3376 1,1/15/2015 3:37 PM

(*

90-r

--

CHAR500

2014

Send with fee and attachmenta-to:
NYS Office of the Attorney General
Charities Bureau Registration Section
120 Broadway
New York, NY 10271 .

NYS Annual Filing for Charitable Organizations

w~w.CharitiesNYS.com

Open to Public
Inspection

1. General information
For Fiscal Year Beginning (mm/dd/yyyy)
Che'ck if Applicable:

El Address Change

and Ending (mm/dd/yyyy)

Name of Organization:

Employer Identification Number (EIN):

MERCER FAMILY FOUNDATION

20-1982204

El Name Change

Mailing Address:

NY Registration Number:

El Initial Filing

119 WEST 72ND STREET #248

21-22-13

El Final Filing

City / State / Zip:

Telephone:

~ Amended Filing
El Reg ID Pending

NY 10069

NEW YORK
Website:

-

Check your organization's

U 7A only ~ EPTL only

registration category:

631-331-0515

Email:

~ DUAL (7A & EPTL)

Find your registration category in the
Charities Registry at www.CharitiesNYS.com

~ EXEMPT

2. Certification
See instructions for certification requirements. Improper certification is a violation of law that may be subject to penalties.
We certify under penalties of perjury that we reviewed this report, including all attachments, and to the best of our knowledge and belief,
they are true, correct and complete in accordance with the laws of the State of New York applicable to this report.

Rebehah fflifebr<D

President or Authorized Officer:

1) lidia 19

nfe-er

Signature

Title

Signature

Title

Date

Chief Financial Officer or Treasurer:
Date

3. Annual Reporting Exemption
Check the exemption(s) that apply to your filing. If your organization is claiming an exemption under the category (7A and EPTL only filers) or both
categories (DUAL filers) that apply to your registration, complete only parts 1, 2, and 3, and submit the certified Char500. No fee, schedules, or
additional attachments are required. If you cannot claim an exemption or are a DUAL filer that claims only one exemption, you must file applicable

schedules and attachments and pay applicable fees.
El 38.7A filing exemption: Total contributions from NY State including residents, foundations, government agencies, etc. did not exceed $25,000
ansi the organization did not engage a professional fund raiser (PFR) or fund raising counsel (FRC) to solicit contributions during the fiscal year.
Or the organization qualifies for another 7A exemption (see instructions).
~ 3b. EPTL filing exemption: Gross receipts did not exceed $25,000 and the market value of assets did not exceed $25,000 at any time during

the fiscal year.

4. Schedules and Attachments
See the following page

for a checklist of
schedules and
attachments to
complete your filing.

El Yes

® No

4a. Did your organization use a professional fund raiser, fund raising counsel or commercial
co-venturer for fund raising activity in NY State? If yes, complete Schedule 4a.

U Yes

® No

4b. Did the organization receive government grants? If yes, complete Schedule 4b.

5. Fee
See the checklist on the

7A filing fee:

next page to calculate your
fee(s). Indicate fee(s) you
are submitting here:

~

Total fee:

EPTL filing fee:

Make a single check or money order

25

~

750

CHAR500 Annual Filing for Charitable Organizations (Updated November 2014)

1022

~

775

~

payable to:
'Denartment of Law"
Page 1 of 4

 3376 11/14/2016 8:46 PM

Form

Return of Private Foundation

990-PF

OMB No. 1545-0052

or Section 4947(a)(1) Trust Treated as Private Foundation

2015

I Do not enter social security numbers on this form as it may be made public.
I information about Form 990-PF and its separate instructions is at www. irs.gov/form990pf.
For calendar year 2015 or tax year beginning
, and ending
Department of the Treasury
Internal Revenue Service

A

Name of foundation

B

Room/suite

City or town, slate or province, country, and ZIP or foreign postal code

NY 10069
_

C

-

-

_ Initial return
Final return
Address change

D

initial retur~t?FBo#2'litplgBjit~v/

Amended 1*y~5

_ Name change-

g U- U

Analysis of Revenue and Expenses (The total of

Operating and Administrative Expenses

Revenue

amounts in columns (b), (c), and (d) may not necessarily equal
the amounts in column (a) (see instructions).)

1
2
3
4
Sa
b
6a

b

Contributions, gifts, grants, etc., received (attach schedule)
Check I ® if the foundation is not required to attach Sch. B
Interest on savings and temporary cash investments
Dividends and interest from securities
Gross rents
Net rental income or (loss)
Netgainor (loss) fromsaleof assets not on line 10

STMT 1

Gross sales price for all assets on line 6a

13,348,449

Gross sales less returns and allowances .

b
c
11
12
13
14
15
16a

Less: Cost of goods sold
Gross profit or (loss) (attach schedule)
Other income (attach schedule)
Total. Add lines 1 through 11
Compensation of officers, directors, trustees, etc.
Other employee salaries and wages
Pension plans, employee benefits
Legal fees (attach schedule)

b Accounting fees (attach schedule)

,0

85% test, check here and attach computation
E

F

If private foundation status was terminated under
section 507(b)(1)(A), check here

If the foundation is in a 60-month termination

under section 507(b)(1)(B), check here

. I~

,

El

to

expenses per
books

69,840
135,517

(b) Net investment

(c) Adjusted net

ncome

income

69,840
135,517

for charitable
purposes
(cash basis only)

69,840
135,517

13,348,449
0

0

STMT 2

13,553,806

205,357

205,357

0

0

0

0

0
*

9,000

Other professional fees (attach schedule)

17

Interest

18

Taxes (attach schedule) (see instructions)

19

Depreciation (attach schedule) and depletion

20

Occupancy

21
22

Travel, conferences, and meetings
Printing and publications

STMT 3

23

Other expenses (att. sch.)

