O\JA. or Section 4947(a)(1) Trust Treated as Private Foundation 01 7

Transcription

1 'Form 990-PF '. Return of Privte Foundtion OMB No or Setion 4947()(1) Trust Treted s Privte Foundtion 01 7 Deprtment of the Tresury Do not enter soil seurity numers on this form s it my e mde puli. internl Revenu9' Servie Go to www. irs.gov/form99opf for instrutions nd the ltest informtion. z For lendr yer 2017 or tx yer eoinnin nd endin. 20 Nme o1foundtion A Employer identifition numer 1Tem1Gol Numer nd street (or P 0 ox numer if mil is not delivered to street ddress) Room/suite B Telephone numer (see instrutions) 1103 Gr y Fox Lne ( 615 ) City or town, stte or provine, ountry, nd ZIP or foreign postl ode C If exemption pplition is pending, hek here q Frnklin TN G Chek ll tht pply: q Initil return q Initil return of former puli hrity D 1. Foreign orgniztions, hek here q q Finl return q Amended return 2. Foreign orgniztions meeting the 85% test, q Address hnge El Nme hnge hek here nd tth omputtion q H Chek type of orgniztion: Setion 501 ()(3) exempt privte foundtion E If privte foundtion sttus ws terminted under setion 507()(1)(A), hek here... Do- El Setion 4947()(1) nonexempt hritle trust [I Other txle privte foundtion El E Fir mrket vlue of ll ssets t J Aounting method: Csh q Arul F If the foundtion is in 60 -month termintion end of yer (from Prt II, ol. (), q Other (speify) I under setion 507()(1)(B), hek here E] --- line 16) $ 3,507. (Prt I, olumn (d) must e- on-sh sis.) Anlysis of Revenue nd Expenses (The totl of () Revenue nd (d) Disursements () mounts in olumns (), (), nd (d) my not neessrily equl expenses per Net investment () Adjusted net for hritle inome inome the mounts in olumn () (see instrutions)) ooks purposes (sh sis only) 1 Contriutions, gifts, grnts, et., reeived (tth shedule) 2, Chek if the foundtion is not required to tth Sh. B 3 Interest on svings nd temporry sh investments 4 Dividends nd interest from seurities Gross rents Net rentl inome or (loss) 6 Net gin or (loss) from sle of ssets not on line 10 Gross sles prie for ll sse o > 7 Cpitl gin net inomj (fr in ) iw- 8 Net short-term pitl i 9 Inome modifitions OCT. 0: o 10 Gross sles less returns n Ilownes Less: Cost of goods so d ^^ Gross profit or (loss) ( 11 Other inome (tth shedule) See. Stmt: Totl. Add lines 1 through 11 2, Compenstion of offiers, diretors, trustees, et. 14 Other employee slries nd wges..... r@ 15 Pension plns, employee enefits..... x 16 Legl fees (tth shedule) Aounting fees (tth shedule) Other professionl fees (tth shedule) 17 Interest Txes (tth shedule) (see instrutions) Depreition (tth shedule) nd depletion. 20 Oupny Trvel, onferenes, nd meetings C 22 Print ing nd pulitions 23 Other expenses (tth shedule) See St Totl operting nd dministrtive expenses. Add lines 13 through , 011. Q. 25 Contriutions, gifts, grnts pid Totl expenses nd disursements. Add lines 24 nd 25 1, Sutrt line 26 from line 12: Exess of revenue over expenses nd disursements 1, 362. Net investment inome (if negtive, enter -0-) Adjusted net inome (if neg tive, enter -0-) For Pperwork Redution At Notie, see instrutions. BAA REV PRO Form 89U-Nr (2017) O\JA 4

