Return of Private Foundation

Transcription

1 l efile GRAPHIC p rint - DO NOT PROCESS As Filed Dt - DLN: Form 990-PF Deprtment of the Tresury Internl Revenue Serwce Return of Privte Foundtion OMB No or Section 4947()(1) Trust Treted s Privte Foundtion Do not enter socil security numers on this form s it my e mde pulic. 0- Informtion out Form 990-PF nd its instructions is t ' ' ' For clendr yer 2015, or tx yer eginning , nd ending Nme of foundtion DART CHARITABLE FOUNDATION Numer nd street ( or P 0 ox numer if mil is not delivered to street ddress) 5 LAMPLIGHT CIRCLE City or town, stte or province, country, nd ZIP or foreign postl code NATICK, MA A Employer identifiction numer BTelephone numer (see instructions) (508) C If exemption ppliction is pending, check here F G Check ll tht pply (Initil return (Initil return of former pulic chrity (-Finl return (Amended return (Address chnge (Nme chnge n ^.iiclr Ly Nc UI UI OIIIcuUii I- OCLLIUII JU± L ) ) CAciilpL NiivLC IUUIIUOuUii (Section 4947( )(1) nonexempt chritle trust (Other txle privte foundtion IFir mrket vlue of ll ssets t end JAccounting method 17 Csh f Accrul of yer (from Prt II, col. (c), I F_ Other ( specify) line ,983 (Prt I, column (d) must e on csh sis.) Anlysis of Revenue nd Expenses (The totl of mounts in columns (), (c), nd (d) my not necessrily equl the mounts in column () (see instructions) ) Revenue nd expenses per () ooks 1 Contriutions, gifts, grnts, etc, received (ttch schedule) D 1. Foreign orgniztions, check here F 2. Foreign orgniztions meeting the 85% test, check here nd ttch computtion E If privte foundtion sttus ws terminted under section 507()(1)(A), check here F F If the foundtion is in 60-month termintion under section 507()(1)(B), check here Ili- F Disursements Net investment Adjusted net for chritle () income (c) income purposes (d) (csh sis only) 2 Check I F- if the foundtion is not required to ttch Sch B Interest on svings nd temporry csh investments Dividends nd interest from securities Gross rents Net rentl income or (loss) co 6 Net gin or (loss) from sle of ssets not on line 10 co Gross sles price for ll ssets on line 6 T 7 Cpitl gin net income (from Prt IV, line 2) Net short-term cpitl gin Income modifictions Gross sles less returns nd llownces Less Cost of goods sold. c Gross profit or (loss) (ttch schedule) Other income (ttch schedule) Totl.Add lines 1 through Compenstion of officers, directors, trustees, etc 14 Other employee slries nd wges Pension plns, employee enefits Legl fees (ttch schedule). Accounting fees (ttch schedule) W c Other professionl fees (ttch schedule) Interest 18 Txes (ttch schedule) (see instructions)... r_ 19 Deprecition (ttch schedule) nd depletion Occupncy Trvel, conferences, nd meetings Printing nd pulictions. 23 Other expenses (ttch schedule) Totl operting nd dministrtive expenses. Add lines 13 through Contriutions, gifts, grnts pid Totl expenses nd disursements.add lines 24 nd Sutrct line 26 from line 12 Excess of revenue over expenses nd disursements 0 Net investment income (if negtive, enter -0-) 7 c Adjusted net income (if negtive, enter -0-)... 7 For Pperwork Reduction Act Notice, see instructions. Ct No 11289X