24

Total operating and administrative expenses.

Add lines 13 through 23
25

Contributions, gifts, grants paid

26
27

Total expenses and disbursements. Add lines 24 and 25.
Subtract line 26 from line 12:

a

1. Foreign organizations, check here

~

1 Oa

c

,

(d) Disbursements

(a) Revenue and

Capital gain net income (from Part IV, line 2)
Net short-term capital gain
Income modifications

7
8
9

El

If exemption application is pending, check here

2. Foreign organizations meeting the

H Check type of organization: ® Section 501(c)(3) exempt private foundation
n Section 4947(a)(1) nonexempt charitable trust n Other taxable private foundation
J Accounting method: ~ Cash ID Accrual
1 Fair market value of all assets at
~ Other (specify)
end of year (from Part 11, col. (c),
22,72 9,081 (Part 1, column (d) must be on cash basis.)
line 16) * $
Part !

Telephone number (see instructions)

631-331-0515

119 WEST 72ND STREET #248
G Check all that apply:

Employer identification number

20-1982204

MERCER FAMILY FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)

NEW YORK

' Open to-pubik inspeqtion

Excess of revenue over expenses and disbursements

b Net investment income (if negative, enter -0-)
c Adjusted net income (if negative, enter -0-)
For Paperwork Reduction Act Notice, see instructions.
DAA

5,000

14,000
24,544,570
24,558,570

0
24,544,570
24,544,570

-11,004,764

205,357
205,357

Form 990-PF (2015)

 3374 11/14/2016 8:46 PM

20-1982204

Form 990-PF (2015) MERCER FAMILY FOUNDATION

Part It .
1'
2
3
4

5
6

Balance Sheets

Attached schedules and amounts in the description column

Beginning of year
-

should be for end-of-year amounts only. (See instructions.)

(a) Book Value

Cash-non-interest-bearing
. _
Savings and temporary cash investments
Accounts receivable I
Less: allowance for doubtful accounts I
Pledges receivable I
Less: allowance for doubtful accounts I
Grants receivable
Receivables due from officers, directors, trustees, and other

Page 2
End of year
(b) Book Value

(c) Fair Market Value

5,568,789

12,302

12,302

28,165,056

22,716,779

22,716,779

33,733,845

22,729,081

22,729,081

0

0

33,733,845
33,733,845

22,729,081
22,729,081

33,733,845

22,729,081

Assets

disqualified persons (attach schedule) (see
instructions)
7

Other notes and loans receivable (att. schedule) # ....

8
9

Less: allowance for doubtful accounts I
Inventories for sale or use
Prepaid expenses and deferred charges

10a
b

c
11

0

Investments - U.S. and state government obligations (attach schedule)

SEE STMT 4

Investments - corporate stock (attach schedule)

Investments - corporate bonds (attach schedule)
Investments -land, buildings, and equipment: basis I
Less: accumulated depreciation (attach sch.) ~

12

Investments - mortgage loans . .

13

Investments - other (attach schedule)

14

Land, buildings, and equipment: basis ~

Liabilities

Less: accumulated depreciation (attach sch.) 4

)

15
16

Other assets (describe h
Total assets (to be completed by all filers - see the

17
18
19
20
21
22
23

instructions. Also, see page 1, item I)
Accounts payable and accrued expenses
Grants payable
Deferred revenue
Loans from officers, directors, trustees, and other disqualified persons .
Mortgages and other notes payable (attach schedule)
Other liabilities (describe 4
Total liabilities (add lines 17 through 22)
Foundations that follow SFAS 117, check here

Net Assets or Fund Balances

and complete lines 24 through 26 and lines 30 and 31.
24
25
26

Unrestricted
Temporarily restricted
Permanently restricted
Foundations that do not follow SFAS 117, check here

)

,[3

;

and complete lines 27 through 31.
27
28
29
30
31

Capital stock, trust principal, or current funds
Paid-in or capital surplus, or land, bldg., and equipment fund
Retained earnings, accumulated income, endowment, or other funds
Total net assets or fund balances (see instructions)
Total liabilities and net assets/fund balances (see

instructions)

Part m

.

......

.....

..........

®

Analysis of Changes in Net Assets or Fund Balances

1 Total net assets or fund balances at beginning of year - Part 11, column (a), line 30 (must agree with

end-of-year figure reported on prior year's return)
2
3
4
5
6

Enter amount from Part 1, line 27a
Other increases not included in line 2 (itemize) I
Add lines 1,2, and 3
Decreases not included in line 2 (itemize) I.. ..
Total net assets or fund balances at end of year (line 4 minus line 5) - Part 11, column (b), line 30

2

33,733,845
-11,004,764

3
4
5

22,729,081

22,729,081

Form 990-PF (2015)

DAA

 3376 11/14/2016 8:46 PM

20-1982204

Form 990-PF (2015) MERCER FAMILY FOUNDATION
Part IV - Capital Gains and Losses for Tax on Investment Income

(b) How acquired

(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.)

la
b

P - Purchase
D - Donation

Page 3
(c) Date acquired

(d) Date sold

(mo., day, yr.)

(mo., day, yr.)

