tx on Invstmnt Inom () List n sri th kin(s) of proprty sol (.g., rl stt, -story rik wrhous; or ommon stok, 00 shs. MLC Co.) () Gross sls pri (f) Dprition llow (or llowl) (g) Cost or othr sis plus xpns of sl () How quir P Purhs D Dontion Complt only for ssts showing gin in olumn (h) n own y th fountion on //9 (i) F.M.V. s of //9 (j) Ajust sis s of //9 (k) Exss of ol. (i) ovr ol. (j), if ny () Dt quir (mo., y, yr.) (h) Gin or (loss) () plus (f) minus (g) () Dt sol (mo., y, yr.) (l) Gins (Col. (h) gin minus ol. (k), ut not lss thn -0-) or Losss (from ol.(h)) Cpitl gin nt inom or (nt pitl loss) If gin, lso ntr in Prt I, lin 7 If (loss), ntr -0- in Prt I, lin 7 Nt short-trm pitl gin or (loss) s fin in stions () n (): If gin, lso ntr in Prt I, lin 8, olumn () (s pgs n 7 of th instrutions). If (loss), ntr -0- in Prt I, lin 8 Prt V Qulifition Unr Stion 90() for Ru Tx on Nt Invstmnt Inom (For optionl us y omsti privt fountions sujt to th stion 90() tx on nt invstmnt inom.) If stion 90()() pplis, lv this prt lnk. Pg Ws th orgniztion lil for th stion 9 tx on th istriutl mount of ny yr in th s prio? If, th orgniztion os not qulify unr stion 90(). Do not omplt this prt. Entr th pproprit mount in h olumn for h yr; s pg 8 of th instrutions for mking ny ntris. () Bs prio yrs Clnr yr (or tx yr ginning in) () Ajust qulifying istriutions () Nt vlu of nonhritl-us ssts () Distriution rtio (ol. () ivi y ol. ()) Totl of lin, olumn () Avrg istriution rtio for th -yr s prio ivi th totl on lin y, or y th numr of yrs th fountion hs n in xistn if lss thn yrs 7 Entr th nt vlu of nonhritl-us ssts for 00 from Prt X, lin Multiply lin y lin Entr % of nt invstmnt inom (% of Prt I, lin 7) A lins n 7 8 Entr qulifying istriutions from Prt XII, lin 8 If lin 8 is qul to or grtr thn lin 7, hk th ox in Prt VI, lin, n omplt tht prt using % tx rt. S th Prt VI instrutions on pg 8.

4 Pg Prt VI Exis Tx Bs on Invstmnt Inom (Stion 90(), 90(), 90(), or 98 s pg 8 of th instrutions) Exmpt oprting fountions sri in stion 90()(), hk hr n ntr N/A on lin. Dt of ruling lttr: (tth opy of ruling lttr if nssry s instrutions) Domsti orgniztions tht mt th stion 90() rquirmnts in Prt V, hk hr n ntr % of Prt I, lin 7 All othr omsti orgniztions ntr % of lin 7. Exmpt forign orgniztions ntr % of Prt I, lin, ol. () Tx unr stion (omsti stion 97()() trusts n txl fountions only. Othrs ntr -0-) A lins n Sutitl A (inom) tx (omsti stion 97()() trusts n txl fountions only. Othrs ntr -0-) Tx s on invstmnt inom. Sutrt lin from lin. If zro or lss, ntr -0- Crits/Pymnts: 00 stimt tx pymnts n 000 ovrpymnt rit to 00 Exmpt forign orgniztions tx withhl t sour Tx pi with pplition for xtnsion of tim to fil (Form 888) Bkup withholing rronously withhl 7 Totl rits n pymnts. A lins through 7 8 Entr ny pnlty for unrpymnt of stimt tx. Chk hr if Form 0 is tth 8 9 Tx u. If th totl of lins n 8 is mor thn lin 7, ntr mount ow 9 0 Ovrpymnt. If lin 7 is mor thn th totl of lins n 8, ntr th mount ovrpi 0 Entr th mount of lin 0 to : Crit to 00 stimt tx Rfun Prt VII-A Sttmnts Rgring Ativitis During th tx yr, i th orgniztion ttmpt to influn ny