CLIENT COPY THE GRAHAM AND CAROLYN HOLLOWAY FAMILY FOUNDATION TRUST P O BOX 989 COLLEYVILLE, TX

Transcription

1 6 TA RETURN CLIENT COPY Client: 44 Prepared for: P O BO 989 COLLEYVILLE, T Prepared by: TASHA WHIDDON, CPA MCILVAIN & ASSOCIATES LLC 44 GATEWAY DRIVE, SUITE 8 COLLEYVILLE, T Date: AUGUST 4, 7 Comments: Route to: FDILL 9//6

2 MCILVAIN & ASSOCIATES LLC 44 GATEWAY DRIVE, SUITE 8 COLLEYVILLE, T August 4, 7 The Graham and Carolyn Holloway P O Box 989 Colleyville, T 764 Dear Valerie: Your 6 Federal Return of Private Foundation will be electronically filed with the Internal Revenue Service upon receipt of a signed Form 8879-EO - IRS e-file Signature Authorization. No tax is payable with the filing of this return. There is an overpayment of,74, of which,74 has been applied to your 7 estimated tax. Please be sure to call us if you have any questions. Sincerely, TASHA WHIDDON, CPA

3 MCILVAIN & ASSOCIATES LLC Client 44 August 4, 7 44 GATEWAY DRIVE, SUITE 8 COLLEYVILLE, T The Graham and Carolyn Holloway P O Box 989 Colleyville, T FEDERAL FORMS Form 99-PF Schedule B Form 8868 Form 8879-EO 6 Return of Private Foundation Schedule of Contributors Application for Extension Depreciation Schedules IRS e-file Signature Authorization FEE SUMMARY Preparation Fee

4 6 Exempt Org. Return prepared for: The Graham and Carolyn Holloway P O Box 989 Colleyville, T 764 MCILVAIN & ASSOCIATES LLC 44 GATEWAY DRIVE, SUITE 8 COLLEYVILLE, T 764

5 6 FEDERAL PRIVATE FOUNDATION TA SUMMARY PAGE 6 DIFF REVENUE PER BOOKS CONTRIBUTIONS, GIFTS, AND GRANTS DIVIDENDS & INTEREST FROM SECURITIES NET GAIN (LOSS) - NONINV. ASSETS/DISP..... OTHER INCOME ,64 6,69 7,96 8,98,64 64,6 74,77 9,7,79 -,94,88 -,4 TOTAL REVENUE ,66,64 7,4 EPENSES PER BOOKS COMPENSATION OF OFFICERS, DIR, ETC ACCOUNTING FEES OTHER PROFESSIONAL FEES TAES DEPRECIATION TRAVEL, CONFERENCES, AND MEETINGS OTHER EPENSES TOTAL OPERATING/ADMINISTRATIVE EP CONTRIBUTIONS, GIFTS, GRANTS PAID ,,,88 4, 9 8,49,69 6,47 94,, 6,,678,997 6,99, 68,8 64, -, ,94 4-6,9, TOTAL EPENSES ,47,88,79 ECESS OF REVENUE OVER EPENSES ,8 7,46-6,8 NET INVESTMENT REVENUE DIVIDENDS & INTEREST FROM SECURITIES CAPITAL GAIN NET INCOME OTHER INCOME ,69 7,96 8,98 64,6 74,77 9,7 -,94,88 -,4 TOTAL REVENUE , 9,7 -,678 NET INVESTMENT EPENSES OTHER PROFESSIONAL FEES TAES TOTAL OPERATING/ADMINISTRATIVE EP ,86,86 78,7, TOTAL EPENSES ,86,8-444 NET INVESTMENT INCOME ,86 7,4 -,4 TA COMPUTATION TA ON NET INVESTMENT INCOME ,,74 -, TA ON INVESTMENT INCOME ,,74 -, PAYMENTS AND CREDITS OVERPAYMENT CREDITED FROM PRIOR YEAR ESTIMATED TA PAYMENTS ,96 7,6,96-7,6 TOTAL PAYMENTS AND CREDITS ,96 7,6 -,74 REFUND OR AMOUNT DUE TA DUE OVERPAYMENT OVERPAYMENT CREDITED TO NET YEAR ,74,74,96,96 -, -, TA RATES MARGINAL TA RATE EFFECTIVE TA RATE %.%.%.% % % ADJUSTED NET INCOME REVENUE DIVIDENDS & INTEREST FROM SECURITIES ,69 64,6 -,94

