Exempt Organization Business Income Tax Return

Transcription

1 Form Deprtment of the Tresury Internl Revenue Servie A For lenr yer 2016 or other tx yer eginning, n ening. Informtion out Form 990-T n its instrutions is ville t Do not enter SSN numers on this form s it my e me puli if your orgniztion is 501()(3). Nme of orgniztion ( Chek ox if nme hnge n see instrutions.) D OMB Open to Puli Inspetion for 501()(3) Orgniztions Only Employer ientifition numer (Employees trust, see instrutions.) B Exempt uner setion Print MINNESOTA COMMUNITY FOUNDATION ( )( 3 ) or E Unrelte usiness tivity oes Numer, street, n room or suite no. If P.O. ox, see instrutions. (See instrutions.) Type 408(e) 220(e) 101 FIFTH STREET EAST, SUITE 2400 Book vlue of ll ssets C t en of yer F Group exemption numer (See instrutions.) G Chek orgniztion type 501() orportion 501() trust 401() trust Other trust H Desrie the orgniztion s primry unrelte usiness tivity. SEE STATEMENT 1 I During the tx yer, ws the orportion susiiry in n ffilite group or prent-susiiry ontrolle group? ~~~~~~ If "," enter the nme n ientifying numer of the prent orportion. J The ooks re in re of CHRISTINE SEARSON Telephone numer Prt I Unrelte Tre or Business Inome (A) Inome (B) Expenses (C) Net 1 Gross reeipts or sles Less returns n llownes Blne ~~~ 12 Other inome (See instrutions; tth sheule) ~~~~~~~~~~~~ Totl. Comine lines 3 through , ,902. Prt II Deutions t Tken Elsewhere (See instrutions for limittions on eutions.) (Exept for ontriutions, eutions must e iretly onnete with the unrelte usiness inome.) T Chek ox if ress hnge 408A 530() City or town, stte or provine, ountry, n ZIP or foreign postl oe 529() SAINT PAUL, MN Cost of goos sol (Sheule A, line 7) ~~~~~~~~~~~~~~~~~ Gross profit. Sutrt line 2 from line 1 ~~~~~~~~~~~~~~~~ 4 Cpitl gin net inome (tth Sheule D) ~~~~~~~~~~~~~~~ Net gin (loss) (Form 4797, Prt II, line 17) (tth Form 4797) ~~~~~~ Cpitl loss eution for trusts ~~~~~~~~~~~~~~~~~~~~ Inome (loss) from prtnerships n S orportions (tth sttement) ~~~ Rent inome (Sheule C) ~~~~~~~~~~~~~~~~~~~~~~ Unrelte et-finne inome (Sheule E) ~~~~~~~~~~~~~~ Interest, nnuities, roylties, n rents from ontrolle orgniztions (Sh. F)~ Investment inome of setion 501()(7), (9), or (17) orgniztion (Sheule G) Exploite exempt tivity inome (Sheule I) ~~~~~~~~~~~~~~ Avertising inome (Sheule J) ~~~~~~~~~~~~~~~~~~~~ Compenstion of offiers, iretors, n trustees (Sheule K) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Slries n wges ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Repirs n mintenne B ets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Interest (tth sheule) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Txes n lienses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Chritle ontriutions (See instrutions for limittion rules) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Depreition (tth Form 4562) Less epreition lime on Sheule A n elsewhere on return Depletion Contriutions to eferre ompenstion plns Exempt Orgniztion Business Inome Tx Return (n proxy tx uner setion 6033(e)) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Totl eutions. A lines 14 through 28 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Employee enefit progrms ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exess exempt expenses (Sheule I) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exess reership osts (Sheule J) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other eutions (tth sheule) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SEE STATEMENT 3 Unrelte usiness txle inome efore net operting loss eution. Sutrt line 29 from line 13 ~~~~~~~~~~~~ Net operting loss eution (limite to the mount on line 30) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SEE STATEMENT 4 Unrelte usiness txle inome efore speifi eution. Sutrt line 31 from line 30 ~~~~~~~~~~~~~~~~~ Speifi eution (Generlly $1,000, ut see line 33 instrutions for exeptions) ~~~~~~~~~~~~~~~~~~~~~ ,902. STMT 2-388,902. 8,877. 4, , , ,111. 1, Unrelte usiness txle inome. Sutrt line 33 from line 32. If line 33 is greter thn line 32, enter the smller of zero or line , LHA For Pperwork Reution At tie, see instrutions. Form 990-T (2016) 105