ntionl, stt, or lol lgisltion or i it prtiipt or intrvn in ny politil mpign? Di it spn mor thn $00 uring th yr (ithr irtly or inirtly) for politil purposs (s pg 9 of th instrutions for finition)? If th nswr is to or, tth til sription of th tivitis n opis of ny mtrils pulish or istriut y th orgniztion in onntion with th tivitis. Di th orgniztion fil Form 0-POL for this yr? Entr th mount (if ny) of tx on politil xpniturs (stion 9) impos uring th yr: () On th orgniztion. $ () On orgniztion mngrs. $ Entr th rimursmnt (if ny) pi y th orgniztion uring th yr for politil xpnitur tx impos on orgniztion mngrs. $ Hs th orgniztion ngg in ny tivitis tht hv not prviously n rport to th IRS? If, tth til sription of th tivitis. Hs th orgniztion m ny hngs, not prviously rport to th IRS, in its govrning instrumnt, rtils of inorportion, or ylws, or othr similr instrumnts? If, tth onform opy of th hngs Di th orgniztion hv unrlt usinss gross inom of $,000 or mor uring th yr? If, hs it fil tx rturn on Form 990-T for this yr? Ws thr liquition, trmintion, issolution, or sustntil ontrtion uring th yr? If, tth th sttmnt rquir y Gnrl Instrution T. Ar th rquirmnts of stion 08() (rlting to stions 9 through 9) stisfi ithr: By lngug in th govrning instrumnt or By stt lgisltion tht fftivly mns th govrning instrumnt so tht no mntory irtions tht onflit with th stt lw rmin in th govrning instrumnt? 7 Di th orgniztion hv t lst $,000 in ssts t ny tim uring th yr? If, omplt Prt II, ol. (), n Prt XV. 7 8 Entr th stts to whih th fountion rports or with whih it is rgistr (s pg 9 of th instrutions) If th nswr is to lin 7, hs th orgniztion furnish opy of Form 990-PF to th Attorny Gnrl (or signt) of h stt s rquir y Gnrl Instrution G? If, tth xplntion 8 9 Is th orgniztion liming sttus s privt oprting fountion within th mning of stion 9(j)() or 9(j)() for lnr yr 00 or th txl yr ginning in 00 (s instrutions for Prt XIV on pg )? If, omplt Prt XIV 9 0 Di ny prsons om sustntil ontriutors uring th tx yr? If, tth shul listing thir nms n rsss. 0 Di th orgniztion omply with th puli insption rquirmnts for its nnul rturns n xmption pplition? W sit rss Th ooks r in r of Tlphon no. Lot t ZIP+ Stion 97()() nonxmpt hritl trusts filing Form 990-PF in liu of Form 0 Chk hr n ntr th mount of tx-xmpt intrst riv or ru uring th yr

5 Prt VII-B Sttmnts Rgring Ativitis for Whih Form 70 My B Rquir Fil Form 70 if ny itm is hk in th olumn, unlss n xption pplis. During th yr i th orgniztion (ithr irtly or inirtly): () () () () () () Engg in th sl or xhng, or lsing of proprty with isqulifi prson? Borrow mony from, ln mony to, or othrwis xtn rit to (or pt it from) isqulifi prson? Furnish goos, srvis, or filitis to (or pt thm from) isqulifi prson? Py ompnstion to, or py or rimurs th xpnss of, isqulifi prson? Trnsfr ny inom or ssts to isqulifi prson (or mk ny of ithr vill for th nfit or us of isqulifi prson)? Agr to py mony or proprty to govrnmnt offiil? (Exption. Chk if th orgniztion gr to mk grnt to or to mploy th offiil for prio ftr trmintion of govrnmnt srvi, if trminting within 90 ys.) If ny nswr is to () (), i