2 Form 990 -PF (2017) Pge 2 Atthed shedules nd mounts in the desription olumn Beginning of yer End of yer B lne Sheet s should e for end-of-yer mounts only (See instrutions.) () Book Vlue () Book Vlue () Fir Mrket Vlue 1 Csh-non-interest-ering , , Svings nd temporry sh investments Aounts reeivle Less: llowne for doutful ounts Pledges reeivle Less: llowne for doutful ounts Grnts reeivle Reeivles due from offiers, diretors, trustees, nd other disqulified persons (tth shedule) (see instrutions) 7 Other notes nd lons reeivle (tth shedule) Less: llowne for doutful ounts Inventories for sle or use % 9 Prepid expenses nd deferred hrges ;Q 10 Investments-U.S. nd stte government oligtions (tth shedule) Investments-orporte stok (tth shedule)..... Investments-orporte onds (tth shedule) Investments-lnd, uildings, nd equipment: sis Less: umulted depreition (tth shedule) Investments-mortgge lons Investments-other (tth shedule) Lnd, uildings, nd equipment: sis Less: umulted depreition (tth shedule) Other ssets (desrie Totl ssets (to e oted m ple y ll filers -see the instrutions. Also, see pge 1, item I) , , , Aounts pyle nd rued expenses Grnts pyle Deferred revenue 20 Lons from offiers, diretors, trustees, nd other disqulified persons Mortgges nd other notes pyle (tth shedule)... J 22 Other liilities (desrie ) Totl liilities (dd lines 17 through 22) Foundtions tht follow SFAS 117, hek here.. nd omplete lines 24 through 26, nd lines 30 nd 31. C o 24 Unrestrited , , 84 m 25 Temporrily restrited Permnently restrited Foundtions tht do not follow SFAS 117, hek here q -+L nd omplete lines 27 through 31. '0 27 Cpitl stok, trust prinipl, or urrent funds Pid-in or pitl surplus, or lnd, ldg., nd equipment fund 29 Retined ernings, umulted inome, endowment, or other funds Totl net ssets or fund lnes (see instrutions)... 1, , 84 Z 31 Totl liilities nd net ssets /fund lnes (see instrutions) , , Mm Anlysis of Chnges in Net Assets or Fund Blnes 1 Totl net ssets or fund lnes t eginning of yer-prt II, olumn (), line 30 (must gree with end-of-yer figure reported on prior yer's return) , Enter mount from Prt I, line , Other inreses not inluded in line 2 (itemize) Add lines 1, 2, nd ,84 5 Dereses not inluded in line 2 (itemize) Totl net ssets or fund lnes t end of yer (line 4 minus line 5)-Prt II, olumn (), line ,84 REV 07/25/18 PRO

3 Pge 3 1 d e 2 d e d e Cpitl Gins nd Losses for Tx on Investment Inome () List nd desrie the kinds of property sold for exmple, rel estte, () () ( 2-story rik wrehouse, or ommon stok, 200 shs MLC Co) (e) Gross sles prie (f) Depreition llowed (or llowle) () How quired P-Purhse D-Dontion (g) Cost or other sis plus expense of sle () Dte quired (mo., dy, yr) (h) Gin or (loss) ((e) plus (f) minus (g)) (d) Dte sold (mo, dy, yr) Complete only for ssets showing gin in olumn (h) nd owned y the foundtion on 12/31/69. (I) Gins (Col. (h) gin minus (i) F MV s of 12/31/69 (j) Adjusted sis (k) Exess of ol (i) ol. (k), ut not less thn -0-) or s of 12/31/69 over ol Q), if ny Losses (from ol (h)) Cpitl gin net inome or (net pitl loss) 1 If gin, lso enter in Prt I, line 7 l If (loss), enter -0- in Prt I, line 7 ) 2 3 Net short-term pitl gin or (loss) s defined in setions 1222(5) nd (6): If gin, lso enter in Prt I, line 8, olumn (). See instrutions. If (loss), enter -0- in l Prt 1, line J 3 Qulifition Under Setion 4940 (e) for Redued Tx on Net Investment Inome (For optionl use y domesti privte foundtions sujet to the setion 4940() tx on net investment inome.) If setion 4940(d)(2) pplies, leve this prt lnk. Ws the foundtion lile for the setion 4942 tx on the distriutle mount of ny yer in the se period? q Yes q No If "Yes," the foundtion doesn't qulify under setion 4940(e). Do not omplete this prt. 1 Enter the pproprite mount in eh olumn for eh yer; see the instrutions efore mking ny entries. Bse period yers Clendr yer (or tx yer eginning in) Adjusted qulifying distriutions Net vlue of nonhritle-use ssets Distriution rtio (ol. () divided y ol ()) i 2 Totl of line 1, olumn (d) Averge distriution rtio for the 5-yer se period-divide the totl on line 2 y 5.0, or y the numer of yers the foundtion hs een in existene if less thn 5 yers Enter the net vlue of nonhritle-use ssets for 2017 from Prt X, line Multiply line 4 y line Enter 1 % of net investment inome (1 % of Prt I, line 27) Add lines 5 nd Enter qulifying distriutions from Prt XII, line If line 8 is equl to or greter thn line 7, hek the ox in Prt VI, line 1, nd omplete tht prt using 1 % tx rte. See the Prt VI instrutions. SAA REV PRO