2 Pce 2 Blnce Sheets Attched schedules nd mounts in the description column Beginning of yer End of yer should e for end-of-yer mounts only (See instructions () Book Vlue () Book Vlue (c) Fir Mrket Vlue 1 Csh-non-interest-ering ,270 1,055 1,055 2 Svings nd temporry csh investments , , ,928 3 Accounts receivle Less llownce for doutful ccounts 0 4 Pledges receivle Less llownce for doutful ccounts 0 5 Grnts receivle Receivles due from officers, directors, trustees, nd other disqulified persons (ttch schedule) (see instructions).. 7 Other notes nd lons receivle (ttch schedule)lkl 0 Less llownce for doutful ccounts 0 8 Inventories for sle or use Prepid expenses nd deferred chrges Investments-U S nd stte government oligtions (ttch schedule) Investments-corporte stock (ttch schedule).... c Investments-corporte onds (ttch schedule) Investments-lnd, uildings, nd equipment sis llk^ Less ccumulted deprecition (ttch schedule) Oil 0 12 Investments-mortgge lons Investments-other (ttch schedule) Lnd, uildings, nd equipment sis Less ccumulted deprecition (ttch schedule) Oil 0 15 Other ssets (descrie 16 Totl ssets (to e completed y ll filers-see the instructions Also, see pge 1, item I) 292, , , Accounts pyle nd ccrued expenses g Grnts pyle w1 CO 19 Deferred revenue T J 20 Lons from officers, directors, trustees, nd other disqulified persons 21 Mortgges nd other notes pyle (ttch schedule) Other liilities (descrie 23 Totl liilities (dd lines 17 through 22) Foundtions tht follow SFAS 117, check here F- 4) nd complete lines 24 through 26 nd lines 30 nd 31. r5 24 Unrestricted 25 Temporrily restricted 26 Permnently restricted Foundtions tht do not follow SFAS 117, check here ' F nd complete lines 27 through Cpitl stock, trust principl, or current funds..... n 28 Pid-in or cpitl surplus, or lnd, ldg, nd equipment fund < 29 Retined ernings, ccumulted income, endowment, or other funds 30 Totl net ssets or fund lnces (see instructions) Totl liilities nd net ssets / fund lnces (see instructions) 0 0 COM Anlysis of Chnges in Net Assets or Fund Blnces 1 Totl net ssets or fund lnces t eginning of yer-prt II, column (), line 30 (must gree with end-of-yer figure reported on prior yer's return) 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 lnces t end of yer (line 4 minus line 5)-Prt II, column (), line

3 Pge 3 l C d e C d e Cpitl Gins nd Losses for Tx on Investment Income List nd descrie the kind(s) of property sold (e g, rel estte, () 2-story rick wrehouse, or common stock, 200 shs MLC Co (e) Gross sles price Deprecition llowed (f) (or llowle) How cquired P-Purchse () D-Dontion Cost or other sis (g) plus expense of sle Dte cquired (c) (mo, dy, yr ) Dte sold (d) (mo, dy, yr Gin or (loss) (h) (e) plus (f) minus (g) Complete only for ssets showing gin in column (h) nd owned y the foundtion on 12/31/69 Gins (Col (h) gin minus Adjusted sis Excess of col (i) col (k), ut not less thn -0-) or (i) F M V s of 12/31/69 (j) s of 12/31/69 (k) over col (j), if ny (I) Losses (from col (h)) C d e 2 If gin, lso enter in Prt I, line 7 Cpitl gin net income or (net cpitl loss) If (loss), enter -0- in Prt I, line 7 3 Net short-term cpitl gin or (loss) s defined in sections 1222(5) nd (6) If gin, lso enter in Prt I, line 8, column (c) (see instructions) If (loss), enter -0- in Prt I, line 8 Ri^ Qulifiction Under Section 4940(e) for Reduced Tx on Net Investment Income (For optionl use y domestic privte foundtions suject to the section 4940( ) tx on net investment income If section 4940( d)(2) pplies, leve this prt lnk Ws the foundtion lile for the section 4942 tx on the distriutle mount of ny yer in the se period? fl Yes F No 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 instructions efore mking ny entries Bse period yers Clendr yer (or tx yer eginning in) Adjusted qulifying distriutions Net vlue of nonchritle-use ssets ( d ) Distriution rtio (col () divided y col (c)) Totlof line 1, column (d) Averge distriution rtio for the 5-yer se period-divide the totl on line 2 y 5, or y the numer of yers the foundtion hs een in existence if less thn 5 yers Enter the net vlue of nonchritle-use ssets for 2015 from Prt X, line Multiply line 4 y line Enter 1% of net investment income (1% of Prt I, line 27) Add lines 5 nd Enter qulifying distriutions from Prt XII, line g 0 If line 8 is equl to or greter thn line 7, check the ox in Prt VI, line 1, nd complete tht prt using 1% tx rte See the Prt VI instructions