N/A

C

d

e
(e) Gross sales price

(f) Depreciation allowed

(g) Cost or other basis

(or allowable)

plus expense of sale

(h) Gain or (loss)
(e) plus (f) minus (g)

a
b
C

d

e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i) F.M.V. as of 12/31/69

(j) Adjusted basis

(k) Excess of col. (i)

as of 12/31/69

over col. (j), if any

(1) Gains (Col. (h) gain minus
col. (k), but not less than -O-) or
Losses (from col. (h))

a
b
C

d

e
2 Capital gain net income or (net capital loss)

F If gain, also enter in Part 1, line 7 ~
L If (ioss), enter -0- in Part 1, line 7

4

3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part 1, line 8, column (c) (see instructions). If (loss), enter -0-in

2

~

Part 1, line 8.

Part V .

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 this part blank.

~ Yes ® No

Was the foundation liable for the section 4942 tax on the distributable amount of any year in the 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 co umn for each year, see the instructions before making any entries.
(a)

Base period years
Calendar year (or tax year beginning in)

(b)

(C)

Adjusted qualifying distributions

Net value of noncharitable-use assets

2014
2013
2012
2011
2010

(d)
Distribution ratio

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

18,298,080
13,487,091
11,669,718
7,095,233
4,032,933

2 Total of line 1, column (d)
..
3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by the

2

number of years the foundation has been in existence if less than 5 years .

3

4 Enter the net value of noncharitable-use assets for 2015 from Part X, line 5

4

5 Multiply line 4 by line 3

5

6 Enter 1% of net investment income (1% of Part l, line 271»

6

2,054

7 Add lines 5 and 6

7

2,054

8
8 Enter qualifying distributions from Part XII, line 4
If line 8is equal to or greater than line 7, check the box in Part VI, line lb, and complete that part using a 1% tax rate. See the
Part VI instructions.

0

24,544,570

Form 990-PF (2015)
DAA

 3374 11/14/2016 8:46 PM

Form 990-PF (2015) MERCER FAMILY FOUNDATION
Part VI
la

20-1982204

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

bate of ruling or determination letter:

(attach copy of letter if necessary-see instructions)
I

b

Domestic foundations that meet the section 4940(e) requirements in Part V, check
here h ® and enter 1 % of Part 1, line 27b

c

All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of
Part 1, line 12, col. (b).
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only, Others enter -0-)
Add lines 1 and 2

2
3
4
5

Page 4

- Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see instructions)

1

2,054

2
3

0
2,054

4
5

0
2,054

7

9,756

-

Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
Tax based on investment income. Subtract line 4 from line 3, If zero or less, enter -0-

Credits/Payments:

6

a

2015 estimated tax payments and 2014 overpayment credited to 2015

Ga

4,756

b

Exempt foreign organizations - tax withheld at source
Tax paid with application for extension of time to file (Form 8868)

Gb
6c

5,000

c
d
7
8

6d
Backup withholding erroneously withheld
Total credits and payments. Add lines 6a through 6d
Enter any penalty for underpayment of estimated tax. Check here ~ if Form 2220 is attached

8

*

9

~
Refunded 4

10
11

Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed

9
10
11

Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid
7,702
Enter the amount of line 10 to be: Credited to 2016 estimated tax I

Part Vll.A
la
b

7,702

Statements Regarding Activities
Yes

During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it

participate or intervene in any political campaign?

N/A

la

Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see
Instructions for the definition)?
If the answer is "Yes" to l a or 1 b, attach a detailed description of the activities and copies of any materials

N/A

11)

N/A

k

No

published or distributed by the foundation in connection with the activities.
c
d

e

Did the foundation file Form 11 20-POL for this year?
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(2) On foundation managers. I $
(1) On the foundation. ~ $
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. I

$

Has the foundation engaged in any activities that have not previously been reported to the IRS?
If "Yes," attach a detailed description of the activities.
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of
incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes

2
3

4a
b

Did the foundation have unrelated business gross income of $1,000 or more during the year?
If "Yes," has it filed a tax return on Form 990-T for this year?

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

5

N/A

2

X

3
4a

X
X

4b

X

5

If 'Yes," attach the statement required by General Instruction T.
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
. By language in the governing instrument, or
. By state legislation that effectively amends the governing instrument so that no mandatory directions that

6

conflict with the state law remain in the governing instrument?
7

Ba

Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part 11, col. (c), and Part XV
Enter the states to which the foundation reports or with which it is registered (see instructions) I

6
7

X
X

Bb

X

NONE
b
9

10

If the answer is "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
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or
49420)(5) for calendar year 2015 or the taxable year beginning in 2015 (see instructions for Part XIV)? If "Yes,"
complete Part XIV
Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their

names and addresses .

9

X

10

X

Form 990-PF (2015)

DAA

 3374 11/14/2016 8:46 PM

Form 990-PF (2015) MERCER FAMILY FOUNDATION

Pmrt viI.A
11

20-1982204

Page 5

' Statements Regarding Activities (continued)

At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the

Yes

rheaning of section 512(b)(13)? If "Yes," attach schedule (see instructions)
12

11

No

X

Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified

person had advisory privileges? If "Yes," attach statement (see instructions)
13

Did the foundation comply with the public inspection requirements for its annual returns and exemption application?

14

Website address * NOT APPLICABLE
The books are in care of ~ REBEKAH MERCER

12
13

X
X

Telephoneno. i -631.--331-6515

119 WEST 72ND STREET
Located at # NEW YORK

15

ZiP+4 i

NY

Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 - Check here

~ ~

I   15 

and enter the amount of tax-exempt interest received or accrued during the year .
16

10023

...