ny of th ts fil to qulify unr th xptions sri in Rgultions stion.9()- or in urrnt noti rgring isstr ssistn (s pg 9 of th instrutions)? Orgniztions rlying on urrnt noti rgring isstr ssistn hk hr Di th orgniztion ngg in prior yr in ny of th ts sri in, othr thn xpt ts, tht wr not orrt for th first y of th tx yr ginning in 00? Txs on filur to istriut inom (stion 9) (os not pply for yrs th orgniztion ws privt oprting fountion fin in stion 9(j)() or 9(j)()): At th n of tx yr 00, i th orgniztion hv ny unistriut inom (lins n, Prt XIII) for tx yr(s) ginning for 00? If, list th yrs 0, 9, 9, 9 Ar thr ny yrs list in for whih th orgniztion is not pplying th provisions of stion 9()() (rlting to inorrt vlution of ssts) to th yr s unistriut inom? (If pplying stion 9()() to ll yrs list, nswr n tth sttmnt s pg 9 of th instrutions.) If th provisions of stion 9()() r ing ppli to ny of th yrs list in, list th yrs hr. 0, 9, 9, 9 Di th orgniztion hol mor thn % irt or inirt intrst in ny usinss ntrpris t ny tim uring th yr? If, i it hv xss usinss holings in 00 s rsult of () ny purhs y th orgniztion or isqulifi prsons ftr My, 99; () th lps of th -yr prio (or longr prio pprov y th Commissionr unr stion 9()(7)) to ispos of holings quir y gift or qust; or () th lps of th 0-, -, or 0-yr first phs holing prio? (Us Shul C, Form 70, to trmin if th orgniztion h xss usinss holings in 00. ) Di th orgniztion invst uring th yr ny mount in mnnr tht woul jopriz its hritl purposs? Di th orgniztion mk ny invstmnt in prior yr (ut ftr Dmr, 99) tht oul jopriz its hritl purpos tht h not n rmov from jopry for th first y of th tx yr ginning in 00? During th yr i th orgniztion py or inur ny mount to: () Crry on propgn, or othrwis ttmpt to influn lgisltion (stion 9())? () Influn th outom of ny spifi puli ltion (s stion 9); or to rry on, irtly or inirtly, ny votr rgistrtion riv? () Provi grnt to n iniviul for trvl, stuy, or othr similr purposs? () Provi grnt to n orgniztion othr thn hritl, t., orgniztion sri in stion 09()(), (), or (), or stion 90()()? () Provi for ny purpos othr thn rligious, hritl, sintifi, litrry, or utionl purposs, or for th prvntion of rulty to hilrn or nimls? If ny nswr is to () (), i ny of th trnstions fil to qulify unr th xptions sri in Rgultions stion.9 or in urrnt noti rgring isstr ssistn (s pg 0 of th instrutions)? Orgniztions rlying on urrnt noti rgring isstr ssistn hk hr If th nswr is to qustion (), os th orgniztion lim xmption from th tx us it mintin xpnitur rsponsiility for th grnt? If, tth th sttmnt rquir y Rgultions stion.9 (). Di th orgniztion, uring th yr, riv ny funs, irtly or inirtly, to py prmiums on prsonl nfit ontrt? Di th orgniztion, uring th yr, py prmiums, irtly or inirtly, on prsonl nfit ontrt? If you nswr to, lso fil Form Pg

