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

Transcription

1 611 Form 99-PF Return of Private Foundation or Setion 4947(a)(1) Trust Treated as Private Foundation Department of the Treasury u Do not enter Soial Seurity numers on this form as it may e made puli. Internal Revenue Servie u Information aout Form 99-PF and its separate instrutions is at For alendar year 1 or tax year eginning, and ending Name of foundation A Employer identifiation numer OMB No Open to Puli Inspetion G H I Fair market value of all assets at J Aounting method: Cash Arual end of year (from Part II, ol. (), Other (speify) line 16) u $ 8,69,45 (Part I, olumn (d) must e on ash asis.) Part I Analysis of Revenue and Expenses (The total of (a) Revenue and Revenue Operating and Administrative Expenses Chek all that apply: Chek type of organization: 1 4 5a 6a a 11 1 Total. Add lines 1 through a Total operating and administrative expenses Initial return Final return Address hange Setion 4947(a)(1) nonexempt haritale trust a Exess of revenue over expenses and disursements... Net investment inome (if negative, enter --) Adjusted net inome (if negative, enter --) For Paperwork Redution At Notie, see instrutions. DAA THE GERBER FOUNDATION Numer and street (or P.O. ox numer if mail is not delivered to street address) City or town, state or provine, ountry, and ZIP or foreign postal ode Amended return Name hange Setion 51()() exempt private foundation amounts in olumns (), (), and (d) may not neessarily equal the amounts in olumn (a) (see instrutions).) Contriutions, gifts, grants, et., reeived (attah shedule)... Chek u if the foundation is not required to attah Sh. B Interest on savings and temporary ash investments Dividends and interest from seurities Gross rents Net rental inome or (loss) Net gain or (loss) from sale of assets not on line Gross sales prie for all assets on line 6a Capital gain net inome (from Part IV, line ) Net short-term apital gain Inome modifiations Gross sales less returns and allowanes Less: Cost of goods sold Gross profit or (loss) (attah shedule) Other inome (attah shedule) Compensation of offiers, diretors, trustees, et Other employee salaries and wages Pension plans, employee enefits Legal fees (attah shedule) Aounting fees (attah shedule) Other professional fees (attah shedule) Interest Taxes (attah shedule) (see instrutions) Depreiation (attah shedule) and depletion Oupany Travel, onferenes, and meetings Printing and puliations Other expenses (att. sh.) Add lines 1 through Contriutions, gifts, grants paid Sutrat line 6 from line 1: Other taxale private foundation expenses per ooks Room/suite 4747 W. 48TH STREET 15 FREMONT MI 4941 Total expenses and disursements. Add lines 4 and 5.. Initial return of a former puli harity 59,567,998 17,515 4,77 5,98,8 STMT 1 1,,48 6,95,6 84,48 1,6 STMT 4,751 STMT 11,885 STMT 4 1,99 5,9 9,48,41 STMT 5 96,66 66,86,51,6 4,116,48,86,55 B C D 1. E F Telephone numer (see instrutions) If exemption appliation is pending, hek here Foreign organizations, hek here Foreign organizations meeting the 85% test, hek here and attah omputation.... If private foundation status was terminated under setion 57()(1)(A), hek here If the foundation is in a 6-month termination under setion 57()(1)(B), hek here (d) Disursements () Net investment () Adjusted net for haritale inome inome purposes (ash asis only) 17,515 4,77 5,98,8 1,,48 6,95,6, ,4 46,544 5,76 5,76 6,71,897 8,199,,78 5,9 9,48,41 48,91 51,98,51,6,76,45

