Return of Private Foundation. 990-PF or Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation

Transcription

1 Form Department of the Treasury Internal Revenue Service te. The foundation may e ale to use a copy of this return to satisfy state reporting requirements. For calendar year 0 or tax year eginning, and ending Name of foundation Return of Private Foundation A Employer identification numer OMB PF or Section 7() nexempt Charitale Trust Treated as a Private Foundation 0 Open to pulic Inspection CASEY FELDMAN MEMORIAL FOUNDATION Numer and street (or P.O. ox numer if mail is not delivered to street address) Room/suite B Telephone numer RIDGE LANE City or town, state, and ZIP code C If exemption application is pending, check here~ SPRINGFIELD, PA 0 G Check all that apply: Initial return Initial return of a former pulic charity D. 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 0() exempt private foundation E If private foundation status was terminated Section 7() nonexempt charitale trust Other taxale private foundation under section 07()()(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 0-month termination (from I, col., line ) Other (specify) under section 07()()(B), check here ~ 7. (, column must e on cash asis.) 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) Contriutions, gifts, grants, etc., received ~~~ 0 N/A Revenue Operating and Administrative Expenses Check if the foundation is not required to attach Sch. B Interest on savings and temporary cash investments ~~~~~~~~~~~~~~ Dividends and interest from securities~~~~~ a Gross rents ~~~~~~~~~~~~~~~~ Net rental income or (loss) a Net gain or (loss) from sale of assets not on line 0 ~~ Gross sales price for all assets on line a ~~ 7 Capital gain net income (from V, line ) ~~~~~ 8 Net short-term capital gain ~~~~~~~~~ Income modifications~~~~~~~~~~~~ Gross sales less returns 0a and allowances ~~~~ Less: Cost of goods sold ~ c Gross profit or (loss) ~~~~~~~~~~~~ Total. Add lines through Compensation of officers, directors, trustees, etc. ~~~ Pension plans, employee enefits ~~~~~~ a Legal fees~~~~~~~~~~~~~~~~~ STMT Accounting fees ~~~~~~~~~~~~~~ STMT c Other professional fees ~~~~~~~~~~~ STMT Other income ~~~~~~~~~~~~~~~ Other employee salaries and wages~~~~~~ Interest ~~~~~~~~~~~~~~~~~~ Taxes~~~~~~~~~~~~~~~~~~~ Depreciation and depletion ~~~~~~~~~ Occupancy ~~~~~~~~~~~~~~~~ Travel, conferences, and meetings ~~~~~~ Printing and pulications ~~~~~~~~~~ Other expenses ~~~~~~~~~~~~~~ STMT Total operating and administrative expenses. Add lines through ~~~~~ Contriutions, gifts, grants paid ~~~~~~~ Total expenses and disursements. Add lines and STATEMENT Sutract line from line : a Excess of revenue over expenses and disursements ~ -8. Net investment income (if negative, enter -0-) ~~~ c Adjusted net income (if negative, enter -0-) N/A 0-0- LHA For Paperwork Reduction Act tice, see instructions. Form 0-PF (0)

2 Form 0-PF (0) Assets Liailities Net Assets or Fund Balances I 7 Other notes and loans receivale ~~~~~~~~ 8 Attached schedules and amounts in the description column should e for end-of-year amounts only. Prepaid expenses and deferred charges ~~~~~~~~~~~~~ 0a Investments - U.S. and state government oligations ~~~~~~~ Investments - land, uildings, and equipment: asis ~~ c Investments - corporate onds ~~~~~~~~~~~~~~~~~ Less: accumulated depreciation ~~~~~~~~ Investments - mortgage loans ~~~~~~~~~~~~~~~~~ Total assets (to e completed y all filers) Loans from officers, directors, trustees, and other disqualified persons Total liailities (add lines 7 through ) Foundations that follow SFAS 7, check here ~~~~ 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 and complete lines through and lines 0 and. Foundations that do not follow SFAS 7, check here and complete lines 7 through. ~~~~~~~~~~~~ Grants receivale ~~~~~~~~~~~~~~~~~~~~~~~ Receivales due from officers, directors, trustees, and other disqualified persons ~~~~~~~~~~~~~~~~~~~~~~ Less: allowance for doutful accounts Inventories for sale or use ~~~~~~~~~~~~~~~~~~~ Investments - corporate stock ~~~~~~~~~~~~~~~~~ Investments - other ~~~~~~~~~~~~~~~~~~~~~~ Land, uildings, and equipment: asis Less: accumulated depreciation ~~~~~~~~ STMT Other assets (descrie ) Accounts payale and accrued expenses ~~~~~~~~~~~~~ Grants payale ~~~~~~~~~~~~~~~~~~~~~~~~ Deferred revenue ~~~~~~~~~~~~~~~~~~~~~~~ ~~~~ Mortgages and other notes payale ~~~~~~~~~~~~~~~ Other liailities (descrie Unrestricted CASEY FELDMAN MEMORIAL FOUNDATION ~~~~~~~~~~~~~~~~~~~~~~~~~ Temporarily restricted ~~~~~~~~~~~~~~~~~~~~~ Permanently restricted~~~~~~~~~~~~~~~~~~~~~ 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 Total liailities and net assets/fund alances II Analysis of Changes in Net Assets or Fund Balances Total net assets or fund alances at eginning of year - I, column, line 0 (must agree with end-of-year figure reported on prior year s return) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Enter amount from, line 7a ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other increases not included in line (itemize) Add lines,, and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Decreases not included in line (itemize) Total net assets or fund alances at end of year (line minus line ) - I, column (), line Form 0-PF (0)

