Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation

Transcription

1 l efile GRAPHIC print - DO NOT PROCESS As Filed Data - Form990-PF Department of the Trea^un Internal Rev enue Ser ice Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation Do not enter social security numers on this form as it may e made pulic. Information aout Form 990-PF and its instructions is at DLN: OMB No For calendar year 2017, or tax year eginning , and ending Name of foundation CHAIN LINK FUNDAMENTALS INC Numer and street (or P 0 ox numer if mail is not delivered to street address) Room/suite 11 JOCHUM AVENUE B Telephone numer (see instructions) (917) City or town, state or province, country, and ZIP or foreign postal code LARCHMONT, NY C If exemption application is pending, check here q G Check all that apply q Initial return q Initial return of a former pulic charity D 1. Foreign organizations, check here q Final return q Amended return 2 Foreign organizations meeting the 85% test, check here and attach com p utation El Address change El Name change E If private foundation status was terminated H Check typ e of or g anization q Section 501(c)(3) exempt private foundation under section 507()(1)(A), check here q Section 4947(a)(1) nonexempt charitale trust q Other taxale private foundation El El I Fair market value of all assets at end J Accounting method q Cash 9 Accrual F If the foundation is in a 60-month termination of year (from Part II, col (c), under section 507()(1)(B), check here line 16)101$ 0 q Other (specify) (Part I, column (d) must e on cash asis ) Analysis of Revenue and Expenses (The total ( a) Revenue and (d) Disursements of amounts n columns (), (c), and (d) may not necessarily () Net investment (c) Adjusted net for charitale expenses per income income purposes equal the amounts in column (a) (see Instructions) ) ooks (cash asis s only) 1 Contriutions, gifts, grants, etc, received (attach schedule) 2 Check W if the foundation is not required to attach Sch B Interest on savings and temporary cash investments 4 Dividends and interest from securities... 5a Gross rents Net rental income or (loss) 6a Net gain or (loss) from sale of assets not on line 10 Gross sales price for all assets on line 6a 7 Capital gain net income (from Part IV, line 2) 8 Net short-term capital gain Income modifications a Gross sales less returns and allowances Less Cost of goods sold.... c Gross profit or (loss) (attach schedule) Other income (attach schedule) Total. Add lines 1 through Compensation of officers, directors, trustees, etc 14 Other employee salaries and wages Pension plans, employee enefits ^C 16a Legal fees (attach schedule) R. Accounting fees (attach schedule) X w c Other professional fees (attach schedule) Interest 18 Taxes (attach schedule) (see instructions) Depreciation (attach schedule) and depletion Occupancy Travel, conferences, and meetings Printing and pulications Other expenses (attach schedule) Total operating and administrative expenses. Add lines 13 through Contriutions, gifts, grants paid Total expenses and disursements. Add lines 24 and 25 o o o 27 Sutract line 26 from line 12 a Excess of revenue over expenses and 0 disursements Net investment income (if negative, enter -0-) 0 c Adjusted net income (if negative, enter -0-)... For Paperwork Reduction Act Notice, see instructions. Cat No 11289X

2 Pane 2 Balance Sheets Attached schedules and amounts in the description column Beginning of year End of year should e for end-of-year amounts only (See instructions (a) Book Value () Book Value (c) Fair Market Value 1 Cash-non-interest-earing Savings and temporary cash investments Accounts receivale Less allowance for doutful accounts 4 Pledges receivale Less allowance for doutful accounts 5 Grants receivale Receivales due from officers, directors, trustees, and other disqualified persons (attach schedule) (see instructions) Other notes and loans receivale (attach schedule) Less allowance for doutful accounts,n 8 Inventories for sale or use Prepaid expenses and deferred charges Q 10a Investments-U S and state government oligations (attach schedule) Investments-corporate stock (attach schedule) c Investments-corporate onds (attach schedule) Investments-land, uildings, and equipment asis Less accumulated depreciation (attach schedule) 12 Investments-mortgage loans Investments-other (attach schedule) Land, uildings, and equipment asis Less accumulated depreciation (attach schedule) 15 Other assets (descrie 16 Total assets (to e completed y all filers-see the instructions Also, see page 1, item I) Accounts payale and accrued expenses Grants payale o 19 Deferred revenue J 20 Loans from officers, directors, trustees, and other disqualified persons 21 Mortgages and other notes payale (attach schedule) Other liailities (descrie 23 Total liailities (add lines 17 through 22) Foundations that follow SFAS 117, check here a> and complete lines 24 through 26 and lines 30 and 31. U 24 Unrestricted Temporarily restricted 26 Permanently restricted Foundations that do not follow SFAS 117, check here q and complete lines 27 through Capital stock, trust principal, or current funds 28 Paid-in or capital surplus, or land, ldg, and equipment fund 29 Retained earnings, accumulated income, endowment, or other funds d Z 30 Total net assets or fund alances (see instructions) Total liailities and net assets / fund alances (see instructions) 0 0 Analysis of Changes in Net Assets or Fund Balances 1 Total net assets or fund alances at eginning of year-part II, column (a), line 30 (must agree with endof-year figure reported on prior year's return) Enter amount from Part I, line 27a Other increases not included in line 2 (itemize) 3 4 Add lines 1, 2, and Decreases not included in line 2 (itemize) 5 6 Total net assets or fund alances at end of year (line 4 minus line 5)-Part II, column (), line 30 6 q

