EFTA01345260.pdf

Form 990-PF (2016) Page 5 Part WI-A Statements Regarding Activities (Continued) 12 At any time dunng the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of section 512(b)(13), If "Yes," attach schedule (see instructions) 11 No 12 Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory pnvileges> If "Yes,' attach statement (see instructions) 12 No 13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application) 13 Yes Website address laN/A 14 The books are in care of PRERIKA KELLERHALS Telephone no a Located at ► ZIP+4 1000802 15 Section 4947(a)(1) nonexempt chantable trusts filing Form 990-PF in lieu of Form 1041 —Check here ► and enter the amount of tax-exempt interest received or accrued dunng the year . . . . . . . . ► 1 15 16 At any time during calendar year 2016, did the foundation have an interest in or a signature or other authonty over Yes No a bank, securities, or other financial account in a foreign country 16 No See instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR) If "Yes', enter the name of the foreign country la Part VII-B Statements Regarding Activities for Which Form 4720 May Be Required File Form 4720 if any item is checked in the "Yes' column, unless an exception applies. Yes No la During the year did the foundation (either directly or indirectly) (1) Engage in the sale or exchange, or leasing of property with a disqualified person> 0 Yes I21 No (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person) 0 Yes No (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person> (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person> 0 Yes No2 (5) Transfer any income or assets to a disqualified person (or make any of either available 0 Yes No2 for the benefit or use of a disqualified person)) (6) Agree to pay money or property to a government official> (Exception. Check "No" 0 Yes No2 if the foundation agreed to make a grant to or to employ the official for a penod after termination of government service, if terminating within 90 days ) 0 Yes No b If any answer is "Yes' to 1a(1)-(6), did any of the acts fail to qualify under the exceptions descnbed m Regulations section 53 4941(d)•3 or in a current notice regarding disaster assistance (see instructions)) lb Organizations relying on a current notice regarding disaster assistance check here c Did the foundation engage in a pnor year in any of the acts described in la, other than excepted acts, that were not corrected before the first day of the tax year beginning in 2016> 2 Taxes on failure to distnbute income (section 4942) (does not apply for years the foundation was a private operating foundation defined in section 49420)(3) or 49420)(5)) a At the end of tax year 2016, did the foundation have any undistnbuted income (lines 64 and 6e, Part XIII) for tax year(s) beginning before 2016) If 'yes," list the years On 20—.....— , 20_ , 20_ , 20_ 0 Yes No2 b Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets) to the year's undistributed income> (If applying section 4942(02) to all years listed, answer 'No" and attach statement—see instructions ) 2b c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here In 20_ , 20_ , 20_ , 20- 3a Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any time during the year) b If "Yes," did it have excess business holdings in 2016 as a result of (1) any purchase by the foundation 0 Yes ❑ 2 No or disqualified persons after May 26, 1969, (2) the lapse of the 5-year penod (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest, or (3) the lapse of the 10-, 15-, or 20-year first phase holding penod>(Use Schedule Co form 4720, to determine if the foundation had excess business holdings in 2016 ) 3b No 4a Did the foundation invest during the year any amount in a manner that would jeopardize its chantable purposes) 4a No b Did the foundation make any investment in a pnor year (but after December 31, 1969) that could jeopardize its chantable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 20167 4b No Fo m 990-PF 2016) CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0031504 CONFIDENTIAL SDNY_GM_00177688 EFTA01345260