2 Form 990-T (2016) MINNESOTA COMMUNITY FOUNDATION Prt III Tx Computtion 35 Orgniztions Txle s Corportions. See instrutions for tx omputtion Controlle group memers (setions 1561 n 1563) hek here See instrutions n: (1) $ (2) $ (3) $ Enter orgniztion s shre of: (1) Aitionl 5% tx (not more thn $11,750) $ (2) Aitionl 3% tx (not more thn $100,000) ~~~~~~~~~~~~~ $ Trusts Txle t Trust Rtes. See instrutions for tx omputtion. Inome tx on the mount on line 34 from: Proxy tx. See instrutions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tx on n-complint Fility Inome. See instrutions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 40 Totl. A lines 37, 38 n 39 to line 35 or 36, whihever pplies Prt IV Tx n Pyments 41 Foreign tx reit (orportions tth Form 1118; trusts tth Form 1116) ~~~~~~~~ e Totl reits. A lines 41 through 41 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other txes. Chek if from: Form 4255 Form 8611 Form 8697 Form 8866 Other (tth sheule) 44 Totl tx. A lines 42 n 43 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 45 Pyments: A 2015 overpyment reite to 2016 ~~~~~~~~~~~~~~~~~~~ 45 1, estimte tx pyments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tx eposite with Form 8868 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Foreign orgniztions: Tx pi or withhel t soure (see instrutions) ~~~~~~~~~~ f g Other reits n pyments: Totl pyments. A lines 45 through 45g ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tx ue. If line 46 is less thn the totl of lines 44 n 47, enter mount owe ~~~~~~~~~~~~~~~~~~~ Overpyment. If line 46 is lrger thn the totl of lines 44 n 47, enter mount overpi ~~~~~~~~~~~~~~ , Enter the mount of line 49 you wnt: Creite to 2017 estimte tx 1,232. Refune Prt V Sttements Regring Certin Ativities n Other Informtion (see instrutions) 51 At ny time uring the 2016 lenr yer, i the orgniztion hve n interest in or signture or other uthority Sign Here Enter your shre of the $50,000, $25,000, n $9,925,000 txle inome rkets (in tht orer): Inome tx on the mount on line 34 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tx rte sheule or Sheule D (Form 1041) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Alterntive minimum tx Other reits (see instrutions) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Generl usiness reit. Atth Form 3800 ~~~~~~~~~~~~~~~~~~~~~~ Creit for prior yer minimum tx (tth Form 8801 or 8827) ~~~~~~~~~~~~~~ Sutrt line 41e from line 40 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e Bkup withholing (see instrutions) ~~~~~~~~~~~~~~~~~~~~~~~~ Creit for smll employer helth insurne premiums (Atth Form 8941) Form 2439 ~~~~~~~~ Form 4136 Other Totl Estimte tx penlty (see instrutions). Chek if Form 2220 is tthe ~~~~~~~~~~~~~~~~~~~ over finnil ount (nk, seurities, or other) in foreign ountry? If YES, the orgniztion my hve to file FinCEN Form 114, Report of Foreign Bnk n Finnil Aounts. If YES, enter the nme of the foreign ountry here During the tx yer, i the orgniztion reeive istriution from, or ws it the grntor of, or trnsferor to, foreign trust? ~~~~~~~~~ If YES, see instrutions for other forms the orgniztion my hve to file. Enter the mount of tx-exempt interest reeive or rue uring the tx yer $ Uner penlties of perjury, I elre tht I hve exmine this return, inluing ompnying sheules n sttements, n to the est of my knowlege n elief, it is true, orret, n omplete. Delrtion of preprer (other thn txpyer) is se on ll informtion of whih preprer hs ny knowlege. = = VP OF FINANCE Signture of offier Dte Title Print/Type preprer s nme Preprer s signture Dte Chek e 45f 45g e My the IRS isuss this return with the preprer shown elow (see instrutions)? self- employe Pi CHRIS HENKE P Preprer Firm s nme AKINS HENKE AND COMPANY Firm s EIN Use Only INWOOD AVENUE NORTH, SUITE 160 Firm s ress OAKDALE, MN Phone no Form 990-T (2016) 3. if PTIN Pge ,

3 Form 990-T (2016) MINNESOTA COMMUNITY FOUNDATION Pge 3 Sheule A - Cost of Goos Sol. Enter metho of inventory vlution N/A 1 Inventory t eginning of yer ~~~ 1 6 Inventory t en of yer ~~~~~~~~~~~~ 6 2 Purhses ~~~~~~~~~~~ 2 7 Cost of goos sol. Sutrt line 6 3 Cost of lor~~~~~~~~~~~ 3 from line 5. Enter here n in Prt I, 4 Aitionl setion 263A osts line 2 ~~~~~~~~~~~~~~~~~~~~ 7 (tth sheule) ~~~~~~~~ 4 8 Do the rules of setion 263A (with respet to Other osts (tth sheule) ~~~ 4 proue or quire for resle) pply to 5 Totl. A lines 1 through 4 5 the orgniztion? Sheule C - Rent Inome (From Rel Property n Personl Property Lese With Rel Property) (see instrutions) 1. Desription of (1) (2) (3) (4) (1) (2) (3) () 2. From personl (if the perentge of rent for personl is more thn 10% ut not more thn 50%) Rent reeive or rue () From rel n personl (if the perentge of rent for personl exees 50% or if the rent is se on profit or inome) 3() Deutions iretly onnete with the inome in olumns 2() n 2() (tth sheule) (4) Totl 0. Totl 0. () Totl inome. A totls of olumns 2() n 2(). Enter () Totl eutions. Enter here n on pge 1, here n on pge 1, Prt I, line 6, olumn (A) 0. Prt I, line 6, olumn (B) 0. Sheule E - Unrelte Det-Finne Inome (see instrutions) 3. Deutions iretly onnete with or llole 2. Gross inome from to et-finne 1. Desription of et-finne or llole to etfinne () Stright line epreition () Other eutions (tth sheule) (tth sheule) (1) (2) (3) (4) (1) (2) (3) (4) 4. Amount of verge quisition 5. Averge juste sis 6. Column 4 ivie 7. Gross inome 8. Allole eutions et on or llole to et-finne of or llole to y olumn 5 reportle (olumn (olumn 6 x totl of olumns (tth sheule) et-finne 2 x olumn 6) 3() n 3()) (tth sheule) % % % % Enter here n on pge 1, Prt I, line 7, olumn (A). Enter here n on pge 1, Prt I, line 7, olumn (B). Totls ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Totl iviens-reeive eutions inlue in olumn 8 0. Form 990-T (2016)

4 Form 990-T (2016) MINNESOTA COMMUNITY FOUNDATION Sheule F - Interest, Annuities, Roylties, n Rents From Controlle Orgniztions (see instrutions) Exempt Controlle Orgniztions 1. Nme of ontrolle orgniztion 2. Employer 3. Net unrelte inome 4. Totl of speifie 5. Prt of olumn 4 tht is 6. Deutions iretly ientifition (loss) (see instrutions) pyments me inlue in the ontrolling onnete with inome numer orgniztion s gross inome in olumn 5 Pge 4 (1) (2) (3) (4) nexempt Controlle Orgniztions 7. Txle Inome 8. Net unrelte inome (loss) 9. Totl of speifie pyments 10. Prt of olumn 9 tht is inlue 11. Deutions iretly onnete (see instrutions) me in the ontrolling orgniztion s with inome in olumn 10 gross inome (1) (2) (3) (4) Totls J Sheule G - Investment Inome of Setion 501()(7), (9), or (17) Orgniztion (see instrutions) (1) (2) (3) (4) 1. Desription of exploite tivity 1. Desription of inome 2. Amount of inome 2. Gross unrelte usiness inome from tre or usiness Enter here n on pge 1, Prt I, line 10, ol. (A). 3. Expenses iretly onnete with proution of unrelte usiness inome Enter here n on pge 1, Prt I, line 10, ol. (B). Enter here n on pge 1, Prt I, line 9, olumn (A). 4. Net inome (loss) from unrelte tre or usiness (olumn 2 minus olumn 3). If gin, ompute ols. 5 through 7. A olumns 5 n 10. Enter here n on pge 1, Prt I, line 8, olumn (A). A olumns 6 n 11. Enter here n on pge 1, Prt I, line 8, olumn (B). 3. Deutions Totl eutions iretly onnete 4. Set-sies 5. n set-sies (tth sheule) (tth sheule) (ol. 3 plus ol. 4) 5. Gross inome 6. Expenses from tivity tht ttriutle to is not unrelte olumn 5 usiness inome Enter here n on pge 1, Prt I, line 9, olumn (B). Totls Sheule I - Exploite Exempt Ativity Inome, Other Thn Avertising Inome (see instrutions) (1) (2) (3) (4) Exess exempt expenses (olumn 6 minus olumn 5, ut not more thn olumn 4). Enter here n on pge 1, Prt II, line 26. Totls Sheule J - Avertising Inome (see instrutions) Prt I Inome From Perioils Reporte on Consolite Bsis 1. Nme of perioil 2. Gross 3. Diret vertising vertising osts inome 4. Avertising gin or (loss) (ol. 2 minus ol. 3). If gin, ompute ols. 5 through Cirultion 6. Reership inome osts 7. Exess reership osts (olumn 6 minus olumn 5, ut not more thn olumn 4). (1) (2) (3) (4) Totls (rry to Prt II, line (5)) Form 990-T (2016)