6 Informtion Aout Offirs, Dirtors, Trusts, Fountion Mngrs, Highly Pi Employs, Prt VIII n Contrtors List ll offirs, irtors, trusts, fountion mngrs n thir ompnstion (s pg 0 of th instrutions): () Nm n rss () Titl, n vrg hours pr wk vot to position () Compnstion (If not pi, ntr -0-) () Contriutions to mploy nfit plns n frr ompnstion Pg () Expns ount, othr llowns Compnstion of fiv highst-pi mploys (othr thn thos inlu on lin s pg of th instrutions). If non, ntr NONE. () Nm n rss of h mploy pi mor thn $0,000 () Titl n vrg hours pr wk vot to position () Compnstion () Contriutions to mploy nfit plns n frr ompnstion () Expns ount, othr llowns Totl numr of othr mploys pi ovr $0,000 Fiv highst-pi inpnnt ontrtors for profssionl srvis (s pg of th instrutions). If non, ntr NONE. () Nm n rss of h prson pi mor thn $0,000 () Typ of srvi () Compnstion Totl numr of othrs riving ovr $0,000 for profssionl srvis Prt IX-A Summry of Dirt Chritl Ativitis List th fountion s four lrgst irt hritl tivitis uring th tx yr. Inlu rlvnt sttistil informtion suh s th numr of orgniztions n othr nfiiris srv, onfrns onvn, rsrh pprs prou, t. Expnss

7 Prt IX-B Summry of Progrm-Rlt Invstmnts (s pg of th instrutions) Dsri th two lrgst progrm-rlt invstmnts m y th fountion uring th tx yr on lins n. Amount Pg 7 All othr progrm-rlt invstmnts. S pg of th instrutions. Totl. A lins through Prt X Minimum Invstmnt Rturn (All omsti fountions must omplt this prt. Forign fountions, s pg of th instrutions.) Fir mrkt vlu of ssts not us (or hl for us) irtly in rrying out hritl, t., purposs: Avrg monthly fir mrkt vlu of suritis Avrg of monthly sh lns Fir mrkt vlu of ll othr ssts (s pg of th instrutions) Totl ( lins,, n ) Rution lim for lokg or othr ftors rport on lins n (tth til xplntion) Aquisition intnss pplil to lin ssts Sutrt lin from lin Csh m hl for hritl tivitis. Entr % of lin (for grtr mount, s pg of th instrutions) Nt vlu of nonhritl-us ssts. Sutrt lin from lin. Entr hr n on Prt V, lin Minimum invstmnt rturn. Entr % of lin Prt XI Distriutl Amount (s pg of th instrutions) (Stion 9(j)() n (j)() privt oprting fountions n rtin forign orgniztions hk hr n o not omplt this prt.) Minimum invstmnt rturn from Prt X, lin Tx on invstmnt inom for 00 from Prt VI, lin Inom tx for 00. (This os not inlu th tx from Prt VI.) A lins n Distriutl mount for justmnts. Sutrt lin from lin Rovris of mounts trt s qulifying istriutions Inom istriutions from stion 97()() trusts A lins n A lins n Dution from istriutl mount (s pg of th instrutions) 7 Distriutl mount s just. Sutrt lin from lin. Entr hr n on Prt XIII, lin 7 Prt XII Qulifying Distriutions (s pg of th instrutions) Amounts pi (inluing ministrtiv xpnss) to omplish hritl, t., purposs: Expnss, ontriutions, gifts, t. totl from Prt I, olumn (), lin Progrm-rlt invstmnts Totl from Prt IX-B Amounts pi to quir ssts us (or hl for us) irtly in rrying out hritl, t., purposs Amounts st si for spifi hritl projts tht stisfy th: Suitility tst (prior IRS pprovl rquir) Csh istriution tst (tth th rquir shul) Qulifying istriutions. A lins through. Entr hr n on Prt V, lin 8, n Prt XIII, lin Orgniztions tht qulify unr stion 90() for th ru rt of tx on nt invstmnt inom. Entr % of Prt I, lin 7 (s pg of th instrutions) Ajust qulifying istriutions. Sutrt lin from lin t:th mount on lin will us in Prt V, olumn (), in susqunt yrs whn lulting whthr th fountion qulifis for th stion 90() rution of tx in thos yrs.