  Yes

At any time during calendar year 2015, did the foundation have an interest in or a signature or other authority

over a bank, securities, or other financial account in a foreign country?

No

X

161

See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes," enter the name of

the foreign country I

Part VII.B
la

Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
During the year did the foundation (either directly or indirectly): '
(1) Engage in the sale or exchange, or leasing of property with a disqualified person?
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a

Yes
El Yes

® No

Yes
Yes
yes

~ No
X No

ID Yes

~ No

~ Yes
.
termination of government service, if terminating within 90 days.)
If any answer is "Yes" to la(1)-(6),did any of the acts fail to qualify under the exceptions described in Regulations

~ No

disqualified person?
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
(5) Transfer any income or assets to a disqualified person (or make any of either available for

the benefit or use of a disqualified person)?

No

X No

(6) Agree to pay money or property to a government official? (Exception. Check "No" if the

foundation agreed to make a grant to or to employ the official for a period after
b

section 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)?
c

N/A
;

1b

N/A

lc

El

Organizations relying on a current notice regarding disaster assistance check here
Did the foundation engage in a prior year in any of the acts described in 1 a, other than excepted acts, that

were not corrected before the first day of the tax year beginning in 2015?
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private

2

operating foundation defined in section 4942(j)(3) or 4942(j)(5))
a

At the end of tax year 2015, did the foundation have any undistributed income (lines 6d and
6e, Part XIII) for tax year(s) beginning before 2015?

If "Yes," list the years I
b

c

20

, 20

, 20

El Yes

® No

, 20

Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year's undistributed income? (If applying section 4942(a)(2) to
all years listed, answer "No" and attach statement - see instructions.)
If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.

N/A

2b

I 20
3a

, 20
, 20
, 20
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise

at any time during the year?
b

4a
b

El Yes

foundation had excess business holdings in 2015.)
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?

N/A

3b
4a

X

Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its

charitable purpose that had not been removed from ieopardy before the first day of the tax year beginning in 2015?

DAA

® No

If "Yes," did it have excess business holdings in 2015 as a result of (1) any purchase by the foundation or
disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the
Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest, or (3) the lapse of
the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if the

X
4b
Form 990-PF (2015)

 3374 11/14/2016 8:46 PM

20-1982204
Form 990-PF (2015) MERCER FAMILY FOUNDATION
Part Vil.8
Statements Regarding Activities for Which Form 4720 May Be Required (continued)
5a

During the year did the foundation pay or incur any amount to:

Yes

® No

EB Yes

~ No

El Yes

® No

El Yes

® No

directly or indirectly, any voter registration drive?
(3) Provide a grant to an individual for travel, study, or other similar purposes?
(4) Provide a grant to an organization other than a charitable, etc., organization described in
section 4945(d)(4)(A)? (see instructions)
(5) Provide for any purpose other than religious, charitable, scientific, literary, or educational

purposes, or for the prevention of cruelty to children or animals?

c

If any answer is "Yes" to Sa(1)-(5), did any of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)?
Organizations relying on a current notice regarding disaster assistance check here
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the tax

because it maintained expenditure responsibility for the grant?
6a

b

® No

El Yes

(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); or to carry on,

b

Page 6

:

.

N/A

sb

.6. El

N/A ~ Yes

~ No

El Yes

~ No

If "Yes," attach the statement required by Regulations section 53.4945-5(d).
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums

on a personal benefit contract?
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?

X

6b

If "Yes" to 6b, file Form 8870.

7a
b

E Yes

At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
If "Yes," did the foundation receive any proceeds or have any net income attributable to the transaction?

Part Vltl

® No

f»

N/A

7b

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors

1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
(b) Title, and average

hours per week
devoted to position

(a) Name and address

REBEKAH MERCER

NEW YORK

240 RIVERSIDE BLVD

NY

2

10069

(d) Contributions to

(c) Compensation
(If not paid,

employee benefit
plans and deferred
compensation

enter ·0-)

(e) Expense account,

other allowances

DIRECTOR

25.00

0

0

0

Compensation of five highest-paid employees (other than those included on line 1 - see instructions). If none, enter
"NONE."
(d) Contributions to

(b) Title, and average
(a) Name and address of each employee paid more than $50,000

hours per week

devoted to position

(c) Compensation

employee benefit
plans and deferred
compensation

(e) Expense account,

other allowances

NONE

Total number of other employees paid over $50,000

~ 1

0

Form 990-PF (2015)

DAA

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20-1982204
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors (continued)

Form 990-PF (2015) MERCER FAMILY FOUNDATION

'Part VIll
3

Page 7

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

(c) Compensation

(b) Type of service

NONE

Total number of others receiving over $50,000 for professional services

Pad IX-A

Summary of Direct Charitable Activities

List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of

organizations and other beneficiaries served, conferences convened, research papers produced, etc.

1

#

Expenses

N/A

2

3

4
Part IX.B

Summary of Program-Related Investments (see instructions)

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.

1

Amount

N/A

2

All other program-related investments. See instructions.