5 Form 990-T (2016) MINNESOTA COMMUNITY FOUNDATION Prt II Inome From Perioils Reporte on Seprte Bsis (For eh perioil liste in Prt II, fill in olumns 2 through 7 on line-y-line sis.) (1) (2) (3) (4) Totls from Prt I 1. Nme of perioil 2. Gross 3. Diret vertising vertising osts inome Enter here n on pge 1, Prt I, line 11, ol. (A). Enter here n on pge 1, Prt I, line 11, ol. (B). 4. Avertising gin or (loss) (ol. 2 minus ol. 3). If gin, ompute ols. 5 through Cirultion 6. Reership inome osts 7. Exess reership osts (olumn 6 minus olumn 5, ut not more thn olumn 4). Enter here n on pge 1, Prt II, line 27. Totls, Prt II (lines 1-5) Sheule K - Compenstion of Offiers, Diretors, n Trustees (see instrutions) 3. Perent of 4. Compenstion ttriutle Title time evote to 1. Nme 2. to unrelte usiness usiness (1) (2) (3) (4) Totl. Enter here n on pge 1, Prt II, line 14 % % % % 9 Pge 5 0. Form 990-T (2016)

6 MINNESOTA COMMUNITY FOUNDATION }}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-T DESCRIPTION OF ORGANIZATION S PRIMARY UNRELATED STATEMENT 1 BUSINESS ACTIVITY }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} UNRELATED BUSINESS INCOME PASSED THROUGH FROM PARTNERSHIP TO FORM 990-T, PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-T INCOME (LOSS) FROM PARTNERSHIPS STATEMENT 2 AND S CORPORATIONS }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} DESCRIPTION AMOUNT }}}}}}}}}}} }}}}}}}}}}}}}} THE COMMUNITY INVESTMENT GROUP PARTNERSHIP EIN# ,902. }}}}}}}}}}}}}} TOTAL TO FORM 990-T, PAGE 1, LINE 5-388,902. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-T OTHER DEDUCTIONS STATEMENT 3 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} DESCRIPTION AMOUNT }}}}}}}}}}} }}}}}}}}}}}}}} TA PREPARATION FEES 4,332. }}}}}}}}}}}}}} TOTAL TO FORM 990-T, PAGE 1, LINE 28 4,332. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-T NET OPERATING LOSS DEDUCTION STATEMENT 4 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} LOSS PREVIOUSLY LOSS AVAILABLE TA YEAR LOSS SUSTAINED APPLIED REMAINING THIS YEAR }}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} 12/31/08 7, ,605. 7, /31/09 5, ,948. 5, /31/10 78, , , /31/11 423, , , /31/12 338, , , /31/13 419, , , /31/14 249, , , /31/15 405, ,470. }}}}}}}}}}}}}} 405,470. }}}}}}}}}}}}}} NOL CARRYOVER AVAILABLE THIS YEAR 1,929,088. 1,929,088. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ 110 STATEMENT(S) 1, 2, 3, 4

7 Eletion to Relinquish Net Operting Loss Crry Bk Perio Minnesot Community Fountion EIN Form 990-T Tx Yer Ening Deemer 31, 2016 The ove txpyer inurre net operting loss for tx yer ene Deemer 31, 2016, n is entitle to rry k perio of two yers with respet to suh loss uner Setion 172()(1) of the Internl Revenue Servie Coe. In orne with Setion 172()(3) of the Internl Revenue Coe, txpyer herey elets to relinquish the entire rry k perio with respet to the urrent net operting loss inurre in its tx yer 2016.

8 Form (Rev. Deemer 2013) Deprtment of the Tresury Informtion out Form 926 n its seprte instrutions is t Internl Revenue Servie Atth to your inome tx return for the yer of the trnsfer or istriution. Prt I U.S. Trnsferor Informtion (see instrutions) Nme of trnsferor MINNESOTA COMMUNITY FOUNDATION Return y U.S. Trnsferor of Property to Foreign Corportion If the trnsferor ws orportion, omplete questions 1 through 1. If the trnsfer ws setion 361() or () trnsfer, ws the trnsferor ontrolle (uner setion 368()) y 5 or fewer omesti orportions? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the trnsferor remin in existene fter the trnsfer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If not, list the ontrolling shreholer(s) n their ientifying numer(s): OMB Atthment Sequene. Ientifying numer (see instrutions) Controlling shreholer Ientifying numer If the trnsferor ws memer of n ffilite group filing onsolite return, ws it the prent orportion?~~~ If not, list the nme n employer ientifition numer (EIN) of the prent orportion: Nme of prent orportion EIN of prent orportion Hve sis justments uner setion 367()(5) een me? ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 If the trnsferor ws prtner in prtnership tht ws the tul trnsferor (ut is not trete s suh uner setion 367), omplete questions 2 through 2. List the nme n EIN of the trnsferor s prtnership: Nme of prtnership EIN of prtnership Is the prtner isposing of its entire interest in the prtnership? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the prtner isposing of n interest in limite prtnership tht is regulrly tre on n estlishe seurities mrket? Prt II Trnsferee Foreign Corportion Informtion (see instrutions) 3 Nme of trnsferee (foreign orportion) 4 Ientifying numer, if ny 5 Aress (inluing ountry) 1 ELIZABETH PLAZA NORTH SYDNEY, NSW 2060 AUSTRALIA 6 Country oe of ountry of inorportion or orgniztion AS 7 Foreign lw hrteriztion (see instrutions) CORPORATION 8 THE COMMUNITY INVESTMENT GROUP Di the prtner pik up its pro rt shre of gin on the trnsfer of prtnership ssets? ~~~~~~~~~~~~~~~ AJ LUCAS GROUP LIMITED Is the trnsferee foreign orportion ontrolle foreign orportion? LHA For Pperwork Reution At tie, see seprte instrutions N/A 4 Referene ID numer AJLUCAS 110.1

