extended to november 15, 2017 return of private...

if the foundation is not required to attach Sch. B

OMB No. 1545-0052

Department of the TreasuryInternal Revenue Service Open to Public Inspection

Number and street (or P.O. box number if mail is not delivered to street address) Room/suite

If exemption application is pending, check here

Foreign organizations meeting the 85% test,check here and attach computation

(The total of amounts in columns (b), (c), and (d) may notnecessarily equal the amounts in column (a).)

Disbursementsfor charitable purposes

(cash basis only)

Check

Interest on savings and temporarycash investments

Net rental income or (loss)

Net gain or (loss) from sale of assets not on line 10Gross sales price for allassets on line 6a

Capital gain net income (from Part IV, line 2)

Gross sales less returnsand allowances

Less: Cost of goods sold

Compensation of officers, directors, trustees, etc.

Excess of revenue over expenses and disbursements

(if negative, enter -0-)

(if negative, enter -0-)

623501 11-23-16

or Section 4947(a)(1) Trust Treated as Private Foundation| Do not enter social security numbers on this form as it may be made public.

| Information about Form 990-PF and its separate instructions is at

For calendar year 2016 or tax year beginning , and ending

A

B

C

Employer identification number

G D 1.

2.

H E

I J F

Analysis of Revenue and Expenses (d)(a) (b) (c)

1

2

3

4

5

7

8

9

11

a

b

6a

b

10a

b

c

12 Total.

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

a

b

c

Total operating and administrative

expenses.

Total expenses and disbursements.

a

b

c

Net investment income

Adjusted net income

For Paperwork Reduction Act Notice, see instructions.

Re

ven

ue

Op

era

tin

g a

nd

Ad

min

istr

ati

ve E

xp

en

se

s

(from Part II, col. (c), line 16)(Part I, column (d) must be on cash basis.)

Form

Name of foundation

Telephone number

City or town, state or province, country, and ZIP or foreign postal code ~|

|

|

|

|

Check all that apply: Initial return Initial return of a former public charity Foreign organizations, check here ~~

Final return Amended return

Address change Name change ~~~~

Check type of organization: Section 501(c)(3) exempt private foundation If private foundation status was terminatedunder section 507(b)(1)(A), check hereSection 4947(a)(1) nonexempt charitable trust Other taxable private foundation ~

Fair market value of all assets at end of year Accounting method: Cash Accrual If the foundation is in a 60-month terminationunder section 507(b)(1)(B), check hereOther (specify) ~

$| Revenue and

expenses per books Net investment

income Adjusted net

income

Contributions, gifts, grants, etc., received ~~~

|

~~~~~~~~~~~~~~

Dividends and interest from securities

Gross rents

~~~~~

~~~~~~~~~~~~~~~~

~~

~~

~~~~~

Net short-term capital gain

Income modifications

~~~~~~~~~

~~~~~~~~~~~~

~~~~

~

Gross profit or (loss)

Other income

~~~~~~~~~~~~

~~~~~~~~~~~~~~~

Add lines 1 through 11 ��

~~~

Other employee salaries and wages

Pension plans, employee benefits

~~~~~~

~~~~~~

Legal fees

Accounting fees

~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~

Other professional fees ~~~~~~~~~~~

Interest

Taxes

~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~

Depreciation and depletion ~~~~~~~~~

Occupancy

Travel, conferences, and meetings

Printing and publications

Other expenses

~~~~~~~~~~~~~~~~

~~~~~~

~~~~~~~~~~

~~~~~~~~~~~~~~

Add lines 13 through 23 ~~~~~

Contributions, gifts, grants paid ~~~~~~~

Add lines 24 and 25 ��

Subtract line 26 from line 12:

~

~~~

��

Form (2016)LHA

www.irs.gov/form990pf.

Part I

990-PF

Return of Private Foundation990-PF 2016

STATEMENT 11

STMT 2 STMT 3 STMT 4

STMT 5

STMT 6

EXTENDED TO NOVEMBER 15, 2017

CLAUDE WORTHINGTON BENEDUM FOUNDATION 25-1086799

1400 BENEDUM-TREES, 223 FOURTH AVE 4122880360

PITTSBURGH, PA 15222

X

X

347,304,439.

X22,351. 22,351.

2,035,293. 5,587,396.

1,486,363.

16,067,286.

11,852,555. 500,915. 0.15,396,562. 22,177,948. 0.1,552,383. 415,142. 0. 1,055,860.623,564. 96,362. 0. 508,312.447,662. 85,443. 0. 345,469.5,824. 3,451. 0. 1,696.38,977. 8,751. 0. 28,511.

1,681,373. 1,357,249. 0. 58,063.181,561.

174,737. 240,318. 0. 80,438.54,998. 12,348. 0.51,600. 11,585. 0. 37,744.

158,095. 66,080. 0. 79,061.12,285. 2,758. 0. 8,986.

330,336. 2,629,549. 0. 269,789.

5,131,834. 5,110,597. 0. 2,473,929.14,450,850. 13,725,600.

19,582,684. 5,110,597. 0. 16,199,529.

<4,186,122.>17,067,351.

0.

15481110 798870 05A10B 2016.04030 CLAUDE WORTHINGTON BENEDUM 05A10B_1 1

STMT 20

STATEMENT 1

if

Department of the Treasury

Internal Revenue ServiceAttachmentSequence No.

Category of filer (see Categories of Filers in the instructions and check applicable box(es)):

Filer's tax yearbeginning , , and ending ,

(4) Check applicable box(es)(1) Name (2) Address (3) Identifying number

Category 1 Category 2 Constructive owner

Name and address of person(s) with custody of the books and records of the foreignpartnership, and the location of such books and records, if different

Sign HereOnly If YouAre FilingThis FormSeparatelyand Not WithYour TaxReturn.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,

correct, and complete. Declaration of preparer (other than general partner or limited liability company member) is based on all information of which preparer has any knowledge.

Signature of general partner or limited liability company member Date

Date PTINPreparer's signaturePrint/Type preparer's nameCheck

self-employed

610651 11-16-16

Date oforganization

Principal placeof business

Principal businessactivity code number

Principal businessactivity

Functionalcurrency

Exchange rate(see instr.)

Attach to your tax return.| Information about Form 8865 and its separate instructions is at .

Filer's identifying number

A

B

C

D

E

F

G1 2(a)

2(b)

3

4 5 6 7 8a 8b

H

1 2

43

5

6

7

8

9

Yes No

a

b

Yes No

Yes No

both

do not

Yes No

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. 8865

OMB No. 1545-1668

Form|

Information furnished for the foreign partnership's tax year, 2016, and ending ,beginning

Name of person filing this return

Filer's address (if you are not filing this form with your tax return)

1 2 3 4

Filer's share of liabilities: Nonrecourse $

If filer is a member of a consolidated group but not the parent, enter the following information about the parent:

Qualified nonrecourse financing $ Other $

Name

Address

EIN

Check if any excepted specified foreign financial assets are reported on this form (see instructions) ��

Information about certain other partners (see instructions)

Name and address of foreign partnership EIN (if any)

Reference ID number

Country under whose laws organized

Provide the following information for the foreign partnership's tax year:

Name, address, and identifying number of agent (if any) in the United States Check if the foreign partnership must file:

Form 1042 Form 8804 Form 1065 or 1065-B

Service Center where Form 1065 or 1065-B is filed:

Name and address of foreign partnership's agent in country of organization, if any

Were any special allocations made by the foreign partnership?

Enter the no. of Forms 8858, Info Return of U.S. Persons With Respect To Foreign Disregarded Entities, attached to this return

~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |

|~ ~~~~~~~~~~~~~

How is this partnership classified under the law of the country in which it is organized?

Does the filer have an interest in the foreign partnership, or an interest indirectly through the foreign partnership, that is a separate

unit under Reg. 1.1503(d)-1(b)(4) or part of a combined separate unit under Reg. 1.1503(d)-1(b)(4)(ii)? If "No," skip question 8b.

If "Yes," does the separate unit or combined separate unit have a dual consolidated loss as defined in Reg. 1.1503(d)-1(b)(5)(ii)?

~~~~~~~~~~~~~ | ~~~~~~~~~~~~~~~~~~

|

|

Does this partnership meet of the following requirements?¥ The partnership's total receipts for the tax year were less than $250,000 and¥ The value of the partnership's total assets at the end of the tax year was less than $1 million.If "Yes," complete Schedules L, M-1, and M-2.

~~~~~~~~~~~~ |

|Firm's name Firm's EIN |

|Firm's address Phone no.

Form (2016)LHA

www.irs.gov/form8865

Return of U.S. Persons With Respect toCertain Foreign Partnerships

118

Paid PreparerUse Only

88652016

pmo

==

JAN 1 DEC 31 2016

25-1086799CLAUDE WORTHINGTON BENEDUM FOUNDATION

XJAN 1 2016 DEC 31 2016

98-1044657AXIOM ASIA PRIVATE CAPITAL FUND III, LPC/O CODAN TRUST COMPANY (CAYMAN) LIMITEDCRICKET SQ, HUTCHINS DR, PO BOX 2681 GTGRAND CAYMAN, CAYMAN ISLANDS CAYMAN ISLANDS

10/05/2012CAYMAN ISLANDS 523900 INVESTMENTS US DOLLARS

X

OGDEN, UT

AXIOM ASIA PRIVATE CAPITAL ASSOC III STATE STREET FUND SVCS (HK) LIMITEDCRICKET SQ, HUTCHINS DR POB 2681 GT 68/F, 8 FINANCE STREETGRAND CAYMAN, CAYMAN ISLANDS KY1-111 CENTRAL HONG KONG

X

EXEMPTED LP

X

MICHAEL M. COMSTOCK P00474378SISTERSON & CO. LLP 25-1467156310 GRANT STREET, SUITE 2100

PITTSBURGH, PA 412-281-2025


(see

inst

ruct

ions

for l

imita

tions

)

Check ifforeignperson

Check ifdirect

partnerName Address Identifying number (if any)


Name Address Identifying number (if any)

Check ifforeignpartner-

ship

EIN(if any)

Total ordinaryincome or lossName Address

610652 11-16-16

2

Schedule A Constructive Ownership of Partnership Interest. b,

a b

Schedule A-1 Certain Partners of Foreign Partnership

Yes No

Schedule A-2 Affiliation Schedule.

Schedule B Income Statement - Trade or Business Income

Caution: only

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

a

b

1a

1b 1c

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16c

17

18

19

20

21

22

Total income (loss).

a

b

Do not

16a

16b

Total deductions.

Ordinary business income (loss)

8865

Inc

om

eD

ed

uc

tio

ns

Form 8865 (2016) Page

Check the boxes that apply to the filer. If you check box enter the name,

address, and U.S. taxpayer identifying number (if any) of the person(s) whose interest you constructively own. See instructions.

Owns a direct interest Owns a constructive interest

(see instructions)

Does the partnership have any other foreign person as a direct partner? ��

List all partnerships (foreign or domestic) in which the foreign partnership owns a direct interest or

indirectly owns a 10% interest.

Include trade or business income and expenses on lines 1a through 22 below. See the instructions for more information.

Gross receipts or sales

Less returns and allowances

Cost of goods sold

Gross profit. Subtract line 2 from line 1c

~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Ordinary income (loss) from other partnerships, estates, and trusts (attach statement)

Net farm profit (loss) (attach Schedule F (Form 1040))

Net gain (loss) from Form 4797, Part II, line 17 (attach Form 4797)

Other income (loss) (attach statement)

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Combine lines 3 through 7 ��

Salaries and wages (other than to partners) (less employment credits)

Guaranteed payments to partners

Repairs and maintenance

Bad debts

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Rent

Taxes and licenses

Interest

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

��

Depreciation (if required, attach Form 4562)

Less depreciation reported elsewhere on return

Depletion ( deduct oil and gas depletion.)

Retirement plans, etc.

~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Employee benefit programs

Other deductions (attach statement)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Add the amounts shown in the far right column for lines 9 through 20 ��

from trade or business activities. Subtract line 21 from line 8 ��

Form (2016)


X

STATEMENT 22



Internal Revenue Service

(a)Date oftransfer

(b)Number of

itemstransferred

(c)Fair market

value on dateof transfer

(d)Cost or other

basis

(e)Section 704(c)

allocationmethod

(f)Gain

recognized ontransfer

(g)Percentage interestin partnership after

transfer

Type ofproperty

(a)Type ofproperty

(b)Date oforiginaltransfer

(c)Date of

disposition

(d)Manner ofdisposition

(e)Gain

recognized bypartnership

(f)Depreciation

recapturerecognized

by partnership

(g)Gain allocated

to partner

(h)Depreciation

recapture allocatedto partner

610661 11-16-16

Attach to Form 8865. See Instructions for Form 8865.Information about Schedule O (Form 8865) and its separate instructions is at


EIN (if any) Reference ID number (see instr)

Part I Transfers Reportable Under Section 6038B

Supplemental Information Required To Be Reported

Part II Dispositions Reportable Under Section 6038B

Part III Yes No

For Paperwork Reduction Act Notice, see the Instructions for Form 8865. Schedule O (Form 8865) 2016

OMB No. 1545-1668

| |

Name of transferor

Name of foreign partnership

Cash

Stock, notesreceivableand payable,and othersecurities

Inventory

Tangiblepropertyused in tradeor business

Intangibleproperty

Otherproperty

(see instructions):

Is any transfer reported on this schedule subject to gain recognition under section 904(f)(3) or section 904(f)(5)(F)? �� |

LHA

www.irs.gov/form8865.

SCHEDULE O(Form 8865) (under section 6038B)

Transfer of Property to a Foreign Partnership

2016

CLAUDE WORTHINGTON BENEDUM FOUNDATION 25-1086799AXIOM ASIA PRIVATE CAPITAL FUND IC/O CODAN TRUST COMPANY (CAYMAN) 98-1044657

210,000. 0.1695

X


if













self-employed

610651 11-16-16

Date oforganization




Functionalcurrency




A

B

C

D

E

F

G1 2(a)

2(b)

3

4 5 6 7 8a 8b

H

1 2

43

5

6

7

8

9

Yes No

a

b

Yes No

Yes No

both

do not

Yes No


OMB No. 1545-1668

Form|




1 2 3 4




Name

Address

EIN




Reference ID number









~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |

|~ ~~~~~~~~~~~~~





~~~~~~~~~~~~~ | ~~~~~~~~~~~~~~~~~~

|

|


~~~~~~~~~~~~ |



Form (2016)LHA



118


88652016

pmo

==

JAN 1 DEC 31 2016


XJAN 1 2016 DEC 31 2016

98-1090087KEYHAVEN SECONDARIES FUND I LP

1 MAPLE PLACELONDON, UNITED KINGDOM W1T 4BB UNITED KINGDOM

12/14/2011UNITED KINGDOM 523900 INVESTMENTS EURO .939990

X

E-FILE

SAME AS G1 SAME AS G1

X

LIMITED PTRSHP

X




(see

inst

ruct

ions

for l

imita

tions

)


Check ifdirect





ship

EIN(if any)


610652 11-16-16

2


a b


Yes No



Caution: only

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

a

b

1a

1b 1c

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16c

17

18

19

20

21

22


a

b

Do not

16a

16b

Total deductions.


8865

Inc

om

eD

ed

uc

tio

ns

Form 8865 (2016) Page




(see instructions)







Cost of goods sold


~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





Bad debts

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Rent

Taxes and licenses

Interest

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

��





~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



Form (2016)


X

JP MORGAN CHASE BANK NA 100 N RIVERSIDE 13-6058820CHICAGO, IL 60606

STATEMENT 23




(a)Date oftransfer

(b)Number of

itemstransferred

(c)Fair market


(d)Cost or other

basis

(e)Section 704(c)

allocationmethod

(f)Gain



transfer

Type ofproperty

(a)Type ofproperty


(c)Date of

disposition


(e)Gain


(f)Depreciation

recapturerecognized

by partnership

(g)Gain allocated

to partner

(h)Depreciation


610661 11-16-16







Part III Yes No


OMB No. 1545-1668

| |

Name of transferor


Cash


Inventory


Intangibleproperty

Otherproperty

(see instructions):


LHA




2016

CLAUDE WORTHINGTON BENEDUM FOUNDATION 25-1086799KEYHAVEN SECONDARIES FUND I LP

98-1090087

169,889. 0.01007

X


if













self-employed

610651 11-16-16

Date oforganization




Functionalcurrency




A

B

C

D

E

F

G1 2(a)

2(b)

3

4 5 6 7 8a 8b

H

1 2

43

5

6

7

8

9

Yes No

a

b

Yes No

Yes No

both

do not

Yes No


OMB No. 1545-1668

Form|




1 2 3 4




Name

Address

EIN




Reference ID number









~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |

|~ ~~~~~~~~~~~~~





~~~~~~~~~~~~~ | ~~~~~~~~~~~~~~~~~~

|

|


~~~~~~~~~~~~ |



Form (2016)LHA



118


88652016

pmo

==

JAN 1 DEC 31 2016


XJAN 1 2016 DEC 31 2016

98-1179527OAKTREE OPPORTUNITIES FUND X, LP

333 SOUTH GRAND AVENUE, 28TH FLLOS ANGELES, CA 90071 CAYMAN ISLANDS


OAKTREE CAPITAL MANAGEMENT LP X333 GRAND AVENUE, 28TH FLLOS ANGELES, CA 90071 OGDEN, UT

WALKERS CORPORATE SERVICES LIMITED OAKTREE CAPITAL MANAGEMENT LPWALKER HSE, 87 MARY STREET 333 GRAND AVENUE, 28TH FLGEORGE TOWN, GRAND CAYMAN, CAYMAN IS LOS ANGELES, CA 90071

X

EXEMPTED LP

X




(see

inst

ruct

ions

for l

imita

tions

)


Check ifdirect





ship

EIN(if any)


610652 11-16-16

2


a b


Yes No



Caution: only

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

a

b

1a

1b 1c

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16c

17

18

19

20

21

22


a

b

Do not

16a

16b

Total deductions.


8865

Inc

om

eD

ed

uc

tio

ns

Form 8865 (2016) Page




(see instructions)







Cost of goods sold


~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





Bad debts

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Rent

Taxes and licenses

Interest

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

��





~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



Form (2016)


X

STATEMENT 24




(a)Date oftransfer

(b)Number of

itemstransferred

(c)Fair market


(d)Cost or other

basis

(e)Section 704(c)

allocationmethod

(f)Gain



transfer

Type ofproperty

(a)Type ofproperty


(c)Date of

disposition


(e)Gain


(f)Depreciation

recapturerecognized

by partnership

(g)Gain allocated

to partner

(h)Depreciation


610661 11-16-16







Part III Yes No


OMB No. 1545-1668

| |

Name of transferor


Cash


Inventory


Intangibleproperty

Otherproperty

(see instructions):


LHA




2016

CLAUDE WORTHINGTON BENEDUM FOUNDATION 25-1086799OAKTREE OPPORTUNITIES FUND X, LP

98-1179527

200,414. 0.0368

X


if













self-employed

610651 11-16-16

Date oforganization




Functionalcurrency




A

B

C

D

E

F

G1 2(a)

2(b)

3

4 5 6 7 8a 8b

H

1 2

43

5

6

7

8

9

Yes No

a

b

Yes No

Yes No

both

do not

Yes No


OMB No. 1545-1668

Form|




1 2 3 4




Name

Address

EIN




Reference ID number









~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |

|~ ~~~~~~~~~~~~~





~~~~~~~~~~~~~ | ~~~~~~~~~~~~~~~~~~

|

|


~~~~~~~~~~~~ |



Form (2016)LHA



118


88652016

pmo

==

JAN 1 DEC 31 2016


XJAN 1 2016 DEC 31 2016

98-1011344WLR RECOVERY FUND V DSS AIV, LPC/O WL ROSS & CO LLC1166 AVENUE OF THE AMERICAS, 25TH FLNEW YORK, NY 10036 CAYMAN ISLANDS


X

E-FILE

X

PARTNERSHIP

X




(see

inst

ruct

ions

for l

imita

tions

)


Check ifdirect





ship

EIN(if any)


610652 11-16-16

2


a b


Yes No



Caution: only

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

a

b

1a

1b 1c

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16c

17

18

19

20

21

22


a

b

Do not

16a

16b

Total deductions.


8865

Inc

om

eD

ed

uc

tio

ns

Form 8865 (2016) Page




(see instructions)







Cost of goods sold


~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





Bad debts

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Rent

Taxes and licenses

Interest

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

��





~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



Form (2016)


X

STATEMENT 25




(a)Date oftransfer

(b)Number of

itemstransferred

(c)Fair market


(d)Cost or other

basis

(e)Section 704(c)

allocationmethod

(f)Gain



transfer

Type ofproperty

(a)Type ofproperty


(c)Date of

disposition


(e)Gain


(f)Depreciation

recapturerecognized

by partnership

(g)Gain allocated

to partner

(h)Depreciation


610661 11-16-16







Part III Yes No


OMB No. 1545-1668

| |

Name of transferor


Cash


Inventory


Intangibleproperty

Otherproperty

(see instructions):


LHA




2016

CLAUDE WORTHINGTON BENEDUM FOUNDATION 25-1086799WLR RECOVERY FUND V DSS AIV, LPC/O WL ROSS & CO LLC 98-1011344

138,961. 0.31

X


if













self-employed

610651 11-16-16

Date oforganization




Functionalcurrency




A

B

C

D

E

F

G1 2(a)

2(b)

3

4 5 6 7 8a 8b

H

1 2

43

5

6

7

8

9

Yes No

a

b

Yes No

Yes No

both

do not

Yes No


OMB No. 1545-1668

Form|




1 2 3 4




Name

Address

EIN




Reference ID number









~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |

|~ ~~~~~~~~~~~~~





~~~~~~~~~~~~~ | ~~~~~~~~~~~~~~~~~~

|

|


~~~~~~~~~~~~ |



Form (2016)LHA



118


88652016

pmo

==

FEB 2 DEC 31 2016


XJAN 1 2016 DEC 31 2016

98-1276355AXIOM ASIA IV, LPCOLLAS CRILL CORPORATE SERVICES LIMITEDWILLOW HOUSE, CRICKET SQUARE, PO BOX 709GRAND CAYMAN, CAYMAN ISLANDS CAYMAN ISLANDS


X

OGDEN, UT

MISSION CAPITAL GP IV LP STATE STREET FUND SVCS (HK) LIMITEDZEPHYR HSE, 122 MARY ST 68/F, 8 FINANCE STREETGRAND CAYMAN, CAYMAN ISLANDS KY1-110 CENTRAL HONG KONG

X

EXEMPTED LP

X




(see

inst

ruct

ions

for l

imita

tions

)


Check ifdirect





ship

EIN(if any)


610652 11-16-16

2


a b


Yes No



Caution: only

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

a

b

1a

1b 1c

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16c

17

18

19

20

21

22


a

b

Do not

16a

16b

Total deductions.


8865

Inc

om

eD

ed

uc

tio

ns

Form 8865 (2016) Page




(see instructions)







Cost of goods sold


~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





Bad debts

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Rent

Taxes and licenses

Interest

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

��





~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



Form (2016)


X

STATEMENT 26




(a)Date oftransfer

(b)Number of

itemstransferred

(c)Fair market


(d)Cost or other

basis

(e)Section 704(c)

allocationmethod

(f)Gain



transfer

Type ofproperty

(a)Type ofproperty


(c)Date of

disposition


(e)Gain


(f)Depreciation

recapturerecognized

by partnership

(g)Gain allocated

to partner

(h)Depreciation


610661 11-16-16







Part III Yes No


OMB No. 1545-1668

| |

Name of transferor


Cash


Inventory


Intangibleproperty

Otherproperty

(see instructions):


LHA




2016

CLAUDE WORTHINGTON BENEDUM FOUNDATION 25-1086799AXIOM ASIA IV, LPCOLLAS CRILL CORPORATE SERVICES L 98-1276355

233,224. 0.21

X


if













self-employed

610651 11-16-16

Date oforganization




Functionalcurrency




A

B

C

D

E

F

G1 2(a)

2(b)

3

4 5 6 7 8a 8b

H

1 2

43

5

6

7

8

9

Yes No

a

b

Yes No

Yes No

both

do not

Yes No


OMB No. 1545-1668

Form|




1 2 3 4




Name

Address

EIN




Reference ID number









~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |

|~ ~~~~~~~~~~~~~





~~~~~~~~~~~~~ | ~~~~~~~~~~~~~~~~~~

|

|


~~~~~~~~~~~~ |



Form (2016)LHA



118


88652016

pmo

==

DEC 22 DEC 31 2016


XJAN 1 2016 DEC 31 2016

98-1342085WLR RECOVERY FUND III IAC AIV, LPC/O WL ROSS & CO LLC1166 AVENUE OF THE AMERICAS, 25TH FLNEW YORK, NY 10036 CAYMAN ISLANDS


X

E-FILE

X

PARTNERSHIP

X




(see

inst

ruct

ions

for l

imita

tions

)


Check ifdirect





ship

EIN(if any)


610652 11-16-16

2


a b


Yes No



Caution: only

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

a

b

1a

1b 1c

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16c

17

18

19

20

21

22


a

b

Do not

16a

16b

Total deductions.


8865

Inc

om

eD

ed

uc

tio

ns

Form 8865 (2016) Page




(see instructions)







Cost of goods sold


~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





Bad debts

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Rent

Taxes and licenses

Interest

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

��





~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



Form (2016)


X

INT'L AUTOMOTIVE COMPONENT 20-8316890




(a)Date oftransfer

(b)Number of

itemstransferred

(c)Fair market


(d)Cost or other

basis

(e)Section 704(c)

allocationmethod

(f)Gain



transfer

Type ofproperty

(a)Type ofproperty


(c)Date of

disposition


(e)Gain


(f)Depreciation

recapturerecognized

by partnership

(g)Gain allocated

to partner

(h)Depreciation


610661 11-16-16







Part III Yes No


OMB No. 1545-1668

| |

Name of transferor


Cash


Inventory


Intangibleproperty

Otherproperty

(see instructions):


LHA




2016

CLAUDE WORTHINGTON BENEDUM FOUNDATION 25-1086799WLR RECOVERY FUND III IAC AIV, LPC/O WL ROSS & CO LLC 98-1342085

12/22/16 156,916. 0.0877

X


}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 8865 AFFILIATION SCHEDULE STATEMENT 22 _}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}

CKTOTAL IF

ORDINARY FOR-IDENTIFYING INCOME EIGN

NAME ADDRESS NUMBER OR (LOSS) P'SH}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} }}}}}}}}}} }}}}ANCHOR EQUITY PTRSFUND I

PO BOX 309, UGLAND HSE 98-1069005X

GRAND CAYMAN, CAYMAN ISLANCHINA CONSUMER CAPFUND II

2003A TWR 3 77 JIANGUO RD 98-1229680X

CHAOYANG DISTRICT, BEIJINGCID GREATER CHINACAP IV

190 ELGIN AVENUE 00-0000000X

GEORGE TOWN, GRAND CAYMAN,INDIA BUSINESS EXCELII-A

IFS CT BANK ST CYBERCITY 98-1015504X

EBENE, MAURITIUS 72201KAIWU WALDEN CAPITALLP


GRAND CAYMAN, CAYMAN ISLANMAGICAPITAL FUND(PARALLEL

HARBOUR PL 103 S CHURCH ST 00-0000000X

GRAND CAYMAN, CAYMAN ISLANSOUTHERN CAPITALFUND III


GRAND CAYMAN, CAYMAN ISLANASCENDENT CAP PTRS I 16/F JARDINE HSE 98-1019637 X

CENTRAL, HONG KONGCDH VENTURE PTRS III PO BOX 309, UGLAND HSE 98-1060764 X

GRAND CAYMAN, CAYMAN ISLANDCM VENTURES CHINAFUND

2420 SAND HILL ROAD 98-1119396X

MENLO PARK, CA 94025LIGHTSPEED CHINAPTRS II


GRAND CAYMAN, CAYMAN ISLANNEXT CAPITAL III LVL 30/31 25 BLIGH ST 00-0000000 X

SYDNEY, AUSTRALIA NEW 2000CITIC CAP CHINA(SKIPPER)

28TH FL, 1 TIM MEI AVE 00-0000000X

CENTRAL, HONG KONGRAISSON CAPITAL 190 ELGIN AVENUE 98-1147193 X

GEORGE TOWN, GRAND CAYMAN,ASCENDENT CAP PTRSII

16/F JARDINE HSE 98-1247526X

CENTRAL, HONG KONGCID GREATER CHINACAP V


GEORGE TOWN, GRAND CAYMAN,KALAARI CAPITAL PTRSIII

IFS CT BANK ST CYBERCITY 98-1242375X

EBENE, MAURITIUS 72201


STATEMENT(S) 2215481110 798870 05A10B 2016.04030 CLAUDE WORTHINGTON BENEDUM 05A10B_1

51

MEKONG ENTERPRISEFUND III

27 HOSPITAL ROAD 00-0000000X

GEORGE TOWN, GRAND CAYMAN,LYFE CAPITAL FUND LP SUITE 1804 1468 NAN JING 98-1257429 X

SHANGHAI, CHINAADVANTECH CAPITAL 190 ELGIN AVENUE 98-1263129 X

GRAND CAYMAN, CAYMAN ISLANREDVIEW CAPITAL LP 190 ELGIN AVENUE 98-1263811 X

GRAND CAYMAN, CAYMAN ISLANMAGICAPITAL FUND II HARBOUR PL 103 S CHURCH ST 00-0000000 X

GRAND CAYMAN, CAYMAN ISLANBANYAN PARTNERS FUNDI

STE 1109, 11/F 3 GARDEN RD 00-0000000X

CENTRAL, HONG KONGBANYAN PARTNERS FUNDII

STE 1109, 11/F 3 GARDEN RD 00-0000000X

CENTRAL, HONG KONGSEABRIGHT II LTD 9TH FL, 52 CYBERCITY 98-1257013 X

EBENE, MAURITIUSJAPAN IRELAND INVPTRS-S

CUSTOM HOUSE PLAZA BL 6 98-1069868X

DUBLIN, UNITED KINGDOMGLOBIS FUND V LP PO BOX 309, UGLAND HSE 98-1349437 X

GRAND CAYMAN, CAYMAN ISLANBANYAN INVEST MGMTCO LTD

STE 1109, 11/F 3 GARDEN RD 98-1225434X

CENTRAL, HONG KONGBANYAN CAPITALHOLDING CO

STE 1109, 11/F 3 GARDEN RD 98-1225595X

CENTRAL, HONG KONG

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 8865 AFFILIATION SCHEDULE STATEMENT 23 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}

CKTOTAL IF


NAME ADDRESS NUMBER OR (LOSS) P'SH}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} }}}}}}}}}} }}}}KSF I MASTER LP 1 MAPLE PLACE 98-1090028 X

LONDON, UNITED KINGDOM W1TALCHEMY PLAN (MAPLE)LP

TRAFALGAR CT, LES BANQUES 98-0458959X

ST PETER PORT, GUERNSEY GYKEYHAVEN GROWTH PTRSII

1 MAPLE PLACE 98-1204603X

LONDON, UNITED KINGDOM W1T

CLAUDE WORTHINGTON BENEDUM FOUNDATION 25-1086799}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}

STATEMENT(S) 22,2315481110 798870 05A10B 2016.04030 CLAUDE WORTHINGTON BENEDUM 05A10B_1

52

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~FORM 8865 AFFILIATION SCHEDULE STATEMENT 24 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}

CKTOTAL IF


NAME ADDRESS NUMBER OR (LOSS) P'SH}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} }}}}}}}}}} }}}}OAKTREE OPP FUND XCAYMAN


GEORGE TOWN, GRAND CAYMAN,OAKTREE OPP FUND X(DE)

333 S GRAND AVE, 28TH FL 47-3322963

LOS ANGELES, CA 90071OCM LUXEMBOURGALISIO TOPC

26A BOULEVARD ROYAL 98-1272334X

LUXEMBOURG L-2449OAKTREE OPPS XHOLDCO LTD


GEORGE TOWN, GRAND CAYMAN,OCM PROSAFE HOLDINGSLLC

333 S GRAND AVE, 28TH FL 81-1103018

LOS ANGELES, CA 90071OAKTREE OPPS X(CAYMAN) 1


GEORGE TOWN, GRAND CAYMAN,

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 8865 AFFILIATION SCHEDULE STATEMENT 25 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}

CKTOTAL IF


NAME ADDRESS NUMBER OR (LOSS) P'SH}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} }}}}}}}}}} }}}}WLR/TRF SHIPPING CLIFTON HSE, 75 FORT ST 98-1207383 X

GRAND CAYMAN, CAYMAN ISLANTRF/SOLUS JV LLC AJELTAKE RD 66-0819733 X

MAJURO, MH 93960NT SUEZ HOLDCO LLC AJELTAKE RD 98-1200087 X

MAJURO, OTHER COUNTRY MH 9SWS VLCC JV LLC 98-1257141 X

WLR/TRF SHIPPING II CLIFTON HSE, 75 FORT ST 98-1201938 XGRAND CAYMAN, CAYMAN ISLAN

SWS VLCC GP LLC 98-1256292 X

TRF/SOLUS GP LLC 66-0822000

NT SUEZ GP LLC 98-1199880 X

CLAUDE WORTHINGTON BENEDUM FOUNDATION 25-1086799}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}

STATEMENT(S) 24,2515481110 798870 05A10B 2016.04030 CLAUDE WORTHINGTON BENEDUM 05A10B_1

53

}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 8865 AFFILIATION SCHEDULE STATEMENT 26 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}

}} CKTOTAL IF


NAME ADDRESS NUMBER OR (LOSS) P'SH}}}}}}}}}}}}}}}}}}}} }}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} }}}}}}}}}} }}}}ALTOS KOREAOPPORTUNITY 2

2882 SAND HILL RD, STE 100 47-5383540

MENLO PARK, CA 94025DCM VENTURES CHINAFUND

2420 SAND HILL ROAD 98-1276648X

MENLO PARK, CA 94025LIGHTSPEED CHINAPTRS III


GRAND CAYMAN, CAYMAN ISLANAP CAYMAN PTRS III 17 F, 4-1-28 TORANOMON 98-1285996 X

TOKYO, JAPANAP CAYMAN PTRS III-I 17 F, 4-1-28 TORANOMON 00-0000000 X

TOKYO, JAPANVIG PRIVATE EQUITYIII-2

16F AIA TWR TONGIL-RO 2GIL 00-0000000X

JUNG-GU SEOUL, SOUTH KOREA


STATEMENT(S) 2615481110 798870 05A10B 2016.04030 CLAUDE WORTHINGTON BENEDUM 05A10B_1

54

(see instructions)

OMB No. 1545-0026

Form

(Rev. December 2013)Department of the TreasuryInternal Revenue Service

AttachmentSequence No.

62453104-01-16

Identifying number

| Information about Form 926 and its separate instructions is at

| Attach to your income tax return for the year of the transfer or distribution.

1

a

b

Yes No

Yes No

Controlling shareholder Identifying number

c Yes No

Name of parent corporation EIN of parent corporation

d Yes No

2

a

Name of partnership EIN of partnership

b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8

4a Identifying number

4b

Yes No

For Paperwork Reduction Act Notice, see separate instructions. 926

(see instructions)

Name of transferor

If the transferor was a corporation, complete questions 1a through 1d.

If the transfer was a section 361(a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or

fewer domestic corporations?

Did the transferor remain in existence after the transfer?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If not, list the controlling shareholder(s) and their identifying number(s):

If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation?~~~

If not, list the name and employer identification number (EIN) of the parent corporation:

Have basis adjustments under section 367(a)(5) been made? ~~~~~~~~~~~~~~~~~~~~~~~~~~~

If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete

questions 2a through 2d.

List the name and EIN of the transferor's partnership:

Did the partner pick up its pro rata share of gain on the transfer of partnership assets?

Is the partner disposing of its interest in the partnership?

Is the partner disposing of an interest in a limited partnership that is regularly traded on an established

securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)

Name of transferee (foreign corporation) , if any

Address (including country) Reference ID number

Country code of country of incorporation or organization

Foreign law characterization (see instructions)

Is the transferee foreign corporation a controlled foreign corporation? ��

LHA Form (Rev. 12-2013)


128

U.S. Transferor Information Part I

Transferee Foreign Corporation Information Part II

Return by a U.S. Transferor of Propertyto a Foreign Corporation926

CLAUDE WORTHINGTON BENEDUM FOUNDATION25-1086799

XX

X

X

AXIOM ASIA PRIVATE CAPITAL FUND III LP 98-1044657XX

X

A3F LTD

CRICKET SQ, HUTCHINS DR, PO BOX 2681GRAND CAYMAN, KY1-1111 CAYMAN ISLANDS BENEDUMAXIOMIII

CJ

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer

Description ofproperty

Fair market value ondate of transfer

Cost or otherbasis

Gain recognized ontransfer

Type ofproperty

Cash

Stock and

securities

Installment obligations,

account receivables or

similar property

Foreign currency or other

property denominated in

foreign currency

Inventory

Assets subject to

depreciation recapture

(see Temp. Regs. sec.

1.367(a)-4T(b))

Tangible property used in

trade or business not listed

under another category

Intangible

property

Property to be leased

(as described in final

and temp. Regs. sec.

1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))

Transfers of oil and gas

working interests (as

described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)

Information Regarding Transfer of Property Part III



12/31/2016 134,491.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Enter the transferor's interest in the foreign transferee corporation before and after the transfer:

Before % After %

Type of nonrecognition transaction (see instructions) |

Indicate whether any transfer reported in Part III is subject to any of the following:

Gain recognition under section 904(f)(3)

Gain recognition under section 904(f)(5)(F)

Recapture under section 1503(d)

Exchange gain under section 987

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did this transfer result from a change in the classification of the transferee to that of a foreign corporation?~~~~~

Indicate whether the transferor was required to recognize income under final and Temporary Regulations sections

1.367(a)-4 through 1.367(a)-6 for any of the following:

Tainted property

Depreciation recapture

Branch loss recapture

Any other income recognition provision contained in the above-referenced regulations

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~

Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? ~~~~

Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section

1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If the answer to line 15a is "Yes," enter the amount of foreign goodwill or going concern value

transferred | $

Was cash the only property transferred?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction? ~~~

If "Yes," describe the nature of the rights to the intangible property that was transferred as a result of the

transaction:

Form (Rev. 12-2013)

Additional Information Regarding Transfer of Property Part IV


.1690 .1690

SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

AXIOM ASIA IV LP 98-1276355XX

X

A4J LTD

WILLOW HOUSE, CRICKET SQUARE, PO BOX 709GRAND CAYMAN, KY1-1107 CAYMAN ISLANDS BENEDUMAXIOMIVA

CJ

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




12/31/2016 184,655.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



.0000 .2140

SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

DAVIDSON KEMPNER INSTITUTIONAL PARTNERS LP 13-3597020XX

X

DKIP (CAYMA) LTD II

190 ELGIN AVENUE, GEORGE TOWNGRAND CAYMAN, KY1-9005 CAYMAN ISLANDS DAVIDSONDKIP

CJ

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




12/01/2016 195,106.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



.0830 .0830

SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

LONE STAR FUND IX (US) LP 46-4793904XX

X

LSF9 BERMUDA MORTGAGE HOLDINGS LTD 98-1178537

WASHINGTON MALL, STE 304, 7 REID STHAMILTON, HM 11 BERMUDA

BD

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




152,709.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



.0270 .0270

SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

LONE STAR FUND IX (US) LP 46-4793904XX

X

LSF9 CONCRETEE II LTD 98-1331469

46 ESPLANADEST. HELIER, JE4 9WG JERSEY

JE

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




230,340.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



.0270 .0270

SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

METROPOLITAN REAL ESTATE PTRS SECONDARIES &CO-INVESTMENTS LP 30-0806654

XX

X

MREP SCIF-INVS NUS-SPV LP 98-1223251

94 SOLARIS AVENUEGRAND CAYMAN, KY1-1108 CAYMAN ISLANDS

CJ

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




125,749.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



2.7170 2.7170

SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

OAKTREE OPPORTUNITIES FUND IX LP 98-1023690XX

X

OAKTREE OPPS IX HOLDCO LTD 98-1104850

190 ELGIN AVENUE, GEORGE TOWNGRAND CAYMAN, KY1-9005 CAYMAN ISLANDS

CJ

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




125,564.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



.0390 .0390

SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

OAKTREE OPPORTUNITIES FUND IX LP 98-1023690XX

X

OCM EMRU TOPCO SARL 98-1346279

26A, BOULEVARD ROYALL-2449 LUXEMBOURG

LU

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




93,314.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



.0000 .0150

SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

OAKTREE OPPPORTUNITIES FUND X HOLDINGS (CAYMAN) LP 98-1221685XX

X

OAKTREE OPPS X HOLDCO LTD 98-1231536

27 HOSPITAL ROAD, GEORGE TOWNGRAND CAYMAN, KY1-9008 CAYMAN ISLANDS

CJ

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




320,701.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



.0300 .0300

SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

OAKTREE OPPPORTUNITIES FUND X HOLDINGS (CAYMAN) LP 98-1221685XX

X

OCM EMRU TOPCO SARL 98-1346279

26A, BOULEVARD ROYALL-2449 LUXEMBOURG

LU

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




94,826.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



.0000 .0160

SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

XX

X

APOLLO EUROPEAN PRINCIPAL FINANCE FUND II

87 MARY STREET, GEORGE TOWNGRAND CAYMAN, KY1-9005 CAYMAN ISLANDS APOLLODOLB

CJ

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




598,838.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

XX

X

APOLLO ENERGY OFFSHORE OPPORTUNITY FUND LTD

ONE MANHATTENVILLE RD, SUITE 201PURCHASE, NY 10577 APOLLOENERGY

EXEMPTED LIMITED COMPANYX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




734,651.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

XX

X

MS PRIVATE EQUITY ASIA III

1585 BROADWAY, 38TH FLOORNEW YORK, NY 10036 MSASIAIII



62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




122,578.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

XX

X

NORTH HAVEN PRIVATE EQUITY ASIA IV, LP (FKA MS PE IV)

PO BOX 309, UGLAND HOUSEGRAND CAYMAN, KY1-1104 CAYMAN ISLANDS NORTHHAVEN

CJ



62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




342,004.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

XX

X

OAK TREE EMERGING MARKET OPPORTUNITIES FUND LP

190 ELGIN AVENUE, GEORGE TOWNGRAND CAYMAN, KY1-9005 CAYMAN ISLANDS OAKTREEEMERGE

CJ



62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




360,000.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

XX

X

RCP FUND VII FEEDER LTD C/O RCP ADVISORS LLC

100 N. RIVERSIDE PLAZA, SUITE 2400CHICAGO, IL 60606 RCPFUNDVIIFEEDE

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




115,116.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

XX

X

VINTAGE VI OFFSHORE

87 MARY STREET, GEORGE TOWNGRAND CAYMAN, KY1-9005 CAYMAN ISLANDS VINTAGEVIOFF

CJ

CORPORATIONX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




190,000.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

XX

X

LAKEWOOD CAPITAL OFFSHORE FUND LTD

THE OBSERVATORY 7-11 SIR JOHN ROGERSON'S QUAYDUBLIN, 2 UNITED KINGDOM LAKEWOODCAPOFF

UK



62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




06/30/2016 3,000,000.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



SECTION 351

XXXX

X

XXXX

X

X

X

X


(see instructions)

OMB No. 1545-0026

Form



62453104-01-16

Identifying number



1

a

b

Yes No

Yes No


c Yes No


d Yes No

2

a


b

c

d

entire

Yes No

Yes No

Yes No

3

5

6

7

8


4b

Yes No


(see instructions)

Name of transferor





~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~











securities market?

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

��

(see instructions)








128





XX

X

X

XX

X

RCP FUND IX FEEDER, LP

100 N. RIVERSIDE PLAZA, SUITE 2400CHICAGO, IL 60606 RCPFUNDIXFEEDER

EXEMPTED LIMITED PARTNERSHIPX


62453204-01-16

2

(a) (b) (c) (d) (e)

926

Form 926 (Rev. 12-2013) Page

(see instructions)

Date oftransfer



Cost or otherbasis


Type ofproperty

Cash

Stock and

securities



similar property



foreign currency

Inventory

Assets subject to



1.367(a)-4T(b))




Intangible

property




1.367(a)-4(c))

Property to be sold

(as described in

Temp. Regs. sec.

1.367(a)-4T(d))



described in Temp.

Regs. sec. 1.367(a)-4T(e))

Other property

(see instructions):

Form (Rev. 12-2013)




11/04/2016 150,000.


62453304-01-16

3

9

(a) (b)

10

11

a

b

c

d

Yes No

Yes No

Yes No

Yes No

12

13

Yes No

a

b

c

d

Yes No

Yes No

Yes No

Yes No

14 Yes No

15 a

Yes No

b

16 Yes No

17 a

b

Yes No

926

Form 926 (Rev. 12-2013) Page

(see instructions)


Before % After %







~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




Tainted property




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~



1.367(a)-1T(d)(5)(iii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


transferred | $




transaction:

Form (Rev. 12-2013)



SECTION 351

XXXX

X

XXXX

X

X

X

X


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