3

Total. Add lines 1 through 3

Form 990-PF (2015)

DAA

 3376 11/14/2016 8:46 PM

20-1982204
this part. Foreign foundations,
complete
must
foundations
domestic
(All
Minimum Investment Return

Form 990-PF (2015) MERCER FAMILY FOUNDATION

Part X

see instructions.)
1

Page 8

-

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

purposes:
a
b
c
d
e

Average monthly fair market value of securities
Average of monthly cash balances
Fair market value of all other assets (see instructions)
Total (add lines la, b, and c)
Reduction claimed for blockage or other factors reported on lines la and

1 c (attach detailed explanation)
2

instructions)
5
6

0
0

'Ic
id

0

2
3

0
0

4

0

5
6

0

  le 

Acquisition indebtedness applicable to line 1 assets
Subtract line 2 from line ld
Cash deemed held for charitable activities. Enter 1 6% of line 3 (for greater amount, see

3
4

la
lb

Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
Minimum investment return. Enter 5% of line 5

Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations

Part XI

and certain foreign organizations check here )·[3 and do not complete this part.)
1
2a

b
c
3
4
5
6
7

Minimum investment return from Part X, line 6
Tax on investment income for 2015 from Part VI, line 5 ...
  2a  
 
Income tax for 2015. (This does not include the tax from Part VI.)
Add lines 2a and 2b
Distributable amount before adjustments. Subtract line 2c from line 1
Recoveries of amounts treated as qualifying distributions
Add lines 3 and 4
Deduction from distributable amount (see instructions)
Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,

1

2,054 li

2b  

line 1

2c
3
4
5
6

7

a
b
2

Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
Expenses, contributions, gifts, etc. - total from Part 1, column (d), line 26
Program-related investments - total from Part IX-8
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,

3

Amounts set aside for specific charitable projects that satisfy the:

a
b
4

Suitability test (prior IRS approval required)
Cash distribution test (attach the required schedule)
Qualifying distributions. Add lines la through 3b. Enter here and on Part V, line 8, and Part XIII, line 4

5

Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income.
s
Enter 1% 0f Part 1, 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), in subsequent years when calculating whether the foundation

purposes

6

0

Qualifying Distributions (see instructions)

Part XII
1

2,054

la
1b

24,544,570

2
=*=
3a
3b
4

24,544,570
2,054
24,542,516

qualifies for the section 4940(e) reduction of tax in those years.

Form 990-PF (2015)

DAA

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20-1982204

Form 990-PF (2015) MERCER FAMILY FOUNDATION

part Xm
1

Page 9

Ondistributed Income (see instructions

Distributable amount for 2015 from Part XI,

(a)

(b)

(c)

(d)

Corpus

Years prior to 2014

2014

2015

line 7
Undistributed income, if any, as of the end of 2015:
a Enter amount for 2014 only
, 20
, 20
b Total for prior years: 20
Excess distributions carryover, if any, to 2015:
3
4,039,000
a From 2010
7,105,215
2011
b From
11,677,197
2012
From
c
13,492,358
d From 2013
18,300,979
2014
From
e
f Total of lines 3a through e
Qualifying distributions for 2015 from Part XII,
4

0

2

line 4: ~ $

54,614,749

24,544,570

a Applied to 2014, 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 2015 distributable amount

5

e Remaining amount distributed out of corpus .
Excess distributions carryover applied to 2015.
(If an amount appears in column (d), the same

24,544,570

amount must be shown in column (a).)
Enter the net total of each column as

6

indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
b Prior years' undistributed income. Subtract

79,159,319

line 4b from line 2b
c Enter the amount of prior years' undistributed

income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
d Subtract line 6c from line 6b. Taxable

amount - see instructions
e Undistributed income for 2014. Subtract line
4a from line 2a. Taxable amount - see

instructions
f

Undistributed income for 2015. Subtract lines
4d and 5 from line 1. This amount must be

distributed in 2016
7

0

Amounts treated as distributions out of corpus

to satisfy requirements imposed by section
170(b)(1)(F) or 4942(g)(3) (Election may be

required-see instructions)
8

Excess distributions carryover from 2010 not

4,039,000

applied on line 5 or line 7 (see instructions)
9
10
a
b
c
d
e

Excess distributions carryover to 2016.
Subtract lines 7 and 8 from line 6a
Analysis of line 9:
Excess from 2011
Excess from 2012
Excess from 2013
Excess from 2014
Excess from 2015 .

75,120,319
7,105,215
11,677,197
13,492,358
18,300 ,979
24,544,570

Form 990-PF (2015)
DAA

 3374 11/14/2016 8:46 PM

20-1982201___-______£29110

Form 990-PF (2015) MERCER FAMILY FOUNDATION

Part XIV
la

b
2a

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

If the foundation has received a ruling or determination letter that it is a private operating

foundation, and the ruling is effective for 2015, enter the date of the ruling
~
dheck box to indicate whether the foundation is a private operating foundationdescribedin section El 4942(j)(3) or
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for

b

each year listed
85% of line 2a

c

Qualifying distributions from Part XII,

d

Amounts included in line 26 not used directly

e

for active conduct of exempt activities
Qualifying distributions made directly
for active conduct of exempt activities.

Tax year
(a) 2015

(b) 2014

Prior 3 years
(c) 2013

[3 4942(j)(5)

(d) 2012

(e) Total

line 4 for each year listed

Subtract line 2d from line 2c
Complete 3a, b, or c for the

3

alternative test relied upon:
a

"Assets" alternative test - enter:
(1) Value of all assets
(2) Value of assets qualifying under

b

"Endowment" alternative test - enter 2/3

section 4942(j)(3)(B)(i)

of minimum investment return shown in
Part X, line 6 for each year listed

c

"Support" alternative test - enter:
(1) Total support other than gross

investment income (interest,
dividends, rents, payments on
securities loans (section
512(a)(5)), or royalties)
(2) Support from general public

and 5 or more exempt
organizations as provided in
section 49420)(3)(B)(lii)
(3) Largest amount of support from

an exempt organization
(4) Gross investment income

Part XV

Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets at

any time during the year - see instructions.)
1
a

Information Regarding Foundation Managers:
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 if they 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 I ~ if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under

other conditions, complete items 2a, b, c, and d.
a

The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:

N/A
b

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

N/A
c

Any submission deadlines:

N/A
d

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

factors:

N/A
OAA

Form 990-PF (2015)

 337411/14/2016 8:46 PM

Form 990-PF (2015) MERCER FAMILY FOUNDATION

Part XV

20-1982204

Page 11

5upplementary Information (continued)

3 Grants and Contributions Paid During the Year or Approved for Future Payment_

Recipient

Name and address (home or business)
a

If recipient is an individual,

show any relationship to
any foundation manager
or substantial contributor

Foundation

status of
recipient

Purpose of grant or

contribution

Amount

Paid during the year

SEE STATEMENT 5
24,544,570

b

Total
...
Approved for future payment

4 3a

24,544,570

N/A

Total.
DAA

~ 3b

Form 990-PF (2015)

 337411/14/2016 8:46 PM

20-1982204

Form 990-PF (2015) MERCER FAMILY FOUNDATION
Analysis of Income-Producing Activities
Part XVI-A
Enter gross amounts unless otherwise indicated.

Excluded by section 512, 513, or 514

Unrelated business income
(a)

(b)

Business code

Amount

Page 12

(C)

(d)

Exclusion

Amount

code

1 Program service revenue:

(e)
Related or exempt

function income
(See instructions.)

a
b
C

d

e
f
g Fees and contracts from government agencies
Membership dues and assessments
Interest on savings and temporary cash investments
Dividends and interest from securities
Net rental income or (loss) from real estate:
a Debt-financed property .
b Not debt-financed property
Net rental income or (loss) from personal property
Other investment income
Gain or (loss) from sales of assets other than inventory
Net income or (loss) from special events
Gross profit or (loss) from sales of inventory
Other revenue: a

2
3
4
5

6

7
8
9
10
11

69,840
135,517

13,348,449

b
C

d

e
12 Subtotal. Add columns (b), (d), and (e)
13 Total. Add line 12, columns (b), (d), and (e)

0

0E

13

13,553,806
13,553,806

(See worksheet in line 13 instructions to verify calculations.)

Part XVI=B
Line No.
7

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 the foundation's exempt purposes (other than by providing funds for such purposes). (See instructions.)

N/A

Form 990-PF (2015)
DAA

 337411/14/2016 8:46 PM

Form 990-PF (2015) MERCER FAMILY FOUNDATION
20-1982204
Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Part Xv'H
Exempt Organizations
1

Page 13

Yes

Did 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

No

organizations?

XX

a Transfers from the reporting foundation to a noncharitable exempt organization of:
(1) Cash
(2) Other assets
b Other transactions:

la(1)

la(2)

XXXXXXX

lb(1)
1 b(2)
lb(3)
1 b(4)
1 b(5)
1 b(6)

(1) Sales of assets to a noncharitable exempt organization
(2) Purchases of assets from a noncharitable exempt organization
(3) Rental of facilities, equipment, or other assets
(4) Reimbursement arrangements
(5) Loans or loan guarantees
(6) Performance of services or membership or fundraising solicitations
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees
d If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market
value of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market

lc

value in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
(a) Line no.

(b) Amount involved

Id) Description of transfers, transactions, and sharing arrangements

(c) Name of noncharitable exempt organization

N/A

2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations

El Yes ® No

described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?
b If "Yes," complete the following schedule.
(a) Name of organization

(c) Description of relationship

(b) Type of organization

N/A

Under penalties of perjury, I dedare 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 taxpayer) is based on all information of which preparer has any knowledge.

May the IRS discuss this return

with the preparer shown below
(see instructions)? El Yes 0 No

Sign
Here

DIRECTOR

~

COPY
,

Date

Signature of omcer or trustee

rep r

Print/Type preparers name

~

Title
Date

ignatur

Check ~~ it

-

Paid

Preparer
Use Only

JACQUELYN JAMES VARGA
Firm's name 4

Firm's address ~

J

GOLUB, LACAPRA, WILSON & DETIBERIIS,
2 ROOSEVELT AVE
11776-3337
PRT JEFF STA, NY

LLP

self-employed

11/14/16

QUELYN JAMES VARGA
PTIN

P00289558

Firm's EIN )

11-3501980

Phone no.

631-331-0515
Form 990-PF (2015)

DAA

 11/14/2016 8:46 PM

3376 Mercer Family Foundation
20-1982204
FYE: 12/31/2015

Federal Statements

Statement 1 - Form 990-PF, Part 1, Line 6a - Sale of Assets

Description
Sale
Price

Date
Sold

Cost

Expense

MEDALLION INVESTMENTS

[)ate

Whom
Sold

How
Received

Acquired

Net
Gain / Loss

Depreciation

1/01/15

PURCHASE

12/31/15 $

13,348,449 $

$

$

$

13,348,449

$

13,348,449 $

0$

0$

0$

13,348,449

TOTAL

Statement 2 - Form 990-PF. Part L Line 16b - Accounting Fees

Description

Charitable
Purpose

Adjusted
Net

Net
Investment

Total
INDIRECT ACCOUNTING FEES
TOTAL

$

9,000 $

$

9,000

$

$

$

0$

0$

0

Statement 3 - Form 990-PF, Part 1, Line 18 - Taxes

Description
Net
Investment

Total
FEDERAL EXCISE TAX
TOTAL

Charitable
Purpose

Adjusted
Net

$

5,000 $

$

$

$

5,000

$

0$

0$

0

Statement 4 - Form 990-PF, Part 11, Line 10b - Corporate Stock Investments

Description
End of
Year

Beginning
of Year

Fair Market
Value

Basis of
Valuation

MEDALLION INVESTMENTS
$
$

TOTAL

28,165,056 $
28,165,056 $

22,716,779 MARKET

$

22,716,779

22,716,779

$

22,716,779

Statement 5 - Form 990-PF. Part XV, Line 3a - Grants and Contributions Paid During the