9 Prt III Informtion Regring Trnsfer of Property (see instrutions) Pge 2 Csh Type of () () () () (e) Desription of Fir mrket vlue on Cost or other te of trnsfer sis Dte of trnsfer Gin reognize on trnsfer Stok n seurities Instllment oligtions, ount reeivles or similr INTEREST REC Foreign urreny or other enominte in foreign urreny Inventory Assets sujet to epreition repture (see Temp. Regs. se ()-4T()) Tngile use in tre or usiness not liste uner nother tegory Intngile Property to e lese (s esrie in finl n temp. Regs. se ()-4()) Property to e sol (s esrie in Temp. Regs. se ()-4T()) Trnsfers of oil n gs working interests (s esrie in Temp. Regs. se ()-4T(e)) Other Supplementl Informtion Require To Be Reporte (see instrutions):

10 Prt IV Aitionl Informtion Regring Trnsfer of Property (see instrutions) 9 Enter the trnsferor s interest in the foreign trnsferee orportion efore n fter the trnsfer: Pge 3 () Before.3743 % () After % 10 Type of nonreognition trnstion (see instrutions) IRC SECTION Inite whether ny trnsfer reporte in Prt III is sujet to ny of the following: Gin reognition uner setion 904(f)(3) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Gin reognition uner setion 904(f)(5)(F) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Repture uner setion 1503() ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exhnge gin uner setion 987 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 12 Di this trnsfer result from hnge in the lssifition of the trnsferee to tht of foreign orportion?~~~~~ 13 Inite whether the trnsferor ws require to reognize inome uner finl n Temporry Regultions setions 1.367()-4 through 1.367()-6 for ny of the following: Tinte ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Depreition repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Brnh loss repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Any other inome reognition provision ontine in the ove-referene regultions ~~~~~~~~~~~~~~~ 14 Di the trnsferor trnsfer ssets whih qulify for the tre or usiness exeption uner setion 367()(3)? ~~~~ 15 Di the trnsferor trnsfer foreign goowill or going onern vlue s efine in Temporry Regultions setion 1.367()-1T()(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the nswer to line 15 is "," enter the mount of foreign goowill or going onern vlue trnsferre $ 16 Ws sh the only trnsferre?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 17 Ws intngile (within the mening of setion 936(h)(3)(B)) trnsferre s result of the trnstion? ~~~ If "," esrie the nture of the rights to the intngile tht ws trnsferre s result of the trnstion:

11 Form (Rev. Deemer 2013) Deprtment of the Tresury Informtion out Form 926 n its seprte instrutions is t Internl Revenue Servie Atth to your inome tx return for the yer of the trnsfer or istriution. Prt I U.S. Trnsferor Informtion (see instrutions) Nme of trnsferor MINNESOTA COMMUNITY FOUNDATION Return y U.S. Trnsferor of Property to Foreign Corportion If the trnsferor ws orportion, omplete questions 1 through 1. If the trnsfer ws setion 361() or () trnsfer, ws the trnsferor ontrolle (uner setion 368()) y 5 or fewer omesti orportions? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the trnsferor remin in existene fter the trnsfer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If not, list the ontrolling shreholer(s) n their ientifying numer(s): OMB Atthment Sequene. Ientifying numer (see instrutions) Controlling shreholer Ientifying numer If the trnsferor ws memer of n ffilite group filing onsolite return, ws it the prent orportion?~~~ If not, list the nme n employer ientifition numer (EIN) of the prent orportion: Nme of prent orportion EIN of prent orportion Hve sis justments uner setion 367()(5) een me? ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 If the trnsferor ws prtner in prtnership tht ws the tul trnsferor (ut is not trete s suh uner setion 367), omplete questions 2 through 2. List the nme n EIN of the trnsferor s prtnership: Nme of prtnership EIN of prtnership Is the prtner isposing of its entire interest in the prtnership? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the prtner isposing of n interest in limite prtnership tht is regulrly tre on n estlishe seurities mrket? Prt II Trnsferee Foreign Corportion Informtion (see instrutions) 3 Nme of trnsferee (foreign orportion) 4 Ientifying numer, if ny 5 Aress (inluing ountry) 183 AVENUE DE CHOISY PARIS, FRANCE 6 Country oe of ountry of inorportion or orgniztion FR 7 Foreign lw hrteriztion (see instrutions) CORPORATION 8 THE COMMUNITY INVESTMENT GROUP Di the prtner pik up its pro rt shre of gin on the trnsfer of prtnership ssets? ~~~~~~~~~~~~~~~ ANNAPURNA THERAPEUTICS S.A.S. Is the trnsferee foreign orportion ontrolle foreign orportion? LHA For Pperwork Reution At tie, see seprte instrutions N/A 4 Referene ID numer ANNAPURNA 110.4

12 Prt III Informtion Regring Trnsfer of Property (see instrutions) Pge 2 Csh Type of () () () () (e) Desription of Fir mrket vlue on Cost or other te of trnsfer sis Dte of trnsfer Gin reognize on trnsfer Stok n seurities Instllment oligtions, ount reeivles or similr INSTALLMENT OB Foreign urreny or other enominte in foreign urreny Inventory Assets sujet to epreition repture (see Temp. Regs. se ()-4T()) Tngile use in tre or usiness not liste uner nother tegory Intngile Property to e lese (s esrie in finl n temp. Regs. se ()-4()) Property to e sol (s esrie in Temp. Regs. se ()-4T()) Trnsfers of oil n gs working interests (s esrie in Temp. Regs. se ()-4T(e)) Other Supplementl Informtion Require To Be Reporte (see instrutions):