2 611 Part II 1 THE GERBER FOUNDATION Balane Sheets Cash non-interest-earing Savings and temporary ash investments Aounts reeivale u Beginning of year End of year Attahed shedules and amounts in the desription olumn should e for end-of-year amounts only. (See instrutions.) (a) Book Value () Book Value () Fair Market Value,499,681 1,4,94 Page 1,4,7 4 Less: allowane for doutful aounts u Pledges reeivale u Less: allowane for doutful aounts u Grants reeivale Reeivales due from offiers, diretors, trustees, and other disqualified persons (attah shedule) (see Assets a 11 instrutions) Other notes and loans reeivale (att. shedule) u Less: allowane for doutful aounts u Inventories for sale or use Prepaid expenses and deferred harges Investments U.S. and state government oligations (attah shedule) Investments orporate stok (attah shedule) Investments orporate onds (attah shedule) Investments land, uildings, and equipment: asis u SEE STMT 6 59,198,17 64,49,185 8,648,11 Liailities Net Assets or Fund Balanes Total assets (to e ompleted y all filers see the Total liailities (add lines 17 through ) Foundations that follow SFAS 117, hek here u and omplete lines 4 through 6 and lines and Less: aumulated depreiation (attah sh.) u Investments mortgage loans Investments other (attah shedule) ,4 Land, uildings, and equipment: asis u Less: aumulated depreiation (attah sh.) u.. STMT , ,15,15 Other assets (desrie u ) instrutions. Also, see page 1, item l) Aounts payale and arued expenses Grants payale Deferred revenue Loans from offiers, diretors, trustees, and other disqualified persons Mortgages and other notes payale (attah shedule) Other liailities (desrie u ) Unrestrited Temporarily restrited Permanently restrited Foundations that do not follow SFAS 117, hek here u and omplete lines 7 through 1. 6,7,959 7 Capital stok, trust prinipal, or urrent funds Paid-in or apital surplus, or land, ldg., and equipment fund Retained earnings, aumulated inome, endowment, or other funds Total net assets or fund alanes (see instrutions) ,7,959 1 Total liailities and net assets/fund alanes (see instrutions) ,7,959 Part III Analysis of Changes in Net Assets or Fund Balanes 1 Total net assets or fund alanes at eginning of year Part II, olumn (a), line (must agree with end-of-year figure reported on prior year's return) Enter amount from Part I, line 7a Other inreases not inluded in line (itemize) u Add lines 1,, and Dereases not inluded in line (itemize) u Total net assets or fund alanes at end of year (line 4 minus line 5) Part II, olumn (), line ,7,959 65,57,14 65,57,14 65,57,14 65,57,14,7 8,69,45 6,7,959,86,55 65,57,14 65,57,14 DAA

3 611 Part IV Capital Gains and Losses for Tax on Investment Inome 1a d e a d (e) Gross sales prie (i) F.M.V. as of 1/1/69 (a) List and desrie the kind(s) of property sold (e.g., real estate, -story rik warehouse; or ommon stok, shs. MLC Co.) () How aquired P Purhase D Donation If gain, also enter in Part I, line 8, olumn () (see instrutions). If (loss), enter -- in } Part I, line Part V Qualifiation Under Setion 494(e) for Redued Tax on Net Investment Inome (For optional use y domesti private foundations sujet to the setion 494(a) tax on net investment inome.) (a) Base period years Calendar year (or tax year eginning in) 1 () Date aquired (mo., day, yr.) (f) Depreiation allowed (g) Cost or other asis (h) Gain or (loss) (or allowale) plus expense of sale (e) plus (f) minus (g) e Complete only for assets showing gain in olumn (h) and owned y the foundation on 1/1/69 1 a d e Capital gain net inome or (net apital loss) (d) Date sold (mo., day, yr.) (l) Gains (Col. (h) gain minus (j) Adjusted asis (k) Exess of ol. (i) ol. (k), ut not less than --) or as of 1/1/69 over ol. (j), if any Losses (from ol. (h)) If gain, also enter in Part I, line 7 If (loss), enter -- in Part I, line 7 Net short-term apital gain or (loss) as defined in setions 1(5) and (6): If setion 494(d)() applies, leave this part lank. Was the foundation liale for the setion 494 tax on the distriutale amount of any year in the ase period? Yes No If Yes, the foundation does not qualify under setion 494(e). Do not omplete this part. Enter the appropriate amount in eah olumn for eah year; see the instrutions efore making any entries THE GERBER FOUNDATION HEDGE FUNDS PIMCO NWQ CAPITAL GAINS FROM PARTNERSHIP K-1'S CAPITAL GAINS FROM PARTNERSHIP K-1'S () Adjusted qualifying distriutions } P P P P P () Net value of nonharitale-use assets (d) Distriution ratio (ol. () divided y ol. ()) Page 5,458,688,5,86 1,96, 1,59,41 1,87,756 1,71,645 19,44,67 19,89, -584,656 14,51 14,51,191,9,191,9 1,96, 1,71, ,656 14,51,191,9 5,98,8 14,51,81,15 69,66, ,57,156 7,4, ,66,871 67,868, ,9,6 6,457, ,7,187 74,96,1.646 Total of line 1, olumn (d) Enter the net value of nonharitale-use assets for 1 from Part, line Multiply line 4 y line Enter 1% of net investment inome (1% of Part I, line 7) Add lines 5 and Enter qualifying distriutions from Part II, line If line 8 is equal to or greater than line 7, hek the ox in Part VI, line 1, and omplete that part using a 1% tax rate. See the DAA Average distriution ratio for the 5-year ase period divide the total on line y 5, or y the numer of years the foundation has een in existene if less than 5 years Part VI instrutions ,179,89,467,594 67,19,54,61,76,45