4 Pge 4 MMM Exise Tx Bsed on Investment Inome (Setion 4940 (), 4940 ( ), 4940 ( e), or 4948-see instrutions) l Exempt operting foundtions desried in setion 4940(d)(2), hek here q nd enter "N/A" on line 1. Dteof ruling or determintion letter: (tth opy of letter if neessry - see instrutions) Domesti foundtions tht meet the setion 4940(e) requirements in Prt V, hek 1 here q nd enter 1 % of Prt I, line 27 All other domesti foundtions enter 2% of line 27. Exempt foreign orgniztions, enter 4% of Prt I, line 12, ol. (). 2 Tx under setion 511 (domesti setion 4947()(1) trusts nd txle foundtions only; others, enter -0-) 2 3 Add lines 1 nd , 4 Sutitle A (inome) tx (domesti setion 4947()(1) trusts nd txle foundtions only; others, enter -0-) 4 5 Tx sed on investment inome. Sutrt line 4 from line 3. If zero or less, enter Credits/Pyments: 2017 estimted tx pyments nd 2016 overpyment redited to Exempt foreign orgniztions-tx withheld t soure Tx pid with pplition for extension of time to file (Form 8868). 6 d Bkup withholding erroneously withheld d 7 Totl redits nd pyments. Add lines 6 through 6d Enter ny penlty for underpyment of estimted tx. Chek here q if Form 2220 is tthed 8 9 Tx due. If the totl of lines 5 nd 8 is more thn line 7, enter mount owed Overpyment. If line 7 is more thn the totl of lines 5 nd 8, enter the mount overpid Enter the mount of line 10 to e. Credited to 2018 estimted tx Refunded 11 Sttements Regrding Ativities 1 During the tx yer, did the foundtion ttempt to influene ny ntionl, stte, or lol legisltion or did it Yes No prtiipte or intervene in ny politil mpign? x Did it spend more thn $100 during the yer (either diretly or indiretly) for politil purposes? See the instrutions for the definition x If the nswer is "Yes" to l or 1, tth detiled desription of the tivities nd opies of ny mterils pulished or distriuted y the foundtion in onnetion with the tivities. Did the foundtion file Form 1120-POL for this yer? X d Enter the mount (if ny) of tx on politil expenditures (setion 4955) imposed during the yer: (1) On the foundtion. $ (2) On foundtion mngers. $ e Enter the reimursement (if ny) pid y the foundtion during the yer for politil expenditure tx imposed on foundtion mngers. $ 2 Hs the foundtion engged in ny tivities tht hve not previously een reported to the IRS? x If "Yes," tth detiled desription of the tivities. 3 Hs the foundtion mde ny hnges, not previously reported to the IRS, in its governing instrument, rtiles of inorportion, or ylws, or other similr instruments? If "Yes," tth onformed opy of the hnges.. 3 X 4 Did the foundtion hve unrelted usiness gross inome of $1,000 or more during the yer? X If "Yes," hs it filed tx return on Form 990 -T for this yer? Ws there liquidtion, termintion, dissolution, or sustntil ontrtion during the yer? x If "Yes," tth the sttement required y Generl Instrution T. 6 Are the requirements of setion 508(e) (relting to setions 4941 through 4945) stisfied either: By lnguge in the governing instrument, or By stte legisltion tht effetively mends the governing instrument so tht no mndtory diretions tht onflit with the stte lw remin in the governing instrument? x 7 Did the foundtion hve t lest $5,000 in ssets t ny time during the yer? If "Yes," omplete Prt II, ol. (), nd Prt XV 7 x 8 Enter the sttes to whih the foundtion reports or with whih it is registered. See