4 Pge 4 Excise Tx Bsed on Investment Income ( Section 4940 ( ), 4940(), 4940 ( e), or 4948-see pge 18 of the instructions) LOWM l Exempt operting foundtions descried in section 4940(d)(2), check here fl nd enter"n/a" on line 1 Dte of ruling or determintion letter (ttch copy of letter if necessry -see instructions) Domestic foundtions tht meet the section 4940(e) requirements in Prt V, check 1 here Rnd enter 1% of Prt I, line c All other domestic foundtions enter 2% of line 27 Exempt foreign orgniztions enter4% of Prt I, line 12, col () 2 Tx under section 511 (domestic section 4947()(1) trusts nd txle foundtions only Others enter -0-) 2 : M 3 Add lines 1 nd Sutitle A (income) tx (domestic section 4947()(1) trusts nd txle foundtions only Others enter -0-) 4 5 Tx sed on investment income.sutrct line 4 from line 3 If zero or less, enter Credits/Pyments 2015 estimted tx pyments nd 2014 overpyment credited to 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 d 7 Totl credits nd pyments Add lines 6 through 6d Enter ny penlty for underpyment of estimted tx Check here F if Form 2220 is ttched 8 9 Tx due.if the totl of lines 5 nd 8 is more thn line 7, enter mount owed Overpyment.If line 7 is more thn the totl of lines 5 nd 8, enter the mount overpid Enter the mount of line 10 to e credited to 2015 estimted tx Refunded 11 0 Sttements Regrding Activities l During the tx yer, did the foundtion ttempt to influence ny ntionl, stte, or locl legisltion or did Yes No it prticipte or intervene in ny politicl cmpign? l No Did it spend more thn $100 during the yer (either directly or indirectly) for politicl purposes (see Instructions for definition)? l No If the nswer is "Yes" to l or 1, ttch detiled description of the ctivities nd copies of ny mterils pulished or distriuted y the foundtion in connection with the ctivities. c Did the foundtion file Form 1120-POL for this yer? c No d Enter the mount (if ny) of tx on politicl expenditures (section 4955) imposed during the yer (1) O n the foundtion $ (2) O n foundtion mngers Ik- $ e Enter the reimursement (if ny) pid y the foundtion during the yer for politicl expenditure tx imposed on foundtion mngers $ 2 Hs the foundtion engged in ny ctivities tht hve not previously een reported to the IRS? No If "Yes," ttch detiled description of the ctivities. 3 Hs the foundtion mde ny chnges, not previously reported to the IRS, in its governing instrument, rticles of incorportion, or ylws, or other similr instruments? If "Yes,"ttch conformed copy of the chnges. 3 No 4 Did the foundtion hve unrelted usiness gross income of $1,000 or more during the yer? No If "Yes," hs it filed tx return on Form 990-T for this yer? No 5 Ws there liquidtion, termintion, dissolution, or sustntil contrction during the yer? No If "Yes,"ttch the sttement required y 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 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? No 7 Did the foundtion hve t lest $5,000 in ssets t ny time during the yer?if "Yes," complete Prt II, col. (c), nd Prt XV Yes 8 Enter the sttes to which the foundtion reports or with which it is registered (see instructions) ' MA If the nswer is "Yes" to line 7, hs the foundtion furnished copy of Form 990-PF to the Attorney Generl (or designte) of ech stte s required y Generl Instruction G? If "No,"ttch explntion. 8 Yes 9 Is the foundtion climing sttus s privte operting foundtion within the mening of section 4942(j)(3) or 4942(j)(5) for clendr yer 2015 or the txle yer eginning in 2015 (see instructions for Prt XIV )? If "Yes, " complete Prt XIV No 10 Did ny persons ecome sustntil contriutors during the tx yer? If "Yes," ttch schedule listing their nmes nd ddres ses No 0