8 Pg 8 Prt XIII Unistriut Inom (s pg of th instrutions) Distriutl mount for 00 from Prt XI, lin 7 Unistriut inom, if ny, s of th n of 000: Entr mount for 000 only Totl for prior yrs: 9,9,9 Exss istriutions rryovr, if ny, to 00: From 99 From 997 From 998 From 999 From 000 f Totl of lins through Qulifying istriutions for 00 from Prt XII, lin : $ Appli to 000, ut not mor thn lin Appli to unistriut inom of prior yrs (Eltion rquir s pg of th instrutions) Trt s istriutions out of orpus (Eltion rquir s pg of th instrutions) Appli to 00 istriutl mount Rmining mount istriut out of orpus Exss istriutions rryovr ppli to 00 (If n mount pprs in olumn (), th sm mount must shown in olumn (). ) Entr th nt totl of h olumn s init low: Corpus. A lins f,, n. Sutrt lin Prior yrs unistriut inom. Sutrt lin from lin () Corpus () Yrs prior to 000 () 000 () 00 f Entr th mount of prior yrs unistriut inom for whih noti of fiiny hs n issu, or on whih th stion 9() tx hs n prviously ssss Sutrt lin from lin. Txl mount s pg of th instrutions Unistriut inom for 000. Sutrt lin from lin. Txl mount s pg of th instrutions Unistriut inom for 00. Sutrt lins n from lin. This mount must istriut in 00 7 Amounts trt s istriutions out of orpus to stisfy rquirmnts impos y stion 70()()(E) or 9(g)() (s pg of th instrutions) 8 Exss istriutions rryovr from 99 not ppli on lin or lin 7 (s pg of th instrutions) 9 Exss istriutions rryovr to 00. Sutrt lins 7 n 8 from lin 0 Anlysis of lin 9: Exss from 997 Exss from 998 Exss from 999 Exss from 000 Exss from 00

9 Prt XIV Privt Oprting Fountions (s pg of th instrutions n Prt VII-A, qustion 9) If th fountion hs riv ruling or trmintion lttr tht it is privt oprting fountion, n th ruling is fftiv for 00, ntr th t of th ruling Chk ox to init whthr th orgniztion is privt oprting fountion sri in stion 9(j)() or Entr th lssr of th just nt Tx yr Prior yrs inom from Prt I or th minimum invstmnt rturn from Prt X for h () 00 () 000 () 999 () 998 () yr list 8% of lin Qulifying istriutions from Prt XII, lin for h yr list Amounts inlu in lin not us irtly for tiv onut of xmpt tivitis Qulifying istriutions m irtly for tiv onut of xmpt tivitis. Sutrt lin from lin Complt,, or for th ltrntiv tst rli upon: Assts ltrntiv tst ntr: () Vlu of ll ssts () Vlu of ssts qulifying unr stion 9(j)()(B)(i) Enowmnt ltrntiv tst Entr of minimum invstmnt rturn shown in Prt X, lin for h yr list Support ltrntiv tst ntr: Pg 9 9(j)() () Totl support othr thn gross invstmnt inom (intrst, ivins, rnts, pymnts on suritis lons (stion ()()), or royltis) () Support from gnrl puli n or mor xmpt orgniztions s provi in stion 9(j)()(B)(iii) () Lrgst mount of support from n xmpt orgniztion () Gross invstmnt inom Prt XV Supplmntry Informtion (Complt this prt only if th orgniztion h $,000 or mor in ssts t ny tim uring th yr s pg of th instrutions.) Informtion Rgring Fountion Mngrs: List ny mngrs of th fountion who hv ontriut mor thn % of th totl ontriutions riv y th fountion for th los of ny tx yr (ut only if thy hv ontriut mor thn $,000). (S stion 07()().) Totl List ny mngrs of th fountion who own 0% or mor of th stok of orportion (or n qully lrg portion of th ownrship of prtnrship or othr ntity) of whih th fountion hs 0% or grtr intrst. Informtion Rgring Contriution, Grnt, Gift, Lon, Sholrship, t., Progrms: Chk hr if th orgniztion only mks ontriutions to prslt hritl orgniztions n os not pt unsoliit rqusts for funs. If th orgniztion mks gifts, grnts, t. (s pg of th instrutions) to iniviuls or orgniztions unr othr onitions, omplt itms,,, n. Th nm, rss, n tlphon numr of th prson to whom pplitions shoul rss: Th form in whih pplitions shoul sumitt n informtion n mtrils thy shoul inlu: Any sumission lins: Any rstritions or limittions on wrs, suh s y gogrphil rs, hritl fils, kins of institutions, or othr ftors:

10 Prt XV Supplmntry Informtion (ontinu) Grnts n Contriutions Pi During th Yr or Approv for Futur Pymnt Ripint Nm n rss (hom or usinss) Pi uring th yr If ripint is n iniviul, show ny rltionship to ny fountion mngr or sustntil ontriutor Fountion sttus of ripint Purpos of grnt or ontriution Pg 0 Amount Totl Approv for futur pymnt Totl

11 Prt XVI-A Anlysis of Inom-Prouing Ativitis Entr gross mounts unlss othrwis init. Unrlt usinss inom () Businss o () Amount Exlu y stion,, or () Exlusion o Progrm srvi rvnu: f g Fs n ontrts from govrnmnt gnis Mmrship us n ssssmnts Intrst on svings n tmporry sh invstmnts Divins n intrst from suritis Nt rntl inom or (loss) from rl stt: Dt-finn proprty t t-finn proprty Nt rntl inom or (loss) from prsonl proprty 7 Othr invstmnt inom 8 Gin or (loss) from sls of ssts othr thn invntory 9 Nt inom or (loss) from spil vnts 0 Gross profit or (loss) from sls of invntory Othr rvnu: Sutotl. A olumns (), (), n () Totl. A lin, olumns (), (), n () (S worksht in lin instrutions on pg to vrify lultions.) Prt XVI-B Rltionship of Ativitis to th Aomplishmnt of Exmpt Purposs Lin. () Amount Pg () Rlt or xmpt funtion inom (S pg of th instrutions.) Explin low how h tivity for whih inom is rport in olumn () of Prt XVI-A ontriut importntly to th omplishmnt of th orgniztion s xmpt purposs (othr thn y proviing funs for suh purposs). (S pg 7 of th instrutions.)

12 Pg Prt XVII Informtion Rgring Trnsfrs To n Trnstions n Rltionships With nhritl Exmpt Orgniztions Di th orgniztion irtly or inirtly ngg in ny of th following with ny othr orgniztion sri in stion 0() of th Co (othr thn stion 0()() orgniztions) or in stion 7, rlting to politil orgniztions? Trnsfrs from th rporting orgniztion to nonhritl xmpt orgniztion of: () Csh () () Othr ssts () Othr Trnstions: () Sls of ssts to nonhritl xmpt orgniztion () () Purhss of ssts from nonhritl xmpt orgniztion () () Rntl of filitis, quipmnt, or othr ssts () () Rimursmnt rrngmnts () () Lons or lon gurnts () () Prformn of srvis or mmrship or funrising soliittions () Shring of filitis, quipmnt, miling lists, othr ssts, or pi mploys If th nswr to ny of th ov is, omplt th following shul. Column () shoul lwys show th fir mrkt vlu of th goos, othr ssts, or srvis givn y th rporting orgniztion. If th orgniztion riv lss thn fir mrkt vlu in ny trnstion or shring rrngmnt, show in olumn () th vlu of th goos, othr ssts, or srvis riv. () Lin no. () Amount involv () Nm of nonhritl xmpt orgniztion () Dsription of trnsfrs, trnstions, n shring rrngmnts Is th orgniztion irtly or inirtly ffilit with, or rlt to, on or mor tx-xmpt orgniztions sri in stion 0() of th Co (othr thn stion 0()()) or in stion 7? If, omplt th following shul. () Nm of orgniztion () Typ of orgniztion () Dsription of rltionship Sign Hr Unr pnltis of prjury, I lr tht I hv xmin this rturn, inluing ompnying shuls n sttmnts, n to th st of my knowlg n lif, it is tru, orrt, n omplt. Dlrtion of prprr (othr thn txpyr or fiuiry) is s on ll informtion of whih prprr hs ny knowlg. Pi Prprr s Us Only Signtur of offir or trust Prprr s signtur Firm s nm (or yours if slf-mploy), rss, n ZIP o Dt Dt Titl Chk if slf-mploy Prprr s SSN or PTIN (S Signtur on pg 8 of th instrutions.) EIN Phon no. ( )