EFTA01345291.pdf

Form 990-PF (2016) Page 4 Part VI Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions) la Exempt operating foundations described in section 4940(d)(2), check here ► 0 and enter "N/A" on line 1 Date of ruling or determination letter (attach copy of letter if necessary-see instructions) b Domestic foundations that meet the section 4940(e) requirements in Part V, check 2,684 here IP 0 and enter 1% of Part I, line 27b c All other domestic foundations enter 2% of line 27b Exempt foreign organizations enter 4% of Part I, line 12, col (b) 2 Tax under section 511 (domestic section 4947(8)(1) trusts and taxable foundations only Others enter -0-) 3 Add lines 1 and 2 3 2,684 4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) 4 • Tax based on investment income. Subtract line 4 from line 3 If zero or less, enter -0- 5 2,684 6 Credits/Payments a 2016 estimated tax payments and 2015 overpayment credited to 2016 6a 113 b Exempt foreign organizations—tax withheld at source 6b c Tax paid with application for extension of time to file (Form 8868) . . 6c d Backup withholding erroneously withheld 6d 7 Total credits and payments Add lines 6a through 64 7 113 8 Enter any penalty for underpayment of estimated tax Check here 0 if Form 2220 is attached 8 9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed ► 9 2,571 10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid. ► 10 11 Enter the amount of line 10 to be credited to 2017 estimated tax IP !Refunded ► 11 Part VII-A Statements Regarding Activities la During the tax year, did the foundation attempt to influence any national, state, or local legislation or did Yes No it participate or intervene in any political campaign, la No b Did it spend more than 5100 during the year (either directly or indirectly) for political purposes (see Instructions for definition)7 lb No if the answer is "Yes- to la or lb, attach a detailed description of the activities and copies of any materials published or distributed by the foundation in connection with the activities e Did the foundation file Form 1120-POL for this year/ It No d Enter the amount (if any) of tax on political expenditures (section 4955) imposed dunng the year (1) On the foundation ► $ (2) On foundation managers IP S e Enter the reimbursement (if any) paid by the foundation dunng the year for political expenditure tax imposed on foundation managers ► $ 2 Has the foundation engaged in any activities that have not previously been reported to the 1857 2 No If "Yes,"attaCh a detailed description of the activities 3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or bylaws, or other similar instruments, If "Yes,' attach a conformed copy of the changes . • 3 No 4a Did the foundation have unrelated business gross income of $1,000 or more dunng the year' 4a No b If "Yes," has it filed a tax return on Form 990-T for this year> 4b No 5 Was there a liquidation, termination, dissolution, or substantial contraction dunng the year' 5 No If "Yes," attach the statement required by General Instruction T 6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) 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/ 6 Yes 7 Did the foundation have at least $5,000 in assets at any time dunng the yearThe "Yes," complete Pan II, col (c), and Pan xV 7 Yes ea Enter the states to which the foundation reports or with which it is registered (see instructions) b If the answer is "Yes' to line 7, has the foundation furnished a copy of Form 990•PF to the Attorney General (or designate) of each state as required by General Instruction G> If 10," attach explanation . 8b Yes 9 Is the foundation claiming status as a pnvate operating foundation within the meaning of section 49420)(3) or 49420)(5) for calendar year 2016 or the taxable year beginning in 2016 (see instructions for Part XIV)> If "Yes," complete Pan XIV 9 No 10 Did any persons become substantial contnbutors during the tax year' If "Yes," attach a schedule listing their names and addresses 10 No Form 990-PF 2016) CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0031550 CONFIDENTIAL SDNY_GM_00 177734 EFTA01345291