Part I. Revenue. Operating and Administrative Expenses. For calendar year 2011 or tax year beginning, 2011, and ending, 20

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1 Form 990-PF Department of the Treasury Internal Revenue Servie Return of Private Foundation or Setion 4947(a)(1) Nonexempt Charitale Trust Treated as a Private Foundation Note. The foundation may e ale to use a opy of this return to satisfy state reporting requirements. OMB No For alendar year 2011 or tax year eginning, 2011, and ending, 20 Name of foundation A Employer identifiation numer Numer and street (or P.O. ox numer if mail is not delivered to street address) Room/suite B Telephone numer (see instrutions) City or town, state, and ZIP ode C If exemption appliation is pending, hek here G Chek all that apply: Initial return Initial return of a former puli harity Final return Amended return Address hange Name hange H Chek type of organization: Setion 501()(3) exempt private foundation Setion 4947(a)(1) nonexempt haritale trust Other taxale private foundation I Fair market value of all assets at J Aounting method: Cash Arual end of year (from Part II, ol. (), Other (speify) line 16) $ (Part I, olumn (d) must e on ash asis.) Revenue Operating and Administrative Expenses Part I Analysis of Revenue and Expenses (The total of amounts in olumns (), (), and (d) may not neessarily equal the amounts in olumn (a) (see instrutions).) (a) Revenue and expenses per ooks D 1. Foreign organizations, hek here... E F () Net investment inome 2. Foreign organizations meeting the 85% test, hek here and attah omputation.. If private foundation status was terminated under setion 507()(1)(A), hek here.... If the foundation is in a 60-month termination under setion 507()(1)(B), hek here.. () Adjusted net inome (d) Disursements for haritale purposes (ash asis only) 1 Contriutions, gifts, grants, et., reeived (attah shedule) 2 Chek if the foundation is not required to attah Sh. B 3 Interest on savings and temporary ash investments 4 Dividends and interest from seurities.... 5a Gross rents Net rental inome or (loss) 6a Net gain or (loss) from sale of assets not on line 10 Gross sales prie for all assets on line 6a 7 Capital gain net inome (from Part IV, line 2).. 8 Net short-term apital gain Inome modifiations a Gross sales less returns and allowanes Less: Cost of goods sold... Gross profit or (loss) (attah shedule) Other inome (attah shedule) Total. Add lines 1 through Compensation of offiers, diretors, trustees, et. 14 Other employee salaries and wages Pension plans, employee enefits a Legal fees (attah shedule) Aounting fees (attah shedule)..... Other professional fees (attah shedule) Interest Taxes (attah shedule) (see instrutions) 19 Depreiation (attah shedule) and depletion.. 20 Oupany Travel, onferenes, and meetings Printing and puliations Other expenses (attah shedule) Total operating and administrative expenses. Add lines 13 through Contriutions, gifts, grants paid Total expenses and disursements. Add lines 24 and Sutrat line 26 from line 12: a Exess of revenue over expenses and disursements Net investment inome (if negative, enter -0-). Adjusted net inome (if negative, enter -0-).. For Paperwork Redution At Notie, see instrutions. Cat. No X

2 Page 2 Part II Attahed shedules and amounts in the desription olumn Beginning of year End of year Balane Sheets should e for end-of-year amounts only. (See instrutions.) (a) Book Value () Book Value () Fair Market Value 1 Cash non-interest-earing Savings and temporary ash investments Aounts reeivale Less: allowane for doutful aounts 4 Pledges reeivale Less: allowane for doutful aounts 5 Grants reeivale Reeivales due from offiers, diretors, trustees, and other disqualified persons (attah shedule) (see instrutions).. 7 Other notes and loans reeivale (attah shedule) Less: allowane for doutful aounts 8 Inventories for sale or use Prepaid expenses and deferred harges a Investments U.S. and state government oligations (attah shedule) Investments orporate stok (attah shedule)..... Investments orporate onds (attah shedule) Investments land, uildings, and equipment: asis Less: aumulated depreiation (attah shedule) 12 Investments mortgage loans Investments other (attah shedule) Land, uildings, and equipment: asis Less: aumulated depreiation (attah shedule) 15 Other assets (desrie ) 16 Total assets (to e ompleted y all filers see the instrutions. Also, see page 1, item I) Aounts payale and arued expenses Grants payale Deferred revenue Loans from offiers, diretors, trustees, and other disqualified persons 21 Mortgages and other notes payale (attah shedule) Other liailities (desrie ) 23 Total liailities (add lines 17 through 22) Foundations that follow SFAS 117, hek here.. and omplete lines 24 through 26 and lines 30 and Unrestrited Temporarily restrited Permanently restrited Foundations that do not follow SFAS 117, hek here and omplete lines 27 through Capital stok, trust prinipal, or urrent funds Paid-in or apital surplus, or land, ldg., and equipment fund 29 Retained earnings, aumulated inome, endowment, or other funds 30 Total net assets or fund alanes (see instrutions) Total liailities and net assets/fund alanes (see instrutions) Assets Liailities Net Assets or Fund Balanes Part III Analysis of Changes in Net Assets or Fund Balanes 1 Total net assets or fund alanes at eginning of year Part II, olumn (a), line 30 (must agree with end-of-year figure reported on prior year s return) Enter amount from Part I, line 27a Other inreases not inluded in line 2 (itemize) 3 4 Add lines 1, 2, and Dereases not inluded in line 2 (itemize) 5 6 Total net assets or fund alanes at end of year (line 4 minus line 5) Part II, olumn (), line

3 Page 3 Part IV 1a d e a d e a d e Capital Gains and Losses for Tax on Investment Inome (a) List and desrie the kind(s) of property sold (e.g., real estate, 2-story rik warehouse; or ommon stok, 200 shs. MLC Co.) (e) Gross sales prie (f) Depreiation allowed (or allowale) () How aquired P Purhase D Donation (g) Cost or other asis plus expense of sale Complete only for assets showing gain in olumn (h) and owned y the foundation on 12/31/69 (i) F.M.V. as of 12/31/69 (j) Adjusted asis as of 12/31/69 2 Capital gain net inome or (net apital loss) { (k) Exess of ol. (i) over ol. (j), if any If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7 } 2 3 Net short-term apital gain or (loss) as defined in setions 1222(5) and (6): If gain, also enter in Part I, line 8, olumn () (see instrutions). If (loss), enter -0- in Part I, line } 3 () Date aquired (mo., day, yr.) Part V Qualifiation Under Setion 4940(e) for Redued Tax on Net Investment Inome (For optional use y domesti private foundations sujet to the setion 4940(a) tax on net investment inome.) If setion 4940(d)(2) applies, leave this part lank. (h) Gain or (loss) (e) plus (f) minus (g) (d) Date sold (mo., day, yr.) (l) Gains (Col. (h) gain minus ol. (k), ut not less than -0-) or Losses (from ol. (h)) Was the foundation liale for the setion 4942 tax on the distriutale amount of any year in the ase period? Yes No If Yes, the foundation does not qualify under setion 4940(e). Do not omplete this part. 1 Enter the appropriate amount in eah olumn for eah year; see the instrutions efore making any entries. (a) Base period years Calendar year (or tax year eginning in) () Adjusted qualifying distriutions () Net value of nonharitale-use assets 2 Total of line 1, olumn (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 existene if less than 5 years (d) Distriution ratio (ol. () divided y ol. ()) 4 Enter the net value of nonharitale-use assets for 2011 from Part X, line Multiply line 4 y line Enter 1% of net investment inome (1% of Part I, line 27) Add lines 5 and Enter qualifying distriutions from Part XII, line If line 8 is equal to or greater than line 7, hek the ox in Part VI, line 1, and omplete that part using a 1% tax rate. See the Part VI instrutions.

4 Page 4 Part VI Exise Tax Based on Investment Inome (Setion 4940(a), 4940(), 4940(e), or 4948 see instrutions) 1a Exempt operating foundations desried in setion 4940(d)(2), hek here and enter N/A on line 1. Date of ruling or determination letter: (attah opy of letter if neessary see instrutions) Domesti foundations that meet the setion 4940(e) requirements in Part V, hek 1 here and enter 1% of Part I, line All other domesti foundations enter 2% of line 27. Exempt foreign organizations enter 4% of Part I, line 12, ol. (). 2 Tax under setion 511 (domesti setion 4947(a)(1) trusts and taxale foundations only. Others enter -0-) 2 3 Add lines 1 and Sutitle A (inome) tax (domesti setion 4947(a)(1) trusts and taxale foundations only. Others enter -0-) 4 5 Tax ased on investment inome. Sutrat line 4 from line 3. If zero or less, enter Credits/Payments: a 2011 estimated tax payments and 2010 overpayment redited to a Exempt foreign organizations tax withheld at soure Tax paid with appliation for extension of time to file (Form 8868). 6 d Bakup withholding erroneously withheld d 7 Total redits and payments. Add lines 6a through 6d Enter any penalty for underpayment of estimated tax. Chek here if Form 2220 is attahed 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 2012 estimated tax Refunded 11 Part VII-A Statements Regarding Ativities 1a During the tax year, did the foundation attempt to influene any national, state, or loal legislation or did it partiipate or intervene in any politial ampaign? a Did it spend more than $100 during the year (either diretly or indiretly) for politial purposes (see page 19 of the instrutions for definition)? If the answer is Yes to 1a or 1, attah a detailed desription of the ativities and opies of any materials pulished or distriuted y the foundation in onnetion with the ativities. Did the foundation file Form 1120-POL for this year? d Enter the amount (if any) of tax on politial expenditures (setion 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 politial expenditure tax imposed on foundation managers. $ 2 Has the foundation engaged in any ativities that have not previously een reported to the IRS? If Yes, attah a detailed desription of the ativities. 3 Has the foundation made any hanges, not previously reported to the IRS, in its governing instrument, artiles of inorporation, or ylaws, or other similar instruments? If Yes, attah a onformed opy of the hanges a Did the foundation have unrelated usiness gross inome of $1,000 or more during the year? a If Yes, has it filed a tax return on Form 990-T for this year? Was there a liquidation, termination, dissolution, or sustantial ontration during the year? If Yes, attah the statement required y General Instrution T. 6 Are the requirements of setion 508(e) (relating to setions 4941 through 4945) satisfied either: By language in the governing instrument, or By state legislation that effetively amends the governing instrument so that no mandatory diretions that onflit with the state law remain in the governing instrument? Did the foundation have at least $5,000 in assets at any time during the year? If Yes, omplete Part II, ol. (), and Part XV 7 8a Enter the states to whih the foundation reports or with whih it is registered (see instrutions) If the answer is Yes to line 7, has the foundation furnished a opy of Form 990-PF to the Attorney General (or designate) of eah state as required y General Instrution G? If No, attah explanation Is the foundation laiming status as a private operating foundation within the meaning of setion 4942(j)(3) or 4942(j)(5) for alendar year 2011 or the taxale year eginning in 2011 (see instrutions for Part XIV)? If Yes, omplete Part XIV Did any persons eome sustantial ontriutors during the tax year? If Yes, attah a shedule listing their names and addresses } Yes No

5 Page 5 Part VII-A Statements Regarding Ativities (ontinued) 11 At any time during the year, did the foundation, diretly or indiretly, own a ontrolled entity within the meaning of setion 512()(13)? If Yes, attah shedule (see instrutions) Did the foundation make a distriution to a donor advised fund over whih the foundation or a disqualified person had advisory privileges? If Yes, attah statement (see instrutions) Did the foundation omply with the puli inspetion requirements for its annual returns and exemption appliation? 13 Wesite address 14 The ooks are in are of Telephone no. Loated at ZIP+4 15 Setion 4947(a)(1) nonexempt haritale trusts filing Form 990-PF in lieu of Form 1041 Chek here and enter the amount of tax-exempt interest reeived or arued during the year At any time during alendar year 2011, did the foundation have an interest in or a signature or other authority Yes No over a ank, seurities, or other finanial aount in a foreign ountry? See the instrutions for exeptions and filing requirements for Form TD F If "Yes," enter the name of the foreign ountry Part VII-B Statements Regarding Ativities for Whih Form 4720 May Be Required File Form 4720 if any item is heked in the Yes olumn, unless an exeption applies. Yes No 1a During the year did the foundation (either diretly or indiretly): (1) Engage in the sale or exhange, or leasing of property with a disqualified person?.. Yes No (2) Borrow money from, lend money to, or otherwise extend redit to (or aept it from) a disqualified person? Yes No (3) Furnish goods, servies, or failities to (or aept them from) a disqualified person?.. Yes No (4) Pay ompensation to, or pay or reimurse the expenses of, a disqualified person?.. Yes No (5) Transfer any inome or assets to a disqualified person (or make any of either availale for the enefit or use of a disqualified person)? Yes No (6) Agree to pay money or property to a government offiial? (Exeption. Chek No if the foundation agreed to make a grant to or to employ the offiial for a period after termination of government servie, if terminating within 90 days.) Yes No If any answer is Yes to 1a(1) (6), did any of the ats fail to qualify under the exeptions desried in Regulations setion (d)-3 or in a urrent notie regarding disaster assistane (see instrutions)? Organizations relying on a urrent notie regarding disaster assistane hek here Did the foundation engage in a prior year in any of the ats desried in 1a, other than exepted ats, that were not orreted efore the first day of the tax year eginning in 2011? Taxes on failure to distriute inome (setion 4942) (does not apply for years the foundation was a private operating foundation defined in setion 4942(j)(3) or 4942(j)(5)): a At the end of tax year 2011, did the foundation have any undistriuted inome (lines 6d and 6e, Part XIII) for tax year(s) eginning efore 2011? Yes No If Yes, list the years 20, 20, 20, 20 3a Are there any years listed in 2a for whih the foundation is not applying the provisions of setion 4942(a)(2) (relating to inorret valuation of assets) to the year s undistriuted inome? (If applying setion 4942(a)(2) to all years listed, answer No and attah statement see instrutions.) If the provisions of setion 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% diret or indiret interest in any usiness enterprise at any time during the year? Yes No If Yes, did it have exess usiness holdings in 2011 as a result of (1) any purhase 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 setion 4943()(7)) to dispose of holdings aquired y gift or equest; or (3) the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Shedule C, Form 4720, to determine if the foundation had exess usiness holdings in 2011.) a Did the foundation invest during the year any amount in a manner that would jeopardize its haritale purposes? 4a Did the foundation make any investment in a prior year (ut after Deemer 31, 1969) that ould jeopardize its haritale purpose that had not een removed from jeopardy efore the first day of the tax year eginning in 2011? 4

6 Page 6 Part VII-B Statements Regarding Ativities for Whih Form 4720 May Be Required (ontinued) 5a During the year did the foundation pay or inur any amount to: (1) Carry on propaganda, or otherwise attempt to influene legislation (setion 4945(e))?. Yes No (2) Influene the outome of any speifi puli eletion (see setion 4955); or to arry on, diretly or indiretly, any voter registration drive? Yes No (3) Provide a grant to an individual for travel, study, or other similar purposes?..... Yes No (4) Provide a grant to an organization other than a haritale, et., organization desried in setion 509(a)(1), (2), or (3), or setion 4940(d)(2)? (see instrutions) Yes No (5) Provide for any purpose other than religious, haritale, sientifi, literary, or eduational purposes, or for the prevention of ruelty to hildren or animals? Yes No If any answer is Yes to 5a(1) (5), did any of the transations fail to qualify under the exeptions desried in Regulations setion or in a urrent notie regarding disaster assistane (see instrutions)? Organizations relying on a urrent notie regarding disaster assistane hek here If the answer is Yes to question 5a(4), does the foundation laim exemption from the tax eause it maintained expenditure responsiility for the grant? Yes No If Yes, attah the statement required y Regulations setion (d). 6a Did the foundation, during the year, reeive any funds, diretly or indiretly, to pay premiums on a personal enefit ontrat? Yes No Did the foundation, during the year, pay premiums, diretly or indiretly, on a personal enefit ontrat?. 6 If Yes to 6, file Form a At any time during the tax year, was the foundation a party to a prohiited tax shelter transation? Yes No If "Yes," did the foundation reeive any proeeds or have any net inome attriutale to the transation?. 7 Part VIII Information Aout Offiers, Diretors, Trustees, Foundation Managers, Highly Paid Employees, and Contrators 1 List all offiers, diretors, trustees, foundation managers and their ompensation (see instrutions). (a) Name and address () Title, and average hours per week devoted to position () Compensation (If not paid, enter -0-) (d) Contriutions to employee enefit plans and deferred ompensation (e) Expense aount, other allowanes 2 Compensation of five highest-paid employees (other than those inluded on line 1 see instrutions). If none, enter NONE. (a) Name and address of eah employee paid more than $50,000 () Title, and average hours per week devoted to position () Compensation (d) Contriutions to employee enefit plans and deferred ompensation (e) Expense aount, other allowanes Total numer of other employees paid over $50,

7 Page 7 Part VIII Information Aout Offiers, Diretors, Trustees, Foundation Managers, Highly Paid Employees, and Contrators (ontinued) 3 Five highest-paid independent ontrators for professional servies (see instrutions). If none, enter NONE. (a) Name and address of eah person paid more than $50,000 () Type of servie () Compensation Total numer of others reeiving over $50,000 for professional servies Part IX-A Summary of Diret Charitale Ativities List the foundation s four largest diret haritale ativities during the tax year. Inlude relevant statistial information suh as the numer of organizations and other enefiiaries served, onferenes onvened, researh papers produed, et. 1 Expenses Part IX-B Summary of Program-Related Investments (see instrutions) Desrie the two largest program-related investments made y the foundation during the tax year on lines 1 and 2. 1 Amount 2 All other program-related investments. See instrutions. 3 Total. Add lines 1 through

8 Page 8 Part X Minimum Investment Return (All domesti foundations must omplete this part. Foreign foundations, see instrutions.) 1 Fair market value of assets not used (or held for use) diretly in arrying out haritale, et., purposes: a Average monthly fair market value of seurities a Average of monthly ash alanes Fair market value of all other assets (see instrutions) d Total (add lines 1a,, and ) d e Redution laimed for lokage or other fators reported on lines 1a and 1 (attah detailed explanation) e 2 Aquisition indetedness appliale to line 1 assets Sutrat line 2 from line 1d Cash deemed held for haritale ativities. Enter 1 1 /2 % of line 3 (for greater amount, see instrutions) Net value of nonharitale-use assets. Sutrat line 4 from line 3. Enter here and on Part V, line Minimum investment return. Enter 5% of line Part XI Distriutale Amount (see instrutions) (Setion 4942(j)(3) and (j)(5) private operating foundations and ertain foreign organizations hek here and do not omplete this part.) 1 Minimum investment return from Part X, line a Tax on investment inome for 2011 from Part VI, line a Inome tax for (This does not inlude the tax from Part VI.)... 2 Add lines 2a and Distriutale amount efore adjustments. Sutrat line 2 from line Reoveries of amounts treated as qualifying distriutions Add lines 3 and Dedution from distriutale amount (see instrutions) Distriutale amount as adjusted. Sutrat line 6 from line 5. Enter here and on Part XIII, line Part XII Qualifying Distriutions (see instrutions) 1 Amounts paid (inluding administrative expenses) to aomplish haritale, et., purposes: a Expenses, ontriutions, gifts, et. total from Part I, olumn (d), line a Program-related investments total from Part IX-B Amounts paid to aquire assets used (or held for use) diretly in arrying out haritale, et., purposes Amounts set aside for speifi haritale projets that satisfy the: a Suitaility test (prior IRS approval required) a Cash distriution test (attah the required shedule) Qualifying distriutions. Add lines 1a through 3. Enter here and on Part V, line 8, and Part XIII, line Foundations that qualify under setion 4940(e) for the redued rate of tax on net investment inome. Enter 1% of Part I, line 27 (see instrutions) Adjusted qualifying distriutions. Sutrat line 5 from line Note. The amount on line 6 will e used in Part V, olumn (), in susequent years when alulating whether the foundation qualifies for the setion 4940(e) redution of tax in those years.

9 Page 9 Part XIII Undistriuted Inome (see instrutions) 1 Distriutale amount for 2011 from Part XI, line Undistriuted inome, if any, as of the end of 2011: a Enter amount for 2010 only Total for prior years: 20,20,20 3 Exess distriutions arryover, if any, to 2011: a From From From d From e From f Total of lines 3a through e Qualifying distriutions for 2011 from Part XII, line 4: $ a Applied to 2010, ut not more than line 2a. Applied to undistriuted inome of prior years (Eletion required see instrutions)... Treated as distriutions out of orpus (Eletion required see instrutions) d Applied to 2011 distriutale amount.. e Remaining amount distriuted out of orpus 5 Exess distriutions arryover applied to 2011 (If an amount appears in olumn (d), the same amount must e shown in olumn (a).) 6 Enter the net total of eah olumn as indiated elow: a Corpus. Add lines 3f, 4, and 4e. Sutrat line 5 Prior years undistriuted inome. Sutrat line 4 from line Enter the amount of prior years undistriuted inome for whih a notie of defiieny has een issued, or on whih the setion 4942(a) tax has een previously assessed.... d Sutrat line 6 from line 6. Taxale amount see instrutions e Undistriuted inome for Sutrat line 4a from line 2a. Taxale amount see instrutions f Undistriuted inome for Sutrat lines 4d and 5 from line 1. This amount must e distriuted in Amounts treated as distriutions out of orpus to satisfy requirements imposed y setion 170()(1)(F) or 4942(g)(3) (see instrutions). 8 Exess distriutions arryover from 2006 not applied on line 5 or line 7 (see instrutions). 9 Exess distriutions arryover to Sutrat lines 7 and 8 from line 6a Analysis of line 9: a Exess from Exess from Exess from d Exess from e Exess from (a) Corpus () Years prior to 2010 () 2010 (d) 2011

10 Page 10 Part XIV Private Operating Foundations (see instrutions and Part VII-A, question 9) 1a If the foundation has reeived a ruling or determination letter that it is a private operating foundation, and the ruling is effetive for 2011, enter the date of the ruling Chek ox to indiate whether the foundation is a private operating foundation desried in setion 4942(j)(3) or 4942(j)(5) 2a Enter the lesser of the adjusted net Tax year Prior 3 years inome from Part I or the minimum (e) Total (a) 2011 () 2010 () 2009 (d) 2008 investment return from Part X for eah year listed % of line 2a Qualifying distriutions from Part XII, line 4 for eah year listed.... d Amounts inluded in line 2 not used diretly for ative ondut of exempt ativities.. e Qualifying distriutions made diretly for ative ondut of exempt ativities. Sutrat line 2d from line Complete 3a,, or for the alternative test relied upon: a Assets alternative test enter: (1) Value of all assets..... (2) Value of assets qualifying under setion 4942(j)(3)(B)(i).... Endowment alternative test enter 2 /3 of minimum investment return shown in Part X, line 6 for eah year listed... Support alternative test enter: (1) Total support other than gross investment inome (interest, dividends, rents, payments on seurities loans (setion 512(a)(5)), or royalties).... (2) Support from general puli and 5 or more exempt organizations as provided in setion 4942(j)(3)(B)(iii).... (3) Largest amount of support from an exempt organization... (4) Gross investment inome... Part XV Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets at any time during the year see instrutions.) 1 Information Regarding Foundation Managers: a List any managers of the foundation who have ontriuted more than 2% of the total ontriutions reeived y the foundation efore the lose of any tax year (ut only if they have ontriuted more than $5,000). (See setion 507(d)(2).) List any managers of the foundation who own 10% or more of the stok of a orporation (or an equally large portion of the ownership of a partnership or other entity) of whih the foundation has a 10% or greater interest. 2 Information Regarding Contriution, Grant, Gift, Loan, Sholarship, et., Programs: Chek here if the foundation only makes ontriutions to preseleted haritale organizations and does not aept unsoliited requests for funds. If the foundation makes gifts, grants, et. (see instrutions) to individuals or organizations under other onditions, omplete items 2a,,, and d. a The name, address, and telephone numer of the person to whom appliations should e addressed: The form in whih appliations should e sumitted and information and materials they should inlude: d Any sumission deadlines: Any restritions or limitations on awards, suh as y geographial areas, haritale fields, kinds of institutions, or other fators:

11 Page 11 Part XV Supplementary Information (ontinued) 3 Grants and Contriutions Paid During the Year or Approved for Future Payment Reipient Name and address (home or usiness) a Paid during the year If reipient is an individual, show any relationship to any foundation manager or sustantial ontriutor Foundation status of reipient Purpose of grant or ontriution Amount Total a Approved for future payment Total

12 Page 12 Part XVI-A Enter gross amounts unless otherwise indiated. Analysis of Inome-Produing Ativities Unrelated usiness inome Exluded y setion 512, 513, or Program servie revenue: a d e f g Fees and ontrats from government agenies 2 Memership dues and assessments Interest on savings and temporary ash investments 4 Dividends and interest from seurities Net rental inome or (loss) from real estate: a Det-finaned property Not det-finaned property (a) Business ode () Amount () Exlusion ode 6 Net rental inome or (loss) from personal property 7 Other investment inome Gain or (loss) from sales of assets other than inventory 9 Net inome or (loss) from speial events Gross profit or (loss) from sales of inventory.. 11 Other revenue: a d e 12 Sutotal. Add olumns (), (d), and (e) Total. Add line 12, olumns (), (d), and (e) (See worksheet in line 13 instrutions to verify alulations.) Part XVI-B Relationship of Ativities to the Aomplishment of Exempt Purposes Line No. (d) Amount (e) Related or exempt funtion inome (See instrutions.) Explain elow how eah ativity for whih inome is reported in olumn (e) of Part XVI-A ontriuted importantly to the aomplishment of the foundation s exempt purposes (other than y providing funds for suh purposes). (See instrutions.)

13 Page 13 Part XVII Information Regarding Transfers To and Transations and Relationships With Nonharitale Exempt Organizations 1 Did the organization diretly or indiretly engage in any of the following with any other organization desried in setion 501() of the Code (other than setion 501()(3) organizations) or in setion 527, relating to politial organizations? Yes No a Transfers from the reporting foundation to a nonharitale exempt organization of: (1) Cash a(1) (2) Other assets a(2) Other transations: (1) Sales of assets to a nonharitale exempt organization (1) (2) Purhases of assets from a nonharitale exempt organization (2) (3) Rental of failities, equipment, or other assets (3) (4) Reimursement arrangements (4) (5) Loans or loan guarantees (5) (6) Performane of servies or memership or fundraising soliitations (6) Sharing of failities, equipment, mailing lists, other assets, or paid employees d If the answer to any of the aove is Yes, omplete the following shedule. Column () should always show the fair market value of the goods, other assets, or servies given y the reporting foundation. If the foundation reeived less than fair market value in any transation or sharing arrangement, show in olumn (d) the value of the goods, other assets, or servies reeived. (a) Line no. () Amount involved () Name of nonharitale exempt organization (d) Desription of transfers, transations, and sharing arrangements 2a Is the foundation diretly or indiretly affiliated with, or related to, one or more tax-exempt organizations desried in setion 501() of the Code (other than setion 501()(3)) or in setion 527? Yes No If Yes, omplete the following shedule. (a) Name of organization () Type of organization () Desription of relationship Sign Here Under penalties of perjury, I delare that I have examined this return, inluding aompanying shedules and statements, and to the est of my knowledge and elief, it is true, orret, and omplete. Delaration of preparer (other than taxpayer) is ased on all information of whih preparer has any knowledge. May the IRS disuss this return with the preparer shown elow (see instrutions)? Yes No Signature of offier or trustee Date Title Print/Type preparer s name Preparer's signature Date PTIN Chek if self-employed Paid Preparer Use Only Firm s name Firm's address Firm's EIN Phone no.