3 Form 0-PF (0) CASEY FELDMAN MEMORIAL FOUNDATION Page V 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.) a c d e a c d e a c d e (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) Complete only for assets showing gain in column (h) and owned y the foundation on // (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 // Losses (from col. (h)) as of // over col. (j), if any If gain, also enter in, line 7 Capital gain net income or (net capital loss) If (loss), enter -0- in, line 7 ~~~~~~ Net short-term capital gain or (loss) as defined in sections () and (): If gain, also enter in, line 8, column. If (loss), enter -0- in, 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. 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 NONE rqs pmo pmo ~~~~~~~~~~~~~~~~ Distriution ratio (col. () divided y col. ) Total of line, 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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Enter the net value of noncharitale-use assets for 0 from Part, line ~~~~~~~~~~~~~~~~~~~~~. Multiply line y line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 8. Enter % of net investment income (% of, line 7) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7 Add lines and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Enter qualifying distriutions from I, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 8 8. If line 8 is equal to or greater than line 7, check the ox in Part VI, line, and complete that part using a % tax rate. See the Part VI instructions. -0- Form 0-PF (0)

4 Form 0-PF (0) CASEY FELDMAN MEMORIAL FOUNDATION Page Part VI Excise Tax Based on Investment Income (Section 0, 0(), 0(e), or 8 - see instructions) a Exempt operating foundations descried in section 0(), check here and enter "N/A" on line Domestic foundations that meet the section 0(e) requirements in Part V, check here (attach copy of letter if necessary-see instructions) c All other domestic foundations enter % of line 7. Exempt foreign organizations enter % of, line, col. (). Tax ased on investment income. Sutract line from line. If zero or less, enter -0- ~~~~~~~~~~~~~~~~~ a 0 estimated tax payments and 0 overpayment credited to 0 ~~~~~~~~ Exempt foreign organizations - tax withheld at source ~~~~~~~~~~~~~~~~ c Tax paid with application for extension of time to file (Form 888) ~~~~~~~~~~~ d Backup withholding erroneously withheld ~~~~~~~~~~~~~~~~~~~~~ Enter any penalty for underpayment of estimated tax. Check here if Form 0 is attached ~~~~~~~~~~~~~ Tax due. If the total of lines and 8 is more than line 7, enter amount owed ~~~~~~~~~~~~~~~~~~~~ Overpayment. If line 7 is more than the total of lines and 8, enter the amount overpaid ~~~~~~~~~~~~~~ Enter the amount of line 0 to e: Credited to 0 estimated tax Refunded Part VII-A Statements Regarding Activities a During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in Did it spend more than 00 during the year (either directly or indirectly) for political purposes (see instructions for definition)? ~~~~~~ If the answer is "" to a or, 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 0-POL for this year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ d Enter the amount (if any) of tax on political expenditures (section ) imposed during the year: () 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 c d a Did the foundation have unrelated usiness gross income of,000 or more during the year? ~~~~~~~~~~~~~~~~~~~~~ If "," has it filed a tax return on Form 0-T for this year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ N/A 7 Date of ruling or determination letter: of, line 7~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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. Did the foundation have at least,000 in assets at any time during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," complete I, col., and Part V. 8a Enter the states to which the foundation reports or with which it is registered (see instructions) PA and enter % Tax under section (domestic section 7() trusts and taxale foundations only. Others enter -0-) ~~~~~~~~~ Add lines and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sutitle A (income) tax (domestic section 7() trusts and taxale foundations only. Others enter -0-) ~~~~~~~~ Credits/Payments: Total credits and payments. Add lines a through d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ any political campaign? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Are the requirements of section 08(e) (relating to sections through ) 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 0 or the taxale year eginning in 0 (see instructions for V)? If "," complete V~~~~~~~~~~~~~~ 0 Did any persons ecome sustantial contriutors during the tax year? If "," attach a schedule listing their names and addresses STMT 7 0 Form 0-PF (0) pnmno a c a