4 611 Part VI Exise Tax Based on Investment Inome (Setion 494(a), 494(), 494(e), or 4948 see instrutions) 1a Exempt operating foundations desried in setion 494(d)(), hek here u and enter N/A on line 1. a 1 estimated tax payments and 1 overpayment redited to a Exempt foreign organizations tax withheld at soure Tax paid with appliation for extension of time to file (Form 8868) d Bakup withholding erroneously withheld d 7 Total redits and payments. Add lines 6a through 6d Enter any penalty for underpayment of estimated tax. Chek here if Form is attahed Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed u 9 1 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid u 1 11 Enter the amount of line 1 to e: Credited to 14 estimated tax u 1,981 Refunded u 11 Part VII-A Statements Regarding Ativities 1a During the tax year, did the foundation attempt to influene any national, state, or loal legislation or did it Yes No d e (1) On the foundation. u $ () On foundation managers. u $ Has the foundation engaged in any ativities that have not previously een reported to the IRS? If Yes, attah a detailed desription of the ativities. onflit with the state law remain in the governing instrument? Did the foundation have at least $5, in assets at any time during the year? If Yes, omplete Part II, ol. (), and Part V a Enter the states to whih the foundation reports or with whih it is registered (see instrutions) u 9 1 Date of ruling or determination letter: (attah opy of letter if neessary see instrutions) Domesti foundations that meet the setion 494(e) requirements in Part V, hek } 1 here u and enter 1% of Part I, line All other domesti foundations enter % of line 7. Exempt foreign organizations enter 4% of Part I, line 1, ol. (). 4 Tax under setion 511 (domesti setion 4947(a)(1) trusts and taxale foundations only. Others enter --) Add lines 1 and Sutitle A (inome) tax (domesti setion 4947(a)(1) trusts and taxale foundations only. Others enter --) Tax ased on investment inome. Sutrat line 4 from line. If zero or less, enter Credits/Payments: partiipate or intervene in any politial ampaign? Did it spend more than $1 during the year (either diretly or indiretly) for politial purposes (see Instrutions for the definition)? If the answer is Yes to 1a or 1, attah a detailed desription of the ativities and opies of any materials pulished or distriuted y the foundation in onnetion with the ativities. Did the foundation file Form 11-POL for this year? Enter the amount (if any) of tax on politial expenditures (setion 4955) imposed during the year: Enter the reimursement (if any) paid y the foundation during the year for politial expenditure tax imposed on foundation managers. u $ Has the foundation made any hanges, not previously reported to the IRS, in its governing instrument, artiles of inorporation, or ylaws, or other similar instruments? If Yes, attah a onformed opy of the hanges a Did the foundation have unrelated usiness gross inome of $1, or more during the year? a If Yes, has it filed a tax return on Form 99-T for this year? N/A Was there a liquidation, termination, dissolution, or sustantial ontration during the year? If Yes, attah the statement required y General Instrution T. 6 Are the requirements of setion 58(e) (relating to setions 4941 through 4945) satisfied either: By language in the governing instrument, or By state legislation that effetively amends the governing instrument so that no mandatory diretions that MI THE GERBER FOUNDATION If the answer is Yes to line 7, has the foundation furnished a opy of Form 99-PF to the Attorney General (or designate) of eah state as required y General Instrution G? If No, attah explanation Is the foundation laiming status as a private operating foundation within the meaning of setion 494(j)() or 494(j)(5) for alendar year 1 or the taxale year eginning in 1 (see instrutions for Part IV)? If Yes, 8, omplete Part IV Did any persons eome sustantial ontriutors during the tax year? If Yes, attah a shedule listing their names and addresses a Page 4 67,19 67,19 67,19 8, 1,981 DAA