13 Prt IV Aitionl Informtion Regring Trnsfer of Property (see instrutions) 9 Enter the trnsferor s interest in the foreign trnsferee orportion efore n fter the trnsfer: Pge 3 () Before % () After % 10 Type of nonreognition trnstion (see instrutions) IRC SECTION Inite whether ny trnsfer reporte in Prt III is sujet to ny of the following: Gin reognition uner setion 904(f)(3) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Gin reognition uner setion 904(f)(5)(F) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Repture uner setion 1503() ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exhnge gin uner setion 987 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 12 Di this trnsfer result from hnge in the lssifition of the trnsferee to tht of foreign orportion?~~~~~ 13 Inite whether the trnsferor ws require to reognize inome uner finl n Temporry Regultions setions 1.367()-4 through 1.367()-6 for ny of the following: Tinte ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Depreition repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Brnh loss repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Any other inome reognition provision ontine in the ove-referene regultions ~~~~~~~~~~~~~~~ 14 Di the trnsferor trnsfer ssets whih qulify for the tre or usiness exeption uner setion 367()(3)? ~~~~ 15 Di the trnsferor trnsfer foreign goowill or going onern vlue s efine in Temporry Regultions setion 1.367()-1T()(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the nswer to line 15 is "," enter the mount of foreign goowill or going onern vlue trnsferre $ 16 Ws sh the only trnsferre?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 17 Ws intngile (within the mening of setion 936(h)(3)(B)) trnsferre s result of the trnstion? ~~~ If "," esrie the nture of the rights to the intngile tht ws trnsferre s result of the trnstion:

14 Form (Rev. Deemer 2013) Deprtment of the Tresury Informtion out Form 926 n its seprte instrutions is t Internl Revenue Servie Atth to your inome tx return for the yer of the trnsfer or istriution. Prt I U.S. Trnsferor Informtion (see instrutions) Nme of trnsferor MINNESOTA COMMUNITY FOUNDATION Return y U.S. Trnsferor of Property to Foreign Corportion If the trnsferor ws orportion, omplete questions 1 through 1. If the trnsfer ws setion 361() or () trnsfer, ws the trnsferor ontrolle (uner setion 368()) y 5 or fewer omesti orportions? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the trnsferor remin in existene fter the trnsfer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If not, list the ontrolling shreholer(s) n their ientifying numer(s): OMB Atthment Sequene. Ientifying numer (see instrutions) Controlling shreholer Ientifying numer If the trnsferor ws memer of n ffilite group filing onsolite return, ws it the prent orportion?~~~ If not, list the nme n employer ientifition numer (EIN) of the prent orportion: Nme of prent orportion EIN of prent orportion Hve sis justments uner setion 367()(5) een me? ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 If the trnsferor ws prtner in prtnership tht ws the tul trnsferor (ut is not trete s suh uner setion 367), omplete questions 2 through 2. List the nme n EIN of the trnsferor s prtnership: Nme of prtnership EIN of prtnership Is the prtner isposing of its entire interest in the prtnership? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the prtner isposing of n interest in limite prtnership tht is regulrly tre on n estlishe seurities mrket? Prt II Trnsferee Foreign Corportion Informtion (see instrutions) 3 Nme of trnsferee (foreign orportion) 4 Ientifying numer, if ny 5 Aress (inluing ountry) P.O. BO 309 UGLAND HOUSE GRAND CAYMAN, KY CAYMAN ISLANDS 6 Country oe of ountry of inorportion or orgniztion CJ 7 Foreign lw hrteriztion (see instrutions) CORPORATION 8 THE COMMUNITY INVESTMENT GROUP Di the prtner pik up its pro rt shre of gin on the trnsfer of prtnership ssets? ~~~~~~~~~~~~~~~ ASIA MEMORIAL GROUP HOLDINGS LIMITED Is the trnsferee foreign orportion ontrolle foreign orportion? LHA For Pperwork Reution At tie, see seprte instrutions N/A 4 Referene ID numer ASIAMEM 110.7

15 Prt III Informtion Regring Trnsfer of Property (see instrutions) Pge 2 Csh Type of () () () () (e) Desription of Fir mrket vlue on Cost or other te of trnsfer sis Dte of trnsfer Gin reognize on trnsfer Stok n seurities Instllment oligtions, ount reeivles or similr Foreign urreny or other enominte in foreign urreny Inventory Assets sujet to epreition repture (see Temp. Regs. se ()-4T()) Tngile use in tre or usiness not liste uner nother tegory Intngile Property to e lese (s esrie in finl n temp. Regs. se ()-4()) Property to e sol (s esrie in Temp. Regs. se ()-4T()) Trnsfers of oil n gs working interests (s esrie in Temp. Regs. se ()-4T(e)) Other EQUITY INT Supplementl Informtion Require To Be Reporte (see instrutions):

16 Prt IV Aitionl Informtion Regring Trnsfer of Property (see instrutions) 9 Enter the trnsferor s interest in the foreign trnsferee orportion efore n fter the trnsfer: Pge 3 () Before % () After % 10 Type of nonreognition trnstion (see instrutions) IRC SECTION Inite whether ny trnsfer reporte in Prt III is sujet to ny of the following: Gin reognition uner setion 904(f)(3) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Gin reognition uner setion 904(f)(5)(F) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Repture uner setion 1503() ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exhnge gin uner setion 987 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 12 Di this trnsfer result from hnge in the lssifition of the trnsferee to tht of foreign orportion?~~~~~ 13 Inite whether the trnsferor ws require to reognize inome uner finl n Temporry Regultions setions 1.367()-4 through 1.367()-6 for ny of the following: Tinte ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Depreition repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Brnh loss repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Any other inome reognition provision ontine in the ove-referene regultions ~~~~~~~~~~~~~~~ 14 Di the trnsferor trnsfer ssets whih qulify for the tre or usiness exeption uner setion 367()(3)? ~~~~ 15 Di the trnsferor trnsfer foreign goowill or going onern vlue s efine in Temporry Regultions setion 1.367()-1T()(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the nswer to line 15 is "," enter the mount of foreign goowill or going onern vlue trnsferre $ 16 Ws sh the only trnsferre?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 17 Ws intngile (within the mening of setion 936(h)(3)(B)) trnsferre s result of the trnstion? ~~~ If "," esrie the nture of the rights to the intngile tht ws trnsferre s result of the trnstion:

17 Form (Rev. Deemer 2013) Deprtment of the Tresury Informtion out Form 926 n its seprte instrutions is t Internl Revenue Servie Atth to your inome tx return for the yer of the trnsfer or istriution. Prt I U.S. Trnsferor Informtion (see instrutions) Nme of trnsferor MINNESOTA COMMUNITY FOUNDATION Return y U.S. Trnsferor of Property to Foreign Corportion If the trnsferor ws orportion, omplete questions 1 through 1. If the trnsfer ws setion 361() or () trnsfer, ws the trnsferor ontrolle (uner setion 368()) y 5 or fewer omesti orportions? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the trnsferor remin in existene fter the trnsfer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If not, list the ontrolling shreholer(s) n their ientifying numer(s): OMB Atthment Sequene. Ientifying numer (see instrutions) Controlling shreholer Ientifying numer If the trnsferor ws memer of n ffilite group filing onsolite return, ws it the prent orportion?~~~ If not, list the nme n employer ientifition numer (EIN) of the prent orportion: Nme of prent orportion EIN of prent orportion Hve sis justments uner setion 367()(5) een me? ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 If the trnsferor ws prtner in prtnership tht ws the tul trnsferor (ut is not trete s suh uner setion 367), omplete questions 2 through 2. List the nme n EIN of the trnsferor s prtnership: Nme of prtnership EIN of prtnership Is the prtner isposing of its entire interest in the prtnership? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the prtner isposing of n interest in limite prtnership tht is regulrly tre on n estlishe seurities mrket? Prt II Trnsferee Foreign Corportion Informtion (see instrutions) 3 Nme of trnsferee (foreign orportion) 4 Ientifying numer, if ny 5 Aress (inluing ountry) 4 RUE LOU HEMMER LUEMBOURG-FINDEL, L-1748 LUEMBOURG 6 Country oe of ountry of inorportion or orgniztion LU 7 Foreign lw hrteriztion (see instrutions) CORPORATION 8 THE COMMUNITY INVESTMENT GROUP Di the prtner pik up its pro rt shre of gin on the trnsfer of prtnership ssets? ~~~~~~~~~~~~~~~ BAIN CAPITAL BMC (LUEMBOURG) S.A.R.L. Is the trnsferee foreign orportion ontrolle foreign orportion? LHA For Pperwork Reution At tie, see seprte instrutions N/A 4 Referene ID numer BAINCAP

18 Prt III Informtion Regring Trnsfer of Property (see instrutions) Pge 2 Csh Type of () () () () (e) Desription of Fir mrket vlue on Cost or other te of trnsfer sis Dte of trnsfer Gin reognize on trnsfer Stok n seurities Instllment oligtions, ount reeivles or similr Foreign urreny or other enominte in foreign urreny Inventory Assets sujet to epreition repture (see Temp. Regs. se ()-4T()) Tngile use in tre or usiness not liste uner nother tegory Intngile Property to e lese (s esrie in finl n temp. Regs. se ()-4()) Property to e sol (s esrie in Temp. Regs. se ()-4T()) Trnsfers of oil n gs working interests (s esrie in Temp. Regs. se ()-4T(e)) Other OTHER PROPERTY Supplementl Informtion Require To Be Reporte (see instrutions):

19 Prt IV Aitionl Informtion Regring Trnsfer of Property (see instrutions) 9 Enter the trnsferor s interest in the foreign trnsferee orportion efore n fter the trnsfer: Pge 3 () Before % () After % 10 Type of nonreognition trnstion (see instrutions) IRC SECTION Inite whether ny trnsfer reporte in Prt III is sujet to ny of the following: Gin reognition uner setion 904(f)(3) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Gin reognition uner setion 904(f)(5)(F) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Repture uner setion 1503() ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exhnge gin uner setion 987 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 12 Di this trnsfer result from hnge in the lssifition of the trnsferee to tht of foreign orportion?~~~~~ 13 Inite whether the trnsferor ws require to reognize inome uner finl n Temporry Regultions setions 1.367()-4 through 1.367()-6 for ny of the following: Tinte ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Depreition repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Brnh loss repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Any other inome reognition provision ontine in the ove-referene regultions ~~~~~~~~~~~~~~~ 14 Di the trnsferor trnsfer ssets whih qulify for the tre or usiness exeption uner setion 367()(3)? ~~~~ 15 Di the trnsferor trnsfer foreign goowill or going onern vlue s efine in Temporry Regultions setion 1.367()-1T()(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the nswer to line 15 is "," enter the mount of foreign goowill or going onern vlue trnsferre $ 16 Ws sh the only trnsferre?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 17 Ws intngile (within the mening of setion 936(h)(3)(B)) trnsferre s result of the trnstion? ~~~ If "," esrie the nture of the rights to the intngile tht ws trnsferre s result of the trnstion:

20 Form (Rev. Deemer 2013) Deprtment of the Tresury Informtion out Form 926 n its seprte instrutions is t Internl Revenue Servie Atth to your inome tx return for the yer of the trnsfer or istriution. Prt I U.S. Trnsferor Informtion (see instrutions) Nme of trnsferor MINNESOTA COMMUNITY FOUNDATION Return y U.S. Trnsferor of Property to Foreign Corportion If the trnsferor ws orportion, omplete questions 1 through 1. If the trnsfer ws setion 361() or () trnsfer, ws the trnsferor ontrolle (uner setion 368()) y 5 or fewer omesti orportions? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the trnsferor remin in existene fter the trnsfer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If not, list the ontrolling shreholer(s) n their ientifying numer(s): OMB Atthment Sequene. Ientifying numer (see instrutions) Controlling shreholer Ientifying numer If the trnsferor ws memer of n ffilite group filing onsolite return, ws it the prent orportion?~~~ If not, list the nme n employer ientifition numer (EIN) of the prent orportion: Nme of prent orportion EIN of prent orportion Hve sis justments uner setion 367()(5) een me? ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 If the trnsferor ws prtner in prtnership tht ws the tul trnsferor (ut is not trete s suh uner setion 367), omplete questions 2 through 2. List the nme n EIN of the trnsferor s prtnership: Nme of prtnership EIN of prtnership Is the prtner isposing of its entire interest in the prtnership? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the prtner isposing of n interest in limite prtnership tht is regulrly tre on n estlishe seurities mrket? Prt II Trnsferee Foreign Corportion Informtion (see instrutions) 3 Nme of trnsferee (foreign orportion) 4 Ientifying numer, if ny 5 Aress (inluing ountry) AESCHENVORSTADT 36 BASEL, 4051 SWITZERLAND 6 Country oe of ountry of inorportion or orgniztion SZ 7 Foreign lw hrteriztion (see instrutions) CORPORATION 8 THE COMMUNITY INVESTMENT GROUP Di the prtner pik up its pro rt shre of gin on the trnsfer of prtnership ssets? ~~~~~~~~~~~~~~~ CRISPR THERAPEUTICS AG Is the trnsferee foreign orportion ontrolle foreign orportion? LHA For Pperwork Reution At tie, see seprte instrutions N/A 4 Referene ID numer CRISPR