5 Form 0-PF (0) CASEY FELDMAN MEMORIAL FOUNDATION Part VII-A Statements Regarding Activities (continued) Section 7() nonexempt charitale trusts filing Form 0-PF in lieu of Form 0 - Check here ~~~~~~~~~~~~~~~~~~~~~~~ and enter the amount of tax-exempt interest received or accrued during the year ~~~~~~~~~~~~~~~~~~~ N/A At any time during calendar year 0, 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ File Form 70 if any item is checked in the "" column, unless an exception applies. a During the year did the foundation (either directly or indirectly): () () () () () () 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 a, other than excepted acts, that were not corrected a At the end of tax year 0, did the foundation have any undistriuted income (lines d and e, II) 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 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)~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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? ~~~~~~~~~~~ Wesite address CASEYFELDMANMEMORIALFOUNDATION.ORG The ooks are in care of JOEL D. FELDMAN Telephone no Located at RIDGE AVE., SPRINGFIELD, PA ZIP+ 0 See the instructions for exceptions and filing requirements for Form TD F 0-.. 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 a()-(), did any of the acts 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 ~~~~~~~~~~~~~~~~~~~~~~ efore the first day of the tax year eginning in 0?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 0? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 0 as a result of () any purchase y the foundation or disqualified persons after May, ; () 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 0-, -, or 0-year first phase holding period? (Use Schedule C, Form 70, to determine if the foundation had excess usiness holdings in 0.) ~~~~~~~~~~~~~~~~~~~~~~ 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, ) that could jeopardize its charitale purpose that had not een removed from jeopardy efore the first day of the tax year eginning in 0? Form 0-PF (0) c a Page -0-

6 Form 0-PF (0) CASEY FELDMAN MEMORIAL FOUNDATION 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: () () () () () 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 0(), (), or (), or section 0()? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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()-(), 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.-. a 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? ~~~~~~~~~~~~~~~~ If "" to, 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 List all officers, directors, trustees, foundation managers and their compensation. Name and address () Title, and average Compensation Contriutions to (e) Expense employee enefit plans hours per week devoted to position (If not paid, enter -0-) and deferred compensation account, other allowances JOEL D. FELDMAN PRESIDENT RIDGE LANE SPRINGFIELD, PA 0 00 DIANNE L. ANDERSON SECRETARY RIDGE LANE SPRINGFIELD, PA 0.00 BRETT FELDMAN TREASURER RIDGE LANE SPRINGFIELD, PA 0.00 Page Compensation of five highest-paid employees (other than those included on line ). 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 (e) Expense account, other allowances Total numer of other employees paid over 0,000 0 Form 0-PF (0) -0-

7 Form 0-PF (0) CASEY FELDMAN MEMORIAL FOUNDATION Page 7 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 Total numer of others receiving over 0,000 for professional services -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. UNIVERSITY OF COLORADO; SCHOLARSHIP CHILDRENS HOSPITAL OF PHILADELPHIA; DONATION FORDHAM UNIVERSITY; SCHOLARSHIP TEMPLE UNIVERSITY; SCHOLARSHIP -B Summary of Program-Related Investments Descrie the two largest program-related investments made y the foundation during the tax year on lines and. N/A 0 Expenses Amount All other program-related investments. See instructions. Total. Add lines through J Form 0-PF (0) -0-7