6 6 FEDERAL PRIVATE FOUNDATION TA SUMMARY PAGE 6 DIFF ADJUSTED NET INCOME REVENUE OTHER INCOME ,98 9,7 -,4 TOTAL REVENUE ,7, -7,66 ADJUSTED NET INCOME EPENSES TOTAL OPERATING/ADMINISTRATIVE EP TOTAL EPENSES ADJUSTED NET INCOME ,7, -7,66 CHARITABLE PURPOSES DISBURSEMENTS TOTAL OPERATING/ADMINISTRATIVE EP CONTRIBUTIONS, GIFTS, GRANTS PAID , 64,, TOTAL EPENSES AND DISBURSEMENTS , 64,, NET ASSETS OR FUND BALANCES NET ASSETS/FUND BAL. AT BEG. OF YEAR ECESS OF REVENUE OVER EPENSES OTHER DECREASES NET ASSETS/FUND BAL. AT END OF YEAR ,74,7,8,74,78,9,7,6 7,46 8,4,74,7 8,89-6,8 -,6 -,6

7 6 GENERAL INFORMATION PAGE FORMS NEEDED FOR THIS RETURN FEDERAL: 99-PF, SCH B, 8868 TA RATES PRIVATE FOUNDATION FEDERAL MARGINAL. % EFFECTIVE. % CARRYOVERS TO 7 UNDISTRIBUTED INCOME CARRYOVERS TO 7 6 ECESS DISTRIBUTIONS FEDERAL ESTIMATES FORM 99-PF //7 6//7 9//7 //7 TOTAL ESTIMATE OVERPAYMENT BALANCE ,74,74,98.

8 Form 8879-EO Department of the Treasury Internal Revenue Service Name of exempt organization Name and title of officer IRS e-file Signature Authorization for an Exempt Organization For calendar year 6, or fiscal year beginning, 6, and ending OMB No , 6 G Do not send to the IRS. Keep for your records. G Information about Form 8879-EO and its instructions is at Employer identification number VALERIE HOLLOWAY SKINNER VICE PRESIDENT Part I Type of Return and Return Information (Whole Dollars Only) Check the box for the return for which you are using this Form 8879-EO and enter the applicable amount, if any, from the return. If you check the box on line a, a, a, 4a, or a, below, and the amount on that line for the return being filed with this form was blank, then leave line b, b, b, 4b, or b, whichever is applicable, blank (do not enter --). But, if you entered -- on the return, then enter -- on the applicable line below. Do not complete more than line in Part I. a a a 4a a Form 99 check here..... G b Total revenue, if any (Form 99, Part VIII, column (A), line ) Form 99-EZ check here..... G b Total revenue, if any (Form 99-EZ, line 9) Form -POL check here G b Total tax (Form -POL, line ) Form 99-PF check here..... G b Tax based on investment income (Form 99-PF, Part VI, line ).... Form 8868 check here.... G b Balance Due (Form 8868, line c b b b 4b b,. Part II Declaration and Signature Authorization of Officer Under penalties of perjury, I declare that I am an officer of the above organization and that I have examined a copy of the organization's 6 electronic return and accompanying schedules and statements and to the best of my knowledge and belief, they are true, correct, and complete. I further declare that the amount in Part I above is the amount shown on the copy of the organization's electronic return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send the organization's return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, the reason for any delay in processing the return or refund, and the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the organization's federal taxes owed on this return, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at no later than business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I have selected a personal identification number (PIN) as my signature for the organization's electronic return and, if applicable, the organization's consent to electronic funds withdrawal. Officer's PIN: check one box only I authorize MCILVAIN & ASSOCIATES LLC to enter my PIN ERO firm name 44 as my signature Enter five numbers, but do not enter all zeros on the organization's tax year 6 electronically filed return. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO to enter my PIN on the return's disclosure consent screen. As an officer of the organization, I will enter my PIN as my signature on the organization's tax year 6 electronically filed return. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I will enter my PIN on the return's disclosure consent screen. Officer's signature Date G G Part III Certification and Authentication ERO's EFIN/PIN. Enter your six-digit electronic filing identification number (EFIN) followed by your five-digit self-selected PIN do not enter all zeros I certify that the above numeric entry is my PIN, which is my signature on the 6 electronically filed return for the organization indicated above. I confirm that I am submitting this return in accordance with the requirements of Pub. 46, Modernized e-file (MeF) Information for Authorized IRS e-file Providers for Business Returns. ERO's signature G TASHA WHIDDON, CPA Date G ERO Must Retain This Form ' See Instructions Do Not Submit This Form To the IRS Unless Requested To Do So BAA For Paperwork Reduction Act Notice, see instructions. Form 8879-EO (6) TEEA74L 8/8/6