3 Page 3 Capital Gains and Losses for Tax on Investment Income la List and descrie the kind(s) of property sold (e g, real estate, 2-story rick warehouse, or common stock, 200 shs MLC Co How acquired P-Purchase D-Donation Date acquired (mo, day, yr) Date sold (mo, day, yr ) a C d e a C d e 2 ( e) Gross sales price (f) Depreciation allowed (or allowale) (g) Cost or other asis plus expense of sale (h) Gain or (loss) (e) plus (f) minus (g) Complete only for assets showing gain in column (h) and owned y the foundation on 12/31/69 (I) (i) (j) (k) Gains (Col (h) gain minus Adjusted asis Excess of col (i) col (k), ut not less than -0-) or F M V as of 12/31/69 as of 12/31/69 over col (3), if any Losses (from col (h)) If gain, also enter in Part I, line 7 Capital gain net income or (net capital loss) ti If (loss), enter -0- in Part I, line 7 3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6) If gain, also enter in Part I, line 8, column (c) (see instructions) If (loss), enter -0- in Part I, line i 3 Qualification Under Section 4940(e)for Reduced Tax on Net Investment Income (For optional use y domestic private foundations suject to the section 4940(a) tax on net investment income ) 2 If section 4940(d)(2) applies, leave this part lank Was the foundation liale for the section 4942 tax on the distriutale amount of any year in the ase period? q No If "Yes," the foundation does not qualify under section 4940(e) Do not complete this part 1 Enter the appropriate amount in each column for each year, see instructions efore making any entries Base period years Calendar year (or tax year eginning in) Adjusted qualifying distriutions Net value of noncha) stale-use assets 2 Total of line 1, column (d) Average distriution ratio for the 5-year ase period-divide the total on line 2 y 5, or y the numer of years the foundation has een in existence if less than 5 years Enter the net value of noncharitale-use assets for 2017 from Part X, line Multiply line 4 y line Enter 11/o of net investment income (1% of Part I, line 27) Add lines 5 and Distriutdon ratio (col () divided y col (c)) 8 Enter qualifying distriutions from Part XII, line If line 8 is equal to or greater than line 7, check the ox in Part VI, line 1, and complete that part using a 1% tax rate See the Part VI instructions