8 Form 0-PF (0) CASEY FELDMAN MEMORIAL FOUNDATION Part Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.) Page 8 a c d e Total (add lines a,, and c) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Net value of noncharitale-use assets. Sutract line from line. Enter here and on Part V, line ~~~~~~~~~~ Minimum investment return. Enter % of line Distriutale Amount (see instructions) (Section (j)() and (j)() private operating foundations and certain foreign organizations check here and do not complete this part.) c 7 Distriutale amount as adjusted. Sutract line from line. Enter here and on II, line 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 a and c (attach detailed explanation) ~~~~~~~~~~~~~~~~~~~~~~ Acquisition indetedness applicale to line assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sutract line from line d~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Cash deemed held for charitale activities. Enter /% of line (for greater amount, see instructions) ~~~~~~~~ Minimum investment return from Part, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ a Tax on investment income for 0 from Part VI, line ~~~~~~~~~~~ Income tax for 0. (This does not include the tax from Part VI.) ~~~~~~~ Add lines a and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Distriutale amount efore adjustments. Sutract line c from line e a ~~~~~~~~~~~~~~~~~~~~~~~ Recoveries of amounts treated as qualifying distriutions~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Deduction from distriutale amount (see instructions) I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amounts paid (including administrative expenses) to accomplish charitale, etc., purposes: Expenses, contriutions, gifts, etc. - total from, column, line ~~~~~~~~~~~~~~~~~~~~~~ Program-related investments - total from -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: Qualifying Distriutions (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Suitaility test (prior IRS approval required) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Cash distriution test (attach the required schedule) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Qualifying distriutions. Add lines a through. Enter here and on Part V, line 8, and II, line ~~~~~~~~~ Foundations that qualify under section 0(e) for the reduced rate of tax on net investment income. Enter % of, line 7 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Adjusted qualifying distriutions. Sutract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~ te. The amount on line 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 (0) a c d c 7 a a

9 Form 0-PF (0) CASEY FELDMAN MEMORIAL FOUNDATION II Undistriuted Income (see instructions) Page Undistriuted income, if any, as of the end of 0: a Enter amount for 0 only ~~~~~~~ Total for prior years: afrom 007 From 008 c From 00 dfrom 00 efrom 0 f Total of lines a through e ~~~~~~~~ aapplied to 0, 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 0 ~~ (If an amount appears in column, the same amount must e shown in column.) Enter the net total of each column as indicated elow: 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 c from line. Taxale eundistriuted income for 0. Sutract line f Undistriuted income for 0. Sutract 8-0- Distriutale amount for 0 from, line 7 ~~~~~~~~~~~~~~~~~,, Excess distriutions carryover, if any, to 0: ~~~ ~~~ ~~~ ~~~ ~~~ Qualifying distriutions for 0 from I, line : 8. years (Election required - see instructions) ~ (Election required - see instructions) Excess distriutions carryover to 0. aexcess from 008~ Excess from 00~ c Excess from 00~ dexcess from 0~ eexcess from 0 ~~~ dapplied to 0 distriutale amount ~~~ line from line ~~~~~~~~~~~ amount - see instructions ~~~~~~~~ a from line a. Taxale amount - see instr.~ lines d and from line. This amount must e distriuted in 0 ~~~~~~~~~~ Amounts treated as distriutions out of corpus to satisfy requirements imposed y section 70()()(F) or (g)() ~~~~ Excess distriutions carryover from 007 not applied on line or line 7 ~~~~~~~ Sutract lines 7 and 8 from line a ~~~~ Analysis of line : () Corpus Years prior to Form 0-PF (0)

10 Form 0-PF (0) CASEY FELDMAN MEMORIAL FOUNDATION V Private Operating Foundations (see instructions and Part VII-A, question ) N/A a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 0, 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 or the minimum 0 () (e) Total 8% of line a ~~~~~~~~~~ c Qualifying distriutions from I, 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: () Value of all assets ~~~~~~ c "Support" alternative test - enter: () () () () 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.) 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().) JOEL D. FELDMAN 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 for each year listed ~~~~~~~~~~~~~~ Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section ()), 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 ~~~~ List any managers of the foundation who own 0% 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 0% or greater interest. NONE 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 of the person to whom applications should e addressed: THE CASEY FELDMAN MEMORIAL FOUNDATION, RIDGE AVENUE, SPRINGFIELD, PA 0 The form in which applications should e sumitted and information and materials they should include: SEE WEBSITE: c Any sumission deadlines: NONE d Any restrictions or limitations on awards, such as y geographical areas, charitale fields, kinds of institutions, or other factors: ONLY CONSISTENT WITH FOUNDATION MISSION Page Form 0-PF (0) 0