9 Form 8868 (Rev. January 7) Application for Automatic Extension of Time To File an Exempt Organization Return OMB No GFile a separate application for each return. Department of the Treasury Internal Revenue Service GInformation about Form 8868 and its instructions is at Electronic filing (e-file). You can electronically file Form 8868 to request a 6-month automatic extension of time to file any of the forms listed below with the exception of Form 887, Information Return for Transfers Associated With Certain Personal Benefit Contracts, for which an extension request must be sent to the IRS in paper format (see instructions). For more details on the electronic filing of this form, visit click on Charities & Non-Profits, and click on e-file for Charities and Non-Profits. Automatic 6-Month Extension of Time. Only submit original (no copies needed). All corporations required to file an income tax return other than Form 99-T (including -C filers), partnerships, REMICs, and trusts must use Form 74 to request an extension of time to file income tax returns. Enter filer's identifying number, see instructions Type or print Name of exempt organization or other filer, see instructions. Employer identification number (EIN) or Number, street, and room or suite number. If a P.O. box, see instructions. File by the due date for filing your return. See instructions. Social security number (SSN) P O BO 989 City, town or post office, state, and ZIP code. For a foreign address, see instructions. COLLEYVILLE, T 764 Enter the Return Code for the return that this application is for (file a separate application for each return) Application Is For Return Code Return Code Application Is For Form 99 or Form 99-EZ Form 99-T (corporation) 7 Form 99-BL Form 47 (individual) Form 99-PF 4 Form 4-A Form 47 (other than individual) Form Form 99-T (section 4(a) or 48(a) trust) Form 99-T (trust other than above) 6 Form 669 Form 887? The books are in the care of G VALARIE SKINNER Telephone No. G Fax No. G? If the organization does not have an office or place of business in the United States, check this box G. If this is for the whole group,? If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) check this box G. If it is for part of the group, check this box.... G and attach a list with the names and EINs of all members the extension is for., 7 / for the organization named above. The extension is for the organization's return for: I request an automatic 6-month extension of time until G G, to file the exempt organization return calendar year 6 or tax year beginning,, and ending If the tax year entered in line is for less than months, check reason: Change in accounting period, Initial return. Final return a If this application is for Forms 99-BL, 99-PF, 99-T, 47, or 669, enter the tentative tax, less any nonrefundable credits. See instructions ,. b If this application is for Forms 99-PF, 99-T, 47, or 669, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit b,96. c Balance due. Subtract line b from line a. Include your payment with this form, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions c a Caution: If you are going to make an electronic funds withdrawal (direct debit) with this Form 8868, see Form 84-EO and Form 8879-EO for payment instructions. BAA For Privacy Act and Paperwork Reduction Act Notice, see instructions. FIFZL //7 Form 8868 (Rev. -7)