21 Prt III Informtion Regring Trnsfer of Property (see instrutions) Pge 2 Csh Type of () () () () (e) Desription of Fir mrket vlue on Cost or other te of trnsfer sis 624. Dte of trnsfer Gin reognize on trnsfer Stok n seurities Instllment oligtions, ount reeivles or similr Foreign urreny or other enominte in foreign urreny Inventory Assets sujet to epreition repture (see Temp. Regs. se ()-4T()) Tngile use in tre or usiness not liste uner nother tegory Intngile Property to e lese (s esrie in finl n temp. Regs. se ()-4()) Property to e sol (s esrie in Temp. Regs. se ()-4T()) Trnsfers of oil n gs working interests (s esrie in Temp. Regs. se ()-4T(e)) Other INSTALLMENT OB Supplementl Informtion Require To Be Reporte (see instrutions):

22 Prt IV Aitionl Informtion Regring Trnsfer of Property (see instrutions) 9 Enter the trnsferor s interest in the foreign trnsferee orportion efore n fter the trnsfer: Pge 3 () Before % () After % 10 Type of nonreognition trnstion (see instrutions) IRC SECTION Inite whether ny trnsfer reporte in Prt III is sujet to ny of the following: Gin reognition uner setion 904(f)(3) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Gin reognition uner setion 904(f)(5)(F) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Repture uner setion 1503() ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exhnge gin uner setion 987 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 12 Di this trnsfer result from hnge in the lssifition of the trnsferee to tht of foreign orportion?~~~~~ 13 Inite whether the trnsferor ws require to reognize inome uner finl n Temporry Regultions setions 1.367()-4 through 1.367()-6 for ny of the following: Tinte ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Depreition repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Brnh loss repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Any other inome reognition provision ontine in the ove-referene regultions ~~~~~~~~~~~~~~~ 14 Di the trnsferor trnsfer ssets whih qulify for the tre or usiness exeption uner setion 367()(3)? ~~~~ 15 Di the trnsferor trnsfer foreign goowill or going onern vlue s efine in Temporry Regultions setion 1.367()-1T()(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the nswer to line 15 is "," enter the mount of foreign goowill or going onern vlue trnsferre $ 16 Ws sh the only trnsferre?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 17 Ws intngile (within the mening of setion 936(h)(3)(B)) trnsferre s result of the trnstion? ~~~ If "," esrie the nture of the rights to the intngile tht ws trnsferre s result of the trnstion:

23 Form (Rev. Deemer 2013) Deprtment of the Tresury Informtion out Form 926 n its seprte instrutions is t Internl Revenue Servie Atth to your inome tx return for the yer of the trnsfer or istriution. Prt I U.S. Trnsferor Informtion (see instrutions) Nme of trnsferor MINNESOTA COMMUNITY FOUNDATION Return y U.S. Trnsferor of Property to Foreign Corportion If the trnsferor ws orportion, omplete questions 1 through 1. If the trnsfer ws setion 361() or () trnsfer, ws the trnsferor ontrolle (uner setion 368()) y 5 or fewer omesti orportions? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the trnsferor remin in existene fter the trnsfer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If not, list the ontrolling shreholer(s) n their ientifying numer(s): OMB Atthment Sequene. Ientifying numer (see instrutions) Controlling shreholer Ientifying numer If the trnsferor ws memer of n ffilite group filing onsolite return, ws it the prent orportion?~~~ If not, list the nme n employer ientifition numer (EIN) of the prent orportion: Nme of prent orportion EIN of prent orportion Hve sis justments uner setion 367()(5) een me? ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 If the trnsferor ws prtner in prtnership tht ws the tul trnsferor (ut is not trete s suh uner setion 367), omplete questions 2 through 2. List the nme n EIN of the trnsferor s prtnership: Nme of prtnership EIN of prtnership Is the prtner isposing of its entire interest in the prtnership? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the prtner isposing of n interest in limite prtnership tht is regulrly tre on n estlishe seurities mrket? Prt II Trnsferee Foreign Corportion Informtion (see instrutions) 3 Nme of trnsferee (foreign orportion) 4 Ientifying numer, if ny 5 Aress (inluing ountry) PASSEIG VALL D HEBRON BARCELONA, SPAIN 6 Country oe of ountry of inorportion or orgniztion SP 7 Foreign lw hrteriztion (see instrutions) CORPORATION 8 THE COMMUNITY INVESTMENT GROUP Di the prtner pik up its pro rt shre of gin on the trnsfer of prtnership ssets? ~~~~~~~~~~~~~~~ MOSAIC BIOMEDICALS, S.L. Is the trnsferee foreign orportion ontrolle foreign orportion? LHA For Pperwork Reution At tie, see seprte instrutions N/A 4 Referene ID numer MOSAIC

24 Prt III Informtion Regring Trnsfer of Property (see instrutions) Pge 2 Csh Type of () () () () (e) Desription of Fir mrket vlue on Cost or other te of trnsfer sis Dte of trnsfer Gin reognize on trnsfer Stok n seurities Instllment oligtions, ount reeivles or similr Foreign urreny or other enominte in foreign urreny Inventory Assets sujet to epreition repture (see Temp. Regs. se ()-4T()) Tngile use in tre or usiness not liste uner nother tegory Intngile Property to e lese (s esrie in finl n temp. Regs. se ()-4()) Property to e sol (s esrie in Temp. Regs. se ()-4T()) Trnsfers of oil n gs working interests (s esrie in Temp. Regs. se ()-4T(e)) Other INSTALLMENT OB Supplementl Informtion Require To Be Reporte (see instrutions):