11 Form 0-PF (0) CASEY FELDMAN MEMORIAL FOUNDATION 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 CHILDRENS HOSPITAL OF PHILADELPHIA NONE DONATION DONATION CHESTNUT STREET PHILADELPHIA, PA 0 00 FORDAM UNIVERSITY NONE ENROLLED SCHOLARSHIP/GRANT 888 SEVENTH AVENUE STUDENT NEW YORK, NY UNIVERSITY OF COLORADO NONE ENROLLED SCHOLARSHIP/GRANT BROADWAY STUDENT BOULDER, CO TEMPLE UNIVERSITY NONE ENROLLED SCHOLARSHIP/GRANT 0 NORTH BROAD STREET STUDENT PHILADELPHIA, PA 0 MISCELLANEOUS CHARITABLE NONE NONE DONATION ORGANIZATIONS (,000 EACH OR LESS) VARIOUS VARIOUS 0 Total Approved for future payment a 00 NONE -0- Total Form 0-PF (0)

12 Form 0-PF (0) Part VI-A Enter gross amounts unless otherwise indicated. 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 Net rental income or (loss) from personal 7 Other investment income ~~~~~~~~~~~~~~ 8 Gain or (loss) from sales of assets other 0 Gross profit or (loss) from sales of inventory Other revenue: a c d 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 instructions to verify calculations.) Part VI-B CASEY FELDMAN MEMORIAL FOUNDATION Analysis of Income-Producing Activities Unrelated usiness income Excluded y section,, or () Exclusion Business code Amount code Amount Relationship of Activities to the Accomplishment of Exempt Purposes (e) Related or exempt function income Page 07. e Sutotal. Add columns (),, and (e) ~~~~~~~~ 07. Total. Add line, columns (),, and (e) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 07. Line 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). < CONTRIBUTIONS ARE PLACED IN A INTEREST BEARING ACCOUNT UNTIL SUCH TIME THEY ARE USED FOR THE FOUNDATIONS EEMPT PURPOSE. BY KEEPING FUNDS IN AN INTEREST BEARING ACCOUNT BANK CHARGES ARE MINIMIZED ENABLING THE FOUNDATION TO UTILIZE A GREATER PORTION FOR ITS EEMPT PURPOSE. -0- Form 0-PF (0)

13 Form 0-PF (0) CASEY FELDMAN MEMORIAL FOUNDATION Page Part VII Information Regarding Transfers To and Transactions and Relationships With ncharitale Exempt Organizations Did the organization directly or indirectly engage in any of the following with any other organization descried in section 0 of the Code (other than section 0() organizations) or in section 7, relating to political organizations? a c () () () () () () () () 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 Transfers from the reporting foundation to a noncharitale exempt organization of: Cash ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other assets~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other transactions: 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 Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations descried in section 0 of the Code (other than section 0()) or in section 7? ~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," complete the following schedule. Name of organization () Type of organization Description of relationship N/A a() a() () () () () () () c 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.)? Sign Here = = Signature of officer or trustee Date Title Print/Type preparer s name Preparer s signature Date Check if PTIN RAYMOND P. MARCHAK, self- employed Paid CPA RAYMOND P. MARCHA /0/ P0088 Preparer Firm s name RAYMOND P. MARCHAK, CPA Firm s EIN Use Only Firm s address 0 SUNNYBROOK DRIVE NORTH KINGSTOWN, RI 08 Phone no Form 0-PF (0) -0-

14 CASEY FELDMAN MEMORIAL FOUNDATION }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} SOURCE AMOUNT }}}}}} }}}}}}}}}}}}}} WELLS FARGO 07. }}}}}}}}}}}}}} TOTAL TO FORM 0-PF, PART I, LINE, COLUMN A 07. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF LEGAL FEES STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} LEGAL }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} TO FM 0-PF, PG, LN A ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF ACCOUNTING FEES STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} ACCOUNTING 0 }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} TO FORM 0-PF, PG, LN B 0 ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF OTHER PROFESSIONAL FEES STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} MEMBERSHIP FEES & LICENSES }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} TO FORM 0-PF, PG, LN C ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ STATEMENT(S),,,