10 Form 99-PF OMB No. 4- Return of Private Foundation 6 or Section 4947(a)() Trust Treated as Private Foundation G Do not enter social security numbers on this form as it may be made public. G Information about Form 99-PF and its separate instructions is at Department of the Treasury Internal Revenue Service For calendar year 6 or tax year beginning, 6, and ending P O BO 989 COLLEYVILLE, T 764 G Check all that apply: Initial return Initial return of a former public charity Final return Amended return Address change Name change H Check type of organization: Section () exempt private foundation Section 4947(a)() nonexempt charitable trust Other taxable private foundation Accrual I Fair market value of all assets at end of year J Accounting method: Cash (from Part II, column, line 6) Other (specify) G (Part I, column must be on cash basis.) 4,969,4. Part I Analysis of Revenue and Expenses (The total of amounts in columns,, and may not necessarily equal the amounts in column (a) (see instructions).) Contributions, gifts, grants, etc., received (attach schedule)... Check G if the foundation is not required to attach Sch. B (a) Revenue and expenses per books Interest on savings and temporary cash investments Dividends and interest from securities a Gross rents b Net rental income 6,69. 6 a Net gain or (loss) from sale of assets not on line b Gross sales price for all 7,96., a b c assets on line 6a Capital gain net income (from Part IV, line ).... Net short-term capital gain O P E R A T I N G A N D E P E N S E S Employer identification number B Telephone number (see instructions) C If exemption application is pending, check here. G D Foreign organizations, check here G Foreign organizations meeting the 8% test, check here and attach computation G E If private foundation status was terminated under section 7()(A), check here G F If the foundation is in a 6-month termination under section 7()(B), check here G Net investment income Adjusted net income Disbursements for charitable purposes (cash basis only) 6,69. 6,69. 7,96. Income modifications Gross sales less returns and allowances Less: Cost of goods sold Gross profit or (loss) (attach schedule) Other income (attach schedule) SEE STATEMENT A D M I N I S T R A T I V E A,64. or (loss) R E V E N U E Open to Public Inspection, Total. Add lines through Compensation of officers, directors, trustees, etc... 4 Other employee salaries and wages Pension plans, employee benefits a Legal fees (attach schedule) ST b Accounting fees (attach sch).... SEE ST c Other professional fees (attach sch).. SEE 7 Interest Taxes (attach schedule)(see instrs)...see......stm Depreciation (attach 8,98. 7,66., 4,. SEE STMT Occupancy Total operating and administrative expenses. Add lines through Contributions, gifts, grants paid Subtract line 6 from line : 8,98. 48,7.,.,88., schedule) and depletion ,98. 4,. 8,49. Travel, conferences, and meetings Printing and publications Other expenses (attach schedule) SEE STATEMENT 6 PART V Total expenses and disbursements. Add lines 4 and a,69. 6,47. 94,,86. 6,47.,86. Excess of revenue over expenses and disbursements b Net investment income (if negative, enter --)... c Adjusted net income (if negative, enter --).... BAA For Paperwork Reduction Act Notice, see instructions.,8.,86. TEEA4L /6/6 94, 94, 48,7. Form 99-PF (6)

11 Form 99-PF (6) Part II Balance Sheets 4 Cash ' non-interest-bearing Savings and temporary cash investments Accounts receivable G Less: allowance for doubtful accounts G Pledges receivable G Less: allowance for doubtful accounts G Grants receivable Receivables due from officers, directors, trustees, and other disqualified persons (attach schedule) (see instructions) Other notes and loans receivable (attach sch)... G Less: allowance for doubtful accounts G 7 A S S E T S 8 9 Beginning of year (a) Book Value Attached schedules and amounts in the description column should be for end-of-year amounts only. (See instructions.) Inventories for sale or use Prepaid expenses and deferred charges Page End of year Book Value Fair Market Value 7,976.,. 7,6.,96.,66,7.,74, ,74,7.,78,9.,7,6.,77,78. 8,89.,74,7.,8.,78,9.,74,7.,78,9.,. a Investments ' U.S. and state government obligations (attach schedule) b Investments ' corporate stock (attach schedule) c Investments ' corporate bonds (attach schedule) Investments ' land, buildings, and equipment: basis G 4 6 L I A B I L I T I E S N F E U T N D A S B S A E L T A S N C O E R S 7 Less: accumulated depreciation (attach schedule) G Investments ' mortgage loans Investments ' other (attach schedule)...statement Land, buildings, and equipment: basis G,97. Less: accumulated depreciation (attach schedule)......see STMT G,44. Other assets (describe G ) Total assets (to be completed by all filers ' see the instructions. Also, see page, item I) Accounts payable and accrued expenses ,99,. 4,969,4. 8 Grants payable Deferred revenue Loans from officers, directors, trustees, & other disqualified persons Mortgages and other notes payable (attach schedule) ) Other liabilities (describeg Total liabilities (add lines 7 through ) Foundations that follow SFAS 7, check here G and complete lines 4 through 6 and lines and. 4 Unrestricted Temporarily restricted Permanently restricted Foundations that do not follow SFAS 7, check here... G and complete lines 7 through. 7 Capital stock, trust principal, or current funds Paid-in or capital surplus, or land, bldg., and equipment fund Retained earnings, accumulated income, endowment, or other funds Total net assets or fund balances (see instructions) Total liabilities and net assets/fund balances (see instructions) Part III Analysis of Changes in Net Assets or Fund Balances 4 6 BAA Total net assets or fund balances at beginning of year ' Part II, column (a), line (must agree with end-of-year figure reported on prior year's return) Enter amount from Part I, line 7a Other increases not included in line (itemize) G Add lines,, and Decreases not included in line (itemize) G SEE STATEMENT 9 Total net assets or fund balances at end of year (line 4 minus line ) ' Part II, column, line TEEAL /6/6,74,7.,8. 4 6,74,7.,74.,78,9. Form 99-PF (6)

