For calendar year 2012 or other tax year beginning See separate instructions. Check box if name changed and see instructions.)

Transcription

1 990-T Department of the Treasury nternal Revenue Service Exempt Organization Business ncome Tax Return (and proxy tax under section 60(e)) 07/01, 2012, and For calendar year 2012 or other tax year beginning 06/0, ending See separate instructions. 501( C )( 408(e) 408A D Employer identification number Check box if name changed and see instructions.) FLORDA STATE UNVERSTY FOUNDATON, NC. Print or 220(e) Type ) 50(a) Number, street, and room or suite no. f a P.O. box, see instructions. E Unrelated business activity codes NNOVATON PARK 2010 LEVY AVE BULDNG B, SUTE 00 (see instructions.) City or town, state, and ZP code 529(a) C Book value of all assets at end of year 550,92,086. TALLAHASSEE, FL 206 F Group exemption number (see instructions) G Check organization type (c) corporation H Describe the organization's primary unrelated business activity. 501(c) trust 401(a) trust NVESTMENT NCOME During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? f "," enter the name and identifying number of the parent corporation. LAURA F. HENSLEY Unrelated Trade or Business ncome J The books are in care of Part À¾µ Open to Public nspection for 501(c) Organizations Only (Employees' trust, see instructions.) B Exempt under section Name of organization ( Check box if address changed A OMB Other trust m m m m m m m (850) Telephone number (B) Expenses (C) Net (A) ncome 1 a Gross receipts or sales b m m m m m m m m m m m mmmmmmmmmm mmmmmmmm mm mmmmmmmmmmmmmm -121, ,575. ATCH 1 mmmmmmmmmmmmmmmmm mmmmmmm mmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmm mmmmmmm 41,096. 4,454. 6,642. mmmmmmmmmmmmmm m m m m m m -80,479. 4, ,9. mmmmmmmmmmmmm Deductions t Taken Elsewhere (see instructions for limitations on deductions) (except for contributions, Less returns and allowances c Balance 1c 2 Cost of goods sold (Schedule A, line 7) Gross profit. Subtract line 2 from line 1c 4 a Capital gain net income (attach Schedule D) 4a 2 b Net gain (loss) ( 4797, Part, line 17) (attach 4797) 4b c Capital loss deduction for trusts 4c 5 ncome (loss) from partnerships and S corporations (attach statement) 5 6 Rent income (Schedule C) 6 7 Unrelated debt-financed income (Schedule E) 7 8 nterest, annuities, royalties, and rents from controlled organizations (Schedule F) 9 8 nvestment income of a section 501(c)(7), (9), or (17) organization (Schedule G) 9 10 Exploited exempt activity income (Schedule ) Advertising income (Schedule J) Other income (see instructions; attach statement) 12 1 Total. Combine lines through 12 1 Part deductions must be directly connected with the unrelated business income) mmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm m m m m m m m m m m m m m m m m m m m m mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mmmmmmmmmmmmmmmmmmmmmmmm mmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmm mmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmm mmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm 14 Compensation of officers, directors, and trustees (Schedule K) Salaries and wages Repairs and maintenance Bad debts nterest (attach statement) Taxes and licenses Charitable contributions (see instructions for limitation rules) 21 Depreciation (attach 4562) Less depreciation claimed on Schedule A and elsewhere on return 22a 2 Depletion 24 Contributions to deferred compensation plans Employee benefit programs Excess exempt expenses (Schedule ) Excess readership costs (Schedule J) Other deductions (attach statement) Total deductions. Add lines 14 through Unrelated business taxable income before net operating loss deduction. Subtract line 29 from line Net operating loss deduction (limited to the amount on line 0) 1 2 Unrelated business taxable income before specific deduction. Subtract line 1 from line 0 2 Specific deduction (generally $1,000, but see line instructions for exceptions) 4 Unrelated business taxable income. Subtract line from line 2. f line is greater than line 2, enter the smaller of zero or line 2 For Paperwork Reduction Act tice, see instructions. 2E L160 C b , , , , ,855. V T (2012)