5 Pge 5 Sttements Regrding Activities (continued) 11 At ny time during the yer, did the foundtion, directly or indirectly, own controlled entity within the mening of section 512()(13)? If "Yes," ttch schedule (see instructions ) No 12 Did the foundtion mke distriution to donor dvised fund over which the foundtion or disqulified person hd dvisory privileges? If "Yes," ttch sttement (see instructions ) No 13 Did the foundtion comply with the pulic inspection requirements for its nnul returns nd exemption ppliction? 13 Yes Wesite ddress 14 The ooks re in cre of ' DINA LEVOVITZ GA DO N Telephone no Locted t LAMPLIGHT CIRCLE NATICK MA ZIP+4 X Section 4947()(1) nonexempt chritle trusts filing Form 990-PF in lieu of Form Check here ik' F nd enter the mount of tx-exempt interest received or ccrued during the yer I At ny time during clendr yer 2015, did the foundtion hve n interest in or signture or other uthority over Yes No l nk, securities, or other finncil ccount in foreign country? 16 No See instructions for exceptions nd filing requirements for FinCEN Form 114, Report of Foreign Bnk nd Finncil Accounts (FBA R) If "Yes", enter the nme of the foreign country lllk^ Sttements Regrding Activities for Which Form 4720 My Be Required File Form 4720 if ny item is checked in the "Yes" column, unless n exception pplies. Yes No During the yer did the foundtion (either directly or indirectly) (1) Engge in the sle or exchnge, or lesing of property with disqulified person? fl Yes F No (2) Borrow money from, lend money to, or otherwise extend credit to (or ccept it from) disqulified person? fl Yes F No (3) Furnish goods, services, or fcilities to (or ccept them from) disqulified person? 1 Yes F No (4) Py compenstion to, or py or reimurse the expenses of, disqulified person? fl Yes F No (5) Trnsfer ny income or ssets to disqulified person (or mke ny of either ville for the enefit or use of disqulified person)? fl Yes F No (6) Agree to py money or property to government officil? ( Exception. Check " No " if the foundtion greed to mke grnt to or to employ the officil for period fter termintion of government service, if terminting within 90 dys ) fl Yes F No If ny nswer is " Yes " to l(1 )-(6 ), did nyof the cts fil to qulify under the exceptions descried in Regultions section (d)-3 or in current notice regrding disster ssistnce (see instructions)? l No Orgniztions relying on current notice regrding disster ssistnce check here Ok- F_ c Did the foundtion engge in prior yer in ny of the cts descried in 1, other thn excepted cts, tht were not corrected efore the first dy of the tx yer eginning in 2015? c No 2 Txes on filure to distriute income (section 4942) (does not pply for yers the foundtion ws privte operting foundtion defined in section 4942(j)(3) or4942(j)(5)) At the end of tx yer 2015, did the foundtion hve ny undistriuted income (lines 6d nd 6e, Prt XIII) for tx yer(s) eginning efore 2015? fl Yes F No If "Yes," list the yers 20, 20, 20, 20 Are there ny yers listed in 2 for which the foundtion is not pplying the provisions of section 4942()(2) (relting to incorrect vlution of ssets) to the yer's undistriuted income? (If pplying section 4942()(2) to llyers listed, nswer "No" nd ttch sttement-see instructions ) No c If the provisions of section 4942()(2) re eing pplied to ny of the yers listed in 2, list the yers here lllk^ 20, 20, 20, 20 3 Did the foundtion hold more thn 2% direct or indirect interest in ny usiness enterprise t ny time during the yer? fl Yes F No If "Yes," did it hve excess usiness holdings in 2015 s result of (1) ny purchse y the foundtion or disqulified persons fter My 26, 1969, (2) the lpse of the 5-yer period (or longer period pproved y the Commissioner under section 4943(c)(7 )) to dispose of holdings cquired y gift or equest, or (3) the lpse of the 10-, 15-, or 20-yer first phse holding period?(use Schedule C, Form 4720, to determine if the foundtion hd excess usiness holdings in 2015.) No 4 Did the foundtion invest during the yer ny mount in mnner tht would jeoprdize its chritle purposes? No Did the foundtion mke ny investment in prior yer (ut fter Decemer 31, 1969) tht could jeoprdize its chritle purpose tht hd not een removed from jeoprdy efore the first dy of the tx yer eginning in No