12 Capital Gains and Losses for Tax on Investment Income Form 99-PF (6) Part IV (a) List and describe the kind(s) of property sold (e.g., real estate, -story brick warehouse; or common stock, shares MLC Company) a b c d e How acquired P ' Purchase D ' Donation Date acquired (mo., day, yr.) Page Date sold (mo., day, yr.) SEE STATEMENT (e) Gross sales price (f) Depreciation allowed (or allowable) (g) Cost or other basis plus expense of sale (h) Gain or (loss) (e) plus (f) minus (g) a b c d e Complete only for assets showing gain in column (h) and owned by the foundation on //69 (j) Adjusted basis (k) Excess of col. (i) (i) F.M.V. as of //69 as of //69 over col. (j), if any (l) Gains (Col. (h) gain minus col. (k), but not less than --) or Losses (from col. (h)) a b c d e If gain, also enter in Part I, line 7 If (loss), enter -- in Part I, line 7 Capital gain net income or (net capital loss) Net short-term capital gain or (loss) as defined in sections () and (6): If gain, also enter in Part I, line 8, column (see instructions). If (loss), enter -in Part I, line Part V ,96. Qualification Under Section 494(e) for Reduced Tax on Net Investment Income (For optional use by domestic private foundations subject to the section 494(a) tax on net investment income.) If section 494() applies, leave this part blank. Was the foundation liable for the section 494 tax on the distributable amount of any year in the base period? If ',' the foundation does not qualify under section 494(e). Do not complete this part. Enter the appropriate amount in each column for each year; see the instructions before making any entries. (a) Base period years Calendar year (or tax year beginning in) 4 Adjusted qualifying distributions Net value of noncharitable-use assets 6,6.,, 99,98., No Distribution ratio (col. divided by col. ),4, 4,978,99. 4,,97. 4,94,888.,9, Total of line, column Average distribution ratio for the -year base period ' divide the total on line by, or by the number of years the foundation has been in existence if less than years Enter the net value of noncharitable-use assets for 6 from Part, line ,7,. Multiply line 4 by line ,88. 6 Enter % of net investment income (% of Part I, line 7b) ,. 7 Add lines and ,8 8 Enter qualifying distributions from Part II, line , If line 8 is equal to or greater than line 7, check the box in Part VI, line b, and complete that part using a % tax rate. See the Part VI instructions. BAA TEEAL /6/6 Form 99-PF (6)

13 Excise Tax Based on Investment Income (Section 494(a), 494, 494(e), or 4948 ' see instructions) Form 99-PF (6) Part VI and enter 'N/A' on line. a Exempt operating foundations described in section 494(), check here G Date of ruling or determination letter: (attach copy of letter if necessary ' see instructions) b Domestic foundations that meet the section 494(e) requirements in Part V, check here.. G and enter % of Part I, line 7b Page 4,. 4,.,. a 6 estimated tax pmts and overpayment credited to a,96. b Exempt foreign organizations ' tax withheld at source b c Tax paid with application for extension of time to file (Form 8868) c d Backup withholding erroneously withheld d 7 Total credits and payments. Add lines 6a through 6d if Form is attached Enter any penalty for underpayment of estimated tax. Check here 8 9 Tax due. If the total of lines and 8 is more than line 7, enter amount owed G 9 Overpayment. If line 7 is more than the total of lines and 8, enter the amount overpaid G Enter the amount of line to be: Credited to 7 estimated tax G Refunded G.,74, c All other domestic foundations enter % of line 7b. Exempt foreign organizations enter 4% of Part I, line, col Tax under section (domestic section 4947(a)() trusts and taxable foundations only. Others enter --) Add lines and Subtitle A (income) tax (domestic section 4947(a)() trusts and taxable foundations only. Others enter --).. Tax based on investment income. Subtract line 4 from line. If zero or less, enter Credits/Payments:,74 Part VII-A Statements Regarding Activities No a 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? a b Did it spend more than during the year (either directly or indirectly) for political purposes (see Instructions for the definition)? b c If the answer is '' to a or b, attach a detailed description of the activities and copies of any materials published or distributed by 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 49) imposed during the year: () On the foundation..... G () On foundation managers G e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed on foundation managers G Has the foundation engaged in any activities that have not previously been reported to the IRS? If ',' attach a detailed description of the activities. Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or bylaws, or other similar instruments? If ',' attach a conformed copy of the changes a Did the foundation have unrelated business gross income of, or more during the year? b If ',' has it filed a tax return on Form 99-T for this year? Was there a liquidation, termination, dissolution, or substantial contraction during the year? If ',' attach the statement required by General Instruction T. 6 Are the requirements of section 8(e) (relating to sections 494 through 494) 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, in assets at any time during the year? If ',' complete Part II, col., and Part V a Enter the states to which the foundation reports or with which it is registered (see instructions) G 4a 4b N/A 6 7 8b T b If the answer is '' to line 7, has the foundation furnished a copy of Form 99-PF to the Attorney General (or designate) of each state as required by General Instruction G? If 'No,' attach explanation Is the foundation claiming status as a private operating foundation within the meaning of section 494(j)() or 494(j)() for calendar year 6 or the taxable year beginning in 6 (see instructions for Part IV)? If ',' complete Part IV. 9 Did any persons become substantial contributors during the tax year? If ',' attach a schedule listing their names and addresses BAA Form 99-PF (6) TEEA4L /6/6