2 8868 Application for Extension of Time To File an Exempt Organization Return (Rev. January 201) Department of the Treasury nternal Revenue Service File a separate application for each return. OMB mmmmmmmmmmmmmmmmm f you are filing for an Automatic -Month Extension, complete only Part and check this box f you are filing for an Additional (t Automatic) -Month Extension, complete only Part (on page 2 of this form). Do not complete Part unless you have already been granted an automatic -month extension on a previously filed Electronic filing (e-file). You can electronically file 8868 if you need a -month automatic extension of time to file (6 months for a corporation required to file 990-T), or an additional (not automatic) -month extension of time. You can electronically file 8868 to request an extension of time to file any of the forms listed in Part or Part with the exception of 8870, nformation Return for Transfers Associated W ith Certain Personal Benefit Contracts, which must be sent to the RS in paper format (see instructions). For more details on the electronic filing of this form, visit and click on e-file for Charities & nprofits. Part Automatic -Month Extension of Time. Only submit original (no copies needed). A corporation required to file 990-T and requesting an automatic 6-month extension - check this box and complete Part only All other corporations (including 1120-C filers), partnerships, REMCs, and trusts must use 7004 to request an extension of time Enter filer's identifying number, see instructions to file income tax returns. mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm Name of exempt organization or other filer, see instructions. Type or print File by the due date for filing your return. See instructions. Employer identification number (EN) or FLORDA STATE UNVERSTY FOUNDATON, NC Number, street, and room or suite no. f a P.O. box, see instructions. Social security number (SSN) NNOVATON PARK, 2010 LEVY AVENUE City, town or post office, state, and ZP code. For a foreign address, see instructions. TALLAHASSEE, FL 206 Enter the Return code for the return that this application is for (file a separate application for each return) Application s For Return Code 990 or 990-EZ 990-BL (individual) 990-PF 990-T (sec. 401(a) or 408(a) trust) 990-T (trust other than above) The books are in the care of mmmmmmmmmmmm Application s For 0 7 Return Code 990-T (corporation) 1041-A LAURA F. HENSLEY Telephone. FA. f the organization does not have an office or place of business in the United States, check this box f this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN). f this is for the whole group, check this box. f it is for part of the group, check this box and attach a list with the names and ENs of all members the extension is for. 1 request an automatic -month (6 months for a corporation required to file 990-T) extension of time 05/15, 20 14, to file the exempt organization return for the organization named above. The extension is until for the organization's return for: calendar year 20 or tax year beginning 07/01, 20 12, and ending 06/0, mmmmmmmmmmmmmmm mmmmmmm mmmmmm 2 f the tax year entered in line 1 is for less than 12 months, check reason: Change in accounting period nitial return Final return a f this application is for 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits. See instructions. a $ b f this application is for 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made. nclude any prior year overpayment allowed as a credit. b $ c Balance due. Subtract line b from line a. nclude your payment with this form, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions. c $ 7, ,150. Caution. f you are going to make an electronic fund withdrawal with this 8868, see 845-EO and 8879-EO for payment instructions. For Privacy Act and Paperwork Reduction Act tice, see nstructions. 2F V 12-7F (Rev )

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4 FLORDA STATE UNVERSTY FOUNDATON, NC T (2012) Page Schedule C - Rent ncome (From Real Property and Personal Property Leased With Real Property) (see instructions) 1. Description of property 2. Rent received or accrued (a) From personal property (if the percentage of rent for personal property is more than 10 but not more than 50) (b) From real and personal property (if the percentage of rent for personal property exceeds 50 or if the rent is based on profit or income) (a) Deductions directly connected with the income in columns 2(a) and 2(b) (attach statement) Total Total (b) Total deductions. Enter here and on page 1, Part, line 6, column (B) m m m m m (c) Total income. Add totals of columns 2(a) and 2(b). Enter here and on page 1, Part, line 6, column (A) Schedule E - Unrelated Debt-Financed ncome (see instructions) 1. Description of debt-financed property. Deductions directly connected with or allocable to debt-financed property (a) Straight line depreciation (b) Other deductions (attach statement) (attach statement) 2. Gross income from or allocable to debt-financed property 4. Amount of average acquisition debt on or allocable to debt-financed property (attach statement) 5. Average adjusted basis of or allocable to debt-financed property (attach statement) 6. Column 4 divided by column 5 Totals 7. Gross income reportable (column 2 x column 6) 8. Allocable deductions (column 6 x total of columns (a) and (b)) Enter here and on page 1, Part, line 7, column (A). Enter here and on page 1, Part, line 7, column (B). m m m m m m m m m m m m m m m m m m m m m m m m m mm mm mm mm mm mm mm mm mm mm mm mm mm mm m m m m m m m m m m m m m Total dividends-received deductions included in column 8 Schedule F - nterest, Annuities, Royalties, and Rents From Controlled Organizations (see instructions) Exempt Controlled Organizations 1. Name of controlled organization 2. Employer identification number. Net unrelated income (loss) (see instructions) 4. Total of specified payments made 5. Part of column 4 that is included in the controlling organization's gross income 6. Deductions directly connected with income in column 5 nexempt Controlled Organizations 7. Taxable ncome 8. Net unrelated income (loss) (see instructions) 9. Total of specified payments made 10. Part of column 9 that is included in the controlling organization's gross income 11. Deductions directly connected with income in column 10 Add columns 5 and 10. Enter here and on page 1, Part, line 8, column (A). Add columns 6 and 11. Enter here and on page 1, Part, line 8, column (B). Totals mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm 2E L160 C682 V T (2012)

