Return of Private Foundation. or Section 4947(a)(1) Trust Treated as Private Foundation NOV 1, 2015 OCT 31, 2016

Transcription

1 Form or Section 7(1) Trust Treated as Private Foundation Department of the Treasury Do not enter social security numers on this form as it may e made pulic. Internal Revenue Service Information aout Form 0-PF and its separate instructions is at For calendar year 01 or tax year eginning, and ending Name of foundation A Employer identification numer CHARLES AND JOAN HERMANOWSKI FAMILY FOUNDATION, INC Numer and street (or P.O. ox numer if mail is not delivered to street address) Room/suite B Telephone numer P.O. BO Check if the foundation is not required to attach Sch. B Interest on savings and temporary cash investments ~~~~~~~~~~~~~~ Dividends and interest from securities~~~~~ OMB Open to Pulic Inspection City or town, state or province, country, and ZIP or foreign postal code C If exemption application is pending, check here~ G Check all that apply: Initial return Initial return of a former pulic charity D 1. Foreign organizations, check here ~~ Final return Amended return. Foreign organizations meeting the 8% test, Address change Name change check here and attach computation ~~~~ H Check type of organization: Section 01() exempt private foundation E If private foundation status was terminated Section 7(1) nonexempt charitale trust Other taxale private foundation under section 07()(1)(A), check here ~ I Fair market value of all assets at end of year J Accounting method: Cash Accrual F If the foundation is in a 60-month termination (from Part II, col., line 16) Other (specify) under section 07()(1)(B), check here ~ $ 1,,. (Part I, column must e on cash asis.) Part I Analysis of Revenue and Expenses Revenue and () Net investment Adjusted net Disursements (The total of amounts in columns (),, and may not for charitale purposes necessarily equal the amounts in column.) expenses per ooks income income (cash asis only) 1 Contriutions, gifts, grants, etc., received ~~~,0 N/A Revenue Operating and Administrative Expenses Return of Private Foundation 0-PF 01 BOCA RATON, FL 81 a Gross rents ~~~~~~~~~~~~~~~~ Net rental income or (loss) 6a Net gain or (loss) from sale of assets not on line 10 ~~ Gross sales price for all assets on line 6a ~~ 88,1. 7 Capital gain net income (from Part IV, line ) ~~~~~ 8 Net short-term capital gain ~~~~~~~~~ Income modifications~~~~~~~~~~~~ Gross sales less returns 10a and allowances ~~~~ 11 Less: Cost of goods sold ~ c Gross profit or (loss) ~~~~~~~~~~~~ 1 Total. Add lines 1 through Compensation of officers, directors, trustees, etc. ~~~ 16a Legal fees~~~~~~~~~~~~~~~~~ Accounting fees ~~~~~~~~~~~~~~ STMT Other income ~~~~~~~~~~~~~~~ Other employee salaries and wages~~~~~~ Pension plans, employee enefits c Other professional fees ~~~~~~~~~~~ Total operating and administrative expenses. Add lines 1 through ~~~~~ Total expenses and disursements. ~~~~~~ Interest ~~~~~~~~~~~~~~~~~~ Taxes~~~~~~~~~~~~~~~~~~~ Depreciation and depletion ~~~~~~~~~ Occupancy ~~~~~~~~~~~~~~~~ Travel, conferences, and meetings ~~~~~~ Printing and pulications ~~~~~~~~~~ Other expenses ~~~~~~~~~~~~~~ STMT Contriutions, gifts, grants paid ~~~~~~~ Add lines and NOV 1, 01 OCT 1, 016 1,17. 1,17.,.,. -6,11. STATEMENT 1 STATEMENT 1,7 STATEMENT 8,. 7,66.,0,6 8,86. 8,86. 1,16. 11,6. 100,00 100,00 11,16. 11,6. 100,00 7 Sutract line 6 from line 1: a Excess of revenue over expenses and disursements ~ -,70. Net investment income (if negative, enter -0-) ~~~ 6,0 c Adjusted net income (if negative, enter -0-) N/A LHA For Paperwork Reduction Act tice, see instructions. Form 0-PF (01) 1