5 611 THE GERBER FOUNDATION Part VII-A Statements Regarding Ativities (ontinued) 11 At any time during the year, did the foundation, diretly or indiretly, own a ontrolled entity within the over a ank, seurities, or other finanial aount in a foreign ountry? See the instrutions for exeptions and filing requirements for Form TD F If Yes, enter the name of the foreign ountry u Part VII-B Statements Regarding Ativities for Whih Form 47 May Be Required File Form 47 if any item is heked in the Yes olumn, unless an exeption applies. Yes No 1a a a 4a meaning of setion 51()(1)? If Yes, attah shedule (see instrutions) Did the foundation make a distriution to a donor advised fund over whih the foundation or a disqualified person had advisory privileges? If Yes, attah statement (see instrutions) Did the foundation omply with the puli inspetion requirements for its annual returns and exemption appliation? During the year did the foundation (either diretly or indiretly): (1) Engage in the sale or exhange, or leasing of property with a disqualified person? Yes No () Borrow money from, lend money to, or otherwise extend redit to (or aept it from) a disqualified person? Yes No () Furnish goods, servies, or failities to (or aept them from) a disqualified person? Yes No (4) Pay ompensation to, or pay or reimurse the expenses of, a disqualified person? Yes No (5) Transfer any inome or assets to a disqualified person (or make any of either availale for (6) Wesite address u The ooks are in are of u.... CATHY OBITS Telephone no. u WEST 48TH STREET Loated at u. FREMONT MI ZIP+4 u Setion 4947(a)(1) nonexempt haritale trusts filing Form 99-PF in lieu of Form 141 Chek here u and enter the amount of tax-exempt interest reeived or arued during the year u At any time during alendar year 1, did the foundation have an interest in or a signature or other authority the enefit or use of a disqualified person)? Agree to pay money or property to a government offiial? (Exeption. Chek No if the foundation agreed to make a grant to or to employ the offiial for a period after termination of government servie, if terminating within 9 days.) If any answer is Yes to 1a(1) (6), did any of the ats fail to qualify under the exeptions desried in Regulations setion (d)- or in a urrent notie regarding disaster assistane (see instrutions)? Organizations relying on a urrent notie regarding disaster assistane hek here u Did the foundation engage in a prior year in any of the ats desried in 1a, other than exepted ats, that were not orreted efore the first day of the tax year eginning in 1? Taxes on failure to distriute inome (setion 494) (does not apply for years the foundation was a private operating foundation defined in setion 494(j)() or 494(j)(5)): At the end of tax year 1, did the foundation have any undistriuted inome (lines 6d and 6e, Part III) for tax year(s) eginning efore 1? If Yes, list the years u......,......,.....,..... Are there any years listed in a for whih the foundation is not applying the provisions of setion 494(a)() (relating to inorret valuation of assets) to the year's undistriuted inome? (If applying setion 494(a)() to all years listed, answer No and attah statement see instrutions.) If the provisions of setion 494(a)() are eing applied to any of the years listed in a, list the years here. u.....,......,......, Did the foundation hold more than a % diret or indiret interest in any usiness enterprise at any time during the year? If Yes, did it have exess usiness holdings in 1 as a result of (1) any purhase y the foundation or disqualified persons after May 6, 1969; () the lapse of the 5-year period (or longer period approved y the Commissioner under setion 494()(7)) to dispose of holdings aquired y gift or equest; or () the lapse of the 1-, 15-, or -year first phase holding period? (Use Shedule C, Form 47, to determine if the foundation had exess usiness holdings in 1.) Did the foundation invest during the year any amount in a manner that would jeopardize its haritale purposes? Did the foundation make any investment in a prior year (ut after Deemer 1, 1969) that ould jeopardize its haritale purpose that had not een removed from jeopardy efore the first day of the tax year eginning in 1? Yes Yes Yes Yes No No N/A N/A No N/A No N/A a 4 Yes Page 5 No DAA