15 CASEY FELDMAN MEMORIAL FOUNDATION }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF OTHER EPENSES STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} (A) (B) (C) (D) EPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES }}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} CHARITABLE PURPOSE SUPPLIES, HANDOUTS, STICKERS BANK CHARGES INSURANCE 8 8 WEBSITE MAINTENANCE AND UPKEEP. }}}}}}}}}}} TO FORM 0-PF, PG, LN. }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}} ~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF DEPRECIATION OF ASSETS NOT HELD FOR INVESTMENT STATEMENT }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} COST OR ACCUMULATED FAIR MARKET DESCRIPTION OTHER BASIS DEPRECIATION BOOK VALUE VALUE }}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} WEBSITE }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} }}}}}}}}}}}} TO 0-PF, PART II, LN ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-PF LIST OF SUBSTANTIAL CONTRIBUTORS STATEMENT 7 PART VII-A, LINE 0 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} NAME OF CONTRIBUTOR ADDRESS }}}}}}}}}}}}}}}}}}} }}}}}}} JOEL D. FELDMAN AND DIANNE L. RIDGE AVE ANDERSON SPRINGFIELD, PA 0 STATEMENT(S),, 7

16 Schedule B (Form 0, 0-EZ, or 0-PF) Department of the Treasury Internal Revenue Service Name of the organization Schedule of Contriutors Attach to Form 0, Form 0-EZ, or Form 0-PF. OMB Employer identification numer Organization type(check one): CASEY FELDMAN MEMORIAL FOUNDATION Filers of: Section: Form 0 or 0-EZ 0( ) (enter numer) organization 7() nonexempt charitale trust not treated as a private foundation 7 political organization Form 0-PF 0() exempt private foundation 7() nonexempt charitale trust treated as a private foundation 0() taxale private foundation Check if your organization is covered y the General Rule or a Special Rule. te. Only a section 0(7), (8), or (0) 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,,000 or more (in money or property) from any one contriutor. Complete Parts I and II. Special Rules For a section 0() organization filing Form 0 or 0-EZ that met the /% support test of the regulations under sections 0() and 70()()(A)(vi) and received from any one contriutor, during the year, a contriution of the greater of (),000 or () % of the amount on (i) Form 0, Part VIII, line h, or (ii) Form 0-EZ, line. Complete Parts I and II. For a section 0(7), (8), or (0) organization filing Form 0 or 0-EZ that received from any one contriutor, during the year, total contriutions of more than,000 for use exclusively for religious, charitale, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and III. For a section 0(7), (8), or (0) organization filing Form 0 or 0-EZ that received from any one contriutor, during the year, contriutions for use exclusively for religious, charitale, etc., purposes, ut these contriutions did not total to more than,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 of,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 V, line, of its Form 0; or check the ox on line H of its Form 0-EZ or on, line of its Form 0-PF, 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) (0) --

17 Schedule B (Form 0, 0-EZ, or 0-PF) (0) Name of organization Employer identification numer Page CASEY FELDMAN MEMORIAL FOUNDATION Contriutors (see instructions). Use duplicate copies of if additional space is needed. () Name, address, and ZIP + JOEL D. FELDMAND AND DIANNE L. ANDERSON Total contriutions RIDGE LAND. SPRINGFIELD, PA 0 Type of contriution Person Payroll ncash (Complete I if there is a noncash contriution.) () Name, address, and ZIP + Total contriutions Type of contriution () Name, address, and ZIP + () Name, address, and ZIP + Total contriutions Total contriutions Person Payroll ncash (Complete I if there is a noncash contriution.) Type of contriution Person Payroll ncash (Complete I if there is a noncash contriution.) Type of contriution Person Payroll ncash (Complete I if there is a noncash contriution.) () Name, address, and ZIP + Total contriutions Type of contriution Person Payroll ncash (Complete I if there is a noncash contriution.) () Name, address, and ZIP + Total contriutions Type of contriution Person Payroll ncash (Complete I if there is a noncash contriution.) -- Schedule B (Form 0, 0-EZ, or 0-PF) (0) 7

18 Schedule B (Form 0, 0-EZ, or 0-PF) (0) Name of organization Page Employer identification numer CASEY FELDMAN MEMORIAL FOUNDATION I ncash Property (see instructions). Use duplicate copies of I if additional space is needed. from () Description of noncash property given FMV (or estimate) (see instructions) Date received from () Description of noncash property given FMV (or estimate) (see instructions) Date received from from () Description of noncash property given () Description of noncash property given FMV (or estimate) (see instructions) FMV (or estimate) (see instructions) Date received Date received from () Description of noncash property given FMV (or estimate) (see instructions) Date received from () Description of noncash property given FMV (or estimate) (see instructions) Date received -- Schedule B (Form 0, 0-EZ, or 0-PF) (0) 8