2 Form 0-PF (01) Assets Liailities Net Assets or Fund Balances Part II Other notes and loans receivale ~~~~~~~~ 8 Less: accumulated depreciation ~~~~~~~~ Attached schedules and amounts in the description column should e for end-of-year amounts only. Prepaid expenses and deferred charges ~~~~~~~~~~~~~ 10a Investments - U.S. and state government oligations ~~~~~~~ Investments - corporate stock ~~~~~~~~~~~~~~~~~ STMT 6 c Investments - corporate onds ~~~~~~~~~~~~~~~~~ STMT 7 11 Investments - land, uildings, and equipment: asis ~~ Less: accumulated depreciation ~~~~~~~~ 1 Investments - mortgage loans ~~~~~~~~~~~~~~~~~ 1 Investments - other ~~~~~~~~~~~~~~~~~~~~~~ STMT Total assets (to e completed y all filers - see the Loans from officers, directors, trustees, and other disqualified persons Total liailities (add lines 17 through ) Balance Sheets Cash - non-interest-earing Savings and temporary cash investments Accounts receivale Less: allowance for doutful accounts Pledges receivale Less: allowance for doutful accounts Foundations that follow SFAS 117, check here and complete lines through 6 and lines 0 and 1. and complete lines 7 through 1. ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~ Grants receivale ~~~~~~~~~~~~~~~~~~~~~~~ Receivales due from officers, directors, trustees, and other disqualified persons ~~~~~~~~~~~~~~~~~~~~~~ Less: allowance for doutful accounts Inventories for sale or use ~~~~~~~~~~~~~~~~~~~ Land, uildings, and equipment: asis Other assets (descrie ) instructions. Also, see page 1, item I) Accounts payale and accrued expenses ~~~~~~~~~~~~~ Grants payale ~~~~~~~~~~~~~~~~~~~~~~~~ Deferred revenue ~~~~~~~~~~~~~~~~~~~~~~~ ~~~~ Mortgages and other notes payale ~~~~~~~~~~~~~~~ Other liailities (descrie Unrestricted CHARLES AND JOAN HERMANOWSKI FAMILY FOUNDATION, INC ~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~ Temporarily restricted ~~~~~~~~~~~~~~~~~~~~~ Permanently restricted~~~~~~~~~~~~~~~~~~~~~ Foundations that do not follow SFAS 117, check here ~ Capital stock, trust principal, or current funds ~~~~~~~~~~~ Paid-in or capital surplus, or land, ldg., and equipment fund ~~~~ Retained earnings, accumulated income, endowment, or other funds~ Total net assets or fund alances~~~~~~~~~~~~~~~~ ) Beginning of year End of year Page Book Value () Book Value Fair Market Value,8. 0,6. 0,6.,107. 7,06. 1,0, ,17 8,06. 88,68. 60, , ,8. 1,70,1. 1,1,7. 1,,. 1,70,1. 1,1,7. 1,70,1. 1,1,7. 1 Part III Total liailities and net assets/fund alances Analysis of Changes in Net Assets or Fund Balances 1,70,1. 1,1,7. 1 Total net assets or fund alances at eginning of year - Part II, column, line 0 (must agree with end-of-year figure reported on prior year s return) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1 1,70,1. Enter amount from Part I, line 7a ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ -,70. Other increases not included in line (itemize) Add lines 1,, and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1,1,617. Decreases not included in line (itemize) PRIOR PERIOD BASIS ADJUSTMENT. 6 Total net assets or fund alances at end of year (line minus line ) - Part II, column (), line 0 6 1,1,7. Form 0-PF (01)

3 CHARLES AND JOAN HERMANOWSKI Form 0-PF (01) FAMILY FOUNDATION, INC Page Part IV Capital Gains and Losses for Tax on Investment Income List and descrie the kind(s) of property sold (e.g., real estate, () How acquired Date acquired Date sold P - Purchase -story rick warehouse; or common stock, 00 shs. MLC Co.) D - Donation (mo., day, yr.) (mo., day, yr.) 1a NORTHERN TRUST - PUBLICLY TRADED SECURITIES CAPITAL GAINS DIVIDENDS P c d e a c d (e) Gross sales price (f) Depreciation allowed (g) Cost or other asis (h) Gain or (loss) (or allowale) plus expense of sale (e) plus (f) minus (g) 8,.,8. -11,7.,16.,16. e Complete only for assets showing gain in column (h) and owned y the foundation on 1/1/6 (l) Gains (Col. (h) gain minus (j) Adjusted asis (k) Excess of col. (i) col. (k), ut not less than -0-) or (i) F.M.V. as of 1/1/6 Losses (from col. (h)) as of 1/1/6 over col. (j), if any a -11,7.,16. c d e If gain, also enter in Part I, line 7 Capital gain net income or (net capital loss) If (loss), enter -0- in Part I, line 7 ~~~~~~ Net short-term capital gain or (loss) as defined in sections 1() and (6): If gain, also enter in Part I, line 8, column. If (loss), enter -0- in Part I, line 8 Part V Qualification Under Section 0(e) for Reduced Tax on Net Investment Income (For optional use y domestic private foundations suject to the section 0 tax on net investment income.) If section 0() applies, leave this part lank. Was the foundation liale for the section tax on the distriutale amount of any year in the ase period? If "," the foundation does not qualify under section 0(e). Do not complete this part. 1 Enter the appropriate amount in each column for each year; see the instructions efore making any entries. () Base period years Calendar year (or tax year eginning in) Adjusted qualifying distriutions Net value of noncharitale-use assets rqs Total of line 1, column ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Average distriution ratio for the -year ase period - divide the total on line y, or y the numer of years the foundation has een in existence if less than years~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ pmo pmo ~~~~~~~~~~~~~~~~ N/A -6,11. Distriution ratio (col. () divided y col. ) 10,17.,100, ,00,167, ,71.,0, ,.,0, ,8.,06, Enter the net value of noncharitale-use assets for 01 from Part, line ~~~~~~~~~~~~~~~~~~~~~ 1,77,78. Multiply line y line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~,. 6 Enter 1% of net investment income (1% of Part I, line 7) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines and 6 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7 6,00. 8 Enter qualifying distriutions from Part II, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 8 100,00 If line 8 is equal to or greater than line 7, check the ox in Part VI, line 1, and complete that part using a 1% tax rate. See the Part VI instructions Form 0-PF (01)