6 611 Part VII-B Statements Regarding Ativities for Whih Form 47 May Be Required (ontinued) 5a During the year did the foundation pay or inur any amount to: 6a (1) () () (4) (5) Carry on propaganda, or otherwise attempt to influene legislation (setion 4945(e))? Influene the outome of any speifi puli eletion (see setion 4955); or to arry on, diretly or indiretly, 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 haritale, et., organization desried in setion 59(a)(1), (), or (), or setion 494(d)()? (see instrutions) Provide for any purpose other than religious, haritale, sientifi, literary, or eduational purposes, or for the prevention of ruelty to hildren or animals? If any answer is Yes to 5a(1) (5), did any of the transations fail to qualify under the exeptions desried in Regulations setion or in a urrent notie regarding disaster assistane (see instrutions)? Organizations relying on a urrent notie regarding disaster assistane hek here u If the answer is Yes to question 5a(4), does the foundation laim exemption from the tax eause it maintained expenditure responsiility for the grant? If Yes, attah the statement required y Regulations setion (d). Did the foundation, during the year, reeive any funds, diretly or indiretly, to pay premiums on a personal enefit ontrat? Did the foundation, during the year, pay premiums, diretly or indiretly, on a personal enefit ontrat? If Yes to 6, file Form a At any time during the tax year, was the foundation a party to a prohiited tax shelter transation? Yes No If Yes, did the foundation reeive any proeeds or have any net inome attriutale to the transation? Part VIII Information Aout Offiers, Diretors, Trustees, Foundation Managers, Highly Paid Employees, and Contrators 1 List all offiers, diretors, trustees, foundation managers and their ompensation (see instrutions). SEE STATEMENT 8 THE GERBER FOUNDATION (a) Name and address () Title, and average hours per week devoted to position N/A () Compensation (If not paid, enter --) Yes Yes Yes Yes Yes Yes Yes No No No No No N/A No No N/A (d) Contriutions to employee enefit plans and deferred ompensation 5 6 Page 6 (e) Expense aount, other allowanes Compensation of five highest-paid employees (other than those inluded on line 1 see instrutions). If none, enter NONE. CATHY OBITS (a) Name and address of eah employee paid more than $5, WEST 48TH STREET FREMONT MI () Title, and average hours per week devoted to position PROGRAM MANA () Compensation (d) Contriutions to employee enefit plans and deferred ompensation (e) Expense aount, other allowanes 4. 77,5 6, Total numer of other employees paid over $5, DAA

7 611 THE GERBER FOUNDATION Part VIII Information Aout Offiers, Diretors, Trustees, Foundation Managers, Highly Paid Employees, and Contrators (ontinued) Five highest-paid independent ontrators for professional servies (see instrutions). If none, enter NONE. NONE (a) Name and address of eah person paid more than $5, () Type of servie () Compensation Page Total numer of others reeiving over $5, for professional servies Part I-A Summary of Diret Charitale Ativities u List the foundation's four largest diret haritale ativities during the tax year. Inlude relevant statistial information suh as the numer of organizations and other enefiiaries served, onferenes onvened, researh papers produed, et. 1 N/A Expenses Part I-B Summary of Program-Related Investments (see instrutions) Desrie the two largest program-related investments made y the foundation during the tax year on lines 1 and. 1 N/A Amount All other program-related investments. See instrutions Total. Add lines 1 through DAA

8 611 Part Minimum Investment Return (All domesti foundations must omplete this part. Foreign foundations, see instrutions.) 1 Fair market value of assets not used (or held for use) diretly in arrying out haritale, et., a Average monthly fair market value of seurities a Average of monthly ash alanes Fair market value of all other assets (see instrutions) d Total (add lines 1a,, and ) d e purposes: Redution laimed for lokage or other fators reported on lines 1a and 1 (attah detailed explanation) e Aquisition indetedness appliale to line 1 assets Sutrat line from line 1d Cash deemed held for haritale ativities. Enter 1½% of line (for greater amount, see instrutions) Net value of nonharitale-use assets. Sutrat line 4 from line. Enter here and on Part V, line Minimum investment return. Enter 5% of line Part I Distriutale Amount (see instrutions) (Setion 494(j)() and (j)(5) private operating foundations and ertain foreign organizations hek here u and do not omplete this part.) 1 Minimum investment return from Part, line a Tax on investment inome for 1 from Part VI, line a 67,19 Inome tax for 1. (This does not inlude the tax from Part VI.) Add lines a and Distriutale amount efore adjustments. Sutrat line from line Reoveries of amounts treated as qualifying distriutions Add lines and Dedution from distriutale amount (see instrutions) Distriutale amount as adjusted. Sutrat line 6 from line 5. Enter here and on Part III, line Part II THE GERBER FOUNDATION Qualifying Distriutions (see instrutions) 4 7 Page 8 7,94,597 5,48 7,79,79 7,79,79 1,99,186 7,179,89,68,995,68,995 67,19,541,976 1,8,54,14,54,14 1 a a Suitaility test (prior IRS approval required) a Cash distriution test (attah the required shedule) Qualifying distriutions. Add lines 1a through. Enter here and on Part V, line 8, and Part III, line Amounts paid (inluding administrative expenses) to aomplish haritale, et., purposes: Expenses, ontriutions, gifts, et. total from Part I, olumn (d), line Program-related investments total from Part I-B Amounts paid to aquire assets used (or held for use) diretly in arrying out haritale, et., purposes Amounts set aside for speifi haritale projets that satisfy the: Foundations that qualify under setion 494(e) for the redued rate of tax on net investment inome. Enter 1% of Part I, line 7 (see instrutions) Adjusted qualifying distriutions. Sutrat line 5 from line Note. The amount on line 6 will e used in Part V, olumn (), in susequent years when alulating whether the foundation qualifies for the setion 494(e) redution of tax in those years. 1a 1,76,45,76,45 67,19,695,6 DAA

