EFTA01345292.pdf

Form 990-PF (2016) Page 10 Part XIV Private Operating Foundations (see instructions and Part VII-A, question 9) la If the foundation has received a ruling or determination letter that it is a pnvate operating foundation, and the ruling is effective for 2016, enter the date of the ruling ► b Check box to indicate whether the organization is a private operating foundation described in section ❑ 4942(7)(3) or ❑ 4942;j)(5) 2a Enter the lesser of the adjusted net Tax year Prior 3 years income from Part I or the minimum (e) Total (a) 2016 (b) 2015 (c) 2014 (d) 20.3 investment return from Part X for each year listed . . . . . . . . . b 85% of line 2a c Qualifying distributions from Part XII, line 4 for each year listed . . . . . d Amounts included in line 2c not used directly for active conduct of exempt e Qualifying distributions made directly for active conduct of exempt activities Subtract line 2d from line 2c . . . . 3 Complete 3a, b, or c for the alternative test relied upon a 'Assets' alternative test—enter (1) Value of all assets (2) Value of assets qualifying under section 49420)(3)03)(i) b 'Endowment" alternative test— enter 2/3 of minimum investment return shown in Part X, line 6 for each year listed. . . c "Support" alternative test—enter (1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(8)(5)), or royalties) . (2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(8)(m). (3) Largest amount of support from an exempt organization (4) Gross investment income Supplementary Information (Complete this part only if the organization had $5,000 or more in Part XV assets at any time during the year—see instructions.) 1 Information Regarding Foundation Managers: a east any managers of the foundation who have contnbuted more than 2% of the total contributions received by the foundation before the close of any tax year (but only if they have contributed more than $5,000) (See section 507(d)(2) ) b list any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or other entity) of which the foundation has a 10% or greater interest 2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs: Check here ► 2 if the foundation only makes contributions to preselected charitable 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 2a, b, c, and d a The name, address, and telephone number or email address of the person to whom applications should be addressed b The form in which applications should be submitted and information and materials they should include c Any submission deadlines d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors Form 990-PF (2016) CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0031556 CONFIDENTIAL SDNY_GM_00 177740 EFTA01345292