19 Schedule B (Form 0, 0-EZ, or 0-PF) (0) Name of organization Page Employer identification numer CASEY FELDMAN MEMORIAL FOUNDATION II from Exclusively religious, charitale, etc., individual contriutions to section 0(7), (8), or (0) organizations that total more than,000 for the year. Complete columns through (e) and the following line entry. For organizations completing II, enter the total of exclusively religious, charitale, etc., contriutions of,000 or less for the year. (Enter this information once.) Use duplicate copies of II if additional space is needed. () 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 from () 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 () 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) (0)

20 0 DEPRECIATION AND AMORTIZATION REPORT FORM 0-PF PAGE 0-PF Asset Date Description Acquired Method Life Line Unadjusted Cost Or Basis Bus % Excl * Reduction In Basis Basis For Depreciation Accumulated Depreciation Current Sec 7 Current Year Deduction WEBSITE 070SL * TOTAL 0-PF PG DEPR (D) - Asset disposed 0 * ITC, Section 7, Salvage, Bonus, Commercial Revitalization Deduction

21 Form 888 (Rev. -0) If you are filing for an Additional (t Automatic) -Month Extension, complete only I and check this ox ~~~~~~~~~~ te. Only complete I if you have already een granted an automatic -month extension on a previously filed Form 888. If you are filing for an Automatic -Month Extension, complete only (on page ). I Additional (t Automatic) -Month Extension of Time. Only file the original (no copies needed). Type or print File y the due date for filing your return. See instructions. Name of exempt organization or other filer, see instructions Numer, street, and room or suite no. If a P.O. ox, see instructions. RIDGE LANE City, town or post office, state, and ZIP code. For a foreign address, see instructions. SPRINGFIELD, PA 0 Page Enter filer s identifying numer, see instructions Employer identification numer (EIN) or CASEY FELDMAN MEMORIAL FOUNDATION Social security numer (SSN) Enter the Return code for the return that this application is for (file a separate application for each return) ~~~~~~~~~~~~~~~~~ 0 Application Is For Form 0 or Form 0-EZ Form 0-BL Form 70 (individual) Form 0-PF Form 0-T (sec. 0 or 08 trust) Form 0-T (trust other than aove) Return Code Application STOP! Do not complete I if you were not already granted an automatic -month extension on a previously filed Form 888. JOEL D. FELDMAN The ooks are in the care of RIDGE AVE. - SPRINGFIELD, PA 0 Telephone FA 7 8a c Is For Balance due. Sutract line 8 from line 8a. Include your payment with this form, if required, y using 8a EFTPS (Electronic Federal Tax Payment System). See instructions. 8c Signature and Verification must e completed for I only. Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the est of my knowledge and elief, it is true, correct, and complete, and that I am authorized to prepare this form. Signature Title Date Return Code Form 0-A 08 Form 70 Form 7 Form 0 Form 8870 If the organization does not have an office or place of usiness in the United States, check this ox~~~~~~~~~~~~~~~~ If this is for a Group Return, enter the organization s four digit Group Exemption Numer (GEN). If this is for the whole group, check this ox. If it is for part of the group, check this ox and attach a list with the names and EINs of all memers the extension is for. I request an additional -month extension of time until NOVEMBER, 0. For calendar year 0, or other tax year eginning, and ending. If the tax year entered in line is for less than months, check reason: Initial return Final return Change in accounting period State in detail why you need the extension PREPARER NEEDS ADDITIONAL TIME TO REVIEW RETURN WITH BOARD OF DIRECTORS AND OFFICERS OF ORGANIZATION AND RESOLVE OPEN ITEMS IN ORDER TO FILE A COMPLETE AND ACCURATE RETURN. If this application is for Form 0-BL, 0-PF, 0-T, 70, or 0, enter the tentative tax, less any nonrefundale credits. See instructions. If this application is for Form 0-PF, 0-T, 70, or 0, enter any refundale credits and estimated tax payments made. Include any prior year overpayment allowed as a credit and any amount paid previously with Form Form 888 (Rev. -0) 8 0--