9 611 Part III Undistriuted Inome (see instrutions) 1 a a d e f Total of lines a through e Qualifying distriutions for 1 from Part II, a Distriutale amount for 1 from Part I, line Undistriuted inome, if any, as of the end of 1: Enter amount for 1 only Total for prior years:,, Exess distriutions arryover, if any, to 1: From From From From line 4: u $ THE GERBER FOUNDATION From ,76,45 64,8,8 Applied to 1, ut not more than line a Applied to undistriuted inome of prior years (a) () () (d) Corpus Years prior to ,171 Page 9,54,14 (Eletion required see instrutions) Treated as distriutions out of orpus (Eletion 5 d e 6 Enter the net total of eah olumn as a required see instrutions) Applied to 1 distriutale amount Remaining amount distriuted out of orpus Exess distriutions arryover applied to (If an amount appears in olumn (d), the same amount must e shown in olumn (a).) indiated elow: Corpus. Add lines f, 4, and 4e. Sutrat line Prior years' undistriuted inome. Sutrat 18,81 814,,54,14 line 4 from line Enter the amount of prior years' undistriuted inome for whih a notie of defiieny has een issued, or on whih the setion 494(a) d tax has een previously assessed Sutrat line 6 from line 6. Taxale e f 7 8 amount see instrutions Undistriuted inome for 1. Sutrat line 4a from line a. Taxale amount see instrutions Undistriuted inome for 1. Sutrat lines 4d and 5 from line 1. This amount must e distriuted in Amounts treated as distriutions out of orpus to satisfy requirements imposed y setion 17()(1)(F) or 494(g)() (see instrutions) Exess distriutions arryover from 8 not applied on line 5 or line 7 (see instrutions) Exess distriutions arryover to a d e Sutrat lines 7 and 8 from line 6a Analysis of line 9: Exess from Exess from Exess from Exess from Exess from ,8,8 18,81 814, DAA

10 611 Part IV Private Operating Foundations (see instrutions and Part VII-A, question 9) 1a If the foundation has reeived a ruling or determination letter that it is a private operating foundation, and the ruling is effetive for 1, enter the date of the ruling u Chek ox to indiate whether the foundation is a private operating foundation desried in setion 494(j)() or 494(j)(5) a Enter the lesser of the adjusted net Tax year Prior years inome from Part I or the minimum investment return from Part for THE GERBER FOUNDATION (a) 1 () 1 () 11 (d) 1 (e) Total Page 1 d e a eah year listed % of line a Qualifying distriutions from Part II, line 4 for eah year listed Amounts inluded in line not used diretly for ative ondut of exempt ativities..... Qualifying distriutions made diretly for ative ondut of exempt ativities. Sutrat line d from line Complete a,, or for the alternative test relied upon: Assets alternative test enter: (1) () (1) () () Value of all assets Value of assets qualifying under setion 494(j)()(B)(i) Endowment alternative test enter / of minimum investment return shown in Part, line 6 for eah year listed..... Support alternative test enter: Total support other than gross investment inome (interest, dividends, rents, payments on seurities loans (setion 51(a)(5)), or royalties) Support from general puli and 5 or more exempt organizations as provided in setion 494(j)()(B)(iii) Largest amount of support from an exempt organization (4) Gross investment inome Part V Supplementary Information (Complete this part only if the foundation had $5, or more in assets at any time during the year see instrutions.) 1 Information Regarding Foundation Managers: a Information Regarding Contriution, Grant, Gift, Loan, Sholarship, et., Programs: Chek here u if the foundation only makes ontriutions to preseleted haritale organizations and does not aept unsoliited requests for funds. If the foundation makes gifts, grants, et. (see instrutions) to individuals or organizations under other onditions, omplete items a,,, and d. a d List any managers of the foundation who have ontriuted more than % of the total ontriutions reeived y the foundation efore the lose of any tax year (ut only if they have ontriuted more than $5,). (See setion 57(d)().) N/A List any managers of the foundation who own 1% or more of the stok of a orporation (or an equally large portion of the ownership of a partnership or other entity) of whih the foundation has a 1% or greater interest. N/A The name, address, and telephone numer or address of the person to whom appliations should e addressed: CATHY OBITS WEST 48TH STREET FREMONT MI 4941 The form in whih appliations should e sumitted and information and materials they should inlude: GRANT APPLICATION FORM Any sumission deadlines: FEBRUARY 15 AND AUGUST 15 Any restritions or limitations on awards, suh as y geographial areas, haritale fields, kinds of institutions, or other fators: SEE STATEMENT 9 DAA