6 Pge 6 5 Sttements Regrding Activities for Which Form 4720 My Be Required (Continued) 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))? fl Yes F No (2) Influence the outcome of ny specific pulic election (see section 4955), or to crry on, directly or indirectly, ny voter registrtion drive? fl Yes F No (3) Provide grnt to n individul for trvel, study, or other similr purposes? 1 Yes F No (4) Provide grnt to n orgniztion other thn chritle, etc, orgniztion descried in section 4945(d)(4)(A)? (see instructions) Yes F No (5) Provide for ny purpose other thn religious, chritle, scientific, literry, or eductionl purposes, or for the prevention of cruelty to children or nimls? Yes F No If ny nswer is "Yes" to 5(1 )-(5 ), did nyof the trnsctions fil to qulify under the exceptions descried in Regultions section or in current notice regrding disster ssistnce (see instructions)? No Orgniztions relying on current notice regrding disster ssistnce check here c If the nswer is "Yes" to question 5(4), does the foundtion clim exemption from the tx ecuse it mintined expenditure responsiility for the grnt? Yes F No If "Yes," ttch the sttement required y Regultions section (d). 6 Did the foundtion, during the yer, receive ny funds, directly or indirectly, to py premiums on personl enefit contrct? fl Yes F No Did the foundtion, during the yer, py premiums, directly or indirectly, on personl enefit contrc t? No If "Yes" to 6, file Form At ny time during the tx yer, ws the foundtion prty to prohiited tx shelter trnsction? 1 Yes F No If yes, did the foundtion receive ny proceeds or hve ny net income ttriutle to the trnsction? No Informtion Aout Officers, Directors, Trustees, Foundtion Mngers, Highly Pid Employees, [cum nd Contrctors 1 List ll officers. directors. trustees. foundtion mngers nd their compenstion (see instructions). Title, nd verge (c) Compenstion(If () Nme nd ddress hours per week not pid, enter () devoted to position -0-) DINA LEVOVITZ GADON TRUSTEE 0 5 LAMPLIGHT CIRCLE 0 NATICK,MA Contriutions to Expense ccount, employee enefit plns (e) other llownces nd deferred compenstion 2 Compenstion of five highest - pid employees ( other thn those included on line 1- see instructions). If none, enter "NONE." () Nme nd ddress of ech employee pid more thn $50,000 Title, nd verge hours per week () devoted to position (c) Compenstion (d) Contriutions to employee enefit plns nd deferred compenstion Expense ccount, (e) other llownces Totl numer of other employees pid over $50,

7 Pge 7 Informtion Aout Officers, Directors, Trustees, Foundtion Mngers, Highly Pid Employees, EE= nd Contrctors (continued) 3 Five highest - pid independent contrctors for professionl services (see instructions ). If none, enter " NONE". () Nme nd ddress of ech person rid more thn $ () Tvroe of service (c) Compenstion Totl numer of others receiving over $ 50,000 for professionl services. Summry of Direct Chritle Activities List the foundtion's four lrgest direct chritle ctivities during the tx yer Include relevnt sttisticl informtion such s the numer of orgniztions nd other eneficiries served, conferences convened, reserch ppers produced, etc Expenses 1Chd Center of Ntick 21,600 2Americn Friends of Torh B'Yisroel 5,000 3Beth El Atereth Isrel 2,615 4 Summry of Progrm - Relted Investments (see instructions) Descrie the two lrgest progrm-relted investments mde y the foundtion during the tx yer on lines 1 nd 2 A mount 1 2 All other progrm-relted investments See instructions 3 Totl. Add lines 1 through

8 Pge 8 Minimum Investment Return ( All domestic foundtions must com p lete this p rt. Forei g n foundtions see instructions. ) 1 Fir mrket vlue of ssets not used (or held for use) directly in crrying out chritle, etc, purposes Averge monthly fir mrket vlue of securities l 0 Averge of monthly csh lnces l 0 c Fir mrket vlue of ll other ssets (see instructions) c 0 d Totl (dd lines l,, nd c) ld 0 e Reduction climed for lockge or other fctors reported on lines l nd 1c (ttch detiled explntion ) le 2 Acquisition indetedness pplicle to line 1 ssets Sutrct line 2 from line ld Csh deemed held for chritle ctivities Enter 1 1/2% of line 3 (for greter mount, see instructions) Net vlue of nonchritle - use ssets.sutrct line 4 from line 3 Enter here nd on Prt V, line Minimum investment return.enter 5% of line Distriutle Amount (see instructions) (Section 4942(j)(3) nd (j)(5) privte operting foundtions nd certin foreign orgniztions check here fl nd do not com p lete this p rt. ) 1 Minimum investment return from Prt X, line Tx on investment income for 2015 from Prt VI, line Income tx for 2015 (This does not include the tx from Prt VI ).. 2 c Add lines 2 nd c 0 3 Distriutle mount efore djustments Sutrct line 2c from line Recoveries of mounts treted s qulifying distriutions Add lines 3 nd Deduction from distriutle mount (see instructions) Distriutle mounts djusted Sutrct line 6 from line 5 Enter here nd on Prt XIII, line Qulifying Distriutions (see instructions) 1 Amounts pid (including dministrtive expenses) to ccomplish chritle, etc, purposes Expenses, contriutions, gifts, etc -totl from Prt I, column (d), line l 0 Progrm-relted investments-totl from Prt IX-B l 0 2 Amounts pid to cquire ssets used (or held for use) directly in crrying out chritle, etc, purposes Amounts set side for specific chritle projects tht stisfy the Suitility test (prior IRS pprovl required) Csh distriution test (ttch the required schedule) Qulifying distriutions.add lines l through 3 Enter here nd on Prt V, line 8, nd Prt XIII, line Foundtions tht qulify under section 4940(e) for the reduced rte of tx on net investment income Enter 1% of Prt I, line 27 (see instructions) Adjusted qulifying distriutions.sutrct line 5 from line Note :The mount on line 6 will e used in Prt V, column (), in susequent yers when clculting whether the foundtion qulifies for the section 4940(e) reduction of tx in those yers

