us internal revenue service: f990pf--1991

8/14/2019 US Internal Revenue Service: f990pf--1991

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OMB No. 1545-0052Return of Private FoundationForm990-PF or Section 4947(a)(1) Charitable Trust Treated as a Private Foundation

(See separate instructions.)Department of the TreasuryInternal Revenue Service Note: You may be able to use a copy of this return to satisfy state reporting requirements.

, 19, 1991, and endingFor the calendar year 1991, or fiscal year beginning

AName of organization

Please type,print, or

attach label.

See SpecificInstructions.

BNumber, street, and room (or P.O. box number)

City or town, state, and ZIP codeC If application pending, check here

D Foreign organizations, check here

H Check type of organization: Exempt private foundationE If your private foundation status terminated

under section 507(b)(1)(A), check here 4947(a)(1) t rust (see instruction C) Other taxable private foundat ion

AccrualCashAccounting method:JI Fair market value of assets at end ofyear (from Part II, col. (c), line 16)

F If the foundation is in a 60-month termination

under section 507(b)(1)(B), check here Other (specify)(Part I column (d) must be on cash basis.) G If address changed, check here

Analysis of Revenue and Expenses (The total ofamounts in columns (b), (c), and (d) may not necessarily

equal the amounts in column (a) (see instructions).)

(d) Disbursementsfor charitable

purposes

(a) Revenue andexpenses per

books

(c) Adjusted netincome

(b) Net investmentincome

Contributions, gifts, grants, etc., received (attach schedule)1

Contributions from split-interest trusts2

Interest on savings and temporary cash investments3Dividends and interest from securities4

Gross rents5a

(Net rental income or (loss) )b

Net gain or (loss) from sale of assets not on line 106

Capital gain net income (from Part IV, line 2)7

Net short-term capital gain8Revenue

Income modifications9

Gross sales minus returns and allowances10a

Minus: Cost of goods soldb

Gross profit or (loss) (attach schedule)c

11 Other income (attach schedule)

Total (add lines 1 through 11)12

Compensation of officers, directors, trustees, etc.13

Other employee salaries and wages14

Pension plans, employee benefits15

Legal fees (attach schedule)16a

Accounting fees (attach schedule)b

Other professional fees (attach schedule)c

Interest17

Taxes (attach schedule)18

Pleaseattachcheckormoneyorderhere.

Depreciation (attach schedule) and depletion19

Occupancy20

Travel, conferences, and meetings21

Printing and publications22

Other expenses (attach schedule)23

Total operating and administrative expenses(add lines 13 through 23)

24

Contributions, gifts, grants paid25OperatingandAdministrativeExpenses

Total expenses and disbursements (add lines 24and 25)

26

Excess of revenue over expenses and disburse-ments (line 12 minus line 26)

27a

Net investment income (if negative, enter -0-)bAdjusted net income (if negative, enter -0-)c

For Paperwork Reduction Act Notice, see page 1 of the instructions. Cat. No. 11289X

Employer identification number

State registration number (see instruction F)

Part I

Form 990-PF (1991)


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Page 2Form 990-PF (1991)

End of yearBeginning of yearAttached schedules and amounts in the description columnshould be for end-of-year amounts only. (See instructions.)Balance Sheets (c) Fair Market Value(b) Book Value(a) Book Value

Cashnon-interest-bearing1

Savings and temporary cash investments2

Accounts receivable 3

minus: allowance for doubtful accounts

Pledges receivable 4


Grants receivable56 Receivables due from officers, directors, trustees, and other

disqualified persons (attach schedule) (see instructions)

Other notes and loans receivable (attach schedule) 7


8 Inventories for sale or use

9 Prepaid expenses and deferred chargesAssets

10a InvestmentsU.S. and state government obligations (attach schedule)

Investmentscorporate stock (attach schedule)b

Investmentscorporate bonds (attach schedule)c

Investmentsland, buildings, and equipment: basis 11

minus: accumulated depreciation (attach schedule)

Investmentsmortgage loans12

Investmentsother (attach schedule)13Land, buildings, and equipment: basis 14

minus: accumulated depreciation (attach schedule)

15 Other assets (describe )

Total assets (completed by all filerssee instructions)16

Accounts payable and accrued expenses17

Grants payable18

Support and revenue designated for future periods (attach schedule)19

Loans from officers, directors, trustees, and other disqualified persons20

Mortgages and other notes payable (attach schedule)21Liabilities

Other liabilities (describe 22 )

Total liabilities (add lines 17 through 22)23Organizations that use fund accounting, check here and complete lines 24 through 27 and lines 31 and 32.

Current unrestricted fund24a

Current restricted fundb

Land, buildings, and equipment fund25

Endowment fund26)Other funds (describe 27

Organizations not using fund accounting, check here and complete lines 28 through 32.

Capital stock or trust principal28

Paid-in capital or capital surplus29

Retained earnings or accumulated income30

Fun

dBalancesorNetAssets

Total fund balances or net assets (see instructions)31

Total liabilities and fund balances/net assets (see instructions)32

Analysis of Changes in Net Assets or Fund Balances

1Total net assets or fund balances at beginning of yearPart II, column (a), line 311

(must agree with end-of-year figure reported on prior years return)2Enter amount from Part I, line 27a23Other increases not included in line 2 (itemize) 34Add lines 1, 2, and 345Decreases not included in line 2 (itemize) 56Total net assets or fund balances at end of year (line 4 minus line 5)Part II, column (b), line 316

Part III

Part II


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Capital Gains and Losses for Tax on Investment Income(b) How acquired

PPurchaseDDonation

(d) Date sold(mo., day, yr.)

(c) Date acquired(mo., day, yr.)

(a) List and describe the kind(s) of property sold, e.g., real estate,2-story brick warehouse; or common stock, 200 shs. MLC Co.

1

(h) Gain or (loss)(e) plus (f) minus (g)(f) Depreciation allowed(or allowable)(e) Gross sales priceminus expense of sale (g) Cost or other basis

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69(l) Losses (from co l. (h))

Gains (excess of col. (h) gain over col. (k),but not less than -0-)

(k) Excess of col. (i)over col. (j), if any

(j) Adjusted basisas of 12/31/69(i)

F.M.V. as of 12/31/69

If gain, also enter in Part I, line 7Capital gain net income or (net capital loss)2If (loss), enter -0- in Part I, line 7 2

3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):

If gain, also enter in Part I, line 8, column (c) (see instructions) If (loss), enter -0-

in Part I, line 8 3

Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income

(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)

If section 4940(d)(2) applies, leave Part V blank.

NoYesWere you liable for the section 4942 tax on the distributable amount of any year in the base period?

If Yes, you do not qualify under section 4940(e). Do not complete this part.

Enter the appropriate amount in each column for each year; see instructions before making any entries.1

(a)Base period years

Calendar year (or fiscal year beginning in)

(d)Distribution ratio

(col. (b) divided by col. (c))

(b)Adjusted qualifying distributions

(c)Net value of noncharitable-use assets

1990

1989

1988

1987

1986

2Total of line 1, column (d)2

Average distribution ratio for the 5-year base perioddivide the total on line 2 by 5, or bythe number of years the foundation has been in existence if less than 5 years

33

4Enter the net value of noncharitable-use assets for 1991 from Part X, line 54

5Multiply line 4 by line 35

6Enter 1% of net investment income (1% of Part I, line 27b)6

7Add lines 5 and 67

8Enter qualifying distributions from Part XII, line 48

If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. Seethe Part VI instructions.

Part V

Part IV


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Page 4Form 990-PF (1991)Excise Tax on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948see instructions)

1a Exempt operating foundations described in section 4940(d)(2), check here and enter N/A on line 1.

Give date of ruling letter (attach copy of ruling letter if necessarysee instructions)1Domestic organizations that meet the section 4940(e) requirements in Part V, check

here and enter 1% of Part I, l ine 27bb

c All other domestic organizations enter 2% of line 27b. Exempt foreign organizations enter 4% of line 27b22 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)33 Add lines 1 and 24

4 Tax under subtitle A (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 55 Tax on investment income (line 3 minus line 4 (but not less than -0-))

6 Credits/Payments:6aa 1991 estimated tax payments and 1990 overpayment credited to 19916bb Exempt foreign organizationstax withheld at source6cc Tax paid with application for extension of time to file (Form 2758)6dBackup withholding erroneously withheldd

77 Total credits and payments (add lines 6a through d)88 Enter any PENALTY for underpayment of estimated tax. Check here if Form 2220 is attached99 TAX DUE. If the total of lines 5 and 8 is more than line 7, enter AMOUNT OWED

1010 OVERPAYMENT. If line 7 is more than the total of lines 5 and 8, enter the AMOUNT OVERPAID

11Refunded Enter the amount of line 10 you want: Credited to 1992 estimated tax 11Statements Regarding Activities

NoFile Form 4720 if you answer No to question 10b, 11b, or 14b or Yes to question 10c, 12b, 13a, 13b, or 14a(2), unless an exception applies.During the tax year, did you attempt to influence any national, state, or local legislation or did you participateor intervene in any political campaign?

1a1a

1bDid you spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)?b

If you answered Yes to 1a or 1b, attach a detailed descr iption of the activities and copies of any mater ialspublished or distributed by the organization in connection with the activities.

1cc Did you file Form 1120-POL, U.S. Income Tax Return for Certain Political Organizations, for this year?2Have you engaged in any activities that have not previously been reported to the Internal Revenue Service?2

If Yes, attach a detailed description of the activities.

Have you made any changes, not previously reported to the IRS, in your governing instrument, articles ofincorporation, or bylaws, or other similar instruments? If Yes, attach a conformed copy of the changes

33

4aDid you have unrelated business gross income of $1,000 or more during the year?4a4bIf Yes, have you filed a tax return on Form 990-T, Exempt Organization Business Income Tax Return, for this year?b

55

If Yes, attach the schedule required by General Instruction T.

Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:6

By language written into the governing instrument, or

By state legislation that effectively amends the governing instrument so that no mandatory directionsthat conflict with the state law remain in the governing instrument? 6

7Did you have at least $5,000 in assets at any time during the year?7If Yes, complete Part II, column (c), and Part XV.

Enter the states to which the foundation reports or with which it is registered (see instructions) 8a

If you answered Yes to line 7, have you furnished a copy of Form 990-PF to the Attorney General (or hisor her designate) of each state as required by General Instruction G? If No, attach explanation

b8b

9 Are you claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) forcalendar year 1991 or fiscal year beginning in 1991 (see instructions for Part XIV)? If Yes, complete Part XIV 9

Self-dealing (section 4941):10

During the year did you (either directly or indirectly):a10a(1)Engage in the sale or exchange, or leasing of property with a disqualified person?(1)10a(2)Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person?(2)10a(3)Furnish goods, services, or facilities to (or accept them from) a disqualified person?(3)10a(4)Pay compensation to or pay or reimburse the expenses of a disqualified person?(4)

Transfer any of your income or assets to a disqualified person (or make any of either available for thebenefit or use of a disqualified person)?

(5)10a(5)

Agree to pay money or property to a government official? (Exception: Check No if you agreed tomake a grant to or to employ the official for a period after he or she terminates government service,if he or she is terminating within 90 days.)

(6)

10a(6)

Was there a liquidation, termination, dissolution, or substantial contraction during the year?

Yes

Part VII

Part VI


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Statements Regarding Activities (continued)NoYes

If you answered Yes to any of questions 10a(1) through (6), were the acts you engaged in excepted actsas described in Regulations sections 53.4941(d)-3 and 4?

10b10b

Did you engage in a prior year in any of the acts described in 10a, other than excepted acts, that wereacts of self-dealing not corrected by the first day of your tax year beginning in 1991?

c10c

11 Taxes on failure to distribute income (section 4942) (does not apply for years you were a private operatingfoundation as defined in section 4942(j)(3) or 4942(j)(5)):

Did you at the end of tax year 1991 have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s)

beginning before 1991? If Yes, list the years

a11a

.,,,If 11a is Yes, are you applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets)to the undistributed income for ALL such years? (If Yes, attach statementsee instructions.)

b11b

If the provisions of section 4942(a)(2) are being applied to ANY of the years listed in 11a, list the years here.c,, .,

Taxes on excess business holdings (section 4943):1212aDid you hold more than a 2% direct or indirect interest in any business enterprise at any time during the year?a

If Yes, did you have excess business holdings in 1991 as a result of (1) any purchase by you or disqualifiedpersons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by theCommissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapseof the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if youhad excess business holdings in 1991.)

b

12b

Taxes on investments that jeopardize charitable purposes (section 4944):1313aa Did you invest during the year any amount in a manner that would jeopardize your charitable purposes?

b Did you make any investment in a prior year (but after December 31, 1969) that could jeopardize your charitablepurpose that you had not removed from jeopardy on the first day of your tax year beginning in 1991? 13b

Taxes on taxable expenditures (section 4945) and political expenditures (section 4955):14

During the year did you pay or incur any amount to:a14a(1)Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?(1)

Influence the outcome of any specific public election (see section 4955); or to carry on, directly orindirectly, any voter registration drive?

(2)14a(2)

14a(3)Provide a grant to an individual for travel, study, or other similar purposes?(3)

Provide a grant to an organization, other than a charitable, etc., organization described in section509(a)(1), (2), or (3), or section 4940(d)(2)?

(4)14a(4)

Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, orfor the prevention of cruelty to children or animals?

(5)14a(5)

If you answered Yes to any of questions 14a(1) through (5), were all such transactions exceptedtransactions as described in Regulations section 53.4945?

b14b

If you answered Yes to question 14a(4), do you claim exemption from the tax because you maintainedexpenditure responsibility for the grant?

c14c

If Yes, attach the statement required by Regulations section 53.49455(d).15Did any persons become substantial contributors during the tax year?15

If Yes, attach a schedule listing their names and addresses.

1616 During this tax year, did you maintain any part of your accounting/tax records on a computerized system?17aDid anyone request to see either your annual return or exemption application (or both)?17a17bb If Yes, did you comply pursuant to the instructions? (See General Instruct ion Q.)

18 The books are in care of Telephone no.

Located at

Section 4947(a)(1) charitable trusts filing Form 990-PF in lieu of Form 1041, U.S. Fiduciary Income Tax Return.Check here 1919

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and ContractorsList all officers, directors, trustees, foundation managers and their compensation (see instructions):1

(e) Compensation(If not paid, enter

-0-)

(c) Contributionsto employeebenefit plans

(b) Title, and averagehours per week

devoted to position

(d) Expense account,other allowances(a)

Name and address

and enter the amount of tax-exempt interest received or accrued during the year

Part VIII

Part VII


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Information About Officers, Directors, Trustees, etc. (continued)

Compensation of five highest paid employees (other than those included on line 1see instructions). If none, enter NONE.2(c) Contributions toemployee benefit

plans

(d) Expense account,other allowances

(b) Title and timedevoted to position (e) Compensation(a) Name and address of employees paid more than $30,000

Total number of other employees paid over $30,000

Five highest paid persons for professional services(see instructions). If none, enter NONE.3

(c) Compensation(b) Type of service(a) Name and address of persons paid more than $30,000

Total number of others receiving over $30,000 for professional services

Summary of Direct Charitable Activities

Summary of Program-Related Investments

Part VIII

Part IX-A

Part IX-B

ExpensesList the foundations four largest direct charitable activities during the tax year. Include relevant statistical information such as the numberof organizations and other beneficiaries served, conferences convened, research papers produced, etc.

AmountDescribe any program-related investments made by the foundation during the tax year.

1

2

3

4

1

2

3


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Qualifying Distributions (see instructions)

Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:1

1aExpenses, contributions, gifts, etc.total from Part I, column (d), line 26a1bb Program-related investmentstotal of lines 1-3 of Part IX-B

2Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,purposes

2

Amounts set aside for specific charitable projects that satisfy the:33aSuitability test (prior IRS approval required)a3bCash distribution test (attach the required schedule)b44

55

6

Qualifying distributions (add lines 1a through 3b). (Enter in Part V, line 8 and Part XIII, line 4.)

6

Organizations that qualify under section 4940(e) for the reduced rate of tax on net investmentincomeenter 1% of Part I, line 27b (see instructions)

Adjusted qualifying distributions (line 4 minus line 5)

Note:The amount on line 6 will be used in Part V, column (b), when calculating the section 4940(e) reduction of tax in subsequentyears.

Minimum Investment Return (All organizations must complete this part.)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,purposes:

1

1aa Average monthly fair market value of securities1bb Average of monthly cash balances1cc Fair market value of all other assets (see instructions)1dd Total (add lines 1a, b, and c)

1eReduction claimed for blockage or other factors (attach detailedexplanation) e

2Acquisition indebtedness applicable to line 1 assets23Line 1d minus line 23

4Cash deemed held for charitable activitiesEnter 112% of line 3 (for greater amount, seeinstructions)

4

5Net-value of noncharitable-use assetsLine 3 minus line 4 (Enter in Part V, line 4.)5

Minimum investment return (Enter 5% of line 5.)6 6

(Section 4942(j)(3) and (j)(5) private operating foundationscheck here and do not complete this part.)

Distributable Amount (see instructions)

1Minimum investment return from Part X, line 612a2a Tax on investment income for 1991 from Part VI, line 5

2bIncome tax under subtitle A, for 1991b2cLine 2a plus line 2bc33 Distributable amount before adjustments (line 1 minus line 2c)

4aRecoveries of amounts treated as qualifying distributions4a4bIncome distributions from section 4947(a)(2) trustsb

4cLine 4a plus line 4bc5Line 3 plus line 4c56Deduction from distributable amount (see instructions)6

7Distributable amount as adjusted (line 5 minus line 6) (Also enter in Part XIII, line 1.)7

Part X

Part XI

Part XII


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Undistributed Income (see instructions)

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

19911990Years prior to 1990Corpus

1 Distributable amount for 1991 from Part XI,line 7

Undistributed income, if any, as of the end of 1990:2

Enter amount for 1990 onlya

19,,1919Total for prior years:bExcess distributions carryover, if any, to 1991:3

a From 1986

b

c

From 1987

From 1988

d

e

From 1989

Total of lines 3a through ef

4 Qualifying distributions for 1991 from PartXII, line 4: $

Applied to 1990, but not more than line 2aa

Applied to undistributed income of prioryears (Election requiredsee instructions)

b

Treated as distributions out of corpus(Election requiredsee instructions)

c

Applied to 1991 distributable amountd

Remaining amount distributed out of corpuse5 Excess distributions carryover applied to 1991.

(If an amount appears in column (d), the sameamount must be shown in column (a).)

6 Enter the net total of each column asindicated below:Corpus. Add lines 3f, 4c, and 4e. Subtract line 5a

Prior years undistributed income (line 2bminus line 4b)

b

Enter the amount of prior years undistributedincome for which a notice of deficiency hasbeen issued, or on which the section 4942(a)tax has been previously assessed

c

Subtract line 6c from line 6b. Taxableamountsee instructions

d

Undistributed income for 1990 (line 2a minusline 4a). Taxable amountsee instructions

e

Undistributed income for 1991 (line 1 minuslines 4d and 5). This amount must bedistributed in 1992

f

7 Amounts t reated as distributions out of corpusto satisfy requirements imposed by section170(b)(1)(E) or 4942(g)(3) (see instructions)

8 Excess distributions carryover from 1986 notapplied on line 5 or line 7 (see instructions)

9 Excess distributions carryover to 1992 (line6a minus lines 7 and 8)

Analysis of line 9:10

Excess from 1991

a Excess from 1987

b Excess from 1988

c

dExcess from 1989

Excess from 1990e

From 1990

Part XIII


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Private Operating Foundations (see instructions and Part VII, question 9)

If the foundation has received a ruling or determination letter that it is a private operatingfoundation, and the ruling is effective for 1991, enter the date of the ruling

1a

4942(j)(3) or 4942(j)(5).Check box to indicate whether you are a private operating foundation described in sectionb

Enter the lesser of the adjusted netincome from Part I or the minimuminvestment return from Part X (for1991; previously Part IX)

2a Prior 3 yearsTax year

Total(e)1988(d)1989(c)1990(b)1991(a)

85% of line 2ab

Qualifying distributions from Part XII, line 4(for 1991; previously Part XIII, line 6)

c

d Amounts included in line 2c not used directlyfor active conduct of exempt activities

e

Complete 3a, b, or c for thealternative test on which you rely:

3

a Assets alternative testenter:

(1) Value of all assets

(2) Value of assets qualifyingunder section 4942(j)(3)(B)(i)

b Endowment alternative testEnter 23 of minimum investmentreturn shown in Part X, line 6, (for1991; previously Part IX, line 6)

c Support alternative testenter:

(1) Total support other than grossinvestment income (interest,dividends, rents, paymentson securities loans (section512(a)(5)), or royalties)

(2) Support from general publicand 5 or more exemptorganizations as provided insect ion 4942(j)(3)(B)(iii)

(3)

Gross investment income(4)Supplementary Information (Complete this part only if you had $5,000 or more in assets at any time during the yearsee instructions.)

Information Regarding Foundation Managers:1List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundationbefore the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)

a

List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of theownership of a partnership or other entity) of which the foundation has a 10% or greater interest.

b

Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:2

Check here if you only make contributions to preselected charitable organizations and do not accept unsolicitedrequests for funds. If you make gifts, grants, etc., (see instructions) to individuals or organizations under other conditions,

complete items 2a, b, c, and d.The name, address, and telephone number of the person to whom applications should be addressed:a

The form in which applications should be submitted and information and materials they should include:b

Any submission deadlines:c

Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or otherfactors:

d

Qualifying distributions made directlyfor active conduct of exempt activities(line 2c minus line 2d)

Largest amount of supportfrom an exempt organization

Part XIV

Part XV


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Supplementary Information (continued)Grants and Contributions Paid During the Year or Approved for Future Payment3

If recipient is an individual,show any relationship toany foundation manageror substantial contributor

Foundationstatus ofrecipient

Recipient Purpose of grant orcontribution

Amount

Name and address (home or business)

Paid during the yeara

Total 3a

Approved for future paymentb

3bTotal

Part XV


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Analysis of Income-Producing Activities

(e)Excluded by section 512, 513, or 514Unrelated business incomeEnter gross amounts unless otherwise indicated.Related or exemptfunction income

(See instructions.)(d)(c)(b)(a)

AmountExclusion codeAmountBusiness codeProgram service revenue:1

(a)

(b)

(c)

(d)(e)

(f)

Fees from government agencies(g)

Membership dues and assessments23 Interest on savings and temporary cash investments

Dividends and interest from securities4

5 Net rental income or (loss) from real estate:

debt-financed property(a)

(b) not debt-financed property

6 Net rental income or (loss) from personal property

7 Other investment income

Gain or (loss) from sales of assets other than inventory8

9 Net income from special fundraising eventsGross profit or (loss) from sales of inventory10

(a)Other revenue:11

(b)

(c)

(d)

(e)

Subtotal (add columns (b), (d), and (e))12

13 TOTAL (add line 12, columns (b), (d), and (e)) (See worksheet for line 13 instructions to verify calculations.)

Relationship of Activities to the Accomplishment of Exempt Purposes

Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the

accomplishment of your exempt purposes (other than by providing funds for such purposes). (See instructions.)

Line No.

Part XVI-A

Part XVI-B


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Information Regarding Transfers To and Transactions and Relationships With NoncharitableExempt Organizations

NoYesDid the organization directly or indirectly engage in any of the following with any other organization described in section

501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

1

Transfers from the reporting organization to a noncharitable exempt organization of:a1a(i)Cash(i)a(ii)Other assets(ii)

Other Transactions:bb(i)

Sales of assets to a noncharitable exempt organization(i) b(ii)Purchases of assets from a noncharitable exempt organization(ii)b(iii)Rental of facilities or equipment(iii)b(iv)Reimbursement arrangements(iv)b(v)Loans or loan guarantees(v)b(vi)Performance of services or membership or fundraising solicitations(vi)

cSharing of facilities, equipment, mailing lists or other assets, or paid employeesc

If the answer to any of the above is Yes, complete the following schedule. The Amount involved column below shouldalways indicate the fair market value of the goods, other assets, or services given by the reporting organization. If theorganization received less than fair market value in any transaction or sharing arrangement, indicate in column (d) the valueof the goods, other assets, or services received.

d

(d) Description of transfers, transactions, and sharing arrangements(c) Name of noncharitable exempt organization(b) Amount involved(a) Line no.

Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizationsdescribed in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?

2a

NoYesIf Yes, complete the following schedule.b

(c) Description of relationship(b) Type of organization(a) Name of organization

Public Inspection

Enter the date the notice of availability of the annual return appeared in a newspaper 1

Enter the name of the newspaper 2

Check here if you have attached a copy of the newspaper notice as required by the instructions. (If the notice is notattached, the return will be considered incomplete.)

3

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge andbelief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.

TitleDateSignature of officer or trustee

Date Preparers social security no.Preparerssignature

Check ifself-employed

Firms name (oryours if self-employed)and address

Paid

Preparers

UseOnly

E.I. No. PleaseSignHere

ZIP code

Social security no.

Part XVII

Part XVIII

us internal revenue service: f990pf--1991

Documents