11 611 THE GERBER FOUNDATION Part V Supplementary Information (ontinued) Grants and Contriutions Paid During the Year or Approved for Future Payment a Reipient Name and address (home or usiness) Paid during the year If reipient is an individual, show any relationship to any foundation manager or sustantial ontriutor Foundation status of reipient Purpose of grant or ontriution Amount Page 11 SEE ATTACHED SEE ATTACHED FREMONT MI 4941 SEE ATTACHED,51,6 Total Approved for future payment N/A u a,51,6 Total u DAA

12 611 THE GERBER FOUNDATION Part VI-A Analysis of Inome-Produing Ativities Enter gross amounts unless otherwise indiated Program servie revenue: a d e f g a Det-finaned property Not det-finaned property Net rental inome or (loss) from personal property Other investment inome Gain or (loss) from sales of assets other than inventory Net inome or (loss) from speial events Gross profit or (loss) from sales of inventory Other revenue: a d e 1 Sutotal. Add olumns (), (d), and (e) Total. Add line 1, olumns (), (d), and (e) (See worksheet in line 1 instrutions to verify alulations.) Part VI-B Relationship of Ativities to the Aomplishment of Exempt Purposes Line No. q Fees and ontrats from government agenies Memership dues and assessments Interest on savings and temporary ash investments Dividends and interest from seurities Net rental inome or (loss) from real estate: N/A Unrelated usiness inome Exluded y setion 51, 51, or 514 (a) () () (d) Business ode Amount Exlusion Amount ode 14 17, , ,, ,98,8 Explain elow how eah ativity for whih inome is reported in olumn (e) of Part VI-A ontriuted importantly to the aomplishment of the foundation s exempt purposes (other than y providing funds for suh purposes). (See instrutions.) Page 1 (e) Related or exempt funtion inome (See instrutions.) 6,95,6 6,95,6 DAA

13 611 Page 1 Part VII Information Regarding Transfers To and Transations and Relationships With Nonharitale Exempt Organizations 1 Did the organization diretly or indiretly engage in any of the following with any other organization desried Yes No a organizations? (1) 1a(1) () Other assets a() Other transations: (1) Sales of assets to a nonharitale exempt organization (1) () Purhases of assets from a nonharitale exempt organization () () Rental of failities, equipment, or other assets () (4) Reimursement arrangements (4) (5) Loans or loan guarantees (5) (6) Performane of servies or memership or fundraising soliitations (6) d Sharing of failities, equipment, mailing lists, other assets, or paid employees If the answer to any of the aove is Yes, omplete the following shedule. Column () should always show the fair market 1 N/A THE GERBER FOUNDATION in setion 51() of the Code (other than setion 51()() organizations) or in setion 57, relating to politial Transfers from the reporting foundation to a nonharitale exempt organization of: Cash value of the goods, other assets, or servies given y the reporting foundation. If the foundation reeived less than fair market value in any transation or sharing arrangement, show in olumn (d) the value of the goods, other assets, or servies reeived. (a) Line no. () Amount involved () Name of nonharitale exempt organization (d) Desription of transfers, transations, and sharing arrangements a Is the foundation diretly or indiretly affiliated with, or related to, one or more tax-exempt organizations desried in setion 51() of the Code (other than setion 51()()) or in setion 57? Yes No If Yes, omplete the following shedule. N/A (a) Name of organization () Type of organization () Desription of relationship Sign Here Under penalties of perjury, I delare that I have examined this return, inluding aompanying shedules and statements, and to the est of my knowledge and elief, it is true, orret, and omplete. Delaration of preparer (other than taxpayer) is ased on all information of whih preparer has any knowledge. May the IRS disuss this return with the preparer shown elow (see instrutions)? Yes No Signature of offier or trustee Date Title TREASURER Paid Preparer Use Only Print/Type preparer's name Preparer's signature C. JOHN KORSTANGE, JR. C. JOHN KORSTANGE, JR. 11//14 Firm's name PTIN Firm's address Firm's EIN H&S COMPANIES, P.C. P.O. BO 9 FREMONT, MI 4941 Phone no. Date Chek if self-employed P DAA