9 Pge 9 «Undistriuted Income (see instructions) () () (c) (d) Corpus Yers prior to Distriutle mount for 2015 from Prt XI, line Undistriuted income, if ny, s of the end of 2015 Enter mount for 2014 only Totl for prior yers 20_, 20_, 20_ 3 Excess distriutions crryover, if ny, to 2015 From From c From d From e From f Totl of lines 3 through e Qulifying distriutions for 2015 from Prt XII, line $ 0 Applied to 2014, ut not more thn line 2 Applied to undistriuted income of prior yers (Election required-see instructions)..... c Treted s distriutions out of corpus (Election required-see instructions)..... d Applied to 2015 distriutle mount.... e Remining mount distriuted out of corpus 5 Excess distriutions crryover pplied to 2015 (If n mount ppers in column (d), the sme mount must e shown in column ().) 6 Enter the net totl of ech column s indicted elow: Corpus Add lines 3f, 4c, nd 4e Sutrct line 5 Prior yers' undistriuted income Sutrct line 4 from line c Enter the mount of prior yers' undistriuted income for which notice of deficiency hs een issued, or on which the section 4942() tx hs een previously ssessed d Sutrct line 6c from line 6 Txle mount -see instructions e Undistriuted income for 2014 Sutrct line 4 from line 2 Txle mount-see instructions f Undistriuted income for 2016 Sutrct lines 4d nd 5 from line 1 This mount must e distriuted in Amounts treted s distriutions out of corpus to stisfy requirements imposed y section 170()(1)(F) or4942(g)(3) (Election my e required - see instructions) Excess distriutions crryover from 2010 not pplied on line 5 or line 7 (see instructions). 9 Excess distriutions crryover to Sutrct lines 7 nd 8 from line Anlysis of line 9 Excess from Excess from c Excess from d Excess from e Excess from

10 Pge 10 «Privte Operting Foundtions (see instructions nd Prt VII-A, question 9) l If the foundtion hs received ruling or determintion letter tht it is privte operting foundtion, nd the ruling is effective for 2015, enter the dte of the ruling k. I Check ox to indicte whether the orgniztion is privte operting foundtion descried in section (- 4942(j)(3) or (- 4942(j)(5) 2 Enter the lesser of the djusted net Tx yer Prior 3 yers income from Prt I or the minimum () 2015 () 2014 (c) 2013 (d) 2012 investment return from Prt X for ech yer listed % of line c Qulifying distriutions from Prt XII, line 4 for ech yer listed..... d Amounts included in line 2c not used directly for ctive conduct of exempt ctivities e Qulifying distriutions mde directly for ctive conduct of exempt ctivities Sutrct line 2d from line 2c Complete 3,, or c for the lterntive test relied upon "Assets" lterntive test-enter (1) Vlue of ll ssets (2) Vlue of ssets qulifying under section 4942(j)(3)(B)(i) "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).... (2) Support from generl pulic nd 5 or more exempt orgniztions s provided in section 4942(j)(3)(B)(iii).... (3) Lrgest mount of support from n exempt orgniztion (e) Totl (4) Gross investment income Supplementry Informtion ( Complete this prt only if the orgniztion 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 contriuted more thn 2% of the totl contriutions received y the foundtion efore the close of ny tx yer (ut only if they hve contriuted more thn $5,000) (See section 507(d)(2) ) 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 2 Informtion Regrding Contriution, Grnt, Gift, Lon, Scholrship, etc., Progrms: Check here if the foundtion only mkes contriutions to preselected chritle 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,, c, nd d The nme, ddress, nd telephone numer or emil ddress of the person to whom pplictions should e ddressed The form in which pplictions should e sumitted nd informtion nd mterils they should include c Any sumission dedlines d Any restrictions or limittions on wrds, such s y geogrphicl res, chritle fields, kinds of institutions, or other fctors