4 CHARLES AND JOAN HERMANOWSKI Form 0-PF (01) FAMILY FOUNDATION, INC Page Part VI Excise Tax Based on Investment Income (Section 0, 0(), 0(e), or 8 - see instructions) 1a Exempt operating foundations descried in section 0(), check here and enter "N/A" on line 1. Date of ruling or determination letter: (attach copy of letter if necessary-see instructions) Domestic foundations that meet the section 0(e) requirements in Part V, check here and enter 1% c All other domestic foundations enter % of line 7. Exempt foreign organizations enter % of Part I, line 1, col. (). Tax ased on investment income. Sutract line from line. If zero or less, enter -0- ~~~~~~~~~~~~~~~~~ a 01 estimated tax payments and 01 overpayment credited to 01 ~~~~~~~~ Exempt foreign organizations - tax withheld at source ~~~~~~~~~~~~~~~~ d Backup withholding erroneously withheld ~~~~~~~~~~~~~~~~~~~~~ Enter any penalty for underpayment of estimated tax. Check here if Form 0 is attached ~~~~~~~~~~~~~ 8 Tax due. If the total of lines and 8 is more than line 7, enter amount owed ~~~~~~~~~~~~~~~~~~~~ 10 Overpayment. If line 7 is more than the total of lines and 8, enter the amount overpaid 10 1,6. 11 Enter the amount of line 10 to e: Credited to 016 estimated tax 1,6. Refunded 11 Part VII-A Statements Regarding Activities 1a 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1a Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for the definition)? ~~~~ 1 If the answer is "" to 1a or 1, attach a detailed description of the activities and copies of any materials pulished or distriuted y the foundation in connection with the activities. c Did the foundation file Form 110-POL for this year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1c d Enter the amount (if any) of tax on political expenditures (section ) imposed during the year: (1) On the foundation. $ () On foundation managers. $ e Enter the reimursement (if any) paid y the foundation during the year for political expenditure tax imposed on foundation managers. $ a Did the foundation have unrelated usiness gross income of $1,000 or more during the year? ~~~~~~~~~~~~~~~~~~~~~ If "," has it filed a tax return on Form 0-T for this year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ N/A 6 7 of Part I, line 7~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tax under section 11 (domestic section 7(1) trusts and taxale foundations only. Others enter -0-) ~~~~~~~~~ Add lines 1 and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sutitle A (income) tax (domestic section 7(1) trusts and taxale foundations only. Others enter -0-) ~~~~~~~~ Credits/Payments: c Tax paid with application for extension of time to file (Form 8868) ~~~~~~~~~~ Total credits and payments. Add lines 6a through 6d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Has the foundation engaged in any activities that have not previously een 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 ylaws, or other similar instruments? If "," attach a conformed copy of the changes ~~~~~~~~~~~~~~~~~~~~~ Was there a liquidation, termination, dissolution, or sustantial contraction during the year? ~~~~~~~~~~~~~~~~~~~~~~ If "," attach the statement required y General Instruction T. Are the requirements of section 08(e) (relating to sections 1 through ) satisfied either: By language in the governing instrument, or 6a 6 6c 6d 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 $,000 in assets at any time during the year? If "," complete Part II, col., and Part V ~~~~~ 8a Enter the states to which the foundation reports or with which it is registered (see instructions) FL If the answer is "" to line 7, has the foundation furnished a copy of Form 0-PF to the Attorney General (or designate) of each state as required y General Instruction G? If "," attach explanation ~~~~~~~~~~~~~~~~~~~~~~~~~ Is the foundation claiming status as a private operating foundation within the meaning of section (j)() or (j)() for calendar year 01 or the taxale year eginning in 01 (see instructions for Part IV)? If "," complete Part IV~~~~~~~~~~~~~~ 10 Did any persons ecome sustantial contriutors during the tax year? If "," attach a schedule listing their names and addresses 10 Form 0-PF (01) pnmno,. 7 a ,

5 CHARLES AND JOAN HERMANOWSKI Form 0-PF (01) FAMILY FOUNDATION, INC Page Part VII-A Statements Regarding Activities (continued) 11 At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of section 1()(1)? If "," attach schedule (see instructions)~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Section 7(1) nonexempt charitale trusts filing Form 0-PF in lieu of Form Check here ~~~~~~~~~~~~~~~~~~~~~~~ and enter the amount of tax-exempt interest received or accrued during the year ~~~~~~~~~~~~~~~~~~~ 1 N/A At any time during calendar year 01, did the foundation have an interest in or a signature or other authority over a ank, securities, or other financial account in a foreign country? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 16 File Form 70 if any item is checked in the "" column, unless an exception applies. 1a During the year did the foundation (either directly or indirectly): (1) () () () () (6) Agree to pay money or property to a government official? ( Exception. Check "" c Did the foundation engage in a prior year in any of the acts descried in 1a, other than excepted acts, that were not corrected a At the end of tax year 01, did the foundation have any undistriuted income (lines 6d and 6e, Part III) for tax year(s) eginning Are there any years listed in a for which the foundation is not applying the provisions of section () (relating to incorrect c If the provisions of section () are eing applied to any of the years listed in a, list the years here. a Did the foundation make a distriution 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 pulic inspection requirements for its annual returns and exemption application? ~~~~~~~~~~~ 1 1 Wesite address The ooks are in care of JOAN A. HERMANOWSKI Telephone no Located at P.O. BO 81000, BOCA RATON, FL ZIP+ 81 See the instructions for exceptions and filing requirements for FinCEN Form 11. If "," enter the name of the foreign country Part VII-B Statements Regarding Activities for Which Form 70 May Be Required Engage in the sale or exchange, or leasing of property with a disqualified person? 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? Pay compensation to, or pay or reimurse the expenses of, a disqualified person? Transfer any income or assets to a disqualified person (or make any of either availale ~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ for the enefit or use of a disqualified person)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 0 days.) ~~~~~~~~~~~~~~~~~~~~~ If any answer is "" to 1a(1)-(6), did any of the acts fail to qualify under the exceptions descried in Regulations section.1- or in a current notice regarding disaster assistance (see instructions)? ~~~~~~~~~~~~~~~~~~~~~ N/A Organizations relying on a current notice regarding disaster assistance check here ~~~~~~~~~~~~~~~~~~~~~ efore the first day of the tax year eginning in 01?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Taxes on failure to distriute income (section ) (does not apply for years the foundation was a private operating foundation defined in section (j)() or (j)()): efore 01? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," list the years,,, valuation of assets) to the year s undistriuted income? (If applying section () to all years listed, answer "" and attach statement - see instructions.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ N/A,,, Did the foundation hold more than a % direct or indirect interest in any usiness enterprise at any time during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," did it have excess usiness holdings in 01 as a result of (1) any purchase y the foundation or disqualified persons after May 6, 16; () the lapse of the -year period (or longer period approved y the Commissioner under section (7)) to dispose of holdings acquired y gift or equest; or () the lapse of the 10-, 1-, or 0-year first phase holding period? (Use Schedule C, Form 70, to determine if the foundation had excess usiness holdings in 01.) ~~~~~~~~~~~~~~~~~~~~~~ N/A a Did the foundation invest during the year any amount in a manner that would jeopardize its charitale purposes? ~~~~~~~~~~~~~ Did the foundation make any investment in a prior year (ut after Decemer 1, 16) that could jeopardize its charitale purpose that had not een removed from jeopardy efore the first day of the tax year eginning in 01? Form 0-PF (01) 1 1c a