4 Page 4 Excise Tax Based on Investment Income ( Section 4940 ( a), 4940 ( ), 4940 ( e), or see instructions) la Exempt operating foundations descried in section 4940(d)(2), check here q and enter "N/A" on line 1 Date of ruling or determination letter (attach copy of letter if necessary-see instructions) Domestic foundations that meet the section 4940(e) requirements in Part V, check 1 0 here q and enter 1% of Part I, line c All other domestic foundations enter 2% of line 27 Exempt foreign organizations enter 4% of Part I, line 12, col () 2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxale foundations only Others enter -0-) 2 3 Add lines 1 and Sutitle A (income) tax (domestic section 4947(a)(1) trusts and taxale foundations only Others enter -0-) 4 5 Tax ased on investment income. Sutract line 4 from line 3 If zero or less, enter Credits/Payments a 2017 estimated tax payments and 2016 overpayment credited to a Exempt foreign organizations-tax withheld at source c Tax paid with application for extension of time to file (Form 8868)... 6c d Backup withholding erroneously withheld d 7 Total credits and payments Add lines 6a through 6d Enter any penalty for underpayment of estimated tax Check here q if Form 2220 is attached 8 9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid Enter the amount of line 10 to e Credited to 2018 estimated tax Refunded 11 Statements Regarding Activities la During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in any political campaign? Did it spend more than $ 100 during the year ( either directly or indirectly ) for political purposes ( see Instructions for definition )? If the answer is "Yes " to la or 1, attach a detailed description of the activities and copies of any materials pulished or distriuted y the foundation in connection with the activities c Did the foundation file Form POL for this year? d Enter the amount ( if any ) of tax on political expenditures ( section 4955 ) imposed during the year (1) On the foundation $ ( 2) On foundation managers $ e Enter the reimursement ( if any ) paid y the foundation during the year for political expenditure tax imposed on foundation managers $ 2 Has the foundation engaged in any activities that have not previously een reported to the IRS? If "Yes, " attach a detailed description of the activities 3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or ylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes.... 4a Did the foundation have unrelated usiness gross income of $1,000 or more during the year? If "Yes," has it filed a tax return on Form 990-T for this year? Was there a liquidation, termination, dissolution, or sustantial contraction during the year? If "Yes," attach the statement required y General Instruction T 6 Are the requirements of section 508(e ) ( relating to sections 4941 through 4945 ) satisfied either By language in the governing instrument, or By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law remain in the governing instrument? Did the foundation have at least $ 5,000 in assets at any time during the year7if " Yes," complete Part II, col (c), and Part XV a Enter the states to which the foundation reports or with which it is registered ( see instructions) 10. Yes No la No l No lc No 2 No 3 No 4a No P No 5 No 6 No 7 No If the answer is "Yes " to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General ( or designate) of each state as required y General Instruction G? If "No," attach explanation 9 Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942 ( j)(5) for calendar year 2017 or the taxale year eginning in 2017 ( see instructions for Part XIV)' If "Yes, " complete Part XIV Did any persons ecome sustantial contriutors during the tax year? If "Yes," attach a schedule listing their names and addresses No 9 No 10 No

5 Form 990-PF ( 2017) Page 5 Statements Regarding Activities ( continued) 11 At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of section 512 ()(13)7 If "Yes," attach schedule ( see instructions ) No 12 Did the foundation make a distriution to a donor advised fund over which the foundation or a disqualified person had advisory privileges? If "Yes," attach statement ( see instructions ) No 13 Did the foundation comply with the pulic inspection requirements for its annual returns and exemption application? 13 Yes Wesite address N/A 14 The ooks are in care of ' JOSH GOTTHELF Telephone no 101 (917 ) Located at 11 JOCHUM AVENUE LARCHMONT NY ZIP+ 4 10, Section 4947(a)(1) nonexempt charitale trusts filing Form 990-PF in lieu of Form Check here q and enter the amount of tax-exempt interest received or accrued during the year I At any time during calendar year 2017, did the foundation have an interest in or a signature or other authority over Yes No la a ank, securities, or other financial account in a foreign country? 16 No See instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR) If "Yes", enter the name of the foreign country 10, Statements Regarding Activities for Which Form 4720 May Be Required File Form 4720 if any item is checked in the " Yes" column, unless an exception applies. During the year did the foundation (either directly or indirectly) (1) Engage in the sale or exchange, or leasing of property with a disqualified person? (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person? (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? (4) Pay compensation to, or pay or reimurse the expenses of, a disqualified person? (5) Transfer any income or assets to a disqualified person (or make any of either availale for the enefit or use of a disqualified person)? (6) Agree to pay money or property to a government official? ( Exception. Check "No" if the foundation agreed to make a grant to or to employ the official for a period W No 0 No R No W No q No after termination of government service, if terminating within 90 days ) W No If any answer is "Yes" to la(l)-(6), did any of the acts fail to qualify under the exceptions descried in Regulations section (d)-3 or in a current notice regarding disaster assistance (see instructions)? Organizations relying on a current notice regarding disaster assistance check here q c Did the foundation engage in a prior year in any of the acts descried in la, other than excepted acts, a c 3a 4a that were not corrected efore the first day of the tax year eginning in Taxes on failure to distriute income (section 4942) (does not apply for years the foundation was a private operating foundation defined in section 4942(j)(3) or 4942(j)(5)) At the end of tax year 2017, did the foundation have any undistriuted income (lines 6d and 6e, Part XIII) for tax year(s) eginning efore If "Yes," list the years 20-, 20-, 20-, 20- Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets) to the year's undistriuted income? (If applying section 4942(a)(2) W No to all years listed, answer "No" and attach statement-see instructions ) If the provisions of section 4942(a)(2) are eing applied to any of the years listed in 2a, list the years here 20-, 20-, 20-, 20 Did the foundation hold more than a 2% direct or indirect interest in any usiness enterprise at any time during the year? If "Yes," did it have excess usiness holdings in 2017 as a result of (1) any purchase y the foundation or disqualified persons after May 26, 1969, (2) the lapse of the 5-year period (or longer period approved y the Commissioner under section 4943(c)(7)) to dispose of holdings acquired y gift or equest, or (3) the lapse of the 10-, 15-, or 20-year first phase holding period7(use Schedule C, Form 4720, to determine if the foundation had excess usiness holdings in 2017 ) Did the foundation invest during the year any amount in a manner that would jeopardize its charitale purposes? Did the foundation make any investment in a prior year (ut after Decemer 31, 1969) that could jeopardize its charitale purpose that had not een removed from jeopardy efore the first day of the tax year eginning in 2017' q No l lc 3 4a No No No No No No 4 I I No