11 Pge 11 Supplementry Informtion (continued) 3 Grnts nd Contriutions Pid During the Yer or Approved for Future Pyment Recipient Nme nd ddress ( home or usiness ) Pid during the yer If recipient is n individul, show ny reltionship to ny foundtion mnger or sustntil contriutor Foundtion sttus of recipient Purpose of grnt or contriution Amount CHABAD CENTER OF NATICK GENERAL FUND SUPPORT 21, BODEN LN NATICK,MA AMERICAN FRIENDS OFTORAH GENERAL SUPPORT 5,000 B'YISRO 11 BROADWAY STE 901 NEWYORKCITY,NY BETH ELATERETH ISRAEL GENERALSUPPORT 2, HUDSON ROAD SUDBURY,MA Totl ,215 Approved for future pyment Totl I 0

12 Pge 12 Anlysis of Income - Producing Activities Enter gross mounts unless otherwise indicted Unrelted usiness income Excluded y section 512, 513, or 514 (e) Relted or exempt () () (c) (d ) function income (See 1 Progrm service revenue Business code Amount Exclusion code Amount instructions c d e f g Fees nd contrcts from government gencies 2 Memership dues nd ssessments Interest on svings nd temporry csh investments Dividends nd interest from securities... 5 Net rentl income or (loss) from rel estte Det-finnced property Not det-finnced 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 10 Gross profit or (loss) from sles of inventory 11 Otherrevenue c d e 12 Sutotl Add columns (), (d), nd (e). o Totl.Add line 12, columns (), (d), nd (e) (See worksheet in line 13 instructions to verify clcultions Reltionship of Activities to the Accomplishment of Exempt Purposes Line No. Explin elow how ech ctivity for which income is reported in column (e) of Prt XVI-A contriuted importntly to the ccomplishment of the foundtion's exempt purposes (other thn y providing funds for such purposes) (See instructions

13 Pge 13 Informtion Regrding Trnsfers To nd Trnsctions nd Reltionships With Nonchritle Exempt Orgniztions 1 Did the orgniztion directly or indirectly engge in ny of the following with ny other orgniztion descried in section 501(c) of the Code (other thn section 501 (c)(3) orgniztions) or in section 527, relting to politicl Yes No orgniztions? Trnsfers from the reporting foundtion to nonchritle exempt orgniztion of (1) Csh l(1) No (2) Other ssets l(2) No Other trnsctions (1) Sles of ssets to nonchritle exempt orgniztion l(1) No (2) Purchses of ssets from nonchritle exempt orgniztion l(2) No (3) Rentl of fcilities, equipment, or other ssets l(3) No (4) Reimursement rrngements l(4) No (5) Lons or lon gurntees l(5) No (6)Performnce of services or memership or fundrising solicittions [ 1(6) No c Shring of fcilities, equipment, miling lists, other ssets, or pid employees d If the nswer to ny of the ove is "Yes," complete the following schedule Column () should lwys show the fir mrket vl ue of the goods, other ssets, or services given y the reporting foundtion If the foundtion received less thn fir mrket vlue in ny trnsction or shring rrngement, show in column (d) the vlue of the goods, other ssets, or services received lc No 2 Is the foundtion directly or indirectly ffilited with, or relted to, one or more tx-exempt orgniztions descried in section 501 ( c) of the Code (other thn section 501(c)(3)) or in section 527? fyes F7No If "Yes," complete the following schedule () Nme of orgniztion () Type of orgniztion (c) Description of reltionship Sign Under penlties of perjury, I declre tht I hve exmined this return, including ccompnying schedules nd sttements, nd to the est of my knowledge nd elief, it is true, correct, nd complete Declrtion of preprer (other thn txpyer) is sed on ll informtion of which preprer hs ny knowledge Here ****** Signture of officer or trustee Dte Print/Type preprer's nme DAVID RHEE CPA Preprer's Signture F is Prepre Use Only Firm's nme 0- DAVID Y RHEE AND CO Firm's ddress 0-47 ELIOT ST NATICK, MA 01760