14 611 Form 456 Department of the Treasury Internal Revenue Servie Name(s) shown on return (99) Business or ativity to whih this form relates INDIRECT DEPRECIATION Depreiation and Amortization (Inluding Information on Listed Property) u See separate instrutions. u Attah to your tax return. Identifying numer THE GERBER FOUNDATION Part I Eletion To Expense Certain Property Under Setion 179 Note: If you have any listed property, omplete Part V efore you omplete Part I. 1 Maximum amount (see instrutions) Total ost of setion 179 property plaed in servie (see instrutions) Threshold ost of setion 179 property efore redution in limitation (see instrutions) Redution in limitation. Sutrat line from line. If zero or less, enter Dollar limitation for tax year. Sutrat line 4 from line 1. If zero or less, enter --. If married filing separately, see instrutions (a) Desription of property () Cost (usiness use only) () Eleted ost OMB No Attahment Sequene No ,,, 7 Listed property. Enter the amount from line Total eleted ost of setion 179 property. Add amounts in olumn (), lines 6 and Tentative dedution. Enter the smaller of line 5 or line Carryover of disallowed dedution from line 1 of your 1 Form Business inome limitation. Enter the smaller of usiness inome (not less than zero) or line 5 (see instrutions) Setion 179 expense dedution. Add lines 9 and 1, ut do not enter more than line Carryover of disallowed dedution to 14. Add lines 9 and 1, less line Note: Do not use Part II or Part III elow for listed property. Instead, use Part V. Part II Speial Depreiation Allowane and Other Depreiation (Do not inlude listed property.) (See instrutions.) 14 Speial depreiation allowane for qualified property (other than listed property) plaed in servie during the tax year (see instrutions) Property sujet to setion 168(f)(1) eletion Other depreiation (inluding ACRS) Part III MACRS Depreiation (Do not inlude listed property.) (See instrutions.) Setion A 17 MACRS dedutions for assets plaed in servie in tax years eginning efore If you are eleting to group any assets plaed in servie during the tax year into one or more general asset aounts, hek here u Setion B Assets Plaed in Servie During 1 Tax Year Using the General Depreiation System DAA () Month and year () Basis for depreiation (d) Reovery (a) Classifiation of property plaed in (usiness/investment use (e) Convention (f) Method (g) Depreiation dedution servie only see instrutions) period 19a -year property 5-year property 7-year property d 1-year property e 15-year property f -year property g 5-year property 5 yrs. S/L h Residential rental 7.5 yrs. MM S/L property 7.5 yrs. MM S/L i Nonresidential real 9 yrs. MM S/L property MM S/L Setion C Assets Plaed in Servie During 1 Tax Year Using the Alternative Depreiation System a Class life S/L 1-year 1 yrs. S/L 4-year 4 yrs. MM S/L Part IV Summary (See instrutions.) 1 Listed property. Enter amount from line Total. Add amounts from line 1, lines 14 through 17, lines 19 and in olumn (g), and line 1. Enter here and on the appropriate lines of your return. Partnerships and S orporations see instrutions For assets shown aove and plaed in servie during the urrent year, enter the portion of the asis attriutale to setion 6A osts For Paperwork Redution At Notie, see separate instrutions. THERE ARE NO AMOUNTS FOR PAGE 1,99 1,99 Form 456 (1)