14 Statements Regarding Activities (continued) Form 99-PF (6) Part VII-A At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of section ()? If ',' attach schedule (see instructions) Page Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges? If ',' attach statement (see instructions) Did the foundation comply with the public inspection requirements for its annual returns and exemption application?.... Website address G N/A The books are in care of G VALARIE SKINNER Telephone no. G Located at G P O BO 989 COLLEYVILLE T ZIP + 4 G 764 G Section 4947(a)() nonexempt charitable trusts filing Form 99-PF in lieu of Form 4 ' Check here N/A... and enter the amount of tax-exempt interest received or accrued during the year G 4 At any time during calendar year 6, did the foundation have an interest in or a signature or other authority over a bank, securities, or other financial account in a foreign country? No N/A No 6 See the instructions for exceptions and filing requirements for FinCEN Form 4. If ',' G enter the name of the foreign country Part VII-B Statements Regarding Activities for Which Form 47 May Be Required File Form 47 if any item is checked in the '' column, unless an exception applies. a During the year did the foundation (either directly or indirectly): () Engage in the sale or exchange, or leasing of property with a disqualified person? No () Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person? () Furnish goods, services, or facilities to (or accept them from) a disqualified person? (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? No No No () Transfer any income or assets to a disqualified person (or make any of either available for the benefit or use of a disqualified person)? No (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 after termination of government service, if terminating within 9 days.) No b If any answer is '' to a()'(6), did any of the acts fail to qualify under the exceptions described in Regulations section.494- or in a current notice regarding disaster assistance (see instructions)? Organizations relying on a current notice regarding disaster assistance check here G c Did the foundation engage in a prior year in any of the acts described in a, other than excepted acts, that were not corrected before the first day of the tax year beginning in 6? b c No N/A Taxes on failure to distribute income (section 494) (does not apply for years the foundation was a private operating foundation defined in section 494(j)() or 494(j)()): a At the end of tax year 6, did the foundation have any undistributed income (lines 6d and 6e, Part III) for tax year(s) beginning before 6? If ',' list the years G,,, No b Are there any years listed in a for which the foundation is not applying the provisions of section 494(a)() (relating to incorrect valuation of assets) to the year's undistributed income? (If applying section 494(a)() to all years listed, answer 'No' and attach statement ' see instructions.) c If the provisions of section 494(a)() are being applied to any of the years listed in a, list the years here. b N/A b If ',' did it have excess business holdings in 6 as a result of () any purchase by the foundation or disqualified persons after May 6, 969; () the lapse of the -year period (or longer period approved by the Commissioner under section 494(7)) to dispose of holdings acquired by gift or bequest; or () the lapse of the -, -, or -year first phase holding period? (Use Schedule C, Form 47, to determine if the foundation had excess business holdings in 6.) b N/A 4 a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes? a G,,, a Did the foundation hold more than a % direct or indirect interest in any business enterprise at any time during the year? No b Did the foundation make any investment in a prior year (but after December, 969) that could jeopardize its charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 6? b Form 99-PF (6) BAA TEEAL /6/6