6 Page 6 Statements Regarding Activities for Which Form 4720 May Be Required (Continued) 5a During the year did the foundation pay or incur any amount to (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))7 (2) Influence the outcome of any specific pulic election (see section 4955), or to carry on, directly or indirectly, any voter registration drive? (3) Provide a grant to an individual for travel, study, or other similar purposes? (4) Provide a grant to an organization other than a charitale, etc, organization descried in section 4945(d)(4)(A)? (see instructions) (5) Provide for any purpose other than religious, charitale, scientific, literary, or W No 0 No W No W No educational purposes, or forthe prevention ofcruelty to children or animals?... 0 No If any answer is "Yes" to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions descried in Regulations section or in a current notice regarding disaster assistance (see instructions)? No Organizations relying on a current notice regarding disaster assistance check here q c If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the tax ecause it maintained expenditure responsiility forthe grant? No If "Yes," attach the statement required y Regulations section (d) 6a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on a personal enefit contract? No Did the foundation, during the year, pay premiums, directly or indirectly, on a personal enefit contract? No If "Yes" to 6, file Form a At any time during the tax year, was the foundation a party to a prohiited tax shelter transaction? W No If yes, did the foundation receive any proceeds or have any net income attriutale to the transaction? No

7 Page 7 Information Aout Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, KEMM and Contractors 1 List all officers, directors, trustees, foundation mana g ers and their com pensation ( see instructions ). Title, and average ( c) Compensation ( If (a) Name and address hours per week not paid, enter () devoted to position - 0-) JOSHUA GOTTHELF President 0 11 JOCHUM AVENUE 0 00 LARCHMONT, NY PATRICK CASSIDY Secretary nd AVENUE NEEDHAM, MA Contriutions to employee Expense account, enefit plans and deferred ( e) other allowances compensation 2 Compensation of five highest-paid employees (other than those included on line 1-see instructions). If none, enter "NONE." (a) Name and address of each employee paid more than $50,000 NONE Title, and average hours per week () devoted to position (c) Compensation (d) Contriutions to employee enefit plans and deferred compensation Expense account, (e) other allowances Total numer of other employees paid over $50, Five highest - paid independent contractors for professional services ( see instructions ). If none, enter "NONE". (a) Name and address of each person paid more than $50,000 () Type of service (c) Compensation NONE Total numer of others receiving over $50,000 for professional services Summary of Direct Charitale Activities List the foundation's four largest direct charitale activities during the tax year Include relevant statistical information such as the numer of organizations and other eneficiaries served. conferences convened. research oaoers produced. etc Expenses 4 1 Summary of Program - Related Investments (see instructions) Descrie the two largest program-related investments made y the foundation during the tax year on lines 1 and 2 Amount 2 3 All other program- related investments See instructions Total. Add lines 1 through