Year

Name
Relationship

Address
Purpose

Status

THE HEARTLAND INSTITUE
NON PROFIT

19 SO.
DONATION

LASALLE STE #903

Address
Amount
CHICAGO IL 60603

100,000

1-5

 3376 Mercer Family Foundation
20-1982204.
FYE: 12/31/2015

11/14/2016 8:46 PM

Federal Statements

Statement 5 - Form 990-PF. Part XV, Line 3a - Grants and Contributions Paid During the
Year (continued)

Name
Relationship

Status

Address
Purpose

CPW @ 79TH STREET
MUSEUM OF NATURAL HISTORY
DONATION
NON PROFIT
MEDIA RESERACH CENTER
1900 CAMPUS COMMONS DRIVE
DONATION
NON PROFIT
THE GEORGE W. BUSH FOUND.
PO BOX 600610
DONATION
NON PROFIT
230 ADMINISTRATION
THE STONY BROOK FOUNDATION
DONATION
NON PROFIT
500 E. CORONADO ROAD
THE BARRY GOLDWATER INSTITUTE
NON PROFIT
DONATION
475 RIVERSIDE DRIVE
THE WORLD SCIENCE FESTIVAL
NON PROFIT
DONATION
MANHATTAN INST. FOR POLICY RESEARCH 52 VANDERBILT AVENUE
NON PROFIT
DONATION
1006 PENNSYLVANIA AVE SE
CITIZENS UNITED FOUNDATION
NON PROFIT
DONATION
900 BROADWAY
FOUNDATION FOR CULTURAL REVIEWING
DONATION
NON PROFIT
ENCOUNTER FOR CULTURE AND EDUCATION 900 BROADWAY
NON PROFIT
DONATION
1006 CAMERON STREET
CHERISH FREEDOM FOUNDATION
NON PROFIT
DONATION
1200 NEW HAMPSHIRE AVE NW
THE BECKET FUND
NON PROFIT
DONATION
5737 MESMER AVENUE
REASON FOUNDATION
DONATION
NON PROFIT
214 MASS AVE NW
HERITAGE FOUNDATION
NON PROFIT
DONATION
575 GREENWICH STREET
MOVING PICTURES INSTITUTE
DONATION
NON PROFIT
3780 VERMONT 100A
THE CALVIN COOLIDGE FOUNDATION
DONATION
NON PROFIT
100 STATE STREET
EMPIRE CENTER FOR PUBLIC POLICY
NON PROFIT
DONATION
667 EAST BIG BEAVER ROAD
LAW ENFORCEMENT EDUCATION FUND
NON PROFIT
DONATION
PO BOX 1279
OISM
DONATION
NON PROFIT
GOVERNMENT ACCOUNTABILITY INSTITUTE TALLAHASSE
NON PROFIT
DONATION
1015 18TH STREET NW
THE FEDERALIST SOCIETY
DONATION
NON PROFIT
PO BOX 3387
NATIONAL YOUTH SCIENCE FUND
DONATION
NON PROFIT
80 PINE STREET
FAMILIES FOR EXCELLENT SCHOOLS
NON PROFIT
DONATION
245 5TH AVENUE
CLASSROOM INC.
DONATION
NON PROFIT
2831 GARBER STREET
BERKELY EARTH
DONATION
NON PROFIT
AUSTIN
TEXAS FREEDOM NETWORK
DONATION
NON PROFIT

Address
Amount
NEW YORK NY 10024

575,000
RESTON VA 20191

3,000,000
DALLAS TX 75360

5,000,000
STONY BROOK NY 11794

2,099,970
PHOENIX AZ 85004

300,000
NEW YORK NY 10115
100,000
NEW YORK NY 10017

300,000
WASHINGTON DC 20003

250,000
NEW YORK NY 10003

100,000
NEW YORK NY 10003

25,000
ALEXANDRA VA 22314

250,000
WASHINGTON DC 20036

250,000
LOS ANGELES CA 90230

50,000
WASHINGTON DC 20002

500,000
NEW YORK NY 10013

500,000
PLYMOUTH VT 05056

273,000
ALBANY NY 12201

100,000

TROY MI 48083
231,600
CAVE JUNCTION OR 97523

200,000
TALLAHASSEE FL 32301

1,735,000
WASHINGTON DC 20036

2,300,000
CHARLESTON WV 25333
100,000
NEW YORK NY 10005

250,000
NEW YORK NY 10037

40,000
BERKELEY CA 94705

250,000
AUSTIN TX 73301

5,000

5

 3376 Mercer Family Foundation
20-1982204,
FYE: 1.2/31/2015

Federal Statements

11/14/2016 8:46 PM

:

Statement 5 - Form 990-PF, Part XV, Line 3a - Grants and Contributions Paid During the
Year (continued)