6 CHARLES AND JOAN HERMANOWSKI Form 0-PF (01) FAMILY FOUNDATION, INC Part VII-B Statements Regarding Activities for Which Form 70 May Be Required (continued) a During the year did the foundation pay or incur any amount to: (1) () () () () Carry on propaganda, or otherwise attempt to influence legislation (section (e))? ~~~~~~~~~~~~~ Influence the outcome of any specific pulic election (see section ); or to carry on, directly or indirectly, any voter registration drive? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Provide a grant to an individual for travel, study, or other similar purposes? ~~~~~~~~~~~~~~~~~ Provide a grant to an organization other than a charitale, etc., organization descried in section ()(A)? (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Provide for any purpose other than religious, charitale, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If any answer is "" to a(1)-(), did any of the transactions fail to qualify under the exceptions descried in Regulations section. or in a current notice regarding disaster assistance (see instructions)? ~~~~~~~~~~~~~~~~~~~~~~~~ N/A Organizations relying on a current notice regarding disaster assistance check here ~~~~~~~~~~~~~~~~~~~~~ c If the answer is "" to question a(), does the foundation claim exemption from the tax ecause it maintained expenditure responsiility for the grant?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ N/A If "," attach the statement required y Regulations section.-. 6a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on a personal enefit contract? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the foundation, during the year, pay premiums, directly or indirectly, on a personal enefit contract? ~~~~~~~~~~~~~~~~ 6 If "" to 6, file Form 887 7a At any time during the tax year, was the foundation a party to a prohiited tax shelter transaction? ~~~~~~~~~ If "," did the foundation receive any proceeds or have any net income attriutale to the transaction? N/A 7 Part VIII Information Aout Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors 1 List all officers, directors, trustees, foundation managers and their compensation. Name and address () Title, and average Compensation Contriutions to (e) Expense hours per week devoted employee enefit plans (If not paid, and deferred account, other to position enter -0-) compensation allowances SEE STATEMENT Compensation of five highest-paid employees (other than those included on line 1). If none, enter "NONE." Name and address of each employee paid more than $0,000 () Title, and average hours per week devoted to position Compensation NONE Contriutions to employee enefit plans and deferred compensation Page 6 (e) Expense account, other allowances Total numer of other employees paid over $0,000 0 Form 0-PF (01)

7 CHARLES AND JOAN HERMANOWSKI Form 0-PF (01) FAMILY FOUNDATION, INC Part VIII Information Aout Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors (continued) Five highest-paid independent contractors for professional services. If none, enter "NONE." Name and address of each person paid more than $0,000 () Type of service Compensation NONE Page 7 Total numer of others receiving over $0,000 for professional services Part I-A Summary of Direct Charitale Activities List the foundation s four largest direct charitale activities during the tax year. Include relevant statistical information such as the numer of organizations and other eneficiaries served, conferences convened, research papers produced, etc. 1NONE Part I-B Summary of Program-Related Investments Descrie the two largest program-related investments made y the foundation during the tax year on lines 1 and. 1 N/A All other program-related investments. See instructions. Total. Add lines 1 through J Expenses Amount 0 Form 0-PF (01)

8 CHARLES AND JOAN HERMANOWSKI Form 0-PF (01) FAMILY FOUNDATION, INC Part Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.) Page 8 1 a c d e Total (add lines 1a,, and c) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Net value of noncharitale-use assets. Sutract line from line. Enter here and on Part V, line ~~~~~~~~~~ 6 Minimum investment return. Enter % of line 6 Part I Distriutale Amount (see instructions) (Section (j)() and (j)() private operating foundations and certain foreign organizations check here and do not complete this part.) 1 a 6 c 7 Distriutale amount as adjusted. Sutract line 6 from line. Enter here and on Part III, line 1 Part II Qualifying Distriutions (see instructions) 1 6 a a Fair market value of assets not used (or held for use) directly in carrying out charitale, etc., purposes: Average monthly fair market value of securities ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Average of monthly cash alances ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Fair market value of all other assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Reduction claimed for lockage or other factors reported on lines 1a and 1c (attach detailed explanation) ~~~~~~~~~~~~~~~~~~~~~~ Acquisition indetedness applicale to line 1 assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sutract line from line 1d~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Cash deemed held for charitale activities. Enter 1 1/% of line (for greater amount, see instructions) ~~~~~~~~ Minimum investment return from Part, line 6 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tax on investment income for 01 from Part VI, line ~~~~~~~~~~~ a 6 Income tax for 01. (This does not include the tax from Part VI.) ~~~~~~~ Add lines a and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Distriutale amount efore adjustments. Sutract line c from line 1 Qualifying distriutions. Add lines 1a through. Enter here and on Part V, line 8, and Part III, line ~~~~~~~~~ Adjusted qualifying distriutions. Sutract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1e ~~~~~~~~~~~~~~~~~~~~~~~ Recoveries of amounts treated as qualifying distriutions~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Deduction from distriutale amount (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amounts paid (including administrative expenses) to accomplish charitale, etc., purposes: Expenses, contriutions, gifts, etc. - total from Part I, column, line 6 ~~~~~~~~~~~~~~~~~~~~~~ Program-related investments - total from Part I-B Amounts paid to acquire assets used (or held for use) directly in carrying out charitale, etc., purposes~~~~~~~~~ Amounts set aside for specific charitale projects that satisfy the: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Suitaility test (prior IRS approval required) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Cash distriution test (attach the required schedule) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Foundations that qualify under section 0(e) for the reduced rate of tax on net investment income. Enter 1% of Part I, line 7 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ te. The amount on line 6 will e used in Part V, column (), in susequent years when calculating whether the foundation qualifies for the section 0(e) reduction of tax in those years. Form 0-PF (01) 1a 1 1c 1d 1 c 6 7 1a 1 a 6 1,6,11. 61,6.,007,86.,007,86. 0,118. 1,77,78. 8,886. 8, ,6. 1,7 100, , ,00 100,00 6,