5 FLORDA STATE UNVERSTY FOUNDATON, NC Schedule G - nvestment ncome of a Section 501(c)(7), (9), or (17) Organization (see instructions) 990-T (2012) 1. Description of income. Deductions directly connected (attach statement) 2. Amount of income 4. Set-asides (attach statement) Page 4 5. Total deductions and set-asides (col. plus col. 4) Totals m m m m m m m m m m m m Enter here and on page 1, Part, line 9, column (A). Enter here and on page 1, Part, line 9, column (B). Schedule - Exploited Exempt Activity ncome, Other Than Advertising ncome (see instructions) 1. Description of exploited activity 2. Gross unrelated business income from trade or business. Expenses directly connected with production of unrelated business income Enter here and on page 1, Part, line 10, col. (A). Enter here and on page 1, Part, line 10, col. (B). 4. Net income (loss) from unrelated trade or business (column 2 minus column ). f a gain, compute cols. 5 through Gross income from activity that is not unrelated business income 6. Expenses attributable to column 5 7. Excess exempt expenses (column 6 minus column 5, but not more than column 4). Totals m m m m m m m m m m m m Enter here and on page 1, Part, line 26. Schedule J - Advertising ncome (see instructions) ncome From Periodicals Reported on a Consolidated Basis Part 2. Gross advertising income 1. Name of periodical. Direct advertising costs 4. Advertising gain or (loss) (col. 2 minus col. ). f a gain, compute cols. 5 through Circulation income 6. Readership costs 7. Excess readership costs (column 6 minus column 5, but not more than column 4). Totals (carry to Part, line (5)) Part mm ncome From Periodicals Reported on a Separate Basis (For each periodical listed in Part, fill in columns 2 through 7 on a line-by-line basis.) 1. Name of periodical 2. Gross advertising income 41,096. ATCH 2. Direct advertising costs 4. Advertising gain or (loss) (col. 2 minus col. ). f a gain, compute cols. 5 through 7. 4, Circulation income 6. Readership costs 6, Excess readership costs (column 6 minus column 5, but not more than column 4). 17, ,922. Totals from Part m m m m Enter here and on page 1, Part, line 11, col. (A). Enter here and on page 1, Part line 11, col. (B). Enter here and on page 1, Part, line ,096. 4,454. Schedule K - Compensation of Officers, Directors, and Trustees (see instructions) Totals, Part (lines 1-5) 1. Name 2. Title 17,922.. Percent of time devoted to business 4. Compensation attributable to unrelated business m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Total. Enter here and on page 1, Part, line 14 2E L160 C682 V T (2012)

6 FLORDA STATE UNVERSTY FOUNDATON, NC ATTACHMENT 1 FORM 990T - LNE 5 -NCOME (LOSS) FROM PARTNERSHPS COMMONFUND CAPTAL NTERNATONAL PARTNERS V, LP COMMONFUND CAPTAL NATURAL RESOURCES PARTNERS V -8,668. COMMONFUND CAPTAL PRVATE EQUTY PARTNERS V, LP -9,279. COMMONFUND CAPTAL VENTURES PARTNERS V, LP DAVDSON KEMPER NSTTUTONAL PARTNERS, LP 19. METROPOLTAN REAL ESTATE PARTNERS V, LP PARK STREET CAPTAL PRVATE EQUTY FUND, LP,287. THE VARDE FUND (B) (FEEDER), LP 52. ENCAP FLATROCK MDSTREAM FUND, LP -49,85. KAYNE ANDERSON ENERGY FUND V, LP -11,126. METROPOLTAN REAL ESTATE PARTNERS V, LP 16,187. WESTBROOK REAL ESTATE FUND, LP -1,67. NCOME (LOSS) FROM PARTNERSHPS -121,575. 6L160 C682 V

7 FLORDA STATE UNVERSTY FOUNDATON, NC ATTACHMENT 2 SCHEDULE J - PART, ADVERTSNG NCOME REPORTED ON A SEPARATE BASS GROSS DRECT ECESS 1. ADVERTSNG ADVERTSNG ADVERTSNG CRCULATON READERSHP READERSHP NAME OF PERODCAL NCOME COSTS GAN OR LOSS NCOME COSTS COSTS STATE NEWSLETTER 41,096. 4,454. 6, , ,922. COLUMN TOTALS 41,096. 4,454. 6, , ,922. 6L160 C682 V ATTACHMENT 2