Name
Relationship

Address
Purpose

Status

THE PHILANTHROPY ROUNDTABLE
NON PROFIT
YOUNG AMERICA'S FOUNDATION
NON PROFIT
CATO INSTITUTE
NON PROFIT

KING'S COLLEGE
NON PROFIT
SUCESS ACADEMY CHARTER SCHOOLS
NON PROFIT
GATESTONE INSTITUTE
NON PROFIT
RECLAIM NEW YORK
NON PROFIT
AMERICAN PRINCIPLES PROJECT
NON PROFIT
WILDLIFE CONSERVATION SOCIETY
NON PROFIT
WILLIAM F. BUCKLEY JR. PROGRAM
NON PROFIT
COLD SPRING HARBOR LAB
NON PROFIT
AMERICAN TRANSPARENCY
NON PROFIT

1730 M STREET NW
WASHINGTON DC 20036
DONATION
260,000
11480 COMMERCE PARK DRIVE RESTON VA 20191-1556
DONATION
1,100,000
100 MASSACHUSETTS AVE NW
WASHINGTON DC 20001
DONATION
300,000

56 BROADWAY
DONATION

95 PINE STREET

DONATION
750 3RD AVENUE
DONATION
1211 AVE OF THE AMERICAS
DONATION
1130 CONNECTICUT AVE, NW
DONATION
2300 SOUTHERN BLVD.
DONATION
234 CHURCH STREET
DONATION
ONE BUNGTOWN ROAD
DONATION
200 S. FRONTAGE ROAD
DONATION
1331 H STREET
ACU FOUNDTION
NON PROFIT
DONATION
1200 NEW HAMPSHIRE AVE NW
SUSAN B. ANTHONY EDUCATION FUND
NON PROFIT
DONATION
1090 VERMONT AVE NW
CENTER FOR UNION FACTS
NON PROFIT
DONATION
14000 INTERNATIONAL ROAD
INTER'L CTR FOR PRESV WILD ANIMALS
NON PROFIT
DONATION
112 ELDEN STREET
CLARE BOOTHE LUCE POLICY INSTITUTE
NON PROFIT
DONTION
1706 NEW HAMPSHIRE AVE NW
THE FUND FOR AMERICAN STUDIES
DONATION
NON PROFIT
AMERICA EDUCATIONAL FOUNDATION INC
2323 CLEAR LAKE CITY BLVD
NON PROFIT
DONATION
MASSACHUSETTS GENERAL CANCER CENTER 125 NASHUA STREET
DONATION
NON PROFIT
TOTAL

Address
Amount

NEW YORK NY 10004
300,000
NEW YORK NY 10005
500,000
NEW YORK NY 10017-2703
100,000
NEW YORK NY 10036

1,250,000
WASHINGTON DC 20036

250,000
BRONX NY 10460

25,000
NEW HAVEN CT 06510

10,000
COLD SPRING HARBOR NY 11

250,000
BURR RIDGE IL 60527

250,000
WASHINGTON DC 20005

120,000
WASHINGTON DC 20036

300,000
WASHINGTON DC 20005-4961

500,000
CUMBERLAND OH 43732

50,000
HERNDON VA 20170

25,000
WASHINGTON DC 20009

10,000
HOUSTON TX 77062

50,000
BOSTON MA 02114

10,000
24,544,570

5

 -~611/14/20168:46 PM

20-1982204 FORM 990-PF ESTIMATES

FOUNDATION
MERCER FAMILY
2.
Form

990-W

(Worksheet)
Department of the Treasury
Internal Revenue Service

Estimated Tax on Unrelated Business Taxable
Income for Tax-Exempt Organizations

OMB No. 1545-0976

2016

(and on Investment Income for Private Foundations)
(Keep for your records. Do not send to the Internal Revenue Service.)

1

Unrelated business taxable income expected in the tax year

1

2

Tax on the amount on line 1. See instructions for tax computation

2

3

Alternative minimum tax (see instructions)

3

4

Total. Add lines 2 and 3

4

5

Estimated tax credits (see instructions)

5

6

Subtract line 5 from line 4

6

7

Other taxes (see instructions)

7

8

Total. Add lines 6 and 7

8

9

Credit for federal tax paid on fuels (see instructions)

9

10a

Subtract line 9 from line 8. Note: If less than $500, the organization is
not required to make estimated tax payments. Private foundations, see

instructions
b

zero or the tax year was for less than 12 months, skip this line and
enter the amount from line 10a on line 10c
c

11

2,054

10c

(a)

(b)

(c)

11

05/16/16

06/15/16

09/15/16

(d)
12/15/16

12

2,054

13

2,054

2015 Overpayment (see

Payment due (Subtract line 13
from line 12)

" """""""
14

For Paperwork Reduction Act Notice, see instructions.

DAA

2,054

Required installments. Enter

instructions)

14

1Ob

Installment due dates (see

25% of line 10c in columns (a)
through (d) unless the
organization uses the annualized
income installment method, the
adjusted seasonal installment
method, or is a "large
organization" (see instructions)
13

2,054

2016 Estimated Tax. Enter the smaller of line 10a or line 10b. If the organization is required to
skip linelOb, entertheamountfrom line 10a on line 10(

instructions)
12

10a

Enter the tax shown on the 2015 return (see instructions). Caution: If

Form 990-W (2016)

 copy OF WITHIN PAPER
RECEIVED

NOV 2 1 2015

NYS OFFICE OF THE ATTORNEY GENERAL
CHARITIES BUREAU