9 Form 0-PF (01) Part III CHARLES AND JOAN HERMANOWSKI FAMILY FOUNDATION, INC Undistriuted Income (see instructions) Page 1 Undistriuted income, if any, as of the end of 01: a Enter amount for 01 only ~~~~~~~ Total for prior years: afrom 010 From 011 c From 01 dfrom 01 efrom 01 f Total of lines a through e ~~~~~~~~ aapplied to 01, ut not more than line a ~ Applied to undistriuted income of prior c Treated as distriutions out of corpus eremaining amount distriuted out of corpus Excess distriutions carryover applied to 01 ~~ (If an amount appears in column, the same amount must e shown in column.) 6 Enter the net total of each column as indicated elow: Distriutale amount for 01 from Part I, line 7 ~~~~~~~~~~~~~~~~~,, Excess distriutions carryover, if any, to 01: ~~~ ~~~ ~~~ ~~~ ~~~ Qualifying distriutions for 01 from Part II, line : $ 100,00 years (Election required - see instructions) ~ (Election required - see instructions) a Corpus. Add lines f, c, and e. Sutract line ~~ Prior years undistriuted income. Sutract c Enter the amount of prior years undistriuted income for which a notice of deficiency has een issued, or on which the section tax has een previously assessed ~~~~~~~~~~~~~~~ dsutract line 6c from line 6. Taxale eundistriuted income for 01. Sutract line f Undistriuted income for 01. Sutract Excess distriutions carryover to 016. aexcess from 011~ Excess from 01~ c Excess from 01~ dexcess from 01~ ~~~ dapplied to 01 distriutale amount ~~~ line from line ~~~~~~~~~~~ amount - see instructions ~~~~~~~~ a from line a. Taxale amount - see instr.~ lines d and from line 1. This amount must e distriuted in 016 ~~~~~~~~~~ Amounts treated as distriutions out of corpus to satisfy requirements imposed y section 170()(1)(F) or (g)() (Election may e required - see instructions) ~~~~ Excess distriutions carryover from 010 not applied on line or line 7 ~~~~~~~ Sutract lines 7 and 8 from line 6a ~~~~ Analysis of line : () Corpus Years prior to ,6. 1,6. 100,166. 8,6. 1,6 eexcess from Form 0-PF (01)

10 CHARLES AND JOAN HERMANOWSKI Form 0-PF (01) FAMILY FOUNDATION, INC Part IV Private Operating Foundations (see instructions and Part VII-A, question ) N/A 1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 01, enter the date of the ruling ~~~~~~~~~~~ Check ox to indicate whether the foundation is a private operating foundation descried in section ~~~ (j)() or (j)() a Enter the lesser of the adjusted net Tax year Prior years income from Part I or the minimum 01 () (e) Total 8% of line a ~~~~~~~~~~ c Qualifying distriutions from Part II, d Amounts included in line c not e Qualifying distriutions made directly Sutract line d from line c~~~~ Complete a,, or c for the alternative test relied upon: a "Assets" alternative test - enter: (1) Value of all assets ~~~~~~ c "Support" alternative test - enter: (1) () () () Gross investment income Part V Supplementary Information (Complete this part only if the foundation had $,000 or more in assets at any time during the year-see instructions.) 1 Information Regarding Foundation Managers: a List any managers of the foundation who have contriuted more than % of the total contriutions received y the foundation efore the close of any tax year (ut only if they have contriuted more than $,000). (See section 07().) JOAN A. HERMANOWSKI List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or other entity) of which the foundation has a 10% or greater interest. NONE investment return from Part for each year listed ~~~~~~~~~ line for each year listed ~~~~~ used directly for active conduct of exempt activities ~~~~~~~~~ for active conduct of exempt activities. () Value of assets qualifying under section (j)()(b)(i) ~ "Endowment" alternative test - enter / of minimum investment return shown in Part, line 6 for each year listed ~~~~~~~~~~~~~~ Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 1()), or royalties)~~~~ Support from general pulic and or more exempt organizations as provided in section (j)()(b)(iii) ~~~ Largest amount of support from an exempt organization ~~~~ Information Regarding Contriution, Grant, Gift, Loan, Scholarship, etc., Programs: Check here if the foundation only makes contriutions to preselected charitale organizations and does not accept unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under other conditions, complete items a,, c, and d. a The name, address, and telephone numer or address of the person to whom applications should e addressed: Page 10 SEE STATEMENT 10 The form in which applications should e sumitted and information and materials they should include: c Any sumission deadlines: d Any restrictions or limitations on awards, such as y geographical areas, charitale fields, kinds of institutions, or other factors: Form 0-PF (01) 10