8 Page 8 Minimum investment Return (All domestic foundations must complete this part Foreign foundations,see instructions 1 Fair market value of assets not used (or held for use) directly in carrying out charitale, etc, purposes a Average monthly fair market value of securities la 0 Average of monthly cash alances l 0 c Fair market value of all other assets (see instructions) is 0 d Total (add lines la,, and c) d 0 e Reduction claimed for lockage or other factors reported on lines la and 1c (attach detailed explanation) le 0 2 Acquisition indetedness applicale to line 1 assets Sutract line 2 from line ld Cash deemed held for charitale activities Enter 1 1/2% of line 3 (for greater amount, see instructions) Net value of noncharitale - use assets. Sutract line 4 from line 3 Enter here and on Part V, line Minimum investment return. Enter 5% of line Distriutale Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here q and do not complete this part ) 1 Minimum investment return from Part X, line a Tax on investment income for 2017 from Part VI, line a Income tax for 2017 (This does not include the tax from Part VI )... 2 c Add lines 2a and c 3 Distriutale amount efore adjustments Sutract line 2c from line Recoveries of amounts treated as qualifying distriutions Add lines 3 and Deduction from distriutale amount (see instructions) Distriutale amount as adjusted Sutract line 6 from line 5 Enter here and on Part XIII, line Qualifying Distriutions (see instructions) 1 Amounts paid (including administrative expenses) to accomplish charitale, etc, purposes a Expenses, contriutions, gifts, etc -total from Part I, column (d), line la 0 Program-related investments-total from Part IX-B l 2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitale, etc, purposes Amounts set aside for specific charitale projects that satisfy the a Suitaility test (prior IRS approval required ) a Cash distriution test (attach the required schedule ) Qualifying distriutions. Add lines la through 3 Enter here and on Part V, line 8, and Part XIII, line Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income Enter 1% of Part I, line 27 (see instructions ) Adjusted qualifying distriutions. Sutract line 5 from line Note : The amount on line 6 will e used in Part V, column (), in susequent years when calculating whether t he foun dation qualifies for the section 4940(e) reduction of tax in those years

9 Page 9 Undistriuted Income (see instructions) (a) () (c) (d) Corpus Years prior to Distriutale amount for 2017 from Part XI, line Undistriuted income, if any, as of the end of 2017 a Enter amount for 2016 only Total for prior years 20-, 20-, 20-3 Excess distriutions carryover, if any, to 2017 a From From c From d From e From f Total of lines 3a through e Qualifying distriutions for 2017 from Part XII, line 4 $ a Applied to 2016, ut not more than line 2a Applied to undistriuted income of prior years (Election required-see instructions)..... c Treated as distriutions out of corpus (Election 0 required-see instructions) d Applied to 2017 distriutale amount..... e Remaining amount distriuted out of corpus 5 Excess distriutions carryover applied to 2017 (If an amount appears in column (d), the same amount must e shown in column (a) ) 6 Enter the net total of each column as indicated elow: a Corpus Add lines 3f, 4c, and 4e Sutract line 5 Prior years' undistriuted income Sutract line 4 from line c Enter the amount of prior years' undistriuted income for which a notice of deficiency has een issued, or on which the section 4942(a) tax has een previously assessed d Sutract line 6c from line 6 Taxale amount -see instructions e Undistriuted income for 2016 Sutract line 4a from line 2a Taxale amount-see instructions f Undistriuted income for 2017 Sutract lines 4d and 5 from line 1 This amount must e distriuted in Amounts treated as distriutions out of corpus to satisfy requirements imposed y section 170()(1)(F) or 4942(g)(3) (Election may e required - see instructions) Excess distriutions carryover from 2012 not applied on line 5 or line 7 (see instructions)... 9 Excess distriutions carryover to Sutract lines 7 and 8 from line 6a Analysis of line 9 a Excess from Excess from c Excess from d Excess from e Excess from 2017.

10 Form 990-PF (201 Pace 10 Private Operating Foundations (see instructions and Part VII-A, question 9) If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2017, enter the date of the ruling Check ox to indicate whether the organization is a private operating foundation descried in section q 4942(j)(3) or q 4942(j)(5) 2a Enter the lesser of the adjusted net Tax year Prior 3 years ( income from Part I or the minimum e) Total (a) 2017 () 2016 (c) 2015 (d) 2014 investment return from Part X for each year listed % of line 2a c Qualifying distriutions from Part XII, line 4 for each year listed..... d Amounts included in line 2c not used directly for active conduct of exempt activities e Qualifying distriutions made directly for active conduct of exempt activities Sutract line 2d from line 2c Complete 3a,, or c for the alternative test relied upon a "Assets" alternative test-enter (1) Value of all assets (2) Value of assets qualifying under section 4942(0)(3)(B)(i) "Endowment" alternative test- enter 2/3 of minimum investment return shown in Part X, line 6 for each year listed... c "Support" alternative test-enter (1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties).... (2) Support from general pulic and 5 or more exempt organizations as provided in section 4942(0)(3)(B)(iii).... (3) Largest amount of support from an exempt organization (4) Gross investment income Sunnlementarv Information ( Complete this Dart only if the organization had $5,000 or more in Lima" assets at any time during the year - see instructions.) 1 Information Regarding Foundation Managers: a List any managers of the foundation who have contriuted more than 2% of the total contriutions received y the foundation efore the close of any tax year (ut only if they have contriuted more than $5,000) (See section 507(d)(2) ) List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or other entity) of which the foundation has a 10% or greater interest 2 Information Regarding Contriution, Grant, Gift, Loan, Scholarship, etc., Programs: Check here q if the foundation only makes contriutions to preselected charitale organizations and does not accept unsolicited requests for funds If the foundation makes gifts, grants, etc (see instructions) to individuals or organizations under other conditions, complete items 2a,, c, and d a The name, address, and telephone numer or address of the person to whom applications should e addressed The form in which applications should e sumitted and information and materials they should include c Any sumission deadlines d Any restrictions or limitations on awards, such as y geographical areas, charitale fields, kinds of institutions, or other factors

11 Form 990-PF (2017 ) Page 11 Supplementary Information (continued) 3 Grants and Contriutions Paid During the Year or Approved for Future Payment If recipient is an individual, Recipient Foundation show any relationship to Purpose of grant or status o f Amount any foundation manager contriution Name and address (home or usiness) recipient or sustantial contriutor a Paid during the year Total. 3a Approved for future payment F Total ^

12 Form 990-PF (2017 ) Page 12 Analysis of Income - Producing Activities gross amounts unless ogram service revenue indicated Unrelated usiness income Excluded y section 512, 513, or 514 (a) Business code () Amount (c) Exclusion code (d) Amount ( e ) Related or exempt function income (See instructions Fees and contracts from government agencies lemership dues and assessments.... Interest on savings and temporary cash investments iividends and interest from securities.... let rental income or (loss) from real estate Det-financed property Not det-financed property..... Net rental income or (loss) from personal property >ther investment income..... Gain or (loss) from sales of assets other than inventory let income or (loss) from special events ;ross profit or (loss) from sales of inventory )ther revenue a 12 S utotal Add columns ( ),, (d), and (e). 13 Total. Add line 12, columns (), (d), and ( e) See worksheet in line 13 instructions to verify calculations Relationship of Activities to the Accomplishment of Exempt Purposes Line No. Explain elow how each activity for which income is reported in column (e) of Part XVI-A contriuted importantly to the accomplishment of the foundation's exempt purposes (other than y providing funds for such purposes) (See instructions )

13 Page 13 Information Regarding Transfers To and Transactions and Relationships With Noncharitale Exempt Organizations 1 Did the organization directly or indirectly engage in any of the following with any other organization descried in section 501 (c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? Yes No a Transfers from the reporting foundation to a noncharitale exempt organization of (1) Cash la(1) No (2) Other assets la(2) No Other transactions (1) Sales of assets to a noncharitale exempt organization l(1) No (2) Purchases of assets from a noncharitale exempt organization l(2) No (3) Rental of facilities, equipment, or other assets l(3) No (4) Reimursement arrangements l(4) No (5) Loans or loan guarantees l(5) No (6) Performance of services or memership or fundraising I No c Sharing of facilities, equipment, mailing lists, other assets, or paid employees lc No d If the answer to any of the aove is "Yes," complete the following schedule Column () should always show the fair market v alue of the goods, other assets, or services given y the reporting foundation If the foundation received less than fair market valu e in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received Line No I () Amount involved I (c) Name of noncharitale exempt organization I (d) Description of transfers, transactions, and sharing arrangements 2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations descried in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? No If "Yes," complete the following schedule (a) Name of organization () Type of organization (c) Description of relationship ign Here Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the est of my knowledge and elief, it is true, correct, and complete Declaration of preparer (other than taxpayer) is ased on all information of which preparer has any knowledge ****** Signature of officer or trustee Date Print/Type preparer's name Preparer's Signature aid BARBARA GOTTHELF v' ci.c.. c. Firm 's name 10, Barara Gotthelf CPA Use Only Firm's address 103 Apple Tree Hill Fitchurg, MA 01420