15 Part VII-B Statements Regarding Activities for Which Form 47 May Be Required (continued) Form 99-PF (6) a During the year did the foundation pay or incur any amount to: () Carry on propaganda, or otherwise attempt to influence legislation (section 494(e))? No () Influence the outcome of any specific public election (see section 49); or to carry on, directly or indirectly, any voter registration drive? () Provide a grant to an individual for travel, study, or other similar purposes? No No (4) Provide a grant to an organization other than a charitable, etc., organization described in section 494(4)(A)? (see instructions) No () Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals? No b If any answer is '' to a()'(), did any of the transactions fail to qualify under the exceptions described in Regulations section.494 or in a current notice regarding disaster assistance (see instructions)? Organizations relying on a current notice regarding disaster assistance check here G c If the answer is '' to question a(4), does the foundation claim exemption from the tax because it maintained expenditure responsibility for the grant? N/A... If ',' attach the statement required by Regulations section.494'. Page 6 b No 6 a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? No b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? b If '' to 6b, file Form a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?... No b If ',' did the foundation receive any proceeds or have any net income attributable to the transaction? n/a... 7b Part VIII N/A Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors List all officers, directors, trustees, foundation managers and their compensation (see instructions). Title, and average Compensation Contributions to hours per week employee benefit (If not paid, (a) Name and address devoted to position plans and deferred enter --) compensation (e) Expense account, other allowances SEE STATEMENT, Compensation of five highest-paid employees (other than those included on line ' see instructions). If none, enter '.' Contributions to Title, and average (a) Name and address of each employee (e) Expense account, employee benefit Compensation hours per week paid more than, other allowances plans and deferred devoted to position compensation Total number of other employees paid over, G BAA TEEA6L /6/6 Form 99-PF (6)

16 Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors (continued) Form 99-PF (6) Part VIII Five highest-paid independent contractors for professional services (see instructions). If none, enter '.' (a) Name and address of each person paid more than, Type of service Page 7 Compensation Total number of others receiving over, for professional services G Part I-A Summary of Direct Charitable Activities List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses N/A 4 Part I-B Summary of Program-Related Investments (see instructions) Describe the two largest program-related investments made by the foundation during the tax year on lines and. Amount N/A All other program-related investments. See instructions. Total. Add lines through G Form 99-PF (6) BAA TEEA7L /6/6

17 Page 8 Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.) Form 99-PF (6) Part Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes: a Average monthly fair market value of securities b Average of monthly cash balances c Fair market value of all other assets (see instructions) d Total (add lines a, b, and c) e Reduction claimed for blockage or other factors reported on lines a and c (attach detailed explanation) e Acquisition indebtedness applicable to line assets Subtract line from line d Cash deemed held for charitable activities. Enter -/% of line (for greater amount, see instructions) Net value of noncharitable-use assets. Subtract line 4 from line. Enter here and on Part V, line Minimum investment return. Enter % of line a b c d 4,7,4. 77,. 4,87,77. 4,87,77. 7,46. 4,7,. 7,766. Part I Distributable Amount (see instructions) (Section 494(j)() and (j)() private operating foundations and certain foreign organizations check here G and do not complete this part.) Minimum investment return from Part, line ,766. a Tax on investment income for 6 from Part VI, line a,. b Income tax for 6. (This does not include the tax from Part VI.) b c Add lines a and b Distributable amount before adjustments. Subtract line c from line Recoveries of amounts treated as qualifying distributions Add lines and Deduction from distributable amount (see instructions) Distributable amount as adjusted. Subtract line 6 from line. Enter here and on Part III, line c 4 6 7,.,44. a b 94,,44.,44. Part II Qualifying Distributions (see instructions) Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes: a Expenses, contributions, gifts, etc. ' total from Part I, column, line b Program-related investments ' total from Part I-B Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes..... Amounts set aside for specific charitable projects that satisfy the: a Suitability test (prior IRS approval required) b Cash distribution test (attach the required schedule) Qualifying distributions. Add lines a through b. Enter here and on Part V, line 8, and Part III, line Foundations that qualify under section 494(e) for the reduced rate of tax on net investment income. Enter % of Part I, line 7b (see instructions) Adjusted qualifying distributions. Subtract line from line a b 4 94, 6,. 9,78. Note: The amount on line 6 will be used in Part V, column, in subsequent years when calculating whether the foundation qualifies for the section 494(e) reduction of tax in those years. BAA Form 99-PF (6) TEEA8L /6/6