11 CHARLES AND JOAN HERMANOWSKI Form 0-PF (01) FAMILY FOUNDATION, INC Part V Supplementary Information (continued) a Grants and Contriutions Paid During the Year or Approved for Future Payment Recipient If recipient is an individual, show any relationship to Foundation any foundation manager status of Name and address (home or usiness) or sustantial contriutor recipient Paid during the year Purpose of grant or contriution Amount Page 11 ALL FLORIDA YOUTH ORCHESTRA INC. N/A PUBLIC CHARITY GENERAL OPERATIONS 1708 NORTH 0TH STREET HOLLYWOOD, FL 0 6,00 BARRY AND FLORENCE FRIEDBERG JCC N/A PUBLIC CHARITY GENERAL OPERATIONS 1 NEIL COURT OCEANSIDE, NY 117 6,00 BATON ROUGE YOUTH COALITION, INC. N/A PUBLIC CHARITY GENERAL OPERATIONS 60 NORTH 11TH STREET BATON ROUGE, LA ,00 BEST FOOT FORWARD FOUNDATION INC N/A PUBLIC CHARITY SUPPORT SERVICES FOR 0 FONTANA BLVD., #108 FOSTER CHILDREN BOCA RATON, FL 7,00 CANINE ASSISTED THERAPIES INC. N/A PUBLIC CHARITY GENERAL OPERATIONS 100 N.E. TH STREET OAKLAND PARK, FL,00 Total SEE CONTINUATION SHEET(S) a 100,00 Approved for future payment NONE Total Form 0-PF (01) 11

12 Form 0-PF (01) Part VI-A Enter gross amounts unless otherwise indicated. 1 Program service revenue: a c d e f g Interest on savings and temporary cash Dividends and interest from securities Net rental income or (loss) from real estate: a 6 Net rental income or (loss) from personal 7 Other investment income ~~~~~~~~~~~~~~ 8 Gain or (loss) from sales of assets other 10 Gross profit or (loss) from sales of inventory 11 Other revenue: a c d Line. Fees and contracts from government agencies ~~~ Memership dues and assessments ~~~~~~~~~ investments ~~~~~~~~~~~~~~~~~~~~ Det-financed property ~~~~~~~~ ~~~~~~~~~~~~~ t det-financed property ~~~~~~~~~~~~ property ~~~~~~~~~~~~~~~~~~~~~ than inventory ~~~~~~~~~~~~~~~~~~~ Net income or (loss) from special events ~~~~~~~ ~~~~~ (See worksheet in line 1 instructions to verify calculations.) Part VI-B < CHARLES AND JOAN HERMANOWSKI FAMILY FOUNDATION, INC Analysis of Income-Producing Activities Unrelated usiness income Excluded y section 1, 1, or 1 () Exclusion Business code Amount code Amount 1 1,17. 1,. 01 1,7 18-6,11. Relationship of Activities to the Accomplishment of Exempt Purposes Explain elow how each activity for which income is reported in column (e) of Part VI-A contriuted importantly to the accomplishment of the foundation s exempt purposes (other than y providing funds for such purposes). (e) Related or exempt function income Page 1 e 1 Sutotal. Add columns (),, and (e) ~~~~~~~~,1. 1 Total. Add line 1, columns (),, and (e) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1, Form 0-PF (01) 1

13 Form 0-PF (01) Part VII 1 a c (1) () (1) () () () () (6) d If the answer to any of the aove is "," complete the following schedule. Column () should always show the fair market value of the goods, other assets, or services given y the reporting foundation. If the foundation received less than fair market value in any transaction or sharing arrangement, show in column the value of the goods, other assets, or services received. Line no. () Amount involved Name of noncharitale exempt organization Description of transfers, transactions, and sharing arrangements a Did the organization directly or indirectly engage in any of the following with any other organization descried in section 01 of the Code (other than section 01() organizations) or in section 7, relating to political organizations? Transfers from the reporting foundation to a noncharitale exempt organization of: Cash ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other assets~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other transactions: CHARLES AND JOAN HERMANOWSKI FAMILY FOUNDATION, INC Information Regarding Transfers To and Transactions and Relationships With ncharitale Exempt Organizations Sales of assets to a noncharitale exempt organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Purchases of assets from a noncharitale exempt organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Rental of facilities, equipment, or other assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Reimursement arrangements ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Loans or loan guarantees ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Performance of services or memership or fundraising solicitations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sharing of facilities, equipment, mailing lists, other assets, or paid employees ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ N/A If "," complete the following schedule. Name of organization () Type of organization Description of relationship N/A 1a(1) 1a() 1(1) 1() 1() 1() 1() 1(6) 1c Page 1 Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations descried in section 01 of the Code (other than section 01()) or in section 7? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Sign Here Paid Preparer Use Only Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the est of my knowledge and elief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is ased on all information of which preparer has any knowledge. = = May the IRS discuss this return with the preparer shown elow (see instr.)? VICE PRESIDENT Signature of officer or trustee Date Title Print/Type preparer s name Preparer s signature Date Check if PTIN self- employed D. MORRISON, CPA D. MORRISON, CPA 0//17 P00807 Firm s name KAUFMAN, ROSSIN & CO., P.A. Firm s EIN Firm s address 6 S. BAYSHORE DRIVE MIAMI, FL 1 Phone no. (0) Form 0-PF (01)

14 CHARLES AND JOAN HERMANOWSKI FAMILY FOUNDATION, INC Part V Supplementary Information Grants and Contriutions Paid During the Year (Continuation) Recipient If recipient is an individual, show any relationship to Foundation Purpose of grant or any foundation manager status of contriution Amount Name and address (home or usiness) or sustantial contriutor recipient CHILDREN'S RESOURCE FUND INC N/A PUBLIC CHARITY SCHOLARSHIP PROGRAM 871 SW 11TH STREET MIAMI, FL 16 10,00 EQUINE ASSISTED THERAPIES OF SOUTH N/A PUBLIC CHARITY PROVIDE HORSE RIDING FLORIDA, INC. FOR CHILDREN P.O. BO 7 BOCA RATON, FL 7,0 FLORIDA STATE UNIVERSITY N/A SCHOOL GENERAL OPERATIONS 71 W. GAINES STREET TALLAHASSEE, FL 06 6,0 GRANDMA'S PLACE, INC. N/A PUBLIC CHARITY GENERAL OPERATIONS 110 OKEECHOBEE BLVD., #6 ROYAL PALM BEACH, FL 11,00 HORIZONS FOR HOMELESS CHILDREN INC. N/A PUBLIC CHARITY PROVIDES FOR YOUNG 170 COLUMBUS AVENUE HOMELESS CHILDREN AND ROBURY, MA 011 THEIR FAMILIES 8,0 KRISTI HOUSE, INC. N/A PUBLIC CHARITY THERAPY FOR ABUSED 16 N.W. 1 AVE. CHILDREN MIAMI, FL 16,00 ST. JOAN OF ARC CATHOLIC CHURCH & N/A CHURCH WITH GENERAL OPERATIONS SCHOOL RELATED SCHOOL 01 SOUTHWEST THIRD AVE. BOCA RATON, FL 10,00 THE JACOB ZWEIG FOUNDATION, INC. N/A PUBLIC CHARITY GENERAL OPERATIONS 1 NW 1TH STREET, #10 MARGATE, FL 06,0 THE READING CONNECTION N/A PUBLIC CHARITY GENERAL OPERATIONS 101 LEE HIGHWAY #170 ARLINGTON, VA 0,00 UNITED CERBRAL PALSY OF BROWARD N/A PUBLIC CHARITY GENERAL OPERATIONS COUNTY 117 SW 1TH COURT FORT LAUDERDALE, FL 1,0 Total from continuation sheets 66,

15 CHARLES AND JOAN HERMANOWSKI FAMILY FOUNDATION, INC Part V Supplementary Information Grants and Contriutions Paid During the Year (Continuation) Recipient If recipient is an individual, show any relationship to Foundation Purpose of grant or any foundation manager status of contriution Amount Name and address (home or usiness) or sustantial contriutor recipient YOUNG PLAYWRIGHTS' THEATER N/A PUBLIC CHARITY TEACHES CHILDREN 7 1TH STREET NW, RD FLOOR THROUGH PLAYWRITING WASHINGTON, DC 000,0 YOUTH ORCHESTRA OF CENTRAL VIRGINIA N/A PUBLIC CHARITY SCHOLARSHIP PROGRAM POST OFFICE BO 8 CHARLOTTESVILLE, VA 0,00 Total from continuation sheets

16 Schedule B (Form 0, 0-EZ, or 0-PF) Department of the Treasury Internal Revenue Service Attach to Form 0, Form 0-EZ, or Form 0-PF. Information aout Schedule B (Form 0, 0-EZ, or 0-PF) and its instructions is at OMB Name of the organization Employer identification numer CHARLES AND JOAN HERMANOWSKI FAMILY FOUNDATION, INC Organization type(check one): Schedule of Contriutors 01 Filers of: Section: Form 0 or 0-EZ 01( ) (enter numer) organization 7(1) nonexempt charitale trust not treated as a private foundation 7 political organization Form 0-PF 01() exempt private foundation 7(1) nonexempt charitale trust treated as a private foundation 01() taxale private foundation Check if your organization is covered y the General Rule or a Special Rule. te. Only a section 01(7), (8), or (10) organization can check oxes for oth the General Rule and a Special Rule. See instructions. General Rule For an organization filing Form 0, 0-EZ, or 0-PF that received, during the year, contriutions totaling $,000 or more (in money or property) from any one contriutor. Complete Parts I and II. See instructions for determining a contriutor s total contriutions. Special Rules For an organization descried in section 01() filing Form 0 or 0-EZ that met the 1/% support test of the regulations under sections 0(1) and 170()(1)(A)(vi), that checked Schedule A (Form 0 or 0-EZ), Part II, line 1, 16a, or 16, and that received from any one contriutor, during the year, total contriutions of the greater of (1) $,000 or () % of the amount on (i) Form 0, Part VIII, line 1h, or (ii) Form 0-EZ, line 1. Complete Parts I and II. For an organization descried in section 01(7), (8), or (10) filing Form 0 or 0-EZ that received from any one contriutor, during the year, total contriutions of more than $1,000 exclusively for religious, charitale, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III. For an organization descried in section 01(7), (8), or (10) filing Form 0 or 0-EZ that received from any one contriutor, during the year, contriutions exclusively for religious, charitale, etc., purposes, ut no such contriutions totaled more than $1,00 If this ox is checked, enter here the total contriutions that were received during the year for an exclusively religious, charitale, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization ecause it received nonexclusively religious, charitale, etc., contriutions totaling $,000 or more during the year ~~~~~~~~~~~~~~~ $ Caution. An organization that is not covered y the General Rule and/or the Special Rules does not file Schedule B (Form 0, 0-EZ, or 0-PF), ut it must answer "" on Part IV, line, of its Form 0; or check the ox on line H of its Form 0-EZ or on its Form 0-PF, Part I, line, to certify that it does not meet the filing requirements of Schedule B (Form 0, 0-EZ, or 0-PF). LHA For Paperwork Reduction Act tice, see the Instructions for Form 0, 0-EZ, or 0-PF. Schedule B (Form 0, 0-EZ, or 0-PF) (01)

17 Schedule B (Form 0, 0-EZ, or 0-PF) (01) Name of organization Employer identification numer CHARLES AND JOAN HERMANOWSKI FAMILY FOUNDATION, INC Page Part I Contriutors (see instructions). Use duplicate copies of Part I if additional space is needed.. () Name, address, and ZIP + Total contriutions Type of contriution 1 JOAN A. HERMANOWSKI Person Payroll P.O. BO $,0 ncash BOCA RATON, FL 81 (Complete Part II for noncash contriutions.).... () Name, address, and ZIP + () Name, address, and ZIP + () Name, address, and ZIP + () Name, address, and ZIP + Total contriutions Total contriutions Total contriutions $ $ $ Total contriutions Type of contriution Person Payroll ncash (Complete Part II for noncash contriutions.) Type of contriution Person Payroll ncash (Complete Part II for noncash contriutions.) Type of contriution Person Payroll ncash (Complete Part II for noncash contriutions.) Type of contriution $ Person Payroll ncash (Complete Part II for noncash contriutions.). () Name, address, and ZIP + Total contriutions Type of contriution $ Person Payroll ncash (Complete Part II for noncash contriutions.) Schedule B (Form 0, 0-EZ, or 0-PF) (01) 17

18 Schedule B (Form 0, 0-EZ, or 0-PF) (01) Page Name of organization Employer identification numer CHARLES AND JOAN HERMANOWSKI FAMILY FOUNDATION, INC Part II ncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.. from Part I () Description of noncash property given FMV (or estimate) (see instructions) Date received $. from Part I. from Part I. from Part I. from Part I () Description of noncash property given () Description of noncash property given () Description of noncash property given () Description of noncash property given FMV (or estimate) (see instructions) FMV (or estimate) (see instructions) FMV (or estimate) (see instructions) $ $ $ FMV (or estimate) (see instructions) Date received Date received Date received Date received $. from Part I () Description of noncash property given FMV (or estimate) (see instructions) Date received $ Schedule B (Form 0, 0-EZ, or 0-PF) (01) 18

19 Schedule B (Form 0, 0-EZ, or 0-PF) (01) Page Name of organization Employer identification numer CHARLES AND JOAN HERMANOWSKI FAMILY FOUNDATION, INC Part III Exclusively religious, charitale, etc., contriutions to organizations descried in section 01(7), (8), or (10) that total more than $1,000 for the year from any one contriutor. Complete columns through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitale, etc., contriutions of $1,000 or less for the year. (Enter this info. once.) $ Use duplicate copies of Part III if additional space is needed.. from Part I () Purpose of gift Use of gift Description of how gift is held (e) Transfer of gift. from Part I. from Part I Transferee s name, address, and ZIP + Relationship of transferor to transferee () Purpose of gift Use of gift Description of how gift is held (e) Transfer of gift Transferee s name, address, and ZIP + Relationship of transferor to transferee () Purpose of gift Use of gift Description of how gift is held (e) Transfer of gift Transferee s name, address, and ZIP + Relationship of transferor to transferee. from Part I () Purpose of gift Use of gift Description of how gift is held (e) Transfer of gift Transferee s name, address, and ZIP + Relationship of transferor to transferee Schedule B (Form 0, 0-EZ, or 0-PF) (01) 1

20 CHARLES AND JOAN HERMANOWSKI FAMILY FOUN 0-71 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT 1 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) REVENUE NET INVESTMENT ADJUSTED SOURCE PER BOOKS INCOME NET INCOME }}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} NORTHERN TRUST INTEREST 1,17. 1,17. }}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} TOTAL TO PART I, LINE 1,17. 1,17. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF DIVIDENDS AND INTEREST FROM SECURITIES STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} CAPITAL (A) (B) (C) GROSS GAINS REVENUE NET INVEST- ADJUSTED SOURCE AMOUNT DIVIDENDS PER BOOKS MENT INCOME NET INCOME }}}}}} }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}} NORTHERN TRUST CAPITAL GAINS DIVIDENDS,16.,16. NORTHERN TRUST INVESTMENTS,. }}}}}}}}}}} TO PART I, LINE,.,. }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}},1.,16.,.,. ~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF OTHER INCOME STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) REVENUE NET INVEST- ADJUSTED DESCRIPTION PER BOOKS MENT INCOME NET INCOME }}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} RECOVERY OF PRIOR YEAR QUALIFIED CONTRIBUTION PAID 1,7 }}}}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} TOTAL TO FORM 0-PF, PART I, LINE 11 1,7 ~~~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ 0 STATEMENT(S) 1,,

21 CHARLES AND JOAN HERMANOWSKI FAMILY FOUN 0-71 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF ACCOUNTING FEES STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} ACCOUNTING FEES,0,6 }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} TO FORM 0-PF, PG 1, LN 16B,0,6 ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF OTHER EPENSES STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} NORTHERN TRUST - INVESTMENT FEES 8,86. }}}}}}}}}}} TO FORM 0-PF, PG 1, LN 8,86. }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} 8,86. 8,86. ~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF CORPORATE STOCK STATEMENT 6 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} FAIR MARKET DESCRIPTION BOOK VALUE VALUE }}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} NORTHERN TRUST - EQUITY SECURITIES 886,10. 0,. NORTHERN TRUST - COMMODITY FUNDS,. 8,6. }}}}}}}}}}}}}} }}}}}}}}}}}}}} TOTAL TO FORM 0-PF, PART II, LINE 10B 7,06. 1,0,087. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF CORPORATE BONDS STATEMENT 7 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} FAIR MARKET DESCRIPTION BOOK VALUE VALUE }}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} NORTHERN TRUST - BOND FUNDS 8,06. 88,68. }}}}}}}}}}}}}} }}}}}}}}}}}}}} TOTAL TO FORM 0-PF, PART II, LINE 10C 8,06. 88,68. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ 1 STATEMENT(S),, 6, 7