8 Florida State University Foundation, nc, EN: FYE: 6/0/201 Net Operating Loss Carryover T, Part, Line 1 ============================================== Amount Carryover Available NOL Carryover Amount Amount Utilized For Carryover Current Year (ncome) Loss FYE June 0, 201 (102,855) - (102,855) NOL carryforward to 6/0/2014 (102,855) (102,855)

9 FLORDA STATE UNVERSTY FOUNDATON, NC. EN: FORM 990-T, PART V, LNE 2 The Organization had an interest in, or signature or other authority over financial accounts in the following countries: Bermuda Canada Cayman slands Hong Kong reland

10 9 26 (Rev. December 2011) OMB Attach to your income tax return for the year of the transfer or distribution. Attachment Sequence Department of the Treasury nternal Revenue Service Part Return by a U.S. Transferor of Property to a Foreign Corporation U.S. Transferor nformation (see instructions) Name of transferor dentifying number (see instructions) FLORDA STATE UNVERSTY FOUNDATON, NC f the transferor was a corporation, complete questions 1a through 1d. a f the transfer was a section 61(a) or (b) transfer, was the transferor controlled (under section 68(c)) by 5 or fewer domestic corporations? b Did the transferor remain in existence after the transfer? mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmm f not, list the controlling shareholder(s) and their identifying number(s): Controlling shareholder dentifying number c f the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? f not, list the name and employer identification number (EN) of the parent corporation: mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm Name of parent corporation d Have basis adjustments under section 67(a)(5) been made? 2 EN of parent corporation mmmmmmmmmmmmmmmmmmmmmmmm f the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 67), complete questions 2a through 2d. a List the name and EN of the transferor's partnership: Name of partnership DAVDSON KEMPNER NSTTUTONAL PARTNERS L.P. EN of partnership mmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm Transferee Foreign Corporation nformation (see instructions) b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? c s the partner disposing of its entire interest in the partnership? d s the partner disposing of an interest in a limited partnership that is regularly traded on an established securities market? Part Name of transferee (foreign corporation) 4 dentifying number, if any BKM HOLDNGS (CAYMAN) LTD. 5 N/A Address (including country) 190 ELGN AVENUE, GEORGE TOWN, GRAND CAYMAN, KY CAYMAN SLANDS 6 Country code of country of incorporation or organization (see instructions) CJ 7 Foreign law characterization (see instructions) CORPORATON 8 s the transferee foreign corporation a controlled foreign corporation? For Paperwork Reduction Act tice, see separate instructions mmmmmmmmmmmmmmmmm 926 (Rev )

11 Page (Rev ) Part nformation Regarding Transfer of Property (see instructions) Type of property Cash (a) Date of transfer 12/20/2012 (b) Description of property (c) Fair market value on date of transfer (d) Cost or other basis (e) Gain recognized on transfer 20,26 Stock and securities nstallment obligations, account receivables or similar property Foreign currency or other property denominated in foreign currency nventory Assets subject to depreciation recapture (see Temp. Regs. sec. 1.67(a)-4T(b)) Tangible property used in trade or business not listed under another category ntangible property Property to be leased (as described in final and temp. Regs. sec. 1.67(a)-4(c)) Property to be sold (as described in Temp. Regs. sec. 1.67(a)-4T(d)) Transfers of oil and gas working interests (as described in Temp. Regs. sec. 1.67(a)-4T(e)) Other property Supplemental nformation Required To Be Reported (see instructions): N/A (Rev )

12 926 (Rev ) Part V Page Additional nformation Regarding Transfer of Property (see instructions) Enter the transferor's interest in the foreign transferee corporation before and after the transfer: 9 (a) Before VAR (b) After VAR Type of nonrecognition transaction (see instructions) 10 RC SECTON 51 ndicate whether any transfer reported in Part is subject to any of the following: Gain recognition under section 904(f) Gain recognition under section 904(f)(5)(F) Recapture under section 150(d) Exchange gain under section 987 mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm 12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? 1 ndicate whether the transferor was required to recognize income under final and temporary Regulations sections 1.67(a)-4 through 1.67(a)-6 for any of the following: Tainted property Depreciation recapture Branch loss recapture Any other income recognition provision contained in the above-referenced regulations mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmm Did the transferor transfer assets which qualify for the trade or business exception under section 67(a)? 1 5 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section 1.67(a)-1T(d)(5)(iii)? mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm 1 7 a Was intangible property (within the meaning of section 96(h)(B)) transferred as a result of the transaction? 11 a b c d a b c d 14 mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm b f the answer to line 15a is "," enter the amount of foreign goodwill or going concern value N/A transferred $ Was cash the only property transferred? 16 mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm b f "," describe the nature of the rights to the intangible property that was transferred as a result of the transaction: N/A (Rev )