25 Prt IV Aitionl Informtion Regring Trnsfer of Property (see instrutions) 9 Enter the trnsferor s interest in the foreign trnsferee orportion efore n fter the trnsfer: Pge 3 () Before % () After % 10 Type of nonreognition trnstion (see instrutions) IRC SECTION Inite whether ny trnsfer reporte in Prt III is sujet to ny of the following: Gin reognition uner setion 904(f)(3) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Gin reognition uner setion 904(f)(5)(F) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Repture uner setion 1503() ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exhnge gin uner setion 987 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 12 Di this trnsfer result from hnge in the lssifition of the trnsferee to tht of foreign orportion?~~~~~ 13 Inite whether the trnsferor ws require to reognize inome uner finl n Temporry Regultions setions 1.367()-4 through 1.367()-6 for ny of the following: Tinte ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Depreition repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Brnh loss repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Any other inome reognition provision ontine in the ove-referene regultions ~~~~~~~~~~~~~~~ 14 Di the trnsferor trnsfer ssets whih qulify for the tre or usiness exeption uner setion 367()(3)? ~~~~ 15 Di the trnsferor trnsfer foreign goowill or going onern vlue s efine in Temporry Regultions setion 1.367()-1T()(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the nswer to line 15 is "," enter the mount of foreign goowill or going onern vlue trnsferre $ 16 Ws sh the only trnsferre?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 17 Ws intngile (within the mening of setion 936(h)(3)(B)) trnsferre s result of the trnstion? ~~~ If "," esrie the nture of the rights to the intngile tht ws trnsferre s result of the trnstion:

26 Form (Rev. Deemer 2013) Deprtment of the Tresury Informtion out Form 926 n its seprte instrutions is t Internl Revenue Servie Atth to your inome tx return for the yer of the trnsfer or istriution. Prt I U.S. Trnsferor Informtion (see instrutions) Nme of trnsferor MINNESOTA COMMUNITY FOUNDATION Return y U.S. Trnsferor of Property to Foreign Corportion If the trnsferor ws orportion, omplete questions 1 through 1. If the trnsfer ws setion 361() or () trnsfer, ws the trnsferor ontrolle (uner setion 368()) y 5 or fewer omesti orportions? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the trnsferor remin in existene fter the trnsfer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If not, list the ontrolling shreholer(s) n their ientifying numer(s): OMB Atthment Sequene. Ientifying numer (see instrutions) Controlling shreholer Ientifying numer If the trnsferor ws memer of n ffilite group filing onsolite return, ws it the prent orportion?~~~ If not, list the nme n employer ientifition numer (EIN) of the prent orportion: Nme of prent orportion EIN of prent orportion Hve sis justments uner setion 367()(5) een me? ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 If the trnsferor ws prtner in prtnership tht ws the tul trnsferor (ut is not trete s suh uner setion 367), omplete questions 2 through 2. List the nme n EIN of the trnsferor s prtnership: Nme of prtnership EIN of prtnership Is the prtner isposing of its entire interest in the prtnership? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the prtner isposing of n interest in limite prtnership tht is regulrly tre on n estlishe seurities mrket? Prt II Trnsferee Foreign Corportion Informtion (see instrutions) 3 Nme of trnsferee (foreign orportion) 4 Ientifying numer, if ny 5 Aress (inluing ountry) JL. SILOAM NO. 6, LIPPO KARAWACI, BENCONGAN, BANTEN, INDONESIA 6 Country oe of ountry of inorportion or orgniztion ID 7 Foreign lw hrteriztion (see instrutions) CORPORATION 8 THE COMMUNITY INVESTMENT GROUP Di the prtner pik up its pro rt shre of gin on the trnsfer of prtnership ssets? ~~~~~~~~~~~~~~~ PT SILOAM INTERNATIONAL HOSPITALS TBK Is the trnsferee foreign orportion ontrolle foreign orportion? LHA For Pperwork Reution At tie, see seprte instrutions N/A 4 Referene ID numer PTSILOAM

27 Prt III Informtion Regring Trnsfer of Property (see instrutions) Pge 2 Csh Type of () () () () (e) Desription of Fir mrket vlue on Cost or other te of trnsfer sis Dte of trnsfer Gin reognize on trnsfer Stok n seurities Instllment oligtions, ount reeivles or similr Foreign urreny or other enominte in foreign urreny Inventory Assets sujet to epreition repture (see Temp. Regs. se ()-4T()) Tngile use in tre or usiness not liste uner nother tegory Intngile Property to e lese (s esrie in finl n temp. Regs. se ()-4()) Property to e sol (s esrie in Temp. Regs. se ()-4T()) Trnsfers of oil n gs working interests (s esrie in Temp. Regs. se ()-4T(e)) Other EQUITY INT Supplementl Informtion Require To Be Reporte (see instrutions):

28 Prt IV Aitionl Informtion Regring Trnsfer of Property (see instrutions) 9 Enter the trnsferor s interest in the foreign trnsferee orportion efore n fter the trnsfer: Pge 3 () Before % () After % 10 Type of nonreognition trnstion (see instrutions) IRC SECTION Inite whether ny trnsfer reporte in Prt III is sujet to ny of the following: Gin reognition uner setion 904(f)(3) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Gin reognition uner setion 904(f)(5)(F) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Repture uner setion 1503() ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exhnge gin uner setion 987 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 12 Di this trnsfer result from hnge in the lssifition of the trnsferee to tht of foreign orportion?~~~~~ 13 Inite whether the trnsferor ws require to reognize inome uner finl n Temporry Regultions setions 1.367()-4 through 1.367()-6 for ny of the following: Tinte ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Depreition repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Brnh loss repture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Any other inome reognition provision ontine in the ove-referene regultions ~~~~~~~~~~~~~~~ 14 Di the trnsferor trnsfer ssets whih qulify for the tre or usiness exeption uner setion 367()(3)? ~~~~ 15 Di the trnsferor trnsfer foreign goowill or going onern vlue s efine in Temporry Regultions setion 1.367()-1T()(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the nswer to line 15 is "," enter the mount of foreign goowill or going onern vlue trnsferre $ 16 Ws sh the only trnsferre?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 17 Ws intngile (within the mening of setion 936(h)(3)(B)) trnsferre s result of the trnstion? ~~~ If "," esrie the nture of the rights to the intngile tht ws trnsferre s result of the trnstion: