Return of Private Foundation. or Section 4947(a)(1) Trust Treated as Private Foundation. Initial return of a former public charity.

Transcription

1 Form Rturn of Privat Founation -PF or Stion 447(a)() Trust Trat as Privat Founation 6 Do not ntr soial surity numrs on this form as it may ma puli. Information aout Form -PF an its sparat instrutions is at For alnar yar 6 or tax yar ginning, an ning Dpartmnt of th Trasury Intrnal Rvnu Srvi G Nam of founation Numr an strt (or P.O. ox numr if mail is not livr to strt arss) City or town, stat or provin, ountry, an ZIP or forign postal o Chk all that apply: H Chk typ of organization: Stion 5()() xmpt privat founation Stion 447(a)() nonxmpt harital trust Othr taxal privat founation I Fair markt valu of all assts at J Aounting mtho: Cash Arual n of yar (from Part II, ol. (), Othr (spify) lin 6) $ 8, (Part I, olumn () must on ash asis.) Analysis of Rvnu an Expnss (Th total of (a) Rvnu an Rvnu Oprating an Aministrativ Expnss Part I 4 5a 6a 7 8 a Total. A lins through a 7 8 Initial rturn Final rturn Arss hang amounts in olumns (), (), an () may not nssarily qual th amounts in olumn (a) (s instrutions).) Contriutions, gifts, grants, t., riv (attah shul). Chk if th founation is not rquir to attah Sh. B Intrst on savings an tmporary ash invstmnts Divins an intrst from suritis Gross rnts Nt rntal inom or (loss) Nt gain or (loss) from sal of assts not on lin Gross sals pri for all assts on lin 6a Capital gain nt inom (from Part IV, lin ) Nt short-trm apital gain Inom moifiations Gross sals lss rturns an allowans Lss: Cost of goos sol Gross profit or (loss) (attah shul) Othr inom (attah shul) Compnsation of offirs, irtors, trusts, t.... Othr mploy salaris an wags Pnsion plans, mploy nfits Lgal fs (attah shul) Aounting fs (attah shul) Othr profssional fs (attah shul) Intrst Taxs (attah shul) (s instrutions) Dpriation (attah shul) an pltion Oupany Travl, onfrns, an mtings Printing an puliations Othr xpnss (att. sh.) Total oprating an aministrativ xpnss. A lins through Contriutions, gifts, grants pai Total xpnss an isursmnts. A lins 4 an 5 7 Sutrat lin 6 from lin : a Exss of rvnu ovr xpnss an isursmnts Nt invstmnt inom (if ngativ, ntr --)..... Ajust nt inom (if ngativ, ntr --) For Paprwork Rution At Noti, s instrutions. MUSTARD SEED FOUNDATION, INC 75 LEESBURG PIKE, SUITE 4 FALLS CHURCH VA 4 Room/suit Initial rturn of a formr puli harity Amn rturn Nam hang xpnss pr ooks,5,88,5,88 48, 6,76 4,4 STMT 4,57 STMT 788 STMT,874 5,478 47,46,685 STMT 4 4,85 684,7,5,6,76,88 7,8 A B C Employr intifiation numr Tlphon numr (s instrutions) OMB No If xmption appliation is pning, hk hr... D. Forign organizations, hk hr E F Opn to Puli Insption Forign organizations mting th 85% tst, hk hr an attah omputation. If privat founation status was trminat unr stion 57()()(A), hk hr If th founation is in a 6-month trmination unr stion 57()()(B), hk hr () Disursmnts () Nt invstmnt () Ajust nt for harital inom inom purposs (ash asis only) 4,5,8 4,5,8 Form -PF (6)

2 Form -PF (6) Part II MUSTARD SEED FOUNDATION, INC Balan Shts Pag Attah shuls an amounts in th sription olumn Bginning of yar En of yar shoul for n-of-yar amounts only. (S instrutions.) (a) Book Valu () Book Valu () Fair Markt Valu Cash non-intrst-aring Savings an tmporary ash invstmnts Aounts rival , Lss: allowan for outful aounts Plgs rival Lss: allowan for outful aounts Grants rival Rivals u from offirs, irtors, trusts, an othr isqualifi prsons (attah shul) (s,6 8 84,4 8 5, 84,4 8 5, Assts 7 8 a instrutions) Othr nots an loans rival (att. shul) Lss: allowan for outful aounts Invntoris for sal or us Prpai xpnss an frr hargs Invstmnts U.S. an stat govrnmnt oligations (attah shul) Invstmnts orporat stok (attah shul) Invstmnts orporat ons (attah shul) Invstmnts lan, uilings, an quipmnt: asis ,5 Liailitis Nt Assts or Fun Balans 4 Lss: aumulat priation (attah sh.) Othr assts (sri Total assts (to omplt y all filrs s th ) instrutions. Also, s pag, itm l) Aounts payal an aru xpnss Grants payal Dfrr rvnu Loans from offirs, irtors, trusts, an othr isqualifi prsons Mortgags an othr nots payal (attah shul) Othr liailitis (sri ) Total liailitis (a lins 7 through ) Founations that follow SFAS 7, hk hr an omplt lins 4 through 6 an lins an Part III Lss: aumulat priation (attah sh.) Invstmnts mortgag loans Invstmnts othr (attah shul) Lan, uilings, an quipmnt: asis Unrstrit Tmporarily rstrit Prmanntly rstrit Founations that o not follow SFAS 7, hk hr an omplt lins 7 through. Capital stok, trust prinipal, or urrnt funs Pai-in or apital surplus, or lan, lg., an quipmnt fun Rtain arnings, aumulat inom, nowmnt, or othr funs Total nt assts or fun alans (s instrutions) Total liailitis an nt assts/fun alans (s 5,56 STMT 5 45,7 4, 5,46 instrutions) Analysis of Changs in Nt Assts or Fun Balans 8,444 Total nt assts or fun alans at ginning of yar Part II, olumn (a), lin (must agr with n-of-yar figur rport on prior yar's rturn) Entr amount from Part I, lin 7a Othr inrass not inlu in lin (itmiz) A lins,, an Drass not inlu in lin (itmiz) Total nt assts or fun alans at n of yar (lin 4 minus lin 5) Part II, olumn (), lin ,44 8,44 8,444 85,775,45,46 8,6 8,6 85,775 8, 8,44 7,8 8,6 8,6 Form -PF (6)

3 Form -PF (6) Part IV a a Capital Gains an Losss for Tax on Invstmnt Inom () Gross sals pri (a) List an sri th kin(s) of proprty sol (.g., ral stat, -story rik warhous; or ommon stok, shs. MLC Co.) () How aquir P Purhas D Donation () Dat aquir (mo., ay, yr.) (f) Dpriation allow (g) Cost or othr asis (h) Gain or (loss) (or allowal) plus xpns of sal () plus (f) minus (g) () Dat sol (mo., ay, yr.) Complt only for assts showing gain in olumn (h) an own y th founation on //6 (l) Gains (Col. (h) gain minus (j) Ajust asis (k) Exss of ol. (i) ol. (k), ut not lss than --) or (i) F.M.V. as of //6 as of //6 ovr ol. (j), if any Losss (from ol. (h)) a Capital gain nt inom or (nt apital loss) If gain, also ntr in Part I, lin 7 If (loss), ntr -- in Part I, lin 7 Nt short-trm apital gain or (loss) as fin in stions (5) an (6): If gain, also ntr in Part I, lin 8, olumn () (s instrutions). If (loss), ntr -- in Part I, lin Part V Qualifiation Unr Stion 44() for Ru Tax on Nt Invstmnt Inom (For optional us y omsti privat founations sujt to th stion 44(a) tax on nt invstmnt inom.) If stion 44()() applis, lav this part lank. Was th founation lial for th stion 44 tax on th istriutal amount of any yar in th as prio? Ys No If Ys, th founation os not qualify unr stion 44(). Do not omplt this part. Entr th appropriat amount in ah olumn for ah yar; s th instrutions for making any ntris. (a) Bas prio yars Calnar yar (or tax yar ginning in) 5 4 MUSTARD SEED FOUNDATION, INC () Ajust qualifying istriutions () Nt valu of nonharital-us assts () Distriution ratio (ol. () ivi y ol. ()) Pag,5, 4, ,68,665 5, ,6,76,44,6.6657,74,46 486, ,87,854, Total of lin, olumn () Avrag istriution ratio for th 5-yar as prio ivi th total on lin y 5, or y th numr of yars th founation has n in xistn if lss than 5 yars Entr th nt valu of nonharital-us assts for 6 from Part, lin Multiply lin 4 y lin ,6,47,7 6 Entr % of nt invstmnt inom (% of Part I, lin 7) A lins 5 an Entr qualifying istriutions from Part II, lin If lin 8 is qual to or gratr than lin 7, hk th ox in Part VI, lin, an omplt that part using a % tax rat. S th Part VI instrutions.,47,7 4,5,8 Form -PF (6)

4 Form -PF (6) Exis Tax Bas on Invstmnt Inom (Stion 44(a), 44(), 44(), or 448 s instrutions) a Exmpt oprating founations sri in stion 44()(), hk hr an ntr on lin. Dat of ruling or trmination lttr: (attah opy of lttr if nssary s instrutions) Domsti founations that mt th stion 44() rquirmnts in Part V, hk hr an ntr % of Part I, lin All othr omsti founations ntr % of lin 7. Exmpt forign organizations ntr 4% of Part I, lin, ol. (). Tax unr stion 5 (omsti stion 447(a)() trusts an taxal founations only. Othrs ntr --) A lins an Sutitl A (inom) tax (omsti stion 447(a)() trusts an taxal founations only. Othrs ntr --) Tax as on invstmnt inom. Sutrat lin 4 from lin. If zro or lss, ntr Crits/Paymnts: a 6 stimat tax paymnts an 5 ovrpaymnt rit to a Exmpt forign organizations tax withhl at sour Tax pai with appliation for xtnsion of tim to fil (Form 8868) Bakup withholing rronously withhl Total rits an paymnts. A lins 6a through Entr any pnalty for unrpaymnt of stimat tax. Chk hr if Form is attah Tax u. If th total of lins 5 an 8 is mor than lin 7, ntr amount ow Ovrpaymnt. If lin 7 is mor than th total of lins 5 an 8, ntr th amount ovrpai Entr th amount of lin to : Crit to 7 stimat tax Rfun a During th tax yar, i th founation attmpt to influn any national, stat, or loal lgislation or i it Ys No partiipat or intrvn in any politial ampaign? a Di it spn mor than $ uring th yar (ithr irtly or inirtly) for politial purposs (s Instrutions for th finition)? If th answr is Ys to a or, attah a tail sription of th ativitis an opis of any matrials pulish or istriut y th founation in onntion with th ativitis. Di th founation fil Form -POL for this yar? Entr th amount (if any) of tax on politial xpniturs (stion 455) impos uring th yar: () On th founation. $ () On founation managrs. $ Entr th rimursmnt (if any) pai y th founation uring th yar for politial xpnitur tax impos on founation managrs. $ Has th founation ngag in any ativitis that hav not prviously n rport to th IRS? If Ys, attah a tail sription of th ativitis. Has th founation ma any hangs, not prviously rport to th IRS, in its govrning instrumnt, artils of inorporation, or ylaws, or othr similar instrumnts? If Ys, attah a onform opy of th hangs a Di th founation hav unrlat usinss gross inom of $, or mor uring th yar? a If Ys, has it fil a tax rturn on Form -T for this yar? Was thr a liquiation, trmination, issolution, or sustantial ontration uring th yar? If Ys, attah th statmnt rquir y Gnral Instrution T. 6 Ar th rquirmnts of stion 58() (rlating to stions 44 through 445) satisfi ithr: By languag in th govrning instrumnt, or By stat lgislation that fftivly amns th govrning instrumnt so that no manatory irtions that onflit with th stat law rmain in th govrning instrumnt? Di th founation hav at last $5, in assts at any tim uring th yar? If Ys, omplt Part II, ol. (), an Part V a Entr th stats to whih th founation rports or with whih it is rgistr (s instrutions) Part VI Part VII-A NONE MUSTARD SEED FOUNDATION, INC Statmnts Rgaring Ativitis If th answr is Ys to lin 7, has th founation furnish a opy of Form -PF to th Attorny Gnral (or signat) of ah stat as rquir y Gnral Instrution G? If No, attah xplanation Is th founation laiming status as a privat oprating founation within th maning of stion 44(j)() or 44(j)(5) for alnar yar 6 or th taxal yar ginning in 6 (s instrutions for Part IV)? If Ys, omplt Part IV Di any prsons om sustantial ontriutors uring th tax yar? If Ys, attah a shul listing thir nams an arsss Pag 4 Form -PF (6)

5 Form -PF (6) 4 Part VII-A MUSTARD SEED FOUNDATION, INC Statmnts Rgaring Ativitis (ontinu) Loat at FALLS CHURCH VA ZIP Stion 447(a)() nonxmpt harital trusts filing Form -PF in liu of Form 4 Chk hr an ntr th amount of tax-xmpt intrst riv or aru uring th yar At any tim uring alnar yar 6, i th founation hav an intrst in or a signatur or othr authority Ys No ovr a ank, suritis, or othr finanial aount in a forign ountry? S th instrutions for xptions an filing rquirmnts for FinCEN Form 4. If "Ys," ntr th nam of th forign ountry Part VII-B Statmnts Rgaring Ativitis for Whih Form 47 May B Rquir Fil Form 47 if any itm is hk in th Ys olumn, unlss an xption applis. Ys No a During th yar i th founation (ithr irtly or inirtly): () Engag in th sal or xhang, or lasing of proprty with a isqualifi prson? Ys No () Borrow mony from, ln mony to, or othrwis xtn rit to (or apt it from) a isqualifi prson? Ys No () Furnish goos, srvis, or failitis to (or apt thm from) a isqualifi prson? Ys No (4) Pay ompnsation to, or pay or rimurs th xpnss of, a isqualifi prson? Ys No (5) Transfr any inom or assts to a isqualifi prson (or mak any of ithr availal for th nfit or us of a isqualifi prson)? Ys No (6) Agr to pay mony or proprty to a govrnmnt offiial? (Exption. Chk No if th founation agr to mak a grant to or to mploy th offiial for a prio aftr trmination of govrnmnt srvi, if trminating within ays.) Ys No If any answr is Ys to a() (6), i any of th ats fail to qualify unr th xptions sri in Rgulations stion 5.44()- or in a urrnt noti rgaring isastr assistan (s instrutions)? Organizations rlying on a urrnt noti rgaring isastr assistan hk hr Di th founation ngag in a prior yar in any of th ats sri in a, othr than xpt ats, that wr not orrt for th first ay of th tax yar ginning in 6? Taxs on failur to istriut inom (stion 44) (os not apply for yars th founation was a privat oprating founation fin in stion 44(j)() or 44(j)(5)): a At th n of tax yar 6, i th founation hav any unistriut inom (lins 6 an 6, Part III) for tax yar(s) ginning for 6? Ys No If Ys, list th yars.....,.....,.....,..... Ar thr any yars list in a for whih th founation is not applying th provisions of stion 44(a)() (rlating to inorrt valuation of assts) to th yar's unistriut inom? (If applying stion 44(a)() to all yars list, answr No an attah statmnt s instrutions.) If th provisions of stion 44(a)() ar ing appli to any of th yars list in a, list th yars hr......,.....,.....,..... a Di th founation hol mor than a % irt or inirt intrst in any usinss ntrpris at any tim uring th yar? Ys No If Ys, i it hav xss usinss holings in 6 as a rsult of () any purhas y th founation or isqualifi prsons aftr May 6, 6; () th laps of th 5-yar prio (or longr prio approv y th Commissionr unr stion 44()(7)) to ispos of holings aquir y gift or qust; or () th laps of th -, 5-, or -yar first phas holing prio? (Us Shul C, Form 47, to trmin if th founation ha xss usinss holings in 6.) a Di th founation invst uring th yar any amount in a mannr that woul jopariz its harital purposs? a Di th founation mak any invstmnt in a prior yar (ut aftr Dmr, 6) that oul jopariz its harital purpos that ha not n rmov from jopary for th first ay of th tax yar ginning in 6? Pag 5 Ys No At any tim uring th yar, i th founation, irtly or inirtly, own a ontroll ntity within th maning of stion 5()()? If Ys, attah shul (s instrutions) Di th founation mak a istriution to a onor avis fun ovr whih th founation or a isqualifi prson ha avisory privilgs? If Ys, attah statmnt (s instrutions) Di th founation omply with th puli insption rquirmnts for its annual rturns an xmption appliation? Wsit arss.. Th ooks ar in ar of.. ERIC HORNBERGER Tlphon no LEESBURG PIKE #4 Form -PF (6)