18 Form 99-PF (6) Page 9 Part III Undistributed Income (see instructions) (a) Corpus Distributable amount for 6 from Part I, line Undistributed income, if any, as of the end of 6: a Enter amount for only b Total for prior years:,, Years prior to 6,44. Excess distributions carryover, if any, to 6: a From b From ,8. c From d From e From f Total of lines a through e Qualifying distributions for 6 from Part II, line 4: G 94, a Applied to, but not more than line a...,8. b Applied to undistributed income of prior years (Election required ' see instructions) c Treated as distributions out of corpus (Election required ' see instructions) d Applied to 6 distributable amount e Remaining amount distributed out of corpus. Excess distributions carryover applied to (If an amount appears in column, the same amount must be shown in column (a).) 6 Enter the net total of each column as indicated below: a Corpus. Add lines f, 4c, and 4e. Subtract line ,98. b Prior years' undistributed income. Subtract line 4b from line b c Enter the amount of prior years' undistributed income for which a notice of deficiency has been issued, or on which the section 494(a) tax has been previously assessed d Subtract line 6c from line 6b. Taxable amount ' see instructions e Undistributed income for. Subtract line 4a from line a. Taxable amount ' see instructions f Undistributed income for 6. Subtract lines 4d and from line. This amount must be distributed in Amounts treated as distributions out of corpus to satisfy requirements imposed by section 7()(F) or 494(g)() (Election may be required ' see instructions) Excess distributions carryover from not applied on line or line 7 (see instructions). 9 Excess distributions carryover to 7. Subtract lines 7 and 8 from line 6a Analysis of line 9:,44.,98.,98. a Excess from..... b Excess from..... c Excess from d Excess from..... e Excess from BAA,98. Form 99-PF (6) TEEA9L /6/6

19 Private Operating Foundations (see instructions and Part VII-A, question 9) Form 99-PF (6) Part IV a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 6, enter the date of the ruling G 494(j)() or b Check box to indicate whether the foundation is a private operating foundation described in section a Enter the lesser of the adjusted net Tax year Prior years income from Part I or the minimum (a) 6 4 investment return from Part for each year listed b 8% of line a c Qualifying distributions from Part II, line 4 for each year listed Page N/A 494(j)() (e) Total d Amounts included in line c not used directly for active conduct of exempt activities e Qualifying distributions made directly for active conduct of exempt activities. Subtract line d from line c Complete a, b, or c for the alternative test relied upon: a 'Assets' alternative test ' enter: () Value of all assets () Value of assets qualifying under section 494(j)()(B)(i) b 'Endowment' alternative test ' enter / of minimum investment return shown in Part, line 6 for each year listed c 'Support' alternative test ' enter: () Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section (a)()), or royalties) () Support from general public and or more exempt organizations as provided in section 494(j)()(B)(iii) () Largest amount of support from an exempt organization (4) Gross investment income Part V Supplementary Information (Complete this part only if the foundation had, or more in assets at any time during the year ' see instructions.) Information Regarding Foundation Managers: a List any managers of the foundation who have contributed more than % of the total contributions received by the foundation before the close of any tax year (but only if they have contributed more than,). (See section 7().) b List any managers of the foundation who own % 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 % or greater interest. Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs: Check here G if the foundation only makes contributions to preselected charitable 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 a, b, c, and d. a The name, address, and telephone number or address of the person to whom applications should be addressed: b The form in which applications should be submitted and information and materials they should include: c Any submission deadlines: d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors: BAA TEEAL /6/6 Form 99-PF (6)

20 Part V Supplementary Information (continued) Form 99-PF (6) Grants and Contributions Paid During the Year or Approved for Future Payment If recipient is an individual, Recipient show any relationship to Foundation status of any foundation manager Name and address (home or business) or substantial contributor recipient a Paid during the year Purpose of grant or contribution Page Amount SEE STATEMENT Total b Approved for future payment G a Total G b BAA TEEAL /6/6 94, Form 99-PF (6)

21 Part VI-A Analysis of Income-Producing Activities Form 99-PF (6) Enter gross amounts unless otherwise indicated. Program service revenue: Unrelated business income (a) Business code Amount Excluded by section,, or 4 Exclusion code Amount Page (e) Related or exempt function income (See instructions.) a b c d e f g Fees and contracts from government agencies... Membership dues and assessments Interest on savings and temporary cash investments Dividends and interest from securities Net rental income or (loss) from real estate: a Debt-financed property b Not debt-financed property Net rental income or (loss) from personal property Other investment income ,69. Gain or (loss) from sales of assets other than inventory.... Net income or (loss) from special events Gross profit or (loss) from sales of inventory ,96. Other revenue: a b CAPITAL GAIN DISTRIBUTION 8,98. c d e Subtotal. Add columns,, and (e) Total. Add line, columns,, and (e) (See worksheet in line instructions to verify calculations.) 4,. 4,. Part VI-B Relationship of Activities to the Accomplishment of Exempt Purposes Line No. I Explain below how each activity for which income is reported in column (e) of Part VI-A contributed importantly to the accomplishment of the foundation's exempt purposes (other than by providing funds for such purposes). (See instructions.) N/A BAA TEEAL /6/6 Form 99-PF (6)