Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM OMB No. 1124-0002; Expires May 31,2020 Supplemental Statement Pursuant to the Foreign Agents Registration Act of 1938, as amended U.S. Department of Justice Washington, dc 20530 For Six Month Period Ending 12/2017 (Insert date) I - REGISTRANT 1. (a) Name of Registrant (b) Registration No. Czech Center New York 5115 (c) Business Address(es) of Registrant 321 East 73rd Street, New York, NY 10021 2. Has there been a change in the information previously furnished in connection with the following? (a) If an individual; (1) Residence address(es) Yes.D No □ (2) Citizenship Yes □ No □ (3) Occupation Yes □ No □ (b) If an organization: (1) Name (2) Ownership or control (3) Branch offices Yes □ Yes □ Yes □ No 0 No 0 No 0 (c) Explain fully all changes, if any, indicated in Items (a) and (b) above. IF THE REGISTRANT IS AN INDIVIDUAL, OMIT RESPONSE TO ITEMS 3,4, AND 5(a). 3. If you have previously filed Exhibit C*l, state whether any changes therein have occurred during this 6 month reporting period. Yes □ No E If yes, have you filed an amendment to the Exhibit C? Yes □ No □ If no, please attach the required amendment. 1 The Exhibit C, for which no printed form is provided, consists of a true copy ot the charter, articles of incorporation, association, and by laws of a registrant that is an organization. (A waiver of the requirement to file ah Exhibit C may be obtained for'good cause upon written application to the Assistant Attorney General, National Security Division, U.S. Department of justice, Washington, DC 20530.) FORM NSD-2 Revised 05/17. Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM (PAGE 2) 4. (a) Have'any perebns ceased acting as partners, officers, 'directors or similar officials of the registrant during this 6 month reporting period? Yes □ No E3 If yes, furnish the following information: Name Position Date Connection Ended (b) Have any persons become partners, officers, directors or similar officials during this 6 month reporting period? Yes □ No 0 ‘ If yes, furnish the following information: Name Residence Address Citizenship Position Date Assumed 5. (a) Has any person named in Item 4(b) rendered services directly in furtherance of the interests of any foreign principal? Yes D No S If yes, identify each such person and describe the service rendered. (b) During this six month reporting period, has the registrant hired as employees or in any other capacity, any persons who rendered or will render services to the registrant directly in furtherance of the interests of any foreign principals) in other than a clerical or secretarial, or in a related or similar capacity? Yes □ No 0 Name Residence Address Citizenship Position Date Assumed (c) Have any employees or individuals, who have filed a short forin registration statement, terminated their employment or Yes □ No S connection with the registrant during this 6 month reporting period? If yes, fomish the following information: Name Position or Connection Date Terminated (d) Have any employees or individuals, who have filed a short form registration statement, terminated their connection with any foreign principal during this 6 month reporting period? Yes D No 13 If yes, fomish the following information: Name Position or Connection Foreign Principal DateTerminated 6. Have short form registration statements been filed by all of the persons named in Items, 5(a) and 5(b) of the supplemental statement? Yes □ No □ If no, list names of persons who have not filed the required statement. N/A Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM (PAGE 3) II - FOREIGN PRINCIPAL 7. Has your connection with any foreign principal ended during this 6 month reporting period? Yes □ No [El If yes, furnish the following information: Foreign Principal Date of Termination 8. Have you acquired any new foreign principal(s)2 during this 6 month reporting period? Yes □ No S If yes, furnish th following information: Name and Address of Foreign Principal(s) Date Acquired 9. In addition to those named in Items 7 and 8, if any, list foreign principal(s)2 whom you continued to represent during die 6 month reporting period. Ministry of Foreign Affairs of the Czech Republic-Czech Centers Division 10, (a) Have, you filed exhibits for the newly acquired foreign principal(s), if any, listed in Item 8? Exhibit A3 Yes □ No □ Exhibit B4 Yes □ No Q If no, please attach the required exhibit (b) Have there been any changes in the Exhibits A and B previously filed for any foreign principal whom you represented during this six month period? Yes □ No 0 If yes, have .you fi led an amendment to these exhibits? Yes □ No □ If no, please attach the required amendment. 2 The term "foreign principal" includes, in addition to those defined in Section 1(b) of the Act, an individual organization any of whose activities are directly or indirectly supervised, directed, controlled, financed, or subsidized in whole of in major port by a foreign government, foreign political party, foreign organization or foreign individual. (See Rule 100(a)(9)). A registrant who represents more than one foreign principal is required to list in the statements he files under the Act only those principals for whom he is not entitled to claim exemption under Section 3 ofthe Act (See Rule 208.) 3 The Exhibit A, which is filed on Form NSD-3, sets forth the information required to be disclosed concerning each foreign principal. 4 The Exhibit B, which is filed on Form NSD-4, sets forth the information concerning the agreement or understanding between the registrant and the foreign principal. Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM (PAGE 4) HI - ACTIVITIES 11. During this 6 month reporting period, have you engaged in any activities for or rendered any services to any foreign principal named in Items 7,8, or 9 of this statement? s Yes B No □ If yes, identify each foreign principal and describe in full detail your activities and services: Ministry of Foreign Affairs of the Czech Republic - Czech Centers Division Promoting of the Czech Republic in the United States in the areas of art, culture, education, and general information on the Czech Republic 12. During this 6 month reporting period, have you on behalf of any foreign principal engaged in political activity5 as defined below? Yes □ No IB If yes, identify each such foreign principal and describe in full detail all such political activity, indicating, among other filings, file relations, interests and policies sought to be influenced and the means employed to achieve this purpose. If file registrant arranged, sponsored or delivered speeches, lectures or radio and TV broadcasts, give details as to dates, places of delivery, names of speakers and subject matter. 13. In addition to file above described activities, if any, have you engaged in activity oh your own behalf which benefits your foreign prihcipal(s)? Yes □ No 0 Ifyes, describe fully. 5 "Political activity,” as defined in Section 1 (o) of the Act, means any activity that the person engaging in believes will, or that the person intends to, in any way influence any agency or official of the Government of the United States dr any section of the public within the United States with reference to formulating, adopting or changing the domestic or foreign policies of the United States or with reference to political or public interests, policies, or relations of a government of a foreign country or a foreign political party. Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM (PAGE 5) IV - FINANCIAL INFORMATION 14. (a) RECEIPTS-MONIES During this 6 .month reporting period, have you received from any foreign principal named in Items 7, 8, or 9 of this statement, or from any other source, for or in the interests of any such foreign principal, any contributions, income or money either as compensation or otherwise? Yes.S No □ If no, explain why. If yes, set forth below in the required detail and separately for each foreign principal an account of such monies.6 Date 8/8/2017 10/24/2017 From Whom Czech Centers Division Czech Centers Division Czech Centers Division Purpose Operations/Events Operations/Events Operations/Events Amount $70,000 $60,000 $57,000 $187,000 Total (b) RECEIPTS - FUNDRAISING CAMPAIGN During this 6 month reporting period, have you received, as part of a fundraising campaign7, any money on behalf of any foreign principal named in Items 7, 8, or 9 of this statement? Yes □ No E If yes, have you filed an Exhibit D8 to your registration? Yes □ No □ If yes, indicate the date the Exhibit D was filed. (c) Date RECEIPTS-THINGS OF VALUE During this 6 month reporting period, have, you received any thing of value9 other than money from any foreign principal named in Items ?, 8, or 9 of this statement, or from any other source, for or in the interests of any such foreign principal? Yes □ No 13 If yes, furnish the following information: Foreign Principal Date Received Thing of Value Purpose 6,7 A registrant is required to file an Exhibit D if he collects or receives contributions, loans, moneys, or other things of value for a foreign principal, as part of a fundraising campaign. (See Rule 201 (e)). 8 Ah Exhibit D, for which ho printed form is provided, sets forth an account of money collected or received as a result of a fundraising campaign and transmitted for a foreign principal. 9 Things of value include but are not limited to gifts, interest free loans, expense free travel, favored stock purchases, exclusive rights, favored treatment over competitors, "kickbacks," and the like. Receivedby NSD/FARA Registration Unit 01/29/2018 5:24:33 PM Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM (PAGE 6) 15. (a) DISBURSEMENTS-MONIES During this 6 month repotting period, have you (1) disbursed or expended monies in connection with activity on behalf of any foreign principal named in Items 7,8, or 9 of this statement? Yes 0 No □ (2) transmitted monies to Euiy such foreign principal? Yes □ No 0 If no, explain in-fall detail why there were no disbursements made on behalf of any foreign principal. If yes, set forth below in the required detail and separately for each foreign principal an account of such monies, including monies transmitted, if any, to each foreign principal. Date July-December 2.017 To Whom Vendors, Employees Purpose Events, Office, Supplies, Equipment, Fees, Postage and Delivery, Travel, Services, Printing, Telecommunications, Utilities, Payroll Amount $180,000 $180,000 Total Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM (PAGE 7) (b) DISBURSEMENTS-THINGS OF VALUE During this 6 month reporting period, have you disposed of anything of value10 other than money in furtherance of or in connection with activities on behalf of any foreign principal named in Items 7,8, or 9 of this statement? Yes □ No 0 If yes, furnish the following information: Date Recipient Foreign Principal Thing of Value Purpose (c) DISBURSEMENTS-POLITICAL CONTRIBUTIONS During this 6 month reporting period, have you from your own funds and on your own behalf either directly or through any other person, made any contributions of money or other things of value11 in connection with an election to any political office, or in connection with any primary election, convention, or caucus held to select candidates for political office? Yes □ No 0 If yes, furnish the following information: Date io, 11 Amount or Thing of Value Political Organization or Candidate Location of Event Things of value include but are not limited to gifts, interest free loans, expense free travel, favored stock purchases, exclusive rights, favored treatment over competitors, "kickbacks," and die like. Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM (PAGE 8) V-INFORMATIONAL MATERIALS 16. (a) During this 6 month reporting period, did you prepare, disseminate or cause to be disseminated any informational materials?'2 Yes IE] No □ If Yes, go to Item 17. (b) If you answered No to Item 16(a), doyou disseminate any material in connection with your registration? Yes □ No O If Yes, please forward the materials disseminated during the six month period to the Registration Unit for review. 17. Identify each such foreign principal. Ministry of Foreign Affairs - Czech Center Division 18. During this 6 month reporting period, has any foreign principal established'a budget or allocated a specified sum of money to finance your activities in preparing or disseminating informational materials? Ves □ No [El If yes, identify each such foreign principal, specify amount, and indicate for what period of time. 19. During this 6 month reporting period, did your activities in preparing, disseminating or causing the dissemination of informational materials include the use of any of the following: □ Radio or TV broadcasts O Advertising campaigns 1E1 Magazine or newspaper □ Motion picture films E Letters or telegrams E Press releases El Pamphlets or other publications E Lectures or speeches □ Other (specify) Electronic Communications E Email 0 Website URL(s): www czechcenter.com 0 Social media websites URL(s): twitter.com/czechcenter, facebook.com/czechcenter, instagram.com/czechcenter □ Other (specify) ; 20. During this 6 month reporting period, did you disseminate or cause to be disseminated informational materials among any of toe following groups: E G G Public officials Legislators Government agencies E Newspapers E Editors E Civic groups or associations G Libraries IE] Educational institutions 0 Nationality groups Q Other (specify) 21. What language was used in the informational materials: E Other (specify) 0 English ^2ec^ 22; Did you file with the Registration Unit, U S. Department of Justice a copy of each item of such' informational materials disseminated or caused to be disseminated during this 6 month reporting period? Yes G .No G 23. Did you label each item of such informational materials with toe statement required by Section 4(b) of toe Act? Yes O No E12 12 The term informational materials includes any oral, visual, graphic, written, or pictorial information or matter of any kind, including that published by means of advertising, books, periodicals, newspapers, lectures, broadcasts, motion pictures, or any means or instrumentality of interstate or foreign commerce or otherwise. Informational materials disseminated by an agent of a foreign principal as part of an activity in itself exempt from registration, or on activity which by itself would not require registration, need not be filed pursuant to Section 4(b) ofthe Act. Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM (PAGE 9) VI - EXECUTION In accordance with 28 U.S.C. § 1746, the undersigned swear(s) or affirm(s) under penalty of peijuiy that he/she has (they have) read the information set forth in this registration statement and the attached exhibits arid that he/she.is (they are) familiar with the contents thereof and that such contents are in their entirety true and accurate to the best of his/her (their) knowledge and belief, except that the undersigned make(s) no representation as to truth or accuracy of the information contained in die attached Short Form Registration Statements), if any, insofar as such information is not within his/her (their) personal knowledge. (Date of signature) January 29,2018 (Print or type name under each signature or provide electronic signature13) /s/ Barbara Karpetova_____________ _________ eSigned 13 This statement shall be signed by the individual agent, if the registrant is an individual, or by a majority of those partners,-officers, directors or persons performing similar functions, if the registrant is an organization, except that the organization can, by power of attorney, authorize one or more individuals to execute this statement oh its behalf. Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM Amendment to Registration Statement January 29,2017 Item 11 Czech Center New York is engaged in promotion of the Czech Republic in the United States of America in the areas of Art, Culture, Education and General Information on the Czech Republic List of events in 07/2017-12/2017 Antidimension Rooftop Cine-Concerts Window to Europe Dvdrak'sAmericanExperiehce A Living Space Jiri Bartovanec Light in Movement Forgotten Light Rehearsal for Truth Window to Europe. The Velvet Revolution The.BlueTour The Two Sides of the Iron Curtain Open House.New York Echoes of Jihlava Dvorak's New World Closely Watched Trains 322 European Physical Theater The Velvet Reunion Prague-NY Effects The Age of Daydreaming The Structure of Crystal The Falcon Prague-NY Effects Window to Europe Before Dvorak Czech Christmas Party Exhibition Film screenings Film screening Concert Film screening Dance Workshop Photography Exhibition Film screening Theater Film screening Photography Exhibition Concert July 7 August 8,15,22 September 5 September 7 Septembers September 12 September 14 September26 September 28,30, October 1 October 4 October 5-November 17 October 5 Panel Discussion Open House Film screenings Concert Film screening Film screening Theater workshop Panel discussion, theater, concert Theater Film screening Film screening Art Exhibition Theater Film screenings Concert Concert October 10 October 14 October 17,19,24,26 November 2 November 7 November 9 November 16 November 17 November 17 November 21 November 28 November 30-December 30 December 1 December 5 December 7 December 10 Received by NSD/FARA Registration Unit 01/29/2018 5:24:33 PM