EXTENSION GRANTED Return of Private Foundation 990-PF Fonn ~@13 or Section 4947(a)(1) Trust Treated as Private Foundation ... Do not enter Social Departmentof theTreasury ... Information Internal Revenue Service about Security numbers on this form as it may be made public. Form 990-PF and its separate instructions For calendar year 2013 or tax vear beainnina JANUARY 1 is at www.irs.gov/form990pf. MARCH 31 , 2013, and endina , 20 13 A Employer identification number Name of foundation CLAUDE R. LAMBE CHARITABLE FOUNDATION 48-0935563 Number and street (or PO box number 1fma1l1snot delivered to street address) P.O. OMBNo 1545-0052 Room/suite B Telephone number (see instructions) BOX 2256 (316) 828-6847 City or town. state or province, country, and ZIP or foreign postal code If exemptionapplicationis ... pending,checkhere • • • • • • • C WICHITA, D KS 67201-2256 _ Initial return Initial return of a former public charity D 1. Foreign organizat1ons.check here 2. Foreign organizations meeting the Final return ~ Amended return 85% test.checkhereand attach Address chance Name chance computation • • • • • • • • H Check type of organization I XI Section 501 (ccr9 exempt private foundation ~ E If private foundationstatuswasterrmnated ~ Section 4947(a)(1) nonexempt charitable trust Other taxable onvate foundation under sectionsO?(b)( 1)(A), checkhere .... ~ I Fair market value of all assets at J Accounting method·LJ Cash Accrual F If the foundation 1sin a 60~onlh termination under section507(b)(1)(8), checkhere • ... end of year (from Part II, col (c), /me Other (specrfy) _____________________ _ 16) ... $ 2, 8 2 9 . 0 0 (Part I, column (d) must be on cash basis) G Check all that apply: ~ n W D Analysis of Revenue and Expenses (The (a) Revenue and expenses per books total of amounts m columns (b), (c), and (d) may not necessar,ly equal the amounts m column (a) (see instructions) J 1 2 3 Contnbut1on~s, grants,etc , received(attachschedule) • Ch k ... ~ 1fthe foundation 1snot required to ec attach Sch B ••••••••• Interest on saVJngsand temporary cash investments 4 D1v1dends and interest from securities b Net rental income or (loss)-------CD 6a Net gam or (loss) from sale of assets not on line ~ b Gross sales pnce for all assets on hne 6a CD il; 7 Cap~lgrunn~1nwmeCTromPartl~l1M2). Net short-term 8 (b) Net investment income f----------1-----------+----------+---------752.00 752.00 '-----------t---------l----l1--A[i5).!fc:'.Gs-tirr'11il:;:s-ll-1 I ~ 10 •- f----------1-----------+--~~~~lf-_ I capital gain 9 Income mod1f1cat1ons • 10 a Gross sales less returns and allowances • • • • • b Less Cost of goods sold (d) Disbursements for charitable purposes ( cash basis onlv) (c) AdJusted net income l---------+--------~----ti=~~~~~t==::::::;::,==::::::,=r::n:c::,;1---- 5 a Gross rents ••••••••••••••••• a:: D . n\~f/c.JTEc:bnh-d--- ~uv,...._.__..-() U\l.~-- -r- r- n "' " :::ic:....~1::::.. "" •" 1 1 __ __~.u_4&_u_~_.u ·~-~·~i,~~·~-- ==== -===f,,====d0C UGu!j'\!J, u~ 1 1 1---------+---------1----------+----------+--------- c Gross profit or (loss) (attach schedule) u, Other income (attach schedule) 12 Total. Add Imes 1 throuoh 13 Compensation of officers, directors, trustees, etc 14 Other employee 15 Pension plans, employee benefits CD ~ 1,512.00 2,264.00 11 !>C 16a w .. .. CD -~ •••• fees (attach schedule) • c Other professional fees (attach schedule). ~ 17 Interest ••••••••••••••••• .!!! 18 c Taxes (attach schedule) (see1nstruct1ons) • • • • ~ Occupancy ·e1e 20 Travel, conferences, ·- 23 ~ 24 Other expenses (attach schedule) Total operating and administrative 0 A~l1n~13~rough23 ! 7.00 t----------1-----------+----------l---------~ •••••••••••• ~ 21 ca 22 g 7.00 Depre~atlon(attachschedule)andde~etlon. Printing 752.00 salaries and wages Legal fees (attach schedule) b Accounting ••• 11 •••• and meetings • and publications • • • • • ••••••••• 769.00 769.00 expenses. ·1--~~~-7~7_6_._0_0~~~~~~-7_._0~0~~~~~~~~~~~~~7_6_9~·-0~0- 26 Contnbutlons, gdts,grantspa~ ••••••• ~~2~,_2~9~9~,_5~9~3_._0~0~~-----~-~--------~~2~,~2~9~6~,_7~7~1~.~0~0Totatexpensesand disbursementsAdd Imes 24 and 25 2 , 300 , 3 69 . 00 7 . 00 2 , 2 97 , 27 Subtract 25 540 . 00 line 26 from hne 12 a Excessof revenueover expensesand disbursements • • b N~inve~me~~come(dneg•~.eM~~~ c Adiusted net income (1f neaat1ve, enter -0-). JSA For Paperwork Reduction Act Notice, see instructions. 3E1410 1 000 t--_2...c,_2_9_8-',_1_0_5_. _0_0---11----------+----------+--------f----------1-------7-4_5_._0_0-+----------+--------~ Fann 990-PF(2013) / -~ ~ J~ Page 2 Form 990-PF (2013) 1@jj1 Balance Sheets Attached schedulesand amounts m the Beginning of year description column should be for end-of-yeari------------t----------.....---------amounts only (See instructions) (a) Book Value 3 Savings and temporary cash investments • Accounts receivable ~ ______________________ Less allowance for doubtful accounts ~ _____________ Pledges receivable ~ ______________ ---------- i------------t----------;---------- 4 Less allowance for doubtful accounts ~ _____________ Grants receivable i------------t----------;---------- 5 6 (b) Book Value (c) Fair Market Value 2 , 2 95 , 304 . 00 Cash - non-interest-beanng • 1 2 End of year Receivables due from officers, directors, _ trustees, and other d1squahf1ed persons (attach schedule) (see 1nstruct1ons) • Other notes and loans receivable (attach schedule) 7 Cl) GI Cl) Cl) c( ~ ____ _ Less allowance for doubtful accounts ~ ____________ -;-----------+----------+---------- 8 lnventones for sale or use 9 Prepaid expenses and deferred charges • 10 a Investments - US and state governmentobligations(attach schedule). 3,580.00 2,829.00 2,829.00 2,829.00 2,829.00 b Investments - corporate stock (attach schedule) • 11 12 13 14 15 16 c Investments - corporate bonds (attach schedule). Investments- land, buildings, ~ and equipment basis ____________ -----_ Less accumulateddeprec1at1on ~ (attach schedule) - - - - - - - - - - - - - - - - - - - -t-----------+----------+---------lnvestments - mortgage loans Investments - other (attach schedule) ~ • Land, buildings,and equipment basis _ Less accumulateddeprec1at1on ~ (attach schedule) - - - - - - - - - - - - - - - - - - - -;-----------+----------+---------Other assets (describe ~ ____________________ ) i------------t-----------t---------Total assets (to be completed by all filers - see the instructions Also, see page 1, item I) • 2 298,884.00 17 18 GI 19 E 20 :c Ill 21 :i 22 Cl) 23 Cl) 779.00 Accounts payable and accrued expenses 2,822.00 Grants payable Deferred revenue Loans from officers, directors,trustees,and other disqualifiedpersons Mortgages and other notes payable (attach schedule) • Other hab1ht1es(describe ~ ATCH _ 5 _____________ ) 1-----------+-------7_._0_0--1 779.00 Total liabilities (add Imes 17 through 22) • GI g 24 Ill Unrestricted iii 25 IXl 26 Permanently restricted • c ::, u.. ... 0 Foundations that do not follow SFAS 117, check here and complete lines 27 through 31 . -3l en 27 28 ~ 29 Capital stock, trust principal, or current funds ai 30 Total net assets or fund balances (see instructions). Total liabilities and net assets/fund balances Z 31 2,298,105.00 • Temporarily restricted "Cl 2,829.00 Foundations that follow SFAS 117, check here. ~~ and complete lines 24 through 26 and lines 30 and 31. ·~·o Paid-in or capitalsurplus, or land, bldg , and equipmentfund Retained earnings, accumulatedincome,endowment,or other funds instructions) •~ • ,.... 11• • 2,298,105.00 (see 2, 2 9 8, 8 8 4 . 0 0 2,829.00 Analysis of Changes in Net Assets or Fund Balances 1 Total net assets or fund balances at beginning of year - Part II, column (a), hne 30 (must agree with end-of-year figure reported on prior year's return). 2 Enter amount from Part I, hne 27a 3 Other increases not included in hne 2 (1tem1ze)~-----------------------------------4 Add lines 1, 2, and 3 5 Decreases not included in hne 2 (1tem1ze)~----------------------------------------1--5-+--------6 Total net assets or fund balances at end of year (hne 4 minus hne 5) - Part II, column (b), hne 30 . 1 2 2,298,105.00 -2,298,105.00 i--3-+--------4 i----;---------- 6 Form JSA 3E1420 1 000 990-PF (2013) Form 990-PF (2013) •!6:R••·- Page 3 Capital Gains and Losses for Tax on Investment Income \DJ HOW (a) List and describe the kind(s) of property sold (e g, real estate, acquired P-Purchase D - Donaloon 2-story brick warehouse, or common stock, 200 shs MLC Co ) (c) Date acquired (mo , day, yr ) (d) Date sold (mo, day, yr) 1a b c d e (g) Cost or other basis plus expense of sale (f) Deprec1at1on allowed (or allowable) (e) Gross sales price {h) Gain or (loss) (e) plus (f) minus (g) a b c d e Comolete onlv for assets showing gain in column (h) and owned bv the foundation on 12/31/69 (i) F M V as of 12/31 /69 0) AdJusted basis as of 12/31 /69 (I) Gains (Col (h) gain minus col (k), but not less than -0-) or Losses (from col (h)) (k) Excess of col (1) over col (J), 1fany a b c d e If gain, also enter in Part I, line 7 } { If (loss), enter -0- 1nPart I, hne 7 i--2-i------------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, hne 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . 3 2 Capital gain net income or (net capital loss) •~ ·-·- 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 this part blank Was the foundation liable for the section 4942 tax on the distributable amount of any year 1nthe base period? If "Yes," the foundation does not qualify under section 4940(e) Do not complete this part. 1 Enter the appropriate amount in each column for each year, see the instructions before making any entries (a) Base penod years Calendar year (or tax year begonnongon) (b) AdJusted qualifying d1stnbut1ons 2 3 3,382,261.00 5,068,581.00 6,651,320.00 8,782,857.00 11,492,427.00 . . . . . . . . ............................. Enter the net value of noncharitable-use 5 Multiply line 4 by line 3 6 Enter 1% of net investment income (1 % of Part I, hne 27b). 7 Add lines 5 and 6 8 Enter qualifying d1stribut1ons from Part XII, line 4. If line 8 1s equal to or greater than line 7, check the box Part VI instructions .......... 3 0.3441 .......... 4 604,120.00 ................... 5 207,854.00 ................... 6 . . . . . . . . . . . . . . . . . . . . . .................... .... JSA 0.6614 0.2376 0.2968 0.3109 0.2137 1.7204 assets for 2013 from Part X, hne 5 ................... [KJ No 2 Total of line 1, column (d) Average d1stribut1on ratio for the 5-year base period - d1v1dethe total on line 2 by 5, or by the number of years the foundation has been in eXlstence If less than 5 years 4 Yes (d) D1stnbut1on ratm (col (b) divided by col (c)) (c) Net value of nonchantable-use assets 2,236,897.00 1,204,226.00 1,973,852.00 2,730,340.00 2,456,244.00 2012 2011 2010 2009 2008 D 7 7.00 207,861.00 .................... in 2,297,540.00 8 Part VI, line 1b, and complete that part using a 1% tax rate See the Form 990-PF(2013) 3E1430 1 000 ------- Page For~ 990-PF (2013) •::.F.n•·a 1a • Excise Tax Based on Investment Exempt operating foundations descnbed in section 4940(d)(2), check here Date of ruling or determination letter _______________ b Domestic foundations here .... LJ .... and enter "N/A" on hne 1 ••• } (attach copy of letter if necessary • see instructions) that meet the section 4940( e) requirements CRJ and enter 4 Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see instructions) in Part V, check 1 7 •00 1% of Part I, hne 27b •••••••••••••••••••••••••••••• c All other domestic foundations enter 2% of line 27b Exempt foreign organizations enter 4% of Part I, line 12, col. (b) 2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0·) 2 3 4 Add lines 1 and 2. • • • • • • • • • • • • • • • • • • • • • • • • ••••••••••••••••• Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) 3 5 Tax based on investment income. Subtract line 4 from hne 3 If zero or less, enter -O- 5 6 Cred1ts/Payments a 2013 estimated tax payments and 2012 overpayment credited to 2013. 6a b Exempt foreign organizations • tax withheld at source • • • • • • • 6b c Tax paid with application for extension of time to file (Form 8868). 6c d Backup w1thhold1ng erroneously withheld 6d • • • • • • • • • • • • 7 Total credits and payments 8 9 Enter any penalty for underpayment of estimated tax. Check here 1O 11 · Statements 8 9 .... •••••• Overpayment. If hne 7 is more than the total of lines 5 and 8, enter the amount overpaid Enter the amount of hne 10 to be Credited to 2014 estimated tax .... •:a. . . l---'1'----1------2-','-8-2_9 ___ o_o_ 1f Form 2220 1s attached Tax due. If the total of Imes 5 and 8 1s more than hne 7, enter amount owed 7.00 2,829.00 Add Imes 6a through 6d • • • • • • • • • • • • • • • • • • • • • • D 7.00 4 2,822.00 2,822.00 .... 10 .... 11 Refunded Regarding Activities 1 a During the tax year, did the foundation Yes attempt to influence any national, state, or local legislation or did 1t part1c1pate No or intervene in any political campaign? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • b Did 1t spend more than $100 during the year ( either directly or indirectly) for political purposes (see Instructions for the 1a X def1nit1on)? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • If the answer is 'Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials pubhshed or 1b x 1c x 2 x or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes • • • 3 x 4 a Did the foundation have unrelated business gross income of $1,000 or more during the year?. 4a x d1stnbuted by the foundation m connection with the acllv1t1es c Did the foundation file Form 1120-POL for this year? • • • • • • • • • • • • • • • • • • • • • • d Enter the amount (1f any) of tax on political expenditures (section 4955) imposed during the year (1) On the foundation .... $ (2) On foundation managers .... $ __________ e Enter the reimbursement (1f any) paid by the foundation during the year for political _ expenditure tax imposed on foundation managers .... $ -------------Has the foundation engaged in any activ1t1es that have not previously been reported to the IRS?. • • • • • • 2 If "Yes," attach a detailed description of the act1v11/es Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, 3 4b b If "Yes," has 1tfiled a tax return on Form 990· T for this year? • • • • • • • • • • • • • •• x 5 Was there a liqu1dat1on, termination, d1ssolut1on, or substantial contraction during the year?•• 5 If 'Yes," attach the statement reqwred by General Instruction T. Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either 6 • By language in the governing instrument, or • By state leg1slat1on that effectively 7 amends the governing instrument so that no mandatory directions that conflict with the state law remain in the governing instrument? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 6 Did the foundation have at least $5,000 in assets at any time during the year? If 'Yes," complete Part II, col (c), and Part XV 7 x x Sb x Ba Enter the states to which the foundation reports or with which 1t 1sregistered (see instructions) .... KS, VA---------------------------------------------------------------------b If the answer 1s 'Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate) of each state as required by General Instruction G? If "No," attach explanation. 9 Is the foundation claiming status as a private operating foundation • . • • . • . • . . . . . . • • . . . . . • •• within the meaning of section 4942(J)(3) or 4942(J)(5) for calendar year 2013 or the taxable year beginning in 2013 (see instructions for Part XIV)? If 'Yes," complete 9 Part XIV . ..•..•.•....••••...•••••.•.......•.••.•.........•....•... 10 Did any persons become substantial contributors addresses . .•••.•.•.•••• during the tax year? If 'Yes," attach a schedule fisting their names and 10 Form JSA 3E1440 1 000 x x 990-PF (2013) Page 5 For°i-n990-PF (2013) ·~·-·..1ll"f~· Statements 11 At time any the during (continued) Regarding Activities year, did foundation, the directly indirectly, or own a 12 Did the make foundation a d1stribut1on a donor to advised over fund controlled within entity which the foundation or ....................... person had advisory privileges? If 'Yes," attach statement (see instructions) Did the foundation 14 Website address .... _NI A _____________ ----------------------------------------------------------The books are 1ncare of .... KARA_ WORTHINGTON _____ -------__________ Telephone no .... 316-82 16 12 13 for its annual returns and exemption application? •••• E. 37TH STREET NORTH WICHITA, LJ .... At authority any time during calendar year 2013, did the foundation have an interest in or a signature or other See the instructions for the foreign country ..,. ·~-·~11"1:• Statements exceptions and Regarding filing requirements Yes Activities TD F 90-22 1 Form If 'Yes," enter the name for Which Form 4720 May Be Required Yes 1 a During the year did the foundation ( either directly or 1nd1rectly) (1) Engage in the sale or exchange, or leasing of property with a d1squahf1edperson? money from, lend money to, or otherwise extend credit • • • • to (or accept to, or pay or reimburse the expenses of, a d1squahf1edperson? a ~ Yes § D Yes CKJ No D Yes CKJ No Yes the benefit or use of a d1squahfied person)?. • • • • foundation agreed to make • • • • • • • • • • • • • • • • • • • • • • • • • • • to a government a grant to or to termination of government service, 1f terminating official? employ (Exception. official the within 90 days). for a period after under the exceptions described section 53 4941 (d)-3 or in a current notice regarding disaster assistance (see instructions)? engage in a prior year in any of the acts No described 1a, other in in Regulations .... d Orgamzat1ons relying on a current notice regarding disaster assistance check here • • • • • c Did the foundation No Check "No" 1f the • • • • • • • • • • • • • • • • b If any answer 1s 'Yes" to 1a(1)-(6), did any of the acts fail to qualify No Yes (5) Transfer any income or assets to a d1squahf1ed person (or make any of either available for (6) Agree to pay money or property than excepted acts, on failure to distribute income (section 4942) (does not apply for years the foundation was 1b x 1c x that were not corrected before the first day of the tax year beginning in 2013? •••••• Taxes No 00 No 0Yes 11 from) disqualified person? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • (3) Furnish goods, services, or fac1ht1esto (or accept them from) a d1squahfied person? •••• (4) Pay compensation x of File Form 4720 if any item is checked in the "Yes" column, unless an exception applies. (2) Borrow No 16 for _ _ 1........,1"'5'----'-I--~--~-- and enter the amount of tax-exempt interest received or accrued during the year • • • • • • • • • • • • • • • • • • over a bank, securities, or other financial account in a foreign country?. 2 x x 8-67 68 ______ KS--------------ZIP+4 .... _ 67220_________ Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF 1n heu of Form 1041 - Check here ...................... .... 4111 Located at 15 requirements x 11 a d1squalif1ed 13 comply with the public inspection the . . . . . . . . ........ meaning of section 512(b)(13)? If 'Yes," attach schedule (see instructions) ••••••••••• a private operating foundation defined in section 4942(J)(3) or 4942(1)(5)) a At the end of tax year 2013, did the foundation have any undistributed 6e, PartXlll)fortaxyear(s)begmmngbefore2013?, lf"Yes,"hsttheyears b Are there (relating ..,. __________ any years listed to incorrect , _________ in 2a for which valuation of income (Imes 6d and D Yes CKJ No prov1s1ons of section 4942(a)(2) ••••••••••••••••••••••••• assets) the to , ________ foundation the year's ·-------- 1s not applying undistributed the income? (If applying section 4942(a)(2) to all years listed, answer "No" and attach statement - see instructions ) • • • • • • • • • • • • • • • • • • • • • • • • • • • • • i---=2=b-+---II--c If the prov1s1ons of section 4942(a)(2) are being applied to any of the years listed in 2a, hst the years here , , , ....___________________ ________________ 3a Did the foundation hold more than a 2% direct or indirect interest in any business enterpnse D at any time during the year? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • b If 'Yes," did 11 have excess d1squalif1ed persons Comm1ss1oner under the 10-, 15-, or after business May 26, section 20-year holdings 1969, 4943(c)(7)) first phase (2) to in 2013 the lapse of the dispose holding as a result of holdings penod? of (1) 5-year period acquired (Use Schedule any (or longer by gift C, purchase period or bequest, Form 4 720, Yes by the approved or (3) the to 0 No foundation determine lapse of tf foundation had excess business holdings m 2013 ) . . • . . • • • • . 4a Did the foundation b Did the foundation charitable invest during the year any amount in a manner that would Jeopardize its charitable purposes? • • • • • make any investment in a prior year (but after December 31, 1969) that or by the the • • ,__3_b ____ • • _ 4a X 4b X could Jeopardize its ouroose that had not been removed from 1eooardv before the first dav of the tax vear beainmna in 2013? Form 990-PF(2013) JSA 3E1450 2 000 Form 990-PF (2013) Page Statements Re arding Activities 6 continued for Which Form 4720 Ma Be Required Sa During the year did the foundation pay or incur any amount to (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? (2) Influence the outcome of any specific public election (see section 4955), directly or indirectly, any voter reg1strat1ondnve? • • • • • • • • • • • • • • • • • • • (3) Provide a grant to an ind1v1dual for travel, study, or other s1m1larpurposes?. (4) Provide a grant to an organization other than a charitable, than religious, charitable, [Kl 0Yes [I]No 0Yes [I]No 0Yes 0No No in • • • ••••• or educational D • • • • • • • • • • • • • • • • [Kl No described in Yes If any answer 1s "Yes" to 5a(1)-(5), did any of the transactions fall to qualify under the exceptions Regulations section 53 4945 or in a current notice regarding disaster assistance (see 1nstruct1ons)? Organizations c described sc1ent1fic, literary, purposes, or for the prevention of cruelty to children or animals?. b • • • • • • etc , organization section 509(a)(1 ), (2), or (3), or section 4940(d)(2)? (see instructions) (5) Provide for any purpose other 0Yes or to carry on, Sb relying on a current notice regarding disaster assistance check here • • • • • • • • If the answer 1s "Yes" to question 5a(4), does the foundation because 1t maintained expenditure respons1b1htyfor the grant? claim exemption from the tax • • • • • • • • • • • • • • • • • D Yes D No D Yes [Kl No If "Yes," attach the statement required by Regulations section 53 4945-S(d) &a Did the foundation, during the year. receive any funds, directly on a personal benefit contract?. or indirectly, to pay premiums • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • b Did the foundation, during the year, pay premiums, directly or 1nd1rectly,on a personal benefit contract? If "Yes" to 6b, file Form 8870 D 7 a At any time during the tax year, was the foundation a party to a proh1b1tedtax shelter transaction? • • b If "Yes," did the foundation receive an ••••• roceeds or have an net income attributable to the transaction? x 6b Yes [Kl No • • • • • 7b Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors 1 List all officers, directors, trustees, foundation managers and their compensation (b) Title, and average hours per week devoted to oos1t1on (a) Name and address (see instructions). (c) Compensation (If not paid, enter-0-l ------------------------------------- 0.00 ATCH 6 (d) Contributions to employee benefit plans and deferred compensation (e) Expense account, other allowances 0.00 0.00 ------------------------------------------------------------------------------------------------------------2 Compensation "NONE." of five highest-paid employees (a) Name and address of each employee paid more than $50,000 (other than those (b) Title, and average hours per week devoted to pos1t1on included on line 1 - see instructions). (c) Compensation (d) Contributions to employee benefit plans and deferred compensation If none, enter (e) Expense account, other allowances NONE Total number of other emolovees paid over $50,000 •..•............................ ~ Form JSA 3E1460 1 000 990-PF (2013) Form 990-PF (2013) Page •@110•Information 7 About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors (continued) 3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE." (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation NONE Total number of others rece1vino over $50,000 for professional services ...................... •itilf!IA Summary ~ of Direct Charitable Activities List the foundation's four largest direct charitable act1v1t1esdunng the tax year Include relevant stat1st1cal information such as the number of organizations and other benefic1anes served, conferences convened, research papers produced, etc 1 Expenses NONE---------------------------------------------------------------------- 2 3 4 ;I Summary of Program-Related Investments (see instructions) Describe the two largest program-related 1 Amount investments made by the foundation dunng the tax year on Imes 1 and 2 NONE --------------------------------------------------------------------------- 2 All other program-related investments See 1nstruct1ons 3 NONE --------------------------------------------------------------------------- Total. Add lines 1 through 3 ..•.....................•..................... ~ Form JSA 3E1465 1 000 990-PF (2013) Page Form 990-PF (2013) 1QMQ Minimum Investment see 1nstruct1ons.) 1 Fair market value of assets not used (or held for use) directly purposes: a Average monthly fair market value of securities b Average of monthly cash balances. . . . . . . . c Fair market value of all other assets (see instructions). m carrying out charitable, etc., 1a 1b 1c 1d d Total (add Imes 1a, b, and c) ......•.............•.•. e Reduction claimed for blockage or other factors reported on Imes 1a and '--1_e_._ _________ 1c (attach detailed explanation) .........•.•........ Acqu1s1t1onindebtedness applicable to line 1 assets Subtract line 2 from line 1d Cash deemed held for charitable act1v1t1es. Enter 1 1/2 % of line 3 (for greater amount, see 2 3 4 130,252.00 483,068.00 613,320.00 __J ............. 2 3 613,320.00 4 5 6 Distributable Amount (see instructions) (Section 4942(.J)(3) and (j)(5) private operating foundations and certain foreign organizations check here ~ and do not complete this part) 6 instructions). . . . . . • . . . . . . . . . . . . . • • . . . . . . . . . • . . . . . . . . . • . . Net value of noncharitable-use assets. Subtract line 4 from line 3 Enter here and on Part V, hne 4 Minimum investment return. Enter 5% of hne 5 1 Minimum investment return from Part X, line 6 ........... 5 8 Return (All domestic foundations must complete this part. Foreign foundations, . 2a 7.00 . 2b b Income tax for 2013 (This does not include the tax from Part VI ) .. c Add Imes 2a and 2b Distributable amount before adjustments Subtract line 2c from line 1. 3 Recoveries of amounts treated as qualifying d1stnbut1ons 4 Add Imes 3 and 4 5 . . . . Deduction from distributable amount (see instructions). . • . . 6 Distributable amount as adjusted. Subtract lme 6 from line 5. Enter here and on Part XIII, 7 line 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . ..........•......... 9 200.00 604,120.00 7,428.00 7,428.00 1 2 a Tax on investment income for 2013 from Part VI, hne 5 ..... •Afflf3ii Qualifying 1 a b 2 3 a b 4 5 7.00 7,421.00 4 5 6 7,421.00 7 7,421.00 Distributions (see instructions) Amounts paid (including adm1nistrat1ve expenses) to accomplish charitable, etc. purposes Expenses, contributions, gifts, etc - total from Part I, column (d), hne 26 .. Program-related investments - total from Part IX-B Amounts paid to acquire assets used (or held for use) directly m carrying out charitable, etc . ..... . . . . . .... .............. . . . . . . . . . . ... . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... 1a 1b 2 purposes •...... Amounts set aside for spec1f1ccharitable projects that satisfy the 3a Su1tab11itytest (prior IRS approval required). . . . . . . . . . . . . 3b Cash d1stribut1on test (attach the required schedule) ....... 4 Qualifying distributions. Add Imes 1a through 3b Enter here and on Part V, hne 8, and Part XIII, hne4 •• Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income 5 Enter 1% of Part I, line 27b (see instructions) ........ 6 Adjusted qualifying distributions. Subtract line 5 from line 4 ........ Note. The amount on line 6 will be used in Part V, column (b), m subsequent years when calculating qualifies for the section 4940(e) reduction of tax m those years 2,297,540.00 ............... ............... .. 6 2c 3 ........ ...... 2,297,540.00 7.00 2,297,533.00 whether the foundation Form JSA 3E1470 1 000 --- -------- -----~ 990-PF (2013) .. p age Form 990-PF (2013) Undistributed for 2013 1 Distributable 2 Und1stnbutedincome, 1f any, as of the end of 2013 line 7 amount from Part XI, (a) Corpus ..................... (b) Years prior to 2012 (c) 2012 (d) 2013 7,421.00 .......... a Enter amount for 2012 only b Total for pnor years 9 Income (see instructions) 20___ll_ ,20---1...Q_ ,2Q_Q2._ Excess d1stribut1ons carryover, 1f any, to 2013 3 1,896,993.00 2,293,087.00 1,645,368.00 953,000.00 2,074,790.00 a From 2008 b From 2009 c From2010 d From 2011 e From 2012 f Total of Imes 3a through e Qualifying 4 line 4 ........... 8,863,238.00 d1stribut1ons for 2013 from Part XII, .....$ 2,297,540.00 a Applied to 2012, but not more than line 2a • • • b Applied to undistributed income of prior years (Election required - see instructions) ••••••• c Treated as distributions out of corpus (Election required - see instructions) ••••••••• d Applied to 2013 distributable e amount ..... 7,421.00 .. 5 Remaining amount distributed out of corpus Excess d1stribut1ons carryover applied to 2013 • (If an amount appears ,n column (d), the same amount must be shown ,n column (a)) 6 Enter the net total indicated below: of each column 2,290,119.00 as a Corpus Add lines 3f, 4c, and 4e Subtract line 5 11,153,357.00 Subtract income b Prior years' undistributed line 4b from line 2b c Enter the amount of prior years' undistributed income for which a notice of def1c1ency has been issued, or on which the section 4942(a) tax has been previously assessed • ............... ....... Taxable line 6b line 6c from d Subtract amount - see instructions e Undistributed income for 2012 Subtract line Taxable amount see 4a from line 2a instructions .. . . . . . . . . . . ........ .......... f Undistributed income for 2013 Subtract Imes 4d and 5 from line 1 This amount must be distributed in 2014 .............. 7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1 )(F) or 4942(9)(3) (see instructions) 8 Excess d1stribut1ons carryover from 2008 not applied on line 5 or line 7 (see instructions) • • • 9 Excess .. distributions carryover Subtract Imes 7 and 8 from line 6a Analysis of line 9 a Excess from 2009 to 1,896,993.00 2014. ... . . . . 9,256,364.00 10 b Excess from 2010 c Excess from 2011 d Excess from 2012 e Excess from 2013 2,293,087.00 1,645,368.00 953,000.00 2,074,790.00 2,274,360.00 Form 990-PF(2013) JSA 3E14801000 ·~=·l·· Page Form 990-PF (2013) 10 Private Operating Foundations ( see instructions and Part VII-A, question 9' 1 a If the foundation foundation, has received a ruling or determination letter that 1t 1s a private b Check box to indicate whether the foundation (a) 2013 Justed net income from Part I or the minimum investment return from Part X for each year listed ..,.. 1s a private operating foundation described m section Tax year 2a Enter the lesser of the ad- I operating and the ruling 1s effective for 2013, enter the date of the ruling •••••••••••••• I I 4942(J)(3) or I I Prior 3 years (b)2012 (c) 2011 4942())(5) (e) Total (d)2010 b 85% of line 2a C Qualifying d1stnbut,ons from Part XII, Ima 4 for each year listed d Amounts included m line 2c not used directly for active conduct of exempt act1v1t1es• e Qualifying d1stnbut1ons made directly for active conduct of exempt act1V1t1es Subtract line 2d from line 2c 3 Complete 3a, b, or c for the alternative test rahed upon a •Assets" (1) (2) alternative test - enter Value of all assets Value of assets qualifying under section 4942())(3)(8)(1). b "Endowment" test- alternative enter 213 of minimum invest- ment return shown en Part X. line 6 for each year listed • C "Support" altemat,ve test - enter (1) Total support other than gross investment income (interest. d1V1dends, rents, on secunt1es payments loans (section 512(a)(5)), or royalties). (2) Support from general public and 5 or more exempt organ1zat1ons as provided m section 4942 (J)(3)(B)(m) (3) Largest amount from port an organ1zat1on. of supexempt (4) Gross investment income. 1::r.,•• :..... 1 Supple'!'entary_ Information (Coi:nplete ~his part only if the foundation at any time during the year - see instructions.) had $5,000 or more in assets Information Regarding Foundation Managers: a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation before the close of any tax year (but only 1fthey have contributed more than $5,000) (See section 507(d)(2)) N/A b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or other entity) of which the foundation has a 10% or greater interest N/A 2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs: Check here..,.. [fil 1f the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. If the foundation makes gifts, grants, etc (see instructions) to ind1v1duals or organizations under other cond1t1ons,complete items 2a, b, c, and d a The name, address. and telephone number or e-mail address of the person to whom apphcat1onsshould be addressed b The form in which applications should be submitted and information and materials they should include: c Any subm1ss1on deadlines d Any restrictions factors: JSA 3E1490 1 000 or hm1tat1ons on awards, such as by geographical areas, charitable fields, kinds of institutions, or other Fonm 990-PF (2013) Form 990-PF (2013) Page 1:fffiJfJSupplementary 3 11 Information (continued) Grants and Contributions Paid Durina the Year or Ancroved for Future Pavment Rec1p1ent Name and address (home or business) a Paid during the year If rec1p1ent1san ind1vtdual, show any relat1onsh1pto any foundation manager or substantial contnbutor Foundation status of rec1p1ent Purpose of grant or contribution Amount ATCH 7 Total ~ Ja ~ Jb 2,296,771.00 b Approved for future payment ATCH 8 Total 2,822.00 Form 990-PF (2013) JSA 3E1491 1 000 .. Page 12 Form 990-PF (2013) Analysis of Income-Producing Activities [!Bl Enter gross amounts unless otherwise 1nd1cated 1 Program service revenue Unrelated business income Excluded by section 512, 513, or 514 (a) (b) (c) (d) Business code Amount Exclusion code Amount (e) Related or exempt function income eemptionNumber (GEN) . If this is for the whole group, check this box •••••• .,.. If it is for part of the group, check this box ••••••• .,.. and attach a list with the names and EINs of all members the extension is for. 4 I request an additional 3-month extension of time until o2 I 1 7 , 20 ..l!._ 5 For calendar year ___ • or other tax year beginning 01/01 , 20 13 , and endi.']l., 03/31 , 20..!2_ 6 If the tax year entered in line 5 is for less than 12 months, ct,eck reason: Initial return ii] Final return Change in accounting period 7 State in detail why you need the extension ADDITIONAL TIME IS REQUIRED TO ACCUMULATETHE D D . D D D INFORMATION NECESSARY TO FILE A COMPLETE AND ACCURATE RETURN. If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits. See instructions. 8a $ b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit and any . amount paid previously with Form 8868. 8b $ c Balance Due. Subtract line 8b from line Ba. Include your payment with this form, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions. 8c $ 8a 0 ,: i 2,829. 0 . Signature and Verification must be completed for Part II only. Under penalties of perjury, I declant that I haw examined this form, lndudlng accompanying schedules and statements, and to the best of my knowledge and belief, it Is true, correct, and complete, and that I am authorized to prepare this form. Form 8868 (Rev. 1-2013) JSA 2F8055 2.000 ~ ~RQQ?l<''l" T