instrutions BAA If the nswer is "Yes " to Tine 7, hs the foundtion furnished opy of Form PF to the Attorney Generl (or designte ) of eh stte s required y Generl Instrution G? If "No," tth explntion..... Is the foundtion liming sttus s privte operting foundtion within the mening of setion 49420)(3) or )(5) for lendr yer 2017 or the tx yer eginning in 2017? See the instrutions for Prt XIV. If "Yes," omplete Prt XIV Did ny persons eome sustntil ontriutors during the tx yer? If " Yes," tth shedule listing their nmes nd ddresses x REV 07/25/18 PRO 8 9 FFXV

5 Pge 5 Sttements Regrding Ativities (ontinued) Yes No 11 At ny time during the yer, did the foundtion, diretly or indiretly, own ontrolled entity within the mening of setion 512()(13)? If "Yes," tth shedule. See instrutions x 12 Did the foundtion mke distriution to donor dvised fund over whih the foundtion or disqulified person hd dvisory privileges? If "Yes," tth sttement. See instrutions x 13 Did the foundtion omply with the puli inspetion requirements for its nnul returns nd exemption pplition? 13 X Wesite ddress N/A The ooks re in re of Sott_ Semptimphelter Telephone no. ( ) Loted t 1103 Gry Fox Ln Frnklin TN ZIP Setion 4947()(1) nonexempt hritle trusts filing Form 990-PF in lieu of Form hek here..... q nd enter the mount of tx-exempt interest reeived or rued during the yer At ny time during lendr yer 2017, did the foundtion hve n interest in or signture or other uthority Yes No over nk, seurities, or other finnil ount in foreign ountry? t) See the instrutions for exeptions nd filing requirements for FinCEN Form 114. If "Yes," enter the nme of 16 x the foreign ountry l Sttements Regrding Ativities for Whih Form 4720 My Be Required File Form 4720 if ny item is heked in the "Yes" olumn, unless n exeption pplies. During the yer, did the foundtion (either diretly or indiretly): (1) Engge in the sle or exhnge, or lesing of property with disqulified person? q Yes (2) Borrow money from, lend money to, or otherwise extend redit to (or ept it from) disqulified person? q Yes (3) Furnish goods, servies, or filities to (or ept them from) disqulified person? q Yes (4) Py ompenstion to, or py or reimurse the expenses of, disqulified person? q Yes (5) Trnsfer ny inome or ssets to disqulified person (or mke ny of either ville for the enefit or use of disqulified person)? q Yes (6) Agree to py money or property to government offiil? ( Exeption. Chek "No" if the foundtion greed to mke grnt to or to employ the offiil for period fter termintion of government servie, if terminting within 90 dys.) q Yes No If ny nswer is "Yes" to 1 (1)-(6), did ny of the ts fil to qulify under the exeptions desried in Regultions setion (d)-3 or in urrent notie regrding disster ssistne? See instrutions Orgniztions relying on urrent notie regrding disster ssistne, hek here q Did the foundtion engge in prior yer in ny of the ts desried in 1, other thn exepted ts, tht were not orreted efore the first dy of the tx yer eginning in 2017? Txes on filure to distriute inome (setion 4942) (does not pply for yers the foundtion ws privte operting foundtion defined in setion 49420)(3) or 4942(()(5)): At the end of tx yer 2017, did the foundtion hve ny undistriuted inome (lines 6d nd 6e, Prt XIII) for tx yer(s) eginning efore 2017? q Yes No If "Yes," list the yers 20, 20, 20, Are there ny yers listed in 2 for whih the foundtion is not pplying the provisions of setion 4942()(2) (relting to inorret vlution of ssets) to the yer's undistriuted inome? (If pplying setion 4942()(2) to ll yers listed, nswer "No" nd tth sttement-see instrutions.) If the provisions of setion 4942 ( )(2) re eing pplied to ny of the yers listed in 2, list the yers here. 20, 20, 20, 20 3 Did the foundtion hold more thn 2% diret or indiret interest in ny usiness enterprise t ny time during the yer? q Yes No If "Yes," did it hve exess usiness holdings in 2017 s result of ( 1) ny purhse y the foundtion or disqulified persons fter My 26, 1969 ; (2) the lpse of the 5-yer period (or longer period pproved y the Commissioner under setion 4943( )(7)) to dispose of holdings quired y gift or equest ; or (3) the lpse of the 10-, 15-, or 20 - yer first phse holding period? ( Use Shedule C, Form 4720, to determine if the foundtion hd exess usiness holdings in 2017.) Did the foundtion invest during the yer ny mount in mnner tht would jeoprdize its hritle purposes? Did the foundtion mke ny investment in prior yer (ut fter Deemer 31, 1969 ) tht ould jeoprdize its hritle purpose tht hd not een removed from jeoprdy efore the first dy of the tx yer eginning in 2017? BAA REV 07/25/18 PRO No No No ONO No Form Yes No x x x (2017)

6 Pge 6 Sttements Regrding Ativities for Whih Form 4720 My Be Required (ontinued) 5 During the yer, did the foundtion py or inur ny mount to: Yes No (1) Crry on propgnd, or otherwise ttempt to influene legisltion (setion 4945(e))?. q Yes No (2) Influene the outome of ny speifi puli eletion (see setion 4955); or to rry on, diretly or indiretly, ny voter registrtion drive? q Yes No (3) Provide grnt to n individul for trvel, study, or other similr purposes?..... q Yes No (4) Provide grnt to n orgniztion other thn hritle, et., orgniztion desried in setion 4945(d)(4)(A)? See instrutions q Yes No (5) Provide for ny purpose other thn religious, hritle, sientifi, literry, or edutionl purposes, or for the prevention of ruelty to hildren or nimls? No If ny nswer is "Yes" to 5(1)-(5), did ny of the trnstions fil to qulify under the exeptions desried in Regultions setion or in urrent notie regrding disster ssistne? See instrutions Orgniztions relying on urrent notie regrding disster ssistne, hek here q If the nswer is "Yes" to question 5(4), does the foundtion lim exemption from the tx euse it mintined expenditure responsiility for the grnt? q Yes q No If "Yes," tth the sttement required y Regultions setion (d). 6 Did the foundtion, during the yer, reeive ny funds, diretly or indiretly, to py premiums on personl enefit ontrt? q Yes No Did the foundtion, during the yer, py premiums, diretly or indiretly, on personl enefit ontrt?. 6 x If "Yes" to 6, file Form At ny time during the tx yer, ws the foundtion prty to prohiited tx shelter trnstion? q Yes No ljlr-^ If "Yes," did the foundtion reeive ny proeeds or hve ny net inome ttriutle to the trnstion?. 7 Informtion Aout Offiers, Diretors, Trustees, Foundtion Mngers, Highly Pid Employees, nd Contrtors 1 List ll offiers, diretors, trustees, nd foundtion mngers nd their ompenstion. See instrutions. () Nme nd ddress empt imphe l t er () Title, nd verge hours per week devoted to position () Compenstion ( If not pid, enter -0 -) (d) Contriutions to employee enefit plns nd deferred ompenstion (e) Expense ount, other llownes Gri Semptimphelter Jennifer--Morrison See--Sttement 2 Compenstion of five highest-pid employees (other thn those inluded on line 1-see instrutions). If none, enter "NONE." () Nme nd ddress of eh employee pid more thn $50,000 () Title, nd verge hours per week devoted to position () Compenstion (d) Contriutions to employee enefit plns nd deferred ompenstion (e) Expense ount, other llownes,none : Totl numer of other employees pid over $50,00 0 Form m1 990-PF (2017) REV 07/25/18 PRO

7 Pge 7 Informtion Aout Offiers, Diretors, Trustees, Foundtion Mngers, Highly Pid Employees, nd Contrtors (ontinued) 3 Five highest - pid independent ontrtors for professionl servies. See instrutions. If none, enter "NONE." () Nme nd ddress of eh person pid more thn $50,000 () Type of servie () Compenstion - None Totl numer of others reeiving over $50,000 for professionl servies.. 0 Summry of Diret Chritle Ativities List the foundtion ' s four lrgest diret hritle tivities during the tx yer Inlude relevnt sttistil informtion suh s the numer of orgniztions nd other enefiiries served, onferenes onvened, reserh ppers produed, et. Expenses IITiI 1 Summry of Progrm-Kelted Investments (see instrutions) Desrie the two lrgest progrm-relted investments mde y the foundtion during the tx yer on lines 1 nd 2 Amount All other progrm-relted investments See instrutions Totl. Add lines 1 through 3 ^AA REV 07/25/18 PRO

8 Pge 8 Minimum Investment Return (All domesti foundtions must omplete this prt. Foreign foundtions, see instrutions.) 1 Fir' mrket vlue of ssets not used (or held for use) diretly in rrying out hritle, et., purposes: Averge monthly fir mrket vlue of seurities Averge of monthly sh lnes Fir mrket vlue of ll other ssets (see instrutions ) d Totl (dd lines 1,, nd ) d e Redution limed for lokge or other ftors reported on lines 1 nd 1 (tth detiled explntion) le 2 Aquisition indetedness pplile to line 1 ssets Sutrt line 2 from line 1d Csh deemed held for hritle tivities. Enter 11/2% of line 3 (for greter mount, see instrutions) Net vlue of nonhritle-use ssets. Sutrt line 4 from line 3. Enter here nd on Prt V, line Minimum investment return. Enter 5% of line Distriutle Amount (see instrutions) (Setion 49420)(3) nd 0)(5) privte operting foundtions nd ertin foreign orgniztions, hek here q nd do not omplete this prt.) 1 Minimum investment return from Prt X, line Tx on investment inome for 2017 from Prt VI, line Inome tx for (This does not inlude the tx from Prt VI.).. 2 Add lines 2 nd Distriutle mount efore djustments. Sutrt line 2 from line Reoveries of mounts treted s qulifying distriutions Add lines 3 nd Dedution from distriutle mount (see instrutions) Distriutle mount s djusted. Sutrt line 6 from line 5. Enter here nd on Prt XIII, line Qulifying Distriutions (see instrutions) 1 Amounts pid (inluding dministrtive expenses) to omplish hritle, et., purposes: Expenses, ontriutions, gifts, et.-totl from Prt I, olumn (d), line Progrm-relted investments-totl from Prt IX-B l 2 Amounts pid to quire ssets used (or held for use) diretly in rrying out hritle, et., purposes Amounts set side for speifi hritle projets tht stisfy the: Suitility test (prior IRS pprovl required) Csh distriution test (tth the required shedule) Qulifying distriutions. Add lines 1 through 3. Enter here nd on Prt V, line 8; nd Prt XIII, line Foundtions tht qulify under setion 4940(e) for the redued rte of tx on net investment inome. Enter 1 % of Prt I, line 27. See instrutions Adjusted qulifying distriutions. Sutrt line 5 from line Note : The mount on line 6 will e used in Prt V, olumn (), in susequent yers when lulting whether the foundtion qulifies for the setion 4940(e) redution of tx in those yers. BAA REV 07 /25/18 PRO

9 Undistriuted Inome Disthutle mount for 2017 from Prt XI, line Undistriuted inome, if ny, s of the end of 2017: Enter mount for 2016 only Totl for prior yers: 2020,20 3 Exess distriutions rryover, if ny, to 2017: From From From d From e From f Totl of lines 3 through e 4 Qulifying distriutions for 2017 from Prt XII, line 4: $ Applied to 2016, ut not more thn line 2 Applied to undistriuted inome of prior yers (Eletion required-see instrutions)... Treted s distriutions out of orpus (Eletion required-see instrutions) d Applied to 2017 distriutle mount.. e Remining mount distriuted out of orpus 5 Exess distriutions rryover pplied to 2017 (If n mount ppers in olumn (d), the sme mount must e shown in olumn ().) 6 Enter the net totl of eh olumn s indited elow: Corpus. Add lines 3f, 4, nd 4e. Sutrt line 5 Prior yers' undistriuted inome. Sutrt line 4 from line Enter the mount of prior yers' undistriuted inome for whih notie of defiieny hs een issued, or on whih the setion 4942() tx hs een previously ssessed.... d Sutrt line 6 from line 6. Txle mount-see instrutions e Undistriuted inome for Sutrt line 4 from line 2. Txle mount-see instrutions f Undistriuted inome for Sutrt lines 4d nd 5 from line 1. This mount must e distriuted in Amounts treted s distriutions out of orpus to stisfy requirements imposed y setion 170()(1)(F) or 4942(g)(3) (Eletion my e required -see instrutions) Exess distriutions rryover from 2012 not pplied on line 5 or line 7 (see instrutions). 9 Exess distriutions rryover to Sutrt lines 7 nd 8 from line Anlysis of line 9: Exess from Exess from Exess from d Exess from e Exess from () Corpus () Yers prior to 2016 BAA REV 07/25/18 PRO 0 () 2016 (d) 2017 Pge 9

10 l 2 d Privte Operting Foundtions (see instrutions nd Prt VII-A, question 9) N/A If the foundtion hs reeived ruling or determintion letter tht it is privte operting foundtion, nd the ruling is effetive for 2017, enter the dte of the ruling L Chek ox to indite whether the foundtion is privte operting foundtion desried in setion F (l)(3) or n Enter the lesser of the djusted net Tx yer Prior 3 yers ^% inome from Prt I or the minimum (e)-to tl () 2017 () 2016 () 2015 (d) 2014 investment return from Prt X for eh yer listed % of line Qulifying distriutions from Prt XII, line 4 for eh yer listed.... Amounts inluded in line 2 not used diretly for tive ondut of exempt tivities e Qulifying distriutions mde diretly for tive ondut of exempt tivities. Sutrt line 2d from line Complete 3,, or for the lterntive test relied upon: "Assets" lterntive test-enter: (1) Vlue of ll ssets..... (2) Vlue of ssets qulifying under setion 4942(j)(3)(B)(i)... "Endowment" lterntive test-enter 2/3 of minimum investment return shown in Prt X, line 6 for eh yer listed... "Support" lterntive test-enter: (1) Totl support other thn gross investment inome (interest, dividends, rents, pyments on seurities lons (setion 512()(5)), or roylties).... (2) Support from generl puli nd 5 or more exempt orgniztions s provided in setion 4942(I)(3)(B)(iii).... (3) Lrgest mount of support from n exempt orgniztion... Pge 1 0 (4) Gross investment inome. Supplementry Informtion (Complete this prt only if the foundtion hd $5,000 or more in ssets t ny time during the yer-see instrutions.) 1 Informtion Regrding Foundtion Mngers: List ny mngers of the foundtion who hve ontriuted more thn 2% of the totl ontriutions reeived y the foundtion efore the lose of ny tx yer (ut only if they hve ontriuted more thn $5,000). (See setion 507(d)(2).) List ny mngers of the foundtion who own 10% or more of the stok of orportion (or n eqully lrge portion of the ownership of prtnership or other entity) of whih the foundtion hs 10% or greter interest. 2 Informtion Regrding Contriution, Grnt, Gift, Lon, Sholrship, et., Progrms: Chek here q if the foundtion only mkes ontriutions to preseleted hritle orgniztions nd does not ept unsoliited requests for funds. If the foundtion mkes gifts, grnts, et., to individuls or orgniztions under other onditions, omplete items 2,,, nd d. See instrutions. The nme, ddress, nd telephone numer or emil ddress of the person to whom pplitions should e ddressed: The form in whih pplitions should e sumitted nd informtion nd mterils they should inlude: Any sumission dedlines: d Any restritions or limittions on wrds, suh s y geogrphil res, hritle fields, kinds of institutions, or other ftors: BAA REV 07/25/18 PRO

11 Form 990-PF (2017 ) Pge 11 Supplementry Informtion (ontinued) 3 Grnts nd Contriutions Pid During the Yer or Approved for Future Pyment If reipient is n individul, Reipient show ny reltionship to ny foundtion mnger or sustntil ontriutor Nme nd ddress (home or usiness) Pid during the yer Foundtion sttus of reipient Purpose of grnt or ontnution Amount M1 Totl.. 3 Approved for future pyment Totl.. ' 3 l BAA REV 07/25/18 PRO

12 Form 990-PF (2017 ) Pge 12 Anlysis of Inome-Produing Ativities Enter gro ss mounts unless otherwise indited. Unrelted u siness inome Exluded y set ion 512, 513, or 514 (e) () () () (d) Relted or exempt funtion inome Business ode Amount Exlusion ode Amount (See instrutions.) 1 Pro rm servie revenue: d e f 9 Fees nd ontrts from government genies 2 Memership dues nd ssessments IntBrest on svings nd temporry sh investments 4 Dividends nd interest from seurities. 5 Ne t rentl inome or (loss ) from rel estte: Det-finned property Not det -finned property Nett rentl inome or (loss) from personl property 7 Ot h er investment inome Gin or (loss ) from sles of ssets other thn inventory 9 Ne t inome or ( loss) from speil events Gross profit or ( loss) from sles of inventory 11 Ot h er revenue: d e Y12 Su )totl. Add olumns (), (d), nd (e) Totl. Add line 12, olumns (), (d), nd (e) (See worksheet in line 13 instrutions to verify lultions.) Reltionship of Ativities to the Aomplishment of Exempt Purposes Line No. 7 Explin elow how eh tivity for whih inome is reported in olumn (e) of Prt XVI-A ontriuted importntly omplishment of the foundtion s exempt purposes (other thn y providing funds for suh purposes). (See instrutions ) to the REV PRO

13 Pge 13 Informtion Regrding Trnsfers to nd Trnstions nd Reltionships With Nonhritle Exempt Orgniztions 1 Did the orgniztion diretly or indiretly engge in ny of the following with ny other orgniztion desried Yes No in setion 501() (other thn setion 501()(3) orgniztions) or in setion 527, relting to politil orgniztions? Trnsfers from the reporting foundtion to nonhritle exempt orgniztion of: (1) Csh (1) X (2) Other ssets l(2) 1 I X Other trnstions: (1) Sles of ssets to nonhritle exempt orgniztion (1) X (2) Purhses of ssets from nonhrltle exempt orgniztion (2) X (3) Rentl of filities, equipment, or other ssets (3) x L (4) Reimursement rrngements (4) x (5) Lons or lon gurntees (5) X (6) Performne of servies or memership or fundrising soliittions (6) X Shring of filities, equipment, miling lists, other ssets, or pid employees x d If the nswer to ny of the ove is "Yes," omplete the following shedule. Column () should lwys show the fir mrket vlue of the goods, other ssets, or servies given y the reporting foundtion. If the foundtion reeived less thn fir mrket vlue in ny trnstion or shring rrngement, show in olumn (d) the vlue of the goods, other ssets, or servies reeived. 2 Is the foundtion diretly or indiretly ffilited with, or relted to, one or more tx-exempt orgniztions desried in setion 501() (other thn setion 501 ()(3)) or in setion 527? q Yes No If "Yes," omplete the following shedule. () Nme of orgniztion () Type of orgniztion () Desription of reltionship Sign Under pen ties of perjury, I delre tht I hve exmined this return, Inluding ompnying shedules nd sttements, nd to the est of my knowledge nd elief, It Is true, orret, omplete. l ton of preprer (other thn txpyer ) is sed on Here -Z4 Sig ure of offier or Dte PrnnVrype preprer ' s nme Preprer ' s sign r I Pid Prpnrer Rihrd Frid g e Use OnIy Firm's nme Rihrd Fridge, CPA BAA Nshville