13 9 26 (Rev. December 2011) OMB Attach to your income tax return for the year of the transfer or distribution. Attachment Sequence Department of the Treasury nternal Revenue Service Part Return by a U.S. Transferor of Property to a Foreign Corporation U.S. Transferor nformation (see instructions) Name of transferor dentifying number (see instructions) FLORDA STATE UNVERSTY FOUNDATON, NC f the transferor was a corporation, complete questions 1a through 1d. a f the transfer was a section 61(a) or (b) transfer, was the transferor controlled (under section 68(c)) by 5 or fewer domestic corporations? b Did the transferor remain in existence after the transfer? mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmm f not, list the controlling shareholder(s) and their identifying number(s): Controlling shareholder dentifying number c f the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? f not, list the name and employer identification number (EN) of the parent corporation: mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm Name of parent corporation d Have basis adjustments under section 67(a)(5) been made? 2 EN of parent corporation mmmmmmmmmmmmmmmmmmmmmmmm f the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 67), complete questions 2a through 2d. a List the name and EN of the transferor's partnership: Name of partnership METROPOLTAN REAL ESTATE PARTNERS V, LP EN of partnership mmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm Transferee Foreign Corporation nformation (see instructions) b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? c s the partner disposing of its entire interest in the partnership? d s the partner disposing of an interest in a limited partnership that is regularly traded on an established securities market? Part Name of transferee (foreign corporation) 4 dentifying number, if any BLACKSTONE REAL ESTATE SPECAL STUATONS (ALBERTA) FUND L.P. 5 Address (including country) C/O THE BLACKSTONE GROUP 45 PARK AVENUE NEW YORK, NY Country code of country of incorporation or organization (see instructions) CA 7 Foreign law characterization (see instructions) PARTNERSHP 8 s the transferee foreign corporation a controlled foreign corporation? For Paperwork Reduction Act tice, see separate instructions mmmmmmmmmmmmmmmmm 926 (Rev )

14 Page (Rev ) Part nformation Regarding Transfer of Property (see instructions) Type of property Cash (a) Date of transfer VAROUS (b) Description of property (c) Fair market value on date of transfer (d) Cost or other basis (e) Gain recognized on transfer 100,029 Stock and securities nstallment obligations, account receivables or similar property Foreign currency or other property denominated in foreign currency nventory Assets subject to depreciation recapture (see Temp. Regs. sec. 1.67(a)-4T(b)) Tangible property used in trade or business not listed under another category ntangible property Property to be leased (as described in final and temp. Regs. sec. 1.67(a)-4(c)) Property to be sold (as described in Temp. Regs. sec. 1.67(a)-4T(d)) Transfers of oil and gas working interests (as described in Temp. Regs. sec. 1.67(a)-4T(e)) Other property Supplemental nformation Required To Be Reported (see instructions): N/A (Rev )

15 926 (Rev ) Part V Page Additional nformation Regarding Transfer of Property (see instructions) Enter the transferor's interest in the foreign transferee corporation before and after the transfer: 9 (a) Before (b) After Type of nonrecognition transaction (see instructions) 10 RC SECTON 51 ndicate whether any transfer reported in Part is subject to any of the following: Gain recognition under section 904(f) Gain recognition under section 904(f)(5)(F) Recapture under section 150(d) Exchange gain under section 987 mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm 12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? 1 ndicate whether the transferor was required to recognize income under final and temporary Regulations sections 1.67(a)-4 through 1.67(a)-6 for any of the following: Tainted property Depreciation recapture Branch loss recapture Any other income recognition provision contained in the above-referenced regulations mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmm Did the transferor transfer assets which qualify for the trade or business exception under section 67(a)? 1 5 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section 1.67(a)-1T(d)(5)(iii)? mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm 1 7 a Was intangible property (within the meaning of section 96(h)(B)) transferred as a result of the transaction? 11 a b c d a b c d 14 mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm b f the answer to line 15a is "," enter the amount of foreign goodwill or going concern value N/A transferred $ Was cash the only property transferred? 16 mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm b f "," describe the nature of the rights to the intangible property that was transferred as a result of the transaction: N/A (Rev )